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

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, Bill C-14 was the well-considered response of the previous Parliament to a Supreme Court of Canada decision, the Carter decision. Bill C-14 became the law, it was incorporated into the Criminal Code of Canada.

I am of the opinion that the Attorney General should defend the laws of the country. The law was only three years old and was a well-considered decision of Parliament. The Attorney General should defend the laws of Parliament.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I am pleased to join the debate on Bill C-7, an act to amend the Criminal Code, specifically section 241 of the Criminal Code. That is the provision of the Criminal Code that makes it illegal to counsel a person to commit suicide or to aid someone to do so.

In the absence of more recent amendments, in the previous Parliament there was Bill C-14 in response to the Carter decision by the Supreme Court of Canada. In that case the court found that the plaintiffs' charter rights had been infringed upon by a strict interpretation of section 241.

Interestingly, Bill C-14 from the previous Parliament stated, as one of its objectives in paragraph six of the preamble:

...permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance between the autonomy of persons who seek medical assistance in dying, on one hand, and the interests of vulnerable persons...on the other;

The relevant provisions in the Criminal Code included that language. It states that qualifications for MAID, including with respect to the person:

their natural death has become reasonably foreseeable, taking into account all of their medical circumstances....

All of this is about to change because of the Truchon decision.

I am speaking to Bill C-7, a bill that would eliminate the reasonable death foreseeability safeguard and expand MAID, medical assistance in dying, to a larger number of people. I have been encouraged to speak to the bill because of the many letters and the correspondence I have received from people in my constituency.

I have received some letters in support of expanding MAID, but the vast majority of the letters I have received encourage me to speak against expanding the availability of medical assistance in dying.

Correspondence that I am receiving from constituents repeat two basic themes. First is that the reasonable foreseeability of death safeguard should be maintained as an effective defence of societal interests and Canadian values. Second is that more should be done to expand palliative care services.

To quote one person, let Canada be a society that is known for its modern and advanced palliative care services and not as a country that has ever expanding use of medical assistance in dying. We should alleviate the suffering, not eliminate the sufferer.

I am going to read quotes from two people who each made the effort to write me a letter.

The first is Dr. den Hollander, who states:

If Canada must allow MAiD in some form (and I wish it didn't), it is incumbent upon us to ensure that it is rare. Eligibility requirements should be tightened, not loosened. More safeguards are necessary, not fewer. Enforcement must be scrupulous, not relaxed. Without these protections, vulnerable people will be pressured by family members, friends and medical practitioners to MAiD.

The second is a woman named Ramona. She works in health care, including palliative care. She quotes a person to whose care she attended, and who died in the Langley Hospice facility, as saying, “I want to live well while I'm dying.” Ramona goes on to comment, “Surely this is what health care was created for, to support people while they are alive, not to speed up their death.”

This is the tenor of the input I am receiving from my constituents.

Behind Bill C-7 is the Superior Court decision in Truchon. The plaintiffs in that case argued that their constitutional rights had been infringed upon by the now amended section 241 of the Criminal Code. They argued that the Carter decision, on which Bill C-14 was based, did not require that a person's end of life be reasonably foreseeable, and that is a true statement. That is not what the Carter decision required.

Secondly, they argued that the legislated end of life requirement violated the right to equality, under section 15 of the charter, and the right to life, liberty and security of the person, under section 7 of the charter. The federal government, acting through the Attorney General's office, did the right thing at that time. It defended its law. That is what the Attorney General should do. Bill C-14 was the well-considered opinion of the previous Parliament. It was the law. The Attorney General must defend the law.

Remarkably, the Quebec Superior Court refused to accept the arguments advanced by the Attorney General. The Quebec Superior Court said that the court cannot accept the first two objectives advanced by the Attorney General regarding the affirmation of the inherent and equal value of every person's life and the importance of preventing suicide.

In the opinion of the justice writing that decision, those two principles were not the underlying philosophy of Bill C-14. It was all about protecting vulnerable persons from being induced, in moments of weakness, to end their lives.

Remarkably, the Attorney General of Canada did not appeal that decision. That is what should have been done. Any self-respecting Attorney General would appeal a decision that attacked the laws of Parliament. This Attorney General elected not to do that. Now we are in this position where we are under pressure to amend the law, when we should instead be following the directive of Bill C-14, and that is to have a comprehensive review of the whole legislation.

That is what we should be doing. What is the rush? The rush is caused by the Attorney General's failure to appeal this decision. It should have been tested through the court system, up to the Supreme Court of Canada.

With the reasonable foreseeability of death safeguard down, this is what we have left. An applicant for MAID qualifies if he or she has a serious and incurable illness, disease or disability; is in an advanced state of decline; or their physical or psychological suffering is intolerable to them, which is a completely subjective test. The reasonable foreseeability of death criteria is now gone.

Let us just test this against a couple of hypothetical situations. We can imagine that a person has Parkinson's or MS, or was in a terrible accident and is a paraplegic. Under this new regime, if it becomes the law, people who are not dying but who meet all the other criteria, however subjective they may be, will qualify for state-sanctioned suicide. One of my constituents has said that we should let Canada be a society that is known for its modern and advanced palliative care services, and not as a country that has ever-expanding use of medical assistance in dying.

