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.

Framework on Palliative Care in Canada Act

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Mr. Speaker, anyone who has watched a loved one suffer through the ordeal of a terminal illness understands the profound importance of palliative and hospice care on behalf of the patient and for the families and loved ones.

I join my caucus in stressing, over the course of this debate, the fundamental right we also stressed in debate on Bill C-14. The New Democrats believe that every Canadian has a right to high quality end-of-life care.

According to the government's own mortality projections, the mortality rate will increase by 33% by 2020, making the need for palliative care as a thoughtfully laid out national strategy an increasingly urgent one, even more imperative within the context of medical-assisted dying.

Current, nearly 25% of the total cost of palliative care is borne by families, and significant disparities remain across Canada with respect to access to end-of-life care, quality of care and those out of pocket expenses. At least 50% of hospice palliative care services are funded by charitable donations, which continues to restrict the size, scope and access Canadians have to palliative programs.

Very few Canadian provinces have designated hospice palliative care as a core service under their provincial health plan. In the remaining provinces, hospice palliative care may be included in provincial home care budgets or other health service budgets, leaving the funding vulnerable to redistribution and cuts. That is why the New Democrats believe we must have a national strategy that can protect the palliative care of Canadians who have access to it, expand access to care for Canadians who do not have it, and improve the quality and affordability of care for all.

I am happy today to speak in support of the bill.

The New Democrats were surprised to find this year's federal budget contained zero federal funds earmarked for palliative care, especially after we fought to incorporate palliative care into the Liberal majority joint committee report on physician assisted dying.

Earlier this year, New Democrat Charlie Angus tabled Motion No. 46, which would accomplish much of what this bill would.

[Bernard Généreux, Conservative, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC]

Mr. Speaker, I am pleased to rise in the House today to support my colleague, the member for Sarnia—Lambton, and her Bill C-277, an act providing for the development of a framework on palliative care in Canada.

Before continuing, I must first congratulate my colleague for her hard work since she was elected in 2015, and for earning the title of most collegial MP. She was awarded that title by her colleagues in the House, from all parties, when the prize was given by Maclean's and L'Actualité last fall. It speaks to the unstinting work done by my colleague, particularly on her present bill.

We are therefore very happy to have an engineer in our Conservative caucus as opposition science critic. That is why I am happy to speak today in support of her Bill C-277, a bill that has attracted attention from key health care stakeholders in my riding, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup.

Like a number of rural ridings in Canada, we find that we have an aging population, and we can already anticipate that the demand for palliative care will rise considerably over the coming years. It has already started. It is therefore important to talk about it and give ourselves time to be well prepared.

Following a Supreme Court decision in Carter, last year, this Parliament passed Bill C-14, which provided a legislative framework for physician-assisted dying. Although the bill was well received by some people who wanted to avail themselves of this right, others had some concerns, because they wanted to make sure that this was not the only option available. In my riding, just like elsewhere in Canada, this is a real question: will we provide only a bill like that, or will we provide other types of care? The other types of care are much needed.

As my colleague from Sarnia—Lambton noted, in the final report of the external committee on options for a legislative response to Carter v. Canada, the Supreme Court stated that a request for physician-assisted death cannot be truly voluntary if the proper palliative care is not available to alleviate the suffering of patients.

This is where we are today. The bill proposed by my colleague seeks to improve the options available to Canadians at the end of their lives. It truly seeks to encourage consultations and dialogue with the provinces to develop a national framework so that palliative care is a real option. In fact, the plan highlights the importance of having access to palliative care of higher quality than what is currently available.

It is important that our seniors and other people with terminal illnesses are protected with healthy, safe, and comfortable options in the last stages of their lives if they do not wish to avail themselves of medical assistance in dying. This is an extremely important point. People must have access to high-quality care to be able to live as long as possible in palliative care facilities. This will prevent many people from even thinking about requesting that their lives be terminated. The dignity of people depends on it.

I would like to highlight the incredible work done in my riding by the Maison Desjardins de soins palliatifs in Rivière-du-Loup, which has provided an enormous amount of care since it opened in 2009. I should also mention the mission of the Fondation Hélène-Caron, which will soon be serving the region of Montmagny and l'Islet through the Maison d'Hélène. Passing Bill C-277 will send a message to organizations like those, all across Canada, that their work is recognized and greatly appreciated.

Last month, Dr. Louise La Fontaine, vice-president of the Société québécoise des médecins en soins palliatifs and a resident of Notre-Dame-du-Portage in my riding, wrote to me to say that Canadians across the country have joined together to draw attention to the importance of palliative care.

She recommends that a national policy be developed in order to considerably improve the quality and consistency of palliative care and access to it. She recommends examining and assessing new models of integrated care, broadening accreditation standards throughout the entire health network, and focusing on areas such as symptom management and advance care planning. Practitioners must also be trained so that they can work in accordance with the various models for integrating palliative care into the management of severe chronic illness.

That is convenient because many of the things she mentioned would be part of the legislative framework if my colleague's Bill C-277 passes.

By asking the Minister of Health to consult with her provincial counterparts, we can ensure that every region of Canada is included in the discussion and that best practices and innovative ideas in the palliative care field are shared. I want to emphasize that because it is an extremely important aspect of the bill. My colleague who just spoke mentioned first nations. Canadian regions differ from one another, of course. One feature of this bill is that it takes all those differences into account and creates a framework for sharing the good practices that some regions are using and looking at which ones would work elsewhere.

I encourage all of my parliamentary colleagues to join me in supporting Bill C-277 so that we can help people across our great nation. If passed, this legislative framework will meet their medical needs and give us a plan that reflects the looming new demographic reality.

I will close by saying that the Lower St. Lawrence region, where my hometown of La Pocatière is located, is the oldest in Canada. What my colleague wants to put in place to facilitate the aging of the population affects us in particular. The bill proposes to provide quality care and enable people to make a fully informed and conscious decision, and to live out their days in an environment where their dignity will be respected.

My brother-in-law died last year after having cancer for seven years. He was treated at a hospice in the Eastern Townships. I had the opportunity to visit him twice. My sister stayed with him for three months.

The Eastern Townships, where Magog and Sherbrooke are located, is well developed. The care offered in the region is already excellent. The experience that these people have developed over the years can most certainly be shared with Canada's other regions.

From what I could see, the quality of care that my brother-in-law received was incredible. I think it is important to mention that.

My colleague came to my riding last week. Our plan was to have her come to my riding to visit palliative care homes, but unfortunately, the weather did not co-operate. I want to thank her for making the effort to meet with my constituents, who have spent a great deal of energy and time fundraising. Palliative care homes are often autonomous thanks to the donations they receive. Donations keep these homes open and operating, as is the case in Rivière-du-Loup.

In Montmagny, Hélène Caron, who is in charge of the project, has cancer. She gives a lot of her time to ensuring that this home exists. It is not a self-serving gesture. She devotes her time to the people and the good of her community.

The bill is unifying. I think that all parties should support it and see it through. Then we could have a national framework for all palliative care homes and the necessary funding to ensure that they are operational.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Mr. Speaker, it is with great pleasure that I rise in the House today and speak in favour of Bill C-277, An Act providing for the development of a framework on palliative care in Canada.

Over the past 10 years I have served in this place, palliative care has been one of the issues that I have spent a lot of time on, and so I would like to thank my colleague, the hon. member for Sarnia—Lambton, for introducing this bill and taking up this great cause at this crucial time in Canadian history.

