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

[The Speaker, Geoff Regan]

The House will now proceed to the taking of the deferred recorded divisions on the motions at report stage of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

The question is on Motion No. 1. If it is negatived, we will have to vote on Motions Nos. 3, 4, 6, 12, 13, and 14.

The House resumed from May 20 consideration of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), as reported with amendments from the committee, and of the motions in Group No. 1.

Public Service Labour Relations Act

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Mr. Speaker, I would like to thank my colleague from Sherbrooke for his very relevant question. Yes, I feel the same way as he does and I agree with his analysis of the situation.

The government is trying to comply with a Supreme Court decision by doing the minimum. It is trying to do only what it has to by inventing concepts, contradicting itself, and even going against the Supreme Court's decision

This shoddy work is going to once again end up before the courts. The same thing happened with Bill C-14. It is the same principle, and that bill is a far cry from the Carter decision. The government needs to be more professional when drafting its bills.

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

Mr. Speaker, that is probably one of the more absurd comments I have heard on the decisions.

The Supreme Court did not require the House of Commons to legislate. It said that existing law, both for Bill C-14 and Bill C-7, was unconstitutional, and if the House of Commons would like to legislate something else, this was the deadline by which it must do it. The Supreme Court suspended its judgment to a date to allow the House of Commons, if it so chose, to pass legislation, very much the same as what happened with the abortion legislation in Canada. When the Supreme Court ruled that abortion violated the security of the person, it gave a period of time for Parliament to act. Parliament tried twice to act and failed to pass any legislation. The world did not end, but the Supreme Court decision was implemented.

That is exactly what would happen on Bill C-14 and Bill C-7. The Supreme Court does not instruct Parliament to do anything. It gave us the opportunity to say that if we felt there were regimes or restrictions that would meet the constitution that we would like to put in place, we had this much time to do it.

I do agree with the member that the Conservatives wasted a lot of that time. However, the present government has wasted a lot of time calling all different kinds of bills instead of dealing expeditiously with those on which it feels it has a deadline.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, the member seems to be somewhat confused with regard to the issue of urgency. We need to recognize that when the Supreme Court of Canada makes a decision, all members have a responsibility to respect that decision. The two bills the member had made reference to are in fact directives coming from the Supreme Court of Canada. Both issues have been granted extensions.

Could the member provide some comment on whether he believes that parliamentarians do not have to respect what the Supreme Court of Canada has said? Is that the New Democratic approach for dealing with decisions that have been made by the Supreme Court of Canada?

The Supreme Court of Canada has been very clear on this issue, and this legislation is before us today because of that. Just because the Conservatives did not do their homework on this bill or Bill C-14, as legislators, we have a responsibility to, at the very least, listen to what the Supreme Court says, and from the government's perspective, to take action to make corrective measures.

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

Mr. Speaker, I thank the hon. member for Rosemont—La Petite-Patrie for his work on a day-to-day basis in the House as an effective voice for working people.

His question gives me an opportunity to say again what I think has happened in Bill C-14 and again in Bill C-7. I do not know where the Liberals get these restrictions they have introduced in both bills. I think Bills C-14 and C-7 alike are headed to litigation.

Rather than solving the problem and getting on with the business of the country, we will be sending people back into the courts on both of these bills. I do not understand why the recommendations in Bill C-14 were not those of the special committee. In Bill C-7, I do not know who made these recommendations. There is no evidence about why things like staffing and harassment were excluded from collective bargaining. I do not know where this idea came from, but I certainly doubt that it is constitutional.

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

I did see him in the precinct today, Madam Speaker. He now works for the Global Fund to Fight AIDS, Tuberculosis and Malaria, so he is still doing very good work.

The Supreme Court of Canada decision is what brought us to where we are today. It is interesting that the Supreme Court has very rarely overruled itself. It has very rarely overruled its previous decisions. In 1999, it had upheld the prohibition on an RCMP union, so I would say it was very unexpected in the legal community that there was such a clear decision in January 2015 in favour of the right of the RCMP members to unionize. It was a six-to-one decision at that time.

Let me read a couple of quotes from the Supreme Court majority in that decision. It states:

We conclude that the s. 2(d) guarantee of freedom of association protects a meaningful process of collective bargaining that provides employees with a degree of choice and independence sufficient to enable them to determine and pursue their collective interests.

It is saying that the regime that was in place, the staff representatives, did not provide what other Canadians were entitled to under the charter, which was to have a choice about who represents them and have those representatives be independent of the RCMP management in this case.

The decision went on to state:

While the RCMP’s mandate differs from that of other police forces, there is no evidence that providing the RCMP a labour relations scheme similar to that enjoyed by other police forces would prevent it from fulfilling its mandate.

What it is really saying is what we know to be true, that in order to have restrictions on rights in Canada, our Constitution requires that they be reasonable, demonstrably justified, and proportionate to some public interest. What the court found in this case is that there was no public interest that justified these kinds of restrictions on collective bargaining for the RCMP.

Quite often in the House, we have talked about “deadlines” set by the Supreme Court: in the case of assisted suicide and in the case of this bill on RCMP unionization. I have always argued, and will still argue, that these are not deadlines. What the court said in both of these cases is that it finds the existing laws unconstitutional, but it will give Parliament a chance to legislate if it wishes to do something different. If Parliament does not legislate by this date, then the law that was in existence will be unconstitutional and the normal legal framework will apply. If we did not pass this by the deadline, which we clearly have not, the RCMP would fall under the Public Service Labour Relations Act.

I am not arguing that we do not need a bill. I actually think there are some justifications for having a bill and for separating the RCMP out from other labour relations associations. The surprise, or not surprise, I guess I would say, is that the Canadian Police Association and the Mounted Police Professional Association also agree with that. There is no demand for all of them to become teamsters or steelworkers. That is not what they are looking for.

Bill C-7 says that there should be one national union representing police only, and that is not really a controversial point, so having a bill that would establish that framework is not a bad idea. However, that is probably about as far as I can go with Bill C-7, because the other main provisions of the bill take away all the aspects that really make meaningful collective bargaining.

I would submit that, just like the bill that was presented on assisted suicide, Bill C-14, Bill C-7 is probably unconstitutional. It is certain to launch another whole round of litigation and will force the spending of both RCMP members' money and public money, as well as the court's time on something we really do not need to do.

The court decision was quite clear at six to one. If we respected that decision in the proposed law, we would be done with this. The new regime of labour relations could then get on with the job of improving the RCMP and the working conditions, including the health and safety of RCMP members. Again, we must remember that our constitutional regime says that the limits are acceptable on rights only if they are reasonable and demonstrably justified in a free and democratic society, and if these limits are proportional to a specific public objective.

What is the public objective in saying that this new labour relations organization could not talk about staffing, deployment, harassment, or discipline? Again, in the quote I read earlier from the decision, it is very clear that the court said that there is no public objective that justifies limiting collective bargaining for the RCMP. Therefore, I would argue that, in parallel, there is also no public objective being achieved by these specific exclusions from collective bargaining.

I do not think we have heard from the government why it selected these things. I have not heard the justification for these exclusions, and the Liberals have not given me a legal argument of how they think this would stand up in court, if we get there again. As I said, I think Bill C-7 is bound for litigation, and that is an unfortunate thing.

Our courts are clogged with all kinds of important issues, and to have their time taken up with something that has been there in 1999 and 2015, to have it back sometime later this year or in 2017 is a waste of everyone's time and resources.

I, of course, as a member of the NDP, supported our position that these exclusions should have been taken out at committee stage. Unfortunately, the government failed to do that, and I believe the Conservatives also supported leaving these exclusions in. However, I will give credit to the government here that it did agree to remove clauses 40 and 42, which would have placed occupational health and safety under workers' compensation boards province by province.

Clearly, there are some exceptional things about the RCMP as a workforce, and it would not have been acceptable to establish a regime where RCMP members, depending on where they were stationed, would be eligible for different kinds of compensation, benefits, or rehabilitation. Therefore, I do applaud the government in agreeing with both the Conservatives and the NDP to take out clauses 40 and 42 and keep occupational health and safety a uniform regime across the country, so that it would not really matter where an RCMP member served, because RCMP members would be entitled to the same package of benefits and protections.

When we talk about staffing, deployment, harassment, and discipline being excluded, what does that actually mean? This is where I go back to all four things I dealt with almost 20 years ago when I first took on being the labour relations representative of my police board.

Staffing is the question of how much work one has to do, whether the vacant positions are filled, and how long is acceptable to leave positions vacant. I know from the RCMP in my own riding on the west shore, where the population was growing and the demands were very great, that there was concern from rank and file members over those four positions that they should have had, that were authorized, but I believe took six years to fill, and it could have been longer. My memory does not serve me so well, because it was so long in actually getting the people they needed.

What impact does that have on the operation of the RCMP? Well, one could say that it causes it to spend more money or it takes away management prerogatives. However, I can tell members that, from the point of view of rank and file people, staffing is about how much overtime they have to work that they do not want to work, that they would rather spend with their family, or rather spend, as most RCMP officers do, volunteering in community events. They wonder if they would be forced to work overtime because those vacancies have not been filled.

This is not to say that the new union of the members would fill the vacancies or decide when they are filled, but they might be able to argue in bargaining what a reasonable time frame would be when a position is not filled. They could say in their collective agreement that, when a position is vacant, it must be filled within six months or within a year. Why is that not something they could bargain about? It is something certainly that I bargained about with our police union: what is an acceptable time frame for filling vacancies?

I simply do not understand why that would not be subject to collective bargaining for the RCMP.

The second one would be deployment. The question of deployment was that of relief and backup, in particular, in municipal forces. How many officers per car? Was it safe to have one officer per car, or did it require two? Through negotiations, after I left the board, it was finally resolved that there were different hours of the day that required different deployment and staffing.

However, what we got through collective bargaining was the input of those rank-and-file members who said that in the daytime it was probably okay to have one officer per car because there were a lot of people on duty, and a lot of resources and backup to call on. However, at nighttime, one person in the car, at three a.m., was probably not a good idea. That was what we were discussing at that time. Again, I do not see how that does not do anything but contribute to better policing for the community and better working conditions for the RCMP, to be able to discuss deployment.

The RCMP also has a lot of very small detachments. One of the big problems that comes up in those detachments is relief. If the RCMP officer is the only officer or one of two officers in a community, how does he or she get any relief from the 24-hour a day demands? What would be wrong with negotiating that if he or she has been the only one, or the only two officers, for a certain period of time, then someone has to come in and relieve the officer of those duties? That would be discussed at collective bargaining. Again, it is about better community policing and better working conditions for RCMP members.

The question of harassment is the one that is the most shocking to me. We dealt with harassment in the police force. When I was appointed to the board, I was the first openly gay police board member in British Columbia. We sat down with the union. First, I had met with the chief, and I said, “Just so you know, my mother already knows.” The chief said, “We already know. We are not called the police for nothing.” We got off to a very good start by having harassment training.

The union met with the board, and we agreed to do harassment training. No one forced anyone to do training. The Board members said that they would go through the training first, and would then ask the union to agree to go through it.

The union president at that time said that it was a complete waste of time. At the end of it, he came back and said that he was wrong, that there were practices taking place in our force that he did not even recognize as harassment.

The last one is discipline. When there is bargaining about discipline, it is not saying the rank-and-file members get to decide if someone is disciplined. They need a voice on what is a fair process for discipline and a voice on what is fair representation.

Those are the kinds of issues with which I had to deal. What are the right time frames? What evidence should be available? Are police officers held to the legal standards of the court in their own disciplinary proceedings? Is that fair or should there be some other disciplinary process agreed to?

Again, all four of these things that are excluded are crucial to having a good working environment for RCMP rank-and-file members, and they also contribute to better policing of our communities.

I know my time is drawing short, but I want to talk about one more staffing issue which has been on my radar since I first got involved in policing. It is the question of recruitment and retirement. It will probably come to a shock to most members in the House that one out of ten police officers in the entire country is currently eligible to retire tomorrow. Officers are staying on and working because of their dedication, but they are already eligible to retire.

How will we deal with that crisis of person power in the RCMP? One of the best ways to do that is to work with the members of the RCMP who are serving now and ask them what are reasonable ways to conquer what is really a crisis.

The other one is recruitment. At the beginning there was some resistance, even in our police force, to using diversity as a criteria in recruiting. We worked with the union at the time. Again, the same union president came back to me and said that when I said that we were not a very diverse police force—we were are all white men—that this was obvious. What was not obvious were the benefits that would come to policing from having a more diverse police force.

They hired two people from the first nations community and two gay and lesbian police officers. He told me that they now had contacts in communities that they never had before, and it helped them do a better job of policing.

Again, negotiating with the rank-and-file unions about issues of staffing, like recruitment, retention, and retirement, will lead to better policing for all of us.

I am sorry I cannot vote for the bill that would establish a framework for a union for the RCMP, but my reason for doing that is the unacceptable exclusions from collective bargaining.

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

Madam Speaker, it is a real pleasure for me to join this important debate on Bill C-7.

I appreciate hearing the thoughtful comments from all members in this House, especially the contribution of members like the member for Yellowhead who just spoke, who have significant experience themselves, or, in other cases, experience through their families with the RCMP. We are all very grateful for their service and for the context that members coming from different walks of life bring to this place.

For people elsewhere who may have just started watching this debate, I want to start my remarks by reviewing some of the basic groundwork in terms of what this bill does.

This legislation seeks to implement a Supreme Court decision that opened the door for the RCMP to form a union. We, in the official opposition, respect the decision of the Supreme Court and recognize that RCMP members are entitled to pursue membership in a union.

We think there are many aspects of Bill C-7 that are positive. In general, it is a reasonable response to the court ruling.

However, on this side of the House, we have consistently taken a very clear position on the importance of a secret ballot. I will talk more about why a secret ballot is important in this specific context and in general. However, that is the principal stumbling block on this legislation for those of us in the official opposition.

We think there are a lot of good things about this legislation, but it is not acceptable to us that a mechanism would be created for joining a union, for electing officials, for anything of that nature, that does not involve a proper democratic process.

Also, by way of context, it is important that the public knows that wage disputes will still be resolved through binding arbitration. This does not open the door to police officers being on strike or anything like that. That is an important element of context as we approach this legislation and the discussion around it.

As we are talking about the RCMP, I want to acknowledge the important work that RCMP officers do across this country, especially in my riding of Sherwood Park—Fort Saskatchewan. We do not have municipal police forces in my constituency. We are fully served by the women and men in the RCMP, and the great work that they do.

The RCMP is an icon. It is one of those recognizable Canadian icons around the world. At the local level, I have personally seen the great work that the RCMP does with the community. That is not just front-end policing, but also engaging in a constructive way with members of the community and with community organizations on issues like education, crime prevention, and those kinds of things.

I am very grateful for the contribution of the RCMP in my constituency and across the country, as well as here on Parliament Hill. We are supported in our work and our functions here by the security that members of the RCMP provide.

I talked earlier about the importance of the secret ballot for us. It is surprising that the government does not get it. I have said before that I would have thought that the debate on the secret ballot was concluded in the 19th century. To coin a phrase, it is 2016. It is strange that there still is no recognition by the government and by other parties of the importance of the secret ballot.

I will say that it is not only this bill but the process that brings this bill forward that marks a double attack against democracy. We not only have an attack on the principle of the secret ballot, but we also have the government not respecting the prerogative of members who wish to speak to the bill by moving forward with their overly aggressive approach to time allocation.

I do think there are appropriate uses of time allocation, of course. These are cases where maybe opposition parties are engaging in deleterious tactics. The government does, in certain contexts, have to move legislation forward. However, in a fairly short time, we have seen the government ramping up the scales on the use of time allocation or closure. This bill is no exception, in spite of the goodwill from the opposition and the effort to work constructively on allocation of time around these things.

We have had this on the euthanasia and assisted suicide bill, and on the budget bill. With regard to this legislation, which is under the gun of time allocation, what the government is doing here is perhaps not as egregious as we have seen in some other cases. I have mentioned. Bill C-14 as one of the most difficult and challenging issues that Parliament has dealt with in a very long time. However, there is still a failure to recognize the importance of the secret ballot and the prerogative of members wanting to speak to and have a fulsome debate on legislation like this. It is a concerning pattern that we see of the government not respecting the principles that should be very important to a well-functioning democratic polity.

That puts this in some important context. On the substantive side, as we talk about the issue of the secret ballot, I want to start by talking about responses to some of the different kinds of arguments we have heard today in this debate, and some of the specific issues around the secret ballot in the context of the RCMP. After that, I will talk about some of the underlying foundational and motivating arguments about the secret ballot and why secret ballots are important. Again, I do not think these are arguments that should have to be made, but clearly they need to be made.

In the context of this specific bill and the RCMP, I want to talk specifically about secret ballots in the context of government certification. We can look at the workplace in some sense as a sort of negotiation, maybe a competition, between workers and their employers. There are certain tools that workers have, and there are certain tools that employers have. It is worth acknowledging that in that sort of imagined competition, public sector workers have an additional advantage. They can bring public pressure to bear on the government to try to bring about concessions in the process of collective bargaining or other forms of negotiation over wages. This is a strategic advantage in that competition or relationship that does not exist in the private sector.

A group of private sector employees cannot organize to vote out their employer, but that is something that public sector employees can do. Therefore, there are additional tools that are available to the public sector. That needs to be recognized and acknowledged as we talk about these dynamics. That helps us to understand the history of why there are higher levels of unionization in the public sector, and also why every certification vote in the public sector has happened via secret ballot, which has led to these higher rates of unionization. There is this strategic advantage.

To the extent that members may raise concerns about employer intimidation preventing certification, it would have to be acknowledged that it is much less plausible in the context of the public sector, again because of these strategic dynamics. Taking that into consideration, it is difficult to justify not allowing a secret ballot in this specific context. The worries that might exist around this in other sectors could be plausibly applied in the case of the public sector.

One of the other strands we have heard in this debate is members saying that a secret ballot could still happen, that, after all, the legislation does not effectively prohibit the use of a secret ballot but simply leaves that determination to a subsequent discussion and evaluation. That is true. There is nothing in this legislation that prohibits the use of a secret ballot. It is possible that a secret ballot could be used or not, but I do not think it is good enough. If one believes that a secret ballot is important, and I think members would acknowledge in many cases how critical a secret ballot is, I do not think it is sufficient to say that there might be a secret ballot.

If I told my constituents that in the next election some ridings in Canada will have secret ballots if we determine they need them and other ridings will not have secret ballots if we determine they do not need them, I do not think my constituents would be particularly satisfied with that. They would say that if a secret ballot is the most fair, honest, reasonable, and democratic way of conducting an election, then why should that not be available to everyone? Why should it not be a guarantee instead of just a possibility? I do not think the argument that there might be a secret ballot holds much water.

We have had some discussion in this debate about the extent to which the RCMP is like the rest of the public service and the extent to which the RCMP is different. It was interesting. I listened to the speech of my friend from Oakville North—Burlington. In the context of questions and comments, she effectively gave very different answers to that question, first in response to my question, and then in response to a question from the member for Esquimalt—Saanich—Sooke. She said on the one hand that we need to have the same process as other public sector individuals, and then she said the RCMP is different. Which is it? This would be our take on that.

Certainly there are important differences between the RCMP and other organizations within the public service. That is why it was important to have some of the variations, some of the exclusions, which were put in this legislation. I think at least our party and the government acknowledged the importance of those exclusions, and our members worked very hard at the committee to refine and deepen those exclusions.

However, the secret ballot is important for everyone. We would advocate a secret ballot in all cases, as we have done on a variety of different measures. The principle of a secret ballot for choosing representatives, for choosing which bargaining unit, or if an individual would like to associate with a particular bargaining unit, is so important that it should not be left to chance. It should not be maybe sometimes and maybe not elsewhere. That is why we have advocated for this consistently across the board.

As well, it is particularly important to have a secret ballot in the case of the RCMP. These are, after all, the women and men on the front lines who are defending us, protecting the physical security of our democracy. We call on the RCMP to ensure the safety and stability of the democratic process and of our lives within this country. For us to then deny the RCMP the same rights that others have in other contexts when they elect people, to deny them the right to the secret ballot in this case, would seem particularly perverse, to me at least. At the same time that they are protecting our fundamental democratic rights, that we would deny those rights to them as members of the RCMP—notwithstanding that we think the secret ballot should be available to all—in that particular situation is quite perverse.

The discussion has also been around the alternative to the secret ballot and how that would look in practice in the RCMP. Some members favour a card-check system. For those who do not know, a card-check system basically involves some members who are seeking a certification asking other members of a potential bargaining unit who want to certify to then sign and check on a card that they would like to sign up. If a certain threshold is achieved in terms of these sign-ups, then there is no subsequent process of deliberation or election; the certification simply then occurs after that card-check system has been evaluated. It occurs automatically.

There are a lot of obvious problems with that. This is a form of public ballot. It does not respect the privacy of the individuals who are being asked to sign. However, a card-check system, as has been pointed out, is particularly inappropriate in the context of the RCMP. We have a very hierarchical structure in which people have to rely on each other all the time.

Members of the RCMP may wish to discuss their political conviction in the context of that environment. They may feel comfortable doing so, and they may feel that their ability to work with their colleagues is not compromised by that. However, that should be their choice. The effect of having a card-check system for certification in this context would be that members might be forced to declare their union convictions through other members. This could have a negative effect, in certain cases, on the collegiality that is so important for the functioning of our national police force.

Therefore, why not simply ensure that members have the privacy they deserve? Why not ensure we have a guarantee of a secret ballot?

My friend from Esquimalt—Saanich—Sooke said something interesting. He said that the proposal for a secret ballot does not need to apply in this case because we are not talking about a public vote. He said that in a sense individuals could choose whether or not they want to join the organization and therefore there is no need for a secret ballot, if I understood what he was saying correctly.

Of course, it just needs to be said that we are talking about what would be a closed shop union. If the RCMP chose to certify, all members of the RCMP, even if they were individually not interested in being part of the union, would have to at least pay dues to the union. This is the process that exists. This is not analogous to simply whether or not an individual chooses to sign up with the local Rotary Club, or Elks, or something like that. This is a question of a whole professional group being brought into a union, potentially against the preferences of some of those members. This is more analogous to a general election in which we would respect and widely recognize the importance of a secret ballot.

Another comment that some members have made during this debate is that secret ballots reduce the rate of unionization. Frankly, that tips their hand a bit because the goal should not be to ensure the maximum level of unionization. The goal should be to ensure a fair process whereby workers can decide if they want to be part of a union. Of course, one could design a system, maybe a card check or something else, that would maximize the rates of certification, but if that happens at the expense of a fair and democratic process in which workers can actually express themselves, then that is not the best direction to go. The goal should be a fair process, and then we would let those who are involved in a fair process decide. A fair process in a democracy will produce the best outcome according to democratic principles, but if we do not have a fair process just because we want a particular outcome, that being higher rates of unionization, that is obviously hardly fair.

That deals with some of the strands in the debate today. I want to just mention what I see as the foundational motivating arguments for a secret ballot. Why do we generally accept that secret ballots are important? First, I think we all understand that people have a right to privacy with respect to their political opinions. Of course, people have the right to express their opinions on issues like certification and other issues, but they also have a right to not express their opinions, to not wish for their co-workers, their employees, even members of their family to know how they vote or how they feel about difficult political questions. This right to privacy really emanates from the idea of autonomy, the idea of self-ownership, that our political opinions are our own and therefore we have the right to decide if we wish to dispose of them in one particular way or another. This sense of the separation of the private space from the public space is foundational to our concept of liberal democracy. It is why we have a secret ballot.

Of course, the secret ballot ensures protection from reprisals. I talked before in the House on a previous bill about the history of secret ballots and how one time when we had public ballots people could be intimidated. They could face reprisals, or could lose employment as a result of how they voted in the then-public ballot. Thus we moved to a secret ballot.

Another reason we have secret ballots is protection against corruption. If we see how someone votes there is a greater risk of someone being offered an inducement. That cannot happen if there is a secret ballot.

Finally is the importance of a vote being preceded by deliberation. This is not possible in the context of a card check system, where someone might sign the card and then read an article or develop new information and think something different later on. One does not have the option of changing one's mind in a card check system but in a secret ballot process there is deliberation, debate, good discussion, and then individuals can come to their conclusions at the appropriate time.

For these reasons, despite some good aspects, I will have to oppose the bill unless the government accepts an amendment to respect the right of members of the RCMP to vote by a secret ballot.

Palliative Care

[Mark Strahl, Conservative, Chilliwack—Hope, BC]

Mr. Speaker, it is a pleasure to present a petition. It is very appropriate given that we are voting on Bill C-14 today.

The petitioners say that it is impossible for a person to give informed consent to assisted suicide or euthanasia if appropriate palliative care is unavailable to them.

They therefore call on Parliament to establish a national strategy on palliative care.

Framework on Palliative Care in Canada Act

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

moved for leave to introduce Bill C-277, An Act providing for the development of a framework on palliative care in Canada.

Mr. Speaker, it is my pleasure to bring forward my private member's bill on palliative care. In the previous session of Parliament, a parliamentary committee of all parties looked at the issue and came forward with recommendations. The bill is the result of that. It is a timely bill, especially in light of the Bill C-14 legislation. The committee that considered the Carter report stated that the request for physician-assisted death could not be truly voluntary if the option of proper palliative care was not available to alleviate a person's suffering.

My bill provides a framework to implement consistent access for palliative care for all Canadians. I hope all parliamentarians on all sides of the House will support it.

(Motions deemed adopted, bill read the first time and printed)

Physician-Assisted Dying

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, the problem with the minister's response is that the Alberta Court of Appeal, the Canadian Bar Association, Barreau du Québec, constitutional experts, and now even former Prime Minister Martin all agree, Bill C-14 in its present form is likely not constitutional.

Even if the bill is passed next week, it will be tied up in legal challenges for years to come, and costly, exhausting court battles for suffering Canadians who just want to see their legal rights vindicated.

Why will the government not do the right thing and work with us to get the bill right the first time?

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

Mr. Speaker, we are committed to moving forward with Bill C-14 and have engaged very broadly on this really complex and deeply personal issue.

We have a deadline of June 6 to meet that has been directed by the Supreme Court of Canada. We are committed to having in place, it is our responsibility as parliamentarians, a legal framework in this country that ensures we find the right balance between personal autonomy, protection of the vulnerable, and ensuring there is access in this country.

[Marjolaine Boutin-Sweet, NDP, Hochelaga, QC]

Mr. Speaker, more and more people are concerned about whether Bill C-14 on medical assistance in dying is constitutional.

On the weekend, we heard from some of the Liberal Party faithful, former prime minister Paul Martin, and former Liberal leader Bob Rae. The government cannot get such an important issue wrong. It is not too late. This evening, Bill C-14 can be amended.

Will the Liberals work with the opposition to ensure that Bill C-14 complies with the charter and the Supreme Court decision?

Criminal Code

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Speaker, I know we have tried this before, but the third time is the charm. Given the importance of debate on this issue, it is important that we have another opportunity to extend it without affecting the timeline for the Supreme Court decision. Therefore, without moving the votes, we could extend debate on this.

Perhaps the government deputy House leader does not feel the same sense of urgency on this matter. He has been spearheading the movement against this motion today. He has spoken twice already, once at second reading and then at report stage, on this bill. However, other members have not spoken at all. They would appreciate that opportunity. I hope perhaps the deputy House leader has had time to call his boss and see if we can get a different answer this time.

The motion is: That notwithstanding any Standing Order or usual practice of the House, the time allocation order for Bill C-14, adopted on May 18, 2016, pursuant to Standing Order 78(3), be deemed amended to replace the words “not more than one further sitting day shall be allotted to the consideration of the report stage...of the bill” with the words “not more than two further sitting days shall be allotted to the consideration at report stage of the bill.”

[Mark Strahl, Conservative, Chilliwack—Hope, BC]

Mr. Speaker, those were very nice words, but I think it is time for action from that side of the House. We are where we are today. We can all play the blame game on why more members have not been able to speak, whether we should have sat until 3 o'clock in the morning, as the member said, or until midnight, or whether or not Motion No. 6, which has been withdrawn, was the answer to get this through.

We saw yesterday, in a spirit I would say of reconciliation, after the events that happened earlier this week, the government House leader withdraw his draconian motion, Motion No. 6, and promise to work with the opposition so that more members would have the opportunity to speak on Bill C-14.

The Liberals brought this bill on a Friday, which allows two hours of debate at report stage. There has been a very reasonable amendment to the motion put on the floor of this House to allow us to debate on Monday. It would not affect the timing of the votes or this bill proceeding to the Senate.

Why is the member opposing the opportunity for more members of Parliament to speak just on Monday? It would not affect the timing, the June 6 deadline, or the business of this House. Why not bring this back on Monday for another day of debate to give more members the opportunity to express themselves?

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

Mr. Speaker, it is with pleasure that I rise to share a few thoughts in regard to the report stage of Bill C-14. Perhaps I can start off by picking up on a couple of the words that were just mentioned.

When we talk about the details, listening to many hours of debate in the chamber on this very important legislation, a couple of things come to mind. One is the seriousness of the debate, the sense of compassion we hear in many of the speeches. People want to identify with the legislation and best represent their constituents. It is one of the reasons it has become somewhat of a difficult issue to try to manage. To try to give a false impression would be most unfortunate. There has been a genuine, serious commitment by the Government of Canada to accommodate all members who would like to address the legislation. We have seen that on several occasions. It would have allowed all members to participate in the debate.

We all share two responsibilities. One is to recognize that the Supreme Court of Canada made a decision, and there is a void. I will provide some comment on that shortly. Second is that all political parties in the chamber have to take responsibility in the debate that has occurred on Bill C-14. Members need to ask themselves why they feel limited in their debate. On a number of occasions, the government has extended the opportunity to afford every member the opportunity to speak. I wanted to be very clear on that point.

When we talk about the issue itself, there is another thing about which we should be talking a great deal. We heard a lot of this during the second reading debate. We have far-reaching legislation that will impact, directly or indirectly, every Canadian in every region of our country. At the end of the day, we need to recognize that this is just one major step. It is a step that has been mandated because nine Supreme Court of Canada judges made the decision that we needed to get some form of framework set up to provide medical assistance in dying.

I believe this legislation delivers that. I recommend that members look at some of the words that have been spoken, in particular by the Minister of Health, and the Minister of Justice. They have done a phenomenal job in getting us to the stage we are at today. I would not want to underestimate the role that others have contributed. In particular, the members of the joint standing committee of the Senate and the House spent many hours in the early part of this year in consultations. I wish to recognize the many efforts of committee members, who after second reading had the opportunity to go through the legislation and look at the possibility of amendments, and number of amendments were brought forward. We saw consensus among all three political parties for some of those amendments, which is great to see.

It is important we recognize that some in the chamber advocate that this bill does not go far enough. Others advocate that it goes too far. I believe the legislation before us today is the best legislation we can develop, put forward, and turn into law. At the end of the day, Canadians from coast to coast to coast will be assured that it is solid legislation.

If we do not pass the legislation in a timely fashion to meet a deadline determined by the Supreme Court of Canada of June 6, there will be a void. Some have said that we can just ignore the void. They can have that opinion if they choose, but it is the responsibility of every parliamentarian to respect the Supreme Court of Canada's decision. If members do not respect that, we are putting at risk a patchwork system, depending in which part of our great nation we happen to live.

There will be additional issues in many different regions that will surface and many will have to spend, potentially, hundreds of thousands of dollars dealing with the legislation in a piecemeal fashion because we did not respect what we have been called upon to do by the Supreme Court of Canada. There is urgency.

We know that caring and compassionate Canadians in every region of the country want us to do our job. That is one of the reasons it did not matter to me if we sat until three or four o'clock in the morning or 11 o'clock at night. We wanted to ensure that members had the opportunity to express themselves. As we get closer to that deadline, we have to get the legislation into the Senate. We have many reasons to be optimistic that the Senate has taken on what I believe is a more independent outlook in terms its responsibilities. Hopefully we will see a very productive Senate in dealing with legislation that has been passed by the elected members who sit in the House.

We have an obligation to do the best job in dealing with this issue. That means we should look at getting this bill through not only at report stage but at third reading in a timely fashion so the Senate is able to deal with it. I look at a glass as being half full, not half empty. I hope the Senate will do the same and assist us in meeting the Supreme Court of Canada's deadline.

I want to emphasize that this is step one. There are many other steps. One of them is the issue of palliative care. I and many of my Liberal caucus colleagues as well as many other members of the House are looking at this. The Government of Canada has been very clear on a solid commitment in two ways.

First is the health care accord. The best way to deliver palliative care is through agreements with the provinces, I wish the Minister of Health the very best in achieving that health care accord.

The second is the financial commitment of billions of dollars from this government to provide strong leadership going into the future, ensuring that palliative care is a top priority of this government and working with the many stakeholders that play a critical role in this so we have the best palliative care system in the world. This government, the Prime Minister, myself, and many colleagues in the House want to achieve good quality, world-class palliative care.

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

Mr. Speaker, following on the comments of the member for Esquimalt—Saanich—Sooke on the issue of the timing on the debate, earlier I offered a unanimous consent motion that would allow us to debate this bill on Monday, which would not change in any way the time allocation vote that we have to have at the report stage of Bill C-14 on Monday evening.

Currently, in just a few minutes, we will stop debating this bill, but with this motion, if it is adopted by the government side, as opposition members are in favour, we would then have a second day of debate at report stage, which would be on Monday.

It is my hope that the government will actually work to do what is reasonable. It does not change the vote that we will have on Monday night on report stage on Bill C-14, but what it does do is it adds a second full day of debate and allows members of Parliament to speak on this important issue.

I will read the following motion for which I am seeking unanimous consent: That notwithstanding any Standing Order or usual practice of the House, the time allocation order for Bill C-14 adopted on May 18, 2016, pursuant to Standing Order 78(3) be deemed amended to replace the words “not more than one further sitting day shall be allotted to the consideration at report stage of the bill”, with the words “not more than two further sitting days shall be allotted to the consideration at report stage of the bill”.

I hope that we will get unanimous consent and allow a second day of debate on this important bill at report stage.

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

Mr. Speaker, I am very glad to have the opportunity to finally speak to the bill at report stage, although, as I just said in my previous question, I am really sad to have to do this under time allocation and knowing that many of my colleagues will not get the chance to bring the voices from their constituencies to this chamber on the bill.

I was prevented from speaking at second reading by the time allocation imposed by the government, but something even more peculiar happened when it did that. The abrupt change of the House schedule on May 4 with time allocation forced the second reading vote forward by five days, and for those of us who have responsibilities both here and in our ridings, it meant on that Wednesday morning, I was already flying west before the time allocation motion was introduced. It meant that I could not be here to cast my vote at second reading because I was already flying in the wrong direction.

I lost my chance to go on record as voting against Bill C-14 in principle. That is what I intended to do, not just because of my own experience and beliefs, but also because I believe it contradicts the Supreme Court's Carter decision, and most important, because the bill contradicts the opinion of virtually every person and every family in my riding that has contacted me about this issue.

I have been involved in discussions about end-of-life issues with several individuals who are facing severe debilitating and painful illnesses. I have talked to them directly. I have met with them and have heard their concerns. This reminds me to mention an important issue that is not in the bill, and that is the issue of palliative care and the need for us as a society to do a much better job with end-of-life care.

I do want to praise those who are actively already working in end-of-life care. This is not a criticism of their efforts that they make each and every day to provide better care for those who are facing end of life, but they are forced to do so too often with too few resources and in substandard situations.

I have been involved in public discussions locally on this issue, stretching back to a public forum on March 21, 2015, which was jointly sponsored by a group called Victoria Choices in Dying and Dying with Dignity. We heard from a panel of speakers, which I was privileged to be on, but we also heard from the public. We heard speaker after speaker at that forum say that they wanted the right to control end-of-life issues. They wanted the right to make decisions for themselves, and they wanted the right for their family members not to have to suffer intolerable pain for great lengths of time, but to be able to make the choice for assisted dying.

I believe, as I said, not just speaking on the basis of my own conscience, but representing the beliefs and needs of my community, that I should oppose Bill C-14, not just for what is not in the bill, like palliative care, which only gets a mention in the preamble and for which the government has, incidentally, provided no new resources and there is no reason to wait for legislation to do that, but I will oppose the bill for what is actually in the bill. I believe the bill is too restrictive and respects neither the letter nor the spirit of the Carter decision.

I think we are in this unfortunate position because the government failed to listen to the key recommendations of our own special joint committee of the House and Senate. The committee made very wise recommendations with regard to the bill, yet only a few of them were incorporated into the bill at the committee stage.

In the interests of time, I will focus on what I believe are the three key faults in Bill C-14.

The first and most important to me is the absence of a provision for advance directives.

I want to talk, if I am able to do so, about a very personal experience, the death of my mother last fall. My mother had always been very clear, even before she developed dementia, and that dementia began to take away her capacity, she did not want measures to keep her alive, lying in the bed without consciousness, with no quality of life, and especially if she were in great pain.

Her dementia was not the immediate cause of her death, so she would not have qualified under the bill because she did not have a terminal illness, but in her case, six years after the onset of the dementia, she no longer had the capacity to make decisions. Other medical conditions left her in a situation which she had feared: in great pain and unable to care for herself. Those other medical conditions did eventually take her life in conjunction with the decisions we as her children and the medical practitioner made at the time.

We feel very fortunate that my mother had been very clear about her wishes. Although that did not really make the decisions we had to make easy, we were confident that we were doing what she had wanted to do. My own family's experience and the experiences of other families in my constituency are why I believe so strongly that Canadians have the right to make advance directives about their care.

The second reason that I am opposing this bill is the fact that it would impose what it calls a reflection period on those at the end of life. Of course, again, those who have dementia or other similar medical conditions would not be able to have a reflection period because they would no longer have capacity. However, even for those who are competent at that point in their life, I believe that the 10 days, which the committee thankfully reduced it to, is still far too long for those who are living in intolerable pain, and far too long not just for them, but far too long to ask their families and friends to witness that suffering. If there is to be a reflection period, it needs to be even shorter than those 10 days.

My third reason for opposing this bill is the fact that it would narrow who is eligible to receive medical assistance in dying to those whose death is “reasonably foreseeable”. I know that others have said that we know what that means and it is specific. However, the only way I can understand that we all know what that means is that all our deaths are reasonably foreseeable, but what it means beyond that, I have no idea. It is not a term that is used in medicine. It is not a term that is used in law. That very ambiguity raises the spectre of excluding people who need medical assistance in dying and who would have been qualified for it under the Carter decision.

According to the lead counsel in the Carter case, even Kay Carter, a fierce advocate for the right to assisted death for those who are suffering intolerably but from a non-fatal condition, would probably be excluded from accessing medical assistance in dying under Bill C-14 as it stands. What this would do is force people into incredibly cruel strategies like starving themselves to death to make their death imminent and allow them to qualify. I would hope that this House would not impose those kinds of restrictions on people and make them make those kinds of choices at the end of their life.

Would I rather have this bill than no bill? The answer I guess I am going to have to decide on. My decision is going to be that yes, I would rather have no bill. I prefer to go with the Carter decision. Do I think it would have been better to have a bill? Yes I do. I am not opposed to having a bill on this, but it has to respect the Carter decision, and it has to have clear provisions in it, and it needs to have a reflection period shorter than 10 days. If we do not have the bill, what happens? We do not have a legal vacuum as people are saying. We have the Carter decision, which would provide guidance. There is a legal framework.

Although I did not actually look this up, when the abortion provisions were removed from the Criminal Code, the House of Commons tried twice to create new law regulating abortions. I am sure these same arguments were made at that time, saying that practitioners would not want to perform abortions because there was no legal framework. In fact, we went with the court decision. We still exist with the court decision on abortion as our legal framework and we have not had chaos in the medical community on that; not that in any way I wish to compare abortion to medical assistance in dying, but only on this issue of whether there is a legal framework that will apply on June 6.

The failure to meet the June 6 deadline for this legislation lies with all of us. It lies with the previous government; it lies with the current government, and it lies with us as a House of Commons. We all have to take responsibility for missing that deadline.

However, I do have to say I believe the government could have managed the House time better so that all of us could have participated in the debate and that debate could have been accomplished in time to meet the deadline. All the Liberals had to do was schedule this bill as a priority in this sitting of the House, which they failed to do. That did not happen. Therefore, I will, when the time comes, stand and vote against this bill at third reading. In the meantime, I will also vote against it at report stage.

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

Mr. Speaker, it is an honour for me to rise today to speak in support of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).

I would like to start off by first acknowledging that medical assistance in dying is a deeply personal issue for all Canadians, which is tied to both their life experiences and personal beliefs. My background as a registered nurse in an oncology unit helped shape my thoughts and opinions on this matter.

Understanding that this is a very sensitive issue, with proponents on all sides of the debate, within days of this new Parliament, the now-government caucus moved swiftly to strike a joint committee to study the matter and make recommendations, which heard from many Canadians and experts on this issue. After working several days, sometimes well into the evening, the committee made its recommendations to Parliament.

Before I continue, I would like to thank all my hon. colleagues on both sides of the House, and in the Senate, who participated in the special committee and the justice committee for their contributions.

I also know that our minister has worked very hard to craft legislation that would ensure that the priorities of Canadians were met when it came to the issue of medical assistance in dying.

I strongly believe that the proposed legislation finds the perfect balance by reconciling the issue of autonomy of competent adults with the protection of vulnerable people through a thoughtful tailoring of the eligibility criteria and robust safeguards that are essential to preventing error and abuse. It also strikes the right balance by ensuring that conscience rights of physicians and nurse practitioners are protected, and commits to continuing to work with the provinces and territories regarding coordination and jurisdictional issues.

I want to assure members that our government is committed to continued discussions with the provinces and territories on a range of issues, not only related to medical assistance in dying but also to a full range of end-of-life options, including palliative care.

In various testimony given before the House committee, witnesses discussed other regimes where medical assistance in dying has been implemented. In Europe, for example, three countries have legislated access to medical assistance in dying, which is Belgium, the Netherlands, and Luxembourg. In the United States, four states have legislated access.

However, where Canada is unique is in the jurisdictional complexities that we face. In Canada, the federal government has exclusive jurisdiction over criminal law, and health is a shared jurisdiction between the federal, provincial, and territorial governments. Primary responsibility for the provision and delivery of health care services rests with individual jurisdictions. This is why our government has proposed legislation that will be applied across all provinces and territories but at the same time will respect and allow flexibility for jurisdictional roles and responsibilities in the areas of health care.

This brings me to another important issue that cannot be ignored or put aside when talking about enabling access to medical assistance in dying when one is approaching end-of-life care, and that is access to quality palliative care. It is very clear that Canadians are looking to their government for leadership to advance the availability and quality of palliative care within the broader scope of how we address Canadians' needs at the end of their life.

We know that most people at the end of life wish to remain at home as long as possible, as long as they are well supported by the services they need. This is why the federal government is committed to improving palliative care as part of a new health accord, supported by a long-term investment of $3 billion over four years.

Recently, federal, provincial, and territorial ministers of health agreed to work individually and collectively on improving home care to better meet the needs of patients closer to home. However, an agreement must still be reached on how funds will be used to strengthen and transform the health care system. We know that all jurisdictions are working diligently to meet the growing home and palliative care needs of their aging populations. However, we also know that jurisdictions are at different points. Some are well advanced in their efforts, and others are at a more moderate stage. By continuing to work with provinces, territories, and stakeholders, we will bolster each other's efforts for the benefit of all Canadians.

Another aspect that I would like to address when we talk about providing Canadians with that full range of options at the end of life is access. The government is very clear in its commitment to facilitate access to these services and to those providing it. This includes access to this new service of medical assistance in dying.

Our government is committed to respecting the autonomy of Canadians suffering from grievous and irremediable medical conditions. Access to medical assistance in dying would only be available for those who meet the following conditions: be a mentally competent adult who is in an advanced state of irreversible decline in capability; have a serious an incurable illness, disease, or disability, and are experiencing, enduring an intolerable suffering; and whose deaths are reasonably foreseeable.

It will also remain a crime to assist a person either in dying or in causing a person's death in situations other than lawful medical assistance in dying.

With regard to Bill C-14, our government is also committed to protecting the exercise of conscience rights as the proposed legislation also provides exemptions for both physicians and nurse practitioners from having to provide medical assistance in dying. Over the course of this national dialogue, we have seen that the protection of conscience rights for these providers is clearly an issue for many Canadians. Our government has listened and made Bill C-14 more explicit on this issue, and therefore more appropriate for the diversity within Canada.

The bill now reads as follows:

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

We trust that this helps to address the concerns some of members may have either personally and/or on behalf of their constituents on the issue of the protection of conscience rights.

Our government is also proposing to work with provinces and territories to create an end-of-life care coordination system. This would have a dual function. It would respect the conscience rights of health care providers, while facilitating access for Canadians to not only medical assistance in dying but a full range of end-of-life options, including palliative care.

The federal government would be prepared to collaborate on developing such a system should provinces and territories wish to participate, so that all Canadians have access to the care they need and deserve. We could also start on this by reviewing the information that we have on assisted dying regimes in other countries to see what they have done, and assessing their applicability to Canada.

Working in the health care field and especially in oncology, I know that health care is about connecting and helping people during their most vulnerable times. This means that we need accountable and transparent regulations to monitor and instill confidence in the appropriate implementation of medical assistance in dying.

This will protect vulnerable patients when they may not be able to do so themselves and help Canadians understand the number of requests for medical assistance in dying, the types of medical conditions that lead to requests, and whether the procedural safeguards in the law are working as intended. It will also work to ensure that high-quality, comparable Canadian data is generated so that any future discussions about changes to the medical assistance in dying system can be based on the best possible evidence.

Therefore, Bill C-14 creates legal obligations for physicians, nurse practitioners, and pharmacists to report certain information for the purpose of monitoring. Regulations will be put in place to guide the information to be provided, to whom, and within what time frame. In the short term, Health Canada is working with our counterparts in the provinces and territories to establish an interim system should the bill be passed on June 6, until a permanent process is in place.

In closing, I would like to once again reaffirm my support for Bill C-14, which I believe is the right approach for medical assistance in dying. It will support and facilitate access for those seeking it, protect our most vulnerable, and protect conscience rights. We know that no one solution can reconcile the diverse perspectives on medical assistance in dying, but we believe we are moving forward together with a balanced approach that is appropriate for Canada at this time.

I thank the Speaker for giving me the opportunity to speak on this very important piece of legislation.

The House resumed consideration of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), as reported (with amendment) from the committee, and of the motions in Group No. 1.

Standing Committee on International Trade

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

Madam Speaker, I am seeking unanimous consent to move a motion. I hope it will be supported by all members, especially those on the government side.

The government has said that it is willing to make amends for this week, and we are very appreciative of that offer. One of the things that could be changed is the perverse impact of the motion on time allocation that was adopted earlier this week. With that motion, at the end of today, which has been the only day of debate on report stage, the vote will be deferred to Monday evening, and we will not be able to have the debate that all members of Parliament want to have on Bill C-14.

The motion I am proposing would allow for a second day of debate that would not in any way delay the debate at report stage but, instead of debating other legislation on Monday, it would allow us to move to Bill C-14. Many members of Parliament want to speak to this, and it simply would not be acceptable to have one day at report stage when this is a critical stage of Bill C-14 in terms of its constitutionality and meeting the court obligations as well.

Having circulated the motion to all parties, I am hopeful that the government will support the following motion: That notwithstanding any Standing Order or usual practice of the House, the time allocation order for Bill C-14 adopted on May 18, 2016, pursuant to Standing Order 78(3), be deemed amended to replace the words “not more than one further sitting day shall be allotted to the consideration of the report stage” of the bill with the words “not more than two further sitting days shall be allotted to the consideration at report stage” of the bill.

This would allow for a second day of debate at report stage. We would still have the votes on Monday evening, but it would allow more members of Parliament to intervene on this important legislation.

Physician-Assisted Dying

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Madam Speaker, the case of the woman from Manitoba known as Patient No. 2 proves that Bill C-14 needs to be amended.

The patient has amyotrophic lateral sclerosis or ALS and meets the criteria set out in the bill. Nevertheless, the doctors who will be providing the care she needs are worried about being taken to court because of the vague definition of reasonably foreseeable natural death.

Will the government adopt the Bloc Québécois amendment, which would remove the threat hanging over health care workers' heads, namely the condition of reasonably foreseeable natural death? I would ask the government to give me a real answer, not just spout rhetoric.

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

Madam Speaker, I want to point out that the Alberta Court of Appeal did not rule on Bill C-14.

In the Carter decision, the Supreme Court of Canada stated that Parliament was in the best position to design a framework for medical assistance in dying, including a series of stringent safeguards. That is what we have done.

The decision by the Alberta Court of Appeal highlighted the need to have a law in place by June 6.

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

Madam Speaker, this is starting to look like another broken promise.

Let us now talk about another mismanaged file: medical assistance in dying. The government keeps talking about the Supreme Court's June 6 deadline as justification for limiting debate and refusing to work with the opposition. That is funny, because the government does not seem to be too concerned with abiding by the ruling itself. It is irresponsible to introduce a bill that a number of experts, and now the Alberta Court of Appeal, have deemed unconstitutional.

How can the government defend Bill C-14, when the bill does not comply with the Canadian Charter of Rights and Freedoms?

Criminal Code

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Madam Speaker, as I sit here and look up in the gallery, I notice some of our finest young Air Cadets who have just walked in, and I would like to acknowledge them today.

I will talk about four issues that I have with the process and with the current legislation. I would like to bring up the notwithstanding clause, compelling, deeming, and a free vote.

I will start with the notwithstanding clause.

I think a lot of us, especially on this side, are a little frustrated that the Supreme Court struck down the law of the land and basically said that it was not adequate to deal with this particular issue. I would argue that this House represents over 30 million Canadians. We are the ones who make the laws in this country. I think we need to remind the courts of that.

Certainly, the courts are challenged to uphold the laws that we write in this place, but when I see the wringing of hands on the other side that we are down to a deadline which is so imminent, I would like to remind those members that we are the body that makes the laws, not the Supreme Court.

I would also like to talk about “compelling”. I will read an amendment proposed by a colleague of mine:

(7.1) It is recognized that the medical practitioner, nurse practitioner, pharmacist or other health care institution care provider, or any such institution, is free to refuse to provide direct or indirect medical assistance in dying.

It sounds pretty practical to me. It goes on:

(7.2) No medical practitioner, nurse practitioner, pharmacist or other healthcare institution care provider, or any such institution, shall be deprived of any benefit, or be subject to any obligation or sanction, under any law of the Parliament of Canada solely by reason of their exercise, in respect of medical assistance in dying....

I guess what I am getting at is compelling one to cause someone else to die. This was brought up to us by a member of this chamber who is a physician. The member said that the physician is not the individual who would actually perform the action, that often it would be a nurse or some other medical staff who would have to perform the actual act taking a life. This is where I get really concerned.

I was talking with somebody while walking up to the Hill yesterday about my argument on Bill C-14 and the compelling side of things. He was actually supportive of making physicians and nurses perform the action of ending someone's life, regardless of what their moral beliefs are, regardless of what their religion is, etc., and that deeply concerns me.

As my hon. colleague in the NDP just mentioned, without bringing this issue to the Supreme Court, if we are going to put in amendments without getting the court's sign-off, my concern is that some practitioner who refused to enact an order to put somebody out of their misery and end their life would have to go before the Supreme Court. The practitioner would have to go through the legal expense and all that grief just to stand up for his or her beliefs, because the legislation does not adequately protect those individuals. It is a huge concern for me and my constituents.

I have talked about deeming before in this place, but I do not think I did a good job the first time in explaining what “deeming” really is and what it gets to.

This is on pages 12 and 13 of Bill C-14, and it is in relation to the Pension Act. I will read the actual clause:

(4) For the purposes of this Act, if a member of the forces receives medical assistance in dying, that member is deemed to have died as a result of the illness, disease or disability for which they were determined to be eligible to receive that assistance, in accordance with paragraph 241.2(3)(a) of the Criminal Code.

On the following page, there is clause 7, which references members of the forces, and it is very similar in what it is expressing.

My deep concern is that when a forces member or a veteran is somehow in tough times financially, it may become an option for the person as a way to get his or her family out of a financial burden by making the ultimate decision and ending his or her life. The fact is that it is not an option today, but this will make it an option in the future. This deeply concerns me.

Then, what of life insurance and what of other documents that relate to illness? What of those? Are they going to be similarly worded, that this would somehow encourage a member or a veteran to take that path?

Last, I would like to talk about free votes. On this side, we were asked about this a lot after the last Parliament. We were asked about how many free votes Conservatives had, and how many free votes the other parties had. When we were on that side, there were over 200 free votes, almost too many to count. We were actually given the true choice to make up our minds in this place. I think for the Liberals at that time they had around 20 free votes, roughly, because there were a few who stood to oppose different things. For the NDP, there was one.

What causes me more concern is that some of these motions have already been voted on in this House. All we have seen on the other side is one to zero in opposition of a particular motion. It concerns me that free votes are not really occurring, and that those members are being whipped into supporting a particular motion.

I say that in a challenging way. I do not say that as a way to say that the government needs to stay there. I think it is a challenge to the Liberals especially across the way to really hold free votes on this. We know there is a bunch of members on the other side with different issues of conscience with this bill. I would challenge the government to really stick to its principles of open and accountable government, sunny ways, etc., with this particular bill.

As my colleague from Cariboo—Prince George has said, this is going to be the defining piece of legislation that comes out of this Parliament. What it is going to look like in the future is going to affect us, our kids, their kids, and well into the future. It needs to be done right.

As a member from the NDP said, we need to make sure that this law is going to hold up in the Supreme Court. It would be wise to have a conversation with the Supreme Court about this particular legislation, with the amendments, and have the court come back and tell us what would hold up and what would not hold up. Short of that, this is just a simple exercise which is taking up a bunch of time, and the legislation will need to be changed all over again.

That is all I have to say. We put together some amendments. I have mentioned a few of my colleague's amendments. There is nothing strange in our amendments. There is nothing that is beyond what is expected by the Canadian public. They are about freedom of choice, freedom of religion, freedom of association, and all the rest of it.

Ultimately, we want Canadians to be free to make that decision, but we also do not want medical practitioners to be forced into making a decision that goes completely against those freedoms. I will end with this. I referred earlier to a medical practitioner in this place, and to a very compassionate argument about being forced into the position of possibly having to end someone's life against that physician's will. I do not want to see any medical doctor, nurse, anybody have to perform that action when they do not want to do it because of their beliefs.

It is a slippery slope, as many have said. I am deeply concerned about it. I hope the government side will think long and hard about pushing this legislation through without due process.

[Colin Carrie, Conservative, Oshawa, ON]

Madam Speaker, I would like to say how happy I am to finally be able to exercise my rights as a member of Parliament to speak to Bill C-14. Over the last few weeks, I have been in line to speak, but have not been able to do so because of the shutting down of debate and the antics put forth by the Liberals. I am really pleased to be able to talk today for my constituents.

I think it is important, when Canadians watch the debate, that they remember the debacle this week and that this was all about a vote on Wednesday to shut down debate on Bill C-14.

As my NDP colleague just said, we only have one more day, just a little over two hours, to debate 16 amendments. I think what is really important is for Canadians listening to this debate to get in touch with their MPs. They only have one week. I want them to look at the amendments and get in touch with their MPs, especially their Liberal MPs. As members sadly know, many of the backbench Liberal MPs will not be able to speak to the bill. The reason is that their front bench does not want them to speak on it. For me, for every member in the House, and for all Canadians, this is a very personal and very important bill, and has strong views on many sides of the debate. It will change the social structure of our country .

If we look at the foundation and the founding principles of our country and the great democracies around the world, they are based upon rights for life, liberty, and the pursuit of happiness. Today, we are actually debating some of the opposites of that: the opposite of life being death, the opposite of liberty being enclosure, and the opposite of pursuit of happiness basically being sadness.

I have been able to speak with, but also to listen to many of my constituents who have very diversified opinions. I think it is essential for all of us here in the House to respect these many points of view. At the extreme of one end, some were very much against the bill. Others were very much in favour of it. However, for most of the people I was able to listen to, they are somewhere in the middle.

The one thing that most of the people in Oshawa I have talked with agree on is that the act of assisted suicide should be an exception and not the rule. In other words, assisted suicide should only be made available on the rarest of occasions, and, of course, have the greatest of safeguards.

My concern, as we heard from my colleague here in the House, is that this is a flawed bill. In the rush to pass the assisted suicide bill before the deadline of June 6, the Liberal government has created confusion and despair. What have the Liberals chosen to do? They have chosen to break their promise to Canadians. I want to bring up and emphasize my question to my colleague across the way. When the Liberals were campaigning, they promised Canadians that they would put $3 billion into a palliative care system. I do not know where my colleague was reading it, but when I read the budget, there is absolutely no new money for health in the budget. In the first year, when the government is rushing to hit this date, there is no new money to support the other side of the equation. There is nothing. There is zero.

As far as health is concerned, this is a horrible message. It means that health care is not a priority for the Prime Minister. Canadians expect a choice between quality palliative care and this legislation. Instead, the Liberal government has chosen to support just one-half of that choice. It has put all its time and resources into assisted suicide and has not provided the promised $3 billion to palliative care, supportive care, for Canada's most vulnerable.

That is why I called on my colleague across the way to call on the Liberal government to immediately keep its promise. It is not too late to invest in palliative care. According to the Supreme Court, and from what we have heard, Canadians have the right to choose, to choose between assisted death, or hopefully the government can give them a choice to live comfortably near the end of their lives.

That is where this is really important and why I am glad I am able to speak today. The constituents I have talked to feel that the Liberal government needs to be held to account. Making the choice between assisted death and good palliative care has to be made available by June 6.

This is the first time in Canadian history that our government in Canada is drafting a law that would make it legal for one person to take the life of another. The Supreme Court has said that it is not just a required service, but has determined that it is a matter of individual rights. What precedent does that set? What do the experts in palliative care say?

Madam Speaker, I would like to share with you, but also with Canadians watching this debate and with my colleagues in the House, some of the thoughts of a very special constituent of mine in Oshawa. Her name is Dr. Gillian Gilchrist.

Dr. Gilchrist is a leading expert in the field of palliative care and she has practised medicine for over 50 years. She started the palliative care system in Oshawa in 1981, which was 35 years ago. I do not know anyone in the country with more experience, more respect, and more knowledge. Recently, through an initiative with Lakeridge Health in Oshawa, and Queen's University, a research chair has been named in her honour, dedicated to palliative care. It is the first fully funded academic research chair in palliative care at a community hospital in Canada. Dr. Gilchrist said that proper palliative care cannot be done without a team, and there is a lot that palliative care can do. There needs to be more volunteers and training. Patients deserve support, and the families need support as well.

One of the things Dr. Gilchrist said to me very strongly is that euthanasia is wrong, that doctors should not do it, and that it is not what they were trained to do. Dr. Gilchrist has treated more than 5,000 patients, and not one of those patients asked for euthanasia. She went on to say that palliative care cannot stretch across every corner in Canada, but with the assistance of the Internet, patients can obtain assistance to treatment as well as the support they need. Those individuals, at the end of their lives, can actually have a true choice. We know that experts have said that given the choice of good palliative care, 95% of patients will choose life over assisted suicide.

This affirms one of the most obvious weaknesses in the Liberal approach to this most personal and sensitive subject. How can the government rush forward so blindly toward an artificial deadline of June 6 without even providing the funds to improve palliative care options for Canadians? Have the Liberals even asked the Supreme Court for an extension?

Choice also belongs to doctors, whom the Supreme Court has said will have to perform this final irreversible act of assisted suicide. Doctors and institutions deserve the right of protection of conscience. We know that doctors have taken a Hippocratic oath that calls for them to first do no harm. The question is, why has the current Liberal government failed to adapt the legislation to provide positive protection for those doctors and institutions who cannot participate in suicide due to conscientious objections?

The legislation being presented today simply references conscience, but there is no guarantee of protection. There is a mishmash across the country. Conservatives have proposed explicit provisions for conscience protection. However, the Liberal government chose watered-down protection.

For me, it is beyond understanding how a group of nine unelected lawyers from the Supreme Court can tell physicians how they must practise medicine. We do not see medical doctors telling lawyers how to practise law, especially without guaranteeing their rights to abstain from a practice that all of them swore to reject. As Dr. Gilchrist told me, this is not why they became doctors.

I want to repeat that I have been prepared multiple times to speak to Bill C-14, and I have been able to listen to my constituents. What I think is really important for Canadians to understand is that this is not a debate about money, about technicalities, and this is not a debate about regulations. This is an unprecedented debate about the subject of one individual taking the life of another. It is a national debate. All Canadians deserve to have their voices heard.

I want to thank you, Madam Speaker, and I want to thank the House leaders for all they have done. This is probably one of the most important issues that I have faced as a parliamentarian in the 12 years that I have been here.

[Kim Rudd, Liberal, Parliamentary Secretary to the Minister of Natural Resources]

Madam Speaker, as I was saying the other day about Bill C-14, it is evident that governments, national associations, and members of the public recognize the moral and ethical struggle that health care providers could experience regarding medical assistance in dying.

Most provincial and medical regulatory bodies have already provided professional guidance around safeguarding the conscience rights of physicians. Provinces like Alberta and New Brunswick say their physicians are under no obligation to participate in assistance in dying. However, they recognize that continuity of care, especially at this most critical time in a person's life, also cannot be neglected. Patients cannot be abandoned.

The Canadian Medical Association's submission to the Special Joint Committee on Physician-Assisted Dying recommended that physician freedom of conscience be recognized as a key component of the federal legislative response to the Carter decision. Participants at a public town hall meeting in Mississauga, Ontario, raised concerns about the ethical dilemmas facing physicians if they chose to be involved in medical assistance in dying.

On May 10, proposed new section 241.2 was carried. In effect, this amendment clarifies that there is nothing in the legislation that would compel a person to provide or assist in providing medical assistance in dying. This amendment would contribute to public awareness that the bill recognizes both the rights of health care providers for freedom of conscience and the needs of Canadians who wish to have access to medical assistance in dying.

It is clear that no health care provider would be required to provide medical assistance in dying. However, we must also respect the rights of people seeking this procedure to have reasonable access. We know that there are many physicians who would provide medical assistance in dying to an eligible patient under their care. We heard from them throughout the consultations leading up to Bill C-14.

In a poll of 372 physicians, the College of Family Physicians of Canada found that 65% would help a competent, consenting, dying patient end his or her life, if requested. However, as was presented to the Standing Committee on Justice and Human Rights by Dr. Jeff Blackmer of the Canadian Medical Association, having health care practitioners willing to provide medical assistance in dying is only one part of the equation. The other very important factor is the ability to connect eligible patients with these willing practitioners.

People seeking medical assistance in dying will have already encountered many challenges. Once they have made this difficult personal choice, they do not need additional barriers, such as the lack of a provider. The government has committed to develop measures that will support access to medical assistance in dying and to work with provinces and territories toward a common approach to referrals or transfer of patient care.

Provinces and territories have also indicated that they feel that a third party referral function would be a viable option. This would respond to the access needs of patients and protect the conscience rights of health care providers who do not wish to refer patients for medical assistance in dying. To this end, we will be working with provinces and territories to develop an end-of-life care coordination system.

In its simplest form, this system would provide a registry of authorized providers willing to accept patients whose providers consciously object to this practice. It could also provide a system through which patients could self-refer to an authorized provider to seek an assessment of their eligibility. The end-of-life care coordination system could also be a source of information and resources to both patients and providers on all aspects of medical assistance in dying—eligibility criteria, safeguards, and so on—as well as information about other end-of-life options, including palliative care.

Similar systems are used in several other countries. For example, both Belgium and the Netherlands offer specialized services that provide physicians with access to a registry of trained, independent, and impartial physicians who offer consultations on end-of-life options, including euthanasia requests.

Collaborative federal, provincial, and territorial work could consider such international examples in establishing a made-in-Canada model to provide providers and patients with access to a system that could transfer care to a physician willing to assess and administer requests for medical assistance in dying.

Additionally, the system could service medical and nurse practitioners in need of an independent consulting practitioner, for example, in rural ridings, such as the one where I live, in remote areas, and where access to a second provider is challenging.

We trust our health care providers to work hand in hand with us in helping to maintain and improve our health. When our needs change, and we look for ways to relieve suffering and avoid a long and painful end, Canadians want to be confident that these providers will not abandon them but will help them choose their own paths.

I look forward to working with my federal, provincial, and territorial colleagues to ensure that, when the time comes, compassionate care and support at the end of life will be available to Canadians without undue burden or delay.

Physicians are key to the end-of-life process. They are a critical thread that not only binds but frames this whole discussion. They are imperative to move this important debate forward. I have shared my very personal experiences on palliative care and on how critical it is.

I met this past weekend with a physician in my riding who spent years working with palliative patients. This is a man who is passionate about end-of-life care, and he expressed unequivocally to me how important this legislation is. He felt that there is a strong desire on behalf of the medical community to find the right path to ensure that we have the best care options. This legislation is a major step forward on that very important path.

This legislation has created a national conversation around end-of-life care, palliative care, and home care and how we want to be treated at the end of our lives. This has to be the most important conversation we can ever have.

This is a true legacy piece. I believe the decisions we make around this bill will reverberate positively for years to come. As I said before, I am confident the proposed legislation provides us with a balanced solution that reconciles diverse interests in medical assistance in dying and is appropriate for Canada.

The House resumed from May 17 consideration of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), as reported (with amendments) from the committee, and of the motions in Group No. 1.

Life Means Life Act

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

moved that Bill C-229, An Act to amend the Criminal Code and the Corrections and Conditional Release Act and to make related and consequential amendments to other Acts (life sentences), be read the second time and referred to a committee.

Mr. Speaker, I rise today to speak to Bill C-229, which would amend the Criminal Code and the Corrections and Conditional Release Act. Before I outline my reasons for bringing this bill forward, I want to make a few general comments, primarily for the members of the opposition who, I am sure, when speaking to this bill, are likely to say that it is just another approach to legislation by a hard right-wing Tea Party Conservative member.

However, I supported Bill C-14 at second reading and in all likelihood will support the bill at third reading. I will be supporting Bill C-16 because I believe all Canadians should be treated with equality and, frankly, it is the motivation behind proposing this legislation, which I will explain in a moment.

I am sure we can all agree that Canada has a reputation as a peaceful country of compassionate neighbours who live in relative comfort and security. We are fortunate that as a country our crime rates are low and we are generally able to walk our streets without fear. However, we must also acknowledge that there are some in our country who seek to do harm. There are some individuals who do not respect our values of peace and compassion. These individuals seek to harm others and make us feel unsafe in our homes, on our streets, and in our communities.

In our country, we perceive that people are innocent until proven guilty beyond a reasonable doubt, and that principle should never change. However, when someone is proven guilty beyond a reasonable doubt of heinous crimes such as multiple murders or murders which are so brutal that they upset us to even hear about them on the evening news, that person must be seriously punished for his or her actions. When a life is taken in such a manner, the families and loved ones of the victims are in essence given a life sentence with no chance of ever seeing that loved one again.

In the past 10 years, the former Conservative government introduced and passed over 60 substantive pieces of legislation to help keep criminals behind bars, to protect children, to put the rights of victims ahead of criminals, and to crack down on drugs, guns, and gangs.

I want to highlight some of the former Conservative government's justice accomplishes. They include the Serious Time for the Most Serious Crime Act, the Tackling Violent Crime Act, the Canadian Victims Bill of Rights Act, the Tougher Penalties for Child Predators Act, the Safe Streets and Communities Act, the Abolition of Early Parole Act, and the Drug-Free Prisons Act.

The most serious offence in the criminal code is murder. First degree murder, a murder that is planned and deliberate, carries a mandatory penalty of life imprisonment with an ineligibility of parole for 25 years. Murders that are not planned and deliberate carry the same penalty where they are committed in certain circumstances, including where they involve the killing of a police officer or sexual assault.

Through previous legislation, the former Conservative government strengthened penalties for murder, including eliminating the faint hope clause, which allowed a murderer to apply for parole after 15 years, and enabling consecutive periods of parole ineligibility for multiple murderers so they would no longer receive a sentencing discount.

Today, I am introducing the life means life act to ensure that the most heinous criminals would be subject to mandatory life sentence without parole. The life means life legislation would ensure that offenders who were convicted of heinous murders and those who were convicted of high treason would be imprisoned for the rest of their natural lives with no access to parole. This would include murders involving sexual assault, kidnapping, terrorism, the killing of police officers or corrections officers, or any first degree murder that would be found to be of a particularly brutal nature.

The life means life act would amend the Criminal Code to make a life sentence without parole mandatory for the following crimes: first degree murder that is planned and deliberate and that involves sexual assault, kidnapping or forcible confinement, terrorism, the killing of police officers or corrections officers, or conduct of a particularly brutal nature; and high treason.

The bill also gives courts the discretion to impose a sentence of life without parole for any other first degree murder where a sentence of life without parole is not mandatory, and second degree murder where the murderer has previously been convicted of either a murder or an intentional killing under the Crimes Against Humanity and War Crimes Act.

The law allows a criminal serving life without parole to apply for exceptional release after serving 35 years. This application would be made to the Minister of Public Safety and the final decision would rest with cabinet. The family of the victim would be able to provide input before any decision. This is consistent with the traditional approach of granting clemency and addresses legitimate constitutional concerns.

I recognize that some of my colleagues will object to this bill. They will say it is wrong to lock up someone for life because the person can be rehabilitated. To them I say, no amount of rehabilitation can bring back the victim of a murder. No amount of rehabilitation can bring back the stolen birthdays, holidays, and special moments in that victim's life. No amount of rehabilitation can bring back that victim to his or her family.

I believe Canadians will largely agree that some crimes should result in the murderer never walking free again. The victims of these murders deserve nothing less. As I said at the outset of my remarks, some of my colleagues will say this is just another Conservative tough-on-crime bill. Well, I am a Conservative and this does fit the definition of tough on crime. Similar laws already exist in the United States, the United Kingdom, New Zealand, and Australia. These governments have found similar measures to protect victims and their families.

To those who would call the bill another Conservative tough-on-crime bill, I would say to them that they are right. As mentioned earlier, when in government, our party introduced a series of measures to restore the balance between the rights of the criminal and those of the victim's family. I believe this bill is the final piece of the Conservatives' efforts to ensure that the scales of justice in the future are never tipped in favour of those who commit heinous crimes at the expense of the family of the victim.

Income Tax Act

[Anthony Housefather, Liberal, Mount Royal, QC]

Mr. Speaker, I would like to thank my colleague for his speech.

I completely agree with him about the role of committees, and I am proud that the members of the Standing Committee on Justice and Human Rights were able to work together to make 16 amendments to Bill C-14. I hope that that will also happen in other committees.

I understand the demand being made by my New Democrat colleague, who wants to offer a tax cut to a bigger group of people than the one provided for in Bill C-2. However, during the election campaign, the NDP did not put forward any proposal to reduce taxes for those who will benefit from Bill C-2 or for anyone else.

How is it that the New Democrats did not propose any tax cuts for the middle class during the election campaign and now they are demanding that sort of tax cut before they will support Bill C-2?

Physician-Assisted Dying

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

Mr. Speaker, I thank my hon. colleague for his substantive engagement in the discussion around Bill C-14.

We are confident that we have made and put forward a public policy decision around medical assistance in dying in this country. This is a transformative piece of legislation on which we have engaged with many Canadians and many members within this House. We look forward to the continued discussion.

We look forward to ensuring that we reach our deadline of June 6 so that we will have a legislative framework in place for medical assistance in dying that is balanced and which speaks to this transformative piece in the period of time that we are in.

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

Mr. Speaker, after applauding Quebec's non-partisan approach in dealing with medical assistance in dying, the Liberal government is taking the exact opposite approach.

It is stifling debate, refusing to listen to experts about the constitutionality of the bill, and rejecting the opposition's most important amendments. Even the Alberta Court of Appeal has contradicted the government. Bill C-14 does not comply with the Carter ruling.

How can the Liberals put forward a bill that could be challenged the very moment it is passed?

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, I hope that my colleague will agree with me that we have tried many times to find a way to extend the hours of debate. At one point, I even moved exactly the same motion as my colleague from Regina—Qu'Appelle, but the House did not support it.

We remain optimistic and we are going to work with everyone to ensure that as many people as possible are able to speak to Bill C-14. However, we are also going to show respect for the Supreme Court and the decision that it imposed on Parliament.

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

Mr. Speaker, the government decided to withdraw Motion No. 6. That is a good thing. Well done. The government has also just told us that it will allow a free and full debate on Bill C-14. That is great.

However, we need to be careful. We got burned on the bill on medical assistance in dying. At second reading, on two separate occasions, government representatives rose to interrupt the debate and put an end to second reading. That is completely unacceptable. The Leader of the Government in the House of Commons is an honourable man. Will he give us his word that every parliamentarian who wants to speak to this bill will have the opportunity to do so and that no government representatives will rise to stop debate?

Business of the House

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, I agree with my colleague on the other side of the aisle that it is important to have more respectful debate in Parliament.

I hope she will agree with me that, particularly with respect to Bill C-14, medical assistance in dying, we have tried on numerous occasions to allow the House to continue for extended hours so all members of Parliament can be heard on this important issue. We will continue to urge the House to do that.

However, we are also conscious of the deadline that the Supreme Court imposed on Parliament, and we think it is important to have the appropriate balanced legislative framework in place by that deadline.

Physician-Assisted Dying

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, as I said, and as we have done from the beginning, we have every intention of giving all members a chance to speak, given the importance and sensitivity of Bill C-14.

However, we also recognize that the Supreme Court has given the government and Parliament a deadline, which is June 6. We believe it is important to strike a balance between the need to hear from all members and the need to abide by the Supreme Court ruling and pass balanced legislation by that deadline.

[Denis Lebel, Conservative, Lac-Saint-Jean, QC]

Mr. Speaker, I thank my colleague for her answer.

Naturally, we all have very strong feelings about Bill C-14. Our constituents elected each and every one of us to this place to debate the issues that matter to Canadians. The opposition members have done important work. We produced a dissenting report that was heeded and respected. I thank the government. We need to continue and go even further.

Do the Liberals plan to give members who want to have their say on behalf of Canadians in this debate the opportunity to speak?

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, it is no secret that we have been trying to extend the hours and allow for more debate on this very important issue. I think all colleagues will agree with the Leader of the Opposition that we recognize the importance and sensitivity of Bill C-14. It is an issue that touches the lives of many Canadians and all parliamentarians, and we will continue to look for a way to extend the debate and allow every member who wants to speak to speak.

However, we also respect the deadline that the Supreme Court of Canada has asked Parliament to respect and we think there is a proper way to balance those two interests.

Government Business No. 6

[Gord Brown, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Mr. Speaker, we went from sunny ways to a dark week in Parliament. We had altercations on the floor of the House; chaotic scheduling of business without notice; the moving of dilatory motions by the government, delaying its own legislation; and the closing of debate on Bill C-14, the first time in history that such measures were used on a moral conscience issue.

Then we wake up Wednesday morning to Motion No. 6, a motion that proposes to legislate by exhaustion, offering unstructured, open-ended debate, potentially sitting 24 hours a day around the clock, all summer long, and when the government is satisfied it has forced through enough business, it can bail out without notice and without a vote.

Motion No. 6 targets the opposition and hamstrings its ability to hold the government to account. It disenfranchises the 60.5% of Canadians who voted for those opposition members. Even the 39.5% of Canadians who voted Liberal will not appreciate or be well-served by the crippling of the opposition.

Motion No. 6 must be withdrawn from the Order Paper and never repeated again.

Reference to the Standing Committee on Procedure and House Affairs

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

Mr. Speaker, I would like to share my time with the member for Lambton—Kent—Middlesex.

I am very troubled, like many today who have stood up to speak. What I would really like to do is perhaps set the table a bit on how we found ourselves in this position. I think more than one incident has created this really unfortunate position we are in today.

I would like to start with the election of October. The Liberals were given a strong majority. In part, their message to Canadians was that they represented change, a new voice, and a change in our democratic process. Canadians listened to that, they watched, and in October provided a strong majority for the Liberals.

I want to quote a part of the Speech from the Throne, which was just five months ago. It states:

Canada succeeds in large part because here, diverse perspectives and different opinions are celebrated, not silenced.

Parliament shall be no exception.

In this Parliament, all members will be honoured, respected and heard, wherever they sit. For here, in these chambers, the voices of all Canadians matter.

The Speech from the Throne is a very critical document. It is the road map that the government is providing and sharing with Canadians on what its plans are.

The speech also indicated, “give Canadians a stronger voice in the House of Commons, the Government will promote more open debate and free votes, and reform and strengthen committees”.

Those are very important commitments.

In every minister's mandate letter, this is included:

I made a personal commitment to bring new leadership and a new tone to Ottawa. We made a commitment to Canadians to pursue our goals with a renewed sense of collaboration.

Again, every minister has that in their mandate letter. It is in the Speech from the Throne. It is the tone that was committed to by the government to be set in the House.

The government is not very old. It is only six months. Of course, we did not sit until January. We had a small sitting in December and then we had a sitting that started in January after Christmas. Perhaps the first month or two, the Liberals lived up to the commitments they made to Canadians. However, starting in the last few weeks, there has been a significant and noticeable change. The hon. opposition leader, the member for Sturgeon River—Parkland, said it best when she said that the Liberals apparently now wanted to have an audience and not an opposition.

We can look at items like democratic reform, which is fundamental. The Liberals do not want all voices heard; they only want their voices to be heard. If we do not agree with them, they will do things like move opposition days to Fridays, which is a very short time and there is not much opportunity to debate.

Everyone in the House recognizes that Bill C-14 is very important legislation, and we need to look at this because it is very important. We returned on Monday, and the understanding was that we would spend most of the day talking about Bill C-14.

I have been in the House for seven years, and I have one of the furthest ridings, which is usually 12 hours door to door. I always make that trip on Sunday night so I am here ready to be present in the House when it opens on Monday.

It is also important to note that the House only sits 26 weeks of the year. There are 26 weeks where members can be in their ridings or cabinet ministers can do some of the important work they have to do outside the House. We know the government wants to get rid of Friday and does not want to show up to work on Monday.

It is very simple math. The government has 184 members, and they need to have 169 in the House on Monday morning. How many were here? There was 139. Even at 169, it means we can still have a few people who are away, or some ministers off doing some of the work they need to do. However, they need to have their people in the House. They were shy of that 169 by 30 members.

The fact the Liberals almost lost the vote is not the responsibility of the opposition; it is the responsibility of the Liberals and their need to show up to work.

Instead of debating Bill C-14, what did we do? With respect to Bill C-14, we hear from the Minister of Health that it has a critical time frame, that it has to get done. Did we debate Bill C-14 on Monday? No. We debated Bill C-10 all day. Although important legislation, it did not have the criticalness to it that Bill C-14 has.

What did we do Tuesday? We debated Bill C-6, the citizenship act, which is important legislation. All legislation is important, but it was not Bill C-14 with its critical timeline.

Then we went back to the debate on Bill C-10, the Air Canada Public Participation Act. Then we debated Bill C-11, the Copyright Act, again, important legislation.

Essentially, we offered to debate Bill C-14 until midnight for two days, but the Liberals had us debate other legislation instead. More important, not only did they have us debate different pieces of legislation, they failed to even provide a parliamentary calendar. That has never been done in the whole time I have been here. We are given the agenda for the week so we can prepare. The Liberals did not even have the respect to provide a parliamentary calendar. All of a sudden we were debating the Copyright Act. That is a profound disrespect to the opposition and it has never been done in Parliament.

Then we hit yesterday, which was Wednesday. We were again ready to debate Bill C-14, which had important amendments from the committee and we needed to debate them. It is important to debate. Debate matters, especially in this instance. At second reading, I had a profound compliment when one of my colleagues said, “Listening to your words in the debate changed my mind in terms of how I'm going to vote”. We are debating life and death. We are debating amendments. What did the Liberals do? They put closure on the debate, maybe one speech at report stage on something so critical. We could have been spending Monday, Tuesday and Wednesday debating the bill.

On top of that, the Liberals introduced Motion No. 6, which was so aptly described this morning as looking at every possible tool the opposition has and taking it away.

The member for Wellington—Halton Hills said:

The fundamental responsibility mechanism in the House is the confidence convention. The 20 or so members of Parliament who are part of the ministry who are the government sit there because they have the confidence of the majority of members of this chamber. It is that confidence convention that is undermined by the motion that the government has put on the paper.

By giving members of the ministry the unilateral right, at any time, to adjourn the House...

We can certainly see a whole host of measures. Certainly we were debating a closure motion. The NDP delayed things for, I understand, less than a minute when the incident happened where the Prime Minister lost control.

As I head toward the end of my time to speak to this important issue, there are a few things that I would like to see.

First, the Prime Minister's apology was appropriate. He also needs to look into his heart to see what created that anger within him and why he responded to it in such an inappropriate way.

More important, I think we all expect him to live up to those standards and commitment he made in the Speech from the Throne to respect all members of the House. This would include removing Motion No. 6.

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

Mr. Speaker, I will be sharing my time with the member for Nanaimo—Ladysmith.

Before I comment on the matter before us this morning, I would like to make a comparison with the discussions we had about Bill C-14.

The discussion started off well enough. I am very happy to have been a member of the Special Joint Committee on Physician-Assisted Dying, where the quality of the debate was very mature. I really enjoyed collaborating with my Liberal and Conservative colleagues on our committee's work. We were all motivated by a desire to work together to get the best results for the people we represent. Even though we did not always agree, our discussions were always respectful.

Our life experiences make us who we are today. Personally, regardless of the situation, I always pay attention to the people around me. Someone just said that, when emotions are running high, our actions may be out of character. No. When my emotions are running high, I am always respectful of the people around me.

I was therefore saying that the Special Joint Committee on Physician-Assisted Dying managed to discuss the issue respectfully. Last week, I attended the first meeting of the Standing Committee on Justice and Human Rights to examine Bill C-14 clause by clause. I think that may have been the beginning of what we saw yesterday. I did not get the impression that the Liberal members who were at that meeting were open to discussion.

My life experience has taught me that discussion and debate yield better results. I did not get the impression that the members at that meeting were open to debate. The members were there, but some of them did not even seem to be interested in the discussion. They were just there to obey the order they had received to vote against any amendments proposed by the opposition.

This week, time allocation motions were moved, motions that would prevent members from speaking in the House. One Liberal colleague made an interesting analogy. When I asked him why we could not have a discussion about Bill C-14, he told me that even he had tried, but it is as though the government is caught in a rushing stream moving toward the deadline, toward its goal, and going against the government right now is like trying to swim against the current at Niagara Falls.

When a government adopts the attitude of wanting to achieve a certain goal at all costs, it will run roughshod over anything standing in its way. In my life, there is something that I refuse to ever accept and that is the excuse that the end justifies the means. That should be unacceptable. I think that we were all able to see the result of that attitude yesterday.

We really need to ensure that our debates in the House are respectful. That is the only way that we will be able to honour the privilege that we have been given of being here to represent our constituents.

In her speech, I heard my Liberal colleague trivialize yesterday's behaviour, and we saw that attitude yesterday as well.

When someone witnesses an act of violence or intimidation and thinks that the victim is partially responsible, that should raise a red flag. That line of reasoning is wrong. Under no circumstances is a victim of an act of violence or intimidation ever responsible for that act.

Some Liberal members are trivializing what happened, saying that he is a good person. I too am a good person and I am never disrespectful towards anyone. I would never do anything that might hurt anyone around me. If genuine respect guides us in all our actions and in all situations, we can ensure that we will always be considerate of those around us.

In his apology this morning, the Prime Minister said that he did not pay attention to his surroundings. When the committee examines this matter, it will have to decide what the consequences should be, and then we will all know what consequences we can expect if we do not pay attention to our surroundings in the House. That is crucial.

What is more, people keep talking about bringing decorum back to this House. Unfortunately, since this government came to power, there has been plenty of lip service, but very little in the way of real measures. If it really wants to bring back decorum, the government should start by withdrawing Motion No. 6, which muzzles the opposition and limits our rights as parliamentarians. That would be far more meaningful as a concrete gesture than any empty rhetoric the Liberals could spew here today.

Some concrete action needs to come from this debate, and we must leave room for discussion. This morning the Minister of Health said that she hoped we would make a wise decision regarding Bill C-14. In order to do so, parliamentarians must be allowed to continue the discussion and debate.

Yesterday's incident occurred when the government was trying to curtail debate. It is the attitude that we saw this week that led to yesterday's actions. After the Prime Minister's apology, some Liberal MPs rose in the House to make light of the situation.

In the House, we must not make light of acts of violence and bullying. Yesterday, when I compared what happened to other acts of violence, that is exactly what I wanted to convey. We must not make light of acts of violence and bullying, no matter where they are committed. This belief must be very clear in everything that is said in the House.

We have the privilege of representing citizens. Consequently, we must rise above what we witnessed yesterday. Since yesterday, I have heard people say that we have to put things into context. The context and the facts are very clear, though, and we must not try to make light of them. It is important that there be very clear consequences for yesterday's actions. The best thing that the government could do about this incident is withdraw Motion No. 6.

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

Mr. Speaker, I listened to most of those comments while eating my lunch, and then I came back in here because I felt it was very important that we actually discuss this.

First, the member quoted many members of Parliament, but she did not actually quote the member for Berthier—Maskinongé.

Yesterday, I was sitting in this House and I said to my friend from New Brunswick Southwest, who is a member of the government, that I had to leave and take an adult timeout. I am a 45-year-old woman, similar in age to the Prime Minister. As an adult, I recognized that I was losing my cool, that I was not happy with the way things were going in the House. Therefore, I took a stance, removed myself from the House, had a breath of fresh air, and came back in.

I did watch what the Prime Minister did yesterday. Actually he and I had some words. Because I feel I can communicate with many members, I said to him that I saw the anger. That is something we have to look at. He is the leader of our country. He needs to be the leader of all Canadians. What I saw last night on Twitter was absolutely disgusting. I saw that the NDP member who had been hit—yes, by accident; I do agree it was an accident—was not just victimized about being hit, but her integrity was totally thrown overboard. No one really cared. They were saying that she was a drama queen, and this and that. That is not what this is about. Although I have great respect for the member for Hull—Aylmer, with respect to his comments about this being a soccer match, yes, it was a soccer match, and our Prime Minister should have been given a red card. His actions were out of line.

When I am not a member of Parliament, I am a mother of five children. I, too, have had to learn to take an adult timeout. The Prime Minister felt that he needed to go over there and say, “We need to do this”. He is not the king of the castle. We are members of Parliament and we need to all work together. If I as the member for Elgin—Middlesex—London recognized that things were getting out of hand, why could he not sit back, allow things to take place, and act as an adult, rather than interfering in something that he had no business interfering in, which resulted in where we are today? We can talk about wanting to talk about Bill C-14, because we all do, but unfortunately because of what happened we cannot, and those actions must be discussed.

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

Mr. Speaker, before I speak to the topic we are discussing this morning, I want to remind the minister that we are not debating Bill C-14 because of the government's actions and the Prime Minister's behaviour yesterday.

I agree with the minister that our life experiences shape how we deal with those around us. I commend her for saying that we must be respectful in our behaviour toward the people around us and in how we deal with others.

What really got to me in the exchange we had yesterday after the Prime Minister apologized was that a number of his Liberal colleagues rose to downplay violence and bullying. They even put part of the blame on the person who was subjected to this violence and bullying.

I would like her to talk about her contribution. What will she do to ensure that her colleagues no longer downplay violence and bullying?

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

Mr. Speaker, I thank the hon. member for echoing my remarks about the very positive tone that we have had in this House on a number of occasions. I think it has set a good standard for us, a standard that hopefully we can learn to aspire to on a daily basis.

I look forward to hearing the hon. member's speech. I agree with her that we need to move forward as quickly as possible to discuss the important matter of Bill C-14. I will remind the hon. member that we have already had, I believe close to 24 hours of debate on the matter of Bill C-14 in this House. I know that there are more comments to come. I have enjoyed many conversations with my colleagues on all sides of this House about the matter, and I hope that we will soon be able to resume that discussion.

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

Mr. Speaker, I will abbreviate my further comments out of respect for my colleague. I simply want the House to understand, and to make a request, that we consider making wise decisions with respect to when it is appropriate for us to move on to debating the important legislation before us.

The only other point I want to add is that, on the one hand, I want to ensure that access is available and, on the other hand, we have a real responsibility to face that if that legislative framework is not in place in due time, there will not be adequate safeguards to protect Canadians.

I know that my colleagues opposite are concerned about that. I hope we can move forward on the debate of Bill C-14 as soon as possible, which I think is so important.

I will respectfully respond to questions in very short order. I am thankful for this opportunity to speak.

[John Barlow, Conservative, Foothills, AB]

Mr. Speaker, I rise on a point of order. I find it very disappointing. On a day when we are speaking about something that is extremely important, the first time in Canadian history that a prime minister has been accused of something like this, and the Minister of Health is talking about Bill C-14. There are some relevancy questions here, and I would appreciate if she would bring this back to the topic we are talking about, which is the actions of the Prime Minister, not Bill C-14.

[Jane Philpott, Liberal, Minister of Health]

Mr. Speaker, I appreciate the opportunity to speak this morning.

As members may know, I arrived in this House just over six months ago, along with many members here, as a representative for the first time. I represent the wonderful riding of Markham—Stouffville. It is a great honour to have the opportunity that we all have to represent the people of our own constituencies.

In that six months, I have learned a great deal from colleagues around this House. I have learned a great deal about parliamentary procedure, and I continue to learn on that matter. I have been encouraged by the professionalism and the high level of debate and discussion on issues that are so fundamentally important to Canadians.

I think about the times that I have spent in this House in that short time. One of the outstanding memories is of the evening that we sat late into the night on an emergency debate about suicide and mental health issues in indigenous communities. I remember hearing members who were moved to tears as they spoke, and seeing other members who were moved to tears as they listened to the comments that were made from all sides of the House of Commons. That was a proud evening for us as Canadians. We have debated so much important legislation, and we know that the things we talk about and the decisions we make in this House will have a fundamental influence on the lives of Canadians.

This has been a particularly challenging week for us all. It has been a week full of emotion. I certainly have had a span of emotions myself. We have had some real struggles together, and we have debated some very serious issues. Every single day, we, as parliamentarians in this House, need to live up to the expectations and the responsibility that we have to the people of Canada, the people we represent. Every day, we are put to the test to meet that challenge in the best way we can.

Today, I heard our Prime Minister deliver sincere apologies for what transpired yesterday, and that was the right course of action. To the members who have been hurt by the incident, I want to empathize and express my sincere concern for them. I trust that any comments that I or others make today would never in any way diminish the feelings of hurt that they have expressed.

We all have different experiences that we bring to the table and to this position. As a result, we experience events in our own unique and personal ways. In my life, I have had the tremendous privilege of working as a family physician. I spent almost 10 years working in sub-Saharan Africa, and then over 17 years working as a family doctor here in Ontario. I have had the privilege of being with people in some of the most vulnerable moments of their lives. I have sat with people as they have been challenged with facing recovery from illness and disability. I have seen so much generosity and so much strength of spirit and human character.

I have seen those same kinds of qualities here in this House. I have seen strength of character. I have seen resilience. I have seen compassion. I hope that, for my part, I will always be able to remain respectful and to enter into that level of conversation with members of this House. I hope that fellow members here have felt that I have provided genuine answers to sometimes challenging questions to the best of my ability during question period, and that I have endeavoured to enter into meaningful debate on these substantive matters. I have attempted to do this with respect for my colleagues and with an attempt to avoid untoward language. I hope I have succeeded, but the evaluations of my colleagues and Canadians will be the evidence of that. This is how I will try to proceed in my role as a parliamentarian.

In the atmosphere of an emotional House of Commons that we are experiencing this week, I hope that we will all, as parliamentarians, reflect on and remember the millions of Canadians who are looking at our proceedings and who will review them. I recently had a conversation with one of my staff members, who recounted the experience he had watching question period with his 10-year-old son, a delightful young man whom I have met. His son said to him that they would never be allowed to talk that way in school. That was a striking comment to hear from a wise young man.

Regardless of what transpires in this chamber, each of us has the ability to manage our own conduct. We must hold ourselves to the highest standards, and I believe we are all going to try to do that. Some days are more challenging than others, but we need to remember that we are here to advance the interests of Canadians. We are here to wrestle with challenging issues. We are here to represent the voices and the diverse perspectives of our constituents.

There are some very important issues at hand that we are going to continue to focus on. We have one legislative bill that I have been particularly involved in that is before the House of Commons. It will continue to be a focus of mine for considerable time to come. We have a responsibility to ensure that we find the solutions to the challenges before us. I look forward to continuing dialogue with members on the work that we need to complete in very short order.

I am pleased that we are having this meaningful debate on an important issue right now. I look forward to hearing from my colleagues about their perspective on determining when it would be appropriate for us to move on to discussing other important matters in the House.

I have been thinking a lot about what our constituents expect of us. They expect us to lead in the House. They expect us to make important decisions and to make laws. We do that on the basis of representing the people who have elected us. We do that on the basis of consultation and seeking the very best scientific evidence we can find. We do it on the basis of sound judgment. I trust that our judgment will be deemed to be appropriate.

I want to specifically encourage members to consider some other work that we have before us in the days to come. I had the privilege of speaking to this in responding to questions yesterday, about why I believe it is so important that we try, as soon as is deemed appropriate, for us to move on to discussing the matter of Bill C-14. This is a matter that I have been deeply involved in and for which we have been under a deadline, a deadline that has put us all in a challenging situation.

The Supreme Court of Canada has asked us, the representatives of the people of Canada in the House, to put an appropriate legislative framework in place around medical assistance in dying. It has been a challenging task, and we have had to do it in a short time period. My concern is that we must meet that deadline if it is at all possible. The reason I am concerned is because we need to make sure that Canadians will have access to medical assistance in dying, as the Supreme Court has made clear that they should. If we do not have a legislative framework in place, my colleagues who are health professionals have expressed to me their concern that there would be very few medical practitioners and nurse practitioners who feel they have the appropriate framework in place to participate in medical assistance in dying.

[The Chair, Liberal, Larry Bagnell]

Good morning. This is meeting number 23 of the Standing Committee on Procedure and House Affairs for the first session of the 42nd Parliament. This meeting is being held in public. Our first item of business is the proposed change in Standing Order 28(3) concerning the meeting time of the House in an emergency situation. Members received a note on the subject, and on page 3 of the note there's a motion for consideration. Members working from their iPads can find the note with the documents for today's meeting.

The second item, then, will be the drafting instructions for a report on the initiatives towards the family-friendly House of Commons, which will be in camera.

The next meeting would be on Tuesday, May 31. The acting clerk and law clerk will return to answer questions on the question of privilege concerning premature disclosure of the contents of Bill C-14.

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, I thank my hon. colleague for his question and for making the point. That is exactly what is wrong with the motion. It, essentially, enables the government to steamroll its own agenda without respect for the normal process of the House, both in debate and in the manner that the debates would be held. I appreciate his remarks.

The government has said that it offered extended hours of debate on Bill C-14, for example. However, he is quite right that those extended hours, which we refused then, before the motion was imposed, could now be imposed on the House so that members who wish to speak to, as I said, one of the most important pieces of legislation that will be considered in the House in our parliamentary lifetime would occur in the dark hours, in a marathon vote, which is obviously intended by the government as a way of talking out the clock.

I believe that if we are to truly respect this institution, if the government is to truly respect the role of an official opposition, it must respect the ability of all members of the House who wish to speak on important legislation to rise in their places and speak to the issues of the day.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Thank you very much.

We've seen the government bring some legislation to the House already. Some of it has been moving through the House pretty quickly, some on important issues, whether it's Bill C-10 on the aerospace industry in Canada or Bill C-14 on medical assistance in dying. Those are issues that I think are quite worthy of study, and yet the legislation has been passing quickly.

We've heard from the President of the Treasury Board that when it comes to access, they need to do more study and they need to have a two-step process whereby they bring in a few changes and see how those go, and then there will be a more robust review process and, ultimately, maybe something looking like a final draft of the legislation in 2018.

In your opinion—I think you started to speak to this but maybe you can just elaborate—if the government wanted to sit down tomorrow and begin drafting legislation, is there sufficient information out there to start in the fall with a comprehensive reform of the Access to Information Act, or is this something that really needs more study? What do you think the government could gain in its two-step process, and how do the reforms they are talking about making in the immediate term really speak to anything that would come later in the more robust reform they are proposing for 2018?

Reference to Standing Committee on Procedure and House Affairs

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, I sat very patiently listening to other members address a very serious issue. I would ask that they respond in kind and listen to what I have to say on this very important issue.

We need to put things into perspective, much as I did back in the 1990s when we had members leaving their seats, suggesting all sorts of behavioural issues, much as I saw today, which included the Prime Minister and others.

I do believe that the government House leader, in a responsible fashion, has made the suggestion that we allow the matter to go before the Standing Committee on Procedure and House Affairs where in fact we will have a good healthy discussion, and where we can take into consideration many aspects of what we witnessed here today. That is indeed the responsible thing for us to do.

I continue to understand the perception of what has taken place over the last couple of days—and I know first-hand because I participated in it—as many members have in the very emotional debate with respect to Bill C-14, as the government has attempted, on numerous occasions, to allow that debate to go on so that all members would be able to speak. However, on the other side, we have seen the opposition try to—

Bill C-14—Time Allocation Motion

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

Mr. Speaker, I hope my hon. colleague will find that I will always treat him with the utmost respect, as he always treats me. I thank him for all of his outstanding work as the critic for health for his party. I look forward to many further conversations with him.

As my hon. colleague knows, I am not a lawyer. However, my understanding of the Carter decision, as I have read it and discussed it with legal colleagues, is that it is based on two specific cases. It uses the term “grievous and irremediable”. It very specifically makes the point that it does not presume to make a decision on behalf of all Canadians. Rather, it presumes to make a decision on behalf of those specific cases. I understand that within the House, and across Canada, there are various interpretations about what the implications of that are for terminal conditions.

I am aware of the decision that was made in Alberta yesterday. That decision specifically said that it was not a commentary about the charter or Bill C-14. Rather, it was a commentary about a specific case and whether it met the criteria for exemption that had been set out in this interim period. It is because of that case and the fact that we have not developed safeguards for terminality in medical assistance in dying that enforces for us why it is important we get this in place. There is very clear solid evidence that the number of physicians who are prepared to provide medical assistance in dying drops considerably with respect to non-terminal cases, and where mental illness is involved, it is even more unlikely physicians will be willing to participate.

It is a very serious matter. I look forward to further discussion and debate on this. We fundamentally believe the legislation is the right legislation for Canada.

[Matthew Dubé, NDP, Beloeil—Chambly, QC]

Mr. Speaker, I would like to use Quebec as an example. In the years ahead, the Quebec National Assembly will serve as an example of what a Parliament can accomplish when it sets partisanship aside.

I understand that the members of the National Assembly had more time to deal with this. Nevertheless, considering all the parties involved in the debate in Quebec, they set an example for us to follow. This absence of partisanship is a real legacy for all Quebeckers, and it shows the kind of results that can be achieved together.

Here, the only legacy that our consideration of Bill C-14 will leave for Canadians is a reminder of a dark day for democracy, when the government's sunny ways were tossed out the window.

The only thing that is remarkable about our current debate on Bill C-14 is the abuse on the part of this government. During the election campaign, the Liberals promised over and over again to be different. The only way this government is any different than the last government is that it is even worse.

Now that Quebec has become a model to be emulated in the future, does the minister really want our handling of such an important bill to become an example of what not to do?

Is this really the legacy we want to leave for our children? I think that we would not want to be remembered as a Parliament that did not work because of a government that kept imposing gag orders.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Mr. Speaker, as a new member of the House I am extremely disappointed with respect to the government's actions. Like all new members in the House, the expectation among my residents in supporting me to come to this great place was that I was going to be able to extend my voice in the debates. As we have seen by the actions of the government, what amounts to effectively a basic dictatorship, debates have been stifled in the House.

I want to remind Canadians and I want to remind the government exactly what it said, what it handed to the Governor General in the throne speech. It is proving not to be worth the paper it was written on now. The throne speech said:

Canada succeeds in large part because here, diverse perspectives and different opinions are celebrated, not silenced. Parliament shall be no exception. In this Parliament, all members will be honoured, respected and heard, wherever they sit. For here, in these chambers, the voices of all Canadians matter.

Further on in the throne speech, it says:

And to give Canadians a stronger voice in the House of Commons, the Government will promote more open debate and free votes, and reform and strengthen committees.

Four times now, with Bills C-6, C-10, C-15 and now C-14, we are seeing debate thwarted. Why the hypocrisy on the part of the government? All Canadians deserve to know.

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

Mr. Speaker, I stand here today as a member of Parliament who takes this job and this decision for Bill C-14 extremely seriously.

I ask both the Minister of Health and the Minister of Justice, recognizing that we have had time allocations, because this is such an important bill to so many Canadians, why could they not voice their opinions when we were debating Bill C-6 and Bill C-11, so that members on this side of the House, including members from their own side, could debate something that is so sensitive?

I, myself, hosted town halls, took letters out to constituents, and spoke to a variety of different physicians and stakeholders throughout this country. Our voices, I feel, are not being heard, regardless of whether we are for or against the bill.

Similar to our member down the aisle, I, too, voted for this to go to committee. I am proud of that because I believe we need to have this open discussion. However, the opportunity for this open discussion has been closed in our faces and I find that extremely frustrating, especially when I am trying to honour my constituents' wants and needs.

Why have the members on the other side not stepped forward to the fact that Bill C-14 is important to Canadians? They should have fought for Canadians when discussing the bill.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I am deeply disappointed that I must rise to debate time allocation on medical assistance in dying, Bill C-14. I voted for this bill at second reading and I believe the record will show I worked collaboratively with colleagues on the Conservative and Liberal sides of the House to improve the bill.

The elephant in the room is that the central feature of this bill, who is eligible for medical assistance in dying, is patently unconstitutional. It limits who is eligible to a narrower class of suffering people than the class that won a unanimous decision in the Supreme Court of Canada in Carter.

Yesterday, the Alberta Court of Appeal unanimously said that the Supreme Court decision cannot be limited to terminally ill people or people who are at the end of life. Virtually all credible constitutional experts agree this is unconstitutional.

For the Liberal Party, that claims it is the party of the charter, I find this so perplexing. It does not comply with the Carter case and it does not comply with the charter. The government is threatening us with untrue stories of legislative chaos if we do not pass its version of the bill.

In the name of all patients who are suffering with enduring pain but are not at end of life, who are watching the government take away their victory in the Supreme Court, how can the government justify ramming through a bill on such a sensitive issue? Why can the government not let us work together to get it right for all Canadians?

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, I move:

That in relation to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), not more than one further sitting day shall be allotted to the consideration of the report stage and one sitting day shall be allotted to the third reading stage of the said bill; and

That fifteen minutes before the expiry of the time provided for Government Orders on the day allotted to the consideration of the report stage and on the day allotted to the third reading stage of the said bill—

Government Business Motion No. 6

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

Mr. Speaker, I would like to add some of my comments here as well and perhaps provide a little bit more for the government House leader to consider as he goes and prepares his remarks.

I will keep my remarks very short, because I think what most members of the House would like to do is debate Bill C-14, which is a bill that could have been called on Monday, on Tuesday morning, or earlier today before the dilatory motions. As the government House leader said during question period, in essence, the Liberals just pulled the fire alarm.

Simply put, Motion No. 6 is a disgrace and not worthy of a democracy such as ours. It is an affront to the dignity of the House and its members.

Motion No. 6 is a complete quashing of the opposition's ability to hold the government to account. It is the total disempowerment of certain members of Parliament, who were sent here by 60.5% of Canadian voters. Motion No. 6 is indirectly disenfranchising every one of those voters through the draconian measures set out.

Beauchesne's, sixth edition, outlines some elements of the Constitution Act and our system of government, which I believe is relevant to this very point. It states:

Canada thus was ensured a responsible Cabinet system with the assumption that there will always be a recognizable government with a legislative programme. If the electorate so wishes, the system also presupposes an Opposition ready and willing to attack the Government in an attempt to have its legislation altered or rejected.... More tentative are such traditional features, as respect for the rights of the minority, which precludes a Government from using to excess the extensive powers that it has to limit debate or to proceed in what the public and the Opposition might interpret as unorthodox ways.

On May 2, 2000, during a discussion of the rule of time allocation at the Standing Committee on Procedure and House Affairs, the former clerk of the House of Commons, Robert Marleau, responded to a question regarding the Speaker's authority to protect the minority in the manner described earlier. The former clerk said, “it exists...intrinsically in the role of the speakership”, and continued, “all the time, where there can be tyranny on either side. It could be the tyranny of the majority or the tyranny of the minority.”

My interpretation of what the clerk said is that there exists a limit to what a majority government can do.

In an earlier point of order, I described how Speaker Fraser ruled on the government tactic of skipping over Routine Proceedings in order to get to a point where time allocation could be moved. On one occasion in 1986, he disallowed it, whereas on other occasions he allowed it.

If there was ever a point when a Speaker should intervene to protect the minority from the tyranny of the majority, Motion No. 6 is it.

Parliament is fundamentally about debate. It is also about the right to dissent in a civilized manner. Genuine political opposition is a necessary attribute of democracy, tolerance, and trust, and the ability of citizens to resolve differences by a peaceful means. The existence and tolerance of an opposing view is essential to the functioning of government.

I have more to say on this, but I would like to reserve the right to come back at a later time when the House is not up against the clock on such an important bill as Bill C-14.

However, Mr. Speaker, I do ask you to consider that Motion No. 6 is a completely unprovoked response to a situation that simply did not exist. I would invite the government to show me one example of a dilatory motion being moved by either opposition party when it came to the legislative agenda that the government is currently putting forward.

The Liberals are unilaterally withdrawing every single tool that the opposition has to propose alternate subjects of debate, they are ignoring the good work of committees, they are preventing members of Parliament from debating such things as motions to instruct a committee, and they are completely changing the rules around the clock and the calendar.

Therefore, I would like to come back to the House at a later time, but being cognizant of what little time left the House has to debate Bill C-14, because of the tactics of the government, I will yield the floor at this time.

Physician-Assisted Dying

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

Mr. Speaker, my question is for the Prime Minister, and I want to start by quoting this from yesterday's unanimous decision by the Alberta Court of Appeal:

...the declaration of invalidity on Carter does not require that the applicant be terminally ill.... The decision itself is clear. No words in it suggest otherwise.... The interpretation urged on us by [the Government of] Canada is not sustainable.

In light of this, would the government be willing to entertain the amendments now before this place at report stage to ensure that Bill C-14 is compliant with the charter?

National Maternity Assistance Program Strategy Act

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

Mr. Speaker, I want to say from the outset that we support this private member's bill. We think this bill is important. We certainly would not describe this bill as coming in by the back door. This bill was introduced by a member of Parliament who was duly elected by his constituents. He came in here through the front door. We are pleased to welcome this bill through the front door, even though it is a private member's bill. To us there is no distinction to be made, contrary to what other colleagues may have said in the past. Private members' bills are important, and I like to reiterate that every chance I get.

On those fine words, we are in favour of this bill. I want to acknowledge the very positive way in which it was introduced. We have here a newly elected member of Parliament, much like myself, who took over from his predecessor in Kingston and the Islands and was privy to a situation that a person shared with him in his riding office.

People watching us on television think that parliamentarians argue all day long. That is simply not true. What we do here in the House is just one part of our work as MPs, because we work a lot in our ridings. In fact we spend more than half our time there. When we meet with Canadians, talk to them, and listen to them, we grasp the essence of our work. That is exactly what happened to the member for Kingston and the Islands. He met in his office with a constituent who had a concern, then he presented the concern here in the House by the front door and not the back door, and that is a good thing.

What is the bill about? The bill would let a woman take preventive leave and receive maternity benefits if her job could have a negative impact on her pregnancy. We must understand that this type of situation is becoming increasingly common. When I say that, I am not being negative, but constructive. That is today's reality.

A few decades ago we could not imagine there would be female welders, such as our colleague's constituent, but today we know that there are no gender-specific jobs. Every job is open to everyone. Men and women alike can do any job there is. However, this leads to situations, in welding for example, where workers are exposed to chemicals or have to do physically demanding work where they have to stand up, bend, stoop, and do other things that might have an impact on a pregnancy. We do not need to be doctors to know that. It is obvious that this is a cause for concern. That is why we are in favour of this bill.

It should be noted that this type of approach, preventive withdrawal, has been around in Quebec for years. I know what I am talking about because my riding is in Quebec.

I would like to share our concerns in that regard. We agree with the principle. I cannot emphasize that enough. We are going to vote in favour of the bill. I just want to reassure everyone of that. However, this bill clearly opens a door that could have significant financial implications. Similar legislation in Quebec has had such implications. I tried to determine exactly how much it costs. That is very difficult because it changes a lot over time. In Quebec, we know that 20% of pregnant women take preventive leave. They may include women who work in hair salons with certain chemicals or nurses who come into contact with sick people, obviously, or chemicals or medical products. They may also include teachers who use chalkboards and other products. We need to be aware that this measure could cost a lot of money. We need to be aware of that. We are talking about 20%, which means that one in five pregnant women in Quebec takes this sort of leave.

Recently, we have been talking a lot about Bill C-14, which, as members know, follows on similar legislation in Quebec. I have been reminded of the Quebec model many times in the past few hours.

To get back to the topic at hand, if the government were to model this system after Quebec's and one out of every five women were to take medical leave, that means 75,000 women would have access to this type of leave. We are not opposed to that. We need to be aware of this reality. However, this could end up costing an additional $245 million. We need to be aware of this. We need to take this into consideration. Either we believe in it or we do not. If we do, we need to do what is necessary.

Since this is a private member's bill that came through the front door, we need to recognize that it cannot have any financial implications. However, this bill could ultimately have some financial implications. We need to keep that in mind.

We completely agree with the other part of the bill, which proposes striking a committee and holding consultations with Canadians. Consultations seems to be a popular word these days. Consultations will help us get to the bottom of this issue, assess the situation, take a look at the Quebec experience, identify what works and what does not work, and learn from what is going on in Quebec, so that we can improve the approach.

I would remind members that we completely agree with the principle. We are cautious about the potential financial implications, and we are open to the discussions and conversations that we, as parliamentarians, need to have with all Canadians on this issue.

We believe in families and we believe that the government should assist families. We support that, but it needs to be done in a positive, constructive manner. We fully recognize that these days, there is no longer such a thing as men's work and women's work. All professions are open to everyone. This is what leads to improvements and enhancements to our laws, regulations and approaches regarding the maternity rights of all Canadian women.

Naturally, we want millions of children to be born here in this big, beautiful country.

Report Stage

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

Mr. Speaker, that certainly raises a good possibility. To invoke the notwithstanding clause would in fact give Parliament the kind of time that we need to study this important issue.

The rush with which the government has moved forward on an issue of such intense, immense significance is really inappropriate. We saw in the joint committee a lack of ability to get many witnesses in. We saw the same thing in the justice committee. Today we have seen a number of examples where we wasted hours on quickly moving other bills forward on the agenda when we, as members, were informed that today, beginning at 10 o'clock this morning, we would begin to discuss Bill C-14.

We have not had enough time to discuss this issue and it is of too great a significance for us to allow this to proceed in its current form.

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

Mr. Speaker, it is a great honour to rise to speak at report stage of Bill C-14.

As I stated earlier in this House, it is unfortunate that the Supreme Court of Canada has taken it upon itself to force legislation to be written, which overturns thousands of years of our understanding of the intrinsic value and dignity of every human life.

The Supreme Court has done this, completely rejecting the fact that elected members of this House have rejected initiatives to legalize physician-assisted suicide on at least 15 occasions since 1991. Most recently, a bill to allow physician-assisted suicide was rejected in 2010 by a vote of 59 to 226.

It is not only that nine unelected judges have inserted themselves into a national conversation that should be initiated in this House of Commons, they have even lamented the fact that an extension was sought to give parliamentarians more time to properly study, discuss, and debate this issue of exceptional importance.

In their judgment of January 15, 2016, in granting an extension, the Supreme Court stated, “That the legislative process needs more time is regrettable, but it does not undermine the point that it is the best way to address this issue.”

Really? It is regrettable? It is regrettable to take more time to think soberly through this complex issue, to implement such momentous change, to destroy the very foundations of medicine, to turn upside down the time-honoured belief that it is fundamentally wrong to kill another human being, and all in the name of compassion?

In regard to the impatience on the part of the Supreme Court, Warren Perley wrote, in Beststory:

Common sense dictates that such momentous changes to the law governing assisted suicide should be based on the compass rather than the clock. Until this point, Canadians have never had access to legally assisted suicide. Instead they have relied on doctors and nurses to administer palliative care, which must include adequate pain management and, in rare cases, palliative sedation. Pro-euthanasia advocates argue this is euthanasia, but they are in error.

Changing laws in matters of such substantive and exceptional significance as assisted suicide should be made by the compass. I could not agree more. Unfortunately, we have thrown away our compass. We no longer need a compass. We now just pool our collective ignorance and decide on the basis of popular opinion to sail off in any direction that suits the winds of the day, rudderless.

One of Canada's indigenous leaders, Mr. Francois Paulette, a Dene leader and chair of Yellowknife's Stanton Territorial Health Authority states that indigenous people are bound by spiritual law, not man-made law. He goes on to state, “We don't play God.... God is responsible for bringing us into this world, and taking our life. It is pretty straightforward.”

Whether as a member of the indigenous community or not, for all Canadians, the crux of the issue before us today, and the source of the conflict and confusion, is the fact that the preamble of our Charter of Rights and Freedoms on one hand, and Bill C-14 on the other, are built on two opposite pillars: one made of gold, and the other of styrofoam.

The preamble of the charter states, “recognize the supremacy of God and the rule of law”. Yes, there is a compass. Yes, there is a North Star. Even our Canadian charter states that in Canada we do recognize this North Star, the supremacy of God.

Yet if we look at the very first paragraph of Bill C-14, we see a totally opposite starting point. Rather than the “supremacy of God”, we see “autonomy of persons”.

My contention is that these two opposite philosophies cannot coexist at the same time, if we are to continue to have true freedom and trust in our society. We may deny God, and man as his image bearer. We can try to kill both God, and man as man. We may press forward in a suicidal course, but it always ends in pure vanity, for we are surrounded inside and out by the reality of God and his order in every sphere of life.

We all know that there are necessary limits placed on the autonomy of humans. Yet on an issue as monumental as the issue of life and death, we are considering extending autonomy without stopping to think what such autonomy might do to our understanding of the value of human life.

Does this autonomy serve well those among us who, for dozens of reasons, find themselves vulnerable, voiceless, and open to abuse in the most extreme and final way possible, an unwanted hastened death?

The very fact that I can drive from my riding of Kitchener—Conestoga to Ottawa each Sunday evening is because the autonomy of all drivers is limited. Drivers heading to Kitchener occupy the north side of the 401 highway as they travel west, so I am free to travel unimpeded on my easterly journey in the southern lanes.

To allow autonomy in many situations in life is foolhardy, to say the least. Our freedom and trust is enhanced by strict limits on personal autonomy for the greater good of community. We could list many such restrictions on personal autonomy: quarantines for highly infectious diseases, such as ebola; prohibition of using highly toxic chemicals and pesticides on private property; the limitation on raising farm animals in the residential area of a city. In these cases and dozens of others, we recognize that the greater community good supersedes individual autonomy.

To retain limits on personal autonomy in the case of physician-assisted suicide is for the greater good of society. To remove the restriction on personal autonomy could very well lead to the crumbling boundaries that our Liberal colleague, the member for Winnipeg Centre, referenced a few weeks ago in the Chamber when he said, “We are in a sorry state. We have truly entered a new age, one of the throwaway culture where all boundaries are starting to crumble”.

I fear for the kind of Canada I will leave for my children and grandchildren if we rush blindly ahead with an endorsement of physician-assisted suicide. The risk to society is too great. The dangers are far too real.

There is no doubt that in spite of our best efforts to place so-called safeguards to protect the vulnerable among us, there will be situations where innocent Canadians will be killed without their expressed consent. There is no doubt in my mind that in spite of our best efforts to spin the difference between suicide and what we are now calling medical assistance in dying, there would be a correlating increase in suicide rates in Canada.

Aaron Kheriaty, associate professor of psychiatry, and director of the medical ethics program at the University of California at Irvine School of Medicine states:

The debate over doctor-assisted suicide is often framed as a personal issue of autonomy and privacy. Proponents argue that assisted suicide should be legalized because it affects only those individuals who--assuming they are of sound mind--are making a rational and deliberate choice to end their lives. But presenting the issue in this way ignores the wider social consequences.

What if it turns out that individuals who make this choice in fact are influencing the actions of those who follow?

He goes on to report that in states where physician-assisted suicide has been legalized, there has been an increase in suicide of 6.3% overall, but among those over 65, an increase of 14.5%.

He continues:

The results should not surprise anyone familiar with the literature on the social contagion effects of suicidal behavior. You don't discourage suicide by assisting suicide.

Aside from publicized cases, there is evidence that suicidal behavior tends to spread person to person through social networks, up to three “degrees of separation” away. So my decision to take my own life would affect not just my friends' risk of doing the same, but even my friends' friends' friends. No person is an island.

Finally, it is widely acknowledged that the law is a teacher. Laws shape the ethos of a culture by affecting cultural attitudes toward certain behaviors and influencing moral norms. Laws permitting physician-assisted suicide send a message that, under especially difficult circumstances, some lives are not worth living – and that suicide is a reasonable or appropriate way out. This is a message that will be heard not just by those with a terminal illness but also by anyone tempted to think he or she cannot go on any longer.

Debates about physician-assisted suicide raise broad questions about societal attitudes toward suicide. Recent research findings on suicide rates press the question: What sort of society do we want to become? Suicide is already a public health crisis. Do we want to legalize a practice that will worsen this crisis?

I believe that life is always to be chosen over what some would call death with dignity. There is nothing dignified about deciding to end someone's life that is not worth living. If the patient has a need, let us address the need. Our goal should be to eliminate the problem, not the patient.

We need to be doing far more to address the needs of vulnerable Canadians. To that end, I have five proposed changes that need to be included in Bill C-14. Four of these have been accepted as amendments by others in the House.

First, the preamble should contain a statement indicating that suicide prevention is an important public policy goal, recognizing the sanctity of life as a societal principle.

Mr. Speaker, I see that I am out of time, so I will try to get my other points in when responding to questions.

[John Oliver, Liberal, Oakville, ON]

Mr. Speaker, I never once suggested that it would be reflective of a failure of the palliative care system. In meeting the needs of Canadians at the end of life, an array of services and professional support are required. Palliative care is part of that, as are the provisions of Bill C-14, in an act of end of life if required.

With respect to natural death and palliative care, people are supported through it. Generally, pain is well managed, and many people opt for natural death, particularly when properly supported with palliative care. However, there will be circumstances where pain cannot be managed or where the loss of autonomy is so dramatic that the palliative care model is insufficient. We need to have the provisions of Bill C-14 available to assist people who wish to end their life as they approach the end of their life.

[Wayne Stetski, NDP, Kootenay—Columbia, BC]

Mr. Speaker, I, too, really appreciate the depth of the discussion that we have had around Bill C-14.

The recommendations that came from the original interparliamentary committee, I thought, were excellent, and I was very supportive of the potential bill at that point. However, I have some real issues with the way the bill currently sits, and I want to focus on two.

Do advance directives not give people more choice in that they at least have the opportunity to do an advance directive rather than wait until they are no longer in a state where they could make a decision at all? Does it not provide more choice to have advance directives?

Secondly, intolerable pain and suffering was a really important part of the Carter decision, and I think should be an important part of the bill. Again, I know personally that if I had a choice later on in life, if I was struggling with intolerable pain and suffering, I would really like to go with a needle in my hand in the arms of somebody who loves me rather than just put it to chance.

Those two provisions are missing from the bill and I would appreciate the member's perspective on why.

[John Oliver, Liberal, Oakville, ON]

Mr. Speaker, I think it is very important to state again that palliative care is not a substitute in all cases for end-of-life decisions as contemplated by Bill C-14. However, it is important that there is an effective health accord that is negotiated with the provinces and territories by the Minister of Health, which will take some time to ensure that there is consistent and uniform high-quality services available across Canada. I think those are the first initiatives that need to take place. However, monitoring and evaluating the effectiveness of the palliative care programs can come as we begin to get them in place.

The House resumed consideration of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), as reported (with amendment) from the committee, and of the motions in Group No. 1.

Bill C-14—Notice of time allocation motion

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Madam Speaker, I would like to advise that an agreement could not be reached under the provisions of Standing Order 78(1) or 78(2) with respect to the report stage and third reading stage of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).

Therefore, under the provisions of Standing Order 78(3), I give notice that a minister of the crown will propose at the next sitting a motion to allot a specific number of days or hours for the consideration and disposal of the proceedings at those stages.

Motions in amendment

[Dominic LeBlanc, Liberal, Beauséjour, NB]

Madam Speaker, I hope you will find unanimous consent for the following motion, which I will read slowly so that colleagues understand exactly what I am proposing, that notwithstanding any standing order or usual practice of the House, the House shall continue to sit beyond the hour of daily adjournment for the purpose of considering Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying), at report stage, and when no member rises to speak or at midnight on that sitting day, whichever is earlier, the debate shall be deemed adjourned and the House deemed adjourned until the next sitting day.

[John Oliver, Liberal, Oakville, ON]

Madam Speaker, I am thankful for the opportunity to join the debate today on Bill C-14, which addresses medical assistance in dying. I would like to acknowledge the incredible respect and thoughtfulness expressed by members in this very delicate debate.

Before I begin, I would like to acknowledge the advice and insights I received from a former colleague, Dr. Lorne Martin, chief of staff at Halton Healthcare, on the medical ethics and physician perspectives that would be created by the legislation.

The bill has generated significant debate and feedback from my riding of Oakville, both from people who wrote or contacted me on their own initiative, as well as those who responded to the forums that were created to solicit feedback through local media and my interactive website, johnoliver.mp. I have read and carefully considered the many views and concerns that came from residents of Oakville and I would like to address those that are relevant to the act and the amendments proposed.

The community responses can be grouped into five categories. The first is from those who are opposed to any form of medically assisted death and want the law to respect and protect every human life from conception to natural death. These are individuals who put forward the principle that we must not take another's life. There were many submissions of this nature.

For people who hold these values, I believe it is important, once again, at this stage, to understand that the Supreme Court of Canada's unanimous decision in the Carter case was a declaration that the Criminal Code prohibitions on assisted dying were not in accordance with the Charter of Rights and Freedoms. Effective June 6, 2016, medically assisted death is legal in Canada whether the bill is passed or not.

Therefore, the issue before this legislature is not whether medically assisted death will be allowed. Rather, the issue is whether medically assisted death will be permitted in accordance with the parameters set out by the Carter ruling or under a legislative framework established by elected representatives. Accordingly, our decisions are how to safely implement this new practice, who should be eligible, what safeguards are needed to protect vulnerable individuals, what are the roles and responsibilities of medical professionals, and how do we create a monitoring regime to ensure accountability, transparency, and improvement in this area as we go forward.

The second category of responses from my community were in reaction to the special joint committee recommendations. Many Oakville residents wrote to me expressing their concern that the rights of vulnerable Canadians may be infringed upon as we protect the rights of those seeking autonomy in their end-of-life decisions. Specific concerns were raised in relation to including Canadians with psychiatric conditions, psychological suffering, and minors.

Bill C-14 and the proposed amendments are more restrictive than both the Carter decision and the committee recommendations, in part, for the reasons raised by these constituents. To protect the rights of the more vulnerable, the bill has not included these broader situations or circumstances in the eligibility criteria, thereby addressing the concerns raised by these residents.

The third category of responses were diametrically opposed to those previously stated. These residents spoke in favour of the Supreme Court decision and about their belief that the Charter of Rights and Freedoms should allow autonomy to the individual in end-of-life decisions. Several accompanied their statements with personal stories of difficult end-of-life experiences for loved ones or worries about their own unique circumstances.

They also expressed concerns that Bill C-14 is too restrictive and does not address all the circumstances that should be considered eligible under the act. In particular, the clause requiring that natural death be reasonably foreseeable was felt to exclude many Canadians that they felt should be allowed.

In addition, there were concerns raised about denying advance directives. Denying advance directives puts people who suffer from degenerative illnesses that will eventually affect their competency in the position of having to exercise their right to an end-of-life decision in advance of losing competency.

The fourth category of concerns surrounded the rights of medical practitioners and institutions to ensure that they would be able to have freedom of conscience and religion to decide whether to participate in a medically assisted death. Bill C-14 would not compel participation by health care providers and I feel it is sufficient.

The final category of responses were fewer in number, but supported the position put forward by Bill C-14 as a reasonable starting point to address the complex and competing values and rights created by the Carter decision.

Having now spent considerable time in understanding and researching the issues raised by my constituents, and after careful consideration and personal reflection, I will be supporting Bill C-14 as reported by the committee for the following reasons.

I committed upon entering the past election and during my campaign to uphold the Canadian Charter of Rights and Freedoms. The Supreme Court ruling clearly found that the existing laws were not compliant with charter rights and freedoms and denied autonomy to a person seeking to end his or her life who clearly consents to the termination of life, and has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual. It is therefore morally incumbent, I believe, on this legislature to put legislation in place to protect this right and freedom, and I support that direction as carried out in the act.

We face, as a legislative body, the difficult task of balancing the competing social and moral values and interests surrounding this direction. For me, the protection of the vulnerable who may be individually or collectively disrespected or coerced to choose a premature death in the face of a too-permissive regime of assistance in dying must be balanced against those suffering from grievous and irremediable conditions.

