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

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

Mr. Speaker, let me just say from the outset what a pleasure it was to serve on the special joint committee with the member for Montcalm, both in the last Parliament and in this one. I always appreciated his very thoughtful interventions and I could tell that he always came to committee quite well prepared.

The member and I have been here since 2015. He will remember that in the original bill, Bill C-14, there was a statutory requirement for a five-year review. We know that Bill C-7 was introduced before that review happened and that the government decided to accept a Senate amendment before it had a chance to establish a special joint committee. That process, that timeline, underlines why Bill C-39 is necessary now.

I wonder if my hon. colleague would just reflect on what has led us to this point and why Bill C-39 is necessary, and for this House to pass it quickly, because of the impending deadline and the fact that we do need to have some space to make sure we are getting these standards right. It is extremely important.

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

Mr. Speaker, like the minister, I have been here since 2015, so I have seen the entire legislative journey of medical assistance in dying, and I have also been the NDP's member on the special joint committee, both in the last Parliament and this one.

Back when Bill C-14 was passed, there was a requirement in that act for a statutory review of the legislation. We did have Bill C-7, and the government did accept the Senate amendment, even though it was contrary to its own charter statement on the matter. It was only after that that we established the special joint committee, which was then delayed by the 2021 election and did not get up and going until May of last year.

In the context of that, I think the Liberals have, in some instances, put the cart before the horse before we have had the appropriate review, but I would also like to hear his comments because there is a crisis in funding for mental health in this country. We have had the Canadian Mental Health Association talk about this. I would like to hear from the justice minister that his government can make a commitment to bring mental health care funding up on par with that of physical care. There is a real crisis, not only in my community, but also in communities from coast to coast to coast. I think that is going to be an important component of this conversation.

[David Lametti, Liberal, Minister of Justice and Attorney General of Canada]

moved that Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Mr. Speaker, I rise today to speak to Bill C-39, an act to amend an act to amend the Criminal Code regarding medical assistance in dying. This bill would extend the exclusion of eligibility for receiving medical assistance in dying, or MAID, in circumstances where the sole underlying medical condition for MAID is a mental illness. The main objective of this bill is to ensure the safe assessment and provision of MAID in all circumstances where a mental illness forms the basis for a request for MAID.

An extension of the exclusion of MAID eligibility in these circumstances would help ensure health care system readiness by, among other things, allowing more time for the dissemination and uptake of key resources by the medical and nursing communities, including MAID assessors and providers. It would also give the federal government more time to meaningfully consider the report of the Special Joint Committee on Medical Assistance in Dying, or AMAD, which is expected this week.

My remarks today will focus on the legislative history of MAID in this country. I want to be clear that medical assistance in dying is a right, as affirmed by the Supreme Court.

In its 2015 Carter v. Canada decision, the Supreme Court of Canada ruled that the sections of the Criminal Code prohibiting physicians from assisting in the consensual death of another person were unconstitutional. In response, in 2016, our government tabled former Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.

The basic purpose of the bill was to give Canadians nearing the end of life who are experiencing intolerable and unbearable suffering the option to obtain medical assistance in dying. The bill was passed two months later, when medical assistance in dying, or MAID, became legal in Canada for people whose natural death was reasonably foreseeable. It included procedural safeguards in order to ensure that the person’s request for medical assistance in dying was free and informed, and to protect the most vulnerable.

In 2019, in Truchon v. the Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. One year later, in response, we introduced a second bill on medical assistance in dying, the former Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

Former Bill C-7 expanded eligibility to receive MAID to persons whose natural death was not reasonably foreseeable. It did so by creating a separate, more stringent set of procedural safeguards that must be satisfied before MAID can be provided. The government proposed, and Parliament supported, these stringent procedural safeguards in recognition of the increased complexities of making MAID available to people who are not otherwise in an end-of-life scenario.

Some of these additional safeguards include a minimum 90-day period for assessing eligibility, during which careful consideration is given to the nature of the person's suffering and whether there is treatment or alternative means available to relieve that suffering. This safeguard effectively prohibits a practitioner from determining that a person is eligible to receive MAID in fewer than 90 days.

Another additional safeguard is the requirement that one of the practitioners assessing eligibility for MAID has expertise in the underlying condition causing the person's suffering or that they must consult with a practitioner who does. The assessing practitioners must also ensure that the person be informed of the alternative means available to address their suffering, such as counselling services, mental health and disability support services, community services and palliative care. It is not enough just to discuss treatment alternatives. They must ensure the person has been offered consultations with relevant professionals who provide those services or care. In addition, both practitioners must agree that the person gave serious consideration to treatment options and alternatives.

The former Bill C-7 extended eligibility to medical assistance in dying to people whose death is not reasonably foreseeable. However, it temporarily excluded mental illness on its own as a ground for eligibility to MAID. In other words, the bill excluded from eligibility for medical assistance in dying cases where a person's sole underlying medical condition is a mental illness. That temporary exclusion from eligibility stems from the recognition that, in those cases, requests for medical assistance in dying were complex and required further review.

In the meantime, the Expert Panel on MAID and Mental Illness conducted an independent review of the protocols, guidance and safeguards recommended in cases where a mental illness is the ground for a request for medical assistance in dying. The expert panel’s final report was tabled in Parliament on May 13, 2022.

The Special Joint Committee on Medical Assistance in Dying also completed its parliamentary review of the provisions of the Criminal Code relating to medical assistance in dying and their application, as well as other related issues, including mental health. We eagerly look forward to the special joint committee’s final report, expected on Friday, February 17.

I would also like to highlight the excellent work of the expert panel, ably led by Dr. Mona Gupta.

This temporary period of ineligibility was set in law to last two years. It will expire on March 17 unless this legal requirement is amended by law. This bill would do just that, and proposes to extend this period of ineligibility for one year, until March 17, 2024.

As I stated at the outset of my remarks, this extension is needed to ensure the safe assessment and provision of MAID in circumstances where a mental illness forms the sole basis of a request for MAID. It is clear that the assessment and provision of MAID in circumstances where a mental illness is the sole ground for requesting MAID raises particular complexities, including difficulties with assessing whether the mental illness is in fact irremediable and the potential impact of suicidal ideation on such requests.

That is why, when some Canadians, experts and members of the medical community called on the federal government to extend the temporary period of ineligibility to make sure the system was ready, we listened. We listened, we examined the situation carefully and we determined that more time was needed to get this right.

As for the state of readiness of the health care system, I would like to take a moment to highlight the great progress that has been made toward the safe delivery of MAID in those circumstances. For example, standards of practice are being developed for the assessment of complex requests for medical assistance in dying, including requests where mental illness is the sole underlying medical condition. Those standards of practice will be adapted or adopted by clinical regulatory bodies and by clinicians in the provinces and territories. These standards are being developed and will be completed in March 2023.

In addition, since October 2021, the Canadian Association of MAiD Assessors and Providers, or CAMAP, has been developing an accredited study program for health professionals. Once completed, that program will include seven training modules on various topics related to the assessment and delivery of medical assistance in dying, including on how to assess requests for medical assistance in dying, assess capacity and vulnerability, and manage complex and chronic situations. That program should be finalized and ready to be implemented next fall.