This legislation is essential for two fundamental reasons. First, it addresses a major gap in our Canadian health care system. The vast majority of Canadians do not have access to an essential health care service, palliative care. Second, in a post-Carter decision Canada, we need to understand the realities and questions Canadians now face when nearing the end of their lives.

My roles and experiences as co-founder of the parliamentary committee on palliative and compassionate care, as a member of the joint committee on assisted suicide and euthanasia, and as an advocate for suicide prevention throughout the last decade, inside the chamber and outside, have all ultimately shaped how I approach this subject, my deep conviction that we need to do better, and that we need to see this legislation passed and implemented as soon as possible.

I would also like to add that as a Christian, the value of life from conception until natural death, and the recognition that life is a sacred gift from God also shape how I approach the topic of sustaining comfortable living for those suffering in their last days.

I would like to begin with a quote from Jean Vanier, founder of L'Arche Canada, as recorded in the final report of the parliamentary committee on palliative and compassionate care entitled, “Not to be Forgotten”:

Each of us is fragile, with deep needs for both love and a sense of belonging. We begin and end our lives vulnerable and dependent, requiring others to care for us.... In our states of dependence, our need cries out for attention and care. If this need is well received, it calls forth the powers of love in others, and creates unity around us, the gifts of the vulnerable to our world. If our cry and our need are unmet, we remain alone and in anguish.... The danger in our culture of productivity and achievement is that we easily dismiss and ignore as unproductive the gifts and the beauty of our most vulnerable members, and we do so at our own peril, dehumanizing ourselves.

The question that we all need to ask ourselves is this: Will we now withhold from our society the love, the care, the attention for our most vulnerable, and in the process dehumanize not only those who need our care, but also ourselves, we, who should be providing that care?

As our committee report, “Not to be Forgotten”, states:

Adequate palliative and end-of-life care becomes more essential as the numbers of Canadians requiring these services grows. Canada is not providing adequate palliative and end-of-life care for all who need it.

In Canada, only 16% to 30% of those who need it, receive palliative care. If that is a failing grade in any ordinary exam, how much more so is it in the context of our dying fellow citizens, friends, and relatives? This is not merely a failing grade, this is a disastrous failing grade. Our report went on to say:

Despite efforts made by palliative care providers, Canadians have a long way to go to meet our goal of quality end-of-life care. Canadians in all parts of our country should be able to get effective palliation of their pain and symptoms, and have their psycho-social and spiritual needs addressed.

So the question is this. What quality of life do we want to provide for Canadians? The provision of proper palliative care is absolutely essential if we are truly serious about maximizing the quality of life of all Canadians, who find themselves in need of these additional supports at a time when they are most vulnerable.

As our report states:

We recommend that the federal government in collaboration with the provinces and territories implement a right to home care, long term care and palliative care, for all residents of Canada, equal to the current rights in the Canada Health Act, to those services defined as “insured health services”, including hospital services, physician services and surgical dental services.

Bill C-277 follows up that same expectation in stating:

The Minister of Health must, in consultation with the representatives of the provincial and territorial governments responsible for health, as well as with palliative care providers, develop and implement a framework designed to give Canadians access to palliative care—provided through hospitals, home care, long-term care facilities and residential hospices—that, among other things,

(f) evaluates the advisability of amending the Canada Health Act to include palliative care services provided through home care, long term care facilities and residential hospices.

In a post-Carter Canada, we need to realize that the environment in which people approach the end of life has changed drastically. According to researchers Tang and Crane, “The risk of suicide doubles for people with chronic pain”.

Now that people have access to medically-assisted suicide, I would argue that there is a high probability that this number may drastically increase as the Canadian population ages and experiences higher rates of chronic pain as outlined above. However, we know that good palliative care can eliminate 99% of all pain.

The heart of the issue, outlined well by the expert panel appointed by our previous Conservative government, is that a request for physician-assisted suicide cannot truly be voluntary if the option of proper palliative care is not readily available to alleviate a person's suffering. While palliative care is not exclusively for the terminally ill, terminally ill Canadians must be given the choice to live as well as they can for as long as they can.

The government has failed to address this gap in our medical system, either through Bill C-14 or budget 2016. Current provincial and territorial approaches to the delivery of palliative care are fragmented. Federal leadership is needed to ensure that all Canadians have access to the same services and quality of care.

There are almost always problems in gaining access to palliative, and a good part of the reason is the lack of medical practitioners who feel qualified to provide state-of-the-art palliative care. There are not enough opportunities to access proper training. Recently, a large medical school in Ontario had 169 applicants for elective time, specifically devoted to study palliative care, yet there was only room for 35 of those applicants to be placed in the program. This problem needs to be corrected.

Again, from the report Not to be Forgotten:

Dr. Valerie Schulz of the Schulich School of Medicine in London Ontario has developed a simple and effective way to get medical students interested in palliative care. Each year 12 students from the undergraduate program become hospice volunteers. Undergoing 30 hours of training, each being mentored by an experienced hospice volunteer; they visit clients in their homes. The experience is priceless for the future doctors, as it gives them a chance to meet and converse with people outside the clinical environment, and without the need to bring a clinical perspective to the relationship. They relate to the hospice clients as persons, learning how they feel and react to the prospect of dying. Friendships are formed, and lessons learned, which will be of lifelong value to the future doctors in terms of person centred care. The clients also are transformed, touched that a future doctor would care enough to spend time with them in a companion role. This program is worth emulation, and broader application.

If larger numbers of medical and other health care students across Canada were able to experience one-on-one relationships as hospice volunteers, the positive effects on our medical culture would be immense. However, we need our medical schools to increase available training options for those students who want access to the specialized training.

Bill C-277 is a step in the right direction in protecting vulnerable Canadians. It builds on the non-partisan unanimously supported work of previous parliamentarians, and I hope all parties will be supporting this historic legislation.

Finally, let me quote from an anonymous author as it relates to palliative care, “To cure sometimes, to relieve often, and to comfort always. This is our work”.

[Kamal Khera, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I am pleased to stand today to discuss Bill C-277, an act providing for the development of a framework on palliative care in Canada. With the introduction of this bill, the member for Sarnia—Lambton has taken a significant step forward in our national dialogue on palliative and end of life care, and I want to thank the member for bringing this forward. I appreciate the opportunity to provide some reflections on this extremely important initiative.

Palliative care is an issue that is gaining increasing attention across our country. This was further magnified by discussions on end-of-life care options that occurred earlier this year when medical assistance in dying became a legal option. Views on this matter differ, but we can all agree that patients should have access to a full range of care options to treat pain and other symptoms at the end of their life.

Palliative care is an approach to health care that focuses on the needs of patients who live with life-threatening conditions as well as on their families. Research shows that it can have a significant impact on improving quality of life for patients, while reducing the stress and burden on their families. As demographics in Canada shift, the need for end-of-life care is increasing. Canadians have been loud and clear in calling for access to high-quality care for those who are approaching the end of their life.

Before being elected as a member of Parliament, I had the privilege of being an oncology nurse at St. Joseph's Health Centre. I have actively provided palliative care to many patients and I have seen first-hand the impact that good-quality palliative care has on patients at the end of their lives and their families.

While palliative care has been improving in Canada, we know there is still much work to be done. Some studies have reported that as few as 16% to 30% of dying Canadians have access to palliative care, depending on where they live in the country.

