Bill C-14 (Historical)

An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

This enactment amends the Criminal Code to, among other things,
(a) create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing, in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process;
(b) specify the eligibility criteria and the safeguards that must be respected before medical assistance in dying may be provided to a person;
(c) require that medical practitioners and nurse practitioners who receive requests for, and pharmacists who dispense substances in connection with the provision of, medical assist­ance in dying provide information for the purpose of permitting the monitoring of medical assistance in dying, and authorize the Minister of Health to make regulations respecting that information; and
(d) create new offences for failing to comply with the safeguards, for forging or destroying documents related to medical assistance in dying, for failing to provide the required information and for contravening the regulations.
This enactment also makes related amendments to other Acts to ensure that recourse to medical assistance in dying does not result in the loss of a pension under the Pension Act or benefits under the Canadian Forces Members and Veterans Re-establishment and Compensation Act. It amends the Corrections and Conditional Release Act to ensure that no investigation need be conducted under section 19 of that Act in the case of an inmate who receives medical assistance in dying.
This enactment provides for one or more independent reviews relating to requests by mature minors for medical assistance in dying, to advance requests and to requests where mental illness is the sole underlying medical condition.
Lastly, this enactment provides for a parliamentary review of its provisions and of the state of palliative care in Canada to commence at the start of the fifth year following the day on which it receives royal assent.

Criminal Code

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, this is such an important debate that we are having here today, and I thank members for sharing their stories.

This is a very personal debate. I recall speaking on Bill C-14 when I first joined Parliament. I talked about my own experiences with death. I have watched other families go through these issues as well. We talked about how we could be part of making those last few days, months, and sometimes years work well and make sure of the necessary resources.

I am coming to this debate speaking from two sides, and am almost sitting on the fence on this. I am bringing forward a letter from Richard Sitzes, who is the chair of Our Choice Matters, part of Community Living Elgin. I would like to read this letter into Hansard, because I think it is very important to hear the voices and concerns of those who are disabled. I am also going to read some Twitter posts from the late Mike Sloan. Other people have covered this, and those in London would know that Mike Sloan passed away on January 20, 2020, with medical assistance in dying. He had a very difficult time, but he shared his experiences through his Twitter feed. Because of my work here in Parliament with those with disabilities, I had started a relationship with him and discussed what life looked like and how we were to move forward.

I will begin with the letter from Richard Sitzes, chair of Our Choice Matters, which is a self-advocate group. He writes:

I'm a constituent in your riding and live in St. Thomas, and am very concerned about Bill C-7 and the changes to Canada's law on medical assistance in dying (MAID). I'm worried about the negative impacts this bill will have for people who have a disability in our riding.

As chair of the Our Choice Matters self advocate group, supported by Community Living Elgin, I am speaking on behalf of our group. In Canada, many people think that their having a disability causes suffering, but people who have a disability say that it is the lack of supports, not disability, that causes them to suffer. We fear that Bill C-7 will make this situation even worse.

Right now, Canadians can only access MAID if they are suffering and close to death. Bill C-7 will make it possible for a person who has a disability to choose medical assistance to die, even if they are not close to death. We strongly believe that removing the end-of-life requirement will increase negative ideas and discrimination against people who have a disability. It will grow the idea that life with a disability is not worth living. We are afraid that people who have a disability will feel pressured to end their lives even if they are not close to death. This has already happened in Canada, and it will get worse because of Bill C-7.

We believe that the federal government should make it easier for people with disabilities to live good lives, not end them. For the safety of people who have a disability, MAID must be available only to people who are close to death. We strongly oppose Bill C-7 and ask that you oppose this legislation.

I was fortunate to follow up on this letter with Richard last week. He has been a volunteer, not only in my office but in our community, for decades. He is a person we see at every volunteer opportunity. He is there at community events to lend a hand. He looks at his life and recognizes that he has so much to give to our community. I have never met a kinder soul in my life. He just wants to help and at the same time wants to be heard. Having had the opportunity to sit down and talk to Richard, I know his concern is that he will not be the person making that choice, but that it will be made for him. He told me that he did not know who would have the final choice. This is something that Richard, who just celebrated his 60th birthday on August 15, is very concerned with. When I look at Richard, I do not see his life as being worth any less than mine. He has so much to offer to all Canadians. I hope we recognize it is imperative that we have appropriate safeguards for people like Richard who have so much to offer.

On the other side, there are some positives as well. This is where I want to talk about Mike Sloan. He was able to share with Canadians, especially in my region, his everyday struggles of living with cancer. As I indicated, I had created a bond with Mike over the last number of years. When he called to tell me he had cancer, the two of us talked about what he would be going through.

Mike had decided that he was going to die with medical assistance. Watching his death, I can understand why. I understand the struggles that he went through, and want to read some of the things that were put on his Twitter feed.

Madam Speaker, how much time do I have, given that I talk so much?

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, allow me the opportunity to reflect on what has brought us to this point.

Shortly after the 2015 election, a number of pieces of legislation were brought before the House. One of those pieces was Bill C-14, a direct response to courts and the many concerns Canadians had with regard to the issue of dying with medical assistance. The issue was thoroughly discussed and debated. A lot of dialogue took place inside and outside the chamber, and, in fact, across the country. The number of Canadians who were engaged in the legislation was extraordinarily high. That was reinforced earlier this year, but I will get to that particular point later.

Back in January or February 2016, there was a great deal of dialogue taking place. Bill C-14 ultimately passed just prior to the summer break, in June 2016. At the time, parliamentarians recognized that there would be a need to make some modifications. In fact, within the legislation we passed, we created the opportunity for us to review it.

It should come as no surprise to anyone that the issue continues today. Even without legislation, dialogue has been taking place among members of Parliament and constituents. I have had ongoing feedback on the issue, in particular through emails, since 2016. People have expressed concerns and issues with the legislation.

The Superior Court of Quebec made a determination on the legislation, which ultimately dictated that we had to bring in Bill C-7. We had initially introduced the bill earlier this year, I think in February. Prior to its being introduced, Canadians were once again formally called upon to provide their thoughts on the issue. It was amazing that in a relatively short time span, we heard from in excess of 300,000 Canadians. People from all across the nation responded to provide their thoughts and ideas on what they would like to see the government and members of Parliament deal with on this very important issue.

We were very hopeful that a committee would have the opportunity to meet and review the legislation, with the idea of looking at ways it might be changed. Then came the pandemic. As we all know, the focus and attention of Canadians changed, just as the House's priorities had to change, in order to respond to the COVID-19 pandemic. As a direct result, we lost the opportunity for that parliamentary group or committee to get together to review the past legislation, and in fact even the legislation that was being proposed in January or February.

Fast-forward to where we are today. Bill C-7 responds to a decision of the Superior Court of Quebec. It is a reasonable and acceptable piece of legislation that, in this form, makes some changes. It deals with some very difficult issues. For example, it drops the number of days of waiting from 10, after a person is approved and in a near-death situation. I believe this will generally receive good support from all sides of the House. There is the reduction of witnesses from two to one. From what little debate there has been thus far, I believe this has the potential to receive good support. The criteria that a person's death must be reasonably foreseeable is an issue that no doubt will be talked about at great length, both in the chamber and at committee. There are other aspects of this legislation that I find very compelling, and I am very interested to hear what people have to say about them.

