An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

This bill was last introduced in the 42nd Parliament, 1st Session, which ended in September 2019.

Sponsor

Status

This bill has received Royal Assent and is now law.

Summary

This is from the published bill. The Library of Parliament often publishes better independent summaries.

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.

Elsewhere

All sorts of information on this bill is available at LEGISinfo, provided by the Library of Parliament. You can also read the full text of the bill.

Votes

June 16, 2016 Passed That a Message be sent to the Senate to acquaint their Honours that this House: agrees with the amendments numbered 1, 2(d), 2(e), 4, and 5 made by the Senate to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying); proposes that amendment 2(c)(i) be amended by replacing the text of the amendment with the following text “sistance in dying after having been informed of the means that are available to relieve their suffering, including palliative care.”; proposes that amendment 3 be amended in paragraph (b) by adding after the words “make regulations” the words “that he or she considers necessary”; respectfully disagrees with amendment 2(a) because requiring that a person who assists to be free from any material benefit arising from the patient's death would eliminate from participation the family members or friends most likely to be present at the patient's express wish, and this would violate patient autonomy in a fundamental and inacceptable manner; and respectfully disagrees with amendments 2(b), 2(c)(ii), and 2(c)(iii) because they would undermine objectives in Bill C-14 to recognize the significant and continuing public health issue of suicide, to guard against death being seen as a solution to all forms of suffering, and to counter negative perceptions about the quality of life of persons who are elderly, ill or disabled, and because the House is of the view that C-14 strikes the right balance for Canadians between protection of vulnerable individuals and choice for those whose medical circumstances cause enduring and intolerable suffering as they approach death.
June 16, 2016 Failed That the motion be amended by: ( a) deleting the paragraph commencing with the words “respectfully disagrees with amendments numbered 2(b), 2(c)(ii), and 2(c)(iii)”; and ( b) replacing the words “agrees with amendments numbered 1, 2(d), 2(e), 4, and 5” with the words “agrees with amendments numbered 1, 2(b), 2(c)(ii), 2(c)(iii), 2(d), 2(e), 4, and 5”.
May 31, 2016 Passed That the Bill be now read a third time and do pass.
May 31, 2016 Failed That the motion be amended by deleting all the words after the word “That” and substituting the following: “Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be not now read a third time but be referred back to the Standing Committee on Justice and Human Rights for the purpose of reconsidering Clause 3 with a view to ensuring that the eligibility criteria contained therein are consistent with the constitutional parameters set out by the Supreme Court in its Carter v. Canada decision.”.
May 30, 2016 Passed That Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), {as amended}, be concurred in at report stage [with a further amendment/with further amendments] .
May 30, 2016 Failed “Health, no later than 45 days after the day”
May 30, 2016 Failed “(7.1) It is recognized that the medical practitioner, nurse practitioner, pharmacist or other health care institution care provider, or any such institution, is free to refuse to provide direct or indirect medical assistance in dying. (7.2) No medical practitioner, nurse practitioner, pharmacist or other healthcare institution care provider, or any such institution, shall be deprived of any benefit, or be subject to any obligation or sanction, under any law of the Parliament of Canada solely by reason of their exercise, in respect of medical assistance in dying, of the freedom of conscience and religion guaranteed under the Canadian Charter of Rights and Freedoms or the expression of their beliefs in respect of medical assistance in dying based on that guaranteed freedom.”
May 30, 2016 Failed “(3.1) The medical practitioner or nurse practitioner shall not provide a person with assistance in dying if the criteria in subsection (1) and the safeguards in subsection (3) have not been reviewed and verified in advance (a) by a competent legal authority designated by the province for that purpose; or (b) if no designation is made under paragraph (a), by a legal authority designated by the Minister of Health in conjunction with the Minister of Justice for that purpose. (3.2) The designation referred to in paragraph (3.1)(b) ceases to have effect if the province notifies the Minister of Justice that a designation has been made under paragraph (3.1)(a).”
May 30, 2016 Failed “(3.1) As it relates to medical assistance in dying, no medical practitioner or nurse practitioner may administer a substance to a person if they and the medical practitioner or nurse practitioner referred to in paragraph (3)(e) concur that the person is capable of self-administering the substance.”
May 30, 2016 Failed “(d) their imminent natural death has become foreseeable, taking into account all of their medical circumstances.”
May 30, 2016 Failed
May 30, 2016 Failed “(f) they have, if they suffer from an underlying mental health condition, undergone a psychiatric examination performed by a certified psychiatrist to confirm their capacity to give informed consent to receive medical assistance in dying.”
May 30, 2016 Failed “(f) prior to making the request, they consulted a medical practitioner regarding palliative care options and were informed of the full range of options.”
May 30, 2016 Failed
May 18, 2016 Passed That, in relation to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), not more than one further sitting day shall be allotted to the consideration at report stage of the Bill and one sitting day shall be allotted to the consideration at third reading stage of the said Bill; and That, 15 minutes before the expiry of the time provided for Government Orders on the day allotted to the consideration at report stage and on the day allotted to the consideration at third reading stage of the said Bill, any proceedings before the House shall be interrupted, if required for the purpose of this Order, and in turn every question necessary for the disposal of the stage of the Bill then under consideration shall be put forthwith and successively without further debate or amendment.
May 4, 2016 Passed That the Bill be now read a second time and referred to the Standing Committee on Justice and Human Rights.
May 4, 2016 Passed That the question be now put.
May 4, 2016 Passed That, in relation to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), not more than one further sitting day shall be allotted to the consideration at second reading stage of the Bill; and That, 15 minutes before the expiry of the time provided for Government Orders on the day allotted to the consideration at second reading stage of the said Bill, any proceedings before the House shall be interrupted, if required for the purpose of this Order, and, in turn, every question necessary for the disposal of the said stage of the Bill shall be put forthwith and successively, without further debate or amendment.

Criminal CodeRoutine Proceedings

June 16th, 2016 / 10:15 a.m.
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Beauséjour New Brunswick

Liberal

Dominic LeBlanc LiberalLeader of the Government in the House of Commons

Mr. Speaker, I wish to state that the completion of Bill C-14 is an urgent matter because a legislative framework is needed to protect our most vulnerable in society and establish clear and consistent practices for medical professionals, while providing access to assisted dying pursuant to the Supreme Court of Canada ruling.

Therefore, pursuant to Standing Order 53, I move:

That, notwithstanding any Standing or special Order or usual practice of the House, when Orders of the Day are called later this day, a Minister of the Crown be authorized to move, without notice, a motion relating to Senate amendments to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

Criminal CodeRoutine Proceedings

June 16th, 2016 / 10:15 a.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, I appreciate the member's arguments with respect to the urgency of this issue. However, he may be aware, and I think should be, that provincial guidelines have already been proposed with respect to this, and provinces are bringing in a framework to deal with this at the provincial level.

That does not negate the possible arguments for or against having a federal framework, but I think it is important to acknowledge, in the context of a claim to the alleged urgency of this issue, what the reality is at the provincial level, because if we look at the various guidelines, it actually seems fairly clear to me that a number of provinces have done a much better job of protecting the vulnerable than the framework the federal government has put in place.

I have raised concerns repeatedly in this House about the lack of protection for the vulnerable in this legislation. It is important that we separate out two different issues. There is the issue of the eligibility criteria, which has been fairly contentious in terms of whether it should be terminal, whether it should simply repeat the language of the Supreme Court, and whether it should use other types of language, as the government does in the somewhat ambiguous term of death being “reasonably foreseeable”, but then there is the separate question with respect to safeguards.

I think, especially in this legislation, whatever Canadians and members of this House think of the provisions in terms of eligibility criteria, that there is an absence of safeguards. If we look at what the provinces have put in place, they have, in many cases, done a much better job of providing important safeguards.

One of the models I would like to draw to the attention of members of the House is the law in place in Manitoba. The law put in place there has actually been praised. It was welcomed as a welcome development, even by someone involved in assisting people accessing assistance in dying, with an understanding of the real benefits of this law.

The system that was set up in Manitoba was that it allowed individuals seeking assistance in dying, euthanasia, or physician-assisted suicide, whatever we want to call it, to have their cases reviewed by government lawyers. It did not require judicial review, which has many advantages but is something that some members have claimed is unduly onerous. It instead created a procedure by which government lawyers would review the eligibility criteria and would be able to, in the context of their legal expertise and knowledge, rule on whether the person in fact met the criteria.

The government's legislation contains absolutely no mechanism for advance legal review by competent authority, and we proposed an amendment to that effect in hopes of seeing the government bring it in. Unfortunately, it would not agree to that.

I think the Manitoba law strikes a good compromise. It does not require judicial review, but it does have some kind of apparatus whereby we have review by competent legal authority. Certainly in the case of Manitoba, the vulnerable in Manitoba are better off under the provisions of the existing standards in Manitoba than they would be under federal legislation.

Let us talk about some of the other provinces. In general, the provinces I was able to look at use language around attending physicians. They have protections in terms of conscience, but they are rooted in this idea of an attending physician being in some way involved in the process.

The federal legislation, Bill C-14, makes no reference to attending physicians. It does not require the involvement of the attending physician at all. It simply says that any two physicians can sign off. We could have two physicians in the country that see a particular case one way and every other physician in the country seeing the case a completely different way. That person would still be able to access euthanasia or assisted suicide.

The guidelines, which in their wisdom most of the provinces, at least most of the ones I have had a chance to look at deal with, have a specifically carved out role for an attending physician. I would argue that involving, in the guidelines, specifically the attending physician provides significantly greater safeguards than we would have otherwise.

This speaks very much to the motion the government House leader put forward, because he is claiming that there is some urgency to passing this legislation on the basis of the protection of the vulnerable. However, if we look at the rules that are in place in the various provinces, it is very clear that they may, so far, in terms of the interim guidelines they have put in place since June 6, have a somewhat more liberal interpretation of the eligibility criteria, but on the issue of safeguards, on the issue of the protection of the vulnerable, they are actually doing a much better job.

I have stated before concerns about The College of Physicians and Surgeons of Ontario's policy with respect to conscience. It is evident in its interim policies that it has introduced, as well, a requirement for effective referral, requiring someone to be complicit or to refer for euthanasia, which is gravely concerning to physicians as well as to many other people within the province of Ontario. However, that would not change with the federal legislation, because the legislation would not provide the necessary protections for conscience.

In other provinces, though, we see a better job in terms of understanding processes that can be put in place which protect the vulnerable and also protect conscience. Therefore, generally speaking, they make reference to this issue of having the attending physician involved, but they do not specifically require the participation or an effective referral. In my home province of Alberta, there has been a system constructed whereby there is a sort of central hub where people would go directly, or where someone might be pointed, in order to have their situation addressed or adjudicated in some way.

These systems prevent what I think is one of the very pernicious aspects of Bill C-14, which is the possibility of doctor shopping. It is where a person, or even a member of their family, could shop the case around, and 10 or 20 different doctors could say absolutely not because the person does not meet the ambiguous criteria. It is somewhat ambiguous under Carter, but no less ambiguous under the provisions of the new government legislation.

What is important in this debate is that people have raised the spectre of a legislative vacuum, in that there will be no legislation, no rules in place whatsoever. Well, June 6 has come and gone, and provinces were ready to respond in a way and to an extent that the federal government simply was not. The government proposed the legislation fairly late. It did not seek to get our buy-in on the substance of the legislation. Instead, the government pushed this forward at a late stage and said that we have to pass it now because it is urgent.

Well, provinces have done a much better job here. Now June 6 has come and gone, and we are not in a vacuum. Provinces have developed standards, policies, and procedures, some of which may be better than others; some of which I may agree with more or less. However, if we look at the substance of these, I think we see that there is not at all a legislative vacuum. In fact, the provinces have in some cases been more effective.

The central issue of doctor shopping, the issue of whether or not someone meets the criteria, needs to be adjudicated. It needs to be adjudicated, hopefully once, and may be subject to appeal or review by someone else. However, there needs to be one person or a group of people who have the expertise, legally and medically, who make the assessment, and then that decision is made.

This fearmongering from the government about the absence of a law or a vacuum, I think really misses the point. We have these bodies, colleges of physicians and surgeons at the provincial level, that have the competency and have come up with guidelines, that have recognized, unlike the government, the concerns about doctor shopping that we have raised repeatedly in the House. They have recognized the problems with conscience and said they could try to construct, using their expertise and authority at the provincial level, a system that works better and that provides real protections for the vulnerable.

Whenever we think about the eligibility criteria, and in some cases the interpretation of the eligibility criteria is different at the provincial level, let us provide the safeguards.

One thing I want to briefly mention is that the federal legislation provides immunity from prosecution for someone who has a “reasonable but mistaken belief” that the standards have been met. Therefore, someone could take the life of a person who did not meet the criteria and still avoid prosecution. That is not a protection for the vulnerable. However, in the absence of the legislation, we do not have that exemption. The vulnerable are better protected because there is not an exemption for those who take life without the consent of the patient and without the proper criteria being met.

In looking at the reality of what is in place at the provincial level, it is not correct at all to talk about a legislative vacuum. Therefore, the motion does not have the urgency that is claimed.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 10:40 a.m.
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Vancouver Granville B.C.

Liberal

Jody Wilson-Raybould LiberalMinister of Justice

She said: Mr. Speaker, I would like to begin my comments by acknowledging the depth and quality of the thoughtful work that the other place has undertaken in its review of Bill C-14.

The number of amendments that were presented and thoroughly debated speaks volumes, not only about the complexity of the issue at hand but also about the dedication with which members of the other place sought to improve the legislation.

Bill C-14, as passed by the House of Commons, expressed our policy choice to address medical assistance in dying in a principled and cautious manner. This policy choice was deliberately and carefully crafted. The bill achieves the most appropriate balance between individuals' autonomy in deciding how their death will occur and protection of vulnerable individuals, as well as broader societal interests. These interests include suicide prevention, equal valuation of every person's life, and preventing the normalization of death in response to suffering. Several amendments were made to Bill C-14 in the other place.

The most significant amendment was the deletion of the definition of “grievous and irremediable medical condition”. The effect of this amendment essentially removes the eligibility requirement that “natural death has become reasonably foreseeable”. This amendment appears to have been motivated by a concern that this criterion is unconstitutional because it does not explicitly appear in the Supreme Court Carter decision.

Many legal experts have testified before the Standing Committee on Legal and Constitutional Affairs in the other place. Some expressed their views that Bill C-14, as initially passed in the House of Commons, would be found unconstitutional if challenged in the courts.

However, other legal experts and professors took the opposite view, that Bill C-14, as adopted in the House of Commons, with the requirement that natural death be reasonably foreseeable, is constitutional. In Carter, the Supreme Court was clear that it is the role of Parliament to craft a complex, regulatory regime with respect to medical assistance in dying and that such a regime would be given a high degree of deference by the courts.

Hon. colleagues, as Minister of Justice and the Attorney General of Canada, I am confident that Bill C-14, as originally drafted and presented in this place, is constitutional. As outlined in an addendum to the legislative background paper that I distributed to all parliamentarians earlier this week, and which I am pleased to table in the House today, the question is whether the complex, regulatory regime found in Bill C-14 is consistent with the charter, not whether it exactly replicates the wording of the Supreme Court in Carter. In the dialogue that this Parliament has with the judiciary, Bill C-14 is our principled, cautious, and deliberate response.

This is a transformational discussion, and a significant first step for our country. It is important to note that Bill C-14 is very different from the former law that was before the court in Carter. Our proposed legislation permits medical assistance in dying for the overwhelming majority of those Canadians who would seek to access it, and it is motivated by broader, new legislative objectives that do not animate the former law.

Bill C-14 is a new law with new features, and an analysis of its constitutionality must reflect this. The Carter ruling alone is not the end of the story, nor is it the end of our national discussion. The conclusion to draw here is that there are diametrically opposed but reasonable points of view about the constitutionality of Bill C-14.

The situation is not unique. It is normal and part of a healthy debate for legal experts to differ on the merits of a particular piece of legislation that has not yet been examined by the courts. However, I would caution that fundamentally altering the delicate balance purposefully struck in Bill C-14 solely because of the existence of these differing views is ill-advised.

As the Supreme Court of Canada stated in Carter, “the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards”. The government's policy choices, as reflected in Bill C-14, were specifically crafted to protect vulnerable Canadians from these different types of risks.

First is the protection of those who will ask for medical assistance in dying. Bill C-14, as passed by this chamber, would limit eligibility to those whose death has become reasonably foreseeable and for whom the risks can be adequately addressed by the robust safeguards found in Bill C-14. However, if eligibility is drastically expanded to all Canadians who are suffering unbearably, regardless of whether or not their death is reasonably foreseeable, as in the amendments the other place proposes, there are more risks of different types that are much harder to detect.

These risks include the very real possibility that individuals may be motivated to request medical assistance in dying for a whole host of reasons, psychosocial, emotional, or systemic, which are separate from their medical condition but that exacerbate their suffering. People may die unnecessarily or prematurely, when other options for improving their quality of life are available. Cases from other jurisdictions that permit medical assistance in dying support these concerns. We do not believe that this is what Canadians want.

Importantly, while the other place expanded eligibility in the bill, it did not introduce new safeguards for the very circumstances where the most caution is required. The result is that any serious medical condition, whether it be a soldier with post-traumatic stress disorder, a young person who suffered a spinal cord injury in an accident, or a survivor whose mind is haunted by memories of sexual abuse, could result in eligibility for medical assistance in dying. I raise these examples from other jurisdictions not to be sensational, but to highlight the real risks at play.

However, beyond the risks for those who make a request for medical assistance in dying, making it available to all Canadians who are suffering would also have repercussions at a much broader level. It would alter our societal values and send the wrong message to our most vulnerable Canadians who may never even request assistance. These are risks for which there are no obvious safeguards.

Broadening eligibility for medical assistance in dying to situations where death is not reasonably foreseeable would contribute to negative perceptions about the quality and dignity of life of people with disabilities. Organizations like the Canadian Association for Community Living and the Council of Canadians with Disabilities, among other disability rights organizations, have cautioned us about the potential devaluation of the lives of Canadians with disabilities that broader eligibility criteria would attract. They tell us that such devaluation happens when the law presumes that life with a disability could be so unbearable that death should be a state-sanctioned option.

Broad eligibility criteria could also send the wrong message that society feels it is appropriate to address suffering in life by choosing death. This message may encourage some who are in crisis and already considering suicide to act, even privately and without assistance. Procedural safeguards would not help these individuals. The relationship between medical assistance in dying and suicide has not been sufficiently studied and we must have more information about this complex situation before we can decide what is right for Canada. I want to acknowledge the thorough and emotional discussion in the other place on this incredibly important issue.

We recognize the important amendments to Bill C-14 adopted by the other place, namely that a person signing on behalf of the patient requesting assistance cannot know or believe that they will benefit from the patient's death. This is indeed a thoughtful amendment that improves the bill and a valuable safeguard that we are pleased to support. Ensuring that a patient is aware of all means available to relieve their suffering, including palliative care, is of course important.

A further amendment concerning the monitoring system introduces mandatory language requiring the Minister of Health to make regulations and guidelines. The government appreciates the other place's concern that regulations to support the monitoring regime be put in place. Canadians want to know that this system will be well monitored and we support this well-crafted amendment from the other place.

Further, there was an amendment requiring that the issues to be studied in the bill, which are mature minors, advance directives, and requests where the sole underlying condition is mental illness, be completed in two years. This amendment from the other place reflects the concern that Canadians have for these incredibly complex issues, and the desire for this government to be held to account on each of them, and for that reason it is supported.

I would also like to acknowledge the substantive work of the Standing Committee on Justice and Human Rights, whose thoughtful study of the bill resulted in 16 amendments from all parties being adopted.

I would urge all members of the House to consider the pressing need for a federal legislative framework governing medical assistance in dying. With no such regime in place at this time, with the force and clarity of the criminal law, all Canadians face significant uncertainty.

It is crucial to keep in mind that Bill C-14 was carefully and deliberately crafted as a cohesive and balanced regime. The balance sought in Bill C-14 would be upset by the broadening of eligibility criteria to individuals who are not approaching death without the corresponding safeguards for these specific cases.

Since forming government, we have spent countless hours consulting with Canadians and stakeholders, carefully considering all of the evidence and diverse perspectives on this incredibly challenging issue. We are confident in the policy choices expressed in Bill C-14. The legislation represents the right approach for Canada at this important time in our country's history. I encourage all members of the House to support the government's motion, which respects the other place's contribution to this important debate and maintains the most appropriate balance for all Canadians.

I am pleased to table, in both official languages, a document entitled, “Legislative Background: Medical Assistance in Dying (Bill C-14)--Addendum”.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 10:55 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Mr. Speaker, I would like to acknowledge the hon. colleague's comments on the crucial nature of Bill C-14 and pursuing a national regime for medical assistance in dying in this country, necessarily so in response to the Supreme Court of Canada's direction. I recognize, as stated in my comments, the importance of ensuring that we proceed with caution with respect to medical assistance in dying, recognizing that there is a link, as articulated by my friend, and that we do everything we can to study this particular issue and proceed with caution on the next steps of this debate in this country.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 10:55 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, the Minister of Justice said, in introducing the motion, that she respectfully disagrees with amendments 2(b) and 2(c) because they would remove the criterion of reasonably foreseeable death and undermine the objectives of Bill C-14. As the House knows, the amendments would make sure that the legislation would be consistent with the constitutional parameters of the Carter case, in the words of the Supreme Court. Professor Hogg said that if the bill was amended in this way it would be consistent with the parameters set out in the Carter case, and if it were not the bill would be unconstitutional.

I would like the minister's reaction to the comments of Dr. Douglas Grant, the chair of the Federation of Medical Regulatory Authorities of Canada, who said that the criteria in the unamended Bill C-14, in other words, the “reasonably foreseeable” language the minister would propose to retain would involve language that is “too vague to be understood or applied by the medical profession and too ambiguous to be regulated effectively.”

I would like the minister's comments on that quote.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 10:55 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Mr. Speaker, I certainly acknowledge my friend across the way for the work and the commitment he has made with respect to Bill C-14 and this discussion.

While I acknowledge the quote that he conveyed from Douglas Grant from the regulators, I would like to counter that discussion with a comprehensive response that we have received from the Canadian Medical Association and physicians across the country who look at the language of reasonable foreseeability and the further definition that we provided in terms of eligibility around “grievous and irremediable” as providing clarity, as providing medical practitioners across the country with the ability, based on their direct relationships with their patients, to determine whether or not a patient is eligible for medical assistance in dying.

We believe that flexibility is the most appropriate response and the medical practitioners have confirmed that with us.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 10:55 a.m.
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Bloc

Luc Thériault Bloc Montcalm, QC

Mr. Speaker, I listened carefully to the minister. I would say that this was not her best argument in defence of Bill C-14.

She seems to be confusing the concepts of being suicidal and assisted suicide. She also claims that adopting the definition in Senator Joyal's amendment and the terms in the Carter decision would put us on a slippery slope, giving people who are suddenly suffering access to medical assistance in dying.

We are talking about medical assistance in dying. Does she think that health care professionals would consent to assist someone who is suicidal? Since they would not give their consent, does she think that a suicidal person under the care of our health care system would not find the help they need to reverse their suicidal state? How does she distinguish between being suicidal and medically assisted suicide, other than by citing the fact that the latter is medically assisted? Does she trust the health care system?

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 10:55 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Mr. Speaker, certainly I acknowledge my colleague across the way for his ongoing commitment and discussion on this important issue.

My words today were in speaking to a motion to the other place in terms of their thoughtful considerations with respect to Bill C-14.

The member opposite speaks to the risks, speaks to the broadening of the criteria in terms of one of the amendments that was sent back. What I was expressing in my comments were the serious concerns that we have. If we were to broaden the eligibility criteria, there would not be the necessary safeguards in place to account for that broadening of the criteria.

What I sought to articulate in my comments were examples highlighted from other jurisdictions, factual examples where a broad criteria has resulted in patients accessing medical assistance in dying in the cases that my colleague across the way speaks to, in terms of individuals who are suffering from mental illness alone. Recognizing that there are other remedies, certainly, we trust medical practitioners to perform their duties responsibly in servicing their patients in the best and most appropriate manner.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 11:10 a.m.
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Winnipeg North Manitoba

Liberal

Kevin Lamoureux LiberalParliamentary Secretary to the Leader of the Government in the House of Commons

Mr. Speaker, I appreciate the comments from the member across the way.

Could the member provide some thoughts on the number of individuals who were involved? We can talk about the decision of the Supreme Court of Canada, and the preliminary work that was done last summer on the issue of assisted dying? We had a joint committee of the House, including the other place. We have had ample opportunity through consultation, even at committee stage with individual members of Parliament. This is a very emotional issue for all of us as we try to deal with the passage of Bill C-14.

Could the member provide any personal insights on the legislation, or about the issue at hand, or provide comment in regard to the amount of individuals who have had, directly or indirectly, an opportunity to participate?

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 11:30 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I am very pleased to rise to address the government's motion on a response to the Senate regarding the amendments it has made to Bill C-14. My personal involvement in this process began in January when I had the honour to serve on a special all-party and Senate committee. My colleague, the member for Saint-Hyacinthe—Bagot, was a very important member of that committee as well. Our mandate was to advise the government on a response that would respect the Supreme Court of Canada decision in Carter, respect the Charter of Rights and Freedoms, and respect the priorities of Canadians.

I have told the House before how very proud I was of the work that we accomplished together, and the spirit as well with which we worked in that place. We knew that the government would not accept all of our recommendations, but each was based on the evidence and faithfully respected the testimony that we heard, testimony of experts who came to us from across this country and reached out to others in the process.

Since Bill C-14 was introduced in the House, I, like many others, have focused great attention on its most surprising feature. That feature was the decision of the government to narrow the declaration of the Supreme Court of Canada to a much smaller circle of eligibility, and it could have proved to be a fatal flaw.

That was the testimony, after all, of the Canadian Bar Association, the Quebec Bar Association, Jean-Pierre Ménard, Joseph Arvay, and later the testimony of Canada's foremost constitutional scholar, Professor Peter Hogg. That was the conclusion, as well, of the courts in Ontario and Alberta. That flaw was important, not only because it fatally weakened the bill against the charter challenge, but also because it would force suffering Canadians to launch a court battle. That flaw was so important and so glaring that it overshadowed much of what was good about Bill C-14. Colleagues who have grown tired of hearing me warn about charter challenges and infringed rights will be pleased to hear little of that from me today, because that fatal flaw has been erased from the bill that is now before the House.

The bill as amended now combines a clear and faithful implementation of the Supreme Court ruling with a system of stringent medical safeguards to individually screen every request for assistance in dying. Those safeguards are based on the evidence received by the all-party committee. They reflect the best practices of other jurisdictions as well as made-in-Canada provisions, which members of all parties have helped shape over the course of this debate.

Without the amendment that came to us from the other place, as Peter Hogg has testified, the bill would not be consistent with the decision in Carter. That was his clear testimony. It also would remove a victory that would be taken from those individuals in Canada who could not comply with the very narrow, and frankly inexplicable restriction, of reasonably foreseeable death. Those individuals have that right as of today until Bill C-14 is enacted. Those rights will be taken away should the motion by the government be passed.

However, I am happy to say that the bill before us today, which contains the language of the Supreme Court decision, would of course be compliant with that decision and with the Charter of Rights and Freedoms. As Professor Hogg has said in the clearest possible terms, if it is not fixed as per the amendment that comes to us today, it will be struck down in the Supreme Court of Canada.

When I speak of Mr. Hogg and I hear the government saying we have different experts in different places, I suppose it is important to remind the House of the accomplishments of that individual. His decisions and his book have been cited over 200 times in the Supreme Court of Canada. By my reckoning, it has been cited 1,627 times in the courts of Canada. To suggest that this professor is just another person with an opinion is really quite disturbing, because the government itself, the Department of Justice, has retained that individual on countless occasions.

For him to say, as he did in the other place, that the bill, without the amendment before us today that would fix the problem, is somehow unconstitutional, that it is just another expert, that lawyers differ, economists differ, whatever, is simply misleading.

Canada's leading constitutional scholar has said in the clearest possible terms that without the amendment that happily is now in the bill before us for debate, it has to be fixed. I termed that testimony a game-changer, because I wondered how on earth a government that has retained this gentleman dozens of times could now turn around and say, as the minister did this morning in her speech, that constitutional scholars just differ and that is how it works.

Happily we have in front of us a bill as amended in the other place that we can support, and that is the good news for Canadians. Some amendments come before us to deal with things like palliative care, an amendment that would require all patients considering medical assistance in dying to get a full briefing on palliative care options.

Another amendment would deal with restricting people who help a person in assisted dying, tightening the rules around what role a person who could materially benefit from the death could do.

Another amendment that comes from the other place would compel the Minister of Health to draft regulations around death certificates and provide greater clarity on what information is collected by medical practitioners.

Another amendment calls for a report to be issued to Parliament within two years on issues that have arisen from the provision of physician-assisted dying. Finally, there are some minor language amendments.

The safeguards in the bill reflect many things. They provide the high degree of care, caution, and scrutiny that is necessary to match a court ruling that was broad in its compassion for the right of suffering Canadians to choose. They reflect the confidence that Canadians have in the skill and judgment of our health care professionals, and they reflect the realities of our vast and diverse country, and the principles of equity that undergird our public health care system, of which Canadians should be so proud.

Much has been said in this chamber about the need to balance respect for the autonomy and protection for the individual. We have heard that so often. The Supreme Court of Canada was unanimous in its analysis of our charter, and it ruled definitively on the question of whose autonomy must be respected on this deeply personal matter of choice.

It was for us, as legislators, then to choose what combination of safeguards might be necessary to screen out from that group those who, by virtue of diminished capacity or external pressure, must be denied this option for their own safety. We consider this question carefully, knowing that excessive caution would have its costs. Excessive barriers would not protect the vulnerable. Rather, they would condemn competent, autonomous, adult Canadians to intolerable suffering by wrongly denying their right to choose.

Neither could the solution be to presumptively deny the autonomy of a whole class of persons granted their right to choose by the Supreme Court of Canada. No matter the rhetoric, to presumptively deny people's autonomy, to assess them not as unique individuals, but to dismiss them blindly as a group, to me, is as deeply patronizing and offensive as it is unnecessary.

The Supreme Court expressed faith in us as legislators that we could devise what they called “a carefully designed and monitored system of safeguards” to address the risks associated with offering the compassionate choice of medical assistance in dying. I, for one, believe the court's faith was not misplaced.

We remember what the Supreme Court of Canada said in Carter:

We have concluded that the laws prohibiting a physician's assistance in terminating life...infringe Ms. Taylor's s. 7 rights to life, liberty and security of the person that is not in accordance with the principles of fundamental justice, and that the infringement is not justified under s. 1 of the Charter. To the extent that the impugned laws deny the s. 7 rights of people like Ms. Taylor they are void by operation of s. 52 of the Constitution Act, 1982.

Here is what the court went on to add:

it is for Parliament and the provincial legislatures...should they so choose, by enacting legislation consistent with the constitutional parameters set out in these reasons.

There are two key points that came out of the Supreme Court's pronouncement. The first is that we did not have to do this at all. The court decision could have stood on its own, as in fact it is doing now, along with the safeguards that the provincial and territorial regulators have put in place. We did not need to do what we have done, but we did, in the words of the court, choose to do so.

The second point, though, is equally important: that we could only do so if what we enacted as legislation was “consistent with the constitutional parameters set out in [our] reasons”.

Here is what Professor Hogg testified in the other place. He said, “In my opinion, [the bill] is not consistent with the constitutional parameters set out in [the Carter reasons].”

The amended bill before us would fix it and be possible for all of us to work in the spirit of collaboration, as we did so effectively in the Special Joint Committee on Physician-Assisted Dying and the Standing Committee on Justice and Human Rights. We wrapped our hands around something that would make Canadians proud, wrapped our arms something that would show the compassion that the Supreme Court of Canada showed in the Carter decision, rather than dividing us on party lines or other lines.

All that the amendment the government announced today it wishes not to follow would do is to ensure that it is consistent with the Supreme Court of Canada and the charter. Much has been said about the fact that we need not follow and put into legislation the precise words of a court judgment. Of course, that is right. The simple path was to put the actual language of the decision into the legislation because that was clear and obvious, and certainly no one could say it would be unconstitutional to do so. Rather, the government wishes to use the words “reasonably foreseeable” natural death, which people on all sides of this place have demonstrated is ludicrous language.

Dr. Douglas Grant, head of the regulatory body for all medical regulatory authorities across the country, has pointed out that the language is vague and unworkable from a medical point of view. The government proposed to take the words of the Supreme Court of Canada, though it did not need to, but at least no one can say they are bad, and substitute words that are incomprehensible to the people, physicians and health care providers, who are being required to implement them.

I cannot understand that. I particularly cannot understand it when to do so would be to take away the rights of Canadians that were hard fought for and won in the Supreme Court of Canada. Why? What do I tell those people who call me and say they have to decide whether to take their own life now, because after this bill comes into force that may not be an option available to them? They won that right in the Supreme Court of Canada. In no way do they feel they are near end of life. They may have 30 more years of excruciating pain and suffering, and how dare we say that they do not have that autonomy as a Canadian individual? However, now the government purports to take away that right.

Please understand that as of June 6, the Supreme Court decision stands alone, carefully governed by rules that apply to health care practitioners from coast to coast to coast. It is not the wild west, as colleagues have already pointed out. We have rules in place that are being enacted and carefully followed. If this motion passes, the moment the current government takes away those rights by saying that people have to have a reasonably foreseeable natural death, they will lose that right.

How can the Liberals possibly argue that this somehow would not deprive Canadians of rights that they won in the court? These are real people. This is real suffering. The government says no, that it has this delicate balance right, and it calls it a public policy choice. Some Canadians think that the government goes too far and some Canadians say it does not go far enough, so it will come right down the middle. That frame is wrong. We are here because we chose to implement a unanimous Supreme Court of Canada decision.

We are not here to say we will pick and choose what we like about this issue.

Can we add additional safeguards? Absolutely, and I am proud of what we did. Can we deal with palliative care? Yes. Can we deal with conscience rights? Of course, and we did, and I am proud of what we achieved.

The elephant in the room is that an entire class of successful litigants have had those rights deprived in this place.

The good news is that we can fix that. We have a path to do that, which comes from the other place. It is language we tried to get through the House before. I do not care where it comes from. I am on the side of suffering Canadians who want the rights that they had before.

It is worth reminding ourselves of a very simple fact. We are not called upon to legalize medical assistance in dying. That was already done by the Supreme Court of Canada and is now the law of the land. Instead, we were invited, if the government chose to do so, to offer the broader framework necessary to give clarity and comfort to all Canadians.

I believe that balance has been achieved in the bill that we have before us, as amended. The words of the Supreme Court are there to speak to whose autonomy must be respected, and the work of all parliamentarians is reflected in the system of safeguards before us. The onus must now be on the government to explain why it proposes to cut the words of the Supreme Court judgment out of the bill we have received from the other chamber.

I know that many of us share a common belief that no one can ever make this difficult choice of medical assistance in dying for another. but by rejecting the ruling of the Supreme Court and removing its words from the bill, that is exactly what the government suggests that we do. I cannot accept that, and on a free vote, it is up to all members to decide whether they can accept that.

I would ask all members in this place to consider the alternative; that is, to accept that what we now have is a balanced bill that bears the marks of the Supreme Court, of Parliament, and of thousands of Canadians who participated in consultations and town halls along the way.

I feel we have in our hands, now, what the special all-party committee set out, in January, to produce; that is, a bill that respects the Supreme Court ruling, respects the Charter of Rights and Freedoms, and respects the priority of Canadians.

We do not need to reopen the debate and cut out the words of the Supreme Court. We do not need to reject the charter fix, which was proposed in this chamber, adopted by the other chamber, and confirmed as constitutional by a most respected scholar on the charter.

I move:

That the motion be amended by:

a) Deleting the paragraph commencing with the words “respectfully disagrees with amendments 2b, 2c(ii) and 2c(iii)”; and

b) Replacing the words “agrees with amendments numbered 1, 2d, 2e, 4 and 5” with “agrees with amendments 1, 2b, 2c(ii), 2c(iii), 2d, 2e, 4 and 5”;

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 11:55 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I want to acknowledge the contribution the member for Sherwood Park—Fort Saskatchewan has made throughout this process in both committees.

The idea that the Manitoba regulators have of interposing a prior judicial restraint, if you will, or the process that the member described, could constitute an effective barrier to access. Canadians accept that their doctors look after them in life, and I believe, with the safeguards that are in place to deal with conflict of interest, a reflection period, and the like, we can trust the same physicians to look after us in death.

I worry about barriers that would impose, particularly in non-urban areas, the notion of finding a lawyer and the like. In Nunavut or northern Manitoba for that matter, it is somewhat troubling. Therefore, I think that would be an effective barrier. I do not think it is required.

I think we have it right in Bill C-14. I just wish the test of eligibility would embrace all Canadians and allow those who won the victory in Carter to not have to march back to the Supreme Court in a few months to be told that.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / noon
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NDP

Murray Rankin NDP Victoria, BC

Madam Speaker, I thank the hon. member for Mount Royal for his superb leadership as chair of the justice committee, which I have the honour to work with him on.

I understand that the Canadian Medical Association agrees with the bill. I have heard from so many doctors in my office who call constantly saying that they do not understand it. Frankly, the CMA is a trade organization for doctors. It is not the regulatory body that has to decide what to do when doctors run afoul of the professional standards being implemented in each of the territories.

I think that the constitutional constraints on us, under a criminal law power, to do some of the things that provinces can better properly do will address some of the very concerns that the member raises, such as whether we have an adequate reflection period, and the like. I am proud to see that, although these rules are not unanimous from from coast to coast to coast, they are fairly consistent. I think taken with Bill C-14, they will provide the kinds of safeguards that Canadians expect.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / noon
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Markham—Stouffville Ontario

Liberal

Jane Philpott LiberalMinister of Health

Madam Speaker, I want to say before I begin that I will be splitting my time with the hon. member for Montcalm.

I am pleased to be here today to continue our important discussion on Bill C-14 concerning medical assistance in dying.

We have seen the serious thought and deliberation that hon. senators have put into this bill over the past few weeks. It is now up to us to carefully examine the amendments that the Senate has presented.

Medical assistance in dying is only available in a very small number of jurisdictions around the world and it is brand new to Canada. What we are talking about with this bill is a fundamental change to social policy in this country. We are pursuing transformative change at the same time as we are facing incredible time pressure to put federal legislation in place. It is, therefore, critically important that we move forward with great care.

There are a number of paths that we could choose to follow with respect to medical assistance in dying in this country. I believe that the choice we have made with Bill C-14 represents the approach that is most appropriate and responsible for Canada, and here is why. It strikes a careful balance between respecting the autonomy of patients seeking assistance in dying and protecting vulnerable people. It would protect the conscience rights of providers and support those who choose to participate. It would put measures in place to study the legislation over time as we understand and gather further data to deal with the issues.

I would first like to bring to the attention of hon. members the ways in which the bill respects the autonomy of patients. Under this legislation, eligible patients approaching the end of their lives would be able to choose a peaceful medically assisted death. This represents a significant shift in the way we approach suffering at the end of life in this country. It provides patients with greater autonomy over their decisions.

The bill also improves access for patients. By allowing nurse practitioners to administer medical assistance in dying, the bill recognizes Canada's unique geographic and demographic realities. Nurse practitioners often work alone to provide vital health care services in underserved regions.

In addition to supporting access and autonomy, Bill C-14 also takes care to protect patients who may be vulnerable. When changing social policy, we must proceed with great caution if there is a chance that those who are most vulnerable among us may be negatively affected. Without appropriate safeguards, the availability of medical assistance in dying could pose threats to marginalized people and those who may lack access to adequate familial, social, or economic supports. This bill would establish robust safeguards and procedures to protect vulnerable persons from being encouraged or coerced into seeking medical assistance in dying.

It is important to recognize that there has been significant support in this piece of legislation from the health care sector, including the Canadian Association for Community Living, which includes 40 individual advocates and 50 organizations. It includes various medical associations, both provincially and federally, the Canadian Nurses Association, the Canadian Association of Advanced Practice Nurses, the Canadian Pharmacists Association, the Canadian Psychiatric Association, the Canadian Association of Social Workers, and many more.

This legislation also complies with the vulnerable persons standard, which I believe sends a strong message to all Canadians about our support for those among us who need most protection.

The bill recognizes that medical professionals have the right to follow their conscience and choose whether or not they want to participate in medical assistance in dying. For those who do choose to participate, the bill ensures that the doctors and nurse practitioners who administer this assistance will not be prosecuted. It also exonerates those who may assist, such as pharmacists and authorized nurses.

Finally, it outlines criteria to help support providers in assessing patients. It is important to keep in mind that health care providers are required to assess the condition of their patients on a regular, if not daily, basis. Assessing the level and type of suffering is already part of medical practice and it is very common in all end-of-life care. It is, for example, a crucial element in determining the best approaches to alleviate suffering in palliative care.

Our eligibility criteria and safeguards offer providers direction and flexibility within their field of expertise and scope of practice to make an assessment about the condition and circumstances of a patient seeking medical assistance in dying on a case by case basis.

Given the complexity and often personal nature of this issue, there is significant debate in terms of the correct approach from many different perspectives. What we have with Bill C-14 is an approach that would put a cautious assisted-dying framework in place while leaving the door open to adjust as we better understand more challenging issues. In the legislation, there is a commitment to independent studies on challenging issues that need to be investigated further before determining what policy considerations the government should make.

One thing is certain, these are issues that present real risks to people in vulnerable circumstances and highlight the complicated nature of balancing autonomy against the protection of vulnerable patients. There is also, of course, a mandatory parliamentary review of this legislation after five years.

I would be remiss if I did not reaffirm here today the importance of improving access to high quality palliative care for all Canadians. Our government has committed to investing in this area. I continue to work with provinces and territories to help support access to all options for care at the end of life.

The motion today has given thoughtful consideration to the work of the upper chamber. I thoroughly appreciated the opportunity to take questions for a two-hour period at the committee of the whole, in addition to the time that I appeared before the committee's pre-study.

There are two amendments made by the upper chamber where we respectfully disagree. As captured in the motion today, we as a government reviewed and sought a path forward that encompasses the Senate's amendments where possible, resulting in our agreement with the five remaining amendments. There is alternative text proposed to reflect the upper chamber's desire to recognize the vital importance of palliative care options for patients. As I have said repeatedly, this is a positive outcome if the result of this legislation allows tangible improvement to access palliative care in Canada.

We also have a responsibility to provide language in the legislation that health care professionals can understand in order to provide access to assisted dying. As is stated in the proposed message to the Senate, removing the criterion of the reasonable foreseeability of natural death would undermine the objectives of Bill C-14 to recognize the significant and continuing public health issue of suicide, to guard against death being seen as a solution to all forms of suffering, and to counter negative perceptions about the quality of life of persons who are elderly, ill, or disabled. Bill C-14 strikes the right balance for Canadians between protection of vulnerable individuals and choice for those whose medical circumstances cause enduring and intolerable suffering.

In conclusion, I would like to underline to my fellow parliamentarians that the approach set out in Bill C-14 is the result of tremendous thought and deliberation over the course of many months. There have been extensive consultations over this past year on the issue of medical assistance in dying with Canadians, stakeholders, and relevant experts. The findings have been reviewed carefully to inform the legislation.

I hope both the House and the Senate are able to support the motion. I would like to thank, from the bottom of my heart, all the parliamentarians from both the upper and the lower chamber who have professionally and thoroughly debated this issue. It is a transformative social policy that governments debate once in a generation, and this piece of legislation is one of those remarkable debates. Make no mistake, this will be a dramatic change for Canada.

In the Carter decision, the Supreme Court acknowledged that it was up to Parliament to craft an appropriate regime. I believe we arrived at the best approach for our country.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 12:10 p.m.
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Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Madam Speaker, my colleague's question gives me an opportunity to reiterate again, as my colleague the Minister of Justice and I have said on numerous occasions, that we are absolutely clear on the fact that the two cases that were reviewed in the matter of Carter v. Canada are cases of people who would absolutely have been eligible under the legislation that is before the House today.

If the Carter decision is read carefully one will understand that it was clearly speaking to people who were facing end-of-life decisions. We are fundamentally affirming today that the people in question in that case would have met the criteria of Bill C-14 for medical assistance in dying.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 12:40 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Madam Speaker, I am pleased to speak to the NDP amendment, as well as to the underlying issues raised by Bill C-14, and to address some outstanding issues.

The first thing I want to do is pick up on a question that my colleague from the NDP just asked with respect to choice. Many of the arguments in favour of this legislation have been framed around this idea of choice. However, at the same time we have to acknowledge that this bill is designed to impose significant limitations on choice as well. It does not legalize suicide in every case. Clearly, I think it suggests that there still ought to be limits on choice. That is a good thing. However, those limitations do not at all protect the vulnerable. They do not go nearly far enough. We would understand the limits of choice in that choice is shaped by values and social norms, and my colleague touched on this as well. The stigma and social acceptability around something shapes the kinds of choices that are made.

In light of the Supreme Court decision and the fact that we have to respond to it, I am very concerned, and I think many of my colleagues at least on this side of the House but perhaps in other corners of the House are concerned, that suicide remains a socially unacceptable choice, and that maybe it should be allowed in certain narrow circumstances as required, but that we do not allow ourselves to shift in a direction where we remove the fundamental stigma around taking human life, and that we maintain a fundamental respect for the intrinsic value and dignity of all human life. It is my belief that going down that road only a little bit is very difficult and perhaps even impossible. In the debate around this issue, we have already seen that, as soon as the can of worms is opened a little bit, there is a major push for expansion to all kinds of other different situations.

The language used, and the language that some members and the NDP amendment want to limit this to, is “grievous and irremediable”. It seems to me that people who take their life do so because they consider themselves to be facing grievous and irremediable suffering. Clearly, there is no one who takes his or her life who does not think that. Therefore, it is not at all a simple matter, as some members have suggested, to clearly demarcate suicide; and then, on the other hand, what is covered by this issue? Choice always has limits. It must have limits, especially when choices may impact the broader social architecture of choice under which other people operate. I think that is an important point that is underlined here, that we need to try, as much as possible, to preserve that underlying concept of the value of human life. I do not think that Bill C-14 has nearly the safeguards to do that. What we could have had, and what we should have at the very least, is some kind of clear legal criteria.

It has been interesting in the discussion today that we have the minister really highlighting the importance of the reasonably foreseeable criterion. I do not support the NDP amendment. All things being equal, I would still like “reasonably foreseeable” to remain in the bill, although I agree with the NDP that it is not at all clear what that means. Then the minister talks about the importance of this criterion and how the entire bill, the system of safeguards, was developed with that criterion in mind. She said that, clearly, if we did not have that aspect in the criteria, we would need additional safeguards. Therefore, she is putting a very large amount of weight on those two undefined words. She said that the Liberals would not want “reasonably foreseeable” to apply to a young person who had some kind of an accident and became permanently disabled. They would not want “reasonably foreseeable” to apply to somebody with just a mental health challenge. However, without meaning to those words, without some kind of clarity, it is not at all clear that those cases that the minister has identified are even excluded by this legislation. Therefore, in a sense, she defeats her own argument by saying that this legislation has limited safeguards because of the narrowing of the criteria, such as only a 10-day waiting period, but given that there was no meaningful, well-defined, narrowing of the criteria, then she acknowledges effectively that the safeguards in this bill are inadequate.

If this legislation were written with a tighter narrowing of criteria in mind, then perhaps we should have actually had some definition of what constituted the new criteria. We should have had some kind of definition of what this means. Of course, Conservatives proposed an amendment to add the word “imminent”. We can say that death is reasonably foreseeable for all of us, but death is not imminent for all of us. That would have at least provided some metric for establishing a distinction between some cases and other cases. The lack of criteria is a huge problem.

It is important, in recognizing the absence of clear criteria, that we again investigate putting review criteria in place. We have seen what the provinces have already done. The reason I say we are not in a legal vacuum is that there is no federal legislation but there are provincial rules in place, so we are not in a legal vacuum, as such, strictly speaking. There are policies and procedures in place at the provincial level. The provinces have introduced many very good safeguards that are not in this federal legislation, and it is important to say that those safeguards, in many cases, would not apply after the federal legislation passes.

Provincial guidelines, in most cases that I have seen, refer to the involvement of the attending physician. They do not just say any two physicians. They say there is some role for an attending physician and a consulting physician, implying that the person involved in adjudicating the case should be, in some ways, involved in the care of the patient and not be some doctor somewhere else who has agreed to sign all the forms for almost anyone. The involvement of the attending physician is important. It could have been included in the federal legislation, but if the federal legislation passes saying any two doctors, then the requirement for an attending physician being involved would no longer apply, because it would be prescribed a certain way in the Criminal Code.

I would encourage the government to take the experience and wisdom of the provinces seriously on this, recognizing that there are no effective legal criteria up front, there are only undefined legal criteria, and we should add in some of the more effective review mechanisms to ensure that, however ambiguous the criteria are, the legal criteria are being met, in fact, such as they are.

I have advocated for the Manitoba model, or some element of it, to be incorporated into the federal model, which involves government lawyers looking at each case. I asked my friend from Victoria about this, and he said that could pose an unnecessary barrier, such as if there are no lawyers available. The model that the Government of Manitoba has put in place includes government lawyers available to review each case. It is not as if one has to go out and find someone, and it is not a process of needing to make an application to the court, although there are, frankly, plenty of cases in the world where someone might need to make an urgent application to a court and there are provisions to allow that to happen.

Therefore, it is not at all true that this is sort of an impossibly onerous barrier, but the Government of Manitoba has done something much less than requiring judicial review. It has simply put in place a system where there is advanced legal review by government lawyers. Recognizing the value of that model, that review process, the government should think about incorporating that into federal legislation or, at the very least, ensure it is not proceeding in a way that interferes with or overturns that provincial set-up.

In conclusion, I want to speak briefly to the issue of protecting the vulnerable. There has been some discussion here about what constitutes vulnerability and who is vulnerable. We can understand “vulnerable” as referring to people who probably, in ideal circumstances, would not choose death, but are in some way in not ideal circumstances, which limits them and propels them toward a choice they would not otherwise make. This can happen often, whether it is a person who does not have perspective because of his or her situation, or whether someone is sort of the victim of suicide contagion and is responding to other things and situations happening in his or her life. It could be someone who is influenced more by social than physical circumstances. We need to be attentive to these things, and that speaks to the importance of robust safeguards.