More recently, a study by Health Quality Ontario found that 40% of Ontarians who died in 2014-15 had not received a palliative care service. Access often depends on physician referrals, the availability of services, and the awareness of care options among patients and their families. The Ontario study found that most patients did not start receiving palliative care until the last months of their lives. This is a concern because early access can be critical, if not the most important, for maintaining the best possible quality of life for a patient. The study also found that fewer than half of the patients who received palliative care received it at home. Most of us want to stay in our homes and communities for as long as possible. When asked, the majority of Canadians said that they would prefer to spend their last days at home. In spite of this, close to two-thirds of deaths in our country are still happening in hospitals.

The Canadian Cancer Society issued a report this year called “Right to Care: Palliative care for all Canadians”. It highlighted a number of gaps, and barriers to palliative care in Canada, such as a lack of standards, limited data, insufficient training for providers, and inadequate support for caregivers.

This study and others like it show that now is the time to work together on addressing these gaps. As was said many times during the debate on Bill C-14, improving palliative care is a priority for our government. In fact, the preamble of this bill clearly signals our intent to support improvements to a range of end of life care services in Canada.

Canadians need real options that respect their plans and preferences for care in what is often a very difficult stage of life. It is obvious that Canadians are looking to their governments to make this happen. Stakeholders, including the Canadian Medical Association, the Canadian Hospice Palliative Care Association, the Quality End of Life Care Coalition of Canada, the Canadian Nurses Association, and the Canadian Cancer Society, have all called for national leadership in the area of palliative care, and we have been listening.

Our government believes that Bill C-277 would provide us with a timely opportunity to take a leadership role on this issue. We support the creation of a framework for palliative care.

I would like to recognize the efforts of the member for Sarnia—Lambton in putting forward such a thoughtful proposal for what this framework could look like. However, in considering this bill, I would urge each member to also consider the need to respect jurisdictional roles and responsibilities in this area. As we know, health is a shared responsibility in our country, with most of the responsibility for delivering care falling under the purview of the provinces and territories. Most provincial and territorial governments already have some form of a palliative care strategy, plan, or framework, or have policies or programs in place to support palliative care. Several provinces recently dedicated funding to improve palliative care services in their respective jurisdictions.

The bill needs to be better aligned with the scope of federal roles and responsibilities in relation to palliative care, and we will be introducing amendments to that effect. The government is well positioned to complement, bolster, and spread the important work under way across the country by provincial and territorial governments, as well as stakeholders across the health care sector.

I believe that amendments could be made that would achieve this objective while respecting the spirit of the bill. As we all know, the government provides provincial and territorial governments with long-term funding for health care. Our government made a platform commitment to provide $3 billion to provinces and territories to deliver more and better home care services for Canadians, including those who need palliative care. This commitment is being pursued in the context of the health accord. Negotiations with provinces and territories are ongoing, and I am optimistic that, in the future, there may be synergies with a proposed framework.

The division of responsibilities for health between the government and provinces and territories presents us with both challenges and opportunities. If we move forward with implementing this bill, it will be important to talk to provincial and territorial governments and key stakeholders on the appropriate scope of a palliative care framework.

It will also be important for us to learn from the significant body of work on palliative care that has been published in recent years. This includes reports from Parliament, provincial and territorial advisory bodies, and stakeholders, such as the Canadian Medical Association.

One key example is the Canadian Hospice Palliative Care Association's 2015 report, “The Way Forward,” which seeks to integrate a palliative approach to care throughout the health care system.

I would like to close by thanking the House for the opportunity to reflect on the importance of this bill, and to offer some considerations as we move forward, reviewing it in greater detail. I believe that a framework for palliative care is the right approach for Canada. I look forward to further discussion on what that framework should look like, so that we can all have better access to palliative care for all Canadians. Once again, I thank the member for bringing this extremely important piece of legislation to this House.

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

Mr. Speaker, as the member knows, I am bringing a fresh perspective to this place. All of the members of the Conservative Party will be supporting this bill, because we recognize that all Canadians need this.

When we studied Bill C-14 this year, we heard all of the witnesses and the people who were providing input say that we need to have good palliative care if we are going to have a true choice. To find out that 70% of Canadians have no access to any kind of palliative care was astounding to me. Therefore, I am happy to say that we will support this, and that is a change.

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

moved that Bill C-277, an act providing for the development of a framework on palliative care in Canada, be read the second time and referred to a committee.

Mr. Speaker, today, I am pleased to stand before the House to bring a private member's bill that would benefit not only my riding of Sarnia—Lambton, but all Canadians.

All of us will eventually come to the end of our lives. We all want to ensure that we live as well as we can for as long as we can. That is why Canadians need proper palliative and end-of-life care. Bill C-277 would provide a framework for palliative care in Canada.

Last parliamentary session, the Parliamentary Committee on Palliative and Compassionate Care studied the matter and came forward with recommendations. This bill is the result of those recommendations.

The committee published an excellent report outlining the current Canadian situation with respect to palliative care. The preamble for my bill is directly pulled from its report. This committee did a complete assessment of current palliative care options in Canada and identified specific areas and needs to be addressed. The report outlined the importance of strong and consistent palliative care options in Canada as well as the necessity of a framework under which to conduct these efforts.

This bill is also timely since, as a result of the Carter decision on assisted dying, the external committee report also recommended that palliative care be available to all Canadians.

The final report of the external committee on options for a legislative response to Carter v. Canada emphasized the importance of palliative care in the context of medically assisted dying. It stated that a request for medically assisted death could not be truly voluntary if the option of proper palliative care was not available to alleviate a person's suffering.

As we all can attest, each of the parties in the House has shown itself to be in favour of implementing a palliative care program in Canada, but very little has been formally announced. We can all agree on the importance of palliative care as well as the importance of making these measures accessible, in a consistent fashion, to all Canadians who need them.

Bill C-277 would define the services to be covered. It would establish standard training requirements for the various levels of service providers. It would come with a plan to achieve consistent access to palliative care for all Canadians. It would define the mechanism by which this is best achieved, with the measurements and data needed to track success.

Canada has an ever-growing number of individuals of all ages experiencing chronic and terminal conditions. Good palliative care covers a wide range of services, such as acute care, hospice care, home care, crisis care, and spiritual and psychological counselling.

A palliative philosophy of care is needed to address a whole variety of needs through an adapted and patient-centred process. The creation and implementation of a palliative care framework would give Canadians access to consistent, high-quality palliative care through hospitals, home care, long-term care facilities, as well as through residential hospices.

When we look at the current palliative care system, we can recognize the work that needs to be done. Current programs are evolving provincially and many are fragmented with little consistency and communication between the parts. A palliative care framework will bring these fragmented parts together in an effort to create a more cohesive, patient-based program, with a common definition of services covered, training standards, and a plan to ensure equal access for all.

There is a need for governance of the consistent implementation and monitoring of palliative and home care. This would require clear and open communication between federal and provincial governments as well as medical practitioners, institutions, and patients.

I would like to acknowledge the Canadian Medical Association, the Canadian Cancer Society, the Canadian Nurses Association, the Canadian Society of Palliative Care Physicians, Pallium Canada, ARPA, the Canadian Hospice Palliative Care Association, and many of their member hospices, like Bruyère Continuing Care, St. Joseph's Hospice, and West Island Palliative Care Residence, the Heart and Stroke Foundation of Canada, the Kidney Foundation, the ALS Society, the Canadian Association of Occupational Therapists, and the more than 50 organization members of the Quality End-of-Life Care Coalition of Canada for their ongoing promotion and support of this bill.