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

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

Cases involving Alzheimer's and dementia raise questions regarding consent and capacity, some rather complex questions since they relate to the prognosis itself. These two types of cases will have to be examined in June as part of the review that Parliament is required to do under Bill C-14.

[Rob Moore, Conservative, Fundy Royal, NB]

Mr. Speaker, specifically on the 10-day cooling off period, does the parliamentary secretary acknowledge that under the current legislation, if necessary, those 10 days could be waived? That was a safeguard put in place by this Parliament and has been taken out in haste.

I would like the parliamentary secretary to comment on a couple of facts that deal with this Parliament. First, a two-week online consultation is not a parliamentary review. Bill C-14 called for a parliamentary review that was to take place this summer before we expand our regime in Canada around medically assisted dying. The Liberal government has jumped ahead with a vast expansion of the legislation without the benefit of that review.

Does the parliamentary secretary see a two-week online consultation having some equivalency with a parliamentary review?

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

Mr. Speaker, I will be splitting my time with my colleague, the member for Kings—Hants.

I am pleased to rise today to speak to Bill C-7. I have some prepared remarks, and during the course of my comments, I will try to sprinkle in some responses to some of the various issues that have already been raised.

Clearly, we are here because there was a decision of the Quebec Superior Court in the Truchon case. This decision struck down a particular criterion under both the Quebec regime and the Canadian regime with respect to the end-of-life nature of medical assistance in dying, this being the reasonable foreseeability of natural death criterion, in particular at the national level.

The court's ruling only applies in Quebec. We heard the minister speaking about this. He suspended its declaration of invalidity for a period of six months, until March 11. It is important for this chamber to understand 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. That motion was actually debated yesterday, and a decision from the court is forthcoming.

Before I go into some of the details in this bill, I want to start off with two important provisions related to conscience protection that were raised by members of the official opposition in the context of this debate. I want the record to be crystal clear that conscience protections are robust in this country and are entrenched in the law.

The first location is in the preamble to the old Bill C-14, which I will read. It 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 wrong, because it is in the statute. Section 9 on page 8 of the old Bill C-14, which amended subsection 241.2(9) of the Criminal Code, says “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

The third point I will read 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 three instances. One is jurisprudential and the other two are statutory. The fourth one is of course the broad penumbra that is cast by section 2 of the charter, which protects freedom of conscience for all Canadians, including those who practise medicine. Therefore, the assertion that somehow conscience rights are not protected or are somehow being eroded is categorically false.

Another point in terms of what is being addressed in today's debate is the notion that a culture of overly facilitating medical assistance in dying is upon us, and 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 security of persons who are vulnerable, including persons with disabilities. That is categorically false and is not commensurate with what is in evidence.

The evidence we have is readily available in the technical briefing that was already provided to all members of Parliament. It is that in total, 13,000 MAID-assisted deaths have happened in this country in the last four years. The average age of people who are accessing MAID is 75 years old. It is being accessed equally by men and women, 51% by men and 49% 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 importantly, 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 this country. I read that into the record because I think it is important for people 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 on my reasons going forward.

I would like to talk about some aspects of the bill. The eligibility criteria have changed, as the Minister of Justice pointed out.

There are two series of safeguards. The first applies to cases in which the person's death is reasonably foreseeable, while the other applies when death is not reasonably foreseeable. The bill would add new safeguards to that second category.

Lastly, the bill allows a person to waive final consent on the day of the procedure in certain circumstances.

I will return to that in a few moments.

Much has been made about the consultation process, including some comments by the member for Mission—Matsqui—Fraser Canyon about it being a rushed procedure and that the government is not adequately listening to Canadians. I have great respect for all members in the House who are participating in this debate and raising a number of very personal, ethical, legal and moral issues. I understand that; the government understands that.

However, to assert that the consultation was not robust is again categorically false. We heard from 125 different individuals, who are experts in this field, whether they are delivering it or acting on behalf of disabled individuals, and from nurses, doctors, etc. We heard from 300,000 Canadians through their responses to a questionnaire that outlined the 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 less 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 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 this debate. This is important, as was outlined by the minister. 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 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 to render someone eligible for MAID.

This complex issue must be examined carefully as part of the parliamentary review of the legislation on medical assistance in dying, which is to start in June of this year, as the minister himself mentioned.

Importantly, the Government of Quebec has also announced the exact same study for the exact same provision, that the issue of mental illness as a sole underlying condition is complex. Issues of consent and capacity and issues of properly being able to diagnose and have a prognosis are critical.

I will move to some of the comments that have been made. It is important for people understand that 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, we have taken the 10-day period of reflection out of the legislation. This was put squarely into issue by the member for Fundy Royal when he asked about the basis for doing that. The basis for it was that the safeguard was not doing the work it was meant to do. As opposed to protecting vulnerability, it was actually increasing the vulnerability of individuals insofar as it was prolonging suffering in some instances.

