Bill C-14 (Historical)

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

This enactment amends the Criminal Code to, among other things,
(a) create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing, in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process;
(b) specify the eligibility criteria and the safeguards that must be respected before medical assistance in dying may be provided to a person;
(c) require that medical practitioners and nurse practitioners who receive requests for, and pharmacists who dispense substances in connection with the provision of, medical assist­ance in dying provide information for the purpose of permitting the monitoring of medical assistance in dying, and authorize the Minister of Health to make regulations respecting that information; and
(d) create new offences for failing to comply with the safeguards, for forging or destroying documents related to medical assistance in dying, for failing to provide the required information and for contravening the regulations.
This enactment also makes related amendments to other Acts to ensure that recourse to medical assistance in dying does not result in the loss of a pension under the Pension Act or benefits under the Canadian Forces Members and Veterans Re-establishment and Compensation Act. It amends the Corrections and Conditional Release Act to ensure that no investigation need be conducted under section 19 of that Act in the case of an inmate who receives medical assistance in dying.
This enactment provides for one or more independent reviews relating to requests by mature minors for medical assistance in dying, to advance requests and to requests where mental illness is the sole underlying medical condition.
Lastly, this enactment provides for a parliamentary review of its provisions and of the state of palliative care in Canada to commence at the start of the fifth year following the day on which it receives royal assent.

Criminal Code

[Jody Wilson-Raybould, Liberal, Minister 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)”.

[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?

[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.

[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?

[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.

[Sean Casey, Liberal, Parliamentary 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?

[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.

[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?

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[Pam Goldsmith-Jones, Liberal, Parliamentary 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.

[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.

[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.

[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.

[Jody Wilson-Raybould, Liberal, Minister 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—

[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.

[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.

[Jane Philpott, Liberal, Minister 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.

[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?

[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.

[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?

[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.

[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?

[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.

[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.

[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.

[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?

[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.

[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

[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?

[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.

[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”.

[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?

[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.

[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?

[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.

[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?

[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.

[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.

[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.

[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.

[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.

[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?

[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.

[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?

[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.

[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.

[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?

[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.

[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?

[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.

[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.

[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.

[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.

[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?

[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—

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

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

[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.

[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?

[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.

[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?

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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?

[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.

[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.

[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?

[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.

[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?

[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.

[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.

[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?

[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.

[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.

[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.

[Anthony Housefather, Liberal, Mount Royal, QC]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Ed Fast, Conservative, Abbotsford, BC]

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

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

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

I believe Bruce Clemenger said it best when he stated:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Ed Fast, Conservative, Abbotsford, BC]

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

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

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

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

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

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

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

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

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

[Ed Fast, Conservative, Abbotsford, BC]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Some of my constituents have also expressed concerns about access.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[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.

[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?

[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.

[Arif Virani, Liberal, Parliamentary 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.

[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—

[The Deputy Speaker, Conservative, Bruce Stanton]

The hon. parliamentary secretary to the Minister of Immigration, Refugees and Citizenship.

[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.

[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.

[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.

[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.

[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.

[Kevin Lamoureux, Liberal, Parliamentary 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?

[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.

[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?

[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.

[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?

[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.

[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.

[Adam Vaughan, Liberal, Parliamentary 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.

[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.

[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?

[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.

[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.

[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.

[Sean Casey, Liberal, Parliamentary 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.

[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.

[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.

[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?

[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.

[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.

[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.

[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.

[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?

[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.

[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?

[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.

[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.

[Adam Vaughan, Liberal, Parliamentary 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?

[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.

[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?

[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.

[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?

[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.

[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.

[Adam Vaughan, Liberal, Parliamentary 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?

[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.

[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.

[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.

[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.

[John McKay, Liberal, Parliamentary 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.

[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.

[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.

[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.

[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.

[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

[Kevin Lamoureux, Liberal, Parliamentary 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?

[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.

[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?

[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.

[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.

[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.

[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.

[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?

[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.

[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.

[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.

[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.

[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?

[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.

[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.

[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?

[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.

[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.

[Kevin Lamoureux, Liberal, Parliamentary 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—

[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.

[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.

[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?

[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.

[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.

[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?

[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.

[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?

[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.

[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.

[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.

[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.

[Kevin Lamoureux, Liberal, Parliamentary 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?

[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.

[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.

[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.

[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.

[Kevin Lamoureux, Liberal, Parliamentary 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.

[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.

[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”?

[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.

[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?

[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?

[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.

[Adam Vaughan, Liberal, Parliamentary 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.

[Mark Strahl, Conservative, Chilliwack—Hope, BC]

Mr. Speaker, I accept the question in the spirit in which it was given.

I think what the court has called on us to do is to set limits. It has not thrown the door completely open. It put its own conditions on grievous and irremediable conditions, and when and where this can be accessed. The court in its ruling has asked Parliament to specifically consider when and where assisted suicide, euthanasia, can be accessed. I think that is what we are doing here today.

There has been debate throughout the day. Some believe the bill does not go far enough in terms of its permissiveness, and others, like myself, believe that it is not tight enough around the court ruling. We are going to have a variety of opinions here, but that is exactly what we are doing. We are talking about what limits we believe should be placed on assisted suicide and euthanasia, because that is what the court has asked us to do.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Mr. Speaker, we have moved 180 degrees, from a criminal activity which was under the Criminal Code to now, where actually we can kill somebody and call it assisted suicide, and at the same time get the health care to pay for it.

I wonder if the member would comment about doctors and nurses who have an ethical or moral gauge within their own soul that will not allow them to do this. Would the bill protect them?

[Mark Strahl, Conservative, Chilliwack—Hope, BC]

Mr. Speaker, I would certainly argue that it would not. There is mention of conscience rights in the preamble, but we have seen before that the preamble is not the meat of the bill. It does not have the same effect that it would if it were in among the provisions of the bill.

I have spoken with many medical professionals since the bill came out, since the Supreme Court ruling came out, and there is grave concern about participating in this sort of scheme. I want to be clear that sometimes there is a religious bent, but often it is an ethical bent. It is people who have spent their entire lives, gone to school, sometimes for over a decade, to help save lives, who are now being told that part of the medical system is to provide assisted suicide or euthanasia services, and they are morally or ethically opposed to doing so.

I do not think the bill goes far enough in protecting those people from opting out of the system, and it is one of the reasons I will not be supporting it.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, I really appreciate the debate. Again, I will go on record as saying that I fear we do not have enough time to have a lengthy debate, but I do appreciate the comments from both sides.

My comments are neither for nor against at this point. However, it says informed consent being given, but in the bill itself there is no advance directive. The very people whom the bill could help, such as someone suffering from advanced stages of ALS, Lou Gehrig's disease, may not be able to give that consent at the time. Is there not a concern, and how can we rectify this as we move forward?

The deadline is speedily approaching. Does my colleague share the same concerns?

[Mark Strahl, Conservative, Chilliwack—Hope, BC]

Mr. Speaker, quite frankly, I think that is one of the unfortunate things that has happened in this debate. Due to the timing of the dissolution of Parliament for the election, there were several months lost when we were not debating this in the chamber. There were many months lost when this was not on the national agenda.

To now rush the bill forward, as we are compelled to do, I cannot think of a bill that deserves more time, more thought, and more debate than the bill before us, yet we have an arbitrary deadline that has been set by the court. That is truly the most unfortunate part of this debate, and one which I hope we do not live to regret.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Mr. Speaker, I thank you for giving me the opportunity to share my thoughts on Bill C-14.

I had the privilege of sitting on the Special Joint Committee on Physician-Assisted Dying. Along with the members of the committee, made up of 11 of our colleagues and five senators, I believe I can say that I was right in the thick of things, when it came to testimonies and opinions from the various stakeholder groups, experts, and everyday citizens.

The debate on medical assistance in dying is an emotional one. That is because it deals with the last of the taboos of any society, namely to plan one's own death and, in a way, to get help organizing it.

Whether you are religious, secular, atheist, philosophically liberal, or ideologically conservative, every opinion on medical assistance in dying matters. In the wake of the Carter decision, the diverging opinions and our deepest moral values now seem to torment us. Either side of the argument on medical assistance in dying is a source both for concern and for hope. This issue leaves no one indifferent, but above all stirs the most sincere and honest emotions.

That is where we run the risk of losing sight of the purpose of the debate. In fact, medical assistance in dying, regardless of our personal values, is not something that any of us must impose on or deny anyone else. I urge all my colleagues to keep in mind that medical assistance in dying is now an individual right recognized by the Supreme Court of Canada, a right that is no one's business but the individual's and, at the same time, a right that does not force anyone to compromise their deepest individual moral convictions.

Morality, taboos, planned death and the emotions this stirs must not cloud the rationale of the Carter decision. If we eliminate our individual morality from the analysis of the Carter decision, then it is rather simple.

First of all, two sections of the Criminal Code are affected, namely section 14 and paragraph 241(b). These provisions prohibit a person from counselling or aiding another person to commit suicide.

Second, as a result of these Criminal Code provisions, a person suffering from a grievous and irremediable illness could prematurely end their life, knowing that no one could help them die when they are no longer able to commit suicide because of the progression of the illness. In short, the prohibition in the Criminal Code provisions I mentioned could lead a person with an irremediable illness to take their own life early, even though they are still enjoying a certain quality of life, because they foresee that they will no longer be able to do so themselves at a later date.

Third, section 7 of the Canadian Charter of Rights and Freedoms states that everyone has the right to life. In Carter, the Supreme Court cited this principle in stating that a person suffering from a terminal illness cannot be deprived of this right. In other words, medical assistance in dying will maximize the time the person has left to live. That is the objective of Bill C-14, which amends the Criminal Code of Canada in order to allow medical assistance in dying.

In its wisdom and with a unanimous decision, the Supreme Court of Canada is showing us the way so that we can amend section 14 and paragraph 241(b) of the Criminal Code, which currently violate the right to life, liberty and security of the person guaranteed by section 7 of our charter.

The principles in Carter that must guide us in developing Bill C-14 are found in paragraph 127 of the decision, a paragraph that I invite my colleagues to read carefully because it will require our attention when we debate this matter.

The Supreme Court of Canada stated:

[These sections] 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.

Also in paragraph 127, the Supreme Court of Canada stated:

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.

I will support this bill at second reading, but I must confess that I hope the committee can re-examine the bill and try to fine-tune it, because I have some concerns.

For example, this bill may suggest a rather restrictive approach with respect to Carter, especially since the bill contains words that are not in this decision. For example, subsection 241.2(2) states: “A person...[has] a serious and incurable illness, disease or disability”. The word “incurable” never appears in the Carter decision, and that may seem a bit too restrictive.

The bill also refers to an “advanced state of irreversible decline in capability”. The words “advanced” and “decline” do not appear in the Carter decision and could be interpreted as rather restrictive language.

Another one of my concerns has to do with the fact that, right now, this bill seems to disregard any advance requests for medical assistance in dying. Since the Carter decision suggests that there may be other requests in other exceptional circumstances, I believe that it is quite likely that people with a grievous and irremediable medical condition may also experience a deterioration of their cognitive and intellectual faculties.

I think that perhaps the committee should re-examine the possibility of an advance request so that someone with Alzheimer's or brain cancer, for example, is not prevented from giving informed consent to medical assistance in dying the second time because of the deterioration of his or her mental and cognitive abilities.

On page 6 of the bill, in paragraph 241.2(3)(h), it reads:

immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request and ensure that the person gives express consent to receive medical assistance in dying.

It seems that this paragraph is rather strict, given that people who are terminally ill could lose consciousness or that their intellectual faculties could be impaired because they are being heavily medicated. They therefore might not be able to consent to the medical assistance in dying the second time.

Those are some of my thoughts on the bill. I hope that the committee responsible for studying it will reflect on these comments.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, it is once again my turn to commend my colleague from New Brunswick, whom I respect and hold in high esteem. In committee, we worked together a great deal and did so positively and constructively. I got to know him, and I believe the feeling is mutual.

Earlier, our colleague mentioned that there are words in the bill, such as “incurable" and “advanced state of decline”, that were not in the Carter decision. There are also words such as “minors” and “reasonably foreseeable” that were not in the Carter decision. Why am I raising the subject of “minors”? Because that was touched on in the majority report. As for “reasonably foreseeable”, that is not clear enough to us.

I would like to hear my colleague's thoughts on the debate that has been going on across Canada for a few weeks now about how to define “reasonably foreseeable”.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Mr. Speaker, my colleague from Louis-Saint-Laurent's question is an excellent one.

The words “reasonably foreseeable” can cause some confusion from a legal point of view. What is reasonably foreseeable? There are many ways to interpret those words. It is true that those words do not appear in the Carter decision and that removing them from the bill would be a good thing.

My colleague often referred to the Quebec version of the law, which is about the moment when a person is at the end of his or her life. The words “end of life”, however, can also cause confusion from a strictly legal point of view. When does end of life begin? Is it 24 hours before a person dies, a week before death, a month before death, or is it the moment when a doctor confirms that no treatment can save that person's life?

The committee needs to take a close look at those words to ensure there is no ambiguity that could open the door to a legal challenge.

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

Mr. Speaker, in the backgrounder, the government refers to having equal access. I am curious as to why the provisions to protect the personal convictions of health care practitioners are not included directly in the text of this bill.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Mr. Speaker, I am not sure I understood my colleague's question correctly.

The independence of doctors is not included anywhere in the bill. Doctors can in fact be independent, because two doctors are needed to approve the consent when a competent adult is seeking medical assistance in dying. This is actually referring to two doctors who are independent in relation to the person seeking medical assistance in dying. If I understood the question correctly, that is what I think.

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

Mr. Speaker, I appreciate the fine comments made by my colleague.

I have raised the issue of palliative care a great deal today. As we go through the debate on this legislation, a lot of members have been talking about the importance of palliative care. Could the member provide some thoughts from his constituency on the whole issue of palliative care? This has been thoroughly discussed as we have debated this bill. Does the member have any thoughts he would like to share with regard to this issue?

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Mr. Speaker, I thank my colleague for his excellent question.

He definitely must have read the report produced by the Special Joint Committee on Physician-Assisted Dying, which recommends taking a long, hard look at palliative care and developing a policy on the issue.

Because of the Carter decision, time is of the essence. To respond to the Carter case meant responding to medical assistance in dying based on the charter and the Criminal Code, which prohibited medical assistance in dying. Palliative care was not the crux of the debate in Carter, although everyone seems to agree that we need to think carefully about this service and provide it for Canadians.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice”, so says section 7 of the Canadian Charter of Rights and Freedoms.

In February of last year, the Supreme Court applied those words to strike down the criminal prohibition against assisted dying.

As a matter of policy, this was a welcome decision. Blanket bans are an ill-advised form of regulating conduct that is not inherently wrongful. The criminal law is a blunt instrument, often imposing costs beyond the benefits it seeks to achieve and it should be resorted to sparingly.

An optimal policy involves nuance legislation that protects those at risk without preventing others from making their own choices and directing their own lives as they see fit.

In response to the Supreme Court's decision in Carter, the government has drafted Bill C-14. The government states correctly that it is no longer a question of whether to legalize assisted dying but how we should do so. In other words, relitigating Carter is a futile exercise when the Supreme Court has already spoken, unanimously no less.

Still, it remains useful to understand how we got to where we are. If we are to adequately address the court's concerns, we should have a complete understanding of those concerns. Having studied section 7 of the charter in depth, I would like to first briefly explain what the Supreme Court requires of us on this issue.

Section 7 of the charter provides the right to life, liberty, and security of the person qualified by the principles of fundamental justice. A violation of life, liberty, and security of the person is only unconstitutional if there is also an infringement of a principle of fundamental justice.

The court has stated that those principles are to be found in the basic tenets and principles of the legal system. The key principle to understand on this issue is over-breadth, or what we refer to as “minimal impairment” under the classic Oakes test under section 1. If a law infringes life, liberty, and security of the person, over-breadth requires the law to be reasonably necessary to achieve an important government objective.

In Carter, the court first determined that the blanket criminal prohibition against assisted dying engages life, liberty, and security of the person. In the court's words:

Liberty protects “the right to make fundamental personal choices free from state interference”.... Security of the person encompasses “a notion of personal autonomy involving control ...over one's bodily integrity...”...

Second, the court determined that the blanket prohibition was over broad. The purpose of the legislation, as defined by former Justice Sopinka in the earlier Rodriguez decision, was “...the protection of the vulnerable who might be induced in moments of weakness to commit suicide ...”. In the court's view, the absolute prohibition on assisted dying went too far. While protecting vulnerable people is the law's object, it caught people outside of this class: those who are competent, fully informed, free from coercion or duress, yet choosing to end their lives.

We are now faced with new legislation, Bill C-14.

Our first job is to assess whether this legislation meets the criteria set by the Supreme Court. To answer this, we must first assess the government's objective, now a dual objective: one, to provide a means by which those subject to grievous and irremediable suffering can die with dignity; and, two, to protect those who wish to continue to live from coercion or undue influence.

Is this legislation reasonably necessary to effect these twin purposes? The answer is, unfortunately, not a resounding yes. It is a resounding almost.

I have real concerns, for example, that limiting access to those for whom death is “reasonably foreseeable”, however one seeks to define that term, would have precluded one of the applicants in the very Carter decision from accessing the new regime.

There is no evidence presented by the government that limiting access to terminal illness is necessary to protect the vulnerable, provided other safeguards are put in place, and it is an open question whether this provision is constitutional.

As one constituent aptly put it, “What Bill C-14 says is: I can express a desire to die when I'm terminally ill, but if I'm not considered competent, it won't count; I can express a desire to die when I'm competent, but if I'm not considered terminally ill, it won't count.” This should be remedied before we pass this legislation.

The remainder of the law may well fall within a range of reasonable options and therefore be charter-compliant. but that cannot possibly be what we aspire to in the House. We may have been tasked by the court to address the constitutionality of the current laws, but we are tasked by Canadians to go beyond that. The law we put forward should not simply fall within a range of reasonable options. It should be the best possible law we are capable of drafting.

I have met with many constituents over the last number of weeks and months to discuss this issue. In early April, for example, we hosted a town hall on the topic. It is, rightly, a sensitive topic for many.

My constituents' views and opinions have informed the following thoughts, all of which revolve around the importance of choice.

First, my constituents overwhelming favour advance directives. I appreciate that this is a complex area. It is one thing to assess an advance directive regarding a permanent coma and another thing to assess an advance directive regarding differing degrees of dementia. However, simply because a matter is complex or difficult does not mean we should not attempt to address it. I believe we need to look at advance directives more seriously and that many of the worries regarding stale decision making can be resolved by sunset clause provisions.

As former Chief Justice Lamer said in Rodriguez, the legal system should not deny consent but should seek to ensure that such consent “is as independent and informed as is reasonably possible”. With appropriate safeguards in place, witness requirements, competency assessments, informed consent through advance directives should be respected.

Second, my constituents overwhelmingly favour placing assisted dying within the context of end-of-life health care overall. Under our charter, access to assisted dying cannot depend upon the availability of palliative care, but, as a matter of policy, for there to be a real choice, we should invest significantly in palliative care options. The $3 billion promise for home care investments is a good start, but it is only a start.

Third, choice depends upon competency and capacity. A competent adult should not be defined by age, but by capacity to understand and to choose.

Fourth, a small but vocal group of constituents have asked for choice for doctors, the right to conscientiously object. It is important for the government to acknowledge the deeply held beliefs of some doctors and we must do our best to reconcile those beliefs with the importance of providing access to assisted dying across our country. It is reasonable to respect doctors' choices, at the outset a cautious approach, providing patients with a public list of participating health professionals across the country.

Fifth, and finally, a similarly cautious approach regarding mental health is also warranted. The foundation of the court's decision was autonomy and dignity, and mental illness, including depression, can impinge upon fully informed and free choice. The law does not require anyone to choose life or death, but allows Canadians to make that deeply personal choice for themselves. For some, the right to life precludes assisted dying, but for others, including former Justice Cory, the right to life includes the right to death.

I will support this legislation at second reading and I hope it will be improved at committee.

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

Mr. Speaker, I fully agree with what the member opposite said about the need for palliative care as an option. Therefore, could he comment on why it is not part of Bill C-14 and why the word does not even appear in budget 2016?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, I was also perplexed that we did not see palliative care options in budget 2016. We have made a commitment to spend $3 billion on home care, as I understand it, although I am not spending the money personally or individually, so I cannot make that choice on my own.

However, I do know that we are committed to working with the provinces, first and foremost, to establish a new health framework. I am convinced by this government that we are committed to investing in home care through that framework.

[David Tilson, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, the member gave an excellent presentation. In fact, I have listened to all the speeches that have been given so far and they are all excellent. Some are for the legislation and some are against. Almost all members speaking for or against the legislation have said that they have some serious concerns about the legislation. The problem is that the Supreme Court of Canada has already extended the time once and the next date is June 6.

The fact is that we are all admitting that there are serious concerns with this bill. It has been studied by a committee of members of Parliament, a committee of the Senate, and the justice committee is reviewing it now as we speak. Should we be rushing through with this? This is a very serious issue. We all agree that this bill is not perfect and we can do better. Therefore, the question is whether we should be asking for yet another extension so members of Parliament and the Senate can spend more time on this subject.

[The Speaker, Liberal, Geoff Regan]

Before I turn to the hon. member for Beaches—East York for his reply, I want to take this opportunity, since the hon. member for Dufferin—Caledon has made mention of the excellent speeches we have heard this evening on this topic from both sides, and I appreciate his comments in that regard, to say that I appreciate the tone of this debate and the desire of all members to take part in it in a very serious and respectful way.

The hon. member for Beaches—East York.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, we have had a parliamentary committee do incredible work getting a report out after holding hearings that would have taken months and months on end in a very short time span. We have legislation before us that requires fixes, yes, but in the main part addresses the Supreme Court's concerns.

I do not believe an extension is necessary. I do not believe it would be granted if sought. I believe it is incumbent upon this House to act expeditiously and get this legislation passed.

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

Mr. Speaker, I appreciate the member's particular focus on the absence of advance directives in the legislation. I share his concern. I would like to explore that a little more with the member. Perhaps he could shine a light on why this might have been missed and how we could fill the gap.

In paragraphs 13 and 14 of the Carter decision, the Supreme Court referred to the cruel choice that is posed to legally competent patients facing degenerative diagnoses, and those who have to choose between taking their lives prematurely or losing capacity later on. The member referred to that in his speech. The solution proposed by the all-party committee, which I salute, was to allow them to record their wishes while legally competent, and then through an advance directive, which would be subject to the same stringent medical and legal safeguards as the instantaneous request that is more identified in the legislation that is before us.

I am hoping the member can shine a light on why his government ignored that very specific and very constructive recommendation.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, I do know that the Canadian Medical Association has raised concerns and red flags with respect to advance directives. I expect that that worry has led my government to proceed more cautiously.

We can note that the parliamentary report in and of itself provided for advance directives, but limited to where individuals had been diagnosed. Even among advance directive advocates, and in looking at that parliamentary report, we can in fact go further. I personally think we ought to go further.

While, unfortunately, those advance directives did not find their way into this legislation, my hope is that parliamentarians across the aisle and on this side of the floor can work together to ensure that we protect fully informed choice, whether one is terminally ill or not, whether one has been diagnosed or not, through advance directives.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Karina Gould, Liberal, Parliamentary Secretary to the Minister of International Development]

Mr. Speaker, I would like to begin my comment with something that the previous speaker mentioned. He said that he appreciated the tone and the level of respect that this debate has taken.

My hon. colleague began by saying that she was not going to offend anyone, or that she hoped not to. However, it is incredibly important to recognize that this issue is deeply personal. It is something that affects many different people. Therefore, to put medical assistance in dying in the way that it was painted, I think is deeply offensive to many of my constituents and people across this country. There is a certain level of respect that needs to be offered to those individuals who are seeking this assistance. They are at a point where they are suffering so immeasurably and so severely that we need to respect that decision and ensure their voices are being heard. That is what this bill addresses. It is important to remember that there are many safeguards within this bill that protect vulnerable individuals.

Because she talked about choices and rights, I am wondering what my colleague would say to someone who is suffering so immeasurably that this is the choice that he or she would make.

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

Mr. Speaker, I would repeat that there are different opinions on this issue. While we want to protect the views of those who would choose this way, there are many who are offended by that choice. We need to recognize that. That was my intent in bringing the message.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Mr. Speaker, one thing I can say about my colleague from Sarnia—Lambton is that we always know where she stands. Quite honestly, this debate is about just that. She certainly would not offend anyone, because we either live or we die. Let us be frank about it. The Supreme Court has given medical people the right to kill people. That is what has happened.

I did not see anything in this bill with respect to the following. Let us say that there are people who are terminally ill and are dying of severe cases of cancer. They might not die of the cancer; rather, they could die because of the poison that is given to them. I am wondering what the death certificates would say in terms of the cause of death. If we are to track any of the statistics, if we do not have some indication of what they actually died from, then we lose track of what this bill would accomplish.

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

Mr. Speaker, my understanding of the way it is intended to work is that if someone does request assisted dying, the cause of death would be listed as the pre-existing condition as opposed to assisted suicide. Therefore, I agree that this will cover up the tracks of how often this is happening. All of the countries that have implemented legislation like this began with good intent and good process. However, people were not following the rigour, so the data tracking was difficult. Eventually, they opened it very wide, which is my concern with this legislation.

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

Mr. Speaker, I wonder if the member could provide some comment. She was a part of the government for a number of years. The Canada health care accord that was signed back in 2004 was allowed to expire. Year after year, we in the opposition argued that the Conservative government of the day should have done something with respect to the renewal of that health care accord. It is a bit much to listen to the Conservatives saying that we are not doing enough in terms of palliative care, because palliative care no doubt would have played a very important role in any future health care accord. If we think of the future of health care delivery, would she not agree that palliative care has to be a major component of that?

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

Mr. Speaker, I absolutely do agree that palliative care has to be a fundamental part of health care as we go forward.

I heard questions earlier tonight that asked when end of life starts. Palliative care experts will tell us that even up to a year before death, in some cases two years, there is an advantage to good palliative care, the kind that does not just occur in the hospitals but in hospices and in home care. Therefore, I encourage the current government to do what it can to implement the promise it made in the budget.

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

Mr. Speaker, I can assure the member that the Liberal government will do what it can in terms of administering a palliative health care policy from coast to coast to coast. It is something we have believed in for many years and ultimately have been advocating for. Therefore, it is with pride when I look to the current Prime Minister and the Minister of Health when we talk about how we are going to see an investment in palliative care.

Before I talk more about palliative care, I want to talk about why we are here today.

It was a Supreme Court decision, a unanimous decision, which needs to be highlighted, where all of the judges came to the conclusion that Canadians suffering intolerably have the right to request assistance to end their suffering. We respect that decision. The issue before us today is, if Canada should have medical assistance in dying, how do we make it available? In essence, that is the issue before us today.

It is important that we recognize that this decision was made in February 2015. The government of the day sat back and did virtually nothing. It took a change in government, when Canadians spoke on October 19, and then a number of weeks that followed. We had the first Liberal-appointed cabinet in the last decade, and part of the mandate letter was to deal with this issue.

We do not have a choice. The Supreme Court has made this decision. We have a responsibility as parliamentarians to act on that court decision.

We have seen an incredible amount of effort put in by members of the Special Joint Committee on Physician-Assisted Dying, who worked virtually around the clock, seven days a week, with Senate colleagues. They did a phenomenal job in terms of getting us into the position of where we are today, which is debating the bill at second reading.

Hopefully, sometime this week, we will see the bill pass second reading. Parliamentarians, many of whom have talked about all sorts of ideas, will be able to make their presentation or express their thoughts at the committee stage, and at the same time allow stakeholders and individuals to share their incredible experience. At the end of the day, if we can improve this legislation, I can assure members that the Government of Canada is open to doing that. We are not fearful of accepting amendments, if in fact it can improve the quality of the legislation.

Within the legislation, members will find that there is an automatic review mechanism. After four years from this legislation becoming law, it will be reviewed by Parliament. I believe that is the responsible thing to do.

As parliamentarians, I would suggest we all have a role to play in terms of looking at how we are going to get this legislation through in a timely fashion. Not only does it have to pass the House and go to committee, it also has to get through the Senate, and it is important that it be done by June 6. We need to do this, because it is one of the ways we ensure that there are standards across the country so that void can be been filled.

We can look at what the legislation would actually do.

Access to medical assistance in dying would only be available to those who meet certain conditions. One, they must be mentally competent adults who are in an advance state of irreversible decline and capability. Two, they must have a serious and incurable illness, disease, or disability, and are experiencing enduring and intolerable suffering caused by their medical condition. Three, it must be those whose death has become reasonably foreseeable, taking into account their medical circumstances. We believe this meets what the Supreme Court of Canada has asked of us.

Obviously, it is a very emotional issue. We all have stories that we can reflect on. In 1999, I was at my father's deathbed. Thanks to good palliative care, I was able to be there at his time of passing. I appreciate the importance of pain management. He was in what I would classify as a fantastic facility. It allowed my father to end his life in a very positive fashion. Having a wonderful relationship with those he truly cared about and loved was very important, not only to me but to my family.

Prior to his going into Riverview Health Centre, I remember that we could barely communicate with him because of the intense pain that he endured. Once he was in the loving and caring hands of our health care professionals in a palliative care unit, with proper medications and painkillers, the difference was night and day. I remember saying to the doctor that we were going to have to look at having him come out, believing that he was getting so much better.

Our health care workers do an incredible service to Canadians. We need to recognize that. We should not be fearful that the legislation is going to obligate a doctor, a nurse, or a nurse practitioner to do something that goes against who they are, or that they are going to be penalized for that.

We have had those assurances, whether it is a charter of rights assurance or assurances from the ministers directly when they brought this bill forward and addressed it. The assurances are there. We are going to provide a service that is necessary. It is the right thing to do.

This is not something that is coming from one political party or one faction of society. It has gone through the court process. Nine Supreme Court judges ruled unanimously. We believe in Canada, and we believe in the rule of law. We recognize that this legislation is necessary.

As I indicated, there is always the opportunity to look for ways to improve the legislation. I am anxious to see it get to the committee stage, and to see if there is anything that could come out of the committee that would make it a better piece of legislation.

I have had the opportunity to listen to a good portion of this debate. I want to emphasize how important it is that we continue to look at palliative care and the potential that the Government of Canada has to show leadership on this issue, much like the current Prime Minister demonstrated leadership by getting in this legislation in its current format and getting the Special Joint Committee on Physician-Assisted Dying working together to bring us to where we are today.

We want to see the same sort of leadership, and I believe it is there, on the issue of palliative care. We do need to see strong national leadership on that issue. That is why I was very glad when the Minister of Health made a $3-billion commitment to palliative care.

Let us not kid ourselves; it will not be easy. I was a health care critic at the provincial level. If we are going to try to implement a program that is going to be universal so that it does not matter what region of the country people are living in, it will require a great deal of sitting down with our provincial counterparts and other stakeholders, in particular our first nations, aboriginal communities, to come up with how we can shape a world-class palliative care system.

Let us not kid ourselves; it is not going to be an easy challenge. That is why I am very grateful for the sense of commitment, whether it is coming from the PMO's office or from the Minister of Health in regard to making sure that, number one, there are financial resources to follow the commitment; and number two, that there is a feeling that in order to achieve it, we have to get people sitting around the table. That is something that is truly different this time around from what it was under the previous administration.

This government believes in working with other levels of government and believes in working with people. I believe that ultimately that is going to make the difference.

Today we debate this very important issue that all Canadians are very much concerned about. All Canadians have an opinion on it. It is such a privilege to express what I believe is what a majority of my constituents would want me to do on this issue and I feel very proud in terms of what this government has been able to accomplish in a relatively short period of time.

[Martin Shields, Conservative, Bow River, AB]

Mr. Speaker, I appreciate the member and the speaker before him for thanking us for the tone of this debate and the non-partisan and impersonal debate it was, although it got a little more personal with our colleague there.

A question I asked earlier was answered in a different way and I will try again. One of the things I see in the document deals with two doctors and two nurse practitioners that will be put in the role of signing or agreeing with the documents. In the rural areas I am familiar with having that many doctors and nurse practitioners can be a challenge. The answer I got was, “That is why there are a lot of nurse practitioners.” In the rural areas I am familiar with there are more doctors than nurse practitioners. There are not many nurse practitioners.

We come down to the challenge in rural areas of those people being known. It is very tough in a smaller community for medical staff to be labelled with that kind of a role. How would my colleague deal with this in rural areas, realizing that nurse practitioners in some areas are not as plentiful as they are in other areas?

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, I note that nurse practitioners for all intents and purposes, even though they have been around for many years, it is only in the recent decade or so that we have seen provinces looking at how we could potentially expand the roles of nurse practitioners.

I realize there are a lot of sensitive issues in regard to health care and the delivery of health care services, which include doctors in many rural communities. The more remote, the more difficult it can be, but there are also many rural communities that have a fairly healthy situation with doctors.

The answer to the question likely lies in working with our health care professionals and different stakeholders like our provinces to see if the concerns the member has raised could possibly be dealt with. I do not have the short answer, but hopefully that will assist him in getting a better understanding of where I am coming from on that issue.

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

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

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

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, as the legislation stands currently, I am fairly confident that it meets the requirements of the Supreme Court of Canada's decision. Having said that, I would remind the member, as I indicated during my remarks, that once we get to the committee stage there will be the opportunity to hear expert witnesses and the individuals who have written the legislation. Many of these questions could be put right to the table.

A lot will depend on how the ebb and flow of the committee goes. It is not to say that I do not know the specific answer, but I would feel far more comfortable given the makeup of the committee and I know the types of effort that people have gone to in looking at the actual wording. A little change in a word could have a fairly profound impact in terms of how the legislation is actually interpreted.

It is best that we understand what is being said in our intent and then we have to rely on the professionals and the individuals who are drafting the legislation and working with the different stakeholders to make sure that we get it right. I am confident that at the end of the day we will get it right.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, I want to thank the hon. member for Spadina—Fort York for his comments and for sharing his experiences with the House.

The hon. member mentioned trust a number of times, about getting it right. With a decision and legislation that bears the gravity that this does, I again go back to the time that we are spending discussing this—this is not a debate; it is a discussion—trying to make sure we get it as close to right as possible. The balance of power rests on that side of the House, and I would think that the public and perhaps those down the street in the Supreme Court can see that we are having those discussions and that, at this point, if the government went across the street and said it needs more time, I would hazard a guess that it would allow that.

Whether it is a notwithstanding clause or just asking for another extension, would my hon. colleague across the way at least say that true leadership would be asking for a bit more time for us to have this great discussion?

[Adam Vaughan, Liberal, Spadina—Fort York, ON]

Mr. Speaker, I was in the House last session when Liberals were in opposition and we moved a motion to speed this debate up to give us that time, and it was defeated. I do not think it is our privilege now, having already gone to the Supreme Court and asked for an extension, to prolong other people's suffering. We have a responsibility to act.

This issue has been in front of us for a lot longer than the bill has been in front of us; the committee spent time on it and did extraordinary work exploring this issue and laying the groundwork for the legislation; and there was work done in the previous Parliament, although not nearly fast enough.

The issue is that we have to accept, as parliamentarians, that we do not produce perfect legislation. We never will. We are just people giving it our best effort. On this bill, where a free vote has been offered to all parliamentarians on this side of the House, and I assume on the other side, we are in the position of trying to make this work. The deadline we have been given by the Supreme Court is the right decision.

It is time to act. It is time to end the suffering for some and provide clarity for others, so I do not think the responsible thing to do is to ask for a delay. We must make a decision, and then we must revisit this issue when problems arise again, because, as surely as we stand here today, they will.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Speaker, I want to thank the hon. member for his compelling speech. The one piece that stood out to me is more of a process issue.

He talked about the need to get this bill to committee so that it can be improved. That is something I would like to see. I could go on about some of the things that I do not think the government got right in this bill, but given that a special committee did a lot of great work on this and issued a report, and the government legislation does not really reflect much of anything that came out of that report, why should we have confidence that the government is going to respond appropriately to the next committee that looks at this bill?

[Adam Vaughan, Liberal, Spadina—Fort York, ON]

Mr. Speaker, I am tempted to quote one of my favourite movies and say, “You have to have a little faith”.

The committee that laid the groundwork for this legislation, the bill that is in front of us, explored a lot of issues; and at the end of the day, the justice minister presented a bill, which in the opinion of the government, gets the issue fundamentally right as it relates to the Supreme Court. It takes away some of the other issues, says that this is core of what we need to do, and leaves it to Parliament to improve upon it. We need to seize that, as parliamentarians, as an opportunity to show how Parliament can work collaboratively around, in particular, difficult issues.

The challenge we have is to find ways to address some of the ideas we want pursued, not just through this specific piece of legislation. Advance consent is an issue for me, or the different names that it is given, like advance care directives. It is a fundamental part of what is missing in this bill, and I want to see that really seized upon by the committee. The palliative care component, the duty of care to people with vulnerabilities, all of those issues are other issues we need to bring to the House, and we need to bring the same level of creativity and compassion to those issues.

We get locked into this notion that governments must present perfect legislation or, otherwise, it is thumbs up or thumbs down. Parliament is not supposed to work that way. We come here representing parties and our constituents, and we have to bring all of that to bear on legislation each and every day, not just simply vote party colours all the time. That is part of the freedom we need to explore in Parliament and one that our leader has put on the table and is trying pursue, and we need members' support to make it happen.

[The Deputy Speaker, Conservative, Bruce Stanton]

Before we resume debate, I want to make a brief comment to all hon. members. First, I want to compliment members, as we have heard earlier today, on some very heartfelt interventions from all sides of the House on this particular issue, a very human and emotional issue that is before the House.

The chair occupants are doing their best to accommodate members and are trying not to cut them off. We are down to 10-minute speeches and five-minute periods for questions and comments, which generally only leaves us enough time for two interventions during that five minute period.

We will do our best, but if members happen to notice that there are a good number of members rising on questions and comments and wish to keep their interventions concise, that would allow more members to participate in that five-minute question and comment period.

We will be as judicious and fair as we can in making sure that all members have the opportunity to finish their points, and so on.

Resuming debate, the hon. member for North Island—Powell River.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Speaker, the member referred to page 7, numbers (5) and (6), which talk about independent witnesses, and the independence of medical and nurse practitioners, ensuring that there is no business relationship, and there is no potential financial benefit from having someone have their death hastened.

Certainly, I agree with these principles that are here, but my concern is that, while they are here, a person could say that, yes, they are independent and all of those things, but there is no method of verifying whether or not that is in fact the case.

I wonder if my colleague would support the idea of a prior review, either a tribunal or judicial review, or some panel which would oversee and verify the facts that are stated.

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

Mr. Speaker, this is part of the realities we are facing.

We know that some of these decisions have to be done in partnership with the provinces which will have certain authority and responsibility in this process.

I think it goes back to that bigger question of making sure there is the support, so that we do not have a patchwork framework across the country. We want to make sure that the services make sense, and we want to make sure that we ask these hard questions.

I am hopeful that the work done in committee will answer some of these questions for us in a good way, and that we will see that process unfold in our relationship with the provincial and territorial governments.

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

Mr. Speaker, palliative care is, indeed, a very important issue.