This progress was achieved through our government's leadership and collaboration with the health system's partners, such as the provincial and territorial governments, professional health organizations, our government's regulatory agencies, clinicians and organizations such as CAMAP.

The Regulations for the Monitoring of Medical Assistance in Dying, which set out the requirements for the presentation of reports on MAID, came into force in November 2018.

These regulations were recently revised to significantly improve the collection of data and reporting on MAID. More specifically, the regulations now provide for the collection of data on race, indigenous identity and any disability of the person. The revised regulations came into force in January 2023, and the information about activities related to medical assistance in dying in 2023 will be published in 2024 in Health Canada's annual MAID report.

I think we can all agree that substantial progress has been made. However, in my opinion, a little more time is needed to ensure the safe assessment and provision of MAID in all cases where a mental illness is the sole basis for a request for MAID.

I want to be clear that mental illness can cause the same level of suffering that physical illness can cause. We are aware that there are persons who are suffering intolerably as a result of their mental illnesses who were waiting to become eligible to receive MAID in March 2023. We recognize that these persons will be disappointed by an extension of ineligibility, and we sympathize with them. I want to emphasize that I believe this extension is necessary to ensure the safe provision of MAID in all cases where a mental illness forms the basis of the request for MAID. We need this extension to ensure that any changes we make are done in a prudent and measured way.

I want to turn now to the more technical part of Bill C-39 and briefly explain how the bill proposes to extend the mental illness exclusion. As I stated earlier in my remarks, former Bill C-7 expanded MAID eligibility to persons whose natural death was not reasonably foreseeable. It also included a provision that temporarily excluded eligibility in circumstances where a mental illness formed the basis of the request for MAID. Bill C-39 would delay the repeal of the mental illness exclusion. This would mean that the period of ineligibility for receiving MAID, in circumstances where the only medical condition identified in support of the request for MAID is a mental illness, would remain in place for an extra year, until March 17, 2024.

I want to reiterate that we need more time before eligibility is expanded in this matter. We need more time to ensure the readiness of the health care system, and more time to consider meaningfully and to potentially act on AMAD's recommendations. This is why I urge members to swiftly support the passage of this bill. It is imperative that it be enacted before March 17. If it is not, MAID will become lawful automatically in these circumstances. It is essential that this bill receive royal assent so that this does not happen before we are confident that MAID can be provided safely in these circumstances. I trust that all colleagues in this place will want to make that happen.

The safety of Canadians must come first. That is why we are taking the additional time necessary to get this right. Protecting the safety and security of vulnerable people and supporting individual autonomy and freedom of choice are central to Canada's MAID regime. We all know that MAID is a very complex personal issue, so it is not surprising that there is a lot of debate. It should go without saying that seeking MAID is a decision that one does not make lightly. I know from speaking with members of the medical community that they take both their critical role in the process and their professional duties toward patients extremely seriously. I trust that medical professionals have their patients' interests at heart, and this sometimes involves supporting their patients' wishes for a planned, dignified ending that is free of suffering.

Once again, I strongly believe that an extension of the exclusion of MAID eligibility in this circumstance is necessary to ensure the health care system's readiness and to give the government more time to meaningfully consider and to potentially implement the AMAD recommendations. I remind the House that those recommendations are expected just one month before the current mental illness exclusion is set to expire. Therefore, I implore all members to support this bill.

[Ed Fast, Conservative, Abbotsford, BC]

moved for leave to introduce Bill C-314, An Act to amend the Criminal Code (medical assistance in dying).

Madam Speaker, I am pleased to table today the mental health protection act. As members know, medically assisted suicide was legalized in Canada in 2016. Under Bill C-14, medical assistance was expressly limited to capable adults who have an irremediable disease that causes enduring and intolerable suffering that cannot be alleviated, and when their natural death is reasonably foreseeable.

At the time, the government and its supportive stakeholders assured Canadians that this would not lead to a slippery slope on which the scope of MAID would be continually be expanded to include other Canadians. Not surprisingly, in the intervening seven years, the government has expanded the scope of MAID by de facto extending its scope to those who are not dying, but who are living with disabilities.

More recently, the government expanded MAID to include mentally ill persons and also signalled its intention to extend this right to mature minor children. Clearly, we are on the slippery slope many of us had warned about, and Canadians have a right to ask who is next. Will it be the drug addicted, the indigent, the homeless, or needy veterans? What about willing seniors who are tired of life? Where does it end?

My bill would reverse this momentum and repeal the government's decision to extend MAID to the mentally ill. The evidence from mental health experts is very clear. There is no consensus in Canada that the mentally ill should be covered by Canada's medically assisted death regime. Issues of irremediability, competency and suicidality are not anywhere close enough to being resolved to justify this major policy shift in favour of death.

Let me be clear: My bill does not, in any way, reverse the rest of Canada's MAID regime. Instead, it arrests Canada's slide down the slippery slope of assisted suicide, which so many of us had predicted would happen. I would respectfully ask that all of my parliamentary colleagues give thoughtful consideration to my bill, and join me in protecting and supporting the most vulnerable in our society.

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

[Dr. Tim Stainton, Director, Canadian Institute for Inclusion and Citizenship, University of British Columbia, As an Individual]

Thank you, Mr. Chair, and members of the committee, for the opportunity to speak to you tonight.

I have reflected many times on the process surrounding Bill C-7. The failure to appeal the Truchon decision was shocking given the significance and scope of its impact.

As Bill C-7 worked its way through Parliament, some 200 disability organizations, including all of the major national bodies, were clear and united in their opposition, warning the government of the threat it posed to disabled people and other vulnerable populations. Numerous witnesses shared their concerns, often with compelling personal narratives. In addition, serious concerns were raised by three UN human rights experts. Not only were all of these concerns ignored, but the bill was massively expanded by a Senate amendment to require the inclusion of mental illness within two years—a significant expansion on the original intent of Bill C-7—without study or review.

Despite this, on March 17, 2021, Bill C-7 received royal assent after the government invoked closure to cut off debate.

It's hard to imagine a similar overwhelming dismissal if we were discussing any other equity group, were they were to voice unified concerns over a bill and were backed by UN human rights experts. Why this was the case can only be explained by recognizing a deep, pervasive and often unconscious ableism that pervades Canadian society.

Canada’s euthanasia and assisted suicide laws have always been about balancing individual autonomy to decide when to end one’s life and the protection of the vulnerable. Subsequent to the passage of Bill C-14, it would seem that protection of the vulnerable has largely been ignored in favour of an increasingly atomistic interpretation of autonomy.

It is somewhat ironic that as we come out of an unprecedented era of COVID-19 where we were all asked to make sacrifices of some of our personal autonomy in favour of broad protection for the whole of society, in the debate on euthanasia and assisted suicide we persist in privileging a view of autonomy more akin to one used by those who railed against the vaccine mandate as an infringement on their individual liberty.

