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.

[Dr. Ann Collins, President, Canadian Medical Association]

Thank you, Madam Chair. It's my honour to appear before you today.

I am Dr. Ann Collins. Over the past three decades in practising medicine, I have taught family medicine, run a family practice, served with the Canadian Armed Forces and worked in nursing home care. Today, in my capacity as president of the Canadian Medical Association, I represent our 80,000 physician members.

In studying Bill C-7, it is incumbent upon us now to consider the effects on patients that the passing of this bill will have, as well as the effects on the medical professionals who provide medical assistance in dying, MAID.

When the original MAID legislation was developed as Bill C-14, the CMA was a leading stakeholder. We have continued that commitment with Bill C-7. Having examined Bill C-7, we know that in a myriad of ways, the results of our extensive consultations with our members align with the findings of the government's round tables.

Fundamentally, the CMA supports the government's prudent and measured approach to responding to the Truchon-Gladu decision. This thoughtful and staged process undertaken by the government is consistent with the CMA's position for a balanced approach to MAID.

Nicole Gladu, whose name is now inextricably tied to the decision, spoke as pointedly as perhaps anyone could when she affirmed that it is up to people like her “to decide if we prefer the quality of life to the quantity of life”. Not everyone may agree with this sentiment, but few can argue that it is a powerful reminder of the real stakeholders when it comes to considerations of this bill. This applies just as critically to those who are currently MAID providers and those who will become providers. They are our members, but we can't lose sight of the fact that we must all support both patients and providers.

Through our consultations, we learned that many physicians felt that clarity was lacking. Recent federal efforts to provide greater clarity for physicians are exceedingly welcome. The CMA is pleased to see new, non-legislative measures lending more consistency to the delivering of MAID across the country. The quality and availability of care, including palliative care, mental health care, care for those suffering from chronic illness and care for persons with disabilities to ensure that patients have access to other appropriate health care services is crucial.

The CMA holds firm on our convictions on MAID from Bill C-14 to Bill C-7. We believe, first, that the choice of those Canadians who are eligible should be respected. Second, we must protect the rights of vulnerable Canadians. This demands strict attention to safeguards. Finally, an environment must exist that insists that practitioners abide by their moral commitments.

These three tenets remain equally valid. Our consultations with members demonstrate strong support for allowing advance requests by eligible patients who may lose capacity before MAID can be provided. The CMA believes in the importance of safeguards to protect the rights of vulnerable Canadians and those who are eligible to seek MAID. The CMA also supports expanding data collection to provide a more thorough account of MAID in Canada; however, this effort must not create an undue administrative burden on physicians.

The CMA views as problematic the language in the bill that explicitly excludes mental illness from being considered an illness, disease or disability, and it has the potential to be stigmatizing to those living with a mental illness. We trust that Parliament will carefully consider the specific language used in the bill.

Finally, the CMA endorses the government's staged approach to carefully examine more complex issues. However, we must move forward to ensure practitioners are given the tools that will be required to safely administer MAID on a wider spectrum, such as support for developing clinical practice guidelines that aid physicians in exercising sound clinical judgment. Such guidance would also serve to reinforce consistency in the application of the legal criteria.

In conclusion, Madam Chair, allow me to thank the committee for the invitation to participate in today's proceedings and to share the perspective of Canada's physicians. The pursuit of a painless and dignified end of life is a noble one. The assurance that the providers of this privilege are supported is an ethical imperative.

[James S. Cowan]

Thank you very much for the opportunity, Madam Chair and Mr. Garrison. Sorry for the technical difficulties.

Perhaps I could just conclude on a couple of points.

Dying with Dignity Canada is concerned about the express exclusion from Bill C-7 of those with mental illness and believes this exclusion to be stigmatizing, discriminatory and likely unconstitutional.

It's worth recalling the words of Justice Baudouin in the Truchon decision. She said:

The vulnerability of a person requesting medical assistance in dying must be assessed exclusively on a case-by-case basis, according to the characteristics of the person and not based on a reference group of so-called “vulnerable persons”.

She went on to say that “the patient’s ability to understand and to consent is ultimately the decisive factor, in addition to the other legal criteria”.

I have one other point, if I may. We strongly believe that the five-year parliamentary review of the MAID legislation and the state of palliative care in Canada, which was scheduled to begin in June 2020, should commence as quickly as possible following the disposition of Bill C-7. More specifically, we expect that the three areas identified for further study in Bill C-14 and addressed in the Council of Canadian Academies report, namely advance requests, mental illness and mature minors, will be considered during that review.

From our perspective, the most pressing of those three areas is the area of advance requests, something that 85% of Canadians support, as confirmed both by our own research and by the government’s consultation. Today, over half a million Canadians live with dementia, and there's no place for them in our current legislation.

[Dr. Tanja Daws]

I have a very different viewpoint.

