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

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

moved that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the third time and passed.

Mr. Speaker, I want to begin today by acknowledging the contributions of all members of the House, in particular, the members of the Standing Committee on Justice and Human Rights, for how they have approached our debate on Bill C-14.

It is clear that members from all parties have engaged closely with their constituents, members of other parties, and their own experiences to make thoughtful and genuine contributions to our country's conversation on medical assistance in dying. This is one of the most important issues that this Parliament will address.

Bill C-14 represents the government's policy choice to address medical assistance in dying, a choice that is fully informed by consultations with Canadians and experts and takes into account all the interests and values surrounding this matter.

When the Carter decision came down in February 2015, one debate ended and another began. It was no longer a question of whether Canada would permit medical assistance in dying, but rather it was about how our country would do it.

Bill C-14 would create a statutory framework for medical assistance in dying that considers the perspectives of those who may wish to access it; those who are concerned about its consequences, including vulnerable persons who could be put at risk by the legalization of this practice; and those who may be asked to provide the assistance.

While the Carter decision told us that an absolute prohibition in the former law went too far, it did not tell us how medical assistance in dying should be implemented. The Supreme Court of Canada acknowledged that the issue “involves complex issues of social policy and a number of competing societal values”. The court stated that it:

emphasized that there may be a number of possible solutions to a particular social problem, and suggested that a “complex regulatory response” to a social ill will garner a high degree of deference.

The challenge facing Parliament is about setting new boundaries. Who should be eligible for medical assistance in dying; what safeguards should be required; how will it be monitored; and what issues require more study?

A proposed law that answers these questions must comply with the charter, but that does not require replicating the Carter decision. The Supreme Court of Canada has recognized that the relationship between the courts and Parliament should be one of dialogue. Just as Parliament must respect the court's ruling, so too must the court respect Parliament's determination of how to craft a statutory scheme in response to the court's judgment.

It is helpful to know how this dialogue has played out in previous instances. For example, in R. v. O'Connor, a 1995 charter challenge in a sexual assault case, the Supreme Court mandated the disclosure of therapeutic records in the Crown's possession and set out a common law procedure for the production of these records.

In response, Parliament enacted a statutory disclosure regime that differed in significant ways from the court's approach. The court upheld the constitutionality of that statutory regime, noting that it could not be presumed, just because Parliament's scheme looked different from what the court had envisioned, that it was unconstitutional.

Instead, there is this dialogue between the legislative branch and the courts. The court can provide the general parameters for a response, but it is for Parliament to craft the regime. Details of that regime matter because they necessarily engage fundamental choices of our rights and values and reconciling the tensions that sometimes exist between them.

In developing a response to the Carter decision, the government was called on to simultaneously promote autonomy, protect the vulnerable, affirm life, prevent suicide, support persons with disabilities, respect freedom of conscience, and fully consider many other valuable interests. As we went about this, we remained mindful of our constitutional framework and the divided jurisdiction between Parliament and the provinces and territories.

In weighing these values and making these policy choices, we were not alone. In the past number of months the national conversation on medical assistance in dying has been rich and fulsome, and no doubt it will continue.

Following the introduction of Bill C-14, the relevant standing committees of Parliament, including the justice and human rights committee and the Senate legal and constitutional affairs committee, which conducted the pre-study of the bill, have heard diverse perspectives from stakeholders and experts on all aspects of medical assistance in dying. Bill C-14 strikes a balance regarding eligibility and safeguards, as well as setting out what the federal law should do and what should be left to the provinces and territories to regulate.

Not everyone agrees with these policy choices. Still, I am confident that the decisions fall squarely within the range of alternatives that are legally open to Parliament to adopt. It would have been easy for the government to cut and paste the language from the court's decision into a new federal statute, but such an approach would have meant ignoring all the consultations and evidence that I have just referenced. It would also have fallen far short of developing a complex regulatory regime to balance competing interests, which the court said was the task of Parliament to craft and not the courts.

That evidence, presented over the past year, confirms that medical assistance in dying may pose risks to the vulnerable, even in circumstances where there is a general consensus that the person should be eligible for the procedure. That is why the bill provides for significant procedural safeguards, even when all of the eligibility criteria are met. This is why the bill would also put in place the necessary legal framework to monitor how medical assistance in dying is implemented in Canada.

In terms of eligibility, the policy choice made by the government was to focus on persons who are in an advanced state of irreversible decline and whose natural deaths have become reasonably foreseeable.

Recall that medical assistance in dying is exceptional because, from a criminal law perspective, it is a situation where one person actively and knowingly participates in the death of another. We criminalize and strongly condemn this conduct in all other circumstances. The only place in our criminal law where this conduct is justified is in self-defence, where individuals are permitted to take a life but only in order to save their own life or someone else's. While medical assistance in dying has medical and health law aspects to it, we cannot lose sight of this dimension either, because it is the criminal law power that is the primary source of Parliament's jurisdiction to address this issue, and it was the criminal law that, before the Carter decision, stood in the way of medical assistance in dying.

Having given careful consideration to the risks that may be posed when anyone, even a physician or nurse practitioner, is permitted to end another person's life, the balance reflected in Bill C-14 is that medical assistance in dying should be a choice for Canadians about how they die, so that they may have access to a peaceful passing. The bill would create a complex regulatory regime to respect this choice and ensure it is exercised in a voluntary and fully informed manner. Equally, the criteria ensure that, for Canadians who are not declining toward death, the focus of medicine remains on improving life, not ending it.

We also recognize that there are those who believe that the law should permit access to medical assistance in dying in other situations. The government heard these concerns loudly and clearly. The Standing Committee on Justice and Human Rights amended the bill to ensure that one or more independent reviews be initiated within six months of the bill receiving royal assent to further examine issues around the eligibility for mature minors, advance requests, and requests where a mental illness is the sole underlying medical condition.

We welcome this amendment and want to emphasize that we will remain open-minded to the evidence that these reviews gather and as Canadian data begins to be generated on how medical assistance in dying is actually working.

The decision to study these three issues further is supported by people who work with patients day in and day out in these three areas, who have been some of the most prominent voices calling for Parliament to proceed with caution.

With respect to mature minors, the Canadian Paediatric Society, represented by Dawn Davies, testified before the Senate committee that there “is simply not enough information to reach an enlightened decision” on this matter and that “It is appropriate that the first iteration of legislation on physician-assisted death does not include...minors”.

She also stated that there have not been sufficient consultations on this issue. The usual capacity and assessment processes, which Bill C-14 supports as appropriate for adults, may not be the right approach for mature minors. We need to consider this issue further.

Advance requests is another area where additional evidence is needed. We have heard many times over the past year that advance requests are likely to be sought in circumstances where persons are suffering from diseases such as Alzheimer's or dementia, but even the Alzheimer Society of Canada has stated in its public position paper that medical assistance in dying should only be possible when a person is competent at the time the assistance is administered. It says that advance requests not only pose risks to vulnerable patients, but they could also contribute to false stereotypes, undermining its message that it is possible to live well with this disease. Further study on this issue is the right policy.

On mental illness as a sole condition motivating a request for assisted dying, it is not surprising that reputable individuals and organizations, including the Centre for Addiction and Mental Health and the Mental Health Commission of Canada, support further study before legislating in this area. Moving forward in this way does not deny the suffering that these illnesses can cause. Rather, it ensures that we get it right and protect some of the most vulnerable and stigmatized persons in our society. For these reasons, I believe that Bill C-14 represents the right policy choices to answer the difficult questions the Supreme Court of Canada left for us as parliamentarians to resolve for 36 million Canadians.

I will now turn to the legal considerations, which play a crucial role in this seminal piece of legislation.

A consistent area of discussion has been around whether Bill C-14 is constitutional. As the Minister of Justice and Attorney General of Canada, I am of the firm opinion that the bill is consistent with the charter and is a justifiable response to the Carter decision.

Bill C-14's eligibility criteria directly respond to the Carter decision. They clarify the intended scope of eligibility, acknowledging the submission of the Canadian Medical Association, which represents 83,000 physicians who will, with nurse practitioners, be responsible for implementing and applying this law in their daily practice. This organization has stated that the language in the bill is a significant improvement over what it views, from a medical perspective, as the court's unworkable term “grievous and irremediable”.

What was the scope of the Carter decision? I appreciate that there are many differing interpretations of the decision, and I acknowledge that the Alberta Court of Appeal recently read Carter in a broad way, while some judges in the Superior Court of Ontario have read it more narrowly. I believe that the Carter decision was about the factual circumstances of that case. At the end of the day, Bill C-14 will be measured against the charter as a whole and not the Carter case. As the Alberta Court of Appeal recognized, “the interpretation and constitutionality of eventual legislation should obviously wait until the legislation has been enacted”.

Bill C-14 addresses both dimensions of section 7 of the charter, respect for autonomy and respect for life. The bill would strike a new balance between these interests through a comprehensive regulatory regime, which would receive deference from the courts. The proposed law would respect individual autonomy for persons who choose medical assistance in dying, but would do so in a careful manner that preserves other crucial objectives: promoting suicide prevention, preventing social stigma of life with a disability, and protecting society's most vulnerable persons from a risk of premature involuntary death.

While Bill C-14 requires that an eligible person be on a trajectory toward death, the flexibility purposefully built into the bill's criteria would allow medical practitioners to respond to a wide variety of medical circumstances, not just predictable diseases that are subject to fixed prognoses of life left to live.

Indeed, unlike some U.S. state regimes that require a specific prognosis, Bill C-14 does not require a strict relationship between the medical condition and the cause of the person's reasonably foreseeable death.

I do not agree with those who say that the Carter decision means that Parliament is constitutionally mandated to enact one of, if not the broadest, assisted dying regimes in the world, and that Parliament has little scope to consider other societal interests aside from autonomy. The court acknowledged that medically assisted death involved complex issues of social policy in a number of competing interests. In matters of this nature, the charter analysis takes into account the fact that there is no single manifestly correct balance of competing interests that are engaged. Deference will be shown, provided that Parliament's solution falls within the range of reasonable alternatives.

Bill C-14 is reasonable. It would provide people who are in a path towards death a choice that would respect their wish to die with dignity. Equally, it would limit medical assistance in dying to persons in these types of circumstances in order to prevent the normalization of suicide, protect vulnerable persons who were disproportionately at risk of inducement to suicide, and affirm the equal value of every person's life.

This balancing of interests addresses the inherent risks associated with permitting medical assistance in dying, and represents what the trial judge in Carter described as a “carefully-designed system imposing stringent limits that were scrupulously monitored and enforced”. Such a system is necessary because the suffering that can lead someone to request assisted dying does not just come from the condition; it also comes from how our society too often treats people with such conditions.

Under an approach where any serious medical condition is eligible, the law would be saying that an assisted death could be an acceptable treatment for a soldier with post-traumatic stress disorder, a young person who suffered a spinal cord injury in an accident, or a survivor whose mind was haunted by memories of sexual abuse.

These are difficult but necessary situations to talk about, because cases like these are the unavoidable consequence of an assisted dying law where the only limit on eligibility is an individual's subjective experience of suffering.

As both the justice and human rights committee and the senate committee heard from several witnesses, the risk to vulnerable people, as well the crucial objectives of suicide prevention and affirming the value of the lives of all Canadians could be greatly increased unless eligibility was limited to persons who were approaching the end of their lives.

As I said, when Bill C-14 was introduced, assisted dying is a matter that touches us all and challenges us all. Divergent views on the bill remain, but we have a responsibility to act for all Canadians. The interim court approval process ends on June 6. If there is no legislation in place at that time, medical assistance in dying will lack a legal framework outside of the province of Quebec.

There is even uncertainty as to whether the court's remedy in Carter, if it came into force on June 6 in place of a statutory regime, would have the legal effect of completely striking down the existing criminal law that prohibits consensual killings and the aiding of suicides outside of an assisted dying context.

While most medical regulators have published interim guidelines, there would be no mandatory or consistent national safeguards. It could be possible, for example, for a physician to end a mature minor's life, depending on the province. Different jurisdictions require different numbers of witnesses, and some provide no waiting period at all.

Uncertainty around Carter parameters would persist and likely lead to inconsistent results in who would be found to be eligible, even between medical practitioners in the same jurisdictions.

We have a choice: To have a statutory framework in place with all of the national-level safeguards and protections that I have described, or having none. Bill C-14 reflects the kind of society we should aspire to be, one that respects individual autonomy and one that affirms that the lives of all Canadians have inherent value and are equally entitled to the protection of the law.

I call on all members of the House to support Bill C-14.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Mr. Speaker, I want to acknowledge the very difficult balancing act that the Minister of Justice has had to deal with in crafting this very sensitive legislation. The one part that still gives me great cause for concern, and I heard this from 100% of the people in my riding, is that there should be very clear and specific language on the protection of the health conscience rights of our health care providers.

Last night, we turned down what I thought was a very reasoned amendment. I hope the minister could share, very clearly, with Canadians why the Liberals voted against what I and most Canadians believed to absolutely critical.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Mr. Speaker, the conscience rights of medical practitioners is of the utmost importance. In every aspect of the consideration of this legislation, we have taken that into account.

I recognize the work of the justice and human rights committee of the House of Commons, which considered substantive amendments and in fact voted in favour of 16 amendments, including having the conscience rights of medical practitioners in the preamble of the legislation. However, for greater certainty, it voted for an amendment to ensure the conscience rights of medical practitioners was in the body of the legislation. There is nothing in the legislation that would compel a medical practitioner to perform medical assistance in dying.

Beyond that, we and the Minister of Health are working in a concerted way with the provinces and territories to assist them in developing the complex regulatory regime that will be required. That is under way, and that conversation will continue.

[Robert Aubin, NDP, Trois-Rivières, QC]

Mr. Speaker, I paid close attention to the minister's speech.

Over the past few weeks, every time we have had the rare opportunity to talk about this particularly important bill, the same issue has come up repeatedly: the Supreme Court's June 6 deadline. Now, even government MPs, including the Minister of Health, are starting to say that the June 6 deadline is hardly a sure thing. Leading senators have said so too.

I should point out that we are operating under time allocation, which means that only three members of my party will have a chance to debate this bill at third reading.

What seems to be the minister's priority right now? Meeting the June 6 deadline, which seems highly unlikely, or building the broadest possible consensus among members of the House, which would likely smooth the way in the Senate as well?

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Mr. Speaker, first, there has been substantive debate on this topic. This has been a national conversation and it has been under way for many months.

I and the government have the utmost respect for the Supreme Court of Canada and the June 6 deadline that it has imposed. We are doing everything we can to ensure we meet that deadline. Certainly there are risks, but the risks are greater if we do not have a legal framework for medical assistance in dying in place by the Supreme Court of Canada's deadline.

If we do not have a legal framework in place, there would be no ability for an individual to apply to a superior court to seek an individual exemption. There would not be the substantive safeguards in place that the Supreme Court in the Carter instructed Parliament to put in place. As well, there would be no certainty for medical practitioners and access would remain uncertain for patients wishing to have medical assistance in dying. It would be irresponsible for us as parliamentarians not to do everything we can to ensure we meet the June 6 deadline.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, the minister never answered my question. She invited us to debate the issue, but when there is a debate, we would expect a majority government to accept some amendments.

The minister referred to the Quebec legislation. Surely she knows that, as it is currently written, the Quebec law excludes all requests for assisted suicide and forces ineligible people to resort to hunger strikes.

Is the minister's bill also along those lines? Does she believe it is acceptable and humane for a person to have to go on a hunger strike to be able to access medical assistance in dying? How would this bill have made Kay Carter eligible to receive that assistance?

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Mr. Speaker, in terms of amendments, 16 have been made to Bill C-14, which have strengthened the proposed legislation with respect to seeking to draw the balance between personal autonomy with protection of the vulnerable and ensuring that we do as much as we can to protect the conscience rights of medical practitioners.

I recognize the member's multiple submissions to the House on this legislation. I also recognize the tremendous experience of years of discussions that the province of Quebec has had with respect to putting in place its own laws.

With respect to Kay Carter, I am absolutely certain that Ms. Carter would qualify under the eligibility regime as presented in Bill C-14. We specifically ensured that we provided a broader definition around what grievous and irremediable meant and we put in place eligibility criteria that would ensure there would be flexibility in our regime and provide medical practitioners with the ability to engage with their patients. They are the most familiar with their patients and by virtue of that relationship can determine whether there is eligibility or not.

[Ken Hardie, Liberal, Fleetwood—Port Kells, BC]

Mr. Speaker, this is a question on behalf of one of my constituents who recognizes the efforts made to ensure that medical practitioners have the freedom of conscience to not participate in this process. My constituent wonders if that protection extends to the right not to refer somebody to someone who is prepared to permit the procedure to go ahead.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Mr. Speaker, I have addressed the issue of conscience rights of medical practitioners by recognizing those rights in the preamble and within the body of our legislation. Also, I further acknowledged that the Minister of Health would be working with the provincial and territorial professional organizations to respect the rights of medical practitioners and to move away from an effective referral and put in place a system that would work with their provinces and territories, and the medical regulators to respect the individual choices of medical practitioners. In addition, we will work to put in place a system wherein we could provide information to those patients who are looking for medical assistance in dying, not imposing something on a medical practitioner. However, that is the relationship with the provincial regulators.

[John Barlow, Conservative, Foothills, AB]

Mr. Speaker, I, too, want to acknowledge the work the justice minister and the committee have done on this legislation. I know how difficult this has been, given the timelines. I appreciate the amendments brought forward by the Conservative members on that committee and the fact that they have listened to the concerns of Canadians and have addressed some of them.

However, the one issue I have heard at the town halls and the feedback I have received from my constituents is on the framework for a strategy on palliative care, which is one of the recommendations of the joint committee study. There is no funding in the 2016 budget for palliative care. We tried to put an amendment through last night, which was voted down. What is the long-term plan for palliative care? Will there be funding and is this something to which the Liberals will commit?

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Mr. Speaker, certainly I would defer these very important questions to the Minister of Health. However, I know that in speaking and working with her throughout the course of the development of this legislation, in every town hall I have been at and every meeting I have had with organizations, individuals, or through the recommendations that have come out of the number of panels, palliative care has been a primary importance to Canadians. It is a primary importance to the Minister of Health, myself, and our government.

The Minister of Health has ensured and committed that while working with the provinces and territories in the renewal of the health accord, we will ensure there are provisions in place to ensure that every Canadian, no matter where one lives right across the country, has access to palliative care. The Minister of Health has made that commitment.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I would like to begin by asking for consent to share my time with the member for Cariboo—Prince George.

[The Deputy Speaker, Bruce Stanton]

Does the hon. member for Langley—Aldergrove have the unanimous consent of the House to split his time?

[Some hon. members]

Agreed.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I want to thank the Minister of Justice for being here today to speak in the House and for sharing her perspective and the government's perspective on Bill C-14. I found her to be always available and very thoughtful, and I thank her for her involvement.

I have been honoured to be part of the joint committee that dealt with the bill starting in January. I was also part of the justice committee when Bill C-14 was sent there. As the minister said, the opinions on this issue of assisted suicide are very diverse. Within each of the parties it is very diverse. However, I want to thank all members of Parliament for being respectful and working together on this important issue.

We are dealing with this issue because of the Carter decision. The Supreme Court said in the Carter decision that this must be allowed. The Criminal Code will be amended, and it is up to Parliament to come up with safeguards, not that this is permitted. However, the Supreme Court decided that we are to create safeguards.

We have also heard that 84% of Canadians want this. However, that statement that we have often heard is a little misleading, because 84% of Canadians do support this under certain criteria, and that criteria is that the illness is terminal, and the person is suffering terribly and repeatedly asks to have assisted suicide to end their suffering. Therefore, it is important to remember that it is under certain conditions.

I have consulted with my constituents on this issue. I sent out a householder, and I was very thorough and non-partisan. The householder I sent out provided a background and laid out all the different issues that Parliament is having to deal with: conscience protection, palliative care, who can provide this service, should there be judicial oversight, should the cause of death be listed for data collection as assisted suicide or euthanasia, mature minors, and on and on.

I had response to this householder, and one week ago, I had our second town hall meeting on this. In both cases, we had a huge response from the constituents. Actually, we have had more of a response to this issue through emails, phone calls, letters, and responses to the householder. We have had more responses on this than on any other issue in the last 12 and a half years that I have been a member of Parliament. People are very engaged and understand what the issues are and the challenges that the House faces.

Again, I thank the Minister of Justice, but as a critique, I think the government could have approached this a little differently, instead of dominating the committee structures, instead of bringing in time allocation, and instead of saying no to all the amendments.

The minister spoke about the 16 amendments, which, of course, were Liberal amendments. Of the amendments, there was one that the Conservative Party and the NDP at committee agreed with, and that was on conscience protection. We asked that all physicians, health care professionals, nurse practitioners, pharmacists, or anybody who is a health care professional who does not want to be involved with this have the right to say no. However, the government turned down that amendment.

The fact is, the parliamentary secretaries in the committee talked to each of the members on that committee and told them that the Liberals were not going to support that. Then the parliamentary secretary of justice actually spoke at the committee and said that the government did not support amending like that.

As the Minister of Justice just said, the government is going to leave it to negotiating with the provinces, and download that responsibility to the provinces. However, what we are doing in Bill C-14 is amending the Criminal Code of Canada. Prior to the Carter decision, it was illegal to assist anybody in a suicide. It was legal to commit suicide but illegal to assist somebody. It was considered homicide if someone assisted somebody.

Under the Carter decision a physician can, under certain conditions, provide assistance in a suicide and euthanasia. That amendment to the Criminal Code also could be elaborated on to say that it would be a criminal offence to force health care professionals or any individuals through coercion or intimidation, to participate in the death of another individual against their will. That is what we suggested.

When Bill C-14 gets referred to the Senate it will have to deal with it. I believe the Senate will refer this legislation back to the House. It is going to refuse to accept Bill C-14 the way it is and it will provide proper conscience protection for physicians.

We heard from the Canadian Medical Association that 70% of physicians in Canada do not want to be a part of this. They do not want to be forced through coercion, intimidation, or threats that they will no longer be able to practise at this or that hospital if they do not participate.

In a National Post article called “'Killing' patients vs. 'doing their job': Sharp division of opinion on whether doctors should be required to assist in suicide”, a doctor says she has been practising medicine for 37 years. The family doctor has decided not to renew her medical licence in June of this year. Dr. Naylor has no desire to quit medicine but she says she is appalled at the thought of being forced to refer. Dr. Burke, who practises physical medicine and rehabilitation in Windsor Ontario, said he is renewing his medical licence in Michigan where assisted suicide is illegal.

I have heard this at town hall meetings across the country and at the two I had in my own community. A young medical student asked me if physicians were going to be forced to do this and I said that there is a good possibility because in Bill C-14 the government is leaving it up to the provinces. We have already heard that the College of Physicians and Surgeons of Ontario will require physicians to effectively refer, which means that a doctor must follow that person through the whole process to make sure he or she does get euthanized if that is what the individual requested. The doctor must participate.

Physicians across this country, like those I just mentioned, are going to refuse to participate, saying they are now of retirement age and will retire or will relocate to another jurisdiction where they will not be forced to be a part of this, which goes against their conscience. A shortage of physicians and nurses will create a medical emergency in Canada. We will have a shortage of physicians and nurses in Canada because they will be forced to participate in something that goes against their conscience.

The government has an opportunity to do the right thing. It refused to do it in the House so it will be left to the Senate. The Senate will decide and it will amend Bill C-14. It will come back to the House in an amended form. We do not know how long that will take but it is obvious that the June 6 deadline will not be met. I hope the government will play differently then and will co-operate with the Senate and not strike down its amendments.

It is better to have Bill C-14 than nothing but it does need to be amended. The government needs to be more open-minded and congenial and work within this parliamentary environment and come up with legislation that represents where Canadians are at on this issue, not where the government is at.

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

Mr. Speaker, we recognize at the outset why we have this legislation. This legislation is the result of a Supreme Court of Canada decision that was unanimous by all nine judges. The decision sets out the legal framework.

We have talked a great deal about the importance of palliative care, an issue that is really important to all Canadians. We have talked about investing in palliative care.

I am a bit concerned with regard to some of the issues that the member has raised. I have been a parliamentarian for many years and here in Ottawa for five years. There have been ample opportunities for members to debate this issue, such as extended sitting hours into the evening. This would have afforded more people the opportunity to have that debate. There have been all sorts of other opportunities.

Does the member believe that there is an obligation on the part of members of Parliament to deal with this issue given the Supreme Court of Canada's decision and its June 6 deadline?

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I agree with the member that there is an obligation to do what we can to see this legislation passed. I wish the government would have asked for a year, not six months. It took Quebec six years and three premiers to come up with this. The government rushed this through and botched it.

The member referred to the time allocation motions to exhaust debate on this. Instead of co-operating and working within Parliament in a proper way by respecting one another and respecting the diverse opinions on it, the government tried to force this, and that has backfired on it. Hopefully, from this point it will co-operate and work with Parliament in a congenial way.

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

Mr. Speaker, I would like to ask my hon. colleague this with respect to the response that he just gave to the member across the way. Would he agree that it makes more sense in terms of the deadline to get this done right? We have rushed this through. It is obviously faulty. As there are still so many opinions at this point on the eve of voting, that is problematic. Would he agree that it would have made more sense to refer this bill back to the Supreme Court and get some clarity on its constitutionality, that we need do this right and not have June 6 leaning over us in a looming way but more as a target, a goal? What we really need to do is to get it right. Would he not agree that the Supreme Court can really play a role in some meaningful development on this bill?