John Stuart Mill, one of the fiercest defenders of individual liberty, provided an analogy for when interference with individual autonomy was permissible. He wrote that if a man is trying to cross a bridge that is unsafe, it is permissible to impede his progress as he does not wish to fall into the river, but rather his will is to cross the bridge.

This committee will be aware of the numerous reports of disabled persons who do not desire to end their lives, but feel they no longer have tenable options given the crushing demands of poverty, forced institutionalization and the lack of necessary services and supports. They are our bridge crossers. They do not wish to fall into the abyss, but without the repairs to the bridge—ending poverty, ending unwanted institutionalization and improving our disability and mental health supports—they feel they have no other option. Rather than restraining them, as Mill suggests, we are shepherding them to the edge and over through MAID.

I'm also concerned as to where this all ends, given the rapid and ill-considered expansion that will be making Canada the world leader in cases of assisted suicide and euthanasia in a mere six years. I worry that we will soon see calls for legalizing the killing of disabled people who are unable to formally consent at the request of their parents or guardians.

Sadly, we know from public reaction to things like the murder of Tracy Latimer and many other cases that so-called “mercy killing” has widespread public support.

If we continue to weaken the need for direct consent through permitting advance directives and allowing children to be euthanized, it is a very small step to involuntary euthanasia of disabled people who are considered unable to consent.

I have a son with an intellectual disability. He cannot directly tell you the value of his life, but he shows us every day in his accomplishments, his laughter, his smile, and those he touches, yet I know that most people who see him in passing assume his life is one of tragedy, suffering and dependency. These people would see an end to his life as a mercy. The Canada I want to believe we live in would value, support and celebrate his life. I increasingly fear it is becoming one that seeks only to end it.

Thank you.

[Dr. Jennifer Gibson]

Thank you for the question. I think it builds on your previous one.

If we think about it, there's the legislation. The clinical guidelines being developed by those who are best equipped, as clinicians, to inform what the practice may look like are going to be important. However, there are other actors who we want to be thinking about.

One key actor here—whom I know has been identified at this committee and who surfaces fairly frequently—is the substitute decision-maker. They play such an essential role in this process. Dr. Reiner's process that he's outlined is very well suited to supporting a substitute decision-maker to be well equipped with an understanding of why a patient may be seeking an advance request, and to be able to be part of that deliberative process. That is an actor. I think there are other actors who have essential roles to play in ensuring that the system around this works well.

A strength of the original Bill C-14, our original legislation, was that there was a monitoring system in place. We were able to track and understand what was going on in the practice and be able to guide continuing policy evolution. However, that is high level, and it often uses quantitative data in reporting statistics. It's very helpful at a population level, but we need to go further down.

Some of the other opportunities we have to strengthen this system as a whole are to continue to foster the types of research that Dr. Reiner has been pursuing and to continue to foster the learning and the training of health professionals that Dr. Perrot is sharing as well. Everyone is in.

Judges Act

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

Mr. Speaker, it is a great pleasure to have the opportunity to speak today on Bill C‑9, right after my friend, the member for Battle River—Crowfoot.

I want to begin by entering this debate midstream and responding to some of the comments that I was hearing in the questions and comments period immediately prior to my speech, before shifting into some of the other comments I want to make specifically about this legislation.

A favourite subject of the member for Winnipeg North is legislative timing and the processes of the House, and I must confess that it is a subject I enjoy engaging in dialogue about as well. However, I think he is always selective in his presentation of the story when it comes to the timing or process of legislation. There are a number of different aspects to that. In particular, he is essentially telling my colleague that we should not be debating this bill because he wants the bill to move forward on a certain timeline.

It is important for everybody listening to know that it is the sole prerogative of the government to schedule the legislation it is moving forward for debate in the time slots we have for presenting it, which is the vast majority of the parliamentary calender. The government needs to set aside some time for opposition days, where opposition parties put forward motions, and there is the possibility for members to move concurrence of committee reports. However, those are quite constrained given the time that those debates take. Of course, there is also Private Members' Business.

There are therefore some opportunities outside of government for legislation, policy or motions to be put forward for debate in the House, but the vast majority of the time is available to the government to schedule at their sole discretion. It is the government that makes decisions about which bills are priorities and which bills to put forward. If it wants a bill to advance, then I think it has an obligation to schedule it for enough days of debate so that debate can be brought to a conclusion. That principle applies for Bill C-9, as it does for any other bill.

What we often see the government do is fail to prioritize a bill within its own allocation of time. Then it acts mystified about the fact that it is not moving based on some artificial timeline that it has set. We saw this with Bill C-22, where the government scheduled it for one day of debate, did not schedule it for weeks afterwards and then asked why the bill was not moving forward. Of course, debate concluded the next time it was scheduled, but it would have moved forward faster if the government had chosen to prioritize it.

I detect the same string of argumentation again here from my friend from Winnipeg North. He is keen to see Bill C-9 move forward, apparently, but not keen enough to have successfully lobbied his House leader to schedule this bill and put it forward on a larger number of days. Friday is a very short day relative to the time we get.

I wanted to spend a few minutes on that particular point because I know it comes up again and again, and to pre-empt, in a sense, what I suspect will be a question from my friend from Winnipeg North, although I will say that I did appreciate him tabling a petition relating to Bill S-223 on organ harvesting. I hope that is a bill the foreign affairs committee will prioritize for deliberation and move forward, because as members know, it has been a long time.

Having responded to that, I want to add my voice to the comments by my friend from Battle River—Crowfoot pertaining to the larger issues of trust in our institutions and independence. We are talking today, in the context of Bill C-9, about certain circumstances, events and comments that have impacted trust and faith in the judiciary, and I think we need to affirm the importance of institutions.

We want to see that our institutions are trusted, but we also want our institutions to be worthy of that trust. Sometimes what we hear from some members is a call to trust institutions without being willing to note when there have been significant problems in the conduct of individuals in those institutions. I think the issue raised by the opposition House leader today with respect to interference by the government in a criminal case is another important issue in the ongoing conversation about trust in our institutions and the actions of government. Acts of interference by the government certainly do have an impact on how our institutions are perceived and the degree to which they are trusted. These matters of interference and the independence of institutions are important in their own right, but they are also important in terms of how they contribute to the level of trust that Canadians can reasonably have, in light of the facts, in the institutions that are so critical for holding our public life together.

Bill C-9, the piece of legislation we are debating today, is, on the face of it, a relatively technical piece of legislation, although as members know, every technical piece of legislation has interesting philosophical issues and questions underneath it. The legislation is about making changes to the mechanisms or processes that are in place around judicial discipline, or the discipline of judges. I will just read the summary. It states:

This enactment amends the Judges Act to replace the process through which the conduct of federally appointed judges is reviewed by the Canadian Judicial Council. It establishes a new process for reviewing allegations of misconduct that are not serious enough to warrant a judge's removal from office and makes changes to the process by which recommendations regarding removal from office can be made to the Minister of Justice. As with the provisions it replaces, this new process also applies to persons, other than judges, who are appointed under an Act of Parliament to hold office during good behaviour.

