Bill C-384 (Historical)

An Act to amend the Criminal Code (right to die with dignity)

This enactment amends the Criminal Code to allow a medical practitioner, subject to certain conditions, to aid a person who is experiencing severe physical or mental pain without any prospect of relief or is suffering from a terminal illness to die with dignity once the person has expressed his or her free and informed consent to die.

Criminal Code

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

moved that Bill C-384, An Act to amend the Criminal Code (right to die with dignity) be read the second time and referred to a committee.

Mr. Speaker, I first introduced a private member's bill on the right to die with dignity in June 2005, because I felt confident that Quebeckers and Canadians needed Parliament to amend the Criminal Code to recognize that every person, subject to certain specific conditions, had the right to an end of life that is consistent with the values of dignity and freedom they have always espoused and so that an individual's wish regarding his or her death would be respected. In fact, I introduced this bill so that people would have a choice, the same right to choose that people in other countries have.

My conviction has grown stronger, and that is why I am introducing an amended bill on the right to die with dignity, Bill C-384. Briefly, it amends the Criminal code so that a medical practitioner does not commit homicide just by helping a person to die with dignity if—I am coming to the conditions—the person is at least 18 years of age, continues to experience severe physical or mental pain without any prospect of relief or suffers from a terminal illness. The person must have provided a medical practitioner with two written requests more than 10 days apart expressly stating the person's free and informed consent to opt to die.

The medical practitioner must have requested and received written confirmation of the diagnosis from another medical practitioner. The other practitioner must be independent and have no personal interest in the death of the person. The medical practitioner must have no reasonable grounds—this is important—to believe that the person's written requests were made under duress or while the person was not lucid. The practitioner must have informed the person of the consequences of his or her requests and of the alternatives available to him or her and must act in the manner indicated by the person, it being understood that the person may, at any time, revoke the requests made under subparagraph (a)(iii) of clause 2 of the bill.

The patient is free to change his mind. The doctor must constantly remind him of that. If he does not change his mind, the doctor must submit a copy of the confirmation referred to in subparagraph (i) to the coroner.

Mr. Speaker, would you please let me know when I have two minutes left?

As we all know, the right to receive medical assistance to die exists in other countries. The Netherlands was the first to make it a right. In that country, before the law existed, doctors who helped patients die were tolerated by the legal system, as long as they complied with medical directives from the country's equivalent of a college of physicians and surgeons. Then the law was changed to reflect what people had been thinking about and doing for all that time.

In the Netherlands, euthanasia is when a doctor, acting on behalf of a patient and in accordance with the patient's strict instructions, deliberately puts an end to the patient's life. I want to emphasize that, in the Netherlands, palliative care is excellent and euthanasia is one of the care options.

Belgium also passed a law after senators from different parties worked together to hold nationwide consultations and agree on a piece of legislation in which euthanasia is defined as an action by a party intentionally ending the life of a person at that person's request. The law has been in place for six years, and there is oversight in place as well. This year, there was a report on the application of the law. For those who fear that permitting people at the end of their lives to choose how they wish to die might result in a huge number of people seeking help to die, the incidence over the past six years in Belgium has been 4 per 1,000. I repeat: 4 per 1,000 deaths.

In Quebec, the debate is ongoing. The Collège des médecins has asked its ethics committee to consider the matter of euthanasia. After three years of study, the committee should soon be making recommendations. As Dr. Yves Robert, the college's secretary, told L'Actualité médicale,

Doctors do not want to abdicate their responsibilities when it comes to euthanasia, but we must determine the scope of those responsibilities and how they are to be carried out.

At its annual meeting on April 16 and 17, 2009, the Association des soins palliatifs broached the topic with a presentation by Dr. Yvon Beauchamp, who began his introduction with the following:

I have found that over the years in Canada, palliative care has been championed as the anti-euthanasia and the universal alternative to an act punishable under the laws of God, the laws of man and the laws of the college of physicians.

He added:

There are people who believe that “increased development of palliative care means there is no longer a need for suicide, assisted suicide and euthanasia.”

I could go on. On August 11, 2009, an Angus Reid survey of 804 adults in Quebec was published with the title, Strong Support in Quebec for Legalizing Euthanasia. The subtitle read, “Most Quebecers believe that laws governing euthanasia should be provincial responsibility.” The survey showed the following figures: 77% of Quebeckers believe euthanasia should be allowed, and 75% think it is a good idea to re-open the debate on euthanasia. On August 22, the Association féminine d'éducation et d'affaires sociales, the AFEAS, well-known in all ridings of Quebec, voted in favour of euthanasia at its convention. Members of the AFEAS took the position that Quebeckers should be allowed to die with dignity.

Palliative care and assisted suicide are not mutually exclusive; they complement each other. I am saying this right off the bat, because I know that I will hear that argument. How many times have I heard, “As long as some people do not have access to palliative care, we cannot consider medical assistance in dying”? Why? That has nothing to do with the issue. Everyone needs access to quality palliative care.

It should also be known that palliative care does not relieve all pain and especially not all the suffering that comes with the end of life, aging and the difficulty of a lengthy hospital stay.

I will read from a text by Dr. Boisvert, a long-time palliative care doctor at the Royal Victoria Hospital:

Caregivers, whose own health is relative, are not equipped to experience the throes of progressive decline (a teaspoon at a time, wrote one patient); the indignity of urinary or fecal (rectal, or worse, vaginal) incontinence—we do not often hear that in Parliament; of constant breathlessness; the throbbing acute pain caused by a collapsing cancerous vertebra, causing the patient to cry out at the slightest movement; the gauntness and extreme weakness that result in total dependence, even for the simplest things such as turning over in bed just slightly or lifting half a glass of water to one's parched lips.

Dr. Boisvert continued:

That is why I do not subscribe to the idea that people should find the strength to suffer to the end or the idea that people should be so compassionate as to suffer with their loved one, when it is the loved one that is truly suffering.

I would add that I do not understand why people prefer to wash their hands of this suffering that cannot be relieved, that can only be relieved by death, because the time that passes is a kind of torture. Do we here have the right not to hear or think about it? Again, palliative care cannot end all pain and suffering.

My colleagues may have received the document from five doctors who oppose my bill. They may have the support of a hundred or so others. What do they have to say? I read this document carefully and it acknowledges that palliative care cannot relieve all pain and suffering and certainly not the suffering described by Dr. Boisvert. Then why are they against my bill?

They say, “These people have to be heard and helped as much as possible, but their request remains absolutely unacceptable to us”.

Why? To me there is a disconnect here. Their position is unacceptable, especially when they admit:

The line between palliation and euthanasia may seem tenuous to some, since the distinction between them lies in the intention of the act and not in what it involves.

They wrote that because palliative care also uses what is known as terminal sedation, which plunges patients into a coma when their suffering cannot otherwise be eased. In such a coma, they cannot eat or drink, but they are still alive and, in the end, they die of lethal complications. This can take a short while or a very long time, and this terminal sedation basically amounts to an act of euthanasia. They claim it is not the same thing. Even the Catholic church says that when any action is taken that has a double effect, such as the positive effect of easing the suffering, and the negative effect, which leads to death, one is not responsible for the negative effect, because it was the positive effect that was sought. This was one of the teachings of Saint Thomas Aquinas.

When we consider that, not as followers of any religion, but as people who are responsible for the well being of our citizens, do we have the right to refuse to look at all the possibilities?

I would like to see the broadest possible committee hear from as many citizens as possible in order to be able to provide end of life medical assistance to people who are suffering greatly, who can no longer endure the suffering and want to end their lives. We should help them die with dignity.

I await your comments and hope to have your support, not for me, but for the people we may one day become. The lottery of death offers no guarantees.

[David Anderson, Conservative, Parliamentary Secretary to the Minister of Natural Resources and for the Canadian Wheat Board]

Mr. Speaker, there were so many failures of logic, and so much misinformation and misguided information there that I hardly know where to start, and I only have a minute or so.

I would like to make the point that we need to understand that allowing people to die is a far cry from causing their death. That is one of the things that the member opposite seems to have completely misunderstood.

She made a number of comments and I would like to mention a couple of them.

She said that according to her bill, physicians are required to provide information and alternatives. The problem with that is that these physicians are basically always advocates, and we have seen in other countries that this does not work. This would not provide the necessary safeguards for patients. It would not protect patients and it would not protect Canadians.

She talked about the fact that choice exists in other countries. While that is true, many of those countries have developed death tourism, so that people go there to die. That is not in line with what we want either the heritage or the future of this country to be about.

It is ironic that she claims that an association for palliative care champions euthanasia. Is this not a complete twisting of the commitment that so many palliative care providers across this country believe in? They believe they are doing good work. They do not believe in euthanasia. Is the member not twisting this in a way that they would abhor?

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

Mr. Speaker, I read in Dr. Boisvert's writings that, in the course of the debate, whether one was for or against euthanasia, there were interventions such as these.

Nevertheless, we must ask what is good for the patients. That is the question. It is not about what we personally want. It is about determining whether or not we should, by changing the Criminal Code, allow doctors who so wish—only those who wish to do so—to medically end the life of someone who wants to die, who has made that choice, who is at the end of life and who is suffering. That is the only question. We are trying to help and that is what the College of Physicians and Surgeons, AFEAS and others are trying to do.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Mr. Speaker, this is a very difficult subject. The end of life is difficult for us all.

The essential core of this legislation is that it would engage society in the ending of a life. It would engage the doctor and it would engage us as a society.

I will give a small but imperfect analogy.

Many years ago our Canadian society decided that we would not have capital punishment. We had found over time that in capital crimes our justice system had made mistakes. We have one of the best justice systems in the world but we make mistakes. Had we had capital punishment in this society, Mr. Marshall would have been executed. Mr. Milgaard would have been executed, and a number of other people would have been executed.

It does not much matter what systems the hon. member proposes in her bill, mistakes will be made. It is inevitable. People's lives will be ended prematurely and they will be ended without full and informed consent. Inevitably, we as a society will bear that shame and that guilt.

I would request that the hon. member respond to the inevitable, the absolute certainty that errors will be made and that therefore she and I and all the rest of us will bear that guilt.

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

Mr. Speaker, I thank my colleague.

I studied the Belgian report. I could make a copy available. Because of the way it was drafted and applied, the Belgian legislation makes it clear that the persons who have asked to die and who have been helped to die were truly at the end of their lives, suffered terribly and could not have been helped by other means—

[Some hon. members]

Oh, oh!

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

I would ask my colleagues to please listen.

Could a mistake be made? Could the life of someone who did not truly wish to die be brought to an end? The person is asked the question repeatedly and there is not one doctor who would want to help someone die if they did not want to. However, if we consider—

[The Deputy Speaker, Conservative, Andrew Scheer]

Resuming debate.

The hon. Parliamentary Secretary to the Minister of Public Works now has the floor.

[Jacques Gourde, Conservative, Parliamentary Secretary to the Minister of Public Works and Government Services and to the Minister of National Revenue]

Mr. Speaker, I am pleased to rise today to speak to BillC-384 that was introduced on May 13, 2009, by the member from La Pointe-de-l'Île. Two previous bills on this subject were introduced by the same member in past sessions of Parliament. One of them was debated in 2005, but did not come to a vote.

Mr. Speaker, I would like to state at the outset that I do not support Bill C-384 which proposes the legalization of physician-assisted suicide and euthanasia under specified conditions. This bill raises a number of serious concerns and I propose to outline the ones I consider to be most important.

First, Bill C-384 is too broad in terms of its scope. Mr. Speaker, Bill C-384 proposes to amend the Criminal Code to provide an exemption not only to the offence of assisted suicide, but also to the offence of murder. These amendments would represent a substantial change to the current state of the law on a matter that touches on life and death.

The proposed legalization of medical euthanasia and assisted suicide would not only apply to terminally-ill patients, but also to persons who suffer from severe physical or mental pain without any prospect of relief. Therefore, under this bill, persons who suffer from depression could request that a doctor help them to commit suicide. They could also request that the doctor carry out the act itself that would cause their death.