A big concern I have is the idea that someone is able to provide consent today but, as an illness or a disease continues, might be prevented from being able to give consent knowingly later, thereby disallowing them from having medical assistance in passing. I know many Canadians share that concern. I am expecting to see a good, healthy discussion on that, whether inside the chamber, in committees or in our constituencies, where we receive feedback.

There is the issue of mental illness and the severity of it. This area is worth ongoing exploration, in different ways. As a former member of the Manitoba legislative assembly, I remember that often when we talked about spending money in health care, mental illness was nowhere near being part of the discussion. In fact, it was a very dear friend of mine, Dr. Gulzar Cheema, who raised this issue at a time when very few people raised it. In general, it is something we need to debate more.

I suspect that as we continue the debate, whether in the chamber or at committee, we will see that it is very emotional for a number of people. I know first-hand how important palliative care is, through the experience of the passing of family, in particular my grandmother and my father. I am very grateful for the Riverview Health Centre in Winnipeg for the service in palliative care they provided. To be there at the passing of my father meant a great deal for me personally, as I knew that when he was there he had the love and care of professionals who deal with people who are passing on. A person has to have a very special heart to deal with that. I had a similar experience with my grandmother, at St. Boniface Hospital. They are two totally different institutions, but the thing they have in common is the supports that are there.

I believe we need to do more in the area of palliative care, and I would love to see more discussion, more debate and more action on the issue. I believe the federal government has a role to play in that area too.

To conclude, I will emphasize for members that here is an opportunity for us not only to look at the core of the issue and have discussions, but to look at some of the issues surrounding end of life and the circumstances that, either directly or indirectly, we are all somewhat familiar with.

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, I want to confirm to the House that the parliamentary secretary, in his speech, spoke the truth when he said that the Liberals got it wrong, because the Liberals did get it wrong. I was on the justice committee with the hon. member when Bill C-14 was before it, and the Conservatives presented over 100 amendments that would have strengthened the bill and provided proper safeguards, all of which were rejected by the Liberal government of the day. One thing that did get passed was the requirement for a mandatory review after five years, but the government has circumvented the requirement with a few consultations, which is completely inappropriate and should be unacceptable to the House.

Health care professionals in my riding are continually asking for better health care conscience protection rights for health care professionals. They have looked at the legislation and do not feel it is there. We have heard the Liberals argue that it is there and that it is adequate, but the health care professionals in my riding, including doctors and nurses, say it is not adequate. I would like the member to respond to that.

[Chris Bittle, Liberal, Parliamentary Secretary to the Minister of Transport]

Madam Speaker, before I begin, I would like to state that I am splitting my time with the hon. member for Winnipeg North.

We have a serious issue before us, the issue of Bill C-7. It has been an excellent debate so far and an excellent opportunity for members on all sides to talk about this issue because it goes to our morality and to our own conscience, and we are hearing from all sides about this. I want to say that we got it wrong with the last piece of legislation; we got it wrong with Bill C-14. I want to commend the Attorney General for coming forward with Bill C-7.

I would also like to recognize a few members who were vocal advocates, working on the justice committee with Murray Rankin at the time; the hon. member for Saanich—Gulf Islands; my friend, the hon. member for Don Valley West and many other members of the Liberal caucus who tried to advance medical assistance in dying so that it would be constitutional.

I am here today to speak in support of Bill C-7, which proposes amendments to medical assistance in dying legislation. Members are aware that the Superior Court of Quebec found the eligibility criterion of reasonably foreseeable natural death from the Criminal Code made legislation to be unconstitutional. The court delayed the effect of the ruling to allow both the federal and Quebec legislatures to respond. The government has agreed with this basic principle of this decision and is now proposing to amend the Criminal Code.

Bill C-7 proposes to repeal the requirement that natural death be reasonably foreseeable. It would create two sets of safeguards: one for those whose death is reasonably foreseeable and another for everyone else. Some of the existing safeguards for those who are dying would be relaxed, and for everyone else there would be a different set of safeguards based on the current ones with some additions and clarifications.

Bill C-7 proposes to continue to use the expression, “reasonably foreseeable” natural death, but as an element that determines which set of safeguards to use and not to use it as an eligibility criterion, which was the issue in the Truchon case.

The proposal to distinguish MAID requests on the basis of whether a person's death is reasonably foreseeable is consistent with the view that MAID for people whose death is reasonably foreseeable presents less risk and complexity than other circumstances, and that the assessment of requests should be tailored to these different types of cases. Having a reasonably foreseeable natural death would also be a critical element for another proposed amendment in the bill. Currently, the MAID law requires the practitioner to give the patient the opportunity to withdraw consent or to affirm their consent just before MAID is provided.

This requirement for final consent is a safeguard; however, it has also caused some MAID patients to choose to end their lives earlier for fear of losing their capacity to provide final consent and, sadly, for some to be denied MAID entirely after losing capacity. I would also like to point out that others chose to decrease their intake of painkillers prior to MAID being provided, to ensure they retained capacity to consent, which leads to an increase in suffering.

BillC-7 would allow for a possible waiver of requirement for final consent for individuals whose death is reasonably foreseeable but where there are fewest risks and complexities in providing MAID to a person who is no longer able to consent. Permitting this proposed waiver of final consent would respond to scenarios like that of Audrey Parker of Nova Scotia, who was diagnosed with terminal cancer that had spread to her brain leaving her uncertain as to how long she would have the capacity to consent. Because she feared losing capacity before her preferred date to receive MAID, she scheduled MAID and ended her life earlier than she wanted. She openly expressed how she felt unfairly forced by the limitations of the MAID law to schedule MAID sooner than preferred and called for amendments to the Criminal Code so that others like her would not be denied the freedom to choose their preferred date to receive medical assistance in dying.

I would recommend that all members listen to the speech in the previous session from the hon. member for Dartmouth—Cole Harbour. I believe Audrey Parker was a constituent of his. He powerfully used her own words to show us where we went wrong, the impacts our failures in the previous legislation had led to, and the impacts on her life. We owe it to people like Audrey Parker, who have been assessed and approved for MAID, to respect their need for freedom in making end-of-life choices. As a compassionate society, we know we can do better to support these individuals. These amendments seek to do just that.

Waiving final consent is, however, an ethically complex question. This is because it involves MAID being administered to a person who is no longer able to consent, or to withdraw the consent they previously gave. Bill C-7 proposes a new approach for patients whose death is reasonably foreseeable, who are assessed and approved for MAID when they have the capacity, and who make very specific arrangements with their practitioner in which they give consent in advance to MAID being administered on a specific day, even if they have lost capacity by that day.

I fully support permitting advance consent for this group of individuals, but at the same time, I note that certain protections must be in place. Specifically, if on the specified day for MAID, the patient has lost their capacity and they nonetheless actively show signs of resistance to the MAID procedure, or behave in a way that indicates a refusal, the practitioner must not follow through on the procedure.

Medical practitioners at the round table expressed concerns in relation to the emotional burden that could arise from such situations, for them and for family members. They talked of possible disagreement with family members on whether to end the life of a person who appears to resist the procedure. A similar situation led to the prosecution of a MAID provider in the Netherlands and made headlines around the world. That situation is what we wish to avoid here in Canada.