It creates mechanisms by which individuals who have been appointed to hold office, pending “good behaviour”, could be considered not to have fulfilled the standards required around good behaviour and could therefore be removed from office and/or face other mechanisms of discipline. I think the details and mechanics of these mechanisms are extremely important, and are things that will be important not only for the House to consider but for committee to go into further.

After reading through the legislation, one thing I found quite interesting was the presence of a review panel of lay people who, by design, cannot have any legal background. It is always interesting to me when there is this balance where, on the one hand, there are aspects of our judicial system where we demand a certain level of expertise, and then on the other hand, there are certain places where, I think for good, understandable reasons, we demand a lack of expertise formally and in practice as a means of saying that we want some people involved in the decision-making who are non-experts.

I recall a quotation from former British prime minister Clement Attlee, who talked about how he wanted his ministers not to be experts on the subjects they were ministers of. I know that is a bit of a parenthetical question, but it is one that has been debated over the years regarding various kinds of appointments.

In any event, this legislation includes a specific, designated role in the termination process for lay people. I want to note as well the justifications by which a judge could be removed from office. Proposed section 80 says, “For the purposes of this Division, the removal from office of a judge is justified only” for these reasons:

(a) infirmity;

(b) misconduct;

(c) failure in the due execution of judicial office;

(d) the judge is in a position that a reasonable, fair-minded and informed observer would consider to be incompatible with the due execution of judicial office.

These are, in some ways, notionally objective criteria, but naturally there is going to be some level of subjectivity in how they will be applied.

There is a history to the consideration of this issue, and there is a history to the discussion of judicial misconduct that touches on some very important and sensitive issues. In my time as a member of Parliament, there has been a fair bit of discussion specifically around the issue of comments by judges dealing with cases of sexual assault. There was a judge who made some very offensive and outrageous comments in the context of a sexual assault trial that he was presiding over. That provoked a lot of conversation about the reality that someone is not rendered all-knowing and all-virtuous simply by the fact that they have received a judicial appointment, and that maybe there is a legitimate place for saying that someone, by their comments or lack of understanding certain things, is no longer fit to be a judge.

How do we preserve the principle of judicial independence, the principle that judges should be making decisions based on the facts of a case and the law rather than making decisions as democratic legislators do, based on other factors, including public opinion? How do we preserve that principle of judicial independence and also say that there are certain societal norms and values that we would like to see reflected in the conduct and statements of judges? There is a point at which a person can go beyond the pale and simply no longer be suited to that position as a function of some of their comments.

There have been a number of ways of getting at this issue. One was from former Conservative leader Rona Ambrose, who put forward a private member's bill, in 2016 or the first half of the 42nd Parliament, that sought to promote judicial education around sexual assault. That is one way of dealing with comments like this: We can say that maybe it is simply about a lack of knowledge and education.

That bill did not pass in Parliament, but a similar bill was put forward and was passed in the 43rd Parliament. As I said at the time, I think we need to recognize the importance of education around these issues, but also recognize that education is not always the full solution. I think there is a lot of data to suggest that when we mandate certain kinds of training courses, for some people it is a meaningful opportunity for them to learn about the matter at hand, but for other people it is just a matter of checking the boxes that are required. Whether it is a meaningful engagement exercise or a box-checking exercise depends somewhat on the way the material is presented, but a lot of it will depend simply on the disposition of the individual and how willing the individual is to substantively engage with the matter at play.

My conclusion is that the proposal from Rona Ambrose about judicial education was very important and worthwhile, but it does not solve the whole problem of either judicial misconduct or potential issues where a judge is making comments in the context of a trial that are very offensive to the victim and to society at large.

That is some of the history of the issue, but there are also other potential issues. This is not just about comments judges make in trials; it could also be about concerns over personal corruption and other things that could be at play in the context of judicial discipline. This is a piece of legislation that, coming out of that long-running public discussion, seeks to make refinements to the processes around judicial discipline.

One thing I would like to note about this discussion is that it presumes the personal fallibility of judges. Maybe it should be fairly obvious, but with the way some of our Canadian debates have proceeded, maybe it is not so obvious that judges are human beings. They have the potential to develop great expertise, great virtue and commitment to their work.

Judges also, like any other human beings, have the potential for grave errors in reasoning, as well as moral errors of various kinds, including misconduct or corruption. They are human beings, are fallible and can make mistakes in various kinds of situations or ways. The heavy criticism of former justice Robin Camp, some of the subsequent discourse and arguments for judicial education the government has supported, and the very existence of this legislation, affirm the reality of judicial fallibility. However, at other times when we are having debates about criminal justice issues and how we respond to particular kinds of charter litigation, the discourse in the House seems to presume something else, which is the infallibility of judges.

It was very striking to me, when I was first elected as a member of Parliament, that we were, on the one hand, dealing with this whole question of former justice Robin Camp and the issues around judicial fallibility, but on the other hand we had members making comments about at the time Bill C-14, which followed the Carter decision of the Supreme Court, where it was repeated that this was a unanimous court decision. Therefore, our goal as a legislature should simply be to interpret the wisdom we were given from this wise council's vision.

I have a great deal of respect for the role the Supreme Court plays in our democracy, but I also think it is legitimate to disagree with decisions that the courts have made. Part of the process of democratic deliberation is recognizing that, if judges can be personally fallible regarding their own conduct, fallible in the sense of making inappropriate comments in a sexual assault case, then they can also be fallible in there determinations about the appropriate sentence and balance of rights that emerge from a series of arguments about how to interpret given facts in light of the charter.

The fact there is diversity in courts of dissent underlines the potential fallibility of judges, and I think we should, in our Canadian democratic discourse, seek to affirm the importance of judicial independence, and the respect that is owed to that institution, while also recognizing that judges make all kinds of mistakes and that Parliament has a role to deliberate about substantive questions of justice and human dignity and to engage in a constructive and healthy back and forth when it comes to decisions, legislation and how we respond to that.

I could cite other cases that brings this issue to the fore, but I see that I am up against my time to some extent. Therefore, I am grateful for the opportunity to address the issues around Bill C-9, to share a bit of the history, and to underline that, for me, one of the lessons coming out of this is to let us acknowledge that judges are human beings. They have an important job to do, but it is legitimate to disagree with and debate the determinations that are made, and to use constitutional tools that affirm the rights and the role of the legislature when it comes to establishing and advancing common values that are determined through democratic deliberation.

Canada Disability Benefit Act

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

Madam Speaker, I appreciate the opportunity to speak to Bill C-22 and, more broadly, to the situation confronting Canadians living with disabilities.

Bill C-22 proposes a new federal financial benefit for Canadians living with disabilities, however, it does not actually define many aspects of the structure of this benefit. I will be voting in favour of the legislation, because I agree with the principle of providing the support, but I am concerned about some of the lacking substance with respect to how this benefit would actually work.