[Diane Bourgeois, Bloc, Terrebonne—Blainville, QC]

That is false.

[Jacques Gourde, Conservative, Lotbinière—Chutes-de-la-Chaudière, QC]

Therefore, when I articulated earlier that Bill C-384 is too broad in its scope, this concern applies to both the fact that it would permit physician-assisted suicide and euthanasia, and to the fact that it would allow a vast array of persons to make a request to a doctor for assisted death.

The second important concern I wish to raise with respect to this bill is how it does not encompass sufficient safeguards.

The subject of safeguards, like the subject of the scope, also has two aspects in the context of this bill.

The first deals with ensuring that the eligibility requirements and the terms used are properly circumscribed. In this respect, Bill C-384 contains a number of vague and undefined terms that could lead to interpretation problems and, therefore, potentially to misunderstandings or abuses.

For example, terms such as “while appearing to be lucid”, “appropriate treatment”, “severe physical or mental pain”, “without any prospect of relief” have the potential to be interpreted very subjectively.

Also, the 10-day “cooling off” period, if you will, is too short to ensure that a person’s wish to die was settled.

The other element of ensuring appropriate safeguards deals with putting in place an effective oversight mechanism. In this respect, it is my view that Bill C-384 contains a woefully insufficient oversight mechanism.

Under Bill C-384, the doctor who would assist in a suicide or terminate someone’s life would only have to provide a copy of the diagnosis to the coroner after the fact. This bill would give a doctor the authority to terminate life on the apparent consent of the patient.

Under the terms of C-384, people as young as 18, diagnosed with depression and not wanting treatment, could ask to have their life terminated by a doctor.

Parliament should not consider such profound changes to the law without prior input from Canadians. Many different stakeholder groups should be consulted in advance of specific reforms being considered. These amendments would have serious implications for the medical profession in particular.

Surely, the medical profession should be consulted in advance of such significant changes being made to current medical ethics and practice.

I know that other countries have struggled with this difficult issue over the years, both in their legislatures and in the courts. While some countries have amended their laws to permit physician-assisted suicide and/or euthanasia, others have not supported such changes. In any event, regardless of what other countries have done, we have to consider what is right for our society. It is not clear to me that the legal regime proposed in this bill is right for Canada.

In closing, I would like to reiterate that I do not support this bill. Bill C-384 would represent a substantial change to the current policy on the criminalization of euthanasia and assisted suicide. It raises a number of significant legal and policy concerns and, in my view, would not adequately protect human life. Bill C-384 would also have a major impact on current medical ethics and practice. Such substantial changes to the law should not be considered without extensive advance consultations.

[Marlene Jennings, Liberal, Notre-Dame-de-Grâce—Lachine, QC]

Mr. Speaker, please remind me when I have two minutes left.

I would like to announce to my colleagues in the House of Commons that the Liberal critic will not be voting in favour of this private member's bill by the hon. member for La Pointe-de-l'Île. I would like to thank her for raising this important issue. I personally think it is such an important and complex matter that a private member's bill is not the right vehicle to engage the public debate that this issue deserves. I would like to read a letter that the Canadian Medical Association addressed to my colleague, the hon. member for La Pointe-de-l'Île. A copy of this letter was sent to all hon. members. It sums up my concerns about this issue. The letter reads,

Madame,

The Canadian Medical Association (CMA) has been very interested in and concerned about the progress of Bill C-384 in the House of Commons. The House is at third reading of a bill that would, in some circumstances, allow a physician to aid a person to die with dignity if that person has provided free and informed consent. The CMA's policy is clear. “Canadian physicians should not participate in euthanasia or assisted suicide.”

As the attached policy notes, euthanasia and assisted suicide must be distinguished from the withholding or withdrawal of inappropriate, futile or unwanted medical treatment or the provision of compassionate palliative care, even when these practices shorten life. The CMA does not support euthanasia or assisted suicide and urges its members to uphold the principles of palliative care. Euthanasia and assisted suicide are opposed by almost every national medical association and prohibited by the law codes of almost all countries.

Our policies also clearly state that “the CMA recognizes that it is the prerogative of society to decide whether the laws dealing with euthanasia and assisted suicide should be changed”, but that there are some concerns that must be addressed before any changes are made. These include:

1. Adequate palliative-care services must be made available to all Canadians. In 1994, our members approved a motion that Canadian physicians should uphold the principles of palliative care. The public has clearly demonstrated its concern with our care of the dying. The provision of palliative care for all who are in need is a mandatory precondition to the contemplation of permissive legislative change. Efforts to broaden the availability of palliative care in Canada should be intensified.

2. Suicide-prevention programs should be maintained and strengthened where necessary. Although attempted suicide is not illegal, it is often the result of temporary depression or unhappiness. Society rightly supports efforts to prevent suicide, and physicians are expected to provide life-support measures to people who have attempted suicide. In any debate about providing assistance in suicide to relieve the suffering of persons with incurable diseases, the interests of those at risk of attempting suicide for other reasons must be safeguarded.

3. A Canadian study of medical decision-making during dying should be undertaken. We know relatively little about the frequency of various medical decisions made near the end of life, how these decisions are made and the satisfaction of patients, families, physicians and other caregivers with the decision-making process and outcomes.

Hence, a study of medical decision making during dying is needed to evaluate the current state of Canadian practice. This evaluation would help determine the possible need for change and identify what those changes should be. If physicians participating in such a study were offered immunity from prosecution based on information collected, as was done during the Remmelink commission in the Netherlands, the study could substantiate or refute the repeated allegations that euthanasia and assisted suicide take place.

4. Consideration should be given to whether any proposed legislation can restrict euthanasia and assisted suicide to the indications intended. Research from the Netherlands and Oregon demonstrate that a large percentage of patients who request aid in dying do so in order to maintain their dignity and autonomy.

If euthanasia or assisted suicide or both are permitted for competent, suffering, terminally ill patients, there may be legal challenges, based on the Canadian Charter of Rights and Freedoms, to extend these practices to others who are not competent, suffering or terminally ill. Such extension is the “slippery slope” that many fear.

This statement has been developed to help physicians, the public and politicians participate in any re-examination of the current legal prohibition of euthanasia and assisted suicide and arrive at a solution in the best interests of Canadians. The CMA is in favour of improving access to palliative care and suicide prevention programs, undertaking a study on how medical decisions are made near the end of life and having a comprehensive public debate on the matter, but we cannot support Bill C-384.

Sincerely,

Anne Doig, MD, CCFP, FCFP,

President

As I indicated at the beginning of my speech, I understand and deeply respect the desire of the hon. member for La Pointe-de-l'Île to bring this matter forth in the House of Commons, and I sympathize with her. I think this is a debate that we should have, but it should be initiated by the government.

I am critical, however, of this government and previous governments of my political stripe for not having had the moral fortitude to take the necessary steps to allow such a debate to take place and not undertaking such a study, as suggested and recommended by the Canadian Medical Association.

I truly believe that it is an issue that many Canadians, many families are grappling with and an idea that they are finding very painful to think about. Government has a responsibility to help Canadians deal with this issue, to see what the actual state is and whether or not this issue can be dealt with in a way that provides dignity and serenity, and also to provide a sense of security that there will not be mistakes made if legislative measures are in fact taken.

As I have said, I blame the government but I also blame my own political party, which formed government for several terms, for not having had the moral courage to deal with this.

[Joe Comartin, NDP, Windsor—Tecumseh, ON]

Mr. Speaker, like other members who have risen to address this issue, I think it is a very painful one for all of us. It is certainly a very emotional one, and it is one to which there is no clear solution.

I will start off by saying, as I have regarding the previous incarnations of the bill, that I am opposed to the bill, and I am opposed to introducing into Canada assisted suicide at this time. I want to say that philosophically I understand the arguments. I have to say I may even be inclined in extreme cases to agree that we need, in those rare cases, an assisted-suicide system. However, that is not where we are at as a society now. I believe it would be a tragedy and a major mistake if we moved to assisted suicide in this country at this time.

I must admit I deliberated quite extensively over whether I should support the bill to get it through second reading and to committee, and ultimately I decided that I was philosophically opposed to it at this time, but more important, I decided that the debate we would have around the bill is not the debate that we need in the country.

The misinformation that we have around assisted suicides and around end-of-life decisions is quite grotesque. We heard from my colleague the member for La Pointe-de-l'Île.

Surveys showed that 70% to 80% of Canadians support euthanasia, but when people are provided with an informed amount of information, that changes dramatically.

I am going to make these two points with regard to the information that is needed. One, the reality is that we do not train our doctors. I have been told to be careful about being overly critical of them, but it is the reality of our medical training. We do not train our doctors anywhere near sufficiently in pain control: pain control techniques and mechanisms and pharmacology.

I come from a community that has a hospice, which I believe is the best in the country. It has been in place for almost 25 years. It has gone out of its way to train local doctors by mentoring. Unfortunately, there was a pain specialist who recently retired. It has been training its doctors in this area, but it is an exception to the rest of the country.

There are all sorts of doctors, including some specialists I think should know better, who believe sincerely that there are a large number of cases in which they cannot control the pain and provide people with dignity at the end of their lives.

I want to quote from a statement made by Dr. Balfour Mount, whose name I think everybody in the country would recognize as being the leading doctor in palliative care. He started palliative care. He teaches at McGill University in Montreal.

We know from what has gone on this past summer in Quebec that physicians' associations there are looking at whether they are going to come onside the euthanasia position. This is what Dr. Mount said:

--the debate should be about the doctor's role in accompanying a terminally ill patient towards the inevitability of death, offering as much dignity and medical assistance as possible.

That is not the same as saying that we should kill people.

Mount said he is profoundly against euthanasia because it is simply not needed...

What he was saying is that it is not needed in the kind of care he is able to provide and that he has provided for the better part of 30 years, as is the case in my community.

I have spoken to Carol Derbyshire, who is the head of the hospice. She said the hospice does not get requests for assisted suicide. They provide the care, not just to the patient but to the family. She was very clear on that. She has seen any number of surveys that say one of the major reasons, aside from pain, that people want assisted suicide in their regime is that they do not want to be a burden on their family, their society, their community. If we can build that system to make sure they do not have to be concerned about that, we take away any desire to terminate their lives arbitrarily and at an earlier date than would be natural.

We need to look at our system right now. Like the previous speaker, I want to be somewhat critical of prior governments. At this point, approximately 20% of our population is covered by meaningful palliative care, hospice and a home care system. That is all we have in the country. Then there is another 15% or maybe 17% who are covered by partial assistance at the end of life.

As an aside, one of the other things Carol said to me is that we have to shift the debate from dying to living out our lives. She is trying to come up with a phraseology that I may be able to use.

However, that is what it is about. It is about providing that system, and we are not doing it. In the last few months the government has cut more funding, the last of the funding it was providing for palliative care. It was mostly for research and helping the provinces set up standards. That is the second cut. Now all funds at the federal level have been eliminated to aid the provinces in establishing educational standards and training standards for palliative care in hospices. The government has cut it all.

The other thing the government has not done, which is another area we need to be working on, is expanding EI benefits for family members who are caring for their parents or a sibling or spouse in need of that kind of assistance.

We have so severely restricted those funds as to make them almost meaningless. That is another area where we could be doing something that would take away the need for this kind of legislation.

We need to train our doctors much better, and we need to build the system. Until we do that, we should not be looking at this kind of legislation. I say that because I have also studied the situation in the Netherlands, Belgium and Oregon fairly extensively. Although they all have different systems of determining when doctors can assist suicide or an individual can get assistance for suicide, the same result is true in all those communities.

I know there are disputes over this, but it is the analysis that I have brought to bear, and I think it is an accurate one. In spite of how we build that system, and I say that about the legislation my colleague has brought here, that is not what actually happens. Should we make the mistake of passing this kind of legislation, we are in effect giving our approval to doctors who are willing to do this, to family members who want it and to those individuals who are still capable of making a decision. They will simply figure out ways of working around the legislation.

