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

[Denis Lemieux, Liberal, Chicoutimi—Le Fjord, QC]

Mr. Speaker, it is a great pleasure to take part in this second reading debate of Bill C-14 on medical assistance in dying in Canada.

I had the privilege of being a member of the Special Joint Committee on Physician-Assisted Dying, and I supported all of the report's recommendations.

However, as many members have acknowledged today, medical assistance in dying is a complex, sensitive, and extremely personal issue.

Ever since the Supreme Court handed down its ruling in Carter last year, Canadians all across the country have been contributing to the discussion. The issue continues to be the subject of serious debate and deliberations all around the world, everywhere from the United States to Europe, Australia, and New Zealand.

In virtually all parts of the world, deliberately ending someone's life and helping someone end his or her own life are serious crimes that carry harsh penalties.

However, as many people know, Canada is not the only jurisdiction to legislate and authorize medical assistance in dying. Four U.S. states, specifically Oregon, Washington, Vermont, and California, along with Colombia, and three European countries, specifically Belgium, the Netherlands, and Luxembourg, have a legislative framework that allows some form of medical assistance in dying.

I listened to more than 60 expert witnesses during the meetings of the Special Joint Committee on Physician-Assisted Dying, and I was deeply moved by the testimony of the hon. Steven Fletcher; Benoît Pelletier; Jean-Pierre Ménard from Quebec; Dr. Cindy Forbes, president of the Canadian Medical Association; and Dr. Monica Branigan of the Canadian Society of Palliative Care Physicians.

Last week, though, I got a call at my constituency office from Bibianne Gauthier, the mother of Jean Truchon. After our conversation, I was able to put a face to a real request for medical assistance in dying.

After meeting Ms. Gauthier and her son Jean, I decided to share this real case with my colleagues in the House and read the letter that Jean Truchon wrote to his health care team on January 20.

I would like the House to know that I personally got permission from Jean Truchon to read this letter in Canada's Parliament. I am also doing this at the request of Mr. Truchon's parents:

“I am 48 years old and I have had cerebral palsy since birth. I spent 22 wonderful years living in an apartment.

On March 11, 2012, my life was turned completely upside down when the medical team at the Centre hospitalier universitaire de Montréal diagnosed me with inoperable degenerative cervical disc disease. That day, I reluctantly put one foot in the grave and I have every intention of putting the rest of my body there on September 1, 2016. I had to resign myself to living in a home and despite the good care I am receiving and my efforts to adjust to the situation, I simply cannot imagine living much longer under these conditions.

My question is this. Since I believe that I do not meet the eligibility criteria for medical assistance in dying [in January of this year], I intend to refuse to allow the staff to feed me or give me water, as I am unable to feed myself. I am asking that my doctor at the centre be authorized to administer a drug to at least relieve the pain.

I look in the mirror and I no longer recognize the man I once was. That is when I say, ‘What is the use in living like this’. Sometimes I think you do not have be at the end of your life to experience the intolerable suffering that I am currently experiencing. Doctors have told me that eventually I will become incontinent. The thought of it is too much to bear. I still have too much dignity to live like that.

At one point, I was in bed and no one responded when I pressed the call bell. I had to relieve myself in bed. It was then that I understood that life in an institution was not for me. I know that other people living a similar life in similar circumstances make different choices. However, in my case, I made the carefully considered decision that 2016 would be my last year.

I realize that dying before my parents is not the best way to go because it defies logic. However, I cannot take it anymore. My family and my friends are aware of and respect my decision even though they do not agree with it, because they are going to lose me. They understand all my struggles, and I thank them for their understanding.

I have considered a more dramatic form of suicide, but the fear of surviving and being in an even worse condition prevents me from doing it. Furthermore, to ease my family's pain, I am choosing to leave in a more honest manner by having them at my side. The antidepressants I have been offered, together with an explanation of their potential benefits, will never give me back the use of my arms or change the prognosis of physical decline. In good conscience and of my own free will, I have refused the medication, which will not give me back the will to live what would seem like an artificial life.

If this letter results in a more objective awareness of those who are suffering and are not at the end of their lives, I will have achieved one of my objectives.

