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

[John Aldag, Liberal, Cloverdale—Langley City, BC]

Mr. Speaker, I rise in the House today in support of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, also known as medical assistance in dying. In January, I was appointed to the Special Joint Committee on Physician-Assisted Dying and I was honoured for the opportunity to be part of this important discussion in Canadian society.

Over the span of a couple of months, my fellow committee members and I spent a lot of time working to understand the complex issue of medical assistance in dying. We discussed, we debated, and we even disagreed on a few issues, but in the end we drafted a report that I thought was the best possible solution for this complex social and legal issue.

Drafting any legislation can be difficult, but it becomes especially difficult when its title includes death or dying. It is a topic that most of us are sensitive toward and many have difficulty confronting.

Within the special joint committee we dealt head-on with a number of difficult issues and were immersed in them for six weeks. We reviewed reports by the provincial and territorial expert advisory panel on physician-assisted dying. We heard from health care regulatory bodies throughout Canada and the federal external panel on options for a legislative response to Carter v. Canada, to name a few.

We had the challenging task of grappling with the major issues touched on by Bill C-14, which include the availability of medical assistance in dying for mature minors or for patients with mental illness, advance consent, conscientious objection, and inevitably ensuring that adequate safeguards were in place to protect the vulnerable.

On February 25, the special joint committee reported back to Parliament where the Minister of Justice and the Minister of Health took the report into consideration and began drafting Bill C-14, which is what I am here to discuss today.

Bill C-14 reflects a number of recommendations made by the special joint committee and these include six main points: allowing both euthanasia and assisted suicide; making it available to permanent residents of Canada, so as not to encourage what some have coined as “suicide or death tourism”; requiring a written request for medical assistance in dying; requiring two witnesses during the time of request; requiring confirmation from two doctors or nurse practitioners that the person making the request meets all of the criteria for medical assistance in dying; and requiring a mandatory statutory review.

The key message I have taken from this very difficult discussion that I was part of and that Canadians are now joining, is that this has to be a patient-centred discussion. I encourage all parliamentarians to set aside personal values and beliefs and focus on what is in the best interests of patients. Medical assistance in dying is, and should only be, about the patient.

Upon reflection on our committee work, I now realize that the committee managed to develop a higher level of comfort with this difficult topic than is held by most Canadians at this point in the public discourse on medical assistance in dying. I am glad to see that the government took the overarching perspective of Canadians into consideration and is willing to use this legislation as a stepping stone for further studies and future revisitation.

In the past few months I have hosted and co-hosted medical assistance in dying town halls. I have spoken directly to my constituents. I have listened to the concerns of my constituents and of many Canadians around the country, and just last week, there was a demonstration for Bill C-14 held at my constituency office. I have heard the positive, the negative, the concerns, and the support, and although I fully support this legislation, I believe there are a few voids that have yet to be filled.

First, during the demonstration last week, important criteria, or better yet lack of criteria, of the bill were brought into question. How does one maintain safeguards when dealing with non-medical personnel? Bill C-14 ensures protections are met for non-medical personnel who participate in medical assistance in dying, including those who aid a person at that person's explicit request to self-administer a substance prescribed as part of the provision of medical assistance in dying, by amending section 241 of the Criminal Code, and introducing proposed section 227 to allow medical assistance in dying if the appropriate conditions are met.

However, what is being done to ensure that non-medical personnel are in fact following the guidelines required by medical assistance in dying? For instance, right before the time of administering the lethal prescription, a patient must be asked whether they would like to continue with medical assistance in dying, but how do we know that these independent individuals are in fact asking this question, among others? How do we know that the individual will not take advantage of the situation or the vulnerable position that the patient is in? These are questions my constituents would like to see addressed.

Second, I recently spoke to someone who was heavily involved in the Carter v. Canada case, who was wondering whether Kay Carter herself would have qualified for medical assistance in dying given the legislation being discussed today. I have read articles stating that she would have been, because she met the criteria for eligibility. However, would health care practitioners consistently agree that Kay Carter would indeed have qualified under this legislation?

The part that I am finding difficult to grasp, for Kay Carter and many others, is the ambiguity of the criterion for imminent death. How do we know that individuals would not be turned away from the service of medical assistance in dying because of the vague nature of this criterion? Who would be responsible for deciding the criteria for imminent death? Will there be inconsistencies in the definition of imminent death? How will we, as a society, address these?

Last, the hard timeline between the date of request and the day on which medical assistance in dying would be provided was yet another point of concern. Many constituents have expressed concerns that this may lead to the hastening of death because the timeline is simply too short. The special joint committee had recommended a flexible waiting period, which would depend on the nature of the illness as opposed to just an imminent death. It was suggested that imminence and competence not be the only factors in determining the timeline, but much rather the rapidity of progression and nature of the patient's medical condition be used when determining the reflection period.

These are a few pieces of the proposed legislation that my constituents and I feel need to be clarified and tightened before the final legislation is created for June 6.

However, I also want to acknowledge that the legislation has done a great job in addressing a number of concerns that have been conveyed by my constituents and many others. For instance, the first misconception I would like to clear up is that Bill C-14 does not address the conscientious objections of medical personnel. It does. There is nothing in the proposed legislation that would compel a health care provider to provide medical assistance in dying or refer a patient to another medical practitioner. Balancing the rights of medical providers and those of patients is generally a matter of provincial and territorial responsibility, and we need to respect that. However, that being said, the federal government has committed to work with the provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

Bill C-14 also recognizes the autonomy of persons who have a grievous and irremediable medical condition that causes them enduring and intolerable suffering and who wish to seek medical assistance in dying, while recognizing the importance of protecting the vulnerable and ensuring adequate safeguards are in place.

Over the past four months, I have encountered a wide variety of perspectives about this complex and difficult issue. Some have been extremely restrictive, while others have been extremely permissive. Some believe the legislation would go too far, while others believe it would not go far enough.

I believe Bill C-14 is an important first step in Canada. It is cautious, even conservative legislation, but it will provide a necessary first response to the Carter decision along with a commitment to continue studying the effects and revisiting important issues of medical assistance in dying in the future.

Ultimately, when it comes to Bill C-14, I would like to see the voids found within the legislation addressed prior to June 6, and I intend to support Bill C-14. I encourage my colleagues on both sides of the House to support the rights of Canadians, and to put patients first by supporting this bill.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Mr. Speaker, this evening, I have the pleasure of being here with my colleagues to speak about the bill on medical assistance in dying.

This is a major issue and I must admit that it gave me a greater understanding of my new role here as the member representing the people of my riding, the new role that I am playing in the House of Commons for our country.

From the beginning, there has been a lot of talk about the budget, transportation, deficits, terrorism, and all sorts of other topics that are all equally important to our country. However, rarely does a bill generate as much uneasiness and discomfort among our constituents as the bill we have before us today.

Not a day has gone by since January that I have not spoken about medical assistance in dying with the people of my riding of Mégantic—L'Érable. Quite honestly, I expected people to give me strong, clear answers. However, it has been quite the opposite. After speaking with people even for just two or three minutes, I have seen that they know how important this issue is, but they hesitate to voice their opinions on it.

I think that, as a member of Parliament, my role is to take a position in accordance with my values and beliefs, all the while representing the will of those who did me the honour of electing me to Parliament.

I must say that I have not yet made up my mind about this issue. Every time I find myself leaning to one side, I hear arguments that make me once again question my views.

This is a complex issue that touches people's hearts and strikes at the very core of their values. A bill about medical assistance in dying is not like any other bill. This is a bill that makes us take a look at ourselves and our lives. We immediately think about our parents, our grandparents, our brothers, our sisters, our friends, and ourselves. Suddenly, a bill that is being discussed in Ottawa, far from my riding, becomes something very personal to the people I talk to.

Allow me to give an example. How would we react if one of our loved ones was suffering at the end of their life and their last moments were unbearable? Most of us have had experience with this. We have been in this type of situation, supporting a loved one at the end of their life. Most often, these people we care about are suffering from a cancer that can cause horrible suffering. No one, absolutely no one, wants to see a loved one suffer.