I respect my colleague from the Bloc extensively. The work she has done on foreign affairs and human rights in this country is almost beyond compare. I do not know if anybody's work is superior to the work she has done. However, I think she is wrong on this one.

I say this as a practising lawyer. I look at the terminology that she used, in particular where we are assessing the patient. She has set out a standard in this legislation about apparent lucidity. That is the terminology. That does not exist anywhere else in the law that I am aware of. If this test were to be applied, it would be easier for a person to commit suicide than it would be for somebody to take over control of their finances. That is simply wrong.

I am running out of time. I think we do need a fuller debate on this, but not in this context. It has to be in the context of people living out their natural lives, and what we, as a society and legislators, have to do to ensure that can happen.

[Serge Cardin, Bloc, Sherbrooke, QC]

Mr. Speaker, first of all, I would like to congratulate and thank my colleague, the hon. member for La Pointe-de-l'Île, who, for a third time, is introducing this bill concerning the right to die with dignity. We could call it the freedom to die with dignity. Clearly, for many people, when they hear that, they hear “suicide”, “assisted suicide” or “euthanasia”, and yes, it makes us shiver, because we have probably all known, every one of the 308 members have probably known someone directly or indirectly who has committed suicide, although no one expected it. We are always surprised. That person was probably suffering, suffering more than anyone can imagine.

We now have resources to help these people, but we have to find them and help them, for they will continue to suffer until we help them. Getting to the point of assisted suicide, this means that the someone is suffering, and there are situations in which there is nothing we can do. That person is suffering, and is becoming something that he or she never thought possible, bent over in pain, or often not bent over, but bedridden and suffering for weeks and months on end, which to that person seems like an eternity. This bill does not seek to eliminate people who are suffering. That is not what we are asking for; rather, we are seeking a right for these people, people who have all their faculties about them, who are suffering, who are aware of their suffering and who want to escape it. These people could commit suicide on their own and no one could stop them. However, some people have philosophical or religious considerations. Philosophy and religion eventually cross paths.

I can say that in ancient times, the Greeks and the Romans were able to bring the issue of suicide out into the open and ensure that it was part of public discourse and debate. That was in ancient times. They decided to discuss it honestly and openly, to debate the matter. Intolerance of suicide began to take root in the 2nd and 3rd centuries and was heightened under the influence of Christianity. Naturally we do not wish to go against people's beliefs. However, we are talking about the right to die with dignity. Some people fear that we are confusing palliative care with assisted suicide, that we are taking sides.

I have experienced this suffering. Who among us has not gone through the experience of watching a loved one die of cancer? Who has not experienced that? If I look at some of the reactions, what is happening now is not any better than what we are asking for. What we are asking for is to allow people to make a free and informed choice. You have probably all seen a loved one go through cancer. At a certain point, the suffering is intolerable. Of course the person is given morphine. At first things are better, but in the long run it is not enough. What to do? How long do we let them lie there unconscious? Are the doctors not somehow assisting them? Some people have a strong heart and their life, which they are no longer conscious of, will continue for as long as their heart beats.

My father, who died at age 68, started having strokes at age 63, shortly after he retired.

He had various handicaps in addition to Alzheimer's disease. Of course there came a time when he had to be hospitalized. He was bedridden and unconscious for weeks, months. My father was strong and he had a healthy heart despite the fact that he was unconscious. It is normal for a human body to want to continue living.

We say that we want what is best for society, yet the fact that we refuse to speak openly and honestly about this issue raises a question. How can we be thinking of what is best for society when confronted with an individual in the final stages of a terminal illness who knows that they will die sooner or later and asks to die with dignity, thereby minimizing their own suffering and that of the people close to them?

I went through a second experience because I was also there when my father-in-law died in my home. He had been receiving palliative care. CLSC staff came to take care of him regularly. The same thing happened: doctors said that they might be able to help the end come sooner. In that case, the patient did not make a request.

This bill covers requests by lucid individuals. If a sick but lucid person decides to end their life with dignity—and everyone knows that they are going to die anyway—who am I to refuse?

We know that such pacts are becoming more and more common. When people know that they cannot end their own lives, they ask another person to help them in the event it becomes necessary. It is not very nice to be asked to do this kind of thing. How heartbreaking. But if there is a legal framework and people can make an informed choice, what right do we have to refuse them? Who am I to decide whether a human being should live or die? I believe that only the dying person has the right to decide whether they want to live or die.

I am certain that if we do not have this debate, more and more cases will come before the courts. People will be faced with such situations and, out of compassion, will decide that they cannot continue to watch loved ones suffer and that they must help them because their loved ones have asked for their help. Who am I to decide that someone will continue to suffer, continue to be bedridden, continue to decline, continue to no longer be the person they once were and no longer know where they are, even though that person asked me to do something for them if this sort of situation should occur?

In my opinion, we, the 308 members of this House, have a duty to consider this issue. I am not trying to convince the members to say yes so that this bill becomes law tomorrow morning. What I am trying to do is convince them to consider, discuss, debate and improve this bill. In the end, it is not up to us to choose. It is up to the person to say lucidly that, in the event something should happen, they want to have control over their life and, ideally, their death as well.

[Paul Szabo, Liberal, Mississauga South, ON]

Mr. Speaker, I thought I would outline some of the subjects that I will deal with in my closing statements in the remainder of my speech.

I spent nine years on the board of the Mississauga Hospital, five years of which were on the ethics committee of the board of directors. During that period of time, I headed up a group that looked at the subject matter of no CPR orders, non-resuscitation policies.

The issues of informed consent and mental competency, whether the person had all the medical information, or were aware of all the options or there was coercion by family members or friends, are important issues to take into consideration.

The bill goes under the moniker of right to die with dignity, but the amendment to the Criminal Code would give a person the right to terminate a life before natural death. It would not give the right to die with dignity to someone. It would give the right of someone to take a life. That is a subtle difference.

I hope as many members as possible will get an opportunity to address this. Palliative care workers are concerned about this. Organizations and hospices are doing their very best to give the best possible care in terrible situations. Disabled in our society are obviously concerned about whether their lives are at risk because someone decides they do not live in dignity.

All human life is dignified life.

[The Deputy Speaker, Conservative, Andrew Scheer]

The hon. member will have eight minutes to conclude his remarks the next time the bill is before the House.

The time provided for the consideration of private members' business has now expired and the order is dropped to the bottom of the order of precedence on the order paper.

It being 2:30 p.m., the House stands adjourned until Monday at 11 a.m. pursuant to Standing Order 24(1).

(The House adjourned at 2:30 p.m.)

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

moved that Bill C-384, An Act to amend the Criminal Code (right to die with dignity), be read the second time and referred to a committee.

Mr. Speaker, I will not have enough time to list everything that has happened and that has been written regarding the right to die with dignity since the debate on BillC-384 began.

It is a sign, if a sign were needed, that shows the need to decriminalize euthanasia and assisted suicide or physician-assisted dying under certain conditions. My bill has a specific objective. It deals only with people capable of making decisions for themselves who are living in conditions of suffering that cannot be alleviated. But it has the merit of forcing a debate on decriminalization that, in Canada, unlike in the United States, is a federal jurisdiction. I think that studying my bill in committee and passing it after consideration and amendments would at last rid us of the criminal nature of physician-assisted dying by euthanasia or assisted suicide.

The Collège des médecins du Québec could then, freely and without fear, continue the admirable work it has begun on appropriate end-of-life care, including terminal sedation and euthanasia. The Quebec National Assembly could, in all good conscience, refer the study of the right to die with dignity to its Commission de la santé et des services sociaux. Not only is it necessary, but it is urgent to remind ourselves of the degree to which the Criminal Code of Canada hinders a genuine debate on vital life questions that so many people are faced with daily. A number of people who have appeared before the Commission de la santé et des services sociaux have done so. Here are some examples.

Jean-Pierre Béland, professor of philosophy and ethics at the Université du Québec à Chicoutimi, wonders what the problem is when it is accepted that a physician must answer to his code of ethics that requires him to make it possible for a patient to die with dignity.

He goes on to say that it is part of the code of ethics and that we all know that the problem lies with the current Criminal Code. This Criminal Code, which falls under federal jurisdiction, recognizes that any act of euthanasia must currently be interpreted as a criminal act within the meaning of the Criminal Code. In practice, is the patient not thrust into an impasse because the law forces doctors and caregivers to live in the ambivalence of palliative care language, which preaches independent choice when, in reality, the patient has no choice because he is denied assisted suicide and euthanasia?

There are tonnes of quotes. I have one from a very remarkable document from the Collège des médecins du Québec on doctors, appropriate care and the debate on euthanasia. The following is an important excerpt from that document:

The status quo makes this research difficult if not impossible. For all sorts of reasons, our society—and doctors are no exception—is in denial not just about euthanasia, but also about death. The current state of the law in Canada certainly has a lot to do with that. In a context where any act aimed at shortening life is considered murder punishable by criminal sanctions, it is rather difficult to have an open and frank discussion on all the care that would be appropriate at the end of life.

My dear colleagues will agree that the Quebec and Canadian context has completely changed since the motion was unanimously passed by the National Assembly of Quebec.

Those are not my words. We did not see it, but representatives in the National Assembly unanimously passed a motion to establish an ad hoc commission “for the purpose of examining the issue of the right to die with dignity and, if need arises, of the procedural requirements”.

The National Assembly commission has already heard from dozens of specialists, be they doctors, ethicists or people who work in palliative care. The quality of their testimony is incredible.

It has brought a question to my mind. Quebec's parliament came together and undertook a joint consultation with specialists. Then, in August, they travelled throughout Quebec. Quebec's National Assembly commission will come forward with a motion. Given the commission's title, it seems that they will want to determine the conditions for dying with dignity. What will the Parliament of Canada do? It will say that it is in charge of the Criminal Code. On what side of the issue will we be? Personally, I hope we will not be against it.

I hope that the Parliament of Canada will take the time to consult and get informed. Of course, I hope that this will be the case when my private members' bill comes before the House. My bill is specific and limited, but it raises the question of criminalization or rather decriminilization. That is the biggest problem. That is the problem.

Who can repeatedly say with confidence that helping someone in unbearable pain, particularly someone in palliative care—that is definitely unbearable pain—is a crime? Many witnesses speak about helping someone die peacefully, so that they do not suffer. Is that really murder? Is that really a crime? Many of them say it is not. That is exactly my point. Within the three physicians' associations in Quebec, approximately 75% say that the option should exist to perform euthanasia in order to help people die under specific conditions. They want to be able to establish these conditions themselves.

I would like to read excerpts from the brief from the Fédération des médecins spécialistes du Québec:

From a medical standpoint, the right to die with dignity and quality end of life care are notions that implicitly refer to euthanasia. It was in that context that a working group on clinical ethics, mandated by the Collège des médecins du Québec, or CMQ, in 2006, decided to address the issue. Based on the reflections of that group and particularly because of the CMQ's position, the federation decided to conduct a survey on euthanasia—

I will talk about that in a moment, but first I would like to read another interesting excerpt:

More and more people no longer have any moral or ethical objection to the idea of allowing a doctor to administer terminal sedation under extraordinary circumstances. Euthanasia is starting to be viewed as an act of support, the final step in quality end of life care. However, from a strictly legal standpoint, the debate continues. The Canadian legal framework, the Criminal Code, stipulates that any action to end another person's life constitutes murder and is therefore subject to criminal sanctions.

But doctors work with people who no longer have any hope and who are no longer treatable.

Regardless of the legislative model eventually passed by the National Assembly regarding civil rights, the Criminal Code of Canada should be amended. This is by no means supported by everyone, considering the firm opposition expressed by certain radical groups that strongly support recriminalizing abortion in Canada.

The reflection paper of the Fédération des médecins omnipraticiens du Québec is also clear and precise. It is even philosophical, to some extent.

Due to improvements in health care, people now live longer and it is possible to delay death, sometimes significantly. However, the ability to live longer has a downside because an increasing number of people suffer from degenerative or incurable illnesses, such as Alzheimer's or cancer, which decrease considerably their quality of life. As a result of the evolution in medical technologies and a better understanding of them, people wish to control end-of-life decisions in order to die with dignity. This evolution in medicine inevitably leads to the debate on end-of-life care and euthanasia.

