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

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, I am pleased to join the debate. The last several speakers raised some excellent points. It is good to see members bring different perspectives to this debate, and I hope to achieve that as well tonight.

I would like to say broadly at the outset that, in a binary world where one must say they are either in favour or not in favour of the availability of medical assistance in dying for people who are adults, mentally competent, grievously and irremediably ill and suffering cruelly from intolerable pain and anguish, I support the availability of assistance in dying for those people.

However, this bill and few bills we would consider in the House are as simple as a binary choice between two poles. Although we have had all kinds of different perspectives on this, the nuances and the details of this bill, as well as the bill that preceded it, Bill C-14, are very important. I enjoy these types of debates where we hear these points of view and can hopefully improve a bill before it is passed, if it is indeed the will of this Parliament to pass the bill.

I have ordinarily been highly critical of the government on a host of issues. I will take advantage of this moment to say that although there was much consternation to get to the final vote that occurred on Bill C-14 in the previous Parliament, there was something in that process that brought out what is good in Parliament. At that time, we had a lot of different perspectives on that bill. We had a bill that was tabled and amended. It was amended in this chamber. It had committee amendments, many of them, that were brought back and voted on by different parties, and we saw members of the Liberals' side who did not agree with their government for a variety of reasons. There were members, including me, who ultimately at third reading did vote with the government to support it.

That is what Parliament should do. It should bring out vigorous debate that really gets to the heart of an issue in order to have good legislation. I thought Bill C-14, at the time, was a reasonable, limited change to criminal law in Canada to both comply with the Carter decision and establish the availability of medical assistance in dying. Credit also should go to members who are no longer a part of the government: the member for Vancouver Granville, who was the minister of justice at the time; and Jane Philpott, who was the minister of health and who showed leadership at that time in debating Bill C-14.

The bill before us today was introduced ostensibly to deal with the Truchon decision and the Quebec superior court's striking down of the reasonable foreseeability phrase from Bill C-14. In this bill, the government has chosen to address other issues at this time. As has been pointed out, there was to be a five-year review, per the previous bill, that should have occurred this summer. I understand the crisis we are in, but let us also not forget we have a government that prorogued the House and prevented the House from examining critical legislation and issues that face Canadians.

The timing of the bill puts us up against something of a deadline looming in December over the Truchon decision, and here we are. December is not very far away when we talk about all the different stages a bill must go through to do it right, to allow all voices to be heard and to allow all members of Parliament to represent their constituents on this.

The bill introduces a few changes beyond addressing the reasonable foreseeability. I am not going to get into the details of that, because time is pressing. However, like most MPs, I have received a lot of correspondence and phone calls from the disability community and concerned citizens who have real reservations about any expansion of medical assistance in dying.

Some have argued from the point of view of a slippery slope and are concerned: Once changes are adopted, what comes after them? I understand the sincerity of these concerns. However, we have to examine the bill for what it says and what it does rather than what people might project into it.

Prior to the adoption of Bill C-14, I had four major concerns regarding medical assistance in dying: first, the assurance that quality palliative care be available to persons considering medical assistance in dying; second, strong safeguards for vulnerable Canadians, such as minors, the mentally ill and the disabled; third, the conscience protection for medical practitioners; and fourth, any changes that would expand the availability of medical assistance in dying be well considered, well thought out, carefully drafted and not rushed.

I share many of the concerns raised by members of the disability community, but we have to deal with this issue and not forget the broader purpose of ensuring the availability of medical assistance in dying. It is not merely to comply with court rulings. We must do this out of a sense of compassion for adults who are grievously ill, intolerably suffering and are of sound mind, and who, of their own free will and volition, wish to obtain medical assistance in dying.

I would not support the bill if I thought it was a clear threat to disabled Canadians or if the bill would lead us into a path where medical assistance in dying is offered as an alternative to palliative care or an alternative to treatment. I do not see that in the bill as is. Recalling the experience of Bill C-14, I assume that the bill will be thoroughly studied and that the committee, after it hears testimony from experts and concerned Canadians, will bring amendments back to the House that may offer better assurance to the disabled community and others.

I am inclined to see the bill go forward as far as committee so that we can have a robust, thorough examination of the bill, and so that as parliamentarians, we can do our legislative jobs to ensure that the best bill possible is brought back to Parliament. I look forward to that and assume that we will have this debate.

I am still a little concerned, though. My colleague from Hull—Aylmer mentioned the five-year review and that a committee hearing would constitute that review. This is what it sounded like he was saying, and this does not seem to be in the spirit of what was passed by the House in Bill C-14. However, there is clearly much work to do in this area, and I hope we will have time for a robust, full and proper hearing of the bill at committee so that when the bill comes back to the chamber at third reading, it will give assurances to those who have raised concerns about medical assistance in dying, in particular to the disabled community.

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

Mr. Speaker, I remember quite well the former member for Winnipeg Centre and his speech on Bill C-14. One of the things I can recall from the Bill C-14 debate was there were a lot of examples, real-life stories. I say that because it is important for us to recognize the seriousness of the legislation we are debating. Ultimately it will go to committee, where there will be opportunities to have that dialogue and who knows what it will eventually come back as.

Does the member believe the bill is moving us in the right direction?

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, it is a privilege to have this opportunity to rise and speak on Bill C-7, an act to amend the Criminal Code (medical assistance in dying).

Not long ago, we in the House debated the merits of Bill C-14. I was a member of the justice committee when the committee was seized with doing that. That opened the door to physician-assisted death in Canada.

I want to begin my speech today with the same words that I used to open my speech on that bill:

I believe in the sanctity of life, and I believe that all life, from conception right through to natural death, has value, has worth, and has purpose.

A pastor friend of mine told me a story that had happened just prior to the passing of Bill C-14 in 2016. A woman the pastor knew who had battled stage four cancer for 10 years, savouring every moment of that time with her grandbabies and family, was told by one of her care workers, “I bet you cannot wait for the assisted-suicide bill to pass.” The pastor recalled the desperation in her tears when she called to recount her story, asking, “Has my life only become a burden to society?”

After the legislation was in effect, another woman was reunited with her childhood sweetheart and engaged to get married when her fiancé discovered that he had stage four cancer. Together they mustered up every possible hope for a future together, only to have their hopes dimmed by repeated offers for medical assistance in dying.

As the House now considers an expansion of MAID, I think it remains vitally important that the worth of every person is reaffirmed and underscored. It must be our priority in this place to remind every Canadian that they have value regardless of their age. They have value regardless of their ability. Their dignity is not determined by their suffering or their autonomy. It is intrinsic. It is inherent. Their lives are worth living.

I think these statements are important, because the reality is that every time we talk about expanding access to MAID, we send a troubling message to those who may be vulnerable: the idea that, if certain conditions or factors are present, somehow a person's life has less worth; the idea that ending a person's life is a mere medical decision among any number of medical decisions.

Expanding eligibility cannot be about removing safeguards and fundamentally redefining the nature and role of assisted death. This bill intends to offer assisted dying to individuals who are not dying, whose lives are still viable. This is a contentious issue that has been raised by multiple legal voices because assisted death was previously sold as an option only when death was imminent, or reasonably foreseeable.