I want to share my own experience. My father died of throat cancer after a difficult eight-month battle against this terrible disease. He was not even 50 years old. Those were difficult months. I think that we all went through something similar in our own lives, when we had to support someone we loved dearly through a very difficult time.

When that stage begins, we do not realize that it is the final stage of that person's life. When doctors set out to treat that person, we do not expect it to be the beginning of the end, so we begin a healing process with our loved one, and we work hard with that person because we love them and we want to fight and win the war on cancer.

At the end of that war, when my father knew that medicine could do nothing more for him, how would I have reacted if someone had suggested ending his life? I do not know because I was one of the last people in my family to tell him he could let go and give up the fight. I did not want him to go even though I knew deep down that it was the only way out for him.

Fortunately, my father received palliative care that minimized his suffering in his final moments. My mother and my brother showed great courage. They were by his side in his final moments because they lived in the same city. I was farther away and saw him on weekends. All of those people and his family members were by his side until the end.

I am certain that he is looking down on me today and that he is very proud to see me here in the House of Commons. My story is that of thousands of Canadians. It is the story of our will to live, and it is the story of our relationship with death.

Soon, I will have to vote on Bill C-14. I will have to decide how our country will respond to the Supreme Court decision that gives some Canadians the right to choose medical assistance in dying. I will repeat that I have not yet made my decision.

I recognize that people who are dying must be able to die with dignity. Dying with dignity does not necessarily mean obtaining medical assistance in dying. Dying with dignity means being able to die surrounded by your loved ones whenever possible, receiving medical treatment that is respectful of one's last moments and, above all, not suffering too much.

I was shocked to learn in the course of the legislative process that not all Canadians have access to palliative care. More than 60% of Canadians who are dying will not have the support required to take this last step in dignity. Even before I take a stand on medical assistance in dying, I believe that we have a duty to change this.

I hope that the goal of members of the House is not to do everything they can so that as many Canadians as possible choose to make use of medical assistance in dying. In fact, I am convinced that it is not. The Supreme Court has ordered us to quickly regulate the use of medical assistance in dying and to set parameters for the entire process. Which Canadians will be given access to medical assistance in dying? How will the most vulnerable members of our society be protected? Who will help the sick people and authorize the use of medical assistance in dying? How will the people who are involved in the dying person's choice be protected?

Over the coming weeks, I am going to show Bill C-14 to my constituents. In a few days, I am going to set up a meeting with a community organization in my riding called Le Havre, which is an aid and support group for people with mental health problems. We are going to hold a round table to talk about medical assistance in dying, the end of life, and people's decision-making abilities. I hope that these discussions will give me a better idea of the choice that I should make in a few weeks.

Fortunately, although it was definitely short on time, the Special Joint Committee on Physician-Assisted Dying managed to ensure that we heard from many groups and citizens to gather their views. I did not attend all the meetings, in fact I attended only one, but it made an impression on me. I will come back to that later.

I want to thank all of my colleagues in the House and the Senate who contributed to the work of the committee. There is no single response to the Carter ruling, because no two situations are identical. The goodwill of everyone allowed parliamentarians to consider two reports, including a dissenting report tabled by our colleagues, the members for Louis-Saint-Laurent, Langley—Aldergrove, Kitchener—Conestoga, and St. Albert—Edmonton. I am pleased that Bill C-14 takes a lot of inspiration from my colleagues' report, because it more closely reflects my concerns at this stage in my own personal thinking.

As I already mentioned, this is not about a race to allow medical assistance in dying. We need to make sure we protect Canadians' charter rights, whether that involves seeking medical assistance in dying or protecting those who will have to face that difficult choice, whether they want to or not, in the coming years. In the current situation, I think Bill C-14 should have been based more on the dissenting report, because the bill does not go far enough to protect vulnerable individuals, their families, and health professionals. What are its main principles? As my colleague from Louis-Saint-Laurent mentioned earlier today, it is about the protection of minors, people with mental illness, and the conscience of doctors and other health professionals.

The bill should apply only to people who are at the end of their lives. The option to receive palliative care is also important to Canadians. Steven Fletcher mentioned something to the joint committee. He said, “The further you move away from the Carter decision, the more likely it is that you're going to step into provincial jurisdiction. When you make that step, I predict you'll go into constitutional darkness, never to be found again.” We have to make the right decision, an informed decision. I think that the dissenting report shows us the way. Soon I will have to take a stand, and I hope that my constituents will help me with that.

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

Mr. Speaker, given that the member is the Parliamentary Secretary to the Prime Minister, does she have any more information she can give us regarding the funding that will be allocated to palliative care?

As she knows, no funding was allocated for that purpose in the latest budget, nor are there any new commitments set out in Bill C-14. Can she give us a little more information in that regard?

[Celina Caesar-Chavannes, Liberal, Parliamentary Secretary to the Prime Minister]

Mr. Speaker, before I begin, I would like to acknowledge the Minister of Justice, the Minister of Health, and the parliamentary secretaries and their teams for their work on this important legislation, and to thank them for their efforts. I would also like to thank the chair and members of the Special Joint Committee on Physician-Assisted Dying, the witnesses they heard from, and the countless Canadians who took part in consultations right across the country. This is not an easy topic for discussion, and I commend all involved for their thoughtful, compassionate, and thorough work.

The Carter decision set out a clear objective for parliamentarians to come up with a legislative framework that allows Canadians who are suffering intolerably the right to request assistance to end their suffering. Bill C-14 is the government's answer to this critical objective, and I stand here today, proud to support this important legislation.

I have heard from constituents on both sides of the issue, some who flatly oppose allowing any access to medical assistance in death, and others who believe the legislation does not go far enough. I have also heard from people who applaud the thoughtful work on this bill and have reached out to me to express their gratitude.

In this regard, it is important to note and to reiterate what has been mentioned many times in this chamber. With this legislation, our task was not to determine if physician-assisted dying was necessary, but to determine how best to move it forward. This is an important consideration and one that is worth repeating.

Of paramount importance to me in reviewing this bill was to determine if it properly considers different interests, including balancing the right to personal autonomy at the end of life with the need to ensure robust protection for the most vulnerable in our society. I believe that this legislation achieves this balance and that it rightly takes the necessary steps to ensure that the rights of all are respected.

With respect to personal autonomy, this legislation responds to the objective mentioned earlier that was provided to us by the Supreme Court of Canada, that Canadians who are suffering intolerably have the right to request assistance to end their suffering.

I am not a lawyer, and as such will not speak to the legal ramifications of this bill. As well, I cannot speak with authority on the constitutional nuances of this bill. However, as a person of faith, it was critically important to me that subsection 2(a) of the Charter of Rights and Freedoms, which grants Canadians the freedom of conscience and religion, was considered and protected.

A couple of weeks ago, I had a meeting in my office with members from the St. John the Evangelist Catholic Church in Whitby. While they understood that the objective for us in this chamber was to come up with a legislative framework for medical assistance in dying, they were gravely concerned about protecting the conscience of medical professionals. They wanted some assurance that the conscience of the health care provider was protected.

Balancing the rights of medical providers and those of the patient is generally a matter of provincial and territorial concern. However, our government is committed to working with the provinces and territories to explore options to facilitate access and care coordination while recognizing the personal convictions of health care providers.

Having worked in health care based research for the bulk of my professional life, I have had the opportunity to work closely with health care professionals in a variety of capacities. It is very important to me that any legislation put forward respected the rights and personal convictions of care providers. I am very pleased to see that this legislation makes mention of this while acknowledging that safeguarding those convictions requires an ongoing conversation with the provinces and territories.

The robust considerations and protections for the most vulnerable in our society inherent in this legislation are also of particular importance. This legislation sets out the criteria for the determination by medical professionals as to whether or not a patient suffers from a grievous or irremediable medical condition. These criteria include that they have a serious and incurable illness, disease or disability; are in an advanced state of irreversible decline in capability; the state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and that their natural death has become reasonably foreseeable.

As a mother of three children and MP for the bedroom communities in my riding of Whitby, I was pleased that the legislation also includes strict eligibility requirements that protect minors. Careful thought and consideration are required to understand and assess a minor's ability to make a decision involving the termination of his or her life. I applaud the decision to further study this aspect of the legislation and look forward to being actively involved at that time.