These are not physicians who teach at universities, although they might say the same thing. These are physicians who deal with patients and look after them in their final days.

These texts both contain the results of surveys on euthanasia. This is what the Fédération des médecins spécialistes discovered.

The survey indicated that medical specialists are prepared to hold a debate on euthanasia (84%) and believe that Quebec society is also ready to discuss this matter (76%). In addition, 75% of medical specialists would certainly or probably be favourable to euthanasia within a clearly defined legislative framework, and believe that Quebec society also supports legalized euthanasia, although to a lesser extent (54%).

Passage of a bill legalizing euthanasia by the House of Commons would receive the support of 76% of specialists.

However, our survey tends to confirm that euthanasia is a factor that medical specialists have to deal with in their practice. According to 81% of respondents, euthanasia is often/sometimes (52%) or rarely practised in Quebec.

The FMOQ survey gave similar results. I would add that more than half of all general practitioners believe that euthanasia is carried out indirectly in Quebec at present. 74% of physicians surveyed believe that euthanasia should be a tool available to doctors in order to fulfill the ethical requirement of helping their patients die with dignity.

74% of the respondents believe that new regulatory and legislative frameworks should be adopted to permit euthanasia.

These are but a few of the many accounts I read or heard. I believe there is no longer any hesitation. I know that, increasingly, the position of those opposed is the fear of the slippery slope.

But we cannot, based on this irrational fear—a number of studies have shown that when legislation exists, there is no slippery slope—and based on the slippery slope refuse assisted suicide to people who are dying in pain. That makes no sense, and that is what we are faced with.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Madam Speaker, I would like to remind the member that the law Reform Commission, going back to the Supreme Court of Canada in Rodriguez v. British Columbia Attorney General, recognized that Canadian society is based on respect for the intrinsic value of human life and the inherent dignity of every human being. That was confirmed by the Law Reform Commission of Canada, which wrote similarly, “In truth the criminal law...serves to underline those values necessary or important to society” and that it is necessary to “reaffirm these values”. Thus in Canada the law has affirmed the intrinsic value and dignity of life.

In the member's own province, at least 100-plus doctors, led by doctors Ayoub, Bourque, Catherine Ferrier, François Lehmann, and Josée Morais, and endorsed by 132 Quebec physicians, have spoken out against these measures. They do not want to be put in the position of having to terminate a patient's life.

Does the member not understand that contrary to her intentions, this bill will allow doctors to provide a patient with a lethal injection, making many Canadians vulnerable to a premature death?

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, I would like to make a few points in response.

First, I will point out that there are 8,000 medical specialists and more than 8,000 general practitioners. Around 100 have signed the letter written by five doctors.

These five doctors had the right to write this letter, but I know that two of them were deacons and another was a member of Opus Dei.

We have a right to defend our religion, but we cannot force our religion on others. I think that in Canada, as attitudes and needs evolve, Parliament should legislate not according to specific religions, but according to the right an individual must have if they are suffering, if they have suffered, and if they are seeking help to die.

When a doctor helps someone die, it has nothing to do with murder. A murder is always a violent act. Helping—

[The Acting Speaker, NDP, Denise Savoie]

Order, please. I will give other hon. members the opportunity to ask questions.

The hon. member for Mississauga South for a quick question.

[Paul Szabo, Liberal, Mississauga South, ON]

Madam Speaker, Dr. Ferrier from McGill University also raises an issue, and I will not read the quote to save time. She basically expresses a concern that doctors would be put in a position where they would have to deliver care as well as euthanasia, and that this would be a conflict in the patient-doctor relationship. In fact, she is concerned that some doctors would not participate, meaning that many people would start hunting around for those who would give them what they want if they could not get it from somebody else. It is going to undermine the system. It is a serious concern.

I wonder whether the member would comment.

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, I want to thank the hon. member for his question.

The majority of doctors, as I was saying, are in favour of reviewing end-of-life care. In end-of-life care there is a place for sedation and a place for euthanasia.

Like me, doctors are convinced that no one should be forced to help someone die, just as no one should be forced to perform an abortion.

Indeed, one needs to be in tune with these issues, but there needs to be legislation that includes what we consider to be essential safeguards.

My bill—

[The Acting Speaker, NDP, Denise Savoie]

There is time for one last question.

The hon. member for Burnaby—Douglas for a very quick question.

[Bill Siksay, NDP, Burnaby—Douglas, BC]

Madam Speaker, I want to thank the member for introducing this important piece of legislation, which I will be proud to support when the time comes for the vote on it.

I want to ask her about the so-called slippery slope. There are some people who believe that this kind of legislation that provides an option of death with dignity leads to a deterioration of palliative care and end of life care. However, Arthur Schafer, the director of the Centre for Professional & Applied Ethics at the University of Manitoba, has studied this and in fact shown that palliative and end of life care get better when this kind of legislation is introduced--

[The Acting Speaker, NDP, Denise Savoie]

Order. The hon. member has 15 seconds to respond to the question.

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, I was looking for another study conducted by a university in Oregon on the law in Oregon and the law in Holland. It focused on a number of vulnerable groups, looking for signs of a slippery slope, but it did not find any. In one group where there were more deaths—

[The Acting Speaker, NDP, Denise Savoie]

Resuming debate. The hon. member for Ancaster—Dundas—Flamborough—Westdale.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Madam Speaker, I am pleased to have the opportunity to speak to Bill C-384, An Act to amend the Criminal Code, which is more commonly known for the issue it tackles: euthanasia and physician assisted suicide. There is no question that the circumstances, pain and emotion surrounding one's desire to even consider euthanasia and assisted suicide are difficult and complex, made all the more poignant by the personal experiences that frame our diverse perspectives.

I must say from the outset that while I fundamentally disagree with this bill, I respect every member of the House and every Canadian who advocates for or against the bill. That is because the circumstances that would bring anyone to contemplate medically assisted suicide, whether it be for himself or herself or a loved one, are very deep, very emotional and very difficult personal decisions.

Throughout this debate we have heard many stories and I am certain that we will hear many more. Each is different and relevant. I do not know if we can ever truly appreciate these until we walk in that particular person's shoes, but please allow me to add my own as well. My mother passed away from a debilitating autoimmune disease called scleroderma. Unfortunately, even today, not a lot is known about this disease.

When death occurs, as was the case with my mother, it is from organ complications after many years of suffering and pain. It is dying from the inside out. My mother's internal vital organs became like stones. Her skin became as fragile as parchment. There were days at the end of her life, I would suspect, although she never spoke to me about it, that she would rather not have lived. They were days that we as her family would rather have not seen her suffer.

However, as heart-wrenching as it was, she found a modicum of serenity and acceptance and we comforted her as best as we possibly could right until the end. My family was blessed by discovering two great champions: my younger sister, Connie Hayes, and my older sister, Suzanne Bryant, who were there day in and day out to care for my mother and bring the family even closer together through this tragic, painful ordeal.

I think we can all agree with the overall objective of ensuring that people with terminal or severe illness suffer less. However, I do not believe that Bill C-384 is the answer. In fact, I have stated before in this place that, in my opinion, Bill C-384 is irresponsible. Frankly, I am convinced that it is diametrically opposed to the Charter of Rights and Freedoms which guarantees individual Canadians the right to life, liberty and the security of person.

I am deeply concerned that Bill C-384 would allow anyone to request medical assistance with suicide or euthanasia without sufficient oversight or regulation. Clearly, no one is going to make that kind of decision lightly, but nor should it be so readily accessible that an irreversible decision could be made too hastily, out of pain or emotion, or out of guilt that someone would be a burden to others.

The flaws with this bill are not with its call to compassion or its appeal for dignity near life's natural end, but with the unintended and, I believe, unmanageable consequences. Moreover, I believe we as parliamentarians have a duty and moral obligation to uphold the value of life. What kind of precedence does this set? At what point on this slippery slope do we stop? Is that really for us to decide?

I would like to quote an article from yesterday's Globe and Mail, written by Margaret Somerville, the founding director of the Centre of Medicine, Ethics and Law at McGill University:

Indeed, one of the people responsible for shepherding through the legislation legalizing euthanasia in the Netherlands recently admitted publicly that doing so had been a serious mistake, because, he said, once legalized, euthanasia cannot be controlled. In other words, justifications for it expand greatly, even to the extent that simply a personal preference “to be dead” will suffice.

I am also worried that Bill C-384 signals a devaluing of life and I believe that is heading in a vastly wrong direction. These are my personal and emotional views and reasons, but they are also the reasons for many hundreds of constituents who have called, written and emailed my office.

I would like to supplement this by referring to some of the work done by committees and commissions over the years related to this specific topic. I hope they help illustrate and amplify my point that we are treading down a very slippery slope.

We should consider this paragraph from the 1982 report by the Law Reform Commission of Canada on this topic that my colleague referred to earlier. It reads, ”There is, first of all, a real danger that the procedure developed to allow the death of those who are a burden to themselves may be gradually diverted from its original purpose and eventually used to eliminate those who are a burden to others, or to society. There is also the constant danger that the subject's consent to euthanasia may not really be a perfectly free and voluntary act”.

Therefore, in addition to the lack of oversight in this bill, what is also troubling is the lack of precise language. I have a copy of the bill in front of me and the actual text is only three pages long, in both official languages. It is hardly anything that would tackle something as serious as bringing about medically assisted death.

The bill before us would allow for physician assisted suicide and euthanasia if the subject appears to be lucid and is in severe physical or mental pain and yet there is no definition of what constitutes severe pain or mental pain. I would hate to see an elderly, ill or disabled Canadian, feeling that he or she is a burden to his or her caregivers or to society, request assisted suicide using severe mental pain as a reason.

In tandem with our duty to uphold the value of life, I also believe we must support quality palliative care and end-of-life care for Canadians so that they will never need to think that euthanasia or assisted suicide is the only relief for their suffering or feel that they would be relieving a burden on their family by taking that path. Our ultimate goal ought to be to help ensure Canadians can live life well to its natural end. With the ageing of the baby boomers, this is an increasingly important issue.

A study of palliative care conducted by a Senate subcommittee in 2000, tabled a thoughtful report called “Quality End-of-Life Care: The Right of Every Canadian”. The report recommended collaborative development of a strategy to improve palliative and end-of-life care with attention to issues such as support to family caregivers, access to home care, training and education, research and surveillance.

Since then, Health Canada has been working to develop a pan-Canadian strategy for palliative and end-of-life care. While much remains to be done, I believe this can help deal with the very real physical, psychological, spiritual and practical needs of a person who is dying and the person's loved ones.

As we discuss, debate and consider Bill C-384, we must not forget what we can do in these areas of health care to help Canadian families from coast to coast. We need to recognize the work being done in hospice care by so many dedicated doctors and nurses, as well as what is being done by great Canadians in the communities in which we live.

It was such a concern for ordinary Canadians in Hamilton to give quality care, end-of-life care to the people of Hamilton that they raised $3 million and built the Dr. Bob Kemp Hospice to ensure hospice care was available to people in need.

We are faced today with a problem that continues to challenge our society. The pitfalls are many and the answers are far from clear. In view of this, I would urge members to reject Bill C-384 and signal to all Canadians that we hold life as sacred and do not find the intentional taking of life acceptable whatsoever.

[Paul Szabo, Liberal, Mississauga South, ON]

Madam Speaker, before I came to this place, I spent five years on the ethics committee of the board of directors of the Mississauga hospital. I learned a great deal about self-determination, competency, the whole idea of informed consent, the realities of coercion by family members, friends and other people who have conflicts of interest, and the risk that the patient may be competent but not understand the risk of incorrect diagnosis or prognosis and the possibility that circumstances can change after he or she has given consent but then lapse into incompetence. These are all very minor, simple ethical questions. There are many more complex ones. These are just a sample.

