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

[Anthony Housefather, Liberal, Mount Royal, QC]

Mr. Speaker, I want to congratulate my colleague from Hamilton West—Ancaster—Dundas on her excellent speech. I very much appreciate the conversations I have had with her on this subject, and I appreciate what I have learned from her in her experience with working with teenagers.

With respect to conscience rights, there have been a lot of comments already from the other side that conscience rights should be included in this bill and that we should find a way to include them in the Criminal Code. What is the member's position on that?

[Filomena Tassi, Liberal, Hamilton West—Ancaster—Dundas, ON]

Mr. Speaker, as I have indicated, I believe that the conscience rights of physicians and practitioners will be protected, and that is based on the assurances we have been given by both the Minister of Justice and the Minister of Health.

The other issue I would like to raise with respect to that is that I am cautious of introducing into legislation any restrictions or precedence with respect to conscience rights, because I think that would set a very dangerous precedent.

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

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

Mr. Speaker, it is an honour to be in the House representing my community of Langley—Aldergrove. This is a very important debate we are having today.

I just want to do a quick review of how we are involved with this debate today. It was approximately a year ago, February 2015, that the Supreme Court made its ruling that Canadians who are suffering should have access to assisted suicide or euthanasia. I will use those terms because they are the terms used in the Criminal Code of Canada.

Terms like “death with dignity” and “medical aid in dying” are used when a physician is helping people in the last days of their life. They are not hastening their death. Palliative care is one of those forms of assistance, in which people are being assisted in the last days of their life. Therefore, to call it medical aid in dying really does not truly capture what we are talking about.

When we had town hall meetings, one of the terms I heard was “medically hastened death”. That more accurately describes what we are talking about. However, I will use the language of the Criminal Code, which the Supreme Court says we have to amend. Those terms are “assisted suicide” and “voluntary euthanasia”.

Mr. Speaker, I will be sharing my time with the incredible member for Abbotsford, the community just to the east of Langley. He is incredible because he was probably Canada's greatest foreign trade minister and did so much for our country. I want to thank him for all his work.

When the Supreme Court made its decision in February last year, what did the previous Parliament do? It knew there was an election coming in October of last year, so it appointed an external panel. The panel was given a clear mandate to consult with Canadians and then create a suggested legislative response.

After the election, the new government contacted the external panel, which had just completed its work of consultation and was in the process of creating the legislative response. The new Parliament could have started right away, because we had until February 6 to deal with the issue.

What did the new government do? It contacted the external panel and said it had changed its mandate. It no longer wanted legislation from the panel. It would create its own legislation. Instead of Parliament being called back and creating a special committee to deal with that legislation—we had until February 6 of this year, which would have given us a few months to debate and work on it—the government changed the mandate, said it was going to create its own legislation, then dithered. For a number of months it dithered, and then it created the special committee. The special committee came up with recommendations. Then what did the government do? It dithered and delayed, to the point now that we have four sitting weeks to basically do what normally takes two years to do.

Quebec took six years and three premiers in a non-partisan environment to create Bill 52 in Quebec, dealing with assisted suicide and euthanasia. It dealt with it in a much more responsible way.

Some would say they wish we did not have this debate. I heard that when we had town hall meetings. However, the Supreme Court in the Carter ruling made that decision for Canada. It said this must be permitted, and it is counting on Parliament to come up with appropriate safeguards to ensure we protect vulnerable Canadians.

What did the new government do? It changed the mandate of the external panel, then dithered. It had a special panel, which was partisan in nature. Then it dithered after the report from that panel. Now we have four sitting weeks.

It is really disappointing the way the new government has handled this. It is too important to be rushed through, but this is what the government is doing.

There are four sitting weeks, and the Liberals are not consulting properly. They are not giving Parliament adequate time to do this properly, and they are ramming it through. It is basically legislation passed by exhaustion.