As a first step in understanding the competing social and moral issues and the charter rights and freedoms of different groups, I believe Bill C-14, while not perfect, is an acceptable starting position for Canadians.

I would have preferred that Bill C-14 was more permissive for those where death is not reasonably foreseeable, and instead, built in protections for those who are vulnerable to the too-permissive language. While the bill's language is open to reasonable interpretation of foreseeable death, it does leave complex legal and ethical decisions with families and medical practitioners that will be open to court challenges and future charter appeals. This will add further stress and suffering to already untenable situations for many.

I do take some comfort from provisions within Bill C-14 to conduct further reviews after five years of eligibility criteria, and from the amendments coming back from the committee to review, after 180 days, other initiatives such as advance directives.

Another factor in my decision to support Bill C-14 is my belief that with properly offered health services, such as palliative care, most Canadians will not opt to use its provisions. Research from other countries suggests that most people prefer to enter into a palliative care program and experience natural death. While palliative care is not always a substitute for medically assisted death, it would be unacceptable to have people choosing medically assisted death as a result of inadequate palliative care services. I believe we can do more to ensure that palliative care programs are available and accessible across Canada, as proposed in some of the amendments.

The work of the Minister of Health in negotiating a new health accord agreement with the provinces and territories is fundamental to achieving these services, and I fully support her diligent efforts to achieve a new accord and ensure that all Canadians have access to high-quality sustainable care.

In discussion with doctors and other health care workers, there is general support and agreement with the bill, particularly the freedom given to caregivers to choose to participate in assisted death based on their own conscience and religious beliefs. I support the freedom that is put forward in the bill and do not feel an amendment is required.

Physicians today are already involved in substantive decisions regarding end of life, working with families or in accordance with advance directives. They often provide key clinical advice in the decision to end life support or to apply do not resuscitate orders. However, asking physicians to interpret and execute advance directives to end a life is ethically more challenging and places significant onus on them as individuals, particularly in hospital environments where they do not know the person or where there is not a family to consult.

Finally, my decision to support the bill arises from personal experiences and the loss of a loved family member who, as she requested, passed away at home in the presence of family. The final days of her life were marked with pain and suffering, which we were able to somewhat alleviate through oral morphine.

However it is allowed, appropriate care at the end of life needs to be available to people when required. I want my family members, fellow Oakvillians, and fellow Canadians to have autonomy in making end-of-life decisions as they have enjoyed autonomy in all of the major decisions in their lives.

I will be supporting Bill C-14 , and I urge all members of the House to support this important bill.

[Sean Casey, Liberal, Charlottetown, PE]

Madam Speaker, there is no question that not all individual members in the Canadian Medical Association are of one voice. The voice of the medical profession has spoken clearly and loudly in support of the legislation. Indeed, there are individual members and groups of doctors who do not feel the same way, one of whom was referred to by the hon. member.

The other point that I would add is this. If we are left without legislation on June 6, it is doctors like the one the hon. member quoted who will be left without a law, without eligibility criteria, and without the present system of applying to a court for an exemption, something that will only exist until June 6. There will be a great deal of uncertainty if no law is passed. That I think will leave doctors in a situation where they will be extremely reluctant to accede to a patient's request for medical assistance in dying without the certainty that is provided in Bill C-14, as flawed as it may be.

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

Madam Speaker, I am pleased to voice my support for Bill C-14, significant legislation that would become Canada's first national medical assistance in dying regime, and would provide a thoughtful and well-considered response to the Supreme Court of Canada's decision in Carter.

I would first like to acknowledge the remarkable work of the members of the House of Commons Standing Committee on Justice and Human Rights who studied Bill C-14 under some very tight time constraints and who nonetheless were able to significantly enrich our reflection and debate on this highly complex and personal issue. This is certainly a matter on which everyone's point of view deserves the utmost respect and consideration. All justice committee members have unquestionably demonstrated these qualities in the course of their work.

Allow me to highlight some areas where the work of the justice committee has been particularly helpful.

Many stakeholders who appeared before the committee, in particular organizations representing medical professionals, expressed a great deal of concern about conscience protections for medical providers. Bill C-14, as a criminal law measure, would create exemptions from conduct that would otherwise be criminal and therefore would not compel anyone to provide medical assistance in dying in any way. However, some stakeholders urged the committee to add a specific clause that would clearly reflect, for greater certainty, their conscience rights as protected under the charter.

On the other hand, other stakeholders such as the Barreau du Québec and Quebec health lawyer Jean-Pierre Ménard affirmed the position previously expressed by the Minister of Justice that the conscience rights of health care providers were matters that fall under the purview of the provinces and territories as well as under the responsibility of medical regulatory bodies, which themselves are provincially regulated.

I am pleased to say that the justice committee carefully listened to submissions from all sides of the debate and that a motion was tabled to address this significant concern within the limits of our constitutional framework. Bill C-14 was amended in order to give a greater sense of comfort to medical professionals that nothing in Bill C-14 would compel individuals to act against their deeply held beliefs.

The justice committee should also be commended for working in a non-partisan way to make improvements to the proposed legislation. For instance, the committee amended the bill to clarify that where persons signed a written request on behalf of a patient who cannot write, they could only do so at the patient's express direction. The committee members also amended the bill to clarify that for the sake of professionals who provided counselling services, giving someone information about medical assistance in dying would not be criminally prohibited.

Although these amendments and several others do not fundamentally change the scope of Bill C-14, they should increase the level of comfort for Canadians, including health care providers and other professionals who may be involved. I applaud the committee for all of its efforts.

We have heard countless times how challenging the issue of medical assistance in dying is and how Canadians and organizations hold divergent views that are informed by strongly held beliefs. I think we can all agree that this tension was most apparent during the debate over who should be eligible for medical assistance in dying in our country.

Just as it was the case before the Special Joint Committee on Physician-Assisted Dying, the justice committee also heard a wide range of views on eligibility and on what was required to respond to the Carter ruling.

At one end of the spectrum, some stakeholders continue to oppose legalization of any form of medical assistance in dying, as is still the case in most countries around the world, or they propose that it be significantly narrowed.

At the other end of the spectrum, some argue that Bill C-14 does not go far enough and urge Parliament to adopt one of the broadest regimes in the world, similar to ones that exist in only three European countries. They maintain that the eligibility criteria in Bill C-14 are too narrow and they should also include mature minors, people suffering solely from a mental illness, and those who have lost their capacity to consent to die, but who have made an advance request for medical assistance in dying.

Somewhere in the middle of that spectrum, though, lies a group of stakeholders who have expressed strong support for Bill C-14 and who recognize that the bill's cautious and balanced approach is imminently justifiable, including the commitment to explore broader eligibility issues in the near future.

Among that group is the Canadian Medical Association, which speaks on behalf of 83,000 physicians across Canada and which supports the adoption of Bill C-14 as it was drafted, and without amendments.

In contrast with those who argue that the Supreme Court's language of grievous and irremediable medical condition is clear and preferable, the Canadian Medical Association takes quite a different position. It says that the criteria in Bill C-14, including the requirement that death be reasonably foreseeable, provides sufficient direction to physicians and is a great improvement from the court's language, which it considers to be vague and unworkable from a medical standpoint.

Similarly, the Canadian Nurses Association, a federation of 11 provincial and territorial nursing associations and colleges, representing nearly 139,000 registered nurses across Canada, has said publicly that its priority is having the bill passed before the June 6 deadline expires. Further, its CEO, Anne Sutherland Boal, stated just yesterday that the successful passing of the bill would be both compassionate and protective to patients, families, and care providers, while emphasizing that the legislative safeguards in the bill would work to protect the most vulnerable Canadians.

Although lawyers and legal academics continue to argue with each other over whether or not the court's language, or the language in Bill C-14, provides sufficient clarity, how can we as parliamentarians discount the views of medical practitioners? The Supreme Court expressed confidence in Canada's physicians to respond to Canadians who wished to access medical assistance in dying, and that confidence is well-placed.

We as parliamentarians must also have confidence in medical practitioners. They will be the ones facing these difficult life and death decisions with their patients and assessing their eligibility. For them, it is not a philosophical or theoretical exercise. They will be applying the very measures in Bill C-14 in their daily practice. Their views must be given significant weight.

National disability rights organizations and others have also supported the approach to eligibility proposed by Bill C-14 as a meaningful safeguard to protect individuals who might be vulnerable in the framework of a medical assistance in dying regime, as a result of societal discrimination, loneliness, or lack of social supports, for example.

On the question of safeguards, the same dynamic has been at play. Some stakeholders expressed support for the measures proposed in Bill C-14, while at the same time seeking to put in place additional safeguards to protect the vulnerable, such as prior judicial authorization. Others, wanting to facilitate broader access, have sought to remove some safeguards, such as the reflection period.

While we respect those who feel that the proposed safeguards are either inadequate or overly burdensome, I believe the safeguards in Bill C-14, taken together, are consistent with many of those found in regimes around the world. Just as the court in Carter was persuaded that the risks to vulnerable Canadians could be adequately managed under a regime with robust safeguards, I am confident the safeguards in Bill C-14 would guard against abuse and error.

Last, I would like to remind all members that Bill C-14, or the provision of medically assisted dying, is not intended to be, or to become, the response to all forms of intolerable suffering. The bill is a thoughtful response to Carter, which recognized the autonomy of those suffering on a path toward death to die peacefully at the time of their choosing and therefore to avoid a prolonged, painful, and undignified death, or one that is inconsistent with their values. Bill C-14 acknowledges the autonomy of such persons to make important end-of-life health care decisions, while also balancing the equally important societal objectives of affirming the value of the lives of all Canadians, preventing suicide, and protecting the most vulnerable in our society.

I believe this legislation respects all interests at stake, and is one of which Canadians can be proud. For all these reasons, I urge all members of the House to support Bill C-14.

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

Madam Speaker, my friend, the hon. member for Kitchener—Conestoga, and I have had occasion to speak outside the chamber about this matter. I have met with a very impressive doctor of palliative medicine who raised the issue that there could be an interference, which I had not understood.

I am comfortable to support Bill C-14, with the amendments, so I need to bracket my comment this way. I do think it is important that no patient fear going to a doctor, for a misplaced fear. It is not something that the bill brings forward, but the palliative care doctor said that, from his point of view, he did not want his facility to provide this service for fear that those who went through those doors might have any concern that they might be medically assisted in something to which they did not consent.

I see, under this law and under our society, no prospect of that ever happening, because the sanctions would be severe. However, I do understand the issue, now, which I had not when he first put the question to me.

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

Madam Speaker, if I were standing alone, saying that I thought it was unconstitutional, I would be arrogant, at the least. However, Joe Arvay, who was the counsel for Kay Carter, the British Columbia Civil Liberties Association, the co-plaintiff in the case with Kay Carter, and so many of those who have studied this might rely on section 1, but I think that is a faint hope.

The Supreme Court, in making the decision it made, that there was a violation of Kay Carter's charter rights, took into account her entire condition.

There will be a challenge to Bill C-14. It will very likely be found to not be charter-compliant, and it falls far short of the expectations of Canadians.

I did not have time in my 10-minute speech to speak to something I spoke to at second reading, which is another disappointment that I have with the bill; that is, the failure to allow for advance directives.

Patients across Canada, people who are suffering, have a right to expect that this Parliament will, at least, reflect what the Supreme Court did in its decision.

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

Madam Speaker, it is an honour to be able to rise at report stage. I appreciate the decision of the Speaker to recognize that, if there was ever a time for exceptional circumstances and exceptions under our Standing Order 76.1(5), this is such an occasion.

The use of the exceptional circumstances here is to allow a real opportunity at report stage to improve the bill. This is not a fake debate about amendments that have no hope. It is my profound hope that the amendments before the House now as we debate this at report stage, with a free vote, with every member allowed to weigh in, can yet improve this legislation to the point where the vast majority of us will be comfortable voting for it with amendments. As it is right now, I do not know if this bill could pass this House in its current state.

Let me just go back for a moment, for context. I do think context and empathy are important on all sides of the House. Bill C-14 is the direct result of the Supreme Court of Canada's unanimous decision in February 2015 to accept that certain provisions of the Criminal Code violate the Charter of Rights and Freedoms insofar as they affect people who are suffering from grievous and irremediable medical conditions, and wish to have the right to choose their own time and way of dying. As the court wrote at the time, “an individual's choice about the end of her life is entitled to respect”.

In my time in Parliament, there has not been a bill that is more difficult to talk about, that touches more on aspects of our own personal principles, faith, beliefs, rights, and politics, all wrapped up in a charter decision. It has been difficult to talk about, but I think it has been approached on all sides with appropriate respect. As my colleague just mentioned, the chair of the justice committee, the hon. member for Mount Royal, did an exceptional job in steering through the many amendments that were reviewed in committee. However, not enough of those amendments were accepted to make the bill acceptable.

Let me go through why I do not think I can vote for the bill without amendments. It is not about what I think; it is not about whether I think the bill is satisfactory. I think everyone on all sides of the House, including government members, admit that it is flawed. It is not quite what one would want, compared to, for instance, the exceptional report of the committee that guided the government, the joint committee report of the House and Senate on how to respond to the Carter decision. This bill falls short.

That is not the basis on which I cannot vote for it now. It is not my opinions. Our challenge as parliamentarians is to ensure that whatever we pass meets the standard set out for us by the Supreme Court of Canada in assessing what it was about the status quo that made the situation for Kay Carter one that was not merely unfair but a violation of her charter rights.

That is the key question here. There is a level of provision for medically assisted dying below which government legislation cannot sink. That bar, that line, is charter rights, as set out by the Supreme Court of Canada.

I wanted to comment and focus a bit on this question, as set by the court, of an individual's choice about the end of her life being entitled to respect. I suppose we could wish that the court now used the female pronoun and intended it generically, as we have heard the male pronoun used generically throughout our lives.

However, I think it can be inferred that the Supreme Court of Canada, using the female pronoun, is talking about the plaintiff before them. It is talking about Kay Carter. Would Kay Carter have access, under Bill C-14, to medically assisted dying? Most observers whom I have heard at this point, knowledgeable observers, do not believe she would.

That, to me, is the crux of the debate, which means that her charter rights would still be infringed, even after we passed Bill C-14 as it is currently written.

This is why. Kay Carter was not about to die from her illness. She had a spinal stenosis that would not kill her. I want to refer to specifically the way Jocelyn Downie, professor of both law and medicine at Dalhousie University, described it that in her view Bill C-14 is unconstitutional. I want to read an excerpt from Professor Downie:

There was no evidence on the record before the court that Kay Carter's death was reasonably foreseeable in any temporally proximate way. In fact, it was just the opposite.

To pick one of many possible examples from the evidence before the court, as Kay Carter wrote in her letter to the Dignitas clinic in Forch, Switzerland:

The neurologist, Dr. Cameron of North Vancouver, assessed me and I had a CAT scan and MRI done. From these tests he told me that I had an ongoing, slow deterioration of the nerves that would never kill me but eventually would reduce me to lie flat in a bed and never move.

In other words, Kay Carter would not fit the definition within the bill that the requirement to be grievous and irremediably affected in a condition that would allow medically assisted death would be a death that was reasonably foreseeable. That clearly suggests, although the language is somewhat vague, that Bill C-14 requires that a person, to be grievous and irremediable within the meaning of the act to access medically assisted dying, has to be in a terminal state.

The court in its unanimous decision may have left some ambiguity for those who were hoping to find a loophole, but I do not think it is there, with the facts of the case right in front of them, Kay Carter, who was not in a terminal state. Beyond that—and this is where I have sympathies for the current government—the Supreme Court gave a year from the day of the decision in February 2015, but the Minister of Justice was not sworn in until November 4. The Prime Minister was not sworn in until November 4. The time limits imposed on the new Liberal government are not of its making, and I am clearly sympathetic.

I opposed at the time going to the court to ask for an extension because deadlines such as this, given the effect of the court's decision rendering those Criminal Code sections unconstitutional, will not create chaos or a situation that cannot be managed.

However, to go back to that moment when the Government of Canada went to the Supreme Court to obtain an extension, in this excerpt Madam Justice Karakatsanis says clearly in questioning one of the counsel: “I'm thinking particularly about somebody has to be a la fin de vie whereas in Carter we rejected terminally ill”.

Let me put it again clearly. A Supreme Court of Canada justice says that in Carter we rejected terminally ill. That is clearly the standard for ensuring that rights are protected: that we must not ensure that in order to access medically assisted death the person be on the verge of death, that their death be reasonably foreseeable, even if we take reasonably foreseeable back to a year or two years. Kay Carter did not have that circumstance.

Another medical expert who has written about Bill C-14 since it came forward, Professor Jesse Pewarchuk, who is a clinical assistant professor of medicine at the University of British Columbia, wrote:

Worse, the wording of the proposed law introduces significant doubt as to whether an Alzheimer’s patient who has yet to lose capacity (yet is certain to) would even be eligible, since death can take years, even from the point of entering long-term nursing care.

“Foreseeable death” and “advanced state of decline in capability” are loaded, ambiguous clauses that seem to eliminate the Charter rights of dementia patients...and to put any physician carrying out their wishes in considerable legal peril.

Without these amendments passing at report stage, I cannot vote for Bill C-14. In an ideal world, I would rather there were a framework of laws for doctors to follow, for nurse practitioners to follow—a framework, consent, reforms, and the witnesses and the independence and the elements of law. However, if these amendments are not passed, I cannot vote for a law that falls below the bar of what the Supreme Court says constitutes protection of charter rights.

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

Madam Speaker, earlier today the House voted on a motion regarding physicians' freedom of conscience, and I did not take notice as to how my colleague voted, so I would ask him this question.

In the context of Bill C-14 at report stage, Motion No. 14 calls for clear definitions of freedom of conscience. Would my colleague support those?

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

Madam Speaker, it is a privilege to speak to Bill C-14 at report stage.

I have brought forward three amendments, two of which are related. Motions Nos. 4 and 9 on the Order Paper relate to requiring someone with an underlying mental health condition to undertake a psychiatric assessment to determine capacity to consent. Motion No. 14 on the Order Paper deals with conscience protections, ensuring that the conscience rights of health professionals and health care institutions are respected. I will get into a little more detail momentarily with regard to those amendments.

Let me just say at the outset that however short or long my parliamentary tenure proves to be, Bill C-14, I have little doubt, will be one of the most important votes that I cast. I believe that is true for all hon. members in this House, because we are talking about a bill that will impact the lives of Canadians not just for years to come, but likely decades to come.

Having regard for the gravity of the decision before us, I have spent a lot of time reflecting on what is the right thing to do. At the present time, I am still reflecting.

One of the shortcomings of Bill C-14 at second reading was the absence of conscience protections. I am pleased that now that the legislation has gone through committee, there has been movement in the right direction when it comes to protecting conscience rights of health care professionals. More specifically, Bill C-14 provides that no individual is obliged to provide, or assist in providing, physician-assisted dying. In addition to that, the preamble has been amended to expressly recognize section 2, freedom of religion and freedom of conscience under the charter.

I want to thank the hon. member for Victoria for his leadership in moving those amendments at committee in close co-operation with me, as well as the hon. member for West Nova. I would be remiss if I did not acknowledge the hon. member for Mount Royal for his hard work and the collaborative approach he took as chair of the justice committee, which resulted in an important improvement in the legislation.

With respect, I believe there is still work to do when it comes to conscience protections. I believe it is important that not only health care professionals but also health care institutions have their charter rights and appropriate conscience protections in place. That is what my amendment would seek to do to ensure that everyone's charter rights are respected.

I would note that Madam Justice McLachlin and Mr. Justice Moldaver at paragraph 94 of the Loyola decision recognized that the individual and collective aspects of section 2 charter rights are intertwined.

With respect to the other two amendments I have brought forward, one of the concerns I have is the fact that in the legislation any two physicians or any two nurse practitioners can determine whether or not a patient satisfies the criteria for physician-assisted dying.

The problem with that is that not every physician and not every nurse practitioner has the training and experience to determine capacity to consent when an underlying mental health challenge is present in a patient.

The clear evidence before the special joint committee of which I was a vice-chair, as well as the justice committee of which I am a member, was that someone with more specialized training, namely a psychiatrist, is required to undertake what is, quite frankly, a complex analysis in many cases.

My amendment would simply provide that anyone who has an underlying mental health challenge be referred to a psychiatrist for a psychiatric assessment to determine his or her capacity to consent. It is a simple amendment. It is a straightforward amendment. It is a much-needed amendment. We simply cannot allow people with mental illness to fall through the cracks. We cannot allow that to happen as parliamentarians. One way we can mitigate that from happening is to pass this very important amendment.

When I look at Bill C-14 in its totality, I see a bill that contains many important safeguards. Those safeguards ought not to be minimized or dismissed. They are there; they are real, and they are serious. At the same time, the bill falls short when it comes to protecting the most vulnerable of the vulnerable, namely, people with mental illness. I see a bill that moves in the right direction when it comes to protecting conscience rights of health professionals, but still falls short when it comes to health care institutions.

Bill C-14 is an imperfect bill. It is not a bad bill, but it is a bill that I believe can be improved upon. As I reflect, I must ask myself whether I support an imperfect bill or do I vote against an imperfect bill having regard for the consequences that would follow in the absence of legislation being cast when the expiration of the declaration on the stay of constitutional invalidity is June 6.

In closing, I will continue to reflect. I am hopeful that some of the gaps in Bill C-14 can be closed. I am hopeful that all hon. members on all sides of the House can work together collaboratively and in a spirit of good faith to try to do the best we can to make this bill the best that it can possibly be in the circumstances. We owe it to patients. We owe it to physicians and health professionals. We owe it to the vulnerable. Most importantly, we owe it to Canadians.

[Murray Rankin, NDP, Victoria, BC]

Madam Speaker, that was exactly the evidence that the Supreme Court heard. The trial court heard voluminous testimony about that and concluded that safeguards were to be properly built-in within their judgment.

In addition to that, Bill C-14 lists many additional safeguards that are provided, and I am comfortable with the result that has been achieved. However, I am not comfortable that we are taking away the rights of so many Canadians, which were achieved at great expense and difficulty in the Supreme Court decision in Carter.

[Murray Rankin, NDP, Victoria, BC]

Madam Speaker, it was a pleasure to be in the riding of my colleague and friend from Edmonton Strathcona to talk about this with hundreds of passionate Canadians who were, frankly, surprised there was no willingness on the part of the government to consider advance directives in Bill C-14.

Since I spoke in Edmonton, I ended up moving that there be amendments specifically to provide that kind of advance requests, as so many witnesses had proposed. However, every Liberal on the committee voted against that change.

I think Canadians are demanding it. I get more letters and calls about this issue than any other deficiency in the bill. I hope that the review that is proposed in the legislation will eventually take us there, because I know Canadians are demanding it.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I appreciate your thoughtful ruling and your recognition that this is indeed a historic event and, as you said, a generational issue. In Motion No. 1, I have suggested that we delete clause 3 of the bill, which is one of the central features of it.

The Supreme Court's ruling in the Carter case was a watershed moment for many Canadians, especially those who had fought so long to have their suffering recognized and their autonomy respected. I was proud to support the principle of Bill C-14 during second reading. I did so thinking of Sue Rodriguez of Victoria, Gloria Taylor, and Kay Carter, and of all of the others who paved the way for the rights of other suffering Canadians to be recognized by the Supreme Court and by Parliament.

While I was proud to support the bill in principle, at the time I raised serious concerns about particular provisions in it. Still, I was optimistic that these concerns would be resolved and the bill improved by hearing from experts and making the necessary amendments in committee. Sadly, that was not to be done.

The first day of consideration in the justice committee ended without a single opposition amendment accepted by the Liberal majority. By the end of the week, after more than 100 amendments were proposed, just 16 were accepted. Of course, I am pleased that my amendment was accepted to strengthen the government's commitment to providing more Canadians with palliative care, mental health supports, better services for patients with Alzheimer's and dementia, and culturally appropriate services for indigenous patients. I thank my colleagues from all parties for supporting my amendments to that end. However, many of the handful of changes at committee were simply minor technical changes.

Along with members from several parties, I offered a solution to the glaring flaw in the bill, the elephant in the room, namely the fact that it simply did not square with the Supreme Court's ruling. I proposed using the exact words of the Supreme Court to determine eligibility. That was of course one of the main recommendations of the special House Senate joint committee that addressed this bill. Sadly, all of these proposals were rejected. It became clear that the government had no interest in changing the central feature of this bill. Therefore, does the Liberals' bill square with the Supreme Court decision in Carter? The answer is clearly no.

The Supreme Court declared the two laws that prevented medical assistance in dying:

...void insofar as they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life; and (2) 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.

That language defined the circumference set out by our highest court as to who had the right to physician-assisted dying. Outside of that circle, there remains a total ban on assistance in dying. Mature minors, those who have lost or never had the capacity to give legal informed consent, those with solely psychiatric conditions, and those with merely minor medical conditions were never eligible in the Supreme Court decision. However, within the circle are all consenting competent adults with a grievous and irremediable illness, disease, or disability that causes enduring and intolerable suffering.

This bill would erase the circle set by the Supreme Court and draws a much smaller circle within it, covering only those nearing the end of life and facing what is called reasonably foreseeable natural death, a phrase which just recently the Collège des médecins du Québec called incomprehensible from a medical perspective.

A lawyer representing the British Columbia Civil Liberties Association at the court hearings said this to the justice committee, “Bill C-14 cuts the heart out of our victory in the Carter case”. By adding an end-of-life requirement onto the court's ruling, Bill C-14 would revoke the right to choose from an entire class of competent adult Canadians. That group is everyone suffering intolerably from an irremediable but non-fatal condition.

I have constituents in my riding who fall into that outer ring beyond the circle of rights recognized by the government, people who are suffering, who saw their suffering recognized by the Supreme Court and who cannot, for the life of them, understand why the government now insists on removing their right to choose this option.

What justification has the government offered for this disturbing decision? At the House and Senate committee, and again at the justice committee, some argued we could not afford to expand the circle of compassion, that the Supreme Court ruling could not be obeyed in full, that not all those who were granted rights in Carter could see those rights upheld because to do so would pose an unacceptable risk to vulnerable persons.

These are important arguments, but they are not new. In fact, they were advanced ably and in great detail before the Supreme Court of Canada. Here is what the court wrote.

At trial [the Crown] went into some detail about the risks associated with the legalization of physician-assisted dying. In its view, there are many possible sources of error... Essentially...there is no reliable way to identify those who are vulnerable and those who are not. As a result, it says, a blanket prohibition is necessary.

I emphasize this:

The evidence accepted by the trial judge does not support Canada’s argument...The trial judge found that it was feasible for properly qualified and experienced physicians to reliably assess patient competence and voluntariness, and that coercion, undue influence, and ambivalence could all be reliably assessed as part of that process....As to the risk to vulnerable populations (such as the elderly and disabled), the trial judge found that there was no evidence from permissive jurisdictions that people with disabilities are at heightened risk of accessing physician-assisted dying....no evidence of inordinate impact on socially vulnerable populations in the permissive jurisdictions...no compelling evidence that a permissive regime in Canada would result in a “practical slippery slope”. accepted by the trial judge does not support [this] argument.

That was the conclusion of the Supreme Court after considering the evidence and arguments raised in Carter, the very same evidence and arguments that were advanced at the joint House and Senate committee, which I was honoured to serve on, and at the justice committee just last week. After considering that evidence and those arguments, the court issued its ruling in Carter, establishing the right to choose medical assistance in dying for everyone inside a carefully measured circle of eligibility.

Quite simply, there was a large circle of eligibility. The government has chosen within that circle to define a smaller class. It simply cannot do that if we believe in the rule of law, if we believe in the fact that the Supreme Court should be listened to in this case.

In conclusion, I simply cannot support moving any further with a bill that would revoke from an entire class of competent adult Canadians rights granted to it by the Supreme Court of Canada.

Speaker's Ruling

[The Speaker, Geoff Regan]

There are 16 motions in amendment standing on the Notice Paper for the report stage of Bill C-14.

Motion No. 5, submitted by the hon. member for Victoria, and Motion No. 10, submitted by the hon. member for Montcalm, propose additional amendments to provisions of the bill that were previously amended in committee. Both motions seek to amend what is meant by “a grievous and irremediable medical condition”.

It should be noted that very similar definitions were proposed and defeated in committee, although they were proposed in reference to a different clause. In the view of the Chair, the objective of these motions is essentially identical to that of the amendments defeated in committee, and these motions will therefore not be selected for consideration at report stage.

The Chair has received letters sent by the hon. member for Sherwood Park—Fort Saskatchewan, the hon. member for Regina—Qu'Appelle, the hon. member for St. Albert—Edmonton, the hon. member for Saanich—Gulf Islands, and the hon. member for Kitchener—Conestoga arguing that certain motions, though previously defeated in committee, should be selected at report stage as they are of such exceptional significance as to warrant a further consideration, in accordance with the notice to Standing Order 76.1(5).

Motions Nos. 2, 11 and 15, submitted by both the hon. member for Barrie—Springwater—Oro-Medonte and the hon. member for Kitchener—Conestoga, as well as Motion No. 8, submitted only by the hon. member for Kitchener—Conestoga, will not be selected by the Chair as they could have been presented in committee. The Chair has difficulty accepting that they should now be accepted at report stage when no attempt was made by either member to present them in committee.

Motions Nos. 4 and 9, submitted by the hon. member for St. Albert—Edmonton and the hon. member for Regina—Qu'Appelle, seek to ensure that a person who suffers from an underlying mental health condition has undergone a psychiatric evaluation to confirm that they are capable of giving informed consent in relation to a request for medical assistance in dying. Motion No. 14, submitted by the same two members, seeks to ensure that people are free to refuse to provide medical assistance in dying. All three motions are identical to amendments defeated in committee.

The same is true for Motion No. 6, submitted by both the hon. member for Montcalm and the hon. member for Saanich—Gulf Islands. This motion seeks to delete paragraph 241.2(2)(d), which states that an individual's natural death must become reasonably foreseeable in order for the individual to be considered to have a grievous and irremediable medical condition.

In the case of the motions submitted by the hon. member for Sherwood Park—Fort Saskatchewan, Motions Nos. 7, 12 and 13 are also identical to amendments defeated in committee. Motion No. 7 seeks to amend paragraph 241.2(2)(d) to reference instead that the person's natural death must be imminent. Motion No. 12 seeks to add a paragraph providing that no substance is to be administered to a person who is capable of self-administering. Motion No. 13 provides for a review of the safeguards in relation to a request by a competent legal authority. Motion No. 3, which provides that a person must have consulted a medical practitioner regarding palliative care options prior to making a request for medical assistance in dying, is very similar to an amendment defeated in committee. The only distinction between the two is that the latter provided that such consultation had to have taken place within the 15 days prior to making the request.

The Chair appreciates the arguments put forward by hon. members as to why they consider these amendments to be of such significance as to warrant further consideration at report stage. I recognize that this is an important issue on which many members have strong and varied opinions. The Chair notes that the bill before us is unique, in its far-reaching social, moral and constitutional implications. The Chair also notes that, given the variety of opinions expressed by various members in all parties in relation to the provisions of this once-in-a-generation bill, the Chair is open to the argument of exceptional significance as contemplated in our Standing Orders. For these reasons, the Chair is prepared, on this occasion, to give members the benefit of the doubt and to select Motions Nos. 3, 4, 6, 7, 9, 12, 13 and 14, even though they were previously defeated in committee or are similar to motions previously defeated in committee.

All of the other motions, Motions Nos. 1 and 16, were examined, and the Chair is satisfied that they meet the guidelines expressed in the note to Standing Order 76.1(5), which deals with the selection of motions in amendment at report stage.

Therefore, Motions Nos. 1, 3, 4, 6, 7, 9, 12, 13, 14, and 16 will be grouped for debate and voted upon according to the voting pattern available at the table.

I shall now propose these motions to the House.

The House proceeded to the consideration of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), as reported (with amendments) from the committee.

Copyright Act

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

Mr. Speaker, I want to follow up on my colleague's question of the right time.

All of us came to the House this morning fully under the impression that we would be debating Bill C-14. Through the joint committee study, through the justice committee study, we were told time and time again that we did not have time to get all these witnesses in. We were under a tight time frame. We were under the deadline of June 6.

Today, we were hoping to start debate on Bill C-14. Instead of that, we have had at least three different bills brought to the House today, taking up the time that members of the House could be debating Bill C-14. The clock is ticking.

Again, what are my colleague's feelings about why the government would have chosen today to implement three bills that could have been passed another week when Bill C-14 was under such a tight timeline?

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

Mr. Speaker, it is a pleasure to rise to speak to this subject. I will be splitting my time with the member for Lethbridge who also serves as our party's critic for disabilities. She is doing a phenomenal job in that role, standing up for vulnerable people.

This is a great bill. It is a bill that all parties as well as unrecognized parties agree on, but it is important to express some disappointment about the reality of the process and how this debate has come up today. We had Bill C-14 on the Notice Paper. Then we had a vote to concur in Bill C-6. Then we had closure on Bill C-10. Now we are on to Bill C-11 without notice.

I say this precisely because of the importance of the bill. It is a bill that we should all be coming together not only on substance but on process. Had we the notice, had we been able to plan this debate at a time when all parties were ready and organized for it, we would have been able to get so much more out of this conversation. There would have been an opportunity to bring in stakeholders perhaps, to listen to and to observe this debate. This would have given all parties the opportunity to ensure that those who really wanted or needed to speak to this were in a position to do so.

Instead, this very important substantive legislation is being used as a procedural weapon, it seems. The government tabled the bill on March 24. As much as the minister has mentioned the urgency of moving this forward, the Liberals could have at least given notice that they were going to do it today. We could have had the bill debated earlier. This is a missed opportunity.

In the previous time slot, my colleague from the NDP, the member for Windsor West, wanted to split his time and a government member blocked that from happening. We have these missed opportunities of collegiality, missed opportunities to work together to put our best foot forward as a House. It is unfortunate, because we agree with the issue and can work together on it. Yes, there are times for partisanship in this place, but the bill should not have been one of those times.

I do not blame the minister for this. I have spoken to the minister at committee and I know she is committed to working across party lines on important issues. However, this speaks to the House leadership on the government side and how it views absolutely nothing it seems as beyond partisanship.

I want to get that out of the way because it is important to put on the record.

Let us talk about the bill. I am very proud to be speaking in favour of it.

Just to highlight for those who may be just joining the debate, the bill has three substantive different parts to it.

The bill would allow not-for-profit organizations acting on behalf of a person with a disability to convert books and other works into an accessible format without first seeking the permission of the copyright holder. It would instantly allow books that were currently not in accessible format to be converted into those formats. That is an important change, one that would make a positive difference.

Also, as part of the treaty that the bill would operate under, the Marrakesh treaty, which was signed in 2013 and would now through this legislation be ratified, it would allow the sharing of those works between different countries participating in that treaty. There is the domestic element of allowing people to have access to this important information. There is also that international element, encouraging sharing between different countries of this vital material.

Finally, the bill would make important related amendments to digital lock provisions.

Obviously we are going to support the bill. It is getting a lot of consensus. This is the conclusion of a prior process of which the previous government was certainly a part. Budget 2015 set out a plan to implement this treaty. Page 286 of budget 2015, stated:

The Government will propose amendments to the Copyright Act to implement and accede to the Marrakesh Treaty to Facilitate Access to Published Works for Persons Who Are Blind, Visually Impaired or Otherwise Print Disabled.

The ability to access printed information is essential to prepare for and participate in Canada’s economy, society and job market. According to Statistics Canada, approximately 1 million Canadians live with blindness or partial sight. The Government will propose amendments to the Copyright Act to implement and accede to the Marrakesh Treaty to Facilitate Access to Published Works for Persons Who Are Blind, Visually Impaired or Otherwise Print Disabled (the Marrakesh Treaty).

Aligning Canada’s copyright limitations and exceptions with the international standard established by the Marrakesh Treaty would enable Canada to accede to this international agreement. Once the treaty is in force, as a member country, [Canada] would benefit from greater access to adapted materials.

It is worth nothing that this process has been in place. Certainly, this was the plan laid out in Canada's economic action plan 2015. However, we are very pleased to see the new government continue on with this important work. This work needed to be done.

I would like to specifically motivate the philosophy behind the bill. It is essential that every person has access to books. Books are a major part of all of our lives, and they are an important part of every child's life.

My daughter, Gianna, and I read books all the time. I read books to her on Skype when I am in Ottawa. I cannot imagine what it would be like to have a child who has a visual impairment and who is unable to get books which he or she can read. My daughter is a voracious reader. I brought four books with me and we went through them all in one evening. I need to bring more books with me next time I come to Ottawa, clearly. It is great to see how important books are to us all, especially kids. We need to ensure that people of all ages, including children, have access to reading material of all kinds.

As has been discussed in the House, people's reading decisions are not limited by the availability of books.

Again, I cannot imagine what it would be like to really want to read a particular book, whether a novel or a work of non-fiction, and be told that because of a disability, I cannot read that book, that the book is not available to me, that the knowledge is not available to me. I think that would be a very difficult thing for anyone to deal with. That is why this legislation is important for ensuring that everyone has access to books, that there can really be the full sharing of knowledge that takes place.

Everyone in every situation should have access to as much knowledge, as many books as possible. There can be nothing but good that would come from more access to books for more people.

I also want to talk about the international dimension of this. One of the things we know about Canada is that many people maybe have come here from other places or maybe were born here, but who like to read books in other languages. They might be more comfortable in a language other than English or French, or they simply enjoy reading works from a range of different languages. Specifically, the international dimension of this treaty would allow Canadians to have greater access to books in other languages that may be in a better format which they can make more use of.

Some of the countries that have signed the treaty so far are Argentina, El Salvador, India, Mali, Paraguay, Singapore, UAE, and Uruguay. In a multicultural Canada that likely means more access to materials in languages like Hindi, Punjabi, and Spanish. It is important that through those international sharing takes place for all Canadians, not just those who want to access things in English or French, have access to them.

Noting the countries that have signed the treaty so far, it does not look like there are that many Francophone countries. In addition to us ratifying this, there is a lot of value in Canada playing a role, encouraging other countries to ratify and, in particular, seeing if we can use our relationships through the Francophonie to encourage more Francophone countries to ratify this and therefore ensure we have good access to more French-language materials.

We need to get to 20 countries. It is important that we get those 20 countries ratifying. I understand from the minister that we only have three more to go. This is an important leadership role Canada can play and the continuing advocacy we have to do.

I mentioned this during questions and comments, but I have had a constituent raise with me the importance of ensuring those tools people access that allow them, as people with disabilities, to operate in the world, to read, and to do other things, it may be an iPad or a speech app on a phone, are tax deductible. I see measures that address those issues as aligning well with the measures in this legislation.

I look forward to supporting the bill.

Bill C-10—Time Allocation Motion

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

Mr. Speaker, what the bill does is kill thousands of aerospace jobs in this country.

The government should not be proud of bringing forward the bill, but I have to comment on the absolute chaos we have seen from the government this morning. In 60 minutes, we have now gone through three pieces of legislation. We were told today was to be reserved for Bill C-14. That was what was placed on the projected order of business. We arrived this morning and the government said no, it would bring in Bill C-6, and then it switched rapidly to Bill C-10.

We know why the Liberals are bringing in Bill C-10. They are trying to provoke closure and bulldoze this through, because yesterday parliamentarians tied in their vote on Bill C-10. The bill is so bad, the legislation is so destructive to aerospace jobs in Canada, as you know, Mr. Speaker, you had to break the tie. It was 139 to 139. That has only happened 11 times in Canadian history, and in fact, it is the first time that a majority government and a government bill has seen a tie vote broken by the Speaker.

Is that not the real reason why sunny ways have turned into dark ways and why the Liberals are trying to bulldoze the bill through? It is because they are embarrassed by the results from yesterday.

Citizenship Act

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

Mr. Speaker, I am looking at the projected order of business for today, and it says very clearly that Bill C-14 is up for debate. I am surprised that the government is refusing to bring that forward when it is on the projected order of business.

I hope, if you seek it, you will find unanimous consent for the following motion: that the order of the day not be Bill C-6, An Act to amend the Citizenship Act and to make consequential amendments to another Act, and that the House proceed to the consideration of report stage of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

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

Again, I would look around the table and thank all members of this committee for the substantive discussions that have been had around Bill C-14 on medical assistance in dying.

To your question, the June 6 deadline of the Supreme Court of Canada is incredibly important, and our government is committed to doing everything we can to meet that deadline, recognizing where the proposed legislation is within the House of Commons, acknowledging the substantive work that senators have done in their pre-study phase, and recognizing the work that they will continue to do in considering Bill C-14. I would stress, again, the importance of meeting the June 6 deadline. We are doing everything we can to ensure that is the case. Not meeting the June 6 deadline, as you rightfully point out, would leave a vacuum in terms of the law, in terms of the application of medical assistance in dying in this country, with regard to eligibility. The court application process for exemptions would no longer exist. There would be no safeguards in place. Medical practitioners would have uncertainty around how the Carter ruling would be applied, and I think, further to that, in terms of patients who want to access medical assistance in dying, they would be limited in doing so, given the uncertainty that would exist. As you know, in this country, the only jurisdiction that has a law around assistance in dying is Quebec, so I am very committed to ensuring that we do everything we can to meet that June 6 deadline.

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

Thank you, Minister. It certainly seems that it has become quite urgent when we see, for example, in Alberta a serious fraud case thrown out. It looks as if this week perhaps two sexual assault cases may be thrown out for delay, so I would reiterate that the appointments are urgently needed now, but I appreciate the answer.

Turning to a different topic with the remaining time I have, the June 6 deadline that the Supreme Court issued to the stay on the declaration of constitutional invalidity is coming up. Obviously, Bill C-14 is moving forward in the House of Commons, but in conversations I have had with Senate colleagues, there seems to be a general consensus that the legislation may not get through the Senate by the June 6 deadline.

In that scenario, what steps is the federal government going to take? What are you going to do as minister? Would you, for example, consider bringing forward an application to the Supreme Court for a short-term extension to allow sufficient time to make sure that legislation can get passed before we end up in a situation where there could be a vacuum with no law and no certainty for physicians, for patients, and no safeguards for the vulnerable?

Third Reading

[Adam Vaughan, Liberal, Parliamentary Secretary to the Prime Minister (Intergovernmental Affairs)]

Mr. Speaker, it is interesting to listen to my colleague across the way, on two fronts: one, the very strong arguments he made that legislation can in fact protect good-paying jobs; two, that government interaction can generate growth in the employment sector.

However, what I would like him to comment or reflect upon is that the previous Conservative government had carriage of this file. It came to the conclusion—I think I am paraphrasing it correctly—that effectively it agreed with Air Canada that there was no provision to legislate there. It concluded that the legislation was weak and that it was not going to intervene. Effectively, it decided to do nothing.

Was doing nothing on this file preferable to securing the jobs that would be secured through Bill C-14? Was the previous government's position of doing nothing on this file but agreeing with Air Canada on it having no obligation to do any work in any one of these major cities in fact the responsible direction to go, or is this position an advancement, by the fact that it protects real jobs in real cities?

Citizenship and Immigration

[Dominic LeBlanc, Liberal, Beauséjour, NB]

Mr. Speaker, there have been discussions with the parties and I am hoping that if you seek it, you would find unanimous consent for the following motion. I move that, notwithstanding any Standing Order or usual practice of the House, on Tuesday, May 17, 2016, and on Wednesday, May 18, 2016, the House continue to sit beyond the ordinary hour of daily adjournment for the purposes of considering Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).

Democratic Reform

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

Mr. Speaker, in his answer, the government House leader tried to reference the thinly veiled attempt to bring in closure last week through Standing Order 56.1. Therefore, I have a motion that I was wondering if I could get unanimous consent on. It is that, notwithstanding any standing order or usual practice of the House, on Tuesday, May 17, 2016, and on Wednesday, May 18, 2016, the House continue to sit beyond the ordinary hour of daily adjournment until midnight for the purposes of considering Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, and at midnight or when no member rises to speak, the House shall adjourn until the next sitting day.

Physician-Assisted Dying

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

Mr. Speaker, this a deeply personal and complex issue, which I have been working on with the Minister of Health and with every member in the House. We are committed to ensuring that we move forward with Bill C-14, to hear robust dialogue and debate, and to ensure that we strike the right balance between ensuring personal autonomy and doing as much as we can to protect the vulnerable.

This is what this piece of legislation does. I am hopeful that we will continue to have discussion, because this is not going to be the end of this discussion. We will consider this as a country—

Physician-Assisted Death

[Dan Ruimy, Liberal, Pitt Meadows—Maple Ridge, BC]

Mr. Speaker, unlike the previous government, we believe in the importance of parliamentary debate, all the while keeping in mind issues such as Supreme Court deadlines.

I believe we have a responsibility to ensure that all members of Parliament who want to participate in debate on legislation such as Bill C-14 should be able to do so.

Could the Leader of the Government in the House of Commons inform the House as to the intention of the government in regard to the debate on Bill C-14 at report stage and third reading?

Opposition Motion—Freedom of Conscience

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

Madam Speaker, I am very pleased to participate in this important debate about conscience rights. It is an honour to follow my friend, the member for Cypress Hills—Grasslands. I want to, particularly, salute the great work done on this motion by the member for Peace River—Westlock, someone who is making a great contribution here, not just with his clever S.O. 31 rhymes but also with his substantive contributions at other times.

I think we have had a good debate today, but at the same time, as much as our conventions are to take a liberal view of topicality, there has been a lot of discussion about aspects of Bill C-14 that do not directly relate to conscience. Maybe that underlines the fact that there actually should have been more discussion of Bill C-14 at second reading. I hope there will not be closure on it at third reading.

I want to focus my comments today on this specific opposition day motion on the issues of conscience.

First of all, right off the bat, I want to underline what we are talking about here. The government has talked about an amendment that was brought in at committee to the legislation that discussed conscience rights. I say, “discussed conscience rights”, but it did not protect conscience rights.

I want to read that amendment so members know exactly what we are talking about. It is on page 8 of the reprinted bill, lines 32 to 34:

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

Let us be clear about what that section says, “nothing in this section compels an individual”, etc. The concern was never that this section compelled individuals, but rather, that the interaction of this legislation and policies at the provincial level, which are pre-existing, which we know exist, without the protections in this legislation will have the effect of a violation of conscience protection.

It is sleight of hand for the government to say there is nothing in the legislation by itself. It is precisely the interaction of the legislation with existing policies that causes the problem.

The government has quite correctly pointed out that Conservative members supported this amendment, because it was a very small step in the right direction. However, on the many substantive problems to the legislation, which we proposed amendments about, we did not see any support from government members. We proposed robust, serious conscience protection, things that would not just reference conscience but would actually protect conscience. We proposed those amendments. The member for St. Albert—Edmonton and others did an excellent job of presenting and advocating those, but unfortunately, to no avail.

That is what we are talking about, whether or not the legislation should contain robust, meaningful protection of conscience.

For all those members who have, today, paid lip service to the idea of conscience, I ask, “Why, then, did the members in the committee not support things that would take the necessary action to protect conscience?”

We have heard a number of different arguments about this issue. We have heard that conscience rights are already protected in the charter, so we do not have to worry about them because they are already part of our underlying laws. Yes, it is correct to say that conscience rights are in the charter, but it is not at all sufficient to say that we do not need policies and legislation that ensure those charter principles are actually implemented.

Why is this important?

First, courts are going to show some degree of deference to the legislature when they are interpreting the exact application of these rights. It is important for the legislature to be clear about the importance of conscience rights to us and how we would like to see it operationalized in particular situations.

It also provides certainty. Without the certainty of guaranteeing positive conscience protection in the legislation, people will have their conscience rights violated, at least in the interim, and will be forced to go to the court to seek a remedy.

I am of the view that the current College of Physicians and Surgeons' policy in Ontario does violate section 2 provisions around conscience in the charter, but this now requires what is happening now, which is a legal challenge. For the time being, it creates a great deal of problems and uncertainty. It prevents many medical practitioners from participating effectively in serving their patients.

It is not enough to just say we have these guarantees in the charter so we do not need to think about them. No. We need to ensure that the rights of conscience are protected in policies and in legislation. That is why we want to see positive conscience rights protection here.

There has been some discussion, as well, about this jurisdictional question. It is curious that the government says, on the one hand, “We've provided conscience protection in the legislation”, and then it says, on the other hand, “Conscience protection is not something we can provide; it's at the provincial level”.

Which is it? Its arguments against the motion are in fact mutually exclusive.

Let us be very clear. This legislation does not provide positive conscience protection, but given that the legislation, Bill C-14, is describing the contours of an exception to the Criminal Code, it is very much within our rights, as the legislature, to say that the exception we are creating in the Criminal Code has conditions and exceptions within it.

There is no principle problem with doing that. Again, as has been discussed, this is something that has been done before when the federal government is involved in areas describing the contours of those exceptions and ensuring conscience protection.

We often talk here about the importance of pluralism, about the value of Canadian multiculturalism. Protection of conscience is an essential part of our fabric as a multicultural nation. People come here from other places, people who have lived here for a long time. They have different kinds of traditions, different kinds of values. Multiculturalism is not just that we look different and eat different food but that we can have substantive different perspectives on what constitutes the good life, and that we can live out those conceptions in our lives and that we can have respectful discussions with each other about those different conceptions of the good life.

However, it is important to have that meaningful robust concept of multiculturalism, of pluralism existing, and that we do protect rights of conscience and religion. It is not enough to just pay lip service to these concepts, like pluralism, they need to be protected. Conscience rights provide the foundation on which a well-functioning pluralistic and multicultural society is built.

I want to underline as well that conscience rights are a right of non-interference. They are not a demand to interfere in someone else's life. An expectation of the protection of a conscience right is simply the expression of someone saying, “Just leave me alone. Just let me do my own thing with my own medical practice. I am not going to interfere with someone else, but just let me do what I wish to do within my own sphere.” That is all those who are seeking conscience protection are asking for.

Therefore, why will the government not ensure that the doctors who want to provide good service to their patients, who want to provide palliative care and other necessary services, and who may have a different conception of the good life or of some of these moral questions than others do are left alone? They are not asking for anything special. They are asking to be left alone so that they can continue to do the good work that they want to do.

One of the counter-arguments we hear is that health care is public, so given that there is some degree of public involvement the state should somehow be able to dictate the terms of health care up to the point of taking away individual conscience rights. Is it not curious that as soon as the state is partially involved in something there is this automatic assertion that conscience rights and the rights of the individuals involved go out the window?

Given that health care is, in practice, provided as a partnership between state funding and individuals who are acting within that system who are motivated not just by the funding that comes from the state but by values, compassion, and a desire to serve their patients, and given that health care is a partnership between community groups, volunteer donors, those who fundraise for local hospitals, as well as the state, why not protect the conscience rights of individuals and of institutions so that they can continue to provide services that reflect their values?

We have talked a lot here about law, theory, and principles of rights. Let us bring this back to something very concrete and practical.

I have mentioned Dr. Nancy Naylor before, who is a palliative care physician in Strathroy, Ontario. I have not spent a lot of time in Strathroy, but I do not suspect that there are a very large number of palliative care physicians there. She is leaving the practice of palliative care because she is concerned that her conscience rights will be infringed as a palliative care physician.

We can talk back and forth about the theory of the rights that are at play here, but never mind the doctor and her career, what is the cost to this doctor's patients, the many people who do not want to die and who just want access to good quality palliative care? What about them? Every time a doctor is forced to leave a jurisdiction because of an infringement on their conscience rights that affects those patients who lose access to that family doctor or palliative care physician. That affects far more patients than the doctor or the doctor's family.

Whatever members think about this arguably important theory of conscience rights, they should think about the impact on patients and about the impact on our already woefully inadequate system of palliative care.

I ask members to support this important motion.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Madam Speaker, we have a motion before us today with a few basic points, and it seems to me that conscience rights for health care professionals are a fundamental freedom, and I argue that they are guarded and protected under the Charter of Rights and Freedoms. However, the failure to protect those conscience rights within our health care system cannot do anything but damage our health care system.

We have a private member's bill, Bill C-268, that addresses these issues and specifically talks about giving people the opportunity to be able to exercise their freedom. I appreciate the minister's attention to this bill. Earlier today, though, she said that this does not create a duty that was not there before. I would argue that actually it does, because this is new ground. This is completely new ground that we are going into. There has never been an expectation in the medical community before that health care providers need to participate in causing death. There are new duties being created here that are not being addressed by Bill C-14 that need to be. We need to stop, take a look at it, and then try to reapply some of those things that are important in terms of conscience rights.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Madam Speaker, I listened closely to our colleague's comments and concerns. I attended public hearings during which the Canadian Medical Association said that freedom of conscience for doctors who would be responsible for providing care related to medical assistance in dying would not be a problem because so many doctors are okay with making that kind of assistance available.

I would like my colleague to tell us more about why he thinks it is important, essential even, for Bill C-14 to include a specific provision on freedom of conscience for doctors and people who will provide care related to medical assistance in dying.

How can we square what he thinks is so important with the Supreme Court's requirement in Carter, which does not mention that issue but says instead that we have to help non-vulnerable people get that assistance?

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Madam Speaker, I am splitting my time with the member for Sherwood Park—Fort Saskatchewan.

I am a little confused as are some people here with the back and forth. Conservatives take Bill C-14 very seriously and we want to debate it. I was surprised a little earlier when it seemed the Liberals wanted us to go all night, through the night. I assume that means they would like to speak during the day and then leave the opposition to speak at night when supposedly no one is listening. I think a reasonable compromise was suggested a couple of minutes ago, which is that we extend the hours to midnight, during which time we would have serious debate on this issue.

That is why we are here today. It is interesting that the notion of freedom of conscience seems to be coming up more and more in our society. In the last couple of weeks, I have crossed paths with it in discussions separate from discussions around Bill C-14.

Yesterday, at the Subcommittee on International Human Rights, someone spoke about working with persecuted minorities and the question came up about what role freedom of conscience plays.

Last week, there was a forum in town about making the world safer for diversity. Dr. Os Guinness talked about how freedom of conscience has always been properly understood as the very first right. We can talk about life, liberty, and happiness, but without freedom of conscience, none of those other things actually exist in reality.

Everybody has beliefs that are important to them. I guess it is a common misconception we have that others have beliefs and I am the one who is unbiased. Each of us brings valid perceptions to these discussions and in our culture, until recently, it seemed that we were generally of the opinion that no one has the right to force anyone to work against their own beliefs.

It seems as we focus more and more on rights and less and less on responsibilities, we find ourselves pressured and I think we have to admit that we often find ourselves pressuring others on their values of conscience and the core values that people hold. It is beginning to affect every area of our culture. With the Carter decision, this has come to the forefront, because it is no longer just perceived discrimination that it is impacting, but it comes right down to the court's decision that having the right to kill oneself is a charter right.

I will take a bit of time to look at the Carter decision. It was a reversal of a previous decision, the Rodriguez decision. The court ruled that we now have, as Canadian citizens, a charter right to kill ourselves and we have the right to have others help us. There are very few guidelines that the court put on that decision. It talked about how the condition had to be irremediable and a grievous condition, basically beyond the person's decision to suffer through it. I could go into the criteria for that, which perhaps I will do a little later.

While the court decided one decision, it created a whole host of other complications. One of them, of course, is the call to reconcile physicians' and patients' rights. The question we are dealing with today is what role others have to play or do they play in that decision to prematurely end life.

Bill C-14 does not solve that. I was glad to hear the minister acknowledge that earlier. Conscience issues are becoming the biggest issues around Bill C-14. In this case, I would argue that the government has failed Canadians.

There is a legitimate question to be asked and I am surprised that it has not even been discussed—it is not discussed in other countries either—as to why medical personnel are expected to be involved at all. However, they are, and even though they are, most of them do not want to participate. The medical personnel whom I have talked to are not accepting of or enthusiastic about this. I have spoken with a number of doctors who say that if they are forced to participate in this, they are willing to leave the country, that they are not going to participate. For those of us who live in rural areas and have a very small supply of medical care, it is a frightening thing to hear one's doctor say he or she is prepared to leave if this is forced on him or her.

I want to talk about the protection of conscience in Bill C-14. The preamble states:

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;...

That is the preamble, which has no legal impact. There is no content within Bill C-14 that provides this balance.

The Senate committee heard some great testimony. The Justice Centre for Constitutional Freedoms said:

...the Court discussed and reiterated the conscience and religious rights of medical practitioners, stating that, “nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

However, then it went on to say, “the Charter rights of patients and physicians will need to be reconciled. Thus, it is apparent that the Court intended Parliament’s legislative response to address the issue of medical practitioners’ conscience rights. Bill C-14 fails to do so.”

It is interesting to me that Bill C-14 actually provides protection for participants, but it does not provide protection for those who do not want to participate. There is an exemption for medical assistance in dying where it says that no medical practitioner commits homicide if they provide a person with medical assistance. It says that no person is a party to homicide if they do anything for the purpose of aiding in that. Then it says that for greater certainty, if the person has any reasonable, even mistaken, belief about any fact that is an element of the exemption, they have no legal responsibility for that.

I just point out that protection for participants has been included for those people who choose to participate, even if they are mistaken in what they have done. I can find no similar parallel protection for those who conscientiously object.

Some have said to pass it on to the provinces. We just heard that a minute ago from my colleague from the NDP. I would argue this is not a provincial issue. If it is, there will be a dozen different scenarios in this country and then the courts will get even more involved than they have been. It is a Criminal Code issue. Why would we give legislative protection in a bill to those who want to participate and then argue that Parliament has no right to legislate protection for those who do not want to take part?

The executive director of the Christian Medical and Dental Society said at the Senate committee:

...what our members cannot do is perform or participate in what is referred to as medical assistance in dying. To be clear, by participation, I also mean playing a role in causing death by arranging for the procedure to be carried out by someone else through referral.

He went on to say that the current preamble respects the personal conviction of health care providers, but it does not have any legal weight, and that no foreign jurisdiction in the world has legalized assisted suicide and euthanasia and then forced their health care workers in hospitals, nursing homes, and hospices to act against their conscience, their mission, or their values. He said that to force providers to act in this way in Canada would actually be to violate section 2 of the Charter of Rights and Freedoms.

It is necessary that the federal government legislate protection of conscience rights for health care professionals in order to respect the charter and to protect our existing health care system. Federal legislation would send a clear signal to provinces, organizations, and the courts that the right of conscience must be protected.

I argue that because medical personnel and supervisory groups cannot and will not agree, Parliament should set those guidelines, and they should be set in the Criminal Code.

A minister said a little earlier today that the protection is in the charter, not in the Criminal Code, but I think that is exactly the concern that Canadians have. The charter interpretation has gone 180° on the issue of assisted suicide, and there is nothing keeping that from happening as well on section 2 of the charter.

We need conscience rights. What are they? They are the right not to participate, the right not to be forced to refer. They are a fundamental freedom guaranteed by section 2 of the charter.

We need to protect the health care system. As I mentioned earlier, I have been told by physicians that they are prepared to leave if they are going to be forced into this, and they are not prepared to go against their own conscience. The Ontario college is making a big mistake in thinking that it can force doctors to do this against their conscience. I am not sure why it thinks it needs to control others who are just trying to do the right thing.

There were other suggestions that we heard a little earlier. For example, what is wrong with allowing patients to transfer their medical care to a doctor of choice? How about a directory of doctors so people can identify doctors who provide such services? We live in an electronic age, that should not be difficult. It would give Canadians confidence they could find medical personnel who would not be acting contrary to their care.

We need to protect the charter right of health care professionals. We need to make it a criminal offence to intimidate or coerce the health care professional to take part directly or indirectly in assisted suicide or euthanasia and to make it a criminal offence to dismiss anyone from employment for taking that position.

As I wrap up, I just want to come back to the point that no person should be put in a position where his or her private rights, which are guaranteed by the charter, are removed by force. Nothing is more fundamental than being able to live out that which we believe, especially if that belief is aimed at supporting and preserving life.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I was actually going to address the point of order raised, but if it is necessary to bring up a separate point of order, I will do it as a separate point of order.

I just want to say that I am very much aware and sensitive to the many negotiations that are taking place surrounding Bill C-14. Having said that, the government's will has always been to try to allow members to address the bill. That is the reason we brought forward the motion earlier today—

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Madam Speaker, on a point of order, I would like to say that we are very disappointed in what is going on in the House regarding Bill C-14. It is very serious legislation. Currently, there are sensitive, ongoing negotiations being conducted in regard to it, and those negotiations should be respected.

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

Madam Speaker, I would like to know if the member can find an obligation anywhere in Bill C-14 for professionals to refer patients. I cannot.

The whole issue of referral rests with professional associations, so it is under provincial jurisdiction. As federal MPs, we are obligated to respect provincial jurisdiction and every individual's basic right to equal access to medical assistance in dying.

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

Madam Speaker, I think we all agree that it is important to protect professionals' freedom of conscience.

The reason I oppose the Conservatives' motion is that they are eliminating the possibility of referring patients to other professionals. If we adopt the Conservatives' motion, patients will no longer have the right to request medical assistance in dying as they do now thanks to the Supreme Court's ruling.

We have to respect patients' rights and freedoms. Bill C-14 does not force health care professionals to refer patients elsewhere if they conscientiously object.

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

—Madam Speaker, I am pleased to speak to the Conservatives' motion today, which states:

That, in the opinion of the House: (a) it is in the public interest to protect the freedom of conscience of a medical practitioner, nurse practitioner, pharmacist or any other health care professional who objects to take part, directly or indirectly, in the provision of medical assistance in dying; (b) everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms; (c) a regime that would require a medical practitioner, nurse practitioner, pharmacist or any other health care professional to make use of effective referral of patients could infringe on the freedom of conscience of those medical practitioners, nurse practitioners, pharmacists or any other health care professional; and (d) the government should support legislation to protect the freedom of conscience of a medical practitioner, nurse practitioner, pharmacist or any other health care professional.

I want to explain why the New Democrats oppose this motion. Throughout the debate on Bill C-14 on medical assistance in dying, the Conservatives have said they are concerned that health care professionals would feel compelled to provide medical assistance in dying to patients, in violation of their personal or religious convictions.

However, the government has clearly indicated, and rightly so, that the bill would not force anyone to provide this service. Although it is not legally necessary to protect freedom of conscience, all of the parties on the Standing Committee on Justice and Human Rights drafted and adopted a compromise amendment, which was proposed by the NDP member for Victoria. The amendment states:

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

Another amendment proposed by the NDP member for Victoria was also made to the preamble to ensure that nothing in this act will affect the guarantee of freedom of conscience, religion, and expression, as enshrined in the charter.

Any other additional measure regarding these freedoms would infringe on the provinces' jurisdiction over health because the regulations governing referrals are determined by medical regulatory authorities and professional bodies, not by the federal government's authority over criminal law.

During the discussions in committee about medical assistance in dying, the NDP and almost every party agreed that it was necessary to respect health care workers' personal conscience. We are therefore very proud to have introduced amendments that all parties of the House helped to draft in order to emphasize that there is nothing in this bill that would compel an individual to provide this service or that would infringe on the freedom of conscience, religion, or expression guaranteed by the charter.

The Conservative motion that we are currently debating is asking the federal government to infringe on provincial jurisdiction. I cannot support that. Each level of government needs to respect the others' jurisdictions. By adopting this type of motion, we would not be respecting provincial jurisdiction. Standards of care are established by medical regulatory authorities, not the Criminal Code.

There are a number of factors related to medical assistance in dying that are not included in the bill, and there are also some factors that are included but create vague definitions that were not set out in the Supreme Court's decision.

Throughout my speech, I will explain why it is worrisome that the Liberals are trying to push through Bill C-14 any way they can. Let us start with the process we must follow.

Once again today, during routine proceedings after oral question period, the Minister of Justice rose in the House seeking unanimous consent to debate Bill C-14 for 24 hours, right through the night, some time next week, on the pretext that she wanted to let every parliamentarian speak to the bill.

However, we had already proposed debating Bill C-14 on medical assistance in dying until midnight next Monday, Tuesday, and Wednesday. That is reasonable. It extends the debate and lets parliamentarians do their jobs. They could continue to debate an extremely complex and very sensitive issue on which there really is no unanimity, consult experts, and obtain input from witnesses who appeared and continue to appear before the committee.

The minister rejected sitting until midnight next Monday, Tuesday, and Wednesday. Furthermore, today, on a Friday, a day when not all MPs are necessarily in the House, she is rather aggressively trying to impose another process on the House to force us to sit for 24 hours. Who will watch this debate in the House of Commons at three or five o'clock in the morning? That is completely absurd, and it does not let parliamentarians do a proper job.

The Liberals have already imposed time allocation on Bill C-14, even though they said it was important to take the time to listen to everyone and have a thorough, intelligent debate on the very controversial topic of medical assistance in dying. That completely contradicts what they said when they were in the opposition. Every time the Conservatives invoked closure or tried to cut a debate short or speed it up, the Liberals were the first on their feet in the House to sound the alarm and condemn such undemocratic measures.

Now that the Liberals are in power, they are using the same undemocratic tactics they condemned back then to shut down debate on a very important subject: medical assistance in dying. I cannot believe what I am seeing. They said they wanted to give Canadians change. Now they are forcing us to accept a deeply flawed bill because, they say, they have to get it done by June 6. Experts have criticized the bill because it is not in line with the Carter decision or the Canadian Charter of Rights and Freedoms. This makes no sense.

I want to come back to some of the points that have been raised since the beginning by a number of experts and members of the House, including NDP members. This will open the door to legal challenges because the bill does not comply with the charter and goes against several processes.

I can cite people from the Barreau du Québec. Many experts and stakeholders have shared their concerns. In fact, there is a definition in the wording of Bill C-14 that refers to parts of the bill. That is a problem because the Supreme Court does not use the same language as Bill C-14.

The Supreme Court talks about a person 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.

However, the bill talks about “reasonably foreseeable natural death”. That wording does not appear in the Carter decision at all.

Jean-Marc Ménard from the Barreau du Québec said in committee that by adopting a criterion that is more restrictive than what section 7 of the Canadian Charter of Rights and Freedoms allows, the bill would go against the charter. He said, “We should be aware that the impact of the law will in future be measured in light of section 7 of the Canadian Charter of Rights and Freedoms”.

Section 7 is broader in scope than what the bill is proposing, which clearly opens the door to legal challenges. What the Barreau du Québec does not want is for people who could have access to medical assistance in dying under the criteria in the Carter decision to no longer have this access because of Bill C-14, introduced by the Liberals.

That happened in Quebec with a slightly more restrictive criterion. For example, people stopped eating so that they would be eligible under the law. That is serious. Some people who feel extremely desperate about their condition, their situation, and their suffering and who do not have access to medical assistance in dying under Bill C-14 may try to end their life in one way or another just so that they can access the service. That is completely ridiculous.

People mainly want to access this service so that they do not have to suffer anymore. They will inflict greater suffering on themselves so that they can have access to this service, which does not make any sense. The minister does not see that. According to the Barreau du Québec, problems such as that may arise. Earlier, the minister answered a question by saying that there is a diversity of opinions and that she does not think that there will be any court challenges. She is in denial. This is coming from the Barreau du Québec.

I would like to quote some other people. According to the Collège des médecins du Québec, Bill C-14 is unworkable. The secretary of the CMQ believes that it would be far less complicated for Quebec doctors to not have a federal law than to have one. He indicated that the legislative measure that the Liberals hope to pass falls somewhere in a grey area between the Supreme Court's decision and Quebec's law.

Another quote gives me goosebumps. Yves Robert, the secretary of the CMQ, said, “Ultimately, the burden does not fall on the shoulders of legislators. It falls on the shoulders of doctors. They are the ones who are going to have to deal with these cases and these requests.”

Many experts have testified and are still testifying before the committee. They are raising worrisome issues and facts. The minister and the members of the committee examining Bill C-14 are ignoring these opinions but are still claiming that they are making informed decisions that reflect the opinions of most experts and the public's recommendations.

I will now talk about the patients. People who pleaded before the Supreme Court, including the Carter family, are saying that because of Bill C-14, Kay Carter and many people like her would not be eligible since their death is not foreseeable because of their illness. That is what Kay Carter's daughter, Lee Carter, said. It is serious.

The people who fought for this, the pioneers of the bill on medical assistance in dying, argued their case before the Supreme Court and won. However, we are taking a step backward. Those people who won their case in the Supreme Court will likely be denied this care by the Liberal government, which is not listening to the advice of experts or ensuring it upholds the Supreme Court ruling.

Another very troubling point is the lack of funding for palliative care.

During the election campaign, the Liberals promised to invest $3 billion in palliative care, end-of-life care, and home care. However, these investments were nowhere to be found in their budget, nor are they in Bill C-14 on medical assistance in dying.

All the Liberal members who have spoken in the House have recognized that we need to work on a long-term strategy to ensure that patients have access to good-quality, long-term palliative care, and to ensure that all those who want to continue living with a decent quality of life are able to do so.

For this to happen, we need more than words. We need investments and a plan. However, we are not seeing any of that. As of today, May 13, 2016, the bill is still in committee. It will soon return at third reading, and the government has yet to propose anything. So far, it has invested zero dollars in palliative care. That is very worrisome. I remind members that our population is aging. More and more people will have serious illnesses and will be experiencing unbearable suffering, and the Liberal government has still not proposed any significant measures to address this.

In 2014, my colleague from Timmins—James Bay moved Motion No. 456, which was about a pan-Canadian palliative and end-of-life care strategy, and that motion was passed. The Liberals voted in favour of the motion to implement such a strategy.

The motion said that the government should work with the provinces and territories to develop a flexible, integrated model of palliative care that takes into account the geographic, regional, and cultural diversity of urban and rural Canada as well as Canada's first nation, Inuit, and Métis people and respects the cultural, spiritual, and familial needs of all Canadians.

The model would also have had the goal of ensuring that all Canadians have access to high-quality home-based and hospice palliative and end-of-life care, providing more support for caregivers, improving the quality and consistency of home and hospice palliative and end-of-life care in Canada, and encouraging Canadians to discuss and plan for end-of-life care.

The Liberals supported this motion. Then how is it that the Liberal government did not announce a specific and real investment in its budget or in committee after discussing medical assistance in dying with the experts? This is actually a very important bill. We have to accommodate as best we can people at the end of life who are suffering. It is completely unacceptable and irresponsible for the government to not have included a plan in the bill.

Nevertheless, we are pleased to have made an amendment to Bill C-14, which will protect the individual's right to freedom of conscience and secure a much greater commitment to palliative care, mental health, dementia, and services to indigenous patients. However, the money must be made available. Writing words on a bill is not enough. Investments are needed in order to implement a palliative care strategy.

Moreover, we must work in a non-partisan manner. The Liberals must open their eyes and realize that their bill is deeply flawed. Their bill could give rise to a thousand and one legal challenges because they are trying to push it through and are not considering the opinions of experts. The experts who returned to committee repeated what they said the first time. It is a waste of time and money.

The NDP is asking the Liberals to refer their bill to the Supreme Court to ensure that it is constitutional and thus prevent countless legal challenges. The Liberals are refusing to do this. What are they afraid of? Whey are they refusing to refer their bill to the Supreme Court if they are so sure that everything is just fine and dandy?

I hope that the Liberals will eventually listen to reason.

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

Madam Speaker, on a point of order, I believe we are still debating the opposition motion. I think the member is asking about Bill C-14, not about the opposition motion or conscience at all.

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

Madam Speaker, with respect to our country, Bill C-14, medical assistance in dying, is a transformation in terms of our thinking and in terms of the discussion around medical assistance in dying. We have had the opportunity to engage with a diversity of opinions, a diversity of expert opinions and individual Canadians right across this country.

I received in my office thousands of letters and engagements on this particular issue. There is always going to be a diversity of opinions on both sides.

The opportunity and the challenge presented to parliamentarians is to ensure that we put forward the best solution, the best balance, in terms of this really difficult issue. I am confident that Bill C-14 responds to the Carter decision of the Supreme Court of Canada and is compliant with the charter.

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

Madam Speaker, a number of experts such as representatives of the Barreau du Québec and the Canadian Bar Association, as well as people who intervened in the Carter case, are saying that there will be several legal challenges to the minister's Bill C-14 on medical assistance in dying, that it violates the Canadian Charter of Rights and Freedoms, that there will be more medical and legal problems, and that many people will not have access to medical assistance in dying services. What are the minister's thoughts on that?

The recommendations made by a number of experts were not accepted. It is very worrisome to see that the Liberal government is hurrying the debate in this manner when there are still many outstanding issues that are not being considered.

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

Madam Speaker, I thank the hon. member for the question and for participating at the committee.

The Civil Marriage Act has been raised a number of times in this House today. I will speak to the Civil Marriage Act in terms of the specific provisions, which referred to specific religious officials and the performance of private functions. We are talking about medical assistance in dying, which is a public general function.

I will say that I embraced the discussions that happened at committee. There were 16 thoughtful amendments proposed. There is nothing in Bill C-14 that would compel a medical practitioner to perform medical assistance in dying. Of the amendments that were made, two of them inject conscience rights into the preamble, and as well within the legislation itself.

Health

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

Mr. Speaker, if that is true, that the government cares about palliative care, it should have told its members on the justice committee.

This week the justice committee shot down almost all opposition amendments on Bill C-14, including this one, “[that if someone] consulted a medical practitioner regarding palliative care options and were informed of the full range of options”.

Can the minister explain why Liberals shot down a very modest amendment requiring that patients simply be informed about palliative care options?

Opposition Motion—Freedom of conscience

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

Mr. Speaker, this is a deeply personal and complex issue, and we have sought to move forward and introduce Bill C-14, a piece of legislation that provides what we believe to be the best option for our country at this time. We have heard from a diversity of perspectives.

The object of this piece of legislation is in response to the Supreme Court of Canada's decision that said two things: one, that an absolute ban on medical assistance in dying in this country is unconstitutional; and, two, it placed upon Parliament the necessary ability and direction that Parliament put in place, a regime that ensures that we protect the personal autonomy of individuals while at the same time ensuring, as much as we can, protection for the vulnerable people among us. This also includes ensuring the conscience rights of medical practitioners.

We have put forward a bill that seeks to do that and that provides the necessary balance and response to the Supreme Court of Canada.

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Mr. Speaker, I thank the minister for attending and participating.

However, I think the minister is misleading the House. She stated that Bill C-14 enables autonomy and access to the majority of those requesting the right to assistance in death. In fact, the bill excludes a whole category of persons, including my constituent, John Tuckwell, who is suffering immeasurably under ALS and has been forced to go to the courts to get assistance in dying.

I wonder if the minister could qualify what she is saying about the majority who are seeking this assistance, who are suffering grievously, according to what the Carter decision has said, and why she is varying the section 7 charter rights of Canadians.

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

Mr. Speaker, I rise in this House to address the opposition motion concerning the conscience rights of health care professionals.

The motion directly relates to Bill C-14, a historic piece of legislation that would create a legislative framework governing the provision of medical assistance in dying.

I call this legislation historic because with its enactment, Canada would not only become one of the first jurisdictions in the world to permit medical assistance in dying, but also, even among this small group of countries, we would be one of the first that does so in the context of a federal system of government.

I am mindful of how important the issue of conscience rights is to health care professionals, as well as many groups who have made representations on their behalf.

In the Carter case, many of the intervenors who participated in the litigation raised the issue of conscience rights, including, as noted by the Supreme Court of Canada in paragraphs 130 and 131 of its decision, the Canadian Medical Association, the Catholic Civil Rights League, the Faith and Freedom Alliance, the Protection of Conscience Project, and the Catholic Health Alliance of Canada.

As the Supreme Court said clearly in its decision, nothing in the court's declaration would compel a physician to provide medical assistance in dying.

Following the Carter decision, the theme of conscience rights featured prominently in the consultations conducted by the federal external panel. Many individuals and organizations made submissions and participated in this process to ensure their perspectives on conscience rights were heard.

The panel's final report noted that while the medical profession is divided on how exactly conscience rights should be protected without compromising patient access, stakeholders were unified in the view that physicians' and other health care professionals' conscience rights must be respected and that those who choose not to participate must not face negative repercussions.

The report of the provincial and territorial expert advisory group which was released in December of last year shows that it also received significant input about, and carefully considered, the conscience rights issue.

When the special joint committee of the House of Commons and the Senate conducted its own study of medical assistance in dying in January and February of this year, conscience rights continued to be front and centre. Numerous witnesses raised it, and the issue was addressed in the committee's report.

Following the introduction of Bill C-14, I have closely followed the Standing Committee on Justice and Human Rights' study of the proposed legislation, as well as the Senate's pre-study, which have both heard significant evidence from many people and organizations about conscience rights.

For example, I am mindful that the House of Commons committee stakeholders were from various diverse backgrounds who held a broad spectrum of views on medical assistance in dying generally supported conscience rights. Individuals and organizations motivated by their faith traditions, including the Evangelical Fellowship of Canada, the Canadian Council of Imams, the Centre for Israel and Jewish Affairs, and Cardinal Thomas Collins all spoke eloquently about why the legalization of medical assistance in dying, which is intended to respect the charter rights of eligible patients, should not have the uncomfortable consequence of violating the charter rights of health care professionals.

Representations from professional organizations, such as the Canada Medical Association, the Canadian Pharmacists Association, the Canadian Society of Palliative Care Physicians, and the Canadian Medical Protective Association also emphasized the need for conscience rights protections not only through legislative measures, but also via a system that would ensure that the patient is not abandoned in his or her hour of need, and would connect the patient with willing providers.

Not everyone agrees on all issues that are posed in medical assistance in dying; however, there is general consensus that the conscience rights of health care practitioners must be taken into consideration as we introduce this practice into our society.

As the Minister of Justice and Attorney General of Canada, I want to express my sincere appreciation to each and every one of these persons and groups, as well as the members in this House who have been so vocal on the issue of conscience rights for contributing to a national conversation on medical assistance in dying.

I am keenly aware that it takes significant time, energy, and effort to prepare and present submissions, whether it is before the courts, consultative bodies, or committees. Rest assured their voices have been heard.

In a moment I will turn to the issue of how the government's approach to medical assistance in dying reflected in Bill C-14 respects the conscience rights of health care professionals and respond to the member opposite's motion.

First I want to take the opportunity to say a few words about the bill and how it respects all rights guaranteed under the charter, including conscience rights. I will say more about this when the bill is reported back by the committee for third reading debate.

At the Standing Committee on Justice and Human Rights as well as in the Senate as part of the legal and constitutional affairs committee's pre-study of the bill, parliamentarians heard from some who have expressed concerns that Bill C-14 falls short of complying with the charter. At the same time, we have also heard from other constitutional experts who have said that given the recent developments in the law, the bill is charter and Carter compliant.

Given all these diverse opinions, the key takeaway here is that nobody has a monopoly on interpreting the charter and nobody can predict with certainty whether a piece of legislation will some day be considered by the courts. Furthermore, many of those who seem certain that this law will be struck down do not acknowledge that Bill C-14 is not the same as the previous criminal prohibition that was struck down.

Let me be clear. This proposed legislation permits medical assistance in dying to an overwhelming number of those who are expected to seek it, namely, those who are nearing or who are at the final stage of life. Data from places where assistance in dying is lawful bear this out. Make no mistake that Bill C-14 would provide access to the vast majority of Canadians who would seek to access it.

At the same time that Bill C-14 permits access to the majority of those who would want it, it would not allow any and all Canadians to access it. It limits access in accordance with the legislative objectives that are stated in the preamble of the bill. These new legislative objectives were not part of the old law. Accordingly, the new legislative objectives change the charter analysis which has not been acknowledged by those who say that Bill C-14 will be struck down.

Even the justices of the Supreme Court themselves cannot pronounce on the constitutionality of legislation until they have a real case before them that is supported by a fulsome evidentiary record and submissions from counsel. This is especially true on issues as complex and sensitive as medical assistance in dying with so many different compelling, competing and important interests.

At the end of the day, the responsibility rightly falls to Parliament to enact a law that is consistent with the charter and which meets the needs of Canadians, striking a fair balance between all the diverse interests that are at stake. As the Supreme Court stated in Carter, any legislative regime will be shown a high degree of deference by the courts. In the context of medical assistance in dying, conscience rights raise distinct and nuanced constitutional issues.

First and foremost, it is critical to note that since the repatriation of the Constitution in 1982 and the enactment of the Charter of Rights and Freedoms, all statutes, whether they are adopted at the federal or provincial and territorial levels, must comply with the charter.

Indeed, as trite as it sounds, we must remember that charter rights do not come from provisions in a given law or regulation. They come from the charter itself. Nothing is gained by having an ordinary statute confirm or affirm charter rights. It is a recognized principle of statutory interpretation that courts should endeavour to interpret and apply laws in a manner that is consistent with the charter and its values.

Whether or not Bill C-14 or any other legislation that is proposed says something specific about charter rights, including conscience rights, it does not mean that such rights are not protected. On the contrary, as the charter is part of our Constitution and the supreme law of the land, such rights are always protected and can only be limited in accordance with the Constitution, such as under section 1 of the charter which allows for reasonable limits that can be demonstrably justified in a free and democratic society.

Therefore, strictly speaking, legislation does not need to restate rights that are already guaranteed in the Constitution, and nothing is gained in terms of charter protections by restating it from a legal point of view. However, in terms of public understanding, I do appreciate that legislative statements referring to charter rights can alleviate the comfort level of those who are affected by the law. I will say more about that in a moment.

Second, but equally important, legal consideration that informs how we must approach conscience rights is the other pillar of our constitutional framework, which has been with us since Confederation. Of course, I am referring to the division of powers between the federal and provincial governments.

When it comes to medical assistance in dying, the Supreme Court of Canada in Carter recognized that the division of powers was implicated when it said, in paragraph 53:

Health is an area of concurrent jurisdiction [and that] aspects of physician-assisted dying may be the subject of valid legislation by both levels of government, depending on the circumstances and the focus of the legislation.

In other words, while health might be, broadly speaking, an area of concurrent jurisdiction, the specific context still matters.

With respect to medical assistance in dying, the major federal authority to legislate in respect of health comes from the criminal law power. That power is concerned with preserving public safety as well as conveying norms about what conduct should attract the most serious sanctions available in our society.

In respect to medical assistance in dying, the main federal role is to ensure that legalization of the practice takes place in a manner that minimizes the risks to the vulnerable and that supports other crucial societal objectives, such as affirming the inherent value of all Canadians' lives, supporting suicide prevention, and promoting the maintenance of a just and peaceful society more generally. This is why Bill C-14 creates criminal law exemptions for medical assistance in dying so that health care providers can lawfully participate in the termination of human life while maintaining criminal prohibitions against such conduct in other situations.

In contrast, while the federal government administers some aspects of health care, for example, to first nations who have not assumed responsibility on reserve, and federal prisoners, provinces have primary responsibility for the delivery of health care and the regulation of professions, including health care professionals, such as physicians, nurses, pharmacists, and others. They also have responsibility for health care institutions, including hospitals. This is because things fall under matters either specifically addressed in section 92 of the Constitution Act of 1982, or are in respect of other provincial heads of power, including matters of a local or private nature in a province.

Federal laws, including amendments to the Criminal Code and other statutes, as proposed in Bill C-14, must respect this division of powers and not unduly interfere in provincial jurisdiction. To do so would be unconstitutional. It is for this reason that we as parliamentarians must be honest with Canadians about the limits of our jurisdiction and acknowledge that it would not be appropriate, for example, to attempt to directly regulate what hospitals or provincial professional regulators can or cannot do with respect to conscience rights. To do so would be misleading to health care providers and to Canadians.

With that said, this does not mean that we cannot address conscience rights in Bill C-14. It just means that we have to do it in a manner that respects the Constitution.

As introduced, the preamble of Bill C-14 included language about respecting the convictions of health care providers. However, it was obvious that many people did not find that reference in the preamble to be adequate and were seeking more precision.

Of course, our government wants all Canadians to have comfort, as much as they can, with Bill C-14. Therefore, I am pleased to report, as has been reported today, that members of the Standing Committee on Justice and Human Rights worked diligently and collaboratively to amend Bill C-14 to indicate Parliament's intent with respect to conscience rights, while also ensuring compliance with the division of powers.

The committee amended the preamble to specifically recognize that everyone has freedom of conscience and religion under section 2 of the charter and that nothing in the act would affect the guarantee of freedom of conscience and religion. The committee also amended the body of the bill so that in the most critical section of the Criminal Code, that law would state, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” I certainly welcome these amendments.

There are a few important features of the amendment to the body of the bill that I believe are worth highlighting.

First, it is prefaced with the expression “for greater certainty”, which is legally important because, as I mentioned earlier, it helps remind the reader that the source of conscience rights is in the charter, not the provision that would be inserted in the Criminal Code.

Second, the new provision explains that nothing compels an individual. That language clearly communicates that while it is true that Bill C-14 would remove the criminal prohibition against medical assistance in dying in certain defined circumstances, such a change to the Criminal Code would not impose any positive duty that did not exist in the law before. It is not this change to the Criminal Code that would make medical assistance in dying a form of health care. It would only open the door to it. It is also consistent with the framework for medical assistance in dying put forward in Bill C-14, which is, as I have mentioned, a new set of criminal law exemptions from various offences that would now permit conduct that used to be illegal, in order to give effect to the Supreme Court's ruling in Carter. We must remember that what the Carter ruling did was to find those criminal prohibitions to be unconstitutional.

Third, the language in the new provision specifically indicates that nothing would compel an individual to provide or participate in providing medical assistance in dying. As all members are aware, charter rights belong to all Canadians, not just physicians, nurse practitioners, or pharmacists. By using the word “individual”, the provision is clear that the bill would not impose any new positive duty on anyone, including but not limited to those health care professionals who provide or participate in providing medical assistance in dying. At the same time, this new provision added by the committee would not interfere with the division of powers, nor would it encroach on the jurisdiction of provincially regulated entities.

In terms of working together, since the Carter decision, one thing that we have consistently heard from many individuals and organizations who have spoken about conscience rights is the need for there to be real, practical solutions to the problem of palliative care. The Minister of Health has emphasized, and I agree with her, that non-legislative measures can act in tandem with Bill C-14 to ensure the charter rights of everyone involved, and that they can be respected.

This is why the government has announced its commitment to work closely with the provinces and territories to put in place a system that will connect willing providers to patients who qualify for medical assistance in dying. This is in line with the long-standing Canadian tradition of co-operative federalism, which is about each level of government working together while also respecting their respective jurisdictions. I am confident that this system will meet the access needs of Canadians and play an important role in ensuring that health care professionals can continue to care for their patients in a manner that is consistent with their beliefs and their values.

The motion from the member opposite is well intentioned. It speaks to rights and values that are important to many Canadians, particularly as they pertain to medical assistance in dying. However, I cannot support it. As amended, Bill C-14 would appropriately respond to all the important considerations that surround medical assistance in dying, including enabling autonomy for persons who choose a peaceful death, protecting vulnerable persons, affirming the value of the lives of all Canadians, and respecting the charter rights of health care professionals. The bill would respect these rights in a manner that is consistent with our constitutional framework. Unfortunately, the motion from the member opposite would fail to meet a similar balance, and I will not be supporting it.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Mr. Speaker, I would just like to ask the member what she might think about the charter compliance of Bill C-14, which we are talking about today, the compliance with the Supreme Court decision, and whether it might save a lot of taxpayer money if the government referred the bill directly to the Supreme Court.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Mr. Speaker, I am speaking today to compel the House to ensure the protection of the freedom of conscience of a medical practitioner, nurse practitioner, pharmacist, or any other health care professional who objects to taking part, directly or indirectly, in the provision of medical assistance in dying.

I would like to introduce everyone to Os Guinness, an author, a social critic, and a member of RZIM speaking team. The great-great-great-grandson of Arthur Guinness, the Dublin brewer, he was born in China in World War II, where his parents were medical missionaries. A witness to the climax of the Chinese revolution in 1949, he was expelled with many other foreigners in 1951 and returned to Europe, where he was educated in England. He completed his undergraduate degree at the University of London and his doctorate in philosophy in the social sciences at Oriel College in Oxford. I say that to give him the credibility he deserves.

He has said, “Freedom of conscience has always been understood as the first right”. In a world ravaged by conflict, there is real threat to human dignity. Dr. Guinness proposes that the way forward is through engaging in the civil public square, where freedom of conscience and religion are promoted for all people, where we can disagree respectfully, where the right to free expression by all human beings is recognized.

In Canada, everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms. No one has the right to demand all services from all providers in all circumstances.

The Coalition for HealthCARE and Conscience represents more than 100 health care facilities, with almost 18,000 care beds and 60,000 staff, and more than 5,000 physicians across our country. They represent several like-minded organizations committed to protecting conscience rights for health practitioners and institutions.

Members of this coalition include the Catholic Archdiocese of Toronto, the Christian Medical and Dental Society of Canada, the Catholic Organization for Life and Family, the Canadian Federation of Catholic Physicians' Societies, the Canadian Catholic Bioethics Institute, Canadian Physicians for Life, and the Catholic Health Alliance of Canada. I echo their concern that Bill C-14 does not protect the conscience rights of health care workers or facilities that morally object to performing or referring for what is being referred to as medically assisted death.

No other foreign jurisdiction in the world that has legalized euthanasia or assisted suicide forces health care workers, hospitals, nursing homes, or hospices to act against their conscience or mission or values. Coalition member and executive director of the Christian Medical and Dental Society of Canada Larry Worthen says, “These conscience rights must be preserved”, and I agree.

A recent Nanos Research poll found that 75% of Canadians agree that doctors should be able to opt out of offering assisted dying, compared to 21% who disagree. The Canadian Medical Association indicates that approximately 70% of Canadian physicians do not want to participate in any way in assisted death and euthanasia, and 30%, approximately 24,000 Canadian physicians, would participate.

In no way should a physician, nurse, pharmacist, or any other health care professional be intimidated or coerced into taking part directly or indirectly in assisted suicide or euthanasia. In the same way, neither should they face dismissal or discrimination in hiring for exercising their freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms.

Like the Coalition for HealthCARE and Conscience, I support the right people have to accept, refuse, and/or discontinue the use of life-sustaining treatment and allow death to occur. I, too, also hold strong moral convictions that it is never justified for a physician to help to take a patient's life under any circumstances. Our health care workers journey with those who are sick and suffering every day and they will continue to do so in a caring and compassionate way. They help patients at the end of life. What they object to is ending their lives.

As I indicated in my first speech in the House of Commons on Bill C-14, we need to and can significantly reduce the number of people who see death as the only possible option to end their suffering by improving medical, palliative care, and social services. As a small but mighty example, I learned at the World Red Cross Day celebration here on the Hill that my local Red Cross received ongoing funding to continue a seniors visitation program for the lonely and elderly through the new horizons for seniors program. When they are not called out to deal with a disaster, these amazing volunteers invest in the quality of life of our elderly.

“Our worth as a society is measured by the support we give to the vulnerable,” says Worthen. “We need increased access to palliative care, chronic disease and mental health services to help individuals who are suffering across the country.”

I truly believe that we have made a very grave error in putting Bill C-14 ahead of a significant palliative care initiative.

I am proud to stand here today, on behalf of my own physician in my hometown of Esterhazy. She is an amazing doctor who takes deep personal interest in her patients. She has invested in continued and specialized training to care for the elderly. I am so grateful that she is my father's physician, who has Alzheimer's. Under no circumstances should she, or any other doctor, be required to assist an individual in taking their own life.

I am standing here today, as a member of Parliament in the Government of Canada, to advocate on behalf of the rights of health care providers. As legislators, our first responsibility is to advocate for the vulnerable and for conscience protection. This is foundational in the Canadian Charter of Rights and Freedoms. Without this protection, we lose our freedoms and our democracy. We have a responsibility to respect the conscience rights of our physicians and health care professionals who choose not to participate in assisted suicide and euthanasia.

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

Mr. Speaker, the member who proposed the motion was present at many of the hearings of the justice committee on this matter. The original draft of Bill C-14 did not have any reference to conscience rights, except in the preamble.

Each party had a proposal to put wording around conscience rights, and quite frankly, it was Parliament at its best to see representatives of the Conservative Party, the New Democratic Party, and the Liberal Party huddle and come up with wording upon which they could all agree.

That wording has been amended in the bill, and here we are with an opposition day motion that seeks to subvert that all-party agreement by presenting a motion like this in Parliament. Furthermore, that all-party agreement resulted in a unanimous vote amending the legislation, as the hon. member pointed out.

I have two questions for the member. Number one, why does he seek to subvert the will and the agreement of the Conservative members of the justice committee? Second, when the department was asked about this particular provision, Joanne Klineberg from the Department of Justice said:

...the view of the department is that this would be outside [the scope of] Parliament's jurisdiction. The provinces have the competence jurisdictionally to legislate on this, and likely it would be invalid federal law.

Does the hon. member have an opinion contrary to that of the Department of Justice that would give us some faith in this?

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

Mr. Speaker, I will be splitting my time with the member for Yorkton—Melville.

I am thankful for this opportunity to speak to the motion before us today. The motion declares that it is in the public interest to protect the freedom of conscience of health care professionals when it comes to medical assistance in dying; and that everybody has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms; and that a regime that would require health care professionals to make use of effective referral of patients could infringe on the freedom of conscience; and that the government should support legislation to protect the freedom of conscience of health care professionals.

It is the federal government's duty to provide legislation that would protect conscience rights of medical practitioners. With respect to the rights of Canadians, it is also the government's duty to protect and preserve our health care system.

Fundamental freedom of conscience is listed alongside other fundamental freedoms we also take for granted here in Canada, such as the freedom of religion, freedom of thought, freedom of belief, freedom of expression, freedom of the press, freedom of peaceful assembly, and freedom of association. Fundamental freedoms are not negotiable. They cannot be tossed aside if they are deemed by some to be inconvenient. Canada is not a dictatorship or a tyranny.

I know from comments made in the House and at committee that all members here are concerned about conscience rights. When Parliament has been faced with balancing conscience rights in the past, it has always strongly supported conscience rights. For example, in the Civil Marriage Act, it clearly states “no person or organization shall be deprived of any benefit, or be subject to any obligation or sanction” when exercising their fundamental charter rights of freedom of conscience.

We can establish a framework that supports patient rights for end of life and supports conscientious objection. The problem is that Bill C-14 would not legally protect conscience rights. If Bill C-14 comes into force, it would immediately put the charter conscience rights of health care professionals at risk and ultimately undermine our health care system.

The government will argue that Bill C-14 was amended at justice committee this past week to prevent health care professionals from being compelled to participate in medical assistance in dying. The amendment made at committee states, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying”.

Let me be clear. The amendment made at the standing committee to Bill C-14 offers no legal protection to health care providers who feel that any involvement in medical assistance in dying goes against their conscience and their profession.

Just because Bill C-14 presently states that nothing in this specific section of the Criminal Code can compel health care professionals, it does not mean that any other entity still cannot compel or coerce a health care provider against his or her conscience rights. For example, an employer could insist upon it or a provincial health care regulatory body could as well.

Health care professionals have been clear that protecting their conscience rights means that health care professionals should never be required to refer patients, provide medical assistance in dying, or be discriminated against for their beliefs or conscience on medical assistance in dying.

During the Supreme Court of Canada hearings on the Carter case, the Canadian Medical Association expressed that “any legislative scheme must legally protect both those physicians who choose to provide this new intervention to their patients, along with those who do not”. Bill C-14 does not offer legal protection.

At committee, Conservatives put forward strong amendments to legally protect health care professionals' conscience rights and they were rejected by the government.

If Bill C-14 passes without legal protections for health care providers' conscience rights, Canada would be the first jurisdiction in the world that legalized assisted suicide without a robust conscience clause for health care providers.

It is also important to recognize that without federal government direction on conscience rights, Canadians and health care professionals would be faced with a patchwork approach, which is not what the Supreme Court of Canada intended. For example, the College of Physicians and Surgeons of Ontario is insisting on an effective referral system. This poses an immediate problem for those doctors who are conscientious objectors and are forced to choose between a career and conscience when this legislation comes into effect.

On Wednesday the Senate heard testimony from the Coalition for HealthCARE and Conscience, an organization and coalition that represents 5,000 physicians, 110 health care facilities, and 60,000 staff in the health care profession.

They expressed grave concern that Bill C-14 offers no legal protection for conscience rights of health care professionals. They were concerned that health care professionals might re-evaluate their career choice.

They stated:

Through our discussions with the provinces, we know that it is unclear whether, in fact, they will decide to legislate. In this legal vacuum, hospitals, colleges, provinces, health authorities, nursing homes and hospitals can create policies that will encroach on the constitutional rights of caregivers. This will create chaos. For example, while one medical college, the CPSO, is requiring referral, at least seven others have already indicated they will not.

It is clear that a patchwork approach to issues like referrals and medical assistance in dying will take place. It is within this legal vacuum that health care professionals will face discrimination, because Bill C-14 would not legally protect conscience rights. This type of situation would not only harm a society but would also harm a health care system. Health care professionals expressed that they would have to make the difficult decision to leave their profession if we fail to protect freedom of conscience rights.

Dr. Sephora Tang, who is an Ottawa psychiatrist, shared with the Senate committee on Wednesday her concerns about the lack of protection in Bill C-14.

She stated:

It is very difficult for me, as a professional physician and psychiatrist, to say that some of my patients I should be referring to medical aid in dying.... With the whole issue of conscientious objection, it's almost as though my professional judgment has been stripped.... If we do not have legislation that allows me to practice according to my conscience, this time that I have with my patients to work with them will be truncated, and I feel to their detriment and to the detriment of the families and friends of the patient that are left behind, and also to the individual health care professionals and the team members who work with this patient as well.

Dr. Matthew Meeuwissen, an emergency doctor from Stony Plain, Alberta, also expressed this opposition to medical assistance in dying. He said that the act of helping a patient to find a physician to assist in suicide is nothing short of complacency in killing vulnerable people. He said, “As a physician, I am not aware of any medical condition where killing my patient is an effective treatment”.

There are many more health care professionals who hold similar views and face ultimately between choosing for their conscience or their work. These health care professionals journey with those who are suffering and sick every day. They help patients at the end of life but object to ending their life.

The Hippocratic Oath rightly recognizes this element of our nature. Health care professionals take an oath stating they will remember that there is art to medicine as well as some science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

Freedom of conscience for all health care professionals must be protected. Hope, a constituent in my riding, sent me an email recently stating:

Conscience Rights are a protected freedom under the Charter of Rights and should NOT be violated. Saying this it should be clearly stated that healthcare providers can refuse to perform or refer for physician assisted suicide on the grounds of conscientious objections. Do not trammel the rights of one group for the perceived rights of another.

A majority of Canadians agree with Hope. A recent Nanos Research poll showed that 75% of Canadians agreed that doctors should be able to opt out of offering assisted dying, compared with 21% who disagreed. Even the Canadian Medical Association noted that approximately 70% of Canadian physicians do not want to participate, directly or indirectly, in assisted suicide.

Freedom of conscience rights must be given a priority, as in the charter. The government should strengthen Bill C-14 by adding codified protections for conscience rights as anticipated in Carter, similar to the recognition of conscience and religious rights in the Civil Marriage Act. This would be accomplished by adding an offence to intimidate or coerce health care professionals to take part, directly or indirectly, in assisted suicide or euthanasia.

The government should also make it an offence to dismiss from employment or to refuse to employ health care professionals if they refuse to take part, directly or indirectly, in assisted suicide or euthanasia.

If freedom of conscience rights for health care professionals is not protected, the rights of a few will trample the charter rights of those who have dedicated their lives to helping us heal and live healthy lives.

I hope the government will support this motion and ultimately act to legislate real protection for health care professionals on medical assistance in dying.

[Gord Brown, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Mr. Speaker, I would like to say that we would support more time to debate Bill C-14, but we ask to amend the motion that the members sit no later than midnight, at which time the House would adjourn.

Business of the House

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, this afternoon, we will continue with the Conservative opposition day. Tomorrow will be a further allotted day. Monday, we will begin report stage and third reading stage of Bill C-10 concerning Air Canada until 2 p.m. After question period, we will move on to Bill C-14 concerning medical assistance in dying.

I have had productive and optimistic discussions with my colleague House leaders. I am hopeful and optimistic that we will have an agreement on the handling of the debate at report stage and third reading of Bill C-14 next week.

Provided we are able to complete debate on Bill C-14 next Wednesday, the House will debate an NDP opposition motion on Thursday.

Finally, pursuant to Standing Order 81(4), I would like to designate Monday, May 16, for consideration in a committee of the whole of the main estimates for the Department of National Defence.

Justice and Human Rights

[Anthony Housefather, Liberal, Mount Royal, QC]

Mr. Speaker, I have the honour to present, in both official languages, the second report of the Standing Committee on Justice and Human Rights, in relation to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

The committee has studied the bill and has decided to report the bill back to the House with amendments.

[Ted Falk, Conservative, Provencher, MB]

Bill C-14 is called medical assistance in dying, but make no mistake, Bill C-14 is physician-assisted suicide.

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

Bill C-14 clearly goes beyond this Supreme Court decision, with a mandate to study making physician-assisted suicide available to mature minors, advance directives, and mentally disabled individuals. This committee heard testimony from approximately 42 individuals and/or groups who have a vested interest in this issue, in addition to officials from the justice department and the Minister of Justice and the Minister of Health.

Over 100 amendments were presented to committee, based on evidence from witness testimony that was provided to committee. Sadly, the government did not present, and in fact voted against, any meaningful amendments. The Conservatives presented many thoughtful amendments that would have strengthened the bill and added important safeguards. This is a missed opportunity.

Let me highlight a few of these missed opportunities. These amendments included assuring that only fully trained and qualified medical practitioners would assess the individual and administer the lethal cocktail that would procure death. We also provided an amendment that would remove psychological suffering as an eligible consideration for physician-assisted suicide. We also suggested that “reasonably foreseeable death” should be replaced with “imminent” or at least “expected death within 30 days”.

Insofar as safeguards, we presented amendments that when a person is self-administering suicide, a physician would be required to be present. We also presented an amendment where we thought judicial review... to ensure that all criteria for physician-assisted suicide eligibility had been met. We also presented an amendment where palliative care consultation, including awareness of all the options and ensuring that palliative care access was available and offered.

We also presented an amendment that would require psychiatric examination to confirm capacity to consent, when mental health was a factor. We also had an amendment that would require reasonable proof that all the criteria had been met, and not just an opinion to that extent.

Finally, we presented an amendment to Bill C-14 that would have provided meaningful conscience protection for individuals and institutions that do not want to participate in the killing of human beings for reasons of conscience and/or religious beliefs. We got a weak compromise.

Regrettably, Mr. Chairman, these opportunities based on evidence from the testimony and interventions of committee witnesses have been forfeited. Bill C-14 is a bill that could have been and should have been better and a bill that I can't support.

Report Stage

[Ali Ehsassi, Liberal, Willowdale, ON]

Mr. Speaker, I am grateful for the opportunity to rise today to speak to Bill C-7 and our government's response to the Supreme Court of Canada's decision.

I would like to thank all of the members who have contributed to this important debate. I particularly would like to thank the Standing Committee on Public Safety and National Security for their hard work on this file, as well as the President of the Treasury Board for introducing this very timely legislation.

Two months ago, a horrific event took place when an assailant approached the armed forces recruiting detachment in my riding of Willowdale and injured two members of our armed forces. Along with local police, the leadership, professionalism, and expertise of the RCMP were instrumental in resolving the situation.

Our government is proudly committed to supporting the brave men and women of the RCMP, and I believe that the bill demonstrates our unwavering support for one of Canada's proudest institutions.

Last week, members of the House contributed to the debate surrounding Bill C-14, another important piece of legislation catalyzed by a Supreme Court decision. I am proud, once again, that our government is heeding a Supreme Court decision in an appropriate and balanced manner.

As my hon. colleague from the riding of Montarville stated on Monday:

In its decision that found the previous labour-relations regime unconstitutional, the Supreme Court determined that the staff relations representative program, which was imposed upon RCMP members, violated their charter rights because it did not allow members any option for representation, nor did it provide an effective mechanism for dispute resolution.

Fundamentally, the proposed legislation would provide RCMP members and reservists with a process to choose their representatives, as well as the process by which they may independently and collectively pursue their workplace interests and objectives. Doing so would allow the RCMP to more effectively negotiate in regard to arbitration, unfair labour practices and grievances, and many other issues.

Recognizing that the RCMP is part of the federal government, Bill C-7 would extend to members exclusions that already apply to most other public servants, such as staffing, pensions, organization of work, and assignment of duties. The RCMP had previously been excluded from collective bargaining rights available to public service employees. The labour relations regulations did not provide a forum to address wage issues, lacked independence, and generally provided RCMP members with limited collective bargaining options.

Bill C-7, therefore, would not only ensure the constitutionality of our laws, but finally bring the RCMP within a recognize bargaining framework from which they have too long been excluded. Bill C-7 would align the RCMP's labour relations regime with that of other federal public servants, the provisions of which have been in place for over 40 years. In fact, the RCMP is the only police force in Canada without a collective agreement. The government has committed to working closely with our provincial and territorial partners, and the bill would bring RCMP labour relations in line with the standards in place at other levels of government.

We believe that strong internal regimes already exist to deal with the aspects of the collective bargaining process not explicitly dealt with by Bill C-7. For example, the RCMP pension advisory committee serves to administer, design, and fund member pension benefits. Labour-management relations committees are in place to deal with workplace conduct issues. Occupational health and safety committees help ensure the safety of RCMP employees. The Royal Canadian Mounted Police Act and subsequent regulations establish internal recourse procedures, while the Public Service Labour Relations Act provides a regulatory framework for more technical matters.

We believe, therefore, that Bill C-7 would be a strong addition to the existing regimes governing the RCMP and its members, including internal policies and practices. Bill C-7 recognizes the important role of the RCMP as Canada's national force for ensuring the safety and security of Canadians.

Our government is committed to listening and engaging with Canadian on the issues that matter to them most. As with all legislation introduced by our government, Bill C-7 has benefited from in-depth consultations with those most likely to be impacted.

The consultation process was led by an independent third party, Mr. Alain Jolicoeur, who engaged extensively with not only the RCMP but with labour groups and other provincial and territorial partners to ensure that the proposed legislation is well rounded and pragmatic. I am proud to report that more than 9,000 regular members completed the survey and over 650 people participated in town hall sessions.

In a recent survey of RCMP members conducted by the independent consultant during the summer of 2015, most respondents expressed their support for the type of framework that has been put forward for the consideration of the House. We feel that the legislation responds appropriately to the Supreme Court's decision, recognizing the primacy of public safety and the crucial role the RCMP provides.

Bill C-7—Time Allocation Motion

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, it is breathtaking that in fewer than five legislative days, the government has delivered a series of body blows, bruising the democratic process in the House.

First it imposed closure on Bill C-14 before a full two-thirds of the official opposition had a chance to speak to a piece of proposed legislation that is clearly deficient and would not meet the direction of the Supreme Court. It is not being materially improved in committee.

Today the government stacked a committee on electoral reform and renewed its pledge to deny Canadians the democratic right to vote in a referendum on such an important and fundamental process in our democracy.

Now the minister is seeking to justify closure on this legislation, on the importance of the secret ballot, by saying that 34 members of the House have spoken in debate. That is less than 10% of House membership.

I am wondering if the minister realizes what an appalling track record his government has set in such a brief period of time.

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

Thank you very much, Madam Chair.

I'm happy to present and speak to the amendment for Bill C-10, which is, of course, an act to amend the Air Canada Public Participation Act and other measures.

My amendment is quite short. Everyone has had a chance to read it, but I will read it into the record. I move that Bill C-10, in clause 1, be amended by adding after line 20 on page 1 the following:

(5) Subsection (4) does not come into force before August 1, 2016.

If I could boil down to a single point the reason for my amendment, it would be the following, and my colleague has already alluded to it. It would be the rush in getting this legislation through Parliament. Too many questions and concerns remain unanswered for my colleagues on this side of the table and me.

First, why is the government so intent on getting this bill passed before the summer break? We've heard from the witnesses that there are no legal or technical reasons for rushing this legislation forward. Why was time allocation used for the very first time in Parliament to send this legislation to committee after two days of debate? Why did the government side stop putting up speakers during second reading shortly after 3 p.m. on the second day of debate, after just a few Liberal members had given speeches and taken questions from opposition members? The day after Bill C-10 was introduced in Parliament, the Minister of Transport responded to a question by saying that, and I quote, “The member...should be delighted for Canada.” It's difficult to see how Canadians could be delighted about this bill considering so few Liberal members could even get enthusiastic enough to defend their minister's legislation in Parliament, on the record, and take direct questions from members opposite.

Is Bill C-10 so important that there was only time to allow a few members to debate this legislation during second reading? Does Air Canada's competitiveness hinge on the prompt passage of this legislation in the House of Commons and the Senate?

In our opinion, the government has not made its case as to why this legislation must receive royal assent before Parliament rises for the summer. This legislation was introduced as a response to the litigation Air Canada was facing, and we heard that many times from the minister, because according to the Attorney General of Quebec and the Attorney General of Manitoba, the carrier wasn't fulfilling its obligations under the Air Canada Public Participation Act. The courts sided with the provinces on two occasions. The Minister of Transport confirmed this during the first question period after Bill C-10 was introduced, and I quote:

As a result of the decision by the Quebec government and Manitoba government not to litigate any further against Air Canada, we felt this was an appropriate time to clarify the law and modernize it so that Air Canada can compete with the rest of the world.

I think we've all heard testimony over the past three meetings and understand that there is no agreement between Air Canada or the Government of Quebec, nor between Air Canada and the Government of Manitoba. The minister is either poorly informed or just twisting the facts. The facts are clear. Case 36791 is presently on leave to appeal in front of the Supreme Court until July 15, 2016. Counsel for Air Canada is Norton Rose Fulbright Canada LLP; counsel for the Attorney General of Quebec is Noël and Associates; and counsel for the Attorney General of Manitoba is Woods LLP.

What is taking place right now is a negotiation between parties, and like all negotiations between parties during litigation, the intention is to settle by finding a mutually agreeable outcome. Parties do not negotiate unless they are willing to settle.

In the case of Quebec, the reasonable settlement appears to be the purchase of the C Series aircraft, and a commitment to undertake that C Series maintenance in Quebec and to create a centre of excellence in the province.

In the case of Manitoba, the reasonable settlement appears to be the transferring of approximately 150 jobs from other places in Canada to the provincial capital. We should be under no illusion that these negotiations are complete. Air Canada hasn't even converted its letter of intent for the C Series into a firm order yet.

There are no new centres of excellence in either Quebec or Manitoba. The Minister of Transport has not provided Parliament with any documentation on when these commitments will be met, or when this lawsuit will be dropped.

I would submit that it's clear from the testimony and from the briefs we have received that neither Quebec nor Manitoba have documentation supporting these settlement discussions. The minister for the economy of Quebec made it quite clear in the brief that she submitted to this committee that the lawsuit was still ongoing, and I'll read the relevant part of her brief into the record: “Pending the conclusion of final agreements, the Government of Quebec has agreed to drop its lawsuit in relation to Air Canada's obligations to have an overhaul and maintenance centre.”

The Deputy Premier of Manitoba also made that quite clear in her testimony, saying that the federal government's approach to Bill C-10, simply put, is “jumping the gun”. Bill C-10 is being rushed through the process before the necessary specific investments and binding commitments by the federal government and Air Canada have been secured.

I don't think this point has been made clear enough, so I'd like to get it on the record. The Government of Quebec, with the Government of Manitoba as an intervener, brought Air Canada to court to challenge the carrier's assertion that it was fulfilling its obligations under the Air Canada Public Participation Act. The Quebec Superior Court ruled in 2013 that Air Canada had not fulfilled its obligations under the Air Canada Public Participation Act. The Quebec Court of Appeals ruled on November 3, 2015, that Air Canada had not fulfilled its obligations under the Air Canada Public Participation Act.

Two months later, on January 5, 2016, Air Canada asked the Supreme Court, Canada's top court, to overturn the Quebec Court of Appeal's decision. If the clause pertaining to aircraft maintenance of the Air Canada Public Participation Act does not exist, the case of Attorney General of Quebec v. Air Canada would become moot in the eyes of the Supreme Court. If there is no law to which Air Canada can be held in terms of undertaking overhaul maintenance in Canada, the carrier cannot be challenged in court on this matter.

Air Canada likes the C Series airplane. They made that clear during their appearance last week, but as recently as January 5, Air Canada's plan was to appeal the Quebec Court of Appeal's decision to the Supreme Court.

Something changed, and Air Canada decided that it was better off settling these lawsuits than pursuing this matter in front of the Supreme Court. Whether the federal government was somehow involved in this change of heart is unknown, beyond a statement by Air Canada's representative indicating that it is acting under the assumption that the section of the Air Canada Public Participation Act we are discussing right now would be repealed. If it wasn't repealed, Air Canada would have to consider its next steps.

The maintenance provision of the Air Canada Public Participation Act mentions three parties: the City of Winnipeg, the Montreal Urban Community, and the City of Mississauga. Air Canada is named in the title of the bill. Obviously, the Montreal Urban Community doesn't exist anymore, but the provincial governments of two of these three areas are presently engaged in a legal challenge on this very act. I think it is very odd that the government is in the process of changing a law in which three-quarters of the parties mentioned in the law are in litigation challenging each other on this very law. This amendment would give these parties more time to negotiate and come to a mutually agreeable compromise.

I want to move on.

On February 17, 2016, Air Canada announced that it had signed a letter of intent to purchase the Bombardier C Series aircraft and maintain these in Quebec. On the same day, the Minister of Transport announced that he would lessen Air Canada's obligations under the Air Canada Public Participation Act. Between the time that Air Canada announced it would challenge the Quebec Court of Appeal's ruling in the Supreme Court, and the Minister of Transport's announcement that he would lessen Air Canada's maintenance obligations under the act, the carrier's representatives met with the Minister of Transport and the Prime Minister's Office at least five times.

According to the Lobbying Commissioner's database, these meetings took place on January 8, January 22, January 27, February 3, and February 15, 2016. When the minister came to committee last week, I asked him about these meetings and for any briefing notes that were prepared for these meetings, but to date I have not received any. He seemed reasonably willing to provide these during committee, contingent upon receiving the dates that were in question. I have provided the dates, and followed up on this request during question period, but was then told by the minister that I was on a fishing trip.

First, we are told that recommendations from the minister's department made their way into the bill. Then we were told we could have these documents. Then I was told I was on a fishing trip when trying to get the very documents that the minister, himself, told me existed.

This bill is one clause. I cannot imagine that a mountain of paperwork would be sent to the committee on this request, so I am disappointed not to be able to see the original work product that informed Bill C-10.

I do have a number of access to information requests out to Transport Canada, but as you can imagine I haven't received any responses yet. Access to information requests take months to be responded to, and more often than not any advice to ministers is blacked out. Considering this legislation was first introduced on March 22, the government's rush to pass Bill C-10 ensures that any documents from Transport Canada that don't support the minister's decision, or any documents, for that matter, won't see the light of day before this bill receives royal assent.

These documents are important because there are just too many loose ends for anyone to believe that a clear policy development process was undertaken at Transport Canada, with options to make Air Canada more competitive presented to the minister and his team. There are dozens of policy options that the minister could have considered to make Air Canada and the entire aerospace sector more competitive, but without having seen these, we can't scrutinize the decision.

If my amendment is accepted, I'm hopeful the government will be willing to use the extra time before Bill C-10 becomes law to share with parliamentarians the recommendations of the transportation department that informed this bill. The need for this reform was not included in the Liberal campaign platform. Actually, Air Canada, or its competitiveness, was not even mentioned. The Minister of Transport cannot claim that he has a mandate from the Canadian electorate to get this bill passed so quickly. The government has not been asked by the Supreme Court to pass this legislation, as was the case with Bill C-7, an act to amend the Public Service Labour Relations Act or Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying). This bill has nothing to do with the budget. If Air Canada is negotiating in good faith with the Government of Quebec and the Government of Manitoba, then this bill doesn't need to pass so quickly because Air Canada won't face further legal challenges. If Air Canada is not negotiating in good faith with the Government of Quebec and the Government of Manitoba, then this bill shouldn't pass, because the Air Canada Public Participation Act, in its current form, remains the main tool of those provinces to get Air Canada to the table to negotiate.

If this legislation doesn't pass, there will be no legal vacuum. Employment levels in both provinces will remain the same. Effectively, the status quo will remain. If the legislation doesn't pass right now, but does so in a few months, the new government in Manitoba will be able to work with the Minister of Transport, the Minister of Natural Resources, and the Minister of Employment and Social Development to ensure that this legislation meets the province's expectations.

This amendment that I am proposing today goes some way to fulfill the very reasonable request from the Government of Manitoba and the Government of Quebec to wait until they settle their lawsuits before passing this bill, by stipulating that this bill not come into effect before August 1, 2016. My preference would have been to propose an amendment that would have stipulated that this legislation would come into effect only when the Attorney General of Quebec and the Attorney General of Manitoba have communicated with the Attorney General of Canada that they have concluded their litigation against Air Canada, but I was informed that according to procedure, and I quote:

An amendment to alter the coming into force clause of a bill by making it conditional, is out of order. This type of amendment goes beyond the scope of the bill and is an attempt to introduce a new question into the bill.

Because the process of negotiating a settlement is always conditional on both parties compromising, no amendment on Air Canada meeting its settlement commitments can be admissible, and I am forced to settle on the language I am proposing. This amendment is not perfect, but it does give the Government of Quebec and the Government of Manitoba more time to negotiate and settle their litigation against Air Canada. It gives the Government of Quebec and the Government of Manitoba more time to see progress from Air Canada in terms of fulfilling the terms of their settlements. With Bill C-10 coming into force at a later date, Air Canada will have, at a minimum, turned its letter of intent to purchase the 45 C Series aircraft into a firm order.

Quite frankly, I really can't see why all members wouldn't support this proposed amendment. For a party that loves to repeat, at every opportunity, that it wants to work hand in hand with the provinces and municipalities, this unilateral action on the part of the federal government gives me the impression that Liberal campaign promises are not worth the paper they are written on.

As my colleague, the member from Mégantic—L'Érable, has pointed out, and it bears repeating, it's very rare that provincial ministers intervene and comment on federal legislation. Yet in this case provincial ministers from two different parties have both made their concerns known, and have asked that BillC-10, an act to amend the Air Canada Public Participation Act and other measures, come into force only upon their concluding their litigation against Air Canada.

The deputy premier of Manitoba, who also serves as Manitoba's attorney general, couldn't have been more clear. I think I already made this point, but I'll make it again, that the federal government's approach to Bill C-10 simply put is jumping the gun. Bill C-10 is being rushed through the process before the necessary specific investments and binding commitments by the federal government and Air Canada have been secured.

Every single member here was able to follow up with Minister Stefanson, and not a single member questioned her statement asserting that litigation had not yet been concluded, or that this bill wasn't being rushed. I expect the Liberal members will tell us that we should just trust the Minister of Transport and the assurances that he has given the committee.

I'll take the opportunity to quote the minister here, because his statement was telling: “My discussions lead me to think that they are very serious, and the commitment is firm.” Without documents to support this statement, I find this statement very problematic.

Just two days after he made that statement, Air Canada came here, and they were also very clear. When asked about whether the purchase of the C Series aircraft and the creation of the centres of aircraft maintenance in Quebec were conditional on this federal legislation getting passed promptly, Air Canada's representative said, “we are operating on the assumption that the act will be amended pursuant to this process. If that doesn't happen, we will assess the decision at the time.” I think it's worth repeating the last sentence: “If that doesn't happen, we will assess the decision at the time.”

My friend from Niagara Centre asked the Attorney General of Manitoba whether she thought a centre of excellence would be beneficial to her province. This question seemed to imply that, should this legislation not get passed as quickly as the government wants, Manitoba would not benefit from Air Canada moving some of its operations to the province, and perhaps creating a smaller western Canadian centre of excellence in aircraft maintenance.

A centre of excellence is a concentration of aircraft maintenance operations, and more broadly, a concentration of aerospace companies. When a major company like Air Canada chooses to get a significant part of its maintenance work done in one specific location, a large number of firms do set up shop there in order to service the airline. That area consequently becomes a centre of excellence. Therefore, anywhere that Air Canada does significant amounts of maintenance can be considered a centre of excellence.

Manitoba has historically been a centre of excellence in aerospace in Canada with over 5,000 jobs in the sector and many companies that drive innovation. The fact is, Madame Chair, that Manitoba would have benefited because Manitoba won in the Quebec Superior Court and won again in the Quebec Court of Appeal.

While I don't want to speculate on how the Supreme Court would have ruled on this matter, precedent would indicate Manitoba had a strong case. Manitoba is not getting these jobs because of this legislation. They would be getting them because they won in court.

To bring this back to my amendment, all legislation should be carefully considered on the basis of its short-, medium-, and long-term impacts.

I think we as a committee have done a good job looking at this proposed legislation over the past three meetings and have heard from many good witnesses. The breadth of the commentary was of the opinion that they don't understand the rush to get this legislation passed, and they have asked explicitly for the passage of the bill to be delayed.

This amendment addresses those concerns.

Thank you.

[Sean Casey, Liberal, Charlottetown, PE]

I just want to put the government's position on the record. The government opposes this amendment. The charter provides a constitutional guarantee of the right to life, liberty, and security of the person, which has informed every aspect of this bill. The provisions of Bill C-14 protect the sanctity of life, and the preamble already recognizes the inherent and equal value of every person's life.

Bill C-14 carefully weighs many important interests, including personal autonomy and the protection of the vulnerable. Separately recognizing a positive responsibility on the part of Parliament to uphold the sanctity of life is not necessary. The bill acknowledges the importance of suicide prevention, respect for Canadians with disabilities, and promotion of well-being more generally.

[The Chair, Liberal, Anthony Housefather]

Ladies and gentlemen, I would like to call to order this session of the Standing Committee on Justice and Human Rights, completing our clause-by-clause review of Bill C-14. When I use the word “completing”, I do mean completing.

I congratulate the members of the committee on their expeditious work so far, and hopefully today will be as collaborative as yesterday was.

Unfortunately, we have the challenge of the bells. We'll try to get as much done as possible between votes, and we'll figure out, when we go for the second vote, whether it pays to come back before the third vote or whether we stay there and just come back after the third vote. I guess we'll figure it out based on timing.

[Carole Morency, Director General and Senior General Counsel, Criminal Law Policy Section, Department of Justice]

I think the wording you have in Bill C-14 as proposed is fairly standard wording for a parliamentary committee report or a review to be undertaken. There's no question that numerous bills that have been passed by Parliament, including in recent years, include a requirement for Parliament to study an issue. It's true that sometimes those studies don't get started, because committees are in control of their own agenda. The matter has to be referred to the committee. The committee takes it on. It's also true that sometimes a committee will undertake a study, and perhaps before the report is tabled there's an election call, or Parliament is prorogued. There are rules to deal with that.

It's also my understanding that when a committee undertakes a study, if they haven't completed the study within the time that the House requires the report to be completed, the committee also can go back to the House and seek an extension of the time in that situation.

So I think there are opportunities within the rules that would allow for and perhaps address the concern that has been raised by the member, but certainly the wording in this clause as introduced is fairly standard in terms of parliamentary committee review.

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

Speaking to that, what Bill C-14 requires is that a report be submitted but with no time frame attached to it. It has happened, in the 12 and a half years I've been here, that to meet a requirement a study will be started or initiated, with no continuum of that study, but they've met the requirement to initiate a study. At times, if it's vague on when it has to be reported, sometimes it never is.

I think this tightens it up. I think to say that from when a report started it has to be submitted within six months takes away the vagueness. We would know that a report would be submitted. There's a tangible timeline. Without that, it's left vague.

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

I agree with the comments made by my colleagues on both sides of me.

Looking back to previous comments, we just dealt with the advance directives regarding mental illness and mature minors, and we have dealt with conscience protection. The only issue that we are not dealing with in Bill C-14 is palliative care.

We have heard, as has been shared time and time again, that an adult who is in a state of suffering cannot provide consent if they do not have their suffering dealt with. Palliative care could be physical, emotional, or depression related. If you do not give someone palliative care, or at least offer it to them, then that issue is not being dealt with properly. You cannot properly administer medical aid in dying if palliative care is not part of it.

We've dealt with mature minors. We've dealt with advance directives and the mental health issue. This is the time when the government has an opportunity to deal with palliative care. If the government does not support it, then they leave that issue off the table. Other than aspirational commitments, this is an opportunity to make a specific commitment, as they have done with the other issues.

I encourage the government to reconsider and support this.

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

I think the suggestion of changing the word “must” to “may” is a good one.

It provides, as a part of Bill C-14, clear direction to the ministers of Health and Justice, but it does not bind them. It provides a suggested direction—gives them the discretion of who is the lead on this. It gives them discretion, if 180 days is not a practical date and maybe 270 days is more practical. It gives them the discretion, as there are consultations ongoing with the provinces and territories. It gives them discretion as what the independent review would look like. I think it's a good suggestion to give them that latitude so that they're not bound. Otherwise, they're accountable but with no clear consequence if they don't meet that, but it could be embarrassing to the government or the minister.

Providing that discretion, I think is a good idea, and I would suggest a subamendment of changing it from “must” to “may”. I'd like to move that.

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

Thank you, and I appreciate the amending motion.

I believe a five-year review, which is what is in C-14, would be a more appropriate time for us to review.

The legislation has to be up and running for a reasonable length of time for us to be able to spot problems and changes that are necessary.

If a standing committee of justice wants to after a couple of years say how is it going, and we want to discuss the issue of advance directives and minors, that would be appropriate, but for it to be in the legislation is presumptive. I think it would be more appropriate to stick with C-14 and a five-year review.

