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

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the funny thing is that people have been saying it is the only solution for 50 years now. Why is it that some hospitals still do not provide palliative care because there is a shortage of units?

Nowadays, in some hospitals, people who request medical assistance in dying cannot experience that end-of-life journey in a palliative care unit, even though palliative care is supposed to be end-of-life care and relief from pain and suffering in an environment that supports human dignity. How is that possible?

We must not think of palliative care and MAID as being mutually exclusive. It is a continuum of care that should be available to these patients. Those who are not terminally ill, for whom the dying process has not already begun and is not irreversible, are also entitled to a suitable environment. Bill C-7 makes that possible, and much more clearly than Bill C-14 did.

That was not possible under Bill C-14, with its unassailable reasonably foreseeable natural death criterion, which the court said undermined patients' right to life.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I listened with great interest and care to the member's speech. It was an important contribution.

I know the member is aware that the original legislation, Bill C-14, required a broader legislative review of medical assistance in dying. That review was supposed to start in June.

Will the member and members of the Bloc be supporting efforts to get this broader review going in parallel with Bill C-7?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I rise today in the House to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying. It is long overdue.

I want to start by saying that the Bloc Québécois is in favour of adopting the principle of this bill, because it clarifies two aspects of medical assistance in dying.

The first has to do with access to medical assistance in dying when death is imminent, meaning that the person is terminal and is receiving palliative care before receiving medical assistance in dying. At least, I hope that is the case, because people in palliative care are not always the ones to request medical assistance in dying. I will come back to this.

The second aspect has to do with people for whom death is not imminent, who were denied access to medical assistance in dying as a result of the “reasonably foreseeable natural death” clause in Bill C-14. The court struck down this criterion, which was the key safeguard. This is what Bill C-7 is designed to fix, and we are happy about that.

As we begin debating the underlying principles of Bill C-7, it will come as no surprise that I am discussing them. It is precisely because we, as lawmakers, did not do our job four years ago when we were studying Bill C-14, that we find ourselves debating Bill C-7 today.

This is a democracy, and parliamentarians, not judges, must make the laws. We, the representatives of the people, the lawmakers, must be the voice of Canadians, especially those who are suffering. Judges only interpret the grammar of justice. They examine the laws we make, as well as the rights and freedoms, and determine whether a potential infringement of rights and freedoms is reasonable or not.

In this case, the court has handed down its ruling: The provisions of the current law, the former Bill C-14, are an unreasonable infringement of rights and freedoms. Furthermore, before Bill C-7 was tabled, two courts had ruled that the Criminal Code, amended by Bill C-14, violated the right to life, liberty and security of the sick person suffering intolerably or with a terminal illness.

We have to be clear about the issue at the heart of this debate: before being legal, this is an ethical debate. On one side of this debate is the paternalistic vision of the state and medical practice, while on the other side is a vision based on the autonomy of the individual and its corollary, the principle of self-determination. I know that all my colleagues in the House have good intentions. They want to do good, they want the best for patients and they are caring. I am sure that during this entire debate they will reflect the very values they are advocating and they will be just as caring and compassionate about the interests of patients.

However, we cannot claim to be caring and compassionate, in other words wanting to do good and what is best for an individual who has reached their breaking point at the end-of-life stage, if we are interfering with that individual's autonomy and self-determination, and if we refuse to respect their wishes on something as personal as their own death. The literature is clear on this.

The basic question is this: What business does the state have interfering in a decision as personal as my own death? My life is my own, as is my death. No one else, and certainly not the state, is going to die in my place. The courts had to reframe the limits of the state's power to intervene because we did not do our job properly.

All I want is for us to understand what is at stake here. I am referring to the law, which my Conservative friends often put up on a pedestal. The value of autonomy is conferred by law through the principle of self-determination, especially with regard to medical care. That is what I want to discuss here today with my colleagues. Let's talk about the autonomy bestowed on a person by law through the principle of self-determination.

In the biomedical context, the principle of self-determination is associated with an inviolable rule, namely the rule of free, informed consent. The rule regarding free, informed consent to treatment has never been challenged in emergency situations. Patients always have the right to refuse treatment.

My question for my colleagues is this: Why would it be any different for human beings experiencing intolerable suffering due to an irreversible illness or condition? Why would it be any different for competent individuals who are neither depressed nor suicidal and who have expressed a desire to live fully until they reach the limit of what they can tolerate?

In the Carter decision, which led to Bill C-7, the Supreme Court ruled that the provisions prohibiting medical assistance in dying violated the right to life, liberty and security of the person. People like Ms. Gladu, Mr. Truchon, Ms. Carter and Ms. Taylor have not reached the end-of-life stage. They might not even be in the terminal phase of their illness. That does not mean they have not reached, or are not in the process of reaching, the limit of what they can tolerate.

The court stated that the restrictive provisions in Bill C-14 were effectively shortening the lives of such individuals, that they violated their right to life by inciting them to commit the act before they were ready. That is what needs to be fixed right here, right now. Bill C-14 did a fairly good job covering the end-of-life care for terminally ill patients whose death was reasonably foreseeable, with the exception of the requirement for a second consent, which is sometimes not necessary and means that people suffer even though they gave their informed consent.

There is no issue for people who are terminally ill. The dying process has already begun and is irreversible. Death is imminent and foreseeable. The issue we need to address as legislators has to do with people whose death is not reasonably foreseeable and imminent. Under Bill C-14, Ms. Carter, Ms. Taylor, Ms. Gladu and Mr. Truchon were ignored.

What we, the members of the Bloc Québécois, want is respect for the moral autonomy of the dying. We often hear the expression “dying with dignity”. I must point out that dying with dignity does not mean having a sanitized death. That is not what it means to die with dignity. The dignity of a person is derived from their freedom to choose and respect for their free will. That is what it means to be a human being. That is what it means to respect a human being. When that is violated, we violate the dignity of the human being.

Whether the death is unpleasant or not is not the issue. The crux of the matter is to allow the human being to make a decision about the end of their life. Unfortunately, in the past, we won the right to die rather than undergo aggressive therapies. At the time, this was called passive euthanasia. The person was left to die without much attention and without death being the intent. Palliative care was still in its infancy. There was a great fear of administering one last fatal dose of medication, but it always ends up causing death. Because palliative care is still care, it does not strictly count as passive euthanasia.

Patients won the right to die rather than undergo aggressive therapies, because people did not use to die from cancer; they died from the treatment. Medical paternalism has at times gone too far and has been less than helpful.

Today's patient-practitioner relationship prioritizes collaboration, negotiation and respect for the patient's choice. Patients alone can assess their quality of life, and that must be respected, which is why medical professionals must be transparent with their diagnoses.

Patients won the battle for the right to die rather than undergo aggressive treatment, and that evolved into palliative care as we know it. For a long time, palliative care was thought of as the only solution that would allow people to die with dignity, but if that is the case, why is it still so hard for people to get that care? If that is the solution, why is there still such a shortage of palliative care units?

Sometimes, even the best, most carefully managed palliative care in the world cannot alleviate people's suffering. Bioethics teaches practitioners to remember that patients come first, and that means listening to them.

That is true for Ms. Rodriguez, Ms. Carter, Ms. Taylor and Mr. Truchon, and it is true for Ms. Gladu and many others who have continued to suffer throughout this pandemic while they wait for us to do our job. Contrary to what some people think, these individuals are not suicidal. They want to live as long as possible.