In the special joint committee, we heard from two witnesses representing aboriginal communities, and they were not consulted. However, another requirement of the Supreme Court of Canada is that we consult properly, but that is not happening with the current government, which is not transparent, not accountable.

I would suggest that the Liberals seriously consider what happens on June 6 if the bill does not pass. What happens in Canada if their mismanagement of this results in no legislation in Canada and we have this legal void, and then the Carter decision takes over? Then we are advocating turning over the responsibility of protecting the vulnerable to each college of physicians and surgeons, and we would have different policies being applied across Canada. It would be a very serious situation.

I am hoping we will work together. I would suggest that the government seriously consider asking for more time from the Supreme Court, because the Liberals have not managed this well, and we have ended up with only four sitting weeks left to do two years' worth of work.

I want to speak to a couple of changes that I believe need to be made in Bill C-14.

The number one thing that I have heard at town hall meetings wherever I was, whether in British Columbia, Saskatchewan, or at home, is the importance of conscience protection.

I had a young nursing student come up to me and say she did not want to be part of this and ask if she would have to be part of this. I said that, at present, the special committee that was formed is recommending that, yes, one would have to be. Also, physicians would have to provide an effective referral. However, Bill C-14 is very silent on this, and it would leave it up to provinces to come up with their own policy on how this would be dealt with.

The Canadian Medical Association said that 70% of physicians in Canada do not want to be part of this, but 30% of physicians in Canada will participate in assisted suicide. Therefore, it is not an access problem, but what do we do about conscience protection?

Bill C-14 clearly needs to be amended to make it a criminal offence to force through intimidation or coercion in any way or threaten a physician that he or she would not be able to practise medicine—or a nurse, pharmacist, or any health care professional—to force them to participate in this against their will. This is the number one thing we heard time and time again: protect conscience rights.

The Criminal Code is being amended, and Bill C-14 needs to be amended to include that type of conscience protection. Without it, we do not have a pan-Canadian approach. We would have different policies in each province and territory, potentially. Some provinces have indicated that some physicians must participate.

On the Charter of Rights protection, the Supreme Court said physicians' charter rights should be protected. However, if we go on and do not provide the legislative protection, if we do not provide proper conscience protection, I am concerned that we will see in Canada physicians leaving the practice, maybe retiring.

I met a physician recently who is 71 years old and he is still practising medicine because he loves to help people. That young student nurse I talked about wants to leave nursing school. I told her not to leave yet. Let us see if we can fix this to make sure her conscience is being protected.

However, if we do not protect the conscience rights of Canadians, of physicians, nurses, and pharmacists, we are going to have people leaving the practice. They will either retire or relocate to another jurisdiction where their conscience will be protected.

We already have a shortage of physicians, nurses, and doctors in Canada. This would create a medical crisis in Canada if we do not protect the conscience rights of Canadians. It is a charter right. It is our responsibility to protect the vulnerable and the conscience rights.

There is a gaping hole in the legislation, Bill C-14. We need to fix that. I see a number of members here who are going to be on the justice committee, and we will be voting as Parliament. I hope we can deal with that.

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

Mr. Speaker, I found it interesting that the member allocated quite a bit of debate time to how this legislation came about. It is important to recognize it is because of a Supreme Court of Canada ruling in February. I disagree with virtually almost everything else the member said, in terms of his implication. The void in leadership occurred from the moment of the release of the Supreme Court decision until October 19, when we finally had a Prime Minister who recognized the importance of the issue and that the Canadian government has a lead role to play. This is something the member at the very least should acknowledge.

After listening to many speakers and in particular the ministers responsible for this legislation, I assure the member that the issue surrounding conscientious objections of health care professionals is being taken care of. I wonder if the member might want to provide some comment in terms of why it is so important that we see this legislation passed in a timely fashion so that we do not continue to have a void and we can have some common ground from coast to coast to coast.