Budget Implementation Act, 2016, No. 1

[Rachel Blaney, NDP, North Island—Powell River, BC]

Madam Speaker, I would first like to take this opportunity to send my thoughts to the people of Fort McMurray. A close friend of my husband lives there, and we all watched in terror as this happened, worrying about the well-being of all the people who were fleeing. It is moments like this that remind us to be grateful for all those we hold dear. It is a reminder of the privilege it is to give when the need arises, and to receive when the hard parts of life happen. I thank all those who have given during this painful time.

Today, the House stands to debate Bill C-15. Budgets are about setting priorities and confirming commitments made, and today I want to discuss some serious concerns I have about the budget.

Bill C-15 is 179 pages long. It amends more than 30 statutes and contains another bill, Bill C-12, which is on the Order Paper before the House of Commons. Now, the time of debate has been shortened. A promise of the Liberal government was transparency and openness. The bill before us has multiple complexities, which include repealing an entire act, retroactive legislation changes, and much more. This alone lessens the capacity for focused discussion in the House, and with a shortened timeline, there is less time for discussion of these important issues.

The people of North Island—Powell River have shared with me their concerns with omnibus bills, and with Bill C-15, the government is going in a direction that concerns many Canadians. I hope this is not what real change looks like.

I know that many people in my riding will feel some relief with the child tax benefit. It is a start; however, I also know that many of my constituents are looking for a real child care strategy.

When I travel in my riding, I am sad to hear the stories of many women who have had to leave their work, because they cannot afford day care. They shared with me their concern that they would miss out on opportunities for their careers. One woman said to me that she just wanted to feel she had a choice in the matter. She loves her children, wants to spend meaningful time with them, and wants to have a career that promises a future for her family. However, the budget does not provide any support for the affordability of child care, nor does it address the reality that there are few day care spaces available.

I talk with single parents who are stranded without the supports for the child care they desperately need. More money in their pocket would provide some support, but if there are no child care spaces available, that is not a solution. Canadians are looking for a comprehensive strategy around child care, and the budget before us does not give it to them.

Veterans are also being shortchanged by the lack of mental health support, and there is nothing for suicide prevention. Veterans affairs have been badly mishandled by the past Conservative and Liberal governments. Pensions have been clawed back, and front-line service cuts have increased wait times for help and access to quality home care, while long-term care is shrinking. Soldiers with PTSD face months of delays before even getting referred for help, and even then, that help is hard to get.

A man from my riding, Dan Thomas, came to see me several weeks ago. A retired soldier with severe PTSD, he talked about how invisible he felt with his long-term issues. He shared with me the helplessness of not being able to receive the support he so desperately requires for his day-to-day life. When people serve their country, they should not feel invisible.

Bill C-12 was tabled in the House of Commons on March 24. The way veterans were treated by the previous government was indeed shameful. They deserve to have this legislation that would affect them discussed in the House, and not a unilateral decision by the current government. By killing Bill C-12 and incorporating it in this omnibus bill, the Liberals have chosen not to make space to listen to veterans' grievances and are playing politics.

Opening the service centres is one step, but it is not the only step required. What concerns me is that Bill C-12 largely fails to provide much-needed supports for mental health or increase support for spouses or caregivers of injured veterans.

We owe it to the men and women who have served our country courageously and honourably to ensure a proper study of these benefit changes to make sure they will address the needs of our veterans. We do not want to see veterans continue to be forced to prove that the leg they lost has not grown back.

This omnibus bill should be split up so that the changes to veterans' benefits receive proper study by Parliament. It is important that we serve those people who have served us so well.

After nearly a decade of Conservative economic mismanagement, middle-class families are working harder than ever yet falling further and further behind. At a time when Canada needs a government that will combat rising inequality, the Liberals' first budget is inadequate.

The Liberals are breaking their promise to reduce the tax rate for small and medium-sized enterprises, the biggest job creators in Canada. They are cancelling the legislation that allowed for any subsequent reductions provided in the bill. However, they made a commitment to lower the rate to 9% by 2019. New Democrats have been fighting for a long time for tax cuts for small businesses, which are the real job creators in Canada.

The Liberals have rejected our proposals to cap transaction fees for credit cards, and are doing nothing to facilitate the transfer of family businesses between generations. This is a direct betrayal of small business owners and will significantly reduce job creation in Canada. The parliamentary budget officer estimates that this cancellation would cost SMEs more than $2.1 billion over the next four years. Meanwhile, consecutive Liberal and Conservative governments have given massive tax giveaways to Canada's most profitable corporations. The Liberals should keep their promise to small businesses by withdrawing the proposal to cancel legislated reductions in the small business tax rate.

More than a quarter of seniors are living in poverty, and some Canadians are wondering whether they will have a secure income when they retire. We welcome the Liberals' recommitment to returning the age of eligibility for old age security and the guaranteed income supplement to 65. We also welcome their recommitment to increase the GIS for single seniors. However, we are disappointed that seniors have to wait until July, despite the Liberals' promise to help them immediately.

This is a useful start, but more can be done. Increasing the GIS by 10% for all seniors would lift nearly 150,000 additional people out of poverty. Income data shows that the median income for single seniors without employer pension income is below $20,000. With the low income measure for a single senior at $22,000 per year, this is unacceptable. I can tell members that there are many seniors in my riding who are living well below $20,000 a year. I have seniors in my riding who, in January, debate whether to purchase medication or keep their heat on. That is not a good debate for seniors who have worked so hard to create this beautiful country we have. These changes should be closely studied to see how we can improve them to help even more seniors, not pushed through in an omnibus bill. The government needs to keep its promise to immediately enhance the CPP.

Last week in this House I spoke to Bill C-14, medical assistance in dying. The bill refers to palliative care in its preamble, yet while introducing this bill the government made no new commitments to palliative care. We have a critically important opportunity to enhance services across the country, yet the government was missing in action on palliative care in the budget, even after promising $3 billion for home care during the campaign. Holding the government to account on the promise of that motion remains one of our top priorities as we assist in the legislative response to the Carter decision.

In my riding, there are many seniors. Home care and palliative care are of huge concern. Seniors living in remote communities want to hear from the government that they matter, that staying in their home is a priority. Many constituents have shared stories of feeling pushed to leave not only their home but their community for health concerns. Accessible services in my remote communities are important.

I cannot support this budget. It does not fulfill the promises made to Canadians. It has some positive steps, but leaves out too many key concerns that would make the lives of my constituents better. Whether it be actual dollars or respecting the process, this budget fails to follow through.

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

Madam Speaker, it is extremely disconcerting that the government would produce a budget basically void of any details on palliative care, especially in light of Bill C-14. It is extremely important we have these enhanced details.

Would the member agree that this is a glaring error in how we move forward responsibly with the budget?

[The Chair, Liberal, Anthony Housefather]

I would ask everyone to please take their seats.

We are ready to begin.

Ladies and gentlemen, I'd like to call this meeting of the Standing Committee on Justice and Human Rights to order as we continue our work in doing our clause-by-clause review of Bill C-14.

We are currently at page 88 in the legislative package that we received, which would be amendment CPC-21.

I would note for everybody's information that NDP-4.1 that we started to deal with this morning will be deferred, as it wasn't in the appropriate section, until we get to Liberal-8. Then NDP-4.1 will be put forward in a different way, before Liberal-8, thanks to the collaborative work of all three parties. Good job, everyone.

We'll move to Mr. Viersen's proposal, CPC-21. I'd ask Mr. Falk if he'd be willing to move it so Mr. Viersen can speak to it, if he's here.

Physician-Assisted Dying

[Justin Trudeau, Liberal, Prime Minister]

Mr. Speaker, on Bill C-14, Canadians understand that this is an important and big step in our nation's history as we move forward on a delicate issue under a time crunch by the Supreme Court.

One of the things Canadians expect is that we take this very seriously and responsibly, and that is exactly what we are doing before committee, and that is what we have been doing with these consultations.

The NDP has put forward amendments to enlarge the scope of the allowances. The Conservatives are putting forward amendments to further restrict it. We are listening to all proposals. We are working hard to ensure that Canadians have the right legal framework to help them with these incredibly personal and sensitive decisions.

[Thomas Mulcair, NDP, Outremont, QC]

Mr. Speaker, a number of experts and legal professionals have serious concerns about the constitutionality of Bill C-14. The legislation could be challenged in court, but in committee, the Liberals have rejected nearly all of the amendments that would have fixed the bill.

What is preventing the Prime Minister from seeking the Supreme Court's opinion on Bill C-14?

With so many raising concerns about the constitutionality of Bill C-14, why will the Prime Minister not simply refer the bill to the Supreme Court to avoid years of legal challenges.

Second Reading

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

Mr. Speaker, I thank my colleague from Saint-Hyacinthe—Bagot. I will not forget the name this time. I have had the great pleasure of working with her on Bill C-14.

Six months ago, Canadians had their say. We are democratic and we respect their choice. If we had been perfect, we would not be on this side of the House. Each government has its own experiences. The reality is that these people got elected by making promises, and now they are doing the complete opposite. That is the reality. These people got elected by promising that there would be a small $10-billion deficit. How big is the deficit now? It is $30 billion. They got elected by promising that they would make tax changes without any cost to the public, but those changes will cost $1.7 billion. These people were elected on a platform, but they are not following through on it.

This is insulting, and it only adds to Canadians' cynicism about politics.

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

Thank you. I appreciate the time to speak to this. Most people around this table—all the people around this table—are friends of mine, and this is both a parliamentary matter of principle and it's also intensely personal. This series of motions that are just being passed, I've been considering whether it will have an immediate effect on my health or merely take years off my life later, and I'm not saying this facetiously. I'm saying in all honesty that this is terrifying for me personally.

What we're facing here is a couple of fictions. The first fiction is that my friend Mark Gerretsen says this is his motion. I know he didn't write it. It was written under the PMO in the previous government. The second fiction is that parliamentary committees are the masters of their own proceedings. It stretches credulity to imagine that parliamentary committees, all of a sudden in the fall of 2013, all automatically adopted the same motion and that it has sprung into the mind of all parliamentary committees simultaneously in the spring of 2016 to do it again.

This is changing the way in which legislation goes through Parliament, changing parliamentary procedures without going through the trouble and the steps it takes to change Standing Orders and change rules. This is the last step required, if every parliamentary committee does this after every election in every session of Parliament. This is essentially taking report stage and making it an anachronistic redundancy, as opposed to being what it was historically, an opportunity for parliamentarians as a whole, not merely members of committees, to suggest amendments.

The brief history of this is that up until the year 2002, members of Parliament of all parties had the right to put forward amendments at report stage. As a result of a 1999 effort by the Alliance party at that time, more than 700 amendments to the Nisga'a treaty were put forward in an attempt to derail it at report stage. The party in power at that time, the former Liberal government of Jean Chrétien—Don Boudria as House leader—retreated to a long process. It took them a couple of years to actually change the parliamentary rules such that a member of Parliament who had an opportunity through their party to put forward amendments to a bill in committee had no such right to put forward further substantive amendments at report stage.

That created the unintended reality that the only members of Parliament with an opportunity to put forward substantive amendments at report stage were those who, again through an irregular process creating two tiers of members of Parliament, were in parties smaller than 12 or sitting as independents. We were the only ones who did have rights to put forward amendments at report stage.

The only remnant of what report stage has been historically, going back through Westminster parliamentary democratic history, was the ironic reality that only members in parties with fewer than 12 had rights to put forward amendments at report stage, because we'd had no opportunity in committee; hence the creation of a fake opportunity of running from committee to committee to put forward amendments, but having no right to move them—as you see in this motion, they're “deemed to have been moved”—having no right to vote on them, and having no right to do anything other than pursue a brief opportunity to make a representation in support of them.

The reality for me personally is that many times committees will be doing clause-by-clause consideration at the same time. I raced to the environment committee in the 41st Parliament with amendments to keep seismic testing out of Sable Island National Park and got there too late. My amendments had all been defeated because I was tied up in a different committee trying to put forward amendments on a different bill.

This creates a virtual impossibility for me personally. Now, I'm very well aware that you've all been told this has to be passed and has to be passed today. Earlier today, the national defence committee was told they had to pass it and had to pass it without giving me an opportunity to speak, because, to make my point, I was tied up with BillC-14, where I'd been summoned to the justice committee to do my amendments there.

[The Chair, Liberal, Larry Bagnell]

Good morning. This is meeting number 20 of the Standing Committee of Procedure and House Affairs for the first session of the 42nd Parliament. This meeting is in public and is being televised.

In our first 15 minutes today, we'll continue our inquiry into the question of privilege related to the matter of premature disclosure of the contents of Bill C-14. In the second hour, we will resume our study of initiatives towards a family-friendly House of Commons. The Clerk of the Ontario Legislative Assembly will appear by video conference.

What we're planning to do, because our time has been truncated, is to just have the opening statements by the Clerk and the Law Clerk.

You have lots of time, because we're not going to do the hour of questioning now. We'll postpone that to another time—so we don't infringe on anyone's privilege by not getting questions and start another case.

[Sean Casey, Liberal, Charlottetown, PE]

I want to put the government's position on the record.

This amendment is well intentioned, but because the amendment is drafted in the conditional, it's incompatible with acceptable language for Criminal Code provisions. You may want to get the view of the officials on this.

The criminal law sets minimal standards for acceptable behaviour in society. Conditional circumstances are typically better addressed by medical practice regulation.

Also, uncertainty would be created. It's unclear if it places an obligation on the medical or the nurse practitioner to determine whether the person has difficulty communicating or what degree of difficulty would trigger the provision. If there's a desire to require additional communication technologies or resources for certain classes of persons, it should be left as a matter of medical practices to be determined by the provinces and medical regulators.

Bill C-14 already requires medical and nurse practitioners to provide medical assistance in dying with reasonable care and skill, according to any applicable provincial standards. This is sufficient to address the concern raised by the amendment, which is unnecessary in the government's view. Existing informed consent procedures require that a person understands the medical options available to them.

[The Chair, Liberal, Anthony Housefather]

Ladies and gentlemen, good morning.

It's a pleasure to call this meeting of the Standing Committee on Justice and Human Rights to order as we resume our clause-by-clause consideration of Bill C-14.

It's a pleasure to have you all here this morning. I hope our discussion continues to be fruitful.

Yesterday was a long session, and I really appreciated everyone's openness and tone. It was an excellent session in terms of tone, and I hope that continues today. I'm sure it will.

We are starting from where we left off, with amendment PV-5.

I'm going to turn to Ms. May to explain PV-5.

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

I think especially now, knowing that Mr. Bittle's amendment is being withdrawn, this is the only chance to amend proposed paragraph 241.2(2)(b) to ensure that we are not insisting upon an additional condition.

It was not part of the Supreme Court of Canada rationale. There was no suggestion in the decision of the court in Carter that one must have an advanced state of irreversible decline and capability. Again, the Dying With Dignity group asked that this entire clause be struck.

I'm hoping that my compromised effort here will meet with support from Liberal members of this committee.

Please pass at least one opposition amendment to BillC-14. I think it will improve our sense of a healthy democracy.

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

Thank you, Mr. Chair.

As I suggested in the opening to my last amendment, in a series of amendments I'm attempting to restore proposed subsection 241.2(2) to a status of definition that's compliant with the Carter decision.

I note that some of the witnesses before the committee asked that this subclause be removed in its entirety. In this one, I haven't gone as far with my amendment as the Dying With Dignity witnesses asked you to do, but what I have done is remove the word “advanced,” so it would now read, “they are in a state of irreversible decline in capability” as opposed to “in an advanced state of irreversible decline”.

The position of Dying With Dignity was that this would force years of severe, unwanted suffering upon people who have a grievous and irremediable medical condition, but who have not yet reached the end stages of their medical condition.

The use of the word “advanced”, again speaking of terms that are imprecise, speaking of areas where we don't have clear medical guidance, in this context is unhelpful in meeting the guidance that we have from the Supreme Court of Canada, and imposes on people who otherwise meet the tests of BillC-14 unnecessary, additional suffering and grievous harm, denying them of their rights for longer than legislators should do.

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

I appreciate, Mr. Chair, the latitude to those of us who are pulled to committee by the motion you passed and don't have the opportunity to present it at the report stage.

I appreciate the chance to plead once again with the Liberal members of this committee to consider that passing Bill C-14 with the language that you find in subparagraph (a)—and then I'll come back to (b) and (d) on other amendments—will have the effect of passing legislation that is not charter-compliant. It will be one that does not meet the standards of section 7 of the Charter of Rights and Freedoms and will create more litigation and more uncertainty instead of doing what's required of lawmakers, regardless of personal opinion or lobby efforts by groups that failed at the Supreme Court of Canada. We have a unanimous Supreme Court of Canada decision, and it's our obligation to meet its terms.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you, Mr. Chair.

I just want to give you the government's position with respect to this amendment. The government opposes this amendment. There is no certainty or clarity around what is meant by “grievous and irremediable medical condition”. The Canadian Medical Association has stated that there is no shared meaning of what constitutes “grievous condition”.

If practitioners interpret it broadly, for example to apply to persons with permanent physical disabilities who are otherwise in good health or persons who have just been diagnosed with a degenerative disease, it could increase the risks posed by medical assistance in dying to vulnerable persons, could contribute to the stigmatization of the quality of lives of persons with disabilities, and potentially undermine suicide prevention.

This amendment is also fundamentally contrary to the government's policy choices as reflected in Bill C-14. As introduced, Bill C-14 contains the clarity that is needed to give confidence to medical professionals to undertake what is otherwise a criminal act.

Thank you, Mr. Chair.

[Rob Oliphant, Liberal, Don Valley West, ON]

I'm speaking in favour of the amendment. I wanted the committee to be clear about a case that the Court of Queen's Bench of Manitoba ruled on last Friday. This is the case of a woman referred to as patient No. 2, the second case under the four-month interim regime from the Supreme Court of Canada, where each province defined its own system with a pre-authorization by a judge.

The judge heard the case of a woman in her fifties who has ALS and has an expectation of living three to five years. She has a disease that is irremediable. She has suffering that is intolerable to her. However, one would not be able to say her death will take place in the reasonably foreseeable future, nor is she necessarily in a decline.

One can argue that her status is very similar to Kay Carter's. However, she is about 30 years younger. I have heard it argued that Kay Carter was elderly. Therefore, her death was foreseeable in the future. This would not be the case of patient No. 2. The judge in this case was taking her leave from the Carter decision and applying it in this case.

If this amendment is not passed, would this patient be allowed a dignified death if Bill C-14 passes unamended? That would be my concern, and that is why I speak in favour of the amendment.

It's important for the committee to be clear that there are cases in which people may be seeking death right now, before this bill is passed, because they fear they would be ineligible to receive the right granted under the Carter case at this time.

That is a grave concern I have. I believe this case should be strongly considered by a judge who has read the law well and is concerned about the nature of this bill. That's all I have to say.

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

The committee has said no to prior judicial oversight. The only form of oversight at this point...and the Carter decision...were that we had a regime with strict safeguards, including enforcement. To this point, Bill C-14 does not have that oversight, other than two physicians or two nurse practitioners. But there is no oversight—no judicial oversight, no oversight whatsoever. We're relying on two people of that competence to end a life, to assist in the ending of a life of an individual at the individual's request.

If we want to amend this, I'd be in favour of amending it, but you would need...and we heard this from testimony. I'm thinking of the special committee; I'm not sure if this committee heard that from the witnesses. There was an encouragement to make sure you do not have the physicians putting themselves in a very dangerous position where the government of the day says that in this case, if there was a charge or a complaint made against a physician or a nurse practitioner, they did this inappropriately. Maybe a family member would not be happy with how the situation was handled, and now we have these physicians in a very dicey situation where they could be charged with homicide.

The encouragement was to have some sort of oversight. I think this is an attempt to provide some oversight—if not judicial, because of concerns it would delay, then in another way.

In the spirit of what is being attempted here, if we don't want a minister of health, is there an appetite to have any oversight? I think it's needed. We've heard that it was needed. Without it, you're going to leave physicians vulnerable to possibly being charged. I appreciate the spirit of it. Maybe we need to find another way.

The other thing, Mr. Chair—and I think it's salient—is that we have one approved amendment to this point. It was a Liberal amendment—and that's good. It was a good amendment; it actually got unanimous support. But that was it. I think that when we, through the discussion, through the debate, highlight some needs for changes, we need to seriously consider them and amend them, if appropriate.

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

I would suggest otherwise. We did hear from medical professionals who spoke to the committee, who said that physicians may not have that talent, that skill level, that expertise, to be able to determine whether or not the patient, the person requesting assistance in medical aid in dying.... That medical GP or nurse practitioner may not have that expertise, and in some cases will not have that. Yet, Bill C-14 will give them the authority to make that assessment without any expertise. We heard clearly from the CMA and other medical professionals on the importance of having a proper assessment.

We've also heard comments of the importance of being Carter-compliant. It was a competent, consenting adult. If somebody is not competent, who has an underlying medical or psychological or psychiatric condition, and you have somebody who is not an expert to determine whether or not they're competent, you'll end up putting at risk vulnerable Canadians.

I think the amendment is very appropriate. It's not redundant; it's necessary. For clarity of the legislation, it should be supported.

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

Chair, I would agree with Mr. Fraser. I think he's captured it quite well. This is Carter-compliant and I think Bill C-14 as written is superior to what is being proposed in the amendment, so we will be voting against the amendment and supporting the language of Bill C-14.

[Carole Morency, Director General and Senior General Counsel, Criminal Law Policy Section, Department of Justice]

The thing that I would draw to the committee's attention—and maybe the member who sponsored it could explain if there's a different rationale—is that it looks to me like it's similar to the process that the Supreme Court has stated as a result of the additional four-month extension on the suspension of the Carter decision, which is that individuals who wish to seek out medical assistance in dying can do it currently through an application to a superior court in the province in which they reside.

It's a different approach from what Bill C-14 as introduced has proposed. I'm not sure if some of the witnesses had spoken to the implications, but certainly, there are different access implications for individuals, such as time constraints, perhaps, and resource implications of going through that process. We haven't seen the motion to amend before, but those are some of the initial considerations.

[Ted Falk, Conservative, Provencher, MB]

I move that Bill 14, in clause 3, be amended by replacing line 6 on page 5 with the following:

dying only if a judge of the superior court in the province in which the person is ordinarily resident, on application by the person, makes an order stating that the court is satisfied that the person meets all of the following criteria:”

In essence, this is prior judicial approval. It will certainly take a lot of the onus off our health care providers, our nurse practitioners, and our physicians as well, because the judge will be the one who makes the final decision. I think what we've noticed in the time since the Carter decision until the present is that this system seems to have been working quite well. The application comes before a judge and the judge looks at it thoroughly to make sure the conditions are consistent with the Carter decision today, and going forward, once this bill receives royal assent, a judge will review each situation and will make sure that the situation is compliant with Bill C-14.

I think it's a very important check and balance, and it also creates protection for health care providers all the way down, because a judge would be doing the final sign-off and making sure that all the i's are dotted and the t's are crossed.

[Joanne Klineberg]

Well, there are a couple of things for the committee's consideration, again.

One, if we think about the exemptions that have been created for people who might aid the physician or the nurse practitioner, it was drafted to say “any person” because there might be other types of professionals. For instance, someone might actually consult a lawyer to determine how they might proceed to obtain medical assistance in dying. That wouldn't be captured.

Also, given the information I provided a few minutes ago, there is no legal possibility that the offence could be interpreted so as to.... Sorry, that was with respect to a slightly different point. But it's really not possible to interpret the criminal offences as though they would prohibit simply giving someone information about a lawful process, so for the committee's consideration for clauses like that we usually draft for greater certainty.

Finally, the definition of “medical assistance in dying”, in Bill C-14 is such that the definition itself doesn't include the eligibility criteria and the safeguards. The definition is merely a nurse practitioner or a medical practitioner who administers a substance to cause the death of a person. So the committee might wish to consider adding words like “obtaining information on the lawful provision of medical assistance in dying” so that you're not capturing other things that a physician might say that would not be within the lawful boundaries of medical assistance in dying.

[The Chair, Liberal, Anthony Housefather]

Ladies and gentlemen, sorry for the delay. I would like to call the Standing Committee on Justice and Human Rights to order. It's a great pleasure to have with us today from the Department of Justice Carole Morency, Joanne Klineberg, and Julie Besner. From the Department of Health, we have Helen McElroy and Sharon Harper. Thank you for coming.

Ladies, it's very nice to have you. We are going to be doing a clause-by-clause review of Bill C-14. This is the first clause-by-clause review this committee has undertaken. The parliamentary clerk has provided me with some instructions that I would like to give members of the committee so that you all know about clause-by-clause review and how it works, as some of us have not done this before. As the name indicates, this is an examination of all the clauses in the order in which they appear in the bill. I will call each clause successively, and each clause is subject to debate and a vote. If there are amendments to the clause in question, I will recognize the member proposing it, who may explain it. The amendment will then be open for debate. When no further members wish to intervene, the amendment will be voted on. Amendments will be considered in the order in which they appear in the package that each member received from the clerk. If there are amendments that are consequential to one another, they will be voted on together.

In addition to having to be properly drafted in the legal sense, amendments must also be procedurally admissible. The chair may be called upon to rule amendments inadmissible if they go against the principle of the bill or beyond the scope of the bill, both of which were adopted by the House when it agreed to the bill at second reading, or if they offend the financial prerogative of the crown. If you wish to eliminate a clause of the bill altogether, the proper course of action is to vote against that clause when the time comes, not to propose an amendment to delete it.

Since this is a first exercise for many new members, the chair will go slowly. I've been advised by some members that I seem to go fast, so I'm going to try to go slowly to allow all members to follow the proceedings properly. If during the process the committee decides not to vote on a clause, that clause can be put aside by the committee so that we can revisit it later in the process.

As indicated earlier, the committee will go through the package of amendments in the order in which they appear and vote on them one at a time unless some are consequential and dealt with together. Amendments have been given a number in the top right corner to indicate which party submitted them. There is no need for a seconder to move an amendment. Once moved, you will need unanimous consent to withdraw it. During debate on an amendment, members are permitted to move subamendments. These subamendments do not require the approval of the mover of the amendment. Only one subamendment may be considered at a time, and this subamendment cannot be amended. When a subamendment is moved to an amendment, it is voted on before another subamendment may be moved. The committee may consider the main amendment and vote on it, and that would be “as amended”. Once every clause has been voted on, the committee will vote on the title and the bill itself. If amendments are adopted, an order to reprint the bill will be required so that the House has a copy for use at report stage.

Finally, the committee will have to order the chair to report the bill to the House. That report contains the text of any adopted amendments as well as an indication of any deleted clauses.

I apologize for speaking only in English, but it would take too long to go over the text again. I hope that you have still all understood by listening to the simultaneous interpretation.

Budget Implementation Act, 2016, No. 1

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

Mr. Speaker, it is a privilege to rise in the House today on behalf of all the residents of my riding who have reached out to my office and spoken to me personally about their dissatisfaction with the first budget of the Liberal government.

Following the release of the budget, my office sent out surveys to every household and business in my riding, asking whether they supported the out-of-control spending of the Liberal government. Out of the responses I have received, over 90% of my constituents do not support these ballooning deficits and unnecessary spending.

Canadians know best, that we need to live within our means and take out loans or increase spending only in urgent situations. There will always be emergencies that require extraordinary measures such as major roof repairs, new pump in a rural water system or the replacement of a car that died without warning.

While most Canadians would agree that these might be good reasons to borrow, I doubt that many would consider it good money management to take out a new loan to pave the driveway or buy a new flat screen TV, especially if already paying down a hefty mortgage.

Along with many members on this side of the House, this is my first budget while sitting in opposition. I am not impressed that the government has already started to tear down the hard work that our Conservative government did to build a strong economy that Canada enjoyed. Nor are my constituents impressed.

The Liberals talk about slow growth in the past. They fail to recognize that Canada led the G7 in economic growth through some of the most challenging times the world has seen since the Great Depression. The current government will not even admit that we left it with a surplus of over $7 billion. The Department of Finance, the parliamentary budget officer, and experts across Canada repeatedly remind the Liberals that they are wrong, but they simply continue to ignore the facts.

This is important because the almost $30 billion the Liberals have decided to borrow is borrowed not out of necessity, but out of a desire to take the hard-earned money made by Canadians and spend it on pet projects for special interest groups. They have ensured that they can continue this out-of-control spending by including in their omnibus budget bill a clause that repeals our balanced budget legislation.

This balanced budget legislation, passed by the previous Parliament, would force future governments to restrict spending so we would not be borrowing on the backs of our future generations and we could incrementally pay down our national debt. However, the Liberals are now removing the hope we had of reducing our debt. Instead, they plan to increase it by another $119 billion.

Many of us in the House have been blessed with children and some of us even with grandchildren. I am blessed with nine grandchildren, but these out-of-control spending budgets accumulated over time will gravely affect them. I want to ensure that the Liberals know that there will be consequences to their poor decisions today.

If we consider just debt charges alone over the course of the government's mandate, interest charges alone increase by almost $10 billion. This is money that could be spent on more important infrastructure projects or increased health transfers. It could also be spent on funding a small business tax cut, or fulfilling the Liberal's promise to increase home care spending and invest in palliative care. Yet there is not one dollar earmarked in this budget for palliative care or increased home care.

Over the next five years, the interest costs alone rise from $25.7 billion to $35.5 billion. That is an increase of almost $10 billion just to pay interest on the increased national debt.

The three topics that have been brought to my attention most often by my constituents are: first, the Liberals' broken promise to lower small business tax rate; second, giving hard-working farmers a cold shoulder; and third, no money given toward increasing access to palliative care for Canadians.

First are the Liberals' broken promises to small businesses. Waterloo region is home to thousands of small businesses and they were all excited to hear that every party in the campaign was going to lower the small business tax rate to 9%. Unfortunately, this promise, like many other promises made by the Liberals, was completely broken in their very first budget.

On top of that, the Minister of Small Business and Tourism, from the Waterloo region herself, has been defending this broken promise throughout the region and across Canada for the past number of weeks. The finance department has estimated that this broken promise will cost the small business sector $2.2 billion over four years.

It is clear that when it really comes down to it, the Liberals fail to understand the crucial role that small business has to play in Canada. One has to wonder if the entire Liberal government agrees with the Prime Minister who stated publicly that small businesses were just “tax havens” for the wealthy.

The Prime Minister really is out of touch with Canadians. We know that roughly two-thirds of small and medium-sized business owners fall directly into the middle class. Employers are about four times more likely to be earning less than $40,000 than they are to be earning more than $250,000.

On top of the broken promise of lowering the tax rate for small business owners, small business owners know that we do not keep on spending money we do not have and are very worried about the direction the government is going.

Speaking on behalf of these small business owners, the president of the Canadian Federation of Independent Business, Dan Kelly, says:

Small business owners across the country are deeply troubled by the ballooning deficit. What was proposed to Canadians as a short-term $10-billion deficit plan to invest in critical infrastructure is now $29 billion with no plan to get back to balance...Small business owners know that today’s deficits are tomorrow’s taxes.

Second, the budget is a complete disaster for all the farmers in my riding.

Growing up on a farm myself, I have a pretty good idea of the amount of work that these men and women put in every day to feed their families and thousands of other families across Canada. We should be supporting these people. However, the budget completely forgets about them. In fact, the only support for the agriculture industry in Canada is extra funding for bureaucrats in Ottawa, none for moms and dads who are up before the sun rises and finish work well after the sun sets.

In my riding, where there are over 1,200 farms, approximately 1,400 in all of Waterloo region accounting for $473 million in gross receipts in 2010, farmers are professionals. They want to meet their social obligations in protecting the environment, in protecting the health of their animals, and in providing the best quality products for their families, for their communities, and for the world.

The Canadian agriculture and agri-food sectors account for more than $100 billion in economic activity every year and employ more than two million Canadians. The importance of agriculture to our national interests cannot be overstated. In fact, one in eight jobs in Canada depends upon agriculture, those in primary agriculture, food processing, horticulture, and farm markets.

Under the previous Conservative government, farming families saw their taxes drop to the lowest level in 50 years and farmers gained access to more international markets than ever. However, today, with this budget, Canadian farm families are being left behind. The Liberals are borrowing $30 billion to spend in other sectors. The Liberal government must make our farm families a priority.

Third is the government's failure to meet its commitment to increasing home care and palliative care.

As we in this chamber are considering Bill C-14, it is now more important than ever that the government make good on its promise to increase funding for home care and palliative care services. I have said it many times already during second reading of Bill C-14, but let me repeat it. Without proper palliative care options to give Canadians considering assisted suicide, they are not making a fully informed decision. We have all failed in protecting vulnerable Canadians.

Therefore, I would suggest that the Liberal government make four changes to the budget immediately, as it would be in the best interests of all Canadians.

First, the government needs to limit the size of its deficit and re-implement the balanced budget legislation that our government introduced. It needs to start realizing the money it is spending is not its money to spend without reserve, but is taxpayer money and belongs to taxpayers.

Second, the government should make good on its promise to lower the small business tax rate. This would be one of the single-best methods to help out the middle class and to grow our economy. These businesses would be able to expand, innovate and hire more workers, immediately helping our economy.

Third, the Liberals should rekindle their relationship with Canadian farmers and immediately include measures in the budget that would lower taxes for these hard-working Canadians who are the heart of our country.

Last, the Liberal government needs to provide funding for home and palliative care across Canada. Over 70% of Canadians who need this form of care do not have access to it. This is something that absolutely needs to be changed. Now, more than ever, we need to protect and care for the most vulnerable among us.

Physician-Assisted Death

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

Mr. Speaker, the second petition is very appropriate, as the committee moves tonight to examine the amendments to Bill C-14.

The petitioners from throughout my riding, as well as from as far away as Winnipeg, call for measures to ensure that through medically assisted death, Canadians can choose to pursue methods of death of their own choice with dignity.

Motions in Amendment

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

Mr. Speaker, I am pleased to address the House to speak to Bill C-7. Throughout the discussion I will take the opportunity to emphasize that, even though I am not my party's critic on the matter related to this bill, two aspects of it concern me in both form and substance.

Bill C-7 concerns the 28,000 officers of the RCMP, or the Royal Canadian Mounted Police.

This bill was introduced in response to the Supreme Court's January 2015 decision in Mounted Police Association of Ontario v. Canada concerning the right of association of RCMP members. In its ruling, the Court gave the government one year to introduce legislation on the right of RCMP members to associate. That deadline was extended to May 16, 2016.

That is the first thing that I wanted to mention, as it reminds us of what we are going through, in terms of form, with the study of Bill C-14 concerning medical assistance in dying, in which I was directly involved.

RCMP members were not unionized, but they were part of groups and could have discussions with the employer under the staff relations representative program, which was established in the 1970s. It worked quite well, but was challenged by some groups of RCMP officers in Ontario, which resulted in this decision.

For the benefit of the Quebeckers who are watching, I should explain that the RCMP is also the largest police force in eight out of 10 provinces. Ontario has the Ontario Provincial Police, Quebec has the Sûreté du Québec, and the other provinces have the RCMP, the Royal Canadian Mounted Police, which is the police force that enforces the laws and regulations and maintains order in Canada.

The Supreme Court ordered the government to pass legislation conferring on RCMP officers freedom of association and the right to collective bargaining. It was at that point that our government, which was in power at the time, began to clear the way for drafting this legislation, under the direction of the hon. member for Bellechasse—Les Etchemins—Lévis.

Negotiations concerning freedom of association, agreements governing salaries, and all such matters do not happen overnight. We need to take the time to do it right, and that is the point we have reached.

The current government introduced Bill C-7. We agree on the principle of the bill, but we had some serious problems with some of the clauses. Therefore, during the clause-by-clause study, my colleague, the hon. member for Durham, who was a minister and who is a lawyer and a member of the Royal Canadian Navy, proposed some very important amendments.

Clauses 40 and 42, which were deleted from Bill C-7, had to do with health care and insurance provided to RCMP members. We are very happy that the government listened to the Conservative member for Durham with respect to deleting these two major clauses.

However, we do not recognize freedom of association in the same way as the government. We have two opposing views. This is also the case with another bill, Bill C-4, which I am working on in my role as employment and social development critic.

What is the government proposing, and what would we have liked to see in this bill? We think that the right of association must be recognized, but that it should be subject to a secret vote that reflects the will of the members. This is a key element that we enshrined in Bill C-525, for example, which was passed by the House of Commons. This bill required that union certification, specifically when a group of workers is trying to unionize, be subject to a secret vote.

The Conservative member for Durham proposed that solution, but the government rejected it. We find that unfortunate. The sacred right of association must be enshrined in law so that, when it comes time to negotiate, that right is even more powerful, legitimate, influential, and authoritative. In our opinion, the best way to ensure and assert that authority and strength is establishing secret ballot voting.

We know what we are talking about here in the House of Commons. We were all elected by secret ballot. That way of doing things dates back to 1874. It is nothing new. Elected members of the House of Commons have been familiar with the principle of the secret ballot for a long time. The same is true for elected officials in the provincial legislatures across the country. Every elected representative is elected by secret ballot. The same is true at the municipal level. Our mayors and municipal councillors are elected by secret ballot. That is a given in our democratic system if we want those representatives to be powerful, strong, authoritative, and competent.

A solid foundation is needed when it comes time to negotiate and discuss and to ensure that people are properly represented. On this side of the House, we believe that the best way to give unions or union representatives more authority is to allow them to obtain that authority by secret ballot. We encountered exactly the same problem with Bill C-4, for which I am the official opposition critic.

Bill C-525, which was introduced by a Conservative member under the former government, enshrined in law regulations regarding unions and the creation of unions through secret ballot. All of us here, who have decision-making authority, obtained that authority because the people in our ridings voted for us. We think that, when people need to create a union or an association, their representatives, who will be given the authority to negotiate with their employer, should be chosen through the same approach.

That is fundamental, but unfortunately, the government members decided to do otherwise. That is the government's decision to make, but it is not what we would have done.

We believe that that element is fundamental and that the government should have acted accordingly. The Supreme Court specifically stated, in the ruling handed down in January of last year:

The flip side of...freedom of association under s. 2(d) is that the guarantee will not necessarily protect all associational activity.

From our perspective, the best way to give the newly formed group the necessary authority is a secret ballot.

I want to be clear. We support the fact that the 28,000 members of the RCMP, for whom we have a lot of respect, are doing a great job. It is the most honourable job in our country. They deserve a lot, and they deserve it for our citizens. We have a lot of respect for them. We agree with the fact that they should have the right to negotiate as a group. We recognize that. That is why our colleague, the hon. member for Durham, did a tremendous job at the parliamentary committee by pulling out two clauses, clauses 40 and 42, which were not as good as they should have been.

However, we are at a crossroads. The government prefers to have a way of recognizing the group that will represent the RCMP members. We believe the RCMP members would be better served if the election of those people as their representatives was done by a secret ballot vote in front of the government. That is why we agree with the principle of the bill, but unfortunately, we will not be supporting Bill C-4 because the government has failed to recognize that the secret ballot vote is the best way to ensure the strongest dignity of this group to be represented.

Health

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

Mr. Speaker, I will expect to see palliative care mentioned in Bill C-14.

The Minister of Health said her priority was palliative care for $3 billion. However, she is spending her time and government resources right now on legalizing marijuana.

Is marijuana a bigger priority for our aging population than palliative care? Is it worthy of her attention now, or is her palliative care initiative going to pot?

Budget Implementation Act, 2016, No. 1

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, I thank my hon. colleague for her thoughtful comments and constructive criticism of this budget. However, a day after the government abruptly shut down debate on Bill C-14 to comply with the Supreme Court order to provide Canadians with the constitutional right to a physician-assisted death, I wonder if she does not find a bit rich the finance minister's comments about avoiding half measures, in that there is not a mention of a penny of the $3 billion promised during the campaign by the Liberals for palliative care, among other things, which would ease Canadians' constitutional right to live a full and complete life. I wonder if my colleague shares my concern about this disappointing delay of priorities.

[Jennifer Gibson]

Some of my current concerns are about the way in which, in a sense, the shift from the Carter decision to Bill C-14 seems to have been motivated by a real concern about vulnerable populations. We've heard from Mr. Arvay this morning about this having led to certain exclusions of persons who have been labelled and classified as vulnerable.

I think that's a dangerous shift, actually, because as long as we label somebody as vulnerable, we are eroding their capacity. We are presuming that they are not capable, and in so doing we are treating them as unequal to the rest of us in society. I think that's a dangerous direction to be moving in.

At the same time, we are concerned about vulnerability. I think there are other mechanisms through which we can meet that concern. The current safeguards that are articulated here are definitely on the right track, but I start to become nervous when we move in the direction of thinking of prior review, of judicial oversight, which I think is motivated by a concern sometimes framed as enhanced transparency but more often as a way to address issues of vulnerability, while we have mechanisms within health care practice that would better serve that goal, and indeed, from a patient perspective, ensure a much more seamless experience for them at the end of life.

With regard to the judicial review process, we have had some experience over the last three months of cases going through the judicial review process to receive access to assisted death. One of the individuals who went through this process pleaded that this not be the mechanism by which they access assisted death because it is a burden, at the end of one's life, to be going through that particular process.

[Murray Rankin, NDP, Victoria, BC]

Thank you.

First of all, I'd like to say thank you to each of the panellists separately.

Dr. Chochinov, we had the benefit at the Senate/House committee of your colleague Maître Pelletier, who was very helpful. You weren't able to be there so it's good to meet you here. Thanks for your work on the expert panel.

Dr. Gibson, your leadership in the provincial and territorial task force is really quite remarkable, and thank you so much for all of the work that you have done respectively.

Of course, Mr. Paterson, than you for your dogged litigation in the Supreme Court as an intervener in Carter. We're very fortunate to have you here.

I want to start with you, Dr. Gibson, on the issue of vulnerability. I want to give you an opportunity, because you were going quickly at the end of your remarks on the issue of vulnerability.

Could you elaborate a little for us and put it in the framework of BillC-14 and explain how we can do much better in conclusion?

Protection of Freedom of Conscience Act

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

moved for leave to introduce Bill C-268, An Act to amend the Criminal Code (medical assistance in dying).

Mr. Speaker, I am honoured to present my private member's bill known as the protection of freedom of conscience act. With the introduction of Bill C-14, I have heard from many Canadians. I think all of us in this House have heard that Bill C-14 has a gaping hole: it does not protect the conscience rights of Canadians. The Carter decision required that conscience rights be protected for medical health care professionals. This is not included in Bill C-14. The government has said that it does not compel but it also does not protect conscience rights. Therefore, I am proud and thankful to represent all Canadians with respect to a pan-Canadian approach to protect the conscience rights of health care professionals with the passage of this bill, the protection of freedom of conscience act.

(Motions deemed adopted, bill read the first time and printed)

[Jennifer Gibson, Director and Sun Life Financial Chair in Bioethics, University of Toronto Joint Centre for Bioethics, As an Individual]

Thank you.

Good morning everyone, and thank you so much for the invitation to join you. As some of you may know, I co-chaired the provincial-territorial expert advisory group on physician-assisted deaths. Most recently I've been working with the Joint Centre for Bioethics task force on medical assistance in dying, in collaboration with health system stakeholders, to prepare for the implementation of medical assistance in dying in Ontario.

Today, though, I'm speaking as an individual. Although the chair has advised that we should not take a philosophical approach, I will be tapping into my disciplinary expertise in ethics and policy to provide an additional perspective to today's conversation.

Over the last few days I've had the opportunity to listen to the testimony of several panels. It has been fascinating and admittedly predictable to see convergence in some areas and continuing divergence in others. Bill C-14 is fundamentally an amendment of the Criminal Code within the parameters of the Charter of Rights and Freedoms and the charter ruling, and it has implications for the conduct of health care. But it is not the comprehensive regulatory regime envisioned in the Carter decision.

This week's discussions underscore how much of the work that we are collectively undertaking through this consultative process is not just legal, although it's about legislation and proper jurisdiction, nor political, although it is part of a parliamentary process. It is also fundamentally what I would call values work, by which I mean the pursuit of a right balance in C-14 of three ethical goals: recognizing and protecting individual autonomy, alleviating or minimizing suffering, and preventing harm. All three ethical goals have been articulated in witness testimonies over the course of the last three days.

As written, Bill C-14 proposes one way to balance these three ethical goals. Specifically, as noted in the preamble, it seeks to strike the most appropriate balance between

the autonomy of persons who seek medical assistance in dying, on one hand, and the interests of vulnerable persons in need of protection and those of society, on the other.

It proposes that this balance be achieved by limiting access to medical assistance in dying to competent adults whose natural deaths are reasonably foreseeable.

Is this the most appropriate balance? Testimony in the last three days suggests otherwise, and I would agree. Witnesses have rightly challenged the definition of “grievous and irremediable medical condition” and particularly proposed paragraph 241.2(2)(d), that is, the much-beleaguered “reasonably foreseeable” paragraph.

In my brief, I recommend removing that “grievous and irremediable” portion entirely and amending proposed paragraph 241.2(1)(c) to bring greater clarity, coherence, and consistency with the parameters already laid out by Carter.

Given its definition of “grievous and irremediable”, Bill C-14 denies medical assistance in dying for competent persons who have a “grievous and irremediable medical condition that causes...enduring and intolerable suffering” but who are not—quoting from the legislative backgrounder—“nearing the end of their lives” or “on a trajectory towards their natural death”, and whose medical condition is not itself fatal.

One might argue, as some witnesses have done, that to limit medical assistance in dying this way offers an important safeguard to protect vulnerable persons who might, as per the preamble, be “induced, in moments of weakness, to end their lives”. But if, as other witnesses have argued, persons like Kay Carter would not be eligible for medical assistance in dying, then many suffering Canadians are being left behind by Bill C-14.

To paraphrase Mr. Bauslaugh's testimony from yesterday evening, Bill C-14 rations compassion only for the suffering of those who are dying. For many, including me, the balance of autonomy, protection of the vulnerable, and minimizing of suffering have not yet been achieved with this definition of “grievous and irremediable”.

There is another area that puts into question whether Bill C-14 is successful in balancing these three key ethical goals. Several witnesses yesterday spoke about the exclusion of mature minors, competent persons who are enduring intolerable suffering from psychiatric illness, and competent persons seeking to make an advance request for medical assistance in dying.

These exclusions, possibly temporary pending further study, as per the non-legislative commitment articulated in the preamble, are explained in the legislative backgrounder as necessary to protect “vulnerable persons” in these “complex” situations. However, exclusion of competent persons on the presumption of vulnerability does not serve the end of balancing autonomy and preventing errors and abuse and may, I fear, actually have the opposite effect of marginalizing and further entrenching the social vulnerability of the very individuals we are seeking to protect.

The protection of vulnerable persons turns on safeguarding competence, voluntariness, and consent. Exclusion of otherwise competent persons may be justifiable to the extent that this is proportional and necessary to prevent another injustice. Failing this, though, these exclusions violate the autonomy of competent persons in these groups and unjustly force these individuals to remain in a state of enduring and intolerable suffering.

Waiting until the fifth year following royal assent to address the results of additional study would be neither reasonable nor just. Hence, echoing other witnesses, my brief recommends that Bill C-14 be amended to establish an expedited schedule for study of medically assisted dying involving mature minors, competent persons with primary psychiatric illness, and persons who have given advance consent while competent.

I will close my brief remarks with the final reflection on vulnerability as it relates to Bill C-14. The call to protect the vulnerable is one that we all share, and it's morally praiseworthy. However, we must ask ourselves who decides who is vulnerable. Is it the individual through his or her lived experience, or is it the rest of us in society who decide what type of vulnerability matters and to whom, and what the appropriate response to vulnerability is?

Witnesses have offered different responses to these questions. Some wish to set limits on which competent person should be eligible for medical assistance in dying, excluding those who are perceived to be in need of protection or susceptible to moments of weakness. Others wish to set up procedural safeguards to protect competence, voluntariness, and consent.

Bill C-14 offers an uncomfortable compromise among these different responses, tilting the balance of ethical goals precariously away from preserving individual autonomy and minimizing intolerable suffering of competent persons.

I know we can do much better for Canadians.

Thank you.

[Josh Paterson, Executive Director, British Columbia Civil Liberties Association]

Thank you very much.

I'm pleased to be here today. I just want to say that although I'm not addressing all of our concerns today, the B.C. Civil Liberties Association continues to stand by our previous submissions to the parliamentary committee that went before.

Today my focus is simply on making the bill Carter-compliant. Bill C-14, in our view, must be amended in order to ensure compliance with the Carter decision and with the Charter of Rights and Freedoms. I have to say we were shocked when we first saw this bill and we learned that not only did it ignore many of the core recommendations of the parliamentary committee, but it actually cut out part of the heart of the victory that our organization had won in Carter.

In our view, this bill forgets what the Carter case was about. This case wasn't just about helping people with terminal illnesses to have a dignified death of their choosing; it was equally about ensuring that people who are trapped in unimaginable suffering from non-terminal illnesses have the right to escape a lifetime of indefinite suffering. Both of these kinds of people were before the court, and importantly, our organization was granted public interest standing to argue this case as an institution, in respect of various kinds of patients. The ruling was not limited to terminal cases, as we know from the mouth of the Supreme Court itself in January. It did not limit the decision to terminal people or to people who were foreseen to die.

The government says, well, this restriction isn't a restriction to those who are terminal. We say that the effect is the same, that under this bill, someone needs to be dying in order to qualify. The court itself has said that this is wrong.

We won that victory after years of gathering evidence, of tireless work, of fighting a federal government that opposed the realization of this right tooth and nail. We systematically were able to beat each of those arguments that were mustered by the government over multiple years. We knew, in winning, that this would make a real difference for people who would otherwise suffer intolerable and terrible deaths. We knew it would make a difference for people who were suffering unimaginably from grievous and irremediable illnesses in life, and now we see this victory being hollowed out, being taken right out of the bill for half of those people.

In order to remedy this, we support the amendment that was referred to by Professor Downie in her remarks yesterday. We take the position that prohibiting patients whose deaths are not reasonably foreseeable from having the choice of medical assistance in dying violates the charter, and that the entire section referring to the definition of “grievous and irremediable” in the bill should be eliminated. In its place, we believe that proposed paragraph 241.2(1)(c) should be amended to state that a person must have 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. This, we believe, will bring the criteria in line with Carter.

If Bill C-14 is not amended to eliminate the requirement that a condition be “incurable” rather than “irremediable”, the requirement that there be an advanced state of irreversible decline, and the requirement that natural death be reasonably foreseeable, the result will be terrible suffering for those Canadians who are barred from accessing medical assistance in dying—and that's what this is about. It's not an academic exercise, or even an exercise, as is often done in this place, quite appropriately, in balancing political interests. It is about the intolerable and unimaginable suffering of real Canadians, and about their rights.

The “reasonably foreseeable” requirement is terribly vague. You've already heard from numerous witnesses who have said so, including The College of Family Physicians of Canada, representing the doctors who are most likely to be dealing with these issues. We believe this requirement, in particular, of reasonably foreseeable natural death, is unconstitutional because it violates the charter right to liberty. It deprives a patient of fundamental choice related to their body. The court concluded that the Criminal Code in its original form, through its blanket prohibition on the right to request a physician's assistance in dying, interfered with liberty by restricting the ability of qualifying patients to make decisions concerning their bodily integrity and their medical care.

It interferes with the charter right to security of the person because it causes a patient to continue to endure suffering, and it interferes with the charter right to life. Since individuals are deprived of the choice of an assisted death, there are some individuals who may take their own lives prematurely in order to avoid intolerable suffering, while they are still physically able to do so.

Now, the government suggests that restricting access to assistance in dying to people whose deaths are “reasonably foreseeable” is justified because it will protect the vulnerable. We've heard already from Mr. Arvay that this argument was used by Canada at court, and the court's decision was clear: Parliament cannot rely on a blanket exclusion of a whole class of people to protect the vulnerable when other less-interfering means are available to do the same thing, for example, to assess decisional capacity on an individual basis. Canada even conceded at the trial, in Carter, and I'm quoting from the Supreme Court reasons:

“It is recognised that not every person who wishes to commit suicide is vulnerable, and that there may be people with disabilities who have a considered, rational and persistent wish to end their own lives”.

There's a really easy way to understand this, and it's that these arguments were made already. As has been described, there is a circle, a class of people, who won a right, who were guaranteed a right. Canada tried to say they didn't have that right; they tried to justify it. Those arguments failed, and that right was recognized. Now the government is taking those same people and trying to pull them out of that protection and use some of the same justifications. This isn't a dialogue. This is the court saying, “This is the law” and the bill saying, “No, it's not the law. We say something else is the law. We say something else is constitutional”. That is just wrong, and frankly, we don't think it will withstand a constitutional challenge, and the result will be costly relitigation of the same point that's already been decided by the Supreme Court of Canada.

In the minute I have remaining, I don't want to spend too much time on it, but I do want to touch on this idea of prior judicial approval that continues to come up in committee. It is a complete departure from current end-of-life practices, and it's one that, of course, as many of you will know, Canada has tried before in respect of abortion, and it was rejected in the Morgentaler decision. The court there held that this procedural barrier of prior approval contributed to violating the charter rights of women by creating delay and, fundamentally, by directly interfering with women's autonomy to make choices about their own bodies by putting a state approval in place in front of their choice. Our experience as counsel with the exemptions right now is that prior approval is costly, time-consuming, prone to delay, and a significant barrier to access. It would be a real mistake for Parliament to reproduce a prior state-approval function for this kind of profoundly personal medical decision when it was soundly rejected nearly 30 years ago in relation to other profoundly personal medical decisions.

Thank you.

[Dr. Harvey Chochinov]

Honourable members of Parliament, my name is Harvey Max Chochinov. I hold the academic rank of distinguished professor of psychiatry at the University of Manitoba. I direct the Manitoba Palliative Care Research Unit, and I hold the only Canada research chair in palliative care. I've spent the entirety of my career working and conducting research in palliative end-of-life care. I'm also the former chair of the external panel on options for a legislative response to Carter v. Canada.

It is my privilege today to share some thoughts on Bill C-14 focusing on possible amendments for your consideration. My submission, which you've received, outlines these in more detail and also includes my rationale for why the current limitations described in the bill, including limiting access to patients whose death is reasonably foreseeable and not including provisions for mental illness, advance directives, and minors, are eminently justifiable and prudent.

The amendments I've put before you for your consideration include the following.

Number one, the government should consider an amendment stipulating that medically hastened death will take the form of assisted suicide, so long as patients are able to take lethal medication on their own. Euthanasia would be reserved for instances in which patients are no longer able to ingest lethal medication independently.

International experience reveals that euthanasia and assisted suicide are vastly different in terms of their uptake and lethality. In the jurisdictions that offer only physician-assisted suicide, the latter accounts for about 0.3% of all deaths. In jurisdictions that offer euthanasia, that form of death accounts for 3% to 4% of all deaths.

Extrapolating these figures to Canada and anticipating approximately 260,000 deaths per year, a regime offering physician-assisted suicide exclusively would expect about 800 to 1,000 of these deaths annually. On the other hand, a regime dominated by euthanasia could expect between 8,000 and 10,000 of these deaths annually.

According to experts appearing before the external panel, this vast difference is largely accounted for by ambivalence. Ambivalence is an important dynamic in considering a hastened death. While assisted suicide offers the possibility of changing one's mind—30% to 40% of patients in Oregon who receive a prescription never in fact use it—euthanasia dramatically reduces that possibility, once it has been scheduled and expectations are set for a specific time and place.

The data is clear. This will ensure that thousands of people each year who are ambivalent about an assisted death will not feel pressured by circumstances to proceed before they are ready to die.

Number two, the government should consider an amendment requiring that all patients obtaining medically hastened death should first be provided with a palliative care consultation. This would be over and above the duties of the two physicians described in the current bill and would be critical, so long as the bill limits access to patients whose natural death is reasonably foreseeable and who are in an advanced stage of irreversible decline in capacities.

The palliative consultants would not be in a decision-making role; rather, their role would be to identify all physical, psychosocial, existential, and spiritual sources of distress underlying the request to die; to ensure that patients are fully informed of all options that could be initiated on their behalf; and finally, to document their findings so that prospectively collected, anonymized information could be entered into a national database providing a detailed and objective basis for Parliament's five-year review of Bill C-14.

Number three, the government should consider an amendment requiring judicial oversight and approval for all medically hastened deaths. Judicial oversight would ensure a precedent-based, consistent, and clearly articulated set of benchmarks regarding when eligibility criteria have been met.

Judicial oversight would insulate health care institutions and professions from any perceived or real hazards associated with medically hastened death and would likely increase access, given the increase in number of health care professionals who would be prepared to engage with patients requesting medically hastened death. Oversight would demonstrate profound leadership, indicating that while Canada has made medically hastened death legal, our government does not yet know how this fits into our current system of health care.

Number four, in the most profound way possible, judicial oversight would ensure a commitment to transparency and objective evaluation of all factors, be they medical, emotional, psychosocial, financial, or environmental, that might underpin a request for medically hastened death.

In conclusion, I believe that the limitations and safeguards currently included in Bill C-14, together with these suggested amendments, would see Canada's approach to medically hastened death marked by integrity, transparency, and wisdom. Thank you.

[Graydon Nicholas]

The way it's open-ended now, if you look at those provisions under this Bill C-14, and if you look at the offences that are created because of this, if you don't notice, if you don't do that, you're subject to a criminal charge, and then of course when you're subject to a criminal charge, you have a right to defend yourself.

[Murray Rankin, NDP, Victoria, BC]

Thank you, Mr. Arvay.

You've obviously been very categorical here this morning with us when you've said essentially—if I'm not putting words in your mouth—that if we as parliamentarians were to pass Bill C-14 in its present form, we would be passing legislation that is unconstitutional. You've said that I think because you've indicated that even Madam Justice Karakatsanis says “we rejected terminally ill” as an approach.

You've argued here that we should leave “grievous and irremediable”, as in the words of the court, for fear that we will undercut what the Supreme Court said through legislation of the kind that's currently before us.

Essentially, you've also said—and here's where I want to ask a question about—that “Carter created a floor and not a ceiling”. I think you meant that Parliament cannot take away rights that are provided in Carter. In other words, if Carter creates a large circle, we can't simply create a subset of that circle. Is that essentially what you're saying in lay terms?

[Graydon Nicholas, Former Lieutenant-Governor of New Brunswick, As an Individual]

Thank you very much. I appreciate the opportunity to be here with honourable members on this matter that is very important to our country as well as here in Ottawa.

I filed my submission, and the three areas I addressed are the sanctity of life, palliative care, and freedom of conscience. I hope you've had a chance to read it; it's limited by your limitation of 750 words.

I want to say first of all that I think it is important to acknowledge two things. One is that I'm here as an aboriginal person. My tribe is Wolastoqiyik from New Brunswick. Maliseet is what the English call us; in French they call us Malécite. In my teachings—from my elders, of course—life is respected in all of its stages. I mention this in my brief. Also I'm here as a Catholic. A principle of our Catholic faith as well is that life is respected in all its stages.

Since I was coming here, a friend of mine gave me a copy of legislation entitled an act to establish Pope John Paul II Day, which was enacted by Parliament and assented to on December 16, 2014, in which Parliament acknowledged the important role that Saint John Paul II played not only in this country but in the world as well.

I want to refer in particular to his “Prayer for Life”. If you don't mind, I'm going to hold on to my eagle feather, Mr. Chairman.

O Mary, bright dawn of the new world,
Mother of the living, to you do we entrust
the cause of life: Look down, O Mother,
upon the vast numbers of babies not
allowed to be born, of the poor whose
lives are made difficult, of men and
women who are victims of brutal
violence, of the elderly and the sick killed
by indifference or out of misguided mercy.
Grant that all who believe in your Son
may proclaim the Gospel of Life with
honesty and love to the people of our
time. Obtain for them the grace to accept
that Gospel as a gift ever new, the joy of
celebrating it with gratitude throughout
their lives and the courage to bear witness
to it resolutely, in order to build, together
with all people of good will, the civilization
of truth and love, to the praise and glory of God,
the Creator and lover of life.

That was on March 25, 1995.

With respect to the issue of palliative care, when two ministers announced Bill C-14, the Minister of Health indicated that there would be some money invested in palliative care. I'll refer honourable members to a study that was done, the report from which was called “Not to be Forgotten: Care of Vulnerable Canadians”. It was done by a parliamentary committee here in 2011. It's an extensive report, a comprehensive report, but I would recommend that at least your researchers look at it, because there's a very strong statement in it about looking at palliative care and making sure that governments uphold this portion. It requires simply an amendment of the Canada Health Act for it to happen. Many people are placed in hospices and other centres and literally wait for their time to die. I know many people, my friends and relatives and family, who have been in that situation. It's important that the government make life as comfortable as possible for these people in the last days of their lives.

The other area I will concentrate on is freedom of conscience. Of course we know it's a fundamental right within our charter.

I remember when this was being debated in 1980. Mind you, I was on the other side; I was advocating for indigenous and aboriginal rights back then throughout our country, making sure that the document would in fact protect our people.

One of the writers of the Universal Declaration of Human Rights was an individual from New Brunswick, Professor Humphrey. Article 18 of that document says that “Everyone has the right to freedom of thought, conscience and religion”. This same phrase, of course, is also repeated in the International Covenant on Civil and Political Rights, again in article 18.

Canada not only acknowledged the existence of these particular declarations, but Canada as a country also signed what's called the optional protocol, which allows a citizen of this particular country to question the decision-making power of Parliament and whether it is in fact fulfilling the obligations under international instruments.

My cousin Sandra Lovelace of course was the first one who took the optional protocol to the United Nations, and she's a senator now. It was about dealing with her identity as an indigenous woman who had lost her rights through marriage to a non-native. Ultimately, Canada was sanctioned by the United Nations, and Canada changed the law in 1985.

I put that on record maybe because as I look at this legislation, I'm not sure if the advisers at the Department of Justice examined this legislation in terms of conscience rights—because there's an absence there—so does it in fact comply with international law? Does it comply with the instruments at the United Nations level? Of course, the Department of Justice has all kinds of experts. I just raise that with the committee, Mr. Chairman, because I think it's something that shouldn't be overlooked. I remember how in the 1980s, when legislation was passed and they would sometimes say, “Okay, hold your nose and let it pass, even if you don't agree with it.”

Conscience is so important and so critical. If you force somebody to do something against their will and they have firm beliefs, what's going to happen to the medical profession? What's going to happen to those institutions that exist and do not wish to participate in this particular arrangement that's going to be enacted by Parliament? Almost everybody is saying that it's inevitable that it's going to pass, but there has to be a reason, and I think parliamentarians should realize that this thing has to be studied. Although they say they'll study it five years from now, you can't wait five years. Circumstances change.

That is what I wanted to put on the record, Mr. Chairman and honourable members, because I understand that all three parties are represented here. I want to thank you very much for allowing me to come here.

I asked to be here because from May 31, 1991, when I was appointed as a provincial court judge, to October of 2014, when I finished my term as lieutenant-governor of the province of New Brunswick, I was in a virtual sphere of silence. As a judge, you can't make comments on public issues, and definitely as a representative of Her Majesty you're not allowed to, so finally, then, I was relieved of this particular burden in October of 2014. I come here today saying that there should be great compassion for people who are ill, suffering, or facing death, but we all should also make their lives comfortable in those last stages.

Thank you very much, Mr. Chairman and members of the committee, for listening to me. I want to wish you well, but I also want to let you know one thing. In my term as lieutenant-governor, I visited schools in New Brunswick. There are certain schools, believe it or not, that pray for parliamentarians and pray for judges every day, because it's part of their school regime. I was impressed. I didn't realize they were doing that.

Even today, as you're meeting here and as you continue your debate, you have people in certain schools in the province of New Brunswick who are praying for you, and prayer is powerful. We need prayer; we need a higher power, and we need a higher authority in order to make just decisions.

Merci beaucoup.

[Joseph Arvay, As an Individual]

Thank you, Mr. Chair and members of the committee, for allowing me to appear before you today.

As the chair indicated, I was the lead counsel in Carter. In that context, I think I probably know better than anybody what this case is about and what it stands for, because I was involved in framing the case. Framing the case means what we decided it was going to be all about, how we pled the case, how the government responded to our pleadings, the evidence presented in the case, the arguments in the case, and the findings in the case.

I can tell you, based on all of that, which I'll elaborate on in the time permitted, that the definition of “grievous and irremediable” in Bill C-14 is clearly inconsistent with the Carter decision, and that in my view, an unquestionable view, it is clearly unconstitutional; and that if the bill is enacted, it will be struck down.

I tell you this not only because of my involvement as lead counsel in Carter. I've been litigating the charter since its very inception—that was 34 years ago—and I probably have more experience litigating the charter than any lawyer in private practice in Canada does, and I've had some notable successes. So when I say that in my view this bill, if the definition of “grievous and irremediable” is left in, is unconstitutional, I say it actually with great confidence.

There are really two issues I want to address in the time I have. One is whether there is anything in the Carter decision that would allow Parliament to enact this bill, insofar as it includes the “reasonably foreseeable” phrase, the meaning of which you all know, as well as the phrase dealing with an “advanced state of irreversible decline”, and, for that matter, “incurable”. I say there is nothing in the Carter decision that allows for these. In fact, there's much in the Carter decision that is inconsistent with these words.

I've handed out a fairly lengthy brief in which I walk through many of these more technical issues, and I'm not going to repeat it in the time I have. I asked the clerk, however, to hand out something to you just now, which I only discovered after I wrote the brief. It is a transcript from the Supreme Court of Canada hearing just last January, when the federal government was asking for an extension of six months in order to allow Parliament more time to enact the law.

You should have it; it's the Supreme Court of Canada case, Lee Carter v. Attorney General of Canada. It is an excerpt of an exchange between Justice Karakatsanis and Rob Frater, the federal government's lawyer, and also Justice Moldaver.

This is very telling, I think. If you go to bottom of page 18, at line 19, Justice Karakatsanis says,

Mr. Frater, can I ask you this: Does your position on the Québec legislation mean that you accept that it complies with Carter? I'm thinking particularly about somebody has to be a la fin de vie whereas in Carter we rejected terminally ill.

That can't be any clearer. The Supreme Court of Canada, in Carter, rejected any requirement that a person be terminally ill. If you go on, there's an exchange between Justice Moldaver and Mr. Frater in which he says that the Quebec legislation is “under-inclusive”. By that he meant that it didn't go as far as Carter required, and this obviously raises serious questions about the constitutionality of the Quebec legislation.

I can tell you the way we pled the case. It was my co-counsel and I who chose the words “grievous and irremediable”; those were our words. We deliberately left out “incurable”, because “incurable” doesn't capture the necessary requirement. We used “grievous and irremediable.”

The government asked what we meant by that. As you see in our brief, we spelled out what we meant by that, and it didn't include “terminal”. Then, in argument before the trial judge, the government lawyer said—and again, this is set out in the brief—that the problem with the plaintiff's definition of “grievous and irremediable” is that it doesn't include “terminal.” The trial judge may have used the word “terminal” a hundred times in her reasons, by reference to other regimes, etc., but she didn't require that a person be terminal in order to avail themselves of physician-assisted dying.

As I said, the Supreme Court of Canada, in its ruling, in its declaration as to who was entitled to physician-assisted dying, didn't limit it to “terminal”. You may say that “reasonably foreseeable” is different from terminal. Well, it's not different from terminal; it's just that there are different ways of defining terminal. Some people define terminal in an arbitrary way as six months from the end of life”. Other people define it in a vague way, such as “at the end of life”, as in the Quebec legislation.

This bill defines it in a similar way, but it's all to the same effect. It's imposing “terminal”, and that's simply contrary to Carter. The reason it's unconstitutional is that by defining those entitled to physician-assisted dying—I guess it's supposed to be called “MAID” today, medical aid in dying, and that's fine—Parliament has excluded an entire group of individuals who otherwise would enjoy the charter rights that the Supreme Court of Canada gave in Carter, and that group is the physically disabled, whose death is not reasonably foreseeable.

In the few minutes I have left, I want to tell you—and I've set this out in my brief in some detail—that as a physically disabled man, I was very sensitive and alive to the arguments made by the disabled rights organizations, organizations whose cause I ordinarily support, but on this point I thought they were just fundamentally wrong, insofar as they suggested that all physically disabled people are not really disabled. You're going to hear from Ms. Pothier and Mr. Baker. If they don't use the term “the social model of disability”, I can tell you that their entire premise before the trial court and the Supreme Court of Canada is that we're not really disabled; we're just impaired, and that society disables us because we live in a city where there are stairs to the buildings or in which ableist society has its own notion of what a dignified life is.

I accept that there's no one conception of a dignified life, but I reject the idea that people with serious medical illnesses or conditions, whatever the cause, are capable of suffering intolerably and capable of saying that this is not a dignified life, even if most disabled people conquer their disabilities and accept that what they have to do to get through the day is not undignified. The premise of Bill C-14, insofar as it has this reasonable foreseeability clause, is that most disabled people, all whose death is not foreseeable, are somehow incapable of making an informed decision about whether or not to seek assistance in death.

I've already read—and you will hear again—that the reason for this, they say, is that the disability could be transitional, situational, or transitory, and if you let a disabled person choose death, they might regret it later. You have to try to get your head around that. The trial judge heard all those arguments and rejected them. The idea that a disability may be transitional, transitory, or situational is something that the disabled groups put to the Supreme Court of Canada. The Supreme Court of Canada rejected that, yet this bill essentially provides that all disabled people are simply taken out of the protection of rights that the Supreme Court of Canada gave them in Carter. Parliament can't do that.

Parliament can't do that by claiming that it's a section 1 justification. Section 1 was fully argued in the Carter case. Carter created a floor of constitutional rights and entitlement, not a ceiling. Parliament can provide further rights and entitlements, and the courts can provide further rights and entitlements, but Parliament can't take away any of the rights and entitlements that the Supreme Court of Canada gave to the disabled. Bill C-14 actually carves right out of the Carter decision the rights given to the physically disabled, and it can't do that.

I see that my time is up. I'm obviously open to questions.

Thank you.

[Iqra Khalid, Liberal, Mississauga—Erin Mills, ON]

Right.

We understand at the federal level, and specifically for Bill C-14, that it is an amendment to the Criminal Code, which is what we have jurisdiction over. The administration of MAID would be something that would be implemented by the provinces.

All three witnesses can comment on the following. Do you think the provinces would be able to come up with a consistent approach, specifically the self-regulation of doctors? For those physicians or medical practitioners who do not want to partake in the administration of death, would the self-regulated bodies be able to take ownership of that piece and ensure that everybody's conscience rights are protected?

[Murray Rankin, NDP, Victoria, BC]

With your analogy to a small circle versus a large circle, you're saying that Bill C-14 covers a small circle. I don't want to put words in your mouth, but the Supreme Court intended a larger circle, and they simply didn't get it right in this law. Is that your submission?

[Jay Cameron]

We say this is an unusual situation. It's important not to miss that what's happening here is the carving out of an exemption for culpable homicide. Because Parliament is carving out that exemption, we say Parliament can set the parameters with respect to who is instituting MAID and how it's being instituted.

We say the 15-day waiting period, for example, would be constitutional, because that is within the boundary of that exemption that's being carved out. We say it doesn't trench on the provincial powers. We say it's necessarily incidental for the exemption that's being carved out.

We know that the Supreme Court of Canada has given that mandate to Parliament. The expectation, when I read Carter, is that the court expects Bill C-14 to balance those rights, and that is what is conspicuously missing. We say there's nothing wrong with putting that protection in the Criminal Code power—namely, under the Criminal Code power in section 91 of the Constitution Act, 1867.

[Jay Cameron, Barrister and Solicitor, Justice Centre for Constitutional Freedoms]

Ladies and gentlemen, thank you very much for having me here tonight. I'm here on behalf of the Justice Centre for Constitutional Freedoms, which is a non-partisan, non-religious charitable organization. Our emphasis is focusing on the charter rights of Canadians, with a special emphasis on the charter rights found in section 2.

I'll start by complimenting the attorney general on Bill C-14, because I think there's much in it that's commendable. While I'm here tonight to talk about conscience rights specifically, I think it's important, given what I've heard here so far tonight, to mention that we believe that Bill C-14 gets a number of things right. It keeps accessibility to this to people who are adults. It keeps the decision with respect to access made for those who are competent at the time of making the decision. We think it gets right that an individual needs a physical ailment and that a person must be mentally sound.

A timely report was released today by what was formerly known as the British Medical Journal. It's now called the BMJ. It was released today. It's been reported on internationally. What it said was that medical error is the third-leading cause of death in the United States. I just want this committee to think about what that means. That means that the medical community, when they're attempting to save somebody's life and prolonging health, kills almost as many people—the third-leading cause of death—as cancer and heart disease in the United States. The system of reporting deaths in Canada, the U.S., and the U.K. relies on what's known as a mortality coding system. It doesn't capture death from medical failure, so it's unknown exactly how many people are being killed accidentally in Canada by the medical community.

My point in referencing that is simply this: mistakes happen, and there are people who are vulnerable in this country who need to be protected. It's apparent that they need to be protected from the very people who are being given licence right now to assist a person to die. It's with great solemnity, I think, that this issue comes before this committee.

The court in Carter said that “Complex regulatory regimes are better created by Parliament than by the courts.” It was in the context of noting the need for legislative reform to allow for medical assistance in dying that the court discussed and reiterated the conscience and religious rights of medical practitioners, stating that “nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.” That's at paragraph 132. Instead the court underlined that “The Charter rights of patients and physicians will need to be reconciled...”. It was within the rubric of reconciling those rights that the court in Carter suggested statutory balancing, statutory address. Unfortunately, Bill C-14 fails to do that.

It's our continued recommendation that, in order to comply with Carter, Bill C-14 should codify the protections for the conscience rights of physicians, nurses, pharmacists, and other health care workers, as well as health care organizations and institutions, to refuse to participate in and refuse to refer for MAID.

The applicants in Carter neither sought nor received a charter right to compel doctors or health care workers to provide or refer for MAID. Despite that fact, the colleges of physicians as well as nurses' associations have instituted requirements that their respective members participate in MAID in disregard of members' conscience rights, on pain of professional sanction and reprisal in some cases. This is Parliament's opportunity to bring uniformity and clarity to the issue of conscience rights, and was made for that reason.

I have two pragmatic reasons in addition to the reasons that were set forward before the subcommittee. First of all, tens of thousands of Canadians trust and rely daily on medical practitioners to perform their duties in an ethical and conscientious manner in the provision of service. The provincial colleges of physicians have ethical requirements for doctors, and they expect physicians to be governed by a strong sense of moral and ethical responsibility.

We say that this committee has to consider the ramifications of overriding a physician's conscience in one aspect of service and then expecting that same physician to act in a conscientious or ethical manner in all of these other service requirements.

We also say it's important for Parliament to recognize that what Carter was talking about was a balancing of rights. There is a right to die recognized in Carter, but there are also rights for medical practitioners. It's important not to lose sight of the forest for the trees. The people who under this current Bill C-14 will be implementing MAID are the people who will wake up tomorrow morning, look themselves in the eye, continue on with their daily business, and know that they performed their duties in an ethical and conscientious manner. The people who have availed themselves of MAID will be gone, but the medical practitioners will still be here.

In my respectful submission—I don't mean to be trite—is it a proper balancing, looking at somebody's life on the verge of expiring, weighed against the decades of medical practitioners who still, on a day-to-day basis, must act in a conscientious and ethical manner? Is it not disproportionate to focus solely, or almost exclusively, on the rights of patients as opposed to those who are tasked with implementing MAID?

We say it is. We say a proper balancing would never oblige an individual to participate in MAID. There have been lots of discussions about whether or not it's legal or constitutional to include a protection in Bill C-14 for conscience rights. We say it is.

First of all, it is clear that right now Bill C-14 is dictating how MAID can be implemented and who can implement it. It is making regulations. It is making laws, or it purports to make laws, with respect to how MAID is to be carried out in the province. If the province is the sole entity that can make laws with respect to MAID, then this legislation would be offside. It's clear that this is not the case. We say it's apparent that conscience rights can be protected.

I would direct your attention to the circumstances in this example, one out of a number that we've thought of. Of course, the general rule with respect to culpable homicide is that there's no killing. It's sort of similar to the general rule that if you are a Canadian individual or organization, you have to pay taxes, because federal taxes are the purview of Parliament. Charities are controlled by the provinces, under section 92 of the Constitution Act, 1867, and yet charitable organizations have to make application to the federal government to both obtain charitable status and continue it. The reason that's the case is that otherwise they would not be allowed to do what they are allowed to do, which is accept tax-exempt donations.

In summation, I'll say that there are other analogous circumstances, such as in the Civil Marriage Act, where there are enumerated protections for conscience rights. We say it would be a mistake not to codify the same in this legislation.

Thank you.

[Sikander Hashmi, Spokesperson, Canadian Council of Imams]

Thank you very much, Mr. Chair.

Good evening, everyone. I'd like to extend our thanks to each of you for all the long hours that you've put in here doing some very important work for us. Thank you very much.

In the Islamic faith tradition, neither euthanasia nor assisted suicide is supported or encouraged. However, since that matter has already been decided by the Supreme Court, our concerns and recommendations regarding Bill C-14 centre around three things: safeguarding the interests of patients in distress, minimizing errors, and conscience protection for health care providers and faith-based facilities.

Most Canadians would agree that life is sacred and that an effort should be made in most if not all circumstances to preserve it. The Koran highlights the importance of saving a life. In verse 5:32 it says: “Whosoever saves a life, it is as if they had saved humanity entirely.” Undoubtedly, the issue of assisted dying is of concern to many Canadians. Canadians are caring people. When we see others in pain and distress, we want to help.

Muslim faith leaders, along with those of other faiths, have a long tradition of caring for the ill. We have witnessed first-hand the terrible toll that illnesses and pain can take on patients and their families. We understand that in some cases, patients experiencing extreme levels of pain and suffering and those expecting the same in the future may desire an end to their life. We empathize with them, and as we draw from our faith traditions, we are instructed to pray for them to gain relief from their suffering and to try our best to make them comfortable by providing the best possible care.

We also know that when a human being voluntarily seeks an end to their life, it is a testament to the extreme pain and distress that they are experiencing or that they are fearing. It is a cry for help.

Whenever an individual seeks to end their life, we as a society know not to grant them their wish. Rather, we offer them compassionate care and assistance with the aim of alleviating the pain and distress that they're experiencing. We never assist them in ending their lives and instead make efforts to dissuade them from doing so.

Requests for death due to pain and distress caused by illnesses or disabilities should be dealt with in a similar manner.

We therefore recommend: first, that under safeguards, Bill C-14 require medical practitioners to ensure that after making a request for assisted death, patients are met by an end-of-life care team consisting of a psychiatrist, a social worker, and, if the patient so wishes, a spiritual care provider; second, that members of the end-of-life care team be required to discuss with patients the reasons for the request and present all available care options to ensure that patients are voluntarily making informed decisions; third, that the end-of-life care team and the medical practitioner confirm that all available treatments and pain reduction techniques have been exhausted and that they have not been able to make the suffering tolerable for the patient under conditions that they consider acceptable.

While Bill C-14 offers some safeguards, we believe there should also be measures in place to ensure that patients and the vulnerable are protected from errors that could have serious consequences. We therefore also recommend that the ability to provide assistance in dying, including access to substances that cause death, be limited to specially trained and certified health care practitioners authorized by the Minister of Health and the Minister of Justice.

This would entail modifying the text of the bill by adding the phrase, “authorized by the Minister of Health and the Minister of Justice” after all references to medical practitioner or nurse practitioner when referring to those permitted to provide assistance in dying.

We are also very concerned about the protection of conscience rights of health care providers and faith-based facilities. Conscience rights should be given the same level of importance as the patient's right to seek assistance in dying. In our view, the level of disengagement from assisted death should be at the discretion of individual health care providers and faith-based care facilities and should be publicly disclosed to would-be patients. This should be specified in the bill.

We firmly believe that as Canadians we must do more to provide compassionate care to those who are ill and to find better and more effective ways to alleviate their suffering and improve their quality of life. We believe it is possible for the federal and provincial governments to respect the Carter decision while promoting the sanctity and value of life.

Instead of encouraging death, let us come together to enhance and cherish life. Thank you very much.

[Prof. Jocelyn Downie, Professor, Faculties of Law and Medicine, Dalhousie University, As an Individual]

Good evening, and thank you for the opportunity to testify before you tonight.

In the time available to me I will not praise the bill, despite the fact there is indeed much to praise in it. I'll instead focus on suggestions for changes to the bill.

The reasons for these suggestions are that Bill C-14 is inconsistent with the Supreme Court of Canada's decision in Carter v. Canada. That is, it is inconsistent with the Canadian Charter of Rights and Freedoms for individuals who meet the Carter criteria. Bill C-14 is also inconsistent with the charter in relation to mature minors, individuals with mental illness, and requests made in advance of loss of capacity.

Unless Bill C-14 is amended, many individuals experiencing enduring and intolerable suffering from grievous and irremediable conditions will be left with three options. They can take their own life prematurely, often by violent or dangerous means; they can stop eating until death by starvation is not too remote or in the not too distant future, such that they will then qualify for assisted death; or they can suffer until they die from natural causes. This is a profoundly and unconscionably cruel choice.

Proposed subsection 241.2(2) unjustifiably limits access to medical assistance in dying. There are a number of problems here. First, contrary to the government's assertions, Kay Carter of Carter v. Canada would meet the Supreme Court of Canada's criteria for access, and yet would not meet the bill's criterion of a reasonably foreseeable natural death. Kay Carter had spinal stenosis. This is not a life-limiting or terminal condition.

There is no indication in it's decision that the Supreme Court of Canada thought that Kay Carter's natural death had become reasonably foreseeable in terms of temporal proximity. There was no evidence on the record before the court that Kay Carter's death was reasonably foreseeable in any temporally proximate way. In fact, it was just the opposite.

To pick but one of many possible examples from the evidence before the court, as Kay Carter wrote in her letter to Dignitas clinic in Forch, Switzerland:

The neurologist, Dr. Cameron of North Vancouver, assessed me and I had a CAT scan and MRI done. From these tests he told me that I had an ongoing, slow deterioration of the nerves that would never kill me but eventually would reduce me to lie flat in a bed and never move.

Second, the government's position on Kay Carter, mental illness, major physical disability, and Bill C-14 is incoherent. The government has no evidence upon which to conclude that Kay Carter's death was not too remote, apart from the fact that she was old. On the logic of its position, if someone has a non-life-threatening mental illness or major physical disability as their sole condition, as long as they are old, they will be eligible. Yet this is precisely what the government is trying to prevent with proposed paragraph 241.2(2)(d). So either Kay Carter didn't meet 241.2(2)(d), or Bill C-14 allows access to medical assistance in dying for individuals whose sole condition is a non-life-threatening mental illness or major physical disability. The government is trying, but they cannot have it both ways.

Third, the phrase “reasonably foreseeable” is untenable as a criterion for access. “Reasonably foreseeable” is impermissibly vague. The debate about whether Kay Carter herself would meet this criterion makes this point crystal clear. The government's suggestion that “reasonably foreseeable” be interpreted as “in the not too distant future” or “not too remote” flies in the face of common usage where it means predictability, not temporal proximity.

Contrary to claims made by the government, the meaning proposed for “reasonably foreseeable” in the government's glossary and public remarks is not consistent with the meaning of “reasonably foreseeable” in either the criminal law or tort law where it means predictability, rather than temporal proximity. That is, it means you can “foresee that” rather than “foresee when”.

I'll now turn to my proposed solution.

First, delete proposed subsection 241.2(2). Second, add “including an illness, disease or disability that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition” to proposed paragraph 241.2(1)(c). Third, add the following definition: “Irremediable” means “cannot be alleviated by means acceptable to the person”. Fourth, replace references to “reasonably foreseeable” elsewhere in the act.

Now I'll move to my second issue, namely, the exclusion of mature minors, individuals with mental illness as their sole condition, and requests made in advance of loss of capacity. It is important to note that the government has acknowledged that Bill C-14 limits the charter rights, specifically by excluding mature minors, individuals with mental illness as their sole condition, and requests made in advance of loss of capacity. However, it has failed to provide parliamentarians with any reasonable basis on which to conclude that these limits are, for section 7 rights, in accordance with the principles of fundamental justice, or for both the sections 7 and 15 rights, demonstrably justified in a free and democratic society. In other words, you have not been given anything solid upon which to base a conclusion that this bill does not violate the charter.

The government provided a legislative background document to explain why it has concluded that Bill C-14 is consistent with the charter. However, this document's justifications for limiting the rights are grossly inadequate. The document's weaknesses include the following: misrepresentation of legislation in the permissive jurisdictions; misrepresentation of data from the permissive jurisdictions; reliance on unreliable sources of evidence for claims about the permissive jurisdictions; reliance on an ethical distinction explicitly rejected by Justice Smith in Carter; reliance on assumptions that are fundamentally inconsistent with the advance directives legislation in place in provinces and territories across this country; and reliance on a staggeringly unbalanced set of experts.

Contrast it with two other significant documents that are available to help guide you in your decision-making, the report of the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, and the report of the Special Joint Committee on Physician-Assisted Dying. Given that they do not share any of the legislative background's weaknesses, I would argue that it is more reasonable for you to rely on them than on the legislative background document, and I would remind you that they both recommend against excluding mature minors, individuals whose sole grievous and irremediable condition is a mental illness, and advance requests.

As for solutions, I think the best solution here would be for you to make amendments to Bill C-14 to make it consistent with the recommendations of the provincial-territorial expert group and the special joint committee, and thereby the charter.

The second-best solution would be for you to have the provisions just mentioned, but have them come into force two years after the act receives royal assent, giving time for the development of policies and procedures and education of health care professionals and the public. However, note that this relates to how, not whether, to include these elements.

As an absolute bare minimum, I would argue that you should delete the preamble's reference to a commitment with no deadline for an exploration of the contested issues of mature minors, advance requests, and requests where mental illness is the sole underlying medical condition. Add a statutory mandate that is in the body of the act for independent expert studies of the contested issues with a prescribed and short deadline—for instance, 18 months—for reporting back to Parliament.

A mere preamble reference to a commitment to do reports on these three pressing issues is too weak when charter rights are being limited and the only question is whether the limits can be justified. Real people suffering in agony will have their charter rights limited every day until the government commissions the studies and then reports back to Parliament. They deserve more than Bill C-14 provides.

Thank you.

[Bruce Clemenger]

I was referring to the “whereas” and then the broader context of what the regime the government is planning to set up in the context of Bill C-14. That's what gives us a concern.

Also, we have a live example of the College of Physicians and Surgeons of Ontario, which is right now requiring effective referral, which is deeply contrary to the religious conscience and beliefs of many doctors. They need protection.

[Bruce Clemenger]

We believe it needs to be amended now, before it is passed, to make clear protection of conscience for both doctors and medical personnel, and also institutions that provide extended care on whose premises someone may request assisted death, should a law pass.

Again, as I said in my comments, the minister did clarify that nothing in the bill says the doctor will be obliged to. However, you look at the “whereas” statements, it's clear that they're creating a regime around Bill C-14 that will deem medically assisted death as medically necessary. Once you create that paradigm, then, in a sense, you're taking what I don't think Carter established: a right to access. It was an exemption from the application of the Criminal Code. If you begin interpreting and framing it as a right to access, then there's an obligation to provide.

The clear example would be the College of Physicians and Surgeons of Ontario, which already requires an effective referral under the current regime while the bill is being suspended for the next four months.

We think it needs to be placed. We think there needs to be a statement in the “whereas” section, clarifying that no one will be compelled to participate contrary to their conscience or beliefs. We think there could be—and you've heard this before—a parallel paragraph inserted in Bill C-14 along the lines of section 3.1 in the Civil Marriage Act to protect it. Also, there have been some proposals—and I know they've been submitted to this committee—that clarify and define Criminal Code provisions against coercion.

[Dr. Gary Bauslaugh, Free Lance Writer, As an Individual]

Thank you, Mr. Chair and members, for having me speak to you today.

I'm going to speak about an issue that could potentially affect the lives of thousands of Canadians. I'll be speaking specifically about the reasonably foreseeable clause and taking the position that was mentioned by colleagues here, that it's not necessary and is problematic.

My hope and the hope of many other Canadians is that the new legislation will prevent situations like that of Sue Rodriguez, who in 1993 was refused permission to get assistance in dying even though she was facing a situation she could not bear to live with, the prospect of long-term and almost total paralysis. Once paralysed she would be unable to do anything to end her own life, which of course would have been perfectly legal. Suicide is legal in Canada, of course, but she was legally prohibited from getting assistance with this legal act.

She did eventually get help from an unknown sympathetic doctor who risked his or her own freedom to save Rodriguez from the grim fate the law said she just had to endure. This is not good enough for a civilized country. Many of us thought that Bill C-14 would help people like Sue Rodriguez and others who find themselves, to use the Supreme Court terminology, with a “grievous and irremediable medical condition”, or to put it in other words, we hoped that the new legislation would be the solution for people in a condition of unrelenting, inescapable misery.

Unfortunately, Bill C-14 would not have helped Sue Rodriguez. This is because of proposed paragraph 242.2(2)(d), which specifies that in order to be eligible for medical assistance in dying, natural death must have become “reasonably foreseeable”. Presumably whatever this means, it must mean something to do with death being imminent. Death was not imminent for Sue Rodriguez. She might have gone on living for years trapped in her paralyzed state.

A similar conclusion about the bill was arrived at by the family of Kay Carter, who was a central figure in the B.C. Supreme Court case that led to the unanimous ruling of the Supreme Court of Canada to strike down our assisted suicide law. Kay Carter was not about to die naturally when she went to Switzerland to get aid in dying, yet her case was at the heart of the decision of the courts. Surely now denying assistance in dying to people like Kay Carter would be a violation of the spirit of the decision of the courts.

Of course, there would be other consequences of the reasonably foreseeable clause. Some people would be forced to go on living in a state of grievous and irremediable suffering. Those with money would simply go to Switzerland. Those without money would simply be out of luck. Some of the unlucky ones would choose very grizzly means of dying, such as shooting themselves, jumping off a high place, or starving themselves. Some attempts at suicide, such as taking an overdose of some drug, may fail, possibly leaving people in worse shape than before.

We can anticipate new charter challenges on this reasonably foreseeable clause if the bill stays as written. But if Rodriguez and Carter would not have been helped by Bill C-14, I began to wonder who would be.

My recent book, The Right to Die, catalogues all the major assisted death cases in Canada since 1941. There were 35 for which a reasonable assessment could be made. Most of the individuals involved in those cases, like Sue Rodriguez and Kay Carter, would not have been helped by Bill C-14. Of the 35 cases, 27 or 77% would not have been helped by Bill C-14. Of those 27, by far the largest number, 19, would likely be excluded by the reasonably foreseeable clause. This is shown in the table that I handed out earlier, where cases are all listed with an assessment of how each might or might not have been affected by the new law.

Thus we have a bill that does not help most of the people who need such help. The main reason is the reasonably foreseeable clause, as judged by my analysis of real Canadian cases. It does not help those who actually need help most. Why do I say that? If a person is about to die anyway, helping them along can indeed be an act of kindness, but with death imminent anyway, their relief from suffering is limited to the short period of time left. It is surely an even greater kindness to provide wished-for assistance in dying to those with grievous and irremediable suffering that might go on for years.

There are other issues one could take up with Bill C-14, for example, the matters of mature minors and mental illness, which have been talked about a lot today. However, these are rare. No examples came up in my survey of Canadian cases. Moreover, the issue of advance directives is an important one. It came up four times out of 35 cases in my analysis. It is a complex issue, and I don't argue with the bill's treading cautiously here.

The reasonably foreseeable clause, however, is a very big problem. It seriously limits the good we can do with this legislation. The bill is about granting mercy to the suffering. Is there any good reason why such mercy should be a rationed commodity? Why should our compassion be limited to those are on the verge of dying? All of those—not just those who are about to die but all of those—in a condition of grievous and irremediable suffering, in a state of misery that cannot be fixed, deserve to have their wishes respected. All of them should have access to assistance in dying.

Thank you.

[Richard Fowler, Canadian Council of Criminal Defence Lawyers]

Thank you for this opportunity.

As this committee appreciates, from hearing the many presentations, medical assistance in dying is and will likely remain a subject that deeply divides people, based on ethical, moral, and religious beliefs. It is because of this that those medical and nurse practitioners who choose to provide medical assistance in dying—and I emphasize the word “choose”, because it's their choice—will, not surprisingly, find their actions carefully scrutinized to ensure compliance with the law. I wish to briefly explain how the law, as presently drafted, fails to protect medical and nurse practitioners who, acting in good faith, make mistakes in providing medical assistance in dying. In other words, what could happen to a doctor or nurse who fails to appropriately apply all the safeguards? Bill C-14 essentially sets out an exemption for what would otherwise be a culpable homicide—and that has to be emphasized—more specifically, first degree murder, an illegal act intended to cause death, which did cause death, and was planned and deliberate. Proposed subsection 227(1) of the act provides that a medical or nurse practitioner does not commit a culpable homicide if they provide medical assistance in dying in accordance with proposed section 241.2 of the Criminal Code.

In other words, failing to comply with all of the safeguards and other provisions in proposed section 241.2 would, potentially, leave a doctor or nurse liable to being prosecuted for a culpable homicide. The only logical culpable homicide would be first degree murder, which as you all know, has a minimum life sentence and minimum parole ineligibility of 25 years. So, that's what they have hanging over their heads, as it stands at the moment, with one exception, which I'll come to in a moment, if they get it wrong in good faith.

You have all seen and been referred to the eligibility requirements and safeguards. They are rightly stringent, but they also include matters over which different people, different doctors and nurses, might disagree, particularly, for example, on questions of whether death is reasonably foreseeable. You heard, I think, earlier today a doctor talk about the fact that foreseeability of a death is something that doctors can disagree about. It is because the safeguards are so stringent that it is easy to see how a doctor or nurse might make an honest error.

For example, a request for medical assistance in dying must be signed and dated before two independent witnesses. Proposed subsection 241.2(5) defines who is or is not independent. For example, a person is not independent if they are a beneficiary under the will or a recipient in any other way of financial or other material benefit resulting from the person's death. It is the doctor's or nurse practitioner's responsibility to make the evaluation of independence. What steps must they take? What degree of inquiry must they make to fulfill this requirement? Do they need to go looking for the will? Do they need to speak to the person who is seeking to die? What level of inquiry is necessary to determine independence? If it later turns out that one or both of the witnesses were not independent, the only defence available to the doctor or nurse would be that their mistake was reasonable. Proposed subsection 227(3) of the act provides a defence if a person makes a reasonable mistake in respect of any fact that is an element of the exemption. In other words “reasonable” means by some objective standard, standards that we don't yet know. You've heard that from other people, because this legislation hasn't come into force. A doctor or nurse who had made a mistake, who acted unreasonably but honestly, in that they believed what they were doing was correct, would not be able to avail themselves of that defence in proposed subsection 227(3). It's what we call in law the difference between a reasonable mistake and an honest mistake. One is objective and one is subjective. A person who makes an honest mistake can still be liable to be prosecuted for murder. They act in good faith but they make an honest mistake.

It is our submission that limiting the defence in proposed subsection 227(3) to only reasonable mistakes rather than honest mistakes—a distinction that is very meaningful in the criminal law—is wrong and potentially unconstitutional, particularly with regard to any prosecution for murder, because, as I'm sure many people here will appreciate, you can only be convicted of murder if you have the appropriate subjective state of mind. It's not measured by any objective standard. However, this exemption is measured entirely by objective standards.

It is our submission that proposed subsection 227(3) should be amended to read:

For greater certainty, the exemption set out in subsection (1) or (2) applies even if the person invoking it has an honest but mistaken belief about any fact that is an element of the exemption.

Thank you.

[Greg DelBigio, Canadian Council of Criminal Defence Lawyers]

Thank you very much.

The CCCDL was formed in 1992. It has executive representation coast to coast to coast. We are very pleased to have been invited to be here to assist this committee in respect of this important legislative proposal.

Mr. Fowler and I will both be presenting. We are both practising lawyers in Vancouver. I'll make preliminary remarks, and Mr. Fowler will follow. We'll address legal and constitutional issues rather than issues that relate to beliefs and policy.

The Supreme Court of Canada decision in Carter began what is sometimes described in the law as a dialogue between the courts and Parliament. Now, to be constitutional, Bill C-14 must conform to what Carter addressed. Carter defined minimum requirements. Future litigation, I would urge, is to be avoided. It's expensive, it's time-consuming, and it is unfair to those who might avail themselves of this legislation.

The Supreme Court of Canada ruled, and that presents Parliament with options. Option number one is to do nothing. Of course, then, if nothing is done, the legislation will fall, and then there's a legislative void. Option number two is to enact law in accordance with Carter. Option number three is to enact a law that goes beyond what Carter says and what Carter addressed, for example, mature minors. It's my position that it is an example of an issue that is beyond Carter. It doesn't mean that it cannot be included, constitutionally or lawfully included, but it's not necessary to include.

The language that you choose can suffer from legal defects in one of two ways. One is over-breadth, as was addressed in Carter, and that is if the law captures more than is necessary to achieve constitutional objectives. A second way in which language can become legally defective or constitutionally defective is if it is vague. I suggest that, as you're contemplating language to address any of these provisions, you ask yourselves if there a common meaning. Is there a usual meaning? We heard discussion earlier that there may be an agreed-upon meaning within certain medical spheres. Ultimately, though, the meaning of a law is going to be up to a court, and it has to be sufficiently precise that it lends itself to interpretation by the courts.

The issue in Carter was whether it a crime to assist another in ending his or her life. The language of Carter, the constitutional language that resulted in the court striking the legislation, was based upon autonomy, dignity, and the need to protect the vulnerable. The conclusion was that “the prohibition on physician-assisted dying is void insofar as it deprives a competent adult of such assistance where” they give clear consent and have “a grievous and irremediable medical condition”. It is our position that the inclusion of the language of “natural death has become reasonably foreseeable” was not contemplated by Carter. It is a restriction, and, again, Carter addressed restrictions. The reason that the legislation fell is because the restrictions were inconsistent with the autonomy. I suggest to you that it is not necessary to include that limiting language.

More importantly, there are two further concerns. The inclusion of that language might give rise to challenges based upon issues of vagueness. What does it mean? Is there an agreed-upon meaning? Can that meaning be properly understood? Because it is a limitation, it might well invite further litigation, and that, I suggest, is to be avoided.

[Julia Beazley, Director, Public Policy, Evangelical Fellowship of Canada]

We are very concerned about the impact going down this road will have on suicide prevention efforts, on attitudes toward suicide, and on rates of suicide generally. In the long term, we believe this will impact the way Canadians understand suffering and the way they respond to it. We appreciate the statement in the preamble recognizing the lasting harm of suicide but feel the legislation needs to contain a stronger statement, acknowledging that suicide is a tragedy that hurts families and communities. We also ask that it be clearly stated in the preamble that the prevention of suicide remains a crucial public policy objective.

We would like to caution the committee against defining hastened death as health care. While this is not done explicitly in the bill, it is implied in the clauses in the preamble relating to the Canada Health Act and to the importance of a consistent national approach to health care. In nearly all public statements from the ministers it is clearly being framed as a form of health care or a medically essential service, as evidenced by the name “medical assistance in dying”.

First, we object to the notion that to deliberately hasten a person's death can be considered health care. Second, what the court allowed for and what the bill does is to create exemptions to Criminal Code prohibitions against culpable homicide and assisted suicide, which is solely federal jurisdiction and needs to remain there. To define this as health care is to relinquish that jurisdiction, and we urge caution on that point.

Further, if hastened death is defined as health care and accepted as such, it will become very difficult to deny access to anybody on any grounds. Such framing of the legislation sets it up for charter challenge.

We were relieved that Bill C-14 does not allow access to hastened death for individuals with mental illness or whose suffering is primarily psychological, but we note with concern that the preamble suggests that it is not so much a firm “no” as it is a “not yet”. We believe the risks to vulnerable Canadians are far too high to allow this. It should be an unequivocal “no”. To this end, in proposed paragraph 241.2(2)(c), we recommend that the words “or psychological” be deleted, so that the provision describes a condition that causes “enduring physical suffering that is intolerable” to the individual.

On the subject of reasonable foreseeability, we were advised by a lawyer that this concept comes from civil and criminal negligence laws. In the context of hastened death, a vague legal concept is not an appropriate criterion. Since under Bill C-14 it is doctors and nurse practitioners who will be the gatekeepers of eligibility, the criterion must be one that is medically understood and assessed. We suggest that “reasonably foreseeable” be replaced with either a specific time frame, such as six months, as in the state of Oregon, or “at the end of life”, as in Quebec. While there is still imprecision and guesswork in either of these concepts, they at least reflect the kind of assessment and judgment that medical professionals are accustomed to making, and therefore are much more appropriate.

We are very concerned that patients will be vulnerable to choosing hastened death if quality palliative care is not available to them as an option, so we affirm wholeheartedly the many calls you have heard for the importance of improved access. As Dr. Branigan said yesterday, we must make the right of access to palliative care as robust as the right of access to assisted death.

We recommend that proposed subsection 241.2(3) be amended to include a requirement that the medical or nurse practitioner ensure that the patient has had a palliative care or other professional consultation to ensure they have been fully informed about the range of available treatments and supports that could ease their suffering. We also affirm the recommendation of the Canadian Society of Palliative Care Physicians that the preamble include a commitment to the establishment of a national palliative care secretariat.

As an additional safeguard, Bill C-14 should require an independent prior review of all cases of hastened death. One way to do this, as you have heard, would be to extend the current requirement for judicial oversight as established by the court when the deadline was extended.

You have heard testimony about the efficiency of the consent and capacity boards in certain provinces. The key for us is this prior review of each case by more than just the two assessing physicians or nurse practitioners. Whether it is by extension of judicial oversight or some other mechanism, we strongly recommend that a straightforward, efficient system can and should be developed for independent prior review of all cases.

[Bruce Clemenger, President, Evangelical Fellowship of Canada]

We appreciate the opportunity to appear before you this evening.

The Evangelical Fellowship of Canada is a national association of evangelical Christians. We were intervenors in the Rodriguez and Carter cases and have appeared numerous times before parliamentary committees on related issues.

Our affiliates include over 40 denominations comprising 7,000 congregations. Pastors and church members regularly care for people in crisis and those who are nearing death. Some of our denominations have extended care facilities and hospices.

The issue before us is how we as a society respond to the suffering of others. We believe the appropriate response to suffering is care, comfort, and compassion, not the hastening of death. Our belief in and commitment to the sanctity of human life and our calling to care for vulnerable persons animate the care we provide.

It is on this basis that we oppose the decriminalization of assisted suicide and euthanasia, but as the government is proceeding with legislation, we are calling for protection of conscience and religious freedom, for the strictest possible safeguards in order to minimize harm and risk to vulnerable persons, to ensure that occurrences are rare, and to protect our society's commitment to the respect for life.

On the matter of freedom of conscience and religion, the minister, when she appeared on Monday, said that this legislation does not compel medical professionals to participate in MAID. While that is technically correct, the minister also said that MAID is now considered “medically necessary” treatment. This places conscientious-objecting persons and institutions at risk of coercion.

Actually, in looking at it today, someone pointed out to me that proposed subsection 227(4) creates an exemption to section 14, which appears to, at least, delete the caveat of “no person is entitled to”. That seems to create an entitlement “for”.

Our concern is that creating a right establishes a corresponding obligation. If you accept the premise that medical aid in dying is a right, you have an obligation to protect, we submit, the freedoms and rights of doctors and other medical professionals.

The College of Physicians and Surgeons of Ontario, as you've heard, has already decided that all doctors must make effective referrals regardless of conscientious objection. What will this government do to protect medical professionals from being coerced to participate in the killing of another? Even in times of war, conscientious objectors were exempted. Medical practitioners must have the right to refuse to participate in physician-hastened death, either directly or indirectly, for reasons of conscience or deeply held beliefs, including the right not to make a referral.

Also, there has been no commitment made to exempt objecting institutions, thus protecting their staff and the communities that provide care, which we feel is equally important. We recommend that protections be included by express statements in the preamble of the bill. We also strongly recommend that conscience protection be included in the legislation as a stand-alone provision in Bill C-14, or as an amendment to the Canada Health Act, or by creating a Criminal Code offence that prohibits coercion of patients, medical care providers, and institutions in relation to medically assisted dying.

Did you know that the Bank Act forbids a bank from coercing someone to obtain a product or service as a condition of receiving another service, or that it is an offence to coerce someone either to belong or to refuse to belong to an artistic group? We are talking about hastening the death of another in this context. How much more important is it to protect the conscience of medical professionals and institutions?

[Dr. Carolyn Pullen]

I will comment first on that. From the nursing association's standpoint, we are comfortable with Bill C-14 as it is currently drafted, with the recommendation that the trifecta of age, mental illness, and capacity assessment, or advance directive, be studied in an expedient manner and in a thorough manner in the coming days. As the legislation stands right now, we are satisfied with that content and the safeguards it includes.

[Prof. Dianne Pothier]

Thank you. I appreciate the opportunity to be here.

My expertise is in constitutional law, including charter law. So that's where I'm coming from. Given the limited time, I'm focusing on the constitutional validity of the definition of grievous and irremediable medical condition in proposed subsection 241.2(2).

I think it's important to get the point that in some ways it's as significant what the Supreme Court of Canada in Carter 2015 didn't say as much as what it did say. The Carter decision, in paragraph 95, refers to the protection of the rights of vulnerable peoples as the constitutional rights of vulnerable peoples, but they don't elaborate on that. That wasn't the nature of the claim before them. They acknowledged that there were constitutional rights of the vulnerable, which they didn't elaborate on in the decision, but that's part of the context of what you have to do in responding to the Carter decision.

In analyzing both section 7 and section 1 and acknowledging the protection of the vulnerable, the real challenge in this context is that the vulnerable are not going to self-identify when they appear in this process. The point of saying we're talking about the constitutional right of the vulnerable is that it's for people who are not well placed to identify and defend their own rights. They're going to present as people who want to die, and the issue is, is this a matter of being at a time of weakness and saying you want something, which, if you had the opportunity to reflect on, you would change your mind about, while if your current wish is acted upon you'll never have that opportunity because you're going to be dead.

The issue is complicated by rights that are in a sense competing, but they're competing in an unusual way, because we're talking about difficulties in identifying the people who need protection.

I want to focus particularly on the provisions of proposed paragraph 241.2(2)(b), which is the advanced decline section, and proposed paragraph 241.2(2)(d), the reasonable foreseeable death sections. The question is whether those two limitations are constitutionally valid.

Lots of folks, including those next to me at this table, have said that since those provisions weren't referred to by the Supreme Court of Canada and Carter, that means you can't do that. I'm afraid that's not a very strong analysis, because, again, it's what they didn't say in terms of comparing it to what they did say.

With regard to proposed subsection (241.2(2)(b) about advanced decline, before Justice Smith at trial, the Quebec legislation wasn't in force yet but the Quebec committee recommendation was before her and she picked up their language in terms of advanced decline and capability, and put it into her declaration of invalidity. The Supreme Court of Canada did not incorporate it. They didn't disagree with it; they didn't agree with it. They didn't even acknowledge that she said it.

So to say that by completely not commenting, not even acknowledging, this issue they somehow pronounced upon it is a very extreme interpretation of what the court is doing. It didn't comment at all and it's the language that's picked up in the Quebec legislation and it's picked up in Bill C-14. A reasonable interpretation of the Supreme Court of Canada not commenting is that they're handing it over to Parliament for Parliament to exercise its best judgment.

Similarly the issue of reasonable foreseeability of death is not referred to in Carter, but before Justice Smith, before the Supreme Court of Canada, they canvassed the North American history versus the European history. In some of the North American versions, they do have some sort of end-of-life limitation. European ones don't.

You might have thought they should say what is good and what is bad, and what are the pros and cons. They don't enter into that analysis. Therefore, it seems clear to me that they're saying they haven't preordained what should happen here, and they are sending it back to Parliament for you to decide whether an end-of-life stipulation of some sort is appropriate here. I think the first point is that the Supreme Court of Canada leaves this open.

If you need confirmation that this is what they're doing, they told us that in Carter 2016 at the time when they were granting the extension of the suspended declaration of invalidity. They made a point of saying that they expressed no opinion on the Quebec legislation. The Quebec legislation has both of the things in proposed subsections 241.2(2)(b) and (d). Proposed subsection 241.2(2)(d) is a slightly different version of it, but it's in the same ballpark in terms of being an end-of-life stipulation.

The court has handed it back to Parliament to decide, but the question still is, if you choose to put in proposed subsections 241.2(2)(b) and (d), is that consistent with section 7 of the charter? My analysis is that it is consistent for both of them. At trial, Canada argued before Justice Smith that if there's even one person who wrongfully ends up dead because of this, that's enough to warrant an absolute ban on physician-assisted death. Justice Smith said that's going way too far, both as a matter of the principles of fundamental justice and as a matter of the section 1 defence for the government. That's going way too far.

Neither Justice Smith nor the Supreme Court of Canada said that there's some magic number here, but they're clearly saying, on the assumption that with safeguards, the risk of error or abuse, of having people prematurely die who ultimately would have changed their minds if they'd had the opportunity.... But if the risk of that is low—

[Dr. Carolyn Pullen, Director, Policy, Advocacy and Strategy, Canadian Nurses Association]

Thank you for this opportunity to suggest amendments to the draft wording of Bill C-14 on behalf of the Canadian Nurses Association.

We are the national association for 139,000 registered nurses across Canada, including nurse practitioners. My name is Dr. Carolyn Pullen.

CNA welcomes the federal government's moderate approach to this challenging legislation, and we support the expeditious passing of this bill. CNA strongly endorses the stated intention to work with the provinces and territories on a pan-Canadian care pathway for end-of-life care, which has the potential to reconcile issues related to access and conscience. We are lending our support to harmonized implementation of MAID across jurisdictions by convening nursing stakeholders, including regulators and educators, to develop a national nursing framework to guide nurses in the implementation of MAID.

The CNA recommendations for amendments to Bill C-14 are based on our view that it will best serve patients and health care providers if the legislation can be clearly understood, is possible for professionals to demonstrate in practice, and is practical to implement in the best interests of the patient. In accordance with these principles, our written brief suggests three amendments to the language used in the draft bill.

Our suggested amendments would remove the criteria that refer to “incurable and reasonably foreseeable death”. We respectfully offer an expanded definition of “grievous and irremediable medical condition”, which we believe is in accordance with the Carter decision, which focused on intolerable suffering rather than on timelines for death. By making the amendments we suggest, section 241.2(2) could be deleted from the bill.

The current wording used in section 6(a) and (c) that address independence of practitioners is also problematic. As written, these clauses leave room for questions about business relationships between practitioners as well as factors that could affect the objectivity of practitioners. For instance, if practitioners have only referred patients to each other in the past, does that imply a business relationship? In small communities, does simply knowing each other imply a relationship that affects independent practice? Confusion about the meaning of these clauses, if left as is, could lead to delays in access to MAID, particularly in rural and remote settings, where the numbers of health care providers to draw on may be limited.

While fully supporting the need for these important safeguards, here the CNA suggests revising these clauses so that they can be more clearly understood, demonstrated in practice, and practical to implement in the best interests of the patient.

Thank you for the opportunity to deliver these prepared remarks and to contribute to this important process.

Second Reading

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

Madam Speaker, I feel very fortunate to rise to speak to this issue today. Unfortunately, as you mentioned, I will not have the full time. I was hoping to speak fully on the issue, especially on behalf of the constituents who have continuously contacted me in my office with their concerns over the issue. I feel unfortunate for those members who have no ability to speak to the bill because of the closure that was forced upon us by the Liberal government.

An issue of this importance should not be forced through closure, as has been done today. This needs to be fully debated to the fullest extent. I am appalled at the other side for what it has done to us here. We need to fully consider all the implications of what is being presented in the bill. There are so many details missing in the definitions and in the possibilities down the road.

I want to relate a personal story here that expresses why I am so concerned about what is missing and why I want to ensure all the safeguards possible are put in place in the bill.

A few years ago, I had the honour and the burden of being the authorized representative for my mother in the final years of her life. Her health was gradually degrading through dementia and diabetes, to the point where it was getting difficult to have just a regular conversation with her. In fact, in the final few months it got to the point where she knew what a telephone was, but she did not know to answer it when it rang, or how to dial it anymore. Having done that for decades, she could no longer associate what to do with the telephone.

After three or four months of that, just before Christmas she became quite ill with the flu. We were not sure if she was going to be able to pull through or not. Whatever that illness did to her in her state of dementia, we are not sure. However, we were fortunate enough to visit with her on Boxing Day. We went in to see her. She had fully fluent and cohesive conversations with us. Not only that, earlier in the day she had picked up the telephone and phoned every one of my five siblings, dialing their phone numbers from memory. That was something she had not been able to do for months.

Right now, many people will look at dementia and some of these degenerative diseases as being incurable, but that day, that very short period of time proved to me that it is not always the case.

Therefore, when we are considering Bill C-14, every last one of us as members of Parliament really need to consider this because we are making a decision that is going to impact not just us in the House but the physicians and caregivers out there dealing with these patients, and with possibly many lives down the road.

I am appalled that we have closure on this today. I certainly hope that what goes to committee and what comes back does not open the floodgates to all the dangerous slippery slopes we see down the road.

[Maureen Klenk, Past President, Canadian Association of Advanced Practice Nurses]

My name is Maureen Klenk and I represent the Canadian Association of Advanced Practice Nurses. I am proud to be a nurse practitioner. I believe I may be the only nurse practitioner who will be presenting to you.

I would like to forward three concerns.

First, although Bill C-14 uses legal language, its primary purpose is to provide Canadians and health care providers with protection and accessibility for medical-assisted dying. Counselling is an everyday activity within every patient exchange. There will be much counselling between the time when a patient requests medical-assisted dying and the provider actually writing the prescription. Therefore, we believe the exemption for medical assistance in dying must include both clauses (a) and (b).

Second, an age restriction and requirement is discriminatory. A 16-year-old with a brain tumour will suffer as much as a 36-year-old, and their prognosis is the same. Yet, we do accept as lawful a 16-year-old signing a surgical consent for his two-year-old daughter.

Third, the terms serious and incurable are not medical terminology and provide the practitioner with no descriptive value.

Also, what is a natural death for a 60-year-old who has ALS? He's not going to die from natural causes. His death is going to occur from the horrible complications of ALS. When would a health care professional know that this 60-year-old's death was reasonable and foreseeable? We believe this is not a measurable term in any context.

CAAPN recommends the removal of clauses (a) and (d) from 241.2(2).

Thank you for the opportunity to contribute to this important process.

[Ahmed Hussen, Liberal, York South—Weston, ON]

This is for the Canadian Medical Association, either one of the representatives.

I'd like to know if you have any concerns with respect to Bill C-14 and whether patients will have difficulty accessing medical assistance in dying as it moves forward.

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

Madam Speaker, I want to note that after two and a half days of debate, I will be one of the last few speakers of the one-quarter parliamentarians who were actually allotted the opportunity to speak at second reading of Bill C-14. However, I do not want to waste my time raging against that particular issue, because we have an important debate in front of us.

I have watched with envy when some of my colleagues have been able to articulate a really clear position on the legislation, both for and against. Truly, it is going to be with no ease that I will make my vote tonight. It is a very difficult decision for many.

I want to start with a quick reflection on some of the facts about this case and really the two cases that were with the Supreme Court of Canada which ultimately ended up in very different results.

I have heard again and again that the public sees Sue Rodriguez and Gloria Taylor as remarkably similar in terms of the struggle they were having with ALS, which of course is a horrific degenerating neurological disease. Notwithstanding those very similar fact patterns, the 2015 Carter decision did not follow the 1993 precedent and, indeed, was really a completely contradictory position which struck down a 21-year-old law which declared physician-assisted suicide as an indictable offence.

It is an age-old argument that the court should interpret laws and not make them. I actually do acknowledge that the Charter of Rights and Freedoms requires interpretation by our courts, but I would also like to argue that once an interpretation is given, the offering of consistent rulings makes sense to the general public.

As societal views change on any particular issue, it is the responsibility of the legislative branch to adapt to changing public values.

I do want to reject the statements that many have made that Parliament was not willing to consider the issue. In 2010, there was a vote. I remember that my colleague Steven Fletcher spoke very eloquently. He had a private member's bill. I have no doubt we would have dealt with this issue again in this Parliament.

I also want to note that Quebec and many countries took a long time, six years, 10 years, to craft a piece of legislation to talk to their communities.

The Supreme Court of Canada's decision affects every Canadian, and every member of Parliament, I believe, had a responsibility to talk to their constituents in detail.

I did send a letter to every household in my riding right after the Supreme Court of Canada decision. This was consultation before the last election. Of the over 1,000 responses I received, approximately 70% recognized there were some cases where they believed that physician-assisted suicide might be important.

Then we had the actual legislation. I made a commitment and said that if anyone wanted to join me in a round table, I would give them every minute of the last constituency week.

As members can imagine, we had round table after round table, including round tables with physicians and seniors groups. They were powerful discussions. They were divisive discussions. People had very different perspectives, but I think there are three areas that they did agree upon.

Palliative care has to be improved. There is no question about that. I did some quick calculations. That $30 billion over four years, in terms of a home care budget in the health authority I represent, is actually a pittance in terms of their being able to change a palliative care system.

Again, everyone agreed that there is a slippery slope and that there is no confidence that we are not going to head down that slippery slope. As a result, two recommendations were made.

One recommendation was that two physicians may make a decision but a social worker and a psychologist should inform the physicians' decision, or alternatively, there should be a judicial review process. I think those were important considerations. They absolutely 100% believe that the protection of health conscience rights of our providers must be in federal legislation.

I will reflect on a few comments from those opposed and from those who were supportive, and then I will conclude.

People opposed to the legislation were not opposed to any technical pieces of the legislation but because they believed we were talking about murder, a profound diminishment of respect for life, and that vulnerable individuals would choose to end their life if they felt they were a burden.

I would like to quote a physician who sent me an email. He said, “I certainly have some concerns with the proposed legislation and would not feel comfortable in bringing about a patient's death. That is not why I went into medicine. I am actively involved in palliative care and believe this is a compassionate and crucial service to people near the end of their lives. Sometimes it's messy and life spills all over the floor. It seems to me that sometimes families want to avoid the challenge of lovingly caring for these individuals. Our society likes tidy, convenient outcomes. It seems to me that this is frequently the motive underlying assisted death. I would take great exception to legislation that would force me to refer someone on for assisted suicide against my conscience. I would certainly explain to the patient that there may be other physicians that would be willing to assist them and taking their life”.

That was from one of the very reputable physicians in the community that I represent. Again, in these round tables there were community members both in support and against the legislation.

We had an 80-year-old woman come to a session who wanted that option available to her. She did not have to worry about family and said that it was strictly something that she wanted for herself.

Another constituent, who joined us, talked about being with her stepdad and dad when they died. She talked about the very awful, tragic end that both of them had in spite of the best palliative care that was available. She expressed how awful it was.

I think she would have rejected the physician's characterization that she would choose that end because it was tidy or because she did not have the compassion. She was clearly willing to do whatever she needed to do to help her stepdad and dad, but felt that they needed better options.

Probably one of the most emotional conversations was when someone said, “I respect your opinion on this issue, and I know that you believe it is wrong, but can you please respect mine?” Again, that dialogue was happening where there was a request of respecting one's opinion.

The legislation needs some work and certainly the commitment around palliative care is very minimal. We must have protection for the conscience rights of our health providers in the legislation. As well, we really need to reflect on providing protection for the vulnerable who feel they are a burden.

I will support the legislation at second reading for three reasons. First, I believe that ultimately it will serve Canadians better than having a legal void. Second, indications are that a significant number, a majority, in my riding do support assisted suicide and euthanasia. Finally, everyone reflects personally, and if I ever had family members with ALS or another devastating disease who said that they wanted to lie on their bed, listen to their music, look at the mountains, rather than palliative sedation at the end of their time, and that's what they choose, how could I not support them in their request to escape intolerable pain and suffering?

[Dr. Jeff Blackmer]

I think it's important to recognize that although we are both medical organizations, we come at this bill with slightly different perspectives and slightly different filters in terms of the way we interpret some of this. I have had a chance to read Dr. Stern's comments.

What I would say is that there has been a lot of discussion around clause (d) and the issue of natural death becoming reasonably foreseeable. We see this as an immeasurable improvement over the alternative, which is to leave it at grievous and irremediable, which has no meaning to physicians whatsoever, and it would essentially leave anyone with any medical condition the ability to request assisted dying.

What the wording in Bill C-14 does is it allows us to understand how grievous this condition has to be. So we would say while it may not be perfect from a physician standpoint—and I've heard colleagues who have said it provides clear guidance, and I've heard colleagues who say I'm not quite sure how to interpret that—it's certainly much improved.

If the committee felt there was additional language that could be added to further improve that, to further clarify that for physicians, we would welcome that.

We also recognize, though, that in a piece of federal legislation you cannot capture all eventualities.

[Dr. Cindy Forbes]

I think that as long as there is a provision.... Our original document did suggest two weeks, but we also suggested that in the case where the prognosis was much graver, much shorter, there be some flexibility. I think Bill C-14 actually does provide that.

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, I am honoured to have the 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).

Let me first thank the members who were part of the Special Joint Committee on Physician-Assisted Dying for this bill and for their hard work. Their work showcased Parliament at its best, what it is capable of when parties put aside politics and the best interests of Canadians are at heart, and in particular when vulnerable Canadians are put at the forefront. I would also like to recognize the members of the Standing Committee on Justice and Human Rights, who are working diligently and endlessly on this issue.

Since the debate began, we have heard many moving and deeply personal stories. These are heartfelt sentiments, some that are so moving, as I listened to their stories it brought a lump to my throat. I thought about how wonderful it is that we have Canadian democracy in this very House, where every single member was supposed to have the opportunity to voice their opinion on this very important issue.

In my view, it is a shame that the government brought forward closure. I do think it is a shame. It was not necessary. I think we could have afforded every single member the opportunity to be heard and to offer their point of view on this important bill.

This bill before us today is one of great importance and significance to Canadians from all walks of life, from coast to coast to coast. Its subject is something that has touched countless Canadians, at least to a degree. Whether caring for an ill member of their family, providing support to a friend or colleague, caring for a loved one, or just contemplating their own wishes should they be in a situation where they are forced to deal with enduring and intolerable suffering, this is an issue that truly impacts all of us.

As this legislation is quite literally dealing with life and death, it is of the utmost importance that Parliament put the best legislation forward. The rights and self-determination of individuals must be supported while simultaneously ensuring that the most vulnerable people in society are protected from harm.

This balance must, and I believe can, be struck. There is no question that end-of-life decisions can be incredibly hard on families, whether the family member is dealing with a serious condition, or the surrounding families and loved ones are witnessing the pain and suffering of their loved one. For those doing the support work, it is deeply emotional and deeply personal.

Should a person ultimately determine that they would prefer to, as many call it, “die with dignity” on their own terms, the gravity of that decision itself is enough for a family and the individual to grapple with. Over the years, we have seen the struggles of families of individuals who are fighting for their right to die with dignity go through time-consuming and difficult court battles, from Sue Rodriguez to Ms. Kay Carter.

These individuals went through the court battle, not just for themselves, I believe, but for all Canadians who wish to have the right to choose to die with dignity. For that, I thank them and their families for their courage, and the courage they have shown to have their voices heard in perhaps the most trying and critical time in their lives.

While I have not been in a situation where one of my loved ones has had to endure this kind of pain, I have known people who have. At such a difficult time, one would think that the last thing these families would want to deal with is the additional stress and hardship imposed on them because Parliament did not have the courage to act.

Parliament has been given the task by the Supreme Court of Canada, based on the ruling known as the Carter decision. The court unanimously decided that Canadians who are suffering intolerably as a result of a “grievous and irremediable medical condition” have a charter-protected right to access medical assistance in dying. On June 6 of this year, a new law adhering to this decision needs to be in place or a legal vacuum will result.

The Special Joint Committee on Physician-Assisted Dying spent considerable time listening to expert testimony and brought forward 21 recommendations in a legislative response to the Carter decision.

The very first question that needs to be answered on Bill C-14 is this: Does this legislation comply with the Carter decision? The special joint committee heard from some advocates and experts who stated that the bill would fall short. This could result in more lengthy court challenges, and more importantly, individuals, families, and medical professionals left navigating incredibly difficult decisions while operating in a legal gray area. In my view, to allow this situation to occur would mean nothing less than a failure of Parliament.

Kay Carter, one of the two women involved in the Supreme Court of Canada case, suffered excruciating and debilitating pain which left her wheelchair-bound and unable to feed herself. Fully mentally and legally competent, and possessing a fierce independence, she sought the right to choose medical assistance in dying if her suffering became unbearable. However, her condition was not considered fatal, and because the final criteria in Bill C-14 for undergoing physician-assisted death is “natural death has become reasonably foreseeable”, many experts have noted that Kay Carter would have been denied access under Bill C-14.

Surely we must question how it could be if Bill C-14 was meant to address the Carter decision, that Kay Carter and others like her, who are legally competent and suffering from serious and incurable but non-fatal conditions, would not be granted that very right under this new law.

My question for the government is quite simple: What is behind the decision to use such different terminology than was used in the court ruling?

Bill C-14 is also silent on a practitioner's right to conscientious objection. Presumably this means the government is leaving it up to the provinces to work that out. Respectfully, the Supreme Court of Canada has tasked the federal government with crafting these laws. Leaving out something as important as practitioners having the right to conscientious objection and failing to meet the test of the Carter ruling, in my view, is a failure of Parliament to live up to its responsibility.