Additionally, this legislation would ensure that those who make a request for assisted dying do so without coercion, having provided informed consent, and given the opportunity to, at any time and in any manner, withdraw their consent. These safeguards are fundamental to Bill C-14. The bill provides safeguards to ensure that individuals can remove consent. The requirements that the request be voluntary and that the person must decide for himself or herself that he or she wants medical assistance in dying is as equally important as the requirement to have the ability to remove consent.

I am proud that this government has listened to stakeholders from across the country and has committed to ensuring that all Canadians have access to quality end-of-life care, including palliative care. Our $3-billion commitment to improving and expanding access to home care is another critically important step and I look forward to seeing continued progress on this vital portfolio in the months ahead.

Finally, I would like to thank and acknowledge my colleagues in the chamber for the thoughtful, measured, and respectful tone struck during this debate. This is not an easy topic of discussion. It is one that challenges us to examine our fundamental beliefs about life and death. I commend all for their work on this file.

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

Mr. Speaker, I appreciate the respectful tone and the way in which all members in this place are approaching an issue which I know could divide us. It touches on the sanctity of life, on issues of great importance to all of us, and on the question of human suffering that so distresses all of us. It interprets a Supreme Court decision. Bill C-14 is a bill that requires a sobriety, a sensitivity and a respectful dialogue as we approach it.

Other members have reflected on what they have learned from their constituents. I need to share the story of what happened to me when I became the member of Parliament for Saanich—Gulf Islands. I was someone who would not have been comfortable with this bill. My constituents may be the most active group of people working for Dying With Dignity.

There are two Dying With Dignity chapters in Saanich—Gulf Islands. I was visited by members from the Salt Spring Island chapter. I was visited by members from the Victoria chapter. Over time, I realized that perhaps my riding had been sensitized to this issue, because Sue Rodriguez lived in my riding.

Her death in 1994 touched all Canadians, as we realized that she tried so hard to get relief from the courts, permission to have a medically assisted death. In the end, it was not possible through the legal system. We all remember her quite courageous and tragic death.

At the time of the court telling Sue Rodriguez that she could not find access to legal medically assisted death, she said, “If I cannot give consent to my own death, whose body is this? Who owns my life?”

These are profound questions that hang in the air still. Some of us might answer that none of us own our own life, that our lives belong to the creator. Some of us may say whatever one believes, each of us has the right to make our own decisions. Those people who might believe one aspect through faith have no right to deny someone else the decision that he or she wants to take, to plan for a death with dignity.

In the course of listening to my constituents, particularly through a series of town hall meetings over the last five years, and through questions and comments that have come to me through the mail, I became persuaded that my job as their member of Parliament was to support access to medically assisted death.

Then my life experience as a lawyer kicked in, and I was very relieved when the Carter decision came down. I thought that at long last we now had legal clarity on this matter, and that Parliament could begin to resolve the issue through the work in Parliament. The issue has been through the courts so often that I felt that we were now in a position as lawmakers and legislators to deal with the decision in Carter.

Just to remind members, the Supreme Court said that the Criminal Code sections that prohibited physician-assisted death violated section 7 of the Charter, and therefore:

....are void insofar as they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life; and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

The court was clear in this decision that we were not speaking of any possibility that one person could make a decision for medical assistance in dying for anyone else. This is a personal decision. The Supreme Court has said that a competent adult person can make this determination. What the court set out as the conditions that would justify medically assisted death was a grievous and irremediable medical condition.

I was disappointed in Bill C-14. I felt, after looking at the report of the special committee, that the legislation would likely anticipate where the court would go in future rulings, and avoid protracted court cases as Canada figured out how we would accommodate medical assistance in dying.

The bill, in not fulfilling even the conditions set out in the decision of the Supreme Court in Carter, would lead to more litigation and more suffering for people who now see that the Supreme Court of Canada has said that to suffer in situations like this violates their charter rights. If we pass Bill C-14 as it is currently drafted, Parliament would be denying them their charter rights going forward.

Other members of Parliament have mentioned this. We know that the legislation is attempting to balance very difficult issues to ensure that there are robust safeguards—and we have had conversations about whether they are sufficiently robust—the sanctity of life, and the protection of vulnerable persons.

This bill is close to getting it right, but where I am really baffled is in the decision not just to say “irremediable” but to insist, as others have noted, that one of the conditions in section 241.2(2)(d), is that their natural death has become “reasonably foreseeable”. I am afraid that is quite baffling, given what the Supreme Court told us we must do. The “irremediable” situation was not described as incurable or terminal. That is a deficiency in the legislation and one that will not just disappoint people who are suffering, but also calls into question the wisdom of this place in interpreting the Supreme Court of Canada's decision to protect charter rights.

Many have spoken about this second area as well. As I read it I thought that this cannot be right, that this must just to be bad drafting, that they cannot mean this. In going through all the conditions, yes, there are safeguards there. There are independent medical practitioners, more than one, and there is not undue influence of any kind. Not to go through every element of it, but as we have to go through quite a protracted process to make a legal declaration, and it would be fulfilled by independent witnesses, one has to go through all of this and then, after all that, at 241.2(3)(h) we find that immediately before providing the medical assistance in dying, the person would be given the opportunity to withdraw the request, ensuring that the person gives express consent to receive medical assistance in dying.

This is gravely disappointing. Those who take the decision that they want medical assistance in dying are now denied that, if their situation is one where we cannot reasonably foresee their natural death and where at the moment they have planned for and gone through this protracted process to ensure that they would have medical assistance in their death, now must be of sound mind to reassert and have the capacity to reassert that they have confirmed this is what they wish. This would surely deny many groups of people who would look to the court decision in Carter as their way of knowing that they would have the right to choose to die with dignity with the assistance of a medical professional.

Many have mentioned these deficiencies in Bill C-14. There are others that have been raised by the British Columbia Civil Liberties Association, as a co-litigant in the Carter case. I am not out of sympathy with those, but perhaps those could wait for another time.

I do not see how Parliament could decide to wait for another time in ensuring that the legislation we pass now is in conformity with the instructions we received from the Supreme Court of Canada.

Calling on my background as a lawyer, as well as my commitment to my constituents, I look at Bill C-14 and ask how we could pass something that would once again be found by a court to violate section 7 charter rights for those Canadians who have met the test in Carter, but would fail the test in Bill C-14. It is an enormously difficult question.

I have enormous respect for all the voices I have heard in the House in this debate at second reading. I will vote for the bill at second reading, but I hope we are prepared to fix its deficiencies in committee.

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

Mr. Speaker, I rise tonight to comment on Bill C-14. Before beginning, I want to commend all members of the House for so far treating this debate with the sensitivity it warrants. This is without doubt an issue that evokes much passion on both sides of the issue. This debate at its essence pits the sanctity of life against the inherent autonomy of the individual. I think it may be a worthwhile exercise to go back in time, not just a little but back a few decades so we can attempt to put the current debate into some legal context.

The common law crimes of attempting suicide and assisting suicide were codified in Canada when Parliament enacted the Criminal Code in 1892. Eighty years later, in 1972, the House repealed the offence of attempting suicide from the Criminal Code based in part on the argument that a legal deterrent was unnecessary in those circumstances. However, the prohibition on assisting suicide remained. This prohibition is found currently in section 241 of the Criminal Code. This in my opinion is the fundamental shortcoming of our current law.

Currently, able-bodied Canadians can take their own lives without any legal consequences. Those who physically cannot are currently discriminated against from doing so. This brings us to Carter, a unanimous decision of the Supreme Court of Canada that overturned the 1993 case of Rodriguez. Carter holds that, among other things, the Criminal Code prohibition against assistance in dying found in section 241 is unconstitutional on the grounds that denying disabled people the right to assisted suicide is contrary to the Charter of Rights and Freedoms.

The current legislative prohibition found in the Criminal Code was held to be over broad in that it prohibited physician-assisted death for a competent adult person who, first, clearly consents to the termination of life, and second, has a grievous and irremediable medical condition including an illness, disease, or disability that causes enduring suffering that is intolerable to the individual and the circumstances of his or her condition.