I hope we can, as a House, still at this last stage, try to bring in some meaningful definitions and safeguards that would protect the vulnerable and protect Canadian society.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 12:55 p.m.
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NDP

Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC

Madam Speaker, it is a privilege for me to rise again in the House to speak about the sensitive and complex issue of medical assistance in dying.

This morning, I had the honour of seconding the motion of my colleague, the member for Victoria. I would like to reiterate how much I admire and respect the commitment and sense of responsibility he has shown throughout the process that has brought us here today.

I have had the opportunity to learn from his great expertise in constitutional law on many different occasions. I am a new member who was elected on October 19, 2015. The Special Joint Committee on Physician-Assisted Dying was the very first parliamentary committee that I have ever been a member of. It was a great privilege for me because all the members of the House of Commons and the senators who worked on that committee did so in a spirit of co-operation in order to achieve the best possible outcome. We did not always agree, but we had a lot of respect for one another and we listened to what everyone had to say. We wanted to ensure that we made the best possible decisions and recommendations for the benefit of all Canadians, while respecting their rights. The 21 recommendations that we did make reflect that desire. One of our main goals throughout our discussions was to ensure that no one was discriminated against.

Naturally, Bill C-14 could not include all 21 recommendations. As I said after our report was released, I think it will continue to be useful for years to come.

My colleague from Victoria and I felt it was important to augment the committee's work with a supplementary opinion. The one thing all of the witnesses agreed on is that medical assistance in dying is linked to palliative care.

We also felt it was important to write a supplementary opinion to connect this issue to all other social determinants. It is important to say that we all have equal rights. However, because of certain social constraints, we must ensure that social determinants are taken into account in implementing medical assistance in dying.

As a member of the committee, I was astounded at the level of expertise we have in Canada on this issue. We heard from more than 60 witnesses, and we read thousands of pages before drafting our report and recommendations. I have a great deal of admiration for many of the witnesses who appeared before us because they put a lot of careful thought into this sensitive issue.

Our thinking on medical assistance in dying has changed in this country. The Supreme Court's Carter decision is proof of that. The witnesses talked to us about the change that has taken place in society. Looking back at the Rodriguez ruling from 20 years ago, it is clear that our society's thinking on end of life has changed.

I believe that our report and recommendations attest to that, and that is why it is so important to me that the bill we pass in the House reflect our constituents' thoughts on this matter. The witnesses, particularly groups representing people with disabilities, put a lot of careful thought into this matter and came to share their ideas with us.

I found it particularly hard when some of these groups told us that a few of their members had had friends or loved ones commit suicide prematurely. We currently have no measures to give these people hope that they will be able to freely choose at which point they will make a request for medical assistance in dying. That concern stuck with me.

I was also struck by the testimony from doctors who came to tell us that the Carter decision, which was handed down on February 6, 2015, changed their profession drastically. These doctors, like the ones I met in my riding, told us that throughout their training and their careers, they have been taught to heal and, failing that, to extend life. Now, they are being told that, according to what the public wants, what the law allows, and what their rights allow, patients in our country will be able to submit a request for medical assistance in dying.

I listened carefully to a number of speeches since we started having this discussion. During my many meetings in my riding of Saint-Hyacinthe—Bagot, I pointed out that it is not up to us, in the House, to decide whether medical assistance in dying should be available or not. The Supreme Court has already ruled on that issue. It is up to us to amend the Criminal Code.

I am from Quebec. The people of Quebec have had the Act respecting end-of-life care since December 2015. As many people have said in the House, that act was the result of six years of work to reach a broad consensus. Of course, in order to reach that broad consensus in Quebec, the legislation still had to comply with the federal Criminal Code. The province could only go so far within its areas of jurisdiction. Now we can pass legislation that allows us to go even further.

The consensus that emerged in Quebec and that was confirmed in my discussions with my constituents is that we now recognize that we have reached a time in our civilization when, as citizens, we want to be able to choose. What the Supreme Court told us is that the Canadian Charter of Rights and Freedoms gives us the freedom to request medical assistance in dying.

In order to deepen my reflections throughout our deliberations in the Special Joint Committee on Physician-Assisted Dying, I felt duty-bound to seek out people and groups in my riding, Saint-Hyacinthe—Bagot, who are dealing with this situation every day and meet with people who are sick or dying. This includes stakeholders and volunteers with a community organization called Les Amis du crépuscule, which provides assistance to people receiving palliative care and later to their grieving families. There are user committees for health care institutions, as well as the Hôtel-Dieu-de-Saint-Hyacinthe hospital foundation. That institution is one of the largest long-term care facilities in Quebec. Hundreds of people spend their last days on earth at the Hôtel-Dieu-de-Saint-Hyacinthe. I think it is around 500 people. That hospital has hundreds of beds, but only 12 palliative care beds.

That is why it has been important from the start of this debate on medical assistance in dying to talk about developing and implementing a real national palliative care strategy. For medical assistance in dying to be a real choice, palliative care also has to be offered as a choice. Unfortunately, many people have limited access to palliative care.

In Saint-Hyacinthe—Bagot, people have access to Maison Victor-Gadbois, a home for end-of-life care for those with cancer. This home receives 800 applications a year, but can house only 200 people.

Doctors have told us that we have developed a health care system based on hospitals and healing. When I met with Monsignor Lapierre, bishop of the Saint-Hyacinthe diocese, to talk about this issue, he made a comment that was full of wisdom. He told me that we should be just as concerned about aggressive treatment as we are about medical assistance in dying. He is sometimes called to the bedside of people who tell him they have had enough.

We must vote on this issue of medical assistance in dying here in the House with a sense of the responsibility we have to represent our constituents who are living with a serious and irremediable illness and intolerable pain.

Every time I rise in the House to speak to this issue, and during each meeting of the joint committee and the Standing Committee on Justice and Human Rights, which studied this bill, I think about the people who are suffering. They are the ones who are at the heart of our discussion on Bill C-14. There are people who are suffering now, and they have high expectations for the bill we are going to pass. When the Supreme Court rendered its decision in Carter, people who were suffering had hope that their right to request medical assistance in dying would be respected.

The amendments in the motion by my colleague from Victoria say that we must not disappoint these people who are suffering and awaiting our decision. They hope that we will allow them to make this request for medical assistance in dying soon and that their rights will be respected.

These people who are suffering need not go to court. I was touched by the testimony given by members of the Carter family, who spent many years before the courts with their mother. When Bill C-14 was introduced, they came to tell us that the bill would not even give their mother the right to request medical assistance in dying. I cannot rise in the House and vote in favour of this bill, knowing that I am leaving people who are suffering to their own devices because they are not in the right class to be eligible for medical assistance in dying.

This week, the Minister of Health told us that we need to think not only about the rights of Canadians, but also about the work of doctors. Since I began thinking about this issue, I have realized how much respect I have for all health care professionals. I also have a lot of faith in their judgment.

The doctors who testified in committee said that, while requests for medical assistance in dying are a new part of their reality, they have been dealing with difficult requests from patients that require them to use their judgment every day since they became doctors.

The difference since the Supreme Court ruling in Carter is that now they must deal with requests for medical assistance in dying. These decisions will be difficult for some. Fortunately, the bill gives them the right to conscientiously object and tell the patient that they are not comfortable complying with their request. We think it is important for the health care system to ensure that patients will not have to find a new doctor in the yellow pages. They must have support in order to exercise their right to ask for medical assistance in dying.

We also believe that sufficient safeguards have been put in place. I was really moved by the representatives of organizations for the disabled who asked us not to be paternalistic or treat the disabled like children. The fact that they have an incurable disease or are living with a degenerative disease or suffering a great deal is no reason to treat them like children. They are autonomous and can provide informed consent.

The Supreme Court talked about suffering that an individual deems intolerable. Nobody can judge another person's suffering. We all react differently to illness. That respect for individuality must permeate the medical assistance in dying law we implement. We must ensure that each individual, each citizen of this country, has the freedom to make that choice if the situation arises.

Nobody in this country wants to be in the position of having to make this request. Nobody wants to face the choice of whether to request medical assistance in dying. Nobody wants to support a loved one in making a choice about requesting medical assistance in dying. Nevertheless, we all hope that, when that day comes, every person will have all the resources they need to give free, informed consent. We hope that every person will feel their rights are being respected and will not be told that, unfortunately, they belong to a small class of people who are not eligible because it is felt that their death is not reasonably foreseeable.

Many, including the Barreau du Québec, the Collège des médecins du Québec, and Quebec's health minister, came and told us that “reasonably foreseeable natural death” does not mean anything and is impractical. In my opinion, we are putting doctors in a position where they cannot reasonably use the flexibility we are trying to give them in a fair and equitable manner because this criterion has no clear meaning for a doctor.

We must ensure that the legislation we pass is consistent with the Supreme Court's decision in Carter and with the Canadian Charter of Rights and Freedoms. We must ensure that once this legislation is enacted people who are suffering will not be required to ask a lawyer to go before the courts to uphold their right to seek medical assistance in dying. At the Special Joint Committee on Physician-Assisted Dying, we heard that the provinces are ready to continue their work to enact provincial legislation. Quebec's health minister said that he was pleasantly surprised at the work of his colleagues from the other provinces.

Today we must pass legislation that is consistent with the Supreme Court's decision in Carter, that is consistent with the Canadian Charter of Rights and Freedoms, and that allows every Canadian to request medical assistance in dying.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 1:25 p.m.
See context

Liberal

Anthony Housefather Liberal Mount Royal, QC

Madam Speaker, I will share my time with my hon. colleague from Winnipeg North.

I rise today in the House to speak to Bill C-14, for the last time, I hope.

Although it was sometimes quite heated, I think that the debate on Bill C-14 brought out the best in us as parliamentarians. All parliamentarians showed a great deal of respect, even though we all have different perspectives on a very sensitive and emotional topic.

Today, I will talk about the amendments that were proposed by the other chamber. I support the motion by the Minister of Justice to accept some amendments and reject others.

The palliative care amendment that was brought in by the Senate is a good amendment. We had a lot of discussion at the Standing Committee on Justice and Human Rights and here in the House on the balance between access to medically assisted dying and the importance of ensuring quality palliative care. The fact that the Senate has once again reinforced the importance of ensuring that information be provided on palliative care before someone has access to medical assistance in dying is something that we should accept. I am pleased that we are going to accept that as amended by the Minister of Justice.

I am also pleased that the Minister of Health will be required to set out guidelines for death certificates within one year. We made amendments at the Standing Committee on Justice and Human Rights to require the Minister of Health to work with her provincial and territorial counterparts to set standards to include coroners. This amendment falls well in line with what the House has already accepted.

It is entirely legitimate for the Senate to ask for a deadline with respect to the studies that will be done on advance directives, mature minors, and psychological illnesses, and to require them to be delivered back to Parliament within two years from the time the studies begin. We in committee amended this to say “must commence within six months”, which is also a reasonable requirement.

What is also eminently reasonable and strongly follows the will of the House of Commons is the minister rejecting the amendment to remove the criteria of death being “reasonably foreseeable”. Removing that requirement entirely changes the bill from applying to someone who is near the end of his or her natural life to encompassing people who may have 30 or 40 years left to live. It may encompass people who have purely psychological illnesses, which was not the intention of the bill, because we have specifically stated that we are doing a study about people who have psychological illnesses.

However, if we look at the definition of “grievous and irremediable” and take out subsection (d) on reasonable foreseeability, then we fall into a situation where someone who has a psychological illness may meet the criteria of subsections (a), (b) and (c), thus completely changing the position of the bill on whether people with purely psychological illnesses can have access to medically assisted dying.

I want to emphasize from a public policy perspective that this legislation took a prudent approach. We can argue back and forth about what medical doctors and lawyers and law professors have said. I sat in committee and listened to well over 40 witnesses. I also had the pleasure of periodically glimpsing in on the Senate Standing Committee on Legal and Constitutional Affairs and listening to its witnesses.

Doctors, lawyers, professors, distinguished people came down on all sides of this issue. There are those who say that the bill is not Carter-compliant or charter-compliant and there are just as many, if not more, who say that the law is Carter-compliant and charter-compliant. In my view, it is the role of Parliament to determine what we believe to be charter-compliant. It is the role of Parliament to determine the best public policy within a charter-compliant law.

Medically assisted dying to me is meant to help people who are suffering intolerably but have an illness that will extinguish their life at some future date.

The court, in Carter, talked about Gloria Taylor and people like Gloria Taylor. Gloria Taylor had ALS. Gloria Taylor was undisputedly going to die from the illness she had.

I believe that ensuring that death is reasonably foreseeable falls entirely in line with public policy guidelines that we expect. Doctors and nurses, many of them, came before us and said that they did not go to school for many years to end people's lives. They went to school to try to help people who were suffering, to try to prolong life as long as possible within the framework that we currently have in the profession. They did not go there to be told that someone who comes to them and who may have many years left to live, and who has an illness that we may find a cure for in four or five years, should have their life extinguished.

As such, I do believe the minister is making the right decision to reject that Senate amendment. I also believe the government carefully researched what was being done in other jurisdictions. There are only nine jurisdictions in the entire world that have legally regulated medical assistance in dying. In all but three of them, there is a requirement that the person's life be near its end.

Whether it is Colombia, or the four United States' states that have these rules, or whether it is Quebec, which adopted its own end-of-life framework, which I understand is different and was pre-Carter, all of them require that a patient be dying, at the very longest, within the next six months, under reasonable medical certainty.

Only in the Netherlands, Belgium, and Luxembourg do we allow people to have their lives taken by medically assisted dying if their natural life is not close to an end. What kinds of situations have we seen in those jurisdictions? We have seen people who I believe many of us in this House would believe should not have access to medically assisted dying being given medically assisted dying.

We saw twins in their 40s, who were blind and starting to go deaf, for example, but had no other conditions that would end their life. Those people needed help, real help, psychological help, help to live their lives, not being told, yes, they should go die together now. People who were purely psychologically ill, who could not get over traumas related to sexual assault. These may be incredibly traumatic psychologically, but there are ways of helping those people that do not involve medically assisted dying.

I do not think Canadians, when we are talking about all the opinion polls that are being cited, where there is support of over 70% for medically assisted death, are contemplating those situations. They are contemplating situations where someone is nearing the end of their natural life and is in intolerable pain.

For me, if we removed reasonable foreseeability, we would be asking the medical profession in Canada, the nursing profession in Canada, other medical practitioners in Canada to be participating in medically assisted death beyond where they decided to do, and even more importantly, we would be doing so without the safeguards that would have been put in the bill had we intended that that class of people be covered. There is no way that a 10-day waiting period suffices when somebody could have 40 years left to live.

In conclusion, I want to say that I support the motion from the Minister of Justice, and I will be voting in favour today.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)Government Orders

June 16th, 2016 / 1:40 p.m.
See context

Winnipeg North Manitoba

Liberal

Kevin Lamoureux LiberalParliamentary Secretary to the Leader of the Government in the House of Commons

Madam Speaker, what a debate this has been. Bill C-14 has been at times a very emotional discussion, both inside the House and outside the House, whether it has been at committee or other places. I have learned a great deal from it. I really appreciated the many members on all sides of the House, no matter what their position has been on Bill C-14, who have been able to articulate and share quite candidly some real life stories, whether it was during second reading, at third reading, or at the committee stage. A number of members of Parliament were engaged in this debate and I would like to acknowledge their contributions.

It has been an interesting process from its beginning. We can talk about the Supreme Court decision and then fast-forward it to December, when there were heavy discussions on how we could come up with a report. We had a joint committee of the House and the Senate where we saw members of both places coming together to work and get a better sense of recommendations, ideas, and thoughts through consultation to make sure we could advance to where we are today. We saw ministers of the crown, two in particular, those for Justice and Health, pull it all together into something that sets a good, solid, legal framework, but will stand up to a charter challenge. l truly believe that to be the case.

From the ministers, to the individuals who sat on the committee, to the individuals who have spoken on this at different levels of readings, to those individuals outside of the House, people throughout our great country have been involved and engaged as much as one can expect on a piece of legislation that is so very important to each and every one of us. I have on numerous occasions stood with petitions dealing with this issue. I know other members have done likewise. I know that all members of the House have had consultations with their constituents, have received correspondence, and had telephone discussions.

I was able to cite a very personal experience with my father and what had taken place at the time of his passing. I was only one of many who was able to share stories. I thought I would provide a highlight in terms of why we are here. As members will know, it was a unanimous decision. All nine Supreme Court judges made the decision that we had to bring in a new law. That is really what Bill C-14 deals with, a new law regarding medical assistance in dying.

The Supreme Court of Canada made that decision and they put in a time frame. We have passed the deadline, but not by too much. It would have been nice to have achieved that deadline, but that is where we are today. If I could make reference to what this is, it is that access to medical assistance in dying would only be available to those who meet certain conditions: mentally competent adults who are in an advanced state of irreversible decline and capability; have a serious and incurable illness, disease, or disability and are experiencing enduring and intolerable suffering caused by their medical condition; and whose death has become reasonably foreseeable, taking into account all of their medical circumstances.

Something that is not highlighted very often is the fact that after four years this whole process will be under review, which is really important to emphasize.

Earlier today at the beginning of the debate, there was a comment that captured the essence of the bill and hopefully will put to rest many minds in regard to the issue that we have been debating. This is a quote from the Minister of Justice this morning. She said, “The bill achieves the most appropriate balance between individuals' autonomy in deciding how their death will occur and protection of vulnerable individuals, as well as broader societal interests.”

That is something the minister said earlier today, and that I concur with 100%.

I will now go to what the Prime Minister has said, and this is a great way to conclude my remarks. He recognized that Bill C-14 does not end the national discussion that needs to take place

We have seen a budget that has brought forward an incentive to ensure we build on a health care accord. This is something we believe is important to all Canadians, because Canadians from coast to coast to coast have told us that. We will continue to build and look toward palliative care as a part of that ongoing discussion.

It is such a privilege to be able to stand up and share a few thoughts and words before the bill ultimately passes.

Criminal CodeGovernment Orders

May 31st, 2016 / 10:10 a.m.
See context

Vancouver Granville B.C.

Liberal

Jody Wilson-Raybould LiberalMinister of Justice and Attorney General of Canada

moved that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the third time and passed.

Mr. Speaker, I want to begin today by acknowledging the contributions of all members of the House, in particular, the members of the Standing Committee on Justice and Human Rights, for how they have approached our debate on Bill C-14.

It is clear that members from all parties have engaged closely with their constituents, members of other parties, and their own experiences to make thoughtful and genuine contributions to our country's conversation on medical assistance in dying. This is one of the most important issues that this Parliament will address.

Bill C-14 represents the government's policy choice to address medical assistance in dying, a choice that is fully informed by consultations with Canadians and experts and takes into account all the interests and values surrounding this matter.

When the Carter decision came down in February 2015, one debate ended and another began. It was no longer a question of whether Canada would permit medical assistance in dying, but rather it was about how our country would do it.

Bill C-14 would create a statutory framework for medical assistance in dying that considers the perspectives of those who may wish to access it; those who are concerned about its consequences, including vulnerable persons who could be put at risk by the legalization of this practice; and those who may be asked to provide the assistance.

While the Carter decision told us that an absolute prohibition in the former law went too far, it did not tell us how medical assistance in dying should be implemented. The Supreme Court of Canada acknowledged that the issue “involves complex issues of social policy and a number of competing societal values”. The court stated that it:

emphasized that there may be a number of possible solutions to a particular social problem, and suggested that a “complex regulatory response” to a social ill will garner a high degree of deference.

The challenge facing Parliament is about setting new boundaries. Who should be eligible for medical assistance in dying; what safeguards should be required; how will it be monitored; and what issues require more study?

A proposed law that answers these questions must comply with the charter, but that does not require replicating the Carter decision. The Supreme Court of Canada has recognized that the relationship between the courts and Parliament should be one of dialogue. Just as Parliament must respect the court's ruling, so too must the court respect Parliament's determination of how to craft a statutory scheme in response to the court's judgment.

It is helpful to know how this dialogue has played out in previous instances. For example, in R. v. O'Connor, a 1995 charter challenge in a sexual assault case, the Supreme Court mandated the disclosure of therapeutic records in the Crown's possession and set out a common law procedure for the production of these records.

In response, Parliament enacted a statutory disclosure regime that differed in significant ways from the court's approach. The court upheld the constitutionality of that statutory regime, noting that it could not be presumed, just because Parliament's scheme looked different from what the court had envisioned, that it was unconstitutional.

Instead, there is this dialogue between the legislative branch and the courts. The court can provide the general parameters for a response, but it is for Parliament to craft the regime. Details of that regime matter because they necessarily engage fundamental choices of our rights and values and reconciling the tensions that sometimes exist between them.

In developing a response to the Carter decision, the government was called on to simultaneously promote autonomy, protect the vulnerable, affirm life, prevent suicide, support persons with disabilities, respect freedom of conscience, and fully consider many other valuable interests. As we went about this, we remained mindful of our constitutional framework and the divided jurisdiction between Parliament and the provinces and territories.

In weighing these values and making these policy choices, we were not alone. In the past number of months the national conversation on medical assistance in dying has been rich and fulsome, and no doubt it will continue.

Following the introduction of Bill C-14, the relevant standing committees of Parliament, including the justice and human rights committee and the Senate legal and constitutional affairs committee, which conducted the pre-study of the bill, have heard diverse perspectives from stakeholders and experts on all aspects of medical assistance in dying. Bill C-14 strikes a balance regarding eligibility and safeguards, as well as setting out what the federal law should do and what should be left to the provinces and territories to regulate.

Not everyone agrees with these policy choices. Still, I am confident that the decisions fall squarely within the range of alternatives that are legally open to Parliament to adopt. It would have been easy for the government to cut and paste the language from the court's decision into a new federal statute, but such an approach would have meant ignoring all the consultations and evidence that I have just referenced. It would also have fallen far short of developing a complex regulatory regime to balance competing interests, which the court said was the task of Parliament to craft and not the courts.

That evidence, presented over the past year, confirms that medical assistance in dying may pose risks to the vulnerable, even in circumstances where there is a general consensus that the person should be eligible for the procedure. That is why the bill provides for significant procedural safeguards, even when all of the eligibility criteria are met. This is why the bill would also put in place the necessary legal framework to monitor how medical assistance in dying is implemented in Canada.

In terms of eligibility, the policy choice made by the government was to focus on persons who are in an advanced state of irreversible decline and whose natural deaths have become reasonably foreseeable.

Recall that medical assistance in dying is exceptional because, from a criminal law perspective, it is a situation where one person actively and knowingly participates in the death of another. We criminalize and strongly condemn this conduct in all other circumstances. The only place in our criminal law where this conduct is justified is in self-defence, where individuals are permitted to take a life but only in order to save their own life or someone else's. While medical assistance in dying has medical and health law aspects to it, we cannot lose sight of this dimension either, because it is the criminal law power that is the primary source of Parliament's jurisdiction to address this issue, and it was the criminal law that, before the Carter decision, stood in the way of medical assistance in dying.

Having given careful consideration to the risks that may be posed when anyone, even a physician or nurse practitioner, is permitted to end another person's life, the balance reflected in Bill C-14 is that medical assistance in dying should be a choice for Canadians about how they die, so that they may have access to a peaceful passing. The bill would create a complex regulatory regime to respect this choice and ensure it is exercised in a voluntary and fully informed manner. Equally, the criteria ensure that, for Canadians who are not declining toward death, the focus of medicine remains on improving life, not ending it.

We also recognize that there are those who believe that the law should permit access to medical assistance in dying in other situations. The government heard these concerns loudly and clearly. The Standing Committee on Justice and Human Rights amended the bill to ensure that one or more independent reviews be initiated within six months of the bill receiving royal assent to further examine issues around the eligibility for mature minors, advance requests, and requests where a mental illness is the sole underlying medical condition.

We welcome this amendment and want to emphasize that we will remain open-minded to the evidence that these reviews gather and as Canadian data begins to be generated on how medical assistance in dying is actually working.

The decision to study these three issues further is supported by people who work with patients day in and day out in these three areas, who have been some of the most prominent voices calling for Parliament to proceed with caution.

With respect to mature minors, the Canadian Paediatric Society, represented by Dawn Davies, testified before the Senate committee that there “is simply not enough information to reach an enlightened decision” on this matter and that “It is appropriate that the first iteration of legislation on physician-assisted death does not include...minors”.

She also stated that there have not been sufficient consultations on this issue. The usual capacity and assessment processes, which Bill C-14 supports as appropriate for adults, may not be the right approach for mature minors. We need to consider this issue further.

Advance requests is another area where additional evidence is needed. We have heard many times over the past year that advance requests are likely to be sought in circumstances where persons are suffering from diseases such as Alzheimer's or dementia, but even the Alzheimer Society of Canada has stated in its public position paper that medical assistance in dying should only be possible when a person is competent at the time the assistance is administered. It says that advance requests not only pose risks to vulnerable patients, but they could also contribute to false stereotypes, undermining its message that it is possible to live well with this disease. Further study on this issue is the right policy.

On mental illness as a sole condition motivating a request for assisted dying, it is not surprising that reputable individuals and organizations, including the Centre for Addiction and Mental Health and the Mental Health Commission of Canada, support further study before legislating in this area. Moving forward in this way does not deny the suffering that these illnesses can cause. Rather, it ensures that we get it right and protect some of the most vulnerable and stigmatized persons in our society. For these reasons, I believe that Bill C-14 represents the right policy choices to answer the difficult questions the Supreme Court of Canada left for us as parliamentarians to resolve for 36 million Canadians.

I will now turn to the legal considerations, which play a crucial role in this seminal piece of legislation.

A consistent area of discussion has been around whether Bill C-14 is constitutional. As the Minister of Justice and Attorney General of Canada, I am of the firm opinion that the bill is consistent with the charter and is a justifiable response to the Carter decision.

Bill C-14's eligibility criteria directly respond to the Carter decision. They clarify the intended scope of eligibility, acknowledging the submission of the Canadian Medical Association, which represents 83,000 physicians who will, with nurse practitioners, be responsible for implementing and applying this law in their daily practice. This organization has stated that the language in the bill is a significant improvement over what it views, from a medical perspective, as the court's unworkable term “grievous and irremediable”.

What was the scope of the Carter decision? I appreciate that there are many differing interpretations of the decision, and I acknowledge that the Alberta Court of Appeal recently read Carter in a broad way, while some judges in the Superior Court of Ontario have read it more narrowly. I believe that the Carter decision was about the factual circumstances of that case. At the end of the day, Bill C-14 will be measured against the charter as a whole and not the Carter case. As the Alberta Court of Appeal recognized, “the interpretation and constitutionality of eventual legislation should obviously wait until the legislation has been enacted”.

Bill C-14 addresses both dimensions of section 7 of the charter, respect for autonomy and respect for life. The bill would strike a new balance between these interests through a comprehensive regulatory regime, which would receive deference from the courts. The proposed law would respect individual autonomy for persons who choose medical assistance in dying, but would do so in a careful manner that preserves other crucial objectives: promoting suicide prevention, preventing social stigma of life with a disability, and protecting society's most vulnerable persons from a risk of premature involuntary death.

While Bill C-14 requires that an eligible person be on a trajectory toward death, the flexibility purposefully built into the bill's criteria would allow medical practitioners to respond to a wide variety of medical circumstances, not just predictable diseases that are subject to fixed prognoses of life left to live.

Indeed, unlike some U.S. state regimes that require a specific prognosis, Bill C-14 does not require a strict relationship between the medical condition and the cause of the person's reasonably foreseeable death.

I do not agree with those who say that the Carter decision means that Parliament is constitutionally mandated to enact one of, if not the broadest, assisted dying regimes in the world, and that Parliament has little scope to consider other societal interests aside from autonomy. The court acknowledged that medically assisted death involved complex issues of social policy in a number of competing interests. In matters of this nature, the charter analysis takes into account the fact that there is no single manifestly correct balance of competing interests that are engaged. Deference will be shown, provided that Parliament's solution falls within the range of reasonable alternatives.

Bill C-14 is reasonable. It would provide people who are in a path towards death a choice that would respect their wish to die with dignity. Equally, it would limit medical assistance in dying to persons in these types of circumstances in order to prevent the normalization of suicide, protect vulnerable persons who were disproportionately at risk of inducement to suicide, and affirm the equal value of every person's life.

This balancing of interests addresses the inherent risks associated with permitting medical assistance in dying, and represents what the trial judge in Carter described as a “carefully- designed system imposing stringent limits that were scrupulously monitored and enforced”. Such a system is necessary because the suffering that can lead someone to request assisted dying does not just come from the condition; it also comes from how our society too often treats people with such conditions.

Under an approach where any serious medical condition is eligible, the law would be saying that an assisted death could be an acceptable treatment for a soldier with post traumatic stress disorder, a young person who suffered a spinal cord injury in an accident, or a survivor whose mind was haunted by memories of sexual abuse.

These are difficult but necessary situations to talk about, because cases like these are the unavoidable consequence of an assisted dying law where the only limit on eligibility is an individual's subjective experience of suffering.

As both the justice and human rights committee and the senate committee heard from several witnesses, the risk to vulnerable people, as well the crucial objectives of suicide prevention and affirming the value of the lives of all Canadians could be greatly increased unless eligibility was limited to persons who were approaching the end of their lives.

As I said, when Bill C-14 was introduced, assisted dying is a matter that touches us all and challenges us all. Divergent views on the bill remain, but we have a responsibility to act for all Canadians. The interim court approval process ends on June 6. If there is no legislation in place at that time, medical assistance in dying will lack a legal framework outside of the province of Quebec.

There is even uncertainty as to whether the court's remedy in Carter, if it came into force on June 6 in place of a statutory regime, would have the legal effect of completely striking down the existing criminal law that prohibits consensual killings and the aiding of suicides outside of an assisted dying context.

While most medical regulators have published interim guidelines, there would be no mandatory or consistent national safeguards. It could be possible, for example, for a physician to end a mature minor's life, depending on the province. Different jurisdictions require different numbers of witnesses, and some provide no waiting period at all.

Uncertainty around Carter parameters would persist and likely lead to inconsistent results in who would be found to be eligible, even between medical practitioners in the same jurisdictions.

We have a choice: To have a statutory framework in place with all of the national-level safeguards and protections that I have described, or having none. Bill C-14 reflects the kind of society we should aspire to be, one that respects individual autonomy and one that affirms that the lives of all Canadians have inherent value and are equally entitled to the protection of the law.

I call on all members of the House to support Bill C-14.

Criminal CodeGovernment Orders

May 31st, 2016 / 10:40 a.m.
See context

Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Mr. Speaker, in terms of amendments, 16 have been made to Bill C-14, which have strengthened the proposed legislation with respect to seeking to draw the balance between personal autonomy with protection of the vulnerable and ensuring that we do as much as we can to protect the conscience rights of medical practitioners.

I recognize the member's multiple submissions to the House on this legislation. I also recognize the tremendous experience of years of discussions that the province of Quebec has had with respect to putting in place its own laws.

With respect to Kay Carter, I am absolutely certain that Ms. Carter would qualify under the eligibility regime as presented in Bill C-14. We specifically ensured that we provided a broader definition around what grievous and irremediable meant and we put in place eligibility criteria that would ensure there would be flexibility in our regime and provide medical practitioners with the ability to engage with their patients. They are the most familiar with their patients and by virtue of that relationship can determine whether there is eligibility or not.

Criminal CodeGovernment Orders

May 31st, 2016 / 10:45 a.m.
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Conservative

Mark Warawa Conservative Langley—Aldergrove, BC

Mr. Speaker, I want to thank the Minister of Justice for being here today to speak in the House and for sharing her perspective and the government's perspective on Bill C-14. I found her to be always available and very thoughtful, and I thank her for her involvement.

I have been honoured to be part of the joint committee that dealt with the bill starting in January. I was also part of the justice committee when Bill C-14 was sent there. As the minister said, the opinions on this issue of assisted suicide are very diverse. Within each of the parties it is very diverse. However, I want to thank all members of Parliament for being respectful and working together on this important issue.

We are dealing with this issue because of the Carter decision. The Supreme Court said in the Carter decision that this must be allowed. The Criminal Code will be amended, and it is up to Parliament to come up with safeguards, not that this is permitted. However, the Supreme Court decided that we are to create safeguards.

We have also heard that 84% of Canadians want this. However, that statement that we have often heard is a little misleading, because 84% of Canadians do support this under certain criteria, and that criteria is that the illness is terminal, and the person is suffering terribly and repeatedly asks to have assisted suicide to end their suffering. Therefore, it is important to remember that it is under certain conditions.

I have consulted with my constituents on this issue. I sent out a householder, and I was very thorough and non-partisan. The householder I sent out provided a background and laid out all the different issues that Parliament is having to deal with: conscience protection, palliative care, who can provide this service, should there be judicial oversight, should the cause of death be listed for data collection as assisted suicide or euthanasia, mature minors, and on and on.

I had response to this householder, and one week ago, I had our second town hall meeting on this. In both cases, we had a huge response from the constituents. Actually, we have had more of a response to this issue through emails, phone calls, letters, and responses to the householder. We have had more responses on this than on any other issue in the last 12 and a half years that I have been a member of Parliament. People are very engaged and understand what the issues are and the challenges that the House faces.

Again, I thank the Minister of Justice, but as a critique, I think the government could have approached this a little differently, instead of dominating the committee structures, instead of bringing in time allocation, and instead of saying no to all the amendments.

The minister spoke about the 16 amendments, which, of course, were Liberal amendments. Of the amendments, there was one that the Conservative Party and the NDP at committee agreed with, and that was on conscience protection. We asked that all physicians, health care professionals, nurse practitioners, pharmacists, or anybody who is a health care professional who does not want to be involved with this have the right to say no. However, the government turned down that amendment.

The fact is, the parliamentary secretaries in the committee talked to each of the members on that committee and told them that the Liberals were not going to support that. Then the parliamentary secretary of justice actually spoke at the committee and said that the government did not support amending like that.

As the Minister of Justice just said, the government is going to leave it to negotiating with the provinces, and download that responsibility to the provinces. However, what we are doing in Bill C-14 is amending the Criminal Code of Canada. Prior to the Carter decision, it was illegal to assist anybody in a suicide. It was legal to commit suicide but illegal to assist somebody. It was considered homicide if someone assisted somebody.

Under the Carter decision a physician can, under certain conditions, provide assistance in a suicide and euthanasia. That amendment to the Criminal Code also could be elaborated on to say that it would be a criminal offence to force health care professionals or any individuals through coercion or intimidation, to participate in the death of another individual against their will. That is what we suggested.

When Bill C-14 gets referred to the Senate it will have to deal with it. I believe the Senate will refer this legislation back to the House. It is going to refuse to accept Bill C-14 the way it is and it will provide proper conscience protection for physicians.

We heard from the Canadian Medical Association that 70% of physicians in Canada do not want to be a part of this. They do not want to be forced through coercion, intimidation, or threats that they will no longer be able to practise at this or that hospital if they do not participate.

In a National Post article called “'Killing' patients vs. 'doing their job': Sharp division of opinion on whether doctors should be required to assist in suicide”, a doctor says she has been practising medicine for 37 years. The family doctor has decided not to renew her medical licence in June of this year. Dr. Naylor has no desire to quit medicine but she says she is appalled at the thought of being forced to refer. Dr. Burke, who practises physical medicine and rehabilitation in Windsor Ontario, said he is renewing his medical licence in Michigan where assisted suicide is illegal.

I have heard this at town hall meetings across the country and at the two I had in my own community. A young medical student asked me if physicians were going to be forced to do this and I said that there is a good possibility because in Bill C-14 the government is leaving it up to the provinces. We have already heard that the College of Physicians and Surgeons of Ontario will require physicians to effectively refer, which means that a doctor must follow that person through the whole process to make sure he or she does get euthanized if that is what the individual requested. The doctor must participate.

Physicians across this country, like those I just mentioned, are going to refuse to participate, saying they are now of retirement age and will retire or will relocate to another jurisdiction where they will not be forced to be a part of this, which goes against their conscience. A shortage of physicians and nurses will create a medical emergency in Canada. We will have a shortage of physicians and nurses in Canada because they will be forced to participate in something that goes against their conscience.

The government has an opportunity to do the right thing. It refused to do it in the House so it will be left to the Senate. The Senate will decide and it will amend Bill C-14. It will come back to the House in an amended form. We do not know how long that will take but it is obvious that the June 6 deadline will not be met. I hope the government will play differently then and will co-operate with the Senate and not strike down its amendments.

It is better to have Bill C-14 than nothing but it does need to be amended. The government needs to be more open-minded and congenial and work within this parliamentary environment and come up with legislation that represents where Canadians are at on this issue, not where the government is at.

Criminal CodeGovernment Orders

May 31st, 2016 / 10:55 a.m.
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Conservative

Mark Warawa Conservative Langley—Aldergrove, BC

Mr. Speaker, that is the salient question: what happens on June 6? I asked for a report from the Library of Parliament. It said that it will be the Carter decision and that it will be applied differently across Canada. In each province it will be the College of Physicians and Surgeons that will determine that. In Ontario, it will be required by physicians whereas in some provinces it will not be. In some provinces the provincial government will be engaged and in others it may not. Therefore, we will have a hodgepodge of how this will be applied across Canada. That is not in the interests of Canadians. Therefore, we need to pass this. Legislation is required. The problem is that Bill C-14 needs to be amended. It has some big holes in it. I hope the government will co-operate and listen to members of the opposition and listen to Canadians and fix Bill C-14.

Criminal CodeGovernment Orders

May 31st, 2016 / 11 a.m.
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Conservative

Todd Doherty Conservative Cariboo—Prince George, BC

Mr. Speaker, I rise in the House today to speak on an issue that may very well be one of the most significant, important social issues that this Parliament, in the life of this government, will ever face. This is not a matter that I take lightly, the issue of life or death.

Over the last few months, I have had the opportunity to speak with constituents in my riding. I have read the letters and emails they have written in. I have consulted with spiritual leaders from many faiths in the communities within my riding. I have sat through every single minute of this debate, because the magnitude of the legislation is something that deserves our thoughtful consideration. It is also something that has been weighing heavily on me, because regardless of my personal beliefs, I represent the tens of thousands of friends and families in the beautiful riding of Cariboo—Prince George.

For years I have worked toward my dream of becoming a member of Parliament, because I knew this opportunity would afford me the chance to make a difference, to be part of meaningful change, and to leave our country better for generations to come, but nothing truly prepares one to vote on a piece of legislation of this magnitude.

I am at the age and the point in my life where, unfortunately, I have seen my fair share of human suffering. It is a true test of humans to watch a loved one, a friend, or even a stranger, who is faced with intolerable suffering with no hope of recovery.

It is a reality that physician-assisted suicide will indeed become law. This we know is true. In 2015, the Supreme Court of Canada issued a landmark ruling in Carter v. Canada, stating that the laws preventing Kay Carter from ending her life in Canada were contrary to the Charter of Rights and Freedoms.

Kay Carter was a schoolteacher, a wife, and a mother. She was suffering from severe spinal stenosis, a disease that was making it impossible for her to move her body. She was 89, and because medical assistance in dying was illegal in Canada, Carter and her family travelled to a Swiss medical clinic, where she chose to end her life in 2010.

It is not in dispute that Carter was faced with intolerable suffering, but Carter's family and their lawyer have publicly stated that they believe that Kay Carter would have been ineligible for medical assistance in dying under Bill C-14. Therefore, my question for my colleagues across the floor is this. If this legislation was built to address the decision of Carter v. Canada, then why would it likely exclude the very case that opened the door for physician-assisted suicide in our country?

Many have expressed their concerns that this legislation is unconstitutional. Benoît Pelletier, a professor from the University of Ottawa, appeared before the special committee tasked with studying assisted suicide. He said that people suffering with illnesses that are terminal or cause intolerable suffering are at risk of being encouraged to seek an assisted death. He also said:

...all persons are potentially vulnerable. Being vulnerable does not disqualify a person...from seeking an assisted death, but it does put that person at risk of being induced to request a death....

This is among the most troubling testimony. Beyond legal implications, the opposition to Bill C-14 crosses party lines. We have heard from Conservative, Liberal, and NDP members, as well as concerned senators, multiple witnesses, and organizations such as the B.C. Civil Liberties Association, the Alberta Court of Appeal, and the Canadian Bar Association. At the core of our democracy is the ability to have thoughtful debate and discussion on a wide range of issues. Some of these issues are easier to address than others. Sometimes there is a unanimous consensus, and sometimes there is not.

We need to acknowledge in cases where there is not consensus that more work needs to be done, amendments need to be considered, and a majority control of the House should not be used to thwart dissenting opinions, especially on an issue of this scope and magnitude.

Dealing with the sanctity of life and death should be cause for more consultation, more discussion, and more debate than that over a pipeline or a budget. We have debated this for approximately 20 hours. Over half of the Conservative caucus has not had the opportunity to debate this subject. Even more of my Liberal colleagues have not had the opportunity to speak on this. It is concerning to me that on a piece of legislation of this magnitude, my Liberal colleagues have not had the opportunity to speak on this. It would appear from the outset that perhaps the Liberal backbenches are, indeed, being muzzled on this important piece of legislation.

Quebec took six years in successive legislative assemblies to develop its physician-assisted suicide law, six years of consultations and commitment to ensure its bill was not just good enough but one that captured most, if not all, concerns and safeguards.

Time and again, we have heard it is good enough at this point. To me, good enough is not good enough when we are talking about life and death. I am a firm believer that it is better to miss a deadline than to get such an impactful piece of public policy wrong. This piece of legislation is likely the most important law in our generation.

The Liberal government should allow all members to speak on behalf of their constituents and engage in further necessary consultations in order to get the legislation right, because the alternative is passing a deeply flawed and in my opinion unconstitutional piece of legislation. Passing Bill C-14 in this manner will result in court challenges that will further deadlock the work of the House and parliamentarians in having a workable document that protects the most vulnerable members of society from abuse.

The debate on assisted suicide over the last few months has opened the door to some of the alternatives that also need to be considered when speaking about Bill C-14. Palliative care is a critical component of this issue. We must always ensure that a proper palliative care strategy is in place. While the government likes to talk about this being core and an important piece in its budget and in moving forward, it has not even been mentioned once in the most current budget.

To ensure that individuals are well informed about their end-of-life options not only physically but to deal with their emotions, palliative care needs to be a viable end-of-life choice. At a time when assisted dying is a hotly contested issue, it is important to engage in conversations around palliative care to ensure that people are making the best decisions to improve their quality of life. We need to protect our most vulnerable.

As I mentioned previously during this debate, I am a father of a mature child who is cognitively challenged. While a healthy and productive member of the community, who I am extremely proud of, my daughter could not, today, make an informed consent, let alone if she was dealing with a grievous and terminal disease.

We also need to consider the medical professionals, the doctors and nurses, who went into their chosen fields to save lives, to improve lives, to ensure that lives are not lost and continue to be healthy. We need to ensure that these individuals are also protected and that the responsibility for this is not downloaded to the provinces. We need to ensure that this piece of legislation does not become a vehicle for those suffering with mental health issues to end their pain or that physician-assisted suicide is not chosen or forced due to obligation or feelings of burden.

Catherine Frazee, professor emerita at the school of disability studies at Ryerson University, said it best when she stated:

At the heart of this debate, we must choose between competing visions of our social fabric. Shall we uncritically submit to the voracious demands of individual liberty no matter what the social cost? Or shall we agree that there are limits to individual freedom, limits that serve all of us when we are vulnerable and in decline?

When we start deconstructing the foundation upon which our society is built, the social fabric, we need to ensure that proper safeguards are in place, a system of checks and balances. This system is not built overnight and it is not built through a limited debate and time allocation. It is built through listening, learning, and acknowledging a wide variety of viewpoints, stories, and opinions, through co-operation and thoughtful analysis and acceptance of amendments, none of which seem to be in line with the Liberal government's priorities.

I would like to thank our colleagues from all sides who have shared their experiences with us over the course of this debate. I appreciate each and every one of their views and their openness in sharing these deeply personal experiences, and I thank those in my riding of Cariboo—Prince George, the countless numbers, who have shared with me their views and experiences.

I would also like to thank the members of the committee who worked tirelessly towards a solution. I thank each of them for taking the time to voice their feelings on this important piece of legislation.

For the reasons I stated throughout my speech, I will not be able to support Bill C-14 as it currently stands.

Criminal CodeGovernment Orders

May 31st, 2016 / 11:10 a.m.
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NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Mr. Speaker, I would like to ask my colleague a question in light of so much wasted opportunity to discuss and really develop a meaningful piece of legislation that all of us could have an opportunity to weigh in on.

I really want to hear a little more about the importance of a palliative care strategy. I found it appalling that we were introducing the bill with such a lack of information. It was almost insensitive that we would be discussing something like Bill C-14 without any real, meaningful, tangible information regarding not just palliative care but enforcing the Canada Health Act in terms of home care.

I wonder if the member could expand on what some of the real tangible actions would be in a palliative care strategy that he would like to see happen in light of this.

Criminal CodeGovernment Orders

May 31st, 2016 / 11:15 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I am honoured today to speak to Bill C-14 at third reading.

Four months ago, I walked into the first meeting of a special House and Senate committee, created to advise the government on its response to the Supreme Court of Canada's decision in the Carter case. We worked long hours and late nights, respectfully and constructively with all parties and involving both chambers. We heard from witnesses and experts from across Canada and from all walks of life.

As we worked, I know that many of us thought of those who had struggled and suffered for the right to control their own lives at the end: people like Sue Rodriguez, who died in 1994 after losing her battle with ALS and losing her battle in the Supreme Court of Canada a year before. I recognized important contributors like Svend Robinson, member of Parliament, in that earlier battle. I think of people like Kay and Lee Carter, Hollis Johnson, William Shoichet, and Gloria Taylor, who fought valiantly and won in the court last year.

The work of the Special Joint Committee on Physician-Assisted Dying proved that a thoughtful and respectful debate was possible, but more than that it proved that a well-crafted bill could win the support of all parties and members of both Houses. I say that because a broad majority of us from all parties and both chambers agreed on 21 recommendations to the current government. I never imagined that I would be standing here now to oppose this bill.

This government bill ignores or rejects the majority of recommendations of that joint House and Senate committee. I am proud of those recommendations. It is true that many would have required great political courage, but all of them faithfully followed the evidence we received from the majority of experts who appeared before us. For example, I sought to have advance requests accepted by people who may lose the ability to provide competent consent at the end. The vast majority of Canadians told us that they want that. However, not only does this bill reject those recommendations, the bill would defy the Supreme Court ruling, fall short of its requirements, and therefore would violate the Charter of Rights and Freedoms for suffering Canadians.

That is the opinion of the Canadian Bar Association, the Barreau du Québec, and many others. That was the ruling of the Alberta Court of Appeal a couple of weeks ago, and just days ago, a court in Ontario echoed the Alberta decision. Justice Paul Perell of the Ontario Superior Court of Justice ruled that the Supreme Court's basis for an assisted death “is the threat the medical condition poses to a person's life and its interference with the quality of that person's life”. He went on to say, “There is no requirement...that a medical condition be terminal or life threatening.”

Despite this, time and again the current government has limited debate and tried to strong-arm a flawed bill through this chamber.

To be sure, this is a complex and sensitive issue, but not a partisan one. The Supreme Court has given us as parliamentarians an opportunity, not an ultimatum, to craft legislation that is consistent with the Carter decision. As is so often the case in this debate, we ought to look at exactly what the court said. Here is what they said, in paragraph 126 of the decision: “It is for Parliament and the provincial legislatures to respond, should they so choose, by enacting legislation consistent with the constitutional parameters set out in these reasons.”

Today the Minister of Justice again suggested that the court instructed us to enact a bill by a particular date. The court said the opposite. Each of us as parliamentarians, facing a free vote, has a simple question to answer: Does this bill obey the constitutional parameters set out by the Supreme Court in Carter? In my submission, that is the only question. If it does not, if it fails that test, then this House is being asked to knowingly infringe the charter rights of suffering Canadians and to enshrine that violation in law.

The Supreme Court of Canada established that all adult competent Canadians suffering intolerably from a grievous and irremediable medical condition have the right to choose assistance in dying. The government would have us honour that right only for patients nearing the end of life.

The Canadian Bar Association has said that such a restriction does not meet the floor of rights established by the court. The Barreau du Québec has said the same, and so has the Canadian Council of Criminal Defence Lawyers, the BC Civil Liberties Association, and many other respected legal organizations.

I suggested removing this line to help the bill comply with the court and the charter, but that idea was rejected by the Liberal majority. Now the Alberta Court of Appeal has ruled unanimously that the government's interpretation of Carter is simply wrong. In a crucial decision that the court wrote a couple of weeks ago, it said:

Carter 2015 does not require that the applicant be terminally ill.... The decision itself is clear. [...] The interpretation urged on us by [the Department of Justice] is not sustainable having regard to the fundamental premise of the Carter case itself....

This is a devastating indictment of the very argument that the government has relied upon to defend Bill C-14 against this rising chorus of critics. Surely that ruling should give us all pause. However, still some will argue that the Supreme Court cannot be obeyed right away, that medical reality dictates a balanced approach.

The government's restrictions have raised eyebrows in the medical community as well. The federation representing every medical regulatory authority in Canada has called this bill's end-to-life requirement “too vague to be understood or applied by the medical profession and too ambiguous to be regulated effectively”.

The College of Physicians and Surgeons of Ontario called it inconsistent with Carter and likely to cause confusion among physicians. The Canadian Nurses Association suggested going back to the words of the Supreme Court, as I have done in this place. If that were done, this controversial line could simply be deleted. I proposed doing exactly that, and my amendments were rejected by the Liberal majority on the Standing Committee on Justice and Human Rights.

Not only are medical groups concerned about the bill, many were not even consulted. According to testimony in the Senate, neither the Federation of Medical Regulatory Authorities of Canada nor any of the provincial or territorial colleges were consulted in the drafting of the bill.

We have a bill in which a few key lines have drawn heavy fire from both the legal and medical communities. These lines could be written on a napkin. They could easily be deleted, as my amendments would have done, and replaced with the exact words of our Supreme Court. Who could resist and oppose that in good faith? However, the government has refused precisely to do that.