In just four short years, we have embarked beyond that final stage of suffering. The whole health care system is feeling the pressure for acceptance of MAID, says Nicole Scheidl. Doctors and medical staff are feeling this pressure. Scheidl adds that the most terrifying thing about MAID is how it will impact the future of medicine, as only doctors comfortable with MAID will go into medicine, unless perhaps some provision is made for conscience rights.

Cardus executive vice-president Ray Pennings warns us that Bill C-7 does not take the protection of conscience rights seriously. He writes:

Conscience rights are Charter rights...including the rights of medical professionals not to participate in MAID in any way and the rights of hospices and other institutions not to cause the deaths of people in their care.

There are other valid concerns as well: psychological suffering in combination with other permanent injuries potentially justified under MAID, the elimination of the 10-day waiting period, the requirement for only one independent witness as opposed to two, the waiving of final consent, and also that a witness cannot be a primary caregiver.

Even in its current form internationally, MAID raises flags. When the United Nations Special Rapporteur on the rights of persons with disabilities visited Canada in 2019, she noted that she was extremely concerned about the implementation of MAID from a disability perspective. She flagged that:

there is no protocol in place to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assistive dying.

She highlighted:

...claims about persons with disabilities in institutions being pressured to seek medical assistance in dying, and practitioners not formally reporting cases involving persons with disabilities.

Her advice was to:

put into place adequate safeguards to ensure that persons with disabilities do not request assistive dying simply because of the absence of community-based alternatives and palliative care.

Instead, Bill C-7 goes the opposite direction in order to expand eligibility.

Let us not forget that every choice we make has a ripple effect of different magnitudes. Mother Teresa once said, “I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” The world can be changed for better or worse. When vulnerable people start feeling like they are only a burden to society because of our actions, we need to consider what kind of culture we are creating.

Kory Earle, the president of People First of Canada, a national organization representing people with intellectual disabilities, expresses his concern that everything is already more difficult for people with intellectual disabilities, including exclusion, isolation, housing, resources when abused, education, securing jobs, social lives and finding friends. He further adds that even their word in court is not considered credible. Mr. Earle explains, “everything, and I mean EVERYTHING, is more difficult for people with intellectual disabilities. Many, many other things should be made easier. This [assisted death] is not one of them.”

Passing Bill C-7 is sending a message that individuals with disabilities are no longer safe. This concern is echoed in a joint statement by over 140 lawyers who fear the perception this bill gives, if even unintentional, the perception that life with a disability is inferior and if ratified by law, we diminish the choice to live with dignity and exasperates systemic discrimination.

On top of this, Canada has tragic statistics around suicide. An average of 10 people die by suicide every day. Statistics reveal that nine of those 10 individuals faced a mental health problem or illness. I know and appreciate that those suffering solely from mental illnesses are not eligible for MAID under Bill C-7, but we are nonetheless sending a devastatingly mixed message.

The former Liberal member for Winnipeg Centre raised these concerns when we were first considering Bill C-14. As he observed the rash of suicides in several first nations communities at that time, he expressed concern that, “we haven't thought out the complete ramifications that a decision like this might have on indigenous communities that seem to be suffering greatly.”

In his speech, he shared one of his memories as a six-year-old child. His family was facing serious financial hardship, forcing his mother to go off in search of work. He and his younger brother were to stay with their father, who he described as “a residential school survivor, an alcoholic, and a member of gangs” with a “terrible temper”.

The rest I will quote directly from the former member. He said:

I remember climbing a tree in the back yard and wrapping a rope around my neck at the age of six... I wrapped that rope around my neck and thought, “Should I jump off into this universe, which is before me?” It was in that back yard that somehow I made the decision to climb down out of that tree and unwind that rope from around my neck.

If in my life I had seen, or I had known, that my grandmother had somehow used physician-assisted dying or physician-assisted suicide, or others in my family had completed the irreparable act, then it would have made it much more difficult for me to continue.

We must be mindful of the messages we send through this debate and always affirm life, but we must also do more than just offer words. We need to ensure that individuals facing end of life have access to the end-of-life care they deserve.

There are important questions we need to be asking to ensure those who are suffering truly have a choice between living well and pursuing MAID. For example, how do we better love those who live in unbearable pain, whatever form that pain takes? Feeling loved gives inherent strength to those losing hope. How do we show people how their lives teach us? How do their contributions strengthen us as individuals and a society? How do we instill in all people that they are not a bother, a financial burden or a disruption to deal with, but that their life is treasured? We must foster this type of society that affirms life and the pursuit of well-being.

As four physicians suggested in the National Post in response to the proposed legislation, increasing health care personnel, improving our quality of care, enhancing our palliative care options and ensure quicker access to psychiatric care would all be more advisable. Instead, we are “fast-tracking death on demand and dismantling the...[earlier] safeguards that were put in place to protect the vulnerable.”

We have all heard that only 30% of Canadians have access to palliative care and disability supports, which is possibly why there were 50 religious leaders who wrote an open letter urging us to consider that. It states:

Palliative care administered with unwavering compassion, generosity and skill expresses the best of who we are. Rather than withdrawing from those who are not far from leaving us, we must embrace them even more tightly, helping them to find meaning up to the last moments of life. This is how we build compassionate communities.

Furthermore, the joint statement by 140 lawyers explains that singling out non-life-threatening illness and disability as eligibility criteria for assisted death—

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, I apologize in advance if there is noise in the background; it is either traffic or my kids, so I have chosen traffic.

I want to start first by speaking to what is at stake with Bill C-7 and with the medical assistance in dying framework overall. What is at stake fundamentally is, first, alleviating intolerable, cruel suffering. The Supreme Court and other courts have spoken about the cruel choice that individuals face in the circumstance where they have a sound mind, they are of capacity and can make these decisions themselves, where they are suffering from an illness that is not going to go away and when they are suffering in an intolerable way. Forcing that suffering upon individuals is cruel and we have to be cognizant of the fact that this is first and foremost about alleviating suffering, but it is about alleviating suffering within the context of empowering and respecting one's personal autonomy.

This is fundamentally about individual rights, and our job fundamentally is to respect those individual rights, to protect those individual rights, to ensure that we end suffering in the course of protecting those individual rights and to make sure that we fulfill the promise of section 7 as it has been interpreted and upheld by our courts, not only in the unanimous Carter decision by the Supreme Court, but also by other courts, like the Alberta Court of Appeal and more.

Now, this bill is important, because it addresses a long-standing concern with Bill C-14. It addresses the concern that we had not answered the call from the Supreme Court adequately. We had added an additional criterion unnecessarily. We had basically said that if people are suffering intolerably and they can absolutely make this choice for themselves, they have capacity, and they have an irremediable condition, an effectively incurable illness, they cannot access this regime if they are not near the end of life or there is not path dependency, but they know the trajectory they are on, even if they are already intolerably suffering.

That, obviously, was unconstitutional. The courts determined that to be so. The government rightly opted not to appeal that decision, and here we are.

Importantly, we have actually gone beyond what the court has mandated in pursuit of individual rights and respect for our charter, as we have said in the case of Audrey Parker, a woman who chose to end her life earlier than she had wanted to. She wanted to get through the holiday season, but she also did not want to lose capacity and then lose the option. She did not want to lose ability to end her life and her suffering. She did not want to lose the possibility of death with dignity, so she chose to end her life before she wanted to. Thankfully, we have actually gone above and beyond what the court has mandated us to do, and we have provided one form of advance request to ensure that individuals, like in Audrey's case, do not end their life before they would like to.