Since I have no expectations that my case will be eligible for medical assistance in dying, I am also appealing to the CIUSSS bioethics committee to allow my treatment team to respect my choice and to allow me to receive the comfort care and the medication required to alleviate my suffering when I stop my feeding.

Thank you for taking the time to read this letter.”

The letter was signed by Jean Truchon.

This extraordinary 48-year-old man is just one of the faces of medical assistance in dying in Canada, but as I read about Jean's courageous decision, I felt that the committee had made good recommendations in its report.

The Minister of Justice consulted all of the existing legislation around the world to draft the government's legislative response to the Carter decision.

The bill sets three eligibility criteria: individuals must be competent adults who are in an advanced state of irreversible decline; they must have a grievous and irremediable illness or disability, and their medical condition must cause them enduring and intolerable suffering; and their deaths must have become reasonably foreseeable, taking into account all of their medical circumstances.

The bill also has a non-legislative component. It provides for further study of three specific topics: mature minors, advance requests, and mental illness.

I am also pleased to see that Bill C-14 includes solid safeguards to prevent mistakes and abuses. I would like to reiterate them: the patient must get an opinion from two independent doctors and the request must be made in writing; the patient has the right to withdraw the request; there is a 15-day waiting period; and consent must be confirmed immediately prior to the administration of the medical assistance in dying.

In closing, I would like to encourage all members to read the document entitled “Legislative Summary of Bill C-14: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)”, which was tabled in the House by the Minister of Justice. It contains important information on the international laws and regimes that influenced the government's approach to medical assistance in dying in Canada.

The government wanted to learn from the experiences of other jurisdictions. The approach it plans to take is broader in scope than that of the United States, which gives access to medical assistance in dying only to people with an incurable disease. The approach the government is considering gives the option of a peaceful death to everyone approaching the end of his or her life, not just those suffering from incurable diseases. At the same time, it eliminates some of the risks that may be associated with a broader regime. The government has also committed to continue examining these more general issues and will continue to observe what is being done elsewhere in the world in terms of medical assistance in dying.

I urge all members to support this bill and send it to committee, thereby responding to our Supreme Court's request to legislate in this area.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Mr. Speaker, I appreciate the many fine words from my colleague, and I would like to ask him a question.

The government has brought this legislation forward because of the Supreme Court of Canada ultimately doing what Liberals believe is the responsible thing to do, with the strong leadership from the Prime Minister's Office to the ministers responsible for bringing forward the legislation itself; but one thing we are often being told about is the importance of not only the legislation but the whole issue of palliative care.

I am wondering if the member might want to take the opportunity to emphasize, from his perspective and his constituents' perspective, just how important palliative care is as part of this whole debate.

[Denis Lemieux, Liberal, Chicoutimi—Le Fjord, QC]

Mr. Speaker, I thank my colleague for his question.

When I sat in the special joint committee, it really struck me how the issue raised by the Carter decision really forced us to reflect on the quality of palliative care in Canada.

That is why I was thrilled to hear that the Minister of Health had announced plans to invest an additional $3 billion over the next four years to improve palliative care. As we said in committee, medical assistance in dying must not replace palliative care. That care constitutes end-of-life care, and medical assistance in dying should be considered part of palliative care. I am therefore very proud of our government's decision and the decision taken by the Minister of Health.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, I too would like to commend my colleague, with whom I served on the special committee struck by the government. The committee was made up of MPs and senators from all political parties.

I would like to know my colleague's thoughts on the text of the bill. It uses words that have raised many questions in Quebec and all across Canada regarding what is reasonably foreseeable: a reasonably foreseeable death. The Quebec legislation clearly states that care must be provided to people who are reaching their end of life.

Is the member comfortable with the term “reasonably foreseeable death”, or would he prefer a definition that is closer to the one used in Quebec, in other words, “end of life”?

[Denis Lemieux, Liberal, Chicoutimi—Le Fjord, QC]

Mr. Speaker, I thank my colleague for his question.

I understand my colleague's points, and I have often heard him use those words in the media in the past few weeks. What Canadians need to know is that the point my colleague raised is one of the four criteria required for access to medical assistance in dying. It is important to explain to Canadians that there is not just one criterion for obtaining medical assistance in dying, but four.