On the first day of committee hearings, a Liberal member asked the Minister of Justice a simple question: “Have we sought outside counsel to ensure charter compliance of this bill?” The minister chose not to answer, citing only her personal confidence in the bill. Clearly, no independent confirmation of its charter compliance has been found.

I appreciate what the minister told this House recently, that no one has a monopoly on interpreting the charter. Of course, the minister is right, but I am afraid that the outlier here is not the critics; it is the government. The Canadian and Quebec bar associations, eminent legal and medical experts, the lead counsel in Carter, all are saying that the bill does not obey the Supreme Court of Canada's ruling.

Against that array, the government stands almost alone, brandishing a backgrounder from the Department of Justice and refusing to refer the question to the Supreme Court, or even to obtain an independent legal opinion.

Now the Alberta Court of Appeal has unanimously rejected the government's argument that the Supreme Court limited its ruling to end-of-life patients. Let me repeat: A provincial court of appeal has already ruled that the government's narrow and selective reading of Carter, the legal argument that supports this bill, is not consistent with the Supreme Court's ruling and therefore infringes a patient's charter rights.

Now we are being asked to enshrine that violation in law, and with what justification? No argument has been made for the bill's compliance with Carter and the charter. The minister is right that Bill C-14's many critics cannot simply assert that the bill is not constitutional, but neither can the government simply assert that it is. No one can claim to know the inner thoughts of our Supreme Court justices, but neither can the government continue to suggest that the intention of their ruling is somehow opaque or unknowable. The ruling was not an ink blot test, it was quite clear. The court was looking at the law with the same objective as the bill, to protect specific vulnerable individuals suffering during moments of weakness. The court found that the previous ban was overbroad because it caught people outside of that class, competent people who were not vulnerable and therefore deserved to have their autonomy respected.

That would remain true under Bill C-14. An entire class of competent adult Canadians would be condemned to intolerable suffering and denied recourse to assistance in dying. They may be forced to end their lives prematurely or violently. These are the same violations of section 7 rights identified already by the court in Carter. Although the court in Carter did not choose to proceed to an analysis of a section 15 infringement, the equality rights provision, the trial judge did. She concluded that the prohibition “imposed a disproportionate burden on persons with physical disabilities, as only they are restricted to self-imposed starvation and dehydration in order to take their own lives”.

As Quebec's minister of health warned us when he spoke out against the bill, this is precisely the same cruel option that will soon face patients if Bill C-14's end-of-life clause is not deleted. It is shameful that the bill leaves suffering Canadians in that cruel position.

At committee, I pressed the Department of Justice on this point. I told them the story of Tony Nicklinson. This story comes from an affidavit filed in the Carter case. During a business trip to Athens, Mr. Nicklinson suffered a severe stroke that caused what is called locked-in syndrome. In this state, he could not move a single muscle of his body except his eyelids. His healthy active mind was trapped in an unresponsive body, without remedy, without hope, and perhaps for decades more. He said he could not even drink and smoke in the hopes of shortening his life. Mr. Nicklinson wrote this in an affidavit, one blink at a time. He told the court this:

The flaw in the argument is the assumption that we all want to live whatever the cost in terms of quality of life when this is clearly not the case. I want to make that choice for myself. What prevents me is the fact that I am too disabled to take my won life and unlike an able bodied persons I need help to die.

By all means protect the vulnerable (by vulnerable I mean those who cannot make decisions for themselves,) just don't include me. I am not vulnerable. I don't need help or protection from death or from those who would help me - if the legal consequences were not so huge....

I am asking for my right to choose when and how to die to be respected. I know that many people feel that they will have failed if someone like me takes his own life and that life is sacred at all costs. I do not agree with that view. Surely the right and decent thing to do would be to empower people so that they can make the choice for themselves.

Mr. Nicklinson did not live in a place which empowered him to make that choice. He did not have the option of medical assistance to die peacefully, and so he starved himself to death. If he were alive today, Bill C-14 would offer him no hope, no respect for his autonomy.

This is the point I made to the Department of Justice. I was told that I was wrong. I was told that Mr. Nicklinson would not have to starve himself to death in Canada. He would just have to starve until a doctor declared his life “reasonably foreseeable”. Those are the words used in Bill C-14.

This is what we are talking about when we say that the bill infringes on the Charter of Rights and Freedoms for Canadians. Quebec's minister of health warned the government that the bill would force competent, consenting patients to endure starvation to win from the current government the rights that were already granted to them in the Carter case.

The court found the previous ban unconstitutional, not only because it violated the rights of competent patients but also because it was unnecessary. A better system was possible. Vulnerability, it said, could be assessed on an individual basis, and well-designed safeguards are capable of protecting the vulnerable. With these facts, the court could see no justification for continuing to deny the autonomy of whole classes of competent patients, like Mr. Nicklinson.

There is still no justification. In fact, the last refuge for the government would be to accept what is now clear, that Bill C-14 does not meet the test of the Supreme Court, and to argue that somehow it is necessary to violate the charter or even wise, because the safeguards the Liberals have developed are too weak to handle more complex cases. The bill is flawed, and I cannot accept that argument.

I was proud to serve on the joint House-Senate committee that offered recommendations to the government before the drafting of Bill C-14. We studied best practices around the world and recommended many of the robust safeguards found in the bill. Above all, I have great confidence in the care and professionalism of Canadian medical practitioners, and so I cannot accept that the Supreme Court was wrong in saying that well-designed safeguards can protect vulnerable people. I cannot accept that this regime is so weak—or Canadian doctors so careless—that it cannot be trusted to faithfully uphold the full charter rights of patients and to filter out those who are not able to make this choice.

Therefore, I am left with a simple conclusion. Enacting the bill would revoke from an entire class of competent and suffering adult Canadians the rights established for them by the Supreme Court. It would do so in a manner that is neither medically necessary nor legally justified.

I have sought to amend the bill and have seen those solutions rejected. I have requested independent constitutional analysis, and found none. I have called on the government to refer it to the Supreme Court of Canada, and it has not. Now I cannot, as a lawyer and a parliamentarian, support the enactment of a law that I believe would be unconstitutional from the outset. To vote for Bill C-14, against the charter rights of suffering patients—and I know some of them by name—I cannot do.

The government may try to excuse the bill's imperfections as inevitable in the circumstances, and I know there are members here who recognize that the bill is flawed but have been told they simply have to pass it by June 6.

Let us be clear about what happens on June 6. The absolute ban on medically assisted dying will not be restored, nor will the offences that prevented it, such as aiding suicide, disappear from the code. In other words, crime will not become legal, nor will medical assistance in dying become illegal. Rather, an exemption will open for patients and physicians acting within the parameters of the Carter decision. Of course, every provincial regulator has made rules to deal with safeguards over the last year anyway. They are ready to go. A federal law is not necessary to provide basic access and safeguards.

I call on my colleagues across the aisle, with whom I have worked constructively and collaboratively, to give real meaning to this free vote, to prove by their example what Canadians know to be true, that the final word on our constitutional rights comes not from the PMO but from the Supreme Court of Canada.

I move:

That the motion be amended by deleting all the words after the word “That” and substituting the following:

“Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be not now read a third time but be referred back to the Standing Committee on Justice and Human Rights for the purpose of reconsidering Clause 3 with a view to ensuring that the eligibility criteria contained therein are consistent with the constitutional parameters set out by the Supreme Court in its Carter v. Canada decision.”

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May 31st, 2016 / 11:40 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I thank the parliamentary secretary for his perspective on this, and I am sorry he is disappointed. We are trying to do our best for Canadians to get a bill in place that will not find suffering Canadians lined up at the Supreme Court doorstep as soon as we pass it. That is why we are doing this, and we hope people will support that initiative.

To talk about a legal vacuum is misleading, with great respect. We already have every college of physicians and surgeons across the land involved in having safeguards in place. Yes, having Bill C-14 on June 6 would be preferable to not having Bill C-14 on June 6, but having knowingly passed a law that is unconstitutional would be even worse. Let us take the time, I say, to get it right, not to get it done right now.

Criminal CodeGovernment Orders

May 31st, 2016 / 11:45 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I am not clear to this moment on why the government is so bent on passing a law that so many believe to be unconstitutional.

I frankly do not understand why the very thoughtful amendments were rejected yesterday. This was purported to be a free vote, but I did not see more than a few Liberal members stand against this bill.

Tonight, I understand we will be voting at third reading. This is the opportunity for members, particularly those concerned about rule of law, to come forward and vote against a bill that is patently unconstitutional, to get it right for Canadians, and protect those individuals who had their rights given to them, clearly, in the Carter case and would now see those rights taken away by Bill C-14.

Criminal CodeGovernment Orders

May 31st, 2016 / 11:45 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, palliative care is something that the former and present members for Windsor—Tecumseh have been pushing passionately in the House, in the justice committee, and in the Senate-House mixed committee.

It is something we wished to see enshrined in this bill. We were disappointed there was not a dollar of money in the federal budget for palliative care, despite promises during the campaign. We were, however, able to get an amendment through in the preamble to Bill C-14 that at least addresses the urgent requirement for palliative care.

The Minister of Health, herself, has pointed out that less than 30% have access to palliative care in Canada. That is connected—it must be so connected—with this bill that we need to do much better on that score.

I just hope the government actually puts its money where its mouth is and comes up, in the health accords, with meaningful help for palliative care and hospice care from coast to coast to coast. It is so urgently needed.

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May 31st, 2016 / 11:45 a.m.
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Liberal

Sonia Sidhu Liberal Brampton South, ON

Mr. Speaker, I am humbled to stand in this place and take this opportunity to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

I will be splitting my time with the member for Kenora.

I know that this issue is very personal to Canadians. It is about quality of life and dignity. It is about autonomy. Most of all, it is about compassion.

I listened to many people in the constituency of Brampton South on this issue. I heard support from most people in my riding. I also heard sincere and heartfelt concerns, particularly from our Orthodox-based communities. I appreciate their conviction, and that they have raised their voices with respect to this important issue.

I will use my time today to explain why I will be voting for this important legislation.

My heart goes out to all of those suffering and their family members, who are facing circumstances I cannot imagine. I think we can agree that it is those who are suffering, and their families, who this debate should be about. I hope that hon. members will not forget that fact. We must lean toward a compassionate approach for those who are affected. This is a serious matter and a complex issue. Therefore, we must find the right balance.

Our government must address this now. The Supreme Court made a unanimous decision, and soon there will be a legislative vacuum.

I think we can agree that a patchwork approach by the provinces would be the wrong approach. We would be ignoring our responsibility to show national leadership on this matter.

The framework laid out in Bill C-14 provides a solid, focused and detailed plan, which will meet the June 6 deadline set out by the court. Let me explain why.

Permitting medical assistance in dying will extend more control to eligible terminally ill patients on how to live out their last days. This legislation also provides important safeguards and limitations. It requires the Minister of Health and the Minister of Justice, in consultation with the provinces, to create regulations that will protect all of those involved.

By permitting medical assistance in dying for competent adults, whose deaths are reasonably foreseeable, I believe we are striking the right balance between the patients' autonomy who seek this medical assistance and the interests of patients in need of protection.

It is important to note that this bill does not stand alone. I would point out the critical work of improving palliative care in this country. The ideas of medical assistance in dying and a strong palliative care system are not in conflict. Rather, the two are complementary and are both important issues to address. That is why I am proud that the Minister of Health has recommitted to home care and palliative care improvements in response to a question that I asked during question period on May 2. In her reply to my question, the minister quoted Dr. Atul Gawande, who talked about how people want not only a good death but a good life to the very end. The minister reiterated her commitment to palliative care and providing dignity when Canadians are suffering. She announced how she will work with the provinces to ensure the high quality care of all Canadians. She also brought up how the Government of Canada is committed to an investment of $3 billion over four years to support that goal of palliative care and home care improvements. I commend this step forward.

We cannot view assisted dying legislation separate from investments in our health care system. Quality palliative care is a critical priority of this government. Indeed, as our government renegotiates the health accord with the provinces, I look forward to seeing palliative care discussed. The work with the provinces, territories, and stakeholders is essential to providing options to end-of-life care.

My background is as a research coordinator and diabetes educator. I know how the roles and views of physicians and nurse practitioners are vital to this issue. As a member of the health committee, and someone who worked in the health care field for almost 20 years, I understand the importance of consulting the people on the front lines. Physicians and nurse practitioners are central to the end-of-life process. Their conscience rights will be respected in this legislation. We are working on the best way to ensure their views are always taken into account.

The rules in this legislation are clear and eligibility has been carefully defined. I want to be clear. There is nothing in the legislation that would compel any medical practitioner or authorized nurse practitioner to provide medical assistance in dying. The legislation is meant to balance access to medical assistance in dying while respecting the personal convictions of health care providers. This is about finding the right balance.

Canadians are looking to their doctors and nurses to provide health care and to help them maintain their quality of life. However, when the quality is no longer attainable, Canadians want to know that their health care providers will also help them when their choice is a dignified end to their lives.

We have struck the right balance in my view by having proper procedural safeguards. Access to medical assistance in dying would only be available to those who meet the following conditions: be a mentally competent adult who is at an advanced state of irreversible decline in capability; have a serious and incurable illness, disease, or disability; experience enduring and intolerable suffering; and whose death is reasonably foreseeable.

It will also remain a crime to assist a person either in dying or in causing a person's death in a situation other than lawful medical assistance in dying. Protective measures are a key part of the legislation to ensure that eligible patients have given informed consent. Patients have to make a written request for medical assistance in dying and have it signed by two independent witnesses. Two independent medical opinions have to confirm that the patient meets all the criteria. These first two criteria are intended to ensure that requests for medical assistance in dying are truly voluntary, that they reflect the wishes of the patient, and are not made as a result of external pressure.

Our evidence-based approach will include regulating, monitoring, and reporting. This monitoring and reporting system will also be able to signal any issues or unexpected consequences. We want Canadians to see a system that is functioning and preventing abuses or errors. This will build up confidence and allow Canadians to make informed decisions about how the system should operate.

I appreciate how other members have spoken about how we will look to international models in terms of ways to work with the provinces and territories. This end-of-life coordination system will respect the role of the provinces, while providing access and respecting peoples' rights.

I want to recognize the work of the committees and the senators who have studied this matter and made recommendations around this debate. These recommendations and testimony from those on all sides of this issue should be taken into account. There have been a number of informative and heartfelt speeches by fellow members who I also want to take a moment to applaud. I also thank the Minister of Justice and the Minister of Health for their work in introducing the legislation.

Bill C-14 strikes a proper balance in view of the Supreme Court of Canada's decision and provides a needed legal framework. As parliamentarians we have the final say on behalf of the people we serve who elected us to be their voice. This is a debate that engages our morality, our sense of justice, and our compassion. It asks tough questions of our legal and medical systems.

We have talked to one another and heard some touching stories. We have reflected on how this issue affects all of us. It has called on us to hear the stories coming from the prospective Canadians who are suffering. It is often all too easy to forget what we would do if we were in their shoes. We often fail to truly appreciate the perspective and experience of those diagnosed with a terminal illness. Their dignity is challenged more and more as they reach their end.

We need to pass this legislation at the soonest possible opportunity. I hope all members will support the bill with me.

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May 31st, 2016 / noon
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Liberal

Sonia Sidhu Liberal Brampton South, ON

Mr. Speaker, I thank my hon. colleague for that great question. Yes, the committee did great work. Without federal legislation in place, Canadians would face an uncertain situation. I respect the views, but the job is about representing our Constitution and Canadians' views in this place. It is also about passing evidence-based policies that benefit Canadians. The people of Brampton South elected me to be their voice here, to bring a different approach, and to implement our government's better plan. Bill C-14 is the right bill at the right time. It is the best approach. We need checks and balances. That is why the committee did a great job. Even the CMA said that. The Canadian Medical Association has pointed out that in the Carter decision, the “...parameters are vague in the extreme, and contain absolutely no clinical direction whatsoever”.

The term “grievous and irremediable” which is used by the court is not a medical term, so we need more clarification for that. That is why the committee did great work. We listened to all the consultations and this is the right bill. We have listened to all Canadians, and this is the right bill that we have to bring.

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May 31st, 2016 / 12:15 p.m.
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Conservative

Ted Falk Conservative Provencher, MB

Madam Speaker, I want to start by saying that I will be splitting my time with the member for Selkirk—Interlake.

I want to say right from the outset that I am conceptually opposed to Bill C-14. I believe in the sanctity of life, and I believe that all life, from conception right through to natural death, has value, has worth, and has purpose.

As a sitting member of the committee for justice and human rights, I spent several weeks together with the committee in significant and lengthy meetings examining Bill C-14. We spent long days listening to witness testimony from experts and organizations from all over the country, and then doing a clause-by-clause analysis of the bill. Despite the many concerns voiced again and again by witnesses, there were no meaningful amendments made to the bill.

Bill C-14 is called medical assistance in dying, but make no mistake, Bill C-14 is physician-assisted suicide. It is important that we make this distinction. The gravity of the bill should not be undermined by the colourful wording. The bill would change Canada forever, and it would be naive to think that Canada's most vulnerable people would not be at risk under the bill in its present state. This is the most significant social re-engineering bill in the past 25 years, because it changes how we view the sanctity of life.

The Supreme Court was very clear that physician-assisted suicide is not a charter right, but it is an exemption that could be provided on an exception basis providing individuals meet certain criteria. The person must be a competent adult who clearly consents to the termination of life, who has a grievous and irremediable medical condition, including an illness, disease, or disability that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

Bill C-14 clearly goes beyond the Supreme Court decision with a mandate to study making physician-assisted suicide available to mature minors, exploring the concept of advance directives, and providing physician-assisted suicide to mentally disabled individuals. This is just not acceptable.

The committee heard testimony from approximately 42 individuals and/or groups who all have a vested interest in this issue. Over 100 amendments were presented to committee based on evidence from witness testimony provided to committee. Sadly, the Liberals did not present any substantive amendments, and in fact, voted against any meaningful amendments presented by any of the opposition parties. The Conservatives presented many thoughtful amendments that would have strengthened the bill and added important safeguards, as they did last night at report stage. This is a missed opportunity.

Let me highlight just a few of these missed amendments, these missed opportunities.

These amendments included things like assuring that only trained and qualified medical practitioners, in other words physicians, would assess the individual and administer the lethal cocktail that would eventually procure death. The way the legislation is presently drafted, it would allow a person to obtain the lethal drug from pharmacists, take it home, self-administer, and procure their own death. This worries me, and it should worry every Canadian. Witnesses presented testimony that in other jurisdictions that permit this practice, 30% to 40% of prescriptions for death go unused.

What happens to these unused drugs? What if the drugs fall into the wrong hands? What if the drugs were not administered properly? What if they did not take all of it and complications set in as a result? How can we be sure that the individuals were not at some point pressured into it? There are just way too many unanswered questions in the bill.

The bill would also make it near impossible for medical practitioners to monitor and report on subsequent events. Did the patient self-administer the drug or did the patient die from an illness? How do we ensure that we have the correct data to track euthanasia in Canada? These are valid concerns being voiced by Canadians, and it could have been addressed in the amendments that we proposed at committee.

The Liberals are unwilling to consider an amendment to ensure physician supervision during the procedure.

In addition, Bill C-14 allows for nurse practitioners to provide medical assistance in dying. There are substantial differences between a medical practitioner and a nurse practitioner, including the length of time spent training and the ability to prescribe various narcotics, yet suddenly, in this bill, we are affording them the ability to assess an individual's eligibility for physician-assisted suicide and prescribe life-ending cocktails, which is in stark contrast to the typical expectations we have of nurse practitioners.

This goes too far and is another issue we sought to address in the bill. Again, this is a missed opportunity.

We also provided an amendment that would have removed psychological suffering as an eligibility consideration for physician-assisted suicide. This, quite simply, leaves too much room for interpretation. Allowing for psychological suffering as an eligibility consideration is the start of a very slippery slope in terms of who can receive physician-assisted suicide and for what purpose.

We also suggested that “reasonably foreseeable death”, as defined in the bill, would be replaced with imminent death or at least death expected within 30 days. We heard testimony from witnesses on either end of the spectrum raising various concerns about this wording. “Reasonably foreseeable” in one physician's eyes could be completely different in the eyes of another. This will certainly open the door to uncertainty among patients and practitioners, and will definitely lead to subsequent lawsuits.

To further strengthen safeguards, we proposed an amendment requiring that prior judicial review had occurred to ensure that all criteria for physician-assisted suicide eligibility had been met.

Dr. Will Johnston, chair of the Euthanasia Prevention Coalition of British Columbia, came to testify before committee. He said the following:

...although it might be assumed, nowhere specifies that doctors must actually examine the patient, the extent to which they must do so, or the extent that doctors must inquire into the internal and external factors that create vulnerability for the patient.

Dr. Johnston brings forward a valuable consideration. Bill C-14 does not stipulate to what degree a patient should be examined nor does it require examination of the factors creating vulnerability for the patient.

In addition, we know that this is a complicated matter and difficult to address in legislation. Every individual and every disease presents a different set of challenges. Judicial oversight would ensure that individuals meet all the criteria given their unique set of circumstances and would further protect Canada's most vulnerable people. Again, this very reasonable amendment was rejected.

We also put forward a request that palliative care consultation be included as a criterion for seeking physician-assisted death. Patients would be made aware of all options available to them and ensure palliative care options were understood, offered, and available.

We heard time and again in committee that access to palliative care is a problem in this country. We also heard that palliative care, especially chronic pain treatment and counselling services, is very successful at alleviating the suffering, depression, and anxiety, things that lead people to wish to hasten their death.

The minister spoke on palliative care, and insisted that palliative care and physician-assisted suicide go hand in hand, yet the committee refused to adopt palliative care consultations as a prerequisite component in the bill.

The Canadian Society of Palliative Care Physicians outlined the issue well before committee. They wrote:

In order to ensure that medically assisted death is not our first or only response to human suffering, we need to build in an explicit legal requirement to identify, explore and record the sources of a person’s suffering and attempt to address the motivations of his/her request for death. This should not be undertaken as a screening or determination process, but rather an opportunity to ensure that a person who requests an assisted death is fully informed of available options for treatment.... The Bill should be amended to incorporate a meaningful right for patients to be informed of the full range of available treatments, technologies and supports that could ease their suffering, whatever its source.

Palliative care consultations would protect patients and ensure that physician-assisted death does not become the first response to human suffering. I cannot understand why the government would not want to ensure patients have sought out all other alternatives before requesting physician-assisted death.

One of the things we were very clear about, which the evidence produced over and over again in committee, was the whole need for conscience rights protection, not only for individuals but institutions. This came across as a large concern. We presented several amendments to committee that would have met the concern of many institutions and individuals that may be forced or required to offer this service. These amendments were all rejected, not only at committee but they were rejected here last night at report stage as well. We find that unacceptable.

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May 31st, 2016 / 12:30 p.m.
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Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

Madam Speaker, I rise somewhat concerned today that I am finally, for the first time, able to speak to Bill C-14. We are at third reading. This bill has been rammed through the House. The Liberals have brought in closure time and again with this bill. Every time it was debated, whether at second reading or report stage, I was not available, or the time was so constrained and the list of speakers of the members of Parliament was so long, that I could not get on the list. Finally, I am able to speak today to Bill C-14 to reflect my concerns and those of my constituents on this bill.

When closure is used in dealing with issues of conscience like we are dealing with today with respect to physician-assisted death or doctor-assisted suicide, whatever we want to call it, we need to take the time to have the debate. We need to have the discussion among parliamentarians and talk to the appropriate experts to ensure that we get this right. If the Liberals rush this bill through the legislative process in the House and if they try to do it in the Senate, I can guarantee that mistakes will be made and this bill will be facing court challenges in a relatively short period of time.

I also have to reflect what my friend from the riding of Provencher said today. It is extremely disappointing that so many reasonable amendments were presented by members of the opposition parties, and not one of them found their way into this bill at report stage last night. That truly is disappointing.

In my riding of Selkirk—Interlake—Eastman, the topic of physician-assisted suicide is divisive, as it is right across the country. The majority of constituents who have contacted my office have been opposed to this policy, on two fronts: first, many people have deeply held moral, ethical, and religious beliefs that are strongly against assisted suicide; and, second, many believe that the policy will be used prematurely to end the lives of those who have become a burden to their families, society, or the medical system.

It is important to note that the Liberals broke a key election promise to invest $3 billion into long term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making. There was unanimous agreement on the Special Joint Committee on Physician-Assisted Dying and among stakeholders, including the Canadian Medical Association, on the need for a pan-Canadian strategy on palliative care, with dedicated funding. This would be an important step forward for Canada. It is something that the Liberals have glossed over in favour of introducing this legislation in a very careless and expeditious manner.

Many medical doctors, nurses, and health care professionals are conflicted with the ethical and moral conundrum that assisted suicide presents, as it runs counter to the modern adaptation of the Hippocratic oath. The University of Ottawa captures the challenge of this principle. It states:

Given the complexity of medicine in the 21st century, an ancient oath cannot possibly encompass current values. Therefore, the significance of the Hippocratic Oath does not reside in its specific guidelines, but rather, in its symbolism of an ideal: the selfless dedication to the preservation of human life.

I would stress “the preservation of human life”.

Although the Canadian Medical Association in the last year has turned its back on its previous position on physician-assisted suicide, the Supreme Court of Canada went to great lengths and grasped at straws to change its position from its previous rulings as to whether there should be exemptions offered for physician-assisted suicide.

The Canadian Medical Association is a member of the World Medical Assembly, which adopted a resolution back in 1992 on this. It revised it slightly in 2005, but reaffirmed it in April of 2015 in Oslo. It states:

Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.

Quite clearly, the World Medical Association, doctors and physicians from right around the globe, is saying that this is unethical.

As has been pointed out, we are quite concerned from our side, and I am in particular, about the charter rights under sections on the freedom of conscience. As has been noted, there was a minor amendment made to Bill C-14 in the preamble to allow for the protection of individuals but not of institutions. Is it strong enough to be considered legal in a case that goes before the courts, the Canadian Human Rights Commission, or one of the provincial human rights commissions, if section 2 is defined in the preamble but is not actually in the clauses of the legislation itself?

Institutions would be exempt, and I know that some members have had conversations with people at some institutions who are very concerned about this. I looked to the St. Boniface General Hospital in Winnipeg, a Catholic-run hospital. They are quite concerned that they, as an institution, will have to violate their own religious and moral beliefs to provide assisted suicide. They believe in the sanctity of life, as many of us on our side do also.

Like most Canadians, I have watched loved ones succumb to lengthy and chronic debilitating illnesses. Dying with dignity is desired by all Canadians. Unfortunately, only a handful of us will die in our sleep with minimal discomfort or pain. I do not believe that we should institute a policy that will provide physician-assisted suicide to every Canadian when they are near their end of life. Dying with dignity does not apply only to physician-assisted suicide. Expanding and improving palliative care services is by far the better public policy, and should be a priority of all health care providers across this country. I am recommitting to working with like-minded Canadians and policy-makers, and parliamentarians right here, who want to enhance palliative care in Manitoba and across the country. My wife Kelly works as a nurse in a personal care home and provides palliative care services all the time. She agrees that strengthening palliative care services will allow more Canadians to die with dignity.

I have met with the Manitoba League of Persons with Disabilities and talked to Carlos Sosa, who is the Manitoba representative on the Council of Canadians with Disabilities. They are very concerned with the way that Bill C-14 is laid out right now because it would do little to address the concerns of the vulnerable and how the law would deal with people in the disabled community. In particular, the bill would not provide for an assessment of vulnerabilities that may induce a person to assist and seek an assisted suicide. It does not have an expedited prior review and authorization by a judge or independent body with expertise in fields of health care, ethics, and law. This was one of the amendments we brought forward last night, and it was defeated.

Rhonda Wiebe, who is the co-chair of the Canadian Council of Disabilities end of life ethics committee, said:

In the Carter decision, the Supreme Court of Canada gave the Government of Canada two assignments (1) develop a regime to provide dying people access to assisted suicide and (2) protect vulnerable Canadians who at a time of weakness may be influenced to accept medical aid in dying. Unfortunately, [Bill] C-14 has some serious gaps when it comes to protecting the vulnerable..... Canada must do enough to protect people like [her] and other Canadians with disabilities who can be made vulnerable by both [their] health conditions and [their] social and economic circumstances.

I am privileged to belong to a political party that allows for free votes on issues of moral and religious beliefs. On policies such as physician-assisted suicide, Conservative members are free to either reflect the will of their constituents or to vote according to their personal beliefs. As someone with very strong Christian values, I cannot support Bill C-14. Bill C-14 needs better protection in place for youth under the age of 18, and safeguards for those who are vulnerable, including those who are dealing with mental health challenges.

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May 31st, 2016 / 12:45 p.m.
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NDP

Peter Julian NDP New Westminster—Burnaby, BC

Madam Speaker, we are dealing with a closure motion today that allows very few members of Parliament to speak. We saw a couple of weeks ago that the government pulled Bill C-14 from the Order Paper a number of times when members of Parliament wanted to speak on it.

We saw, as well, a government refusing even the ability yesterday, under closure, knowing that we had a vote on Monday evening, to allow members of Parliament to speak during the day. It defies logic that a non-partisan bill of this nature would be treated so reprehensibly by the government.

Given all of the concerns raised by legal and medical professionals, their communities, the concerns about the lack of constitutionality of the bill, which has now been pointed out in two court decisions, why does the member think the government is trying to ram through this bill in such a partisan and inappropriate way?

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May 31st, 2016 / 12:50 p.m.
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Liberal

Francis Scarpaleggia Liberal Lac-Saint-Louis, QC

Madam Speaker, I will be sharing my time with my hon. colleague from Pierrefonds—Dollard.

In this postmodern world of ours, with its tendency at times toward a certain kind of what some might call libertarian relativism, we must continue to believe and affirm that there exist values that we can all agree are objectively good and worth protecting and promoting, values that should inform, motivate, and guide us both individually and collectively. Namely, we must subscribe to the imperative that we as human beings have a duty to support each other in our struggle in this fight for life, as some colleagues have put it, this struggle against the undeniable reality of our finite existence, our mortality. Every moment of life has value. This truth is to be asserted and upheld. This is the prevailing consensus, one that has become deeply rooted and entrenched in society over the course of history. It is also our best instinct. Many of my constituents fear that Bill C-14 would undermine this consensus, this instinct. I understand this fear.

We cannot allow ourselves to fall into indifference, to be quietly seduced by the facile notion found in the well-worn phrase “to each his own”, whereby we agree on everyone's right to choose, but beyond that we do not think it our business to provide reinforcement for the desirable and good choice. When I hear anyone appear to frame the debate on medical assistance in dying as one of pure libertarian choice, I must admit that a little part of me shudders.

After much reflection, I do not believe that Bill C-14 would necessarily lead us down a path to an increasingly permissive and contagious attitude toward self-directed death.

I would like to quote bioethicist Margaret Somerville, someone generally identified as a philosophical conservative on bioethical matters, someone who has written on the dangers of legalized doctor-assisted death:

The bill would legislate these actions as an "exemption" from—an exception to—prosecution for the Criminal Code offences of culpable homicide and assisted suicide that would otherwise be committed. Treating medically assisted dying as an exception will help to ensure, as is essential, that it does not become part of the norm for how Canadians die;

In other words, Bill C-14 would not normalize medically assisted dying as perhaps has occurred in Belgium and the Netherlands, the two most often cited examples of the slippery slope.

Dr. Sommerville goes on to say that:

Recognizing medically assisted dying as an exception also helps to establish that access to it is not a right but rather, under certain conditions, an immunity from prosecution for a criminal offence....

This approach, she further states, “carries an important anti-suicide public health message.”

I would add that the government has taken care to emphasize this message in the bill's preamble, which acknowledges that “suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities”.

I am not a doctor who deals with life and death on a daily basis and I have never been at death's door.

Like every one of us here, I am an elected member trying to make the best possible decision in the context of the undeniable reality that the Supreme Court made a unanimous decision in the heart-rending Carter case.

The court's decision requires Parliament to create a new legal framework to regulate a specific aspect of end of life. If we fail to do our jobs now, the result will be a partial legal and regulatory vacuum. To quote the Ontario Hospital Association, if the bill is not passed by June 6, “Assisted dying would be lawful where it is provided in accordance with the parameters established by the Court and provincial regulatory bodies.”

The parameters set out by the court are fairly general. The court did not offer precise prescriptions for what an operative medical assistance in dying framework should look like. It is not the role of the courts to be so prescriptive.

This is not to say that I do not have concerns in voting for this legislation. Absent a Supreme Court ruling, and had the issue been raised once again through a private member's bill, I would very likely not have voted for medical assistance in dying. I have already, in the past, voted against a private member's bill on doctor-assisted suicide.

However, we do have a Supreme Court decision that creates a requirement to act. The Prime Minister and the Minister of Justice and the Minister of Health have, in my view, acted wisely in taking a cautious approach to the issue, notwithstanding the excellent work of the special joint committee under the capable and intelligent stewardship of my friend and colleague the member for Don Valley West.

The bill may not be perfect, but I believe it would be a mistake to suggest that it leaves a wide-open field in medically assisted dying, a fear expressed to me by many thoughtful constituents committed in the highest degree to the protection of human life.

Bill C-14 would establish numerous criteria to be met before access to medically assisted dying could be granted. In addition to being 18 years of age, the person must have a grievous and irremediable medical condition that meets four distinct criteria: the illness, disease, or disability must be serious and incurable; the individual must be in an advanced state of irreversible decline; moreover, the illness must be causing enduring physical or psychological suffering that is intolerable; and natural death must be said to be reasonably foreseeable. In addition, the person must make a voluntary request that is free from external pressure and that is the result of informed consent.

The bill also includes a number of safeguards, and the individual must make a request in writing or through another reliable means. If the request is being signed by a proxy, that proxy must be at least 18 years of age and understand the nature of the request. The request must be made after the person has been informed that his or her natural death has become reasonably foreseeable.

The request must be signed and dated before two independent witnesses, and in turn, these witnesses must not consciously be beneficiaries, financial or in any other material way, of the individual making the request, and they must not be directly involved in providing personal care to the person making the request.

Two medical practitioners must provide a written opinion confirming that the person meets the eligibility criteria, and these medical practitioners must be independent. For example, one cannot be a supervisor of the other or a mentor of the other.

Crucially, the person must be informed that he or she has an opportunity to withdraw the request at any time.

All of this said, I am not at all convinced that medical assistance in dying is a serene and dignified phenomenon, even if often depicted in this way. I suspect that complications may arise. This is why it is crucial and to the government's credit that the bill allows for monitoring of medical assistance in dying through detailed reporting.

A few years ago, a handful of parliamentarians, including the members for Kitchener—Conestoga and Carlton Trail—Eagle Creek, the former members for Newmarket—Aurora, Guelph, and Windsor—Tecumseh, and myself, wondered about enhancing and improving palliative care in Canada.

We joined the committee on compassionate and palliative care and produced a report. The silver lining in this debate is that palliative care is receiving a degree of attention never before seen in this chamber or in national discourse at large.

It is my sincere hope that, once quality palliative care of the kind provided by the West Island Palliative Care Residence is available through appropriate federal and provincial funding to all Canadians approaching death, this legislation will become somewhat of a relic, and medical assistance in dying will no longer be considered the default option in relieving end of life pain and suffering.

In this regard, I am heartened that, in addition to the government's existing commitment to do more to fund palliative care, the bill makes specific reference to this commitment. The advent of universally available quality palliative care will hopefully one day be seen as the high-water mark in the measure of a truly just society.

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May 31st, 2016 / 12:55 p.m.
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Bloc

Luc Thériault Bloc Montcalm, QC

Madam Speaker, my Liberal colleagues are lavish in their praise of the minister. They think that the bill is perfect and will easily pass the test of the charter and the courts.

My question is simple. How does Bill C-14 guarantee a reasonable expectation of the right to life; liberty, by which I mean freedom of conscience in the sense of respecting autonomy; and security of the person, in the case of a person suffering from a grievous and irremediable illness, if the person has to go on a hunger strike to be eligible for medical assistance in dying and meet the reasonably foreseeable natural death criterion?

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May 31st, 2016 / 1 p.m.
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Liberal

Frank Baylis Liberal Pierrefonds—Dollard, QC

Madam Speaker, there is a poem by the great Welsh poet, Dylan Thomas, entitled, Do Not Go Gentle Into That Good Night. It is a poem of a son calling out to his dying father to fight his imminent death, and it ends as follows:

And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

He is imploring his father to fight to the very end, to rage against the dying of the light. I believe this stanza describes the very essence of western philosophy when it comes to dying. Simply put, do not accept death.

However, life is terminal. The very definition of life is to die. A rock does not live, because a rock does not die. A tree lives, because a tree dies. A person lives, because he or she dies. So, am I going to die?

This is the subject of an excellent Ted Talks by a first responder. It is about a paramedic who would often arrive at the scene of an accident only to find a victim whose injuries were so severe that he or she was not going to survive. These victims would inevitably look up to this paramedic and ask: “Am I going to die?” In those moments, he would always lie and say no. He did so because he thought that was the kind, caring thing to do. Then a few years ago, he arrived at the scene of a severe motorcycle accident to find a victim who again asked the same question. For some reason, he told the truth and said yes. The reaction was not what he expected. The victim showed calm, inner peace, wisdom, and acceptance. From that time forward, he always told the truth.

Dylan Thomas in his poem tells us “wise men at their end know dark is right”. Therefore, am I going to die? Yes. We are all going to die.

Now we find ourselves discussing an issue that is foreign to many of us. With Bill C-14, we are trying to determine when it is acceptable to accept to die. That is to say, when it is acceptable to go gentle into that good night. This is essentially what we are debating with this bill.

Some argue that the bill should follow the Supreme Court's ruling to the letter. Some argue that the bill should be broad to encompass all possible scenarios. Some argue that the bill should be narrow and restricted so as to protect the vulnerable. Some argue that there should be no bill at all, and we should not be on this path regardless of what the Supreme Court says.

Here in the House we have had great debate on this matter. It has been passionate, intelligent, and respectful. It has been the House of Parliament at its best. For example, the member for St. Albert—Edmonton, who was on the special joint committee that prepared the guiding report for this legislation, has spoken eloquently on why he believes this bill is missing certain key protections. On the other hand, the member for Victoria, who was also on the special joint committee, has expressed, in a thoughtful, intelligent manner, his strong belief that the bill is too restrictive in certain areas.

I have received numerous personal letters from many sides of this argument, letters from people who are suffering now and fear not being able to access this gentle path when their time comes. Other letters are from caregivers who look after the grievously sick, the aged, and the mentally incapacitated. They are deeply concerned that these vulnerable people will not be protected. My own father has written on this bill.

I was out meeting constituents a few weeks ago and a lady came up to me. She said that she really liked what my father had written in the newspaper. Now, people get confused at times, and I did not know about this, so I just thanked her. When I got home, I called my father and asked if he wrote something in the paper. He said, “Yes”. I asked to see it, if he could email it me. He said, “No, I've erased it”, because he does not like to keep clutter on his computer.

I asked him to explain the gist of what he said, and he went on to explain that the term “reasonably foreseeable natural death” was a difficult one, even for a physician. My father had suffered severe heart attacks 25 years ago and was told to put his affairs in order by his physician.

Here he was, using the example of his own life to say, “I am alive 25 years later.” He is alive because on a dark night 25 years ago, he chose to “rage against the dying of the light.”

None of these people are wrong. Everyone has an opinion, and everyone's opinion is valid. For each person, that destination, that moment in time when it is acceptable to accept death is different, and rightfully so.

If the destination is uncertain, how do we arrive at it? Cautiously. There is a concept in engineering called “overshoot”. Simply put, the faster one arrives at their destination, the more likely one is to overshoot it. For example, if someone is driving in a car toward a stop sign and if he or she is going very fast and slams on the brakes, the individual will shoot past the stop sign. On the other hand, if someone goes very slowly, it will take that individual very long time to get to the stop sign and he or she may even stop short.

We have an uncertain destination that is different for each person. How do we get there? Cautiously. We go toward that destination slowly. This is precisely the approach that the Minister of Health and the Minister of Justice have decided to take.

With Bill C-14, we are moving forward to this destination slowly, and we accept that we may even stop short. The bill acknowledges this. It is explicitly written into the law that it will be re-examined in a few years' time, precisely to allow for adjustments.

This is a very wise approach, and I commend the Minister of Health and the Minister of Justice for the work they have done to bring us here.

In summary, we will all face our death. At that time, some of us will choose to fight death to bitter end. As a society, we already support that decision and we use the full weight of our medical system to help those people who choose to "rage against the dying of the light".

On the other hand, some of us will choose to accept death with inner peace and calm. As a society, we must now accept their decision and allow our medical system to help them. With this bill, we will help some of those people to "go gentle into that good night."

Criminal CodeGovernment Orders

May 31st, 2016 / 1:45 p.m.
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Markham—Stouffville Ontario

Liberal

Jane Philpott LiberalMinister of Health

Madam Speaker, I am going to be splitting my time with the member for Surrey Centre

The topic we are addressing today is a solemn one. As a result, the past few weeks have been emotional for all parliamentarians, myself included, as we have wrestled with the matter of assisted dying.

The government had the responsibility to respond to the Supreme Court decision that was made in February 2015. I joined my colleagues in addressing that responsibility after we formed government in November 2015. Thus, in the very short time since forming government, there has been an incredible amount of work by officials and parliamentarians, with input from Canadians with a diverse range of views.

Before us today is a legislative framework that we believe is the right approach for Canada. It is transformative. It would forever change the range of options that Canadians would have as they approach the end of their life. I would like to reflect on the principles that make up the foundation of our government's legislative approach in developing the legislation that is before the House today.

First, it is about the principle of personal autonomy, in helping people to write their own story, in a sense, in providing Canadians with access to medical assistance in dying, for the Supreme Court made it clear to us that Canadians must have that access.

We have the responsibility to abide by the Charter of Rights and Freedoms, and we have the responsibility to put forth legislation that respects the decisions of the Supreme Court of Canada. This legislation before the House today, if passed, would do just that.

The legislation also respects the principle of the inherent value of life. It is written, therefore, with appropriate safeguards that would protect vulnerable individuals. It would also firmly uphold the conscience rights of health care providers.

Over the past several weeks and months, I have had conversations with members in this chamber from all sides of the House. The Minister of Justice and I have appeared at committees in the House and the Senate. I have personally had numerous meetings and phone calls with many interested advocates, in addition to the witnesses whom committees have heard on this particular legislation.

It is worth noting today that the professional bodies that represent health care providers are supportive of this legislative approach. These include the Canadian Medical Association, Canadian Nurses Association, Canadian Pharmacists Association, and HealthCareCan, which represents our nation's hospitals and academic health sciences centres.

Just today, parliamentarians received an open letter from 36 organizations representing the vulnerable, including the Canadian Association for Community Living, which has come out in support of this bill. Each organization may have continued areas of interest in which they wish to seek clarifications or undertake work with my department or with provinces and territories so that they can properly work with their members on implementing assistance in dying.

As I have said in the past, this is an iterative process. It is why not only would we study further potential areas of assisted dying within a short period of time, if the legislation passes, but there would also be a parliamentary review of this important legislation.

Let us discuss the matter of timing. The Supreme Court of Canada gave our government an extension to put a legislative framework in place by June 6. Before going further, allow me to say that I respect the roles and responsibilities everyone has here as parliamentarians, as well as the responsibilities that senators hold in the upper chamber.

There is a good reason for all of us to want to reflect upon and investigate this legislation in a thoughtful manner on behalf of Canadians. The reality is that we are facing a finite amount of time before there is a legal void, an absence of legislation to address the matter.

Despite what some may say, there are real and very serious challenges if there is no legislative framework in place. As I said yesterday, there is a real risk that there could be no law in place by June 6. It is important to underscore what is at stake.

First, organizations like the Canadian Medical Association and the Canadian Medical Protective Association have made it clear that they believe there is a vast majority of doctors who would not participate in assistance in dying without a legislative framework, despite the protections that some say the Carter decision provides.

Doctors are being advised by the appropriate associations to seek legal counsel before proceeding with any form of assisted dying, including consulting patients, and this would pose significant access issues and result in a situation where the Supreme Court's decision is not being realized.

Second, it would be illegal for any other health care providers to offer assistance in dying. That means that nurses, pharmacists, social workers, and other providers recognized by amendments passed at committee would face no legal protection. In particular, pharmacists who are needed to dispense medications required for medical assistance in dying require clarification.

Finally, there is the possibility that some could receive assistance in dying without a legislative framework in place, who would not otherwise have been eligible under the government's approach. This means, for example, the risk that someone facing severe depression could seek assistance in dying and that the safeguards to protect that individual would be inadequate or nonexistent.

I also want to remind members that medical assistance in dying is unlikely to be the choice for the vast majority of individuals at the end of life, and at its core our health care system is there to keep Canadians healthy. Canadians should have access to high-quality palliative care. This is something to which I have been, and will continue to be, committed to addressing with our provincial and territorial colleagues, along with the delivery of our government's platform commitment of $3 billion for home care.

Our government put forth this legislation that would transform end-of-life care options for Canadians. It is an approach that respects their rights under the charter, protects our most vulnerable, and considers the needs of health care providers.

I want to thank my fellow parliamentarians for their attention to the bill. Many of us are new to this role, and this is no small matter that we have been asked to address on behalf of the 36 million Canadians whom we represent. I thank them for engaging in the conversation with respect and dignity. I thank them for doing their utmost to consider the perspective of others, even if it differs greatly from their own. I thank them for the serious discourse we have undertaken in a situation where it is likely impossible to write legislation that would entirely satisfy every diverse view.

Recognizing our responsibility to implement legislation, I urge members to support Bill C-14 for today's final vote. I look forward to working with the Senate, if the House wishes to proceed to the next stage of our legislative process.

Criminal CodeGovernment Orders

May 31st, 2016 / 1:55 p.m.
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Green

Elizabeth May Green Saanich—Gulf Islands, BC

Madam Speaker, for both the Minister of Health and the Minister of Justice, with real sincerity, I know how difficult this has been. I think all Canadians are grateful for the care in the approach. However, that does not change the result right now, today, as I do not feel I can vote for Bill C-14.

It grieves me to say so, but I do not believe Bill C-14 is compliant with the Carter decision. I see this as a strange conflict in a sense between two professions in Canada: the legal community and the doctors. I know what the doctors want from Parliament, and I know what the legal community is telling us. As a trained lawyer, I do not see how Bill C-14 is compliant with Carter.

Because future judges will read these debates for guidance, how on earth could Kay Carter access medically assisted dying under Bill C-14?

Physician-Assisted DyingOral Questions

May 31st, 2016 / 2:25 p.m.
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NDP

Thomas Mulcair NDP Outremont, QC

They waited until April before introducing their bill. We all agree on that.

After the Liberals refused calls from the NDP to refer Bill C-14 to the Supreme Court, the Alberta Court of Appeal called out the Liberals for pushing a bill that flies in the face of the Carter decision. Now the Ontario courts are raising concerns about whether the bill respects the Charter of Rights and Freedoms.

How many court decisions will it take before the Liberals finally admit they have made mistakes? Why would the Prime Minister prefer that suffering Canadians spend years in court fighting for their rights instead of getting his new law right the first time?

Physician-Assisted DyingOral Questions

May 31st, 2016 / 2:25 p.m.
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Papineau Québec

Liberal

Justin Trudeau LiberalPrime Minister

Mr. Speaker, Canadians understand that this is a big step in our society. It is one that must be taken responsibly and with full awareness of both the concerns around vulnerability and the need to defend Canadians' rights, freedoms, and choices. That is exactly what we put forward.

We understand that this is the beginning of a conversation that will go on for the coming years, as court cases, evidence, concerns, and doctors evolve in their thinking as we approach this.

However, this is a big step. It needs to be taken right, and that is exactly what Bill C-14 does.

Criminal CodeGovernment Orders

May 31st, 2016 / 3:10 p.m.
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Liberal

Randeep Sarai Liberal Surrey Centre, BC

Mr. Speaker, I am pleased to participate in the third reading debate on Bill C-14, which would provide a federal framework on medically assisted dying. As acknowledged by many in the House in the last number of weeks, medical assistance in dying is a complex, challenging, and deeply personal issue for us all.

Since the Supreme Court of Canada rendered its unanimous decision in Carter last year, it has been discussed by many Canadians in different settings from coast to coast to coast. The issues continue to be debated and thoughtfully discussed worldwide, from the United States to Europe to Australia and New Zealand. Almost everywhere in the world, the act of ending one's life deliberately and the act of helping someone to end their life are serious crimes punishable by severe sentences.

Nevertheless, Canada is not alone in creating a legislative regime to permit medical assistance in dying. There are four American states, Oregon, Washington, Vermont, and California, the country of Colombia, and the three European countries of Belgium, the Netherlands, and Luxembourg that currently have legislative regimes that allow some form of medical assistance in dying.

These different international regimes share similarities, especially with regard to safeguards, oversight, and reporting, most of which are included in Bill C-14. These similarities are as follows: requests for medical assistance in dying must be in writing, made voluntarily by the patient, and in many cases witnessed by independent witnesses; a second opinion from an independent physician must be sought; and a delay or reflection period between the request and the actual provision of medical assistance in dying is required.

Colombia has a unique approval process for medical assistance in dying. It involves interdisciplinary committees within each hospital that assess requests and support patients and their families throughout the process.

In addition, almost all international regimes have mandatory oversight systems involving independent national or regional committees and government agencies or departments, which collect and process data in order to properly monitor medical assistance in dying. They make annual or biannual reports on medical assistance public in their respective jurisdictions. This evidence was critical to the Supreme Court of Canada's analysis in the Carter litigation.

Unlike the fairly consistent approaches, the safeguard and oversight that we see in other countries, the various laws take two different approaches with regard to both: one, the form of medical assistance in dying that is permitted; and, two, the medical circumstances under which it can legally be provided.

One could describe the different approaches with regard to eligibility and the form as being a spectrum. At one end of the spectrum stands the four American states that enacted the legislation, starting with Oregon in 1997, Washington in 2008, Vermont in 2013, and most recently California, just last year.

In these states, a mentally competent adult aged 18 years or older can obtain the assistance of a physician to die, only if their request is voluntary, and if they suffer from a terminal disease, which is defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.