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I agree that June 6 is a date that is not likely to be reached, and that the government should be asking for an extension. It should have asked for a longer period of time from the get-go.

We need to do this right. To rush it and get it wrong is not in the interest of protecting the vulnerable Canadians who would be considering assisted suicide.

I think there is an environment, an appetite, for us to work together to get this done right. If the government wants to bully this through and no matter what happens get it done by June 6, that will not happen.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Mr. Speaker, I would like to congratulate my colleague on his thoughtful speech.

We have heard the response by the minister with respect to the June 6 deadline. I would like to hear other or better answers with respect to that time frame. Therefore, I would ask the hon. member what he thinks will happen if we do not have a law in place by June 6.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, that is the salient question: what happens on June 6? I asked for a report from the Library of Parliament. It said that it will be the Carter decision and that it will be applied differently across Canada. In each province it will be the College of Physicians and Surgeons that will determine that. In Ontario, it will be required by physicians whereas in some provinces it will not be. In some provinces the provincial government will be engaged and in others it may not. Therefore, we will have a hodgepodge of how this will be applied across Canada. That is not in the interests of Canadians. Therefore, we need to pass this. Legislation is required. The problem is that Bill C-14 needs to be amended. It has some big holes in it. I hope the government will co-operate and listen to members of the opposition and listen to Canadians and fix Bill C-14.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, I rise on a point of order. Earlier today, under tabling of documents, I indicated that the government was responding to 10 petitions. However, I should have said 11 petitions.

[The Deputy Speaker, Bruce Stanton]

I am sure the House appreciates the clarification on the part of the parliamentary secretary, and that he has brought it to the attention of the House at the first instance.

Resuming debate, the hon. member for Cariboo—Prince George.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, I rise in the House today to speak on an issue that may very well be one of the most significant, important social issues that this Parliament, in the life of this government, will ever face. This is not a matter that I take lightly, the issue of life or death.

Over the last few months, I have had the opportunity to speak with constituents in my riding. I have read the letters and emails they have written in. I have consulted with spiritual leaders from many faiths in the communities within my riding. I have sat through every single minute of this debate, because the magnitude of the legislation is something that deserves our thoughtful consideration. It is also something that has been weighing heavily on me, because regardless of my personal beliefs, I represent the tens of thousands of friends and families in the beautiful riding of Cariboo—Prince George.

For years I have worked toward my dream of becoming a member of Parliament, because I knew this opportunity would afford me the chance to make a difference, to be part of meaningful change, and to leave our country better for generations to come, but nothing truly prepares one to vote on a piece of legislation of this magnitude.

I am at the age and the point in my life where, unfortunately, I have seen my fair share of human suffering. It is a true test of humans to watch a loved one, a friend, or even a stranger, who is faced with intolerable suffering with no hope of recovery.

It is a reality that physician-assisted suicide will indeed become law. This we know is true. In 2015, the Supreme Court of Canada issued a landmark ruling in Carter v. Canada, stating that the laws preventing Kay Carter from ending her life in Canada were contrary to the Charter of Rights and Freedoms.

Kay Carter was a schoolteacher, a wife, and a mother. She was suffering from severe spinal stenosis, a disease that was making it impossible for her to move her body. She was 89, and because medical assistance in dying was illegal in Canada, Carter and her family travelled to a Swiss medical clinic, where she chose to end her life in 2010.

It is not in dispute that Carter was faced with intolerable suffering, but Carter's family and their lawyer have publicly stated that they believe that Kay Carter would have been ineligible for medical assistance in dying under Bill C-14. Therefore, my question for my colleagues across the floor is this. If this legislation was built to address the decision of Carter v. Canada, then why would it likely exclude the very case that opened the door for physician-assisted suicide in our country?

Many have expressed their concerns that this legislation is unconstitutional. Benoît Pelletier, a professor from the University of Ottawa, appeared before the special committee tasked with studying assisted suicide. He said that people suffering with illnesses that are terminal or cause intolerable suffering are at risk of being encouraged to seek an assisted death. He also said:

...all persons are potentially vulnerable. Being vulnerable does not disqualify a person...from seeking an assisted death, but it does put that person at risk of being induced to request a death....

This is among the most troubling testimony. Beyond legal implications, the opposition to Bill C-14 crosses party lines. We have heard from Conservative, Liberal, and NDP members, as well as concerned senators, multiple witnesses, and organizations such as the B.C. Civil Liberties Association, the Alberta Court of Appeal, and the Canadian Bar Association. At the core of our democracy is the ability to have thoughtful debate and discussion on a wide range of issues. Some of these issues are easier to address than others. Sometimes there is a unanimous consensus, and sometimes there is not.

We need to acknowledge in cases where there is not consensus that more work needs to be done, amendments need to be considered, and a majority control of the House should not be used to thwart dissenting opinions, especially on an issue of this scope and magnitude.

Dealing with the sanctity of life and death should be cause for more consultation, more discussion, and more debate than that over a pipeline or a budget. We have debated this for approximately 20 hours. Over half of the Conservative caucus has not had the opportunity to debate this subject. Even more of my Liberal colleagues have not had the opportunity to speak on this. It is concerning to me that on a piece of legislation of this magnitude, my Liberal colleagues have not had the opportunity to speak on this. It would appear from the outset that perhaps the Liberal backbenches are, indeed, being muzzled on this important piece of legislation.

Quebec took six years in successive legislative assemblies to develop its physician-assisted suicide law, six years of consultations and commitment to ensure its bill was not just good enough but one that captured most, if not all, concerns and safeguards.

Time and again, we have heard it is good enough at this point. To me, good enough is not good enough when we are talking about life and death. I am a firm believer that it is better to miss a deadline than to get such an impactful piece of public policy wrong. This piece of legislation is likely the most important law in our generation.

The Liberal government should allow all members to speak on behalf of their constituents and engage in further necessary consultations in order to get the legislation right, because the alternative is passing a deeply flawed and in my opinion unconstitutional piece of legislation. Passing Bill C-14 in this manner will result in court challenges that will further deadlock the work of the House and parliamentarians in having a workable document that protects the most vulnerable members of society from abuse.

The debate on assisted suicide over the last few months has opened the door to some of the alternatives that also need to be considered when speaking about Bill C-14. Palliative care is a critical component of this issue. We must always ensure that a proper palliative care strategy is in place. While the government likes to talk about this being core and an important piece in its budget and in moving forward, it has not even been mentioned once in the most current budget.

To ensure that individuals are well informed about their end-of-life options not only physically but to deal with their emotions, palliative care needs to be a viable end-of-life choice. At a time when assisted dying is a hotly contested issue, it is important to engage in conversations around palliative care to ensure that people are making the best decisions to improve their quality of life. We need to protect our most vulnerable.

As I mentioned previously during this debate, I am a father of a mature child who is cognitively challenged. While a healthy and productive member of the community, who I am extremely proud of, my daughter could not, today, make an informed consent, let alone if she was dealing with a grievous and terminal disease.

We also need to consider the medical professionals, the doctors and nurses, who went into their chosen fields to save lives, to improve lives, to ensure that lives are not lost and continue to be healthy. We need to ensure that these individuals are also protected and that the responsibility for this is not downloaded to the provinces. We need to ensure that this piece of legislation does not become a vehicle for those suffering with mental health issues to end their pain or that physician-assisted suicide is not chosen or forced due to obligation or feelings of burden.

Catherine Frazee, professor emerita at the school of disability studies at Ryerson University, said it best when she stated:

At the heart of this debate, we must choose between competing visions of our social fabric. Shall we uncritically submit to the voracious demands of individual liberty no matter what the social cost? Or shall we agree that there are limits to individual freedom, limits that serve all of us when we are vulnerable and in decline?

When we start deconstructing the foundation upon which our society is built, the social fabric, we need to ensure that proper safeguards are in place, a system of checks and balances. This system is not built overnight and it is not built through a limited debate and time allocation. It is built through listening, learning, and acknowledging a wide variety of viewpoints, stories, and opinions, through co-operation and thoughtful analysis and acceptance of amendments, none of which seem to be in line with the Liberal government's priorities.

I would like to thank our colleagues from all sides who have shared their experiences with us over the course of this debate. I appreciate each and every one of their views and their openness in sharing these deeply personal experiences, and I thank those in my riding of Cariboo—Prince George, the countless numbers, who have shared with me their views and experiences.

I would also like to thank the members of the committee who worked tirelessly towards a solution. I thank each of them for taking the time to voice their feelings on this important piece of legislation.

For the reasons I stated throughout my speech, I will not be able to support Bill C-14 as it currently stands.

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

Mr. Speaker, if I may, I will just add on to that in expressing our gratitude and appreciation to the many individuals who were involved in getting us to where we are today, including the joint standing committee between the Senate and the House, and the members of the committee who studied it after second reading.

We recognize the many hours of discussion and debate, and presentations from individuals from different regions of the country. Canadians have been afforded, through their elected officials, over the last year, the opportunity to get in touch with and to talk with individuals, members of Parliament, and other stakeholders who put in a great deal of effort.

I believe that the member will not be disappointed in the long run, and that he will find that the legislation is in fact charter proof. It will set that legal framework, and at the end of the day it will be an asset, in terms of going forward to ensure that the right thing is done on this very important issue.

Would the member not acknowledge that at the very least there has been a great deal of input into the creation of the legislation? The member would know since January of last year there has been a great deal of discussion on this issue.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, my comments are not meant to diminish the work that was done by the committee in getting the bill to where we are today. Obviously this is a topic that is hotly contested.

My concern is there are 338 members of Parliament who were elected to be the voices of their constituents, the voices of Canadians from coast to coast to coast. We have had approximately 20 hours of debate. We have had time allocation. We are again debating a bill, discussing a piece of legislation, the most important piece of legislation that our generation will see, and there are dissenting feelings and expressions of concern from all sides.

Over half of our caucus on this side has not had the opportunity to speak to this. I would hazard a guess that even more on the government side have not had the opportunity to voice their true concerns on this important piece of legislation.

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

Mr. Speaker, I would like to ask my colleague a question in light of so much wasted opportunity to discuss and really develop a meaningful piece of legislation that all of us could have an opportunity to weigh in on.

I really want to hear a little more about the importance of a palliative care strategy. I found it appalling that we were introducing the bill with such a lack of information. It was almost insensitive that we would be discussing something like Bill C-14 without any real, meaningful, tangible information regarding not just palliative care but enforcing the Canada Health Act in terms of home care.

I wonder if the member could expand on what some of the real tangible actions would be in a palliative care strategy that he would like to see happen in light of this.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, the government has talked about its palliative care strategy and how it is a key component of the bill. In reality, there was no mention of palliative care or increased spending for palliative care in budget 2016. It has been brought up time and time again.

I am a firm believer that we must do everything in our power to ensure that those who are suffering are made comfortable, and that those who are at their end of life are also given and afforded the necessities of life, in terms of making sure their end of life is as comfortable as possible.

The challenge I have with the government is that it has not put any money towards that. It is an afterthought. Furthermore, it is downloading the responsibility to the provincial governments to qualify, to make sure that they are looking after conscience protection of medical professionals, and not only that, we also know that the palliative responsibilities are going to fall to provincial entities.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I am honoured today to speak to Bill C-14 at third reading.

Four months ago, I walked into the first meeting of a special House and Senate committee, created to advise the government on its response to the Supreme Court of Canada's decision in the Carter case. We worked long hours and late nights, respectfully and constructively with all parties and involving both chambers. We heard from witnesses and experts from across Canada and from all walks of life.

As we worked, I know that many of us thought of those who had struggled and suffered for the right to control their own lives at the end: people like Sue Rodriguez, who died in 1994 after losing her battle with ALS and losing her battle in the Supreme Court of Canada a year before. I recognized important contributors like Svend Robinson, member of Parliament, in that earlier battle. I think of people like Kay and Lee Carter, Hollis Johnson, William Shoichet, and Gloria Taylor, who fought valiantly and won in the court last year.

The work of the Special Joint Committee on Physician-Assisted Dying proved that a thoughtful and respectful debate was possible, but more than that it proved that a well-crafted bill could win the support of all parties and members of both Houses. I say that because a broad majority of us from all parties and both chambers agreed on 21 recommendations to the current government. I never imagined that I would be standing here now to oppose this bill.

This government bill ignores or rejects the majority of recommendations of that joint House and Senate committee. I am proud of those recommendations. It is true that many would have required great political courage, but all of them faithfully followed the evidence we received from the majority of experts who appeared before us. For example, I sought to have advance requests accepted by people who may lose the ability to provide competent consent at the end. The vast majority of Canadians told us that they want that. However, not only does this bill reject those recommendations, the bill would defy the Supreme Court ruling, fall short of its requirements, and therefore would violate the Charter of Rights and Freedoms for suffering Canadians.

That is the opinion of the Canadian Bar Association, the Barreau du Québec, and many others. That was the ruling of the Alberta Court of Appeal a couple of weeks ago, and just days ago, a court in Ontario echoed the Alberta decision. Justice Paul Perell of the Ontario Superior Court of Justice ruled that the Supreme Court's basis for an assisted death “is the threat the medical condition poses to a person's life and its interference with the quality of that person's life”. He went on to say, “There is no requirement...that a medical condition be terminal or life threatening.”

Despite this, time and again the current government has limited debate and tried to strong-arm a flawed bill through this chamber.

To be sure, this is a complex and sensitive issue, but not a partisan one. The Supreme Court has given us as parliamentarians an opportunity, not an ultimatum, to craft legislation that is consistent with the Carter decision. As is so often the case in this debate, we ought to look at exactly what the court said. Here is what they said, in paragraph 126 of the decision, “It is for Parliament and the provincial legislatures to respond, should they so choose, by enacting legislation consistent with the constitutional parameters set out in these reasons.”

Today the Minister of Justice again suggested that the court instructed us to enact a bill by a particular date. The court said the opposite. Each of us as parliamentarians, facing a free vote, has a simple question to answer: Does this bill obey the constitutional parameters set out by the Supreme Court in Carter? In my submission, that is the only question. If it does not, if it fails that test, then this House is being asked to knowingly infringe the charter rights of suffering Canadians and to enshrine that violation in law.

The Supreme Court of Canada established that all adult competent Canadians suffering intolerably from a grievous and irremediable medical condition have the right to choose assistance in dying. The government would have us honour that right only for patients nearing the end of life.

The Canadian Bar Association has said that such a restriction does not meet the floor of rights established by the court. The Barreau du Québec has said the same, and so has the Canadian Council of Criminal Defence Lawyers, the BC Civil Liberties Association, and many other respected legal organizations.

I suggested removing this line to help the bill comply with the court and the charter, but that idea was rejected by the Liberal majority. Now the Alberta Court of Appeal has ruled unanimously that the government's interpretation of Carter is simply wrong. In a crucial decision that the court wrote a couple of weeks ago, it said:

Carter 2015 does not require that the applicant be terminally ill.... The decision itself is clear. [...] The interpretation urged on us by [the Department of Justice] is not sustainable having regard to the fundamental premise of the Carter case itself....

This is a devastating indictment of the very argument that the government has relied upon to defend Bill C-14 against this rising chorus of critics. Surely that ruling should give us all pause. However, still some will argue that the Supreme Court cannot be obeyed right away, that medical reality dictates a balanced approach.

The government's restrictions have raised eyebrows in the medical community as well. The federation representing every medical regulatory authority in Canada has called this bill's end-to-life requirement “too vague to be understood or applied by the medical profession and too ambiguous to be regulated effectively”.

The College of Physicians and Surgeons of Ontario called it inconsistent with Carter and likely to cause confusion among physicians. The Canadian Nurses Association suggested going back to the words of the Supreme Court, as I have done in this place. If that were done, this controversial line could simply be deleted. I proposed doing exactly that, and my amendments were rejected by the Liberal majority on the Standing Committee on Justice and Human Rights.

Not only are medical groups concerned about the bill, many were not even consulted. According to testimony in the Senate, neither the Federation of Medical Regulatory Authorities of Canada nor any of the provincial or territorial colleges were consulted in the drafting of the bill.

We have a bill in which a few key lines have drawn heavy fire from both the legal and medical communities. These lines could be written on a napkin. They could easily be deleted, as my amendments would have done, and replaced with the exact words of our Supreme Court. Who could resist and oppose that in good faith? However, the government has refused precisely to do that.

On the first day of committee hearings, a Liberal member asked the Minister of Justice a simple question: “Have we sought outside counsel to ensure charter compliance of this bill?” The minister chose not to answer, citing only her personal confidence in the bill. Clearly, no independent confirmation of its charter compliance has been found.

I appreciate what the minister told this House recently, that no one has a monopoly on interpreting the charter. Of course, the minister is right, but I am afraid that the outlier here is not the critics; it is the government. The Canadian and Quebec bar associations, eminent legal and medical experts, the lead counsel in Carter, all are saying that the bill does not obey the Supreme Court of Canada's ruling.

Against that array, the government stands almost alone, brandishing a backgrounder from the Department of Justice and refusing to refer the question to the Supreme Court, or even to obtain an independent legal opinion.

Now the Alberta Court of Appeal has unanimously rejected the government's argument that the Supreme Court limited its ruling to end-of-life patients. Let me repeat: A provincial court of appeal has already ruled that the government's narrow and selective reading of Carter, the legal argument that supports this bill, is not consistent with the Supreme Court's ruling and therefore infringes a patient's charter rights.

Now we are being asked to enshrine that violation in law, and with what justification? No argument has been made for the bill's compliance with Carter and the charter. The minister is right that Bill C-14's many critics cannot simply assert that the bill is not constitutional, but neither can the government simply assert that it is. No one can claim to know the inner thoughts of our Supreme Court justices, but neither can the government continue to suggest that the intention of their ruling is somehow opaque or unknowable. The ruling was not an ink blot test, it was quite clear. The court was looking at the law with the same objective as the bill, to protect specific vulnerable individuals suffering during moments of weakness. The court found that the previous ban was overbroad because it caught people outside of that class, competent people who were not vulnerable and therefore deserved to have their autonomy respected.

That would remain true under Bill C-14. An entire class of competent adult Canadians would be condemned to intolerable suffering and denied recourse to assistance in dying. They may be forced to end their lives prematurely or violently. These are the same violations of section 7 rights identified already by the court in Carter. Although the court in Carter did not choose to proceed to an analysis of a section 15 infringement, the equality rights provision, the trial judge did. She concluded that the prohibition “imposed a disproportionate burden on persons with physical disabilities, as only they are restricted to self-imposed starvation and dehydration in order to take their own lives”.

As Quebec's minister of health warned us when he spoke out against the bill, this is precisely the same cruel option that will soon face patients if Bill C-14's end-of-life clause is not deleted. It is shameful that the bill leaves suffering Canadians in that cruel position.

At committee, I pressed the Department of Justice on this point. I told them the story of Tony Nicklinson. This story comes from an affidavit filed in the Carter case. During a business trip to Athens, Mr. Nicklinson suffered a severe stroke that caused what is called locked-in syndrome. In this state, he could not move a single muscle of his body except his eyelids. His healthy active mind was trapped in an unresponsive body, without remedy, without hope, and perhaps for decades more. He said he could not even drink and smoke in the hopes of shortening his life. Mr. Nicklinson wrote this in an affidavit, one blink at a time. He told the court this:

The flaw in the argument is the assumption that we all want to live whatever the cost in terms of quality of life when this is clearly not the case. I want to make that choice for myself. What prevents me is the fact that I am too disabled to take my own life and unlike an able bodied person I need help to die.

By all means protect the vulnerable (by vulnerable I mean those who cannot make decisions for themselves,) just don't include me. I am not vulnerable. I don't need help or protection from death or from those who would help me - if the legal consequences were not so huge....

I am asking for my right to choose when and how to die to be respected. I know that many people feel that they will have failed if someone like me takes his own life and that life is sacred at all costs. I do not agree with that view. Surely the right and decent thing to do would be to empower people so that they can make the choice for themselves.

Mr. Nicklinson did not live in a place which empowered him to make that choice. He did not have the option of medical assistance to die peacefully, and so he starved himself to death. If he were alive today, Bill C-14 would offer him no hope, no respect for his autonomy.

This is the point I made to the Department of Justice. I was told that I was wrong. I was told that Mr. Nicklinson would not have to starve himself to death in Canada. He would just have to starve until a doctor declared his life “reasonably foreseeable”. Those are the words used in Bill C-14.

This is what we are talking about when we say that the bill infringes on the Charter of Rights and Freedoms for Canadians. Quebec's minister of health warned the government that the bill would force competent, consenting patients to endure starvation to win from the current government the rights that were already granted to them in the Carter case.

The court found the previous ban unconstitutional, not only because it violated the rights of competent patients but also because it was unnecessary. A better system was possible. Vulnerability, it said, could be assessed on an individual basis, and well-designed safeguards are capable of protecting the vulnerable. With these facts, the court could see no justification for continuing to deny the autonomy of whole classes of competent patients, like Mr. Nicklinson.

There is still no justification. In fact, the last refuge for the government would be to accept what is now clear, that Bill C-14 does not meet the test of the Supreme Court, and to argue that somehow it is necessary to violate the charter or even wise, because the safeguards the Liberals have developed are too weak to handle more complex cases. The bill is flawed, and I cannot accept that argument.

I was proud to serve on the joint House-Senate committee that offered recommendations to the government before the drafting of Bill C-14. We studied best practices around the world and recommended many of the robust safeguards found in the bill. Above all, I have great confidence in the care and professionalism of Canadian medical practitioners, and so I cannot accept that the Supreme Court was wrong in saying that well-designed safeguards can protect vulnerable people. I cannot accept that this regime is so weak—or Canadian doctors so careless—that it cannot be trusted to faithfully uphold the full charter rights of patients and to filter out those who are not able to make this choice.

Therefore, I am left with a simple conclusion. Enacting the bill would revoke from an entire class of competent and suffering adult Canadians the rights established for them by the Supreme Court. It would do so in a manner that is neither medically necessary nor legally justified.

I have sought to amend the bill and have seen those solutions rejected. I have requested independent constitutional analysis, and found none. I have called on the government to refer it to the Supreme Court of Canada, and it has not. Now I cannot, as a lawyer and a parliamentarian, support the enactment of a law that I believe would be unconstitutional from the outset. To vote for Bill C-14, against the charter rights of suffering patients—and I know some of them by name—I cannot do.

The government may try to excuse the bill's imperfections as inevitable in the circumstances, and I know there are members here who recognize that the bill is flawed but have been told they simply have to pass it by June 6.

Let us be clear about what happens on June 6. The absolute ban on medically assisted dying will not be restored, nor will the offences that prevented it, such as aiding suicide, disappear from the code. In other words, crime will not become legal, nor will medical assistance in dying become illegal. Rather, an exemption will open for patients and physicians acting within the parameters of the Carter decision. Of course, every provincial regulator has made rules to deal with safeguards over the last year anyway. They are ready to go. A federal law is not necessary to provide basic access and safeguards.

I call on my colleagues across the aisle, with whom I have worked constructively and collaboratively, to give real meaning to this free vote, to prove by their example what Canadians know to be true, that the final word on our constitutional rights comes not from the PMO but from the Supreme Court of Canada.

I move:

That the motion be amended by deleting all the words after the word “That” and substituting the following:

“Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be not now read a third time but be referred back to the Standing Committee on Justice and Human Rights for the purpose of reconsidering Clause 3 with a view to ensuring that the eligibility criteria contained therein are consistent with the constitutional parameters set out by the Supreme Court in its Carter v. Canada decision.”

[The Deputy Speaker, Bruce Stanton]

The amendment is admissible.

Questions and comments, the hon. parliamentary secretary to the government House leader.

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

Mr. Speaker, I must say that I am disappointed that the member has chosen to move yet another amendment. It has become very clear that there are many members of the House who would rather not have legislation in place, the legal framework. I would suggest that, if we were to follow the will of those individuals, there would be a legal vacuum in Canada, where the most vulnerable individuals would be put into compromised positions. It would be unfortunate.

I listened very closely to what the member was talking about, and I disagree. With the Supreme Court decision, there is a role for Ottawa and the provinces.

My question is this. Why does the member choose to believe it is better to have a legal vacuum than to have a legal framework? Would he not agree that there are going to be more people in vulnerable positions because of that vacuum?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I thank the parliamentary secretary for his perspective on this, and I am sorry he is disappointed. We are trying to do our best for Canadians to get a bill in place that will not find suffering Canadians lined up at the Supreme Court doorstep as soon as we pass it. That is why we are doing this, and we hope people will support that initiative.

To talk about a legal vacuum is misleading, with great respect. We already have every college of physicians and surgeons across the land involved in having safeguards in place. Yes, having Bill C-14 on June 6 would be preferable to not having Bill C-14 on June 6, but having knowingly passed a law that is unconstitutional would be even worse. Let us take the time, I say, to get it right, not to get it done right now.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, I would really like to thank the member for Victoria for what was a very substantive speech. It is rare in the House, although we all like to speak out, that we hear a member basically pull apart the government's arguments on assisted dying and put forward, as the member for Victoria has, the real reasons the government has so badly botched what should have been a non-partisan approach to the bill, which should have involved all members of Parliament. Instead, the government has been so clearly partisan that it has risked the actual objective of the bill to accomplish some sort of legislative framework and risked having it put in place.