The special joint committee recommended that the government consider the topic of advance directives. While the court was silent on this as cognitive decline and therefore legal competence was not going to become an issue for the plaintiffs in the case, the Canadian public has been vocal about this. Experts appearing at committee stated that people dealing with these sorts of illnesses, such as Alzheimer's and other forms of dementia, will be left with no legal options.

My constituents of Vancouver East have brought this issue to my attention. A Vancouver East resident wrote, “Without the option to make advance requests for assisted dying, Canadians with dementia, or other degenerative illnesses that rob victims of their competence, will be effectively excluded from access.”

It is my belief that this completely goes against the spirit of the Supreme Court ruling on physician-assisted dying.

In going forward, I hope there will be changes to this legislation to bring it to the place where it is both Carter compliant and charter compliant.

I have no doubt that my colleague the member for Victoria will continue to work diligently and consult on this very matter with experts and people affected.

I would like to point out that while the bill in its preamble cites the importance of palliative care, I hope that the government will actually deliver on palliative care as well.

It should be all of our obligation to make sure that these choices are afforded to Canadians and that in their choices, they are supported with every effort to make that choice a reality.

[Dr. Catherine Ferrier, President, Physicians’ Alliance against Euthanasia]

Thank you very much.

I'm a physician and I have over 30 years' experience diagnosing, treating, and caring for frail older people, often suffering from Alzheimer's disease and other dementia. In addition to seeing patients in the clinic, I often visit their home as a geriatric consultant to a home care service.

My professional niche, as it were, includes capacity assessment, assessment in intervention for patients and families in crisis because of cognizant, psychiatric, and social problems. I regularly see abused and neglected patients, and I often testify in court for abused patients or for those whose families are fighting over powers of attorney or inheritance issues.

I'm also the President of the Physicians' Alliance Against Euthanasia, a group of doctors who see any law allowing doctors to intentionally end the life of their patients as contrary to the goals of medicine and the good of our patients, especially the most vulnerable and those who cannot speak for themselves. Founded in Quebec in 2012, the alliance now includes over 750 doctors, each of whom has signed our declaration and is supported by more than 14,000 citizens. We are, of course, aware that Bill C-14 will legalize medically assisted dying in some form, as is already the case in Quebec. While remaining completely opposed to these acts, we offer our suggestions for amendments to the bill in an attempt to protect patients' health care environment and the integrity of our profession.

We are somewhat relieved that there is a certain caution in the bill compared with the extreme recommendations of the special joint committee. We also note that the bill does not propose euthanasia and assisted suicide as medical acts or health care, as they are in Quebec. We agree that they are neither, so it cannot be required of our profession to perform them. The international medical community maintains to this day its opposition to these practices.

Since the vast majority of desires for death are caused by mental illness, which can and often does co-exist with the medical conditions that are considered to justify euthanasia or assisted suicide in the Carter decision and in this bill, we are called to exercise extreme caution. Such desires can also be caused by feelings of hopelessness, loneliness, fear, grief, shame, lack of access to support, insufficient palliative care, poverty, unemployment, violence, and abuse. These can also be addressed by health and social service professionals.

In this context my colleague, Mr. Racicot, talked about the fact that they are not charter rights. I argue that neither are they health care. We fail to understand the concerns about access to death that are being expressed in the public debate around this law. Elderly and chronically and terminally ill Canadians do not need access to death, they need access to care—medical treatment, home care, care by family members, residential care—all of which are seriously lacking.

You just heard some descriptions of sorely lacking care of elderly patients. I would argue that the alternative to that is not to kill them but to take better care of them, which we should be doing in Canada in 2016. To facilitate access to death while remaining unable to provide the care our citizens need is irresponsible, to say the least, and is unworthy of a progressive and prosperous country such as ours.

We appreciate the government's commitment to developing non-legislative measures that would support the improvement of a full range of options for end-of-life care, as is said in the preamble to this bill, but that would have to be implemented at truly high speed if we want the choice of life to be as available as death will be before long.

If you wish to show a true commitment to life for Canadians, this bill must contain protection for patients who are at risk of constraint to choose death. As it stands, it's certainly not as bad as it could have been if you had followed all of the committee recommendations, but the criteria are still ambiguous and open to subjective interpretation. This is inevitable to some extent, because it's impossible to define an eligibility criteria that would protect everybody, but we think you can do better.

The only way to ensure patient safety in a regime of legal euthanasia and assisted suicide is to require prior authorization of the death by a judge. In practice in medicine, we use courts all the time for committing patients who are dangerous to themselves or others to hospitals, to ordering that somebody be removed from their home if it's no longer safe.

It's something that's common. It can be done rapidly. It does not need to be a barrier, and the cases we've seen in recent months in other provinces have shown it happened relatively quickly. I think this should also be done after an evaluation of the patient and the patient's situation by health and social service professionals to explore the causes of suffering, as well as any inducements to choose death that could arise from non-medical conditions and circumstances, and that measures should be taken to address these sources of suffering before accepting a request for death.

This should not be seen as gatekeeping of access to death, but rather as promoting life wherever possible, which should be the goal of the law.

I have some brief comments on the criteria as currently written. The requirement that the request be made by a capable adult is essential, but most doctors lack the skills to assess decision-making capacity, and even experts disagree in complex cases. The terms “grievous and irremediable medical condition”, “advanced state of decline in capacity”, and “irreversible decline” are wide open to subjective interpretation and could be understood to include hundreds of thousands of Canadians with serious chronic illness who would be eligible for death under this criteria.

Enduring physical or psychological suffering that's intolerable, and that cannot be relieved under conditions the person considers acceptable, is entirely subjective and opens the door to anyone refusing effective treatment and demanding euthanasia instead. The requirement that natural death be reasonably foreseeable means nothing to us as physicians. Doctors are not able to accurately estimate life expectancy until the last days to maybe two weeks before death. Before that it's a guessing game. Call it “imminently dying”, and then we know what you're talking about.

To ensure a request for death is voluntary and without external pressure requires in-depth psychosocial and family assessment by a team of professionals well beyond medicine. Even then there may be no way of knowing that the patient is acting out of guilt or protecting an abuser. The written consent waiting time and requirement for a second doctor are not protections against abuse or coercion to request death. The first two can be waived, and patients or others can doctor-shop until they find two willing doctors.

There should be no opening even later to children or people with psychiatric illness. I wrote a separate brief in my own name, besides the brief of the physicians' alliance, that speaks to the dangers of euthanasia by advance directive that we can discuss in the question period if you choose.

My second point is about what is often called freedom of conscience, but is also about protecting health care services from becoming death-promoting environments and thereby protecting patients from those environments. I suggest you include in the law a prohibition against requiring any health professional to cause the death of a patient, or to refer a patient to another person to obtain their death—even through a third party, as is the case in Quebec—and against requiring any health care institution to euthanize patients under its care or to assist in a patient's suicide.

There's no justification for imposing any duty to implement this political decision, which is foreign to the medical profession, on medicine as a whole, or on any individual practitioner or institution. Attempts to do so are already being seen, both in Quebec and in Ontario, through requirements to refer. The federal law cannot just leave this question to the provinces. In Quebec, since December, doctors who are unwilling to euthanize patients must refer them to an administrative body that will ensure the death occurs. This does not protect the patient or the professional integrity of the physician. If I were a surgeon and a patient asked me for a procedure I thought was either not going to help them or would be too risky, I would refuse to do it, and I would also refuse to send the patient to someone else who would do it. They would, of course, be free to go and find a doctor of their choosing if they wanted to.

In palliative care in Quebec, one excellent palliative care physician has compared her daily life under this law to living in a war zone. You never know when a death request is going to land on you. You can't be giving hope to dying patients in one room and euthanizing them in the next.

Another doctor retired early the day the law came into effect for this reason. Highly skilled doctors and nurses who have given years and decades to the care of dying patients are suffering burnout, taking sick leave, and being driven from the field by confrontations over a supposed right to be killed, and by threats of losing funding if they insist on caring for people rather than killing them.

Patients are refusing treatment for their symptoms because of their fear of receiving the injection without having asked for it. Some patients who attempt suicide by overdose are not being resuscitated because the notion is being promoted that people who want to die should be helped to do so instead of being saved from their suicidal impulses. We need safe spaces for patients where inflicting death is not an option, and we need to respect the freedom of those health professionals for whom it is a violation of their fundamental principles and institutions whose basic philosophy rejects it.

Patients can be transferred to another professional or another institution, if necessary. This would not cause problems of so-called access, only inconvenience at times. If the professional or institution makes their position clear, the patient need not consult them. The protection of patients should always trump access to death.

In summary, at the very least we need prior authorization by a court after a careful evaluation of the situation, as I discussed. We need to create safe spaces for patients by respecting all individuals and institutions that refuse to collaborate with inflicting death.

Thank you.

[Ali Ehsassi, Liberal, Willowdale, ON]

Mr. Speaker, of course, the reason I said that is that I have had plenty of opportunities to speak to various constituents. What I can say is that after having spoken to many constituents, they understood the context within which the bill has been adopted. They appreciate full well that the Supreme Court considered this issue. They also understand full well that many consultations went on and that what resulted from those consultations was Bill C-14.

[Guy Lauzon, Conservative, Stormont—Dundas—South Glengarry, ON]

Mr. Speaker, the member mentioned that he was very confident that the majority of his constituents would support his position on Bill C-14. I actually sent a survey to every one of the 45,000 homes in my riding and got the opposite result. As a matter of fact, 65% of the respondents are opposed to Bill C-14 and 35% are in favour of it.

I wonder if he would be willing to do that in his riding just to confirm what he is stating in the House of Commons.

[Ali Ehsassi, Liberal, Willowdale, ON]

Mr. Speaker, I am grateful for the opportunity to rise today to join many other colleagues in addressing the significant national debate surrounding Bill C-14, and our government's prompt and appropriate response to the Supreme Court's Carter decision. I believe this was a duty the previous government neglected, and I am proud of our government's response to this complex issue.

Bill C-14 represents a mandated response to the Supreme Court's Carter decision by providing a national framework to ensure, subject to necessary safeguards, access to a fundamental and inviolable right enshrined under section 7 of the Canadian charter. After all, the Carter decision transformed the question before the government from one focused on whether the government should legislate and legalized medical assistance in dying to the very different question of how fast to legislate and legalize medical assistance in dying.

Despite the clear contours delineated by the Supreme Court, I would like to acknowledge the hard work of all members of the House over the course of the past several months to contribute to this important national debate by recognizing the crucial role of the Special Joint Committee on Medical Assistance in Dying, and acknowledging the leadership demonstrated by the Minister of Justice and the Minister of Health for introducing this transformative legislation.

I would also like to thank all Canadians who have, in one way or another, participated in nation-wide consultations with their provincial and federal governments. I am very proud that many constituents in my riding of Willowdale took the time to approach me regarding various aspects of this bill, and having listened to them, I realize full well that this is a deeply important issue for many Canadians.

At the centre of the profound and solemn debate that has ensued in the House and elsewhere, have been discussions focused on such foundational principles, such as the need to respect individual rights, equity, consent and capacity, clarity, dignity, and accountability. Yet, given the extensive debate that has occurred in the House, I would like to specifically focus my remarks on two specific aspects of this bill which I believe need to be further highlighted and emphasized.

The first issue I will focus on is that Bill C-14 represents a significant first step that now requires further co-operation with our provincial and territorial partners. Second, it is important to recognize the significant safeguards embedded in Bill C-14.

One of the primary characteristics of charter rights, of course, is equal access. If charter rights are by definition universal, they must, within reason, be equally accessible to all Canadians. This is where I believe Bill C-14 comes into play by establishing a national framework for medical assistance in dying that can ensure equitable access across provinces and territories. I feel that Bill C-14 fulfills an expressed desire by our provincial and territorial governments for a national framework to address this timely issue.

I strongly believe that this legislation provides an opportunity for the federal government to facilitate a collaborative approach, which includes provincial and territorial consultation. Specifically, the bill's own preamble clearly states that the law must apply consistently across all of Canada. As such, this bill advocates for a national framework in order to avoid variations from province to province.

As we all know, the Quebec government has in many ways laid the groundwork for medical assistance in dying with their own provincial legislation. However, while provinces will continue to act as key legislative and administrative partners in medical assistance in dying, I think we can all agree that establishing a pan-Canadian, national approach was crucial.

We should continue to work with the provinces and territories to explore mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying, thus avoiding crucial gaps in access and delivery.

Furthermore, in keeping with our government's commitment to evidence-based decision-making, we will engage with the provinces and territories to support the development of a pan-Canadian monitoring system to collect and analyze data, monitor trends, and publicly report on medical assistance in dying.

This two-way relationship is important. In other words, Bill C-14 represents the beginning of a partnership on medical assistance in dying. Our provincial colleagues, informed by the framework we have provided, can now begin the process of implementing their own medical assistance in dying regimes. Quebec, of course, has already done so, while Ontario and most other provinces have begun the process through the creation of a PT advisory groups on physician-assisted dying.

Allow me now to shift to the second element I would like to address today, the topic of the safeguards included within Bill C-14.

Bill C-14 makes Canada the ninth jurisdiction in the world to legalize medical assistance in dying, not including Quebec. Fortunately, we have been able to learn from their experiences to implement safeguards that will protect the most vulnerable while also allowing suffering Canadians access to their charter rights. Bill C-14 is, therefore, a carefully and deliberately crafted piece of legislation, which learns from the best practices of other governments to legalize medical assistance in dying.

As the Supreme Court made clear in paragraph 117 of the Carter decision, the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards. Our government is committed to addressing the task put forth by the Supreme Court. We understand that this is a complex and emotional issue for many Canadians. As a result, we want to ensure that protecting the charter rights of some Canadians does not infringe upon the charter rights of others.

Bill C-14 provides strict criteria outlining precisely who is eligible for medical assistance in dying. Relatively strict guidelines are required when dealing with such a significant issue and eligibility is limited to three prescribed sets of conditions contained in Bill C-14.

Bill C-14 also includes safeguards protecting the personal convictions of health care providers. This is a fact that bears repeating as there seems to be some misunderstanding and confusion surrounding this issue. There is nothing in Bill C-14 that compels any medical practitioner to perform medical assistance in dying against their will.

As the Minister of Justice recently confirmed in her appearance before the Standing Committee on Justice and Human Rights on May 2, 2016, she said:

There is nothing in our legislation that would compel a medical practitioner to perform medical assistance in dying as you point out. The jurisdiction in terms of regulations falls to the provinces and territories.

The Minister of Health also addressed this issue in her remarks before the same committee and apart from reiterating that the issue of the conscience rights of health providers falls within the jurisdiction of the provinces, she confirmed that the federal government is already working with the provinces to develop a care coordination system for end-of-life care.

Finally, I believe the inclusion in Bill C-14 of a five-year review clause is another important safeguard. While I have the utmost confidence that the bill would address the issues presented to the government via the Carter decision, this mechanism would allow for future improvements and modifications, if need be.

Before concluding, allow me to also emphasize that Bill C-14 is part of a larger discussion around end-of-life health care. In that spirit, I am proud of the commitments our government has made toward palliative care, through a much-needed $3-billion investment over four years for home and palliative care.

I am confident that the vast majority of my constituents support medical assistance in dying and support Bill C-14. I urge my colleagues in the House to support the bill as well. By boldly, yet responsibility, reacting to the Carter decision, our government has created a workable and pragmatic national framework that would allow us to closely collaborate with the provinces and territories.

Bill C-14 marks the beginning of a new era. By addressing the expanded charter rights laid out by the Carter decision, this legislation would provide Canadians access to a long-overdue right.

The House resumed from May 3 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 second time and referred to a committee, and of the motion that this question be now put.

[Michel Racicot, Vice-President, Living With Dignity]

Thank you, Mr. Chairman.

As you know, I'm a lawyer with over 40 years' experience in computer and telecom law, so you might be wondering what I'm doing here. I'm here because I've assisted many terminally ill persons, beginning with my wife, who died of cancer at age 37 in 1985 after we had adopted three children.

I am here also because I've seen, on a daily basis and sometimes for several weeks and years, the day-to-day reality of palliative care workers attending to the needs of patients in their last weeks, days, and sometimes hours of life. I'm also vice-president of Living with Dignity/Vivre dans la Dignité, an organization representing over 5,000 citizens who are concerned about the future of our health care system and indeed about our nation.

Governments in this country take great strides with public media campaigns to try to prevent suicide—suicide of young people, of aboriginals, of Inuit—and unfortunately politicians make the headlines when a wave of suicides hits a reserve. But now we're about to authorize doctors to take their patients' lives or to help those patients commit suicide. Are we are no longer going to send emergency squads to try to persuade a person not to jump from a bridge, or are we going to send doctors to push them to their death? This is a dire reality that we are now facing.

Many have claimed that medical aid in dying is now a new charter right. Carter did not create a new constitutional right to death; the court only concluded that the prohibitions of the Criminal Code infringe on the existing rights to life, liberty, and security as guaranteed by the charter. Since the charter is part of our Constitution, the creation of a new charter right to death would have required the Constitution to be amended, which requires the involvement of Parliament and of all the provincial legislatures. This could not have been done by the Supreme Court, and the court did not create a new charter right to death, only an exemption from criminal law.

Before turning to the amendments, let me try to set our perception of what the power of Parliament is. Many have claimed that Parliament is bound to adopt a law within the confines set forth in Carter. Parliament is not held captive by the Supreme Court decision. It need not adopt a law that fits within the parameters set forth in Carter. Carter is based on the premise that the prohibition on assisted suicide and euthanasia is intended to protect only vulnerable people, not to protect all Canadians. Parliament now has the power to set the record straight and to confirm in no uncertain terms in a new bill that the prohibition against assisted suicide and euthanasia is indeed to protect all Canadians. It also has the power to re-enact those prohibitions, despite the Supreme Court decision.

As the Supreme Court itself recognized, between 1991 and 2010 this House and its committees debated no less than six private members' bills that were seeking to decriminalize assisted suicide, and none was passed. I'm calling on you. Should you ignore completely the wisdom of the hundreds of members of the House of Commons who decided not to decriminalize assisted suicide in the past? Or, should you not remind your colleagues that indeed your predecessors acted responsibly and with wisdom in rejecting this approach? You have the power and you have the responsibility to make history for our population, our children, our grandchildren, and their descendants.

Re-enacting the provisions struck in part by Carter requires political courage. It also requires all members of Parliament to be able to exercise their right to freedom of conscience protected by the charter and without being forced to vote according to a party line. This is our call to action.

Of course, if this Parliament does not re-enact these prohibitions, it can still set safeguards. Contrary to what CMA has said, our experience teaches us that these safeguards may not be sufficient to help protect all Canadians. This House has the power to prescribe, as it is said in the charter, “such reasonable limits...as can be demonstrably justified in a free and democratic society”. These limits can be more stringent that those specified in Carter.

The court recognized itself in Carter:

Parliament must be given the opportunity to craft an appropriate remedy. [....] ...issuing [a constitutional] exemption would create uncertainty, undermine the rule of law, and usurp Parliament’s role. Complex regulatory regimes are better created by Parliament than by the courts.

Let me now turn to certain amendments we're proposing.

In the order that the Supreme Court made last January 15, to prolong the extension of the suspension of their decision, the court said the persons who wanted to avail themselves of medical assistance in dying, as permitted in Carter, could apply to the superior court of their jurisdiction. And the court even said:

Requiring judicial authorization during [the] interim period ensures compliance with the rule of law and provides an effective safeguard against potential risks to vulnerable people.

We think that this reasoning is not only valid until June 6, but this process should continue beyond June 6, when Bill C-14 comes into effect. Abuses and errors are possible. We know medical errors exist, and as it concerns medical assistance in dying, an abuse or an error will be fatal. We therefore submit that Bill C-14 be amended to provide that medical assistance in dying can only be obtained with the prior authorization of a superior court.

Turning to transparency in data collection and reporting, Quebec has been now experiencing euthanasia for over four months. Several aspects have now become clearer, some of which are frankly very troubling.

One of them concerns the transparency and data collection and the reporting. Under practice guidelines issued by our Collège des médecins du Québec, a physician filling out the certificate of death, prescribed under the Public Health Act of Quebec, must enter the disease or morbid condition that warranted medical aid in dying and led to death as the immediate cause of death. This is not the manner of death—cardiac arrest—but the disease, injury, or complication that caused death.

The college goes on by stating that the term “medical aid in dying” should not appear on the certificate of death. Indeed, if this information were disclosed to family members who had not been informed, it could on one hand go against a patient's wishes to keep the information confidential, and on the other hand cause them harm.

Well, this guideline is forcing doctors to falsify the cause of death in a public document, and this is contrary to the applicable regulation that specified that the physician must indicate the cause of death in the most precise manner possible. Thus, if a doctor follows the guideline of the Quebec Collège des médecins, he might be prosecuted and be subject to a penal offence.

To address this risk, Bill C-14, proposes to add to the Criminal Code the offence of committing forgery in relation to a request for medical assistance in dying. However, the term “forgery” is not defined, and we have to look at section 366 of the Criminal Code for its definition.

In light of the Quebec experience, and of the need to monitor compliance with all required conditions to provide medical assistance in dying in the future, we strongly recommend that proposed subsection 241.4(1) be modified to include the offence of making any false declaration, by any means, to the effect that the cause of death was not medical assistance in dying, but was the underlying medical condition that justified a recourse to it.

Lastly, I'd like to talk briefly about the danger of good faith defences. Bill C-14 proposes that any person who has reasonable but mistaken belief about any fact that is an element of the exemption for medical assistance in dying should nevertheless be able to invoke the exemption from the crime of culpable homicide or the crime of assisted suicide.

Although these provisions are well intended, they do not unfortunately pass any serious examination in light of the experience that abuse of the elderly and sick persons is rampant in our society, as Dr. Ferrier, and other physicians dealing on a daily basis with these types of patients can attest. This is inviting a floodgate of abuse.

For such reasons, we recommend that these provisions of good faith defences be struck from Bill C-14.

I thank you for your attention.

[Dr. Jeff Blackmer, Vice-President, Medical Professionalism, Canadian Medical Association]

Thank you, Dr. Forbes, and committee members.

As mentioned, I will speak to the CMA's response on the core elements of this legislation. We certainly welcome questions from the committee today and at any time over the course of your important study.

First, the CMA's position is that the safeguards proposed in Bill C-14 are robust and are aligned with our recommendations. These safeguards include considerations such as patient eligibility criteria, process requirements to request medical assistance in dying, as well as monitoring and reporting requirements.

Second, the CMA supports the legislative objective to recognize that a consistent framework for medical assistance in dying across Canada is extremely desirable.

In addition to these robust safeguards, the enactment of definitions for medical assistance in dying, as well as what constitutes a grievous and irremediable medical condition in federal legislation, is essential to the achievement of a consistent, pan-Canadian framework.

Our principles-based recommendations reflect on the subjective nature of what constitutes enduring and intolerable suffering, as well as a grievous and irremediable condition, as well as the physician's role in helping make an eligibility determination.

We also support the objective to support the provision of a full range of options for end-of-life care and to respect always the personal convictions of health care providers. To this end, we encourage the federal government to very rapidly advance its commitment to develop a pan-Canadian end-of-life coordinating system. Ideally, this should be in place by June 6.

The CMA is aware that one jurisdiction has made such a system available to support connecting patients who qualify for assisted dying with willing providers. Until this system is available across the country, there may be a disparity of support for patients and practitioners from province to province.

Finally, it is our position that Bill C-14, to the extent constitutionally possible, must respect the personal convictions of health care providers by protecting the rights of those who do not wish to participate in assisted dying or to directly refer a patient to someone who does wish to participate.

We would be very pleased to speak further on this critical issue, one that is also essential for a consistent pan-Canadian framework.

Thank you for your attention.

[Dr. Cindy Forbes, President, Canadian Medical Association]

Thank you, Mr. Chair.

As you mentioned, I'm Dr. Cindy Forbes, president of the Canadian Medical Association. I'm also a family physician from Nova Scotia. I'm joined today by Dr. Jeff Blackmer, vice-president of medical professionalism. Dr. Blackmer has led the CMA's work on medical assistance in dying.

As the national organization representing over 83,000 Canadian physicians, the CMA has played an instrumental role in the public dialogue on what should be the framework to govern assisted dying. Let me recap our role. It was the CMA's position that making medical assistance in dying legal was for society to decide. We did not take a position on that question.

Following the Supreme Court's landmark decision last year, the CMA has focused its considerable efforts, consulting with physicians and the public on what the framework should be. In the course of our work, CMA has consulted directly with tens of thousands of members. Our position and remarks today are informed by these extensive consultations. Today, we are here on behalf of Canada's doctors to convey one overarching message: the CMA recommends that parliamentarians support the enactment of Bill C-14 as proposed and without amendment.

As the national professional association representing Canada's physicians, the CMA has played an important role in leading the public dialogue on end-of-life care. This in-depth consultation was instrumental to the development of the CMA's “Principles-based Recommendations for a Canadian Approach to Assisted Dying”. The CMA's core recommendations address four areas: patient eligibility, procedural safeguards, the roles and responsibilities of physicians, and ensuring effective patient access. The CMA's recommendations on these issues form our position on the overall framework to govern medical assistance in dying in Canada.

Before turning the floor over to my colleague, Dr. Blackmer, who will review CMA's response on the core elements of the legislation, I will provide our response on the overall approach.

Put simply, the CMA strongly supports the government's overall response to the Carter decision. This includes legislative and non-legislative measures. Of particular importance are the commitments to develop a pan-Canadian end-of-life care coordinating system and to support the full range of end-of-life care options, including expanding palliative care.

Finally, the CMA recognizes that there's been significant public discussion regarding the approach for the “Carter plus” issues. These include eligibility for mature minors, advance care directives, and mental health as a sole condition.

The CMA supports the approach proposed by the federal government not to include these issues in Bill C-14 and to study them in greater detail prior to advancing legislative proposals. This approach aligns with the approach taken by other jurisdictions, for example, Belgium.

I'll now turn the microphone over to my colleague, Dr. Blackmer.

Bill C-14—Time Allocation Motion

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

Mr. Speaker, it is incredibly important that we meet the June 6 deadline of the Supreme Court of Canada.

The object of this piece of legislation is to ensure that we balance personal autonomy and provide protection to the vulnerable. If we do not have legislation in place as of June 6, there will be no safeguards in place, and the medical practitioners will have uncertainty with respect to the eligibility criteria around somebody who wants to access medical assistance in dying.

The Supreme Court of Canada said two things. It said that an absolute prohibition on medical assistance in dying is unconstitutional, and it put it to Parliament to do our job, to put in place a substantive piece of legislation that reflects the diversity of views that exist in this country. That is what Bill C-14 does.

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

Mr. Speaker, this is a difficult debate because it is not about Bill C-14. It is about democracy in this place. The reason it is not democracy is that for the last four years under the majority Conservative government, we saw the illegitimate use of closure more than 100 times in this place. We looked to the new government and we believed in the mandate that there would be greater respect for opposition parties.

My faith in that was crushed by the decision of the hon. House leader to insist that Liberals at committee pass a motion that deprived me of my rights at report stage. Now we have closure on this matter.

I have the utmost respect for the Minister of Justice. I hold her in high esteem, so I ask her this question. In balancing the harms, the harm to democracy in this place versus the risk that taking the time to do Bill C-14 right might take us beyond June 6, would there be harm done? That is my key point as a lawyer. The Supreme Court of Canada decision could take effect. We could be late having royal assent and there could be a—

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

Mr. Speaker, I agree with my colleague across the aisle about the sensitive nature, the deeply emotional, and complex realities in our consideration of Bill C-14. Putting in place a medical assistance in dying regime in our country is transformative. It is a paradigm shift.

There has been substantive debate. There have been submissions made by 84 members in the House. There was ample opportunity to debate this.

Ten members from the member opposite's party had the opportunity to speak, and members from his party stopped speaking last night at 11:00 o'clock.

We need to fundamentally ensure that we meet the Supreme Court of Canada's deadline of June 6. We are endeavouring to do so to ensure we can get this substantive piece of legislation through the parliamentary process to comply with the Supreme Court's deadline.

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

Mr. Speaker, that is absolute rubbish, and it is shameful. The opposition parties were very clear that we wanted to debate the issue throughout the week. That was the initial government offer. Now we are seeing a shameful backtracking from the government.

The Liberals promised sunny ways. They promised that they would respect opposition parties in the House. I remember them promising as well that they would respect parliamentary debate in this place. They had no better opportunity to prove they would actually walk the talk than on Bill C-14, which is a non-partisan issue to which I think all members of Parliament want to give voice.

However, now we are seeing, shamefully, the use of closure to shut down what should have been a non-partisan debate through the course of this week.

What is even more appalling is that in the previous government, it would allow five days of debate. The Liberals are shutting this down after two-and-a-half days of debate, only. Why are sunny ways turning to dark ways, and why are Liberals shutting down debate on the bill after only two-and-a-half days?

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

Mr. Speaker, I am pleased to stand to speak about this. We recognize that the Supreme Court of Canada has put in place a deadline of June 6. We respect the Supreme Court of Canada in terms of responding to the Carter decision and have put forward Bill C-14 to do just that.

There has been substantive debate in the House. We have had over 21 hours of debate. Eighty-four members of Parliament, from every party in the House, have had the opportunity to speak.

We need to ensure we meet the court's deadline. We need to get this into committee so if amendments are proposed, they can be proposed at the committee stage.

I would further respectfully submit that yesterday we tried to extend the sitting hours as late as necessary to ensure that all MPs who wanted to speak had the opportunity to do so. Unfortunately, the opposition decided to limit the hours of debate.

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

moved:

That, in relation to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), not more than one further sitting day shall be allotted to the consideration at second reading stage of the Bill;

and

That, 15 minutes before the expiry of the time provided for Government Orders on the day allotted to the consideration at second reading stage of the said Bill, any proceedings before the House shall be interrupted, if required for the purpose of this Order, and, in turn, every question necessary for the disposal of the said stage of the Bill shall be put forthwith and successively, without further debate or amendment.

Physician-Assisted Dying

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Mr. Speaker, this week the Barreau du Québec submitted a brief to the Standing Committee on Justice and Human Rights that confirms that Bill C-14 on medical assistance in dying does not meet the requirements set out by the Supreme Court in the Carter decision.

I happen to know that there are a few government MPs who are also members of the Barreau du Québec, and I am sure they could confirm the credibility of the representatives from the Barreau for the minister, if necessary.

Will the government, which includes 40 MPs from Quebec, nine of which are members of the Barreau du Québec, amend Bill C-14 to address the gaps outlined by the Barreau du Québec?

Criminal Code

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

Mr. Speaker, we have heard many extremely poignant statements over the past few days in this chamber. Here are a few of them, not necessarily word for word, but the essence is there: This is by far the most crucial question we have faced in this chamber in the past 10 years. We are experiencing a fundamental shift in society. Centuries of thought are being overturned. Thousands of years of the understanding of the sacred gift of human life are being discarded.

The Liberal member of Parliament for Winnipeg Centre stated:

Perhaps this is just another step on the road of moral relativism that we are in nowadays, but even our judiciary cannot serve as a balance between the different societies making up Canada. We are in a sorry state. We have truly entered a new age, one of the throwaway culture where all boundaries are starting to crumble.

He goes on to say:

From an indigenous perspective, I look at this bill and I cannot support it, because it leads to a place where I do not believe we are looking out for the interests of all people within our society. It is not allowing us to fully comprehend the needs of everyone who makes up Canadian societies, but really, it is taking us down a path that is very dangerous, and we do not know where it ends.

This comment is true not only for our indigenous communities, but also for the overwhelming majority of all Canadians who are informed by their faith, whether that be Jewish, Muslim, Sikh, or Christian.

I want to read from a very insightful blog that I came across today.

...from its very first sentence the bill sounds the final death-knell, for all public purposes, of Abrahamic faith. The Carter/C-14 doctrine of autonomy is a clear repudiation of that kind of faith and the establishment of a new faith in man as utterly independent of God. One does not need to be Abrahamic to understand this. If the Parliament of Canada recognizes personal autonomy as extending a moral right to determine the manner and timing of one’s own death, and to take one’s own life or another’s life, it necessarily recognizes the person—and [Parliament] itself as a deliberative body of persons—as lying outside of all putative divine authority in such matters. In short, the C-14 preamble is the final repudiation of the Charter preamble. “The principles of fundamental justice”...now operate independently of any reference whatsoever to the supremacy of God. The link between “the supremacy of God and the rule of law” is decisively severed.

He then goes on to quote Nietzsche:

What were we doing when we unchained this earth from its sun? Whither is it moving now? Whither are we moving? Away from all suns? Are we not plunging continually? Backward, sideward, forward, in all directions? Is there still any up or down? Are we not straying, as through an infinite nothing? Do we not feel the breath of empty space? Has it not become colder? Is not night continually closing in on us? Do we not need to light lanterns in the morning? Do we hear nothing as yet of the noise of the gravediggers who are burying God? Do we smell nothing as yet of the divine decomposition? Gods, too, decompose. God is dead. God remains dead. And we have killed him.

Over the past few days in the House, we have heard from many members with a wide variety of positions. Let me first say that I am very thankful that the government decided not to follow through with all of the recommendations made in the Liberal-dominated special joint committee report and decided rather to incorporate many of the comments of the dissenting report created by me and other members of the Conservative Party.

While Bill C-14 is a huge improvement from the very permissive, wide-open regime recommended by the joint committee, the legislation falls far short in protecting some of our most vulnerable Canadians, and as a result, I cannot support it.

First, there is no firm commitment to conscience protection for doctors and other health care workers who for a variety of reasons may not want to participate in any fashion in physician-assisted suicide. This includes the need to make a referral to a participating doctor.

While the preamble states boldly that it is “desirable to have a consistent approach to medical assistance in dying across Canada”, and later refers to “respect the personal convictions of health care providers”, there is no section in the actual clauses of Bill C-14, no clear, unequivocal statement that no doctor or health care worker would be under any obligation to participate.

Just as important, what about health care institutions and hospices which, because of the core values they embrace, may not want to have physician-assisted suicide available in their institutions? What about a hospice which raises upward of 50% of its own revenue from private donations and which relies largely on armies of volunteers and donors who believe in the inherent and intrinsic dignity of human life? My fear is that if any of these institutions are forced into situations in which they are obligated to engage in physician-assisted suicide, the community may face the very real possibility of losing those volunteers and donors, and ultimately, may in fact lose the very institution itself. This would be a tragic unintended consequence of not guaranteeing conscience rights to doctors, health care workers, and institutions.

These changes must be included in Bill C-14 if we are to respect the professionals and institutions that provide excellent quality of health care every day.

There also needs to be a clear commitment to providing palliative care as a real and viable option. To offer physician-assisted suicide without a meaningful offer of available and palliative care is to provide no option.

Let me quote Dr. David Baker:

Without a right to palliative care, Canadians will soon be receiving publicly funded physician assistance to die because it [palliative care] is not available. This will infringe their s. 7 Charter right to life, liberty and the security of their persons and their section 15 equality rights as Canadians with disabilities and seniors.

Another important amendment that is needed is to have a system of prior review. There needs to be a legal system in place to ensure that no coercion occurs and to ensure that the two independent witnesses are in fact independent and that the two independent doctors are in fact independent.

Dr. Trudo Lemmens, the chair on health law and policy at the faculty of law at the University of Toronto stated:

...some eligibility criteria are inevitably quite open to interpretation, which makes it all the more problematic that an assessment of competency and informed consent by two physicians is seen as sufficient to ensure compliance. I continue to support a prior review system as reflected in the Vulnerable Person Standard, which is supported by a wide and inclusive coalition of patient and disability advocacy groups, health professional organizations, health care institutions and individuals with a wide variety of ideological and religious affiliations.

While I am fundamentally opposed to the taking of human life at any point, if we are to adopt legislation as a House of Commons, if we are going to go down this road, we need to be sure that we have far more stringent safeguards included in the bill.

[Kelly McCauley, Conservative, Edmonton West, AB]

Mr. Speaker, before I start, I would like to thank my friend from Yellowhead for his kind words on Fort McMurray. The devastation there is overwhelming. I would like the people there to know they have my prayers, and I am sure the thoughts and prayers of everyone in the House today.

I used to work in Fort McMurray. In fact, the very first hotel I managed just burned down. I know the people there will be counting on our support, and the people there know everyone in the House will be supporting them.

I rise today to discuss Bill C-14. This is obviously a very difficult issue for many people in the House, and I appreciate the views expressed here today and in yesterday's debate. Members oppose the bill on faith-based grounds, legal grounds, ethical grounds, and for other reasons. Others praise and support the bill.

I truly respect each member's personal contribution to the parliamentary debate. I would like to express my gratitude to the members of the Special Joint Committee on Physician-Assisted Dying. It is probably one of the most difficult, if not the most difficult, issues we are going to face in this Parliament.

We all know someone who has died in pain, a loved one, a child, a colleague. We have all seen the ravages of disease on the body of people we once saw only as the embodiment of life and hope. I have lost two of my most beloved uncles to cancer. One of these uncles was a lifer in the Royal Canadian Navy, who finished his career in service to Canada as base commander at CFB Esquimalt.

Commander Larry Dzioba, as any commander would be, was ready for his battle that would come. He fought cancer to the end and was still living independently, in relatively good health, up until the final two days before he passed away. I credit his strong Ukrainian stock for his strength and always think that he viewed pain as something to be tolerated.

Another uncle of mine, Michael McCauley, passed away after years of chemotherapy and radiation. In the end, he passed away at home in his bed surrounded by his family. He maintained his dignity until the very end.

Another very close friend of mine, my dear friend Peter, died of lung cancer a few years back. Peter and I worked together at the famed Deerhurst Resort in Muskoka, pre-gazebo days, and later together in Edmonton. Peter went from diagnosis to death in just three months, but his family and friends will forever be grateful to the wonderful staff at the Cross Cancer Institute in Edmonton, who ensured that Peter lived his final days as comfortably as possible and with dignity.

Unfortunately, however, far too many Canadians suffer due to inadequate palliative care. A 2015 study shows that anywhere from 15% to 30% of Canadians have access to adequate palliative care, and even at the highest levels of the spectrum, it is nowhere near enough.

This is where my concerns with Bill C-14 begin. From the bill's preamble, I quote the following:

Whereas it is desirable to have a consistent approach to medical assistance in dying across Canada

The government wishes to have a universal approach to assisted suicide in Canada, but does not state the need for universal access to palliative care across Canada. Members of the House have repeatedly commented on access to broadband Internet as a human right, yet there is nothing about a human right to palliative care. The government commits to broadband expansion in its 2016 budget, but if we search “palliative” in budget 2016, we get the message ''no matches were found''. It is disgraceful and shameful.

The health minister has said that $3 billion will be committed over four years for palliative care across the country, but there are no details on this. It is not listed once in the budget. There is no information on how it will be rolled out or how it will be paid for.

In fact, the $3 billion is probably the same $3 billion that the Liberals promised in their election campaign for increased home care services. It is not specifically for palliative care, which they are stating now, but for home care services.

Alarmingly, the health minister said in January, just before meeting with provincial health ministers, that "more money isn't necessarily the only solution”. The $3 billion is promised, yet it does not seem to exist anywhere in the budget and, according to the government, may not be necessary. I would argue that virtually every doctor who treats terminally ill patients would disagree.

It is paramount that the government states immediately how it will ensure equal access to proper palliative care across this country. It is unfathomable that the government would introduce assisted dying legislation without announcing a detailed strategy to prevent terminally ill Canadians from believing doctor-assisted suicide is their only option.

The government has a moral obligation to outline such a strategy and provide adequate funding immediately. It is not enough to simply spout off a few talking points, get in a few good sound bites, and then hope it is later forgotten.

The government has not done nearly enough to think through this bill in its haste to meet the Supreme Court's deadline. It has not begun to consult with the provinces on many of the responsibilities that will be downloaded onto them. For example, Alberta has been working on this for five months with no apparent consultation with the government.

I believe assisted suicide is not the answer to the complex problem of human suffering, whether it be physical, emotional, or even spiritual suffering. Medical advances specifically in pain management drugs have gone a long way in helping the suffering bear pain and keep their dignity. What is really needed above and beyond the medical advances and improvements in palliative care is a willingness to be involved in the lives of those who suffer. The reasonable answer to suffering is love, companionship, and hope for the better, hope for tomorrow, for hope allows us to continue on.

In addition to the philosophical objections that I have to this bill, there are many practical concerns. One is the lack of education on the matter of alternative methods for care of the terminally ill. For example, a survey of pre-licensure pain curricula in the health science faculties of 10 different Canadian universities showed that many would-be doctors receive less training in pain management than their counterparts in veterinary medicine. Meanwhile, a survey of over 1,100 doctors and nurses showed that those who treat fewer terminally ill patients, therefore knowing the least about symptom management, are most likely the ones in favour of assisted suicide, whereas those with the most experience with symptom management and end-of-life care tend to oppose it.

Dr. Max Chochinov, a noted specialist on palliative care, explains that the will to live is directly inverse to the amount of pain and that loss of dignity drives wanting to die and treatment of pain can improve sense of dignity.

I realize that we will have doctor-assisted suicide in Canada. The courts have decreed it, and society appears to demand it, but we in this House must ensure that we are doing everything to ensure we protect the vulnerable and enshrine the belief that all life is precious before we introduce a new law.

There are holes that must be addressed before Bill C-14 becomes law. Like many others in the House, I am disappointed that there are no provisions to protect the rights of doctors, nurses, and other medical practitioners who object to participating in assisted dying or referring on conscience grounds. We must protect their rights regarding referrals as well.

My own doctor stated on the issue, “not selling you a drug but sending you to a street corner for drugs where you are murdered makes me just as complicit in your death.” I enjoy the bluntness of my doctor.

It is not enough to simply leave it to the provinces or to say that there is no problem because so far no health professional has been forced against his or her conscience to perform certain acts. The rights of health care professionals must be respected and must be enshrined in federal law. It has always been our society's custom to assist the suffering, to be by their side, and not to kill them. This practice must be reaffirmed, and a respectful approach to human life must be upheld, one that recognizes that the intrinsic worth with which every human being is endowed is not eradicated by suffering.

Life is precious and I believe that our nation's laws must reflect this fact. In the Gospel of Life, Pope John Paul II wrote very eloquently about the issue of assisted suicide. He stated that assisted suicide is a crime which no human law can claim to legitimize. However, he further stated that elected officials “could licitly support proposals aimed at limiting the harm done by such a law and at lessening its negative consequences at the level of general opinion and public morality. This does not in fact represent an illicit cooperation with an unjust law, but rather a legitimate and proper attempt to limit its evil aspects.”

Doctor-assisted suicide is already a reality in Canada. While I acknowledge that Bill C-14 reflects many of the safeguards of the dissenting report put forward by my Conservative colleagues on the special committee, it is still a flawed piece of legislation. It does not include an obligation to provide all possible palliative and pain management options to terminally ill patients. It does not mandate that funding be given and then maintained for end-of-life care. It does not guard the conscience rights of medical professionals. Beyond this, Bill C-14 does not offer a legitimate and proper attempt to limit the evil aspects of suicide. It is for these reasons that I will not be supporting this bill.

[Scott Reid, Conservative, Lanark—Frontenac—Kingston, ON]

Mr. Speaker, I thought that rather than giving my rationale and telling people how I will vote at the end, I would do the opposite.

I want to say, first of all, that I will be voting yes at second reading to this bill, so that it can be sent to committee where it can be discussed in principle, and perhaps be amended to make it better than it currently is.

At third reading, I will be guided in my voting by the instructions of my constituents. I am mailing out what I call a constituency referendum. It is effectively a survey designed to ask them in as impartial a way as possible how they would have their member of Parliament vote. The reason I am doing this is that I believe, when it comes to a profound issue of conscience like this, the consciences of my constituents are every bit as good as my own conscience, that of the other members of Parliament, or the people on the Supreme Court of Canada. They will guide me at third reading.

My comments today are, therefore, about the underlying issue that I think is at stake here as we, meaning Parliament, the courts, the policy-makers here in Canada and frankly in every country in the world, must face as we deal with the realities of life and death at this particular moment in time.

Right now, and this is not something that has always been true in our history, life is expensive, maintaining life is expensive, and death is cheap. This is something that has not been true throughout our history.

Anybody who reads the novels of the Brontë sisters is aware of the fact that in the mid-19th century, and in every century before that, life was relatively inexpensive to maintain, in part because the ability of medical technology to keep people alive was so limited. The doctor would arrive, perhaps bleed someone if they had a simple fever, and then, at least this is how it happens in the novels, advise the relatives to prepare themselves. The financial difference between life and death was very limited.

That is no longer true. I want to make this point in the context of a health issue that has nothing to do with euthanasia or the assisted suicide or assisted dying debate, but it really illustrates just how expensive life is in a world of improved technology and pharmaceuticals.

This month, May is cystic fibrosis month. I know somebody who has cystic fibrosis, and I have become very passionately involved in this. Every year, I encourage members of Parliament to wear a rose, and we will all be doing this next Wednesday, in honour of those who have cystic fibrosis. I wear the cystic fibrosis pin today.

Now there was a drug introduced in 2012, called ivacaftor, trade name Kalydeco, which, for the 4% to 5% of cystic fibrosis patients who have the delta-F508 mutation of the gene with the CFTR protein, for that small segment of cystic fibrosis sufferers, this drug effectively turns what would otherwise be a terminal disease into a manageable illness that is problematic but not fatal.

It is available at a very high cost to them, their families, or the public health care system, depending on where the patient lives. The cost to get access to Kalydeco is approximately $300,000 American per year. The patents on drugs are typically about 20 years long. Presumably at the end of that 20-year period, the cost will drop dramatically, but right now it is $300,000 per year. Members can do the math, $300,000 times 20 means that it is $6 million to keep one individual alive.

It is well worthwhile, but the fact is that life is expensive, whereas denying them this care, and some provinces do not give public funding for the drug, is cheap. That costs very little. I do not mean to suggest that the drug company is charging unreasonably, or any of these other subsidiary questions. It cost $458 million for Vertex, the company that developed this drug, to bring it to market. My observation is simply that life is very expensive and maintaining life is expensive. Death is cheap.

Now, turning to palliative care, of course it costs a great deal less than this to keep people alive on palliative care at the end of their lives. However, the fact is that denying care is less expensive. This is exclusive of the Supreme Court ruling. It is exclusive of whatever is in Bill C-14 or should, or should not, be in Bill C-14. This creates a dynamic in which there is a strong financial incentive for policy-makers to promote the less expensive option, as there is in everything.

In this case, it means that the incentive to do what is necessary to allow the life option as opposed to the death option is reversed or weakened. This means the incentive to not provide palliative care is going to be very strong.

In this situation, the Supreme Court of Canada ruling in Carter v. Canada is likely to have tilted the dynamic in favour of death as a solution to the high-cost problem of maintaining lives that are deemed to be not worth living.

To make the point about how this is relevant, I want to quote from what the health minister said on the Friday before the break, in her speech on the issue. I had the good fortune to be able to question her afterwards about this. She said:

Today, Canadians are aware, and have a general understanding, of palliative care. However, some studies have [shown] that the overwhelming majority, perhaps 70% or more of us, do not have access to it, particularly in rural and remote areas. Many providers are not well trained to provide palliative care services.

I think she was just presenting what she regards correctly, as a fact. However, read this a different way and a more sinister meaning becomes evident. We lack the funds, or the provinces lack the funds, for palliative care, but death is the less expensive way to ensure that no one lives an unbearable life.

Again, I do not think she meant this in a sinister way. The implication was simply there to be found, and taking her words and reading them a little differently, we see that implication.

Faced with this problem, the problem brought upon us by the fact that we can extend life in a way that never could before but with limited funds and, inevitably, there are not enough funds to deal with all the life needs that are out there, the wrong move taken for a reason that seems noble but is poorly thought through could have disastrous consequences.

To make this point, I want to turn to one of the best books on public policy I have ever read, Lectures on the Relation between Law and Public Opinion in England during the Nineteenth Century, by the great Albert Venn Dicey.

Writing about Lord Shaftesbury, the well-meaningful philanthropist and statesman, he writes something that I think could well be applied to the Supreme Court's ruling in Carter v. Canada:

...the natural desire of an ardent philanthropist to save from immediate suffering any class of persons who are unable completely to protect themselves against oppression, and to do this by the means which lie nearest to hand, without deeply considering whether action which gives immediate relief to [these] sufferers...may not possibly in the end produce evils of untold magnitude.

In response to this, the danger is that we will do what Dicey warned about Parliament reacting. He was talking about the British Parliament. He was writing of a different century, but this is a warning that is well taken by any Parliament dealing with this kind of situation.

He said:

...laws passed to meet a particular emergency, or to satisfy a particular demand...produce, in the long run, more effect on legislative opinion than a law which openly embodies a wide principle. Laws of emergency often surreptitiously introduce or reintroduce into legislation, ideas which would not be accepted if brought before the attention of Parliament or of the nation.

This legislation is being introduced in haste in response to an artificial deadline, and it is an artificial deadline, set up by a Supreme Court which has a noble goal in mind but which has not, in my view, looked at all the implications of what it is trying to do. In dealing with a highly atypical set of cases, all of our jurisprudence in Canada at the Supreme Court level is based upon suffers of ALS who, on that bell curve of different ways in which people can die, either fully in charge as ALS sufferers are of their wills and their minds but not of their bodies or, at the other extreme, like Alzheimer's sufferers perhaps in reasonable physical health but not in possession of their faculties, and everybody in between. We have used that set of cases that have come before us because that is the way the court system works. Only the mentally capable can get their cases to the court and the court has generalized in a way that leads, potentially, into a hasty reaction that could lead to a principle being introduced into our law which may have, as Dicey says, unfathomable consequences.

I ask us all to move very cautiously and to seriously consider the possibility of amendments to this legislation in the coming weeks, as we go into committee.

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

Mr. Speaker, I thank the hon. member for a very thoughtful speech. Obviously we have come down on different sides of this issue, but certainly what he put into that speech is something that was clearly thought out and very well delivered and expressed.

The member talked so passionately about the sanctity of life. If others in this chamber come down on this issue at this time in the same manner as the hon. member, we will be left on June 6 without any criminal law with respect to medical assistance in dying, and the safeguards that are built into Bill C-14 will not become the law of the land. There will not be a requirement for two doctors to pass opinion on a patient. There will not be a requirement for two independent witnesses. There will not be a requirement for a signed request.

We are in a situation in this Parliament where the question before us is not whether, it is how, and the how that has been put forward is one that contains these safeguards that will be lost if this legislation is not advanced to committee.

Given the member's deep-felt thoughts on the sanctity of life, could he respond to the ramifications that arise out of a defeat of this legislation on June 6?

[Len Webber, Conservative, Calgary Confederation, AB]

Mr. Speaker, today I rise in this House to speak to Bill C-14 and to the issue of medically assisted dying.

This is a complex issue for which there are strong opinions on both sides. Some of my comments may be new to this debate and some will echo those of others before me. However, they are all the voice of my constituents in Calgary Confederation.

As my constituent Brenda Robinson said to me in a letter, “There is no doubt that we are in a defining moment for our nation on this important issue. So many lives hang in the balance of how our leaders craft this legislation.”

As I said, there are many sides to this complex issue. The people watching this debate the last couple of days, those people in the galleries, or those watching CPAC on their computers are able to pick and choose the parts of this legislation that they do and do not like, but I and all of us in the House only have the option of a yea or a nay when it comes to a vote. We know that the legislation will pass. It has to pass because the court has said so.

Members may or may not know that I am a big proponent of palliative care. My constituency assistant Lou Winthers in Calgary was the founder and executive director of Hospice Calgary. My late father-in-law was the executive chef at the Rosedale Hospice in Calgary. He spent much of his long life career as an executive chef in many hotels throughout the country. He spent his final years cooking for the dying in the hospice in Calgary.

For many years, my family has volunteered with Hospice Calgary. Never would I have ever thought that I would be fighting for a bed for my wife one day. I saw then first-hand how critical it is that we have a good palliative care system here in Canada.

Through my experience with Hospice Calgary, I also saw first-hand how horribly underfunded this specialized care is within our current health care system. We need to improve palliative care both for the patients and their families. I cannot thank the staff enough at Agapé Hospice for the support they gave me and my family only a few years ago. I only wish that all Canadians had the access and support they need to get palliative care during one of the toughest times in one's life. We need to do better, and we can do better, but we have a long way to go.

I have received more correspondence on this issue than any other issue since being elected or during my 10 years as an MLA in Alberta. Normally, we see letters either urging an MP to support or oppose legislation. However, the inevitability of this legislation has resulted in a different kind of response. My constituents are writing to suggest how things can be improved and to express concerns with respect to very specific parts. This has made for some very emotional and thoughtful reading.

Ken, a constituent in my riding, wrote to me saying, “Even though I am personally against all euthanasia on personal, moral, and faith grounds, I concede [we] will probably have to have a law that allows it in extreme circumstances. But many of the current recommendations go far beyond, and in effect could allow this to become an ‘on-demand service’ that leaves many of the most vulnerable unprotected.” Ken's letter is one of many that raise concern for our most vulnerable.

Connie C., another constituent who wrote to me, is passionately against any form of suicide. She said, “My father's death was a gradual decline that spanned a four-month period, it was a difficult time for him and for the family. However, we shared some very meaningful time together during those four months and I have a new appreciation for the death process. It was painful and difficult for him, unfortunately struggle is part of the human experience.... Suicide cuts short the human experience and no physician should be asked to end a human life.” That is what Connie had to say.

On the other side of the issue, there are those who wish to have access to these medically assisted options.

Valerie wrote to me and said, “My father and others in my family have had dementia and I saw how they forgot to bathe and brush their teeth and refused to let others take care of them. My father lived his last 6 months in a nursing bed doing nothing but lay in bed. If I get dementia I know I do not want to live like that. If I do not have the option of physician assisted dying then I will opt to find a way to end my life while I am still able to make this decision. I beg you to please allow me a better option should I get dementia.”

Debra Lee wrote to me, and she wrote to the Minister of Justice as well, with a perspective that few have. She worked for over 40 years as a registered nurse. She said, “I saw my share of people die, many of them with good management of their symptoms but some who did suffer a great deal–from physical as well as emotional pain. Some people received intrusive treatments which had no hope of curing them or even easing their suffering. But for too long in my career, I observed a death denying culture–everyone from health providers, family members and individuals themselves having difficulty accepting death.”

As I stated earlier, this issue is complex.

Another constituent, Catherine G., focused on some of the specific parts of the proposed legislation that she felt needs to be improved. She expressed concerns that there is not enough protection for the vulnerable. She said, “I believe that physician assisted death will leave many elderly people open to the worse form of abuse. They may feel pressured to accept it since they feel themselves to be a burden to their loved ones. We must care for the sick and elderly; doctors must never kill.”

Many expressed concern for the most vulnerable in society, but some also wrote about their own vulnerability.

Tracey wrote, “Today my mother is slowly starving to death in the advanced stages of Alzheimer's. Since my grandmother also had it, there is a good chance I will as well. Without assisted suicide I will be forced to commit suicide as soon as I am diagnosed because I won't allow my children to go through what I have, nor do I wish to suffer as my mother has.”

Doug James, another constituent of mine, echoed my sentiments exactly when he said, “I suggest that we are better off having what some will call incomplete legislation, rather than no legislation at all, and trust that future legislation can be passed to address any deficiencies.”

It is for this reason alone that I will be supporting the bill. It is not about a vote of approval for the bill or the circumstances that brought it about. Rather, it is a vote that recognizes that when it comes to something as personal and sensitive as death, it is better to have options available, even if we do not like them, even if we do not believe in them. It is better to have some legal framework than none at all.

My decision will undoubtedly be welcomed by some and loathed by others, but I am confident that my constituents will look at my past, my experiences, and respect that in the absence of an overwhelming and clear direction from my constituents, I am voting for choice.

In closing, I want to also echo a deep concern expressed by David MacPhail, who wrote to me and said, “There should be clear conscience protections for health care workers and facilities in the legislation.... It is not right that people should be forced to participate against their deeply held convictions, either through referral or by doing the procedure.” He went on to say, “It is not necessary to make dedicated physicians and healthcare workers put their careers on the line and open themselves to professional disciplinary action simply because they wish to follow their conscience”.

Finally, I want to reiterate my main concern with the dying process, and that is palliative care. I challenge all in this House to approach this issue with as much energy, urgency, and focus as we have seen on this bill.

I believe that when we all focus on a shared goal, we can achieve remarkable improvements in a very timely fashion. Let us hope that we see the same prioritization when it comes to addressing palliative care.

[Jim Eglinski, Conservative, Yellowhead, AB]

Mr. Speaker, just before I begin my speech, I would like to say to the people of Fort McMurray tonight that my heart and thoughts go to them. They are fleeing their community tonight. Eighty thousand people have to evacuate. They are fighting for their lives tonight. We are thinking of them.

I rise in this House today 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). The issue of euthanasia and physician-assisted suicide has been debated in Canada for a number of years. However, a resolution for this sensitive issue became critical since the decision of Carter v. Canada, which unanimously struck down the Criminal Code ban on assisted dying, and gave Parliament a year to come up with new legislation.

This legislation must apply to competent adults with grievous and irreversible medical conditions that cause enduring suffering and who clearly consent to ending their lives. Bill C-14 seeks to fulfill section 7 of the charter, namely the right to life, liberty, and security. The bill proposes a wide and detailed range of legislated objectives, legal notions, patient eligibility criteria, exemptions from the criminal liability, and safeguards. However, as experience shows, the question of life and death is very vague. An absolute prohibition of assisted dying forces Canadians who have grievous and irreversible medical conditions to suffer and look for medical assistance abroad to end their lives.

There have been two cases in Canada: Rodriguez, and Carter v. Canada. As well, there have been approximately six private member's bills between 1991 and 2010 that sought to decriminalize assisted suicide. None of these were successful. In Carter v. Canada, the Supreme Court stated:

While opponents to legalization emphasized the inadequacy of safeguards and the potential to devalue human life, a vocal minority spoke in favour of reform, highlighting the importance of dignity and autonomy and the limits of palliative care in addressing suffering. The Senate considered the matter as well, issuing a report on assisted suicide and euthanasia in 1995. The majority expressed concerns about the risk of abuse under a permissive regime and the need for respect for life. A minority supported an exemption to the prohibition in some circumstances.

It is evident by the quote that physician-assisted dying is highly divisive; people are separated across this country. Bill C-14 is a very difficult bill for me personally to wrap my mind around. I feel, like many Canadians, that we are put here on earth for a reason. The reason could be debated for days, but like all living things we strive to live by adapting to our environment. From bugs to humans, we adapt to survive, to live. All creatures eventually die—some as prey to others, some to the environment, some to the weather, some to sickness, and some to age. Most will fight for life if threatened. As humans, it is our nature to fight to live.

Our nation has experienced two world wars where our veterans fought to give us freedom and better lives. How many of them would have laid down their lives if they had known that later people would be able to take their own lives as outlined in this Bill C-14. A number of World War II veterans have told me that this is wrong. Is it wrong? This is where I personally have difficulty in finding an answer to this extremely moral question. I am honestly confused and my emotions are mixed. Allow me to explain.

Both of my parents died of cancer, as did both of my in-laws. I watched my father's weight decline from 190 pounds to 75 pounds when he passed. He suffered immensely, as did my mother and my in-laws, but they fought for life until the bitter end. It hurt me to watch them go that way, but they made me realize the need to fight for life. That is what I first thought: never give up the fight until the end.

Fifteen years ago, I lost my life partner of 30 years to cancer. I hate the word “cancer“. My wife, like myself, believed in fighting to the bitter end. I watched my wife battle cancer for two years. If any treatment, from radiation to chemotherapy, could go wrong, it did with her, compounding the pain and agony she suffered. I watched and assisted her as her body weakened and she lost control over its functions.

I was with her when she took her last breath. I am a strong person emotionally, but by the end, I was emotionally broken as I watched her suffer so much. I wanted to end her suffering. She was hanging on to life day after day after day, and I asked, why the suffering?

We had agreed to fight as a couple only filling out a do-not-resuscitate order. At the end, I would have done anything to put her out of her suffering and pain. Morphine finally did the same. Now I ask myself if Bill C-14 is wrong or right. During my wife's last week of living, I would have welcomed the bill to stop her pain and suffering. That was 15 years ago. I still hurt when I think of my wife suffering, yet I am so proud of her fight to live. That fight gave us an extra year together, which I am so grateful for. Do I vote yes for Bill C-14, or do I vote no? I am so personally torn on this issue.

I respect the rights of individuals and the rights that Bill C-14 may give them, but my heart says we have to fight for life. I am glad that this is a free vote. I have weighed the pros and cons and it is a difficult decision, but I cannot support this bill. There are too many grey areas. Betty Unger, an Alberta senator, said, “There is something terribly wrong when a government does more to guarantee that the living can die, than to ensure that the dying can live”.

That being said, I believe the government must emphasize palliative care over physician-assisted dying. I praise those who have chosen to work in the environment and I understand that we have much to do to make palliative care better. Because of lack of staff, families often provide the primary care.

Physician-assisted dying is a difficult issue for me and it is for many sitting in the House. If Bill C-14 is passed, I ask that it include stringent safeguards to protect vulnerable populations and protect the conscience rights of workers in institutions in the health care sector. Members on all sides of the House have a variety of positions on physician-assisted dying. I appreciate our party's recognition that this is a moral issue and allowing members a free vote on this very difficult matter of conscience.

I thank all the presenters on Bill C-14 for helping me decide to say no.

[Jacques Gourde, Conservative, Lévis—Lotbinière, QC]

Mr. Speaker, I want to congratulate all parliamentarians for having the courage to participate in this sensitive debate.

According to the Supreme Court decision, it is up to the House to debate Bill C-14, which has to do with medical assistance in dying. The Supreme Court has given us the daunting task and the responsibility of establishing a framework for this. We are also having to do some soul searching about the finite nature of our lives and the lives of the people we represent.

It will be difficult and heartbreaking for me to make this decision for others, and it would also be difficult to make this decision for myself or one of my loved ones. I think that, ultimately, the law as a whole will not be perfect. It will only be acceptable, in light of all the changes it will make to the way we see life, for generations to come.

I do not want to dwell on the particularities of this bill, but I simply want to share the thoughts, feelings, and, especially, concerns that I have shared with many of my constituents in Lévis—Lotbinière.

All of us, as Canadian MPs, have the opportunity to have a close relationship with our constituents thanks to the many means of communication available. It is always a great privilege and a sign of undeniable trust to listen to heartfelt confidences.

I observed great resiliency but, at the same time, great concern about the bill. I use the term “resiliency” because, in Quebec, the debate was held over a long period of time and my constituents accepted the voice of the majority of the Quebec National Assembly, even though the decision was not unanimous.

The concern was caused by the version of the bill, which provides a broader interpretation than what Quebeckers had said they wanted. I hope that the final version of the bill will allay these concerns, if not completely eliminate them.

What was surprising was that the discussions I had with my constituents all led to another very important issue, palliative care. Unfortunately, not all Canadians have access to palliative care and that is the problem. Why not focus on life and on living with dignity, as was suggested by Sauveur Champagne, one of my constituents, and on the quality of our lives in our last days? Appropriate care could have prevented this debate.

There is medical comfort care and ethically provided adequate support that, unfortunately, not everyone can access for different reasons. Some people who are optimistic by nature shared with me that the issue of medical assistance in dying made them realize the importance of life and of fully enjoying it with their loved ones and friends. It is human nature to enjoy the best that life has to offer.

I believe that Canadians are aware that life is very fragile and that we all have the opportunity to share love and friendship, to strengthen bonds and to help one another while we can.

We all have to be aware of the need to strike a balance between our personal family time and the time we can generously give to others.

Other people have also talked to me about the collateral damage associated with learning that someone chose to end their life this way. This will leave scars on our society if it is not properly regulated and accepted, given that part of our population does not support this bill, since it goes against their fundamental, cultural, and religious beliefs.

With all due respect, we must consider the views of that segment of the population, which is just as important, because they are also entitled to have a say in this Parliament. Others, on a more personal level, are going through the process of losing of a child or parent right now, and they could, to various degrees, change their views on the act of choosing to end one's life.

That being said, ultimately, the decision to end one's life is up to the individual, based on his or her convictions, beliefs, and physical condition. I hope it remains a personal choice that is respected by all family, friends, and loved ones, a choice that is not influenced by any external pressures.

The question we need to ask is this: how can we be sure that this will not get out of control? It will be difficult to include safeguards in the law that will cover all of the very different individual cases. That is why many of us already feel as though this law will not be perfect; it will merely be acceptable. As medical advances allow people to live longer, what will be the appropriate degree of dignity, for those who have to decide?

For those who want to enjoy more precious moments, this may represent a tremendous opportunity to prolong their lives. For the others, the door will now be open to allow them to make a new choice, which also seems to bring hope to those who no longer want to count the days.

Personally, I have would have liked to wait and do what Quebec did, to take five years to assess the impact of this type of end-of-life option. Taking that amount of time to conduct a comprehensive study would help us, as legislators, make a more informed decision. I think that would be the wise thing to do in order to make the right choices for the safety of Canadians and future generations. However, that is not going to happen, since we are obligated to make such a quick decision. In my opinion, there will always be some doubt since the law will be merely acceptable. Time will tell whether this change in direction was a good one. May God help us.

Every parliamentarian here in the House and in the Senate will make a significant contribution to this debate. We must all bring a rational and moral tenor to this debate as we align it with Canadian values and thinking in a way that respects all of our Canadian communities.

After this debate, we will all be aware that, for better or worse, the Canada we knew will no longer be the same. We will live with this new law. We have to ensure that it will be interpreted in accordance with our guidelines.

In closing, the best way for people to figure out where they stand on this issue is for all Canadians to experience the end of life alongside someone who is dying. That is the only way to understand the full import and humanity of imminent death.

That would also provide an opportunity to appreciate and cherish the dying person and every second of the gift of life, to learn from that person's wisdom and the rich experiences that deeply moved and changed him or her throughout life, because it is human nature to seek constant improvement and to leave a legacy to our children, our loved ones, our closest friends. Personally, that experience—

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Mr. Speaker, it is an honour to talk to this issue. In my 10 years here, this has likely been one of the most sensitive, most compassionate and emotional discussions I have had with my constituents in Lambton—Kent—Middlesex.

Let me start with a little background. Bill C-14 is an act to amend the Criminal Code to allow assisted dying, so we can allow someone under the law to kill someone else. It sort of catches me in the pit of my stomach, quite honestly. Section 241 of the Criminal Code talks about counselling or aiding suicide. It says:

Everyone who

a. counsels a person to commit suicide, or

b. aids or abets a person to commit suicide,

whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years.

That is what Canada has been built upon in terms of the desire to not have people help people kill themselves.

In February of last year, the Supreme Court of Canada gave all the exemptions to this Criminal Code. The Criminal Code now gives an exemption for medical assistance in dying, so no medical practitioner or nurse practitioner can be charged. There is an exemption for people aiding the practitioner. If the doctor is doing it, and a nurse practitioner is helping, they are exempt from any charges.

The pharmacist who provides the cocktail, whether injected by the doctor or prepared so the patient injects it on his or her own, is exempt from any criminal charge.

There is an exemption now for a person aiding a patient. No person commits an offence if he or she does anything at another person's explicit request.

The coverall is that if there is a mistake made, no charges can come forward.

I find it quite extraordinary that with the stroke of a pen, nine judges made a decision to take a criminal law in the country and turn it 180 degrees, now make something that was criminal a health remedy. We now have to encourage people to take someone else's life.

I find it quite hypocritical that we are talking about assisted suicide, assisted death at this time. We like to use comforting words so it does not really mean we are actually giving someone the authority to kill someone else, but that is what we are doing. That is what the Supreme Court told us we have to do. At the same time, we have a national strategy on suicide prevention.

I am not sure where the government is on that discussion at this time, but I find the two of them are running in opposite directions. When my colleagues talked about first nations, we have all read about the issues. We are all up in arms and disturbed when we see not only individuals but groups coming together to commit suicide.

One of the key things in any long-term care is palliative care. We have heard this from just about everyone. Many of us have talked about our experiences or someone we know. I can also speak of that.

My parents died of cancer. Anyone who knows someone who has had bone cancer knows of the pain that comes with it. Maybe back then though, when my parents were suffering and succumbed to cancer, there was true palliative care. In their cases it never crossed their minds to ask for some sort of assistance to terminate their lives, let alone ask to have their doctor either provide or give them the solution to take their lives.

We talk a lot about palliative care, where it is and how it will be funded. We have the governing party saying that it is in the budget. The member from Winnipeg said it was in the budget. It has not been produced. We know it is not in the budget. If we read the preamble, we might read between the lines, if one has a visionary mind that there might be money for it. There just is not. It is not in the legislation. It is not in the budget. I am afraid it is a lone wolf out in the desert saying it.

We need to take some lessons from other countries, like Belgium and the Netherlands. Belgium started this 15 years ago. It was very secure so patients did not get on a slippery slope. However, now it is estimated that 32% of those patients never gave their consent for their euthanasia. We are told it now increases by about 47% per year.

As palliative care dollars drop, the desire to have something to take the pain away, which palliative care could look after, goes to assisted suicide.

I have some serious concerns about this. I talked about palliative care. I also do not see where there is any protection for doctors, nurses, nurse practitioners. Nor is there protection for institutions that have a moral conscience, an ethical bar that will not allow them. I have talked to doctors and nurses. A nurse had asked me if this was true. I said we would have to wait for the legislation. She said that if it were true, she would be out of it. She could not kill someone or be part of the euthanization of someone. A doctor who took an oath to protect lives said that he never took any oath to take away life.

Does the government have a vision in the future? This raises a huge issue, because on page 2 of the bill, it says:

...the Government of Canada has committed to develop non-legislative measures that would support the improvement of a full range of options for end-of-life care—

...giving rise to requests by mature minors, advance requests and requests where mental illness is the sole underlying medical condition.

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

Madam Speaker, I am thankful to have this opportunity to speak on Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts.

Assisted suicide is a grave matter and has serious implications for all society, in the short term and in the long term. Based on the experiences of countries like the Netherlands and Belgium, which have legalized assisted suicide, we can know with great certainty that vulnerable populations, such as seniors, youth, and those who struggle with mental illness, will inevitably be put at risk.

Legalization of assisted suicide has also greatly undermined the public trust in the medical system in these countries. That is why I am opposed to legalizing assisted suicide.

Bill C-14, in its current form, leaves segments of society vulnerable and provides no protection for professionals or institutions, and undermines the credibility of our health care system and the important work that health care providers do to help people live.

I urge members to take great care with this legislation and to weigh every word to ensure that our most vulnerable people are never placed at risk.

In the past, this House has debated capital punishment, another means in which to take a person's life. Capital punishment was rejected, in part because the risk of ending one innocent life was one life too many. Should that same principle not guide us in our debate today?

Ray Pennings, co-founder of Cardus, recently expressed the importance of this in an editorial, writing:

While every word in a legal definition matters, the language of this debate matters in a broader setting. How do we as a society understand personal autonomy and the taking of one's life? How do we distinguish between a group of teenagers on an aboriginal reserve entering into a suicide pact, after deciding that life is not worth living, from citizens with a terminal diagnosis, fearing they've become a burden to their families and society, who similarly decide that death is preferable to life?

The debate is hardly new, but there are distinctions that can be made which require care and a precision of language. It is concerning that the utilization of language is heading in the opposite direction.

Mr. Pennings goes on to demonstrate this shift in the two Supreme Court of Canada cases. In the 1991 Rodriguez decision, which upheld the prohibition against assisted suicide, the term “assisted suicide” was used 92 times. However, in the 2015 Carter decision, in which the Court came to an opposite conclusion, the term “assisted suicide” was used only 23 times, while the term “assisted death” was used 24 times.

When we look at the current legislation before us, we see that the term “assisted suicide” does not appear at all, the term “suicide” appears only seven times, and the phrase “medical assistance in dying” is used 72 times.

In 20 years, we have progressed from recognizing the value and dignity of life and making every effort to discourage people from suicide, to now offering assisted suicide as a form of health care and calling it “medical assistance in dying.”

While I find many parts of Bill C-14 alarming, I want to start with this shift in the language. It is misleading to use “medical assistance in dying” in the context in which this bill does. Medical assistance in dying is not helping people choose to end their lives. Medical assistance in dying is what the medical community calls palliative care or hospice care.

As Canadians, we are blessed to live in a country that has a great health care system, with many physicians who care deeply about helping their patients live fulfilling and healthy lives. When circumstances change and patients are facing an incurable deadly disease, these same doctors use their medical knowledge to relieve pain and suffering through end-of-life care. This is real medical assistance in death.

That is why I believe amendments are necessary to correct the hijacking of real health care. First, Bill C-14 should be amended to replace “medical assistance in dying” with simply “assistance in dying”. This would separate assisted suicide from health care.

Second, to complement the removal of medical terms from Bill C-14, I recommend amendments that allow for licences to be given to individuals through the Department of Justice that allow them to assist others in ending their life. This would eliminate the requirement of the medical community to be involved, as well as any concerns around the conscience rights of doctors. Licensed individuals, including doctors who wish to participate, could assist in the assisted suicide process and allow our health system to remain focused on its primary objective of providing health care to all Canadians.

Third, I believe the eligibility for assisted suicide in Bill C-14 must require that individuals seeking assisted suicide first be provided with counselling or psychological services and a legal judicial review.

There are a number of amendments that I believe are also critical for the bill, but many of them have already been raised by my colleagues. I want to return to what is truly at the heart of this debate; that is, protecting vulnerable members of our society and reducing the suffering of those who are dying.

This has been raised by many members from all sides of the House. Helping people die with dignity is not, and never will be, achieved through legislation of assisted suicide. Rather, helping die well can only be achieved through improving our focus upon palliative care. Every Canadian has the right to quality health care, and this includes high-quality palliative care.

That is why I have seconded a motion on palliative care tabled by my NDP colleague, the member for Timmins—James Bay. This member has pointed out often that there has been no real commitment by the government to palliative care.

I was recently moved by a comment from my colleague in the other House, Senator Betty Unger, a registered nurse, who wrote:

Access to palliative care is as much a Charter right as access to physician-assisted dying.... [M]ost people will acknowledge that there is something terribly wrong when a government does more to guarantee that the living can die, than to ensure that the dying can live.

I would call upon the government to demonstrate that it views palliative care as much as a charter right as assisted suicide.

Assisted suicide and euthanasia is one of the issues that influenced my decision to run as a member of Parliament. It is an issue that also concerns many of my constituents.

Earlier this year, I sent out a survey to my constituents on assisted suicide and euthanasia. Over 92% of my constituents responded that they were opposed to assisted suicide being available to children. The vast majority also took the time to express they opposed assisted suicide for all people, not just children.

My constituents also expressed concern that doctors must be given conscience protection, including Michelle, who wrote, “Doctors take an oath to save lives, they should not be asked to end them by patients or families' choice”.

Opposition to assisted suicide in my riding also crossed party lines. Amy wrote me, “As a Liberal supporter, I feel torn on these issues. I can understand both sides. However...this issue seems almost equivalent to legal murdering”.

On the issue of pain and suffering, Maggie wrote to me, “Having seen friends and family make decisions in the midst of pain and weariness, and having been through deep depression and weariness of emotional pain; I know that clear good decisions are never made in the valleys of life. I've come through wanting to end my life and experienced more joy than I [ever] thought...possible”.

My constituents also include 14 first nation communities in northern Alberta. During the special joint committee hearings earlier this year, Dr. Alika Lafontaine, who is the president of the Indigenous Physicians Association of Canada and who also works throughout northern Alberta, said:

What we are pleading for in indigenous communities is not medically assisted dying. That already exists in more ways that can be counted. What we are pleading for is medically assisted life.

Indigenous physicians want to help indigenous people live, not die.

Dr. Lafontaine also expressed that there have not been “meaningful consultations with indigenous peoples” and that “the effects of creating a literal program where patients intentionally die within the medical system will further disengage and disenfranchise indigenous patients and families”.

Earlier this year, I asked the Minister of Health about the consultations, and she admitted that the Liberal government did not consult directly with indigenous organizations on assisted suicide legislation.

Indigenous leaders tell me, “Nothing about us without us”.

I am deeply concerned about the impacts that legalizing assisted suicide would have on the indigenous communities.

Finally, the topic of suffering is often raised when discussing suicide. The argument is made that assisted suicide should be made available to all who suffer, even children. Proponents will argue that life with pain and suffering is undignified life and, therefore, assisted suicide should be available to anyone suffering pain.

I could not disagree more. People's dignity is not tied to their circumstances, but comes from the very fact that they are human.

More important, our health care providers are incredibly talented at helping patients manage pain. Even when it comes to children in palliative care, doctors are not—I repeat, not—seeking assisted suicide as a solution.

Dr. Stephen Liben, director of the Montreal Children's Hospital's pediatric palliative care program, said:

There aren’t these children that are asking to please die now. It never happens.... The last thing I need as a palliative care physician for children is a euthanasia law—the last thing....

This would not be an extra tool for relieving suffering at all, it would only muddy the waters and make things more confusing.

I cannot support Bill C-14 at this time, but should significant amendments be made in the protection of conscience rights of health care workers and the removal of health care references, I would consider support.

[Luc Thériault, Bloc, Montcalm, QC]

Here, we are facing a different challenge: how to legislate in respect of assisted suicide. Bill C-14 uses the same terminology as the Quebec law. However, there is confusion about what the Quebec law covers, and so this bill still does not completely govern assisted suicide, in the belief that it answers the question of what medical assistance in dying should be.

You told us that medical assistance in dying should be limited to "adult patients on the brink of natural death." In fact, the words "natural death" are problematic for me. That seems to be based more on the Quebec law. However, a person suffering from a degenerative disease—for example, ALS—is not entitled to make an advance request and is ultimately condemned to become a prisoner in their own body and to die choking on their own mucus because the law does not give them the right to assisted suicide. When that happens, the person is very far along in the process. A person can be in the terminal stage of a disease without being in the terminal phase of life.

What do you mean by natural death? In palliative care, death is induced by the sedation you are given to control pain.

[Luc Thériault, Bloc, Montcalm, QC]

The reason I asked you that question is that the Quebec law deals with a situation that is completely different from the one addressed by Bill C-14.

The Quebec law, rather than positing two opposing situations—palliative care and a request to die—treated it as being a continuum of end of life care. Euthanasia itself, or medical assistance in dying, is possible only in the terminal phase of life, where the process of dying has been irreversibly set in motion.

[Richard Marceau]

In terms of the process itself, everyone agrees that it was remarkable. The people in civil society were listened to and heard. I would particularly note the remarkable work done by Véronique Hivon, whom you met with yesterday, I think. I also know her personally.

Quebec has been exemplary in its consideration of this issue. It also had the time to come to a position that was quite broadly shared. You said that 94 out of 125 members of the National Assembly were in favour of that position, as compared to only 22 who opposed it.

I know that you are very familiar with politics in the National Assembly. It is very difficult to manage to achieve that level of consensus on an issue like this. It is quite remarkable.

The work in front of you as federal parliamentarians is very difficult, because you have very limited time. You are still here and it is nearly 8:30 p.m. You have spent the day working on this issue. I am familiar with the work done by the justice committee, and Bill C-14 is quite complex. It takes a lot of concentration, and that is a demanding task.

Personally, I am an admirer of the Quebec law on this subject. Knowing the institution where you sit, and a number of you around this table, I am sure that the work you will do will also be serious, limited though the time is. I am sure you would have liked to have more time, but that is unfortunately not the case. I am sure that the work you are doing and will be doing will result in a position that will both comply with the decision of the Supreme Court of Canada—we have the rule of law in Canada and we must respect that Court's decision—and, I hope, meet the aspirations of the largest possible number of people.

[Luc Thériault, Bloc, Montcalm, QC]

I like having time.

Mr. Fletcher, with all due respect to the other witnesses and meaning them no offence, I came here this evening, after a very busy day, to be sure to hear you because, for one thing, you are inspiring. Some people claim to be well-wishers and do-gooders when it comes to vulnerable individuals. By interfering with their self-determination and their autonomy, they imagine themselves, in all their paternalism, to be doing good, when we know very well that this is not the case.

Yesterday, the Barreau du Québec said exactly what you have said this evening. I don't know whether you find it reassuring, but there are others who share your opinion of Bill C-14. That is simply a comment, an expression of appreciation. I also share your reading, because we are talking at all times about vulnerable individuals. However, the Supreme Court has specifically taken a position under section 7 of the Canadian Charter of Rights and Freedoms to protect vulnerable individuals, in particular when it says that a total ban, as is the case at present, infringes not only a person's security and freedom but also their right to life, in that it could lead to the person taking their life prematurely, when, in fact, individuals with a degenerative disease, for example, are not suicidal. They want to live as long as possible, until the time comes, at the point where their condition appears to be completely unbearable, when they are no longer able to end their own life. Those people are the sole judges of their condition. On that point, your testimony seems very eloquent.

Mr. Marceau, you are familiar with the law in Quebec. I think there is some confusion in Bill C-14. What do you think about the Quebec law, on which there was consensus after six years of discussion, and that the National Assembly passed by a vote of 94 to 22? What do you think about Quebec's act respecting end-of-life care?

[Guy Lauzon, Conservative, Stormont—Dundas—South Glengarry, ON]

Madam Speaker, with all due respect to the member across the way, I would like him to show me the cash.

There was a $3 billion commitment in the Liberals' platform, and all of a sudden it is not in the budget. The member is asking us to trust them, that they are going to have an agreement with the provinces and it is going to be there.

Quite frankly, we should not be passing Bill C-14 until we have palliative care in place. We heard about the gentleman lived 60 years. Imagine if he would have taken advantage of Bill C-14, assisted suicide. However, we have to talk about Bill C-14, which is a different case.

With all due respect, as I said, I would like to see the cash.

[Guy Lauzon, Conservative, Stormont—Dundas—South Glengarry, ON]

Madam Speaker, I arrived here a very fortunate man 12 years ago, elected by the electors of Stormont—Dundas—South Glengarry. I really believe that since that time this is probably the most complex and sensitive issue I have ever witnessed come before Parliament, for me personally anyhow.

As far as disclosure goes, I am a practising Catholic. As a result of that, I will definitely be voting against Bill C-14. For me, this is a moral issue. I strongly believe in the sanctity of life. In fact, ever since I can remember, I have taught that life is precious, especially a human life, but also an animal or an insect's life. All through my life I have been taught that life is a gift from God and we should respect it as such.

That is not the only reason I will be voting against Bill C-14. Because this is such an important issue, I thought I should get input from my constituents. I took the trouble of sending a survey to 45,000 homes in my riding. The results were: 65% of the constituents of Stormont—Dundas—South Glengarry were against Bill C-14, and 35% were in favour of the bill, with conditions. I read many of the comments of the 35% and those conditions were rather strict. They called for very limited assisted dying.

I want to thank the joint committee. I wish I had been on the committee, but in other respects I am glad I was not. It must have been a very emotional committee on which to serve. I want to thank all the members for the hard work they put into it, especially the members of the Conservative Party, because they issued a dissenting report. Thank God for that dissenting report.

I must give the government credit for accepting some of the issues included in the dissenting report. They were things like limiting it to competent adults 18 or over. That is so important. If we are to have this legislation, at least we should have that as one of the criteria. The other one was safeguards for vulnerable persons. My colleague, the member for Brantford—Brant, spoke about that. He has a son who is in that category. There was also protection for physicians who disagreed. I have had so many physicians in my riding say that they cannot support this and believe they will be in trouble if they do not support it.

As many of my colleagues said, we have to do this. The Supreme Court of Canada has told us we must. However, if we must do it, let us minimize the damage. There is a way to do that. It is called palliative care.

During the campaign, the Liberal Party promised $3 billion for long-term care, including palliative care. However, in the budget, as my colleagues have stated, there was no hint of any money for long-term care and certainly no money for palliative care. It is nowhere to be found in the budget.

The special joint committee and most of the stakeholders who appeared before it, including the Canadian Medical Association, spoke of the need for a pan-Canadian strategy on palliative care, with dedicated funding. They suggested that there be dedicated funding for palliative care if we were to enact Bill C-14.

My Liberal colleagues are in the House. They are going to have a caucus meeting tomorrow, as will we. Money for palliative care should be brought up at that meeting.

I spoke with the manager of the Cornwall hospice today. Cornwall hospice is in my riding. About eight to ten years ago the community came together. We thought we needed a hospice so we raised funds. Now we have a wonderful 10-bed facility that deals with 100 to 150 patients per year.

I had heard through the grapevine, and through reading, that sometimes people left palliative care. I called the manager of this hospice directly and asked if this had ever happened. He said, “most definitely”.

On average, three to four people leave palliative care in a year. Sometimes they are gone for six months to 24 months. Imagine if some of those people had chosen the route of Bill C-14.

I was doing some reading on this issue, and it really struck a chord in my heart. I would like to quote something that I read, which is from the Euthanasia Prevention Coalition. It says:

Yet of the millions of mis-diagnoses every year, many are terminal mis-diagnoses. We know this because of the thousands of people who “graduate” from hospice each year.

People leave hospices not only in Cornwall, but right across North America and the world. There are so many examples of people outliving terminal prognosis, from Ted Kennedy living a year longer than predicted, to John Norton from Florence, Massachusetts, who testified before the state legislature. When he was diagnosed with ALS, he would have definitely used assisted suicide were it available. Luckily for John, his family, and everyone who has come to know him, assisted suicide was not state policy. He went into remission, and 60 years later he is urging people to reject assisted suicide. I rest my case.

[Michael Bach, Executive Vice-President, Canadian Association for Community Living]

Thank you, and good evening honourable Chair and members of the committee.

On behalf of our association, I'm pleased to present our brief outlining specific proposed amendments to Bill C-14, a brief we title “Medical Assistance in Dying: A Private Request, a Public Act”.

Let me begin why we chose this title for our brief. Our membership has been struck by the reactions to our proposals and efforts to advance robust safeguards for vulnerable persons, often with the following comments. “This is someone's private decision”. “What business does the state have being involved?” “It's a matter of choice; why should that choice be questioned?” “The focus has to be on enabling people to get what they need, so they can die in dignity”. We appreciate the depth of the concern, the first-hand experience, the desperation, and the frustration that motivate these kinds of reactions to proposals for robust safeguards.

One of the main difficulties in the debate is that it is actually not as straightforward as some commentators seem to suggest, to design a public service to respond to people's request for what Bill C-14, calls medical aid in dying. After all, we are talking about a public service designed to end people's lives, not to provide palliative care or other supports. The Minister of Health has made clear that's for future conversation and consultation with the provinces and territories.

We're now engaged in building a new public service in Canada designed to make people dead. I put this starkly, not to be provocative but so that we can bring as much clarity as possible to what it is that we are actually doing with eyes wide open, about what is at stake.

The Supreme Court of Canada, in paragraph 2 of the Carter decision, made the stakes clear. On the one hand stands the autonomy and dignity of a competent adult, who seeks death as a response to a grievous and irremediable medical condition. On the other stands the sanctity of life and the need to protect the vulnerable. It goes on to say people who are vulnerable to being induced to commit suicide.

We think there are two main policy questions to answer in order to deliver on these policy goals. Who is the service intended for, and how can we best ensure that delivering the new public service will only be to those who are truly autonomous and not to those who are being induced to die by suicide?

The first question, who is the service intended for? We fully support the definition of eligible persons for this service as laid out in Bill C-14. We concur with the conclusions of constitutional law expert, Professor Dianne Pothier, who wrote, in a piece published in Policy Options just last week, that the Supreme Court's silence on the particulars of the definition of grievous and irremediable should not be taken to tie Parliament's hands. Indeed, the court was very clear that it was up to Parliament to define this term and the parameters of the system.

As Professor Pothier notes, the trial judge actually defined the term and she did so quite clearly. The Supreme Court neither rejected the definition nor added to it. The trial judge defined the term to include only those conditions that left the person in an advanced state of weakening capacities, with no chance of improvement, and specifically excluded those whose source of intolerable suffering was psychosocial in nature. In granting the constitutional exemption to Ms. Taylor, the criterium was that she would be terminally ill and near death, and there was no hope of her recovery.

Although the Supreme Court of Canada did not define grievous and irremediable, the fact that it adopted the trial judge's terminology, without comment, offers a strong inference that it found the trial decision definition and the criteria valid, otherwise, the court would likely have altered the criteria or rejected the terminology. We also support, very clearly and for reasons the Professor Pothier has laid out, the inclusion of a criteria of reasonably foreseeable natural death.

Second, and we can get into a discussion on that later, how can we best ensure that we're delivering this new public service only to those who are truly autonomous and not to those who are vulnerable to being induced to die by suicide?

A main challenge in designing this service is to identify and respond to people who may be induced to use the new system to die. One of the challenges is that it's not a straightforward exercise to identify who, in fact, is vulnerable to being induced.

What do we mean by being induced to die by suicide in such a system? There's a large body of clinical research on inducement to suicide, and recent evidence and case examples from Oregon, the Netherlands, and Belgium. We've recently undertaken a review of this research, which points to five main ways in which people can be induced.

First, there can be distorted or disordered insight into one's condition and options available to a person as a result of the mental health issue.

Second, there can be hopelessness arising from self-stigma associated with negative cultural messages and stereotypes about one's condition.

Third, there can be direct coercion, and there are many examples in the Oregon and Belgium-Netherlands systems of direct coercion. One that we've shared is of a caregiver in Oregon who said to her husband, you either use the system to die or you go into long-term care. He didn't want to go into long-term care, so he chose the system to die. Given that 40% of elderly persons in long-term care in Canada are either clinically depressed or show symptoms of clinical depression this should be a real concern for us, and given also the lack of family supports.

A fourth form of inducement is through what the psychiatric literature calls the psychodynamics of the relationship with health care professionals, where physicians may feel a sense of guilt from not being able to heal a person and a person comes to feel like a lost cause. This is called in psychiatric terms transference and counter-transference.

A survey of psychiatrists involved in consulting on request for physician-assisted death in the Netherlands indicated that such dynamics influenced 25% of the requests in which they had provided psychiatric consultation and 19% of cases they consulted on physician-assisted death went ahead to be authorized by physicians, even though the psychiatrist had advised that issues of transference and counter-transference appeared to be influencing the decision.

A fifth way of people being induced is because of a lack of access to needed support or information about what options might be available, meaning effectively that people are not making informed decisions.

Our proposed amendments to address these concerns are laid out in our brief and include, in summary, an expansion of the preamble to include a study on independent prior review. We believe that a system for prior review is essential to guard against the very real risks and complex nature of the reality of inducement that is pervasive in the systems that exist and to ensure that the legal criteria Carter laid out are met.

Second is a clearer standard for informed consent. The bill only references external pressure. The Supreme Court was clear that people who were induced to die by suicide needed to be safeguarded. The standard should include reference to inducement, undue influence, and coercion.

As well, there are only five provinces and territories that actually have statutory standards of informed consent across the country, and colleges also have varying guidelines.

A proposed additional safeguard is that before medical assistance is provided, the medical practitioner or nurse practitioner must confirm that a qualified clinician has provided the person with a palliative care consultation, outlining the full range of treatment, technology, and support options and provided written confirmation that the person had the capacity to refuse those options.

Fourth, we believe that until further study is done, either the current system of superior court prior review should stay in place or proposals advanced for putting a tribunal system in place should be incorporated into the bill.

Here are a couple of final ones. The bill provides that the Minister of Health may make regulations related to information to be gathered. We believe that should be amended to say the minister must make those regulations and those regulations should come into force on the day the law comes into force, so that we can be assured that information is being gathered about requests, the socio-demographic information, the reasons people are refusing options, and the reasons they are requesting this service.

Finally, we believe that the bill should include a requirement that the ministers of Justice and Health table a report in Parliament on an annual basis based on analysis of the information that is collected under the regulations.

Thank you.

Some of our members support medical assistance in dying, focusing on the fate of people who have an incurable or debilitating illness for which there is no remedy. Others oppose it, based on traditional religious grounds or thinking that it would precipitate the practice of euthanasia.

Although there are differences of opinion, a broad consensus exists within our community on the fact that, in response to the decision of the Supreme Court in the Carter case, important measures must be taken: to protect health care providers who object to medical assistance in dying for reasons of conscience; to ensure that eligibility for medical assistance in dying is sufficiently regulated to protect vulnerable individuals; and to provide genuine access to quality palliative care.

I would like to start with the question of conscientious objection. Many health care professionals oppose medical assistance in dying based on their deep professional, religious or moral convictions.

Unfortunately, Bill C-14 is silent at present on the question of the freedom of conscience of the doctors, nurses and pharmacists who could be asked to provide medical assistance in dying. Some health care providers believe that merely recommending medical assistance in dying to a patient is an unacceptable act.

We are encouraged by the fact that Bill C-14 does not force doctors to refer patients directly. If that had been the case, Canada would have been the only country to impose that requirement, which probably could not comply with the Supreme Court's direction to strike a balance between doctors' and patients' rights.

However, I would stress that any accommodation concerning the approach taken by health care professionals should not limit patients' access to medical assistance in dying.

Several models have been proposed to balance these rights. For example, the Canadian Medical Association has proposed a separate central information, counselling, and referral service to which objecting physicians could direct patients seeking physician-hastened death.

Dr. Hershl Berman, a specialist in internal medicine and palliative medicine at the Temmy Latner Centre for Palliative Care in Toronto and an associate professor in the Faculty of Medicine at the University of Toronto, recently proposed another model in The Hill Times. He wrote:

Rather than actively referring patients, all physicians should be required to report any request for assisted death to the provincial Ministry of Health or a regulatory body. Physicians would be required to register if they are willing and qualified to provide MAID, and indicate how many additional patients they are able to take on per year. If the report is from a doctor willing to provide the service, he or she would receive confirmation. If not, the registry would connect the patient with a nearby practitioner.

“MAID” stands for medical assistance in dying.

Dr. Berman noted this as well:

In addition to respecting the beliefs and values of physicians who object to MAID, this process has an additional benefit. Many physicians, especially specialists, have a limited network of colleagues to whom they are accustomed to referring. In isolation, particularly in under-serviced areas, any doctor may have difficulty finding a colleague willing to accept the patient. If the process is managed centrally, a registry can ensure more effective and timely access for patients who wish to hasten their own death.

I would now like to talk about eligibility. We sympathize with patients who have not reached the age of majority, who have a health problem and would like to have recourse to medical assistance in dying. We also have to consider the serious difficulties that would face both the minors who would make such a serious decision themselves and the parents who would make the decision on behalf of their child.

Considering the finality of medical assistance in dying, we believe in the need to take a cautious approach to the criteria relating to consent. We believe the government has struck a fair balance in Bill C-14 by limiting access to medical assistance in dying to competent adults aged 18 and over. This approach is consistent with the laws on medical assistance in dying in Quebec and other jurisdictions in North America. We believe, as Bill C-14 provides, that if medical assistance in dying is allowed, it should be limited to adult patients on the brink of natural death.

We acknowledge those within our community who would prefer that medical assistance in dying be available more broadly, along the lines of the situation in some European countries, and we empathize with their motivations. However, these concerns appear to be beyond the scope of what the Supreme Court intended in its decision, which stated:

...high-profile cases of assistance in dying in Belgium...would not fall within the parameters suggested in these reasons, such as euthanasia for minors or persons with psychiatric disorders or minor medical conditions.

Many members of our community believe that Canadians should be able to give consent to medical assistance in dying before suffering physical or mental deterioration, and give advance instructions in the event they were to become incapable of acting. Some people consider this to be a fundamental component of any effective scheme. Others, however, have expressed concerns.

After diagnosis, a patient might justifiably not want to continue to live during the terminal phase of their illness. However, that does not necessarily mean that they will continue to want medical assistance in dying when they become eligible, when they are no longer competent to revoke their consent. If the committee chooses to amend Bill C-14 to include advance directives, we believe they should adhere to the same rigorous guarantees defined in the bill to ensure informed consent. Patients will have to meet those requirements when they are capable of giving informed consent, and their directive will be respected once they meet the eligibility criteria.

In conclusion, I would like to discuss a matter on which there is broad consensus: the need to provide high quality, universally available palliative care as an end of life option. Medical assistance in dying cannot be a substitute for palliative care, home care or support for patients in the terminal phase and their caregivers. It is essential that medical assistance in dying not be the only option or the default option available to Canadian patients.

Thank you, Mr. Chair. I will be pleased to answer questions in the language of your choice.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Madam Speaker, as others have said before me, we are debating this evening one of the most important issues of our time. It is not just an important issue but a difficult issue. In fact, it is a real constellation of difficult issues and difficult decisions. It is an issue that has been a concern in Canada for decades, including the case of Sue Rodriguez more than 20 years ago. We are talking of it again because of the landmark Carter decision that has instructed Parliament to create legislation to legalize and regulate medically assisted dying.

Like all members of the House, I have received many letters, emails, phone calls, and personal representations from all sides of the issue. Some people are concerned that because of the restrictions in the legislation they would not be eligible for the procedure should they need it in the future; while others are worried that medical practitioners who have ethical concerns would not be able to opt out if they wish.

Obviously we need good legislation that clearly spells out the eligibility criteria for this procedure as well as the regulations around the actual procedure itself. Because of these needs, I am generally in favour of this legislation, but I feel that it is deficient in several regards.

We have to ensure that this bill properly addresses the Supreme Court decision. The last thing we need is to prolong the suffering of grievously ill people through more litigation.

As I mentioned, we also need to ensure that the practitioners who are undertaking these procedures are protected regarding their roles and moral beliefs. Last week in the House, I tabled a petition from many of my constituents on this issue.

We need to ensure that people with progressive illnesses have access to suitable palliative care, as many people have mentioned here this evening. They need access to palliative care, pain management, and home care so that medically assisted dying is not set out simply because other more appropriate actions are not available.

Finally, we need to ensure that this procedure is equally available across the country.

The need for this procedure is clear as was laid out in the Supreme Court decision. One of my constituents has already requested legal access to the procedure, several months ago, without waiting for our action here as his suffering was so great. He waited through the foot-dragging of the previous government, but could wait no longer. Clearly, other Canadians who are suffering through intolerable pain and discomfort will continue to access this service through more complicated legal channels if we do not pass legislation here.

Just last Friday, I met with another constituent who is suffering with advanced progressive multiple sclerosis. He wanted to talk first about federal funding for research into experimental treatments for MS. Because of the advanced nature of his disease he was not able to access the present experimental treatments, but he desperately wanted others to have greater access in the future. However, now that he cannot dress himself, bathe himself, or even shave his face, he feels that life with any dignity is fast slipping away. He is deeply concerned that he would not be eligible for medically assisted dying because his natural death may be years away and not “reasonably foreseeable” as this bill now states. Many experts feel that even Kay Carter, who brought the case before the Supreme Court, would not be eligible for medically assisted dying under the criteria now set out in Bill C-14.

The same constituent also recounted how difficult life is for his wife as he faces his progressive illness. He would like better access to home care services and later palliative care, so that his wife can have respite from his daily care. However, these services are not available equally across Canada. We desperately need a national palliative care strategy and the funding that goes with it to ensure that patients who need this care have access to it. Bill C-14 refers to palliative care in its preamble, but it is silent after that. The government was silent on palliative care in the budget, despite a promise for $3 billion for home care in the election campaign.

Hospice care is also needed across this country, but it is even less available than hospital palliative care. In my riding, there is only one hospice centre and it is five hours by road from the east side of the riding. I have met with an active hospice society on the eastern edge of the riding, but it is struggling to find funding for a hospice, despite a clear need for it and a strong case that it will save a considerable amount of money in the local health care system. This disparate amount of care is a concern to me, since we do not want people choosing medically assisted dying simply because they do not have access to proper pain management, palliative care, home care, or hospice treatment.

Finally, I would like to talk about advance directives. Many people with progressive diseases would like to provide their loved ones and physicians clear instructions regarding their fate if they become incapable of giving those instructions at a later date because of their deteriorating physical condition. The special joint committee that studied this issue made a recommendation to allow advance directives regarding medically assisted dying under certain conditions, but this recommendation is not included in Bill C-14. Certainly advance directives must be crystal clear if they are to be used, but it is an issue that we must face.

To conclude, I feel that the eligibility criteria put forth in this bill may not reflect the Supreme Court ruling that brought us to this point. While we have to be careful to protect the most vulnerable in our society, many Canadians, including the constituent I mentioned at the start, will suffer even more than they are now if we get this wrong.

I know that this debate will continue at committee and I hope some of the concerns I and others have raised will be addressed in the few weeks remaining before the June 6 deadline.

[Steven Fletcher, As an Individual]

Okay, thank you, Mr. Chairperson.

Thank you everyone for the opportunity to comment on Bill C-14.

My comments are going to be brief and focused on the bill. I've already spoken in front of the joint committee, and I initiated some private members' bills in the previous Parliament on this issue. I've also written a book called Master of My Fate on the parliamentary process.

I would like to first of all commend everyone involved. This is a difficult issue. There are some very good things in the bill. I found in many ways that it mirrored the private members' bills that I had introduced. This includes the provisions around making sure that people who may have a vested interest in the demise of an individual are not involved in the decision-making process. I encourage you to keep that in the bill. It's not an amendment; it's a thumbs-up for what is there.

I would also say that on the age of consent at 18, the bill is probably realistic at this time.

I think, though, that we need to collect empirical data over the next few years to find out where the demands and the needs are, and why people would request a physician-assisted death, by having a mandated parliamentary report that is public, with empirical data. It could perhaps be funded through the Canadian Institutes of Health Research. In order to make good public policy, you need good empirical data, especially on such a difficult issue as this.

Now, on the amendments, the Supreme Court was very clear that sections 241 and 14 of the Criminal Code unjustifiably infringe on section 7 of the charter and are of no force or effect at this time. Moreover, the Supreme Court made it very clear that the prohibition for physician-assisted death for a competent person “who...clearly consents to the termination of life and...has a grievous and irremediable medical condition (including an illness, disease, or disability) that causes enduring suffering that it is intolerable to that individual in circumstances” that they find themselves in....

The bill clearly is not consistent with the Supreme Court decision on the issue of terminal illness and that you have to be on a trajectory of end of life in order to take advantage of one's charter rights. I can understand, politically, why this was done, but it is quite frankly something that will go to the courts, and it will be changed to what the Supreme Court says. You cannot deny someone their charter rights because they happen to have a disability that may last 40 years, or an illness that goes on forever.

There are unfortunately many such situations that exist, such as ALS. There's also MS or stroke victims. There are many permutations of illness, and by saying that they have to be on a death spiral essentially denies them their charter rights.

The other comment I would have is on proposed paragraph 241(b). It's not clear to me that someone would be made aware of all their charter rights, including physician-assisted death. It seems to say that, if you raise it with someone, you are in deep trouble. I think people would like to know the entire range of options is available to them, including physician-assisted death in some cases. It seems to forbid medical practitioners from expressing that—or anyone else for that matter.

Regarding advance consent, I think this should be part of the mandate of whatever you decide to do for the future. It may be a bridge too far this time around. We've come a long way in a couple of years, but I can understand the challenges with that. But again, if someone has dementia or something happens to them in the future, why can they not state what their preferences are before they lose their cognitive ability? There's nothing in the Supreme Court decision that would prevent that.

Finally, there's been a lot of drama around the Supreme Court decision in the last year, and people are trying to weave their way through a difficult legislative process. I very much get the challenges that you have as MPs, but at the end of the day, it's all going to come back to what the Supreme Court has said.

Committee, without the amendments, particularly in proposed section 241, you're going to have to decide if you are going to force people who are disabled or have a disability or illness to go to the Supreme Court to exercise their charter rights or if you accept what is inevitable and just replace the wording with what the Supreme Court said in the first place.

I'd like to thank everyone for the opportunity to be here today. Of course we always have to realize that offering more resources for people is important, but sometimes all the resources in the world don't make a difference or can't make a difference, and people are suffering every day. We need to be empathetic to those people.

Thank you very much.

[The Chair, Liberal, Anthony Housefather]

We're going to reconvene with the next panel of witnesses. It's a pleasure to have each and every one of you with us today.

We are joined by Steven Fletcher, a former member of Parliament and a new member of the Legislature of Manitoba. Congratulations on your election.

We are joined by the Centre for Israel and Jewish Affairs, represented by Richard Marceau, a former member of Parliament, who is the general counsel and senior political adviser. Welcome, Mr. Marceau.

We're also joined by the Canadian Association for Community Living, Mr. Michael Bach, who is the executive vice-president. Welcome, Mr. Bach.

Each of you has eight minutes, then we're going to move to questions. As all of you know, we're studying Bill C-14, so we would very much appreciate if you would comment on the bill itself and the proposed amendments to the bill, and not general comments you may have made to the special committee.

That being said, Mr. Fletcher, the floor is yours.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Mr. Speaker, as I approached this speech tonight, I have said to many in my community and my family that this would be the most important speech I ever deliver as a member of the House. I have been here eight years and hope to represent my constituents into the future.

I am going to speak about the most vulnerable, about meaningful safeguards, and about addressing the slippery slope that is Bill C-14.

First, here is full disclosure. I am the parent of a 29-year-old intellectually disabled son. I held the hand of my mother as she exited this world in pain. I watched a very close friend pass away over two years, in pain from a horrible disease.

Earlier in this debate, the member for Durham used words that resonated with me, that we all seek “compassion on both sides of this issue”, and that is essential.

I am going to refer to some messages that have been written and sent. I should also disclose that I, too, have held public meetings. In fact, this issue was brought up during the election campaign, and I stated my position very clearly and concisely to the voters on this particular issue.

I would like to start with a quote from the member for Calgary Nose Hill who said in her opening statement that this is about “the sanctity of human life”, “defining the morality of our country”.

I would like to read the words of someone who is greatly respected. His name is Jean Vanier, and he wrote an article, along with Hollee Card, in The Globe and Mail on March 1. He heads up an organization called L’Arche, and he said:

We in L’Arche have had the privilege of accompanying many on life’s journey, not only in times of health and strength, but in times of fragility and weakness as well. Through this experience we have learned many things.

Most importantly, we have learned that it is the most fragile among us who are the closest to their humanity, to their suffering, and to their need to be loved. It is they who show the rest of us the way to live in truth and in love.

He goes on to say:

This is why we have a special obligation to ensure that the care available to each of us throughout our lives, but especially in our final stages of life, affirms both our dignity and humanity. Otherwise, we diminish our range of experience to include only our independence. We diminish the love we can share, and the vulnerability we can show to one another.

Such a spartan culture ultimately devalues life. In its place we must recommit to honouring and accepting ourselves and others by finding ways to accept our frailties, and the full course of life.

Members can see that Bill C-14 undermines the precarious position of people with disabilities in Canada.

Other interesting comments that were shared with all parliamentarians came from an individual named Hugh Scher, a solicitor and lawyer, who for 25 years has advocated on these issues. By the way, he points out at the very front end of his letter to us that he was not invited to talk at the committee, yet he has advised every party in the House on these issues.

Let us talk about the safeguards he points out.

Judicial or Tribunal oversight to ensure compliance with legislated requirements and to identify vulnerability before the fact is an essential requirement for effective oversight in respect of any regime of assisted suicide;

He goes on to say:

The requirement of judicial or tribunal oversight and of vulnerability assessment and identification before the fact by way of prior review are an essential requirement of any regime of assisted suicide and must be implemented by Parliament in the event that there is to be any prospect of safe implementation of an assisted suicide regime. Failure to implement such measures will leave vulnerable Canadians at significant risk without any means of enforcement or protection from abuse;

By the way, Bill C-14 does not have those protective measures of judicial oversight in it.

Some say the bill does not go far enough. Let us take the example of Belgium and how it has evolved over the years. Thirty-two per cent of cases carried out in Belgium are without any request or prior consent of the individual. Even though the law requires it, it is ignored and it is not prosecuted. The numbers since that bill was introduced until today are staggering. What happens is that society changes. Society changes and this becomes the norm. People start accepting the fact that this is the way it is.

One of the issues with Bill C-14 is the fact that, in the preamble, there is a statement to allow for further study for mature minors and persons with mental illness. To me, I interpret that as code. That code is saying that those who want wide-open, available euthanasia, death on request, are not to worry, that it is coming. That is the code. If we look at the report of this particular special committee and what it brought back to Parliament, stating what these people would love to have, we see the code that it will be coming. It is written right in the preamble of the bill.

Some have said that it is the incremental expansion over the course of time in ways not yet contemplated. Over time, citizens become more used to it. Over time, the law would encourage and encompass people with more ailments and younger patients. There is a dangerously contagious effect of assisted-suicide laws that has been observed in the Benelux countries and in the jurisdictions that have had this law on the books for a long time. This is about the sanctity of human life, defining the morality of our country, as the member for Calgary Nose Hill so accurately said.

Let us talk just a minute about the conscience rights of health professionals in institutions. These are not in the bill. We would have to amend this bill to have these rights in there. At my public meetings, we had many doctors who expressed their view that this was absolutely essential for them to carry on in practice really and they would look to alternative jurisdictions to not have to abide by this. That is also for health care professionals in general.

Moving on to palliative care, I and the people of my riding are very fortunate to have the finest palliative care in the country. One of the individuals who spoke at the public meeting said she has watched many people at end of life resolve issues among their friends and family, who would never have had the chance. These are people who have passed along in the best possible environment.

My comment is that the Supreme Court has forced us to this position. If we are to have a law, we must have a law that is as airtight as possible. We must protect the most vulnerable. If one person dies because of a badly scripted law in this country, it will all be on us.

I appreciate the time to speak tonight.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you, Chair.

Thank you to all the witnesses.

Mr. Scher, in your presentation you mentioned that the first problem with Bill C-14 is that it provides legal immunity to any person who directly participates in euthanasia and assisted suicide. I submit to you that's over-broad. It provides blanket immunity to people who assist in medical assistance in dying, which is a much more constrained circumstance.

Would you like to comment on that?

[Murray Rankin, NDP, Victoria, BC]

Someone suggested there are no protections in this C-14 for the vulnerable, which, of course, is absurd. One of them is the eight conditions listed in 241.2(3), so-called safeguards, one of which, Dr. Smith, is to provide the opportunity to withdraw consent at the end and in a sense require you to confirm your consent to receive medical assistance in dying at the very last, immediately before the medical assistance in dying is provided. I'd like your views on whether that's workable in the real world of morphine drips and intense pain at the end of life. Is that workable, in your judgment?

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

Mr. Speaker, it is certainly an important and sobering issue that I rise to address, which is on the minds of many Canadian families.

Last year, the Supreme Court of Canada found the current Criminal Code prohibition on physician-assisted dying to be constitutionally invalid. This decision required the government to revisit Canada's long-standing prohibition against euthanasia and assisted suicide.

Bill C-14 came about as a response to the Supreme Court ruling on the Carter case. The Carter case determined that persons who satisfy the following criterion of being a competent adult, suffering intolerably from a grievous and irremediable condition, and able to give their clear consent, have a right under section 7 of the charter to physician-assisted dying, or PAD.

Since that decision, the government appointed a Special Joint Committee on Physician-Assisted Dying to make recommendations on a legislative response. Liberal and NDP members in the main report for the special joint committee recommended a very permissive physician-assisted death regime beyond the parameters set aside by the Carter case. Their original report included provisions that suggested that physician-assisted death be available to persons with terminal and non-terminal illnesses, and to persons with physical and psychological conditions. What was most concerning, however, was the suggestion that the government would, in the future, study issues related to physician-assisted death for minors.

The recommendations and provisions suggested by the original report would set Canada on a very treacherous path. In response to these concerns, my Conservative colleagues released a dissenting report, which reined in some of the worrying suggestions and put forward a framework that more closely reflects the Carter decision.

In the dissenting report, my colleagues raised key issues that the legislation could tackle, which included limiting physician-assisted death to competent adults 18 or over; safeguards for vulnerable persons, including a provision for a psychiatric assessment; no advance directives; and conscience protections for physicians. Bill C-14 has adopted some of these key provisions from my colleagues' dissenting report.

The main safeguards in Bill C-14 include limiting euthanasia and assisted suicide to physical illnesses only, and putting in place an age restriction for such procedures. For those individuals who fall under the criteria for PAD, there is no specific referral to a psychiatrist in order to determine whether there are underlying mental illness issues that would compromise their capacity to give an informed consent.

Letters have been pouring in from communities in my riding. I did promise my constituents that I would listen and study all of the important points that have been raised.

This situation has pit the gravely ill against their own family's moral positions, and I too have been touched by the many stories that I have heard. Departed friends and family members had spoken to me in the past about allowing for a merciful end to their suffering, a position that many of us may find ourselves in when our time has come.

However, I am concerned that amendments may be introduced in committee to make the current legislative framework more permissive, or that an opening is presented for regulation to allow for the same permissiveness later on. This concern does not come from thin air, but rather from the very study penned by the special joint committee. Perhaps there could be amendments that would spell out a more restrictive legal framework so that we could effectively ensure that the safeguards are there to always protect the most vulnerable.

Canadian families on all sides of this debate are left anxious as to what lies ahead when the bill moves forward. The Carter case has forced Canadians to come to terms with this difficult decision.

I want to reiterate what my Conservative colleagues have been saying in the weeks leading up to this debate: our priority as parliamentarians should be to ensure that any new legislation developed conforms strictly to the Supreme Court decision, nothing more and nothing less.

Most Canadians want to see the government focus on improving palliative care, as it is an integral part of end-of-life care. There was unanimous agreement from the special joint committee and stakeholders, including the CMA, on the need for a pan-Canadian strategy on palliative care with dedicated funding. If it were up to Canadians, a national strategy on palliative care would be priority number one.

The conscience rights of health care professionals should also be taken into consideration. For some, physician-assisted death is against their moral code. It would be unjust to force a medical professional to act against their convictions. The oath to do no harm is founded in our commitment to look after one another and to care for our most vulnerable through viable medical interventions that honour the sanctity of life. There are many physicians and other health care providers that have raised this issue both with their members of Parliament and at committee. We parliamentarians need to address this for their sake.

There are harsh lessons to be learned from past experiences of jurisdictions such as Belgium. After legalizing euthanasia, deaths from such interventions increased every year. Safeguards were allowed to be removed and euthanasia is now available to individuals who are experiencing mental distress.

One of the most troubling instances of this slippery slope was when the Belgian parliament approved a bill that removed the age restriction from physician-assisted death, a provision actually recommended by our special joint committee report. This PAD extension to minors was not included in the original legislation passed by Belgium years before either.

The slippery slope is a real social phenomenon. We cannot allow Canada to go down that path. We cannot allow any legislation on physician-assisted death to be permissive. Provisions must be restrictive as the Carter case dictates it to be. Canadians expect us to be steadfast in delivering a fair and clear legislation, but we have to avoid expediting any circumstances that would lead to fewer safeguards.

I urge my colleagues to learn from these harsh realities and lessons. While it has become imperative that the House pass legislation before June 6, it is equally important to make sure that we have an effective piece of legislation.

It is also true that not having a legislative framework to address physician-assisted death is equally irresponsible. Without a comprehensive legislative framework, Canada would consist of a patchwork of provincial protocols that would create other serious concerns.

We must also remember to be realistic. Even with safeguards, consent can be coerced and vulnerable individuals will never be without risk. In Belgium, there are cases where physician-assisted death was administered without explicit consent; it could very well happen here. Life and death decisions should never come easily, nor should it come from anyone other than oneself .

Life is truly a gift and we must treat it as such. Providing care should always be the priority, and I hope that a pan-Canadian strategy on end-of-life care is also unveiled. This legislation as it is does not carry sufficient provisions and safeguards. We can do better. We owe it to our constituents to do better.

I hope that if the bill is sent to committee, parliamentarians will have the chance to amend it further to include improved safeguards.

In closing, I would like to pay tribute to friends and family I have lost along the way. My mother and father, Verna and Herman Dreeshen, in life taught me and others so much about compassion and kindness. My parents also showed so much during their final days about strength of character, faith, and the realities of life. Of course, they are both dearly missed. The care they received was exceptional and there were opportunities for us to talk.

I remember specifically when my father passed away I had been in the House for two weeks. The first week we had elected a Speaker, so I had the chance to go home that weekend and talk to him about the individuals I had spoken to, such as Ken Dryden whom I did not agree with politically but I certainly did on hockey. We had a chance to talk.

I also had a chance, during the next break, to speak with the prime minister and talk about different issues and things that were going on. To be able to relay that information to him the week before he died was very important.

I say to all Canadians, as we face this sobering reality for ourselves and our loved ones, that they should know they are always in our hearts and prayers.

[André Schutten]

My concern there is that there is nothing built into the code as it's drafted, that is, Bill C-14. There's no oversight for somebody else signing for another individual. Both James and Pieter are unable to sign for themselves. Under this provision as it's written somebody else can sign on their behalf. James and Pieter would both testify that they have very supportive families so it wouldn't be an issue for them. Perhaps there is a family where they see a family member such as James or Pieter as a burden. They could sign on their behalf possibly without Pieter or James being fully aware or possibly under coercion and there are no checks or balances. There's no clear oversight to test whether that signed statement is then voluntarily being given by someone like James or Pieter.

If you're going to get consent through written means then there are other ways you can get that from someone like Pieter or James. I would recommend that this committee consult experts in this field. You could find different ways so the consent comes directly from the patient involved, not some other proxy.

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

Mr. Speaker, I often say it is a pleasure for me to rise, because it is such an incredible honour to even stand in the House of Commons and attempt, in our own ways, to try to represent the great group of Canadians from our territories. Yet, as I approached Parliament this evening, thinking about this particular debate, I found myself struggling to use the word “pleasure”. It is simply because this debate strikes at the very heart of some of the most difficult questions we face as legislators, that we face as Canadians, that we face as friends and family of those who have faced the incredible difficulty of end of life.

There has been a certain amount of trepidation and perhaps fear from many of us in this place to talk about end of life, end-of-life care, the palliative care question, and to talk about end of life and the issue of medical assistance in dying, physician-assisted suicide.

I suppose there are some things required of us all in this debate. One is to fully appreciate and understand that great sense of responsibility and to bring to this conversation as much humility as we can muster. For some of us in elected office, humility is not always at the ready and available. It is also perhaps to bring the best wisdom we can from those who know a great deal more about this subject than we might.

Oftentimes we say that we have to separate the personal from the political, that we as legislators have to act purely in the best means and understanding that we have about the law and how we wish to craft the law in a way that is defensible at the Supreme Court and representative of our constituents. Yet, this debate brings those two things together for many of us.

This is incredibly personal for any who have stood in the House and spoken to this bill, or who will, if one reflects back on any experiences we have had with family members facing those challenges at end of life.

The Supreme Court of Canada ruled unanimously and gave Parliament a timeline to work toward creating legislation. It struck down the laws in Canada as it saw them. Many of those judges were appointed by the previous Conservative government.

What concerns me in what we see before us today is the government, as we often hear, has attempted to strike a balance. It has attempted to seek a perfect middle ground on such a contentious issue. While I admit that is a very difficult thing to do on legislation on an issue like this, we raised a number of concerns at the special committee.

We continue to raise those concerns, even though the New Democrats support getting this bill to the committee stage so we can hear from those witnesses who now have seen the final legislation. We need to understand whether it is constitutional, whether it is helpful, and whether it will actually achieve what the Supreme Court and Canadians have asked us to do.

I mentioned in the past that it was with regret that after the Supreme Court came down with a very clear directive to Parliament to form a new law, to create new rules for our country, the previous government was unwilling or unable, for whatever reasons, to begin that work at all. We sought to pass a motion in the House of Commons to start the committee process, to bring the witnesses in so we could hear from them, but we were also six to seven months out from an election. The government seemed to not want to really talk about it.

The government struck some process that has since not borne any fruit, and now we are under the proverbial legislative gun. We are sitting late. The committee has worked incredibly hard. I want to thank all members, Conservative, Liberal, and New Democrats alike, who worked tirelessly to bring us incredibly important recommendations, some which made it into this bill, some which did not.

I know the Liberal co-chair of the committee has expressed his disappointment on some of these important issues. Yet, we face this time crunch, somewhat of Parliament's own manufacturing, unfortunately. While the process has been hard worked at, it perhaps will need some revising as the bill moves forward.

Let me take some specific moments and some concerns that we raised. The protection of medical practitioners, while it appears in what is called the preamble of the bill, in the aspirations of the bill, it does not appear in the actual heart of the legislation, it does not appear in the law. For those in the medical services community who have sincere religious, heartfelt beliefs that prevent them from assisting someone with end-of-life procedures, we need to have the most complete protection for those health care professionals.

I come from northern British Columbia. This is an absolutely contentious issue. Faith leaders from a broad set of denominations and those working within the medical profession, who are incredibly dedicated and gifted medical service providers, have come forward with serious concerns. I am not able to allay their concerns with what I see in this legislation.

We helped unanimously pass a motion from the member for Timmins—James Bay to finally have a national palliative care strategy. It is the other side of this coin. While there is the incredibly important issue of what happens at that moment of end of life, for all the moments leading up to that, what kind of care do we offer those who are passing from this life? What kind of honour, respect and love do we offer them through our medical system, through this great Canadian public medical system?

For so many years, governments have spoken the words. They have said that palliative care is important. They have said that they care for our seniors, for our elders, and for our sick, yet we see nothing for this in budget after budget. We do not see the ability to lift up that burden together and provide that palliative care. In some senses, Bill C-14 would be an opportunity to enshrine at least into law the requirement for the country to finally have a national palliative care strategy. It is disappointing that it is only referenced as opposed to being brought in with full weight and structure.

I was also disappointed because the committee worked so hard. As a New Democrat, it is difficult for me to credit a joint Senate House of Commons committee. However, I know those good senators came to this process with an open mind. They worked very diligently and came up with a series of recommendations for the government over a number of the issues, and they were simply ignored.

That brings me to another concern. Legal and medical experts told us that even Ms. Carter would not actually qualify for assistance under this bill. She brought this case to the Supreme Court. She suffered so much. Her family went through hell trying to achieve the services they desired and had to go all the way to the Supreme Court. It finally won that arduous process.

Rather than get that perfect place where the government has sought to balance the competing interests over such a sensitive topic, my concern is that the government has muddled it entirely and invited future challenges in court. We have also heard from some of the lawyers who presented in front of the court. They said that this legislation would be challenged almost immediately. Therefore, what have we just gone through?

The committee met many hours and heard from dozens of witnesses. We looked at the very clear ruling from the Supreme Court. Then we came out the other end with something in the middle that offered neither side any great solace, if there are just two sides in this debate. We have heard from a number of the groups that have worked tirelessly on this issue, for decades in some cases, of their disappointment and dissatisfaction. Happily, the way the process works in our Parliament, the bill can go and be remedied.

This is the true test for the new government. This is its first constitutional legislation. This is the first time it must meet the challenge of the charter in legislation. Will it meet that challenge with the humility, courage, and intelligence that is required to do the right thing, not just the right thing by the courts, but the right thing by Canadians who are desperately seeking the ability to end their life on their terms when they are suffering so greatly? For us, to stand in judgment of them and their families, for us to say we will decree, under more and more narrow definitions, who can actually access this service seems dangerous to me. It seems hubris and unintelligent. This is simply because we invite years more of litigation in the courts and years more of uncertainty and suffering by those very families that are already suffering with a family member whose life is coming to an end in such terrible conditions.

I want to congratulate again the members who served, particularly the member for Victoria, who brought his legal wisdom and his compassion to this conversation, as well as the member for Timmins—James Bay, who first and most importantly raised this issue of palliative care and the need for that strategy. To all members of the House, we must find our convictions, find our courage, do the right thing, and do what is necessary both legally and morally.

[Pieter Harsevoort, Association for Reformed Political Action]

I thank you all for allowing me to come here and for the privilege of speaking to you, members of the committee.

I'd like to echo James's concerns and add my own two cents. I do have concerns with Bill C-14, including it's lack of linguistic precision.

Sadly, I feel the bill is dangerously dependent on euphemisms. Throughout, “medically assisted dying” is used to describe what is, in reality, physician-assisted suicide. This is problematic in the way that it undercuts palliative care. After all, what is palliative care if it is not medically assisted dying? I urge you to please use accurate terminology so that termination of life is not confused with palliative medicine.

Furthermore, the proposed law necessitates that, in order for someone to assist an individual with suicide a medical professional must be of the opinion that the person meets all the criteria, including the opinion that they have a grievous medical condition. Since the term “grievous” is vague, an attempt is made to make that definition more specific in proposed subsection 241.2(2).

However, even here, Bill C-14 runs into problems. How is one to define “intolerable suffering” as opposed to “tolerable suffering”? The reality is that intolerable suffering is relative. Suffering is modified by many diverse factors. Therapies and treatments are readily available to address all of these factors. Not only is unendurable suffering relative, but it is too much to ask a physician to judge whether or not someone is indeed experiencing intolerable suffering.

In order to ensure that physicians don't approve euthanasia for vulnerable persons like James and myself in moments of weakness, specifics must be added to clause 3. This means including the need for reasonable proof, rather than mere opinion, in proposed paragraph 241.2(3)(a), and the addition of a specific prognosis in proposed paragraph 241.2(2)(d) to replace the phrase “natural death has become reasonably foreseeable”.

Proposed subsection 241(5) provides an exemption for aiding an individual to self-administer a substance for the purpose of ending their life. In an attempt to respect autonomy, the key checks and balances put in place elsewhere in the bill are hereby bypassed. We cannot just assume that people will be protected by the safeguards outlined in proposed subsection 241.2(3).