There are many people here who believe the bill goes too far. There are many others who do not believe it goes far enough, and I fall generally in that camp. I think we could do a lot more, but I appreciate the compromise presented in this bill.

The member for Spadina—Fort York who spoke earlier is correct in that anything we do will face further challenges. For better or for worse, I do not believe this file is ever going to be completely closed. It is too close to the hearts of too many people. I think all members can agree with that.

The member wants to resolve a number of conflicts she sees between the bill and the Supreme Court ruling. I am wondering if the member plans to submit amendments to achieve that very thing at committee, and if she agrees that the committee process is the best way to address these issues within the tight timelines we face.

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

Mr. Speaker, I hope that the committee will continue the work when the bill gets there.

One of my frustrations is that many of the thoughtful recommendations that were brought forth by the last committee were not put into this bill.

I would like to see a review of the wonderful recommendations that were already made, and to make sure that we do not repeat the work that was already done.

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

Mr. Speaker, this is a difficult topic, and I am generally in agreement with what the member has put forward.

We heard earlier from the parliamentary secretary to the Prime Minister that there would be a possibility for amendments. I am wondering whether the hon. member for North Island—Powell River has considered amendments from her party, and whether we have any indication that the Liberal government will in fact entertain amendments that come from opposition members of Parliament.

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

Mr. Speaker, it is very important that all voices be heard strongly in this process.

For me in the work that I am doing, speaking with my riding has been very powerful. People are concerned. People are very supportive. Some people are very unsupportive of this process.

It is important that the government continue to do its work, to make sure that the voices are heard, so that the voices of the ridings across this country are heard.

[François Choquette, NDP, Drummond, QC]

Mr. Speaker, I want to congratulate my hon. colleague on his excellent speech. It was very well delivered and very well explained. Truly, I could not have done better.

I also want to thank my hon. colleagues from Saint-Hyacinthe—Bagot and Victoria for their excellent work on this special committee to arrive at the findings we have here.

What struck me most in my colleague's speech was the issue of palliative care. The NDP worked very hard to put in place a palliative care strategy. In my riding, we have Maison René-Verrier, which does excellent work for people who, sadly, are at the end of their life. It is very important to support those people, to be very close to them, and to help them get through this stage we must all go through.

I would like my hon. colleague to say a bit more about the importance of providing palliative care. Unfortunately, the Liberal government still has not delivered on its promises on palliative care.

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

Mr. Speaker, that is an excellent question.

Palliative care is so important. We do have an aging population, and as people get to that part of their life, they want to know the services are there for them. I represent a vast riding with many rural communities. We face many challenges in helping people stay in their communities for a period of time as they age.

Having a Canadian strategy that really engages the provinces and territories to work collaboratively to meet the needs of constituents across this country is imperative. We have already had a vote on a motion that the member for Timmins—James Bay presented and that was nearly unanimous.

In this House, we know palliative care is important. I hope we continue our work to make sure that service is delivered.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Speaker, I want to thank my colleague for pointing out that a few times tonight reference has been made to “when this bill gets to committee”. It in fact is in committee right now, and the committee has started its work. I understand it has had four hours of study already, and it will continue that tomorrow.

My colleague referred to broad consultation a number of times. He referenced the expert panel. We have the expert panel report. Unfortunately, the Liberal government chose not to accept any recommendations from the expert panel. Therefore, we are somewhat limited with respect to broad consultation.

Also, in terms of broad consultation, a number of groups requested to appear before the joint committee that were not allowed to be present simply because of the time pressure. Therefore, to use the term “broad consultation” is a bit of a stretch. However, I certainly hope that in the next week of study at the justice committee there will be broader consultation.

My colleague referred to the fact that this should apply equally across Canada. I wonder if he would agree that if we can apply the access to physician-assisted dying across Canada, we could also at least ensure conscience right protection for physicians and other medical health practitioners, as well as institutions that offer health care, be applied equally across Canada.

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

Mr. Speaker, the consultations have been broad. The joint committee heard from over 60 witnesses and received over 100 different briefs. Over the next week, my colleagues and I will hear from 42 witnesses. We have yet to determine the number of briefs that we will receive, but I expect it will exceed the number of witnesses who we are hearing. We are getting a broad variety of opinions from faith groups, medical associations, individuals, and bar associations.

The other issue that my hon. friend brought up was conscience rights, and whether they can be enshrined. This is a Criminal Code amendment at its core. This law would not compel physicians to do anything. We have to respect the jurisdiction of the provinces and the provinces regulate medical professions and so do the independent colleges of physicians and surgeons and colleges of nurses, and so on and so forth. We have to respect the rights of the provinces to legislate in that regard.

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

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

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

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

Mr. Speaker, the Supreme Court has been clear. It has set for us a deadline of June 6 to pass legislation. This is not a matter of whether medical assistance in dying is to be legal; it is to establish a framework.

I am concerned that should we go forward there will be a vacuum in which there is no regulation. We must act. The Supreme Court has given us an extension of time. We have the time in which to do it. I know it may seem that we are a bit rushed, but we are willing to work extra hard on the justice committee to ensure it gets back to this place in the appropriate amount of time. However, it is imperative that we get this work completed, and get it to the other place so that vacuum does not exist.

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

Mr. Speaker, earlier an hon. member talked about respecting provincial jurisdictions.

Does the government know how it is going to ensure that the practice will not be too different from one end of the country to the other? In other words, how will it prevent fragmentation while respecting provincial jurisdiction?

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

Mr. Speaker, I believe the bill is set up in an appropriate way that it would allow for the provinces to set up with their own colleges and with their own regulations on how medical assistance would be provided. As the hon. member knows, the provision of health care services in the country is the jurisdiction of the province. We respect that and the bill makes provisions for that. The minister has stated that she looks forward to working with the provinces to assist in a framework across the country.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Speaker, I want to thank my colleague for her impassioned speech on this topic, and especially the examples of her father and friend. I thank her for sharing that with us.

I would ask my colleague to comment further on the importance of this legislation, in particular for other members of communities who are contemplating this important decision in their lives.

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

Mr. Speaker, I think that this is a social bill. As I said, we must leave partisanship aside and listen to what Canadians want us to do as legislators. A lot of people have concerns about this bill because they do not believe it is sufficiently well framed. That is why if we are required to do this, I want it to be drafted in such a way that it respects all Canadians. This bill must include safeguards for those who are going to use it. Those safeguards are just as important for us, the legislators, but they are especially important for Canadians.

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

Mr. Speaker, I thank the member for personalizing the conversation in relation to family members. It is appreciated.

Coming back to the issue of palliative care, I want to thank the Conservative members of the special committee who put a focus in their dissenting report on the importance of palliative care and the failure of successive governments to implement that.

I want to flag again the work that my colleague from Timmins—James Bay is doing on the palliative care issue and the fact that he was able to get the House to agree. It was a rare moment of close agreement a couple of years ago.

I am hoping that the member can talk a bit more about what steps the House and the government might take to bring some of those recommendations around palliative care to fruition.

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

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

We are talking at length about medical assistance in dying, but the need for palliative care is also great. I used to provide support for people who were dying and suffering. We need palliative care so that people who wish to continue living despite the illness consuming them can live in a supportive environment where they are properly cared for and find relief from their illnesses.

Some of them want to live more than anything, whereas others want to die. We have to look at both sides of the coin. We should have this debate because it is not a partisan debate but rather a societal debate.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, we were very pleased and moved to hear our newly elected colleague, who has also served in other sessions. It is clear that she is experienced.

Are people in my colleague's riding talking about this issue? What are they telling her?

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

Mr. Speaker, I would like to thank my colleague for his question.

Yes, they are obviously talking to me about this issue. I see both sides of the issue, and they are very well defined. When I visit the urban part of my community, people tell me that they are in favour of this bill. When I visit the rural part, people are starting to ask some good questions that make me think about the importance of representing both parties in this bill: the people who are at the end of their lives and the people who want to live. That is what is missing in this bill. Quite frankly, palliative care has been forgotten. Therefore, I am hearing one thing from the urban population and another from the rural population.

As legislators, we want a law that benefits all Canadians, whether they have the right to die or not.

[Larry Bagnell, Liberal, Yukon, YT]

Mr. Speaker, I am happy to rise on this very important debate. It affects all of us, including my wife Melissa, my seven-year-old daughter Aurora, my four-year-old son Dawson, me, and everyone. Not all bills affect every Canadian, but this does. It is a very critical debate.

When this first came up in the House, I voted against it, because sadly there is much elder abuse in Canada, people who take advantage of those with less capacity. I encourage all legislatures, all four levels of government in Canada, all government workers, and all journalists to do everything in their power to work to eliminate elder abuse. That includes the protections needed in this particular bill.

I was also not comforted by what happens in some European countries with legislation. Many people are assisted in dying without their consent.

I have now been convinced by six items. First is the great care that was put into the protection provisions of this bill. There are two doctors or nurse practitioners, totally independent from each other, who are needed to approve the consent.

Informed consent is needed, and again at the time that the act will be carried out. The person must be suffering from intolerable pain. They must provide written consent. They must be in the process of dying, and there must be a 15-day waiting period.

There must be a five-year review of this bill, with the additions that many people might be suggesting during this debate.

Also, I have been convinced by the overwhelming support of my constituents who have contacted me, saying that people should have assistance in choosing the time to end their intolerable suffering.

I have also been convinced by the government's strong conviction, ensuring that there is good palliative care, so that the lack thereof is not what forces the choice of this other decision under this law.

I am also convinced by the cautious approach the government has taken to ensure that such a major life-and-death decision is done right.

Finally, I am convinced that there will be no sanction against health care workers who do not want to participate. I talked to a very experienced medical administrator who suggested that it could be up to 90% of doctors who would choose not to participate. For the provincial and territorial governments, that will provide an administrative challenge for those very small communities that may only have one practitioner.

I have asked my constituents, through the newspaper, to give me feedback. I received very heartfelt thanks and heartfelt views on all sides of this legislation, similar to what I am sure the other 338 members of Parliament have from many of their constituents. Of course, they were not all the same.

I have not had any bad experiences, as a number of MPs have had. However, I was moved by the sad stories of those who did, primarily with family members.

I remember a call from a mayor who told the story of the terrible suffering of a family member. It had gone on far longer than was ever needed. There was no benefit to the person. They did not want to be there.

I remember a call from another friend in a very similar situation. They exposed the myth that it was important not to do this in order to have family gathering together for a peaceful end. They outlined how that is a myth because at the end, in that particular case, the person was in so much pain and it was so distracting, the person did not want to or have the ability to see or gather with anyone.

I had feedback from another constituent whose father and other relatives had Alzheimer's disease. It was a terrible end that they did not want to have, and it could have been ended earlier.

Other constituents gave a large number of different views. One person said that if we allowed such suffering to go on in an animal, we would be charged. Another person talked about their husband who had a rapidly deteriorating disease. He wanted to die at home with family and could not. The doctor explained how that was not possible. They had a terrible painful experience in the hospital for their last few days.

On the other side of the issue, I had a nurse contact me who is totally against the bill and did not think we should proceed with it.

Then there were two views related to the people who are left behind in these situations. There were a number of people who, when in this terrible pain and suffering, did not want the suffering of their relatives and friends to go on. They wanted to terminate their lives so there would be no suffering left for their family and friends. On the other side of the coin, a person suggested we did not want to deny family and friends the wonderful ability to care for that person to the end.

Another person suggested that we have to make sure that all publicly funded health care facilities must allow this.

I also had a suggestion from someone who works with seniors, wanting an advance directive, similar to what is in the Yukon Care Consent Act for end of life that exists right now.

In summary, a majority of my constituents were in favour of assisted dying. Some were against it, like a woman from the small community of Haines Junction. Of those in favour, a number of them want some of the suggestions that people have talked about here today. Many were in favour of having advance directives. I would say that is the biggest amendment they would like to occur at second reading.

I want to close with a couple of suggestions for the committee to wrestle with. First is the advance directives. If people have a debilitating disease, they have to give informed consent at the very last minute, but they may not be able to, as they might not be in condition to do so, so it defeats the whole purpose. Perhaps it should be allowed only for those who are not capable at the last minute so that, as has occurred in the past, people with advance directives who in the end did not want them carried out are not taken advantage of.

The second biggest suggestion was related to the description of foreseeable future. On one side it may provide the flexibility that people want to make the right decision at the right time. On the other hand, it may not be enough definition. Medical workers want more definition, so they are not caught on the wrong side of a criminal law suit.

I had a student ask me an interesting question: what if a person suffering from an insufferable physical disease also has a mental illness and therefore could not give the informed consent? I am glad the committee will further study mental illness. I had a number of people suggest that mental health, Alzheimer's, and even mature youth need to be dealt with.

I want to thank my constituents and members of the House for this very non-partisan, thoughtful debate on this life-and-death situation for all of us. Hopefully, in the end we will find the combination that gives the most peace to the most Canadians.

[Bernard Généreux, Conservative, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC]

Mr. Speaker, my colleague gave an excellent speech. He described his riding, which is very big like mine. Actually, I think his riding is even bigger than mine.

Rural regions often have difficulty obtaining services. In my opinion, offering palliative care would be one way to make up for the lack of services available to people who need help at the end of their lives. I would like my colleague to talk about how increasing services and care at centres designed for that purpose fits in with this bill.

[Larry Bagnell, Liberal, Yukon, YT]

Mr. Speaker, I definitely agree with the member. I am very happy that the minister is so committed to palliative care, which is an important part of this whole process, so that a person does not have to make a decision on assisted death just because good palliative care is not available.

My mother had wonderful palliative care in B.C., and I would hope that is available to all Canadians.

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

Mr. Speaker, I would like to discuss further with the member the comments he has heard from his constituents around conscientious objection from health care providers and practitioners.

New Democrats in the all-party committee made a clear recommendation that no health care worker should ever be compelled to participate in assisted dying and that they should be legally shielded from unfair consequences resulting from that personal decision.

Despite my intention to support the bill at second reading and send it to committee, there is still concern that there are no legislative measures to enshrine that recommendation, although we are hearing from the government that it may be interested in non-legislative options.

I would be interested to hear whether the member has further ideas about which side of the regulation that issue might fall and whether he shares my concern that it would be better, for the sake of health care providers, to lock in those protections and guarantees.

[Larry Bagnell, Liberal, Yukon, YT]

Mr. Speaker, none of the health care people I talked with were concerned that their protection was not in the bill, but I certainly hope the committee does look at it.

[Sean Casey, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Mr. Speaker, I thank my colleague, the member for Yukon, for his remarks. Clearly, he has consulted widely through his community and through his riding.

There are a couple of points arising, one is with respect to medical directives.

There has been a lot of discussion around medical directives, but the international experience, certainly in the Netherlands, is that even where they are allowed, most of the time medical practitioners are reluctant to rely upon them; and so, we would be very much forging new ground in that regard in a very compressed timeframe. Perhaps the member would like to give us some reflections in that regard.

The second point, I think, relates more to his riding; that is, in this legislation, there is something that is fairly unique to Canada, which is an enhanced role for nurse practitioners. The goal of the government certainly was, by allowing an enhanced role for nurse practitioners, to ensure access or to provide greater access for rural and remote communities. Perhaps the member would like to comment on whether that is important in an area like Yukon.

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

In 30 seconds or less, the hon. member for Yukon.

[Larry Bagnell, Liberal, Yukon, YT]

Mr. Speaker, in 30 seconds I cannot deal with the advance directives other than to say it is very important that the committee deal with this in depth. That is why I am glad that, failing that, it will be taken up in the five-year review of the bill.

With respect to nurse practitioners, yes, in places like rural areas, there are huge, vast areas, larger probably than any country in Europe, that do not have a single doctor. So, nurse practitioners are increasingly playing a very important role. I think that is why the government included them in this legislation.

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

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

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

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

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

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

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

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

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

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

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

Section 7 of the charter says:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Speaker, the member has added one more to a long list of excellent speeches here today from all parties. Congratulations on that.

There are many conflicting emotions and opinions for so many people on this issue. I want to congratulate the government for taking those different viewpoints, balancing them with one another and with the requirement of the court ruling, and coming up with this excellent piece of legislation.

Would I like it to go further? Yes, I would. Personally, I would like to see the right to assisted death by a living will—that is advance approval—included as the member referenced. I also know that not everyone agrees with that for a variety of completely valid reasons. Indeed, many of our colleagues would like this bill to be more restrictive on certain points.

I congratulate also the special committee on such tremendous work and on producing such a comprehensive report that looks at these substantial and substantive nuances and conflicts. In the context of all the circumstances before us, the government has done the best possible job of balancing all of these different perspectives to get this bill in within the imposed and very rapid deadline.

I wonder if the member agrees that even on the points where he may disagree, the government has achieved a real working compromise that moves us forward as a country on this extremely important issue, and that the risk of doing too much and then having it fail outweighs the benefits of having a bill that would do everything the more progressive among us would like.

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

Mr. Speaker, I will agree with the member that the timeline is not ideal. Here we are on May 2, and June is next month and that is the deadline. This bill still has to make it through committee, come back for report and third reading, and go through the Senate before the Governor General signs off. In that time, we have not had much time to do the proper work, but we have to deal with what we have.

As for the certain clauses that the member was talking about, I just wish that the government had listened a bit more and followed the special joint committee's recommendations. Specifically with proposed paragraph 241.2(2)(d), that was a glaring oversight. However, again I do welcome its going to committee and I hope we have amendments that do it justice.

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

Mr. Speaker, based on what the member and others have said, it seems there is a consensus emerging, at least from the different opposition parties, about the need to have clearer and better protection of conscience. The Liberals say this is important to them. Why not put it in the legislation, exactly as the member talked about, using the model of the Civil Marriage Act?

I would caution the member on putting too much stock in the special joint committee. I know the member was not part of that process, but my big concern was that there was a real bias in terms of the witnesses who were able to present and the witnesses who were not able to present. Just one example is that we had three separate panels from the organization Dying with Dignity. However, many intervenors on the other side of the issue, people who actually intervened in the Carter decision and presented to the federal expert panel, were not able to participate in the special joint committee. I understand, from what I have heard so far, that the justice committee is looking at a more balanced group of witnesses and I really appreciate that. However, I would caution the member to consider the process that led to that result, and hopefully we will see a more balanced group of witnesses from the justice committee.

On the issue of advance directives, the big problem with advance directives is that those are used in very specific situations where the outcomes and all the elements can be predicted in advance. The problem is that it is very difficult to predict what exactly will happen to someone undergoing one of these illnesses or how the individual will respond to it. I wonder if the member can talk about the problems of using advance directives when there is not certainty at all about the kind of process that a person is going to go through or how that person is going to experience that at that time.

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

Mr. Speaker, I recognize that everyone in the House to some extent has had personal experience with the loss of a loved one. For me, it was my wife's grandmother, who was suffering from dementia. Had we stepped back a few years with her when she was present and cognizant and if she had been able to peek into the future and look at what her life would end up being, she might have wanted a different path. It is very hard to witness someone going through that who has lost the mental faculty to make a decision on his or her own.

I agree with the member. It is a very thorny subject, but I believe it is one that absolutely deserves a closer look. Someone who has a diagnosis of dementia is going to look at section 7 of the charter and is going to say, “This is failing me.” He or she is then going to take it to the Supreme Court and I am pretty sure that the Supreme Court will rule in that person's favour. It is up to us to grapple with this issue now.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Speaker, the member talked about the possibility of amendments. I would like to suggest one amendment and hear his comments on it.

We have these criteria in the bill, but the criteria only mean something if there is some kind of assessment in advance. If the only assessment of each case is retrospective, then there is very little way of adjudicating if someone is actually meeting the criteria. There is no way of protecting the vulnerable, because even if there is some suspicion of a problem, the person is already dead.

Our first priority should be to protect people who do not consent, who do not want this, from being pushed into it.

Would the member agree with me that a simple system of advanced, legal review by some kind of cognizant authority is necessary to ensure that people who do not consent do not have their lives taken inadvertently? It could be a judge, or a consent and capacity board, and the model could vary from province to province.

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

Mr. Speaker, we have a rare opportunity to hear from the member for Sherwood Park—Fort Saskatchewan, and I appreciate his question in this House. It is an important question.

I think everyone here agrees that we would all be very disappointed if we enacted a law that resulted in people having their lives terminated without their consent. I agree with the member that, as long as the mechanism in place could still be processed quickly without further suffering to the patient, it is a safeguard that should be in the system. We want to ensure that we are aligned with the Supreme Court that the patient consents to the termination of his or her life. I am happy to support whatever we need to do to ensure that is in the legislation.

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

Mr. Speaker, although the hon. member for Newmarket—Aurora is not in the position of being a parliamentary secretary or a minister, as a member of the majority Liberal government my question to him is this. Does he have any sense of whether the committee will be open to amendments and whether the governing party will allow amendments?

I have had the very depressing experience today of watching Liberal members being forced to vote for a motion that I pleaded them not to vote for. It is the first time I have had a very strong sense that perhaps the respect for individual members of Parliament and the ability to bring amendments at committee, reflecting the will of the committee, may be more circumscribed than I would have hoped.

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

Mr. Speaker, the member is correct that, like her, I am not a minister of the crown or a parliamentary secretary. However, like her, I am a Dalhousie law graduate and have a complete respect for the legal process. I think, for the legal and law-making processes to work well, committees must have the ability, the power, and the capacity to make amendments when that is the will of the committee or the House. I trust and I have faith in the justice committee that it will be not only willing but able to do so at the committee stage.

[Martin Shields, Conservative, Bow River, AB]

Mr. Speaker, I appreciate the member's contribution to the discussion this evening. One of the challenges I find with this legislation is from my past experience when I was on a board that was attempting to design do-not-resuscitate orders with doctors. It took us a couple of years before they finally agreed to it, and it turned into four levels, not one, of do-not-resuscitate orders. What we then found was that the doctors still found a way to not implement them. They said that we as a board had decided on the policy but that they did not want to implement it.

My question to my colleague is this. We have 10 different provinces and territories. How will we deal with a profession that really does not want to implement this particular process?

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

Mr. Speaker, I do not necessarily share my colleague's pessimism with respect to the ability of our provinces to implement processes that may or may not be derived at the federal level. I also do not necessarily agree that they may not want to implement them. If there is a robust consultation system in place with the provinces, the medical associations, and the health professionals in all of the provinces, by working in consultation, knowing full well that whatever process is in place has to be in line with the Supreme Court of Canada, I am convinced and optimistic that we will be able to come up with a reasonable process that ensures that doctors and health professionals are protected, and that the rights of the patients are protected at the same time.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Sean Casey, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Mr. Speaker, I always appreciate the thoughtful remarks from the member for Saanich—Gulf Islands.

However, I want to push back a little on her suggestion that this is bound for unsuccessful litigation and ask her these three questions. Would she agree that the court in its decision did not define “grievous and irremediable”? Would she agree that it was open to Parliament to provide such a definition? Would she agree that at page 98 of the decision, the Supreme Court said it would give a great degree of deference to any complex regulatory scheme that is put in place by Parliament to respond to the decision?

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

Mr. Speaker, I return the compliment to my friend, the member for Charlottetown and parliamentary secretary. I enjoy working with him as well.

However, in answering his question, while the court did not define “grievous and irremediable”, it is a logical leap, which I will not take, to imagine that the court was not considering the specific case in front of it. In other words, the case of Kay Carter dealt with someone who was in a grievous and irremediable situation, but her natural death was not foreseeable at that moment. The facts set before the court that led it to make this ruling was that there was a violation of charter rights, not in the abstract, but for the plaintiff, the litigant, before them. It described her condition as “grievous and irremediable”. In that, it did not insist that we know or that her doctors know that her natural death was foreseeable. In other words, the facts set in this case did not require a terminal illness.

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

Mr. Speaker, I want to thank my colleague for her thoughtful remarks, although I may disagree with her on some of her conclusions.

Would she agree that there needs to be better protection within the legislation to ensure that should their conscience not allow medical or health care practitioners who are providing end-of-life care to go down that path, that they should have the freedom not to participate?

Second, in terms of the potential future of this regime, in whatever form it ends up taking, is she concerned at all about the impact on the potential lack of trust between patient and doctor? What would this do to the patient-doctor relationship in terms of trust, especially for those who are elderly, who may be facing end-of-life decisions?

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

Mr. Speaker, I do not think there is any dispute—well, I should not say there is no dispute—between the hon. member and myself. It is only right that a health care professional would have the ability to say that they would not want to assist in a situation like this.

As for whether I think this would call into question the relationship between a patient and their doctor, I do not see that it would. I believe that doctors who are not prepared to assist in this way will make a recommendation to the patient that they find somebody who is prepared to do it. They know they need to get independent medical advice from more than one medical professional.

I have great respect for the medical profession. I cannot imagine the medical profession urging someone to consider an option such as medical-assisted dying if that is not something the individual, on their own, has chosen because they are in a situation of grievous suffering and they wish that for themselves. I do not see it contaminating the doctor-patient relationship.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Speaker, it is good to hear the member talk about how she sees the protection of conscience as very important, but I would simply ask, why not protect it in the legislation? There is, of course, a precedent for this. We have talked about the Civil Marriage Act including protection for conscience at the federal level. A similar model could be used.

Essentially, what we are being told by the government is that we are talking about it, so why not just take the government's word for it. Taking the government's word for it just is not good enough. We want to see conscience protection included in the legislation.

Also, does the member clearly understand that the protection of conscience includes the right to choose not to refer? There has been some confusion about that by some other members. Respecting an individual's conscience includes the right to not only not provide a service but to not be complicit in providing the service by using a formal referral. Physicians do not have an objection to providing information, of course, and facilitating the orderly transfer of records, but there is a big difference between that and a formal referral. I would appreciate the member's comments on that as well.

[Celina Caesar-Chavannes, Liberal, Whitby, ON]

Mr. Speaker, with respect to the right of a physician not to refer, as I said in my comments, this is for the provinces and territories to determine, with the help of the government, to respect the conscience rights of physicians.

The question about referrals did come up in my riding. Many were concerned about that. I hope that consideration is part of an ongoing conversation with the provinces and territories and medical professionals.

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

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

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

[Celina Caesar-Chavannes, Liberal, Whitby, ON]

Mr. Speaker, as the Minister of Health has stated many times in this House, she is in constant dialogue with the provinces and territories to renew the health accord. There is a commitment of $3 billion in the budget to look at end-of-life care, including home care and palliative care.

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

Mr. Speaker, as a follow-up to my previous question, to put a finer point on it, the current policy of the College of Physicians and Surgeons of Ontario is to require referral if something falls within the standard of care, or in an emergency or urgent situation, to actually require the provision of that service. This is not something that can wait for further consultation, because if this legislation passes, then right after June 6, or whenever this would take effect, it would be required in Ontario for physicians to either refer or potentially to provide this service.

If the member accepts the value of protecting conscience, recognizing that this could be the reality and the outcome in her riding once this legislation passes, would she not support immediate changes to this legislation which formally and directly would ensure the protection of conscience in that legislation?

[Celina Caesar-Chavannes, Liberal, Whitby, ON]

Mr. Speaker, I do respect the fact that there are jurisdictional boundaries with respect to what we can and cannot legislate. The provinces and territories have jurisdiction over this particular aspect and the government will continue to work with the provinces and territories to ensure that the conscience rights of our medical professionals are taken into consideration with respect to this bill.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Mr. Speaker, I appreciate the comments by my friend across the way, but I am confused about the emphasis on palliative care with the deadline that is presented to us, which is June 6.

If we were going to venture into palliative care and incorporate it into the legislation, we would have to have talks with the provinces that would actually be delivering the palliative care. The first thing we would have to do is define what proper palliative care would be, and that would become confusing because in some cases there would be family members available and in other cases there would not. I had a case in my own family with two grandmothers over 100 years of age whose children were in their eighties. I am not sure whether a definition could incorporate them into that.

Given the deadline we have and the involvement with the provinces, how would my colleague suggest that we possibly approach the palliative care question?

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

Mr. Speaker, in an ideal world, we would have the time to do things in order. Unfortunately, the Supreme Court imposed a deadline. I think that the choices when it comes to end of life are comprehensive choices. We cannot just offer people medical assistance in dying without also offering them the possibility of dying gently, with dignity, and with palliative care. We must offer both options to Canadians.

As to how to do that, it is a judge who decided to force our hand and make us proceed more quickly. We must do everything in our power to make palliative care available. It is our duty as members of Parliament.

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

Mr. Speaker, with respect to palliative care, one of the proposals we have heard is to have a right to palliative care put into this legislation. We could not fully operationalize it today, but we could introduce a right that people could expect to have. That would fit really well with this.

This bill provides no conscience protection for doctors and nurses. If Parliament supports this bill, doctors in Ontario will not be able to opt out of performing euthanasia, and it is possible that some doctors will leave the profession. I urge the government to include conscience protection for doctors in this bill.

Does the hon. member agree with that?

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

Mr. Speaker, obviously, we cannot ask anyone to go against their values. We cannot force a health care professional to participate. As stated in the dissenting report, the act must protect the freedom of conscience of doctors, health care professionals, and all those who will be called upon to participate in this process.

That is an excellent question, and the answer should be obvious. I do not see how the opposite could happen, unless there was a new case before the Supreme Court because we would have unfortunately failed in this exercise.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Speaker, I think the hon. member respectfully engaged in some obvious sleight of hand with respect to the conscience provisions that are not in this legislation. He has said that it is a misconception to say that this legislation does not address conscience, but then he says there is nothing in the legislation that would directly infringe conscience. The fact is that the legislation does not contain conscience protection.

The member is right that it would not require the infringement of conscience, but it does not contain conscience protection. The effect of the absence of conscience protection is that in the province of Ontario at least, and perhaps other provinces, as soon as this legislation takes effect and euthanasia will enter the standard of care, physicians will be required to either refer or even, in certain situations, will be required to provide. The member should know that this would be the clear effect of this legislation. He should acknowledge that.

Again, if the member thinks conscience is important, why does the government not put forward amendments which would actually ensure the protection of conscience? Let us stop this slippery game about the language. If we all agree that conscience is important, why do we not firmly protect it in the legislation?

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

Mr. Speaker, as was stated by one of my colleagues earlier, the comment is that the provinces and territories will end up dealing with this issue of conscientious objection. The colleges will need to deal with referral. I have spoken to people within my home province of British Columbia, and the sense is that the provincial and territorial jurisdictions will need to be involved, and that is the appropriate place to address conscientious objection within this topic of medical assistance in dying.

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

Mr. Speaker, I want to thank my hon. colleague for Cloverdale—Langley City. Again, it is a marked departure from previous debates in this place to hear so many members of the governing party speaking clearly of their own concerns about government legislation.

I would ask my hon. colleague if he has a sense of whether the government, the minister, the committee, will have the right and expectation of being able to accept amendments, if that becomes the decision of the committee operating independent of control by the Prime Minister's Office or the minister.

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

Mr. Speaker, I believe very much that we have a good piece of legislation. As I said in my comments, it is a starting piece for a very difficult subject.

Our government has been very clear that we have legislation that has been put forward. We are in the consultation stage right now. We are having this debate. I believe that if compelling arguments are brought forward, they will at least be considered as the final legislation comes forward. I will be watching, along with my constituents, on what the final bill looks like.

[Michael Levitt, Liberal, York Centre, ON]

Mr. Speaker, I want to thank the hon. member for his speech, and I also want to add my voice in congratulating the members of this House for the tone of the debate this evening on what has been a rather late night.

Like all members of this House, I spent the last week in my riding of York Centre, where I had the opportunity to hear from a number of my constituents on this issue and on this bill. What I heard most was that it strikes a balance. I heard from people across the spectrum, who phoned or came into the office, that it is striking a balance, that there is work to be done, but that they feel this is a solid place to start as we head to the committee phase.

From my point of view, the advance directive provisions, dealing with individuals with mental illness, and many other things still need to be looked at.

I would ask the member what he feels are some of the things that the committee can be examining in this next phase, because I believe that the House should pass the bill and send it to committee.

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

Mr. Speaker, I would encourage the committee to listen to the comments that are being put forward, both the questions and concerns, and attempt to have witnesses who can address those, as the special joint committee had done. Then we will be able to weigh through the evidence, as we are about evidence-based policy, and see how the recommendations can be made to perhaps strengthen Bill C-14.

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

Mr. Speaker, I am probably one of the last to speak today, since it is almost midnight.

Since this is my first long speech, I would like to take this opportunity to thank the 105,000 voters I represent. Not all 105,000 of my constituents voted for me, but more than 44% of the people of Portneuf—Jacques-Cartier did. I thank them.

Members win election campaigns, but we never do so alone. It is a family affair. Family is important to me. I would like to take this opportunity to thank my wife, Isabelle, who happens to be here this week. She is not in the gallery because it is late, but I appreciate her being here in Ottawa. I also want to thank my children, who are currently asleep. Charles-Antoine and Ann-Frédérique participated in my election campaign and sacrificed quality time with their father during the campaign. I want to thank them.

Last year, 2015, was a very difficult year for me. Talking about it is very emotional for me. There was an election. The 338 MPs here campaigned, but unfortunately, as fate would have it, my father passed away right in the middle of the campaign, on August 19. Unfortunately, he will never see me here in the House. He would probably have been very proud. My mother died in May. Both of my parents died in the same year, in 2015. I had two loyal volunteers up there watching over me. Sadly, my mother died of cancer like so many Canadians. We all have our story. I am sharing mine today. My father and mother died in 2015, but the year ended on a high note because I was elected.

My mother was diagnosed with cancer two years before she died. That is why I am taking part in this evening's debate, because I supported my mother through her illness. She passed away on May 1, 2015. She lived through that agony, and I would call it agony, but she was serene. She had some good times in those two years. She enjoyed the gatherings we had during those last two years. I saw her smile. I saw her stay positive. I saw her become a fighter. Unfortunately, on May 1, at 6:50 p.m., I had the unfortunate experience of finding her in her hospital bed after she had died. She had just begun palliative care. Unfortunately, it happened just a few minutes before I entered the room. That is why this debate is so important to me. I supported her. She did not really have the opportunity to improve her condition, which deteriorated really quickly.

The principle behind Bill C-14 is to allow Canadians to die with dignity. What is the definition of “dignity”? Dignity can be described as the respect, consideration, or regard that someone or something deserves. Human dignity is the principle whereby no person should ever be treated as an object or as a means, but rather as an intrinsic entity.

Out of respect, I can say that my mother was treated with dignity. She was treated with respect throughout her agony. She was respected until the very end. The law did not exist. Is this law really necessary? The Supreme Court requires us to make a decision, pass a law, accept a law and enact it. However, what worries me about this law are the parameters. It is important to understand that we must allow people to have access to medical assistance in dying.

However, human nature being what it is, it is difficult to take rights away from people after implementing a law that is too broad in scope. I therefore invite parliamentarians and the committee that will be examining the bill to be thorough and restrictive.

Let us begin by talking about the definition of “reasonably foreseeable”. I would like to inform the House that according to my life expectancy, I will die in 2044 at the age of 79. That is reasonable and foreseeable. That means we have a problem. This term is not defined clearly enough. It is not specific enough. The definition is too broad.

The Supreme Court of Canada gave us the mandate to determine the criteria for defining grievous and irremediable medical conditions. Why are we afraid of using science to define these criteria? Science can determine whether someone is at the end of his or her life. We are afraid to use words like “terminal”. A word like that does not really leave room for interpretation. If science tells a person that his or her condition is terminal, then it means that it is terminal and that that person should expect to die in the near future.

I would encourage the people who will be assessing the legislation to be very specific. We need to restrict access to this procedure. In my opinion, the first criterion should be that access is limited to people who are, unfortunately, terminally ill. I want to emphasize that safeguards should be put in place to restrict access to medical assistance in dying. We need to set very strict and restrictive parameters.

Doctors are there to save lives. They need to abide by the Hippocratic oath. Nurse practitioners are also being added to the mix. When they went to school, they did not expect to have to take any action that would result in death. We are talking about professionals who want to treat people to help improve their health. Why are we asking them to do the opposite? Are we going to ask other groups who work in hospitals to engage in this type of intervention? The nursing associations that I consulted were very surprised to be given this new responsibility and be part of this debate.

Some argue that there are regions that do not have access to doctors. If there are no nurse practitioners, who are we going to ask? The bill provides for a 15-day waiting period. To my knowledge, in this very beautiful country of Canada, the second-largest in the world, we are never 15 days away from treatment by doctors. We must not hand over the responsibility of carrying this out to a professional body other than the medical profession.

Do my colleagues know that a person other than nurse practitioners and doctors can go around with the famous drug that ends life? Clause 4 of the bill clearly stipulates:

No pharmacist who dispenses a substance to a person other than a medical practitioner or nurse practitioner commits an offence under paragraph (1)(b) if the pharmacist dispenses the substance further to a prescription that is written by such a practitioner in providing medical assistance in dying in accordance with section 241.2.

That is dangerous. People will be able to walk the streets with a drug that kills. We must also protect our seniors. They are vulnerable people. Heirs, insurance policies, caregivers, and families can take advantage of seniors. Let us protect our seniors. Let us be restrictive and put safeguards in place to impose as many limits as possible.

There is a centre called Cité Joie in my riding. I can understand that people reach the point of exhaustion. The centre offers respite. I can tell you that I have seen people there with extraordinary smiles.

I cannot bear to no longer see such happiness. We have to support these people. We cannot give them that possibility. I have much to say. However, in closing, I would like to inform the House that I have not made up my mind about the final bill. I am asking the committee that will study it to put more restrictive provisions in the bill so that we can believe in life and we resort to the legislation only at the end of life.

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

Mr. Speaker, I appreciate the personal story and the comments by my colleague from Portneuf—Jacques-Cartier. This is a very personal, emotional and important debate. Like me, he is a new MP, and he was not here when the Carter decision was handed down.

However, I am somewhat frustrated by the fact that nothing was done in the four months that passed between the time that the Supreme Court ruling was handed down and the end of the 41st parliament.

Since we were given such a short deadline, does my colleague believe that passing the bill at second reading would improve the situation, even if he is not satisfied with the conditions, or would he be happy with the void created by the failure to pass the bill at third reading, in the event that the changes he wants were not accepted?

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

Mr. Speaker, we cannot change the past, but we can change the future.

We, the members of the opposition, are here to work with the government members. I do not want partisanship to enter into this debate, because this issue is too important for that.

Now, can we move forward on this bill? I very much appreciate my colleague's question, and I am not here to obstruct this bill. I respect my colleague. I am here to work with all parliamentarians so that all Canadians, whether in my riding or my colleagues' ridings, will be satisfied with our work and how we are representing them on this non-partisan file.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, facts are facts.

A year ago, when the Supreme Court directed Parliament to legislate, we did not really have a choice. The Supreme Court knew it was an election year. Parliament therefore had just three months before the fall election was called.

During that time, the government, under the leadership of the right hon. member for Calgary Heritage, struck a committee of three independent Canadian experts to study the situation. It is a lie to say that the former government did nothing. The committee produced a lengthy report with several recommendations. It was a great help to the parliamentary committee that produced the main report and the dissenting report. Those are the facts.

We talked about this for six years in Quebec. Here in the House of Commons, we have limited time. Nevertheless, is the member listening to his constituents, and are his constituents talking to him about this very sensitive subject?