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

On the question raised by the member for Sherwood Park—Fort Saskatchewan most recently with respect to how one assures informed consent is applied when it has not been solicited actively, I have 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 that they want to access it and provide consent in writing, that consent would be sufficient.

In direct response to the member for Sherwood Park—Fort Saskatchewan, could it be vitiated? Yes. First, if the person has not lost capacity, consent could be vitiated. Second, it could be done by a physical gesture that would be interpreted to fully and finally eliminate that consent for the purposes of the practitioners.

The bill strikes a balance and the balance is important. We are conscious that a compassionate response that protects vulnerable individuals and also respects their dignity and autonomy is critical and what is required by the Constitution.

That is what this bill represents and I am very hopeful, as the member from the Bloc Québécois pointed out, that we can achieve all-party consensus on that very fundamental point.

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

Mr. Speaker, I had the privilege of serving on the justice committee with the member for Cowichan—Malahat—Langford in the last Parliament. I had the benefit of serving as the vice-chair of the Special Joint Committee on Physician-Assisted Dying and then served on the justice committee following that, when it dealt with Bill C-14.

I acknowledge that the circumstances Audrey Parker and others like her found themselves in presents a real, difficult challenge from the legal, moral and ethical standpoint. However, a regime that provides for advance directives does cause me some level of concern.

In the Carter decision, the Supreme Court of Canada made clear that there must be clear consent. How can there be clear consent absent contemporaneous consent on something that is ultimately irreversible when carried out?

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I have already received some correspondence on this particular bill. A number of people back home have already organized a community meeting with me on this legislation when I am back in the riding during the constituency week next week. It is a group that had a lot of concerns with Bill C-14. Based on their faith, they had some real concerns with it.

I knew when I walked into the room to meet with them the first time that we were not going to walk out in agreement with each other. However, I think we surprised each other with how respectful we were. We walked out of there respecting each other's positions, with a sure knowledge that we had each given this issue some deep thought. I expect that the same tone of conversation will happen again when I meet with them next week to discuss this bill.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I agree with the member. As I said in my opening remarks, this is a subject with such weight and importance to so many people across this country, whether they live in Nova Scotia, Quebec or in my home province of British Columbia. We owe it not only to ourselves in this chamber but to the people we represent to treat this subject with the respect it deserves.

As a member of Parliament who served in the previous Parliament, I was, by and large, quite impressed with the tone of debate on Bill C-14. I know there were some disagreements on the bill, but members ultimately tried to bring their disagreements and respective positions on the bill to the floor with as much respect as possible. During many of the speeches in this place at the time, members who were here will remember that the chamber was so silent we could hear a pin drop, because we knew how important the bill was to members speaking and, more importantly, to their constituents watching back home.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, it is quite incredible to be revisiting this issue. I can remember when the debate on Bill C-14 went on, back in 2016. There were some amazing speeches uttered in Centre Block during that time. This truly was an issue that had a profound effect on so many members in the chamber but, we know, also on so many members of our society.

I was honoured in 2017 to serve as our party's justice critic. I am pleased to again be serving in the role as the deputy justice critic for the NDP. I have always felt that this particular critic role brings with it a very great weight of responsibility, especially when we are dealing with the Criminal Code. I do not think there is any other statute in Canada that has such a profound effect on people when they violate any of its provisions. It also gives a lot of guidance, as is the case in medical assistance in dying, over the parameters that are set up.

Regarding medical assistance in dying I, like many members in the chamber, received a lot of correspondence on the issue back in 2016, both from constituents who were against it and from constituents who wanted me to take up the cause.

I think that is the challenge that we as members of Parliament face on a regular basis. We have to look at our constituents' wishes, but they are not always very clear cut. We have to try to balance those with our own personal views on the subject and, at the end of the day, try to be accountable for the decisions we have made on behalf of our constituents in this place.

When it comes to an issue as complex as medical assistance in dying, I fundamentally believe that we must go beyond partisanship and work together with a compassionate lens. Ultimately, we must make sure that Canadians can die with dignity, compassion and fairness, and without excessive suffering.

I am pleased to see the introduction of Bill C-7 as part of the effort to help those who are looking to end their unnecessary suffering as they face the end of life. Bill C-7 is coming to us as a result of a decision in a Quebec court. For me personally, and for many members of the New Democratic caucus, it was quite evident in 2016 when we were debating Bill C-14 that this issue would come back to us. We knew it was only a matter of time.

I can remember referring, in the debates on Bill C-14, quite clearly to the Carter decision, which was handed down by the Supreme Court on February 6, 2015, in the final months of the 41st Parliament, when the Harper government was in power.

When the present Liberal government came to power in 2015, this was one of the major challenges it was faced with, because there was an impending deadline and there was a real rush to get in legislation that was going to respect the Carter decision.

I want to give a shout-out to two of my colleagues, Murray Rankin and Brigitte Sansoucy. As members of the New Democratic caucus, they sat on the special joint committee that looked at this issue as a result of the Carter decision, and presented the committee's recommendations to the House of Commons.

