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

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Mr. Speaker, the member gave a great speech, laying out a very empathetic case for why the Senate's amendments should be rejected. The debate I have heard so far is not about the amendments the House has already made within Bill C-7 to the original Bill C-14. I disagreed with the House and voted in the minority because I felt that our response to the Truchon decision went too far at the time.

What the Senate has done is to go far, far beyond what the original debate was in the House and the witness testimony that we heard and the considerations in the justice committee. Could the member perhaps just comment on that point?

[Arif Virani, Liberal, Parkdale—High Park, ON]

Mr. Speaker, I know this is personal for others, just as it is personal for me. Obviously mental health touches all of us and all of our families, and it has touched my family.

That is a difficult question to answer, but what I would say is that I am comfortable trying to proceed incrementally as we have done, starting with Bill C-14 and now with Bill C-7, but doing it on the basis of having a lot of input from those in the medical community whose jobs are to diagnose, treat and provide support to those who are suffering from a mental illness.

What I cannot do, obviously, is put myself in the shoes of another person who, in terms of manifesting their autonomy, might be contemplating and considering taking such a step. That is difficult for me to do personally, but what I can do is ensure that I, as a parliamentarian, try to provide equal access to different options, including end-of-life options, to Canadians, should they choose to end their suffering.

[Arif Virani, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Mr. Speaker, I am very pleased to participate in the consideration of the amendments proposed by the Senate to Bill C-7, which seeks to amend the Criminal Code provisions on medical assistance in dying.

Our colleagues did a lot of work on Bill C-7 and proposed reasoned amendments following careful deliberations. The Standing Senate Committee on Legal and Constitutional Affairs heard from a variety of witnesses as part of two different studies. I followed the debate at second and third reading and thought that the speeches given in the Senate reflected the range of perspectives shared by the many witnesses.

It is therefore with great respect for the work of the Senate that we are examining the amendments it is proposing to Bill C-7. As the minister explained, there are three amendments that we plan to support, with some adjustments.

The first relates to the collection and analysis of data about the race of persons seeking MAID. Let me say here that we have heard extensively in the House of Commons and the Senate about the need for better and more robust data collection with respect to MAID. That data has been collected since MAID first entered into the legislative landscape, but certainly improvements can be made.

It is important now, especially during Black History Month, to note that one of the Senate amendments proposes tracking the analysis of data on the race of persons who are accessing MAID. This is important because we have clearly seen a light shone on the important issue of systemic racism in Canada, North America and around the planet. We need to understand how racialized persons, because of their inherent vulnerability, may be disproportionately impacted by MAID and address that vulnerability with our legislative response.

I would say, however, as articulated by previous speakers, including the minister, that the amendment the government proposes to make to this portion of what the Senate is suggesting would make it more inclusive in light of all of the witness testimony given in both the House and the Senate. By that I mean in addition to race-based data, data about disability and indigenous identity would be collected and analyzed. This, of course, is important, especially and specifically as we broaden the MAID regime to circumstances where death is not reasonably foreseeable, in response to the Truchon decision, which creates the real possibility that people will seek and obtain MAID because of vulnerabilities in their lives as opposed to their health conditions. I am grateful to the Senate for proposing this important legislative change.

The second Senate amendment the government supports, with some adjustments, is the sunset clause that attaches to the mental illness exclusion. We heard extensively about this from the previous speaker and in other interventions that have been made. The Senate amendment proposes a sunset clause of 18 months. The government is suggesting that the sunset clause be extended to 24 months.

Second, and very importantly, we are requiring that the Minister of Justice and the Minister of Health ask a group of experts to make recommendations on safeguards, protocols and guidance for MAID on the basis of mental illness alone. Those experts would be required to report back to the ministers within one year, which would leave an additional year for the government to consider what safeguards should be legislated and for Parliament to consider things when enacting any subsequent legislation.

I want to give some context surrounding the sunset clause because it is obviously a pressing matter for today's debate and a pressing issue for all parliamentarians.

The government's position is that it needs more time to consider and enact safeguards for the population of people whose sole underlying condition is a mental illness. The Minister of Justice was always clear that the questions of whether MAID for mental illness should be allowed and, if so, what safeguards were needed would be studied in the course of an upcoming parliamentary review.

What the sunset clause would do, in combination with a requirement for an expert review, is commit to a definite timeline for eligibility of persons whose only medical condition is mental illness. This would reduce the risk that some Canadians would feel the need to challenge the exclusion before the courts should they believe it is unconstitutional. It would also provide them with the certainty that two years following royal assent of Bill C-7, eligibility on the basis of mental illness would be considered with the requisite safeguards attached.

This point about potential constitutional challenges is not an academic point alone. We know this is a complicated issue that balances competing constitutional rights. Obviously we know from the Truchon decision that there has been litigation with respect to the old Bill C-14, and virtually all observers recognize that there is very likely to be constitutional challenges related to the current bill, Bill C-7, should it be enacted. In fact, we heard testimony about this at a House of Commons standing committee. Some witnesses said the exclusion of mental illness alone could perhaps give rise to a section 15 challenge. We are trying to ensure that Canadians who are concerned about this exclusion would have a remedy that is not via the court process, but rather through the task force of experts and the parliamentary study that would follow therefrom.

We heard a lot from the previous member about evidence and whether the government believes in evidence-based approaches. I would reiterate for the record that absolutely we do, and some of that evidence relates to a very specific document in the submissions that were made by the Association des médecins psychiatres du Québec.

In November 2020, the Quebec association of psychiatrists, or AMPQ, published a very informative discussion paper on access to medical assistance in dying for people with mental illness, which underscores the reasons that the government believes that a 24-month sunset clause is needed.

The work of this association will no doubt be foundational to the expert review of this issue. It points to some possible solutions, but they are fairly complex. That is why we need to carefully consider solutions that could work nationally.

The association is of the view that whether a mental illness is incurable or not can “only be determined at the end of a long process, after attempting several treatments and assessing their effects”. The association further notes that before coming to a conclusion on eligibility a psychiatrist “should explore other aspects that shape the patient’s life experience and consider strategies to improve the social circumstances that add to the suffering”. This dovetails exactly with some of the interventions made in the last portion of the debate by members of the NDP, who talked about supports that surround a person's life circumstances, such as income security, housing security and so on.

Going back to the submission from the association, it notes, “Psychiatrists must be involved as both the first and second assessors”, and also notes, “access to psychiatric care varies significantly from one region to the next.”

In light of all of these considerations, the Association des médecins psychiatres du Québec suggests that we create a new administrative body with regional offices dedicated to MAID on the basis of mental illness that would coordinate such requests, identify MAID assessors and providers, and ensure access to psychiatrists. It also suggest that such an administrative body could monitor the assessment process in real time instead of after the fact.

I highlight this in some detail because I believe the association's discussion paper is focal to why we as a government believe that a 24-month sunset clause is needed. The work of the association will no doubt be foundational to the expert review of this issue. The paper points to possible solutions, some of which are fairly complex in nature, which underscores the need for careful consideration of what could work nationally. Further, I underscore that government and Parliament will need time to make decisions about which safeguards should be codified in federal MAID legislation as a matter of criminal law relating to mandatory access across the country.

I will now turn to the third amendment.

The third amendment being proposed by the Senate, which the government proposes to support with some modifications, relates to the notion of the parliamentary review. The government has repeatedly committed to facilitating the start of the parliamentary review required by Bill C-14 as soon as possible following the adoption of the current Bill C-7. Our proposed adjustments to the amendment proposed by the Senate would ensure that all of the relevant issues are front and centre for the joint parliamentary committee that would undertake this work. I underscore the notion that it is joint, because it would be a combined study by the Senate and the House of Commons, similar to what we saw prior to the advent of the original Bill C-14. Its mandate would look at things that were contemplated by the original intended review of Bill C-14, such as requests by mature minors and issues that relate to advance directives.

In addition, we would include palliative care and safeguards for persons with disabilities within the scope of that mandatory joint parliamentary review by the Senate and the House. We also proposed to adjust the timelines, so they are both realistic in a pandemic environment but still ambitious, given the seriousness of the issues at hand. These are important features we feel would enable us to move forward in a collaborative manner involving the work of both Houses of Parliament, as well as the work of all legislators from various parties.

I would note parenthetically that, obviously, the member for Esquimalt—Saanich—Sooke has been very instrumental in leading the charge and a call for a study in Parliament of the previous bill, Bill C-14. Some of what we are proposing incorporates his views on the scope of what that review should look like.

Finally, there are two Senate amendments that, in the government's view, cannot be supported.

The first is the amendment to the mental illness exclusion itself. While I appreciate that some have advocated for greater clarity around what mental illness means in this context, the government is concerned that this particular amendment, as drafted by the Senate, implies that neurocognitive disorders are ordinarily understood as being mental illnesses, which, in fact, may not be the case. The federal government will work with its provincial and territorial counterparts to ensure a consistent application of the mental illness exclusion until it sunsets.