I would like to ask the member for Victoria a question. He spoke very eloquently to the uncertainty that is created by this bill being rammed through the House of Commons. Could he speak to what uncertainty we and Canadians are going to see as a result of having a bill rammed through the House of Commons that does not meet the constitutional obligations or the obligations set out in the Supreme Court decision?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I thank my colleague and friend from Burnaby—New Westminster for his remarks as well.

This is the quintessential non-partisan issue in the House. It was not a Liberal, Conservative, or NDP initiative. It came forth because the Supreme Court said that, if we chose, we could enact legislation to address the Carter ruling. We chose to do so. It was not a partisan issue. I have tried—and I think the record will show—to be as constructive and non-partisan as possible, working with Conservative and Liberal colleagues to make amendments to the bill at committee, for example.

For a party that claims to be the party of the Charter of Rights and Freedoms to do what it is about to do is really quite shocking to me. I do not understand. The medical and legal uncertainty that I tried to address during my speech is so obviously going to happen now. Do not take my word for it; it is medical and legal regulators who are saying that, so we have to do a better job.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, when we hear arguments from the other side saying that there is this legal opinion here or there is this thought over there, it is somewhat concerning.

I am sure the opposition is very aware that there is extensive legal opinion from many different lawyers who have clearly indicated that what we are debating today is in fact in compliance with Canada's constitution and our charter, and that it will stand the test.

Will the member not at the very least acknowledge that there is in fact a significant legal community that is endorsing this legislation?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I will not acknowledge that there is a significant body of legal opinion to that effect.

I will acknowledge that the Department of Justice, which lost at trial and lost unanimously in the Supreme Court of Canada, is of that view. I will acknowledge that it lost its case in the Alberta Court of Appeal. I will acknowledge that a week or so ago Justice Perell in the Ontario Superior Court also rejected the Department of Justice's view.

I will say that the Canadian Bar Association, the Barreau du Québec, Monsieur Ménard, Joseph Arvay, and eminent constitutional scholars from coast to coast have taken this position.

I cannot predict with certainty what a Supreme Court will say, but I am confident I would rather be in their shoes than on the side of the government with its position that does not appear to even have an independent legal opinion behind it.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Mr. Speaker, I would like to congratulate my colleague from Victoria for his usual thoughtful speeches and analysis and his approach to many topics here in the House.

What happened yesterday with the voting against some of the thoughtful amendments presented was that the government has voted them down. I would like to hear the member's opinion on why this has happened. I can only see it as for political reasons, and nothing more.

Could the member give us his views on that?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I am not clear to this moment on why the government is so bent on passing a law that so many believe to be unconstitutional.

I frankly do not understand why the very thoughtful amendments were rejected yesterday. This was purported to be a free vote, but I did not see more than a few Liberal members stand against this bill.

Tonight, I understand we will be voting at third reading. This is the opportunity for members, particularly those concerned about rule of law, to come forward and vote against a bill that is patently unconstitutional, to get it right for Canadians, and protect those individuals who had their rights given to them, clearly, in the Carter case and would now see those rights taken away by Bill C-14.

[Brian Masse, NDP, Windsor West, ON]

Mr. Speaker, could the member give a little perspective on how we are dealing with hospice and palliative care in this matter?

These are very important issues raised in this chamber by the previous member for Windsor—Tecumseh, Mr. Joe Comartin, and being carried on by the current member for Windsor—Tecumseh.

The potential path of this bill will lead to every senator having an opportunity to speak to this bill, but not members of Parliament. Could my colleague tell us what he feels about that, which I think is a real shame and an affront to democracy?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, palliative care is something that the former and present members for Windsor—Tecumseh have been pushing passionately in the House, in the justice committee, and in the Senate-House mixed committee.

It is something we wished to see enshrined in this bill. We were disappointed there was not a dollar of money in the federal budget for palliative care, despite promises during the campaign. We were, however, able to get an amendment through in the preamble to Bill C-14 that at least addresses the urgent requirement for palliative care.

The Minister of Health, herself, has pointed out that less than 30% have access to palliative care in Canada. That is connected—it must be so connected—with this bill that we need to do much better on that score.

I just hope the government actually puts its money where its mouth is and comes up, in the health accords, with meaningful help for palliative care and hospice care from coast to coast to coast. It is so urgently needed.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, I am humbled to stand in this place and take this opportunity to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

I will be splitting my time with the member for Kenora.

I know that this issue is very personal to Canadians. It is about quality of life and dignity. It is about autonomy. Most of all, it is about compassion.

I listened to many people in the constituency of Brampton South on this issue. I heard support from most people in my riding. I also heard sincere and heartfelt concerns, particularly from our Orthodox-based communities. I appreciate their conviction, and that they have raised their voices with respect to this important issue.

I will use my time today to explain why I will be voting for this important legislation.

My heart goes out to all of those suffering and their family members, who are facing circumstances I cannot imagine. I think we can agree that it is those who are suffering, and their families, who this debate should be about. I hope that hon. members will not forget that fact. We must lean toward a compassionate approach for those who are affected. This is a serious matter and a complex issue. Therefore, we must find the right balance.

Our government must address this now. The Supreme Court made a unanimous decision, and soon there will be a legislative vacuum.

I think we can agree that a patchwork approach by the provinces would be the wrong approach. We would be ignoring our responsibility to show national leadership on this matter.

The framework laid out in Bill C-14 provides a solid, focused and detailed plan, which will meet the June 6 deadline set out by the court. Let me explain why.

Permitting medical assistance in dying will extend more control to eligible terminally ill patients on how to live out their last days. This legislation also provides important safeguards and limitations. It requires the Minister of Health and the Minister of Justice, in consultation with the provinces, to create regulations that will protect all of those involved.

By permitting medical assistance in dying for competent adults, whose deaths are reasonably foreseeable, I believe we are striking the right balance between the patients' autonomy who seek this medical assistance and the interests of patients in need of protection.

It is important to note that this bill does not stand alone. I would point out the critical work of improving palliative care in this country. The ideas of medical assistance in dying and a strong palliative care system are not in conflict. Rather, the two are complementary and are both important issues to address. That is why I am proud that the Minister of Health has recommitted to home care and palliative care improvements in response to a question that I asked during question period on May 2. In her reply to my question, the minister quoted Dr. Atul Gawande, who talked about how people want not only a good death but a good life to the very end. The minister reiterated her commitment to palliative care and providing dignity when Canadians are suffering. She announced how she will work with the provinces to ensure the high quality care of all Canadians. She also brought up how the Government of Canada is committed to an investment of $3 billion over four years to support that goal of palliative care and home care improvements. I commend this step forward.

We cannot view assisted dying legislation separate from investments in our health care system. Quality palliative care is a critical priority of this government. Indeed, as our government renegotiates the health accord with the provinces, I look forward to seeing palliative care discussed. The work with the provinces, territories, and stakeholders is essential to providing options to end-of-life care.

My background is as a research coordinator and diabetes educator. I know how the roles and views of physicians and nurse practitioners are vital to this issue. As a member of the health committee, and someone who worked in the health care field for almost 20 years, I understand the importance of consulting the people on the front lines. Physicians and nurse practitioners are central to the end-of-life process. Their conscience rights will be respected in this legislation. We are working on the best way to ensure their views are always taken into account.

The rules in this legislation are clear and eligibility has been carefully defined. I want to be clear. There is nothing in the legislation that would compel any medical practitioner or authorized nurse practitioner to provide medical assistance in dying. The legislation is meant to balance access to medical assistance in dying while respecting the personal convictions of health care providers. This is about finding the right balance.

Canadians are looking to their doctors and nurses to provide health care and to help them maintain their quality of life. However, when the quality is no longer attainable, Canadians want to know that their health care providers will also help them when their choice is a dignified end to their lives.

We have struck the right balance in my view by having proper procedural safeguards. Access to medical assistance in dying would only be available to those who meet the following conditions: be a mentally competent adult who is at an advanced state of irreversible decline in capability; have a serious and incurable illness, disease, or disability; experience enduring and intolerable suffering; and whose death is reasonably foreseeable.

It will also remain a crime to assist a person either in dying or in causing a person's death in a situation other than lawful medical assistance in dying. Protective measures are a key part of the legislation to ensure that eligible patients have given informed consent. Patients have to make a written request for medical assistance in dying and have it signed by two independent witnesses. Two independent medical opinions have to confirm that the patient meets all the criteria. These first two criteria are intended to ensure that requests for medical assistance in dying are truly voluntary, that they reflect the wishes of the patient, and are not made as a result of external pressure.

Our evidence-based approach will include regulating, monitoring, and reporting. This monitoring and reporting system will also be able to signal any issues or unexpected consequences. We want Canadians to see a system that is functioning and preventing abuses or errors. This will build up confidence and allow Canadians to make informed decisions about how the system should operate.

I appreciate how other members have spoken about how we will look to international models in terms of ways to work with the provinces and territories. This end-of-life coordination system will respect the role of the provinces, while providing access and respecting people's rights.

I want to recognize the work of the committees and the senators who have studied this matter and made recommendations around this debate. These recommendations and testimony from those on all sides of this issue should be taken into account. There have been a number of informative and heartfelt speeches by fellow members who I also want to take a moment to applaud. I also thank the Minister of Justice and the Minister of Health for their work in introducing the legislation.

Bill C-14 strikes a proper balance in view of the Supreme Court of Canada's decision and provides a needed legal framework. As parliamentarians we have the final say on behalf of the people we serve who elected us to be their voice. This is a debate that engages our morality, our sense of justice, and our compassion. It asks tough questions of our legal and medical systems.

We have talked to one another and heard some touching stories. We have reflected on how this issue affects all of us. It has called on us to hear the stories coming from the prospective Canadians who are suffering. It is often all too easy to forget what we would do if we were in their shoes. We often fail to truly appreciate the perspective and experience of those diagnosed with a terminal illness. Their dignity is challenged more and more as they reach their end.

We need to pass this legislation at the soonest possible opportunity. I hope all members will support the bill with me.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Mr. Speaker, there is one part of the argument that the Liberals have put forward that makes absolutely no sense to me and that is the firm commitment they have given for $3 billion toward palliative care. They say they have to negotiate the health accord and we have to do this and we have to do that. This matter is too important.

The Liberals thought that education for aboriginals was important and they put it in the budget. Now they are looking at the negotiation process. With respect to the $3 billion for palliative care I do not know if they are trying to keep their deficit somewhere below that $30 billion that they extended it to. It makes no sense that the money for palliative care is not in this budget while they are negotiating with the provinces in terms of how it be spent.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, I respect that we have heard a diversity of opinions for this bill. Palliative care is about dignity while dying from natural causes. Canadians have clearly indicated that they want to maintain their independence and receive care at home, including at the end of their lives. Recently, federal, provincial, and territorial ministers of health agreed to work individually and collectively to improve home care to better meet the needs of patients closer to home, including those who need palliative care. This is the right plan that provides more options.

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

Mr. Speaker, I would like to ask my hon. colleague a bit more about some of the concepts. I am very concerned with the idea of this being a balanced approach, that in this case balance is a logical fallacy here because an evidence-based approach has been ignored so far. I do not understand how that can be compromised in this kind of a profound situation with a bill dealing with something as serious as medically assisted dying.

Is the member at all concerned that there has been no independent legal analysis sought with regard to adherence to the charter? There has not been any. Is that a concern at all in this so-called balanced approach?

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, I thank my hon. colleague for that great question. Yes, the committee did great work. Without federal legislation in place, Canadians would face an uncertain situation. I respect the views, but the job is about representing our Constitution and Canadians' views in this place. It is also about passing evidence-based policies that benefit Canadians. The people of Brampton South elected me to be their voice here, to bring a different approach, and to implement our government's better plan. Bill C-14 is the right bill at the right time. It is the best approach. We need checks and balances. That is why the committee did a great job. Even the CMA said that. The Canadian Medical Association has pointed out that in the Carter decision, the “...parameters are vague in the extreme, and contain absolutely no clinical direction whatsoever”.

The term “grievous and irremediable” which is used by the court is not a medical term, so we need more clarification for that. That is why the committee did great work. We listened to all the consultations and this is the right bill. We have listened to all Canadians, and this is the right bill that we have to bring.

[Bryan May, Liberal, Cambridge, ON]

Mr. Speaker, I want to thank the member for Brampton South for her speech and her contribution to this debate.

The core principle that this debate is about, which is balance, cannot be emphasized enough. This has been mentioned by all sides. I am wondering if the hon. member can speak a bit more about the government's investment in palliative care, as well as possibly elaborating a bit on the work that has been done in each of the ridings to consult.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, the Minister of Health has been very clear. She committed in this House, in response to the question I asked on May 2, to invest in palliative care. As part of a multi-year health accord, the federal government has committed to providing $3 billion over the next four years to improve home care, including palliative care. The minister is working with the provinces and territories. Palliative care is more about dignity while dying from natural causes. That is the right plan. Our health minister is very keen to implement that, and that is what we are doing.

[Bob Nault, Liberal, Kenora, ON]

Mr. Speaker, it is an honour to have this opportunity to speak to this legislation and enter this debate. First, I want to thank the leadership of all the parties for making this a free vote. This is such an emotional, difficult, and personal debate. Having had the opportunity to sit in the House since the eighties, I have had the opportunity to be involved in many debates. From my experience, this is one of the most difficult debates that as a parliamentarian I have entered into.

I want to be clear, as we start this discussion, that I support the legislation, and I will lay out to some extent the reason why I feel this way. This decision has to be based on our own personal life experiences and some would say, our own values. However, the reality is that all members in this place come from different parts of Canada, come from different experiences, and have different understandings in some respects of what we are entering into.

We all have to keep this in mind. This is fundamental societal change. This is fundamental because we are moving to allow individual Canadians, people we love, people we are close to, people who are our neighbours, our friends, the ability to have medical assistance in dying. It should be one of those debates that should not be taken lightly. Nor should it be a debate where we talk specifically about what the lawyers or the courts are saying. Yes, we have a court case to deal with and the Supreme Court has told us what its sense is, that in fact people have a right to assisted dying. However, we should not diminish the importance of what that may do to our country over the long term.

I want to use my experience as a member of Parliament to explain the rationale for being extremely careful and diligent in our decisions as we move forward over the next number of years.

I represent a riding that probably has the most suicides of anywhere in Canada. Over the last decade, I have watched hundreds of young people take their lives, people who I know their families, their moms and dads, and have watched with some horror as they have made that kind of decision. Yes, it is a little different than what we are debating today, but it defines how we feel about the objective of allowing people to make that ultimate decision of taking their own life with the medical assistance of others.

We should in some regard be careful not to assume what is being said by others in the House, for example, that the legislation does not go far enough, or that it may be not charter compliant because it is too restrictive, or that it goes too far for some people who have made equally compassionate arguments in the House. This decision has to be based on where we think we want our society to go. It is not up to the courts to define and to suggest, as some have suggested even today, that we have not gone far enough so therefore we have to go all the way to a particular place because it may not potentially be compliant with the charter.

I sat in cabinet for a number of years and I have seen many legal arguments put to cabinet on different issues by legal counsel and on many occasions. On many occasions I have had the opportunity to see the decision made right or the decision made wrong, or the advice to be given not exactly as we had anticipated. Therefore, we cannot stand in this place and assure Canadians that this legislation is absolutely perfect one way or the other.

That is why I like the approach the government has taken. It has taken an approach that it is very restrictive. It gives society time to look at the other areas that we may consider, as parliamentarians, to allow people to take their own life, for example, minors.

As I said, I have had the experience of watching many young children take their lives. To talk about minors who are willing to take their lives and make it legal and easier, if I could put it in those terms, is not something I totally support. I am very concerned about that.

I am worried about the whole issue of advance requests. It is hard to predict the situation a person will find themselves in, so we need to have more study of the whole issue of advance requests, and minors and mental illness.

I support the legislation, not because the leadership told me to do it. I do not tend to work that way and never have. I think it is the best approach for something that would fundamentally change our society forever.

We have to remind ourselves as we stand here, and when we vote tonight, that someone close to us very soon will use this legislation. It may not be as comfortable and as simple as some people have made it sound. We have had this discussion today.

The legal framework is important. It is important for the Senate not to get into this discussion about whether or not it goes far enough. The reality of it is that if it is a framework that allows us to get the compliance we need through the charter, we should move forward on it. I want to make this clear. I do not care which legislation we would pass, the one the NDP seems to favour or the one the Conservatives seem to want to have, and I am not sure exactly which way that would go. That legislation will go to the Supreme Court to be tested as we move forward. It does not matter which legislation we pass because this is such a fundamental change to our society, there is no doubt people will go to the Supreme Court to test the reality of the legislation.

Here is the reality we face. Under the legislation, we allow mentally competent adults who are in an advanced state of irreversible decline in 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, to seek assisted dying. That is a pretty large amount to start with.

I know this will change our health care system for the next generations. I strongly recommend to members of Parliament not to be too quick to judge what other generations will want to have 50, 100 years from now. We should be very careful about that.

I believe, as most Liberals do, in individual rights. I am not suggesting we restrict those, but the right to choose for people who are competent is fair. Having control and obviously the dignity in dying are very important concepts for me as a member of Parliament.

Today I am pleased to have this opportunity to make these comments. This is not a partisan issue. This will not get any member of Parliament more votes, one way or the other. This is a profound fundamental change in how I will deal with individuals every day with whom I am close. I want to ensure we get it right. If we did restrict it too much this time, I would rather do that than go too far.

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, when I first polled my constituents, I found that most of them were opposed to doctor-assisted suicide because they had heard stories about Belgium and the Netherlands, and had seen how it was a slippery slope. However, most of them believe that if these are fairly restricted, there are cases where it may be implemented. How do we stop the slippery slope? That is my question for the member.

Most Canadians want to be assured that doctor-assisted dying is limited to competent adult individuals, and the member spoke about that. They would not want those under the age of 18, who might feel depressed or have mental issues, to access assisted dying. As far as vulnerable people, how we confirm their capacity to consent is another concern.

In the last part of the member's speech, he said that he was a Liberal and that he believed in individual rights. Why do we not have in the legislation conscience rights protections for physicians and other medical practitioners who oppose physician-assisted dying? Right now, in Ontario, it is a requirement—

[The Assistant Deputy Speaker, Carol Hughes]

Order, please. Other people will want to ask questions as well, and it is only five minutes. Therefore, I will give some time for a response.

The hon. member for Kenora.

[Bob Nault, Liberal, Kenora, ON]

Madam Speaker, my colleague has asked a good question. It goes back to my original discussion that we should go slowly and take our time. We should not just let the Supreme Court, or courts, decide what Parliament should decide. We have to make decisions in this place based on what is good for Canadians, in accordance with their beliefs and values. They will be interpreted in the courts, as will this legislation. If in fact, as the member has suggested, we do not allow for conscience rights for members of the medical profession to not participate and if this is considered to be unacceptable to the courts, we will hear that, and we will have further debates.

I have been in this place for 17 years, and my colleague has been here quite a long time himself. We will continue to have this debate, because it is a fundamental change for us as a society. We cannot compare ourselves to other countries, and we should be very careful how we approach that.

[Robert Aubin, NDP, Trois-Rivières, QC]

Madam Speaker, I listened carefully to my colleague's comments.

Two things really caught my attention. The first was at the beginning of his speech, when he commended the leadership of all the parties for allowing a free vote on this bill. Obviously, I also commend that. It seems to me, however, that in addition to a free vote, we should be making a more concerted effort to seek the broadest possible consensus in the House. I think that is where our views diverge somewhat.

Furthermore, at the end of his speech, the other point that struck me is when he said that, no matter which legislation we pass, whether it is an NDP, Conservative, or Liberal bill, it will face a court challenge.

My question is very simple: why did the Liberals refuse to refer the bill to the Supreme Court, which would have ensured that it was acceptable?

[Bob Nault, Liberal, Kenora, ON]

Madam Speaker, the use of sending references to the Supreme Court should be used sparingly. I know the opposition tends to like the idea of sending this to the Supreme Court. I am sure it will go to the Supreme Court, but it will go on specific matters, not based on whether we think the overall bill is charter compliant or not.

I firmly believe the bill is charter compliant. I agree with the minister that it does meet the test, and that it will not be the bill we are dealing with specifically, Bill C-14. It will be matters like whether we did not go far enough, and others will challenge that.

I know you are trying to hurry me up, Madam Speaker. I was going to answer the other question. Maybe I will get it in the next go-around.

[The Assistant Deputy Speaker, Carol Hughes]

I want to remind members that there are five minutes of questions and answers, which is not a lot of time. If members can keep their questions as short as possible, we can get as many in as possible.

The hon. member for Provencher.

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, I want to start by saying that I will be splitting my time with the member for Selkirk—Interlake.

I want to say right from the outset that I am conceptually opposed to Bill C-14. I believe in the sanctity of life, and I believe that all life, from conception right through to natural death, has value, has worth, and has purpose.

As a sitting member of the committee for justice and human rights, I spent several weeks together with the committee in significant and lengthy meetings examining Bill C-14. We spent long days listening to witness testimony from experts and organizations from all over the country, and then doing a clause-by-clause analysis of the bill. Despite the many concerns voiced again and again by witnesses, there were no meaningful amendments made to the bill.

Bill C-14 is called medical assistance in dying, but make no mistake, Bill C-14 is physician-assisted suicide. It is important that we make this distinction. The gravity of the bill should not be undermined by the colourful wording. The bill would change Canada forever, and it would be naive to think that Canada's most vulnerable people would not be at risk under the bill in its present state. This is the most significant social re-engineering bill in the past 25 years, because it changes how we view the sanctity of life.

The Supreme Court was very clear that physician-assisted suicide is not a charter right, but it is an exemption that could be provided on an exception basis providing individuals meet certain criteria. The person must be a competent adult who clearly consents to the termination of life, who has a grievous and irremediable medical condition, including an illness, disease, or disability that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

Bill C-14 clearly goes beyond the Supreme Court decision with a mandate to study making physician-assisted suicide available to mature minors, exploring the concept of advance directives, and providing physician-assisted suicide to mentally disabled individuals. This is just not acceptable.

The committee heard testimony from approximately 42 individuals and/or groups who all have a vested interest in this issue. Over 100 amendments were presented to committee based on evidence from witness testimony provided to committee. Sadly, the Liberals did not present any substantive amendments, and in fact, voted against any meaningful amendments presented by any of the opposition parties. The Conservatives presented many thoughtful amendments that would have strengthened the bill and added important safeguards, as they did last night at report stage. This is a missed opportunity.

Let me highlight just a few of these missed amendments, these missed opportunities.

These amendments included things like assuring that only trained and qualified medical practitioners, in other words physicians, would assess the individual and administer the lethal cocktail that would eventually procure death. The way the legislation is presently drafted, it would allow a person to obtain the lethal drug from pharmacists, take it home, self-administer, and procure their own death. This worries me, and it should worry every Canadian. Witnesses presented testimony that in other jurisdictions that permit this practice, 30% to 40% of prescriptions for death go unused.

What happens to these unused drugs? What if the drugs fall into the wrong hands? What if the drugs were not administered properly? What if they did not take all of it and complications set in as a result? How can we be sure that the individuals were not at some point pressured into it? There are just way too many unanswered questions in the bill.

The bill would also make it near impossible for medical practitioners to monitor and report on subsequent events. Did the patient self-administer the drug or did the patient die from an illness? How do we ensure that we have the correct data to track euthanasia in Canada? These are valid concerns being voiced by Canadians, and it could have been addressed in the amendments that we proposed at committee.

The Liberals are unwilling to consider an amendment to ensure physician supervision during the procedure.

In addition, Bill C-14 allows for nurse practitioners to provide medical assistance in dying. There are substantial differences between a medical practitioner and a nurse practitioner, including the length of time spent training and the ability to prescribe various narcotics, yet suddenly, in this bill, we are affording them the ability to assess an individual's eligibility for physician-assisted suicide and prescribe life-ending cocktails, which is in stark contrast to the typical expectations we have of nurse practitioners.

This goes too far and is another issue we sought to address in the bill. Again, this is a missed opportunity.

We also provided an amendment that would have removed psychological suffering as an eligibility consideration for physician-assisted suicide. This, quite simply, leaves too much room for interpretation. Allowing for psychological suffering as an eligibility consideration is the start of a very slippery slope in terms of who can receive physician-assisted suicide and for what purpose.

We also suggested that “reasonably foreseeable death”, as defined in the bill, would be replaced with imminent death or at least death expected within 30 days. We heard testimony from witnesses on either end of the spectrum raising various concerns about this wording. “Reasonably foreseeable” in one physician's eyes could be completely different in the eyes of another. This will certainly open the door to uncertainty among patients and practitioners, and will definitely lead to subsequent lawsuits.

To further strengthen safeguards, we proposed an amendment requiring that prior judicial review had occurred to ensure that all criteria for physician-assisted suicide eligibility had been met.

Dr. Will Johnston, chair of the Euthanasia Prevention Coalition of British Columbia, came to testify before committee. He said the following:

...although it might be assumed, nowhere specifies that doctors must actually examine the patient, the extent to which they must do so, or the extent that doctors must inquire into the internal and external factors that create vulnerability for the patient.