In the U.S. states, the physician is only permitted to provide the patient with a prescription for a substance that the patient must self-administer at a time of their choosing. This is commonly known as physician-assisted suicide.

What is commonly called euthanasia, where the physician administers an injection to the patient, is expressly prohibited in these states. Advance requests are also not allowed.

While these legislative measures in the U.S. accommodate individuals suffering from diseases that cause a steady, rapid, and predictable decline toward death, such as some forms of cancer, they do not accommodate other conditions, including some degenerative diseases that are enduring and predictable, nor do they enable patients who are physically unable to self-administer a substance to access a medically assisted death.

The Colombian regime, which was developed in response to two rulings from its Constitutional Court, has eligibility criteria similar to that of the U.S. states. It limits eligibility to adults who have a terminal illness, defined as a progressive and irreversible serious condition or pathology that will cause death within a relatively short time frame. It does not require the person to have a prognosis of six months, but it does require that death is expected in the short term. Unlike the American states, Colombia only permits a physician to administer a substance that causes a person's death. However, Colombia's regime does permit a patient to prepare an advance request for medically assisted death, which is not permitted in the U.S.

At the other end of the spectrum, there is Belgium, the Netherlands, and Luxembourg, known as the “Benelux” countries. In these three northern European countries, patients are eligible for medical assistance in dying if they have “intolerable” or “unbearable” physical or psychological suffering resulting from a serious and incurable medical condition where there is no prospect for improvement. Eligible individuals do not need to be dying or suffering from life-threatening conditions. Both physician-assisted suicide and what is commonly called voluntary euthanasia are permitted in these countries.

While advance requests are permitted, there are some differences between the Benelux states. In Belgium and Luxembourg, advance requests can only be carried out where the patient is in a state of irreversible unconsciousness, while in the Netherlands, advance requests are also permitted where patients are unable to express their wishes but are conscious, such as for persons with dementia or Alzheimer's.

While medical assistance in dying is only available to adults in Luxembourg, children as young as 12 years of age can request medical assistance in dying with their parents' consent in the Netherlands. In Belgium, adults and emancipated minors can request medical assistance in dying for the same kinds of conditions. In 2014, Belgium extended eligibility to minors of any age, but only where they are likely to die in the short term and where their suffering is physical. Additional safeguards must also be met.

The experience and lessons from the Benelux countries have been closely examined. For example, in the Netherlands, while the legislation permits advance requests for patients who have lost their ability to express their wishes, Dutch research suggests that physicians are generally unwilling to provide medical assistance in dying, due to the inability of these patients to comprehend their medical condition and their inability to express informed consent.

The government has sought to learn from the experiences of other jurisdictions. The proposed legislation is broader than the U.S. state approach, which only permits those with a fatal disease to access assistance. Instead, Bill C-14 provides the option of a peaceful death to everyone who is in decline toward the natural end of their life, not just those who suffer from fatal diseases or terminal illnesses. At the same time, it avoids some of the risks that the Benelux-style regimes might present, although such broader questions, and the experience of other regimes around the world, will continue to be studied.

I urge all members to support this incredibly important bill to answer the call of our Supreme Court to legislate in this area.

Criminal CodeGovernment Orders

May 31st, 2016 / 3:25 p.m.
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Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

Mr. Speaker, I will share my time with my colleague the member for Carlton Trail—Eagle Creek.

This is a very difficult time in my short political career, because it is a sensitive subject that should be free of partisanship. All opinions are right, and no one is wrong. We are all good Canadians of good conscience, and we are looking for the best solution on such a sensitive subject.

When it comes to this subject, we are not here to try to convince anyone; we are here to explain our point of view. According to the Supreme Court’s decision in the Carter case, it is not a matter of determining whether we are for or against medical assistance in dying, but of determining how we will apply it.

Here we are at the final reading of Bill C-14. At my leader’s invitation, I had the privilege of participating in the parliamentary committee that studied the matter and produced a main report and a dissenting report. My official opposition colleagues and I signed the dissenting report, while my Conservative colleagues in the Senate signed the main report. This shows that there was no partisanship in our approach.

In our dissenting report, we raised five major concerns. Most of them were noted by the government and are reflected in Bill C-14. We were against the medical assistance in dying bill applying to minors; the government listened to us. We were against the bill applying in the case of mental illness; the government listened to us. We wanted complete openness concerning conscience protections for physicians and institutions; the government listened to us in part. We also wanted a clear commitment from the government concerning palliative care; the government listened to us in part.

On another note, I salute my colleague from Sarnia—Lambton, who introduced Bill C-277 in the House almost exactly 24 hours ago. The aim of this private member’s bill is to force the government to make a firm commitment to provide the necessary palliative care to as many Canadians as possible. As we know, only one-third of Canadians have access to that type of care. With Bill C-277, we want that to be enforced.

Those are the elements of Bill C-14 that we consider positive or semi-positive. Now here are the things that are of great concern to us.

First, there is the famous definition of reasonably foreseeable death. For us, this makes absolutely no sense. “Reasonably foreseeable” means both everything and nothing. I am going to die some day. That is reasonably foreseeable, of course, but it means absolutely nothing. From sage experience, Quebec used the expression “end of life”. That is at least clearer.

There is also the matter of nurse practitioners, who have the same decision-making powers as physicians under the bill. I have tremendous respect for nurses, and I know what I am talking about, since they are often the first people, and sometimes the only people, who see us when we are in hospital. However, when it is a matter of life or death, and that is literally the issue here, I would prefer that physicians have the ultimate responsibility rather than the wonderful nurses.

The points I have just mentioned are based on Quebec’s experience. I know what I am talking about, because I was a member of the National Assembly of Quebec. We worked on and gave serious consideration to the issues surrounding medical assistance in dying for six years, whereas here in the House we had only a few months to do the same work.

Later, I will talk about an unfortunate statement we heard during question period.

Based on Quebec’s experience, we built our case for the dissenting report. The current bill includes some elements in full, others to some extent, and still others not at all. It is a fairly even balance of the positive and negative elements.

Then there remains the famous issue of constitutionality. Every bill that is put forward can be challenged. In fact, whatever bill was introduced, it would have been challenged by one group or another. For weeks, some people have been saying that it is constitutional, and others have been saying that it is not. Most of the people we heard from said that it did not make sense and that it did not comply with the Constitution or the Carter decision. However, this morning, in La Presse, if I remember correctly, three constitutional experts from three different universities, namely Laval University, the University of Montreal, and UQAM, said it was constitutional.

If we table a bill, we will hear a bunch of lawyers say that it is good and a bunch of lawyers say it is not good. This is the point, and we have to live with that. It is democracy. This is how it works in our judiciary system.

I say this with great respect for legal eagles. I know that there are some here, some prestigious ones in fact, and I salute them, including the member for Mont-Royal.

The charter issue is another interesting point. Some people say it complies with the charter, while others say it does not.

Let us try not to be too partisan. If we cannot rely on the Liberal government to draft a bill that complies with the charter, whom can we rely on? Do I need to remind anyone that it was the Liberal Party, under the leadership of the Right Hon. Pierre Elliott Trudeau, father of the current Prime Minister, who enshrined the Canadian Charter of Rights and Freedoms in the 1982 Constitution, signed some 300 feet from here by Her Majesty the Queen on April 17, 1982? We all remember that. The sky was overcast, and at the very moment the signing took place, there was a rumble of thunder. Just a brief history lesson.

Seriously, I am not the greatest fan of the charter, much less of the Liberal Party, especially not the Liberal Party, but good Lord, if we cannot rely on the Liberal government to draft a bill that complies with the charter, I wonder whom we can rely on.

The events are balanced. This bill has good points and bad points. Over the past 24 hours, three events occurred that are worth thinking about. First, yesterday we voted on 10 possible amendments and they were all defeated by the Liberal majority. I commend the government members who voted against their party's position for their courage, honour, and dignity. Well done.

However, I believe that two of those amendments, both of them introduced by the member for St. Albert—Edmonton, were essential.

The first amendment protected the most vulnerable members of our society by proposing that people undergo a psychiatric assessment before giving their consent. We think that is extremely important because protecting the most vulnerable members of our society is essential. Nevertheless, the government voted against that amendment.

The second amendment had to do with conscience protections for institutions. I speak on behalf on my friends from Quebec when I say that, in Quebec, institutions such as hospitals are secular. However, outside Quebec, some institutions are religious and act according to the dictates of their conscience. We need to protect their conscience rights, but this bill does not do that. We proposed that amendment, but the government voted against it. That is unfortunate. The government refused to accept amendments.

Moreover, this morning, Quebec's health and social services minister, Gaétan Barrette, made a statement. I know the guy. He is honest, hard-working, conscientious, and a man of integrity. He is also a medical specialist who was once an administrator and is now a minister. Speaking on behalf of the government of Quebec, he said:

I myself am disinclined, for governmental and professional reasons, to support C-14 because of its worst feature: reasonably foreseeable natural death. That makes no sense. It cannot be enforced. I would be very hesitant to get on board C-14 as it stands...

He added that the bill is very off-putting, that this is a bad clause, and that it is [too much] of a minefield for him.

The third element applies to the Prime Minister's statements in question period today. He said he is working with the provinces on this, but that has no basis in fact. Worse still, he said, “we drew a great deal of inspiration from the reflections of the Quebec National Assembly”.

I can tell you one thing. I sat in the National Assembly. I was there for the six years that this was being studied. What we have seen here in the past six months does not resemble in the least what took place in the National Assembly.

I will not revisit the unfortunate events that took place two weeks ago when there was to be a vote to restrict our right to speak. I will look at the overall process. Unfortunately, the government did not follow the example set by the National Assembly in terms of either substance or form.

Consequently, bearing in mind the positive and negative elements of the bill and the three events that have taken place over the course of the past 24 hours, that is, the vote against the amendments, which were all rejected, the statement by the Quebec minister of health and social services, and the misleading statement by the Prime Minister of Canada, I will be voting against this bill.

Criminal CodeGovernment Orders

May 31st, 2016 / 3:40 p.m.
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Conservative

Kelly Block Conservative Carlton Trail—Eagle Creek, SK

Mr. Speaker, it is a privilege to rise in my place today and add the voices of my constituents to the debate on Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, regarding medical assistance in dying.

I want to begin by telling this House that, in the almost nine years that I have been a member of this place, I have not been asked about or received as much correspondence as I have on the matter of physician-assisted suicide. It is clear that Canadians and members of this House have varied and deeply held beliefs and convictions on this issue, which have been informed by our life experiences. We members also have a responsibility to balance our personal beliefs with those of our constituents and the incredible wealth of knowledge they share with us. The widespread reaction to this short debate in Parliament confirms my belief and, I believe, the belief of my colleagues that physician-assisted suicide represents the defining issue of this Parliament.

Bill C-14 would have the most lasting impact on Canadians and the social fabric of our society because each one of us could at some point see someone we know struggle with such a decision. My constituents' opinions on this issue have been genuine, considered, and informative, with a clear majority opposing physician-assisted suicide. I am pleased to inform them that I share their views. I believe in the inviolable dignity of all human life, and that it is to be protected by law from conception to natural death. Therefore, I have opposed and will continue to oppose any attempt to legalize euthanasia or physician-assisted suicide.

I have grave concerns with the process surrounding the introduction and passage of this bill. I am cognizant that Bill C-14 is now at third reading and that many members are still grappling with how they will vote later today. I hope all members will be able to vote freely, as Conservative members will be able to do.

This legislation was first introduced in this place on April 14, less than two months ago. Passing a bill in a month and a half is a challenge under any circumstances, but passing a bill of this magnitude and in this amount of time is reckless and demonstrates a complete disregard for the significance of this issue to all Canadians. As my colleague from Lethbridge noted in her earlier remarks, the Supreme Court of Canada has sent Parliament into an unending abyss of grey, and each day parliamentarians are being tested on the future limits of this legislation as one what-if leads to another. I do not believe that all the impacts of this bill can be assessed in such a tight timeline, as this truly is a new moral space for Canadians to contemplate.

Like many of us here, I am concerned that minors may eventually be able to attain medical assistance in dying. I am concerned for the well-being of those struggling through mental illness because, quite frankly, we as a country are only now beginning to recognize and understand its reach and impacts on so many. As well, I am concerned with the notion that doctors who for legitimate reasons of faith or conscience oppose medical assistance in dying would be forced to participate in this process contrary to their personal ethics.

While the government has presented us with a bill that is much narrower in scope than the recommendations made by the special committee, stakeholders on both sides of this issue have raised many what-is-next questions. These have not been answered, and I am therefore disappointed that consultations and debate on Bill C-14 are ending prematurely.

Many of my constituents have suggested that the government should consider using section 33 of the Charter of Rights and Freedoms, the notwithstanding clause, to prevent physician-assisted suicide rather than rushing a bill through Parliament that appears to fully satisfy no one. I want the government and my constituents to know that I would support using the notwithstanding clause to prevent the Supreme Court's decision in Carter v. Canada from having any effect. While I am not a constitutional expert, I assume that section 33 was included in the charter because the prime minister and the premiers of the day wanted to affirm that a democratically elected federal Parliament and provincial legislatures, and not the judicial branch, would have the responsibility to pass laws on matters of public policy.

By refusing to invoke the notwithstanding clause, the government is prematurely ending our deliberations on this bill, and consequently removing many voices from the discussion.

Parliament should be passing laws that the courts then interpret within the charter. Courts should not be telling Parliament what laws it needs to pass and by when they must be passed.

I do not believe that former premier of Saskatchewan Allan Blakeney would have signed the charter without the presence of the notwithstanding clause, as it protected the rights of Saskatchewan's legislature to override a court decision with which it might not agree.

Then prime minister Pierre Elliott Trudeau agreed when he said:

...it is a way that the legislatures, federal and provincial, have of ensuring that the last word is held by the elected representatives of the people rather than by the courts.

Former prime minister Jean Chrétien, who was at the time Canada's justice minister, made a similar comment:

The purpose of an override clause is to provide the flexibility that is required to ensure that legislatures rather than judges have the final say on important matters of public policy.

If physician-assisted suicide is not an issue for the Parliament of Canada to invoke section 33, what is?

Liberal members have continuously used the June 6 deadline as justification to pass the bill quickly, yet I would posit that the notwithstanding clause exists precisely so that Parliament, and not the courts, can set the timeline on important matters of public policy. At the very least, the government could have used this clause to give itself more time to consult Canadians and draft legislation that conforms to the court's decision and protects life.

Quebec's National Assembly took six years to develop its legislation on physician-assisted suicide, yet the Supreme Court only gave the federal government a total of 16 months to put in place new legislation. Unfortunately, it is clear that using the notwithstanding clause is not an approach that the current government would even consider.

I will use my remaining time to address the issue of conscience rights for medical professionals.

I believe that opening the door to physician-assisted suicide is a slippery slope for our society. However, I believe that it is even more reckless if we fail to protect conscience rights in this legislation.

Without adequate protection for the conscience rights of medical professionals, Parliament, and more specifically the current governing party, is inserting the thinnest edge of the wedge when it comes to legislative disregard for conscience rights. If the current Parliament fails to respect these rights, we are setting a most dangerous precedent.

Precedents matter. Members might not be in the House or even alive to see the effects that the precedents set by passing Bill C-14 may have, which is why the protection of conscience rights today is so important.

I would have expected that most in this place would support conscience rights for medical professionals. I took at face value that the government included a mention of conscience rights in the preamble of the bill as an indication of its support for the principle, but the results of last night's vote demonstrated that this was not the case.

No one is a permanent or an eternal member of this place. Just like legislators in past parliaments, the only lasting effect we can have on the future is to be clear in our intentions through the laws we pass today. Therefore, it behooves us as members of the 42nd Parliament to be very specific in what is allowed and what is being protected with this piece of legislation.

In conclusion, our only legacy as a Parliament is what we pass into law. We have a responsibility to get this legislation right and ensure that all the issues that have been raised are addressed.

Criminal CodeGovernment Orders

May 31st, 2016 / 3:50 p.m.
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Liberal

Majid Jowhari Liberal Richmond Hill, ON

Mr. Speaker, I will be splitting my time with the hon. member for Montcalm.

I am humbled by the opportunity to stand in the House to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying), at third reading. It is an important issue facing all Canadians.

Every time I come to the House, I come I wearing three hats. The first is the hat entrusted to me as a member of Parliament representing my constituents of Richmond Hill; the second is the hat of a legislator working hard to make the best decisions for all Canadians; and the third is the hat of an individual with his own convictions and beliefs.

Today, I will open my heart and share my thoughts, hoping to reach the hearts of all Canadians.

Let me start by acknowledging how challenging an issue this is. It is difficult for a person to engage in a conversation about death, yet our government has honourably taken on this responsibility.

On April 30, I participated in a York Region town hall, where a sizeable portion of the attendees were from Richmond Hill. They passionately spoke to this matter from all sides. I am inspired by the passion found within my constituency, and I would like to assure them, and all Canadians, that we are in this together.

I am sharing my story with the House, a story that complements the perspective of my constituents, and the work that we do in the House.

This is the story of my father's journey dealing with the inner turmoil caused by cancer. It is the exact reason why I am so passionate about the bill. I wrestled with this issue because each one of my hats had a strong stake in this debate and the final decision to be made.

The difficulty of beating cancer is well known to many. However, despite the odds, my father fought this disease. He fought it with all his power and he succeeded. Unfortunately, his success was short-lived and he relapsed in no time.

As a loving and supportive family, we did everything for my father to keep him happy and comfortable during the end of his days. However, no matter what we did, it was not good enough to relieve his pain. No amount of moral and social support was stronger than his inner suffering. We provided him with palliative care, but it was not enough. It broke my heart to watch my father slowly lose himself through the process. At the end, he was more concerned about the impact of his suffering on us than on him. After all, his pain was alleviated with heavy doses of morphine. However, there was no remedy for his mental pain and the hit to his pride.

I have heard the concern that providing medical assistance in dying would negatively impact vulnerable people. However, as I stated before, what made my father vulnerable was not having the option to put an end to his journey.

Eventually, my father suffered from two illnesses, one physical and the other mental. The amount of pain he was going through physically began affecting him psychologically as well. He began isolating himself from us, and in the end was suffering alone.

I agree with the government's commitment to support quality end-of-life services and to continue working with the provinces and territories to improve palliative care. Canadians and the Richmond Hill community have made it clear that is what they want. To that end, the government has committed to a long-term investment into palliative care of $3 billion over four years. However, no amount of investment into palliative care would have relieved my father's agony.

My father's experience is not a unique one. I am sure that others in the House know of someone who has endured similar distress.

We have a big responsibility to Canadians. Our responsibility is to make Canada great, to provide Canadians with the means for a better life, to facilitate their realization of their vision, and to help them achieve their dreams and aspirations. We were elected to represent their wishes, to provide services, and to make legislation to achieve those ends.

Let us look at the data that speaks to what Canadians want. Polls show that a majority of Canadians accept the idea and would even request medical assistance in dying if it were available to them. Those polls also show that over the years the acceptance level of medical assistance in dying has been been increasing. As Canadians became more aware of the matter, they began to empathize with those who suffer. In Richmond Hill alone, the local parliament project has shown that over 70% of my riding agrees that individuals who are terminally ill should be allowed to end their lives with the assistance of a medical professional.

In February of 2016, a Statistics Canada demographic analysis showed that persons aged 65 and over make up a record proportion of our population. It also showed that the proportion of seniors in our population has been increasing over the past 50 years, and the trend is continuing. What does this mean for us as legislators and representatives? It means that we must be forward thinking in our legislation and we must ensure there are mechanisms in place to deal with future problems.

The Carter case has shown us already that our current legislation is outdated, and the Supreme Court has asked us to update it. We are faced with a June 6 deadline. Let us ensure that we are prepared for this demographic shift and potential needs, such as the one on the table today. In order to ensure that we are prepared for this shift, we must ensure that we address key issues in our current system.

According to a research article published by the journal Palliative Medicine, in Canada, we need to streamline our legislative, financial, and regulatory affairs in terms of delivery of palliative care services. This means that once the legislation is passed we must continue to conduct studies and address lagging areas of hospice and palliative care services delivery.

I was fortunate enough to hear points of view from my neighbours in Richmond Hill during the town hall. They opened up their hearts and shared with me. The most powerful story came from people suffering with terminal illnesses, similar to the one my father had. They spoke of the importance of making advance requests, addressing the issue of mental illness, and access to mature minors. I am happy to hear that the government will appoint independent bodies to study these issues. I have seen members of the relevant committees work hard to ensure that they provide a reasonable approach to the legislation.

It is after carefully thinking through all these issues that I have decided to support Bill C-14.

I realize our government has genuinely worked hard on the bill. As it stands, Canadians do not have a choice on how to say goodbye to this world. My father died in my arms. He died in an attempt to say something to me, something I will never know. He did not choose when to leave me. He did not choose how to leave.

Through my declaration of Bill C-14, I am sending four messages. To my conscience, I can say rest assured that with this decision I have balanced the three hats and their responsibilities to the best of my ability. To my dad, I would say, “It took 10 years to understand what you wanted to say to me before you left me. Dad, in supporting this bill, I am happy to carry your wishes forward”. To my constituents and the Richmond Hill community, I want to assure them they were consulted, they were heard, and they are well represented.

To all Canadians, it has been a long and hard journey, but the journey of a thousand miles begins with the first step. However, in order for the journey to begin, the bill needs to pass. Let us work together to take that first step.

Criminal CodeGovernment Orders

May 31st, 2016 / 4:40 p.m.
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NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Mr. Speaker, as members are aware, Bill C-14 now goes to third reading, which gives the Senate two days to consider it before the June 6 deadline.

While I acknowledge the government's expressed desire to get the bill passed before the Supreme Court's June 6 deadline, I think most people agree that this is too important a piece of legislation to rush, especially considering that in its present form it is not likely to pass constitutional muster. On this, I second NDP justice critic, the member for Victoria, when he said, “I cannot accept passing a bill that I know to be unconstitutional”.

The key flaw of Bill C-14 is the end-of-life requirement of a reasonably foreseeable natural death. This is the part that conflicts with the Supreme Court, which did not require terminality or end of life, and therefore, according to the Carter decision, infringes on the charter rights of all those who have a grievous and irremediable condition that causes them intolerable suffering but who are not dying as a result.

The Canadian and Quebec bar associations, various other legal experts, and now the Alberta Court of Appeal, has said that this requirement conflicts with the Supreme Court. Medical groups do not like it either. The body that represents every provincial medical regulator has come out against the bill as being too vague for doctors to follow.

The NDP put forward a number of amendments that would have improved the bill tremendously. Had they not been rejected, the bill would likely have had a better shot at making it through the Senate.

We suggested removing the controversial end-of-life requirement, which is almost certainly unconstitutional, and replacing it with the exact words that the Supreme Court used in its decision. However, the Liberals rejected that.

Of more than 100 amendments moved, just 16 were accepted, and they were mostly minor technical clarifications. However, the NDP did manage to secure agreement on two amendments that were introduced and adopted unanimously, and that was clarifying conscience objection rights and adding a stronger commitment to palliative care.

As criticism grows against the bill, the government increasingly falls back on the excuse of a deadline imposed on us by the Supreme Court, which is not exactly true. The court said that it would give federal and provincial governments a year to put in place more complex regulatory regimes should they choose. On June 6, an exemption is opened in two Criminal Code offences for patients and physicians acting within the guidelines that the court set out in the Carter decision.

There is not a vacuum, and to be blunt, murder will not become legal, nor will medical aid in dying return to being illegal without a federal law in place.

Over the past year, every provincial medical regulator has developed guidelines for medical aid in dying that physicians must follow. These safeguards are very close to the safeguards proposed in Bill C-14. Federal leadership is necessary to ensure that access is equitable across Canada and to prevent a patchwork, but it is not strictly necessary to ensure basic access right now. Therefore, this final push to get the bill through the House is most unfortunate, and it is not the outcome we had hoped for.

The NDP worked long days in good faith with other parties, but it is better than passing a flawed bill, defying the Supreme Court, and infringing on the charter rights of suffering Canadians, which prompted this legislative response in the first place. For us, this is not a partisan issue. We have collaborated with all parties from the start on this and will continue that constructive approach, especially when it comes to championing the causes for our health care and palliative care.

We had a chance to get this bill right, but the government does not seem interested in listening at this point. It is important here to step back and reflect on how we got to where we are now.

In February 2015, a unanimous Supreme Court ruling established the charter-protected right of competent adult Canadians experiencing enduring and intolerable suffering as a result of grievous and irremediable medical conditions, including a disease, disability, or illness, to access medical assistance in dying. In February 2015, the Supreme Court unanimously decided in Carter v. Canada that Canadians who are suffering intolerably because of a grievous and irremediable medical condition have a charter-protected right to access medical assistance in dying.

The effect of the ruling was suspended until June 6, 2016. The reports of an interprovincial task force and a federal expert panel, as well as a wide array of witness testimony, were considered by a joint special committee of Parliament, resulting in 21 recommendations on a legislative response to Carter.

We succeeded in adding major actionable recommendations on palliative care to that report. This issue of palliative care is what, for myself, goes directly to what I object to most about Bill C-14 in its current state.

Should the government rush into a bill like Bill C-14 without also having a plan to shore up and extend palliative care? The answer is, of course, most emphatically no, it should not.

As noted in the recent report by the Canadian Cancer Society, “Right to Care: Palliative care for all Canadians”, there are gaps in palliative care across the country. As my colleague mentioned in her speech, it is very heart-wrenching to know some of the stats and facts about what is actually available right now in palliative care for Canadians.

It is an epic fail for the government to be putting forward a bill while at the same time ignoring the real tangible details that we need to give us confidence as we move forward in a future with medical-assisted dying. That was so insensitive.

About 45% of cancer patients die in acute care hospitals, even though most Canadians prefer to die at home. Not only are acute care settings more costly than dedicated palliative care, they are also not equipped to provide the most appropriate care to palliative care patients and their families.

Palliative care can increase the efficient use of our public health care dollars, but increased care outside of a hospital setting can place undue financial hardship on family caregivers. Health care costs tend to increase substantially in the months and weeks before death, due to increasing frailty and dependence on health care services.

We believe that the government should take a lead in providing appropriate funding for palliative care. Improving palliative care in all settings, including outside the hospital, should result in a more efficient use of health care dollars.

However, there will be upfront costs to facilitate change. Federal, provincial, and territorial governments should work together to establish a financing plan, and create a national palliative care transition fund to ensure the changes needed to improve palliative care in Canada can take place.

When I look at the latest version of Bill C-14, it states that:

...it commits to working with provinces, territories and civil society to facilitate access to palliative and end-of-life care, care and services for individuals living with Alzheimer’s and dementia, appropriate mental health supports and services and culturally and spiritually appropriate end-of-life care for Indigenous patients.

Now, it is all well and good, but precise commitments need to be made, and this bill is quite vague.

The only other time palliative care is mentioned in the bill is:

....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.

On the fifth year? To me, this seems to be way too far in the future. Canadians of all political persuasions and faiths, indeed, Canadians of goodwill everywhere deserve something more definite and concrete than a promise to review palliative care within five years.

This is all the more disappointing, given that the government could have addressed this issue in its recent first budget as it knew that we would soon be debating Bill C-14. However, as we know, not a single dollar was earmarked for palliative care measures. We should have fortified health care, palliative care, home care before we crafted Bill C-14. It would have alleviated our anxiety on what the future holds.

Criminal CodeGovernment Orders

May 31st, 2016 / 4:55 p.m.
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NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Mr. Speaker, I appreciate the hon. member's comments because I am one of those people who does champion not just palliative care but recommitting this country to universal health care access. We have all heard through assisted dying many stories from our constituents, who are very disconcerted. It is really scary for ordinary Canadians to read the text of a bill that could be passed tonight, and then to have almost platitudes, very ambiguous comforts about palliative care. That is where the problem is.

I do agree that it is very important, and I think maybe the hon. member misses my point that it should have been front-loaded. Those details should have come first, and then present the text for Bill C-14. That makes it that much easier for people to be able to accept. I know as recently as last week, I heard people who are heartbroken saying, “My father was in the hospital hallway for nine days before he passed away. What are you going to do about that? I don't want to hear any more about Bill C-14. What are you going to do about that?” My heart breaks.

It is not just that my heart breaks. I know now I have to show some federal leadership like all of us here. That needs to come first. It would be very easy for the current governing party to stand up with some real hard-core statements, not these ambiguous things that are meant to placate us and just sort of distract us from the issue.

Where is this money? Recommit to the Canada health accord. Enforce the Canada Health Act when it comes to home care. You could make three bold statements right now that would change the whole atmosphere of this. That has been missed and that is what is highly frustrating. When it comes to working with other jurisdictions, yes you have to take federal leadership that is strong and true, and strong—

Criminal CodeGovernment Orders

May 31st, 2016 / 4:55 p.m.
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Liberal

Ramesh Sangha Liberal Brampton Centre, ON

Mr. Speaker, it is a great pleasure for me to have this opportunity to share my ideas and opinions regarding Bill C-14 to amend the Criminal Code.

In a unanimous decision on February 6, 2015, the Supreme Court of Canada turned down the provision in the Criminal Code, giving Canadian adults who were mentally competent and suffering intolerably and enduringly the right to a doctor's help in dying.

The court suspended its ruling for 12 months, with a decision taking effect in 2016, giving the government enough time to amend its laws. In January 2016, the court granted an additional four month extension to its ruling suspension.

Until now, it is a crime in Canada to assist another person in ending their own life. As a result, people who are grievously and irremediably ill cannot seek a physician's assistance in dying and may be condemned to a life of severe and intolerable suffering. A person facing this prospect has two options: they can take their own life prematurely, often by violent or dangerous means, or they can suffer until they die from natural causes. The choices are cruel.

This enactment would amend 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 criteria for eligibility, 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 further to, medical assistance in dying; provide information for the purpose of monitoring medical assistance in dying; 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 statues being affected.

We have reached to the final stage of debate in the House regarding the process, with hours of debate on Bill C-14.

The biggest thing during these debates was the sense of compassion with which the House heard from members debating for their individual constituents. That is the reason the bill touched the hearts of not only the members of the House, but also the hearts of Canadian from coast to coast to coast. Now, when the bill has reached to its final stage, I appreciate and congratulate every member for actively participating in building the most important and valuable laws on assisted dying and also to the government for affording full opportunity to all members to be part and parcel of this delicate and important legislation.

I also appreciate the extensive hard work done by both the Minister of Health and theMinister of Justice and by the members of the Joint Standing Committee of the Senate and the House.

Being new to this legislate process, I was a thrilled to watch yesterday's voting by the House on numerous motions. I saw members were in favour of few motions and were against on other motions. I realized the importance of these motions on assisted dying for the members of the House. That is the way member use their choices out of their own conscience and the will their constituents. I realized the real sense of democracy and a true parliamentary decision process being adopted.

This enactment to amend the existing Criminal Code is an important step and is auxiliary to new enactment regarding medical assistance in dying. Being legislators, it is our duty to see that medical service providers and other persons who provide assistance in medical assistance dying are legally safe.

As we all know, this is a first major revolutionary enactment. Going forward, there may be many ancillary issues cropping up. I and my Liberal caucus colleagues as well as many other members of the House are keen to see that bill should pass. I urge all members of the House to vote in favour of Bill C-14, an act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

Physician-Assisted DyingOral Questions

May 30th, 2016 / 2:25 p.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, the problem with the minister's response is that the Alberta Court of Appeal, the Canadian Bar Association, Barreau du Québec, constitutional experts, and now even former Prime Minister Martin all agree, Bill C-14 in its present form is likely not constitutional.

Even if the bill is passed next week, it will be tied up in legal challenges for years to come, and costly, exhausting court battles for suffering Canadians who just want to see their legal rights vindicated.

Why will the government not do the right thing and work with us to get the bill right the first time?

Framework on Palliative Care in Canada ActRoutine Proceedings

May 30th, 2016 / 3:10 p.m.
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Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

moved for leave to introduce Bill C-277, An Act providing for the development of a framework on palliative care in Canada.

Mr. Speaker, it is my pleasure to bring forward my private member's bill on palliative care. In the previous session of Parliament, a parliamentary committee of all parties looked at the issue and came forward with recommendations. The bill is the result of that. It is a timely bill, especially in light of the Bill C-14 legislation. The committee that considered the Carter report stated that the request for physician-assisted death could not be truly voluntary if the option of proper palliative care was not available to alleviate a person's suffering.

My bill provides a framework to implement consistent access for palliative care for all Canadians. I hope all parliamentarians on all sides of the House will support it.

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

Public Service Labour Relations ActGovernment Orders

May 30th, 2016 / 4:50 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Madam Speaker, it is a real pleasure for me to join this important debate on Bill C-7.

I appreciate hearing the thoughtful comments from all members in this House, especially the contribution of members like the member for Yellowhead who just spoke, who have significant experience themselves, or, in other cases, experience through their families with the RCMP. We are all very grateful for their service and for the context that members coming from different walks of life bring to this place.

For people elsewhere who may have just started watching this debate, I want to start my remarks by reviewing some of the basic groundwork in terms of what this bill does.

This legislation seeks to implement a Supreme Court decision that opened the door for the RCMP to form a union. We, in the official opposition, respect the decision of the Supreme Court and recognize that RCMP members are entitled to pursue membership in a union.

We think there are many aspects of Bill C-7 that are positive. In general, it is a reasonable response to the court ruling.

However, on this side of the House, we have consistently taken a very clear position on the importance of a secret ballot. I will talk more about why a secret ballot is important in this specific context and in general. However, that is the principle stumbling block on this legislation for those of us in the official opposition.

We think there are a lot of good things about this legislation, but it is not acceptable to us that a mechanism would be created for joining a union, for electing officials, for anything of that nature, that does not involve a proper democratic process.

Also, by way of context, it is important that the public knows that wage disputes will still be resolved through binding arbitration. This does not open the door to police officers being on strike or anything like that. That is an important element of context as we approach this legislation and the discussion around it.

As we are talking about the RCMP, I want to acknowledge the important work that RCMP officers do across this country, especially in my riding of Sherwood Park—Fort Saskatchewan. We do not have municipal police forces in my constituency. We are fully served by the women and men in the RCMP, and the great work that they do.

The RCMP is an icon. It is one of those recognizable Canadian icons around the world. At the local level, I have personally seen the great work that the RCMP does with the community. That is not just front-end policing, but also engaging in a constructive way with members of the community and with community organizations on issues like education, crime prevention, and those kinds of things.

I am very grateful for the contribution of the RCMP in my constituency and across the country, as well as here on Parliament Hill. We are supported in our work and our functions here by the security that members of the RCMP provide.

I talked earlier about the importance of the secret ballot for us. It is surprising that the government does not get it. I have said before that I would have thought that the debate on the secret ballot was concluded in the 19th century. To coin a phrase, it is 2016. It is strange that there still is no recognition by the government and by other parties of the importance of the secret ballot.

I will say that it is not only this bill but the process that brings this bill forward that marks a double attack against democracy. We not only have an attack on the principle of the secret ballot, but we also have the government not respecting the prerogative of members who wish to speak to the bill by moving forward with their overly aggressive approach to time allocation.

I do think there are appropriate uses of time allocation, of course. These are cases where maybe opposition parties are engaging in deleterious tactics. The government does, in certain contexts, have to move legislation forward. However, in a fairly short time, we have seen the government ramping up the scales on the use of time allocation or closure. This bill is no exception, in spite of the goodwill from the opposition and the effort to work constructively on allocation of time around these things.

We have had this on the euthanasia and assisted suicide bill, and on the budget bill. With regard to this legislation, which is under the gun of time allocation, what the government is doing here is perhaps not as egregious as we have seen in some other cases. I have mentioned. Bill C-14 as one of the most difficult and challenging issues that Parliament has dealt with in a very long time. However, there is still a failure to recognize the importance of the secret ballot and the prerogative of members wanting to speak to and have a fulsome debate on legislation like this. It is a concerning pattern that we see of the government not respecting the principles that should be very important to a well-functioning democratic polity.

That puts this in some important context. On the substantive side, as we talk about the issue of the secret ballot, I want to start by talking about responses to some of the different kinds of arguments we have heard today in this debate, and some of the specific issues around the secret ballot in the context of the RCMP. After that, I will talk about some of the underlying foundational and motivating arguments about the secret ballot and why secret ballots are important. Again, I do not think these are arguments that should have to be made, but clearly they need to be made.

In the context of this specific bill and the RCMP, I want to talk specifically about secret ballots in the context of government certification. We can look at the workplace in some sense as a sort of negotiation, maybe a competition, between workers and their employers. There are certain tools that workers have, and there are certain tools that employers have. It is worth acknowledging that in that sort of imagined competition, public sector workers have an additional advantage. They can bring public pressure to bear on the government to try to bring about concessions in the process of collective bargaining or other forms of negotiation over wages. This is a strategic advantage in that competition or relationship that does not exist in the private sector.

A group of private sector employees cannot organize to vote out their employer, but that is something that public sector employees can do. Therefore, there are additional tools that are available to the public sector. That needs to be recognized and acknowledged as we talk about these dynamics. That helps us to understand the history of why there are higher levels of unionization in the public sector, and also why every certification vote in the public sector has happened via secret ballot, which has led to these higher rates of unionization. There is this strategic advantage.

To the extent that members may raise concerns about employer intimidation preventing certification, it would have to be acknowledged that it is much less plausible in the context of the public sector, again because of these strategic dynamics. Taking that into consideration, it is difficult to justify not allowing a secret ballot in this specific context. The worries that might exist around this in other sectors could be plausibly applied in the case of the public sector.

One of the other strands we have heard in this debate is members saying that a secret ballot could still happen, that, after all, the legislation does not effectively prohibit the use of a secret ballot but simply leaves that determination to a subsequent discussion and evaluation. That is true. There is nothing in this legislation that prohibits the use of a secret ballot. It is possible that a secret ballot could be used or not, but I do not think it is good enough. If one believes that a secret ballot is important, and I think members would acknowledge in many cases how critical a secret ballot is, I do not think it is sufficient to say that there might be a secret ballot.

If I told my constituents that in the next election some ridings in Canada will have secret ballots if we determine they need them and other ridings will not have secret ballots if we determine they do not need them, I do not think my constituents would be particularly satisfied with that. They would say that if a secret ballot is the most fair, honest, reasonable, and democratic way of conducting an election, then why should that not be available to everyone? Why should it not be a guarantee instead of just a possibility? I do not think the argument that there might be a secret ballot holds much water.

We have had some discussion in this debate about the extent to which the RCMP is like the rest of the public service and the extent to which the RCMP is different. It was interesting. I listened to the speech of my friend from Oakville North—Burlington. In the context of questions and comments, she effectively gave very different answers to that question, first in response to my question, and then in response to a question from the member for Esquimalt—Saanich—Sooke. She said on the one hand that we need to have the same process as other public sector individuals, and then she said the RCMP is different. Which is it? This would be our take on that.

Certainly there are important differences between the RCMP and other organizations within the public service. That is why it was important to have some of the variations, some of the exclusions, which were put in this legislation. I think at least our party and the government acknowledged the importance of those exclusions, and our members worked very hard at the committee to refine and deepen those exclusions.

However, the secret ballot is important for everyone. We would advocate a secret ballot in all cases, as we have done on a variety of different measures. The principle of a secret ballot for choosing representatives, for choosing which bargaining unit, or if an individual would like to associate with a particular bargaining unit, is so important that it should not be left to chance. It should not be maybe sometimes and maybe not elsewhere. That is why we have advocated for this consistently across the board.

As well, it is particularly important to have a secret ballot in the case of the RCMP. These are, after all, the women and men on the front lines who are defending us, protecting the physical security of our democracy. We call on the RCMP to ensure the safety and stability of the democratic process and of our lives within this country. For us to then deny the RCMP the same rights that others have in other contexts when they elect people, to deny them the right to the secret ballot in this case, would seem particularly perverse, to me at least. At the same time that they are protecting our fundamental democratic rights, that we would deny those rights to them as members of the RCMP— notwithstanding that we think the secret ballot should be available to all—in that particular situation is quite perverse.

The discussion has also been around the alternative to the secret ballot and how that would look in practice in the RCMP. Some members favour a card-check system. For those who do not know, a card-check system basically involves some members who are seeking a certification asking other members of a potential bargaining unit who want to certify to then sign and check on a card that they would like to sign up. If a certain threshold is achieved in terms of these sign-ups, then there is no subsequent process of deliberation or election; the certification simply then occurs after that card-check system has been evaluated. It occurs automatically.

There are a lot of obvious problems with that. This is a form of public ballot. It does not respect the privacy of the individuals who are being asked to sign. However, a card-check system, as has been pointed out, is particularly inappropriate in the context of the RCMP. We have a very hierarchical structure in which people have to rely on each other all the time.

Members of the RCMP may wish to discuss their political conviction in the context of that environment. They may feel comfortable doing so, and they may feel that their ability to work with their colleagues is not compromised by that. However, that should be their choice. The effect of having a card-check system for certification in this context would be that members might be forced to declare their union convictions through other members. This could have a negative effect, in certain cases, on the collegiality that is so important for the functioning of our national police force.

Therefore, why not simply ensure that members have the privacy they deserve? Why not ensure we have a guarantee of a secret ballot?

My friend from Esquimalt—Saanich—Sooke said something interesting. He said that the proposal for a secret ballot does not need to apply in this case because we are not talking about a public vote. He said that in a sense individuals could choose whether or not they want to join the organization and therefore there is no need for a secret ballot, if I understood what he was saying correctly.

Of course, it just needs to be said that we are talking about what would be a closed shop union. If the RCMP chose to certify, all members of the RCMP, even if they were individually not interested in being part of the union, would have to at least pay dues to the union. This is the process that exists. This is not analogous to simply whether or not an individual chooses to sign up with the local Rotary Club, or Elks, or something like that. This is a question of a whole professional group being brought into a union, potentially against the preferences of some of those members. This is more analogous to a general election in which we would respect and widely recognize the importance of a secret ballot.

Another comment that some members have made during this debate is that secret ballots reduce the rate of unionization. Frankly, that tips their hand a bit because the goal should not be to ensure the maximum level of unionization. The goal should be to ensure a fair process whereby workers can decide if they want to be part of a union. Of course, one could design a system, maybe a card check or something else, that would maximize the rates of certification, but if that happens at the expense of a fair and democratic process in which workers can actually express themselves, then that is not the best direction to go. The goal should be a fair process, and then we would let those who are involved in a fair process decide. A fair process in a democracy will produce the best outcome according to democratic principles, but if we do not have a fair process just because we want a particular outcome, that being higher rates of unionization, that is obviously hardly fair.

That deals with some of the strands in the debate today. I want to just mention what I see as the foundational motivating arguments for a secret ballot. Why do we generally accept that secret ballots are important? First, I think we all understand that people have a right to privacy with respect to their political opinions. Of course, people have the right to express their opinions on issues like certification and other issues, but they also have a right to not express their opinions, to not wish for their co-workers, their employees, even members of their family to know how they vote or how they feel about difficult political questions. This right to privacy really emanates from the idea of autonomy, the idea of self-ownership, that our political opinions are our own and therefore we have the right to decide if we wish to dispose of them in one particular way or another. This sense of the separation of the private space from the public space is foundational to our concept of liberal democracy. It is why we have a secret ballot.

Of course, the secret ballot ensures protection from reprisals. I talked before in the House on a previous bill about the history of secret ballots and how one time when we had public ballots people could be intimidated. They could face reprisals, or could lose employment as a result of how they voted in the then-public ballot. Thus we moved to a secret ballot.

Another reason we have secret ballots is protection against corruption. If we see how someone votes there is a greater risk of someone being offered an inducement. That cannot happen if there is a secret ballot.

Finally is the importance of a vote being preceded by deliberation. This is not possible in the context of a card check system, where someone might sign the card and then read an article or develop new information and think something different later on. One does not have the option of changing one's mind in a card check system but in a secret ballot process there is deliberation, debate, good discussion, and then individuals can come to their conclusions at the appropriate time.

For these reasons, despite some good aspects, I will have to oppose the bill unless the government accepts an amendment to respect the right of members of the RCMP to vote by a secret ballot.

Public Service Labour Relations ActGovernment Orders

May 30th, 2016 / 5:20 p.m.
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NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

I did see him in the precinct today, Madam Speaker. He now works for the Global Fund to Fight AIDS, Tuberculosis and Malaria, so he is still doing very good work.

The Supreme Court of Canada decision is what brought us to where we are today. It is interesting that the Supreme Court has very rarely overruled itself. It has very rarely overruled its previous decisions. In 1999, it had upheld the prohibition on an RCMP union, so I would say it was very unexpected in the legal community that there was such a clear decision in January 2015 in favour of the right of the RCMP members to unionize. It was a six-to-one decision at that time.

Let me read a couple of quotes from the Supreme Court majority in that decision. It states:

We conclude that the s. 2(d) guarantee of freedom of association protects a meaningful process of collective bargaining that provides employees with a degree of choice and independence sufficient to enable them to determine and pursue their collective interests.

It is saying that the regime that was in place, the staff representatives, did not provide what other Canadians were entitled to under the charter, which was to have a choice about who represents them and have those representatives be independent of the RCMP management in this case.

The decision went on to state:

While the RCMP’s mandate differs from that of other police forces, there is no evidence that providing the RCMP a labour relations scheme similar to that enjoyed by other police forces would prevent it from fulfilling its mandate.

What it is really saying is what we know to be true, that in order to have restrictions on rights in Canada, our Constitution requires that they be reasonable, demonstrably justified, and proportionate to some public interest. What the court found in this case is that there was no public interest that justified these kinds of restrictions on collective bargaining for the RCMP.

Quite often in the House, we have talked about “deadlines” set by the Supreme Court: in the case of assisted suicide and in the case of this bill on RCMP unionization. I have always argued, and will still argue, that these are not deadlines. What the court said in both of these cases is that it finds the existing laws unconstitutional, but it will give Parliament a chance to legislate if it wishes to do something different. If Parliament does not legislate by this date, then the law that was in existence will be unconstitutional and the normal legal framework will apply. If we did not pass this by the deadline, which we clearly have not, the RCMP would fall under the Public Service Labour Relations Act.

I am not arguing that we do not need a bill. I actually think there are some justifications for having a bill and for separating the RCMP out from other labour relations associations. The surprise, or not surprise, I guess I would say, is that the Canadian Police Association and the Mounted Police Professional Association also agree with that. There is no demand for all of them to become teamsters or steelworkers. That is not what they are looking for.

Bill C-7 says that there should be one national union representing police only, and that is not really a controversial point, so having a bill that would establish that framework is not a bad idea. However, that is probably about as far as I can go with Bill C-7, because the other main provisions of the bill take away all the aspects that really make meaningful collective bargaining.

I would submit that, just like the bill that was presented on assisted suicide, Bill C-14, Bill C-7 is probably unconstitutional. It is certain to launch another whole round of litigation and will force the spending of both RCMP members' money and public money, as well as the court's time on something we really do not need to do.

The court decision was quite clear at six to one. If we respected that decision in the proposed law, we would be done with this. The new regime of labour relations could then get on with the job of improving the RCMP and the working conditions, including the health and safety of RCMP members. Again, we must remember that our constitutional regime says that the limits are acceptable on rights only if they are reasonable and demonstrably justified in a free and democratic society, and if these limits are proportional to a specific public objective.

What is the public objective in saying that this new labour relations organization could not talk about staffing, deployment, harassment, or discipline? Again, in the quote I read earlier from the decision, it is very clear that the court said that there is no public objective that justifies limiting collective bargaining for the RCMP. Therefore, I would argue that, in parallel, there is also no public objective being achieved by these specific exclusions from collective bargaining.

I do not think we have heard from the government why it selected these things. I have not heard the justification for these exclusions, and the Liberals have not given me a legal argument of how they think this would stand up in court, if we get there again. As I said, I think Bill C-7 is bound for litigation, and that is an unfortunate thing.

Our courts are clogged with all kinds of important issues, and to have their time taken up with something that has been there in 1999 and 2015, to have it back sometime later this year or in 2017 is a waste of everyone's time and resources.

I, of course, as a member of the NDP, supported our position that these exclusions should have been taken out at committee stage. Unfortunately, the government failed to do that, and I believe the Conservatives also supported leaving these exclusions in. However, I will give credit to the government here that it did agree to remove clauses 40 and 42, which would have placed occupational health and safety under workers' compensation boards province by province.

Clearly, there are some exceptional things about the RCMP as a workforce, and it would not have been acceptable to establish a regime where RCMP members, depending on where they were stationed, would be eligible for different kinds of compensation, benefits, or rehabilitation. Therefore, I do applaud the government in agreeing with both the Conservatives and the NDP to take out clauses 40 and 42 and keep occupational health and safety a uniform regime across the country, so that it would not really matter where an RCMP member served, because RCMP members would be entitled to the same package of benefits and protections.

When we talk about staffing, deployment, harassment, and discipline being excluded, what does that actually mean? This is where I go back to all four things I dealt with almost 20 years ago when I first took on being the labour relations representative of my police board.

Staffing is the question of how much work one has to do, whether the vacant positions are filled, and how long is acceptable to leave positions vacant. I know from the RCMP in my own riding on the west shore, where the population was growing and the demands were very great, that there was concern from rank and file members over those four positions that they should have had, that were authorized, but I believe took six years to fill, and it could have been longer. My memory does not serve me so well, because it was so long in actually getting the people they needed.

What impact does that have on the operation of the RCMP? Well, one could say that it causes it to spend more money or it takes away management prerogatives. However, I can tell members that, from the point of view of rank and file people, staffing is about how much overtime they have to work that they do not want to work, that they would rather spend with their family, or rather spend, as most RCMP officers do, volunteering in community events. They wonder if they would be forced to work overtime because those vacancies have not been filled.

This is not to say that the new union of the members would fill the vacancies or decide when they are filled, but they might be able to argue in bargaining what a reasonable time frame would be when a position is not filled. They could say in their collective agreement that, when a position is vacant, it must be filled within six months or within a year. Why is that not something they could bargain about? It is something certainly that I bargained about with our police union: what is an acceptable time frame for filling vacancies?

I simply do not understand why that would not be subject to collective bargaining for the RCMP.