The second Senate amendment we propose to reject is the amendment to expand the waiver of final consent. Providing MAID in the absence of final consent is extraordinary and carries risks, and we acknowledge that. The Senate amendment goes beyond the scope and principle of Bill C-7, which would permit the waiver of final consent only in narrow circumstances that present the fewest risks. Any expansion of advance consent or proposal for advance requests, which are sometimes called advance directives, will involve greater risks and should be the object of careful consideration by the parliamentary review.

It has always been the notion that the issue of advance directives should be contemplated only after consideration by the broader parliamentary review. This was the case with the previous Bill C-14, and it is certainly the case now with what we are proposing as a government with respect to the parliamentary review that should ensue herefrom.

In the time I have remaining here, I would like to canvass a couple of points.

One is the notion that has arisen during the discourse of today's debate that somehow the government and de facto the Senate are somehow pursuing a route that is putting undue focus on facilitating an end of suffering, including facilitating the passing of an individual, as opposed to making the condition of life more viable and also more supported. That assertion is categorically false. The government's record over the last five and a half to six years speaks for itself in terms of the supports we have put in place, whether they are in long-term care, home care or supports for mental illness.

It relates to, as the previous member mentioned, a unanimous consent motion being passed regarding a suicide hotline. The supports we have put in place, such as the Canada health and social transfer, and a few intensive efforts to address home care and palliative care, are significant investments. We are ensuring that people are making such significant decisions based on the full understanding of what options are available to them and what supports are available to them. Can more be done? Of course, more can be done. I think that is what is important about what arises from a debate such as this.

The second thing I want to underscore is something that arose many times when Bill C-7 was in our chamber the first time, meaning its second and third readings prior to being sent to the Senate, which has again arisen today in the context of today's debate, and that is this idea that persons with disabilities are somehow being victimized, targeted or unfairly treated by this particular bill. I will raise a couple of important points, which I think are really important for all members of Parliament to understand. I have raised these points before, but I will reiterate them.

What we are talking about here is autonomy and the autonomy of individuals to make choices about the end of their lives and their passing, and that butts up against the need to protect vulnerable people. It is an important balance, and that is what is at the heart of this. This makes it probably the most difficult issue any of us have dealt with, at least it has been for me in my five and a half years as as parliamentarian. That being said, people need to understand that the case that was brought before the courts that we are responding to now was brought by two individuals: Monsieur Truchon and Madame Gladu.

Both suffered from disabilities, but because they were not near the end of their lives, they were prevented from accessing the MAID regime under Bill C-14. This is because it was, at that point and even now, until the law is potentially changed, an end-of-life only regime.

I want to read for members what the court analyzed with respect to that, because we have heard a lot in this discussion that somehow what we are trying to do in Bill C-7 is discriminatory of persons with disabilities. The notion of discrimination under section 15 was squarely in front of the court in the Truchon case, and what the court said is quite the opposite. I am quoting from paragraph 678 of the Truchon decision. The court said:

The requirement at issue reveals a legislative regime within which suffering takes a back seat to the temporal connection with death. Where natural death is not reasonably foreseeable, the consent in suffering of the disabled are worthy only of the sympathy of Parliament, which has adopted a protectionist policy toward every such person, regardless of his or her personal situation. As soon as death approaches, however, the state is prepared to recognize the right to autonomy. This is a flagrant contradiction of the fundamental principles concerning respect for the autonomy of competent people, and it is this unequal recognition of the right to autonomy and dignity that is discriminatory in this case.

The judge went on, in paragraph 681:

By seeking to counter only one of the stereotypes that the disabled face—vulnerability—the challenge provision perhaps perpetuates another probably more pernicious stereotype: the inability to consent fully to medical assistance in dying. Yet the evidence amply establishes that Mr. Truchon is fully capable of exercising fundamental choices concerning his life and his death. As a consequence, he is deprived of the exercise of these choices essential to his dignity as a human being, due to his personal characteristics that the challenged provision does not consider. He can neither commit suicide by a method of his choosing nor legally request this assistance.

I read this into the record to remind parliamentarians that discriminating against anyone in Canada should not be countenanced. However, what was squarely before the court was whether the old regime was discriminatory against persons with disabilities who want to make autonomous choices about their passing, but were not near the end of their lives. The court found, conclusively, that the old regime was discriminatory. That is what prompted this and other changes to the legislation.

I think it is very important to understand that. When I, and others, talk about the heterogeneity among people with disabilities, that is what we are driving at. It is not for Parliament, in my respectful view, to impede, limit or curtail the competence and autonomy of persons, including persons with disabilities, who want to make significant choices about how and in what manner to end their suffering.

I think a compassionate response by this Parliament, a response that entrenches dignity, requires us to do the opposite. I know it is difficult. I know it is moral. I know it is an issue fraught with a lot of personal conviction, and that it is a difficult task for many of us, but that is the task before us as parliamentarians. As somebody who is familiar with discrimination law, I wanted to correct the record, in terms of what I have heard in today's debate and previous debates, about how discrimination plays into the analysis.

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

Mr. Speaker, in a 2017 position paper with respect to the previous bill on this issue, Bill C-14, the Canadian Mental Health Association said, “As a recovery-oriented organization, CMHA does not believe that mental illnesses are irremediable.” Again, “CMHA does not believe that mental illnesses are irremediable.” By adopting this amendment as proposed by the government, we would be directly contradicting what the Canadian Mental Health Association is saying with respect to mental illness. This is a government that talks about being guided by experts and science. That has become a totally meaningless talking point for it now. We have all of these organizations and the experts come forward to say that some people disagree. Come on. The evidence is very clear and the experts agree. Let us listen to the Canadian Mental Health Association and support the initiative of—

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

Mr. Speaker, miracles never cease. Maybe this is the beginning of a dramatic change in things. Time will tell.

Regardless, the specific comments by the member for Timmins—James Bay that really were kind of “aha” moments for me was when he said that Bill C-7, even as previously written, and certainly with these proposed amendments, would make people living with disabilities in some sense second-class citizens when accessing our health care systems, as we would put them on a different track. He said it would create “a second track of humanhood in this country”, which is something that all of us should be seized with, especially in response to the repeated testimony of many organizations that represent Canadians with disabilities, as well as organizations representing Canadians dealing with mental health challenges.

We are here debating Senate amendments to Bill C-7, and specifically debating an amendment by my colleague that would try to change the government's response to the largest substantive amendment by the Senate that the government is proposing to agree with. I will delve particularly into the issues of that amendment. However, first of all, the government is using all kinds of arguments today, and previously, about how this has been a long time coming, that it has been debated extensively. I want to respond specifically by commenting a little on the journey that brought us here with this legislation, because we have really taken all kinds of twists and turns far from where this conversation on this particular bill started.

Allegedly, the genesis of this conversation was a lower court decision in Quebec that dealt specifically with the issue of reasonable foreseeability, and not the issue we are talking about today. It is a different issue that dealt with the issue of whether somebody should be able to access euthanasia if their death is not reasonably foreseeable. This court said that a person should be able to access euthanasia in that case. The government, contrary to advice from us, decided not to appeal that ruling. Importantly, the government could have proceeded with appealing that ruling and then used the window of time available to consider a different legislative response. However, the government created for itself a sharp timeline through its decision to not repeal that ruling.

Subsequent to that, this justice minister brought forward a piece of legislation that deals with many issues related to euthanasia far beyond the parameters of that court decision. The court decision dealt with reasonable foreseeability. I believe that if the government had proposed a piece of legislation that dealt with, and only with, the question of reasonable foreseeability and left other issues for other pieces of legislation, then that bill would have long passed and we would not be talking about fourth extensions, new court deadlines and so forth.

The reason we are in a situation where the bill has not yet passed is that, effectively, the government created an omnibus bill by tacking onto the issue of dealing with reasonable foreseeability many other, unrelated issues: questions of advance consent, questions of removing existing safeguards, questions around the 10-day reflection period. There were many different issues that had to be discussed as the result of the government's decision to put forward legislation, most of which were completely unrelated to the Truchon decision.

I think that, in a very misleading way, the government tried to create this artificial timeline link to the Truchon decision for all sorts of issues that have absolutely nothing to do with the Truchon decision, and there is very little basis for debating that reality. The government could have focused its response to the Truchon decision on the issues raised by that decision, and likely would have been able to justify a more aggressive timeline with respect to the bill, because there would not have been so many issues that needed to be discussed.

The government put all of those additional issues into Bill C-7 while failing to move forward with a mandated legislative review. The previous bill, Bill C-14, had mandated that there would be a legislative review. The government has not moved forward on that at all, and instead packed all of these other issues into Bill C-7. Then we had debate in the House, we had committee hearings and all the way along the government was trying to create as much urgency as it could, saying that “We have to move this forward because of the Truchon decision”, even though there was extra content riding on that issue, far more than was dealt with in the original Truchon decision.