Increasingly, we see from the government a desire to limit the actual work of Parliament in defining the nature and scope of programs. Instead, the government wants a blank cheque from Parliament, legislation that authorizes ministers to shape and define a program independently, according to their discretion.

In general, this is not a good way for governments to operate in a democracy and, in particular, I do not think the Liberal government has shown itself trustworthy when it comes to working out the details of critical programs.

When it comes to the structure of this benefit, the government's message is “just trust us.” From a government that cannot figure out how to deliver passports in a timely manner, cannot address the affordability crisis in Canada and cannot secure our borders, the message of “just trust us” seems rather hollow.

I have two specific concerns about the prospective structure of this program that I do want to highlight.

First, I share the concern of many about how this program would interact with other existing programs, including those provided at the provincial level. If a new federal benefit leads to a loss of eligibility for other existing benefits, then it would leave people worse off overall. It is not inevitable that this would be the case, but this is a matter that will require careful and respectful dialogue with other levels of government and hard work at every stage, hard work that the government has not always been prepared to do.

At this point, the government is passing broad framework legislation without ensuring that it will actually leave Canadians with disabilities better off in every case. The government does not have to wait for this legislation to pass to begin those discussions and I would encourage it to actually engage those discussions now about protecting existing benefits, because aspects of those dialogues may inform suggested amendments.

The second concern I have is that it is critically important that the structure of this benefit program protects access for Canadians with disabilities who are working or are trying to get into work. Even with existing benefit programs at other levels, certain Canadians with disabilities may find themselves in a position where entering the workforce actually leaves them worse off. It is critically important that work always leaves people better off financially.

Supporting Canadians, including Canadians living with disabilities, in being able to access meaningful work has long been a key priority for Conservatives.

Why is this important? Overwhelmingly, Canadians of all backgrounds and circumstances want to be able to work and are happier and more fulfilled if they are able to work. In this context, by work, I do not just mean commodified work, but work of any sort, where individuals exert themselves in order to contribute positively to the world around them.

The science of happiness and fulfillment measurement shows us that work generally makes people happier by providing them with meaning and with a workplace-based community, and with a greater level of power and agency. Quite apart from the notably important income-earning properties of work, work also provides meaning and happiness, totally independent of whether it generates income.

Think tank Cardus has done excellent work on this question of work and disability. It has found that most Canadians living with disabilities want to work or want to work more, but it has also found that the vast majority of public policy, focus and money has been toward income support as opposed to supports that help people get into work.

The critical point about work support and income support is that they are not mutually exclusive. In fact, often, they are necessarily complementary. Some people require income support in order to afford the resources and transportation required to find and get a job in the first place. If income supports are withdrawn immediately once people work or start work, they may not be able to afford vital necessities, as well as the things they need to sustain them in their new job.

Having both fulfilling work and steady income are vital for human happiness and fulfillment. Having income without work or work without income are both, in a sense, problematic.

Of course, having income is not just about fulfillment and happiness; it is about basic survival. Canadians with disabilities need income to take care of their own needs and the needs of those they love.

For most of us, work comes with earning income. However, when benefit programs are poorly structured, people may actually be forced to choose between work and income, because benefits are cut off or income is lost as a result of working. In such cases, given how essential income is for survival, people will understandably choose income over work if they are forced to choose between these things. It is cruel and pointless to force people to make this choice, to choose between the happiness associated with work and receiving the financial support that they need.

Income supports for Canadians with disabilities can and should go hand in hand with workplace support, only peeling those income supports back gradually when it is clear that income support is not required because of the level that an individual is able to work.

We saw an example of this terrible choice between work and income during the pandemic with the poorly constructed CERB program. Unemployed Canadians who were accessing CERB, and who were then offered part-time work, were in many cases actually worse off financially if they took that work because part-time work would push them over the threshold for CERB eligibility, even if they were not earning close to what they would have been entitled to receive under CERB. Thus people were forced to remain out of work in order to access the resources they needed to support their families.

Not only does it make zero financial or economic sense to create a financial disincentive to work, but it also puts people in the painful position of needing to choose between the happiness and dignity that come from work on the one hand and from financial security on the other hand. That is why we feel it is very important that this new federal program be structured in such a way that Canadians with disabilities, many of whom can and do work, or want to work, are not rendered worse off by entering the work force.

There is nothing in the text of the bill that would suggest it could not be structured in a way to ensure that work always pays, but the past record of the government gives us significant cause for concern. In the 42nd Parliament, the member for Carleton, now the leader of the Conservative Party, proposed Bill C-395, a bill specifically designed to address this problem of work sometimes bringing about a loss in benefits for Canadians living with disabilities.

Bill C-395 would have amended the Federal-Provincial Fiscal Arrangements Act to ensure that, in negotiations around transfers and the construction of benefits for Canadians living with disabilities, people with disabilities would not lose more through taxation and the reduction of benefits than they gain as a result of working. It would have protected Canadians with disabilities from these kinds of perverse situations where they would have to choose between the happiness that comes from work or the financial security that comes from government benefits.

If Bill C-395 were the law of the land, we could then pass this bill, even as written, with the confidence that the benefits constructed would leave people better off, but when it came to a vote on Bill C-395, Liberals actually opposed it. Liberals opposed the common-sense proposal from our leader to ensure that Canadians who work are better off as a result of the money they earn.

Sadly, Liberals do not seem to appreciate the value, dignity and happiness that comes from hard work. I am not sure if it can be found in the scope of this legislation as written, but I would welcome amendments that would capture the spirit of our leader's past work to protect Canadians with disabilities from being punished for working.

Parenthetically, I want to say something directly to employers about hiring Canadians with disabilities. Research done by Cardus shows that many employers have an exaggerated perception of the cost associated with accommodation. Cardus' work shows that including and accommodating employees with disabilities is often much cheaper than employers initially expect and that funding may be available from different levels of government for businesses, including small businesses, seeking to accommodate customers and employees living with disabilities.

Further, as our leader has previously shared in the context of speaking to Bill C-395, there are many cases of Canadians with disabilities who make incredible, committed and loyal employees who bring unique competencies for the workplace. Governments have a responsibility to ensure that poorly structured benefit programs do not undermine the ability of Canadians to access work, but employers also need to lead in pushing aside stereotypes and recognizing the contributions that Canadians with disabilities can make to their workplace. Many employers are already doing this, and I congratulate those who are doing this already.

Those were the main points I wanted to make on Bill C-22, but it is also very important to speak to the context of the legislation, which is the significant negative impacts on the lives of Canadians living with disabilities that flow from the government's radical ableist approach to euthanasia, the so-called MAID regime. We simply cannot have a conversation about financial benefits separate from a recognition that the biggest threat to the lives of Canadians living with disabilities is that those without disabilities are much more likely to be offered suicide prevention and recovery support, while our brothers and sisters, cousins and friends who are living with disabilities are being denied those supports and actively pushed towards death, even if they are saying they do not want it.