I watched a very interesting interview with Ms. Gladu. What did she say to us? What did she want? She wanted the freedom to choose. Having this freedom greatly diminishes the suffering and anguish.

With Bill C-14, the government said its intention was to protect the most vulnerable. Is there anyone more vulnerable than a person who is suffering from intolerable pain, who is living with an incurable illness and who is being told to go to court for the right to choose and to die with dignity? Is there anything more important and more intimately personal for an individual than their own death?

I have a hard time understanding my Conservative colleagues' argument that the state must decide for an individual, when they are so economically libertarian. Several Conservatives felt that Bill C-14 went too far. The courts said that it did not go far enough and that it violated fundamental rights.

Elected members of the National Assembly of Quebec advanced the debate without pitting palliative care against medical assistance in dying. They chose to include requests for assistance in dying as part of a continuum of end-of-life care that is consistent with palliative care. Whether we are talking about a degenerative disease or an illness that causes extreme pain but is not terminal, let us not pit those two realities against each other. Respect for human dignity includes proper support when one is dying, which requires doctors to have the humility to recognize that they cannot always help people manage their pain adequately.

Our society recognizes people's right to self-determination throughout their lifetime but takes it away from them at the most intimate moment of their lives. In so doing, we think that we know what is best for people or that we are doing the right thing, when we are actually undermining human dignity, their freedom to choose.

There is no more important moment in a person's life than their death. Learning to live is learning to die. Learning to die is learning to live. I say that because the clock starts ticking the moment the doctor cuts the umbilical cord.

The Carter decision and the Baudouin ruling sent us back to the drawing board. We need to do our job as legislators and stop off-loading the problems and the ethical, social and political questions onto the courts. We have a job to do as legislators.

There is a sociology of law. In a society, the law evolves with people's consciences. I know I am straying from the technical details of the bill, but we will have plenty of time to discuss them in committee.

The bill proposes that a person who is not terminally ill must consent twice and be bound by a 90-day period. I really wanted to talk about advance consent, since that is about all that is missing from the bill.

Bill C-7 does not address degenerative cognitive diseases, which are predictable diseases. Doctors can tell patients how they will progress. People with these diseases often remain of sound mind for years and do not appear to be sick, but eventually, they become forgetful and then die. They can also experience complications from being bedridden or immobilized or conditions other than that disease. I think a person with Alzheimer's, for example, should have the opportunity to make an advance request. This bill does not take those people into account.

Still, I said at the outset that we agreed on the principle and the grounds for discussing this bill. We will have time to talk about these issues. I urge my colleagues to bring substantive arguments to the debate on the adoption in principle of medical assistance in dying.

I remember when the previous Parliament studied Bill C-14. I heard arguments about how we were putting ourselves on a slippery slope. Some people were practically saying that long-term care homes would turn into euthanasia factories. If evil people are working in our health system, they should be fired, no matter what job they do, because they have no business there. I am not buying the argument that this is a slippery slope because people are evil.

We must assume from the outset that everyone working in the health care system is caring and compassionate. Increased health transfers would enable these people to provide better care, and maybe there would be more palliative care units in hospitals. Even though people have been saying for 50 years that palliative care is the only solution, I do not believe it is. It makes no sense that people do not have better access to palliative care in this day and age.

I would like to end my speech, which I trust was a substantive one, with a wish for all of us, here in the House, concerning the delicate issue of the end-of-life. I sincerely hope—which is what the patients who turned to the courts were hoping for—to face death serenely, peacefully and without suffering. That is my wish for everyone, because that is the best wish we can make for a human being. We should imagine ourselves being at peace on our death bed and being able to let go because we have palliative care to support us in our journey towards death. That is the best wish we can make for a human being.

I am therefore calling for a debate on both the substance and the principles. I am also appealing to the humanity of all my colleagues so we can finally provide an adequate response to all those who are suffering and have been waiting for far too long.

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

Madam Speaker, I can say that some of the key safeguards that were deemed to be essential in Bill C-14 have been removed. The member speaks about the 10-day reflection period. It is unclear why that was removed when the law, as it stands, currently provides an exception for cases where the lack of capacity to consent is imminent. That would provide for a shorter reflection period, so it is unclear why the government would choose to remove it altogether.

With respect to the removal of the need for providing two witnesses, the need is now to provide only one witness, which is in fact a lesser safeguard than what is required when a testator executes a will.

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

Madam Speaker, when Bill C-14 was discussed, I did warn the House that if we look to other countries and how they enacted medical assistance in dying, we would see that they began with death rates in their countries of less than 1% and grew to 8%, through people not following the safeguards. It seems to me that the government, in the new version, has removed all of the safeguards: the reasonably foreseeable death provision, the independent two witness provision, the 10-day cooling-off period provision and asking for consent immediately prior.

Would the member agree that all the safeguards have been removed, or are there ones that still remain in place?

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

Madam Speaker, yes, it is correct that the member and I did serve on the justice committee together during the deliberation and study on Bill C-14.

When we speak about conscience protections, they are fundamentally important. It is important to remember that the Supreme Court of Canada, in the Carter decision, did recognize that Canadians have a right, in certain circumstances, to physician-assisted dying, but at the same time the court expressly stated that no physician should be compelled to provide the procedure. It is important that the Carter decision be respected.

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

Madam Speaker, I am pleased to rise to speak on Bill C-7, an act to amend the Criminal Code respecting medical assistance in dying.

At the outset, I will say that the subject of medical assistance in dying is perhaps one of the most complex issues that could come before Parliament. Profound moral, legal and ethical questions are raised. Medical assistance in dying raises questions of individual autonomy, the need to respect the sanctity of life and the need to protect vulnerable persons, among other considerations.

It is no wonder that Canadians have such profound, deeply held and diverse views on this subject matter. After all, when we are talking about physician-assisted dying, we are talking about issues that literally concern life and death. When we, as parliamentarians, give consideration to an appropriate framework that provides safeguards, we must do so with regard to the fact that we are talking about a procedure that, when carried out, is irreversible. The patient dies. It is indeed a weighty subject of profound importance.

I am certainly informed of the complexity of the issue through my experience of having, in the last Parliament, served as the vice-chair of the Special Joint Committee on Physician-Assisted Dying. This committee was tasked with reviewing the Carter decision of the Supreme Court, which struck down the blanket Criminal Code prohibition and tasked Parliament and the committee with putting forward recommendations for a legislative response. I then sat on the justice committee, which studied Bill C-14, the government's legislative response. In that regard, I am in the unique position of having been through the process from start to finish, from the study of the Carter decision of the special joint committee through to the passage of Bill C-14 in June 2016.

The bill before us purportedly responds to the Truchon decision of the Superior Court of Quebec, which struck down an important component of Bill C-14, namely, that in order to qualify for medical assistance in dying, one's death must be reasonably foreseeable. When the Truchon decision was issued in September 2019, we on this side of the House in the official opposition called on the Attorney General to do the right thing and appeal the decision. We did this for a number of reasons.

To begin with, it is the responsibility of the Attorney General to uphold laws passed by Parliament. The law passed by Parliament was Bill C-14. I would note that the law had been passed a mere three years prior to the issuance of the Truchon decision. It was passed after a comprehensive review of the Carter decision and a comprehensive review of possibilities for a legislative framework. Therefore, in the end, Bill C-14 was a carefully thought-out and debated piece of legislation. One would think that in the face of that, the minister would have appealed the decision.