This leads us to where we are today. The court decision requires strict limits that are scrupulously monitored. This government is proposing a framework that considers different interests, including personal autonomy toward the end of one's life, the protection of vulnerable persons, and conscience rights, all values that are deeply important to Canadians across this country.

The debate regarding medical assistance in dying is important to each and every one of us for different and for deeply personal reasons in many cases. For all Canadians this is a difficult and profoundly sensitive issue tied to their life experiences and personal beliefs.

I have heard many of my constituents share with me their opinions on the bill, some of whom face difficult and sometimes unimaginable health challenges. Just today, I received an email from a woman in my riding suffering from a slow-moving form of ALS. Gradually this horrible disease has taken her voluntary muscle control, making it difficult for her to sign her own name, to speak, and to even form the most basic sentences.

In her own words to me she describes the situation as thus, “Our hearts continue to pump. We are aware of everything happening to us and around us, but become unable to do the simplest things for ourselves. We cannot predict our lifespan”. She urged the House, through me, to reconsider the issue of advance directives. This is one Canadian who will be directly impacted by Bill C-14, one Canadian of many.

Members may ask why I relay this story. It is because Bill C-14 clearly states that a requirement for assisted dying must be that natural death is within the reasonably foreseeable future. For many Canadians, suffering and looking toward the future of only further pain and suffering, there is no clear, distinguishable path to death, but this should not diminish their choices. For some, without this choice in the future, it can feel like a loss of comfort, a loss of safety and a loss of autonomy.

Additionally, this past weekend I had the opportunity to sit with a few of my fellow members of Parliament from York region to listen to important concerns and questions relating to Bill C-14. With an open mic, this event not only provided the opportunity for the participants to express their views and opinions on medically assisted dying, but also allowed me a great opportunity to meet and discuss on a more personal level with the people in my community who would be directly affected by the results of this debate.

While these discussions are important, it is equally important that a person does not come to end-of-life decisions lightly. Oftentimes the decision follows years of personal deliberation and what I can only imagine would be the most difficult conversations of a family member and those closest to them.

For these reasons and many others, Bill C-14 cannot and should not be taken lightly. While there will always be those who believe the bill does not go far enough, others believe it goes too far.

The Supreme Court of Canada unanimously decided that Canadians suffering intolerably had the right to request assistance to end their suffering. The bill respects that decision. However, I would encourage all members to engage with their constituents on this important matter and bring that informed advice to committee.

Medical assistance in dying represents a significant change in the Canadian medical landscape, and this government has conducted consultations with many experts. Physicians have indicated that they would be most comfortable providing this option to patients approaching death as another option alongside palliative care, withdrawal of treatment or palliative sedation. These options are all individually important and are woven into the bill to ensure that patients are served and equally protected, as well to limit any risks to the physician.

As this government engages with the provinces and territories to support the development of a pan-Canadian monitoring system to collect and analyze data, monitor trends and publicly report on medical assistance in dying, I ask that we all take time to consult with our constituents.

While I am open to the government's Bill C-14 and will support it to move it to committee, I do feel some amendments may be necessary. We, as legislators, are not doing our jobs if we are not open to continually hearing from Canadians and engaging in meaningful consultations and dialogue, especially on an issue as important and fundamental as this one.

I urge all members to also support the bill. I thank the Speaker for allowing me to rise to speak on such an important topic and share my perspective.

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

Mr. Speaker, it is an honour to rise in the House today to continue the debate on Bill C-14.

I truly believe that this debate we are having, and the quality of the debate I have heard throughout the day, is going to be a watershed moment for our country. It is certainly going to be one for the history books, because through a charter challenge, the Supreme Court is forcing us as a legislative body, as a country, to fundamentally examine the meaning of life, the meaning of death, and how we as a society treat those two very difficult concepts.

Death is a hard subject to talk about. Humans have, for thousands of years, struggled with the concept and how we deal with it. Many of us turn to spirituality to find answers, and others are more matter of fact. In any case, the debate concerning life and end of life has reached Parliament's doorstep, and it is up to us as parliamentarians to carry the torch and do that subject the honour and justice it deserves.

As a rookie member of Parliament for the great riding of Cowichan—Malahat—Langford, I have been receiving correspondence from my constituents. I must say to the constituents who are watching the debate today that I have never been prouder to be an MP for their area. The tone in which they have written me, whether they disagreed with the legislation or supported it, has been incredibly respectful.

Of the concerns that I have seen from constituents, some want to see more protection for health care workers. They are concerned that freedom of conscience and freedom of religion are not respected enough in the legislation. However, others do not think that the bill goes far enough. They have looked at the ruling from the Carter decision and compared the provisions of Bill C-14 with it and have found it lacking.

I have heard other hon. members in the House say that, no matter what bill comes out at royal assent, they do see challenges in the future, but it is up to us as parliamentarians to do the best we can with the time we have.

Speaking of the bill, I am going to support this legislation at second reading, because I think we have something to work with. To do honour and justice to it, we must send it to committee so that we can have a more fulsome look at its provisions, and we can hear from witnesses. Furthermore, we must take the recommendations from the special joint committee and see if some of those recommendations can be adequately applied.

I support this legislation, because I believe in a patient-centred approach. I realize that my support of this legislation will cause some of my constituents distress. It is one of the challenges of being an MP. It is balancing the views of one's constituents with one's own personal values. This is the eternal struggle that each and every one of us finds in the House every single day.

However, I believe that, if we are talking about values, one important concept to look at is to not impose one's values on someone else, but to respect a person's values. If a person's values means that he or she is choosing a way out to end suffering that we as healthy people can only imagine, well then we must respect that choice. I fundamentally believe in that.

Looking at the Carter decision, the Supreme Court ruled that it had to be a competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition, including illness, disease, or disability, which causes enduring suffering and is intolerable to the individual in the circumstances of his or her condition.

Section 7 of the charter says:

Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

The court found that the prohibition on physician-assisted dying infringed on the right to life, liberty, and security of the person in a manner that is not in accordance with the principles of fundamental justice, and that is why we are here today.

Of the recommendations of the special joint committee, there are three in particular that I want to look at. In a 10-minute speech, to look at all 21 is rather impossible, so I will start with recommendation 7, which dealt with advance directives.

There was a recommendation that advance directives be allowed, but unfortunately, Bill C-14 only makes mention of advance directives in the preamble. The preamble committed to exploring it, but there was no firm commitment in the legislation.

The other recommendation I want to look at is number 10 regarding freedom of conscience. The preamble, again, committed to non-legislative measures in this particular area. There is a template that the government could have followed. There is precedent in protecting freedom of conscience and freedom of religion. It goes all the way back to 2005 when Parliament passed the Civil Marriage Act.

For the reference of all MPs in the House, I will note that section 3 of the Civil Marriage Act states, “It is recognized that officials of religious groups are free to refuse to perform marriages that are not in accordance with their religious beliefs.” Section 3.1 says, “For greater certainty, no person or organization shall be deprived of any benefit, or be subject to any obligation or sanction, under any law of the Parliament of Canada solely by reason of their exercise”. There was a template and hopefully this is one area that the committee can examine further.

The other recommendation I want to look at is number 2. That was basically following the Carter decision. It states, “That medical assistance in dying be available to individuals with terminal and non-terminal grievous and irremediable medical conditions”. Unfortunately, the text of the bill, referring specifically to proposed paragraph 241.2(2)(d), reads, “their natural death has become reasonably foreseeable”.

This is one section where I do not know why the government wrote it in, because it goes against what the Carter decision specified and it goes against what the special joint committee recommended, yet it is here. I see nothing but problems with this. I see future charter challenges.

We owe it to Canadians to get this bill right the first time and not force people to go through the courts for several more years, only to have this legislation dumped back in our laps again. It is the same with advance directives. There will be people who get a diagnosis of dementia. We all know the end result of having Alzheimer's and they will ask why they are being excluded and why their advance directives are not being respected.