Among those who support legal euthanasia around the world, Canada is still increasingly seen as a cautionary tale, a warning of what not to do. In this vein, I want to start with a bit of history. Euthanasia in Canada started with Bill C-14, which was passed in the 42nd Parliament. This legislation affixed the name “medical assistance in dying” to what had previously been called euthanasia, the process of doctors killing a consenting patient. That legislation sought to define a regime whereby people could choose hastened death if their death was deemed reasonably foreseeable.

I criticized the legislation at the time for, among other things, not being sufficiently clear about what was actually meant by “reasonably foreseeable”. Indeed, there were significant abuses, even in the immediate aftermath of the passage of the legislation, whereby doctors determined someone's death to be reasonably foreseeable based on a string of hypotheticals when a person had nothing approaching a terminal condition.

For example, back in 2016, I highlighted a case in Vancouver where a physician declared a depressed person eligible for euthanasia without examining the individual because that patient “could easily get bed sores and then die of infection”. A person's death was, prior to examination, declared reasonably foreseeable because the person could theoretically die from an as yet uncontracted bed sore infection if they were bed bound as a result of the depression. These were the kinds of perverse outcomes that were possible even in 2016 as a result of a lack of safeguards and the ambiguity around what was meant by “reasonably foreseeable”.

The current rules allow someone also to consult many different physicians before finding two who will approve. Therefore, if 20 or 200 doctors say no, the criteria are not met, but then two say yes, the criteria are met, then the killing of the patient can proceed. The ambiguity and the opportunity to consult multiple doctors before getting the desired result means that, indeed, the holes were, and still are, large enough to drive a truck through. These were the pre-existing problems that were already, in particular, raising concerns of the disability community. The lack of clarity around what were and were not circumstances where death was reasonably foreseeable opened the door for people who were living with disabilities to be encouraged to pursue MAID, even if they did not want to, and even if they were actually not eligible.

Members do not have to take my word for it because the minister responsible for this legislation, the Minister of Employment, Workforce Development and Disability Inclusion of Canada, during a subsequent discussion of Bill C-7, said, “I regularly hear from families who are appalled by the fact that they take their child, potentially their older child and are offered unprovoked MAID. I think that has to stop.” That is from a minister in the government. This was already the context following the passage of Bill C-14 and prior to the passage of Bill C-7.

The road to Bill C-7 was much more contrived than the road to bill C-14. The already nebulous reasonable foreseeability clause was challenged and a lower court in one province proposed to overturn this restriction. The federal government could have appealed that lower court decision and, indeed, had a strong basis for doing so. An appeal would, at the very least, have given parliamentarians more time to consider a broad range of legislative options. Instead, the government made a political choice to embrace the lower court ruling and the artificial timeline it created, pushing medical assistance in dying for Canadians with disabilities. This was not about following a court ruling. This was about something the government could have appealed, but wanted to use the court ruling to advocate for a long-standing objective.

Following this contrived process, the government put forward Bill C-7, which was rightly opposed by all of the leading organizations representing Canadians living with disabilities, as well as by domestic and international human rights authorities.

Krista Carr from Inclusion Canada said, “Inclusion Canada has advocated for safeguards in MAID since we intervened in the Carter case. Our biggest fear has always been that having a disability would become an acceptable reason for state-provided suicide. Bill C-7 is our worst nightmare.” She continued, “By having a disability itself under Bill C-7 as the justification for the termination of life, the very essence of the Charter of Rights and Freedoms would be shattered. Discrimination on the basis of disability would once again be entrenched in Canadian law.”

She said further that the “singling out of one particular...group” of people based on their personal characteristics, which happen to be protected under the Charter of Rights and Freedoms, and to use those as grounds to justify the termination of the lives of the people who have those characteristics is just wrong, and that we would never consider doing this for any other group of people, including those who are indigenous, racialized or LGBTQ.

Dr. Heidi Janz from the Council of Canadians with Disabilities said:

People with disabilities are at a higher risk of suicide due to systemic and internalized ableism, yet they face substantial barriers when trying to access suicide prevention services. Medical professionals overlook typical sources of stress. Problems arising from relationship breakdowns, depression and isolation are wrongly attributed to disability. The removal of “reasonably foreseeable” natural death as a limiting eligibility criterion for the provision of MAID will result in people with disabilities seeking MAID as an ultimate capitulation to a lifetime of ableist oppression.

Finally, Bonnie Brayton from the DisAbled Women's Network of Canada pointed out, “Bill C-7, is sadly lacking in any meaningful public consultation with any people with disabilities despite how much more profoundly it could affect anyone who lives with a disability.” The disability community overwhelmingly opposed Bill C-7 and has repeatedly raised concerns about negative pressure and coercion impacting Canadians living with disabilities.

What about autonomy? The government would argue that Bill C-7 provides people with disabilities the option of medically facilitated death, but they do not have to chose that option. It is just another option that people have. To this, I would note that autonomy is always expressed in a social, legal and economic context. The context is that many Canadians living with disabilities struggle to access the key supports and services they need.

We do not have sufficient workplace supports in place and there are gaps in terms of community and income supports. In that context, the law and the medical system say to a person living with a disability that they have a simple way out and they can choose to die. If someone is at a point of existential agony and they have a disability, then the system will offer them death as a supposed solution.

In effect, if a person like me, without a disability, is experiencing existential distress and suicidal ideation, and if I were to discuss that distress with a doctor, I would be offered suicide prevention. However, if a person with a disability, the same as me in every other respect, is experiencing the same existential distress and suicidal ideations, and they discuss their distress with a doctor, they will be offered suicide facilitation by that same medical system.

That difference in the way the law and the health system treat those living with and without disabilities obviously sends a message to everyone involved in those interactions about whose life the law and the health system deem to be more or less worth living. The Liberal government has built a staircase to suicide prevention and a ramp to suicide facilitation.

As much as members opposite would like to say that this is about autonomy, the social and legal context that the government has created is not neutral and it is, in fact, discriminatory. Disability rights groups overwhelmingly see this reality, which is why they have been diametrically opposed to the approach of the government, and so much for “nothing about us without us”.

Canadians with disabilities feel devalued by a system that offers them easy death and does not offer them critical supports to live. Sadly, the mentality of the medical system is changing as well in response to these legal changes. The House has heard from many witnesses at different times and in different communities where patients were repeatedly pushed toward death and even called selfish for rejecting that option.

I will quote the minister again who said herself, “I regularly hear from families who are appalled by the fact that they take their child, potentially their older child and are offered unprovoked MAID. I think that has to stop.”

In response to the testimony we heard, Conservatives sought to amend Bill C-7 to guarantee that a physician or other health care worker would not raise euthanasia or MAID with a patient, unless the patient raises it first. This amendment would have ensured that, for instance, a person with a disability who goes to the doctor for something unrelated would not be offered facilitated death out of the blue. This would have solved the problem the minister identified, but the government opposed this—

[Spencer Hawkswell, President and Chief Executive Officer, TheraPsil]

Thank you.