That is why Bill C-7 proposes an additional provision that states that signs of resistance from the patient would make the advanced consent invalid on the specific day and going forward. While an incapable person could no longer withdraw their consent from a legal perspective, given their track record and decision-making capacity, it is proposed that MAID not be permitted under this circumstance. The approach provides much needed clarity for practitioners and family members that MAID be prohibited if the patient is resisting. The bill would also make it clear that an anticipated reflexive response, like flinching when the needle is inserted, does not count as resistance.

It is important to be clear, however, that this amendment is not about advance requests. Advance requests for MAID refer to a situation in which a person puts in writing they would want to receive MAID at some later date when they are not able to consent to it, if circumstances arise that they predict would cause them unbearable suffering.

In this situation, a person is not asking for MAID now. Instead, they are putting in writing that they want it at a later date on the basis of anticipated suffering that has not yet happened. The most likely scenario would involve people who are diagnosed with conditions that could lead to dementia, such as Alzheimer's. These people would want to have a plan in place if their worst fears should come to pass.

Bill C-7 does not propose to allow MAID on the basis of advance requests. MAID in these circumstances would be extremely complex, would avoid ethical challenges and would require more time to consider such measures. In speaking to the Attorney General, I voiced my concern that we need to spend more time considering these measures. I hope that the issue will be studied during further upcoming parliamentary review of the MAID legislation.

Taking more time to study advance requests is consistent with the approach of the Government of Quebec, which is also moving forward to hold public consultations on the issue so that all of its dimensions can be better understood.

MAID is one of the most sensitive and challenging social issues we are currently faced with. Recognizing how deeply personal this issue is to so many people, and to so many members of this place, the government has listened carefully to the diverse opinions of Canadians and has considered the expertise shared by experts, MAID providers and other experts in the development of this important piece of legislation. Bill C-7 responds to the Superior Court of Quebec ruling, but it also achieves balance that respects personal autonomy, while protecting the vulnerable as well as equity rights for all Canadians.

For these reasons, I call on all members to support the bill.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, these are absolutely the kinds of supports that are needed, but the reality is that they are not actually in place everywhere. This makes a huge difference.

I will give an example from the first year after Bill C-14 came into law. Sarnia—Lambton has a huge capacity for palliative care. We have a hospice with 20 beds. There are also beds in the hospital, and we have home care. We have an integrated palliative care system. There were two requests for medical assistance in dying in the first year. London, just an hour away, has a population that is about three times larger than Sarnia's population. It had 300 requests for MAID because it does not have adequate palliative care services.

The government can help out with establishing hospice. The virtual palliative care work that has started is very helpful, especially in rural and remote areas, but it of course requires broadband Internet access. The government can also use some of the successful models, like using paramedics in their off hours, to deliver palliative care. These things could really boost the existence of the supports people are being counselled about, and then people could take advantage of them.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I am happy to have the opportunity to rise today to speak to Bill C-7. It is a very serious matter. As the member for Fundy Royal just mentioned, it is a matter of life and death. I was part of the debate on the original bill, Bill C-14, and I am familiar with a number of the issues with that bill.

It is very disturbing to me. I understand with the Quebec court decision the government had to make a response of some sort, but the previous bill required them to do a fulsome parliamentary review, which was supposed to take effect this past summer. The government refused to let Parliament sit this summer and do the kind of fulsome work that needed to be done.

It is actually quite irresponsible that when the government introduced Bill C-7, instead of just addressing what was time sensitive in responding to the Quebec decision, it went further and took actions without doing that fulsome review of how things have been going with Bill C-14 in the last number of years.

For those watching at home who are not familiar with Bill C-7, the bill would repeal the provision that requires a person's death to be reasonably foreseeable. In addition to that, it would specify that people whose sole underlying condition is mental illness are not eligible for medical assistance in dying. It would create two sets of safeguards that have to be respected before medical assistance in dying can be provided to a person, and it would permit medical assistance in dying to be provided to a person who has been found eligible to receive it and whose death is reasonably foreseeable but who has lost the capacity to consent before the medical assistance in dying is provided. That is sort of an advance consent, and we will talk a bit more about that.

Bill C-14 was not without some issues that were not addressed in the previous legislation and will probably be considered in the fulsome review. There was a question about whether minors should be able to receive medical assistance in dying. There was significant discussion about advance consent. A lot of Canadians were demanding it, and I will talk a bit about some of the considerations that may have kept the government from moving ahead at that time. There was discussion of those who are not mentally competent to give consent. There have been a number of speeches today mentioning people with dementia, for example. That is another area where there was work done by the Council of Canadian Academies, the CCA. It did fulsome reports on a number of these things, and I will talk a bit about what was found.

There was discussion today about the protection of conscience rights, and I do not agree necessarily with the Parliamentary Secretary to the Minister of Justice. I see the charter provisions that were put into Bill C-14, but forcing somebody to refer, when they do not want to have anything to do with the process at all, is actually violating their rights. I am not a fan of violating one person's rights to give another person their rights. That is not good, so we need to have more discussion about that.

In its report, the special committee that studied the Carter decision said that, without good-quality palliative care, people really cannot make a true decision. They really do not have a choice. Obviously I have been an advocate for palliative care. My private member's bill, Bill C-277, on palliative care, was unanimously passed in the House and in the Senate. The government did a good job of putting the framework in place to get consistent access for all Canadians to palliative care.

The problem is that, once the framework was in, the government has since really not pushed ahead. There are 70% of Canadians who have no access to good-quality palliative care. Especially in the time of COVID, where people are dying, it is becoming even more important. The government needs to take action to up its game on palliative care to make it more available to Canadians.

There is an opportunity and a responsibility for the government to show leadership in how palliative care is being implemented in Canada. Right now, for example, British Columbia is violating the World Health Organization's requirements for where MAID should be performed. It has specifically said that palliative care is a different thing from medical assistance in dying and that they should not be performed at the same location because of a tendency by people wanting palliative care to be afraid that they will accidentally receive medical assistance in dying against their wishes. There is an opportunity for the government to revisit that and I am hopeful that it will.

With respect to the Council of Canadian Academies, many issues were studied. On the advance directives and advance consent issue, we see in this legislation that the government is allowing people who believe their conditions are going to decline and are eligible to receive medical assistance in dying to have a 90-day advance consent. It is not clear to me in the legislation when the 90 days start. Is it when patients first have discussions with their physicians? When does the clock start? That is a clarification that is needed in the legislation.

When the council looked at advance directives, it said there were a few difficulties. The first one was how to prove people have informed consent, what the criteria are and what the definition is of that. Therefore, that would have to be addressed. Who decides what is intolerable suffering, especially if the person has lost capacity? That is another question that needs to be and should be considered in this fulsome review that is required and that I would have preferred to have had before this bill came forward.

As a point of information, Belgium and Luxembourg only allow an advance directive when a person is permanently unconscious. That is the only way they will allow a person to have an advance directive in place: If they become permanently unconscious, they will receive medical assistance in dying.