It is through organizations and groups like these that we can integrate palliative care into the current health care system and make a true difference in the lives of Canadians.

Support from across Canada is also evident in the 83 petitions on palliative care that have been presented to the House in this session alone. Thousands of letters have been received by members of Parliament on all sides of the House.

The current palliative care options in Canada are simply inadequate and do not meet the needs of Canadians.

In 2011, it is estimated that only 16% to 30% of those in need were receiving proper palliative and end-of-life care. Our current health care system favours short-term acute care, which it does extremely well. However, it lacks the capacity and the funding to properly, and consistently, provide quality long-term palliative and end-of-life care. The cost of acute care is four times that of hospice palliative care, so there is an opportunity to provide more of this kind of care for less money.

Regional accessibility is also an important issue. Currently, palliative care options are available in most heavily populated regions. However, the availability of palliative care in remote or less populated areas is often very limited or non-existent. There is a pressing need for a plan to address how to provide services to these areas. The region where you live should have no impact on whether palliative care is or is not available to you.

Palliative care would also offer an enhanced quality of life for those who, for various reasons, do not choose medically assisted dying. Data in countries that offer assisted dying shows that where good palliative care is available, 95% of people choose to live as well as they can for as long as they can. Palliative care will provide an option that would be preferable to many medical practitioners, nurse practitioners, and health care institutions that for religious and conscience reasons would prefer to help their patients live well.

With those 65 and older making up approximately 15% of the Canadian population, the geriatric and palliative care needs of Canadians will only increase. Palliative care can be cost efficiently delivered within the home or in community-based systems, such as hospices, nursing homes, and long-term care homes.

Funding palliative care in homes and in stand-alone facilities will alleviate pressure on hospitals and free up many much-needed hospital beds.

The proper training of medical practitioners and nurse practitioners is an important step in creating a comprehensive and well-equipped palliative care structure. On average, medical and nursing students spend as little as 20 hours of their four years of study learning about palliative and end-of-life care. In 2011, there were fewer than 200 geriatricians in Canada. Today, the estimated need is upwards of 600.

This bill will also have a positive impact on the lives of caregivers. In 2011, there were an estimated 4 million to 5 million family caregivers in Canada, who contribute $25 billion to the Canadian economy. These same caregivers often have a heavier financial burden and have to miss one or more months of work because of their duties. Family caregivers provide 80% of all home care in Canada, and 77% of these caregivers are women.

This might seem like a lot of statistics, but these numbers are not to be taken lightly. Caregivers experience financial, social, and physical burdens that can have lasting effects on their lives. I quote the Canadian Cancer Society when I say that “Canadian caregivers are the invisible backbone of the health care system, providing $25 billion in unpaid care”.

This added support will encourage palliative care in the home, which has been demonstrated to be beneficial for everyone involved. Allowing patients to stay in their homes for as long as possible is a wise and compassionate choice that should be offered to every Canadian.

As we can imagine, long-term data on the subject is hard to come by. What data we do have shows that Canada has a lot of work to do in the field of palliative care. Dr. Fred McGinn, of the Hospice Society of Halifax, calculated that in 2011 there were over 200 residential hospices in the United Kingdom and over 1,300 residential hospices in the United States. However, there were only 30 free-standing residential hospices in Canada.

Canada needs to develop its capacity for residential and hospice palliative care. In terms of actual spending, it costs between $600 and $800 a day to have a palliative care bed in a hospital. Comparatively, it costs only $55 a day to have palliative care beds at home. In-between these, it costs $200 to $300 a day to have a palliative care bed in hospice. In extreme cases, it could cost upward of $1,200 a day for beds in acute care in hospital while a patient is awaiting other accommodations, so it would be much more cost-effective to fund quality at-home and in-hospice palliative care beds over beds in hospitals.

Our lack of data and research on palliative care is why I believe it is essential we include further research and data collection in the bill. Many other UN countries have or have had laws in place with regard to palliative care.

A report from the United Nations and World Wide Palliative Care Alliance suggests that the cost of care at end of life, measures between 25% and 30% of all medical expenditures. Shockingly in Canada, 50% of palliative care funding currently has to come from charitable donations. This report determined that overall, the utilization of hospital based and in-home based hospice and palliative care services significantly reduced the cost of care, while providing equal if not better quality care for patients.

In this House, the government has stated it would allocate $3 billion to home care and to palliative care over the next four years.

This bill to create an overarching framework guaranteeing quality palliative care would provide an ideal complimentary legislation to Bill C-14 in the sense that it will take into account the concerns expressed by health professionals all while creating a quality palliative care strategy. Having end-of-life options gives patients a real choice in an already difficult situation.

Establishing a clear and comprehensive palliative care framework will allow patients to make well-informed decisions about how they spend their remaining time with family and friends.

I believe that my riding of Sarnia—Lambton is an excellent example of palliative care done right. One in five residents of Sarnia is 65 or over, and this number is on the rise. Sarnia is considered to be ahead of many communities with its 10-bed hospice and eight to 10-bed hospital palliative care unit. We have more than five palliative care specialists in our area, and as a community, Sarnia—Lambton has many institutions and groups that support and deliver palliative care, such as St. Joseph's Hospice, the Bluewater Health Palliative Care Unit, and the Erie St. Clair Community Care Access Centre and the VON.

Unfortunately, resources such as these are not abundant everywhere. This has been attributed to a lack of medical training and personnel in this field and a lack of funding. A very small number of Canadians in need of palliative care are able to receive it. With less than 30% of Canadians having access to quality palliative care, concrete changes need to be made.

As a large portion of our population approaches retirement, the issue will just continue to grow. I am looking to create a framework to implement consistent and quality palliative care across Canada. No Canadian should be denied these essential end of life programs and services because of their region or their finances. Every Canadian deserves the right to be able to end their life in peace and comfort knowing that they had the final choice. The bill will result in Canadians having that real choice.

I would once again like to thank the numerous groups, organizations and hospices for their support. After all, 95% of people who have good palliative choose to live as well as they can for as long as they can. I believe every Canadian should be given that option, so let us join together with one voice to call for quality palliative care as a right of all Canadians by supporting Bill C-277.

Salaries Act

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

Mr. Speaker, I rise today to speak to Bill C-24, an act to amend the Salaries Act and to make a consequential amendment to the Financial Administration Act.

The bill can be broken down into three major components: the legal creation of eight new Liberal ministerial positions, including three ministers; the elimination of six regional development agency ministers; and the amendment to the Salaries Act so that all ministers are paid equally.

Before I start speaking directly to these points, I want to share with everyone the importance of economic development agencies. I have seen first-hand in my own riding the positive impact of federal economic agencies, and more specifically, of the Federal Economic Development Agency for Southern Ontario.

In 2009, the federal government created FedDev Ontario. Prime Minister Stephen Harper announced this agency, recognizing the global recession and the specific challenges in every region of the country. The agency was created to deal with the specific and distinct needs of southern Ontario, tailored to the priorities of the region. The agency was developed as a tool to help businesses and communities succeed with necessary resources.