Most importantly, there must be oversight to ensure that patients are given the opportunity to revoke the request as outlined in proposed paragraph 241.2(3)(h). We must be careful that the appropriate balance mentioned in the preamble to the bill is not skewed too far towards autonomy, at the expense of vulnerable persons in need of protection, such as James and me.

The only true protection of the sanctity of life is a ban on euthanasia, but barring that, these recommendations will improve the situation for the disabled and ill.

[James Schutten, Association for Reformed Political Action]

Hi. I am James Schutten. Thanks for the opportunity to speak to you about this important issue.

When I was two years old, I was diagnosed with spinal muscular atrophy, which has left me with serious physical disabilities. I require someone to set up my feeding tube, suction my trach, turn me over in bed, take me to the bathroom, and scratch my head. I am not telling you this to make you feel sorry for me. I don't feel sorry for myself. However, you need to know that these professionals and family members need to care about my life and whether I live or die.

This is why I needed to talk to you about your draft law legalizing doctor-assisted death, and how that law will affect me and others like me.

I've gone to the hospital because of illness, and medical staff questioned whether extreme measures were worth it. This makes me very nervous, because I feel as if I am not worth the trouble. Thankfully, my family has my back to speak with the doctors on my behalf. If I have anxiety now, how much more if Bill C-14 comes into effect?

What if society started from the perspective that I do have value? What if people didn't view me as a burden for others to carry? I am one of those people who the Supreme Court of Canada thinks should have this right to doctor-assisted death. What if, instead, I had the right to palliative care or resources to help me continue to be a productive member of society?

I believe others like me feel the same way, but this right to die makes me feel as if society thinks I should choose to die.

Therefore, I urge you to add to proposed subsection 241.2(3) the requirement that palliative care is meaningfully made available to the patient.

Look past my wheelchair, and see that I am an asset in my community. I volunteer at a nursing home a few days a week and help out at an elementary school, all of which I really enjoy.

I don't believe that anyone has the right to choose exactly when to die. God alone decides, and he does not make mistakes. He has a purpose for everything. My faith and family add value to my life. Instead of investing money into a bill which normalizes the choice of death, our country should invest time and money into giving people with illness, disabilities, and old age a will to live.

I have one last thing to say. I want you to know that I am not a public speaker. I was very nervous to come here, but I feel that this goes far beyond just me and my insecurities and limitations. I need to speak up because this is so important. Please remember me when you make your decision.

Thank you.

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 second time and referred to a committee, and of the motion that this question be now put.

[André Schutten, Legal Counsel, Association for Reformed Political Action]

Thank you very much, and good evening, honourable members.

My name is André Schutten. I'm a lawyer with ARPA Canada. We were intervenors in the Carter case, and we have analyzed the various legislative and policy proposals that have been published since that decision was released in February by the Supreme Court.

I want to emphasize at the beginning that Parliament is not forced to pass a law legalizing euthanasia or assisted suicide. If Parliament passes such a law, it does so willingly and cannot wash its hands simply because the Supreme Court made you do it.

In fact, the Supreme Court made an error, and Parliament has a moral duty to correct that mistake. Parliament has a legal option—and I'm not talking about the notwithstanding clause—to fully protect all human life by prohibiting euthanasia and assisted suicide. I would be happy to discuss during the question period how that can done as an amendment to Bill C-14.

If Parliament insists on choosing to legalize assisted suicide and euthanasia, it will put the lives of vulnerable people at unacceptable risk, thus violating their constitutional right to equal protection of the law. The Supreme Court Law Review just published an article that I wrote making that very argument. Again, during the question period, I'd be happy to take questions on how Bill C-14 and the Carter decision actually violate section 15 constitutional rights of men like James and Pieter, who are sitting beside me.

Now I'm a healthy, able-bodied Canadian, as are all of you, including the doctor you just heard from, but I don't think we fully appreciate the disadvantage that Bill C-14 puts on some of our fellow Canadians who courageously face many obstacles that we will never face. Instead of me trying to convince you of those types of things, I've asked two such Canadians to share their perspectives directly with you, to comment on how Bill C-14 affects them, and then to share changes that they believe are necessary in order to make them feel a little more secure living in a post-Carter Canada.

I'm going to turn it over to James first, and then to Pieter.

[Angus Gunn]

Well, I don't think it can be said that Carter compels the extension of this opportunity to advance directives. I think the logic of Carter, however, compels that conclusion.

I think what you can be assured of is that if advance directives are not incorporated into this bill, there will be litigation over that issue. I think it's a given that either it will be put into the bill or its absence will be challenged. This is not an issue that I think will be left to the legislature ultimately. I think the courts will be asked to opine on this point if Bill C-14 remains silent on the point.

Notice of time allocation motion

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

Mr. Speaker, I think I have a more reasonable approach to managing some of the debate left for Bill C-14. Therefore, I would seek the unanimous consent of the House for the following motion:

That, notwithstanding any Standing Order or usual practice of the House, on Tuesday, May 3, 2016, the House shall continue to sit beyond the hour of daily adjournment for the purpose of considering Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), at second reading, and when no member rises to speak, or at 12:00 a.m., whichever is earlier, that debate be deemed adjourned, and the House deemed adjourned until the next sitting day.

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, an agreement could not be reached under the provisions of Standing Orders 78(1) or 78(2) with respect to the second reading stage of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).

Under the provisions of Standing Order 78(3), I give notice that a minister of the crown will propose at the next sitting a motion to allot a specific number of days or hours for the consideration and disposal of proceedings at the said stage.

Criminal Code

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, pursuant to Standing Order 26(1), I move:

That the House shall continue to sit beyond the hour of daily adjournment for the purpose of considering Bill C-14, An Act to amend the Criminal Code and make related amendments to other Acts (medical assistance in dying), at second reading.

[Hazel Self, Chair, Board of Directors, Communication Disabilities Access Canada]

Thank you very much.

Good afternoon, ladies and gentlemen. I want to present a rationale and propose two amendments to Bill C-14 to ensure that people with speech and language disabilities are given appropriate communication accommodations and supports in order to provide informed consent in the context of medical assistance in dying.

I am chair of the board of Communication Disabilities Access Canada, which is a national non-profit organization that promotes accessibility and human rights for over 450,000 people in Canada who have speech and language disabilities due to disabilities such as cerebral palsy, autism spectrum disorder, fetal alcohol syndrome, cognitive delay, Down's syndrome, traumatic brain injury, aphasia after a stroke, dementia, ALS, Parkinson's disease, Huntington's disease, and multiple sclerosis.

Bear in mind that with any condition I've just mentioned, the individual could be also suffering from terminal cancer. They may have cerebral palsy but also have cancer.

A person with a communication disability may have speech that is slurred or difficult to understand, or they may have little or no speech and communicate by pointing to letters, symbols, or pictures, or by using a communication device. Some communication disabilities, such as aphasia after a stroke, impact on a person's ability to understand and process what others are saying, but do not affect their cognitive ability to make decisions.

The incidence of speech and language disabilities increases with age and includes people with pre-existing and age-related disabilities, as well as communication challenges related to typical aging, such as hearing and vision loss, reduced comprehension of complex sentences, and word-finding difficulties.

Effective communication is essential for all patients facing end-of-life decisions. Successful communication is a two-way process in which messages are correctly and unambiguously understood by both the patient and the medical practitioner. This includes getting and understanding information about one's diagnosis, prognosis, treatment, and palliative options, weighing up information to reach a decision, and communicating that decision and the reasons for the decision.

These are complex communication issues for anyone and are further compounded for people who have compromised speech and language abilities due to disabilities that affect their ability to understand spoken and written language, retain options and appreciate consequences to options, and to ask questions, give opinions, and communicate a decision. However, with appropriate communication accommodations and supports, many people with speech and language disabilities can make and communicate informed decisions.

There is ample evidence to demonstrate that many people with speech and language disabilities experience significant barriers when interacting with medical practitioners about their health care, and specifically within informed consent situations. Unlike people who are deaf and who may require sign language interpreters, or people who require oral translators, there are currently no protocols or directives in place to ensure that people with speech and language disabilities are provided with appropriate communication accommodations and supports.

People with speech and language disabilities report that health care professionals often overlook and misunderstand their wishes. They are very anxious about the lack of safeguards in Bill C-14. They report that medical practitioners often do not know how to make spoken or written information accessible to them; do not understand what they are communicating when they use ways other than speech to convey their messages; assume their speech and language disability is a cognitive disability; underestimate their capacity to make their own decisions and end-of-life directives; defer to family members and personal support staff to communicate on their behalf; and rely on untrained people to assist with their communication where an arm's-length, mutual, qualified professional communication assistant is required. They also undervalue, typically, the quality of their life and their need for health care interventions.

CDAC is asking for stronger safeguards for people with communication disabilities. These safeguards must include a directive to medical practitioners to engage a communication professional to assess the patient and to provide any required accommodations and supports.

We are proposing the following amendments to C-14 to ensure that people can effectively communicate about medically assisted death. If there is any question about the communication process as identified by the medical practitioner or the patient, then a neutral independent professional with expertise in the patient's communication needs must be engaged in order to assess the required communication accommodations and/or to provide direct communication support. Communication accommodations and supports are required if the patient has challenges understanding information provided to them, retaining and weighing out the consequences of options as part of the decision-making process, and accurately and authentically communicating their decisions. Communication accommodations include picture or letter boards, speech output devices or communication support from a sign language interpreter, deaf-blind intervenor, speech language pathologist, language translator, or cultural interpreter.

Our second directive has to do with the subclause titled “Unable to sign”, regarding proposed subsection 241.2(4),

If the person requesting medical assistance in dying is unable to sign and date the request, another person—who is at least 18 years of age and who understands the nature of the request for medical assistance in dying—may do so in the person’s presence

to which we would like to add “under their direction on their behalf”.

Thank you.

[Angus Gunn, Counsel, Alliance of People with Disabilities Who Are Supportive of Legal Assisted Dying Society]

Honourable members of Parliament, Mr. Chair, thank you for the opportunity to appear before you this afternoon. Before you is Margaret Birrell, who is president of the alliance. My name is Angus Gunn, and I have served as litigation counsel for the alliance since 2011.

I have been asked to deliver some prepared remarks, and Ms. Birrell will be pleased to respond to any questions the committee might have.

The members of the alliance that I represent are leading advocates for disability rights. The alliance sought and obtained intervenor status at all three levels of court in the Carter litigation to advocate for the right that was ultimately recognized by the Supreme Court of Canada.

In these prepared remarks, the alliance makes four recommendations for suggested amendments to Bill C-14. The first is to restore the efficacy of advanced directives. Bill C-14 does not take up the special joint committee's recommendation that the use of advance requests be permitted. The charter rights of those who suffer from dementia are not less deserving of protection just because their enduring and intolerable suffering results from an illness that also robs them of decision-making capacity.

The government has provided two rationales for excluding advance directives, neither of which we say withstands scrutiny. The first is:

Advance directives generally do not provide reliable evidence of a person’s consent at the time that medical assistance in dying would be provided.

Advance directives do provide highly reliable evidence of a person's consent while the capacity to give consent is intact. Dementia ultimately destroys the capacity to give consent. To insist on such consent at the time of medical assisted dying is to require the impossible. Are there really individuals who decided they would rather die than weather the storm of Alzheimer's for example, but then later change their mind because Alzheimer's isn't so bad after all? Even if these people do exist, why should their vulnerability trump that of the thousands of individuals whose wishes have not changed, but whose illness robs them of the ability to confirm that fact. Why is the blanket ban the Supreme Court of Canada rejected for sufferers of ALS acceptable for sufferers of dementia? Excluding advance directives will cause needless suffering for thousands of Canadians and will condemn us to protracted charter litigation simply to define the perimeter of Carter's cruel choice.

The second rationale offered by the government is that disallowing advance directives guards against the effects of inaccurate assumptions about quality and value of life. The reality of Alzheimer's at late stage is not a matter of assumption. If a competent individual makes an informed decision that at a certain stage of decline the quality and value of life will have degraded to a point where medical assisted dying is desired, why isn't that decision entitled to respect? Who is the state to discard that decision as reflecting inaccurate assumptions? The alliance urges the committee to restore the efficacy of advance directives in relation to medical assisted dying.

The second amendment is to remove the requirement that death be reasonably foreseeable. Bill C-14 rations the availability of medical assisted dying upon an individual's natural death being reasonably foreseeable. Nowhere is that requirement visible in the Carter decision. To the contrary, Kay Carter suffered from the non-life-limiting, non-terminal disease of spinal stenosis.

The government suggests that to permit medical assisted dying for those not approaching natural death could undermine suicide prevention initiatives, could normalize death as a solution to many forms of suffering, or could de-prioritize respect for human life and equality.

These objectives are already well served by other elements of the Carter test, including the need for a grievous and irremediable illness or condition, the need for enduring an intolerable physical or psychological suffering, the requirement that suffering be incapable of relief, the need for a medical or nurse practitioner opinion, and the 15-day waiting period. The controversy over whether Ms. Carter could have won her litigation, but be ineligible under Bill C-14, illustrates the problem with this provision.

Wherever one lands on that debate, Canadian criminal law adheres to the principle of certainty. Prohibited conduct must be fixed and knowable in advance. It offends this principle for conduct to be criminalized, or not, based on a case-by-case application of ambiguous concepts such as “reasonably foreseeable” and “not too remote”. Canadians who experience intolerable suffering, and physicians who wish to assist, should not have to guess about the criminality of their actions based on a retroactive application of concepts with no settled meaning. The alliance urges the committee to remove the requirement that natural death be reasonably foreseeable.

The third reform is that independent recommendations on mature minors and mental illness should be required by statute. At the moment, the preamble to Bill C-14 makes only a non-binding pledge to explore these other situations, but these topics are too important to be left to such an uncertain process. The act, we submit, should mandate a panel of independent experts be asked to make recommendations on these two subjects on a defined and limited deadline.

Finally, the alliance urges that two legislative drafting choices that are visible in Bill C-14 should be amended. First of all, Bill C-14 confusingly uses the word “they” to refer to individuals. An example is subsection 227(1), which says:

227 (1) No medical practitioner or nurse practitioner commits culpable homicide if they provide a person with medical assistance in dying in accordance with section 241 (2).

This use of the singular “they”, aside from being jarring to the eyes and ears, fails to harmonize with the bulk of the Criminal Code, which generally achieves gender neutrality not by using the singular “they”, but rather by using such phrases as “that person”, or “the person”, or “he or she“, or “his or her”. Alternatively the provisions can be reworded altogether to avoid the problem: “No valuable practitioner commits culpable homicide who provides a person with medical assistance in dying.”

Bill C-14 also uses em dashes in several clauses, which make for complicated and lengthy clauses that need to be read multiple times just to be understood. It also inappropriately demotes, as parenthetic asides, language that plays an important role in the bill itself. Clarity and ease of reference would favour the use of lettered subparagraphs instead.

The alliance thanks you again for the opportunity to provide these prepared remarks and to participate in the important work of this committee.

[Candice Bergen, Conservative, Portage—Lisgar, MB]

Madam Speaker, I am going to try to watch my time, and I hope to be on the same timeline as you are.

I am grateful to have the opportunity to speak to Bill C-14, which is a bill that makes amendments to the Criminal Code and other acts that would, for the first time in Canadian history, make it legal for someone to have medical assistance in taking his or her own life.

It would also make it legal for not just a doctor, nurse practitioner, or somebody involved in the medical community, but an aid, somebody outside of the medical community to kill someone, should the person want to be killed, if the conditions that are set out in this legislation are met.

It is an extremely serious matter that we have before us, and no doubt it will go down as a historic matter. It is something that will go down in history.

I want to take a couple of moments to address a few things. I want to begin by talking about where and how we got to this place, and build on some of the things that my colleague just talked about. The Supreme Court of Canada ruled just over a year ago that it was a charter right for Canadians to be able to have medical assistance in dying. The court gave us a year, a very short time frame, to talk about it, to consult, and to come up with legislation.

I want to take this opportunity to articulate not only my frustration but the concern of many of my constituents and many Canadians in what seems to be happening over and over again. Certainly, the Supreme Court is within its purview to make these decisions that have huge and lasting implications on Canadian society. Unfortunately, what is happening is Canadians feel, and it is becoming more and more prevalent, that they have no say in these matters, whether it is issues like assisted death, which is before us right now, or legalized prostitution, which we had to deal with in the last Parliament.

We are also seeing laws that have been passed in both this House and the other place that are being overturned by the Supreme Court of Canada. We have seen this in recent years and even recent weeks.

I would say for the record, and I would suggest, that it might be time for the government to start using the tools that we have at our disposal to bring some more balance back to our process. We have the legislative branch of our democracy and we have the executive, which are both accountable to voters. Then we have our judiciary, which is a very valuable part of it, but it has become what I believe and what my constituents are telling me imbalanced. They feel that there are nine people down the street in Ottawa who are making very important decisions, and the Canadian people have no say in them.

The tool that we had when the Conservatives were in government is the notwithstanding clause. For the record, I want to say that I think we might have to, and I know the government now has four years and there is a lot that can happen, for the people of Canada, start using that.

We are, though, at a place where the Supreme Court has ruled, and we absolutely respect that. Even though we might disagree with something that is said by a judge or a number of judges, in Canada, we respect the law and we follow the law.

Again, my colleague talked about how the Liberals could have asked for more time, and certainly that is something that could have been done, but we are now at a place where we have to look at a law and either pass the law or not.

I will not be able to support this piece of legislation. I believe it is flawed. My constituents have not had enough time to talk about it and be part of the process. A number of the issues that are concerning about the bill have already been articulated. I want to reinforce that I am very concerned there is not enough protection for vulnerable persons who may be victims or easily manipulated.

In my previous role, I worked a lot with people with disabilities with a variety of abilities. I met recently in Winnipeg with an individual who has an intellectual disability, but is a very smart, capable individual. He said to me, “Sometimes we can be taken advantage of when we are getting a new phone. It is so easy to manipulate us.” He said, “I am worried if somebody is trying to encourage some of us to die, we can be easily manipulated.” There is very little protection in this legislation for vulnerable Canadians.

There is also no protection, or very little protection, as has already been stated, for doctors, nurses, or other medical practitioners, or institutions for that matter, where killing someone goes against their conscience. The federal government has a duty to protect their rights. This bill could be strengthened by protecting those rights.

Also, it is very unclear and ambiguous, as far as language goes, around waiting times, around those who can sign for a patient, and there is very little oversight as far as who may have a financial benefit if somebody were to have an assisted death.

There are number of huge concerns. More time is needed to fix these flaws and to protect the vulnerable and rights of conscience.

Last, I want to talk a bit about my experience working in palliative care. I was a volunteer for a number of years. It was really something to behold to be with people as they went through those last stages of life.

However, there are a lot of misconceptions about what assisted suicide is, what assisted death is. I talked to one of my friends this weekend and she said, “Well, of course, Candice, if I'm in a vegetative state, I would like to be able to have the cord unplugged. I don't want to be kept alive.”

I said to her, “That's not assisted suicide. You absolutely already have that right in Canada to have a living will, to have a do-not-resuscitate order, to refuse medical treatment.” Those are all things that are already entrenched in law and that Canadians have the right to refuse. I think even our Prime Minister talked a number of years ago about his own father refusing medical treatment when he had cancer. Absolutely every Canadian has that right.

However, that is not at all what we are talking about today. That is not the decision that we are forced to make in a hasty way. That is not the decision that Canadians are being cheated out of being able to talk about, and being able to even, dare I say, vote on. It should be a major issue for Canadians to have major input. We are not talking about refusing treatment. We are not talking about saying “do not resuscitate”. We are not talking about palliative sedation, either.

My sister passed away nine years ago from cancer. Some of my family members said, “I think she died because the doctor gave her a lot of morphine when she was in pain.” No, she did not die from the morphine. She died from the cancer. Palliative sedation is not assisted suicide.

I find it ironic, in a very sad way. I just finished my 308 conversations in my riding last week. The 308 conversations was an initiative of the Canadian Mental Health Commission. It was a wonderful idea for 308—at that point 308 members of Parliament, now there are 338 of us—conversations around how we prevent suicide and how we better equip ourselves as community leaders, as health practitioners, as people working with youth, to prevent suicide.

I had these meetings. About 70 people were there, committed to preventing suicide in our communities in Portage—Lisgar. I said, “Folks, I am now going back to Ottawa and I am going to be debating how we can help people commit suicide.”

This is a very difficult issue. It is not one that we can just excuse and say, “Well, in this case, we don't want these people to die, because they're young people who have bullied on the Internet, so we want to make sure they don't commit suicide, but for somebody else who might have a mental illness and just has no hope, we want to be able to help them commit suicide.”

That is wrong and I do not think we can easily reconcile the two. I think we need to talk about it and we need to have protections in place.

Palliative care is very important. It is about giving hope to people. Studies show that if people have a terminal illness and they are assured they can die pain-free, they choose life and they let God decide when they go.

I think we can all agree, absolutely, that it is about helping people and giving them hope, whether it is a mental illness or whether it is a terminal illness; we give them hope and we help alleviate their pain. I do not think we ever want to see choosing death as the honourable way out. We never want our loved ones to feel like it would be more honourable if they chose death. I think we can all agree. Let us choose life every step of the way. Let us choose life.

[Professor Carrie Bourassa, Professor, Indigenous Health Studies, First Nations University of Canada, As an Individual]

Thank you. I hope I've prepared this properly. I apologize if I haven't. At the last parliamentary committee where I was asked to present, I read something in a similar format, but not the same content. Forgive me if I haven't done it correctly.

I want to start by saying that in terms of the bill that's being proposed, many first nations communities are not fully prepared for the implementation of Bill C-14. For that matter, in my opinion, neither is the Canadian health care system, due to the interconnectedness of the ongoing oppression, especially the intergenerational effects of the residential school system and the lack of general awareness of this ongoing oppression, as well as the need for further development of cultural safety models in health care systems.

The First Nations Health Authority states that today first nations are still affected by colonization and assimilation, systemic discrimination and racism; child apprehension; land dispossession; loss of tradition, language, and culture; the legacy of residential schools; and intergenerational trauma and its effects. The residential school system and intergenerational trauma often overshadows the other forms of ongoing oppression, and rightly so, due to the recent conclusion of the Truth and Reconciliation Commission.

As a result of the residential school system and its intergenerational effects, first nations are likely to suffer from mental health issues, including depression and suicidal ideation. This would include the older aboriginal population. While attention has been most recently focused on the epidemic of youth suicides in first nations communities, globally, suicide in many countries is as high or higher than suicide rates for young people. Due to the current research gaps in the area of aging for the older aboriginal population, this is an area clearly in need of further research in order to understand how the elderly are being affected by suicide.

The older aboriginal population could be more at risk for suicidal ideation due to the cultural genocide of the residential school system, whereby the loss of parenting skills that allowed for a child to grow in a traditional home environment and learn cultural norms; the loss of traditional healing methodologies; and the loss of traditional knowledge and history, including gender roles and the role of the elderly in society, were significant impacts.

Included in the loss of traditional knowledge and history would be whether assisted dying was practised, and if so, under what circumstances. The high suicide rates in the aboriginal community, combined with the loss of the aforementioned, create a situation where the introduction of assisted-dying legislated practices could create significant problems. How will high rates of suicide among the elderly affect their ability to neutrally determine the right to die? How will a lack of knowledge of traditional customs affect the ability of the elderly to determine the right to die?

The intergenerational impacts of the residential school system discussed for the elderly are just as applicable for the ill and the disabled. How does a significant loss, the cultural genocide of the residential school system, impact first nations today in the valuation of their lives?

When first nations communities can positively state they are in a period of stabilization in terms of community wellness, maybe that would be a time to consider introducing such legislation, but not now when too many communities are just beginning to recover from ongoing oppression, and particularly that of the residential school system.

The Health Council of Canada calls for awareness and understanding of the history of colonization, institutional discrimination, and power imbalances when cultural safety models are developed and implemented. The ongoing oppression of first nations is not well known to the general Canadian public or to health care practitioners, despite some efforts, including an understanding of this, such as mandatory introductory courses on indigenous health for nursing students offered here at First Nations University of Canada.

Regardless of these initial efforts, cultural humility, a key component of cultural safety, reminds us that a four-month class or a 12-hour course is not the equivalent of a lifetime of enduring the impact of ongoing oppression. Ongoing relationships between patient and health care practitioner need to be developed and nurtured in order to create trust for the patient.

Relationships such as these take time.

Evidence of the general lack of cultural awareness and sensitivity can easily be found in the media when familiar former political figures offer relocation strategies for youth suicide epidemics in northern remote first nations communities. The lack of mass Canadian public outcry at this strategy is indicative of the systemic problems that need to be overcome.

Without relevant cultural safety models being implemented for health care practitioners to offset the historically compounded views of first nations in society and academia, what kinds of relationships will health care practitioners have with first nations patients who are elderly, ill, or disabled? Will it be a long-term relationship, or two strangers meeting to decide life or death?

Will it be remembered that first nations have a wealth of knowledge and history that at times needs to be nurtured back from the effects of ongoing oppression, especially the residential school system? Will the resiliency of first nations, a clear reminder of how first nations have endured and overcome adversity, be remembered?

Without an understanding of this, would it not be too easy for a client to accept assisted dying without truly giving informed consent, or a health care professional to accept such flawed consent?

Meegwetch, and thank you.

[John Barlow, Conservative, Foothills, AB]

Madam Speaker, I rise today to speak about what I think is one of the most important issues that we will ever face in this Parliament. I know this is going to be a very difficult debate in the House, as physician-assisted suicide and euthanasia are deeply emotional not only to us in the House but obviously to our constituents.

First of all, I would like to say that I am very relieved to see addressed in Bill C-14 some of the concerns that were raised by my Conservative colleagues and Canadians across the country.

The recommendations included in the report from the Special Joint Committee on Physician-Assisted Dying were extremely troubling and went well beyond the parameters outlined in the Supreme Court's Carter decision. My Conservative colleagues and I, as well as Canadians across the country, voiced our concerns on the far-reaching recommendations in the report, and we urged the Liberal government to tighten safeguards in this legislation.

My constituents were concerned with the broad and vague guidelines in some of these recommendations. Like many of my Conservative colleagues, I felt it was very important to discuss these recommendations with my residents, and I held several open houses across the constituency. I held these open houses because I felt it was critical to get feedback from southern Albertans on their feelings on doctor-assisted dying.

However, I also thought it was important to raise awareness about some of the recommendations that could potentially be part of the legislation before us. Initially, I think we saw that the vast majority of Canadians supported doctor-assisted dying, but I would like to say that I think the vast majority of those Canadians who support it were unclear about what could potentially be part of the legislation.

I think in their minds, they saw doctor-assisted dying as involving an adult suffering with a terminal physical ailment, and that became abundantly clear at the open houses that I had in my constituency, which had anywhere from 30 to 300 people, including many of my rural physicians. Almost every single person at these open houses—supportive of doctor-assisted dying or not—was shocked at the potential that could have been in the legislation upon seeing the recommendations that were part of that special joint committee.

These people certainly did not expect that doctor-assisted dying would be available to mature minors. They certainly did not expect it to be available to people suffering from mental illness. They also expected that there would be protection for physicians on decisions of conscience, and very strict guidelines around advance directives. Since I held those open houses and started to raise some awareness within the constituency with my residents, I received hundreds of emails and letters from residents who are very concerned about the potential ramifications in Bill C-14.

Generally, people in Foothills want to make sure that vulnerable people in our society are protected in the legislation, and I believe Canadians want the same. I am pleased to see some of the concerns that we raised are included in Bill C-14, which did not include mature minors and did not include people with mental illness. However, the legislation says that those things will still be studied, which means the door is wide open for mature minors and people with mental and psychological illnesses to be part of the legislation in the future.

However, there are still some other issues that I think were not addressed, such as protection for our physicians in decisions of conscience, and palliative care. In all the meetings I hosted, palliative care came up repeatedly. Many of my residents feel that palliative care was truly never addressed as part of the legislation.

We are blessed to have a facility in my riding, the Foothills Country Hospice. I have toured this facility many times and spoken with patients and their families. I could see that the hospice has been a godsend—I got that from their responses—and has become such a wonderful, important part of our community.

Accessible, consistent, and effective palliative care programs across the country would consistently support people in their end-of-life care. Unfortunately, palliative care is not offered on a consistent basis across this country. The report recommended that palliative care be an integral part of doctor-assisted dying legislation, and this is one recommendation in the report with which I wholeheartedly agree.

If we proceed with medical-assisted dying, palliative care must be a fundamental piece of this program. However, palliative care was not mentioned in the 2016 budget, nor has there been any funding whatsoever committed to a national palliative care program.

Foothills residents also spoke resoundingly about the need to protect physicians' and other medical professionals' rights of conscience. Overwhelmingly, my constituents felt that no one should be compelled to administer physician-assisted dying if doing so was contrary to their personal beliefs and ethics. Additionally, almost everyone who spoke to me recognized that referring a patient to another physician to assist in their death does not absolve that first physician from the ethical dilemma.

In my riding of Foothills, the rural towns have one or two, if any, doctors. Imposing on a doctor in a rural community to participate in doctor-assisted dying puts those rural physicians in a very difficult position in those small towns. They need to have a choice, and we need to show leadership to give them that choice. We cannot download that burden on to provinces or the provincial colleges of physicians and surgeons. Physicians across Canada need our support and our leadership, and that should be part of Bill C-14.

In addition, there needs to be some support structure for physicians who would be participating in doctor-assisted dying. They would be facing mental health issues, as we are now seeing in Quebec. We must ensure there are programs in place to support our physicians in dealing with the potential emotional and mental scars of participating in doctor-assisted dying. Canadians want to achieve a healthy balance between the person seeking physician-assisted death and a physician's own charter rights to abstain from this procedure if it violates the physician's moral ethics and faith.

The Supreme Court came up several times in conversations I had in my riding. Residents are frustrated that the Supreme Court would presume to dictate a law upon parliamentarians. Canadians understand we elect parliamentarians in our country to make laws and the Supreme Court is in place to rule on the constitutionality of those laws. They do not understand, however, why the Supreme Court, an unelected body, is now dictating law to our elected House of Commons and why it is implementing such an unreasonable timeline to come up with the law. My constituents and, I believe, many Canadians are understandably upset that this is how physician-assisted dying came forth.

What does this have to do with this debate? This inversion of the process has left parliamentarians and Canadians scrambling under an unreasonable timeline to develop a complicated piece of legislation that not only ensures that the rights of all involved are protected, but also that the safety of our most vulnerable is also protected. This conversation and public debate simply require more time than has been afforded us currently.

Usually at the end of any of my speeches in debate I encourage hon. members of the House to either vote in favour or against whatever piece of legislation we are debating. Today I am not going to do that. I believe the first priority in this is to ask the Supreme Court for more time. This is one of the most important decisions that we will ever make as parliamentarians, and I truly believe this is a decision that should not be made on an arbitrary timeline. The consequences of this legislation are irreversible. If we make a bad choice now, someone may die who should not have. Canadians on both sides of the issue deserve better. In fact, they deserve our best.

The government has failed on this issue by not challenging the Supreme Court on this timeline. When Quebec developed similar legislation, it took more than six years. We are trying to do something similar in six months. This type of legislation should not be done in weeks. It should be done over a complete mandate of a government.

As parliamentarians, can we honestly say that we have had an opportunity to consult and speak with all stakeholders? Can we really say Canadians have had enough time to digest the implications of the bill and have been given sufficient time to provide feedback to their representatives?

The Supreme Court's decision has made it clear that we will have doctor-assisted dying. As a member of Parliament, my focus here is to ensure that there are sufficient safeguards in Bill C-14 to protect the most vulnerable in our society: children, people with disabilities, those with mental health issues, and our seniors.

Can each of us in the House look our constituents in the eye and say we have done our due diligence in just a few weeks? Can we say with confidence that the safeguards in the legislation are properly in place to protect those who need our support and our help? In the short amount of time we have been given, I simply cannot make that claim.

Unfortunately, it appears the government is not going to ask for an extension. In fact, it is no longer even putting up speakers to participate in the debate. On one of the most important issues that we will face as parliamentarians, the Liberals are not even participating. They are silencing the voice of Canadians who desperately want to talk about this important issue.

I hope we all take the opportunity in the time that is left to speak to our constituents, get their feedback, raise the awareness, talk to them about what the implications of the legislation are. I know people in my riding are extremely split on where they want to go with the legislation. I hope the other parties in the House will follow the Conservatives' lead and allow all of us to have a free vote and speak for our constituents.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, in my colleagues' interventions, there is sometimes a presumption, it seems, of malfeasance when it comes to the health care system. When the slippery slope argument is invoked, it is as though people think that health care providers do not need to be caring and compassionate, first and foremost, in order to be hired. If that is not the case, they should be thanked and let go. I find it strange that so little consideration is given to health care providers.

We have talked a lot about vulnerable individuals. Those are precisely the people the Supreme Court was trying to protect. The Supreme Court indicated that people with degenerative diseases, who have a grievous and irremediable condition, who are experiencing intolerable suffering, should have access to medical assistance in dying, under section 7. It is pretty remarkable to see that all the rights in section 7, namely, the right to life, the right to liberty, and the right to security of the person, are affected by the total prohibition.

The Supreme Court wanted to protect people in an extremely vulnerable situation. When we talk about protecting the vulnerable, who and what are we talking about? It is as though, when someone enters into a continuum of end-of-life care, they are given the choice from the outset between an injection and comfort care. There is a presumption that should not be there.

What the Supreme Court is asking the legislator to do is to provide a framework for assisted suicide, in other words, for all those whose natural death is not reasonably foreseeable. Those people do not need palliative care. What they need is legislation that frames the provisions to allow them to die with dignity, according to their wishes, and on their terms. That is the essence of the debate.

Yesterday in committee, the Barreau du Québec told us that Bill C-14 was not in line with the Carter decision. Last week, the Carter family's lawyer told us that Ms. Carter would not have been entitled to medical assistance in dying. How can the government claim that she would have been entitled? That was the response in committee by the Minister of Health and the Minister of Justice. Did they get an outside opinion?

The Barreau du Québec just said that this bill, because of the totally vague criterion of “reasonably foreseeable natural death”, will make this legislation a legal hornets' nest. I hope that after all this energy we are putting into this debate we will not end up with endless court challenges. The Barreau du Québec sounded the alarm yesterday, as did the Carter family's lawyer. The bill is telling people who have a degenerative disease and are suffering immensely that they cannot make an advance directive.

People with degenerative diseases, such as multiple sclerosis, ALS, and other cognitive diseases, are not suicidal. They want to live as long as possible until their condition becomes intolerable to them. It is not up to us or anyone else to decide what is or is not tolerable suffering for a person. How could we presume to do so?

We have to protect these people from extreme suffering and a society that is basically trying to make decisions for them.

If Kay Carter did not have access to medical assistance in dying, and if advance requests are not allowed for people with degenerative diseases, then it seems as if this bill does not treat all grievous and irremediable medical conditions that people might have the same way.

The minister says that Kay Carter would have been entitled to medical assistance in dying under the reasonably foreseeable natural death provision. Exactly what does “foreseeable” mean in this case? Does it have anything to do with her age? I hope that we are not talking about age discrimination here. Spinal stenosis can be intolerable at 52, 62, or 82 years of age. Age is therefore not a criterion.

If we want to be thorough, we absolutely must provide a framework and amend the bill to include advance requests.

Furthermore, we must remove the criterion of reasonably foreseeable natural death. Even in a situation as clear as someone in palliative care requesting death, this is not a natural death. Yes, the process of death is irreversible. The patient wants to put an end to the irreversible process of a slow death. It is up to patients to decide whether this is what they want. It is their choice.

However, claims that patients will be forced to make a decision have no place in this debate. This is not the case. I have heard members say that this is frightening and that we should invest in palliative care. As I said this morning, palliative care is important, and the Quebec law addresses this issue, among other things. What about assisted suicide? These people do not need palliative care. They do not need it and we do not need to invest in palliative care to fix their problem. We simply need to respect their right to self-determination.

That is why advance requests are so important. These people do not want to move forward without the assurance that they will be cared for. We are not the ones to decide for them. They will decide.

Of course, sometimes there are people who suffer from insomnia. Things can happen in an instant one night. You go to bed at night and everything is fine. When you get up in the morning everything has changed. For that reason, we have to amend the bill. We must also amend the bill to include an equivalency clause, as I mentioned this morning.

The debate lasted six years in Quebec. Quebec's legislation provides a very good framework for end-of-life care, and it would be unacceptable for this bill to interfere with the Quebec law. That is why we are insisting on these amendments.

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Madam Speaker, key among the considerations lying at the centre of the debate on Bill C-14, physician-assisted dying, is the ruling made in February 2015 by the Supreme Court of Canada in the Carter case, striking down sections of the Criminal Code that prohibited the provision of assistance in dying on the grounds that they were unconstitutional as they violated parts of article 7 of the Charter of Rights and Freedoms that “everyone has the right of life, liberty and security of the person”.

The court ruled that the Criminal Code provisions were of no force or effect to the extent that they prohibited physician-assisted death for a competent adult person who clearly consented to the termination of life and had a grievous and irremediable medical condition, including an illness, disease or disability, that caused enduring suffering that was intolerable to the individual in the circumstances of his or her condition.

The court then suspended the declaration of invalidity for a year and in turn granting to the current federal government an additional four months to June 6 of this year, after which the Criminal Code offences would become null and void.

Clearly, action is necessary to uphold our constitutional and charter rights.

Also, it is important to give consideration to the recommendations by the all-party Special Joint Committee on Physician-Assisted Dying struck by the government and mandated to review the report on the external panel and options for a legislative response established by the former Conservative government, and to make recommendations on the framework of a federal response that would respect the constitution, the charter and Canadian priorities.

The committee recommendations are based on the testimony of a wide diversity of witnesses and review of parallel legislation enacted in other jurisdictions, including Quebec.

The committee considered a great many critical issues, including: Should there be a condition based on age? How will the law protect the vulnerable? Should the law recognize advance medical directives? Should the law impose waiting periods? Should the law enable conscience objections by health providers? What is the correct terminology to apply? What are the respective jurisdictions of federal and provincial authorities? How do we ensure equal access to these medical services, and the need to expand access to palliative care, including on the NDP call for a national strategy?

The challenge before us is to determine whether Bill C-14 clearly and properly addresses these matters.

This is a highly personal and emotional topic for all members in this place and frankly all Canadians facing life and death decisions. Members of my own immediate family struggled in their last days. My younger sister suffered a painful extended period prior to her death, even where some palliative care was available. My older sister suffered a lesser quality of existence for far too many years because the only accommodation for younger, chronically ill patients was an extended care facility for seniors.

Our governments must deliver on promises for expanded palliative care for all, and housing for the chronically ill and disabled. This access is surely also a charter right.

I have carefully considered the letters and conversations with my constituents who have expressed a wide range of views and perspectives on the matter of medically assisted dying. What I found discouraging is the lack of full understanding by many I have spoken with, and the misinformation being provided to them about the implications of the Supreme Court decision, and in particular, those who have expressed opposition to the enactment of a law on providing medical assistance to the dying.

I hosted a meeting in my constituency with my colleague, the MP for Victoria, the co-chair of the special joint committee, to provide an opportunity to understand the background to Bill C-14, including the ruling by the Supreme Court, the report of the special joint committee and the tabled bill.

I have been deeply impacted in my views by meetings with a constituent suffering deeply with a fast-paced diagnosis of ALS, already unable to speak and desperately hoping to be able to gain assistance in his death when he determines it is the right time for passing.

I have heard from constituents concerned that the bill reduces the rights of Canadians to choose an assisted death, while others expressed concern the bill would increase risks to the disabled. I must share that by far the majority of views expressed to me, including at my public forum, have expressed concern that the bill does not go far enough in upholding the directions by the Supreme Court to uphold the constitutional and charter rights of Canadians.

How well does Bill C-14 address these key needs and concerns? The bill does set forth a basic framework for decriminalizing medically assisted deaths, including right of access. However, instead of following the recommendations of the Special Joint Committee on Physician-Assisted Dying to adopt the clear and precise terms set forth by the Supreme Court to determine access to medically assisted death, this bill would add further onerous, and frankly nonsensical qualifiers. Most notable is the requirement that a person's natural death has become reasonably foreseeable. Surely that is the case for every human being on this earth.

The Carter family, who was the subject of the Supreme Court ruling, has spoken out strongly against these added criteria. Worse, it is the opinion expressed by numerous legal experts that these additional criteria lack legal certainty and would inevitably force already suffering patients to return to the courts or to travel overseas or to kill themselves. None of these options present a compassionate alternative or uphold our constitutional and charter rights.

I would like to share briefly some words that a constituent sent me:

Nineteen years ago, I watched my 87-year-old mother spend three weeks in severe pain as cancer ate her alive, begging to be put out of misery. The proposed law on medically assisted dying is 19 years too late, but at least it will spare others in similar condition. Unfortunately, it doesn't cover those whose death is not imminent but who have medical conditions that are causing them intolerable suffering. That must be rectified before this law is passed.

A second widespread concern expressed to me is the failure of Bill C-14 to provide for advance directives. I am aware from my discussions with Alberta officials that this is a matter of grave concern to Albertans, many of whom are erroneously of the belief that their personal directives cover medical intervention. Many of my constituents have asked me to demand that this right be extended. Again, I quote from a constituent's letter:

I would like to have the ability to have an advance directive that would stipulate the conditions under which I would want to have my life ended. At the point I would want assisted death, I may not have the mental or physical capacity to restate my wishes. If this bill passes without the proposed amendments, my only option will be to go to the river valley some minus-30 night and freeze to death. This, of course, will create stress on my family, the community, and police as they search for my body.

Others have expressed concern that the law would fail to prohibit hospitals or other institutions from denying access to medically assisted death on the grounds of religious beliefs. While they accept that individual medical practitioners should be extended that right, they strongly believe there should be a duty to refer to another practitioner, and preferably for the delivery of services within the same institution. This would be the compassionate decision, given the dire state of many who would be making this request.

While the Special Joint Committee on Physician-Assisted Dying agreed to a waiting period between the request and delivery of the services, many have expressed concern that Bill C-14 would require a 15-day wait period. Much more preferable would be a waiting period as determined by the medical practitioner, based on the circumstances of each case. I can speak from personal experience that to require a suffering sibling to hang on with severe pain for more than two weeks after making the decision to let go is nothing less than cruel and unusual punishment, and surely offends one's charter rights.

The bill will provide protections to practitioners and afford protections for the disabled. What it would fail to do is extend clear rights to Canadians to determine their own fate within reasonable parameters. Equally disappointing is the failure of the current government to include in its budget the promised dollars for palliative care for all Canadians.

I will vote for this bill at second reading to be considered by a committee. However, I implore the government to ensure that our concerns, the concerns expressed by our constituents and by all Canadians, be considered by the committee members who are undertaking simultaneous review, and to give fair and full consideration to any recommended amendments.

[Shanaaz Gokool, Chief Executive Officer, Dying With Dignity Canada]

Good afternoon.

Thank you to the justice and human rights committee for inviting Dying With Dignity Canada to this hearing today.

We have been on the assisted dying file for well over 30 years. If anyone recognizes the historic moment that our country is now in, we certainly do. However, we are very concerned about Bill C-14 and its unjustified deviation from many of the core recommendations of the special joint parliamentary committee.

We are concerned that the government's definition of “grievous and irremediable” does not meet the minimum standards of Carter. If Carter is the floor for assisted dying, we're now in the basement. We are also particularly concerned that there is not a provision for advanced consent for people who have a diagnosis of a “grievous and irremediable” condition such as dementia or Huntington's.

While Dying With Dignity Canada's policies are informed by our physicians' advisory council, we're not doctors and we're not lawyers. We represent the 85% of Canadians who support the Carter decision and the 80% of Canadians who support advanced consent with a diagnosis. As such, our organization has a responsibility to discuss the vulnerable groups of people who will be left behind if Bill C-14 is not substantively amended. The people I will mention today are but a snapshot representation of the thousands of Canadians who will not be able to find comfort in Bill C-14 and who may have to go to court to establish their charter right to die.

The following is not an exhaustive list of concerns, but it does highlight some key exclusions.

The government's legislation redefines “grievous and irremediable” and introduces new terms, such as “incurable”, “advanced state of irreversible decline”, and “reasonably foreseeable”. These new terms will exclude people who have serious chronic medical conditions and will exclude people who are not imminently dying.

So who are we talking about? Who's going to be excluded?

This is Linda Jarrett. Linda was diagnosed at the age of 50 with secondary progressive multiple sclerosis. At 68, she can no longer walk, and the years ahead are deeply troubling for her. She does not want to stay in a 24/7 long-term care facility for what could be years on end. She wants choice and the comfort of knowing that she will be able to make a choice, if her condition and her suffering becomes too much to bear.

This is Ronald Phelps with his daughter Laura. He had a debilitating stroke that left him bedridden and losing his ability to speak. Further complications meant doctors were going to have to amputate both of his arms and both of his legs. Instead, he chose to starve and dehydrate himself to death, which, as his daughter Laura said seemed really to be piling torture onto torture. Others like Ronald Phelps deserve compassion and choice, not more suffering to find peace.

Here is Drew Sperry, who died painfully from ALS and whose greatest fear was not dying, but living, in his own words, “trapped inside my body gasping like a fish on the wharf”.

Let's not forget about Jean Brault, a Quebec man who had a blood clot in his brain and over a period of years suffered from a series of debilitating strokes. Mr. Brault thought, when the legislation came into effect in Quebec, that it meant release from his torment. He was told by his doctors that he met the criteria: he couldn't walk, he was losing his ability to speak, and he was in an incredible amount of pain. But he was also told he wasn't dying fast enough, so he starved himself for 53 days and dehydrated himself for eight days before he was able to qualify for an assisted death. He told the media that he had to self-mutilate to be liberated from suffering.

The government needs to ask whether these are the only choices available to people like Linda, Ronald, Drew, and Jean: to suffer horribly for years or even decades before dying a protracted, painful death or to starve and dehydrate themselves to death, and now, with this narrow and restrictive legislation, to show courage in the face of their suffering and to go to court to fight for their right to die.

We ask that proposed section 241.2 be amended to use the court's language in Carter and to strike “incurable”, “advanced state of irreversible decline”, and “natural death has become reasonably foreseeable”.

Now I will turn to the issue of advance consent. Without advance consent people with a diagnosis for a “grievous and irremediable medical condition” such as dementia, Huntington's, or Parkinson's will face a cruel choice.

This is the one the courts sought to avoid in Carter, to try and take their own lives far too early while they may still have months, or even years left ahead, but while they are still physically and mentally able to do so, or to die in a manner they would describe as horrific.

This is Gillian Bennett, a B.C. woman who was diagnosed with dementia. In the summer of 2014 she took her own life while she was able to, and in her words “I, Gillian, will no longer be here. What is to be done with my carcass? It will be physically alive, but there will be no one inside”.

Here's Margot Bentley, a former dementia nurse who in a cruel twist of fate said she wanted to be allowed to die if she ever developed dementia. She has now been living and dying with dementia for 17 years. As her daughter Katherine says, she is indeed terminally ill, she and people like her. In 2011, in Canada, over 740,000 Canadians are living with dementia. That's 15% of the population over the age of 65. They are completely excluded from this legislation. They cannot ask for an assisted death in advance under this legislation, and they can't ask for it while they are still competent. They will not qualify.

In the summer of 2015 Lee-Anne Peters, who was 30 years old, took her own life after a number of attempts. She was in the mid stages of Huntington's disease, and she knew what was coming for her. Her mother Lisa said Lee-Anne prayed every day to be allowed to choose her own time where she could no longer enjoy life, but because there was no legislation, she was forced to end her life early, alone, and without friends or family, while she was still able to.

Gillian, Margot, and Lee-Anne represent hundreds of thousands of Canadians who have already been given a life sentence. By excluding advance consent, the federal government has acknowledged their Charter of Rights will be violated. The legislation must be amended immediately to include advance consent, or the federal government must provide a sincere commitment to ensure whole groups of people based solely on their medical condition are not discriminated against, and add a statutory mandatory mandate requiring an independent expert study of the issues with a prescribed deadline of 18 months to report back to Parliament with possible amendments to the Criminal Code. This remedy may also be applied for the inclusion of mental illness and competent minors.

In conclusion, if this legislation is not significantly amended then we can expect to see more seriously ill, chronically ill, sick, and dying Canadians who will have to go back to court to access what we believe will be their charter rights. Haven't enough sick and dying people already sacrificed so much for us, and haven't they already gone to court to establish the Charter of Rights for people who are grievous and irremediable ill?

Thank you.

[Laurence Worthen, Executive Director, Christian Medical and Dental Society of Canada, Coalition for HealthCARE and Conscience]

Thank you, Cardinal Collins.

Members of our coalition support the right of patients to refuse or discontinue treatment at end of life, allowing the underlying illness to take its course.

We wish to make it clear that should Parliament legalize medical aid in dying, we will not in any way obstruct patients who decide to seek that procedure, and we will never abandon our patients.

We know there are many ways to respect patient decisions that do not violate the conscience of health care workers or institutions. The Canadian Medical Association and other experts have said there is no necessity for there to be a conflict between these two values.

Our own proposal recommends the use of transfer of care and direct patient access, so patients have the choice of staying with their physician for care or transferring care to another physician.

Facilities that cannot provide the procedure on their premises are prepared to help transfer patients to the facility of their choice if the patient so desires.

To force providers to act against their moral convictions is to breach section 2 of the Charter of Rights and Freedoms. We know hospitals and regulators all across the country are right now developing policies on this subject. For example, the College of Physicians and Surgeons of Ontario has already provided a provisional policy that will force doctors to provide a referral for euthanasia and assisted suicide. At the same time at least seven other provincial colleges have not taken that approach.

Legislation from Parliament would send a clear signal that the charter rights of caregivers all across Canada can be protected. Canadians should not have to deal with a patchwork approach.

Parliament has legislated matters that overlap into provincial or territorial jurisdiction in the past. Consider, for example, the Civil Marriage Act passed by Parliament in 2005 to legalize and regulate same-sex marriage. While marriage falls under provincial jurisdiction, this is federal legislation that governs marriage. The act contains language in its preamble and a specific clause recognizing that officials of religious groups are free to refuse to perform marriages that are not in accordance with their religious beliefs.

Our coalition recommends Parliament use the same legislative approach in Bill C-14, including language both in the preamble to the bill and in a specific clause that confirms that individuals or faith-based health care institutions that oppose euthanasia or assisted suicide are not to be compelled to engage in it and are not to be discriminated against as a result of their opposition.

Our proposed amendments to the preamble of Bill C-14 read as follows, and in the interests of time I will read two of those that we submitted in our brief.

Whereas Parliament respects and affirms freedom of conscience and religion for health care practitioners and faith based institutions, and whereas nothing in this act affects the guarantee of freedom of conscience or religion, and in particular the freedom of health care practitioners and faith based institutions to refuse to provide or participate in the provision of medical assistance in dying.

Our proposed amendments to the body of the act would read as follows:

It is recognized that health care practitioners are free to refuse to participate in medical aid in dying, either directly or indirectly, if doing so is not in accordance with their conscience or religious beliefs. For greater certainty, no person or organization shall be deprived of any benefit or be subject to any obligation or sanction under any law of the Parliament of Canada solely by reason of their exercise or refusal to exercise in respect of medical aid in dying of the freedom of conscience and religion guaranteed under the Canadian Charter of Rights and Freedoms.

In closing, we would like to mention that the Carter case clearly stated that no physician could be forced to participate in assisted death. The court also said this was a matter that engaged the charter freedoms of conscience and religion.

It is not in the public interest to discriminate against the category of people based solely on their moral convictions and religious beliefs. This does not create the kind of tolerant, inclusive, or pluralistic society that Canadians deserve.

Thank you.

[Cardinal Thomas Collins, Archbishop, Archdiocese of Toronto, Coalition for HealthCARE and Conscience]

Good afternoon, and thank you for providing the opportunity to speak with you about Bill C-14, legislation that will have a profound impact on Canadian society for years to come.

I appear today on behalf of the Coalition for HealthCARE and Conscience. Joining me is my colleague Larry Worthen, the executive director of the Christian Medical and Dental Society of Canada, which is a member of our coalition. We represent more than 5,000 physicians across Canada and more than 110 health care facilities and almost 18,000 care beds and 60,000 staff.

As we have previously stated, because of our mission and our moral convictions, we cannot support or condone assisted suicide or euthanasia. We understand, however, that the Supreme Court of Canada has directed the federal government to pass legislation on euthanasia/assisted suicide by June 6 and that Bill C-14 comes as a result of that decision.

Today we will address the need for amendments to Bill C-14 to protect conscience rights for physicians and health care facilities. Our members are committed to caring for their patients at every stage of life. We know what it is to journey with those who are facing great suffering in mind and body. We are committed to serving those who suffer with a compassionate love that is rooted in faith and expressed through the best medical care available.

What our members cannot do is perform or participate in what is being referred to as medically assisted death. To be clear, by participation I also mean playing a role in causing death by arranging for the procedure to be carried out by someone else through a referral.

We acknowledge that the draft legislation tabled on April 14 set aside, at least for the moment, some of the most disturbing recommendations from the parliamentary joint committee. We remain concerned, however, that the bill does not protect the conscience rights of health care workers and facilities with moral objections to euthanasia and assisted suicide.

We see no reference to conscience rights in Bill C-14. The preamble to the legislation notes that the government respects “the personal convictions of health care providers.” While that respect is appreciated, it does not carry the same legal weight as legislative protection. No foreign jurisdiction in the world that has legalized euthanasia/assisted suicide forces health care workers, hospitals, nursing homes, or hospices to act against their conscience or mission and values.

It appears that the federal government is leaving this issue to the provinces and territories for consideration, but if the federal government enacts a law that establishes euthanasia/assisted suicide across Canada, it needs to provide robust protection of conscience rights across Canada.

It is essential that the government ensure that effective conscience protection is given to health care providers, both institutions and individuals. It is simply not right or just to say to an individual, “You do not have to do what is against your conscience, but you must make sure it happens.” It is equally unjust to require a health care facility to repudiate its institutional conscience or mission. We would note that no health care facility in Canada makes every procedure available to its patients.

We will continue to journey lovingly with our patients every day. We ask that you protect all health care workers and the institutions that are successors to the pioneers of health care in our country to ensure that they may continue their mission of care and healing.

Larry.

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

Madam Speaker, three times pro-doctor-assisted suicide groups testified, but the committee did not hear from any anti-euthanasia advocacy groups.

Now the government is telling us that the justice committee, during its hearings, will allow amendments. The Liberals say that the committee can make amendments and better define things like conscience rights, or what happens when a doctor refuses to assist a person to commit suicide. The committee may look at the term “reasonable foreseeable death” or the issue of advance consent. However, I have no faith in the Liberal-dominated committee that will hear Bill C-14.

Today the Liberals are in a hurry to pass the bill and send it to committee. I have served and chaired many committees, I have seen how witness lists have been tightly controlled. I do not believe the views of average Canadians will be heard at this committee. I do not believe the religious community in Canada will even be given the chance to testify. I think we will see a Liberal-dominated committee that will turn down all amendments that might change the bill.

We already saw that at the previous special joint committee. That is why the official opposition had to table a dissenting report to the conclusions of the committee. We listed the problems that must be addressed. I am thankful for some of those issues being addressed in Bill C-14.

There is a void in Canada, and elsewhere for that matter, on behalf of people who do not ever deal with death and dying on a day-to-day basis. Many are in absolute fear of dying. It is the great unknown. There is a chance there will be unbearable pain and suffering, many people believe. We do not know.

Palliative care experts tell us that it is possible to find balance in the human body. The human body is very good at shutting itself down, and palliative care is all about assisting each individual in that process compassionately.

My daughter and wife both serve as nurses. They have been at the bedsides of those who are dying and have compassionately cared for them, making certain that pain is addressed, or that there is very little pain in some cases.

The provinces will decide certain questions on the bill. Health services are, as we know, a provincial jurisdiction. The government knows this and it is trying to wash its hands of some of that issue. In fact, the Liberal government knows there are going to be many problems within the bill when we move forward to the next level and try to get unanimity among all the provinces and territories.

The government has already said that it will continue to study the issues of doctor-assisted suicide. Some have said that we will continue to study the issue around mature minors. Will they someday be able to receive assisted suicide, or people with mental illness? The government is going to study that as well as advance requests.

We know we live in a time where there is a slippery slope. Here we are debating Bill C-14. Most of us think those are the parameters today, but what will they be tomorrow? If it is a right today for some people to have doctor-assisted suicide, why is it not then a right for someone else? How long do we think it will before the courts take that one on and change what we may very well want to implement here today? I think it is a concern for people on both sides of the House. It is not good enough, so we need to do some of this work before we talk about the many other things.

There are a couple of areas of concern with the bill that need to be addressed at committee. Canadians need to be certain that physician-assisted dying is limited to competent adult persons 18 years of age and older. We need to ensure safeguards for vulnerable persons and confirm their capacity to make decisions about their life or being killed. We need conscience protections for physicians, and this is the big one.

We need conscience protections for physicians, nurses and other medical practitioners who oppose physician-assisted dying. Once Bill C-14 is passed into law, without conscience protections, euthanasia and assisted suicide will enter the standard of care.

I should have spoken more quickly, because I have about five more pages. It is a heartfelt issue. I believe in the sanctity of life.

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

Madam Speaker, it is always a pleasure to stand in the House to debate the issues of the day, although this is not one that I would have ever chosen to debate in the House. It has been debated before a number of times. Each time it was defeated, and each time it brought me a certain degree of relief when it was.

I want to thank the many constituents of Battle River—Crowfoot who have contacted me about the issue of doctor-assisted suicide. This issue has been raised a number of times, as I said, and every time my constituents have been very vocal in their opposition to making assisted suicide available.

There are some who disagree and are willing to support efforts to make assisted dying available in very limited circumstances, but the vast majority of my constituents in Battle River—Crowfoot, and, I dare say, most Canadians, do not want to unleash doctor-assisted suicide on our country. Why? It is because we have seen what has happened, to be quite frank, in other countries, how it started, and where it is now. I am not sure if we are going down any different road.

One of constituents from Bashaw, Alberta, sent me a letter and a paragraph in that letter sums up how things seem to be going. I will quote what was said. The letter states:

We want students to make responsible decisions for themselves about all manner of things from sexual activity to career choices to not inflicting self-harm. At the same time, we tell them they are only advanced animals with no eternal purpose. On the reserves, especially, we talk about our respect for the Elders and then as a broader society we discuss how we can help our elders kill themselves. We encourage youth to stay away from drugs and excessive alcohol consumption. Then we discuss how to legalize marijuana.

Here we are today with the Liberal government forcing us to pass a law that would legalize doctor-assisted suicide. We should be talking in the House about palliative care and end-of-life treatment. Did we hear that or see a line item in the budget? No, not a mention.

We should be providing funding to improve and provide palliative care to our aging population in our cities and rural communities. The previous Conservative government started the consultation. After the Carter decision, many submissions were made by Canadians. It is a difficult issue in households across Canada for families who face this and confront the issue. It is a very controversial and highly emotional issue.

Many Canadians believe that the Supreme Court's decision in the Carter v. Canada case is another instance of judicial activism. That was stated in many of the letters received by my constituency office. The court struck down the criminal laws against physician-assisted dying. Many Canadians supported the laws against doctor-assisted suicide. There was a very small group asking for this, the smallest of minorities, but the Supreme Court gave these special interest groups what they wanted.

I believe the Liberal government has shirked its responsibility to educate Canadians on what we are debating. There has not been enough consultations with individuals, groups, and experts. Even today, in the midst of this debate, which has been a good debate, the Liberals tried to shut down the debate. The Liberals have not taken into account a range of interests in Bill C-14, such as those advocating religious freedom. The previous speaker talked about the conscience rights of physicians and health providers and many are advocating for safeguards to protect the vulnerable. This bill is not a compassionate approach that considers all pertinent interests.

I do not believe the Special Joint Committee on Physician-Assisted Dying did a sufficient study. Quebec studied this issue for six years. Other countries studied it for years. However, the court has given Canada only a matter of weeks of study. The committee did not study what happened in other jurisdictions where we have seen this brought forward. The special joint committee heard from pro-euthanasia lobby groups. It had some of the pro-euthanasia groups appear on three separate panels.

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 second time and referred to a committee, and of the motion that this question be now put.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, certainly a fundamental part of the bill is rights and freedoms for everyone, including those in the medical profession who would be asked to assist people who qualified under the conditions of Bill C-14; with respect to those aspects of it they would have to be. However, they have rights to be protected as well, and the bill has to ensure that it is protecting the rights of our medical professionals.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, they might be in a pitiful state. However, that does not mean that one would end their lives because they are in a pitiful state. In our eyes, there are a lot of people who are in a pitiful state when we look at them. However, nobody says that they necessarily want to end their lives. We may not like to see them suffering and reduced to a pitiful state, as the member called it, but they do not necessarily see that. Therefore, what we are trying to do is find that balance.

I hate the idea that anyone would be in such pain that they would ask to have his or her life ended. I would like to make that person as comfortable as possible and help him or her in every way we humanly can. I do not want to see a whole lot of people saying that their lives are miserable and that they want to end them. There are a bunch of conditions in Bill C-14. They would have to get two opinions. There is a whole list of things. Therefore, it would not be done casually. However, it is all in the eye of the beholder.

I do not want to make this easy, and I do not think Bill C-14 does that. It is trying find a balance that is fair for people to be able to make a decision if they are in a horrific situation. My seatmate may be in that situation.

What would the member say if he was asked and the person fit the conditions? I am not sure.

[Cara Zwibel, Director, Fundamental Freedoms Program, Canadian Civil Liberties Association]

Thank you.

Mr. Chair, members of the committee, on behalf of the Canadian Civil Liberties Association I want to thank the committee for the invitation to make submissions on Bill C-14.

The CCLA fights for the civil liberties, human rights, and democratic freedoms of all people across Canada. Founded in 1964, we are an independent, national, non-governmental organization working in the courts, before legislative committees, in the classrooms, and in the streets, protecting the rights and freedoms cherished by Canadians and enshrined in our Constitution. CCLA's major objectives include the promotion and legal protection of individual freedom and dignity, and for the past 51 years we have worked to advance these goals.

Like many of the groups and individuals you may be hearing from, the CCLA was an intervenor in the Carter case. We argued in that case that the absolute prohibition on medically assisted death was a violation of section 7 of the charter that could not be upheld. The Supreme Court's decision clearly affirmed that this is the case and recognized that to deny assistance to individuals who were suffering from grievous and irremediable medical conditions violates their most basic rights.

The government's decision to table Bill C-14 recognizes the need for national legislation on this issue, and to a certain extent, some of the provisions in the bill are in our view in line with the court's decision.

We have concerns about some aspects of the bill, and in our view it suffers from at least one significant and fatal flaw. That is where I will begin to focus my submissions.

The bill defines who is eligible for medical assistance in dying by requiring a “grievous and irremediable medical condition”, and that language is in keeping with the court's language in Carter. But the bill goes on to define the criteria required for establishing that condition by stating that the individual's

natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

In our view, this requirement is not in keeping with the language or spirit of the court's decision in Carter. The focus of the ruling was on suffering and quality of life, not quantity. The reasonable foreseeability requirement will cause confusion, is unnecessary, and in our view should be removed. It's a clear departure from the court's decision and one that needs to be acknowledged and addressed by this committee.

The language of reasonable foreseeability is vague in the context of life and death: the death of every human being is reasonably foreseeable. Presumably this requirement connotes some proximity to a natural death, yet it's very unclear how this will be interpreted or assessed.

Adding to the confusion, the government has released background documents and the minister has made speeches suggesting that this requirement should not be a barrier for individuals such as Kay Carter, who suffered from spinal stenosis and was one of the people at the centre of the Carter case. Those explanations and justifications in our view do not sit comfortably with the bill's actual language.

If the government doesn't intend to create a barrier here, Parliament should amend the legislation accordingly. We have included a specific recommendation on this point in our written brief.

In particular, we propose that proposed subsection 241.2 (2) of the Criminal Code be amended to delete its paragraph (d) so that its remaining paragraphs would form the exclusive criteria for establishing a grievous and irremediable medical condition. We've included some language that we think should be added for greater certainty.

The second point I want to briefly address is the bill's exclusion of mature minors and its failure to allow for advance requests.

While the government's introduction of the bill was accompanied by a commitment to engage in further study on these issues, we are concerned that this further study will mean delays and suffering for individuals.

As I think we all know, the assisted dying issue is a controversial one. Parliament has in the past been unwilling to address the issue without the impetus of a judicial ruling. The fact that the Supreme Court's decision in Carter does not squarely address mature minors or advance directives does not in our view diminish the government's or Parliament's obligations to respect charter rights or to guard against needless suffering.

In CCLA's view there is no principled reason to distinguish between mature minors and competent adults, since the definition of a mature minor is someone who has been assessed to be capable of making a particular treatment decision. Amendments, in our view, should be made to allow for advance requests for medical assistance in dying where an individual is otherwise eligible. We see no principle basis to exclude an advance request when such requests are already permitted to allow an individual to consent to termination of life-sustaining treatment.

The third point I want to address is a smaller one, and it relates to one of the safeguards that's included in the bill, which dictates that a person's request for medial assistance in dying is signed before two independent witnesses. The bill goes on to exclude certain individuals from acting as independent witnesses. To be clear, CCLA doesn't object to this kind of safeguard in principle, but looking at the language of the safeguard, and who is excluded from acting as an independent witness, we are concerned it may be difficult to find individuals to fulfill that function. I am not sure how Parliament can best address this issue. It might be included in terms of a regulation-making power for the Minister of Health to address the permission of witnesses. We appreciate there are division of power issues here, but I did want to bring that issue to the committee's attention. In our view, failing to address it could pose a practical barrier for the effective implementation of this legislation.

Finally, I'd like to address a question in terms of the process before this committee. Witnesses invited to submit briefs to this committee were given very little notice and advised to keep written submissions brief. I appreciate your sitting tonight for a marathon meeting, and that a number of the meetings over the next few days are quite lengthy, but the committee is only spending four consecutive days on this important issue. The limits that are placed on the scope of submissions being made and the truncated timeline for consideration of the bill is cause for concern. We appreciate there was significant work done by the federal external panel, and by the interprovincial advisory group, and the special joint committee of the issue of physician-assisted dying, but the reality is this committee is the first opportunity anyone has had to look at a piece of legislation, and consider it, and make submissions in relation to it. This is an issue on which every Canadian is a stakeholder, and a more robust process for considering the legislation is warranted. We say this because the CCLA believes that the fact the declaration of invalidity will take effect in early June creates a legal vacuum.

The Minister of Justice, in introducing this bill, has said the bill falls within the parameters of the Carter decision, but that if no federal legislation is in place on June 6, it's the parameters of that decision that will govern. While we do believe national legislation on the issue is important and beneficial for a number of reasons, this doesn't mean we should rush to enact a law that hasn't been sufficiently considered through a meaningful democratic process.

Thank you.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, I cannot say I am pleased to join this discussion, because I think it is an issue that is very difficult for all of us as parliamentarians, as Canadians, to deal with these very sensitive issues. However, I do want to begin by thanking the constituents of Humber River—Black Creek. Many took the time to call or to write my office on the issue, or come by to see me, many in tears, talking and relating to episodes within their own family and their worries about what Bill C-14 would actually mean. As always, I appreciate my constituents' thoughts and the fact that they have taken an active role in what happens here because they understand that the debate here is going to impact on many of their lives.

As might be expected, the issue of medical assistance in dying is one that is difficult for many. The question is deeply personal, emotional, and even spiritual, and I understand and appreciate the concerns and challenges many have with the subject matter before us.

I, too, have struggled with these decisions, as have others. For example, I was deeply concerned when I was first confronted with the report of the Special Joint Committee on Physician-Assisted Dying. In particular, one of the areas I was concerned about was the idea that minors might be able to obtain medical assistance in dying. I was also concerned with the notion that doctors who, for legitimate issues of faith or conscience, oppose medical assistance in dying might be forced to participate in this process contrary to their personal beliefs. Both of these things would have made the bill clearly unacceptable to me.

Fortunately, Bill C-14 attempts to address these issues by seeking to find a balance in this legislation, the best approach to ensure that dying patients who are suffering unbearable pain have the choice of a peaceful death and that the vulnerable are protected. I still question whether we have done the very best job we could do. I know the committee worked very hard at this and spent many hours listening to people. I guess I am still looking to see if we can make it better. However, I have to acknowledge the extremely tight timelines we are under, and the House must contend with those deadlines or we will have no protection for anyone.

The Supreme Court decision and the parliamentary timelines over the past year have combined to thrust us into this time crunch that none of us would have preferred to be in. This does not change the fact that we are here now. Nor does it change the fact that the defeat of Bill C-14 would mean the current prohibition on medical assistance in dying would end. The fact is that the Supreme Court unanimously decided that Canadians suffering intolerably have the right to request assistance to end their suffering.

The issue before us is not if, but how, we do this. This is not a political issue for me, and I do not believe it is a political issue for anyone in the House. Like my colleagues, I have looked at this matter as a person, a daughter, a mother, a grandmother, and someone who has watched many friends grapple with the complex, costly, and emotional challenges connected with terminal illness.

Palliative care, parental leave, family leave, and home care, while not directly contained in Bill C-14, must be part of the discussion, and they are. As I listen to the debate, it is clear that the matter is one that members are contemplating in a holistic way. I am pleased to hear again as part of the debate on this legislation that the government is committed to supporting quality end-of-life services and will continue to work with provinces and territories to improve palliative care for everyone. That means we will engage with the provinces and territories to support the development of a pan-Canadian monitoring system to collect and analyze data, monitor trends, and publicly report on medical assistance in dying. This helps to assure us that the government's approach is one of caution, one that is seeking a balance.

I also need to acknowledge the parliamentary secretary's verification that the government will work with the provinces and territories to explore mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying, while respecting the personal convictions of health care providers.

This is important because it would ensure that the concerns raised by many within the medical community would be addressed.

I mention this for a key reason. Canadians want religious freedoms to be protected for all Canadians, including doctors. Canadians also expect their government to respect and defend the Charter of Rights and Freedoms. Bill C-14 would attempt to do this while putting safeguards in place to protect the vulnerable as well.

Again, the Supreme Court of Canada unanimously decided that Canadians who are suffering have the right to medical assistance in dying. This means that the issue before us again is not if but how. After extensive consultation and extensive work by the committee, the government is proposing a framework that considers different interests, including personal autonomy toward the end of life, the protection of vulnerable persons, and the rights of conscience.

Access to medical assistance in dying, as envisioned under Bill C-14, would be available only to those who meet these conditions: mentally competent adults who are in an advanced state of irreversible decline in capability; who have a serious and incurable illness, disease, or disability and are experiencing enduring and intolerable suffering caused by their medical condition; and who have deaths that have become reasonably foreseeable, taking into account their condition.

For me, this is not just a discussion about the extension of life, nor should it be exclusively a decision about prolonging one's death. In instances where the end of life is near, the court has spoken and Parliament must now step up. If we fail to take action, we know the consequences, so doing nothing is not appropriate.

In order for me to support Bill C-14, I need to be assured of the government's firm and unwavering understanding that it will continue to support quality end-of-life services and will work with provinces and territories to improve palliative care. Again, end-of-life care is not just about medical assistance; it is about so many other things.

We have to remember Dr. Low in Toronto and his appeal by video to end his own life. We remember Sue Rodriguez. We remember all of those. Do I have a right to decide who dies and who lives, or that someone should endure the kind of pain that many are suffering? What would I do if my husband had ALS and begged me to end his life because he could not stand the pain? Do I have the right to say no? However, I also believe that it is God's right to call us all.

Bill C-14 is attempting to deal with a very difficult issue for all of us and for Canadians. Let us get it to committee. Let us see if we can make it stronger and make it better so that we are putting the emphasis on the palliative care and on the kinds of drugs that would eliminate the pain and make people more comfortable, so that none of us will have to make that decision.

[Derek Ross, Executive Director, Christian Legal Fellowship]

Good afternoon.

Thank you, Mr. Chair.

I am Derek Ross. I serve as executive director and legal counsel to the Christian Legal Fellowship. With me is Jon Sikkema, associate legal counsel at the CLF.

We wish to thank this committee for affording us the opportunity to make these submissions.

CLF is a registered charity and a national association of more than 600 legal professionals who share a commitment to the Christian faith. As an organization of lawyers, we seek to advance justice and the public good by drawing attention to fundamental principles of law.

One of those core principles is the sanctity of life, which the Supreme Court recognized as one of our most fundamental societal principles in Carter. That principle affirms that every person's life, no matter how old, disabled, or infirm the person may be, has inherent equal worth and value.

As the Supreme Court recognized in Rodriguez, the active participation by one individual in the death of another is intrinsically, morally, and legally wrong. That principle, expressed by Justice Sopinka, was not challenged or overturned in Carter, although Carter does now allow a legal exception to it in certain circumstances.

The challenge for us, and for you the committee and for Parliament, is the question: how can we best protect and preserve the equal value and inherent worth of all people in a post-Carter Canada?

We have framed our submissions in answering that question on the presumption that Parliament will legalize euthanasia and assisted suicide, which we'll refer to as MAID, in certain circumstances, although there are other and in our view more appropriate options available to Parliament, which we've explained elsewhere.

However, because the bill before this committee takes the path of legalization, we urge Parliament to be forward-thinking and to proactively guard against some of the negative impacts, perhaps unforeseen and unintended, that Bill C-14 might have—negative impacts that can be at least partially reduced with certain amendments that we and others recommend.

We urge Parliament to consider the following questions.

How will the legalization of MAID affect our societal attitudes towards suicide?

How might it contribute to normalizing suicide as a choice-worthy option, not just in the MAID context, but generally?

We know that the drafters of Bill C-14 are attuned to this issue, as the preamble acknowledges that suicide is a public health issue, not just a private one, and the Department of Justice's background paper also says that MAID is not being made available in wide circumstances, because that could undermine suicide prevention initiatives and normalize death as a solution to many forms of suffering.

The government is right to be concerned about those potential consequences and needs to be even more deliberate in guarding against them. We need to protect the efforts of physicians, health organizations, and charities to prevent suicide. We are concerned that such groups may avoid steering individuals away from suicidal ideations for fear that they will be seen as interfering with MAID or access to it.

This is evident in Quebec, where the college of physicians recently discovered that emergency room doctors were allowing suicide victims to die, when life-saving treatment was available. In media reports, the legalization of assisted death in that province was cited as creating ambiguity about the need to intervene. Parliament must eliminate any such ambiguity here and play a lead role in combatting the normalization of suicide.

What specifically can this committee do within the framework of this bill?

We say that Parliament should specifically affirm in the preamble to Bill C-14 that suicide prevention remains an important public policy goal. In addition, the preamble should state that sanctity of life remains one of Canada's most fundamental societal principles; that it is not contrary to the public interest to express the view that participating in causing a person's death is intrinsically, morally, and legally wrong; and that MAID should be considered only as a last resort, not as a measure to be presented to patients as just another treatment option among others.

This, in our view, is an important means of sending a clear signal, even if Parliament chooses to allow MAID, that MAID is not to be seen as a new normal medical response to suffering or even just as one option among and equal to others. This also means that Parliament should protect the charitable status of organizations devoted to preventing suicide as well as religious organizations and health care facilities that decline to provide MAID at their facilities, and should do so through clear amendments to the Income Tax Act, which we set out in our brief.

These amendments will serve to promote freedom of religion, conscience, and expression, but just as importantly, respect and preserve a medical and societal culture in which treatment is promoted as a solution to suffering, not suicide.

Similarly, we need to protect patients from being pressured to obtain MAID. Counselling or abetting a person to commit suicide will wisely remain illegal under this bill. This provision, section 241(a), addresses suicide only, and does not seem to address things like voluntary euthanasia, which is considered homicide and not suicide. This may be a drafting error, but either way it must be remedied. The reality is that patients will face external pressures to obtain and receive MAID. Bill C-14 acknowledges this. Under the legislation, as drafted, when this happens, the only consequence is that a patient may be considered ineligible for MAID, and only if the patient's doctor determines that the request was made because of, and a result of, that external pressure. Even if the physician determines that the patient was ineligible, the patient can still seek MAID from another physician, potentially under continued pressure from that same third party. The second, or tenth, or twentieth physician may fail to detect the external pressure on the patient. With respect, this is a significant oversight that leaves even the most malicious and prolonged forms of pressure and coercion seemingly free of prosecution. We recommend specific provisions to remove any ambiguity in this regard, and make it an offence to counsel, encourage, intimidate, or coerce a person to die by suicide or homicide, including euthanasia.

We also urge Parliament to explicitly protect the rights of those who object to participating in MAID, such as health care providers. I know others will be speaking to that matter this afternoon. In legalizing euthanasia, Bill C-14 places the most vulnerable members of society at risk. CLF endorses the recommendations contained in the Vulnerable Persons Standard. In addition, we recommend a number of amendments to Bill C-14, to protect the most vulnerable from abuse, which are set out in our brief. It is our submission that the court's ruling in Carter does not preclude Parliament from doing any of these things, and all of these provisions and amendments are necessary, not only to protect the vulnerable, but to preserve a culture that celebrates the equal and inherent value of every life.

Thank you.

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

Madam Speaker, I thank my colleague for his question.

Several aspects of Bill C-14 blur the line between federal and provincial health jurisdictions. As soon as we start talking about palliative care, we are talking about health care, which is a provincial jurisdiction.

Nevertheless, the federal government can still take a leadership role, especially with its health transfers, so that Canadians across the country have equal access to palliative care as part of the end-of-life care continuum. Naturally, this must be done in accordance with the provincial and territorial legislatures.

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

Madam Speaker, I cannot tell you how privileged I feel to take part in this discussion, and I mean “discussion”, because in the course of our work, which went on until midnight last night and will do the same tonight, it really has been a discussion, with the goal of coming up with the best possible solution, and not a partisan debate.

These kinds of subjects come up very rarely in history, and when the time comes for me to leave politics, I will look back on this as one of the most memorable topics of discussion in my time here.

In studying a bill, we must of course take a rational and intellectual approach, based on facts and science; however, with this kind of subject, we cannot ignore our personal experiences and, for many of us, the dimension of faith that goes along with life and quality of life.

Just a few decades ago, it would have been unthinkable for us to have a debate on the issue raised in Bill C-14. Today, this discussion is essential in order to address the concerns many Canadians have about quality of life.

Our society is constantly evolving, and for obvious and sometimes valid reasons, our democratic institutions will always be partly out of step with popular sentiment. However, the wishes of the majority should not be the only factor that guides us in our decision-making, because if our democratic institutions do not protect minorities, I wonder who will.

There are some historic issues that stand out in the life of a parliament, and as a result of the Carter ruling, we are now being called on to deal with such an issue. Although we are aware that there is little time left to deal with such a vast and also complex issue, we nevertheless have the good fortune of being able to refer to the Quebec experience, which quite surely can be a source of inspiration and can answer many of our questions.

Today, armed with the Quebec experience, our personal experiences, and input from many organizations and people in our respective ridings, we are being called on to make the best possible decision about how to provide medical assistance in dying. This is not about whether or not this assistance should be available.

The Supreme Court made that decision in Carter. As we all know, it was a unanimous ruling that sent a clear message on behalf of those who have spent years fighting for the right to die with dignity. It is up to us to legislate a framework for that assistance in a way that ensures respect for everyone's charter rights.

The bill is far from perfect, but at this point, I plan to vote in favour of it so that we can have the opportunity to perfect it by suggesting useful amendments during the committee's study.

I would like to share a very personal experience because I think that is the best entry point with this issue. Until recently, I was spared any major health problems, but not long ago, when I had a kidney stone that was relatively benign and easily treated, I had to cope with waiting six hours to get a drug that would alleviate my suffering.

When I shared my story with a few people I know, several of whom had had similar experiences, I saw how quickly people responded to suffering with sincere compassion.

Although this was a relatively minor health problem, for the first time, I felt, in my own body, the pain that may have been felt by my own parents, who both died of cancer. I spent as much time as possible with them when they had to move into a hospice. There is no doubt that their suffering was enduring and intolerable and that their health problems were grievous and irremediable. They met all of the criteria set out by the Supreme Court.

The workers in that hospice understood and still understand that no one should have to suffer while they are waiting to die when there are ways to relieve their pain, even though, in many cases, one of the side effects of the drugs is to precipitate death.

I have to say that when I remember the relief that I saw on my mother's and father's faces, I am inclined to support this bill and try to improve it.

This bill should be accompanied by a real national strategy on palliative care. In my opinion, some or all of the $3 billion that the Liberals promised for home care during the election campaign should have been included in the most recent budget. However, that is not the case.

Cancer can strike at any age and often there is no hope of recovery. Many other diseases produce similar effects of enduring and intolerable suffering without necessarily being life-threatening.

That is why I am also concerned about the fact that in this bill, the government did not use the wording in the conditions set out in the Supreme Court's decision. The Supreme Court basically said that Canadian adults who are able to consent and who have a grievous and irremediable medical condition that causes enduring suffering that is intolerable to them have the charter-protected right to physician-assisted death. That is the crux of the Carter decision, which gave rise to the bill that is before us today, Bill C-14.

What is the government trying to do today with this fourth criterion that it added, whereby the natural death has to be reasonably foreseeable? I have to admit to the House that in my mind at least, this is confusing. The terms are hard to define, the likely commendable goal being to seek the broadest consensus, even though that consensus already exists. If not, we would not be debating this bill. The Supreme Court likely would not have ruled the same way either if it had not sensed the evolution of this society.

We are about to undermine the process with such a vague and mandatory criterion because the legislation tells us that to have access to medical assistance in dying, the person absolutely must meet the four criteria set out in the legislation. The first three criteria are easy to understand, but the fourth is exceptionally vague.

I hope to see this fourth criterion disappear during our discussions in committee. With it, we are about to force those who are suffering to again demonstrate the unconstitutionality of the legislation, leading us right back to where we are today. We are here now, so let us see the work through and do it properly. Let us agree to ensure that this bill complies with the Constitution, that it will not be challenged later, and that those who wish to use it can finally do so.

Other questions remain practically unanswered, which is why the work coming up in committee after the bill passes second reading, I hope, is so important. As we point out in our supplementary opinion attached to the report, the government must adopt an approach to legislating medical assistance in dying based on the following principles: protecting vulnerable persons; taking into account the ethical concerns of all medical professionals; guaranteeing equal access to medical assistance in dying; protecting the conscientious objection of health care professionals; and respecting jurisdictions.

My time is running out, so I will conclude by saying that the NDP's job is to clarify the ambiguous provisions in the bill, strengthen the bill to avoid charter challenges, and demand stronger commitments with respect to palliative care and mental health care services to protect the most vulnerable Canadians. I can sense this in listening to my colleagues and all members of this House.

I am prepared to take questions from my esteemed colleagues.

[Nicola Di Iorio, Liberal, Saint-Léonard—Saint-Michel, QC]

Madam Speaker, before I participate in the debate at second reading on Bill C-14, concerning medical assistance in dying, I want to tell the people faced with making difficult end-of-life decisions and their loved ones that I am thinking of them.

Everyone knows that medical assistance in dying is a complex, delicate, and extremely personal issue. Since the Supreme Court ruled in the Carter case last year, Canadians have been taking part in this national debate. This issue continues to be debated and seriously considered around the world.

I would like to share with my colleagues what is happening elsewhere in the world. Almost everywhere, the deliberate taking of a life or aiding someone to end their life are serious crimes punished by lengthy sentences. As many people know, Canada is not alone in legislating to authorize medical assistance in dying.

Oregon, Washington, Vermont, and California are examples nearby. A little further away, Colombia, Belgium, the Netherlands, and Luxembourg have legislation authorizing one type or another of medical assistance in dying. The provisions on safeguards, controls, and reports, which are all found in Bill C-14, are similar.

Usually, requests for medical assistance in dying must be voluntarily submitted by the patient in writing. In many cases, this must also be done in the presence of independent witnesses. The patient must obtain a second opinion from an independent doctor and must wait a certain amount of time between the day the written request is submitted and the day that the medical assistance in dying is provided.

Colombia has a unique approval process for requests for medical assistance in dying. Every hospital has interdisciplinary committees to assess such requests and support the patients and their families throughout the process.

Nearly all of the regimes we have looked at include a mandatory monitoring system in which independent committees collect information to monitor the situation. That information is then used to publish periodic public reports on medical assistance in dying.

The safeguards and controls set out in various statutes are relatively consistent. However, there are differences in the types of medical assistance in dying that are authorized and the circumstances in which medical assistance in dying is authorized. The differences in terms of who is eligible for medical assistance in dying and the way that assistance can be provided fall along a continuum.

On the one hand, we have the four U.S. states, which I mentioned earlier and which have enacted laws: Oregon in 1997, Washington in 2008, Vermont in 2013, and, more recently, California in 2015. In these states, a mentally competent adult 18 years of age or older can receive the assistance of a physician to die, provided that their request is voluntary and this person is suffering from a terminal disease, defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.

In these U.S. states, just one doctor may prescribe a substance that the patient administers to put an end to their life at the time of their choosing. This is what we commonly refer to as physician-assisted suicide. Voluntary euthanasia, in which the physician administers a substance that causes the death of the patient, is expressly prohibited. Patients are also not able to submit an advance directive.

In Colombia, a ministerial resolution was drafted in response to two rulings by the country's constitutional court. The resolution contains eligibility criteria similar to those of the U.S. states.

It limits eligibility to adults who have an incurable disease, which is defined as a serious, progressive, and irreversible disease, or a pathology that will lead to death within a relatively short time frame. It requires a specific prognosis of six months, in other words, the assurance that death is expected relatively soon. Unlike the U.S. states, Colombia authorizes only euthanasia. A doctor must administer the substance that will cause the patient's death.

At the other end of the spectrum are Belgium, the Netherlands, and Luxembourg. In those three countries, patients can access medical assistance in dying if they are experiencing intolerable or unbearable physical or mental suffering caused by a serious incurable illness and if there is no possibility of improvement. Patients do not have to be dying or suffering from an illness that puts their life in danger in order to be eligible. In other words, physician-assisted suicide and voluntary euthanasia are authorized in those countries.

Although medical assistance in dying is provided only to adults in Luxembourg, minors as young as 12 can seek medical assistance in dying, with their parents' consent, in the Netherlands. In Belgium, adults and emancipated minors can seek medical assistance in dying in similar circumstances. In 2014, Belgium expanded its eligibility to include children of all ages, but only if their death is likely to occur in the short term and their suffering is physical.

The experiences and lessons learned by the Benelux countries were closely examined. For example, the law in the Netherlands authorizes requests for patients who no longer have the ability to express their wishes. However, research suggests that doctors are generally not prepared to euthanize such patients.

Consideration was also given to the Benelux countries' experience regarding patients who are suffering intolerably solely because of a mental illness. This is a very controversial issue. Evidence shows an upward trend in the percentage of people who seek euthanasia solely because of mental illness, and experts are starting to express their concerns about the fact that medical assistance in dying under such circumstances is becoming increasingly common. For example, in Belgium, people have been euthanized because of intolerable suffering resulting from depression, anorexia, blindness, fear of a disability or further suffering, and the pain caused by the lost of a loved one.

Many people fear that such broad access to medical assistance in dying can present real risks for people who are lonely or isolated and those who do not have any social, economic, or community support. It could also reinforce prejudice regarding the quality of life of seniors, people who are sick, and people with disabilities.

Our government sought to learn from the experience of other jurisdictions. The government is committed to continuing to examine the more general issues, and it will continue to observe what is being done elsewhere in the world in terms of medical assistance in dying.

I support Bill C-14, which was introduced by our government. Once this bill is passed, it will alleviate the suffering of those covered by its scope and will allow people to die with dignity.

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

Mr. Speaker, I am pleased to rise to speak to Bill C-14, the government's response to the Carter decision that we have recently dealt with by tabling this particular piece of legislation.

I wish to state at the outset that I will be supporting the bill, but with some reservations. I will explain why I believe the bill deserves support, but by the same token, I believe that somehow in a future Parliament the bill could go further.

I intend to engage in this discussion by going through three thematic components in the brief 10 minutes I have to make my contribution to this important debate. I know this has been at times an emotional issue for parliamentarians, but in the three thematic components, I wish to give my rationale for my support at this time.

The first of the three themes looks at the moral considerations that many members and much of the broader public have expressed. Second, I want to discuss perhaps more fulsomely our duty as parliamentarians to respond to issues of constitutionality, particularly when they are challenged in the courts. Third, in the short remaining time I will have, I wish to express some personal thoughts on this as it impacts me directly.

First, I want to thank many constituents in my riding of Scarborough—Agincourt for their interventions on this subject. This has been an emotional matter, and I would have to state on the record that the overwhelming majority of constituents who reached out to me are opposed to the government introducing Bill C-14. That has been primarily on moral grounds. They feel that allowing physician-assisted death is essentially tantamount to murder.

In the opportunities I have had to discuss this matter with my constituents, I made it clear that Parliament is under a positive obligation to respond to the decision in the Carter case. If Parliament does not present some form of legislation, the consequence of its failure to do so would mean that the provisions of section 14 and subsection 241(b) of the Criminal Code would no longer be operative as of June 6. We would essentially be left in the situation of a legislative vacuum. It is important to put a regulatory framework around physician-assisted death.

As I pivot from the issue of morality to the issue of our responsibility as parliamentarians, I want to raise the point that while morality is important, and this has been a theme discussed in the House, ultimately we as parliamentarians must first make sure that we put in laws that pass the constitutional test. Where the Supreme Court of Canada has rendered a decision indicating that something is not constitutional, that it is a breach of some form of the constitution, whether on jurisdictional grounds or on grounds under the charter, Parliament needs to respond. In my view, that is what the government is doing in Bill C-14, under a very difficult timeline. That is perhaps why there has been a decision to introduce Bill C-14 in a relatively controlled and restrictive manner. It is reflective of the fact that we are under a very tight time obligation.

Therefore, I understand why the Minister of Justice, the Minister of Health and others, who have done yeoman's work in this regard, have taken initial steps to make sure it meets the constitutional test set out by the Supreme Court of Canada. However, in my view, it does not necessarily go far enough.

I want to pay tribute to the ministers and to all the other many parties and Canadians who have contributed to the debate. I note that there was incredible work done by the Special Joint Committee on Physician-Assisted Dying, led by Senator Ogilvie and the member for Don Valley West. I want to pay tribute to all the members who participated in that committee.

I want to note the contributions of the federal external panel, the provincial-territorial expert panel, and the many stakeholders and Canadians who have contributed to this very difficult debate.

I would note, though, that not only have many of my constituents expressed concerns with respect to this particular bill, but in some specific instances they have asked us to consider invoking the section 33 notwithstanding clause found in the charter, which of course is the legislative override provision. I would view that as a more sophisticated way of saying they oppose it and that ultimately parliamentarians should please consider overriding the charter rights of certain individuals by invoking or using the notwithstanding clause.

I would say to those individuals who have expressed that particular feeling that this is something we have to do and tread upon very carefully, particularly where we are potentially treading on rights that have been protected under the Canadian Charter of Rights and Freedoms. I would submit respectfully that it is important we do so in a manner that follows the tests that are similarly found in section 1 that were ultimately articulated in the Oakes decision that deals with the judicial override clause that is found in the charter.

Under Oakes, there are essentially three tests that need to be met, and if any one of those tests fails, namely in dealing with the judicial override, then one would not be able to invoke section 1, and I would argue that one would have to use the same principles under section 33 in exercising the legislative override. Those three tests basically deal with rational connection, that the impairment is done in as minimal a way as possible, and that we look at the deleterious effects and salutary benefits of any limitation that is imposed under section 1.

Typically, in application of section 1 of the charter in most instances, the failure falls under the second test, that the impairment is not as minimal as possible. Certainly, that was the basis in which the section 1 test was applied in Carter and which the court found that the proposed absolute ban on physician-assisted death did not meet the minimal impairment test. The court had carefully gone through the trial judge's analysis and concurred with the trial judge's position with respect to the application of section 1.

In terms of whether we would consider invoking section 33, as I mentioned already, this Parliament, this House of Commons, has never exercised section 33 as a legislative override, and I would argue that we too should be extremely careful. That is the test that we need to apply as parliamentarians in terms of determining whether we feel it is appropriate to use the legislative override.

As I mentioned before, the bill seeks to meet in a very expedited fashion a court-imposed time challenge and to deal with the suspension of the declaration of invalidity under sections 14 and 241 of the Criminal Code of Canada. We must do so by June 6.

As I have indicated before, I will be providing my support for the bill, but I would argue that there are a couple of additional things that we as a Parliament need to consider in the future. These were articulated quite clearly in the report from the special joint committee of the Senate and the House of Commons.

My first issue is that the bill currently does not deal with the issue of advance directives. I am sympathetic to those Canadians, particularly those who are suffering from diseases like ALS and others, who may still be in quite good shape at the present time, but at some future point, when they are getting close to their end-of-life situation, will not be able to express their particular consent. In my view, the issue of a clearly articulated regulatory framework that allows for advance consent should be considered.

I am also—

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 second time and referred to a committee, and of the motion that this question be now put.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Mr. Chair, I would respectfully disagree with my colleague. My colleagues who sit on the government committee here are solely using the point that this legislation does not require a five-year review because the committee is master of its own domain. By the same logic, the health committee should be able to look at the issue contained in Bill C-14, yet the government has stated that it is material enough to require a review in five years. I respect the fact that the government.... I'm not sure what they would have to hide, or why they would vote against a five-year review, especially in light of the Auditor General report that we saw today on instances of fraud being not detected within the Department of Citizenship and Immigration.

I find my colleague is perhaps grasping at straws to justify his logic.

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

Mr. Chen has offered me some of his time.

In respect to this issue, it's critical to understand this committee is the master of its own process. Apropos of what Mr. Chen has indicated, the matters the committee wishes to study can be determined by the subcommittee on procedure here at this committee earlier than a five-year period or later than a five-year period.

In terms of the point made by Ms. Rempel, as to whether there's an inconsistency by not implementing a mandatory review in this legislation with what is transpiring with the Bill C-14 issue, there is absolutely no inconsistency. That undermines the notion that somehow what is applied for with one piece of legislation under a different minister, and under their mandate, must therefore be applied to every single piece of government legislation that is being enacted by the Government of Canada.

That is clearly not the way this government operates, nor is that the way that any government has operated. Decisions made with respect to whether mandatory reviews are required are made in consultation with ministerial or departmental officials relevant to that ministry, relevant to that minister's own decision-making, and also germane to the issues that are at issue within that specific legislative context.

The position being articulated by Mr. Chen is that in the context of this legislation it does not meet that threshold requiring a mandatory review, particularly when you have a standing committee populated by members of all three parties that can initiate such a review on their own volition.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Mr. Chair, by that logic my colleague opposite has negated the Minister of Health in saying that Bill C-14 requires a five-year review, which is part of the bill we're debating in the Commons today, so there's a bit of a dichotomy there, or a lapse in logic.

I would direct a question to the department officials, and perhaps if they can inform the committee of the commonality of five-year reviews in terms of legislation, as well elaborate on whether a parliamentary review would constitute a sunset clause of this particular piece of legislation.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, as I said in my speech, the government chose to leave people who are not at the end of their lives out of Bill C-14.

In some cases, individuals might want medical assistance in dying. One example that comes to mind is people on hemodialysis, an onerous and time-consuming treatment. After 10, 15, or 20 years of such demanding treatments, people might be worn out and might want to stop. All patients have the right to refuse treatment. A patient who refuses this treatment will die in the short term, but continuing to receive the treatment will not cause death. That means that the patient's end of life is not reasonably foreseeable, and he or she may therefore not be covered under this bill. People may want medical assistance in dying, but some of them are not covered under this bill as written. That must be fixed.

I think we should concentrate on palliative care first and foremost. Allowing medical assistance in dying makes no sense unless we have optimal palliative care in place.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, I think it is very important to rise to speak to Bill C-14, today and on other days of debate.

As my colleagues probably know, I am a health care professional. I still work at the hospital a few times a month, mainly in emergency and intensive care. This is important to me. End-of-life care is very important, which is why I supported a motion that my colleague from Timmins—James Bay moved during the previous Parliament. That motion dealt with a national palliative care strategy.

To begin, I would like to highlight two or three points from the Supreme Court decision that I think are particularly important to this discussion. The decision states:

...the prohibition [of medical assistance in dying] deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

And by leaving them to endure intolerable suffering, it impinges on their security of the person.

It is important to mention that the Supreme Court decision underscores the government's responsibility to address the suffering that people experience. It is also important to understand the difference between suffering and pain. Pain is a physiological reaction to stress, such as an injury. Suffering has to do with an emotional experience.

Take, for example, a very painful event such as childbirth. That pain is associated with a positive emotional experience, the birth of a child. That event does not necessarily cause suffering, but it does cause significant pain.

A person might also have a minor injury that can cause extreme suffering because of the emotional experience associated with it. I think it is important to make that distinction.

These days, we have excellent therapeutic ways to alleviate pain. Opiates were long used, but now we also have patient-controlled analgesic pumps. We can even offer continuous palliative sedation, similar to what intensive care patients receive when they are intubated to ensure that they do not feel any pain. There are a number of extremely effective ways of alleviating pain, in addition to non-pharmacological methods. We have a good range of treatments to offer patients who are in pain.

It is possible to alleviate the suffering that comes with an emotional experience such as the end of life or an end-of-life diagnosis without resorting to medical assistance in dying. In that case, palliative care is an option. The bill applies to adults with a serious and incurable illness, disease, or disability who are in an advanced state of irreversible decline in capability and whose natural death has become reasonably foreseeable.

Obviously, we are talking here about people who are at the end of their lives, people who need palliative care. The purpose of palliative care is to ease the suffering of both the patient and the family. Palliative care helps ensure that people are cared for properly, and that they have the help they need to get through the grieving process and the hardship associated with illness.

We want to take away all the pain, but we also want to provide support for the family.

Optimal palliative care helps not only the patient but also the whole family, so that the patient's death can be as peaceful as possible for everyone involved. We are going about things the wrong way by providing medical assistance in dying when the palliative care offered in Canada is not yet optimal.

When palliative care facilities are underfunded and need to try to drum up donations every year, they are unable to offer optimal palliative care. Most of these facilities can only take patients who are expected to die in less than three months. However, people can often live much longer than that with a terminal illness and they need a lot more support.

Moreover, in many rural areas, palliative care beds are reserved through surgical units. That means that nurses who are taking care of palliative care patients also have to take care of seven or eight other patients. Nurses are therefore unable to respond quickly or spend as much time as they should with the families, and the patient's death does not go the way he or she would like.

For people who do not have the means or who do not want to die at home, unfortunately the hospital is often the only other option when palliative care beds are not available. This is not an easy experience, and it can create suffering because patients do not always have all the support they deserve.

There has been a lot of effort in recent years to remove some natural processes from hospitals. One example would be the birthing centres that have been set up. The thinking is that it would be better for mothers to go through pregnancy and childbirth a little more naturally in a setting other than a hospital, as long as there are no medical complications.

The same thing is being done with death, which is a natural process. It is being taken out of hospitals to make the experience much more positive, in a place other than the medical setting of a hospital.

Hospices try to remove all traces of hospitals. They have hospital beds, but they try to use the patients' own bedding, have large windows, and help patients forget that they are not at home.

Unfortunately, no matter how hard the palliative care facilities work, they are often underfunded. For example, the Maison du bouleau blanc, in my riding, has four beds, only two of which are subsidized. It therefore relies on donations to maintain its other two beds. It has a large room with big windows and a shower, but this is the only room that the facility has been able to convert to an ideal palliative care room.

These people cannot afford nurses. The people who work there are extremely dedicated practical nurses. However, they have some legal limits. For that reason, all the protocols regarding doctors working with palliative care facilities had to be updated, in order to ensure proper care for the patients.

We could address a number of shortcomings and avoid making the patients suffer. If someone who receives a terminal diagnosis knows that they will receive good palliative care as their condition worsens, they may not choose to take their own life prematurely. This would therefore help protect the right to life.

However, as long as do nothing on palliative care, we are working backwards. We cannot reverse the life-based medical model to allow for medical assistance in dying if our palliative care services are not as good as possible or accessible to all Canadians, regardless of where they live, even if they live in a remote region.

Since I am out of time, I would be happy to take questions from my colleagues.

[Kate Young, Liberal, London West, ON]

Mr. Speaker, the minister went on to say that her experiences as a family physician reinforced her sense that we must “uphold the principles of palliative care, as well as respecting the rights of patients to make their own decisions about their care as they approach the end of life”.

Earlier this year, the minister met with provincial and territorial health ministers in Vancouver to launch discussions on a new multi-year health accord. Through the health accord process, our government will be making significant investments totalling $3 billion dollars to help deliver more and better quality home care services for Canadians. We expect that support for palliative care in a variety of settings, where patients can receive the ongoing care they need and deserve at the end of life, will be one of the priorities going forward. I agree that there is no doubt that care at the end of life should be there when people need it. We want all Canadians to have access to the best care possible.

The issues in this area are complex. However, I strongly believe that Bill C-14 has struck the right balance between competing rights and policy objectives.

I call on members of this House to support it.

[Kate Young, Liberal, Parliamentary Secretary to the Minister of Transport]

Mr. Speaker, I am pleased to speak to Bill C-14, which would enact a federal legislative framework to permit medical assistance in dying across Canada.

Medical assistance in dying is a deeply personal issue for all Canadians, as we have witnessed. As parliamentarians, we must consider a diverse range of views on this complex issue. I know that we all take this responsibility very seriously.

The starting point is, of course, the February 6, 2015 decision of the Supreme Court of Canada in Carter v. Canada. The court unanimously held that the criminal laws prohibiting physician-assisted dying interfere with liberty and security of the person by denying grievously and irremediably ill individuals the ability to make decisions concerning their bodily integrity and medical care, and leaving them to endure intolerable suffering.

The court also held that the laws deprive some people of life by forcing them to end their lives prematurely for fear that they would be incapable of doing so when they reached a point where their suffering was intolerable. The court accepted that the criminal prohibition on assistance in dying furthers a pressing and substantial legislative objective, that of preventing vulnerable individuals from being induced to die by suicide against their will in a moment of weakness.

However, the court concluded that a permissive regime with properly designed and administered safeguards was capable of protecting vulnerable people from abuse and error, and that the absolute prohibition went farther than necessary to achieve its objective. The court appropriately left the task of designing this new regime to Parliament.

The proposed legislation responds to the Carter ruling by enacting a new legal framework for access to medical assistance in dying, including the safeguards that the court called for in order to minimize the potential for errors and abuse.

The court did not define the term "grievously and irremediably ill", but the proposed legislation does define it in a manner that is consistent with these circumstances. Specifically, the person must be in an advanced state of irreversible decline in capability. The person must have a serious and incurable medical condition. The person must be suffering intolerably. The person's death must have become reasonably foreseeable, taking into account all of the person's unique medical circumstances.

Canadians would have the comfort of knowing that they would be able to get the assistance they need if they are suffering intolerably when their capacity declines as they approach the end of their lives.

Like so many honourable members who have stood in this house to debate this difficult legislation, I have my own personal story that makes this issue all the more relevant. My mother, Eleanor Anderson, spent over 10 years in a wheelchair after suffering a massive stroke at the age of 69. She had to learn to walk, talk, eat, everything right from scratch. Then it happened again, another stroke five years later. She fought back again, but with each stroke a little more of her was taken away.

She never wanted to feel helpless. During those years in a wheelchair, my mother would try her best to do everything on her own, whether it was dressing, loading the dishwasher, or simply wiping down the kitchen counter. During those years, she never wanted our sympathy.

Despite her tenacity, she knew the day would come when she could not fight any longer. She made it very clear to my father, to me, and my brother that if the time came and she was not able to do much more than lie in a bed, she wanted to drift away peacefully. As expected, what we all feared eventually happened.

She continued to have small strokes, losing mobility and function with each one, to the point that she could no longer sit up in her wheelchair, talk, or even eat. We were not even sure if she knew any of us anymore. She pulled out the feeding tube that kept her alive, to the point where the doctors said they wanted to insert a tube in her stomach. That was not the life my mother wanted, and so we said no. We had to let her go. Doctors agreed it was best, and said she would only last a few days.

We asked that she be moved to palliative care at another hospital. Ironically, they said they could not move her because she would not make it, that she would die en route, and so she lay in that hospital bed, and we watched her slowly starve to death.

She would last 12 days, and her death was anything but peaceful. It was the most excruciating experience I have ever been through, and nothing prepared me or my family for her death. I know my mother would have agreed that this legislation is a step in the right direction. She would have wanted to be able to communicate her desire to die with dignity. However, she would have also wanted her family to follow through on her wishes.

Twelve years later, my dad said to me, after catching an infection, “I just want to close my eyes and not wake up”. That is exactly what happened. He was gone two days later. He got his wish. However, I know that many people are not as fortunate, and it is for those people that we must be prepared to lend our voice.

Health Minister Jane Philpott said this in her speech to the House:

...every person, every story, is unique. However, much is shared in common: the hope to die in peace; the desire to be respected; and to have personal autonomy and dignity honoured by family and health care providers alike.

Minister Philpott went on to say that her experience as a family physician reinforced her sense that we must—

[Alice Wong, Conservative, Richmond Centre, BC]

Mr. Speaker, today I rise to discuss Bill C-14.

As we well know, Bill C-14 is the government's response to the Supreme Court ruling in the Carter decision last February. The court gave the government a total of 16 months to form legislation, so here we are in the House today, debating the bill.

I was pleased to see that the bill included many recommendations provided by my Conservative colleagues in their dissenting report from the special joint committee report on this issue. However, I do not believe the bill in its current form is good enough.

I have benefited from listening to my colleagues' speeches, and appreciate the passion each has shown as they discuss Bill C-14 in the House. Indeed, I have made my own consultations with various interested parties in my riding of Richmond Centre, and look forward to sharing them with you.

We have received many suggestions and comments on the legislation, both from parties that believe the bill is too restrictive and those who believe it is not restrictive enough. Indeed, I am rather impressed that there was significant public interest on this bill, and I would like to continue to encourage people in Richmond Centre who have not given their thoughts on this matter to write to myself or my office.

My voting position on second reading will be carefully considered from a balance of available information, including from the consultations I have held with interested stakeholders in my riding.

To begin, I would like to share some of my personal experiences. During my time as the Minister of State for Seniors, I had the opportunity to work with many groups who are devoted to protecting our most vulnerable and ensuring quality palliative care. The unfortunate reality is that there are many seniors who are not provided with effective end-of-life care. Instead, they are subject to elder abuse and are often pressured into making decisions to avoid becoming a burden to their families. This is tragic. It is absolutely imperative that we ensure that there are safeguards to protect seniors against such elder abuse.

A potential safeguard to protect financial abuse of elders, which is a very common and unfortunate form of elder abuse, is to simply prohibit any independent witnesses from financially profiting at all from the will or the estate of those who requested physician-assisted suicide. This was actually a recommendation from a group of constituents I met with recently. They pointed out that in the bill, the independent witnesses that have to sign the documentation to enable the physician-assisted suicide only have to know or believe they are not a beneficiary under the will of the person making such a request. Again, this is simply not enough.

Back in my riding of Richmond Centre, I have been an active member of the Richmond Rotary Club. This club was instrumental in building the first hospice in Richmond. It was there that I and my fellow Rotarians witnessed first-hand the benefits quality palliative care can bring people. Life is valuable at every stage. One of my primary concerns with physician-assisted suicide is that it will only complicate end-of-life decisions. Individuals who are sick or need additional care will see themselves as a burden, and choose death to avoid placing further expectations on family members.

Instead, we need to be supporting family caregivers and demonstrating that every life is valuable.

As others have noted, there was no allocation in the budget for palliative care services. This is totally and absolutely unacceptable. This issue is quickly becoming more about access to death than access to life. It is absolutely essential that the government make a commitment to strengthen palliative care and encourage citizens to seek such care first. Palliative care provides death with true dignity and not a forced death, which is what physician-assisted suicide is.

Last year, I had the opportunity to meet with organizations such as the Council for Canadians with Disabilities, the CCD. I met with its representatives to discuss their concerns and the importance of protecting individuals with disabilities. More recently, they were able to appear as witnesses at the special joint committee to discuss their views on possible legislation. The CCD was very concerned with the recommendations provided by the committee and commented, “The permissive approach would put vulnerable people at risk”.

We cannot ignore the needs of our most vulnerable. It is crucial that the legislation reflect the concerns of groups such as the Council for Canadians with Disabilities to ensure all Canadians are protected.

I would like to share a few of the comments I have heard from my constituents over the past several months. I will emphasize that my repeating these comments in the House today does not mean that I endorse all of them, but rather, this is a reflection of the variety of comments received. I know as an elected figure this may be hazardous as I may be quoted out of context; however, it is my duty to ensure that these voices are heard.

A primary theme as a result of my consultations is that Bill C-14 would only decriminalize the act of physician-assisted suicide as performed by medical practitioners.

I will add that there would be no effects or changes to the Canada Health Act, nor would it instruct our provinces to provide this procedure as something to be covered under provincial medical insurance plans. In my home province of British Columbia, this is the medical services plan, the MSP.

In general, there seemed to be a considerable amount of confusion about whether the provincial governments would actually provide this procedure and whether they would indeed pay for it.

One stakeholder group mentioned it wished to invoke the notwithstanding clause to maintain the previous provisions of the Criminal Code. This group found the terminology of what constituted a terminal illness to be a slippery slope and that unendurable pain could be mitigated with quality palliative care. As it realized that this was generally not a realistic approach with the existing government, it also mentioned that it was hoping for a robust protection for health care providers and facilities to act according to their conscience.

There were many other comments, but I have only 10 minutes for this speech, so I will state again that I have been pleased with the amount of interest we have received from engaged citizens and stakeholder groups on Bill C-14. I will be making my voting decision after giving the people of Richmond Centre the maximum period of time to send their feedback.

I would like to end my speech with a short story. Many members of my family are health professionals. Even among those who are young, many desire to grow up to be doctors or nurses. When I ask my young nieces and nephews why they want to be a doctor, I always receive the same simple answer, “I want to save lives.”

[Joël Lightbound, Liberal, Louis-Hébert, QC]

Mr. Speaker, rarely in this parliamentary life are we called upon to debate such an important subject, an issue that requires such seriousness, rigour, sensitivity, and compassion.

With that in mind, I want to begin by commending the professionalism of all my colleagues in the House, who, from the beginning of our study of Bill C-14, have set partisanship aside and have made this debate more of a discussion, rather than a debate per se.

The subject that we are being asked to deal with today is one that invariably raises sincere emotions and touches a nerve with all of us, not only here in Ottawa, but all across the country. Developing a framework for medical assistance in dying means striking a balance between implementing a right with such irrevocable consequences on the one hand, and protecting vulnerable people with regard to that right on the other hand.

What right are we talking about? It is the right of a competent adult, who freely consents and suffers from a grievous and irremediable illness causing intolerable suffering, to die at the time of their choosing and with the necessary assistance and medical support. This is a right guaranteed by section 7 of the Canadian Charter of Rights and Freedoms, which states that everyone has the right to life, liberty, and security of the person. This right was unanimously recognized by the Supreme Court of Canada on February 6, 2015, in the Carter case. This right protects life, because the absolute prohibition in section 14 and paragraph 241(b) of the Criminal Code on aiding or counselling another person to commit suicide made individuals suffering from grievous and irremediable illness feel that they were forced to take their own lives prematurely out of fear that the progression of their illness would make it impossible for them to do so and that their suffering would become intolerable.

The absolute nature of the blanket prohibition on medical assistance in dying deprived people of a portion of their life that they could otherwise have enjoyed. This right also protects the liberty and security of the person.

As the Supreme Court explained in paragraph 66 of its decision in Carter, by denying people the right to request a physician’s assistance in dying, the Criminal Code is interfering with “their ability to make decisions concerning their bodily integrity and medical care”. The Criminal Code thus trenches on liberty. Since that option was not available to Canadians, they had to endure intolerable suffering, which also impinged on their right to security of the person.

Although the Supreme Court recognized that medical assistance in dying is one of the rights guaranteed under section 7 of the charter, those rights are not absolute. Limitations and restrictions can be placed on those rights, according to the principle set out in Oakes, which is based on section 1 of the charter. The principles in question are those of minimal impairment and an important government objective.

Bill C-14 must be examined through that lens. Although people with grievous and irremediable medical conditions should be given the right and means to die with dignity, that is not an absolute right. We also need to protect vulnerable people, people who are unable to provide informed consent, and people who could be subject to undue pressure.

My position could evolve, as I continue to listen to my colleagues and constituents and as I continue to reflect on this topic.

However, I think that it is a good idea to exclude minors and people with mental illness from this bill. Like many members in the House, and like the Quebec National Assembly when their work was complete, I think that including minors would have created some virtually insurmountable problems with respect to consent, as my Conservative colleague from Louis-Saint-Laurent pointed out.

With respect to people with mental illness, I think that in the absence of full and informed consent, the sanctity of life must prevail. Since such consent is nearly impossible to obtain under the circumstances, it is prudent to exclude people with mental illness from the bill.

Conversely, I think that some aspects of the bill raise some questions. One aspect is the notion of a death that is reasonably foreseeable, which the government wants to introduce, even though this notion was not in the Carter decision.

The court recognized that not having access to medical assistance in dying could cause intolerable suffering and, therefore, impinges on the individual's right to security of the person.

I also think that individuals who are suffering from a grievous and irremediable medical condition but who are not at the end of their life, which unfortunately is the case for many people in Canada, are therefore being deprived of the right to security and integrity of the person.

I am afraid that with this addition, one of the appellants in Carter would not have had access to medical assistance in dying. I am not certain either that such a restriction minimally impairs a charter right, as seen in Oakes.

Second, although I am aware that there is a need for robust protections and that the bill includes many, which is a good thing most certainly, I have doubts about the protection provided by the provision in paragraph 241.2(3)(h), which stipulates that immediately before medical assistance in dying is provided, a patient must reiterate his or her free, informed, and full consent.

Doctors would have to stop administering medication, such as morphine, which eases the patient's pain, in order to obtain this full consent. I fear that this provision will create excessive suffering for individuals at a moment when they want to gently leave behind their overwhelming suffering.

Third, I was not convinced that advance consent was a good idea, but I was enlightened by my colleagues. Although I am still not convinced, I welcome the government's willingness to study the issue further.

Lastly, like many of my constituents, I think medical assistance in dying must be brought into the broader context of end-of-life care. To that end, I also welcome the promise to invest $3 billion over four years in home care.

I believe that, like the bill, this is a step in the right direction, but it is not the final destination. I will vote in favour of this bill at second reading, and I encourage my colleagues to do the same.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

Mr. Speaker, I am privileged to rise in this chamber in support of Bill C-14, medical assistance in dying.

I am in favour of the bill, not only because it was mandated by the Supreme Court of Canada, but for very personal reasons. I believe it is a bill, a policy, that respects the rights of individual Canadians who are suffering unbearable pain. It respects their right to die a peaceful death.

I rise today to speak in favour of this bill on medical assistance in dying, not because of the Supreme Court's decision to strike down the criminal law banning medical assistance in dying, but rather for very personal reasons.

To begin with, the bill refers to medically assisted dying. It is not referred to as medically assisted suicide. My common definition of suicide, and I believe it is society's definition, is intentionally taking one's own life when death is not imminent. In the case of Bill C-14, there are clear conditions that would qualify an individual for medical help in dying. This would include, of course, the reality that death is imminent for that individual.

Henceforth, I believe we should stop calling it suicide because it is clearly not suicide in the common form of our understanding. I also believe that there is no parallel with the very sad and tragic suicide epidemic that is occurring in indigenous communities across our great country. In my mind, one is an apple and one is an avocado. They should not be compared.

The whole debate around medically assisted death is deeply personal and has led to some very emotional discussions. For me, it has led to much personal reflection. Like many Canadians, like many people in these chambers, I have seen too many family members and friends suffer excruciating pain needlessly when death was imminent.

Very personal for me was an experience last August 2, the same day that the federal election was called, when my mother passed away. She was 96 years old and she had been living alone for the last 20 years. She had been living bedridden and in pain in a care home for the last five years.

My mother was a religious person and had a special relationship with her god. She prayed every day. She scolded me for not attending church as often as I should. Over the last 20 years her body deteriorated, but her mind and hearing stayed sharp. Over the last 10 years, my mother shared with me her desire to have her life end. Medical advances had helped her to live longer, but her quality of life had severely deteriorated. She had become completely bedridden in the last five years and, in the last four years, malignant masses and tumours had developed throughout her lower body. Constant pain set in, and pain protocol was established. My mother, tough as nails, continued to breathe, pray, and hope that God would come and take her away. The praying and hoping continued for years and years.

My mother was of sound mind. She was a religious person who was at peace with her god. Families, nuns, and a priest would visit her faithfully. They gave her comfort, but she continued to express to me that she wanted to die peacefully and comfortably. She wished that there was a way to end the unbearable physical pain that could no longer be managed regardless of the care she received. I wish she could have had that choice, and she should have had that choice.

My personal feeling is that the legislation does not go far enough. I would have preferred that those who are experiencing enduring and intolerable suffering, with no chance of ever improving during their lifetime, be allowed the opportunity to access medically assisted dying, under the strict conditions that we have imposed in the bill.

However, I also understand that the legislation shifts the paradigm in such a profound way that in the future we will be making reviews. The law will be improved, and evidence will be collected. I hope that myths will be dispelled, and individual human dignity, self-determination, and choice will be nurtured further.

This choice is the basis of our discussions today. We hope to offer this choice to individuals who, in their last moments on earth, are experiencing intolerable physical suffering as a result of a grievous and irremediable medical condition. The debate is not about suicide. It is about trying to ensure the dignity of the dying person. We make choices about the care we receive throughout our life, and it is unfortunate that this choice is taken away from us at the end of our life.

It is true that the Supreme Court's decision in Carter v. Canada made physician-assisted death legislation necessary. I believe many of us have spoken to the fact that the timelines are anything but ideal. Would I have preferred to have another six months of debate, consultation, and discussion in order to make this reality? Of course, I would have preferred that. I believe every member in these chambers would have preferred that.

However, it is also true that there are people who feel that this legislation does not go far enough. There are also people who are opposed to physician-assisted death entirely. I have had many discussions with constituents on this issue.

I represent Saint-Boniface—Saint Vital, a riding with many Catholic constituents, and they have all made their views very clear.

Everyone, regardless of their position in this debate, wants to ensure the protection and dignity of individuals. The notion of dignity, which has come up several times in these chambers, is highly individual. Personal history, personal beliefs, and personal health situations all define what dignity means to the individual, and I might also add the right to self-determine.

Dying with dignity is a personal choice that needs to be respected. This bill is necessary. As a society, we must make sure that the best care possible is available to all our fellow Canadians.

This is an important moment in our history, where consultation has not only played an important role in the past but will play an important role into the future. I applaud the government for undertaking vast consultations across Canada and abroad to ensure that this legislation defends people's choices and freedoms in a way that protects the most vulnerable. It also supports personal convictions of health care providers.

I further congratulate the government on taking the time to continue the very important consultations and discussion surrounding mature minors, people who suffer from mental illness, and people who would like to arrange advance directives.

I would like to add that I fully support the government's commitment to a full range of options for quality end-of-life care, including palliative care, an area in which the St. Boniface Hospital, in my riding, is a leader. This bill establishes responsible measures to promote a standard approach to medical assistance in dying across Canada. It recognizes the inherent value and the equality of every human life.

The proposed legislation sets the framework for medically assisted dying across the country. It also provides a review in five years. It is balanced, responsible, and a very compassionate response to a very difficult, very personal issue.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Madam Speaker, it is good to be here today to speak to Bill C-14. One of the principles we have in the House is that legislation is best built on a very solid foundation, and this bill does not have that.

What the Supreme Court ruled years ago on the Rodriguez case was very clear. However, just over a year ago, as with so many other decisions and so many other directions, the Supreme Court reversed itself. If it had really good underlying reasons for doing that, it would have been fine, but the justification for it was very interesting. It was a mistake in perception as set forward by the Supreme Court. The justices called it a changing matrix of social and legal facts which brought them to their conclusion. I and others are concerned that this makes our laws, including the interpretation of charter rights, dependent upon the opinions of a very small group of people. I will talk a bit more about the matrix of social and legal facts in a few minutes.

From my perspective, this is not an improvement. Many of my colleagues on both sides of the House have shared their concerns about Bill C-14, with some supporting it and others opposing it. However, a number of things are missing in the bill, and we need to have further discussion about. I heard a few comments earlier about the timeline, how pressured it was, how we needed to get this done and that this basically was prohibiting us from taking the time needed to discuss these things a bit further and with a bit more depth.

There is no clear definition of what irremediable means. The bill talks about that being the requirement for someone to qualify for physician-assisted dying.

I am concerned about the expansion of this process to nurse practitioners, so it would not just include physicians. People have asked why medical personnel are even involved with this. They have asked whether there is not some other place this can be done so people do not have to be concerned that when they go into the hospital for medical care, rather than receiving a positive side of medical care, they receive a very negative side of it.

There is a criminal exemption for those who perform euthanasia, but there is no protection for those who do not want to participate. A number of people are very concerned about what is called conscience rights and the lack of protection for that in the legislation.

There is a lack of clarity around psychological conditions and how that may come into play with this issue. One of the things that really concerns a lot of people is the lack of a vulnerability assessment, taking the time to find out if people are being pressured or whether there is some vulnerability that is bringing them to the point where they have made a decision that may be wrong for them.

Some people have called for a prior judicial review. There is no mention of that in the legislation.

Also, there is a lack of clarity on data collection. This has been an issue in a number of areas. Will we see good data collection? Will someone keep a good set of records on what goes on with this process?

We often have heard the concern that there is no clear commitment to palliative care. We just heard a member from the government talk about this. The Liberals made this commitment during the election campaign. They felt it was within their jurisdiction to promise $3 billion toward palliative care, but now, in the House, we hear them talk about how other jurisdictions are responsible for this. It sounds as if the Liberals are trying to avoid their responsibilities for this.

I would like to go back to the Supreme Court decision. It turned back the former position. It reversed it and it left us with an open field when it came to the issue of assisted suicide or assisted dying. The only thing the Supreme Court said in its ruling on Carter was that the person needed to consent and that the person needed to have a grievous and irremediable medical condition causing enduring and intolerable suffering. If we look at that, we see it leaves that whole area very open.

As I said earlier, good legislation should have a good foundation. I do not believe this does because of the Supreme Court decision. The foundation is the Carter decision and it hardly qualifies as a stable base on which to create good legislation.

I do not suppose we will get this done today, but we will come back at another stage on this bill. However. I would like to take a few minutes to talk a bit about the Supreme Court's recent decision in Carter v. Canada. It obviously is a very controversial decision and touches on a sensitive issue for many Canadians because there are very deeply held beliefs on both sides of this issue.

The Supreme Court acknowledged that the prohibition on assisted suicide was in general a valid exercise of federal criminal law. It also decided that the law went too far and it did not apply in cases where a competent adult with a grievous medical condition could consent to the termination of his or her life. I believe this decision is disturbing for a number of reasons.

The first is that the court ignored parliamentary consensus. In its decision, it claimed that the reversal from its earlier position in Rodriguez v. B.C. was necessary because of a different matrix of legislative and social facts. Yet, the purported differing matrix ignores the clear and unchanged parliamentary consensus opposing assisted suicide.

Between 1991 and 2012, nine private members' bills were introduced in the House of Commons, all seeking to amend the Criminal Code to decriminalize assisted suicide or euthanasia. Six were voted on and all of them failed to pass. When considering the matrix of legislative facts, the court gave weight to legislative developments in Belgium, Switzerland, Oregon, Washington, and the Netherlands, but it completely ignored the legislative record of Canada's Parliament.

Second, the court found no societal consensus in Canada on this issue. In her decision at the trial level of Carter v. Canada in the Supreme Court of B.C., Justice Smith wrote, “As to physician-assisted death, weighing all of the evidence, I do not find that there is a clear societal consensus either way”. Clearly whatever the change in that matrix of legal and social facts entails, it did not include a clear consensus from the people of Canada”.

This lack of consensus remains unchanged in the 22 years since the Rodriguez case in which the court stated, “No consensus can be found in favour of the decriminalization of assisted suicide. To the extent that there is a consensus, it is that human life must be respected”.

Clearly, the court found no consensus among western countries. While insisting again this matrix of legislative and social facts had changed since the last Supreme Court ruling on the issue, it acknowledged that physician-assisted dying remained a criminal offence in most western countries. Regardless, it chose to align itself with the minority of jurisdictions that allowed it.

I believe the court misinterpreted Parliament's objective in prohibiting assisted suicide. In its ruling, it put significant weight on the parliamentary objective of two sections, section 241(b) and 14 of the Criminal Code, which prohibit assisted suicide. The court asserted that these sections were put in place only to fulfill the state interest in protecting the vulnerable. However, in the earlier court case with Rodriguez, the court had said the objective of this section was not simply “protecting the vulnerable”, but also “preserving life”.

It had written, “In this case, it is not disputed that in general s.241(b) is valid and desirable legislation which fulfils the government's objectives of preserving life and protecting the vulnerable”. This position was reaffirmed several times.

By insisting that in Carter the purpose of section 241 was only to protect the vulnerable, the Supreme Court was able to conclude that this prohibition put people outside this class and that there were people who did not need to be protected by it. The court's conclusion was that the current law was over broad and grossly disproportionate to its objectives. That allowed it to say that Parliament needed to establish safeguards to ensure that those who truly wanted to be euthanized would be able to do that.