I would like to talk a bit about palliative care. I know it is a subject that has been talked about a lot in the House. The reason is that when this bill receives royal assent in June, it is going to be the law of the land. Palliative care is in such a sorry state in so many jurisdictions in Canada right now that I do not want Canadians to be living in a hospital bed somewhere with substandard care and thinking their only way out is to end their lives. That is why we talk about palliative care with such urgency, because once this bill becomes the law of the land, that is what some Canadians may think is their only option. We have to treat it with the urgency that it deserves.

I would now like to talk a bit about the great work that the member for Timmins—James Bay has done. It is very important to recognize that a previous motion in the House of Commons was passed with all-party support in 2014, yet here we are in 2016 still talking about it. I would love to have seen some firm dollar commitments in the budget. Until we see that, all we have is talk. We need an absolute pan-Canadian palliative care strategy. I was honoured to walk in the Hike for Hospice on the weekend in my riding. A great bunch of people in the community came out for it.

I would like to end on the concept of empathy versus sympathy. Up until this point, our country has had a sympathetic viewpoint on this whole issue and true empathy means that people step outside of just feeling sorry for people and actually perceive the world through their eyes. That is what this legislation aims to do, to see the world through the eyes of someone who is suffering from a condition. We have no idea what it is like and that is what everyone needs to be doing in this country, being more empathetic and trying to provide true support.

I will end there. I am thankful for this opportunity.

[Sylvie Boucher, Conservative, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, every one of us has their own story, experiences, destiny, and perspective on life and death.

However, no one, and I mean no one, can be indifferent to the bill we will soon be voting on. It is important to respect the personal and private opinions of all our colleagues on both sides of the House.

Just 15 years ago, we might never have had this discussion or this debate. Quebec paved the way with its end-of-life legislation. After more than six years of countless meetings and many discussions, and not without much debate involving all of society, members of Quebec's National Assembly passed the bill, which became a reality for Quebec.

One of my former colleagues in the House, the Hon. Steven Fletcher, introduced two bills on this issue in 2014, thus laying the groundwork for national reflection. In 2015, the Supreme Court also struck down the Criminal Code section that prohibits a doctor from assisting someone to end their life in very specific circumstances.

There is little time left before the Government of Canada puts in place a Canadian law to provide a framework for medical assistance in dying.

A special joint committee was struck, and six weeks of meetings, discussions, and testimony followed. The committee then tabled a report in the House of Commons. In response, a bill was drafted. Now we need to work together to make the bill law.

We must take Canadians' opinions into account. This is not a partisan issue. This is a social issue that should bring people together. First and foremost, we must protect the most vulnerable members of society. It is the Government of Canada's duty to legislate on this very difficult matter. This bill touches our core values. We will never achieve unanimity.

Even so, we have to address concerns that have been raised about a subject that is still sensitive and emotional for all of us. It is our duty to have a frank and open discussion to move the debate forward in response to the Supreme Court of Canada's request.

I think we need to set aside any emotions we might be feeling in connection with such a personal and sensitive subject. We must ensure that the legislation includes guarantees to protect the most vulnerable members of our society as well as the conscience rights of doctors and other health professionals.

As legislators, we must have an open discussion that respects who we are, and we must be free to vote in accordance with what we believe deep down.

We must also make some amendments to ensure that there is an excellent framework for this legislation.

We must respect the rights of the ill, but we must also respect the right of doctors to say no. There is currently a grey area that leaves room for interpretation by the provinces. We must be united as a country on protecting doctors, pharmacists, and institutions. I am talking about all health care personnel.

The Government of Canada must ensure that the people who make use of this legislation are making a clear and informed choice and have all of the information they need to make an informed decision.

There are some concerns, especially in the details of the bill, with respect to the fact that nurses have the same decision-making power as doctors in providing medical assistance in dying.

I remind members that Bill C-14 on medical assistance in dying is the government's response to the Carter decision. In this decision, the court ruled that people have a right to medical assistance in dying if they are adults, if they are suffering from a grievous and irremediable medical condition, and if they have given informed consent.

It is important to consider what “informed consent” means. It must be clearly defined, to ensure that the Canadian public is fully aware of what is involved.

We must also consider and propose solutions for people who want to live, in spite of their illness, and for those who want to be with their loved ones even though they realize they are at the end of their life. I think it is very important that we invest much more in palliative care.

We are talking a lot about medical assistance in dying, but I get the impression that in this debate members are forgetting about the most important thing, and that is the ill person. There is little or no reference to those who will never make use of this legislation.

On a more personal note, I too have had to think carefully about this issue. I carefully weighed the pros and cons. I looked to my own experiences for answers to my questions. I searched my past. I looked at myself in the mirror and thought about my views on life and death. I saw the face of my father, who was stuck in a wheelchair for over six years. Not a day went by when he did not shed some tears. How many times did he tell me that he would rather die than be there, paralyzed, unable to walk or be completely autonomous?

However, I also thought about the time when, of necessity, I ended up supporting my friend Rachel through the terminal stage of her illness. She had AIDS, but she wanted to live at all costs, despite the illness that was consuming her.

Then there is me, both a legislator and a human being, who must, in all honesty, reflect logically on what I myself would do if I were at the end of my life and had to make a choice. There is no obvious answer. However, I dislike aggressive therapy, and everything is already there in black and white.

This debate has forced me to think beyond death itself to accepting it and to the grieving process that is necessary either for the person involved or the loved ones.

The medical assistance in dying legislation is not perfect. There are some things that need to be redefined and a few amendments to incorporate, but we have to keep in mind that the Supreme Court is pressing us to pass legislation by June 6. That is why I am voting in favour of this motion, in order for the bill to go back to committee and for the committee, which is duly appointed, to study the provisions and ensure that all Canadians are protected. They are what matter most here.

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

Mr. Speaker, the member for St. Catharines is right, that the process is not over. There are more people to hear from, more studies to be done, more details to be hashed out.

Would the member like to remind our colleagues what the results of not passing Bill C-14 would be? The Carter decision does not provide us a deadline after which the status quo remains. There are real world results for this being defeated. Would the member like to address the real world effects of this bill not passing?

[Chris Bittle, Liberal, St. Catharines, ON]

Mr. Speaker, I am pleased to have an opportunity to participate in the second reading debate on Bill C-14, the proposed legislative approach to medical assistance in dying in our country.

This is a historic bill, and it tackles an issue that is of great interest and importance to many Canadians. It is also one that raises divergent and deeply held personal views, which is why broad consultations with a variety of groups and organizations were essential before reforms could be developed and considered by Parliament.

Members are aware that a special joint committee of the House of Commons and the Senate recently studied this issue, in January and February of this year, and in the context of that study, had the opportunity to hear from 61 witnesses and consider over 100 written briefs.

Other recent consultation initiatives were undertaken by the federal external panel on options for a legislative response to Carter in Canada, from July to December 2015, and the provincial and territorial experts advisory group on physician-assisted dying, from August to December 2015. Each panel met with representatives of dozens of stakeholder groups and received numerous written submissions from key organizations, including the medical sector, disability rights groups, legal and civil liberty organizations, and faith groups. Furthermore, many of the organizations that were consulted held extensive consultations with their own membership, some over the span of years, and shared the benefit of those with these panels.

Of course, we are also indebted to the years of consultations undertaken by the provincial government in Quebec leading up to its own legislation in this area. The extensive work that those in Quebec undertook was carefully considered, and I thank them for their leadership on this issue. It informs this proposed legislation as well.

The broad and in-depth consultations that have occurred over the past year across this country have undoubtedly enriched the policy development process that has led to the introduction of Bill C-14. I am pleased to see in the document entitled “Legislative Background: Medical Assistance in Dying (Bill C-14)” which accompanied the bill and was tabled in this place by the Minister of Justice, that the development of the proposed legislation was informed by the evidence before all levels of court in the Carter case by available Canadian and international research, social science evidence, governmental reports, and parliamentary studies.

That document also tells us that it was informed by the experience of existing international medical assistance in dying regimes around the world, as well as by numerous recent consultation activities on medical assistance in dying, including the work of the special joint committee, the federal external panel, the provincial-territorial expert advisory group, the work of the Canadian Medical Association and the College of Family Physicians of Canada, as well as the work of the provincial colleges of physicians and surgeons.