This bill, on those two fronts, is positive. There are some challenges. That is not going to stop me from supporting this legislation at second reading, but it does give one pause. I think we, as parliamentarians, have to be very careful about adding additional exclusions to accessing the MAID regime. That is what this bill would do, unfortunately. I have heard others speak to the issue of mental illness, and there are reasons to proceed cautiously, but there are not good reasons for blanket exclusions. In fact, we potentially render the bill unconstitutional with blanket exclusions, just as we did with exclusions in Bill C-14.

I hope at committee there is expert testimony on this piece, and I hope we get this right. I will give an example specifically on mental illness. In 2016, there was a case at the Alberta Court of Appeal. A woman, identified as E.F., had capacity, she was suffering intolerably, it was irremediable, she had consulted with her family and she had made the decision to end her life. She was able to do so, thankfully, because of the Alberta Court of Appeal applying the Carter decision by the Supreme Court. If the federal justice department had gotten its way in that case, it would have read down Carter to mean only terminal illness. Of course, they said that is not the case. Then we saw, through Bill C-14, that our government tried to impose that kind of criteria, and the court subsequently struck it down. The justice department lost that leg of the argument.

Then, in E.F., they put forward the argument that it could not be an underlying psychiatric condition on its own, but that is exactly what E.F.'s was, an underlying psychiatric condition. The court said that this underlying psychiatric condition, which manifested itself in great significant pain in the documented evidence, did not affect her capacity to make a decision. She was of sound mind.

In E.F., the Alberta Court of Appeal went beyond that. As to the consideration whether MAID should be available to people with mental illness as their sole underlying condition, the Alberta Court of Appeal, in E.F., said that the Supreme Court, in Carter, had canvassed this conversation, this discussion and this concern. Unanimously, they had determined that it was not an additional exclusion. It was not a factor to exclude, and not an additional criterion for eligibility, for those with mental illnesses and those with physical illnesses, so long as they meet the specific criterion of an irremediable condition of intolerable suffering and that they have capacity. It may be that one is depressed, or it may be that one is suffering from a mental health issue such that it impinges upon one's capacity to consent, but in other cases it clearly does not. In E.F., it did not. The justice lawyers lost that case, yet here we are.

In Bill C-14, the government added an additional criterion of close-to-terminal illness and reasonably foreseeable death, and it was struck down. Here, the justice department is adding that second argument from E.F. that it already lost in the courts, and is adding a blanket exclusion for mental illness. As a matter of constitutionality, I would say that if this excludes the case of E.F., which it does, then it creates a ready constitutional challenge. I will be reading the Charter statement from the justice department very closely. I am not suggesting that we do not proceed cautiously, but a blanket exclusion on mental health, when there is a case like E.F. before the court, is likely to render this law unconstitutional, and that has to be addressed by the committee.

The second piece I want to flag is the two tracks. If one's death is reasonably foreseeable, then there is no additional track. There is not even a 10-day waiting period. That 10-day waiting period has been waived, although there was not great concern even with that 10-day waiting period. There is this dual track now, if one's death is not reasonably foreseeable, where one waits 90 days. This is what we are telling people in those circumstances. I have spoken to family members who are affected by this, and they are absolutely challenged by these circumstances when one is already intolerably suffering: They are suffering from a condition that is not going to go away, and they are making this decision themselves, having capacity. If we respect personal autonomy at all, surely a fundamental life decision like this is one that we have to respect, and we are telling these individuals that they have to wait another 90 days, and not just suffer but suffer intolerably for another 90 days. It is inexplicable that we are asking people to suffer intolerably for that length of time. Those are the two specific issues that need to be addressed at committee in a serious way in order to make this bill not only constitutional, but to make it the best bill that it can be.

I wish we had dealt with this last item, because the idea of constantly revisiting this conversation instead of just getting it right for Canadians in need is frustrating. I mentioned Audrey Parker, and we are addressing one type of advance request. However, I do wish that, in the course of this legislation, we had answered the second type of advance request, in which an individual has been diagnosed and is not yet suffering intolerably, but that future is not so far away. Those individuals should also be in a place where they can make an advance request, if we are to respect their autonomy and respect their wishes.

I just wish politics did not get in the way. That is what this is. This bill is a cautionary step. It does not go as far as it could because of politics. I know Conservative members will say it goes too far and others will say we have to be concerned about vulnerable Canadians. We know we can protect vulnerable Canadians and respect people's individual choices at the same time, and I wish politics did not get in the way of alleviating suffering. I wish politics did not get in the way of respecting and protecting individual rights. We like to say we are the party of the Charter. I wish we carried through that promise and demanded greater respect for individual rights in the course of Bill C-7.

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

Madam Speaker, it is a real pleasure for me to be joining the debate today, from my riding, on Bill C-7. I find myself in a unique position because, having given a speech on this very same bill earlier this year, I see we now find ourselves still at second reading for what, I would argue, is absolutely the most important piece of legislation we have before us at this time.

I was also one of the members of Parliament who had the honour of participating in the previous debate on Bill C-14 during the 42nd Parliament. I can remember very much the debates that went on in 2016 and the amount of attention that was given to that piece of legislation. We had an expert committee. We had a special joint committee. There were many hours spent, both in the House of Commons and at the Standing Committee on Justice and Human Rights, on that important piece of legislation because it made a monumental amendment to the Criminal Code in recognition of a very important Supreme Court ruling that forced Parliament to finally take the necessary action.

I remember, during that time, we in the New Democratic caucus ultimately voted against Bill C-14, but we always took the time to explain to people that we were ultimately supportive of what the overall aims of the bill were. Our major problem of the time was that the bill was too restrictive. I remember very well in 2016 referencing a particular section of the bill that I knew would be challenged by the court. Lo and behold, here we are in the year 2020, and we are revisiting that problematic section and having to fix a mistake that was made very clearly four years ago.

It is good to see Bill C-7, and it is good to see that we are complying with challenges that were made before the courts, this time coming in response to the Truchon decision by the Superior Court of Quebec. I know that we are operating under quite a tight deadline. That being said, I still think Parliament has to do a full job on this bill. As parliamentarians, whether we support the legislation, have problems with it or are opposed to it, we owe it to the people of Canada to give this debate as full a discussion and time as Bill C-14 had.

At this time, in particular for the benefit of the people of Cowichan—Malahat—Langford, it is important to underline why we are here discussing this. It really centres on the Charter of Rights and Freedoms, notably sections 7 and 15.

I am increasingly seeing section 7 as probably the most important part of the charter or one of the most important parts, because so many cases seem to be coming forward that directly reference section 7. I know it is open to interpretation, but if we go along with successive court rulings, my own personal view on the subject is that it is a very important section because it is ultimately making the case that every person in Canada has the right to autonomy over their own body. That is why it is such an important section. If we truly believe in the rights of individuals to make decisions for themselves over what goes on with their own bodies, section 7 is incredibly important. It is really life, liberty and security of the person. That is the part that has to be underlined.