The justice committee held a very limited number of hearings, I think it was only four, on all of the issues raised by Bill C-7. Despite that limited time, many people came forward to express significant concerns and opposition. There were physicians, mental health experts and people representing those in the disability community, and not a single stakeholder representing the disability community expressed support for this legislation. Not only were so many people coming forward to those committee hearings, but there also were over 100 written briefs submitted to the justice committee by individuals or groups who took the time to express their perspective and, generally, their concern about this legislation.

The justice committee moved so quickly that it is a veritable certainty that members did not have any reasonable opportunity to review those briefs. In fact, many of those briefs were initially rejected by the committee; then subsequently, thanks to the good work of my colleague from St. Albert—Edmonton, those briefs were formally received, but the committee then immediately proceeded into clause-by-clause consideration of the bill without allowing time to review the content of the briefs.

We had this urgency created by the government's decision to pile issues on top of the Truchon decision that were unrelated to the decision. Then we had extremely limited consultations by the justice committee, as the government tried to use this trick as a justification for pushing the legislation through as quickly as possible.

However, throughout those conversations at the justice committee, the government was clear that its bill and its policy was not to allow euthanasia when the primary underlying complaint is mental health challenges. The Parliamentary Secretary to the Minister of Justice and others have repeatedly spoken about this aspect of the legislation, namely, that it includes an exception clearly specifying that mental health challenges should not be a basis to receive euthanasia.

On that point, the government was right, and even if members have questions about the substantive value of that position, they should appreciate how the question of whether those dealing with mental health challenges as their primary complaint should receive euthanasia is a completely separate question from the issues raised by the Truchon decision.

The bill then went through committee, came back to the House and Conservatives expressed their perspective. The vast majority of our caucus voted against this legislation. We voted in favour of report stage amendments. There was an extension of hours to accommodate the speeches. The bill then went to the Senate and the Senate has now tried to dramatically further expand the bill.

As we all know, the unelected Senate, made up now overwhelmingly of individuals who have no party affiliation and who were appointed by the current Prime Minister, undertook a study that went far beyond the scope of the existing bill and recommended a radical expansion, certainly beyond what stakeholders and the public were looking for, and beyond what had ever been considered or debated by the House of Commons.

Whatever very legitimate criticisms one might have of the old model of the Senate, made up of non-elected people with strong party affiliations and who are not not directly accountable, at least there was some mechanism of accountability through political parties. However, now we have in the Senate a vast majority of individuals who are not connected to any political party, who are not identifiable in terms political affiliations, and who are appointed by the Prime Minister without any consultation with other parties, without any kind of oversight, and who then exercise a defining power over legislation. That is a huge problem that we have to grapple with.

Part of how we could grapple with it in the House of Commons is by having the courage, when we receive amendments from the Senate that go far beyond the scope of anything considered in the original debate on the bill, never mind what was in Truchon, to say “no” to them. We could say that we appreciate the review work that has taken place, but at the end of the day, Canadians elect members of the House of Commons who are empowered to study issues in detail and to hear from Canadians and to come to conclusions.

The Senate can study and make recommendations, but, at the end of the day, what the government is now proposing by adopting the amendment proposed by the Senate with respect to mental health as its position is that the people's House, the House of Commons, should adopt in a single day something that the government had up until now said was not its policy, something that is clearly very complex and requires further study.

Not only is it unrelated to Bill C-7, but it is also completely unrelated and light years away from anything contemplated in the Truchon decision, which dealt very narrowly with the question of reasonable foreseeability.

We have this particular issue of the Truchon decision, with Bill C-7 piling many other issues on top of it, and now we have the Senate piling so many additional issues on top of that, including its proposed amendment on advance directives for those who are healthy. Somehow we, in the House of Commons, are supposed to change our position on this fundamental issue, with no study and no review at committee and the government seems to want this to happen in a single day.

I will go further than that in terms of the process. I was up last night preparing information, looking for the data. It was certainly well after 9:30 p.m. Eastern time, closer to 10:00 p.m. that the Order Paper was published. It was only then that it was evident what the government's position was. The government expects that if it takes a position on this substantive, really earth-shattering issue for Canadians dealing with mental health challenges and their family members, that members will see it and adopt that position, or in any event vote on it, all within a single day.

What a profound degeneration of our democratic institutions the government is trying to preside over. There are many other examples that we could talk about. We could talk about the lack of respect by the government for motions passed by the House of Commons on various other issues.

What we see before us right now is a government, that did not win the popular vote in the last election, telling us to, in a single day, adopt a series of changes that were proposed by a Senate made up of independents that the Liberals appointed primarily, and is complaining about members wanting to engage in these issues at greater depth.

The direction the government is taking our democracy is very troubling. I hope that members would stand with us, at least members from all opposition parties, in insisting that the government do so much better on this and support the amendment put forward by my colleague that we are debating right now that rejects this very substantive amendment from the Senate and, instead, say that if the government wants to change its policy with respect to euthanasia for those dealing with mental health challenges, it should at least propose that as part of a legislative package not constrained by a court timeline, and that the House could take the time required to study it at committee, to assess those issues and to move forward, instead of this artificial timeline created by the pairing of the Truchon decision with all of these other issues.

Those issues of process are of critical importance, but I now want to comment on the specific issues raised by this amendment, that is, the government's proposal now to allow euthanasia for people whose primary and only health challenge is a mental health challenge.

All of us, including me, have people in our lives who are close to us, either friends or family members, who have suffered from or are suffering from mental health challenges. I am sure many, if not most, if not all members of the House have had a conversation with someone in their life who comes to them and says, “I don't think I can go on. The pain I am experiencing....”

In those situations, I think for all of us, how we love those people and try to support them is by trying to show them that are loved and valued and that their lives are worth living.

We invest so much time and energy into suicide-prevention education. We try to tell younger people, older people and people of all ages that their lives are valuable, that they are loved and that their lives are worth living. We recognize that for those who are really in the depths of experiencing mental health challenges, it may feel like there is no treatment and there is no going on. However, mental health authorities have said in this country that mental health challenges are not incurable, that it gets better, that there are ways forward and that there are ways of managing, responding to and even fully addressing these kinds of challenges. We as individuals try to send the message to others in these moments of real, existential pain that they are loved and valued, and that there are ways of managing and addressing their pain.

This amendment would radically change that reality. It would take us from a world in which the emphasis is on suicide prevention for those who experience these challenges to a world in which a person who feels that they are in the depths of despair can go to a health care practitioner and say, “This is what I am experiencing. I think I cannot go on.” Instead of affirming to the person that life is worth living, they can be supported and that it does get better, the person would be told that the their options are having a practitioner work with them to try to make things better or having the state facilitate their desire for suicide.

What message does it send if we go from a dynamic of suicide prevention to one where some people experience suicide prevention and others experience suicide facilitation? What if somebody who is in the real depths of existential pain and going through deep challenges is called upon to choose between suicide prevention and suicide facilitation?

We had a unanimous consent motion adopted by the House to have a national 988 suicide prevention line. What message would it send to people if Parliament were to pass the amendment proposed by the Senate? What message would it send to people in that situation? I wonder what message it would send to young people who are dealing with these challenges.

Of course, the current legislative framework is that euthanasia is only available to those who are 18 years of age and older. That is also being considered as part of a review, so we cannot bank on that remaining a reality if this passes.

I asked what kind of message it would send to young people facing these challenges if we told them that it was acceptable to society for the state to facilitate suicidal ideation for adults, and that the solution was some kind of state-coordinated suicide facilitation. It really is horrible, in terms of the direction it would take us and the example that it would send.

Former Liberal MP Robert-Falcon Ouellette spoke eloquently and shared his perspective, from his indigenous culture and values, about what was so wrong about the government's original Bill C-14. He and I had a town hall in my riding together: a Liberal MP and a Conservative MP. We talked about many issues, most of which we disagreed on but some of which we agreed on. He made the point of asking what message it would send to younger people when older people are told that death is the solution. The values that he brought to the table underline the need for listening to Canadians on this issue. They underline the need for stronger consultation with indigenous communities.

As one previous witness told the committee on Bill C-7, indigenous Canadians are looking for medically assisted life. People with disabilities and mental health challenges would say the same thing: What they are looking for is medical assistance in living, not this rushed track, for those who are dealing with mental health challenges, toward suicide facilitation.

This needs more debate. I believe the amendment from my colleague should be supported to defeat the Senate amendment so that we can do more to protect people in vulnerable situations across the spectrum of challenges, and so that we do not, as the member for Timmins—James Bay spoke about, create a dynamic in this country where those living with disabilities are viewed or treated by our medical system as second-class citizens.

I look forward to the continuing conversation and to questions from my colleagues. Again, we need to do something like that.

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

Mr. Speaker, that is why I took great pains during the course of my speech to point out that the mandated legislative review, as was spelled out in Bill C-14, has not yet happened, which is why my colleague from Esquimalt—Saanich—Sooke brought in Motion No. 51 to set up a special committee to study the matter.