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

Mr. Speaker, I wish the member had answered some of the questions that I put forward, one of which is what happens on June 6, in four sitting weeks, if the Liberals are not able to pass this. After October 19, one of the first things the Liberals did was to change the mandate of the external panel. They should not have done that, but they did. Then they dithered and did not do anything. They created the problem. There was an external panel of eminent people in Canada who had consulted during the election, so we would end up with non-partisan legislation.

What have the Liberals done? They changed the mandate, created a partisan committee with the report's recommendations, many of them not good, and that is why we had dissenting reports. We had bad recommendations from that committee. We need to fix the legislation, and I look forward to working constructively.

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

Mr. Speaker, I want to thank my colleague for his work on the committee and also his continuing work on seniors care.

Just to follow up with my colleague across the way, in terms of the expert panel, there was a point where I had the report of the expert panel. The unfortunate part is that the Liberals refused any recommendations from the panel. They said it could give them the report but they did not want any recommendations. That was really a sad day, seeing the expert work that was done.

My question goes to the point of definition. Currently, Bill C-14 is called medical assistance in dying. I pointed out on a number of occasions that, many times when we see social engineering projects, they are preceded by verbal engineering, and I think this is another way that this is happening.

I would like my colleague to comment on the difference between physician-assisted suicide and voluntary euthanasia, because we know that the outcomes of those two different methods are vastly different. In fact there is a tenfold increase in people dying by voluntary euthanasia over physician-assisted suicide because of some of the ambivalence that occurs.

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

Mr. Speaker, there is a vast difference between the two definitions. In physician-assisted suicide, the physician would provide the lethal dose but the person must self-administer. With voluntary euthanasia, the physician or health care professional would administer it. The big question then is, when people use euthanasia, whether the person has been properly consulted. Do they really want this to happen, or are they closing their eyes? Are they able to self-administer, and should they? Therefore, they are two very different definitions.

It was the decision of the Supreme Court in the Carter ruling that it is a competent adult providing consent, proper competence being deemed by, if it is a psychiatric issue, a prior assessment to make sure the person is competent. Bill C-14, to give it credit, requires asking at the last minute to be sure people want to have their life ended. That is very important. The special joint committee did not want this prior asking of “are you sure you want this”. Death is permanent. Bill C-14 has that right, but we need to make sure that the person is competent and is giving consent right to the last moment.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, I appreciate the opportunity to add my voice to those who have expressed serious concerns about this legislation. Bill C-14 would, for the first time ever in Canada, establish a national right to die and the right to seek assistance in the act of committing suicide.

I acknowledge that the issue of assisted suicide is highly complex and of course deeply sensitive. Like it or not, the issue has been dropped in our laps by the Supreme Court of Canada and each one of us has been elected to wrestle with this very tough issue. I hope that, at the very least, we will have the courage to reject solutions that, on their face, may, by some, be characterized as progress, but in reality degrade rather than elevate the intrinsic value of each and every human life.

I believe that every human life is God given and is deserving of dignity, value, and protection. Indeed, from my earliest years as a public official in the community of Abbotsford, I have made it clear that my constituents can and should always expect me to defend human life against all threats. Today is no different. The legislation we are debating today represents a watershed moment in the life of this country, one in which our fundamental values are being re-examined and tested.

I believe Bruce Clemenger said it best when he stated:

With the introduction of Bill C-14, Canada has crossed a significant threshold.... The decriminalization of euthanasia and assisted suicide constitutes a fundamental shift in how we as a society value and understand life and the duty of care we owe one another. Never before have we as a nation said that intentional killing is an appropriate response to suffering, or that we should take the life of the one who suffers rather than finding ways to alleviate their suffering.

Let me begin by commenting on the role that the Supreme Court should or should not play in articulating a right to die. As a lawyer and lawmaker, I have the greatest of respect for the rule of law, for the courts which sustain it, and for the individuals who occupy the bench. It is the rule of law and our court system that are intended to act as a bulwark against oppression and discrimination and defend our prevailing national values, including our personal freedom and our democratic institutions.