The consultation process has been robust and comprehensive. This has provided an opportunity for a variety of stakeholders from diverse perspectives to share their views and to reflect the views of other stakeholders who may not necessarily share their point of view.

I would like to briefly outline the considerations that some of the key stakeholders have raised with respect to this issue. One of the key stakeholder groups on this issue, given the active role they will be playing in response to requests for medical assistance in dying, is the medical profession, and by that I mean the various types of health care providers, such as doctors, nurses, pharmacists, nurse practitioners as well as their regulatory bodies.

The importance of this issue for the medical profession was underscored by a representative of the Canadian Medical Association who appeared before the special joint committee and testified that medical assistance in dying is a difficult and controversial issue for the medical profession, that it represents a sea change for physicians in Canada.

Many of the people who spoke from the perspective of the medical profession emphasized the need for clarity in the law so that health care providers are crystal clear about what is permissible and what is not permissible in providing medical assistance in dying, and that federal legislation is needed to ensure national consistency.

I am pleased that the proposed legislation responds to that request for clarity and consistency. Bill C-14 comprehensively sets out who can do what and to whom, and which safeguards are to be complied with. Moreover, as it is a proposed amendment to the Criminal Code, it would apply equally across Canada.

The unanimous decision of the Supreme Court of Canada in Carter focused on the role physicians could play in medical assistance in dying. I am pleased to see that in Bill C-14 explicit exemptions are also included for other types of health care providers, such as nurse practitioners, pharmacists, or other persons who would assist a medical practitioner or nurse practitioner with a request for medical assistance in dying.

This is responsive to the wealth of information received from representatives of nursing to pharmacist organizations in the course of various consultations.

Another important request that was raised by the medical profession was the need to respect the conscience rights of health care professionals who may object to providing medical assistance in dying. I would highlight that the bill makes explicit reference in the preamble to respecting the personal convictions of health care providers.

I will also note that the government has committed to working with the provinces and territories to support access to medical assistance in dying by connecting willing health care providers with patients. To me, this strikes an appropriate balance between supporting patient access or respecting the conscience rights of health care providers, as well as the jurisdiction of the provinces and territories.

Lastly, the medical profession, among other stakeholders, expressed a strong desire for a national monitoring system for medical assistance in dying. I am very pleased to see that Bill C-14 would empower the Minister of Health to make regulations to establish a federal monitoring system, with the associated requirements for health care providers who would be responsible for handling requests for medical assistance in dying to provide information for the purpose of that monitoring.

Several key stakeholders, and in particular disability rights groups, raised the necessity of robust safeguards to protect the right to life of every person in our country. This of course includes people who are ill, elderly, or disabled. Some national disability rights groups also indicated that stringent safeguards were needed to ensure the voluntary nature of a request for medical assistance in dying, free from any pressure or coercion, and based on informed consent, the heart of which was ensuring the patient had the capacity to make the decision in question.

The consultations that have occurred thus far, and the ones that will continue over the coming week, are crucial to ensuring we get this bill right. I am very much looking forward to the testimony that will be presented before the Standing Committee on Justice and Human Rights this coming week, a committee of which I am a member. I am eager to gauge the opinions of all sides of the debate on medical assistance in dying. I look forward to working with my committee colleagues to bring this bill back to Parliament and have a sound framework in place by the June 6 Supreme Court of Canada deadline.

Parliament has debated the issue of medical assistance in dying on several occasions over the past two decades. Each time, it was not able to support amendments to the Criminal Code to make this a reality for Canadians. The time has come to make this change. I believe this proposed legislation should be passed. I agree with the legislative background paper the Minister of Justice has tabled, and its statements that this proposed legislation strikes an appropriate balance between the autonomy of those seeking access to medical assistance and the interests of vulnerable persons in our society. I would urge all members of the House to support the second reading of Bill C-14.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, today this House stands to discuss Bill C-14. As we do so, we must seriously consider this important responsibility. The Supreme Court decision has been made. The job in this House is to create legislation that would provide clear boundaries moving forward.

In February 2015, the Supreme Court of Canada concluded that the absolute prohibition on assisted suicide violated the charter rights of Canadians suffering intolerably with grievous and irremediable medical conditions who, being adults and assessed as competent decision-makers, would otherwise seek medical assistance in dying on their own terms.

In response, the joint special committee of Parliament was tasked to consult with experts and Canadians who reflect the diverse perspectives on this issue. It reviewed the Supreme Court's decision in the Carter case and the 400-page judgment of the B.C. Supreme Court that preceded it. It studied Quebec's new assisted dying law, as well as the reports of two major panels on medical aid in dying, which together heard from 13,000 Canadians and more than 100 organizations. The committee then held 11 hearings, called 61 expert witnesses, and received more than 100 written briefs from groups across Canada.

I have read the report and want to thank the committee for the great work it has done, resulting in 21 recommendations on a legislative response. These recommendations demonstrate balance and sensitivity, respecting the autonomy of patients, the rights of health care practitioners and vulnerable individuals, and the fundamentally personal nature of this issue to every Canadian.

I have also been listening to the constituents in my riding of North Island—Powell River, where people are very concerned. Many from my riding are worried that there is not enough support for palliative and end-of-life care. They want to know that the vulnerable will be protected and they want to know that those who suffer greatly can decide to die with dignity. I have had many letters from my constituents, and I know there will be many more. This is a subject that deserves much discussion in each riding across Canada.

Bill C-14 is also a very personal one for me. Years ago, I was a volunteer for a hospice and watched many people die. I remember being present for people who were in so much pain and who wanted the release of death so badly that starving themselves became their only solution. I remember the agony of the people and their families who just wanted a safe release from this pain.

I also sat with people who fought every day for one more. Their desire to continue in the face of such pain was tremendous.

After volunteering there for years, I left knowing that death is an intensely personal process and that honouring people and their families through it is so important.

Today, I want to talk to Bill C-14, the Liberal government's legislative response to the Carter case.

The Liberal bill has raised new concerns and leaves many questions, for me, unanswered.

There is consensus among academics, health professionals, faith communities, and the public that Canadians deserve better end-of-life and palliative care treatment.

The federal government has a role to play in working with the provinces and the territories, as well as first nations, Inuit, and Métis communities, on finding strategies that work.

We have a critically important opportunity to enhance the services across the country, yet the government was missing in action in the budget on palliative care—even after promising $3 million for home care during the campaign. Holding the government to account on the promise of that motion remains one of our top priorities as we assist in the legislative response to the Carter decision.

This bill refers to palliative care in its preamble; yet while introducing this bill, the government made no new commitments to palliative care. The people of my riding want to see this investment happen.

The NDP took a significant step forward in the last Parliament when a motion brought by the member for Timmins—James Bay to establish a pan-Canadian palliative and end-of-life care strategy earned nearly unanimous support of the House of Commons.

Palliative care is about patient- and family-centred physical, psychological, and spiritual care.

Everyone dies, every family has to deal with the loss of a loved one, and these traumatic moments are made more difficult and more expensive when there is no access to quality palliative care. With an aging population, it is crucial that the federal government provide leadership now.

The government backgrounder refers to the following system to ensure equal access:

The government is proposing to work with provinces and territories on the development of mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying. This system would help connect patients with a physician or nurse practitioner willing to provide medical assistance in dying, and support the personal convictions of health care providers who choose not to participate. It would also respect the privacy of those who are willing to provide this assistance. This system could also offer other end-of-life care options to both patients and providers.

However, this is not mentioned at all in the bill. This leaves a lack of clarity and room for poor decisions. It is important to respect the health care practitioners' freedom of conscience while at the same time respecting the needs of the patient.

Having seen the previous government's agenda being held up in the courts time and time again, Canadians expect a government to be thorough. Now is the time to strengthen the bill against charter challenges by resolving contradictions with the Supreme Court ruling in Carter. Canadians have waited long enough. Let us get it right the first time.

It is not a partisan criticism either. The co-chair, Conservative Senator Ogilvie, told the Hill Times that the law as it has been introduced will be challenged in courts, and he is disappointed that the government did not take more of the committee's recommendations.