I will take this opportunity to remind my colleague from Louis-Saint-Laurent about what he said this morning in response to a question from our colleague opposite. I was so sad to hear it. According to the member from Louis-Saint-Laurent, cases like Mr. Truchon's, which I talked about just now, are unintended consequences. That is what he said in response to my colleague.

I want the member to know that I really disagree with him. I invite him to talk to Mr. Truchon's parents. He will see that Mr. Truchon and his family are altogether remarkable and are not trying to abuse the system in the way that the member for Louis-Saint-Laurent suggested this morning.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, I know from personal experience how hard it can be to be with people who are at the end of their life. I have actually been with people who have starved themselves to precipitate their end of life more quickly.

One of the concerns I have with this bill is that it would limit people who have health issues that are unbearably painful but whose end of life is far away in some cases. My question is this. How does the member think this would work with this bill, and how can we support people who have done the due diligence, have independent thought, and are ready to go when they are in unbearable pain?

[Denis Lemieux, Liberal, Chicoutimi—Le Fjord, QC]

Mr. Speaker, I thank my colleague for her question.

I look at the situation that Mr. Truchon and his family are in, and I see the law in Quebec. Mr. Ménard told us that he would certainly have drafted Quebec's law a little differently in light of the Carter decision.

Today we are asking ourselves a big question in relation to the bill we are debating that was introduced by the Minister of Justice. Mr. Truchon's family is a real-life example. Will they have to watch their son suffer for five, seven, eight days, or will our bill enable them to witness a gentle death that lasts four or five minutes?

[Mark Strahl, Conservative, Chilliwack—Hope, BC]

Mr. Speaker, it is always an honour to stand in this place and participate in the debate, no matter what the subject matter. There are some debates that are more important than others, and I would venture to say that parliamentary historians will not be poring over the Hansard of the latest budget implementation act in five, 10, or 50 years from now. However, the debate we are taking part in today is not just any debate. It matters. How we as a Parliament, as a group of elected representatives, respond to it will have a profound impact on our society and on the value we place on life in the months and years ahead.

We are here to debate Bill C-14. The short title of the bill is the medical assistance in dying act. I would suggest that this title downplays the decision that we as parliamentarians are being asked to make. Bill C-14 would remove the criminal prohibitions for killing a person, or helping that person kill himself or herself, in certain situations. That is the harsh, stark reality of what we are dealing with in this bill. It is not just another medical procedure that we can sterilize with antiseptic and non-offensive language. This is a serious matter. It will result in a fundamental shift in Canadian society, and making the language more palatable and less jarring does not change that.

We are here because of the Supreme Court of Canada's Carter decision. While the court had previously ruled that the Criminal Code provisions on euthanasia and assisted suicide were constitutional and did not violate the charter, last February it reversed itself and struck down sections of the Criminal Code. It gave Parliament until June to come up with a law that respects its ruling and places restrictions on when and where euthanasia and assisted suicide can take place without criminal penalty.

The Council of Canadians with Disabilities and the Canadian Association for Community Living have produced an excellent commentary on the court's decision, warning that persons with disabilities, including people with serious mental and emotional disabilities, have been put at serious risk. They have also provided these sobering statistics:

...in Belgium, the number of Assisted Suicide deaths has increased an average of 47.77% annually since 2003, and in the Netherlands it has increased 64.13% since 1995, with no end in sight to this increase.

They have called upon Parliament to “place crucial safeguards on the Court’s judgment to limit access to assisted suicide”.

Unfortunately, the joint parliamentary committee report on assisted suicide went the other way, suggesting that doctor-assisted suicide should even be made available to minor children and those struggling with mental illnesses. As a result, Conservative MPs on the committee filed a dissenting report recommending stronger protections for the vulnerable. Thankfully, most of their recommendations have made their way into Bill C-14.

I have heard from hundreds of my constituents who oppose assisted suicide and euthanasia. They fundamentally believe that the Supreme Court's ruling and this bill will lead us down a slippery slope. Some oppose it on religious grounds, believing in the sanctity of life at all stages. Others oppose it for a variety of logical or ethical reasons.

