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, an excellent resource from 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 CodeGovernment Orders

April 22nd, 2016 / 10:05 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 second time and referred to a committee.

Madam Speaker, I am pleased to rise in the House to address Bill C-14, which would, for the first time in our country's history, create a federal legislative framework to permit medical assistance in dying across Canada.

Before I begin my remarks today, I want to acknowledge that medical assistance in dying is a challenging issue for all Canadians. It is difficult. Death and dying are not things that we are comfortable talking about in our society. We all have stories of our families and those people close to us, which touch us and challenge us in this regard. Nonetheless, since the release of last year's decision in the Supreme Court of Canada in the Carter case, this government has not shied away from having difficult conversations with Canadians.

Equally, I want to recognize that we did not wrestle with these issues alone. I commend the dedicated efforts of all the individuals and organizations that have made tremendous contributions to the public debate and dialogue around how we implement medical assistance in dying in Canada.

I do not have time to include in my remarks today all the names of the people who have been involved, but I would first like to recognize the members of the special joint committee who exemplified dedication and service to Canadians in delivering a comprehensive report under extremely difficult and tight time constraints. Their task was not easy, but they rose to the challenge.

I also want to acknowledge the work of the federal external panel and the provincial expert advisory group, as well as the thousands of individual Canadians, experts, and organizations that participated in these consultations.

I would like to stress how invaluable all of this input and evidence was in the development of the bill, as explained and referenced in the Department of Justice legislative background on Bill C-14, which I will be tabling later this morning and which will be available on the Justice Canada website at the time. The bill that is before the House today is the culmination of all of these efforts.

From the start, we have known from the Supreme Court of Canada's unanimous Carter decision, that it is not about whether or not to have medical assistance in dying; it is about how we will do it. We are keenly aware of the diverse perspectives on this issue, and each of them raises worthy considerations. We have also looked carefully at the evidence from other jurisdictions that permit medical assistance in dying.

With all of this in mind, and in appreciating the limited time frame we have had to respond to the Carter decision, our government has chosen an approach that respects both the charter and the needs and values of Canadians.

First, it would permit physicians and nurse practitioners to provide medical assistance in dying, so that patients who are suffering intolerably from a serious medical condition, and whose death is reasonably foreseeable given all of their medical circumstances, can have a peaceful death and not be forced to endure slow and painful suffering.

Second, it would commit to study the other situations in which a request for medical assistance in dying might be made; situations that were not in evidence before the court in the Carter litigation and were beyond the scope of its ruling.

This evidenced-based approach will allow us to respect the autonomy and the charter rights of Canadians while ensuring robust protections for vulnerable persons. It is the right approach for our country.

Our government, under the leadership of my colleague, the Minister of Health, will be bringing forward non-legislative approaches to support the bill, including an end-of-life care coordination system for linking patients to willing providers, and in the context of a new health accord, we will promote the improvements to palliative care across the country.

To ensure public safety, the bill would re-enact section 14 and subsection 241(b) of the Criminal Code, but provide exemptions to permit medical assistance in dying for eligible persons. The bill would limit eligibility to persons 18 years and over who are capable of making decisions with respect to their health.

The bill would require that the person be competent at the time that the medical assistance in dying is provided, which practically means that advance directives would not be permitted. Requests must be fully informed and free from coercion, to ensure they reflect the person's true wishes.

The bill would also require that the person have a grievous and irremediable condition, which is defined in the bill. The definition is intended to be applied flexibly by physicians and nurse practitioners who can use their training, ethics, and good judgment to apply the criteria.

To be clear, the bill does not require that people be dying from a fatal illness or disease or be terminally ill. Rather, it uses more flexible wording; namely, that “their natural death has become reasonably foreseeable, taking into account all of their medical circumstances”. This language was deliberately chosen to ensure that people who are on a trajectory toward death in a wide range of circumstances can choose a peaceful death instead of having to endure a long or painful one.

As the Supreme Court of Canada noted, Gloria Taylor was dying from a terminal illness and would be eligible. So too would Kay Carter, who was 89 and according to the court suffered from spinal stenosis, which itself does not cause death but can become life-threatening in conjunction with other circumstances such as age and frailty.

This approach to eligibility responds directly to the Supreme Court's ruling, as it noted in paragraph 127:

The scope of this declaration is intended to respond to the factual circumstances in this case. We make no pronouncement on other situations where physician-assisted dying may be sought.

In our view the people captured by the court's ruling would be eligible under the proposed legislation. Moreover, the legislation proposes a workable standard. The Canadian Medical Association, in supporting the legislation, has stated that the proposed eligibility criteria are one of several “critical elements to support a consistent, national approach”.

Bearing in mind that medical assistance in dying can pose real risks and equally that we do not wish to promote premature death as a solution to all medical suffering, these criteria may not allow eligibility for some circumstances, such as a person with a major physical disability who is otherwise in good health, or a person who solely suffers from mental illness. These conditions, in absence of additional medical circumstances, may not be associated with a reasonably foreseeable death.

Our approach in no way denies the suffering experienced by persons who would not be eligible. In partnership with the provinces and territories, we will do what we can to improve the quality of health services and other supports that are needed to enable such individuals to live a better quality of life.

We have listened to those who say that permitting medical assistance in dying as a response to suffering in life, as opposed to suffering in the dying process, will put already vulnerable individuals at greater risk. We recognize that medical assistance in dying will in many respects fundamentally change our medical culture and our society. It is appropriate in this context to focus our attention on facilitating personal autonomy in the dying process where the risks to the vulnerable are manageable.

The bill recognizes that procedural safeguards are necessary and appropriate in medical assistance in dying. The bill would adopt the recommendations of the special joint committee regarding the appropriate safeguards. For example, eligibility must be assessed by at least two medical practitioners or authorized nurse practitioners.

The bill would also set out a legal framework for a compulsory monitoring regime to ensure that we have Canadian data to assess how medical assistance in dying is working in practice.

This is an issue that will require close co-operation with the provinces and territories, and the monitoring requirements would only become binding after the Minister of Health brings forward regulations, which she will develop in consultation with those governments.

Finally, the bill would commit Parliament to review its provisions after five years.

In addition to the parliamentary review mechanism included in the bill, we will also undertake independent studies into three key issues that the Supreme Court of Canada declined to address in the Carter ruling: eligibility for persons under the age of 18; advance requests; and requests for medical assistance in dying solely on the basis of mental illness.

To be clear, the ruling in Carter was expressly limited to a competent adult person who clearly consents to the termination of life. Further, the Supreme Court stated that assistance in dying for minors or persons with psychiatric disorders would not fall within the parameters suggested in these reasons. Simply put, the court in Carter did not hear evidence related to these sorts of cases, nor did the Supreme Court find that there was a right to medical assistance in dying in any of these circumstances.

Regarding persons under 18, we are mindful of the evidence heard at the special joint committee that more specific study and evidence are needed, given the irrevocable nature of the procedure and the fact that minors are vulnerable by virtue of their age.

In terms of advance requests, where a person makes a request in advance for a form of treatment that they would want if they lose their ability to express their wishes, the risks of error and abuse increase when a person is unable to confirm previously stated wishes. In effect, a person loses the ability to withdraw their consent to die. They would no longer clearly consent, in the language of Carter.

We are also mindful of evidence that people often err in making predictions about how they will respond to future medical suffering. In the very few jurisdictions where advance requests are allowed, physicians generally will not perform medical assistance in dying under ethically difficult circumstances where the person is conscious but mentally incompetent to express their wishes. More study of this complex issue is needed.

With regard to mental illness as the sole basis for a request for medical assistance in dying, further study is also needed. This is the delicate balance that the bill would strike. Circumstances beyond the scope of the Carter decision will be studied. However, at this moment, we will act responsibly as we take our first steps as a country on this challenging issue.

A question that many have about the bill is whether it is consistent with the Carter ruling. There will always be a diversity of opinions about what is required to respond to a particular judgment, but it falls to Parliament not only to respect the court's decision, but also to listen to diverse voices and decide what the public interest demands. It is never as simple as simply cutting and pasting the words from a court's judgment into a new law.

The bill before the House today respects Carter and complies with the Charter of Rights. The court ruled that the previous law, which involved a complete prohibition, went too far in restricting the rights of Canadians like Ms. Carter and Ms. Taylor, whose natural deaths had become reasonably foreseeable, to choose medical assistance in dying.

As I have already mentioned, the court expressly stated that it did not pronounce on anything beyond the factual circumstances of the case before it. The court did not define the term “grievous and irremediable condition”. It left the task of definition, as well as the elaboration of public policy and safeguards, to Parliament.

The eligibility criteria in the bill are consistent not only with the legal principles of Carter but with the circumstances of the plaintiffs in the Carter case, including Gloria Taylor, who was suffering from fatal ALS, and Kay Carter, who was also in a state of irreversible decline and nearing the end of her life.

In finding that an absolute prohibition was unconstitutional, the court did not require Parliament to enact a specific medical assistance in dying regime. Rather, it directed us to address the deficiencies of the previous law. The court said:

...physician-assisted death involves complex issues of social policy and a number of competing societal values. Parliament faces a difficult task in addressing this issue; it must weigh and balance the perspective of those who might be at risk in a permissive regime against that of those who seek assistance in dying.

This is precisely what Bill C-14 does. It respects personal autonomy, protects the vulnerable, and affirms the inherent value in every human life.

The bill would create a consistent national floor in terms of eligibility and procedural safeguards under the federal criminal law power, which is there to ensure the safety of all Canadians.

The requirements we see in the bill would have to be respected across the country. However, provinces and professional regulatory bodies may also choose under their jurisdiction to add additional safeguards or requirements, such as how to respect the conscience rights of their medical professionals and health care institutions while ensuring access for patients. To this end, as I have already mentioned, my colleague, the Minister of Health, will be working with her counterparts to bring forward a coordinated system for linking patients to willing providers.

I want to say a few words about how the bill will give Canadians confidence that the risks associated with medical assistance in dying will be carefully addressed.

Ultimately, we want medical assistance in dying to reflect the true autonomous choice of Canadians who request it. However, we know how autonomy can be compromised in both overt and subtle ways. At points in our life, all of us are vulnerable. However, vulnerability is experienced disproportionately by those Canadians who are alone or lack social supports, who live in poverty, who face discrimination or a multitude of other reasons. Some people may feel that they are a burden to others or struggle to find joy and purpose in their life. The availability of medical assistance in dying must not inadvertently tempt persons who are experiencing these or other sorts of vulnerabilities to choose a premature death, nor should it suggest that dying is an appropriate response to a life with disability.

It makes sense to limit medical assistance in dying to situations where death is reasonably foreseeable, where our physicians, nurse practitioners, and others, can draw on their existing ethical and practical knowledge, training, and expertise in addressing these challenging circumstances.

Coupled with robust procedural safeguards, the bill would effectively respond to the risks and ensure that requests for medical assistance in dying are made freely, autonomously, and with the benefit of full information.

More fundamentally, our government wants medical assistance in dying to be there for Canadians, so they can have a choice of a peaceful death that accords with how they have lived their life, over a painful and prolonged one that does not.

Our government believes in the equality of all Canadians' lives and sees the inherent value in each of them.

Before eligibility for medical assistance in dying is extended beyond persons who are suffering intolerably and in a state of decline toward death, which is what the Carter decision was about, we need to be absolutely confident that we would not be putting vulnerable people at risk. We need to be confident that we are not undermining important policy goals and/or societal values, such as supporting Canadians with physical or mental disabilities to live out healthy lives and fully participate in our society.

I look forward to working with all members of these chambers on this incredibly difficult and complex issue, to ensure that before June 6, 2016, our country will have a law that respects autonomy and provides choice to Canadians, while also protecting those in our society who we too often lose sight of. Together, let us take this opportunity to build a consensus of which Canadians can be proud.

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

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:25 a.m.
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Conservative

Scott Reid Conservative Lanark—Frontenac—Kingston, ON

Madam Speaker, the minister tells us correctly that the court left the task of defining certain terms to Parliament. Therefore, it is regrettable that the key term “reasonably foreseeable death” in this legislation is not defined. This is problematic, because in her speech, in which she expresses the intent of the government on the subject, she is ambiguous as to what the meaning could be.

She said that it is not necessary to be “terminally ill”. Therefore, “reasonably foreseeable” does not mean that we have a projected end date to that person's life, unless she has some definition of terminally ill that is different from the one normally used. On the other hand, she said that we do not promote premature death. Again, these two are directly in contradiction, unless she has some definition for the term premature death that has not yet been shared with us.

Therefore, I will ask this question to the minister. Would she object to an amendment to this legislation in the committee process that would give a definition to the term “reasonably foreseeable”, so that it is not left up to other individuals who may apply different standards, and so that Canadians are not faced with what I think is an unreasonable amount of uncertainty as to what this bill will do once it is put into practice?

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:25 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Madam Speaker, first let me say that I am looking forward to the substantive discussion that we have in this House around this particular issue. I am certainly looking forward to the discussion that will ensue in both Houses in terms of the committee work. I expect that the robust discussion will lead to many suggestions for potential improvements of the bill. I believe fundamentally in the democratic process, and look forward to the discussions at committee, at which I will be participating.

The question was specifically around reasonable foreseeability. In terms of the legislation, reasonable foreseeability and the elements of eligibility in terms of being able to seek medical assistance in dying, all must be read together. We purposefully provided flexibility to medical practitioners to use their expertise, to take into account all of the circumstances of a person's medical condition and what they deem most appropriate or define as reasonably foreseeable.

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:25 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Madam Speaker, I would like to begin by congratulating the minister on a very thoughtful presentation. I am grateful for that.

The minister, in her remarks, did refer to the need for a delicate balance and believes that she has that balance right in the bill before us. She then talked about the need for parliamentarians to listen to Canadians, but also, of course, to listen—fundamentally, I thought she said—to the court.

The question I have is with respect to the rule of law. Had we listened to other Canadians in the context of other delicate issues, such as abortion or same-sex marriage rights or the like, that might have undercut what the court said in those judgements. My question for the minister is this. If she is persuaded by evidence she hears that we do not have that delicate balance right: (a), would she agree to amendments, and, (b), would she agree to perhaps refer this to the Supreme Court of Canada in an official reference to ensure we have the delicate balance, to which she referred, right?

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:30 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Madam Speaker, I am confident in the proposed legislation that we put forward in terms that it meets and answers the Supreme Court of Canada decision in Carter. As well, it is compliant with the Charter of Rights and Freedoms. The Supreme Court was very clear on two things: one, an absolute ban on medical assistance in dying is contrary to the charter; and, two, it is up to Parliament and provincial legislatures to design the complex regulatory regime around it.

With respect to the question on putting a reference to the Supreme Court of Canada, we as legislators have a responsibility to ensure that we are putting forward the right balance. It is our job to do that. It would certainly be premature to consider any reference to the Supreme Court of Canada in advance of Parliament having a law in place.

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:30 a.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 would like to thank and congratulate the minister on her speech and on her incredible leadership on a question that is so important in our country at this time.

I have a couple of questions. In her speech, the minister talked about the fact that there were many influences on the decision that the government ultimately decided to take. I would invite her to perhaps talk about the influence of the special joint committee on Bill C-14, and also on the Quebec legislation on Bill C-14.

The other question I would ask the minister to address arises out of the question from the Conservative member opposite and his expressed concern over the lack of clarity in the words “reasonable foreseeability”.

Could the minister comment on how the terms have been recognized and interpreted by the courts, and the guidance that it should be able to provide us in understanding the purpose of the legislation?

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:30 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Madam Speaker, in terms of influences, it is welcomed as well as supported. I thank the special joint committee for its substantive recommendations, all of which have propelled forward a national discussion on this really important issue.

I had the opportunity to work closely with and be in communication with the province of Quebec, hearing and learning from it regarding the years it invested to come up with its own medical aid and dying legislation, which was enacted last year.

On reasonable foreseeability, this is a commonly used term in many areas of the law, including criminal law. It is applied depending on the nature of the circumstances of a particular piece of legislation.

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:30 a.m.
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Conservative

Karen Vecchio Conservative Elgin—Middlesex—London, ON

Madam Speaker, the minister's excellent speech gives Canadians a good idea of what this legislation is about, and I applaud her on that.

When I look at this legislation, I need to find a balance. I am taking this back to my constituents and we are talking about it. I have a specific question on this. I have a friend who has been suffering from ALS, so this might be too much of a timeline and I might not be able to actually get the answer. Would we be looking at foreseeable death as the time of diagnosis? He has been suffering for about 12 years. Are we saying that the day after he was diagnosed, he could then say that he believed this was best way for him to finish his life and proceed with assisted dying now, or would he have to wait until he became more ill?

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:35 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Madam Speaker, I certainly support all members going back to their ridings and having this discussion with their constituents.

On reasonable foreseeability and diagnosis, as I said, we leave the determination, taking into account all of the elements, up to medical practitioners. The requirement of reasonable foreseeability must be in conjunction with an irreversible state of decline or a trajectory toward death. That would be determined on a case-by-case basis, recognizing the many views that we were provided on individual circumstances of patients being quite different.

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:35 a.m.
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Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, I would like to thank the Minister of Justice and Attorney General of Canada for her thoughtful presentation this morning.

The issue of physician-assisted dying is one of the most important social issues that Canada has faced in some time. There is no question that physician-assisted dying will be one of the most important issues this Parliament must address.

I had the unique opportunity to give special attention to the issue of physician-assisted dying as a vice-chair of the Special Joint Committee on Physician-Assisted Dying. The special joint committee had a very short time period to deal with a highly sensitive and complex issue. While I, along with my Conservative MP colleagues on the committee, the hon. member for Louis-Saint-Laurent, the member for Langley—Aldergrove and the member for Kitchener—Conestoga, were not able to agree with all the recommendations in the main committee report, all members from all parties and in both Houses worked respectfully and in good faith to do what they believed was best for Canada and respectful of the law arising from the Carter decision.

I would particularly like to a acknowledge the hon. member for Don Valley West, who served ably as chair of the special joint committee.

The issue of physician-assisted dying raises many deep legal, moral and ethical questions. It is an issue that Canadians get very emotional about, and that is understandable. When we are talking about physician-assisted dying, we are talking about something that is probably the most important thing to any human being, living and dying, the right to live and the right to die.

It is not a new issue to Parliament. Indeed, over the last 25 or so years, this issue has come before Parliament 14 or 15 times. Each time Parliament was asked the question whether to legalize physician-assisted dying or not, Parliament chose not to. However, the issue of whether we should legalize physician-assisted dying or not is over, because the Supreme Court of Canada in Carter determined that physician-assisted dying was a charter right for certain Canadians.

While the Supreme Court recognized that physician-assisted dying was a charter right for certain Canadians, it is important to emphasize that the Supreme Court said that it was a charter right for certain Canadians. The Supreme Court did not say that physician-assisted dying was a charter right to anyone, any time, anywhere, under any circumstances in Canada. Rather, the court set out a clear set of parameters. More specifically, what the court determined was that competent adult persons who were suffering intolerably from a grievous and irremediable condition and who gave their clear consent, had a right under section 7 of the charter to physician-assisted dying.

In so deciding, the Supreme Court sought to strike a balance between respecting individual autonomy with the need to protect vulnerable persons. The Supreme Court was satisfied that balance could be achieved with what the court characterized at paragraph 105 of its decision as a system of carefully designed and monitored safeguards.

The test before Parliament is to find that balance in the way of a legislative response. As a starting point for a legislative response, it is important to look to the Carter decision. Does the legislation satisfy the parameters of Carter?

I am satisfied that the legislation does satisfy the general parameters of Carter in limiting physician-assisted dying to competent adult persons who are suffering from an incurable disease or illness, in an irreversible state of decline, and whose death is foreseeable.

That being said, I believe the legislation falls short in at least two regards at this present time. First, I am not satisfied that the legislation sufficiently protects vulnerable persons, persons particularly with underlying mental health challenges. Second, I am disappointed that the legislation does not contain provisions to protect the conscience rights of physicians and allied health professionals.

With respect to safeguards, it is true that the legislation limits physician-assisted dying to persons who are suffering from a physical illness, and make no mistake, that is a very important safeguard. That safeguard, by the way, is consistent with what the Supreme Court pronounced in holding that one had a right to physician-assisted dying in the context of an irremediable condition.

However, where the legislation falls short is that it does not take into account persons who have a physical illness on the one hand, but on the other hand, suffer from an underlying mental health challenge. Make no mistake about it; if people have underlying mental health challenges, are suffering from physical illnesses, and they meet all the criteria of Carter, they have a right to physician-assisted dying as does every other Canadian who meets that criteria. The issue is ensuring their capacity to consent.

In that regard, it is important to remember that the Supreme Court, as one of the key criterion in the parameters that it set out, said that individuals must give their clear consent. Now the evidence before the special joint committee is that physicians generally have the training and skill to diagnose someone with an underlying mental health challenge, to identify the underlying mental health challenge. However, to take the next step, to undertake the kind of complex analysis of determining capacity and consent, a significant amount of evidence said that any physician was not able to do it. Rather, someone with more specialized training such as a psychiatrist would be able to undertake that type of assessment.

I would respectfully submit that it would be an important improvement in the legislation to contain a safeguard to require a psychiatrist to undertake an evaluation of the patient who is determined to have an underlying mental health challenge to determine capacity to consent on a decision that is ultimately irreversible.

With respect to conscience protections, I am disappointed that there is no provision for conscience protections in the legislation. Rather, this has been passed on to the provinces, to colleges, and to professional regulating bodies. The Government of Canada has a duty to protect the conscience rights of physicians and allied health professionals.

The conscience rights of physicians are charter rights and those charter rights are as important as the charter rights of patients to access physician-assisted dying. The charter rights of physicians with respect to the protection of their conscience and right to conscientious objection is not only any charter right, it is a charter right under section 2 of the charter. Section 2 charter rights are considered to be fundamental freedoms.

It is important that the legislation sufficiently respect everyone's charter rights, the charter rights of patients and the charter rights of physicians.

Last, I want to emphasize the importance for the government to respond quickly in the area of palliative care. This is very critical. It is something that Parliament has talked about for a long time. There have been somewhere in the neighbourhood of four or five Senate committee reports. There was at least one report out of the House of Commons. I know that the hon. member for Kitchener—Conestoga chaired a committee that looked at the issue of palliative care.

Now that physician-assisted dying has become a reality, it is time to end the discussion. It is time to act when it comes to providing access to palliative care. It is widely recognized that palliative care is an essential part of end-of-life decision-making. One thing that I heard over and over again as a member of the special joint committee was that a person cannot truly consent to physician-assisted dying unless the person has all options available to them. One of those options is palliative care, but the fact is that only 15% to 30% of Canadians have access to palliative care. Let me say that the option of palliative care without access to palliative care is no option at all.

I want to acknowledge that the Minister of Health did announce $3 billion in funding for palliative care. This is a very important step in the right direction, but it is also noteworthy that there is no mention of palliative care in the budget. There is not one new cent for funding towards palliative care. It begs the question, where is this funding going to come from and when, and where is it going to go? It is absolutely important that the government take decisive action on palliative care.

With that, I would say that this legislation is a significant step in the right direction, having regard for some of the recommendations in the special joint committee main report that I believe went beyond the scope of Carter. I want to thank the government for listening, for considering the dissenting report that was authored by me, as well as my three Conservative MP colleagues on the committee.

However, it is imperfect legislation. There are some of what I would consider to be significant flaws. I am hopeful that the government will be amenable as the legislation moves forward to accepting amendments so that everyone's charter rights can be respected, the charter rights of patients, the charter rights of physicians and allied health professionals, and the charter rights of vulnerable persons.

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April 22nd, 2016 / 10:50 a.m.
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Liberal

Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB

Madam Speaker, the speech by the hon. member for St. Albert—Edmonton was impassioned and very principled.

Just from my perspective, the question was brought up as to whether or not medical practitioners should have the right to exercise their conscience in either performing or referring with respect to this. I have practised medicine for 20 years. I know the importance of keeping to one's conscience in the medical practice.

Another controversial issue in our society is abortion. There is no legislative protection for physicians that says they have the right to refuse to perform abortions or refuse to refer for them. However, no physician in Canada, to my knowledge, has ever been forced to perform against one's conscience.

I do not know that such legislation is therefore required for the same objection in this issue.

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April 22nd, 2016 / 10:50 a.m.
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Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, that is an important question.

I am concerned that there will be inconsistencies. There already seem to be some inconsistencies with some of the guidelines that have come out of the colleges.

I think there is a simple way to address this to ensure that physicians' charter rights are respected, and I think the federal government can play a role in that with a fairly simple amendment to the legislation.

I would note that there is a precedent for this type of legislation. It is section 3 of the Civil Marriage Act, which simply provides that no religious officials may be penalized if they decide not to partake in a civil marriage.

I think that something similar to section 3 of the Civil Marriage Act could be included in this legislation and would go a long way to ensuring that everyone's charter rights, including those of physicians, are protected.

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April 22nd, 2016 / 10:50 a.m.
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NDP

The Assistant Deputy Speaker NDP Carol Hughes

I would remind members that, as opposed to shouting out things, if they want to contribute, please stand to be recognized.

Questions and comments. The hon. member for Victoria.

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April 22nd, 2016 / 10:50 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Madam Speaker, I would like to congratulate my colleague, the member for St. Albert—Edmonton, for his very useful contribution in the same spirit with which he contributed so much during the work of the Special Joint Committee on Physician-Assisted Dying, which I had the honour of being part of. I would like to echo his thanks to the member for Don Valley West and also Senator Ogilvie, who co-chaired that important committee. I just hope that during this debate we can sustain that same tone of respectful dialogue.

He indicated that he was satisfied that Bill C-14 is consistent with the Carter case. On that point, as I will elaborate I hope later today, I respectfully disagree but hope we can work together in the justice committee to get it right for all Canadians.

I was taken with his comments on conscience protection in the legislation, something which just came up as well in the comment from my colleague across the way.

In pointing out it is a charter right for those who have conscience reasons not to participate in medical aid in dying, I think he made an excellent reference to section 3.1 of the Civil Marriage Act which gives a recognition for that conscience protection in that legislation.

I am wondering whether or not it should be appropriate to leave this to the provinces. Some have said this is a matter, and I think the minister made that point as well, of provincial jurisdiction working with the colleges. On the other hand, the member points out that it involves the charter, and therefore, those individuals who wish to support those rights are going to have to work with 13 other jurisdictions.

I would like the member's comments on whether he thinks that is appropriate.

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April 22nd, 2016 / 10:50 a.m.
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Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, I want to thank my friend, the hon. member for Victoria, and also acknowledge the important contribution that he made to the special joint committee. His contribution was very valuable.

I would just reiterate the point that I previously made, that I do see a need for consistency, and that could be done in the way of a simple amendment to the legislation.

On the issue of jurisdiction, I would note that in the Carter decision, the Supreme Court expressly recognized that health care is an area of concurrent jurisdiction, so I believe there is ample room jurisdictionally for the government to act in this regard.

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April 22nd, 2016 / 10:55 a.m.
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West Vancouver—Sunshine Coast—Sea to Sky Country B.C.

Liberal

Pam Goldsmith-Jones LiberalParliamentary Secretary to the Minister of Foreign Affairs

Madam Speaker, I thank the hon. member for St. Albert—Edmonton for his service on the special joint committee.

I am very interested in the questions that we are going to ask ourselves as a Canadian society in the future. I am interested in his views on advance consent, consent for mature minors, and eligibility based solely on mental illness.

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April 22nd, 2016 / 10:55 a.m.
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Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, I believe that any legislative response needs to adhere to the parameters of Carter. What the Supreme Court said with respect to minors is “competent adult person”. If the Supreme Court contemplated minors, the Supreme Court would have said so, but it did not say that. It was very clear in saying “competent adult person”.

Similarly, with respect to advance directives, the Supreme Court said that persons who were suffering intolerably from a grievous and irremediable condition have a right to physician-assisted dying, not persons who anticipate that they will suffer from a grievous and irremediable condition.

I would also note that in the province of Quebec, which cast Bill 52, over the course of six years, three national assemblies, and three different governments, advance directives were initially in the first draft of Bill 52, but they were ultimately removed from the legislation when it was passed by the Quebec National Assembly, because legislators in Quebec were not satisfied that advance directives could be incorporated into the legislation without mitigating significant risks.

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April 22nd, 2016 / 10:55 a.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Madam Speaker, I thank the member for his remarks and the good work he did on the committee, and to some extent, the brave face he is putting on.

Of course, members worked hard on that committee, but were aware of the problems in the process as well. The fact is, we heard from three separate panels from the lobby group Dying With Dignity Canada, and we did not hear from any anti-euthanasia advocacy group.

I want to follow up on the question about conscience, because I think we had some misinformation from the other side.

The reality is that right now in Ontario, the policy of the College of Physicians and Surgeons is that there is a requirement not only to refer, but also to provide services that are within the standard of care in an emergency situation. Members from other provinces, and I am not from Ontario either, should know that this is presently the reality in Ontario.

Therefore, if we pass this legislation without conscience protection, presumably euthanasia and assisted suicide will enter the standard of care and then fit within that existing policy framework of the College of Physicians and Surgeons in Ontario. We might hope that they might change the policy or create special accommodation, but in the absence of that, that will be the reality right away.

I want to know what the member thinks about that, and maybe just underline why conscience is important because of the current reality in Ontario and the need for consistency across the country.

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April 22nd, 2016 / 10:55 a.m.
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Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, I do not support an effective referral regime. I believe that an effective referral regime would contravene section 2 of the charter. I would also note that there is no jurisdiction in the world that has an effective referral regime, not Belgium, not the Netherlands, not any of the states in the U.S. that have physician-assisted dying, and not the province of Quebec.

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April 22nd, 2016 / 10:55 a.m.
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Vancouver Granville B.C.

Liberal

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

Madam Speaker, I would like to thank my hon. colleague across the way for his work on the special joint committee and certainly for his speech today.

I appreciate the discussion around conscience rights of medical practitioners and institutions. I wonder if my friend has any comments on the Canadian Medical Association's agreement with respect to the legislation and not advocating a worry with respect to conscience rights.

Also, I would like to know if my friend—

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April 22nd, 2016 / 11 a.m.
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NDP

The Assistant Deputy Speaker NDP Carol Hughes

I am sorry, We only have time for a brief question, and we need an answer.

The hon. member for St. Albert—Edmonton.

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April 22nd, 2016 / 11 a.m.
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Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, first of all, there is a large number of physicians who have raised this issue. I think Parliament owes it to them to address the issue.

I agree with the Minister of Justice and Attorney General of Canada that it is absolutely imperative, absolutely essential, that Parliament pass legislation before the declaration on the stay of constitutional invalidity expires on June 6.

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

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April 22nd, 2016 / 12:25 p.m.
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Markham—Stouffville Ontario

Liberal

Jane Philpott LiberalMinister of Health

Mr. Speaker, I am honoured today to speak following on the comments made by my colleague, the Minister of Justice and Attorney General of Canada, when she introduced Bill C-14, an act to amend the Criminal Code for medical assistance in dying.

This is a historic debate on a matter of tremendous significance for Canada and for all Canadians. Advancing this issue and getting a legislative framework in place to allow medical assistance in dying is a solemn responsibility. This a deeply personal issue for every Canadian.

When a dying person approaches the end of life, many more people other than just that individual are affected, including the person's family, community, and employer, as well as the people working in our network of social and health care services, those who provide support during our difficult times.

For many people, death is a difficult topic. Conversations about death are difficult to have, whether it is with a family member or, in particular, with a health care provider. This topic is difficult on both sides of the conversation.

Our government has given this matter careful consideration.

Over the past 30 years, I have experienced the reality of talking frankly and openly with, perhaps, hundreds of patients as they were facing death. Through every stage of the process, my patients have taught me valuable lessons, lessons about caring and compassion, about fear and anxiety, about the importance of support when recovery is no longer probable.

In working with patients in the final months and years of their lives, I have learned that 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.

My experiences have also reinforced my 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.

On February 6, 2015, the Supreme Court of Canada declared that the Criminal Code prohibitions on assisted dying were unconstitutional. The federal government was given one year to develop a federal framework to address this decision.

On January 15, the Supreme Court granted a four-month extension, to June 6 of this year, to give our government time to develop a legislative framework for Parliament to consider.

The Supreme Court's decision marked a watershed moment in an important and long-standing debate surrounding the right of Canadians to have the choice to a medically-assisted death. However, how it will be implemented, for whom and by whom, needs careful consideration.

As parliamentarians, we have heard from Canadians on this issue through so many conversations with our constituents and through the dedicated work of the joint parliamentary committee. Hundreds of experts and organizations, both in our country and abroad, have contributed volumes to our understanding of this very difficult subject. Many have spoken passionately about their work on the front lines of palliative care, hospice care, and end-of-life care. Others have talked about personal experiences with loved ones and about easing the physical and emotional pain that they experience.

Our government is grateful for the work of the federal external panel on Carter and for the work of the Special Joint Committee on Physician-Assisted Dying.

We have also benefited from the work undertaken in the provinces and territories on this issue, including the thoughtful recommendations of the expert advisory group on physician-assisted dying.

We are grateful to members of Parliament who have shared their own thoughtful, considered, and wide-ranging insights over the past few months and, indeed, years.

Our government has listened, and the legislation we are tabling is the product of their efforts and their collective wisdom and experience.

Today, we are taking decisive action. I think that it is good news for Canadians, including those who are facing this personal and very difficult choice, their families, and their care providers, who have all been carefully considering this legislation.

For people who wish to have the choice of seeking medical assistance in dying, Bill C-14 would allow that, in keeping with the Supreme Court of Canada's decision. This proposed bill is the product of careful consideration of several principles that guide our government, including the desire to support personal autonomy and access to health care services, while recognizing that it is imperative to protect vulnerable persons, individually and collectively, from coercion and disrespect.

With Bill C-14, certain health care providers would, under certain circumstances and conditions, be exempt from Criminal Code offences in order to allow them to provide or assist in providing medical assistance in dying.

The bill would clearly define the criteria that must be met for individuals to be eligible. We have set up safeguards to be followed to ensure that these criteria are met and that the request is truly voluntary. This is critically important to protect vulnerable populations and, frankly, to ensure that anyone who contemplates medical aid in dying has fully reflected on their choice.

We also create the foundation for a regime to monitor medical assistance in dying so we can see how it is working in Canada.

With this bill, we are demonstrating our government’s commitment to supporting the autonomy of patients who are approaching the end of their lives, while protecting the most vulnerable in our society.

There has been considerable focus on whether providers should be free to exercise their conscience rights. I want to underscore that this proposed legislation does not compel any health care practitioner to provide medical assistance in dying. Practitioners will have the right to choose as their conscience dictates.

However, we must also respect the rights of people seeking this procedure by ensuring that those providers who have expressed a preparedness to help patients can do so without fear of criminal prosecution. Under Bill C-14, certain health care providers, such as physicians and authorized nurse practitioners who administer medical assistance in dying would be exempt from criminal prosecution.

Since nurses and nurse practitioners have the authority to deliver many of the same medical services as family physicians, in that they can assess, diagnose, and treat patients, they, too, would be exempt from criminal prosecution.

This is critical, as nurse practitioners often work alone providing vital health care services in underserved areas, such as the most remote and rural parts of Canada. Other providers, such as pharmacists, registered nurses, and physicians who may provide assistance would also be exempt from criminal prosecution.

Therefore, rest assured that health care workers who provide and assist in providing medical assistance in dying will have no reason to fear criminal prosecution as long as they follow the appropriate safeguards.

In consultations leading up to this bill, there was strong consensus among Canadians that standardized data needs to be collected on the practice of medical assistance in dying.

In addition to Criminal Code amendments, this bill creates the power necessary for the Minister of Health to make regulations about the information to be collected, the use and protection of that information, and the processes for collecting and reporting that information.

We agree that a robust, transparent monitoring system on the practice of medical assistance in dying is essential, and analysis and trends need to be reported to the public on a regular basis. We, as the Government of Canada and Canadians, need to understand as much as possible about how the system is operating in practice so we can address any potential concerns.

To that end, this proposed bill commits the federal government to working with the provinces and territories to develop a pan-Canadian monitoring system. The system will allow us to collect and analyze data, monitor trends, and make recommendations for potential legislation and policy reforms.

We are not starting from scratch. Around the world in other places that have legalized medical assistance in dying, mandatory oversight systems are in place to carry out monitoring and public reporting each year.

We can look to these examples to help us decide what is right for Canada. We can also look closer to home, in Quebec, where a monitoring system was recently established.

Developing a robust pan-Canadian system with provinces, territories, and stakeholders will take time, and we know we need to be tracking this information as soon as possible.

From a health perspective, I feel strongly that it is important for us work toward consistency in the provision of health care services for all Canadians, regardless of where they live. Canadians and stakeholders are expecting and hoping for a pan-Canadian approach. They do not want a patchwork where they observe significant differences in quality and availability of services in their own community, province, or territory relative to other parts of the country.

A fundamental value in Canada is our commitment that Canadians across the country will have access to medically necessary health care services when they need them. This view reflects the underlying principles of universality, accessibility, and comprehensiveness so vital to our health care system.

Bill C-14 contains well-defined eligibility criteria and safeguards, which go a very long way to achieving our government's objective of a consistent framework for medical assistance in dying. While certain implementation details will be left to provinces, territories, and medical regulatory bodies, we will all operate under the same legal and access framework.

My health minister colleagues across the country have looked to us for leadership on a consistent approach for all Canadians. I am pleased that our proposed bill fulfills that expectation.

No aspect of what we do on the question of complementary measures should be done precipitously. There are several particularly challenging issues. On these, our proposed bill suggests a cautious approach that will seek further advice, as suggested by the special joint committee.

However, we also recognize that there is a difference between the decision to accept or forgo treatment and the decision to hasten one's own death. Accordingly, a higher standard of decision-making capacity should be required in the latter case.