On the issue of minors, “mature minors” would have to be defined. In Quebec, that is defined as people aged 14 to 17. However, we have to make sure they have the capacity to make medical decisions and confirm they understand that it is voluntary and they are not under duress. There are not many jurisdictions that have extended this to mature minors. The Netherlands does allow people aged 12 to 16, with parental permission, to have medical assistance in dying, and those aged 16 to 18 with parental consultation. Belgium allows it if the person is terminal, but pediatric palliative care has to be provided as an option. Therefore, there needs to be further discussion on that one.

Then there are those who suffer from mental illness. I was very pleased to see that it is clear in this legislation that they would not be eligible. It was very controversial. The council that studied it could not agree. There was discussion about the capability for informed consent and the fact that people with depression could have good and bad days and may change their minds, which again points to the need for some kind of cooling-off period. The Netherlands allows this but for dementia only, and there is still a lot of controversy about that.

The safeguards that were in the bill originally seem to have been removed. I am not a fan of doing that because I would say that if we remove the conditions that have to be met in order to get something, more people will take advantage of it. I am concerned with a broader creep on this, but I am sure there will be fulsome discussion about this at committee.

In Canada, everyone has the freedom to express themselves, to believe what they want and to choose what they want, and we should treat everyone's individual choices with respect.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I will be splitting my time with the member for Sarnia—Lambton.

It is my pleasure as shadow minister for justice for the official opposition to use this opportunity to speak to the proposed legislation before us. It is important legislation. We have been hearing points from both sides of the House on Bill C-7, which impacts many Canadians. In fact, it impacts us all. This is a piece of legislation that deals with life and death, and there is probably nothing more important that we could be talking about today.

Any time we, as legislators, are asked to review and analyze legislation like this, it is critical that we take the time to get it right, and this is part of the problem. As we have heard many times over the course of the last year, we should not be dealing with this legislation today because the Minister of Justice and this government should have appealed that decision.

This is what was being called for by those in the medical community, those in the disability community and individuals across the country after that decision came out in Quebec. The right thing to do, which is what our party, the Conservative Party, called on the government to do, would have been to appeal that decision.

What we have been left with is a patchwork across our country. We have been left with confusion. We should have had the certainty of an appeal to the Supreme Court of Canada on something this important. Instead, the government took the Superior Court of Quebec decision, responded to it and, in my view, went far beyond what was required to respond to that decision. I will discuss some of those things.

The bill was introduced as a response to a Superior Court of Quebec decision made on September 11, 2019. That decision found that the law was too restrictive in the requirement for death to be reasonably foreseeable in order to access medical assistance in dying. At the time, we called upon the government to appeal this decision to the Supreme Court.

As we debate the bill before us, we still do not have the clarity that we could have had if the government had appealed that decision. Rather than defend its own legislation, this government has used this as an opportunity to broaden assistance in dying legislation in this country without doing the fundamental consultation and homework necessary to get an important decision like this right. Even in the previous legislation, Bill C-14, there was to be a mandatory review of assistance in dying legislation and what flowed from it, which was to take place this past summer. This government circumvented all of that with this new legislation.

When the government passed Bill C-14 in the 42nd Parliament, it required this review to be conducted this year. The review was to analyze the state of assistance in dying in Canada in a comprehensive way, and instead of waiting for that, we see with this legislation the government going far beyond what had to be done to respond to the Quebec court decision.

This topic is a very sensitive issue for many in the House who have personal experience with it and, indeed, it is a sensitive issue for many Canadians. We ask that all members on each side of the House be aware of this. While there may be disagreements, we are each here to represent our constituents and arrive at legislation that best protects Canadians.

I have heard directly from many Canadians who are concerned about the lack of protection for conscience rights for health care professionals in both the bill before us and the original MAID legislation. As the government looks to broaden the legislation further, it becomes even more important that the conscience rights of health care professionals are protected. By further expanding medical assistance in dying, the government risks reducing the number of medical professionals willing to take part in this process. It is also important to note that this expanded access could result in a heavy emotional burden on those health care providers, as we head into uncharted territory with the bill.

We, as members of Parliament, cannot appreciate the burden that this has put on health care providers who are working in this system and providing medical assistance in dying.

Further, there are very few protections in place for medical professionals who do not want to participate in the process and may be penalized, as a result, by an employer. This is a point that I raised when Bill C-7 was introduced earlier this year, and it is disappointing to see that it was not corrected in this version of the bill.

This brings me to my next point about standing up for Canadians with disabilities. The 10-day waiting period, which could already be waived in the legislation for extenuating circumstances, has been removed. I heard the chief justice say today that removing the 10-day waiting period was universally accepted in his consultations across the country. I wonder who he has been talking to.

Yesterday I spoke with a group that represents those with disabilities across the country at Inclusion Canada. Those in that group said that they are in favour of maintaining the 10-day waiting period, and their role is to stand up for individuals with disabilities. It is interesting to note that they called on the minister of justice at the time to appeal the decision of the Quebec court. They said that medical assistance in dying must have limits. Individual rights must be balanced with protections, not only for our most vulnerable citizens, but also for society as well.

One of the most important foundations of our Canadian society and identity is that we are a caring, compassionate country. For those with disabilities, their experience now is that they are told, often bluntly, that they would be better off dead. The Foley case in London, Ontario, is one example of this. This decision, if it remains unquestioned, will simply erode provincial health responsibilities for expert clinical care and social support for people who are fragile.

The Minister of Justice would also be familiar with a letter written to him on October 4, 2019, which was signed by over 70 organizations that stand up for Canadians with disabilities from coast to coast to coast. They wrote that they found the decision by the Superior Court of Quebec to be very concerning. One of the reasons for this concern was that the decision failed to respect Parliament's authority to balance the interests of the individuals with the interests of society, effectively limiting Parliament's capacity to pursue social targets, such as substantive equality and inclusion.

They describe the decision as a dangerous precedent, writing, “The Supreme Court must weigh in on this flawed analysis. The decision will entrench stereotypes and exacerbate stigma further for Canadians with disabilities.” The letter continues, and I agree, “[We] must avoid sending a message that having a disability is a fate worse than death.... Canada must appeal the decision to prevent additional stereotyping”. The letter concluded by urging the government to appeal the decision to the Supreme Court.

Again, the letter was signed by over 70 organizations, including the Council for Canadians with Disabilities, the Canadian Association for Community Living, Disability Law Centre, People First of Canada and the Canadian Mental Health Association. I mention this because it underscores how we need to get this legislation right.

Last November, the Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Care Physicians issued a call to action due to ongoing confusion in the general public regarding hospice, palliative care and MAID. Quite frankly, palliative care focuses on improving the quality of life and symptoms through a person-centred approach for those living with life-threatening conditions.

The federal government should be looking for ways to improve further palliative care across Canada, as was committed to many times by the government. In their call to action, the groups I mentioned state, “Less than 30% of Canadians have access to high quality hospice palliative care, yet more than 90% of all deaths in Canada would benefit from it.”