When we look at the Carter decision, which really started this whole process rolling just over five years ago now, we can see that they felt the prohibition on allowing people to take their own lives because of suffering violated their Charter rights. I will just quote from the ruling. It was stated that:

Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

It went on to say:

An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.

Thus, it violates section 7 of the Charter of Rights and Freedoms. Just to read it into the record, so that everyone is quite clear on what we are referring to, section 7 reads that:

Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

What Carter was clearly explaining to people was that by not allowing people this option, by keeping them in a state of constant suffering, of basically confining them to their bodies, we were in fact violating their section 7 rights. That was the clear message that was delivered to Parliament.

There is always a careful dance between our courts and the legislature. The courts, of course, are very much responsible for interpreting the law, but also finding when such a law runs contrary to our Constitution. They also recognize that Parliament has its role to play as the lawmakers, as the one institution that can amend the law based on people's wishes. That was the task that was handed to us at the beginning of the 42nd Parliament.

When that special joint committee with the other place was formed, there were some clear recommendations that directly followed from the Carter decision. Recommendation number two, which I will read into the record, was as follows:

That medical assistance in dying be available to individuals with terminal and non-terminal grievous and irremediable medical conditions that cause enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

The problem that led us to where we are today was the fact that Bill C-14, as a government bill, decided to insert a reference to “reasonably foreseeable death”. This meant that if one had a medical condition for which death was not reasonably foreseeable, one could not qualify for medical assistance in dying.

Also, as a part of that special joint committee's recommendations, it did touch on the subject of advanced directives which is also, I am glad to see, addressed in Bill C-7.

The Truchon decision of 2019, in the Superior Court of Québec, involved two plaintiffs who were each suffering from grave and incurable medical conditions that caused tremendous suffering and a total loss of autonomy.

They were 74-year-old Nicole Gladu, who used a wheelchair and had post-polio syndrome, which is a condition that weakened her muscles and reactivated her childhood scoliosis. She had difficulty breathing and was in constant pain. As well, there was 51-year-old Jean Truchon, who was born with cerebral palsy and no longer had the use of his four limbs. He lost the use of his only working limb back in 2012, due to severe spinal stenosis that left him almost completely paralyzed and caused painful spasms. He gave up most of his activities and went into assisted living since there was little he could do by himself.

Both of these individuals were refused medical assistance in dying under the Quebec legislation regarding end-of-life care as they were not at the end of their lives. Their deaths were not reasonably foreseeable.

With those grave medical conditions, they were prisoners in their own bodies but unable to find any relief. Really the heart of the matter here is how we, as an institution, respect individual autonomy. We can only imagine the pain and suffering they were going through on an hourly basis. When two individuals have arrived at this decision and obviously had the time to think about it, I think it is incumbent upon us to respect that, but more importantly to respect the fact that we have had a court look into this and determine that their charter rights were fundamentally violated.

That brings me through the long journey over the last five years to Bill C-7.

I am pleased to see the bill introduced. The Minister of Justice was one of four Liberals who voted against Bill C-14. I think he is now having a moment where it has come full circle. Now, as the Minister of Justice, I hope he feels some satisfaction in bringing in corrective measures to address the problems he saw as a Liberal member of Parliament back in 2016, when he voted against the government's legislation at the time.

As is required by the decision of the Quebec court, Bill C-7 will expand access to medical assistance in dying to those whose death is not reasonably foreseeable. I can assure the House that we are providing our support to the bill in principle at second reading. However, we will be doing our due diligence when it reaches the Standing Committee on Justice to ensure that access to medical assistance in dying has not been unreasonably restricted for those whose death is not reasonably foreseeable by the addition of the new conditions in the legislation.

We also want to ensure the standard of eligibility for receiving medical assistance in dying remains high. We remain disappointed that there has been no commitment by the minister to refer the question of the adequacy of the safeguards against pressure to seek medical assistance in dying to the formal legislative review, which will begin in June, again at the Standing Committee on Justice. Perhaps the government can hear those words, reflect upon them and address our concerns with respect to that aspect.

Going into some of the finer details of the bill, essentially there is a two-track process in Bill C-7. There is one for those whose death is reasonably foreseeable and one for those whose death is not reasonably foreseeable.

For the one where death is reasonably foreseeable, the 10-day waiting period is removed; the number of independent witnesses required for the written request is reduced from two to one; a paid professional or health care worker can be an independent witness; and the creation of a waiver of final consent.

For the second track, which is ultimately the part of the bill that is responding to the decision from the Quebec court, a few more restrictions are in place. The first big one, which will warrant some further study at committee, requires a minimum 90-day assessment period, which I think the legislation states can be shortened if loss of capacity is imminent and the assessments have been completed.

However, as I have said in previous questions and comments, we have already heard from some members of the medical community. They say that the 90-day assessment requirement may mean their patients have to endure another 90 days of suffering. For physicians, who take the Hippocratic oath to do no harm, if their patients are experiencing harm every day because of that suffering, that weighs very heavily on their conscience.

There are some other specifics in that other track process that I do not think warrant going into too much detail at this stage. The Standing Committee on Justice will do that.