Dr. Johnston brings forward a valuable consideration. Bill C-14 does not stipulate to what degree a patient should be examined nor does it require examination of the factors creating vulnerability for the patient.

In addition, we know that this is a complicated matter and difficult to address in legislation. Every individual and every disease presents a different set of challenges. Judicial oversight would ensure that individuals meet all the criteria given their unique set of circumstances and would further protect Canada's most vulnerable people. Again, this very reasonable amendment was rejected.

We also put forward a request that palliative care consultation be included as a criterion for seeking physician-assisted death. Patients would be made aware of all options available to them and ensure palliative care options were understood, offered, and available.

We heard time and again in committee that access to palliative care is a problem in this country. We also heard that palliative care, especially chronic pain treatment and counselling services, is very successful at alleviating the suffering, depression, and anxiety, things that lead people to wish to hasten their death.

The minister spoke on palliative care, and insisted that palliative care and physician-assisted suicide go hand in hand, yet the committee refused to adopt palliative care consultations as a prerequisite component in the bill.

The Canadian Society of Palliative Care Physicians outlined the issue well before committee. They wrote:

In order to ensure that medically assisted death is not our first or only response to human suffering, we need to build in an explicit legal requirement to identify, explore and record the sources of a person’s suffering and attempt to address the motivations of his/her request for death. This should not be undertaken as a screening or determination process, but rather an opportunity to ensure that a person who requests an assisted death is fully informed of available options for treatment.... The Bill should be amended to incorporate a meaningful right for patients to be informed of the full range of available treatments, technologies and supports that could ease their suffering, whatever its source.

Palliative care consultations would protect patients and ensure that physician-assisted death does not become the first response to human suffering. I cannot understand why the government would not want to ensure patients have sought out all other alternatives before requesting physician-assisted death.

One of the things we were very clear about, which the evidence produced over and over again in committee, was the whole need for conscience rights protection, not only for individuals but institutions. This came across as a large concern. We presented several amendments to committee that would have met the concern of many institutions and individuals that may be forced or required to offer this service. These amendments were all rejected, not only at committee but they were rejected here last night at report stage as well. We find that unacceptable.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I want to congratulate my hon. colleague on the excellent work he is doing as deputy chair of the Standing Committee on Justice and Human Rights. While we disagree about the ramifications or the outcome of the committee hearings, I want to thank him for his part in the process. It is always a pleasure working with him.

I disagree that there were no meaningful amendments made at committee. There were 16 amendments made, including issues of conscience and palliative care. What is problematic is that we talk about the Liberals rejecting them, but the Liberals did not reject amendments that were proposed by the opposition and vote against them. I do not know of any occasion when the NDP, Bloc, and the Green Party agreed with the Conservatives. There were always differences and the Liberals were sort of in the middle, agreeing with some and not agreeing with others. Therefore, I do not think it is fair to say the government or the Liberals rejected the amendments.

I will give one example and ask my hon. friend if he can respond to it. My hon. friend spoke of an amendment that came up at committee related to—

[The Assistant Deputy Speaker, Carol Hughes]

As I have mentioned, members have to try to keep their questions short so that others have the opportunity to ask questions as well. I will now ask the member to respond.

The hon. member for Provencher.

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, I am not sure what I am responding to, but I also want to make reference to my colleague from Mount Royal. He chairs the Standing Committee on Justice and Human Rights and he does a very admirable job. He serves us and this country well. He seeks to maintain a neutral and unbiased position, and gives us all an opportunity to present our concerns.

However, he is not completely accurate when he states that amendments were considered, because the consideration Conservatives asked for regarding conscience rights, in particular, was to have the bill amended, not merely to amend the preamble. The preamble states that no one shall be compelled by this legislation to perform physician-assisted suicide, but it does not provide specific and implicit conscience rights protection for health care individuals.

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

Madam Speaker, I want to ask my hon. colleague to expand on the issue of amendments being addressed. Would he agree that no opposition amendments were accepted that were to the core provisions of the bill and that they were mostly minor or technical clarifications in nature?

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, I want to thank my colleague for that question because she is absolutely correct. There were no meaningful amendments directed toward the core of the bill that were accepted. The amendments that were accepted were minor in nature, or technical. The only substantive amendment of any sort, which is weak, is that there will be a palliative care review conducted every five years, along with a review of physician-assisted suicide legislation. Other than that, there were no amendments accepted by the Liberal government from the NDP, the Bloc, the Green Party, or the Conservative Party that were of any consequence.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Madam Speaker, I am going to use an example again. The Liberals promised $3 billion for palliative care. They say they cannot put it in the budget because they have to negotiate with the provinces. I notice that they certainly have not completed their negotiations with the provinces in terms of how the infrastructure money is going to be spent.

The Liberals made a promise on something as critical as palliative care. I would ask my colleague if their excuse of still having to come to some sort of conclusion with the provinces actually holds any sway, because I have not received a good answer on that issue from any of the Liberals.

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, that is a great question, because the Liberals did make a commitment to provide funding for palliative care. The doctors and nurses I have spoken to have said that when proper palliative care is available, the need for physician-assisted suicide just about falls down to nil. Had the money been in the budget that was promised by the Liberal government during the campaign, it would have helped to address that concern.

If we could provide proper palliative care for individuals, it would address the two basic fears that people told me they have at end of life. Number one is whether the pain can be controlled and number two is whether they can be helped with their fear, and both of those things can be addressed through proper palliative care.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Madam Speaker, I rise somewhat concerned today that I am finally, for the first time, able to speak to Bill C-14. We are at third reading. This bill has been rammed through the House. The Liberals have brought in closure time and again with this bill. Every time it was debated, whether at second reading or report stage, I was not available, or the time was so constrained and the list of speakers of the members of Parliament was so long, that I could not get on the list. Finally, I am able to speak today to Bill C-14 to reflect my concerns and those of my constituents on this bill.

When closure is used in dealing with issues of conscience like we are dealing with today with respect to physician-assisted death or doctor-assisted suicide, whatever we want to call it, we need to take the time to have the debate. We need to have the discussion among parliamentarians and talk to the appropriate experts to ensure that we get this right. If the Liberals rush this bill through the legislative process in the House and if they try to do it in the Senate, I can guarantee that mistakes will be made and this bill will be facing court challenges in a relatively short period of time.

I also have to reflect what my friend from the riding of Provencher said today. It is extremely disappointing that so many reasonable amendments were presented by members of the opposition parties, and not one of them found their way into this bill at report stage last night. That truly is disappointing.

In my riding of Selkirk—Interlake—Eastman, the topic of physician-assisted suicide is divisive, as it is right across the country. The majority of constituents who have contacted my office have been opposed to this policy, on two fronts: first, many people have deeply held moral, ethical, and religious beliefs that are strongly against assisted suicide; and, second, many believe that the policy will be used prematurely to end the lives of those who have become a burden to their families, society, or the medical system.

It is important to note that the Liberals broke a key election promise to invest $3 billion into-long term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making. There was unanimous agreement on the Special Joint Committee on Physician-Assisted Dying and among stakeholders, including the Canadian Medical Association, on the need for a pan-Canadian strategy on palliative care, with dedicated funding. This would be an important step forward for Canada. It is something that the Liberals have glossed over in favour of introducing this legislation in a very careless and expeditious manner.

Many medical doctors, nurses, and health care professionals are conflicted with the ethical and moral conundrum that assisted suicide presents, as it runs counter to the modern adaptation of the Hippocratic oath. The University of Ottawa captures the challenge of this principle. It states:

Given the complexity of medicine in the 21st century, an ancient oath cannot possibly encompass current values. Therefore, the significance of the Hippocratic Oath does not reside in its specific guidelines, but rather, in its symbolism of an ideal: the selfless dedication to the preservation of human life.

I would stress “the preservation of human life”.

Although the Canadian Medical Association in the last year has turned its back on its previous position on physician-assisted suicide, the Supreme Court of Canada went to great lengths and grasped at straws to change its position from its previous rulings as to whether there should be exemptions offered for physician-assisted suicide.

The Canadian Medical Association is a member of the World Medical Assembly, which adopted a resolution back in 1992 on this. It revised it slightly in 2005, but reaffirmed it in April of 2015 in Oslo. It states:

Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.

Quite clearly, the World Medical Association, doctors and physicians from right around the globe, is saying that this is unethical.

As has been pointed out, we are quite concerned from our side, and I am in particular, about the charter rights under sections on the freedom of conscience. As has been noted, there was a minor amendment made to Bill C-14 in the preamble to allow for the protection of individuals but not of institutions. Is it strong enough to be considered legal in a case that goes before the courts, the Canadian Human Rights Commission, or one of the provincial human rights commissions, if section 2 is defined in the preamble but is not actually in the clauses of the legislation itself?

Institutions would be exempt, and I know that some members have had conversations with people at some institutions who are very concerned about this. I looked to the St. Boniface General Hospital in Winnipeg, a Catholic-run hospital. They are quite concerned that they, as an institution, will have to violate their own religious and moral beliefs to provide assisted suicide. They believe in the sanctity of life, as many of us on our side do also.

Like most Canadians, I have watched loved ones succumb to lengthy and chronic debilitating illnesses. Dying with dignity is desired by all Canadians. Unfortunately, only a handful of us will die in our sleep with minimal discomfort or pain. I do not believe that we should institute a policy that will provide physician-assisted suicide to every Canadian when they are near their end of life. Dying with dignity does not apply only to physician-assisted suicide. Expanding and improving palliative care services is by far the better public policy, and should be a priority of all health care providers across this country. I am recommitting to working with like-minded Canadians and policy-makers, and parliamentarians right here, who want to enhance palliative care in Manitoba and across the country. My wife Kelly works as a nurse in a personal care home and provides palliative care services all the time. She agrees that strengthening palliative care services will allow more Canadians to die with dignity.

I have met with the Manitoba League of Persons with Disabilities and talked to Carlos Sosa, who is the Manitoba representative on the Council of Canadians with Disabilities. They are very concerned with the way that Bill C-14 is laid out right now because it would do little to address the concerns of the vulnerable and how the law would deal with people in the disabled community. In particular, the bill would not provide for an assessment of vulnerabilities that may induce a person to assist and seek an assisted suicide. It does not have an expedited prior review and authorization by a judge or independent body with expertise in fields of health care, ethics, and law. This was one of the amendments we brought forward last night, and it was defeated.

Rhonda Wiebe, who is the co-chair of the Canadian Council of Disabilities end of life ethics committee, said:

In the Carter decision, the Supreme Court of Canada gave the Government of Canada two assignments (1) develop a regime to provide dying people access to assisted suicide and (2) protect vulnerable Canadians who at a time of weakness may be influenced to accept medical aid in dying. Unfortunately, [Bill] C-14 has some serious gaps when it comes to protecting the vulnerable..... Canada must do enough to protect people like [her] and other Canadians with disabilities who can be made vulnerable by both [their] health conditions and [their] social and economic circumstances.

I am privileged to belong to a political party that allows for free votes on issues of moral and religious beliefs. On policies such as physician-assisted suicide, Conservative members are free to either reflect the will of their constituents or to vote according to their personal beliefs. As someone with very strong Christian values, I cannot support Bill C-14. Bill C-14 needs better protection in place for youth under the age of 18, and safeguards for those who are vulnerable, including those who are dealing with mental health challenges.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I am sure that my hon. colleague inadvertently stated something that is not correct, which is that conscience amendments were not added to the bill. We did have a conscience amendment that was drafted in conjunction with the member for St. Albert—Edmonton, the member for Victoria, the member for Central Nova, and I, which is in the bill. The preamble was amended and the bill itself was amended. I just want to correct him on that point.

There was a judgment by the Alberta court yesterday, saying that a non-Canadian citizen, not eligible for medicare, was eligible for physician-assisted dying. We have had a judgment from the Court of Appeal of Alberta that stated that a psychiatric patient of 58 years old who was not dying—death was not only not imminent but not even foreseeable—was eligible.

Does the hon. member not agree that without this law being adopted by June 6, and without safeguards in place, such as two opinions, a waiting period, and all of the other safeguards in the bill, that we will be going down a very slippery slope?

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

I do agree, Madam Speaker, that we do not want the slippery slope. We do not want judges, without any background at all in the ethics or medical field, making rulings on individuals in cases like the member for Mount Royal just outlined.

We also know that the amendment that was accepted was rather watered down. Again, it is in the preamble and not in the body of the bill.

We have some options here. The government has options. It can request an extension from the Supreme Court of Canada so we do not have to go for the June 6 deadline. We can work with the opposition members and make this right and accept some of these amendments that we brought forward and are very reasonable, or we could use the notwithstanding clause. There are options out there, but ultimately I ask people to defeat the bill.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Madam Speaker, we are dealing with a closure motion today that allows very few members of Parliament to speak. We saw a couple of weeks ago that the government pulled Bill C-14 from the Order Paper a number of times when members of Parliament wanted to speak on it.

We saw, as well, a government refusing even the ability yesterday, under closure, knowing that we had a vote on Monday evening, to allow members of Parliament to speak during the day. It defies logic that a non-partisan bill of this nature would be treated so reprehensibly by the government.

Given all of the concerns raised by legal and medical professionals, their communities, the concerns about the lack of constitutionality of the bill, which has now been pointed out in two court decisions, why does the member think the government is trying to ram through this bill in such a partisan and inappropriate way?

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Madam Speaker, there is no question that this is an issue that deserves to have the proper time for debate in Parliament. The government, for whatever reason, other than the June 6 deadline, rather than doing the right thing and asking for another extension so we can get this right, is using closure, very autocratic measures to limit debate, and not allowing us, as parliamentarians, to express the will of our constituents or our own personal beliefs.

We know we should have the time to get it right. Whenever we see these types of motions, especially on legislation that will affect the long-term history of Canada—this is something that will go on into the future with little chance for amendment or change—we have to get it right. The way we do that is not through using closure and draconian measure that the Liberals have forced upon us.

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, with all due respect, the member who gave his speech talked a bit about why the government would have done it. In some ways it may be competence or incompetence. The Liberals pushed this off as long as they could, expecting that they would be able to ramrod it through, and now they are saying they will not make the June 6 deadline. What will they do? That very well may be it.

I thank the hon. member for speaking on palliative care. Why does my colleague who gave the speech believe that the government would not have addressed palliative care initially in the budget, saying that it recognized what was coming and offering its commitment to palliative care?

Through all this debate—

[The Assistant Deputy Speaker, Carol Hughes]

I want to give the member a chance to respond, so I will ask for a brief answer from the member for Selkirk—Interlake—Eastman.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Madam Speaker, I agree with my friend from Battle River—Crowfoot. There is no question that this legislation is being ramrodded through without proper consideration. There is no question that the issue of palliative care is not even addressed in the budget or in this policy development that we are working on right now. If we are going to deal with end-of-life issues properly, we need to have palliative care.

All the Liberals want to do is talk about those issues without committing the dollars that they promised they were going to commit.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Madam Speaker, I will be sharing my time with my hon. colleague from Pierrefonds—Dollard.

In this postmodern world of ours, with its tendency at times toward a certain kind of what some might call libertarian relativism, we must continue to believe and affirm that there exist values that we can all agree are objectively good and worth protecting and promoting, values that should inform, motivate, and guide us both individually and collectively. Namely, we must subscribe to the imperative that we as human beings have a duty to support each other in our struggle in this fight for life, as some colleagues have put it, this struggle against the undeniable reality of our finite existence, our mortality. Every moment of life has value. This truth is to be asserted and upheld. This is the prevailing consensus, one that has become deeply rooted and entrenched in society over the course of history. It is also our best instinct. Many of my constituents fear that Bill C-14 would undermine this consensus, this instinct. I understand this fear.

We cannot allow ourselves to fall into indifference, to be quietly seduced by the facile notion found in the well-worn phrase “to each his own”, whereby we agree on everyone's right to choose, but beyond that we do not think it our business to provide reinforcement for the desirable and good choice. When I hear anyone appear to frame the debate on medical assistance in dying as one of pure libertarian choice, I must admit that a little part of me shudders.

After much reflection, I do not believe that Bill C-14 would necessarily lead us down a path to an increasingly permissive and contagious attitude toward self-directed death.

I would like to quote bioethicist Margaret Somerville, someone generally identified as a philosophical conservative on bioethical matters, someone who has written on the dangers of legalized doctor-assisted death:

The bill would legislate these actions as an "exemption" from—an exception to—prosecution for the Criminal Code offences of culpable homicide and assisted suicide that would otherwise be committed. Treating medically assisted dying as an exception will help to ensure, as is essential, that it does not become part of the norm for how Canadians die;

In other words, Bill C-14 would not normalize medically assisted dying as perhaps has occurred in Belgium and the Netherlands, the two most often cited examples of the slippery slope.

Dr. Sommerville goes on to say that:

Recognizing medically assisted dying as an exception also helps to establish that access to it is not a right but rather, under certain conditions, an immunity from prosecution for a criminal offence....

This approach, she further states, “carries an important anti-suicide public health message.”

I would add that the government has taken care to emphasize this message in the bill's preamble, which acknowledges that “suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities”.

I am not a doctor who deals with life and death on a daily basis and I have never been at death's door.

Like every one of us here, I am an elected member trying to make the best possible decision in the context of the undeniable reality that the Supreme Court made a unanimous decision in the heart-rending Carter case.

The court's decision requires Parliament to create a new legal framework to regulate a specific aspect of end of life. If we fail to do our jobs now, the result will be a partial legal and regulatory vacuum. To quote the Ontario Hospital Association, if the bill is not passed by June 6, “Assisted dying would be lawful where it is provided in accordance with the parameters established by the Court and provincial regulatory bodies.”

The parameters set out by the court are fairly general. The court did not offer precise prescriptions for what an operative medical assistance in dying framework should look like. It is not the role of the courts to be so prescriptive.

This is not to say that I do not have concerns in voting for this legislation. Absent a Supreme Court ruling, and had the issue been raised once again through a private member's bill, I would very likely not have voted for medical assistance in dying. I have already, in the past, voted against a private member's bill on doctor-assisted suicide.

However, we do have a Supreme Court decision that creates a requirement to act. The Prime Minister and the Minister of Justice and the Minister of Health have, in my view, acted wisely in taking a cautious approach to the issue, notwithstanding the excellent work of the special joint committee under the capable and intelligent stewardship of my friend and colleague the member for Don Valley West.

The bill may not be perfect, but I believe it would be a mistake to suggest that it leaves a wide-open field in medically assisted dying, a fear expressed to me by many thoughtful constituents committed in the highest degree to the protection of human life.

Bill C-14 would establish numerous criteria to be met before access to medically assisted dying could be granted. In addition to being 18 years of age, the person must have a grievous and irremediable medical condition that meets four distinct criteria: the illness, disease, or disability must be serious and incurable; the individual must be in an advanced state of irreversible decline; moreover, the illness must be causing enduring physical or psychological suffering that is intolerable; and natural death must be said to be reasonably foreseeable. In addition, the person must make a voluntary request that is free from external pressure and that is the result of informed consent.

The bill also includes a number of safeguards, and the individual must make a request in writing or through another reliable means. If the request is being signed by a proxy, that proxy must be at least 18 years of age and understand the nature of the request. The request must be made after the person has been informed that his or her natural death has become reasonably foreseeable.

The request must be signed and dated before two independent witnesses, and in turn, these witnesses must not consciously be beneficiaries, financial or in any other material way, of the individual making the request, and they must not be directly involved in providing personal care to the person making the request.

Two medical practitioners must provide a written opinion confirming that the person meets the eligibility criteria, and these medical practitioners must be independent. For example, one cannot be a supervisor of the other or a mentor of the other.

Crucially, the person must be informed that he or she has an opportunity to withdraw the request at any time.

All of this said, I am not at all convinced that medical assistance in dying is a serene and dignified phenomenon, even if often depicted in this way. I suspect that complications may arise. This is why it is crucial and to the government's credit that the bill allows for monitoring of medical assistance in dying through detailed reporting.

A few years ago, a handful of parliamentarians, including the members for Kitchener—Conestoga and Carlton Trail—Eagle Creek, the former members for Newmarket—Aurora, Guelph, and Windsor—Tecumseh, and myself, wondered about enhancing and improving palliative care in Canada.

We founded the committee on compassionate and palliative care and produced a report. The silver lining in this debate is that palliative care is receiving a degree of attention never before seen in this chamber or in national discourse at large.

It is my sincere hope that, once quality palliative care of the kind provided by the West Island Palliative Care Residence is available through appropriate federal and provincial funding to all Canadians approaching death, this legislation will become somewhat of a relic, and medical assistance in dying will no longer be considered the default option in relieving end of life pain and suffering.

In this regard, I am heartened that, in addition to the government's existing commitment to do more to fund palliative care, the bill makes specific reference to this commitment. The advent of universally available quality palliative care will hopefully one day be seen as the high-water mark in the measure of a truly just society.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, my Liberal colleagues are lavish in their praise of the minister. They think that the bill is perfect and will easily pass the test of the charter and the courts.

My question is simple. How does Bill C-14 guarantee a reasonable expectation of the right to life; liberty, by which I mean freedom of conscience in the sense of respecting autonomy; and security of the person, in the case of a person suffering from a grievous and irremediable illness, if the person has to go on a hunger strike to be eligible for medical assistance in dying and meet the reasonably foreseeable natural death criterion?

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Madam Speaker, I am unaware of the specific case mentioned by my colleague.

[Luc Thériault, Bloc, Montcalm, QC]

Carter.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

I am told that it is the Carter case. We believe, as the Minister of Justice has mentioned on many occasions, that Ms. Carter would have been eligible under the criteria established by the bill. I concur with that opinion and I respect it.

Naturally, there will be differences of opinion about this legislation. I am certain that we have not seen the end of litigation.

[David Graham, Liberal, Laurentides—Labelle, QC]

Madam Speaker, I would like to thank my colleague from Lac-Saint-Louis for his good speech.

Is he satisfied with the process that took place and is he pleased with the result?

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Madam Speaker, I am pleased with the outcome of the debate. I believe that we have had a very comprehensive debate on the issue. I have been here until midnight at least once to listen to the excellent speeches of members from all parties in the House on the issue.

We must not forget that, unlike some legislation debated in the House, this matter is also currently being debated by society at large. This debate is not being held in a vacuum. Not only do members have the opportunity to express their opinions, and as far as I know most have done so, but this debate is also being held in the media, in people's kitchens and in community centres.

[Robert Aubin, NDP, Trois-Rivières, QC]

Madam Speaker, I would like to thank my colleague for his comments.

I would like to go back to the criterion of reasonably foreseeable natural death because in Quebec there have been people who starved themselves in an attempt to meet this criterion.

Does the member not believe that this criterion runs completely counter to the guidelines established by the Carter ruling?

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Madam Speaker, we put a lot of faith in the Supreme Court's opinion, as we should.

Right now, we cannot predict how the Supreme Court will rule if this bill ends up before it. Chances are good that the court will respect the will of the House that is expressed this evening at third reading.

We believe that the bill is consistent with the parameters set out by the court in Carter. We also believe that the court will, to a large extent, respect the will of the House, which is sincerely trying to act in accordance with the court's decision in Carter.

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

Madam Speaker, there is a poem by the great Welsh poet, Dylan Thomas, entitled, Do Not Go Gentle Into That Good Night. It is a poem of a son calling out to his dying father to fight his imminent death, and it ends as follows:

And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

He is imploring his father to fight to the very end, to rage against the dying of the light. I believe this stanza describes the very essence of western philosophy when it comes to dying. Simply put, do not accept death.

However, life is terminal. The very definition of life is to die. A rock does not live, because a rock does not die. A tree lives, because a tree dies. A person lives, because he or she dies. So, am I going to die?

This is the subject of an excellent Ted Talks by a first responder. It is about a paramedic who would often arrive at the scene of an accident only to find a victim whose injuries were so severe that he or she was not going to survive. These victims would inevitably look up to this paramedic and ask: “Am I going to die?” In those moments, he would always lie and say no. He did so because he thought that was the kind, caring thing to do. Then a few years ago, he arrived at the scene of a severe motorcycle accident to find a victim who again asked the same question. For some reason, he told the truth and said yes. The reaction was not what he expected. The victim showed calm, inner peace, wisdom, and acceptance. From that time forward, he always told the truth.

Dylan Thomas in his poem tells us “wise men at their end know dark is right”. Therefore, am I going to die? Yes. We are all going to die.

Now we find ourselves discussing an issue that is foreign to many of us. With Bill C-14, we are trying to determine when it is acceptable to accept to die. That is to say, when it is acceptable to go gentle into that good night. This is essentially what we are debating with this bill.

Some argue that the bill should follow the Supreme Court's ruling to the letter. Some argue that the bill should be broad to encompass all possible scenarios. Some argue that the bill should be narrow and restricted so as to protect the vulnerable. Some argue that there should be no bill at all, and we should not be on this path regardless of what the Supreme Court says.

Here in the House we have had great debate on this matter. It has been passionate, intelligent, and respectful. It has been the House of Parliament at its best. For example, the member for St. Albert—Edmonton, who was on the special joint committee that prepared the guiding report for this legislation, has spoken eloquently on why he believes this bill is missing certain key protections. On the other hand, the member for Victoria, who was also on the special joint committee, has expressed, in a thoughtful, intelligent manner, his strong belief that the bill is too restrictive in certain areas.