I really believe, especially with mental illness and the fact that the Standing Committee on Justice and Human Rights said that adequate protocols and safeguards are not yet in place, that we need to have a very substantive review before we change the legislation.

Again, I made reference to building the plane as we are flying it. I really believe we need to hear from a committee before we make recommendations as to how the legislation should proceed.

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

Madam Speaker, we certainly are dealing with a very sensitive subject matter with today. This Parliament and the last Parliament both have had quite a long journey in dealing with the substance and subject matter of medical assistance in dying.

I know that I along with many of my colleagues in all parties have been recipients of a huge amount of correspondence on this subject matter, both from organized groups across the country and our very own constituents. It can be hard as a member of Parliament to find one's own way through all of that, because the feedback we receive and the strong passions are evident on both sides of the argument. I was a witness to that with Bill C-14 and, of course, it has been replayed for Bill C-7.

There have been difficult conversations with constituents. I have constituents who feel the government legislation does not go far enough. They felt that way for Bill C-14 and some feel the same way for Bill C-7. Others feel it goes too far and establishes dangerous precedents. It can be tough, but in those conversations I have had with my constituents, I have always tried to guide myself with the difference between sympathy and empathy. With sympathy, we can feel sorry for one's situation in life, but we are still looking at another person's situation with our own biases and world view, whereas true empathy, which is very much required when we are dealing with medical assistance in dying, is to try to put ourselves into that other people's shoes, to try to see the world from their point of view, to see exactly why these issues and matters are so important to them.

I also try to use section 7 of the charter to guide myself, the fact that it is explicitly written that 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. Essentially it means that people have a right to control their own bodily integrity. It is engaged whenever the state tries to interfere with personal autonomy.

This is really the crux of the matter. It is personal autonomy, a person's decision on how he or she is going to meet the end of his or her life. For those of us who are blessed to lead healthy lives, who are not intolerably suffering from a grievous and irremediable medical condition, we really cannot know what other people's lives are like. We do not know what it is like for those people to not have autonomy over their own bodily functions or their bodily integrity, so to speak.

In today's debate, one thing should be very clear. The House of Commons has already spoken to Bill C-7. We have already decided on what we want to do as the people's elected representatives. Of course, the Senate has reviewed the final third reading version of the bill that we sent to it and the Senate sent it back to us with some of its recommendations. This is not the time or the place to go over old arguments that were already dealt with by the House. This is really a time for us to focus exclusively on what the Senate has brought to us.

It is important to note that nothing in Bill C-7 is going to change the very high standards set out in the original Bill C-14. To receive medical assistance in dying, patients need to have a condition that is incurable. They must be in a state of irreversible decline and they must be facing intolerable suffering. The door is not being opened wide, as some have suggested. Those basic parameters are still in place.

When we are dealing with this subject matter, it is important to note that most Canadians know someone who has been affected by intolerable suffering at the end of his or her life. Generally, my caucus has been supportive of this bill because it does respond to the need to reduce that unnecessary suffering at the end of life. As I alluded to, section 7 of the charter helps to preserve the autonomy of decision-making for individuals.

I made reference to the fact that most Canadians know someone who has been affected by a disease and intolerable suffering. I have had that personal experience as well with a close family member, and that happened at a time before we had medical assistance in dying. It was a long-drawn-out battle with cancer. It can be hard on the family members too, because they have to watch a beloved family member suffer, in some cases for several months, before the end mercifully does come.

It is a very weighty subject matter, and I want to approach today's debate with that firmly in mind.

I was first elected in 2015, so I was a member of the 42nd Parliament. I was there for all the Bill C-14 debate, which was forced upon Parliament at the time by the Supreme Court of Canada's decision in Carter. We, as New Democrats, ultimately did not support Bill C-14, because we felt the bill at the time was too restrictive. I remember referring to the fact that the courts would force this bill back before Parliament, and that happened with the Quebec superior court.

I do not want to dwell too long on this history, but one thing that is very important to mention, in the context of today's debate, is that Bill C-14 had a provision in clause 10, which mandated that a legislative review had to happen at the beginning of the fifth year. I will read it out for my hon. colleagues. Clause 10 reads as follows:

At the start of the fifth year after the day on which this Act receives royal assent, the provisions enacted by this Act are to be referred to the committee of the Senate, of the House of Commons or of both Houses of Parliament that may be designated or established for the purpose of reviewing the provisions.

That is very clear language, and the beginning of the fifth year was in June 2020. We are almost at the end of February 2021.

The reason I raise this is that this important legislation review would have dealt with a lot of the questions the House is now considering and debating. It almost feels like we are building parts of the plane as we are flying. Many of these debatable items that are going on with Bill C-7 need a very careful study. They need to have the timeline afforded to them so we can hear from Canadians across the country, from expert witnesses and actually craft a law that responds to those very important bits of feedback.

I also want to take this opportunity to recognize my friend and colleague, the member for Esquimalt—Saanich—Sooke, a neighbouring riding of mine. He has long recognized this legislative requirement of Bill C-14. He has raised it with the Minister of Justice on several occasions.

Due to his frustration at the government's inaction on this front, he introduced Motion No. 51, which would establish a special committee of the House to include a review that would not be limited to but would expand on several issues. It would have looked at requests for medical assistance in dying by mature minors, advanced requests and, most important, requests where mental illness was the sole underlying medical condition. The committee would also be charged with looking at the state of palliative care, the adequacy of safeguards against pressure on the vulnerable and so on. If we had such a committee in place, already looking at these issues, then we may have had some answers to these important questions by this point.

I will move on to what the Senate has sent back to the House. I was reviewing some of the transcripts from the Senate, some from its legal and constitutional affairs committee, but also from its third reading of the bill.

The Senate legal and constitutional affairs committee decided to report back to the main body of the Senate with no amendments to the bill but some observations. The substantive amendments to the bill all came at third reading. For example, there was a proposed change to the wording of subsection 1(2) for mental illness to include a neurocognitive disorder, looking at advanced requests and so on.

Today, we are dealing with the government's response to those amendments. The government has crafted a motion for the House to consider on what amendments it agrees with, those it does not and those it wants to amend. The Senate disagreed with the expanded definition for the exclusion of mental illness. The government's motion disagrees with the advanced request part of it.

However, as a quick summary, the government motion agrees to the sunset clause for the mental health exclusion. Instead of 18 months, the government has proposed it be expanded to two years after royal assent. Essentially this legislation, once it becomes a statute of Canada, if passed in this manner, will have a ticking clock of two years for a committee to come up with the appropriate safeguards in place.

The government's motion in response to the Senate also mandates that the minister is to set up a committee of experts to work on mental health protocols. It requires a voluntary collection of data based on indigenous identity, race and disability. It sets up a joint committee to do the legislative review, starting 30 days after royal assent.

The most substantive part of the government's motion that really stands out to me is the fact the government is agreeing to the sunset clause on the mental health exclusion. The reason it stands out for me is because when Bill C-7 was originally proposed to the House, the government's own charter statement made some very strong references to why mental health, as an underlying condition, was to be excluded. For the government to backtrack on that and agree to a sunset clause stands out to me.

I acknowledge that we will have two years, but with such a substantive change to the law. it would make sense to me as a legislator to have a specific committee set up to look at all the things we need to look at to make this bill appropriate and proper so it fits will all the important safeguards we need to have in place. I am a bit wary of having that timeline put on the House and forcing us to do these things.

My Conservative colleague before me has now proposed an amendment to the government's motion. Basically, the Conservatives are proposing to get rid of the sunset clause. That is the most substantive thing. At first glance, that seems reasonable, but because I have only really had about 10 minutes to adequately review what the Conservatives have proposed, I would like more time to refer back to that in later days.

I mentioned the charter statement the government initially brought out for Bill C-7. I would like to read a highlighted section of that charter statement where it reasons why it wants to exclude the mental health provisions in the bill. It says, “evidence suggests that screening for decision-making capacity is particularly difficult, and subject to a high degree of error.” It further says, “mental illness is generally less predictable than physical illness.” It also highlights some concerns from other countries that permitted medical assistance in dying for mental illness, namely Belgium, the Netherlands and Luxembourg.

I want to make it clear that I am not necessarily of the opinion that mental health should be excluded, full stop. What I am saying and what I am arguing is that we need to have an appropriate review of all of this incredibly weighty subject matter before we dive into actually changing the legislation.

This is backed up by the work that was done in the House of Commons' very own Standing Committee on Justice and Human Rights. The justice committee heard that the protocols and safeguards for medical assistance in dying for those with mental illness do not exist and that it would take a significant amount of time to develop them from a clinical perspective. The fact is that if the committee's work on mental health is not complete within two years, that clause will be sunset. I have a real problem with us putting that part up front before we do the hard work at committee.

If I were to summarize my speech, the real issue I have is that I do not believe we should have a substantive expansion of what Bill C-7 purported to do when the bill was passed by the House. I do not think we should have any expansion to it before we have had those reviews in place.