At the time, the prime minister appointed the hon. Gary Goodyear to tour and engage workers, businesses, and community leaders. Gary was a member of Parliament from Cambridge who not only represented the area but was able to see the issues first-hand and work with leaders to create solutions for the economic downturn.

Through the creation of this agency, many incredible opportunities came to fruition, and over $1 billion was provided over five years. Mr. Goodyear's job was to work with the departments and account for putting programs into action, working to expedite funding for economic development, diversification, and community development.

Programs included under FedDev Ontario were the community adjustment fund, the National Research Council industrial research assistance program, the community futures program, and the Business Development Bank of Canada.

Overall, the agency's mandate was aimed at addressing the short-term economic needs of the communities hit hard by the economic recession. FedDev was able to announce a number of important initiatives, including an $8-million investment to build an air cargo terminal at the London International Airport and improvements to Highway 8 in co-operation with the Province of Ontario.

All that being said, I believe that we have a very competent minister currently at the helm, but I believe that expecting one minister to personally oversee all the important projects that fall under his portfolio is asking for failure. I believe that we need to have someone accountable for all the money that floats through these agencies who has knowledge of an area and the specific needs of that area.

Although I have travelled this beautiful country a bit, l recognize the vast differences from region to region. The needs of Atlantic Canada are vastly different from those of Alberta, yet currently they both need assistance. They need someone on the ground advocating on their behalf and recognizing what works best in their own communities. I feel that it is not the time to have one minister accountable for all the money and all the projects. I think this is reckless and poorly thought out, regardless of the efforts of the current minister.

That leads me to point number one: the creation of eight new Liberal ministerial positions. We see the government chopping the important positions at the economic development agencies yet creating new positions when we do not even know what they are for. Maybe if the government could share its plans for what the ministers are, it might get greater support from the opposition. Instead, it is proposing these new positions with no information.

The government is asking for a blank cheque payable to someone for something. Does that sound transparent? I would urge the government to just tell us. Let Canadians know what it is doing and why. These are simple requests, but instead, we are being asked to support Bill C-24 with no further information. The ministers have not yet been named. We have no idea what they will be doing, and we have no idea why they will be doing it.

The government was elected one year ago today on slogans like “transparency”, and today I am speaking and questioning the government on its plans. I thought I would be silly and maybe help the government with the meaning of transparency, using the ever so competent source, Wikipedia, which says, “Transparency is operating in such a way that it is easy for others to see what actions are performed.”

If Wikipedia gets it, why does the Liberal government not? Why are we voting on something in the House of Commons that is so unclear? Why are we voting blindly on an issue? The Liberals are asking us to support something about which we have no idea. Truly, it is sounds like something I would say to my husband in the car. If I am not positive about the outcome, I usually say to him, “Trust me”. I know then that it is between him and me, not 30 million taxpayers, and that I can therefore be accountable to him.

However, we are being asked to give carte blanche authorization for something we do not know about, so the words, “trust me”, just cannot matter. When we are asking the government to give us some sort of ideas, we should be privy to what those requests are, especially when there are three new ministers that will be set up.

Finally, I would like to touch on the ministerial equality proposal. The Prime Minister proudly announced his gender-equal cabinet. Shortly afterwards, it was pointed out that he had appointed only women to junior ministerial positions. I am 100% supportive of the idea of gender equality, but as many of our colleagues have pointed out, the solution to this “oops” is taking all of the junior ministers and giving them more money. Any woman fighting for gender equality sees the holes in this solution.

Let us just break this down to the simple facts. These are the following portfolios that are currently junior ministers: the Minister of all Francophonie, the Minister of Science, Minister of Small Business and Tourism, the Minister of Sports and Persons with Disabilities, and the Minister of the Status of Women. All of these positions are very important and necessary, but the Prime Minister is trying to end the gender gap in his own cabinet by saying these positions are equal to those of senior ministers.

This is not about gender parity; it is about saving face and protecting his reputation as a feminist. I find his solution quite an overreach and very degrading. Each of these women in their portfolios works hard, but if we asked them, not one would say they have a job that is equivalent to the Minister of Finance or the Minister of National Defence. There is a very big difference.

In our caucus, members who were previously in these positions speak frankly and honestly. Their roles are very different and their portfolios are much smaller and focused. The role of senior minister comes with a deputy minister and a larger departmental budget, as this is needed.

This one-tier approach is not modernizing and I question whether this is about gender parity or ministerial parity. Truly, this is neither. This is not about pay equity or equal pay for equal work, as my NDP colleague had clearly pointed out in her opening speech last week.

Let us look at this in simple terms. We talk of this as being about all ministers at the cabinet table having equal jobs. Let us be honest. I will take this back to something I have a lot of experience with, which is the restaurant business. If I am looking at a restaurant, I would look at the different roles that were set up. We would have the executive chef, the sous chef, the order cook, the manager of the front of the house, the servers and bartenders. We would have everyone. At the end of the day, everyone needs to work to make this restaurant work and every single person has a very important job to do, but the onus will be on the executive chef and the manager. Although the executive chef is out there doing the meals and doing the meal planning, the sous chef will be cutting celery and carrots.

We are trying to say that some of these small roles are not as small as they seem. The thing I have problems with is that when we look at this, we all need everyone to work together at the cabinet table and be equal, but that does not mean their jobs are equal. We cannot compare what a person does as an executive chef or a minister to what a sous chef does or to what a junior minister may do. I am not trying to say that these roles are not very important, because they are, but at the end of the day, let us look at the work.

We talked about ministerial parity; let us now talk about work parity. Do we see these ministers doing the same amount of work that the ministers of state are doing? I think the answer is very clear and it is no.

Would I truly want to be the Minister of Finance setting up a budget for 2017 and also having to do a full forecast? That is a lot of work. Would I want to be the Minister of Justice who has to deal with almost every single bill that comes through the House of Commons? Absolutely not. Those are overwhelming things.

On the other side, I do recognize the importance of these junior roles, but saying they are not junior roles does not make them more senior. I really appreciate all of the work that we have done. We have just come out of an excellent 2016 Olympics, but does that make the Minister of Sports' role as important as the role of the Minister of Finance?

I want to show that huge difference because there is a huge difference. I think for us to say there is not would be rude, and the only reason that some people are not willing to say so is that she is a woman. Therefore, we have to say that it is an equal role. It truly is not an equal role.

We also look at the Minister of Status of Women, for whom I have great respect. She does an excellent job going around and checking important things about women throughout the country, including violence against women. Once again, is that role as great as that of the Minister of Justice? I am using these two women for comparison's sake, because they have different roles but are both female. Let us look at the two of them as equals.

We have the Minister of Justice, who was recently involved with a huge bill like Bill C-14. She is dealing with different aboriginal issues, with the Minister of Indigenous and Northern Affairs, and with health issues. She is dealing with so many different things. We have to recognize that the job of the Minister of State for the Status of Women is a very focused one and does not include all of what the Minister of Justice may do.

I also look at the Minister of Health. I have great respect for her and the work she has to do. We have to understand how comprehensive her job is, not only working on her own role but working with all of the provinces.

We are sitting here talking about job parity, but this is not about job parity because if it were about job parity, we would be looking at equal work, and this is not equal work.