I have also been contacted by some constituents who support the concept of euthanasia in principle and in certain circumstances. Having myself watched a number of family members and friends ranging in age from 13 to 85 die from cancer over the last few years, I understand the desire to ease the suffering of those we love as much as possible at the end of their lives. I believe that, instead of considering euthanasia and assisted suicide as a desired way to provide relief to dying patients, the federal government should be doing more, in concert with the provinces, to promote and expand comprehensive palliative care services right across the country.

Indeed, we voted nearly unanimously for expanded palliative care services and a plan in the last Parliament. During the election campaign, the government promised to inject $3 billion into palliative care. However, its budget did not include a dollar of funding or a mention of it coming anytime soon. The Minister of Health referenced her commitment to palliative care again today in question period. However, words are not enough. We need action, and it should have been a companion to this legislation, not an afterthought.

I want to talk about my main concern with assisted suicide as it relates to this bill and the ruling by the Supreme Court.

We need to continue the national conversation about improving our mental health system of care, which is currently failing too many Canadians. Mental Health Week starts today. The Canadian Mental Health Association is encouraging us to get loud on ending the stigma around mental illness.

Many of us have participated in, and will participate in, events this week to do just that. We put on green ribbons. We have attended champions of mental health dinners. We celebrate those who have spoken out and shared their stories of overcoming the darkness in which they have often lived for years. We beg people struggling with mental illness to reach out. We tell them that help is available, and it is. We grieve whenever individuals take their own life as a result of their mental illness.

Indeed, we have had many debates in the House, with heartfelt speeches by members on all sides, trying to figure out how we can best support those struggling with mental illness. Why did we do that? It is because we believe we must provide hope for those who are suffering. We believe that every life is worth saving and that those with mental illness can be treated, helped, and hopefully made well again.

We are told we should, as parliamentarians, separate assisted suicide from suicide brought on by mental illness. We should not be under the impression that we get to choose whether these two issues will be conflated or not. If assisted suicide becomes normalized, we should not be surprised if societal attitudes on other types of suicide change as well.

I recognize that mental illness is currently excluded from permissible cases for assisted suicide or euthanasia, but the government has said it will be embarking on further studies to look at the unique implications of situations where mental illness is the sole underlying medical condition. Indeed, Liberals mentioned their intention to move forward on this study at the technical briefing on Bill C-14.

Why would the government want to study this matter further if not to bring it forward as a future amendment to the bill? We cannot allow the door to be opened even a crack to allow for those suffering from mental illness to be able to access physician-assisted suicide.

I recently spoke to someone who was diagnosed with bipolar II disorder about the bill. This person attempted to be well with every tool available, and shared the following with me:

My disease is a challenge every single day of my life. Sometimes I work to keep the symptoms at bay from minute to minute. Suffering is a given. And yet, I have much joy and hope, so much to live for. But what if I get really sick, what if I can not manage for an extended period and fall into a deep unbearable depression? Do I need to write an advanced directive to my doctor, asking them explicitly not to allow me access to euthanasia? To ask them to help me fight for my life, even if I can't do that in my moment of total despair?

We need to say it loud and clear that suicide is not the answer for mental illness, whether it is medically assisted or not.

I know that my time is short, so I will move on to another concern I have, and that is the possibility of having two nurse practitioners to sign off on assisted suicide or euthanasia requests for a patient. Nurse practitioners play a vital role in many remote, rural, and northern communities, but when we are dealing with a matter this serious, this permanent, with these types of consequences, I believe that not only should two doctors be required to sign off but that there should be a requirement for a psychological examination or independent oversight from a social worker to be done on patients before they can access assisted suicide or euthanasia.

This would provide an additional level of protection to ensure that patients are truly capable of making decisions with respect to their health and that the request to end their life was not made as a result of external pressure as is mentioned in section 241.2 of the bill.

Finally, Bill C-14 does not enshrine the legal rights of medical professionals such as doctors, nurses, pharmacists, and caregivers to opt out of providing assisted suicide services or referrals if their personal conscience, beliefs, or ethics do not permit them to do so. This is a critical flaw.

As the bill does not adequately protect vulnerable people and does not adequately protect the conscience rights of medical professions, unfortunately, I cannot support it.