In my experience as a MAID provider, especially for people with disabilities and even advanced illnesses, such as multiple sclerosis, the entire treatment team had been obstructing patients' access to care, and actually inducing traumatic stress in those patients and their families with their personal views that patients should keep on trying when they have really reached the end of the line, after years or decades of illness.

My patients with disabilities who qualify for MAID under Bill C-14 have told me multiple times that they abandoned health care because their practitioners continued to force upon them the concepts of continuing to struggle when they were done.

We found that, initially, providers of health care, including family physicians and specialists, would abandon patient care. That stopped after provincial regulations from colleges made it clear that this was not okay. We now actually find that patients abandon their health care workers and vote with their feet, and actually compromise their disability care and their palliative care. As MAID providers, we then pick that up, and work on that from scratch before we even start to make progress.

There are other unintended outcomes when people who think they're doing the right thing to protect their patient actually take it too far, and there are always two sides to a coin.

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

Thank you.

In terms of addressing what I feel is unfairness and not accurate information, the position was put by Dr. Coelho that an amendment needs to be made to this legislation to address conscience rights. In fact, Bill C-14 was amended at committee and validated in Parliament. Subsection 241.2(9) of the old Bill C-14, now in the Criminal Code, says, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” It is in the legislation now. It's also in the preamble. It's also in section 2 of the charter, and it's also in paragraph 132 of the Carter decision, where the court went to great lengths to indicate that no medical practitioner would be forced to provide a service they don't wish to.

In my mind, Dr. Coelho, it seems the concern is actually with the direct referral regime, which has been actually upheld in litigation in your own province of Ontario, where it was deemed to be held constitutional in the approach that is currently done. Direct referrals also occur with respect to any other provisions or treatments that doctors don't feel they want to provide themselves.

Perhaps you could respond to that in 45 seconds, and then give Dr. Daws the time to do the same. Thank you.

[Dr. Tanja Daws, Family Physician, As an Individual]

Thank you for allowing me to speak.

I'm a family physician from Vancouver Island, servicing rural communities. I have been a physician for 20 years in total and have done MAID since 2016.

I want to thank Parliament for the time it has given to study Bill C-7, because I know that for some it will seem to never be safe enough. From reading House of Commons Debates notes, I could see that for many there were specific fears relating to disability, vulnerability and slippery slopes, and frustration by other members that the bill never seems to go far enough.

I want to specifically focus on two issues, but in my brief I did provide more information specifically addressing the MAID process as to how we assess patients and the nuance and detail involved. I share the same practice profile as my colleague and can state that in the four years of doing MAID I have never seen vulnerable patients being abused. That is something that we are specifically looking for in MAID assessment. We spend much more time than we spend with regular patients—over months, if needed—to come to eligibility decisions, even if there was just a 10-day wait period in the past.

As MAID providers, we bring an added level in that many are palliative care physicians and many work with disabled patients to start with, and we feel that our moral grit is strong enough to ensure that we are another layer of comfort and care for those patients, more so than just being MAID assessors.

I want to take the time to spend some attention on two separate issues that I think will flow forward on a practical level in MAID from Bill C-7. The first is around the clarification of expertise.

In this brief, I wanted to focus on the fact that family physicians and nurse practitioners provide the majority of the backbone of Canadian health care by doing primary care and also by being co-pilots with our specialty colleagues. Where “expertise” is mentioned in the bill, we realize with appreciation that it's not to change the equitable access to MAID, but rather to ensure that people are more in place to assess these patients thoroughly, especially when we talk about vulnerability and disability.

I do, however, feel that most family physicians, specifically those who deal with these people for decades of knowing them, for decades as their primary caregivers, are probably in the best position to help them. Most MAID providers come from this field, the same as nurse practitioners. In medicine, when you feel you are not equipped medically or knowledge-wise, or you feel you're missing something, that's when you always phone a friend and refer to a specialist or another colleague.

I don't think that in MAID assessments that process will be different. We have shown that in the MAID community more MAID providers have done palliative care courses, and we are all looking at courses to help us with cultural sensitivity as well as with vulnerability and sensitivity. We are all willing to do training to ensure that we will have enhanced skills to make it safer.

I do think the one thing that will be very difficult with how expertise is defined in Bill C-7 is that it may be very difficult in some illnesses to have a MAID assessor feel that they are an expert. It may be impossible, for instance, to find a neurologist who is willing to be an expert and be a MAID assessor.

I would like to propose the idea to the committee that perhaps the two MAID assessors, if they feel they are at the expert level, could continue in that role, but where they feel that none of them could be expert enough, they could perhaps refer to a third expert, such as an addiction specialist or a pain specialist. They are not actual specialities per se, like surgery, but they can ask for a consultant opinion, which is pretty much what we are doing at the moment with Bill C-14, when we refer patients for a formal capacity assessment. Their assessors, who are usually psychiatrists or geriatric psychiatrists, are not comfortable being MAID assessors or providers, but they're happy to be consultants.