As part of the eligibility criteria, the bill specifies that individuals must have reached the age of 18 to seek medical assistance in dying.

There is the equally if not more contentious matter of advanced directives. Advanced directives are used to indicate wishes for treatment if a person can no longer communicate.

The prospect of permitting requests for assistance in dying through advance directives is concerning to many Canadians. At the same time, others feel strongly that they should be able to convey their wishes for a medically-assisted death in advance of a future point time when, as in the case of a progressively debilitating condition such as dementia, they are no longer competent to make a request.

Advance directives are a difficult issue for many individuals, family members and health care providers. As difficult as it is to discuss the end of life ln the final days, it can be even more difficult to predict one's wishes and circumstances in the case where it is further off, especially in the distant future.

Many people are also troubled by the prospect of patients with a psychiatric disorder being eligible for assistance in dying on the basis of psychological suffering alone. There are strongly held views on both sides of this issue. That is why legislating medical assistance in dying has required a cautious approach, and that is why we have committed to independent studies to explore the challenging issues of mature minors, advanced directives, and mental illness further.

Following a period of study and further reflection, we will be better positioned to determine how these issues best fit into a Canadian framework for medical assistance in dying.

I believe that this is an approach that most Canadians would favour.

I said earlier in my remarks that this bill did not compel participation by health care providers to do anything which would run counter to their convictions. At the same time, we are also mindful that the exercise of conscience rights by providers may constitute a barrier to access for those who are seeking medical aid in dying. There is therefore a federal interest on behalf of Canadians in working with our provinces and territories to support access.

Collaborative work with provinces and territories could build on important international examples, such as the well-established networks we see in the Netherlands and Belgium. These provide insight as to how an end-of-life care coordination system could help facilitate access to a consulting physician or nurse practitioner. This is particularly important in rural and remote areas, or in situations where identifying a second provider to assess eligibility may be problematic.

One of the things I have heard is that better palliative care would assist in the end-of-life care options that have now been prescribed by the Supreme Court. I know first hand that there is a place and a need for both.

Palliative care focuses on relieving suffering and improving the quality of life for the living and dying. It provides relief to people dealing with a range of life-threatening conditions such as cancer, cardiovascular disease and amyotrophic lateral sclerosis, or ALS.

Today, Canadians are aware, and have a general understanding, of palliative care. However, some studies have found that the overwhelming majority, perhaps 70% or more of us, do not have access to it, particularly in rural and remote areas. Many providers are not well trained to provide palliative care services. Reinforcing this government's commitment to quality palliative care, this proposed bill signals our intent to support improvements to a range of end-of-life care services.

Like other health care services, the delivery of palliative care is mainly the responsibility of provinces and territories. However, the federal government can make significant contributions in this area. We are already supporting a number of initiatives aimed at improving capacity in our health care system to provide palliative care.

In partnership with the provinces and territories, health care providers, and non-governmental health organizations, the federal government has funded initiatives designed to advance palliative care awareness, education, national standards, and research. For real improvements to be made, we need to work closely with provinces and territories.

Since my appointment as the Minister of Health, it has been my immediate priority to reach out to provinces and territories to discuss needed transformation in our health care system, including care at the end of life, particularly in the setting where Canadians say they most wish to die; that is usually in their own home and community.

In that spirit, early this year I 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 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 believe that by working together, we can bring real change to the health care system so that Canadians can continue to have access to high-quality, sustainable care.

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. We want them to have autonomy in making decisions as they approach the end of their lives.

We are facing a challenging time frame to put this legislation in place, with a June 6 deadline. However, I believe that with this proposed bill, we have found a balanced approach that reflects the best interests of Canadians. That is why I urge all members of this House to support Bill C-14.

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April 22nd, 2016 / 12:45 p.m.
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Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

Mr. Speaker, I have some serious questions, especially for this minister.

Just now, the minister said that doctors' conscience was protected. I was very surprised to hear that. I did not read that clause. I would like the minister to tell me exactly which clause says that doctors' conscience will be protected.

Each and every one of us understood that, going forward, the provinces would define protection for doctors, which means that there could be 10 different interpretations. That is not a good thing. This is a federal Parliament, and we must act on behalf of all Canadians.

I have a second point I would like to raise. If there is to be protection for doctors' conscience, which we want, why not follow the Quebec model, which allows a third party to transfer a patient to another doctor? In other words, if the attending physician who does not want to treat the patient informs a third party, such as hospital or CLSC officials, the third party can transfer the case to another doctor.

I have two questions: Can the minister tell me exactly which clause in the bill protects doctors' conscience? Why not follow the Quebec model?

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April 22nd, 2016 / 12:45 p.m.
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Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Mr. Speaker, as my colleague knows, this is a bill to amend the Criminal Code. As such, the bill is prepared in that format.

As he well knows, the matter of the care and delivery of care falls into the realm of provinces and territories.

I have made the commitment to work with my colleagues, the ministers of health across the country, to ensure that they understand that no health care providers should be required to provide care, that they should respect their conscience rights, but at the same time to make sure that all Canadians will have access to all options of care. I am prepared to work with them.

We have made the commitment to develop a pan-Canadian approach to care coordination at the end of life to make sure that all Canadians will have access to care.

We have deemed, through the tabling of the bill, to demonstrate that this is a medically necessary option for care at the end of life. I will work with my colleagues across the country to make sure it is there for Canadians.

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April 22nd, 2016 / 12:45 p.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I commend the minister, as well as her colleague, the Minister of Justice, for their leadership on this very sensitive issue.

Aside from the issue of advanced requests and the issue of the unfortunate drafting of the bill, the issue I hear most about is the failure in this initiative to specifically commit to palliative care.

The minister has given words on that subject again today, but we note that there was nothing in the budget, despite campaign promises to that end.

I would ask the minister this. Would she consider restoring the secretariat on palliative and end-of-life care, and the development of a fully funded pan-Canadian palliative and end-of-life care strategy, in collaboration with provinces, territories, and civil society?

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April 22nd, 2016 / 12:45 p.m.
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Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Mr. Speaker, that is an important question from the hon. member. I have reiterated, as he said, our commitment to ensure that we improve access to palliative care. Indeed, it would be my desire to see that every Canadian should access high-quality palliative care at the end of their life to give them that opportunity.

I often quote Dr. Atul Gawande, who talks about the fact that people not only need to have a good death, they need to have access to a good life to the very end.

This is extremely important to me. I will be working with the provinces and territories. I have already been working with my department. We will be investing in home care, and we will determine that all the necessary investments are in place. I am exploring all opportunities for how we can ensure that commitment is upheld and that care is available to Canadians.

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April 22nd, 2016 / 12:45 p.m.
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Liberal

Sean Casey Liberal Charlottetown, PE

Mr. Speaker, I thank the minister for her thoughtful speech and for her leadership on this extremely sensitive issue at an historic time for Canadians.

Much of what falls within the health domain is within the jurisdiction of the provinces. There is no question that the provinces are looking to the federal government for leadership.

Given the very compressed time frame that we have, I wonder if the minister could comment on the importance of the June 6 date with respect to the matters within the provincial domain. There is no question that the June 6 date is critical with respect to the matters that fall under the criminal law, but what is the significance of that date? Is it as important for the matters that are within the minister's jurisdiction?

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April 22nd, 2016 / 12:50 p.m.
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Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Mr. Speaker, the hon. member has raised an important matter, and that is the reality that we need to have a legislative framework in place.

The provinces and territories have spoken to me loudly and clearly about their desire to make sure we have a consistent approach across the country. That came up in my meeting with health ministers in January. Since the bill has been tabled, my colleagues have told me they are pleased that it provides that framework for them. They have already done a tremendous amount of work across the country in determining their next steps. They have been working with regulatory bodies, and those regulatory bodies have put in place a number of measures to make sure that Canadian health care providers are educated and prepared for the changes the bill will put in place.

The June 6 deadline, no doubt, is an important one. That is why I urge all members of the House to support the bill, so that we will have a legislative framework that will provide that access to consistent care across the country.

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April 22nd, 2016 / 12:50 p.m.
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Conservative

Scott Reid Conservative Lanark—Frontenac—Kingston, ON

Mr. Speaker, the minister in her comments said that nothing in the bill compels health care professionals to participate in assisting with a death. She also stated there is a federal interest in ensuring that nobody is denied access to medically assisted death. This raises a problem. A charter right to something cannot be withheld by someone else who is either a government agent, or is operating within the purview of a set of rules that gives them a monopoly over providing access to that right.

The minister could correct this problem. It will essentially cause the courts to require health care professionals to provide assisted death against their own consciences and will, unless the following change is made. She could add a specific protection to the law that would meet the section 1 charter requirement. It says that the rights and freedoms set out in the charter are subject only to “such reasonable limits prescribed by law”, which means statute, “as can be demonstrably justified in a free and democratic society”.

If the minister did that, there will be protection for physicians. If not, it is only a matter of time before the courts require physicians to provide assisted death. That will result in terrible crises of conscience for physicians who would not want to do that based on their profoundly held moral beliefs.

Criminal CodeGovernment Orders

April 22nd, 2016 / 12:50 p.m.
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Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Mr. Speaker, I look forward to further conversation with the member about this matter. I will continue to discuss this with my colleague the Minister of Justice as well.

I want to make sure that the member understands that physicians and other care providers make deeply complex decisions every day. They approach their work with thoughtfulness. They approach their work with their conscience intact. They will need to be able to continue to do that. We need to make sure that those conscience rights are protected, as they are now. We also know that Canadians need to be able to have access to this care. Those physicians and care providers will undertake to make sure that care is transferred, in the situation where they are not able to provide a certain type of care for any reason, including the reason of conscience rights.

I am determined to work with my colleagues across the country, with the Canadian Medical Association, the Canadian Nurses Association, to make sure that this is well understood, that we find mechanisms to make sure there is a care coordination system, so that no one will be denied access to medically necessary care.

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April 22nd, 2016 / 12:50 p.m.
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NDP

Pierre-Luc Dusseault NDP Sherbrooke, QC

Mr. Speaker, I thank the minister for her speech.

She recognizes that the right to physician-assisted dying is a constitutional right in light of the court's recent decision. That is what she said. She also wants to protect physician conscience rights. Speaking of which, what mechanism will she put in place to ensure that every Canadian has the constitutional right to physician-assisted dying, while also protecting doctors' rights to choose whether to engage, or not engage, in this practice?

This service must also be made available in places where there are very few doctors and very few medical services. What mechanism does the minister intend to put in place to ensure that all Canadians have equal access to this new right?

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April 22nd, 2016 / 12:55 p.m.
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Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Mr. Speaker, I look forward to further conversations with my colleague about this.

If there is anything we heard loud and clear, in a uniform way across the country, it was the matter of respecting the conscience rights of health care providers. We will continue to make sure that is upheld.

Members have also heard me say repeatedly in the House that I believe Canadians need to have access to all forms of medically necessary care across the country. That is a fundamental principle upheld by the Canada Health Act, which I will continue to uphold.

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April 22nd, 2016 / 12:55 p.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I am thankful and, to be honest, humbled by the opportunity to join this important debate.

Yesterday a group of high school students were visiting from my riding, and we talked for a few minutes about this debate and what would unfold in their Parliament. I told them that we were about to tackle one of those rare questions in the social and political life of a country, watershed moments, where we can translate our values into a law and touch the lives of Canadians in a profound way. I believe that this is one of those moments.

Let me say at the outset that I will be supporting this bill at second reading. New Democrats have decided that rather than seek consensus on a question so personal, we will be encouraging our members to take the time to consult with their constituents, to reflect carefully on this bill, and to vote with their conscience. Let me affirm my deep respect and admiration for members, wherever they sit in the House, who rise to express views that may differ from the views that I have on this bill.

I am reminded of something a former Conservative member of the House said when he appeared before the joint special committee. At the end of his eloquent and moving testimony, he stopped, looked around, and said, with his usual knack for not pulling any punches, “By the way, everything you decide here will affect every Canadian who is alive and every Canadian there will be in the future, and it will probably set the framework for the western world, so think about it.”

Let me say to Mr. Fletcher, to the young constituents who visited me yesterday, and to every Canadian who will follow this important debate in living rooms, law offices, and hospital beds, that I have every confidence that Parliament will give this bill the careful scrutiny it needs and the respectful debate that it deserves.

We are here because of the Supreme Court's unanimous ruling in the Carter case. The case was long and complex, but the decision was crystal clear. It states:

[...] s. 241(b) and s. 14 of the Criminal Code are void insofar as they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life; and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

That is what the court concluded. It is noteworthy for its humanity. It does not force doctors or bureaucrats to parse a patient's suffering, or weigh precisely how much pain and fear is tolerable and how much is intolerable. Instead, it recognizes the ability, indeed the right, of competent Canadians to decide for themselves when their suffering becomes intolerable in the circumstances of their condition.

In fact, the next line of the judgment goes further, recognizing the right of those competent Canadians to define what treatments may be unacceptable for them. It states:

“Irremediable”, it should be added, does not require the patient to undertake treatments that are not acceptable to the individual.

In just seven lines, the Supreme Court of Canada, the highest court in our land, affirmed that competent adult Canadians could consent to the termination of life, could define uniquely and for their life what intolerable suffering means to them, and could define to a large degree what an irremediable condition means to them, respecting their right to refuse treatments they determine to be unacceptable. Not only did the court unanimously affirm the right of competent Canadians to make their choices, it found two provisions of the Criminal Code unconstitutional insofar as they prevent eligible individuals from doing so.

Let us remind ourselves of the meaning of that word “unconstitutional”. In explaining such a finding in the Constitutional Law of Canada, Professor Peter Hogg quotes a U.S. justice to say this:

An unconstitutional act is not a law; it confers no rights; it imposes no duties; it affords no protection; it creates no office; it is in legal contemplation as inoperative as though it had never been passed.

Professor Hogg continues:

When a court holds that a law is unconstitutional, the invalidity of the law “does not arise from the fact of its having been declared unconstitutional by a court, but from the operation of [the supremacy clause of the constitution]”.

In principle, he said that the law is “invalid from the moment it is enacted”. The fact that the Supreme Court delayed the effect of its ruling in the Carter case does not detract from the force of that finding of unconstitutionality.

The court did not request that Parliament pare back the prohibition against assisted dying in these cases to a less intrusive level. It demolished the legal barriers that denied Canadians the choice as completely as if they had never been built.

The court then wrote:

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.

That is what we are here to do, to measure this bill against the constitutional parameters illuminated for us by our Supreme Court.

I was proud to serve on the joint special committee on physician-assisted dying.

I worked on that committee with my extraordinary colleague from Saint-Hyacinthe—Bagot. I thank her for her many hours of work and for her in-depth knowledge of Quebec law. Her wisdom greatly improved our report.

Together with parliamentarians of all official parties and both chambers, we reviewed the Supreme Court judgment and the provincial court decision that preceded it. We looked at laws in Quebec and around the world. We reviewed two major studies, which together heard from 13,000 Canadians and more than 100 organizations. We held 11 hearings. We called 61 expert witnesses and took written briefs from individuals and groups from all across this country.

That committee had a duty, in my view, to make recommendations for all Canadians and to consider all the situations that might arise in the coming years, and seek clear answers, founded on the law, on medical evidence, and on our shared values.

I am so thankful to all members of that committee for their work, for their commitment to respect the collaboration beyond and above party lines, and for their dedication in helping Parliament pass a law that does respect the constitutional parameters set out by the court, indeed, a law for all Canadians.

Based on that broad consultation and that evidence, and a strong majority spanning both chambers and all parties, we agreed on 21 recommendations to ensure that eligible Canadians have the option, and to protect individuals in situations of particular vulnerability.

These recommendations were not made lightly. Each was made after lengthy discussion with an eye to the future. Each was rooted in careful consideration of the evidence, the requirements of the Carter case and of our Charter of Rights and Freedoms, and of course the rights of suffering Canadians.

I must be honest at this point. I was deeply disappointed to find the majority of recommendations of the all-party committee either missing from or contradicted by the provisions in the government's bill.

The all-party committee recommended that the law use the exact words of the Supreme Court. This bill would cloud those words with new and very vague and ambiguous restrictions. Let me pause on that point.

Without delving into the details, let me share two concerns about an area so crucial that, in my view and in the view of many experts who have called me, it inappropriately narrows the scope of the entire bill.

First, this bill would limit its scope to medical conditions that are “incurable”, a word the Supreme Court did not use and a requirement it did not set. While the court was quick to make clear that it would never force patients to undergo unacceptable treatments to prove their condition was irremediable, no similar direction is found in this bill, none.

It would seem to compel patients to undergo treatments that they would object to in order to be eligible for assistance in dying. That could prove to be cruel and unusual and in itself contrary to the charter.

Second, the bill limits its scope to patients facing what it terms a “reasonably foreseeable” natural death, another requirement found nowhere in the decision. In fact, this concept was never raised once before us by any witnesses in the all-party committee; nor, as far as I can tell, does it have any precedent in any jurisdiction. It is not hard to see why. After all, it is almost hopelessly ambiguous.

Does it mean a death that is imminent, or simply one that we can predict with confidence? The government has provided a glossary that suggests “foreseeable in the not-to-distant future” or “on a trajectory toward death”, but of course those terms could be applied to every single one of us.

I want to read the conclusions of one of Canada's most revered constitutional lawyers, Joseph Arvay, QC. He stated:

As the lead council in the Carter case, I probably know better than anyone the evidence led, the arguments made, and the full implication of the judgements at all levels and I have no doubt that the Bill, if enacted, would be struck down as unconstitutional insofar as the “foreseeability clause” is concerned and perhaps other clauses as well.

Given that the Department of Justice lawyers did not prevail at the Supreme Court of Canada and the case was decided unanimously against their position, I assume the minister has a comprehensive legal opinion from outside council. Will she table that opinion at the justice committee? Will she force desperately ill Canadians to have to go to the Supreme Court again?

These restrictions that have no root in the Supreme Court decision are so fundamental that they affect the scope of the bill itself. However, they are not the only ways in which the bill seems to reject the advice of our committee.

The all-party committee recommended that the law not exclude patients who completed a valid request in advance of losing their capacity. The bill would offer those Canadians nothing but the cruel choice the court spoke of, the choice between a death they consider premature and the rising fear of a life they consider intolerable.

The all-party committee agreed that indigenous patients should be given the option of culturally and spiritually appropriate end-of-life and palliative services. It agreed that mental health services and supports for all Canadians must be improved immediately. It agreed that far too few Canadians can access the quality palliative and end-of-life care they deserve, and it identified concrete steps for the government to take on every one of these priorities for Canadians, and yet the bill contains nothing binding on any of these. There is not one dollar of new funding, not one commitment or timeline.

Of course there are those who ask us to be patient, who say this is just a first step. However, incremental change offers cold comfort to those suffering intolerably today. Nor does our charter allow unconstitutional provisions to be made right by degrees, by steps.

There are those who say that, while improving palliative care, or obeying patients' advance requests, or protecting the conscience rights of health care workers are good ideas, they were not named in the Carter ruling and so cannot be included in the bill, but neither did the case mention nurse practitioners, or record keeping, or witnesses, or multiple doctors, all of which are addressed in the bill.

These are all good and practical steps. Indeed, many are recommendations of the all-party committee, so we must replace a conveniently selective attention to the Carter decision with a consistent commitment to the charter rights and health care priorities of all Canadians.

The reality is that this moment is not going to come again. Canadians are counting on us to get it right now. That means abiding by the letter and spirit of the Supreme Court ruling and strengthening the bill against obvious challenges to its charter compliance.

It means taking real action on the priorities that Canadians recognize that are connected, including better mental health services and more accessible palliative and end-of-life care options for everyone.

Specifically, I urge all members to consider recommendation 19 of the all-party committee, which called for the re-establishment of the secretariat on palliative and end-of-life care and the development of a fully funded pan-Canadian palliative and end-of-life care strategy in collaboration with the provinces, territories, and civil society.

As anyone who has sifted through the mountain of evidence on this issue can attest, it is easy to get lost in the details, but at the end of it all, we are called to a question of principle. It is a principle reflected in the words of Mr. Justice Binnie in another ruling, which I paraphrase here. He said that, while we may first instinctively recoil from a decision to seek death, it is clear that it can arise from a deeply personal and fundamental belief about how we wish to live. We are asked to consider in what circumstances we can deny adult competent Canadians suffering intolerably from a grievous medical condition the right to make these fundamental decisions, the choices in Carter of what constitutes intolerable suffering, and which treatments are acceptable.

This is about choice. Canadians want options when they near the end of life or when they find themselves trapped in intolerable suffering. In my view, the bill before us denies that to too many Canadians, in too many cases, with too little justification.

By leaving unresolved so many of the tensions that play in the Carter case, the bill invites immediate challenges on similar grounds. These court battles would necessarily engage the full legal resources of the government against the arguments of the most weak and vulnerable Canadians imaginable. That is not what Canadians want. We do not need more conflict, division, or delay. What we need is constructive compromise, and what we insist upon is compliance with the Supreme Court of Canada's unanimous decision.

No government can be expected to pre-empt every challenge to a new law, but a government can at least be expected to recognize that a Supreme Court of Canada decision is not a recommendation. It can do better than try to drive a square peg into a round hole.

We can do better than altering the careful words of our Supreme Court of Canada. We can do better than flatly contradicting the evidence of experts and the advice of parliamentarians from all parties and both chambers.

We can do better than excluding patients whose valid request is approved but who lose capacity just before it can be acted upon. We can do better than condemning those people to intolerable suffering because, of course, their condition did not match the letter the bill.

Finally, I believe we can do better than offering only non-binding promises of more discussion on issues that are as urgent as giving every Canadian the mental health services they need and the options for palliative and end-of-life care they richly deserve.

I truly believe what I told those young people from Victoria yesterday. This is a moment that will not come again for us as legislators.

We have a duty to see the House pass a bill that respects the Carter decision, that respects our Charter of Rights and Freedoms, and that accords with the priorities of Canadians. Sadly, in my judgment, the bill before us is not that bill, but it can be.

Therefore, let us give it the study it needs and the debate Canadians deserve. Let us make whatever changes are needed to meet those standards. Let us do this work together, let us get it right, and let us work assiduously for all Canadians to get it right

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April 22nd, 2016 / 1:15 p.m.
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Liberal

Arnold Chan Liberal Scarborough—Agincourt, ON

Mr. Speaker, I want to thank my hon. colleague, the member for Victoria, for a very impassioned speech and a very important contribution to the debate. I particularly take note of his objections, despite the fact that he has expressed his ultimate support for the legislation that the government has introduced in Bill C-14.

I want to specifically get to one of the objections that he raised, which deals with the question about the foreseeability clause.

He noted that the lead counsel in the Carter decision, Mr. Joseph Arvay Q.C., raised concerns with respect to the constitutionality of the proposed Bill C-14. I want to ask my friend what proposed changes would be necessary so that the definition of reasonable foreseeability, currently found in proposed paragraph 241.2(2)(d), would deal with the legal standard. I believe that is the nature of his objection.

I would add the caveat that, as I recall the Minister of Justice's presentation at the time, the determination of reasonable foreseeability would be left to physicians. Is there some amendment you could propose that would in fact address the legal standards, which I think is the nature of the objection?

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April 22nd, 2016 / 1:15 p.m.
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Liberal

The Assistant Deputy Speaker Liberal Anthony Rota

I would like to remind hon. members to appreciate that they are speaking through the Speaker and not directly across the floor.

The hon. member for Victoria.

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April 22nd, 2016 / 1:15 p.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, this is a very fundamental question that goes to the difficulty at the heart of this.

I want to be clear when referencing Joseph Arvay, who many consider the leading constitutional lawyer of his generation, that I do not mean to stop there. I have heard this concern about “reasonably foreseeable” from people from coast to coast, eminent jurists whom I respect enormously.

I would say the simple solution is to do what the Supreme Court told us, which is to simply use the words of the decision, the words “grievous” and “irremediable”. I do not know that anything has been added. I know a lot has been taken away by the definition that is there. I am hoping that the government is open to reasoned debate and amendments that are in the same spirit that we worked in under the joint special committee.

I believe we can do better. This clause is beyond comprehension to jurists of the highest quality and reputation across the country. Why is it there? It comes from nowhere. It comes from nowhere in the decision. It comes from no other jurisdiction that we have been able to find. All it would do is create uncertainty. Does “reasonably foreseeable” mean solely in time? Does it mean about conditions? Nobody knows.

It is that uncertainty that doctors are telling me they cannot accept. Therefore, they will be reluctant to provide the services until they get the kind of certainty that we tried in the committee to provide, and which Canadians will need. Those who are advising and insuring physicians and medical practitioners are certainly going to need more than words like “reasonably foreseeable”.

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April 22nd, 2016 / 1:15 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, I was pleased to hear the minister talking about international comparisons. One of my disappointments with the Special Joint Committee on Physician-Assisted Dying was that we did not do a sufficient study, at all, of what has happened in other jurisdictions where we have seen these laws brought in.

Specifically, I want to talk about a study that was done in Belgium in 2010, which was quoted in the Canadian Medical Association Journal. It surveyed nurses and found that a full 120 of 248 of them said they had been involved in cases of euthanasia where there was no consent. Of the 248 nurses who had been involved in euthanasia, almost half of them had been involved in cases where there was no consent. Yet, the direction we are going with this legislation, and the model that I know the member advocates, because it follows the special joint committee, is very similar to the Belgian model.

I would ask the member why Canada would follow Belgium when there have been significant problems with actual consent. Why do we not look at jurisdictions that have been more effective and put in place things like advanced legal review?

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April 22nd, 2016 / 1:20 p.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I thank my colleague for the question and for his work during the deliberations of the special joint committee.

The Belgian study to which he refers is one of many studies. In the judgment at the trial level of the B.C. Supreme Court, which is several hundred pages, Madam Justice Smith referred to these studies and others like them. She concluded that we can do better in our bill. She concluded that it was appropriate that the constitution reflect that competent adults have the ability to use physician-assisted dying, medical aid in dying, when they meet the very specific and stringent conditions that were articulated.

Consent is at the core of this. One has to be careful that there is consent that has not been pressured in any way. I think the bill does a good job of addressing that.

The idea of having some kind of advance legal requirement for consent determination and the like was rejected by the committee because it would be an absolute barrier to many people, particularly in remote communities, from being able to have the choice that the Supreme Court said Canadians constitutionally enjoy.

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April 22nd, 2016 / 1:20 p.m.
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NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Mr. Speaker, I would like to commend the member on his very thoughtful speech today, and thank him for the work that he did on the Special Joint Committee on Physician-Assisted Dying along with the member for Saint-Hyacinthe—Bagot on behalf of our caucus. The committee was so ably chaired by the member for Don Valley West, whom I also wish to thank for his work on behalf of this chamber.

My question has to do with conversations I had with two constituents who are facing the issue of physician-assisted dying, and the case of my own mother last fall. This has to do with the advance consent notion.

I am going to use the case of my mother because I know it so well. She had medical conditions that were going to lead her to a position where it was going to be difficult to continue living, and she also had dementia. She wished to give consent in advance before the dementia got so bad that she could no longer give consent. When her other medical conditions advanced, she was no longer competent, so we were faced with very difficult decisions as a family, but what we did know was her very clear statements before of what she wished to have happen.

How would the bill deal with very difficult situations like this? Did the Supreme Court decision deal with these kinds of cases?

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April 22nd, 2016 / 1:20 p.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, first, I say to my friend from Esquimalt—Saanich—Sooke that I am sorry for the loss of his mother.

I want members to know that the bill would not do anything about that. It is a sad deficiency that I keep hearing about day after day in my office. People will not be allowed to determine, even if they have the very condition that they feared the most, dementia, Alzheimer's, and the like, what will happen at the end of their life.

We have the terrible situation, with real-world examples from British Columbia, where a person who worked all her life nursing people with dementia said, “I do not want that to happen to me, being spoon-fed and in diapers in an institution”. Contrary to her expressed wishes, this bill will do nothing to address that. That is the deficiency I hear most about in my riding as well.

Most Canadians asked for that. The polls are absolutely clear that the circumstance my colleague recounted is precisely what people fear, and this bill sadly will not do what the recommendation of the joint committee and others have urged us to do, namely, to provide in circumstances where people delineate precisely when it is time for that physician-assisted dying to take place. There will be no opportunity to do that. We can do better. We must do better.

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April 22nd, 2016 / 1:20 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, I have a quick follow-up to the member's previous response. I do not think it is a good response at all to say there have been other studies without actually quoting them.

We have seen significant studies from Belgium and other Benelux countries that show that without an effective system of advance legal review, which need not be onerous, and one suggestion has been to use consent and capacity boards which already exist at the provincial level, a simple system of not onerous advance review could be added to this legislation which would ensure that we do not go down the road that many of the studies have shown us going down in the Benelux countries. What is wrong with adding that basic protection?

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April 22nd, 2016 / 1:20 p.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I appreciate the opportunity to be more specific.

Advance legal review would be an absolute barrier for many people, particularly in remote communities. I have confidence in doctors. Doctors do these things every day. They look after us in life, and I trust them to look after us in the last days of our life as well. To talk about a consent and capacity board which one province has and others do not is not helpful. We need to figure out how we can do this. We are absolutely required to address the needs of the vulnerable, but we cannot provide an untenable barrier to people whose constitutional rights are affected. That would not work, and we would oppose such an amendment.

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April 22nd, 2016 / 1:25 p.m.
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Liberal

The Assistant Deputy Speaker Liberal Anthony Rota

Resuming debate, the hon. member for Sherwood Park—Fort Saskatchewan. I just want to remind the member that he has about four minutes and thirty seconds, and the balance of his time will be returned to him when this issue comes before the House again.

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April 22nd, 2016 / 1:25 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, I appreciate the opportunity, and I will be splitting my time.

I want to discuss specific aspects of the legislation today. On Monday, I will have an opportunity to talk about some underlying philosophical questions.

I want to be clear that I do not believe in an all-or-nothing approach. Many of my colleagues and I who have broad philosophical concerns about what is happening here are still willing to vote in favour of legislation that does not recriminalize euthanasia, if it advances positively in the direction of saving some lives, especially minimizing the risk to vulnerable persons. However, this legislation does not contain meaningful safeguards. Without amendment, it will protect no one.

We know that this law has written exceptions. However, it has exceptions to the exceptions; and may I say it has exceptions to the exceptions that are not at all exceptional?

This legislation has a requirement for the provision of written consent. However, if people cannot provide written consent, someone else can do it on their behalf.

This legislation prescribes a waiting period. However, the waiting period does not apply in the event of possible imminent death or loss of capacity.

There is so much ambiguity here.

The government has said that mental illness is excluded. However, in section 241.2(2) the legislation clearly states that physical or psychological suffering qualifies a person to seek premature death.

The legislation says that death must be “reasonably foreseeable”. May I say that death is reasonably foreseeable for all of us? It is those who think that death is not reasonably foreseeable who probably need the medical attention. Why not put in the word “terminal”? When I was learning to drive, my mother thought that death was “reasonably foreseeable” every time we got into the car. That is no criterion.

There is a requirement that two physicians sign off. However, given the huge ambiguities, obviously doctors are likely to have a wide range of interpretations of the rules. The estimates are that there are 77,000 physicians in this country, and the likely practice of doctor-shopping will ensure that people who think they meet the wooly and ambiguous criteria can somewhere find two physicians.

The member for Victoria said earlier today that this is something doctors do every day. No, it is not. Doctors do not take lives every day. This is fundamentally different from the normal practice of medicine. When we have so many different doctors and opinions to choose from, these are not effective safeguards.

Given these five comically ridiculous exceptions to the exceptions, there is no doubt that detailed provincial legislation or regulation will be required in every case. Therefore, it is not at all clear to me what this law is supposed to accomplish.

Further, there are two key areas where the prevailing rules under this law would leave us demonstrably worse off than the Carter ruling alone.

First, there is a terrifying clause in this bill, which states that if someone kills someone else but can demonstrate, at least beyond a reasonable doubt, that he or she had a reasonable but mistaken belief that the criteria applied then that person cannot be penalized. We can find that at 241(6). Therefore, we can kill someone who did not consent and escape prosecution on the basis of reasonable but mistaken belief. Whatever is done, I implore the government to take this very dangerous section out. This is going even beyond the Belgian model.

Second, this legislation provides no protection for conscience rights, despite the court's clear statement that nothing in this decision required particular health care practitioners to be involved, and despite the clear assurance of the Canadian Medical Association that access does not require taking away section 2 conscience rights.

This legislation constitutes a perfect storm. Ambiguous criteria, no advance legal review, no conscience protection, and allowances for doctor-shopping are not meaningful safeguards at all. The bill leaves patients, seniors, the sick, and the disabled vulnerable to error and systemic abuse. We have seen this in Belgium before. I have quoted the studies during questions and comments. We do not want to go down this road in Canada at all.

The government must introduce simple amendments to this legislation, which define the criteria more clearly, which address the problems I have mentioned, and which introduce an effective system of advance legal review.

As I have mentioned, a person seeking hastened death should require the sign-off of competent legal authority. One such model could involve the use of consent and capacity boards or some kind of judicial review. It need not be onerous.

This process need not be complicated. It would ensure that people are not accidentally killed and that their killer is able to hide behind the ambiguous criteria of reasonable but mistaken belief.

We cannot save every life today. However, it is better to light a candle than to curse the darkness. From my perspective, too many have spent too long just cursing the darkness. Let us amend this bill and fix it so that we can get the work we need done.

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April 22nd, 2016 / 1:30 p.m.
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Liberal

The Assistant Deputy Speaker Liberal Anthony Rota

Order, please. The hon. member will have five minutes and a few seconds remaining when this debate is resumed in the House.

It being 1:30 p.m., the House will now proceed to the consideration of private members' business as listed on today's order paper.

The House resumed from April 22, consideration of the motion that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the second time and referred to a committee.

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May 2nd, 2016 / 12:05 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, this legislation contains no meaningful safeguards. Even its exceptions are full of holes. The written consent provision excludes those who cannot sign. The waiting period can be routinely waived. Mental illness is not excluded. The requirement that death be reasonably foreseeable would exclude no one, and the requirement that two doctors sign off merely encourages doctor shopping. Even if the already ambiguous criteria are not followed, someone who kills an unwilling patient can be let off the hook if he or she claims a reasonable but mistaken belief that the criteria applied.

Clearly, we have a perfect storm of ambiguous criteria and a reasonable but mistaken belief clause which means that it would be nearly impossible to prosecute anyone who kills a patient, even without consent.

Today I want to make three additional points: the decline of moral language, the need for advance review, and the way in which an absence of conscience protection is further undermining an already inadequate system of palliative care.

This debate has been characterized by a decline of language. Terms like “suicide”, “euthanasia”, and “killing” are rejected and replaced by fundamentally inaccurate phrases like “medical assistance in dying”. Every day physicians assist their patients in the context of dying without killing them.

The decline of language is also evident in the euphemistic use of terms like “dignity” and “compassion”. The phrase “dying with dignity” implies that suffering or disabled people do not have dignity, and this reflects a very dangerous world view. For a long time we have understood that dignity is immutable; it is an intrinsic characteristic of all human beings. Our immutable dignity is the reason we put down suffering dogs, but we do not put down suffering humans.

This human exceptionalism, this idea of universal and immutable human dignity is the basis of our conception of human rights. Human rights, the ostensible basis on which this legislation is advanced, stand on a moral foundation of universal immutable human dignity, and those who wish to redefine dignity so dramatically should at least provide us with their alternative definition.

I have encouraged the government to amend this legislation to include a system of advance review by competent legal authority. This could take many forms. It could involve review by a provincial consent and capacity board. It could involve a requirement for review by a judge. It could involve the simple requirement in this legislation that the provinces set up their own systems of advance legal review or that an independent lawyer certified and retained for this purpose replace the role of one of the witnesses.

There are multiple options here, some better than others. The criteria are not worth the paper they are written on if someone with competent legal authority is not making a determination in advance to ensure the legal criteria are met.

The government, though, wants to force doctors into this role. However, doctors do not constitute competent legal authority. Doctors do not make these types of decisions in other parts of their work, given how aberrant the taking of life is from the normal medical process of protecting life, and the proposed legislation's allowance for doctor shopping does not actually mean that the doctor providing the prior care would provide advance review, since the patient, or worse, someone else, could simply go on the Internet to find a doctor with a more liberal interpretation of the criteria.

A simple system of advance legal review by competent authority would eliminate doctor shopping and achieve the central objective: it would ensure that people who have not consented or do not meet the criteria are not killed, without any effective means to investigate that after the fact. Data from Benelux countries show alarmingly high rates of euthanasia for patients who have not consented; however, prosecution of those who take life without consent in a medical environment is almost non-existent.

Finally, a lack of conscience protection pushes people out of the provision of palliative care when already far too few Canadians have access to it. Dr. Nancy Naylor, a family and palliative care physician with 40 years of experience, is now leaving the profession. She said, "I have no wish to stop. but I will not be told that I must go against my moral conscience." She is speaking out because her patients who will be left without access to palliative care cannot. What good does it do anyone to leave conscience protection out of this legislation, and chase good principled palliative care physicians out of the profession at a time when we need them most?

Many doctors say that this is not medical care at all, and we should let them focus on what they do best.

The Supreme Court decision punched a hole in the previous law, and this legislature cannot change that, but the government appears to be taking advantage of these events to widen the hole still further. No law would be a bad situation, but this law could make a bad situation worse. It would leave vulnerable seniors and sick and disabled persons at risk with no meaningful restrictions.

We should stop the madness and fix the bill.

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May 2nd, 2016 / 12:10 p.m.
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Liberal

Rob Oliphant Liberal Don Valley West, ON

Mr. Speaker, I have a very simple and direct question for the member for Sherwood Park—Fort Saskatchewan.

Does the member support the unanimous decision of the Supreme Court judges in honouring the request of Ms. Taylor and Ms. Carter to have assistance in dying?