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

Mr. Speaker, I thank my colleague from Louis-Saint-Laurent, who has a lot of experience, especially on this issue. He had the privilege of working in the Quebec National Assembly, and he participated in the debate over six years. As he said, it is rather odd that we are taking six months, while Quebec took six years. It is no wonder we are here so late this evening. As parliamentarians, we are working extra hard.

I obviously meet with many constituents in my riding. They all want to discuss this very sensitive topic. There is no standard opinion on this issue, and no one blindly agrees. It is important to listen. As I mentioned in my speech, everyone has had a different experience with death, whether it is the death of a friend, family member, or child.

This is therefore a very emotional issue, and my constituents talk to me about it. I listen to them and ask questions to ensure that I am representing them well. When we vote on this bill in the House, I will make a decision that I think best reflects the beliefs of the people of Portneuf—Jacques-Cartier.

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

There being no further members rising for debate, pursuant to order made earlier today, the debate is deemed adjourned and the House stands adjourned until tomorrow at 10 a.m., pursuant to Standing Order 24(1).

(The House adjourned at 11:55 p.m.)

The House resumed from May 2 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.

[Kim Rudd, Liberal, Parliamentary Secretary to the Minister of Natural Resources]

Mr. Speaker, I am here today to talk about an issue that touches the lives of every Canadian—how we die. It is not an issue we usually like to discuss, but with the Supreme Court's decision in the Carter case, it is now at the forefront of our government's political and health agenda. On February 6, 2015, the Supreme Court of Canada unanimously declared that the criminal court prohibitions on physician-assisted dying were constitutionally invalid. Changes will come into effect on June 6 of this year. All governments are preparing to respond.

Consultations with the public have made it clear that there is extensive support for the provision of medical assistance in dying. An Angus Reid research poll that was published earlier this month found that 90% of Canadians surveyed think that some form of assisted dying should be allowed. The government takes the Supreme Court of Canada decision seriously.

It is a deeply felt and sensitive issue for all Canadians, and we understand it is essential that implementation of this new legislation be undertaken with careful consideration. That is why the government has developed a framework based on empathy, appropriate protections for vulnerable Canadians, and the need for choice. Careful consideration has been given to the eligibility criteria, substantive and procedural safeguards, and recommendations for monitoring and reporting.

I also want to make it clear, however, that medical assistance in dying is not to be the only choice for a peaceful, dignified death. No matter where people stand on the issues surrounding medical assistance in dying, they all agree that we must improve palliative care. Palliative care is a multidisciplinary approach to health care for individuals and families who are living with a life-threatening disease as well as other conditions. It focuses on improving quality of life through the prevention and relief of physical and psychological suffering, with treatment plans tailored to the needs of the patient and the family.

Reports about the status of palliative care in Canada suggest that the delivery of and access to palliative care and hospice care varies greatly across Canada. This is due to differences in regional demographics, societal needs, organization of health care services, and levels of funding.

When asked, most Canadians indicate that they would prefer to die at home in the presence of loved ones. There is clearly a need to bridge this disconnect and for all levels of government to support the needs and desires of Canadians at the end of their lives to receive the most appropriate, timely, and compassionate care. The gaps in palliative care have been raised repeatedly over the years by a number of organizations. It is very clear that Canadians are looking to their governments for leadership to close these gaps.

In the past, palliative care in Canada has been delivered primarily in hospitals by specialists, and largely to cancer patients in the last stages of their illness. While many people still associate palliative care with hospitals and cancer patients exclusively, it can be delivered to a variety of patients and in different settings, including long-term care facilities or even one's own home.

It is estimated that the health system is currently unable to provide palliative care to 70% of those who could benefit from it. This is why our government is taking immediate steps to address this gap and work with the provinces and territories so that more Canadians have access to the care options that are right for them when they need them.

The government is currently funding the Pallium Foundation of Canada to support training in palliative care to front-line health care workers, and this initiative is complementing a previous initiative called the way forward. This is aimed at integrating a palliative-care approach throughout the health care system and across a range of providers and settings.

The federal government has also supported a number of initiatives to improve public awareness: health care professional education and training, national best practices, and standards and research. Federal investments in research also expand the depth and breadth of understanding of end-of-life-care issues and how best to address them.

Recently, the federal government provided $14 million over two years for the Canadian Foundation for Healthcare Improvement to support applied health services research, as well as the foundation's work to identify savings and efficiencies in the health care system, including a palliative care component. In budget 2016, the government also committed to making compassionate care benefits easier to access, more flexible, and inclusive for those who provide care for seriously ill family members, and more flexible parental leave benefits to better accommodate unique family and work situations.

As with other health care services, delivery of palliative care is mainly the responsibility of the provinces and territories. While each province and territory has some level of palliative care services, with some moving ahead with frameworks or strategies, there are wide variances both within and between jurisdictions. Many are focusing on integrating palliative care with other types of care across settings and services. However, Canadians' ability to access palliative care remains mixed, depending on where one lives.

The Government of Canada has committed to developing non-legislative measures that would support the improvement of a full range of options on end-of-life care. In the discussions with provincial and territorial governments toward developing a new health accord, our government has committed to provide $3 billion over the next four years to improve home care, including palliative care.

I firmly believe my own experiences with end-of-life care are not unique from those of thousands upon thousands of Canadians. Losing my grandfather John, my mother, Gaye, and my Aunt Babs is something that has never left me. These people were titans in my life. My mom and Aunt Babs taught me everything I know about being passionate and determined, about giving of oneself to others, and about what it means to be a woman. They both had such a profound effect on every day of my life. I am here totally because of their legacy of excellence.

Both of these women, who were so strong and committed to family and community, were so harmed as human beings by diseases that ravaged them. I learned what it meant to sleep on the floor day after day because they were afraid to be alone. I learned how to administer morphine and Ativan and that, if they even whimpered, I was to give more, as that meant they were still being torn apart inside.

I learned how to raise or lower a home hospital bed. I learned how important palliative care is, to have access to it, but these are things I wish I had never had to learn. From all of them, I learned in those last days that there was no peace; there was only pain. There was no dignity, only terrible uncertainty. There was not nobility in their suffering. I learned pity.

I am proud to stand in the House today and express my support for this critical piece of legislation. Not only does it respond to the decision by the Supreme Court of Canada in terms of amending the Criminal Code, but it also provides an excellent framework to facilitate the necessary changes to our health care system, which responds to this decision.

Our government has listened to Canadians. Our government has listened to the experts. We have developed an approach that we believe reflects this input. It is now time to move forward with this legislation so that individuals, families, and health professionals have more options for end-of-life care, including medical assistance in dying.

[Dianne Lynn Watts, Conservative, South Surrey—White Rock, BC]

Madam Speaker, I want to thank my colleague for her gracious words in describing what she has gone through. As she said, many people have gone through those tough times.

I have a question. The minister, yesterday, stood in the House and stated that there were $3 billion for palliative care, yet there was nothing in the budget. I am wondering if the member can explain where those dollars will come from and how they will be allocated.

[Kim Rudd, Liberal, Northumberland—Peterborough South, ON]

Madam Speaker, the budget did indeed include $3 billion for home care. As the member may know, the minister has spoken a number of times in the House about her negotiations with the provinces and territories regarding how this framework for health care in general across Canada will be determined.

As I said in my speech, it is the prime responsibility of the provinces and territories and our responsibility as a federal government to work with them to find the best way forward for individuals in the provinces and territories.

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

Madam Speaker, I thank the hon. member for her very moving speech on this issue.

In paragraphs 13 and 14 of the Carter decision, the Supreme Court of Canada referred to the cruel choice faced by patients with degenerative disease. Under the government's current bill, those patients cannot provide advance directives. They have to choose between taking their lives prematurely or suffering for the rest of their lives because they cannot satisfy the conditions under which they could have access to medical assistance in dying.

Why did the government reject this recommendation? Does the hon. member think that this could be amended at committee stage?

[Kim Rudd, Liberal, Northumberland—Peterborough South, ON]

Madam Speaker, when we look at the Carter decision and the government's response to that decision, it is about finding a balance. As I said in my speech, we listened to Canadians and to the experts. We recognize that June 6 is a very imminent date and that we have found the best solution for now.

As the member may know, there was a commitment to look at three or four further elements, including advance care decision-making. I believe there is a commitment to work on that, going forward. I welcome the work from the member opposite on that issue.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, we have had many comments in the House that the government has not gone far enough with Bill C-14 in being prescriptive about how it would be applied to the different types of medical institutes that are provincially regulated. They are similar to comments about how we would apply climate change legislation provincially, when provincial governments have already started the work on this.

In light of what Quebec has done already in terms of applying this, could we have a comment on the role between the federal and provincial governments in applying this legislation?

[Kim Rudd, Liberal, Northumberland—Peterborough South, ON]

Madam Speaker, there is a very strong role for the federal government to work with the provinces and territories. There are many questions yet to be answered during the discussions with the provinces and territories, and there are best practices around the world that have been examined and will continue to be examined with respect to implementation.

I do not believe that, as a federal government, our role is to be prescriptive. It is to provide the tools to help the provinces and territories build the framework for their own situations. In my speech I talked about the access being different depending on where one lives. Sometimes it is about geography. Therefore, we have to address the multitude of options that will be available.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I am thankful to be able to add my voice to the discussion on Bill C-14, medical assistance in dying.

The Supreme Court of Canada has put what I perceive as an inappropriate timeline on this House in regard to this legislation, because it has come to the conclusion that the Criminal Code of Canada is unconstitutional in making it illegal for anyone to cause the death of another person who consents to die or to assist a person to end their own life.

In speaking with a very concerned constituent last week who was in law school when the charter was enacted, the comment was made that the university law professors of the day assured a troubled graduating class that what is actually happening today would never happen.

We are now in a place where, in attempting to guarantee every person their charter rights and freedoms, we are endangering the rights and freedoms of others. A synergy of wisdom and selflessness is needed in balancing what is perceived as best for me in relation to what is best for others. Just because we can, does not mean we should.

As well, in determining if we should, it seems to me the wise approach would be to look at those who already did, and regret. This would require learning from recent history rather than pretending that what we are doing is somehow progressive, when it has already been proven to be a regressive decision elsewhere.

The Supreme Court has chosen to ignore its own previous decision on the issue, along with six different parliaments that have previously rejected assisted suicide. It appears that the plumb line is not what is best for society and humanity as a whole, but rather what is the latest progressive trend that is putting the strongest pressure on how we live and relate as a society.

I have been a pastor's wife, and a caregiver in hospitals and level 4 care homes. I have worked in a mental illness hospital. I have been an education aid for special needs children in kindergarten and high school students.

I am the daughter of a father with Alzheimer's, the grandmother of a high-achieving grandson with autism, and I have a loved one who is suffering with mental illness. I, too, am well aware of life's challenges. My personal belief is that life is sacred from conception to natural death, and the protection of the most vulnerable in our society must always be the determining factor in how we choose to govern and make laws in Canada.

This is the expression as well that has been sent to me over and over again from constituents in my riding and across Canada, and today we need to have a debate in this House that is very balanced and presenting all views from all people in Canada.

Life is challenging, and dying, far more often than not, is difficult for the one passing away and in some ways even more so for those experiencing end of life alongside the individual who is dying. I believe there is value in that as well.

The misfortunate reality of Bill C-14 is that it will cause far greater grief than it will appease. Making something legal does not make it morally right. People who request a physician-assisted death can be motivated by a range of factors unrelated to their medical condition. These factors can make some people vulnerable to request assisted death when what they want and deserve is better treatment and palliative care.

It needs to be pointed out that the Belgian euthanasia law does not apply to non-competent patients and it does not allow the deliberate shortening of their lives. The Belgium euthanasia law system, which Bill C-14 mirrors, has been proven to be abused and insufficient to monitor the decision-making process.

For example, the Journal of Medical Ethics published a research article written by Raphael Cohen-Almagor, a human rights activist and chair of the politics department at the University of Hull. His article “First do no harm: intentionally shortening lives of patients without their explicit request in Belgium” focuses mainly on published data concerning the practice of causing death without patient request in Belgium.

The research indicates that the practice remains common, resulting in over 1,000 hastened deaths without request each year, or 32% of the cases of euthanasia. Moreover, in almost half of those cases the doctors refused to report the matter to the overseeing body, despite a legal requirement to do so.

This example clearly shows the legislation is lacking an oversight by an independent third party before the patient is put to death. Sadly, but realistically, the safeguards in Bill C-14 are likely to be insufficient and ineffective in real life conditions.

Furthermore, Bill C-14 applies to those with physical or psychological illnesses who are experiencing enduring and intolerable suffering as a result of their medical condition. Our focus must first be on raising the quality and availability of high-quality palliative care as the humane way to relieve pain, loneliness, and fear for the end-of-life patient and to provide encouragement, direction, and support for loved ones through the natural process of end of life. Bill C-14 does not require a palliative care route be entered upon first, neither does it require the patient to have tried other treatments before requesting medical assistance to die.

As well, I am still deeply concerned for our medical professionals who have contacted me in great numbers who could face severe consequences if they do not assist an individual to take their own life, for whatever reason. No one in our country should be forced to affirm or provide a service that goes against their conscience. The federal government's law leaves this crucial issue for the provinces to deal with, allowing even more interpretations of the general wording.

There should be a structured national system to address the cases when a publicly funded health care organization or separate doctors are unwilling for any reason to provide aid in dying when the patient has requested it.

Furthermore, the bill extends the amendments to the Criminal Code for medical practitioners, nurses, and registered practical nurses. Such an approach is broader than any other jurisdiction in the world and makes it impossible to create a transparent national system.

It is necessary to take into consideration the psychological factors that Bill C-14 would actually influence and encourage. The secularism of our courts affirms a premise that everything is socially constructed, and as a result laws greatly shape the ethos of culture, affecting cultural attitudes toward certain behaviours and influencing moral norms. Medical assisted dying laws send a message that in certain conditions suicide is a reasonable and appropriate way out. The problem is that this message will be received not only by those who have painful, terminal illnesses, but also by those who are tempted to think they can no longer go on.

A study by David Jones and David Paton proved that legalizing assisted dying in other states has led to a rise in overall suicide rates, both assisted and unassisted. This greatly undermines the work of suicide prevention organizations and programs.

As the Conservative deputy critic for veterans affairs and a member of the veterans affairs committee, I believe legalizing assisted suicide would only increase the challenges of providing mental health care and suicide prevention initiatives for those suffering from post traumatic stress injuries.

I agree with my Liberal colleague from Winnipeg Centre who spoke last evening that the government should at the very least postpone legalizing assisted death for at least five to 10 years, until it is absolutely clear what sort of impact it would have in all corners of Canada. His concern is well founded in regard to fighting the suicide spirit that needs to be healed on our reserves in Canada.

Another report in Current Oncology from 2011 summarized that euthanasia in the Netherlands has changed significantly in the 30 years since it was first adopted. It has shifted from medically assisted dying for people who are terminally ill to those who are chronically ill, from physical illness to those who suffer from mental illness, and then to those who suffer the psychological distress of mental suffering, and now to euthanasia of those over 70 who are simply tired of living.

The culture now is that euthanasia becomes expected while palliative care and functional hospice is gradually portrayed and felt to be “selfish”. That is a quote from the UK Daily Mail on September 24, 2013.

This implicates that the bill would not only affect those making a rational and deliberate choice to end their lives, but would also have a significantly wider impact on those who are required to provide such a service or their privilege and right to work in the medical field could be challenged, and also on wider social groups as a whole.

When facing a choice, which we are with the bill, where should the priority for us as legislators be? The imposition by the Supreme Court of Canada to invoke such controversial legislation, which is proven to be failing in other countries; the approach of the committee to manage witnesses and to make recommendations that go far beyond the Carter decision; and the need to first of all institute high-quality palliative care as an intrinsic value and an actual clear priority of the government are all valid reasons that I feel I cannot support Bill C-14.

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

Madam Speaker, I appreciate the views the member expressed in addressing this legislation.

The question I have is related to the Supreme Court of Canada. Every Supreme Court judge, and it was unanimous, indicated that Canada needed to change the law. There is a void that was created back in February. The Supreme Court gave us a legal mandate of one year. There was an extension granted. There is no doubt that if we believe in the rule of law and respect our Supreme Court that there is a requirement for us to bring forward legislation. The legislation has to pass by June 6 in order to fill that void. There is no option to not fill the void. It is our parliamentary responsibility.

Does the member believe, as many of us inside this chamber believe, that we do have a responsibility to respond to the Supreme Court of Canada, recognizing that while this might not be perfect legislation, there is that responsibility? To the best of my knowledge, I believe that this legislation meets that criteria. What does the member have to say in regard to that responsibility?

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I do appreciate the question, and I expected it.

I have the greatest respect for our Supreme Court. I have had the privilege of being part of an orientation, going there, and listening. It is not that I do not respect the Supreme Court and its role. However, as a parliamentarian my first responsibility is to Canadians.

I feel that the initial one-year decision by the Supreme Court was wrong. It is not enough time. Then, for the government to request six months and only be given another four months, I believe that is wrong.

We are in a situation here in Canada where we cannot get this wrong. Changing things as we go is very difficult, as my friend on this side of the House said last night. We need to do it right.

My first responsibility is to Canadians. Our first responsibility is to do what is right, regardless of the situation we are facing under pressure. I am not a lawyer. I understand the Charter of Rights and Freedoms has a notwithstanding clause that should never be abused, but perhaps in this situation that is what we should be looking at.

[Kennedy Stewart, NDP, Burnaby South, BC]

Madam Speaker, I listen with great interest to the debate on this very important issue.

However, there seems to be some confusion as to what we have been asked to do by the Supreme Court. This is not an optional measure that we are taking. The government has no option to put this bill in. It has been ordered by the court, and that is how our constitution works.

I am hearing a rather extraordinary request from the member, which is for the government to invoke the notwithstanding clause. I am not sure that would actually work in this instance. I am wondering if the member would care to elaborate on that.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I am not a lawyer. We all know that. I am speaking from my heart, and I am speaking for Canadians across this country who are very concerned about the responsibilities that we have in coming to a decision on this. Ultimately, I feel our responsibility, first of all, is to Canadians. I understand that it is difficult situation that I am putting forward.

I guess I am a politician, because I went through the process and I am standing here today. However, I have to say that at this point in my life it is not about a career, and it has nothing to do with being seen to do what certain people in the House feel we should do. It is to respond to what I believe is right in this circumstance in Canada.

We have seen where this is severely abused in other countries. We have already heard from our own committee and from people across the House that they want more. The Carter family is not happy. The situation is extremely complex, and I do not believe we should be rushed into a decision.

[Vance Badawey, Liberal, Niagara Centre, ON]

Madam Speaker, I am pleased to speak in support of Bill C-14, which would address medical assistance in dying.

The government has listened very carefully to Canadians and reflected upon the invaluable contributions of the special joint committee of members of the House of Commons, senators, the external panel, the provincial-territorial expert advisory group, and many others throughout our nation.

The bill appropriately recognizes the autonomy of Canadians to choose medical assistance in dying, while also protecting vulnerable persons and respecting the Carter decision of the Supreme Court of Canada.

My remarks will focus upon the eligibility criteria and procedural safeguards, which together represent the heart of the bill.

As the Minister of Justice has stated, the bill is aimed at addressing the issues raised by the Carter decision. The government has committed to collecting and analyzing evidence regarding how medical assistance in dying is working in practice and considering the findings of independent studies into additional issues that were not addressed in the Carter decision, which will be launched after the bill is passed.

Given the fundamental societal and medical issues that medical assistance in dying raises for our country, a cautious approach is in fact warranted. The stakes are just too high.

The bill contains five key eligibility criteria.

First, the bill would also require that the person requesting medical assistance in dying be at least 18 years of age and be capable of making decisions with respect to their health.

Several witnesses before the special joint committee, including the Canadian Paediatric Society, noted that medical assistance in dying raised unique considerations when it came to young people. Assessing a minor's capacity to decide to seek medical assistance in dying is difficult when the stakes are so high and the decision is irreversible.

Importantly, the committee also heard that there was in fact no Canadian pediatric data regarding requests for medical assistance in dying from young people or whether pediatricians would be willing to participate in this procedure. Prudence and common sense support further study of this very difficult issue.

With respect to capacity, this requirement means people must be able to confirm their choice at the time the medical assistance in dying is in fact provided. Therefore, the bill would not permit what are commonly called “advance requests”.

Permitting medical assistance in dying to be administered to a patient who is unable to express his or her wishes increases the risks of error and abuse. People who cannot express their wishes may want to continue living, even though they made a request at an earlier point in time.

Simply put, an advance request takes away the right of people to change their minds when they lose capacity.

The proposed approach also recognizes that physicians and health professionals frequently struggle with interpreting and applying other evidence directives in general. Advance requests for medical assistance in dying would be even more complicated to administer. Clearly, there is a need for further study and evidence concerning advance requests.

The bill also contains eligibility criteria that people make a voluntary request for medical assistance in dying and that they do so with the benefit of fully informed consent.

These requirements are common sense.

Medical assistance in dying must not be an alternative in situations where patients might prefer a different treatment, but are not aware of it or they do not know their diagnosis or its likely trajectory. Nor must it be the product of external pressure or the person's believe that he or she is a burden or unwanted.

Next, the bill would require that the person be suffering from a grievous and irremediable medical condition. This is defined term that has several characteristics, including the condition is serious and incurable; the person is in an advanced state of irreversible decline in capability; the condition is causing the person enduring suffering; and the person's natural death has become reasonably foreseeable in all of his or her medical circumstances, without requiring a specific prognosis.

The bill intends to permit medical assistance in dying as a choice for Canadians whose lives are on a path toward their end. As the Supreme Court suggested in various places in Carter, medical assistance in dying is similar in nature to forms of end-of-life care, such as palliative sedation, or the withdrawal of life-saving treatment. This definition is intended to allow for flexibility for physicians and nurse practitioners to consider all of the person's medical circumstance.

Bill C-14 is clear that no specific prognosis of time remaining is required. Moreover, a person could qualify based on the cumulative effect of multiple conditions or medical circumstances that individually may not be fatal, but when taken together make the person's death reasonably foreseeable. For example, people in medical circumstances similar to those experienced by Kay Carter, Gloria Taylor, Sue Rodriguez, as well the people who have obtained individual constitutional exemptions across Canada since the Supreme Court's ruling this past January, would all be eligible under this bill.

However, medical assistance in dying is not a solution to all forms of medical suffering. Such an approach would raise unacceptable risks, particularly for vulnerable people throughout our society. Take the example of someone who is exclusively suffering from a physical or mental disability, but who is otherwise in good health and whose natural death is still many years away. Making medical assistance in dying available to people in these circumstances risks reinforcing negative stereotypes of the lives lived by Canadians with disabilities, and could suggest that death is an acceptable alternative to any level of medical suffering or disability. This risks undermining our efforts to combat suicide, a pressing public health problem that affects not only those who die by suicide, but also their families, friends, and overall communities.

Next, to ensure that Canadians can have confidence that medical assistance in dying is administered appropriately, the bill also contains the procedural safeguards generally in line with those recommended by the special joint committee. These measures would ensure that requests for medical assistance in dying would be made in writing, witnessed by two independent persons, and that there would be a 15-day wait period to guard against people making a decision too quickly, which cannot be reversed. In respect of the waiting period, there would be flexibility for situations where a person's death or loss of capacity was imminent.

Most important, the eligibility of the person would have to be assessed and confirmed by two physicians or nurse practitioners who are independent of each other. The person would also have the right to change his or her mind about receiving medical assistance in dying, including just before the procedure would be administered. These safeguards will be effective at protecting Canadians but will not be so burdensome that they will impede access.

Finally, the bill would require that the person be eligible for health services funded by a government in Canada. This requirement exists to ensure that Canada does not become a destination for people from around the world who visit the country solely for this purpose by obtaining medical assistance in dying. However, recognizing that Canadians often move from one province to another or sometimes live abroad for significant periods, the bill includes an exception to this requirement to ensure these people would not be excluded solely because they are subject to a waiting period or residency requirement for public health care.

Medical assistance in dying is one of the most challenging and complex social and legal issues of our time, particularly given our society's aging population. However, the government has embraced this challenge and has listened carefully to the diverse perspectives of Canadians.

The bill before Parliament today was crafted with both compassion and clear thinking, and represents thoughtful and principled legislation. It promises the autonomy of Canadians to choose medical assistance in dying, protects vulnerable persons, and respects the Supreme Court's decision.

I call on members of the House to support this bill.

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

Madam Speaker, on at least three occasions now we have heard from the other side the confusion created around the use of discontinuing medical treatment and physician-assisted suicide. These are not at all the same. We all agree, and have agreed for many years, that it is not incumbent on any patient to continue life-extending, life-prolonging treatment.

Earlier today a colleague of the member commented that there were $3 billion in this budget for home care and palliative care. That comment was incorrect. Would my colleague correct that?

Finally, would my colleague agree to an amendment in the legislation that would require a palliative care consultation for patients who requested medical assistance in dying so these patients would be provided with the full range of options of treatments and supports available to them? Therefore, people requesting physician-assisted suicide would need to have a palliative care consultation prior to proceeding with their request.

[Vance Badawey, Liberal, Niagara Centre, ON]

Madam Speaker, first, in fact there is money allocated in our budget for home care. Within the home care line item, there would be consultations continuing with palliative care and those who administer palliative care throughout the country, as well as mental health care services. In fact, I came from a meeting this morning with the Minister of Health and the Minister of Justice which confirmed those discussions were continuing to happen throughout the nation.

With respect to the second question about palliative care, the simple answer is yes. Although we are reacting to the Supreme Court ruling and putting in place legislation that is based on giving choice to Canadians, we are not going to end there. We will continue to discuss this issue with Canadians across the country and with that, strengthen those programs before individuals make those decisions.

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, I listened with interest to the speech from my hon. colleague. He very clearly said that he believed this legislation would conform with the Supreme Court decision in Carter.

I have read a very spirited and well-reasoned letter recently from Joe Arvay, the lawyer who argued the Carter decision. He very vociferously disagrees with that comment. Specifically, he focuses on the fact that the Supreme Court decision very clearly has said that physician-assisted death should be available to those who suffer purely from a grievous and irremediable condition. Yet, this legislation would go further than that and would add the additional requirement that the death be reasonably foreseeable. Mr. Arvay argued that was an unwarranted and illegitimate extension of the Supreme Court decision. In fact, he argued that the test of reasonably foreseeable death was specifically raised through the court process and rejected at all levels of the courts through this process.

Could my hon. colleague tell us how he thinks the legislation would conform with the Supreme Court decision when it so clearly contradicts the Supreme Court's statement of the criteria required for access to physician-assisted death?

[Vance Badawey, Liberal, Niagara Centre, ON]

Madam Speaker, I did not make a comment with respect to this conforming with the Supreme Court decision. My comment was specific to this legislation giving some substance to an issue in which the Supreme Court left a void.

We have listened to Canadians. We have heard loud and clear that Canadians want a choice to ensure they make a proper decision after discussing these issues with their physicians, their family, and their friends. With that, as I said in my statement, end of life would have to be foreseeable and would have to be imminent, and those decisions would be concluded then by those discussions between physicians and individuals. The legislation would then support those choices for every Canadian.

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, I want to begin my remarks by acknowledging the delicacy, sensitivity, and grace that the subject before us requires. The subject matter of this debate, assisted dying, raises issues of the most profound importance, indeed of life and death.

They engage our deepest sentiments not only as parliamentarians but as humans. They involve our conscience, our morality, our ethics, our values, our philosophies, our spirituality, our individuality, and our dignity. I believe we must approach these issues with the utmost care, compassion, and respect, because Canadians have diverse and deeply held views on this matter, all worthy of consideration and deference.

The context of the debate is clear: death is feared, suffering is feared, loss of control is feared. With the advances in modern medicine, people today can, and indeed must, contemplate living without an acceptable quality of life, of being alive but not living, of possessing basic bodily functions without agency, without dignity, without hope.

At the same time, we fear the diminution of the sanctity of life, of the possibility of abuse of the vulnerable among us, embarking on a slippery slope that challenges long-standing foundational tenets of respect for the preservation of human life. This debate is about a fundamental collision of values, one which is based on the instinct to live and to preserve life in all instances, and the other premised on the right to control our inevitable passing as an inherent aspect of our individualism and personal liberty.

I hope that we treat the issues involved in this debate with the compassion and respect that they deserve, because we must simultaneously balance the notions of death with dignity with life with dignity. There will be no right or wrong here. There is only the possibility of compromise, understanding, and moving forward with as much wisdom and sensitivity as possible.

In many ways, we have taken an unfortunate path to the present. We are here by virtue of the legal process. It was based on a rights-based analysis and decision engendered by the mandate of a court, quite legitimately, because of a charter-based argument that challenged criminal provisions as violating individual constitutional rights.

We are not here because of a discussion based on faith, or conscience, or ethics. This has left many Canadians feeling rushed and robbed of the kind of full debate that perhaps ought to have been conducted on a matter of such social depth. As such, we are here debating not if, but how assisted death might best be implemented.

However, I do take comfort in the fact that the Supreme Court of Canada arrived at its decision unanimously, something that does not commonly occur. This gives me confidence that the most learned jurists in our nation were certain that we, as parliamentarians, can and must construct a system that allows Canadians to seek and obtain the assistance of their medical providers in ending their lives in tightly defined circumstances.

I would like to address my comments and thoughts on two areas: palliative care, and key aspects of this legislation. I am the health critic for the New Democratic Party and, as such, I approach this issue not only from a values or ethical or moral perspective, but from a health care point of view. I believe one of the most central aspects of the debate before us must revolve around palliative care. If we are honest, we will acknowledge that we as a nation have failed to construct the range and quality of end-of-life care that is essential to provide Canadians with the confidence they need to live their lives to the fullest extent.

We as a society have been remiss, slow to develop a system of palliative care that is so essential when we contemplate end-of-life issues. If we are to do our best to create the conditions where Canadians avail themselves of assisted death only in the rarest of circumstances, we must focus on achieving a number of things.

We must create pain-management programs to ensure that we have the widest possible resources to make everyone comfortable, regardless of their medical condition or proximity to end of life. We must develop home care resources to ensure that folks, especially seniors, can live their remaining days in the comfort of their personal surroundings, communities, memories, friends, and families.

We must construct palliative units across our country that allow people who are approaching their end to have environments that are comfortable, enriching, graceful, and interesting, and where spouses, children, families, and friends can be together in respectful private settings. They should have the very best medical care a developed country like Canada can muster. If we were to invest in world-class palliative care, we would likely see relatively few Canadians seeking assisted death.

Regardless of where one is placed on this debate, I think we all agree that we should be trying our best to encourage all Canadians to choose to live their lives to the fullest. This bill, the government, and its recent budget have thus far failed to identify and provide the resources needed to make a world-class palliative care system a reality in this country. Talk is not enough, and this must change. As New Democrats, we will work ceaselessly to press the government to allocate the resources necessary to build a world-class palliative care system across Canada. We will press the governments of every province and territory to work together to ensure that this system is available to all Canadians, regardless of where they live.

I have some key observations.

I personally believe that competent adults have the right to determine the conditions of their passing in the circumstances identified by the Supreme Court, namely where they face a grievous and irremediable medical condition that they find intolerable, and with a carefully designed and secure process that ensures their wishes can be ascertained with certainty. To the extent that this legislation deviates from that decision, it must be amended.

If it is truly the case that the prime successful litigant in the Supreme Court case, Ms. Kay Carter, would not be permitted a physician-assisted passing under this legislation, that is patently wrong. I believe we must tread extremely cautiously in this area and move very deliberately.

While I have listened carefully to those who favour a broad expansion of assisted death beyond the Supreme Court's careful parameters, I do not agree. In my view, care and caution are required in such delicate matters. Very difficult considerations accompany the issues of mature minors, psychological suffering, and advance consent. I believe it is the wisest course to engage fully with Canadians prior to legislating in these areas. We are moving from a society that has observed criminal sanctions for suicide and assisted death for centuries, to one which is constructing a system in response to the circumstances presented to the Supreme Court in the Carter case. In my view, this is sufficient for the moment, and we ought to focus our efforts on ensuring that the Carter principles are properly enshrined in law.

As the father of a child with special needs, I want to ensure that every vulnerable Canadian is fully protected with respect to all circumstances in this area. I am sympathetic to those who fear a slide down a slippery slope that puts vulnerable Canadians at risk, and I agree that we must ensure tight parameters are in place to prevent this. I believe that we can and must explicitly ensure that medical personnel and institutions have their rights of faith and conscience fully protected. Just as I believe that Canadians who wish to exercise their charter rights to access assisted dying must be respected, so too must those who choose not to be involved in such matters because of their faith or values not be compelled to do so. The constitutional rights of some Canadians must not be enforced at the cost and by the diminution of the constitutional rights of other Canadians.

I further believe that faith-based health institutions are direct extensions of the faith communities and groups that sponsor them and, as such, constitute expressions of values that are eminently worthy of protection. I believe we can ensure that all Canadians have access to their Carter rights while also protecting the equally important rights of those who may have conscientious objections to participating in any way in them.

In the end, it is my fundamental conviction that we as parliamentarians can and must craft legislation that reflects the best of who we are as Canadians: people who cherish individual rights and liberties, people who care deeply about each other, people who are compassionate and concerned with justice, and people who are dedicated to making our society one that is ruled by law, by wisdom, and by respect for all.

I will do my very best to reflect these values as we craft this important legislation for Canadians.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Madam Speaker, I would like to first thank my colleague for his comments, which will make us carefully reflect on Bill C-14.

We should reflect on what is at the very heart of the debate on the Carter case and the Supreme Court decision. In one passage of the Supreme Court ruling in Carter, the justices state that the current Criminal Code provisions at the very core of the Carter case protect the vulnerable to such an extent that they constitute almost an absolute protection, which is prejudicial to some Canadians who are not vulnerable and would like to have access to medical assistance in dying.

I would like to hear what my colleague thinks of the Supreme Court's view as it relates to the current bill.

What are his thoughts on people who are not vulnerable as defined by the Supreme Court and how this is reflected in the bill?

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, in many ways, that question gets to the very heart of the matter before us, which is that the Supreme Court has clearly and carefully ruled that competent adults in Canada who are suffering from grievous and irremediable conditions ought to be allowed the ability to choose their end of life and get assistance from their medical professionals to do so.

Where this issue gets very difficult is when we consider the extensions of that decision, when we talk about whether mature minors ought to be able to access those same conditions, even if they are not vulnerable. It is about people suffering from a psychological or mental health condition, and whether those conditions are in and of themselves sufficient to warrant access to physician-assisted death, even if they are not vulnerable. Finally, there is the issue of advance consent, which I think many Canadians agree with in principle, but I believe raises very difficult issues of implementation.

I am one who agrees with the government in terms of moving very carefully in this legislation. I am mindful of the fact that many civil liberties groups feel that the legislation could have been more broad and extended physician-assisted death to groups beyond the Carter decision, but I believe we must move and tread carefully in this area. The issues are so important, and Canadians are so engaged in this, that it is better that we move correctly than that we move quickly.

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

Madam Speaker, I want to thank my colleague for his speech, and I want to especially thank him for his commitment to protecting the conscience rights of health care workers and institutions. I am wondering if he would agree to an amendment that would actually guarantee those rights in the legislation. It is clear that the legislation wants to take a pan-Canadian approach for the availability of physician-assisted suicide. I think it is equally important that we have a pan-Canadian approach in terms of protecting the conscience rights of health care workers and institutions.

Second, I was pleased to hear his commitment to protecting the vulnerable. There are some safeguards listed in the bill as it relates to independent witnesses, independent doctors, and so on. I am wondering if my colleague would also agree to an amendment that would include within the regime a pre-judicial or some type of prior review that would ensure that the independent witnesses who claim to be independent, and the doctors, are actually facing up to that fact.

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, I would like to thank my hon. colleague for those thoughtful points. They also raise fundamental issues that will be discussed at committee. I could not be clearer than I was in my speech in saying that I believe the conscience rights of those who do not want to participate in assisted death, medical practitioners and institutions, ought to be explicitly protected. I am certain amendable to the form it takes, whether that is in the legislation or otherwise, but what is important is that the principle is respected.

With respect to the member's second question about additional safeguards to ensure that the vulnerable are protected, again, I agree with him fully that the principle of protecting the vulnerable has to be a core foundational aspect of this legislation. I would be willing to look at any other procedures that may work, whether it is by amendment to the bill or otherwise, to accomplish that.

[Julie Dzerowicz, Liberal, Davenport, ON]

Madam Speaker, I rise today to speak to Bill C-14, the medical assistance in dying bill.

To me, it is legislation that reflects where society is today. It is the right one for where the majority of Canadians are, and provides a strong foundation on which to build. It recognizes the inherent and equal value of every life, and honours the dignity and autonomy of an eligible person to choose medical assistance in dying under well-defined rules and conditions.

The introduction of this bill is big and represents a fundamental change in how we as Canadians view the right to life, liberty, and security of the person in Canada.

I confess that this is not an easy issue for me to talk about, but it is an important one to the residents of Davenport, the riding I am honoured and proud to represent. We as a society do not talk very much about death. It makes us nervous, and so this bill, which creates a framework to enable access to medical assistance in dying in Canada to those who are eligible, is a particularly sensitive topic.

I want to acknowledge that I have a large Catholic community in my riding, and many who believe that only God can decide when one dies, that death should be left in God's hands. On the other side, I have a number of groups within Davenport that think the proposed legislation does not go nearly far enough. Recognizing the blessed diversity of opinion, I invited community leaders to meet with me to discuss Bill C-14, to hear from them their specific concerns.

What I found was that I had to remind many of them that in February 2015 the Supreme Court of Canada unanimously, all nine members, voted to strike down the sections of the Criminal Code that made it illegal for anyone, including a doctor, to cause the death of another person who consents to die, or to assist a person to end his or her own life. I reminded them that the Supreme Court proclaimed that the prohibition on physician-assisted dying infringes on the right to life, liberty, and security of the person in a manner that is not in accordance with the principles of fundamental justice.

The Supreme Court gave the government a certain amount of time to introduce legislation. That date is currently June 6, which is why we are here today. Just as an aside, I was curious to see how many times the Supreme Court actually voted unanimously, and it has done so only 35 times since 1979.

There was no question that medical assistance in dying would become legal in Canada. What had to be determined is what kind of legislation we were going to introduce.

The Supreme Court's decision meant an important shift in our society's perception of personal autonomy. It signalled that a person's sense of dignity is intricately tied to how one perceives his or her quality of life. The decision to allow Canadians the choice of medical assistance in dying sheds light on the evolving role of our health care system and the role of patients in decision-making.

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

In addition to the consultation, I have received many letters from residents in Davenport. There are those who believe there should be no legislation at all, others who think that the proposed bill is not strong enough in protecting the conscience rights of doctors or in protecting the most vulnerable, and a further group who worry that the legislation does not go far enough, that we as a government have been too narrow in our interpretation of the Supreme Court decision. I will address all these concerns in the next few minutes.

Let me first address those who do not believe there should be any legislation. What many may not understand is that if the Liberal government does not create a new law by June 6 of this year, it means medical assistance in dying is legal if it is conducted in a way that adheres to the considerations outlined by the Supreme Court in its Carter ruling. Canadians would then not have any national framework and no law, which in my opinion would lead to a wild west, where it would be up to any one person's interpretation of the Carter decision and a situation that I believe would be open to abuse.