I realize that in some cases, the Senate does like to provide feedback to the House, and there have been several instances of amendments being proposed by the Senate. The real issue I have, the elephant in the room, is that the Senate is still an unelected and unaccountable body.

As members of Parliament, we have to face our constituents. We are accountable to the people who elected us. Whenever the next election comes, the people of my riding of Cowichan—Malahat—Langford are going to judge me on how well I did my job. It is the same for every single member of Parliament who sits in the House of Commons. We have to be accountable for the things we say in the House and how we vote. Senators do not have to do that. I know there are a lot of honourable people who serve in that institution, but they are free from that accountability mechanism. The real problem I have is that I firmly believe the House must always be the final arbiter in the decisions that are made, because the people of Canada elected us to make the laws on their behalf.

In response to the many concerns I have heard raised, both in the House and in correspondence from the disability community, I would like to leave my colleagues with some thoughts. If we are rightly concerned about how persons with disabilities are currently living in Canada and what their quality of life is like, rather than focusing so much on Bill C-7 and medical assistance in dying, why do we not take this opportunity to start enacting reforms and enacting policies to make their lives better? If we look at the income supports that are out there for persons with disabilities and the amount of money they get to scrape by every month, we see a shameful record on our country, and it is something that we need to fix.

We have already acknowledged through the pandemic and through COVID-19 response measures that individuals should be receiving $2,000 a month to get by, but we do not afford that to persons with disabilities. Even when the House had an opportunity to get financial aid to that group of people in Canada, it took us over six months to do so. That is a shameful record, and it is something that the House really needs to concentrate on if we are going to adequately and meaningfully address that issue.

I appreciate having had this opportunity to speak to Bill C-7 and I welcome any questions and comments that my colleagues may have.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, without presuming what the committee will find, I think that advance requests for neurocognitive diseases will be possible, but we will also be able to make some technical amendments to the existing law to make it fairer.

That is what I would say, since Bill C-7 was a closed bill that could not be used to make amendments to Bill C-14. We can now look at this issue and see how the law can be improved. The concept of advance requests can be dealt with, with all of the necessary safeguards to reassure everyone, including practitioners, because this is a new practice—

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

Madam Speaker, the member for Montcalm indicated that the Bloc will be supporting the government's motion in response to the Senate amendments, and I want to ask him specifically about the sunset clause. I listened with great interest to his arguments, but he would know full well that Bill C-14 mandated a legislative review, which was supposed to have begun at the beginning of the fifth year, in June 2020. We are already way past that date.

The government's charter statement raised concerns about extending this law to mental illness, and even the justice committee's review of the bill showed that safeguard protocols do not exist and that it would take a significant amount of time to develop them. I am not necessarily against this, but would the member not agree that it would probably be a better approach to have a full review before we actually engage in an amendment to the legislation?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I do not want to keep members in suspense for too long. The Bloc Québécois will support the government's motion, and I will explain why.

I would like to tell all my colleagues that we need to work across party lines on these sensitive issues and find a way to move forward.

I remind my colleagues that Quebec's end-of-life legislation has often been cited as an example, not only because it is a good system, but also because of the way all members of the Quebec National Assembly worked together to create that system. Quebec's act came into force in 2015. The Select Committee on Dying with Dignity was created in 2009. The legislation was passed in 2014 and assented to in June 2014. This means that there was a process that ultimately involved debate. The Quebec National Assembly was able to consider all the differences and find common ground, which served as the foundation for the act. At the end of the process there were very few people against the act. There was broad consensus on this piece of legislation, both in the National Assembly and among Quebeckers.

In Ottawa, members have always taken action in response to court rulings. The amendments that need to be made to the Criminal Code in order to incorporate all of these sensitive issues are related to a court ruling. In this case, the legislators finally need to take action because the law has been deemed unconstitutional and found to violate fundamental rights.

According to Baudouin and Carter, Bill C-14 deprives people of the right to life. For example, it was depriving Ms. Carter, Ms. Gladu, Mr. Truchon and Ms. Taylor of their right to life because they were being forced to shorten their lives. That is not a trivial matter. It is serious.

My Conservative colleagues are saying that we need to protect human dignity and life. I completely agree, but it is important that we not create the opposite effect of what we claim to defend through government paternalism. Vulnerable people are capable of defending and exercising their rights.

However, it is rather appalling to see that, since Bill C-14 was introduced and since a decision was rendered in Carter, we have placed on the shoulders of vulnerable people, people with irreversible diseases, people who are enduring unbearable suffering, the burden of defending their case before the court in order to get access to medical assistance in dying.

Why are we agreeing to vote in favour of the motion? We are doing so because we need to make progress in a debate like this.

I have said this before and I will come back to it again later. Even though we said that we agree with the underlying principles of Bill C-7, we would have liked for the bill to go a little further. However, we still need to recognize that Bill C-7 responds to situations like those of Ms. Gladu, Mr. Truchon and Ms. Parker.

Bill C-7 also makes it possible for people in the terminal phase of life—I am not talking about the terminal stage of an illness when death is not foreseeable—to avoid waiting the mandatory 10 days with two witnesses before finally proceeding. Many people with cancer go through a long process. Even in the most aggressive cases, it takes a few months. People wait until the last minute to proceed because nobody wants to die. Everyone wants to wait until the last minute and push the limits of what they can tolerate. Once they reach that limit, these people want help.

Once in the terminal phase of life, a person who had been receiving palliative care at home may be taken to the hospital urgently, where health workers will note their rapidly deteriorating condition. Consider a person who, for the past two years, six months or three months, has always told their therapists that they want medical assistance in dying because they do not want to suffer. This person has been receiving palliative care and medication at home, but their condition is deteriorating. Why should they have to wait 10 days for access to medical assistance in dying in the terminal phase of life when the process of dying has begun and is irreversible? Bill C-7 covers this situation and offers this option. That is a step in the right direction.

There are of course other sensitive issues to be addressed, such as mental illness as the sole underlying medical condition. In my remarks last December, I had the opportunity to say that, as a parliamentarian and legislator, I did not have the expertise to reach a decision on that point. I think it is wise that the motion implies two things and that an independent panel of experts is being set up. The panel will have to look at the recommended protocols, guidelines and safeguards for MAID requests from patients with mental illness as their only condition.

Earlier, my Conservative colleague was talking about the requirement to have safeguards that protect the individual and help prevent abuse. Our Conservative colleagues would have us believe that we are in some sort of house of horrors, as though the health care system itself were inherently evil, and we need to protect persons with disabilities because our prejudices about these individuals might cause health care professionals to give up, as though people are going to be coerced and euthanized without their consent. I find it very difficult to understand that kind of rhetoric.

A similar independent panel of experts was set up in Quebec and a report was prepared. I think we should carry on with this work to get a clearer picture. Not only will the panel of experts deal with this issue, but there will also be something else we have been asking for for a long time and that is the creation of a review committee for the entire body of work. Bill C-7 could have included amendments to C-14, An Act to amend the Criminal Code, which could have led to a new review of the legislation in two, three or four years. In just 30 days a special joint committee will study the issues of mature minors, advance requests, mental illness, palliative care in Canada and the protection of Canadians with disabilities.

Whether or not an election is triggered and there ends up being a change in government this committee is enshrined in law and will begin sitting in 30 days. It will work for a year before tabling its recommendations. We may reach a consensus or hold discussions for at least 12 months, which the court-imposed deadlines did not allow Parliament to do in relation to Bill C-7 and its previous version, Bill C-14. I think it is necessary.

To come back to the social acceptance of Bill C-7, I would point out to my Conservative colleagues that an average of 80% of people across the country approve it, from 88% in Quebec to 77% in Alberta. I think moving forward is a reasonable compromise. If in 24 months MAID is made available to people with mental illness, this deadline will help determine the necessary safeguards to make practitioners comfortable with this as well. In fact, we need to hear their point of view on this.

On the issue of advance requests for medical assistance in dying, I find it timely that the committee will start sitting in 30 days and that its members will work hard across party lines for the benefit of people who are suffering, like Sarah Demontigny. We will not forget these people, and we will establish a process to ensure that the advance requests they are drafting today will apply once our work is done. That is my hope.

Without making assumptions about the results of our efforts, I think we can come up with something better than the amendment proposed by the Senate if we have meaningful discussions and hear from witnesses. This would make it possible for Quebec, which is responsible for implementing this practice of advance requests, to properly regulate it. We could identify how to best amend the Criminal Code to allow for this.

I spoke about the legal aspect, but I will now come back to the fundamental principles. We are in the process of reaching a compromise because reason dictates that we must move forward. Bill C-7 represented a step in the right direction with the official commitment of an expert panel on mental health. I think it would be a good idea that the special committee I mentioned be a joint committee. This would ensure that everyone is doing the same work and hearing the same witnesses at the same time to eventually arrive at a conclusion, rather than having a game of ping pong between the two chambers—one of which is outdated, in our opinion. Let us rally together.