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May 2nd, 2016 / 12:10 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, I was actually very clear about that point in my speech.

Regardless of the private opinions of members with respect to this issue more generally, we know that the government is not addressing at all the task that the court put in front of it. The task that the court gave the government was to develop a system that would make this happen while also protecting the vulnerable. The government replaced some criteria in the court decision with equally, if not more, ambiguous criteria in its response. We are not seeing any development in this regard from the government at all.

I do have to underline, and again we see it in the question that the member asked, the euphemistic language here. Doctors provide medical assistance in dying every day that does not involve killing their patients. If members defend it, good for them, but they should have the honesty to describe the issue properly, because calling something “medical assistance in dying” is clearly misleading. It distracts from the central question we are supposed to be debating.

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May 2nd, 2016 / 12:10 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Mr. Speaker, I listened with great interest to my hon. colleague.

The reason Parliament has been put in this position by the Supreme Court is the complete lack of action by the Conservatives in dealing with this issue over a period of 10 years. The Conservatives cut the palliative care initiatives that were in place, took no movement on the issue of palliative care, and refused to deal with the fact that they knew the Supreme Court decision was coming.

The Supreme Court has now stepped into that vacuum and has put this Parliament and, I feel, all Canadians in a very difficult position, because if we do not have a law by June, we will have another legal vacuum in which this door could actually be blown open much wider.

The question is, is the role of this Parliament to do something positive, where we can assure that those who are sick and dying are able to access quality palliative care? We had pushed a motion through the House of Commons last session, and there was no money. The Conservatives and the former prime minister took no steps to put that into action.

We now have Motion No. 46 which talks about the need to establish palliative norms, working with the provinces, working to change the EI provisions so that families can get the support they need to take the pressure off them.

Is my colleague willing to accept a legal vacuum in June if this House does not move? Is he willing to work in a proactive manner with our party in establishing palliative care access so that we can actually present Canadians with more of a balance than simply the law on euthanasia?

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May 2nd, 2016 / 12:10 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, I thank the member for his work on this. I want to address a few of the points the member made.

It is a strange definition of lack of action to say that the repeated express will of the House on the issue of euthanasia somehow constitutes a lack of action. Of course we had proposals that came forward before the court decision, and those were rejected by an overwhelming majority of this House, which included the majority of Liberal and, I believe, New Democrat members at the time, as well.

With respect to the issue of a legal vacuum, I would like to see better legislation come forward which clarifies the situation. I would support this bill if it were amended in a number of key ways. However, the existing legislation does not in any way address the task that the court asked us to do, which is to actually describe and define what the situation would look like in terms of euthanasia and assisted suicide in Canada.

The government has replaced some ambiguity in the court decision with greater ambiguity in the legislation. Legislation is only worth proposing if it improves on the absence of legislation.

In terms of investment in palliative care, I agree with the hon. member that there is more work to do. I would not accept his characterization of the previous government as doing nothing on that issue, but I would certainly agree that more investment is needed.

The problem with this legislation is it moves in the opposite direction. Allowing euthanasia and assisted suicide without conscience protection has the effect of pulling doctors who would otherwise want to be involved in palliative care out of palliative care if they do not want to participate in euthanasia. At the very least, conscience protection should be added. That would preserve the existing system of palliative care that we have, and then we could build on that by working to do more.

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May 2nd, 2016 / 12:15 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, I have had the honour of serving the people of Kitchener—Conestoga and being part of many important discussions and debates here in this chamber over the past 10 years. As members of Parliament, we are given the solemn obligation to chart the way forward for our great nation of Canada. The motions we table, the amendments we consider, the legislation we adopt will always impact, positively or negatively, the very people who elected us to represent them in the capital city of our nation, and they will also impact generations of Canadians to follow.

The impact of our deliberations and decisions we make on this critical life and death issue will impact the very fabric of our country. If I may say, it will leave a lasting legacy for good or for ill of our understanding of what it means to part of the human family.

Because of the very serious nature of the topic in front of us today, we, and by that I mean every member of this chamber, must take a step back and consider some very foundational questions. Each of us needs to ask ourselves these difficult questions. How we as members perceive these foundational issues is absolutely key to addressing this sobering topic before us today.

Consider with me for the next few moments these questions. What does it mean to be human? What gives human life meaning and value? Does every human life possess intrinsic value and dignity, regardless of perceived deformity, regardless of perceived disability, regardless of the perception of being a burden, regardless of whether or not a person may have achieved their best before date?

For me, the answer to all of these question is a resounding “yes”. Every human life is worthy of our utmost respect and protection. Every human life matters. Therefore, needless to say, I do not support physician-assisted suicide, or voluntary euthanasia or any legislation that would further devalue human life.

My world view is influenced by my life experiences, and most profoundly it has been shaped by my faith. I believe every human life has intrinsic value and dignity that needs to be held in high honour and esteemed, in other words, to be considered worthy.

There is a saying in the Talmud, “Whoever destroys a soul, it is considered as if he destroyed an entire world. And whoever saves a life, it is considered as if he saved an entire world.”

On the Peace Tower of our Parliament buildings carved in stone above the west window, members will find these words taken from ancient Hebrew writings in the book of Proverbs, “Where there is no vision, the people perish.”

What is our vision for Canada? I ask each of my colleagues today what their vision is for Canada.

My vision for Canada is one where every human life is valued and cherished from the moment of conception to the moment of natural death. It is my firm belief that life is a gift from God and that this gift is far too precious to be discarded or destroyed. Every human life is filled with infinite value and, yes, every person, regardless of disability, deformity, depression, or devaluation based on criteria of so-called “usefulness” has something to teach us about what it means to be human.

For those who are suffering, we have the privilege to come alongside and care deeply. We provide proper pain relief, palliative care, human touch and love, in other words, we provide compassion.

The very meaning of the word compassion is “to suffer with”. It is to come alongside and enter into the suffering, to come alongside with feeling and care. Compassion is supporting them. It is to ignore the fact that compassion has everything to do with relationships if we are to allow physician-assisted suicide. We simply cannot have compassion if the relationship has been intentionally terminated.

That being said, the Supreme Court of Canada has established grounds for an exemption from prosecution for physicians who would assist in administering the suicide dose or carry out the act of euthanasia. The Supreme Court of Canada has done this, completely rejecting the fact that the elected members of the House of Commons 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. My contention is that it is not the job of the Supreme Court to create laws but rather to interpret them.

I was one of the members of Parliament who served on the joint committee appointed to study physician-assisted dying. Our committee heard from many witnesses representing many different viewpoints. We heard from medical professionals, palliative care experts, mental health professionals, the disability community, the aboriginal community, various faith communities, legal and constitutional experts, and ethicists. As members might expect, from such a large variety of people, there was a very diverse response.

The unfortunate reality is that the timeline given to our committee for the completion of our report and recommendations did not allow for the large number of groups who wanted to appear before this committee. Groups like the Euthanasia Prevention Coalition, L'Arche Canada, Living with Dignity, as well as Dr. Balfour Mount, who is considered to be the father of palliative care in Canada and in fact in North America, were not allowed to appear at all.

The joint committee report had no teeth when it came to insisting that before physician-assisted suicide could be offered or even considered in Canada, there should at the very least be a credible offer of accessible and affordable palliative care to those who faced such a final solution of hastened death. Like the committee report, Bill C-14 fails miserably in stepping up with real change on this crucial issue.

Dr. Harvey Chochinov, chair of the external panel, professor of psychiatry at the University of Manitoba, and Canada research chair for palliative care, suggests that all patients requesting medical aid in dying would need to have a palliative care consultation to ensure that patients would be fully informed of all palliative care options that could be initiated in order to mitigate the suffering of patients. To ignore the very real lack of choice without a concurrent real offer of palliative care is to offer no choice, only hastened death.

I am thankful that Bill C-14 has incorporated many of the viewpoints of the dissenting report. However, it still includes very vague and subjective language and does not address many key issues raised by witnesses who appeared before the joint committee.

A major concern in this entire discussion has been the overt attempts to soften the language. Rather than call it physician-assisted suicide or voluntary euthanasia, it was then referred to as physician-assisted dying. Even physicians objected vigorously to the term “physician-assisted dying”, especially palliative care physicians. For many decades these doctors have been assisting patients through the natural dying process.

It has been said that all social engineering is preceded by verbal engineering. We will find no better example of that verbal engineering than in the matter before us today. This topic is far too important to allow this vague and euphemistic language to go unchallenged. As Dr. Chochinov notes, Bill C-14 makes no distinction between physician-assisted suicide and euthanasia, yet both are included in what the bill calls “medical assistance in dying”. It is extremely important to outline the difference, because international experience reveals that they are vastly different in terms of their uptake and lethality. In jurisdictions that offer only physician-assisted suicide, such as Oregon, these deaths account for about 0.3% of all deaths. In jurisdictions that offer euthanasia, hastened death accounts for approximately 3.0%, a tenfold increase.

If we were to extrapolate these figures to Canada where there are approximately 260,000 deaths per year, under a physician-assisted suicide regime, there would be approximately 780 deaths per year. However, if we were to extrapolate that to allow for euthanasia, the number of deaths would increase to 7,800 per year, which as I pointed out is a tenfold increase. The reason for the lower numbers under a physician-assisted suicide regime is ambivalence. It is crucial that at the very least the government needs to point out that if we are to proceed with this, we have to ask that those who request physician-assisted death must follow through on physician-assisted death rather than voluntary euthanasia because the numbers are so different.

Another key missing component is the matter of conscience protection for doctors and health care workers. If it is possible to ensure a “consistent approach to medical assistance in dying”, as the preamble asserts, there is no reason why at the same time a consistent approach to guarantee conscience rights cannot be included in Bill C-14.

Finally, Bill C-14 should include a system of judicial oversight in order to protect vulnerable persons. While two independent witnesses and two independent doctors sounds good on paper, the risks of overt or subtle coercion are too great and the possibility of abuse too real. These assertions need to be verified under a framework of legal oversight.

In summary, we should be offering hope to all Canadians. As legislators, we should be doing everything in our power to ensure that not one single person dies needlessly. It is with this in mind that I repeat the need for at least three major amendments to Bill C-14: first, vulnerable Canadians need better protection with a system of judicial oversight; second, doctors, health care personnel and institutions need clear conscience protection; and, finally, Canadians who are suffering need a real option of palliative care not hastened death.

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May 2nd, 2016 / 12:25 p.m.
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Liberal

Anthony Housefather Liberal Mount Royal, QC

Mr. Speaker, it is clear that the hon. member is very passionate about life, and that certainly comes through in what he has said.

I want to ask the member about his comments with respect to the Supreme Court. He seems to believe that the Supreme Court needs to defer to the will of Parliament. However, that is not the Charter of Rights oriented system we now have in Canada. We adopted the Charter of Rights because we believed it would guarantee the protection of individual liberties, regardless of what the majority necessarily believed. In this case, whether the member, other members or I like it or not, the Supreme Court came to a decision in Carter that said medically-assisted dying was open to a certain segment of the Canadian population.

Based on what the hon. member has said, it sounds as if he is suggesting the only real path is using the notwithstanding clause to override the court's decision. Is the hon. member asking us to do that?

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May 2nd, 2016 / 12:25 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, I know my colleague is also passionate about life.

It is clear that there was a very short timeline for the committee to hear witnesses, take all of that input and come up with a report to give to the government, and then the government to craft legislation. Now we are under a very strict timeline, even in terms of debate in the House. The justice committee itself will be under an extremely short timeline. It is clear to me that we do not have adequate time to give this serious topic the serious consideration it really needs.

Whether the government wants to invoke the notwithstanding clause or not, I will not suggest that. It certainly would be one option. What I do know is that by rushing ahead the way we are at this point, we will not have the kind of law Canadians deserve.

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May 2nd, 2016 / 12:25 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Mr. Speaker, I have great respect for the work my colleague has done on issues of palliative care over the years with the parliamentary committee.

We agree on many things and disagree on some things, as wont in the House. I share his frustration with the Supreme Court's decision on the timelines. I respect the Supreme Court's right and power to establish rules and laws where it believes Parliament has left a vacuum. However, the new government should have been given the opportunity, as a form of good will, to engage the population of our country in this very important discussion as it affects every person and cuts across party lines. It would have been fair to give the new government the ability to hear from Canadians. I agree with the member. We are now under a very strict timeline of which Canadians are watching but are not a part.

Given these are the limits that have been placed on us by the Supreme Court, my concern is the legal vacuum that happens if we as the House do not respond to this, and the dangers that legal vacuum will create with other individuals and organizations stepping forward knowing they can go to the Supreme Court if Parliament has not acted.

Therefore, has my colleague considered the danger of that legal vacuum if we do not have a law in place by the end of June?

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May 2nd, 2016 / 12:25 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, I want to thank my colleague for the work he has done on palliative care. I was honoured to support the motion he presented to the House last year. It was an honour to work across Parliament, across partisan lines, to facilitate the report “Not to be Forgotten”, which includes many recommendations. I am proud to say that a number of those recommendations have been completely or partially implemented, but we have a long way to go.

I am concerned as well about the potential legal vacuum that could exist if we do nothing. However, I have pointed out in my comments that there are at least three key amendments that the legislation needs if it is in any way going to resemble what I think are adequate safeguards for vulnerable people. Those include that vulnerable Canadians need better protection with a system of judicial oversight. It is fine to say that there are two medical doctors, two independent witnesses, and yet no way of actually asserting that those are in fact independent.

Another one is health care protection for conscience of health care workers. It would be totally inappropriate for an institution that was set up to improve end-of-life care and to walk with patients through that end-of-life natural process to demand that they go diametrically opposite to the principles under which they were founded and now have to participate in physician hastened death.

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May 2nd, 2016 / 12:30 p.m.
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Liberal

Rob Oliphant Liberal Don Valley West, ON

Mr. Speaker, I will be sharing my time with the member for Oakville North—Burlington.

I want to begin by taking a moment to pay tribute to two Canadian women whom I did not know but have come to know in their deaths, and who I think are two of the most courageous women. They are Gloria Taylor and Kay Carter. These two women were on a journey of life that was not of their choosing, and they came to the point in their lives where they wanted some assistance in the final days of their lives in the final part of their journey.

As a United Church minister, I walked that journey with many people, hundreds of people in fact, and have done even more funerals where I did not know the people and only came to know them through the stories of their families and the legacy they left behind. Kay Carter and Gloria Taylor are two such women whose courage, tenacity, hopefulness, and love of life have instructed us to this very day, where we are now considering a bill on medical assistance in dying.

In paying tribute to them, I also want to give them thanks for engaging us in what is one of the best civics lessons that we could ever have as a chamber. Each of the branches of our government has a chance to speak to this. There is a legislative branch and a judicial branch, as well as the executive branch.

We actually began this conversation in 1982 where we invoked the charter that is now so much part of our Canadian culture of rights and freedoms. That charter has instructed all Canadians, Canada's courts, and Canada's legislators since the day it was passed. The reality is that when Kay Carter and Gloria Taylor made their appeal to the Supreme Court of British Columbia, and it went to the Court of Appeal in B.C. and then to the Supreme Court of Canada, we had the opportunity to have our judicial branch take a look at their rights and the possibility of their having assistance in their deaths. The courts ruled on that and gave one year for the parliamentary branch and the executive branch to come up with a law.

The parliamentary branch then spoke by having a joint committee with the House and the Senate. I need to say to this chamber that it was probably the richest experience I have had as a member of Parliament. Men and women—senators and members of this House—engaging in a discussion, listening to the stories of life and of death and of healing and of hope, changed me profoundly. It gave me the opportunity to recognize that the parliamentary system that we have gives Canadians a great opportunity to hear their voices being heard at committee and now in this House.

The executive branch then picked up from the report and has presented Bill C-14. I want to thank the minister for her work on this, and the work of her office and of justice, for taking the report that we did seriously, engaging in it further, and coming up with a piece of legislation that at this time I am very clear I will be supporting at second reading.

That does not mean that I think we are finished with this piece of legislation, because it is now back to the parliamentary system where we are to engage in the dialogue with the executive branch about making a law that could be good enough better. When we are dealing with issues of life and death, I do not think “good enough” is good enough. We can honour the quest that Gloria Taylor and Kay Carter engaged in and that the Supreme Court of Canada ruled on and that the executive branch has presented a law on, and as parliamentarians take seriously the Charter of Rights and Freedoms, take it to our hearts and look at what it is that we as members of Parliament are sworn to. It is more than allegiance to Her Majesty. It is about upholding the Constitution of this country and engaging in it with love, with commitment, with passion, and with hope, and looking at how the decision that the Supreme Court made can actually live out in the life of Canada.

We have a piece of legislation that is before us today, and it was decided that section 7 of the charter could not be used to deny the rights of two women looking for assistance in their deaths. The government of the day tried to fight that section 7 declaration of rights by invoking section 1 of the charter, saying that there were reasonable grounds to withhold those rights. However, the Supreme Court of Canada did not allow that. It said it would be unreasonable to deny those rights to be given to those women. The court made a very specific decision on a very specific case at a specific time.

The Supreme Court also said in paragraph 127 of the decision that it did not pronounce on things that were not before it in that case. That was a requirement for Parliament and also the bill, which, yes, does engage all Canadians in a discussion about what it is that we can have as a continuum of care that continues to the place where we help people on that final journey.

We come at it differently. I have full respect for the hon. member for Kitchener—Conestoga. He has engaged this subject well and I have taken into account the fact that he has passion. We have come at it differently, but I have no doubt that everyone on both sides of the House is concerned about the well-being of Canadians. However, I think the bill needs to go even further to be faithful to our Constitution.

I have concerns in that I think there could be further challenges to the bill in the courts, which I do not think Canadians should have to endure. I have a couple of very specific concerns that I would like to raise in the House and one is the use of the word “incurable”.

The court was very clear that it did not want to use the word “incurable”. Instead, it used the word “irremediable”. By invoking the word “incurable”, one begins to look at the disease instead of the person. What I mean by that is that sometimes a disease may be incurable or curable, but the person has the right, the Supreme Court said, not to undertake treatments that are not acceptable to that person. The treatments may be cruel or punishing and the reality is that the court said they do not need to undertake them. The disease may be curable, but that person has chosen a different path and that, under section 7, is their right. I have that concern about invoking that word.

The other concern I have is the introduction of the concept of foreseeable death or death in the foreseeable future. All of us live a precarious life. Life is fragile, life is precious, and life is dear, but for some life has become intolerable. Some diseases are not necessarily mortal in the sense that people are automatically going to their final days with that disease, but people still have pain that is intolerable. The Supreme Court decision in Carter says they have the right to medical assistance in dying.

The introduction of that concept of death in the foreseeable future has muddied the waters. Physicians are asking what it means. Does it mean “terminal”? Some hospitals have a different definition of “terminal” than other hospitals and other physicians have. We have to be very careful on that.

The third point I would make is about one of the safeguards. This is robust legislation. There are safeguards in place that I do not believe are of great concern. One safeguard worries me, and that is the final one in the third section on safeguards, proposed paragraph 241.2(3)(h), which says that immediately before the administration of those substances that will cause death, the person needs to, once again, declare competently that they want death to happen.

I have been in too many hospital rooms. I have sat with too many dying people. Most of the people who will access this kind of continuum of care are dying and will probably be receiving morphine. To take them off the morphine to ensure they have the capacity to give consent is cruel. The reality is that in a 15-day period, that person should be allowed to make a gracious exit and be given the compassion not to be once again required to become competent, because the morphine is helping them with their intolerable suffering. That they are suffering intolerably has already been declared.

With those exceptions, I am supportive of the bill. The justice committee has its work to do. I am looking forward to thorough deliberations. I have utter confidence in every member of that committee. I am looking forward to the bill returning to the House and going to the other place. I know that Canadians will have a law that helps them and makes Canada a richer and stronger country.

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May 2nd, 2016 / 12:40 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, I want to thank my colleague for his work as co-chair of the committee and for the good working relationship that our committee had.

There is one concern I have, and this happened frequently during our committee hearings as well, I believe unintentionally, or perhaps intentionally. There is a conflation of two issues. One is physician-assisted dying or physician-assisted suicide, and the other is simply discontinuing medical treatment.

Patients have always had the right to refuse what my colleague refers to as punishing medical treatment that may prolong their lives. I wonder if my colleague would clarify that this was not his intent, and that, in fact, patients have always had the right to refuse medical treatment that would extend their lives unnecessarily or, as people say, “It's okay to pull the plug”.

These are issues that we have dealt with for many years. That is not the issue that we are talking about today. I am concerned that this kind of language is creating some confusion on the part of people who may think we simply want to extend life at all costs with whatever medications are necessary, or with medical procedures that may go beyond what the patient requests.

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May 2nd, 2016 / 12:40 p.m.
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Liberal

Rob Oliphant Liberal Don Valley West, ON

Mr. Speaker, indeed, I think the member for Kitchener—Conestoga has it right. There are a variety of ways that people die and there are people who have been very clear about having a “do not resuscitate” order or that no heroic measures be taken.

However, there also comes a time when certain people have reached the end and physicians are working with them. There is a covenant. There is a sacred covenant, I believe, between our physicians and patients that allow them to understand that the role of the physician is to end suffering. It is not necessarily to prolong life. There are certain times when the natural course of life is taking too long for people who are suffering.

There was a case in Quebec recently where someone did not meet the bar because their death was not in the foreseeable future. They had to actually starve themselves, stop taking food, stop taking water, for 53 days, until they were finally allowed to pass away, as people say these days. I think that is unfair, and the Supreme Court has ruled that unfair.

The reality is that the Supreme Court has said it both allows for physicians to assist people in dying and for people to take that upon themselves with physicians helping them. I am proud to live in a country that is that compassionate.

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May 2nd, 2016 / 12:40 p.m.
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Green

Elizabeth May Green Saanich—Gulf Islands, BC

Mr. Speaker, I want to thank my friend the member for Don Valley West and also my friend the member for Kitchener—Conestoga. I do not recall, in the five years that I have been in this place, a conversation or a debate that has taken place over an issue that is this difficult where there has been as much respect given one side to the other, one member to the other. We all recognize this is a deeply difficult issue. It is an ethical issue, it is an issue of rights, and it is also an issue of individual morality. It is a tough one, to put it mildly.

However, I am concerned about one part of this legislation that the hon. member for Don Valley West touched upon; that is, the notion of insisting that the person be capable of, once again, reasserting their decision to ask for physician-assisted death even after they have lost the capacity to have mental competence.

Again, on this question of an advance directive, this section of the legislation goes against the very essence of what the Supreme Court of Canada said we must do, which is to not put people in a position where they feel they must take their own life prematurely. They want to be able to trust the fact that they have made determinations for their end-of-life care.

I put that to my friend, the member for Don Valley West. Is that not, in a sense, asking the impossible, to ask someone who lacks mental competence to reaffirm a very clear decision that was made when they had mental competence?

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May 2nd, 2016 / 12:40 p.m.
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Liberal

Rob Oliphant Liberal Don Valley West, ON

Mr. Speaker, I want to thank the hon. member for her passion and compassion, as well.

This is the largest issue that has been raised in my riding in the last several weeks. Along with the member for Don Valley East, we held a town hall with about 200 people; 90% of whom asked for some capacity for an advance directive. They are very afraid that they are going to have to have a premature death because they are so worried that if dementia, Alzheimer's, or other diseases take place that would rob them of capacity, they are going to have to do that early. They are very concerned about that.

I had another meeting this week, in Leaside, and again, that issue came up.

I think the reality is that this will be unfolding over time. I think it is very important to review this legislation. We are going to take time as a society. I believe it has to happen.

One member I need to acknowledge is the late Francine Lalonde from the Bloc Québécois who brought this up and I also forgot to—

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May 2nd, 2016 / 12:45 p.m.
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Liberal

The Assistant Deputy Speaker Liberal Anthony Rota

Resuming debate. The hon. member for Oakville North—Burlington.

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May 2nd, 2016 / 12:45 p.m.
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Liberal

Pam Damoff Liberal Oakville North—Burlington, ON

Mr. Speaker, I am grateful for the opportunity to rise today to speak about Bill C-14, medical assistance in dying.

Death is a word that elicits strong emotions. We celebrate life. We embrace life. We talk about living. However, we avoid talking about death. We shy away from those conversations because they make us uncomfortable.

It is my sincere hope that this legislation will open the door to conversations about end of life and palliative care, about dying with dignity, and death.

I first want to thank all Canadians who participated in consultations with their provinces and the federal government on this issue. I want to acknowledge the work of all members of the Special Joint Committee on Physician-Assisted Death, who reported to Parliament at the end of February, and in particular my colleague, the member for Don Valley West, as well as the Minister of Justice and the Minister of Health. I personally appreciate their sensitivity and thoughtful dialogue.

I listened to the Minister of Justice and the Minister of Health when they spoke in the House on this bill. I have complete confidence in them to steward us as we begin the legislative process on Bill C-14, as well as in conversations about death and dying.

This is an issue that we have struggled with for many years. I recall in the early 1990s when former MP Svend Robinson compassionately took Sue Rodriguez's hand as she unsuccessfully sought permission from the Supreme Court to end her life as her ALS progressed.

The reasons for the need for this legislation are clear. The Supreme Court, in the Carter decision, unanimously decided that Canadians suffering intolerably have the right to request assistance to end their suffering.

With this legislation, the government has attempted to reach a balance, but, of course, in doing so will not please all people. Are there areas where the legislation does not go far enough? In my opinion, the answer is yes. Those with dementia will remain without an important option for end of life.

When on a journey with a terminal illness, there remains many questions pertaining to this legislation. I have no doubt that there will be fulsome discussion at committee on the legislation. I have received correspondence from residents concerned about implementation of this legislation by the territories and provinces. I am pleased that there will be additional study. This is just the beginning of the conversation, as it should be.

I know there are those who feel that this legislation goes too far. For the most part, I believe these people are fundamentally opposed to the Carter decision. However, regardless of where people fall on this legislation, I think we can all agree that the way we deal with death needs improvement.

Whether a grievously ill patient chooses to die at home, in a palliative care facility, or chooses medical assistance in dying, we should be having these conversations sooner, and lovingly assisting them in their end of life. These are not decisions that should be made during a health crisis, which is often the case. Rather, each of us should be engaged in advanced care planning.

I recall, shortly before my father passed away a few years ago, sitting in his hospital room as he battled pneumonia. My sister and I had to talk to him about his wishes should his heart stop. As members can tell, it was one of the most difficult conversations that we ever had. While it was painful and heartbreaking, it was also necessary.

While I recognize that this legislation is not the same as deciding on a do-not-resuscitate order, talking about death is difficult. Talking about the death of a loved one is incredibly difficult. However, because it is difficult does not mean we should not talk about it. In fact, I would say that because it is difficult is the very reason we should talk about it.

We do such a poor job of educating people about their choices for end of life. There are choices. We also do a really poor job of making available those choices for end of life. For those who wish to die at home, there are a lack of resources available to them. For those wishing palliative care, those options too are limited.

I believe the federal government needs to work with the provinces and territories to develop a better framework for end-of-life care. Our platform has included a much-needed $3 billion over four years for home care and palliative care.

Today marks the beginning of National Hospice Palliative Care Week. Shortly after I was elected, I had the opportunity to visit Carpenter Hospice in Burlington, one of the only palliative care options available in Oakville and Burlington for those in the last days and months of their lives. While I was there, we not only talked about the wonderful facility, but we talked about how we as a society need to have more open conversations about death.

I was deeply touched by Bonnie Tompkin's story. She is a community health coordinator at Carpenter Hospice, but her story is a very personal one. When her fiancé Ian was diagnosed with terminal cancer, he was adamant that he wanted medical assistance in dying. As is common, his biggest concern was the burden he would place on loved ones as his illness progressed. After he saw Carpenter Hospice and was educated on the options available to him, he made the choice to spend his last days at the hospice.

Carpenter Hospice is actively working with the City of Burlington on adopting a compassionate city charter. Widely implemented in the United Kingdom, citizens in compassionate communities are engaged, knowledgeable, and informed about death, dying, loss, and bereavement.

As our health and well-being extends beyond our health care system to our friends and loved ones, our connections to public spaces, and those in community, the thinking behind the compassionate city charter is that the community plays a similar role at the end of life. To quote from the compassionate city charter:

Compassionate Cities are communities that recognize that all natural cycles of sickness and health, birth and death, and love and loss occur everyday within the orbits of its institutions and regular activities. A compassionate city is a community that recognizes that care for one another at times of crisis and loss is not simply a task solely for health and social services, but is everyone's responsibility.

Compassionate cities are supportive of diverse religious and cultural beliefs. I met with a couple in my riding who were concerned that this legislation would normalize suicide, but if we are building compassionate communities and talking about both life and death, then we can give people the tools they need, and options for life.

The was a time when we did not talk about cancer. That changed when a one-legged young man embarked on the cross-country Marathon of Hope on April 12, 1980, forcing us to acknowledge not only his cancer, but the fact that people with disabilities need not be hidden from view.

We are only now starting to have a conversation about mental health, another subject that until recently was only spoken about in hushed tones. In fact, today on Parliament Hill, there was a walk for mental health awareness.

Death is another taboo subject, and one we do not want to talk about. However, because we do not talk about it, we do a disservice to our friends and loved ones when the time comes to face their own mortality.

I recently had a conversation with one of my best friends about death and dying, about this legislation, what end-of-life care should be, and what is lacking. Her husband, my good friend, is living with a terminal illness, ALS. Another of my good friends is currently navigating his father's end-of-life journey. These conversations are very hard, but perhaps in having these conversations we will make it easier for all of us to have choices, dignified choices about how our lives will end.

Death will never be easy to talk about, nor should it be, but death needs to be as much a part of our conversation as is life. We need to talk about life options and death with dignity. The time is long overdue.

We should perhaps take a page from the compassionate city charter and acknowledge that how we deal with death, dying, loss, and bereavement should be shared with the entire community, in every city from coast to coast to coast.

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May 2nd, 2016 / 12:55 p.m.
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Conservative

Todd Doherty Conservative Cariboo—Prince George, BC

Mr. Speaker, I would like to thank the member for sharing her heartfelt feelings on this matter.

I am a new member of Parliament, and this is obviously a topic that is important to Canadians from coast to coast to coast. I wish we had more time to debate and discuss the topic.

The hon. member for Don Valley West referenced Quebec in his presentation. However, Quebec took six years to make its recommendations. Quebec took the time to meet with groups from all over, including families and those who were for and against. Again, I wish we had more time on this, but clearly we do not.

I met with a group of nursing students the other week. My son is going through sciences and wants to be a doctor. They all had the same question. This is something that through their chosen field they will ultimately be faced with, and it is a difficult decision. They go into this industry to help, protect, and make people better, yet at one point they are going to have to make the choice to administer this. The nursing students were flabbergasted that this responsibility could come down to them. The comments they had were, “I don't know if I can do that. I don't know if this is the right profession for me.”

What are we supposed to say to them? There should be more discussion about conscience protection in this. I understand all sides of the issue, and I have witnessed family members at end of life go through terrible areas. I have a special needs adult child, and I have concerns.

What are we supposed to say to the next generation of doctors and nurses, that we have not put safeguards in place through the bill before us?

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May 2nd, 2016 / 12:55 p.m.
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Liberal

Pam Damoff Liberal Oakville North—Burlington, ON

Mr. Speaker, to be honest, I know that people struggle with how to do many things when going into the medical profession. Doctors and nurses have to struggle with care throughout their careers. There are options for referrals if people feel strongly about this, but I think it is something that will be part of the discussions with the provinces and associations that govern nurses and doctors. It is a very important conversation to have, but certainly those professions already deal with very difficult decisions every day.

We trust them. I believe it was the member for Don Valley West who said that we trust the medical profession with our lives, and we need to trust them with our deaths.

As I said, it is the start of the conversation, not the end of the conversation. I think that is also the conversation we would have with new people going into nursing or medicine.

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May 2nd, 2016 / 12:55 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Mr. Speaker, I listened with great interest to my hon. colleague, and I am hearing the word “compassion” a great deal, and “options”. The problem is that most Canadians do not have those options because they do not have access to quality palliative care.

My colleague mentioned an election promise, but an election promise does not create it. This is done in the budget, and there were zero dollars for palliative care. This has to be spoken about in the House. Otherwise, everything else we are talking about is a fiction.

In areas of competence under federal jurisdiction, the word “compassion” strikes me because of section 12.1 of the non-insured health benefits for indigenous people. When they are being flown out to die, it says that under absolutely no circumstances will a loved one be allowed to travel with them. The federal government's rule for denying those from being with their loved ones who are dying is the word “compassion”. It is written into the federal guidelines that for these families, for compassionate reasons, their loved one has to die alone.

However, we can change this in the House. This is an area under federal jurisdiction. Will the Liberals look at dealing with this now so that we can be credible on this larger topic of compassionate choice at end of life?

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May 2nd, 2016 / 1 p.m.
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Liberal

Pam Damoff Liberal Oakville North—Burlington, ON

Mr. Speaker, I would like to thank the member for his passion on this issue. It is an important one. I know that he has done a lot of work with our Minister of Indigenous and Northern Affairs on this.

We do have to be more compassionate. Whether it is for our indigenous people or any people across the country, we need better options for palliative care.

To answer your question, that is why we need to start talking about it and to start investing and looking at how we can deliver.

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May 2nd, 2016 / 1 p.m.
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Liberal

The Assistant Deputy Speaker Liberal Anthony Rota

I want to remind the hon. members that they do speak through the Speaker.

This a very difficult topic, and I just want to comment on the level of respect that is taking place in the House this morning. That is a tribute to all of the members who are here today.

Resuming debate, the hon. member for Louis-Saint-Laurent.

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May 2nd, 2016 / 1 p.m.
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Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

Mr. Speaker, as I rise today, I feel a sense of gravity and strong emotion. This is not the first time. Two years ago, when I was a member of the National Assembly of Quebec, I rose to debate the extremely sensitive subject of medical assistance in dying. At the provincial level, the debate was about end-of-life care.

This is therefore the second time that I have participated in the debate and the vote on this extremely delicate subject, and I intend to do so with diligence, careful consideration, and a great deal of compassion.

Usually when I rise I want to convince. That is the job of all politicians, to convince people. In this case, I do not want to convince; I just want to talk and to explain where I stand. Also, in political debate there is good and there is bad. In this case, no one is good and no one is bad; they are only honest Canadian citizens who want the best for the future of this country and the best for the future of our people, even if this debate is quite difficult and fragile.

Why are we here today?

We are here because a year ago, in February 2015, the Supreme Court made a ruling that had very serious and important consequences. It was the Carter decision that centred on medically assisted death.

The Supreme Court did not ask the House of Commons and Canada's Parliament to take a position for or against medically assisted death, but to develop a legal framework for it. That is the principle underlying this whole debate. We are not here to debate whether medically assisted death is good or bad. We are here to figure out how to give people access to it.

However, I have often said, and I want to repeat now from my seat in the House, that I find it very unfortunate that the Supreme Court gave the Parliament of Canada just under a year to take action. That is completely irresponsible. I know what I am talking about. I was a member of the Quebec National Assembly for almost seven years. I was there for the six years of detailed, painstaking work that led up to the passage of Bill 52. It took six years and three different governments with three different premiers: the hon. Jean Charest, the hon. Pauline Maurois, and the hon. Philippe Couillard. We worked on it for six years. There were two full years of direct consultation, and over 275 Quebeckers shared their opinions on the subject. However, the Supreme Court ordered the Parliament of Canada to take action within one year.

Why do I find that irresponsible? Because the Supreme Court knew that it was an election year and that this is not a subject for partisan political discussion. Despite all that, the Supreme Court ordered us to come up with legislation in under a year. The court knew that, as of February, the countdown was on to the month of June and that everything would then come to a grinding halt because the election was called for the fall and a new government would be taking office. In theory, parliamentarians could do nothing until December or January, and that proved to be true. In short, we lost six months in which we could have been debating this extremely important issue.

However, all was not lost. The previous government, led by the right hon. member for Calgary Heritage, set up a committee of three experts, including a former Quebec minister, whom I salute. This committee assessed all of the legal and parliamentary options regarding this sensitive issue and produced a document over 400 pages long. I am very proud to know that this work was done, despite the fact that it was an election year. I will come back to that a little later in my speech.

The report was written, but there was an election, and the new government created a parliamentary committee that could be described as bilateral, since it was made up of MPs and senators. The committee was co-chaired by a Liberal MP and a Conservative senator. Basically, the foundation for non-partisanship was laid, so that was good.

Despite the fact that we had very little time to do our work, in fact barely five or six weeks, we had 13 meetings, we heard from 61 witnesses, and 132 briefs were submitted. That is great, considering the time we had. I want to commend all of my colleagues who are here. I see the House co-chair, as well as my colleague from Toronto. I apologize, but I do not know all the riding names by heart. The names are very long, and perhaps we should change that one day, but that is another matter altogether.

I want to commend all of my colleagues for working in such a positive, constructive, and non-partisan manner. It was an extremely delicate and difficult subject, but we took a serious and thorough look at it.

After all our work, two reports were produced: a main report and a dissenting report signed by the member for Langley—Aldergrove, the member for Kitchener—Conestoga, the member for St. Albert—Edmonton, and me.

Before I get into the substance of the dissenting report, which I signed, I want to point out that the Conservative MPs on the committee were the ones who signed it. However, it was not a Conservative dissenting report, since the Conservative senators did in fact sign the main report.

Let there be no mistake: in this case the dissenting report was not a Conservative dissenting report. It was a dissenting report from members of Parliament, because the Conservative senators signed the majority report.

It is very clear, and we have to be very careful with that. There was not a political agenda behind our dissenting report.

In the dissenting report, my three colleagues and I were driven by the need to protect the most vulnerable, but also by Carter and especially by what we referred to in our report as “the Quebec experience”.