The second one would be deployment. The question of deployment was that of relief and backup, in particular, in municipal forces, How many officers per car? Was it safe to have one officer per car, or did it require two? Through negotiations, after I left the board, it was finally resolved that there were different hours of the day that required different deployment and staffing.

However, what we got through collective bargaining was the input of those rank-and-file members who said that in the daytime it was probably okay to have one officer per car because there were a lot of people on duty, and a lot of resources and backup to call on. However, at nighttime, one person in the car, at three a.m., was probably not a good idea. That was what we were discussing at that time. Again, I do not see how that does not do anything but contribute to better policing for the community and better working conditions for the RCMP, to be able to discuss deployment.

The RCMP also has a lot of very small detachments. One of the big problems that comes up in those detachments is relief. If the RCMP officer is the only officer or one of two officers in a community, how does he or she get any relief from the 24-hour a day demands? What would be wrong with negotiating that if he or she has been the only one, or the only two officers, for a certain period of time, then someone has to come in and relieve the officer of those duties? That would be discussed at collective bargaining. Again, it is about better community policing and better working conditions for RCMP members.

The question of harassment is the one that is the most shocking to me. We dealt with harassment in the police force. When I was appointed to the board, I was the first openly gay police board member in British Columbia. We sat down with the union. First, I had met with the chief, and I said “Just so you know, my mother already knows.” The chief said, “We already know. We are not called the police for nothing.” We got off to a very good start by having harassment training.

The union met with the board, and we agreed to do harassment training. No one forced anyone to do training. The Board members said that they would go through the training first, and would then ask the union to agree to go through it.

The union president at that time said that it was a complete waste of time. At the end of it, he came back and said that he was wrong, that there were practices taking place in our force that he did not even recognize as harassment.

The last one is discipline. When there is bargaining about discipline, it is not saying the rank-and-file members get to decide if someone is disciplined. They need a voice on what is a fair process for discipline and a voice on what is fair representation.

Those are the kinds of issues with which I had to deal. What are the right time frames? What evidence should be available? Are police officers held to the legal standards of the court in their own disciplinary proceedings? Is that fair or should there be some other disciplinary process agreed to?

Again, all four of these things that are excluded are crucial to having a good working environment for RCMP rank-and-file members, and they also contribute to better policing of our communities.

I know my time is drawing short, but I want to talk about one more staffing issue which has been on my radar since I first got involved in policing. It is the question of recruitment and retirement. It will probably come to a shock to most members in the House that one out of ten police officers in the entire country is currently eligible to retire tomorrow. Officers are staying on and working because of their dedication, but they are already eligible to retire.

How will we deal with that crisis of person power in the RCMP? One of the best ways to do that is to work with the members of the RCMP who are serving now and ask them what are reasonable ways to conquer what is really a crisis.

The other one is recruitment. At the beginning there was some resistance, even in our police force, to using diversity as a criteria in recruiting. We worked with the union at the time. Again, the same union president came back to me and said that when I said that we were not a very diverse police force—we were are all white men—that this was obvious. What was not obvious were the benefits that would come to policing from having a more diverse police force.

They hired two people from the first nations community and two gay and lesbian police officers. He told me that they now had contacts in communities that they never had before, and it helped them do a better job of policing.

Again, negotiating with the rank-and-file unions about issues of staffing, like recruitment, retention, and retirement, will lead to better policing for all of us.

I am sorry I cannot vote for the bill that would establish a framework for a union for the RCMP, but my reason for doing that is the unacceptable exclusions from collective bargaining.

Public Service Labour Relations ActGovernment Orders

May 30th, 2016 / 5:45 p.m.
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NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Mr. Speaker, I thank the hon. member for Rosemont—La Petite-Patrie for his work on a day-to-day basis in the House as an effective voice for working people.

His question gives me an opportunity to say again what I think has happened in Bill C-14 and again in Bill C-7. I do not know where the Liberals get these restrictions they have introduced in both bills. I think Bills C-14 and C-7 alike are headed to litigation.

Rather than solving the problem and getting on with the business of the country, we will be sending people back into the courts on both of these bills. I do not understand why the recommendations in Bill C-14 were not those of the special committee. In Bill C-7, I do not know who made these recommendations. There is no evidence about why things like staffing and harassment were excluded from collective bargaining. I do not know where this idea came from, but I certainly doubt that it is constitutional.

Public Service Labour Relations ActGovernment Orders

May 30th, 2016 / 5:45 p.m.
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Liberal

Kevin Lamoureux Liberal Winnipeg North, MB

Mr. Speaker, the member seems to be somewhat confused with regard to the issue of urgency. We need to recognize that when the Supreme Court of Canada makes a decision, all members have a responsibility to respect that decision. The two bills the member had made reference to are in fact directives coming from the Supreme Court of Canada. Both issues have been granted extensions.

Could the member provide some comment on whether he believe that parliamentarians do not have to respect what the Supreme Court of Canada has said? Is that the New Democratic approach for dealing with decisions that have been made by the Supreme Court of Canada?

The Supreme Court of Canada has been very clear on this issue, and this legislation is before us today because of that. Just because the Conservatives did not do their homework on this bill or Bill C-14, as legislators, we have a responsibility to, at the very least, listen to what the Supreme Court says, and from the government's perspective, to take action to make corrective measures.

Public Service Labour Relations ActGovernment Orders

May 30th, 2016 / 5:45 p.m.
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NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Mr. Speaker, that is probably one of the more absurd comments I have heard on the decisions.

The Supreme Court did not require the House of Commons to legislate. It said that existing law, both for Bill C-14 and Bill C-7, was unconstitutional, and if the House of Commons would like to legislate something else, this was the deadline by which it must do it. The Supreme Court suspended its judgment to a date to allow the House of Commons, if it so chose, to pass legislation, very much the same as what happened with the abortion legislation in Canada. When the Supreme Court ruled that abortion violated the security of the person, it gave a period of time for Parliament to act. Parliament tried twice to act and failed to pass any legislation. The world did not end, but the Supreme Court decision was implemented.

That is exactly what would happen on Bill C-14 and Bill C-7. The Supreme Court does not instruct Parliament to do anything. It gave us the opportunity to say that if we felt there were regimes or restrictions that would meet the constitution that we would like to put it place, we had this much time to do it.

I do agree with the member that the Conservatives wasted a lot of that time. However, the present government has wasted a lot of time calling all different kinds of bills instead of dealing expeditiously with those on which it feels it has a deadline.

Public Service Labour Relations ActGovernment Orders

May 30th, 2016 / 6 p.m.
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NDP

Alexandre Boulerice NDP Rosemont—La Petite-Patrie, QC

Mr. Speaker, I would like to thank my colleague from Sherbrooke for his very relevant question. Yes, I feel the same way as he does and I agree with his analysis of the situation.

The government is trying to comply with a Supreme Court decision by doing the minimum. It is trying to do only what it has to by inventing concepts, contradicting itself, and even going against the Supreme Court's decision

This shoddy work is going to once again end up before the courts. The same thing happened with Bill C-14. It is the same principle, and that bill is a far cry from the Carter decision. The government needs to be more professional when drafting its bills.

Criminal CodeGovernment Orders

May 20th, 2016 / 10:05 a.m.
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Northumberland—Peterborough South Ontario

Liberal

Kim Rudd LiberalParliamentary Secretary to the Minister of Natural Resources

Madam Speaker, as I was saying the other day about Bill C-14, it is evident that governments, national associations, and members of the public recognize the moral and ethical struggle that health care providers could experience regarding medical assistance in dying.

Most provincial and medical regulatory bodies have already provided professional guidance around safeguarding the conscience rights of physicians. Provinces like Alberta and New Brunswick say their physicians are under no obligation to participate in assistance in dying. However, they recognize that continuity of care, especially at this most critical time in a person's life, also cannot be neglected. Patients cannot be abandoned.

The Canadian Medical Association's submission to the Special Joint Committee on Physician-Assisted Dying recommended that physician freedom of conscience be recognized as a key component of the federal legislative response to the Carter decision. Participants at a public town hall meeting in Mississauga, Ontario, raised concerns about the ethical dilemmas facing physicians if they chose to be involved in medical assistance in dying.

On May 10, proposed new section 241.2 was carried. In effect, this amendment clarifies that there is nothing in the legislation that would compel a person to provide or assist in providing medical assistance in dying. This amendment would contribute to public awareness that the bill recognizes both the rights of health care providers for freedom of conscience and the needs of Canadians who wish to have access to medical assistance in dying.

It is clear that no health care provider would be required to provide medical assistance in dying. However, we must also respect the rights of people seeking this procedure to have reasonable access. We know that there are many physicians who would provide medical assistance in dying to an eligible patient under their care. We heard from them throughout the consultations leading up to Bill C-14.

In a poll of 372 physicians, the College of Family Physicians of Canada found that 65% would help a competent, consenting, dying patient end his or her life, if requested. However, as was presented to the Standing Committee on Justice and Human Rights by Dr. Jeff Blackmer of the Canadian Medical Association, having health care practitioners willing to provide medical assistance in dying is only one part of the equation. The other very important factor is the ability to connect eligible patients with these willing practitioners.

People seeking medical assistance in dying will have already encountered many challenges. Once they have made this difficult personal choice, they do not need additional barriers, such as the lack of a provider. The government has committed to develop measures that will support access to medical assistance in dying and to work with provinces and territories toward a common approach to referrals or transfer of patient care.

Provinces and territories have also indicated that they feel that a third-party referral function would be a viable option. This would respond to the access needs of patients and protect the conscience rights of health care providers who do not wish to refer patients for medical assistance in dying. To this end, we will be working with provinces and territories to develop an end-of-life care coordination system.

In its simplest form, this system would provide a registry of authorized providers willing to accept patients whose providers consciously object to this practice. It could also provide a system through which patients could self-refer to an authorized provider to seek an assessment of their eligibility. The end-of-life care coordination system could also be a source of information and resources to both patients and providers on all aspects of medical assistance in dying—eligibility criteria, safeguards, and so on—as well as information about other end-of-life options, including palliative care.

Similar systems are used in several other countries. For example, both Belgium and the Netherlands offer specialized services that provide physicians with access to a registry of trained, independent, and impartial physicians who offer consultations on end-of-life options, including euthanasia requests.

Collaborative federal, provincial, and territorial work could consider such international examples in establishing a made-in-Canada model to provide providers and patients with access to a system that could transfer care to a physician willing to assess and administer requests for medical assistance in dying.

Additionally, the system could service medical and nurse practitioners in need of an independent consulting practitioner, for example, in rural ridings, such as the one where I live, in remote areas, and where access to a second provider is challenging.

We trust our health care providers to work hand in hand with us in helping to maintain and improve our health. When our needs change, and we look for ways to relieve suffering and avoid a long and painful end, Canadians want to be confident that these providers will not abandon them but will help them choose their own paths.

I look forward to working with my federal, provincial, and territorial colleagues to ensure that, when the time comes, compassionate care and support at the end of life will be available to Canadians without undue burden or delay.

Physicians are key to the end-of-life process. They are a critical thread that not only binds but frames this whole discussion. They are imperative to move this important debate forward. I have shared my very personal experiences on palliative care and on how critical it is.

I met this past weekend with a physician in my riding who spent years working with palliative patients. This is a man who is passionate about end-of-life care, and he expressed unequivocally to me how important this legislation is. He felt that there is a strong desire on behalf of the medical community to find the right path to ensure that we have the best care options. This legislation is a major step forward on that very important path.

This legislation has created a national conversation around end-of-life care, palliative care, and home care and how we want to be treated at the end of our lives. This has to be the most important conversation we can ever have.

This is a true legacy piece. I believe the decisions we make around this bill will reverberate positively for years to come. As I said before, I am confident the proposed legislation provides us with a balanced solution that reconciles diverse interests in medical assistance in dying and is appropriate for Canada.

Criminal CodeGovernment Orders

May 20th, 2016 / 10:15 a.m.
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Conservative

Colin Carrie Conservative Oshawa, ON

Madam Speaker, I would like to say how happy I am to finally be able to exercise my rights as a member of Parliament to speak to Bill C-14. Over the last few weeks, I have been in line to speak, but have not been able to do so because of the shutting down of debate and the antics put forth by the Liberals. I am really pleased to be able to talk today for my constituents.

I think it is important, when Canadians watch the debate, that they remember the debacle this week and that this was all about a vote on Wednesday to shut down debate on Bill C-14.

As my NDP colleague just said, we only have one more day, just a little over two hours, to debate 16 amendments. I think what is really important is for Canadians listening to this debate to get in touch with their MPs. They only have one week. I want them to look at the amendments and get in touch with their MPs, especially their Liberal MPs. As members sadly know, many of the backbench Liberal MPs will not be able to speak to the bill. The reason is that their front bench does not want them to speak on it. For me, for every member in the House, and for all Canadians, this is a very personal and very important bill, and has strong views on many sides of the debate. It will change the social structure of our country .

If we look at the foundation and the founding principles of our country and the great democracies around the world, they are based upon rights for life, liberty, and the pursuit of happiness. Today, we are actually debating some of the opposites of that: the opposite of life being death, the opposite of liberty being enclosure, and the opposite of pursuit of happiness basically being sadness.

I have been able to speak with, but also to listen to many of my constituents who have very diversified opinions. I think it is essential for all of us here in the House to respect these many points of view. At the extreme of one end, some were very much against the bill. Others were very much in favour of it. However, for most of the people I was able to listen to, they are somewhere in the middle.

The one thing that most of the people in Oshawa I have talked with agree on is that the act of assisted suicide should be an exception and not the rule. In other words, assisted suicide should only be made available on the rarest of occasions, and, of course, have the greatest of safeguards.

My concern, as we heard from my colleague here in the House, is that this is a flawed bill. In the rush to pass the assisted suicide bill before the deadline of June 6, the Liberal government has created confusion and despair. What have the Liberals chosen to do? They have chosen to break their promise to Canadians. I want to bring up and emphasize my question to my colleague across the way. When the Liberals were campaigning, they promised Canadians that they would put $3 billion into a palliative care system. I do not know where my colleague was reading it, but when I read the budget, there is absolutely no new money for health in the budget. In the first year, when the government is rushing to hit this date, there is no new money to support the other side of the equation. There is nothing. There is zero.

As far as health is concerned, this is a horrible message. It means that health care is not a priority for the Prime Minister. Canadians expect a choice between quality palliative care and this legislation. Instead, the Liberal government has chosen to support just one-half of that choice. It has put all its time and resources into assisted suicide and has not provided the promised $3 billion to palliative care, supportive care, for Canada's most vulnerable.

That is why I called on my colleague across the way to call on the Liberal government to immediately keep its promise. It is not too late to invest in palliative care. According to the Supreme Court, and from what we have heard, Canadians have the right to choose, to choose between assisted death, or hopefully the government can give them a choice to live comfortably near the end of their lives.

That is where this is really important and why I am glad I am able to speak today. The constituents I have talked to feel that the Liberal government needs to be held to account. Making the choice between assisted death and good palliative care has to be made available by June 6.

This is the first time in Canadian history that our government in Canada is drafting a law that would make it legal for one person to take the life of another. The Supreme Court has said that it is not just a required service, but has determined that it is a matter of individual rights. What precedent does that set? What do the experts in palliative care say?

Madam Speaker, I would like to share with you, but also with Canadians watching this debate and with my colleagues in the House, some of the thoughts of a very special constituent of mine in Oshawa. Her name is Dr. Gillian Gilchrist.

Dr. Gilchrist is a leading expert in the field of palliative care and she has practised medicine for over 50 years. She started the palliative care system in Oshawa in 1981, which was 35 years ago. I do not know anyone in the country with more experience, more respect, and more knowledge. Recently, through an initiative with Lakeridge Health in Oshawa, and Queen's University, a research chair has been named in her honour, dedicated to palliative care. It is the first fully funded academic research chair in palliative care at a community hospital in Canada. Dr. Gilchrist said that proper palliative care cannot be done without a team, and there is a lot that palliative care can do. There needs to be more volunteers and training. Patients deserve support, and the families need support as well.

One of the things Dr. Gilchrist said to me very strongly is that euthanasia is wrong, that doctors should not do it, and that it is not what they were trained to do. Dr. Gilchrist has treated more than 5,000 patients, and not one of those patients asked for euthanasia. She went on to say that palliative care cannot stretch across every corner in Canada, but with the assistance of the Internet, patients can obtain assistance to treatment as well as the support they need. Those individuals, at the end of their lives, can actually have a true choice. We know that experts have said that given the choice of good palliative care, 95% of patients will choose life over assisted suicide.

This affirms one of the most obvious weaknesses in the Liberal approach to this most personal and sensitive subject. How can the government rush forward so blindly toward an artificial deadline of June 6 without even providing the funds to improve palliative care options for Canadians? Have the Liberals even asked the Supreme Court for an extension?

Choice also belongs to doctors, whom the Supreme Court has said will have to perform this final irreversible act of assisted suicide. Doctors and institutions deserve the right of protection of conscience. We know that doctors have taken a Hippocratic oath that calls for them to first do no harm. The question is, why has the current Liberal government failed to adapt the legislation to provide positive protection for those doctors and institutions who cannot participate in suicide due to conscientious objections?

The legislation being presented today simply references conscience, but there is no guarantee of protection. There is a mishmash across the country. Conservatives have proposed explicit provisions for conscience protection. However, the Liberal government chose watered-down protection.

For me, it is beyond understanding how a group of nine unelected lawyers from the Supreme Court can tell physicians how they must practise medicine. We do not see medical doctors telling lawyers how to practise law, especially without guaranteeing their rights to abstain from a practice that all of them swore to reject. As Dr. Gilchrist told me, this is not why they became doctors.

I want to repeat that I have been prepared multiple times to speak to Bill C-14, and I have been able to listen to my constituents. What I think is really important for Canadians to understand is that this is not a debate about money, about technicalities, and this is not a debate about regulations. This is an unprecedented debate about the subject of one individual taking the life of another. It is a national debate. All Canadians deserve to have their voices heard.

I want to thank you, Madam Speaker, and I want to thank the House leaders for all they have done. This is probably one of the most important issues that I have faced as a parliamentarian in the 12 years that I have been here.

Criminal CodeGovernment Orders

May 20th, 2016 / 10:45 a.m.
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Conservative

Bob Zimmer Conservative Prince George—Peace River—Northern Rockies, BC

Madam Speaker, as I sit here and look up in the gallery, I notice some of our finest young Air Cadets who have just walked in, and I would like to acknowledge them today.

I will talk about four issues that I have with the process and with the current legislation. I would like to bring up the notwithstanding clause, compelling, deeming, and a free vote.

I will start with the notwithstanding clause.

I think a lot of us, especially on this side, are a little frustrated that the Supreme Court struck down the law of the land and basically said that it was not adequate to deal with this particular issue. I would argue that this House represents over 30 million Canadians. We are the ones who make the laws in this country. I think we need to remind the courts of that.

Certainly, the courts are challenged to uphold the laws that we write in this place, but when I see the wringing of hands on the other side that we are down to a deadline which is so imminent, I would like to remind those members that we are the body that makes the laws, not the Supreme Court.

I would also like to talk about “compelling”. I will read an amendment proposed by a colleague of mine:

(7.1) It is recognized that the medical practitioner, nurse practitioner, pharmacist or other health care institution care provider, or any such institution, is free to refuse to provide direct or indirect medical assistance in dying.

It sounds pretty practical to me. It goes on:

(7.2) No medical practitioner, nurse practitioner, pharmacist or other healthcare institution care provider, or any such institution, shall be deprived of any benefit, or be subject to any obligation or sanction, under any law of the Parliament of Canada solely by reason of their exercise, in respect of medical assistance in dying....

I guess what I am getting at is compelling one to cause someone else to die. This was brought up to us by a member of this chamber who is a physician. The member said that the physician is not the individual who would actually perform the action, that often it would be a nurse or some other medical staff who would have to perform the actual act taking a life. This is where I get really concerned.

I was talking with somebody while walking up to the Hill yesterday about my argument on Bill C-14 and the compelling side of things. He was actually supportive of making physicians and nurses perform the action of ending someone's life, regardless of what their moral beliefs are, regardless of what their religion is, etc., and that deeply concerns me.

As my hon. colleague in the NDP just mentioned, without bringing this issue to the Supreme Court, if we are going to put in amendments without getting the court's sign-off, my concern is that some practitioner who refused to enact an order to put somebody out of their misery and end their life would have to go before the Supreme Court. The practitioner would have to go through the legal expense and all that grief just to stand up for his or her beliefs, because the legislation does not adequately protect those individuals. It is a huge concern for me and my constituents.

I have talked about deeming before in this place, but I do not think I did a good job the first time in explaining what “deeming” really is and what it gets to.

This is on pages 12 and 13 of Bill C-14, and it is in relation to the Pension Act. I will read the actual clause:

(4) For the purposes of this Act, if a member of the forces receives medical assistance in dying, that member is deemed to have died as a result of the illness, disease or disability for which they were determined to be eligible to receive that assistance, in accordance with paragraph 241.2(3)(a) of the Criminal Code.

On the following page, there is clause 7, which references members of the forces, and it is very similar in what it is expressing.

My deep concern is that when a forces member or a veteran is somehow in tough times financially, it may become an option for the person as a way to get his or her family out of a financial burden by making the ultimate decision and ending his or her life. The fact is that it is not an option today, but this will make it an option in the future. This deeply concerns me.

Then, what of life insurance and what of other documents that relate to illness? What of those? Are they going to be similarly worded, that this would somehow encourage a member or a veteran to take that path?

Last, I would like to talk about free votes. On this side, we were asked about this a lot after the last Parliament. We were asked about how many free votes Conservatives had, and how many free votes the other parties had. When we were on that side, there were over 200 free votes, almost too many to count. We were actually given the true choice to make up our minds in this place. I think for the Liberals at that time they had around 20 free votes, roughly, because there were a few who stood to oppose different things. For the NDP, there was one.

What causes me more concern is that some of these motions have already been voted on in this House. All we have seen on the other side is one to zero in opposition of a particular motion. It concerns me that free votes are not really occurring, and that those members are being whipped into supporting a particular motion.

I say that in a challenging way. I do not say that as a way to say that the government needs to stay there. I think it is a challenge to the Liberals especially across the way to really hold free votes on this. We know there is a bunch of members on the other side with different issues of conscience with this bill. I would challenge the government to really stick to its principles of open and accountable government, sunny ways, etc., with this particular bill.

As my colleague from Cariboo—Prince George has said, this is going to be the defining piece of legislation that comes out of this Parliament. What it is going to look like in the future is going to affect us, our kids, their kids, and well into the future. It needs to be done right.

As a member from the NDP said, we need to make sure that this law is going to hold up in the Supreme Court. It would be wise to have a conversation with the Supreme Court about this particular legislation, with the amendments, and have the court come back and tell us what would hold up and what would not hold up. Short of that, this is just a simple exercise which is taking up a bunch of time, and the legislation will need to be changed all over again.

That is all I have to say. We put together some amendments. I have mentioned a few of my colleague's amendments. There is nothing strange in our amendments. There is nothing that is beyond what is expected by the Canadian public. They are about freedom of choice, freedom of religion, freedom of association, and all the rest of it.

Ultimately, we want Canadians to be free to make that decision, but we also do not want medical practitioners to be forced into making a decision that goes completely against those freedoms. I will end with this. I referred earlier to a medical practitioner in this place, and to a very compassionate argument about being forced into the position of possibly having to end someone's life against that physician's will. I do not want to see any medical doctor, nurse, anybody have to perform that action when they do not want to do it because of their beliefs.

It is a slippery slope, as many have said. I am deeply concerned about it. I hope the government side will think long and hard about pushing this legislation through without due process.

Physician-Assisted DyingOral Questions

May 20th, 2016 / 11:25 a.m.
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NDP

Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC

Madam Speaker, this is starting to look like another broken promise.

Let us now talk about another mismanaged file: medical assistance in dying. The government keeps talking about the Supreme Court's June 6 deadline as justification for limiting debate and refusing to work with the opposition. That is funny, because the government does not seem to be too concerned with abiding by the ruling itself. It is irresponsible to introduce a bill that a number of experts, and now the Alberta Court of Appeal, have deemed unconstitutional.

How can the government defend Bill C-14, when the bill does not comply with the Canadian Charter of Rights and Freedoms?

Physician-Assisted DyingOral Questions

May 20th, 2016 / noon
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Bloc

Gabriel Ste-Marie Bloc Joliette, QC

Madam Speaker, the case of the woman from Manitoba known as Patient No. 2 proves that Bill C-14 needs to be amended.

The patient has amyotrophic lateral sclerosis or ALS and meets the criteria set out in the bill. Nevertheless, the doctors who will be providing the care she needs are worried about being taken to court because of the vague definition of reasonably foreseeable natural death.

Will the government adopt the Bloc Québécois amendment, which would remove the threat hanging over health care workers' heads, namely the condition of reasonably foreseeable natural death? I would ask the government to give me a real answer, not just spout rhetoric.

MotionsRoutine Proceedings

May 20th, 2016 / 12:05 p.m.
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NDP

Peter Julian NDP New Westminster—Burnaby, BC

Madam Speaker, I am seeking unanimous consent to move a motion. I hope it will be supported by all members, especially those on the government side.

The government has said that it is willing to make amends for this week, and we are very appreciative of that offer. One of the things that could be changed is the perverse impact of the motion on time allocation that was adopted earlier this week. With that motion, at the end of today, which has been the only day of debate on report stage, the vote will be deferred to Monday evening, and we will not be able to have the debate that all members of Parliament want to have on Bill C-14.

The motion I am proposing would allow for a second day of debate that would not in any way delay the debate at report stage but, instead of debating other legislation on Monday, it would allow us to move to Bill C-14. Many members of Parliament want to speak to this, and it simply would not be acceptable to have one day at report stage when this is a critical stage of Bill C-14 in terms of its constitutionality and meeting the court obligations as well.

Having circulated the motion to all parties, I am hopeful that the government will support the following motion: That notwithstanding any Standing Order or usual practice of the House, the time allocation order for Bill C-14 adopted on May 18, 2016, pursuant to Standing Order 78(3), be deemed amended to replace the words “not more than one further sitting day shall be allotted to the consideration of the report stage” of the bill with the words “not more than two further sitting days shall be allotted to the consideration at report stage” of the bill.

This would allow for a second day of debate at report stage. We would still have the votes on Monday evening, but it would allow more members of Parliament to intervene on this important legislation.

Criminal CodeGovernment Orders

May 20th, 2016 / 12:15 p.m.
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Brampton West Ontario

Liberal

Kamal Khera LiberalParliamentary Secretary to the Minister of Health

Mr. Speaker, it is an honour for me to rise today to speak in support of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).

I would like to start off by first acknowledging that medical assistance in dying is a deeply personal issue for all Canadians, which is tied to both their life experiences and personal beliefs. My background as a registered nurse in an oncology unit helped shape my thoughts and opinions on this matter.

Understanding that this is a very sensitive issue, with proponents on all sides of the debate, within days of this new Parliament, the now-government caucus moved swiftly to strike a joint committee to study the matter and make recommendations, which heard from many Canadians and experts on this issue. After working several days, sometimes well into the evening, the committee made its recommendations to Parliament.

Before I continue, I would like to thank all my hon. colleagues on both sides of the House, and in the Senate, who participated in the special committee and the justice committee for their contributions.

I also know that our minister has worked very hard to craft legislation that would ensure that the priorities of Canadians were met when it came to the issue of medical assistance in dying.

I strongly believe that the proposed legislation finds the perfect balance by reconciling the issue of autonomy of competent adults with the protection of vulnerable people through a thoughtful tailoring of the eligibility criteria and robust safeguards that are essential to preventing error and abuse. It also strikes the right balance by ensuring that conscience rights of physicians and nurse practitioners are protected, and commits to continuing to work with the provinces and territories regarding coordination and jurisdictional issues.

I want to assure members that our government is committed to continued discussions with the provinces and territories on a range of issues, not only related to medical assistance in dying but also to a full range of end-of-life options, including palliative care.

In various testimony given before the House committee, witnesses discussed other regimes where medical assistance in dying has been implemented. In Europe, for example, three countries have legislated access to medical assistance in dying, which is Belgium, the Netherlands, and Luxembourg. In the United States, four states have legislated access.

However, where Canada is unique is in the jurisdictional complexities that we face. In Canada, the federal government has exclusive jurisdiction over criminal law, and health is a shared jurisdiction between the federal, provincial, and territorial governments. Primary responsibility for the provision and delivery of health care services rests with individual jurisdictions. This is why our government has proposed legislation that will be applied across all provinces and territories but at the same time will respect and allow flexibility for jurisdictional roles and responsibilities in the areas of health care.

This brings me to another important issue that cannot be ignored or put aside when talking about enabling access to medical assistance in dying when one is approaching end-of-life care, and that is access to quality palliative care. It is very clear that Canadians are looking to their government for leadership to advance the availability and quality of palliative care within the broader scope of how we address Canadians' needs at the end of their life.

We know that most people at the end of life wish to remain at home as long as possible, as long as they are well supported by the services they need. This is why the federal government is committed to improving palliative care as part of a new health accord, supported by a long-term investment of $3 billion over four years.

Recently, federal, provincial, and territorial ministers of health agreed to work individually and collectively on improving home care to better meet the needs of patients closer to home. However, an agreement must still be reached on how funds will be used to strengthen and transform the health care system. We know that all jurisdictions are working diligently to meet the growing home and palliative care needs of their aging populations. However, we also know that jurisdictions are at different points. Some are well advanced in their efforts, and others are at a more moderate stage. By continuing to work with provinces, territories, and stakeholders, we will bolster each other's efforts for the benefit of all Canadians.

Another aspect that I would like to address when we talk about providing Canadians with that full range of options at the end of life is access. The government is very clear in its commitment to facilitate access to these services and to those providing it. This includes access to this new service of medical assistance in dying.

Our government is committed to respecting the autonomy of Canadians suffering from grievous and irremediable medical conditions. Access to medical assistance in dying would only be available for those who meet the following conditions: be a mentally competent adult who is in an advanced state of irreversible decline in capability; have a serious an incurable illness, disease, or disability, and are experiencing, enduring an intolerable suffering; and whose deaths are reasonably foreseeable.

It will also remain a crime to assist a person either in dying or in causing a person's death in situations other than lawful medical assistance in dying.

With regard to Bill C-14, our government is also committed to protecting the exercise of conscience rights as the proposed legislation also provides exemptions for both physicians and nurse practitioners from having to provide medical assistance in dying. Over the course of this national dialogue, we have seen that the protection of conscience rights for these providers is clearly an issue for many Canadians. Our government has listened and made Bill C-14 more explicit on this issue, and therefore more appropriate for the diversity within Canada.

The bill now reads as follows:

For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.

We trust that this helps to address the concerns some of members may have either personally and/or on behalf of their constituents on the issue of the protection of conscience rights.

Our government is also proposing to work with provinces and territories to create an end-of-life care coordination system. This would have a dual function. It would respect the conscience rights of health care providers, while facilitating access for Canadians to not only medical assistance in dying but a full range of end-of-life options, including palliative care.

The federal government would be prepared to collaborate on developing such a system should provinces and territories wish to participate, so that all Canadians have access to the care they need and deserve. We could also start on this by reviewing the information that we have on assisted dying regimes in other countries to see what they have done, and assessing their applicability to Canada.

Working in the health care field and especially in oncology, I know that health care is about connecting and helping people during their most vulnerable times. This means that we need accountable and transparent regulations to monitor and instill confidence in the appropriate implementation of medical assistance in dying.

This will protect vulnerable patients when they may not be able to do so themselves and help Canadians understand the number of requests for medical assistance in dying, the types of medical conditions that lead to requests, and whether the procedural safeguards in the law are working as intended. It will also work to ensure that high-quality, comparable Canadian data is generated so that any future discussions about changes to the medical assistance in dying system can be based on the best possible evidence.

Therefore, Bill C-14 creates legal obligations for physicians, nurse practitioners, and pharmacists to report certain information for the purpose of monitoring. Regulations will be put in place to guide the information to be provided, to whom, and within what time frame. In the short term, Health Canada is working with our counterparts in the provinces and territories to establish an interim system should the bill be passed on June 6, until a permanent process is in place.

In closing, I would like to once again reaffirm my support for Bill C-14, which I believe is the right approach for medical assistance in dying. It will support and facilitate access for those seeking it, protect our most vulnerable, and protect conscience rights. We know that no one solution can reconcile the diverse perspectives on medical assistance in dying, but we believe we are moving forward together with a balanced approach that is appropriate for Canada at this time.

I thank the Speaker for giving me the opportunity to speak on this very important piece of legislation.

Criminal CodeGovernment Orders

May 20th, 2016 / 12:25 p.m.
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NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Mr. Speaker, I am very glad to have the opportunity to finally speak to the bill at report stage, although, as I just said in my previous question, I am really sad to have to do this under time allocation and knowing that many of my colleagues will not get the chance to bring the voices from their constituencies to this chamber on the bill.

I was prevented from speaking at second reading by the time allocation imposed by the government, but something even more peculiar happened when it did that. The abrupt change of the House schedule on May 4 with time allocation forced the second reading vote forward by five days, and for those of us who have responsibilities both here and in our ridings, it meant on that Wednesday morning, I was already flying west before the time allocation motion was introduced. It meant that I could not be here to cast my vote at second reading because I was already flying in the wrong direction.

I lost my chance to go on record as voting against Bill C-14 in principle. That is what I intended to do, not just because of my own experience and beliefs, but also because I believe it contradicts the Supreme Court's Carter decision, and most important, because the bill contradicts the opinion of virtually every person and every family in my riding that has contacted me about this issue.

I have been involved in discussions about end-of-life issues with several individuals who are facing severe debilitating and painful illnesses. I have talked to them directly. I have met with them and have heard their concerns. This reminds me to mention an important issue that is not in the bill, and that is the issue of palliative care and the need for us as a society to do a much better job with end-of-life care.

I do want to praise those who are actively already working in end-of-life care. This is not a criticism of their efforts that they make each and every day to provide better care for those who are facing end of life, but they are forced to do so too often with too few resources and in substandard situations.

I have been involved in public discussions locally on this issue, stretching back to a public forum on March 21, 2015, which was jointly sponsored by a group called Victoria Choices in Dying and Dying with Dignity. We heard from a panel of speakers, which I was privileged to be on, but we also heard from the public. We heard speaker after speaker at that forum say that they wanted the right to control end-of-life issues. They wanted the right to make decisions for themselves, and they wanted the right for their family members not to have to suffer intolerable pain for great lengths of time, but to be able to make the choice for assisted dying.

I believe, as I said, not just speaking on the basis of my own conscience, but representing the beliefs and needs of my community, that I should oppose Bill C-14, not just for what is not in the bill, like palliative care, which only gets a mention in the preamble and for which the government has, incidentally, provided no new resources and there is no reason to wait for legislation to do that, but I will oppose the bill for what is actually in the bill. I believe the bill is too restrictive and respects neither the letter nor the spirit of the Carter decision.

I think we are in this unfortunate position because the government failed to listen to the key recommendations of our own special joint committee of the House and Senate. The committee made very wise recommendations with regard to the bill, yet only a few of them were incorporated into the bill at the committee stage.

In the interests of time, I will focus on what I believe are the three key faults in Bill C-14.

The first and most important to me is the absence of a provision for advance directives.

I want to talk, if I am able to do so, about a very personal experience, the death of my mother last fall. My mother had always been very clear, even before she developed dementia, and that dementia began to take away her capacity, she did not want measures to keep her alive, lying in the bed without consciousness, with no quality of life, and especially if she were in great pain.

Her dementia was not the immediate cause of her death, so she would not have qualified under the bill because she did not have a terminal illness, but in her case, six years after the onset of the dementia, she no longer had the capacity to make decisions. Other medical conditions left her in a situation which she had feared: in great pain and unable to care for herself. Those other medical conditions did eventually take her life in conjunction with the decisions we as her children and the medical practitioner made at the time.

We feel very fortunate that my mother had been very clear about her wishes. Although that did not really make the decisions we had to make easy, we were confident that we were doing what she had wanted to do. My own family's experience and the experiences of other families in my constituency are why I believe so strongly that Canadians have the right to make advance directives about their care.

The second reason that I am opposing this bill is the fact that it would impose what it calls a reflection period on those at the end of life. Of course, again, those who have dementia or other similar medical conditions would not be able to have a reflection period because they would no longer have capacity. However, even for those who are competent at that point in their life, I believe that the 10 days, which the committee thankfully reduced it to, is still far too long for those who are living in intolerable pain, and far too long not just for them, but far too long to ask their families and friends to witness that suffering. If there is to be a reflection period, it needs to be even shorter than those 10 days.

My third reason for opposing this bill is the fact that it would narrow who is eligible to receive medical assistance in dying to those whose death is “reasonably foreseeable”. I know that others have said that we know what that means and it is specific. However, the only way I can understand that we all know what that means is that all our deaths are reasonably foreseeable, but what it means beyond that, I have no idea. It is not a term that is used in medicine. It is not a term that is used in law. That very ambiguity raises the spectre of excluding people who need medical assistance in dying and who would have been qualified for it under the Carter decision.

According to the lead counsel in the Carter case, even Kay Carter, a fierce advocate for the right to assisted death for those who are suffering intolerably but from a non-fatal condition, would probably be excluded from accessing medical assistance in dying under Bill C-14 as it stands. What this would do is force people into incredibly cruel strategies like starving themselves to death to make their death imminent and allow them to qualify. I would hope that this House would not impose those kinds of restrictions on people and make them make those kinds of choices at the end of their life.

Would I rather have this bill than no bill? The answer I guess I am going to have to decide on. My decision is going to be that yes, I would rather have no bill. I prefer to go with the Carter decision. Do I think it would have been better to have a bill? Yes I do. I am not opposed to having a bill on this, but it has to respect the Carter decision, and it has to have clear provisions in it, and it needs to have a reflection period shorter than 10 days. If we do not have the bill, what happens? We do not have a legal vacuum as people are saying. We have the Carter decision, which would provide guidance. There is a legal framework.

Although I did not actually look this up, when the abortion provisions were removed from the Criminal Code, the House of Commons tried twice to create new law regulating abortions. I am sure these same arguments were made at that time, saying that practitioners would not want to perform abortions because there was no legal framework. In fact, we went with the court decision. We still exist with the court decision on abortion as our legal framework and we have not had chaos in the medical community on that; not that in any way I wish to compare abortion to medical assistance in dying, but only on this issue of whether there is a legal framework that will apply on June 6.

The failure to meet the June 6 deadline for this legislation lies with all of us. It lies with the previous government; it lies with the current government, and it lies with us as a House of Commons. We all have to take responsibility for missing that deadline.

However, I do have to say I believe the government could have managed the House time better so that all of us could have participated in the debate and that debate could have been accomplished in time to meet the deadline. All the Liberals had to do was schedule this bill as a priority in this sitting of the House, which they failed to do. That did not happen. Therefore, I will, when the time comes, stand and vote against this bill at third reading. In the meantime, I will also vote against it at report stage.

Criminal CodeGovernment Orders

May 20th, 2016 / 12:35 p.m.
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NDP

Peter Julian NDP New Westminster—Burnaby, BC

Mr. Speaker, following on the comments of the member for Esquimalt—Saanich—Sooke on the issue of the timing on the debate, earlier I offered a unanimous consent motion that would allow us to debate this bill on Monday, which would not change in any way the time allocation vote that we have to have at the report stage of Bill C-14 on Monday evening.

Currently, in just a few minutes, we will stop debating this bill, but with this motion, if it is adopted by the government side, as opposition members are in favour, we would then have a second day of debate at report stage, which would be on Monday.

It is my hope that the government will actually work to do what is reasonable. It does not change the vote that we will have on Monday night on report stage on Bill C-14, but what it does do is it adds a second full day of debate and allows members of Parliament to speak on this important issue.

I will read the following motion for which I am seeking unanimous consent: That notwithstanding any Standing Order or usual practice of the House, the time allocation order for Bill C-14 adopted on May 18, 2016, pursuant to Standing Order 78(3) be deemed amended to replace the words “not more than one further sitting day shall be allotted to the consideration at report stage of the bill”, with the words “not more than two further sitting days shall be allotted to the consideration at report stage of the bill”.

I hope that we will get unanimous consent and allow a second day of debate on this important bill at report stage.

Criminal CodeGovernment Orders

May 20th, 2016 / 12:45 p.m.
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Winnipeg North Manitoba

Liberal

Kevin Lamoureux LiberalParliamentary Secretary to the Leader of the Government in the House of Commons

Mr. Speaker, it is with pleasure that I rise to share a few thoughts in regard to the report stage of Bill C-14. Perhaps I can start off by picking up on a couple of the words that were just mentioned.

When we talk about the details, listening to many hours of debate in the chamber on this very important legislation, a couple of things come to mind. One is the seriousness of the debate, the sense of compassion we hear in many of the speeches. People want to identify with the legislation and best represent their constituents. It is one of the reasons it has become somewhat of a difficult issue to try to manage. To try to give a false impression would be most unfortunate. There has been a genuine, serious commitment by the Government of Canada to accommodate all members who would like to address the legislation. We have seen that on several occasions. It would have allowed all members to participate in the debate.

We all share two responsibilities. One is to recognize that the Supreme Court of Canada made a decision, and there is a void. I will provide some comment on that shortly. Second is that all political parties in the chamber have to take responsibility in the debate that has occurred on Bill C-14. Members need to ask themselves why they feel limited in their debate. On a number of occasions, the government has extended the opportunity to afford every member the opportunity to speak. I wanted to be very clear on that point.

When we talk about the issue itself, there is another thing about which we should be talking a great deal. We heard a lot of this during the second reading debate. We have far-reaching legislation that will impact, directly or indirectly, every Canadian in every region of our country. At the end of the day, we need to recognize that this is just one major step. It is a step that has been mandated because nine Supreme Court of Canada judges made the decision that we needed to get some form of framework set up to provide medical assistance in dying.

I believe this legislation delivers that. I recommend that members look at some of the words that have been spoken, in particular by the Minister of Health, and the Minister of Justice. They have done a phenomenal job in getting us to the stage we are at today. I would not want to underestimate the role that others have contributed. In particular, the members of the joint standing committee of the Senate and the House spent many hours in the early part of this year in consultations. I wish to recognize the many efforts of committee members, who after second reading had the opportunity to go through the legislation and look at the possibility of amendments, and number of amendments were brought forward. We saw consensus among all three political parties for some of those amendments, which is great to see.

It is important we recognize that some in the chamber advocate that this bill does not go far enough. Others advocate that it goes too far. I believe the legislation before us today is the best legislation we can develop, put forward, and turn into law. At the end of the day, Canadians from coast to coast to coast will be assured that it is solid legislation.

If we do not pass the legislation in a timely fashion to meet a deadline determined by the Supreme Court of Canada of June 6, there will be a void. Some have said that we can just ignore the void. They can have that opinion if they choose, but it is the responsibility of every parliamentarian to respect the Supreme Court of Canada's decision. If members do not respect that, we are putting at risk a patchwork system, depending in which part of our great nation we happen to live.

There will be additional issues in many different regions that will surface and many will have to spend, potentially, hundreds of thousands of dollars dealing with the legislation in a piecemeal fashion because we did not respect what we have been called upon to do by the Supreme Court of Canada. There is urgency.

We know that caring and compassionate Canadians in every region of the country want us to do our job. That is one of the reasons it did not matter to me if we sat until three or four o'clock in the morning or 11 o'clock at night. We wanted to ensure that members had the opportunity to express themselves. As we get closer to that deadline, we have to get the legislation into the Senate. We have many reasons to be optimistic that the Senate has taken on what I believe is a more independent outlook in terms its responsibilities. Hopefully we will see a very productive Senate in dealing with legislation that has been passed by the elected members who sit in the House.

We have an obligation to do the best job in dealing with this issue. That means we should look at getting this bill through not only at report stage but at third reading in a timely fashion so the Senate is able to deal with it. I look at a glass as being half full, not half empty. I hope the Senate will do the same and assist us in meeting the Supreme Court of Canada's deadline.

I want to emphasize that this is step one. There are many other steps. One of them is the issue of palliative care. I and many of my Liberal caucus colleagues as well as many other members of the House are looking at this. The Government of Canada has been very clear on a solid commitment in two ways.

First is the health care accord. The best way to deliver palliative care is through agreements with the provinces, I wish the Minister of Health the very best in achieving that health care accord.

The second is the financial commitment of billions of dollars from this government to provide strong leadership going into the future, ensuring that palliative care is a top priority of this government and working with the many stakeholders that play a critical role in this so we have the best palliative care system in the world. This government, the Prime Minister, myself, and many colleagues in the House want to achieve good quality, world-class palliative care.

Criminal CodeGovernment Orders

May 20th, 2016 / 12:55 p.m.
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Conservative

Mark Strahl Conservative Chilliwack—Hope, BC

Mr. Speaker, those were very nice words, but I think it is time for action from that side of the House. We are where we are today. We can all play the blame game on why more members have not been able to speak, whether we should have sat until 3 o'clock in the morning, as the member said, or until midnight, or whether or not Motion No. 6, which has been withdrawn, was the answer to get this through.

We saw yesterday, in a spirit I would say of reconciliation, after the events that happened earlier this week, the government House leader withdraw his draconian motion, Motion No. 6, and promise to work with the opposition so that more members would have the opportunity to speak on Bill C-14.

The Liberals brought this bill on a Friday, which allows two hours of debate at report stage. There has been a very reasonable amendment to the motion put on the floor of this House to allow us to debate on Monday. It would not affect the timing of the votes or this bill proceeding to the Senate.

Why is the member opposing the opportunity for more members of Parliament to speak just on Monday? It would not affect the timing, the June 6 deadline, or the business of this House. Why not bring this back on Monday for another day of debate to give more members the opportunity to express themselves?

Criminal CodeGovernment Orders

May 20th, 2016 / 1:15 p.m.
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NDP

Daniel Blaikie NDP Elmwood—Transcona, MB

Mr. Speaker, I know we have tried this before, but the third time is the charm. Given the importance of debate on this issue, it is important that we have another opportunity to extend it without affecting the timeline for the Supreme Court decision. Therefore, without moving the votes, we could extend debate on this.

Perhaps the government deputy House leader does not feel the same sense of urgency on this matter. He has been spearheading the movement against this motion today. He has spoken twice already, once at second reading and then at report stage, on this bill. However, other members have not spoken at all. They would appreciate that opportunity. I hope perhaps the deputy House leader has had time to call his boss and see if we can get a different answer this time.

The motion is: That notwithstanding any Standing Order or usual practice of the House, the time allocation order for Bill C-14, adopted on May 18, 2016, pursuant to Standing Order 78(3), be deemed amended to replace the words “not more than one further sitting day shall be allotted to the consideration of the report stage...of the bill” with the words “not more than two further sitting days shall be allotted to the consideration at report stage of the bill.”

Citizenship ActGovernment Orders

May 17th, 2016 / 10:10 a.m.
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NDP

Peter Julian NDP New Westminster—Burnaby, BC

Mr. Speaker, I am looking at the projected order of business for today, and it says very clearly that Bill C-14 is up for debate. I am surprised that the government is refusing to bring that forward when it is on the projected order of business.

I hope, if you seek it, you will find unanimous consent for the following motion: that the order of the day not be Bill C-6, An Act to amend the Citizenship Act and to make consequential amendments to another Act, and that the House proceed to the consideration of report stage of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

Bill C-10—Time Allocation MotionAir Canada Public Participation ActGovernment Orders

May 17th, 2016 / 11:05 a.m.
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NDP

Peter Julian NDP New Westminster—Burnaby, BC

Mr. Speaker, what the bill does is kill thousands of aerospace jobs in this country.

The government should not be proud of bringing forward the bill, but I have to comment on the absolute chaos we have seen from the government this morning. In 60 minutes, we have now gone through three pieces of legislation. We were told today was to be reserved for Bill C-14. That was what was placed on the projected order of business. We arrived this morning and the government said no, it would bring in Bill C-6, and then it switched rapidly to Bill C-10.

We know why the Liberals are bringing in Bill C-10. They are trying to provoke closure and bulldoze this through, because yesterday parliamentarians tied in their vote on Bill C-10. The bill is so bad, the legislation is so destructive to aerospace jobs in Canada, as you know, Mr. Speaker, you had to break the tie. It was 139 to 139. That has only happened 11 times in Canadian history, and in fact, it is the first time that a majority government and a government bill has seen a tie vote broken by the Speaker.

Is that not the real reason why sunny ways have turned into dark ways and why the Liberals are trying to bulldoze the bill through? It is because they are embarrassed by the results from yesterday.

Copyright ActGovernment Orders

May 17th, 2016 / 1:30 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, it is a pleasure to rise to speak to this subject. I will be splitting my time with the member for Lethbridge who also serves as our party's critic for disabilities. She is doing a phenomenal job in that role, standing up for vulnerable people.

This is a great bill. It is a bill that all parties as well as unrecognized parties agree on, but it is important to express some disappointment about the reality of the process and how this debate has come up today. We had Bill C-14 on the Notice Paper. Then we had a vote to concur in Bill C-6. Then we had closure on Bill C-10. Now we are on to Bill C-11 without notice.

I say this precisely because of the importance of the bill. It is a bill that we should all be coming together not only on substance but on process. Had we the notice, had we been able to plan this debate at a time when all parties were ready and organized for it, we would have been able to get so much more out of this conversation. There would have been an opportunity to bring in stakeholders perhaps, to listen to and to observe this debate. This would have given all parties the opportunity to ensure that those who really wanted or needed to speak to this were in a position to do so.

Instead, this very important substantive legislation is being used as a procedural weapon, it seems. The government tabled the bill on March 24. As much as the minister has mentioned the urgency of moving this forward, the Liberals could have at least given notice that they were going to do it today. We could have had the bill debated earlier. This is a missed opportunity.

In the previous timeslot, my colleague from the NDP, the member for Windsor West, wanted to split his time and a government member blocked that from happening. We have these missed opportunities of collegiality, missed opportunities to work together to put our best foot forward as a House. It is unfortunate, because we agree with the issue and can work together on it. Yes, there are times for partisanship in this place, but the bill should not have been one of those times.

I do not blame the minister for this. I have spoken to the minister at committee and I know she is committed to working across party lines on important issues. However, this speaks to the House leadership on the government side and how it views absolutely nothing it seems as beyond partisanship.