In addition to that, when one, having respect for this place and the laws passed by Parliament, actually looks at the Truchon decision and the reasoning of Madam Justice Baudouin, it should be all the more apparent the need to appeal the decision. Madam Justice Baudouin, in concluding that the reasonable foreseeability criterion contravened section 7 and section 15 of the charter, was driven, arguably, by a restrictive interpretation of the purpose of the law. Indeed, Madam Justice Baudouin reached her conclusion by singularly focusing on one objective of the law, namely, to protect vulnerable persons from being induced in a moment of weakness to ending their life.

However, that was not the only objective of the legislation. When one looks at the preamble of Bill C-7, it expressly provides for other objectives, including the sanctity of life, the dignity of the elderly and disabled, and suicide prevention, yet the judge in Truchon focused exclusively on only one of those objectives.

What Parliament sought to do in providing for a reasonably foreseeable criterion was to respond to what the Supreme Court called upon Parliament to do, namely, to strike a balance between individual autonomy and the need to respect vulnerable persons.

The Attorney General, moments ago, stood in this place and said that the government chose not to appeal the decision because it agreed with the substance of the decision. That is quite interesting because only four years ago, three years before the minister decided not to appeal the decision, ministers on that side of the House emphasized how critical the reasonably foreseeable criterion is to provide and ensure effective safeguards to protect the most vulnerable.

To that end I would quote the former health minister, Jane Philpott, who, on June 16, 2016 stated:

We are concerned with the Senate's recommendation for the removal of the clause that recommends that this be considered only in the face of natural death being reasonably foreseeable because of the fact that people with mental illness, among others, would not be adequately protected.

Then there are the comments of the then attorney general, the hon. member for Vancouver Granville, who introduced Bill C-14 and stated:

There are other compelling reasons for there to be a requirement that the person's natural death be reasonably foreseeable. First, it provides a fair way to restrict eligibility without making assisted dying available to almost everyone. Second, restricting eligibility in this way is necessary to protect the vulnerable.

In the face of those objectives, it is quite a departure and quite convenient for the minister to say that he was going to effectively abdicate his responsibility as attorney general to uphold the laws passed by Parliament by allowing a single decision of a single lower court judge in one province of this country to stand. The Attorney General acknowledged, and we should make no mistake about it, that the effect of Truchon and its codification, by way of this piece of legislation, significantly transforms the medical assistance in dying framework in Canada.

At the time of the Carter decision and when this House, four short years ago, debated Bill C-14, medical assistance in dying was thought to be an exception to the rule, not the rule. It was thought to be appropriate in certain circumstances in an end-of-life context, where one who was suffering intolerably could, upon providing clear consent, hasten their death.

With this legislation, it would now be appropriate to terminate human life even in the absence of a terminal illness and even in circumstances where the suffering is medically manageable. That is a radical transformation, and it creates a number of complexities around issues of suffering that might be psychological or existential and outside of an end-of-life context. When one removes the reasonably foreseeable criterion, all that is left is that one must have a serious disease, illness or disability, be in state of decline, and be suffering physically or psychologically as a result.

When one removes an end-of-life, or reasonably foreseeable, component, that already arguably subjective test becomes a whole lot more subjective, and that has the potential to put vulnerable persons' lives at risk. One can see that with those broad parameters, persons with degenerative disabilities could have their lives terminated, notwithstanding that they may have years, if not decades, to live. That has caused enormous concern in the disability community across Canada.

One month after the Truchon decision was issued, some 72 organizations from across Canada, representing a cross-section of the disability community, wrote to the Attorney General and pleaded with him to appeal the Truchon decision. They did so out of concern that persons with disabilities could be put at risk and have their lives prematurely ended.

The writers of the letter noted that the legislation could arguably contravene article 10 of the UN Convention on the Rights of Persons with Disabilities, which provides that persons with disabilities should be treated equally under the law. They note that persons with disabilities could be treated unequally because one could have medical assistance in dying made available to them for no other reason than they happen to be disabled.

It should be noted that the UN rapporteur on the rights of persons with disabilities sounded the alarm when she said she was, “extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective.” From a disability perspective, that plea fell on deaf ears on the part of the Attorney General in terms of his failure to appeal the Truchon decision.

In light of what a significant change this legislation means, it is unfortunate that it has come to this, because appealing the decision would have allowed for time. It would have allowed time for Parliament to take into consideration the significant complexities associated with this change, a mere four years after Parliament had legislated a comprehensive regime, and it would have provided clarity in terms of informing Parliament about the scope of the framework upon which Parliament can legislate.

However, instead of taking the appropriate time to ensure that any legislative change respects the charter, because respecting the charter, including life, means protecting vulnerable persons, we are here with a profoundly significant piece of legislation being rushed. It is being rushed in the face of the expiration of the stay on the declaration of constitutional invalidity, effective this December.

While the Attorney General and the government emphasized the Truchon decision, it must be noted that this legislation goes well beyond the scope of Truchon. It removes important safeguards, including the 10-day reflection period. It removes the requirement that there be two witnesses to confirm that a person made the request of their own free will and that the request reflected their true consent. It provides for a complex advanced consent regime, one of those complex areas when it comes to medical assistance in dying policy, and it does all of this pre-empting what Parliament had determined, called upon and legislated in Bill C-14; namely, a legislative review that was supposed to take place this spring, but is not going ahead.

Now we are in this rushed process, instead of having an opportunity for members of Parliament to come together to hear from expert witnesses, to review the state of the law, to give consideration to the comprehensive reports of the Council of Canadian Academies and to receive diverse feedback on all of these issues. It need not have been this way. It should not have been this way, and it is regrettable that the government has so recklessly put us in this position by rushing through legislation that, arguably, could put vulnerable Canadians at risk and remove critical safeguards.

[David Lametti, Liberal, Minister of Justice]

moved that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Madam Speaker, I am pleased to speak today about Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, MAID. The bill before the House today is identical to former Bill C-7, which I was proud to have introduced in February following significant consultation among Canadians and experts. I believe this bill reflects a consensus among Canadians and I call on all of my colleagues in this place to support its timely passage.

As members will recall, this bill proposes a legislative response to the Quebec Superior Court's ruling in Truchon and Gladu, in which the court ruled that it is unconstitutional to limit MAID to persons whose death is reasonably foreseeable. That declaration of invalidity, which applies only in Quebec, was initially suspended for six months and subsequently extended by four months, such that it would have come into effect on July 12.

We were all working toward that deadline when this bill was initially introduced. As with many other aspects of our lives, the COVID-19 pandemic disrupted our usual parliamentary activities and it became impossible to meet the July deadline. As Attorney General, I asked for a further extension, which the court granted, until December 18, 2020.

Even though the ruling in Truchon and Gladu was suspended, Quebeckers who are experiencing intolerable suffering and who meet all the eligibility criteria except that of reasonably foreseeable death can apply to the court for an exemption that would allow a practitioner to provide medical assistance in dying despite Parliament not yet having amended the legislation.

Six exemptions have been granted since Justice Baudouin handed down her ruling in September 2019, and others are under review. The availability of exemptions limits the impact of the suspension of the ruling in Quebec.