I have received numerous personal letters from many sides of this argument, letters from people who are suffering now and fear not being able to access this gentle path when their time comes. Other letters are from caregivers who look after the grievously sick, the aged, and the mentally incapacitated. They are deeply concerned that these vulnerable people will not be protected. My own father has written on this bill.

I was out meeting constituents a few weeks ago and a lady came up to me. She said that she really liked what my father had written in the newspaper. Now, people get confused at times, and I did not know about this, so I just thanked her. When I got home, I called my father and asked if he wrote something in the paper. He said, “Yes”. I asked to see it, if he could email it me. He said, “No, I've erased it”, because he does not like to keep clutter on his computer.

I asked him to explain the gist of what he said, and he went on to explain that the term “reasonably foreseeable natural death” was a difficult one, even for a physician. My father had suffered severe heart attacks 25 years ago and was told to put his affairs in order by his physician.

Here he was, using the example of his own life to say, “I am alive 25 years later.” He is alive because on a dark night 25 years ago, he chose to “rage against the dying of the light.”

None of these people are wrong. Everyone has an opinion, and everyone's opinion is valid. For each person, that destination, that moment in time when it is acceptable to accept death is different, and rightfully so.

If the destination is uncertain, how do we arrive at it? Cautiously. There is a concept in engineering called “overshoot”. Simply put, the faster one arrives at the destination, the more likely one is to overshoot it. For example, if someone is driving in a car toward a stop sign and if he or she is going very fast and slams on the brakes, the individual will shoot past the stop sign. On the other hand, if someone goes very slowly, it will take that individual a very long time to get to the stop sign and he or she may even stop short.

We have an uncertain destination that is different for each person. How do we get there? Cautiously. We go toward that destination slowly. This is precisely the approach that the Minister of Health and the Minister of Justice have decided to take.

With Bill C-14, we are moving forward to this destination slowly, and we accept that we may even stop short. The bill acknowledges this. It is explicitly written into the law that it will be re-examined in a few years' time, precisely to allow for adjustments.

This is a very wise approach, and I commend the Minister of Health and the Minister of Justice for the work they have done to bring us here.

In summary, we will all face our death. At that time, some of us will choose to fight death to bitter end. As a society, we already support that decision and we use the full weight of our medical system to help those people who choose to "rage against the dying of the light".

On the other hand, some of us will choose to accept death with inner peace and calm. As a society, we must now accept their decision and allow our medical system to help them. With this bill, we will help some of those people to "go gentle into that good night."

[François Choquette, NDP, Drummond, QC]

Madam Speaker, I am pleased to participate in this debate. This discussion is really important for everyone in the Drummond region. In my region, people are very concerned about palliative care. We have people who are working very hard in the field of palliative care in the greater Drummond region. For example, there is Maison René-Verrier, which provides wonderful palliative care. I know that palliative care is important to the Liberals, but unfortunately, there was nothing in the most recent budget in that regard. There is also nothing in this bill to indicate that the government is really going to focus on palliative care. I would like to hear my colleague's thoughts on that.

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

Madam Speaker, that is an excellent question. Palliative care plays a key role in a person's decision about whether or not to choose medical assistance in dying. On the West Island of Montreal, we are lucky to have the West Island Palliative Care Residence, which is known throughout Canada for its expertise in palliative care. I know that we have already taken steps to talk to the people who work there to find out more about their excellent model so that it can be expanded upon and applied across the country.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, the member for Drummond mentioned palliative care. Perhaps he is not aware that at committee we inserted palliative care in the bill twice, in the preamble and in the bill. In the preamble we stated that palliative care, and the Minister of Health's requirement to work with her provincial and territorial counterparts on palliative care, was an essential issue that needed to be done. In the bill we stated that, after five years, the committee reporting on medically assisted dying also needed to report on palliative care, because nobody in the country should exercise medical assistance in dying because of a lack of good palliative care.

Was the member for Pierrefonds—Dollard aware of these amendments, and could he talk more about the government's commitment to palliative care?

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

Madam Speaker, again, palliative care is a critically important aspect of the decision that one day all of us will face. Hopefully, it will be there for all of us.

As the member mentioned, this is part of the preamble and an essential part of the process we are going through. Some people are frustrated that everything is not done at once, that everything has not fallen into place overnight. It does not work like that in the real world. This is why I believe the right approach is to go slow, learn from our experiences, and, at the same time, work to bring about palliative care, which will have a critical impact on people who are forced to make such challenging decisions.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, my friend from Pierrefonds—Dollard talked about a balanced approach. I am sure he is aware of the court decision yesterday that stated that a non-Canadian citizen had the right to exercise medical assistance in dying in the absence of legislation that clearly set out what Parliament intended for medical assistance in dying.

Could the member talk a little about his concerns if the deadline of June 6 is not met by Parliament?

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

Madam Speaker, I think the country as a whole is concerned about this issue and it is incumbent upon us as legislators to put something in place. I disagree with people who say that no law is better than this law. I would tell them that no law is perfect, and no law will not be amended and no law will not be subject to changes as we learn, experience, and go forward.

I strongly encourage those who oppose it and say the will vote for nothing to do their job as legislators, put something in place and then work to make it better.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Madam Speaker, I will be sharing my time with the member for Bruce—Grey—Owen Sound.

It is with great humility that I stand in my place today as the member of Parliament for Renfrew—Nipissing—Pembroke to represent the good people of my riding on such a weighty issue as the one before Parliament today, medical assistance in dying.

The debate strikes right at the heart of who we are as a nation, and I pray we get this right, as is humanly possible.

I thank all those constituents who answered my call to contact me regarding their thoughts on the legislation. I am pleased to confirm I have sought out the views from as many constituents as possible to guide, when the time comes, to support or oppose the government, or the Supreme Court, who are driving this issue today.

I have listened carefully to my fellow MPs on this topic. They have expressed various points of view eloquently. In keeping with my principles, and those for which my voters have elected and continue to re-elect me, I believe it is important to give a voice to those individuals who have not been given the opportunity to speak in this place, but should be heard.

I am pleased to add to the debate on medical assistance in dying with a sampling of letters and comments that have been received by my office to guide me in the debate. While time does not permit me to read all the correspondence I received onto the official record, I want to assure them that all points of view are important and will be considered.

This is a letter from Carmel in Pembroke. It reads, “Dear honourable member, I understand that the government plans to introduce a law regarding medical aid in dying. I totally disagree with many of the recommendations of the special joint committee on physician-assisted dying. Once euthanasia and assisted suicide are legalized we have embarked on a slippery slope. The boundaries will continue to be challenged. I urge you to write a law as restrictive as possible, and to respect and include the rights of many Canadians, who see any legalization of euthanasia and assisted suicide as murder. As a former health care worker for many years, I urge the government to invest more money in palliative care. I know from experience, pain can be controlled. They will receive passionate loving care and death will come naturally. Trusting that common sense will prevail in your good judgment.”

This email was received from David in Arnprior:

“Hello Member of Parliament. I do not support this legislation, not because I do not firmly believe in a competent citizen's right to commit suicide at the end of life as determined solely and completely by that individual, but because C-14 does not go far enough. This bill certainly needs to be passed federally so a provincial regulatory ragtag patchwork does not evolve. As well, C-14 needs expansion in at least four areas: Enshrine my right to predetermine through a pre-arranged power of attorney for personal care that suicide is my wish if I become incapable of making that choice later on; in other words, similar to my legal right now to refuse treatment before treatment is ever needed. Enshrine my right to commit suicide on my own, without a doctor's direct assistance. This change will allow “medical practitioners” to merely prescribe requested and appropriate meds for this most personal action, not to have to do it themselves in an environment perhaps not of my own choosing. Following from number 2, ensure that a broad array of competently trained, caring “medical practitioners” beyond merely MDs are available to assist as I may desire; the so called “death doula” model. Ensure that the so-called mentally ill can benefit from the legislation if they are deemed competent to do so by due process, since by virtue of being labelled mentally ill, a person should not also be deemed mentally irrational or incompetent in all areas or aspects of life. This is very unlike children under 18 or the developmentally delayed however, who must be closely protected, at least by benefit of clear due process. At the same time, there is a clear need for those ethically opposed in both caring professions and institutions to be able to opt out because of their beliefs, but only insofar as they must also be compelled to refer me to those who are non-opposed. This should also hold true by the way, for abortion, legalized marijuana, and like matters. There is also a clear case for broadly based, publicly funded “palliative care” services for those who want this kind of assistance. At the end of one's life it must always be about informed and competent personal freedom of choice, whatever that choice may be. This is in fact the basis of all quality of life and death, as entrenched in our Canadian charter, as decided by our Supreme Court. A national referendum on the matter is unwise and not needed. Similarly, I refer you back to Conservative P.M. Mulroney's 1980s second election, which was a referendum/vote writ large on free trade. He won then, as did NAFTA. Therefore, I largely agree with the previous Pierre Trudeau's 1960s statement when he was Liberal justice minister: “The state has no right in the bedrooms of the nation”. I think that goes a bit too far. The state does have a "limited" right, but only to ensure vulnerable persons, as well as persons who may become vulnerable, are not exploited, and are always treated with dignity and respect. In this, the Dutch, Swiss and Oregon models serve well. Thank you; please do acknowledge this email and feel free to share your thoughts.”

This note was received from David in Combermere. It states, “Our local newspaper here in Barry's Bay featured your request for input on Bill C-14. Thank-you for doing that. I personally view the bill as a Pandora's box and with so much language that leaves it ambiguous enough for the Liberal government to permit almost anything for the killing of Canadians. I don't know if you follow the studied newsletters of the Euthanasia Prevention Coalition and its editor, Alex Schadenberg, but I am enclosing their latest issue on Bill C-14. It's a whopper. EPC clearly presents the issues I endorse and in a more studied way than I could present to you. Please consider it my opinion on this vital life and death issue that you are wanting to present to Parliament. Thank you for all that you can do in this matter. God bless you.”

This letter was received from Betty from Killaloe. It reads, “Dear Member of Parliament, I strongly oppose physician-assisted suicide. I believe that life is given to us by God and should be taken away by Him as well. We don't know what his plan is for us and we need to trust Him with our lives. Even for non-believers, once that door is open to taking the life of a patient who is terminally ill, how long will it be until a needle will be given to those who are in long-term care, who are costing the health care system a lot of money to keep them there? How about the disabled whom a lot of people believe are a burden to our society, the mentally ill, etc. Let us put money into our palliative care and hospices where people can die naturally. History has shown us that where people interfere with the natural order and God's plan, evil and disaster follow. God's law states "thou shalt not kill" which should be above all the laws of the land. Thank you for giving me a chance to express my views.”

This email came from a couple in Arnprior. It says, “Dear Member of Parliament, Both my wife and I are advocates for doctor-assisted dying. We not only would like to see assisted dying for those people who are in need of this procedure and who have their full faculties but even more so for the thousands of poor souls suffering from Alzheimer's and who cannot make an informed decision. What we suggest is that it be made legal for people to choose this option during the preparation of their will with family and/or doctor as witness to this wish. We have a mother in long-term care in Almonte and the number of people suffering from Alzheimer's disease far outnumber the people who are lucid. I am sure if these people had a choice it would be to end their lives rather than sit in wheelchairs all day and to be treated, through no fault of their own, like babies. Our total hearts and admiration go out to the nurses and aides who care for those in need. We cannot thank them enough.”

Nancy from Deep River wrote, “Dear Member of Parliament, I'm answering your request for feedback on the specific euthanasia bill. First, a few generalities. I see the entire dynamics against a background where there is a movement for a culture of death, COD, and a movement for a culture of life. The culture of death tends to be hidden and manipulative. The well researched documentary CD called ‘Agenda’ provides evidence of this. There are elitists who want to reduce the world population by almost any means. Some of them want to make a shambles of the capitalist system so that their socialist ideal swoops down as the saver of the world. It is ironic that these elitists are socialist. I have read that the CIA supported the radical feminist movement, which has been instrumental in tearing down family structures and consequently economic stability. Hilary Clinton said, quite clearly even if not in these exact words, because I don't remember exactly how she expressed it, that in our society there are Judeo-Christian values that ‘we’ have to get rid of.”

“Specific examples show this. ‘They rope in well-intentioned liberals, like fools conned into their service. Now to the specifics. The most dangerous thing about the bill is that there is nothing in the law to protect the conscience rights of medical personnel. This means we would have legislated immorality if the bill passes in its current form. Such a law would corrupt an important sector of the citizenry. Corrupt citizens are antithetical to a healthy democracy. If conscience protection is not in the law, it is almost certain that somehow the “inconvenience” of non-participating physicians will be swept aside by a bureaucracy, just as it is now in Quebec. The bill does have some restrictions. I can believe that it was drafted in order to satisfy the Supreme Court's mandate in a careful manner. There are two facts against an optimistic view of these restrictions. Note the language we hear on the news, about beginning gently with euthanasia. Such language indicates that the plan is over time to include more situations where euthanasia would be permissible. Make no mistake about these restrictions. Like dew on roses, they will evaporate. This has been the experience in Europe.”

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

Madam Speaker, my question for the member is related to the whole need that we have before us today. This legislation will provide the legal framework to ensure that vulnerable people across Canada are at least being considered and taken care of.

At the committee stage, we saw members from all political parties were able to advance amendments and ultimately get some accepted which is a wonderful thing. Does the member believe it is better to have some legislation or a law in place than no law in place? Because if it is the latter, there are going to be many Canadians who will be very vulnerable to this situation.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Madam Speaker, what I am doing is providing the thoughts of my constituents who feel that this has not had proper debate and would like to see longer debate. As Nancy from Deep River was saying. “Now in the Netherlands a significant percentage of deaths are reported as executed by physicians without any request by the patient or family. The actual number would have to be greater than those where the physician has the temerity to admit this, which is murder and is illegal.

From a practical standpoint, it is almost impossible to make restrictions robust over time. The Council of Canadians with Disabilities says the bill does not provide protections it asked for in its vulnerable persons standard. Those protections, which are not in the bill, have to do with the assessment of vulnerabilities that may be inducing a person to seek assisted suicide as well as a review with the authorities with relevant expertise. In sum, the bill has three major drawbacks.”

[Robert Aubin, NDP, Trois-Rivières, QC]

Madam Speaker, I paid close attention to my colleague's remarks, and I admire her choice to use her time to serve as her constituents' mouthpiece.

We have all heard from people in our ridings who are in favour of medical assistance in dying and people who are not. Their views are polar opposites. However, there is one theme most people agree on: palliative care.

My question is simple: is there a way to reconcile the perspectives of those who are in favour and those who are not? We know that increasing pain medicine dosage in palliative care often results in death. In many cases, patients lose consciousness. With medical assistance in dying, patients consciously choose to leave their loved ones for the same reason and use the same medication to do so.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Madam Speaker, as a matter of fact, a worker in palliative care explained to me that Canadians are very confused by the bill because the definition of palliative care is medical assistance in dying. This bill is the same thing. They are begging the question, does the government think that palliative care and assisted dying as in the bill are one and same.

Janet from Cobden said it best: “Real medicine does not kill. Real medicine alleviates suffering without eliminating the one who suffers.” She asks if I am “okay with corrupting real medicine to allow for this abuse to occur? The court made a fundamental error in making this decision.”

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Madam Speaker, the question I have heard twice today from the opposite side is this. Is it better to have a law today than not having a law? Are we telling people we are going to pass the bill for assisted dying today because it is cheaper than assisted dying tomorrow? Why can we not ask for extra time and make sure that we get the best bill possible? I would like to see if my hon. colleague would be able to comment on this.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Madam Speaker, through the correspondence I received, many people, as they were from Ontario, are skeptical that the whole bill has little more to do with saving the provincial government money in health care costs.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Madam Speaker, it is a pleasure to speak to the bill today in the House of Commons and share my time with the hon. member for Renfrew—Nipissing—Pembroke.

I am pleased to rise in the House today to speak to the legislation, as I said. I have had the honour of being a member of Parliament since 2004. I can honestly say that this is one of the most sensitive and controversial pieces of legislation that I have spoken to in the House. This is an issue that many Canadians have very strong opinions on, so it is very important that throughout this process we respect all sides and ensure that we can come up with the best legislation possible, which responds to as many concerns as possible.

Today I would like to share some of my personal opinions on the legislation, as well as the expressed opinions of my constituents, many whom I have heard from. My vote on the bill will be based on what my constituents want and what my own conscience is telling me.

I recently wrote an op-ed in my local newspapers and distributed it to all media in the riding to connect with and consult with my constituents on the bill. I asked them to send their concerns to my office so that when I vote on the bill, I can be confident that I am voting in a manner that represents the views of my constituents. As of right now, the majority of my constituents, almost 80%, have told me to vote against the legislation. I want to point out that some of them are totally opposed to the bill and some would support some small amendments but are against it in its current form.

Emails and letters are still coming in as we speak. The main concerns that have been presented by those who disagree with the bill are the need for further protections for the vulnerable, further protections for the conscience rights of health care workers, and the need for an improved national palliative care strategy.

I share many of the same concerns as my constituents. It is absolutely vital that there are safeguards for those who are vulnerable. For me, this includes three different groups of people. The first group would be children. We need to have a more robust discussion and study whether children under 18 years old should be allowed access to physician-assisted dying and who has the authority to make that decision.

Second, it is paramount that those who have debilitating diseases, such as Alzheimer's, have a number of safeguards to ensure that they have fully consented to physician-assisted death while they were in a sound state of mind. The bill, as it is currently drafted, has a number of important first steps, but I feel it could go much further. The question is simple. Are there enough safeguards? Are we certain that we have it right?

I appreciate the work that was done by the special committee that was struck to hold consultations before drafting the bill and also the work done by the justice committee. This has been a very one-sided and rushed process. When it comes to protecting the vulnerable, I do not want to leave any stone unturned. A matter like this deserves an intense and lengthy study by parliamentarians, all parliamentarians. It is very disturbing to know that at this point the government is not willing to have that full debate.

Furthermore, it was made very clear in the House last night that the government is not willing to even entertain the notion of adopting any amendments, and that is wrong. On such a sensitive matter, it would have been my hope that the government would take a more sincere approach to working with other parties in an attempt to get the bill right.

A number of important amendments that would have addressed some very serious concerns were voted down by the government last night. I was deeply disappointed to see partisanship take precedence over common sense. It was refreshing to see some individuals, in all parties, vote according to their consciences and beliefs. That does not happen enough in this place, so I thank those members.

Finally is the question of whether the bill would allow those with mental illnesses to have access to physician-assisted death, as expressed by some of my colleagues. I would be very troubled if this was the case. It is my firm belief that mental illness is, in fact, an illness.

That being said, I would find it very troubling if an individual who was suffering from a mental illness had access to physician-assisted death. Mental illness quite possibly could mean that someone in a very poor state of mind, to use that terminology, could ask for assisted suicide when he or she would in all likelihood maybe not make this choice if in a sound state of mind. I believe this would send a wrong message to others suffering from mental illness. I am afraid that it would encourage more suicide, assisted or otherwise.

There are many groups in my riding who have put in a tremendous amount of work to combat mental illness and educate those suffering with mental illness that help is always available. We need to send that message that help is always available. Being able to seek physician-assisted death for a mental illness would, in my mind, run counter to this work. This is another area that deserves much closer study so that we as members of Parliament can be confident that the bill would not allow this.

Furthermore, National Nursing Week was only a few weeks ago. In light of this, it is very important to reiterate that we need robust protections for the conscience rights of health care professionals. Last night, the government had an opportunity to recognize the conscience rights of health care professionals, but chose not to take it. An amendment proposed by my colleague, the member for Sherwood Park—Fort Saskatchewan would have recognized that medical practitioners and health care professionals are free to refuse to provide direct or indirect medical assistance in dying. Unfortunately the government voted against this amendment.

The Charter of Rights and Freedoms states, “Everyone has the following fundamental freedoms”. What is first on that list? It is freedom of conscience and religion. I urge the government to put partisanship aside and recognize the charter rights of health care professionals. No one should be forced to perform any task that goes against his or her freedom of conscience or beliefs.

I am not trying to reopen a previous debate held in the House, but I have to use an example that is very similar to the point that I am trying to make right now. Therefore, I would compare this to ministers or clergy who do not believe in performing same-sex marriages. Freedom of conscience and religion are fundamental freedoms that protect individuals who do not wish to take part in something that runs counter to their beliefs. This same kind of thing is not in the bill. Simply put, someone should not be required to participate in something or provide any service that she or he does not believe in. This must be an important consideration in designing the regulatory framework. Again, I wish that we had more time to hear from concerned health care professionals about this.

I would like to conclude with a comment on the timeline of this issue, and voice my concerns around putting forward legislation in such a rushed manner.

As I said earlier, I have been a member of Parliament since 2004, and in that 12 years that I have spent in this place, this bill is near or at the top of the list of the most intense and deeply sensitive matters I have spoken to.

I fully recognize, as we all do in the House, the limitations on the orders that come from the Supreme Court. However, having said that, rushing through the bill and getting it not right is not worth the sake of a few days or weeks, whatever it takes. I urge all members to think about that. June 6 is a date that everybody has hard ingrained in their minds, but I am quite sure the courts would allow flexibility.

Let us take the time and do it right. Given the sensitivity and public concern with this issue, I do not think that it is appropriate or prudent to rush through this process. I fully understand that there is a stated deadline, as I said, that the court has given Parliament to have it done. However, with this in mind, once again I have to point out that I have a number of concerns with the Supreme Court's limiting the ability of members of Parliament to have the time to have a robust debate and to allow for a more intense study of this important issue.

On too many instances I have heard some members say they will just have to revisit this in the future or they will revisit that part of it, as if they are admitting that this is a flawed bill, and it is a flawed bill. As members of Parliament I do not think that we can—

[The Assistant Deputy Speaker, Carol Hughes]

Excuse me, I am sorry. The time is up.

Questions and comments, the hon. member for Fleetwood—Port Kells.

[Ken Hardie, Liberal, Fleetwood—Port Kells, BC]

Madam Speaker, I thank the two previous speakers because between them they laid out the essence of the challenge facing the House in coming to a reasonable decision on this.

It is very difficult to get something as complex as this right the first time, and I can appreciate why the previous government basically backed away from this kind of process, because it did have the better part of the year to deal with the consequences of the Supreme Court decision.

Particularly regarding the preamble, I would like to ask a question of the hon. member. It says:

Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms; Whereas nothing in this Act affects the guarantee of freedom of conscience and religion;

Furthermore, this morning I had the opportunity to ask the Minister of Health whether or not that extended to the freedom not to refer somebody ahead. What additionally would the member prescribe that would provide the kind of comfort that he seems to ask for in terms of medical practitioners?

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Madam Speaker, I think it is very clear and obvious that the government, the minister, is trying to pretend that safeguards for health care professionals, doctors, etc., are there and they are protected. It is clear to most Canadians, including a lot who voted for the government, that the safeguards are not in place.

I find it ironic that a few weeks or months ago we were all saddened to hear about the rash of suicides in Attawapiskat, and all of a sudden we switch gears and we are into a bill that is basically suicide in another form.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Madam Speaker, I heard my colleague from Bruce—Grey—Owen Sound talk with great passion about the issue of mental health.

He also talked about the amendments that had been proposed. A very logical amendment to me was that someone perhaps with cancer who had an underlying mental health issue would have a psychiatric assessment as part of their decision-making. I was really surprised that something that seemed so important and logical as having a psychiatric assessment was turned down in the House. I am just wondering if my colleague would make some comments on that particular issue.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Madam Speaker, my colleague and friend raises a very good point.

Another safeguard in the bill, which I spoke to in my speech, is to make sure that when people make the decision, if it comes to that in their life where they want to have assisted suicide, their decision is made in a strong state of mind.

The condition that could have put that in place in the bill was an amendment that went before the House last night and was turned down by the government. Why? It just looks like partisanship. The Liberals figure they got it right the first time and they will not listen to anyone when they say the opposite. It showed last night that they are not willing to listen to any advice on the bill and that is very disappointing.

[Jane Philpott, Liberal, Minister of Health]

Madam Speaker, I am going to be splitting my time with the member for Surrey Centre.

The topic we are addressing today is a solemn one. As a result, the past few weeks have been emotional for all parliamentarians, myself included, as we have wrestled with the matter of assisted dying.

The government had the responsibility to respond to the Supreme Court decision that was made in February 2015. I joined my colleagues in addressing that responsibility after we formed government in November 2015. Thus, in the very short time since forming government, there has been an incredible amount of work by officials and parliamentarians, with input from Canadians with a diverse range of views.

Before us today is a legislative framework that we believe is the right approach for Canada. It is transformative. It would forever change the range of options that Canadians would have as they approach the end of their life. I would like to reflect on the principles that make up the foundation of our government's legislative approach in developing the legislation that is before the House today.

First, it is about the principle of personal autonomy, in helping people to write their own story, in a sense, in providing Canadians with access to medical assistance in dying, for the Supreme Court made it clear to us that Canadians must have that access.

We have the responsibility to abide by the Charter of Rights and Freedoms, and we have the responsibility to put forth legislation that respects the decisions of the Supreme Court of Canada. This legislation before the House today, if passed, would do just that.