I also want to touch on another aspect of Bill C-7, which is the advance directive. This is known as the Audrey Parker amendment. It refers to Audrey Parker, a Halifax woman who was diagnosed with stage four breast cancer, which metastasized to her bones and a tumour on her brain. She spent the last weeks of her life raising awareness about the challenges facing Canadians who had been assessed and approved for assisted dying. She opted to die earlier than she would have otherwise wanted to. The legal requirement in the existing legislation is that the suffering person has to be competent immediately before the life-ending treatment is administered.

That presents a number of problems. If someone has already been approved for medical assistance in dying within the tight confines of what is written in Bill C-7, he or she can give that advance directive so that those wishes will be fulfilled even if there is a loss of competency. It would remove a sense of pressure that could be brought to bear on individuals who may feel compelled to take their life earlier, while they still have competency and the ability to act on their own directive. Therefore, I think this is a particularly important section of this legislation that should be noted, and I certainly look forward to seeing what kind of testimony we hear at the justice committee.

I have received some correspondence with respect to the Audrey Parker amendment. I have an email here from a constituent. She sent me a copy of her letter to the justice minister. She states:

These steps ensure that the patient qualifies for medical assistance in dying under the law, making the late-stage consent requirement unnecessary — and puts an enormous physical and emotional strain on people who are at risk of suddenly losing capacity, or who need heavy medications to manage their pain.

Most importantly, this unfair requirement means that people in the Assessed and Approved category are faced with a cruel choice: access assisted dying now, or wait longer and risk losing out on their right to a peaceful death.

Right now, dying people are ending their lives far earlier than they would like, or are refusing adequate pain care out of fear that they will lose out on their right to a peaceful death. This is an unacceptable burden for anyone to bear, and it is a clear and grave violation of Canadians' Charter rights.

That is just an example of some of the correspondence I have received on that particular aspect. It is actually really nice and refreshing to hear someone lay it out quite clearly because I think if we were to visit any riding we would all have constituents who have faced those pressures.

This is weighty subject matter. I know that in this chamber and indeed across this great country there are going to be multiple views on whether we are in fact going down the right path.

In moments like this when we are called upon to make these momentous decisions, we are required to look inside ourselves and to switch more from sympathy to empathy. I see this difference between the two. Sympathy is feeling sorry for someone else, while empathy is trying to put oneself in that person's shoes in order to view the world as she or he sees it.

The truth is that the members of this chamber who are lucky enough to have their health and to lead privileged lives cannot adequately express or feel what it is like to live in a body that feels like a prison and to know that kind of suffering. My ultimate view of this bill, and what guides me in the direction we need to take, is that it is about trying to make sure we can give people the dignity in death that they had in life, to respect their autonomy, to respect their choice and to make sure that their charter rights are not violated.

I conclude by stating that the New Democrats will be supporting this bill at second reading, with the full realization that the committee work is before us, which will be a real opportunity to hear from members of the public and witnesses. Hopefully, when this bill returns to the House we will have a product that we all feel we have done our best on and that lives up to the important wishes of our constituents who are living with these incredible amounts of suffering.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, the speech of my colleague from the Bloc was very passionate speech. I very much enjoyed listening to it.

When we looked at this issue in the previous Parliament, what was very clear back then was the Carter decision. What was very clear back then were the recommendations of the special joint committee. What was not very clear was why the government at the time had inserted the clause that required a reasonably foreseeable death. During my speech on Bill C-14 in 2016, I knew that clause would force us to come back and revisit this issue.

Parliament did look at this issue, we did deliberate and a number of parliamentarians at the time identified this as a problem. Then I see the Truchon decision, and that simply forces Parliament to clean up its act, to actually get the job done properly this time.

Who are we to impose our values on people who have gone through the suffering, who are being forced to live with these medical conditions? We have no idea what kind of a world they are living in. The member is very right that it is about treating their life with dignity and also allowing them to die with dignity in what is an incredibly personal choice.

I want to get my colleague's thoughts on a particular section of the bill that sets the assessment period at 90 days. For someone whose death is not reasonably foreseeable, but is facing intolerable suffering, what does he think of the 90-day period? The New Democratic caucus has already heard from physicians who have great concern that they may have to force their patients to wait an additional 90 days when it is already quite obvious the suffering is very grave.

Could my colleague provide us with his thoughts on that section of the bill?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, it is with some emotion that I rise in the House today to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

We are debating Bill C-7 today because the legislators who were here four years ago did not do their job properly when they debated Bill C-14. We do not live in a democracy run by judges. We are the ones that make the laws and who must make the voices of citizens heard, particularly the voices of those who are suffering. All judges do is interpret the grammar of justice. They look at the laws and people's rights and freedoms and determine whether the infringements are reasonable or not. However, before Bill C-14 was introduced, two courts told us that, according to the law, the Criminal Code infringes on the right to life and the right to liberty and security of those who are ill and suffering, are struggling with unbearable pain or have a terminal illness.

Today, I hope that we will seize the opportunity that is given to us. I hope that we will extend the debate until June because this is a serious subject. I hope that we will have a calm, rational debate.