We also have to mention section 15 of the Charter of Rights and Freedoms, which guarantees quality before and under the law and makes sure people are free from discrimination. Why those two sections have such an important bearing in this case is that this bill is trying to make sure people have the right to say what goes on with their own bodies and that in making that decision they are not going to be discriminated against.

I have been listening to the debates on Bill C-7, both from the previous week and today. I acknowledge that many members are bringing forward some concerns with the bill, and I understand and want to validate those concerns. I do not believe we have to make the debate on Bill C-7 an overly partisan issue. That is why I made the comment at the beginning that it is important that all members of Parliament, no matter what party they belong to, be given the chance to fully air their views.

I believe the bill passes muster at second reading and deserves a vote of confidence at this stage of debate, because if there are particular sections of the bill that need further attention, that work is best done at the Standing Committee on Justice and Human Rights.

I fully understand that many members have raised concerns about the removal of safeguards. I have heard many members talk about the state of palliative care in Canada, whether there is enough being done with suicide prevention and so on, and I am very sympathetic to those. I think every member of Parliament, no matter what part of the country we are fortunate enough to represent, can relate to those concerns. We can relate to the concerns that we have received through email correspondence, letters, phone calls and speaking with our constituents face to face.

I am lucky enough to have a hospice undergoing major construction right now. There is a new hospice being built in the Cowichan Valley. I am really glad to see that the level of palliative care in my home riding is going to be significantly better than it was, but of course more can always be done.

Ultimately what is guiding me in this is that it is quite impossible for me, as a member of Parliament who is lucky enough to have his health and not have a grievous and irremediable medical condition, to really understand the level of suffering some individuals in Canada go through. When we are talking about the bill, the struggle we have before us is to not subject other people to our own values, whether those are guided by religious beliefs or the way we were raised and so on. It is quite impossible for people who are healthy and lucky enough to have all of their faculties to understand what the day-to-day life existence is of people who are suffering from one of these incurable and irremediable medical conditions.

Therefore, what is guiding me and members of the New Democratic caucus is an overall goal of trying to ease that suffering, to respect those people's section 7 rights and to understand that they should have the ability to live their lives in dignity and make a determination as to how they want to exit this world. I know it is an uncomfortable debate for many people to have, but that is what is going to be guiding me through these deliberations. I hope it is something all members can take note of.

Following on the speech my colleague, the member for Esquimalt—Saanich—Sooke, gave the other day concerning the legislative review that was part of the former Bill C-14, I want to draw the attention of members to the fact that this was a requirement of Bill C-14. The member for Esquimalt—Saanich—Sooke has put forward a proposal through his private member's motion, Motion No. 51, that will establish a special committee to look at how the legislation is doing. That is something Parliament can easily do while we are deliberating the provisions of Bill C-7. The creation of such a special committee to look at how Bill C-14 has been enacted over the last four years is really important.

This goes back to my first point that, yes we are operating under deadlines, yes we have had people waiting for some time, but, ultimately, it is critically important that we let Parliament deliberate this issue to the fullest extent possible.

With that, I conclude my remarks and look forward to any questions my colleagues may have.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, it is my honour and privilege to join this debate today, though it is a sad one for me. I remember coming to this place. We passed Bill C-14 right off the get-go. It is where I cut my teeth in politics, I would say. At the time, we mentioned that this was a slippery slope. We had seen it in the Netherlands. Currently the government there is passing legislation to allow children under the age of 12 to be euthanized. They are working with what's called the Groningen protocol, where it is not the individual but a group of doctors making the decision as to who gets to live and who gets to die. Here, we saw that this erosion of protection began virtually as the ink was drying on the original bill. We have seen the government not uphold the wishes of this Parliament. We have seen a junior court strike down the law, calling it unconstitutional.

This is where I have some frustration. The ink was not even dry on the bill when it was being challenged in the courts. It had just passed through the House of Commons. It is incumbent upon the executive branch of government to defend the decisions of this place, whether the government agrees with a court or not, and this was a brand new law that had just been thoroughly discussed in this place. We had worked hard for the amendments. For the government to abandon all the work we had done and decide that a junior court decision stood and that it was not going to appeal it to a higher court, like the Supreme Court, was an abdication of the executive branch's responsibility, and I definitely want to acknowledge my frustration that the government did not appeal this court decision.

That said, this bill is much broader than the court decision, and I would argue that we continue down the slippery slope. When Bill C-14 was introduced, I remember talking about the slippery slope and being assured it was not a thing. Yet here we are, removing safeguards from the bill.

This bill definitely makes two classes of Canadians. Across the country, we see a big emphasis on suicide prevention. Every level of government in this country has suicide prevention strategies. We see community groups getting together to run hotlines. Facebook has a warning system to help folks who are considering suicide. Facebook will even identify them and notify people who are close to them that their friend is not feeling well. The American military has worked with Facebook as well, to identify veterans who are considering suicide. We see throughout Canadian society that there is very much a focus on preventing suicide.

Where does that comes into play in this bill? It would create two levels of Canadians. In one case, there are able-bodied, otherwise healthy people suffering from mental illness who are considering suicide. All of those suicide-prevention apparatuses come to their aid. We even have bridges in this country that have nets to catch people in case they jump. All of that stuff comes to the aid of those particular people. However, for sick people who have a grievous and irremediable condition, that stuff is optional and they can request death. They can go to their doctor and say they are not feeling well and are suffering, and that their grievous and irremediable condition has affected their mental health and they are having suicidal thoughts. Then suddenly they are eligible for assisted suicide.

This creates two classes of people. If they are otherwise healthy, suicide prevention is granted to them; if they have an underlying grievous and irremediable condition, they are eligible for, as the government likes to call it, medical assistance in dying or assisted suicide. That is what this bill would do.

Prior to this bill, there was a requirement that a person's death be reasonably foreseeable. I remember that when we were discussing this, we found it to be kind of nebulous. What did that mean? There was no timeline on it. I remember we said that for a death to be reasonably foreseeable, it would have to be in six months or within a year. Those were amendments we brought forward. The government did not go for them back then. Now we see the courts are taking that off and the government is not even defending it. That is definitely one of the concerns we have. We are creating two classes of citizens: one for which suicide prevention is available and one for which it is optional.

The other thing I want to talk about is an amendment we brought to the original bill, one that I think would be an improvement on this bill. It is the need for video verification. In the current rendition of the bill, the timelines have been reduced or eliminated altogether, from the time of the request to the time when MAID is administered. There is a concern that family members may not be convinced that their loved one requested MAID and that they were giving consent at the moment thereof. There has been a suggestion by some groups that there be a video recording of the administration of MAID. That is an amendment I would seek at committee. We would definitely like to see something like this.

Lastly, we would like to see the government work to enhance assistance in living. With COVID, many of our old folks in seniors care facilities are not able to see their loved ones because of restrictions on movements and not being able to travel. The military had to be called in to deal with some of the situations. We talk a lot in this place about dying with dignity, but maybe it is time that we started focusing on living with dignity, having a dignified life, taking care of our elders and being part of a family.

I have talked to folks who have been working in the old folks homes lately and it has been a rough job. They say the loneliness is a major issue in old folks homes these days. The loneliness leads to mental health issues, and if those mental health issues are not addressed, people will become suicidal and will request MAID for loneliness. Is that what we really want in this country? Assistance in living is something we have to be concerned about.