This is not a case where good enough legislation is good enough. This is a life and death issue, so let us get the right legislation.

The people in my riding are concerned about safeguards. They know the value of life and want to make sure that some lives are not considered less valued than others. I could not agree more. I have members of my family who have severe mental illness and who are differently abled. They are precious to me, and I would not wish them gone from my life.

Right now, Bill C-14 would legalize medical assistance in dying for competent adults 18 years of age or older who meet the following criteria: serious and incurable illness, disease or disability; in an advanced state of irreversible decline in capability; experiencing enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

There are also requirements for two independent medical practitioners or nurse practitioners to confirm each criterion. The request must be in writing where possible and witnessed by an independent adult, and a 15-day reflection period must be observed. To help protect people in vulnerable situations, the witness to the request cannot be a beneficiary under the will of the patient, someone who may benefit from the patient's death, or directly involved in providing care to the patient. The two physicians or nurse practitioners must also be independent from one another. Safeguards must be there to provide the support that patients and their families need during this painful time.

We know that this is a difficult issue that touches many in a personal way. There are many issues to discuss, and we hope to see them discussed. Therefore, I will be voting in support of the bill, but I know that it is going to a special committee, and when it returns to the House I hope to see many more changes made.

Many speakers today are expressing their profound disbelief that Bill C-14 would deny Kay Carter, one of the two women on whose behalf this case was brought to the Supreme Court, suffering from serious and incurable but non-fatal conditions, the right to choose medical assistance in dying.

According to many experts, their only remaining recourse to meet the bill's final criterion would be to starve themselves to near death, as we have seen people do in Quebec, in order to meet the province's eligibility criteria. I have seen this in action, and it is a dreadful way to die.

Going forward, New Democrats will consult with experts and people affected as we study this legislation very carefully. As Amy Engel wrote, “I want to be someone strong and brave enough to make hard choices. But I want to be fair and loving enough to make the right ones”.

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

Mr. Speaker, I thank members for pursuing this issue not just from some excellent legal scholarship, and we heard that tonight with presentations from my colleagues, but also talking about the impact their lives have had on how they assess the legislation before us.

I too will reflect on my time on this planet, dealing with the challenges of watching a loved one pass away. In this case it was my mother. It was 20 years ago this past January. After a very determined 15-year battle with cancer, she succumbed. Part of the process involved palliative care at the end, which was excellent. However, it was too much for her at one point and she called her three children around, my two sisters and myself. She said, “Kids, I've had enough.” She pulled her oxygen mask off and said, “Don't revive me. I love you. Goodbye.”

We had been dealing with three or four months, it is almost impossible to measure the time, of watching my mother struggle on to make sure that all the kids were there to say goodbye, and saying goodbye to loved friends and family. Clearly, after 15 years, she had had enough.

We sat there by the bedside and watched as life started to leave my mother's body. For myself, who had been in the city and was taking care of her at the end, most persistently on a daily basis, it was too much for me. I could not take it anymore. I left the hospital room knowing that I had said my goodbyes and this was the end. When I came in the next morning, there was my mother sitting up in bed saying, “Well, that didn't work.” Palliative care continued for weeks afterward. It was a palliative care that got more fragile, more painful, and a greater hardship for her and for us to deal with, but in the end she passed away.

She had a do not revive order. As we talk about this issue, we have found ways in the country before to assist people in making decisions, even when they are not in a place to make those decisions.

That is what we are struggling with today. How do we find a more proactive and more informed way of doing this when different dimensions and different diagnostic tools come into play, and different eventualities are being considered?

What we are trying to figure out here is how to extend the do not resuscitate orders into a new sphere of medical assistance. That is the essence of what we are trying to do. It strays into other areas. I have heard it in these debates that the legislation is fine but it does not do X or it does not do Y, which are really topics for other pieces of legislation. We are not focusing on what we are trying to get done right here.

The bill responds to the Supreme Court, as we are compelled to do constitutionally. I do not resent it. It is an extraordinary responsibility to respond to the Supreme Court when it assesses our laws to be lacking or the needs of our population not being met. What we are trying to do is to get a perfect letter through a defined letter box and making sure it clears that letter box.

People in our country are suffering and families are suffering as we debate this. I appreciate the sentiment from many people in the debate to try to get the legislation perfect. It deserves to be perfect. We all strive to make it perfect. However, we cannot let perfection get in the way of what is needed and what is good. There is goodness in the bill, because it does limit people's suffering. Have we done enough on palliative care? Of course not. Have we done enough on the quality of life? Of course not. Have we done enough on medical research? Of course not.

Death is still a very difficult subject for far too many of us. However, Bill C-14 responds to the court's challenge in a very particular way, and the committee will try to make it better. I trust it will come back to the House with a better bill. I hope we can get the bill to committee as soon as possible so it has the space to work on that perfection, rather than us pursuing our task of trying to perfect the criticism of the bill. We need to get the bill to committee so it can be studied, some of the language refined, some of the opportunities better understood, and some of the restrictions better defined. We need to get it to committee quickly.

However, we have to resist being afraid of this bill because it would start to do things that we have not contemplated, such as the slippery-slope comments we had, where we are worried about what happens with person X and person Y in five and ten years' time if these conditions change. We have to look at the legislation that is in front of us, we have to deliver it to committee with criticisms attached, and then we have to trust ourselves as colleagues, as parliamentarians engaged in this issue, to try to and hope to deliver a better bill for the next reading and then on to the Senate for its work and for its resolution.

Let us not kid ourselves. There will be no bill passed in this Parliament that will not be challenged at some future date at the Supreme Court. There will be no new thinking or new idea or new circumstance that does not demand of us to revisit this bill in one, two, three, five, or ten years from now. We have lived on this planet for thousands of years and never perfected the art of dying. It is a tough issue. It is a hard issue. If we lose sight of the fact that our inability to come to terms with that promotes and prolongs the suffering of individuals, we will have truly failed as parliamentarians. We are being asked to make a tough call. This legislation would define what we think is a good judgment and would define what we think is a good approach to this.

I can hear good ideas emerging. However, the debate being called for by many quarters about improving palliative care did not need this bill for that call to be made. We should have been perfecting palliative care years ago. The call to ensure that vulnerable people are better protected and their quality of life is better protected did not need this bill for that debate to happen. Vulnerable people should have been spoken to and their needs addressed long before this bill was ever presented.

However, to use those as roadblocks to end suffering is unconscionable in my perspective, and we have to respond to the deadline that has been imposed upon us by a court that has already been asked to extend that deadline once and already has referenced the suffering as a reason not to extend it again. We have a duty, and we have a duty tonight and over the next few days to get this bill to committee as quickly as possible, and then to listen to what we have said to one another in these last few hours. I do not think anybody has presented a concern that is not of value and does not inform our ability to talk about this bill in more pronounced ways and more reflective ways, and that is good.

Let us amend. Let us lean into the parliamentary committees that we have here. Let us trust one another to fix good ideas and make them better ideas. That is what the committee process is supposed to be about, and that is something that I trust will happen. Let us measure the impact of this debate through that process and ensure that our voices and the voices of our constituents are heard in this debate and also heard in the legislation as it moves forward. At the end of the day, let us be honest with ourselves. We will be revisiting this issue the minute it gets royal assent. We will revisit it because life brings us these challenges as surely as it brings us death. We have to be, on these sorts of issues, smart enough to trust one another, compassionate enough to learn from one another, and at the end of the day, disciplined enough to ensure that this Parliament works for those who are suffering, those who are vulnerable, and those who want to live out their last few days with dignity.

My mum taught me a lot about life by the way she died, and I am sure it is a story that all of us have learned from loved ones as we have watched them move through very difficult times. However, I also remember my mum saying, as she was sitting there, that she loved us and it was not just her suffering she was trying to manage, it was ours. Therefore, it is not just our difficult decision we are trying to manage here today; it is the country's difficult decision.

I trust all members to take that seriously, but I also trust them to support us as we pursue palliative-care improvement, as we pursue the opportunity to improve the lives of vulnerable people in this country, and as we seek to deliver choice to people about how they move forward, with support when they make mistakes but understanding when they get it right.