That said, it is eminently within our prerogative as MPs to also respectfully question and challenge the very decisions that our courts make and to suggest what particular issues should more appropriately be left for Parliament to decide. It is my view that matters of protecting life and the taking of life should remain the sole domain and prerogative of the duly elected representatives of the people of Canada, namely, the members of the House.

More to the point, many Canadians are having great difficulty grasping how the court would presume to specifically direct Parliament to implement legislation that effectively creates a right to die and a state-sanctioned role in the taking of a life, all under the threat of the court doing so on its own. Therefore, let me be very clear. I am deeply sympathetic to the suffering of so many whose conditions are terminal, who have concluded that there is no medical hope for healing, who suffer from unbearable pain, whose quality of life has been eroded beyond measure, or who consider themselves an undue burden upon family, friends, and their caregivers. That is exactly why our first and primary focus should be to improve and extend 21st-century palliative care to all Canadians whose lives could be measurably improved by it.

Is it not ironic that at the same time that we are debating the state-sanctioned taking of a human life for compassionate reasons, the Liberal government has failed to follow through on its solemn promise to expand the availability of palliative care. The promised $3 billion would have gone a long way to ensuring that palliative care becomes an essential part of the end-of-life decision-making process.

Instead of barrelling ahead with active euthanasia legislation, is it not incumbent upon us as lawmakers to first explore every opportunity to provide compassionate and effective palliative care to those who are in the terminal stages of disease and health? We owe Canadians so much more than simply an ill-considered rush to implement a directive from Canada's Supreme Court.

A cursory study of assisted suicide regimes around the world quickly reveals that even the most stringent and well-meaning safeguards are never completely effective in ensuring that no wrongful deaths occur. Jurisdictions like Belgium have acknowledged that of the thousands of assisted suicides that have taken place, some have taken the lives of those who could not or did not provide an informed consent, or who otherwise should not have died.

In this country, here in Canada, we abolished capital punishment exactly because we could not guarantee that an innocent life would not be taken. Yet, today, we are being asked to take the morbidly contradictory position of saying that notwithstanding that some vulnerable or unwilling individuals would lose their lives, we are prepared to take that very risk. The hypocrisy is astounding.

I also note that Bill C-14 fails to properly address the right of physicians, nursing professionals, and health care institutions to refuse to participate in the taking of a human life. Leaving it to the provinces, territories, and professional associations to regulate is not the answer, and will simply result in a patchwork of directives that ultimately compromise the ability of doctors and nurses to refuse any direct or indirect participation in assisted suicide.

It is highly likely that a health care professional in one jurisdiction will find his or her right to conscientious objection protected, while a colleague in another province is left without such a fundamental right. That is unconscionable and a clear abdication of the government's obligation to protect the rights of all Canadians, irrespective of where they practice medicine.

The right of medical professionals to refuse direct or indirect participation in assisted suicide should never, ever, be subject to negotiation or compromise. On that measure alone, Bill C-14 fails the test.

Many Canadians have expressed a legitimate fear that Bill C-14 will become the precursor to much more radical right-to-die policies. They are right. I have no doubt that the legislation before us, if passed, will very quickly become the thin edge of the wedge to secure future liberalization of assisted suicide to include children, the mentally and physically disabled, the chronically ill, the elderly, and those no longer considered to be productive contributors to Canada. Is that really the Canada we were elected to build?

This debate exposes an astonishing irony. Today we are experiencing, to our national shame, an unprecedented epidemic of suicides of our youth on first nations reserves. In response, the federal government is undertaking extraordinary efforts to prevent such suicides from happening in the future.

Yet, at the same time, here we are, in this House, debating an assisted suicide bill that the special parliamentary committee recommended should in the future include extend the right to die to vulnerable children, the very group we are working so hard to save in first nations communities. Colleagues, what are we thinking?