Third, I would just like to address, in terms of the final waiver, that the specified day as a choice for patients can provoke unintended harm by causing anxiety. It's very hard to write down a day, but patients may be more comfortable writing down a period that they would give for that advance consent. This should also be transferable to other providers, as we do have holidays and conferences, or we may be in COVID quarantine, and another provider may have to act on that waiver.

Finally, we are concerned with obstruction from third parties, as in the recent Nova Scotia case. If we deem that the patient is not suffering and the family agrees, then we can stand back.

[Luc Thériault, Bloc, Montcalm, QC]

I will be brief.

Minister, Mr. Garrison raised an important issue: the bill is worthy of merit, but it leaves a number of delicate elements behind.

The legislative amendments enacted by Bill C-14 were supposed to be reviewed in the summer of 2020. Similarly, I imagine that you could commit to the consideration continuing, after Bill C-7 passes, to work on weak points, as a number of stakeholders from various backgrounds would like.

Wouldn't that be a positive compromise to reconcile Mr. Garrison's position with yours? Would you commit today to us looking into those delicate elements following the passage of Bill C-7?

[Luc Thériault, Bloc, Montcalm, QC]

What practicians need is clear legislation. Yet the criterion of reasonably predictable natural death was not a clear criterion. It lent itself to numerous interpretations and excluded people such as Ms. Gladu and Mr. Truchon, who then won the case. Mr. Truchon used medical assistance in dying. That criterion probably did not pass the test in Ms. Carter's case. Had there been certainty that Bill C-14 passed the test, the Supreme Court would have been asked for its opinion.

Let's now move forward. The patient is the standard, but they have to be heard.

Currently, palliative care is sometimes being pitted against medical assistance in dying. Because resources allocated to palliative care are lacking, proponents of that care are opposed to medical assistance in dying. To them, that's an escape route that lacks the necessary guidelines. There could be some division in that area.

Have you noted this opposition between palliative care and medical assistance in dying, in the sense that proponents of palliative care find that not enough is being done, while this was meant to be the solution for dying with dignity?

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

Ministers, respected colleagues, welcome.

I would like to begin by saying that, while we are asking questions to clarify this bill's intentions, people are suffering. People have been suffering since Bill C-14 was passed. We cannot ignore this.

In her ruling, judge Baudoin stated that this suffering was unreasonable under section 1 of the Canadian Charter of Rights and Freedoms. What is more, she said that Bill C-14 was a violation of a fundamental right set out in section 7 of the charter: the patient is entitled not only to safety, but to life. Owing to legislative provisions, the patient was being forced to shorten their life, out of fear of no longer being able to give their consent after losing their faculties. Minister Lametti talked about Ms. Parker's case. That is what we must take into account, and that is the perspective we should use in our work today.

Over the course of this debate and this study, two philosophical views will clash: on the one hand, paternalism of the state, which manifests in medical paternalism; on the other hand, a vision based on the legal principle whereby all individuals are entitled to self-determination.

The question we should ask ourselves is the following: what are the limits of the state intervention power at a patient's most intimate moment in life? Why would the state meddle in a patient's decision that concerns their own death, that has to do with their right to self-determination?

Contrary to my Conservative colleague, I would today like to congratulate Minister Lametti for putting forward this bill, which I feel has a broad consensus.

Mr. Lametti, do you have any figures showing the acceptability of Bill C-7 across Canada and Quebec? I know that Quebec has a broad consensus, but is that the case elsewhere in the country?

[Rob Moore, Conservative, Fundy Royal, NB]

Thanks, Minister.

Madam Chair, this government decided not to defend its own legislation at the first instance, which is incredibly unusual and, in fact, offensive to Parliament, which passed the legislation.

Minister, we know that rather than appealing the Superior Court decision, you chose, instead, to introduce this bill, which in fact goes far beyond simply responding to the decision. This was all done before a parliamentary review that was supposed to take place under your government's own legislation.

Why did your government choose to skip an important parliamentary review that was supposed to look at MAID in the Canadian context after Bill C-14 was passed? Why did you skip that review and, instead, go beyond what was required in the Truchon decision?

Criminal Code

[Mel Arnold, Conservative, North Okanagan—Shuswap, BC]

Mr. Speaker, I certainly agree with the member that the review of the original Bill C-14, medical assistance in dying, needs to take place so there is a proper review of what has been happening since 2016 when it passed. As we move forward with this bill, we certainly need to be cautious and review it, because what we are dealing with here as legislators is the life and death of other people.

[Mel Arnold, Conservative, North Okanagan—Shuswap, BC]

Mr. Speaker, it is an honour to rise and speak in this House on Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

Each and every time that I speak in this House, I am reminded that the opportunity has been entrusted to me by the citizens of North Okanagan—Shuswap, first in 2015, and again in 2019. It is roughly five years now since I arrived in this place for the first time and I still remember the anticipation I experienced as I approached my work as a member of Parliament. I still carry great appreciation for the opportunity to serve the people of North Okanagan—Shuswap and, indeed, all Canadians.