The legislation also respects the principle of the inherent value of life. It is written, therefore, with appropriate safeguards that would protect vulnerable individuals. It would also firmly uphold the conscience rights of health care providers.

Over the past several weeks and months, I have had conversations with members in this chamber from all sides of the House. The Minister of Justice and I have appeared at committees in the House and the Senate. I have personally had numerous meetings and phone calls with many interested advocates, in addition to the witnesses whom committees have heard on this particular legislation.

It is worth noting today that the professional bodies that represent health care providers are supportive of this legislative approach. These include the Canadian Medical Association, Canadian Nurses Association, Canadian Pharmacists Association, and HealthCareCan, which represents our nation's hospitals and academic health sciences centres.

Just today, parliamentarians received an open letter from 36 organizations representing the vulnerable, including the Canadian Association for Community Living, which has come out in support of this bill. Each organization may have continued areas of interest in which they wish to seek clarifications or undertake work with my department or with provinces and territories so that they can properly work with their members on implementing assistance in dying.

As I have said in the past, this is an iterative process. It is why not only would we study further potential areas of assisted dying within a short period of time, if the legislation passes, but there would also be a parliamentary review of this important legislation.

Let us discuss the matter of timing. The Supreme Court of Canada gave our government an extension to put a legislative framework in place by June 6. Before going further, allow me to say that I respect the roles and responsibilities everyone has here as parliamentarians, as well as the responsibilities that senators hold in the upper chamber.

There is a good reason for all of us to want to reflect upon and investigate this legislation in a thoughtful manner on behalf of Canadians. The reality is that we are facing a finite amount of time before there is a legal void, an absence of legislation to address the matter.

Despite what some may say, there are real and very serious challenges if there is no legislative framework in place. As I said yesterday, there is a real risk that there could be no law in place by June 6. It is important to underscore what is at stake.

First, organizations like the Canadian Medical Association and the Canadian Medical Protective Association have made it clear that they believe there is a vast majority of doctors who would not participate in assistance in dying without a legislative framework, despite the protections that some say the Carter decision provides.

Doctors are being advised by the appropriate associations to seek legal counsel before proceeding with any form of assisted dying, including consulting patients, and this would pose significant access issues and result in a situation where the Supreme Court's decision is not being realized.

Second, it would be illegal for any other health care providers to offer assistance in dying. That means that nurses, pharmacists, social workers, and other providers recognized by amendments passed at committee would face no legal protection. In particular, pharmacists who are needed to dispense medications required for medical assistance in dying require clarification.

Finally, there is the possibility that some could receive assistance in dying without a legislative framework in place, who would not otherwise have been eligible under the government's approach. This means, for example, the risk that someone facing severe depression could seek assistance in dying and that the safeguards to protect that individual would be inadequate or nonexistent.

I also want to remind members that medical assistance in dying is unlikely to be the choice for the vast majority of individuals at the end of life, and at its core our health care system is there to keep Canadians healthy. Canadians should have access to high-quality palliative care. This is something to which I have been, and will continue to be, committed to addressing with our provincial and territorial colleagues, along with the delivery of our government's platform commitment of $3 billion for home care.

Our government put forth this legislation that would transform end-of-life care options for Canadians. It is an approach that respects their rights under the charter, protects our most vulnerable, and considers the needs of health care providers.

I want to thank my fellow parliamentarians for their attention to the bill. Many of us are new to this role, and this is no small matter that we have been asked to address on behalf of the 36 million Canadians whom we represent. I thank them for engaging in the conversation with respect and dignity. I thank them for doing their utmost to consider the perspective of others, even if it differs greatly from their own. I thank them for the serious discourse we have undertaken in a situation where it is likely impossible to write legislation that would entirely satisfy every diverse view.

Recognizing our responsibility to implement legislation, I urge members to support Bill C-14 for today's final vote. I look forward to working with the Senate, if the House wishes to proceed to the next stage of our legislative process.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Madam Speaker, I would like to acknowledge the very difficult job the Minister of Health has had in crafting this piece of legislation.

The one piece of the bill that I find very bothersome is the $3 billion commitment to palliative care. I know the Liberals argue that they have to work out a deal with the provinces in health accords.

There are many items in the budget, and I could pull out five or six where commitments have been made in the budget and all the t's and i's have not been crossed and dotted. Why was the money for palliative care not in the budget this year? Does the minister not believe that the government could work something out with the provinces and territories in a timely way on such an important issue?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Madam Speaker, one of the themes we have heard many times in the House is the importance of Canadians having access to high-quality palliative care.

As my colleague knows, health care delivery lies largely in the domain of provinces and territories. I have been impressed with the work of my colleagues, the ministers of health in those jurisdictions, and I will continue to work with them. We look forward to establishing a health accord that will provide further investments to enhance the work they are already doing in the area of palliative care.

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

Madam Speaker, when we asked Department of Justice and Department of Health officials to identify the legal or legislative basis for the reasonably foreseeable natural death clause, they referred us to the minister. I am not yet convinced that this clause, which nobody really seems to understand, is necessary.

Can the minister tell us why such a vague clause was included in such an important bill?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Madam Speaker, the member's question is one we have heard before, and I am pleased to answer it today.

As the member knows, we were asked to establish legislation on the matter of medical assistance in dying. The Carter decision included language around grievous and irremediable conditions. In drafting the legislation, it was felt that there had to be further clarification, which has been supported by health care workers who, in one sense, did not want to be limited by a particular deadline to say it is expected that a person is within six months of dying.

This is a piece of language that has been supported to respect the professional opinion of health care providers who know when a grievous and irremediable condition has reached the point that death is reasonably foreseeable.

[Sean Casey, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I have two quick questions.

If we do not have legislation in place by June 6, or if there is a gap, what happens to the process that is presently available for patients to apply to a court to be granted medical assistance in dying?

Second, if we do not have a bill in place by June 6, or if there is a gap thereafter, will medical assistance in dying be available to people who do not have a health card and who are not covered by medicare?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Madam Speaker, I urge members of this House to understand the seriousness of the matter of a legal void, which might exist. I recognize that some have argued that this is not an important point, but I want members to understand that, if what is important to them is that Canadians have access to medical assistance in dying, the best way to do that is to support this legislation. Without it, health care providers require further clarification. They are being advised to seek legal counsel. There will be serious problems with accessing medical assistance in dying.

I am also concerned about the other end of the spectrum, where patients might access assistance in dying without adequate safeguards in place.

My colleague also raises the matter that the legislation makes it clear that this assistance in dying is available for Canadians who are otherwise supported by our universally funded public health insurance plan. There would be serious concerns about whether or not there would be access to assistance in dying for people who do not fall into those eligibility categories.

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

Madam Speaker, for both the Minister of Health and the Minister of Justice, with real sincerity, I know how difficult this has been. I think all Canadians are grateful for the care in the approach. However, that does not change the result right now, today, as I do not feel I can vote for Bill C-14.

It grieves me to say so, but I do not believe Bill C-14 is compliant with the Carter decision. I see this as a strange conflict in a sense between two professions in Canada: the legal community and the doctors. I know what the doctors want from Parliament, and I know what the legal community is telling us. As a trained lawyer, I do not see how Bill C-14 is compliant with Carter.

Because future judges will read these debates for guidance, how on earth could Kay Carter access medically assisted dying under Bill C-14?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Madam Speaker, as a health care provider, it is my understanding and belief that people like Kay Carter would be able to access assistance in dying under this legislation.

Also, I would refer the member to the Minister of Justice and the documents she has presented in this House, which affirm the fact that this legislation meets the requirements of the Charter of Rights and Freedoms. I look forward to further conversations to support that.

The House resumed consideration of the motion that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the third time and passed, and of the amendment.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Mr. Speaker, I am pleased to participate in the third reading debate on Bill C-14, which would provide a federal framework on medically assisted dying. As acknowledged by many in the House in the last number of weeks, medical assistance in dying is a complex, challenging, and deeply personal issue for us all.

Since the Supreme Court of Canada rendered its unanimous decision in Carter last year, it has been discussed by many Canadians in different settings from coast to coast to coast. The issues continue to be debated and thoughtfully discussed worldwide, from the United States to Europe to Australia and New Zealand. Almost everywhere in the world, the act of ending one's life deliberately and the act of helping someone to end their life are serious crimes punishable by severe sentences.

Nevertheless, Canada is not alone in creating a legislative regime to permit medical assistance in dying. There are four American states, Oregon, Washington, Vermont, and California, the country of Colombia, and the three European countries of Belgium, the Netherlands, and Luxembourg that currently have legislative regimes that allow some form of medical assistance in dying.

These different international regimes share similarities, especially with regard to safeguards, oversight, and reporting, most of which are included in Bill C-14. These similarities are as follows: requests for medical assistance in dying must be in writing, made voluntarily by the patient, and in many cases witnessed by independent witnesses; a second opinion from an independent physician must be sought; and a delay or reflection period between the request and the actual provision of medical assistance in dying is required.

Colombia has a unique approval process for medical assistance in dying. It involves interdisciplinary committees within each hospital that assess requests and support patients and their families throughout the process.

In addition, almost all international regimes have mandatory oversight systems involving independent national or regional committees and government agencies or departments, which collect and process data in order to properly monitor medical assistance in dying. They make annual or biannual reports on medical assistance public in their respective jurisdictions. This evidence was critical to the Supreme Court of Canada's analysis in the Carter litigation.

Unlike the fairly consistent approaches, the safeguard and oversight that we see in other countries, the various laws take two different approaches with regard to both: one, the form of medical assistance in dying that is permitted; and, two, the medical circumstances under which it can legally be provided.

One could describe the different approaches with regard to eligibility and the form as being a spectrum. At one end of the spectrum stands the four American states that enacted the legislation, starting with Oregon in 1997, Washington in 2008, Vermont in 2013, and most recently California, just last year.

In these states, a mentally competent adult aged 18 years or older can obtain the assistance of a physician to die, only if their request is voluntary, and if they suffer from a terminal disease, which is defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.

In the U.S. states, the physician is only permitted to provide the patient with a prescription for a substance that the patient must self-administer at a time of their choosing. This is commonly known as physician-assisted suicide.

What is commonly called euthanasia, where the physician administers an injection to the patient, is expressly prohibited in these states. Advance requests are also not allowed.

While these legislative measures in the U.S. accommodate individuals suffering from diseases that cause a steady, rapid, and predictable decline toward death, such as some forms of cancer, they do not accommodate other conditions, including some degenerative diseases that are enduring and predictable, nor do they enable patients who are physically unable to self-administer a substance to access a medically assisted death.

The Colombian regime, which was developed in response to two rulings from its Constitutional Court, has eligibility criteria similar to that of the U.S. states. It limits eligibility to adults who have a terminal illness, defined as a progressive and irreversible serious condition or pathology that will cause death within a relatively short time frame. It does not require the person to have a prognosis of six months, but it does require that death is expected in the short term. Unlike the American states, Colombia only permits a physician to administer a substance that causes a person's death. However, Colombia's regime does permit a patient to prepare an advance request for medically assisted death, which is not permitted in the U.S.

At the other end of the spectrum, there is Belgium, the Netherlands, and Luxembourg, known as the “Benelux” countries. In these three northern European countries, patients are eligible for medical assistance in dying if they have “intolerable” or “unbearable” physical or psychological suffering resulting from a serious and incurable medical condition where there is no prospect for improvement. Eligible individuals do not need to be dying or suffering from life-threatening conditions. Both physician-assisted suicide and what is commonly called voluntary euthanasia are permitted in these countries.

While advance requests are permitted, there are some differences between the Benelux states. In Belgium and Luxembourg, advance requests can only be carried out where the patient is in a state of irreversible unconsciousness, while in the Netherlands, advance requests are also permitted where patients are unable to express their wishes but are conscious, such as for persons with dementia or Alzheimer's.

While medical assistance in dying is only available to adults in Luxembourg, children as young as 12 years of age can request medical assistance in dying with their parents' consent in the Netherlands. In Belgium, adults and emancipated minors can request medical assistance in dying for the same kinds of conditions. In 2014, Belgium extended eligibility to minors of any age, but only where they are likely to die in the short term and where their suffering is physical. Additional safeguards must also be met.

The experience and lessons from the Benelux countries have been closely examined. For example, in the Netherlands, while the legislation permits advance requests for patients who have lost their ability to express their wishes, Dutch research suggests that physicians are generally unwilling to provide medical assistance in dying, due to the inability of these patients to comprehend their medical condition and their inability to express informed consent.

The government has sought to learn from the experiences of other jurisdictions. The proposed legislation is broader than the U.S. state approach, which only permits those with a fatal disease to access assistance. Instead, Bill C-14 provides the option of a peaceful death to everyone who is in decline toward the natural end of their life, not just those who suffer from fatal diseases or terminal illnesses. At the same time, it avoids some of the risks that the Benelux-style regimes might present, although such broader questions, and the experience of other regimes around the world, will continue to be studied.

I urge all members to support this incredibly important bill to answer the call of our Supreme Court to legislate in this area.

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

Mr. Speaker, I very much respect my colleague from Surrey Centre's rather broad survey of some of the jurisdictions around the world that have brought in medical assistance in dying. I particularly appreciated his detailed analysis in terms of giving us a framework in which we could construct our particular legislation that is currently before the House.

My question to my friend is this. We have certainly heard comments coming from the government, particularly from the Prime Minister, that have suggested that this particular legislation is simply an initial step. Are there aspects in some of the research he has done with respect to the other jurisdictions that he thinks would be helpful in contributing to the dialogue moving forward?

[Randeep Sarai, Liberal, Surrey Centre, BC]

Mr. Speaker, there are certain aspects. I think the balance is going to be how open we can make this process, or how narrow it can be. There is always a fear of making it too broad, and on the other hand making it very restrictive for people who need this right so they are able to access it.

The other process that will be very important is to see what gaps might be in the system. Certain diseases or conditions might not be addressed properly in the legislation now, but as we monitor California, Vermont, and the various U.S. states, along with the Benelux countries of Belgium, Luxembourg, and the Netherlands, we can see where the gaps have been addressed and where they have come up in the courts. I hope that this House, along with the Minister of Justice, can address those from time to time as they arise.

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

Mr. Speaker, last evening in the House, we saw the reluctance on the part of the majority of the Liberal Party to include effective conscience protection for medical professionals and institutions that provide health care to Canadians. We do know that two colleges have already indicated that they expect their doctors, even if they are opposed to physician-assisted suicide, to make an effective referral to have physician-assisted suicide carried out.

My question to my colleague is, why would he and his party not realize the importance of allowing a medical professional with years and years of professional training, who opposes the idea of helping someone to die early, to have conscience freedom? Why would he oppose the aspect of having conscience freedom for medical workers, and also for the institutions that are providing very effective health care for our Canadian population?

[Randeep Sarai, Liberal, Surrey Centre, BC]

Mr. Speaker, I thank the member for his question, and I am glad that both sides of the House take this issue very seriously.

My understanding is that the bill and the preamble were already amended at the committee stage. The individual is protected, except for the institutions. I think the matter was already addressed, and that is why many members did not support that amendment. The matter has already been addressed in the preamble as well as the bill itself.

[Anthony Housefather, Liberal, Mount Royal, QC]

Mr. Speaker, I very much appreciate the excellent speech by my friend from Surrey Centre, and I want to reiterate what he said. Both in the bill and in the preamble, there are conscience exceptions for individuals, which was agreed to by all members of the committee.

However, many members are concerned about advance directives. The committee said that studies would begin within six months. However, one of the things that is very important to note is that advance directives, even in the one country that allows it for people with dementia and other declining illnesses, is not really carried out. In the Netherlands, given the concerns about what someone's wishes actually are at the time of death if they have dementia, almost nothing happens.

I wonder if my colleague would confirm that he also agrees that this matter requires further study before we would ever implement it.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Mr. Speaker, I agree with the member. An advance directive is an issue that we need to study, and even six months might be a short period of study. I think a longer period would be needed to address such concerns.

We need to see how it would be carried out. Only after that has been looked at should we think about advance directives. It is a subject that needs a lot of comprehension. I think it would be hard for a person to make that directive initially, without guidelines and safeguards around it.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, I will share my time with my colleague the member for Carlton Trail—Eagle Creek.

This is a very difficult time in my short political career, because it is a sensitive subject that should be free of partisanship. All opinions are right, and no one is wrong. We are all good Canadians of good conscience, and we are looking for the best solution on such a sensitive subject.

When it comes to this subject, we are not here to try to convince anyone; we are here to explain our point of view. According to the Supreme Court’s decision in the Carter case, it is not a matter of determining whether we are for or against medical assistance in dying, but of determining how we will apply it.

Here we are at the final reading of Bill C-14. At my leader’s invitation, I had the privilege of participating in the parliamentary committee that studied the matter and produced a main report and a dissenting report. My official opposition colleagues and I signed the dissenting report, while my Conservative colleagues in the Senate signed the main report. This shows that there was no partisanship in our approach.

In our dissenting report, we raised five major concerns. Most of them were noted by the government and are reflected in Bill C-14. We were against the medical assistance in dying bill applying to minors; the government listened to us. We were against the bill applying in the case of mental illness; the government listened to us. We wanted complete openness concerning conscience protections for physicians and institutions; the government listened to us in part. We also wanted a clear commitment from the government concerning palliative care; the government listened to us in part.

On another note, I salute my colleague from Sarnia—Lambton, who introduced Bill C-277 in the House almost exactly 24 hours ago. The aim of this private member’s bill is to force the government to make a firm commitment to provide the necessary palliative care to as many Canadians as possible. As we know, only one-third of Canadians have access to that type of care. With Bill C-277, we want that to be enforced.

Those are the elements of Bill C-14 that we consider positive or semi-positive. Now here are the things that are of great concern to us.

First, there is the famous definition of reasonably foreseeable death. For us, this makes absolutely no sense. “Reasonably foreseeable” means both everything and nothing. I am going to die some day. That is reasonably foreseeable, of course, but it means absolutely nothing. From sage experience, Quebec used the expression “end of life”. That is at least clearer.

There is also the matter of nurse practitioners, who have the same decision-making powers as physicians under the bill. I have tremendous respect for nurses, and I know what I am talking about, since they are often the first people, and sometimes the only people, who see us when we are in hospital. However, when it is a matter of life or death, and that is literally the issue here, I would prefer that physicians have the ultimate responsibility rather than the wonderful nurses.

The points I have just mentioned are based on Quebec’s experience. I know what I am talking about, because I was a member of the National Assembly of Quebec. We worked on and gave serious consideration to the issues surrounding medical assistance in dying for six years, whereas here in the House we had only a few months to do the same work.

Later, I will talk about an unfortunate statement we heard during question period.

Based on Quebec’s experience, we built our case for the dissenting report. The current bill includes some elements in full, others to some extent, and still others not at all. It is a fairly even balance of the positive and negative elements.

Then there remains the famous issue of constitutionality. Every bill that is put forward can be challenged. In fact, whatever bill was introduced, it would have been challenged by one group or another. For weeks, some people have been saying that it is constitutional, and others have been saying that it is not. Most of the people we heard from said that it did not make sense and that it did not comply with the Constitution or the Carter decision. However, this morning, in La Presse, if I remember correctly, three constitutional experts from three different universities, namely Laval University, the University of Montreal, and UQAM, said it was constitutional.

If we table a bill, we will hear a bunch of lawyers say that it is good and a bunch of lawyers say it is not good. This is the point, and we have to live with that. It is democracy. This is how it works in our judiciary system.

I say this with great respect for legal eagles. I know that there are some here, some prestigious ones in fact, and I salute them, including the member for Mont-Royal.

The charter issue is another interesting point. Some people say it complies with the charter, while others say it does not.

Let us try not to be too partisan. If we cannot rely on the Liberal government to draft a bill that complies with the charter, whom can we rely on? Do I need to remind anyone that it was the Liberal Party, under the leadership of the Right Hon. Pierre Elliott Trudeau, father of the current Prime Minister, who enshrined the Canadian Charter of Rights and Freedoms in the 1982 Constitution, signed some 300 feet from here by Her Majesty the Queen on April 17, 1982? We all remember that. The sky was overcast, and at the very moment the signing took place, there was a rumble of thunder. Just a brief history lesson.

Seriously, I am not the greatest fan of the charter, much less of the Liberal Party, especially not the Liberal Party, but good Lord, if we cannot rely on the Liberal government to draft a bill that complies with the charter, I wonder whom we can rely on.

The events are balanced. This bill has good points and bad points. Over the past 24 hours, three events occurred that are worth thinking about. First, yesterday we voted on 10 possible amendments and they were all defeated by the Liberal majority. I commend the government members who voted against their party's position for their courage, honour, and dignity. Well done.

However, I believe that two of those amendments, both of them introduced by the member for St. Albert—Edmonton, were essential.

The first amendment protected the most vulnerable members of our society by proposing that people undergo a psychiatric assessment before giving their consent. We think that is extremely important because protecting the most vulnerable members of our society is essential. Nevertheless, the government voted against that amendment.

The second amendment had to do with conscience protections for institutions. I speak on behalf on my friends from Quebec when I say that, in Quebec, institutions such as hospitals are secular. However, outside Quebec, some institutions are religious and act according to the dictates of their conscience. We need to protect their conscience rights, but this bill does not do that. We proposed that amendment, but the government voted against it. That is unfortunate. The government refused to accept amendments.

Moreover, this morning, Quebec's health and social services minister, Gaétan Barrette, made a statement. I know the guy. He is honest, hard-working, conscientious, and a man of integrity. He is also a medical specialist who was once an administrator and is now a minister. Speaking on behalf of the government of Quebec, he said:

I myself am disinclined, for governmental and professional reasons, to support C-14 because of its worst feature: reasonably foreseeable natural death. That makes no sense. It cannot be enforced. I would be very hesitant to get on board C-14 as it stands...

He added that the bill is very off-putting, that this is a bad clause, and that it is [too much] of a minefield for him.

The third element applies to the Prime Minister's statements in question period today. He said he is working with the provinces on this, but that has no basis in fact. Worse still, he said, “we drew a great deal of inspiration from the reflections of the Quebec National Assembly”.

I can tell you one thing. I sat in the National Assembly. I was there for the six years that this was being studied. What we have seen here in the past six months does not resemble in the least what took place in the National Assembly.

I will not revisit the unfortunate events that took place two weeks ago when there was to be a vote to restrict our right to speak. I will look at the overall process. Unfortunately, the government did not follow the example set by the National Assembly in terms of either substance or form.

Consequently, bearing in mind the positive and negative elements of the bill and the three events that have taken place over the course of the past 24 hours, that is, the vote against the amendments, which were all rejected, the statement by the Quebec minister of health and social services, and the misleading statement by the Prime Minister of Canada, I will be voting against this bill.

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

Mr. Speaker, I am going to be honest. I agree with a significant part of what the member has said today. I was one of the members on the government side who actually voted with the opposition on some of the amendments that were brought forward, including the one that related to protections to ensure there was an appropriate medical opinion when there was a question with respect to capacity in the case of someone with a previous mental health condition.

I want to get to the other issue that was advanced, and that was the one with respect to dealing with institutions. I did not support that amendment and I want to say why on the record. I felt the provision should not appropriately fall within the Criminal Code and that, in fact, there was a more appropriate type of response through our regulatory colleges at the provincial level. I think this is why the government side overwhelmingly rejected that provision.

I want to get back to the question my friend talked about with respect to reasonable foreseeability. I share some concerns that have been raised by members on the other side with respect to reasonable foreseeability. What would the member suggest would make this provision clearer, particularly as it relates to setting a clear legal standard as guidance for physicians who would have to operate under this provision?

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, because as the minister of health in Quebec said, it is unpractical. We cannot deal with that. I will say this in French because it is very difficult for me to say in English. It is raisonnablement prévisible. It is everything, but nothing. This is why we have to be clear.

As in the Quebec experience, it was crystal clear, end of life. That is why we suggest this. By the way, this is why all of our amendments were based on the Quebec experience. In the Quebec experience, there were six full years of studious work, which is not the case here. This is why the government should have followed the lead of the National Assembly of Quebec, which is not the case. This is not what the Prime Minister said.

Let me be clear. The bill is not perfect, but we all recognize that on June 7 there will be no law because the Senate will not have had enough time to adopt the bill. Therefore, I think the Conservatives will vote against the bill.

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Mr. Speaker, I wonder if the member could speak to the issue of nurse practitioners. I do not know if he has had the opportunities I have had in my life. For example, I worked in Yukon. One of my friends is a nurse practitioner in one of the small towns in Yukon. Over time nurses were given expanded powers to do various things, like stitch people, and so forth.

Who will have the responsibility for enabling a patient who is seeking medically assisted death to have access to a physician and who will pay for that patient to go to where there is a doctor, or for the doctor, or doctors, to go to where the patient is in isolated communities?

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, that is a very serious question. First, I want to repeat that I have great respect for nurses, and I pay them a great deal of respect. However, my argument was based on the Quebec experience.

Quebec had exactly the same issue. It is not the Yukon, but le nouveau Québec, which is in the far north, was facing exactly the same issue and the same difficulties as Yukon. We are not talking about someone who has had a car accident and we have to make a decision immediately. We are talking about people who suffer and have a lot of time, maybe too much time, to think about it. It is not a question of hours or days; it is a question of months.