Over the years, I have gotten to know many doctors and nurses, and have on numerous occasions dialogued with them on the issue of euthanasia. Our health care professionals are deeply compassionate, caring people who go to great lengths to ensure that patients who are terminal and suffering from great pain are made comfortable. They exercise a high level of discretion when they administer medications that alleviate pain, even where such medications may, on occasion, hasten the patient's death. The government's introduction of Bill C-14 failed to take that into account.

Let me close. More than a dozen times in the past this Parliament has considered and consistently rejected assisted suicide legislation. For whatever reason, our Supreme Court has now seen fit to insert itself into this debate by reversing itself on the Rodriguez decision. Its directive to the House to implement assisted suicide legislation calls upon us to act courageously and reject that directive.

Let us resist the urge to tread upon the steep and slippery slope of a policy whose implications are unclear, and whose trajectory represents a fundamental undermining of our foundational values.

We are faced with a monumental decision, one that challenges us to reaffirm the pre-eminence and inviolability of a human life. May we choose wisely and reject this deeply flawed bill.

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

Mr. Speaker, the Minister of Justice and the Minister of Health have really gone to lengths to ensure that this legislation strikes a balance between the complexities of medical assistance in dying. The Minister of Health has often stood in the House and talked about the fact that we need to improve our palliative care system as well as our home care system to ensure that people are having the best quality of life up until their time of death.

We now have a situation where we need to have this legislation go through, and I am wondering if my colleague could tell me why the previous government did not act and take charge on this particular issue when they were in power and are questioning our motives now.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, I can assure the member that we actually did take an active role in addressing the Carter decision. However, our government at the time was taking its time to get this right. Broad consultations across the country is the least that we could do with something this important, this critical to our foundational values.

Since when is the taking of a life defined as health care? That is my struggle. This country was founded upon values that respected the value of human life and protecting human lives. This is a huge step in the wrong direction, one that I am committed to resisting, as a parliamentarian and someone who deeply loves this country.

This legislation is a very dangerous step on a slippery slope of which we do not know where it will lead, but it is very clear it will lead to much greater liberalization and cast a much greater net in the future.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, I listened with great interest to my hon. colleague. I find it very unfortunate, though, to use the suffering of the children in Attawapiskat in this debate.

I have heard it used by some people in the faith community. I find that it is a real debasement of the issue because of what the children are suffering there, with the lack of basic mental health services from the federal government, the intergenerational trauma of the residential schools, and the churches just walking away from their legal obligations.

Edmund Metatawabin, a survivor of St. Anne's Residential School, who knows these families well says that there is a direct highway between the injustice committed by the federal government and the effect it is having on these children. I can tell my colleague, being in the community, I hear that. I respect his judgment on many things and I am just asking that we be careful when we bring in something tied to this.

My concern in listening to my hon. colleague is that I do believe it is the role of Parliament to offer legislation on what is the right of life and death in this country, but the Supreme Court decision is acted.

I think it is incumbent upon us to be truthful with the Canadian people that if Parliament does not respond to this legislation, it will create a legal vacuum, and in that legal vacuum, all manner of agents may step forward, may be heard, and may be recognized by the Supreme Court. It is not enough to say that we can push back against the Supreme Court. If we do not meet this deadline, then a legal vacuum will ensue and much broader interpretations may result.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, I want to be very sensitive to the hon. member's comments about not using the children of Attawapiskat as an unnecessary element in this debate, but I think it bears noting that this is a critical issue across Canada when our first nations are struggling with an epidemic of suicide. I look at this legislation in all earnestness and I see how it flies in the face of what we are trying to do, which is not only to protect and defend human life but to create an environment within Canada where life can be lived in a way that is not only happy but productive and contributes to building a better society.

With respect to his specific question, how do we approach this ruling from the Supreme Court of Canada? The government well knows it does have remedies available to address the ruling of the court. It has tools within the charter itself to respond to this decision.