Each and every member of this House has been entrusted by their constituents to represent all constituents, and this is a responsibility that I hope all members keep as a guiding principle as we undertake our work. I do not think anyone could be fully prepared for what the role of being an MP entails and the unexpected situations that arise, but I will say that I came here with an open mind, eager to listen and committed to doing my very best to represent the constituents of North Okanagan—Shuswap.

Shortly after the 2015 federal election, Bill C-14 on medical assistance in dying was introduced to the 42nd Parliament. In fairly short order, Bill C-14 was debated and passed. As members will recall, Bill C-14 was passed in response to the Supreme Court decision that ruled that adults with grievous and irremediable medical conditions are entitled to physician-assisted suicide, as it was termed at the time.

Over the time that was allotted for debate and committee study of the original Bill C-14 legislation, I took the opportunity to hear from constituents and took what I heard at that time to form my position on the legislation at hand. Since then, I have continued to listen to constituents on all sides of this debate in an effort to ensure that I am aware of their many differing viewpoints. I have heard from many who believe in the sanctity of all human life and believe the time of life and death is to be decided by a greater power than any of us possess. I have also heard from others with various incurable health conditions who want the ability to choose an appropriate time so that they are able to pass with dignity, and the ability to choose when to say a final goodbye.

While listening to and pondering the various personal beliefs and scenarios shared by constituents, I have also reflected on my own personal experience and how fortunate many of us are that we have not had to make the very difficult, personal decision that many Canadians face every day.

I would like to share what weighed heavily on my mind during the debate and considerations, back in 2016, and remains with me today as we revisit this topic in the legislature. My mother had developed dementia over a period of years before her passing. At first, we did not recognize the symptoms or maybe we did not want to actually acknowledge that they were there, but as time went on Mom became more forgetful. At first it was just that she would end up with multiple jugs of milk in the fridge because each time she went to the grocery store she simply remembered that she needed milk and not the fact that she had just bought some the day before.

As time progressed, her memory got worse and eventually she moved into a full-care home where she was safe and cared for. Initially it was only her short-term memory that faded away and she could still remember many things from earlier in her life and about her family, but that gradually changed. One thing we did notice in the last few months of her life was that she no longer used the telephone. It would ring but she was not able to put the pieces together to pick it up and talk to whoever was calling. The phone had been a big part of her life as she would always call all of her children, grandchildren and great-grandchildren on our birthdays, but for a number of months she was no longer able to remember phone numbers, what the telephone was for, or how to start a conversation.

At the time of what turned out to be her last Christmas, we made plans to have her home for Christmas dinner and we all looked forward to the day. Then on Christmas morning, we got a call from the care home. They said she had come down with the flu and would not be able to go out. We managed to get through Christmas Day but were concerned the illness was more than she could take in her frail condition.

The next day we were surprised when the care home called and said my mom was doing much better that day and asked if we wanted to come for a visit. We headed out, knowing that mom might not be looking or feeling her best because she had been ill.

We walked into the room that day and were totally taken aback. She was sitting up, fully articulate and waiting for us. We were shocked when she started conversations like someone had turned back the clock two years on her dementia. She told us how she felt bad she had not been able to go out and do any Christmas shopping for the grandchildren and many other things she had not been able to communicate for months.

When we returned home later that day, our answering machine was full of messages from my five siblings all wondering what was going on with mom. She had picked up the phone and called each of them from the numbers in her head and had extensive conversations with each of them.

We were all in shock from this remarkable recovery of her memory and the restoration of her mental function from what had been considered incurable. Unfortunately, the recovery was temporary and only lasted about 24 hours, but nonetheless it was a complete reversal of her dementia for that period of time. To this day, no one has been able to explain how or why this happened. We wondered, at the time, and still wonder today if there may be a cure just around the corner.

This is only one scenario, and in the time since medical assistance in dying became legal, I have heard from constituents and observed cases where family members have been quite open about their aging parent or terminally ill family member. They have been open about how, at some point, the parent or family member is no longer the person they once were and no longer wants to carry on. I have heard how they want to be able to make the choice and should not be denied that choice.

In considering the legislation before us today, we must consider all of the people and lives that will be affected by our decision. It is a very difficult task when we are not able to hear all of the different scenarios, learn the details about symptoms and reasons for personal choices.

That is why I urge all members to consider what safeguards should be in place and if safeguards are not in the current text of the bill, can it be amended so that our decision respects the needs and rights of our constituents and Canadians.

I will continue to open my mind and listen to what I hear from my constituents. I expect I might hear cases like mine where we were fortunate that when mom passed peacefully in her sleep a few months later, we did not have to make those difficult decisions. There are cases where a cure might be found soon for someone who is incurable today. There are cases where there is no hope for recovery and someone wants to ensure dignity is retained.