If I were in small business and paying everyone the same, I would go bankrupt. Our government has to look at this as not being about equal work. This is about a time when the Prime Minister last year appointed his cabinet, which was scrutinized through the lens of his statement that his cabinet was gender-equal. The media pointed out that he truly did not have a gender-equal cabinet so because some of those ministers were ministers of state. Therefore, we are now giving large increases to those ministers of state, chopping off the words “of state”, and saying that they are equal. Let us be honest. Changing the name of minister of state and making it “minister” and not increasing the workload and saying that they are the same as everyone else who is sitting along that front bench is not true. I think we all have to sit back and see that.

I asked a question earlier of my colleague the parliamentary secretary, because I know that in my own region I have an excellent parliamentary secretary who works very hard. I sit there, and before I question the minister of state, I am thinking “How is this going to roll out?” Although I know she works very hard, should I expect that in time the parliamentary secretaries are going to be saying, “I do a lot of work as well because when the minister is not here I sit here on Fridays, and when the minister is not available I take a lot of the calls and requests”.

What is going to happen? Is this going to be a snowball effect so that the next thing we know, even a critic like me will get a raise? To me, that does not sound right. Our work is as members of Parliament and we are elected to come here, making the amount of money that we do. Yes, they got a cabinet position; congratulations, they get more money. But at the same time, they are working hard and all members of Parliament should be working hard for all Canadians.

I want to go back to the three main topics here. We are talking about removing the regional ministers, which I feel is very unnecessary. As I indicated, even in my own hometown we have seen great things done because of the impact and the knowledge of those ministers. I am not going to sit here and say that the minister is not doing a great job, but he has a huge role. By having people under those regional agencies, they have first-hand experience and knowledge of those particular files and how they can see Canadians in economic development.

The other issue is the mystery three ministers that we discussed. We talk about transparency. We need to see that transparency. If the current government wants us to support three more ministers, tell us why, tell us who, and tell us what they are going to be doing in the future and how they are going to benefit all Canadians.

Finally, on the issue of ministerial parity that I just wrapped up on, if we break down all of the issues involved and really look at them, I want all of the government members and every member here saying, “Is this the right bill to support?” I cannot support a bill when there are so many unknowns. I cannot support a bill when there is talk of parity that really is not parity. As well, I cannot support a bill when I know that as a result, we will be cutting the Canada Economic Development for Quebec Regions agency, the Canadian Northern Economic Development Agency minister, the Federal Economic Development Agency for Southern Ontario minister, the Federal Economic Development Initiative in Northern Ontario minister, the Atlantic Canada Opportunities Agency minister, as well as the Western Economic Diversification Canada minister. All of them have great tasks and great roles. I think it is very important that they continue to sit at the cabinet table to have that impact and to be able to advocate for their regions in the current cabinet and government.

Physician-Assisted Dying

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I am tabling a petition today signed by many constituents of Winnipeg North.

This petition deals with Bill C-14. Just to provide assurances to those who have signed this petition, many of the issues raised in the petition were in fact debated through the process. I look forward to having another debate on it in a few years.

Opposition Motion—Appointments to the Supreme Court

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, this really is real change from the member across the way, is it not? However, more seriously, we have heard the Liberals try to use this argument before. In question period, we essentially heard the Duffy defence from the government House leader, who said that the government was acting within the rules. However, I think Canadians expect respect for our institutions. That is what we have consistently provided as an opposition and what we are calling for in the context of this motion.

I will not say that the previous government was perfect in every respect, but in the last year we have seen things like Motion No. 6, which went far beyond anything that was ever contemplated under the previous government. We have seen things like the invocation of closure on Bill C-14, on euthanasia, which is a deeply sensitive issue. There was no history under the previous government of bringing in closure on fundamental issues of conscience. That is very clear. In a very short time, the current government has come in promising so-called real change and has delivered—

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

[The Speaker, Geoff Regan]

It being 3:09 p.m., the House will now proceed to the taking of the deferred recorded division on the amendment to the motion to concur in the Senate amendments to Bill C-14.

Call in the members.

Physician-Assisted Dying

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Mr. Speaker, I have said many times in the House that I am confident that this bill is constitutional. We have worked hard on an extremely complex issue to find the right and necessary balance between personal autonomy and protecting the vulnerable. There are multiple objectives contained within Bill C-14. It is the right approach for Canada right now, and we look forward, hopefully soon, to having our legislation in place.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, the amendments to Bill C-14 are now before the House. We have another chance to pass a bill that respects the right to medical assistance in dying.

Will this government accept our amendment to make this bill constitutional, instead of forcing Canadians who are suffering to fight for years in court?

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

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

Madam Speaker, what a debate this has been. Bill C-14 has been at times a very emotional discussion, both inside the House and outside the House, whether it has been at committee or other places. I have learned a great deal from it. I really appreciated the many members on all sides of the House, no matter what their position has been on Bill C-14, who have been able to articulate and share quite candidly some real-life stories, whether it was during second reading, at third reading, or at the committee stage. A number of members of Parliament were engaged in this debate and I would like to acknowledge their contributions.

It has been an interesting process from its beginning. We can talk about the Supreme Court decision and then fast-forward it to December, when there were heavy discussions on how we could come up with a report. We had a joint committee of the House and the Senate where we saw members of both places coming together to work and get a better sense of recommendations, ideas, and thoughts through consultation to make sure we could advance to where we are today. We saw ministers of the crown, two in particular, those for Justice and Health, pull it all together into something that sets a good, solid, legal framework, but will stand up to a charter challenge. l truly believe that to be the case.

From the ministers, to the individuals who sat on the committee, to the individuals who have spoken on this at different levels of readings, to those individuals outside of the House, people throughout our great country have been involved and engaged as much as one can expect on a piece of legislation that is so very important to each and every one of us. I have on numerous occasions stood with petitions dealing with this issue. I know other members have done likewise. I know that all members of the House have had consultations with their constituents, have received correspondence, and had telephone discussions.

I was able to cite a very personal experience with my father and what had taken place at the time of his passing. I was only one of many who was able to share stories. I thought I would provide a highlight in terms of why we are here. As members will know, it was a unanimous decision. All nine Supreme Court judges made the decision that we had to bring in a new law. That is really what Bill C-14 deals with, a new law regarding medical assistance in dying.

The Supreme Court of Canada made that decision and they put in a time frame. We have passed the deadline, but not by too much. It would have been nice to have achieved that deadline, but that is where we are today. If I could make reference to what this is, it is that access to medical assistance in dying would only be available to those who meet certain conditions: mentally competent adults who are in an advanced state of irreversible decline and capability; have a serious and incurable illness, disease, or disability and are experiencing enduring and intolerable suffering caused by their medical condition; and whose death has become reasonably foreseeable, taking into account all of their medical circumstances.

Something that is not highlighted very often is the fact that after four years this whole process will be under review, which is really important to emphasize.

Earlier today at the beginning of the debate, there was a comment that captured the essence of the bill and hopefully will put to rest many minds in regard to the issue that we have been debating. This is a quote from the Minister of Justice this morning. She said, “The bill achieves the most appropriate balance between individuals' autonomy in deciding how their death will occur and protection of vulnerable individuals, as well as broader societal interests.”

That is something the minister said earlier today, and that I concur with 100%.

I will now go to what the Prime Minister has said, and this is a great way to conclude my remarks. He recognized that Bill C-14 does not end the national discussion that needs to take place

We have seen a budget that has brought forward an incentive to ensure we build on a health care accord. This is something we believe is important to all Canadians, because Canadians from coast to coast to coast have told us that. We will continue to build and look toward palliative care as a part of that ongoing discussion.