When legislation is so fundamentally flawed, as is Bill C-14, as a person of conscience, as a person of faith, as a person who loves this country dearly, it is my duty to speak up against this kind of legislation and to say, no, there are better ways of addressing this.

I am so pleased with my colleague who has raised the issue of palliative care consistently in this House. That should be the first focus of the work we are doing to help people who find themselves in these circumstances.

[Joyce Murray, Liberal, Parliamentary Secretary to the President of the Treasury Board]

Mr. Speaker, I will be sharing my time with the member for Parkdale—High Park.

I am proud to stand in this House today in support of Bill C-14, introduced by the hon. Minister of Justice.

With this bill, our government recognizes the autonomy that Canadians hold over their own lives, the expertise of our medical professionals, and the decision of the Supreme Court of Canada. Through extensive consultation, we have introduced a balanced solution that will restore dignity, protect the vulnerable, and allow our nation's medical professionals to respect the wishes of their patients.

Until now, Canadians faced horribly debilitating end-of-life suffering and had no legal control over their own lives. In desperation, some have gone to court to regain this control. However, it is a difficult process, which has compounded the physical and emotional strain felt by the patients and their families.

Doctors, nurses, and family members alike have felt powerless to assist those they care for, with no legal means to honour the wishes of those who suffer. They face emotional strain and difficult moral dilemmas, as the law prohibits them from respecting the dignity of their patients and doing what they often know is compassionate medical assistance for a good death.

Many of us in this chamber and across the country have personal stories of the kind of suffering I have mentioned. I do as well. I have an indelible memory of visiting a dear friend of many decades in the hospitals, whose body was breaking down from a terminal illness. He was in excruciating pain for weeks. He eventually declared that he would not eat or take any water or liquids. He finally passed away after six days of even more miserable suffering.

We are here to talk about a bill that is setting out a new form of medical service in Canada, which is medical assistance in dying. With this bill, we recognize that the decisions over one's person, including the decision to end one's life with dignity, should ultimately rest with the individual and not with the government.

Through consultation and careful consideration, Bill C-14 includes the following safeguards: a requirement for a second independent medical opinion; a 15-day reflection period; the ability for a patient to withdraw consent at any time; and a rigorous requirement for documentation at every step, with new criminal offences to prevent any potential abuse.

This government recognizes the need to respect the moral conscience of individual medical professionals. While every patient who fits the medical criteria will have access to medically assisted dying, no individual doctor or nurse will be required to participate if it conflicts with his or her values and beliefs.

Some medical professionals have expressed reluctance to refer a patient seeking medically assisted death to a physician who can provide the service because they feel that the referral would make them complicit in the death of the patient.

However, while it is absolutely critical to reflect important safeguards, we must also respect that the people seeking this procedure should have reasonable access.

In Carter, the Supreme Court of Canada recognized that the conscience rights of physicians will need to be reconciled with the charter rights of patients seeking medical assistance in dying. Although much of the necessary balancing will be a matter for the provinces and territories, our government is committed to working collaboratively with provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

The federal government will offer support to help ensure that all Canadians have access to the medical aid they need. One approach is a pan-Canadian coordination system for access to medical aid in dying. We can start by reviewing the assisted dying regimes in other countries to see what they have done and assess their applicability to Canada.

Closer to home, in Quebec, the act respecting end-of-life care offers other examples. It includes a range of end-of-life care, including palliative care, palliative sedation, and medical assistance in dying. The legislation makes the service broadly available in institutions and at home.

Physicians in Quebec are not required to provide this option, but they are required to notify the institution or local authority of any request and to forward the patient's request form. The institution will then take the necessary steps to find another physician as soon as possible to address the request.

Many people in Vancouver Quadra who have contacted me about the bill have expressed their support for medical assistance in dying. As their representative, I am pleased to support the work of my colleagues, the Minister of Health and the Minister of Justice.