I would like to take a moment to note the passing of Mr. Truchon, one of the plaintiffs in the case that led to these important changes to our medical assistance in dying regime. Like many Canadians, Mr. Truchon was concerned about the impact of the pandemic on his quality of life in addition to the suffering caused by his medical condition. He want the option to obtain medical assistance in dying, which he did in April. I would like to express my deepest condolences to his loved ones.

The bill before members today, four years after the enactment of Canada's first medical assistance in dying provisions in 2016, proposes a significant change to Canada's MAID regime in broadening eligibility to persons whose natural death is not reasonably foreseeable.

The 2016 amendments were, themselves, a historic change in our criminal law. They created exemptions to some of the most serious criminal offences, which aim to protect one of our most fundamental values, that of human life. These exemptions sought to protect and promote another of our most cherished values, individual freedom, and more specifically, the freedom to decide when enough medical suffering is enough and to choose when and how one's life should end.

Health Canada's first annual report on medical assistance in dying in Canada released this past July indicates that since then nearly 14,000 Canadians have received MAID. In 2019, MAID accounted for 2% of deaths in Canada.

The requirement for reasonably foreseeable natural death was part of a MAID regime that was adopted in 2016. However, we decided not to appeal the Truchon and Gladu decision because we agreed that medical assistance in dying should be available as a means to address intolerable suffering outside of the end-of-life context. To ensure the consistency of criminal law across the country, we committed to amending the Criminal Code.

Before amending the Criminal Code, we conducted an extensive consultation with Canadians. We gathered responses from 300,000 people through an online questionnaire. My colleagues, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, our parliamentary secretaries and I also held round tables across Canada with over 125 experts and stakeholders. The summary of these activities can be viewed on the website of the Department of Justice.

Based on these consultations and other sources of information, the bill proposes adjusting both the eligibility criteria and the procedural safeguards to respond to the decision rendered in Truchon and Gladu. The bill also proposes allowing patients to waive the requirement to give final consent in specific circumstances so that they do not lose their access to medical assistance in dying.

We know that Canadians are also concerned about other issues that are not addressed in this bill. I am thinking, in particular, of access to medical assistance in dying on the basis of mental illness. I am also thinking about advance requests for medical assistance in dying for people who are not yet suffering but fear they will be after they have lost their ability to request this assistance and who want to make their wishes known before that happens.

The upcoming parliamentary review of the medical assistance in dying regime and of the state of palliative care in Canada will provide an opportunity to give these complex issues the time and attention they deserve. It is up to Parliament to determine the scope of this review and when to conduct it.

COVID-19 has delayed this important review, but I am confident that Parliament will undertake it as soon as possible. That being said, our government's top priority is to meet the deadline set by the Quebec Superior Court in the Truchon and Gladu case.

Before I discuss the contents of the bill in more detail, I would like to note the important concerns of many individuals in the disability community about changing Canada's MAID policy from a way to avoid a painful death to a means of relieving intolerable suffering. It is crucial that these concerns not be forgotten as we resume our debate. In the view of many disability groups, a MAID regime that does not limit eligibility to those whose death is already reasonably foreseeable enshrines in law the erroneous view that disability itself is a valid reason for ending life. We have also heard from individuals living with disabilities, like Mr. Truchon and Ms. Gladu, that autonomy in how they choose to live and die is paramount. These are complex and nuanced points of view.

Let me be absolutely clear. Our government supports the equality of all Canadians without exception and categorically rejects the notion that a life with a disability is one that is not worth living or worse than death itself. I believe the fundamental principle that all lives have equal and intrinsic value can be balanced with other important interests and societal values, in particular, the importance of individual choice for Canadians. This balance is at the heart of the bill's objectives, which are to recognize the autonomy of individuals to choose MAID as a means for relieving intolerable suffering, regardless of the foreseeability of their natural death, while at the same time protecting vulnerable persons, recognizing that suicide is an important public health issue and affirming the inherent and equal value of every person's life.

I will now go into the specifics of various elements of the bill.

The bill proposes to expand eligibility for medical assistance in dying by repealing the criteria for a reasonably foreseeable natural death. Medical assistance in dying would therefore be available to people suffering unbearable pain, who have a serious and incurable disease, infection or disability, and whose medical condition is characterized by an advanced and irreversible decline in their capacity.

This removal of “reasonable foreseeability of natural death” from the eligibility criteria would mean that some persons whose only condition is a mental illness could be eligible for MAID. However, the bill proposes to exclude mental illness on its own as a ground for MAID eligibility.

Our consultations and the report of the Council of Canadian Academies that studied this issue indicated that the trajectory of mental illness is more difficult to predict than that of most physical illnesses, that spontaneous improvement is possible, and that a desire to die and an impaired perception of one's circumstances are symptoms, themselves, of some mental illnesses.

This means that it would be very difficult to determine when, if ever, it is appropriate to grant someone's request that their life be ended solely on the basis of mental illness. In no way does this suggest that persons with a mental illness necessarily lack the decision-making capacity to consent to MAID, or that the suffering associated with a mental illness is of a lesser degree than the suffering associated with physical illness.

During second reading debate of former Bill C-7, some members noted their support for this exclusion while others raised concerns. This issue requires much more thought and debate. We feel the parliamentary review of the MAID legislation would be an appropriate forum for this.

The bill also proposes changes to the safeguards, since the existing safeguards were designed to protect persons whose death is reasonably foreseeable.

Expanding eligibility requires changes to the safeguards, since many experts believe there are greater risks in assessing applications for medical assistance in dying from individuals whose death is not reasonably foreseeable.

The bill therefore proposes two sets of safeguards. Each applies whether natural death is reasonably foreseeable or not. This is the only role that the concept of reasonably foreseeable death would play in the new regime. It would no longer constitute grounds for refusing a request for medical assistance in dying.

Reasonable foreseeability of natural death, or RFND, refers to a temporal but flexible connection between the person's overall medical circumstances and their anticipated death. It allows for clinical judgment, as it requires a comprehensive individual assessment that does not have a result in a specific prognosis and clearly does not require death to be imminent.

Individuals may decline towards death along trajectories of greater or lesser predictability. As such, RFND is not defined by a maximum or minimum prognosis, but it does require a temporal link to death in the sense that the person is approaching the end of their life in the near term.

We kept the RFND standard because it provides flexibility in relation to the difficult and imprecise exercise of anticipating when natural death might occur. A natural death that is expected within six to 12 months certainly meets the RFND standard. That was made clear when Parliament adopted Bill C-14 as an end-of-life regime. It did not impose a six- to 12-month prognosis requirement to preserve flexibility, but it still considered such timelines to be within the meaning of RFND.

A person's death may also be foreseeable in the temporal sense over longer periods, depending on the particular circumstances under consideration. However, having an illness that will cause death several years in the future would not normally meet the condition of RFND.

Safeguards for those whose deaths are reasonably foreseeable are based on safeguards that currently exist with two changes. First, the 10-day reflection period would be eliminated. Second, the request for medical assistance in dying will no longer require the signature of two independent witnesses, just one.

A person paid to provide health care services or personal care who is not involved in the assessment of the person's eligibility for medical assistance in dying can now act as an independent witness.

During second reading of former Bill C-7, some hon. members expressed concern about removing some of the safeguards.

Allow me to assure hon. members that these changes are based on the comments we received during our consultations and follow through on them.

For those whose natural death is foreseeable, many of whom spend a long time seriously thinking about what they want to do, the 10-day reflection period might unduly prolong their suffering.