We would prefer to have an analysis from physicians instead of nurses. I must repeat that I have a lot of respect for the nurses in Yukon, in Montreal, in Quebec, in Ottawa, and from coast to coast.

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

Mr. Speaker, it is a privilege to rise in my place today and add the voices of my constituents to the debate on Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, regarding medical assistance in dying.

I want to begin by telling this House that, in the almost nine years that I have been a member of this place, I have not been asked about or received as much correspondence as I have on the matter of physician-assisted suicide. It is clear that Canadians and members of this House have varied and deeply held beliefs and convictions on this issue, which have been informed by our life experiences. We members also have a responsibility to balance our personal beliefs with those of our constituents and the incredible wealth of knowledge they share with us. The widespread reaction to this short debate in Parliament confirms my belief and, I believe, the belief of my colleagues that physician-assisted suicide represents the defining issue of this Parliament.

Bill C-14 would have the most lasting impact on Canadians and the social fabric of our society because each one of us could at some point see someone we know struggle with such a decision. My constituents' opinions on this issue have been genuine, considered, and informative, with a clear majority opposing physician-assisted suicide. I am pleased to inform them that I share their views. I believe in the inviolable dignity of all human life, and that it is to be protected by law from conception to natural death. Therefore, I have opposed and will continue to oppose any attempt to legalize euthanasia or physician-assisted suicide.

I have grave concerns with the process surrounding the introduction and passage of this bill. I am cognizant that Bill C-14 is now at third reading and that many members are still grappling with how they will vote later today. I hope all members will be able to vote freely, as Conservative members will be able to do.

This legislation was first introduced in this place on April 14, less than two months ago. Passing a bill in a month and a half is a challenge under any circumstances, but passing a bill of this magnitude and in this amount of time is reckless and demonstrates a complete disregard for the significance of this issue to all Canadians. As my colleague from Lethbridge noted in her earlier remarks, the Supreme Court of Canada has sent Parliament into an unending abyss of grey, and each day parliamentarians are being tested on the future limits of this legislation as one what-if leads to another. I do not believe that all the impacts of this bill can be assessed in such a tight timeline, as this truly is a new moral space for Canadians to contemplate.

Like many of us here, I am concerned that minors may eventually be able to obtain medical assistance in dying. I am concerned for the well-being of those struggling through mental illness because, quite frankly, we as a country are only now beginning to recognize and understand its reach and impacts on so many. As well, I am concerned with the notion that doctors who for legitimate reasons of faith or conscience oppose medical assistance in dying would be forced to participate in this process contrary to their personal ethics.

While the government has presented us with a bill that is much narrower in scope than the recommendations made by the special committee, stakeholders on both sides of this issue have raised many what-is-next questions. These have not been answered, and I am therefore disappointed that consultations and debate on Bill C-14 are ending prematurely.

Many of my constituents have suggested that the government should consider using section 33 of the Charter of Rights and Freedoms, the notwithstanding clause, to prevent physician-assisted suicide rather than rushing a bill through Parliament that appears to fully satisfy no one. I want the government and my constituents to know that I would support using the notwithstanding clause to prevent the Supreme Court's decision in Carter v. Canada from having any effect. While I am not a constitutional expert, I assume that section 33 was included in the charter because the prime minister and the premiers of the day wanted to affirm that a democratically elected federal Parliament and provincial legislatures, and not the judicial branch, would have the responsibility to pass laws on matters of public policy.

By refusing to invoke the notwithstanding clause, the government is prematurely ending our deliberations on this bill, and consequently removing many voices from the discussion.

Parliament should be passing laws that the courts then interpret within the charter. Courts should not be telling Parliament what laws it needs to pass and by when they must be passed.

I do not believe that former premier of Saskatchewan Allan Blakeney would have signed the charter without the presence of the notwithstanding clause, as it protected the rights of Saskatchewan's legislature to override a court decision with which it might not agree.

Then prime minister Pierre Elliott Trudeau agreed when he said:

...it is a way that the legislatures, federal and provincial, have of ensuring that the last word is held by the elected representatives of the people rather than by the courts.

Former prime minister Jean Chrétien, who was at the time Canada's justice minister, made a similar comment:

The purpose of an override clause is to provide the flexibility that is required to ensure that legislatures rather than judges have the final say on important matters of public policy.

If physician-assisted suicide is not an issue for the Parliament of Canada to invoke section 33, what is?

Liberal members have continuously used the June 6 deadline as justification to pass the bill quickly, yet I would posit that the notwithstanding clause exists precisely so that Parliament, and not the courts, can set the timeline on important matters of public policy. At the very least, the government could have used this clause to give itself more time to consult Canadians and draft legislation that conforms to the court's decision and protects life.

Quebec's National Assembly took six years to develop its legislation on physician-assisted suicide, yet the Supreme Court only gave the federal government a total of 16 months to put in place new legislation. Unfortunately, it is clear that using the notwithstanding clause is not an approach that the current government would even consider.

I will use my remaining time to address the issue of conscience rights for medical professionals.

I believe that opening the door to physician-assisted suicide is a slippery slope for our society. However, I believe that it is even more reckless if we fail to protect conscience rights in this legislation.

Without adequate protection for the conscience rights of medical professionals, Parliament, and more specifically the current governing party, is inserting the thinnest edge of the wedge when it comes to legislative disregard for conscience rights. If the current Parliament fails to respect these rights, we are setting a most dangerous precedent.

Precedents matter. Members might not be in the House or even alive to see the effects that the precedents set by passing Bill C-14 may have, which is why the protection of conscience rights today is so important.

I would have expected that most in this place would support conscience rights for medical professionals. I took at face value that the government included a mention of conscience rights in the preamble of the bill as an indication of its support for the principle, but the results of last night's vote demonstrated that this was not the case.

No one is a permanent or an eternal member of this place. Just like legislators in past parliaments, the only lasting effect we can have on the future is to be clear in our intentions through the laws we pass today. Therefore, it behooves us as members of the 42nd Parliament to be very specific in what is allowed and what is being protected with this piece of legislation.

In conclusion, our only legacy as a Parliament is what we pass into law. We have a responsibility to get this legislation right and ensure that all the issues that have been raised are addressed.

[Anthony Housefather, Liberal, Mount Royal, QC]

Mr. Speaker, I want to clarify that at committee we did adopt two amendments related to conscience; one in the preamble and one in the body of the legislation. In fact, the amendment put forward yesterday was one that was defeated at committee, because there was no agreement at committee that the institutions should avail themselves of these protections but that simply individuals should.

I want to come back to the comments on the notwithstanding clause.

The federal government has never used the notwithstanding clause. It has been used twice by provinces. It was used once by Alberta on same sex marriage, about which even my Conservative colleagues have changed their minds last weekend. More important, it was used in Quebec, which I personally experienced, on the language of signs. The Quebec government promised English-speaking Quebeckers that bilingual signs would be allowed, and then reversed itself and used the notwithstanding clause to tell our community that we had no place to be visible in our own province.

I would ask the hon. member, based on the Canadian experiences of the use of this clause—how an entire community felt their rights had been recognized in the court and then thrown out by their own government—how she could believe that we should use a notwithstanding clause in a case like this.

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

Mr. Speaker, the federal Parliament, a provincial legislature, or a territorial legislature may declare that one of its laws or part of a law applies temporarily, notwithstanding countermanding sections of the charter, thereby nullifying any judicial review by overriding the charter protections for a limited period of time.

The clause was a compromise that was reached during the debate over the new Constitution in the early 1980s. Among the provinces' major complaints with the charter was its effect of shifting power from elected officials to the judiciary, giving the courts the final word. As I said in my comments, premiers across this country, especially those in Alberta and Saskatchewan, believed it needed to be part of the charter to strongly object to a court overriding the laws they had put in place.

[Kevin Waugh, Conservative, Saskatoon—Grasswood, SK]

Mr. Speaker, regarding protection for institutions, you represented the Saskatoon West riding for many years, and in that riding we have a Catholic-based hospital called St. Paul's Hospital. Could the member tell me how the hospital is going to deal with this, in a Catholic-based hospital, when we have no protection for institutions like this in the country?

[The Assistant Deputy Speaker, Anthony Rota]

I am sure the hon. member meant the member for Carlton Trail—Eagle Creek and not me, the Speaker. I just remind the hon. member to speak in the third person. Thank you.

The hon. member for Carlton Trail—Eagle Creek.

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

Mr. Speaker, we have what we understand to be a faith-based facility providing health care in the city of Saskatoon. It is the St. Paul's Hospital. It has provided care to Saskatchewanians for many decades. Originally it was the Grey Nuns who provided the care, and now that facility is an affiliate of the health region in Saskatoon.

I would suggest that a faith-based facility would employ a number of medical professionals who would want to have their conscience rights protected, and the faith they express through the care they provide should also be protected. There would be deep concern if conscience rights for individuals as well as faith-based facilities would not be protected in this legislation.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, I will be splitting my time with the hon. member for Montcalm.

I am humbled by the opportunity to stand in the House to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying), at third reading. It is an important issue facing all Canadians.

Every time I come to the House, I come I wearing three hats. The first is the hat entrusted to me as a member of Parliament representing my constituents of Richmond Hill; the second is the hat of a legislator working hard to make the best decisions for all Canadians; and the third is the hat of an individual with his own convictions and beliefs.

Today, I will open my heart and share my thoughts, hoping to reach the hearts of all Canadians.

Let me start by acknowledging how challenging an issue this is. It is difficult for a person to engage in a conversation about death, yet our government has honourably taken on this responsibility.

On April 30, I participated in a York Region town hall, where a sizeable portion of the attendees were from Richmond Hill. They passionately spoke to this matter from all sides. I am inspired by the passion found within my constituency, and I would like to assure them, and all Canadians, that we are in this together.

I am sharing my story with the House, a story that complements the perspective of my constituents, and the work that we do in the House.

This is the story of my father's journey dealing with the inner turmoil caused by cancer. It is the exact reason why I am so passionate about the bill. I wrestled with this issue because each one of my hats had a strong stake in this debate and the final decision to be made.

The difficulty of beating cancer is well known to many. However, despite the odds, my father fought this disease. He fought it with all his power and he succeeded. Unfortunately, his success was short-lived and he relapsed in no time.

As a loving and supportive family, we did everything for my father to keep him happy and comfortable during the end of his days. However, no matter what we did, it was not good enough to relieve his pain. No amount of moral and social support was stronger than his inner suffering. We provided him with palliative care, but it was not enough. It broke my heart to watch my father slowly lose himself through the process. At the end, he was more concerned about the impact of his suffering on us than on him. After all, his pain was alleviated with heavy doses of morphine. However, there was no remedy for his mental pain and the hit to his pride.

I have heard the concern that providing medical assistance in dying would negatively impact vulnerable people. However, as I stated before, what made my father vulnerable was not having the option to put an end to his journey.

Eventually, my father suffered from two illnesses, one physical and the other mental. The amount of pain he was going through physically began affecting him psychologically as well. He began isolating himself from us, and in the end was suffering alone.

I agree with the government's commitment to support quality end-of-life services and to continue working with the provinces and territories to improve palliative care. Canadians and the Richmond Hill community have made it clear that is what they want. To that end, the government has committed to a long-term investment into palliative care of $3 billion over four years. However, no amount of investment into palliative care would have relieved my father's agony.

My father's experience is not a unique one. I am sure that others in the House know of someone who has endured similar distress.

We have a big responsibility to Canadians. Our responsibility is to make Canada great, to provide Canadians with the means for a better life, to facilitate their realization of their vision, and to help them achieve their dreams and aspirations. We were elected to represent their wishes, to provide services, and to make legislation to achieve those ends.

Let us look at the data that speaks to what Canadians want. Polls show that a majority of Canadians accept the idea and would even request medical assistance in dying if it were available to them. Those polls also show that over the years the acceptance level of medical assistance in dying has been increasing. As Canadians became more aware of the matter, they began to empathize with those who suffer. In Richmond Hill alone, the local parliament project has shown that over 70% of my riding agrees that individuals who are terminally ill should be allowed to end their lives with the assistance of a medical professional.

In February of 2016, a Statistics Canada demographic analysis showed that persons aged 65 and over make up a record proportion of our population. It also showed that the proportion of seniors in our population has been increasing over the past 50 years, and the trend is continuing. What does this mean for us as legislators and representatives? It means that we must be forward thinking in our legislation and we must ensure there are mechanisms in place to deal with future problems.

The Carter case has shown us already that our current legislation is outdated, and the Supreme Court has asked us to update it. We are faced with a June 6 deadline. Let us ensure that we are prepared for this demographic shift and potential needs, such as the one on the table today. In order to ensure that we are prepared for this shift, we must ensure that we address key issues in our current system.

According to a research article published by the journal Palliative Medicine, in Canada, we need to streamline our legislative, financial, and regulatory affairs in terms of delivery of palliative care services. This means that once the legislation is passed we must continue to conduct studies and address lagging areas of hospice and palliative care services delivery.

I was fortunate enough to hear points of view from my neighbours in Richmond Hill during the town hall. They opened up their hearts and shared with me. The most powerful story came from people suffering with terminal illnesses, similar to the one my father had. They spoke of the importance of making advance requests, addressing the issue of mental illness, and access to mature minors. I am happy to hear that the government will appoint independent bodies to study these issues. I have seen members of the relevant committees work hard to ensure that they provide a reasonable approach to the legislation.

It is after carefully thinking through all these issues that I have decided to support Bill C-14.

I realize our government has genuinely worked hard on the bill. As it stands, Canadians do not have a choice on how to say goodbye to this world. My father died in my arms. He died in an attempt to say something to me, something I will never know. He did not choose when to leave me. He did not choose how to leave.

Through my declaration of Bill C-14, I am sending four messages. To my conscience, I can say rest assured that with this decision I have balanced the three hats and their responsibilities to the best of my ability. To my dad, I would say, “It took 10 years to understand what you wanted to say to me before you left me. Dad, in supporting this bill, I am happy to carry your wishes forward”. To my constituents and the Richmond Hill community, I want to assure them they were consulted, they were heard, and they are well represented.

To all Canadians, it has been a long and hard journey, but the journey of a thousand miles begins with the first step. However, in order for the journey to begin, the bill needs to pass. Let us work together to take that first step.

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

Mr. Speaker, I want to commend my colleague for his very heartfelt remarks and identify with him in the loss of close relatives.

One of the misleading points that has been said over and over again in the House is the percentage of Canadians that support euthanasia, physician-assisted suicide. Inevitably the Liberals are quoting statistics that relate to a terminal illness. The bill has nothing to do with terminal illness.

My question goes back to the issue of conscience protection. We heard many Liberal colleagues refer to the protection in the preamble, which says:

Whereas nothing in this Act affects the guarantee of freedom of conscience and religion;

Then on page 8, in proposed subsection 241.2(9), it says:

For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.

Those are fine sounding statements, but there is no ironclad protection for the medical professional to not be involved in physician-assisted suicide or euthanasia. There is no protection for him or her not to have to refer or make an effective referral, and more importantly, there is absolutely no protection for institutions that were created by volunteers, are staffed by volunteers, and are run by donations of individual Canadians, hospices that were set up with the express purpose of helping people through those final days of life.

Why would my colleague not ensure that, at the very least, physicians, medical workers, medical professionals, and institutions have that conscience protection to allow them not to participate in something they find morally objectionable?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, I would like to highlight the fact that there are three pillars that provide the proper safeguards in this matter. We are providing proper safeguards for the people. We are providing safeguards for the doctors and the nurse practitioners, and we are also providing safeguards for the medical associations as well as other practitioners.

I also want to mention that we will be working very closely with the provinces and territories to make sure those proper safeguards are put in place and the people who need the help are protected.

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

Mr. Speaker, I thank the member for his very heartfelt speech and for sharing his very personal and profound story with the House. I agree that if a bill like this were in place it would have alleviated, in particular, his father's suffering.

Based on personal experience, what is the member's opinion on granting Canadians the option for advance directives?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, I believe that Canadians need to have the option of how to end their lives. Unfortunately, my father did not have that option. When he was diagnosed with an advanced case of cancer, we consulted with the doctor and asked for options. We were basically given very interesting options. We were told that if we were religious, to go pray, and if we were science believers, to go bet on the science that in 5% of the cases like my father's the person would die from a heart attack. The other 95% would suffer deeply and go through organ failure. Whether we believe in science or not, we were lucky that he made the transition as a result of a heart attack when he passed away.

During the town hall in York Region, I was greeted by a couple from Richmond Hill who shared their story with me. The husband was suffering exactly the same stage of cancer as my father and both of our stories really resonated with each other.

I believe that Canadians should have this option. My father would have suffered much less had he not experienced that prolonged mental distress. The government has announced that it will appoint one or more independent bodies to study advance requests in the context of medical assistance in dying. I look forward to being part of that consultation process and I invite all members in the House to participate. As I said, this is a journey of a hundred thousand miles and this is the first step. We have to take that first step, but we need to stay engaged.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, I thank my colleague for sharing his speaking time with me. It is small consolation, since the members of my political party were excluded from the committee formed to produce a bill.

Today, I can only say that we are witness to a sad chapter in the history of “parliamentary” democracy in Ottawa and in the House of Commons. I would even say that it is the product of a deplorable process, in both form and content.

Quebec has been cited often as an example. I followed and participated in that process. It was a process that aimed for transpartisanship, not just in words, not just in spin, but in actual fact. The goal of that transpartisanship was to achieve the broadest possible consensus.

Obviously, there was no Carter decision. Consequently, the Quebec government and the opposition parties included what was a step forward with regard to the problem of end-of-life care. They included medical assistance in dying in a continuum of end-of-life care, which is a provincial responsibility, by the way. They combined what was always considered distinct, that is, palliative care versus euthanasia, and they said that from then on, Quebec would provide end-of-life care. Obviously, that would take place in a palliative care setting, because there would no longer be any point to curative care. When someone goes to palliative care, recovery is no longer possible.

At that point, they said that there would be palliative care, in which a person can die voluntarily at the conclusion of his or her end-of-life process, which is irremediable and already under way. The person is then in the terminal phase of life. If, one morning, the person, having received the appropriate palliative care, is completely at peace and ready to let go, this is not a failure of palliative care. That could be considered what we might wish for everyone here, that is, to be on one’s death bed, utterly serene, ready to let go and at peace with oneself. Palliative care can also lead to that.

That is what Quebec decided to do, but it did not do so in the way the Liberal Party chose to do it. The Liberals steamrolled parliamentarians, and this bill was controlled by the executive from beginning to end, with the excuse that June 6 was a deadline that could not be circumvented. At the moment, we are well aware that with all the pitfalls and problems in this bill, it is impossible to meet that deadline.

The government should have, with the assent of all parliamentarians, given us the means to act and found ways of doing things properly instead of gagging people, since we know full well the deadline will not be met. We are told that it is very serious, but I must point out that the Morgentaler decision was struck down and declared unconstitutional as far back as 1988, but as far as I know, it is still in the Criminal Code, and we have not descended into total chaos in that area.

We have to move forward, but let us not get carried away. With regard to form and content, the question we have to address at this stage is the minister’s unproven claim that her bill passes the charter test.

In the Morgentaler decision, the judges struck down the abortion law based on just one of the principles, just one of the rights affirmed in section 7 of the charter: “Everyone has the right to life, liberty and security of the person”.

Since the judges in the Carter case decided that three rights had been unreasonably infringed, namely the right to liberty, the right to life and the right to security of the person, it would suffice for just one of these rights to be infringed for it to be unreasonably infringed and for section 1 to fail to save the minister’s law.

Now, I asked her the question several times. I asked her to show me how a grievous and irremediable disease or disability that causes a patient intolerable suffering does not unreasonably infringe the right of that patient to security of the person. According to the government’s bill, to have access to medical assistance in dying, this person will have to either go before the courts, or go on a hunger strike so as to approximate the totally deplorable, inhuman, vague and unconstitutional criterion of reasonably foreseeable natural death.

The government never made an effort to accept even one of the amendments, however unimportant, from the opposition. It amended its bill on its own. I have never seen an attitude so contemptuous of the legislature. If this is the legislative democracy and the legislative powers of the House of Commons, it is hard to swallow, especially on a subject as sensitive as this one.

However much we boasted, if we were that sure of ourselves, we still had the option of referring this to the Supreme Court. It is true that it is not up to the Supreme Court justices to make the laws. However Parliament did nothing for the last 40 years. Eventually, certain citizens won a judgment. The only solution recommended over the last 40 years was palliative care, as if that were the answer to all our problems.

The Carter decision must not resolve only the end-of-life issue, but also the assisted suicide issue. There are people on the other side of the House who do not even differentiate between suicide and assisted suicide, which is in fact decriminalized. These are not the same realities. Suicide is not irremediable as long as the person has not acted out. A suicidal state can be corrected. There are people who are able to help these persons; there is therapy and medication.

However, when a person is suffering from Alzheimer’s, that is irreversible. If the government had agreed to remove this criterion, it would have corrected a number of shortcomings in this bill. In particular, it would have made it possible for any request to be made in advance, meaning that people could make a valid request before becoming incapable of doing so. However, the government is doing only as it wishes and is washing its hands of this.

The government is displaying political cowardice regarding the role it is obliged to play in the House. It is not the democracy of judges that we are demanding, but rather a democracy that respects the legislative power and the ability of legislators to define laws.

Also, let us stop trivializing things. It is our duty to make good laws that make sense. Judges, as custodians of rights and freedoms, have the duty to determine whether those laws are in compliance with the charter and the Constitution.

Therefore let us stop claiming that any law that leaves this place will necessarily be challenged and that the judges will have to make a ruling. What is absolutely inhumane is that the burden of litigation will fall on the shoulders of vulnerable persons and those who are suffering.

People who are vulnerable and suffering are precisely those the minister claimed she wanted to protect.

[Sean Casey, Liberal, Charlottetown, PE]

Mr. Speaker, frankly, it is a little disappointing to hear such a partisan speech on an issue like this. I have two questions for the hon. member.

He said that the committee had rejected all serious and important amendments. He knows for a fact that the committee accepted one of his amendments. Was that not a serious or important amendment?

The second question I wish to ask is as follows. In his view, the bill is unconstitutional. Today an article was published in La Presse, which consulted four constitutional experts in Quebec. Of those four, three were from different universities and thought that the bill was constitutional.

Does he acknowledge that there is a diversity of opinions among constitutional experts? Does he accept that? Does he accept that the Supreme Court has said that it is Parliament that has to act and is in the best position to act?

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, if I have 10 minutes to respond, I will respond to each of the questions.

My colleague is confusing passion with partisanship. My comments go well beyond partisanship, and at this stage, I have just indicated that my party will never lend its support to such a bad bill.

Furthermore, there are certain constitutional experts who, from the heights of their office, may not have an accurate grasp of the field and the practical realities. If we have a criterion as vague as reasonably foreseeable natural death, we have to know what that means in terms of operationalizing it in the field. People in Quebec were already saying that the law was consensual and posed no problems. We are starting to see that there are certain disparities across regions and institutions. I am therefore very mistrustful of people who are not familiar with the field on a question as serious and delicate as this.

That being said, the amendment you mentioned was minor, relative to the one that consisted in striking and eliminating the totally wrong-headed, unacceptable, and unconstitutional notion of reasonably foreseeable natural death.

[The Assistant Deputy Speaker, Anthony Rota]

I would remind the hon. member to speak in the third person, through the Speaker.

The hon. member for Kitchener—Conestoga has the floor for questions and comments.

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

Mr. Speaker, I could not agree with my colleague more concerning the job of the Supreme Court and the job of this legislature. The Supreme Court has overturned the will of this legislature, which has been expressed probably 15 times since 1991, clearly rejecting initiatives to allow physician-assisted suicide. Therefore, I agree with my colleague on that.

I have a question for my colleague that is actually posed by Dr. Will Johnston, a medical doctor from Vancouver. He says:

...can you imagine end of life care so good that you would set aside your demand for assisted suicide? If you can, let's continue to create such care. If you can't or won't, your focus would seem to be on suicide rather than the relief of suffering and you are likely to do more harm than good.

Does it actually give Canadians a real choice when we currently have palliative care only available to approximately 30% of our population of those who would need palliative care? Does it give them a choice if we offer them physician-assisted suicide on one hand, but cannot offer them actual available, affordable palliative care on the other?

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, I have already answered my colleague concerning palliative care. I repeat that, 40 years ago, it was said to be the only way to manage end-of-life care.

However, in 40 years, palliative care has not become more accessible. Indeed, there is an accessibility problem. Therefore, that is not the only solution.

Nevertheless, Quebec was very careful to place end-of-life care within the continuum of assistance in dying and comprehensive palliative care. Therefore I do not think that is antithetical or contradictory.

There are diseases and afflictions that make people suffer. There are no drugs that can take away the pain or suffering of those people who are dying or afflicted.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, there have been some discussions among the parties and members of the House in regard to what I am about to propose, three separate motions. I will propose one at a time, asking for unanimous consent. The first one reads:

That, in relation to the annual conference of the Canadian Council of Public Accounts Committee and the Canadian Council of Legislative Auditors, annual conference, ten members of the Standing Committee on Public Accounts be authorized to travel to Yellowknife, Northwest Territories in August, 2016, and that the necessary staff accompany the committee.

[The Assistant Deputy Speaker, Anthony Rota]

Do we have unanimous consent?