I will start by saying that I am sure my colleagues in the House all have good intentions. They want to do good. They have kind hearts. I am sure that their behaviour throughout the debate will reflect the very values they are advocating, namely benevolence and caring. However, we cannot be benevolent and want what is best for a terminally ill person if we refuse to listen to what that person has to say before they die.

All I want is for us to understand what is at stake here, I am referring to the law, which my Conservative friends have always put on a pedestal. The value of autonomy is conferred by law through the principle of self-determination, especially with regard to medical care. I will come back to that.

I will take a moment in this debate on such a crucial and delicate issue to say that I hope all my colleagues get to cross the threshold of death peacefully, quietly and painlessly. That is my wish for everyone, because the best fate we can wish on another human being is to find peace, to let go and to receive what is known as good palliative care if they are terminally ill with an irreversible ailment. More on that later.

Today we are discussing the autonomy conferred by law through the principle of self-determination. In the biomedical context, there is a rule. A value gives rise to a principle, which in this case is self-determination. This principle gives rise to a specific rule, namely the rule of free, informed consent. The rule about free, informed consent to treatment has never been challenged in emergency situations.

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?

I therefore invite my colleagues to join me in a debate on autonomy and self-determination. If someone shows up at an emergency room, they cannot be treated without their consent. Everyone has the right to refuse treatment, by the way.

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 those provisions 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 the issue that we are called upon to address. There is no issue for people who are terminally ill. The issue we need to address as legislators has to do with people whose death is not reasonably foreseeable and imminent.

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. I imagine we will do so eventually. That is about all that is missing from the bill. Clearly the Bloc Québécois is in favour of passing this bill in principle.

What we want is respect for the moral autonomy of the dying. We often speak of dying with dignity. Dying with dignity does not mean having a sanitized death. That is not it. 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. 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, we called this passive euthanasia. The person was left to die 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, which always ends up causing death, because palliative care provides care.

Human beings won the right to die rather than undergo aggressive therapies. People did not die of cancer; the therapies killed them. Experiments were conducted on human beings. Doctors led the way to ensure that they would have quality of life if they were to be struck by cancer. They did not want to receive treatments that would make them ill for a year when they only had two years to live.

The right to die won out over aggressive treatment plans. That idea evolved and became palliative care.

For a long time, palliative care was thought of as the only solution that would allow someone to die with dignity. However, in the past 30 years, were there people living with terminal illnesses, dying a slow, agonizing death, who did not receive all of the palliative care they needed until the end of their life, if that was what they wanted?

First, we need to look at whether palliative care is accessible. There is an increase in requests for medical assistance in dying. Bioethics talks about clinical ethics, in which the patient comes first. It is about listening. Sometimes, even the best palliative care in the world, with the best framework in the world, cannot alleviate someone's suffering.

That is true for Ms. Gladu and for Mr. Truchon, but those people are not suicidal. They want to live as long as possible. When they want to die, they may be given anti-depressants. They will be of sound mind when they make their decision. That decision will be reversible. I was listening to Ms. Gladu the other day. What does she want? She wants freedom of choice. In many cases, once people have that choice, they have so much respect for their dignity that they are no longer in such a hurry. That reduces suffering tremendously. That is the issue we are dealing with.

We must not sidestep this issue on the grounds that we want to move swiftly. I have a lot of questions about the bill because it does not address degenerative cognitive disease. I think a person with Alzheimer's should have the opportunity to make an advance request.

These are predictable diseases. Doctors can tell patients how they will progress. People with these diseases often remain of sound mind for years. Eventually, they become forgetful. In the end, they die not of the disease itself but of complications from being bedridden or immobilized or conditions other than that disease. This bill does not take those people into account.

What I would hate is to see a repeat of what happened with Bill C-14. The reasonably foreseeable natural death criterion was established, and it was supposed to protect vulnerable people.

Is there anyone more vulnerable than someone 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? It is not as though the person's neighbour is going to die for them.

I have a hard time understanding our Conservative colleagues' argument that the state must decide for an individual, when they are so economically libertarian.

In 1957, Pope Pius XII was a pioneer. He said that we must stop claiming that only God can decide whether we should die a slow death. At a certain point, he made it possible for us to sanction palliative care.

Today, let us not pit palliative care and medical assistance in dying against each other, regardless of 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. 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.

I appeal to my colleagues' humanity. I am a staunch democrat, humanist and, of course, sovereignist. I am all of those things, but one does not take precedence over the other when it comes to problems like this.

I am not saying that the federal government should have challenged that ruling because it came from a Quebec court. In any case, it is a court under federal jurisdiction that rendered that decision.

This ruling challenges us as legislators to do our job and stop off-loading the problems, the ethical, social and political questions to 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. However, I said from the outset that we agree in principle and on the grounds for discussion of this bill. I apologize for being overly philosophical today, but that is where the substance of the debate lies; it is ethical and it is political in the noblest sense of these words. Indeed, it is up to us to make the laws to ensure the well-being of all. It is a philosophical debate and, in a way, a theological debate that leads us to the law. However, regardless of how much time we spend on this, let us use substantive arguments.