I want to stress my previous point that this is an important issue for many Canadians. On matters of literal life or death, we need to take our responsibilities as legislators—

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, I believe it was taken out because, in terms of practicality, it served no purpose. The Minister of Justice and many of our colleagues heard from families, now that we have been living with Bill C-14 for over three years, about the 10-day period. Patients who have already made the decision that they need medical assistance consulted with their doctors, nurses and families about that extra 10-day period. Why is not 15 days? Why is it not five days instead of 10? They said it served no purpose.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, the previous bill required two witnesses and this bill only requires one witness. This was actually raised with the Minister of Justice. I believe this will correct the issues that arose from the previous bill, Bill C-14. The current bill strikes the right balance to make sure there is access to a doctor or nurse who has knowledge of the particular patients in question.

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

Madam Speaker, my question for my friend from Glengarry—Prescott—Russell is with respect to advance consent. The legislation provides for advance consent in certain circumstances in which a patient might lose their capacity.

When we studied the issue of advance consent under Bill C-14, the Canadian Medical Association noted that it was an extremely complex area. The expert panel's final report from the Council of Canadian Academies noted that there are significant knowledge gaps and a lack of consensus with respect to administering euthanasia, or medical assistance in dying, when a patient has lost capacity.

Why would the government include that in this bill, rather than allow a more thorough legislative review to take place, which it has pre-empted?

[Arif Virani, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I will be splitting my time with the member for Glengarry—Prescott—Russell.

I am pleased today to speak on Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying.

As members know, clearly we are here because of the decision of the Quebec Superior Court in the Truchon case. That decision struck down a particular criterion under both the Quebec and Canadian regimes with respect to the end-of-life nature of medical assistance in dying, which is the reasonable foreseeability of natural death criterion, in particular, at the national level.

I will agree with some of the members we have heard from today that this is perhaps the most important issue we have faced in the last five years of this Parliament, both in the last Parliament and today. Fine-tuning the approach to medical assistance in dying is something that is intensely personal, but also intensely important to all of us in the chamber and to all Canadians.

What we should know at the outset is that the court's ruling in Truchon applies only in Quebec. We heard the minister speak about this. The court suspended its declaration of invalidity for a period of six months, until March 11.

It is important for this chamber to recall that on February 17 of this year, the Attorney General of Canada filed a motion to request an extension to give Parliament sufficient time to enact an appropriate response to ensure consistency in the criminal law. Given the circumstances of COVID and the pandemic, an extension was further sought and granted in June until December 18 of this year. Therefore, December 18 is the new deadline.

Before I go into some of the details in the bill, I want to start out with two important provisions that relate to conscience protection. This was raised in today's debate and was also raised in the context of an earlier debate on this bill in a previous parliamentary session. I think it is critical the record be crystal clear that conscience protections are robust in this country and are entrenched in law.

I am responding here to questions that were raised by the member for Sherwood Park—Fort Saskatchewan. The first location for conscience protections is in the preamble to the old bill, Bill C-14, which states, “Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms”.

I have had further questions from members of the official opposition about why it is only in the preamble and not in the statute. That assertion is categorically incorrect, because conscience protections are in the statute itself. Section 9, page 8, of Bill C-14, which amended the Criminal Code, states, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

Lastly, the third point I will refer to is from the Carter decision of the Supreme Court, which has been the subject of extensive discussion in this chamber thus far. I am reading from paragraph 132 of the majority reasons in Carter. The court states, “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

Those are the three instances where the freedoms set out in section 2 of the charter are taken into account. One is jurisprudential and the other two are statutory. The fourth one is of course section 2 of the charter, which protects freedom of conscience for all Canadians, including those who practice medicine. Therefore, the assertion that somehow conscience rights are not protected or are somehow being eroded is categorically false.

Another point on what is being addressed in today's debate is the notion that a culture of overly facilitating medical assistance in dying is upon us. Here I am referencing some of the interventions made again by the official opposition, particularly the member for Sarnia—Lambton, that somehow this government bill is pushing us further toward predatory practices by health care practitioners or toward disavowing the right to life, liberty and the security of persons who are vulnerable, including persons with disabilities. That is categorically false and is not commensurate with what is in the evidence.

The evidence that we have is that, in total, nearly 14,000 medical assistance in dying deaths have happened in the country in the last four years. The average age of the people accessing MAID is 75 years old. It is being accessed equally by men and women, 51% of the time by men and 49% of the time by women. The most common medical condition is cancer, followed by neurological conditions. In that 67% of all people who access it have cancer; second, come neurological conditions; and third, come cardiovascular conditions.

Very important, in the most recent year of analysis, a grand total of 5,444 people accessed MAID in this country. That represents 1.89% of all deaths in the country. I am saying that specifically for the purposes of the debate, because it is important for Canadians to understand that there is not some sort of culture of medical assistance in dying that is being foisted upon unwitting individuals. I will elaborate upon this going forward.

I would like to address a few aspects of this bill. The eligibility criteria have changed, as the Minister of Justice mentioned this morning.

There are two sets of safeguards. One applies when the individual's death is reasonably foreseeable, while the other applies when it is not. The bill adds new safeguards for this second category.

The bill proposes allowing final consent to be waived on the day of the procedure in exceptional circumstances.

Earlier in the year, the minister, along with the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, as well as myself and other parliamentary secretaries, conducted a very vast consultation process. We heard from 125 individuals, who are experts in this field, whether they are delivering it or acting on behalf of disabled individuals, from nurses, doctors, etc. We also heard from 300,000 Canadians through their responses to a questionnaire that outlined various scenarios.

The views of those individuals were quite concrete in the direction they were seeking. They wanted to be empowered in terms of their autonomy, dignity and their choices. They were seeking fewer obstacles to what had evolved to become an overly restrictive regime, as identified by the court in Truchon. That important feature must be canvassed here. What is important to understand is that the input received was critical to the development of the bill.

As part of the proposed amendments to the Criminal Code, the reasonably foreseeable death provision will be removed from the eligibility criteria. This is in response to the Truchon decision.

In terms of legal impact, this amendment would mean that people whose death is not reasonably foreseeable would be eligible for medical assistance in dying if they meet all of the other eligibility criteria.

This point is very important. The bill proposes to exclude persons whose sole underlying condition is mental illness. This has been touched upon by different people who have already intervened in the context of today's debate and in previous debates in the previous session of Parliament. This is important, as was outlined by the minister this morning. It recognizes the increased complexities and risks associated with such cases, which were highlighted by many practitioners, stakeholders and experts at the main round tables.

What is also very important is that the Canadian Mental Health Association supports the position we are taking with respect to excluding mental illness as a sole underlying condition. This complex issue must be examined carefully as part of the parliamentary review of the legislation on medical assistance in dying.

Importantly, the Government of Québec has also announced the exact same study for the exact same provision in the context of mental illness. Issues of consent and capacity and properly being able to diagnose this and having a prognosis are critical.

I will move to some of the comments that have been made. It is important for people to understand the safeguards are under two tracks. Those safeguards respond to persons whose deaths are reasonably foreseeable and those whose death is not.

With respect to some of the aspects raised in the context of today's debate, please understand we have taken the 10-day period of reflection out of the legislation. The basis for this was that the safeguard was not doing the work it was meant to do. As opposed to protecting those who were vulnerable, it was increasing vulnerability insofar as it was prolonging suffering.

We have heard some people were so concerned about their inability to provide their final consent after 10 days that they would stop taking their pain medication, which was simply creating further suffering just to maintain the ability to provide final consent.

With respect to how we can ensure informed consent is applied when it has not been solicited actively, there are two responses. This is with regard to the advanced consent regime.