I want to get that out of the way because it is important to put on the record.

Let us talk about the bill. I am very proud to be speaking in favour of it.

Just to highlight for those who may be just joining the debate, the bill has three substantive different parts to it.

The bill would allow not-for-profit organizations acting on behalf of a person with a disability to convert books and other works into an accessible format without first seeking the permission of the copyright holder. It would instantly allow books that were currently not in accessible format to be converted into those formats. That is an important change, one that would make a positive difference.

Also, as part of the treaty that the bill would operate under, the Marrakesh treaty, which was signed in 2013 and would now through this legislation be ratified, it would allow the sharing of those works between different countries participating in that treaty. There is the domestic element of allowing people to have access to this important information. There is also that international element, encouraging sharing between different countries of this vital material.

Finally, the bill would make important related amendments to digital lock provisions.

Obviously we are going to support the bill. It is getting a lot of consensus. This is the conclusion of a prior process of which the previous government was certainly a part. Budget 2015 set out a plan to implement this treaty. Page 286 of budget 2015, stated:

The Government will propose amendments to the Copyright Act to implement and accede to the Marrakesh Treaty to Facilitate Access to Published Works for Persons Who Are Blind, Visually Impaired or Otherwise Print Disabled.

The ability to access printed information is essential to prepare for and participate in Canada’s economy, society and job market. According to Statistics Canada, approximately 1 million Canadians live with blindness or partial sight. The Government will propose amendments to the Copyright Act to implement and accede to the Marrakesh Treaty to Facilitate Access to Published Works for Persons Who Are Blind, Visually Impaired or Otherwise Print Disabled (the Marrakesh Treaty).

Aligning Canada’s copyright limitations and exceptions with the international standard established by the Marrakesh Treaty would enable Canada to accede to this international agreement. Once the treaty is in force, as a member country, [Canada] would benefit from greater access to adapted materials.

It is worth nothing that this process has been in place. Certainly, this was the plan laid out in Canada's economic action plan 2015. However, we are very pleased to see the new government continue on with this important work. This work needed to be done.

I would like to specifically motivate the philosophy behind the bill. It is essential that every person has access to books. Books are a major part of all of our lives, and they are an important part of every child's life.

My daughter, Gianna, and I read books all the time. I read books to her on Skype when I am in Ottawa. I cannot imagine what it would be like to have a child who has a visual impairment and who is unable to get books which he or she can read. My daughter is a voracious reader. I brought four books with me and we went through them all in one evening. I need to bring more books with me next time I come to Ottawa, clearly. It is great to see how important books are to us all, especially kids. We need to ensure that people of all ages, including children, have access to reading material of all kinds.

As has been discussed in the House, people's reading decisions are not limited by the availability of books.

Again, I cannot imagine what it would be like to really want to read a particular book, whether a novel or a work of non-fiction, and be told that because of a disability, I cannot read that book, that the book is not available to me, that the knowledge is not available to me. I think that would be a very difficult thing for anyone to deal with. That is why this legislation is important for ensuring that everyone has access to books, that there can really be the full sharing of knowledge that takes place.

Everyone in every situation should have access to as much knowledge, as many books as possible. There can be nothing but good that would come from more access to books for more people.

I also want to talk about the international dimension of this. One of the things we know about Canada is that many people maybe have come here from other places or maybe were born here, but who like to read books in other languages. They might be more comfortable in a language other than English or French, or they simply enjoy reading works from a range of different languages. Specifically, the international dimension of this treaty would allow Canadians to have greater access to books in other languages that may be in a better format which they can make more use of.

Some of the countries that have signed the treaty so far are Argentina, El Salvador, India, Mali, Paraguay, Singapore, UAE, and Uruguay. In a multicultural Canada that likely means more access to materials in languages like Hindi, Punjabi, and Spanish. It is important that through those international sharing takes place for all Canadians, not just those who want to access things in English or French, have access to them.

Noting the countries that have signed the treaty so far, it does not look like there are that many Francophone countries. In addition to us ratifying this, there is a lot of value in Canada playing a role, encouraging other countries to ratify and, in particular, seeing if we can use our relationships through the Francophonie to encourage more Francophone countries to ratify this and therefore ensure we have good access to more French-language materials.

We need to get to 20 countries. It is important that we get those 20 countries ratifying. I understand from the minister that we only have three more to go. This is an important leadership role Canada can play and the continuing advocacy we have to do.

I mentioned this during questions and comments, but I have had a constituent raise with me the importance of ensuring those tools people access that allow them, as people with disabilities, to operate in the world, to read, and to do other things, it may be an iPad or a speech app on a phone, are tax deductible. I see measures that address those issues as aligning well with the measures in this legislation.

I look forward to supporting the bill.

Copyright ActGovernment Orders

May 17th, 2016 / 1:40 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, I want to follow up on my colleague's question of the right time.

All of us came to the House this morning fully under the impression that we would be debating Bill C-14. Through the joint committee study, through the justice committee study, we were told time and time again that we did not have time to get all these witnesses in. We were under a tight time frame. We were under the deadline of June 6.

Today, we were hoping to start debate on Bill C-14. Instead of that, we have had at least three different bills brought to the House today, taking up the time that members of the House could be debating Bill C-14. The clock is ticking.

Again, what are my colleague's feelings about why the government would have chosen today to implement three bills that could have been passed another week when Bill C-14 was under such a tight timeline?

Speaker's RulingCriminal CodeGovernment Orders

May 17th, 2016 / 3:25 p.m.
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Liberal

The Speaker Liberal Geoff Regan

There are 16 motions in amendment standing on the Notice Paper for the report stage of Bill C-14.

Motion No. 5, submitted by the hon. member for Victoria, and Motion No. 10, submitted by the hon. member for Montcalm, propose additional amendments to provisions of the bill that were previously amended in committee. Both motions seek to amend what is meant by “a grievous and irremediable medical condition”.

It should be noted that very similar definitions were proposed and defeated in committee, although they were proposed in reference to a different clause. In the view of the Chair, the objective of these motions is essentially identical to that of the amendments defeated in committee, and these motions will therefore not be selected for consideration at report stage.

The Chair has received letters sent by the hon. member for Sherwood Park—Fort Saskatchewan, the hon. member for Regina—Qu'Appelle, the hon. member for St. Albert—Edmonton, the hon. member for Saanich—Gulf Islands, and the hon. member for Kitchener—Conestoga arguing that certain motions, though previously defeated in committee, should be selected at report stage as they are of such exceptional significance as to warrant a further consideration, in accordance with the notice to Standing Order 76.1(5).

Motions Nos. 2, 11 and 15, submitted by both the hon. member for Barrie—Springwater—Oro-Medonte and the hon. member for Kitchener—Conestoga, as well as Motion No. 8, submitted only by the hon. member for Kitchener—Conestoga, will not be selected by the Chair as they could have been presented in committee. The Chair has difficulty accepting that they should now be accepted at report stage when no attempt was made by either member to present them in committee.

Motions Nos. 4 and 9, submitted by the hon. member for St. Albert—Edmonton and the hon. member for Regina—Qu'Appelle, seek to ensure that a person who suffers from an underlying mental health condition has undergone a psychiatric evaluation to confirm that they are capable of giving informed consent in relation to a request for medical assistance in dying. Motion No. 14, submitted by the same two members, seeks to ensure that people are free to refuse to provide medical assistance in dying. All three motions are identical to amendments defeated in committee.

The same is true for Motion No. 6, submitted by both the hon. member for Montcalm and the hon. member for Saanich—Gulf Islands. This motion seeks to delete paragraph 241.2(2)(d), which states that an individual's natural death must become reasonably foreseeable in order for the individual to be considered to have a grievous and irremediable medical condition.

In the case of the motions submitted by the hon. member for Sherwood Park—Fort Saskatchewan, Motions Nos. 7, 12 and 13 are also identical to amendments defeated in committee. Motion No. 7 seeks to amend paragraph 241.2(2)(d) to reference instead that the person's natural death must be imminent. Motion No. 12 seeks to add a paragraph providing that no substance is to be administered to a person who is capable of self-administering. Motion No. 13 provides for a review of the safeguards in relation to a request by a competent legal authority. Motion No. 3, which provides that a person must have consulted a medical practitioner regarding palliative care options prior to making a request for medical assistance in dying, is very similar to an amendment defeated in committee. The only distinction between the two is that the latter provided that such consultation had to have taken place within the 15 days prior to making the request.

The Chair appreciates the arguments put forward by hon. members as to why they consider these amendments to be of such significance as to warrant further consideration at report stage. I recognize that this is an important issue on which many members have strong and varied opinions. The Chair notes that the bill before us is unique, in its far-reaching social, moral and constitutional implications. The Chair also notes that, given the variety of opinions expressed by various members in all parties in relation to the provisions of this once-in-a-generation bill, the Chair is open to the argument of exceptional significance as contemplated in our Standing Orders. For these reasons, the Chair is prepared, on this occasion, to give members the benefit of the doubt and to select Motions Nos. 3, 4, 6, 7, 9, 12, 13 and 14, even though they were previously defeated in committee or are similar to motions previously defeated in committee.

All of the other motions, Motions Nos. 1 and 16, were examined, and the Chair is satisfied that they meet the guidelines expressed in the note to Standing Order 76.1(5), which deals with the selection of motions in amendment at report stage.

Therefore, Motions Nos. 1, 3, 4, 6, 7, 9, 12, 13, 14, and 16 will be grouped for debate and voted upon according to the voting pattern available at the table.

I shall now propose these motions to the House.

Motions in amendmentCriminal CodeGovernment Orders

May 17th, 2016 / 3:40 p.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I appreciate your thoughtful ruling and your recognition that this is indeed a historic event and, as you said, a generational issue. In Motion No. 1, I have suggested that we delete clause 3 of the bill, which is one of the central features of it.

The Supreme Court's ruling in the Carter case was a watershed moment for many Canadians, especially those who had fought so long to have their suffering recognized and their autonomy respected. I was proud to support the principle of Bill C-14 during second reading. I did so thinking of Sue Rodriguez of Victoria, Gloria Taylor, and Kay Carter, and of all of the others who paved the way for the rights of other suffering Canadians to be recognized by the Supreme Court and by Parliament.

While I was proud to support the bill in principle, at the time I raised serious concerns about particular provisions in it. Still, I was optimistic that these concerns would be resolved and the bill improved by hearing from experts and making the necessary amendments in committee. Sadly, that was not to be done.

The first day of consideration in the justice committee ended without a single opposition amendment accepted by the Liberal majority. By the end of the week, after more than 100 amendments were proposed, just 16 were accepted. Of course, I am pleased that my amendment was accepted to strengthen the government's commitment to providing more Canadians with palliative care, mental health supports, better services for patients with Alzheimer's and dementia, and culturally appropriate services for indigenous patients. I thank my colleagues from all parties for supporting my amendments to that end. However, many of the handful of changes at committee were simply minor technical changes.

Along with members from several parties, I offered a solution to the glaring flaw in the bill, the elephant in the room, namely the fact that it simply did not square with the Supreme Court's ruling. I proposed using the exact words of the Supreme Court to determine eligibility. That was of course one of the main recommendations of the special House Senate joint committee that addressed this bill. Sadly, all of these proposals were rejected. It became clear that the government had no interest in changing the central feature of this bill. Therefore, does the Liberals' bill square with the Supreme Court decision in Carter? The answer is clearly no.

The Supreme Court declared the two laws that prevented medical assistance in dying:

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

That language defined the circumference set out by our highest court as to who had the right to physician-assisted dying. Outside of that circle, there remains a total ban on assistance in dying. Mature minors, those who have lost or never had the capacity to give legal informed consent, those with solely psychiatric conditions, and those with merely minor medical conditions were never eligible in the Supreme Court decision. However, within the circle are all consenting competent adults with a grievous and irremediable illness, disease, or disability that causes enduring and intolerable suffering.

This bill would erase the circle set by the Supreme Court and draws a much smaller circle within it, covering only those nearing the end of life and facing what is called reasonably foreseeable natural death, a phrase which just recently the Collège des médecins du Québec called incomprehensible from a medical perspective.

A lawyer representing the British Columbia Civil Liberties Association at the court hearings said this to the justice committee, “Bill C-14 cuts the heart out of our victory in the Carter case”. By adding an end-of-life requirement onto the court's ruling, Bill C-14 would revoke the right to choose from an entire class of competent adult Canadians. That group is everyone suffering intolerably from an irremediable but non-fatal condition.

I have constituents in my riding who fall into that outer ring beyond the circle of rights recognized by the government, people who are suffering, who saw their suffering recognized by the Supreme Court and who cannot, for the life of them, understand why the government now insists on removing their right to choose this option.

What justification has the government offered for this disturbing decision? At the House and Senate committee, and again at the justice committee, some argued we could not afford to expand the circle of compassion, that the Supreme Court ruling could not be obeyed in full, that not all those who were granted rights in Carter could see those rights upheld because to do so would pose an unacceptable risk to vulnerable persons.

These are important arguments, but they are not new. In fact, they were advanced ably and in great detail before the Supreme Court of Canada. Here is what the court wrote.

At trial [the Crown] went into some detail about the risks associated with the legalization of physician-assisted dying. In its view, there are many possible sources of error... Essentially...there is no reliable way to identify those who are vulnerable and those who are not. As a result, it says, a blanket prohibition is necessary.

I emphasize this:

The evidence accepted by the trial judge does not support Canada’s argument...The trial judge found that it was feasible for properly qualified and experienced physicians to reliably assess patient competence and voluntariness, and that coercion, undue influence, and ambivalence could all be reliably assessed as part of that process....As to the risk to vulnerable populations (such as the elderly and disabled), the trial judge found that there was no evidence from permissive jurisdictions that people with disabilities are at heightened risk of accessing physician-assisted dying....no evidence of inordinate impact on socially vulnerable populations in the permissive jurisdictions...no compelling evidence that a permissive regime in Canada would result in a “practical slippery slope”. accepted by the trial judge does not support [this] argument.

That was the conclusion of the Supreme Court after considering the evidence and arguments raised in Carter, the very same evidence and arguments that were advanced at the joint House and Senate committee, which I was honoured to serve on, and at the justice committee just last week. After considering that evidence and those arguments, the court issued its ruling in Carter, establishing the right to choose medical assistance in dying for everyone inside a carefully measured circle of eligibility.

Quite simply, there was a large circle of eligibility. The government has chosen within that circle to define a smaller class. It simply cannot do that if we believe in the rule of law, if we believe in the fact that the Supreme Court should be listened to in this case.

In conclusion, I simply cannot support moving any further with a bill that would revoke from an entire class of competent adult Canadians rights granted to it by the Supreme Court of Canada.

Motions in amendmentCriminal CodeGovernment Orders

May 17th, 2016 / 3:50 p.m.
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NDP

Murray Rankin NDP Victoria, BC

Madam Speaker, it was a pleasure to be in the riding of my colleague and friend from Edmonton Strathcona to talk about this with hundreds of passionate Canadians who were, frankly, surprised there was no willingness on the part of the government to consider advance directives in Bill C-14.

Since I spoke in Edmonton, I ended up moving that there be amendments specifically to provide that kind of advance requests, as so many witnesses had proposed. However, every Liberal on the committee voted against that change.

I think Canadians are demanding it. I get more letters and calls about this issue than any other deficiency in the bill. I hope that the review that is proposed in the legislation will eventually take us there, because I know Canadians are demanding it.

Motions in amendmentCriminal CodeGovernment Orders

May 17th, 2016 / 4:10 p.m.
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Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, it is a privilege to speak to Bill C-14 at report stage.

I have brought forward three amendments, two of which are related. Motions Nos. 4 and 9 on the Order Paper relate to requiring someone with an underlying mental health condition to undertake a psychiatric assessment to determine capacity to consent. Motion No. 14 on the Order Paper deals with conscience protections, ensuring that the conscience rights of health professionals and health care institutions are respected. I will get into a little more detail momentarily with regard to those amendments.

Let me just say at the outset that however short or long my parliamentary tenure proves to be, Bill C-14, I have little doubt, will be one of the most important votes that I cast. I believe that is true for all hon. members in this House, because we are talking about a bill that will impact the lives of Canadians not just for years to come, but likely decades to come.

Having regard for the gravity of the decision before us, I have spent a lot of time reflecting on what is the right thing to do. At the present time, I am still reflecting.

One of the shortcomings of Bill C-14 at second reading was the absence of conscience protections. I am pleased that now that the legislation has gone through committee, there has been movement in the right direction when it comes to protecting conscience rights of health care professionals. More specifically, Bill C-14 provides that no individual is obliged to provide, or assist in providing, physician-assisted dying. In addition to that, the preamble has been amended to expressly recognize section 2, freedom of religion and freedom of conscience under the charter.

I want to thank the hon. member for Victoria for his leadership in moving those amendments at committee in close co-operation with me, as well as the hon. member for West Nova. I would be remiss if I did not acknowledge the hon. member for Mount Royal for his hard work and the collaborative approach he took as chair of the justice committee, which resulted in an important improvement in the legislation.

With respect, I believe there is still work to do when it comes to conscience protections. I believe it is important that not only health care professionals but also health care institutions have their charter rights and appropriate conscience protections in place. That is what my amendment would seek to do to ensure that everyone's charter rights are respected.

I would note that Madam Justice McLachlin and Mr. Justice Moldaver at paragraph 94 of the Loyola decision recognized that the individual and collective aspects of section 2 charter rights are intertwined.

With respect to the other two amendments I have brought forward, one of the concerns I have is the fact that in the legislation any two physicians or any two nurse practitioners can determine whether or not a patient satisfies the criteria for physician-assisted dying.

The problem with that is that not every physician and not every nurse practitioner has the training and experience to determine capacity to consent when an underlying mental health challenge is present in a patient.

The clear evidence before the special joint committee of which I was a vice-chair, as well as the justice committee of which I am a member, was that someone with more specialized training, namely a psychiatrist, is required to undertake what is, quite frankly, a complex analysis in many cases.

My amendment would simply provide that anyone who has an underlying mental health challenge be referred to a psychiatrist for a psychiatric assessment to determine his or her capacity to consent. It is a simple amendment. It is a straightforward amendment. It is a much needed amendment. We simply cannot allow people with mental illness to fall through the cracks. We cannot allow that to happen as parliamentarians. One way we can mitigate that from happening is to pass this very important amendment.

When I look at Bill C-14 in its totality, I see a bill that contains many important safeguards. Those safeguards ought not to be minimized or dismissed. They are there; they are real, and they are serious. At the same time, the bill falls short when it comes to protecting the most vulnerable of the vulnerable, namely, people with mental illness. I see a bill that moves in the right direction when it comes to protecting conscience rights of health professionals, but still falls short when it comes to health care institutions.

Bill C-14 is an imperfect bill. It is not a bad bill, but it is a bill that I believe can be improved upon. As I reflect, I must ask myself whether I support an imperfect bill or do I vote against an imperfect bill having regard for the consequences that would follow in the absence of legislation being cast when the expiration of the declaration on the stay of constitutional invalidity is June 6.

In closing, I will continue to reflect. I am hopeful that some of the gaps in Bill C-14 can be closed. I am hopeful that all hon. members on all sides of the House can work together collaboratively and in a spirit of good faith to try to do the best we can to make this bill the best that it can possibly be in the circumstances. We owe it to patients. We owe it to physicians and health professionals. We owe it to the vulnerable. Most importantly, we owe it to Canadians.

Motions in amendmentCriminal CodeGovernment Orders

May 17th, 2016 / 4:40 p.m.
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Green

Elizabeth May Green Saanich—Gulf Islands, BC

Madam Speaker, it is an honour to be able to rise at report stage. I appreciate the decision of the Speaker to recognize that, if there was ever a time for exceptional circumstances and exceptions under our Standing Order 76.1(5), this is such an occasion.

The use of the exceptional circumstances here is to allow a real opportunity at report stage to improve the bill. This is not a fake debate about amendments that have no hope. It is my profound hope that the amendments before the House now as we debate this at report stage, with a free vote, with every member allowed to weigh in, can yet improve this legislation to the point where the vast majority of us will be comfortable voting for it with amendments. As it is right now, I do not know if this bill could pass this House in its current state.

Let me just go back for a moment, for context. I do think context and empathy are important on all sides of the House. Bill C-14 is the direct result of the Supreme Court of Canada's unanimous decision in February 2015 to accept that certain provisions of the Criminal Code violate the Charter of Rights and Freedoms insofar as they affect people who are suffering from grievous and irremediable medical conditions, and wish to have the right to choose their own time and way of dying. As the court wrote at the time, “an individual's choice about the end of her life is entitled to respect”.

In my time in Parliament, there has not been a bill that is more difficult to talk about, that touches more on aspects of our own personal principles, faith, beliefs, rights, and politics, all wrapped up in a charter decision. It has been difficult to talk about, but I think it has been approached on all sides with appropriate respect. As my colleague just mentioned, the chair of the justice committee, the hon. member for Mount Royal, did an exceptional job in steering through the many amendments that were reviewed in committee. However, not enough of those amendments were accepted to make the bill acceptable.

Let me go through why I do not think I can vote for the bill without amendments. It is not about what I think; it is not about whether I think the bill is satisfactory. I think everyone on all sides of the House, including government members, admit that it is flawed. It is not quite what one would want, compared to, for instance, the exceptional report of the committee that guided the government, the joint committee report of the House and Senate on how to respond to the Carter decision. This bill falls short.

That is not the basis on which I cannot vote for it now. It is not my opinions. Our challenge as parliamentarians is to ensure that whatever we pass meets the standard set out for us by the Supreme Court of Canada in assessing what it was about the status quo that made the situation for Kay Carter one that was not merely unfair but a violation of her charter rights.

That is the key question here. There is a level of provision for medically assisted dying below which government legislation cannot sink. That bar, that line, is charter rights, as set out by the Supreme Court of Canada.

I wanted to comment and focus a bit on this question, as set by the court, of an individual's choice about the end of her life being entitled to respect. I suppose we could wish that the court now used the female pronoun and intended it generically, as we have heard the male pronoun used generically throughout our lives.

However, I think it can be inferred that the Supreme Court of Canada, using the female pronoun, is talking about the plaintiff before them. It is talking about Kay Carter. Would Kay Carter have access, under Bill C-14, to medically assisted dying? Most observers whom I have heard at this point, knowledgeable observers, do not believe she would.

That, to me, is the crux of the debate, which means that her charter rights would still be infringed, even after we passed Bill C-14 as it is currently written.

This is why. Kay Carter was not about to die from her illness. She had a spinal stenosis that would not kill her. I want to refer to specifically the way Jocelyn Downie, professor of both law and medicine at Dalhousie University, described it that in her view Bill C-14 is unconstitutional. I want to read an excerpt from Professor Downie:

There was no evidence on the record before the court that Kay Carter's death was reasonably foreseeable in any temporally proximate way. In fact, it was just the opposite.

To pick one of many possible examples from the evidence before the court, as Kay Carter wrote in her letter to the Dignitas clinic in Forch, Switzerland:

The neurologist, Dr. Cameron of North Vancouver, assessed me and I had a CAT scan and MRI done. From these tests he told me that I had an ongoing, slow deterioration of the nerves that would never kill me but eventually would reduce me to lie flat in a bed and never move.

In other words, Kay Carter would not fit the definition within the bill that the requirement to be grievous and irremediably affected in a condition that would allow medically assisted death would be a death that was reasonably foreseeable. That clearly suggests, although the language is somewhat vague, that Bill C-14 requires that a person, to be grievous and irremediable within the meaning of the act to access medically assisted dying, has to be in a terminal state.

The court in its unanimous decision may have left some ambiguity for those who were hoping to find a loophole, but I do not think it is there, with the facts of the case right in front of them, Kay Carter, who was not in a terminal state. Beyond that—and this is where I have sympathies for the current government—the Supreme Court gave a year from the day of the decision in February 2015, but the Minister of Justice was not sworn in until November 4. The Prime Minister was not sworn in until November 4. The time limits imposed on the new Liberal government are not of its making, and I am clearly sympathetic.

I opposed at the time going to the court to ask for an extension because deadlines such as this, given the effect of the court's decision rendering those Criminal Code sections unconstitutional, will not create chaos or a situation that cannot be managed.

However, to go back to that moment when the Government of Canada went to the Supreme Court to obtain an extension, in this excerpt Madam Justice Karakatsanis says clearly in questioning one of the counsel: “I'm thinking particularly about somebody has to be a la fin de vie whereas in Carter we rejected terminally ill”.

Let me put it again clearly. A Supreme Court of Canada justice says that in Carter we rejected terminally ill. That is clearly the standard for ensuring that rights are protected: that we must not ensure that in order to access medically assisted death the person be on the verge of death, that their death be reasonably foreseeable, even if we take reasonably foreseeable back to a year or two years. Kay Carter did not have that circumstance.

Another medical expert who has written about Bill C-14 since it came forward, Professor Jesse Pewarchuk, who is a clinical assistant professor of medicine at the University of British Columbia, wrote:

Worse, the wording of the proposed law introduces significant doubt as to whether an Alzheimer’s patient who has yet to lose capacity (yet is certain to) would even be eligible, since death can take years, even from the point of entering long-term nursing care.

“Foreseeable death” and “advanced state of decline in capability” are loaded, ambiguous clauses that seem to eliminate the Charter rights of dementia patients...and to put any physician carrying out their wishes in considerable legal peril.

Without these amendments passing at report stage, I cannot vote for Bill C-14. In an ideal world, I would rather there were a framework of laws for doctors to follow, for nurse practitioners to follow—a framework, consent, reforms, and the witnesses and the independence and the elements of law. However, if these amendments are not passed, I cannot vote for a law that falls below the bar of what the Supreme Court says constitutes protection of charter rights.

Motions in amendmentCriminal CodeGovernment Orders

May 17th, 2016 / 4:55 p.m.
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Green

Elizabeth May Green Saanich—Gulf Islands, BC

Madam Speaker, if I were standing alone, saying that I thought it was unconstitutional, I would be arrogant, at the least. However, Joe Arvay, who was the counsel for Kay Carter, the British Columbia Civil Liberties Association, the co-plaintiff in the case with Kay Carter, and so many of those who have studied this might rely on section 1, but I think that is a faint hope.

The Supreme Court, in making the decision it made, that there was a violation of Kay Carter's charter rights, took into account her entire condition.

There will be a challenge to Bill C-14. It will very likely be found to not be charter-compliant, and it falls far short of the expectations of Canadians.

I did not have time in my 10-minute speech to speak to something I spoke to at second reading, which is another disappointment that I have with the bill; that is, the failure to allow for advance directives.

Patients across Canada, people who are suffering, have a right to expect that this Parliament will, at least, reflect what the Supreme Court did in its decision.

Motions in amendmentCriminal CodeGovernment Orders

May 17th, 2016 / 4:55 p.m.
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Green

Elizabeth May Green Saanich—Gulf Islands, BC

Madam Speaker, my friend, the hon. member for Kitchener—Conestoga, and I have had occasion to speak outside the chamber about this matter. I have met with a very impressive doctor of palliative medicine who raised the issue that there could be an interference, which I had not understood,.

I am comfortable to support Bill C-14, with the amendments, so I need to bracket my comment this way. I do think it is important that no patient fear going to a doctor, for a misplaced fear. It is not something that the bill brings forward, but the palliative care doctor said that, from his point of view, he did not want his facility to provide this service for fear that those who went through those doors might have any concern that they might be medically assisted in something to which they did not consent.

I see, under this law and under our society, no prospect of that ever happening, because the sanctions would be severe. However, I do understand the issue, now, which I had not when he first put the question to me.

Motions in amendmentCriminal CodeGovernment Orders

May 17th, 2016 / 4:55 p.m.
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Charlottetown P.E.I.

Liberal

Sean Casey LiberalParliamentary Secretary to the Minister of Justice and Attorney General of Canada

Madam Speaker, I am pleased to voice my support for Bill C-14, significant legislation that would become Canada's first national medical assistance in dying regime, and would provide a thoughtful and well-considered response to the Supreme Court of Canada's decision in Carter.

I would first like to acknowledge the remarkable work of the members of the House of Commons Standing Committee on Justice and Human Rights who studied Bill C-14 under some very tight time constraints and who nonetheless were able to significantly enrich our reflection and debate on this highly complex and personal issue. This is certainly a matter on which everyone's point of view deserves the utmost respect and consideration. All justice committee members have unquestionably demonstrated these qualities in the course of their work.

Allow me to highlight some areas where the work of the justice committee has been particularly helpful.

Many stakeholders who appeared before the committee, in particular organizations representing medical professionals, expressed a great deal of concern about conscience protections for medical providers. Bill C-14, as a criminal law measure, would create exemptions from conduct that would otherwise be criminal and therefore would not compel anyone to provide medical assistance in dying in any way. However, some stakeholders urged the committee to add a specific clause that would clearly reflect, for greater certainty, their conscience rights as protected under the charter.

On the other hand, other stakeholders such as the Barreau du Québec and Quebec health lawyer Jean-Pierre Ménard affirmed the position previously expressed by the Minister of Justice that the conscience rights of health care providers were matters that fall under the purview of the provinces and territories as well as under the responsibility of medical regulatory bodies, which themselves are provincially regulated.

I am pleased to say that the justice committee carefully listened to submissions from all sides of the debate and that a motion was tabled to address this significant concern within the limits of our constitutional framework. Bill C-14 was amended in order to give a greater sense of comfort to medical professionals that nothing in Bill C-14 would compel individuals to act against their deeply held beliefs.

The justice committee should also be commended for working in a non-partisan way to make improvements to the proposed legislation. For instance, the committee amended the bill to clarify that where persons signed a written request on behalf of a patient who cannot write, they could only do so at the patient's express direction. The committee members also amended the bill to clarify that for the sake of professionals who provided counselling services, giving someone information about medical assistance in dying would not be criminally prohibited.

Although these amendments and several others do not fundamentally change the scope of Bill C-14, they should increase the level of comfort for Canadians, including health care providers and other professionals who may be involved. I applaud the committee for all of its efforts.

We have heard countless times how challenging the issue of medical assistance in dying is and how Canadians and organizations hold divergent views that are informed by strongly held beliefs. I think we can all agree that this tension was most apparent during the debate over who should be eligible for medical assistance in dying in our country.

Just as it was the case before the Special Joint Committee on Physician-Assisted Dying, the justice committee also heard a wide range of views on eligibility and on what was required to respond to the Carter ruling.

At one end of the spectrum, some stakeholders continue to oppose legalization of any form of medical assistance in dying, as is still the case in most countries around the world, or they propose that it be significantly narrowed.

At the other end of the spectrum, some argue that Bill C-14 does not go far enough and urge Parliament to adopt one of the broadest regimes in the world, similar to ones that exist in only three European countries. They maintain that the eligibility criteria in Bill C-14 are too narrow and they should also include mature minors, people suffering solely from a mental illness, and those who have lost their capacity to consent to die, but who have made an advance request for medical assistance in dying.

Somewhere in the middle of that spectrum, though, lies a group of stakeholders who have expressed strong support for Bill C-14 and who recognize that the bill's cautious and balanced approach is imminently justifiable, including the commitment to explore broader eligibility issues in the near future.

Among that group is the Canadian Medical Association, which speaks on behalf of 83,000 physicians across Canada and which supports the adoption of Bill C-14 as it was drafted, and without amendments.

In contrast with those who argue that the Supreme Court's language of grievous and irremediable medical condition is clear and preferable, the Canadian Medical Association takes quite a different position. It says that the criteria in Bill C-14, including the requirement that death be reasonably foreseeable, provides sufficient direction to physicians and is a great improvement from the court's language, which it considers to be vague and unworkable from a medical standpoint.

Similarly, the Canadian Nurses Association, a federation of 11 provincial and territorial nursing associations and colleges, representing nearly 139,000 registered nurses across Canada, has said publicly that its priority is having the bill passed before the June 6 deadline expires. Further, its CEO, Anne Sutherland Boal, stated just yesterday that the successful passing of the bill would be both compassionate and protective to patients, families, and care providers, while emphasizing that the legislative safeguards in the bill would work to protect the most vulnerable Canadians.

Although lawyers and legal academics continue to argue with each other over whether or not the court's language, or the language in Bill C-14, provides sufficient clarity, how can we as parliamentarians discount the views of medical practitioners? The Supreme Court expressed confidence in Canada's physicians to respond to Canadians who wished to access medical assistance in dying, and that confidence is well-placed.

We as parliamentarians must also have confidence in medical practitioners. They will be the ones facing these difficult life and death decisions with their patients and assessing their eligibility. For them, it is not a philosophical or theoretical exercise. They will be applying the very measures in Bill C-14 in their daily practice. Their views must be given significant weight.

National disability rights organizations and others have also supported the approach to eligibility proposed by Bill C-14 as a meaningful safeguard to protect individuals who might be vulnerable in the framework of a medical assistance in dying regime, as a result of societal discrimination, loneliness, or lack of social supports, for example.

On the question of safeguards, the same dynamic has been at play. Some stakeholders expressed support for the measures proposed in Bill C-14, while at the same time seeking to put in place additional safeguards to protect the vulnerable, such as prior judicial authorization. Others, wanting to facilitate broader access, have sought to remove some safeguards, such as the reflection period.

While we respect those who feel that the proposed safeguards are either inadequate or overly burdensome, I believe the safeguards in Bill C-14, taken together, are consistent with many of those found in regimes around the world. Just as the court in Carter was persuaded that the risks to vulnerable Canadians could be adequately managed under a regime with robust safeguards, I am confident the safeguards in Bill C-14 would guard against abuse and error.

Last, I would like to remind all members that Bill C-14, or the provision of medically-assisted dying, is not intended to be, or to become, the response to all forms of intolerable suffering. The bill is a thoughtful response to Carter, which recognized the autonomy of those suffering on a path toward death to die peacefully at the time of their choosing and therefore to avoid a prolonged, painful, and undignified death, or one that is inconsistent with their values. Bill C-14 acknowledges the autonomy of such persons to make important end-of-life health care decisions, while also balancing the equally important societal objectives of affirming the value of the lives of all Canadians, preventing suicide, and protecting the most vulnerable in our society.

I believe this legislation respects all interests at stake, and is one of which Canadians can be proud. For all these reasons, I urge all members of the House to support Bill C-14.

Motions in amendmentCriminal CodeGovernment Orders

May 17th, 2016 / 5:10 p.m.
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Liberal

Sean Casey Liberal Charlottetown, PE

Madam Speaker, there is no question that not all individual members in the Canadian Medical Association are of one voice. The voice of the medical profession has spoken clearly and loudly in support of the legislation. Indeed, there are individual members and groups of doctors who do not feel the same way, one of whom was referred to by the hon. member.

The other point that I would add is this. If we are left without legislation on June 6, it is doctors like the one the hon. member quoted who will be left without a law, without eligibility criteria, and without the present system of applying to a court for an exemption, something that will only exist until June 6. There will be a great deal of uncertainty if no law is passed. That I think will leave doctors in a situation where they will be extremely reluctant to accede to a patient's request for medical assistance in dying without the certainty that is provided in Bill C-14, as flawed as it may be.

Motions in amendmentCriminal CodeGovernment Orders

May 17th, 2016 / 5:10 p.m.
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Liberal

John Oliver Liberal Oakville, ON

Madam Speaker, I am thankful for the opportunity to join the debate today on Bill C-14, which addresses medical assistance in dying. I would like to acknowledge the incredible respect and thoughtfulness expressed by members in this very delicate debate.

Before I begin, I would like to acknowledge the advice and insights I received from a former colleague, Dr. Lorne Martin, chief of staff at Halton Healthcare, on the medical ethics and physician perspectives that would be created by the legislation.

The bill has generated significant debate and feedback from my riding of Oakville, both from people who wrote or contacted me on their own initiative, as well as those who responded to the forums that were created to solicit feedback through local media and my interactive website, johnoliver.mp. I have read and carefully considered the many views and concerns that came from residents of Oakville and I would like to address those that are relevant to the act and the amendments proposed.

The community responses can be grouped into five categories. The first is from those who are opposed to any form of medically assisted death and want the law to respect and protect every human life from conception to natural death. These are individuals who put forward the principle that we must not take another's life. There were many submissions of this nature.

For people who hold these values, I believe it is important, once again, at this stage, to understand that the Supreme Court of Canada's unanimous decision in the Carter case was a declaration that the Criminal Code prohibitions on assisted dying were not in accordance with the Charter of Rights and Freedoms. Effective June 6, 2016, medically assisted death is legal in Canada whether the bill is passed or not.

Therefore, the issue before this legislature is not whether medically assisted death will be allowed. Rather, the issue is whether medically assisted death will be permitted in accordance with the parameters set out by the Carter ruling or under a legislative framework established by elected representatives. Accordingly, our decisions are how to safely implement this new practice, who should be eligible, what safeguards are needed to protect vulnerable individuals, what are the roles and responsibilities of medical professionals, and how do we create a monitoring regime to ensure accountability, transparency, and improvement in this area as we go forward.

The second category of responses from my community were in reaction to the special joint committee recommendations. Many Oakville residents wrote to me expressing their concern that the rights of vulnerable Canadians may be infringed upon as we protect the rights of those seeking autonomy in their end-of-life decisions. Specific concerns were raised in relation to including Canadians with psychiatric conditions, psychological suffering, and minors.

Bill C-14 and the proposed amendments are more restrictive than both the Carter decision and the committee recommendations, in part, for the reasons raised by these constituents. To protect the rights of the more vulnerable, the bill has not included these broader situations or circumstances in the eligibility criteria, thereby addressing the concerns raised by these residents.

The third category of responses were diametrically opposed to those previously stated. These residents spoke in favour of the Supreme Court decision and about their belief that the Charter of Rights and Freedoms should allow autonomy to the individual in end-of-life decisions. Several accompanied their statements with personal stories of difficult end-of-life experiences for loved ones or worries about their own unique circumstances.

They also expressed concerns that Bill C-14 is too restrictive and does not address all the circumstances that should be considered eligible under the act. In particular, the clause requiring that natural death be reasonably foreseeable was felt to exclude many Canadians that they felt should be allowed.

In addition, there were concerns raised about denying advance directives. Denying advance directives puts people who suffer from degenerative illnesses that will eventually affect their competency in the position of having to exercise their right to an end-of-life decision in advance of losing competency.

The fourth category of concerns surrounded the rights of medical practitioners and institutions to ensure that they would be able to have freedom of conscience and religion to decide whether to participate in a medically assisted death. Bill C-14 would not compel participation by health care providers and I feel it is sufficient.

The final category of responses were fewer in number, but supported the position put forward by Bill C-14 as a reasonable starting point to address the complex and competing values and rights created by the Carter decision.

Having now spent considerable time in understanding and researching the issues raised by my constituents, and after careful consideration and personal reflection, I will be supporting Bill C-14 as reported by the committee for the following reasons.

I committed upon entering the past election and during my campaign to uphold the Canadian Charter of Rights and Freedoms. The Supreme Court ruling clearly found that the existing laws were not compliant with charter rights and freedoms and denied autonomy to a person seeking to end his or her life who clearly consents to the termination of life, and has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual. It is therefore morally incumbent, I believe, on this legislature to put legislation in place to protect this right and freedom, and I support that direction as carried out in the act.

We face, as a legislative body, the difficult task of balancing the competing social and moral values and interests surrounding this direction. For me, the protection of the vulnerable who may be individually or collectively disrespected or coerced to choose a premature death in the face of a too-permissive regime of assistance in dying must be balanced against those suffering from grievous and irremediable conditions.

As a first step in understanding the competing social and moral issues and the charter rights and freedoms of different groups, I believe Bill C-14, while not perfect, is an acceptable starting position for Canadians.

I would have preferred that Bill C-14 was more permissive for those where death is not reasonably foreseeable, and instead, built in protections for those who are vulnerable to the too-permissive language. While the bill's language is open to reasonable interpretation of foreseeable death, it does leave complex legal and ethical decisions with families and medical practitioners that will be open to court challenges and future charter appeals. This will add further stress and suffering to already untenable situations for many.

I do take some comfort from provisions within Bill C-14 to conduct further reviews after five years of eligibility criteria, and from the amendments coming back from the committee to review, after 180 days, other initiatives such as advance directives.

Another factor in my decision to support Bill C-14 is my belief that with properly offered health services, such as palliative care, most Canadians will not opt to use its provisions. Research from other countries suggests that most people prefer to enter into a palliative care program and experience natural death. While palliative care is not always a substitute for medically assisted death, it would be unacceptable to have people choosing medically assisted death as a result of inadequate palliative care services. I believe we can do more to ensure that palliative care programs are available and accessible across Canada, as proposed in some of the amendments.

The work of the Minister of Health in negotiating a new health accord agreement with the provinces and territories is fundamental to achieving these services, and I fully support her diligent efforts to achieve a new accord and ensure that all Canadians have access to high-quality sustainable care.

In discussion with doctors and other health care workers, there is general support and agreement with the bill, particularly the freedom given to caregivers to choose to participate in assisted death based on their own conscience and religious beliefs. I support the freedom that is put forward in the bill and do not feel an amendment is required.

Physicians today are already involved in substantive decisions regarding end of life, working with families or in accordance with advance directives. They often provide key clinical advice in the decision to end life support or to apply do not resuscitate orders. However, asking physicians to interpret and execute advance directives to end a life is ethically more challenging and places significant onus on them as individuals, particularly in hospital environments where they do not know the person or where there is not a family to consult.

Finally, my decision to support the bill arises from personal experiences and the loss of a loved family member who, as she requested, passed away at home in the presence of family. The final days of her life were marked with pain and suffering, which we were able to somewhat alleviate through oral morphine.

However it is allowed, appropriate care at the end of life needs to be available to people when required. I want my family members, fellow Oakvillians, and fellow Canadians to have autonomy in making end-of-life decisions as they have enjoyed autonomy in all of the major decisions in their lives.

I will be supporting Bill C-14 , and I urge all members of the House to support this important bill.

Motions in amendmentCriminal CodeGovernment Orders

May 17th, 2016 / 5:20 p.m.
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Liberal

Dominic LeBlanc Liberal Beauséjour, NB

Madam Speaker, I hope you will find unanimous consent for the following motion, which I will read slowly so that colleagues understand exactly what I am proposing, that notwithstanding any standing order or usual practice of the House, the House shall continue to sit beyond the hour of daily adjournment for the purpose of considering Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying), at report stage, and when no member rises to speak or at midnight on that sitting day, whichever is earlier, the debate shall be deemed adjourned and the House deemed adjourned until the next sitting day.

Report StageCriminal CodeGovernment Orders

May 17th, 2016 / 5:25 p.m.
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Liberal

John Oliver Liberal Oakville, ON

Mr. Speaker, I think it is very important to state again that palliative care is not a substitute in all cases for end-of-life decisions as contemplated by Bill C-14. However, it is important that there is an effective health accord that is negotiated with the provinces and territories by the Minister of Health, which will take some time to ensure that there is consistent and uniform high-quality services available across Canada. I think those are the first initiatives that need to take place. However, monitoring and evaluating the effectiveness of the palliative care programs can come as we begin to get them in place.

Report StageCriminal CodeGovernment Orders

May 17th, 2016 / 5:25 p.m.
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NDP

Wayne Stetski NDP Kootenay—Columbia, BC

Mr. Speaker, I, too, really appreciate the depth of the discussion that we have had around Bill C-14.

The recommendations that came from the original interparliamentary committee, I thought, were excellent, and I was very supportive of the potential bill at that point. However, I have some real issues with the way the bill currently sits, and I want to focus on two.

Do advance directives not give people more choice in that they at least have the opportunity to do an advance directive rather than wait until they are no longer in a state where they could make a decision at all? Does it not provide more choice to have advance directives?

Secondly, intolerable pain and suffering was a really important part of the Carter decision, and I think should be an important part of the bill. Again, I know personally that if I had a choice later on in life, if I was struggling with intolerable pain and suffering, I would really like to go with a needle in my hand in the arms of somebody who loves me rather than just put it to chance.

Those two provisions are missing from the bill and I would appreciate the member's perspective on why.

Report StageCriminal CodeGovernment Orders

May 17th, 2016 / 5:30 p.m.
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Liberal

John Oliver Liberal Oakville, ON

Mr. Speaker, I never once suggested that it would be reflective of a failure of the palliative care system. In meeting the needs of Canadians at the end of life, an array of services and professional support are required. Palliative care is part of that, as are the provisions of Bill C-14, in an act of end of life if required.

With respect to natural death and palliative care, people are supported through it. Generally, pain is well managed, and many people opt for natural death, particularly when properly supported with palliative care. However, there will be circumstances where pain cannot be managed or where the loss of autonomy is so dramatic that the palliative care model is insufficient. We need to have the provisions of Bill C-14 available to assist people who wish to end their life as they approach the end of their life.

Report StageCriminal CodeGovernment Orders

May 17th, 2016 / 5:30 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, it is a great honour to rise to speak at report stage of Bill C-14.

As I stated earlier in this House, it is unfortunate that the Supreme Court of Canada has taken it upon itself to force legislation to be written, which overturns thousands of years of our understanding of the intrinsic value and dignity of every human life.

The Supreme Court has done this, completely rejecting the fact that elected members of this House have rejected initiatives to legalize physician-assisted suicide on at least 15 occasions since 1991. Most recently, a bill to allow physician-assisted suicide was rejected in 2010 by a vote of 59 to 226.

It is not only that nine unelected judges have inserted themselves into a national conversation that should be initiated in this House of Commons, they have even lamented the fact that an extension was sought to give parliamentarians more time to properly study, discuss, and debate this issue of exceptional importance.

In their judgment of January 15, 2016, in granting an extension, the Supreme Court stated, “That the legislative process needs more time is regrettable, but it does not undermine the point that it is the best way to address this issue.”

Really? It is regrettable? It is regrettable to take more time to think soberly through this complex issue, to implement such momentous change, to destroy the very foundations of medicine, to turn upside down the time-honoured belief that it is fundamentally wrong to kill another human being, and all in the name of compassion?

In regard to the impatience on the part of the Supreme Court, Warren Perley wrote, in Beststory:

Common sense dictates that such momentous changes to the law governing assisted suicide should be based on the compass rather than the clock. Until this point, Canadians have never had access to legally assisted suicide. Instead they have relied on doctors and nurses to administer palliative care, which must include adequate pain management and, in rare cases, palliative sedation. Pro-euthanasia advocates argue this is euthanasia, but they are in error.

Changing laws in matters of such substantive and exceptional significance as assisted suicide should be made by the compass. I could not agree more. Unfortunately, we have thrown away our compass. We no longer need a compass. We now just pool our collective ignorance and decide on the basis of popular opinion to sail off in any direction that suits the winds of the day, rudderless.

One of Canada's indigenous leaders, Mr. Francois Paulette, a Dene leader and chair of Yellowknife's Stanton Territorial Health Authority states that indigenous people are bound by spiritual law, not man-made law. He goes on to state, “We don't play God.... God is responsible for bringing us into this world, and taking our life. It is pretty straightforward.”

Whether as a member of the indigenous community or not, for all Canadians, the crux of the issue before us today, and the source of the conflict and confusion, is the fact that the preamble of our Charter of Rights and Freedoms on one hand, and Bill C-14 on the other, are built on two opposite pillars: one made of gold, and the other of styrofoam.

The preamble of the charter starts out “recognize the supremacy of God and the rule of law”. Yes, there is a compass. Yes, there is a North Star. Even our Canadian charter states that in Canada we do recognize this North Star, the supremacy of God.

Yet if we look at the very first paragraph of Bill C-14, we see a totally opposite starting point. Rather than the “supremacy of God”, we see “autonomy of persons”.

My contention is that these two opposite philosophies cannot coexist at the same time, if we are to continue to have true freedom and trust in our society. We may deny God, and man as his image bearer. We can try to kill both God, and man as man. We may press forward in a suicidal course, but it always ends in pure vanity, for we are surrounded inside and out by the reality of God and his order in every sphere of life.

We all know that there are necessary limits placed on the autonomy of humans. Yet on an issue as monumental as the issue of life and death, we are considering extending autonomy without stopping to think what such autonomy might do to our understanding of the value of human life.

Does this autonomy serve well those among us who, for dozens of reasons, find themselves vulnerable, voiceless, and open to abuse in the most extreme and final way possible, an unwanted hastened death?

The very fact that I can drive from my riding of Kitchener—Conestoga to Ottawa each Sunday evening is because the autonomy of all drivers is limited. Drivers heading to Kitchener occupy the north side of the 401 highway as they travel west, so I am free to travel unimpeded on my easterly journey in the southern lanes.

To allow autonomy in many situations in life is foolhardy, to say the least. Our freedom and trust is enhanced by strict limits on personal autonomy for the greater good of community. We could list many such restrictions on personal autonomy: quarantines for highly infectious diseases, such as ebola; prohibition of using highly toxic chemicals and pesticides on private property; the limitation on raising farm animals in the residential area of a city. In these cases and dozens of others, we recognize that the greater community good supercedes individual autonomy.

To retain limits on personal autonomy in the case of physician-assisted suicide is for the greater good of society. To remove the restriction on personal autonomy could very well lead to the crumbling boundaries that our Liberal colleague, the member for Winnipeg Centre, referenced a few weeks ago in the Chamber when he said, “We are in a sorry state. We have truly entered a new age, one of the throwaway culture where all boundaries are starting to crumble”.

I fear for the kind of Canada I will leave for my children and grandchildren if we rush blindly ahead with an endorsement of physician-assisted suicide. The risk to society is too great. The dangers are far too real.

There is no doubt that in spite of our best efforts to place so-called safeguards to protect the vulnerable among us, there will be situations where innocent Canadians will be killed without their expressed consent. There is no doubt in my mind that in spite of our best efforts to spin the difference between suicide and what we are now calling medical assistance in dying, there would be a correlating increase in suicide rates in Canada.

Aaron Kheriaty, associate professor of psychiatry, and director of the medical ethics program at the University of California at Irvine School of Medicine states:

The debate over doctor-assisted suicide is often framed as a personal issue of autonomy and privacy. Proponents argue that assisted suicide should be legalized because it affects only those individuals who--assuming they are of sound mind--are making a rational and deliberate choice to end their lives. But presenting the issue in this way ignores the wider social consequences.

What if it turns out that individuals who make this choice in fact are influencing the actions of those who follow?