In introducing Bill C-14, the Liberal government purposely created legislation which as narrowly as possible adhered to the Supreme Court decision. It is narrow because this bill is meant to be a first step. It is meant to ground the legislation properly.

The legislation would do three things. It would allow physicians, nurses, and those who help them provide assistance in dying to eligible patients without the risk of being charged. It would also provide safeguards to make sure that those who receive medical assistance in dying are eligible, can give informed consent, and voluntarily request it. Finally, it would lay the foundation for the Minister of Health to make regulations to establish a process for monitoring and reporting on the use of medical assistance in dying.

I will pause for a second to reiterate the first point, because as mentioned, many have written to me to express their concern that the legislation as drafted does not protect the conscience rights of doctors. I want to be clear that there is nothing in the legislation that compels any medical practitioner or authorized nurse practitioner to provide medical assistance in dying or to refer a patient to another medical practitioner. The legislation is meant to balance access to medical assistance in dying while respecting the personal convictions of health care providers.

The legislation is also clear on who is eligible. A person has to be mentally competent, 18 years of age or over, make a voluntary request, and give informed consent to receive medical assistance in dying. They have to have a serious and incurable illness, disease or disability, be in an advanced state of irreversible decline in capability, experiencing and enduring intolerable suffering as a result of their medical condition, and be on a course toward the end of life. Death would have to be reasonably foreseeable in all of the circumstances of the person's health.

Protective measures are also a key part of the legislation to ensure that patients eligible have given informed consent. Patients have to make a written request for medical assistance in dying and have it signed by two independent witnesses. Also, two independent medical opinions have to confirm that the patient meets all the criteria. These first two criteria are intended to ensure that requests for medical assistance in dying are truly voluntary, that they reflect the wishes of the patient and are not made as a result of external pressure or coercion.

Too many of my constituents have said to me, “My dad was in the hospital. We kind of felt forced that maybe we would want to sort of end things.” I said that this legislation does not help with that. The patient has to make a written request. It has to be signed by two independent witnesses, and there has to be two independent medical opinions.

In addition, the second criterion also helps to reassure the medical practitioner who would provide medical assistance in dying that he or she is acting within the scope of the law and consistent with reasonable medical knowledge and skill.

The other criteria for patients to be eligible are that there is a mandatory 15-day waiting period; the patient has the right to withdraw a request at any time; and consent must be confirmed immediately before medical assistance in dying is provided. It is a very thoughtful protocol with very strong safeguards.

As part of this legislation, the foundation is also laid for the Minister of Health to establish a process for monitoring and reporting on the use of medical assistance in dying. We need to know, and Canadians need to be satisfied, that the system is operating as planned to respect the autonomy for eligible individuals while protecting vulnerable people.

Public trust and transparency in the implementation of medical assistance in dying are essential. This monitoring and reporting system will also be able to signal any issues or unexpected consequences.

Monitoring would also ensure that high-quality comparable Canadian data are generated so that any future discussions about changes to the medical assistance in dying system could be made based on the best possible evidence. Indeed, there will be a review of the legislation in five years, which could bring about changes that reflect the data gathered in this period.

For those who believe that this legislation has not gone far enough, there is a commitment to independent studies into three key issues that the Supreme Court of Canada in Carter declined to address. The first was the eligibility for persons under the age of 18. The second is the advance request. The third is requests for medical assistance in dying solely on the basis of mental illness.

It is also important to mention that palliative care, ensuring that all Canadians live as well as possible until their death, is equally important to this government. Just yesterday the Minister of Health stood in this House to reaffirm our commitment to $3 billion over four years for home care.

The minister is working hard with her counterparts across Canada on the next version of our health care accord, and high-quality palliative care for all Canadians is a key part of their deliberations.

I also should mention that one of the great positive side effects of introducing this legislation is that we are having a wide discussion on a national level. We need to be discussing this issue fully and we need to be understanding it.

In closing, I want to quickly thank and commend the great work that was done by the Special Joint Committee on Medical Assistance in Dying under the great leadership of my colleague, the MP for Don Valley West. I also thank the Minister of Justice and the Minister of Health for their excellent work in introducing this legislation.

Bill C-14 is meant to be a legislative foundation on which we will build moving forward . It recognizes the inherent and equal value of every life, and it honours the dignity and the autonomy of an eligible person to choose medical assistance in dying under well-defined rules and conditions. It is the right legislation for Canadian society today, and I will be supporting this legislation.

[Dianne Lynn Watts, Conservative, South Surrey—White Rock, BC]

Madam Speaker, again we hear about the $3 billion for palliative care. We have yet to find it in the budget. There is some language around home care, but there is no identification of palliative care. Could the member please clarify that?

[Julie Dzerowicz, Liberal, Davenport, ON]

Madam Speaker, I can understand why there is some confusion. We have reaffirmed our commitment. We made a promise and we continue to be committed to $3 billion over four years for home care. It has not been introduced in the 2016 budget, but we have reconfirmed our commitment to $3 billion over four years.

Also, the minister has been very clear that high-quality palliative care for all Canadians is a key part of her current deliberations with her counterparts, the provincial ministers of health right across the country. I have great faith and hope that something will be brought forward in due time.

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

Madam Speaker, the debate on medical assistance in dying is certainly very important.

Although the bill is being brought forward very quickly, some amendments are needed, especially for some of the definitions that are a little vague. From the beginning we have heard that a natural death must be reasonably foreseeable. Doctors cannot even agree on what this means. The government has not been able to define what is a reasonably foreseeable death.

Can the member shed some light on this? Will there be clarifications at the committee stage to fix this? The greater the uncertainty, the more difficult it will be for professionals to make clear decisions and ensure that there are no abuses.

[Julie Dzerowicz, Liberal, Davenport, ON]

Madam Speaker, there is a very clear list. It is a very thoughtful list of criteria of who would be eligible for medical assistance in dying. We have put a safeguard in place where two independent medical practitioners would have to give the same opinion. We have done that to help reassure each of those medical practitioners who want to provide the medical assistance in dying that he or she is acting within the scope of the law and consistent with reasonable medical knowledge and skill. They act as a bit of a check and balance on each other in terms of interpreting the list of criteria of who would be eligible for medical assistance in dying.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, I want to begin by congratulating my colleague on her excellent presentation on a very difficult issue that is clearly troubling for all of us here in the House.

One of the things I continue to hear from many people in Humber River—Black Creek is about elderly people feeling that their families are not interested in seeing them just wither away, and how do they know they are protected. We know all of the answers are here, but the challenge is to communicate and give that level of confidence to Canadians.

I would be interested to hear how my colleague plans to ensure the people in her constituency understand what is required before any kind of action could be taken to end someone's life.

[Julie Dzerowicz, Liberal, Davenport, ON]

Madam Speaker, this is something that very much weighs on me. I want to do a huge communication effort. I felt that there was not an understanding that there was a Supreme Court decision and a law had to be enacted.

My objective is to do a series of interviews with a number of local newspapers and radio stations to make sure people are as educated as possible on this issue.

[David Sweet, Conservative, Flamborough—Glanbrook, ON]

Madam Speaker, I must say at the outset that the prayer we began our session with this morning, that we would be mindful of making good laws and serving Canadians, has never meant so much to me, and I think many of my colleagues here today, anytime it has ever been said from the Speaker's chair.

I would like to thank my colleagues and members opposite for their thoughts and words on this deep, ethical, moral, legal, and religious question. While I may not agree with all the points that have been made thus far, I do not doubt for one second that the comments of all members are truly heartfelt, genuine, reflective, and respectful.

Unfortunately, I do not have time to address all the concerns of the bill, such as, but not limited to—as my colleague the member for Lethbridge has so eloquently articulated—the poisonous change in our cultural mindset the bill will likely encourage, reducing the value of life to a measure of ability or function rather than its inherent worth and dignity, and causing Canadians who would never have considered taking their own life before to do so.

As the member for Scarborough—Guildwood mentioned, the bill would be under expansionary pressure from the day it comes into effect, and where we could end up is troubling.

The peril that I do not think has been fully addressed is that in which those in vulnerable communities could find themselves.

As I said, because time is limited, I am going to focus upon two issues, but again, my serious concerns are not limited to these alone. First is the regrettable absence of more discussion and action on palliative and hospice care as a precursor to this legislation. Second is the need and the duty of all members here to respect and protect those physicians and health care professionals who object on conscience.

Before I get into these two points, I want to offer my reflections on where we have come from on this issue.

It was only six years ago that we debated the same issue and voted down the private member's bill, Bill C-384, of a former member of this House. It should be noted that this was the second attempt at the same private member's bill by the former member, who had previously introduced Bill C-407.

I will say that I voted against and spoke out against the bills, not only because of my own personal convictions, but also because of my steadfast belief that those bills did not uphold the moral obligation we have as parliamentarians to protect the vulnerable and the inherent dignity of all life.

Bill C-384 and Bill C-407 were seriously flawed because they sent us down a path of unintended consequences. They were that slippery slope that has so often been spoken of here in this chamber, regarding the debate of ethical dilemmas that our families, doctors, and health care workers would face.

My reservation then is sustained today. Why is there not more emphasis on palliative care?

Is it not better to support quality palliative and end-of-life care for Canadians, so they will never need to think that euthanasia or assisted suicide is the only option, or better option, for their suffering?

Is it not our duty to uphold the value and dignity of life in this manner?

In my own home community of Hamilton, we have outstanding organizations like Emmanuel House and the Dr. Bob Kemp Hospice, which work on a daily basis to make end of life better for people. I know hospices are doing outstanding work in all the communities across this country.

I recognize that, in the view of the Supreme Court's Carter decision, we are faced with a new reality, one where we need to respect its decision vis-à-vis the charter rights of those in dire circumstances while still ensuring the dignity of life is upheld. However, I am very concerned that there was no further investigation, no rigorous effort to enhance palliative care and invest in hospice construction, in advance of this legislation or in conjunction with it.

While the federal government's response to the Supreme Court's Carter decision makes reference to the need to support improvements of a full range of end-of-life care options, it does little about it, other than acknowledging it as a non-legislative response.

I do not think that is good enough, and I believe all Canadians do not think that is good enough either.

Instead of a vague reference to a multi-year health accord that would include home care and palliative care as one option, where was the commitment in the throne speech? Where was the commitment in the budget?

If the commitment is serious, why is it not backed up with funding?

This is the missing piece. If we are going to go down the legislative path of physician-assisted dying because of charter rights, then we in this place have a duty, and the Government of Canada has a duty, to have first acted upon palliative and hospice care.

That was the viewpoint of two Senate studies, which I cited back in 2010 when I spoke out against Bill C-384. First, in 1995, there was the Special Senate Committee on Euthanasia and Assisted Suicide that in its report, “Of Life and Death”, made a number of recommendations to improve access to palliative care services, standards of care, and training of health care professionals.

In 2000, the Standing Senate Committee on Social Affairs, Science and Technology tabled another report, titled “Quality End-of-Life Care: The Right of Every Canadian”, which again recommended a strategy and vast improvements to palliative and end-of-life care, as well as support for family caregivers, home care, research, and surveillance.

It breaks my heart, and I know the hearts of all members in the House, that people are suffering. Just this past summer, in the middle of the election campaign, I watched my own younger brother succumb to the ravages of lymphatic cancer, and I was grateful for the care, understanding, and compassion of everyone at Emmanuel House, the hospice where he stayed in his final days.

I know that this bill attempts to address those individuals who have given up hope; yet I believe there are, most often, better ways to address their suffering. It is our obligation to do everything possible with palliative and hospice care, to give a modicum of hope, comfort, and peace to those suffering at the end of their lives and to their families who are also suffering. Once again, I believe this discussion should have preceded this bill.

The final point I want to touch on today is one that I know other members have already raised, but please allow me to amplify their concerns. That is the protection of physicians' conscience rights and, quite frankly, those of the other health care professionals and caregivers on a doctor's team who might be placed in the circumstances that this bill would allow.

First, I do not think there is a shred of doubt that we must offer clear and indisputable protections to those who object on ethical, moral, or religious grounds. In these matters of life and death, that is more than the right thing to do; it is the only thing to do.

Second, I believe that, to send this important signal to the medical community, families, individuals who are suffering, and all Canadians, these conscience protections for physicians must be included in the bill itself, and not just in the preamble. The bill needs to include a punitive measure for those who would seek to pressure, force, or coerce anyone to assist someone in taking his or her life.

I am thankful for the opportunity to offer these reflections. I know every member of the House will be doing a lot of thinking, soul searching, and prayerful consideration as we grapple with this legislation. I sincerely hope and pray that we continue to do so with extreme caution and care. God bless Canada.

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

Madam Speaker, I would like to highlight a couple of points.

One is, of course, that this legislation is before us because of a unanimous decision by the Supreme Court of Canada, which means that it is the responsibility of all parliamentarians in the chamber to ultimately do what I and most believe is the responsible thing to do, which is to pass legislation. We have a deadline of June 6. There is a great expectation that the bill will be going to committee stage at some point, and my question is related to that.

The member referenced the importance of there possibly being amendments to the bill. The Government of Canada is, in fact, open to ideas, suggestions, and presentations at the committee stage, and I am wondering if the member wants to comment on how important it is that the bill goes to committee in a timely fashion so that the committee is able to do some of the things that might be of benefit if the legislation is improved. I am sure the member will find that the government is willing to improve the legislation. No one on this side is going to oppose healthier and stronger legislation.

I also recognize the importance of the bill going from the House to the Senate, keeping in mind June 6. I am wondering if the member would provide comment on what he believes would be important for getting the bill out of second reading stage in a timely fashion, so that we can do some work on it at committee stage, and if he has some thoughts on the committee stage and the process of getting it all done by June 6.

[David Sweet, Conservative, Flamborough—Glanbrook, ON]

Madam Speaker, I think that is exactly the reason this debate is not only an emotional one but a profoundly intense one. The fact is that we have this June 6 date looming over us while we are dealing with such a huge question; that of life itself. It is a question that the Province of Quebec took six years to deal with. It is a question that the country of Belgium took 10 years to deal with. However, we have deal with it now in such a short time frame, and I understand the expeditious manner in which we have to proceed.

That said, I think it was incumbent upon the Liberals, prior to tabling this legislation, that their own principles that they mentioned in their own platform should have been part of this legislation or should have even preceded this legislation in the sense of making sure that every Canadian had the better option, the option to be able to go to a place where they are loved, and for those people who do not have any family, places where they could get relief from their pain and be with people who care for them right to their last days. That was not included in this legislation.

I hope the Liberals would be open to making sure that part of their infrastructure dollars would be set aside for hospice construction, and that they would also be negotiating specifically with provinces right now to delineate funds specifically for palliative care so that the service is enhanced rather than it going into the general fund of provinces and not seeing the light of day to serve people who need it.

[Karine Trudel, NDP, Jonquière, QC]

Madam Speaker, the Conservatives who serve on the special committee did not agree with each other. Four of them disagreed with the committee and expressed a dissenting opinion. They eloquently expressed their concerns, which included the need to give Canadians better palliative care. They said it was important to expand access to palliative care, as part of the medical assistance in dying initiative.

Could my colleague elaborate on this and tell us what concrete measures this government can take to give more Canadians access to good palliative care at the end of life?

[David Sweet, Conservative, Flamborough—Glanbrook, ON]

Madam Speaker, I articulated some of it, but I will say that I am a person who is dedicated to the separation of jurisdictions. In case there are some members who might think that I was suggesting that the federal government would impose some kind of regime in regard to the operation or execution of health care, which is a provincial jurisdiction, I was not saying that.

What I was saying is that, certainly, the current Liberals have been willy nilly with the till already, committing billions to other things. I think that, on this very important question, they could take some of those infrastructure dollars that they have already committed and set aside those dollars for hospice construction. They should then make sure, in their deliberations that they are having right now with the provinces in regard to a health accord, that they make it very clear that any future expansion of funds would be based on a good accountability in regard to the increase of palliative care across the country.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I listened closely to all of my colleagues.

Yesterday, I participated in the committee's hearings. This is my first opportunity to speak in the House.

I have just 10 minutes, but I would like to start by saying that everyone here is caring. Everyone is concerned about the well-being of people who are at the end of their lives, and everyone wants the best for them. However, just because we want to care does not necessary mean that we do what is best for people. We are not necessarily doing what is best for someone if we infringe on a person's autonomy and self-determination.

In the moral sense of the term, human dignity is connected to respect for self-determination. That should be the basis of our debate. Yesterday, in committee, I heard people say that we should consider a person's dignity in relation to their illness. They were talking about whether the person is wearing diapers, which is just frightening. Only that individual can make judgments about their own quality of life, and we cannot compare one life to another.

By way of introduction, since Bill C-14 is quite similar to part of the Quebec law, I would like to provide some context regarding the basis of that law. At the request of medical specialists and other civil society groups in Quebec, in the fall of 2009, the Quebec National Assembly created a deliberative space in order to give people the opportunity to express their views on an issue that could not be more personal: their own end of life.

From that moment on, the status quo was no longer an option for Quebec parliamentarians. Five years later, on June 5, 2014, the National Assembly passed Bill 52, The Act Respecting End-of-Life Care. One aspect of that act is medical assistance in dying.

This work was guided by two premises. First, my death, like my life, is my own. Second, the autonomy bestowed on a person by law through the principle of self-determination and its corollary rule of free and informed consent, which applies in biomedical contexts, is never questioned throughout that person's life, even in times of weakness or extreme emergency. Why then would things be any different at the end of a person's life?

Why would a person's right to self-determination be taken away because he or she is terminally ill? On what grounds would that be done? Is there any more personal and unique time in a person's life than the moment of death? What more could we wish than for a person to be able to calmly and peacefully pass on into death without any fear of suffering or any actual suffering? Is that not what we all hope for and what we would wish for any human being?

The consensus that was reached in Quebec was to make these premises part of a continuum of care, so that palliative care and euthanasia, two realities in the history of this issue, would no longer be set in opposition to each other. Why pit palliative care and euthanasia against each other? This question has been implicit in many of my Conservative colleague's speeches, because unlike in Quebec, we did not hold a debate on the right to die, which used to be associated with passive euthanasia.

People had to fight for the right to die. At the time, paternalistic doctors tended to focus on the curative aspect, and people were dying from the chemotherapy, not the cancer. Over the years, there has been a shift from passive euthanasia to palliative care. Human beings have thus acquired the right to die.

Palliative care is about taking a holistic approach to end-of-life care. This concept was developed by Cicely Saunders, in England, and dates back to 1967. Why should a request for assisted dying arising out of a positive experience of care near the end of one's life be considered a failure? The dying process has started and is irreversible.

A person might wake up one morning and decide that he or she is ready to give up. A person might also decide that that is not the case and that he or she wants to go on living, and die a slow death. The Quebec legislation in no way precludes one or the other, because it places end-of-life care in a continuum of care.

For more than 30 years, palliative care was considered the only way to die with dignity at the end of one's life. It became apparent that such care did not meet every need. Most requests for medical assistance in dying are made as part of the process of palliative care. Very rarely does a person who receives a terminal diagnosis from a doctor immediately request an injection. If so, it all depends on the stage of the cancer. The patient might be put on anti-depressants and told to get his or her affairs in order. There are things that a person needs to do before dying.

One of the difficulties with Bill C-14 is that it groups together two realities under medical assistance in dying. One is covered by Quebec, namely euthanasia and end-of-life care, which includes palliative care; the other is assisted suicide. This choice is causing the conceptual confusion that leads to the impasse in our debates.

Assisted suicide is not euthanasia. The difference is that a person can be at the terminal phase of a degenerative disease without being near death. A person can suffer tremendously without being in a situation of reasonably foreseeable natural death.

The Supreme Court has asked legislators to provide a framework for assisted suicide. This is what the Supreme Court told us in section 7:

Insofar as they prohibit physician-assisted dying for competent adults who seek such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering, ss. 241 (b) and 14 of the Criminal Code deprive these adults of their right to life, liberty and security of the person under s. 7 of the Charter. The right to life is engaged where the law or state action imposes death or an increased risk of death on a person, either directly or indirectly. Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

That is what we have been asked to do, and that is what we need to figure out.

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

Madam Speaker, we have heard a great deal of discussion about the legislation itself. However, one of the important components of the whole debate is the concern that we heard this morning related to palliative care. I argued yesterday, and I am carrying it forward today, that it is important that we as a federation recognize that in dealing with palliative care this is what Canadians are concerned about no matter what region of the country they are in. Whether it be British Columbia, Nova Scotia, Quebec, or Manitoba, people are genuinely concerned about palliative care.

In dealing with the issue of palliative care, would the member not agree that there is a federal responsibility to work with our provincial counterparts to deliver the best type of palliative care to all of the different regions of our country because that is what people across the country want?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, people see palliative care as the answer to dying with dignity, but that care can be difficult or impossible to access, unfortunately.

I am talking about palliative care as it should be. That does not mean putting sick people in beds in hallways and leaving them to die. It means holistic care delivered by specially trained staff along with adequate pain management, which was not allowed sometimes. Patients were not receiving the dosage they needed because it was thought that a high dosage could cause death.

Quebec has dealt with that. The province has a framework for palliative care as end-of-life care. Health care is under provincial jurisdiction, and Quebec is a leader on this. I think this bill needs an equivalency clause so that the federal law will not result in duplication, thereby changing the way Quebec's law works.

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

Madam Speaker, I believe that at the beginning of his comments my hon. friend talked about what dignity is and said that dignity is up to the individual to decide. If you decide you have dignity, then you do, and perhaps if you decide you do not have dignity, then you do not. I find this definition rather troubling. First, there is no regime of assisted suicide proposed here or anywhere else that defines dignity in this wholly subjective way. It still tries to say that a person who has these physical or psychological symptoms can have dignity and someone without those symptoms cannot. It would seem that the typical understanding of dignity in this legislation and elsewhere does look for these external markers.

I liked what my colleague from Portneuf—Jacques-Cartier had to say yesterday about dignity being intrinsic to all human beings, because if we interpret dignity in the subjective way that the member has, I wonder where that leaves any efforts at suicide prevention. If a person said, regardless of his or her external circumstances, that he or she does not have dignity, then where does that leave efforts to tell that person that he or she does have intrinsic dignity and that he or she should not take his or her life? I wonder what the member thinks about the implications of his account of dignity for anyone in a difficult situation, anyone who might want to take his or her life.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I think it is a shame that my Conservative colleague is confusing suicide with assisted suicide.

Things can change for individuals who are contemplating suicide, but those seeking assisted suicide are suffering from serious and incurable illnesses and intense suffering that will never go away. That is a big difference.

What I said was that people might want the right thing, might want to do the right thing, but that does not necessarily mean they are doing the right thing. Taking away a person's independence and self-determination is not doing the right thing. Taking away a person's independence is taking away their dignity. A person's dignity is rooted in self-determination, even when that person is vulnerable.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Madam Speaker, it is good to be here today to speak to Bill C-14. One of the principles we have in the House is that legislation is best built on a very solid foundation, and this bill does not have that.

What the Supreme Court ruled years ago on the Rodriguez case was very clear. However, just over a year ago, as with so many other decisions and so many other directions, the Supreme Court reversed itself. If it had really good underlying reasons for doing that, it would have been fine, but the justification for it was very interesting. It was a mistake in perception as set forward by the Supreme Court. The justices called it a changing matrix of social and legal facts which brought them to their conclusion. I and others are concerned that this makes our laws, including the interpretation of charter rights, dependent upon the opinions of a very small group of people. I will talk a bit more about the matrix of social and legal facts in a few minutes.

From my perspective, this is not an improvement. Many of my colleagues on both sides of the House have shared their concerns about Bill C-14, with some supporting it and others opposing it. However, a number of things are missing in the bill, and we need to have further discussion about. I heard a few comments earlier about the timeline, how pressured it was, how we needed to get this done and that this basically was prohibiting us from taking the time needed to discuss these things a bit further and with a bit more depth.

There is no clear definition of what irremediable means. The bill talks about that being the requirement for someone to qualify for physician-assisted dying.

I am concerned about the expansion of this process to nurse practitioners, so it would not just include physicians. People have asked why medical personnel are even involved with this. They have asked whether there is not some other place this can be done so people do not have to be concerned that when they go into the hospital for medical care, rather than receiving a positive side of medical care, they receive a very negative side of it.

There is a criminal exemption for those who perform euthanasia, but there is no protection for those who do not want to participate. A number of people are very concerned about what is called conscience rights and the lack of protection for that in the legislation.

There is a lack of clarity around psychological conditions and how that may come into play with this issue. One of the things that really concerns a lot of people is the lack of a vulnerability assessment, taking the time to find out if people are being pressured or whether there is some vulnerability that is bringing them to the point where they have made a decision that may be wrong for them.

Some people have called for a prior judicial review. There is no mention of that in the legislation.

Also, there is a lack of clarity on data collection. This has been an issue in a number of areas. Will we see good data collection? Will someone keep a good set of records on what goes on with this process?

We often have heard the concern that there is no clear commitment to palliative care. We just heard a member from the government talk about this. The Liberals made this commitment during the election campaign. They felt it was within their jurisdiction to promise $3 billion toward palliative care, but now, in the House, we hear them talk about how other jurisdictions are responsible for this. It sounds as if the Liberals are trying to avoid their responsibilities for this.

I would like to go back to the Supreme Court decision. It turned back the former position. It reversed it and it left us with an open field when it came to the issue of assisted suicide or assisted dying. The only thing the Supreme Court said in its ruling on Carter was that the person needed to consent and that the person needed to have a grievous and irremediable medical condition causing enduring and intolerable suffering. If we look at that, we see it leaves that whole area very open.

As I said earlier, good legislation should have a good foundation. I do not believe this does because of the Supreme Court decision. The foundation is the Carter decision and it hardly qualifies as a stable base on which to create good legislation.

I do not suppose we will get this done today, but we will come back at another stage on this bill. However. I would like to take a few minutes to talk a bit about the Supreme Court's recent decision in Carter v. Canada. It obviously is a very controversial decision and touches on a sensitive issue for many Canadians because there are very deeply held beliefs on both sides of this issue.

The Supreme Court acknowledged that the prohibition on assisted suicide was in general a valid exercise of federal criminal law. It also decided that the law went too far and it did not apply in cases where a competent adult with a grievous medical condition could consent to the termination of his or her life. I believe this decision is disturbing for a number of reasons.

The first is that the court ignored parliamentary consensus. In its decision, it claimed that the reversal from its earlier position in Rodriguez v. B.C. was necessary because of a different matrix of legislative and social facts. Yet, the purported differing matrix ignores the clear and unchanged parliamentary consensus opposing assisted suicide.

Between 1991 and 2012, nine private members' bills were introduced in the House of Commons, all seeking to amend the Criminal Code to decriminalize assisted suicide or euthanasia. Six were voted on and all of them failed to pass. When considering the matrix of legislative facts, the court gave weight to legislative developments in Belgium, Switzerland, Oregon, Washington, and the Netherlands, but it completely ignored the legislative record of Canada's Parliament.

Second, the court found no societal consensus in Canada on this issue. In her decision at the trial level of Carter v. Canada in the Supreme Court of B.C., Justice Smith wrote, “As to physician-assisted death, weighing all of the evidence, I do not find that there is a clear societal consensus either way”. Clearly whatever the change in that matrix of legal and social facts entails, it did not include a clear consensus from the people of Canada”.

This lack of consensus remains unchanged in the 22 years since the Rodriguez case in which the court stated, “No consensus can be found in favour of the decriminalization of assisted suicide. To the extent that there is a consensus, it is that human life must be respected”.

Clearly, the court found no consensus among western countries. While insisting again this matrix of legislative and social facts had changed since the last Supreme Court ruling on the issue, it acknowledged that physician-assisted dying remained a criminal offence in most western countries. Regardless, it chose to align itself with the minority of jurisdictions that allowed it.

I believe the court misinterpreted Parliament's objective in prohibiting assisted suicide. In its ruling, it put significant weight on the parliamentary objective of two sections, section 241(b) and 14 of the Criminal Code, which prohibit assisted suicide. The court asserted that these sections were put in place only to fulfill the state interest in protecting the vulnerable. However, in the earlier court case with Rodriguez, the court had said the objective of this section was not simply “protecting the vulnerable”, but also “preserving life”.

It had written, “In this case, it is not disputed that in general s.241(b) is valid and desirable legislation which fulfils the government's objectives of preserving life and protecting the vulnerable”. This position was reaffirmed several times.

By insisting that in Carter the purpose of section 241 was only to protect the vulnerable, the Supreme Court was able to conclude that this prohibition put people outside this class and that there were people who did not need to be protected by it. The court's conclusion was that the current law was over broad and grossly disproportionate to its objectives. That allowed it to say that Parliament needed to establish safeguards to ensure that those who truly wanted to be euthanized would be able to do that.

That interpretation tramples on the intention of Parliament to preserve life. Had it considered the full purpose of these sections of the Criminal Code rather than just that one objective of protecting the vulnerable, I think the outcome would have been very different.

I would make one final point before my time runs out. The court really leaves the definition of irremediable open to patient interpretation. The court decided that irremediable did not require the patient to undertake treatments that were not acceptable to them. In other words, although treatment may be available, the condition still qualifies as irremediable if the treatment is not acceptable to the patient.

I wanted to express my concerns. However, I think we will come back to some of the things the Supreme Court touched on as well in terms of the right to die being conflated with the right to life and some of the other issues.

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

Mr. Speaker, I want to highlight the fact that the Supreme Court of Canada unanimously decided that Canadians suffering intolerably had the right to request assistance to end their suffering. We respect that decision of the Supreme Court of Canada, as we think all members of the House would.

The issue before us is not if Canada should have medical assistance in dying, but rather how we make it available. It is important to recognize, given the sensitivity of the very issue we are debating today, that we have until June 6 to deal with the issue. If we do not deal with the issue, it will be most inappropriate as parliamentarians, representing Canadians from coast to coast to coast. There is an obligation for us to meet that void that has been put in place by the Supreme Court of Canada.

Would the member at least acknowledge the fact that we have to pass some legislation? Are there any possible amendments the member would like to see to make it easier for him to support the legislation?

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, my point was exactly that. It is the court that has brought us to this point, and the timeline is the court's timeline.

As one of my colleagues pointed out a little earlier, that deadline prohibits us from dealing with these issues as fully as we probably should. We have not had any discussion about the implications of the Supreme Court decision. We have never sat down and had those discussions.

The government has come forward, under pressure, with legislation that many people feel is inadequate. One of the areas I find very troubling is the lack of conscience protection, and I mentioned that a little earlier.

Many people in the disabled community are very concerned about the fact that there is no vulnerability protection. They do not want to see a development of peer pressure in society where people feel somehow obligated to participate in this activity.

There is a number of issues around this. The timeline we are on is not helping us to discuss and resolve those issues among Canadians.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, following up on the question of my hon. colleague on the government side, I share his concern that we seem to be moved toward filling a legislative gap because of the Supreme Court decision, which is very true.

On the other hand, it strikes me as the realistic situation that if we do not have legislation in place by the June 6 date given by the Supreme Court, then we would be in the untenable position of having a legislative vacuum. There would be absolutely no provisions concerning assisted death at all. The Supreme Court has found that the provisions of the Criminal Code that govern this matter are unconstitutional and only suspended the application of that judgment until June.

Does my hon. colleague have any thoughts about how we could bring in appropriate legislation and also avoid the untenable situation of having a legislative lacuna in Canada?

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, one of the things is that we are here. We are having the debate and discussion, and we are having it within the established timeline. We are trying to do a good job of setting up the guidelines and the safeguards on this issue.

The reality is that the acceptance of assisted suicide and euthanasia is not universal across the country. It was not something that was decided by the elected members of the House, those who are here to represent the people. It was decided by the Supreme Court of Canada. It made the decision that we had a charter right to this in Canada, so we needed to move forward with this legislation.

However, the Parliament of Canada needs to take some time to do this carefully to ensure we do it correctly for people.

There is a number of other things I had to say. One of them would have been about the slippery slope that countries find themselves on when they move into this area. We need to have a discussion about that as well. I do not hear members talking about this.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

Mr. Speaker, I am privileged to rise in this chamber in support of Bill C-14, medical assistance in dying.

I am in favour of the bill, not only because it was mandated by the Supreme Court of Canada, but for very personal reasons. I believe it is bill, a policy, that respects the rights of individual Canadians who are suffering unbearable pain. It respects their right to die a peaceful death.

I rise today to speak in favour of this bill on medical assistance in dying, not because of the Supreme Court's decision to strike down the criminal law banning medical assistance in dying, but rather for very personal reasons.

To begin with, the bill refers to medically assisted dying. It is not referred to as medically assisted suicide. My common definition of suicide, and I believe it is society's definition, is intentionally taking one's own life when death is not imminent. In the case of Bill C-14, there are clear conditions that would qualify an individual for medical help in dying. This would include, of course, the reality that death is imminent for that individual.

Henceforth, I believe we should stop calling it suicide because it is clearly not suicide in the common form of our understanding. I also believe that there is no parallel with the very sad and tragic suicide epidemic that is occurring in indigenous communities across our great country. In my mind, one is an apple and one is an avocado. They should not be compared.

The whole debate around medically assisted death is deeply personal and has led to some very emotional discussions. For me, it has led to much personal reflection. Like many Canadians, like many people in these chambers, I have seen too many family members and friends suffer excruciating pain needlessly when death was imminent.

Very personal for me was an experience last August 2, the same day that the federal election was called, when my mother passed away. She was 96 years old and she had been living alone for the last 20 years. She had been living bedridden and in pain in a care home for the last five years.

My mother was a religious person and had a special relationship with her god. She prayed every day. She scolded me for not attending church as often as I should. Over the last 20 years her body deteriorated, but her mind and hearing stayed sharp. Over the last 10 years, my mother shared with me her desire to have her life end. Medical advances had helped her to live longer, but her quality of life had severely deteriorated. She had become completely bedridden in the last five years and, in the last four years, malignant masses and tumours had developed throughout her lower body. Constant pain set in, and pain protocol was established. My mother, tough as nails, continued to breathe, pray, and hope that God would come and take her away. The praying and hoping continued for years and years.

My mother was of sound mind. She was a religious person who was at peace with her god. Families, nuns, and a priest would visit her faithfully. They gave her comfort, but she continued to express to me that she wanted to die peacefully and comfortably. She wished that there was a way to end the unbearable physical pain that could no longer be managed regardless of the care she received. I wish she could have had that choice, and she should have had that choice.

My personal feeling is that the legislation does not go far enough. I would have preferred that those who are experiencing enduring and intolerable suffering, with no chance of ever improving during their lifetime, be allowed the opportunity to access medically assisted dying, under the strict conditions that we have imposed in the bill.

However, I also understand that the legislation shifts the paradigm in such a profound way that in the future we will be making reviews. The law will be improved, and evidence will be collected. I hope that myths will be dispelled, and individual human dignity, self-determination, and choice will be nurtured further.

This choice is the basis of our discussions today. We hope to offer this choice to individuals who, in their last moments on earth, are experiencing intolerable physical suffering as a result of a grievous and irremediable medical condition. The debate is not about suicide. It is about trying to ensure the dignity of the dying person. We make choices about the care we receive throughout our life, and it is unfortunate that this choice is taken away from us at the end of our life.

It is true that the Supreme Court's decision in Carter v. Canada made physician-assisted death legislation necessary. I believe many of us have spoken to the fact that the timelines are anything but ideal. Would I have preferred to have another six months of debate, consultation, and discussion in order to make this reality? Of course, I would have preferred that. I believe every member in these chambers would have preferred that.

However, it is also true that there are people who feel that this legislation does not go far enough. There are also people who are opposed to physician-assisted death entirely. I have had many discussions with constituents on this issue.

I represent Saint-Boniface—Saint Vital, a riding with many Catholic constituents, and they have all made their views very clear.

Everyone, regardless of their position in this debate, wants to ensure the protection and dignity of individuals. The notion of dignity, which has come up several times in these chambers, is highly individual. Personal history, personal beliefs, and personal health situations all define what dignity means to the individual, and I might also add the right to self-determine.

Dying with dignity is a personal choice that needs to be respected. This bill is necessary. As a society, we must make sure that the best care possible is available to all our fellow Canadians.

This is an important moment in our history, where consultation has not only played an important role in the past but will play an important role into the future. I applaud the government for undertaking vast consultations across Canada and abroad to ensure that this legislation defends people's choices and freedoms in a way that protects the most vulnerable. It also supports personal convictions of health care providers.

I further congratulate the government on taking the time to continue the very important consultations and discussion surrounding mature minors, people who suffer from mental illness, and people who would like to arrange advance directives.

I would like to add that I fully support the government's commitment to a full range of options for quality end-of-life care, including palliative care, an area in which the St. Boniface Hospital, in my riding, is a leader. This bill establishes responsible measures to promote a standard approach to medical assistance in dying across Canada. It recognizes the inherent value and the equality of every human life.

The proposed legislation sets the framework for medically assisted dying across the country. It also provides a review in five years. It is balanced, responsible, and a very compassionate response to a very difficult, very personal issue.

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

Mr. Speaker, I thank the member for his speech, and particularly for having the courage to share some of his personal story and interactions with dying. These personal stories help us to add context.

Unfortunately, because of the lack of palliative care that we have in this country, there are many cases where a person may think or be told that their pain is not manageable when in fact their pain is manageable. This is why I think we need a greater emphasis on palliative care and pain management.

I want to ask specifically about dealing with palliative care in the context of the legislation before us. We have heard that there is a commitment, not in this budget but at some point in the future, to make investments in palliative care. Most of us think that is a good thing. The problem is that individuals do not have access to quality palliative care, and yet there is no allowance in the legislation requiring that they be offered palliative care before pursuing the option of assisted suicide or euthanasia.

I wonder if the member would support an amendment, as was recommended this morning in committee by an association representing palliative care doctors, to ensure that people would be offered palliative care, and that people would not opt for euthanasia simply because they do not have access to palliative care.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

Mr. Speaker, I met extensively with the St. Boniface Hospital in my ward, and with the Archbishop of Saint Boniface. There is certainly no argument from me that palliative care is extremely important in this whole topic.

We committed, post-election, $3 billion over the course of four years for improved home care, which is tightly connected to palliative care. We also have to take the health minister at her word when she says that palliative care is an absolute priority in her term as health minister. A lot of it is about partnerships with the governments across Canada.

I agree that palliative care needs to be improved. We need to improve the budgets on palliative care, and I support that notion.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, I would like to congratulate my hon. colleague on a thoughtful and sensitive speech. I also share his distinction between suicide and assisted death. That is an important distinction that all parliamentarians would do well to keep in mind.

I have two quick questions for him. First, he mentioned palliative care. I am the health critic for the New Democrats. I have pored over the budget of the government, and we know that the $3 billion promised during the election campaign by the Liberal government for home care is simply non-existent in the budget. I would like his comments on that and how he feels we can build a world-class palliative care system without a government that is prepared to put money behind it.