[Adam Vaughan, Liberal, Parliamentary Secretary to the Prime Minister (Intergovernmental Affairs)]

Mr. Speaker, I listened with interest to the presentation and appreciate that these issues bring back memories and experiences that are extraordinarily personal, and I do not mean to move into those areas unduly, so I hope the member can forgive the question.

In situations where, quite clearly, individuals are exerting an individual right and an individual choice, I wonder if the member could reflect upon what right we have to impose bureaucracy, layers of decision-making, additional voices, and additional concerns into people's lives when they are trying to make a choice for themselves about the most personal decision they may ever have to make.

[Mark Strahl, Conservative, Chilliwack—Hope, BC]

Mr. Speaker, I accept the question in the spirit in which it was given.

I think what the court has called on us to do is to set limits. It has not thrown the door completely open. It put its own conditions on grievous and irremediable conditions, and when and where this can be accessed. The court in its ruling has asked Parliament to specifically consider when and where assisted suicide, euthanasia, can be accessed. I think that is what we are doing here today.

There has been debate throughout the day. Some believe the bill does not go far enough in terms of its permissiveness, and others, like myself, believe that it is not tight enough around the court ruling. We are going to have a variety of opinions here, but that is exactly what we are doing. We are talking about what limits we believe should be placed on assisted suicide and euthanasia, because that is what the court has asked us to do.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Mr. Speaker, we have moved 180 degrees, from a criminal activity which was under the Criminal Code to now, where actually we can kill somebody and call it assisted suicide, and at the same time get the health care to pay for it.

I wonder if the member would comment about doctors and nurses who have an ethical or moral gauge within their own soul that will not allow them to do this. Would the bill protect them?

[Mark Strahl, Conservative, Chilliwack—Hope, BC]

Mr. Speaker, I would certainly argue that it would not. There is mention of conscience rights in the preamble, but we have seen before that the preamble is not the meat of the bill. It does not have the same effect that it would if it were in among the provisions of the bill.

I have spoken with many medical professionals since the bill came out, since the Supreme Court ruling came out, and there is grave concern about participating in this sort of scheme. I want to be clear that sometimes there is a religious bent, but often it is an ethical bent. It is people who have spent their entire lives, gone to school, sometimes for over a decade, to help save lives, who are now being told that part of the medical system is to provide assisted suicide or euthanasia services, and they are morally or ethically opposed to doing so.

I do not think the bill goes far enough in protecting those people from opting out of the system, and it is one of the reasons I will not be supporting it.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, I really appreciate the debate. Again, I will go on record as saying that I fear we do not have enough time to have a lengthy debate, but I do appreciate the comments from both sides.

My comments are neither for nor against at this point. However, it says informed consent being given, but in the bill itself there is no advance directive. The very people whom the bill could help, such as someone suffering from advanced stages of ALS, Lou Gehrig's disease, may not be able to give that consent at the time. Is there not a concern, and how can we rectify this as we move forward?

The deadline is speedily approaching. Does my colleague share the same concerns?

[Mark Strahl, Conservative, Chilliwack—Hope, BC]

Mr. Speaker, quite frankly, I think that is one of the unfortunate things that has happened in this debate. Due to the timing of the dissolution of Parliament for the election, there were several months lost when we were not debating this in the chamber. There were many months lost when this was not on the national agenda.

To now rush the bill forward, as we are compelled to do, I cannot think of a bill that deserves more time, more thought, and more debate than the bill before us, yet we have an arbitrary deadline that has been set by the court. That is truly the most unfortunate part of this debate, and one which I hope we do not live to regret.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Mr. Speaker, I thank you for giving me the opportunity to share my thoughts on Bill C-14.

I had the privilege of sitting on the Special Joint Committee on Physician-Assisted Dying. Along with the members of the committee, made up of 11 of our colleagues and five senators, I believe I can say that I was right in the thick of things, when it came to testimonies and opinions from the various stakeholder groups, experts, and everyday citizens.

The debate on medical assistance in dying is an emotional one. That is because it deals with the last of the taboos of any society, namely to plan one's own death and, in a way, to get help organizing it.