He goes on to report that in states where physician-assisted suicide has been legalized, there has been an increase in suicide of 6.3% overall, but among those over 65, an increase of 14.5%.

He continues:

The results should not surprise anyone familiar with the literature on the social contagion effects of suicidal behavior. You don't discourage suicide by assisting suicide. [...]

Aside from publicized cases, there is evidence that suicidal behavior tends to spread person to person through social networks, up to three “degrees of separation” away. So my decision to take my own life would affect not just my friends' risk of doing the same, but even my friends' friends' friends. No person is an island.

Finally, it is widely acknowledged that the law is a teacher. Laws shape the ethos of a culture by affecting cultural attitudes toward certain behaviors and influencing moral norms. Laws permitting physician-assisted suicide send a message that, under especially difficult circumstances, some lives are not worth living – and that suicide is a reasonable or appropriate way out. This is a message that will be heard not just by those with a terminal illness but also by anyone tempted to think he or she cannot go on any longer.

Debates about physician-assisted suicide raise broad questions about societal attitudes toward suicide. Recent research findings on suicide rates press the question: What sort of society do we want to become? Suicide is already a public health crisis. Do we want to legalize a practice that will worsen this crisis?

I believe that life is always to be chosen over what some would call death with dignity. There is nothing dignified about deciding to end someone's life that is not worth living. If the patient has a need, let us address the need. Our goal should be to eliminate the problem, not the patient.

We need to be doing far more to address the needs of vulnerable Canadians. To that end, I have five proposed changes that need to be included in Bill C-14. Four of these have been accepted as amendments by others in the House.

First, the preamble should contain a statement indicating that suicide prevention is an important public policy goal, recognizing the sanctity of life as a societal principle.

Mr. Speaker, I see that I am out of time, so I will try to get my other points in when responding to questions.

Report StageCriminal CodeGovernment Orders

May 17th, 2016 / 5:40 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, that certainly raises a good possibility. To invoke the notwithstanding clause would in fact give Parliament the kind of time that we need to study this important issue.

The rush with which the government has moved forward on an issue of such intense, immense significance is really inappropriate. We saw in the joint committee a lack of ability to get many witnesses in. We saw the same thing in the justice committee. Today we have seen a number of examples where we wasted hours on quickly moving other bills forward on the agenda when we, as members, were informed that today, beginning at 10 o'clock this morning, we would begin to discuss Bill C-14.

We have not had enough time to discuss this issue and it is of too great a significance for us to allow this to proceed in its current form.

National Maternity Assistance Program Strategy ActPrivate Members' Business

May 17th, 2016 / 6:05 p.m.
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Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

Mr. Speaker, I want to say from the outset that we support this private member's bill. We think this bill is important. We certainly would not describe this bill as coming in by the back door. This bill was introduced by a member of Parliament who was duly elected by his constituents. He came in here through the front door. We are pleased to welcome this bill through the front door, even though it is a private member's bill. To us there is no distinction to be made, contrary to what other colleagues may have said in the past. Private members' bills are important, and I like to reiterate that every chance I get.

On those fine words, we are in favour of this bill. I want to acknowledge the very positive way in which it was introduced. We have here a newly elected member of Parliament, much like myself, who took over from his predecessor in Kingston and the Islands and was privy to a situation that a person shared with him in his riding office.

People watching us on television think that parliamentarians argue all day long. That is simply not true. What we do here in the House is just one part of our work as MPs, because we work a lot in our ridings. In fact we spend more than half our time there. When we meet with Canadians, talk to them, and listen to them, we grasp the essence of our work. That is exactly what happened to the member for Kingston and the Islands. He met in his office with a constituent who had a concern, then he presented the concern here in the House by the front door and not the back door, and that is a good thing.

What is the bill about? The bill would let a woman take preventive leave and receive maternity benefits if her job could have a negative impact on her pregnancy. We must understand that this type of situation is becoming increasingly common. When I say that, I am not being negative, but constructive. That is today's reality.

A few decades ago we could not imagine there would be female welders, such as our colleague's constituent, but today we know that there are no gender-specific jobs. Every job is open to everyone. Men and women alike can do any job there is. However, this leads to situations, in welding for example, where workers are exposed to chemicals or have to do physically demanding work where they have to stand up, bend, stoop, and do other things that might have an impact on a pregnancy. We do not need to be doctors to know that. It is obvious that this is a cause for concern. That is why we are in favour of this bill.

It should be noted that this type of approach, preventive withdrawal, has been around in Quebec for years. I know what I am talking about because my riding is in Quebec.

I would like to share our concerns in that regard. We agree with the principle. I cannot emphasize that enough. We are going to vote in favour of the bill. I just want to reassure everyone of that. However, this bill clearly opens a door that could have significant financial implications. Similar legislation in Quebec has had such implications. I tried to determine exactly how much it costs. That is very difficult because it changes a lot over time. In Quebec, we know that 20% of pregnant women take preventive leave. They may include women who work in hair salons with certain chemicals or nurses who come into contact with sick people, obviously, or chemicals or medical products. They may also include teachers who use chalkboards and other products. We need to be aware that this measure could cost a lot of money. We need to be aware of that. We are talking about 20%, which means that one in five pregnant women in Quebec takes this sort of leave.

Recently, we have been talking a lot about Bill C-14, which, as members know, follows on similar legislation in Quebec. I have been reminded of the Quebec model many times in the past few hours.

To get back to the topic at hand, if the government were to model this system after Quebec's and one out of every five women were to take medical leave, that means 75,000 women would have access to this type of leave. We are not opposed to that. We need to be aware of this reality. However, this could end up costing an additional $245 million. We need to be aware of this. We need to take this into consideration. Either we believe in it or we do not. If we do, we need to do what is necessary.

Since this is a private member's bill that came through the front door, we need to recognize that it cannot have any financial implications. However, this bill could ultimately have some financial implications. We need to keep that in mind.

We completely agree with the other part of the bill, which proposes striking a committee and holding consultations with Canadians. Consultations seems to be a popular word these days. Consultations will help us get to the bottom of this issue, assess the situation, take a look at the Quebec experience, identify what works and what does not work, and learn from what is going on in Quebec, so that we can improve the approach.

I would remind members that we completely agree with the principle. We are cautious about the potential financial implications, and we are open to the discussions and conversations that we, as parliamentarians, need to have with all Canadians on this issue.

We believe in families and we believe that the government should assist families. We support that, but it needs to be done in a positive, constructive manner. We fully recognize that these days, there is no longer such a thing as men's work and women's work. All professions are open to everyone. This is what leads to improvements and enhancements to our laws, regulations and approaches regarding the maternity rights of all Canadian women.

Naturally, we want millions of children to be born here in this big, beautiful country.

Business of the HouseOral Questions

May 12th, 2016 / 3:05 p.m.
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Beauséjour New Brunswick

Liberal

Dominic LeBlanc LiberalLeader of the Government in the House of Commons

Mr. Speaker, this afternoon, we will continue with the Conservative opposition day. Tomorrow will be a further allotted day. Monday, we will begin report stage and third reading stage of Bill C-10 concerning Air Canada until 2 p.m. After question period, we will move on to Bill C-14 concerning medical assistance in dying.

I have had productive and optimistic discussions with my colleague House leaders. I am hopeful and optimistic that we will have an agreement on the handling of the debate at report stage and third reading of Bill C-14 next week.

Provided we are able to complete debate on Bill C-14 next Wednesday, the House will debate an NDP opposition motion on Thursday.

Finally, pursuant to Standing Order 81(4), I would like to designate Monday, May 16, for consideration in a committee of the whole of the main estimates for the Department of National Defence.

Physician-Assisted DyingOral Questions

May 4th, 2016 / 3:05 p.m.
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Bloc

Rhéal Fortin Bloc Rivière-du-Nord, QC

Mr. Speaker, this week the Barreau du Québec submitted a brief to the Standing Committee on Justice and Human Rights that confirms that Bill C-14 on medical assistance in dying does not meet the requirements set out by the Supreme Court in the Carter decision.

I happen to know that there are a few government MPs who are also members of the Barreau du Québec, and I am sure they could confirm the credibility of the representatives from the Barreau for the minister, if necessary.

Will the government, which includes 40 MPs from Quebec, nine of which are members of the Barreau du Québec, amend Bill C-14 to address the gaps outlined by the Barreau du Québec?

Bill C-14—Time Allocation MotionCriminal CodeGovernment Orders

May 4th, 2016 / 3:20 p.m.
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Beauséjour New Brunswick

Liberal

Dominic LeBlanc LiberalLeader of the Government in the House of Commons

moved:

That, in relation to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), not more than one further sitting day shall be allotted to the consideration at second reading stage of the Bill;

and

That, 15 minutes before the expiry of the time provided for Government Orders on the day allotted to the consideration at second reading stage of the said Bill, any proceedings before the House shall be interrupted, if required for the purpose of this Order, and, in turn, every question necessary for the disposal of the said stage of the Bill shall be put forthwith and successively, without further debate or amendment.

Bill C-14—Time Allocation MotionCriminal CodeGovernment Orders

May 4th, 2016 / 3:25 p.m.
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Vancouver Granville B.C.

Liberal

Jody Wilson-Raybould LiberalMinister of Justice and Attorney General of Canada

Mr. Speaker, I am pleased to stand to speak about this. We recognize that the Supreme Court of Canada has put in place a deadline of June 6. We respect the Supreme Court of Canada in terms of responding to the Carter decision and have put forward Bill C-14 to do just that.

There has been substantive debate in the House. We have had over 21 hours of debate. Eighty-four members of Parliament, from every party in the House, have had the opportunity to speak.

We need to ensure we meet the court's deadline. We need to get this into committee so if amendments are proposed, they can be proposed at the committee stage.

I would further respectfully submit that yesterday we tried to extend the sitting hours as late as necessary to ensure that all MPs who wanted to speak had the opportunity to do so. Unfortunately, the opposition decided to limit the hours of debate.

Bill C-14—Time Allocation MotionCriminal CodeGovernment Orders

May 4th, 2016 / 3:25 p.m.
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NDP

Peter Julian NDP New Westminster—Burnaby, BC

Mr. Speaker, that is absolute rubbish, and it is shameful. The opposition parties were very clear that we wanted to debate the issue throughout the week. That was the initial government offer. Now we are seeing a shameful backtracking from the government.

The Liberals promised sunny ways. They promised that they would respect opposition parties in the House. I remember them promising as well that they would respect parliamentary debate in this place. They had no better opportunity to prove they would actually walk the talk than on Bill C-14, which is a non-partisan issue to which I think all members of Parliament want to give voice.

However, now we are seeing, shamefully, the use of closure to shut down what should have been a non-partisan debate through the course of this week.

What is even more appalling is that in the previous government, it would allow five days of debate. The Liberals are shutting this down after two-and-a-half days of debate, only. Why are sunny ways turning to dark ways, and why are Liberals shutting down debate on the bill after only two-and-a-half days?

Bill C-14—Time Allocation MotionCriminal CodeGovernment Orders

May 4th, 2016 / 3:25 p.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Mr. Speaker, I agree with my colleague across the aisle about the sensitive nature, the deeply emotional, and complex realities in our consideration of Bill C-14. Putting in place a medical assistance in dying regime in our country is transformative. It is a paradigm shift.

There has been substantive debate. There have been submissions made by 84 members in the House. There was ample opportunity to debate this.

Ten members from the member opposite's party had the opportunity to speak, and members from his party stopped speaking last night at 11:00 o'clock.

We need to fundamentally ensure that we meet the Supreme Court of Canada's deadline of June 6. We are endeavouring to do so to ensure we can get this substantive piece of legislation through the parliamentary process to comply with the Supreme Court's deadline.

Bill C-14—Time Allocation MotionCriminal CodeGovernment Orders

May 4th, 2016 / 3:35 p.m.
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Green

Elizabeth May Green Saanich—Gulf Islands, BC

Mr. Speaker, this is a difficult debate because it is not about Bill C-14. It is about democracy in this place. The reason it is not democracy is that for the last four years under the majority Conservative government, we saw the illegitimate use of closure more than 100 times in this place. We looked to the new government and we believed in the mandate that there would be greater respect for opposition parties.

My faith in that was crushed by the decision of the hon. House leader to insist that Liberals at committee pass a motion that deprived me of my rights at report stage. Now we have closure on this matter.

I have the utmost respect for the Minister of Justice. I hold her in high esteem, so I ask her this question. In balancing the harms, the harm to democracy in this place versus the risk that taking the time to do Bill C-14 right might take us beyond June 6, would there be harm done? That is my key point as a lawyer. The Supreme Court of Canada decision could take effect. We could be late having royal assent and there could be a—

Bill C-14—Time Allocation MotionCriminal CodeGovernment Orders

May 4th, 2016 / 3:45 p.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Mr. Speaker, it is incredibly important that we meet the June 6 deadline of the Supreme Court of Canada.

The object of this piece of legislation is to ensure that we balance personal autonomy and provide protection to the vulnerable. If we do not have legislation in place as of June 6, there will be no safeguards in place, and the medical practitioners will have uncertainty with respect to the eligibility criteria around somebody who wants to access medical assistance in dying.

The Supreme Court of Canada said two things. It said that an absolute prohibition on medical assistance in dying is unconstitutional, and it put it to Parliament to do our job, to put in place a substantive piece of legislation that reflects the diversity of views that exist in this country. That is what Bill C-14 does.

Second ReadingCriminal CodeGovernment Orders

May 4th, 2016 / 4:40 p.m.
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Liberal

Ali Ehsassi Liberal Willowdale, ON

Mr. Speaker, I am grateful for the opportunity to rise today to join many other colleagues in addressing the significant national debate surrounding Bill C-14, and our government's prompt and appropriate response to the Supreme Court's Carter decision. I believe this was a duty the previous government neglected, and I am proud of our government's response to this complex issue.

Bill C-14 represents a mandated response to the Supreme Court's Carter decision by providing a national framework to ensure, subject to necessary safeguards, access to a fundamental and inviolable right enshrined under section 7 of the Canadian charter. After all, the Carter decision transformed the question before the government from one focused on whether the government should legislate and legalized medical assistance in dying to the very different question of how fast to legislate and legalize medical assistance in dying.

Despite the clear contours delineated by the Supreme Court, I would like to acknowledge the hard work of all members of the House over the course of the past several months to contribute to this important national debate by recognizing the crucial role of the Special Joint Committee on Medical Assistance in Dying, and acknowledging the leadership demonstrated by the Minister of Justice and the Minister of Health for introducing this transformative legislation.

I would also like to thank all Canadians who have, in one way or another, participated in nation-wide consultations with their provincial and federal governments. I am very proud that many constituents in my riding of Willowdale took the time to approach me regarding various aspects of this bill, and having listened to them, I realize full well that this is a deeply important issue for many Canadians.

At the centre of the profound and solemn debate that has ensued in the House and elsewhere, have been discussions focused on such foundational principles, such as the need to respect individual rights, equity, consent and capacity, clarity, dignity, and accountability. Yet, given the extensive debate that has occurred in the House, I would like to specifically focus my remarks on two specific aspects of this bill which I believe need to be further highlighted and emphasized.

The first issue I will focus on is that Bill C-14 represents a significant first step that now requires further co-operation with our provincial and territorial partners. Second, it is important to recognize the significant safeguards embedded in Bill C-14.

One of the primary characteristics of charter rights, of course, is equal access. If charter rights are by definition universal, they must, within reason, be equally accessible to all Canadians. This is where I believe Bill C-14 comes into play by establishing a national framework for medical assistance in dying that can ensure equitable access across provinces and territories. I feel that Bill C-14 fulfills an expressed desire by our provincial and territorial governments for a national framework to address this timely issue.

I strongly believe that this legislation provides an opportunity for the federal government to facilitate a collaborative approach, which includes provincial and territorial consultation. Specifically, the bill's own preamble clearly states that the law must apply consistently across all of Canada. As such, this bill advocates for a national framework in order to avoid variations from province to province.

As we all know, the Quebec government has in many ways laid the groundwork for medical assistance in dying with their own provincial legislation. However, while provinces will continue to act as key legislative and administrative partners in medical assistance in dying, I think we can all agree that establishing a pan-Canadian, national approach was crucial.

We should continue to work with the provinces and territories to explore mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying, thus avoiding crucial gaps in access and delivery.

Furthermore, in keeping with our government's commitment to evidence-based decision making, we will engage with the provinces and territories to support the development of a pan-Canadian monitoring system to collect and analyze data, monitor trends, and publicly report on medical assistance in dying.

This two-way relationship is important. In other words, Bill C-14 represents the beginning of a partnership on medical assistance in dying. Our provincial colleagues, informed by the framework we have provided, can now begin the process of implementing their own medical assistance in dying regimes. Quebec, of course, has already done so, while Ontario and most other provinces have begun the process through the creation of a PT advisory groups on physician-assisted dying.

Allow me now to shift to the second element I would like to address today, the topic of the safeguards included within Bill C-14.

Bill C-14 makes Canada the ninth jurisdiction in the world to legalize medical assistance in dying, not including Quebec. Fortunately, we have been able to learn from their experiences to implement safeguards that will protect the most vulnerable while also allowing suffering Canadians access to their charter rights. Bill C-14 is, therefore, a carefully and deliberately crafted piece of legislation, which learns from the best practices of other governments to legalize medical assistance in dying.

As the Supreme Court made clear in paragraph 117 of the Carter decision, the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards. Our government is committed to addressing the task put forth by the Supreme Court. We understand that this is a complex and emotional issue for many Canadians. As a result, we want to ensure that protecting the charter rights of some Canadians does not infringe upon the charter rights of others.

Bill C-14 provides strict criteria outlining precisely who is eligible for medical assistance in dying. Relatively strict guidelines are required when dealing with such a significant issue and eligibility is limited to three prescribed sets of conditions contained in Bill C-14.

Bill C-14 also includes safeguards protecting the personal convictions of health care providers. This is a fact that bears repeating as there seems to be some misunderstanding and confusion surrounding this issue. There is nothing in Bill C-14 that compels any medical practitioner to perform medical assistance in dying against their will.

As the Minister of Justice recently confirmed in her appearance before the Standing Committee on Justice and Human Rights on May 2, 2016, she said:

There is nothing in our legislation that would compel a medical practitioner to perform medical assistance in dying as you point out. The jurisdiction in terms of regulations falls to the provinces and territories.

The Minister of Health also addressed this issue in her remarks before the same committee and apart from reiterating that the issue of the conscience rights of health providers falls within the jurisdiction of the provinces, she confirmed that the federal government is already working with the provinces to develop a care coordination system for end-of-life care.

Finally, I believe the inclusion in Bill C-14 of a five-year review clause is another important safeguard. While I have the utmost confidence that the bill would address the issues presented to the government via the Carter decision, this mechanism would allow for future improvements and modifications, if need be.

Before concluding, allow me to also emphasize that Bill C-14 is part of a larger discussion around end-of-life health care. In that spirit, I am proud of the commitments our government has made toward palliative care, through a much-needed $3-billion investment over four years for home and palliative care.

I am confident that the vast majority of my constituents support medical assistance in dying and support Bill C-14. I urge my colleagues in the House to support the bill as well. By boldly, yet responsibility, reacting to the Carter decision, our government has created a workable and pragmatic national framework that would allow us to closely collaborate with the provinces and territories.

Bill C-14 marks the beginning of a new era. By addressing the expanded charter rights laid out by the Carter decision, this legislation would provide Canadians access to a long-overdue right.

Second ReadingCriminal CodeGovernment Orders

May 4th, 2016 / 5:10 p.m.
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NDP

Jenny Kwan NDP Vancouver East, BC

Mr. Speaker, I am honoured to have the opportunity to speak to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

Let me first thank the members who were part of the Special Joint Committee on Physician-Assisted Dying for this bill and for their hard work. Their work showcased Parliament at its best, what it is capable of when parties put aside politics and the best interests of Canadians are at heart, and in particular when vulnerable Canadians are put at the forefront. I would also like to recognize the members of the Standing Committee on Justice and Human Rights, who are working diligently and endlessly on this issue.

Since the debate began, we have heard many moving and deeply personal stories. These are heartfelt sentiments, some that are so moving, as I listened to their stories it brought a lump to my throat. I thought about how wonderful it is that we have Canadian democracy in this very House, where every single member was supposed to have the opportunity to voice their opinion on this very important issue.

In my view, it is a shame that the government brought forward closure. I do think it is a shame. It was not necessary. I think we could have afforded every single member the opportunity to be heard and to offer their point of view on this important bill.

This bill before us today is one of great importance and significance to Canadians from all walks of life, from coast to coast to coast. Its subject is something that has touched countless Canadians, at least to a degree. Whether caring for an ill member of their family, providing support to a friend or colleague, caring for a loved one, or just contemplating their own wishes should they be in a situation where they are forced to deal with enduring and intolerable suffering, this is an issue that truly impacts all of us.

As this legislation is quite literally dealing with life and death, it is of the utmost importance that Parliament put the best legislation forward. The rights and self-determination of individuals must be supported while simultaneously ensuring that the most vulnerable people in society are protected from harm.

This balance must, and I believe can, be struck. There is no question that end-of-life decisions can be incredibly hard on families, whether the family member is dealing with a serious condition, or the surrounding families and loved ones are witnessing the pain and suffering of their loved one. For those doing the support work, it is deeply emotional and deeply personal.

Should a person ultimately determine that they would prefer to, as many call it, “die with dignity” on their own terms, the gravity of that decision itself is enough for a family and the individual to grapple with. Over the years, we have seen the struggles of families of individuals who are fighting for their right to die with dignity go through time-consuming and difficult court battles, from Sue Rodriguez to Ms. Kay Carter.

These individuals went through the court battle, not just for themselves, I believe, but for all Canadians who wish to have the right to choose to die with dignity. For that, I thank them and their families for their courage, and the courage they have shown to have their voices heard in perhaps the most trying and critical time in their lives.

While I have not been in a situation where one of my loved ones has had to endure this kind of pain, I have known people who have. At such a difficult time, one would think that the last thing these families would want to deal with is the additional stress and hardship imposed on them because Parliament did not have the courage to act.

Parliament has been given the task by the Supreme Court of Canada, based on the ruling known as the Carter decision. The court unanimously decided that Canadians who are suffering intolerably as a result of a “grievous and irremediable medical condition” have a charter-protected right to access medical assistance in dying. On June 6 of this year, a new law adhering to this decision needs to be in place or a legal vacuum will result.

The Special Joint Committee on Physician-Assisted Dying spent considerable time listening to expert testimony and brought forward 21 recommendations in a legislative response to the Carter decision.

The very first question that needs to be answered on Bill C-14 is this: Does this legislation comply with the Carter decision? The special joint committee heard from some advocates and experts who stated that the bill would fall short. This could result in more lengthy court challenges, and more importantly, individuals, families, and medical professionals left navigating incredibly difficult decisions while operating in a legal gray area. In my view, to allow this situation to occur would mean nothing less than a failure of Parliament.

Kay Carter, one of the two women involved in the Supreme Court of Canada case, suffered excruciating and debilitating pain which left her wheelchair bound and unable to feed herself. Fully mentally and legally competent, and possessing a fierce independence, she sought the right to choose medical assistance in dying if her suffering became unbearable. However, her condition was not considered fatal, and because the final criteria in Bill C-14 for undergoing physician-assisted death is “natural death has become reasonably foreseeable”, many experts have noted that Kay Carter would have been denied access under Bill C-14.

Surely we must question how it could be if Bill C-14 was meant to address the Carter decision, that Kay Carter and others like her, who are legally competent and suffering from serious and incurable but non-fatal conditions, would not be granted that very right under this new law.

My question for the government is quite simple: What is behind the decision to use such different terminology than was used in the court ruling?

Bill C-14 is also silent on a practitioner's right to conscientious objection. Presumably this means the government is leaving it up to the provinces to work that out. Respectfully, the Supreme Court of Canada has tasked the federal government with crafting these laws. Leaving out something as important as practitioners having the right to conscientious objection and failing to meet the test of the Carter ruling, in my view, is a failure of Parliament to live up to its responsibility.

The special joint committee recommended that the government consider the topic of advance directives. While the court was silent on this as cognitive decline and therefore legal competence was not going to become an issue for the plaintiffs in the case, the Canadian public has been vocal about this. Experts appearing at committee stated that people dealing with these sorts of illnesses, such as Alzheimer's and other forms of dementia, will be left with no legal options.

My constituents of Vancouver East have brought this issue to my attention. A Vancouver East resident wrote, “Without the option to make advance requests for assisted dying, Canadians with dementia, or other degenerative illnesses that rob victims of their competence, will be effectively excluded from access.”

It is my belief that this completely goes against the spirit of the Supreme Court ruling on physician-assisted dying.

In going forward, I hope there will be changes to this legislation to bring it to the place where it is both Carter compliant and charter compliant.

I have no doubt that my colleague the member for Victoria will continue to work diligently and consult on this very matter with experts and people affected.

I would like to point out that while the bill in its preamble cites the importance of palliative care, I hope that the government will actually deliver on palliative care as well.

It should be all of our obligation to make sure that these choices are afforded to Canadians and that in their choices, they are supported with every effort to make that choice a reality.

Second ReadingCriminal CodeGovernment Orders

May 4th, 2016 / 5:25 p.m.
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Conservative

Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC

Madam Speaker, I want to note that after two and a half days of debate, I will be one of the last few speakers of the one-quarter parliamentarians who were actually allotted the opportunity to speak at second reading of Bill C-14. However, I do not want to waste my time raging against that particular issue, because we have an important debate in front of us.

I have watched with envy when some of my colleagues have been able to articulate a really clear position on the legislation, both for and against. Truly, it is going to be with no ease that I will make my vote tonight. It is a very difficult decision for many.

I want to start with a quick reflection on some of the facts about this case and really the two cases that were with the Supreme Court of Canada which ultimately ended up in very different results.

I have heard again and again that the public sees Sue Rodriguez and Gloria Taylor as remarkably similar in terms of the struggle they were having with ALS, which of course is a horrific degenerating neurological disease. Notwithstanding those very similar fact patterns, the 2015 Carter decision did not follow the 1993 precedent and, indeed, was really a completely contradictory position which struck down a 21-year-old law which declared physician-assisted suicide as an indictable offence.

It is an age-old argument that the court should interpret laws and not make them. I actually do acknowledge that the Charter of Rights and Freedoms requires interpretation by our courts, but I would also like to argue that once an interpretation is given, the offering of consistent rulings makes sense to the general public.

As societal views change on any particular issue, it is the responsibility of the legislative branch to adapt to changing public values.

I do want to reject the statements that many have made that Parliament was not willing to consider the issue. In 2010, there was a vote. I remember that my colleague Steven Fletcher spoke very eloquently. He had a private member's bill. I have no doubt we would have dealt with this issue again in this Parliament.

I also want to note that Quebec and many countries took a long time, six years, 10 years, to craft a piece of legislation to talk to their communities.

The Supreme Court of Canada's decision affects every Canadian, and every member of Parliament, I believe, had a responsibility to talk to their constituents in detail.

I did send a letter to every household in my riding right after the Supreme Court of Canada decision. This was consultation before the last election. Of the over 1,000 responses I received, approximately 70% recognized there were some cases where they believed that physician-assisted suicide might be important.

Then we had the actual legislation. I made a commitment and said that if anyone wanted to join me in a round table, I would give them every minute of the last constituency week.

As members can imagine, we had round table after round table, including round tables with physicians and seniors groups. They were powerful discussions. They were divisive discussions. People had very different perspectives, but I think there are three areas that they did agree upon.

Palliative care has to be improved. There is no question about that. I did some quick calculations. That $30 billion over four years, in terms of a home care budget in the health authority I represent, is actually a pittance in terms of their being able to change a palliative care system.

Again, everyone agreed that there is a slippery slope and that there is no confidence that we are not going to head down that slippery slope. As a result, two recommendations were made.

One recommendation was that two physicians may make a decision but a social worker and a psychologist should inform the physicians' decision, or alternatively, there should be a judicial review process. I think those were important considerations. They absolutely 100% believe that the protection of health conscience rights of our providers must be in federal legislation.

I will reflect on a few comments from those opposed and from those who were supportive, and then I will conclude.

People opposed to the legislation were not opposed to any technical pieces of the legislation but because they believed we were talking about murder, a profound diminishment of respect for life, and that vulnerable individuals would choose to end their life if they felt they were a burden.

I would like to quote a physician who sent me an email. He said, “I certainly have some concerns with the proposed legislation and would not feel comfortable in bringing about a patient's death. That is not why I went into medicine. I am actively involved in palliative care and believe this is a compassionate and crucial service to people near the end of their lives. Sometimes it's messy and life spills all over the floor. It seems to me that sometimes families want to avoid the challenge of lovingly caring for these individuals. Our society likes tidy, convenient outcomes. It seems to me that this is frequently the motive underlying assisted death. I would take great exception to legislation that would force me to refer someone on for assisted suicide against my conscience. I would certainly explain to the patient that there may be other physicians that would be willing to assist them and taking their life”.

That was from one of the very reputable physicians in the community that I represent. Again, in these round tables there were community members both in support and against the legislation.

We had an 80-year-old woman come to a session who wanted that option available to her. She did not have to worry about family and said that it was strictly something that she wanted for herself.

Another constituent, who joined us, talked about being with her stepdad and dad when they died. She talked about the very awful, tragic end that both of them had in spite of the best palliative care that was available. She expressed how awful it was.

I think she would have rejected the physician's characterization that she would choose that end because it was tidy or because she did not have the compassion. She was clearly willing to do whatever she needed to do to help her stepdad and dad, but felt that they needed better options.

Probably one of the most emotional conversations was when someone said, “I respect your opinion on this issue, and I know that you believe it is wrong, but can you please respect mine?” Again, that dialogue was happening where there was a request of respecting one's opinion.

The legislation needs some work and certainly the commitment around palliative care is very minimal. We must have protection for the conscience rights of our health providers in the legislation. As well, we really need to reflect on providing protection for the vulnerable who feel they are a burden.

I will support the legislation at second reading for three reasons. First, I believe that ultimately it will serve Canadians better than having a legal void. Second, indications are that a significant number, a majority, in my riding do support assisted suicide and euthanasia. Finally, everyone reflects personally, and if I ever had family members with ALS or another devastating disease who said that they wanted to lie on their bed, listen to their music, look at the mountains, rather than palliative sedation at the end of their time, and that's what they choose, how could I not support them in their request to escape intolerable pain and suffering?

Second ReadingCriminal CodeGovernment Orders

May 4th, 2016 / 5:40 p.m.
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Conservative

Mel Arnold Conservative North Okanagan—Shuswap, BC

Madam Speaker, I feel very fortunate to rise to speak to this issue today. Unfortunately, as you mentioned, I will not have the full time. I was hoping to speak fully on the issue, especially on behalf of the constituents who have continuously contacted me in my office with their concerns over the issue. I feel unfortunate for those members who have no ability to speak to the bill because of the closure that was forced upon us by the Liberal government.

An issue of this importance should not be forced through closure, as has been done today. This needs to be fully debated to the fullest extent. I am appalled at the other side for what it has done to us here. We need to fully consider all the implications of what is being presented in the bill. There are so many details missing in the definitions and in the possibilities down the road.

I want to relate a personal story here that expresses why I am so concerned about what is missing and why I want to ensure all the safeguards possible are put in place in the bill.

A few years ago, I had the honour and the burden of being the authorized representative for my mother in the final years of her life. Her health was gradually degrading through dementia and diabetes, to the point where it was getting difficult to have just a regular conversation with her. In fact, in the final few months it got to the point where she knew what a telephone was, but she did not know to answer it when it rang, or how to dial it anymore. Having done that for decades, she could no longer associate what to do with the telephone.

After three or four months of that, just before Christmas she became quite ill with the flu. We were not sure if she was going to be able to pull through or not. Whatever that illness did to her in her state of dementia, we are not sure. However, we were fortunate enough to visit with her on Boxing Day. We went in to see her. She had fully fluent and cohesive conversations with us. Not only that, earlier in the day she had picked up the telephone and phoned every one of my five siblings, dialing their phone numbers from memory. That was something she had not been able to do for months.

Right now, many people will look at dementia and some of these degenerative diseases as being incurable, but that day, that very short period of time proved to me that it is not always the case.

Therefore, when we are considering Bill C-14, every last one of us as members of Parliament really need to consider this because we are making a decision that is going to impact not just us in the House but the physicians and caregivers out there dealing with these patients, and with possibly many lives down the road.

I am appalled that we have closure on this today. I certainly hope that what goes to committee and what comes back does not open the floodgates to all the dangerous slippery slopes we see down the road.

Criminal CodeGovernment Orders

May 3rd, 2016 / 10:25 a.m.
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Conservative

Cathay Wagantall Conservative Yorkton—Melville, SK

Madam Speaker, I am thankful to be able to add my voice to the discussion on Bill C-14, medical assistance in dying.

The Supreme Court of Canada has put what I perceive as an inappropriate timeline on this House in regard to this legislation, because it has come to the conclusion that the Criminal Code of Canada is unconstitutional in making it illegal for anyone to cause the death of another person who consents to die or to assist a person to end their own life.

In speaking with a very concerned constituent last week who was in law school when the charter was enacted, the comment was made that the university law professors of the day assured a troubled graduating class that what is actually happening today would never happen.

We are now in a place where, in attempting to guarantee every person their charter rights and freedoms, we are endangering the rights and freedoms of others. A synergy of wisdom and selflessness is needed in balancing what is perceived as best for me in relation to what is best for others. Just because we can, does not mean we should.

As well, in determining if we should, it seems to me the wise approach would be to look at those who already did, and regret. This would require learning from recent history rather than pretending that what we are doing is somehow progressive, when it has already been proven to be a regressive decision elsewhere.

The Supreme Court has chosen to ignore its own previous decision on the issue, along with six different parliaments that have previously rejected assisted suicide. It appears that the plumb line is not what is best for society and humanity as a whole, but rather what is the latest progressive trend that is putting the strongest pressure on how we live and relate as a society.

I have been a pastor's wife, and a caregiver in hospitals and level 4 care homes. I have worked in a mental illness hospital. I have been an education aid for special needs children in kindergarten and high school students.

I am the daughter of a father with Alzheimer's, the grandmother of a high-achieving grandson with autism, and I have a loved one who is suffering with mental illness. I, too, am well aware of life's challenges. My personal belief is that life is sacred from conception to natural death, and the protection of the most vulnerable in our society must always be the determining factor in how we choose to govern and make laws in Canada.

This is the expression as well that has been sent to me over and over again from constituents in my riding and across Canada, and today we need to have a debate in this House that is very balanced and presenting all views from all people in Canada.

Life is challenging, and dying, far more often than not, is difficult for the one passing away and in some ways even more so for those experiencing end of life alongside the individual who is dying. I believe there is value in that as well.

The misfortunate reality of Bill C-14 is that it will cause far greater grief than it will appease. Making something legal does not make it morally right. People who request a physician-assisted death can be motivated by a range of factors unrelated to their medical condition. These factors can make some people vulnerable to request assisted death when what they want and deserve is better treatment and palliative care.

It needs to be pointed out that the Belgian euthanasia law does not apply to non-competent patients and it does not allow the deliberate shortening of their lives. The Belgium euthanasia law system, which Bill C-14 mirrors, has been proven to be abused and insufficient to monitor the decision-making process.

For example, the Journal of Medical Ethics published a research article written by Raphael Cohen-Almagor, a human rights activist and chair of the politics department at the University of Hull. His article “First do no harm: intentionally shortening lives of patients without their explicit request in Belgium” focuses mainly on published data concerning the practice of causing death without patient request in Belgium.

The research indicates that the practice remains common, resulting in over 1,000 hastened deaths without request each year, or 32% of the cases of euthanasia. Moreover, in almost half of those cases the doctors refused to report the matter to the overseeing body, despite a legal requirement to do so.

This example clearly shows the legislation is lacking an oversight by an independent third party before the patient is put to death. Sadly, but realistically, the safeguards in Bill C-14 are likely to be insufficient and ineffective in real life conditions.

Furthermore, Bill C-14 applies to those with physical or psychological illnesses who are experiencing enduring and intolerable suffering as a result of their medical condition. Our focus must first be on raising the quality and availability of high-quality palliative care as the humane way to relieve pain, loneliness, and fear for the end-of-life patient and to provide encouragement, direction, and support for loved ones through the natural process of end of life. Bill C-14 does not require a palliative care route be entered upon first, neither does it require the patient to have tried other treatments before requesting medical assistance to die.

As well, I am still deeply concerned for our medical professionals who have contacted me in great numbers who could face severe consequences if they do not assist an individual to take their own life, for whatever reason. No one in our country should be forced to affirm or provide a service that goes against their conscience. The federal government's law leaves this crucial issue for the provinces to deal with, allowing even more interpretations of the general wording.

There should be a structured national system to address the cases when a publicly funded health care organization or separate doctors are unwilling for any reason to provide aid in dying when the patient has requested it.

Furthermore, the bill extends the amendments to the Criminal Code for medical practitioners, nurses, and registered practical nurses. Such an approach is broader than any other jurisdiction in the world and makes it impossible to create a transparent national system.

It is necessary to take into consideration the psychological factors that Bill C-14 would actually influence and encourage. The secularism of our courts affirms a premise that everything is socially constructed, and as a result laws greatly shape the ethos of culture, affecting cultural attitudes toward certain behaviours and influencing moral norms. Medical assisted dying laws send a message that in certain conditions suicide is a reasonable and appropriate way out. The problem is that this message will be received not only by those who have painful, terminal illnesses, but also by those who are tempted to think they can no longer go on.

A study by David Jones and David Paton proved that legalizing assisted dying in other states has led to a rise in overall suicide rates, both assisted and unassisted. This greatly undermines the work of suicide prevention organizations and programs.

As the Conservative deputy critic for veterans affairs and a member of the veterans affairs committee, I believe legalizing assisted suicide would only increase the challenges of providing mental health care and suicide prevention initiatives for those suffering from post traumatic stress injuries.

I agree with my Liberal colleague from Winnipeg Centre who spoke last evening that the government should at the very least postpone legalizing assisted death for at least five to 10 years, until it is absolutely clear what sort of impact it would have in all corners of Canada. His concern is well founded in regard to fighting the suicide spirit that needs to be healed on our reserves in Canada.

Another report in Current Oncology from 2011 summarized that euthanasia in the Netherlands has changed significantly in the 30 years since it was first adopted. It has shifted from medically assisted dying for people who are terminally ill to those who are chronically ill, from physical illness to those who suffer from mental illness, and then to those who suffer the psychological distress of mental suffering, and now to euthanasia of those over 70 who are simply tired of living.

The culture now is that euthanasia becomes expected while palliative care and functional hospice is gradually portrayed and felt to be “selfish”. That is a quote from the UK Daily Mail on September 24, 2013.

This implicates that the bill would not only affect those making a rational and deliberate choice to end their lives, but would also have a significantly wider impact on those who are required to provide such a service or their privilege and right to work in the medical field could be challenged, and also on wider social groups as a whole.

When facing a choice, which we are with the bill, where should the priority for us as legislators be? The imposition by the Supreme Court of Canada to invoke such controversial legislation, which is proven to be failing in other countries; the approach of the committee to manage witnesses and to make recommendations that go far beyond the Carter decision; and the need to first of all institute high-quality palliative care as an intrinsic value and an actual clear priority of the government are all valid reasons that I feel I cannot support Bill C-14.

Criminal CodeGovernment Orders

May 3rd, 2016 / 10:40 a.m.
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Liberal

Vance Badawey Liberal Niagara Centre, ON

Madam Speaker, I am pleased to speak in support of Bill C-14, which would address medical assistance in dying.

The government has listened very carefully to Canadians and reflected upon the invaluable contributions of the special joint committee of members of the House of Commons, senators, the external panel, the provincial-territorial expert advisory group, and many others throughout our nation.

The bill appropriately recognizes the autonomy of Canadians to choose medical assistance in dying, while also protecting vulnerable persons and respecting the Carter decision of the Supreme Court of Canada.

My remarks will focus upon the eligibility criteria and procedural safeguards, which together represent the heart of the bill.

As the Minister of Justice has stated, the bill is aimed at addressing the issues raised by the Carter decision. The government has committed to collecting and analyzing evidence regarding how medical assistance in dying is working in practice and considering the findings of independent studies into additional issues that were not addressed in the Carter decision, which will be launched after the bill is passed.

Given the fundamental societal and medical issues that medical assistance in dying raises for our country, a cautious approach is in fact warranted. The stakes are just too high.

The bill contains five key eligibility criteria.

First, the bill would also require that the person requesting medical assistance in dying be at least 18 years of age and be capable of making decisions with respect to their health.

Several witnesses before the special joint committee, including the Canadian Paediatric Society, noted that medical assistance in dying raised unique considerations when it came to young people. Assessing a minor's capacity to decide to seek medical assistance in dying is difficult when the stakes are so high and the decision is irreversible.

Importantly, the committee also heard that there was in fact no Canadian pediatric data regarding requests for medical assistance in dying from young people or whether pediatricians would be willing to participate in this procedure. Prudence and common sense support further study of this very difficult issue.

With respect to capacity, this requirement means people must be able to confirm their choice at the time the medical assistance in dying is in fact provided. Therefore, the bill would not permit what are commonly called “advance requests”.

Permitting medical assistance in dying to be administered to a patient who is unable to express his or her wishes increases the risks of error and abuse. People who cannot express their wishes may want to continue living, even though they made a request at an earlier point in time.

Simply put, an advance request takes away the right of people to change their minds when they lose capacity.

The proposed approach also recognizes that physicians and health professionals frequently struggle with interpreting and applying other evidence directives in general. Advance requests for medical assistance in dying would be even more complicated to administer. Clearly, there is a need for further study and evidence concerning advance requests.

The bill also contains eligibility criteria that people make a voluntary request for medical assistance in dying and that they do so with the benefit of fully informed consent.

These requirements are common sense.

Medical assistance in dying must not be an alternative in situations where patients might prefer a different treatment, but are not aware of it or they do not know their diagnosis or its likely trajectory. Nor must it be the product of external pressure or the person's believe that he or she is a burden or unwanted.

Next, the bill would require that the person be suffering from a grievous and irremediable medical condition. This is defined term that has several characteristics, including the condition is serious and incurable; the person is in an advanced state of irreversible decline in capability; the condition is causing the person enduring suffering; and the person's natural death has become reasonably foreseeable in all of his or her medical circumstances, without requiring a specific prognosis.

The bill intends to permit medical assistance in dying as a choice for Canadians whose lives are on a path toward their end. As the Supreme Court suggested in various places in Carter, medical assistance in dying is similar in nature to forms of end-of-life care, such as palliative sedation, or the withdrawal of life-saving treatment. This definition is intended to allow for flexibility for physicians and nurse practitioners to consider all of the person's medical circumstance.

Bill C-14 is clear that no specific prognosis of time remaining is required. Moreover, a person could qualify based on the cumulative effect of multiple conditions or medical circumstances that individually may not be fatal, but when taken together make the person's death reasonably foreseeable. For example, people in medical circumstances similar to those experienced by Kay Carter, Gloria Taylor, Sue Rodriguez, as well the people who have obtained individual constitutional exemptions across Canada since the Supreme Court's ruling this past January, would all be eligible under this bill.

However, medical assistance in dying is not a solution to all forms of medical suffering. Such an approach would raise unacceptable risks, particularly for vulnerable people throughout our society. Take the example of someone who is exclusively suffering from a physical or mental disability, but who is otherwise in good health and whose natural death is still many years away. Making medical assistance in dying available to people in these circumstances risks reinforcing negative stereotypes of the lives lived by Canadians with disabilities, and could suggest that death is an acceptable alternative to any level of medical suffering or disability. This risks undermining our efforts to combat suicide, a pressing public health problem that affects not only those who die by suicide, but also their families, friends, and overall communities.

Next, to ensure that Canadians can have confidence that medical assistance in dying is administered appropriately, the bill also contains the procedural safeguards generally in line with those recommended by the special joint committee. These measures would ensure that requests for medical assistance in dying would be made in writing, witnessed by two independent persons, and that there would be a 15-day wait period to guard against people making a decision too quickly, which cannot be reversed. In respect of the waiting period, there would be flexibility for situations where a person's death or loss of capacity was imminent.

Most important, the eligibility of the person would have to be assessed and confirmed by two physicians or nurse practitioners who are independent of each other. The person would also have the right to change his or her mind about receiving medical assistance in dying, including just before the procedure would be administered. These safeguards will be effective at protecting Canadians but will not be so burdensome that they will impede access.

Finally, the bill would require that the person be eligible for health services funded by a government in Canada. This requirement exists to ensure that Canada does not become a destination for people from around the world who visit the country solely for this purpose by obtaining medical assistance in dying. However, recognizing that Canadians often move from one province to another or sometimes live abroad for significant periods, the bill includes an exception to this requirement to ensure these people would not be excluded solely because they are subject to a waiting period or residency requirement for public health care.

Medical assistance in dying is one of the most challenging and complex social and legal issues of our time, particularly given our society's aging population. However, the government has embraced this challenge and has listened carefully to the diverse perspectives of Canadians.

The bill before Parliament today was crafted with both compassion and clear thinking, and represents thoughtful and principled legislation. It promises the autonomy of Canadians to choose medical assistance in dying, protects vulnerable persons, and respects the Supreme Court's decision.

I call on members of the House to support this bill.

Criminal CodeGovernment Orders

May 3rd, 2016 / 11:05 a.m.
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Liberal

René Arseneault Liberal Madawaska—Restigouche, NB

Madam Speaker, I would like to first thank my colleague for his comments, which will make us carefully reflect on Bill C-14.

We should reflect on what is at the very heart of the debate on the Carter case and the Supreme Court decision. In one passage of the Supreme Court ruling in Carter, the justices state that the current Criminal Code provisions at the very core of the Carter case protect the vulnerable to such an extent that they constitute almost an absolute protection, which is prejudicial to some Canadians who are not vulnerable and would like to have access to medical assistance in dying.

I would like to hear what my colleague thinks of the Supreme Court's view as it relates to the current bill.

What are his thoughts on people who are not vulnerable as defined by the Supreme Court and how this is reflected in the bill?

Criminal CodeGovernment Orders

May 3rd, 2016 / 11:10 a.m.
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Liberal

Julie Dzerowicz Liberal Davenport, ON

Madam Speaker, I rise today to speak to Bill C-14, the medical assistance in dying bill.

To me, it is legislation that reflects where society is today. It is the right one for where the majority of Canadians are, and provides a strong foundation on which to build. It recognizes the inherent and equal value of every life, and honours the dignity and autonomy of an eligible person to choose medical assistance in dying under well-defined rules and conditions.

The introduction of this bill is big and represents a fundamental change in how we as Canadians view the right to life, liberty, and security of the person in Canada.

I confess that this is not an easy issue for me to talk about, but it is an important one to the residents of Davenport, the riding I am honoured and proud to represent. We as a society do not talk very much about death. It makes us nervous, and so this bill, which creates a framework to enable access to medical assistance in dying in Canada to those who are eligible, is a particularly sensitive topic.

I want to acknowledge that I have a large Catholic community in my riding, and many who believe that only God can decide when one dies, that death should be left in God's hands. On the other side, I have a number of groups within Davenport that think the proposed legislation does not go nearly far enough. Recognizing the blessed diversity of opinion, I invited community leaders to meet with me to discuss Bill C-14, to hear from them their specific concerns.

What I found was that I had to remind many of them that in February 2015 the Supreme Court of Canada unanimously, all nine members, voted to strike down the sections of the Criminal Code that made it illegal for anyone, including a doctor, to cause the death of another person who consents to die, or to assist a person to end his or her own life. I reminded them that the Supreme Court proclaimed that the prohibition on physician-assisted dying infringes on the right to life, liberty, and security of the person in a manner that is not in accordance with the principles of fundamental justice.

The Supreme Court gave the government a certain amount of time to introduce legislation. That date is currently June 6, which is why we are here today. Just as an aside, I was curious to see how many times the Supreme Court actually voted unanimously, and it has done so only 35 times since 1979.

There was no question that medical assistance in dying would become legal in Canada. What had to be determined is what kind of legislation we were going to introduce.

The Supreme Court's decision meant an important shift in our society's perception of personal autonomy. It signalled that a person's sense of dignity is intricately tied to how one perceives his or her quality of life. The decision to allow Canadians the choice of medical assistance in dying sheds light on the evolving role of our health care system and the role of patients in decision-making.

Canadians are looking to their doctors and nurses to provide health care, and to help them maintain their quality of life. However, when that quality is no longer attainable, Canadians want to know that their health care providers will also help them when their choice is a dignified end to their lives.

In addition to the consultation, I have received many letters from residents in Davenport. There are those who believe there should be no legislation at all, others who think that the proposed bill is not strong enough in protecting the conscience rights of doctors or in protecting the most vulnerable, and a further group who worry that the legislation does not go far enough, that we as a government have been too narrow in our interpretation of the Supreme Court decision. I will address all these concerns in the next few minutes.

Let me first address those who do not believe there should be any legislation. What many may not understand is that if the Liberal government does not create a new law by June 6 of this year, it means medical assistance in dying is legal if it is conducted in a way that adheres to the considerations outlined by the Supreme Court in its Carter ruling. Canadians would then not have any national framework and no law, which in my opinion would lead to a wild west, where it would be up to any one person's interpretation of the Carter decision and a situation that I believe would be open to abuse.

In introducing Bill C-14, the Liberal government purposely created legislation which as narrowly as possible adhered to the Supreme Court decision. It is narrow because this bill is meant to be a first step. It is meant to ground the legislation properly.

The legislation would do three things. It would allow physicians, nurses, and those who help them provide assistance in dying to eligible patients without the risk of being charged. It would also provide safeguards to make sure that those who receive medical assistance in dying are eligible, can give informed consent, and voluntarily request it. Finally, it would lay the foundation for the Minister of Health to make regulations to establish a process for monitoring and reporting on the use of medical assistance in dying.

I will pause for a second to reiterate the first point, because as mentioned, many have written to me to express their concern that the legislation as drafted does not protect the conscience rights of doctors. I want to be clear that there is nothing in the legislation that compels any medical practitioner or authorized nurse practitioner to provide medical assistance in dying or to refer a patient to another medical practitioner. The legislation is meant to balance access to medical assistance in dying while respecting the personal convictions of health care providers.