The government is conscious of the Audrey Parker situation and we are seized with it. When people have been assessed and approved for this procedure and when they make a determination they want to access it and provide consent in writing, that consent would be sufficient.

In direct response to whether it could be vitiated, yes it could. First, if the person has not lost capacity, consent could be vitiated. Second, it could be done by a physical gesture that could be interpreted to fully and finally eliminate that consent for the purposes of the practitioners. That is in response to a question posed by the member for St. Albert—Edmonton.

This bill strikes a balance and the balance is important, a compassionate response that protects vulnerable people, respects their dignity and autonomy and what is required by the Constitution. I am very hopeful we can achieve all-party consensus on this fundamental issue.

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

Madam Speaker, let me start by saying how much I would rather be in the House today than at home managing a small raise hand function on the screen and our own barking dogs. More seriously, let me say how much I would rather have completed this debate in March when it comes to avoiding or preventing unnecessary suffering.

COVID-19 has required us all to make adjustments. Obviously the adjustments we have to make as parliamentarians pale in comparison to the experience of most Canadians, especially those who have lost loved ones to COVID-19; those who have lost their livelihoods; those who are still struggling to make ends meet, to keep a roof over their head and to put food on the table; and those who are struggling with the pandemic while contending with life-threatening illnesses.

Let me also preface my remarks on Bill C-7 with a few words on why we find Bill C-7 before the House at all. There is a tendency by both the Liberals and Conservatives to emphasize that we are here because of a deadline imposed for changes in medical assistance in dying by the Quebec Superior Court decision in the Truchon case. That is true technically.

However, it obscures the role of the plaintiffs in that case, Jean Truchon and Nicole Gladu, who went to court to contest the provisions of Bill C-14, which they found violated their charter rights by causing or prolonging unnecessary suffering for those at the end of life and for denying individuals autonomy of decision-making over the end of their own lives.

I actually want to thank the plaintiffs today who brought us here, and also to stop for a moment to express my condolences to the family of Mr. Truchon, who left Canada a better place as a result of his attempt to improve the way we deal with medical assistance in dying, when he left us in April.

When it comes to medical assistance in dying, for New Democrats, our priority has always been, and remains, avoiding unnecessary suffering being inflicted on those who are already suffering from terminal illnesses and at the same time avoiding prolonging suffering for their families who have to bear witness to that suffering.

We were glad to see this legislation come forward in February, very promptly for a new government, but we are disappointed that we are here in October, starting over again. Some of this delay was due to COVID-19, but the blame for this delay lays equally at the feet of the Liberals for proroguing the House.

In February, there was recognition by all parties that there were two pieces of work outstanding on medical assistance in dying. First was the need to amend Bill C-7 to conform with the charter as demanded by the Quebec Superior Court ruling in the Truchon case, which found the current law too restrictive. This is the very reason New Democrats voted against Bill C-14 when it originally came before the House.

Even before the court ruling, there were many calling for changes. Those who listened carefully to the terminally ill, their families and practitioners providing the medical assistance knew well the unnecessary suffering that was being inflicted, and continues to be inflicted by our current law.

The second task with regard to medical assistance in dying was to conduct a legislative review of the broader issues around MAID after four years of our experience with it. This is not to be confused with a normal review of the specific legislative changes proposed in Bill C-7. This broader legislative review of the issues arising out of medical assistance in dying was mandated in the original legislation and was supposed to start this June.

Bill C-14 required that the review specifically look at the question of advance requests, requests from mature minors and requests where mental illness is the sole underlying condition, but it was not to be limited to those topics.

I am disappointed that the second task appears to have fallen off the agenda for the Minister of Justice. Early this morning I asked him to commit to starting this broader review in parallel with the examination of the changes in Bill C-7. As I told him then, I put Motion M-51 on the Order Paper today to create a special committee of the House that could conduct this broader review at the same time as the justice committee deals with the urgent changes needed and required because of the court decision and because of the unnecessary suffering inflicted by our current law.

I want to talk about each of these two tasks in more human and practical terms by starting with very personal stories, one for each of these. It is clear to me that the current legislation has some unintended and cruel consequences. These were clearly demonstrated by what happened to a very good friend of mine.

On January 1, 2019, I went to a traditional New Year's levee in one of the communities in my riding. When I arrived, I was not surprised to be greeted enthusiastically by someone I had become close friends with over 10 years involvement in public life together. I was surprised, however, to see her right arm was in a sling.

I am not going to name this friend today because I did not seek formal permission from her family to do so, but I am telling her story today as I trust she would want her unfortunate experience with medical assistance in dying to make a difference.

When I asked my friend what was happening, she recounted how, suddenly and inexplicably, she began having trouble using her arm over the holidays and that she was going to have it checked out as soon as possible. A month later, she began to see other symptoms and she found out that she had an inoperable brain tumour the size of a raisin but growing, growing slowly but growing nonetheless. This was a condition that would prove to be painful, debilitating and terminal.

As her condition rapidly deteriorated, she began to make plans for her end of life. Just four short months after a diagnosis, my partner and I received an invitation to what she was calling a masquerade ball in her honour. My friend was incredibly brave and never lost her sense of humour or her love of life right up to the end.

On that Saturday, she checked herself out of the hospital to celebrate her life with us that night. Rather than, as she joked, allowing us to get together after she was gone and talk about her then, she preferred to see us before and to hear what we had to say before she had to leave. Just days later, we found out she was gone. With her death, we were not only deprived of a larger-than-life member of the local arts community. We were also deprived of a friend whose enthusiasm for life had always been infectious.

Why such a sudden exit? The current law requires that those who have already been assessed and approved for medical assistance in dying be competent when the final moment to receive that assistance comes. Therefore, my friend was forced to depart weeks if not months early because she feared the loss of competence that might result from her brain tumour if she waited too long, and that this loss of competence would prevent her receiving medical assistance in dying and thus inflict weeks or months of suffering on her as the patient but also, more important to her, weeks of suffering on her family and friends who would be forced to witness a prolonged dying.

Bill C-7 would fix this by removing the requirement for final consent for those who are already assessed and approved for medical assistance in dying. This would take away the need to go early in order to avoid the loss of competence that now prevents receiving medical assistance in dying.

The bill would also make the process more straightforward in several other ways. It would do so by taking away the mandatory 10-day waiting period, reducing the number of witnesses required from two to one and expanding who could serve as a witness. These are all things practitioners have told us are unduly restrictive and only end up unnecessarily prolonging suffering.

Right now, I should take a moment to thank four doctors who have been kind enough to share with me their experiences in providing, or not providing in some cases, medical assistance in dying to hundreds of patients. Again, I will not name them today to respect their privacy, but my conversations with these four incredible people have helped me understand how medical assistance in dying operates in real life.

I should mention one other change in Bill C-7 that would have more substantial impacts. That is the removal of the requirement that death be imminent before one can receive medical assistance in dying. Bill C-7 then sets out a more restrictive process than that for those whose death is imminent and where there is more time for assessment and decision-making. However, I should emphasize, Bill C-7 still maintains the high standards set in the original legislation that in order to receive medical assistance in dying patients must have a condition that is incurable, must be in a state of irreversible decline and must face intolerable suffering. This means that Bill C-7 would not open the door for medical assistance in dying quite as wide as some have suggested.