Euthanasia involves a physician directly injecting a lethal substance into another person with the person's consent. Physician assisted suicide involves a physician who provides the individual with information, guidance and the means, such as a prescription for a lethal drug, with the intent that the person himself or herself will take his or her own life. That is the difference.

Bill C-384 seeks to legalize both euthanasia and assisted suicide. It purports to provide the right to die with dignity when in fact what it does is it gives the medical practitioner the right to terminate or assist in the termination of life before natural death.

It would change section 14 of the Criminal Code such that a medical practitioner does not commit homicide if he or she aids a person to die with dignity who has given his or her free or informed consent, who has a terminal illness, and who continues, after expressly refusing the appropriate treatments available, to experience severe physical or mental pain without any prospect of relief.

There are some flaws in the bill. I looked at it carefully. My immediate reaction is that it does not restrict this availability to Canadian residents. Anyone could walk into Canada and request euthanasia, which is silly.

The bill does not define terminal illness. It does not define lucidity. It does not define a whole bunch of things. In fact, it requires the patient to be free from duress or coercion, but it does not give any indication of how that might be addressed.

This bill is an amendment to the Criminal Code. It is two paragraphs long.

I have before me the bill of one jurisdiction and it is 10 pages long. Let me highlight some of it. It includes 20 definitions that are necessary to be there so it is operable. Also, under “Written Request for Medication”, it has section 2, who may initiate a written request; section 3, the form for written requests; section 4, the attendant physician responsibilities; section 5, consulting physician confirmation; section 6, counselling referral; section 7, informed decision; section 8, family written notification. It goes on. It includes written and oral requests; the right to rescind; waiting periods; medical record; documentation requirements; residential requirements; disposal of unused medication; effect on construction of wills, contracts and statutes; insurance and annuity policies; construction of the act. Under “Immunities and Liabilities” it covers the sanctions of prohibiting a health care provider from participating; liabilities and claims from government authorities; and forms to request. I could go on.

This is a comprehensive bill on a very serious subject. The bill before us for debate is not. Based on my review of the bill and the legislation in other jurisdictions, I have concluded that this bill is seriously flawed, inoperable and irreparable in its current form.

We have to look at the experience of other jurisdictions. It is instructive.

Oregon has had the law for 12 years. In 2009, 93 people obtained prescriptions for the lethal drug, but only 53 actually took their lives. In Washington state in the first 10 months, which is how long it has had the law, 63 people got the lethal drug, but only 36 took their lives. Does it paint a little picture? There are some numbers here.

In all of these jurisdictions people were asked why they were seeking euthanasia or assisted suicide. Ninety-one per cent of them said that it was losing the ability to participate in the activities that make life enjoyable. Eighty-two per cent said they were worried about losing their dignity. Only 23% said they were worried about the pain and suffering. We cannot ask people who are not the patient how they feel about this. We have to ask people who are facing this situation.

It is clear to me the concern about pain and suffering, which is really the only major justification the member has given on this bill, in fact is not the compelling reason that some people request termination of life.

Our health care system is there to meet the needs of all, including the disabled, the terminally ill, the aged and the most vulnerable in our society. We meet those needs through continuing care, palliative care, stroke and geriatric rehabilitation, long-term care, hospices, home care and family medicine. We need to continue to improve that care, not terminate it.

Palliative care workers are very concerned about this bill. Organizations and hospices are doing their very best to give the best possible care in difficult situations. The disabled in our society are obviously very concerned about whether their lives are at risk because someone decides they are not living in dignity.

As well, the legalization of euthanasia and assisted suicide would reduce funding for palliative care, reduce the number of palliative care service centres and reduce the number of palliative care physicians.

There are some slippery slope considerations. I would simply point out that people are not valueless because they are chronically dependent or dying. They continue to be human beings and should be respected and supported in their time of need and, as a result of the loss of a patient's autonomy because the final decision will belong to a physician, not to the individual. I mentioned personal autonomy.

Our experience shows that there is an absolute certainty that errors will occur and that lives of people will be wrongly terminated.

Our social, moral and ethical values, as expressed in our laws, practices and customs, define who we are as a people and as a country. The thought of deliberately taking a human life for any reason is simply incompatible with Canadian reality. The decriminalization of euthanasia and assisted suicide depends entirely on the participation of the medical profession, and it should be noted that the majority of the medical profession is opposed. As I mentioned in my question earlier, it will pit doctor against doctor, depending on whether they support it.

What we really need is a national strategy for comprehensive palliative care to address any gaps in compassionate care services. This also involves an increase in education for doctors and medical students who normally receive little training in the benefits or advancements in palliative care.

For all of those reasons, I am strongly opposed to euthanasia and assisted suicide and I will be voting against Bill C-384. In my view, it is simply wrong to deliberately kill another human being. The miracle of life is inherently dignified and each day is a gift to be cherished.

[Joe Comartin, NDP, Windsor—Tecumseh, ON]

Madam Speaker, there is no doubt, having learned from the prior debates on this bill and again this evening, that this is an extremely difficult issue for all of us to confront as parliamentarians.

It is a private member's bill, so it will be a free vote for all members of Parliament, and all of us as individual members of Parliament must make our decisions. I know most of my caucus are opposed to the bill at this time, but there are certainly other members who, in good conscience, will vote in favour of it.

That division in attitudes comes from a philosophical basis, from a religious basis and from a moral basis on both sides of the issue. I have taken a somewhat different approach in my opposition, because I am opposed at this time. I cannot rule out that at some point, our Canadian society should in fact have a provision that would exempt this type of death from the Criminal Code's definition of murder, but we are not there today. I am quite convinced of that. In all good conscience, again for my colleague from the Bloc, I have serious problems with the methodology in the bill. I will come back to that if I have enough time at the end.

My approach is one simply of analyzing where we are as a society, both in Canada and at a somewhat more extended level, in some of the countries and jurisdictions that have introduced the concept of assisted suicide in whatever form or methodology they have done it. In terms of all the work I have done on this, I have come very definitely to the conclusion that it would be premature for Canadian society, at this time, to move down this road. Again, we may never move down this road, but we certainly should not at this time, for two primary reasons.

First, it is quite clear that as a society, we do not have the medical professionals ready, trained and equipped to deal with pain control. One studies the curriculum in medical schools and the position that doctors take when they are out of medical school and practising, whether they are general practitioners or specialists. It is quite clear that the knowledge out there on pain control has nowhere near permeated 100% of our medical profession.

I say this from a good deal of experience in my own community. I believe we have the best hospice in the country. I think it is 25 years old now. One of the programs we instituted about four years ago, or a bit longer, was a mentoring process by a pain specialist, who is now retired. She conducted a mentoring program, funded by the provincial government, for general practitioners. We now have put about 30 general practitioners through that process, educating them. These doctors are practising, some for a good deal of time, but they have to learn, for the sake and benefit of their patients, how to control their pain. It has been very successful.

The director of our hospice tells me that she does not get requests for assisted suicide. This woman has worked in this field for over 20 years in the Windsor area. The hospice is able to provide them with the resources, the pain control and sometimes the setting, so it is not necessary for individuals to have to make that decision of ending their own lives earlier than what would naturally occur. They are able to do that, yet still have full dignity of living out their lives to the fullest, both in time and in quality of life.

The other reason I believe this is premature is we do not have anywhere near the services in palliative care in hospices that we should have. The statistics I have on this show quite clearly that only about 20% of the regions are fully covered by full palliative care in hospices. We have perhaps another 15% or maybe 20% where we have partial coverage. We have a long way to go, and we should be concentrating on that.

I must admit I get to be critical of the government. One thing that happened, not in this current budget but in the two budgets before that, was the money to assist in setting standards for those palliative care centres and hospices was cut. There is no money left in the federal budget for the type of research and the setting of standards that would help the provinces in those areas.

We need to finish building the infrastructure before we move to considering whether we are going to have assisted suicide. We then need to look at other jurisdictions. What has happened there is not what I think we see in the common viewpoint of the average Canadian.

The average Canadian thinks the person who will have an assisted suicide is the stereotypical sufferer of Lou Gehrig's disease, that type of debilitating and terminal illness, those people who near the end of their lives will be unable to do anything to end their lives themselves and so they need assistance. That is the image out there. That is what shows up in the opinion polls.

If we study every jurisdiction that has moved to assisted suicide, that is not the person who is primarily using the system. It is almost overwhelmingly, and I am talking very high percentages, 75%, 80%, 85% of the cases, the frail elderly and, in some cases, younger people suffering from severe disabilities. It is not someone suffering from Lou Gehrig's disease.

Until we are in a position to complete the building of the medical infrastructure that we need to support patients, we cannot go down this road. We have to think about the unintended consequences every time we pass legislation, and this is certainly a classic example of where we end up with an unintended circumstance. We think what we are doing is helping a patient, a citizen of our country, but what we are doing is severely terminating lives of this much larger group in the form of the frail elderly.

Again, I have looked at all the jurisdictions, of which I am aware, where they have legislation. We heard from my Conservative colleague about the minister who moved the legislation through the Parliament in Holland. In 2009 the minister went public, supporting exactly the position I set forth before Parliament tonight. She recognized they did not have anywhere near a full system of palliative care in Holland. She has recognized, by the statistics that are coming out now, that it is the frail elderly who are overwhelming being euthanized. It is not what was intended. This was a consequence that resulted. She has made it quite clear that if faced with the decision today, she would not have marshalled that legislation through her legislature until that system was built.

This is not an easy issue, but it is very clear to me that the bill is so premature. We are at a stage in our development of our society where we can build the rest of that system. It will require some additional financial resources, but it is not great and we can afford to do it. That is what we should do and put off this type of legislation for quite some time into the future, if ever.

[Diane Bourgeois, Bloc, Terrebonne—Blainville, QC]

Madam Speaker, I would like to begin by congratulating my colleague from La Pointe-de-l'Île for having the courage to introduce such a bill. It is an honour for me to support this bill. I recognize the member's wisdom in foreseeing what is to come.

We will all grow old and at some point we may have to choose what we want to do with our lives. We may have cancer or a degenerative disease and we may have to make a choice. If we cannot do so, we may think back on today's debate.

To consider this bill and its consequences, we must keep a very open mind. All my colleagues who have spoken have provided us with various insights about the consequences of the bill. We are talking about this, and it is a good thing.

I wonder if we are ready not to brush off this bill, to improve it and send it to committee for further discussion. Contrary to what has been said, this bill does not devalue life.

If we read this bill carefully, we can see that it calls for a mechanism leading people to make conscious decisions.

Two members have made false and dishonest comments about the bill. These comments are tainted by religious ideology. They cannot tell me that they have read the bill correctly. Their religious ideology showed through their comments.

My colleague was right when she said that those who usually oppose abortion are predisposed to oppose this bill. People often bring up the protection of life for all manners of things. Some even go as far as to lie to the House tonight to show that they are against the bill. What some members said about the bill is not true.

Now...

[The Acting Speaker, NDP, Denise Savoie]

Order. I believe it is a violation of the Standing Orders to say—

[Diane Bourgeois, Bloc, Terrebonne—Blainville, QC]

Madam Speaker, I withdraw the word I used. I will simply say that some people go out of their way to misrepresent what the bill is trying to do. I apologize, but I am still of the same opinion.

We all want to die with dignity. I listened to one of our colleagues across the floor who was saying earlier that his mother passed away while in pain, but despite everything, she died peacefully. How would he know? How can he know if his mother died peacefully while she was in pain? She had no choice. Perhaps she would have felt more peaceful if she had had the choice. There was nothing else to help her. I do not know. I think the members was making a gratuitous remark.

Let us talk about palliative care. Yes, there is some very good care, but there are also people who will simply be left on their own at the end of their lives, even if they have good palliative care. Does anyone here know someone who has died of Alzheimer's disease? What happens in the last four or five days of the life of someone dying of Alzheimer's disease? They can no longer swallow and they can no longer think. They are simply left on their own and given cortisone or morphine.

I have before me a text written by Claire Morissette. She died on July 20, 2007. She explains what she was going through during her final days. I would like to read a passage. This is what she wrote about pain.