This also deals with palliative care. Palliative care is something the government pays lip service to. We have called for national strategies on this. We have called for money to be put into it. In the absence of palliative care, there is no real choice. There is no ability for somebody to say that this is what they are choosing. Palliative care is an acknowledgement that while there is, humanly speaking, nothing more we can do, we can make a person comfortable and allow them to be surrounded by friends and family as they leave this earth. We would very much like to see the government pursue a significant improvement in palliative care, rather than allowing the elderly members of our families to vanish into an old folks home, where we are not allowed to visit them at this point, to die of loneliness and be offered MAID as the first available option.

This bill has many concerns. It is the first evidence of the slippery slope that is happening in the euthanasia debate, and I definitely wanted to raise that concern. I am also concerned that this bill creates two classes of citizens, as I clearly outlined. I am looking forward to the government making some amendments to the bill and look forward to being able to participate in those discussions at committee.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Mr. Speaker, I am pleased to rise today to discuss Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying, or MAID.

As a physician, I took a keen interest when Parliament passed federal legislation in June 2016 to allow eligible Canadian adults to request medical assistance in dying. This was subsequent to the February 2015 Supreme Court of Canada ruling that parts of the Criminal Code would need to change to satisfy the Canadian Charter of Rights and Freedoms.

At the time, I was also a member of the provincial parliament in Ontario and was involved in how that province would ensure people would have their personal choice of access to medical assistance in dying, while also ensuring the conscience rights of health care providers would be respected. The actual implementation of MAID was our responsibility and was very carefully considered.

Working with provincial organizations like the College of Physicians and Surgeons of Ontario, we established policies to ensure that, should physicians have conscientious objections to administering MAID, systems were in place to provide appropriate care options to the patient. Consistent with the expectations set out in the college's professional obligations and human rights policy, physicians who decline to provide MAID due to a conscientious objection must do so in a manner that respects patient dignity and must not impede access to MAID.

They must communicate their objection to the patient directly and with sensitivity, informing the patient that the objection is due to personal and not clinical reasons. They must not express personal moral judgments about the beliefs, lifestyle, identity or characteristics of the patient. They must provide the patient with information about all options for care that may be available or appropriate to meet their clinical needs, concerns and/or wishes, and they must not withhold information about the existence of any procedure or treatment because it conflicts with their conscience or religious beliefs. They must not abandon the patient and must provide the patient with an effective referral. Physicians must make the effective referral in a timely manner and must not expose patients to adverse clinical outcomes due to a delay in making the effective referral.

While there is importance in ensuring widespread access to MAID, the law specifically acknowledges the conscience rights of health care providers and the role they may play in providing medical assistance in dying. As a physician who spent all of my time in clinical practice doing my best to preserve life, I feel this balance is working well, and the amendments proposed in Bill C-7 do not make any changes to any of this.

As a government, we remain committed to working with provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

What are the amendments that Bill C-7 proposes?

In response to the Superior Court of Quebec's Truchon decision, it repeals the MAID eligibility criterion that applies when a person's natural death is reasonably foreseeable. The criterion is the 10-day reflection period. One concern at the forefront is to ensure that measures are in place that provide safeguards for the MAID process. I believe Bill C-7 does precisely this. It proposes to create two sets of safeguards that must be respected before MAID is provided. For persons whose natural death is reasonably foreseeable, the existing safeguards, as amended by Bill C-7, would continue to apply. For persons whose natural death is not reasonably foreseeable, the existing safeguards with additional safeguards would apply.

I think we are all aware of the concern about increased risks where MAID is provided to persons who are not dying in the short term. That is why additional safeguards would apply where a person's natural death is not reasonably foreseeable. With these new safeguards, specific attention with respect to both time and expertise would be devoted to assessing requests for MAID and to ensuring those making the request are made aware of and seriously consider all other available means of relieving their suffering, including palliative care. In nearly half of the reported MAID deaths in Canada to date, the practitioner providing MAID had in fact consulted with at least one other health care professional in addition to the required second opinion from another practitioner. There is no question these practitioners are taking their responsibilities very seriously.

For those whose death is reasonably foreseeable, Bill C-7 most importantly proposes to eliminate the 10-day reflection period, which many practitioners say can prolong unbearable suffering.

The proposed amendments of the bill will allow waiver of final consent for persons whose natural death is reasonably foreseeable, who have been assessed and approved to receive MAID and who have made an arrangement with their practitioners for waiver of final consent because they are at risk of losing decision-making capacity before their chosen date to receive MAID.

We have heard many touching stories during the course of debate on this bill and situations like that of Audrey Parker, who chose to access MAID on November 1, 2018, despite her desire to see Christmas with her family. She feared that she would lose her capacity to give full consent before Christmas and so she requested MAID before then. Considering her case, we see the need for this amendment in real human terms. Ms. Parker, herself, stated:

I would like nothing more than to make it to Christmas, but if I become incompetent along the way, I will lose out on my choice of a beautiful, peaceful and, best of all, pain-free death.

Since the Truchon decision, our government has engaged in extensive consultations. Beginning in January of this year, over 300,000 Canadians took the time to participate in an online questionnaire on the subject. It should be noted that as part of this questionnaire, direct questions were asked about final consent for MAID. The following question was asked:

Imagine that a person makes a request for MAID, is found to be eligible, and is awaiting the procedure. A few days before the procedure, the person loses the capacity to make health care decisions, and cannot provide final consent immediately before the procedure. In your opinion, should a physician or nurse practitioner be allowed to provide MAID to a person in these circumstances?

Over 78% of participants said yes, that a person in these circumstances should be allowed to receive medical assistance in dying.

In addition to the online questionnaire, the Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion hosted a series of 10 in-person round tables across the country, from January 13 to February 3 of this year. These round tables allowed the ministers to hear from over 125 experts and stakeholders, including doctors, nurse practitioners, health regulatory bodies, key health stakeholders, legal experts, civil organizations and, of course, the disability community.

The ministers also hosted a separate round table focused on receiving specific feedback from indigenous practitioners and community leaders.

The importance of palliative care continues to be raised in these discussions. Our government recognizes the need for quality and appropriate palliative care, which is why it has worked collaboratively with partners, such as the provinces and territories, to develop a framework on palliative care. To support this framework, our government is implementing a targeted action plan, which will help to improve access to palliative care for underserved populations and support families, health care providers and communities. In addition, our government is providing $6 billion in federal funding directly to provinces and territories to support better home and community care, including palliative care.

There is no question that MAID is a very important consideration for all of us. This is an issue about which all Canadians care. I know in my riding of Markham—Stouffville, it is a concern that a significant number of my constituents have shared with me. This matter is extremely complex and further discussion will be needed during a future parliamentary review of the previous Bill C-14.

There is a medical aphorism attributed to Sir William Osler, a Canadian who is considered the father of modern medicine and internationally recognized, that says that a physician's duty is to “cure sometimes, relieve often, comfort always.” Our MAID legislation provides comfort to those facing death. For now, let us move forward with Bill C-7 and provide compassionate care to those in need.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I thank the hon. member for Chatham-Kent—Leamington, where we also have family members. As we have these discussions, we do see the cross-ties across Canada as we look at these issues.