It is such a privilege to be able to stand up and share a few thoughts and words before the bill ultimately passes.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I will share my time with my hon. colleague from Winnipeg North.

I rise today in the House to speak to Bill C-14, for the last time, I hope.

Although it was sometimes quite heated, I think that the debate on Bill C-14 brought out the best in us as parliamentarians. All parliamentarians showed a great deal of respect, even though we all have different perspectives on a very sensitive and emotional topic.

Today, I will talk about the amendments that were proposed by the other chamber. I support the motion by the Minister of Justice to accept some amendments and reject others.

The palliative care amendment that was brought in by the Senate is a good amendment. We had a lot of discussion at the Standing Committee on Justice and Human Rights and here in the House on the balance between access to medically assisted dying and the importance of ensuring quality palliative care. The fact that the Senate has once again reinforced the importance of ensuring that information be provided on palliative care before someone has access to medical assistance in dying is something that we should accept. I am pleased that we are going to accept that as amended by the Minister of Justice.

I am also pleased that the Minister of Health will be required to set out guidelines for death certificates within one year. We made amendments at the Standing Committee on Justice and Human Rights to require the Minister of Health to work with her provincial and territorial counterparts to set standards to include coroners. This amendment falls well in line with what the House has already accepted.

It is entirely legitimate for the Senate to ask for a deadline with respect to the studies that will be done on advance directives, mature minors, and psychological illnesses, and to require them to be delivered back to Parliament within two years from the time the studies begin. We in committee amended this to say “must commence within six months”, which is also a reasonable requirement.

What is also eminently reasonable and strongly follows the will of the House of Commons is the minister rejecting the amendment to remove the criteria of death being “reasonably foreseeable”. Removing that requirement entirely changes the bill from applying to someone who is near the end of his or her natural life to encompassing people who may have 30 or 40 years left to live. It may encompass people who have purely psychological illnesses, which was not the intention of the bill, because we have specifically stated that we are doing a study about people who have psychological illnesses.

However, if we look at the definition of “grievous and irremediable” and take out subsection (d) on reasonable foreseeability, then we fall into a situation where someone who has a psychological illness may meet the criteria of subsections (a), (b) and (c), thus completely changing the position of the bill on whether people with purely psychological illnesses can have access to medically assisted dying.

I want to emphasize from a public policy perspective that this legislation took a prudent approach. We can argue back and forth about what medical doctors and lawyers and law professors have said. I sat in committee and listened to well over 40 witnesses. I also had the pleasure of periodically glimpsing in on the Senate Standing Committee on Legal and Constitutional Affairs and listening to its witnesses.

Doctors, lawyers, professors, distinguished people came down on all sides of this issue. There are those who say that the bill is not Carter-compliant or charter-compliant and there are just as many, if not more, who say that the law is Carter-compliant and charter-compliant. In my view, it is the role of Parliament to determine what we believe to be charter-compliant. It is the role of Parliament to determine the best public policy within a charter-compliant law.

Medically assisted dying to me is meant to help people who are suffering intolerably but have an illness that will extinguish their life at some future date.

The court, in Carter, talked about Gloria Taylor and people like Gloria Taylor. Gloria Taylor had ALS. Gloria Taylor was undisputedly going to die from the illness she had.

I believe that ensuring that death is reasonably foreseeable falls entirely in line with public policy guidelines that we expect. Doctors and nurses, many of them, came before us and said that they did not go to school for many years to end people's lives. They went to school to try to help people who were suffering, to try to prolong life as long as possible within the framework that we currently have in the profession. They did not go there to be told that someone who comes to them and who may have many years left to live, and who has an illness that we may find a cure for in four or five years, should have their life extinguished.

As such, I do believe the minister is making the right decision to reject that Senate amendment. I also believe the government carefully researched what was being done in other jurisdictions. There are only nine jurisdictions in the entire world that have legally regulated medical assistance in dying. In all but three of them, there is a requirement that the person's life be near its end.

Whether it is Colombia, or the four United States' states that have these rules, or whether it is Quebec, which adopted its own end-of-life framework, which I understand is different and was pre-Carter, all of them require that a patient be dying, at the very longest, within the next six months, under reasonable medical certainty.

Only in the Netherlands, Belgium, and Luxembourg do we allow people to have their lives taken by medically assisted dying if their natural life is not close to an end. What kinds of situations have we seen in those jurisdictions? We have seen people who I believe many of us in this House would believe should not have access to medically assisted dying being given medically assisted dying.

We saw twins in their 40s, who were blind and starting to go deaf, for example, but had no other conditions that would end their life. Those people needed help, real help, psychological help, help to live their lives, not being told, yes, they should go die together now. People who were purely psychologically ill, who could not get over traumas related to sexual assault. These may be incredibly traumatic psychologically, but there are ways of helping those people that do not involve medically assisted dying.

I do not think Canadians, when we are talking about all the opinion polls that are being cited, where there is support of over 70% for medically assisted death, are contemplating those situations. They are contemplating situations where someone is nearing the end of their natural life and is in intolerable pain.

For me, if we removed reasonable foreseeability, we would be asking the medical profession in Canada, the nursing profession in Canada, other medical practitioners in Canada to be participating in medically assisted death beyond where they decided to do, and even more importantly, we would be doing so without the safeguards that would have been put in the bill had we intended that that class of people be covered. There is no way that a 10-day waiting period suffices when somebody could have 40 years left to live.

In conclusion, I want to say that I support the motion from the Minister of Justice, and I will be voting in favour today.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, it is a privilege for me to rise again in the House to speak about the sensitive and complex issue of medical assistance in dying.

This morning, I had the honour of seconding the motion of my colleague, the member for Victoria. I would like to reiterate how much I admire and respect the commitment and sense of responsibility he has shown throughout the process that has brought us here today.

I have had the opportunity to learn from his great expertise in constitutional law on many different occasions. I am a new member who was elected on October 19, 2015. The Special Joint Committee on Physician-Assisted Dying was the very first parliamentary committee that I have ever been a member of. It was a great privilege for me because all the members of the House of Commons and the senators who worked on that committee did so in a spirit of co-operation in order to achieve the best possible outcome. We did not always agree, but we had a lot of respect for one another and we listened to what everyone had to say. We wanted to ensure that we made the best possible decisions and recommendations for the benefit of all Canadians, while respecting their rights. The 21 recommendations that we did make reflect that desire. One of our main goals throughout our discussions was to ensure that no one was discriminated against.

Naturally, Bill C-14 could not include all 21 recommendations. As I said after our report was released, I think it will continue to be useful for years to come.

My colleague from Victoria and I felt it was important to augment the committee's work with a supplementary opinion. The one thing all of the witnesses agreed on is that medical assistance in dying is linked to palliative care.

We also felt it was important to write a supplementary opinion to connect this issue to all other social determinants. It is important to say that we all have equal rights. However, because of certain social constraints, we must ensure that social determinants are taken into account in implementing medical assistance in dying.

As a member of the committee, I was astounded at the level of expertise we have in Canada on this issue. We heard from more than 60 witnesses, and we read thousands of pages before drafting our report and recommendations. I have a great deal of admiration for many of the witnesses who appeared before us because they put a lot of careful thought into this sensitive issue.

Our thinking on medical assistance in dying has changed in this country. The Supreme Court's Carter decision is proof of that. The witnesses talked to us about the change that has taken place in society. Looking back at the Rodriguez ruling from 20 years ago, it is clear that our society's thinking on end of life has changed.