There are many other personal situations out there and as legislators, we must remember that. We have a duty to consider more than just our own personal opinions or those of the people close to us. We must be considerate of those who will be tasked with carrying out what we legislate. We must guard against any loophole or opportunity for this legislation to be exploited or abused, because we are literally legislating on matters of life and death here. Let us consider all of that in our deliberations.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, before getting into the details of the proposed legislation in front of us, I first want to make sure that in the House we avoid a common misunderstanding that seems to come up whenever people strongly disagree with assisted suicide or related issues. Quite often, someone in favour of allowing assisted suicide or removing safeguards will express compassion and empathy for those who are suffering. In saying this, I am not questioning their feelings or their sincerity; nobody wants to suffer or watch their loved ones go through terrible pain. What I am saying here, for everyone's benefit, is that those who are opposed to it or who want to support safeguards have a deep sense of compassion and empathy for those who are suffering. In other words, our human feelings of compassion by themselves do not automatically lead to one position or another.

Along with my wife, I have watched four grandparents pass away, and at present we have another one who is living in palliative care. Each time I have witnessed and cared for family members as they go through difficult health problems, I am reminded of the importance of always affirming a dying person's dignity while they live out the last part of their life.

For the past year, we have had widespread awareness of and concern for how the spread of COVID-19 could devastate seniors and others who are more vulnerable because of medical conditions. For the most part, these are the same people who are at risk and would be even more so under this new law. Along with everything else we could learn from 2020, I hope we can improve our medical practices and strengthen safeguards for the most vulnerable in every area, including this one.

As we continue to debate Bill C-7, it is important for all of us to take a moment to carefully consider its wider impact and unintended consequences. If passed, the new law will significantly expand the number of Canadians who will be eligible for assisted suicide. Whether we agree with these changes or not, it is clear that they are major and fundamental.

It was only a few years ago that Parliament passed Bill C-14, which created the legal framework for what it called “medical assistance in dying”. Previously, the Criminal Code had considered it a serious crime to either kill a patient or participate in a patient's suicide. While amending the section on culpable homicide and defining eligibility, it presented MAID as the narrow exception.

At the time, the former justice minister, with the same sense of transparency for which she later fell out of favour with the Liberal government, publicly stated, “We recognize that medical assistance in dying will in many respects fundamentally change our medical culture and our society.” It was true for what happened back then, and now we are adding some more major changes before the last ones were ever properly reviewed. There was supposed to be an official review of the MAID system, but that has not happened.

Without having a thorough and careful review, we are supposed to proceed with Bill C-7 anyway. So far, in the current session, we have started debating this bill for part of only four days. I hope there will be much more time than this for considering this bill at every stage, especially when it is studied by the justice committee. There is so much that should be said, and the amount of time we all have to work with is too limited.

I share the deep concern of many Canadians who recognize that this bill undermines our country's commitment to upholding and protecting the equal value of each human life. More particularly, there needs to be even more attention given to how assisted suicide, especially in the way this bill handles it, affects the lives and social well-being of people with disabilities.

Over the past year, the idea of systemic discrimination has come to the forefront of our public discourse in Canada, in the U.S. and around the world. To help us better reflect on how it can relate to this discussion, we can look to the work of Dr. Laverne Jacobs. Dr. Jacobs is a law professor at the University of Windsor. She has approached the issue with her legal expertise and speaks from her experience as a Black woman living with disabilities in Canada.

As part of a longer presentation about MAID back in January, she compared and related the experiences of minority communities. She said, “What's particularly troubling about any system or any structure of systemic discrimination is that once ideas that are harmful to a minority group have been legislated into law, it is very difficult to convince the general public that they are not stigma-inducing or ultimately discriminatory. So in both cases, in both the case of racial inequality in the U.S. and the case of MAID here in Canada, we're dealing with the stigmatization of a historically disadvantaged group.”

In an article on the subject of MAID, Dr. Jacobs wrote:

More explicitly, while the MAID law indeed requires consent, these irreversible choices about ending a life are made in a complex social, cultural and health-care context, where lack of access to adequate care, lack of social support and overall ableist stigma have an impact on the choices people with disabilities may have.

In the same article, she also said:

There are also concerns, fuelled by developments in the few countries that provide access to MAID outside the end-of-life context, that being elderly and fragile is increasingly accepted as a reason for a physician-assisted death and that this may create subtle pressure.

This is a small sample of her work, and Parliament would do well to take a closer look at the rest of her comments.

Loss, especially one of this nature, directs and shapes people's actions and attitudes. We cannot say that people with disabilities and other vulnerable populations have not told us this and explained how this bill will inevitably hurt them. Many other advocates and members of the disability community have been speaking out with similar fears, but they were not heard when they called for the government to appeal the Quebec Superior Court ruling. They have also been ignored when it comes to the problems in Bill C-7.

Bill C-7 has to do with life and death, which are ultimate realities. It is reasonable to expect that altering the way our institutions and culture approach the most consequential matters will have wide-ranging effects across all of society. It is hard, if not impossible, to imagine where we will end up if we follow this path.

In my remaining time, I want to highlight some of these problems.