We are doing this for those who are suffering, who have waited too long and who, today, have hope that we will finally complete this work. I believe that the government's motion represents the light at the end of the tunnel for these people, because there is a deadline and we will get there if we all act in good faith and without partisanship.

Bill C-7 already contains fundamental principles, which I will repeat. First, death—my death, just like my life—belongs to me. Why did I say that and why did I say earlier that the Conservatives are practising government paternalism?

I said those things because my own death is a very personal thing, and the state must not tell me what to do or make decisions for me. The state should be creating a framework to protect my decisions. I do not think people should be pressured or forced to go into palliative care until their last breath or to request medical assistance in dying.

During any clinical study, the patient is the standard. When someone who is ill has determined their own limit of what is tolerable, we need to listen to what they are telling us and what comes out of their suffering. This allows us to provide support.

I find it very disturbing that in the debate on medical assistance in dying, MAID and palliative care are always pitted against each other, but in reality, it is a continuum and they complement each other. Later in my speech I will define the notion of human dignity.

Who would not want to receive palliative care before dying from a serious degenerative disease that causes intolerable suffering? We all want relief; no one wants to suffer.

When it comes to end-of-life care, the least you can give someone is palliative care. Unfortunately, for the past 50 years, palliative care has not been the only answer for everyone, unless one is ideologically committed and determined to prove it. At that point, someone comes to the patient's bedside and imposes some religious or other ideology. No, that is not it.

We are in a process where it is imperative that we consider that palliative care can be successful even when a patient's request for MAID emerges. Why? Because the patient is at peace and ready to let go. In fact, I hope all my colleagues are at peace and able to let go when the time comes. This could also be an example of very good palliative care. Palliative care is about support when someone is dying, the easing of suffering and psychological support. It is possible that some will die after suffering until the end, but it is also possible that some are ready to let go. That is when they can be supported.

It is not up to the family or the state to make decisions on behalf of the dying patient or the person suffering from a serious and irreversible condition causing intolerable suffering. The underlying principle of Bill C-7 puts into perspective what is enshrined in law for every human being, namely self-determination.

The law guarantees everyone the right to self-determination. Why take this right away from me at the most intimate moment of my life, meaning my death? Why should the state be allowed to take away my right to self-determination in my decision to suffer until I die in palliative care or to seek MAID? It would be utterly absurd for the state to assume that power.

The state must provide us a framework to be able to do this. I often hear members talk about human dignity. Human dignity implies that we must absolutely—

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, first of all, if we fail to meet this deadline, we will have a different regime existing in Quebec than in the rest of Canada. In Quebec, the Bill C-14 regime would be enlarged to include death that is not reasonably foreseeable without any kind of safeguards. On the other hand, Quebeckers would not benefit from the Audrey Parker amendment or the other compassionate improvements that we made in the end-of-life regime.

In the rest of Canada, there are people who would like to have access to MAID who are not at the end of their life. They would be denied. This is a source of suffering for so many people and they would like it to be alleviated, but they would also not have access to the new benefits in the bill, such as the Audrey Parker amendment.

[David Lametti, Liberal, Minister of Justice]

moved:

That a message be sent to the Senate to acquaint Their Honours that, in relation to Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), the House:

agrees with amendment 1(a)(ii) made by the Senate;

respectfully disagrees with amendment 1(a)(i) because this matter, including questions of most appropriate precise definitions, whether those definitions should be included in the Criminal Code or elsewhere, and whether any consequential amendments or protections relating to issues such as consent and capacity are necessary in relation to such an amendment, will also be addressed by the expert panel and the upcoming parliamentary review, and the Government will collaborate with provincial and territorial health authorities to ensure a consistent approach;

respectfully disagrees with amendment 1(a)(iii), 1(b) and 1(c) because it would permit advance requests for medical assistance in dying before an individual has a grievous and irremediable medical condition, a change which goes beyond the scope of the bill, and further, this expansion of the medical assistance in dying regime requires significant consultations and study, including a careful examination of the safeguards for persons preparing advance request and safeguards for practitioners administering medical assistance in dying, all of which could be part of the parliamentary review undertaken to study this important type of advance request to reflect the crucial input of Canadians affected by the medical assistance in dying regime;

proposes that, with respect to amendment 2:

the portion of paragraph 241.31(3)(a) before subparagraph (i) be amended by replacing it with the following:

“(a) respecting the provision and collection, for the purpose of monitoring medical assistance in dying, of information relating to requests for, and the provision of, medical assistance in dying, including”;

clause 241.31(3)(a)(i)(B) be amended by adding after the words “respecting the race” the words “or indigenous identity”;

subparagraph 241.31(3)(a)(i) be amended by deleting “and” at the end of clause (A), by adding “and” at the end of clause (B) and by adding the following after clause (B):

“(C) information — other than information that must be provided in relation to the assessment of eligibility to receive medical assistance in dying and the application of safeguards — respecting any disability, as defined in section 2 of the Accessible Canada Act, of a person who requests or receives medical assistance in dying, if the person consents to providing that information,”;

paragraph 241.31(3)(b) be amended by replacing it with the following:

“(b) respecting the use, analysis and interpretation of that information, including for the purposes of determining the presence of any inequality – including systemic inequality – or disadvantage based on race, Indigenous identity, disability or other characteristics, in medical assistance in dying;”;

as a consequence of amendments 1(a)(ii) and 3, proposes that the following amendment be added:

“1. New clause 3.1, page 9: Add the following after line 20:

“Independent Review

3.1 (1) The Minister of Justice and the Minister of Health must cause an independent review to be carried out by experts respecting recommended protocols, guidance and safeguards to apply to requests made for medical assistance in dying by persons who have a mental illness.

(2) A report containing the experts’ conclusions and recommendations must be provided to the Ministers no later than the first anniversary of the day on which this Act receives royal assent.

(3) The Ministers must cause the report to be tabled in each House of Parliament within the first 15 days on which the House is sitting after the day on which they receive the report.”;”

proposes that, with respect to amendment 3:

section 5 be amended by replacing it with the following:

“Review

5 (1) A comprehensive review of the provisions of the Criminal Code relating to medical assistance in dying and their application, including but not limited to issues relating to mature minors, advance requests, mental illness, the state of palliative care in Canada and the protection of Canadians with disabilities must be undertaken by a Joint Committee of both Houses of Parliament.

(2) The Joint Committee shall be composed of five Members of the Senate and ten Members of the House of Commons, including five Members from the governing party, three Members of the Official Opposition, and two Members of the opposition who are not Members of the Official Opposition, with two Chairs of which the House Co-Chair shall be from the governing party and the Senate Co-Chair shall be determined by the Senate.

(3) The quorum of the Committee is to be eight Members whenever a vote, resolution or other decision is taken, so long as both Houses and one Member of the governing party in the House and one from the opposition in the House and one Member of the Senate are represented, and that the Joint Chairs be authorized to hold meetings, to receive evidence and authorize the printing thereof, whenever six Members are present, so long as both Houses and one Member of the governing party in the House and one Member from the opposition in the House and one Member of the Senate are represented.

(4) The Committee must commence its review within 30 days after the day on which this Act receives royal assent.

(5) The Committee must submit a report of its review – including a statement of any recommended changes – to Parliament no later than one year after the day on which it commenced the review.

(6) When the report, referenced in paragraph (5), has been tabled in both Houses, the Committee shall expire.”;

section 6 be amended by replacing the words “18 months after” with the words “on the second anniversary of”.

Mr. Speaker, I would like to begin my remarks today by acknowledging the comprehensive study and debate of Bill C-7 in the other place. I applaud their diligence in holding a pre-study of Bill C-7 this past November and an in-depth committee study of the bill earlier this month, and a thematic third reading debate two weeks ago.

The matter of medical assistance in dying, or MAID, is a serious and complex one. The Senate has given it serious thought, and I believe we have given it serious thought in our response in this motion.

Before discussing the amendments, I want to remind hon. members of the process that got us here.

As members will recall, the bill proposes a legislative response to the Superior Court of Quebec's Truchon and Gladu decision in which the court ruled that it was unconstitutional to limit MAID to persons whose death was reasonably foreseeable.

To develop this bill, my colleagues, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, our parliamentary secretaries and I held round table discussions across Canada with over 125 experts and stakeholders.

The government also ran a public online survey, to which over 300,000 Canadians across the country responded. A report summarizing the consultations was released in March. Our government fulfilled its mandate by creating this legislation. The whole process resulted in the bill that was introduced in the House last February.

As hon. members know, we had a thorough debate on this bill before the work of the House was suspended.

The objective of the bill is to recognize the autonomy of individuals choosing MAID as a means of relieving intolerable suffering regardless of the foreseeability of their natural death, while at the same time protecting vulnerable persons and affirming the inherent and equal value of every person's life.

Bill C-7 proposes important changes to the Criminal Code's provisions on MAID in response to the Truchon decision and informed by the results of the January and February 2020 consultations. We recognize these changes represent a critical shift. Our government has been working very hard since the Truchon decision on responding to this important court ruling and remains committed to doing so as quickly as possible.