I am proud to say that I witnessed the Quebec experience. Together, we applied that experience in the dissenting report and used it as a model in determining what should be done. We did that because in Quebec, we took our time to address this issue properly.

In Quebec, after six years of debate, work, intellectual rigour, and careful consideration, we came to certain conclusions. Bill 52 became law to ensure that everything is done properly with a certain social consensus.

It is very tough to have consensus on this difficult issue.

Our dissenting report outlined five concerns. I will read them, then go over them one by one.

First, we felt that end-of-life care should not be provided to minors. Second, we established that people suffering from mental illness should not have access to medical assistance in dying. Third, we raised the need to protect the conscience of doctors and health care professionals. Fourth, medical assistance in dying should be provided only to people at the end of their life. Lastly, we had some serious concern over palliative care. Those are the five concerns outlined in our dissenting report. Let us look at them one by one.

First, this should not apply to minors. This is a very sensitive topic. The Supreme Court was talking about adults, not minors. What is more, the Quebec experience applied only to adults. This otherwise creates almost insurmountable problems.

Imagine if the parents of a 16-year-old son or daughter refuse to allow their child to receive end-of-life care. What then? Who is right, the child or the parents?

In the worst case scenario, if a 17-year-old child asks for end of life care, which his father wants but not his mother, who is right? Do we try to convince the mother? That is so difficult, so touchy, so fragile.

That is why our dissenting report put aside minors, aided by the Quebec experience.

We do not want this bill on medical assistance in dying to apply to people with mental illness because it is almost impossible to determine at what point they are capable of giving informed consent. People with mental illness are unaware of what is happening. I know that it is terrible to say such things, but it is the truth.

This is the truth. For those who suffer from mental illness, it is very tough and difficult for them to be very clear on what they want to do. If we were to put them in that kind of situation, we would see the worst. Again, based on the Quebec experience, we put it aside.

Let us now discuss conscience protections for physicians and health care practitioners. This is a delicate but very important subject. Quebec came up with a rather unique solution, and one that the government should use as a model.

We must respect the patient who, in his heart and soul, wants to receive end-of-life care. However, we must also respect the physician who must provide this care. If the physician does not want to proceed, we must respect that. This is Quebec's solution: the physician who does not want to provide this care must refer his patient to a third party, namely, the administrator of the hospital or CLSC, and this third party will refer the patient to another physician. Thus, a physician does not refer his patient to another physician because a third party is involved. Consequently, a physician who is uncomfortable dealing with this situation does not find himself referring his patient to another physician. This decision must be respected. This is a detail, but it is all about the details in this bill and the entire medical assistance in dying situation. We must have conscience protections.

Once again, based on the Quebec experience, we believe that the same is true with respect to the end of life. At what point can patients give their consent to medical assistance in dying?

Quebec, after examining this issue for six years, concluded that patients were able to give consent at the end of their life and not before. It is quite easy for a guy like me, who is 51 years old, in good shape, and feeling well, to say that if I ever get sick, no problem, the doctors will come and that will be it. It is easy for me to say that at the age of 51, when I am in good health. However, will I feel the same way when I am at the very end of my life? Not necessarily, which is why we need protections in this area. Once again, there are five concerns based on the Quebec experience. The fourth one has to do with the fact that Quebec makes it clear that only patients who are receiving end-of-life care may receive this type of medical assistance.

The last concern is palliative care. My colleague from the second opposition party spoke about this earlier. We believe it is extremely important to have full, comprehensive palliative care for all Canadians, and not just for one-third of Canadians, as is the case now. We really need to focus on this.

There was the main report, the dissenting report, and the five concerns I mentioned, which were based on safeguards for the most vulnerable, the Carter decision, and the Quebec experience. After we presented our report, it was up to the government to proceed and introduce its bill.

Therefore, what we have now is Bill C-14. What we like in the bill is what it does not have. That is funny to say, but it is true, because the bill put aside some of the most touchy subjects that we put in our dissenting report.

In our dissenting report, we did not want medical assistance in dying to be available to minors or people suffering from mental illness. The government embraced our position, which is good. We thank it for that. Congratulations.

However, we still have some other concerns regarding this bill, particularly when it comes to conscience protection. This bill contains no provisions regarding the protection of conscience for doctors and other medical practitioners, including nurses and pharmacists, in the context of medical assistance in dying.

I asked the Minister of Health about this during the debate two weeks ago. She said that it was not mentioned because it falls within provincial jurisdiction. Technically, that is true, but we are in a federal Parliament. The bill's own preamble clearly states that the law must adapt and apply consistently all across Canada. We need to have a national policy in order to avoid fluctuations from province to province. Once again, I urge the government to learn from the Quebec experience, which allows for the protection of conscience for doctors.

What will happen if that protection is not ensured? It will be left up to the provinces to decide whether they want to provide, or not, a framework for this in a particular way. I understand the goodwill of the Minister of Health, but there is such a thing as too much vagueness. In this situation, we are not talking about deciding between an apple and an orange; we are talking about deciding whether to live or die. Vagueness is unacceptable in this situation. We need to provide clear guidelines, particularly regarding conscience protection, because there is nothing that is more fragile and more precious than the conscience of someone who is there to save lives or end lives, depending on the patient's wishes.

I invite the government to take a closer look at the Quebec experience and really take note of that experience, as well as what we have said.

As I mentioned earlier, in Quebec it is clear that this type of care is provided at the end of life. In the legislation we find the concept of “reasonably foreseeable”. I have to read that because I have been asked about this a number of times and I always have a hard time because it is a bit vague.

I can assure the House of one thing: I am going to die. That is foreseeable. There is no doubt. I am 51 and I think I have done more than I have left to do. Reasonably, I could die in a few decades. I am in no hurry, by the way.

What I am trying to say is that “reasonably foreseeable” is not clear. The first question I was asked in an interview on RDI by Julie Drolet, a former colleague whom I salute, was whether I really understand this “reasonably foreseeable”. Well, the answer is no, not really. That being said, I am not the one who drafted the legislation. Perhaps we need to ask the minister that question.

All that to say that this needs to be clear, as does “conscience protection”. The same goes for end-of-life and what is reasonably foreseeable. It is much too vague.

During an interview last weekend on Radio-Canada's political television show, Les coulisses du pouvoir, Quebec's health minister, Dr. Gaétan Barrette, said there could certainly be a debate about the legality of this bill with respect to the notion of reasonably foreseeable death. He added that it should be reasonably foreseeable regardless of the prognosis on the progression of the disease. After all, if death is reasonably foreseeable, that means a prognosis has been reasonably established.

In situations like that, there is no clear answer. I would ask the government reasonably, no pun intended, to clarify its thinking on this.

There is a similar issue with regard to nurses and doctors. They say that nurses can provide the care. I want to be very clear. I have tremendous respect for nurses. Based on my experience in Quebec, they are the ones who keep the health system going, and I thank them for that. However, we think that a diagnosis of this importance needs to come from a doctor. People might think I am saying the same thing over and over again, but that is the conclusion drawn from the Quebec experience after six years of thorough, serious work.

With respect to palliative care, we all agree that more money should go to that. I would like to point out that the latest budget allocated no money to palliative care, even though that is an extremely important and sensitive subject. In a press conference, the Leader of the Government in the House of Commons talked about allocating $3 billion. That is very nice, but we would like to see that in the budget. The government can be sure we would support that enthusiastically.

Nothing is perfect, especially this bill, but we should be very concerned about that. We should be very concerned, because if we do not adopt a law, good or bad, we will have to deal with the Carter decision. For some people, it will be the worst-case scenario, because in that case, the medical professional associations in some provinces will say one thing and the associations in other provinces will say another thing; some provincial legislatures will adopt certain bills and other legislatures will adopt other bills. There will be a lot of movement in Canada in that case and the last thing we want is movement. We need a clear bill on those issues.

I want to say that this is obviously a very emotional debate. Everyone who speaks to this issue will be right. They have the right to do so and we hope they will. No one here is wrong, no one here is right. We are all honest Canadians and we want to do what is best for the future of this country and for the future of Canadians.

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May 2nd, 2016 / 1:20 p.m.
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Liberal

Anthony Housefather Liberal Mount Royal, QC

Mr. Speaker, I would like to thank my hon. colleague for his very wise words.

I imagine that as one of the MPs who wrote the dissenting report, he must be generally pleased. In drafting the bill, the government really took a look at the dissenting report.

I would like to ask a questions about conscience. We all agree that we must protect the freedom of conscience of medical practitioners and nurse practitioners, but this has to do with criminal law. There is a criminal prohibition, and now there is an exemption from the criminal prohibition.

Where in the bill will we include protection for a nurse's or medical practitioner's freedom of conscience? I understand that it is a good thing to have a bill that will cover all Canadians and that there will be consistency across Canada. However, as you know and as you said in your speech, this comes under provincial jurisdiction.

Do you have other examples? As committee chair, I am interested in this because I want to determine whether we can accept an amendment on this issue or whether such protections already exist in the Criminal Code.

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May 2nd, 2016 / 1:20 p.m.
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Liberal

The Assistant Deputy Speaker Liberal Anthony Rota

Before the member answers the question, I would like to remind members that it is important that they address their comments to the Chair and not directly to other members.

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May 2nd, 2016 / 1:20 p.m.
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Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

I will answer my distinguished colleague's question through you, Mr. Speaker. He is a lawyer so he knows what he is talking about when he says that this is a legal issue.

This issue falls under provincial jurisdiction. However, it is such an important one that we need to ensure that we have a consistent approach across the provinces.

If doctors' conscience is not protected in the legislation, some medical associations might challenge it, which will lead to variations from province to province. That will result in delays and the rise of health tourism, a term that horrifies me. For example, dissatisfied people in Alberta may go to Quebec, and dissatisfied people in Quebec may go to Newfoundland.

That could very well happen in this case. As the member so clearly stated, we are all gathered here because this issue relates to the Criminal Code. This issue sits at the very precarious junction where the Criminal Code meets health care delivery, an area of provincial jurisdiction.

I find it hard to imagine that one of the provinces would challenge this sort of law because this issue falls under its own jurisdiction. In the unlikely event that one of the provincial health ministers dared to do so, he would have to face the wrath of the people he represents.

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May 2nd, 2016 / 1:20 p.m.
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NDP

Robert Aubin NDP Trois-Rivières, QC

Mr. Speaker, I thank my colleague from Louis-Saint-Laurent for his wonderful speech. I was listening carefully. He rightly brought up his own experience with the debate held in Quebec, and I think this experience is very important.

In Quebec, legislators realized that this law had to respect Quebec's own areas of jurisdiction, so they quickly started talking about end-of-life care, to ensure that the debate remained focused on health care.

Will the decision that we are making in Ottawa prevent unintended consequences that may not even have been considered in Quebec? For example, people are starving themselves to get access to end-of-life care.

By getting the legislation right in Ottawa, we can ensure that this legislation enables people who have serious medical concerns to make this decision. It always comes back to the issue of a reasonably foreseeable natural death. I agree with my colleague that this concept is rather vague. However, we do not want to have people starve themselves to access a service to which they are entitled.

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May 2nd, 2016 / 1:20 p.m.
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Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

Mr. Speaker, unfortunately, no legislation could have prevented that type of situation. We have to realize that.

There is not much we can do about people who are in utter despair. It would be nice to pass legislation asking them not to starve themselves in order to access this care. That goes without saying, but it will not stop those who are in the darkest days of their lives and feeling so vulnerable that they would go to such lengths. Should we pass such legislation? It is too hard.

It is on all of us as parliamentarians. We have certain responsibilities, but we must also work within certain boundaries, including our conscience, which is part of being human. That is why we must protect the most vulnerable among us. That is why this will not apply to minors and especially not to those suffering from mental illness. Those people are far too fragile.

If I said that this could prevent unintended consequences, I would be lying, unfortunately, because we cannot control human nature. We can try to limit them, but preventing them completely is wishful thinking.

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May 2nd, 2016 / 1:25 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, I want to follow up on the question from the member for Mount Royal about jurisdiction and conscience, because it is a very important question. In fact, the Carter decision recognizes health care as a joint area of jurisdiction, so it is very clear that there is involvement of the federal jurisdiction. Also, it is important to acknowledge the parallels to the same-sex marriage debate and what the then Liberal government did in the Civil Marriage Act with respect to protecting the conscience of religious officials who did not want to perform same-sex marriages. It was important at the time, as part of that debate, to ensure that nobody would be forced to perform that union, a religious official who did not want to. It was put in that legislation, even though the solemnization of marriage is done at the provincial level.

We see a clear parallel, and if it was doable then by a Liberal government, there is no reason not to include conscience protection in this legislation as well. Very similar language could in fact be used in the development of the amendment. That is important. It is something worth considering when we have a major social change like this. Some people will want to be part of that change, but others will not want to be part of that change, and we should respect those who do not want to be part of that change.

I wonder if the member sees a parallel between these two debates and would support including a similar provision in this law, as the previous Liberal government did in the Civil Marriage Act.

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May 2nd, 2016 / 1:25 p.m.
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Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

Mr. Speaker, I will speak to what I know. I am very familiar with the issue of medial assistance in dying and end-of-life care, as I took part in drafting the two applicable statutes. I can say that in extremely sensitive and fragile cases, we have to respect the doctor. I personally received calls from Quebec doctors about this. They told me that they were there to save lives and what they were being asked to do goes against their long-held beliefs. They agreed to do it, but we have to realize that doctors are ultimately there to save lives.

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May 2nd, 2016 / 1:25 p.m.
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Liberal

Lloyd Longfield Liberal Guelph, ON

Mr. Speaker, the hon. member has an excellent approach to the subject. It is definitely something very personal for each of us. I know myself, with my mother's passing, we had some very difficult conversations at that time.

This goes beyond what we do in the House here. However, one of our responsibilities is to provide guidelines for the conversations.

Let us look at the role the provinces play in this conversation. I was personally struggling with recommendation 11 from the committee, as a member of a Catholic community within my riding and having a lot of Catholics reporting to me that they were very concerned about Catholic institutions being mandated to perform services against their conscience.

The current legislation is leaving some very important details up to regulations with the provinces and those who are reporting to the provinces. We have a tight timeline. We have to provide some guidelines that may be seen by some as not restrictive enough and by others as too restrictive.

Could the hon. member comment on the need to have some flexibility in terms of getting this to the provinces for further discussion?

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May 2nd, 2016 / 1:25 p.m.
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Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

Mr. Speaker, based on the Quebec experience, we have to have conversations with each other. We need to have good conversations with the provinces. We had that in Quebec.

The member talked about his personal experience, as did his colleague a few minutes ago. I want to say that everyone has the right to act on behalf of their own conscience.

In Quebec, I voted for the law. I voted for the bill. However, 22 members of the National Assembly voted against it, all members of the Liberal Party, the governing party. Among them, 11 cabinet ministers, nearly half of the cabinet ministers, voted against that bill.

I do not want to interfere with everyone.

However, every member has to know that he or she is entitled to vote their conscience and that every vote is important, every vote is good because it is the vote of each individual member.

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May 2nd, 2016 / 1:30 p.m.
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Liberal

Julie Dabrusin Liberal Toronto—Danforth, ON

Mr. Speaker, I rise today to speak to Bill C-14 regarding medical assistance in dying. This is not the first time I have had the honour to participate in the discussion of this matter as a member of Parliament. I also was a member of the Special Joint Committee on Physician Assisted Dying. As a member of that committee, I was able to hear the thoughts of many people, both in my riding of Toronto-Danforth and across the country, on this very important issue that affects us all, and that is our end-of-life care.

My preference would have been for a bill that would have allowed for a broader scope of application. However, I support this legislation because it is a first step in the right direction, and it was a commitment to study the important issues of age, mental health, and advance directives, as will become apparent as I speak further. We need to take this first step, because this file has been left to languish for too long. My step would have been a bit bigger, but I am ready to start here on this path of incremental change.

Mr. Speaker, I intend to share my time with the member for Hamilton West—Ancaster—Dundas.

To date, we have struggled with the question of whether to allow, or not, medical assistance in dying. However, now we are faced with a different question, specifically, how we are going to legislate that assistance. This is an important change for us to consider, because following the Supreme Court of Canada decision in Carter, medical assistance in dying will be legal as of June 6. This bill is important because it gives us the opportunity to create a federal framework to govern medical assistance in dying.

In 1983, the Law Reform Commission of Canada reported on “Euthanasia, Aiding Suicide and Cessation of Treatment”. It found three basic principles reflected in our law, and I find that these principles set a good basis for our debate. The first is that the protection of human life is a fundamental value. The second is that patients have the right to autonomy and self-determination in making decisions about their medical care. The third is that human life needs to be considered from a quantitative and qualitative perspective.

I find it particularly instructive that the second principle creates a basis for a patient-centred approach to medical assistance in dying. This was the approach adopted by the Special Joint Committee on Physician-Assisted Dying on which I served.

Looking at the history of this issue, I have traced a long path of private members' bills, Senate bills, and private motions in the House. The issue has been before us approximately 11 times since 1991. The list of past attempts on this issue is incredible and demonstrates that efforts that have been made to grapple, unsuccessfully, with this issue have continued for too long. It is why I find it so important for the House to cross over this impasse and to take the first step toward legislating a framework.

The issue has not only been before us here. The other place has also considered the matter in committees, subcommittees, and bills. Just over 20 years ago, the Special Senate Committee on Euthanasia and Assisted Suicide released its report “Of Life and Death”.

The goal of that committee was to set the stage for the national debate that would take place in the years to come. The majority of senators on the committee were not ready to support medical assistance in dying. The minority on that committee made some recommendations to support medical assistance in dying for an individual who was competent and suffering from an irreversible illness that had reached an intolerable stage, as certified by medical practitioners.

Over the weekend, I finished reading the Hon. Steven Fletcher's book, Master of My Fate, which outlines his experience as a parliamentarian, generally, but focuses upon private members' bills that he brought on the issue of medical assistance in dying. The book brought special insight into his journey on this question. He shared his story of the massive accident that rendered him quadriplegic and his election to the House, including the time he served as a cabinet minister.

Our most recent initiative in the House on the issue of medical assistance in dying was two connected private members' bills put forth by the Hon. Mr. Fletcher. The first, Bill C-581, proposed to amend the Criminal Code to permit a doctor to assist a person in taking his or her own life. The eligibility criteria proposed in the bill would track the language in Carter very closely. I will read the most salient eligibility criterion for the sake of the House:

...a person must...have been diagnosed by a physician as having an illness, a disease or a disability (including disability arising from traumatic injury) that causes physical or psychological suffering that is intolerable to that person and that cannot be alleviated by any medical treatment acceptable to that person, or the person must be in a state of weakening capacities with no chance of improvement...

His other initiative, Bill C-582, proposed to establish a Canadian commission on physician-assisted death, which would have collected data from physicians who performed physician-assisted death. It recognized the possibility for incremental steps.

The bills were read a first time and left to languish on the Order Paper. However, on December 2, 2014, similar legislation was introduced in the other place and was debated on seven occasions, as late as June 2, 2015.

As we all know, during that time frame of December 2, 2014, to June 2, 2015, the Carter decision was released.

It is also worth noting that there have been active discussions in our provinces and territories about a framework for medical assistance in dying. The most notable example is Quebec, which struck a committee in 2009 to develop legislation on medical assistance in dying. The legislation came into effect in December of 2015. Much has been said regarding that law, and I will not repeat it, but it is notable that they too have a terminality provision.

I found it interesting that in testimony before our committee, Jean-Pierre Ménard of the Barreau du Québec stated that he believed the terminality clause of the Quebec legislation would have to be removed in light of the Carter decision. It underscores the point that such legislation will develop through incremental changes.

Working on the joint committee was an amazing experience. It was the first special joint committee in 20 years, and I see a strong value to this form of collaboration on major issues. The witness testimony and the thoughtful written submissions gave us a strong base upon which to form our recommendations. I stand behind the recommendations that we made. We did not come to our decisions easily. We lost sleep, debated a lot, and worked together to formulate our recommendations.

How then does my background on this file inform my views of the legislation we are debating today. I would have preferred that it would be broader. Most of what I have heard from my own constituents favours a broader approach. However, the bill is the first step into a complicated matter.

We need to empower individuals to choose how to manage the end of their lives and give value to the law reform commission's idea of a patient centred approach. Also, we need to consider not only the quantity of life but the quality. We need to respect people's autonomy and their right to be free from suffering, without putting vulnerable Canadians at risk. Bill C-14 gets us much closer to that goal than we currently find ourselves.

I would have preferred that we remove the clause of a reasonable and natural death, which refers to the foreseeability of a natural death. It is a terminality clause of sorts. The clause is vague and could place an overly broad restriction on a sick person's right to be free from pain and suffering. The concern about this terminology is that it tends to devalue the lives of the oldest among us. They are the most likely to be given permission to seek medical assistance in death with the legislation.

The young and sick suffer as much as the elderly. To quote Steven Fletcher “If the person is a cognitive adult, why on earth would we impose our views on what their quality of life is on them?”

The lack of advanced directives in the legislation is also too restrictive. A fundamental point of the Carter decision was that the Supreme Court of Canada had found a violation of “Life, Liberty, and Security of the Person” if individuals would feel they would have to cut their lives short because they did not have an expectation that they could end it later when the time would come. It is a tricky issue, but I am happy to see a commitment to study the issue further.

In my opinion, the positives of the bill outnumber the negatives, so I will be supporting the bill. However, I do see it as a first step on the journey.

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May 2nd, 2016 / 1:40 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, I want to thank my colleague for her service on the joint parliamentary committee that studied physician-assisted dying.

My colleague referred many times to my former colleague, Steven Fletcher, who appeared before the committee. I have had many conversations with him, and I understand his position. However, my concern is that had Mr. Fletcher had access to physician assisted suicide years ago when his accident first occurred, he very well may have followed through. That would have been a huge loss for Canada and for his family.

My concern is that when we implement these kinds of decisions, there is always the risk of one person inadvertently terminating his or her life, which would be a huge loss. We no longer practice capital punishment in Canada. One of the reasons is that it is too great a risk that one innocent person might die.

How would my colleague ensure that someone like Mr. Fletcher, who in a time of deep depression and deep physical suffering, may have taken the choice that would have hurt him and all of Canada because of the loss of his life and his contribution to our country?

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May 2nd, 2016 / 1:40 p.m.
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Liberal

Julie Dabrusin Liberal Toronto—Danforth, ON

Mr. Speaker, I would rather not speak about an individual specifically when I respond to my friend, because I cannot predict what his decisions may or may not have been if this legislation had been in place.

To speak more generally, I understand the point the member is raising. It was a question that was a concern to me and the committee as well when we examined the issue of a person who suffered a traumatic injury and was faced with a change of circumstances. How would that person handle these types of decisions? We did hear evidence before the committee on this issue, especially from Professor Jocelyn Downie, which stands out in my mind.

When we talk about irremediable as part of the determination and the assessment of competence, a person right after a traumatic injury may not, in a medical opinion, be found to be in an irremediable state and able to make the competence test because he or she would be in a state of flux at that moment.

We need to look at that further. That is just something we heard in our evidence. It was one position. That is why I am so happy we are committed to looking at the issues and discussing them further, because it is an important question.

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May 2nd, 2016 / 1:40 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Mr. Speaker, this issue affects all of us and we respect the very personal views that are brought forward.

What concerns me in the legislation that has been put before us is that we are not talking about an overall balance in end-of-life choices. We are talking about the very specific responses to the Carter decision. Eighty per cent of Canadians do not have access to quality palliative care. Therefore, 80% of Canadians facing end of life and their families do not have choices about good quality end-of-life care. In this vacuum, there must be a commitment by the federal government, but we have not seen that. We saw zero dollars in the budget for palliative care.

The New Democrats have Motion No. 46 before the House about moving forward not only on a palliative care strategy, but also taking responsibility for areas under federal jurisdiction. The federal government plays a huge role in the delivery of health services and it denies palliative care services often. There are also issues of changing EI provisions to help families.

Where is the government's commitment to the larger discussion on end of life in which Canadians need to be engaged?

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May 2nd, 2016 / 1:40 p.m.
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Liberal

Julie Dabrusin Liberal Toronto—Danforth, ON

Mr. Speaker, palliative care is an important part of the discussion about end-of-life care. There is no question that it has come up several times in this place and it is important.

I am a little wary of throwing around percentages and numbers. At committee, we heard a lot of different percentages. Perhaps it is that we do not have a fulsome understanding at this moment about what access to palliative care truly is. This needs further examination as well. On the numbers, I am a little concerned about percentages.

From what we heard and read at committee, the jurisdictions that have introduced medical assistance in dying have increased their access to palliative care at the same time as quality of that care.

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May 2nd, 2016 / 1:45 p.m.
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Liberal

Filomena Tassi Liberal Hamilton West—Ancaster—Dundas, ON

Mr. Speaker, I am honoured to rise in the House today to address Bill C-14. This bill is a response to the Supreme Court of Canada's unanimous ruling in the case of Carter v. Canada. The Supreme Court mandated that the Government of Canada create a framework for the provision of medical assistance in dying within a year of the ruling. That time lapsed on February 6, 2016, and an extension was granted until June 6, 2016.

The Supreme Court gave our government a short time in which to study this challenging and historic issue. I have listened to constituents who have argued passionately on both sides of this debate. I have struggled with the moral and ethical implications of this legislation. I understand that this is an emotionally charged and challenging topic.

Civilized societies have always recognized the sanctity of life. Countries around the world have legislated against the taking of another person's life. Historically, the taking of life has been considered to be the worst of crimes. The issue of medical assistance in dying poses a complex challenge to all Canadians because it brings together several different and difficult issues. There are questions of charter rights and personal freedoms. There are questions of protecting the vulnerable and responding to those who are enduring intolerable pain. There are theological, moral, and ethical considerations.

As well, this issue is an emotional one, fraught with the feelings of those who take strong positions on either side of the debate, and leavened by the feelings of those people who are experiencing such grievous suffering that they no longer wish to continue living.

Another element is purely economic, whether it is the pressures of inheritance or financial instability or the overwhelming cost of health care during the end of life. While we do not like to cite these utilitarian perspectives, their existence cannot be denied.

As well, this debate touches upon one's vision of a just society, whether one feels that ultimate justice involves complete choice or whether one feels that justice is best served by sometimes limiting the avenues available to a person so as to keep open the possibility of a happier tomorrow, a more desirable future, one that can be looked forward to rather than dreaded. I feel that this legislation finds a balance between these two perspectives, allowing choice to those who wish to end their grievous suffering and are already far along the path to dying and protecting those who may be vulnerable.

The ruling in Carter v. Canada was expressly limited to a competent adult person who clearly consents to the termination of his or her life. Furthermore, the Supreme Court of Canada did not find that there was a right to medical assistance in dying for minors or persons with psychiatric disorders. I was greatly relieved that these provisions were not included in this legislation.

To ensure that the path to the end is as fair and secure as possible, it is imperative that we accompany any legislation for medical assistance with enhanced support for palliative care. All parliamentarians have stories to share with respect to their engagement with people. We have interactions that have a profound impact upon us and never leave us.

On the campaign trail, I had the opportunity to visit a number of long-term care facilities. On one of these occasions, after the candidates gave speeches, there was an opportunity to mingle. I approached a man, who handed me a piece of paper. It was a petition for more personal support workers. He had tears in his eyes as he asked me to sign the petition. I sat with him and he explained his situation. He was there caring for his wife, who was beside him in a wheelchair. She had endured a serious stroke. This man was not advocating for his wife, as he was there every waking hour to take care of her, but he was advocating for others whom he witnessed daily not getting the care they needed. This was just not fair, not right, and clearly not just.

We have serious work to do in palliative care, which is connected to home care. Our government has pledged $3 billion to home care, and I am strongly encouraged by the health minister's commitment to see that high-quality home care is accessible to all Canadians. I look forward to engaging my colleagues in these debates and fighting for greatly enhanced palliative care for Canadians.

I have spent the last 20 years working with youth as a chaplain in high schools in Hamilton and Ancaster, Ontario. During this time, I have walked with thousands of students as they have negotiated the difficult terrain of adolescence and early adulthood. Their struggles are real, and the burdens they carry through family difficulty, personal struggles with identity, emotional pain, loneliness, rejection, or alienation are all real.

Young people face a complex and often overwhelming world in their physical neighbourhoods, in the relationships they inhabit, and in the virtual worlds in which they are thrown head first, often not ready. One only has to look at the terrible cases of online bullying that have removed the joy from the lives of young people and replaced it with sadness, depression, and in some cases suicide. I believe in our youth. I have spent my life believing for them and in them when they have sometimes stopped believing in themselves. I have made it my life's work. Amazingly, although their worlds sometimes sombred into darkest night and they feared that any light might have been extinguished forever, together we found a glimmer, a flicker that with love, inclusion, acceptance, and safety grew into a flame and then a roaring fire, not only of hope but of a desire to change the world, to bring healing to others who suffer and are rejected. These same teenagers have now stepped up and become leaders with a conviction to change the world. If assisted dying had been available to them when they were in the depths of their depression, they might not be with us today.

I am pleased that this legislation does not include mature minors, and I call for a renewed focus on creating a better, happier, more secure, and stabler world for our young people, online and in the physical world.

I have debated the morality of the question of medical assistance in dying. There are many who believe that in good conscience they cannot support assisted dying. For those who feel this way, I wish to address the issue of conscience.

People often equate conscience with values and beliefs. While conscience most certainly includes these, it also is much more complex. Conscience is at the very core of who we are as people. Conscience deals with reality. It appreciates the facts that are before us. The facts here are that the Supreme Court of Canada has ruled that medical assistance in dying is a charter right. We are not faced with the question of whether we allow medical assistance in dying; rather, we are faced with the question of in what conditions we will allow medical assistance in dying.

In my view, the bill before us is narrow in scope and respects the charter as interpreted in Carter v. Canada. Bill C-14 fulfills the legislative mandate delivered by the Supreme Court in a way that meets the charter but attempts to protect the vulnerable and the powerless. Although we can never fully protect the vulnerable, we can do our best. This is what Bill C-14 does.

Finally, I wish to affirm my support for respecting the personal values and beliefs of doctors and nurses and the mission statements upon which some institutions were created.

As the Minister of Justice has said, and I quote:

To this end, as I have already mentioned, my colleague, the Minister of Health, will be working with her counterparts to bring forward a coordinated system for linking patients to willing providers.

As is outlined in the government preamble to this bill, the Government of Canada has committed to developing non-legislative measures that will “respect the personal convictions of health care providers”. As the Minister of Health has indicated, “Practitioners will have the right to choose as their conscience dictates”.

I will continue to fight for the protection of the rights of morally objecting physicians and institutions while ensuring access for patients to their charter rights.

In light of all of these arguments, I stand in this House today in support of this fair and thoughtful legislation.

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May 2nd, 2016 / 1:50 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, this bill makes it possible for a person to ask a doctor for help committing suicide. If the doctor refuses because the person does not meet the criteria, that person can go to plenty of other doctors to get help.

Does the member agree that we need some rules around that practice of going from doctor to doctor?

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May 2nd, 2016 / 1:55 p.m.
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Liberal

Filomena Tassi Liberal Hamilton West—Ancaster—Dundas, ON

Mr. Speaker, as I have indicated, I will always respect the conscience rights of doctors. As the Minister of Health and the Minister of Justice have both confirmed, what we are speaking about here is the issue of accessibility. It has been made clear in this legislation and in the comments of both ministers that accessibility is an important issue. We will ensure that our consultations with provincial and territorial partners will provide accessibility that will be open to all Canadians who wish to pursue medical assistance in dying.

In Canada, we have approximately 77,000 physicians and more than 360,000 registered nurses. For me, it is not going to be a matter of having to go from physician to physician. I think that, with the brilliant work of our Minister of Health, accessibility will be available to people, and there is no question of conscience rights becoming an issue because of the accessibility point.

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May 2nd, 2016 / 1:55 p.m.
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NDP

Pierre-Luc Dusseault NDP Sherbrooke, QC

Mr. Speaker, I would like to thank my colleague for her speech.

I was wondering whether, like her colleague, she thinks that the bill does not go far enough. Does she have concerns about compliance with the Supreme Court decision that this bill responds to? Does she think that the bill goes far enough? Does she share the same concerns as her colleague who spoke earlier? Perhaps the bill is not enough. Perhaps it is too limited in scope. Perhaps it does not fully comply with the Supreme Court's decision.

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May 2nd, 2016 / 1:55 p.m.
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Liberal

Filomena Tassi Liberal Hamilton West—Ancaster—Dundas, ON

Mr. Speaker, as I made clear in my speech, I think that this bill does go far enough with respect to the Carter v. Canada decision.

I expressed concern with respect to one area, which is minors and psychiatric care, and I am glad to see that the legislation does not include minors and psychiatric disorders. This stems from my work with youth.

I have worked with youth over the past 20 years, and I have seen them struggle through very difficult times. I have been with them in their darkest days. I have taken those same youth to the Dominican Republic on mission trips, and I have seen how the experience of working with the poor has turned their lives around.

My focus would be on ensuring that youth receive the support they want and that those who are at the end of their life, through palliative care, also receive the support they need and deserve.

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May 2nd, 2016 / 1:55 p.m.
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Liberal

Anthony Housefather Liberal Mount Royal, QC

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

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

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May 2nd, 2016 / 1:55 p.m.
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Liberal

Filomena Tassi Liberal Hamilton West—Ancaster—Dundas, ON

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

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

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

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May 2nd, 2016 / 3:10 p.m.
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Conservative

Mark Warawa Conservative Langley—Aldergrove, BC

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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May 2nd, 2016 / 3:20 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, I found it interesting that the member allocated quite a bit of debate time to how this legislation came about. It is important to recognize it is because of a Supreme Court of Canada ruling in February. I disagree with virtually almost everything else the member said, in terms of his implication. The void in leadership occurred from the moment of the release of the Supreme Court decision until October 19, when we finally had a Prime Minister who recognized the importance of the issue and that the Canadian government has a lead role to play. This is something the member at the very least should acknowledge.

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

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May 2nd, 2016 / 3:20 p.m.
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Conservative

Mark Warawa Conservative Langley—Aldergrove, BC

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

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

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May 2nd, 2016 / 3:25 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

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

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

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

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

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May 2nd, 2016 / 3:25 p.m.
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Conservative

Mark Warawa Conservative Langley—Aldergrove, BC

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

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

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May 2nd, 2016 / 3:25 p.m.
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Conservative

Ed Fast Conservative Abbotsford, BC

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

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

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

I believe Bruce Clemenger said it best when he stated:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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May 2nd, 2016 / 3:35 p.m.
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Whitby Ontario

Liberal

Celina Caesar-Chavannes LiberalParliamentary Secretary to the Prime Minister

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

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

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May 2nd, 2016 / 3:35 p.m.
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Conservative

Ed Fast Conservative Abbotsford, BC

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

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

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

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May 2nd, 2016 / 3:40 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

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

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

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

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

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

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May 2nd, 2016 / 3:40 p.m.
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Conservative

Ed Fast Conservative Abbotsford, BC

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

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

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

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

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May 2nd, 2016 / 3:40 p.m.
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Vancouver Quadra B.C.

Liberal

Joyce Murray LiberalParliamentary Secretary to the President of the Treasury Board

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Some of my constituents have also expressed concerns about access.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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May 2nd, 2016 / 3:50 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

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

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

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

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

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

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May 2nd, 2016 / 3:55 p.m.
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Liberal

Joyce Murray Liberal Vancouver Quadra, BC

Mr. Speaker, I want to thank the member for those thoughtful proposals.

There will be a committee process in which these kinds of ideas can be put forward and the committee can hear from expert witnesses. What we do not want to do is put unnecessary barriers in the way of people who are qualified to have this kind of end-of-life assistance.

I do want to say that it would have been helpful if the Conservative Party had done the work on how to follow through on the Supreme Court of Canada's requirement for medical assistance in dying when that Supreme Court ruling came out. There could have been much more discussion in Parliament a year ago, which is what our party called for and the Conservatives refused to do.

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May 2nd, 2016 / 3:55 p.m.
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NDP

Robert Aubin NDP Trois-Rivières, QC

Mr. Speaker, I thank my colleague for her speech.

I want to begin by saying how much I appreciate the tone of our exchanges today. It is inspiring and a change from our debates.

My question is quite simple and is on the example my colleague gave in her speech about one of her friends who stopped eating and drinking for six days in order to end his life. Although the Supreme Court's criteria are relatively clear in the legislation, the fourth element is rather vague in my opinion.

We are talking about natural death becoming reasonably foreseeable. Could my colleague provide some clarification on this fourth criterion? If someone meets the first three criteria, would he not be forced, once again, to stop drinking and eating in order to meet the four criteria to get the service he is seeking?

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May 2nd, 2016 / 3:55 p.m.
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Liberal

Joyce Murray Liberal Vancouver Quadra, BC

Mr. Speaker, I thank the member for the question.

I can guarantee that my friend's condition was consistent with the criteria of our bill.

As I said in my remarks, with such a short time to deliver on the Supreme Court's mandate in the timeframe available, it is important to be cautious on how this is framed. That is what the proposed law would do. It finds the correct balance between safeguards for the vulnerable, the rights of physicians and nurses, and the personal rights of those who wish to have assistance in dying.

We have time moving forward to continue considering situations such as the member has brought forward to confirm that we have the balance right, or make adjustments in the future when the bill is reviewed in five years.

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May 2nd, 2016 / 3:55 p.m.
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Parkdale—High Park Ontario

Liberal

Arif Virani LiberalParliamentary Secretary to the Minister of Immigration

Mr. Speaker, I rise today to speak to Bill C-14. I start with reference to the Supreme Court of Canada's Carter decision, about which we have heard much.

In the opening paragraph of that ruling, the unanimous court said:

It is a crime in Canada to assist another person in ending her 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: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.

I agree with the Supreme Court. The choice is cruel.