That interpretation tramples on the intention of Parliament to preserve life. Had it considered the full purpose of these sections of the Criminal Code rather than just that one objective of protecting the vulnerable, I think the outcome would have been very different.

I would make one final point before my time runs out. The court really leaves the definition of irremediable open to patient interpretation. The court decided that irremediable did not require the patient to undertake treatments that were not acceptable to them. In other words, although treatment may be available, the condition still qualifies as irremediable if the treatment is not acceptable to the patient.

I wanted to express my concerns. However, I think we will come back to some of the things the Supreme Court touched on as well in terms of the right to die being conflated with the right to life and some of the other issues.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I listened closely to all of my colleagues.

Yesterday, I participated in the committee's hearings. This is my first opportunity to speak in the House.

I have just 10 minutes, but I would like to start by saying that everyone here is caring. Everyone is concerned about the well-being of people who are at the end of their lives, and everyone wants the best for them. However, just because we want to care, that does not necessarily mean that we do what is best for people. We are not necessarily doing what is best for someone if we infringe on a person's autonomy and self-determination.

In the moral sense of the term, human dignity is connected to respect for self-determination. That should be the basis of our debate. Yesterday, in committee, I heard people say that we should consider a person's dignity in relation to their illness. They were talking about whether the person is wearing diapers, which is just frightening. Only that individual can make judgments about their own quality of life, and we cannot compare one life to another.

By way of introduction, since Bill C-14 is quite similar to part of the Quebec law, I would like to provide some context regarding the basis of that law. At the request of medical specialists and other civil society groups in Quebec, in the fall of 2009, the Quebec National Assembly created a deliberative space in order to give people the opportunity to express their views on an issue that could not be more personal: their own end of life.

From that moment on, the status quo was no longer an option for Quebec parliamentarians. Five years later, on June 5, 2014, the National Assembly passed Bill 52, The Act Respecting End-of-Life Care. One aspect of that act is medical assistance in dying.

This work was guided by two premises. First, my death, like my life, is my own. Second, the autonomy bestowed on a person by law through the principle of self-determination and its corollary rule of free and informed consent, which applies in biomedical contexts, is never questioned throughout that person's life, even in times of weakness or extreme emergency. Why then would things be any different at the end of a person's life?

Why would a person's right to self-determination be taken away because he or she is terminally ill? On what grounds would that be done? Is there any more personal and unique time in a person's life than the moment of death? What more could we wish than for a person to be able to calmly and peacefully pass on into death without any fear of suffering or any actual suffering? Is that not what we all hope for and what we would wish for any human being?

The consensus that was reached in Quebec was to make these premises part of a continuum of care, so that palliative care and euthanasia, two realities in the history of this issue, would no longer be set in opposition to each other. Why pit palliative care and euthanasia against each other? This question has been implicit in many of my Conservative colleague's speeches, because unlike in Quebec, we did not hold a debate on the right to die, which used to be associated with passive euthanasia.

People had to fight for the right to die. At the time, paternalistic doctors tended to focus on the curative aspect, and people were dying from the chemotherapy, not the cancer. Over the years, there has been a shift from passive euthanasia to palliative care. Human beings have thus acquired the right to die.

Palliative care is about taking a holistic approach to end-of-life care. This concept was developed by Cicely Saunders, in England, and dates back to 1967. Why should a request for assisted dying arising out of a positive experience of care near the end of one's life be considered a failure? The dying process has started and is irreversible.

A person might wake up one morning and decide that he or she is ready to give up. A person might also decide that that is not the case and that he or she wants to go on living, and die a slow death. The Quebec legislation in no way precludes one or the other, because it places end-of-life care in a continuum of care.

For more than 30 years, palliative care was considered the only way to die with dignity at the end of one's life. It became apparent that such care did not meet every need. Most requests for medical assistance in dying are made as part of the process of palliative care. Very rarely does a person who receives a terminal diagnosis from a doctor immediately request an injection. If so, it all depends on the stage of the cancer. The patient might be put on anti-depressants and told to get his or her affairs in order. There are things that a person needs to do before dying.

One of the difficulties with Bill C-14 is that it groups together two realities under medical assistance in dying. One is covered by Quebec, namely euthanasia and end-of-life care, which includes palliative care; the other is assisted suicide. This choice is causing the conceptual confusion that leads to the impasse in our debates.

Assisted suicide is not euthanasia. The difference is that a person can be at the terminal phase of a degenerative disease without being near death. A person can suffer tremendously without being in a situation of reasonably foreseeable natural death.

The Supreme Court has asked legislators to provide a framework for assisted suicide. This is what the Supreme Court told us in section 7:

Insofar as they prohibit physician-assisted dying for competent adults who seek such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering, ss. 241 (b) and 14 of the Criminal Code deprive these adults of their right to life, liberty and security of the person under s. 7 of the Charter. The right to life is engaged where the law or state action imposes death or an increased risk of death on a person, either directly or indirectly. Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

That is what we have been asked to do, and that is what we need to figure out.

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

I want to thank my colleagues on the other side for their interventions.

The reason I suggested at the last committee meeting that we bring the law clerk in—and I thank the analyst for his report to give us some background—is that I wanted to delve a bit more carefully, notwithstanding the finding by the Speaker of a prima facie case of a breach of members' privilege.

I'm not yet convinced that we in fact do have a breach of members' privilege. I've tried to look at The Globe and Mail article carefully, and I don't necessarily see evidence—at least in the article—that the reporter in question actually had a copy of the bill, which would be a breach of our privileges. Maybe someone did do something, and brief somebody out of turn in terms of the content of the bill, but it mostly talks about things that are not found in the bill as opposed to what was actually in the bill.

I go back, for example, to the reference in the paper by the analyst, looking at similar questions of privileges referred to committee, specifically about the example he cited from the member from Provencher from March of.... Sorry, I have the wrong one. I mean the Speaker's ruling of 2010 dealing with the member from Regina—Lumsden—Lake Centre about the premature disclosure of a private member's bill, where that had been disclosed on the member's website, which was then, of course, determined to be a breach of members' privileges.

I wanted to probe that a little bit more. Let's say I'm bringing in something under the Criminal Code dealing with the current private member's bill that's dealing with impaired driving. I say that I'm bringing in a private member's bill on the Criminal Code, but I'm not dealing with murder and I'm not dealing with consecutive sentencing. Would that be a breach of members' privileges when I don't disclose the actual contents of the bill that is before the House?

That's really my point here. In fact, was there actual significant...? Was the person actually reporting details of the substantive matters that were actually in Bill C-14 when it was introduced into the House on April 14?

[Julie Dzerowicz, Liberal, Davenport, ON]

Madam Speaker, I rise today to speak to Bill C-14, the medical assistance in dying bill.

To me, it is legislation that reflects where society is today. It is the right one for where the majority of Canadians are, and provides a strong foundation on which to build. It recognizes the inherent and equal value of every life, and honours the dignity and autonomy of an eligible person to choose medical assistance in dying under well-defined rules and conditions.

The introduction of this bill is big and represents a fundamental change in how we as Canadians view the right to life, liberty, and security of the person in Canada.

I confess that this is not an easy issue for me to talk about, but it is an important one to the residents of Davenport, the riding I am honoured and proud to represent. We as a society do not talk very much about death. It makes us nervous, and so this bill, which creates a framework to enable access to medical assistance in dying in Canada to those who are eligible, is a particularly sensitive topic.

I want to acknowledge that I have a large Catholic community in my riding, and many who believe that only God can decide when one dies, that death should be left in God's hands. On the other side, I have a number of groups within Davenport that think the proposed legislation does not go nearly far enough. Recognizing the blessed diversity of opinion, I invited community leaders to meet with me to discuss Bill C-14, to hear from them their specific concerns.

What I found was that I had to remind many of them that in February 2015 the Supreme Court of Canada unanimously, all nine members, voted to strike down the sections of the Criminal Code that made it illegal for anyone, including a doctor, to cause the death of another person who consents to die, or to assist a person to end his or her own life. I reminded them that the Supreme Court proclaimed that the prohibition on physician-assisted dying infringes on the right to life, liberty, and security of the person in a manner that is not in accordance with the principles of fundamental justice.

The Supreme Court gave the government a certain amount of time to introduce legislation. That date is currently June 6, which is why we are here today. Just as an aside, I was curious to see how many times the Supreme Court actually voted unanimously, and it has done so only 35 times since 1979.

There was no question that medical assistance in dying would become legal in Canada. What had to be determined is what kind of legislation we were going to introduce.

The Supreme Court's decision meant an important shift in our society's perception of personal autonomy. It signalled that a person's sense of dignity is intricately tied to how one perceives his or her quality of life. The decision to allow Canadians the choice of medical assistance in dying sheds light on the evolving role of our health care system and the role of patients in decision-making.

Canadians are looking to their doctors and nurses to provide health care, and to help them maintain their quality of life. However, when that 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.

In addition to the consultation, I have received many letters from residents in Davenport. There are those who believe there should be no legislation at all, others who think that the proposed bill is not strong enough in protecting the conscience rights of doctors or in protecting the most vulnerable, and a further group who worry that the legislation does not go far enough, that we as a government have been too narrow in our interpretation of the Supreme Court decision. I will address all these concerns in the next few minutes.

Let me first address those who do not believe there should be any legislation. What many may not understand is that if the Liberal government does not create a new law by June 6 of this year, it means medical assistance in dying is legal if it is conducted in a way that adheres to the considerations outlined by the Supreme Court in its Carter ruling. Canadians would then not have any national framework and no law, which in my opinion would lead to a wild west, where it would be up to any one person's interpretation of the Carter decision and a situation that I believe would be open to abuse.

In introducing Bill C-14, the Liberal government purposely created legislation which as narrowly as possible adhered to the Supreme Court decision. It is narrow because this bill is meant to be a first step. It is meant to ground the legislation properly.

The legislation would do three things. It would allow physicians, nurses, and those who help them provide assistance in dying to eligible patients without the risk of being charged. It would also provide safeguards to make sure that those who receive medical assistance in dying are eligible, can give informed consent, and voluntarily request it. Finally, it would lay the foundation for the Minister of Health to make regulations to establish a process for monitoring and reporting on the use of medical assistance in dying.

I will pause for a second to reiterate the first point, because as mentioned, many have written to me to express their concern that the legislation as drafted does not protect the conscience rights of doctors. I want to be clear that there is nothing in the legislation that compels any medical practitioner or authorized nurse practitioner to provide medical assistance in dying or to refer a patient to another medical practitioner. The legislation is meant to balance access to medical assistance in dying while respecting the personal convictions of health care providers.

The legislation is also clear on who is eligible. A person has to be mentally competent, 18 years of age or over, make a voluntary request, and give informed consent to receive medical assistance in dying. They have to have a serious and incurable illness, disease or disability, be in an advanced state of irreversible decline in capability, experiencing and enduring intolerable suffering as a result of their medical condition, and be on a course toward the end of life. Death would have to be reasonably foreseeable in all of the circumstances of the person's health.

Protective measures are also a key part of the legislation to ensure that patients eligible have given informed consent. Patients have to make a written request for medical assistance in dying and have it signed by two independent witnesses. Also, 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 or coercion.

Too many of my constituents have said to me, “My dad was in the hospital. We kind of felt forced that maybe we would want to sort of end things.” I said that this legislation does not help with that. The patient has to make a written request. It has to be signed by two independent witnesses, and there has to be two independent medical opinions.

In addition, the second criterion also helps to reassure the medical practitioner who would provide medical assistance in dying that he or she is acting within the scope of the law and consistent with reasonable medical knowledge and skill.

The other criteria for patients to be eligible are that there is a mandatory 15-day waiting period; the patient has the right to withdraw a request at any time; and consent must be confirmed immediately before medical assistance in dying is provided. It is a very thoughtful protocol with very strong safeguards.

As part of this legislation, the foundation is also laid for the Minister of Health to establish a process for monitoring and reporting on the use of medical assistance in dying. We need to know, and Canadians need to be satisfied, that the system is operating as planned to respect the autonomy for eligible individuals while protecting vulnerable people.

Public trust and transparency in the implementation of medical assistance in dying are essential. This monitoring and reporting system will also be able to signal any issues or unexpected consequences.

Monitoring would also ensure that high-quality comparable Canadian data are generated so that any future discussions about changes to the medical assistance in dying system could be made based on the best possible evidence. Indeed, there will be a review of the legislation in five years, which could bring about changes that reflect the data gathered in this period.

For those who believe that this legislation has not gone far enough, there is a commitment to independent studies into three key issues that the Supreme Court of Canada in Carter declined to address. The first was the eligibility for persons under the age of 18. The second is the advance request. The third is requests for medical assistance in dying solely on the basis of mental illness.

It is also important to mention that palliative care, ensuring that all Canadians live as well as possible until their death, is equally important to this government. Just yesterday the Minister of Health stood in this House to reaffirm our commitment to $3 billion over four years for home care.

The minister is working hard with her counterparts across Canada on the next version of our health care accord, and high-quality palliative care for all Canadians is a key part of their deliberations.

I also should mention that one of the great positive side effects of introducing this legislation is that we are having a wide discussion on a national level. We need to be discussing this issue fully and we need to be understanding it.

In closing, I want to quickly thank and commend the great work that was done by the Special Joint Committee on Medical Assistance in Dying under the great leadership of my colleague, the MP for Don Valley West. I also thank the Minister of Justice and the Minister of Health for their excellent work in introducing this legislation.

Bill C-14 is meant to be a legislative foundation on which we will build moving forward . It recognizes the inherent and equal value of every life, and it honours the dignity and the autonomy of an eligible person to choose medical assistance in dying under well-defined rules and conditions. It is the right legislation for Canadian society today, and I will be supporting this legislation.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Madam Speaker, I would like to first thank my colleague for his comments, which will make us carefully reflect on Bill C-14.

We should reflect on what is at the very heart of the debate on the Carter case and the Supreme Court decision. In one passage of the Supreme Court ruling in Carter, the justices state that the current Criminal Code provisions at the very core of the Carter case protect the vulnerable to such an extent that they constitute almost an absolute protection, which is prejudicial to some Canadians who are not vulnerable and would like to have access to medical assistance in dying.

I would like to hear what my colleague thinks of the Supreme Court's view as it relates to the current bill.

What are his thoughts on people who are not vulnerable as defined by the Supreme Court and how this is reflected in the bill?

[The Clerk of the Committee, Ms. Joann Garbig]

Thank you, Chair.

If the committee would like, we can begin with a short chronology of the events in the House that gave rise to the order of reference to the committee, go on to a brief explanation of the specific privilege in question, do a brief summary of two similar cases that came before the committee some years ago, and then perhaps give members a sense of options going forward.

When a public bill is going to be introduced in the House, it has to be put on notice. On April 12 notice was given for the introduction of Bill C-14, the assisted-dying legislation. That same day The Globe and Mail published an article containing specific elements about the bill, and referenced a source familiar with the legislation, a person who was not authorized to speak publicly about it.

The next night, April 13, The National on CBC TV had similar details about the bill, and the source again was not identified. On April 14 the bill was introduced in the House, given first reading, and became a public document at that point.

On that same day, April 14, the official opposition House leader rose on a question of privilege regarding the premature disclosure of the contents of Bill C-14. In his intervention, he stated that the details about the bill that had been disclosed in The Globe and Mail article went beyond journalistic speculation, and that they matched the contents of the bill.

Following his intervention, the chief government whip rose and stated that the government takes any breach of privilege very seriously, and that no person had been authorized to discuss the contents of the bill prior to its introduction. He gave an unreserved apology, and committed to ensuring that no further such incidents would occur in the future.

The Speaker ruled on the question of privilege on April 19, and decided that the question raised by the opposition House leader constituted a prima facie, or at first sight, breach of privilege.

As per the standard practice, the member who had raised the question of privilege was then invited to move a motion to send the matter to this committee for further study and consideration.

The House adopted the motion on April 19, and this then became the order of reference before the committee today.

[The Chair, Liberal, Larry Bagnell]

Good morning. This is meeting number 18 of the Standing Committee on Procedure and House Affairs for the first session of the 42nd Parliament. This meeting is being held in public.

Our business today is the order of reference from the House, of April 19, 2016, concerning premature disclosure of the contents of Bill C-14. At the last meeting, the committee decided to invite the law clerk and parliamentary counsel to appear. As it turns out, he's willing to appear, but he's not available this week.

The Library of Parliament and the clerk in the House of Commons procedural services agreed to do a report for us on the background and history, the types of things the law clerk would have provided. We can look at that and determine what, if any, further action we need on the privilege.

Members using their iPad will find the briefing note with the documents for today's meeting. There are a few paper copies for anyone who didn't bring it. The clerk and the analyst are prepared to speak to this briefing note and answer questions. During the second hour we'll do committee business, including any follow up from that. We can also confirm the items we have on the upcoming agenda.

Just before we start, everyone's seen this paper we're discussing. Does anyone have any objections to us giving this to Kady O'Malley? It seems like most of this stuff is public anyway. It's just historical.

Does anyone want to make friends or enemies with Kady O'Malley?

[Vance Badawey, Liberal, Niagara Centre, ON]

Madam Speaker, I am pleased to speak in support of Bill C-14, which would address medical assistance in dying.

The government has listened very carefully to Canadians and reflected upon the invaluable contributions of the special joint committee of members of the House of Commons, senators, the external panel, the provincial-territorial expert advisory group, and many others throughout our nation.

The bill appropriately recognizes the autonomy of Canadians to choose medical assistance in dying, while also protecting vulnerable persons and respecting the Carter decision of the Supreme Court of Canada.

My remarks will focus upon the eligibility criteria and procedural safeguards, which together represent the heart of the bill.

As the Minister of Justice has stated, the bill is aimed at addressing the issues raised by the Carter decision. The government has committed to collecting and analyzing evidence regarding how medical assistance in dying is working in practice and considering the findings of independent studies into additional issues that were not addressed in the Carter decision, which will be launched after the bill is passed.

Given the fundamental societal and medical issues that medical assistance in dying raises for our country, a cautious approach is in fact warranted. The stakes are just too high.

The bill contains five key eligibility criteria.

First, the bill would also require that the person requesting medical assistance in dying be at least 18 years of age and be capable of making decisions with respect to their health.

Several witnesses before the special joint committee, including the Canadian Paediatric Society, noted that medical assistance in dying raised unique considerations when it came to young people. Assessing a minor's capacity to decide to seek medical assistance in dying is difficult when the stakes are so high and the decision is irreversible.

Importantly, the committee also heard that there was in fact no Canadian pediatric data regarding requests for medical assistance in dying from young people or whether pediatricians would be willing to participate in this procedure. Prudence and common sense support further study of this very difficult issue.

With respect to capacity, this requirement means people must be able to confirm their choice at the time the medical assistance in dying is in fact provided. Therefore, the bill would not permit what are commonly called “advance requests”.

Permitting medical assistance in dying to be administered to a patient who is unable to express his or her wishes increases the risks of error and abuse. People who cannot express their wishes may want to continue living, even though they made a request at an earlier point in time.

Simply put, an advance request takes away the right of people to change their minds when they lose capacity.

The proposed approach also recognizes that physicians and health professionals frequently struggle with interpreting and applying other evidence directives in general. Advance requests for medical assistance in dying would be even more complicated to administer. Clearly, there is a need for further study and evidence concerning advance requests.

The bill also contains eligibility criteria that people make a voluntary request for medical assistance in dying and that they do so with the benefit of fully informed consent.

These requirements are common sense.

Medical assistance in dying must not be an alternative in situations where patients might prefer a different treatment, but are not aware of it or they do not know their diagnosis or its likely trajectory. Nor must it be the product of external pressure or the person's belief that he or she is a burden or unwanted.

Next, the bill would require that the person be suffering from a grievous and irremediable medical condition. This is defined term that has several characteristics, including the condition is serious and incurable; the person is in an advanced state of irreversible decline in capability; the condition is causing the person enduring suffering; and the person's natural death has become reasonably foreseeable in all of his or her medical circumstances, without requiring a specific prognosis.

The bill intends to permit medical assistance in dying as a choice for Canadians whose lives are on a path toward their end. As the Supreme Court suggested in various places in Carter, medical assistance in dying is similar in nature to forms of end-of-life care, such as palliative sedation, or the withdrawal of life-saving treatment. This definition is intended to allow for flexibility for physicians and nurse practitioners to consider all of the person's medical circumstance.

Bill C-14 is clear that no specific prognosis of time remaining is required. Moreover, a person could qualify based on the cumulative effect of multiple conditions or medical circumstances that individually may not be fatal, but when taken together make the person's death reasonably foreseeable. For example, people in medical circumstances similar to those experienced by Kay Carter, Gloria Taylor, Sue Rodriguez, as well the people who have obtained individual constitutional exemptions across Canada since the Supreme Court's ruling this past January, would all be eligible under this bill.

However, medical assistance in dying is not a solution to all forms of medical suffering. Such an approach would raise unacceptable risks, particularly for vulnerable people throughout our society. Take the example of someone who is exclusively suffering from a physical or mental disability, but who is otherwise in good health and whose natural death is still many years away. Making medical assistance in dying available to people in these circumstances risks reinforcing negative stereotypes of the lives lived by Canadians with disabilities, and could suggest that death is an acceptable alternative to any level of medical suffering or disability. This risks undermining our efforts to combat suicide, a pressing public health problem that affects not only those who die by suicide, but also their families, friends, and overall communities.

Next, to ensure that Canadians can have confidence that medical assistance in dying is administered appropriately, the bill also contains the procedural safeguards generally in line with those recommended by the special joint committee. These measures would ensure that requests for medical assistance in dying would be made in writing, witnessed by two independent persons, and that there would be a 15-day wait period to guard against people making a decision too quickly, which cannot be reversed. In respect of the waiting period, there would be flexibility for situations where a person's death or loss of capacity was imminent.

Most important, the eligibility of the person would have to be assessed and confirmed by two physicians or nurse practitioners who are independent of each other. The person would also have the right to change his or her mind about receiving medical assistance in dying, including just before the procedure would be administered. These safeguards will be effective at protecting Canadians but will not be so burdensome that they will impede access.

Finally, the bill would require that the person be eligible for health services funded by a government in Canada. This requirement exists to ensure that Canada does not become a destination for people from around the world who visit the country solely for this purpose by obtaining medical assistance in dying. However, recognizing that Canadians often move from one province to another or sometimes live abroad for significant periods, the bill includes an exception to this requirement to ensure these people would not be excluded solely because they are subject to a waiting period or residency requirement for public health care.

Medical assistance in dying is one of the most challenging and complex social and legal issues of our time, particularly given our society's aging population. However, the government has embraced this challenge and has listened carefully to the diverse perspectives of Canadians.

The bill before Parliament today was crafted with both compassion and clear thinking, and represents thoughtful and principled legislation. It promises the autonomy of Canadians to choose medical assistance in dying, protects vulnerable persons, and respects the Supreme Court's decision.

I call on members of the House to support this bill.

[Ahmed Hussen, Liberal, York South—Weston, ON]

In terms of your duty to protect medical professionals, do you feel that Bill C-14 provides adequate protection from criminal prosecution for medical practitioners who provide medical assistance in dying?

[Murray Rankin, NDP, Victoria, BC]

Dr. Stern, you were very helpful during our Senate/House deliberations. You were equally helpful today. I take your testimony very seriously because, of course, as you say, you're on the front lines. You're at the intersection of medicine and law, and you're the ones who decide whether a doctor is going to get coverage if they're sued for trying to implement this law in good faith.

We didn't have an opportunity to read your very careful submissions in advance. I want to make sure we do justice to them.

I want to pursue something that Mr. McKinnon and you were discussing, namely, the issue of Bill C-14 trying to provide clarity through the words “reasonably foreseeable”, which it seems most witnesses have told us has not occurred. You make a couple of suggestions depending on which way we want to turn, namely, to add the words, “whether or not death is imminent” or otherwise.

In the testimony and legal commentary, many of us have been hearing about the implications of the Carter decision, the Supreme Court case, and that it was deliberately not to be left to terminal patients, not to be limited to people at the end of life. The justices were deliberate in their choice of the words, “grievously and irremediably ill patient”. There was no suggestion of terminality.

The euphemism that their natural death has become “reasonably foreseeable”, it will be argued, is inconsistent with what the Supreme Court said. If that's accurate, then your choice about adding the phrase “whether or not death is imminent” is a non-starter. With respect, I would say that the alternative that you're suggesting for this provision, that “natural death has become reasonably foreseeable and is expected to be imminent”, is equally ambiguous.

I'm not quite sure where to land on this. Other witnesses, such as Mr. Ménard from Quebec, said yesterday that we should just eliminate this section, because it adds nothing. We've heard today that it's neither legal nor medical.

I'm wondering why your recommendation didn't simply say to get rid of that ambiguity, we should delete that phrase.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I am thankful to be able to add my voice to the discussion on Bill C-14, medical assistance in dying.

The Supreme Court of Canada has put what I perceive as an inappropriate timeline on this House in regard to this legislation, because it has come to the conclusion that the Criminal Code of Canada is unconstitutional in making it illegal for anyone to cause the death of another person who consents to die or to assist a person to end their own life.

In speaking with a very concerned constituent last week who was in law school when the charter was enacted, the comment was made that the university law professors of the day assured a troubled graduating class that what is actually happening today would never happen.

We are now in a place where, in attempting to guarantee every person their charter rights and freedoms, we are endangering the rights and freedoms of others. A synergy of wisdom and selflessness is needed in balancing what is perceived as best for me in relation to what is best for others. Just because we can, does not mean we should.

As well, in determining if we should, it seems to me the wise approach would be to look at those who already did, and regret. This would require learning from recent history rather than pretending that what we are doing is somehow progressive, when it has already been proven to be a regressive decision elsewhere.

The Supreme Court has chosen to ignore its own previous decision on the issue, along with six different parliaments that have previously rejected assisted suicide. It appears that the plumb line is not what is best for society and humanity as a whole, but rather what is the latest progressive trend that is putting the strongest pressure on how we live and relate as a society.

I have been a pastor's wife, and a caregiver in hospitals and level 4 care homes. I have worked in a mental illness hospital. I have been an education aid for special needs children in kindergarten and high school students.

I am the daughter of a father with Alzheimer's, the grandmother of a high-achieving grandson with autism, and I have a loved one who is suffering with mental illness. I, too, am well aware of life's challenges. My personal belief is that life is sacred from conception to natural death, and the protection of the most vulnerable in our society must always be the determining factor in how we choose to govern and make laws in Canada.

This is the expression as well that has been sent to me over and over again from constituents in my riding and across Canada, and today we need to have a debate in this House that is very balanced and presenting all views from all people in Canada.

Life is challenging, and dying, far more often than not, is difficult for the one passing away and in some ways even more so for those experiencing end of life alongside the individual who is dying. I believe there is value in that as well.

The misfortunate reality of Bill C-14 is that it will cause far greater grief than it will appease. Making something legal does not make it morally right. People who request a physician-assisted death can be motivated by a range of factors unrelated to their medical condition. These factors can make some people vulnerable to request assisted death when what they want and deserve is better treatment and palliative care.

It needs to be pointed out that the Belgian euthanasia law does not apply to non-competent patients and it does not allow the deliberate shortening of their lives. The Belgium euthanasia law system, which Bill C-14 mirrors, has been proven to be abused and insufficient to monitor the decision-making process.

For example, the Journal of Medical Ethics published a research article written by Raphael Cohen-Almagor, a human rights activist and chair of the politics department at the University of Hull. His article “First do no harm: intentionally shortening lives of patients without their explicit request in Belgium” focuses mainly on published data concerning the practice of causing death without patient request in Belgium.

The research indicates that the practice remains common, resulting in over 1,000 hastened deaths without request each year, or 32% of the cases of euthanasia. Moreover, in almost half of those cases the doctors refused to report the matter to the overseeing body, despite a legal requirement to do so.

This example clearly shows the legislation is lacking an oversight by an independent third party before the patient is put to death. Sadly, but realistically, the safeguards in Bill C-14 are likely to be insufficient and ineffective in real life conditions.

Furthermore, Bill C-14 applies to those with physical or psychological illnesses who are experiencing enduring and intolerable suffering as a result of their medical condition. Our focus must first be on raising the quality and availability of high-quality palliative care as the humane way to relieve pain, loneliness, and fear for the end-of-life patient and to provide encouragement, direction, and support for loved ones through the natural process of end of life. Bill C-14 does not require a palliative care route be entered upon first, neither does it require the patient to have tried other treatments before requesting medical assistance to die.

As well, I am still deeply concerned for our medical professionals who have contacted me in great numbers who could face severe consequences if they do not assist an individual to take their own life, for whatever reason. No one in our country should be forced to affirm or provide a service that goes against their conscience. The federal government's law leaves this crucial issue for the provinces to deal with, allowing even more interpretations of the general wording.

There should be a structured national system to address the cases when a publicly funded health care organization or separate doctors are unwilling for any reason to provide aid in dying when the patient has requested it.

Furthermore, the bill extends the amendments to the Criminal Code for medical practitioners, nurses, and registered practical nurses. Such an approach is broader than any other jurisdiction in the world and makes it impossible to create a transparent national system.

It is necessary to take into consideration the psychological factors that Bill C-14 would actually influence and encourage. The secularism of our courts affirms a premise that everything is socially constructed, and as a result laws greatly shape the ethos of culture, affecting cultural attitudes toward certain behaviours and influencing moral norms. Medical assisted dying laws send a message that in certain conditions suicide is a reasonable and appropriate way out. The problem is that this message will be received not only by those who have painful, terminal illnesses, but also by those who are tempted to think they can no longer go on.

A study by David Jones and David Paton proved that legalizing assisted dying in other states has led to a rise in overall suicide rates, both assisted and unassisted. This greatly undermines the work of suicide prevention organizations and programs.

As the Conservative deputy critic for veterans affairs and a member of the veterans affairs committee, I believe legalizing assisted suicide would only increase the challenges of providing mental health care and suicide prevention initiatives for those suffering from post-traumatic stress injuries.

I agree with my Liberal colleague from Winnipeg Centre who spoke last evening that the government should at the very least postpone legalizing assisted death for at least five to 10 years, until it is absolutely clear what sort of impact it would have in all corners of Canada. His concern is well founded in regard to fighting the suicide spirit that needs to be healed on our reserves in Canada.

Another report in Current Oncology from 2011 summarized that euthanasia in the Netherlands has changed significantly in the 30 years since it was first adopted. It has shifted from medically assisted dying for people who are terminally ill to those who are chronically ill, from physical illness to those who suffer from mental illness, and then to those who suffer the psychological distress of mental suffering, and now to euthanasia of those over 70 who are simply tired of living.

The culture now is that euthanasia becomes expected while palliative care and functional hospice is gradually portrayed and felt to be “selfish”. That is a quote from the UK Daily Mail on September 24, 2013.

This implicates that the bill would not only affect those making a rational and deliberate choice to end their lives, but would also have a significantly wider impact on those who are required to provide such a service or their privilege and right to work in the medical field could be challenged, and also on wider social groups as a whole.

When facing a choice, which we are with the bill, where should the priority for us as legislators be? The imposition by the Supreme Court of Canada to invoke such controversial legislation, which is proven to be failing in other countries; the approach of the committee to manage witnesses and to make recommendations that go far beyond the Carter decision; and the need to first of all institute high-quality palliative care as an intrinsic value and an actual clear priority of the government are all valid reasons that I feel I cannot support Bill C-14.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, we have had many comments in the House that the government has not gone far enough with Bill C-14 in being prescriptive about how it would be applied to the different types of medical institutes that are provincially regulated. They are similar to comments about how we would apply climate change legislation provincially, when provincial governments have already started the work on this.

In light of what Quebec has done already in terms of applying this, could we have a comment on the role between the federal and provincial governments in applying this legislation?

The House resumed from May 2 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 second time and referred to a committee.

[Juliet Guichon, Assistant Professor, University of Calgary Cumming School of Medicine, As an Individual]

Thank you very much for your invitation to address a section of Bill C-14. We are both from the University of Calgary medical school. Whereas I am trained in law with a doctoral degree and called to the bar of Ontario, my colleague Ian Mitchell is, as you have heard, a pediatrician who is a specialist in pediatric respirology and in ethics.

Proposed subsection 241.31(3) concerns regulations about creating, collecting, using, publishing, storing, and disposing of information about requests for and provision of medical assistance in dying generally. We respectfully make two recommendations concerning this subsection, but before we do that we respectfully recommend that this subsection of the Criminal Code should be based on the following two principles. First, all deaths that occur in Canada must be recorded accurately, and second, medical assistance in dying must be monitored scrupulously.

The proper implementation of these principles would foster protection, prevention, health promotion, health planning, and in rare cases, prosecution. Because the field of death reporting and death monitoring is not well known, we presume very briefly to describe it.

First is accurate reporting of death. Vital statistics are valuable only if the reports are accurate. An accurate report of how a person died is required to be contained in the medical certificate of death in common-law Canada, and in the bulletin de décès in Quebec.

Stating how someone dies entails identifying and stating truthfully the cause and the manner or circumstances of death. These two terms are terms of art, which are best understood by experts. It is not unusual for physicians without forensic training to have difficulty distinguishing between cause of death and manner of death, or to have difficulty naming the immediate antecedent and underlying cause of death. Consequently, in many provinces, medical certificates of death, which were originally completed by physicians, even in natural deaths, are routinely reviewed and corrected by forensic pathologists, medical examiners, or coroners, who have sub-specialty training in accurate death reporting.

Coroners exist in all provinces and territories except four. Those four are Alberta, Manitoba, Nova Scotia, and Newfoundland and Labrador. These four provinces have adopted the medical examiner system of death reporting. For our purposes, however, coroners and medical examiners perform the same functions. Sometimes, only these experts are permitted to establish cause and manner of death, and to complete the medical certificate of death.

For example, in Alberta, Manitoba, Prince Edward Island, and Nova Scotia, when a death occurs within 10 days of surgery, only the medical examiner or coroner may complete the medical certificate of death. Such requirements ensure that death is reported accurately.

Dr. Mitchell will discuss scrupulous monitoring.

[Dr. Hartley Stern, Executive Director and Chief Executive Officer, Canadian Medical Protective Association]

Hello, everyone. I am Dr. Hartley Stern and I am the executive director and chief executive officer of the Canadian Medical Protective Association.

Honourable members, thank you for giving me the opportunity to take part in this consultation process.

In providing medical legal advice and evidence-based education, the Canadian Medical Protective Association, the CMPA, sits at the intersection of the Canadian health care and legal systems. As such, we are already and will continue to be on the front lines in guiding physicians called upon by patients in individual cases for direction on medical assistance in dying, or MAID.

It is through this lens that we propose recommendations for amendments to Bill C-14 to ensure the legislation provides clear eligibility criteria and safeguards for patients, while ensuring health care professionals are not exposed to criminal sanctions for good faith participation in MAID.

The CMPA is generally supportive of Bill C-14. Given the complexity of the issue, we believe the bill strikes a reasonable balance between access and safeguards and leaves room for adaptation and change over time as we in Canada continue to gain experience with MAID.

As I said before the joint parliamentary committee, it is very important to focus operationally on the issues of eligibility, criteria, and safeguards. These are challenging issues. The Criminal Code amendments are crucial to confirming that physicians providing a patient with medical aid in dying are not in violation of the general prohibition on assisted suicide. This is a fundamental requirement to permit physicians to enter into that trusting and empathetic relationship with the patient that is so essential to the implementation of this policy.

We are pleased that the preamble of the legislation recognizes the need to adopt a consistent approach across Canada to medical assistance in dying, while recognizing the provinces' jurisdictions over various related matters, including the delivery of health care services, the regulation of health care professionals, and the role of medical examiners and coroners.

We do believe that the proposed legislation can be improved and submit the following recommendations to enhance operational clarity. I will touch on a few key points and encourage you to refer to our written submission for more substantive remarks.

On clarity, eligibility criteria, and safeguard requirements, the CMPA is pleased that Bill C-14 has provided clarity regarding the age requirement and the issue of advance requests for MAID. We believe, however, that Bill C-14 should state unequivocally whether or not a patient must be at the end of his or her life to be eligible to receive MAID. Uncertainty exists currently about the intended meaning of the requirement that

their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

If it is intended that the patient does not need to be at the end of life, then the committee should consider amending the paragraph to state that natural death has become reasonably foreseeable whether or not death is imminent. Conversely, if it is intended that patients need to be at the end of life, then the provision should specify that natural death has become reasonably foreseeable and is expected to be imminent. Patients and their physicians must be provided with a clear understanding of who is eligible and when.

Turning to the provision requiring compliance with provincial laws and standards, we agree that MAID must be provided in accordance with any applicable provincial laws, rules, or standards, as contemplated in proposed subsection 241.2(7). However, we believe that this proposed subsection should be deleted from Bill C-14, since it does not belong in criminal legislation. Health care professionals have to deliver care to patients in accordance with professional standards regardless of such a provision. Those health care providers that are negligent in the delivery of care may face regulatory or civil proceedings, but should not face criminal sanctions for breaching the standard of care or for failing to follow a policy created by the regulatory authority.

Furthermore, as currently worded, the good faith provisions in proposed subsections 227(1) and 241(6) are not available to health care professionals who may fall below the standard of care. Ensuring that well-intended health care professionals are not subject to criminal sanctions for breaching the standard of care is important to ensure access for patients by encouraging the participation of practitioners in MAID.

Turning in respect to protection for counselling a person to die by suicide, we believe that Bill C-14 should be amended to expressly state that no practitioner is guilty of a criminal offence for counselling a person to die by suicide under paragraph 241(1)(a) when a practitioner provides a patient with information about MAID in the course of considering possible medical options.

It is important that practitioners not fear criminal prosecution for raising MAID with their patients, where medically appropriate. Without such a provision, health care professionals may be reluctant to even discuss MAID with their patients.

Regarding the good faith protections, the bill provides for some degree of protection for good faith compliance but only does so with regard to criminal sanctions. The CMPA believes that the protection in proposed subsection 241.(6) should be extended to include civil and disciplinary proceedings for practitioners acting in good faith. Such protection exists legislatively elsewhere.

Reassuring practitioners acting in good faith that they are protected from criminal sanction, civil liability, and regulatory sanction is an important provision that will again help ensure access for patients.

On the issue of disproportionate sanctions, we believe that some of the sanctions provided in Bill C-14 are disproportionate to the relatively minor nature of the offences. Imprisonment for up to five years for failing to inform a pharmacist that the substance prescribed is intended for MAID, and imprisonment for up to two years for failing to comply with reporting obligations, is excessive and unnecessary. It seems to us that a maximum penalty consisting of a fine would be a sufficient deterrent in those circumstances.

On a final note, the CMPA recommends that the brief reference to right of conscience in the preamble of the legislation be expanded, given the importance to practitioners that their personal convictions are to be respected in this area. Consideration might be given to including in the preamble to Bill C-14 language to the effect that nothing in the act compels health care providers to provide MAID.

In conclusion, honourable members of Parliament, it is undeniable that this bill bears great importance to Canadians. We support your efforts in working to ensure that this most complex social issue is dealt with in a manner that respects the importance of the relationship between the patient and health care professionals, and the necessity to ensure that both are protected along this journey.

On behalf of the CMPA, I would like to thank the committee for inviting me to speak. We will be very pleased to provide any further information or data you may need.

Thank you very much.

[Prof. Theo Boer]

Ladies and gentlemen, I would like to thank the committee for inviting me today. I will make some remarks, but then I'll also go over to the bill itself.

In 2001 the Dutch Parliament adopted a law that is largely similar to Bill C-14.

For 10 years I was a member of a euthanasia review committee, a committee that decides after the fact whether a case of assisted dying was in accordance with the law. In those years I personally reviewed 4,000 euthanasia cases.

A 2012 government study, based on data collected as early as 2010, concluded that the Dutch law was solid. Until this day, the study is quoted to attest to the robustness of the law.

Admittedly, the Dutch euthanasia law does provide relief to many very ill patients. It provides doctors the necessary legal protection, and in doing so, it also provides transparency.

However, since 2010 the landscape has changed. Last week the euthanasia review committees presented their annual report, which I can show you here. It was presented just a week ago. It says that the numbers have gone up considerably, meaning that since 2010 the numbers went up from 3,000 to 5,500. Today one in 25 patients dies as a result of euthanasia, and we have seen a significant expansion in the pathology behind the euthanasia requests. The number of patients, for example, with dementia went up from 25 to 110 in five years. The number of psychiatric patients went up from two to 56 last year. Likewise, the numbers for euthanasia for people suffering from age-related diseases went up from a handful to 200. Contrary to what one might expect, the suicide numbers also went up, by 36% in the same period.

Before the end of this week, a person who is very dear to me will die through euthanasia. He is a man in his thirties suffering from the consequences of a sex-change operation, which he now sees as a crucial mistake. We have corresponded extensively, and I begged him not to make another decision that is irrevocable. However, the possibility of euthanasia has made him unwilling to seriously consider any other solution. In the words of your own bill, under proposed paragraph 241.2(2)(c), he says that this treatment is no longer acceptable to him.

In today's Canada, my friend would still be alive. My friend did not need pressure from outside, because what sufficed was loneliness, despair, self-contempt, and the societal climate in which euthanasia features as a remedy to serious suffering. I honestly think that the law has contributed to this climate. That's why I think Bill C-14 may need some adjustments. I do not doubt that Bill C-14 has good, noble, and important medical intentions, but I question the effectiveness of its criteria, which in its preamble, are referred to as “robust”.

In the Netherlands, we use exactly the same wording about our own criteria. Fifteen years later, however, I can tell you that even the most robust criteria may become like wax. Once new categories of patients start exploring the limits of the law, the criterion of intolerable suffering, for example, has become largely identical to what a patient wishes. After all, when a person insists on having euthanasia, who are we to question the intolerability of his suffering? Or when a person refuses palliative care, who are we to insist there are still ways that his suffering can be eased in a less radical way?

The developments in the Netherlands are even more remarkable given the increase in the quality of palliative care since the 1990s, the so-called pioneering years of the euthanasia law.

In an article in a journal of the Royal Dutch Medical Association, two ethicists and a doctor suggest 10 rules for patients who want to have euthanasia; for example, be verbally gifted but be humble; do not make a depressed impression on your doctor; if you still enjoy your hobbies, don't mention them; stress the seriousness of your physical suffering; etc.

According to an RDMA survey published last year, 70% of physicians in the Netherlands experienced pressure to perform euthanasia, and 64% are of the opinion that the pressure has increased.

Ladies and gentlemen, the decision you are about to take belongs to the most far reaching that Parliament can ever make. The outcome will influence the way that Canadians will die 30 years or 40 years from now. On a more fundamental level, it will impact the way people define suffering and cope with it. Please, therefore, allow me three remarks.

One, Bill C-14 exempts euthanasia from the Criminal Code. In normal life, any person has the right to do anything that is not unlawful. Consequently, doctors will have the right to perform euthanasia under the given conditions. This right to kill is among the most peculiar elements of the bill. To kill means that an intentional, direct, and irreversible act removes a person from the community of the living. Even on request, such a decision should always remain the exception. The society that legalizes euthanasia is bound to have an ambiguous relationship with the same society's resolve to prevent suicide. I do not think that the exemption from the Criminal Code is the right signal. I would suggest the Dutch system, in which physicians are punishable—hard as that may be—until they have provided proof that they have acted in accordance with the exceptions described in the law, in that order.

Two, given the intrinsically problematic, ethical character of killing, I think it is desirable that Bill C-14 contains unambiguous conscience protection for health care professionals.

Finally, I am probably not the only one who is puzzled by the fact that the requirement that a natural death should be reasonably foreseeable contains no specification. In hindsight wisdom, I think the biggest mistake of the Dutch is their failure to include a requirement of life expectation. This has made possible—and I have done research on this—that the average time between a euthanasia and the natural death that was expected has expanded from days or weeks to months, and in certain cases even years or decades.

Of course, any term has an element of randomness. However, not being specific about the term has even bigger disadvantages, because it gives away the only element that is left in the law that has an objective character. I would strongly suggest, even aware of the [Inaudible--Editor] advantages of it, to include a clear and unnegotiable term, such as a three-month or six-month requirement; and to initiate consultations, always, to alleviate the suffering; and to see to the needs of the people who have a longer life expectancy. Had the Dutch done so, we would not have seen much of the slippery slope that we find ourselves on now.

Thank you very much.

[Sally Guy, Social Worker and Policy Analyst, Canadian Association of Social Workers]

Thank you and good morning.

On behalf of the board of the Canadian Association of Social Workers and our provincial and territorial partner organizations, I'd like to thank this committee for choosing to hear the perspective of social work on Bill C-14.

Our organization was founded in 1926. We're the national association voice for the social work profession. We have a dual mandate to promote the profession as well as to advance issues of social justice.

I will get right to the point on Bill C-14. Although social workers will not be administering or providing a substance to cause death, it's reasonable that they would be involved in the lead-up or the consultative process leading to the decision to undergo medical assistance in dying. Social workers may also be among the care providers to whom a client would bring their end of life concerns, and may actually be the first point of contact in this regard.

As key members of interdisciplinary teams, and quite often as the only health, mental health, or helping professional in certain rural, remote, or northern contexts, social workers must be able to provide therapeutic counselling services; support to clients, their families, and even their networks; and referrals to service on the subject of medical assistance in dying. They must be able to do all of that without fear of criminal consequence.

It is very important that clients who are considering medical assistance in dying are able to bring these end of life concerns to their preferred care provider. It's equally important that care providers who are entering into these end of life discussions, or even consultations, can do so without worrying that they are going to be party to an offence.

To this end, CASW is concerned about the lack of clarity around the exemption for persons aiding a practitioner and persons aiding a patient under paragraph 241(b) of the Criminal Code, specifically as this might apply to social workers. Furthermore, Bill C-14 focuses very much on the provision—the actual act of providing or administering the substance to cause death in medical assistance in dying—with little emphasis on the process beforehand, that consultative process, the lead-up.

We're seeking further clarity on paragraph 241(a), specifically as to whether social workers who will be participating in client care leading to a decision to undergo medical assistance in dying could potentially be seen as counselling or abetting a person to die by suicide. Of course we want to avoid that.

To address this, we would recommend that C-14 be amended to clarify the meaning of “counsel”. Mental health providers like social workers provide therapeutic counselling services and engage in therapeutic conversations with their clients all the time. In this sense, “counsel” has a very different meaning from the one that's intended by paragraph 241(a). We think that this could be easily addressed by simply revising the word “counsel” in 241(a) to “persuades or encourages”, so it would read, “persuades or encourages a person to die by suicide”.

On top of that, we would also recommend creating or amending some language to provide an exemption for social workers who would be engaging with clients on the subject of medical assistance in dying, whereas “engage” could be defined as the provision of therapeutic counselling, the referral to information, supports to clients, their families, and even their broader networks, and of course, referrals to service.

This would just ensure that no social worker who engages with a person or a client on the topic of MAID, or medical assistance in dying, whether preceding or following that person's decision to undergo it, would be party to an offence under paragraphs 241(a) and (b), and equally that no social worker who aids a practitioner or patient by engaging with the person on the topic of MAID would be party to an offence.

I hope I kept that brief.

With that being said, I want to thank you again for hearing from social workers and I look forward to any questions that you might have.

[Dr. Georges L'Espérance]

Finally, I have one more thought on assisted suicide.

The Association is concerned about section 241.1b) of BillC-14, which in our opinion opens the door to a type of assisted suicide. In our view, it must be very clear that medical assistance in dying is and must remain a strictly medical act, administered by a physician, nurse clinician or pharmacist, according to the legislative provisions of each province.

There are four reasons for this.

First, current medical science makes it possible for persons with serious and grave medical conditions to live very comfortably for a period of time. It is incumbent on medicine to help patients until the end and to respect their independence and dignity when they can endure no more, either physically and psychologically.

Second, the immediate and compassionate presence of a physician or nurse clinician is necessary to address any problem that might arise during the administration of medical assistance in dying.

Third, a very strict framework must be established as regards professional, ethical and moral conduct and responsibility.

Fourth, any confusion must be prevented between medical assistance in dying and an unexpected suicide, which is always a terrible tragedy.

We understand the objective of not making it a crime for someone to help another person choose assisted suicide, whether in Switzerland or elsewhere. Yet the possibility of obtaining medical assistance in dying in Canada should eliminate this alternative, and fairly, regardless of the physical, financial or psychosocial capacities of the person with the terminal condition.

Thank you for your attention.

[The Chair, Liberal, Anthony Housefather]

I hereby convene the meeting.

Thank you for coming to this meeting of the Standing Committee on Justice and Human Rights. It's a great pleasure to have everyone here as we continue our discussions of Bill C-14.

We have four witnesses today, Dr. Georges L'Espérance, President of the Quebec Association for the Right to Die with Dignity, who is accompanied by Dr. Nacia Faure.

We also have with us Sally Guy, who is with the Canadian Association of Social Workers. Thank you very much for being here.

As an individual, we have with us Dr. Theo Boer, who is a professor of ethics and has experience with this in Holland. Welcome, Dr. Boer.

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

Mr. Speaker, I am probably one of the last to speak today, since it is almost midnight.

Since this is my first long speech, I would like to take this opportunity to thank the 105,000 voters I represent. Not all 105,000 of my constituents voted for me, but more than 44% of the people of Portneuf—Jacques-Cartier did. I thank them.

Members win election campaigns, but we never do so alone. It is a family affair. Family is important to me. I would like to take this opportunity to thank my wife, Isabelle, who happens to be here this week. She is not in the gallery because it is late, but I appreciate her being here in Ottawa. I also want to thank my children, who are currently asleep. Charles-Antoine and Ann-Frédérique participated in my election campaign and sacrificed quality time with their father during the campaign. I want to thank them.

Last year, 2015, was a very difficult year for me. Talking about it is very emotional for me. There was an election. The 338 MPs here campaigned, but unfortunately, as fate would have it, my father passed away right in the middle of the campaign, on August 19. Unfortunately, he will never see me here in the House. He would probably have been very proud. My mother died in May. Both of my parents died in the same year, in 2015. I had two loyal volunteers up there watching over me. Sadly, my mother died of cancer like so many Canadians. We all have our story. I am sharing mine today. My father and mother died in 2015, but the year ended on a high note because I was elected.

My mother was diagnosed with cancer two years before she died. That is why I am taking part in this evening's debate, because I supported my mother through her illness. She passed away on May 1, 2015. She lived through that agony, and I would call it agony, but she was serene. She had some good times in those two years. She enjoyed the gatherings we had during those last two years. I saw her smile. I saw her stay positive. I saw her become a fighter. Unfortunately, on May 1, at 6:50 p.m., I had the unfortunate experience of finding her in her hospital bed after she had died. She had just begun palliative care. Unfortunately, it happened just a few minutes before I entered the room. That is why this debate is so important to me. I supported her. She did not really have the opportunity to improve her condition, which deteriorated really quickly.

The principle behind Bill C-14 is to allow Canadians to die with dignity. What is the definition of “dignity”? Dignity can be described as the respect, consideration, or regard that someone or something deserves. Human dignity is the principle whereby no person should ever be treated as an object or as a means, but rather as an intrinsic entity.

Out of respect, I can say that my mother was treated with dignity. She was treated with respect throughout her agony. She was respected until the very end. The law did not exist. Is this law really necessary? The Supreme Court requires us to make a decision, pass a law, accept a law and enact it. However, what worries me about this law are the parameters. It is important to understand that we must allow people to have access to medical assistance in dying.

However, human nature being what it is, it is difficult to take rights away from people after implementing a law that is too broad in scope. I therefore invite parliamentarians and the committee that will be examining the bill to be thorough and restrictive.

Let us begin by talking about the definition of “reasonably foreseeable”. I would like to inform the House that according to my life expectancy, I will die in 2044 at the age of 79. That is reasonable and foreseeable. That means we have a problem. This term is not defined clearly enough. It is not specific enough. The definition is too broad.

The Supreme Court of Canada gave us the mandate to determine the criteria for defining grievous and irremediable medical conditions. Why are we afraid of using science to define these criteria? Science can determine whether someone is at the end of his or her life. We are afraid to use words like “terminal”. A word like that does not really leave room for interpretation. If science tells a person that his or her condition is terminal, then it means that it is terminal and that that person should expect to die in the near future.

I would encourage the people who will be assessing the legislation to be very specific. We need to restrict access to this procedure. In my opinion, the first criterion should be that access is limited to people who are, unfortunately, terminally ill. I want to emphasize that safeguards should be put in place to restrict access to medical assistance in dying. We need to set very strict and restrictive parameters.

Doctors are there to save lives. They need to abide by the Hippocratic oath. Nurse practitioners are also being added to the mix. When they went to school, they did not expect to have to take any action that would result in death. We are talking about professionals who want to treat people to help improve their health. Why are we asking them to do the opposite? Are we going to ask other groups who work in hospitals to engage in this type of intervention? The nursing associations that I consulted were very surprised to be given this new responsibility and be part of this debate.

Some argue that there are regions that do not have access to doctors. If there are no nurse practitioners, who are we going to ask? The bill provides for a 15-day waiting period. To my knowledge, in this very beautiful country of Canada, the second-largest in the world, we are never 15 days away from treatment by doctors. We must not hand over the responsibility of carrying this out to a professional body other than the medical profession.

Do my colleagues know that a person other than nurse practitioners and doctors can go around with the famous drug that ends life? Clause 4 of the bill clearly stipulates:

No pharmacist who dispenses a substance to a person other than a medical practitioner or nurse practitioner commits an offence under paragraph (1)(b) if the pharmacist dispenses the substance further to a prescription that is written by such a practitioner in providing medical assistance in dying in accordance with section 241.2.

That is dangerous. People will be able to walk the streets with a drug that kills. We must also protect our seniors. They are vulnerable people. Heirs, insurance policies, caregivers, and families can take advantage of seniors. Let us protect our seniors. Let us be restrictive and put safeguards in place to impose as many limits as possible.

There is a centre called Cité Joie in my riding. I can understand that people reach the point of exhaustion. The centre offers respite. I can tell you that I have seen people there with extraordinary smiles.

I cannot bear to no longer see such happiness. We have to support these people. We cannot give them that possibility. I have much to say. However, in closing, I would like to inform the House that I have not made up my mind about the final bill. I am asking the committee that will study it to put more restrictive provisions in the bill so that we can believe in life and we resort to the legislation only at the end of life.

[John Aldag, Liberal, Cloverdale—Langley City, BC]

Mr. Speaker, I would encourage the committee to listen to the comments that are being put forward, both the questions and concerns, and attempt to have witnesses who can address those, as the special joint committee had done. Then we will be able to weigh through the evidence, as we are about evidence-based policy, and see how the recommendations can be made to perhaps strengthen Bill C-14.

[John Aldag, Liberal, Cloverdale—Langley City, BC]

Mr. Speaker, I rise in the House today in support of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, also known as medical assistance in dying. In January, I was appointed to the Special Joint Committee on Physician-Assisted Dying and I was honoured for the opportunity to be part of this important discussion in Canadian society.

Over the span of a couple of months, my fellow committee members and I spent a lot of time working to understand the complex issue of medical assistance in dying. We discussed, we debated, and we even disagreed on a few issues, but in the end we drafted a report that I thought was the best possible solution for this complex social and legal issue.

Drafting any legislation can be difficult, but it becomes especially difficult when its title includes death or dying. It is a topic that most of us are sensitive toward and many have difficulty confronting.

Within the special joint committee we dealt head-on with a number of difficult issues and were immersed in them for six weeks. We reviewed reports by the provincial and territorial expert advisory panel on physician-assisted dying. We heard from health care regulatory bodies throughout Canada and the federal external panel on options for a legislative response to Carter v. Canada, to name a few.

We had the challenging task of grappling with the major issues touched on by Bill C-14, which include the availability of medical assistance in dying for mature minors or for patients with mental illness, advance consent, conscientious objection, and inevitably ensuring that adequate safeguards were in place to protect the vulnerable.

On February 25, the special joint committee reported back to Parliament where the Minister of Justice and the Minister of Health took the report into consideration and began drafting Bill C-14, which is what I am here to discuss today.

Bill C-14 reflects a number of recommendations made by the special joint committee and these include six main points: allowing both euthanasia and assisted suicide; making it available to permanent residents of Canada, so as not to encourage what some have coined as “suicide or death tourism”; requiring a written request for medical assistance in dying; requiring two witnesses during the time of request; requiring confirmation from two doctors or nurse practitioners that the person making the request meets all of the criteria for medical assistance in dying; and requiring a mandatory statutory review.

The key message I have taken from this very difficult discussion that I was part of and that Canadians are now joining, is that this has to be a patient-centred discussion. I encourage all parliamentarians to set aside personal values and beliefs and focus on what is in the best interests of patients. Medical assistance in dying is, and should only be, about the patient.

Upon reflection on our committee work, I now realize that the committee managed to develop a higher level of comfort with this difficult topic than is held by most Canadians at this point in the public discourse on medical assistance in dying. I am glad to see that the government took the overarching perspective of Canadians into consideration and is willing to use this legislation as a stepping stone for further studies and future revisitation.

In the past few months I have hosted and co-hosted medical assistance in dying town halls. I have spoken directly to my constituents. I have listened to the concerns of my constituents and of many Canadians around the country, and just last week, there was a demonstration for Bill C-14 held at my constituency office. I have heard the positive, the negative, the concerns, and the support, and although I fully support this legislation, I believe there are a few voids that have yet to be filled.

First, during the demonstration last week, important criteria, or better yet lack of criteria, of the bill were brought into question. How does one maintain safeguards when dealing with non-medical personnel? Bill C-14 ensures protections are met for non-medical personnel who participate in medical assistance in dying, including those who aid a person at that person's explicit request to self-administer a substance prescribed as part of the provision of medical assistance in dying, by amending section 241 of the Criminal Code, and introducing proposed section 227 to allow medical assistance in dying if the appropriate conditions are met.

However, what is being done to ensure that non-medical personnel are in fact following the guidelines required by medical assistance in dying? For instance, right before the time of administering the lethal prescription, a patient must be asked whether they would like to continue with medical assistance in dying, but how do we know that these independent individuals are in fact asking this question, among others? How do we know that the individual will not take advantage of the situation or the vulnerable position that the patient is in? These are questions my constituents would like to see addressed.

Second, I recently spoke to someone who was heavily involved in the Carter v. Canada case, who was wondering whether Kay Carter herself would have qualified for medical assistance in dying given the legislation being discussed today. I have read articles stating that she would have been, because she met the criteria for eligibility. However, would health care practitioners consistently agree that Kay Carter would indeed have qualified under this legislation?

The part that I am finding difficult to grasp, for Kay Carter and many others, is the ambiguity of the criterion for imminent death. How do we know that individuals would not be turned away from the service of medical assistance in dying because of the vague nature of this criterion? Who would be responsible for deciding the criteria for imminent death? Will there be inconsistencies in the definition of imminent death? How will we, as a society, address these?

Last, the hard timeline between the date of request and the day on which medical assistance in dying would be provided was yet another point of concern. Many constituents have expressed concerns that this may lead to the hastening of death because the timeline is simply too short. The special joint committee had recommended a flexible waiting period, which would depend on the nature of the illness as opposed to just an imminent death. It was suggested that imminence and competence not be the only factors in determining the timeline, but much rather the rapidity of progression and nature of the patient's medical condition be used when determining the reflection period.

These are a few pieces of the proposed legislation that my constituents and I feel need to be clarified and tightened before the final legislation is created for June 6.

However, I also want to acknowledge that the legislation has done a great job in addressing a number of concerns that have been conveyed by my constituents and many others. For instance, the first misconception I would like to clear up is that Bill C-14 does not address the conscientious objections of medical personnel. It does. There is nothing in the proposed legislation that would compel a health care provider to provide medical assistance in dying or refer a patient to another medical practitioner. Balancing the rights of medical providers and those of patients is generally a matter of provincial and territorial responsibility, and we need to respect that. However, that being said, the federal government has committed to work with the provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

Bill C-14 also recognizes the autonomy of persons who have a grievous and irremediable medical condition that causes them enduring and intolerable suffering and who wish to seek medical assistance in dying, while recognizing the importance of protecting the vulnerable and ensuring adequate safeguards are in place.

Over the past four months, I have encountered a wide variety of perspectives about this complex and difficult issue. Some have been extremely restrictive, while others have been extremely permissive. Some believe the legislation would go too far, while others believe it would not go far enough.

I believe Bill C-14 is an important first step in Canada. It is cautious, even conservative legislation, but it will provide a necessary first response to the Carter decision along with a commitment to continue studying the effects and revisiting important issues of medical assistance in dying in the future.

Ultimately, when it comes to Bill C-14, I would like to see the voids found within the legislation addressed prior to June 6, and I intend to support Bill C-14. I encourage my colleagues on both sides of the House to support the rights of Canadians, and to put patients first by supporting this bill.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Mr. Speaker, this evening, I have the pleasure of being here with my colleagues to speak about the bill on medical assistance in dying.

This is a major issue and I must admit that it gave me a greater understanding of my new role here as the member representing the people of my riding, the new role that I am playing in the House of Commons for our country.

From the beginning, there has been a lot of talk about the budget, transportation, deficits, terrorism, and all sorts of other topics that are all equally important to our country. However, rarely does a bill generate as much uneasiness and discomfort among our constituents as the bill we have before us today.

Not a day has gone by since January that I have not spoken about medical assistance in dying with the people of my riding of Mégantic—L'Érable. Quite honestly, I expected people to give me strong, clear answers. However, it has been quite the opposite. After speaking with people even for just two or three minutes, I have seen that they know how important this issue is, but they hesitate to voice their opinions on it.

I think that, as a member of Parliament, my role is to take a position in accordance with my values and beliefs, all the while representing the will of those who did me the honour of electing me to Parliament.

I must say that I have not yet made up my mind about this issue. Every time I find myself leaning to one side, I hear arguments that make me once again question my views.

This is a complex issue that touches people's hearts and strikes at the very core of their values. A bill about medical assistance in dying is not like any other bill. This is a bill that makes us take a look at ourselves and our lives. We immediately think about our parents, our grandparents, our brothers, our sisters, our friends, and ourselves. Suddenly, a bill that is being discussed in Ottawa, far from my riding, becomes something very personal to the people I talk to.

Allow me to give an example. How would we react if one of our loved ones was suffering at the end of their life and their last moments were unbearable? Most of us have had experience with this. We have been in this type of situation, supporting a loved one at the end of their life. Most often, these people we care about are suffering from a cancer that can cause horrible suffering. No one, absolutely no one, wants to see a loved one suffer.

I want to share my own experience. My father died of throat cancer after a difficult eight-month battle against this terrible disease. He was not even 50 years old. Those were difficult months. I think that we all went through something similar in our own lives, when we had to support someone we loved dearly through a very difficult time.

When that stage begins, we do not realize that it is the final stage of that person's life. When doctors set out to treat that person, we do not expect it to be the beginning of the end, so we begin a healing process with our loved one, and we work hard with that person because we love them and we want to fight and win the war on cancer.

At the end of that war, when my father knew that medicine could do nothing more for him, how would I have reacted if someone had suggested ending his life? I do not know because I was one of the last people in my family to tell him he could let go and give up the fight. I did not want him to go even though I knew deep down that it was the only way out for him.

Fortunately, my father received palliative care that minimized his suffering in his final moments. My mother and my brother showed great courage. They were by his side in his final moments because they lived in the same city. I was farther away and saw him on weekends. All of those people and his family members were by his side until the end.

I am certain that he is looking down on me today and that he is very proud to see me here in the House of Commons. My story is that of thousands of Canadians. It is the story of our will to live, and it is the story of our relationship with death.

Soon, I will have to vote on Bill C-14. I will have to decide how our country will respond to the Supreme Court decision that gives some Canadians the right to choose medical assistance in dying. I will repeat that I have not yet made my decision.

I recognize that people who are dying must be able to die with dignity. Dying with dignity does not necessarily mean obtaining medical assistance in dying. Dying with dignity means being able to die surrounded by your loved ones whenever possible, receiving medical treatment that is respectful of one's last moments and, above all, not suffering too much.

I was shocked to learn in the course of the legislative process that not all Canadians have access to palliative care. More than 60% of Canadians who are dying will not have the support required to take this last step in dignity. Even before I take a stand on medical assistance in dying, I believe that we have a duty to change this.

I hope that the goal of members of the House is not to do everything they can so that as many Canadians as possible choose to make use of medical assistance in dying. In fact, I am convinced that it is not. The Supreme Court has ordered us to quickly regulate the use of medical assistance in dying and to set parameters for the entire process. Which Canadians will be given access to medical assistance in dying? How will the most vulnerable members of our society be protected? Who will help the sick people and authorize the use of medical assistance in dying? How will the people who are involved in the dying person's choice be protected?

Over the coming weeks, I am going to show Bill C-14 to my constituents. In a few days, I am going to set up a meeting with a community organization in my riding called Le Havre, which is an aid and support group for people with mental health problems. We are going to hold a round table to talk about medical assistance in dying, the end of life, and people's decision-making abilities. I hope that these discussions will give me a better idea of the choice that I should make in a few weeks.

Fortunately, although it was definitely short on time, the Special Joint Committee on Physician-Assisted Dying managed to ensure that we heard from many groups and citizens to gather their views. I did not attend all the meetings, in fact I attended only one, but it made an impression on me. I will come back to that later.

I want to thank all of my colleagues in the House and the Senate who contributed to the work of the committee. There is no single response to the Carter ruling, because no two situations are identical. The goodwill of everyone allowed parliamentarians to consider two reports, including a dissenting report tabled by our colleagues, the members for Louis-Saint-Laurent, Langley—Aldergrove, Kitchener—Conestoga, and St. Albert—Edmonton. I am pleased that Bill C-14 takes a lot of inspiration from my colleagues' report, because it more closely reflects my concerns at this stage in my own personal thinking.

As I already mentioned, this is not about a race to allow medical assistance in dying. We need to make sure we protect Canadians' charter rights, whether that involves seeking medical assistance in dying or protecting those who will have to face that difficult choice, whether they want to or not, in the coming years. In the current situation, I think Bill C-14 should have been based more on the dissenting report, because the bill does not go far enough to protect vulnerable individuals, their families, and health professionals. What are its main principles? As my colleague from Louis-Saint-Laurent mentioned earlier today, it is about the protection of minors, people with mental illness, and the conscience of doctors and other health professionals.

The bill should apply only to people who are at the end of their lives. The option to receive palliative care is also important to Canadians. Steven Fletcher mentioned something to the joint committee. He said, “The further you move away from the Carter decision, the more likely it is that you're going to step into provincial jurisdiction. When you make that step, I predict you'll go into constitutional darkness, never to be found again.” We have to make the right decision, an informed decision. I think that the dissenting report shows us the way. Soon I will have to take a stand, and I hope that my constituents will help me with that.

[Marjolaine Boutin-Sweet, NDP, Hochelaga, QC]

Mr. Speaker, given that the member is the Parliamentary Secretary to the Prime Minister, does she have any more information she can give us regarding the funding that will be allocated to palliative care?

As she knows, no funding was allocated for that purpose in the latest budget, nor are there any new commitments set out in Bill C-14. Can she give us a little more information in that regard?

[Celina Caesar-Chavannes, Liberal, Parliamentary Secretary to the Prime Minister]

Mr. Speaker, before I begin, I would like to acknowledge the Minister of Justice, the Minister of Health, and the parliamentary secretaries and their teams for their work on this important legislation, and to thank them for their efforts. I would also like to thank the chair and members of the Special Joint Committee on Physician-Assisted Dying, the witnesses they heard from, and the countless Canadians who took part in consultations right across the country. This is not an easy topic for discussion, and I commend all involved for their thoughtful, compassionate, and thorough work.

The Carter decision set out a clear objective for parliamentarians to come up with a legislative framework that allows Canadians who are suffering intolerably the right to request assistance to end their suffering. Bill C-14 is the government's answer to this critical objective, and I stand here today, proud to support this important legislation.

I have heard from constituents on both sides of the issue, some who flatly oppose allowing any access to medical assistance in death, and others who believe the legislation does not go far enough. I have also heard from people who applaud the thoughtful work on this bill and have reached out to me to express their gratitude.

In this regard, it is important to note and to reiterate what has been mentioned many times in this chamber. With this legislation, our task was not to determine if physician-assisted dying was necessary, but to determine how best to move it forward. This is an important consideration and one that is worth repeating.

Of paramount importance to me in reviewing this bill was to determine if it properly considers different interests, including balancing the right to personal autonomy at the end of life with the need to ensure robust protection for the most vulnerable in our society. I believe that this legislation achieves this balance and that it rightly takes the necessary steps to ensure that the rights of all are respected.

With respect to personal autonomy, this legislation responds to the objective mentioned earlier that was provided to us by the Supreme Court of Canada, that Canadians who are suffering intolerably have the right to request assistance to end their suffering.

I am not a lawyer, and as such will not speak to the legal ramifications of this bill. As well, I cannot speak with authority on the constitutional nuances of this bill. However, as a person of faith, it was critically important to me that subsection 2(a) of the Charter of Rights and Freedoms, which grants Canadians the freedom of conscience and religion, was considered and protected.

A couple of weeks ago, I had a meeting in my office with members from the St. John the Evangelist Catholic Church in Whitby. While they understood that the objective for us in this chamber was to come up with a legislative framework for medical assistance in dying, they were gravely concerned about protecting the conscience of medical professionals. They wanted some assurance that the conscience of the health care provider was protected.

Balancing the rights of medical providers and those of the patient is generally a matter of provincial and territorial concern. However, our government is committed to working with the provinces and territories to explore options to facilitate access and care coordination while recognizing the personal convictions of health care providers.

Having worked in health care based research for the bulk of my professional life, I have had the opportunity to work closely with health care professionals in a variety of capacities. It is very important to me that any legislation put forward respected the rights and personal convictions of care providers. I am very pleased to see that this legislation makes mention of this while acknowledging that safeguarding those convictions requires an ongoing conversation with the provinces and territories.

The robust considerations and protections for the most vulnerable in our society inherent in this legislation are also of particular importance. This legislation sets out the criteria for the determination by medical professionals as to whether or not a patient suffers from a grievous or irremediable medical condition. These criteria include that they have a serious and incurable illness, disease or disability; are in an advanced state of irreversible decline in capability; the state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and that their natural death has become reasonably foreseeable.

As a mother of three children and MP for the bedroom communities in my riding of Whitby, I was pleased that the legislation also includes strict eligibility requirements that protect minors. Careful thought and consideration are required to understand and assess a minor's ability to make a decision involving the termination of his or her life. I applaud the decision to further study this aspect of the legislation and look forward to being actively involved at that time.

Additionally, this legislation would ensure that those who make a request for assisted dying do so without coercion, having provided informed consent, and given the opportunity to, at any time and in any manner, withdraw their consent. These safeguards are fundamental to Bill C-14. The bill provides safeguards to ensure that individuals can remove consent. The requirements that the request be voluntary and that the person must decide for himself or herself that he or she wants medical assistance in dying is as equally important as the requirement to have the ability to remove consent.

I am proud that this government has listened to stakeholders from across the country and has committed to ensuring that all Canadians have access to quality end-of-life care, including palliative care. Our $3-billion commitment to improving and expanding access to home care is another critically important step and I look forward to seeing continued progress on this vital portfolio in the months ahead.

Finally, I would like to thank and acknowledge my colleagues in the chamber for the thoughtful, measured, and respectful tone struck during this debate. This is not an easy topic of discussion. It is one that challenges us to examine our fundamental beliefs about life and death. I commend all for their work on this file.

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

Mr. Speaker, I appreciate the respectful tone and the way in which all members in this place are approaching an issue which I know could divide us. It touches on the sanctity of life, on issues of great importance to all of us, and on the question of human suffering that so distresses all of us. It interprets a Supreme Court decision. Bill C-14 is a bill that requires a sobriety, a sensitivity and a respectful dialogue as we approach it.

Other members have reflected on what they have learned from their constituents. I need to share the story of what happened to me when I became the member of Parliament for Saanich—Gulf Islands. I was someone who would not have been comfortable with this bill. My constituents may be the most active group of people working for Dying With Dignity.

There are two Dying With Dignity chapters in Saanich—Gulf Islands. I was visited by members from the Salt Spring Island chapter. I was visited by members from the Victoria chapter. Over time, I realized that perhaps my riding had been sensitized to this issue, because Sue Rodriguez lived in my riding.

Her death in 1994 touched all Canadians, as we realized that she tried so hard to get relief from the courts, permission to have a medically assisted death. In the end, it was not possible through the legal system. We all remember her quite courageous and tragic death.

At the time of the court telling Sue Rodriguez that she could not find access to legal medically assisted death, she said, “If I cannot give consent to my own death, whose body is this? Who owns my life?”

These are profound questions that hang in the air still. Some of us might answer that none of us own our own life, that our lives belong to the creator. Some of us may say whatever one believes, each of us has the right to make our own decisions. Those people who might believe one aspect through faith have no right to deny someone else the decision that he or she wants to take, to plan for a death with dignity.

In the course of listening to my constituents, particularly through a series of town hall meetings over the last five years, and through questions and comments that have come to me through the mail, I became persuaded that my job as their member of Parliament was to support access to medically assisted death.

Then my life experience as a lawyer kicked in, and I was very relieved when the Carter decision came down. I thought that at long last we now had legal clarity on this matter, and that Parliament could begin to resolve the issue through the work in Parliament. The issue has been through the courts so often that I felt that we were now in a position as lawmakers and legislators to deal with the decision in Carter.

Just to remind members, the Supreme Court said that the Criminal Code sections that prohibited physician-assisted death violated section 7 of the Charter, and therefore:

....are void insofar as they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life; and (2) 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.

The court was clear in this decision that we were not speaking of any possibility that one person could make a decision for medical assistance in dying for anyone else. This is a personal decision. The Supreme Court has said that a competent adult person can make this determination. What the court set out as the conditions that would justify medically assisted death was a grievous and irremediable medical condition.

I was disappointed in Bill C-14. I felt, after looking at the report of the special committee, that the legislation would likely anticipate where the court would go in future rulings, and avoid protracted court cases as Canada figured out how we would accommodate medical assistance in dying.

The bill, in not fulfilling even the conditions set out in the decision of the Supreme Court in Carter, would lead to more litigation and more suffering for people who now see that the Supreme Court of Canada has said that to suffer in situations like this violates their charter rights. If we pass Bill C-14 as it is currently drafted, Parliament would be denying them their charter rights going forward.

Other members of Parliament have mentioned this. We know that the legislation is attempting to balance very difficult issues to ensure that there are robust safeguards—and we have had conversations about whether they are sufficiently robust—the sanctity of life, and the protection of vulnerable persons.

This bill is close to getting it right, but where I am really baffled is in the decision not just to say “irremediable” but to insist, as others have noted, that one of the conditions in section 241.2(2)(d), is that their natural death has become “reasonably foreseeable”. I am afraid that is quite baffling, given what the Supreme Court told us we must do. The “irremediable” situation was not described as incurable or terminal. That is a deficiency in the legislation and one that will not just disappoint people who are suffering, but also calls into question the wisdom of this place in interpreting the Supreme Court of Canada's decision to protect charter rights.

Many have spoken about this second area as well. As I read it I thought that this cannot be right, that this must just to be bad drafting, that they cannot mean this. In going through all the conditions, yes, there are safeguards there. There are independent medical practitioners, more than one, and there is not undue influence of any kind. Not to go through every element of it, but as we have to go through quite a protracted process to make a legal declaration, and it would be fulfilled by independent witnesses, one has to go through all of this and then, after all that, at 241.2(3)(h) we find that immediately before providing the medical assistance in dying, the person would be given the opportunity to withdraw the request, ensuring that the person gives express consent to receive medical assistance in dying.

This is gravely disappointing. Those who take the decision that they want medical assistance in dying are now denied that, if their situation is one where we cannot reasonably foresee their natural death and where at the moment they have planned for and gone through this protracted process to ensure that they would have medical assistance in their death, now must be of sound mind to reassert and have the capacity to reassert that they have confirmed this is what they wish. This would surely deny many groups of people who would look to the court decision in Carter as their way of knowing that they would have the right to choose to die with dignity with the assistance of a medical professional.

Many have mentioned these deficiencies in Bill C-14. There are others that have been raised by the British Columbia Civil Liberties Association, as a co-litigant in the Carter case. I am not out of sympathy with those, but perhaps those could wait for another time.

I do not see how Parliament could decide to wait for another time in ensuring that the legislation we pass now is in conformity with the instructions we received from the Supreme Court of Canada.

Calling on my background as a lawyer, as well as my commitment to my constituents, I look at Bill C-14 and ask how we could pass something that would once again be found by a court to violate section 7 charter rights for those Canadians who have met the test in Carter, but would fail the test in Bill C-14. It is an enormously difficult question.

I have enormous respect for all the voices I have heard in the House in this debate at second reading. I will vote for the bill at second reading, but I hope we are prepared to fix its deficiencies in committee.

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

Mr. Speaker, I rise tonight to comment on Bill C-14. Before beginning, I want to commend all members of the House for so far treating this debate with the sensitivity it warrants. This is without doubt an issue that evokes much passion on both sides of the issue. This debate at its essence pits the sanctity of life against the inherent autonomy of the individual. I think it may be a worthwhile exercise to go back in time, not just a little but back a few decades so we can attempt to put the current debate into some legal context.

The common law crimes of attempting suicide and assisting suicide were codified in Canada when Parliament enacted the Criminal Code in 1892. Eighty years later, in 1972, the House repealed the offence of attempting suicide from the Criminal Code based in part on the argument that a legal deterrent was unnecessary in those circumstances. However, the prohibition on assisting suicide remained. This prohibition is found currently in section 241 of the Criminal Code. This in my opinion is the fundamental shortcoming of our current law.

Currently, able-bodied Canadians can take their own lives without any legal consequences. Those who physically cannot are currently discriminated against from doing so. This brings us to Carter, a unanimous decision of the Supreme Court of Canada that overturned the 1993 case of Rodriguez. Carter holds that, among other things, the Criminal Code prohibition against assistance in dying found in section 241 is unconstitutional on the grounds that denying disabled people the right to assisted suicide is contrary to the Charter of Rights and Freedoms.

The current legislative prohibition found in the Criminal Code was held to be over broad in that it prohibited physician-assisted death for a competent adult person who, first, clearly consents to the termination of life, and second, has a grievous and irremediable medical condition including an illness, disease, or disability that causes enduring suffering that is intolerable to the individual and the circumstances of his or her condition.

This leads us to where we are today. The court decision requires strict limits that are scrupulously monitored. This government is proposing a framework that considers different interests, including personal autonomy toward the end of one's life, the protection of vulnerable persons, and conscience rights, all values that are deeply important to Canadians across this country.

The debate regarding medical assistance in dying is important to each and every one of us for different and for deeply personal reasons in many cases. For all Canadians this is a difficult and profoundly sensitive issue tied to their life experiences and personal beliefs.

I have heard many of my constituents share with me their opinions on the bill, some of whom face difficult and sometimes unimaginable health challenges. Just today, I received an email from a woman in my riding suffering from a slow-moving form of ALS. Gradually this horrible disease has taken her voluntary muscle control, making it difficult for her to sign her own name, to speak, and to even form the most basic sentences.

In her own words to me she describes the situation as thus, “Our hearts continue to pump. We are aware of everything happening to us and around us, but become unable to do the simplest things for ourselves. We cannot predict our lifespan”. She urged the House, through me, to reconsider the issue of advance directives. This is one Canadian who will be directly impacted by Bill C-14, one Canadian of many.

Members may ask why I relay this story. It is because Bill C-14 clearly states that a requirement for assisted dying must be that natural death is within the reasonably foreseeable future. For many Canadians, suffering and looking toward the future of only further pain and suffering, there is no clear, distinguishable path to death, but this should not diminish their choices. For some, without this choice in the future, it can feel like a loss of comfort, a loss of safety and a loss of autonomy.

Additionally, this past weekend I had the opportunity to sit with a few of my fellow members of Parliament from York region to listen to important concerns and questions relating to Bill C-14. With an open mic, this event not only provided the opportunity for the participants to express their views and opinions on medically assisted dying, but also allowed me a great opportunity to meet and discuss on a more personal level with the people in my community who would be directly affected by the results of this debate.

While these discussions are important, it is equally important that a person does not come to end-of-life decisions lightly. Oftentimes the decision follows years of personal deliberation and what I can only imagine would be the most difficult conversations of a family member and those closest to them.

For these reasons and many others, Bill C-14 cannot and should not be taken lightly. While there will always be those who believe the bill does not go far enough, others believe it goes too far.

The Supreme Court of Canada unanimously decided that Canadians suffering intolerably had the right to request assistance to end their suffering. The bill respects that decision. However, I would encourage all members to engage with their constituents on this important matter and bring that informed advice to committee.

Medical assistance in dying represents a significant change in the Canadian medical landscape, and this government has conducted consultations with many experts. Physicians have indicated that they would be most comfortable providing this option to patients approaching death as another option alongside palliative care, withdrawal of treatment or palliative sedation. These options are all individually important and are woven into the bill to ensure that patients are served and equally protected, as well to limit any risks to the physician.

As this government engages with the provinces and territories to support the development of a pan-Canadian monitoring system to collect and analyze data, monitor trends and publicly report on medical assistance in dying, I ask that we all take time to consult with our constituents.

While I am open to the government's Bill C-14 and will support it to move it to committee, I do feel some amendments may be necessary. We, as legislators, are not doing our jobs if we are not open to continually hearing from Canadians and engaging in meaningful consultations and dialogue, especially on an issue as important and fundamental as this one.

I urge all members to also support the bill. I thank the Speaker for allowing me to rise to speak on such an important topic and share my perspective.

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

Mr. Speaker, it is an honour to rise in the House today to continue the debate on Bill C-14.

I truly believe that this debate we are having, and the quality of the debate I have heard throughout the day, is going to be a watershed moment for our country. It is certainly going to be one for the history books, because through a charter challenge, the Supreme Court is forcing us as a legislative body, as a country, to fundamentally examine the meaning of life, the meaning of death, and how we as a society treat those two very difficult concepts.

Death is a hard subject to talk about. Humans have, for thousands of years, struggled with the concept and how we deal with it. Many of us turn to spirituality to find answers, and others are more matter of fact. In any case, the debate concerning life and end of life has reached Parliament's doorstep, and it is up to us as parliamentarians to carry the torch and do that subject the honour and justice it deserves.

As a rookie member of Parliament for the great riding of Cowichan—Malahat—Langford, I have been receiving correspondence from my constituents. I must say to the constituents who are watching the debate today that I have never been prouder to be an MP for their area. The tone in which they have written me, whether they disagreed with the legislation or supported it, has been incredibly respectful.

Of the concerns that I have seen from constituents, some want to see more protection for health care workers. They are concerned that freedom of conscience and freedom of religion are not respected enough in the legislation. However, others do not think that the bill goes far enough. They have looked at the ruling from the Carter decision and compared the provisions of Bill C-14 with it and have found it lacking.

I have heard other hon. members in the House say that, no matter what bill comes out at royal assent, they do see challenges in the future, but it is up to us as parliamentarians to do the best we can with the time we have.

Speaking of the bill, I am going to support this legislation at second reading, because I think we have something to work with. To do honour and justice to it, we must send it to committee so that we can have a more fulsome look at its provisions, and we can hear from witnesses. Furthermore, we must take the recommendations from the special joint committee and see if some of those recommendations can be adequately applied.

I support this legislation, because I believe in a patient-centred approach. I realize that my support of this legislation will cause some of my constituents distress. It is one of the challenges of being an MP. It is balancing the views of one's constituents with one's own personal values. This is the eternal struggle that each and every one of us finds in the House every single day.

However, I believe that, if we are talking about values, one important concept to look at is to not impose one's values on someone else, but to respect a person's values. If a person's values means that he or she is choosing a way out to end suffering that we as healthy people can only imagine, well then we must respect that choice. I fundamentally believe in that.

Looking at the Carter decision, the Supreme Court ruled that it had to be a competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition, including illness, disease, or disability, which causes enduring suffering and is intolerable to the individual in the circumstances of his or her condition.

Section 7 of the charter says:

Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

The court found that the prohibition on physician-assisted dying infringed on the right to life, liberty, and security of the person in a manner that is not in accordance with the principles of fundamental justice, and that is why we are here today.

Of the recommendations of the special joint committee, there are three in particular that I want to look at. In a 10-minute speech, to look at all 21 is rather impossible, so I will start with recommendation 7, which dealt with advance directives.

There was a recommendation that advance directives be allowed, but unfortunately, Bill C-14 only makes mention of advance directives in the preamble. The preamble committed to exploring it, but there was no firm commitment in the legislation.

The other recommendation I want to look at is number 10 regarding freedom of conscience. The preamble, again, committed to non-legislative measures in this particular area. There is a template that the government could have followed. There is precedent in protecting freedom of conscience and freedom of religion. It goes all the way back to 2005 when Parliament passed the Civil Marriage Act.

For the reference of all MPs in the House, I will note that section 3 of the Civil Marriage Act states, “It is recognized that officials of religious groups are free to refuse to perform marriages that are not in accordance with their religious beliefs.” Section 3.1 says, “For greater certainty, no person or organization shall be deprived of any benefit, or be subject to any obligation or sanction, under any law of the Parliament of Canada solely by reason of their exercise”. There was a template and hopefully this is one area that the committee can examine further.

The other recommendation I want to look at is number 2. That was basically following the Carter decision. It states, “That medical assistance in dying be available to individuals with terminal and non-terminal grievous and irremediable medical conditions”. Unfortunately, the text of the bill, referring specifically to proposed paragraph 241.2(2)(d), reads, “their natural death has become reasonably foreseeable”.

This is one section where I do not know why the government wrote it in, because it goes against what the Carter decision specified and it goes against what the special joint committee recommended, yet it is here. I see nothing but problems with this. I see future charter challenges.

We owe it to Canadians to get this bill right the first time and not force people to go through the courts for several more years, only to have this legislation dumped back in our laps again. It is the same with advance directives. There will be people who get a diagnosis of dementia. We all know the end result of having Alzheimer's and they will ask why they are being excluded and why their advance directives are not being respected.

I would like to talk a bit about palliative care. I know it is a subject that has been talked about a lot in the House. The reason is that when this bill receives royal assent in June, it is going to be the law of the land. Palliative care is in such a sorry state in so many jurisdictions in Canada right now that I do not want Canadians to be living in a hospital bed somewhere with substandard care and thinking their only way out is to end their lives. That is why we talk about palliative care with such urgency, because once this bill becomes the law of the land, that is what some Canadians may think is their only option. We have to treat it with the urgency that it deserves.

I would now like to talk a bit about the great work that the member for Timmins—James Bay has done. It is very important to recognize that a previous motion in the House of Commons was passed with all-party support in 2014, yet here we are in 2016 still talking about it. I would love to have seen some firm dollar commitments in the budget. Until we see that, all we have is talk. We need an absolute pan-Canadian palliative care strategy. I was honoured to walk in the Hike for Hospice on the weekend in my riding. A great bunch of people in the community came out for it.

I would like to end on the concept of empathy versus sympathy. Up until this point, our country has had a sympathetic viewpoint on this whole issue and true empathy means that people step outside of just feeling sorry for people and actually perceive the world through their eyes. That is what this legislation aims to do, to see the world through the eyes of someone who is suffering from a condition. We have no idea what it is like and that is what everyone needs to be doing in this country, being more empathetic and trying to provide true support.

I will end there. I am thankful for this opportunity.

[Sylvie Boucher, Conservative, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, every one of us has their own story, experiences, destiny, and perspective on life and death.

However, no one, and I mean no one, can be indifferent to the bill we will soon be voting on. It is important to respect the personal and private opinions of all our colleagues on both sides of the House.

Just 15 years ago, we might never have had this discussion or this debate. Quebec paved the way with its end-of-life legislation. After more than six years of countless meetings and many discussions, and not without much debate involving all of society, members of Quebec's National Assembly passed the bill, which became a reality for Quebec.

One of my former colleagues in the House, the Hon. Steven Fletcher, introduced two bills on this issue in 2014, thus laying the groundwork for national reflection. In 2015, the Supreme Court also struck down the Criminal Code section that prohibits a doctor from assisting someone to end their life in very specific circumstances.

There is little time left before the Government of Canada puts in place a Canadian law to provide a framework for medical assistance in dying.

A special joint committee was struck, and six weeks of meetings, discussions, and testimony followed. The committee then tabled a report in the House of Commons. In response, a bill was drafted. Now we need to work together to make the bill law.

We must take Canadians' opinions into account. This is not a partisan issue. This is a social issue that should bring people together. First and foremost, we must protect the most vulnerable members of society. It is the Government of Canada's duty to legislate on this very difficult matter. This bill touches our core values. We will never achieve unanimity.

Even so, we have to address concerns that have been raised about a subject that is still sensitive and emotional for all of us. It is our duty to have a frank and open discussion to move the debate forward in response to the Supreme Court of Canada's request.

I think we need to set aside any emotions we might be feeling in connection with such a personal and sensitive subject. We must ensure that the legislation includes guarantees to protect the most vulnerable members of our society as well as the conscience rights of doctors and other health professionals.

As legislators, we must have an open discussion that respects who we are, and we must be free to vote in accordance with what we believe deep down.

We must also make some amendments to ensure that there is an excellent framework for this legislation.

We must respect the rights of the ill, but we must also respect the right of doctors to say no. There is currently a grey area that leaves room for interpretation by the provinces. We must be united as a country on protecting doctors, pharmacists, and institutions. I am talking about all health care personnel.

The Government of Canada must ensure that the people who make use of this legislation are making a clear and informed choice and have all of the information they need to make an informed decision.

There are some concerns, especially in the details of the bill, with respect to the fact that nurses have the same decision-making power as doctors in providing medical assistance in dying.

I remind members that Bill C-14 on medical assistance in dying is the government's response to the Carter decision. In this decision, the court ruled that people have a right to medical assistance in dying if they are adults, if they are suffering from a grievous and irremediable medical condition, and if they have given informed consent.

It is important to consider what “informed consent” means. It must be clearly defined, to ensure that the Canadian public is fully aware of what is involved.

We must also consider and propose solutions for people who want to live, in spite of their illness, and for those who want to be with their loved ones even though they realize they are at the end of their life. I think it is very important that we invest much more in palliative care.

We are talking a lot about medical assistance in dying, but I get the impression that in this debate members are forgetting about the most important thing, and that is the ill person. There is little or no reference to those who will never make use of this legislation.

On a more personal note, I too have had to think carefully about this issue. I carefully weighed the pros and cons. I looked to my own experiences for answers to my questions. I searched my past. I looked at myself in the mirror and thought about my views on life and death. I saw the face of my father, who was stuck in a wheelchair for over six years. Not a day went by when he did not shed some tears. How many times did he tell me that he would rather die than be there, paralyzed, unable to walk or be completely autonomous?

However, I also thought about the time when, of necessity, I ended up supporting my friend Rachel through the terminal stage of her illness. She had AIDS, but she wanted to live at all costs, despite the illness that was consuming her.

Then there is me, both a legislator and a human being, who must, in all honesty, reflect logically on what I myself would do if I were at the end of my life and had to make a choice. There is no obvious answer. However, I dislike aggressive therapy, and everything is already there in black and white.

This debate has forced me to think beyond death itself to accepting it and to the grieving process that is necessary either for the person involved or the loved ones.

The medical assistance in dying legislation is not perfect. There are some things that need to be redefined and a few amendments to incorporate, but we have to keep in mind that the Supreme Court is pressing us to pass legislation by June 6. That is why I am voting in favour of this motion, in order for the bill to go back to committee and for the committee, which is duly appointed, to study the provisions and ensure that all Canadians are protected. They are what matter most here.

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

Mr. Speaker, the member for St. Catharines is right, that the process is not over. There are more people to hear from, more studies to be done, more details to be hashed out.

Would the member like to remind our colleagues what the results of not passing Bill C-14 would be? The Carter decision does not provide us a deadline after which the status quo remains. There are real world results for this being defeated. Would the member like to address the real world effects of this bill not passing?

[Chris Bittle, Liberal, St. Catharines, ON]

Mr. Speaker, I am pleased to have an opportunity to participate in the second reading debate on Bill C-14, the proposed legislative approach to medical assistance in dying in our country.

This is a historic bill, and it tackles an issue that is of great interest and importance to many Canadians. It is also one that raises divergent and deeply held personal views, which is why broad consultations with a variety of groups and organizations were essential before reforms could be developed and considered by Parliament.

Members are aware that a special joint committee of the House of Commons and the Senate recently studied this issue, in January and February of this year, and in the context of that study, had the opportunity to hear from 61 witnesses and consider over 100 written briefs.

Other recent consultation initiatives were undertaken by the federal external panel on options for a legislative response to Carter in Canada, from July to December 2015, and the provincial and territorial experts advisory group on physician-assisted dying, from August to December 2015. Each panel met with representatives of dozens of stakeholder groups and received numerous written submissions from key organizations, including the medical sector, disability rights groups, legal and civil liberty organizations, and faith groups. Furthermore, many of the organizations that were consulted held extensive consultations with their own membership, some over the span of years, and shared the benefit of those with these panels.

Of course, we are also indebted to the years of consultations undertaken by the provincial government in Quebec leading up to its own legislation in this area. The extensive work that those in Quebec undertook was carefully considered, and I thank them for their leadership on this issue. It informs this proposed legislation as well.

The broad and in-depth consultations that have occurred over the past year across this country have undoubtedly enriched the policy development process that has led to the introduction of Bill C-14. I am pleased to see in the document entitled “Legislative Background: Medical Assistance in Dying (Bill C-14)” which accompanied the bill and was tabled in this place by the Minister of Justice, that the development of the proposed legislation was informed by the evidence before all levels of court in the Carter case by available Canadian and international research, social science evidence, governmental reports, and parliamentary studies.

That document also tells us that it was informed by the experience of existing international medical assistance in dying regimes around the world, as well as by numerous recent consultation activities on medical assistance in dying, including the work of the special joint committee, the federal external panel, the provincial-territorial expert advisory group, the work of the Canadian Medical Association and the College of Family Physicians of Canada, as well as the work of the provincial colleges of physicians and surgeons.

The consultation process has been robust and comprehensive. This has provided an opportunity for a variety of stakeholders from diverse perspectives to share their views and to reflect the views of other stakeholders who may not necessarily share their point of view.

I would like to briefly outline the considerations that some of the key stakeholders have raised with respect to this issue. One of the key stakeholder groups on this issue, given the active role they will be playing in response to requests for medical assistance in dying, is the medical profession, and by that I mean the various types of health care providers, such as doctors, nurses, pharmacists, nurse practitioners as well as their regulatory bodies.

The importance of this issue for the medical profession was underscored by a representative of the Canadian Medical Association who appeared before the special joint committee and testified that medical assistance in dying is a difficult and controversial issue for the medical profession, that it represents a sea change for physicians in Canada.

Many of the people who spoke from the perspective of the medical profession emphasized the need for clarity in the law so that health care providers are crystal clear about what is permissible and what is not permissible in providing medical assistance in dying, and that federal legislation is needed to ensure national consistency.

I am pleased that the proposed legislation responds to that request for clarity and consistency. Bill C-14 comprehensively sets out who can do what and to whom, and which safeguards are to be complied with. Moreover, as it is a proposed amendment to the Criminal Code, it would apply equally across Canada.

The unanimous decision of the Supreme Court of Canada in Carter focused on the role physicians could play in medical assistance in dying. I am pleased to see that in Bill C-14 explicit exemptions are also included for other types of health care providers, such as nurse practitioners, pharmacists, or other persons who would assist a medical practitioner or nurse practitioner with a request for medical assistance in dying.

This is responsive to the wealth of information received from representatives of nursing to pharmacist organizations in the course of various consultations.

Another important request that was raised by the medical profession was the need to respect the conscience rights of health care professionals who may object to providing medical assistance in dying. I would highlight that the bill makes explicit reference in the preamble to respecting the personal convictions of health care providers.

I will also note that the government has committed to working with the provinces and territories to support access to medical assistance in dying by connecting willing health care providers with patients. To me, this strikes an appropriate balance between supporting patient access or respecting the conscience rights of health care providers, as well as the jurisdiction of the provinces and territories.

Lastly, the medical profession, among other stakeholders, expressed a strong desire for a national monitoring system for medical assistance in dying. I am very pleased to see that Bill C-14 would empower the Minister of Health to make regulations to establish a federal monitoring system, with the associated requirements for health care providers who would be responsible for handling requests for medical assistance in dying to provide information for the purpose of that monitoring.

Several key stakeholders, and in particular disability rights groups, raised the necessity of robust safeguards to protect the right to life of every person in our country. This of course includes people who are ill, elderly, or disabled. Some national disability rights groups also indicated that stringent safeguards were needed to ensure the voluntary nature of a request for medical assistance in dying, free from any pressure or coercion, and based on informed consent, the heart of which was ensuring the patient had the capacity to make the decision in question.

The consultations that have occurred thus far, and the ones that will continue over the coming week, are crucial to ensuring we get this bill right. I am very much looking forward to the testimony that will be presented before the Standing Committee on Justice and Human Rights this coming week, a committee of which I am a member. I am eager to gauge the opinions of all sides of the debate on medical assistance in dying. I look forward to working with my committee colleagues to bring this bill back to Parliament and have a sound framework in place by the June 6 Supreme Court of Canada deadline.

Parliament has debated the issue of medical assistance in dying on several occasions over the past two decades. Each time, it was not able to support amendments to the Criminal Code to make this a reality for Canadians. The time has come to make this change. I believe this proposed legislation should be passed. I agree with the legislative background paper the Minister of Justice has tabled, and its statements that this proposed legislation strikes an appropriate balance between the autonomy of those seeking access to medical assistance and the interests of vulnerable persons in our society. I would urge all members of the House to support the second reading of Bill C-14.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, today this House stands to discuss Bill C-14. As we do so, we must seriously consider this important responsibility. The Supreme Court decision has been made. The job in this House is to create legislation that would provide clear boundaries moving forward.

In February 2015, the Supreme Court of Canada concluded that the absolute prohibition on assisted suicide violated the charter rights of Canadians suffering intolerably with grievous and irremediable medical conditions who, being adults and assessed as competent decision-makers, would otherwise seek medical assistance in dying on their own terms.

In response, the joint special committee of Parliament was tasked to consult with experts and Canadians who reflect the diverse perspectives on this issue. It reviewed the Supreme Court's decision in the Carter case and the 400-page judgment of the B.C. Supreme Court that preceded it. It studied Quebec's new assisted dying law, as well as the reports of two major panels on medical aid in dying, which together heard from 13,000 Canadians and more than 100 organizations. The committee then held 11 hearings, called 61 expert witnesses, and received more than 100 written briefs from groups across Canada.

I have read the report and want to thank the committee for the great work it has done, resulting in 21 recommendations on a legislative response. These recommendations demonstrate balance and sensitivity, respecting the autonomy of patients, the rights of health care practitioners and vulnerable individuals, and the fundamentally personal nature of this issue to every Canadian.

I have also been listening to the constituents in my riding of North Island—Powell River, where people are very concerned. Many from my riding are worried that there is not enough support for palliative and end-of-life care. They want to know that the vulnerable will be protected and they want to know that those who suffer greatly can decide to die with dignity. I have had many letters from my constituents, and I know there will be many more. This is a subject that deserves much discussion in each riding across Canada.

Bill C-14 is also a very personal one for me. Years ago, I was a volunteer for a hospice and watched many people die. I remember being present for people who were in so much pain and who wanted the release of death so badly that starving themselves became their only solution. I remember the agony of the people and their families who just wanted a safe release from this pain.

I also sat with people who fought every day for one more. Their desire to continue in the face of such pain was tremendous.

After volunteering there for years, I left knowing that death is an intensely personal process and that honouring people and their families through it is so important.

Today, I want to talk to Bill C-14, the Liberal government's legislative response to the Carter case.

The Liberal bill has raised new concerns and leaves many questions, for me, unanswered.

There is consensus among academics, health professionals, faith communities, and the public that Canadians deserve better end-of-life and palliative care treatment.

The federal government has a role to play in working with the provinces and the territories, as well as first nations, Inuit, and Métis communities, on finding strategies that work.

We have a critically important opportunity to enhance the services across the country, yet the government was missing in action in the budget on palliative care—even after promising $3 million for home care during the campaign. Holding the government to account on the promise of that motion remains one of our top priorities as we assist in the legislative response to the Carter decision.

This bill refers to palliative care in its preamble; yet while introducing this bill, the government made no new commitments to palliative care. The people of my riding want to see this investment happen.

The NDP took a significant step forward in the last Parliament when a motion brought by the member for Timmins—James Bay to establish a pan-Canadian palliative and end-of-life care strategy earned nearly unanimous support of the House of Commons.

Palliative care is about patient- and family-centred physical, psychological, and spiritual care.

Everyone dies, every family has to deal with the loss of a loved one, and these traumatic moments are made more difficult and more expensive when there is no access to quality palliative care. With an aging population, it is crucial that the federal government provide leadership now.

The government backgrounder refers to the following system to ensure equal access:

The government is proposing to work with provinces and territories on the development of mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying. This system would help connect patients with a physician or nurse practitioner willing to provide medical assistance in dying, and support the personal convictions of health care providers who choose not to participate. It would also respect the privacy of those who are willing to provide this assistance. This system could also offer other end-of-life care options to both patients and providers.

However, this is not mentioned at all in the bill. This leaves a lack of clarity and room for poor decisions. It is important to respect the health care practitioners' freedom of conscience while at the same time respecting the needs of the patient.

Having seen the previous government's agenda being held up in the courts time and time again, Canadians expect a government to be thorough. Now is the time to strengthen the bill against charter challenges by resolving contradictions with the Supreme Court ruling in Carter. Canadians have waited long enough. Let us get it right the first time.

It is not a partisan criticism either. The co-chair, Conservative Senator Ogilvie, told the Hill Times that the law as it has been introduced will be challenged in courts, and he is disappointed that the government did not take more of the committee's recommendations.

This is not a case where good enough legislation is good enough. This is a life and death issue, so let us get the right legislation.

The people in my riding are concerned about safeguards. They know the value of life and want to make sure that some lives are not considered less valued than others. I could not agree more. I have members of my family who have severe mental illness and who are differently abled. They are precious to me, and I would not wish them gone from my life.

Right now, Bill C-14 would legalize medical assistance in dying for competent adults 18 years of age or older who meet the following criteria: serious and incurable illness, disease or disability; in an advanced state of irreversible decline in capability; experiencing enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

There are also requirements for two independent medical practitioners or nurse practitioners to confirm each criterion. The request must be in writing where possible and witnessed by an independent adult, and a 15-day reflection period must be observed. To help protect people in vulnerable situations, the witness to the request cannot be a beneficiary under the will of the patient, someone who may benefit from the patient's death, or directly involved in providing care to the patient. The two physicians or nurse practitioners must also be independent from one another. Safeguards must be there to provide the support that patients and their families need during this painful time.

We know that this is a difficult issue that touches many in a personal way. There are many issues to discuss, and we hope to see them discussed. Therefore, I will be voting in support of the bill, but I know that it is going to a special committee, and when it returns to the House I hope to see many more changes made.

Many speakers today are expressing their profound disbelief that Bill C-14 would deny Kay Carter, one of the two women on whose behalf this case was brought to the Supreme Court, suffering from serious and incurable but non-fatal conditions, the right to choose medical assistance in dying.

According to many experts, their only remaining recourse to meet the bill's final criterion would be to starve themselves to near death, as we have seen people do in Quebec, in order to meet the province's eligibility criteria. I have seen this in action, and it is a dreadful way to die.

Going forward, New Democrats will consult with experts and people affected as we study this legislation very carefully. As Amy Engel wrote, “I want to be someone strong and brave enough to make hard choices. But I want to be fair and loving enough to make the right ones”.

[Adam Vaughan, Liberal, Parliamentary Secretary to the Prime Minister (Intergovernmental Affairs)]

Mr. Speaker, I thank members for pursuing this issue not just from some excellent legal scholarship, and we heard that tonight with presentations from my colleagues, but also talking about the impact their lives have had on how they assess the legislation before us.

I too will reflect on my time on this planet, dealing with the challenges of watching a loved one pass away. In this case it was my mother. It was 20 years ago this past January. After a very determined 15-year battle with cancer, she succumbed. Part of the process involved palliative care at the end, which was excellent. However, it was too much for her at one point and she called her three children around, my two sisters and myself. She said, “Kids, I've had enough.” She pulled her oxygen mask off and said, “Don't revive me. I love you. Goodbye.”

We had been dealing with three or four months, it is almost impossible to measure the time, of watching my mother struggle on to make sure that all the kids were there to say goodbye, and saying goodbye to loved friends and family. Clearly, after 15 years, she had had enough.

We sat there by the bedside and watched as life started to leave my mother's body. For myself, who had been in the city and was taking care of her at the end, most persistently on a daily basis, it was too much for me. I could not take it anymore. I left the hospital room knowing that I had said my goodbyes and this was the end. When I came in the next morning, there was my mother sitting up in bed saying, “Well, that didn't work.” Palliative care continued for weeks afterward. It was a palliative care that got more fragile, more painful, and a greater hardship for her and for us to deal with, but in the end she passed away.

She had a do not revive order. As we talk about this issue, we have found ways in the country before to assist people in making decisions, even when they are not in a place to make those decisions.

That is what we are struggling with today. How do we find a more proactive and more informed way of doing this when different dimensions and different diagnostic tools come into play, and different eventualities are being considered?

What we are trying to figure out here is how to extend the do not resuscitate orders into a new sphere of medical assistance. That is the essence of what we are trying to do. It strays into other areas. I have heard it in these debates that the legislation is fine but it does not do X or it does not do Y, which are really topics for other pieces of legislation. We are not focusing on what we are trying to get done right here.

The bill responds to the Supreme Court, as we are compelled to do constitutionally. I do not resent it. It is an extraordinary responsibility to respond to the Supreme Court when it assesses our laws to be lacking or the needs of our population not being met. What we are trying to do is to get a perfect letter through a defined letter box and making sure it clears that letter box.

People in our country are suffering and families are suffering as we debate this. I appreciate the sentiment from many people in the debate to try to get the legislation perfect. It deserves to be perfect. We all strive to make it perfect. However, we cannot let perfection get in the way of what is needed and what is good. There is goodness in the bill, because it does limit people's suffering. Have we done enough on palliative care? Of course not. Have we done enough on the quality of life? Of course not. Have we done enough on medical research? Of course not.

Death is still a very difficult subject for far too many of us. However, Bill C-14 responds to the court's challenge in a very particular way, and the committee will try to make it better. I trust it will come back to the House with a better bill. I hope we can get the bill to committee as soon as possible so it has the space to work on that perfection, rather than us pursuing our task of trying to perfect the criticism of the bill. We need to get the bill to committee so it can be studied, some of the language refined, some of the opportunities better understood, and some of the restrictions better defined. We need to get it to committee quickly.

However, we have to resist being afraid of this bill because it would start to do things that we have not contemplated, such as the slippery-slope comments we had, where we are worried about what happens with person X and person Y in five and ten years' time if these conditions change. We have to look at the legislation that is in front of us, we have to deliver it to committee with criticisms attached, and then we have to trust ourselves as colleagues, as parliamentarians engaged in this issue, to try to and hope to deliver a better bill for the next reading and then on to the Senate for its work and for its resolution.

Let us not kid ourselves. There will be no bill passed in this Parliament that will not be challenged at some future date at the Supreme Court. There will be no new thinking or new idea or new circumstance that does not demand of us to revisit this bill in one, two, three, five, or ten years from now. We have lived on this planet for thousands of years and never perfected the art of dying. It is a tough issue. It is a hard issue. If we lose sight of the fact that our inability to come to terms with that promotes and prolongs the suffering of individuals, we will have truly failed as parliamentarians. We are being asked to make a tough call. This legislation would define what we think is a good judgment and would define what we think is a good approach to this.

I can hear good ideas emerging. However, the debate being called for by many quarters about improving palliative care did not need this bill for that call to be made. We should have been perfecting palliative care years ago. The call to ensure that vulnerable people are better protected and their quality of life is better protected did not need this bill for that debate to happen. Vulnerable people should have been spoken to and their needs addressed long before this bill was ever presented.

However, to use those as roadblocks to end suffering is unconscionable in my perspective, and we have to respond to the deadline that has been imposed upon us by a court that has already been asked to extend that deadline once and already has referenced the suffering as a reason not to extend it again. We have a duty, and we have a duty tonight and over the next few days to get this bill to committee as quickly as possible, and then to listen to what we have said to one another in these last few hours. I do not think anybody has presented a concern that is not of value and does not inform our ability to talk about this bill in more pronounced ways and more reflective ways, and that is good.

Let us amend. Let us lean into the parliamentary committees that we have here. Let us trust one another to fix good ideas and make them better ideas. That is what the committee process is supposed to be about, and that is something that I trust will happen. Let us measure the impact of this debate through that process and ensure that our voices and the voices of our constituents are heard in this debate and also heard in the legislation as it moves forward. At the end of the day, let us be honest with ourselves. We will be revisiting this issue the minute it gets royal assent. We will revisit it because life brings us these challenges as surely as it brings us death. We have to be, on these sorts of issues, smart enough to trust one another, compassionate enough to learn from one another, and at the end of the day, disciplined enough to ensure that this Parliament works for those who are suffering, those who are vulnerable, and those who want to live out their last few days with dignity.

My mum taught me a lot about life by the way she died, and I am sure it is a story that all of us have learned from loved ones as we have watched them move through very difficult times. However, I also remember my mum saying, as she was sitting there, that she loved us and it was not just her suffering she was trying to manage, it was ours. Therefore, it is not just our difficult decision we are trying to manage here today; it is the country's difficult decision.

I trust all members to take that seriously, but I also trust them to support us as we pursue palliative-care improvement, as we pursue the opportunity to improve the lives of vulnerable people in this country, and as we seek to deliver choice to people about how they move forward, with support when they make mistakes but understanding when they get it right.

I hope we can get it right with this legislation. I hope the committee gets it right, and I hope the next debate about this finds even more consensus.

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

Mr. Speaker, I appreciated the parliamentary secretary's speech. In the Carter ruling of the Supreme Court of Canada when it held up the appeal, it defined a competent adult person as one who clearly consents to the termination of life and has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

In Bill C-14 under proposed paragraph 241.2(2)(d), the legislation specifically mentions that a natural death has to be reasonably foreseeable. I want to know the member's opinion on that specific section of the bill. Does he believe that complies with the Carter ruling and is the government prepared to refer this legislation at some point down the road to the Supreme Court to make sure that we do not have future charter challenges?

[Jean-Pierre Ménard]

First of all, you have to understand the meaning of the Quebec legislation. I was very closely involved in that process. The objective of that piece of legislation is to regulate all of end-of-life care. That legislation does not come under criminal law, but under health. It covers all end-of-life care practices, including palliative care, physician-assisted death, advance medical directives, and so on. The legislation's objective is slightly different from that of the bill we are debating.

Before us is a bill that aims to amend the Criminal Code in the context of physician-assisted death, which was more broadly defined by the Supreme Court than by the Quebec legislation. In terms of equivalence, this bill is not the federal counterpart to the Quebec legislation—that much is clear. The Quebec act has a more restrictive objective.

Furthermore—and I'm saying this with all due respect for the federal legislator—many measures found in Bill C-14 are cut and pasted from the Quebec legislation in certain aspects. That's adequate, as that piece of legislation was not misguided, either. However, the issue you are raising seems relevant to me. To the extent possible, we have to avoid regime duality and Quebec citizens having to deal with two legal standards regulating their decisions once the legislation has been adopted.

If someone wants to have access to assisted suicide, it's impossible under the provincial standard, but it could be possible under the federal legislation. The procedure is slightly different. It is probably important to hold back a bit by stating that the Government of Canada can exempt a province from certain formalities or give it some flexibility when it comes to specific aspects of the legislation. However, in terms of the substance, it cannot go too far, as the intention must be compatible with the Supreme Court's decision, as well as with section 7 of the Canadian Charter of Rights and Freedoms and the rules we are currently establishing in committee.

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

Mr. Speaker, I will preface my comments tonight by saying it is not my intent to offend anyone, but I do believe that this is the time for plain speaking.

This bill is about choices and it is about rights. Although I resent that the Supreme Court has ignored 15 rulings of Parliament that said we did not want to bring in any law on this subject, I respect that we have to bring one in by June 6. Of course, if we do not bring one in, I am not sure that the consequence is worse than this rushed Bill C-14. As I understand it, if we do not bring in legislation, we remain in the circumstance we are today, where there is the precedent of the Carter decision but no law in either direction for or against.

I said that the bill is about choices and rights. First, let us talk about choices. If I want to kill someone, myself, my baby, or someone else, this is a choice I can make today in Canada. Each one has consequences not just for me, but for many others. If I kill myself, my insurance will not pay out, and that will affect my family. They will also deal with, hopefully, the emotional trauma from the shock of missing me.

If I kill my baby pre-term, I have to live with that, and the father of the baby has to deal with it, but otherwise, there is currently no consequence.

If I kill someone else, I risk imprisonment. I understand that the Carter decision is trying to ensure that even people who cannot pick up a gun themselves can choose to get assistance in killing themselves.

However, their choice does have an impact on others. It has an impact on the health providers who are opposed to participating and whose rights of religious freedom and the right to refuse to participate are not adequately protected in this current version of Bill C-14.

It has an impact on the taxpayer, who will be paying for several doctor consults, and if some of the suggested amendments come into place, additional psychiatric reviews or judicial reviews, as well as the drugs to do the deed. When we kill ourselves, we pay for the bullets or the rope.

Let us look at how this legislation addresses the Carter decision. Keep in mind that the Carter decision limited the scope to those who are over 18, terminally ill, and can give consent. I do not see anywhere in the Charter of Rights and Freedoms that we have the right to die, only that we have the right to live, so certainly the Carter decision, in my view, is flawed.

However, the decision limited the scope to those over 18, terminally ill, and with the ability to give consent, so I find it incredible that this bill before us is looking to study extending this right to mature minors, to those with psychological only conditions of suffering, and those who do not qualify as mentally competent to give consent.

I was a youth leader for over 30 years, and I have known young people who broke up with their boyfriends and girlfriends and who took their own lives. These were tragedies that could have been avoided if hope and counsel had been provided. However, there will be many more lives taken before their time if we allow mature minors to ask for assisted death.

This is a dark path. We should not be studying it or even considering it.

With regard to the studies on whether people who are mentally ill should be able to request medical assistance in dying, I am asking that the bill be amended to ensure that it does not provide for that possibility at all.

Many people suffer from depression, but it is treatable. I know many people who take anti-depressants and medications that come with a warning that possible side effects may include suicidal thoughts. If we start killing people who are not actually dying, it is akin to murder.

For those who want to give their advance consent to be killed later, I ask them: why wait? Why not let them choose suicide when they are still able to commit suicide, rather than letting someone do it for them? They are not choosing to commit suicide in the beginning because they want to live as well and for as long as they can. That is why Canada needs good palliative care.

In my riding of Sarnia—Lambton, we have excellent palliative care. St. Joseph's Hospice has a wonderful staff, and we have the co-operation of Bluewater Health, the VON, community care, and so many other organizations, along with palliative care specialists who give the end of life dignity and meaning.

However, because palliative care is not completely funded in Canada, the hospice has to undergo significant fundraising of some $1.4 million each year. Government funding covers only 43% of the costs. Food, building maintenance, program coordinators, day hospice, and crisis support are not covered.

The cost of palliative care at home or in hospice is one-quarter of the cost of palliative care in acute care facilities. However, Bill C-14 would not do what it so simply could: amend the Canada Health Act to make palliative care a covered service so that all Canadians would have the end-of-life care that would cause them to choose life. Yes, of those who have good palliative care, 95% of them choose to live as long as they can and as well as they can. That is something missing in this bill.

Now that we have talked about choices, let us talk about rights. Most people who want to kill themselves can pick up the gun, or take an overdose, or hang themselves, or whatever. We are not talking about a huge percentage of people who cannot pick up the needle or swallow the pill. We are talking about a very slight minority of people. On the other hand, we have millions of health care workers, doctors, and nurses who for reasons of religion or otherwise do not want to participate in the killing of people, yet this bill says nothing about that. The rhetoric when the bill was presented said that health care providers would be able to refuse to participate or refer. However, based on the history of broken promises, I would want to see that one in black and white in the bill to be sure that the intent to protect the rights of health care workers is captured.

Let us move on to the subject of taxpayers' rights. When an individual decides to kill himself, he pays for his own bullets or pills. Now, the bill seeks to transfer that burden to taxpayers, who will have to cover the cost of medical consults and associated administrative formalities. I am opposed to my tax dollars being used to kill people.

I believe that, if people want to kill themselves, they should have to pay for the entire process. Some may say that killing people costs less than taking care of them, but that is a slippery slope, is it not? It creates a situation where we may start calculating the price of keeping people alive. In time, death may become a way to save money.

That was the case in all of the other countries that have implemented similar legislative measures. Belgium, the Netherlands, and Denmark all started out with strict guarantees. However, these guarantees were hard to implement and were eventually set aside.

After that, it became easy and practical to get rid of vulnerable and undesirable members of society. The percentage of deaths rose from less than 1% to 6%. I do not believe that there is enough accountability in this bill and I would like to see improvements made in that regard.

As I said, this bill is about choices and rights. I believe the bill does not do enough to protect the rights of health care workers, the young, and the vulnerable. I believe the choice to kill oneself should come with consequences, which are not well laid out in this bill, such as forfeiting of insurance and the cost of the deed for starters.

I am recommending that the bill be amended in committee to document the protection of health care workers' right to refuse without retribution, to capture the duty of the requesting individual to cover the cost of the process, and to remove from the scope of this bill the studying of mature minors, advance consent, and those suffering psychologically.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you, Chair. There are many questions to ask and a lot of excellent witnesses.

I'm going to focus on Barreau du Québec because you are the first legal organization we've spoken with outside of the justice department.

The Department of Justice and the ministers are quite certain and quite confident that Bill C-14 is charter compliant and fully fulfills Carter. I take it that you are not in agreement with either of those assertions.

You talked about some of this already, so I'll focus on one small aspect in particular.

The definition of a grievous and irremediable condition includes a requirement for the patient to be in an advanced state of irreversible decline. Do you think that this is mandated by Carter and do you think it's an appropriate condition?

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

Mr. Speaker, I fully agree with what the member opposite said about the need for palliative care as an option. Therefore, could he comment on why it is not part of Bill C-14 and why the word does not even appear in budget 2016?

[Jean-Pierre Ménard]

There may actually be all sorts of reasons, moral or other, to think otherwise, but from a strictly legal standpoint, the bill as it is worded creates a very real problem. I am a practising lawyer and I have clients, including groups of disabled individuals. Some of those groups have asked us to consider this scenario. In such a fundamental bill, it is important to generate some legal certainty for Canadians. The standards and the rules of the game must be clear for everyone.

This bill proposes a standard to enable access to medical assistance in dying, but the issue, with all due respect, is that this is not the standard from section 7 of the Canadian Charter of Rights and Freedoms as set out by the Supreme Court in the Carter decision. When a more narrow standard is adopted to cover end of life and similar issues, the problem lies in the fact that a void is being created. In fact, those individuals who do not meet the end-of-life conditions included in Bill C-14, but who do meet the conditions related to grievous and irremediable illness from the Carter decision, want to have the right to access medical assistance in dying. The Supreme Court decision truly applied to those individuals.

The Supreme Court did base its decision on end-of-life criteria. It did not wonder whether the individuals were really at the end of their life. That is not a factor the court considered. It talks about people suffering from grievous and irremediable conditions, some of which may lead to a sooner end of life. When the court gave section 7 all its scope, it did so consciously, I believe, in order to ensure a broader reach than that ensured by the bill.

The problem is that, by setting limits as has been done in this case, there is a risk of overlooking some of the people who have the constitutional right to access medical assistance in dying. This bill will take away that right or force those who want to exercise it to start from scratch again before the courts, so that the Supreme Court would once again fill that void. Two, three or four years down the road, the House of Commons—Parliament—will have to amend its legislation again.

The Barreau du Québec does not feel that this is desirable, especially when it comes to individuals with a grievous and irremediable medical condition who would have to engage in a legal battle again. That is not what we should aim for as a society.

We can agree or disagree. The Supreme Court may have gone too far, but we are talking about the Supreme Court and the law of the land. We cannot ignore this for the sake of other principles.

As for the criterion whereby death must be reasonably foreseeable, we have a similar problem in Quebec, as well. In fact, the criterion whereby the individual must be at the end of their life is also being debated. We are in the process of applying the legislation, and there are issues with this. As the criterion can sometimes be too nebulous, the position may vary from one physician to the next. Some are saying that, to be considered at the end of life, people have to be dying, terminally ill, while others are talking about three or six months. It is clear that reasonably foreseeable death is an excessively vague criterion. For Canadians, it is important that legal standards be clear, applicable and easy to understand for everyone.

We have held a long debate in Quebec to decide whether it was desirable to establish a time frame—such as six months or three months. The issue is that medical science is unable to predict whether the time frame will be three months or six months, depending on the individual. Therefore, we have decided that it would be preferable to give physicians an opportunity to use their discretion.

However, the problem is that, with nebulous criteria, Canadians' rights become more or less elastic, and that leads to problems. Taking into account those problems, as well as the scope of the Carter decision, we have recommended that this criterion simply be removed from the legislation.

[Murray Rankin, NDP, Victoria, BC]

Thank you, Chair.

I want to start with the Barreau du Québec, and particularly with Mr. Ménard, and to thank you very much, sir, for the very helpful testimony that you provided to the Senate-House committee, where you were one of our first witnesses. You were very valuable in explaining the Quebec experience and you've helped a great deal today.

I listened, I confess, in English to your remarks, and I took a few notes that I want to get your comments on.

You spoke about Bill C-14 being too restrictive. You said that the law is not based on the Carter principles, that it can be constitutionally challenged, that it's more restrictive than section 7, and you alluded again to a constitutional challenge. Then you spoke about “reasonably foreseeable” death, the expression in proposed paragraph 241.2(2)(d) that you said should be eliminated from the list of criteria. You indicated that it was too nebulous and that clarity needed to be provided in a definition that was so unclear.

What you've done is given us the same testimony we've heard from Professor Downie, from the east coast, and we'll be hearing on Thursday from the lawyer, Mr. Arvay, who argued the case from the west coast. You've talked to us from French Canada and English Canada.

There seems to be, among a lot of legal experts such as yourself, an acknowledgement that this is simply inconsistent with Carter. I'd like you to elaborate.

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

Mr. Speaker, “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice”, so says section 7 of the Canadian Charter of Rights and Freedoms.

In February of last year, the Supreme Court applied those words to strike down the criminal prohibition against assisted dying.

As a matter of policy, this was a welcome decision. Blanket bans are an ill-advised form of regulating conduct that is not inherently wrongful. The criminal law is a blunt instrument, often imposing costs beyond the benefits it seeks to achieve and it should be resorted to sparingly.

An optimal policy involves nuanced legislation that protects those at risk without preventing others from making their own choices and directing their own lives as they see fit.

In response to the Supreme Court's decision in Carter, the government has drafted Bill C-14. The government states correctly that it is no longer a question of whether to legalize assisted dying but how we should do so. In other words, relitigating Carter is a futile exercise when the Supreme Court has already spoken, unanimously no less.

Still, it remains useful to understand how we got to where we are. If we are to adequately address the court's concerns, we should have a complete understanding of those concerns. Having studied section 7 of the charter in depth, I would like to first briefly explain what the Supreme Court requires of us on this issue.

Section 7 of the charter provides the right to life, liberty, and security of the person qualified by the principles of fundamental justice. A violation of life, liberty, and security of the person is only unconstitutional if there is also an infringement of a principle of fundamental justice.

The court has stated that those principles are to be found in the basic tenets and principles of the legal system. The key principle to understand on this issue is over-breadth, or what we refer to as “minimal impairment” under the classic Oakes test under section 1. If a law infringes life, liberty, and security of the person, over-breadth requires the law to be reasonably necessary to achieve an important government objective.

In Carter, the court first determined that the blanket criminal prohibition against assisted dying engages life, liberty, and security of the person. In the court's words:

Liberty protects “the right to make fundamental personal choices free from state interference”.... Security of the person encompasses “a notion of personal autonomy involving control ...over one's bodily integrity...”.

Second, the court determined that the blanket prohibition was over broad. The purpose of the legislation, as defined by former Justice Sopinka in the earlier Rodriguez decision, was “...the protection of the vulnerable who might be induced in moments of weakness to commit suicide ...”. In the court's view, the absolute prohibition on assisted dying went too far. While protecting vulnerable people is the law's object, it caught people outside of this class: those who are competent, fully informed, free from coercion or duress, yet choosing to end their lives.

We are now faced with new legislation, Bill C-14.

Our first job is to assess whether this legislation meets the criteria set by the Supreme Court. To answer this, we must first assess the government's objective, now a dual objective: one, to provide a means by which those subject to grievous and irremediable suffering can die with dignity; and, two, to protect those who wish to continue to live from coercion or undue influence.

Is this legislation reasonably necessary to effect these twin purposes? The answer is, unfortunately, not a resounding yes. It is a resounding almost.

I have real concerns, for example, that limiting access to those for whom death is “reasonably foreseeable”, however one seeks to define that term, would have precluded one of the applicants in the very Carter decision from accessing the new regime.

There is no evidence presented by the government that limiting access to terminal illness is necessary to protect the vulnerable, provided other safeguards are put in place, and it is an open question whether this provision is constitutional.