My second story, also very personal, deals with one of the broader issues that the review of MAID was supposed to deal with. This story is my mother's story. My mum passed away just short of five years ago, during the debate on MAID. This is a story I have told before during the debate on the original bill, but one which still lacks resolution.

My mother had always been very clear with my sister and me about her wishes regarding the end of her life. For her, it was simple. She asked us that if she ended up bedridden, unable to shower or feed herself, and did not know who we were, then to please let her go. She suffered from dementia and other underlying conditions that were complicated by a serious fall and, fortunately for her, she was not forced to endure for long those conditions she had feared.

Unfortunately, the kind of advance directive or advance request that my mother had wanted to give is still not allowed under the existing legislation. I know many in my community, and more specifically, many in my own social circles, fear just such an outcome and feel that they should be able to make their own end-of-life wishes known and have them respected, just as they are now when it comes to questions of refusal of medical treatment. I tend to be of the same opinion. However, my discussions with practitioners providing medical assistance in dying have persuaded me that this question is not as simple as it appears on its face. This remains one of the important issues the legislative review of the current legislation can address and is mandated to address by Bill C-14.

As I mentioned earlier, there were other issues that were assigned to this broader review in the original Bill C-14, including requests from mature minors and requests for mental illness as the sole underlying condition, but one concern was missed. Let me take a moment now to address the concerns of disability advocates that, with the removal of the requirement that death be imminent, there will be pressure on the vulnerable in our society to choose medical assistance in dying.

First and foremost, as a society we can and must do better in offering support to people with disabilities. Failure to provide necessary resources to ensure that everyone can enjoy full and equal participation in life is a current and ongoing black mark on all of us. We have only to look at the failure to deliver additional assistance promptly to persons with disabilities during this pandemic to remind ourselves how often we forget about those living with disabilities. However, we should not dismiss the concerns of the disability community about medical assistance in dying out of hand. The legislative review is the place for us to consider seriously the question of whether the existing safeguards preventing pressure on the vulnerable to choose medical assistance in dying are, in fact, sufficient.

Before I conclude, I want to remind members that, as a society, we must do better in the job of end-of-life care. Again, COVID has demonstrated the tragic deficiencies in long-term care in ways I hope we will not ignore.

New Democrats will support the bill and help expedite its passage in order to bring an end to unnecessary suffering and to meet the deadline imposed by the Quebec court in the Truchon decision, but this support has always been predicated on going forward with a larger review without delay.

I have drafted a motion, Motion No. 151, which I have tabled today. I look forward to hearing a positive response from the government on this. We have just heard a positive response from the Bloc, and I am hoping for a positive response from the Conservatives.

Proceeding with Bill C-7 without proceeding with the broader review is only getting half the job done on medical assistance in dying. At the same time, failure to conduct the broader review potentially undermines public support for medical assistance in dying, which, so far, has only continued to grow. In fact, I believe this is one of the most important questions that could ever come before Parliament.

I look forward to the debate on the specific improvements that we can make to Bill C-7, but I urge all of us to consider undertaking the broader review of issues around medical assistance in dying without delay.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the funny thing is that people have been saying it is the only solution for 50 years now. Why is it that some hospitals still do not provide palliative care because there is a shortage of units?

Nowadays, in some hospitals, people who request medical assistance in dying cannot experience that end-of-life journey in a palliative care unit, even though palliative care is supposed to be end-of-life care and relief from pain and suffering in an environment that supports human dignity. How is that possible?

We must not think of palliative care and MAID as being mutually exclusive. It is a continuum of care that should be available to these patients. Those who are not terminally ill, for whom the dying process has not already begun and is not irreversible, are also entitled to a suitable environment. Bill C-7 makes that possible, and much more clearly than Bill C-14 did.

That was not possible under Bill C-14, with its unassailable reasonably foreseeable natural death criterion, which the court said undermined patients' right to life.

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

Madam Speaker, I listened with great interest and care to the member's speech. It was an important contribution.

I know the member is aware that the original legislation, Bill C-14, required a broader legislative review of medical assistance in dying. That review was supposed to start in June.

Will the member and members of the Bloc be supporting efforts to get this broader review going in parallel with Bill C-7?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I rise today in the House to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying. It is long overdue.

I want to start by saying that the Bloc Québécois is in favour of adopting the principle of this bill, because it clarifies two aspects of medical assistance in dying.

The first has to do with access to medical assistance in dying when death is imminent, meaning that the person is terminal and is receiving palliative care before receiving medical assistance in dying. At least, I hope that is the case, because people in palliative care are not always the ones to request medical assistance in dying. I will come back to this.

The second aspect has to do with people for whom death is not imminent, who were denied access to medical assistance in dying as a result of the “reasonably foreseeable natural death” clause in Bill C-14. The court struck down this criterion, which was the key safeguard. This is what Bill C-7 is designed to fix, and we are happy about that.

As we begin debating the underlying principles of Bill C-7, it will come as no surprise that I am discussing them. It is precisely because we, as lawmakers, did not do our job four years ago when we were studying Bill C-14, that we find ourselves debating Bill C-7 today.

This is a democracy, and parliamentarians, not judges, must make the laws. We, the representatives of the people, the lawmakers, must be the voice of Canadians, especially those who are suffering. Judges only interpret the grammar of justice. They examine the laws we make, as well as the rights and freedoms, and determine whether a potential infringement of rights and freedoms is reasonable or not.

In this case, the court has handed down its ruling: The provisions of the current law, the former Bill C-14, are an unreasonable infringement of rights and freedoms. Furthermore, before Bill C-7 was tabled, two courts had ruled that the Criminal Code, amended by Bill C-14, violated the right to life, liberty and security of the sick person suffering intolerably or with a terminal illness.

We have to be clear about the issue at the heart of this debate: before being legal, this is an ethical debate. On one side of this debate is the paternalistic vision of the state and medical practice, while on the other side is a vision based on the autonomy of the individual and its corollary, the principle of self-determination. I know that all my colleagues in the House have good intentions. They want to do good, they want the best for patients and they are caring. I am sure that during this entire debate they will reflect the very values they are advocating and they will be just as caring and compassionate about the interests of patients.

However, we cannot claim to be caring and compassionate, in other words wanting to do good and what is best for an individual who has reached their breaking point at the end-of-life stage, if we are interfering with that individual's autonomy and self-determination, and if we refuse to respect their wishes on something as personal as their own death. The literature is clear on this.

The basic question is this: What business does the state have interfering in a decision as personal as my own death? My life is my own, as is my death. No one else, and certainly not the state, is going to die in my place. The courts had to reframe the limits of the state's power to intervene because we did not do our job properly.

All I want is for us to understand what is at stake here. I am referring to the law, which my Conservative friends often put up on a pedestal. The value of autonomy is conferred by law through the principle of self-determination, especially with regard to medical care. That is what I want to discuss here today with my colleagues. Let's talk about the autonomy bestowed on a person by law through the principle of self-determination.

In the biomedical context, the principle of self-determination is associated with an inviolable rule, namely the rule of free, informed consent. The rule regarding free, informed consent to treatment has never been challenged in emergency situations. Patients always have the right to refuse treatment.