After months of review of Bill C-7 in both the House of Commons and the Senate, we are now at a critical stage. There are Canadians who are suffering intolerably and would become eligible for MAID under the government's proposed changes, but they are currently unable to access the medical assistance in dying regime. This matter has been thoroughly examined and Canadians need to be able to access the regime. We are renewing our commitment to the parliamentary review to look at the wide variety of other issues related to MAID outside of Bill C-7, but it is essential that we pass this legislation.

Following its thorough debate, the other place has adopted five amendments to Bill C-7. The most significant amendment is the sunset clause that would repeal the mental illness exclusion 18 months after Bill C-7 receives royal assent. I know that many senators and some witnesses from whom they heard believe that the exclusion of mental illness unjustifiably infringes the equality rights guaranteed by section 15 of the charter. I do not share that view. It is my opinion as Minister of Justice and Attorney General of Canada that the mental illness exclusion is constitutional because it serves a protective purpose and is narrowly crafted.

I have spoken before about the inherent complexities and risks with MAID on the basis of mental illness as the sole criterion, such as suicidality being a symptom of some mental illnesses, the impossibility of predicting whether in any given case symptoms will improve or not and the increased difficulty of capacity assessments. These are the concerns that led the government to exclude mental illness as the sole condition for MAID eligibility, given the proposal to broaden it beyond the end of life context. This decision was accompanied by a commitment to further consider the issue of MAID for mental illness in the parliamentary review required by former Bill C-14.

We heard from witnesses who share those concerns, but we also heard from several others who said that excluding everyone with mental illness as a sole underlying condition could be stigmatizing and pointless.

Some mental health experts believe that practitioners can assess the eligibility criteria case by case, particularly the voluntariness of each request and each patient's decision-making capacity.

In November 2020, the Association des psychiatres du Québec released a discussion paper exploring safeguards and procedures that could be put in place for the provision of MAID on the ground of mental illness alone.

While I do think the exclusion is constitutional, and I do not believe that we are fully prepared to safely proceed with the provision of MAID on the ground of mental illness alone, I also hear the concern expressed by Canadians that this exclusion fails to address the issue of whether and when the provision of MAID will be permitted to alleviate intolerable suffering due to mental illness.

That is why I propose that we support the sunset clause, but with an amendment so that it would repeal the mental illness exclusion after 24 months instead of after 18 months, after Bill C-7 comes into force. In combination with this amendment, I am also proposing the enactment of the requirement that the Minister of Health and I establish an expert panel to review safeguards protocols for guidance for such cases. We would give this group of experts 12 months to consider these difficult questions and make their recommendations to us, which we will make public by tabling their report in Parliament. The government and Parliament would then have 12 additional months to consider what safeguards should be legislated before the exclusion is repealed.

We hope this compromise can be acceptable to the other place. While some work has begun on potential safeguards for this group of persons, the work is far from complete and enacting legislation takes time. We think 24 months is still an ambitious timeline to implement such an important change in Canada's MAID policy, but it still provides a fixed timeline in the relatively near future for considering MAID eligibility on the basis of mental illness.

We also welcome the Senate's amendment concerning the parliamentary review. We suggest making a few changes to the timetable for completing the work, and we think it is appropriate to include key issues that this review will address.

The parliamentary review should address important issues, most of which were highlighted during the procedures and committee debates on Bill C-7 in both chambers, including palliative care in Canada, protecting Canadians with disabilities, safeguards for persons with mental illness, medical assistance in dying for mature minors, advance requests for medical assistance in dying and the legislation on medical assistance in dying more generally.

The spirit of the amendment aligns with the government's commitment to make it easier to call for a parliamentary review as soon as possible following royal assent to Bill C-7. This review is absolutely essential for the future of medical assistance in dying in Canada.

During consultations and the committee process in the House and in the Senate, we noted that a certain number of issues should have been reviewed and addressed, but they required a more in-depth study than was possible to carry out within the court-imposed deadline.

Bill C-14 calls on Parliament to conduct that review, and we are using this message today to initiate the process. While the motion sets out important issues that need to be examined, I do not expect the list to be limited to only those issues. Medical assistance in dying is a very broad subject, and we hope to hear from many Canadians on a wide variety of subjects related to it.

Having heard from many witnesses and spoken to many Canadians about Bill C-7, I know that people have different views on these issues. They are challenging issues, and I look forward to the parliamentary review, to hearing from many more Canadians on the subject and to seeing what comes out of this review.

I will let other colleagues speak in greater detail about the Senate amendments to the MAID monitoring regime. I will say that I am proud to support this Senate amendment, with some modifications to make it more inclusive, as a necessary step in the right direction toward gathering better data to inform us all, going forward, about the operation of MAID in Canada. Good data is what grounds good policy, and by knowing more about who requests MAID and why, we can assess the impact of broadening the MAID regime and provide Canadians with the transparency and public trust that such a regime requires.

That brings me to two Senate amendments that I do not believe we can support.

The Senate adopted an amendment that will enable people whose death is not reasonably foreseeable to sign a waiver of final consent. Bill C-7 set out a general policy on the waiver of final consent that intentionally limited it to the most obvious cases with the least amount of uncertainty, specifically when a person's death was reasonably foreseeable and the person was ready to receive medical assistance in dying.

Since the question of expanding the circumstances in which medical assistance in dying can be administered in the absence of contemporaneous consent requires more in-depth study, it is best if it is addressed by the parliamentary review. I know that many people will be disappointed with that decision.

Last year, I had the opportunity to meet Sandra Demontigny, who was diagnosed with early onset Alzheimer's at 39 years of age. She is an advocate for advance requests for medical assistance in dying. We had a long conversation. I was very touched by her story, her beliefs and her book. We will soon begin an in-depth study of this important issue during the parliamentary review.

Finally, while I appreciate the efforts at clarifying what constitutes a mental illness in the MAID context, this is a matter that can and will be addressed by the expert panel and the upcoming parliamentary review, and the government will collaborate with provincial and territorial health authorities to ensure a consistent approach. Through this work, I am confident there will be consistency on the scope of the exclusion, going forward.

Medical assistance in dying has always been a difficult issue that generates a variety of opinions on all sides of the issue. It is an issue that strikes deeply to every Canadian's personal morals and sensibilities. As such, it requires different interests to be considered. I firmly believe that Bill C-7 does so. The law would continue to require informed consent and a voluntary request made by a person with decision-making capacity, while also creating a more robust set of safeguards when the person's natural death is not reasonably foreseeable. These safeguards would require significant attention to be paid to all of the alternatives that might help alleviate suffering on the part of a person whose death is not reasonably foreseeable.

I believe that Bill C-7 is one important and prudent step in ensuring greater respect for the autonomy of a broader category of Canadians who are suffering intolerably. Our legislation would make only the necessary changes to ensure a MAID regime that is responsive to our experience to date and respects the charter rights and freedoms of Canadians to autonomy and safety. In Carter the court said, “the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards”, and that is exactly what Bill C-7 would continue to do.

I look forward to working with all members of Parliament to pass these reasonable amendments prior to the court deadline on Friday. If the suspension period expires without the passage of Bill C-7, Truchon would come into effect without the benefit of the protection, safeguards and exclusions of our proposed bill. I encourage all members of the House to support the government's motion on the Bill C-7 amendments.

Alleged Premature Disclosure of Contents of Bill C-22

[Rob Moore, Conservative, Fundy Royal, NB]

Mr. Speaker, I am rising on a question of privilege concerning the recent premature disclosure of the contents of Bill C-22, an act to amend the Criminal Code and the Controlled Drugs and Substances Act.

Yesterday, the CBC posted online, at 8:47 a.m., an article that outlined details of Bill C-22. Bill C-22 was introduced in the House later that morning. The article outlined several measures contained in the bill, including amendments to the Criminal Code and the Controlled Drugs and Substances Act and the elimination of several mandatory minimum penalties. The article also boasts a reliance on sources, not unlike in the case I raised with you, Mr. Speaker, on another matter of privilege almost one year ago.

On February 25, 2020, I was on my feet in the House defending the privileges of the House on the matter of the premature disclosure of the contents of Bill C-7, an act to amend the Criminal Code (medical assistance in dying). In that case, The Canadian Press posted an article that disclosed the details of the bill before it was introduced in the House and after the bill went on notice.

On March 10, 2020, Mr. Speaker, you came back to the House with your ruling. You said:

First, based on a reading of the Canadian Press article on Bill C-7 on medical assistance in dying, and in the absence of any explanation to the contrary, I must conclude that the anonymous sources mentioned were well aware of our customs and practices and chose to ignore them. It seems clear to me that the content of the bill was disclosed prematurely while it was on notice and before it was introduced in the House.

The rule on the confidentiality of bills on notice exists to ensure that members, in their role as legislators, are the first to know their content when they are introduced. Although it is completely legitimate to carry out consultations when developing a bill or to announce one’s intention to introduce a bill by referring to its public title available on the Notice Paper and Order Paper, it is forbidden to reveal specific measures contained in a bill at the time it is put on notice.