As one constituent aptly put it, “What Bill C-14 says is: I can express a desire to die when I'm terminally ill, but if I'm not considered competent, it won't count; I can express a desire to die when I'm competent, but if I'm not considered terminally ill, it won't count.” This should be remedied before we pass this legislation.

The remainder of the law may well fall within a range of reasonable options and therefore be charter-compliant, but that cannot possibly be what we aspire to in the House. We may have been tasked by the court to address the constitutionality of the current laws, but we are tasked by Canadians to go beyond that. The law we put forward should not simply fall within a range of reasonable options. It should be the best possible law we are capable of drafting.

I have met with many constituents over the last number of weeks and months to discuss this issue. In early April, for example, we hosted a town hall on the topic. It is, rightly, a sensitive topic for many.

My constituents' views and opinions have informed the following thoughts, all of which revolve around the importance of choice.

First, my constituents overwhelming favour advance directives. I appreciate that this is a complex area. It is one thing to assess an advance directive regarding a permanent coma and another thing to assess an advance directive regarding differing degrees of dementia. However, simply because a matter is complex or difficult does not mean we should not attempt to address it. I believe we need to look at advance directives more seriously and that many of the worries regarding stale decision-making can be resolved by sunset clause provisions.

As former Chief Justice Lamer said in Rodriguez, the legal system should not deny consent but should seek to ensure that such consent “is as independent and informed as is reasonably possible”. With appropriate safeguards in place, witness requirements, competency assessments, informed consent through advance directives should be respected.

Second, my constituents overwhelmingly favour placing assisted dying within the context of end-of-life health care overall. Under our charter, access to assisted dying cannot depend upon the availability of palliative care, but, as a matter of policy, for there to be a real choice, we should invest significantly in palliative care options. The $3 billion promise for home care investments is a good start, but it is only a start.

Third, choice depends upon competency and capacity. A competent adult should not be defined by age, but by capacity to understand and to choose.

Fourth, a small but vocal group of constituents have asked for choice for doctors, the right to conscientiously object. It is important for the government to acknowledge the deeply held beliefs of some doctors and we must do our best to reconcile those beliefs with the importance of providing access to assisted dying across our country. It is reasonable to respect doctors' choices, at the outset a cautious approach, providing patients with a public list of participating health professionals across the country.

Fifth, and finally, a similarly cautious approach regarding mental health is also warranted. The foundation of the court's decision was autonomy and dignity, and mental illness, including depression, can impinge upon fully informed and free choice. The law does not require anyone to choose life or death, but allows Canadians to make that deeply personal choice for themselves. For some, the right to life precludes assisted dying, but for others, including former Justice Cory, the right to life includes the right to death.

I will support this legislation at second reading and I hope it will be improved at committee.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Mr. Speaker, I thank you for giving me the opportunity to share my thoughts on Bill C-14.

I had the privilege of sitting on the Special Joint Committee on Physician-Assisted Dying. Along with the members of the committee, made up of 11 of our colleagues and five senators, I believe I can say that I was right in the thick of things, when it came to testimonies and opinions from the various stakeholder groups, experts, and everyday citizens.

The debate on medical assistance in dying is an emotional one. That is because it deals with the last of the taboos of any society, namely to plan one's own death and, in a way, to get help organizing it.

Whether you are religious, secular, atheist, philosophically liberal, or ideologically conservative, every opinion on medical assistance in dying matters. In the wake of the Carter decision, the diverging opinions and our deepest moral values now seem to torment us. Either side of the argument on medical assistance in dying is a source both for concern and for hope. This issue leaves no one indifferent, but above all stirs the most sincere and honest emotions.

That is where we run the risk of losing sight of the purpose of the debate. In fact, medical assistance in dying, regardless of our personal values, is not something that any of us must impose on or deny anyone else. I urge all my colleagues to keep in mind that medical assistance in dying is now an individual right recognized by the Supreme Court of Canada, a right that is no one's business but the individual's and, at the same time, a right that does not force anyone to compromise their deepest individual moral convictions.

Morality, taboos, planned death and the emotions this stirs must not cloud the rationale of the Carter decision. If we eliminate our individual morality from the analysis of the Carter decision, then it is rather simple.

First of all, two sections of the Criminal Code are affected, namely section 14 and paragraph 241(b). These provisions prohibit a person from counselling or aiding another person to commit suicide.

Second, as a result of these Criminal Code provisions, a person suffering from a grievous and irremediable illness could prematurely end their life, knowing that no one could help them die when they are no longer able to commit suicide because of the progression of the illness. In short, the prohibition in the Criminal Code provisions I mentioned could lead a person with an irremediable illness to take their own life early, even though they are still enjoying a certain quality of life, because they foresee that they will no longer be able to do so themselves at a later date.

Third, section 7 of the Canadian Charter of Rights and Freedoms states that everyone has the right to life. In Carter, the Supreme Court cited this principle in stating that a person suffering from a terminal illness cannot be deprived of this right. In other words, medical assistance in dying will maximize the time the person has left to live. That is the objective of Bill C-14, which amends the Criminal Code of Canada in order to allow medical assistance in dying.

In its wisdom and with a unanimous decision, the Supreme Court of Canada is showing us the way so that we can amend section 14 and paragraph 241(b) of the Criminal Code, which currently violate the right to life, liberty and security of the person guaranteed by section 7 of our charter.

The principles in Carter that must guide us in developing Bill C-14 are found in paragraph 127 of the decision, a paragraph that I invite my colleagues to read carefully because it will require our attention when we debate this matter.

The Supreme Court of Canada stated:

[These sections] are void insofar as they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life; and (2) 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.

Also in paragraph 127, the Supreme Court of Canada stated:

The scope of this declaration is intended to respond to the factual circumstances in this case. We make no pronouncement on other situations where physician-assisted dying may be sought.

I will support this bill at second reading, but I must confess that I hope the committee can re-examine the bill and try to fine-tune it, because I have some concerns.

For example, this bill may suggest a rather restrictive approach with respect to Carter, especially since the bill contains words that are not in this decision. For example, subsection 241.2(2) states: “A person...[has] a serious and incurable illness, disease or disability”. The word “incurable” never appears in the Carter decision, and that may seem a bit too restrictive.

The bill also refers to an “advanced state of irreversible decline in capability”. The words “advanced” and “decline” do not appear in the Carter decision and could be interpreted as rather restrictive language.

Another one of my concerns has to do with the fact that, right now, this bill seems to disregard any advance requests for medical assistance in dying. Since the Carter decision suggests that there may be other requests in other exceptional circumstances, I believe that it is quite likely that people with a grievous and irremediable medical condition may also experience a deterioration of their cognitive and intellectual faculties.

I think that perhaps the committee should re-examine the possibility of an advance request so that someone with Alzheimer's or brain cancer, for example, is not prevented from giving informed consent to medical assistance in dying the second time because of the deterioration of his or her mental and cognitive abilities.

On page 6 of the bill, in paragraph 241.2(3)(h), it reads:

immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request and ensure that the person gives express consent to receive medical assistance in dying.

It seems that this paragraph is rather strict, given that people who are terminally ill could lose consciousness or that their intellectual faculties could be impaired because they are being heavily medicated. They therefore might not be able to consent to the medical assistance in dying the second time.

Those are some of my thoughts on the bill. I hope that the committee responsible for studying it will reflect on these comments.

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

Thank you, Chair.

Thank you to the witnesses for being here.

I'm sure most of us in this room have experienced saying goodbye to a loved one or a friend. In my 66 years, I've said goodbye to my parents and my in-laws. Whether it's at a young age like my mother, at 47, suddenly in her sleep, or most recently my mother-in-law, it hurts.

My mother-in-law had dementia. She was never in a pitiful state. She lived a very wonderful life of love. We loved her. She was dignified. She was dignified because we gave her that dignity. She was never in a pitiful state. I heard in testimony today that it could be defined as a pitiful state, and in special committee I heard that it's not sensible for somebody to be in an adult diaper in the last year of their life in bed with dementia, but we loved her and we miss her.

We went to say goodbye to her. We were told by her family physician that she had two to five days to live. We asked what sense there was in giving her her meds, her glaucoma drops, her dementia medicine, and whatnot. As a family we said to just stop the medicine and let her go. After three days of staying with her—she was in California—my wife said goodbye. It was a wonderful experience. When we came back, we phoned the rest home: Is she gone? No. The next day: Is she gone? No. When we called the third day, they said somebody wanted to talk to us.

She came back. We had another wonderful year. It was one of the best years we had.

I tell you, we don't know what we're playing with here. We don't know if somebody's going. She missed Dad and she wanted to go. She would have qualified. But she came back, and we had that wonderful year.

Dr. Johnston, regarding putting “nothing compels a physician to” in the preamble, preambles are not usually seen by the court as the guiding principles as they would be if they were actually in the bill. I think all of us have heard from witnesses that the number one issue—and we're hearing it over and over again—is to protect the conscience rights of physicians, nurses, pharmacists, medical practitioners. We need to get it right when we protect vulnerable Canadians and we need to protect conscience rights. The Supreme Court in the Carter decision highlighted that.

The legislation that's proposed in Bill C-14 at this point is silent on that. It's been explained by the minister and the department that it does not say that anyone is forced to participate in this, but it is silent on it. Would it help, instead of having it in a preamble, to actually state in the bill that it would be a criminal offence to force, intimidate, or coerce a physician or health care practitioner, nurse practitioner, or pharmacist to participate against their will?

What we have in the Carter decision is that it was legal to commit suicide, but it was illegal to assist somebody. Carter has said that under certain criteria, you can assist somebody. The pendulum has swung to where the special committee has said you must refer, but the Canadians that I'm hearing from want conscience protected.

My question to you is this: if Bill C-14 were amended to make it a criminal offence to coerce, intimidate, or force a physician, do you think that would deal with the issue as far as conscience protection is concerned?

[Dr. Will Johnston, Chair, Euthanasia Prevention Coalition of British Columbia, As an Individual]

Thank you very much, Chair and members of the committee. It's an honour to be here today.

I am a family physician with 35 years of experience. I deliver babies. I look after people who are at the palliative end of life. I look after people with disabilities who are nowhere near dying. I am perhaps the only person at this table who has conducted capability assessments—about a hundred of them, in fact—with a lot riding on a legal medical assessment of whether the person was capable.

It was with some great relief that I saw that Bill C-14 at first reading, as drafted, took a very careful approach. Far from trying to be groundbreaking or in the van of the entire world in its daring nature, it took a very responsible approach to the many issues in front of us.

I'd like to take a minute to tell you a story about Uncle Matt.

Uncle Matt was a strong older man who was on a hunting trip in northern B.C. He spent two weeks traipsing through the bush, but on the way home, near Chilliwack, he began to suffer weakness on one side of his body. He was having a stroke. He eventually was transferred to Surrey Memorial Hospital and came to my attention 10 days after a feeding tube had been pulled out. His niece contacted me because she was able to discern that he wanted to live. He was able to say “hungry“, “thirsty“, and the niece asked Uncle Matt's daughter, “Why are you not putting that tube back down? We think he wants to live.” Her reply, in part, was “I've been tallying things up, and he wasn't a very nice man.”

The niece and another nephew kidnapped him from Surrey Memorial Hospital and took him to Vancouver General Hospital. The nurse there, although he was able to croak out the word “thirsty“, was aware they did not hold powers of attorney and put him in an ambulance and sent him back to Surrey Memorial. He died.

He died during an emergency hearing that I helped arrange, during which a judge actually issued an order that the feeding tube be put back down, that he be rehydrated, and that his true wishes discerned.

Now, this is not to say that the people who've come to Nino or who have come in front of Françoise are like Uncle Matt, because the people who have self-selected to approach people who are involved with end-of-life planning and that organization have already self-selected to be highly motivated. This is to simply demonstrate that the medical system, as it now stands, consisted for Uncle Matt of doctors who would not listen to the possibility that he wanted to live and was being intentionally dehydrated to death—he had several million dollars' worth of real estate—and that the hospital risk management, such as it was, was more concerned about the hospital not being sued than it was about Uncle Matt's wishes being respected.

This takes me to the point that this bill, 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. I refer you here to the vulnerable person standard, which is being published now and which contains four key elements that should be reflected in this legislation.

This lack of requirement for the two doctors—and I use doctors to mean doctors and nurse practitioners—to deeply engage with the patient begins with the acceptance by the doctors of a written request, which can be created before two witnesses by someone representing the patient who purports to understand the nature of the request. The doctors do not have to meet, nor do they have to assess the motives of the representative. The patient representative and two witnesses must be physically together at some point in time, but a doctor does not have to be present at that time.

The two witnesses are not required to have any understanding of the situation, other than that a request is being signed and dated. The witnesses are not expected to have any knowledge of the patient's decision-making capability or the representatives' motives. Under the draft act, any number of physicians may be canvassed by anyone to find two who approve of death in any given situation.

The factors that are enumerated in the safeguard section of the bill in proposed section 241.2 are in many ways moot. Therefore, I would propose the first amendment of four that I'm interested in proposing, and it is that there needs to be some form of prior review by a third party, such as an independent, objective judge, or some sort of process in which the facts that brought this person to the point of being proposed for assisted suicide or euthanasia could be reviewed.

I can tell you that it is extremely difficult to make these determinations, and I have done it many times. I think that to expect that any two doctors in the medical system could do that is to invite wrongful death. I am sure that in 20 years, as the members of this committee must understand, many deaths will have occurred under the auspices of Bill C-14. I'm sure the members of the committee will want to think that if there are wrongful deaths emanating from this legislation, you did your best to plug the gaps, to fill in the holes, and to make sure that vulnerable people were truly protected. As it stands, the two-doctor standard for assessing consent and capacity, I would suggest, is insufficient, and I think I've been echoed in that concern by others.

My second point is that it seems that Mr. Rankin has the deepest understanding of the fact that a long period of time may happen between the dispensing of the medication and the death of the patient. In that period of time, there is room for abuse, sadly. In Oregon, once the dose is dispensed from a pharmacy, it goes out into the wild blue yonder and is never accounted for again. If the patient struggled and was actually given the dose by someone else, one would never know.

Although Mr. Rankin's insistent questioning on this matter may be designed to lay the groundwork for advance consent to be put in place, I think there's another interpretation that could be taken from his acute observation, and that is on the wording of proposed paragraph 241.2(3)(h), under safeguards, that the physician must

immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request

I would suggest that this wording really should be “at the time of”. Furthermore, why is it not possible for the lethal dose to be dispensed not from a pharmacist to the patient but from a pharmacist to the doctor, so that the doctor could ensure that at the time the lethal dose was used, the elements of consent were there and the capacity was there? This would address the concerns of Mr. Emberley from the pharmaceutical association as well as some of Francine Lemire's concerns.

We have heard four times, I think, from Minister Wilson-Raybould that nothing in this act compels anyone to become involved in assisted suicide and euthanasia. That, I think, suggests that the time may be right for those words to actually appear in this bill: “nothing in this act compels”. That could appear in the preamble. That could appear in another section. I think it would go a long way toward giving that central direction to conscience protection and the protection of professional judgment that is so desirable.

There is another question, of course, and that is the issue of whether we could actually make a simple wording change in the eligibility section of this bill, which would in some ways answer three of the four areas that I've talked about so far. We could actually.... I'm sorry. It's in proposed section 227, a proposed new section of the Criminal Code that deals with exemptions from criminal prosecution for doctors and others who provide assistance in dying to someone who qualifies under the eligibility criteria.

Under proposed subsection 241(2), it is stated that:

No medical practitioner or nurse practitioner commits an offence

There, we could easily say “no specially licensed medical practitioner or nurse practitioner”. This would address several concerns at once. One is that in the eligibility criteria, it is nowhere specified that the person has to have received the services or an offer of services of a multidisciplinary team that could try to address the symptoms that gave rise to the request for death. A specially licensed physician or specially licensed nurse practitioner could be charged with making sure that this had happened.

I think that's worth commenting on further. I've heard it said several times that it was unconscionable that this be left to two physicians who are not charged with making sure that alternatives have been offered, and that could easily be fitted into the eligibility criteria.

I look forward to your questions.

[Françoise Hébert]

I want to step in now and address the second point in our brief, which is advance requests for medical aid to die.

Bill C-14 ignores recommendation 7 of the special joint committee, which would permit advance requests for someone diagnosed with a condition likely to cause loss of competence—for example, Alzheimer's disease. The government is proposing instead an independent study of advance requests, and it may revisit the issue in five years when the bill is reviewed.

Here is our view.

Dementing diseases such as Alzheimer's are terminal. They kill vital brain cells slowly and cruelly. The course of the disease can last up to 20 years after a diagnosis. In the late stages of dementing diseases, the body is alive but the brain is compromised beyond repair. The person has become a shell, living in an advanced state of irreversible decline in capability. It is a pitiable state to be in.

The idea of being demented deeply scares me. I would rather be dead than live the final stages of dementia. We've all heard someone say “Just shoot me” as they imagine themselves severely demented. We foresee the loss of quality in their future life. They foresee the quality of life in their future life, and they beg to be allowed to receive assistance to die if they have by then lost the capacity to make the request. We believe that a valid advance request that includes a specific, independently verifiable description of a future state so devoid of quality that life itself would be intolerable to the individual should survive its author's loss of capacity to request assistance to die.

Some will say this can't work because that person might change their mind, but we posit that when you lose the capacity to make an informed choice about your own body, then you also lose the capacity to change your mind, and your advance request should stand as the last expressed wishes of your competent self.

If my validly written and witnessed advance request describes a state of being so lacking in quality that it would be intolerable to me, and if my description of that state is sufficiently clear that my legal substitute decision-maker and two independent medical professionals can verify that my debilitation has reached the point that I so clearly described, then my advance request should satisfy legal requirements to allow me to receive assistance to die.

Our overall view comes down to this. Bill C-14 must put forward clear rules about who is eligible for assistance to die, but it must do this in a way that respects the autonomy of the individual, in consultation with medical professionals, to decide when suffering has become so intolerable that death is preferable. This can be done in real time, or it can be done in advance through a clear and valid advance request. We beg you not to abandon to a pitiable fate those Canadians who would take the time to draft an advance request for assistance to die should they at some point in the future lose the capacity to make an advance contemporaneous request.

Trust the people who elected you to represent them, and trust the medical profession.

Thank you.

[Mark Strahl, Conservative, Chilliwack—Hope, BC]

Mr. Speaker, it is always an honour to stand in this place and participate in the debate, no matter what the subject matter. There are some debates that are more important than others, and I would venture to say that parliamentary historians will not be poring over the Hansard of the latest budget implementation act in five, 10, or 50 years from now. However, the debate we are taking part in today is not just any debate. It matters. How we as a Parliament, as a group of elected representatives, respond to it will have a profound impact on our society and on the value we place on life in the months and years ahead.

We are here to debate Bill C-14. The short title of the bill is the medical assistance in dying act. I would suggest that this title downplays the decision that we as parliamentarians are being asked to make. Bill C-14 would remove the criminal prohibitions for killing a person, or helping that person kill himself or herself, in certain situations. That is the harsh, stark reality of what we are dealing with in this bill. It is not just another medical procedure that we can sterilize with antiseptic and non-offensive language. This is a serious matter. It will result in a fundamental shift in Canadian society, and making the language more palatable and less jarring does not change that.

We are here because of the Supreme Court of Canada's Carter decision. While the court had previously ruled that the Criminal Code provisions on euthanasia and assisted suicide were constitutional and did not violate the charter, last February it reversed itself and struck down sections of the Criminal Code. It gave Parliament until June to come up with a law that respects its ruling and places restrictions on when and where euthanasia and assisted suicide can take place without criminal penalty.

The Council of Canadians with Disabilities and the Canadian Association for Community Living have produced an excellent commentary on the court's decision, warning that persons with disabilities, including people with serious mental and emotional disabilities, have been put at serious risk. They have also provided these sobering statistics:

...in Belgium, the number of Assisted Suicide deaths has increased an average of 47.77% annually since 2003, and in the Netherlands it has increased 64.13% since 1995, with no end in sight to this increase.

They have called upon Parliament to “place crucial safeguards on the Court’s judgment to limit access to assisted suicide”.

Unfortunately, the joint parliamentary committee report on assisted suicide went the other way, suggesting that doctor-assisted suicide should even be made available to minor children and those struggling with mental illnesses. As a result, Conservative MPs on the committee filed a dissenting report recommending stronger protections for the vulnerable. Thankfully, most of their recommendations have made their way into Bill C-14.

I have heard from hundreds of my constituents who oppose assisted suicide and euthanasia. They fundamentally believe that the Supreme Court's ruling and this bill will lead us down a slippery slope. Some oppose it on religious grounds, believing in the sanctity of life at all stages. Others oppose it for a variety of logical or ethical reasons.

I have also been contacted by some constituents who support the concept of euthanasia in principle and in certain circumstances. Having myself watched a number of family members and friends ranging in age from 13 to 85 die from cancer over the last few years, I understand the desire to ease the suffering of those we love as much as possible at the end of their lives. I believe that, instead of considering euthanasia and assisted suicide as a desired way to provide relief to dying patients, the federal government should be doing more, in concert with the provinces, to promote and expand comprehensive palliative care services right across the country.

Indeed, we voted nearly unanimously for expanded palliative care services and a plan in the last Parliament. During the election campaign, the government promised to inject $3 billion into palliative care. However, its budget did not include a dollar of funding or a mention of it coming anytime soon. The Minister of Health referenced her commitment to palliative care again today in question period. However, words are not enough. We need action, and it should have been a companion to this legislation, not an afterthought.

I want to talk about my main concern with assisted suicide as it relates to this bill and the ruling by the Supreme Court.

We need to continue the national conversation about improving our mental health system of care, which is currently failing too many Canadians. Mental Health Week starts today. The Canadian Mental Health Association is encouraging us to get loud on ending the stigma around mental illness.

Many of us have participated in, and will participate in, events this week to do just that. We put on green ribbons. We have attended champions of mental health dinners. We celebrate those who have spoken out and shared their stories of overcoming the darkness in which they have often lived for years. We beg people struggling with mental illness to reach out. We tell them that help is available, and it is. We grieve whenever individuals take their own life as a result of their mental illness.

Indeed, we have had many debates in the House, with heartfelt speeches by members on all sides, trying to figure out how we can best support those struggling with mental illness. Why did we do that? It is because we believe we must provide hope for those who are suffering. We believe that every life is worth saving and that those with mental illness can be treated, helped, and hopefully made well again.

We are told we should, as parliamentarians, separate assisted suicide from suicide brought on by mental illness. We should not be under the impression that we get to choose whether these two issues will be conflated or not. If assisted suicide becomes normalized, we should not be surprised if societal attitudes on other types of suicide change as well.

I recognize that mental illness is currently excluded from permissible cases for assisted suicide or euthanasia, but the government has said it will be embarking on further studies to look at the unique implications of situations where mental illness is the sole underlying medical condition. Indeed, Liberals mentioned their intention to move forward on this study at the technical briefing on Bill C-14.

Why would the government want to study this matter further if not to bring it forward as a future amendment to the bill? We cannot allow the door to be opened even a crack to allow for those suffering from mental illness to be able to access physician-assisted suicide.

I recently spoke to someone who was diagnosed with bipolar II disorder about the bill. This person attempted to be well with every tool available, and shared the following with me:

My disease is a challenge every single day of my life. Sometimes I work to keep the symptoms at bay from minute to minute. Suffering is a given. And yet, I have much joy and hope, so much to live for. But what if I get really sick, what if I can not manage for an extended period and fall into a deep unbearable depression? Do I need to write an advanced directive to my doctor, asking them explicitly not to allow me access to euthanasia? To ask them to help me fight for my life, even if I can't do that in my moment of total despair?

We need to say it loud and clear that suicide is not the answer for mental illness, whether it is medically assisted or not.

I know that my time is short, so I will move on to another concern I have, and that is the possibility of having two nurse practitioners to sign off on assisted suicide or euthanasia requests for a patient. Nurse practitioners play a vital role in many remote, rural, and northern communities, but when we are dealing with a matter this serious, this permanent, with these types of consequences, I believe that not only should two doctors be required to sign off but that there should be a requirement for a psychological examination or independent oversight from a social worker to be done on patients before they can access assisted suicide or euthanasia.

This would provide an additional level of protection to ensure that patients are truly capable of making decisions with respect to their health and that the request to end their life was not made as a result of external pressure as is mentioned in section 241.2 of the bill.

Finally, Bill C-14 does not enshrine the legal rights of medical professionals such as doctors, nurses, pharmacists, and caregivers to opt out of providing assisted suicide services or referrals if their personal conscience, beliefs, or ethics do not permit them to do so. This is a critical flaw.

As the bill does not adequately protect vulnerable people and does not adequately protect the conscience rights of medical professions, unfortunately, I cannot support it.

[Nino Sekopet, Client Services Manager, End of Life Planning Canada]

Thank you, Françoise.

Thank you for having me here. My name is Nino Sekopet, and I am a psychotherapist retained by End of Life Planning Canada to support people who want a safe place to talk about dying. For four years before this, I played the same role with Dying With Dignity Canada.

I deal every day with the complex and profound topic of the end of life. I see it as a continuum that, unfortunately, consists of two emotionally charged and polarized extremes. We have people who support physician-assisted dying and we have people who oppose it. There is also a vast space in between. Looking through a purely psychological lens, I believe that when we as individuals or as a society stand in either one of those polarizing extremes, deserting the vast in-between space, we miss something very important. We miss the very thing that gives the charge to those polarizing extremes. We fail to recognize the impact on the end of life. We fail to recognize the impact of the fear and insecurity that drives the emotional charge at both extremes.

I believe that if we are able to correctly address the impact of fear and insecurity, and if we do it to the degree that is necessary, those polarizing extremes will lose some of their charge. We will become less polarized. As individuals and as a society, we will become healthier and more willing to consider and accept our differences. We will become more inclusive rather than exclusive. We will become more tolerant.

What I've learned through my work with people approaching death is that clarity is the best way to contain fear and create a space where these patients can feel more secure. Clarity provides a psychological frame within which individuals can rest safely, knowing that they are secure, recognized, and validated. This applies to everyone at the end of life, to all of us. It applies equally to health care professionals, to patients, and to their families.

In my professional opinion, the reasonably foreseeable natural death criterion proposed in Bill C-14 provides little security, little frame of reference. Because of its openness to interpretation, it encourages fear and insecurity, rather than creating space for safety. Removing that criterion from the proposed legislation will restore clarity in line with the Supreme Court's Carter decision. It will benefit everyone engaged in the end-of-life territory, patients as well as health care professionals. It will ultimately benefit all of us as individuals and as a society.

I would like to invite you to step into the vast in-between space and contain the fear of all individuals engaged in end-of-life territory by removing the reasonably foreseeable natural death criterion from the proposed legislation. I invite you to trust the individual who is suffering terribly, and that person's physician, to know when their time has come. By doing that, you will make us all feel safer, regardless of our place on the end-of-life spectrum.

Thank you.

[Françoise Hébert, Chair, End of Life Planning Canada]

Thank you very much.

Thank you, Mr. Chair, for the privilege of appearing before the committee this evening.

I'm Françoise Hébert, chair of End of Life Planning Canada. Before retiring four years ago to become a full-time volunteer, I was the CEO of the Alzheimer Society of Toronto. We actually trained Chief Blair's staff on how to find the poor lost souls who got lost all the time.

My colleague, Nino Sekopet, is a psychotherapist. He is our client services manager. You may recognize him from the current issue of Maclean's magazine, which profiles him as Canada's leading assisted-death counsellor. Nino is the one to call if you want a safe and confidential place to talk about how to achieve a good death, and he is being swarmed by the media these days—his 15 minutes of fame.

End of Life Planning Canada regrets that Bill C-14 is creating certain limitations and conditions that will shut the door to the option of assisted dying for many Canadians who might otherwise meet the criteria set out in the Carter decision.

The Special Joint Committee on Physician-Assisted Dying got it largely right, in our view, and we hope that this committee will agree that strength and gumption are called for when regulating a Charter of Rights and Freedoms issue, even if this means going further than other jurisdictions have in dealing with such a fraught and deeply personal decision as to request assistance to die. Therefore, we beg each of you around this table, as the Supreme Court justices did so well, to imagine yourself with a grievous and irremediable medical condition that's causing you enduring suffering that is intolerable to you. That is the perspective that you need to legislate from.

I'm going to turn it over for three minutes to my colleague, the famous Nino Sekopet.

[Jean-Pierre Ménard, Member, Working Group on the End-of-Life Care, Barreau du Québec]

Ladies and gentlemen, members of the committee, good evening.

The Barreau du Québec is the first intervenor from a province where legislation already exists on medical assistance in dying. The law has been in effect since December 10, 2015. There have already been dozens of cases, and certain issues have begun to arise in applying the law in some situations. To contribute to your debate, we are going to share some of the difficulties we have observed here and there, so that you may avoid encountering the same issues with the federal act. They are not major ones, but we have to be aware of them.

As Mr. Battista said, our first comment concerns the issue of assisting someone to commit suicide. The Quebec legislation does not provide for assisting suicide. We must not forget that the Quebec law is very comprehensive. It covers all of the medical assistance in dying practices that are under provincial jurisdiction. We decided not to include assisting suicide because at the time it was seen as an aspect that was essentially criminal, and the province had no jurisdiction in the matter. The provincial act is an act on care, it is not criminal legislation. Consequently, assisting suicide was not included. However, this will now be made accessible through medical assistance in dying.

We think it is important to think about measures to regulate this that are not contained in the Quebec legislation or any other provincial law. As Mr. Battista pointed out, one of the difficulties comes from the fact that the physician has no control over what happens once he has provided the medication to the patient. He cannot even certify that the patient really did pass away because of that process, nor can he determine when the death occurred. To the extent that the federal law permits assisting suicide, we think it should contain more obligations, such as requiring from those who assist the person that they immediately notify authorities, either the physician or a public authority, that the person has passed away in this manner, so that the proper management of the process may be monitored.

As Mr. Battista pointed out, there is an issue regarding physicians' ethical obligations. There is, for instance, the obligation of following one's patient and not abandoning him. For some physicians, giving a patient a pill and allowing him or her to take it himself is seen as a kind of abandonment. It can also be difficult for a physician to get involved in such a process.

Let's talk about compatibility with the Carter ruling. We should be aware that the impact of the law will in future be measured in light of section 7 of the Canadian Charter of Rights and Freedoms, which is broader in scope than what the bill is proposing. If we adopt more restrictive criteria than what is now allowed under section 7 of the Canadian Charter of Rights and Freedoms, clearly we will be opening the door to legal challenges. The Barreau du Québec feels that it is not desirable that people who could have access to medical assistance in dying under the criteria in the Carter decision, no longer have this access because of Bill C-14. We have seen what happens in Quebec when a more restrictive standard is applied. For instance, some people have stopped eating in order to become eligible under the law. This type of situation, which occurs because of a more restrictive criterion, is not a desirable development. This is important and that is why we made that recommendation.

Moreover, we think that the criterion of reasonably foreseeable death is too vague, too uncertain. It is important for the Barreau du Québec that citizens be able to count on a legal standard that is as clear as possible. The fact that this is highly subject to interpretation, because of the wording, may deprive certain Canadians of the constitutional right to obtain assistance in dying. If we want such a criterion to be present, it is important to develop it more. However, since this criterion does not exist in the Carter ruling, we think that leaving it in the bill will open the door to legal debates. That is why we recommend the pure and simple elimination of paragraph 241.2(2)(d) proposed in the bill.

I'd like to discuss a few more technical situations regarding the safeguards, among others the characteristics of the witnesses. The standards being imposed are so strict that it will be difficult even for the person concerned to find a witness to sign the form. Members of the family and many other people are excluded. We should remember that the witness only attests the signature, nothing more. In any case, the physician is going to have to verify that the patient gave his or her consent freely. I think that too much is being imposed on the witnesses. These criteria would be more appropriate if we were asking for consent on behalf of someone else. But in the case of a simple witness, we think that these measures are far too rigid.

Let's move on to the declaration. Our brief was written from the perspective that a very detailed provincial law exists, and we are adding a federal law. In order to avoid a multiplication of forms and reports, I think it would be important that there be an exception in the bill; when the government is satisfied with the provincial declarations that are required, there should be an exemption in the bill so that physicians do not have to make a host of declarations. An overabundance of paperwork will also discourage a certain number of physicians from doing these things.

In Quebec, the reporting process is already very elaborate. Why should there be an additional report? I think that this will only make the process more cumbersome, unnecessarily. However, nothing prevents federal authorities from requiring that the province provide the information collected through its own monitoring measures. In Quebec, the province monitors medical assistance in dying. We have created an organization specifically for that purpose, the Commission sur les soins de fin de vie, the end of life care board, in addition to the monitoring done by the Collège des médecins and the Conseil des médecins, dentistes et pharmaciens. And so the creation of a new level of monitoring seems superfluous to us. We think you should consider less onerous monitoring measures in the provinces where a law already exists.

Thank you.

[Denis Lemieux, Liberal, Chicoutimi—Le Fjord, QC]

Mr. Speaker, it is a great pleasure to take part in this second reading debate of Bill C-14 on medical assistance in dying in Canada.

I had the privilege of being a member of the Special Joint Committee on Physician-Assisted Dying, and I supported all of the report's recommendations.

However, as many members have acknowledged today, medical assistance in dying is a complex, sensitive, and extremely personal issue.

Ever since the Supreme Court handed down its ruling in Carter last year, Canadians all across the country have been contributing to the discussion. The issue continues to be the subject of serious debate and deliberations all around the world, everywhere from the United States to Europe, Australia, and New Zealand.

In virtually all parts of the world, deliberately ending someone's life and helping someone end his or her own life are serious crimes that carry harsh penalties.

However, as many people know, Canada is not the only jurisdiction to legislate and authorize medical assistance in dying. Four U.S. states, specifically Oregon, Washington, Vermont, and California, along with Colombia, and three European countries, specifically Belgium, the Netherlands, and Luxembourg, have a legislative framework that allows some form of medical assistance in dying.

I listened to more than 60 expert witnesses during the meetings of the Special Joint Committee on Physician-Assisted Dying, and I was deeply moved by the testimony of the Hon. Steven Fletcher; Benoît Pelletier; Jean-Pierre Ménard from Quebec; Dr. Cindy Forbes, president of the Canadian Medical Association; and Dr. Monica Branigan of the Canadian Society of Palliative Care Physicians.

Last week, though, I got a call at my constituency office from Bibianne Gauthier, the mother of Jean Truchon. After our conversation, I was able to put a face to a real request for medical assistance in dying.

After meeting Ms. Gauthier and her son Jean, I decided to share this real case with my colleagues in the House and read the letter that Jean Truchon wrote to his health care team on January 20.

I would like the House to know that I personally got permission from Jean Truchon to read this letter in Canada's Parliament. I am also doing this at the request of Mr. Truchon's parents:

“I am 48 years old and I have had cerebral palsy since birth. I spent 22 wonderful years living in an apartment.

On March 11, 2012, my life was turned completely upside down when the medical team at the Centre hospitalier universitaire de Montréal diagnosed me with inoperable degenerative cervical disc disease. That day, I reluctantly put one foot in the grave and I have every intention of putting the rest of my body there on September 1, 2016. I had to resign myself to living in a home and despite the good care I am receiving and my efforts to adjust to the situation, I simply cannot imagine living much longer under these conditions.

My question is this. Since I believe that I do not meet the eligibility criteria for medical assistance in dying [in January of this year], I intend to refuse to allow the staff to feed me or give me water, as I am unable to feed myself. I am asking that my doctor at the centre be authorized to administer a drug to at least relieve the pain.

I look in the mirror and I no longer recognize the man I once was. That is when I say, ‘What is the use in living like this’. Sometimes I think you do not have be at the end of your life to experience the intolerable suffering that I am currently experiencing. Doctors have told me that eventually I will become incontinent. The thought of it is too much to bear. I still have too much dignity to live like that.

At one point, I was in bed and no one responded when I pressed the call bell. I had to relieve myself in bed. It was then that I understood that life in an institution was not for me. I know that other people living a similar life in similar circumstances make different choices. However, in my case, I made the carefully considered decision that 2016 would be my last year.

I realize that dying before my parents is not the best way to go because it defies logic. However, I cannot take it anymore. My family and my friends are aware of and respect my decision even though they do not agree with it, because they are going to lose me. They understand all my struggles, and I thank them for their understanding.

I have considered a more dramatic form of suicide, but the fear of surviving and being in an even worse condition prevents me from doing it. Furthermore, to ease my family's pain, I am choosing to leave in a more honest manner by having them at my side. The antidepressants I have been offered, together with an explanation of their potential benefits, will never give me back the use of my arms or change the prognosis of physical decline. In good conscience and of my own free will, I have refused the medication, which will not give me back the will to live what would seem like an artificial life.

If this letter results in a more objective awareness of those who are suffering and are not at the end of their lives, I will have achieved one of my objectives.

Since I have no expectations that my case will be eligible for medical assistance in dying, I am also appealing to the CIUSSS bioethics committee to allow my treatment team to respect my choice and to allow me to receive the comfort care and the medication required to alleviate my suffering when I stop my feeding.

Thank you for taking the time to read this letter.”

The letter was signed by Jean Truchon.

This extraordinary 48-year-old man is just one of the faces of medical assistance in dying in Canada, but as I read about Jean's courageous decision, I felt that the committee had made good recommendations in its report.

The Minister of Justice consulted all of the existing legislation around the world to draft the government's legislative response to the Carter decision.

The bill sets three eligibility criteria: individuals must be competent adults who are in an advanced state of irreversible decline; they must have a grievous and irremediable illness or disability, and their medical condition must cause them enduring and intolerable suffering; and their deaths must have become reasonably foreseeable, taking into account all of their medical circumstances.

The bill also has a non-legislative component. It provides for further study of three specific topics: mature minors, advance requests, and mental illness.

I am also pleased to see that Bill C-14 includes solid safeguards to prevent mistakes and abuses. I would like to reiterate them: the patient must get an opinion from two independent doctors and the request must be made in writing; the patient has the right to withdraw the request; there is a 15-day waiting period; and consent must be confirmed immediately prior to the administration of the medical assistance in dying.

In closing, I would like to encourage all members to read the document entitled “Legislative Summary of Bill C-14: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)”, which was tabled in the House by the Minister of Justice. It contains important information on the international laws and regimes that influenced the government's approach to medical assistance in dying in Canada.

The government wanted to learn from the experiences of other jurisdictions. The approach it plans to take is broader in scope than that of the United States, which gives access to medical assistance in dying only to people with an incurable disease. The approach the government is considering gives the option of a peaceful death to everyone approaching the end of his or her life, not just those suffering from incurable diseases. At the same time, it eliminates some of the risks that may be associated with a broader regime. The government has also committed to continue examining these more general issues and will continue to observe what is being done elsewhere in the world in terms of medical assistance in dying.

I urge all members to support this bill and send it to committee, thereby responding to our Supreme Court's request to legislate in this area.

[Raj Grewal, Liberal, Brampton East, ON]

Mr. Speaker, Bill C-14 represents a direct response to the Carter ruling. It sets out a framework to ensure that we have assisted dying in this country within a framework that ensures we protect the most vulnerable people from abuse.

On second reading, the Attorney General said the government will be putting forward, publicly, the documents that examine the charter impact of the bill for all Canadians and this House to look at as well.

We will be working with the provinces and territories to ensure that we have regulations to protect this framework, because this is a very sensitive issue for all Canadians. This bill is a great response to the Carter ruling, and the parliamentary review after five years will ensure that this issue keeps building forward.

[Ahmed Hussen, Liberal, York South—Weston, ON]

With respect to the request for medical assistance in dying, other jurisdictions require more than one request. Bill C-14 requires one request.

How is the medical practitioner supposed to determine if the request is only of a passing nature, if it's only one request? Do you have any views on that?

[Ahmed Hussen, Liberal, York South—Weston, ON]

Thank you very much, Chair.

My question is for Ms. Lemire. Do you have any concerns with respect to whether patients will have any difficulties accessing medical assistance in dying as it is provided under Bill C-14?

[Raj Grewal, Liberal, Brampton East, ON]

Mr. Speaker, I rise today to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.

I would like to start by saying that I value and recognize the deeply personal and difficult nature of this topic for many across our great nation. We all know at least one person who has passed, or may pass, in intolerable pain. It is difficult for families to witness their loved ones suffering, but more so for the patient who has no control over his or her situation and believes he or she should have a choice for a peaceful death. This, my friends, is the reason we need to have this discussion and pass this legislation.

Many of our colleagues on both sides of the House and in both chambers have worked diligently over the last few months on the Special Joint Committee on Physician-Assisted Dying in order to help create a comprehensive framework that upholds the essence of the Supreme Court's decision as a result of the Carter case. This decision balances different interests and protects vulnerable persons. I would like to thank all of our colleagues on the joint committee, their staff, library analysts, the clerk, and all of the witnesses who appeared and sent briefs to the committee.

This is not an easy topic on which to give, hear, or read testimony day in and day out, and for many it can take an emotional toll. At the same time, witnesses who contributed to the consultations should be commended for being a valuable part of Canada's history, as we shape this nation's law to allow our citizens to die with dignity.

Just last year, a provincial and territorial advisory group on medical assistance in dying was established, with most provinces and territories participating, led by Ontario. This shows the need for and interest in adapting our laws to allow for death with dignity.

Included in this report is the unequivocal call for amendments to the code to allow for assisted dying by regulated health professionals and to protect these professionals while they do it. We look forward to working with these territorial and provincial partners. It is also why, as part of our budget, we have put a multi-year health accord forward, with the federal government's commitment to providing $3 billion over the next four years to improve home care and palliative care.

On February 6, 2015, the Supreme Court of Canada unanimously declared that the Criminal Code prohibitions against physician-assisted dying were unconstitutional when considering competent adults who clearly consented to die, who were suffering, and where death was reasonably foreseeable. I would like to quote a vital part of that SCC ruling. It states:

It is a crime in Canada to assist another person in ending her 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: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.

This highlights the core of this issue, and the special joint committee showed it understood the Supreme Court's points. The report of the committee illustrates this, and I will quote from it. It states, "Our response to the Carter ruling must be focused on the needs and wishes of patients. The Committee was unanimous in recognizing the overarching need to have safeguards to protect the vulnerable.”

Therefore, the objectives of this legislation are comprehensive and adequately balance all the core elements of the discussion on this topic, some of which are: recognizing personal autonomy and dignity; recognizing inherent and equal value of every life; setting out eligibility for competent adults where death is reasonably foreseeable and who are suffering intolerably; balancing different interests, including personal autonomy toward the end of life and the protection of vulnerable persons; and encouraging a consistent approach across Canada.

Bill C-14 incorporates the points made by various stakeholders, including doctors and nurse practitioners, patients and families, civil rights groups, leading experts, faith-based groups, provincial and territorial governments, and more.

To enable access to medical assistance in dying, the Criminal Code will be changed so physicians, nurse practitioners, and those who help them can provide eligible patients assistance in dying without the risk of being charged with assisted suicide or homicide. There will be safeguards to ensure those who receive medical assistance in dying are eligible, can give informed consent and can voluntarily request it. The foundation will be laid for the Minister of Health to make regulations to establish a process for monitoring and reporting on the use of medical assistance in dying. It is crucial that the ability to provide assistance in dying is not limited to physicians.

Nurse practitioners are an important part of this framework if we are to provide all Canadians with equitable access to a peaceful death. Nurse practitioners have the authority to deliver many of the same medical services as family physicians. They can assess, diagnose, prescribe and treat patients. They can act independently in every jurisdiction, except Quebec, where they practice under the authority of a physician. That is why they are covered under Bill C-14.

In order to ensure the safety of all vulnerable persons, we have included the following safeguards that must be respected: a medical opinion to ensure the patient meets all of the established criteria; a second independent medical opinion; a request in writing or by proxy before two independent witnesses; the right to withdraw the request at any time; a 15-day waiting period, unless death or loss of capacity is imminent; and, consent must be confirmed immediately before medical assistance in dying is provided.

As a government that values the power of evidence-based decision-making, the provisions regarding monitoring will be critical for transparency and public accountability of medical assistance in dying, as well as to evaluate whether the law is achieving its goals of respecting the autonomy of eligible persons to choose medical assistance in dying while protecting vulnerable persons and the conscience rights of health care professionals.

Nearly all jurisdictions that permit a form of medical assistance in dying have established monitoring systems for these purposes. The government would work with the provinces and territories in developing these regulations and in establishing an interim system until a permanent process is in place. As the legislation stipulates that there must be a parliamentary review in five years, the data collected from monitoring will be essential to improving the law.

There are those who say this legislation does not go far enough. We have listened carefully and appreciate their input and passion for a thorough framework for medical assistance in dying. It is their tireless advocacy which will ensure that we have the best possible legislation regarding this very sensitive issue.

With that being said, at this time not enough is known about the risks or benefits of medical assistance in dying for minors. We could certainly use more time to study this, as well as advance requests when mental illness is the sole underlying medical condition for requests.

These are important parts of the issue that cannot be written in hastily. They will be studied independently once this bill is passed so we meet our responsibility as a government to protect all vulnerable persons from any potential abuses or error.

To conclude, we do not have an easy task ahead of us. However, most things worth doing are not easy. We each have been elected to make difficult decisions and work hard to do what is best for our constituents and all Canadians. Canadians have spoken loudly on this issue, and we know that a majority of them support medical assistance in dying. We owe it to them to vibrantly debate and pass this legislation in order to allow Canadians a choice in how they end their lives.

[Philip Emberley, Director, Professional Affairs, Canadian Pharmacists Association]

Thank you very much, Mr. Chair, and also the committee, for inviting us to speak today.

First I'd like to acknowledge the difficult task you have before you. The final legislation must strike a balance between the needs of patients, the right to access, and ensuring that health care providers are fully equipped to deliver quality care regardless of the setting.

This is a very complicated and emotional issue for many, and one that has dominated much of the profession's discussions over the last year. Very early on in our discussions within the profession, it was clear there was an important role for pharmacists as the dispensers of the lethal dose of medication for assisted dying. Over the past year, we've worked with our members to understand the impact of the court's ruling and their views on the issue. We did this through an extensive survey of pharmacists and through the development of guiding principles, which we released in February.

Pharmacists are keenly aware of their role as a primary health care provider. They are consistently rated as one of the most trusted professions and they are often the first point of contact within our health care system.

We're already hearing stories of community pharmacists being asked questions about assisted dying. As a profession, we've been very encouraged to see the conversation around assisted dying expand from what was solely seen as physician-assisted dying to what is now called medical assistance in dying. This acknowledges that, like any other health care service or procedure, assisted dying involves a much larger team of health care professionals.

However, we must also appreciate that Bill C-14 is only one component of Canada's legislative response to the Supreme Court's decision and that many important practical considerations will be left up to the provinces and territories to address. This will require additional practice guidelines and regulations.

Generally speaking, as it is drafted now, we believe that Bill C-14 appropriately recognizes the role of pharmacists and protects those pharmacists who choose to participate from any criminal liability that could result from dispensing a lethal dose of medication.

I'd like to make some comments on some of the specific provisions in the bill.

First, it is important to note that under proposed section 241.1, medical assistance in dying is permitted in two instances: it can be administered directly by a physician or nurse, or it can be self-administered. This has significant implications for the role that pharmacists might have to play in assisted dying. In particular, in the case of self-administration, we see a far greater role for pharmacists, who may have to dispense the drugs directly to the patients. It's conceivable that this could be the last interaction between the patient and a health care professional prior to death, so we are pleased to see that proposed subsection 241(4) of Bill C-14 specifically exempts pharmacists from criminal liability if they dispense a substance to a person other than a medical practitioner or nurse practitioner.

We are also very supportive of proposed subsection 241.2(8), which requires that the medical practitioner or nurse practitioner who prescribes the substance inform the pharmacist that the substance is intended for that purpose. This is something we specifically called for, and we are pleased to see it reflected in legislation.

In addition to the specific provisions we've highlighted, we also want to draw your attention to two key elements that are not provided for in legislation but that we feel are equally important. Although we are not proposing any amendments to the legislation, we are hopeful that the federal government will work with its provincial and territorial counterparts, as well as stakeholders, to address these issues in the coming months.

On the issue of conscience, we strongly believe that pharmacists and other health care professionals should not be compelled to participate in assisted dying if it is counter to their personal beliefs. The legislation does not set out whether or how health care professionals can refuse a request. This leaves protection of conscience for health care professionals, including pharmacists, up to the provinces and to professional regulators. In addition, and to ensure that freedom of conscience is respected, pharmacists should not be compelled to refer the patient directly to another pharmacist who will fulfill the patient's request. This is an important consideration for pharmacists who view referral as morally equivalent to personally assisting a patient to die.

To provide equal protection of a pharmacist's right to conscientious objection and a patient's right to access, CPhA recommends the creation of an independent information body with the capacity to refer to a participating pharmacist, and we urge the federal government to work with the provinces and territories to create and implement such a system.

The second issue that is particularly relevant to pharmacists in their day-to-day practice is the question of drug access.

There is no single medication or drug that exists to end someone's life. Rather, it can be a cocktail of medications that could be administered by someone or self-administered. Depending on how it's administered, different drugs could be used.

Of great concern to pharmacists, who are all too familiar with issues of drug availability and accessibility, is that the drugs in question are in some cases not readily available in Canada. There is still some work to be done to understand which drugs might be most effective in assisted dying. Evidence shows that high doses of barbiturates are usually effective for death when self-administered, while a combination of barbiturates and a neuromuscular blocking agent is more appropriate for physician- or nurse-administered injection.

To give you an example, in Oregon, where drugs for assisted dying are solely self-administered, one of two barbiturates is used, neither of which is currently available in Canada. It is critical for Health Canada, as the regulator of drugs, to ensure that whatever drugs are recommended be available and accessible to patients and their health teams. We welcome the opportunity to work with them to address this issue.

In conclusion, we urge that this legislation be passed quickly in order to ensure that there is a framework in place by the June 6 deadline and to allow the provinces and territories an opportunity to develop appropriate practice guidelines and regulations. Over the coming months, our provincial pharmacy associations will continue to work with their respective regulators to ensure that appropriate practice guidelines are in place.

We thank you again for the opportunity to appear and we look forward to answering your questions.

Thank you.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, as I rise today to speak about the grave implications of Bill C-14, I am reminded of the Yiddish proverb, which says: “From fortune to misfortune is a short step; from misfortune to fortune is a long way”. I am afraid that the legislation being brought forward by the current government is a short step to misfortune, and the path with proper safeguards would be a long one.

This is a difficult subject, but the floor of the House of Commons was made to debate weighty subjects, to define how we live in our Confederation, to seek out the objective truth, and to legislate wisely.

However, the House has addressed the issue several times over the last decades. In 1983, the Law Reform Commission of Canada recommended against legalizing or decriminalizing euthanasia or assisted suicide. In 1993, the Supreme Court dismissed the challenge by Sue Rodriguez on the Criminal Code prohibition of assisted dying. In 2006, Bill C-407, a bill that would have allowed physician-assisted suicide in certain circumstances, died on the Order Paper in that Parliament. We can see in the chronology the hesitancy to legalize assisted suicide, and for good reason.

Bill C-14 would impact how Canadians view the worth of their lives and the lives of their loved ones. The safeguards we put in place must protect Canadians from abuse when it comes to physician-assisted suicide, and that is something all Canadians can agree on. We must ensure that, as far as possible, the legislation we craft mitigates the harm inherent in legalizing the killing of human beings.

Additionally, I remind my fellow parliamentarians that the ruling of the Supreme Court in Carter v. Canada directly contradicts the Supreme Court's 1993 decision in Rodriguez v. British Columbia. In that ruling, the Supreme Court was clear when it stated that section 241(b) of the Criminal Code of Canada was in fact constitutional. It reads:

Every one who...

aids or abets a person to commit suicide,

whether suicide ensues or not, is guilty of an indictable offence

At that time, it was ruled that the Canadian Charter of Rights and Freedoms confirmed its legality.

Millions of Canadians believe that the Supreme Court erred in its interpretation of sections 1 and 7 of the charter. Despite this, I recognize that the court made a unanimous decision. Therefore, the question before us is no longer whether assisted suicide should be legalized or not, but rather to conform with the Carter decision in what the contents of the legislation should be, as well as the safeguards. That is the matter before us.

Many of my constituents have reached out to me with concerns about the direction that this legislation is taking. Bill C-14 would fail to provide stringent limits. It would fail to keep the deadly wolf of abuse and misapplication at bay.

Constituents like Alexia Blackwell wrote to me that, “Legislation must clearly spell out the protections provided by the Charter of Rights and Freedoms so that caregivers and their organizations will be protected from coercion or discrimination.”

Canadians must have access to palliative care before and alongside physician-assisted suicide so that their first end-of-life option can always be a peaceful, compassionate, and natural death.

Palliative care provides compassionate and ethical end-of-life care for those suffering intolerably as a result of a grievous and irremediable medical condition. It must always be presented as an alternative to physician-assisted suicide.

I would also like to note that in 2014, the House voted in favour of a motion brought forward by the hon. member for Timmins—James Bay, which read:

That, in the opinion of the House, the government should establish a Pan-Canadian Palliative and End-of-life Care Strategy...ensuring all Canadians have access to high quality home-based and hospice palliative end-of-life care...

That is the sort of care we should be working towards.

A very important safeguard, and one that I feel has only been partially addressed by the bill before us, is the conflict of interest that is bound to arise if we do not ensure that physicians are prohibited from benefiting directly or indirectly from recommending or performing physician-assisted suicide. I say this because, like millions of Canadians, I firmly believe that no person in Canada should profit from death. Since physicians in Canada are paid directly by their provincial health authorities, they cannot be placed in a situation where helping a patient choose physician-assisted suicide, or an extensive palliative care plan, or a chronic disease plan could be influenced by a consideration of monetary gain.

Similar prohibitions on physicians profiting for performing the physician-assisted suicide procedure exist in other jurisdictions that have now legalized the procedure, including Germany, Switzerland, and Oregon. These laws exist for good reason. As much as we may not like the idea, it is possible for unethical physicians to promote the idea of assisted dying over other health care alternatives if they stand to benefit from it.

The Dutch government, concerned over accusations that the practice of euthanasia was being abused, undertook studies in 1990, 1995, and 2001. Physicians were guaranteed anonymity and immunity from what they revealed in regard to violations of the guidelines. Therefore, the findings of these studies are indicative of what was going on in the practice of their profession.

It quickly became apparent that half of Dutch doctors had no hesitation in suggesting that their patients consider euthanasia, which compromised the necessary voluntary nature of the process. In addition, 50% of these cases were not reported, according to a study by researchers from the University of Ghent in Amsterdam.

Even more alarming was the fact that a quarter of the physicians said that they were terminating the lives of patients without an explicit request from the patient. Another third of the physicians said that they could conceive of doing so; they were not just thinking that they could do so.

We must not be naive about the possibility of coercion. That is why I am asking the government to amend paragraph 241.2(6)(b) and delete “other than standard compensation for their services relating to the request”, thus making the assisted-suicide decision and the provision free of any financial consideration.

Another issue I have heard brought up frequently is the lack of definition for the phrase “intolerable suffering”. I have heard a lot of talk about this particular issue. Should the definition of suffering include those struggling with mental illnesses, those struggling financially perhaps, or those who suffer from intense boredom? We should be protecting people from their suicidal desires rather than enabling them. After all, is that not the whole point of the excellent mental health initiative called Bell Let's Talk campaign, which we all support?

We cannot simultaneously work to end depression and suicide while also creating legislation that would allow people to request assisted dying simply because their situation has led them to consider their personal suffering intolerable or their death reasonably foreseeable. Realistically, this would fundamentally change the practice of psychiatry, the central focus of which is to develop good mental health that prevents suicide and shows persons the value of living and the inherent dignity of their condition.

Considering this incoherency, we must ensure that requests for physician-assisted suicide are considered objectively by a judicial review body that ensures the request is voluntary, well considered, informed, and consistent over time. This regulatory body must ensure that consent is actually being given by the patient requesting the physician-assisted suicide, and that all requests are reported to this body. The need for this sort of regulatory body is evident when we consider other jurisdictions where physician-assisted suicide is legal.

According to a study published in the Journal of Oncology Practice, over 500 people in the Netherlands are euthanized involuntarily every year. In 2005, a total of 2,400 deaths by euthanasia or physician-assisted suicide were reported, representing 1.7% of deaths in the Netherlands. There were 560 of these deaths that occurred without proper documentation of consent. In Belgium, the rate of euthanasia deaths that occur without explicit consent is three times higher than it is in the Netherlands.

Speaking of ambiguous requirements, it is the inevitability of life that it must end. From the moment we breathe our first breath outside our mother's womb, it is reasonably foreseeable that we will die. That is another vague, confusing term that at best fails to provide any meaningful guideline for physicians or their provincial colleges as they evaluate individual requests. Another vague term is the definition of medical practitioner as a person entitled to practise medicine under the laws of a province. This is problematic because that definition changes from province to province. In my home province of Alberta, it includes osteopaths, also known as chiropractors.

When deciding whether to provide assisted dying, physicians can follow their conscience without discrimination. No one should be compelled or coerced to provide assistance in suicide. I held a round table last week with participants who were for and against assisted suicide. I asked the question, regardless of whether people were for or against, what part of the bill they believed was most critical. They said it was protection for conscience. The people want an extension to protect the ability for people to say no based on moral and ethical grounds.

We must be very careful that Bill C-14 will not force Canadian physicians with deeply held religious, moral, or ethical beliefs about the sanctity of human life to go against both their conscience and the Hippocratic oath. I believe that section 2 of the Charter of Rights and Freedoms that protects freedom of conscience and religion, as well as freedom of thought, belief, opinion, and expression applies here. Further, what is the point of any of these rights if we cannot express them through action or inaction without state coercion?

I could go on about the ways that Bill C-14 would go far beyond the recommendations of the Supreme Court, how it lacks the strict safeguards referred to in Carter, or the broadly worded definitions that are a problem. I could speak of the irresponsibility of poorly defining the person who is eligible to undertake or to perform assisted suicide.

This bill is based on badly reasoned and inadequately researched recommendations from a committee that failed to seek proper input from a broad diversity of Canadian beliefs and opinions. The National Assembly of Quebec got it right by allowing for six years of debate, through three different assemblies, to study and consider all of this.

To finish, I urge the government to move significant amendments to this legislation or drop this bill entirely and table a better one. The path back from the misfortunes of this bill is too significant to get it wrong.

[Dr. Francine Lemire, Executive Director and Chief Executive Officer, College of Family Physicians of Canada]

Thank you very much.

The College of Family Physicians of Canada is the national body responsible for establishing the standards for the training, certification, and lifelong education of family physicians. In this regard, we do welcome Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts.

We're pleased that the bill represents a prudent first step. We believe that the medical community is being given a reasonable opportunity to familiarize itself with the new changes and accommodate accordingly. It has been noted that medical assistance in dying has not been a reality for nearly every physician currently practising in our country, but will be a feature of our health care system starting in June.

As family practice is frequently the point of first contact with the public in our health care system, family doctors are often the first to witness how medical decisions that have legal implications can affect patient care decisions. Further clarification is required regarding the eligibility criteria for accessing assisted death, particularly the requirements for eligible patients who are facing a natural death that is reasonably foreseeable. For example, a progressive multiple sclerosis patient might fit the criteria of having an incurable disease and being in a state of irreversible decline and suffering, but the timing of foreseeable death might be difficult to determine. Some specificity around this criterion is needed.

There are also questions regarding the subjective interpretation of what could be considered physical or psychological suffering that is intolerable. As family doctors we witness every day in our practices that there are varying degrees of what is considered intolerable pain or suffering. Depending on the patient's threshold, tolerance can vary greatly.

Complex health issues such as physician-assisted dying and abortion require a level of protection for the privacy of not only the patient but also the health professionals providing these procedures. To ensure a level of security for the provider, names or information about those assisting in the procedures should not be released to the public or the media. Physicians and other care providers, such as nurse practitioners, should feel safe and secure when they care for patients.

In providing medical aid in dying to a patient with a long-standing relationship, a provider should not feel under pressure to do so for other patients under the same or other circumstances. Every case should be considered on its own merits.

The CFPC would also like to see further clarifications regarding the criteria for consent. What occurs if a patient provides a voluntary request for medical aid in dying, and during the defined waiting period of at least 15 clear days, their mental capacity deteriorates unexpectedly to a point where they're no longer able to reaffirm the request for assistance? Clearer guidelines on how to assist a patient without abandoning their needs should be outlined.

Clarity of process and resource availability will be crucial for physicians and their patients, as well as an understanding of criteria, when providing physician-assisted dying. There need to be assurances that a physician's conscientious objection will be considered and balanced with both the rights of the provider and the necessity of ensuring that patients are not abandoned when they are most vulnerable.

Regardless of any legislation created, physicians must be cognizant of the scope of their responsibility in providing care to a patient. The CFPC maintains that family physicians should, above all, remain committed to their relationships with patients and their patients' loved ones during this last chapter of their lives. Recognizing that those who have serious illness or disabilities and those who are dying are among their most vulnerable patients, family doctors are health advocates on behalf of such patients.

We also place great value on palliative care. The college will continue its work in fostering high-quality palliative care within the scope of comprehensive continuous care provided by family doctors, including those with enhanced skills in this area. We believe that Bill C-14 would benefit from having the support of a national palliative care strategy. Although a small percentage of Canadians may request medical aid in dying , everyone in Canada will likely need to access palliative care. No matter where one lives in the country, one should have access to high-quality palliative care towards the end of life.

My colleagues who helped me prepare this brief suggested that at this point I provide a real-life story.

I'm often asked whether any of my patients have asked me for medical aid in dying. The reality is that no one, to this point, has asked. I believe part of the reason is that they did not know it was going to become a reality.

The only person who asked me is my own mother, in May of 2013. She was a “super senior”, to quote Mr. Housefather. She was 94 years of age, with terrible mixed arterial and venous insufficiency in her legs, ulcers, and terrible pain, which morphine treated by making her a zombie and for which anything less did not do the job. At that time my mother asked me whether she could get medical aid in dying, and at that time she would have met the criteria for medical aid in dying.

We fast-forward three years, and this diagnostic test that she had, an arteriogram, in fact was therapeutic. Her ulcers are now healed, but she has declined cognitively. She's quite limited. She really is a frail elderly person, and I'm not sure that today she could articulate those kinds of wishes, although it could be said that she has a degree of existential suffering.

If we were to ask her today, she probably would accept that Mother Nature should run its course. I think that as we move forward with this legislation, we need to accept that three years ago we might have done assisted dying based on the conditions my mother had at that time and she might have died, even though we know that she is now alive. I think we need to feel comfortable with that. In the same way, we need to feel comfortable thinking of my mother today at 97 as a frail elderly person who's prepared to wait for Mother Nature to run its course without necessarily making the same request. Even though the quality of her life, by some standards, could be viewed as not the best, by her own standards it's probably okay. We need to think about all these things as we think about this legislation.

We look forward to continuing to offer our advice and perspective as the legislation takes shape.

Thank you very much.

[Dr. Karen R. Cohen, Chief Executive Officer, Canadian Psychological Association]

Thank you.

Good evening. Thank you, honourable members of the committee, for giving the Canadian Psychological Association the opportunity to speak to you this evening about Bill C-14.

The CPA has two specific concerns with the bill.

The first concerns the role of health providers in end-of-life decision-making. The second concerns the assessment of a person’s capacity to give consent to end his or her life, particularly when a psychological or cognitive disorder is concomitant with a grievous and irremediable physical one. Accordingly, we have three recommendations that we're asking you to consider.

Proposed subsection 241(1) notes that it is an offence to counsel a person to die by suicide and to aid a person to die by suicide. Proposed subsections 241(2) and 241(3) appear to exempt practitioners from the provisions of proposed subsection 241(1) if they provide medical assistance in dying or aid a practitioner in providing medical assistance in dying.

The CPA's concern is that the exemptions articulated in proposed subsections 241(2) and 241(3) appear relevant to aiding a person in dying but not to counselling a person about an end-of-life decision. While proposed subsections 241(2) and 241(3) appear to exempt practitioners for involvement in the act of dying itself, regulated health providers will reasonably be involved in decision-making before any end-of-life act is carried out. Psychologists would be among the health providers who might assess a person’s capacity to give consent to medically assisted death. Psychologists would also be among the providers to whom persons with irremediable conditions might bring their end-of-life concerns.

It is important that persons who are considering hastening death have the opportunity to bring their concerns to a trusted regulated health provider if they so wish. It is equally important that a regulated health provider who enters into an end-of-life discussion or consultation with a patient also be exempt from proposed subsection 241(1).

Our first recommendation is for an additional exemption that stipulates that no regulated health practitioner commits an offence if they assess a person’s capacity to give consent to an end-of-life decision and/or provide counselling regarding end-of-life decision-making issues at the request of a person with a grievous and irremediable condition, or if they aid a health practitioner in the assessment of a person’s capacity to give consent to an end-of-life decision and/or in the discussion of an end-of-life decision for a person with a grievous and irremediable condition.

We also want to note that the word “counsel” in English, as used in proposed paragraph 241(1)(a), has both legal and profession-specific meaning. Mental health providers such as psychologists can be said to regularly provide counselling to their patients. In this sense, “counsel” has a very different meaning than the one intended by proposed paragraph 241(1)(a).

Our second recommendation is that proposed paragraph 241(1)(a) be revised such that “counsels” is replaced by “persuades or encourages”. It would then read “persuades or encourages a person to die by suicide or abets a person in dying by suicide”.

Finally, the CPA was also concerned that the bill is silent on how capacity to give consent should be assessed. While in many instances it may be straightforward to ascertain that informed consent can and has been given, there may be times when it may not be. Examples might be when a patient has a cognitive or psychological disorder concomitant with a grievous and irremediable physical one. The concomitance of a cognitive or psychological disorder with a physical one occurs commonly.

The CPA's submission to the expert panel that reported to the parliamentary panel made the following point, which I quote:

...the global experience of suffering, including suffering due to physical symptoms, is much more pervasive among terminally ill patients who are depressed than among those who are not depressed.... In the Netherlands, Dees [and his colleagues] have reported that only patients with a comorbid diagnosis of a mental disorder suffer unbearably all the time. Hence, it is likely to be a common scenario for depressed terminally ill patients to make requests for assistance in ending their lives. To prepare for this, legislation should be informed by certain clinical realities.... A mere diagnosis of a depressive disorder does not necessarily mean that someone is incompetent to make critical health decisions. Especially severe depression, however, may result in negative attitudinal biases that distort rational decision making around medical aid in dying....

The assessment of a person’s capacity to give informed consent, particularly when that person has a concomitant psychological or cognitive disorder, must be left to those regulated health providers with the training and expertise to undertake these kinds of complex assessments.

It is CPA's view that psychologists, along with physician specialists such as psychiatrists and neurologists, have the necessary training and expertise.

Our third and final recommendation is that a new provision be added under “Safeguards” as subparagraph 241.2(3)(i), as follows:

ensure that when a person presents with a grievous and irremediable medical condition concomitant with a cognitive and/or psychological one, the person's capacity to give consent be assessed by a regulated health provider whose scope of practice includes the assessment of cognitive and/or psychological conditions.

On behalf of the CPA, I thank you for your important work in the interests of the Canadian public. I'd be glad to answer any questions about our submission.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Madam Speaker, I appreciate this opportunity to discuss the Government of Canada's commitment to establish a framework for medical assistance in dying.

On April 16, I hosted a town hall meeting for the residents of Don Valley East on this matter. As we know, this is a very emotional and personal matter. It was important for me to listen to my constituents' concerns and to ensure that their concerns were heard. Some of my constituents wanted dementia and Alzheimer's to be included, others wanted advance directives, and some wanted protection for the vulnerable.

In order to ensure that there is no confusion on what this bill is all about, I am taking this opportunity to speak on the matter.

Being part of the Abrahamic tradition, I had to park my own beliefs and listen to my constituents and ensure, as a parliamentarian, a balanced approach. Some of my constituents thought that this bill does not go far enough. Others felt that we should not allow it. To help my constituents have a say in this matter, I have asked them that when this bill goes to committee to make a submission to the justice committee.

The Supreme Court of Canada's decision in Carter has significant implications for provincial and territorial governments, and touches many Canadians in a very personal way. A number of individuals have already been granted exemptions by provincial superior courts to access medical assistance in dying. This is in keeping with the conditions set out by the Supreme Court's decision to extend the timeline for its ruling to come into effect to June 6, 2016. It is now time for us to establish a legislative framework for medical assistance in dying to legally become part of the options available to Canadians at their end of life.

Bill C-14 would provide Canadians with greater autonomy over their health care at the end of life, while also providing protection to health care providers and to individuals who may be vulnerable. It would provide provinces and territories with a strong foundation for implementation.

Canada is not the first to implement medical assistance in dying. In Europe, for example, three countries have legislated access to medical assistance in dying: Belgium, the Netherlands, and Luxembourg. In the United States, four states have legislated access.

Where Canada is unique is in the jurisdictional complexities we face. In Canada, the federal government has exclusive jurisdiction over criminal law. However, health care is a shared jurisdiction between the federal, provincial, and territorial governments. Primary responsibility for the provision and delivery of health care services rests with individual jurisdictions. The provinces are responsible for hospitals, the delivery of health care, and regulation of the medical profession, among other things.

As provinces and territories bear ultimate responsibility for the implementation of medical assistance in dying, the scope of the federal legislation has a significant impact on them.

That is why our government has been working collaboratively across governments, while at the same time respecting jurisdictional roles and responsibilities.

When health ministers met in January, they came to an agreement that a robust and consistent regime across the country is in the best interests of Canadians. Health Canada has also engaged in ongoing discussions with health officials in the provinces and territories to hear their views on many aspects of this important issue.

By establishing national eligibility criteria and safeguards, this bill will help ensure consistency across the country as well as respect the underlying criteria of the Canada Health Act.

The proposed legislation will set out who is eligible to receive medical assistance in dying and the safeguards that must be adhered to for medical practitioners to be protected from criminal responsibility.

Provinces and territories cannot modify these Criminal Code exemptions through their own legislation or regulations.

However, the provinces and territories can legislate or introduce policy measures with respect to aspects of medical assistance in dying under their jurisdiction. This could include identifying any special training for offering medical assistance in dying, specific forms to be filled out, or how the cause of death should be recorded.

However, in order to respect the principle of accessibility upheld in the Canada Health Act, provinces, territories, and regulatory bodies would need to consider the implications that any additional guidelines or regulations would have for patient access.

The bill gives the Minister of Health the authority to make regulations about the information to be collected and the processes for collecting it. Working with provinces and territories will be critical to determining how a pan-Canadian monitoring mechanism can be put in place, the types of information to be collected, and the reporting requirements among other elements.

In reviewing the bill, I see that the government has taken into account the concerns of some health care providers; that is, the protection of their conscience rights. The Supreme Court was clear that providers should not be compelled to provide medical assistance in dying. However, the government is also aware that the exercise of such rights may constitute a barrier to access for those who are seeking it.

To address these issues, the government will work with provinces and territories to support access to medical assistance in dying, while respecting the personal convictions of health care providers. This could include, for example, a pan-Canadian system that would facilitate access for patients to willing providers of medical aid in dying.

Throughout the consultations on medical assistance in dying, we heard loud and clear from Canadians calling for more resources for quality palliative and end-of-life care.

With Canada's aging population as well as growing rates of chronic disease, we must consider ways to support the improvement of a full range of options for end-of-life care. This includes better integration and expansion of access to services at home, including palliative care.

Medically assisted dying is a complex and important issue for Canadians and requires collaboration across jurisdictions to ensure that we have a framework that fits within our uniquely Canadian context.

I would therefore like the bill to go before committee where our collective thinking and robust consultation will hopefully result in a better bill, which is satisfactory to all. I think the bill at least provides a foundation for our continued collaboration.

[Murray Rankin, NDP, Victoria, BC]

This is just a drafting question, I believe.

I mentioned to the ministers that our recommendation at this special joint committee was that there always be one medical practitioner and perhaps a nurse practitioner. We're very sensitive to the need for access in remote parts of Canada, but as I read Bill C-14, it in every stage refers to “medical practitioner or nurse practitioner”. It would appear that this will be the only jurisdiction in Canada—and I'm not saying this is wrong, but I want clarification from officials—where a physician-assisted death could occur without the involvement of a physician. Am I reading the bill correctly?

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

Madam Speaker, my colleague has outlined many of the concerns that many of us in the House have. Throughout debate today we have heard government members assure us that conscience protection is included in Bill C-14. I do not share that optimism because I do not see it here, other than in the preamble, and it is actually along with the intention to expand physician-assisted dying to minors and people with psychological issues. That is a pretty weak commitment.

My bigger concern is that the bill is totally silent on protection for health institutions. We know that many hospices in Canada have been started with the express purpose of improving the quality of life for those approaching end of life and many of them are supported by very generous donors. If we are to insist that those institutions now need to participate in physician-assisted dying, I have concerns that we will end up losing a lot of health care facilities in our country. I am wondering if my colleague would share any comments on her views on protection for institutions.

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

Madam Speaker, the member made some very insightful remarks. I certainly agree with him on many of the points he made in terms of how Bill C-14 needs to be improved, the panel oversight, some protections for conscience rights, and those kinds of things.

My question relates to the legal profession. I am not a lawyer, so I will ask my colleague who is a lawyer. He commented that in the Rodriguez decision in 1993, the Supreme Court decided that the social good was of higher importance than relieving the suffering of one individual. That ruling was affirmed again in the Latimer case in 1997.

I wonder if my colleague would comment on what he thinks changed in terms of the law that created a situation where the Supreme Court would reverse itself on a fundamental issue when from my perspective, I do not see that any laws have changed.

If he has time, I would love the hon. member to give the Vanier quote.

[John McKay, Liberal, Parliamentary Secretary to the Minister of National Defence]

Madam Speaker, I was quite encouraged by the previous two speakers and their internal discussion on this issue. It does show that within parties, and I know within our party, there is considerable debate about this issue.

I found trying to assemble my thoughts to be quite difficult as it does go to the heart of our beliefs, our values, and our experiences. Sometimes, frankly, they are not reconcilable beliefs or values.

First, I take the opportunity to compliment the government on allowing a free vote. That is particularly important on this side of the chamber. In a debate such as this, it is very important that members feel complete freedom to speak freely, to vote freely, and to, as much as possible, minimize the partisan jabs that go on in this place. Because this is a free debate and a free vote, it actually strengthens this vote. It is, after all, important that we reflect the consensus of Canadians. They put us here, and they are the ones who we are to reflect.

In this perpetual dialogue between Parliament and the court, it is important that we establish a standard of deference for both institutions, both of which are critical to our freedoms and our democracy. Because this is a free vote, I believe it will therefore strengthen Parliament's expression on Bill C-14.

Some have said today that this decision flows from the Carter decision, and indeed Bill C-14 before us is a response to that decision. However, I would argue that the debate predates Carter by at least several decades as Canada unwinds itself from its Judeo-Christian heritage.

The sixth biblical commandment says simply “thou shalt not kill”. One way or another, it has formed the basis for our legislation and our jurisprudence for the last 4,000 years. In religious and secular terms, it is the doctrine of the sanctity of life.

The last time the Supreme Court dealt with this issue was, as has been mentioned many times, in the Rodriguez decision. At that time, Mr. Justice Sopinka spoke for the majority when he said, “This argument focuses on the generally held and deeply rooted belief in our society that human life is sacred or inviolable.”

He then goes on to reference section 7 of the charter and states that it is rooted in “the profound respect for the value of human life”, which is the right to life and the right not to be deprived therefore except in accordance with the principles of justice.

My own views, frankly, parallel Mr. Justice Sopinka, and in part explain why I do not support capital punishment. The reason I do not support capital punishment is that so often we get it wrong. Similarly, my views are pro-life, which I know is a minority view. I try to be, in my own philosophical way, as consistent as I can be.

What has happened for the justices to do what is an about-face, and disavow their own decision? I know that some will say that the charter is a living tree, but still this is a very significant change of position and even a disavowal of their previous decision in a space of less than 25 years.

In my view, it is the rapidity with which Canadians have disavowed their Judeo-Christian heritage on the sanctity of life and have substituted a test of the functionality of life. Life has to be functional in order to have meaning. Life for its own sake, let alone being created in the image of God, does not meet the test of functionality.

I appreciate that images of people in great suffering are felt deeply by us all and, as the previous speaker said, there is compassion on both sides of this argument.

I do hope the government means what it says in the preamble:

And whereas the Government of Canada has committed to develop non-legislative measures that would support the improvement of a full range of options for end-of-life care, respect the personal convictions of health care providers and explore other situations—each having unique implications...

I would be distressed if this were mere lip service, but I have some confidence that the money set aside will in fact start to address some of the situations where people find themselves in end-of-life situations with very few, if no, alternatives. I think as we as a society age, this is going to become more and more of a critical issue.

However, concerns have also been raised by those who represent vulnerable communities and their concerns are legitimate.

Jurisdictions that have gone down the route of assisted suicide have, frankly, a bit of a spotty record. Once institutionalized, there seems to be upward pressure on the numbers and expansion of categories and cases which seem to fall outside of even the most generous interpretation of the law. It is perfectly understandable that there will be expansionary pressure. Indeed, it is a certainty that those who want individual autonomy as the value that is above all other values will challenge this legislation. That is a guaranteed certainty.

However, for those who cannot speak for themselves or for whom consent is problematic at the best of times, there is a worry that the categories of “assistance” would be expanded. I know this sounds like a slippery slope argument, and that is only because it is.

There is an absolute certainty of judicial challenge, regardless what the Government of Canada puts forward, how this Parliament votes and possibly explains the reluctance of the previous government to engage.

While I support Bill C-14 as the best that could be offered up under these circumstances and therefore will vote for it, I would have liked to have seen a couple of other measures included.

First, I would have liked to have seen a panel approach, rather than the one that is offered up. In Ontario, we have declarations of medical competency. It is based upon a panel of one doctor, one lawyer, and one other.

It makes sense to me that leaving the process exclusively in the hands of health care professionals will inevitably create a bias to the questions doctors ask about health concerns rather than procedural concerns, consent concerns, and ethical concerns which lawyers, ethicists, and others focus upon.

It seems to me that if a panel of mixed professionals is required for mental health competency, which is after all a reversible decision, then a panel of three mixed professionals should be the norm in a decision that is not reversible. It also may go a long way to alleviate the concerns of “doctor shopping”. It would lead also to a consistency of approach across the country.

The second measure is conscientious objections. I have heard the argument that no health care professional can be compelled to participate, and it might even be true. I think we can solve that quite easily by simply stating that explicitly in the legislation.

Finally, there has been a lot of negative commentary about the right of religious groups to comment on this bill. It might be pointed out that rabbis, imams, pastors, priests, nuns, and so on, have literally sat at bedsides millions of times as people have passed. They have every right to give their opinion and they bring with them literally thousands of years of experience.

I would like to finish with a quote from Jean Vanier, which I obviously will not get to, but I know you will want to hear in the response to questions, Madam Speaker.

[Erin O'Toole, Conservative, Durham, ON]

Madam Speaker, I would like to thank my friend and learned colleague who has provided a lot of perspective on this. That one issue needs to be addressed at committee or immediately with respect to Bill C-14, because it shows that already the legislation and the framework is flawed.

Going back to my earlier comments, this is a difficult circumstance, where, as parliamentarians, we are faced with compassion on both sides of the issue. Provided we have shared time between the member for Thornhill and myself, who may disagree on the final elements of what we see missing in Bill C-14, it shows the gravity of this decision, why we should have this debate, and why more members should be here to share their personal views with respect to concerns on either side.

[Erin O'Toole, Conservative, Durham, ON]

Madam Speaker, even his framing of this, that mistakes can be made, sort of shows that it is very difficult for Parliament or any sort of regulatory regime, or the professions themselves, to set certainty. In fact, one of my main concerns with Bill C-14 is that it essentially kicks the issue back to the courts by using a reasonable foreseeable standard, which is kind of the linchpin of our common law.

When it comes to the case of a veteran with PTSD, there is no reasonable foreseeable end to that person's life at all, provided there is proper intervention. I have talked to military members, lower ranks and higher ranks. When the black dog, as Winston Churchill described it, hits people, they do think their own only option is to end their lives. However, I have met veterans who are now helping dozens of other veterans because they have found a path to wellness through a whole variety of programs and have made the decision to err on the side of help and not on the side of tragedy.

The very fact that the special committee put mental injuries, many of which can be treated, in the framework for euthanasia shows how difficult it will be to find the right balance.

[Erin O'Toole, Conservative, Durham, ON]

Mr. Speaker, I would like to start by thanking my colleague, the member of Parliament for Thornhill, for a very thoughtful presentation in this House.

A debate on Bill C-14 is an example of this House of Commons at its best. Canadians do not send us here to have unanimous agreement on issues of the day. We are here to represent our ridings, the constituents who have sent us to Ottawa. We belong to political parties. We have different leaders' roles. However, we are Canadians who bring an experience and a point of view to this chamber.

Infrequently, we share that view in the personal stories that people bring to the House of Commons. Today, on the difficult subject of Bill C-14, I learned of my colleague's perspective and personal experience with a member of his family, his personal experience covering the Rodriguez case in the 1990s as a journalist, and how that has combined to formulate his position on assisted dying or euthanasia. Members should welcome that.

It is unfortunate that we do not have a full House for important debates like this. We get so busy, but it is important for us to learn the perspective that each of us brings as a member of this chamber. We are not sent here to be surrogates for other interests or to run polls. We are sent with the judgment to try to look at legislation from the lens of our own experience, education, and background. Many members have brought that to this floor today, and I applaud them for it.

I have looked at Bill C-14, and I have struggled with it. Certainly this is a place where there are two sides on this issue, maybe broken down even more than that. However, there is compassion at the heart of both sides, and that is what is often forgotten in this debate. Why I say this should be the House of Commons at its best is that the Supreme Court of Canada recognized the role of Parliament to clarify the law with respect to euthanasia in a way that is thoughtful and complies with its direction in Carter. This is indeed one of the important debates that we should not fear in our House of Commons. We should ensure that we take part vigorously and share perspectives, as my friend from Thornhill has.

I have looked at Bill C-14, not just as a member of this chamber but also as a lawyer. I have reviewed the case law going back on this some 20 years. I have also reviewed it as a father of two children, a husband—I know my wife is watching today—and the son of a strong woman who died from cancer when I was nine. My most formative memories of my mother Mollie are in her palliative stage of that disease. Of course, all of these things combine to formulate my position on Bill C-14 and what I feel is the government's position with respect to Carter.

However, I am using my speech today to talk about some of the concerns I have with the bill. I will start with a Supreme Court of Canada quote from Justice Sopinka:

Regardless of one's personal views as to whether the distinctions drawn between withdrawal of treatment and palliative care, on the one hand, and assisted suicide on the other are practically compelling, the fact remains that these distinctions are maintained and can be persuasively defended.

Within the Rodriguez decision in 1993, the Supreme Court struggled with the role of the state at end of life in euthanasia or assisted dying. It struggled with whether that role should be passive with respect to palliative care, treating and helping and comforting and limiting pain at end of life, or whether the role of the state should be an active role at end of life.

Justice Sopinka, in the majority court in 1993, said that the bright line of the active versus passive could be persuasively defended. That was the language of the court. Canadians remember, as my friend from Thornhill did, the tragic circumstance of Ms. Rodriguez and her compassionate arguments with respect to that. Bill C-14 is about the role of the state. It is not suicide alone, and that is why we have to have legislation that both accepts the Carter decision but brings us to a position that Canadians can be comfortable with, that persuasively defends it.

The second quote I will use is from Carter, paragraph 117, as to why the court found the position of the trial judge to be compelling. It states:

We agree with the trial judge that the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards.

At paragraph 120, it went on to state:

We should not lightly assume that the regulatory regime will function defectively....

What the Supreme Court did was to allow this Parliament to come up with a regulatory regime to function effectively. The importance of that function is to ensure that what both courts said, the court of the Sopinka decision and the unanimous court of today in Carter, is that the decisionally vulnerable should be safeguarded. That was clearly part of the direction of both courts. This key element, and the aspect of what I consider to be the challenge for an ironclad regulatory regime, the slippery slope argument, is where I find Bill C-14 to be failing. That is why I am not supportive of it.

In the Carter decision, the court said that it was not in a straitjacket because it rejected euthanasia in the Rodriguez decision, and it looked at it in light of recent charter decisions. However, it is looking to Parliament for a system that does not allow the decisionally vulnerable, those impacted by a terrible diagnosis, under the strain and stress of an illness, to at a moment want to take their life and have the state play a role in that. Both courts recognized that these are vulnerable Canadians who need to be safeguarded. My concern is that this would not take place within this legislation before this chamber.

If we look at the great work that members of the all-party committee did, from the aspects of the all-party committee recommendations to what is before us in Bill C-14, the bill actually reflects more of the work done by the Conservative opposition on that committee. However, it certainly shows an indication of where the regulatory regime regarding assisted death would go. At some point in the future, it will likely include mature minors, and it will likely include people afflicted with mental illness, because that was the recommendation of the all-party committee.

As a veterans advocate for years before I joined Parliament, and having the privilege of being the veterans minister, I have met dozens of veterans who would have been decisionally vulnerable when they were suffering from depression, post-traumatic stress disorder, or another operational stress injury, but who are now leading productive lives as mothers and fathers. Some have returned to their role in the military. Many are actually advocating and helping other veterans.

Therefore, I am concerned with a regime that indicates that is where it will go. I know that Bill C-14 does not contain those provisions. However, the slippery slope element, which both the Sopinka courts and the McLachlin courts considered, show that is what we should anticipate in a few years. Although this House of Commons is well-intentioned, with an impossible regulatory regime, unable to look at every situation, I think the persuasively defended bright line has not been accomplished in Bill C-14.

Another example I will provide is that the Carter family themselves have expressed concern with Bill C-14. However, the Minister of Justice, in her thoughtful remarks in this chamber, which I appreciated, suggested that both appellants would have been provided for with respect to their assisted death under Bill C-14. That is not according to the family. The minister had to use language relating to a condition that can become “reasonably foreseeable” of death. Therefore, even the distinction between the named plaintiff in this case, the position of the family and the people who advocated for them, is at odds with Bill C-14 and the position of the justice minister.

If anything shows the fact that there is already a slippery slope and a very difficult framework to set, I am concerned that this has been rushed and it will not defend and safeguard against the decisionally vulnerable.

Could Bill C-14 be improved or, if Parliament could take more time, could it address this issue that confronts this place with Carter? In my weighing of all of the issues, as I said, as a parliamentarian who tries to draw upon my own experiences, as everyone does in this place, I do not think Bill C-14 can do that. I still feel that the persuasively defended bright line accomplished in the Sopinka decision has not been met by Bill C-14. In addition, many of the concerns providing the slippery slope that the Supreme Court in Carter raised have not been addressed by Bill C-14 either.

However, I have appreciated people sharing their points of view on this important issue. Parliament should not fear important debates. Members should come here in a respectful and thoughtful tone.

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, the reality is that the three parties to the Carter decision would not be assisted by Bill C-14. I listed the three conditions: spinal stenosis, ALS, and multiple sclerosis. All three of these particular afflictions would require additional legislative provision. I believe that is why the legislation will be back before the Supreme Court to order an extension of its provisions.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Thank you, Mr. Chair.

By way of comment, I want to say that this issue has obviously been very difficult for many people to deal with. I think the government has put forward legislation that is somewhat reasonable at this point. I want to commend the members of the joint committee for the work they've done and commend this committee for the work that you are doing to get a better handle on the legislation.

I have only one question and it's for both ministers. You've mentioned that there have been ongoing discussions with the territories and the provinces with respect to Bill C-14.

Mr. Chair, through you, have any of the provinces or territories raised any concerns whatsoever about this bill and, if so, could the ministers please explain some of those concerns to the committee?

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

Thank you for the question.

There is nothing in Bill C-14, our proposed legislation, that would compel a medical practitioner to engage in medical assistance in dying. As you quite rightly point out, this is within the jurisdiction of the provinces and territories, and Minister Philpott will continue to work with her counterparts to assist in putting together the regulatory framework, to assist the provinces.

[Peter Kent, Conservative, Thornhill, ON]

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

I think it is important for Canadians to realize that the legislation before us is neither the alpha nor the omega in the continuing conversations Canadians are having about physician-assisted death. The Supreme Court forced this legislative moment on reluctant politicians with the Carter decision, but the conversation has been simmering, occasionally percolating, for decades in hospital intensive care wards, doctors' offices, around family dinner tables and at the bedsides of loved ones, from holy pulpits and at congressional retreats, medical schools and law schools, from theist philosophers and from the atheist sort. Most personally, the conversation has been conducted within ourselves, in our own minds, in both sickness and in health.

If the proposed legislation before us is neither the beginning nor the end of our ongoing conversation about physician-assisted death, what is it? Where exactly are we?

First of all, I think it is abundantly clear that we are definitely not where the Supreme Court told us to go. The legislation before us, which I believe will easily pass the House, and should as well the Senate, is only an interim step that will almost certainly very quickly lead us again to the Supreme Court.

The official opposition has set as its highest priority safeguards to protect the most vulnerable in society as well as the conscience rights of physicians and other health care professionals. We are pleased that the government accepted recommendations from the Conservative dissenting report from the special joint committee to exclude minors, to include stringent safeguards to protect those with underlying mental health challenges, and to recognize the risks involved with advance directives, which I will come back to in a moment. However, there are still concerns with the proposed legislation before us.

First, a point that has been and will be raised by colleagues many times, and I believe on both sides of the House, is the lack of specified conscience protection, an assurance that medical practitioners and institutions may decline participation in physician-assisted death. However, I do not believe that should be a problem, because I do not believe there will be a shortage of physicians willing to assist those patients who meet the criteria for assistance.

Also, there are the concerns, again raised by many of my colleagues, on the need for greater provisions for prior review, for consideration of underlying health issues, and for the effect of possible psychological disorders on patient decision-making. I believe those matters should be thoroughly reviewed again in committee.

As well, many of my colleagues have expressed concern with the extension of the Supreme Court's specific direction that physician-assisted death be performed by medical doctors to also include nurse practitioners. We know the government's logic in broadening the responsibility is to provide for remote areas where qualified nurse practitioners now carry out many of the services traditionally provided by MDs. Again, I believe the legislation needs more specificity in this area. I firmly believe that many nurse practitioners are qualified, capable, and willing, but perhaps the legislation should explicitly state that nurse practitioners be engaged only as physicians of last resort in circumstances where no medical doctor is available.

I also recognize the widespread concern and resistance to the vague nature of such phrases within Bill C-14 as “reasonably foreseeable”. I personally accept such imprecise conditions because I realize that as magnificent as modern medicine is today, prognoses regarding the time of a final breath or a final heartbeat are still often only educated guesses. This is certainly worthy of further examination at committee.

Finally, one of the most important shortcomings in convincing Canadians to accept Bill C-14 is in the government's unkept and—I will be perfectly frank—broken promise on palliative care.

The Liberals made a campaign commitment to invest $3 billion in long-term care, including palliative care. The importance of access to palliative care in end-of-life decision-making was one of the few unanimous points of agreement in the special joint committee's report.

We as parliamentarians can rush to meet the Supreme Court deadline of June 6, but at the same time, the government has a clear duty, a moral obligation, to put in extra effort to expedite fulfillment of that promise to expand the availability of accessible, affordable, acceptable palliative care for all of those who, for reason of conscience, faith, or choice decide not to avail themselves of physician-assisted death.

I firmly believe that choice must be extended, as I believe the Supreme Court clearly meant it to be in the Carter decision, to patients suffering from the specific diseases and conditions that formed the basis of the Carter decision: the brutally imprisoning final stages of spinal stenosis; the choking, smothering final stages of ALS; and the unrelieved pain of irreversible but interminably long final stages of progressive multiple sclerosis.

While I am on this point, I remarked earlier on the need to recognize the risks involved in advance directives for diseases such as Alzheimer's, dementia, and the like. That said, I believe advance directives must eventually be allowed in physician-assisted death.

I consulted with many individuals and groups in my riding of Thornhill in recent months and beyond. I greatly respect—profoundly respect—the advice and interventions of various faith communities, social agencies, and medical institutions and their concern over the need for greater protection of the most vulnerable.

My personal decision, which will determine my vote on this legislation, is a product of three individuals and their experiences. In my previous life as a journalist, I followed closely the unsuccessful legal crusade of Sue Rodriguez as ALS steadily increased its deadly grip and her rhetorical question posed to Canadians: “If I cannot give consent to my own death, whose body is this? Who owns my life?”

In the previous couple of Parliaments I became close with another thoughtful, courageous Canadian, a fellow member of Parliament, the Hon. Steven Fletcher, Canada's first quadriplegic MP, re-elected three times and just last month elected to the Manitoba legislature, who did not give up after his life-changing accident 20 years ago. He met immense challenges and he overcame them.

However, in two private members' bills tabled two years ago, which I seconded, and in testimony before the parliamentary committee this January, Steven made a powerfully convincing argument for self-determination to one day make a final decision. He said such a law would be based on an individual's own morals and ethics while stressing that there should be no pressure on that person from society, family, friends, or the institution they may be in.

I was also powerfully informed and persuaded by the tragically tortuous passing of my brother-in-law, Rik Davidson, a brilliant academic, through Alzheimer's. Should such an ending be diagnosed for me, I assure the House that an advance directive would be composed, and either under law or not, it would be fulfilled.

Finally, as a cancer survivor, I have had many hours of reflection, during treatment and since, to ponder the issues involved in this debate on a personal level. I am fortunate that modern medicine, faith, and an incredibly supportive wife and family have left me—for now—clear and happily continuing my late-life adventure as a politician.

I am honoured that I can participate in this debate to argue for the passage of Bill C-14, eventual broadening of this legislation's provisions, and immediate government action to expand palliative care facilities and services, because I passionately believe that the issue before us ultimately comes down to choice: the free choice of a competent adult individual to choose between accessible, affordable palliative health care and the constitutional right to physician-assisted death.

[Matt DeCourcey, Liberal, Fredericton, NB]

Mr. Speaker, with the Supreme Court's decision in Carter, Canadians were given notice that medical assistance in dying would effectively become legal in Canada. It was, hence, the responsibility of the government to put forward clear rules around who is eligible to obtain medical assistance in dying, what safeguards must be followed to protect vulnerable individuals, and to create a monitoring regime to ensure accountability, transparency, and public trust in the system. Federal legislation was also important to ensure that a consistent approach to medical assistance in dying would be available across Canada.

Bill C-14 is the result of extensive consultation over the past year with individuals, groups, and experts at home and abroad. It takes into account a range of interests, including personal autonomy and safeguards to protect the vulnerable. It also recognizes the diverse and personal ways in which individual Canadians arrive at the question of medical assistance in dying. It balances individual rights and informed conscience, and respects the professional ethics and conscience of physicians and medical practitioners.

This legislation also addresses and proposes broad action on an aspect of end-of-life care where Canadians, regardless of their views of medical assistance in dying, have clearly indicated that they want action, chiefly, palliative and hospice care. I had the pleasure yesterday to take part in Hike for Hospice in sunny Fredericton and I am proud of the overwhelming support demonstrated by community members for such a worthy and important cause.

As we address an issue as delicate as medical assistance in dying, we cannot act without a full and intentional movement toward expanding all options of end-of-life care. The government has made clear that as part of a multi-year health accord, financial resources to improve home care, including palliative care, will be of primary importance. Also, as we launch Mental Health Week today in Canada, we must recommit our efforts to providing greater care and support for those suffering from mental illness and deliver on clinical and community-based approaches that will allow greater access to mental well-being for Canadians who suffer from mental afflictions.

On December 11, a Special Joint Committee on Physician-Assisted Dying was tasked with reviewing recent consultation activities. The committee also consulted with Canadians and stakeholders and made recommendations on the framework of a federal response to the Carter decision. The committee met 16 times, heard from 61 witnesses, received more than 100 briefs, and tabled its final report to Parliament on February 25.

I would like to extend my thanks for the work of the committee, as well as for the individual commitment demonstrated toward this issue from each and every committee member.

I, too, have heard from hundreds of people in the riding I represent, and have sought out wisdom and advice from leaders within the disability community who are calling for assurances that those with vulnerabilities will be safeguarded from outside influence in their personal decision-making; from the faith community, including trusted mentors and friends, who have encouraged me to reflect upon my own informed conscience in rendering a decision on this important matter; from the medical community, including leading voices, who have called for a sage and measured approach to the development of a framework around medical assistance in dying; and from those seeking a more liberalized approach, who may be dissatisfied with the framework that is proposed in front of us.

I have listened, I am listening, and I will continue to listen to people in the riding I represent. I have reflected, I am reflecting, and I will continue to reflect upon this important decision that will change the way Canadians consider end of life.

I approached this question like many others, with great humility, understanding that in a pluralistic society as rich and diverse as Canada's there will undoubtedly be those who feel that this legislation does not meet their world view. I wish to extend my empathy and understanding to them, and let them know that I, like all my colleagues, will continue to do my best for them.

I believe the ministers charged with crafting this legislation and the government as a whole have also approached this question with great sensitivity. The approach being taken is emblematic of a government that has listened to citizens, and will continue to listen to the wide diversity of opinion on this personal and challenging decision.

With this in mind, I wish to express my general comfort with the legislation before us. I would like to take the time to explain in greater depth the elements of the legislation and what it means for Canadians.

First, to allow access to medical assistance in dying in Canada, the Criminal Code would need to be amended so that doctors, nurse practitioners, and those who assist them can help eligible patients die without the risk of being charged with assisting a suicide or committing a homicide. There will also be safeguards to ensure that those who receive medical assistance in dying are eligible for it, can give their informed consent, and voluntarily requested assistance in dying.

A voluntary and informed request must be submitted in writing by the person in the presence of two independent witnesses, and a second medical opinion is required. No one aside from the person wishing to receive medical assistance in dying can make that voluntary request. This approach holds that the right to choose medical assistance in dying belongs only to the competent adult who would receive it. This is also necessary to protect vulnerable people.

A person who wants to access medical assistance in dying would have to meet the following criteria. They would have to be a mentally competent adult of 18 years or older. They would have to have a serious and incurable illness, disease or disability, be in an advanced state of irreversible decline of capability, and experience enduring and intolerable suffering as a result of their medical condition. They would, in effect, have to be on a course toward end of life. Death would have to be reasonably foreseeable.

The proposed legislation holds that mature minors would not be eligible nor would people suffering solely from a mental illness. The government is, however, proposing an independent study of the legal, medical, and ethical issues related to medical assistance in dying for mature minors, for those suffering from a mental illness, and around advance directives.

Again, the bill includes protections to ensure that patients are eligible and have given their informed consent. There would be a mandatory waiting period of at least 15 days, and patients could withdraw their consent at any time.

Also, there is nothing in the proposed legislation that would compel a health care provider to provide medical assistance in dying or to refer a patient to another practitioner.

The proposed approach to this most difficult of questions does its best to recognize individual choice for adults who are suffering intolerably and for whom death is reasonably foreseeable. It seeks to affirm the inherent and equal value of every person's life. It has the goal of protecting vulnerable people and reaffirms society's goal with regard to preventing suicide. It is an approach that recognizes where we are as a society and as a people advancing in the world. It is respectful of the divergent voices of Canadians and it demonstrates flexibility in its ability to reassess and examine the issue of medical assistance in dying in the weeks, months, and years to come.

I wish to thank my constituents who have reached out to me on this important matter and the many more who, I know, have wrestled with this question internally.

Know that this Parliament and I will do our collective best to serve each one's interests and those of their neighbours on this and on all important matters.

[Chris Bittle, Liberal, St. Catharines, ON]

Minister Wilson-Raybould, I wanted to commend you and your department for releasing the legislative background behind Bill C-14. I appreciate the commitment to openness and transparency. I think we can all agree that it's contributed to a significant debate across Canada, and will contribute to an intense discussion around this table.

Could you highlight to the committee the importance of this review, and address any of the possible concerns raised in it?

[Murray Rankin, NDP, Victoria, BC]

Because the time is so limited, let me ask a question on another topic.

Today's Globe and Mail has an article by UBC professor of medicine Dr. Jesse Pewarchuk, who talks about the issue that I also wanted to raise, that of advance requests, or so-called advance directives, which, as you know, is something that was recommended by the Senate-House committee. Dr. Pewarchuk writes as follows:

Bill C-14’s biggest flaw is that it forces the hand of those who have a progressive disease that relentlessly and predictably results in lost mental capacity to consent. Alzheimer’s patients can expect, with virtual certainty, to lose the capacity to make medical decisions over time.

He claims that “the wording of the proposed law introduces...doubt as to whether an Alzheimer’s patient who has yet to lose capacity (yet is certain to) would even be eligible, since death can take years...”. He says that “foreseeable death” and “advanced state of decline in capability”, the phrases in the definition in the bill, “are loaded, ambiguous clauses that seem to eliminate the Charter rights of dementia patients to be eligible...”.

Would you consider advance directives to address that problem?

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

Mr. Speaker, it is my honour to stand to speak in support of Bill C-14, a significant piece of legislation that would allow for the first time in Canadian history the provision of medical assistance in dying across the country.

I believe Bill C-14 directly and thoughtfully responds to the Supreme Court of Canada decision in Carter. This legislation would strike a careful balance between the autonomy of competent adults whose deaths are reasonably foreseeable to seek medical assistance in dying and the protection of vulnerable people through careful tailoring of the eligibility criteria and robust safeguards that are essential to prevent error and abuse.

As recognized by the Canadian Medical Association before the Special Joint Committee on Physician-Assisted Dying, one cannot underscore enough the significance of this sea change in Canadian medical practice and Canadian society as a whole.

At present, there are eight jurisdictions in the world, in addition to Quebec, that have adopted precise legal rules on medical assistance in dying: four U.S. states, Colombia, and the European countries of Belgium, the Netherlands, and Luxembourg.

The international community is looking at Canada's leadership on this issue right now, and I commend all hon. members on both sides of this House for their invaluable contributions to this complex and sensitive debate.

Bill C-14 would establish the criminal law rules regarding medical assistance in dying that address issues including eligibility, procedural safeguards, and the framework for a pan-Canadian monitoring system. In addition to the comprehensive legislative response proposed in Bill C-14, the government would undertake independent studies into three key issues that the Supreme Court declined to address in Carter: eligibility for persons under 18, advance requests, and requests for medical assistance in dying solely on the basis of a mental illness.

Allow me today to provide all members with further clarifications on the eligibility criteria included in Bill C-14 and how they respond to the Carter ruling, a question that has been asked numerous times since the bill was introduced.

Under Bill C-14, medical assistance in dying would only be available to mentally competent adults: one, who have a serious and incurable illness, disease or disability; two, who are in an advanced state of irreversible decline in capability; three, who experience enduring and intolerable physical or psychological suffering as a result of their medical situation; and four, whose natural death has become reasonably foreseeable taking into account all of their medical circumstances and without requiring any specific prognosis as to the length of time that they have remaining.

I would emphasize that those are the exact words of the legislation, because there has been some incorrect reporting on what is actually required. It is also important to remember that the criteria must not be read in isolation. Each element mutually informs the meaning and scope of the others. They work together to create a clear picture.

Some people wonder what reasonable foreseeability of death means given that everyone's death is reasonably foreseeable in the sense that death, like taxes, is inevitable for all of us. Bill C-14 expressly states that the person's natural death has become reasonably foreseeable, which clearly indicates that a change in the patient's medical circumstances is required. The patient is now on a path toward death, but previously he or she was not. A healthy person's death is not reasonably foreseeable unless the person experiences a change in his or her medical circumstances.

Mr. Speaker, at the outset of my remarks, I neglected to inform you, but I do now, that I will be sharing my time with the esteemed member for Fredericton.

The concept of reasonable foreseeability is also well known in law, and assessment depends on the context. In the context of medical assistance in dying, it would require a real possibility of the patient's death within a period of time that is not too remote from circumstances that can be predicted within a range of reasonable possibilities. Again, the legislation expressly states that a specific prognosis as to the time the patient has remaining would not be required. Because everyone's trajectory toward the end of life would be unique, this criterion was carefully crafted to provide maximum flexibility to medical practitioners so that they may assess the overall medical circumstances of a patient on a case-by-case basis. The overall medical circumstances, as opposed to any particular type of condition, are what matters when the objective is to give Canadians the option of a peaceful medically assisted death instead of having to endure a prolonged or painful one.

As recognized by medical standards and guidelines on prognostic indicators, there are many factors that may contribute to a patient's being assessed as approaching the end of life, including the presence of an advanced, progressive, and incurable disease, but also completely different factors, such as age, the general frailty of the patient, and risks of death from complications of other conditions that may not be fatal on their own, but which can jeopardize the life of someone who is otherwise weakened.

As recently recognized by the Canadian Medical Association, the requirement that natural death has become reasonably foreseeable would provide clearer guidance than the court's use of “grievous and irremediable” in that it would indicate , and I quote the CMA representative, that the condition should be “towards the end of the spectrum”, but does not mean “terminal or that death is immediately on the horizon”.

If we consider the Carter ruling itself, the Supreme Court expressly stated that the scope of its declaration was intended to respond to the factual circumstances of the case, and that it made no pronouncement on other situations where physician-assisted dying may be sought. Bill C-14 would directly respond to the factual circumstances of both Kay Carter and Gloria Taylor, who were both in decline and suffering while on a trajectory toward the end of their lives without it being certain when exactly they would die.

The Supreme Court did not define the term “grievous and irremediable medical condition”. It rather acknowledged that it was Parliament's task to weigh and balance the perspective of those who might be at risk in a permissive regime against those who seek assistance in dying. This is exactly what Bill C-14 does. It defines eligibility in a manner that is consistent with the Carter ruling read in its entirety, and provides necessary clarity on the assessment of eligibility.

Some have expressed concern over the lack of express protection for conscience rights of health care providers. The legislative objectives of Bill C-14, which are clearly stated in its preamble, include respecting the personal convictions of health care providers while also recognizing the provinces' jurisdiction over various matters related to medical assistance in dying. Balancing the interests of medical practitioners and those of patients is such a matter. Importantly, nothing in Bill C-14 would compel health care providers to provide any assistance that may be contrary to their conscience rights. More important than legal protections in a statute book are the concrete and practical actions that are directly aimed at supporting conscience rights of practitioners. In this regard, the Minister of Health has offered to work in collaboration with the provinces and territories on the development of an end-of-life care coordination system to help respect the providers' conscience rights while facilitating patients' access to care including assistance in dying.

Some have expressed concern that the safeguards in the bill are not sufficient. The proposed safeguards are generally consistent with and perhaps even a little stronger than the safeguards found in other medical assistance in dying regimes around the world.

The trial judge in Carter considered voluminous evidence on the efficacy of these regimes, and the evidence persuaded her that the risks to vulnerable people could be adequately managed under such systems. We are equally confident that these safeguards would guard against abuse and error.

I believe the proposed legislation is the right way forward on medical assistance in dying for Canada at this time and is a principled response to the Carter decision. I would urge all members to support second reading of Bill C-14.

[Ahmed Hussen, Liberal, York South—Weston, ON]

Quickly, under the framework established by Bill C-14, a provincial health care facility could choose not to provide medical assistance in dying. I'd like to know what your views are on that.

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

I will add to that, because I think it's helpful to understand how we came to the decision you see before you in Bill C-14.

The request for personal autonomy was heard loud and clear. We heard it from the folks who were involved in the Carter case, and we are obviously very sensitive to their desires and the desires of others like them who want to have that personal autonomy.

Where Minister Wilson-Raybould and I felt particularly burdened was how we could make sure that we provided for that personal autonomy, while very much feeling the weight of the life and death decisions that were also on our shoulders in terms of the protection of not simply individuals, but society as a whole. I think you'll see that reflected in the legislation.

We are fundamentally committed to making sure people can, in a sense, write their own stories and write the final chapter of their lives as much as possible, but we felt a real weight with the fact this would be the end of people's lives. We need to make sure that appropriate safeguards are in place so that nobody comes to the end of their life without adequate protection. We as a government, and we as parliamentarians, have a responsibility to uphold that solemn responsibility.

If we had more time, I'd love to tell you a bit more about that. We undertook this with a deep sense of obligation to protect not only individuals and their rights, but also society as a whole and the challenges there.

[Ahmed Hussen, Liberal, York South—Weston, ON]

In your opinion, does Bill C-14 adequately balance the principles of autonomy and the protection of vulnerable individuals? Please explain why or why not, and describe any improvements that could be made to the bill in this respect.

[Wayne Stetski, NDP, Kootenay—Columbia, BC]

Mr. Speaker, I rise today to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts related to medical assistance in dying.

I support the bill at second reading. However, it does need to be amended.

I will start today with a story. Some years ago, my wife Audrey and I adopted a beautiful sable sheltie dog by the name of Princess Diana of Cornwall. She was named at a time when we lived on Cornwall Drive in Port Coquitlam, and the world was abuzz with a royal wedding involving two people named Charles and Diana.

Princess was a great dog. Unfortunately, when she was about 11 years old, she developed cancer. We were already living in our current home city of Cranbrook, located in the Rocky Mountains area of British Columbia. As the cancer progressed, Princess was living with more pain and discomfort. We consulted our local vet regularly. One day he told us that she was terminal and in a lot of pain and he thought the best thing we could do for her was to end her suffering. He asked us to bring her back the next day. We took her home to say our goodbyes, and the next day I brought Princess back to the veterinarian. He asked me if I would like to leave her with him or whether I would like to stay. I said I would stay. I held her in my arms and watched the needle go into her paw. She lay down and died in my arms. As I stood there with tears in my eyes, I thought that if I were ever in intolerable pain from an incurable disease, this is how I would want to leave this world, with a needle in my paw, lying in the arms of someone I love. I personally became a believer in physician-assisted suicide right there 20 years ago.

I am not suggesting that the death of a pet and that of a human are equivalent, though they certainly can feel much the same, as many who have loved a beloved pet will know. We need to take even more care that we have it right when we are talking about euthanasia through a human lens.

As members know, in February 2015, a unanimous Supreme Court ruling established the charter-protected right of competent adult Canadians who are experiencing enduring and intolerable suffering as a result of a grievous and irremediable medical condition, including a disease, disability, or illness, to access medical assistance in dying. We in the NDP are committed to implementing the Supreme Court order decision with balance and sensitivity, respecting the autonomy of patients, the rights of health care practitioners and vulnerable individuals, and the fundamentally personal nature of this issue to every Canadian; in other words, we need to get this legislation right.

Last week, when I was back in my riding of Kootenay—Columbia, I met with Bendina Miller, the past president of the Canadian Association for Community Living. The CACL was one of the main supporters of the vulnerable persons standard, the purpose of which is to protect the vulnerable in Canada, as Bill C-14, medical assistance in dying, moves forward. While the CACL believes that the bill in its current form takes appropriate steps toward addressing the vulnerability of people living with a disability, it believes some improvements are required to meet the Supreme Court's intent that the legislation must provide fair access to assisted death and also protect vulnerable persons who may be influenced or induced to use the system to die.

The Canadian Association for Community Living recommends five areas of substantive amendment to this draft bill. I will summarize them here.

First, Bill C-14 should be amended to extend the current requirement for judicial oversight until such time as a study of the merits and implications of the bill allows them to be clearly understood.

Second, included in the bill should be an explicit legal requirement to identify, explore, and record the sources of a person's suffering, and an attempt to address the motivations of his or her request for death.

Third, Bill C-14 should be amended to meet the requirements of the Carter decision and should specify that a voluntary request for medical assistance in dying cannot be made as a result of external pressure or any form of inducement.

Fourth, Bill C-14 should be amended to specify that the minister “will” make, not “may” make, regulations regarding the mandatory reporting of information about requests and the provision of assisted dying.

Fifth, it should mandate a palliative care or other professional evaluation to ensure patients' rights to informed consent by having information about the full range of available treatments and supports that could ease their suffering.

The bill should not proceed without an enhanced national palliative care strategy, which is clearly missing in the Liberal government's 2016-17 budget.

Back in November, I had the pleasure of meeting new members of Parliament from all of the parties represented here in the House, except the Green Party. I was struck by how consistent the words were from all of my colleagues. They said they were here to work collaboratively to build a better Canada. It was very encouraging for me as a new MP, because that is also why I am here.

When I am back home in my riding sharing with my constituents what we are doing here in the House, I tell them that we are working on three bills in particular that would fundamentally change Canada, going forward: first of all, proportional representation voting; second, legalizing marijuana; and third, physician-assisted suicide.

This is the first of those three bills to come to the House for debate and further study, and we need to work together collaboratively to build a better future for Canadians. The bill would do three things: maximize one's willingness to live through expanded palliative care, ensure that our vulnerable citizens are protected, and give our citizens the Supreme Court assured right to choose to die in the arms of someone who loves them, if they are experiencing enduring and intolerable suffering as a result of a grievous and irremediable medical condition.

Let us amend the bill collaboratively and give Canadians the best possible outcome on this very important and emotional issue.

[Jane Philpott, Liberal, Minister of Health]

Thank you, Mr. Chair.

I will be making a few comments in French as well, for those who need the earphones.

Mr. Chair and honourable committee members, thank you for the opportunity to appear before you this afternoon. I am very pleased to be here with my colleague to discuss this important subject of medical assistance in dying.

I think that each of us around this table would not deny the monumental nature of the piece of legislation with which we are involved. This speaks to the profound and solemn nature of our responsibility as representatives of the people of Canada to make wise decisions, and I thank you for sharing with us in this process and look forward to your comments and questions.

Conversations about the end of life can be incredibly challenging. I can say that from personal experience, and I know that all of you have had similar experiences and have your own personal stories about end-of-life conversations, yet it's a vital conversation that we need to participate in as individuals, as members of Parliament, and as a society.

They are difficult conversations for health care providers as well. Health care providers may not have had an education that has adequately prepared them for discussing this, let alone providing the supports that patients need at the end of life. As we strive to meet the needs of Canadians at the end of life, we also encounter a system that can often frustrate the attempts of people to live out their personal autonomy.

We all want a system where respect for personal autonomy is a cornerstone of all policies. We also want a system where the rights of the most vulnerable are respected and protected. This legislation is one important piece of the puzzle when it comes to ensuring that Canadians have access to not only a good life, but also a good death.

It's about empowering patients to take control of their own narrative and ensuring that Canadians can receive compassionate care as they approach the end of life.

As you well know, we listened to what Canadians and stakeholders had to say before we developed this legislation. We reviewed it closely to ensure consistency with the charter. We looked closely at the Carter decision to ensure that individuals in similar circumstances would have access to care that would alleviate suffering, including the option for medical assistance in dying.

In the course of this debate and since the introduction of this bill, we have heard from several parliamentarians and many stakeholders. Some have had concerns that the legislation goes too far, and we acknowledge that for many the new reality in the post-Carter era is an unfamiliar one and will heighten anxieties about how we protect the most vulnerable in society.

I want to assure those Canadians that we acknowledge their concerns, and we believe that the safeguards in place in this bill will ensure that we protect the rights of those most at risk.

We've also heard from others who feel that the proposed legislation does not go far enough and who would like to see expanded eligibility in certain areas, and we would also like to thank these Canadians for speaking up on behalf of those who are suffering.

Our commitment as a government was to respond to the Carter decision. This necessitates changes to the Criminal Code that will protect health care professionals as they support patients in their decision-making. At the same time, we are committed to taking time to address additional questions that are more complex and where more time and study are needed.

For instance, the proposed legislation sets the minimum eligible age for decision-making at 18—the age of majority in most provinces and territories. We believe this is appropriate, given the unique and irreversible nature of this decision. We know that the capacity to make health care decisions is not tied strictly to age and that depending on the province, children as young as 14 have had the right to refuse or consent to medical treatment.

Given the divergence of opinion on this issue among Canadians and stakeholders, the special joint committee, as you know, called for further study and broad-based consultations on the issue surrounding the concept of mature minors. Our proposed legislation reflects that guidance and the need to tread carefully; however, we acknowledge the difficult situations that mature minors and their families face at the end of life, and we commit to taking the necessary time to study this matter in the months to come.

We faced similar challenges in considering the issue of advance directives. The Supreme Court did not deal with this issue in Carter, and the views of Canadians and stakeholders, as you know, are divided. I understand the hardship for those Canadians who fear that after being diagnosed with a disease such as dementia they may experience a decline that could compromise their dignity. This has led to pleas to allow people to make requests for medical assistance in dying well in advance of the time when the person is no longer competent to make or reaffirm a desire to accelerate their own death.

I had the opportunity to meet with a group called Dying With Dignity recently to understand their perspective and the thoughtfulness with which they presented their case.

After 30 years of practising medicine, I am well aware of the concerns of Canadians who endure suffering at the end of life, and understand why some would contemplate using advance requests to seek medical assistance in dying. However, we must consider the complex policy and medical practice issues raised by advance requests.

By their very nature, advance requests are made before they're needed. Even if reviewed regularly, they would be an enacted only when a person has lost competence or is no longer able to communicate. This means that the final consent, a key requirement in most assisted-dying regimes around the world, could not be verified by a health care provider or anyone else.

Health care stakeholder groups have cautioned that advance directives for other forms of medical treatment can be very difficult to respect in practice, and the implications would be more significant in the case of assisted dying.

As June 6 approaches, we have limited time to better understand how advance directives would work in practice. Determining how they would be carried out would require extensive consultations with Canadians, stakeholders, medical professionals, regulatory bodies, provinces, and territories. In light of these circumstances, we are proposing to explore this issue with further study.

The proposed legislation also does not permit eligibility solely on the basis of suffering from mental illness. There's no denying that mental illness can cause profound suffering, but illnesses such as chronic depression, cognitive disorders, and schizophrenia raise particular concerns with respect to informed decision making.

We've consulted with numerous stakeholders on this issue and have concluded that the nuances are not sufficiently understood at this time to allow safe and appropriate legislation to be crafted.

To that end, the government is making a commitment to mandate one or more independent studies on the questions of requests by mature minors, advance requests, or requests for mental illness as the sole underlying medical condition.

Bill C-14 also includes a clause that requires Parliament to conduct a review of the legislation five years after royal assent. This will allow for a parliamentary review of the complex issues, as well as the evolving experience of Canadians in implementing medical assistance in dying.

Finally, one cannot discuss this legislation without a reaffirmation of the importance of improving access to high-quality palliative care for all Canadians. Our government is firmly committed to investing in this area, and I look forward to working with provinces and territories to ensure equitable access to all options for care at the end of life.

In closing, we believe this proposed legislation values the personal autonomy of Canadians, in line with the Supreme Court's decision in Carter, while ensuring the protection of vulnerable Canadians and the conscience rights of providers.

I want to thank all of you and others who have engaged thoughtfully and respectfully on this challenging issue. I know this committee is going to hear a range of views and opinions in the coming days and weeks.

I thank you for your consideration. I look forward to your responses.

I welcome any questions you may have.

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

Mr. Speaker, there is a couple of things I would like to clarify. The member and his colleague who spoke earlier said, pretty unequivocally, that no doctor would be required to participate in this regime. I do not see any protection in Bill C-14 that would assure doctors they would not be required to participate, other than a very vague comment in the preamble talking about that possibility. It certainly does not put ironclad protection in the bill.

The other issue I would like to raise with all my colleagues on the other side is palliative care. We continue to hear their commitment to palliative care. I applaud that. We need better palliative care. I have been working on that years. We can talk about it, but I do not see any evidence in the budget of the $3 billion that was promised to be immediately invested. I am very concerned. We need to get working on this. I want to see an actual firm commitment within the budget so we have something we can take to Canadians that says help is on the way.

Barring that, to offer physician-assisted death without—

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

Thank you, Mr. Chair.

I will present first, and then my colleague will present after me.

First of all, I want to acknowledge you, Mr. Chair, and the members of the committee. Thank you for providing us with this important opportunity to be here to speak about Bill C-14, which responds to last year's unanimous decision of the Supreme Court of Canada in Carter v. Canada and introduces a federal framework around medical assistance in dying.

Medical assistance in dying, as you said, Mr. Chair, is a complex and deeply personal issue. Every jurisdiction in the world that permits it or has debated it has carefully considered the wide range of interests at stake. In Canada, we work within a distinct legal and constitutional framework, which includes a division of powers between provincial, territorial, and federal governments, and the Charter of Rights and Freedoms, all of which inform the government's choices as reflected in this bill.

Bill C-14 would establish criminal law rules regarding medical assistance in dying that address eligibility, procedural safeguards, and the framework for a monitoring system. The proposed legislation would re-enact sections 14 and section 241, paragraph (b), of the Criminal Code, so that it would continue to be a crime to assist another person to die or to cause another person's death with their consent, except if either of these actions were done in accordance with the rules for medical assistance in dying as set out in this bill.

Bill C-14 would exempt physicians and authorized nurse practitioners from criminal liability if they provide medical assistance in dying to an eligible person in accordance with the procedural safeguards in the legislation. It would also exempt others who might be involved in this process, such as pharmacists who fill the prescription for medication.

Importantly, the bill includes a parliamentary review five years after coming into force. The government is also committed to further studying the complex issues of medical assistance in dying in the context of advance requests, mature minors, and where a mental illness is the sole underlying medical condition, none of which were before the court in Carter.

The government chose this approach after thoroughly considering the full range of potential options for a medical-assistance-in-dying regime. As noted in our legislative background paper, which I tabled at second reading, this included analyzing and comparing regimes in other jurisdictions, including Quebec's legislation, certain American states, several European countries, the country of Colombia, and others.

The government also relied on consultations conducted in this country, including the work of the special joint committee, the external panel, the provincial-territorial expert advisory group, and Quebec's multi-year study that informed the development of that province's own legislation. We also engaged and consulted with a wide array of stakeholders.

With the benefit of all this evidence and knowledge, which exceeds even the detailed record that was before the Supreme Court of Canada in the Carter case, the government has thoughtfully addressed this issue. Bill C-14 would allow for greater flexibility than the laws that exist in the United States, which are limited to terminally ill patients. At the same time, it does not go as far as some of the more permissive regimes in European countries. As the court noted in its Carter decision, “Complex regulatory regimes”—such as this—“are better created by Parliament than by the courts.”

Bill C-14 is fair and practical, and presents a balanced approach.

In terms of eligibility. I'm aware the requirement that a person's natural death be “reasonably foreseeable” has received some attention, including in terms of how it relates to the Carter decision. I would like to address these concerns.

The bill was deliberately drafted to respond to the circumstances that were the focus of the Carter case, where the court only heard evidence about people with late-stage incurable illnesses who were in physical decline and whose natural deaths were approaching. The court said the complete prohibition on assisted dying was a violation of charter rights for persons in these circumstances. In this way, the eligibility criteria in Bill C-14 comply with the Carter decision. They focus on the entirety of the person's medical circumstances and not on the specific list of approved conditions or illnesses.

By defining the term “grievous and irremediable medical condition”, the bill would ensure that all competent adults who are in an irreversible decline while on a path toward their death would be able to choose a peaceful, medically assisted death, whether or not they suffer from a fatal or terminal condition.

A person can be approaching a natural death based on medical circumstances that are not directly related to a serious, incurable illness, for example. As well, eligibility does not depend on a person's having a given amount of time remaining, such as a certain number of weeks or months to live, as in the United States. Reasonable foreseeability of death is ultimately a medical decision, and not a legal one, to be made by taking into account all of the person's medical circumstances, including the types and number of medical conditions, frailty, age, etc.

The vice-president of the Canadian Medical Association has confirmed that reasonable foreseeability of death is a standard that provides sufficient guidance to physicians and nurse practitioners by taking out a lot of the subjectivity that was left by the court's undefined concept of a grievous condition, while allowing those with the necessary medical knowledge and expertise to make the decisions based on the individual circumstances of each case.

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

Other approaches to eligibility that were proposed and suggested would be arbitrary. For example, it would be arbitrary to permit people with degenerative but non-fatal conditions to have access to medical assistance in dying before their deaths have become reasonably foreseeable, while excluding individuals with mental illness alone, or those born with a physical disability, or those suffering physically or psychologically for any other reason. These are not viable options, in our opinion, as they discriminate on the basis of a person's medical condition from the outset rather than allowing the medical practitioner to consider all of the person's circumstances.

Others have suggested that the government should grant access liberally, based on the subjective experience of suffering of each individual and the right to choose when life ceases to have meaning, with little in the way of objective parameters related to their condition or safeguards. Our government firmly believes that medical assistance in dying should not be available for any and all types of suffering. If that were the case, the risk to vulnerable people would be greatly increased and, frankly, would be unacceptable. Such an approach could contribute to the stigmatization of persons with disabilities; it could undermine suicide prevention; and it could lead marginalized or lonely individuals to seek medical assistance to end their lives prematurely.

As the court noted in Carter, when crafting legislation, Parliament must balance and weigh the perspective of those who might be at risk in a permissive regime. Our government respects the Supreme Court of Canada, and believes that in legislating in this incredibly complex and personal area, we must be concerned with protecting the dignity of these Canadians' lives.

This is why the criteria in the bill address the full range of medical circumstances that can make a person's death reasonably foreseeable. In doing so, the law sends a clear message about the intended purpose of medical assistance in dying: to give competent adults who are in a path toward their natural death the choice of a peaceful passing. It also provides maximum flexibility for medical assessment to health care providers, both in terms of the circumstances that led a person to be on a trajectory toward death and in terms of the time during which they can seek medically assisted death.

I want to emphasize the importance of having a legislative response in place before June 6, 2016, when the court's declaration of invalidity expires. Without a new law, on June 6 the parameters of the Carter decision would come into effect.