My question for my colleagues is this: Why would it be any different for human beings experiencing intolerable suffering due to an irreversible illness or condition? Why would it be any different for competent individuals who are neither depressed nor suicidal and who have expressed a desire to live fully until they reach the limit of what they can tolerate?

In the Carter decision, which led to Bill C-7, the Supreme Court ruled that the provisions prohibiting medical assistance in dying violated the right to life, liberty and security of the person. People like Ms. Gladu, Mr. Truchon, Ms. Carter and Ms. Taylor have not reached the end-of-life stage. They might not even be in the terminal phase of their illness. That does not mean they have not reached, or are not in the process of reaching, the limit of what they can tolerate.

The court stated that the restrictive provisions in Bill C-14 were effectively shortening the lives of such individuals, that they violated their right to life by inciting them to commit the act before they were ready. That is what needs to be fixed right here, right now. Bill C-14 did a fairly good job covering the end-of-life care for terminally ill patients whose death was reasonably foreseeable, with the exception of the requirement for a second consent, which is sometimes not necessary and means that people suffer even though they gave their informed consent.

There is no issue for people who are terminally ill. The dying process has already begun and is irreversible. Death is imminent and foreseeable. The issue we need to address as legislators has to do with people whose death is not reasonably foreseeable and imminent. Under Bill C-14, Ms. Carter, Ms. Taylor, Ms. Gladu and Mr. Truchon were ignored.

What we, the members of the Bloc Québécois, want is respect for the moral autonomy of the dying. We often hear the expression “dying with dignity”. I must point out that dying with dignity does not mean having a sanitized death. That is not what it means to die with dignity. The dignity of a person is derived from their freedom to choose and respect for their free will. That is what it means to be a human being. That is what it means to respect a human being. When that is violated, we violate the dignity of the human being.

Whether the death is unpleasant or not is not the issue. The crux of the matter is to allow the human being to make a decision about the end of their life. Unfortunately, in the past, we won the right to die rather than undergo aggressive therapies. At the time, this was called passive euthanasia. The person was left to die without much attention and without death being the intent. Palliative care was still in its infancy. There was a great fear of administering one last fatal dose of medication, but it always ends up causing death. Because palliative care is still care, it does not strictly count as passive euthanasia.

Patients won the right to die rather than undergo aggressive therapies, because people did not use to die from cancer; they died from the treatment. Medical paternalism has at times gone too far and has been less than helpful.

Today's patient-practitioner relationship prioritizes collaboration, negotiation and respect for the patient's choice. Patients alone can assess their quality of life, and that must be respected, which is why medical professionals must be transparent with their diagnoses.

Patients won the battle for the right to die rather than undergo aggressive treatment, and that evolved into palliative care as we know it. For a long time, palliative care was thought of as the only solution that would allow people to die with dignity, but if that is the case, why is it still so hard for people to get that care? If that is the solution, why is there still such a shortage of palliative care units?

Sometimes, even the best, most carefully managed palliative care in the world cannot alleviate people's suffering. Bioethics teaches practitioners to remember that patients come first, and that means listening to them.

That is true for Ms. Rodriguez, Ms. Carter, Ms. Taylor and Mr. Truchon, and it is true for Ms. Gladu and many others who have continued to suffer throughout this pandemic while they wait for us to do our job. Contrary to what some people think, these individuals are not suicidal. They want to live as long as possible.

I watched a very interesting interview with Ms. Gladu. What did she say to us? What did she want? She wanted the freedom to choose. Having this freedom greatly diminishes the suffering and anguish.

With Bill C-14, the government said its intention was to protect the most vulnerable. Is there anyone more vulnerable than a person who is suffering from intolerable pain, who is living with an incurable illness and who is being told to go to court for the right to choose and to die with dignity? Is there anything more important and more intimately personal for an individual than their own death?

I have a hard time understanding my Conservative colleagues' argument that the state must decide for an individual, when they are so economically libertarian. Several Conservatives felt that Bill C-14 went too far. The courts said that it did not go far enough and that it violated fundamental rights.

Elected members of the National Assembly of Quebec advanced the debate without pitting palliative care against medical assistance in dying. They chose to include requests for assistance in dying as part of a continuum of end-of-life care that is consistent with palliative care. Whether we are talking about a degenerative disease or an illness that causes extreme pain but is not terminal, let us not pit those two realities against each other. Respect for human dignity includes proper support when one is dying, which requires doctors to have the humility to recognize that they cannot always help people manage their pain adequately.

Our society recognizes people's right to self-determination throughout their lifetime but takes it away from them at the most intimate moment of their lives. In so doing, we think that we know what is best for people or that we are doing the right thing, when we are actually undermining human dignity, their freedom to choose.

There is no more important moment in a person's life than their death. Learning to live is learning to die. Learning to die is learning to live. I say that because the clock starts ticking the moment the doctor cuts the umbilical cord.

The Carter decision and the Baudouin ruling sent us back to the drawing board. We need to do our job as legislators and stop off-loading the problems and the ethical, social and political questions onto the courts. We have a job to do as legislators.

There is a sociology of law. In a society, the law evolves with people's consciences. I know I am straying from the technical details of the bill, but we will have plenty of time to discuss them in committee.

The bill proposes that a person who is not terminally ill must consent twice and be bound by a 90-day period. I really wanted to talk about advance consent, since that is about all that is missing from the bill.

Bill C-7 does not address degenerative cognitive diseases, which are predictable diseases. Doctors can tell patients how they will progress. People with these diseases often remain of sound mind for years and do not appear to be sick, but eventually, they become forgetful and then die. They can also experience complications from being bedridden or immobilized or conditions other than that disease. I think a person with Alzheimer's, for example, should have the opportunity to make an advance request. This bill does not take those people into account.

Still, I said at the outset that we agreed on the principle and the grounds for discussing this bill. We will have time to talk about these issues. I urge my colleagues to bring substantive arguments to the debate on the adoption in principle of medical assistance in dying.

I remember when the previous Parliament studied Bill C-14. I heard arguments about how we were putting ourselves on a slippery slope. Some people were practically saying that long-term care homes would turn into euthanasia factories. If evil people are working in our health system, they should be fired, no matter what job they do, because they have no business there. I am not buying the argument that this is a slippery slope because people are evil.

We must assume from the outset that everyone working in the health care system is caring and compassionate. Increased health transfers would enable these people to provide better care, and maybe there would be more palliative care units in hospitals. Even though people have been saying for 50 years that palliative care is the only solution, I do not believe it is. It makes no sense that people do not have better access to palliative care in this day and age.

I would like to end my speech, which I trust was a substantive one, with a wish for all of us, here in the House, concerning the delicate issue of the end-of-life. I sincerely hope—which is what the patients who turned to the courts were hoping for—to face death serenely, peacefully and without suffering. That is my wish for everyone, because that is the best wish we can make for a human being. We should imagine ourselves being at peace on our death bed and being able to let go because we have palliative care to support us in our journey towards death. That is the best wish we can make for a human being.

I am therefore calling for a debate on both the substance and the principles. I am also appealing to the humanity of all my colleagues so we can finally provide an adequate response to all those who are suffering and have been waiting for far too long.