As everyone knows, the Department of Justice, unfortunately, has a history of leaking the contents of government bills. On April 19, 2016, the Speaker found that there was a prima facie case of privilege regarding Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying). At the time, he said:

As honourable members know, one of my most important responsibilities as Speaker is to safeguard the rights and privileges of members, individually and collectively. Central to the matter before us today is the fact that, due to its pre-eminent role in the legislative process, the House cannot allow precise legislative information to be distributed to others before it has been made accessible to all members. Previous Speakers have regularly upheld not only this fundamental right, but also expectation, of the House.

Another question of privilege was raised on March 19, 2001, regarding, once again, the Department of Justice briefing the media on a bill before members of Parliament. In that ruling, Speaker Milliken said this at page 1840 of the House of Commons Debates:

In preparing legislation, the government may wish to hold extensive consultations and such consultations may be held entirely at the government’s discretion. However, with respect to material to be placed before parliament, the House must take precedence. Once a bill has been placed on notice, whether it has been presented in a different form to a different session of parliament has no bearing and the bill is considered a new matter. The convention of the confidentiality of bills on notice is necessary, not only so that members themselves may be well informed, but also because of the pre-eminent rule which the House plays and must play in the legislative affairs of the nation.

The Speaker found another case of contempt on October 15, 2001, once again involving the Department of Justice, which does not seem to learn, after it briefed the media on the contents of a bill prior to the legislation being introduced in the House.

We are being asked once again to deal with the contemptuous actions of the Minister of Justice and his justice team. We have had countless rulings from the Speaker. The House has expressed itself on numerous occasions. We have had three debates and extensive committee studies.

The message is crystal clear, yet the responsible minister continues to draft bills and then leak those bills to the media, ignoring the will of the House. I ask, Mr. Speaker, that you find a prima facie case of privilege, and I am prepared to move the appropriate motion.

Criminal Code

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, for the record, I want to restate that I voted against Bill C-14 when it came before the House four years ago. We have come to a difficult spot as a country and as a nation when we diminish the value of life.

I believe that all life is important. This piece of legislation, based on the ruling in the Truchon decision in Quebec, goes much further than that ruling suggests. It also does not provide the proper protection for conscience rights for medical professionals. It takes away that 10-day reflection period. That is an important note to make because as I said, 263 people changed their minds during that 10-day reflection period. This bill removes it. This is same-day death being proposed by the Liberals.

If someone is having a bad day facing an illness that they think is unbearable and degenerative, and for whatever reason they request medical assistance in dying, they do not have the 10-day reflection period to see whether that was the right decision. Under this legislation, that decision would be permanent and final.

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, what results from this bill is truly a matter of life and death. The decisions we make here always have some ripple effects on others, but this bill needs to be about protecting the rights of some of our most vulnerable.

It is from a place of deep conviction that I speak on Bill C-7. My hon. colleague for Thunder Bay—Rainy River echoed some of these concerns and convictions in a CBC article written by Kathleen Harris. He states:

I don't like voting against my party, but as someone with a medical background and somebody who has dealt with this issue over the years a lot, I think morally it's incumbent upon me to stand up when it comes to issues of health and life and death.

I find it heartbreaking that we are putting doctors and legislators in this position. As the member opposite suggests, the primary issue is protection of conscience rights for medical professionals, health care providers, and the rights of hospices and other institutions not wanting to cause the death of people in their care.

As a Maclean's editorial explains, many doctors who may be willing to expedite the natural process of dying, given their traditional role to relieve suffering, would likely be threatened by the qualitative and ethical distinction between hastening a death that is drawing near and ending a life that is expected to persist. This is a very valid point.

When one senator asked an expert witness whether it was true that medical professionals were leaving because of the lack of conscience rights, Dr. Leonie Herx replied that she knew of doctors who took early retirement for reasons of professional integrity or because of their own personal moral compass.

Do we want to harden the hearts of those who, because of their very own world view, cannot comply? These are people who feel that MAID is a betrayal of their professional commitment to save lives, a betrayal of their faith or a betrayal of their conscience.

A CBC article says it rather well:

Rather than instilling hope and helping to build resilience by focusing on options for living, health care providers will now be asked to discuss an early death.

Many helpful voices express serious reservation with this bill. Constitutional lawyer and author Don Hutchinson explains that this bill does not provide a sound structure and protection for all people, especially those living with disabilities, chronic pain or mental illness.

The executive vice-president of Inclusion Canada told us that for the disabled community, Bill C-7 is their worst nightmare. Their “biggest fear has always been that having a disability would become an acceptable reason for state-provided suicide.”

Colleagues may say that will never happen. Many of us never thought that we would be here debating same-day MAID, yet here we are. We are hearing stories that are happening today even with the current legislation.

Palliative care consultant Dr. Herx described the experience of Candice Lewis, “a 25-year-old woman with a developmental disability and chronic medical problems”. When she entered the ER, a doctor approached her mother and suggested that she consider MAID for her daughter. She refused. The doctor promptly told her she was being selfish.

The disabled community has made it very clear, time and again, that they have suffered at the hands of our current legislation and they feel directly targeted by this new MAID legislation, as no other community is directly referred to in the proposed amendments to the current legislation.

Despite the holes in the current legislation adopted in 2016, the government is pushing for a further expansion to the eligibility of MAID at an alarming pace. Krista Carr, executive vice-president of Inclusion Canada, explains that the community of Canadians with disabilities and their families have long feared that “having a disability would become an acceptable reason for state-provided suicide”.

According to the Council of Canadian Academies, without its reasonably foreseeable natural death provision, Canada would become more permissive with respect to medical assistance in dying than any other jurisdiction in the world.

There are also the voices of Lemmens and Krakowitz-Broker. They explain that, unlike in any other country in the world, the new bill fails to explicitly require that all reasonable options be made available and tried before allowing physicians to end a patient's life. Even when that decision for MAID is made, we absolutely need to reserve the right for people to have a change of heart.

Dr. Leonie Herx, the past president of the Canadian Society of Palliative Care Physicians and chair of the division of palliative medicine at Queen's University, sees life stories every day that show how people can change their minds with respect to MAID. She refers to one beloved patient who arrived at her clinic asking for MAID, but quickly abandoned his quest after being assured of his worth and that he was not a burden.

Recently, the member for Vancouver Granville asked the justice minister in the House why the 10-day reflection period and reconfirmation of consent were waived in this proposed new legislation. She said that the removal of these safeguards was not required by the Truchon decision: the ruling the Liberals chose not to appeal.

I noted the member's comments with great interest, given that she was the former justice minister who brought forward the original bill to legalize MAID in Canada, known as Bill C-14. In response to her questions and other critics, the current justice minister replied that the 10-day waiting period only increased suffering and that he had even heard of people who stopped taking their medications during this period.

Ensuring that all Canadians have access to care needs to be our top priority to address the needs of suffering Canadians. Death cannot, and should not, be the only choice to end excessive suffering. I have talked to many health care providers who say that we have the tools and resources here in Canada to alleviate all kinds of suffering, and even to alleviate the anxiety of individuals facing imminent death.

John Diefenbaker once said, “Freedom is the right to be wrong, not the right to do wrong.” Canadians value our right to think freely, to consider our thoughts and opinions, and to change our minds if we so choose. The elimination of the 10-day reflection period and the requirement to reconfirm consent takes this option away from those facing this difficult situation. How are we preserving the right for people to change their minds when we waive the waiting period? It would seem that this bill makes the choice for MAID to be final and irreversible.

That is not what is reported in the “First Annual Report on Medical Assistance in Dying in Canada, 2019”. It says that 3.6% of the patients who made a written request for MAID subsequently withdrew that request. While that may not seem like a very significant number, to put it into context 263 people out of the 7,336 people who completed written requests later chose to change their minds because they had the opportunity to do that in the 10-day waiting period. That is 263 lives. Every single one of them deserved the right and the freedom to make that decision. This piece of legislation before us would take that right away from individuals.

Experts speaking to the Senate committee on Bill C-7 discussed how, in the proposed bill, MAID eligibility would apply to treatable diseases where death was not imminent. This is also where the bill adds a 90-day assessment period. It is no wonder that people with disabilities or chronic illnesses feel threatened by this legislation. This addition is especially concerning when people are faced with a sudden, dramatic life-changing illness or disability, as it often takes much longer than three months to gain a renewed perspective.

It is no wonder the former health minister, Dr. Jane Philpott, and the member of Parliament for Vancouver Granville wrote an editorial for Maclean's urging Parliament to proceed with caution, and questioning whether there was enough medical and social evidence to even understand the implications of these potential changes.

Saying that we are at a defining moment in history by approving this bill without further amendments is not an overstatement. I am thankful for the opportunity to highlight these very real risks, and I want to urge the Liberal government to address the bill's serious challenges.