Most notably, Bill C-7 removes the reasonably foreseeable natural death criterion, which is very concerning to me. I am concerned that removing it will normalize suicide over time. Without appealing the decision, the government is going beyond what the Quebec Superior Court ruled.

As one example, the government wants to allow for advance directives. As I have said before, there has been no thorough review of MAID as it currently operates. I am also not aware of any specific study about the risks and problems associated with a process for advance directives. That should happen well before we ever consider enacting it.

Advance requests raise difficult questions. For example, I have to wonder: Could someone consent in advance to be killed once they reach a state they fear but have never experienced, like living with advanced dementia? Further, once someone has signed an advance request and lost the capacity to consent to medical treatment, at what point exactly would their life be terminated? More alarming to me is this: If a non-capable person seems to resist a lethal injection, can the physician still proceed with the injection if the physician believes that the resistance is not due to any understanding on the patients' part that the injection will kill them? Bill C-7 states that apparent resistance means a doctor must not proceed but clarifies that involuntary responses to contact is not resistance. This raises another question. How does a doctor determine if the response to contact is involuntary?

Given that advance requests raise serious ethical issues, oversight challenges and safety risks, legalizing advance directives in the way that Bill C-7 would is irresponsible. This is the position we are left with when we are not trying to create effective accountability mechanisms and when we have insufficient data.

I am also troubled that Bill C-7 would remove the 10-day waiting period. Frankly, I find this disturbing. The 10-day waiting period in Bill C-14 already had a built-in exemption for those whose death or loss of capacity to consent was imminent, and as such, I cannot understand why the removal of this waiting period is necessary or prudent. On the contrary, I find it negligent.

It is well established that the desire to die is often transient. Suffering individuals have ups and downs throughout the day, throughout the week and throughout the year. No one should be able to make a death or life decision when at their most vulnerable point. The 10-day waiting period effectively allows a patient to reconsider their decision and take the time to speak with loved ones. This is critical.

Finally, I want to add that I believe the bill should add a provision that prohibits medical practitioners from discussing MAID unless the patient explicitly asks. We must not underestimate the power of pressure and suggestion, no matter how subtle, especially when it is combined with social stigma, as I mentioned before.

Journalist Ben Mattlin, who suffers from spinal muscular atrophy, wrote this in the New York Times:

I’ve lived so close to death for so long that I know how thin and porous the border between coercion and free choice is, how easy it is for someone to inadvertently influence you to feel devalued and hopeless—to pressure you ever so slightly but decidedly into being “reasonable,” to unburdening others, to “letting go.”

Perhaps, as advocates contend, you can’t understand why anyone would push for assisted-suicide legislation until you’ve seen a loved one suffer. But you also can’t truly conceive of the many subtle forces—invariably well meaning, kindhearted, even gentle, yet as persuasive as a tsunami—that emerge when your physical autonomy is hopelessly compromised.

Despite Mattlin's significant physical disability, he is a father, husband, author and journalist. He has a successful life and knows what he wants. He is less vulnerable than others who might be more easily persuaded that MAID is their best option. In this way, voluntary MAID is the start of a slippery slope that leads to involuntary MAID.

[Chris Lewis, Conservative, Essex, ON]

Mr. Speaker, I rise today to speak to Bill C-7, which proposes to remove safeguards contained in the existing Criminal Code provisions for medical assistance in dying, as well as to expand eligibility. This is a grave matter and one that should not be treated lightly. Its impacts will be significant, especially for vulnerable Canadians. It is important that we get this right.

Before I get into the substantive issues contained in this bill, I would like to add my voice to those of the people who previously urged the Minister of Justice to appeal the Quebec Superior Court's ruling to the Supreme Court. One month after the Quebec Superior Court decision, 72 organizations that help Canadians with disabilities wrote to the minister, calling on him to appeal the decision. Less than a week later, 300 physicians signed a similar letter and since then, many others have voiced their concerns as well.

Referring it to the Supreme Court would have been the more prudent course of action, as it would have provided Parliament with a framework within which it could legislate. Alas, those many voices, as well as those of my Conservative colleagues in the House, went unheeded.

Further, when Parliament passed Bill C-14 in 2016, the legislation required a parliamentary review of its provisions to commence at the start of the fifth year following royal assent. That review, which was also to include a study of the state of palliative care in Canada, could have taken place this past summer but, instead, the government opted to shut down Parliament. That was time squandered.

There was much wisdom in including a mandatory review when Bill C-14 was adopted. Now, instead of giving this matter the thorough attention benefiting its gravity, parliamentarians are being asked to rush legislation through to meet the judicial deadline of December 18, unless, of course, a third extension is sought and granted. We call that putting the cart before the horse. It is therefore vital, in the short time we have to review these changes to the MAID clauses in the Criminal Code, that we hear from as many Canadians as possible from all walks of life, and especially those likely to be most impacted by any expansion of the current laws.