Suffering is much like shivering. You shrivel up, your entire body contracts from your scalp to your feet. It HURTS!!! It hurts constantly. The shivering consumes all your strength, all your consciousness, it is exhausting. Think about it: could you stand shivering for ten days, twenty days, two months, years on end?

Then relief comes, the shot of morphine. It is like a wave of warmth that releases you from the shivering, blessed relaxation on an open beach. Thank you!!! Oh, thank you!!! That feels so good. But, [with doses like that], you hallucinate, you become confused, half-deranged.

While this is going on [listen carefully], the body drains away. Lacking appetite and exercise, you dissolve. In the mirror, you see (no exaggeration) a concentration camp skeleton. You have no buttocks to sit on, your breasts are empty, your knees are unreliable. [In fact, you have to hold a pillow between your knees so you can keep them together.] Your skin shrivels; wrinkles take over. How humiliating. What is worse, because of the medication, your urine, your feces, your flatulence, your breath, your vomit all smell like the end of the world, and, in complete humiliation, you inflict it on the people helping you. If you have to defecate in bed, in a dry bedpan, the stench is beyond description. Then someone else has to wipe your bottom, which is still more humiliating.

Is that how we want people to live? Is that dying with dignity? That is truly the end of the road. She goes on to say that making even the smallest movement takes an enormous amount of energy. People watch DVDs and try to get used to it, but when they are really suffering, all they want is to find sleep, deep sleep, unconsciousness, oblivion. Yes, indeed, everyone feels awful about it. Everyone wants to help, to do what they can. But their helplessness is tangible.

Claire Morissette continues on, saying that people will cry in secret, no matter how hard they try to keep the atmosphere from being too dismal. But their grief is heartbreaking. Is that really allowing a person to live with dignity?

She says that she could die of hunger or she could die of thirst. She knows that she will die, but all she wants is to die with dignity and to be allowed to choose where, when and how she will die.

This bill introduced by the member for La Pointe-de-l'Île will allow, would allow or would have allowed this person and their doctor to talk about options. All that is requested is our compassion. We would not let an animal die this way. If your dog was suffering, you would take him to the veterinarian. What about a human who is suffering terribly? We do not give them the possibility—

[The Acting Speaker, NDP, Denise Savoie]

Order. Resuming debate. The hon. member for Langley has about two minutes before adjournment proceedings.

[Mark Warawa, Conservative, Parliamentary Secretary to the Minister of the Environment]

Madam Speaker, the seniors that the hon. member just spoke of are not trash. They are treasures.

I would like to state from the outset that I do not support Bill C-384 which proposes the legalization of physician assisted suicide and euthanasia under specific conditions.

The bill raises a number of serious concerns and I propose to outline the ones that I consider the most troubling.

First, Bill C-384 is too broad in terms of its scope. Bill C-384 proposes to amend the Criminal Code to provide an exemption not only for the offence of assisted suicide but also for the offence of murder. These amendments would represent a substantial change in the current state of law on a matter that touches life and death.

The proposed legalization of medical euthanasia and assisted suicide would not only apply to terminally ill patients but also to persons who suffer from severe physical or mental pain without a prospect of relief.

Therefore, under the bill, persons who suffer from depression could request that a doctor help them to commit suicide. They could also request that the doctor carry out the act itself that would cause their death.

When I articulated earlier that Bill C-384 is too broad in its scope, this concern applies to both the fact that it would permit physician assisted suicide and euthanasia, and to the fact that it would allow a vast array of persons to make a request to a doctor for assisted death.

[The Acting Speaker, NDP, Denise Savoie]

Order, please. The hon. member will have approximately eight minutes when the bill comes back to the House for debate.

The time provided for the consideration of private members' business has now expired and the order is dropped to the bottom of the order of precedence on the order paper.

The House resumed from March 16 consideration of the motion that Bill C-384, An Act to amend the Criminal Code (right to die with dignity), be read the second time and referred to a committee.

[Mauril Bélanger, Liberal, Ottawa—Vanier, ON]

Mr. Speaker, according to the rules, I have 10 minutes to speak about a complex, controversial topic that has numerous moral, legal, economic, social, religious, ethical and other implications. It is impossible, in 10 minutes, to talk about this subject with the depth it deserves.

One of the reasons why this bill should be passed at this stage is that the question of euthanasia, assisted suicide, the end of life and the right to die with dignity is such a complex and delicate question that the Parliament of Canada, where the people send their representatives to discuss serious issues, need to look at it.

A second argument in favour of an affirmative vote is the need to clearly define the terminology. Very different terms are used in speaking about Bill C-384, An Act to amend the Criminal Code (right to die with dignity).

Every one of the 200 to 300 letters I received referred to euthanasia. Almost all these citizens asked me to oppose it and I accepted. I am clearly, categorically and completely opposed to euthanasia.

Yet, we should have a clear understanding of euthanasia. In all end-of-life situations, euthanasia takes place when the person who makes the decision to end the life is not the person dying. No other person, whether they are a health professional or not, has the right to put an end to the life of another person. One of the most famous recent cases was that of Robert Latimer, who ended the life of his daughter Tracy for compassionate reasons. I do not doubt Mr. Latimer's intentions, but his decision was unacceptable and the courts dealt with it as such.

In our society, no person has the right to decide to put an end to the life of another person. I read and reread the bill introduced by the member for La Pointe-de-l'Île. As far as I can see, it does not deal with euthanasia, but with the right to die with dignity. Implicitly and explicitly, this means that this right, if it were established, would be the right of the person who decides to exercise it and of no other person. In addition, this person would have to be competent and coherent.

To illustrate the need for clarity in our vocabulary, which is the second reason for an affirmative vote, we should note that the member for La Pointe-de-l'Île herself used the term euthanasia, in an article published in Le Devoir on April 15, when citing the position of the Collège des médecins du Québec. The Canadian Medical Association Journal suggests eliminating the use of the word euthanasia and instead having doctors refer to end-of-life assistance. The different terms used can lead to confusion, which should be avoided.

Here in the House, we talk of dying with dignity. Others talk about assisted suicide or even euthanasia. Maybe we are talking about the same thing, hence the need to define the terms. Let us try to have an enlightened debate, not a debate that leads to confusion. We will not clarify anything by refusing to study it.

For me, euthanasia means that someone else makes the decision to put an end to my life and I do not. I am opposed to that and I will always be opposed. However, if I was suffering from a degenerative, terminal disease and if I still had my faculties, I might like to seek the help of professionals who, on a voluntary basis only, could help me to end my suffering in a dignified and planned way.

Is that not something that a number of us would like to choose? I can say that many of my fellow Canadians would.

I would not like to impose my views on others. If someone else in the same situation, suffering, that is, from a degenerative, terminal disease, wanted to prolong his life to the extent that our science allows, I would respect his choice. And I hope that mine would be respected under similar circumstances, that is, that my life would be ended with the help of professionals and that those professionals could not be accused of having broken the law. That is what this is about.

Let us recall the case of Sue Rodriguez, who suffered from a debilitating, terminal illness. She asked that a qualified doctor be permitted to end her life at a time of her choosing. In 1993, let us not forget, the Supreme Court was divided on the question. The Court dismissed Ms. Rodriguez's request five to four. The majority justices based their dismissal of the request on the sanctity of life. The justices who supported the request felt that the right to freely end one's life was paramount. We can see that the debate had already begun in 1993, but the Parliament of Canada continues to avoid it.

Our society already recognizes and respects the will of mentally competent people, under precise circumstances, such as not being kept alive by artificial means or resuscitated if they previously indicated, according to established criteria, that they do not wish to be kept alive.

This is something our institutions take into consideration when they handle end-of-life management, and proper procedures have been put in place. The current approach was not established without a lot of debate, discussion, listening and serious consideration. The same is true of the notion of dying with dignity. We need in-depth debate. We have to consider the legal, economic, social, moral and ethical aspects of the issue.

We should give people an opportunity to come to Parliament—or better yet, the government should go to the people—so that they can express their opinions, share their points of view and add information they deem relevant to the debate. In my opinion, if we shut down the debate without that kind of discussion, we will not be meeting people's expectations or fulfilling our responsibilities as parliamentarians.

Parliament is a place for talking, for discussing, for considering, for learning and then for deciding and legislating. Society is already debating the issue of dying with dignity. I just hope that Canada's Parliament will participate in the debate, will help to structure it, contribute to it and facilitate it so that together, we can make a decision about how to proceed. To date, no government has been willing to launch this important debate. Members have made a few attempts to do so. Will we succeed tomorrow at second reading? I hope so.

I hope so, because I think it is our duty to ensure that Canada's Parliament participates openly, fully and respectfully in debates on important issues such as the one raised in Bill C-384. I therefore urge my colleagues to send this bill to a parliamentary committee so that it can do its work.

[Bill Siksay, NDP, Burnaby—Douglas, BC]

Mr. Speaker, I am very pleased to have the opportunity to speak in this debate on Bill C-384, An Act to amend the Criminal Code (right to die with dignity). I want to thank the member for La Pointe-de-l'Île for bringing it forward.

At the outset, I want to make it clear that I will be voting for this bill and that I support the right to die with dignity. This will come as no surprise to my constituents, since my support for such legislation is something I have made clear on many occasions, both before and after I was first elected.

I have heard from many constituents concerned about this issue and this particular bill. Here is how some expressed their concern. I am quoting from a letter I received: “There are many members of our community who live with disabilities, with terminal illness, with depression, and in various stages of physical or mental decline. They suffer and must not be pressured into feeling an obligation to die because they are burdens to others. They have a right to proper and adequate treatment, pain management, and compassionate end of life care. Euthanasia and assisted suicide, disguised as pain relief and meant to kill, have no place as optional treatment plans.”

I can agree with much in that statement but obviously not all. Any legalization of assisted suicide or voluntary euthanasia must not be about pressure. It must not be about making someone feel they are a burden to society or to their family. This is especially true for those with disabilities, those who are depressed or those with terminal illnesses. Treatment, care and pain management must be provided.

The fact remains that pain management does not stop all suffering. Palliative care does not ease all suffering. Despite the best medical treatment and care, some people still have an agonizing death. In those exceptional circumstances, I believe that allowing people the choice to end their own lives should be possible.

It is also true that protocols are now in place to allow this option for many people. Some call it passive or indirect euthanasia, describing the situation where doctors prescribe pain medication that places people in a coma and hastens their death. This is widely practised today in Canada but practised quietly, described by some as underground. It is often not directly acknowledged, which means it is available to some and not to others. The problem of legality also means that it is practised without real oversight. This is unacceptable.

Equally unacceptable to some people at the end of their lives is the practice of being sedated into unconsciousness and then denied food and fluids. Instead, they would prefer a clear personal choice for a dignified death. Like any piece of legislation, the bill before us today may not be perfect, but it is an important issue to debate and an important proposal to study. It is high time that it was on the legislative agenda of Parliament.

Sue Rodriguez, who in the early 1990s was living with ALS, famously asked the question, whose body is it, when she petitioned the Supreme Court for a physician-assisted suicide. She was ultimately denied in a close five-to-four decision. However, in February 1994, she did die at a time of her own choosing with the help of a physician. A police investigation resulted, but charges were never laid.

I remember that time very acutely because at the time I worked for the former MP for Burnaby—Douglas, Svend Robinson. Svend, everyone will recall, worked for years with Sue Rodriguez on the issue of physician-assisted suicide and was with her when she died. In my opinion, many acts of love and bravery were performed the day Sue died, by Sue, by Svend and by the anonymous doctor who assisted her. I was never prouder of Svend than when, at a press conference following Sue's death, he was asked if the highest duty of an MP should not be upholding the law and he responded that the highest duty of a member of Parliament is love.

I answered hundreds of phone calls in Svend's office after Sue's deaths, hundreds of moving, sometimes desperate, sometimes angry calls, but one in particular from a family investigated by the police for taking seriously a terminally ill loved one's questions about assisted suicide and euthanasia will stay with me forever. Just for discussing these issues in their family member's hospital room, they were reported to the police, who then visited them at their home. For some people the conversation is possible and results in the assistance they seek. For others, the conversation is not possible or results in other unacceptable consequences.