The Supreme Court concluded that the criminal law as it currently stands was not only cruel, it was also unconstitutional. The court found that section 7 of the charter required access to medical assistance in dying, subject to certain safeguards. That is where the House finds itself today.

Let us be clear. The question facing parliamentarians is not whether we can permit Canadians access to medical assistance in dying. That access must be permitted to comply with the charter. The actual question facing us is how to design the access. In terms of design, I believe Bill C-14 strikes the right balance. The balance is between the right, on the one hand, of a competent person who seeks an assisted death in response to a grievous and irremediable condition, as compared to the need to protect the vulnerable from being induced to commit suicide at a time of weakness.

Striking this balance is not simple. Nor is it permanent, and this is an important point. The balance must be calibrated and re-calibrated according to changing evidence and the evolution of societal values. Indeed, the Supreme Court's 2015 decision, which reversed the court's earlier ruling in 1993 in Rodriguez, is evidence of this very evolution. However, for now, in terms of where we are in 2016, I am firmly of the view that the bill would strike the right balance.

There is another reason why I rise before members today to speak in favour of the bill. That is because I have spent my career as a constitutional litigator fighting for people's rights, their human rights, their charter rights, their right to equality. Treating people equally means treating people with respect, according them dignity and according them autonomy. The bill would do that. It would give people control over their own lives, including the conclusion of their lives. It would allow those nearing death to pass in a manner of their choosing with less suffering.

In empowering choice, the bill would empower Canadians. It would strengthen us as a people because it is informed by a desire to give Canadians more autonomy and, as a result, greater dignity.

For the rest of my speaking time I would like to address two major categories of concern that this bill raises: the criticism that Bill C-14 does not go far enough to make medical assistance in dying available; and the opposite criticism that the bill goes too far and makes medical assistance in dying too accessible.

In this first category, the concerns are that Bill C-14 is not broad enough. They centre on three main components, and we have heard some of them this afternoon and in previous days of debate. For now, it is proposed that medical assistance in dying only be permitted for adults and for those who suffer from more than a mental illness alone. In addition, for now Bill C-14 would not provide for advanced directives regarding medical assistance in dying.

The words “for now” are important. The government has committed to an independent study of legal, ethical, and medical issues that are raised by each of these three different categories. This is important. If medical assistance in dying is to be expanded into any of these three areas, it must be done only after a comprehensive study of the benefits and the risks associated with permitting medical assistance in dying in such circumstances.

I was determined to hear from my constituents directly on this important legislation. Therefore, in early April I hosted a town hall in my riding of Parkdale—High Park on the issue of medical assistance in dying. The engaged constituents of my community came prepared with thoughtful and personal reflections, with concerns, and with questions, many of which related to these very three items I just raised.

While the residents and community, like me, are keen to protect and promote the autonomy and dignity of all Canadians, including youth and the mentally ill, the residents of my community also cautioned about moving too quickly in an area where the consequences of a decision were final and irreversible. They noted, for example, that in Belgium medical assistance in dying had been legalized and studied for a period of 12 years prior to medical assistance in dying being made available to minors. The mentally ill, it was noted, would be able to avail themselves of medical assistance in dying under this legislation provided the mental illness was part of the patient's overall medical circumstances and that the applicant was still able to meet all of the general eligibility criteria.

As one who has championed the rights of mental health consumer/survivors in my community, I know it is critical that before embarking on the path of increased access to medical assistance in dying for those whose condition is mental illness alone, we get this right.

As we have said repeatedly, our government believes in enacting legislation that is well reasoned, carefully analyzed, and based, above all, on sound evidence. The proposed independent studies into things like access for minors will help inform this analysis and critical evidence-building process. Importantly, Bill C-14 also contains a provision which calls for a mandatory review of the entire legislation every five years.

As I said at the outset, finding the right balance in legislation of this nature is not permanent; it is fluid. It is a dynamic process which can and must adapt to changing evidence and societal norms.

Bill C-14 is not an extensive enough category. We also find an argument relating to reasonable foreseeability. We heard questions about it this afternoon. Some assert that the requirement to Bill C-14 that a person's death must be reasonably foreseeable is an unnecessary barrier. Such concerns are unfounded. Bill C-14 is actually more permissive than any assisted-dying legislation in North America. In Quebec, an applicant must have a terminal disease. Bill C-14 is more accessible. It would allow medical assistance in dying where death is reasonably foreseeable, looking at the totality of the medical circumstances.

In addition, in each of the four American states that have legislated medical assistance in dying, one is required to have a specific prognosis that an individual has less than six months to live. There is no such temporal restriction in Bill C-14.

Finally, in the category of Bill C-14 not being quite broad enough, some contend that the bill should stipulate, and again we heard it this afternoon, that medical practitioners are professionally bound to provide such service. This criticism misunderstands the nature of Bill C-14. It is an amendment to the federal Criminal Code. It is also misguided jurisdictionally.

Wearing my constitutional hat, it is clear that the federal government has an important role to play in maintaining universal access to insured health services, but the ultimate delivery of medical services is primarily a matter of provincial jurisdiction. Our government, as was mentioned by my colleague, has committed to work going forward with provinces and territories to support access for medical assistance in dying, while simultaneously respecting the personal convictions of health care providers. This approach reflects the balancing that must occur when addressing competing charter claims.

On the one hand, the section 7 claims of those who seek access to medical assistance in dying must be balanced with the freedom of conscience rights that are entrenched in subsection 2(a) of the charter. Those are the freedom of conscience rights of health care providers. The Supreme Court recognized this in the Carter decision, in paragraph 132, and this bill recognizes it in the preamble.

The second broad category is that the bill is too permissive.

In fact, those who maintain that Bill C-14 is too permissive are the ones who are failing in the fundamental responsibility to protect people who might commit suicide in a moment of weakness.

Requesting medical assistance in dying is not simple. Nor should it be. Requests must be made in writing. This has a meaningful impact. All such requests must be witnessed by two independent individuals. They cannot be a beneficiary in a will or a person charged with the care of the ill individual. A request must then be approved in writing by not one, but two different medical practitioners. Finally, the bill calls for a mandatory waiting period of 15 days in order to allow individuals to reflect on the seriousness of this choice.

The bill goes further. It requires an extensive regime of monitoring, so data and trends respecting medical assistance in dying can be obtained and analyzed by government. This kind of monitoring will ensure transparency, but more important, it will facilitate strengthening safeguards where required.

Finally, I am encouraged by the fact that Bill C-14 not only reflects the significance of choosing medical assistance in dying, but that every choice ought to be an informed one. By this, I am referring to the pressing need to enhance palliative care in Canada, a need expressed to me time and again by residents in my riding of Parkdale—High Park. If we are to ensure that the significant choice of requesting medical assistance in dying is fully informed, it is critical that we work collectively, in a non-partisan manner, to ensure that improved palliative care is readily available.

In conclusion, I reiterate that this proposed legislation is neither too restrictive nor too permissive. It strikes the correct balance, while simultaneously recognizing that with further study and mandatory review, the balance will continue to be re-calibrated to reflect new evidence and evolving societal values respecting medical assistance in dying.

Most important, the bill would eliminate the cruel choice that the Supreme Court described in the opening paragraph of the Carter decision. No longer will grievously ill Canadians be faced with either taking their own life prematurely or prolonged suffering until they die. Bill C-14 would give such Canadians what the charter requires, autonomy. It would give them control over their passing in a manner that ensures their dignity. For this reason, I will be supporting this legislation.

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May 2nd, 2016 / 4:05 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, there is a couple of things I would like to clarify. The member and his colleague who spoke earlier said, pretty unequivocally, that no doctor would be required to participate in this regime. I do not see any protection in Bill C-14 that would assure doctors they would not be required to participate, other than a very vague comment in the preamble talking about that possibility. It certainly does not put iron-clad protection in the bill.

The other issue I would like to raise with all my colleagues on the other side is palliative care. We continue to hear their commitment to palliative care. I applaud that. We need better palliative care. I have been working on that years. We can talk about it, but I do not see any evidence in the budget of the $3 billion that was promised to be immediately invested. I am very concerned. We need to get working on this. I want to see an actual firm commitment within the budget so we have something we can take to Canadians that says help is on the way.

Barring that, to offer physician-assisted death without—

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May 2nd, 2016 / 4:10 p.m.
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Conservative

The Deputy Speaker Conservative Bruce Stanton

The hon. parliamentary secretary to the Minister of Immigration, Refugees and Citizenship.

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May 2nd, 2016 / 4:10 p.m.
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Liberal

Arif Virani Liberal Parkdale—High Park, ON

Mr. Speaker, my hon. colleague has raised two points. One is the issue of doctor participation, and it is broader than just doctors; it is also nurse practitioners. Clearly, in the Carter decision, paragraph 132, the court went beyond the call to specify that nothing in its decision would compel a health care practitioner from being required or compelled to provide medical assistance in dying.

The preamble, as my colleague noted, reflects that same sort of rhetoric. I would put it to him that our party and this government firmly believe in complying with the charter, including all aspects of the charter, including section 2(a), which protects those conscience rights.

On the issue of palliative care, the member is correct. It would be inappropriate for palliative care to be entered into this bill, which deals with a discreet amendment to the Criminal Code. An announcement was made today in question period, and my friend was here to hear it. The minister indicated the amount of monies being allocated for palliative care. I would ask him to put faith in the minister. She is a family physician and has been on the ground providing these services. She recognizes the important need for palliative care to be provided in a robust way so people have an informed choice when they make this significant decision.

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May 2nd, 2016 / 4:10 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Mr. Speaker, I listened with great interest to my hon. colleague.

My concern with the lack of action on palliative care is that there was zero dollars in the budget. We have a promise now, but that is another year lost. I find it extraordinary to be talking about the right to die, but not the right to quality palliative care and the role the federal government has to play.

The other area that concerns me is the federal government has major health responsibilities in the delivery of health services to the military, the federal penitentiaries, and indigenous people. Yet, under section 12.1 of the first nations non-insured health benefits, when people are dying and have to be taken out of a reserve for palliative treatment, their loved ones are not allowed to go with them.

It says in federal regulations that the first reason to deny loved ones to be with their spouse at the end of life is compassion. Compassion is the number one rule for denying loved ones a chance to have palliative care. If the Liberals are serious about ending these cruel choices, they will tell that health minister to change the wording in the health guidelines now, so loved ones are never separated at the time of death.

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May 2nd, 2016 / 4:10 p.m.
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Liberal

Arif Virani Liberal Parkdale—High Park, ON

Mr. Speaker, as we have indicated, the palliative care financial allotments do not appear in this discreet legislation. The member has raised an issue about whether they should have appeared in the budget. I can assure the member that we are working to renew a lapsed agreement called the Canada health accord, with which the member for Timmins—James Bay will be very familiar.

The previous government simply allowed that to lapse. We do not believe in governing in that manner. We believe in engaging with provinces and meeting with them to understand their needs, and to address them going forward in a robust manner that is consensual, two-way, and that provides the financial supports that are needed by the provinces and territories.

With respect to first nations palliative care in particular, and the very particular issue that the member for Timmins—James Bay has raised, I think it is an important issue. Obviously more important than the issue we are dealing with discreetly here is repairing a woeful and shameful record in respect of first nations peoples, which has existed for generations.

We see that reflected in every mandate letter provided to every cabinet minister by the Prime Minister. That is something on which we are actively working. We have had robust debates about mental health in particular communities, including the community the member represents. However, that is only one part of a broader piece that needs to be addressed.

I look forward to working closely with the member going forward about how to address compassionate care and palliative care, in particular for first nations people, as part of our duty of care to first nations.

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May 2nd, 2016 / 4:10 p.m.
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Conservative

The Deputy Speaker Conservative Bruce Stanton

Before we resume debate, I get the sense, especially given the nature of the debate today, of the need for time for members to explain points in questions that they might pose to a speaker who has just presented. We are doing our best. In the five-minute period, it is very difficult to pose much more than two questions and receive their responses. If members make their interventions more concise, obviously more members can participate, but in all honesty and as the presiding officer, the last thing we want to do is cut people off.

We will be as judicious as we possibly can, but if members are able to be concise in their interventions, it would help their colleagues to have more opportunities to pose questions in the five-minute period.

Resuming debate, the hon. member for Saint-Hyacinthe—Bagot.

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May 2nd, 2016 / 4:15 p.m.
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NDP

Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC

Mr. Speaker, first of all I would like to say that I will be sharing my time with my colleague from Kootenay—Columbia.

Medical assistance in dying is definitely one of the most important social issues our country and our Parliament will face and have faced in a long time. There is no doubt in my mind that this is the most delicate issue that our Parliament will have to deal with.

I would like to say that I will be supporting this bill at second reading stage even though I feel that we need to amend it.

We have known from the beginning that the NDP will have a free vote on this personal and delicate issue. Therefore, we are not seeking a consensus, but rather we want to continue consulting our constituents and the many experts studying this issue in order to determine what would be the best bill to reflect Canadians' rights.

It is important that we clarify the bill we are studying because it leaves room for interpretation and, above all, it contradicts the Supreme Court's ruling in the Carter case.

We will debate the necessary amendments in a non-partisan manner, but it is important for everyone here in the House to remember why we are voting on this issue. The issue at hand is not whether we are for or against medical assistance in dying. The Supreme Court of Canada was very clear that medical assistance in dying is a charter right. We are here to debate the bill and ensure that it reflects the Carter decision and does not leave anything open to interpretation.

As I just said, the Supreme Court unanimously ruled that competent Canadian adults who are suffering intolerably as a result of a grievous and irremediable medical condition have the right, under the charter, to medical assistance in dying.

The Supreme Court mandated our Parliament, and also the provincial legislatures, to pass legislation that is compatible with the Supreme Court's decision. This decision sent a strong message to update our laws, which are meant to protect vulnerable people and also the health care professionals who help them.

It is important not to politicize this issue or deal with it in a partisan manner. It is also important not to reduce this major issue to a pro-life and pro-choice debate since we know that debates like that can be never-ending.

I am very proud to have been a member of the Special Joint Committee on Physician-Assisted Dying. I worked on that committee with my colleague from Victoria, and I would like to sincerely thank him for his expertise, experience, and wealth of knowledge on this issue. This was my first experience with committee work. I would therefore like to thank him again, along with all of the committee members and the staff who assisted us. It was a privilege for me to be part of that committee because it gave me the opportunity to carefully study the Supreme Court's decision in this regard, and the provincial court decision that preceded it. We also carefully considered the laws in Quebec. I am very proud of the role that Quebec has played in leading the way on this sensitive issue. We also considered legislation from countries around the world.

Our committee reviewed two major studies, which together heard from over 13,000 people and more than 100 organizations. We held 11 hearings.

Sixty-one expert witnesses shared their work with us. Since February 6, 2015, the day of the Supreme Court ruling, every medical organization in the country and every organization that represents people with illnesses or health care professionals has given this sensitive issue very careful consideration. Those speaking on behalf of doctors told us how they were trained up until February 6, 2015. Their careers were based on the duty to heal. Since February 6, 2015, they have become aware that their role is now also to help people avail themselves of their right to seek medical assistance in dying.

During the committee's work, I made a point of meeting with all of the organizations in Saint-Hyacinthe—Bagot with an interest in this issue. I met with representatives of organizations for people with disabilities, user committees, institutions, medical institution representatives, and an organization that works with bereaved families and supports people at the end of their lives. I shared the committee's thoughts with them. I also had a meeting with all of these stakeholders to discuss our committee's report. Everyone who is directly involved in this issue and deals with it on a daily basis was very comfortable with our recommendations.

The role of the committee was to take advantage of this unique opportunity to reflect on all of the aspects of physician-assisted dying. Of course, we know that the government will not take all of our 21 recommendations into account in its bill. As the parliamentary secretary was saying, we do not have a lot of time. However, we should be considering all aspects of this issue. We made one recommendation that generated a lot of questions, our recommendation on mature minors.

Some witnesses told us that, for years, they have been helping young people around 16 or 17 years of age who have lived with incurable diseases for a long time and that those young people achieved a degree of maturity that very few adults achieve over the course of their lives.

Of course, after hearing this sort of testimony, we cannot close the door on that aspect of the issue. We cannot move forward with it now, because studies need to be done. One of our recommendations was that the necessary studies be conducted according to a certain timeline. We should not wait for these young people to end up before the Supreme Court.

As I said, the legislation leaves too much room for interpretation. I believe that, as parliamentarians, we have the duty to ensure that people who are sick do not have to continue to go before the courts to defend their right to physician-assisted dying.

Lawyers told us that we could consider the Carter ruling as a floor. That is what we, as MPs, chose to do. The Conservatives are saying that the Carter ruling should be considered a ceiling. The Liberals decided to go below the Carter ruling and down into the basement with their provision on reasonably foreseeable natural death, and that needs to change.

The Liberals keep telling us that $3 billion has been promised for palliative care. That is only a promise. There was nothing about it in the budget. However, all of the witnesses spoke about palliative care. Everyone in my riding has talked to me about it too. The important thing is to work for the best interests of all Canadians and to allow them to die with dignity.

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May 2nd, 2016 / 4:25 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, with respect to the importance of palliative care, the member referenced that we heard from the government, not only in recent weeks, but for a number of months, in terms of its commitment to palliative care. It is a very important part of the debate, no doubt, and as we continue to debate, a very emotional piece of legislation about which we are all very opinionated. However, one of the things that is very important for us to recognize, when we talk about palliative care, is that there are many different stakeholders—in particular, provinces, first nations, and so forth—that need to play a critical role in the development of palliative care policy.

I wonder if the member might want to provide some comment, from her perspective, as to how important it is that Ottawa work with the different stakeholders to ensure that we do provide the type of palliative care that Canadians from coast to coast want to see?

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May 2nd, 2016 / 4:25 p.m.
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NDP

Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC

Mr. Speaker, we must go much further. The federal government must provide leadership on palliative care. It is all very well to promise $3 billion and to promise to talk about it, but there was no money in the last budget to initiate discussions with the provinces and carry out the necessary studies.

I held consultations in my riding, which has one of the largest long-term care facilities in Quebec. For hundreds of seniors, there are only 12 palliative care beds in that institution. That is clearly inadequate. It is not enough to promise $3 billion. There has to be money in the budget, and the government has to get to work on this right now.

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May 2nd, 2016 / 4:25 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, I thank the member for her remarks.

The member for Parkdale—High Park, I believe it was, is quite correct to say that this legislation would create one of the most permissive euthanasia regimes in the world. That is certainly what I understood him to say, and I think that would be quite correct.

We are limited to some extent, obviously, by the legal environment we are in. However, my concern is that this does not contain the safeguards we need to ensure that there are precautions in place so that someone who took someone's life without consent would be effectively prosecuted.

I want to ask the member if she would support my proposal to remove the reasonable, but mistaken, provision within this bill. I think that would be a substantial improvement.

The bill right now says that people could avoid prosecution if they have a reasonable, but mistaken, belief that someone consented. This would allow people to take the life of a person who did not consent and, yet, escape prosecution if they could at least show, beyond a reasonable doubt, that they had a reasonable, but mistaken, belief.

Would the member support removing that very concerning section, in order to ensure that vulnerable people are protected?

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May 2nd, 2016 / 4:25 p.m.
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NDP

Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC

Mr. Speaker, the clause on natural death that is reasonably foreseeable is the most contentious clause in this bill.

Yesterday, Quebec's health minister, Gaétan Barrette, said that the courts would quickly strike down this clause. He even called on doctors to rely on Quebec's law rather than the federal law as drafted. We have a duty to ensure that the law is clear.

In recent weeks, some Quebeckers have starved themselves to death while trying to become eligible for medical assistance in dying. That has to stop. People have to be able to decide to die with dignity. Our law must allow it.

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May 2nd, 2016 / 4:30 p.m.
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NDP

Pierre-Luc Dusseault NDP Sherbrooke, QC

Mr. Speaker, I would like to thank my colleague for her work on this issue.

Could she talk about access to medical assistance in dying for all Canadians, no matter where they live in Canada, as it is now a right protected by the charter as a result of the ruling?

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May 2nd, 2016 / 4:30 p.m.
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NDP

Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC

Mr. Speaker, the issue of access to medical assistance in dying is indeed crucial. Since it is a right, of course it must be accessible. That is why it is important to extend this capacity to other health care professionals.

When it comes to assessing eligibility for medical assistance in dying, physicians take care of that. The riding I represent is 50 kilometres from the nearest urban centre, and some of my constituents do not have access to a doctor. It is therefore important to allow other health care professionals to help people exercise their right.

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May 2nd, 2016 / 4:30 p.m.
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NDP

Wayne Stetski NDP Kootenay—Columbia, BC

Mr. Speaker, I rise today to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts related to medical assistance in dying.

I support the bill at second reading. However, it does need to be amended.

I will start today with a story. Some years ago, my wife Audrey and I adopted a beautiful sable sheltie dog by the name of Princess Diana of Cornwall. She was named at a time when we lived on Cornwall Drive in Port Coquitlam, and the world was abuzz with a royal wedding involving two people named Charles and Diana.

Princess was a great dog. Unfortunately, when she was about 11 years old, she developed cancer. We were already living in our current home city of Cranbrook, located in the Rocky Mountains area of British Columbia. As the cancer progressed, Princess was living with more pain and discomfort. We consulted our local vet regularly. One day he told us that she was terminal and in a lot of pain and he thought the best thing we could do for her was to end her suffering. He asked us to bring her back the next day. We took her home to say our goodbyes, and the next day I brought Princess back to the veterinarian. He asked me if I would like to leave her with him or whether I would like to stay. I said I would stay. I held her in my arms and watched the needle go into her paw. She lay down and died in my arms. As I stood there with tears in my eyes, I thought that if I were ever in intolerable pain from an incurable disease, this is how I would want to leave this world, with a needle in my paw, lying in the arms of someone I love. I personally became a believer in physician-assisted suicide right there 20 years ago.

I am not suggesting that the death of a pet and that of a human are equivalent, though they certainly can feel much the same, as many who have loved a beloved pet will know. We need to take even more care that we have it right when we are talking about euthanasia through a human lens.

As members know, in February 2015, a unanimous Supreme Court ruling established the charter-protected right of competent adult Canadians who are experiencing enduring and intolerable suffering as a result of a grievous and irremediable medical condition, including a disease, disability, or illness, to access medical assistance in dying. We in the NDP are committed to implementing the Supreme Court order decision with balance and sensitivity, respecting the autonomy of patients, the rights of health care practitioners and vulnerable individuals, and the fundamentally personal nature of this issue to every Canadian; in other words, we need to get this legislation right.

Last week, when I was back in my riding of Kootenay—Columbia, I met with Bendina Miller, the past president of the Canadian Association for Community Living. The CACL was one of the main supporters of the vulnerable persons standard, the purpose of which is to protect the vulnerable in Canada, as Bill C-14, medical assistance in dying, moves forward. While the CACL believes that the bill in its current form takes appropriate steps toward addressing the vulnerability of people living with a disability, it believes some improvements are required to meet the Supreme Court's intent that the legislation must provide fair access to assisted death and also protect vulnerable persons who may be influenced or induced to use the system to die.

The Canadian Association for Community Living recommends five areas of substantive amendment to this draft bill. I will summarize them here.

First, Bill C-14 should be amended to extend the current requirement for judicial oversight until such time as a study of the merits and implications of the bill allows them to be clearly understood.

Second, included in the bill should be an explicit legal requirement to identify, explore, and record the sources of a person's suffering, and an attempt to address the motivations of his or her request for death.

Third, Bill C-14 should be amended to meet the requirements of the Carter decision and should specify that a voluntary request for medical assistance in dying cannot be made as a result of external pressure or any form of inducement.

Fourth, Bill C-14 should be amended to specify that the minister “will” make, not “may” make, regulations regarding the mandatory reporting of information about requests and the provision of assisted dying.

Fifth, it should mandate a palliative care or other professional evaluation to ensure patients' rights to informed consent by having information about the full range of available treatments and supports that could ease their suffering.

The bill should not proceed without an enhanced national palliative care strategy, which is clearly missing in the Liberal government's 2016-17 budget.

Back in November, I had the pleasure of meeting new members of Parliament from all of the parties represented here in the House, except the Green Party. I was struck by how consistent the words were from all of my colleagues. They said they were here to work collaboratively to build a better Canada. It was very encouraging for me as a new MP, because that is also why I am here.

When I am back home in my riding sharing with my constituents what we are doing here in the House, I tell them that we are working on three bills in particular that would fundamentally change Canada, going forward: first of all, proportional representation voting; second, legalizing marijuana; and third, physician-assisted suicide.

This is the first of those three bills to come to the House for debate and further study, and we need to work together collaboratively to build a better future for Canadians. The bill would do three things: maximize one's willingness to live through expanded palliative care, ensure that our vulnerable citizens are protected, and give our citizens the Supreme Court assured right to choose to die in the arms of someone who loves them, if they are experiencing enduring and intolerable suffering as a result of a grievous and irremediable medical condition.

Let us amend the bill collaboratively and give Canadians the best possible outcome on this very important and emotional issue.

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May 2nd, 2016 / 4:35 p.m.
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Spadina—Fort York Ontario

Liberal

Adam Vaughan LiberalParliamentary Secretary to the Prime Minister (Intergovernmental Affairs)

Mr. Speaker, I thank the member for his considered remarks to the House, but I did not hear a reference to the notion or the concept of advance consent. I am curious as to whether he has thoughts on that issue and how those concerns may be addressed in the parliamentary process as this bill moves through committee.

Clearly, some of the other areas we understand as areas that need to be questioned and explored by committee. We accept that and think it is a good legislative process. However, I did not hear those remarks, and I am interested to hear the member's thoughts on that.

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May 2nd, 2016 / 4:35 p.m.
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NDP

Wayne Stetski NDP Kootenay—Columbia, BC

Mr. Speaker, absolutely, I think that is missing from the current version of the bill. I think it is really important to give Canadians the opportunity for an advance declaration of what their wishes are, particularly if they know their disease is leading to a condition where they will not have the ability to make that decision themselves later on. Therefore, I do think that should be in the bill.

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May 2nd, 2016 / 4:35 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, I want to pick up on the question of advance consent, because it has come up a number of times today.

What we heard from the special committee, at least from those who are involved in health care or represent those who are involved in health care, is that it is very difficult to have an advance directive about a very hypothetical situation in which a people do not actually know how they will experience what they will be going through. With an advance consent provision, one may end up with a situation where someone, who at the present time does not want to die, still has their life taken because of something they wrote down earlier, and they may be experiencing those events differently from how they expected.

I want to ask the member specifically with regard to sexual consent. We have a very clear understanding that a person cannot consent in advance. There has to be contemporaneous consent in the context of sexual consent. Therefore, why would we have a different and lower standard for someone consenting to die than for someone consenting to engage in sexual relations?

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May 2nd, 2016 / 4:40 p.m.
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NDP

Wayne Stetski NDP Kootenay—Columbia, BC

Mr. Speaker, I really do not think it is a lower standard. If we have the opportunity to declare our intent ahead of time and put it in writing, that at least gives us some opportunity to have some say over our future. If we reach the point where we cannot consent and we cannot not consent, and then we have no options at all. Therefore, at least having an opportunity to declare our wishes ahead of time is an improvement over not having any choice at all.

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May 2nd, 2016 / 4:40 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, I really hesitated getting up to ask this question, but my colleague, and I respect him and his work, inferred some similarity between the loss of a pet and the loss of a loved one, a human. I have lost lots of pets over the last 60 years, and yes, I have shed some tears, and I have had this kind of experience. However, to infer that there is even a 1% similarity between losing a pet and losing a family member I think misses the point.

I watched my mother and dad approach death. I watched a brother, who lay unconscious for a month in hospital on life support approach death and die. Five years ago today, my wife suffered an intracranial hemorrhage and two days later passed away. However, not in one of those situations, not in one of them, would I have wanted to end their lives one day earlier.

We need to realize what suffering can teach us as we walk alongside those who are suffering and enter into their suffering. That is what it means to be human. My concern is that if we lose the drive to walk with those who are suffering and lose the commitment to actually do something about palliative care and provide good care for those who are suffering, we are really missing the boat.

I would like my colleague to comment on the lack in the budget of actual hard commitment to really get on with palliative care.

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May 2nd, 2016 / 4:40 p.m.
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NDP

Wayne Stetski NDP Kootenay—Columbia, BC

Mr. Speaker, let me repeat what I said during my speech. I am not suggesting that the death of a pet and the death of a human are equivalent.

We need to take even more care that we get it right when we are talking about euthanasia using a human lens. I absolutely agree that palliative care is critical. We need to make sure that we have a national palliative care strategy to go along with this, but they need to go hand in hand if they are to move forward at all.

The story I told was what convinced me that if I had a choice, I would choose to die with dignity.

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May 2nd, 2016 / 4:40 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

Mr. Speaker, it is my honour to stand to speak in support of Bill C-14, a significant piece of legislation that would allow for the first time in Canadian history the provision of medical assistance in dying across the country.

I believe Bill C-14 directly and thoughtfully responds to the Supreme Court of Canada decision in Carter. This legislation would strike a careful balance between the autonomy of competent adults whose deaths are reasonably foreseeable to seek medical assistance in dying and the protection of vulnerable people through careful tailoring of the eligibility criteria and robust safeguards that are essential to prevent error and abuse.

As recognized by the Canadian Medical Association before the Special Joint Committee on Physician-Assisted Dying, one cannot underscore enough the significance of this sea change in Canadian medical practice and Canadian society as a whole.

At present, there are eight jurisdictions in the world, in addition to Quebec, that have adopted precise legal rules on medical assistance in dying: four U.S. states, Colombia, and the European countries of Belgium, the Netherlands, and Luxembourg.

The international community is is looking at Canada's leadership on this issue right now, and I commend all hon. members on both sides of this House for their invaluable contributions to this complex and sensitive debate.

Bill C-14 would establish the criminal law rules regarding medical assistance in dying that address issues including eligibility, procedural safeguards, and the framework for a pan-Canadian monitoring system. In addition to the comprehensive legislative response proposed in Bill C-14, the government would undertake independent studies into three key issues that the Supreme Court declined to address in Carter: eligibility for persons under 18, advance requests, and requests for medical assistance in dying solely on the basis of a mental illness.

Allow me today to provide all members with further clarifications on the eligibility criteria included in Bill C-14 and how they respond to the Carter ruling, a question that has been asked numerous times since the bill was introduced.

Under Bill C-14, medical assistance in dying would only be available to mentally competent adults: one, who have a serious and incurable illness, disease or disability; two, who are in an advanced state of irreversible decline in capability; three, who experience enduring and intolerable physical or psychological suffering as a result of their medical situation; and four, whose natural death has become reasonably foreseeable taking into account all of their medical circumstances and without requiring any specific prognosis as to the length of time that they have remaining.

I would emphasize that those are the exact words of the legislation, because there has been some incorrect reporting on what is actually required. It is also important to remember that the criteria must not be read in isolation. Each element mutually informs the meaning and scope of the others. They work together to create a clear picture.

Some people wonder what reasonable foreseeability of death means given that everyone's death is reasonably foreseeable in the sense that death, like taxes, is inevitable for all of us. Bill C-14 expressly states that the person's natural death has become reasonably foreseeable, which clearly indicates that a change in the patient's medical circumstances is required. The patient is now on a path toward death, but previously he or she was not. A healthy person's death is not reasonably foreseeable unless the person experiences a change in his or her medical circumstances.

Mr. Speaker, at the outset of my remarks, I neglected to inform you, but I do now, that I will be sharing my time with the esteemed member for Fredericton.

The concept of reasonable foreseeability is also well known in law, and assessment depends on the context. In the context of medical assistance in dying, it would require a real possibility of the patient's death within a period of time that is not too remote from circumstances that can be predicted within a range of reasonable possibilities. Again, the legislation expressly states that a specific prognosis as to the time the patient has remaining would not be required. Because everyone's trajectory toward the end of life would be unique, this criterion was carefully crafted to provide maximum flexibility to medical practitioners so that they may assess the overall medical circumstances of a patient on a case-by-case basis. The overall medical circumstances, as opposed to any particular type of condition, are what matters when the objective is to give Canadians the option of a peaceful medically assisted death instead of having to endure a prolonged or painful one.

As recognized by medical standards and guidelines on prognostic indicators, there are many factors that may contribute to a patient's being assessed as approaching the end of life, including the presence of an advanced, progressive, and incurable disease, but also completely different factors, such as age, the general frailty of the patient, and risks of death from complications of other conditions that may not be fatal on their own, but which can jeopardize the life of someone who is otherwise weakened.

As recently recognized by the Canadian Medical Association, the requirement that natural death has become reasonably foreseeable would provide clearer guidance than the court's use of “grievous and irremediable” in that it would indicate , and I quote the CMA representative, that the condition should be “towards the end of the spectrum”, but does not mean “terminal or that death is immediately on the horizon”.

If we consider the Carter ruling itself, the Supreme Court expressly stated that the scope of its declaration was intended to respond to the factual circumstances of the case, and that it made no pronouncement on other situations where physician-assisted dying may be sought. Bill C-14 would directly respond to the factual circumstances of both Kay Carter and Gloria Taylor, who were both in decline and suffering while on a trajectory toward the end of their lives without it being certain when exactly they would die.

The Supreme Court did not define the term “grievous and irremediable medical condition”. It rather acknowledged that it was Parliament's task to weigh and balance the perspective of those who might be at risk in a permissive regime against those who seek assistance in dying. This is exactly what Bill C-14 does. It defines eligibility in a manner that is consistent with the Carter ruling read in its entirety, and provides necessary clarity on the assessment of eligibility.

Some have expressed concern over the lack of express protection for conscience rights of health care providers. The legislative objectives of Bill C-14, which are clearly stated in its preamble, include respecting the personal convictions of health care providers while also recognizing the provinces' jurisdiction over various matters related to medical assistance in dying. Balancing the interests of medical practitioners and those of patients is such a matter. Importantly, nothing in Bill C-14 would compel health care providers to provide any assistance that may be contrary to their conscience rights. More important than legal protections in a statute book are the concrete and practical actions that are directly aimed at supporting conscience rights of practitioners. In this regard, the Minister of Health has offered to work in collaboration with the provinces and territories on the development of an end-of-life care coordination system to help respect the providers' conscience rights while facilitating patients' access to care including assistance in dying.

Some have expressed concern that the safeguards in the bill are not sufficient. The proposed safeguards are generally consistent with and perhaps even a little stronger than the safeguards found in other medical assistance in dying regimes around the world.

The trial judge in Carter considered voluminous evidence on the efficacy of these regimes, and the evidence persuaded her that the risks to vulnerable people could be adequately managed under such systems. We are equally confident that these safeguards would guard against abuse and error.

I believe the proposed legislation is the right way forward on medical assistance in dying for Canada at this time and is a principled response to the Carter decision. I would urge all members to support second reading of Bill C-14.

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May 2nd, 2016 / 4:50 p.m.
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Conservative

Martin Shields Conservative Bow River, AB

Mr. Speaker, I appreciate the presentation on the debate today. One of the areas I am concerned about with the bill is that in rural Canada it can be a challenge to identify two physicians or two nurse practitioners. Outside the large urban areas there are a smaller number of doctors and often not even a nurse practitioner. Even if we had those four, it would quickly become identifiable who those people were, and that could be a severe challenge in rural communities. The only other alternative then is referrals. Again, those are the people who become the referral that people go to.

That is a question I have with this legislation. I am very concerned about the limited number of medical people who would have to be involved in this process outside the major urban centres.

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May 2nd, 2016 / 4:55 p.m.
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Liberal

Sean Casey Liberal Charlottetown, PE

Mr. Speaker, it is that very concern that was borne in mind when the decision was made to extend the exemption with respect to medical aid in dying to nurse practitioners. We see more and more in the country, with doctors being abundant in major centres and not so much outside of major centres, that much of the load has now fallen to nurse practitioners. That is the very reason why they are included.

Access is important with respect to any charter right. The member raises a very valid concern and the specific attempt to address it is with respect to the inclusion of nurse practitioners.

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May 2nd, 2016 / 4:55 p.m.
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NDP

Georgina Jolibois NDP Desnethé—Missinippi—Churchill River, SK

Mr. Speaker, I have a question about access to adequate medical services and access to nurse practitioners or doctors. Where I come from, in my riding, most reserves and communities do not have that privilege when we talk about the national palliative care strategy. I am very concerned because where I come from we do not even have access to a nurse. How can the government ensure that we can have this meaningful discussion in a broader context to help people die with dignity?

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May 2nd, 2016 / 4:55 p.m.
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Liberal

Sean Casey Liberal Charlottetown, PE

Mr. Speaker, clearly, the last two questions point out the unevenness of access to medical services right across the country.

Today in Parliament we are debating an act to amend the Criminal Code. The government's response to the Carter decision was both legislative and non-legislative. The legislative measures are the ones we are debating now, but in terms of non-legislative measures, there is a commitment of $3 billion in home care, a significant part of which would be palliative care.

This legislation alone would not resolve the inequality in access to medical services across the country. We acknowledge that. It cannot do that. That is something the government has to continue to strive to accomplish through the negotiation of the health accord and through working with provinces for a palliative care strategy and for medical coverage in rural and remote areas.

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May 2nd, 2016 / 4:55 p.m.
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Liberal

Nick Whalen Liberal St. John's East, NL

Mr. Speaker, I would like to thank the member for his comments and reasoned commentary on this.

I had the good opportunity of having a round table last week with the Newfoundland and Labrador coalition of pensioners and seniors associations. To a person, they were favourable of the approach we have taken with this legislation. There was one issue that really hit to the crux of what they felt might be far enough or not far enough in the legislation. That was with respect to advance care directives. They also had a concern with respect to determining in advance whether or not one's condition would become intolerable. They were also concerned about the ability of provinces to have appropriate registries in place to handle that type of medical care.

I would ask the member if he agrees that this integrative approach of going incrementally toward medical assistance in dying is the proper way to go, or if he feels we should go even further at this stage.