There are two changes to the existing law that are most troubling. The first is the repeal of the provision that requires that a person's natural death be reasonably foreseeable and its replacement with the words “grievous” and “irremediable”. The other is the elimination of the clause requiring a 10-day waiting period between when MAID is requested and when it can be administered. These changes need careful study. What will the unintended consequences be?

Moving forward, the priority of the Conservative Party is ensuring this type of legislation includes safeguards for the most vulnerable in our society, as well as for the conscience rights of physicians and all other health care professionals. One concern in that regard is ensuring adequate safeguards to protect those who may not have the ability to consent. Many of those involved in the care and advocacy for citizens with disabilities are sounding the alarm. We would be well advised to heed them.

I would like to quote from the letter from 72 advocacy groups written to the Minister of Justice just last fall. They were among those who urged the minister to appeal the Quebec Superior Court's decision in Truchon and Gladu. These are their words:

When the original medical assistance in dying legislation was debated in Parliament, there was a clear understanding that MAiD must have limits; that individual rights must be balanced with protections not only for our most vulnerable citizens, but for our society as well. One of the most important foundations of our Canadian identity is that we are a caring, compassionate country. We...place a high premium on being inclusive and tolerant while working hard toward the accommodation and integration of minority members of our communities. And yet, if the Quebec decision is allowed to stand [or as it stands now codified in the law], we will be in serious danger of losing this fundamental element of our Canadian identity. Our neighbours and our loved ones living with disabilities already continually experience the devaluation of their lives. They are frequently told—often bluntly—that they would be “better off dead.”

The letter makes the point that the unintended consequences would be to “...erode provincial health responsibilities for expert clinical care and social support of citizens who are fragile.”

It is crucial that adequate safeguards are included in Bill C-7, and that will be one of my highest priorities. Another concern worth repeating is removal of the end-of-life criterion. As the Council of Canadians with Disabilities stated in its October 2000 letter to the Minister of Justice, “Without the equalizing effect of the end-of-life criterion, which guarantees that the common thread between all persons who access an assisted death in Canada is that they are all dying,” with the proposed changes, “...persons with disabilities will be able to gain access ultimately because they have a disability.”

A worse stereotype could not be institutionalized in law: that disability-related suffering, largely caused by a lack of support and equality, justifies the termination of a person's life.

I now want to take some time to address the need for palliative care in Canada and the importance of such end-of-life care. As mentioned previously, a study of palliative care was to be included in a mandated parliamentary review. This should have happened before Parliament took action to expand the current Criminal Code provisions. Again, I would like to turn to the experts on this: the doctors and other health care professionals who provide end-of-life care and face these life-and-death decisions every day.

The Canadian Society of Palliative Care Physicians strongly advocates for the prioritization of adequate investment in, and enhancement of, palliative care services. Without access to high quality palliative care, some patients who are suffering may feel that MAID is their only option because their suffering has been inadequately addressed, or they perceive that their families or social supports must carry an excessive burden. Data regarding availability, access, quality and types of special palliative care, for example, are essential not only for those requesting or receiving MAID, but in general in order to better inform areas for improvement. Palliative care should remain distinct from MAID to ensure clarity, and to avoid risk of confusion and the potential for people to refuse palliative care services because they may confuse them with MAID.

During my consultations on Bill C-7, the doctors I have spoken with have stressed that palliative care is more than providing access to morphine, and that the public needs to be educated on this. As well, concern was expressed that elder abuse and financial motives, such as inheritance, could contribute to an abuse of MAID. Another concern is the temptation to save health care dollars with MAID. It is easy to conclude that MAID is more cost effective than continuing care. This raises ethical questions about its potential overuse, particularly as the previous safeguards are being lifted.

These are all serious concerns. I look forward to hearing what the doctors and health professionals on the front lines recommend as we move forward. I would also like to make a brief comment about the need for conscience protection for physicians. Doctors are concerned that they will be forced to administer MAID. I have been advised that the Ontario College of Physicians has created a policy that doctors have to arrange a referral. Some doctors have confided to me that they are considering leaving their profession over this. Suffice to say that physicians should have their freedom of conscience protected, and that this fundamental freedom needs to be codified in law as has been done in Australia.

In closing, I urge the House to take our responsibility to review this legislation seriously and to do as thorough a job as possible, keeping uppermost in mind those most affected by the decisions that we make. As those 300 physicians said in their letter to the Minister of Justice, “For all patients who seek an assisted death, we must ask first if they have had access to adequate and funded social and living supports, as well as exemplary health care and symptom management, in order to assure that they are not seeking an assisted death.” I think we can and must do better.

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

Mr. Speaker, I will start with the second question first. I agree that more money and resources should go to palliative care. People should be given a real choice. If the choice is between intolerable suffering or seeking medical assistance in dying, that is not a real choice.

As for conflating medical assistance in dying with suicide, the point that I was making was that Bill C-14 amended section 241 of the Criminal Code, which is the provision dealing with suicide.