Under the proposed legislation, medical assistance in dying would be available only to mentally competent adults who are eligible for publicly funded health services in Canada, who have an incurable illness, disease, or disability, are suffering intolerably, are in an advanced state of irreversible decline in capability, and whose death is reasonably foreseeable.

Some of my constituents have also expressed concerns about access.

Our criteria permit medical assistance in dying for some, but not all individuals who may seek it. We have heard concerns from some Canadians and experts about extending eligibility to mature minors, permitting requests made in advance, and including psychological illness as a sole underlying condition.

I want to let Canadians know that our government has heard their concerns.

At the present time, the limited information available on these issues warrants the cautious approach in the draft legislation before us.

However, the government is making a commitment to undertake independent studies on these issues to better understand the risks. The results of the reports will feed into the five-year legislative review set out in the bill.

There are other facets of the challenge of access. As we all know, our country has many remote and rural communities that face challenges in accessing health care services, including access to a physician or other health care provider. Although delivery of health care is a provincial and territorial responsibility, accessibility is one of the five main principles of the Canada Health Act.

I am pleased to report that, along with the protection of vulnerable populations, questions of access have been considered and addressed throughout the proposed legislation and in the complementary initiatives.

Let me provide an example. The umbrella term “medical assistance in dying” encompasses both the situation where a provider must be physically present to administer a substance that causes death, and the situation where the provider prescribes a medication that the person can take himself or herself. Having criminal exemptions for both procedures would help to increase access for eligible people and provide choices in the circumstances around which medical assistance in dying is provided.

Second, the draft legislation provides exemptions for both physicians and nurse practitioners to be able to provide this assistance. Nurse practitioners, or those with an equivalent designation, are authorized in many provinces to perform medical functions that are necessary for medical assistance in dying.

Exempting nurse practitioners from criminal liability provides the provinces and territories with an additional option to facilitate access to medical assistance in dying in underserved areas.

I will offer another example of how we are working to support access in our health care system. Canadians, experts, and stakeholders have focused on the need to improve access to quality palliative care in Canada, even as we consider how to implement medical assistance in dying. We have listened. Our government is making the commitment to develop, along with the provinces and territories, measures to support the improvement of a full range of end-of-life care, including palliative care.

In the context of a new health accord, our government has committed to providing $3 billion over the next four years to improve home care, including palliative care. Discussions with the provinces and territories are already under way.

In the meantime, it is essential that we end the suffering and restore the dignity of Canadians currently experiencing grievous and irremediable medical conditions as soon as possible.

The draft legislation before us acknowledges the need for access, alongside the need for safeguards and protections. With the bill, our government would achieve these objectives and meet the deadlines imposed by the Supreme Court of Canada.

I have confidence that we can put in place a system that meets the needs of Canadians for compassionate care and support at the end of life.

I invite my colleagues in this House, and all Canadians, to contribute their views to this discussion as we continue the process of updating our laws to reflect 21st-century realities. Our door is open, our government is listening, and we are committed to supporting our medical professionals, protecting our most vulnerable, and restoring the dignity of Canadians in their most trying moments.

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

Mr. Speaker, the member concluded by asking that we update the law to reflect 21st-century realities. By my count, this is the third issue on which the government is using an argument of dates to demonstrate a particular legislative opinion. We need more than just the dates.

With respect to the legislation before us, I have advocated for two changes.

One is that we have some kind of advance review by a competent legal authority to ensure that somebody receiving this service, or whatever we want to call it, did actually meet the criteria. Without advanced legal review, there is no way of actually ensuring that the criteria were met. A person could go from doctor to doctor, or someone else could go from doctor to doctor for them. I want to know what the member thinks about advanced review by a competent legal authority.

Also, what does the member think about removing the “reasonable but mistaken” clause, which would allow somebody who takes somebody else's life without consent to escape prosecution if they had a reasonable but mistaken belief that the person did consent?

Would the member accept those two changes? With those two changes, I think many of us would have a much easier time supporting the legislation so that we can meet the timeline.