We also learned that people who live in long-term care facilities or in remote regions may have difficulty finding two independent witnesses. These difficulties are exacerbated by the pandemic. The independent witness confirms the identity of the person, but does not participate in assessing their eligibility for medical assistance in dying. Only one person is required for meeting that safety objective.

Newly eligible persons whose death is not reasonably foreseeable would benefit from additional safeguards, the purpose of which is to ensure that sufficient time and expertise is devoted to the assessment of their MAID request. Where death is not reasonably foreseeable, the suffering motivating a MAID request may be due to a broader range of sources that warrant greater attention before someone's life is prematurely ended, to reduce the risk of providing MAID when there is a possibility of alleviating the person's suffering.

Specifically, the bill proposes a minimum 90-day assessment period, which would require that at least one of the practitioners assessing eligibility has expertise in the condition that is causing the person's intolerable suffering. A formal specialization or certification by a medical college would not be required. The bill would also require that a person whose death is not reasonably foreseeable be informed of and offered available means to relieve suffering, such as mental health and disability supports. In addition, the practitioner would have to be satisfied that those other means of relieving suffering have been seriously considered.

These are clarifications to the existing requirement of informed consent. It is our hope that these steps are already taken in all cases, but the Criminal Code would explicitly require them for those whose death is not reasonably foreseeable.

In addition to changes in response to the decision in Truchon and Gladu, the bill would let a person whose natural death is reasonably foreseeable and who has been deemed eligible to receive MAID to waive final consent if there is a risk they will lose the capacity to consent before the date on which they chose to receive MAID.

At present, the Criminal Code requires that, immediately before providing MAID, the practitioner must ensure that the person has given express consent to MAID and that they have the opportunity to withdraw their request. This safeguard, which attests to the irreversible nature of death and the importance of obtaining consent at the point of ending life, simply cannot be met if the person has lost the capacity to consent. This seems unfair when a person has been deemed eligible and was awaiting the procedure. In such cases, the rule could push some individuals to obtain medical assistance in dying earlier than they wanted to.

Under the amendments proposed in the bill, a person whose death is foreseeable, who has already been assessed and approved for MAID and has decided they want to receive it, could make an advance consent arrangement with their practitioner, setting out the date for the provision of MAID and their consent to MAID if they no longer have the capacity to consent at that later point.

According to round table participants and experts who looked at this question for the Council of Canadian Academies' 2018 reports, providing for advance consent in this way presents relatively little complexity or risk, and some practitioners have indicated they would be relatively comfortable providing MAID under such circumstances.

The bill does not propose to permit advance requests in contrast to what I have just described as advance consent. Advance requests are documents that may be provided at some future unknown date, if and when a set of expected circumstances materializes and when the person is no longer able to give consent. This issue is significantly more complex and challenging, and it will be examined during the parliamentary review.

Finally, the bill would enhance the monitoring regime, which is crucial for accountability and transparency. I have examined the bill for charter compliance and I am confident that it responds to the Truchon ruling in a way that respects the charter. I will soon table a charter statement that sets out key considerations about the bill's potential impacts on charter rights and freedoms.

In conclusion, these important amendments seek to guarantee that medical assistance in dying—

Reference to Standing Committee on Procedure and House Affairs

[Rob Moore, Conservative, Fundy Royal, NB]

moved:

That the matter of the premature disclosure of the contents of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying) be referred to the Standing Committee on Procedure and House Affairs.

Mr. Speaker, thank you for your finding that a breach of our privileges did exist in this case in the leaking of the contents of Bill C-7 to the media before members of the House could see the bill.

There is a reason we have rules in this place to protect the rights and the privileges of members of Parliament in this place on all sides of the House, so that we are able to do the job that we were elected to do, which is to represent our constituents, to pass legislation and to debate. Those are the things that we have been given the ability to do by our constituents. When we have government departments, government members that do not abide by the rules of the House, it undermines not just those members in the opposition; it undermines all of us.

It is well-established practice in the House that when a bill is on notice for introduction, the House has the first right to the contents of the bill. Everyone in the House knows this. We know that the House is paramount when it comes to the introduction of the legislation, but if there is any one department in the whole of government that we would expect would know the rules around the laws and procedures in the House, that department would be the justice department, the department tasked with making laws that impact the lives of all Canadians. That department knows better. That is a department filled with hundreds if not thousands of lawyers and legal minds that know better.

Let us say they did not know better. Just like with any one of our children, sometimes if they make a mistake, we correct them. Maybe if they make a second mistake, we will correct them again. By the third time around, we expect that they know the rules.

This is the fourth time there has been found a breach of our privileges in the House that was made by the Department of Justice. In fact, the last ruling on this matter was also on the previous legislation around medical assistance in dying. It was even the same legislation.

The article that was put forward within The Canadian Press had very detailed and specific information contained in the bill. That is why this breach of privilege has been found.

The reporters and those who were leaking know that contempt has occurred by revealing later in the article that, "The sources spoke on condition of anonymity because they were not authorized to reveal details of the bill prior to its tabling in the House of Commons this afternoon."

There is no doubt in anyone's mind that those who were leaking this information from the Department of Justice or some other arm of government knew exactly what they were doing when they did it. What they thought about this place is not much, because we have rules, and they thumbed their nose at the rules that we have.

After the sources indicated to the reporter that they were aware of their guilty actions, they boldly and defiantly continued their affront to Parliament by providing even more detail of the bill. Quoting again from that article, “Sources say today's bill will not deal with broader issues that were excluded in the new law and that must be considered as part of a parliamentary review of the law that is to begin this summer.” Again, bang on with what was in the bill.

We saw the news articles and we thought we knew what had happened, another leak from the Department of Justice, another affront to this Parliament, another breach of all of our collective privileges, but again we had to read the bill to find out whether in fact that was the case.

We carefully reviewed the contents of Bill C-7 following its introduction in the House. When I and other members of Parliament got to see the bill for the first time, others in the media had seen the bill in its entirety for hours before.

The details reported by The Canadian Press hours earlier were indeed contained in Bill C-7. Ironically, over and over, the first precedent that I had quoted earlier was from the last Parliament, brought to the Speaker's attention on April 14, 2016, and in regard to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).

The department in question is being absolutely recidivist. It is not taking seriously the consequences and the rulings of Speakers. The Speaker in 2016 found that there was, in fact, a prima facie case of privilege regarding Bill C-14 and said:

As honourable members know, one of my most important responsibilities as Speaker is to safeguard the rights and privileges of members, individually and collectively. Central to the matter before us today is the fact that, due to its pre-eminent role in the legislative process, the House cannot allow precise legislative information to be distributed to others before it has been made accessible to all members. Previous Speakers have regularly upheld not only this fundamental right, but also expectation, of the House.

The Speaker's concluding remarks in 2016 were as follows:

In this instance, the chair must conclude that the House's right of first access to legislative information was not respected. The chair appreciates the chief government whip's assertion that no one in the government was authorized to publicly release the specific details of the bill before its introduction. Still, it did happen, and these kinds of incidents cause grave concern among hon. members. I believe it is a good reason why extra care should be taken to ensure that matters that ought properly to be brought to the House first do not in any way get out in the public domain prematurely.

On October 4, 2010, on page 4711 of the House of Commons Debates, Speaker Milliken noted:

It is indisputable that it is a well-established practice and accepted convention that this House has the right of first access to the text of bills that it will consider.