Second, in terms of the Supreme Court decision, it clearly said that assisted death should be available to anybody who suffers from a grievous and irremediable condition. This legislation includes additional criteria beyond the Supreme Court's instructions, including requiring that death be easily foreseeable. That has led to the perverse situation where Ms. Carter, the litigant in that case, likely would not be able to avail herself of assisted death, even though she successfully won the case. I wonder if he has any comment on the legislation in that regard.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

Mr. Speaker, I think the hon. member would agree that the bill being introduced, and that will be adopted, is profoundly shifting the paradigm on this issue. There are people who think it goes too far. There are people who think it does not go far enough. However, the reality is that it profoundly shifts the paradigm on the issue of medically assisted dying. It will be reviewed in five years, and I think there will be ample opportunity to improve it. I am confident that will happen.

On the palliative care commitment, it is quite clear that there is $3 billion over four years. I was sitting in this seat when the health minister made a commitment to improve palliative care service over the next four years.

[Joël Lightbound, Liberal, Louis-Hébert, QC]

Mr. Speaker, rarely in this parliamentary life are we called upon to debate such an important subject, an issue that requires such seriousness, rigour, sensitivity, and compassion.

With that in mind, I want to begin by commending the professionalism of all my colleagues in the House, who, from the beginning of our study of Bill C-14, have set partisanship aside and have made this debate more of a discussion, rather than a debate per se.

The subject that we are being asked to deal with today is one that invariably raises sincere emotions and touches a nerve with all of us, not only here in Ottawa, but all across the country. Developing a framework for medical assistance in dying means striking a balance between implementing a right with such irrevocable consequences on the one hand, and protecting vulnerable people with regard to that right on the other hand.

What right are we talking about? It is the right of a competent adult, who freely consents and suffers from a grievous and irremediable illness causing intolerable suffering, to die at the time of their choosing and with the necessary assistance and medical support. This is a right guaranteed by section 7 of the Canadian Charter of Rights and Freedoms, which states that everyone has the right to life, liberty, and security of the person. This right was unanimously recognized by the Supreme Court of Canada on February 6, 2015, in the Carter case. This right protects life, because the absolute prohibition in section 14 and paragraph 241(b) of the Criminal Code on aiding or counselling another person to commit suicide made individuals suffering from grievous and irremediable illness feel that they were forced to take their own lives prematurely out of fear that the progression of their illness would make it impossible for them to do so and that their suffering would become intolerable.

The absolute nature of the blanket prohibition on medical assistance in dying deprived people of a portion of their life that they could otherwise have enjoyed. This right also protects the liberty and security of the person.

As the Supreme Court explained in paragraph 66 of its decision in Carter, by denying people the right to request a physician’s assistance in dying, the Criminal Code is interfering with “their ability to make decisions concerning their bodily integrity and medical care”. The Criminal Code thus trenches on liberty. Since that option was not available to Canadians, they had to endure intolerable suffering, which also impinged on their right to security of the person.

Although the Supreme Court recognized that medical assistance in dying is one of the rights guaranteed under section 7 of the charter, those rights are not absolute. Limitations and restrictions can be placed on those rights, according to the principle set out in Oakes, which is based on section 1 of the charter. The principles in question are those of minimal impairment and an important government objective.

Bill C-14 must be examined through that lens. Although people with grievous and irremediable medical conditions should be given the right and means to die with dignity, that is not an absolute right. We also need to protect vulnerable people, people who are unable to provide informed consent, and people who could be subject to undue pressure.

My position could evolve, as I continue to listen to my colleagues and constituents and as I continue to reflect on this topic.

However, I think that it is a good idea to exclude minors and people with mental illness from this bill. Like many members in the House, and like the Quebec National Assembly when their work was complete, I think that including minors would have created some virtually insurmountable problems with respect to consent, as my Conservative colleague from Louis-Saint-Laurent pointed out.

With respect to people with mental illness, I think that in the absence of full and informed consent, the sanctity of life must prevail. Since such consent is nearly impossible to obtain under the circumstances, it is prudent to exclude people with mental illness from the bill.

Conversely, I think that some aspects of the bill raise some questions. One aspect is the notion of a death that is reasonably foreseeable, which the government wants to introduce, even though this notion was not in the Carter decision.

The court recognized that not having access to medical assistance in dying could cause intolerable suffering and, therefore, impinges on the individual's right to security of the person.

I also think that individuals who are suffering from a grievous and irremediable medical condition but who are not at the end of their life, which unfortunately is the case for many people in Canada, are therefore being deprived of the right to security and integrity of the person.

I am afraid that with this addition, one of the appellants in Carter would not have had access to medical assistance in dying. I am not certain either that such a restriction minimally impairs a charter right, as seen in Oakes.

Second, although I am aware that there is a need for robust protections and that the bill includes many, which is a good thing most certainly, I have doubts about the protection provided by the provision in paragraph 241.2(3)(h), which stipulates that immediately before medical assistance in dying is provided, a patient must reiterate his or her free, informed, and full consent.

Doctors would have to stop administering medication, such as morphine, which eases the patient's pain, in order to obtain this full consent. I fear that this provision will create excessive suffering for individuals at a moment when they want to gently leave behind their overwhelming suffering.

Third, I was not convinced that advance consent was a good idea, but I was enlightened by my colleagues. Although I am still not convinced, I welcome the government's willingness to study the issue further.

Lastly, like many of my constituents, I think medical assistance in dying must be brought into the broader context of end-of-life care. To that end, I also welcome the promise to invest $3 billion over four years in home care.

I believe that, like the bill, this is a step in the right direction, but it is not the final destination. I will vote in favour of this bill at second reading, and I encourage my colleagues to do the same.

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

Mr. Speaker, I have two specific follow-up questions. The member alluded to the government's commitment on home care, but we need to be clear that there is a big difference between palliative care and home care. Home care is the care that someone receives in their home to support their ongoing independence—it could be at varying stages—and palliative care is specifically the care for those who are dying.

I wonder if the member could clarify what kinds of investments we will see in palliative care, especially since neither of these things were in the budget.

Second, I want to ask him about contemporaneous consent, because the concern I have is that if we were to move down the road of having advance directives in this legislation, we would have a very different consent there than for sexual consent. In the context of sexual consent, of course, we require contemporaneous consent.

Why would we have a lower bar for consent when someone is choosing to die than for someone who is choosing to engage in sexual activity?

[Joël Lightbound, Liberal, Louis-Hébert, QC]

Mr. Speaker, I would like to begin by answering my colleague's question about money for home care and palliative care. I heard the minister say several times that palliative care is a priority for the government, a crucial priority that the government plans to invest in.

The government's pledge to invest $3 billion in home care over four years comes at a time when most of the people receiving home care are at the end of their lives. I completely agree with the member: palliative care should be and is a priority for this government.

With regard to his question concerning consent, my mind is not made up on advance directives, but I think there is a difference between consent in terms of sexual relations and consent when people know they have a debilitating illness that will prevent them from consenting further down the road. I think the distinction is clear.

However, my mind is not made up on that subject. I wish to hear more about advance directives and I am glad that the government has decided to study that question further.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, I appreciated my colleague's remarks.

Yesterday, the Barreau du Québec stated that the reasonably foreseeable natural death provision in the bill is not consistent with the Carter decision or the right to life in section 7. Ms. Carter would not have had access to medical assistance in dying unless reasonably foreseeable natural death were interpreted as having to do with age, which is an absolutely unnecessary distinction here.

I would like to hear my colleague's thoughts on that.

[Joël Lightbound, Liberal, Louis-Hébert, QC]

Mr. Speaker, I thank my colleague for his excellent question.

As I mentioned in my speech, I agree with the Barreau du Québec on that. I think the notion of reasonably foreseeable adds a criterion that did not exist in the Carter decision. Unfortunately, it places people who are suffering from a serious and incurable illness and experiencing suffering that is intolerable in situations where, if they are not terminally ill, they cannot receive medical assistance in dying.

That is one aspect of the bill that I personally have a problem with. Still, I think it is a step in the right direction, which is why I urge all members of the House to support this bill at second reading so it can go to committee.

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

Mr. Speaker, I thank my colleague from Louis-Hébert for his very clear speech on an issue that is so personal for many of us.

Almost everyone here in the House who is participating in this debate has similar stories from their own lives.

In my case, my grandmother was no longer able to teach downhill skiing at the end of her life. After teaching it for nearly 70 years, she started falling, until her injuries were too serious for her to survive them.

I do not think this came under the canopy of medical assistance in dying or assisted suicide. I find that circumstance unacceptable. We need to fix this lack of dignity.

Is my colleague worried about the legal vacuum that would exist if this bill is not passed within the prescribed time frame?

[Joël Lightbound, Liberal, Louis-Hébert, QC]

Mr. Speaker, I would like to thank my colleague for his question. In fact, we must avoid this legislative vacuum for Canadians.

That is why I believe voting for this prudent bill is the right thing to do. It is a step in the right direction, and it could go further.

This issue was debated in Quebec for years. Canada is just beginning to debate it, and I believe that the debate will have to continue for the next few years. The bill provides for a review of the act in the first five years.

We must have this debate, and we absolutely must present Canadians with a law before June 6, 2016.

[Alice Wong, Conservative, Richmond Centre, BC]

Mr. Speaker, today I rise to discuss Bill C-14.

As we well know, Bill C-14 is the government's response to the Supreme Court ruling in the Carter decision last February. The court gave the government a total of 16 months to form legislation, so here we are in the House today, debating the bill.

I was pleased to see that the bill included many recommendations provided by my Conservative colleagues in their dissenting report from the special joint committee report on this issue. However, I do not believe the bill in its current form is good enough.

I have benefited from listening to my colleagues' speeches, and appreciate the passion each has shown as they discuss Bill C-14 in the House. Indeed, I have made my own consultations with various interested parties in my riding of Richmond Centre, and look forward to sharing them with you.

We have received many suggestions and comments on the legislation, both from parties that believe the bill is too restrictive and those who believe it is not restrictive enough. Indeed, I am rather impressed that there was significant public interest on this bill, and I would like to continue to encourage people in Richmond Centre who have not given their thoughts on this matter to write to myself or my office.

My voting position on second reading will be carefully considered from a balance of available information, including from the consultations I have held with interested stakeholders in my riding.

To begin, I would like to share some of my personal experiences. During my time as the Minister of State for Seniors, I had the opportunity to work with many groups who are devoted to protecting our most vulnerable and ensuring quality palliative care. The unfortunate reality is that there are many seniors who are not provided with effective end-of-life care. Instead, they are subject to elder abuse and are often pressured into making decisions to avoid becoming a burden to their families. This is tragic. It is absolutely imperative that we ensure that there are safeguards to protect seniors against such elder abuse.

A potential safeguard to protect financial abuse of elders, which is a very common and unfortunate form of elder abuse, is to simply prohibit any independent witnesses from financially profiting at all from the will or the estate of those who requested physician-assisted suicide This was actually a recommendation from a group of constituents I met with recently. They pointed out that in the bill, the independent witnesses that have to sign the documentation to enable the physician-assisted suicide only have to know or believe they are not a beneficiary under the will of the person making such a request. Again, this is simply not enough.

Back in my riding of Richmond Centre, I have been an active member of the Richmond Rotary Club. This club was instrumental in building the first hospice in Richmond. It was there that I and my fellow Rotarians witnessed first-hand the benefits quality palliative care can bring people. Life is valuable at every stage. One of my primary concerns with physician-assisted suicide is that it will only complicate end-of-life decisions. Individuals who are sick or need additional care will see themselves as a burden, and choose death to avoid placing further expectations on family members.

Instead, we need to be supporting family caregivers and demonstrating that every life is valuable.

As others have noted, there was no allocation in the budget for palliative care services. This is totally and absolutely unacceptable. This issue is quickly becoming more about access to death than access to life. It is absolutely essential that the government make a commitment to strengthen palliative care and encourage citizens to seek such care first. Palliative care provides death with true dignity and not a forced death, which is what physician-assisted suicide is.

Last year, I had the opportunity to meet with organizations such as the Council for Canadians with Disabilities, the CCD. I met with its representatives to discuss their concerns and the importance of protecting individuals with disabilities. More recently, they were able to appear as witnesses at the special joint committee to discuss their views on possible legislation. The CCD was very concerned with the recommendations provided by the committee and commented, “The permissive approach would put vulnerable people at risk”.

We cannot ignore the needs of our most vulnerable. It is crucial that the legislation reflect the concerns of groups such as the Council for Canadians with Disabilities to ensure all Canadians are protected.

I would like to share a few of the comments I have heard from my constituents over the past several months. I will emphasize that my repeating these comments in the House today does not mean that I endorse all of them, but rather, this is a reflection of the variety of comments received. I know as an elected figure this may be hazardous as I may be quoted out of context; however, it is my duty to ensure that these voices are heard.

A primary theme as a result of my consultations is that Bill C-14 would only decriminalize the act of physician-assisted suicide as performed by medical practitioners.

I will add that there would be no effects or changes to the Canada Health Act, nor would it instruct our provinces to provide this procedure as something to be covered under provincial medical insurance plans. In my home province of British Columbia, this is the medical services plan, the MSP.

In general, there seemed to be a considerable amount of confusion about whether the provincial governments would actually provide this procedure and whether they would indeed pay for it.

One stakeholder group mentioned it wished to invoke the notwithstanding clause to maintain the previous provisions of the Criminal Code. This group found the terminology of what constituted a terminal illness to be a slippery slope and that unendurable pain could be mitigated with quality palliative care. As it realized that this was generally not a realistic approach with the existing government, it also mentioned that it was hoping for a robust protection for health care providers and facilities to act according to their conscience.

There were many other comments, but I have only 10 minutes for this speech, so I will state again that I have been pleased with the amount of interest we have received from engaged citizens and stakeholder groups on Bill C-14. I will be making my voting decision after giving the people of Richmond Centre the maximum period of time to send their feedback.

I would like to end my speech with a short story. Many members of my family are health professionals. Even among those who are young, many desire to grow up to be doctors or nurses. When I ask my young nieces and nephews why they want to be a doctor, I always receive the same simple answer, “I want to save lives.”

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

Mr. Speaker, the member is concerned about access to death versus access to life. On the timeline we are working with, imposed by the Carter ruling, is precisely access to death that we are addressing here. I do not believe there is anyone here who is opposed to looking at palliative care.

For me, freedom to life is very much like, and as important as, freedom of religion. Freedom of religion includes the freedom to be religious in any manner we choose, just as it includes the freedom from religion. Freedom of life includes the freedom to live, but it includes the fundamental right not to live. The latter is not a right that should be exercised lightly, and it is extremely important to have processes in place, as this bill proposes to do in line with the Carter decision.

I believe we should make every effort as a society and as a Parliament to make every person's life as good as possible. Indeed, that is a principal obligation of government. I believe that the decision of when to end one's life is a decision that belongs to the person whose life is ending, and only that person.

Does my colleague agree that the best defence of life we can provide is by getting this law through on deadline, avoiding a legal vacuum, even if it means revisiting the issue later?

[Alice Wong, Conservative, Richmond Centre, BC]

Mr. Speaker, I know I am not alone in stating that the time frame set out by the Supreme Court was not sufficient. Sixteen months is not nearly enough time to adequately examine evidence, consult with Canadians, and prepare well-drafted, careful, and sound legislation. I do not think it is appropriate to approve legislation simply because it is good enough or we are on a time crunch. It is never our responsibility to rush legislation. We represent our constituents to ensure a better and safer Canada.

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

Mr. Speaker, I have mixed feelings about the Conservative member's speech.

On the one hand, the Conservatives are complaining about not having enough time to debate the issue. As everyone knows, it was the Conservatives who opposed the opposition motion to create a multi-party committee to study the Carter decision. This would have started the ball rolling on a study of medical assistance in dying. Therefore, they are part of the reason why debate and studies on the issue were delayed.

On the other hand, I agree with the member that we need more palliative care and that financial resources must be allocated to palliative care. Many people want to stop their suffering, but they do not necessarily want to die right away or to access medical assistance in dying. Above all, they want the pain to stop.

Today, the Liberals say that they are prepared to allocate $3 billion over four years. However, there are no timelines.

I would like to hear what the member has to say about that.

[Alice Wong, Conservative, Richmond Centre, BC]

Mr. Speaker, I heard the Liberals say that they wanted to commit themselves to $3 billion over four years. However, it is not in the budget. If it is not in the budget, where is the money? The most important thing is to not make empty promises, but to really keep their promises and take real action.

I appreciate the fact that my colleague from the NDP also stressed the importance of palliative care. It is exactly the same message that this is an option for end-of-life choices. Ending one's life by force is not the only choice.

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

Mr. Speaker, my colleague referenced the government's supposed commitment on palliative care, but it is actually worse than that, because the Liberals have said palliative or home care. One of the members pointed out quite rightly that palliative care can happen in the home, but these are not the same thing. There are many kinds of home care that are very much essential which are not the same as palliative care.

I would say it is important that we deal with palliative care, not just separately maybe sometime in the future, but specifically in this legislation. The federal expert panel, which the previous government set up, was clear that people cannot be construed to have consented to euthanasia or assisted suicide unless they had an option of palliative care available to them.

I would like the member's comments on that.

[Alice Wong, Conservative, Richmond Centre, BC]

Mr. Speaker, there is indeed a very clear distinction between home care and palliative care.

Palliative care is about helping the relatives, the friends and families of the one who is terminally ill and who is expecting to die. It helps them go through the end-of-life period of time together in a positive way so that it is a good end-of-life option. That is unlike home care, which is only for helping seniors get up, do their washing, do their dishes, and other things. There is definitely a clear distinction between home care and palliative care, especially hospice homes.

[Kate Young, Liberal, Parliamentary Secretary to the Minister of Transport]

Mr. Speaker, I am pleased to speak to Bill C-14, which would enact a federal legislative framework to permit medical assistance in dying across Canada.

Medical assistance in dying is a deeply personal issue for all Canadians, as we have witnessed. As parliamentarians, we must consider a diverse range of views on this complex issue. I know that we all take this responsibility very seriously.

The starting point is, of course, the February 6, 2015 decision of the Supreme Court of Canada in Carter v. Canada. The court unanimously held that the criminal laws prohibiting physician-assisted dying interfere with liberty and security of the person by denying grievously and irremediably ill individuals the ability to make decisions concerning their bodily integrity and medical care, and leaving them to endure intolerable suffering.

The court also held that the laws deprive some people of life by forcing them to end their lives prematurely for fear that they would be incapable of doing so when they reached a point where their suffering was intolerable. The court accepted that the criminal prohibition on assistance in dying furthers a pressing and substantial legislative objective, that of preventing vulnerable individuals from being induced to die by suicide against their will in a moment of weakness.

However, the court concluded that a permissive regime with properly designed and administered safeguards was capable of protecting vulnerable people from abuse and error, and that the absolute prohibition went farther than necessary to achieve its objective. The court appropriately left the task of designing this new regime to Parliament.

The proposed legislation responds to the Carter ruling by enacting a new legal framework for access to medical assistance in dying, including the safeguards that the court called for in order to minimize the potential for errors and abuse.

The court did not define the term "grievously and irremediably ill", but the proposed legislation does define it in a manner that is consistent with these circumstances. Specifically, the person must be in an advanced state of irreversible decline in capability. The person must have a serious and incurable medical condition. The person must be suffering intolerably. The person's death must have become reasonably foreseeable, taking into account all of the person's unique medical circumstances.

Canadians would have the comfort of knowing that they would be able to get the assistance they need if they are suffering intolerably when their capacity declines as they approach the end of their lives.

Like so many honourable members who have stood in this house to debate this difficult legislation, I have my own personal story that makes this issue all the more relevant. My mother, Eleanor Anderson, spent over 10 years in a wheelchair after suffering a massive stroke at the age of 69. She had to learn to walk, talk, eat, everything right from scratch. Then it happened again, another stroke five years later. She fought back again, but with each stroke a little more of her was taken away.

She never wanted to feel helpless. During those years in a wheelchair, my mother would try her best to do everything on her own, whether it was dressing, loading the dishwasher, or simply wiping down the kitchen counter. During those years, she never wanted our sympathy.

Despite her tenacity, she knew the day would come when she could not fight any longer. She made it very clear to my father, to me, and my brother that if the time came and she was not able to do much more than lie in a bed, she wanted to drift away peacefully. As expected, what we all feared eventually happened.

She continued to have small strokes, losing mobility and function with each one, to the point that she could no longer sit up in her wheelchair, talk, or even eat. We were not even sure if she knew any of us anymore. She pulled out the feeding tube that kept her alive, to the point where the doctors said they wanted to insert a tube in her stomach. That was not the life my mother wanted, and so we said no. We had to let her go. Doctors agreed it was best, and said she would only last a few days.

We asked that she be moved to palliative care at another hospital. Ironically, they said they could not move her because she would not make it, that she would die en route, and so she lay in that hospital bed, and we watched her slowly starve to death.

She would last 12 days, and her death was anything but peaceful. It was the most excruciating experience I have ever been through, and nothing prepared me or my family for her death. I know my mother would have agreed that this legislation is a step in the right direction. She would have wanted to be able to communicate her desire to die with dignity. However, she would have also wanted her family to follow through on her wishes.

Twelve years later, my dad said to me, after catching an infection, “I just want to close my eyes and not wake up”. That is exactly what happened. He was gone two days later. He got his wish. However, I know that many people are not as fortunate, and it is for those people that we must be prepared to lend our voice.

Health Minister Jane Philpott said this in her speech to the House:

...every person, every story, is unique. However, much is shared in common: the hope to die in peace; the desire to be respected; and to have personal autonomy and dignity honoured by family and health care providers alike.

Minister Philpott went on to say that her experience as a family physician reinforced her sense that we must—

[The Deputy Speaker, Conservative, Bruce Stanton]

Order, please. I try to make a point not to interrupt the member when that happens. However, we have a Standing Order that suggests we not use other members' names in the House. That includes when ministers are being quoted. I realize that the hon. member did not put it that way in this case, but even if a member's name appears in a citation, for example, we avoid that. If the member would substitute the minister's title or her riding name, then she is good to go.

[Kate Young, Liberal, London West, ON]

Mr. Speaker, the minister went on to say that her experiences as a family physician reinforced her sense that we must “uphold the principles of palliative care, as well as respecting the rights of patients to make their own decisions about their care as they approach the end of life”.

Earlier this year, the minister met with provincial and territorial health ministers in Vancouver to launch discussions on a new multi-year health accord. Through the health accord process, our government will be making significant investments totalling $3 billion dollars to help deliver more and better quality home care services for Canadians. We expect that support for palliative care in a variety of settings, where patients can receive the ongoing care they need and deserve at the end of life, will be one of the priorities going forward. I agree that there is no doubt that care at the end of life should be there when people need it. We want all Canadians to have access to the best care possible.

The issues in this area are complex. However, I strongly believe that Bill C-14 has struck the right balance between competing rights and policy objectives.

I call on members of this House to support it.

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

Mr. Speaker, I would like to ask the member about the concept of advance review by a competent legal authority. One of the concerns I have with this legislation is that we have various criteria, some of which I think need to be more specific, but there is no mechanism for ensuring that complex legal criteria are met. What some have proposed, and there has been some agreement from at least one member on the other side, is that if we had a system in place where there was someone with not just medical but legal expertise reviewing it to say, yes or no, the criteria are or are not met in this case, that would be a good way of ensuring that vulnerable people, the people who do not consent or do not meet the criteria, are not being pushed into it or receiving euthanasia or assisted suicide without the law being followed.

Would the member agree with me that an amendment to ensure some kind of advance review by competent legal authority would be an effective way of improving this bill?

[Kate Young, Liberal, London West, ON]

Mr. Speaker, under the proposed legislation, two independent health care professionals would need to evaluate the circumstances of a patient's health. If I understand correctly, the member is saying that we should go one step further and have someone from the legal community also be a part of that. I think that is up for discussion, something that certainly should be discussed at the committee level. That is why I hope this will be moved forward.

[Karine Trudel, NDP, Jonquière, QC]

Mr. Speaker, I thank my colleague for her speech.

This topic goes to the core of our values and our ways of life.

The Quebec bar recently confirmed that if the bill were passed as drafted, it would be unconstitutional. What does my colleague thing about that?

[Kate Young, Liberal, London West, ON]

Mr. Speaker, this is obviously a decision that all of us have to make individually and take in all of the information that we are hearing, not only from what we have so far from the committee but also what is happening across the country, and certainly what has happened in Quebec. I think that is something to which we all need to listen and be open.

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

Mr. Speaker, I would like to thank the Parliamentary Secretary to the Minister of Transport for sharing personal stories, because that does help to understand the background we coming from when we are trying to deal with this issue.

We have heard a lot today and yesterday about the balance between safeguards and providing this right. Perhaps the member could provide us with some better insights into which safeguards give her the most comfort with this legislation.

[Kate Young, Liberal, London West, ON]

Mr. Speaker, safeguards are necessary, because there are the vulnerable in our society whom we must protect. Therefore, it is important for us to have different steps of safeguards.

Each person who is going through this journey of death is different. I think we do need to have safeguards in place, and certainly the safeguards would be different in different situations.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, what does my colleague say to people who claim that under the existing bill Ms. Carter would not have had access to medical assistance in dying?

[Kate Young, Liberal, London West, ON]

Mr. Speaker, this is one area where I think there is a point of discussion. Some people would say that she would have met the criteria of the four areas. It is something on which I think it is necessary to have a debate.

Of course, in Ms. Carter's position, where she was at her end of life will be different from someone else. However, I truly believe, in looking at the legislation, that she would have been able to have assisted dying under this legislation.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, I think it is very important to rise to speak to Bill C-14, today and on other days of debate.

As my colleagues probably know, I am a health care professional. I still work at the hospital a few times a month, mainly in emergency and intensive care. This is important to me. End-of-life care is very important, which is why I supported a motion that my colleague from Timmins—James Bay moved during the previous Parliament. That motion dealt with with a national palliative care strategy.

To begin, I would like to highlight two or three points form the Supreme Court decision that I think are particularly important to this discussion. The decision states:

...the prohibition [of medical assistance in dying] deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

And by leaving them to endure intolerable suffering, it impinges on their security of the person.

It is important to mention that the Supreme Court decision underscores the government's responsibility to address the suffering that people experience. It is also important to understand the difference between suffering and pain. Pain is a physiological reaction to stress, such as an injury. Suffering has to do with an emotional experience.

Take, for example, a very painful event such as childbirth. That pain is associated with a positive emotional experience, the birth of a child. That event does not necessarily cause suffering, but it does cause significant pain.

A person might also have a minor injury that can cause extreme suffering because of the emotional experience associated with it. I think it is important to make that distinction.

These days, we have excellent therapeutic ways to alleviate pain. Opiates were long used, but now we also have patient-controlled analgesic pumps. We can even offer continuous palliative sedation, similar to what intensive care patients receive when they are intubated to ensure that they do not feel any pain. There are a number of extremely effective ways of alleviating pain, in addition to non-pharmacological methods. We have a good range of treatments to offer patients who are in pain.

It is possible to alleviate the suffering that comes with an emotional experience such as the end of life or an end-of-life diagnosis without resorting to medical assistance in dying. In that case, palliative care is an option. The bill applies to adults with a serious and incurable illness, disease, or disability who are in an advanced state of irreversible decline in capability and whose natural death has become reasonably foreseeable.

Obviously, we are talking here about people who are at the end of their lives, people who need palliative care. The purpose of palliative care is to ease the suffering of both the patient and the family. Palliative care helps ensure that people are cared for properly, and that they have the help they need to get through the grieving process and the hardship associated with illness.

We want to take away all the pain, but we also want to provide support for the family.

Optimal palliative care helps not only the patient but also the whole family, so that the patient's death can be as peaceful as possible for everyone involved. We are going about things the wrong way by providing medical assistance in dying when the palliative care offered in Canada is not yet optimal.

When palliative care facilities are underfunded and need to try to drum up donations every year, they are unable to offer optimal palliative care. Most of these facilities can only take patients who are expected to die in less than three months. However, people can often live much longer than that with a terminal illness and they need a lot more support.

Moreover, in many rural areas, palliative care beds are reserved through surgical units. That means that nurses who are taking care of palliative care patients also have to take care of seven or eight other patients. Nurses are therefore unable to respond quickly or spend as much time as they should with the families, and the patient's death does not go the way he or she would like.

For people who do not have the means or who do not want to die at home, unfortunately the hospital is often the only other option when palliative care beds are not available. This is not an easy experience, and it can create suffering because patients do not always have all the support they deserve.

There has been a lot of effort in recent years to remove some natural processes from hospitals. One example would be the birthing centres that have been set up. The thinking is that it would be better for mothers to go through pregnancy and childbirth a little more naturally in a setting other than a hospital, as long as there are no medical complications.

The same thing is being done with death, which is a natural process. It is being taken out of hospitals to make the experience much more positive, in a place other than the medical setting of a hospital.

Hospices try to remove all traces of hospitals. They have hospital beds, but they try to use the patients' own bedding, have large windows, and help patients forget that they are not at home.

Unfortunately, no matter how hard the palliative care facilities work, they are often underfunded. For example, the Maison du bouleau blanc, in my riding, has four beds, only two of which are subsidized. It therefore relies on donations to maintain its other two beds. It has a large room with big windows and a shower, but this is the only room that the facility has been able to convert to an ideal palliative care room.

These people cannot afford nurses. The people who work there are extremely dedicated practical nurses. However, they have some legal limits. For that reason, all the protocols regarding doctors working with palliative care facilities had to be updated, in order to ensure proper care for the patients.

We could address a number of shortcomings and avoid making the patients suffer. If someone who receives a terminal diagnosis knows that they will receive good palliative care as their condition worsens, they may not choose to take their own life prematurely. This would therefore help protect the right to life.

However, as long as do nothing on palliative care, we are working backwards. We cannot reverse the life-based medical model to allow for medical assistance in dying if our palliative care services are not as good as possible or accessible to all Canadians, regardless of where they live, even if they live in a remote region.

Since I am out of time, I would be happy to take questions from my colleagues.

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

Mr. Speaker, I thank the member for Abitibi—Témiscamingue for her extensive remarks on palliative care.

As she may know, I was a member of the Special Joint Committee on Physician-Assisted Dying, and we talked a lot about palliative care. We also talked about how, for some people, that is not enough. Even though they have access to palliative care, they want the right to medical assistance in dying.

Can the member help me think of some ideas for people who want medical assistance in dying? They do not want palliative care; they want medical assistance in dying.

What safeguards does she think we should put in place for them so we can give them that right?

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, as I said in my speech, the government chose to leave people who are not at the end of their lives out of Bill C-14.

In some cases, individuals might want medical assistance in dying. One example that comes to mind is people on hemodialysis, an onerous and time-consuming treatment. After 10, 15, or 20 years of such demanding treatments, people might be worn out and might want to stop. All patients have the right to refuse treatment. A patient who refuses this treatment will die in the short term, but continuing to receive the treatment will not cause death. That means that the patient's end of life is not reasonably foreseeable, and he or she may therefore not be covered under this bill. People may want medical assistance in dying, but some of them are not covered under this bill as written. That must be fixed.

I think we should concentrate on palliative care first and foremost. Allowing medical assistance in dying makes no sense unless we have optimal palliative care in place.

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

Mr. Speaker, I thank the member for her eloquent remarks, specifically around the importance of palliative care. We have heard from the NDP some agreement with what we have been saying, which is on the importance of palliative care as well as conscience protection. We have actually heard the Liberals in some instances, and in different ways, saying that these things are important as well.

My view would be that we need to make sure that these things are included in this legislation, that we have protection for a right for someone to access palliative care, and a right of conscience. We hear reassurances from the government that it cares about these things as well, so let us get this into legislation so that Canadians and those of us who are voting on the bill can have certainty that those rights will be protected.

Would the member agree that we need amendments specifically in this legislation, not just separate funding commitments, but amendments in this legislation, to ensure that people will be offered palliative care and that there will be protection of conscience?

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, I agree that it makes no sense to guarantee the right to medical assistance in dying without guaranteeing the right to receive optimal, high quality palliative care. Both options have to be on the table.

For example, someone who is diagnosed with advanced cancer could be offered medical assistance in dying. They know that option is on the table. However, palliative care might not be available in their region. They would have to relocate and spend their dying moments far from their family. They are not being offered a full choice. If we really want to be consistent in terms of what we are putting on the table, then both rights have to be guaranteed to end-of-life patients.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Mr. Speaker, indeed this is a heavy subject for most Canadians. Physician-assisted suicide is definitely weighty. There were laws that we thought were sufficient, but it is as a result of the Supreme Court deciding the law is not sufficient that we are in this predicament today of having to find some alternatives.

I will be speaking to some different issues. I would not say they are of the highest importance to me. I will speak about those issues a little later. However, I want to talk about a few of the issues that are not talked about as much. One of them is on page 11 of the bill, called “Deeming”. I will read from the act itself. It states:

For the purposes of this Act, if a member of the forces receives medical assistance in dying, that member is deemed to have died as a result of the illness, disease or disability for which they were determined to be entitled to receive that assistance

I will go to the next page, where it again says “Deeming”. This time it states:

For the purposes of this Act, if a member or a veteran receives medical assistance in dying, that member or veteran is deemed to have died as a result of the illness, disease or disability for which they were determined to be entitled to receive that assistance

I mention that today as a former member of the veterans affairs committee, which dealt with PTSD, with veterans who have experienced trauma as a result of war, as well as relatives who have suffered trauma and PTSD as a result of war. I am concerned about this clause in a dramatic way, due to the potential for it to be used as a way out for families. It could be a means of financial assurance, if the member decides it is a way out, that could provide sustenance for his or her family.

I feel it would open a door that was previously closed to members. We certainly respect the ones who have passed as a result of suicide, but I am concerned that this opens the door wider, to making it a somewhat legitimate exercise and to potentially doing it for families to receive benefit. We should be looking at more ways to help members of the forces and veterans with PTSD rather than giving them a doorway out.

The second issue I would say is a more significant argument for me, and that is the issue of compelling. Compelling has different forms. Compelling, as we heard from physicians who are friends of mine, and nurses, could be a doctor compelling a nurse to deliver a life-ending drug. Can a patient compel a doctor to end that patient's life? Does a senior feel compelled to end his or her life to lessen the financial burden to the family? Does a senior feel compelled to end his or her life to make room for others in hospital rooms and beds in our country?

I feel that there are a lot of arguments. I will first talk about the argument of a physician compelling a nurse. Certainly there is discussion within the bill to allow physicians to have the freedom to do what they wish to do based on their religious beliefs, or the basic belief that life is sacred and not wanting to take part in assisted dying. Most of us fully understand the way that the Supreme Court can be used as a tool. A citizen could use the Supreme Court as a tool if a doctor refused service.

If a doctor refused to assist a person to end his or her life, it would likely end up in a court, which I am sure will happen if this bill passes the way that it is. Doctors could be held to account, if a law is enacted that they have a responsibility to perform that duty for Canadian citizens. Likewise, if doctors feel compelled to perform that service, which is what we heard in testimony from doctors directly, doctors do not actually give the injection or do the duty of ending the life. It is passed on to another member of the medical staff, usually a nurse, and that person will be compelled by a doctor's order to deliver the life-ending treatment or drug. Those are huge issues, and any one of those breaks in the chain could potentially end up in a court. A particular member of medical staff would be ordered to enforce that care.

I will move on to the more general compelling of seniors and people who are ill in our society. I have two senior parents. May dad is 82 and my mom is 72. The last thing I would want would be for them to feel like they are a burden on our system. They have contributed all their lives. To this day, my dad still works as a carpenter out in the shop. He pays his taxes. A senior should not feel like he or she needs to end his or her life based on a health care system that needs more space or is just too expensive.

I love my parents, but that is not always the case across Canada. Different families do not agree as much as I do with my parents and there are frictions within families. Would some of these frictions within families be used to compel seniors to possibly end their lives because they have been made to feel they are a burden on our system? Certainly these are the what-if cases, but with 30 million people, these cases will arise, if they have not arisen already. It is deeply concerning to me that this is even an option.

Much has been said of late about the suicides in Attawapiskat and suicide in general and what the feelings are about suicide. I do not think we can sugar coat it. We call it end of life and some other groups have call it different names, but it is suicide. It is the ending of someone's life.

What concerns me is an example of what could potentially happen. A group of individuals who feel they do not want to be on Earth anymore go into a physician's office and based on a psychiatrist's exam and review, they are warranted to end their lives. I am concerned this opens the door wide to an acceptance of suicide as a somewhat acceptable form of living in this world or ending one's life in this world. It is a huge concern for me.

Lastly, I will speak about why I do not think we need to be in this situation. It goes back to the notwithstanding clause. I had a conversation with a judge on a plane ride home to Vancouver. My comment to the judge was that as members of Parliament we were checked every four years during an election. Often we would see many different faces in this place. The people of Canada have checked us. Some have made it back and some have not. We see some new faces. They made it here because the people spoke.

What check is on the judiciary of our country? The response from this Supreme Court justice was that there was a check, the notwithstanding clause.

I know it is yeoman's work to even try to get this kind of law into some kind of acceptable form because of so many diversities, but we already have a law. It is the job of 338 members of the House of Commons to enact laws. It is the job of the Supreme Court to uphold those laws. My concern is that there seems to be a usurping of our particular body by the Supreme Court. I would challenge the government to look into that. It should look into whether we already have a law. A lot of us still accept the law for what it is. Rather than having a discussion about reforming and rewriting what is already there, we need to go back and really think seriously about it.

I certainly agree with most people here that palliative care needs to be better in Canada. We have all had passionate arguments about the sanctity of life. I believe all were created equal in this place.

However, we need to seriously think about either rewriting the law as it was, as Canadians have sent us here to do, or upholding the laws that are already in place by previous bodies of elected people to the House. We need to honour this place. This is the place where we make laws. It is not just we 338 individuals. We have been sent here to represent over 30 million people, and their voices need to be heard loud and clear.

It is a tough argument to have in this place. There are many issues on both sides that we all feel very passionate about, in whatever form that is, but we need to consider seriously upholding the laws currently in place.

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

Mr. Speaker, we need to emphasize the fact that the Supreme Court decision was made unanimously by all the sitting Supreme Court judges, which says a lot. Therefore, when the member makes reference to using the notwithstanding clause, I would caution him.

So that people understand this, because the member seemed to give this a lot of attention, access to medical assistance in dying would only be available to those who would meet certain conditions: they must be mentally competent adults who are in an advance state of irreversible decline and capability; have a serious and incurable illness, disease, or disability, and experience enduring and intolerable suffering caused by their medical condition; and whose deaths have become reasonably foreseeable, taking into account all of their medical circumstances.

This law is better than the alterative, which is no law. The member has specifically expressed his concerns with the legislation. I would strongly suggest he share those concerns with the standing committee to see if there are ways in which we can deal with some of those.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Mr. Speaker, the fact the member has spoken to me, means he is exercising that right of the citizens who sent him here. He likely represents about 100,000 people, based on riding size. I represent 107,000 people. If seven or nine individuals supersede an elected body that represents 30 million, then we disagree on numbers.

The member talked about certain definitions. Correct me if I am wrong, but we are all in certain phases of decline. We all are going to meet our end someday. My concern is that such an open definition would apply to any individual on this planet. Again, once we open it up that wide, we open it wide up for abuse.