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May 2nd, 2016 / 4:55 p.m.
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Liberal

Sean Casey Liberal Charlottetown, PE

Mr. Speaker, I thank the member for St. John's East for the question and also that he used part of his constituency week to consult with his constituents. That is extremely important. It is something that I did as well.

The government has clearly proceeded carefully. Given the compressed time frame that we were given by virtue of the inaction prior to the election and the deadline imposed by the Supreme Court, I believe that this is the prudent course. The preamble of the bill and the non-legislative measures indicate that there will be a further, more detailed, thorough, and more drawn-out examination of the more sensitive questions, and I think that is the best solution for Canada at this time.

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May 2nd, 2016 / 5 p.m.
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Liberal

Matt DeCourcey Liberal Fredericton, NB

Mr. Speaker, with the Supreme Court's decision in Carter, Canadians were given notice that medical assistance in dying would effectively become legal in Canada. It was, hence, the responsibility of the government to put forward clear rules around who is eligible to obtain medical assistance in dying, what safeguards must be followed to protect vulnerable individuals, and to create a monitoring regime to ensure accountability, transparency, and public trust in the system. Federal legislation was also important to ensure that a consistent approach to medical assistance in dying would be available across Canada.

Bill C-14 is the result of extensive consultation over the past year with individuals, groups, and experts at home and abroad. It takes into account a range of interests, including personal autonomy and safeguards to protect the vulnerable. It also recognizes the diverse and personal ways in which individual Canadians arrive at the question of medical assistance in dying. It balances individual rights and informed conscience, and respects the professional ethics and conscience of physicians and medical practitioners.

This legislation also addresses and proposes broad action on an aspect of end-of-life care where Canadians, regardless of their views of medical assistance in dying, have clearly indicated that they want action, chiefly, palliative and hospice care. I had the pleasure yesterday to take part in Hike for Hospice in sunny Fredericton and I am proud of the overwhelming support demonstrated by community members for such a worthy and important cause.

As we address an issue as delicate as medical assistance in dying, we cannot act without a full and intentional movement toward expanding all options of end-of-life care. The government has made clear that as part of a multi-year health accord, financial resources to improve home care, including palliative care, will be of primary importance. Also, as we launch Mental Health Week today in Canada, we must recommit our efforts to providing greater care and support for those suffering from mental illness and deliver on clinical and community-based approaches that will allow greater access to mental well-being for Canadians who suffer from mental afflictions.

On December 11, a Special Joint Committee on Physician-Assisted Dying was tasked with reviewing recent consultation activities. The committee also consulted with Canadians and stakeholders and made recommendations on the framework of a federal response to the Carter decision. The committee met 16 times, heard from 61 witnesses, received more than 100 briefs, and tabled its final report to Parliament on February 25.

I would like to extend my thanks for the work of the committee, as well as for the individual commitment demonstrated toward this issue from each and every committee member.

I, too, have heard from hundreds of people in the riding I represent, and have sought out wisdom and advice from leaders within the disability community who are calling for assurances that those with vulnerabilities will be safeguarded from outside influence in their personal decision-making; from the faith community, including trusted mentors and friends, who have encouraged me to reflect upon my own informed conscience in rendering a decision on this important matter; from the medical community, including leading voices, who have called for a sage and measured approach to the development of a framework around medical assistance in dying; and from those seeking a more liberalized approach, who may be dissatisfied with the framework that is proposed in front of us.

I have listened, I am listening, and I will continue to listen to people in the riding I represent. I have reflected, I am reflecting, and I will continue to reflect upon this important decision that will change the way Canadians consider end of life.

I approached this question like many others, with great humility, understanding that in a pluralistic society as rich and diverse as Canada's there will undoubtedly be those who feel that this legislation does not meet their world view. I wish to extend my empathy and understanding to them, and let them know that I, like all my colleagues, will continue to do my best for them.

I believe the ministers charged with crafting this legislation and the government as a whole have also approached this question with great sensitivity. The approach being taken is emblematic of a government that has listened to citizens, and will continue to listen to the wide diversity of opinion on this personal and challenging decision.

With this in mind, I wish to express my general comfort with the legislation before us. I would like to take the time to explain in greater depth the elements of the legislation and what it means for Canadians.

First, to allow access to medical assistance in dying in Canada, the Criminal Code would need to be amended so that doctors, nurse practitioners, and those who assist them can help eligible patients die without the risk of being charged with assisting a suicide or committing a homicide. There will also be safeguards to ensure that those who receive medical assistance in dying are eligible for it, can give their informed consent, and voluntarily requested assistance in dying.

A voluntary and informed request must be submitted in writing by the person in the presence of two independent witnesses, and a second medical opinion is required. No one aside from the person wishing to receive medical assistance in dying can make that voluntary request. This approach holds that the right to choose medical assistance in dying belongs only to the competent adult who would receive it. This is also necessary to protect vulnerable people.

A person who wants to access medical assistance in dying would have to meet the following criteria. They would have to be a mentally competent adult of 18 years or older. They would have to have a serious and incurable illness, disease or disability, be in an advanced state of irreversible decline of capability, and experience enduring and intolerable suffering as a result of their medical condition. They would, in effect, have to be on a course toward end of life. Death would have to be reasonably foreseeable.

The proposed legislation holds that mature minors would not be eligible nor would people suffering solely from a mental illness. The government is, however, proposing an independent study of the legal, medical, and ethical issues related to medical assistance in dying for mature minors, for those suffering from a mental illness, and around advance directives.

Again, the bill includes protections to ensure that patients are eligible and have given their informed consent. There would be a mandatory waiting period of at least 15 days, and patients could withdraw their consent at any time.

Also, there is nothing in the proposed legislation that would compel a health care provider to provide medical assistance in dying or to refer a patient to another practitioner.

The proposed approach to this most difficult of questions does its best to recognize individual choice for adults who are suffering intolerably and for whom death is reasonably foreseeable. It seeks to affirm the inherent and equal value of every person's life. It has the goal of protecting vulnerable people and reaffirms society's goal with regard to preventing suicide. It is an approach that recognizes where we are as a society and as a people advancing in the world. It is respectful of the divergent voices of Canadians and it demonstrates flexibility in its ability to reassess and examine the issue of medical assistance in dying in the weeks, months, and years to come.

I wish to thank my constituents who have reached out to me on this important matter and the many more who, I know, have wrestled with this question internally.

Know that this Parliament and I will do our collective best to serve each one's interests and those of their neighbours on this and on all important matters.

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May 2nd, 2016 / 5:10 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, this member and the previous member referred to the “flexibility” of this legislation. Flexibility may be a good quality to have at a dinner party, but it is not much of a virtue in the context of legislation. Flexibility does not help physicians who are going to have to look at this legislation and decide if something is legal or not. Let us not call it “flexibility”; let us be clear and call it “ambiguity”.

I wonder if the member would support at least clarifying the ambiguous criteria, because the more he talked, the less I understood.

He talked about death being “reasonably foreseeable” and said that one has to be on a course toward end of life. Again, we are all on a course toward the end of life.

What prevents the government from amending the legislation to actually, in a very basic and sensible way, define what we are talking about? Ideally it would put in the word “terminal”, because that is what is implied but not said—and if it is not said, then it is not in the legislation.

Could we get some clarity around what these things actually mean?

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May 2nd, 2016 / 5:10 p.m.
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Liberal

Matt DeCourcey Liberal Fredericton, NB

Mr. Speaker, I thank my colleague across the aisle for his question, although I would caution him to advance with some modesty in the commentary he uses to talk about this sensitive issue.

As I explained, I did have the opportunity to consult with medical practitioners, with leading voices, about where they saw this legislation fitting into what we needed to accomplish as a government in response to Carter.

My general reflection of these conversations has been that the medical field is, by and large, comfortable. Of course there will be those who will not see this within their own world view, and that is where the flexibility in this legislation exists: to ensure we meet the rights of those adults who are suffering intolerably to access medical assistance in dying while also recognizing the conscience of practitioners who will be providing the service.

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May 2nd, 2016 / 5:10 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Mr. Speaker, I listened with great interest to my hon. colleague. I think what is disturbing me in the tone of the debate today is that there is an impression being created by the Conservatives that somehow the great moral crusade here is to actually defy the Supreme Court ruling. The Supreme Court ruling made a decision that has really tied the hands of Parliament. I may not agree with how it arrived at it or I may not agree with the fact that it has limited our ability to consult with Canadians, but one thing I am very aware of is that this right already exists now. It is already being practised by the courts, and if Parliament does not frame clear legislation with clear limits, there will be a legal vacuum come this summer in which the fears that my Conservative colleagues are raising may well be much more realized by other parties who step forward and go to the Supreme Court to say Parliament has failed in its fundamental duty to act.

Given the constraints put upon us by the Supreme Court, I would like to ask my hon. colleague what he feels will happen if Parliament does not come up with this bill to meet the timeline of the Supreme Court and leaves that legal vacuum that would exist across this country?

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May 2nd, 2016 / 5:10 p.m.
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Liberal

Matt DeCourcey Liberal Fredericton, NB

Mr. Speaker, I think the best way I could reply is by explaining to my hon. colleague the advice that I have been given, again, from people in the medical community, people in the vulnerability community, and all those who have first-hand experience in trying to deal with end-of-life situations.

They have all impressed upon me the need for this Parliament to move with legislation that is caring, that is compassionate, that is smart, that recognizes in fact that the Supreme Court has already decided upon this issue, and that it is up to us as legislators, as parliamentarians, as leaders in our community, to come up with appropriate legislation that would best meet the collective interests of Canadians.

I cannot speak in specifics of what might happen, but I do know, in consultation with those who do have insight into vacuums in the legal and medical system, that it is not something we want to see here in Canada.

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May 2nd, 2016 / 5:10 p.m.
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Conservative

Peter Kent Conservative Thornhill, ON

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

I think it is important for Canadians to realize that the legislation before us is neither the alpha nor the omega in the continuing conversations Canadians are having about physician-assisted death. The Supreme Court forced this legislative moment on reluctant politicians with the Carter decision, but the conversation has been simmering, occasionally percolating, for decades in hospital intensive care wards, doctors' offices, around family dinner tables and at the bedsides of loved ones, from holy pulpits and at congressional retreats, medical schools and law schools, from theist philosophers and from the atheist sort. Most personally, the conversation has been conducted within ourselves, in our own minds, in both sickness and in health.

If the proposed legislation before us is neither the beginning nor the end of our ongoing conversation about physician-assisted death, what is it? Where exactly are we?

First of all, I think it is abundantly clear that we are definitely not where the Supreme Court told us to go. The legislation before us, which I believe will easily pass the House, and should as well the Senate, is only an interim step that will almost certainly very quickly lead us again to the Supreme Court.

The official opposition has set as its highest priority safeguards to protect the most vulnerable in society as well as the conscience rights of physicians and other health care professionals. We are pleased that the government accepted recommendations from the Conservative dissenting report from the special joint committee to exclude minors, to include stringent safeguards to protect those with underlying mental health challenges, and to recognize the risks involved with advance directives, which I will come back to in a moment. However, there are still concerns with the proposed legislation before us.

First, a point that has been and will be raised by colleagues many times, and I believe on both sides of the House, is the lack of specified conscience protection, an assurance that medical practitioners and institutions may decline participation in physician-assisted death. However, I do not believe that should be a problem, because I do not believe there will be a shortage of physicians willing to assist those patients who meet the criteria for assistance.

Also, there are the concerns, again raised by many of my colleagues, on the need for greater provisions for prior review, for consideration of underlying health issues, and for the effect of possible psychological disorders on patient decision-making. I believe those matters should be thoroughly reviewed again in committee.

As well, many of my colleagues have expressed concern with the extension of the Supreme Court's specific direction that physician-assisted death be performed by medical doctors to also include nurse practitioners. We know the government's logic in broadening the responsibility is to provide for remote areas where qualified nurse practitioners now carry out many of the services traditionally provided by MDs. Again, I believe the legislation needs more specificity in this area. I firmly believe that many nurse practitioners are qualified, capable, and willing, but perhaps the legislation should explicitly state that nurse practitioners be engaged only as physicians of last resort in circumstances where no medical doctor is available.

I also recognize the widespread concern and resistance to the vague nature of such phrases within Bill C-14 as “reasonably foreseeable”. I personally accept such imprecise conditions because I realize that as magnificent as modern medicine is today, prognoses regarding the time of a final breath or a final heartbeat are still often only educated guesses. This is certainly worthy of further examination at committee.

Finally, one of the most important shortcomings in convincing Canadians to accept Bill C-14 is in the government's unkept and—I will be perfectly frank—broken promise on palliative care.

The Liberals made a campaign commitment to invest $3 billion in long-term care, including palliative care. The importance of access to palliative care in end-of-life decision-making was one of the few unanimous points of agreement in the special joint committee's report.

We as parliamentarians can rush to meet the Supreme Court deadline of June 6, but at the same time, the government has a clear duty, a moral obligation, to put in extra effort to expedite fulfillment of that promise to expand the availability of accessible, affordable, acceptable palliative care for all of those who, for reason of conscience, faith, or choice decide not to avail themselves of physician-assisted death.

I firmly believe that choice must be extended, as I believe the Supreme Court clearly meant it to be in the Carter decision, to patients suffering from the specific diseases and conditions that formed the basis of the Carter decision: the brutally imprisoning final stages of spinal stenosis; the choking, smothering final stages of ALS; and the unrelieved pain of irreversible but interminably long final stages of progressive multiple sclerosis.

While I am on this point, I remarked earlier on the need to recognize the risks involved in advance directives for diseases such as Alzheimer's, dementia, and the like. That said, I believe advance directives must eventually be allowed in physician-assisted death.

I consulted with many individuals and groups in my riding of Thornhill in recent months and beyond. I greatly respect—profoundly respect—the advice and interventions of various faith communities, social agencies, and medical institutions and their concern over the need for greater protection of the most vulnerable.

My personal decision, which will determine my vote on this legislation, is a product of three individuals and their experiences. In my previous life as a journalist, I followed closely the unsuccessful legal crusade of Sue Rodriguez as ALS steadily increased its deadly grip and her rhetorical question posed to Canadians: “If I cannot give consent to my own death, whose body is this? Who owns my life?”

In the previous couple of Parliaments I became close with another thoughtful, courageous Canadian, a fellow member of Parliament, the Hon. Steven Fletcher, Canada's first quadriplegic MP, re-elected three times and just last month elected to the Manitoba legislature, who did not give up after his life-changing accident 20 years ago. He met immense challenges and he overcame them.

However, in two private members' bills tabled two years ago, which I seconded, and in testimony before the parliamentary committee this January, Steven made a powerfully convincing argument for self-determination to one day make a final decision. He said such a law would be based on an individual's own morals and ethics while stressing that there should be no pressure on that person from society, family, friends, or the institution they may be in.

I was also powerfully informed and persuaded by the tragically tortuous passing of my brother-in-law, Rik Davidson, a brilliant academic, through Alzheimer's. Should such an ending be diagnosed for me, I assure the House that an advance directive would be composed, and either under law or not, it would be fulfilled.

Finally, as a cancer survivor, I have had many hours of reflection, during treatment and since, to ponder the issues involved in this debate on a personal level. I am fortunate that modern medicine, faith, and an incredibly supportive wife and family have left me—for now—clear and happily continuing my late-life adventure as a politician.

I am honoured that I can participate in this debate to argue for the passage of Bill C-14, eventual broadening of this legislation's provisions, and immediate government action to expand palliative care facilities and services, because I passionately believe that the issue before us ultimately comes down to choice: the free choice of a competent adult individual to choose between accessible, affordable palliative health care and the constitutional right to physician-assisted death.

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May 2nd, 2016 / 5:20 p.m.
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Spadina—Fort York Ontario

Liberal

Adam Vaughan LiberalParliamentary Secretary to the Prime Minister (Intergovernmental Affairs)

Mr. Speaker, the issue of advance consent or advance care directives was spoken to in the presentation to the House of the hon. member. My question is about how the timing in that regard could be spoken to in amendments to this legislation.

How would the hon. member see advance care directives provided at the age of 20 when the person will encounter difficulties maybe 30, 40, 50 years later? Alternatively, upon diagnosis of a situation and immediately entering into advance care directives, how would the hon. member model timetabling around that so as to review the person's decision before the ultimate act is pursued?

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May 2nd, 2016 / 5:20 p.m.
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Conservative

Peter Kent Conservative Thornhill, ON

Mr. Speaker, I thank my colleague for a very thoughtful question, one that has been asked many times in recent months as the Supreme Court deadline has loomed. There are a great many accounts written by Alzheimer's patients with significant medical and academic ability, who compose diaries from the time of diagnosis and their observations of steadily diminishing capacity.

There is a point, supported by an Alzheimer's patient in the final stages, and I would be surprised if they would allow that they themselves, even though they might be unaware, continue to that final stage. The burden on family, friends, and the medical institutions is overwhelming. The period of 15 days obviously does not work, but there are some worthy accounts which can be referred to. There was a great personal diary in The New York Times Sunday magazine a few months ago about an academic who was provided with mail order barbiturates from Mexico to be prepared when she realized she was in the last stages of fully controlling her life and her situation.

I think physicians and experts in this area could provide us with answers to the member's question.

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May 2nd, 2016 / 5:25 p.m.
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Conservative

Michael Chong Conservative Wellington—Halton Hills, ON

Mr. Speaker, I want to thank the member for Thornhill for his thoughtful views on the bill and for his personal stories relating to the bill.

In his speech, he mentioned that he did not believe the bill was compliant with the Supreme Court. Could he tell the House in what ways he believes the bill is not compliant with the Carter decision?

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May 2nd, 2016 / 5:25 p.m.
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Conservative

Peter Kent Conservative Thornhill, ON

Mr. Speaker, the reality is that the three parties to the Carter decision would not be assisted by Bill C-14. I listed the three conditions: spinal stenosis, ALS, and multiple sclerosis. All three of these particular afflictions would require additional legislative provision. I believe that is why the legislation will be back before the Supreme Court to order an extension of its provisions.

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May 2nd, 2016 / 5:25 p.m.
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NDP

Pierre-Luc Dusseault NDP Sherbrooke, QC

Mr. Speaker, I thank my colleague for his speech.

I would like to know what he thinks about the government's decision to use a different definition than the one set out in the Carter decision. The Supreme Court's decision used the term grievous and irremediable medical condition. Although the government was well aware of what was in the Supreme Court's decision, it decided to use a different definition.

What does my colleague think about the uncertainty this could create in the legal system and especially in our health care system?

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May 2nd, 2016 / 5:25 p.m.
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Conservative

Peter Kent Conservative Thornhill, ON

Mr. Speaker, I thank my colleague for his question.

I think the answer is politics. As we have seen characteristic of the Liberal government in recent weeks and months, it is reluctant to reach difficult decisions. There is an attempt to keep everyone happy on every file, with procrastination and avoidance of the tough decisions that need to be taken. I think this is another case, such as with pipelines, military missions abroad, the environment. However, in this case, risk aversion has basically brought the government to enter a piece of legislation which does not go, as I said, where the Supreme Court ordered us to go.

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May 2nd, 2016 / 5:25 p.m.
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Conservative

Erin O'Toole Conservative Durham, ON

Mr. Speaker, I would like to start by thanking my colleague, the member of Parliament for Thornhill, for a very thoughtful presentation in this House.

A debate on Bill C-14 is an example of this House of Commons at its best. Canadians do not send us here to have unanimous agreement on issues of the day. We are here to represent our ridings, the constituents who have sent us to Ottawa. We belong to political parties. We have different leaders' roles. However, we are Canadians who bring an experience and a point of view to this chamber.

Infrequently, we share that view in the personal stories that people bring to the House of Commons. Today, on the difficult subject of Bill C-14, I learned of my colleague's perspective and personal experience with a member of his family, his personal experience covering the Rodriguez case in the 1990s as a journalist, and how that has combined to formulate his position on assisted dying or euthanasia. Members should welcome that.

It is unfortunate that we do not have a full House for important debates like this. We get so busy, but it is important for us to learn the perspective that each of us brings as a member of this chamber. We are not sent here to be surrogates for other interests or to run polls. We are sent with the judgment to try to look at legislation from the lens of our own experience, education, and background. Many members have brought that to this floor today, and I applaud them for it.

I have looked at Bill C-14, and I have struggled with it. Certainly this is a place where there are two sides on this issue, maybe broken down even more than that. However, there is compassion at the heart of both sides, and that is what is often forgotten in this debate. Why I say this should be the House of Commons at its best is that the Supreme Court of Canada recognized the role of Parliament to clarify the law with respect to euthanasia in a way that is thoughtful and complies with its direction in Carter. This is indeed one of the important debates that we should not fear in our House of Commons. We should ensure that we take part vigorously and share perspectives, as my friend from Thornhill has.

I have looked at Bill C-14, not just as a member of this chamber but also as a lawyer. I have reviewed the case law going back on this some 20 years. I have also reviewed it as a father of two children, a husband—I know my wife is watching today—and the son of a strong woman who died from cancer when I was nine. My most formative memories of my mother Mollie are in her palliative stage of that disease. Of course, all of these things combine to formulate my position on Bill C-14 and what I feel is the government's position with respect to Carter.

However, I am using my speech today to talk about some of the concerns I have with the bill. I will start with a Supreme Court of Canada quote from Justice Sopinka:

Regardless of one's personal views as to whether the distinctions drawn between withdrawal of treatment and palliative care, on the one hand, and assisted suicide on the other are practically compelling, the fact remains that these distinctions are maintained and can be persuasively defended.

Within the Rodriguez decision in 1993, the Supreme Court struggled with the role of the state at end of life in euthanasia or assisted dying. It struggled with whether that role should be passive with respect to palliative care, treating and helping and comforting and limiting pain at end of life, or whether the role of the state should be an active role at end of life.

Justice Sopinka, in the majority court in 1993, said that the bright line of the active versus passive could be persuasively defended. That was the language of the court. Canadians remember, as my friend from Thornhill did, the tragic circumstance of Ms. Rodriguez and her compassionate arguments with respect to that. Bill C-14 is about the role of the state. It is not suicide alone, and that is why we have to have legislation that both accepts the Carter decision but brings us to a position that Canadians can be comfortable with, that persuasively defends it.

The second quote I will use is from Carter, paragraph 117, as to why the court found the position of the trial judge to be compelling. It states:

We agree with the trial judge that the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards.

At paragraph 120, it went on to state:

We should not lightly assume that the regulatory regime will function defectively....

What the Supreme Court did was to allow this Parliament to come up with a regulatory regime to function effectively. The importance of that function is to ensure that what both courts said, the court of the Sopinka decision and the unanimous court of today in Carter, is that the decisionally vulnerable should be safeguarded. That was clearly part of the direction of both courts. This key element, and the aspect of what I consider to be the challenge for an ironclad regulatory regime, the slippery slope argument, is where I find Bill C-14 to be failing. That is why I am not supportive of it.

In the Carter decision, the court said that it was not in a straitjacket because it rejected euthanasia in the Rodriguez decision, and it looked at it in light of recent charter decisions. However, it is looking to Parliament for a system that does not allow the decisionally vulnerable, those impacted by a terrible diagnosis, under the strain and stress of an illness, to at a moment want to take their life and have the state play a role in that. Both courts recognized that these are vulnerable Canadians who need to be safeguarded. My concern is that this would not take place within this legislation before this chamber.

If we look at the great work that members of the all-party committee did, from the aspects of the all-party committee recommendations to what is before us in Bill C-14, the bill actually reflects more of the work done by the Conservative opposition on that committee. However, it certainly shows an indication of where the regulatory regime regarding assisted death would go. At some point in the future, it will likely include mature minors, and it will likely include people afflicted with mental illness, because that was the recommendation of the all-party committee.

As a veterans advocate for years before I joined Parliament, and having the privilege of being the veterans minister, I have met dozens of veterans who would have been decisionally vulnerable when they were suffering from depression, post-traumatic stress disorder, or another operational stress injury, but who are now leading productive lives as mothers and fathers. Some have returned to their role in the military. Many are actually advocating and helping other veterans.

Therefore, I am concerned with a regime that indicates that is where it will go. I know that Bill C-14 does not contain those provisions. However, the slippery slope element, which both the Sopinka courts and the McLachlin courts considered, show that is what we should anticipate in a few years. Although this House of Commons is well intentioned, with an impossible regulatory regime, unable to look at every situation, I think the persuasively defended bright line has not been accomplished in Bill C-14.

Another example I will provide is that the Carter family themselves have expressed concern with Bill C-14. However, the Minister of Justice, in her thoughtful remarks in this chamber, which I appreciated, suggested that both appellants would have been provided for with respect to their assisted death under Bill C-14. That is not according to the family. The minister had to use language relating to a condition that can become “reasonably foreseeable” of death. Therefore, even the distinction between the named plaintiff in this case, the position of the family and the people who advocated for them, is at odds with Bill C-14 and the position of the justice minister.

If anything shows the fact that there is already a slippery slope and a very difficult framework to set, I am concerned that this has been rushed and it will not defend and safeguard against the decisionally vulnerable.

Could Bill C-14 be improved or, if Parliament could take more time, could it address this issue that confronts this place with Carter? In my weighing of all of the issues, as I said, as a parliamentarian who tries to draw upon my own experiences, as everyone does in this place, I do not think Bill C-14 can do that. I still feel that the persuasively defended bright line accomplished in the Sopinka decision has not been met by Bill C-14. In addition, many of the concerns providing the slippery slope that the Supreme Court in Carter raised have not been addressed by Bill C-14 either.

However, I have appreciated people sharing their points of view on this important issue. Parliament should not fear important debates. Members should come here in a respectful and thoughtful tone.

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May 2nd, 2016 / 5:40 p.m.
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Spadina—Fort York Ontario

Liberal

Adam Vaughan LiberalParliamentary Secretary to the Prime Minister (Intergovernmental Affairs)

Madam Speaker, putting aside the fact that we are under a deadline because of inaction by the previous Parliament and that an extension has already been sought at the Supreme Court, the issue that concerns me is this notion that people with psychiatric conditions, post-traumatic stress disorder, I think, was the issue raised, would be able to avail themselves far too easily of physician-assisted dying.

Does the member not reflect upon the provisions around requiring attending doctors or medical personnel to assess the psychiatric condition of the individual seeking this? Are those not the safeguards that would prevent an unfortunate circumstance from being pursued based on psychiatric conditions which were present when the request was made?

Are those safeguards not significant enough to prevent a mistake from being made and could they not be strengthened with further conversation in committee?

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May 2nd, 2016 / 5:40 p.m.
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Conservative

Erin O'Toole Conservative Durham, ON

Madam Speaker, even his framing of this, that mistakes can be made, sort of shows that it is very difficult for Parliament or any sort of regulatory regime, or the professions themselves, to set certainty. In fact, one of my main concerns with Bill C-14 is that it essentially kicks the issue back to the courts by using a reasonable foreseeable standard, which is kind of the linchpin of our common law.

When it comes to the case of a veteran with PTSD, there is no reasonable foreseeable end to that person's life at all, provided there is proper intervention. I have talked to military members, lower ranks and higher ranks. When the black dog, as Winston Churchill described it, hits people, they do think their own only option is to end their lives. However, I have met veterans who are now helping dozens of other veterans because they have found a path to wellness through a whole variety of programs and have made the decision to err on the side of help and not on the side of tragedy.

The very fact that the special committee put mental injuries, many of which can be treated, in the framework for euthanasia shows how difficult it will be to find the right balance.

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May 2nd, 2016 / 5:40 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Madam Speaker, I want to underline that there has been some discussion here about psychological suffering. The legislation very clearly includes psychological suffering as a criterion and subsection 241.2(2) talks about physical or psychological suffering being a criterion. The member, quite rightly, illustrates how having these provisions could create a more permissive environment for suicide more generally. We have heard his concerns about veterans. The member for Winnipeg Centre has spoken quite eloquently about the effect of some of this in the aboriginal community.

Would the member agree with me that we should simply remove the reference to psychological suffering from the legislation? It would be cleaner and clearer if we were to talk specifically about physical suffering and would not create some of these problems that he and others have raised.

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May 2nd, 2016 / 5:40 p.m.
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Conservative

Erin O'Toole Conservative Durham, ON

Madam Speaker, I would like to thank my friend and learned colleague who has provided a lot of perspective on this. That one issue needs to be addressed at committee or immediately with respect to Bill C-14, because it shows that already the legislation and the framework is flawed.

Going back to my earlier comments, this is a difficult circumstance, where, as parliamentarians, we are faced with compassion on both sides of the issue. Provided we have shared time between the member for Thornhill and myself, who may disagree on the final elements of what we see missing in Bill C-14, it shows the gravity of this decision, why we should have this debate, and why more members should be here to share their personal views with respect to concerns on either side.

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May 2nd, 2016 / 5:45 p.m.
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NDP

The Assistant Deputy Speaker NDP Carol Hughes

We are now at the five-hour mark for this part of the debate. Now we are going to the 10-minute debate and 5 minutes of questions and answers.

Resuming debate, the hon. parliamentary secretary to the Minister of National Defence.

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May 2nd, 2016 / 5:45 p.m.
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Scarborough—Guildwood Ontario

Liberal

John McKay LiberalParliamentary Secretary to the Minister of National Defence

Madam Speaker, I was quite encouraged by the previous two speakers and their internal discussion on this issue. It does show that within parties, and I know within our party, there is considerable debate about this issue.

I found trying to assemble my thoughts to be quite difficult as it does go to the heart of our beliefs, our values, and our experiences. Sometimes, frankly, they are not reconcilable beliefs or values.

First, I take the opportunity to compliment the government on allowing a free vote. That is particularly important on this side of the chamber. In a debate such as this, it is very important that members feel complete freedom to speak freely, to vote freely, and to, as much as possible, minimize the partisan jabs that go on in this place. Because this is a free debate and a free vote, it actually strengthens this vote. It is, after all, important that we reflect the consensus of Canadians. They put us here, and they are the ones who we are to reflect.

In this perpetual dialogue between Parliament and the court, it is important that we establish a standard of deference for both institutions, both of which are critical to our freedoms and our democracy. Because this is a free vote, I believe it will therefore strengthen Parliament's expression on Bill C-14.

Some have said today that this decision flows from the Carter decision, and indeed Bill C-14 before us is a response to that decision. However, I would argue that the debate predates Carter by at least several decades as Canada unwinds itself from its Judeo-Christian heritage.

The sixth biblical commandment says simply “thou shalt not kill”. One way or another, it has formed the basis for our legislation and our jurisprudence for the last 4,000 years. In religious and secular terms, it is the doctrine of the sanctity of life.

The last time the Supreme Court dealt with this issue was, as has been mentioned many times, in the Rodriguez decision. At that time, Mr. Justice Sopinka spoke for the majority when he said, “This argument focuses on the generally held and deeply rooted belief in our society that human life is sacred or inviolable.”

He then goes on to reference section 7 of the charter and states that it is rooted in “the profound respect for the value of human life”, which is the right to life and the right not to be deprived therefore except in accordance with the principles of justice.

My own views, frankly, parallel Mr. Justice Sopinka, and in part explain why I do not support capital punishment. The reason I do not support capital punishment is that so often we get it wrong. Similarly, my views are pro-life, which I know is a minority view. I try to be, in my own philosophical way, as consistent as I can be.

What has happened for the justices to do what is an about-face, and disavow their own decision? I know that some will say that the charter is a living tree, but still this is a very significant change of position and even a disavowal of their previous decision in a space of less than 25 years.

In my view, it is the rapidity with which Canadians have disavowed their Judeo-Christian heritage on the sanctity of life and have substituted a test of the functionality of life. Life has to be functional in order to have meaning. Life for its own sake, let alone being created in the image of God, does not meet the test of functionality.

I appreciate that images of people in great suffering are felt deeply by us all and, as the previous speaker said, there is compassion on both sides of this argument.

I do hope the government means what it says in the preamble:

And whereas the Government of Canada has committed to develop non-legislative measures that would support the improvement of a full range of options for end-of-life care, respect the personal convictions of health care providers and explore other situations?—?each having unique implications...

I would be distressed if this were mere lip service, but I have some confidence that the money set aside will in fact start to address some of the situations where people find themselves in end-of-life situations with very few, if no, alternatives. I think as we as a society age, this is going to become more and more of a critical issue.

However, concerns have also been raised by those who represent vulnerable communities and their concerns are legitimate.

Jurisdictions that have gone down the route of assisted suicide have, frankly, a bit of a spotty record. Once institutionalized, there seems to be upward pressure on the numbers and expansion of categories and cases which seem to fall outside of even the most generous interpretation of the law. It is perfectly understandable that there will be expansionary pressure. Indeed, it is a certainty that those who want individual autonomy as the value that is above all other values will challenge this legislation. That is a guaranteed certainty.

However, for those who cannot speak for themselves or for whom consent is problematic at the best of times, there is a worry that the categories of “assistance” would be expanded. I know this sounds like a slippery slope argument, and that is only because it is.

There is an absolute certainty of judicial challenge, regardless what the Government of Canada puts forward, how this Parliament votes and possibly explains the reluctance of the previous government to engage.

While I support Bill C-14 as the best that could be offered up under these circumstances and therefore will vote for it, I would have liked to have seen a couple of other measures included.

First, I would have liked to have seen a panel approach, rather than the one that is offered up. In Ontario, we have declarations of medical competency. It is based upon a panel of one doctor, one lawyer, and one other.

It makes sense to me that leaving the process exclusively in the hands of health care professionals will inevitably create a bias to the questions doctors ask about health concerns rather than procedural concerns, consent concerns, and ethical concerns which lawyers, ethicists, and others focus upon.

It seems to me that if a panel of mixed professionals is required for mental health competency, which is after all a reversible decision, then a panel of three mixed professionals should be the norm in a decision that is not reversible. It also may go a long way to alleviate the concerns of “doctor shopping”. It would lead also to a consistency of approach across the country.

The second measure is conscientious objections. I have heard the argument that no health care professional can be compelled to participate, and it might even be true. I think we can solve that quite easily by simply stating that explicitly in the legislation.

Finally, there has been a lot of negative commentary about the right of religious groups to comment on this bill. It might be pointed out that rabbis, imams, pastors, priests, nuns, and so on, have literally sat at bedsides millions of times as people have passed. They have every right to give their opinion and they bring with them literally thousands of years of experience.

I would like to finish with a quote from Jean Vanier, which I obviously will not get to, but I know you will want to hear in the response to questions, Madam Speaker.

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May 2nd, 2016 / 5:55 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Madam Speaker, the member made some very insightful remarks. I certainly agree with him on many of the points he made in terms of how Bill C-14 needs to be improved, the panel oversight, some protections for conscience rights, and those kinds of things.

My question relates to the legal profession. I am not a lawyer, so I will ask my colleague who is a lawyer. He commented that in the Rodriguez decision in 1993, the Supreme Court decided that the social good was of higher importance than relieving the suffering of one individual. That ruling was affirmed again in the Latimer case in 1997.

I wonder if my colleague would comment on what he thinks changed in terms of the law that created a situation where the Supreme Court would reverse itself on a fundamental issue when from my perspective, I do not see that any laws have changed.

If he has time, I would love the hon. member to give the Vanier quote.

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May 2nd, 2016 / 5:55 p.m.
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Liberal

John McKay Liberal Scarborough—Guildwood, ON

Madam Speaker, I am not sure the law has changed all that much. I do think societal conditions have changed, and I think there is a value shift that is going on from a communitarian view of life to a personal autonomy view of life. I think that actually is expressed by Jean Vanier, a philosopher, a theologian, a humanitarian, the founder of L'Arche, and a former Royal Canadian Navy officer, who said:

A society which discards those who are weak and non-productive risks exaggerating the development of reason, organisation, aggression and the desire to dominate. It becomes a society without a heart, without kindness—a rational and sad society, lacking celebration, divided within itself and given to competition, rivalry and, finally, violence.

I do not think we are there, but frankly, those are concerns that have been expressed and I think they are concerns that bear being listened to.

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May 2nd, 2016 / 5:55 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Madam Speaker, one of the concerns we have as New Democrats is the issue of finding a balance on this legislation.

It was put forward and put upon the House by the Supreme Court. It has laid down a set of rules that we have to respond to, but if we are to move in that direction, the obvious question is, where are the standards for palliative care across this country?

There are many areas under provincial jurisdiction, but the federal government plays an important role in the delivery of health care and the federal government also has a major responsibility in areas of its own jurisdiction, and we have seen a lack of action.

We moved through the last Parliament a national palliative care strategy, but we saw no movement from the government in the budget. We are now hearing on this day that we are discussing medically assisted death that they will come forward at some point with all kinds of money, but there is nothing there now.

We have Motion No. 46 that will be coming before the House about establishing a coherent national palliative care strategy, working also to improve the EI benefits for caregivers so that families are given support, and also calling on the federal government to establish standards under federal jurisdiction.

I ask my hon. colleague what he believes the role of this Parliament is on moving forward with palliative care at this important time.

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May 2nd, 2016 / 5:55 p.m.
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Liberal

John McKay Liberal Scarborough—Guildwood, ON

Madam Speaker, I thank my hon. colleague for his work in the last few months with the people in Attawapiskat.

He puts the question in a very pointed way. We are in a bit of jam. We have a limited time frame in which to actually pass legislation which affects the Criminal Code.

When the Minister of Health answered a similar question in question period earlier today, she said that she is absolutely committed to putting forward a palliative care strategy. I am prepared to accept her at her word. Knowing her personally, knowing her personal background, knowing her integrity, I am perfectly at ease with accepting her word on this and her seeking out funds in order to put money behind that strategy.

I think the hon. member has raised a pretty legitimate issue, and we would all be a lot more comforted if we were doing this legislation in the context of a tabled palliative care strategy.