This all goes back to my point about the Department of Justice not taking seriously the rules of this House. The one department that ought to know best about the rules of this House is now a four-time offender, with breaches of privileges found by successive Speakers over the last several years, sometimes over the same bill subject matters. The House, and the rules of the House, are being completely ignored.

The Speaker found another case of contempt on October 15, 2001, after, and members are not going to believe this, the Department of Justice briefed the media on the contents of a bill prior to the legislation being introduced in the House.

Maybe, in this minority House, members can finally take this department and this Minister of Justice's office to account and to task for their continuous disrespect of the privileges and the rights of this place, and the rights of all Canadians who send us as members of Parliament to do good work on their behalf.

Alleged Premature Disclosure of Two Bills—Speaker's Ruling

[The Speaker, Anthony Rota]

I am ready to rule on the questions of privilege raised on February 25 by the member for Fundy Royal and on February 27 by the Parliamentary Secretary to the Leader of the Government in the House of Commons concerning the premature disclosure of two bills.

Allow me first to recapitulate the arguments presented by the two members.

On February 25, 2020, the member for Fundy Royal raised a question of privilege regarding a Canadian Press article published online on February 24 that detailed specific information contained in Bill C-7, an act to amend the Criminal Code with regard to medical assistance in dying, even before it was introduced in the House by the Minister of Justice. The member quoted from the article in question, which mentioned that anonymous sources allegedly discussed the contents of the bill with the journalist while knowing full well that doing so contravened the practices of the House. The member for Fundy Royal feels that this premature disclosure of the bill constitutes a breach of his privileges and contempt of the House.

On February 27, the Parliamentary Secretary to the Leader of the Government in the House of Commons raised a question of privilege also concerning the premature disclosure of a bill.

During this intervention, the parliamentary secretary said that a bill entitled “an act to amend the Criminal Code (unlawfully imported firearms)”, put on notice on February 21 by the member for Markham—Unionville, was also the subject of an article published on February 24 in iPolitics before it was introduced in the House. On February 25, the member put another bill on notice, one with a slightly different title, “an act to amend the Criminal Code (possession of unlawfully imported firearms)”. The bill became Bill C-238 after it was introduced on February 27.

The parliamentary secretary feels that the provisions of Bill C-238 correspond to what was described in the iPolitics article, and he presumed, therefore, that the two bills are in large measure the same. The parliamentary secretary suggested that this disclosure contravenes the principle that members are the first to know the contents of a bill. Since a breach of privilege was apparently committed, he suggested referring the matter to the Standing Committee on Procedure and House Affairs.

On February 28, the member for Markham—Unionville apologized and admitted that he had indeed discussed the contents of the first bill with fellow members and journalists. He said that he had acted in ignorance of the rule prohibiting discussion of bills on notice before they are introduced in the House. He also explained the reasons for the change in title between the two bills.

The same day, the parliamentary secretary to the leader of the government in the House presented his most sincere apologies for the premature disclosure of Bill C-7, saying in passing that no one within the government had been authorized to discuss the bill before its introduction in the House.

I believe that the whole matter can be summarized as follows.

First, based on a reading of the Canadian Press article on Bill C-7 on medical assistance in dying, and in the absence of any explanation to the contrary, I must conclude that the anonymous sources mentioned were well aware of our customs and practices and chose to ignore them. It seems clear to me that the content of the bill was disclosed prematurely while it was on notice and before it was introduced in the House.

Second, in his apology, the member for Markham—Unionville made it clear that his two bills on firearms were substantially the same, apart from the slightly different titles. It seems clear to the Chair, therefore, that the member also discussed a bill before its introduction. It matters little that the bill in question was subsequently withdrawn and never introduced in the House.

The rule on the confidentiality of bills on notice exists to ensure that members, in their role as legislators, are the first to know their content when they are introduced. Although it is completely legitimate to carry out consultations when developing a bill or to announce one’s intention to introduce a bill by referring to its public title available on the Notice Paper and Order Paper, it is forbidden to reveal specific measures contained in a bill at the time it is put on notice.

In this case, it is clear that the content of the bills, both the private member's bill and the government bill, were revealed to the media before their introduction and first reading. The question now is to determine whether the disclosure of these bills was a breach of the House’s privilege and whether mitigating circumstances should be considered.

In this instance, I am prepared to give the benefit of the doubt to the member for Markham—Unionville when he says that he was unaware of the rules regarding the confidentiality of bills on notice. I believe that his remarks were sincere and that he believed he was advancing his cause in a legitimate fashion.

My analysis is different for the question of privilege raised by the member for Fundy Royal concerning government Bill C-7. Permit me to quote a part of the article at the heart of this matter:

The sources spoke on condition of anonymity because they were not authorized to reveal details of the bill prior to its tabling in the House of Commons this afternoon.

Everything indicates that the act was deliberate. It is difficult to posit a misunderstanding or ignorance of the rules in this case.

On April 19, 2016, my predecessor, faced with a similar situation regarding the premature disclosure of Bill C-14 on medical assistance in dying, found a prima facie case of privilege in a decision that can be located on pages 2442 and 2443 of the Debates.

In light of the information provided by the member for Fundy Royal, the precedents and the current practice in this matter, the Chair notes the existence of sufficient grounds to conclude that there was a prima facie breach of the privilege of the House and the members and their right to be the first to know the contents of Bill C-7.

Consequently, I now invite the member for Fundy Royal to move the appropriate motion.

Opposition Motion—Additional Allotted Days

[John Nater, Conservative, Perth—Wellington, ON]

Madam Speaker, “Parliament is more than procedure – it is the custodian of the nation’s freedom.” Those words were spoken by the great defender of parliamentary democracy, the Right Hon. John George Diefenbaker.

Today, we find ourselves called upon to once again stand in support of this great institution, to once again stand for the right of opposition parliamentarians to hold the government to account.

Many Canadians may not be closely following the business of supply. They may not closely follow the allotted days, or the opposition days, that are often called in Parliament. However, these days, in which the agenda of the House falls to the opposition parties, are absolutely essential to our great parliamentary democracy. We as the opposition, both the official opposition and the other opposition parties, have the right to bring forward matters that we feel are important to our constituents and to all Canadians.

Beauchesne's Parliamentary Rules and Forms, sixth edition, states “The Opposition prerogative is very broad in the use of the allotted day and ought not to be interfered with except on the clearest and most certain procedural grounds.”

We have brought forward this opposition day motion on this day for very important reasons. The Liberal government decided to punish the official opposition by giving us a short parliamentary day, a short day when only two full speaking slots would be allocated to the opposition parties.

The Liberal government seems to have forgotten that it is among the weakest governing mandate in Canadian history. The Liberals forget that they actually lost the popular vote in the last election and Canadians saw fit to return them with a minority of seats in this place.

Bosc and Gagnon states the following, on page 855:

The setting aside of a specified number of sitting days on which the opposition chooses the subject of debate derives from the tradition which holds that Parliament does not grant supply until the opposition has had an opportunity to demonstrate why it should be refused.

In other words, before we as the opposition can consent to the continued funding of the government, we must, and we will, have the opportunity to raise our concerns in this place. We will not be silenced. We will not accept that the government, and only the government, has a legitimate voice in this place.

I would remind members of the Liberal Party that they are first and foremost members of the legislative branch of government. Those who do not sit in cabinet are not members of the executive branch. They are parliamentarians and parliamentarians first and foremost. They too should be concerned that the members of the executive branch of government are the ones who are trying to control the debate of this very place.