[Kennedy Stewart, NDP, Burnaby South, BC]

Mr. Speaker, I am very confused by the Conservatives who keep raising the use of the notwithstanding clause. Could the member perhaps flesh out how he would see this going forward?

If we are going to at least discuss this, I would like to hear some idea about how the member thinks we could start this process of using a notwithstanding clause to override the Supreme Court decision.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Mr. Speaker, on the notwithstanding clause, I do not know if it has been used. Somebody can correct me if I am wrong on whether it has been used or not. However, it should be used very carefully.

My point is that we need to ensure that the governing body that represents the citizens of Canada in creating laws for this place and for the country is supreme in its ability. That is what we are sent here to do. Because a body of judges has said otherwise, I do not think changes our responsibility to our country and to our citizens. This is why I support it.

I was not aware of anybody else suggesting the notwithstanding clause. This is a personal opinion. However, we need to ensure this place remains sacred and we represent what Canadians say to us.

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

Mr. Speaker, my colleague has talked about the notwithstanding clause and, realistically, that would be anathema to the current government. The Liberals' attitude seems to be that one cannot even disagree or hold a different point of view than that of the Supreme Court.

However, at the same time, the government needs to accept responsibility for, in fact, in some ways, going much further than the court decision. We have things like the reasonable but mistaken clause, which would allow someone to escape prosecution for taking someone's life who maybe did not consent if that person had a reasonable but mistaken belief that the criteria were met. The court referred to that there is nothing in its decision that should infringe on conscience, but yet we see the legislation has no protection on conscience.

Could the member comment on the fact that the government is not just implementing what the Supreme Court directed, but is actually going much further, and it needs to take responsibility for that?

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Mr. Speaker, I think the member is referring to the Carter decision. What we have seen are problematic issues with the current bill. It has gone far past what the Carter decision said it would wish to see.

Again, I implore the government to consider rethinking this bill, maybe splitting it into different issues, so it addresses conscience rights and compelling somebody to do something they do not want to do.

Canadians care deeply about this issue. I hope the government takes our discussions back to committee, and approves some amendments at the very least.

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Mr. Speaker, I move:

That this question be now put.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Mr. Speaker, I would ask for clarification as to exactly what the intent of the question being put is. I am unclear on the intention. Does this mean closure on debate on the issue? Perhaps you, Mr. Speaker, could answer that.

[The Deputy Speaker, Conservative, Bruce Stanton]

I realize this might be a new procedure for some. Certainly, it has been a while since we have had something like this before the House.

I invite members, if they have questions on the procedural side of this, to speak with the Table. Essentially the motion that this question be put does not in any way prohibit the continuation of debate. We are still in debate, now on the motion.

The member for Moncton—Riverview—Dieppe used her 10-minute time to put the motion before the House. She still has five minutes for questions and comments, after which we will proceed with regular debate and whoever is next in order.

That was the hon. member for Brantford—Brant's question. We will now go to the hon. member for Moncton—Riverview—Dieppe for her response.

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Mr. Speaker, we have been debating this bill for quite some time. The simple response is that we want this healthy debate to continue for the next period of time, however, we also want to see this move on to the work the committee needs to get done.

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

Mr. Speaker, if I understand correctly, the motion is that the question be now put. I want to know if there are specific concerns because we had agreed to continue the debate this evening and tomorrow evening. What changed?

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Mr. Speaker, I thank my colleague for the question.

This does not mean that the debate cannot continue. We are even prepared to sit this evening into the wee hours of the morning to ensure that every member of the House has the time to debate this subject that is so very important to everyone.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, that does not seem very clear to me as a way to operate.

First, none of the leaders was notified. I do not see why the government is suddenly moving the previous question when according to the motion moved by the parliamentary assistant, we expected to debate the bill tonight until midnight and tomorrow.

If this changes nothing, why is this motion being moved like this, without warning? I would like to say that there are already many members who cannot speak in the House, including those in my party. So far, I have had only 10 minutes of speaking time in total on behalf of my party. I do not see why the government is moving the previous question this afternoon, without telling anyone.

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Mr. Speaker, I thank the hon. member for his question and his comments.

Once again, all of us in the House recognize that the time and the issue being debated are very sensitive. We have until June 6 to act. That is why we want to give every hon. member in the House the opportunity to debate this bill. We also want to make sure that the bill is studied in committee. That is very important to moving the bill along.

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

Mr. Speaker, I am wondering if the member could confirm the realization that the Supreme Court of Canada decision, which was unanimous, said that we have to have the legislation in place by June 6. Members are going to be able to continue to debate this. There are still discussions and negotiations taking place to facilitate more debate, and we are anxious to see that. However, it is important to recognize that the bill has to get through the committee stage and ultimately to the Senate.

I would hope the member would agree that a responsible government would ensure there is timely passage of this bill, because we are talking about a unanimous decision that was made by the Supreme Court of Canada, and it has to be dealt with by June 6.

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Mr. Speaker, I thank the hon. member for his question and his comments.

That is basically it. Once again, we want to make sure that every hon. member in the House will have an opportunity to debate this bill. However, we are all aware that we need to move to the committee stage because we want the bill to be passed.

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, I must say despite the justification offered by the House leader and the hon. member, this is an extraordinary disruption, even though members were assured that debate would continue. As the member should know, the justice committee is now in extended sittings, from early morning to late night, and is still hearing witnesses. Expediting this bill now, changing the schedule now, is not going to change the course or the receptiveness of the committee to consider what eventually we send to committee.

I think this is extraordinary and bizarre in that it is normally the business of the House leaders to confer in the normal business of Parliament while debate continues, as the government assured us it would. We are still wondering why the member has taken this side track in the midst of debate.

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Mr. Speaker, once again, we want to encourage a healthy debate in the House and ensure that all members have the right and the opportunity to speak to this bill. We want to ensure that the bill goes to committee since we have a deadline to meet.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Mr. Speaker, I did not mean to start off my remarks by commenting on this situation of closing debate and calling the question, but this is an absolute shambles, and is making a mockery of what is supposed to be an important debate among members. Most of us have the right to have a free vote on this issue. The Liberals are making a mockery of this place, and I for one am not impressed at all.

To get back to the topic at hand, it is important that we have meaningful debate on this issue. I want to participate on behalf of me and my constituents, and I am sure there are many other members of Parliament who want to do the same thing.

This is very important legislation for our country, and of course members of our Conservative caucus have been very active in the run-up to this debate. We have had some serious reservations leading up to how this bill was to be written. Those reservations were expressed in a dissenting report from the special joint committee that studied the subject. Now, many of us are relieved that the legislation echoed some of the recommendations included in the dissenting report, such as certain limits on minors, and of course, many of us do believe there has to be, according to the Supreme Court ruling, some provision in our law for dying with dignity. However, we do have some concerns, and I am going to express my own, regarding aspects of this bill.

Unfortunately, this bill opens the door to assisted suicide for people with mental health problems, and that worries us.

This bill includes a provision for psychological suffering. This would open a large door. I am worried about how this would apply to the mentally ill. How would this be applied in reality? Are we going down some slippery slope by including this provision for psychological suffering? I am sure there will be an approach to amend this particular section, but right now the amendment to the Criminal Code would add that illness, disease or disability, or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable. This is the concerning provision, and I echo my other colleagues who have raised this issue as well.

Quebec has come up with its own legislation on assistance in dying. In Quebec's law, only people aged 18 and over with a serious and incurable illness who are in an advanced state of irreversible decline in capability can request medical aid in dying.

The attending physician must ensure that his or her patient has clearly consented to physician-assisted dying, ensuring among other things that it is not the result of external pressure, providing the patient with a full prognosis on the condition and possible treatment options along with likely consequences. The physician, under Quebec law, must also ensure the continuation of consent with interviews with the patient held at different times, spaced by a reasonable time having regard to the patient's condition. I would say that these are appropriate safeguards in the Quebec law. I would like to see similar safeguards in the Canadian law.

Another concern to us is in relation to the rights of conscience of physicians and health institutions.

We are very concerned about the conscience rights of medical personnel.

As mentioned in the dissenting report, section 2 of the Canadian Charter of Rights and Freedoms guarantees all Canadians freedom of conscience and religion. The dissenting report clearly states that there was near unanimous agreement among the witnesses that physicians who objected to taking part in physician-assisted dying for reasons of conscience should not be forced to do so. Although not obliged directly by this legislation to provide PAD, physician-assisted dying, the obligation to refer patients through an effective referral infringes on the spirit, and I would say the letter, of section 2 of the charter. I therefore believe that such a regime is unnecessary and note that Canada would be the first jurisdiction in the world to require an effective referral regime.

I believe there are better models that would protect the charter rights of physicians and provide access to physician-assisted dying, but under this legislation, physicians who conscientiously object to physician-assisted dying are required to provide information to their patients on how to access PAD and to advise the government of his or her patient's request. I believe this is unfair to the physician and this legislation does not sufficiently protect physicians' rights. I also believe that health care institutions that object to offering physician-assisted dying and related services should be exempted in accordance with the Supreme Court's determination that individual collective aspects of freedom of religion and conscience guaranteed under the charter are indissolubly intertwined.

In my home province of Ontario, the current policy of the College of Physicians and Surgeons is that it is a requirement not only to refer, but also to provide services that are within the standard of care of an emergency situation. Therefore, passing this legislation without conscience protection would mean that PAD would enter the standard of care and would fit within the existing policy framework of the College of Physicians and Surgeons in Ontario. It means that in my jurisdiction, there would be an effective right to force the physician to be part of this process even when she or he does not want to be part of the process. This is a major and grave concern to me and to physicians in my constituency as well.

The other issue that should concern us is whether this legislation respects the Carter decision and would it survive a charter challenge. I would say there is sufficient and grave cause to understand that this may not be the case. I would put it to my hon. colleagues, if we cannot pass legislation that could survive a charter challenge, why are we going through this process in the first place? Again, it makes a mockery of the situation.

I am hopeful that the government, as the bill moves forward, would accept amendments to ensure that everyone's charter rights are respected whether they be physicians or medical personnel, and that the charter rights of vulnerable persons be respected as well. We owe it to Canadians to get this right the first time, to protect the conscience rights of physicians and health professionals while respecting the parameters of the Carter decision.

Canadians expect us to work hard and do this right.

I want to acknowledge that the other point raised by my colleagues is a good one. Where is the palliative care money, the $3 billion in funding for palliative care? There is no mention of it in the budget. As they say sometimes in politics as in life, the devil is in the details. Where is the funding going to come from? How is it going to be allocated? It is absolutely imperative the government take decisive action on palliative care.

That ends my comments on the bill, but I want to reiterate that the shenanigans that went on before I rose are absolutely unacceptable to free and democratic debate on an issue of conscience for many members of this House, for all members of this House. I object to the motion being put forward in the way that it was. I object to the process that is being put forward by the government as it tries to shut down debate of members who want to advance their positions and those of their constituents.

[Vance Badawey, Liberal, Niagara Centre, ON]

Mr. Speaker, innovative models across Canada are integrating palliative care approaches across the nation in a variety of settings, including the home, incorporating advance care planning, preparing more health care, including more providers to deliver palliative care, recognizing the importance of family and friend caregivers and their needs, along with other good practices throughout our great country.

Other than palliative care which the member mentioned at the end of his comments, what other services besides those that are being practised today throughout our nation would he recommend be put in place for this program?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Mr. Speaker, I thank the hon. member for his thoughtful question. Indeed, as a former provincial minister of health and federal minister of health, I think it is important that we find ways to integrate and coordinate our care for the individual. That is absolutely correct.

I would also, though, mention to the hon. member that in my consultations with those in the palliative care infrastructure in my riding, they were not exactly thrilled with the prospect that they would be associated with physician-assisted dying. They see themselves as a final resting place before death, as a place of hope, as a comfort place, rather than a place where this debate over physician-assisted dying would be the focus.

I think we have to be careful. I think we need more palliative care; however, we also need a process by which we get to the right conclusion and the right part of the health care system.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, I appreciate the comments from the hon. member for Parry Sound—Muskoka.

Perhaps the motion which was just moved is not to limit the debate and the comments coming from this side. Over the course of the debate and the discussion we have had over the last day and a bit, we have also heard some dissenting remarks from the government side, as well. Perhaps the motion is not just to stifle the debate on this side but also to stifle it within the government's own party.

I wonder if my hon. colleague feels the same.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Mr. Speaker, that same thought had crossed my mind. I was originally supposed to be speaking at 3:20 p.m. It is nowhere near that time now. The only conclusion I could come to is that hon. members on the Liberal side of the House were declining their speaking spots. Maybe there is some great dissension going on in the Liberal caucus right now over the bill, that all of a sudden the bill is not as popular as the manipulators on that side of the House thought it was going to be and now they want to shut down debate not only for those of us on this side of the House, but on their own side of the House as well. I find the whole thing outrageous.

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, and of the motion that this question be now put.

[The Speaker, Liberal, Geoff Regan]

Order, please. I would encourage members who wish to have discussions to take them behind the curtains or out into the lobby.

I wish to inform the House that because of the deferred recorded division, government orders will be extended by nine minutes.

Resuming debate, the hon. member for Scarborough—Agincourt.

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

Mr. Speaker, I am pleased to rise to speak to Bill C-14, the government's response to the Carter decision that we have recently dealt with by tabling this particular piece of legislation.

I wish to state at the outset that I will be supporting the bill, but with some reservations. I will explain why I believe the bill deserves support, but by the same token, I believe that somehow in a future Parliament the bill could go further.

I intend to engage in this discussion by going through three thematic components in the brief 10 minutes I have to make my contribution to this important debate. I know this has been at times an emotional issue for parliamentarians, but in the three thematic components, I wish to give my rationale for my support at this time.

The first of the three themes looks at the moral considerations that many members and much of the broader public have expressed. Second, I want to discuss perhaps more fulsomely our duty as parliamentarians to respond to issues of constitutionality, particularly when they are challenged in the courts. Third, in the short remaining time I will have, I wish to express some personal thoughts on this as it impacts me directly.

First, I want to thank many constituents in my riding of Scarborough—Agincourt for their interventions on this subject. This has been an emotional matter, and I would have to state on the record that the overwhelming majority of constituents who reached out to me are opposed to the government introducing Bill C-14. That has been primarily on moral grounds. They feel that allowing physician-assisted death is essentially tantamount to murder.

In the opportunities I have had to discuss this matter with my constituents, I made it clear that Parliament is under a positive obligation to respond to the decision in the Carter case. If Parliament does not present some form of legislation, the consequence of its failure to do so would mean that the provisions of section 14 and subsection 241(b) of the Criminal Code would no longer be operative as of June 6. We would essentially be left in the situation of a legislative vacuum. It is important to put a regulatory framework around physician-assisted death.

As I pivot from the issue of morality to the issue of our responsibility as parliamentarians, I want to raise the point that while morality is important, and this has been a theme discussed in the House, ultimately we as parliamentarians must first make sure that we put in laws that pass the constitutional test. Where the Supreme Court of Canada has rendered a decision indicating that something is not constitutional, that it is a breach of some form of the constitution, whether on jurisdictional grounds or on grounds under the charter, Parliament needs to respond. In my view, that is what the government is doing in Bill C-14, under a very difficult timeline. That is perhaps why there has been a decision to introduce Bill C-14 in a relatively controlled and restrictive manner. It is reflective of the fact that we are under a very tight time obligation.

Therefore, I understand why the Minister of Justice, the Minister of Health and others, who have done yeoman's work in this regard, have taken initial steps to make sure it meets the constitutional test set out by the Supreme Court of Canada. However, in my view, it does not necessarily go far enough.

I want to pay tribute to the ministers and to all the other many parties and Canadians who have contributed to the debate. I note that there was incredible work done by the Special Joint Committee on Physician-Assisted Dying, led by Senator Ogilvie and the member for Don Valley West. I want to pay tribute to all the members who participated in that committee.

I want to note the contributions of the federal external panel, the provincial-territorial expert panel, and the many stakeholders and Canadians who have contributed to this very difficult debate.

I would note, though, that not only have many of my constituents expressed concerns with respect to this particular bill, but in some specific instances they have asked us to consider invoking the section 33 notwithstanding clause found in the charter, which of course is the legislative override provision. I would view that as a more sophisticated way of saying they oppose it and that ultimately parliamentarians should please consider overriding the charter rights of certain individuals by invoking or using the notwithstanding clause.

I would say to those individuals who have expressed that particular feeling that this is something we have to do and tread upon very carefully, particularly where we are potentially treading on rights that have been protected under the Canadian Charter of Rights and Freedoms. I would submit respectfully that it is important we do so in a manner that follows the tests that are similarly found in section 1 that were ultimately articulated in the Oakes decision that deals with the judicial override clause that is found in the charter.

Under Oakes, there are essentially three tests that need to be met, and if any one of those tests fails, namely in dealing with the judicial override, then one would not be able to invoke section 1, and I would argue that one would have to use the same principles under section 33 in exercising the legislative override. Those three tests basically deal with rational connection, that the impairment is done in as minimal a way as possible, and that we look at the deleterious effects and salutary benefits of any limitation that is imposed under section 1.

Typically, in application of section 1 of the charter in most instances, the failure falls under the second test, that the impairment is not as minimal as possible. Certainly, that was the basis in which the section 1 test was applied in Carter and which the court found that the proposed absolute ban on physician-assisted death did not meet the minimal impairment test. The court had carefully gone through the trial judge's analysis and concurred with the trial judge's position with respect to the application of section 1.

In terms of whether we would consider invoking section 33, as I mentioned already, this Parliament, this House of Commons, has never exercised section 33 as a legislative override, and I would argue that we too should be extremely careful. That is the test that we need to apply as parliamentarians in terms of determining whether we feel it is appropriate to use the legislative override.

As I mentioned before, the bill seeks to meet in a very expedited fashion a court-imposed time challenge and to deal with the suspension of the declaration of invalidity under sections 14 and 241 of the Criminal Code of Canada. We must do so by June 6.

As I have indicated before, I will be providing my support for the bill, but I would argue that there are a couple of additional things that we as a Parliament need to consider in the future. These were articulated quite clearly in the report from the special joint committee of the Senate and the House of Commons.

My first issue is that the bill currently does not deal with the issue of advance directives. I am sympathetic to those Canadians, particularly those who are suffering from diseases like ALS and others, who may still be in quite good shape at the present time, but at some future point, when they are getting close to their end-of-life situation, will not be able to express their particular consent. In my view, the issue of a clearly articulated regulatory framework that allows for advance consent should be considered.

I am also—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I am sorry, but the time is up. The member will be able to finish through questions and comments.

[Scott Reid, Conservative, Lanark—Frontenac—Kingston, ON]

Madam Speaker, part of what I am doing in raising my intervention at this point is to actually give my colleague the opportunity to finish off the point he was making, which I think was quite close to his conclusion.

As he does, I wonder if he could also address something that came up in his discussion of advance directives, which was the very last thing he was addressing. He mentioned individuals who suffer from ALS. I would submit to him, and I would be interested in his response to this, that the Supreme Court's jurisprudence in this matter is based entirely on cases of individuals with ALS who approach death in a very atypical manner, in that their minds typically are completely intact while their bodies are completely frozen.

Advance directives, I would submit, are primarily something that deals with the opposite situation, where the person's body may be fine, but the mind is gone, most obviously someone who is affected by Alzheimer's or some other form of dementia.

If the member could work that into his comments, I would appreciate it. If not, I would very much like to hear the rest of what he has to say.

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

Madam Speaker, I thank my colleague for his generosity.

I was simply getting to the issue of mature minors, to say that I do have some additional trouble and am concerned about appropriate safeguards. That was my other particular area of concern.

Let us get back to the question that my friend posed with respect to ALS or other conditions where the body is sound but the mind is not and the person may not be able to express the issue of consent. Again, I think the key is the particular regulatory framework that is put around the issue of advance consent.

Clearly, a person, knowing that at some point in the future he or she will be losing his or her mental capacity, would have to have expressed it extremely clearly in an unreserved fashion that would ultimately meet the regulatory framework set out, with two physicians concurring that in fact consent was given in an express manner, and setting out the clear guidelines, the clear situation in which he or she would be prepared to be administered with medically assisted death.

If we could create that kind of a framework, I think that would address the concern the hon. member may have.

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

Madam Speaker, my hon. colleague from Scarborough—Agincourt has a very thoughtful approach to this issue.

I am in the enviable position of knowing that while not all of my constituents support this bill, most of my constituents support this bill, because they have been waiting a long time to see compassion in medically assisted death. I particularly want to commend my colleague for voting on this bill, knowing that the comments he has heard from his constituents go the other way.

I want to give him a little more time to share with us what he plans to say in further convincing his constituents that what he has done is required under the Charter of Rights and Freedoms.

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

Madam Speaker, I want to get to my final point which is personal.

Not only am I a member who has to decide as a parliamentarian, but I am also a member who was recently diagnosed with recurrent cancer. I may in fact be someone who may have to, potentially, depending on how treatment goes, avail myself of this option. It is not one I would like to contemplate, not one that I think is a choice I would like to make, but it is a practical reality of something I might have to face.

We simply have to have an honest conversation with our constituents. In fact, I commend my colleague from Victoria, who has offered to come and do a joint presentation in my riding to explain the practical realities of this bill. At the same time, we need to hear from Canadians and understand why they have objections.

At the end of the day, the point I want to make is when there is not societal consensus on a particular issue, we ultimately have to make sure that any bill that is put before us is constitutional and does not trample on the rights of individual Canadians.

[Nicola Di Iorio, Liberal, Saint-Léonard—Saint-Michel, QC]

Madam Speaker, before I participate in the debate at second reading on Bill C-14, concerning medical assistance in dying, I want to tell the people faced with making difficult end-of-life decisions and their loved ones that I am thinking of them.

Everyone knows that medical assistance in dying is a complex, delicate, and extremely personal issue. Since the Supreme Court ruled in the Carter case last year, Canadians have been taking part in this national debate. This issue continues to be debated and seriously considered around the world.

I would like to share with my colleagues what is happening elsewhere in the world. Almost everywhere, the deliberate taking of a life or aiding someone to end their life are serious crimes punished by lengthy sentences. As many people know, Canada is not alone in legislating to authorize medical assistance in dying.

Oregon, Washington, Vermont, and California are examples nearby. A little further away, Colombia, Belgium, the Netherlands, and Luxembourg have legislation authorizing one type or another of medical assistance in dying. The provisions on safeguards, controls, and reports, which are all found in Bill C-14, are similar.

Usually, requests for medical assistance in dying must be voluntarily submitted by the patient in writing. In many cases, this must also be done in the presence of independent witnesses. The patient must obtain a second opinion from an independent doctor and must wait a certain amount of time between the day the written request is submitted and the day that the medical assistance in dying is provided.

Colombia has a unique approval process for requests for medical assistance in dying. Every hospital has interdisciplinary committees to assess such requests and support the patients and their families throughout the process.

Nearly all of the regimes we have looked at include a mandatory monitoring system in which independent committees collect information to monitor the situation. That information is then used to publish periodic public reports on medical assistance in dying.

The safeguards and controls set out in various statutes are relatively consistent. However, there are differences in the types of medical assistance in dying that are authorized and the circumstances in which medical assistance in dying is authorized. The differences in terms of who is eligible for medical assistance in dying and the way that assistance can be provided fall along a continuum.

On the one hand, we have the four U.S. states, which I mentioned earlier and which have enacted laws: Oregon in 1997, Washington in 2008, Vermont in 2013, and, more recently, California in 2015. In these states, a mentally competent adult 18 years of age or older can receive the assistance of a physician to die, provided that their request is voluntary and this person is suffering from a terminal disease, defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.

In these U.S. states, just one doctor may prescribe a substance that the patient administers to put an end to their life at the time of their choosing. This is what we commonly refer to as physician-assisted suicide. Voluntary euthanasia, in which the physician administers a substance that causes the death of the patient, is expressly prohibited. Patients are also not able to submit an advance directive.

In Colombia, a ministerial resolution was drafted in response to two rulings by the country's constitutional court. The resolution contains eligibility criteria similar to those of the U.S. states.

It limits eligibility to adults who have an incurable disease, which is defined as a serious, progressive, and irreversible disease, or a pathology that will lead to death within a relatively short time frame. It requires a specific prognosis of six months, in other words, the assurance that death is expected relatively soon. Unlike the U.S. states, Colombia authorizes only euthanasia. A doctor must administer the substance that will cause the patient's death.

At the other end of the spectrum are Belgium, the Netherlands, and Luxembourg. In those three countries, patients can access medical assistance in dying if they are experiencing intolerable or unbearable physical or mental suffering caused by a serious incurable illness and if there is no possibility of improvement. Patients do not have to be dying or suffering from an illness that puts their life in danger in order to be eligible. In other words, physician-assisted suicide and voluntary euthanasia are authorized in those countries.

Although medical assistance in dying is provided only to adults in Luxembourg, minors as young as 12 can seek medical assistance in dying, with their parents' consent, in the Netherlands. In Belgium, adults and emancipated minors can seek medical assistance in dying in similar circumstances. In 2014, Belgium expanded its eligibility to include children of all ages, but only if their death is likely to occur in the short term and their suffering is physical.

The experiences and lessons learned by the Benelux countries were closely examined. For example, the law in the Netherlands authorizes requests for patients who no longer have the ability to express their wishes. However, research suggests that doctors are generally not prepared to euthanize such patients.

Consideration was also given to the Benelux countries' experience regarding patients who are suffering intolerably solely because of a mental illness. This is a very controversial issue. Evidence shows an upward trend in the percentage of people who seek euthanasia solely because of mental illness, and experts are starting to express their concerns about the fact that medical assistance in dying under such circumstances is becoming increasingly common. For example, in Belgium, people have been euthanized because of intolerable suffering resulting from depression, anorexia, blindness, fear of a disability or further suffering, and the pain caused by the lost of a loved one.

Many people fear that such broad access to medical assistance in dying can present real risks for people who are lonely or isolated and those who do not have any social, economic, or community support. It could also reinforce prejudice regarding the quality of life of seniors, people who are sick, and people with disabilities.

Our government sought to learn from the experience of other jurisdictions. The government is committed to continuing to examine the more general issues, and it will continue to observe what is being done elsewhere in the world in terms of medical assistance in dying.

I support Bill C-14, which was introduced by our government. Once this bill is passed, it will alleviate the suffering of those covered by its scope and will allow people to die with dignity.

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

Madam Speaker, one thing my colleague intimated early in his speech was the number of countries that allow physician-assisted suicide. There is sometimes a misconception that most countries do allow physician-assisted suicide. The reality is that less than 3% of the world's population live in areas where physician-assisted suicide is accessible.

I have a question, though, regarding the terminology being used in this bill, “medical assistance in dying”. There is no clear demarcation between physician-assisted suicide and voluntary euthanasia. Part of that, I think, is because we like the softer language of the current bill, but the more important distinction is that in a regime that has physician-assisted suicide, the results are that only 0.3% of all deaths are attributed to physician-assisted suicide. In regimes that have voluntary euthanasia, it is 3.0%, a tenfold increase in the number of deaths resulting from a system with voluntary euthanasia.

I am wondering if my colleague would agree to include an amendment in the final bill that would say that wherever possible, where the patient is able to, it must be physician-assisted suicide, so that the patients themselves must administer the drug that the doctor prescribes.

[Nicola Di Iorio, Liberal, Saint-Léonard—Saint-Michel, QC]

Madam Speaker, I would like to thank my colleague for his question.

My colleague spoke about certain statistics and data, which I appreciate. I say that with all due respect and without any sarcasm whatsoever. However, this is not about ratings and assessing the numbers and the data. This is about human suffering. We should not lose sight of the fact that this exercise is made necessary by a Supreme Court ruling based on the charter. The current situation is no longer acceptable.

The purpose of my explanation was to show that there are situations where countries have been much more permissive and we have major concerns. In other situations, countries have been far less permissive, and now there are questions. We tried to do something that addressed the problems raised by the Supreme Court, while dealing with the information that we have before us, which is about human suffering.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Madam Speaker, today's debate is critical. It is extremely important. It affects everyone, and it gives rise to both hopes and fears in our communities.

The NDP thinks that we need to listen to the experts, and it also wants the government's bill to measure up to the Supreme Court's decision in Carter. Right now, we have some concerns about that. For example, in paragraphs 13 and 14, the Supreme Court talks about the cruel choice that patients with degenerative diseases face. Will they put an end to their life right away, or will they wait until they are no longer able to do so?

The all-party committee made a recommendation that patients be allowed to make an advance request regarding their end of life when they know that their situation is irreversible. Unfortunately, the recommendation from the all-party committee was not included in the government's bill. Would my colleague agree to add this recommendation to the bill in order to improve it?

[Nicola Di Iorio, Liberal, Saint-Léonard—Saint-Michel, QC]

Madam Speaker, I thank my colleague for his question.

There is one thing I must point out that is very meaningful. In life, we are all faced with choices, and we make these choices, but when the time comes to act on our choices, we have the option of changing our minds. We often exercise this right.

In the situation my colleague mentioned, the individual could not change their mind. That is why the government chose not to accept this recommendation. Someone makes a choice, but when the time comes to act on it, no one can ask them whether they have changed their mind or are reconsidering their decision.

People are autonomous and the choice is theirs to make. The government decided to accept that choice.

[Robert Aubin, NDP, Trois-Rivières, QC]

Madam Speaker, I cannot tell you how privileged I feel to take part in this discussion, and I mean “discussion”, because in the course of our work, which went on until midnight last night and will do the same tonight, it really has been a discussion, with the goal of coming up with the best possible solution, and not a partisan debate.

These kinds of subjects come up very rarely in history, and when the time comes for me to leave politics, I will look back on this as one of the most memorable topics of discussion in my time here.

In studying a bill, we must of course take a rational and intellectual approach, based on facts and science; however, with this kind of subject, we cannot ignore our personal experiences and, for many of us, the dimension of faith that goes along with life and quality of life.

Just a few decades ago, it would have been unthinkable for us to have a debate on the issue raised in Bill C-14. Today, this discussion is essential in order to address the concerns many Canadians have about quality of life.

Our society is constantly evolving, and for obvious and sometimes valid reasons, our democratic institutions will always be partly out of step with popular sentiment. However, the wishes of the majority should not be the only factor that guides us in our decision-making, because if our democratic institutions do not protect minorities, I wonder who will.

There are some historic issues that stand out in the life of a parliament, and as a result of the Carter ruling, we are now being called on to deal with such an issue. Although we are aware that there is little time left to deal with such a vast and also complex issue, we nevertheless have the good fortune of being able to refer to the Quebec experience, which quite surely can be a source of inspiration and can answer many of our questions.

Today, armed with the Quebec experience, our personal experiences, and input from many organizations and people in our respective ridings, we are being called on to make the best possible decision about how to provide medical assistance in dying. This is not about whether or not this assistance should be available.

The Supreme Court made that decision in Carter. As we all know, it was a unanimous ruling that sent a clear message on behalf of those who have spent years fighting for the right to die with dignity. It is up to us to legislate a framework for that assistance in a way that ensures respect for everyone's charter rights.

The bill is far from perfect, but at this point, I plan to vote in favour of it so that we can have the opportunity to perfect it by suggesting useful amendments during the committee's study.

I would like to share a very personal experience because I think that is the best entry point with this issue. Until recently, I was spared any major health problems, but not long ago, when I had a kidney stone that was relatively benign and easily treated, I had to cope with waiting six hours to get a drug that would alleviate my suffering.

When I shared my story with a few people I know, several of whom had had similar experiences, I saw how quickly people responded to suffering with sincere compassion.

Although this was a relatively minor health problem, for the first time, I felt, in my own body, the pain that may have been felt by my own parents, who both died of cancer. I spent as much time as possible with them when they had to move into a hospice. There is no doubt that their suffering was enduring and intolerable and that their health problems were grievous and irremediable. They met all of the criteria set out by the Supreme Court.

The workers in that hospice understood and still understand that no one should have to suffer while they are waiting to die when there are ways to relieve their pain, even though, in many cases, one of the side effects of the drugs is to precipitate death.

I have to say that when I remember the relief that I saw on my mother's and father's faces, I am inclined to support this bill and try to improve it.

This bill should be accompanied by a real national strategy on palliative care. In my opinion, some or all of the $3 billion that the Liberals promised for home care during the election campaign should have been included in the most recent budget. However, that is not the case.

Cancer can strike at any age and often there is no hope of recovery. Many other diseases produce similar effects of enduring and intolerable suffering without necessarily being life-threatening.

That is why I am also concerned about the fact that in this bill, the government did not use the wording in the conditions set out in the Supreme Court's decision. The Supreme Court basically said that Canadian adults who are able to consent and who have a grievous and irremediable medical condition that causes enduring suffering that is intolerable to them have the charter-protected right to physician-assisted death. That is the crux of the Carter decision, which gave rise to the bill that is before us today, Bill C-14.

What is the government trying to do today with this fourth criterion that it added, whereby the natural death has to be reasonably foreseeable? I have to admit to the House that in my mind at least, this is confusing. The terms are hard to define, the likely commendable goal being to seek the broadest consensus, even though that consensus already exists. If not, we would not be debating this bill. The Supreme Court likely would not have ruled the same way either if it had not sensed the evolution of this society.

We are about to undermine the process with such a vague and mandatory criterion because the legislation tells us that to have access to medical assistance in dying, the person absolutely must meet the four criteria set out in the legislation. The first three criteria are easy to understand, but the fourth is exceptionally vague.

I hope to see this fourth criterion disappear during our discussions in committee. With it, we are about to force those who are suffering to again demonstrate the unconstitutionality of the legislation, leading us right back to where we are today. We are here now, so let us see the work through and do it properly. Let us agree to ensure that this bill complies with the Constitution, that it will not be challenged later, and that those who wish to use it can finally do so.

Other questions remain practically unanswered, which is why the work coming up in committee after the bill passes second reading, I hope, is so important. As we point out in our supplementary opinion attached to the report, the government must adopt an approach to legislating medical assistance in dying based on the following principles: protecting vulnerable persons; taking into account the ethical concerns of all medical professionals; guaranteeing equal access to medical assistance in dying; protecting the conscientious objection of health care professionals; and respecting jurisdictions.

My time is running out, so I will conclude by saying that the NDP's job is to clarify the ambiguous provisions in the bill, strengthen the bill to avoid charter challenges, and demand stronger commitments with respect to palliative care and mental health care services to protect the most vulnerable Canadians. I can sense this in listening to my colleagues and all members of this House.

I am prepared to take questions from my esteemed colleagues.

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

Madam Speaker, I would like to put a different twist on this. We have heard a great deal about another component: the issue of palliative care. There is merit to getting further insight and comments on the record with regard to that.

I know the member's background and, in particular, his political affiliation. Recognizing that the leadership in Ottawa needs to work with different levels of government to get something of equal value in every region of our country, I am wondering of the member would provide his thoughts on the importance of investing in palliative care. We might find situations where people make this decision, and one thing they take into consideration, no doubt, is what sort of palliative care there might be. Would the member like to comment on that particular issue?

[Robert Aubin, NDP, Trois-Rivières, QC]

Madam Speaker, I thank my colleague for his question.

Several aspects of Bill C-14 blur the line between federal and provincial health jurisdictions. As soon as we start talking about palliative care, we are talking about health care, which is a provincial jurisdiction.

Nevertheless, the federal government can still take a leadership role, especially with its health transfers, so that Canadians across the country have equal access to palliative care as part of the end-of-life care continuum. Naturally, this must be done in accordance with the provincial and territorial legislatures.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Madam Speaker, it is kind of funny to hear government members say that palliative care is a priority for them considering that there is nothing for palliative care in the budget.

Can my esteemed colleague help us figure out what is going on?

[Robert Aubin, NDP, Trois-Rivières, QC]

Madam Speaker, I thank my colleague for his question. Unfortunately, my response will sound a little partisan, which is what I hoped to avoid on this issue.

That is the kind of response the government has been offering up since coming to power six months ago. The government members went on and on about middle-class tax cuts, but the cuts will not help anyone who earns $45,000 or less. Those people are still not part of the middle class.

They say one thing but do another. What do people remember? Actions. During the election campaign, the Liberals promised to invest $3 billion in home care, which includes many different services. I am sure some of that money could have been allocated to palliative care and incorporated into this bill.

Of the $3 billion that was promised, not a penny showed up in the latest budget for any kind of home care. They seem to have postponed this important element. We have an aging population in Canada and Quebec, and we need to tackle these crucial issues.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, I cannot say I am pleased to join this discussion, because I think it is an issue that is very difficult for all of us as parliamentarians, as Canadians, to deal with these very sensitive issues. However, I do want to begin by thanking the constituents of Humber River—Black Creek where many took the time to call or to write my office on the issue, or come by to see me, many in tears, talking and relating to episodes within their own family and their worries about what Bill C-14 would actually mean. As always, I appreciate my constituents' thoughts and the fact that they have taken an active role in what happens here because they understand that the debate here is going to impact on many of their lives.

As might be expected, the issue of medical assistance in dying is one that is difficult for many. The question is deeply personal, emotional, and even spiritual, and I understand and appreciate the concerns and challenges many have with the subject matter before us.

I, too, have struggled with these decisions, as have others. For example, I was deeply concerned when I was first confronted with the report of the Special Joint Committee on Physician-Assisted Dying. In particular, one of the areas I was concerned about was the idea that minors might be able to attain medical assistance in dying. I was also concerned with the notion that doctors who, for legitimate issues of faith or conscience, oppose medical assistance in dying might be forced to participate in this process contrary to their personal beliefs. Both of these things would have made the bill clearly unacceptable to me.

Fortunately, Bill C-14 attempts to address these issues by seeking to find a balance in this legislation, the best approach to ensure that dying patients who are suffering unbearable pain have the choice of a peaceful death and that the vulnerable are protected. I still question whether we have done the very best job we could do. I know the committee worked very hard at this and spent many hours listening to people. I guess I am still looking to see if we can make it better. However, I have to acknowledge the extremely tight timelines we are under, and the House must contend with those deadlines or we will have no protection for anyone.

The Supreme Court decision and the parliamentary timelines over the past year have combined to thrust us into this time crunch that none of us would have preferred to be in. This does not change the fact that we are here now. Nor does it change the fact that the defeat of Bill C-14 would mean the current prohibition on medical assistance in dying would end. The fact is that the Supreme Court unanimously decided that Canadians suffering intolerably have the right to request assistance to end their suffering.

The issue before us is not if, but how, we do this. This is not a political issue for me, and I do not believe it is a political issue for anyone in the House. Like my colleagues, I have looked at this matter as a person, a daughter, a mother, a grandmother, and someone who has watched many friends grapple with the complex, costly, and emotional challenges connected with terminal illness.

Palliative care, parental leave, family leave, and home care, while not directly contained in Bill C-14, must be part of the discussion, and they are. As I listen to the debate, it is clear that the matter is one that members are contemplating in a holistic way. I am pleased to hear again as part of the debate on this legislation that the government is committed to supporting quality end-of-life services and will continue to work with provinces and territories to improve palliative care for everyone. That means we will engage with the provinces and territories to support the development of a pan-Canadian monitoring system to collect and analyze data, monitor trends, and publicly report on medical assistance in dying. This helps to assure us that the government's approach is one of caution, one that is seeking a balance.