The disability community is involved with the consultation process and will continue to be involved. We are reacting to the Superior Court ruling from Quebec, where we do need to look at some amendments. When we can get those in place, we will do the further review of Bill C-14, which will include the broader issues the member has mentioned.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, before I get started, I will let you know I am splitting my time with the member for Markham—Stouffville.

Today, I have the opportunity to participate in this debate on Bill C-7 from my riding in Guelph. Before I get going on the debate, I would like to recognize that Guelph is situated on the ancestral homelands of the Anishinabe people, specifically the traditional territories of the Mississaugas of the Credit First Nation.

I am proud our government has brought forward a bill that proposes changes that respond to the Superior Court of Quebec's September 2019 Truchon ruling. The proposed changes were informed by concerns and issues raised during consultations earlier this year in discussions with provincial, territorial and indigenous partners. As a result, we have had careful consideration of past experience with MAID in Canada.

I recognize medical assistance in dying is a deeply personal and complex issue. I have heard extensive feedback from my constituents on this topic as recently as this morning. During today's debate, we are hearing very personal stories from MPs that are very similar to what we heard when we first brought forward the legislation in Bill C-14. There are arguments for and against, which we need to recognize and look at.

Some of my constituents who have shared their support for these amendments and the swift passage of this bill have noted to me the importance of dying with dignity, as well as consistent and equal accessibility for all Canadians, as part of what our legislation needs to provide.

Earlier this year, I had a constituent reach out to me and share her personal story regarding medical assistance in dying. She told me that she felt very strongly about this issue because her husband of 56 years, John, had passed last December after four years of battling an illness and how appreciative she was that we had taken some first steps toward addressing these issues. She told me about the vibrant man John was, with a big heart, a successful career and an impressive education. She told me they had conversations about getting old together and how they would deal with aging, but these discussions did not include suffering or what might happen if the pain became too great. As John's illness progressed, he was moved into a long-term care facility where he spent the rest of his life. It was there that she saw so many others who were unable to be independent. She was saddened to see there was no dignity for these people, or for her husband John, as they were no longer able to look after their own personal needs. I saw this myself with my mother as she went through care in her last 10 years of life. The story of my constituent was one that conveys the importance of providing a diverse end-of-life option for Canadians that will help them provide the right decisions to be able to end their days with dignity, comfort and peace of mind.

Of course, there are two sides to this debate. I have heard from other people and received a lot of feedback that they understand we are coming at this as a deeply personal and sensitive topic for everyone, but are concerned these new amendments may impact the disability community, something we have discussed in the debate today, and the conscience rights of medical practitioners or our work toward improving palliative care. They all really do stitch together. While I am sympathetic to these concerns, I am also pleased to see our new legislation strikes the right balance of autonomy and protection of vulnerable people. This is thanks to many disability advocates who have participated actively throughout the consultation process, including specific round tables that focused on issues faced by the disability community. As was mentioned earlier in the debate, 300,000 people had input throughout the month of January 2020 to help us get to where we are today.

Additionally, our law specifically acknowledges the conscience rights of health care providers and the role they play in providing medical assistance in dying. These new amendments do not make changes to these rights and I know we will continue to work with provinces and territories to support access to medical assistance in dying while also respecting the personal convictions of health care providers.

However, the most common concern I have heard from my constituents is the need to prioritize palliative care over medical assistance in dying.

It is really the end-of-life care that we are talking about in both cases. In palliative care, Canadians are approaching the end of their life, and they deserve to receive care in the setting of their choice and to live out their days in comfort and dignity. They also deserve the freedom to make this fundamental decision about life and death without fear of their personal choice being obstructed by politics or government.

In Guelph, we are very blessed to have a wonderful palliative care facility that has been growing over the years as people recognize this as an option towards the end-of-life care that they are looking for.

However, 70% of Canadians are left without access to adequate palliative care. We have the responsibility to act in the interests of patients and their families, which is why our government supports access to both palliative care and medical assistance in dying. End-of-life issues are as diverse as Canadians themselves, and these issues also change throughout the course of medical needs and procedures that are available.

It is our responsibility as a government to provide as many options as possible for Canadians, so that they can take these deeply personal choices and make them on their own. That is why our government has worked collaboratively with partners, such as the provinces and territories, to develop a framework on palliative care. To support this framework, our government is implementing a targeted action plan that will help to improve access to palliative care for underserved populations; support families, health care providers and communities; and look at the funding that is needed to be able to execute our plans.

I would like to take this opportunity to thank Hospice Wellington and its executive director, Pat Stuart for the amazing work they do to support our most vulnerable citizens, including through palliative care.

I would also like to thank the constituents of Guelph who have personally reached out to me over the last several months to share their feedback, suggestions and personal stories around medical assistance in dying. I look forward to continuing to engage with my colleagues on this important subject and with my constituents, so that we can work to create a system that is responsive to the needs of patients, and creates an environment that can create comfort and reassurance for patients and their families.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for the question.

Eliminating the 10 days is a matter of dignity. This will allow some people to avoid suffering for days unnecessarily. As far as the committee work is concerned, we are aware that there is a world of difference between Bill C-14 and Bill C-7.

It is already planned, but the committee will have to address the issues of advance requests, which is something many seniors' groups are calling for, particularly for some people with degenerative diseases. There is also the issue of mental health and that of minors.

There are more issues that need to be studied, and I know that the committee will do the most exceptional work possible with input from all parties.

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

Madam Speaker, I thank the member for Richmond—Arthabaska for his very frank and candid comments.

I would just like to clarify something. He mentioned that the Liberal Party did not accept the other parties' amendments. That is not quite accurate, because during the debate on Bill C-14, we accepted an amendment endorsed by all parties concerning medical practitioners' freedom of conscience and religion.

I would also like to point out that Bill C-7 does allow for advance consent, but not advance directives. The issue of advance directives will be dealt with in the comprehensive review, which will take place every five years.

I would also like to point out that there is a 90-day waiting period to eliminate the impulsiveness my colleague pointed out in his speech. For example, when a minor has an accident, we do not want them to make an impulsive decision on this matter.

Does the member opposite believe that having a specialist is necessary? For example, Mr. Truchon, who was from Quebec just like the member opposite, had cerebral palsy. Our party believes that a physician must have the requisite expertise to treat and advise patients before they make their decision.

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I am very pleased to speak to the important Bill C-7. We need to know its origins to understand why we are at this point today.

In 2016, working on Bill C-14 was a rather difficult exercise given that the Liberal government was intent on bulldozing it through. I believe that is the right expression, because the government refused all amendments proposed by the different opposition parties, including the Conservative Party, the NDP and the Bloc Québécois.

The government put pressure on the Senate by giving it a deadline. The Senate wanted to improve the bill before the House voted on it. What was the end result? In September 2019, the Superior Court pointed out that the bill passed by the House was not adequate, especially with respect to the issue of the foreseeability of the date of the person's death.

That is where we find ourselves today. We are in the House debating an extremely sensitive subject, but we have not had much time to consult the experts.

Everyone has a different perspective on the issue, whether they are members of the House or members of the public in Quebec or elsewhere in Canada.

I wrote a speech, but I have decided not to read it. Instead, I would like to share my own experience with my colleagues.