Palliative care and pain management are indeed issues related to this topic. We need to do more to ensure excellent palliative care is available to all. We need to ensure there is research and training in pain management. We know that when patients can be assured about those issues, most are relieved to know they will not suffer unduly. For many, that is all the insurance they need.

However, not all who have terminal diseases are guaranteed that they will not suffer terribly at the end of their lives and some of those people request assistance in dying.

Many opponents of dying with dignity note that the end of a life can be a time of reconciliation, when a strong sense of inner peace can be experienced, and there is no doubt about that, but it is also true that this is not always possible for every dying person. For some, there is no peace or reconciliation possible when they are subjected to terrible agony without the possibility of relief. In those cases, death may offer the only possibility of peace and reconciliation.

I believe it is possible to craft a law that works and provides appropriate safeguards. This has happened in other jurisdictions, in Belgium, the Netherlands, Luxembourg, Switzerland, and the states of Oregon and Washington.

Many people bring a theological perspective to this issue. Theologian Daniel Maguire has written extensively on the issue and he has said, “If you start out with the physicalist presumption, that only one's organic system can determine death in a way that is natural to humans, the discussion is stopped in its tracks. If however, you grant that it is natural for humans to deliberate about alternative possibilities and to pursue that course which commends itself to their reason, then death by choice can be discussed. It could in fact be seen as quite natural to humans whose distinctive dignity is their capacity for choice”.

He goes on to ask the question, “Why should disease, not the patient, have all the say?”

The legal perspective for allowing the right to die is also important to note. Supreme Court Justice Peter Cory's dissenting opinion in the 1993 Sue Rodriguez case should be remembered in this debate. He said:

The life of an individual must include dying. Dying is the final act in the drama of life. If, as I believe, dying is an integral part of living, then as a part of life it is entitled to the constitutional protection provided by s. 7. It follows that the right to die with dignity should be as well protected as any other aspect of the right to life. State prohibitions that would force a dreadful, painful death on a rational but incapacitated terminally ill patient are an affront to human dignity.

The bill before us is not about making the decision for others. It is about ensuring people who are dying have the ability to make choices about their own life and can exercise those choices with informed consent.

This bill talks about adult decision-makers who are lucid, those who are in physical or mental pain that cannot be relieved or those suffering from a terminal illness, those who have made the request twice, 10 days apart, freely and with full information from their doctor.

The bill provides that the medical diagnosis must be reviewed by an impartial medical practitioner with no personal interest in the death of the person. The bill gives the power to the patient to revoke the request at any time.

These are the reasons I am glad Parliament is finally debating this issue. I will be voting for this bill, and I hope it will proceed to committee where it can be studied in detail, where witnesses can be heard on its provisions and where improvements can be made as appropriate.

[Nicole Demers, Bloc, Laval, QC]

Mr. Speaker, I am very proud to rise today to speak to the bill introduced by my colleague from La Pointe-de-l'Île. I do so, because I know this member very well. I know that she is a sensible woman, a courageous woman, and above all, a woman with incredible intellectual integrity.

I do not know anything about medication. I am not a doctor. I have no legal knowledge about anything addressed in this bill. But I do have a lot of life experience, and I hope to be the voice of reasoning on this bill this evening.

I have a great deal of life experience, and have found myself in many different situations. That is why today I am perhaps more willing to pass this bill so that we can further discuss it. I say this because I realize that, in my circles, it is a difficult subject to discuss. I think it is difficult to talk about death in Quebec. It is a difficult matter to bring up. We are afraid of death. We fear death as we fear life. We are afraid of death because it is final, scary and we do not know what will happen afterwards. We are afraid of the unknown.

I have watched loved ones die. People I loved very much did not ask me to help them die because they were ready to die; they asked me to just listen to them talk about death.

In the early 1980s, I volunteered for Sésame, an organization that supported people living with AIDS. At that time, most people suffering from AIDS were terminally ill. They did not have the benefit of therapies to help them live longer with the virus without being so sick.

I remember one young man whom I was assisting. During his last days in hospital, he asked me to take him in my arms and to listen to him. Everyone who visited him in the hospital told him that it would be all right, that he would get better, not to worry and that everything would work out. It was not true. It was a lie. They tried to sustain the illusion. He was tired. He was ready to die but he wanted to talk about it openly. He died after telling me that he was ready to die and that he wanted to die, and after I had told him that it was all right and that I accepted that he was ready to die and that he wanted to die. I found it to be a moment of great tenderness and beauty because we had faced reality.

And I think that we are asking for that as well in this bill. Medicine has evolved to the point where people are living to 110, 112 or 115. I tip my hat to those who live to that age and are healthy. However, there are seniors in assisted-living homes who are not able to take care of themselves and who suffer constantly because of cancer or a degenerative disease. We keep them here and help them survive—not live, survive—and we do not give them the chance to choose. I think that this is criminal in a way. It is also a bit sadistic to allow people to suffer. If we know that a person has written a living will and that during their life that person decided they want to die when they are no longer able to stand the pain, I think that we should respect that right.

My colleague's bill establishes very specific guidelines to ensure that no one can go beyond that wish, so that no one, for example, could help a child die, since they would not understand. Nor could you help someone with intellectual disabilities die.

The person who chooses to do this must write their intentions twice in 15 days. It provides a moment to reflect, to take a step back and ask if it is really what they want. This moment ensures that the person makes an informed choice while lucid.

Contrary to what I have read in a number of emails that I have received, I do not believe that this bill will undermine peoples' lives. I do not believe that. I sincerely believe that this bill needs to be passed and studied in committee. It must be passed with all its clauses because they will rule out any mistakes. We cannot go beyond these guidelines.

A few years ago, I saw my grandmother die in the hospital at age 92. She worked hard her whole life. She was an exceptional woman. The year before she was admitted to hospital, she had redone her entire hardwood floor. She sanded and stained it by hand, by herself. She was a strong woman, even at 92.

When she was in the hospital and I went to see her, she told me she was tired. I asked the doctors and nurses how she was doing, how her health was, how she was feeling and what care they were giving her. They replied that she was receiving automatic injections of morphine to relieve her pain. I told myself that since they were giving her morphine, it meant that she was going to die soon. When someone is given morphine, their entire system shuts down. I was told that it was better for her this way.

Doctors and nurses know what they are doing. They know and they do this in certain circumstances in which they are not authorized to do it, but they know that if they do not, the individual will suffer needlessly for several months. These things happen. I think doctors would also be relieved to finally have legislation that allows them to end people's suffering, without facing any accusations.

This bill was drafted by an individual who reflected very carefully on the matter, who met with people and experts from everywhere to talk about and debate the issue, and who helped establish an organization that promotes this issue. I am sure that when she drafted the bill, she did not know that she herself would develop cancer, which she battled so courageously.

As long as one has a life to live and wants to live it, life should go on. However, when an individual can no longer endure the pain they are suffering, I want them to have choices. They should be able to say they want to die with dignity and ask for help in that regard.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Mr. Speaker, I am pleased to participate in today's debate of Bill C-384. The bill proposes to amend the Criminal Code to legalize euthanasia and assisted suicide.

This subject is a very difficult and sensitive one. It touches on the matter of medical ethics and the criminal law. The bill proposes that doctors be authorized to intentionally and actively terminate the life of a patient on his or her request. Under the current criminal law, such an act constitutes murder, or if the act itself, which causes death, is carried out by the patient himself or herself, it constitutes assisted suicide.

I do not support the general principle behind the bill. I do not believe doctors should be given the power to end a human life in this way. Bill C-384 offers death as a solution to pain and suffering. I do not believe that this is the right solution for Canadians.

People with serious but non-life threatening illnesses should be offered treatment and support. So too should people with severe mental pain. People with terminal illness should be offered good palliative care. As a society, we must support quality health care services for all Canadians, including care for the dying.

I fully appreciate how this issue is the subject of great divergent views in our society. Contrary to how some commentators may suggest, the various polls that have been conducted on this issue in Canada have not demonstrated a clear consensus for reforms along the lines of what is proposed in Bill C-384.

The polling questions have generally focused on terminally ill patients. Bill C-384 does not focus merely on persons who suffer from a terminal illness. The scope of the bill is extremely broad. It would allow people who are not in the process of dying to ask a doctor to end their life. It includes people who want to commit suicide due to illness.

Furthermore, the breadth of the proposed amendments is not limited to those who suffer from severe physical illness but also mental illness. On this point, serious concerns have been expressed by several hon. members on how the bill includes a number of vague terms that have not been defined, terms such as severe physical or mental pain, or while appearing to be lucid but left undefined.

I believe doctors would not be provided clear guidance with these proposals. I also believe it would have huge implications for the provisions of medical services, not to mention potentially serious conflict with medical ethical standards.

As another hon. member mentioned earlier in the second reading debate of the bill, the Canadian Medical Association has stated that it does not support euthanasia and assisted suicide. It clearly urges its members to uphold the principles of palliative care. The Canadian Medical Association's policy on this issue is unequivocal: Canadian physicians do not participate in euthanasia or assisted suicide. Furthermore it has specifically stated that it does not support Bill C-384.

We have also heard how the bill does not provide sufficient safeguards to protect against potential abuses and ensure proper reporting. Therefore, the use of vague terms, some of which I have just mentioned, along with the fact that the reporting requirement consists of providing a copy of the diagnosis to the coroner after the fact raises a concern that people's lives could be terminated without their true and informed consent or while they are in a vulnerable state.

Since the introduction of the bill, a number of petitions from Canadians have been forwarded to the House. Those petitions, numbering in the hundreds, possibly thousands, have urged the House of Commons to oppose the bill.

I have already mentioned that I cannot support the general principle behind this bill. I believe that the overall thrust of the present debate at second reading has pointed to serious concerns with this bill, both with the general scope of it and in terms of the many flaws contained in it. As a result of these broad concerns, I think it would be premature for the House to refer this issue to a committee for further study.

[Michael Savage, Liberal, Dartmouth—Cole Harbour, NS]

Mr. Speaker, I am pleased to have the opportunity to speak to this bill this evening. It is a bill whose progress I have followed with particular attention and the opportunity to speak tonight is one that I am very appreciative to have.

I want to say at the outset that I will not be voting for this bill. I do not support this bill and I do not support its intent. I do, however, want to commend the member, who has proposed this bill and who has led this fight, for her diligent work on this file, her sincere and informed opinion and understanding of this issue, but I believe it is one of those issues where people who have equal interests can have different points of view. It is a sensitive issue and it may well be an issue that needs a more fulsome debate in this country.

I want to speak to this bill from two points of view. I want to speak to it from a personal point of view. Like most members of the House, I have had experience with people who have died with dignity. It has had a profound effect on my life and the lives of my family and it has certainly had a profound effect on how I view this bill. I want to talk personally in a way that I would not normally about my own situation. I want to talk about my parents.

My parents both had cancer. I do not believe that cancer beat them. I think they beat cancer even though cancer took their lives. My father was diagnosed with inoperable cancer in July 2001. The prognosis was very bleak but he started an aggressive treatment of chemo. He had chemo treatments 24 hours a day and it worked. My father entered a remission period and had a remarkable period of remission in his life. While on remission, he visited Africa and Russia. He did the social development work that mattered very much to him. We felt as close to my father in that period as we ever did.

In November 2002 the cancer returned, and a few weeks later my mother was diagnosed with bowel cancer, one week before Christmas. I am one of seven children. My two sisters became full-time caregivers for my parents from Christmas 2002 onward. By mid-January, my mother was in palliative care, although she was at home, and our family was honoured to care for her. We cared for her in her home. On March 31, 2003, she passed away. Three days after her funeral, my dad was told that his chemo treatments were no longer advised and he came off chemo and entered palliative care as well. He passed away on May 13, six weeks to the day after my mother.

I tell this story because my parents died at home, in peace and sure that they were headed to a better place. We knew as their children that they were ready to leave this world. They both fought cancer with great courage and neither one of them were people to give up without a fight. They felt entirely in control, not only at the end of their life but in control of their death.