I also need to acknowledge the parliamentary secretary's verification that the government will work with the provinces and territories to explore mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying, while respecting the personal convictions of health care providers.

This is important because it would ensure that the concerns raised by many within the medical community would be addressed.

I mention this for a key reason. Canadians want religious freedoms to be protected for all Canadians, including doctors. Canadians also expect their government to respect and defend the Charter of Rights and Freedoms. Bill C-14 would attempt to do this while putting safeguards in place to protect the vulnerable as well.

Again, the Supreme Court of Canada unanimously decided that Canadians who are suffering have the right to medical assistance in dying. This means that the issue before us again is not if but how. After extensive consultation and extensive work by the committee, the government is proposing a framework that considers different interests, including personal autonomy toward the end of life, the protection of vulnerable persons, and the rights of conscience.

Access to medical assistance in dying, as envisioned under Bill C-14, would be available only to those who meet these conditions: mentally competent adults who are in an advanced state of irreversible decline in capability; who have a serious and incurable illness, disease, or disability and are experiencing enduring and intolerable suffering caused by their medical condition; and who have deaths that have become reasonably foreseeable, taking into account their condition.

For me, this is not just a discussion about the extension of life, nor should it be exclusively a decision about prolonging one's death. In instances where the end of life is near, the court has spoken and Parliament must now step up. If we fail to take action, we know the consequences, so doing nothing is not appropriate.

In order for me to support Bill C-14, I need to be assured of the government's firm and unwavering understanding that it will continue to support quality end-of-life services and will work with provinces and territories to improve palliative care. Again, end-of-life care is not just about medical assistance; it is about so many other things.

We have to remember Dr. Low in Toronto and his appeal by video to end his own life. We remember Sue Rodriguez. We remember all of those. Do I have a right to decide who dies and who lives, or that someone should endure the kind of pain that many are suffering? What would I do if my husband had ALS and begged me to end his life because he could not stand the pain? Do I have the right to say no? However, I also believe that it is God's right to call us all.

Bill C-14 is attempting to deal with a very difficult issue for all of us and for Canadians. Let us get it to committee. Let us see if we can make it stronger and make it better so that we are putting the emphasis on the palliative care and on the kinds of drugs that would eliminate the pain and make people more comfortable, so that none of us will have to make that decision.

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

Madam Speaker, I listened intently and I want to thank the member for her speech. She brought up Dr. Don Low who was a microbiologist who died from brain-stem cancer. She mentioned his suffering. In fact, he was not in pain and he died in the arms of his wife eight days after making that video. However, he would have qualified because he was at end of life. He was not physically suffering, but he was suffering and when we asked what was the suffering, it was that he had lost control of bodily functions.

We heard last night at the justice committee that somebody who is in an adult diaper who is suffering dementia is seen as somebody in a pitiful state. My mother-in-law, a wonderful person, had dementia and was in a similar state but I did not see her as pitiful. Would the member see somebody who has dementia and is in an adult diaper as suffering and being in a pitiful state?

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, they might be in a pitiful state. However, that does not mean that one would end their lives because they are in a pitiful state. In our eyes, there are a lot of people who are in a pitiful state when we look at them. However, nobody says that they necessarily want to end their lives. We may not like to see them suffering and reduced to a pitiful state, as the member called it, but they do not necessarily see that. Therefore, what we are trying to do is find that balance.

I hate the idea that anyone would be in such pain that they would ask to have his or her life ended. I would like to make that person as comfortable as possible and help him or her in every way we humanly can. I do not want to see a whole lot of people saying that their lives are miserable and that they want to end them. There are a bunch of conditions in Bill C-14. They would have to get two opinions. There is a whole list of things. Therefore, it would not be done casually. However, it is all in the eye of the beholder.

I do not want to make this easy, and I do not think Bill C-14 does that. It is trying find a balance that is fair for people to be able to make a decision if they are in a horrific situation. My seatmate may be in that situation.

What would the member say if he was asked and the person fit the conditions? I am not sure.

[Sheri Benson, NDP, Saskatoon West, SK]

Madam Speaker, I want to thank my hon. colleague for her comments and her openness to look at and share the fact that we do need to move forward on the how, and that the government needs to be open to amendments and ensure that what we find at the end is compliant with the case so that people can move forward in a good and positive way.

The member also commented on people sharing their beliefs and views. Of course, I have had those in my office as well.

One thing that is important to me, and I would welcome her comments on, is including provisions to protect health care providers. For many people it is a faith-based decision. We need to protect their rights and ensure that this is included in the bill so that those folks, and the people who are supporting them, feel comforted that it is there and their rights are protected.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, certainly a fundamental part of the bill is rights and freedoms for everyone, including those in the medical profession who would be asked to assist people who qualified under the conditions of Bill C-14; with respect to those aspects of it they would have to be. However, they have rights to be protected as well, and the bill has to ensure that it is protecting the rights of our medical professionals.

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, and of the motion that this question be now put.

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, it is always a pleasure to stand in the House to debate the issues of the day, although this is not one that I would have ever chosen to debate in the House. It has been debated before a number of times. Each time it was defeated, and each time it brought me a certain degree of relief when it was.

I want to thank the many constituents of Battle River—Crowfoot who have contacted me about the issue of doctor-assisted suicide. This issue has been raised a number of times, as I said, and every time my constituents have been very vocal in their opposition to making assisted suicide available.

There are some who disagree and are willing to support efforts to make assisted dying available in very limited circumstances, but the vast majority of my constituents in Battle River—Crowfoot, and, I dare say, most Canadians, do not want to unleash doctor-assisted suicide on our country. Why? It is because we have seen what has happened, to be quite frank, in other countries, how it started, and where it is now. I am not sure if we are going down any different road.

One of constituents from Bashaw, Alberta, sent me a letter and a paragraph in that letter sums up how things seem to be going. I will quote what was said. The letter states:

We want students to make responsible decisions for themselves about all manner of things from sexual activity to career choices to not inflicting self-harm. At the same time, we tell them they are only advanced animals with no eternal purpose. On the reserves, especially, we talk about our respect for the Elders and then as a broader society we discuss how we can help our elders kill themselves. We encourage youth to stay away from drugs and excessive alcohol consumption. Then we discuss how to legalize marijuana.

Here we are today with the Liberal government forcing us to pass a law that would legalize doctor-assisted suicide. We should be talking in the House about palliative care and end-of-life treatment. Did we hear that or see a line item in the budget? No, not a mention.

We should be providing funding to improve and provide palliative care to our aging population in our cities and rural communities. The previous Conservative government started the consultation. After the Carter decision, many submissions were made by Canadians. It is a difficult issue in households across Canada for families who face this and confront the issue. It is a very controversial and highly emotional issue.

Many Canadians believe that the Supreme Court's decision in the Carter v. Canada case is another instance of judicial activism. That was stated in many of the letters received by my constituency office. The court struck down the criminal laws against physician-assisted dying. Many Canadians supported the laws against doctor-assisted suicide. There was a very small group asking for this, the smallest of minorities, but the Supreme Court gave these special interest groups what they wanted.

I believe the Liberal government has shirked its responsibility to educate Canadians on what we are debating. There has not been enough consultations with individuals, groups, and experts. Even today, in the midst of this debate, which has been a good debate, the Liberals tried to shut down the debate. The Liberals have not taken into account a range of interests in Bill C-14, such as those advocating religious freedom. The previous speaker talked about the conscience rights of physicians and health providers and many are advocating for safeguards to protect the vulnerable. This bill is not a compassionate approach that considers all pertinent interests.

I do not believe the Special Joint Committee on Physician-Assisted Dying did a sufficient study. Quebec studied this issue for six years. Other countries studied it for years. However, the court has given Canada only a matter of weeks of study. The committee did not study what happened in other jurisdictions where we have seen this brought forward. The special joint committee heard from pro-euthanasia lobby groups. It had some of the pro-euthanasia groups appear on three separate panels.

[An hon. member]

Three times.

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, three times pro-doctor-assisted suicide groups testified, but the committee did not hear from any anti-euthanasia advocacy groups.

Now the government is telling us that the justice committee, during its hearings, will allow amendments. The Liberals say that the committee can make amendments and better define things like conscience rights, or what happens when a doctor refuses to assist a person to commit suicide. The committee may look at the term “reasonable foreseeable death” or the issue of advance consent. However, I have no faith in the Liberal-dominated committee that will hear Bill C-14.

Today the Liberals are in a hurry to pass the bill and send it to committee. I have served and chaired many committees, I have seen how witness lists have been tightly controlled. I do not believe the views of average Canadians will be heard at this committee. I do not believe the religious community in Canada will even be given the chance to testify. I think we will see a Liberal-dominated committee that will turn down all amendments that might change the bill.

We already saw that at the previous special joint committee. That is why the official opposition had to table a dissenting report to the conclusions of the committee. We listed the problems that must be addressed. I am thankful for some of those issues being addressed in Bill C-14.

There is a void in Canada, and elsewhere for that matter, on behalf of people who do not ever deal with death and dying on a day-to-day basis. Many are in absolute fear of dying. It is the great unknown. There is a chance there will be unbearable pain and suffering, many people believe. We do not know.

Palliative care experts tell us that it is possible to find balance in the human body. The human body is very good at shutting itself down, and palliative care is all about assisting each individual in that process compassionately.

My daughter and wife both serve as nurses. They have been at the bedsides of those who are dying and have compassionately cared for them, making certain that pain is addressed, or that there is very little pain in some cases.

The provinces will decide certain questions on the bill. Health services are, as we know, a provincial jurisdiction. The government knows this and it is trying to wash its hands of some of that issue. In fact, the Liberal government knows there are going to be many problems within the bill when we move forward to the next level and try to get unanimity among all the provinces and territories.

The government has already said that it will continue to study the issues of doctor-assisted suicide. Some have said that we will continue to study the issue around mature minors. Will they someday be able to receive assisted suicide, or people with mental illness? The government is going to study that as well as advance requests.

We know we live in a time where there is a slippery slope. Here we are debating Bill C-14. Most of us think those are the parameters today, but what will they be tomorrow? If it is a right today for some people to have doctor-assisted suicide, why is it not then a right for someone else? How long do we think it will before the courts take that one on and change what we may very well want to implement here today? I think it is a concern for people on both sides of the House. It is not good enough, so we need to do some of this work before we talk about the many other things.

There are a couple of areas of concern with the bill that need to be addressed at committee. Canadians need to be certain that physician-assisted dying is limited to competent adult persons 18 years of age and older. We need to ensure safeguards for vulnerable persons and confirm their capacity to make decisions about their life or being killed. We need conscience protections for physicians, and this is the big one.

We need conscience protections for physicians, nurses and other medical practitioners who oppose physician-assisted dying. Once Bill C-14 is passed into law, without conscience protections, euthanasia and assisted suicide will enter the standard of care.

I should have spoken more quickly, because I have about five more pages. It is a heartfelt issue. I believe in the sanctity of life.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Madam Speaker, I want to assure my colleague across the way that in our group, we have taken all of these concerns to heart.

I heard a lot in the discussion about political motives. We do not have any political motives other than having to answer the Supreme Court's request that we present a bill by June 6. One should not be predicting what the outcome of a committee will be. We are approaching this, I believe, in a fair, honest, and principled way.

The question I have is as follows. What is it, so far, in the bill that says we are making someone do something they do not want to do? Is there something in the bill that sounds like we are making someone do something that they do not want to do, whether it is to take some sort of medicine to end their life or to provide the service?

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, I do not think I talked about the motives of the government a lot in my speech. We all understand the government is doing this because the Supreme Court made a decision and directed us to do it. I am not saying there are certain political motives. Forgive me, if it came across that way. I certainly did not mean to say that.

However, I am skeptical. I am very pleased when I hear the member say that he believes in good faith that amendments will be taken at committee, and that in good faith we will hear from all different types of witnesses. To be honest, I have seen in the past where it has been shut down. We saw it in the joint committee. It was a very narrow group of witnesses to which the committee was able to listen.

On the member's other question, which was—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

We do have to get to another question. Questions and comments, the hon. member for Essex.

[Tracey Ramsey, NDP, Essex, ON]

Madam Speaker, this issue is something with which all of us are grappling, those who live in our riding, our family members, and friends.

The member mentioned palliative care and the fact that there was absolutely no money allocated for it in the budget. I believe a strong palliative care goes hand-in-hand with this bill.

Could the member speak to the ways that a commitment from the Liberal government could ensure that people have the option of palliative care when they are at the end of their life?

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, again, we have an aging population in the country. More and more people are living longer. Health and medicine, as well as many other things, are prolonging life.

We need to be aware of that, and we need to ask what it will look like 10 years down the road. We need to start having a stronger commitment, right now, toward palliative care so when decisions like this need to be made people have an alternative. To be quite frank, if I had seen a line item in a budget that said that because of the Carter decision, the government would now focus on palliative care, I would have applauded that.

In the last government, we started consultations on palliative care. In fact, the Leader of the Opposition, who was health minister at the time, started consultations on Alzheimer's patients, palliative care, and long-term care. Again, we were looking forward to this type of debate.

Obviously on all sides, as we live out our lives, we want to know that the end is going to be lived as comfortably and compassionately as a society like ours should be providing.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

It is my duty pursuant to Standing Order 38 to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Montcalm, Physician-Assisted Dying; the hon. member for Regina—Lewvan, Employment Insurance; and the hon. member for London—Fanshawe, International Trade.

Resuming debate, the hon. member for Edmonton Strathcona.

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Madam Speaker, key among the considerations lying at the centre of the debate on Bill C-14, physician-assisted dying, is the ruling made in February 2015 by the Supreme Court of Canada in the Carter case, striking down sections of the Criminal Code that prohibited the provision of assistance in dying on the grounds that they were unconstitutional as they violated parts of article 7 of the Charter of Rights and Freedoms that “everyone has the right of life, liberty and security of the person”.

The court ruled that the Criminal Code provisions were of no force or effect to the extent that they prohibited physician-assisted death for a competent adult person who clearly consented to the termination of life and had a grievous and irremediable medical condition, including an illness, disease or disability, that caused enduring suffering that was intolerable to the individual in the circumstances of his or her condition.

The court then suspended the declaration of invalidity for a year and in turn granting to the current federal government an additional four months to June 6 of this year, after which the Criminal Code offences would become null and void.

Clearly, action is necessary to uphold our constitutional and charter rights.

Also, it is important to give consideration to the recommendations by the all-party Special Joint Committee on Physician-Assisted Dying struck by the government and mandated to review the report on the external panel and options for a legislative response established by the former Conservative government, and to make recommendations on the framework of a federal response that would respect the constitution, the charter and Canadian priorities.

The committee recommendations are based on the testimony of a wide diversity of witnesses and review of parallel legislation enacted in other jurisdictions, including Quebec.

The committee considered a great many critical issues, including: Should there be a condition based on age? How will the law protect the vulnerable? Should the law recognize advance medical directives? Should the law impose waiting periods? Should the law enable conscience objections by health providers? What is the correct terminology to apply? What are the respective jurisdictions of federal and provincial authorities? How do we ensure equal access to these medical services, and the need to expand access to palliative care, including on the NDP call for a national strategy?

The challenge before us is to determine whether Bill C-14 clearly and properly addresses these matters.

This is a highly personal and emotional topic for all members in this place and frankly all Canadians facing life and death decisions. Members of my own immediate family struggled in their last days. My younger sister suffered a painful extended period prior to her death, even where some palliative care was available. My older sister suffered a lesser quality of existence for far too many years because the only accommodation for younger, chronically ill patients was an extended care facility for seniors.

Our governments must deliver on promises for expanded palliative care for all, and housing for the chronically ill and disabled. This access is surely also a charter right.

I have carefully considered the letters and conversations with my constituents who have expressed a wide range of views and perspectives on the matter of medically assisted dying. What I found discouraging is the lack of full understanding by many I have spoken with, and the misinformation being provided to them about the implications of the Supreme Court decision, and in particular, those who have expressed opposition to the enactment of a law on providing medical assistance to the dying.

I hosted a meeting in my constituency with my colleague, the MP for Victoria, the co-chair of the special joint committee, to provide an opportunity to understand the background to Bill C-14, including the ruling by the Supreme Court, the report of the special joint committee and the tabled bill.

I have been deeply impacted in my views by meetings with a constituent suffering deeply with a fast-paced diagnosis of ALS, already unable to speak and desperately hoping to be able to gain assistance in his death when he determines it is the right time for passing.

I have heard from constituents concerned that the bill reduces the rights of Canadians to choose an assisted death, while others expressed concern the bill would increase risks to the disabled. I must share that by far the majority of views expressed to me, including at my public forum, have expressed concern that the bill does not go far enough in upholding the directions by the Supreme Court to uphold the constitutional and charter rights of Canadians.

How well does Bill C-14 address these key needs and concerns? The bill does set forth a basic framework for decriminalizing medically assisted deaths, including right of access. However, instead of following the recommendations of the Special Joint Committee on Physician-Assisted Dying to adopt the clear and precise terms set forth by the Supreme Court to determine access to medically assisted death, this bill would add further onerous, and frankly nonsensical qualifiers. Most notable is the requirement that a person's natural death has become reasonably foreseeable. Surely that is the case for every human being on this earth.

The Carter family, who was the subject of the Supreme Court ruling, has spoken out strongly against these added criteria. Worse, it is the opinion expressed by numerous legal experts that these additional criteria lack legal certainty and would inevitably force already suffering patients to return to the courts or to travel overseas or to kill themselves. None of these options present a compassionate alternative or uphold our constitutional and charter rights.

I would like to share briefly some words that a constituent sent me:

Nineteen years ago, I watched my 87-year-old mother spend three weeks in severe pain as cancer ate her alive, begging to be put out of misery. The proposed law on medically assisted dying is 19 years too late, but at least it will spare others in similar condition. Unfortunately, it doesn't cover those whose death is not imminent but who have medical conditions that are causing them intolerable suffering. That must be rectified before this law is passed.

A second widespread concern expressed to me is the failure of Bill C-14 to provide for advance directives. I am aware from my discussions with Alberta officials that this is a matter of grave concern to Albertans, many of whom are erroneously of the belief that their personal directives cover medical intervention. Many of my constituents have asked me to demand that this right be extended. Again, I quote from a constituent's letter:

I would like to have the ability to have an advance directive that would stipulate the conditions under which I would want to have my life ended. At the point I would want assisted death, I may not have the mental or physical capacity to restate my wishes. If this bill passes without the proposed amendments, my only option will be to go to the river valley some minus-30 night and freeze to death. This, of course, will create stress on my family, the community, and police as they search for my body.

Others have expressed concern that the law would fail to prohibit hospitals or other institutions from denying access to medically assisted death on the grounds of religious beliefs. While they accept that individual medical practitioners should be extended that right, they strongly believe there should be a duty to refer to another practitioner, and preferably for the delivery of services within the same institution. This would be the compassionate decision, given the dire state of many who would be making this request.

While the Special Joint Committee on Physician-Assisted Dying agreed to a waiting period between the request and delivery of the services, many have expressed concern that Bill C-14 would require a 15-day wait period. Much more preferable would be a waiting period as determined by the medical practitioner, based on the circumstances of each case. I can speak from personal experience that to require a suffering sibling to hang on with severe pain for more than two weeks after making the decision to let go is nothing less than cruel and unusual punishment, and surely offends one's charter rights.

The bill will provide protections to practitioners and afford protections for the disabled. What it would fail to do is extend clear rights to Canadians to determine their own fate within reasonable parameters. Equally disappointing is the failure of the current government to include in its budget the promised dollars for palliative care for all Canadians.

I will vote for this bill at second reading to be considered by a committee. However, I implore the government to ensure that our concerns, the concerns expressed by our constituents and by all Canadians, be considered by the committee members who are undertaking simultaneous review, and to give fair and full consideration to any recommended amendments.

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

Madam Speaker, the member ended her comments about palliative care and asked the government to make a commitment toward it. It is important for us to reinforce at times that there is a very substantial commitment that has been made in terms of the future of palliative care. Contrary to what the Conservatives might say, it actually is in the budget. All one needs to do is to read it. If they have lost their copy, I am more than happy to provide them with a copy of it.

My question is related to the fact that we have a Minister of Health who has made a commitment to work with provincial stakeholders and others to try to develop that cross-Canada palliative care program. I am asking for the member to provide comment. Would she not agree that the government has an obligation to work with the different provinces that administer health care, whether it is palliative care, home care services, independent, and so forth, and that it is in fact what we are witnessing today?

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Madam Speaker, my hon. member's question gives me an opportunity to raise this issue. The federal government does not have to confer with provinces and territories in those areas where it is directly responsible for medical services to our military, first nations, Métis, and Inuit people. How about starting with delivery of the requirement by the federal government to provide access for palliative care for all those it is responsible for?

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

Madam Speaker, to follow up on the palliative care question and whether it is mentioned in the budget, I would ask my colleague to give me the page number. I would be glad to look it up for myself. I can point in the platform to where it was clearly indicated that immediately Liberals would invest $3 billion in palliative care, but I do not see it in the budget.

More importantly, would my colleague agree that in the legislation we could insert an amendment that would require that for all those requesting physician-assisted suicide, it be mandatory that they at least have a palliative care consultation before they proceed with the physician-assisted suicide?

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Madam Speaker, I am sorry, I would not agree to that requirement because we know that less than 15% of Canadians have access to palliative care. Essentially that would be a means of denying medical assistance access to Canadians.

Even in the case where my sister had access to palliative care, there were many aspects. For example, she had no access to a psychologist or a sociologist, although there was a social worker who was available in the cancer clinic. However, because they were not doing direct medical intervention, they kicked her out of the cancer clinic. Even with palliative care, she was suffering unendurable pain. Pain is a very personal experience, so even where there were wonderful doctors and caregivers, she was in such extreme pain that she could not be touched.

I do not agree with that as a condition. Nonetheless, I do agree that there is an obligation on the government, and it would have been nice if the previous Conservative government had in fact funded palliative care.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Madam Speaker, I want to thank my colleague for her very touching and personal speech and the concrete examples she shared.

My question has to do with the specific case of people who have degenerative diseases. The special joint committee recommended that these individuals be able to state their final wishes through advance written directives, while they still have the legal capacity to make decisions. At some point, they will lose the capacity to express their wishes for their end of life. The committee made that recommendation, but the government did not include it in the bill.

Is this an amendment that could improve the bill?

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Madam Speaker, I mentioned that directly in my address. If there is one topic that is of greatest concern to my constituents who have raised this over and over again, it has been the right to provide an advance directive. During the open dialogue that I sponsored in my riding, many of my constituents were horrified to discover from a lawyer who was present that while they thought they could provide an advance directive, it only covers their financial situation.

I have since talked to the medical doctor who is an elected member of the Alberta legislature and is pursuing this, and I am hoping that between the federal and provincial governments, we will actually provide this opportunity. It is the only compassionate direction in which to go.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, in my colleagues' interventions, there is sometimes a presumption, it seems, of malfeasance when it comes to the health care system. When the slippery slope argument is invoked, it is as though people think that health care providers do not need to be caring and compassionate, first and foremost, in order to be hired. If that is not the case, they should be thanked and let go. I find it strange that so little consideration is given to health care providers.

We have talked a lot about vulnerable individuals. Those are precisely the people the Supreme Court was trying to protect. The Supreme Court indicated that people with degenerative diseases, who have a grievous and irremediable condition, who are experiencing intolerable suffering, should have access to medical assistance in dying, under section 7. It is pretty remarkable to see that all the rights in section 7, namely, the right to life, the right to liberty, and the right to security of the person, are affected by the total prohibition.

The Supreme Court wanted to protect people in an extremely vulnerable situation. When we talk about protecting the vulnerable, who and what are we talking about? It is as though, when someone enters into a continuum of end-of-life care, they are given the choice from the outset between an injection and comfort care. There is a presumption that should not be there.

What the Supreme Court is asking the legislator to do is to provide a framework for assisted suicide, in other words, for all those whose natural death is not reasonably foreseeable. Those people do not need palliative care. What they need is legislation that frames the provisions to allow them to die with dignity, according to their wishes, and on their terms. That is the essence of the debate.

Yesterday in committee, the Barreau du Québec told us that Bill C-14 was not in line with the Carter decision. Last week, the Carter family's lawyer told us that Ms. Carter would not have been entitled to medical assistance in dying. How can the government claim that she would have been entitled? That was the response in committee by the Minister of Health and the Minister of Justice. Did they get an outside opinion?

The Barreau du Québec just said that this bill, because of the totally vague criterion of “reasonably foreseeable natural death”, will make this legislation a legal hornets' nest. I hope that after all this energy we are putting into this debate we will not end up with endless court challenges. The Barreau du Québec sounded the alarm yesterday, as did the Carter family's lawyer. The bill is telling people who have a degenerative disease and are suffering immensely that they cannot make an advance directive.

People with degenerative diseases, such as multiple sclerosis, ALS, and other cognitive diseases, are not suicidal. They want to live as long as possible until their condition becomes intolerable to them. It is not up to us or anyone else to decide what is or is not tolerable suffering for a person. How could we presume to do so?

We have to protect these people from extreme suffering and a society that is basically trying to make decisions for them.

If Kay Carter did not have access to medical assistance in dying, and if advance requests are not allowed for people with degenerative diseases, then it seems as if this bill does not treat all grievous and irremediable medical conditions that people might have the same way.

The minister says that Kay Carter would have been entitled to medical assistance in dying under the reasonably foreseeable natural death provision. Exactly what does “foreseeable” mean in this case? Does it have anything to do with her age? I hope that we are not talking about age discrimination here. Spinal stenosis can be intolerable at 52, 62, or 82 years of age. Age is therefore not a criterion.

If we want to be thorough, we absolutely must provide a framework and amend the bill to include advance requests.

Furthermore, we must remove the criterion of reasonably foreseeable natural death. Even in a situation as clear as someone in palliative care requesting death, this is not a natural death. Yes, the process of death is irreversible. The patient wants to put an end to the irreversible process of a slow death. It is up to patients to decide whether this is what they want. It is their choice.

However, claims that patients will be forced to make a decision have no place in this debate. This is not the case. I have heard members say that this is frightening and that we should invest in palliative care. As I said this morning, palliative care is important, and the Quebec law addresses this issue, among other things. What about assisted suicide? These people do not need palliative care. They do not need it and we do not need to invest in palliative care to fix their problem. We simply need to respect their right to self-determination.

That is why advance requests are so important. These people do not want to move forward without the assurance that they will be cared for. We are not the ones to decide for them. They will decide.

Of course, sometimes there are people who suffer from insomnia. Things can happen in an instant one night. You go to bed at night and everything is fine. When you get up in the morning everything has changed. For that reason, we have to amend the bill. We must also amend the bill to include an equivalency clause, as I mentioned this morning.

The debate lasted six years in Quebec. Quebec's legislation provides a very good framework for end-of-life care, and it would be unacceptable for this bill to interfere with the Quebec law. That is why we are insisting on these amendments.

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

Madam Speaker, I was not going to ask a question, but I could not let this opportunity pass me by.

I would like to ask my colleague this question with respect to advance directives. Let us say that someone signs an advance directive when he or she is first diagnosed with dementia, for example, and later on has a change of mind. However, once that person is in a demented state, he or she is unable to sign a request and therefore has to follow through. Is the member not concerned that there could be the potential for people to die needlessly if in their present state they are enjoying life, but when they signed the advance directive they thought they would not be? My concern is that an innocent person could die due to an advance directive, and for me, that would be one too many. I would like my colleague to comment on that.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, my colleague and I are not health practitioners. I am not a doctor or a researcher specializing in degenerative diseases.

What I do know from my lengthy career in bioethics, is that people with degenerative diseases want society to allow them the option of not living with extreme suffering. There are always means of communicating. There are people who can use signals. For example, some people have written books by blinking. An individual could prepare an advance directive and indicate that a particular signal means “yes”. Before getting to that point, I would hope that the required steps are taken. There is a way to regulate advance directives, instead of believing that a person's wishes will not be respected.

[John Barlow, Conservative, Foothills, AB]

Madam Speaker, I rise today to speak about what I think is one of the most important issues that we will ever face in this Parliament. I know this is going to be a very difficult debate in the House, as physician-assisted suicide and euthanasia are deeply emotional not only to us in the House but obviously to our constituents.

First of all, I would like to say that I am very relieved to see addressed in Bill C-14 some of the concerns that were raised by my Conservative colleagues and Canadians across the country.

The recommendations included in the report from the Special Joint Committee on Physician-Assisted Dying were extremely troubling and went well beyond the parameters outlined in the Supreme Court's Carter decision. My Conservative colleagues and I, as well as Canadians across the country, voiced our concerns on the far-reaching recommendations in the report, and we urged the Liberal government to tighten safeguards in this legislation.

My constituents were concerned with the broad and vague guidelines in some of these recommendations. Like many of my Conservative colleagues, I felt it was very important to discuss these recommendations with my residents, and I held several open houses across the constituency. I held these open houses because I felt it was critical to get feedback from southern Albertans on their feelings on doctor-assisted dying.

However, I also thought it was important to raise awareness about some of the recommendations that could potentially be part of the legislation before us. Initially, I think we saw that the vast majority of Canadians supported doctor-assisted dying, but I would like to say that I think the vast majority of those Canadians who support it were unclear about what could potentially be part of the legislation.

I think in their minds, they saw doctor-assisted dying as involving an adult suffering with a terminal physical ailment, and that became abundantly clear at the open houses that I had in my constituency, which had anywhere from 30 to 300 people, including many of my rural physicians. Almost every single person at these open houses—supportive of doctor-assisted dying or not—was shocked at the potential that could have been in the legislation upon seeing the recommendations that were part of that special joint committee.

These people certainly did not expect that doctor-assisted dying would be available to mature minors. They certainly did not expect it to be available to people suffering from mental illness. They also expected that there would be protection for physicians on decisions of conscience, and very strict guidelines around advance directives. Since I held those open houses and started to raise some awareness within the constituency with my residents, I received hundreds of emails and letters from residents who are very concerned about the potential ramifications in Bill C-14.

Generally, people in Foothills want to make sure that vulnerable people in our society are protected in the legislation, and I believe Canadians want the same. I am pleased to see some of the concerns that we raised are included in Bill C-14, which did not include mature minors and did not include people with mental illness. However, the legislation says that those things will still be studied, which means the door is wide open for mature minors and people with mental and psychological illnesses to be part of the legislation in the future.

However, there are still some other issues that I think were not addressed, such as protection for our physicians in decisions of conscience, and palliative care. In all the meetings I hosted, palliative care came up repeatedly. Many of my residents feel that palliative care was truly never addressed as part of the legislation.

We are blessed to have a facility in my riding, the Foothills Country Hospice. I have toured this facility many times and spoken with patients and their families. I could see that the hospice has been a godsend—I got that from their responses—and has become such a wonderful, important part of our community.

Accessible, consistent, and effective palliative care programs across the country would consistently support people in their end-of-life care. Unfortunately, palliative care is not offered on a consistent basis across this country. The report recommended that palliative care be an integral part of doctor-assisted dying legislation, and this is one recommendation in the report with which I wholeheartedly agree.

If we proceed with medical-assisted dying, palliative care must be a fundamental piece of this program. However, palliative care was not mentioned in the 2016 budget, nor has there been any funding whatsoever committed to a national palliative care program.

Foothills residents also spoke resoundingly about the need to protect physicians' and other medical professionals' rights of conscience. Overwhelmingly, my constituents felt that no one should be compelled to administer physician-assisted dying if doing so was contrary to their personal beliefs and ethics. Additionally, almost everyone who spoke to me recognized that referring a patient to another physician to assist in their death does not absolve that first physician from the ethical dilemma.

In my riding of Foothills, the rural towns have one or two, if any, doctors. Imposing on a doctor in a rural community to participate in doctor-assisted dying puts those rural physicians in a very difficult position in those small towns. They need to have a choice, and we need to show leadership to give them that choice. We cannot download that burden on to provinces or the provincial colleges of physicians and surgeons. Physicians across Canada need our support and our leadership, and that should be part of Bill C-14.

In addition, there needs to be some support structure for physicians who would be participating in doctor-assisted dying. They would be facing mental health issues, as we are now seeing in Quebec. We must ensure there are programs in place to support our physicians in dealing with the potential emotional and mental scars of participating in doctor-assisted dying. Canadians want to achieve a healthy balance between the person seeking physician-assisted death and a physician's own charter rights to abstain from this procedure if it violates the physician's moral ethics and faith.

The Supreme Court came up several times in conversations I had in my riding. Residents are frustrated that the Supreme Court would presume to dictate a law upon parliamentarians. Canadians understand we elect parliamentarians in our country to make laws and the Supreme Court is in place to rule on the constitutionality of those laws. They do not understand, however, why the Supreme Court, an unelected body, is now dictating law to our elected House of Commons and why it is implementing such an unreasonable timeline to come up with the law. My constituents and, I believe, many Canadians are understandably upset that this is how physician-assisted dying came forth.

What does this have to do with this debate? This inversion of the process has left parliamentarians and Canadians scrambling under an unreasonable timeline to develop a complicated piece of legislation that not only ensures that the rights of all involved are protected, but also that the safety of our most vulnerable is also protected. This conversation and public debate simply require more time than has been afforded us currently.

Usually at the end of any of my speeches in debate I encourage hon. members of the House to either vote in favour or against whatever piece of legislation we are debating. Today I am not going to do that. I believe the first priority in this is to ask the Supreme Court for more time. This is one of the most important decisions that we will ever make as parliamentarians, and I truly believe this is a decision that should not be made on an arbitrary timeline. The consequences of this legislation are irreversible. If we make a bad choice now, someone may die who should not have. Canadians on both sides of the issue deserve better. In fact, they deserve our best.

The government has failed on this issue by not challenging the Supreme Court on this timeline. When Quebec developed similar legislation, it took more than six years. We are trying to do something similar in six months. This type of legislation should not be done in weeks. It should be done over a complete mandate of a government.

As parliamentarians, can we honestly say that we have had an opportunity to consult and speak with all stakeholders? Can we really say Canadians have had enough time to digest the implications of the bill and have been given sufficient time to provide feedback to their representatives?

The Supreme Court's decision has made it clear that we will have doctor-assisted dying. As a member of Parliament, my focus here is to ensure that there are sufficient safeguards in Bill C-14 to protect the most vulnerable in our society: children, people with disabilities, those with mental health issues, and our seniors.

Can each of us in the House look our constituents in the eye and say we have done our due diligence in just a few weeks? Can we say with confidence that the safeguards in the legislation are properly in place to protect those who need our support and our help? In the short amount of time we have been given, I simply cannot make that claim.

Unfortunately, it appears the government is not going to ask for an extension. In fact, it is no longer even putting up speakers to participate in the debate. On one of the most important issues that we will face as parliamentarians, the Liberals are not even participating. They are silencing the voice of Canadians who desperately want to talk about this important issue.

I hope we all take the opportunity in the time that is left to speak to our constituents, get their feedback, raise the awareness, talk to them about what the implications of the legislation are. I know people in my riding are extremely split on where they want to go with the legislation. I hope the other parties in the House will follow the Conservatives' lead and allow all of us to have a free vote and speak for our constituents.

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

Madam Speaker, I know there is a complaint that we are not allowing debate on this particular matter, but we have certainly extended the courtesy and opportunity for all members who want to participate in this particular process to do so.

The deadline of June 6 is one that was imposed by the court. We as a government and the Minister of Justice asked for a longer period of time. The court denied it and decided that June 6 was the deadline with respect to Parliament having an answer to the Carter decision.

I ask my friend how we ultimately get around this particular problem of the deadline that was imposed when his party was in government and did nothing last year.

[John Barlow, Conservative, Foothills, AB]

Madam Speaker, it is great to see my colleague back in the House.

I appreciate and understand the tight timeline, but the Liberal government had opportunities to ask for another extension. Can we honestly say that we can accomplish what we have been asked to do in just a matter of weeks, when every other jurisdiction has done this over a matter of years? It is more important that we get this right than it is to meet some kind of deadline that has been imposed by the Supreme Court.

After the election, the Liberal government asked for the first extension and got four months. It should have challenged that with all of its resources and said that is simply not enough time. The consequences of this are not something that I personally can live with. If we make mistakes, it is horrible to say, but it could have fatal consequences, and that is not something I want on my conscience.

[Tracey Ramsey, NDP, Essex, ON]

Madam Speaker, in his impassioned speech, my colleague from Foothills brought up one issue that I have also heard about from my constituents and I understand it is a concern for Canadians. It is about health practitioners' personal conscientious objections. Through our work in the all-party committee, the NDP made a clear recommendation to the government that no health care worker should ever be compelled to participate in assisted dying and should be legally shielded from unfair consequences resulting from that personal decision.

We in the NDP are concerned that these protections are not included directly in the legislation, even though the government promised that they will be addressed soon in non-legislative measures. We are going to hold the government to that promise.

I ask my colleague, will your party hold the government to that promise as well?

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I would remind members that they address questions to the Chair and not to colleagues in the House.

The hon. member for Foothills.

[John Barlow, Conservative, Foothills, AB]

Madam Speaker, absolutely, one of the top issues that has come up in my riding is protection for health practitioners to make this decision on their own and not have it imposed on them. This goes to the point that I think all of us are trying to make. There are so many issues that still need to be addressed.

My colleague on the other side has said that there have been all kinds of opportunities to debate this. Six or seven of my colleagues who are hoping to speak on this later this evening may not have that opportunity because the government is putting closure on this debate.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Madam Speaker, throughout this discussion and debate, I have heard many heartfelt positions. I have also heard many calls for the bill to go to committee, where amendments can be made to it. I truly feel that most Canadians believe, as the member has indicated, that this bill is about someone's mom, dad, sister, or brother who is on life support with a terminal illness.

I wonder if the member might be able to give some idea, if the bill were to go to committee, if there are any amendments that could be made that he would find appropriate.

[John Barlow, Conservative, Foothills, AB]

Madam Speaker, the safest thing to do with this bill would be to make it as tight and as rigid as possible. The Carter decision involved a competent adult suffering with a terminal illness. That is how we should have kept it.

I do not think we should now have psychological issues as an underlying factor and a decision to study mature minors. I do not think we should be starting here; we should be starting here, making it as narrow and as strict as possible, and not try to put the cat back in the bag afterward. We need to ensure that this remains about competent adults who are suffering from a terminal illness.

[Candice Bergen, Conservative, Portage—Lisgar, MB]

Madam Speaker, I am going to try to watch my time, and I hope to be on the same timeline as you are.

I am grateful to have the opportunity to speak to Bill C-14, which is a bill that makes amendments to the Criminal Code and other acts that would, for the first time in Canadian history, make it legal for someone to have medical assistance in taking his or her own life.

It would also make it legal for not just a doctor, nurse practitioner, or somebody involved in the medical community, but an aid, somebody outside of the medical community to kill someone, should the person want to be killed, if the conditions that are set out in this legislation are met.

It is an extremely serious matter that we have before us, and no doubt it will go down as a historic matter. It is something that will go down in history.

I want to take a couple of moments to address a few things. I want to begin by talking about where and how we got to this place, and build on some of the things that my colleague just talked about. The Supreme Court of Canada ruled just over a year ago that it was a charter right for Canadians to be able to have medical assistance in dying. The court gave us a year, a very short time frame, to talk about it, to consult, and to come up with legislation.