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

Mr. Speaker, I am pleased to join the debate today on Bill C-7, an act to amend the Criminal Code. Specifically Bill C-7 would amend section 241 of the Criminal Code, the provision that makes it illegal for a person to help someone else commit suicide. This section of the code was amended by the last Parliament in response to a Supreme Court of Canada decision in 2015, the Carter decision.

Bill C-14, a 2016 bill, stated that one of its objectives was, “permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance.” I would agree with that. The relevant operative provision in the act then sets out the criteria for determining whether a person qualifies for MAID, including that with respect to that person “their natural death has become reasonably foreseeable, taking into account all of their medical circumstances.” However, all of this is about to change if the government has its way with the current draft legislation, Bill C-7.

I am speaking to that bill because I have been encouraged by many of my constituents. Admittedly I have received some letters in support of the government's initiative to expand the reach of MAID, but the vast majority have encouraged me to speak in favour of leaving the law as it is or further restricting access to MAID.

The correspondence I have received in favour of keeping up the safeguards fall into two categories. First, the reasonably foreseeable death safeguard should stay in place. Second, more should be done to expand palliative care services. It was pointed out to me by many that many seniors and other people with serious diseases did not have good ready access to adequate palliative care.

I will quote Rebecca, one of the letter writers, “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 MAID.” As a proud Canadian, I agree with that statement.

What is behind the current Bill C-7 is the 2019 Quebec Superior Court decision in Truchon. The plaintiffs in that case challenged the constitutionality of the then three-year-old law, arguing that their charter rights had been violated. The federal government, acting through the Attorney General's office at that time, did the right thing. It defended the law, which is what we would expect an Attorney General to do for Canada's laws.

The AG argued as follows, setting out the three main objectives of Bill C-14, which are still relevant today or at least they should be.

First, it is important to affirm the inherent and equal value of every person's life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled. Second, suicide is a significant health issue. Third, vulnerable people must be protected from being induced in moments of weakness to end their lives. I think we would all agree with that.

However, the Quebec court did not. It refused to accept the first two principles as representing the objectives of the law. It said, “the Court cannot accept the two first 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.”

Having thrown aside those principles, it was easy for the court then to decide that the law needed to be changed. Remarkably, the current Attorney General did not appeal that decision. Instead the Liberals are now hastening to amend the legislation to eliminate the reasonable foreseeability of death safeguard.

With the reasonable foreseeability of death safeguard down, this is what we now have left. First, the applicant for MAID has a serious and incurable disease, illness or disability. Second, they are in an advanced state of decline. Third, their psychological or physical suffering is intolerable to them, which is completely a subjective test.

For example, people with Parkinson's, or MS or quadriplegic patients would check off all those boxes. If they had psychological suffering on top of that, they would be eligible for MAID.

Under this new regime, if it becomes law, people who are not dying but who meet all the other criteria will satisfy the requirements for state-sanctioned assisted dying.

I want to reiterate what Rebecca from my riding said. She said, “Let Canada be a society that is known for its modern and palliative care services and not as a country that has ever expanding use of MAID.”

I know the law will be amended. It must be to satisfy the Truchon decision. However, I will point out four things that I hope the committee will take into consideration in improving Bill C-7.

My first point is that the 10-day reflection period for the track one patients, those whose death is reasonably foreseeable, should come back. It should be there. That was not a requirement of Truchon and I do not believe that Bill C-7 is improved by taking that10-day reflection period out. For track two applicants for MAID, people whose death is not reasonably foreseeable, there is a 90-day reflection period, and I agree with that.

The second point I want to make is about the 90-day reflection period. I agree with it, but the wording is inadequate. I would recommend to the committee that it amend the 90-day reflection period clause to be the same as the 10-day reflection period clause, but with the necessary change in wording.

My third point is that Bill C-7 would reduce the number of witnesses required for a patient's written directive for MAID. There is absolutely no requirement for that at all and it is certainly not an improvement. Many of the legal documents, including last wills and testaments, require two witnesses as a safeguard against coercion and that should be maintained.

The fourth improvement is that the provision in Bill C-7 saying that a patient's request for MAID must be voluntary without coercion should be expanded to prohibit the attending physician or other health care professional from being the first to raise the availability of MAID option. MAID should never be presented as just another option because in some circumstances, that in itself, would be coercive.

When Bill C-7 was first introduced into the House back in January, COVID-19 had not hit us yet. Since then, many seniors have died of this virus and many others are in isolation. I have seen first-hand the devastating effect isolation has on the mental and physical well-being of seniors, my father-in-law included, as it would for any person. We are created to be social creatures after all.

As my constituent Sarah told me in a very thoughtfully drafted, “[Bill C-7] will put many elderly Canadians, isolated and lonely in their long-term care homes, at greater risk of being considered eligible for MAiD. That is not how we should be caring for our seniors!”

Let us use our experience with COVID-19 as a lens to have a very careful review of this draft legislation to reconfirm our commitment to value life and to build as many safeguards as we can around our most vulnerable citizens.