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May 2nd, 2016 / 6 p.m.
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Conservative

Michelle Rempel Conservative Calgary Nose Hill, AB

Madam Speaker, Canada is a secular state, but we are not, however, an amoral state. Our morality is defined in the shared set of values that sustain our pluralism, and our freedom of speech enables civil society to explore and frame what we define as right and what we define as wrong.

The law and policy that parliamentarians set also have the effect of shaping social norms. In this, I ask my colleagues in considering this bill to consider our responsibility as parliamentarians in defining the morality of our country. This is a sacred connection between us and the Canadians we represent.

The introduction of the Canadian Charter of Rights and Freedoms guarantees certain political rights to Canadian citizens and civil rights of everyone in Canada from the policies and actions of all areas and levels of government. It also greatly expands the scope of judicial review in Canada.

The Supreme Court of Canada ruling on physician-assisted dying, or the Carter ruling, touches the core of our nation's morality in that it discusses the sanctity of human life and how we should, as a nation, best respect it. It places the onus on Parliament to respond with a new legislative framework to address the issue of physician-assisted dying per the scope of the ruling. It also places an onus on Canadians to actively participate in one of the most transformative debates that Canada has had in a generation.

The Minister of Justice, in her speech on this bill, stated:

From the start, we have known from the Supreme Court of Canada's unanimous Carter decision, that it is not about whether or not to have medical assistance in dying; it is about how we will do it.

I disagree.

The debate in this place that the Carter ruling has spurred is about how we respond to the ruling, not simply how to allow physician-assisted dying to occur. This is material because the Carter ruling does not allow us to abdicate our responsibility to decide whether physician-assisted dying should occur or in what context it should be allowed.

To be clear, with this bill the government has chosen to respond to the Carter ruling by allowing physician-assisted dying to occur in the context defined therein. It could have responded to it in many ways, including the invocation of the notwithstanding clause of the charter.

My concern with the government's approach to the Carter ruling is multi-faceted, but particularly troubling to me is that much of its rationale for its response seems to be that the Supreme Court has forced Parliament to allow a framework for physician-assisted dying.

In this matter of deep concern and sensitivity to all Canadians with all viewpoints on this issue, this is not a sufficient enough explanation to show the government's intent over time as to how approaching broader questions related to physician-assisted dying should be addressed.

I say this not simply as an indictment of the government, but as a cause for reflection for us all. While the Carter ruling came out over a year ago, all of our political platforms and national debates were largely silent on approaches to this issue during the last federal election campaign.

While parliamentary panels and committees did a remarkable amount of work in a short period of time, similar legislation in Quebec took nearly six years of public engagement to draft and pass, and even then, Quebec's National Assembly was divided.

There are issues the government has touched upon in relation to the Carter ruling which I do not believe Canadians have given us a clear mandate to legislate upon.

I also believe that the bill in its current state would leave provincial legislatures and medical associations with unresolved legislative issues leading to a balkanized patchwork of legislation and processes related to this issue.

While I appreciate that the government must respond to the Carter ruling in a shortly defined period, I am concerned that the government has not clearly specified its preliminary positions on many issues raised in the joint committee report and in tone has resigned itself to the inevitability of future charter challenges on this legislation.

In this context, I respectfully urge my colleagues here and the government to deeply focus upon our responsibility as parliamentarians to respond to the Carter ruling with firmness and clarity and to do the following.

First, change the timing of the parliamentary review of this legislation to two years after coming into force as opposed to five years, and to develop a strategy to actively engage a wide range of Canadians in this discussion.

This would promote us as legislators and our electorate to embark upon a fully informed discussion on how to best provide end-of-life care and ease of suffering to Canadians, with the hope of engaging more Canadians on issues that arose in the joint committee report, which I do not believe we have a clear mandate to legislate upon and are beyond the scope of Carter. This early review would also allow Parliament to assess the efficacy of the government's proposed safeguards. The review of this legislation should also be held on a regular, as opposed to a one-time, basis. The requirement of an annual report to Parliament regarding the government's response to the Carter ruling would also be helpful.

Second, the government has signalled the need to study issues of use of advance directives in physician-assisted dying, availability of physician-assisted dying to mature minors, and the definition of conditions beyond the scope of the Carter ruling under which physician-assisted dying would be available in the future.

To date, the government has not described the framework, the timing, nor the scope under which these studies would occur. This needs to be rectified immediately, hopefully with the input of members from a broad range of the community. Further, the government should commit to taking policy responses to these issues to the electorate before allowing them to come to pass.

Third, the bill is silent on direction regarding conscience rights of medical practitioners and faith-based care facilities in being required to provide physician-assisted dying to patients. In this, we are forcing the issue to be decided by provincial legislatures and by medical associations. This silence is an abdication of our responsibility to the electorate, as the Carter ruling clearly outlines the need for Parliament to respect the charter rights of both patients seeking physician-assisted death and the conscience rights of health care providers. I also have concerns regarding the selection of a panel approach to approval, as opposed to the way the bill currently outlines the selection.

Fourth, I am concerned the government's response to the Carter ruling to date is simply this bill. This fails a significant component of the Carter ruling. The ruling in its conclusion relies upon the assumption that a legislative framework allowing physician-assisted death would ensure that physicians properly inform patients of their diagnosis and prognosis and the range of available options for medical care, including palliative care interventions aimed at reducing pain and avoiding the loss of personal dignity, prior to allowing physician-assisted death to occur. In this, I believe Canadians have the responsibility to ensure that the range of options available to patients in this situation is robust and in every situation enables people to lessen their suffering while living.

In saying this, I in no way diminish the legitimate right for patients to choose the path of their end-of-life care. However, our country will have failed them if our response to the Carter ruling simply focuses on legislative mechanisms to allow physician-assisted death to occur rather than also placing a significant new emphasis on increasing and improving the range of available options for patients facing grievous and irremediable medical conditions.

Our response should also be clear about the limitations we would place on further expansions to the scope of access to physician-assisted dying. This includes a formal response from all levels of government, civil society, non-governmental organizations, Canada's faith community, and individuals to talk about and address the following: the mental anguish those facing grievous and irremediable medical conditions experience; how to support those who provide care to those who are suffering; reducing barriers to access to end-of-life care, including isolation, availability, and cost; reducing the stigma of mental health issues in Canada, and providing care and compassion to those facing this issue; ensuring a culture in which suicide is normalized does not arise, and ensuring strategies for suicide prevention are prioritized; ensuring that medical professionals have robust and comprehensive training on end-of-life care; developing and funding a comprehensive palliative care strategy to be implemented at the same time the bill comes into force; ensuring that physician-assisted dying does not evolve in our society as a promoted response to a diagnosis of a grievous and irremediable medical condition; and engaging research institutions and granting councils in a discussion on how to fund and manage research related to end-of-life care, and ensuring that what we have learned is effectively translated into public policy and clinical practice.

This discussion should not be treated as static, and a mechanism to address the success of programs and initiatives, in coordination with provinces and territories, health care providers, civil society, and the public at large, to address these issues on a regular basis should be immediately implemented.

Our collective response must first and foremost come from a place of compassion for those who are suffering. Our response must recognize the spirit of the Carter ruling in that Canadians ultimately have the right to choose their path of care.

However, we cannot abdicate our responsibility to respond to these issues to the courts or to other levels of government, nor should we see a legal framework in which physician-assisted dying occurs as a comprehensive response to the Carter ruling. Instead, we should ensure that our response is comprehensive, is clear and thoughtful, and is backed by a mandate from Canadians. Our covenant with our electors and the respect for the sanctity of life demand nothing less

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May 2nd, 2016 / 6:10 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

Madam Speaker, I listened attentively to many of the comments the member made. There were several ideas which ultimately have a lot of validity. I have listened to the debate today, and she and other members have been very willing to share their many opinions on the legislation and justifiably so.

We have been fairly clear about wanting to get the legislation to committee. We are all very much aware of the Supreme Court of Canada deadline which is looming.

I would ask if the member would at the very least recognize the importance of getting the legislation to committee, where members like herself and others could share their thoughts on how they might improve the legislation. At the same time, they could provide Canadians from different parts of our great nation the opportunity to provide direct input to our standing committee.

Would she not support getting the bill to committee as soon as possible so we could actually get that feedback, especially given the deadline from the Supreme Court of Canada and the fact that we also have to get the bill through the Senate of Canada?

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May 2nd, 2016 / 6:10 p.m.
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Conservative

Michelle Rempel Conservative Calgary Nose Hill, AB

Madam Speaker, while I appreciate that the government does have a timeline in which to respond to the Carter ruling, I also find its response to be lacking for the reasons that I have outlined in my speech.

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May 2nd, 2016 / 6:10 p.m.
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NDP

Pierre-Luc Dusseault NDP Sherbrooke, QC

Madam Speaker, I thank my colleague for her speech.

However, how can she tell the House that it is not our duty to abide by this ruling and to grant this right? The court stipulated that medical assistance in dying is now a right guaranteed by the Canadian Charter of Rights and Freedoms.

As legislators, how can we refuse to grant a right that was confirmed in the Supreme Court decision?

What does she want us to do if she does not want us to abide by the court's decision and understand that this is now a charter right that must be granted to all Canadians?

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May 2nd, 2016 / 6:10 p.m.
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Conservative

Michelle Rempel Conservative Calgary Nose Hill, AB

Madam Speaker, as I outlined in my speech, the options afforded to us as parliamentarians with regard to a Supreme Court ruling are many. The government has chosen to respond with this bill and I do not feel that the government has responded adequately in terms of providing a concurrent framework on palliative care outlining how. For example, the Liberals talked about studying an expansion of the Carter ruling in terms of situations in which physician-assisted dying would occur.

I believe it is incumbent upon the government to clearly communicate this prior to a vote happening in the House of Commons. I do not think it has done that to date. I certainly think there is a little more work to do on this before it is an adequate response to the Carter ruling.

Criminal CodeGovernment Orders

May 2nd, 2016 / 6:10 p.m.
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Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Madam Speaker, my colleague has outlined many of the concerns that many of us in the House have. Throughout debate today we have heard government members assure us that conscience protection is included in Bill C-14. I do not share that optimism because it do not see it here, other than in the preamble, and it is actually along with the intention to expand physician-assisted dying to minors and people with psychological issues. That is a pretty weak commitment.

My bigger concern is that the bill is totally silent on protection for health institutions. We know that many hospices in Canada have been started with the express purpose of improving the quality of life for those approaching end of life and many of them are supported by very generous donors. If we are to insist that those institutions now need to participate in physician-assisted dying, I have concerns that we will end up losing a lot of health care facilities in our country. I am wondering if my colleague would share any comments on her views on protection for institutions.

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May 2nd, 2016 / 6:15 p.m.
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Conservative

Michelle Rempel Conservative Calgary Nose Hill, AB

Madam Speaker, the Carter ruling is quite clear in the need to acknowledge both the charter rights of patients in choosing their end-of-life care and the charter rights of medical practitioners. I do not believe that the bill has adequately done that. It will leave it to the provinces and medical associations, and I feel this is an abdication of our responsibility as parliamentarians.

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May 2nd, 2016 / 6:15 p.m.
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Liberal

Yasmin Ratansi Liberal Don Valley East, ON

Madam Speaker, I appreciate this opportunity to discuss the Government of Canada's commitment to establish a framework for medical assistance in dying.

On April 16, I hosted a town hall meeting for the residents of Don Valley East on this matter. As we know, this is a very emotional and personal matter. It was important for me to listen to my constituents' concerns and to ensure that their concerns were heard. Some of my constituents wanted dementia and Alzheimer's to be included, others wanted advance directives, and some wanted protection for the vulnerable.

In order to ensure that there is no confusion on what this bill is all about, I am taking this opportunity to speak on the matter.

Being part of the Abrahamic tradition, I had to park my own beliefs and listen to my constituents and ensure, as a parliamentarian, a balanced approach. Some of my constituents thought that this bill does not go far enough. Others felt that we should not allow it. To help my constituents have a say in this matter, I have asked them that when this bill goes to committee to make a submission to the justice committee.

The Supreme Court of Canada's decision in Carter has significant implications for provincial and territorial governments, and touches many Canadians in a very personal way. A number of individuals have already been granted exemptions by provincial superior courts to access medical assistance in dying. This is in keeping with the conditions set out by the Supreme Court's decision to extend the timeline for its ruling to come into effect to June 6, 2016. It is now time for us to establish a legislative framework for medical assistance in dying to legally become part of the options available to Canadians at their end of life.

Bill C-14 would provide Canadians with greater autonomy over their health care at the end of life, while also providing protection to health care providers and to individuals who may be vulnerable. It would provide provinces and territories with a strong foundation for implementation.

Canada is not the first to implement medical assistance in dying. In Europe, for example, three countries have legislated access to medical assistance in dying: Belgium, the Netherlands, and Luxembourg. In the United States, four states have legislated access.

Where Canada is unique is in the jurisdictional complexities we face. In Canada, the federal government has exclusive jurisdiction over criminal law. However, health care 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. The provinces are responsible for hospitals, the delivery of health care, and regulation of the medical profession, among other things.

As provinces and territories bear ultimate responsibility for the implementation of medical assistance in dying, the scope of the federal legislation has a significant impact on them.

That is why our government has been working collaboratively across governments, while at the same time respecting jurisdictional roles and responsibilities.

When health ministers met in January, they came to an agreement that a robust and consistent regime across the country is in the best interests of Canadians. Health Canada has also engaged in ongoing discussions with health officials in the provinces and territories to hear their views on many aspects of this important issue.

By establishing national eligibility criteria and safeguards, this bill will help ensure consistency across the country as well as respect the underlying criteria of the Canada Health Act.

The proposed legislation will set out who is eligible to receive medical assistance in dying and the safeguards that must be adhered to for medical practitioners to be protected from criminal responsibility.

Provinces and territories cannot modify these Criminal Code exemptions through their own legislation or regulations.

However, the provinces and territories can legislate or introduce policy measures with respect to aspects of medical assistance in dying under their jurisdiction. This could include identifying any special training for offering medical assistance in dying, specific forms to be filled out, or how the cause of death should be recorded.

However, in order to respect the principle of accessibility upheld in the Canada Health Act, provinces, territories, and regulatory bodies would need to consider the implications that any additional guidelines or regulations would have for patient access.

The bill gives the Minister of Health the authority to make regulations about the information to be collected and the processes for collecting it. Working with provinces and territories will be critical to determining how a pan-Canadian monitoring mechanism can be put in place, the types of information to be collected, and the reporting requirements among other elements.

In reviewing the bill, I see that the government has taken into account the concerns of some health care providers; that is, the protection of their conscience rights. The Supreme Court was clear that providers should not be compelled to provide medical assistance in dying. However, the government is also aware that the exercise of such rights may constitute a barrier to access for those who are seeking it.

To address these issues, the government will work with provinces and territories to support access to medical assistance in dying, while respecting the personal convictions of health care providers. This could include, for example, a pan-Canadian system that would facilitate access for patients to willing providers of medical aid in dying.

Throughout the consultations on medical assistance in dying, we heard loud and clear from Canadians calling for more resources for quality palliative and end-of-life care.

With Canada's aging population as well as growing rates of chronic disease, we must consider ways to support the improvement of a full range of options for end-of-life care. This includes better integration and expansion of access to services at home, including palliative care.

Medically assisted dying is a complex and important issue for Canadians and requires collaboration across jurisdictions to ensure that we have a framework that fits within our uniquely Canadian context.

I would therefore like the bill to go before committee where our collective thinking and robust consultation will hopefully result in a better bill, which is satisfactory to all. I think the bill at least provides a foundation for our continued collaboration.

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May 2nd, 2016 / 6:25 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Madam Speaker, I enjoyed listening to the member's speech. She did something interesting at the beginning where she referenced her personal religious beliefs coming from the Abrahamic tradition. We have heard a number of Liberal members reference their personal religious beliefs, but then also say that they are going to have to in some way park those beliefs.

When I think about the relationship between faith and reason, I am often drawn to think of one of Plato's dialogues called Euthyphro and I would commend it to the reading of hon. members. It discusses the question of the origin of goodness; in particular, is a thing good because it is declared so by religion, or is a thing declared good by a religion because it is intrinsically so? I think most of us would agree that religions declare things good or bad because they are so intrinsically. They do not render a thing good or bad by declaring them so.

It is one thing for the member to ignore religious convictions, but it is another to ignore the underlying realities and truths that those things express.

I want to ask the member to further comment on that dynamic. I want to ask her if she believes in the universal immutable human dignity as a reality, not just as an arbitrary confession. Does the member believe that to be a reality and will that be expressed in the vote she makes on the bill?

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May 2nd, 2016 / 6:25 p.m.
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Liberal

Yasmin Ratansi Liberal Don Valley East, ON

Madam Speaker, for me and for the religious beliefs of all of the Abrahamic tradition, life is sacred. However, what we are talking about here is people who have unbearable diseases, and the Carter case is very clear. As people with religious convictions, we have to ensure that Parliament observes the laws of the land and observes the Charter of Rights and Freedoms. My assessment is that, if we are to move forward with this bill and help our constituents and Canadians live with dignity, we should let this bill go before committee and listen to other concerns and then come up with a robust bill.

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May 2nd, 2016 / 6:25 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Madam Speaker, I have been listening with great interest, and this is a profound discussion that we are having tonight. The issue in terms of what people are able to access at end of life has been put before this House, not simply because of the Carter decision and not because of, as some colleagues have said, a narrow rewriting of the legislation. However, if we are going to rewrite this legislation, we have to deal with the huge shortfalls in end-of-life care for those who are wanting to live—the palliative-care needs of the sick and their families. Yet only 16% to 30% of Canadians are able to access quality palliative care. Only four provinces even have a palliative-care framework. It is the responsibility of the federal government to work with the provinces, and also to put the money on the table to say that palliative end-of-life choices are going to be available. However, we saw zero money in the budget from the current government.

If this bill is going to be in place in June, we are going to be in a situation in Canada where people will have technically the right to end their life if they are facing intolerable suffering, but they will not also share the same right to access quality health care for their family if they are living in under-serviced areas and patchwork areas. I am asking why the current government has not stepped forward in advance of this legislation to start dealing with the huge shortfalls we are facing in palliative care.

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May 2nd, 2016 / 6:25 p.m.
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Liberal

Yasmin Ratansi Liberal Don Valley East, ON

Madam Speaker, palliative care is an important aspect. I believe, when I was doing my presentation, I made palliative care part of the comprehensive framework that we have to work with. There are cases in one of the states where it is the Cadillac version of palliative care. Those people who have the Cadillac version of palliative care are the first ones to want assisted dying. I do not mean to say that we should not have palliative care. It is extremely important, and choices are important. However, to have a robust and very strong bill, we need to send this bill to committee and work around it.

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May 2nd, 2016 / 6:30 p.m.
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Liberal

Robert-Falcon Ouellette Liberal Winnipeg Centre, MB

Madam Speaker, a report in The Globe and Mail on April 24, 2016, says 13-year-old Sheridan Hookimaw killed herself on the banks of the river that winds through Attawapiskat. The sickly girl had been flown out for weekly medical appointments. She wanted to end her pain, and in the process, she set off a chain reaction not only in her community but in communities right across this country, which we are still dealing with today.

This debate strikes at the very heart of the meaning of life, it strikes at the heart of bureaucracy, and it strikes at the heart of how we care for the most vulnerable in our society. I have been told over and over again that this situation is different, that there is no connection.

In the indigenous world view, everything is interconnected. It is holistic, meaning that when a change is made in one place, the impact will be felt elsewhere, and the two cannot be separated. In the western world view, often we compartmentalize things. We believe that we can play, that we can control certain situations, that we can effect change here and not see change in other places. Above all, we have come to believe ourselves able to predict and control all, to control the future. This does not mean, though, that we should not take action.

The impact of this bill on people in Toronto may be very different than on the people in Nunavik or Attawapiskat. Our role as parliamentarians is to place ourselves in the moccasins of others, to place ourselves outside of our own experiences, to see the world through another cosmology and other world view, and to see the impact that our decisions may have on others.

We are making profound changes in concepts surrounding life, which cannot be undone in the future. In the indigenous tradition and philosophy, we are required to think seven generations into the future. If I am wrong and there is no connection between Attawapiskat and physician-assisted dying or suicide, if the average person does not see a connection and communities do not see a greater stress, then I will gladly say I was wrong; but if there is an impact, which is caused by the valorization of suicide, then what?

When the House passed amendments to the Criminal Code on other issues in our criminal justice system, who would have thought that indigenous peoples would now make up 23.2% of the prison population? It seems that madam justice is blind to the suffering of many of her fellow citizens. We have equal laws, and yet the treatment and effects are unequal across our country. We make laws often for the average person, but the impact is felt most by those who are on the margins of society.

Even though we have the Gladue rulings in our justice system and cases where we are supposed to take into consideration someone's upbringing, someone's past, unfortunately, those are not reflected in our justice system. Therefore, how can we be assured that the changes we are making today in the House will not have an equally detrimental impact on others?

My earliest memory, one of my strongest memories, is as a little six-year-old boy. My mother had just lost a house. We were in tough economic times in Calgary, Alberta, and she could no longer support us. She was a single mom, and she went off on the road looking for work. She decided at one point she could no longer raise me or my little brother by herself and she needed help, so she went to her ex-husband, my father. My father was a residential school survivor, an alcoholic, and a member of gangs. We knew all these things.

We knew he had a terrible temper. We were told this as young children, and we were very scared as children. We were dropped off at his place, with his parents, my grandmother and grandfather, and we were very upset. It is the only time that I remember my brother peeing his bed, because of the stress, because my mother had to find work because of economic stresses in her life.

I remember climbing a tree in the back yard and wrapping a rope around my neck at the age of six. This is a true story. People often think it cannot be true, but this happens in our country, like the case of the 13-year-old girl in Attawapiskat.

I wrapped that rope around my neck and thought, “Should I jump off into this universe, which is before me?” It was in that back yard that somehow I made the decision to climb down out of that tree and unwind that rope from around my neck.

If in my life I had seen, or I had known, that my grandmother had somehow used physician-assisted dying or physician-assisted suicide, or others in my family had completed the irreparable act, then it would have made it much more difficult for me to continue.

We might not think the impact will be there, but we do not know. We assume we know these things. We are deciding the future of a few for the end of a few.

In the case of Sheridan Hookimaw, as a society, we are unable to provide the necessary care, the love and the protection. We have failed our most vulnerable.

The Canadian Webbian bureaucracy was unable to respond to the needs of a 13-year-old girl. How can we be sure that it will now be able to respond to the needs of all in the future in our societies?

This debate is about life itself. Indigenous people never knew of suicide. It was unheard of in indigenous communities. Yet it now continues to plague our communities, and the spirit of suicide seems to always be there.

Life is not easy. It is about struggle, about fighting for another day. If indigenous peoples had committed suicide, then we would not be here today for all the trials and tribulations we have faced.

I participate in one of the high ceremonies of the indigenous custom and tradition of the Plains Cree. It is called the sundance. It is a four-day ceremony, and for three days and three nights, no food or water shall pass my lips. I pierce my body to sacrifice myself for others, in prayer for them. I do this not for myself, not to ask for something for myself, but for others.

In the sundance, in the sundance lodge, my Sundance Chief David Blacksmith talks about the spirit of suicide, how it is coming to take our young and is starting to take our old people, how it is affecting our society, how it is destroying our sense of community, and I have to listen to it. I have to be moved by the words he brings, because the people surrounding me in the sundance have all been affected by it.

We are placing ourselves now outside of nature. Nature itself is hard, to strive, to struggle, to see another day. It is a struggle that is noble. Now placing the tasks in the hands of the state removes us from nature, telling the state that it will now be the one who will be enabling us to do these things; someone else will be deciding, bureaucracy will now be deciding.

Others may feel that they are a burden. Others may say that they are a burden. I think there is something noble in sacrifice and in striving in the struggle for life itself, to hold someone's hands in the final moment, to have to grow up and not simply say, “I am going to hand it off to someone else to look after, but that I will stand there or I will sit there, holding your hand at that exact moment. Even in your final breaths, even though it may be difficult, we will continue on”.

Perhaps this is just another step on the road of moral relativism that we are in nowadays, but even our judiciary cannot serve as a balance between the different societies making up Canada. 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.

Finally I would like to say, in the words of Elder Winston Wuttunee, “If you cry, your children will die”. It is dangerous to abandon one's self to the luxury of grief. It deprives one of courage and even of the wish for recovery.

From an indigenous perspective, I look at this bill and I cannot support it, because it leads to a place where I do not believe we are looking out for the interests of all people within our society. It is not allowing us to fully comprehend the needs of everyone who makes up Canadian societies, but really, it is taking us down a path that is very dangerous, and we do not know where it ends.

Let us be very careful in this House, and take the time that is necessary as we make our decisions.

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May 2nd, 2016 / 6:40 p.m.
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Conservative

Todd Doherty Conservative Cariboo—Prince George, BC

Madam Speaker, I would like to thank my hon. colleague for sharing his views on this.

I know I will be reprimanded for this, but I am disappointed by the disrespect that one of his own colleagues made while he was speaking, by walking not once but twice directly in front and making noises, while he was trying to give that heartfelt presentation.

I have considerable concerns with the bill, and my comments are neither for nor against, but on the timing, the time we have to debate it and the rush to get the legislation through. Quebec took six years to, hopefully, get it right.

I have an adult child who is 28 years old. She presents herself as mature and is beautiful, but cognitively, she is developmentally challenged. My concern is that there are not enough measures in the bill as it exists today that would protect the cognitively challenged. It says a “competent” adult has the right to make this request. Who determines that adult is competent to make that decision, and are there enough safeguards in place for those who are cognitively challenged?

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May 2nd, 2016 / 6:40 p.m.
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Liberal

Robert-Falcon Ouellette Liberal Winnipeg Centre, MB

Madam Speaker, not being a lawyer, I am not sure. However, I know once we start doing a process, once we have gone down this path, we cannot go back. We need to take time to look at Quebec and see what happens there, how it plays out in that jurisdiction, before we start elaborating in other jurisdictions.

I understand that there are people who are suffering, but I do not think we have dealt properly with the suffering that goes on in many communities. We have not taken the time to really understand or to make sure that they feel protected.

I do not have a lot of comments to offer the member, but it is a concern as well.

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May 2nd, 2016 / 6:40 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Madam Speaker, it was very unfortunate that my colleague invoked the name of young Sheridan in the House in this debate. She did not die because she was suffering from an incurable illness like Lou Gehrig's disease. She died because of lazy indifference from federal and provincial officials, from poverty, and the fact that we do not have mental health workers. It took months to get her body home through the bureaucratic red tape, as the family could not deal with the trauma.

What we are dealing with here is our obligation before the Supreme Court. This is our job. However, it is extremely dangerous and unprofessional to invoke the suffering of those children as a way to say that we are not doing our job here.

We have a job to do before the Supreme Court, but we also have a job for those children, so a young child like Sheridan will never ever be denied mental health services because some official says we will not give it to them, or that they are going to have to live in a squalid shack because some official will not sign off on the housing agreements. Those are fundamentally different.

Knowing the family and what these children have gone through, it is very unfortunate that my colleague has used those stories to somehow conflate these two issues, which are fundamentally different.

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May 2nd, 2016 / 6:40 p.m.
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Liberal

Robert-Falcon Ouellette Liberal Winnipeg Centre, MB

Madam Speaker, unfortunately, perhaps the member fails to understand indigenous philosophy, which is about the interconnectedness of everything. The member may believe that these are unconnected events, but in fact they are connected. We could debate about the definition of the bill. We could say “medically assisted dying” or “medically assisted suicide”. Our use of terminology is very important. If we use “medically assisted suicide”, it has connotations to it that people will understand. I am sure at some point that people will be banging on the doors at some emergency wards and saying they are suffering, they want to end it, and ask for help.

I apologize if I offended anyone in invoking the name of the young girl, but her name is in the newspapers and her case is well known. If we cannot speak truth in this place and use the truths that are out in society here in the House of Commons then where else will it happen?

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May 2nd, 2016 / 6:45 p.m.
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NDP

The Assistant Deputy Speaker NDP Carol Hughes

Before we resume debate, I want to remind people that when others are speaking it would be good to allow that person to speak without going back and forth. I want to make sure we keep that level of respect here in the House.

Resuming debate, the hon. member for Calgary Shepard.

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May 2nd, 2016 / 6:45 p.m.
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Conservative

Tom Kmiec Conservative Calgary Shepard, AB

Madam Speaker, as I rise today to speak about the grave implications of Bill C-14, I am reminded of the Yiddish proverb, which says: “From fortune to misfortune is a short step; from misfortune to fortune is a long way”. I am afraid that the legislation being brought forward by the current government is a short step to misfortune, and the path with proper safeguards would be a long one.

This is a difficult subject, but the floor of the House of Commons was made to debate weighty subjects, to define how we live in our Confederation, to seek out the objective truth, and to legislate wisely.

However, the House has addressed the issue several times over the last decades. In 1983, the Law Reform Commission of Canada recommended against legalizing or decriminalizing euthanasia or assisted suicide. In 1993, the Supreme Court dismissed the challenge by Sue Rodriguez on the Criminal Code prohibition of assisted dying. In 2006, Bill C-407, a bill that would have allowed physician-assisted suicide in certain circumstances, died on the Order Paper in that Parliament. We can see in the chronology the hesitancy to legalize assisted suicide, and for good reason.

Bill C-14 would impact how Canadians view the worth of their lives and the lives of their loved ones. The safeguards we put in place must protect Canadians from abuse when it comes to physician-assisted suicide, and that is something all Canadians can agree on. We must ensure that, as far as possible, the legislation we craft mitigates the harm inherent in legalizing the killing of human beings.

Additionally, I remind my fellow parliamentarians that the ruling of the Supreme Court in Carter v. Canada directly contradicts the Supreme Court's 1993 decision in Rodriguez v. British Columbia. In that ruling, the Supreme Court was clear when it stated that section 241(b) of the Criminal Code of Canada was in fact constitutional. It reads:

Every one who

aids or abets a person to commit suicide,

whether suicide ensues or not, is guilty of an indictable offence

At that time, it was ruled that the Canadian Charter of Rights and Freedoms confirmed its legality.

Millions of Canadians believe that the Supreme Court erred in its interpretation of sections 1 and 7 of the charter. Despite this, I recognize that the court made a unanimous decision. Therefore, the question before us is no longer whether assisted suicide should be legalized or not, but rather to conform with the Carter decision in what the contents of the legislation should be, as well as the safeguards. That is the matter before us.

Many of my constituents have reached out to me with concerns about the direction that this legislation is taking. Bill C-14 would fail to provide stringent limits. It would fail to keep the deadly wolf of abuse and misapplication at bay.

Constituents like Alexia Blackwell wrote to me that, “Legislation must clearly spell out the protections provided by the Charter of Rights and Freedoms so that caregivers and their organizations will be protected from coercion or discrimination.”

Canadians must have access to palliative care before and alongside physician-assisted suicide so that their first end-of-life option can always be a peaceful, compassionate, and natural death.

Palliative care provides compassionate and ethical end-of-life care for those suffering intolerably as a result of a grievous and irremediable medical condition. It must always be presented as an alternative to physician-assisted suicide.

I would also like to note that in 2014, the House voted in favour of a motion brought forward by the hon. member for Timmins—James Bay, which read:

That, in the opinion of the House, the government should establish a Pan-Canadian Palliative and End-of-life Care Strategy...ensuring all Canadians have access to high quality home-based and hospice palliative end-of-life care...

That is the sort of care we should be working towards.

A very important safeguard, and one that I feel has only been partially addressed by the bill before us, is the conflict of interest that is bound to arise if we do not ensure that physicians are prohibited from benefiting directly or indirectly from recommending or performing physician-assisted suicide. I say this because, like millions of Canadians, I firmly believe that no person in Canada should profit from death. Since physicians in Canada are paid directly by their provincial health authorities, they cannot be placed in a situation where helping a patient choose physician-assisted suicide, or an extensive palliative care plan, or a chronic disease plan could be influenced by a consideration of monetary gain.

Similar prohibitions on physicians profiting for performing the physician-assisted suicide procedure exist in other jurisdictions that have now legalized the procedure, including Germany, Switzerland, and Oregon. These laws exist for good reason. As much as we may not like the idea, it is possible for unethical physicians to promote the idea of assisted dying over other health care alternatives if they stand to benefit from it.

The Dutch government, concerned over accusations that the practice of euthanasia was being abused, undertook studies in 1990, 1995, and 2001. Physicians were guaranteed anonymity and immunity from what they revealed in regard to violations of the guidelines. Therefore, the findings of these studies are indicative of what was going on in the practice of their profession.

It quickly became apparent that half of Dutch doctors had no hesitation in suggesting that their patients consider euthanasia, which compromised the necessary voluntary nature of the process. In addition, 50% of these cases were not reported, according to a study by researchers from the University of Ghent in Amsterdam.

Even more alarming was the fact that a quarter of the physicians said that they were terminating the lives of patients without an explicit request from the patient. Another third of the physicians said that they could conceive of doing so; they were not just thinking that they could do so.

We must not be naive about the possibility of coercion. That is why I am asking the government to amend paragraph 241.2(6)(b) and delete “other than standard compensation for their services relating to the request”, thus making the assisted-suicide decision and the provision free of any financial consideration.

Another issue I have heard brought up frequently is the lack of definition for the phrase “intolerable suffering”. I have heard a lot of talk about this particular issue. Should the definition of suffering include those struggling with mental illnesses, those struggling financially perhaps, or those who suffer from intense boredom? We should be protecting people from their suicidal desires rather than enabling them. After all, is that not the whole point of the excellent mental health initiative called Bell Let's Talk campaign, which we all support?

We cannot simultaneously work to end depression and suicide while also creating legislation that would allow people to request assisted dying simply because their situation has led them to consider their personal suffering intolerable or their death reasonably foreseeable. Realistically, this would fundamentally change the practice of psychiatry, the central focus of which is to develop good mental health that prevents suicide and shows persons the value of living and the inherent dignity of their condition.

Considering this incoherency, we must ensure that requests for physician-assisted suicide are considered objectively by a judicial review body that ensures the request is voluntary, well considered, informed, and consistent over time. This regulatory body must ensure that consent is actually being given by the patient requesting the physician-assisted suicide, and that all requests are reported to this body. The need for this sort of regulatory body is evident when we consider other jurisdictions where physician-assisted suicide is legal.

According to a study published in the Journal of Oncology Practice, over 500 people in the Netherlands are euthanized involuntarily every year. In 2005, a total of 2,400 deaths by euthanasia or physician-assisted suicide were reported, representing 1.7% of deaths in the Netherlands. There were 560 of these deaths that occurred without proper documentation of consent. In Belgium, the rate of euthanasia deaths that occur without explicit consent is three times higher than it is in the Netherlands.

Speaking of ambiguous requirements, it is the inevitability of life that it must end. From the moment we breathe our first breath outside our mother's womb, it is reasonably foreseeable that we will die. That is another vague, confusing term that at best fails to provide any meaningful guideline for physicians or their provincial colleges as they evaluate individual requests. Another vague term is the definition of medical practitioner as a person entitled to practise medicine under the laws of a province. This is problematic because that definition changes from province to province. In my home province of Alberta, it includes osteopaths, also known as chiropractors.

When deciding whether to provide assisted dying, physicians can follow their conscience without discrimination. No one should be compelled or coerced to provide assistance in suicide. I held a round table last week with participants who were for and against assisted suicide. I asked the question, regardless of whether people were for or against, what part of the bill they believed was most critical. They said it was protection for conscience. The people want an extension to protect the ability for people to say no based on moral and ethical grounds.

We must be very careful that Bill C-14 will not force Canadian physicians with deeply held religious, moral, or ethical beliefs about the sanctity of human life to go against both their conscience and the Hippocratic oath. I believe that section 2 of the Charter of Rights and Freedoms that protects freedom of conscience and religion, as well as freedom of thought, belief, opinion, and expression applies here. Further, what is the point of any of these rights if we cannot express them through action or inaction without state coercion?

I could go on about the ways that Bill C-14 would go far beyond the recommendations of the Supreme Court, how it lacks the strict safeguards referred to in Carter, or the broadly worded definitions that are a problem. I could speak of the irresponsibility of poorly defining the person who is eligible to undertake or to perform assisted suicide.

This bill is based on badly reasoned and inadequately researched recommendations from a committee that failed to seek proper input from a broad diversity of Canadian beliefs and opinions. The National Assembly of Quebec got it right by allowing for six years of debate, through three different assemblies, to study and consider all of this.

To finish, I urge the government to move significant amendments to this legislation or drop this bill entirely and table a better one. The path back from the misfortunes of this bill are too significant to get it wrong.

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May 2nd, 2016 / 6:55 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

Madam Speaker, I am sure the member is somewhat familiar that this decision was made by the Supreme Court well over a year ago. The previous government virtually did nothing to address the issue. It had a panel, and I recognize that, but it fell far short in trying to come up with any sort of legislation. We had opposition days to encourage the Conservative government to take action, but it chose to do nothing.

In hindsight, does the member believe there was an obligation on the former government to at least advance the issue in a more timely fashion? By doing that, who knows where we might be today. However, at the very least, we need to recognize the restraints we are currently under with the Supreme Court of Canada. We still have to go through the Senate. Does he believe there will be value in getting this to committee so we can talk about the many ideas we are hearing today and listen to what Canadians have to say in the hopes that—

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May 2nd, 2016 / 6:55 p.m.
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NDP

The Assistant Deputy Speaker NDP Carol Hughes

Order, please. We have to give time for the answer so other people can ask questions as well.

The hon. member for Calgary Shepard.

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May 2nd, 2016 / 6:55 p.m.
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Conservative

Tom Kmiec Conservative Calgary Shepard, AB

Madam Speaker, I was worried that the member had almost become mute after the Manitoba election results.