The scope of the decision is uncertain in several respects and, as a result, there would be uncertainty as to how it would be applied in practice. Assuming for a moment that the Carter decision read down in section 14 and section 241, paragraph (b), of the Criminal Code so that except for medical assistance in dying these criminal laws would be in force, sufficient uncertainty would still remain.

First, given that in the medical community there is no common understanding of a “grievous and irremediable” condition, it would become difficult for a patient who would be eligible under Bill C-14 to gain access to medical assistance in dying. Without a clear law in place, some physicians who may otherwise be willing to provide it could refuse to do so because they are not clear on who properly qualifies.

As well, failing to define the Carter parameters with federal legislation could lead to a wide variation on how eligibility is applied, not only between provinces or regions, but within them. Access in remote and rural areas would be negatively affected, not only because physicians may be unwilling to provide medical assistance in dying in such an uncertain legal environment, but also because, under the Carter decision, nurse practitioners are not able to provide assistance.

Second, the current interim court approval process will end on June 6. Therefore, outside of Quebec, there would be no legally binding framework to govern medical assistance in dying in Canada. In other words, there would be no mandatory procedural safeguards to prevent abuses and protect vulnerable persons.

Guidelines published by medical regulators are not binding, nor are they uniform, which further risks creating a patchwork across Canada. This can pose very serious public safety risks. For instance, a patient could both request and receive medical assistance in dying on the same day. Without going through an exhaustive list of risks, needless to say, it would be irresponsible to let June 6 come and go without a federal law in place.

As the court made clear in paragraph 117 of Carter, “the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards”. Bill C-14 provides a responsible and balanced framework that limits those risks and puts in place those safeguards.

I certainly welcome the opportunity to discuss this bill and contribute to your study of the proposed legislation. The approach in Bill C-14 responds to the Carter decision with what I believe is sensitivity in all of the issues that were before the court in this case and creates a responsible and fair legal framework to permit medical assistance in dying in Canada for the first time in our country's history.

Now, with your permission, Mr. Chair, I would like to turn it over to Minister Philpott.

[The Chair, Liberal, Anthony Housefather]

Ladies and gentlemen, welcome to this first meeting of the Standing Committee on Justice and Human Rights related to our study of Bill C-14.

It is a great pleasure to welcome all of you here.

Today's subject matter is difficult. It's subject matter on which we have to reconcile autonomous rights, rights that have been set out in the charter, and rights set out in the Carter decision with the protection of the vulnerable.

The most important thing for me is that we do all of this with great respect. I know that our committee is capable of that, and I'm pleased today to welcome our first witnesses.

We have the Minister of Justice, the Honourable Jody Wilson-Raybould, and the Minister of Health, the Honourable Jane Philpott. With them, from the Department of Justice, we have William Pentney, the deputy minister and deputy attorney general; and from the Department of Health, Simon Kennedy, the deputy minister.

I'm going to turn it over to you, ministers. I'm not sure which one of you is going to speak first, but you're very welcome here.

[Arif Virani, Liberal, Parliamentary Secretary to the Minister of Immigration]

Mr. Speaker, I rise today to speak to Bill C-14. I start with reference to the Supreme Court of Canada's Carter decision, about which we have heard much.

In the opening paragraph of that ruling, the unanimous court said:

It is a crime in Canada to assist another person in ending her 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: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.

I agree with the Supreme Court. The choice is cruel.

The Supreme Court concluded that the criminal law as it currently stands was not only cruel, it was also unconstitutional. The court found that section 7 of the charter required access to medical assistance in dying, subject to certain safeguards. That is where the House finds itself today.

Let us be clear. The question facing parliamentarians is not whether we can permit Canadians access to medical assistance in dying. That access must be permitted to comply with the charter. The actual question facing us is how to design the access. In terms of design, I believe Bill C-14 strikes the right balance. The balance is between the right, on the one hand, of a competent person who seeks an assisted death in response to a grievous and irremediable condition, as compared to the need to protect the vulnerable from being induced to commit suicide at a time of weakness.

Striking this balance is not simple. Nor is it permanent, and this is an important point. The balance must be calibrated and recalibrated according to changing evidence and the evolution of societal values. Indeed, the Supreme Court's 2015 decision, which reversed the court's earlier ruling in 1993 in Rodriguez, is evidence of this very evolution. However, for now, in terms of where we are in 2016, I am firmly of the view that the bill would strike the right balance.

There is another reason why I rise before members today to speak in favour of the bill. That is because I have spent my career as a constitutional litigator fighting for people's rights, their human rights, their charter rights, their right to equality. Treating people equally means treating people with respect, according them dignity and according them autonomy. The bill would do that. It would give people control over their own lives, including the conclusion of their lives. It would allow those nearing death to pass in a manner of their choosing with less suffering.

In empowering choice, the bill would empower Canadians. It would strengthen us as a people because it is informed by a desire to give Canadians more autonomy and, as a result, greater dignity.

For the rest of my speaking time I would like to address two major categories of concern that this bill raises: the criticism that Bill C-14 does not go far enough to make medical assistance in dying available; and the opposite criticism that the bill goes too far and makes medical assistance in dying too accessible.

In this first category, the concerns are that Bill C-14 is not broad enough. They centre on three main components, and we have heard some of them this afternoon and in previous days of debate. For now, it is proposed that medical assistance in dying only be permitted for adults and for those who suffer from more than a mental illness alone. In addition, for now Bill C-14 would not provide for advance directives regarding medical assistance in dying.

The words “for now” are important. The government has committed to an independent study of legal, ethical, and medical issues that are raised by each of these three different categories. This is important. If medical assistance in dying is to be expanded into any of these three areas, it must be done only after a comprehensive study of the benefits and the risks associated with permitting medical assistance in dying in such circumstances.

I was determined to hear from my constituents directly on this important legislation. Therefore, in early April I hosted a town hall in my riding of Parkdale—High Park on the issue of medical assistance in dying. The engaged constituents of my community came prepared with thoughtful and personal reflections, with concerns, and with questions, many of which related to these very three items I just raised.

While the residents and community, like me, are keen to protect and promote the autonomy and dignity of all Canadians, including youth and the mentally ill, the residents of my community also cautioned about moving too quickly in an area where the consequences of a decision were final and irreversible. They noted, for example, that in Belgium medical assistance in dying had been legalized and studied for a period of 12 years prior to medical assistance in dying being made available to minors. The mentally ill, it was noted, would be able to avail themselves of medical assistance in dying under this legislation provided the mental illness was part of the patient's overall medical circumstances and that the applicant was still able to meet all of the general eligibility criteria.

As one who has championed the rights of mental health consumer/survivors in my community, I know it is critical that before embarking on the path of increased access to medical assistance in dying for those whose condition is mental illness alone, we get this right.

As we have said repeatedly, our government believes in enacting legislation that is well reasoned, carefully analyzed, and based, above all, on sound evidence. The proposed independent studies into things like access for minors will help inform this analysis and critical evidence-building process. Importantly, Bill C-14 also contains a provision which calls for a mandatory review of the entire legislation every five years.

As I said at the outset, finding the right balance in legislation of this nature is not permanent; it is fluid. It is a dynamic process which can and must adapt to changing evidence and societal norms.

Bill C-14 is not an extensive enough category. We also find an argument relating to reasonable foreseeability. We heard questions about it this afternoon. Some assert that the requirement to Bill C-14 that a person's death must be reasonably foreseeable is an unnecessary barrier. Such concerns are unfounded. Bill C-14 is actually more permissive than any assisted-dying legislation in North America. In Quebec, an applicant must have a terminal disease. Bill C-14 is more accessible. It would allow medical assistance in dying where death is reasonably foreseeable, looking at the totality of the medical circumstances.

In addition, in each of the four American states that have legislated medical assistance in dying, one is required to have a specific prognosis that an individual has less than six months to live. There is no such temporal restriction in Bill C-14.

Finally, in the category of Bill C-14 not being quite broad enough, some contend that the bill should stipulate, and again we heard it this afternoon, that medical practitioners are professionally bound to provide such service. This criticism misunderstands the nature of Bill C-14. It is an amendment to the federal Criminal Code. It is also misguided jurisdictionally.

Wearing my constitutional hat, it is clear that the federal government has an important role to play in maintaining universal access to insured health services, but the ultimate delivery of medical services is primarily a matter of provincial jurisdiction. Our government, as was mentioned by my colleague, has committed to work going forward with provinces and territories to support access for medical assistance in dying, while simultaneously respecting the personal convictions of health care providers. This approach reflects the balancing that must occur when addressing competing charter claims.

On the one hand, the section 7 claims of those who seek access to medical assistance in dying must be balanced with the freedom of conscience rights that are entrenched in subsection 2(a) of the charter. Those are the freedom of conscience rights of health care providers. The Supreme Court recognized this in the Carter decision, in paragraph 132, and this bill recognizes it in the preamble.

The second broad category is that the bill is too permissive.

In fact, those who maintain that Bill C-14 is too permissive are the ones who are failing in the fundamental responsibility to protect people who might commit suicide in a moment of weakness.

Requesting medical assistance in dying is not simple. Nor should it be. Requests must be made in writing. This has a meaningful impact. All such requests must be witnessed by two independent individuals. They cannot be a beneficiary in a will or a person charged with the care of the ill individual. A request must then be approved in writing by not one, but two different medical practitioners. Finally, the bill calls for a mandatory waiting period of 15 days in order to allow individuals to reflect on the seriousness of this choice.

The bill goes further. It requires an extensive regime of monitoring, so data and trends respecting medical assistance in dying can be obtained and analyzed by government. This kind of monitoring will ensure transparency, but more important, it will facilitate strengthening safeguards where required.

Finally, I am encouraged by the fact that Bill C-14 not only reflects the significance of choosing medical assistance in dying, but that every choice ought to be an informed one. By this, I am referring to the pressing need to enhance palliative care in Canada, a need expressed to me time and again by residents in my riding of Parkdale—High Park. If we are to ensure that the significant choice of requesting medical assistance in dying is fully informed, it is critical that we work collectively, in a non-partisan manner, to ensure that improved palliative care is readily available.

In conclusion, I reiterate that this proposed legislation is neither too restrictive nor too permissive. It strikes the correct balance, while simultaneously recognizing that with further study and mandatory review, the balance will continue to be recalibrated to reflect new evidence and evolving societal values respecting medical assistance in dying.

Most important, the bill would eliminate the cruel choice that the Supreme Court described in the opening paragraph of the Carter decision. No longer will grievously ill Canadians be faced with either taking their own life prematurely or prolonged suffering until they die. Bill C-14 would give such Canadians what the charter requires, autonomy. It would give them control over their passing in a manner that ensures their dignity. For this reason, I will be supporting this legislation.

[Joyce Murray, Liberal, Parliamentary Secretary to the President of the Treasury Board]

Mr. Speaker, I will be sharing my time with the member for Parkdale—High Park.

I am proud to stand in this House today in support of Bill C-14, introduced by the hon. Minister of Justice.

With this bill, our government recognizes the autonomy that Canadians hold over their own lives, the expertise of our medical professionals, and the decision of the Supreme Court of Canada. Through extensive consultation, we have introduced a balanced solution that will restore dignity, protect the vulnerable, and allow our nation's medical professionals to respect the wishes of their patients.

Until now, Canadians faced horribly debilitating end-of-life suffering and had no legal control over their own lives. In desperation, some have gone to court to regain this control. However, it is a difficult process, which has compounded the physical and emotional strain felt by the patients and their families.

Doctors, nurses, and family members alike have felt powerless to assist those they care for, with no legal means to honour the wishes of those who suffer. They face emotional strain and difficult moral dilemmas, as the law prohibits them from respecting the dignity of their patients and doing what they often know is compassionate medical assistance for a good death.

Many of us in this chamber and across the country have personal stories of the kind of suffering I have mentioned. I do as well. I have an indelible memory of visiting a dear friend of many decades in the hospitals, whose body was breaking down from a terminal illness. He was in excruciating pain for weeks. He eventually declared that he would not eat or take any water or liquids. He finally passed away after six days of even more miserable suffering.

We are here to talk about a bill that is setting out a new form of medical service in Canada, which is medical assistance in dying. With this bill, we recognize that the decisions over one's person, including the decision to end one's life with dignity, should ultimately rest with the individual and not with the government.

Through consultation and careful consideration, Bill C-14 includes the following safeguards: a requirement for a second independent medical opinion; a 15-day reflection period; the ability for a patient to withdraw consent at any time; and a rigorous requirement for documentation at every step, with new criminal offences to prevent any potential abuse.

This government recognizes the need to respect the moral conscience of individual medical professionals. While every patient who fits the medical criteria will have access to medically assisted dying, no individual doctor or nurse will be required to participate if it conflicts with his or her values and beliefs.

Some medical professionals have expressed reluctance to refer a patient seeking medically assisted death to a physician who can provide the service because they feel that the referral would make them complicit in the death of the patient.

However, while it is absolutely critical to reflect important safeguards, we must also respect that the people seeking this procedure should have reasonable access.

In Carter, the Supreme Court of Canada recognized that the conscience rights of physicians will need to be reconciled with the charter rights of patients seeking medical assistance in dying. Although much of the necessary balancing will be a matter for the provinces and territories, our government is committed to working collaboratively with provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

The federal government will offer support to help ensure that all Canadians have access to the medical aid they need. One approach is a pan-Canadian coordination system for access to medical aid in dying. We can start by reviewing the assisted dying regimes in other countries to see what they have done and assess their applicability to Canada.

Closer to home, in Quebec, the act respecting end-of-life care offers other examples. It includes a range of end-of-life care, including palliative care, palliative sedation, and medical assistance in dying. The legislation makes the service broadly available in institutions and at home.

Physicians in Quebec are not required to provide this option, but they are required to notify the institution or local authority of any request and to forward the patient's request form. The institution will then take the necessary steps to find another physician as soon as possible to address the request.

Many people in Vancouver Quadra who have contacted me about the bill have expressed their support for medical assistance in dying. As their representative, I am pleased to support the work of my colleagues, the Minister of Health and the Minister of Justice.

Under the proposed legislation, medical assistance in dying would be available only to mentally competent adults who are eligible for publicly funded health services in Canada, who have an incurable illness, disease, or disability, are suffering intolerably, are in an advanced state of irreversible decline in capability, and whose death is reasonably foreseeable.

Some of my constituents have also expressed concerns about access.

Our criteria permit medical assistance in dying for some, but not all individuals who may seek it. We have heard concerns from some Canadians and experts about extending eligibility to mature minors, permitting requests made in advance, and including psychological illness as a sole underlying condition.

I want to let Canadians know that our government has heard their concerns.

At the present time, the limited information available on these issues warrants the cautious approach in the draft legislation before us.

However, the government is making a commitment to undertake independent studies on these issues to better understand the risks. The results of the reports will feed into the five-year legislative review set out in the bill.

There are other facets of the challenge of access. As we all know, our country has many remote and rural communities that face challenges in accessing health care services, including access to a physician or other health care provider. Although delivery of health care is a provincial and territorial responsibility, accessibility is one of the five main principles of the Canada Health Act.

I am pleased to report that, along with the protection of vulnerable populations, questions of access have been considered and addressed throughout the proposed legislation and in the complementary initiatives.

Let me provide an example. The umbrella term “medical assistance in dying” encompasses both the situation where a provider must be physically present to administer a substance that causes death, and the situation where the provider prescribes a medication that the person can take himself or herself. Having criminal exemptions for both procedures would help to increase access for eligible people and provide choices in the circumstances around which medical assistance in dying is provided.

Second, the draft legislation provides exemptions for both physicians and nurse practitioners to be able to provide this assistance. Nurse practitioners, or those with an equivalent designation, are authorized in many provinces to perform medical functions that are necessary for medical assistance in dying.

Exempting nurse practitioners from criminal liability provides the provinces and territories with an additional option to facilitate access to medical assistance in dying in underserved areas.

I will offer another example of how we are working to support access in our health care system. Canadians, experts, and stakeholders have focused on the need to improve access to quality palliative care in Canada, even as we consider how to implement medical assistance in dying. We have listened. Our government is making the commitment to develop, along with the provinces and territories, measures to support the improvement of a full range of end-of-life care, including palliative care.

In the context of a new health accord, our government has committed to providing $3 billion over the next four years to improve home care, including palliative care. Discussions with the provinces and territories are already under way.

In the meantime, it is essential that we end the suffering and restore the dignity of Canadians currently experiencing grievous and irremediable medical conditions as soon as possible.

The draft legislation before us acknowledges the need for access, alongside the need for safeguards and protections. With the bill, our government would achieve these objectives and meet the deadlines imposed by the Supreme Court of Canada.

I have confidence that we can put in place a system that meets the needs of Canadians for compassionate care and support at the end of life.

I invite my colleagues in this House, and all Canadians, to contribute their views to this discussion as we continue the process of updating our laws to reflect 21st-century realities. Our door is open, our government is listening, and we are committed to supporting our medical professionals, protecting our most vulnerable, and restoring the dignity of Canadians in their most trying moments.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, I want to be very sensitive to the hon. member's comments about not using the children of Attawapiskat as an unnecessary element in this debate, but I think it bears noting that this is a critical issue across Canada when our first nations are struggling with an epidemic of suicide. I look at this legislation in all earnestness and I see how it flies in the face of what we are trying to do, which is not only to protect and defend human life but to create an environment within Canada where life can be lived in a way that is not only happy but productive and contributes to building a better society.

With respect to his specific question, how do we approach this ruling from the Supreme Court of Canada? The government well knows it does have remedies available to address the ruling of the court. It has tools within the charter itself to respond to this decision.

When legislation is so fundamentally flawed, as is Bill C-14, as a person of conscience, as a person of faith, as a person who loves this country dearly, it is my duty to speak up against this kind of legislation and to say, no, there are better ways of addressing this.

I am so pleased with my colleague who has raised the issue of palliative care consistently in this House. That should be the first focus of the work we are doing to help people who find themselves in these circumstances.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, I appreciate the opportunity to add my voice to those who have expressed serious concerns about this legislation. Bill C-14 would, for the first time ever in Canada, establish a national right to die and the right to seek assistance in the act of committing suicide.

I acknowledge that the issue of assisted suicide is highly complex and of course deeply sensitive. Like it or not, the issue has been dropped in our laps by the Supreme Court of Canada and each one of us has been elected to wrestle with this very tough issue. I hope that, at the very least, we will have the courage to reject solutions that, on their face, may, by some, be characterized as progress, but in reality degrade rather than elevate the intrinsic value of each and every human life.

I believe that every human life is God given and is deserving of dignity, value, and protection. Indeed, from my earliest years as a public official in the community of Abbotsford, I have made it clear that my constituents can and should always expect me to defend human life against all threats. Today is no different. The legislation we are debating today represents a watershed moment in the life of this country, one in which our fundamental values are being re-examined and tested.

I believe Bruce Clemenger said it best when he stated:

With the introduction of Bill C-14, Canada has crossed a significant threshold.... The decriminalization of euthanasia and assisted suicide constitutes a fundamental shift in how we as a society value and understand life and the duty of care we owe one another. Never before have we as a nation said that intentional killing is an appropriate response to suffering, or that we should take the life of the one who suffers rather than finding ways to alleviate their suffering.

Let me begin by commenting on the role that the Supreme Court should or should not play in articulating a right to die. As a lawyer and lawmaker, I have the greatest of respect for the rule of law, for the courts which sustain it, and for the individuals who occupy the bench. It is the rule of law and our court system that are intended to act as a bulwark against oppression and discrimination and defend our prevailing national values, including our personal freedom and our democratic institutions.

That said, it is eminently within our prerogative as MPs to also respectfully question and challenge the very decisions that our courts make and to suggest what particular issues should more appropriately be left for Parliament to decide. It is my view that matters of protecting life and the taking of life should remain the sole domain and prerogative of the duly elected representatives of the people of Canada, namely, the members of the House.

More to the point, many Canadians are having great difficulty grasping how the court would presume to specifically direct Parliament to implement legislation that effectively creates a right to die and a state-sanctioned role in the taking of a life, all under the threat of the court doing so on its own. Therefore, let me be very clear. I am deeply sympathetic to the suffering of so many whose conditions are terminal, who have concluded that there is no medical hope for healing, who suffer from unbearable pain, whose quality of life has been eroded beyond measure, or who consider themselves an undue burden upon family, friends, and their caregivers. That is exactly why our first and primary focus should be to improve and extend 21st-century palliative care to all Canadians whose lives could be measurably improved by it.

Is it not ironic that at the same time that we are debating the state-sanctioned taking of a human life for compassionate reasons, the Liberal government has failed to follow through on its solemn promise to expand the availability of palliative care. The promised $3 billion would have gone a long way to ensuring that palliative care becomes an essential part of the end-of-life decision-making process.

Instead of barrelling ahead with active euthanasia legislation, is it not incumbent upon us as lawmakers to first explore every opportunity to provide compassionate and effective palliative care to those who are in the terminal stages of disease and health? We owe Canadians so much more than simply an ill-considered rush to implement a directive from Canada's Supreme Court.

A cursory study of assisted suicide regimes around the world quickly reveals that even the most stringent and well-meaning safeguards are never completely effective in ensuring that no wrongful deaths occur. Jurisdictions like Belgium have acknowledged that of the thousands of assisted suicides that have taken place, some have taken the lives of those who could not or did not provide an informed consent, or who otherwise should not have died.

In this country, here in Canada, we abolished capital punishment exactly because we could not guarantee that an innocent life would not be taken. Yet, today, we are being asked to take the morbidly contradictory position of saying that notwithstanding that some vulnerable or unwilling individuals would lose their lives, we are prepared to take that very risk. The hypocrisy is astounding.

I also note that Bill C-14 fails to properly address the right of physicians, nursing professionals, and health care institutions to refuse to participate in the taking of a human life. Leaving it to the provinces, territories, and professional associations to regulate is not the answer, and will simply result in a patchwork of directives that ultimately compromise the ability of doctors and nurses to refuse any direct or indirect participation in assisted suicide.

It is highly likely that a health care professional in one jurisdiction will find his or her right to conscientious objection protected, while a colleague in another province is left without such a fundamental right. That is unconscionable and a clear abdication of the government's obligation to protect the rights of all Canadians, irrespective of where they practice medicine.

The right of medical professionals to refuse direct or indirect participation in assisted suicide should never, ever, be subject to negotiation or compromise. On that measure alone, Bill C-14 fails the test.

Many Canadians have expressed a legitimate fear that Bill C-14 will become the precursor to much more radical right-to-die policies. They are right. I have no doubt that the legislation before us, if passed, will very quickly become the thin edge of the wedge to secure future liberalization of assisted suicide to include children, the mentally and physically disabled, the chronically ill, the elderly, and those no longer considered to be productive contributors to Canada. Is that really the Canada we were elected to build?

This debate exposes an astonishing irony. Today we are experiencing, to our national shame, an unprecedented epidemic of suicides of our youth on first nations reserves. In response, the federal government is undertaking extraordinary efforts to prevent such suicides from happening in the future.

Yet, at the same time, here we are, in this House, debating an assisted suicide bill that the special parliamentary committee recommended should in the future extend the right to die to vulnerable children, the very group we are working so hard to save in first nations communities. Colleagues, what are we thinking?

Over the years, I have gotten to know many doctors and nurses, and have on numerous occasions dialogued with them on the issue of euthanasia. Our health care professionals are deeply compassionate, caring people who go to great lengths to ensure that patients who are terminal and suffering from great pain are made comfortable. They exercise a high level of discretion when they administer medications that alleviate pain, even where such medications may, on occasion, hasten the patient's death. The government's introduction of Bill C-14 failed to take that into account.

Let me close. More than a dozen times in the past this Parliament has considered and consistently rejected assisted suicide legislation. For whatever reason, our Supreme Court has now seen fit to insert itself into this debate by reversing itself on the Rodriguez decision. Its directive to the House to implement assisted suicide legislation calls upon us to act courageously and reject that directive.

Let us resist the urge to tread upon the steep and slippery slope of a policy whose implications are unclear, and whose trajectory represents a fundamental undermining of our foundational values.

We are faced with a monumental decision, one that challenges us to reaffirm the pre-eminence and inviolability of a human life. May we choose wisely and reject this deeply flawed bill.

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

Mr. Speaker, there is a vast difference between the two definitions. In physician-assisted suicide, the physician would provide the lethal dose but the person must self-administer. With voluntary euthanasia, the physician or health care professional would administer it. The big question then is, when people use euthanasia, whether the person has been properly consulted. Do they really want this to happen, or are they closing their eyes? Are they able to self-administer, and should they? Therefore, they are two very different definitions.

It was the decision of the Supreme Court in the Carter ruling that it is a competent adult providing consent, proper competence being deemed by, if it is a psychiatric issue, a prior assessment to make sure the person is competent. Bill C-14, to give it credit, requires asking at the last minute to be sure people want to have their life ended. That is very important. The special joint committee did not want this prior asking of “are you sure you want this”. Death is permanent. Bill C-14 has that right, but we need to make sure that the person is competent and is giving consent right to the last moment.

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

Mr. Speaker, I want to thank my colleague for his work on the committee and also his continuing work on seniors care.

Just to follow up with my colleague across the way, in terms of the expert panel, there was a point where I had the report of the expert panel. The unfortunate part is that the Liberals refused any recommendations from the panel. They said it could give them the report but they did not want any recommendations. That was really a sad day, seeing the expert work that was done.

My question goes to the point of definition. Currently, Bill C-14 is called medical assistance in dying. I pointed out on a number of occasions that, many times when we see social engineering projects, they are preceded by verbal engineering, and I think this is another way that this is happening.

I would like my colleague to comment on the difference between physician-assisted suicide and voluntary euthanasia, because we know that the outcomes of those two different methods are vastly different. In fact there is a tenfold increase in people dying by voluntary euthanasia over physician-assisted suicide because of some of the ambivalence that occurs.

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

Mr. Speaker, it is an honour to be in the House representing my community of Langley—Aldergrove. This is a very important debate we are having today.

I just want to do a quick review of how we are involved with this debate today. It was approximately a year ago, February 2015, that the Supreme Court made its ruling that Canadians who are suffering should have access to assisted suicide or euthanasia. I will use those terms because they are the terms used in the Criminal Code of Canada.

Terms like “death with dignity” and “medical aid in dying” are used when a physician is helping people in the last days of their life. They are not hastening their death. Palliative care is one of those forms of assistance, in which people are being assisted in the last days of their life. Therefore, to call it medical aid in dying really does not truly capture what we are talking about.

When we had town hall meetings, one of the terms I heard was “medically hastened death”. That more accurately describes what we are talking about. However, I will use the language of the Criminal Code, which the Supreme Court says we have to amend. Those terms are “assisted suicide” and “voluntary euthanasia”.

Mr. Speaker, I will be sharing my time with the incredible member for Abbotsford, the community just to the east of Langley. He is incredible because he was probably Canada's greatest foreign trade minister and did so much for our country. I want to thank him for all his work.

When the Supreme Court made its decision in February last year, what did the previous Parliament do? It knew there was an election coming in October of last year, so it appointed an external panel. The panel was given a clear mandate to consult with Canadians and then create a suggested legislative response.

After the election, the new government contacted the external panel, which had just completed its work of consultation and was in the process of creating the legislative response. The new Parliament could have started right away, because we had until February 6 to deal with the issue.

What did the new government do? It contacted the external panel and said it had changed its mandate. It no longer wanted legislation from the panel. It would create its own legislation. Instead of Parliament being called back and creating a special committee to deal with that legislation—we had until February 6 of this year, which would have given us a few months to debate and work on it—the government changed the mandate, said it was going to create its own legislation, then dithered. For a number of months it dithered, and then it created the special committee. The special committee came up with recommendations. Then what did the government do? It dithered and delayed, to the point now that we have four sitting weeks to basically do what normally takes two years to do.

Quebec took six years and three premiers in a non-partisan environment to create Bill 52 in Quebec, dealing with assisted suicide and euthanasia. It dealt with it in a much more responsible way.

Some would say they wish we did not have this debate. I heard that when we had town hall meetings. However, the Supreme Court in the Carter ruling made that decision for Canada. It said this must be permitted, and it is counting on Parliament to come up with appropriate safeguards to ensure we protect vulnerable Canadians.

What did the new government do? It changed the mandate of the external panel, then dithered. It had a special panel, which was partisan in nature. Then it dithered after the report from that panel. Now we have four sitting weeks.

It is really disappointing the way the new government has handled this. It is too important to be rushed through, but this is what the government is doing.

There are four sitting weeks, and the Liberals are not consulting properly. They are not giving Parliament adequate time to do this properly, and they are ramming it through. It is basically legislation passed by exhaustion.

In the special joint committee, we heard from two witnesses representing aboriginal communities, and they were not consulted. However, another requirement of the Supreme Court of Canada is that we consult properly, but that is not happening with the current government, which is not transparent, not accountable.

I would suggest that the Liberals seriously consider what happens on June 6 if the bill does not pass. What happens in Canada if their mismanagement of this results in no legislation in Canada and we have this legal void, and then the Carter decision takes over? Then we are advocating turning over the responsibility of protecting the vulnerable to each college of physicians and surgeons, and we would have different policies being applied across Canada. It would be a very serious situation.

I am hoping we will work together. I would suggest that the government seriously consider asking for more time from the Supreme Court, because the Liberals have not managed this well, and we have ended up with only four sitting weeks left to do two years' worth of work.

I want to speak to a couple of changes that I believe need to be made in Bill C-14.

The number one thing that I have heard at town hall meetings wherever I was, whether in British Columbia, Saskatchewan, or at home, is the importance of conscience protection.

I had a young nursing student come up to me and say she did not want to be part of this and ask if she would have to be part of this. I said that, at present, the special committee that was formed is recommending that, yes, one would have to be. Also, physicians would have to provide an effective referral. However, Bill C-14 is very silent on this, and it would leave it up to provinces to come up with their own policy on how this would be dealt with.

The Canadian Medical Association said that 70% of physicians in Canada do not want to be part of this, but 30% of physicians in Canada will participate in assisted suicide. Therefore, it is not an access problem, but what do we do about conscience protection?

Bill C-14 clearly needs to be amended to make it a criminal offence to force through intimidation or coercion in any way or threaten a physician that he or she would not be able to practise medicine—or a nurse, pharmacist, or any health care professional—to force them to participate in this against their will. This is the number one thing we heard time and time again: protect conscience rights.

The Criminal Code is being amended, and Bill C-14 needs to be amended to include that type of conscience protection. Without it, we do not have a pan-Canadian approach. We would have different policies in each province and territory, potentially. Some provinces have indicated that some physicians must participate.

On the Charter of Rights protection, the Supreme Court said physicians' charter rights should be protected. However, if we go on and do not provide the legislative protection, if we do not provide proper conscience protection, I am concerned that we will see in Canada physicians leaving the practice, maybe retiring.

I met a physician recently who is 71 years old and he is still practising medicine because he loves to help people. That young student nurse I talked about wants to leave nursing school. I told her not to leave yet. Let us see if we can fix this to make sure her conscience is being protected.

However, if we do not protect the conscience rights of Canadians, of physicians, nurses, and pharmacists, we are going to have people leaving the practice. They will either retire or relocate to another jurisdiction where their conscience will be protected.

We already have a shortage of physicians, nurses, and doctors in Canada. This would create a medical crisis in Canada if we do not protect the conscience rights of Canadians. It is a charter right. It is our responsibility to protect the vulnerable and the conscience rights.

There is a gaping hole in the legislation, Bill C-14. We need to fix that. I see a number of members here who are going to be on the justice committee, and we will be voting as Parliament. I hope we can deal with 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 second time and referred to a committee.

Business of the House

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

Mr. Speaker, I believe if you canvass the House you will find there have been discussions among the parties, and if you seek it, I think you will find unanimous consent to adopt the following motion:

That, notwithstanding any Standing Order or usual practice of the House, on Monday, May 2, 2016, the House shall continue to sit beyond the ordinary hour of daily adjournment for the purpose of considering Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), at second reading and when no Member rises to speak, or at midnight on that sitting day, whichever is earlier, the debate be deemed adjourned, and the House deemed adjourned until the next sitting day.

Criminal Code

[Filomena Tassi, Liberal, Hamilton West—Ancaster—Dundas, ON]

Mr. Speaker, I am honoured to rise in the House today to address Bill C-14. This bill is a response to the Supreme Court of Canada's unanimous ruling in the case of Carter v. Canada. The Supreme Court mandated that the Government of Canada create a framework for the provision of medical assistance in dying within a year of the ruling. That time lapsed on February 6, 2016, and an extension was granted until June 6, 2016.

The Supreme Court gave our government a short time in which to study this challenging and historic issue. I have listened to constituents who have argued passionately on both sides of this debate. I have struggled with the moral and ethical implications of this legislation. I understand that this is an emotionally charged and challenging topic.

Civilized societies have always recognized the sanctity of life. Countries around the world have legislated against the taking of another person's life. Historically, the taking of life has been considered to be the worst of crimes. The issue of medical assistance in dying poses a complex challenge to all Canadians because it brings together several different and difficult issues. There are questions of charter rights and personal freedoms. There are questions of protecting the vulnerable and responding to those who are enduring intolerable pain. There are theological, moral, and ethical considerations.

As well, this issue is an emotional one, fraught with the feelings of those who take strong positions on either side of the debate, and leavened by the feelings of those people who are experiencing such grievous suffering that they no longer wish to continue living.

Another element is purely economic, whether it is the pressures of inheritance or financial instability or the overwhelming cost of health care during the end of life. While we do not like to cite these utilitarian perspectives, their existence cannot be denied.

As well, this debate touches upon one's vision of a just society, whether one feels that ultimate justice involves complete choice or whether one feels that justice is best served by sometimes limiting the avenues available to a person so as to keep open the possibility of a happier tomorrow, a more desirable future, one that can be looked forward to rather than dreaded. I feel that this legislation finds a balance between these two perspectives, allowing choice to those who wish to end their grievous suffering and are already far along the path to dying and protecting those who may be vulnerable.

The ruling in Carter v. Canada was expressly limited to a competent adult person who clearly consents to the termination of his or her life. Furthermore, the Supreme Court of Canada did not find that there was a right to medical assistance in dying for minors or persons with psychiatric disorders. I was greatly relieved that these provisions were not included in this legislation.

To ensure that the path to the end is as fair and secure as possible, it is imperative that we accompany any legislation for medical assistance with enhanced support for palliative care. All parliamentarians have stories to share with respect to their engagement with people. We have interactions that have a profound impact upon us and never leave us.

On the campaign trail, I had the opportunity to visit a number of long-term care facilities. On one of these occasions, after the candidates gave speeches, there was an opportunity to mingle. I approached a man, who handed me a piece of paper. It was a petition for more personal support workers. He had tears in his eyes as he asked me to sign the petition. I sat with him and he explained his situation. He was there caring for his wife, who was beside him in a wheelchair. She had endured a serious stroke. This man was not advocating for his wife, as he was there every waking hour to take care of her, but he was advocating for others whom he witnessed daily not getting the care they needed. This was just not fair, not right, and clearly not just.

We have serious work to do in palliative care, which is connected to home care. Our government has pledged $3 billion to home care, and I am strongly encouraged by the health minister's commitment to see that high-quality home care is accessible to all Canadians. I look forward to engaging my colleagues in these debates and fighting for greatly enhanced palliative care for Canadians.

I have spent the last 20 years working with youth as a chaplain in high schools in Hamilton and Ancaster, Ontario. During this time, I have walked with thousands of students as they have negotiated the difficult terrain of adolescence and early adulthood. Their struggles are real, and the burdens they carry through family difficulty, personal struggles with identity, emotional pain, loneliness, rejection, or alienation are all real.

Young people face a complex and often overwhelming world in their physical neighbourhoods, in the relationships they inhabit, and in the virtual worlds in which they are thrown head first, often not ready. One only has to look at the terrible cases of online bullying that have removed the joy from the lives of young people and replaced it with sadness, depression, and in some cases suicide. I believe in our youth. I have spent my life believing for them and in them when they have sometimes stopped believing in themselves. I have made it my life's work. Amazingly, although their worlds sometimes sombred into darkest night and they feared that any light might have been extinguished forever, together we found a glimmer, a flicker that with love, inclusion, acceptance, and safety grew into a flame and then a roaring fire, not only of hope but of a desire to change the world, to bring healing to others who suffer and are rejected. These same teenagers have now stepped up and become leaders with a conviction to change the world. If assisted dying had been available to them when they were in the depths of their depression, they might not be with us today.

I am pleased that this legislation does not include mature minors, and I call for a renewed focus on creating a better, happier, more secure, and stabler world for our young people, online and in the physical world.

I have debated the morality of the question of medical assistance in dying. There are many who believe that in good conscience they cannot support assisted dying. For those who feel this way, I wish to address the issue of conscience.

People often equate conscience with values and beliefs. While conscience most certainly includes these, it also is much more complex. Conscience is at the very core of who we are as people. Conscience deals with reality. It appreciates the facts that are before us. The facts here are that the Supreme Court of Canada has ruled that medical assistance in dying is a charter right. We are not faced with the question of whether we allow medical assistance in dying; rather, we are faced with the question of in what conditions we will allow medical assistance in dying.

In my view, the bill before us is narrow in scope and respects the charter as interpreted in Carter v. Canada. Bill C-14 fulfills the legislative mandate delivered by the Supreme Court in a way that meets the charter but attempts to protect the vulnerable and the powerless. Although we can never fully protect the vulnerable, we can do our best. This is what Bill C-14 does.

Finally, I wish to affirm my support for respecting the personal values and beliefs of doctors and nurses and the mission statements upon which some institutions were created.

As the Minister of Justice has said, and I quote:

To this end, as I have already mentioned, my colleague, the Minister of Health, will be working with her counterparts to bring forward a coordinated system for linking patients to willing providers.

As is outlined in the government preamble to this bill, the Government of Canada has committed to developing non-legislative measures that will “respect the personal convictions of health care providers”. As the Minister of Health has indicated, “Practitioners will have the right to choose as their conscience dictates”.

I will continue to fight for the protection of the rights of morally objecting physicians and institutions while ensuring access for patients to their charter rights.

In light of all of these arguments, I stand in this House today in support of this fair and thoughtful legislation.

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

Mr. Speaker, I rise today to speak to Bill C-14 regarding medical assistance in dying. This is not the first time I have had the honour to participate in the discussion of this matter as a member of Parliament. I also was a member of the Special Joint Committee on Physician Assisted Dying. As a member of that committee, I was able to hear the thoughts of many people, both in my riding of Toronto-Danforth and across the country, on this very important issue that affects us all, and that is our end-of-life care.

My preference would have been for a bill that would have allowed for a broader scope of application. However, I support this legislation because it is a first step in the right direction, and it was a commitment to study the important issues of age, mental health, and advance directives, as will become apparent as I speak further. We need to take this first step, because this file has been left to languish for too long. My step would have been a bit bigger, but I am ready to start here on this path of incremental change.

Mr. Speaker, I intend to share my time with the member for Hamilton West—Ancaster—Dundas.

To date, we have struggled with the question of whether to allow, or not, medical assistance in dying. However, now we are faced with a different question, specifically, how we are going to legislate that assistance. This is an important change for us to consider, because following the Supreme Court of Canada decision in Carter, medical assistance in dying will be legal as of June 6. This bill is important because it gives us the opportunity to create a federal framework to govern medical assistance in dying.

In 1983, the Law Reform Commission of Canada reported on “Euthanasia, Aiding Suicide and Cessation of Treatment”. It found three basic principles reflected in our law, and I find that these principles set a good basis for our debate. The first is that the protection of human life is a fundamental value. The second is that patients have the right to autonomy and self-determination in making decisions about their medical care. The third is that human life needs to be considered from a quantitative and qualitative perspective.

I find it particularly instructive that the second principle creates a basis for a patient-centred approach to medical assistance in dying. This was the approach adopted by the Special Joint Committee on Physician-Assisted Dying on which I served.

Looking at the history of this issue, I have traced a long path of private members' bills, Senate bills, and private motions in the House. The issue has been before us approximately 11 times since 1991. The list of past attempts on this issue is incredible and demonstrates that efforts that have been made to grapple, unsuccessfully, with this issue have continued for too long. It is why I find it so important for the House to cross over this impasse and to take the first step toward legislating a framework.

The issue has not only been before us here. The other place has also considered the matter in committees, subcommittees, and bills. Just over 20 years ago, the Special Senate Committee on Euthanasia and Assisted Suicide released its report “Of Life and Death”.

The goal of that committee was to set the stage for the national debate that would take place in the years to come. The majority of senators on the committee were not ready to support medical assistance in dying. The minority on that committee made some recommendations to support medical assistance in dying for an individual who was competent and suffering from an irreversible illness that had reached an intolerable stage, as certified by medical practitioners.

Over the weekend, I finished reading the Hon. Steven Fletcher's book, Master of My Fate, which outlines his experience as a parliamentarian, generally, but focuses upon private members' bills that he brought on the issue of medical assistance in dying. The book brought special insight into his journey on this question. He shared his story of the massive accident that rendered him quadriplegic and his election to the House, including the time he served as a cabinet minister.

Our most recent initiative in the House on the issue of medical assistance in dying was two connected private members' bills put forth by the Hon. Mr. Fletcher. The first, Bill C-581, proposed to amend the Criminal Code to permit a doctor to assist a person in taking his or her own life. The eligibility criteria proposed in the bill would track the language in Carter very closely. I will read the most salient eligibility criterion for the sake of the House:

...a person must...have been diagnosed by a physician as having an illness, a disease or a disability (including disability arising from traumatic injury) that causes physical or psychological suffering that is intolerable to that person and that cannot be alleviated by any medical treatment acceptable to that person, or the person must be in a state of weakening capacities with no chance of improvement...

His other initiative, Bill C-582, proposed to establish a Canadian commission on physician-assisted death, which would have collected data from physicians who performed physician-assisted death. It recognized the possibility for incremental steps.

The bills were read a first time and left to languish on the Order Paper. However, on December 2, 2014, similar legislation was introduced in the other place and was debated on seven occasions, as late as June 2, 2015.

As we all know, during that time frame of December 2, 2014, to June 2, 2015, the Carter decision was released.

It is also worth noting that there have been active discussions in our provinces and territories about a framework for medical assistance in dying. The most notable example is Quebec, which struck a committee in 2009 to develop legislation on medical assistance in dying. The legislation came into effect in December of 2015. Much has been said regarding that law, and I will not repeat it, but it is notable that they too have a terminality provision.

I found it interesting that in testimony before our committee, Jean-Pierre Ménard of the Barreau du Québec stated that he believed the terminality clause of the Quebec legislation would have to be removed in light of the Carter decision. It underscores the point that such legislation will develop through incremental changes.

Working on the joint committee was an amazing experience. It was the first special joint committee in 20 years, and I see a strong value to this form of collaboration on major issues. The witness testimony and the thoughtful written submissions gave us a strong base upon which to form our recommendations. I stand behind the recommendations that we made. We did not come to our decisions easily. We lost sleep, debated a lot, and worked together to formulate our recommendations.

How then does my background on this file inform my views of the legislation we are debating today? I would have preferred that it be broader. Most of what I have heard from my own constituents favours a broader approach. However, the bill is the first step into a complicated matter.

We need to empower individuals to choose how to manage the end of their lives and give value to the law reform commission's idea of a patient-centred approach. Also, we need to consider not only the quantity of life but the quality. We need to respect people's autonomy and their right to be free from suffering, without putting vulnerable Canadians at risk. Bill C-14 gets us much closer to that goal than we currently find ourselves.

I would have preferred that we remove the clause of a reasonable and natural death, which refers to the foreseeability of a natural death. It is a terminality clause of sorts. The clause is vague and could place an overly broad restriction on a sick person's right to be free from pain and suffering. The concern about this terminology is that it tends to devalue the lives of the oldest among us. They are the most likely to be given permission to seek medical assistance in death with the legislation.

The young and sick suffer as much as the elderly. To quote Steven Fletcher “If the person is a cognitive adult, why on earth would we impose our views on what their quality of life is on them?”

The lack of advance directives in the legislation is also too restrictive. A fundamental point of the Carter decision was that the Supreme Court of Canada had found a violation of “Life, Liberty, and Security of the Person” if individuals would feel they would have to cut their lives short because they did not have an expectation that they could end it later when the time would come. It is a tricky issue, but I am happy to see a commitment to study the issue further.

In my opinion, the positives of the bill outnumber the negatives, so I will be supporting the bill. However, I do see it as a first step on the journey.

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

Mr. Speaker, as I rise today, I feel a sense of gravity and strong emotion. This is not the first time. Two years ago, when I was a member of the National Assembly of Quebec, I rose to debate the extremely sensitive subject of medical assistance in dying. At the provincial level, the debate was about end-of-life care.

This is therefore the second time that I have participated in the debate and the vote on this extremely delicate subject, and I intend to do so with diligence, careful consideration, and a great deal of compassion.

Usually when I rise I want to convince. That is the job of all politicians, to convince people. In this case, I do not want to convince; I just want to talk and to explain where I stand. Also, in political debate there is good and there is bad. In this case, no one is good and no one is bad; they are only honest Canadian citizens who want the best for the future of this country and the best for the future of our people, even if this debate is quite difficult and fragile.

Why are we here today?

We are here because a year ago, in February 2015, the Supreme Court made a ruling that had very serious and important consequences. It was the Carter decision that centred on medically assisted death.

The Supreme Court did not ask the House of Commons and Canada's Parliament to take a position for or against medically assisted death, but to develop a legal framework for it. That is the principle underlying this whole debate. We are not here to debate whether medically assisted death is good or bad. We are here to figure out how to give people access to it.

However, I have often said, and I want to repeat now from my seat in the House, that I find it very unfortunate that the Supreme Court gave the Parliament of Canada just under a year to take action. That is completely irresponsible. I know what I am talking about. I was a member of the Quebec National Assembly for almost seven years. I was there for the six years of detailed, painstaking work that led up to the passage of Bill 52. It took six years and three different governments with three different premiers: the Hon. Jean Charest, the Hon. Pauline Maurois, and the Hon. Philippe Couillard. We worked on it for six years. There were two full years of direct consultation, and over 275 Quebeckers shared their opinions on the subject. However, the Supreme Court ordered the Parliament of Canada to take action within one year.

Why do I find that irresponsible? Because the Supreme Court knew that it was an election year and that this is not a subject for partisan political discussion. Despite all that, the Supreme Court ordered us to come up with legislation in under a year. The court knew that, as of February, the countdown was on to the month of June and that everything would then come to a grinding halt because the election was called for the fall and a new government would be taking office. In theory, parliamentarians could do nothing until December or January, and that proved to be true. In short, we lost six months in which we could have been debating this extremely important issue.

However, all was not lost. The previous government, led by the right hon. member for Calgary Heritage, set up a committee of three experts, including a former Quebec minister, whom I salute. This committee assessed all of the legal and parliamentary options regarding this sensitive issue and produced a document over 400 pages long. I am very proud to know that this work was done, despite the fact that it was an election year. I will come back to that a little later in my speech.

The report was written, but there was an election, and the new government created a parliamentary committee that could be described as bilateral, since it was made up of MPs and senators. The committee was co-chaired by a Liberal MP and a Conservative senator. Basically, the foundation for non-partisanship was laid, so that was good.

Despite the fact that we had very little time to do our work, in fact barely five or six weeks, we had 13 meetings, we heard from 61 witnesses, and 132 briefs were submitted. That is great, considering the time we had. I want to commend all of my colleagues who are here. I see the House co-chair, as well as my colleague from Toronto. I apologize, but I do not know all the riding names by heart. The names are very long, and perhaps we should change that one day, but that is another matter altogether.

I want to commend all of my colleagues for working in such a positive, constructive, and non-partisan manner. It was an extremely delicate and difficult subject, but we took a serious and thorough look at it.

After all our work, two reports were produced: a main report and a dissenting report signed by the member for Langley—Aldergrove, the member for Kitchener—Conestoga, the member for St. Albert—Edmonton, and me.

Before I get into the substance of the dissenting report, which I signed, I want to point out that the Conservative MPs on the committee were the ones who signed it. However, it was not a Conservative dissenting report, since the Conservative senators did in fact sign the main report.

Let there be no mistake: in this case the dissenting report was not a Conservative dissenting report. It was a dissenting report from members of Parliament, because the Conservative senators signed the majority report.

It is very clear, and we have to be very careful with that. There was not a political agenda behind our dissenting report.

In the dissenting report, my three colleagues and I were driven by the need to protect the most vulnerable, but also by Carter and especially by what we referred to in our report as “the Quebec experience”.

I am proud to say that I witnessed the Quebec experience. Together, we applied that experience in the dissenting report and used it as a model in determining what should be done. We did that because in Quebec, we took our time to address this issue properly.

In Quebec, after six years of debate, work, intellectual rigour, and careful consideration, we came to certain conclusions. Bill 52 became law to ensure that everything is done properly with a certain social consensus.

It is very tough to have consensus on this difficult issue.

Our dissenting report outlined five concerns. I will read them, then go over them one by one.

First, we felt that end-of-life care should not be provided to minors. Second, we established that people suffering from mental illness should not have access to medical assistance in dying. Third, we raised the need to protect the conscience of doctors and health care professionals. Fourth, medical assistance in dying should be provided only to people at the end of their life. Lastly, we had some serious concern over palliative care. Those are the five concerns outlined in our dissenting report. Let us look at them one by one.

First, this should not apply to minors. This is a very sensitive topic. The Supreme Court was talking about adults, not minors. What is more, the Quebec experience applied only to adults. This otherwise creates almost insurmountable problems.

Imagine if the parents of a 16-year-old son or daughter refuse to allow their child to receive end-of-life care. What then? Who is right, the child or the parents?

In the worst case scenario, if a 17-year-old child asks for end of life care, which his father wants but not his mother, who is right? Do we try to convince the mother? That is so difficult, so touchy, so fragile.

That is why our dissenting report put aside minors, aided by the Quebec experience.

We do not want this bill on medical assistance in dying to apply to people with mental illness because it is almost impossible to determine at what point they are capable of giving informed consent. People with mental illness are unaware of what is happening. I know that it is terrible to say such things, but it is the truth.

This is the truth. For those who suffer from mental illness, it is very tough and difficult for them to be very clear on what they want to do. If we were to put them in that kind of situation, we would see the worst. Again, based on the Quebec experience, we put it aside.

Let us now discuss conscience protections for physicians and health care practitioners. This is a delicate but very important subject. Quebec came up with a rather unique solution, and one that the government should use as a model.

We must respect the patient who, in his heart and soul, wants to receive end-of-life care. However, we must also respect the physician who must provide this care. If the physician does not want to proceed, we must respect that. This is Quebec's solution: the physician who does not want to provide this care must refer his patient to a third party, namely, the administrator of the hospital or CLSC, and this third party will refer the patient to another physician. Thus, a physician does not refer his patient to another physician because a third party is involved. Consequently, a physician who is uncomfortable dealing with this situation does not find himself referring his patient to another physician. This decision must be respected. This is a detail, but it is all about the details in this bill and the entire medical assistance in dying situation. We must have conscience protections.

Once again, based on the Quebec experience, we believe that the same is true with respect to the end of life. At what point can patients give their consent to medical assistance in dying?

Quebec, after examining this issue for six years, concluded that patients were able to give consent at the end of their life and not before. It is quite easy for a guy like me, who is 51 years old, in good shape, and feeling well, to say that if I ever get sick, no problem, the doctors will come and that will be it. It is easy for me to say that at the age of 51, when I am in good health. However, will I feel the same way when I am at the very end of my life? Not necessarily, which is why we need protections in this area. Once again, there are five concerns based on the Quebec experience. The fourth one has to do with the fact that Quebec makes it clear that only patients who are receiving end-of-life care may receive this type of medical assistance.

The last concern is palliative care. My colleague from the second opposition party spoke about this earlier. We believe it is extremely important to have full, comprehensive palliative care for all Canadians, and not just for one-third of Canadians, as is the case now. We really need to focus on this.

There was the main report, the dissenting report, and the five concerns I mentioned, which were based on safeguards for the most vulnerable, the Carter decision, and the Quebec experience. After we presented our report, it was up to the government to proceed and introduce its bill.

Therefore, what we have now is Bill C-14. What we like in the bill is what it does not have. That is funny to say, but it is true, because the bill put aside some of the most touchy subjects that we put in our dissenting report.

In our dissenting report, we did not want medical assistance in dying to be available to minors or people suffering from mental illness. The government embraced our position, which is good. We thank it for that. Congratulations.

However, we still have some other concerns regarding this bill, particularly when it comes to conscience protection. This bill contains no provisions regarding the protection of conscience for doctors and other medical practitioners, including nurses and pharmacists, in the context of medical assistance in dying.

I asked the Minister of Health about this during the debate two weeks ago. She said that it was not mentioned because it falls within provincial jurisdiction. Technically, that is true, but we are in a federal Parliament. The bill's own preamble clearly states that the law must adapt and apply consistently all across Canada. We need to have a national policy in order to avoid fluctuations from province to province. Once again, I urge the government to learn from the Quebec experience, which allows for the protection of conscience for doctors.

What will happen if that protection is not ensured? It will be left up to the provinces to decide whether they want to provide, or not, a framework for this in a particular way. I understand the goodwill of the Minister of Health, but there is such a thing as too much vagueness. In this situation, we are not talking about deciding between an apple and an orange; we are talking about deciding whether to live or die. Vagueness is unacceptable in this situation. We need to provide clear guidelines, particularly regarding conscience protection, because there is nothing that is more fragile and more precious than the conscience of someone who is there to save lives or end lives, depending on the patient's wishes.

I invite the government to take a closer look at the Quebec experience and really take note of that experience, as well as what we have said.

As I mentioned earlier, in Quebec it is clear that this type of care is provided at the end of life. In the legislation we find the concept of “reasonably foreseeable”. I have to read that because I have been asked about this a number of times and I always have a hard time because it is a bit vague.

I can assure the House of one thing: I am going to die. That is foreseeable. There is no doubt. I am 51 and I think I have done more than I have left to do. Reasonably, I could die in a few decades. I am in no hurry, by the way.

What I am trying to say is that “reasonably foreseeable” is not clear. The first question I was asked in an interview on RDI by Julie Drolet, a former colleague whom I salute, was whether I really understand this “reasonably foreseeable”. Well, the answer is no, not really. That being said, I am not the one who drafted the legislation. Perhaps we need to ask the minister that question.

All that to say that this needs to be clear, as does “conscience protection”. The same goes for end-of-life and what is reasonably foreseeable. It is much too vague.

During an interview last weekend on Radio-Canada's political television show, Les coulisses du pouvoir, Quebec's health minister, Dr. Gaétan Barrette, said there could certainly be a debate about the legality of this bill with respect to the notion of reasonably foreseeable death. He added that it should be reasonably foreseeable regardless of the prognosis on the progression of the disease. After all, if death is reasonably foreseeable, that means a prognosis has been reasonably established.

In situations like that, there is no clear answer. I would ask the government reasonably, no pun intended, to clarify its thinking on this.

There is a similar issue with regard to nurses and doctors. They say that nurses can provide the care. I want to be very clear. I have tremendous respect for nurses. Based on my experience in Quebec, they are the ones who keep the health system going, and I thank them for that. However, we think that a diagnosis of this importance needs to come from a doctor. People might think I am saying the same thing over and over again, but that is the conclusion drawn from the Quebec experience after six years of thorough, serious work.

With respect to palliative care, we all agree that more money should go to that. I would like to point out that the latest budget allocated no money to palliative care, even though that is an extremely important and sensitive subject. In a press conference, the Leader of the Government in the House of Commons talked about allocating $3 billion. That is very nice, but we would like to see that in the budget. The government can be sure we would support that enthusiastically.

Nothing is perfect, especially this bill, but we should be very concerned about that. We should be very concerned, because if we do not adopt a law, good or bad, we will have to deal with the Carter decision. For some people, it will be the worst-case scenario, because in that case, the medical professional associations in some provinces will say one thing and the associations in other provinces will say another thing; some provincial legislatures will adopt certain bills and other legislatures will adopt other bills. There will be a lot of movement in Canada in that case and the last thing we want is movement. We need a clear bill on those issues.

I want to say that this is obviously a very emotional debate. Everyone who speaks to this issue will be right. They have the right to do so and we hope they will. No one here is wrong, no one here is right. We are all honest Canadians and we want to do what is best for the future of this country and for the future of Canadians.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Mr. Speaker, I am grateful for the opportunity to rise today to speak about Bill C-14, medical assistance in dying.

Death is a word that elicits strong emotions. We celebrate life. We embrace life. We talk about living. However, we avoid talking about death. We shy away from those conversations because they make us uncomfortable.

It is my sincere hope that this legislation will open the door to conversations about end of life and palliative care, about dying with dignity, and death.

I first want to thank all Canadians who participated in consultations with their provinces and the federal government on this issue. I want to acknowledge the work of all members of the Special Joint Committee on Physician-Assisted Death, who reported to Parliament at the end of February, and in particular my colleague, the member for Don Valley West, as well as the Minister of Justice and the Minister of Health. I personally appreciate their sensitivity and thoughtful dialogue.

I listened to the Minister of Justice and the Minister of Health when they spoke in the House on this bill. I have complete confidence in them to steward us as we begin the legislative process on Bill C-14, as well as in conversations about death and dying.

This is an issue that we have struggled with for many years. I recall in the early 1990s when former MP Svend Robinson compassionately took Sue Rodriguez's hand as she unsuccessfully sought permission from the Supreme Court to end her life as her ALS progressed.

The reasons for the need for this legislation are clear. The Supreme Court, in the Carter decision, unanimously decided that Canadians suffering intolerably have the right to request assistance to end their suffering.

With this legislation, the government has attempted to reach a balance, but, of course, in doing so will not please all people. Are there areas where the legislation does not go far enough? In my opinion, the answer is yes. Those with dementia will remain without an important option for end of life.

When on a journey with a terminal illness, there remains many questions pertaining to this legislation. I have no doubt that there will be fulsome discussion at committee on the legislation. I have received correspondence from residents concerned about implementation of this legislation by the territories and provinces. I am pleased that there will be additional study. This is just the beginning of the conversation, as it should be.

I know there are those who feel that this legislation goes too far. For the most part, I believe these people are fundamentally opposed to the Carter decision. However, regardless of where people fall on this legislation, I think we can all agree that the way we deal with death needs improvement.

Whether a grievously ill patient chooses to die at home, in a palliative care facility, or chooses medical assistance in dying, we should be having these conversations sooner, and lovingly assisting them in their end of life. These are not decisions that should be made during a health crisis, which is often the case. Rather, each of us should be engaged in advance care planning.

I recall, shortly before my father passed away a few years ago, sitting in his hospital room as he battled pneumonia. My sister and I had to talk to him about his wishes should his heart stop. As members can tell, it was one of the most difficult conversations that we ever had. While it was painful and heartbreaking, it was also necessary.

While I recognize that this legislation is not the same as deciding on a do-not-resuscitate order, talking about death is difficult. Talking about the death of a loved one is incredibly difficult. However, because it is difficult does not mean we should not talk about it. In fact, I would say that because it is difficult is the very reason we should talk about it.

We do such a poor job of educating people about their choices for end of life. There are choices. We also do a really poor job of making available those choices for end of life. For those who wish to die at home, there are a lack of resources available to them. For those wishing palliative care, those options too are limited.

I believe the federal government needs to work with the provinces and territories to develop a better framework for end-of-life care. Our platform has included a much-needed $3 billion over four years for home care and palliative care.

Today marks the beginning of National Hospice Palliative Care Week. Shortly after I was elected, I had the opportunity to visit Carpenter Hospice in Burlington, one of the only palliative care options available in Oakville and Burlington for those in the last days and months of their lives. While I was there, we not only talked about the wonderful facility, but we talked about how we as a society need to have more open conversations about death.

I was deeply touched by Bonnie Tompkin's story. She is a community health coordinator at Carpenter Hospice, but her story is a very personal one. When her fiancé Ian was diagnosed with terminal cancer, he was adamant that he wanted medical assistance in dying. As is common, his biggest concern was the burden he would place on loved ones as his illness progressed. After he saw Carpenter Hospice and was educated on the options available to him, he made the choice to spend his last days at the hospice.

Carpenter Hospice is actively working with the City of Burlington on adopting a compassionate city charter. Widely implemented in the United Kingdom, citizens in compassionate communities are engaged, knowledgeable, and informed about death, dying, loss, and bereavement.

As our health and well-being extends beyond our health care system to our friends and loved ones, our connections to public spaces, and those in community, the thinking behind the compassionate city charter is that the community plays a similar role at the end of life. To quote from the compassionate city charter:

Compassionate Cities are communities that recognize that all natural cycles of sickness and health, birth and death, and love and loss occur everyday within the orbits of its institutions and regular activities. A compassionate city is a community that recognizes that care for one another at times of crisis and loss is not simply a task solely for health and social services, but is everyone's responsibility.

Compassionate cities are supportive of diverse religious and cultural beliefs. I met with a couple in my riding who were concerned that this legislation would normalize suicide, but if we are building compassionate communities and talking about both life and death, then we can give people the tools they need, and options for life.

There was a time when we did not talk about cancer. That changed when a one-legged young man embarked on the cross-country Marathon of Hope on April 12, 1980, forcing us to acknowledge not only his cancer, but the fact that people with disabilities need not be hidden from view.

We are only now starting to have a conversation about mental health, another subject that until recently was only spoken about in hushed tones. In fact, today on Parliament Hill, there was a walk for mental health awareness.

Death is another taboo subject, and one we do not want to talk about. However, because we do not talk about it, we do a disservice to our friends and loved ones when the time comes to face their own mortality.

I recently had a conversation with one of my best friends about death and dying, about this legislation, what end-of-life care should be, and what is lacking. Her husband, my good friend, is living with a terminal illness, ALS. Another of my good friends is currently navigating his father's end-of-life journey. These conversations are very hard, but perhaps in having these conversations we will make it easier for all of us to have choices, dignified choices about how our lives will end.

Death will never be easy to talk about, nor should it be, but death needs to be as much a part of our conversation as is life. We need to talk about life options and death with dignity. The time is long overdue.

We should perhaps take a page from the compassionate city charter and acknowledge that how we deal with death, dying, loss, and bereavement should be shared with the entire community, in every city from coast to coast to coast.

[Rob Oliphant, Liberal, Don Valley West, ON]

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

I want to begin by taking a moment to pay tribute to two Canadian women whom I did not know but have come to know in their deaths, and who I think are two of the most courageous women. They are Gloria Taylor and Kay Carter. These two women were on a journey of life that was not of their choosing, and they came to the point in their lives where they wanted some assistance in the final days of their lives in the final part of their journey.

As a United Church minister, I walked that journey with many people, hundreds of people in fact, and have done even more funerals where I did not know the people and only came to know them through the stories of their families and the legacy they left behind. Kay Carter and Gloria Taylor are two such women whose courage, tenacity, hopefulness, and love of life have instructed us to this very day, where we are now considering a bill on medical assistance in dying.

In paying tribute to them, I also want to give them thanks for engaging us in what is one of the best civics lessons that we could ever have as a chamber. Each of the branches of our government has a chance to speak to this. There is a legislative branch and a judicial branch, as well as the executive branch.

We actually began this conversation in 1982 where we invoked the charter that is now so much part of our Canadian culture of rights and freedoms. That charter has instructed all Canadians, Canada's courts, and Canada's legislators since the day it was passed. The reality is that when Kay Carter and Gloria Taylor made their appeal to the Supreme Court of British Columbia, and it went to the Court of Appeal in B.C. and then to the Supreme Court of Canada, we had the opportunity to have our judicial branch take a look at their rights and the possibility of their having assistance in their deaths. The courts ruled on that and gave one year for the parliamentary branch and the executive branch to come up with a law.

The parliamentary branch then spoke by having a joint committee with the House and the Senate. I need to say to this chamber that it was probably the richest experience I have had as a member of Parliament. Men and women—senators and members of this House—engaging in a discussion, listening to the stories of life and of death and of healing and of hope, changed me profoundly. It gave me the opportunity to recognize that the parliamentary system that we have gives Canadians a great opportunity to hear their voices being heard at committee and now in this House.

The executive branch then picked up from the report and has presented Bill C-14. I want to thank the minister for her work on this, and the work of her office and of justice, for taking the report that we did seriously, engaging in it further, and coming up with a piece of legislation that at this time I am very clear I will be supporting at second reading.

That does not mean that I think we are finished with this piece of legislation, because it is now back to the parliamentary system where we are to engage in the dialogue with the executive branch about making a law that could be good enough better. When we are dealing with issues of life and death, I do not think “good enough” is good enough. We can honour the quest that Gloria Taylor and Kay Carter engaged in and that the Supreme Court of Canada ruled on and that the executive branch has presented a law on, and as parliamentarians take seriously the Charter of Rights and Freedoms, take it to our hearts and look at what it is that we as members of Parliament are sworn to. It is more than allegiance to Her Majesty. It is about upholding the Constitution of this country and engaging in it with love, with commitment, with passion, and with hope, and looking at how the decision that the Supreme Court made can actually live out in the life of Canada.

We have a piece of legislation that is before us today, and it was decided that section 7 of the charter could not be used to deny the rights of two women looking for assistance in their deaths. The government of the day tried to fight that section 7 declaration of rights by invoking section 1 of the charter, saying that there were reasonable grounds to withhold those rights. However, the Supreme Court of Canada did not allow that. It said it would be unreasonable to deny those rights to be given to those women. The court made a very specific decision on a very specific case at a specific time.

The Supreme Court also said in paragraph 127 of the decision that it did not pronounce on things that were not before it in that case. That was a requirement for Parliament and also the bill, which, yes, does engage all Canadians in a discussion about what it is that we can have as a continuum of care that continues to the place where we help people on that final journey.

We come at it differently. I have full respect for the hon. member for Kitchener—Conestoga. He has engaged this subject well and I have taken into account the fact that he has passion. We have come at it differently, but I have no doubt that everyone on both sides of the House is concerned about the well-being of Canadians. However, I think the bill needs to go even further to be faithful to our Constitution.

I have concerns in that I think there could be further challenges to the bill in the courts, which I do not think Canadians should have to endure. I have a couple of very specific concerns that I would like to raise in the House and one is the use of the word “incurable”.

The court was very clear that it did not want to use the word “incurable”. Instead, it used the word “irremediable”. By invoking the word “incurable”, one begins to look at the disease instead of the person. What I mean by that is that sometimes a disease may be incurable or curable, but the person has the right, the Supreme Court said, not to undertake treatments that are not acceptable to that person. The treatments may be cruel or punishing and the reality is that the court said they do not need to undertake them. The disease may be curable, but that person has chosen a different path and that, under section 7, is their right. I have that concern about invoking that word.

The other concern I have is the introduction of the concept of foreseeable death or death in the foreseeable future. All of us live a precarious life. Life is fragile, life is precious, and life is dear, but for some life has become intolerable. Some diseases are not necessarily mortal in the sense that people are automatically going to their final days with that disease, but people still have pain that is intolerable. The Supreme Court decision in Carter says they have the right to medical assistance in dying.

The introduction of that concept of death in the foreseeable future has muddied the waters. Physicians are asking what it means. Does it mean “terminal”? Some hospitals have a different definition of “terminal” than other hospitals and other physicians have. We have to be very careful on that.

The third point I would make is about one of the safeguards. This is robust legislation. There are safeguards in place that I do not believe are of great concern. One safeguard worries me, and that is the final one in the third section on safeguards, proposed paragraph 241.2(3)(h), which says that immediately before the administration of those substances that will cause death, the person needs to, once again, declare competently that they want death to happen.

I have been in too many hospital rooms. I have sat with too many dying people. Most of the people who will access this kind of continuum of care are dying and will probably be receiving morphine. To take them off the morphine to ensure they have the capacity to give consent is cruel. The reality is that in a 15-day period, that person should be allowed to make a gracious exit and be given the compassion not to be once again required to become competent, because the morphine is helping them with their intolerable suffering. That they are suffering intolerably has already been declared.

With those exceptions, I am supportive of the bill. The justice committee has its work to do. I am looking forward to thorough deliberations. I have utter confidence in every member of that committee. I am looking forward to the bill returning to the House and going to the other place. I know that Canadians will have a law that helps them and makes Canada a richer and stronger country.

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

Mr. Speaker, I have had the honour of serving the people of Kitchener—Conestoga and being part of many important discussions and debates here in this chamber over the past 10 years. As members of Parliament, we are given the solemn obligation to chart the way forward for our great nation of Canada. The motions we table, the amendments we consider, the legislation we adopt will always impact, positively or negatively, the very people who elected us to represent them in the capital city of our nation, and they will also impact generations of Canadians to follow.

The impact of our deliberations and decisions we make on this critical life and death issue will impact the very fabric of our country. If I may say, it will leave a lasting legacy for good or for ill of our understanding of what it means to part of the human family.

Because of the very serious nature of the topic in front of us today, we, and by that I mean every member of this chamber, must take a step back and consider some very foundational questions. Each of us needs to ask ourselves these difficult questions. How we as members perceive these foundational issues is absolutely key to addressing this sobering topic before us today.

Consider with me for the next few moments these questions. What does it mean to be human? What gives human life meaning and value? Does every human life possess intrinsic value and dignity, regardless of perceived deformity, regardless of perceived disability, regardless of the perception of being a burden, regardless of whether or not a person may have achieved their best before date?

For me, the answer to all these questions is a resounding yes. Every human life is worthy of our utmost respect and protection. Every human life matters. Therefore, needless to say, I do not support physician-assisted suicide, or voluntary euthanasia or any legislation that would further devalue human life.

My world view is influenced by my life experiences, and most profoundly it has been shaped by my faith. I believe every human life has intrinsic value and dignity that needs to be held in high honour and esteemed, in other words, to be considered worthy.

There is a saying in the Talmud, “Whoever destroys a soul, it is considered as if he destroyed an entire world. And whoever saves a life, it is considered as if he saved an entire world.”

On the Peace Tower of our Parliament Buildings carved in stone above the west window, members will find these words taken from ancient Hebrew writings in the book of Proverbs, “Where there is no vision, the people perish.”

What is our vision for Canada? I ask each of my colleagues today what their vision is for Canada.

My vision for Canada is one where every human life is valued and cherished from the moment of conception to the moment of natural death. It is my firm belief that life is a gift from God and that this gift is far too precious to be discarded or destroyed. Every human life is filled with infinite value and, yes, every person, regardless of disability, deformity, depression, or devaluation based on criteria of so-called “usefulness” has something to teach us about what it means to be human.

For those who are suffering, we have the privilege to come alongside and care deeply. We provide proper pain relief, palliative care, human touch and love, in other words, we provide compassion.

The very meaning of the word compassion is “to suffer with”. It is to come alongside and enter into the suffering, to come alongside with feeling and care. Compassion is supporting them. It is to ignore the fact that compassion has everything to do with relationships if we are to allow physician-assisted suicide. We simply cannot have compassion if the relationship has been intentionally terminated.

That being said, the Supreme Court of Canada has established grounds for an exemption from prosecution for physicians who would assist in administering the suicide dose or carry out the act of euthanasia. The Supreme Court of Canada has done this, completely rejecting the fact that the elected members of the House of Commons have rejected initiatives to legalize physician-assisted suicide on at least 15 occasions since 1991. Most recently, a bill to allow physician-assisted suicide was rejected in 2010 by a vote of 59 to 226. My contention is that it is not the job of the Supreme Court to create laws but rather to interpret them.

I was one of the members of Parliament who served on the joint committee appointed to study physician-assisted dying. Our committee heard from many witnesses representing many different viewpoints. We heard from medical professionals, palliative care experts, mental health professionals, the disability community, the aboriginal community, various faith communities, legal and constitutional experts, and ethicists. As members might expect, from such a large variety of people, there was a very diverse response.

The unfortunate reality is that the timeline given to our committee for the completion of our report and recommendations did not allow for the large number of groups who wanted to appear before this committee. Groups like the Euthanasia Prevention Coalition, L'Arche Canada, Living with Dignity, as well as Dr. Balfour Mount, who is considered to be the father of palliative care in Canada and in fact in North America, were not allowed to appear at all.

The joint committee report had no teeth when it came to insisting that before physician-assisted suicide could be offered or even considered in Canada, there should at the very least be a credible offer of accessible and affordable palliative care to those who faced such a final solution of hastened death. Like the committee report, Bill C-14 fails miserably in stepping up with real change on this crucial issue.

Dr. Harvey Chochinov, chair of the external panel, professor of psychiatry at the University of Manitoba, and Canada research chair for palliative care, suggests that all patients requesting medical aid in dying would need to have a palliative care consultation to ensure that patients would be fully informed of all palliative care options that could be initiated in order to mitigate the suffering of patients. To ignore the very real lack of choice without a concurrent real offer of palliative care is to offer no choice, only hastened death.

I am thankful that Bill C-14 has incorporated many of the viewpoints of the dissenting report. However, it still includes very vague and subjective language and does not address many key issues raised by witnesses who appeared before the joint committee.

A major concern in this entire discussion has been the overt attempts to soften the language. Rather than call it physician-assisted suicide or voluntary euthanasia, it was then referred to as physician-assisted dying. Even physicians objected vigorously to the term “physician-assisted dying”, especially palliative care physicians. For many decades these doctors have been assisting patients through the natural dying process.

It has been said that all social engineering is preceded by verbal engineering. We will find no better example of that verbal engineering than in the matter before us today. This topic is far too important to allow this vague and euphemistic language to go unchallenged. As Dr. Chochinov notes, Bill C-14 makes no distinction between physician-assisted suicide and euthanasia, yet both are included in what the bill calls “medical assistance in dying”. It is extremely important to outline the difference, because international experience reveals that they are vastly different in terms of their uptake and lethality. In jurisdictions that offer only physician-assisted suicide, such as Oregon, these deaths account for about 0.3% of all deaths. In jurisdictions that offer euthanasia, hastened death accounts for approximately 3.0%, a tenfold increase.

If we were to extrapolate these figures to Canada where there are approximately 260,000 deaths per year, under a physician-assisted suicide regime, there would be approximately 780 deaths per year. However, if we were to extrapolate that to allow for euthanasia, the number of deaths would increase to 7,800 per year, which as I pointed out is a tenfold increase. The reason for the lower numbers under a physician-assisted suicide regime is ambivalence. It is crucial that at the very least the government needs to point out that if we are to proceed with this, we have to ask that those who request physician-assisted death must follow through on physician-assisted death rather than voluntary euthanasia because the numbers are so different.

Another key missing component is the matter of conscience protection for doctors and health care workers. If it is possible to ensure a “consistent approach to medical assistance in dying”, as the preamble asserts, there is no reason why at the same time a consistent approach to guarantee conscience rights cannot be included in Bill C-14.

Finally, Bill C-14 should include a system of judicial oversight in order to protect vulnerable persons. While two independent witnesses and two independent doctors sounds good on paper, the risks of overt or subtle coercion are too great and the possibility of abuse too real. These assertions need to be verified under a framework of legal oversight.

In summary, we should be offering hope to all Canadians. As legislators, we should be doing everything in our power to ensure that not one single person dies needlessly. It is with this in mind that I repeat the need for at least three major amendments to Bill C-14: first, vulnerable Canadians need better protection with a system of judicial oversight; second, doctors, health care personnel and institutions need clear conscience protection; and, finally, Canadians who are suffering need a real option of palliative care not hastened death.

The House resumed from April 22, 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 second time and referred to a committee.

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

Mr. Speaker, I want to thank my hon. colleague, the member for Victoria, for a very impassioned speech and a very important contribution to the debate. I particularly take note of his objections, despite the fact that he has expressed his ultimate support for the legislation that the government has introduced in Bill C-14.

I want to specifically get to one of the objections that he raised, which deals with the question about the foreseeability clause.

He noted that the lead counsel in the Carter decision, Mr. Joseph Arvay Q.C., raised concerns with respect to the constitutionality of the proposed Bill C-14. I want to ask my friend what proposed changes would be necessary so that the definition of reasonable foreseeability, currently found in proposed paragraph 241.2(2)(d), would deal with the legal standard. I believe that is the nature of his objection.

I would add the caveat that, as I recall the Minister of Justice's presentation at the time, the determination of reasonable foreseeability would be left to physicians. Is there some amendment you could propose that would in fact address the legal standards, which I think is the nature of the objection?

[Jane Philpott, Liberal, Minister of Health]

Mr. Speaker, I am honoured today to speak following on the comments made by my colleague, the Minister of Justice and Attorney General of Canada, when she introduced Bill C-14, an act to amend the Criminal Code for medical assistance in dying.

This is a historic debate on a matter of tremendous significance for Canada and for all Canadians. Advancing this issue and getting a legislative framework in place to allow medical assistance in dying is a solemn responsibility. This is a deeply personal issue for every Canadian.

When a dying person approaches the end of life, many more people other than just that individual are affected, including the person's family, community, and employer, as well as the people working in our network of social and health care services, those who provide support during our difficult times.

For many people, death is a difficult topic. Conversations about death are difficult to have, whether it is with a family member or, in particular, with a health care provider. This topic is difficult on both sides of the conversation.

Our government has given this matter careful consideration.

Over the past 30 years, I have experienced the reality of talking frankly and openly with, perhaps, hundreds of patients as they were facing death. Through every stage of the process, my patients have taught me valuable lessons, lessons about caring and compassion, about fear and anxiety, about the importance of support when recovery is no longer probable.

In working with patients in the final months and years of their lives, I have learned that every person, every story, is unique. However, much is shared in common: the hope to die in peace; the desire to be respected; and to have personal autonomy and dignity honoured by family and health care providers alike.

My experiences have also reinforced my sense that we must uphold the principles of palliative care, as well as respecting the rights of patients to make their own decisions about their care as they approach the end of life.

On February 6, 2015, the Supreme Court of Canada declared that the Criminal Code prohibitions on assisted dying were unconstitutional. The federal government was given one year to develop a federal framework to address this decision.

On January 15, the Supreme Court granted a four-month extension, to June 6 of this year, to give our government time to develop a legislative framework for Parliament to consider.

The Supreme Court's decision marked a watershed moment in an important and long-standing debate surrounding the right of Canadians to have the choice to a medically assisted death. However, how it will be implemented, for whom and by whom, needs careful consideration.

As parliamentarians, we have heard from Canadians on this issue through so many conversations with our constituents and through the dedicated work of the joint parliamentary committee. Hundreds of experts and organizations, both in our country and abroad, have contributed volumes to our understanding of this very difficult subject. Many have spoken passionately about their work on the front lines of palliative care, hospice care, and end-of-life care. Others have talked about personal experiences with loved ones and about easing the physical and emotional pain that they experience.

Our government is grateful for the work of the federal external panel on Carter and for the work of the Special Joint Committee on Physician-Assisted Dying.

We have also benefited from the work undertaken in the provinces and territories on this issue, including the thoughtful recommendations of the expert advisory group on physician-assisted dying.

We are grateful to members of Parliament who have shared their own thoughtful, considered, and wide-ranging insights over the past few months and, indeed, years.

Our government has listened, and the legislation we are tabling is the product of their efforts and their collective wisdom and experience.

Today, we are taking decisive action. I think that it is good news for Canadians, including those who are facing this personal and very difficult choice, their families, and their care providers, who have all been carefully considering this legislation.

For people who wish to have the choice of seeking medical assistance in dying, Bill C-14 would allow that, in keeping with the Supreme Court of Canada's decision. This proposed bill is the product of careful consideration of several principles that guide our government, including the desire to support personal autonomy and access to health care services, while recognizing that it is imperative to protect vulnerable persons, individually and collectively, from coercion and disrespect.

With Bill C-14, certain health care providers would, under certain circumstances and conditions, be exempt from Criminal Code offences in order to allow them to provide or assist in providing medical assistance in dying.

The bill would clearly define the criteria that must be met for individuals to be eligible. We have set up safeguards to be followed to ensure that these criteria are met and that the request is truly voluntary. This is critically important to protect vulnerable populations and, frankly, to ensure that anyone who contemplates medical aid in dying has fully reflected on their choice.

We also create the foundation for a regime to monitor medical assistance in dying so we can see how it is working in Canada.

With this bill, we are demonstrating our government’s commitment to supporting the autonomy of patients who are approaching the end of their lives, while protecting the most vulnerable in our society.

There has been considerable focus on whether providers should be free to exercise their conscience rights. I want to underscore that this proposed legislation does not compel any health care practitioner to provide medical assistance in dying. Practitioners will have the right to choose as their conscience dictates.

However, we must also respect the rights of people seeking this procedure by ensuring that those providers who have expressed a preparedness to help patients can do so without fear of criminal prosecution. Under Bill C-14, certain health care providers, such as physicians and authorized nurse practitioners who administer medical assistance in dying would be exempt from criminal prosecution.

Since nurses and nurse practitioners have the authority to deliver many of the same medical services as family physicians, in that they can assess, diagnose, and treat patients, they, too, would be exempt from criminal prosecution.

This is critical, as nurse practitioners often work alone providing vital health care services in underserved areas, such as the most remote and rural parts of Canada. Other providers, such as pharmacists, registered nurses, and physicians who may provide assistance would also be exempt from criminal prosecution.

Therefore, rest assured that health care workers who provide and assist in providing medical assistance in dying will have no reason to fear criminal prosecution as long as they follow the appropriate safeguards.

In consultations leading up to this bill, there was strong consensus among Canadians that standardized data needs to be collected on the practice of medical assistance in dying.

In addition to Criminal Code amendments, this bill creates the power necessary for the Minister of Health to make regulations about the information to be collected, the use and protection of that information, and the processes for collecting and reporting that information.

We agree that a robust, transparent monitoring system on the practice of medical assistance in dying is essential, and analysis and trends need to be reported to the public on a regular basis. We, as the Government of Canada and Canadians, need to understand as much as possible about how the system is operating in practice so we can address any potential concerns.

To that end, this proposed bill commits the federal government to working with the provinces and territories to develop a pan-Canadian monitoring system. The system will allow us to collect and analyze data, monitor trends, and make recommendations for potential legislation and policy reforms.

We are not starting from scratch. Around the world in other places that have legalized medical assistance in dying, mandatory oversight systems are in place to carry out monitoring and public reporting each year.

We can look to these examples to help us decide what is right for Canada. We can also look closer to home, in Quebec, where a monitoring system was recently established.

Developing a robust pan-Canadian system with provinces, territories, and stakeholders will take time, and we know we need to be tracking this information as soon as possible.

From a health perspective, I feel strongly that it is important for us work toward consistency in the provision of health care services for all Canadians, regardless of where they live. Canadians and stakeholders are expecting and hoping for a pan-Canadian approach. They do not want a patchwork where they observe significant differences in quality and availability of services in their own community, province, or territory relative to other parts of the country.

A fundamental value in Canada is our commitment that Canadians across the country will have access to medically necessary health care services when they need them. This view reflects the underlying principles of universality, accessibility, and comprehensiveness so vital to our health care system.

Bill C-14 contains well-defined eligibility criteria and safeguards, which go a very long way to achieving our government's objective of a consistent framework for medical assistance in dying. While certain implementation details will be left to provinces, territories, and medical regulatory bodies, we will all operate under the same legal and access framework.

My health minister colleagues across the country have looked to us for leadership on a consistent approach for all Canadians. I am pleased that our proposed bill fulfills that expectation.

No aspect of what we do on the question of complementary measures should be done precipitously. There are several particularly challenging issues. On these, our proposed bill suggests a cautious approach that will seek further advice, as suggested by the special joint committee.

However, we also recognize that there is a difference between the decision to accept or forgo treatment and the decision to hasten one's own death. Accordingly, a higher standard of decision-making capacity should be required in the latter case.

As part of the eligibility criteria, the bill specifies that individuals must have reached the age of 18 to seek medical assistance in dying.

There is the equally if not more contentious matter of advanced directives. Advanced directives are used to indicate wishes for treatment if a person can no longer communicate.

The prospect of permitting requests for assistance in dying through advance directives is concerning to many Canadians. At the same time, others feel strongly that they should be able to convey their wishes for a medically assisted death in advance of a future point time when, as in the case of a progressively debilitating condition such as dementia, they are no longer competent to make a request.

Advance directives are a difficult issue for many individuals, family members and health care providers. As difficult as it is to discuss the end of life ln the final days, it can be even more difficult to predict one's wishes and circumstances in the case where it is further off, especially in the distant future.

Many people are also troubled by the prospect of patients with a psychiatric disorder being eligible for assistance in dying on the basis of psychological suffering alone. There are strongly held views on both sides of this issue. That is why legislating medical assistance in dying has required a cautious approach, and that is why we have committed to independent studies to explore the challenging issues of mature minors, advanced directives, and mental illness further.

Following a period of study and further reflection, we will be better positioned to determine how these issues best fit into a Canadian framework for medical assistance in dying.

I believe that this is an approach that most Canadians would favour.

I said earlier in my remarks that this bill did not compel participation by health care providers to do anything which would run counter to their convictions. At the same time, we are also mindful that the exercise of conscience rights by providers may constitute a barrier to access for those who are seeking medical aid in dying. There is therefore a federal interest on behalf of Canadians in working with our provinces and territories to support access.

Collaborative work with provinces and territories could build on important international examples, such as the well-established networks we see in the Netherlands and Belgium. These provide insight as to how an end-of-life care coordination system could help facilitate access to a consulting physician or nurse practitioner. This is particularly important in rural and remote areas, or in situations where identifying a second provider to assess eligibility may be problematic.

One of the things I have heard is that better palliative care would assist in the end-of-life care options that have now been prescribed by the Supreme Court. I know first hand that there is a place and a need for both.

Palliative care focuses on relieving suffering and improving the quality of life for the living and dying. It provides relief to people dealing with a range of life-threatening conditions such as cancer, cardiovascular disease and amyotrophic lateral sclerosis, or ALS.

Today, Canadians are aware, and have a general understanding, of palliative care. However, some studies have found that the overwhelming majority, perhaps 70% or more of us, do not have access to it, particularly in rural and remote areas. Many providers are not well trained to provide palliative care services. Reinforcing this government's commitment to quality palliative care, this proposed bill signals our intent to support improvements to a range of end-of-life care services.

Like other health care services, the delivery of palliative care is mainly the responsibility of provinces and territories. However, the federal government can make significant contributions in this area. We are already supporting a number of initiatives aimed at improving capacity in our health care system to provide palliative care.

In partnership with the provinces and territories, health care providers, and non-governmental health organizations, the federal government has funded initiatives designed to advance palliative care awareness, education, national standards, and research. For real improvements to be made, we need to work closely with provinces and territories.

Since my appointment as the Minister of Health, it has been my immediate priority to reach out to provinces and territories to discuss needed transformation in our health care system, including care at the end of life, particularly in the setting where Canadians say they most wish to die; that is usually in their own home and community.

In that spirit, early this year I met with provincial and territorial health ministers in Vancouver to launch discussions on a new multi-year health accord. Through the health accord process, our government will be making significant investments totalling $3 billion to help deliver more and better quality home care services for Canadians.

We expect that support for palliative care in a variety of settings, where patients can receive the ongoing care they need and deserve at the end of life, will be one of the priorities going forward.

I believe that by working together, we can bring real change to the health care system so that Canadians can continue to have access to high-quality, sustainable care.

There is no doubt that care at the end of life should be there when people need it. We want all Canadians to have access to the best care possible. We want them to have autonomy in making decisions as they approach the end of their lives.

We are facing a challenging time frame to put this legislation in place, with a June 6 deadline. However, I believe that with this proposed bill, we have found a balanced approach that reflects the best interests of Canadians. That is why I urge all members of this House to support Bill C-14.

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 second time and referred to a committee.

Physician-Assisted Dying

[Jane Philpott, Liberal, Minister of Health]

Madam Speaker, I am aware of the excellent work of Dr. Naylor and I am pleased that she has had such an illustrious career in palliative care.

One of the reasons that we introduced Bill C-14 was the fact that Canadians need access to all options for care at the end of life. We are committed in this government to make sure, as the Supreme Court has indicated, that people have access to assistance in dying, and I am pleased that people like Dr. Naylor are also providing assistance for people to live well until the end of their lives.

Criminal Code

[Murray Rankin, NDP, Victoria, BC]

Madam Speaker, I would like to congratulate my colleague, the member for St. Albert—Edmonton, for his very useful contribution in the same spirit with which he contributed so much during the work of the Special Joint Committee on Physician-Assisted Dying, which I had the honour of being part of. I would like to echo his thanks to the member for Don Valley West and also Senator Ogilvie, who co-chaired that important committee. I just hope that during this debate we can sustain that same tone of respectful dialogue.

He indicated that he was satisfied that Bill C-14 is consistent with the Carter case. On that point, as I will elaborate I hope later today, I respectfully disagree but hope we can work together in the justice committee to get it right for all Canadians.

I was taken with his comments on conscience protection in the legislation, something which just came up as well in the comment from my colleague across the way.

In pointing out it is a charter right for those who have conscience reasons not to participate in medical aid in dying, I think he made an excellent reference to section 3.1 of the Civil Marriage Act which gives a recognition for that conscience protection in that legislation.

I am wondering whether or not it should be appropriate to leave this to the provinces. Some have said this is a matter, and I think the minister made that point as well, of provincial jurisdiction working with the colleges. On the other hand, the member points out that it involves the charter, and therefore, those individuals who wish to support those rights are going to have to work with 13 other jurisdictions.

I would like the member's comments on whether he thinks that is appropriate.

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

Madam Speaker, I would like to thank and congratulate the minister on her speech and on her incredible leadership on a question that is so important in our country at this time.

I have a couple of questions. In her speech, the minister talked about the fact that there were many influences on the decision that the government ultimately decided to take. I would invite her to perhaps talk about the influence of the special joint committee on Bill C-14, and also on the Quebec legislation on Bill C-14.

The other question I would ask the minister to address arises out of the question from the Conservative member opposite and his expressed concern over the lack of clarity in the words “reasonable foreseeability”.

Could the minister comment on how the terms have been recognized and interpreted by the courts, and the guidance that it should be able to provide us in understanding the purpose of the legislation?

[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 second time and referred to a committee.

Madam Speaker, I am pleased to rise in the House to address Bill C-14, which would, for the first time in our country's history, create a federal legislative framework to permit medical assistance in dying across Canada.

Before I begin my remarks today, I want to acknowledge that medical assistance in dying is a challenging issue for all Canadians. It is difficult. Death and dying are not things that we are comfortable talking about in our society. We all have stories of our families and those people close to us, which touch us and challenge us in this regard. Nonetheless, since the release of last year's decision in the Supreme Court of Canada in the Carter case, this government has not shied away from having difficult conversations with Canadians.

Equally, I want to recognize that we did not wrestle with these issues alone. I commend the dedicated efforts of all the individuals and organizations that have made tremendous contributions to the public debate and dialogue around how we implement medical assistance in dying in Canada.

I do not have time to include in my remarks today all the names of the people who have been involved, but I would first like to recognize the members of the special joint committee who exemplified dedication and service to Canadians in delivering a comprehensive report under extremely difficult and tight time constraints. Their task was not easy, but they rose to the challenge.

I also want to acknowledge the work of the federal external panel and the provincial expert advisory group, as well as the thousands of individual Canadians, experts, and organizations that participated in these consultations.

I would like to stress how invaluable all of this input and evidence was in the development of the bill, as explained and referenced in the Department of Justice legislative background on Bill C-14, which I will be tabling later this morning and which will be available on the Justice Canada website at the time. The bill that is before the House today is the culmination of all of these efforts.

From the start, we have known from the Supreme Court of Canada's unanimous Carter decision, that it is not about whether or not to have medical assistance in dying; it is about how we will do it. We are keenly aware of the diverse perspectives on this issue, and each of them raises worthy considerations. We have also looked carefully at the evidence from other jurisdictions that permit medical assistance in dying.

With all of this in mind, and in appreciating the limited time frame we have had to respond to the Carter decision, our government has chosen an approach that respects both the charter and the needs and values of Canadians.

First, it would permit physicians and nurse practitioners to provide medical assistance in dying, so that patients who are suffering intolerably from a serious medical condition, and whose death is reasonably foreseeable given all of their medical circumstances, can have a peaceful death and not be forced to endure slow and painful suffering.

Second, it would commit to study the other situations in which a request for medical assistance in dying might be made; situations that were not in evidence before the court in the Carter litigation and were beyond the scope of its ruling.

This evidenced-based approach will allow us to respect the autonomy and the charter rights of Canadians while ensuring robust protections for vulnerable persons. It is the right approach for our country.

Our government, under the leadership of my colleague, the Minister of Health, will be bringing forward non-legislative approaches to support the bill, including an end-of-life care coordination system for linking patients to willing providers, and in the context of a new health accord, we will promote the improvements to palliative care across the country.

To ensure public safety, the bill would re-enact section 14 and subsection 241(b) of the Criminal Code, but provide exemptions to permit medical assistance in dying for eligible persons. The bill would limit eligibility to persons 18 years and over who are capable of making decisions with respect to their health.

The bill would require that the person be competent at the time that the medical assistance in dying is provided, which practically means that advance directives would not be permitted. Requests must be fully informed and free from coercion, to ensure they reflect the person's true wishes.

The bill would also require that the person have a grievous and irremediable condition, which is defined in the bill. The definition is intended to be applied flexibly by physicians and nurse practitioners who can use their training, ethics, and good judgment to apply the criteria.

To be clear, the bill does not require that people be dying from a fatal illness or disease or be terminally ill. Rather, it uses more flexible wording; namely, that “their natural death has become reasonably foreseeable, taking into account all of their medical circumstances”. This language was deliberately chosen to ensure that people who are on a trajectory toward death in a wide range of circumstances can choose a peaceful death instead of having to endure a long or painful one.

As the Supreme Court of Canada noted, Gloria Taylor was dying from a terminal illness and would be eligible. So too would Kay Carter, who was 89 and according to the court suffered from spinal stenosis, which itself does not cause death but can become life-threatening in conjunction with other circumstances such as age and frailty.

This approach to eligibility responds directly to the Supreme Court's ruling, as it noted in paragraph 127:

The scope of this declaration is intended to respond to the factual circumstances in this case. We make no pronouncement on other situations where physician-assisted dying may be sought.

In our view the people captured by the court's ruling would be eligible under the proposed legislation. Moreover, the legislation proposes a workable standard. The Canadian Medical Association, in supporting the legislation, has stated that the proposed eligibility criteria are one of several “critical elements to support a consistent, national approach”.

Bearing in mind that medical assistance in dying can pose real risks and equally that we do not wish to promote premature death as a solution to all medical suffering, these criteria may not allow eligibility for some circumstances, such as a person with a major physical disability who is otherwise in good health, or a person who solely suffers from mental illness. These conditions, in absence of additional medical circumstances, may not be associated with a reasonably foreseeable death.

Our approach in no way denies the suffering experienced by persons who would not be eligible. In partnership with the provinces and territories, we will do what we can to improve the quality of health services and other supports that are needed to enable such individuals to live a better quality of life.

We have listened to those who say that permitting medical assistance in dying as a response to suffering in life, as opposed to suffering in the dying process, will put already vulnerable individuals at greater risk. We recognize that medical assistance in dying will in many respects fundamentally change our medical culture and our society. It is appropriate in this context to focus our attention on facilitating personal autonomy in the dying process where the risks to the vulnerable are manageable.

The bill recognizes that procedural safeguards are necessary and appropriate in medical assistance in dying. The bill would adopt the recommendations of the special joint committee regarding the appropriate safeguards. For example, eligibility must be assessed by at least two medical practitioners or authorized nurse practitioners.

The bill would also set out a legal framework for a compulsory monitoring regime to ensure that we have Canadian data to assess how medical assistance in dying is working in practice.

This is an issue that will require close co-operation with the provinces and territories, and the monitoring requirements would only become binding after the Minister of Health brings forward regulations, which she will develop in consultation with those governments.

Finally, the bill would commit Parliament to review its provisions after five years.

In addition to the parliamentary review mechanism included in the bill, we will also undertake independent studies into three key issues that the Supreme Court of Canada declined to address in the Carter ruling: eligibility for persons under the age of 18; advance requests; and requests for medical assistance in dying solely on the basis of mental illness.

To be clear, the ruling in Carter was expressly limited to a competent adult person who clearly consents to the termination of life. Further, the Supreme Court stated that assistance in dying for minors or persons with psychiatric disorders would not fall within the parameters suggested in these reasons. Simply put, the court in Carter did not hear evidence related to these sorts of cases, nor did the Supreme Court find that there was a right to medical assistance in dying in any of these circumstances.

Regarding persons under 18, we are mindful of the evidence heard at the special joint committee that more specific study and evidence are needed, given the irrevocable nature of the procedure and the fact that minors are vulnerable by virtue of their age.

In terms of advance requests, where a person makes a request in advance for a form of treatment that they would want if they lose their ability to express their wishes, the risks of error and abuse increase when a person is unable to confirm previously stated wishes. In effect, a person loses the ability to withdraw their consent to die. They would no longer clearly consent, in the language of Carter.

We are also mindful of evidence that people often err in making predictions about how they will respond to future medical suffering. In the very few jurisdictions where advance requests are allowed, physicians generally will not perform medical assistance in dying under ethically difficult circumstances where the person is conscious but mentally incompetent to express their wishes. More study of this complex issue is needed.

With regard to mental illness as the sole basis for a request for medical assistance in dying, further study is also needed. This is the delicate balance that the bill would strike. Circumstances beyond the scope of the Carter decision will be studied. However, at this moment, we will act responsibly as we take our first steps as a country on this challenging issue.

A question that many have about the bill is whether it is consistent with the Carter ruling. There will always be a diversity of opinions about what is required to respond to a particular judgment, but it falls to Parliament not only to respect the court's decision, but also to listen to diverse voices and decide what the public interest demands. It is never as simple as simply cutting and pasting the words from a court's judgment into a new law.

The bill before the House today respects Carter and complies with the Charter of Rights. The court ruled that the previous law, which involved a complete prohibition, went too far in restricting the rights of Canadians like Ms. Carter and Ms. Taylor, whose natural deaths had become reasonably foreseeable, to choose medical assistance in dying.

As I have already mentioned, the court expressly stated that it did not pronounce on anything beyond the factual circumstances of the case before it. The court did not define the term “grievous and irremediable condition”. It left the task of definition, as well as the elaboration of public policy and safeguards, to Parliament.

The eligibility criteria in the bill are consistent not only with the legal principles of Carter but with the circumstances of the plaintiffs in the Carter case, including Gloria Taylor, who was suffering from fatal ALS, and Kay Carter, who was also in a state of irreversible decline and nearing the end of her life.

In finding that an absolute prohibition was unconstitutional, the court did not require Parliament to enact a specific medical assistance in dying regime. Rather, it directed us to address the deficiencies of the previous law. The court said:

...physician-assisted death involves complex issues of social policy and a number of competing societal values. Parliament faces a difficult task in addressing this issue; it must weigh and balance the perspective of those who might be at risk in a permissive regime against that of those who seek assistance in dying.

This is precisely what Bill C-14 does. It respects personal autonomy, protects the vulnerable, and affirms the inherent value in every human life.

The bill would create a consistent national floor in terms of eligibility and procedural safeguards under the federal criminal law power, which is there to ensure the safety of all Canadians.

The requirements we see in the bill would have to be respected across the country. However, provinces and professional regulatory bodies may also choose under their jurisdiction to add additional safeguards or requirements, such as how to respect the conscience rights of their medical professionals and health care institutions while ensuring access for patients. To this end, as I have already mentioned, my colleague, the Minister of Health, will be working with her counterparts to bring forward a coordinated system for linking patients to willing providers.

I want to say a few words about how the bill will give Canadians confidence that the risks associated with medical assistance in dying will be carefully addressed.

Ultimately, we want medical assistance in dying to reflect the true autonomous choice of Canadians who request it. However, we know how autonomy can be compromised in both overt and subtle ways. At points in our life, all of us are vulnerable. However, vulnerability is experienced disproportionately by those Canadians who are alone or lack social supports, who live in poverty, who face discrimination or a multitude of other reasons. Some people may feel that they are a burden to others or struggle to find joy and purpose in their life. The availability of medical assistance in dying must not inadvertently tempt persons who are experiencing these or other sorts of vulnerabilities to choose a premature death, nor should it suggest that dying is an appropriate response to a life with disability.

It makes sense to limit medical assistance in dying to situations where death is reasonably foreseeable, where our physicians, nurse practitioners, and others, can draw on their existing ethical and practical knowledge, training, and expertise in addressing these challenging circumstances.

Coupled with robust procedural safeguards, the bill would effectively respond to the risks and ensure that requests for medical assistance in dying are made freely, autonomously, and with the benefit of full information.

More fundamentally, our government wants medical assistance in dying to be there for Canadians, so they can have a choice of a peaceful death that accords with how they have lived their life, over a painful and prolonged one that does not.

Our government believes in the equality of all Canadians' lives and sees the inherent value in each of them.

Before eligibility for medical assistance in dying is extended beyond persons who are suffering intolerably and in a state of decline toward death, which is what the Carter decision was about, we need to be absolutely confident that we would not be putting vulnerable people at risk. We need to be confident that we are not undermining important policy goals and/or societal values, such as supporting Canadians with physical or mental disabilities to live out healthy lives and fully participate in our society.

I look forward to working with all members of these chambers on this incredibly difficult and complex issue, to ensure that before June 6, 2016, our country will have a law that respects autonomy and provides choice to Canadians, while also protecting those in our society who we too often lose sight of. Together, let us take this opportunity to build a consensus of which Canadians can be proud.

Finally, I am tabling a document, in both official languages, entitled “Legislative Background: Medical Assistance in Dying (Bill C-14)”.

Business of the House

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, today, we will complete the debate on the New Democratic Party's opposition day on the Canadian dairy industry.

Tomorrow we will begin an important debate at second reading on Bill C-14, medical assistance in dying.

Next week, as my friend pointed out, we will be back in our ridings working hard to meet the people who elected us and sent us here.

When the House returns on Monday, May 2, we will continue our second reading debate of Bill C-14. I hope that we can sit late on Monday and Tuesday of that week so that all members who want to speak to this important bill can do so.

On Wednesday, the House will begin second reading debate on Bill C-15, the budget implementation act, 2016, No. 1. We will continue that important debate on Thursday.

I hope, Mr. Speaker, that you will allow me to take this opportunity to wish Her Majesty the Queen a very happy 90th birthday.

Reference to Standing Committee on Procedure and House Affairs

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

moved:

That the matter of the premature disclosure of the contents of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be referred to the Standing Committee on Procedure and House Affairs.

Mr. Speaker, I will be very brief in my remarks.

First, I want to thank you for your ruling. I think you approached it with the gravity it deserves, and you had excellent examples to cite.

As mentioned in the ruling, the details around the case have not really been disputed; therefore, I do not suspect there will need to be a whole lot of debate, hopefully not. I hope all members appreciate the importance of preserving our rights in this matter and, as mentioned, the rights of having first access to legislation.

I just want to take this opportunity to thank the chief government whip for his remarks when this matter was first brought up. It demonstrated the good faith that all members attempt to bring to the chamber. I hope it is instructive to the administrative staff on the government side, perhaps in the ministers' offices or wherever this leak originated, that their first duty is to serve members and the ministers, not to serve political masters or to achieve political ends. They really do have to put the dignity and authority of the House at the top of the list.

Whoever is responsible for this must understand that we are a parliamentary democracy and that political decisions made by staff to try to frame the debate in the media are not acceptable when that infringes upon our rights and dignities.

I hope the House agrees to send this to the procedure and House affairs committee so that the committee can look into what happened, perhaps determine who did it, perhaps determine what systems could be put in place to avoid this type of thing in the future, and if the culprit is found, bring that detail back to the House for the House to decide what to do with it further.

I am going to conclude my remarks there. I think I said everything I had to in my remarks. I do not want to belabour the point. I do appreciate your ruling, Mr. Speaker. You summed it up very nicely. I do hope that my colleagues will join me in voting for this motion. It is important that each and every one of us send the message back to the political people with whom we work that the rights of the House are important, that we take those seriously, and that we put them at the forefront when we make these kinds of decisions.

Alleged Premature Disclosure of Contents of Bill C-14—Speaker's Ruling

[The Speaker, Geoff Regan]

I am now prepared to rule on the question of privilege raised on April 14, 2016, and again yesterday, by the House leader of the official opposition concerning the premature disclosure of the contents of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).

I would like to thank the House Leader of the Official Opposition for having raised this matter, as well as the chief government whip and the hon. member for New Westminster—Burnaby for their submissions.

In presenting his case, the House leader of the official opposition pointed out that specific and detailed information contained in Bill C-14 was reported in a newspaper article and elsewhere in the media before the bill had been introduced in the House. In describing the seriousness of this matter, which he considered to be a breach of members' privileges, he stressed the need for members to access information in order to fulfill their parliamentary duties, as well as the respect required for the essential role of the House in legislative matters.

In response, the chief government whip, acknowledging the problem, stated, “...our government takes any breach of the privilege of members and of the House very seriously”. He then noted that such a premature divulgation of the bill's contents had not been authorized and apologized unreservedly, committing to ensure that it would not happen again.

This being the first question of privilege to be raised in this Parliament, I want to take this opportunity to inform members of the role of the Speaker in this regard, particularly as it is a narrowly defined role.

As House of Commons Procedure and Practice, second edition, states at page 141:

Great importance is attached to matters involving privilege. A Member wishing to raise a question of privilege in the House must first convince the Speaker that his or her concern is prima facie (on the first impression or at first glance) a question of privilege. The function of the Speaker is limited to deciding whether the matter is of such a character as to entitle the Member who has raised the question to move a motion which will have priority over Orders of the Day; that is, in the Speaker's opinion, there is a prima facie question of privilege. If there is, the House must take the matter into immediate consideration. Ultimately, it is the House which decides whether a breach of privilege or a contempt has been committed.

In adjudicating questions of privilege, the Speaker carefully considers the effect that the alleged breach has on members' ability to function. At page 145 of O'Brien and Bosc, it states:

In deliberating upon a question of privilege, the Chair will take into account the extent to which the matter complained of infringed upon any Member's ability to perform his or her parliamentary functions or appears to be a contempt against the dignity of Parliament.

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

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

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

This important convention exists so that members can properly exercise their functions as legislators. Speaker Milliken saw fit to reiterate it in that particular case, even though in those unique circumstances—the member admitted to having herself prematurely released the contents of her own private member's bill, so no doubt existed as to the provenance of the leak—he chose not to rule that the incident constituted a prima facie case of privilege.

It is within this context that I, as Speaker, must review each case on its own merits. Having done so, the facts are clear and undisputed in this instance: detailed information regarding the content of Bill C-14 was indeed made available through the media before the bill itself had been introduced in the House. There were no arguments raised to the contrary. Therefore, there was a direct contravention of the House's right to first access.

The chief government whip has unequivocally apologized for any breaches of confidentiality in this instance, recognizing the seriousness of the matter; this should be reassuring to all members. That being said, it would appear to the Chair, at first glance, that the leaking of the bill’s contents and, thus, the pre-empting of members’ access to legislative information, has impeded the ability of members to perform their parliamentary functions. In a strikingly similar case, quoted by the honourable opposition House leader, Speaker Milliken stated, at page 1840 of the House of Commons Debates of March 19, 2001:

The convention of the confidentiality of bills on notice is necessary, not only so that members themselves may be well informed, but also because of the pre-eminent [role] which the House plays and must play in the legislative affairs of the nation.

He concluded by affirming that it was ”a situation that the Chair cannot condone”.

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

Thus, the available precedents lead me to conclude that this incident constitutes a prima facie question of privilege, and I now invite the House leader of the official opposition to move the appropriate motion.

[Scott Reid, Conservative, Lanark—Frontenac—Kingston, ON]

There is something I have to say that nobody has brought up before; it is just my observation. People say that they are constantly in demand back in their riding. I have a rural riding with many small communities—the classic place that makes many demands on your time—but in my experience, when I say that I can't be at someone's event because the House is sitting, I have never once in 16 years up here had someone say to me that this is not good enough. Everybody accepts that this is my first job. Of course, there were times when people came from all over the country by train and could not get back.

It strikes me that more availability inevitably means more demands on you, and if you aren't available simply because you have to stay in Ottawa for the job, there would be a reasonable accommodation on the part of constituents. Maybe I just got nicer constituents than most people. I actually do think that, but others will disagree.

I have one last thing. You mentioned the idea of one day for second reading, except for special bills. We all understand that Bill C-14, the assisted suicide bill, is a matter of conscience. They are not always so clearly distinguished this way. Do you have any tests that would be applied to allow us to tell when a bill is of the ordinary run and when it is not of the ordinary run?

[Cara Zwibel, Director, Fundamental Freedoms Program, Canadian Civil Liberties Association]

Thank you.

Mr. Chair and members of the committee, on behalf of the Canadian Civil Liberties Association I want to thank the committee for this invitation to participate in your study on access to the justice system.

The CCLA fights for the civil liberties, human rights, and democratic freedoms of all people across Canada. Founded in 1964, we are an independent, national, non-governmental organization working in the courts, before legislative committees, in the classrooms, and in the streets protecting the rights and freedoms cherished by Canadians and entrenched in our Constitution. CCLA's major objectives include the promotion and legal protection of freedom and personal dignity, and for the past 51 years we have worked to advance these goals.

CCLA has a deep and long-standing commitment to access to justice and views this issue as a major priority that, frankly, Canada has failed to sufficiently address. We appreciate that this study is examining a number of issues, including the newly reinstated court challenges program, access to legal aid, delays in the administration of justice, and section 4.1 of the Department of Justice Act. All of these issues are worthy of study, and we will be submitting a written brief to the committee outlining our position on each of these issues in the coming weeks.

Today, however, I intend to focus my comments on section 4.1 of the Department of Justice Act, and more specifically, I would like to address the committee on steps that can and, in our view, must be taken to address critical accountability and transparency gaps in our law-making process.

As you all know, section 4.1 of the Department of Justice Act requires the Minister of Justice to examine every bill introduced in or presented to the House of Commons by the government and report to the House if any of the provisions of the bill are inconsistent with the Canadian Charter of Rights and Freedoms.

You will also probably be aware that currently this provision is interpreted in a way that does not require a report to Parliament unless the minister is of the view that there is no credible argument that can be made for the consistency of the legislation with the rights guarantees. As a result of this standard, not a single report to Parliament has ever been made, yet, as we all know, many government laws have been struck down by our courts or are the subject of fierce constitutional concerns by legal experts.

In our view the current approach and standard are woefully inadequate.

CCLA has been concerned for some time about the interpretation and effect of section 4.1. We were the only intervenor in the federal court case brought by former Department of Justice lawyer Edgar Schmidt, who challenged the current interpretation of the section. The Schmidt case highlighted some of the weaknesses in our legislative process.

Our current system, in our view, does not ensure that you, as members of Parliament, those elected by the people and charged with passing our laws, are in a position to fully appreciate your constitutional obligations or how legislation may impact protected rights.

CCLA's work on this issue has extended well beyond the intervention in the Schmidt case. In late 2015, CCLA launched our #CharterFirst campaign, and since that time we've been engaged in consultations with some of Canada's leading constitutional law scholars and political scientists to consider how our legislative process can be improved. The goal of these consultations and of the project more broadly is to ensure systematic, meaningful, and transparent consideration of a proposed law's constitutional vulnerabilities. In other words, we want there to be a real and substantive discussion of which rights may be affected by a proposed law and whether any infringement or violation of rights is reasonably justified.

Nearly a thousand Canadians have already joined our campaign, so there's clearly an appetite for change among the Canadian public.

I'm going to talk about identifying the problem and developing solutions. In terms of the problem, the simple fact is that the current approach under section 4.1 of the Department of Justice Act is not working. In our view, every elected representative has an obligation to respect and uphold the Constitution; however, we appreciate that members of Parliament will not always have the information they might need to assess the impact of legislation on constitutional rights. While the government benefits from a large team of legal advisers in the Department of Justice, the legal resources that members can access are often quite limited.

The current interpretation of section 4.1 may actually have a perverse effect. When no report is made by the Minister of Justice, the government may take the position that there are effectively no constitutional concerns for Parliament to worry about. This is not only misleading, it impoverishes the level of debate and discussion on a bill.

I can't articulate the problem any better than has been done by Professor Janet Hiebert, a political scientist who's written extensively on this subject. She says:

In Canada, the practice of non-reporting to the House of Commons that Bills are inconsistent with the Charter occurs because the Minister of Justice has concluded that a credible Charter argument can be made in support of the claim that the Bill is reasonable. But this denies Parliament the information or assumptions that led to this conclusion. The absence of any explanation also denies Parliament relevant information for assessing whether or not the government has been overly risk-averse or cautious in its legislative decisions. Parliament should not be placed in the untenable position of having to either pass legislation that may have a high degree of risk of subsequently being declared invalid or, alternatively, having insufficient information to assess decisions that avoid ambitious objectives or comprehensive means because of governmental and bureaucratic attempts to manage or avoid Charter risks.

The consequences that flow from the current approach are not confined to what happens in Parliament. After a law is passed, avoidable constitutional challenges often follow and these challenges cost taxpayers dearly. They consume precious judicial resources which could be better spent on other things. Laws that are passed, even though they may violate constitutional rights, can have a direct and very negative effect on people's lives.

To take but one example, the last government passed legislation that changed the timing of parole eligibility for certain offenders and made that change retroactive. Every court that considered this law, including the Supreme Court of Canada, found it to be unconstitutional. While that case made its way through the courts, the applicants in the case, and many others no doubt, spent additional time in jail, in one case an additional close to two years. If we can prevent an unreasonable and unconstitutional loss of liberty by improving our legislative process, it is in our view incumbent on us to do so.

In terms of our solutions, as part of our #CharterFirst campaign, CCLA will be delivering detailed policy proposals on how we believe this issue can best be addressed. Our proposals will aim to enhance the roles of both the legislative and executive branches of government to better ensure that the laws we pass comply with constitutional obligations.

To be clear, the goal is not to ensure that there are no more constitutional challenges or even to reach a consensus on what the Constitution requires. Rather, we want to enrich the debate, make the government's rationale in proposing laws more transparent, and provide members of Parliament with the tools to hold government accountable and make informed decisions about legislation. Our proposals are being developed as we speak, but are based on our consultations with the experts that I mentioned earlier.

We understand the Minister of Justice has recently announced an intention to table in Parliament the government's charter justification underlying Bill C-14, the assisted dying bill. We are anxious to see what this statement looks like and hope that it will allow for enhanced debate and discussion on this important and contentious bill.

The minister's decision to do this is a good step forward, but in our view these kinds of discussions can't be contingent on a decision by the minister introducing a bill. We need systematic and proactive measures in place, codified in legislation, to ensure that every bill that's ultimately passed by Parliament, including private members' bills and bills originating in the Senate, has received the time and space for truly informed debate on constitutional vulnerabilities.

We look forward to working with the committee on this issue going forward and certainly welcome any input that you may have on this important project.

Thank you.

Instruction to Committee on Bill C-2

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Speaker, tomorrow it will be six months since the new government was elected. The most recent bill introduced was Bill C-14.

A handful of the bills that are before Parliament are quite routine. They have to do with the estimates. There are around three of those 14 bills that are straight-up repeals of the previous government's laws. Two of those bills are mandated by the Supreme Court, which is why we are dealing with them. In fact, the only non-routine bill that has come from the government of its own volition is a bill to betray Air Canada workers. That is the only original legislative initiative we have seen from the government, and I will have more to say on that shortly.

I wonder, given the extreme paucity of the legislative agenda so far, is there any good reason at all that we would not be given the time to consider these two things separately? It is not like there is anything else getting in the way.

Alleged Premature Disclosure of Contents of Bill C-14

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

Mr. Speaker, I will be very brief on this. I want to raise a follow-up point to my question of privilege that I raised last week on the premature disclosure of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts. When I did so, the chief government whip rose in his place and offered his sincere apologies on behalf of the government, and of course, I do want to thank him for that. However, I do not believe it is sufficient to leave it at that.

I trust, Mr. Speaker, that you will allow the House to decide this matter, and hopefully the House in its infinite wisdom will send the matter to the Standing Committee on Procedure and House Affairs for further study.

In my question of privilege, I referred to the case in 2001 when the government House leader at the time, the Hon. Don Boudria, also apologized for the premature disclosure of the contents of a government bill. The Speaker in that case allowed a motion to be proposed referring that question of privilege to committee.

Members from all sides of the House then, and it would appear that members from all sides of the House today, believe that this is a grave matter deserving of further consideration. We do not know what the circumstances are. The chief government whip himself admitted he does not know what the circumstances are. He stated on Thursday:

I am not aware of the details surrounding the media report referred to by the member, but I want to assure the House that our government takes any breach of the privilege of members and of the House very seriously.

I can tell the House that at no point was anyone authorized to publicly discuss the specific details of the bill prior to introduction.

If no one was authorized to discuss the bill publicly, then we need to find out how this happened. The chief government whip went on to say that the “government will work to ensure that this does not happen again”, which I think members will appreciate. However, this is not a matter solely for the government. This is a matter involving the privileges of this House.

This matter should be reviewed by a parliamentary committee. If the government gets to the bottom of this internally or has new policies to offer relating to the confidentiality of bills, I expect it to explain all that to a standing committee of this House.

In short, an apology, while appreciated, is indicative of the seriousness in which the government views this matter. Of course, the opposition does as well. The apology does not take away the contempt that exists and, specifically, since we do not know who did it, I do not suppose the government whip was taking on any of the blame himself. It clearly seems to be someone else, and that apology cannot be made on behalf of an unknown person. We need to see if it is possible to find out who did it and what the circumstances were, and have the committee report back to the House.

When you are finished deliberating and have heard all the arguments, Mr. Speaker, if you find in our favour, I will be prepared to move the appropriate motion to send this to committee.

Physician-Assisted Dying

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

Mr. Speaker, we look forward to having a vigorous debate on Bill C-14. As the Attorney General, I read the Carter decision very carefully. I am confident we are responding in a substantive way to the Carter decision, as well as ensuring that it is in compliance with the Charter of Rights and Freedoms. We have put forward what we believe is the best solution now which balances personal autonomy and ensures we protect the vulnerable. I look forward to the debate.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, when asked about Bill C-14 on Friday, the Parliamentary Secretary to the Minister of Justice said that the bill on physician-assisted dying would have made Kay Carter eligible despite the vague concept of “reasonably foreseeable natural death”.

Can the Minister of Justice tell us whether she shares her colleague's opinion, and if so, how spinal stenosis fulfills the “reasonably foreseeable natural death” criterion?

Business of the House

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, I have good news. I have no documents to table, and thus there is no need to worry.

This afternoon will conclude the fourth and final day of the budget debate.

Tomorrow we will commence second reading of Bill C-10, the Air Canada legislation, and continue that debate on Monday.

Next week, we will have opposition days on Tuesday and Thursday. On Wednesday, we will begin debate on Bill C-14 on medical assistance in dying, introduced this morning by my colleague, the Minister of Justice.

Alleged Premature Disclosure of Contents of Bill C-14

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

Mr. Speaker, I appreciate the member for Regina—Qu'Appelle, with his vast knowledge of procedure and practices here in the House of Commons, raising the point. I appreciate the chief government whip's apology.

I want to get on the record that it is indeed a very serious case in the case of Bill C-14. There is no doubt about this.

I want to cite the current government House leader when he was faced with a similar situation, not in government but in opposition, around the case of Bill C-52. The member for Beauséjour, now the government House leader, said the following on information coming out prior to disclosure of the bill in Parliament:

We believe this situation constitutes a fundamentally unfair contempt of Parliament, and we would ask you to rule on this very serious matter.

He went on to say, in the case of Bill C-52, that:

Before the opposition received an embargoed copy or before the bill was actually tabled in the House of Commons, some of us were responding to very specific media questions following...[disclosure of the bill].

He then said there is no doubt that this was a very serious breach of privilege.

Therefore, I think it is important to note the concerns of both the Conservative official opposition and the NDP opposition. We certainly look forward to the follow-up that the government will be doing in this regard.

[Andrew Leslie, Liberal, Orléans, ON]

Mr. Speaker, I listened to the intervention of my hon. colleague from the Conservative Party concerning the troubling suggestion that someone from the government prematurely disclosed the contents of Bill C-14, the bill concerning medical assistance in dying, which was introduced earlier today.

I am not aware of the details surrounding the media report referred to by the member, but I want to assure the House that our government takes any breach of the privilege of members and of the House very seriously.

I can tell the House that at no point was anyone authorized to publicly discuss the specific details of the bill prior to introduction.

On behalf of the government, I unreservedly apologize to the House and to members. Our government will work to ensure that this does not happen again.

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

Mr. Speaker, I rise on a question of privilege regarding the premature disclosure of the contents of Bill C-14, an act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) introduced earlier today.

On the same day the bill was put on notice, details of the bill were reported in The Globe and Mail. The article begins:

The Liberal government is set to introduce its much-anticipated physician-assisted-dying law on Thursday, a bill that will exclude those who only experience mental suffering, such as people with psychiatric conditions, according to a source familiar with the legislation.

This is not a case of journalistic speculation. The reporter identified someone in the know who provided to her specifics of the bill. The journalist continues to refer to this source later in the article:

The bill also won’t allow for advance consent, a request to end one’s life in the future, for those suffering with debilitating conditions such as dementia. In addition, there will be no exceptions for “mature minors” who have not yet reached 18 but wish to end their own lives.

Those three issues, however, will be alluded to in the legislation for further study, according to the source, who is not authorized to speak publicly about the bill.

These are very specific elements of the legislation. The CBC The National gave similar details last night, and it too referenced sources.

Now that Bill C-14 has been introduced and we now know the details, we also know that those details were reported in The Globe and Mail and elsewhere in the media prior to its introduction.

On March 19, 2001, the Speaker ruled on a question of privilege regarding an incident whereby the media was briefed on a justice bill, Bill C-15, before members of Parliament. The Speaker indicated that there were two important issues in that case: the matter of the embargoed briefing to the media and the issue of members' access to information required to fulfill their duties.

In his ruling, the Speaker said:

In preparing legislation, the government may wish to hold extensive consultations and such consultations may be held entirely at the government’s discretion. However, with respect to material to be placed before parliament, the House must take precedence....The convention of the confidentiality of bills on notice is necessary, not only so that members themselves may be well informed, but also because of the pre-eminent rule which the House plays and must play in the legislative affairs of the nation. To deny...information concerning business that is about to come before the House, while at the same time providing such information to media that will likely be questioning members about that business, is a situation that the Chair cannot condone.

That matter was referred to the Standing Committee on Procedure and House Affairs. The committee concluded:

...the protocol of the Department of Justice whereby no briefings or briefing materials should be provided with respect to a bill on notice until its introduction in the House of Commons should be adopted as a standard policy by all government departments. We believe that such a policy is respectful of the House of Commons and its Members. It recognizes the legislative role of Parliament, and is consistent with parliamentary privilege and the conventions of Parliament.

The committee went on to say:

This incident highlights a concern shared by all members of the Committee: apparent departmental ignorance of or disrespect for the role of House of Commons and its Members. Even if the result is unintended, the House should not tolerate such ignorance within the government administration to undermine the perception of Parliament’s constitutional role in legislating. The rights of the House and its Members in this role are central to our constitutional and democratic government.

On October 15, 2001, the content of another justice bill, Bill C-36 was leaked to the media. The Liberal government House leader at the time, Don Boudria, rose in his place and did, in my opinion, the right thing. He stated:

Last Friday afternoon I received a copy of Bill C-36. As is my role as Leader of the Government in the House of Commons, I do what is known as a review of the bill. I took precautions then and earlier with the minister and all of her staff to ensure that the bill was not in any way given to the media or otherwise. I was given that assurance by everyone I spoke to.

On Saturday I saw extracts from the bill in the media. They were not all factually correct but enough of them were that it caused me to be as concerned as the hon. member when raising this question in the House.

I cannot say much more other than to apologize on behalf of whoever is guilty of this. I use the word guilty because that is what comes to mind, given the respect that I have for this institution. Anyone who breaches that respect is guilty of an offence in my book. The problem is that we do not know who it is.

The situation here before us is identical. We do not know who leaked the contents of the bill. The article refers to "a source familiar with the legislation”.

On the same day that the question of privilege was raised, the Speaker ruled and said:

I have to say at once this appears to be similar to the issue raised earlier before me with respect to Bill C-15. In my opinion it appears that there has been again a breach of the privileges of the House in relation to this piece of legislation.

The hon. member for Winnipeg—Transcona in his remarks tried to assist the Chair by suggesting that it was for the Chair to investigate the matter and come up with the name of the culprit and so on. I respect his opinion of course in all matters, but in this matter I think his view is perhaps wrong. There is a body that is well equipped to commit acts of inquisition, and that is the Standing Committee on Procedure and House Affairs....

Accordingly, in my view this is a matter which ought to be sent to the committee.

In my opinion, we clearly have a breach of privilege. The contents of Bill C-14 were leaked to The Globe and Mail and perhaps others, and we do not know who the culprit is.

We in the opposition are very concerned about this dismissive view of the role of the House. I trust that members of the government are equally concerned and would want to get to the bottom of it, as Mr. Boudria did in 2001.

I have no doubt, Mr. Speaker, that you too would be concerned, and that is why I ask that you do as your predecessors have done and refer this matter to the Standing Committee on Procedure and House Affairs.

In conclusion, if you would permit me to speculate here for a moment, Mr. Speaker, I suspect that Mr. Boudria had the usual struggles that House leaders and their staff have with ministers' communication directors who like to preposition the government's message on a bill. However, they did not understand the role that the House played then, and perhaps they do not now, but members of Parliament certainly do. I do not think any member, regardless of what side of the House he or she sits on, wants to have their independence taken over by staff in ministers' or departmental offices.

Criminal Code

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

moved for leave to introduce Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

(Motions deemed adopted, bill read the first time and printed)