I ought not to need to remind the government of its legislative record and its mismanagement of House time in the previous Parliament. At the time of dissolution, it had left at least 17 government bills lying on the Order Paper. This is in spite of the fact that it used time allocation on dozens of occasions. On top of that, there were 13 motions for closure and 40 motions to proceed to orders of the day, thereby bypassing the opportunity for opposition MPs to move concurrence motions or to table petitions on behalf of the constituents in each of our 338 ridings across the country.

Today's debate is about returning the House to the people, to give the official opposition, the Bloc Québécois and the New Democratic Party each one additional opposition day during the supply period, to give each of these parties the opportunity to raise the issues before granting supply to the Liberal government.

I do not need to remind the House either about the disregard we have seen in the past by the Liberal Party to this institution.

In the previous Parliament, on one of its very first bills, Bill C-14, the medical assistance in dying act, the Liberal government was found to have contravened the rights and privileges of the House by leaking the contents to the media before it was tabled for all parliamentarians to see. Old habits die hard, because it appears it did that once again this time with Bill C-7, the amendments to medical assistance in dying.

The Conservatives do not need to remind the Liberals either about the impacts they bring upon themselves when they attempt to use draconian measures to shut down debate in the House. We all remember Motion No. 6, when they tried to unilaterally take control of every mechanism for debate in the House. We do not need to remind the Liberals of the standing order standoff, when they tried to diminish the opportunity for the opposition to hold the government to account by unilaterally changing the rules of the House. It fell to the Conservatives, as the official opposition, and the third party, the New Democrats, to ensure we were that line of defence, that we were that thin line of the wedge to prevent the Liberal government from doing that.

In fact, in the previous Parliament, during a debate in this very House on a question of privilege, one of the most significant matters with which the House can be seized, a Liberal member of Parliament, the member for Brossard—Saint-Lambert, stood in the House, used a procedural measure to move to orders of the day and killed that debate. However, our Parliament is stronger than any one Liberal member of Parliament. At that time, the Speaker saw fit to return that question of privilege to the House so members of Parliament could have their voices heard.

We see this time and again with the Liberal government. At every opportunity it has to do the right thing, it goes the opposite direction.

That brings me to the events we have seen just in the last couple of weeks on the new NAFTA. It is not a great deal and it is not the worst deal; it is somewhere in between. We are the party of free trade and we support the implementation of the new NAFTA despite its imperfections. However, to hear the Deputy Prime Minister state publicly and in this place that the Conservative Party was somehow trying to delay the new NAFTA is an insult to the opposition and to the House of Commons.

Just yesterday, my colleague, the opposition House leader, gave the Liberals the opportunity to right their wrong by bringing forward NAFTA today. We could be debating NAFTA today and I could be raising the concerns of the people of Perth—Wellington, the farmers, the manufacturers, individuals who have concerns with the bill. However, the Liberals did not budge. In fact, speaking for the government, the parliamentary secretary to the government House leader said no, that the government would not be willing to bring NAFTA forward. That is unacceptable.

We stand here today debating this opposition motion, a motion that gives the rights and responsibilities of the House back to all its members. I encourage all members to stand for their parliamentary privilege, to stand for democracy and vote in favour of this motion.

Criminal Code

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, when Bill C-14 was introduced in the previous Parliament, the decision was made to not include advance directives. I think that was purposeful. Had we been allowed to deal with the issues that the Truchon case identified and keep all of these other issues in mind for the statutory review that is being contemplated, it would have allowed us far more time to look at the legislation, see what was and was not working and have a timely and comprehensive study of Bill C-14.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I want to ask the member about what I think is an unintended consequence of Bill C-14. It is the situation where people are forced to choose to go early because they are afraid of losing competence at the last minute, something the new bill addresses.

There are many examples of it across the country, I have one example that is very close to me. I have a friend who wanted to see family and relatives and spend some time doing last things because she had a very serious brain tumour. She chose to go earlier because she feared losing competence.

That is an unintended consequence of the current legislation. People should be able to make that choice and have an orderly and dignified end to their lives. Does the member not see that as an unintended consequence?

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, I appreciate the opportunity to speak on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, which was introduced earlier this week and dramatically expands the existing euthanasia regime in Canada.

This bill was introduced in response to a ruling made September 11, 2019, where the Superior Court of Québec found, in Truchon versus the Attorney General of Canada, that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life.

I believe it is completely unacceptable that the government did not appeal the Truchon decision to the Supreme Court. Truchon struck down vital protections for vulnerable Canadians that the Liberal government put in place less than five years ago. Appealing this decision would have allowed us to get certainty on the framework within which Parliament can legislate.

The summary of the bill states that it amends the Criminal Code to:

among other things,

(a) repeal the provision that requires a person's natural death to be reasonably foreseeable in order for them to be eligible for medical assistance in dying...

It excludes mental health as an eligible reason to receive assisted suicide. It creates two sets of safeguards that must be respected before medical assistance in dying may be provided, which differ in application depending on whether death is reasonably foreseeable. It also creates an advance directive wherein a medical practitioner can proceed with assisted suicide without consent immediately before administering it, assuming all other criteria are met and the patient enters into an arrangement in writing with a medical practitioner or a nurse practitioner to cause death on a specified day.

While these changes are significant, it is the other things where I will focus most of my attention. In responding to Bill C-14 in the last Parliament and now to this bill, it has always been our priority, on this side of the House, to ensure that legislation permitting euthanasia and assisted suicide includes safeguards for the most vulnerable in our society, as well as for the conscience rights of physicians and allied health professionals.

Of all the proposed changes, I am most concerned about the removal of the 10-day waiting period. This was not a change mandated by Truchon. Rather, it is a deliberate choice by the Liberal government to strike down one of the most important safeguards for vulnerable people facing uncertain medical prognoses.

Nearly every one of us can think of someone in their lives, perhaps a friend, a grandparent or even a spouse, who has received a serious diagnosis. The emotional impact of hearing that news can be overwhelming for both the patients and their families. It can cause depression, anxiety and a great fear of the unknown.

I am sure many of us can also think of people we know who have received terminal diagnoses and went on to beat their illness and live for years afterwards. However, with the safeguard of a 10-day waiting period gone, such stories may be fewer and farther between.

Without having to take the time to come to terms with their situation, to speak to their families and to learn about treatment options from their doctors, many people will make emotional decisions based on fear.

Another amendment removes the need for two independent witnesses and allows health care workers to act as witnesses. People may not even hear another voice offering a different solution.

By making these changes, we diminish the extremely important role legislators play in contemplating all of the unintended outcomes and consequences and then protecting against them. We know very well that the current euthanasia regime has serious problems, that it has been abused and that it has been used as a tool of desperation after the failures of government.

Sean Tagert suffered from an advanced case of ALS that left him completely paralyzed, unable to speak and reliant on a ventilator. Despite these challenges, Tagert fought to stay alive so he could watch his son, whom he spoke of in lengthy Facebook posts, grow up.

Sean required 24-hour in-home medical assistance to stay alive. Initially the health care system provided him only 15 hours, leaving Sean to somehow pay hundreds of dollars each day. Eventually, even that was too much for the health authority. Health care authorities told Sean that he would no longer receive funding for home care, leaving as his only option institutional care at a facility hours away, separated from family and removed from the son he called his reason for living.