The previous government called national consultations and started the process of hearing from Canadians on what they wanted to see in the bill. It is an excuse to say that the timetable is so short. A few months have gone by since October 19. The current government could have tabled a bill and we could have considered it. We would have had much more time for a fulsome debate.

The answer is simple. The government should have simply tabled a bill back in December or January to get the process started. The Liberals knew the deadline and they knew when would be too late. Instead, they have chosen to table a bill so far along the process that requires us to have shortened debate and a shorter review time.

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May 2nd, 2016 / 6:55 p.m.
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NDP

Sheila Malcolmson NDP Nanaimo—Ladysmith, BC

Mr. Speaker, I heard a lot of agreement, but I want to reflect on the correspondence I am getting from people in my riding of Nanaimo—Ladysmith.

One writer said, “I want to have the choice how and when I am ready to die. It is not simply a matter of providing palliative care facilities, but we should definitely have more and better hospice care in people's homes as well as residential hospice within the community. I consider it a basic human right and though it is of essential importance to me in my senior years, I believe that people of all ages should be supported in facing their own end.”

This is an issue that has gone on for a long time and my sense is this Parliament and people are ready to decide. However, following up on my colleague's comment across the aisle, the Conservatives had opportunities to consult, but slowed and slowed.

I think all parties recognize that the Quebec leadership on this issue, so far as thorough and complete consultation, is to be admired. After the Carter decision and while they were still in power, why did the Conservatives not take the initiative and do the consultation we needed?

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May 2nd, 2016 / 7 p.m.
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Conservative

Tom Kmiec Conservative Calgary Shepard, AB

Mr. Speaker, obviously I was not a member of the government in the previous Parliament, but the Conservatives called for national consultations, appointed a panel and heard from Canadians on what they wanted to see in the bill. Again, the current government could have tabled a bill in December or January and kicked off the process in the House to ensure we would have enough time to get it to committee, have a fulsome consideration of section by section and leave enough time for the Senate to also contribute to the debate.

We can debate whether the timelines were good or not, but they are what they are. We have until June 6 to report back and have a bill that is passed by both Houses of Parliament. The most important thing is the content of the bill. That is what we are debating. We are not debating whether the timelines are appropriate. It is the content, the safeguards and conformity with the Carter decision that are important.

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May 2nd, 2016 / 7 p.m.
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Liberal

Raj Grewal Liberal Brampton East, ON

Mr. Speaker, I rise today to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.

I would like to start by saying that I value and recognize the deeply personal and difficult nature of this topic for many across our great nation. We all know at least one person who has passed, or may pass, in intolerable pain. It is difficult for families to witness their loved ones suffering, but more so for the patient who has no control over his or her situation and believe he or she should have a choice for a peaceful death. This, my friends, is the reason we need to have this discussion and pass this legislation.

Many of our colleagues on both sides of the House and in both chambers have worked diligently over the last few months on the Special Joint Committee on Physician-Assisted Dying in order to help create a comprehensive framework that upholds the essence of the Supreme Court's decision as a result of the Carter case. This decision balances different interests and protects vulnerable persons. I would like to thank all of our colleagues on the joint committee, their staff, library analysts, the clerk, and all of the witnesses who appeared and sent briefs to the committee.

This is not an easy topic on which to give, hear, or read testimony day in and day out, and for many it can take an emotional toll. At the same time, witnesses who contributed to the consultations should be commended for being a valuable part of Canada's history, as we shape this nation's law to allow our citizens to die with dignity.

Just last year, a provincial and territorial advisory group on medical assistance in dying was established, with most provinces and territories participating, led by Ontario. This shows the need for and interest in adapting our laws to allow for death with dignity.

Included in this report is the unequivocal call for amendments to the code to allow for assisted dying by regulated health professionals and to protect these professionals while they do it. We look forward to working with these territorial and provincial partners. It is also why, as part of our budget, we have put a multi-year health accord forward, with the federal government's commitment to providing $3 billion over the next four years to improve home care and palliative care.

On February 6, 2015, the Supreme Court of Canada unanimously declared that the Criminal Code prohibitions against physician-assisted dying were unconstitutional when considering competent adults who clearly consented to die, who were suffering, and where death was reasonably foreseeable. I would like to quote a vital part of that SCC ruling. It states:

It is a crime in Canada to assist another person in ending her 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: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.

This highlights the core of this issue, and the special joint committee showed it understood the Supreme Court's points. The report of the committee illustrates this, and I will quote from it. It states, "Our response to the Carter ruling must be focused on the needs and wishes of patients. The Committee was unanimous in recognizing the overarching need to have safeguards to protect the vulnerable.”

Therefore, the objectives of this legislation are comprehensive and adequately balance all the core elements of the discussion on this topic, some of which are: recognizing personal autonomy and dignity; recognizing inherent and equal value of every life; setting out eligibility for competent adults where death is reasonably foreseeable and who are suffering intolerably; balancing different interests, including personal autonomy toward the end of life and the protection of vulnerable persons; and encouraging a consistent approach across Canada.

Bill C-14 incorporates the points made by various stakeholders, including doctors and nurse practitioners, patients and families, civil rights groups, leading experts, faith-based groups, provincial and territorial governments, and more.

To enable access to medical assistance in dying, the Criminal Code will be changed so physicians, nurse practitioners, and those who help them can provide eligible patients assistance in dying without the risk of being charged with assisted suicide or homicide. There will be safeguards to ensure those who receive medical assistance in dying are eligible, can give informed consent and can voluntarily request it. The foundation will be laid for the Minister of Health to make regulations to establish a process for monitoring and reporting on the use of medical assistance in dying. It is crucial that the ability to provide assistance in dying is not limited to physicians.

Nurse practitioners are an important part of this framework if we are to provide all Canadians with equitable access to a peaceful death. Nurse practitioners have the authority to deliver many of the same medical services as family physicians. They can assess, diagnose, prescribe and treat patients. They can act independently in every jurisdiction, except Quebec, where they practice under the authority of a physician. That is why they are covered under Bill C-14.

In order to ensure the safety of all vulnerable persons, we have included the following safeguards that must be respected: a medical opinion to ensure the patient meets all of the established criteria; a second independent medical opinion; a request in writing or by proxy before two independent witnesses; the right to withdraw the request at any time; a 15-day waiting period, unless death or loss of capacity is imminent; and, consent must be confirmed immediately before medical assistance in dying is provided.

As a government that values the power of evidence-based decision making, the provisions regarding monitoring will be critical for transparency and public accountability of medical assistance in dying, as well as to evaluate whether the law is achieving its goals of respecting the autonomy of eligible persons to choose medical assistance in dying while protecting vulnerable persons and the conscience rights of health care professionals.

Nearly all jurisdictions that permit a form of medical assistance in dying have established monitoring systems for these purposes. The government would work with the provinces and territories in developing these regulations and in establishing an interim system until a permanent process is in place. As the legislation stipulates that there must be a parliamentary review in five years, the data collected from monitoring will be essential to improving the law.

There are those who say this legislation does not go far enough. We have listened carefully and appreciate their input and passion for a thorough framework for medical assistance in dying. It is their tireless advocacy which will ensure that we have the best possible legislation regarding this very sensitive issue.

With that being said, at this time not enough is known about the risks or benefits of medical assistance in dying for minors. We could certainly use more time to study this, as well as advance requests when mental illness is the sole underlying medical condition for requests.

These are important parts of the issue that cannot be written in hastily. They will be studied independently once this bill is passed so we meet our responsibility as a government to protect all vulnerable persons from any potential abuses or error.

To conclude, we do not have an easy task ahead of us. However, most things worth doing are not easy. We each have been elected to make difficult decisions and work hard to do what is best for our constituents and all Canadians. Canadians have spoken loudly on this issue, and we know that a majority of them support medical assistance in dying. We owe it to them to vibrantly debate and pass this legislation in order to allow Canadians a choice in how they end their lives.

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May 2nd, 2016 / 7:10 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, the member wrapped up by referencing opinion polls. Of course, we know Canadians support strong safeguards, including conscience protection. There will be some form of assisted suicide in this country going forward, but Canadians want to see us do the hard work of putting in safeguards.

The member talked specifically about the court decision. He would know that when the court granted the four-month extension, it put in place a system by which people could still, in the interim, seek euthanasia or assisted suicide, but they needed to go before a judge to do that. The court in its wisdom understood the need for some kind of system of legal review.

With ambiguous criteria, the absence of advanced legal review, and allowances for people to go from doctor to doctor until they get the right outcome or the outcome they want, this is not a system for ensuring that any kind of meaningful check occurs at all.

Would the member agree with me, and agree, frankly, with the direction the court seems to have given us when they granted the extension, that we should have some kind of system of advanced legal review by competent authority, and it would not have to be onerous, to ensure that whatever criteria are in this legislation are actually met in every case?

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May 2nd, 2016 / 7:10 p.m.
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Liberal

Raj Grewal Liberal Brampton East, ON

Mr. Speaker, the government has laid out a clear framework to ensure that the most vulnerable people in our society are protected. For mentally competent adults who are in an advanced state of irreversible decline and capability, have a serious and incurable disease, and for whom death is reasonably foreseeable, there will be not one but two medical opinions by independent witnesses.

We have also stipulated that we will be working with the provinces and territories to ensure that we have regulations that are in the best interests of all Canadians.

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May 2nd, 2016 / 7:10 p.m.
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NDP

Sheila Malcolmson NDP Nanaimo—Ladysmith, BC

Mr. Speaker, we want the bill to move forward. We want this medical service to be accessible to all. We also want to get the details right.

During the election campaign, the leader of the Liberal Party issued a statement that told us that he believed the Supreme Court made the right decision and that Canada's laws must be consistent with the court's ruling, because that is the right thing to do.

If experts who testified in the Carter case find that in fact the outline of the bill is not consistent with the court's direction and ruling, will the Prime Minister and his party still support the direction of this legislation, or will they bring forward amendments at committee in order to bring it in line with the Supreme Court ruling? Will they seek a reference to the Supreme Court to ensure that their proposal is completely charter compliant?

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May 2nd, 2016 / 7:10 p.m.
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Liberal

Raj Grewal Liberal Brampton East, ON

Mr. Speaker, Bill C-14 represents a direct response to the Carter ruling. It sets out a framework to ensure that we have assisted dying in this country within a framework that ensures we protect the most vulnerable people from abuse.

On second reading, the Attorney General said the government will be putting forward, publicly, the documents that examine the charter impact of the bill for all Canadians and this House to look at as well.

We will be working with the provinces and territories to ensure that we have regulations to protect this framework, because this is a very sensitive issue for all Canadians. This bill is a great response to the Carter ruling, and the parliamentary review after five years will ensure that this issue keeps building forward.

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May 2nd, 2016 / 7:15 p.m.
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Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Mr. Speaker, I heard the member talk about the details for the physicians and nurse practitioners making decisions.

I am wondering if the member would agree that the legislation puts the onus on the provinces, and in particular, the regulatory bodies. By doing so, it opens the doors for different regulatory decisions across Canada and these will not be uniform and consistent across the country.

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May 2nd, 2016 / 7:15 p.m.
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Liberal

Raj Grewal Liberal Brampton East, ON

Mr. Speaker, my hon. colleague is well aware that health care is a joint federal and provincial jurisdiction, and as a federal government, we have to work with our partners, the provinces and territories, to pass this legislation and set a framework.

We clearly stated that we are willing to work with our partners to ensure that in Canada our confederation works best for all Canadians, especially on issues such as physician-assisted dying, and that we have the best interests of Canadians at heart.

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May 2nd, 2016 / 7:15 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Mr. Speaker, I am very proud to take part in this debate as the representative for the people of Timmins—James Bay.

This is a historic debate for our country. The issue of medical assistance in dying is very complex and very personal. As parliamentarians, we have a duty to work together, strike a balance, respect the Supreme Court ruling in Carter, put in place the necessary protections for vulnerable individuals and seniors, and, lastly, introduce a national plan in order to guarantee access to palliative care.

At the beginning of this discussion, I think it is very important to put on the record that none of us come into this discussion with any level of moral superiority. This issue affects every single one of us. It affects our families. We cannot discuss this issue without putting it through the prism of our own personal lives and the lives of the people we know.

During this very time that the discussion has been going on, I was in the hospital with someone very close to me. The doctors said that there was nothing more to be done, they would have to go to hospice, and there were only days left. This person who is very close to me said that if they only had days, they were getting their hair done and were going to buy some nice shoes, $600 shoes. Being from a Scottish family, that was quite shocking. They said if they only had days, they were going to go out and have a nice dinner. Those days have turned into weeks.

Every day is a miracle. That is something we need to recognize. The power and the will to live is so incredible. We have to support it. We also have to recognize those who are living with intolerable pain, and be respectful of those whose hopes for the future are so crushed by debilitating illness. It puts us in a very special position, to be careful.

I want to say at the outset that I respect the importance and supremacy of the Supreme Court in our country, but I think it made a fundamental error and mistake in its treatment of the Canadian people. I think it was responding to what it felt was the last government's refusal to respond on a number of court decisions, so it put a firm timeline on Parliament to act.

It would have been fair for the Supreme Court to recognize that in October there was an election, a new mandate, and a new government. That government should have been given the opportunity to take this discussion across the country. This discussion should not be dealt with simply within this Parliament. This discussion should be a mandate that every Canadian is able to participate in. It is very unfortunate, and nobody will ever accuse me of giving the government a free pass, but the government's hands have been tied in a very unfortunate manner, in that we have to have this legislation passed by June.

For those who are very concerned about this legislation and in listening to some of my Conservative colleagues, I would warn that if Parliament does not act and if Parliament does not set the parameters for this legislation, we will then see a legal vacuum. The decisions on medically assisted death are already being made by the courts across this country. They are stepping into the vacuum that exists now.

It is incumbent upon us to respond. It is not good enough to say that we will fight this, that it is not the Supreme Court's job, and that Parliament should take back control. People can say whatever they want, but at the end of the day if we do not act by June, there will be a legal vacuum in this country. I would tell any of my colleagues who are very concerned about this legislation to just watch what happens in a legal vacuum, where others go back to the Supreme Court saying that they want to expand the rules much further.

Where does that bring us? One of my concerns is that if we are going to talk about the right that people have, the constitutional right, wherever they are in this country, to end their life if they are in medically difficult circumstances, how can we have that discussion without saying that people also have the right to quality palliative end-of-life care?

Across this country, only 16% to 30% of Canadians are able to access quality palliative care. Only six provinces have palliative care definitions under their framework. In fact, only four provinces actually even have a palliative care framework. There is a patchwork across this country.

We respect, within the House, that much of the health care services are delivered through the provinces, but the federal government has a fundamental role to play in working with the provinces. This is why the New Democratic Party pushed in the last Parliament for a national palliative care strategy, respecting the provincial and territorial jurisdictions but working to find ways of establishing proper palliative services. Pretty much every parliamentarian voted for that, yet we have seen no action. We have seen no action from the present government, which is a fundamental mistake if we are talking about having this legislation in by June.

Today is the first day I have ever heard someone from the government talk about their election promise that was supposed to be $3 billion. Well, that $3 billion is not happening now. Again, we are putting that to some time in the future. That is not acceptable. I have heard people talk about cruel limited choices and compassion, but it happens all the time. If someone is living in a rural area in Northern Ontario and are sick, and their children are living in Alberta or B.C., they are having to make some pretty tough decisions on their own. I have dealt with them in my office, and that lack of access to quality palliative care is heartbreaking.

The New Democratic Party has pushed Motion No. 46 in this new Parliament, which calls for the establishment of a pan-Canadian palliative end-of-life strategy. It has already been supported by Parliament, but we have not seen any action on it. We are asking for that to be moved now, to re-establish the secretariat on palliative and end-of-life care, with dedicated funding. That could have been done in this budget and it could still be done now to implement a national awareness campaign on end-of-life care so that people can have this discussion. I have been hearing lots of talk about how important it is to have this discussion in the House, but the federal government can play a role in furthering the discussion.

The other area is EI benefits for compassionate care so that people are able to look after their loved ones. Finally, there is a huge area of jurisdiction under the federal government, where it delivers health services to indigenous people, people in the military, and people in prisons.

Section 12.1 under the federal health act says that under no circumstances whatsoever, when someone is dying on a reserve and is being flown out for their final hours, will their spouse be allowed on the plane with them. They are to die alone. Under section 12.1 of these standards, it says it cannot be appealed. The first rule in the health standards says under no circumstances will compassion be accepted. That could be changed tomorrow. The health minister could stand up and say it is an unacceptable, cruel standard that the federal government would allow an elderly person to die alone without their life partner there, and that they would have written into the legislation that under no circumstances would compassion be considered a reason for letting someone be with them when they die. What kind of nation are we, if we think that is a perfect bureaucratic standard? It is not.

Therefore, if we are going to have this discussion about allowing people with incurable suffering to make that choice, and if we are going to make it available nationally, then it is incumbent upon the House to say that every family that has a loved one who is suffering will have the support they need, because how we come through death as a family is how we find ourselves. We either come out through these deaths stronger and closer together, or sometimes we see families breaking apart because of the strain that is put on them by a system that has failed them again and again, and when they needed it in the most vulnerable moment in their lives.

I am asking my colleagues. We could rise to a higher level in the House. We could rise to what we are called to do, which is to establish a vision for our nation. This is an opportunity, but it is going to have to move beyond simply this legislation. It is going to have to be done in conjunction with a plan for palliative care across the country.

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May 2nd, 2016 / 7:25 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, I appreciate many of the comments on the issue of palliative care. As a former health critic in the Province of Manitoba, I spent a good number of hours meeting and talking with individuals who were very much concerned about the need for expanding palliative care. This is an issue that all provinces, as they try to deal with their provincial budgets, have to come to grips with. It is not an easy issue.

The Minister of Health and the Prime Minister have made the commitment, and we want to demonstrate strong leadership on this file. We are talking about $3 billion. We are talking about the issue of a health care accord renewal. The last time that took place was back in 2004.

There is an opportunity for us as parliamentarians to recognize that we need to invest in palliative care, but at the same time would the member not agree that it is absolutely critical that in demonstrating this leadership we also need to work with our provincial stakeholders and others to ensure that we are providing a service, so that it does not matter what region in the country, there is some level of basic palliative care for all Canadians?

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May 2nd, 2016 / 7:25 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Mr. Speaker, certainly the reason we passed the palliative care strategy in the last Parliament was that one of the key first lines was to work in conjunction with the provinces and territories, but we have not seen that action. There was no action on the call for establishing the palliative care strategy. We can talk about it, but unless we establish a palliative care strategy or unless we put in the secretariat, this is just talk.

Yes, it is $3 billion, but there was nothing in the budget. There were zero dollars in the budget to deal with the shortfalls in health care.

My colleague can shake his head all he wants, but an election promise does not make palliative care. Palliative care is made by political will, and political will needs someone to stand up and say in a budget or a throne speech that we will establish that secretariat and we will make this happen.

So far, today has been the first time the Liberals have announced it. Lo and behold, guess what we are discussing. We are talking about medically assisted death and suddenly there is all this will on the other side. However, that will is the power of the government.

I would ask the Liberals, where were the dollars for health care for first nations under their jurisdiction when we got zero dollars to augment the huge shortfall? On palliative care, the Liberals can talk all they want, but they are going to have to put the structures in place and they have not done it yet.

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May 2nd, 2016 / 7:25 p.m.
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Conservative

Jim Eglinski Conservative Yellowhead, AB

Mr. Speaker, the hon. member mentioned quite a bit about the vacuum that may come about if this does not happen. I would like his opinion on what would happen if this House votes the bill down.

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May 2nd, 2016 / 7:25 p.m.
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NDP

Charlie Angus NDP Timmins—James Bay, ON

Mr. Speaker, I think it would be incredibly irresponsible if we told the Supreme Court that we have taken our opportunity to respond to it and we are not going to do it. Is the Supreme Court going to sit around and say that is perfectly reasonable? The Supreme Court will say that we had an opportunity to draft legislation with clear rules and clear limits, and in that vacuum other decisions will be made.

There will be groups that will come forward and will challenge the Supreme Court and say that they saw the Carter decision and they do not think it goes far enough and they want to establish further rights. Those rights would be established because Parliament has made it known under the mandate. I believe that we should have had more time, but we do not have more time. If we are telling the Supreme Court that we are not going to take our responsibility here in the House to draft legislation, in that vacuum, a lot of steps are going to be taken and members of Parliament are not going to be able to do anything except get up and make their Standing Order 31 statements to rail at the Supreme Court once again.

It is our responsibility; we have that duty, and we can do it now. I would say we all work together, because we are all in this together. We have to come out with legislation. Otherwise, that vacuum is going to be, potentially, very socially difficult and maybe destructive.

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May 2nd, 2016 / 7:30 p.m.
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Liberal

Denis Lemieux Liberal Chicoutimi—Le Fjord, QC

Mr. Speaker, it is a great pleasure to take part in this second reading debate of Bill C-14 on medical assistance in dying in Canada.

I had the privilege of being a member of the Special Joint Committee on Physician-Assisted Dying, and I supported all of the report's recommendations.

However, as many members have acknowledged today, medical assistance in dying is a complex, sensitive, and extremely personal issue.

Ever since the Supreme Court handed down its ruling in Carter last year, Canadians all across the country have been contributing to the discussion. The issue continues to be the subject of serious debate and deliberations all around the world, everywhere from the United States to Europe, Australia, and New Zealand.

In virtually all parts of the world, deliberately ending someone's life and helping someone end his or her own life are serious crimes that carry harsh penalties.

However, as many people know, Canada is not the only jurisdiction to legislate and authorize medical assistance in dying. Four U.S. states, specifically Oregon, Washington, Vermont, and California, along with Colombia, and three European countries, specifically Belgium, the Netherlands, and Luxembourg, have a legislative framework that allows some form of medical assistance in dying.

I listened to more than 60 expert witnesses during the meetings of the Special Joint Committee on Physician-Assisted Dying, and I was deeply moved by the testimony of the hon. Steven Fletcher; Benoît Pelletier; Jean-Pierre Ménard from Quebec; Dr. Cindy Forbes, president of the Canadian Medical Association; and Dr. Monica Branigan of the Canadian Society of Palliative Care Physicians.

Last week, though, I got a call at my constituency office from Bibianne Gauthier, the mother of Jean Truchon. After our conversation, I was able to put a face to a real request for medical assistance in dying.

After meeting Ms. Gauthier and her son Jean, I decided to share this real case with my colleagues in the House and read the letter that Jean Truchon wrote to his health care team on January 20.

I would like the House to know that I personally got permission from Jean Truchon to read this letter in Canada's Parliament. I am also doing this at the request of Mr. Truchon's parents:

“I am 48 years old and I have had cerebral palsy since birth. I spent 22 wonderful years living in an apartment.

On March 11, 2012, my life was turned completely upside down when the medical team at the Centre hospitalier universitaire de Montréal diagnosed me with inoperable degenerative cervical disc disease. That day, I reluctantly put one foot in the grave and I have every intention of putting the rest of my body there on September 1, 2016. I had to resign myself to living in a home and despite the good care I am receiving and my efforts to adjust to the situation, I simply cannot imagine living much longer under these conditions.

My question is this. Since I believe that I do not meet the eligibility criteria for medical assistance in dying [in January of this year], I intend to refuse to allow the staff to feed me or give me water, as I am unable to feed myself. I am asking that my doctor at the centre be authorized to administer a drug to at least relieve the pain.

I look in the mirror and I no longer recognize the man I once was. That is when I say, ‘What is the use in living like this’. Sometimes I think you do not have be at the end of your life to experience the intolerable suffering that I am currently experiencing. Doctors have told me that eventually I will become incontinent. The thought of it is too much to bear. I still have too much dignity to live like that.

At one point, I was in bed and no one responded when I pressed the call bell. I had to relieve myself in bed. It was then that I understood that life in an institution was not for me. I know that other people living a similar life in similar circumstances make different choices. However, in my case, I made the carefully considered decision that 2016 would be my last year.

I realize that dying before my parents is not the best way to go because it defies logic. However, I cannot take it anymore. My family and my friends are aware of and respect my decision even though they do not agree with it, because they are going to lose me. They understand all my struggles, and I thank them for their understanding.

I have considered a more dramatic form of suicide, but the fear of surviving and being in an even worse condition prevents me from doing it. Furthermore, to ease my family's pain, I am choosing to leave in a more honest manner by having them at my side. The antidepressants I have been offered, together with an explanation of their potential benefits, will never give me back the use of my arms or change the prognosis of physical decline. In good conscience and of my own free will, I have refused the medication, which will not give me back the will to live what would seem like an artificial life.

If this letter results in a more objective awareness of those who are suffering and are not at the end of their lives, I will have achieved one of my objectives.

Since I have no expectations that my case will be eligible for medical assistance in dying, I am also appealing to the CIUSSS bioethics committee to allow my treatment team to respect my choice and to allow me to receive the comfort care and the medication required to alleviate my suffering when I stop my feeding.

Thank you for taking the time to read this letter.”

The letter was signed by Jean Truchon.

This extraordinary 48-year-old man is just one of the faces of medical assistance in dying in Canada, but as I read about Jean's courageous decision, I felt that the committee had made good recommendations in its report.

The Minister of Justice consulted all of the existing legislation around the world to draft the government's legislative response to the Carter decision.

The bill sets three eligibility criteria: individuals must be competent adults who are in an advanced state of irreversible decline; they must have a grievous and irremediable illness or disability, and their medical condition must cause them enduring and intolerable suffering; and their deaths must have become reasonably foreseeable, taking into account all of their medical circumstances.

The bill also has a non-legislative component. It provides for further study of three specific topics: mature minors, advance requests, and mental illness.

I am also pleased to see that Bill C-14 includes solid safeguards to prevent mistakes and abuses. I would like to reiterate them: the patient must get an opinion from two independent doctors and the request must be made in writing; the patient has the right to withdraw the request; there is a 15-day waiting period; and consent must be confirmed immediately prior to the administration of the medical assistance in dying.

In closing, I would like to encourage all members to read the document entitled “Legislative Summary of Bill C-14: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)”, which was tabled in the House by the Minister of Justice. It contains important information on the international laws and regimes that influenced the government's approach to medical assistance in dying in Canada.

The government wanted to learn from the experiences of other jurisdictions. The approach it plans to take is broader in scope than that of the United States, which gives access to medical assistance in dying only to people with an incurable disease. The approach the government is considering gives the option of a peaceful death to everyone approaching the end of his or her life, not just those suffering from incurable diseases. At the same time, it eliminates some of the risks that may be associated with a broader regime. The government has also committed to continue examining these more general issues and will continue to observe what is being done elsewhere in the world in terms of medical assistance in dying.

I urge all members to support this bill and send it to committee, thereby responding to our Supreme Court's request to legislate in this area.

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May 2nd, 2016 / 7:40 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, I appreciate the many fine words from my colleague, and I would like to ask him a question.

The government has brought this legislation forward because of the Supreme Court of Canada ultimately doing what Liberals believe is the responsible thing to do, with the strong leadership from the Prime Minister's Office to the ministers responsible for bringing forward the legislation itself; but one thing we are often being told about is the importance of not only the legislation but the whole issue of palliative care.

I am wondering if the member might want to take the opportunity to emphasize, from his perspective and his constituents' perspective, just how important palliative care is as part of this whole debate.

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May 2nd, 2016 / 7:40 p.m.
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Liberal

Denis Lemieux Liberal Chicoutimi—Le Fjord, QC

Mr. Speaker, I thank my colleague for his question.

When I sat in the special joint committee, it really struck me how the issue raised by the Carter decision really forced us to reflect on the quality of palliative care in Canada.

That is why I was thrilled to hear that the Minister of Health had announced plans to invest an additional $3 billion over the next four years to improve palliative care. As we said in committee, medical assistance in dying must not replace palliative care. That care constitutes end-of-life care, and medical assistance in dying should be considered part of palliative care. I am therefore very proud of our government's decision and the decision taken by the Minister of Health.

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May 2nd, 2016 / 7:40 p.m.
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Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

Mr. Speaker, I too would like to commend my colleague, with whom I served on the special committee struck by the government. The committee was made up of MPs and senators from all political parties.

I would like to know my colleague's thoughts on the text of the bill. It uses words that have raised many questions in Quebec and all across Canada regarding what is reasonably foreseeable: a reasonably foreseeable death. The Quebec legislation clearly states that care must be provided to people who are reaching their end of life.

Is the member comfortable with the term “reasonably foreseeable death”, or would he prefer a definition that is closer to the one used in Quebec, in other words, “end of life”?

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May 2nd, 2016 / 7:40 p.m.
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Liberal

Denis Lemieux Liberal Chicoutimi—Le Fjord, QC

Mr. Speaker, I thank my colleague for his question.

I understand my colleague's points, and I have often heard him use those words in the media in the past few weeks. What Canadians need to know is that the point my colleague raised is one of the four criteria required for access to medical assistance in dying. It is important to explain to Canadians that there is not just one criterion for obtaining medical assistance in dying, but four.

I will take this opportunity to remind my colleague from Louis-Saint-Laurent about what he said this morning in response to a question from our colleague opposite. I was so sad to hear it. According to the member from Louis-Saint-Laurent, cases like Mr. Truchon's, which I talked about just now, are unintended consequences. That is what he said in response to my colleague.

I want the member to know that I really disagree with him. I invite him to talk to Mr. Truchon's parents. He will see that Mr. Truchon and his family are altogether remarkable and are not trying to abuse the system in the way that the member for Louis-Saint-Laurent suggested this morning.

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May 2nd, 2016 / 7:40 p.m.
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NDP

Rachel Blaney NDP North Island—Powell River, BC

Mr. Speaker, I know from personal experience how hard it can be to be with people who are at the end of their life. I have actually been with people who have starved themselves to precipitate their end of life more quickly.

One of the concerns I have with this bill is that it would limit people who have health issues that are unbearably painful but whose end of life is far away in some cases. My question is this. How does the member think this would work with this bill, and how can we support people who have done the due diligence, have independent thought, and are ready to go when they are in unbearable pain?

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May 2nd, 2016 / 7:45 p.m.
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Liberal

Denis Lemieux Liberal Chicoutimi—Le Fjord, QC

Mr. Speaker, I thank my colleague for her question.

I look at the situation that Mr. Truchon and his family are in, and I see the law in Quebec. Mr. Ménard told us that he would certainly have drafted Quebec's law a little differently in light of the Carter decision.

Today we are asking ourselves a big question in relation to the bill we are debating that was introduced by the Minister of Justice. Mr. Truchon's family is a real-life example. Will they have to watch their son suffer for five, seven, eight days, or will our bill enable them to witness a gentle death that lasts four or five minutes?

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May 2nd, 2016 / 7:45 p.m.
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Conservative

Mark Strahl Conservative Chilliwack—Hope, BC

Mr. Speaker, it is always an honour to stand in this place and participate in the debate, no matter what the subject matter. There are some debates that are more important than others, and I would venture to say that parliamentary historians will not be poring over the Hansard of the latest budget implementation act in five, 10, or 50 years from now. However, the debate we are taking part in today is not just any debate. It matters. How we as a Parliament, as a group of elected representatives, respond to it will have a profound impact on our society and on the value we place on life in the months and years ahead.

We are here to debate Bill C-14. The short title of the bill is the medical assistance in dying act. I would suggest that this title downplays the decision that we as parliamentarians are being asked to make. Bill C-14 would remove the criminal prohibitions for killing a person, or helping that person kill himself or herself, in certain situations. That is the harsh, stark reality of what we are dealing with in this bill. It is not just another medical procedure that we can sterilize with antiseptic and non-offensive language. This is a serious matter. It will result in a fundamental shift in Canadian society, and making the language more palatable and less jarring does not change that.

We are here because of the Supreme Court of Canada's Carter decision. While the court had previously ruled that the Criminal Code provisions on euthanasia and assisted suicide were constitutional and did not violate the charter, last February it reversed itself and struck down sections of the Criminal Code. It gave Parliament until June to come up with a law that respects its ruling and places restrictions on when and where euthanasia and assisted suicide can take place without criminal penalty.

The Council of Canadians with Disabilities and the Canadian Association for Community Living have produced an excellent commentary on the court's decision, warning that persons with disabilities, including people with serious mental and emotional disabilities, have been put at serious risk. They have also provided these sobering statistics:

...in Belgium, the number of Assisted Suicide deaths has increased an average of 47.77% annually since 2003, and in the Netherlands it has increased 64.13% since 1995, with no end in sight to this increase.

They have called upon Parliament to “place crucial safeguards on the Court’s judgment to limit access to assisted suicide”.

Unfortunately, the joint parliamentary committee report on assisted suicide went the other way, suggesting that doctor-assisted suicide should even be made available to minor children and those struggling with mental illnesses. As a result, Conservative MPs on the committee filed a dissenting report recommending stronger protections for the vulnerable. Thankfully, most of their recommendations have made their way into Bill C-14.

I have heard from hundreds of my constituents who oppose assisted suicide and euthanasia. They fundamentally believe that the Supreme Court's ruling and this bill will lead us down a slippery slope. Some oppose it on religious grounds, believing in the sanctity of life at all stages. Others oppose it for a variety of logical or ethical reasons.

I have also been contacted by some constituents who support the concept of euthanasia in principle and in certain circumstances. Having myself watched a number of family members and friends ranging in age from 13 to 85 die from cancer over the last few years, I understand the desire to ease the suffering of those we love as much as possible at the end of their lives. I believe that, instead of considering euthanasia and assisted suicide as a desired way to provide relief to dying patients, the federal government should be doing more, in concert with the provinces, to promote and expand comprehensive palliative care services right across the country.

Indeed, we voted nearly unanimously for expanded palliative care services and a plan in the last Parliament. During the election campaign, the government promised to inject $3 billion into palliative care. However, its budget did not include a dollar of funding or a mention of it coming anytime soon. The Minister of Health referenced her commitment to palliative care again today in question period. However, words are not enough. We need action, and it should have been a companion to this legislation, not an afterthought.

I want to talk about my main concern with assisted suicide as it relates to this bill and the ruling by the Supreme Court.

We need to continue the national conversation about improving our mental health system of care, which is currently failing too many Canadians. Mental Health Week starts today. The Canadian Mental Health Association is encouraging us to get loud on ending the stigma around mental illness.

Many of us have participated in, and will participate in, events this week to do just that. We put on green ribbons. We have attended champions of mental health dinners. We celebrate those who have spoken out and shared their stories of overcoming the darkness in which they have often lived for years. We beg people struggling with mental illness to reach out. We tell them that help is available, and it is. We grieve whenever individuals take their own life as a result of their mental illness.

Indeed, we have had many debates in the House, with heartfelt speeches by members on all sides, trying to figure out how we can best support those struggling with mental illness. Why did we do that? It is because we believe we must provide hope for those who are suffering. We believe that every life is worth saving and that those with mental illness can be treated, helped, and hopefully made well again.

We are told we should, as parliamentarians, separate assisted suicide from suicide brought on by mental illness. We should not be under the impression that we get to choose whether these two issues will be conflated or not. If assisted suicide becomes normalized, we should not be surprised if societal attitudes on other types of suicide change as well.

I recognize that mental illness is currently excluded from permissible cases for assisted suicide or euthanasia, but the government has said it will be embarking on further studies to look at the unique implications of situations where mental illness is the sole underlying medical condition. Indeed, Liberals mentioned their intention to move forward on this study at the technical briefing on Bill C-14.

Why would the government want to study this matter further if not to bring it forward as a future amendment to the bill? We cannot allow the door to be opened even a crack to allow for those suffering from mental illness to be able to access physician-assisted suicide.

I recently spoke to someone who was diagnosed with bipolar II disorder about the bill. This person attempted to be well with every tool available, and shared the following with me:

My disease is a challenge every single day of my life. Sometimes I work to keep the symptoms at bay from minute to minute. Suffering is a given. And yet, I have much joy and hope, so much to live for. But what if I get really sick, what if I can not manage for an extended period and fall into a deep unbearable depression? Do I need to write an advanced directive to my doctor, asking them explicitly not to allow me access to euthanasia? To ask them to help me fight for my life, even if I can't do that in my moment of total despair?

We need to say it loud and clear that suicide is not the answer for mental illness, whether it is medically assisted or not.

I know that my time is short, so I will move on to another concern I have, and that is the possibility of having two nurse practitioners to sign off on assisted suicide or euthanasia requests for a patient. Nurse practitioners play a vital role in many remote, rural, and northern communities, but when we are dealing with a matter this serious, this permanent, with these types of consequences, I believe that not only should two doctors be required to sign off but that there should be a requirement for a psychological examination or independent oversight from a social worker to be done on patients before they can access assisted suicide or euthanasia.

This would provide an additional level of protection to ensure that patients are truly capable of making decisions with respect to their health and that the request to end their life was not made as a result of external pressure as is mentioned in section 241.2 of the bill.

Finally, Bill C-14 does not enshrine the legal rights of medical professionals such as doctors, nurses, pharmacists, and caregivers to opt out of providing assisted suicide services or referrals if their personal conscience, beliefs, or ethics do not permit them to do so. This is a critical flaw.

As the bill does not adequately protect vulnerable people and does not adequately protect the conscience rights of medical professions, unfortunately, I cannot support it.

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May 2nd, 2016 / 7:55 p.m.
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Spadina—Fort York Ontario

Liberal

Adam Vaughan LiberalParliamentary Secretary to the Prime Minister (Intergovernmental Affairs)

Mr. Speaker, I listened with interest to the presentation and appreciate that these issues bring back memories and experiences that are extraordinarily personal, and I do not mean to move into those areas unduly, so I hope the member can forgive the question.

In situations where, quite clearly, individuals are exerting an individual right and an individual choice, I wonder if the member could reflect upon what right we have to impose bureaucracy, layers of decision-making, additional voices, and additional concerns into people's lives when they are trying to make a choice for themselves about the most personal decision they may ever have to make.

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May 2nd, 2016 / 7:55 p.m.
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Conservative