The vote on Bill C-14 was the hardest vote I cast in my first four years in Ottawa.

On the one hand, I had some constituents asking me to vote in favour of the bill, while others wanted me to make sure that the legislation would protect the most vulnerable and honour the conscientious objection rights of medical practitioners. On the other hand, I had constituents going through a very difficult time with a loved one who was suffering and could not access MAID.

I did not sleep well the night before the vote. I knew that no matter which position I took, whatever I said in the House could be interpreted by the media and by Canadians. Allow me to explain. Some members voted against Bill C-14, and I would imagine that others will vote against Bill C-7. Members voting against the bill are doing so not because they are against it, but because they do not think it goes far enough.

The opposite is also true. Some members voted in favour of Bill C-14 in 2016 because they wanted to make sure people got the bare minimum. No matter which side we took, we had to explain something extremely sensitive, and I do not think a simple yes or no could accomplish that.

I often ask myself, who am I to decide for someone else? As lawmakers, it is our duty to protect the most vulnerable, especially if we remove the criterion of reasonably foreseeable natural death for access to MAID. This is reflected in the questions that some members have been asking in the House. I am sure it reflects the opinion of many Canadians who wonder what would happen if a person wanted to give advance written consent in case their situation changed over time. There is much more to this debate, and I do not think we are done talking about it.

Madam Speaker, I forgot to tell you that I will be sharing my time with the member for Calgary Signal Hill.

I am very concerned about ensuring that this bill enables all Canadians, wherever they may live in this country, to have access to the appropriate resources to make the right decision for their situation. The current pandemic has exposed the weaknesses in our health care systems. I doubt all Canadians in rural areas have access to specialists who can guide them and give them the right information so that they can make a decision based on their circumstances.

I am also very concerned about minors and vulnerable people. During the study of Bill C-14 in 2016, I had the opportunity to hear the testimony of two witnesses who had suffered accidents and endured the most traumatic ordeals a human being can experience. They told me that, had they had access to MAID back then, they probably would not have been talking to me that day because they had been in such a dark place at the time.

I know people who were there for the final moments when someone who was suffering asked for MAID. I am certainly concerned about all that, and it makes me wonder what the best solution is. Is it because we do not have the necessary palliative care resources? Is it because both the federal and provincial governments and health care facilities are making poor decisions? I am wondering about that.

I must say, I feel like we are rushing the process today, because has been quite a while since the courts asked Parliament to modernize this legislation after what happened in Quebec. This is a government that shut down Parliament under the pretext of being in a pandemic, as though we could not do more than one thing at a time. There are 338 MPs. Committees could have continued to sit. We could have heard from experts who could have explained this issue to us properly so we could make the right decision, the best decision.

Again, this is something that will not be easy for many of us. We have differing opinions within our party and elsewhere. However, I would like to note that I am proud of my party for letting me vote freely. I want to thank my leader for allowing this, without any pressure from my organization. I hope that all political parties will offer this choice, because this is a vote of conscience, and it is challenging for us to represent our constituents, who do not all share the same opinion. We also have our own conscience. For some, this is a matter of religion or beliefs, which means we may not all see eye to eye on this file.

Personally, the thing I wrestle with the most is wondering who I am to decide what is best for someone who is suffering. I believe that is what will guide my decision on the day of the vote. I hope that I will be able to make the right decision and that all of us can then work with the government to put all the necessary resources in place to properly inform and educate the public, and provide everything we can to vulnerable people who are going through tough times with loved ones, so that they are adequately supported in making the best decision.

In closing, I hope that next time, we will have more time to talk about people who are not vulnerable, sick or about to die, but still want to express advance consent.

[Pam Damoff, Liberal, Parliamentary Secretary to the Minister of Indigenous Services]

Madam Speaker, it is a pleasure to follow the wise words of my colleague, the member for Mount Royal.

I am pleased to speak in favour of Bill C-7, an act to amend the Criminal Code, medical assistance in dying. As hon. members know, this bill responds to the Superior Court of Québec decision that struck down the eligibility criteria that naturally occurring death be reasonably foreseeable.

In the last Parliament, I spoke during debate on the original MAID legislation. At that time, I talked about the need for us to have conversations with loved ones about death and dying. “Death” is a word that elicits strong emotions. We celebrate life, we embrace life and we talk about living. However, we avoid talking about death. We shy away from those conversations because they make us uncomfortable. I know there are those who feel this legislation goes too far. However, regardless of where people fall on this legislation, I think we can all agree that the way we deal with and talk about death needs improvement.

Whether a grievously ill patient chooses to die at home or in a palliative care facility or chooses medical assistance in dying, we should be having these conversations sooner and lovingly assisting those who are ill in the end of their life. These decisions are often made during a health crisis. Ideally, each of us should be engaged in advanced care planning.

I would like to share the story of Bob Lush, an incredible man, respected lawyer and my friend. Bob and his wife Maureen shared a love and bond that was obvious to all who met them. Bob died on March 17. This summer I had lunch with Maureen and she shared with me the decision they took to use MAID. With Maureen's permission, I would like to share Bob's story.

Bob had been diagnosed with multiple system atrophy and pulmonary fibrosis. He also exhibited symptoms of Parkinson’s. While his body was failing him, his mind was as sharp as ever. Over time, these serious health issues would worsen, which led his doctors to tell him that he was palliative and that there was nothing more they could do. A palliative care nurse asked if they had thought about MAID and provided them with a brochure. It was not an option they had considered before, but Bob and Maureen together decided that this option would be the most loving way for Bob to leave this earth. I cannot possibly put into words the tremendous love these two shared.

Maureen described for me Bob's last days. They chose March 17. All medical equipment was removed from Bob's room and it was filled with flowers and candles. They loved listening to James Taylor's “American Standard” album, and it was playing. Maureen and Bob's son John were by his side. As Moon River played, the doctor administered the MAID drugs. Bob closed his eyes and peacefully, painlessly and humanely passed away. To hear Maureen describe it, I could hear both the love in her voice and the sadness of losing Bob, but she had no regrets and, in fact, wanted Bob's story to be shared so that other families could consider this option for their loved one, if it was the right decision for them.

The legislation before us here today would update our MAID laws in several ways. The bill would maintain existing safeguards and ease certain safeguards for eligible persons whose death is reasonably foreseeable. New and modified safeguards would be introduced for eligible persons whose death is not reasonably foreseeable. Persons whose natural death is reasonably foreseeable, who have been assessed as being eligible for MAID and who are at risk of losing capacity, can make an arrangement with their practitioners in which they provide their consent in advance, which allows the practitioner to administer MAID on a specified day, even if the person has lost their decision-making capacity.

For persons who choose MAID by self-administration, a person could waive in advance the requirement for final consent in case complications arise following self-administration, leading to loss of capacity but not death. These new safeguards would exclude eligibility for individuals suffering solely from mental illness. It would also allow the waiver of final consent for eligible persons whose natural death is reasonably foreseeable and who may lose capacity to consent before MAID can be provided.

This legislation would also expand data collection through the federal monitoring regime to provide a more complete picture of medical assistance in dying in Canada. These are important changes and ones that have been called for since 2016, when the government responded to the Carter decision with its original legislation.