I hope we can get it right with this legislation. I hope the committee gets it right, and I hope the next debate about this finds even more consensus.

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

Mr. Speaker, I appreciated the parliamentary secretary's speech. In the Carter ruling of the Supreme Court of Canada when it held up the appeal, it defined a competent adult person as one who clearly consents to the termination of life and has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

In Bill C-14 under proposed paragraph 241.2(2)(d), the legislation specifically mentions that a natural death has to be reasonably foreseeable. I want to know the member's opinion on that specific section of the bill. Does he believe that complies with the Carter ruling and is the government prepared to refer this legislation at some point down the road to the Supreme Court to make sure that we do not have future charter challenges?

[Jean-Pierre Ménard]

First of all, you have to understand the meaning of the Quebec legislation. I was very closely involved in that process. The objective of that piece of legislation is to regulate all of end-of-life care. That legislation does not come under criminal law, but under health. It covers all end-of-life care practices, including palliative care, physician-assisted death, advance medical directives, and so on. The legislation's objective is slightly different from that of the bill we are debating.

Before us is a bill that aims to amend the Criminal Code in the context of physician-assisted death, which was more broadly defined by the Supreme Court than by the Quebec legislation. In terms of equivalence, this bill is not the federal counterpart to the Quebec legislation—that much is clear. The Quebec act has a more restrictive objective.

Furthermore—and I'm saying this with all due respect for the federal legislator—many measures found in Bill C-14 are cut and pasted from the Quebec legislation in certain aspects. That's adequate, as that piece of legislation was not misguided, either. However, the issue you are raising seems relevant to me. To the extent possible, we have to avoid regime duality and Quebec citizens having to deal with two legal standards regulating their decisions once the legislation has been adopted.

If someone wants to have access to assisted suicide, it's impossible under the provincial standard, but it could be possible under the federal legislation. The procedure is slightly different. It is probably important to hold back a bit by stating that the Government of Canada can exempt a province from certain formalities or give it some flexibility when it comes to specific aspects of the legislation. However, in terms of the substance, it cannot go too far, as the intention must be compatible with the Supreme Court's decision, as well as with section 7 of the Canadian Charter of Rights and Freedoms and the rules we are currently establishing in committee.

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

Mr. Speaker, I will preface my comments tonight by saying it is not my intent to offend anyone, but I do believe that this is the time for plain speaking.

This bill is about choices and it is about rights. Although I resent that the Supreme Court has ignored 15 rulings of Parliament that said we did not want to bring in any law on this subject, I respect that we have to bring one in by June 6. Of course, if we do not bring one in, I am not sure that the consequence is worse than this rushed Bill C-14. As I understand it, if we do not bring in legislation, we remain in the circumstance we are today, where there is the precedent of the Carter decision but no law in either direction for or against.

I said that the bill is about choices and rights. First, let us talk about choices. If I want to kill someone, myself, my baby, or someone else, this is a choice I can make today in Canada. Each one has consequences not just for me, but for many others. If I kill myself, my insurance will not pay out, and that will affect my family. They will also deal with, hopefully, the emotional trauma from the shock of missing me.

If I kill my baby pre-term, I have to live with that, and the father of the baby has to deal with it, but otherwise, there is currently no consequence.

If I kill someone else, I risk imprisonment. I understand that the Carter decision is trying to ensure that even people who cannot pick up a gun themselves can choose to get assistance in killing themselves.

However, their choice does have an impact on others. It has an impact on the health providers who are opposed to participating and whose rights of religious freedom and the right to refuse to participate are not adequately protected in this current version of Bill C-14.

It has an impact on the taxpayer, who will be paying for several doctor consults, and if some of the suggested amendments come into place, additional psychiatric reviews or judicial reviews, as well as the drugs to do the deed. When we kill ourselves, we pay for the bullets or the rope.

Let us look at how this legislation addresses the Carter decision. Keep in mind that the Carter decision limited the scope to those who are over 18, terminally ill, and can give consent. I do not see anywhere in the Charter of Rights and Freedoms that we have the right to die, only that we have the right to live, so certainly the Carter decision, in my view, is flawed.

However, the decision limited the scope to those over 18, terminally ill, and with the ability to give consent, so I find it incredible that this bill before us is looking to study extending this right to mature minors, to those with psychological only conditions of suffering, and those who do not qualify as mentally competent to give consent.

I was a youth leader for over 30 years, and I have known young people who broke up with their boyfriends and girlfriends and who took their own lives. These were tragedies that could have been avoided if hope and counsel had been provided. However, there will be many more lives taken before their time if we allow mature minors to ask for assisted death.

This is a dark path. We should not be studying it or even considering it.

With regard to the studies on whether people who are mentally ill should be able to request medical assistance in dying, I am asking that the bill be amended to ensure that it does not provide for that possibility at all.

Many people suffer from depression, but it is treatable. I know many people who take anti-depressants and medications that come with a warning that possible side effects may include suicidal thoughts. If we start killing people who are not actually dying, it is akin to murder.

For those who want to give their advance consent to be killed later, I ask them: why wait? Why not let them choose suicide when they are still able to commit suicide, rather than letting someone do it for them? They are not choosing to commit suicide in the beginning because they want to live as well and for as long as they can. That is why Canada needs good palliative care.

In my riding of Sarnia—Lambton, we have excellent palliative care. St. Joseph's Hospice has a wonderful staff, and we have the co-operation of Bluewater Health, the VON, community care, and so many other organizations, along with palliative care specialists who give the end of life dignity and meaning.

However, because palliative care is not completely funded in Canada, the hospice has to undergo significant fundraising of some $1.4 million each year. Government funding covers only 43% of the costs. Food, building maintenance, program coordinators, day hospice, and crisis support are not covered.

The cost of palliative care at home or in hospice is one-quarter of the cost of palliative care in acute care facilities. However, Bill C-14 would not do what it so simply could: amend the Canada Health Act to make palliative care a covered service so that all Canadians would have the end-of-life care that would cause them to choose life. Yes, of those who have good palliative care, 95% of them choose to live as long as they can and as well as they can. That is something missing in this bill.

Now that we have talked about choices, let us talk about rights. Most people who want to kill themselves can pick up the gun, or take an overdose, or hang themselves, or whatever. We are not talking about a huge percentage of people who cannot pick up the needle or swallow the pill. We are talking about a very slight minority of people. On the other hand, we have millions of health care workers, doctors, and nurses who for reasons of religion or otherwise do not want to participate in the killing of people, yet this bill says nothing about that. The rhetoric when the bill was presented said that health care providers would be able to refuse to participate or refer. However, based on the history of broken promises, I would want to see that one in black and white in the bill to be sure that the intent to protect the rights of health care workers is captured.

Let us move on to the subject of taxpayers' rights. When an individual decides to kill himself, he pays for his own bullets or pills. Now, the bill seeks to transfer that burden to taxpayers, who will have to cover the cost of medical consults and associated administrative formalities. I am opposed to my tax dollars being used to kill people.

I believe that, if people want to kill themselves, they should have to pay for the entire process. Some may say that killing people costs less than taking care of them, but that is a slippery slope, is it not? It creates a situation where we may start calculating the price of keeping people alive. In time, death may become a way to save money.

That was the case in all of the other countries that have implemented similar legislative measures. Belgium, the Netherlands, and Denmark all started out with strict guarantees. However, these guarantees were hard to implement and were eventually set aside.

After that, it became easy and practical to get rid of vulnerable and undesirable members of society. The percentage of deaths rose from less than 1% to 6%. I do not believe that there is enough accountability in this bill and I would like to see improvements made in that regard.

As I said, this bill is about choices and rights. I believe the bill does not do enough to protect the rights of health care workers, the young, and the vulnerable. I believe the choice to kill oneself should come with consequences, which are not well laid out in this bill, such as forfeiting of insurance and the cost of the deed for starters.

I am recommending that the bill be amended in committee to document the protection of health care workers' right to refuse without retribution, to capture the duty of the requesting individual to cover the cost of the process, and to remove from the scope of this bill the studying of mature minors, advance consent, and those suffering psychologically.