I want to take this opportunity to articulate not only my frustration but the concern of many of my constituents and many Canadians in what seems to be happening over and over again. Certainly, the Supreme Court is within its purview to make these decisions that have huge and lasting implications on Canadian society. Unfortunately, what is happening is Canadians feel, and it is becoming more and more prevalent, that they have no say in these matters, whether it is issues like assisted death, which is before us right now, or legalized prostitution, which we had to deal with in the last Parliament.

We are also seeing laws that have been passed in both this House and the other place that are being overturned by the Supreme Court of Canada. We have seen this in recent years and even recent weeks.

I would say for the record, and I would suggest, that it might be time for the government to start using the tools that we have at our disposal to bring some more balance back to our process. We have the legislative branch of our democracy and we have the executive, which are both accountable to voters. Then we have our judiciary, which is a very valuable part of it, but it has become what I believe and what my constituents are telling me imbalanced. They feel that there are nine people down the street in Ottawa who are making very important decisions, and the Canadian people have no say in them.

The tool that we had when the Conservatives were in government is the notwithstanding clause. For the record, I want to say that I think we might have to, and I know the government now has four years and there is a lot that can happen, for the people of Canada, start using that.

We are, though, at a place where the Supreme Court has ruled, and we absolutely respect that. Even though we might disagree with something that is said by a judge or a number of judges, in Canada, we respect the law and we follow the law.

Again, my colleague talked about how the Liberals could have asked for more time, and certainly that is something that could have been done, but we are now at a place where we have to look at a law and either pass the law or not.

I will not be able to support this piece of legislation. I believe it is flawed. My constituents have not had enough time to talk about it and be part of the process. A number of the issues that are concerning about the bill have already been articulated. I want to reinforce that I am very concerned there is not enough protection for vulnerable persons who may be victims or easily manipulated.

In my previous role, I worked a lot with people with disabilities with a variety of abilities. I met recently in Winnipeg with an individual who has an intellectual disability, but is a very smart, capable individual. He said to me, “Sometimes we can be taken advantage of when we are getting a new phone. It is so easy to manipulate us.” He said, “I am worried if somebody is trying to encourage some of us to die, we can be easily manipulated.” There is very little protection in this legislation for vulnerable Canadians.

There is also no protection, or very little protection, as has already been stated, for doctors, nurses, or other medical practitioners, or institutions for that matter, where killing someone goes against their conscience. The federal government has a duty to protect their rights. This bill could be strengthened by protecting those rights.

Also, it is very unclear and ambiguous, as far as language goes, around waiting times, around those who can sign for a patient, and there is very little oversight as far as who may have a financial benefit if somebody were to have an assisted death.

There are number of huge concerns. More time is needed to fix these flaws and to protect the vulnerable and rights of conscience.

Last, I want to talk a bit about my experience working in palliative care. I was a volunteer for a number of years. It was really something to behold to be with people as they went through those last stages of life.

However, there are a lot of misconceptions about what assisted suicide is, what assisted death is. I talked to one of my friends this weekend and she said, “Well, of course, Candice, if I'm in a vegetative state, I would like to be able to have the cord unplugged. I don't want to be kept alive.”

I said to her, “That's not assisted suicide. You absolutely already have that right in Canada to have a living will, to have a do-not-resuscitate order, to refuse medical treatment.” Those are all things that are already entrenched in law and that Canadians have the right to refuse. I think even our Prime Minister talked a number of years ago about his own father refusing medical treatment when he had cancer. Absolutely every Canadian has that right.

However, that is not at all what we are talking about today. That is not the decision that we are forced to make in a hasty way. That is not the decision that Canadians are being cheated out of being able to talk about, and being able to even, dare I say, vote on. It should be a major issue for Canadians to have major input. We are not talking about refusing treatment. We are not talking about saying “do not resuscitate”. We are not talking about palliative sedation, either.

My sister passed away nine years ago from cancer. Some of my family members said, “I think she died because the doctor gave her a lot of morphine when she was in pain.” No, she did not die from the morphine. She died from the cancer. Palliative sedation is not assisted suicide.

I find it ironic, in a very sad way. I just finished my 308 conversations in my riding last week. The 308 conversations was an initiative of the Canadian Mental Health Commission. It was a wonderful idea for 308—at that point 308 members of Parliament, now there are 338 of us—conversations around how we prevent suicide and how we better equip ourselves as community leaders, as health practitioners, as people working with youth, to prevent suicide.

I had these meetings. About 70 people were there, committed to preventing suicide in our communities in Portage—Lisgar. I said, “Folks, I am now going back to Ottawa and I am going to be debating how we can help people commit suicide.”

This is a very difficult issue. It is not one that we can just excuse and say, “Well, in this case, we don't want these people to die, because they're young people who have bullied on the Internet, so we want to make sure they don't commit suicide, but for somebody else who might have a mental illness and just has no hope, we want to be able to help them commit suicide.”

That is wrong and I do not think we can easily reconcile the two. I think we need to talk about it and we need to have protections in place.

Palliative care is very important. It is about giving hope to people. Studies show that if people have a terminal illness and they are assured they can die pain-free, they choose life and they let God decide when they go.

I think we can all agree, absolutely, that it is about helping people and giving them hope, whether it is a mental illness or whether it is a terminal illness; we give them hope and we help alleviate their pain. I do not think we ever want to see choosing death as the honourable way out. We never want our loved ones to feel like it would be more honourable if they chose death. I think we can all agree. Let us choose life every step of the way. Let us choose life.

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

Madam Speaker, I want thank my friend, the member for Portage—Lisgar, for her contribution.

I want to go back to the beginning of her contribution, where she talked about the potential application of section 33 under the charter. It was actually part of the context of my own remarks when I talked specifically about its use and application. Of course, this Parliament has never actually used section 33 yet, to apply it to any particular piece of legislation. I am wary about its use, given that we are ultimately talking about where there has already been a determination by the courts and certain individuals' rights protected under the Charter of Rights and Freedoms would then be subject to a legislative override under section 33.

Is there a particular test that my friend, the member for Portage—Lisgar, thinks should be applied, in terms of helping parliamentarians assess when it would be appropriate to use section 33?

I had suggested that we would use the same kinds of tests that would be found under section 1, in particular, trying to minimally impair the rights of someone where their charter rights have been protected.

[Candice Bergen, Conservative, Portage—Lisgar, MB]

Madam Speaker, those are very important questions.

As my colleague has said, one of the things we have not done is that no parliament has used the notwithstanding clause. Those are discussions we almost do not want to talk about because there seems to be some negativity. Even now, if the current government were to talk about it in any context, there would probably be some. It is almost politically incorrect to talk about it. We should be having these conversations, whether in formal or informal groups. What would be the test? Personally, I think one of them would be that if a government decided to invoke the notwithstanding clause, it then commit to take that particular issue to the electorate so that there would be an extra layer of test on it.

Those are good questions. I do not have the exact answers. All I know is that there is a growing sense of voters who feel they have less ability, when they were not even asked about the issue of assisted suicide in the election. Some of them still think that palliative sedation is assisted suicide, when it is not. There has to be a better way whereby Canadians know that they have a voice, and that our system is equally empowered so that there is not one part of our democratic system that has more power over the other.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Speaker, we have heard talk on the government side about how important this debate and discussion is, and that it has done what it has done on other issues. It pointed fingers at the government of the past saying that it did not get anything done and that this is really important, yet earlier today we saw the current government try to force closure on this debate. My concern is this. The government has limited the discussion all along the way, whether in the special committee or within this debate today.

In sending this bill to committee, because ultimately that is where we are going with this, does the member believe that, given everything that we have seen with the government to date, there will be that fair and open consultation on this legislation that the government is telling us to just trust them with and that the assurance is there? Does the hon. member have the same concerns that I have with respect to what we have seen in the past?

[Candice Bergen, Conservative, Portage—Lisgar, MB]

Madam Speaker, I am typically the first to get in a good partisan jab here and there. I definitely think that there are members of the government who want to shut this down quickly, get it over with, and move on to something else. However, I have to believe that there are members of the Liberal Party, members of Parliament who are part of the Liberal caucus, who have some of the same concerns we have, and my hope is that they will speak up.

I know we have heard a lot about the current government wanting to give backbenchers more say and more influence in the government. Therefore, I am hoping that they are hearing from their constituents, and that they also recognize how difficult and how important this is. I hope that there will be a free vote on this. Then, I hope that they will advocate strongly in their caucus for the appropriate amount of time to be given, and that they will consider amendments.

What we are counting on in this case is the integrity, the strength, and the individual ability of Liberal backbenchers to stand up in a strong way to maybe some of those in the front who want to move things along quickly. That would be my hope.

This is really difficult. It is not easy for anyone. I have to believe that the backbenchers and the government have the best intentions in mind.

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, pursuant to Standing Order 26(1), I move:

That the House shall continue to sit beyond the hour of daily adjournment for the purpose of considering Bill C-14, An Act to amend the Criminal Code and make related amendments to other Acts (medical assistance in dying), at second reading.

[The Deputy Speaker, Conservative, Bruce Stanton]

Will those members who object to the motion please rise in their places?

And 15 or more members having risen:

There being more than 15 members rising, the motion is deemed to have been withdrawn.

(Motion withdrawn)

Notice of time allocation motion

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, an agreement could not be reached under the provisions of Standing Orders 78(1) or 78(2) with respect to the second reading stage of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).

Under the provisions of Standing Order 78(3), I give notice that a minister of the crown will propose at the next sitting a motion to allot a specific number of days or hours for the consideration and disposal of proceedings at the said stage.

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

Mr. Speaker, I think I have a more reasonable approach to managing some of the debate left for Bill C-14. Therefore, I would seek the unanimous consent of the House for the following motion:

That, notwithstanding any Standing Order or usual practice of the House, on Tuesday, May 3, 2016, the House shall continue to sit beyond the hour of daily adjournment for the purpose of considering Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), at second reading, and when no member rises to speak, or at 12:00 a.m., whichever is earlier, that debate be deemed adjourned, and the House deemed adjourned until the next sitting day.

[The Deputy Speaker, Conservative, Bruce Stanton]

Does the hon. opposition House leader have the unanimous consent of the House to propose this motion?

[Some hon. members]

Agreed.

[The Deputy Speaker, Conservative, Bruce Stanton]

The House has heard the terms of the motion. Is it the pleasure of the House to adopt the motion?

[Some hon. members]

Agreed.

[The Deputy Speaker, Conservative, Bruce Stanton]

(Motion agreed to)

[The Deputy Speaker, Conservative, Bruce Stanton]

It being 5:37 p.m., the House will now proceed to the consideration of private members' business as listed on today's Order Paper.

Criminal Code

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

moved that Bill C-247, An Act to amend the Criminal Code (passive detection device), be read the second time and referred to a committee.

Mr. Speaker, I am proud to rise today to speak to my private member's bill, Bill C-247. If passed, Bill C-247 will prevent injuries and deaths from impaired driving, which continues to cause needless and heartbreaking tragedies in communities across Canada. Specifically, Bill C-247 will increase deterrence and rates of apprehension by allowing the use of passive alcohol sensors at roadside screenings for impaired drivers. I will explain the details of that proposal shortly.

In addition, Bill C-247 would rename the crime of “impaired driving causing death” to “vehicular homicide” as a result of impairment. That change would denote greater moral responsibility for the crime of impaired driving, while preserving judicial discretion to tailor sentences to particular circumstances.

The change is based on a proposal called Kassandra's law that was brought forward in 2015 by the Conservative member for Langley—Aldergrove. I am grateful that he has seconded Bill C-247 and I am pleased that we can work together across party lines to prevent drunk driving for the benefit of all Canadians.

Impaired driving has touched constituents in every riding across the country. My riding of Mississauga—Streetsville is no exception. Last year during the summer, my constituents lost a local leader, educator, mentor, and most importantly a father and a husband. Out of respect for the family, I will refrain from using his name.

Sadly, one night during July of 2015, while riding his bicycle, he was struck from behind by an impaired driver and pronounced dead at the scene. As a secondary school teacher, he spent years dedicating his time to educating and inspiring youth within my riding. His former students and those who knew him conveyed to me what a positive impact he made on those around him. I understand that he inspired many of his students to pursue post-secondary education.

Tragically his life was cut short by an intoxicated driver, someone who chose to put lives at risk rather than call a cab. His death denied five children their father, denied a wife her husband, denied students their teacher, and denied future young people a mentor who could have helped them make positive choices in life.

Soon after being elected, I received an email from a constituent who was greatly saddened by what had happened and also concerned that such senseless tragedies continued to occur at alarming rates in our country. She implored me to take action, and I am now doing so with Bill C-247.

As I said, if passed, the bill will prevent injuries and deaths from impaired driving. It will do this with two measures to increase deterrence and rates of apprehension. The first measure authorizes the use of passive alcohol sensors at roadside screenings for impaired drivers. What would this change mean?

Currently law enforcement in Canada conducts organized stops at check points to screen drivers for impairment. For example, Ontario conducts a program called reduce impaired driving everywhere, RIDE. When stopping drivers, officers apply breath tests if they, through odour or appearance, reasonably suspect a driver has consumed alcohol. However, according to a 2009 report of the House Standing Committee on Justice and Human Rights, only a small fraction of impaired drivers are currently apprehended.

Bill C-247 would increase apprehension and deterrence by authorizing the use of passive alcohol sensors by police at organized stops, or when they had reasonable grounds to make a stop for suspected impairment. Passive alcohol sensors detect alcohol when placed near a driver's face. A positive reading would provide reasonable grounds to conduct a breath test on an approved screening device.

I am confident that the use of passive alcohol sensors at organized roadside screenings will be charter compliant. I say this because, in its decision in Dedman v. The Queen, the Supreme Court held that the somewhat random searches in Ontario's RIDE program were constitutional because driving was a “licensed activity that is subject to regulation and control for the protection of life and property.” The legal takeaway is that driving is a licensed activity that is subject to reasonable limits because of the risk to others who share the roads. Using passive alcohol sensors would be a reasonable limit that is far more effective at catching impaired drivers than the current method employed at roadside screenings.

Mothers Against Drunk Driving Canada has endorsed Bill C-247, citing passive alcohol sensors' benefits. Andrew Murie, CEO of MADD Canada, said, “The ability for police to use Passive Alcohol Sensors will have a great impact on reducing the number of alcohol impaired drivers on our roadways. This private member bill...will allow police to maximize the technology that is available to detect drinking drivers at roadside. MADD Canada appreciates [these efforts] to lower the number of alcohol related crashes, deaths and injuries”.

Now I want to spend some time on the second measure in Bill C-247. As I said, the bill would also rename the crime of “impaired driving causing death” to “vehicular homicide”. This change would denote greater moral culpability, and that is appropriate. The decision to get behind the wheel while impaired is completely reckless, and the devastating consequences are predictable. A conviction should reflect that culpability.

To raise a recent example, this is the crime for which Marco Muzzo recently received a 10-year sentence for killing three children and their grandfather. That tragedy was directly caused by his decision to get behind the wheel, with a blood-alcohol level nearly three times the legal limit.

The Criminal Code of Canada states that a person commits homicide when directly or indirectly by any means causes the death of a human being. Drunk driving causing death would be a form of culpable homicide because it is morally and legally blameworthy. The moment an impaired driver gets behind the wheel, he or she puts others at risk. Words carry weight, they are not empty, and this culpability needs to be accurately reflected in Canadian law. At the same time, this change would preserve judicial discretion to tailor sentences to individual circumstances.

The proposal to call the crime of impaired driving causing death what it really is, vehicular homicide, was originally brought forward as Kassandra's law after Kassandra Kaulius of Surrey, B.C., a 22-year-old victim of impaired driving. The Conservative member for Langley—Aldergrove tabled Kassandra's law as Bill C-652 in the previous Parliament, and again I am pleased that he has seconded Bill C-247.

Last week, I had the opportunity to meet with Kassandra's parents, Markita and Victor. When I was discussing this upcoming speech, Victor pointed out that today, May 3, will mark five years to the day that their beautiful 22-year-old daughter lost her life.

Throughout her life, Kassandra was a lively and enthusiastic person who loved sports. As her parents recall, from the time she was three years old she was already running around her family's backyard playing sports with her older siblings. As she got older, her passion for sports grew. She competed on her high school volleyball, basketball, and softball teams, eventually receiving athletic scholarships, and had dreams of one day becoming a teacher.

On the one hand, the inspiration behind this bill was a teacher who inspired students and whose life was unjustly taken from him. On the other hand, part of the bill has been named after a young woman who dreamed of becoming a teacher and whose life was unjustly taken from her.

I also want to mention Families For Justice, the organization Markita and Victor have worked so hard to establish and have used to promote awareness of impaired driving. They have collected over 100,000 signatures in support of their cause. I commend their efforts to provide support and counselling services for families that have lost loved ones.

I do not need to remind the House of the harms of impaired driving. According to MADD, impaired driving continues to be the leading criminal cause of death in Canada, claiming almost twice as many lives per year as all categories of homicide combined.

In 2010, impaired driving accounted for approximately 1,082 deaths, 63,281 injuries, and $20.62 billion in financial and social costs. What is important to note is the fact that Statistics Canada indicates that 53% of all adult victims were between the ages of 18 and 35. This means that Canada is being denied young minds that would shape the future of the country.

Furthermore, our country's impaired driving record has been, and remains, poor in comparison to other developed countries. Millions of Canadians continue to drive after drinking, one reason being they believe they can do so with relatively little fear of being apprehended.

An international review of 15 countries reported that Canada has the second-highest rate of alcohol involvement in fatal crashes. Similarly, a Transport Canada study found that Canada had the highest rate of impairment among fatally injured drivers of eight countries in the Organisation for Economic Co-operation and Development. Furthermore, Canada had the highest rate of alcohol-related traffic fatalities as a percentage of total fatalities among 13 countries.

Although the selective breath testing programs that are currently in place are a productive step toward preventing impaired driving, the majority of impaired drivers go undetected at sobriety checkpoints. MADD reports that of the four million to five million drivers who are stopped each year at sobriety checkpoints, less than 1% are subject to roadside breath testing on an approved screening device.

It is for this reason that the main measure in my bill, the authorization of passive alcohol sensors, is evidence-based and necessary. These devices detect the presence and approximate amount of alcohol in a driver's exhaled breath by sampling the ambient air near his or her mouth.

The device also contains a pump that draws in air over a sensor that reacts to alcohol and registers a reading within a matter of seconds.

Passive alcohol sensors provide an easy, reliable and non-intrusive method of efficiently screening a large number of drivers with minimal delay, which will ultimately save more lives each year.

Passive alcohol sensors have been around for some time. The technology is not new, however, initially they were units on their own. It is important to note that when discussing passive alcohol sensors, for the most part, we are simply discussing a feature built into many of the approved screening devices already carried by peace officers. This means that the express authorization of a passive alcohol sensor would most likely allow officers to use their current devices, optimizing the tools already available to them.

As Robert Solomon, a law professor at Western University, has said, “...currently nothing preventing Canadian police from using PASs”.

Regardless, amendments to the Criminal Code explicitly authorizing police to use passive alcohol sensors would be effective. It would create a national standard which would ultimately reduce the confusion that otherwise arises from having 13 different provincial and territorial enforcement powers and practices. Police officers would also be more likely to use PASs if they are given express statutory authority to do so. Furthermore, the publicity surrounding the introduction of a national passive alcohol sensor program together with the knowledge that police officers are using more sophisticated detection methods would increase the perceived risk of apprehension and ultimately have a deterrent impact.

Over the past months, I have consulted with numerous police officers and police chiefs all over the country. It is apparent that the overarching consensus is that the more tools available to the police, the better.

To conclude, the problem of impaired driving needs to be better addressed by Parliament. The goal of my bill is not only to change how we view impaired driving offences, but to reduce instances of deaths and injuries by employing modern technology. Hopefully, with the passage of Bill C-247, we will further deter drinking and driving to safeguard Canadians, their families, and our communities.

I look forward to this bill going to committee, and I welcome amendments as well.

[Omar Alghabra, Liberal, Parliamentary Secretary to the Minister of Foreign Affairs (Consular Affairs)]

Mr. Speaker, I would first like to congratulate my colleague on his first private member's bill, and also for his sincere effort in confronting and combatting impaired driving.

The hon. member and I represent the same city, the city of Mississauga. The Peel regional police frequently conducts RIDE programs. Could the member elaborate on how his bill would enhance or help the efforts of the Peel regional police in confronting impaired driving?

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, when using the passive alcohol sensor, not only would we speed up the RIDE program but we would have a greater degree of accuracy. It would allow the current approved screening device to use the feature of the passive alcohol sensor to pretty much detect whether there would be alcohol in the ambient air around an individual's face with greater accuracy. Once there is that greater accuracy and speed, the police would be able to go through a greater number of people, thereby capturing potential drunk drivers

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, I want to congratulate my hon. colleague on his first private member's bill.

Perhaps the member mentioned this in his speech and I missed it. Could he tell us of other jurisdictions that are using this device? Have there been any constitutional or charter challenges on the use of it with a police agency wherever this new technology is being used?

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, to the best of my knowledge, it is being used in the United States, specifically California. I believe similar devices are being used in Australia.

I do not know of any charter challenges that may have occurred in those jurisdictions, but I believe this passive alcohol sensor would survive a charter challenge, as I stated in my speech, due to Dedman v. The Queen. It pretty much states that it is a reasonable limit to regulate, because when one has a driver's licence, it is pretty much a privilege, and in order to keep others safe, that is a reasonable grounds to interfere on someone's rights of driving.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, I want to thank my hon. colleague. Having lost a brother early on to drinking and driving, this is obviously something that hits home for me.

I have tabled a few private member's bills, going through the process and crafting the legislation, and also dealing with stakeholders. The member mentioned MADD, or Mothers Against Drunk Driving. Are there other agencies, including perhaps police agencies or police associations that are in support of the use of this? Could the member enlighten the House on this as well?

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, I am sorry to hear of the member's loss. As he said, MADD does endorse the bill. I have spoken to a number of police agencies. I have yet to have an official endorsement, so I would rather have them unnamed at the moment, but I am working in consultation with them. I hope to have those endorsements soon.

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

Mr. Speaker, I would like to commend my colleague for a job well done in terms of presenting a private member's bill that appears to have some fairly wide support both inside and outside of the chamber. I understand the member is open to some potential amendments.

I would ask the member to provide comment on how technology can often assist our police in having something added to their tool belt, if I can put it that way, to make our streets safer.

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, we should always use technology as it advances. As I mentioned, the passive alcohol sensor has been around for quite some time, but before it was a self-contained unit. Now it is a feature in the approved screening devices that many of the agencies carry.

It is a tool at their disposal, and at the moment it is not being used. It is available for them. We should use these technologies to stop drunk drivers.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Mr. Speaker, it is a privilege to rise to speak to Bill C-247.

At the outset, let me congratulate the member for Mississauga—Streetsville for his impassioned speech. While I will not be able to support the bill for reasons that I will explain momentarily, I do want to acknowledge that this legislation is well intentioned and that the objectives of the hon. member are noble.

Impaired driving is the leading cause of criminal death in Canada. In 2016, that is simply unacceptable. However, that being said, it is important to acknowledge that over the last several decades, Canada has come a long way to combatting impaired driving. Indeed, over the last two decades, the percentage of motor vehicle deaths involving impaired drivers has decreased. In some year-to-year comparisons, there have perhaps been increases, but the trend line is clear and they are going down. While that is not a reason to celebrate, it is evidence that the combination of public awareness, policing efforts, and legislative changes over the last several decades are having a positive effect.

Nonetheless, there continues to be people who drink, drive, and cause carnage on our roads. These are people like Johnathan Pratt. He was someone who, in 2011, killed three young men outside of Beaumont, Alberta. Pratt was more than three times over the legal limit, driving 199 kilometres an hour down a highway when he rammed into a vehicle occupied by the young men, effectively crushing them to death.

Then there is Roger Walsh, someone who killed a wheelchair-bound woman while he was impaired and behind the wheel. This was Walsh's nineteenth conviction for impaired driving.

The vast majority of Canadians understand that impaired driving is dangerous, that it is illegal, and most importantly that it is wrong. The vast majority of Canadians not only understand those facts, but are heeding the message and choosing not to get behind the wheel while impaired.

However, there are some who continue to do so. There is no one profile of an impaired driver. There are many instances of people who rarely drive impaired, or perhaps someone decides to do so one fateful night and in turn causes injury or death on the road. However, a big part of the problem in terms of those who are causing carnage on our roads is that they are regular, repeat, hard-core drunk drivers.

The question that we must ask as parliamentarians is, how do we deal with a relatively small number of people who are causing a disproportionate amount of grief, death, and injury on our roads? The answer is that we need to ensure that those types of offenders are held accountable to the fullest extent of the law. Unfortunately, some of the laws on the books today are simply not doing the job to the degree that they ought to.

That is why I was very pleased to see that my colleague, the hon. member for Bellechasse—Les Etchemins—Lévis, introduced a private member's bill, Bill C-226. Bill C-226 contains some important measures to hold serious impaired driving offenders accountable. It would impose a mandatory minimum for an impaired driver who causes death. It would increase sentencing for impaired drivers who cause bodily harm from 10 years to 14 years. It would also allow for consecutive sentencing for impaired drivers who cause multiple deaths to ensure that every victim of impaired driving is accounted for.

When it comes to holding regular, repeat, and hard-core drunk drivers accountable, unfortunately, unlike Bill C-226, I believe that Bill C-247 falls short. While Bill C-247 falls short in this regard, it would impose a form of random breath testing, passive alcohol sensors. Certainly I would acknowledge that Bill C-226 does not contain passive sensors, but I have some reservations about any form of random breath testing.

Under sections 8 and 9 of the charter, it would most certainly run afoul. It is quite arguable that it could be saved under section 1 of the charter, and I believe there would be a reasonable chance that it would be saved. However, the issue is what impact it will have in reducing the number of impaired drivers and deaths on our roads. The evidence is mixed on that question.

Indeed, there is some body of statistical evidence that indicates this type of testing has no more impact in reducing impaired driving than things that are currently employed by law enforcement, such as checkstops. Indeed, in the city of Edmonton in the last few years, one thing that had the biggest impact in reducing impaired driving was the city posting signs saying that if people see impaired drivers, they should phone 911. Therefore, I think we have to perhaps look at other alternatives to random breath testing. What is more, I believe this legislation just does not cut it when it comes to holding the most serious offenders accountable for impaired driving.

It is on that basis that I regretfully will not support this particular bill. However, I want to commend the hon. member for bringing it forward, because it is an important debate and an important issue that Parliament must continue to address.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, I would like to say that I will support the bill introduced by my Liberal colleague. We think that it is a way to better detect alcohol. However, the fact remains that the problem of impaired driving is much more complex than that. This is just one of many measures that need to be implemented to better detect impaired driving.

The bill would allow police officers to use passive alcohol detection devices. A passive detection device is a meter with a display of coloured stripes that light up when the presence of alcohol is detected in the ambient air. In order for a police officer to administer a breathalyzer test, he must have grounds to suspect that the person consumed alcohol. That does not necessarily mean that the police officer needs grounds to suspect that the person is drunk, just that he or she consumed alcohol. The police officer can then administer a breathalyzer test.

This device would not be used to collect evidence, but it would help give police officers the grounds they need to conduct breathalyzer tests and perhaps detect more people who have been drinking. It could help prevent impaired driving. Every year, too many families are the victims of impaired driving. That is why we must make use of all of the tools available. However, we need to do a lot more to prevent drunk driving. There are many factors to consider. In rural areas, it is a matter of infrastructure, of public transit, or organizations that provide driver services.

When people do not really have any options for getting home after a night out, it may, unfortunately, make our roads less safe. We need to look at those aspects of the issue. Data indicates that it can take up to three years before a person who regularly drives drunk is caught by the police.

For instance, in our rural regions, people who drink might decide to use back roads that have less traffic to get home, in order to avoid roadside checks. There are also people who drink in the morning. By noon, these people could already be impaired. Roadblocks are more often set up at night. This does not necessarily allow authorities to catch everyone who might be impaired. Furthermore, this might not be the first thing an officer thinks of when they stop someone for running a stop sign at 11 a.m., for example.

Using the tool in question, we would be able to better screen these individuals, so it is a good tool, but we need to do a lot more to discourage people from driving while impaired. Of course, any time we increase the risk of being arrested, the risk of being caught, that can have an impact on the number of drunk drivers, but we need to do a lot more.

Unfortunately, there are people who are repeat offenders. It is really hard to put an end to this. We also see cases where there is no doubt about the person's state. When these people decide to drive while impaired but do not hurt anyone, the consequences are relatively minor, so they may continue doing it for quite a while, and as a result, the safety of the public is at risk during that entire period.

It is therefore important to take a more enlightened approach and examine the problem of drinking and driving in its entirety.

As I said, we will be supporting the measure introduced by my colleague, but it is just one small measure among many much larger initiatives that should be implemented to actually reduce the problem of drinking and driving.

In my riding, a disproportionate number of people drive under the influence. For example, in the RCM of Témiscamingue, which has the smallest population of the four RCMs I represent, there are more drunk driving incidents. It is also the largest RCM in terms of size, and there is little in the way of taxi service.

Ville-Marie is the biggest city in the RCM of Témiscamingue, and I believe there is one single taxi in operation there, and it is not available nights. This points to a lack of infrastructure. There is no taxi service because there is not enough demand, and there are no local services to drive people home. That can cause people to take risks they should not take. Locally, there is a lot of awareness-raising going on. Groups are trying to make people understand that they have to plan how to get home before they start drinking. This work is never done.

Organizations that try to prevent drinking and driving should receive more support, especially in rural regions where people have few alternatives. We cannot tell them to take the bus, walk, or ride their bike. It is simply impossible. Some people live 30 kilometres from town. It is very hard. Taking a taxi is not really an option either.

When it comes to drinking and driving, there has to be a better strategy than passive detection devices. We have to gain a better understanding of the situation and take the time to talk with the people on the ground. We have to talk to people convicted of impaired driving, in order to determine what they could have done to avoid taking the wheel. We have to learn from past mistakes in order to prevent the loss of lives. It is not easy.

As a caregiver, I have seen people arrive at the hospital in the middle of the night who, minutes earlier were behind the wheel of their car with more than twice the potentially lethal limit of alcohol in their blood. Intoxicated is not the word for people like that. They are as drunk as a skunk, if you will pardon the expression.

When we see such situations, we can only hope that more efforts will be made to solve the problem of drunk driving. We have been working on this for years, and I do not believe that we are going to solve the problem by taking a piecemeal approach. We have to have a comprehensive plan. I hope that such a plan will be introduced and that we will take a giant step forward in the fight against impaired driving.

We must not forget that many Canadians have lost a loved one because of drunk driving. I hope that my children will never be exposed to this danger, that I will be able to provide them with infrastructure, and that I will teach them to be responsible when it comes to drinking. I hope that more lives will not be lost and that more families will not be broken.

I am pleased to express my views on this matter. I look forward to following the committee study and I hope that a much more comprehensive plan will emerge.

[Bill Blair, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Mr. Speaker, I am very honoured and pleased to have the opportunity to rise today and join in the second reading debate of Bill C-247 introduced by the member for Mississauga—Streetsville.

I will begin by offering congratulations to the member for Mississauga—Streetsville for his passion and commitment to this very significant problem in our society.

He and I have had the privilege of having a number of conversations about the various approaches and concerns he had with respect to impaired driving. He has shared with me some of the stories, as he did today about Kassandra's death, but other things have compelled him to respond with this private member's bill, and I want to commend him for his passion and commitment in bringing this important issue forward.

The social impact of impaired driving in Canada cannot be overstated. We have heard a number of statistics, but it is important to actually break those down into the impact it is having on families and communities across this country.

Each year, on average, nearly 1,500 Canadians lose their lives as a direct result of a decision some Canadian has made to operate a motor vehicle while impaired by alcohol. That means, on average, that each and every day in this country nearly four people lose their lives, and there are very few families and no communities that have not been impacted by this terrible crime. As has already been stated, impaired driving is the number one leading cause of criminal death in Canada.

As my colleague the member for St. Albert—Edmonton has indicated, we have seen some improvement over the past number of decades in societal condemnation and in the number of impaired drivers we see; but there is so much more work to be done.

It is important to reflect on why we have seen some of those reductions. I was actually a young police officer in 1979 when the first roadside screening program was established in the city of Toronto, the RIDE program, which is now “reduce impaired driving everywhere” but began as “reduce impaired driving in Etobicoke”. As young police officers, we were sent out with the task of randomly pulling over vehicles on the street to determine if their drivers had been drinking and driving.

That program had two very important purposes. The first purpose was to detect the people who were driving impaired and to hold them responsible for their conduct. However, perhaps most importantly and most impactfully, it had the effect of sending a very clear message about society's condemnation of impaired driving, the seriousness with which we as a society and our police and courts took this offence. It also created a stronger impression among the population that this was a crime, a crime that would be dealt with effectively, a crime where we would increase the likelihood of detection, where there was a greater certainty of consequences and that those consequences would be significant and serious enough to deter that criminal behaviour.

We have also seen some additional tools and technologies that have enhanced our ability to be more effective in those roadside stops. For example, many years ago, roadside screening devices were developed that enabled police officers to administer a test on the basis of reasonable suspicion of those people who we believed had been consuming alcohol prior to operating a motor vehicle.

If I may, I will explain to my colleagues a little bit how that is done. I actually got a fair bit of experience at roadside RIDE spot checks as a police officer in Toronto. I think for the last 20 years, I have spent every New Year's Eve standing along the roadway with a number of other police officers pulling over cars.

When we do that, as a car is going through the spot check, the police officer will stop the driver and make certain observations and certain inquiries. Among the observations, the officer will will try to detect the scent of alcohol on the driver or glassy eyes or slurred speech. We would ask those drivers if they had been drinking alcohol.

If we make observations that cause us to be suspicious that the driver has been consuming alcohol—and it has to be a reasonable suspicion, not a mere suspicion but not at the level of reasonable, probable grounds—police officers are empowered in law to make a demand for the driver to submit to a roadside screening test, the consequences of which can lead to other things I will speak of. However, because we stop literally thousands of cars in an evening in this way, the opportunity to detect if the individual has been consuming alcohol is somewhat limited.

The experience of police officers across this country in conducting those all important random stops has been that people do not not admit to having consumed alcohol or the signs of consumption are not obvious. We know that many people avoid detection, notwithstanding the enormous amount of resources and effort being put into making a difference in our communities. It is quite obvious to those of us who have worked out on the streets in our communities and seen the carnage, seen the impact it has on families, seen the literally thousands of people who have lost loved ones to impaired driving, that we must do more.

Our current court system is processing nearly 60,000 criminal cases each and every year related to impaired driving. In addition to that, there are literally tens of thousands of injuries as a result of the decision that some people make to drink and drive. We must do more. The private member's bill brought forward by my friend from Mississauga—Streetsville gives the police authorities one more tool to enable them to do their job.

Bill C-247 proposes to amend the Criminal Code to specifically authorize the police to use a device referred to as a passive detection device, often referred to as a passive alcohol sensor, at the roadside in an effort to better detect impaired drivers. These sensors are able to detect alcohol in the ambient air. It does not require that the driver blow into a machine. It can provide police officers with a reasonable suspicion that would enable them to make a demand for a roadside screening device to be administered.

Not two weeks ago there was another private member's bill brought forward in this House by the hon. member for Bellechasse—Les Etchemins—Lévis. In that bill, he made a number of very important proposals. Many members, representing all parties, stood in this House to express their concern about the need to do more with respect to impaired driving. I would submit that the private member's bill that we are speaking to today is along very similar lines. It is one additional and important tool that may enable us to keep our communities safe.

Historically, there have been a number of things that we know can make a difference in preventing crime in our society. One of the most significant things that we can do as a society is to increase the likelihood of detection and conviction for those who would choose to commit a crime. We know that the offence of impaired driving often goes undetected even at roadside screening sites where the police are randomly stopping cars. We know that the proposed private member's bill would increase the likelihood of detection.

We also know it is important to reinforce societal condemnation of impaired driving. We can do that through public education. We can do it by advising people of the risks and consequences of driving impaired. I can give an example of when the increased likelihood of detection and consequences made a real difference to the safety of our communities.

In many jurisdictions across this country, drivers under the age of 21 are required to drive free of all alcohol and are subject to administrative suspension if they choose to drink and drive. The likelihood of consequences at the roadside screening events has had a very significant effect on drivers under 21 right across this country choosing not to drink and drive. It has changed the societal attitudes among those young people about drinking and driving and has made our roadways safer. Anything that we can do to improve the decisions that people make about not drinking and driving will make our roadways safer.

In the limited time that I have, I also want to make some reference to the other important element of Bill C-247, which proposes to change the name of two impaired driving offences. This bill proposes to rename two impaired driving offences, specifically the offence of impaired driving causing death and the offence of “over 80” causing death, to vehicular homicide as a result of impairment. I think there is cause to consider both of these recommendations. I look forward to having the opportunity to bring this matter before the justice committee for further discussion.

I believe it is very important that this House do everything possible to respond to the tragedies that families and communities have experienced as a result of impaired driving.

I want to take a final opportunity to commend the member for Mississauga—Streetsville for his commitment, and I want to assure him of all our commitment to do everything possible to make our roadways safer for all of our citizens.

[The Deputy Speaker, Conservative, Bruce Stanton]

Resuming debate. The hon. member for Bellechasse—Les Etchemins—Lévis.

[Steven Blaney, Conservative, Bellechasse—Les Etchemins—Lévis, QC]

Mr. Speaker, I want to thank the member for Scarborough Southwest for what was almost a testimony with his experience on the ground. I was privileged to meet him for the first time here in Ottawa at a ceremony where we honoured the fallen in the line of duty. He certainly is bringing his experience to the House in a very important debate regarding impaired driving.

Also, I want to praise the member for Mississauga—Streetsville for bringing this private member's bill forward. The member for Scarborough Southwest said that the bill would give the police one more additional tool. In this House we are giving more tools to law enforcement to ensure that we reduce the number of deaths caused by impaired driving.

In his speech, the member referred to the other part of the private member's bill, which is to change the name of this crime which is already in the Criminal Code. It is the biggest cause of death in the Criminal Code. There is an expression.

In French we say, “il faut appeler un chat un chat”.

In English, we say to call a spade a spade.

I would ask the member, in 2016 are Canadians ready to accept that when a person willingly takes to a public road and is obviously not meeting the first requirement, which is to have a licence to follow the rules of the road and also to be sober, and then hurts or kills someone, it is a homicide? In the member's view, is Canadian society ready to consider a death caused by impaired driving as a homicide?

[The Deputy Speaker, Conservative, Bruce Stanton]

We are actually resuming debate. We are under the private members' hour rules of the Standing Orders. There are questions and comments for five minutes after the sponsor's introductory comments on the bill.

That said, I recognized the member for Bellechasse—Les Etchemins—Lévis under resuming debate, and it was a slot for his party. He has actually up to 10 minutes if he wishes to continue to make some commentary. There will not be an opportunity for the parliamentary secretary to respond in this case, but if the member wishes to carry on, he has another seven and a half minutes if he wishes to weigh in on this particular point.