[Some hon. members]

Agreed.

[An hon. member]

No.

[The Assistant Deputy Speaker, Anthony Rota]

I am afraid we do not have unanimous consent.

Resuming debate, the hon. member for Saint-Hyacinthe—Bagot.

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

Mr. Speaker, I would first like to tell you that I will share my time with my colleague from Windsor—Tecumseh.

As a new member, I had, for my very first experience on a committee, the immense privilege of sitting on the Special Joint Committee on Physician-Assisted Dying. It was a privilege in a number of respects. First, I was there with my colleague from Victoria, who shared with me his experience as well as his expertise as a constitutional lawyer. He was very generous in allowing me to work with him in the committee.

It was also a privilege because it was an opportunity to learn about all the work that had been done since February 6, 2015, when the Supreme Court handed down its decision in the Carter case. We read the report of the group of experts that criss-crossed Canada throughout last summer and fall and met with everyone interested in the issue of medical assistance in dying. They also met with people in the various American states that have had medical assistance in dying for 10 or 20 years. They went to Europe. They reported to us on everything they had learned about medical assistance in dying. We also read the report of the group of provincial and territorial experts. Although Quebec was the trailblazer, working on the issue for six years and passing a law on end-of-life care last December, several provinces have studied the issue.

It was also a privilege to hear over 60 witnesses who came to present their points of view, whether as legal experts or as physicians. We met with representatives of different professional associations such as nurses and pharmacists. I found it really rewarding to hear all these witnesses and to better understand the different points of view. Indeed, on the subject of medical assistance in dying, as has been noted, there can be an opinion and its counter-argument. It was in light of all these views that we arrived at our recommendations. However, the particularly rewarding aspect of sitting on this committee was the commitment of the 11 MPs and five senators who gave full meaning to the term “working together”.

As a member of this committee, I developed a great sense of fellowship with all these parliamentarians. In spite of our differing views, we took the time to listen to each other, and we were respectful in our work. We spent dozens if not hundreds of hours working together. In spite of our differences of opinion, we were all committed to arriving at the best possible outcome.

This commitment to so complex and delicate a subject was for me a truly useful experience. Unfortunately, when I reported for the first meeting of the Standing Committee on Justice and Human Rights, the first evening when we did the clause-by-clause study and when we considered what I regard as the most significant amendments dealing with the most fundamental elements of the bill, I did not feel at all that open-mindedness, that commitment on the part of the Liberal representatives sitting on that committee. I did not feel that same willingness to listen to each other to arrive at the best possible outcome.

That evening, I was very disappointed to see that certain committee members quite simply did not seem to want to be there. They may have been checking their email, because they spent a lot of time with their noses buried in their tablets or looking at the ceiling. They mechanically voted against the amendments proposed by the opposition. Viewed from the outside, they seemed to be acting like good little soldiers.

In the special joint committee, we did indeed arrive at one dissenting report, a supplementary opinion. However, throughout our work on the 21 recommendations, we had this desire to reach the best possible outcome on this very difficult subject.

Since tabling our report, I have fallen into the habit of saying that it will be relevant for at least 10 years. Of course, I did not expect the government to take all of our recommendations into account. In so short a time, that was not possible.

Basically, what the Supreme Court has told us is that medical assistance in dying is a right. Since it is a right, therefore, we were motivated throughout our discussions and our work by the desire to be sure not to discriminate against anyone. However, this evening I will be obliged to vote against this bill, even though I have invested hundreds of hours of work in it and even though I have read thousands of pages and heard all those witnesses. For me, reasonably foreseeable natural death is a ground of discrimination, based on age, for example.

As a member of the special joint committee, I had the opportunity to take time to meet with my constituents. I wanted to seek out the wisdom of those who work with persons at the end of life before taking a position on the various recommendations. I wanted to test my assumptions and my thoughts. I had the opportunity to meet, for example, with Les Amis du crépuscule. This community organization in my riding works every day with persons at the end of their lives. Those workers told me that they would respectfully welcome anything that we would decide, because they welcome the choices that people make. Indeed, the question of medical assistance in dying is essentially a question of choice. One person may choose to request such assistance. Another, who for reasons of conscience or other reasons cannot accept calling for medical assistance in dying, need only refrain from requesting it.

These meetings made me realize just how unavailable palliative care is in our communities. The member for Victoria and I made note of this in our supplementary opinion in the report of the special joint committee. My riding includes the Hôtel-Dieu, one of the largest hospitals for long-term care in Quebec. Hundreds of persons die there every year. There are only 12 beds for palliative care. We have one home that accommodates people at the end of life who are suffering from cancer. This home receives 800 applications per year and can accept only 200.

Some people have told me that, if they have to be ill as they end their lives, they want to have quality care and to live with dignity beforehand, so they can die with dignity. This was a very strong message for me, because fundamentally, we must remember that this bill is intended to ensure that each of our fellow citizens is able to die with dignity.

[Colin Fraser, Liberal, West Nova, NS]

Mr. Speaker, I would like to thank my colleague for her speech.

However, I happen to disagree. I am a member of the Standing Committee on Justice and Human Rights, and I take exception to the fact that she mentioned that during the very considerable and time-consuming debate on the amendments before the committee, the Liberals were not interested, not listening, or not working in the best interests of Canadians. The fact that we happen to disagree with some of the amendments that were put forward by the parties opposite does not mean that we were not taking our job seriously. I do not think it was fair to characterize it in those terms.

There were in fact 16 amendments made at committee, some proposed by the NDP, some by the Bloc, and some by the Conservative Party. We worked collaboratively on things such as amending the preamble and putting palliative care in it, as well as amending conscience rights to include a clause to ensure that nothing could compel anyone to perform the service.

I note as well that the NDP voted against almost all, if not all, of the proposals by the Conservative Party. Therefore, for her to say that Liberals were not interested would cause me to wonder if the New Democrats were not interested in listening when other amendments from other parties were put forward.

My question is this. Does she not agree that Liberals worked collaboratively and that the 16 amendments did improve the bill at committee?

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

Mr. Speaker, I am sorry that my colleague was offended by what I said.

What I said is that there is a difference in how the two committees operated. I invite him to talk to his colleagues who were there the evening we first began studying the bill clause by clause and his colleagues who sat on the special joint committee because there were really two completely different work atmospheres.

Members cannot vote for conflicting amendments. Yesterday evening, I voted for some amendments and against others.

I asked some of my Liberal colleagues who sat on the special joint committee whether they were able to share their opinions on medical assistance in dying and the topics discussed by the special joint committee with their caucus. One of them told me that the government is moving in one direction and going against it would be like trying to paddle against the current at Niagara Falls. I do not understand that attitude when we are examining such an important bill.

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

Mr. Speaker, I want to thank my colleague, whom I had the privilege of working with on the Special Joint Committee on Physician-Assisted Dying, for her input.

I am pleased to hear that she is going to vote against this bill. She is voting against it for different reasons than I am, but I would like to ask her this. It looks very probable, based on last night's vote, that this bill will pass, at least in the House. Assuming the bill passes, would my colleague at least agree that we have to do better on conscience protection?

Right now, there is a weak statement in the preamble, which is not part of the bill. There is another statement in the actual bill that says nothing compels an individual to participate, but there is no ironclad protection for physicians, medical workers, and medical professionals, and especially for institutions. I wonder if my colleague would agree that there should at least be more robust protections in this bill for medical workers, and health care institutions.

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

Mr. Speaker, this evening, some members will vote against this bill for conflicting reasons. The government will have accomplished that.

With regard to conscientious objection, I believe that, if certain people do not want medical assistance in dying because of conscientious objection, all they have to do is not ask for it. With regard to health professionals, the joint special committee clearly established that some aspects of health fall under federal jurisdiction, while others fall under provincial jurisdiction.

In my opinion, the role of doctors and the way they do their work falls under the responsibility of professional bodies and provincial jurisdiction. I feel like telling my colleague that a doctor who refuses to provide medical assistance in dying should at least give the patient some direction.

[The Assistant Deputy Speaker, Anthony Rota]

It is my duty, pursuant to Standing Order 38, to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Saanich—Gulf Islands, the Environment; the hon. member for Sherwood Park—Fort Saskatchewan, Foreign Affairs.

The House resumed consideration of the motion that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the third time and passed, and of the amendment.

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

Mr. Speaker, as members are aware, Bill C-14 now goes to third reading, which gives the Senate two days to consider it before the June 6 deadline.

While I acknowledge the government's expressed desire to get the bill passed before the Supreme Court's June 6 deadline, I think most people agree that this is too important a piece of legislation to rush, especially considering that in its present form it is not likely to pass constitutional muster. On this, I second NDP justice critic, the member for Victoria, when he said, “I cannot accept passing a bill that I know to be unconstitutional”.

The key flaw of Bill C-14 is the end-of-life requirement of a reasonably foreseeable natural death. This is the part that conflicts with the Supreme Court, which did not require terminality or end of life, and therefore, according to the Carter decision, infringes on the charter rights of all those who have a grievous and irremediable condition that causes them intolerable suffering but who are not dying as a result.

The Canadian and Quebec bar associations, various other legal experts, and now the Alberta Court of Appeal, have said that this requirement conflicts with the Supreme Court. Medical groups do not like it either. The body that represents every provincial medical regulator has come out against the bill as being too vague for doctors to follow.

The NDP put forward a number of amendments that would have improved the bill tremendously. Had they not been rejected, the bill would likely have had a better shot at making it through the Senate.

We suggested removing the controversial end-of-life requirement, which is almost certainly unconstitutional, and replacing it with the exact words that the Supreme Court used in its decision. However, the Liberals rejected that.

Of more than 100 amendments moved, just 16 were accepted, and they were mostly minor technical clarifications. However, the NDP did manage to secure agreement on two amendments that were introduced and adopted unanimously, and that was clarifying conscience objection rights and adding a stronger commitment to palliative care.

As criticism grows against the bill, the government increasingly falls back on the excuse of a deadline imposed on us by the Supreme Court, which is not exactly true. The court said that it would give federal and provincial governments a year to put in place more complex regulatory regimes should they choose. On June 6, an exemption is opened in two Criminal Code offences for patients and physicians acting within the guidelines that the court set out in the Carter decision.

There is not a vacuum, and to be blunt, murder will not become legal, nor will medical aid in dying return to being illegal without a federal law in place.

Over the past year, every provincial medical regulator has developed guidelines for medical aid in dying that physicians must follow. These safeguards are very close to the safeguards proposed in Bill C-14. Federal leadership is necessary to ensure that access is equitable across Canada and to prevent a patchwork, but it is not strictly necessary to ensure basic access right now. Therefore, this final push to get the bill through the House is most unfortunate, and it is not the outcome we had hoped for.

The NDP worked long days in good faith with other parties, but it is better than passing a flawed bill, defying the Supreme Court, and infringing on the charter rights of suffering Canadians, which prompted this legislative response in the first place. For us, this is not a partisan issue. We have collaborated with all parties from the start on this and will continue that constructive approach, especially when it comes to championing the causes for our health care and palliative care.

We had a chance to get this bill right, but the government does not seem interested in listening at this point. It is important here to step back and reflect on how we got to where we are now.

In February 2015, a unanimous Supreme Court ruling established the charter-protected right of competent adult Canadians experiencing enduring and intolerable suffering as a result of grievous and irremediable medical conditions, including a disease, disability, or illness, to access medical assistance in dying. In February 2015, the Supreme Court unanimously decided in Carter v. Canada that Canadians who are suffering intolerably because of a grievous and irremediable medical condition have a charter-protected right to access medical assistance in dying.

The effect of the ruling was suspended until June 6, 2016. The reports of an interprovincial task force and a federal expert panel, as well as a wide array of witness testimony, were considered by a joint special committee of Parliament, resulting in 21 recommendations on a legislative response to Carter.

We succeeded in adding major actionable recommendations on palliative care to that report. This issue of palliative care is what, for myself, goes directly to what I object to most about Bill C-14 in its current state.

Should the government rush into a bill like Bill C-14 without also having a plan to shore up and extend palliative care? The answer is, of course, most emphatically no, it should not.

As noted in the recent report by the Canadian Cancer Society, “Right to Care: Palliative care for all Canadians”, there are gaps in palliative care across the country. As my colleague mentioned in her speech, it is very heart-wrenching to know some of the stats and facts about what is actually available right now in palliative care for Canadians.

It is an epic fail for the government to be putting forward a bill while at the same time ignoring the real tangible details that we need to give us confidence as we move forward in a future with medical-assisted dying. That was so insensitive.

About 45% of cancer patients die in acute care hospitals, even though most Canadians prefer to die at home. Not only are acute care settings more costly than dedicated palliative care, they are also not equipped to provide the most appropriate care to palliative care patients and their families.

Palliative care can increase the efficient use of our public health care dollars, but increased care outside of a hospital setting can place undue financial hardship on family caregivers. Health care costs tend to increase substantially in the months and weeks before death, due to increasing frailty and dependence on health care services.

We believe that the government should take a lead in providing appropriate funding for palliative care. Improving palliative care in all settings, including outside the hospital, should result in a more efficient use of health care dollars.

However, there will be upfront costs to facilitate change. Federal, provincial, and territorial governments should work together to establish a financing plan, and create a national palliative care transition fund to ensure the changes needed to improve palliative care in Canada can take place.

When I look at the latest version of Bill C-14, it states that:

...it commits to working with provinces, territories and civil society to facilitate access to palliative and end-of-life care, care and services for individuals living with Alzheimer’s and dementia, appropriate mental health supports and services and culturally and spiritually appropriate end-of-life care for Indigenous patients.

Now, it is all well and good, but precise commitments need to be made, and this bill is quite vague.

The only other time palliative care is mentioned in the bill is:

....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.

On the fifth year? To me, this seems to be way too far in the future. Canadians of all political persuasions and faiths, indeed, Canadians of goodwill everywhere deserve something more definite and concrete than a promise to review palliative care within five years.

This is all the more disappointing, given that the government could have addressed this issue in its recent first budget as it knew that we would soon be debating Bill C-14. However, as we know, not a single dollar was earmarked for palliative care measures. We should have fortified health care, palliative care, home care before we crafted Bill C-14. It would have alleviated our anxiety on what the future holds.

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

Mr. Speaker, just to pick up on the member's last point, there are many things I could talk about but we recognize within the Government of Canada, the Liberal Party, how important palliative care is. I used to be a health care critic in the Province of Manitoba. I am very much familiar with the needs of palliative care. It is important that we recognize that the best way to deliver palliative care is in co-operation with the province and the many different stakeholders. It goes even beyond government.

One of the initiatives that this government has taken responsibility for in terms of providing good strong leadership is the idea of working with the different provincial and territorial ministers of health in order to achieve a new health care accord. By doing that, we are that much more able to provide the type of palliative care that Canadians want to see in the future.

My question for the member is this. Does she not believe that it is important for the federal government not only to make the financial commitment that it has made, which is billions of dollars, but that it is equally important that we work with the stakeholders so that Canadians will get the best possible palliative care system in the world; and that can only be achieved if the federal government is prepared to show leadership, which it has done, and we work with the provinces that are delivering our health care services?

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

Mr. Speaker, I appreciate the hon. member's comments because I am one of those people who does champion not just palliative care but recommitting this country to universal health care access. We have all heard through assisted dying many stories from our constituents, who are very disconcerted. It is really scary for ordinary Canadians to read the text of a bill that could be passed tonight, and then to have almost platitudes, very ambiguous comforts about palliative care. That is where the problem is.

I do agree that it is very important, and I think maybe the hon. member misses my point that it should have been front-loaded. Those details should have come first, and then present the text for Bill C-14. That makes it that much easier for people to be able to accept. I know as recently as last week, I heard people who are heartbroken saying, “My father was in the hospital hallway for nine days before he passed away. What are you going to do about that? I don't want to hear any more about Bill C-14. What are you going to do about that?” My heart breaks.

It is not just that my heart breaks. I know now I have to show some federal leadership like all of us here. That needs to come first. It would be very easy for the current governing party to stand up with some real hard-core statements, not these ambiguous things that are meant to placate us and just sort of distract us from the issue.

Where is this money? Recommit to the Canada health accord. Enforce the Canada Health Act when it comes to home care. You could make three bold statements right now that would change the whole atmosphere of this. That has been missed and that is what is highly frustrating. When it comes to working with other jurisdictions, yes you have to take federal leadership that is strong and true, and strong—

[The Assistant Deputy Speaker, Anthony Rota]

Questions and comments.

I want to remind the hon. member that she is talking through the chair and not directly to the other speaker.

We have time for a brief question. That one went on for a bit longer than anticipated.

The hon. member for Kitchener—Conestoga.

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

Mr. Speaker, I want to thank my colleague from Windsor—Tecumseh for her statement. Earlier today her colleague from Saint-Hyacinthe—Bagot indicated that doctors who do not wish to participate in physician-assisted suicide must at least make an effective referral.

I want to point out that, “...forcing a physician to refer for assisted-suicide would infringe the physician’s freedom of conscience and religion. From the physician’s perspective, referring is a form of participation because, by acting as a step in the process, the physician is directly helping the patient obtain the service”. That is from a National Post review.

Would my colleague not agree that there needs to be more clear, unequivocal protection for conscience rights for medical doctors and for institutions that do not wish to participate in any form in physician-assisted suicide?

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

Mr. Speaker, that is a very intriguing question. I believe these comprehensive conversations need to take place in that provincial jurisdiction, that provincial arena. However, up until now we have not been able to have those meaningful discussions because this was something in the Criminal Code. The Supreme Court has addressed that.

Now no one is vilified when they talk about it at a provincial level. They can actually make some comprehensive arrangements and people can be acknowledged in a safe environment professionally as they address this complex issue.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, it is a great pleasure for me to have this opportunity to share my ideas and opinions regarding Bill C-14 to amend the Criminal Code.

In a unanimous decision on February 6, 2015, the Supreme Court of Canada turned down the provision in the Criminal Code, giving Canadian adults who were mentally competent and suffering intolerably and enduringly the right to a doctor's help in dying.

The court suspended its ruling for 12 months, with a decision taking effect in 2016, giving the government enough time to amend its laws. In January 2016, the court granted an additional four-month extension to its ruling suspension.

Until now, it is a crime in Canada to assist another person in ending their own life. As a result, people who are grievously and irremediably ill cannot seek a physician's assistance in dying and may be condemned to a life of severe and intolerable suffering. A person facing this prospect has two options: they can take their own life prematurely, often by violent or dangerous means, or they can suffer until they die from natural causes. The choices are cruel.

This enactment would amend 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 criteria for eligibility, 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 further to, medical assistance in dying; provide information for the purpose of monitoring medical assistance in dying; 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 statues being affected.

We have reached to the final stage of debate in the House regarding the process, with hours of debate on Bill C-14.

The biggest thing during these debates was the sense of compassion with which the House heard from members debating for their individual constituents. That is the reason the bill touched the hearts of not only the members of the House, but also the hearts of Canadian from coast to coast to coast. Now, when the bill has reached to its final stage, I appreciate and congratulate every member for actively participating in building the most important and valuable laws on assisted dying and also the government for affording full opportunity to all members to be part and parcel of this delicate and important legislation.

I also appreciate the extensive hard work done by both the Minister of Health and the Minister of Justice and by the members of the Joint Standing Committee of the Senate and the House.

Being new to this legislative process, I was thrilled to watch yesterday's voting by the House on numerous motions. I saw members were in favour of few motions and were against on other motions. I realized the importance of these motions on assisted dying for the members of the House. That is the way of members use their choices out of their own conscience and the will their constituents. I realized the real sense of democracy and a true parliamentary decision process being adopted.

This enactment to amend the existing Criminal Code is an important step and is auxiliary to new enactment regarding medical assistance in dying. Being legislators, it is our duty to see that medical service providers and other persons who provide assistance in medically assisted dying are legally safe.

As we all know, this is a first major revolutionary enactment. Going forward, there may be many ancillary issues cropping up. I and my Liberal caucus colleagues as well as many other members of the House are keen to see that bill should pass. I urge all members of the House to vote in favour of Bill C-14, an act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

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

Mr. Speaker, repeatedly throughout the day today, and even last night in the vote, we saw a reticence on the part of primarily the Liberal Party to accept the recommendation and the amendment that would guarantee conscience rights for medical professionals and institutions. Repeatedly they have indicated that we can count on provincial regulatory bodies, which will care for this and conscience protection will be guaranteed. However, as we have seen, the Royal College of Physicians and Surgeons of Ontario and Saskatchewan have both indicated that there is an expectation on the part of their medical professionals to at least refer for the practice of physician-assisted suicide.

Would my colleague on the other side not agree that at the very least, if we are to have a bill that goes down the path of allowing physician-assisted suicide and voluntary euthanasia, we should guarantee in law, in the bill, that physicians and health care institutions will not be obligated to act against their moral conscience?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, we are going through this enactment, which is useful for the persons who are really in need of medical assistance in dying. People who are working for the purpose of execution of the act are required to be exempted from the offence of culpable homicide. The Supreme Court has already given instructions to pass a law to develop procedures easy for them to perform their duty. It is a duty of the physician or the duty of the persons who are medically authorized to perform these acts and we are here to ensure they are provided the necessary safeguards.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, we have all struggled with this very delicate and sensitive issue in light of the Supreme Court direction, which has left parliamentarians with the task of constructing a law that conforms with the Supreme Court case decision in the Carter case. Of course, the Carter case laid down very specific criteria in allowing Kay Carter, the litigant in that case, getting the court's approval for her to access physician-assisted death.

Ms. Carter did not have a terminal illness. She specifically did not have a condition that would lead to her foreseeable death. Yet the court found that her rights under the charter were violated.

When the court laid down the clear criteria required in a grievous and irremediable condition, could the member explain why the Liberal government added the extra criteria of requiring that death be reasonably foreseeable when the lawyer that argued the case and every serious constitutional expert in the land, the Court of Appeal in Alberta and in Ontario, all indicated that it would be unconstitutional?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, my colleague is especially concerned about people dying when they are not critically ill. However, the Supreme Court has given direction to the government to take care of those who are critically ill and need assistance in dying, and to follow the procedures, which we have to now include in the bill, to ensure those procedures are followed by doctors, nurse practitioners, and those who execute the law.

We talk about assisted dying and about the laws being properly executed. Doctors and others who are involved in providing these procedures, maybe the prescription provider as well, all have the right to provide their duties freely without fear of being penalized later.

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

Mr. Speaker, could the member elaborate on the importance of establishing the legal framework by June 6? We believe this is very important. At the beginning of his comments, the member talked about the Supreme Court of Canada decision. That decision means we need to have legislation passed by June 6. Perhaps he would like to provide further comment on this importance of this as we will be voting on this shortly. We all have a responsibility to address the Supreme Court of Canada's decision.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, we are facing a timeline. The instructions given from the Supreme Court gave a June 6 deadline. That limitation period is looming over our heads. We should respect the Supreme Court order.

However, at the same time, we are trying our best to meet those limitations. As I already said in my submission, the House has tried its best to meet those requirements. Every member has their own part and parcel to play in the debate. Now, at the final stage, when we are prepared to make it law, we should work together to ensure the bill comes into force, as per the requirement of the Supreme Court.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Mr. Speaker, the hon. member urged us at the end of his speech to vote for Bill C-14. I would like to ask him if he could outline three good reasons why we should.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, first, the important thing is to have legislation in place to give safety to those who assist a person in dying. They should have clear safety in that they are not committing culpable homicide. The Supreme Court has already said we should do that.

Second, there is a requirement that there be maximum information obtained so more and more improvements can be done on these regulations by the health minister from time to time.

Third, as we know, if there is a failure to comply with the legislation, we should have the best provisions so we can make amendments to punish those who do not comply properly with the law.

[The Deputy Speaker, Bruce Stanton]

Order, please. It being 5:15 p.m., pursuant to an order made on Wednesday, May 18 it is my duty to interrupt the proceedings and put forthwith every question necessary to dispose of the third reading stage of the bill now before the House.

The question is on the amendment. Is it the pleasure of the House to adopt the amendment?

[Some hon. members]

Agreed.

No.

[The Deputy Speaker, Bruce Stanton]

All those in favour of the amendment will please say yea.

[Some hon. members]

Yea.

[The Deputy Speaker, Bruce Stanton]

All those opposed will please say nay.

[Some hon. members]

Nay.

[The Deputy Speaker, Bruce Stanton]

In my opinion the yeas have it.

And five or more members having risen:

Call in the members.

(The House divided on the amendment, which was negatived on the following division:)

Vote #75

[The Speaker, Geoff Regan]

I declare the amendment defeated.

The next question is on the main motion.

Is it the pleasure of the House to adopt the motion?

[Some hon. members]

Agreed.

No.

[The Speaker, Geoff Regan]

All those in favour of the motion will please say yea.

[Some hon. members]

Yea.

[The Speaker, Geoff Regan]

All those opposed will please say nay.

[Some hon. members]

Nay.

[The Speaker, Geoff Regan]

In my opinion the yeas have it.

And five or more members having risen:

(The House divided on the motion, which was agreed to on the following division:)

Vote #76

[The Speaker, Geoff Regan]

I declare the motion carried.

(Bill read the third time and passed)

[The Speaker, Geoff Regan]

It being 6:06, the House will now proceed to the consideration of private members' business as listed on today's Order Paper.