Whether you are religious, secular, atheist, philosophically liberal, or ideologically conservative, every opinion on medical assistance in dying matters. In the wake of the Carter decision, the diverging opinions and our deepest moral values now seem to torment us. Either side of the argument on medical assistance in dying is a source both for concern and for hope. This issue leaves no one indifferent, but above all stirs the most sincere and honest emotions.

That is where we run the risk of losing sight of the purpose of the debate. In fact, medical assistance in dying, regardless of our personal values, is not something that any of us must impose on or deny anyone else. I urge all my colleagues to keep in mind that medical assistance in dying is now an individual right recognized by the Supreme Court of Canada, a right that is no one's business but the individual's and, at the same time, a right that does not force anyone to compromise their deepest individual moral convictions.

Morality, taboos, planned death and the emotions this stirs must not cloud the rationale of the Carter decision. If we eliminate our individual morality from the analysis of the Carter decision, then it is rather simple.

First of all, two sections of the Criminal Code are affected, namely section 14 and paragraph 241(b). These provisions prohibit a person from counselling or aiding another person to commit suicide.

Second, as a result of these Criminal Code provisions, a person suffering from a grievous and irremediable illness could prematurely end their life, knowing that no one could help them die when they are no longer able to commit suicide because of the progression of the illness. In short, the prohibition in the Criminal Code provisions I mentioned could lead a person with an irremediable illness to take their own life early, even though they are still enjoying a certain quality of life, because they foresee that they will no longer be able to do so themselves at a later date.

Third, section 7 of the Canadian Charter of Rights and Freedoms states that everyone has the right to life. In Carter, the Supreme Court cited this principle in stating that a person suffering from a terminal illness cannot be deprived of this right. In other words, medical assistance in dying will maximize the time the person has left to live. That is the objective of Bill C-14, which amends the Criminal Code of Canada in order to allow medical assistance in dying.

In its wisdom and with a unanimous decision, the Supreme Court of Canada is showing us the way so that we can amend section 14 and paragraph 241(b) of the Criminal Code, which currently violate the right to life, liberty and security of the person guaranteed by section 7 of our charter.

The principles in Carter that must guide us in developing Bill C-14 are found in paragraph 127 of the decision, a paragraph that I invite my colleagues to read carefully because it will require our attention when we debate this matter.

The Supreme Court of Canada stated:

[These sections] are void insofar as they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life; and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

Also in paragraph 127, the Supreme Court of Canada stated:

The scope of this declaration is intended to respond to the factual circumstances in this case. We make no pronouncement on other situations where physician-assisted dying may be sought.

I will support this bill at second reading, but I must confess that I hope the committee can re-examine the bill and try to fine-tune it, because I have some concerns.

For example, this bill may suggest a rather restrictive approach with respect to Carter, especially since the bill contains words that are not in this decision. For example, subsection 241.2(2) states: “A person...[has] a serious and incurable illness, disease or disability”. The word “incurable” never appears in the Carter decision, and that may seem a bit too restrictive.

The bill also refers to an “advanced state of irreversible decline in capability”. The words “advanced” and “decline” do not appear in the Carter decision and could be interpreted as rather restrictive language.

Another one of my concerns has to do with the fact that, right now, this bill seems to disregard any advance requests for medical assistance in dying. Since the Carter decision suggests that there may be other requests in other exceptional circumstances, I believe that it is quite likely that people with a grievous and irremediable medical condition may also experience a deterioration of their cognitive and intellectual faculties.

I think that perhaps the committee should re-examine the possibility of an advance request so that someone with Alzheimer's or brain cancer, for example, is not prevented from giving informed consent to medical assistance in dying the second time because of the deterioration of his or her mental and cognitive abilities.

On page 6 of the bill, in paragraph 241.2(3)(h), it reads:

immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request and ensure that the person gives express consent to receive medical assistance in dying.

It seems that this paragraph is rather strict, given that people who are terminally ill could lose consciousness or that their intellectual faculties could be impaired because they are being heavily medicated. They therefore might not be able to consent to the medical assistance in dying the second time.

Those are some of my thoughts on the bill. I hope that the committee responsible for studying it will reflect on these comments.