I'm a patient-rights advocate and the CEO at TheraPsil, a non-profit dedicated to supporting patients in accessing psilocybin, a substance commonly found in what's otherwise known as magic mushrooms that has an amazing ability to help people through the therapeutic process. It usually has been used in studies to help people with end-of-life distress.

I'm here today to advocate on behalf of a number of our constituents and patients who have the right to die in Canada with medical assistance in dying, but currently are being denied their right to try psilocybin. Specifically, I will refer to a patient, Janis Hughes, who is a 65-year-old woman in Manitoba with stage 4 breast cancer and an advocate with a two-year prognosis who in her own words states, “It is not only patronizing but an infringement upon my charter rights to have a Canadian government deny me access to psilocybin, a substance that has helped me with my palliative care treatment and end-of-life distress while allowing me at the same time only one alternative—medical assistance in dying.”

To relate what this has to do with MAID, it is about improving palliative care and adjunct or prior therapies.

The last time psilocybin was brought up in this meeting, it was shot down as a pseudo-science for its lack of research and not having much to do with medical assistance in dying. However, first in relation to the research, I might remind everyone that there is actually quite a bit of research behind psilocybin, specific research coming out of Johns Hopkins and NYU, that far surpasses much of the research that was done for medical cannabis and perhaps medical assistance in dying. These were both legalized on the basis of human rights, and that is what we are talking about here today—a human rights issue in need of compassion.

Second, to answer how MAID is connected to the psilocybin issue, the people whom I represent, such as Ms. Hughes, are directly affected by this committee. Psilocybin access is currently available through the special access program to those who have failed every other treatment, leaving MAID as one of their only alternatives if psilocybin is not allowed. This represents a woeful incongruity in our health care system. I believe that if this committee is made aware of this incongruity, they may see a situation in which we're allowing people to die before they're able to try substances such as psilocybin that might help them alleviate end-of-life distress and help with their palliative care before MAID.

Where is the compassion? Why is there not a more patient-centred approach when constituents and stakeholders of the actions of this committee are being told that they are being denied prior or adjunct treatments to MAID?

I am personally a big supporter of medical assistance in dying and have agreed with everything I've heard so far. We must move it forward quickly, but we must also see it in the context of palliative care in Canada, especially where patients are being denied access to other therapies.

Bill C-14 and Bill C-7 required establishing this committee in the House of Commons and Senate to conduct a comprehensive review of the Criminal Code, MAID provisions and their application and issues relating to mental illness and the state of palliative care in Canada. I believe that we are talking about the state of palliative care in Canada.

I am here to defend Canadians with mental illness and those struggling to receive adequate palliative care. Our health care system prides itself on being patient-centred and giving people the right to die after the Carter proclamation—if you don't have the right to die, then whose body is it? At the same time, it will limit these same Canadians by expanding MAID while ignoring issues related to adjunct or prior treatments, such as psilocybin access.

I believe that this is unconscionable. Given the constituents affected by this committee, this review will be subject to broader options relating to medical death while their request to seek treatment such as psilocybin to better their quality of life is being ignored.

I don't believe that the members of this committee should let such a thing happen. I'm asking for your compassion and support for people like Janis. I believe that Canadians who have the right to die should similarly have the right to try psilocybin and perhaps other controlled substances prior to MAID.

I believe, however, that we should start with psilocybin access, given the robust research. We should expect this to increase to other treatments and substances that may hold other grounding.

I'm urging this committee to add in its report that regulations for medical psilocybin access for those seeking MAID should be given a priority and that it should be a possible prior treatment for a number of Canadians seeking this. I do not intend in any way to slow down any of the other work that is being done on MAID and on other issues; rather, I encourage the expansion of other alternative treatments at the same time. Again, I am referring to psilocybin.

I am here to defend people like Ms. Janis Hughes and hundreds of other patients who have reached out to our organization and who are feeling disheartened that we might make MAID available in as little as three days while someone like Ms. Hughes has waited seven months for access to psilocybin and has been forced to break the law to access it.

I do not believe that this reflects well upon the state of palliative care in Canada, and I believe that, similar to the comments made by Dr. Downar, this is simply a reflection of other therapies—adjunct and prior therapies—that need to be made available while our MAID committee is expanding possible options for medical assistance in dying.

Please consider it. Thank you.

[Dr. Michael Trew]

Thank you.

I think I like the wording of the expert panel for sharing. I think that is a bit of a shift from how most people read Bill C-14.

[Dr. Michael Trew, Clinical Associate Professor, University of Calgary, As an Individual]

Thank you for inviting me to speak today.

With regard to a few words about my relevant background, I've been a clinical psychiatrist for 40 years in Calgary, with a special interest in the interplay between mental disorders and physical disorders. I am a clinical associate professor at the University of Calgary. I am the former chief medical officer of addiction and mental health at Alberta Health Services.

I chaired the Alberta Health Services non life-limiting expert panel from 2016 to 2018. I'm a member of the Canadian Psychiatric Association task group on MAID in mental disorders as the sole underlying medical condition. I am also a member of the Canadian Association of MAID Assessors and Providers, and I have provided psychiatric assessment primarily as it regards capacity in community settings.

In general terms, I respect and agree with the overall goals of Bill C-14 and Bill C-7,, along with the “Final Report of the Expert Panel on MAID and Mental Illness”.

In my view, mental disorders have long been seen as separate and distinct from physical disorders. I believe that any ongoing distinction between mental disorders and physical disorders in MAID-regulated legislation is unlikely to stand up to court review.

From my own clinical experience, I can describe cases that most people would agree represent appropriate use of MAID for people who have a mental disorder as their sole underlying medical condition. I can also report cases that most people would be very uncomfortable with if MAID for mental disorders were provided.

The challenge is to identify a reliable assessment system to make these determinations. Failure to generate such a system invites risks, including substantial variability from jurisdiction to jurisdiction, the risk of providing too much or too little MAID for mental disorders, the attendant ethical distress for providers and survivors, and MAID shopping.

In my view, the courts have judged on the most extreme cases, those with very strong and reasonable plaintiffs. These cases of extreme suffering and disability have established the principles that underlie MAID in general. Looking at them now, they seem relatively black and white, while some of the track two cases—and I anticipate many of the mental disorder as the sole underlying medical condition cases—will be very nuanced and grey in their details.

Not all of our requesters are or will be very reasonable. The level of complexity, combined with the current practice, which has emphasized for good reasons the independence of assessments, calls for some consideration of the processes and the expectations going forward.

The drive for MAID in the first place was largely driven by a person-centred, human rights-based approach. Bill C-14 largely focused on the question of not whether a person was going to die soon, but how and when they would die soon. I believe we have seen this taken up largely by individuals who are used to a high degree of personal control in their lives and choose to take this step at the time of their death. It has been very well received, and providers and survivors have attested to the relief and thanks that most would see as signs of success. The completion rate has been high in this group, once the formal request was made.

The anticipated situation for MAID with mental disorders being the sole underlying medical condition is very different. The Benelux experience reports a completion rate in the ranges of 0.5% to 4.5%, while our current overall Canadian completion rate in 2021 was reported to be 81%. This means an entirely different expectation is set for assessors, as well as providers, for those who request MAID for mental disorders.