It is hard for anybody who has seen people they love die, like so many have, and not be impacted by that. I want to speak to how that impacts my view on this bill because my parents both made a decision. I can recall the conversation with my father when he said that he would no longer be eating. He was at home and he had decided that he would no longer eat. He knew he was ready to go. I do not think he ever actually said to us that he was going to die in two or three days but he was in control of that part of his life and he knew it was time. Likewise, my mother made those same decisions. The opportunity for us as family to be with them in those circumstances was an opportunity I cherished.

When I think about people my age with parents, it seems that one of two things happens. They either die in circumstances quicker than we would like or sometimes they take longer in their passing than they would probably like for the sake of their own family.

However, I do not believe that we needed this legislation to allow my parents to have control of their death. T go to a place that they were ready to go to was a decision that they made, were comfortable making and were able to make under the laws that existed and under what they considered to be the God that they were prepared to join.

I also do not like this bill because a number of people I represent in my capacity as the critic for human resources, particularly in the disability community, are very concerned about this bill. They do not know exactly where it will lead. At the very least, they think there should be a more serious debate about this before final decisions are made. It should be something that is consulted widely and taking into account the various levels of palliative care.

I do not think anybody here would say that our palliative care system is as strong as it should be. My parents went through this process in Nova Scotia. My father, as a medical doctor, had pioneered some of the palliative care back in the 1970s. He was at the bedside of many people when they passed away and was a big believer in palliative care. When he passed away we were very fortunate in that we are a reasonably well off family. We are not rich but we are comfortable. There are seven kids. Every day, every one of us would go and talk to our mom and dad and be with them when they needed help. We had a prayer session three times a day with a great gospel from the Benedictine monks called the The Glenstal Book of Prayer: A Benedictine Prayer Book.

We took great comfort from all of those things, but the palliative care system is not strong enough. Many people in Nova Scotia and in the rest of Canada simply do not have access to palliative care or even, in some cases, home care that we need to have. That is where I believe our efforts should be.

Let us look at what other nations are doing with the issue of euthanasia. Let us consider what supports we have for people in the community. The experience I had with my parents led me to believe that if there is one thing that we should all strive to have in Canada, and that we as parliamentarians should fight for, it is the opportunity for people to die at home if they wished to. Most people cannot afford that because its costs money to have night nurses and day nurses.

For us, because there were seven children and because we had parents who made it easy, we were able and in fact honoured to provide that service to our parents, perhaps as some small, tangible appreciation for all they had done for us.

Let us focus on palliative care and home care. Let us provide the supports that people need in their time of need. Let us be very mindful of people with disabilities, particularly people who are not always able to make decisions on their own and who rely upon others for support, guidance and the everyday aspects of their lives.

I do not support this bill. I truly do commend the member and I commend all people who have expressed their views on this debate. My view comes from my personal experience and my concern for people who are concerned that this bill might impact negatively upon their lives. For those reasons, I cannot support this bill.

[Jim Maloway, NDP, Elmwood—Transcona, MB]

Mr. Speaker, I am pleased to rise today to speak to this bill.

Having listened to the presentation by the member for Dartmouth—Cole Harbour, I find that my situation is remarkably similar to his.

Up to two or three years ago, I, too, like other members here, would have advocated for this type of bill thinking that it was a positive solution, but after my experience, which almost mirrors that of the previous member, of having had two parents who both had cancer at the same time, I came to the conclusion that this was not the way to proceed.

I do commend the member for bringing the bill forward because it is important to advance the debate. It is important that pain management issues and palliative care be advanced as quickly as possible.

We were lucky enough in the city of Winnipeg to have a fairly good system of palliative care, so we were able to take advantage of that in both of my parent's cases. While palliative care is well served in the Winnipeg region, I am mindful that half of the population lives outside of Winnipeg and I would expect that palliative care facilities are not available in a lot of those areas. We have a long way to go toward improving our palliative care centre. I am told that the situation in the rest of the country is not as good as that in Winnipeg. I am not sure whether it was the member for Windsor—Tecumseh but I know other members talked about how only 20% of the population in Canada is covered for palliative care in hospices and another 15% of the country is only partially covered.

In terms of jurisdictions, the member for Windsor—Tecumseh made an excellent presentation. He seemed to have the same sort of view as me, that while this was a good place to start the discussion, procedures are not yet in place to proceed with a bill such as this. He talked about other jurisdictions in the world where this is the practice. I have been aware of the situation in Holland for a number of years but I was not aware of the situation in Washington state or in Oregon. My colleague certainly talked about those in great detail. He explained that in the 12 years that the state of Oregon has had such legislation, 93 people were candidates but only 50 actually took their own lives. He indicated that the law was much newer in Washington state so there were smaller numbers to look at.

My colleague said that in Holland, for example, it was basically the frail and the elderly who were using this method and that the minister in charge of the legislation in Holland had actually changed her mind on the issue. This is a minister in the Government of Holland where such a practice is legal, who has inside information about how the system works in Holland, and she has changed her mind on the subject.

This is essentially a work in progress.

I am concerned about the point made by some members that if we were to adopt this measure, it would cut back the impetus to improve palliative care. As long as assisted suicide is illegal, the pressure will still be on governments and jurisdictions to develop palliative care as quickly as possible. If we passed legislation like this bill, then the pressure would be off.

The other major concern we have is people not feeling that they are free to make their own decisions. There will always be cases where mistakes are made. We do not want to develop a situation as I believe exists or may have existed in Holland, where it becomes a place for people from other countries to go to take advantage of the situation. That would develop the whole issue into an industry, almost a business venture. I do not think we want that kind of situation to develop.

Certainly disabled groups in the country have been very clear for many years that they think this is the thin edge of the wedge. They are, and I think rightly so, very concerned about this.

I served in the provincial legislature for 23 years. I do not think anybody, in 23 years, ever phoned my office or asked me to support legislation of this type. This is something we have to take a much more in-depth look at.

Another area that we have looked at is the whole issue of pain management. As the member for Windsor—Tecumseh mentioned, the doctors need more training. There needs to be more training done in the area of pain management. With proper pain management, people can manage a disease much more effectively than they can without proper pain management.

We do not need to have situations where there are people with a terminal disease and we do not have proper hospices and palliative care or proper pain management and people feel there is no way out and it would be so much easier for them to succumb to pressures, perceived or otherwise. The last thing we want is for people to feel they do not want to be a burden on their family any more and do not want to deal with pressure that they think is there. Maybe the pressure is not there, but they imagine it is. We should be encouraging people to fight as hard as possible to stay alive, with the proper pain management systems and proper encouragement. To me, it is a negative to be entertaining the idea that assisted suicide is an option.

I know other colleagues of mine probably would like to speak. The member for Edmonton—Strathcona and I have spoken about this issue before.

It is a very difficult issue for people, but it is something we all will have to face at some time. I think the time has come for us to rely on medical decisions and pain management issues and proper hospice care. That is the way we should look at it. That is the way we should move forward to develop a comprehensive palliative care system in this country so that we give people more options so that they, in their own minds, do not view assisted suicide as the only option available and choose that option when they perhaps should not be choosing that option.

[The Acting Speaker, Conservative, Barry Devolin]

Resuming debate. The hon. member for Timmins--James Bay will have three minutes.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, I am very proud to speak to this bill. I would say at the outset that I think the House of Commons is the place for this debate. I have received thousands of letters from my constituents who are deeply concerned about this issue.

This is a discussion that is worth having because the issue of suffering, the issue of death is perhaps one of the most profound issues we can deal with as a society. It touches each of us. Each of us is brought into the final moments of death at a level of intimacy and concern we never would have felt possible.

I spent much of the last three weeks with my father at the palliative care centre in Scarborough General Hospital. I want to say on the record that the palliative care that exists in this country is second to none. Two years ago I spent time with my brother-in-law as he lay dying at Perram House in Toronto. The experience I had there had a profound impact on me and my whole family and our understanding of this.

The question before us today is what we should be doing as a society. It is an issue that cuts to the very essence of this House of Commons. We need to bring forth the option of saying we have to maintain the ability of Canada's health care system to manage pain for people in palliative care so that they can go through that final journey.

It is possible to do it without taking the option of saying we have to go the assisted suicide route. I understand why people might believe that is an option, but I do not believe it is the option we should be taking as a society. To take that position and for us to vote on this in the House of Commons means more than making a statement. We have to provide the resources necessary so that our medical systems and our families have the support they need. Otherwise we will be leaving the sick, the suffering and the dying in a situation in which they should not be left.

It is possible to have good pain management. It is possible to treat people with dignity right through the final moments. However, that has to be a decision we make as a society and a commitment we make to each other that we will be there as a society, we will be there with the medical system, we will be there as family and we will be there as a community.

This debate has reminded us of the need to make that commitment. I hope this House of Commons will make that commitment when the time comes to vote.

[The Acting Speaker, Conservative, Barry Devolin]

The hon. member for La Pointe-de-l'Île has a five-minute right of reply.

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

Mr. Speaker, I would like to start by thanking all my colleagues who took part in the debate, but I want to say that palliative care and my bill on the right to die with dignity are not mutually exclusive, but complementary.

I wrote something in 2005, before I learned I had cancer. I wrote this, and I still believe wholeheartedly in it:

Any lucid person facing a very difficult and painful end of life, which they consider degrading, an unfitting end to the life they have led, inconsistent with their condition as a free person, has to be able to decide how they wish to die, including if they want to be aided in that objective.

It is the individual who must choose. It is not society that must choose for the individual. The individual must have the freedom to choose at the end of their life.

The experience of doctors who look after individuals who have been allowed to be helped to die in countries that have passed legislation in this regard is enlightening. One might infer that, knowing that they will be able to get help to die with dignity when they reach the point where their life has definitely become unbearable, it will be easier for people to live fully a painful end of life or a life of extreme limitations because they feel imprisoned in their bodies. As Félix Leclerc reminded us, death is full of life.

I could quote Justice Cory, who also says that section 7 of the charter gives Canadians the constitutional right to life, liberty and security of the person. This provision emphasizes the dignity inherent in human existence. Death is an integral part of life and as such is therefore entitled to the constitutional protection provided by section 7. A person should have the right to choose their own death.

I understand why my colleague's parents made the choice they did. His father was a doctor. It was their choice. Nonetheless, sometimes the end of life comes after a period of extreme suffering and at a time when people can decide they no longer can tolerate their life, their dependence on others and their unending suffering. I have sent hon. members a text a constituent sent me on what it is to suffer and I invite hon. members to read it. People can decide their limits and ask for assistance to die and not to live for another month or two just to suffer more and become more emaciated.

I can tell you that when I wrote that, I did not know what unbearable pain was. Now I do and I have learned that medicine, with all its progress, can only provide help with side effects such as hallucinations or other terrible effects to the body. We have to have the right to choose. I am speaking on behalf of the vulnerable. They are the ones who need this type of legislation the most because only this type of legislation will allow them to be the people they choose to be. There are currently many places where people can die and with all the instruments available to doctors, it is possible to help people die without them having to ask.

A person's right to choose is what is at the heart of this bill. I am asking hon. members to vote in favour of this bill in order that it may be referred to a committee. Then members of the committee could examine what seems—

[The Acting Speaker, Conservative, Barry Devolin]

It being 6:28 p.m., the time provided for debate has expired.

The question is on the motion. Is it the pleasure of the House to adopt the motion?

[Some hon. members]

Agreed.

No.

[The Acting Speaker, Conservative, Barry Devolin]

All those in favour will please say yea.

[Some hon. members]

Yea.

[The Acting Speaker, Conservative, Barry Devolin]

All those opposed will please say nay.

[Some hon. members]

Nay.

[The Acting Speaker, Conservative, Barry Devolin]

In my opinion, the nays have it.

And five or more members having risen:

Pursuant to Standing Order 93, a recorded division stands deferred until Wednesday, April 21, 2010, immediately before the time provided for private members' business.