Since MAID became legal in June 2016, there have been more than 13,000 reported medically assisted deaths in Canada. This figure is based on voluntarily reported data from the provinces and territories prior to November 1, 2018; and the data collected under the new monitoring regime after that date. MAID deaths as a percentage of all deaths in Canada remains consistent with other international assisted-dying regimes.

The government undertook extensive consultation in order to update the MAID legislation. In January and February 2020, the Government of Canada engaged with provinces, territories, Canadians, indigenous groups, key stakeholders, experts and practitioners to receive their feedback on expanding Canada's MAID framework. Over 300,000 Canadians participated in online public consultations between January 13 and January 27 of this year.

It is important to recognize that MAID is not the right option for everyone. We still have work to do to educate Canadians about end-of-life options. When the former Bill C-14 was debated in the House, I spoke about palliative care and the need to educate Canadians about it as an end-of-life option. I was pleased the Senate amended our original bill to include palliative care in the legislation. Our government has worked collaboratively with partners, including the provinces and territories, to develop a framework on palliative care. We are implementing a targeted action plan of providing $6 billion directly to provinces and territories to better support home and community care, including palliative care.

I would like to share once again Bonnie Tompkins' story, a story I shared in 2016 during debate on the original MAID legislation. She is currently compassionate communities national lead for Pallium Canada, a national non-profit organization focused on building professional and community capacity to help improve the quality and accessibility of palliative care in Canada.

When her fiancé, Ian, was diagnosed with terminal cancer, he was adamant that he wanted medical assistance in dying. As is common, his biggest concern was the burden he would place on loved ones as his illness progressed. After he saw Carpenter Hospice in Burlington and was educated on the options available—

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

Madam Speaker, I had the privilege of serving with the hon. member for Mount Royal on the justice committee when we studied Bill C-14

The member rightfully talked about the process in which we heard from a diverse range of viewpoints. It is ironic that this legislation circumvents that opportunity to hear from a diverse range of viewpoints by pre-empting a legislative review, which should have started in June.

The hon. member will know that this decision goes well beyond the scope of the Truchon decision. One such area is with respect to advance consent, to which he alluded. Arguably this goes beyond the scope of the Carter decision inasmuch as Carter stated not once, not twice but on three occasions that a patient must clearly consent.

How can the hon. member defend that with respect to legislation that arguably goes beyond the scope of Carter? How can consent be truly meaningful if it is not contemporaneous?

[Anthony Housefather, Liberal, Parliamentary Secretary to the Minister of Labour]

Madam Speaker, I will be sharing my time with the hon. member for Oakville North—Burlington.

This is a very difficult bill and subject for us to deal with. In this case, the sanctity of life, something that all of us cherish, conflicts with the liberty interests protected under section 7 of the charter. This is one of those difficult times where we have to recognize that our own religious views, our own moral views are not the ones we can simply impose on Canadians. We have to recognize that charter rights are sacrosanct. Sometimes, as a member, those are difficult moments.

I personally have said before that I would not choose medically assisted dying for myself. Nor would I encourage family members to avail themselves of the opportunity for medically assisted dying. However, I also fully respect the right of every Canadian to choose for his or herself whether this right should be exercised personally.

In the Carter decision, the Supreme Court of Canada upheld that under section 7 of the charter, there was a certain subgroup of Canadians whose liberty interests were violated by the existing provisions in the Criminal Code on not assisting someone to commit suicide. The Supreme Court in Carter told us that there was a subsection of Canadians, those who were in constant enduring pain and suffering that could not be alleviated by medical treatment reasonably acceptable to them, who had the right to have their death hastened by having medical professionals assist them in doing so.

In the last Parliament, our government brought in Bill C-14. I had the privilege of being the chairman of the Standing Committee on Justice and Human Rights. We heard from a great cross-section of Canadians. We heard from those who represented the disabled community and those who believed in the right to die with dignity. We heard from members of the clergy from all faiths. We heard from university professors, lawyers and doctors. We heard from a great cross-section of Canadians who had very diverse and different opinions.

What we tried to do was craft a law that brought Canadian society together, that protected the vulnerable but yet still afforded everyone the right that the Supreme Court had recognized in Carter, which was the right to decide for one's self whether to terminate one's life in the event he or she was in enduring pain and suffering that could not be alleviated by medical treatment reasonably acceptable to that person.

As well, we had to recognize that when we dealt with the Carter decision in Bill C-14, Canada was at the beginning of a list of countries dealing with medically assisted dying. There were very few countries in the world that had gone where Canada was going. Belgium, Holland, Uruguay and a few American states were, but that was it. Canadian society needed to come to terms with medically assisted dying and learn more about the process before we went too far.

That is why, at the time, I supported a clause in the bill that said that medically assisted dying was limited to those whose end of their natural life was reasonably foreseeable. However, we knew that would change over time and that as Canadian society looked at the experience of medically assisted dying, the bill would come back for review before Parliament and would need to change.

At the justice committee, we proposed a number of important amendments to that bill. We inserted, by unanimous agreement at the committee, conscience rights to ensure that the doctors, nurses and pharmacists whose own beliefs would be offended by medically assisted dying were not compelled to participate in the process. We said that Parliament would need to review some subjects that we were not dealing with, such as the issue of mental illness on its own; the issue of mature minors; and, probably most important, the issue of advance directives for those suffering with dementia.

We also adopted a motion that palliative care had to be part of that review. People should have their death hastened because palliative care treatment is not available to them in Canada.

This bill takes the medically assisted dying regime, Bill C-14, a step further based on the Truchon decision. It held that the provisions we had put in the law about reasonably foreseeable death were not constitutional and that a subgroup of Canadians who may have many more years to live but were in constant pain, enduring interminable suffering, and could not have that alleviated by medical treatment reasonable acceptable to them also had the right to medically assisted dying.

This bill establishes that this group of people also have the right to medically assisted death in Canada, but also imposes additional safeguards on them, namely a 90-day waiting period. We understand that certain people, for example, may suffer a traumatic injury and need time to consider all their options and come to terms with their situation before finally going through with a medically assisted death.

Also, based on the Canadian experience, we are amending the bill to allow certain Canadians who are about to lose their ability to offer agreement to medically assisted dying, because they have lost their capacity to consent, to do an advance consent.

Some Canadians want to access medical assistance in dying knowing that they may still have a few more weeks to live. The only reason they want to access it sooner is that they do not want to lose their capacity to consent to medical assistance in dying.

Personally, I want these people to be able to continue to live and spend those last few weeks with their families. I do not want them to end their lives prematurely because they are worried about losing their capacity to consent to the procedure.

The amendment to the law, this bill that is before us, gives hope to this group. These people will have permission to sign a contract with their doctor indicating that they want to put an end to their life on a specific date, even if they lose the capacity to consent to medical assistance in dying in the meantime.

However, there is still a safeguard in the sense that if people who have lost their capacity to consent show through any action or words that they no longer wish to end their life, the doctor must then stop the procedure.

I strongly support the bill. I think Canadian society has evolved with respect to how we see medically assisted dying. As Canadians, we now have seen where the procedure works and where it does not work. We have seen which groups have been positively impacted and which groups have been left out and where we can improve on the procedure.

Following a great deal of consultation and national interest and seeing a change in how Canadian opinion sees medically assisted dying, this bill is the right one at the right time.