The legislation is also clear on who is eligible. A person has to be mentally competent, 18 years of age or over, make a voluntary request, and give informed consent to receive medical assistance in dying. They have to have a serious and incurable illness, disease or disability, be in an advanced state of irreversible decline in capability, experiencing and enduring intolerable suffering as a result of their medical condition, and be on a course toward the end of life. Death would have to be reasonably foreseeable in all of the circumstances of the person's health.

Protective measures are also a key part of the legislation to ensure that patients eligible have given informed consent. Patients have to make a written request for medical assistance in dying and have it signed by two independent witnesses. Also, two independent medical opinions have to confirm that the patient meets all the criteria. These first two criteria are intended to ensure that requests for medical assistance in dying are truly voluntary, that they reflect the wishes of the patient and are not made as a result of external pressure or coercion.

Too many of my constituents have said to me, “My dad was in the hospital. We kind of felt forced that maybe we would want to sort of end things.” I said that this legislation does not help with that. The patient has to make a written request. It has to be signed by two independent witnesses, and there has to be two independent medical opinions.

In addition, the second criterion also helps to reassure the medical practitioner who would provide medical assistance in dying that he or she is acting within the scope of the law and consistent with reasonable medical knowledge and skill.

The other criteria for patients to be eligible are that there is a mandatory 15-day waiting period; the patient has the right to withdraw a request at any time; and consent must be confirmed immediately before medical assistance in dying is provided. It is a very thoughtful protocol with very strong safeguards.

As part of this legislation, the foundation is also laid for the Minister of Health to establish a process for monitoring and reporting on the use of medical assistance in dying. We need to know, and Canadians need to be satisfied, that the system is operating as planned to respect the autonomy for eligible individuals while protecting vulnerable people.

Public trust and transparency in the implementation of medical assistance in dying are essential. This monitoring and reporting system will also be able to signal any issues or unexpected consequences.

Monitoring would also ensure that high-quality comparable Canadian data are generated so that any future discussions about changes to the medical assistance in dying system could be made based on the best possible evidence. Indeed, there will be a review of the legislation in five years, which could bring about changes that reflect the data gathered in this period.

For those who believe that this legislation has not gone far enough, there is a commitment to independent studies into three key issues that the Supreme Court of Canada in Carter declined to address. The first was the eligibility for persons under the age of 18. The second is the advance request. The third is requests for medical assistance in dying solely on the basis of mental illness.

It is also important to mention that palliative care, ensuring that all Canadians live as well as possible until their death, is equally important to this government. Just yesterday the Minister of Health stood in this House to reaffirm our commitment to $3 billion over four years for home care.

The minister is working hard with her counterparts across Canada on the next version of our health care accord, and high-quality palliative care for all Canadians is a key part of their deliberations.

I also should mention that one of the great positive side effects of introducing this legislation is that we are having a wide discussion on a national level. We need to be discussing this issue fully and we need to be understanding it.

In closing, I want to quickly thank and commend the great work that was done by the Special Joint Committee on Medical Assistance in Dying under the great leadership of my colleague, the MP for Don Valley West. I also thank the Minister of Justice and the Minister of Health for their excellent work in introducing this legislation.

Bill C-14 is meant to be a legislative foundation on which we will build moving forward . It recognizes the inherent and equal value of every life, and it honours the dignity and the autonomy of an eligible person to choose medical assistance in dying under well-defined rules and conditions. It is the right legislation for Canadian society today, and I will be supporting this legislation.

Criminal CodeGovernment Orders

May 3rd, 2016 / 11:40 a.m.
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Bloc

Luc Thériault Bloc Montcalm, QC

Madam Speaker, I listened closely to all of my colleagues.

Yesterday, I participated in the committee's hearings. This is my first opportunity to speak in the House.

I have just 10 minutes, but I would like to start by saying that everyone here is caring. Everyone is concerned about the well-being of people who are at the end of their lives, and everyone wants the best for them. However, just because we want to care does not necessary mean that we do what is best for people. We are not necessarily doing what is best for someone if we infringe on a person's autonomy and self-determination.

In the moral sense of the term, human dignity is connected to respect for self-determination. That should be the basis of our debate. Yesterday, in committee, I heard people say that we should consider a person's dignity in relation to their illness. They were talking about whether the person is wearing diapers, which is just frightening. Only that individual can make judgments about their own quality of life, and we cannot compare one life to another.

By way of introduction, since Bill C-14 is quite similar to part of the Quebec law, I would like to provide some context regarding the basis of that law. At the request of medical specialists and other civil society groups in Quebec, in the fall of 2009, the Quebec National Assembly created a deliberative space in order to give people the opportunity to express their views on an issue that could not be more personal: their own end of life.

From that moment on, the status quo was no longer an option for Quebec parliamentarians. Five years later, on June 5, 2014, the National Assembly passed Bill 52, The Act Respecting End-of-Life Care. One aspect of that act is medical assistance in dying.

This work was guided by two premises. First, my death, like my life, is my own. Second, the autonomy bestowed on a person by law through the principle of self-determination and its corollary rule of free and informed consent, which applies in biomedical contexts, is never questioned throughout that person's life, even in times of weakness or extreme emergency. Why then would things be any different at the end of a person's life?

Why would a person's right to self-determination be taken away because he or she is terminally ill? On what grounds would that be done? Is there any more personal and unique time in a person's life than the moment of death? What more could we wish than for a person to be able to calmly and peacefully pass on into death without any fear of suffering or any actual suffering? Is that not what we all hope for and what we would wish for any human being?

The consensus that was reached in Quebec was to make these premises part of a continuum of care, so that palliative care and euthanasia, two realities in the history of this issue, would no longer be set in opposition to each other. Why pit palliative care and euthanasia against each other? This question has been implicit in many of my Conservative colleague's speeches, because unlike in Quebec, we did not hold a debate on the right to die, which used to be associated with passive euthanasia.

People had to fight for the right to die. At the time, paternalistic doctors tended to focus on the curative aspect, and people were dying from the chemotherapy, not the cancer. Over the years, there has been a shift from passive euthanasia to palliative care. Human beings have thus acquired the right to die.

Palliative care is about taking a holistic approach to end-of-life care. This concept was developed by Cicely Saunders, in England, and dates back to 1967. Why should a request for assisted dying arising out of a positive experience of care near the end of one's life be considered a failure? The dying process has started and is irreversible.

A person might wake up one morning and decide that he or she is ready to give up. A person might also decide that that is not the case and that he or she wants to go on living, and die a slow death. The Quebec legislation in no way precludes one or the other, because it places end-of-life care in a continuum of care.

For more than 30 years, palliative care was considered the only way to die with dignity at the end of one's life. It became apparent that such care did not meet every need. Most requests for medical assistance in dying are made as part of the process of palliative care. Very rarely does a person who receives a terminal diagnosis from a doctor immediately request an injection. If so, it all depends on the stage of the cancer. The patient might be put on anti-depressants and told to get his or her affairs in order. There are things that a person needs to do before dying.

One of the difficulties with Bill C-14 is that it groups together two realities under medical assistance in dying. One is covered by Quebec, namely euthanasia and end-of-life care, which includes palliative care; the other is assisted suicide. This choice is causing the conceptual confusion that leads to the impasse in our debates.

Assisted suicide is not euthanasia. The difference is that a person can be at the terminal phase of a degenerative disease without being near death. A person can suffer tremendously without being in a situation of reasonably foreseeable natural death.

The Supreme Court has asked legislators to provide a framework for assisted suicide. This is what the Supreme Court told us in section 7:

Insofar as they prohibit physician-assisted dying for competent adults who seek such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering, ss. 241 (b) and 14 of the Criminal Code deprive these adults of their right to life, liberty and security of the person under s. 7 of the Charter. The right to life is engaged where the law or state action imposes death or an increased risk of death on a person, either directly or indirectly. Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

That is what we have been asked to do, and that is what we need to figure out.

Criminal CodeGovernment Orders

May 3rd, 2016 / 11:55 a.m.
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Conservative

David Anderson Conservative Cypress Hills—Grasslands, SK

Madam Speaker, it is good to be here today to speak to Bill C-14. One of the principles we have in the House is that legislation is best built on a very solid foundation, and this bill does not have that.

What the Supreme Court ruled years ago on the Rodriguez case was very clear. However, just over a year ago, as with so many other decisions and so many other directions, the Supreme Court reversed itself. If it had really good underlying reasons for doing that, it would have been fine, but the justification for it was very interesting. It was a mistake in perception as set forward by the Supreme Court. The justices called it a changing matrix of social and legal facts which brought them to their conclusion. I and others are concerned that this makes our laws, including the interpretation of charter rights, dependent upon the opinions of a very small group of people. I will talk a bit more about the matrix of social and legal facts in a few minutes.

From my perspective, this is not an improvement. Many of my colleagues on both sides of the House have shared their concerns about Bill C-14, with some supporting it and others opposing it. However, a number of things are missing in the bill, and we need to have further discussion about. I heard a few comments earlier about the timeline, how pressured it was, how we needed to get this done and that this basically was prohibiting us from taking the time needed to discuss these things a bit further and with a bit more depth.

There is no clear definition of what irremediable means. The bill talks about that being the requirement for someone to qualify for physician-assisted dying.

I am concerned about the expansion of this process to nurse practitioners, so it would not just include physicians. People have asked why medical personnel are even involved with this. They have asked whether there is not some other place this can be done so people do not have to be concerned that when they go into the hospital for medical care, rather than receiving a positive side of medical care, they receive a very negative side of it.

There is a criminal exemption for those who perform euthanasia, but there is no protection for those who do not want to participate. A number of people are very concerned about what is called conscience rights and the lack of protection for that in the legislation.

There is a lack of clarity around psychological conditions and how that may come into play with this issue. One of the things that really concerns a lot of people is the lack of a vulnerability assessment, taking the time to find out if people are being pressured or whether there is some vulnerability that is bringing them to the point where they have made a decision that may be wrong for them.

Some people have called for a prior judicial review. There is no mention of that in the legislation.

Also, there is a lack of clarity on data collection. This has been an issue in a number of areas. Will we see good data collection? Will someone keep a good set of records on what goes on with this process?

We often have heard the concern that there is no clear commitment to palliative care. We just heard a member from the government talk about this. The Liberals made this commitment during the election campaign. They felt it was within their jurisdiction to promise $3 billion toward palliative care, but now, in the House, we hear them talk about how other jurisdictions are responsible for this. It sounds as if the Liberals are trying to avoid their responsibilities for this.

I would like to go back to the Supreme Court decision. It turned back the former position. It reversed it and it left us with an open field when it came to the issue of assisted suicide or assisted dying. The only thing the Supreme Court said in its ruling on Carter was that the person needed to consent and that the person needed to have a grievous and irremediable medical condition causing enduring and intolerable suffering. If we look at that, we see it leaves that whole area very open.

As I said earlier, good legislation should have a good foundation. I do not believe this does because of the Supreme Court decision. The foundation is the Carter decision and it hardly qualifies as a stable base on which to create good legislation.

I do not suppose we will get this done today, but we will come back at another stage on this bill. However. I would like to take a few minutes to talk a bit about the Supreme Court's recent decision in Carter v. Canada. It obviously is a very controversial decision and touches on a sensitive issue for many Canadians because there are very deeply held beliefs on both sides of this issue.

The Supreme Court acknowledged that the prohibition on assisted suicide was in general a valid exercise of federal criminal law. It also decided that the law went too far and it did not apply in cases where a competent adult with a grievous medical condition could consent to the termination of his or her life. I believe this decision is disturbing for a number of reasons.

The first is that the court ignored parliamentary consensus. In its decision, it claimed that the reversal from its earlier position in Rodriguez v. B.C. was necessary because of a different matrix of legislative and social facts. Yet, the purported differing matrix ignores the clear and unchanged parliamentary consensus opposing assisted suicide.

Between 1991 and 2012, nine private members' bills were introduced in the House of Commons, all seeking to amend the Criminal Code to decriminalize assisted suicide or euthanasia. Six were voted on and all of them failed to pass. When considering the matrix of legislative facts, the court gave weight to legislative developments in Belgium, Switzerland, Oregon, Washington, and the Netherlands, but it completely ignored the legislative record of Canada's Parliament.

Second, the court found no societal consensus in Canada on this issue. In her decision at the trial level of Carter v. Canada in the Supreme Court of B.C., Justice Smith wrote, “As to physician-assisted death, weighing all of the evidence, I do not find that there is a clear societal consensus either way”. Clearly whatever the change in that matrix of legal and social facts entails, it did not include a clear consensus from the people of Canada”.

This lack of consensus remains unchanged in the 22 years since the Rodriguez case in which the court stated, “No consensus can be found in favour of the decriminalization of assisted suicide. To the extent that there is a consensus, it is that human life must be respected”.

Clearly, the court found no consensus among western countries. While insisting again this matrix of legislative and social facts had changed since the last Supreme Court ruling on the issue, it acknowledged that physician-assisted dying remained a criminal offence in most western countries. Regardless, it chose to align itself with the minority of jurisdictions that allowed it.

I believe the court misinterpreted Parliament's objective in prohibiting assisted suicide. In its ruling, it put significant weight on the parliamentary objective of two sections, section 241(b) and 14 of the Criminal Code, which prohibit assisted suicide. The court asserted that these sections were put in place only to fulfill the state interest in protecting the vulnerable. However, in the earlier court case with Rodriguez, the court had said the objective of this section was not simply “protecting the vulnerable”, but also “preserving life”.

It had written, “In this case, it is not disputed that in general s.241(b) is valid and desirable legislation which fulfils the government's objectives of preserving life and protecting the vulnerable”. This position was reaffirmed several times.

By insisting that in Carter the purpose of section 241 was only to protect the vulnerable, the Supreme Court was able to conclude that this prohibition put people outside this class and that there were people who did not need to be protected by it. The court's conclusion was that the current law was over broad and grossly disproportionate to its objectives. That allowed it to say that Parliament needed to establish safeguards to ensure that those who truly wanted to be euthanized would be able to do that.

That interpretation tramples on the intention of Parliament to preserve life. Had it considered the full purpose of these sections of the Criminal Code rather than just that one objective of protecting the vulnerable, I think the outcome would have been very different.

I would make one final point before my time runs out. The court really leaves the definition of irremediable open to patient interpretation. The court decided that irremediable did not require the patient to undertake treatments that were not acceptable to them. In other words, although treatment may be available, the condition still qualifies as irremediable if the treatment is not acceptable to the patient.

I wanted to express my concerns. However, I think we will come back to some of the things the Supreme Court touched on as well in terms of the right to die being conflated with the right to life and some of the other issues.

Criminal CodeGovernment Orders

May 3rd, 2016 / 12:10 p.m.
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Liberal

Dan Vandal Liberal Saint Boniface—Saint Vital, MB

Mr. Speaker, I am privileged to rise in this chamber in support of Bill C-14, medical assistance in dying.

I am in favour of the bill, not only because it was mandated by the Supreme Court of Canada, but for very personal reasons. I believe it is bill, a policy, that respects the rights of individual Canadians who are suffering unbearable pain. It respects their right to die a peaceful death.

I rise today to speak in favour of this bill on medical assistance in dying, not because of the Supreme Court's decision to strike down the criminal law banning medical assistance in dying, but rather for very personal reasons.

To begin with, the bill refers to medically assisted dying. It is not referred to as medically assisted suicide. My common definition of suicide, and I believe it is society's definition, is intentionally taking one's own life when death is not imminent. In the case of Bill C-14, there are clear conditions that would qualify an individual for medical help in dying. This would include, of course, the reality that death is imminent for that individual.

Henceforth, I believe we should stop calling it suicide because it is clearly not suicide in the common form of our understanding. I also believe that there is no parallel with the very sad and tragic suicide epidemic that is occurring in indigenous communities across our great country. In my mind, one is an apple and one is an avocado. They should not be compared.

The whole debate around medically assisted death is deeply personal and has led to some very emotional discussions. For me, it has led to much personal reflection. Like many Canadians, like many people in these chambers, I have seen too many family members and friends suffer excruciating pain needlessly when death was imminent.

Very personal for me was an experience last August 2, the same day that the federal election was called, when my mother passed away. She was 96 years old and she had been living alone for the last 20 years. She had been living bedridden and in pain in a care home for the last five years.

My mother was a religious person and had a special relationship with her god. She prayed every day. She scolded me for not attending church as often as I should. Over the last 20 years her body deteriorated, but her mind and hearing stayed sharp. Over the last 10 years, my mother shared with me her desire to have her life end. Medical advances had helped her to live longer, but her quality of life had severely deteriorated. She had become completely bedridden in the last five years and, in the last four years, malignant masses and tumours had developed throughout her lower body. Constant pain set in, and pain protocol was established. My mother, tough as nails, continued to breathe, pray, and hope that God would come and take her away. The praying and hoping continued for years and years.

My mother was of sound mind. She was a religious person who was at peace with her god. Families, nuns, and a priest would visit her faithfully. They gave her comfort, but she continued to express to me that she wanted to die peacefully and comfortably. She wished that there was a way to end the unbearable physical pain that could no longer be managed regardless of the care she received. I wish she could have had that choice, and she should have had that choice.

My personal feeling is that the legislation does not go far enough. I would have preferred that those who are experiencing enduring and intolerable suffering, with no chance of ever improving during their lifetime, be allowed the opportunity to access medically assisted dying, under the strict conditions that we have imposed in the bill.

However, I also understand that the legislation shifts the paradigm in such a profound way that in the future we will be making reviews. The law will be improved, and evidence will be collected. I hope that myths will be dispelled, and individual human dignity, self-determination, and choice will be nurtured further.

This choice is the basis of our discussions today. We hope to offer this choice to individuals who, in their last moments on earth, are experiencing intolerable physical suffering as a result of a grievous and irremediable medical condition. The debate is not about suicide. It is about trying to ensure the dignity of the dying person. We make choices about the care we receive throughout our life, and it is unfortunate that this choice is taken away from us at the end of our life.

It is true that the Supreme Court's decision in Carter v. Canada made physician-assisted death legislation necessary. I believe many of us have spoken to the fact that the timelines are anything but ideal. Would I have preferred to have another six months of debate, consultation, and discussion in order to make this reality? Of course, I would have preferred that. I believe every member in these chambers would have preferred that.

However, it is also true that there are people who feel that this legislation does not go far enough. There are also people who are opposed to physician-assisted death entirely. I have had many discussions with constituents on this issue.

I represent Saint-Boniface—Saint Vital, a riding with many Catholic constituents, and they have all made their views very clear.

Everyone, regardless of their position in this debate, wants to ensure the protection and dignity of individuals. The notion of dignity, which has come up several times in these chambers, is highly individual. Personal history, personal beliefs, and personal health situations all define what dignity means to the individual, and I might also add the right to self-determine.

Dying with dignity is a personal choice that needs to be respected. This bill is necessary. As a society, we must make sure that the best care possible is available to all our fellow Canadians.

This is an important moment in our history, where consultation has not only played an important role in the past but will play an important role into the future. I applaud the government for undertaking vast consultations across Canada and abroad to ensure that this legislation defends people's choices and freedoms in a way that protects the most vulnerable. It also supports personal convictions of health care providers.

I further congratulate the government on taking the time to continue the very important consultations and discussion surrounding mature minors, people who suffer from mental illness, and people who would like to arrange advance directives.

I would like to add that I fully support the government's commitment to a full range of options for quality end-of-life care, including palliative care, an area in which the St. Boniface Hospital, in my riding, is a leader. This bill establishes responsible measures to promote a standard approach to medical assistance in dying across Canada. It recognizes the inherent value and the equality of every human life.

The proposed legislation sets the framework for medically assisted dying across the country. It also provides a review in five years. It is balanced, responsible, and a very compassionate response to a very difficult, very personal issue.

Criminal CodeGovernment Orders

May 3rd, 2016 / 12:25 p.m.
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Liberal

Joël Lightbound Liberal Louis-Hébert, QC

Mr. Speaker, rarely in this parliamentary life are we called upon to debate such an important subject, an issue that requires such seriousness, rigour, sensitivity, and compassion.

With that in mind, I want to begin by commending the professionalism of all my colleagues in the House, who, from the beginning of our study of Bill C-14, have set partisanship aside and have made this debate more of a discussion, rather than a debate per se.

The subject that we are being asked to deal with today is one that invariably raises sincere emotions and touches a nerve with all of us, not only here in Ottawa, but all across the country. Developing a framework for medical assistance in dying means striking a balance between implementing a right with such irrevocable consequences on the one hand, and protecting vulnerable people with regard to that right on the other hand.

What right are we talking about? It is the right of a competent adult, who freely consents and suffers from a grievous and irremediable illness causing intolerable suffering, to die at the time of their choosing and with the necessary assistance and medical support. This is a right guaranteed by section 7 of the Canadian Charter of Rights and Freedoms, which states that everyone has the right to life, liberty, and security of the person. This right was unanimously recognized by the Supreme Court of Canada on February 6, 2015, in the Carter case. This right protects life, because the absolute prohibition in section 14 and paragraph 241(b) of the Criminal Code on aiding or counselling another person to commit suicide made individuals suffering from grievous and irremediable illness feel that they were forced to take their own lives prematurely out of fear that the progression of their illness would make it impossible for them to do so and that their suffering would become intolerable.

The absolute nature of the blanket prohibition on medical assistance in dying deprived people of a portion of their life that they could otherwise have enjoyed. This right also protects the liberty and security of the person.

As the Supreme Court explained in paragraph 66 of its decision in Carter, by denying people the right to request a physician’s assistance in dying, the Criminal Code is interfering with “their ability to make decisions concerning their bodily integrity and medical care”. The Criminal Code thus trenches on liberty. Since that option was not available to Canadians, they had to endure intolerable suffering, which also impinged on their right to security of the person.

Although the Supreme Court recognized that medical assistance in dying is one of the rights guaranteed under section 7 of the charter, those rights are not absolute. Limitations and restrictions can be placed on those rights, according to the principle set out in Oakes, which is based on section 1 of the charter. The principles in question are those of minimal impairment and an important government objective.

Bill C-14 must be examined through that lens. Although people with grievous and irremediable medical conditions should be given the right and means to die with dignity, that is not an absolute right. We also need to protect vulnerable people, people who are unable to provide informed consent, and people who could be subject to undue pressure.

My position could evolve, as I continue to listen to my colleagues and constituents and as I continue to reflect on this topic.

However, I think that it is a good idea to exclude minors and people with mental illness from this bill. Like many members in the House, and like the Quebec National Assembly when their work was complete, I think that including minors would have created some virtually insurmountable problems with respect to consent, as my Conservative colleague from Louis-Saint-Laurent pointed out.

With respect to people with mental illness, I think that in the absence of full and informed consent, the sanctity of life must prevail. Since such consent is nearly impossible to obtain under the circumstances, it is prudent to exclude people with mental illness from the bill.

Conversely, I think that some aspects of the bill raise some questions. One aspect is the notion of a death that is reasonably foreseeable, which the government wants to introduce, even though this notion was not in the Carter decision.

The court recognized that not having access to medical assistance in dying could cause intolerable suffering and, therefore, impinges on the individual's right to security of the person.

I also think that individuals who are suffering from a grievous and irremediable medical condition but who are not at the end of their life, which unfortunately is the case for many people in Canada, are therefore being deprived of the right to security and integrity of the person.

I am afraid that with this addition, one of the appellants in Carter would not have had access to medical assistance in dying. I am not certain either that such a restriction minimally impairs a charter right, as seen in Oakes.

Second, although I am aware that there is a need for robust protections and that the bill includes many, which is a good thing most certainly, I have doubts about the protection provided by the provision in paragraph 241.2(3)(h), which stipulates that immediately before medical assistance in dying is provided, a patient must reiterate his or her free, informed, and full consent.

Doctors would have to stop administering medication, such as morphine, which eases the patient's pain, in order to obtain this full consent. I fear that this provision will create excessive suffering for individuals at a moment when they want to gently leave behind their overwhelming suffering.

Third, I was not convinced that advance consent was a good idea, but I was enlightened by my colleagues. Although I am still not convinced, I welcome the government's willingness to study the issue further.

Lastly, like many of my constituents, I think medical assistance in dying must be brought into the broader context of end-of-life care. To that end, I also welcome the promise to invest $3 billion over four years in home care.

I believe that, like the bill, this is a step in the right direction, but it is not the final destination. I will vote in favour of this bill at second reading, and I encourage my colleagues to do the same.

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May 3rd, 2016 / 12:35 p.m.
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Conservative

Alice Wong Conservative Richmond Centre, BC

Mr. Speaker, today I rise to discuss Bill C-14.

As we well know, Bill C-14 is the government's response to the Supreme Court ruling in the Carter decision last February. The court gave the government a total of 16 months to form legislation, so here we are in the House today, debating the bill.

I was pleased to see that the bill included many recommendations provided by my Conservative colleagues in their dissenting report from the special joint committee report on this issue. However, I do not believe the bill in its current form is good enough.

I have benefited from listening to my colleagues' speeches, and appreciate the passion each has shown as they discuss Bill C-14 in the House. Indeed, I have made my own consultations with various interested parties in my riding of Richmond Centre, and look forward to sharing them with you.

We have received many suggestions and comments on the legislation, both from parties that believe the bill is too restrictive and those who believe it is not restrictive enough. Indeed, I am rather impressed that there was significant public interest on this bill, and I would like to continue to encourage people in Richmond Centre who have not given their thoughts on this matter to write to myself or my office.

My voting position on second reading will be carefully considered from a balance of available information, including from the consultations I have held with interested stakeholders in my riding.

To begin, I would like to share some of my personal experiences. During my time as the Minister of State for Seniors, I had the opportunity to work with many groups who are devoted to protecting our most vulnerable and ensuring quality palliative care. The unfortunate reality is that there are many seniors who are not provided with effective end-of-life care. Instead, they are subject to elder abuse and are often pressured into making decisions to avoid becoming a burden to their families. This is tragic. It is absolutely imperative that we ensure that there are safeguards to protect seniors against such elder abuse.

A potential safeguard to protect financial abuse of elders, which is a very common and unfortunate form of elder abuse, is to simply prohibit any independent witnesses from financially profiting at all from the will or the estate of those who requested physician-assisted suicide This was actually a recommendation from a group of constituents I met with recently. They pointed out that in the bill, the independent witnesses that have to sign the documentation to enable the physician-assisted suicide only have to know or believe they are not a beneficiary under the will of the person making such a request. Again, this is simply not enough.

Back in my riding of Richmond Centre, I have been an active member of the Richmond Rotary Club. This club was instrumental in building the first hospice in Richmond. It was there that I and my fellow Rotarians witnessed first-hand the benefits quality palliative care can bring people. Life is valuable at every stage. One of my primary concerns with physician-assisted suicide is that it will only complicate end-of-life decisions. Individuals who are sick or need additional care will see themselves as a burden, and choose death to avoid placing further expectations on family members.

Instead, we need to be supporting family caregivers and demonstrating that every life is valuable.

As others have noted, there was no allocation in the budget for palliative care services. This is totally and absolutely unacceptable. This issue is quickly becoming more about access to death than access to life. It is absolutely essential that the government make a commitment to strengthen palliative care and encourage citizens to seek such care first. Palliative care provides death with true dignity and not a forced death, which is what physician-assisted suicide is.

Last year, I had the opportunity to meet with organizations such as the Council for Canadians with Disabilities, the CCD. I met with its representatives to discuss their concerns and the importance of protecting individuals with disabilities. More recently, they were able to appear as witnesses at the special joint committee to discuss their views on possible legislation. The CCD was very concerned with the recommendations provided by the committee and commented, “The permissive approach would put vulnerable people at risk”.

We cannot ignore the needs of our most vulnerable. It is crucial that the legislation reflect the concerns of groups such as the Council for Canadians with Disabilities to ensure all Canadians are protected.

I would like to share a few of the comments I have heard from my constituents over the past several months. I will emphasize that my repeating these comments in the House today does not mean that I endorse all of them, but rather, this is a reflection of the variety of comments received. I know as an elected figure this may be hazardous as I may be quoted out of context; however, it is my duty to ensure that these voices are heard.

A primary theme as a result of my consultations is that Bill C-14 would only decriminalize the act of physician-assisted suicide as performed by medical practitioners.

I will add that there would be no effects or changes to the Canada Health Act, nor would it instruct our provinces to provide this procedure as something to be covered under provincial medical insurance plans. In my home province of British Columbia, this is the medical services plan, the MSP.

In general, there seemed to be a considerable amount of confusion about whether the provincial governments would actually provide this procedure and whether they would indeed pay for it.

One stakeholder group mentioned it wished to invoke the notwithstanding clause to maintain the previous provisions of the Criminal Code. This group found the terminology of what constituted a terminal illness to be a slippery slope and that unendurable pain could be mitigated with quality palliative care. As it realized that this was generally not a realistic approach with the existing government, it also mentioned that it was hoping for a robust protection for health care providers and facilities to act according to their conscience.

There were many other comments, but I have only 10 minutes for this speech, so I will state again that I have been pleased with the amount of interest we have received from engaged citizens and stakeholder groups on Bill C-14. I will be making my voting decision after giving the people of Richmond Centre the maximum period of time to send their feedback.

I would like to end my speech with a short story. Many members of my family are health professionals. Even among those who are young, many desire to grow up to be doctors or nurses. When I ask my young nieces and nephews why they want to be a doctor, I always receive the same simple answer, “I want to save lives.”

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May 3rd, 2016 / 12:50 p.m.
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London West Ontario

Liberal

Kate Young LiberalParliamentary Secretary to the Minister of Transport

Mr. Speaker, I am pleased to speak to Bill C-14, which would enact a federal legislative framework to permit medical assistance in dying across Canada.

Medical assistance in dying is a deeply personal issue for all Canadians, as we have witnessed. As parliamentarians, we must consider a diverse range of views on this complex issue. I know that we all take this responsibility very seriously.

The starting point is, of course, the February 6, 2015 decision of the Supreme Court of Canada in Carter v. Canada. The court unanimously held that the criminal laws prohibiting physician-assisted dying interfere with liberty and security of the person by denying grievously and irremediably ill individuals the ability to make decisions concerning their bodily integrity and medical care, and leaving them to endure intolerable suffering.

The court also held that the laws deprive some people of life by forcing them to end their lives prematurely for fear that they would be incapable of doing so when they reached a point where their suffering was intolerable. The court accepted that the criminal prohibition on assistance in dying furthers a pressing and substantial legislative objective, that of preventing vulnerable individuals from being induced to die by suicide against their will in a moment of weakness.

However, the court concluded that a permissive regime with properly designed and administered safeguards was capable of protecting vulnerable people from abuse and error, and that the absolute prohibition went farther than necessary to achieve its objective. The court appropriately left the task of designing this new regime to Parliament.

The proposed legislation responds to the Carter ruling by enacting a new legal framework for access to medical assistance in dying, including the safeguards that the court called for in order to minimize the potential for errors and abuse.

The court did not define the term "grievously and irremediably ill", but the proposed legislation does define it in a manner that is consistent with these circumstances. Specifically, the person must be in an advanced state of irreversible decline in capability. The person must have a serious and incurable medical condition. The person must be suffering intolerably. The person's death must have become reasonably foreseeable, taking into account all of the person's unique medical circumstances.

Canadians would have the comfort of knowing that they would be able to get the assistance they need if they are suffering intolerably when their capacity declines as they approach the end of their lives.

Like so many honourable members who have stood in this house to debate this difficult legislation, I have my own personal story that makes this issue all the more relevant. My mother, Eleanor Anderson, spent over 10 years in a wheelchair after suffering a massive stroke at the age of 69. She had to learn to walk, talk, eat, everything right from scratch. Then it happened again, another stroke five years later. She fought back again, but with each stroke a little more of her was taken away.

She never wanted to feel helpless. During those years in a wheelchair, my mother would try her best to do everything on her own, whether it was dressing, loading the dishwasher, or simply wiping down the kitchen counter. During those years, she never wanted our sympathy.

Despite her tenacity, she knew the day would come when she could not fight any longer. She made it very clear to my father, to me, and my brother that if the time came and she was not able to do much more than lie in a bed, she wanted to drift away peacefully. As expected, what we all feared eventually happened.

She continued to have small strokes, losing mobility and function with each one, to the point that she could no longer sit up in her wheelchair, talk, or even eat. We were not even sure if she knew any of us anymore. She pulled out the feeding tube that kept her alive, to the point where the doctors said they wanted to insert a tube in her stomach. That was not the life my mother wanted, and so we said no. We had to let her go. Doctors agreed it was best, and said she would only last a few days.

We asked that she be moved to palliative care at another hospital. Ironically, they said they could not move her because she would not make it, that she would die en route, and so she lay in that hospital bed, and we watched her slowly starve to death.

She would last 12 days, and her death was anything but peaceful. It was the most excruciating experience I have ever been through, and nothing prepared me or my family for her death. I know my mother would have agreed that this legislation is a step in the right direction. She would have wanted to be able to communicate her desire to die with dignity. However, she would have also wanted her family to follow through on her wishes.

Twelve years later, my dad said to me, after catching an infection, “I just want to close my eyes and not wake up”. That is exactly what happened. He was gone two days later. He got his wish. However, I know that many people are not as fortunate, and it is for those people that we must be prepared to lend our voice.

Health Minister Jane Philpott said this in her speech to the House:

...every person, every story, is unique. However, much is shared in common: the hope to die in peace; the desire to be respected; and to have personal autonomy and dignity honoured by family and health care providers alike.

Minister Philpott went on to say that her experience as a family physician reinforced her sense that we must—

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May 3rd, 2016 / 1 p.m.
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Liberal

Kate Young Liberal London West, ON

Mr. Speaker, the minister went on to say that her experiences as a family physician reinforced her sense that we must “uphold the principles of palliative care, as well as respecting the rights of patients to make their own decisions about their care as they approach the end of life”.

Earlier this year, the minister met with provincial and territorial health ministers in Vancouver to launch discussions on a new multi-year health accord. Through the health accord process, our government will be making significant investments totalling $3 billion dollars to help deliver more and better quality home care services for Canadians. We expect that support for palliative care in a variety of settings, where patients can receive the ongoing care they need and deserve at the end of life, will be one of the priorities going forward. I agree that there is no doubt that care at the end of life should be there when people need it. We want all Canadians to have access to the best care possible.

The issues in this area are complex. However, I strongly believe that Bill C-14 has struck the right balance between competing rights and policy objectives.

I call on members of this House to support it.

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May 3rd, 2016 / 1:05 p.m.
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NDP

Christine Moore NDP Abitibi—Témiscamingue, QC

Mr. Speaker, I think it is very important to rise to speak to Bill C-14, today and on other days of debate.

As my colleagues probably know, I am a health care professional. I still work at the hospital a few times a month, mainly in emergency and intensive care. This is important to me. End-of-life care is very important, which is why I supported a motion that my colleague from Timmins—James Bay moved during the previous Parliament. That motion dealt with with a national palliative care strategy.

To begin, I would like to highlight two or three points form the Supreme Court decision that I think are particularly important to this discussion. The decision states:

...the prohibition [of medical assistance in dying] deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

And by leaving them to endure intolerable suffering, it impinges on their security of the person.

It is important to mention that the Supreme Court decision underscores the government's responsibility to address the suffering that people experience. It is also important to understand the difference between suffering and pain. Pain is a physiological reaction to stress, such as an injury. Suffering has to do with an emotional experience.

Take, for example, a very painful event such as childbirth. That pain is associated with a positive emotional experience, the birth of a child. That event does not necessarily cause suffering, but it does cause significant pain.

A person might also have a minor injury that can cause extreme suffering because of the emotional experience associated with it. I think it is important to make that distinction.

These days, we have excellent therapeutic ways to alleviate pain. Opiates were long used, but now we also have patient-controlled analgesic pumps. We can even offer continuous palliative sedation, similar to what intensive care patients receive when they are intubated to ensure that they do not feel any pain. There are a number of extremely effective ways of alleviating pain, in addition to non-pharmacological methods. We have a good range of treatments to offer patients who are in pain.

It is possible to alleviate the suffering that comes with an emotional experience such as the end of life or an end-of-life diagnosis without resorting to medical assistance in dying. In that case, palliative care is an option. The bill applies to adults with a serious and incurable illness, disease, or disability who are in an advanced state of irreversible decline in capability and whose natural death has become reasonably foreseeable.

Obviously, we are talking here about people who are at the end of their lives, people who need palliative care. The purpose of palliative care is to ease the suffering of both the patient and the family. Palliative care helps ensure that people are cared for properly, and that they have the help they need to get through the grieving process and the hardship associated with illness.

We want to take away all the pain, but we also want to provide support for the family.

Optimal palliative care helps not only the patient but also the whole family, so that the patient's death can be as peaceful as possible for everyone involved. We are going about things the wrong way by providing medical assistance in dying when the palliative care offered in Canada is not yet optimal.

When palliative care facilities are underfunded and need to try to drum up donations every year, they are unable to offer optimal palliative care. Most of these facilities can only take patients who are expected to die in less than three months. However, people can often live much longer than that with a terminal illness and they need a lot more support.

Moreover, in many rural areas, palliative care beds are reserved through surgical units. That means that nurses who are taking care of palliative care patients also have to take care of seven or eight other patients. Nurses are therefore unable to respond quickly or spend as much time as they should with the families, and the patient's death does not go the way he or she would like.

For people who do not have the means or who do not want to die at home, unfortunately the hospital is often the only other option when palliative care beds are not available. This is not an easy experience, and it can create suffering because patients do not always have all the support they deserve.

There has been a lot of effort in recent years to remove some natural processes from hospitals. One example would be the birthing centres that have been set up. The thinking is that it would be better for mothers to go through pregnancy and childbirth a little more naturally in a setting other than a hospital, as long as there are no medical complications.

The same thing is being done with death, which is a natural process. It is being taken out of hospitals to make the experience much more positive, in a place other than the medical setting of a hospital.

Hospices try to remove all traces of hospitals. They have hospital beds, but they try to use the patients' own bedding, have large windows, and help patients forget that they are not at home.

Unfortunately, no matter how hard the palliative care facilities work, they are often underfunded. For example, the Maison du bouleau blanc, in my riding, has four beds, only two of which are subsidized. It therefore relies on donations to maintain its other two beds. It has a large room with big windows and a shower, but this is the only room that the facility has been able to convert to an ideal palliative care room.

These people cannot afford nurses. The people who work there are extremely dedicated practical nurses. However, they have some legal limits. For that reason, all the protocols regarding doctors working with palliative care facilities had to be updated, in order to ensure proper care for the patients.

We could address a number of shortcomings and avoid making the patients suffer. If someone who receives a terminal diagnosis knows that they will receive good palliative care as their condition worsens, they may not choose to take their own life prematurely. This would therefore help protect the right to life.

However, as long as do nothing on palliative care, we are working backwards. We cannot reverse the life-based medical model to allow for medical assistance in dying if our palliative care services are not as good as possible or accessible to all Canadians, regardless of where they live, even if they live in a remote region.

Since I am out of time, I would be happy to take questions from my colleagues.

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May 3rd, 2016 / 1:15 p.m.
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NDP

Christine Moore NDP Abitibi—Témiscamingue, QC

Mr. Speaker, as I said in my speech, the government chose to leave people who are not at the end of their lives out of Bill C-14.

In some cases, individuals might want medical assistance in dying. One example that comes to mind is people on hemodialysis, an onerous and time-consuming treatment. After 10, 15, or 20 years of such demanding treatments, people might be worn out and might want to stop. All patients have the right to refuse treatment. A patient who refuses this treatment will die in the short term, but continuing to receive the treatment will not cause death. That means that the patient's end of life is not reasonably foreseeable, and he or she may therefore not be covered under this bill. People may want medical assistance in dying, but some of them are not covered under this bill as written. That must be fixed.

I think we should concentrate on palliative care first and foremost. Allowing medical assistance in dying makes no sense unless we have optimal palliative care in place.

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May 3rd, 2016 / 3:15 p.m.
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Liberal

Arnold Chan Liberal Scarborough—Agincourt, ON

Mr. Speaker, I am pleased to rise to speak to Bill C-14, the government's response to the Carter decision that we have recently dealt with by tabling this particular piece of legislation.

I wish to state at the outset that I will be supporting the bill, but with some reservations. I will explain why I believe the bill deserves support, but by the same token, I believe that somehow in a future Parliament the bill could go further.

I intend to engage in this discussion by going through three thematic components in the brief 10 minutes I have to make my contribution to this important debate. I know this has been at times an emotional issue for parliamentarians, but in the three thematic components, I wish to give my rationale for my support at this time.

The first of the three themes looks at the moral considerations that many members and much of the broader public have expressed. Second, I want to discuss perhaps more fulsomely our duty as parliamentarians to respond to issues of constitutionality, particularly when they are challenged in the courts. Third, in the short remaining time I will have, I wish to express some personal thoughts on this as it impacts me directly.

First, I want to thank many constituents in my riding of Scarborough—Agincourt for their interventions on this subject. This has been an emotional matter, and I would have to state on the record that the overwhelming majority of constituents who reached out to me are opposed to the government introducing Bill C-14. That has been primarily on moral grounds. They feel that allowing physician-assisted death is essentially tantamount to murder.

In the opportunities I have had to discuss this matter with my constituents, I made it clear that Parliament is under a positive obligation to respond to the decision in the Carter case. If Parliament does not present some form of legislation, the consequence of its failure to do so would mean that the provisions of section 14 and subsection 241(b) of the Criminal Code would no longer be operative as of June 6. We would essentially be left in the situation of a legislative vacuum. It is important to put a regulatory framework around physician-assisted death.

As I pivot from the issue of morality to the issue of our responsibility as parliamentarians, I want to raise the point that while morality is important, and this has been a theme discussed in the House, ultimately we as parliamentarians must first make sure that we put in laws that pass the constitutional test. Where the Supreme Court of Canada has rendered a decision indicating that something is not constitutional, that it is a breach of some form of the constitution, whether on jurisdictional grounds or on grounds under the charter, Parliament needs to respond. In my view, that is what the government is doing in Bill C-14, under a very difficult timeline. That is perhaps why there has been a decision to introduce Bill C-14 in a relatively controlled and restrictive manner. It is reflective of the fact that we are under a very tight time obligation.

Therefore, I understand why the Minister of Justice, the Minister of Health and others, who have done yeoman's work in this regard, have taken initial steps to make sure it meets the constitutional test set out by the Supreme Court of Canada. However, in my view, it does not necessarily go far enough.

I want to pay tribute to the ministers and to all the other many parties and Canadians who have contributed to the debate. I note that there was incredible work done by the Special Joint Committee on Physician-Assisted Dying, led by Senator Ogilvie and the member for Don Valley West. I want to pay tribute to all the members who participated in that committee.

I want to note the contributions of the federal external panel, the provincial-territorial expert panel, and the many stakeholders and Canadians who have contributed to this very difficult debate.

I would note, though, that not only have many of my constituents expressed concerns with respect to this particular bill, but in some specific instances they have asked us to consider invoking the section 33 notwithstanding clause found in the charter, which of course is the legislative override provision. I would view that as a more sophisticated way of saying they oppose it and that ultimately parliamentarians should please consider overriding the charter rights of certain individuals by invoking or using the notwithstanding clause.

I would say to those individuals who have expressed that particular feeling that this is something we have to do and tread upon very carefully, particularly where we are potentially treading on rights that have been protected under the Canadian Charter of Rights and Freedoms. I would submit respectfully that it is important we do so in a manner that follows the tests that are similarly found in section 1 that were ultimately articulated in the Oakes decision that deals with the judicial override clause that is found in the charter.

Under Oakes, there are essentially three tests that need to be met, and if any one of those tests fails, namely in dealing with the judicial override, then one would not be able to invoke section 1, and I would argue that one would have to use the same principles under section 33 in exercising the legislative override. Those three tests basically deal with rational connection, that the impairment is done in as minimal a way as possible, and that we look at the deleterious effects and salutary benefits of any limitation that is imposed under section 1.

Typically, in application of section 1 of the charter in most instances, the failure falls under the second test, that the impairment is not as minimal as possible. Certainly, that was the basis in which the section 1 test was applied in Carter and which the court found that the proposed absolute ban on physician-assisted death did not meet the minimal impairment test. The court had carefully gone through the trial judge's analysis and concurred with the trial judge's position with respect to the application of section 1.

In terms of whether we would consider invoking section 33, as I mentioned already, this Parliament, this House of Commons, has never exercised section 33 as a legislative override, and I would argue that we too should be extremely careful. That is the test that we need to apply as parliamentarians in terms of determining whether we feel it is appropriate to use the legislative override.

As I mentioned before, the bill seeks to meet in a very expedited fashion a court-imposed time challenge and to deal with the suspension of the declaration of invalidity under sections 14 and 241 of the Criminal Code of Canada. We must do so by June 6.

As I have indicated before, I will be providing my support for the bill, but I would argue that there are a couple of additional things that we as a Parliament need to consider in the future. These were articulated quite clearly in the report from the special joint committee of the Senate and the House of Commons.

My first issue is that the bill currently does not deal with the issue of advance directives. I am sympathetic to those Canadians, particularly those who are suffering from diseases like ALS and others, who may still be in quite good shape at the present time, but at some future point, when they are getting close to their end-of-life situation, will not be able to express their particular consent. In my view, the issue of a clearly articulated regulatory framework that allows for advance consent should be considered.

I am also—

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May 3rd, 2016 / 3:30 p.m.
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Liberal

Nicola Di Iorio Liberal Saint-Léonard—Saint-Michel, QC

Madam Speaker, before I participate in the debate at second reading on Bill C-14, concerning medical assistance in dying, I want to tell the people faced with making difficult end-of-life decisions and their loved ones that I am thinking of them.

Everyone knows that medical assistance in dying is a complex, delicate, and extremely personal issue. Since the Supreme Court ruled in the Carter case last year, Canadians have been taking part in this national debate. This issue continues to be debated and seriously considered around the world.

I would like to share with my colleagues what is happening elsewhere in the world. Almost everywhere, the deliberate taking of a life or aiding someone to end their life are serious crimes punished by lengthy sentences. As many people know, Canada is not alone in legislating to authorize medical assistance in dying.

Oregon, Washington, Vermont, and California are examples nearby. A little further away, Colombia, Belgium, the Netherlands, and Luxembourg have legislation authorizing one type or another of medical assistance in dying. The provisions on safeguards, controls, and reports, which are all found in Bill C-14, are similar.

Usually, requests for medical assistance in dying must be voluntarily submitted by the patient in writing. In many cases, this must also be done in the presence of independent witnesses. The patient must obtain a second opinion from an independent doctor and must wait a certain amount of time between the day the written request is submitted and the day that the medical assistance in dying is provided.

Colombia has a unique approval process for requests for medical assistance in dying. Every hospital has interdisciplinary committees to assess such requests and support the patients and their families throughout the process.

Nearly all of the regimes we have looked at include a mandatory monitoring system in which independent committees collect information to monitor the situation. That information is then used to publish periodic public reports on medical assistance in dying.

The safeguards and controls set out in various statutes are relatively consistent. However, there are differences in the types of medical assistance in dying that are authorized and the circumstances in which medical assistance in dying is authorized. The differences in terms of who is eligible for medical assistance in dying and the way that assistance can be provided fall along a continuum.

On the one hand, we have the four U.S. states, which I mentioned earlier and which have enacted laws: Oregon in 1997, Washington in 2008, Vermont in 2013, and, more recently, California in 2015. In these states, a mentally competent adult 18 years of age or older can receive the assistance of a physician to die, provided that their request is voluntary and this person is suffering from a terminal disease, defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.

In these U.S. states, just one doctor may prescribe a substance that the patient administers to put an end to their life at the time of their choosing. This is what we commonly refer to as physician-assisted suicide. Voluntary euthanasia, in which the physician administers a substance that causes the death of the patient, is expressly prohibited. Patients are also not able to submit an advance directive.

In Colombia, a ministerial resolution was drafted in response to two rulings by the country's constitutional court. The resolution contains eligibility criteria similar to those of the U.S. states.

It limits eligibility to adults who have an incurable disease, which is defined as a serious, progressive, and irreversible disease, or a pathology that will lead to death within a relatively short time frame. It requires a specific prognosis of six months, in other words, the assurance that death is expected relatively soon. Unlike the U.S. states, Colombia authorizes only euthanasia. A doctor must administer the substance that will cause the patient's death.

At the other end of the spectrum are Belgium, the Netherlands, and Luxembourg. In those three countries, patients can access medical assistance in dying if they are experiencing intolerable or unbearable physical or mental suffering caused by a serious incurable illness and if there is no possibility of improvement. Patients do not have to be dying or suffering from an illness that puts their life in danger in order to be eligible. In other words, physician-assisted suicide and voluntary euthanasia are authorized in those countries.

Although medical assistance in dying is provided only to adults in Luxembourg, minors as young as 12 can seek medical assistance in dying, with their parents' consent, in the Netherlands. In Belgium, adults and emancipated minors can seek medical assistance in dying in similar circumstances. In 2014, Belgium expanded its eligibility to include children of all ages, but only if their death is likely to occur in the short term and their suffering is physical.

The experiences and lessons learned by the Benelux countries were closely examined. For example, the law in the Netherlands authorizes requests for patients who no longer have the ability to express their wishes. However, research suggests that doctors are generally not prepared to euthanize such patients.

Consideration was also given to the Benelux countries' experience regarding patients who are suffering intolerably solely because of a mental illness. This is a very controversial issue. Evidence shows an upward trend in the percentage of people who seek euthanasia solely because of mental illness, and experts are starting to express their concerns about the fact that medical assistance in dying under such circumstances is becoming increasingly common. For example, in Belgium, people have been euthanized because of intolerable suffering resulting from depression, anorexia, blindness, fear of a disability or further suffering, and the pain caused by the lost of a loved one.

Many people fear that such broad access to medical assistance in dying can present real risks for people who are lonely or isolated and those who do not have any social, economic, or community support. It could also reinforce prejudice regarding the quality of life of seniors, people who are sick, and people with disabilities.

Our government sought to learn from the experience of other jurisdictions. The government is committed to continuing to examine the more general issues, and it will continue to observe what is being done elsewhere in the world in terms of medical assistance in dying.

I support Bill C-14, which was introduced by our government. Once this bill is passed, it will alleviate the suffering of those covered by its scope and will allow people to die with dignity.