I believe that our report and recommendations attest to that, and that is why it is so important to me that the bill we pass in the House reflect our constituents' thoughts on this matter. The witnesses, particularly groups representing people with disabilities, put a lot of careful thought into this matter and came to share their ideas with us.

I found it particularly hard when some of these groups told us that a few of their members had had friends or loved ones commit suicide prematurely. We currently have no measures to give these people hope that they will be able to freely choose at which point they will make a request for medical assistance in dying. That concern stuck with me.

I was also struck by the testimony from doctors who came to tell us that the Carter decision, which was handed down on February 6, 2015, changed their profession drastically. These doctors, like the ones I met in my riding, told us that throughout their training and their careers, they have been taught to heal and, failing that, to extend life. Now, they are being told that, according to what the public wants, what the law allows, and what their rights allow, patients in our country will be able to submit a request for medical assistance in dying.

I have listened carefully to a number of speeches since we started having this discussion. During my many meetings in my riding of Saint-Hyacinthe—Bagot, I pointed out that it is not up to us, in the House, to decide whether medical assistance in dying should be available or not. The Supreme Court has already ruled on that issue. It is up to us to amend the Criminal Code.

I am from Quebec. The people of Quebec have had the Act respecting end-of-life care since December 2015. As many people have said in the House, that act was the result of six years of work to reach a broad consensus. Of course, in order to reach that broad consensus in Quebec, the legislation still had to comply with the federal Criminal Code. The province could only go so far within its areas of jurisdiction. Now we can pass legislation that allows us to go even further.

The consensus that emerged in Quebec and that was confirmed in my discussions with my constituents is that we now recognize that we have reached a time in our civilization when, as citizens, we want to be able to choose. What the Supreme Court told us is that the Canadian Charter of Rights and Freedoms gives us the freedom to request medical assistance in dying.

In order to deepen my reflections throughout our deliberations in the Special Joint Committee on Physician-Assisted Dying, I felt duty-bound to seek out people and groups in my riding, Saint-Hyacinthe—Bagot, who are dealing with this situation every day and meet with people who are sick or dying. This includes stakeholders and volunteers with a community organization called Les Amis du crépuscule, which provides assistance to people receiving palliative care and later to their grieving families. There are user committees for health care institutions, as well as the Hôtel-Dieu-de-Saint-Hyacinthe hospital foundation. That institution is one of the largest long-term care facilities in Quebec. Hundreds of people spend their last days on earth at the Hôtel-Dieu-de-Saint-Hyacinthe. I think it is around 500 people. That hospital has hundreds of beds, but only 12 palliative care beds.

That is why it has been important from the start of this debate on medical assistance in dying to talk about developing and implementing a real national palliative care strategy. For medical assistance in dying to be a real choice, palliative care also has to be offered as a choice. Unfortunately, many people have limited access to palliative care.

In Saint-Hyacinthe—Bagot, people have access to Maison Victor-Gadbois, a home for end-of-life care for those with cancer. This home receives 800 applications a year, but can house only 200 people.

Doctors have told us that we have developed a health care system based on hospitals and healing. When I met with Monsignor Lapierre, bishop of the Saint-Hyacinthe diocese, to talk about this issue, he made a comment that was full of wisdom. He told me that we should be just as concerned about aggressive treatment as we are about medical assistance in dying. He is sometimes called to the bedside of people who tell him they have had enough.

We must vote on this issue of medical assistance in dying here in the House with a sense of the responsibility we have to represent our constituents who are living with a serious and irremediable illness and intolerable pain.

Every time I rise in the House to speak to this issue, and during each meeting of the joint committee and the Standing Committee on Justice and Human Rights, which studied this bill, I think about the people who are suffering. They are the ones who are at the heart of our discussion on Bill C-14. There are people who are suffering now, and they have high expectations for the bill we are going to pass. When the Supreme Court rendered its decision in Carter, people who were suffering had hope that their right to request medical assistance in dying would be respected.

The amendments in the motion by my colleague from Victoria say that we must not disappoint these people who are suffering and awaiting our decision. They hope that we will allow them to make this request for medical assistance in dying soon and that their rights will be respected.

These people who are suffering need not go to court. I was touched by the testimony given by members of the Carter family, who spent many years before the courts with their mother. When Bill C-14 was introduced, they came to tell us that the bill would not even give their mother the right to request medical assistance in dying. I cannot rise in the House and vote in favour of this bill, knowing that I am leaving people who are suffering to their own devices because they are not in the right class to be eligible for medical assistance in dying.

This week, the Minister of Health told us that we need to think not only about the rights of Canadians, but also about the work of doctors. Since I began thinking about this issue, I have realized how much respect I have for all health care professionals. I also have a lot of faith in their judgment.

The doctors who testified in committee said that, while requests for medical assistance in dying are a new part of their reality, they have been dealing with difficult requests from patients that require them to use their judgment every day since they became doctors.

The difference since the Supreme Court ruling in Carter is that now they must deal with requests for medical assistance in dying. These decisions will be difficult for some. Fortunately, the bill gives them the right to conscientiously object and tell the patient that they are not comfortable complying with their request. We think it is important for the health care system to ensure that patients will not have to find a new doctor in the Yellow Pages. They must have support in order to exercise their right to ask for medical assistance in dying.

We also believe that sufficient safeguards have been put in place. I was really moved by the representatives of organizations for the disabled who asked us not to be paternalistic or treat the disabled like children. The fact that they have an incurable disease or are living with a degenerative disease or suffering a great deal is no reason to treat them like children. They are autonomous and can provide informed consent.

The Supreme Court talked about suffering that an individual deems intolerable. Nobody can judge another person's suffering. We all react differently to illness. That respect for individuality must permeate the medical assistance in dying law we implement. We must ensure that each individual, each citizen of this country, has the freedom to make that choice if the situation arises.

Nobody in this country wants to be in the position of having to make this request. Nobody wants to face the choice of whether to request medical assistance in dying. Nobody wants to support a loved one in making a choice about requesting medical assistance in dying. Nevertheless, we all hope that, when that day comes, every person will have all the resources they need to give free, informed consent. We hope that every person will feel their rights are being respected and will not be told that, unfortunately, they belong to a small class of people who are not eligible because it is felt that their death is not reasonably foreseeable.

Many, including the Barreau du Québec, the Collège des médecins du Québec, and Quebec's health minister, came and told us that “reasonably foreseeable natural death” does not mean anything and is impractical. In my opinion, we are putting doctors in a position where they cannot reasonably use the flexibility we are trying to give them in a fair and equitable manner because this criterion has no clear meaning for a doctor.

We must ensure that the legislation we pass is consistent with the Supreme Court's decision in Carter and with the Canadian Charter of Rights and Freedoms. We must ensure that once this legislation is enacted people who are suffering will not be required to ask a lawyer to go before the courts to uphold their right to seek medical assistance in dying. At the Special Joint Committee on Physician-Assisted Dying, we heard that the provinces are ready to continue their work to enact provincial legislation. Quebec's health minister said that he was pleasantly surprised at the work of his colleagues from the other provinces.

Today we must pass legislation that is consistent with the Supreme Court's decision in Carter, that is consistent with the Canadian Charter of Rights and Freedoms, and that allows every Canadian to request medical assistance in dying.