When I hear arguments to the effect that this is a slippery slope, I think about the study of Bill C-14, during the last Parliament, when some people were practically saying that nursing homes and long-term care facilities would become euthanasia machines. I do not know of any evil people who work in health care, in any position. If such a person exists, then let them be fired, because they have no place there. I am not buying the slippery slope argument.

We must assume from the outset that all stakeholders in the health system are caring and compassionate. Yes, they sometimes experience difficulties. With just a slight increase in health transfers, they could provide better care and there might be more palliative care units in hospitals. Even though I do not believe that palliative care is the only solution, that is what people have been saying for 50 years. It makes no sense that there are not more palliative care units.

Not everyone asks for MAID. I talk a lot about those who do not pose a problem. In Quebec, where the Quebec law is in effect, the obligation to meet the criterion of a reasonably foreseeable natural death forces people to go to court or to go on hunger strikes. This criterion was unconscionable, and the courts handed down an appropriate ruling in that regard.

Therefore, I appeal to my colleagues' humanity.

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

Madam Speaker, I am going to offer four clarifications and then ask the member a question.

The first clarification is that, with respect to the conscience rights and whether they exist, they do exist in three places and I outlined them already: in the preamble, in subsection 241.2(9) of what was then C-14 and in the Carter jurisprudence. I think that is important, because this member is urging us to return to Supreme Court jurisprudence.

The second is about withdrawal of consent. Can it be done? Yes it can, through non-verbal means. That is entrenched in this bill.

The third is that the notion that people can die “all in one day”, and I am quoting the member opposite, is actually patently inaccurate in terms of the empirical evidence. There are two independent medical practitioners, completely divorced from the people who verify the identity of an individual, who determine the eligibility. Those people take some time to do so. It does not happen “all in one day.”

Finally, the issue about the independent witness going from one to two is simply to reduce one of the barriers.

If the concern is for ensuring that the autonomy and dignity of all individuals are entrenched here, does the member opposite agree that when the court, in Carter and in the Truchon decision, talks about ensuring that intolerable suffering is no longer continued, and that the dignity of those people who are making a personal choice about how they choose to exit this life should that be respected in the context of this legislation?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, in Bill C-14 from the previous Parliament, the decision was made not to include advance directives, meaning that someone would have to give consent at the time of medically assisted death. That is why, in the previous legislation, someone would have to consent and then give a further consent at the time of medically assisted death.

The bill before us would change that. This is a major expansion of Canada's laws on assisted dying. It was done under the premise of a response to an unrelated court decision in Quebec.

There is a reason parliamentarians and the House put in place a statutory review of this regime: so that we can consider new measures and look at what is working and see what is not working. This is why the whole discussion on this aspect of consent should have been done in the course of the statutory review.

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

Madam Speaker, I thank the member opposite for his contribution to today's debate and I welcome him back to the House.

I will begin by correcting about five errors in the member's speech and then I will ask him a question.

The first point is with respect to the Truchon decision. It was not appealed, first because we agree with the substance of the decision and secondly because we disagree with prolonging the suffering of Mr. Truchon or Ms. Gladu or people like them.

The second point is with respect to health care providers and the potential of a chilling effect being exacted upon them. It is a valid point, and that is why we have entrenched important safeguards in the legislation, such as the requirement for advanced consent to be done in writing.

The third point is on people being pressured as medical practitioners to engage in this practice, which is patently false. Bill C-14 has conscience rights entrenched in its preamble and in the body of the bill, and the Carter decision, in its penultimate paragraph, said that the charter protections under section 2 for freedom of religion does not compel any health care practitioner in this country to provide this service.

With regard to the member's attempt at an analogy between the 90-day assessment period and the 10-day reflection period, they are different qualitative matters. Reflection is not assessment.

The member raised a very valid point about palliative care. We agree and understand that palliative care must be robust and we fully support the idea, which is why this government put $6 billion into home care, including palliative care, two budgets ago. Does the member agree that this was a useful investment?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, it is a great pleasure today to rise as the shadow minister of justice for the official opposition to speak to the government's Bill C-7. As I rise to speak on this bill, I do so with concern over some of the contents within it and even over the way it was presented to the House this week when, unfortunately, many of us read about the contents of the bill in the media, rather than seeing it first in this House.

The bill was intended to be a response to the Quebec Superior Court decision that was made on September 11, 2019. The decision stated that the law as it stood was too restrictive around the requirement for death to be reasonably foreseeable. The official opposition called on the government at the time to appeal the decision to the Supreme Court of Canada in order for Parliament to receive clarity about the parameters in which we would legislate, but the bill was introduced without that clarity.

Not only was the bill introduced without that clarity, but it goes far beyond what was required to meet the Quebec Superior Court's decision. I believe that is an affront to this Parliament, because when the previous bill, Bill C-14, was passed in the 42nd Parliament, the wisdom of this Parliament required that there be a statutory review of our assisted dying regime in Canada. That statutory review was and is to take place in June of this year.