Sean appealed, but to no avail. He was going to lose his home care. Mr. Tagert fought long and hard for the rights of persons with disabilities and their families but in the end, he was driven by his desperate circumstances to believe that assisted suicide was his only option. He was “worn out”, in his own words. On August 6, 2019, he ended his life.

I am going to read from the statement his family posted at that time:

We would ask, on Sean's behalf, that the government recognize the serious problems in its treatment of ALS patients and their families, and find real solutions for those already suffering unimaginably.

“Real solutions” does not mean removing the safeguards for those who are the most vulnerable. It means providing true alternatives, be that palliative care, in-home care or the unique care needed.

It is not enough to simply put in legislation as we find here in proposed paragraph 241.2(3.1)(g), under Safeguards:

...[to] ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care and has been offered consultations with relevant professionals who provide those services or...care.

If we have no intention of ensuring that those services are being funded or are even available, we have failed.

I note that the current federal government broke a key election commitment to invest $3 billion in long-term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making. That point has been made over and over during this debate.

People should never be put in a position where they believe death is the only solution available to them. We are, and we must be, better than that. We must protect every human life with a jealousy born of the knowledge that each person is unique, and has an innate dignity that nothing, not time, not illness nor disability, can ever take away.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Madam Speaker, it is an honour to speak today to Bill C-7 regarding medical assistance in dying. This is the second time, the first being in the last Parliament, that I have had the opportunity to take part in the debate on this absolutely essential legislation on such a difficult subject.

This bill represents a major improvement and reflects some of the amendments that I made but that failed in the House, in the 42nd Parliament. Some of those amendments, in fact, were picked up and approved by the Senate.

I want to stop and reflect on the trajectory of this issue in Canada.

As identified when I rose in my place, I am a member of Parliament for Saanich—Gulf Islands and I believe that Saanich—Gulf Islands may have more constituents concerned with and calling for medical assistance in dying than perhaps any other riding in Canada. There are two active death-with-dignity groups within my community, one on Salt Spring Island and one on the Saanich Peninsula, and I think it is for a very simple reason.

Feelings run high, and honestly, my constituents persuaded me in 2011 and 2012 that I had to stand up for ensuring that there was access to medical assistance in dying and stand up for removing the Criminal Code punishments for people who, motivated by compassion and basic human dignity, assisted someone who was dealing with unbearable suffering in their last days and weeks.

The reason that my community is so very implicated in this issue is that Sue Rodriguez was a resident of North Saanich. She was unable to take her own life due to the effects of ALS, but she was able to find a doctor, who remains anonymous to this day, who assisted her in ending her own life.

It is clear that many people in my riding support the measures in Bill C-7, as they did support Bill C-14 in the previous Parliament.

This is about helping to alleviate suffering through medical assistance in dying. This difficult and very serious situation is unfair to anyone.

Sue Rodriguez went to court, so it is also a trajectory of court cases. The Supreme Court of Canada ruled in 1993 against Sue Rodriguez. She was suffering from ALS. ALS runs as a thread through what I want to talk about today. Sue was losing ability and had lost ability to speak, to swallow and to walk. We know the trajectory of ALS. She asked the court to change the law and she was unsuccessful. That was in 1993. By the way, it was a very close decision. It was five to four, a very close decision. She died a year later, on February 12, 1994.

Then we take it to 22 years later. That is how slowly the laws evolve. It takes a while. The Supreme Court of Canada and the laws of Canada evolve to meet the changing circumstances. I think part of the reason is that we also realize now, unlike 20, 30, 40, 50 years ago, that we can prolong lives and sufferings through miracle advancements in medical science, but before we passed this law in the 42nd Parliament, we were denying people death with dignity and the ability to control their own decision-making about the timing of their own death.

Along came the Carter decision, finally, in 2015. Twenty-two years after the Supreme Court of Canada decision in Rodriguez, we had the decision in Carter. I felt very strongly when we debated the bill for medical assistance in dying in this place in the last Parliament, the 42nd Parliament, that our legislative efforts fell far short of what the Supreme Court of Canada ruled in Carter.

I felt quite sure, and said many times in this place, that the legislation we were passing, while an improvement, would not stand up to legal scrutiny and would be ruled unconstitutional by the courts. Now we have the decision that came out last September in the Truchon case, and again a court has given us a deadline to come up with an improvement. It is being called Audrey's amendment. Certainly a lot of people have identified with that situation, and their hearts have been broken by knowing that medical assistance in dying was out of the reach of people who were suffering gravely but feared they would not be able to form the required consent on the day of the procedure.

I think the bill before us is a substantial improvement, and it really reflects on how courts grapple with this issue and how society grapples with it.

I have to say that in the 42nd Parliament, I found the debate remarkably respectful. Across all parties, we recognized that these are serious matters of life and death, not to be trifled with and not to be turned into partisan debate. The reality is that in this legislation we do make amends for some mistakes in the previous bill.

I always find it rather odd that we have to find that a person's natural death is “reasonably foreseeable”. I do not think any of us in this place fancy ourselves immortal. All of our deaths are entirely foreseeable; we just do not know exactly the time and place in which they will occur.

Doctors of those who are suffering from a terminal illness are not even able to say the reasonably foreseeable date. What does it mean to be reasonably foreseeable? We put people in a stricture where even if they knew they had a terminal illness, such as ALS, they could not necessarily get aid from this legislation and they could not necessarily give advance consent to a doctor to indicate that they did not want to go through what they knew lay ahead of them.

One of my best friends emailed earlier today to ask me to stand up and fight this bill, because she is dying with ALS and she did not think the bill would cover her. I spoke to the Minister of Justice to confirm that I was reading the bill correctly and that, yes, they were thinking specifically of people with ALS.

Our friend who used to sit in that chair, Mauril Bélanger, was lost to us so quickly through ALS. My friend, who is losing the ability of speech, is in a chair and has tubes in her stomach that cause enormous pain. She knows that her lungs will give out, so she is emailing me while we are having this debate. I was really relieved to talk to the Minister of Justice and realize that I am reading the bill correctly, that my friend can get the help that is needed to be assessed and be able to say that she wants consent in advance.

However, I do think that there are some areas for amendments that should be made here, and I wish we had more time. I hope the court will give us the additional four months, but we do not know that.

Some of the bogeymen that have been raised here today I think are considered in the bill. We do have the requisite safeguards to keep vulnerable people safe. No one can give permission for medical assistance in dying other than the patients themselves. They still have to meet very tight criteria. They have to have a sworn witness. They have to have a doctor. The bill also provides that on the day of the procedure, if a person indicates that they have changed their mind, they are completely allowed and of course have the right to indicate that they have changed their mind through all sorts of gestures and words, but not through any involuntary gestures. I think the bill is drafted as well as it can be, but we will continue to consider it in the amendments at clause-by-clause consideration.

The bill does continue to ensure that the death is reasonably foreseeable, and there may be some complications there in the language. I note concerns from Dr. Jocelyn Downie at Dalhousie University, who is one of Canada's leading experts in this field, and I want to hear her evidence. I hope that she will be a witness, and I am sure she will be, as well as Dr. Stefanie Green, the president of the Canadian Association of MAID Assessors and Providers. We want to make sure we get the language right.

I will close by thanking the Minister of Justice and the government for following through and hearing the cries of Audrey, from Halifax, that her death be not in vain.