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

[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.