I anticipate that this will be seen by some as being overly paternalistic. This may invite further court challenges unless the overlying administration is very carefully set and appropriate training is provided in concert across the country.

I appreciate the wording of the expert panel in describing shared decision-making. I believe we also need to build in the appropriate room for discussion between assessors after their first assessment in order to have the full opportunity to discuss these challenging cases. As noted above, while this is not explicitly banned in the legislation, the emphasis on independence of assessment leaves the impression that talking between assessors after their first meeting may not be acceptable.

I also appreciate the expert panel's recommendation for involvement of treatment teams as part of this expanded process.

I would recommend—

Protection of Freedom of Conscience Act

[Mark Gerretsen, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons (Senate)]

Madam Speaker, I am pleased to participate in the debate on Bill C-230, the protection of freedom of conscience act. I appreciate the contributions of the member for Carlton Trail-Eagle Creek to medical assistance in dying, or MAID, which is a complex and deeply personal issue to many Canadians.

First, I want to acknowledge that the aim of the bill, which is to support the conscience rights of health care professionals, is indeed laudable. The government has always supported conscience rights, which is why, since the very beginning of Canada's MAID framework in a former bill, Bill C-14, these rights have been specifically recognized and acknowledged. However, at the same time, the criminal law is a blunt instrument that should be reserved for the most serious situations.

In my remarks today, I want to raise some questions about whether new offences are an appropriate solution to the legitimate concerns raised by the bill's sponsor. In this regard, it bears recalling the primary reason the criminal law is concerned with MAID in the first place, which is to provide the necessary exemptions to ensure that persons who choose to provide or assist in providing MAID do not face criminal consequences for doing so. The MAID provisions found in the Criminal Code were carefully crafted to respect the autonomy of Canadians, respond to the evolving issues and protect vulnerable persons. In other words, the involvement of criminal law is necessary to permit MAID while ensuring it is carried out in a safe, responsible manner.

However, Bill C-230 seeks to involve the criminal law in two very different ways: first, to create a new MAID-specific intimidation offence, and second, to create an employment sanctions offence. With respect to the former, the intimidation offence, it is worth reiterating that the Criminal Code already provides provisions for several offences that would be available to respond to situations where a health care professional is a victim of coercive or threatening behaviour, including the intimidation offence in section 423 and the extortion offence in section 346.

To me, it is not evident that an additional specific offence is required to protect conscience rights. I should also say that I am not aware of any evidence of health care professionals facing threatening circumstances in the context of refusing to provide MAID or that there is a specific gap that needs to be filled in our law.

I have taken note of the fact that the proposed intimidation offence in Bill C-230 would be a summary conviction offence, which, if enacted, would stand out from other intimidation offences in the Criminal Code. The existing offences are either straight indictable or hybrid offences. In addition to being duplicative of existing offences, the fact that the proposed intimidation offence would only be prosecutable by summary conviction may suggest that intimidating conduct is less serious in a MAID context, which seems counterintuitive.

To further highlight why I have concerns about creating a specific intimidation offence as proposed by Bill C-230, I would like to draw members' attention to a recent example that offers a clear contrast. Last year, as members will recall, unfortunately in some parts of our country there was a threatening atmosphere of intimidation present for many health care professionals who were simply trying to go to work and care for members of their communities during the pandemic. That is why the government responded with Bill C-3, an act to amend the Criminal Code and the Canada Labour Code, which provided new criminal law tools to protect all health care workers and all Canadians who are seeking their care.

I believe Bill C-3 was an appropriate criminal law response to the credible threats to the safety and security of health care professionals and Canadians, but I am not convinced that a similar response is necessary when it comes to the situation of conscience rights and the provision of MAID. It seems to me that the charter and existing criminal law offences already provide the necessary protections for those rights, alongside the specific provision in the current MAID framework that expressly states that nothing in the federal law compels an individual to provide or assist in providing MAID. There is simply no obvious need to supplement what already exists.

Turning to the employment sanctions offence, I am struggling with Bill C-230's proposal to create a new offence that would exclusively target employers who dismiss or refuse to employ health care professionals who choose not to provide MAID. Moreover, in my view, Bill C-230's employment sanctions offence would not address the concerns described in the bill's preamble regarding conscience rights and certain requirements for professionals to make effective referrals for MAID.

As members are aware, in some jurisdictions, the professional orders that regulate health care professions have established requirements that their members provide effective referrals for MAID. While there have been cases where these requirements were challenged, the courts, including the Court of Appeal for Ontario, have upheld them, noting that this is a difficult issue that involves taking into consideration the conscience rights of professionals and the needs of their patients.

I do not believe it would be constructive for Parliament to intervene by creating a new criminal offence such as the one proposed by the bill. Rather, a more productive approach is for the government to continue its efforts to work closely with the provinces and territories on the implementation of MAID in a manner that supports persons who may be considering it and the health care professionals who provide exceptional care to their patients.

For the reasons I have mentioned, I have significant concerns with Bill C-230. While I agree wholeheartedly with protecting the conscience rights of all health care professionals, including those who choose to participate or refuse to participate in MAID, I am not persuaded that the two offences proposed in the bill are necessary or desirable.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Right. I was going to get to that in a moment, so I'll go there now.

If a patient has terminal cancer but also has a mental disorder, as the law currently stands and as it did under Bill C-14 and Bill C-7, that person could qualify for MAID solely on the basis of the cancer diagnosis, but if they are not excluded from having access because they also have a mental disorder. That's the state of the law, correct?

[Ellen Cohen]

First, I would like to see the government push the deadline back because it's unrealistic. I signed on in June and we didn't start our first meeting until the end of August, so it was rushed. I understand that your panel and this process is being rushed as well. I'm not sure what the hurry is.

I know that we made many recommendations. Dr. Wieman remarked on Dr. Goulet's experience in Manitoba as a MAID assessor. We talked about teams. She talked about having a great team. I think there needs to be some kind of thought into how people....

It's difficult for doctors, as I understand, as well. I clearly understood that as I was sitting at the panel. I understand the difficulties, but I think that if the government is going to move forward, they need to help support the medical community to develop the processes collectively. There needs to be a standard across the country so that things don't go off course.

Mental health legislation went off course. Every province does it differently. What I witnessed in Bill C-14 was that every province monitored differently and some of the provinces had “unknown” categories. Way too many people were dying from unknown—

[Trish Nichols]

Well, we have criteria for MAID. In Bill C-14, there are definite criteria for MAID, and Alan did not meet the criteria for MAID, medically or according to the laws that are set by legislation. He did not meet those. He didn't meet the criteria, because he didn't have a foreseeable death. He was admitted under the Mental Health Act as a danger to himself.

I don't know.... There needs to be a law put in place to protect people from being administered and put into a hospital against their will, don't you think, for that in itself? Then, to actually be offered MAID, and transferred and bounced around a hospital, and kept from his family....