It is in that review period that parliamentarians would be able to go more into depth on how the government's legislation has worked over the past several years and on how best to proceed. Rather than wait for that review, as it should have done, the government has decided to start making amendments to the legislation now, avoiding the in-depth review that is to take place shortly.

The reality is that when we are talking about this legislation, we are literally talking about the matter of life and death. This is an incredibly sensitive issue. Members on all sides of the house have diverse opinions on it, and it is because of this diversity of opinions and because of the sensitivity of this issue that the Quebec Superior Court decision should have been appealed to the Supreme Court of Canada for further clarity. However, as the government has now opened this legislation up, it is upon us as legislators to now highlight other matters that should be addressed and included.

My office has heard plenty from concerned Canadians about the lack of protection for conscience rights for health care professionals. This is particularly important now that the government is broadening medical assistance in dying to include individuals whose death is not reasonably foreseeable. Expanding medical assistance in dying to more patients could in fact diminish the number of medical professionals willing to take part in the process. The fact is that this expanded access could result in a heavy emotional burden on those health care providers.

None of us here can fully appreciate the burden put on those health care providers currently working in the system and providing medical assistance in dying. The fact is that there is nothing about ensuring proper support to health care professionals who provide this service and there continue to be no penalties for pressuring a medical professional into providing medical assistance in dying, nor are there penalties for punishing or penalizing a medical professional who does not participate in medical assistance in dying. This means there continues to be no real protection for conscience rights for health care professionals.

The issue of advance directives, now rebranded as a “waiver of final consent” by this government, is a complex one that poses questions of ethics and safety and issues with oversight. The fact that the legislation legalizing this is half a page of a bill shows a lack of care given to this issue. This issue rightly should have been discussed as part of the parliamentary review to take place this summer.

The process for the creation and execution of this agreement remains ambiguous. Further, there is a lack of clarity on the process for proceeding with an advance directive agreement upon the date selected. The process will only be stopped if a patient expresses a form of resistance, but we do not know what that looks like. What if they are simply confused or groggy at the time? Under the legislation, unless they resist, the process will still proceed.

The bill also removes the 10-day waiting requirement when a person's death is reasonably foreseeable. When I read in media reports before the bill was tabled that this would be included, I, like many of my colleagues and parliamentarians, questioned as to what prompted its removal. I still remain incredibly concerned as to why this was included. This is particularly true because there was already the ability to remove the 10-day waiting period if a person's death or loss of capacity to consent was imminent, so why proceed with the removal of a safeguard that Parliament saw fit to include in the previous legislation?

It is also confusing that Bill C-7 requires a 90-day waiting period when a patient's death is not reasonably foreseeable. Why add an extended wait period for one, but remove the wait period entirely for the other?

On the issue of whether a death is reasonably foreseeable or not reasonably foreseeable, there is no clarification or guidance for health care professionals. As a result, it is not up to them to make the determination as to what category to put a patient under. That determination will decide whether a patient can access medical assistance in dying immediately or if they will require a 90-day waiting period. This is an extraordinary amount of pressure that the government is putting on health care professionals across this country.

The changing of witness requirements under this legislation has also been mentioned. The law requires only one independent witness, which is down from two.

All of these changes lead to an expansion of the law in Canada far beyond what was addressed in the Quebec court decision, an expansion that should have required deeper reflection through the study that is to take place this summer.

For a moment, let us speak to a point that seems to be lost in this conversation: palliative care services in this country.

The reality is if the choice is between a lack of quality palliative care and medically assisted dying, that really is no choice at all. Unfortunately, over the past number of years there have been instances of patients feeling they were forced to choose death because of a lack of palliative care.

The story of Archie Rolland comes to mind. Archie was a Montreal landscape architect who chose to end his life rather than continue suffering at a long-term care facility that was failing to provide him adequate care.

He had ALS and had his life upended when he was forced to move from a Montreal hospital that specialized in treating patients with severe respiratory ailments to a long-term care facility for geriatric patients. Mr. Rolland did not want to go, but he was transferred against his wishes. He called the system “inhuman”. He felt he was not getting adequate care, so he chose death.

I do not think that this is any real choice at all. We must have the discussion in this country about palliative care because people must not feel forced into a decision on medically assisted death. Mr. Rolland's story makes it clear that there was a failure of the system to provide him with adequate care. We risk medically assisted death being seen as some sort of bureaucratic solution for people who require an extra level of care. In a country like Canada, that is simply not acceptable. The government risks expanding a culture of not valuing life, and we should all agree in this place that we must place value on human life.

In closing, the bill disrespects Parliament and the parliamentary process. With Bill C-14, parliamentarians did a significant amount of work in the House and committee in an attempt to build consensus. The work was challenged by the Quebec Superior Court, but rather than defending the will of elected representatives in court, the Liberals immediately backed down.

Now the Liberals are responding not just to that decision but are also undoing the work of the joint committee on Bill C-14 by adding new measures.

Many of these issues should be dealt with in the summer when we have our scheduled parliamentary review. This is a complex matter that requires proper scrutiny and debate.