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.

Medical Assistance in Dying

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, Bill C‑7 would not have been possible and would not have passed if Bill C‑14 had not infringed on people's right to life.

I am very disappointed to hear my colleague's comments. He has not read Bill C‑390, but he is in charge of procedure. He should be able to understand the bills that are introduced in the House. He should at least have a basic knowledge of that. Since he does not know, since he is ignorant, he does not know that the proposed solution—

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I move that the second report of the Special Joint Committee on Medical Assistance in Dying, presented on Wednesday, February 15, 2023, be concurred in.

Today, I am starting off the debate on the report on medical assistance in dying that was presented in February 2023. It is entitled “Medical Assistance in Dying in Canada: Choices for Canadians” and was presented by the Special Joint Committee on Medical Assistance in Dying, which was struck in May 2021. The report was presented a year and a half ago. I am bringing this debate back to the House because, as reported in the news, Quebec began authorizing advance requests for people with degenerative and incapacitating diseases yesterday. The answers the Prime Minister gave us yesterday suggest to me that he does not understand the issues at all and has not given them any thought since May 2021. That is unacceptable to people who are suffering.

Today, I would like to take a moment to remember all those we have lost, as well as those who are currently disappearing into the abyss of dementia. They are slowly but surely and irreversibly becoming prisoners of time, of each moment that fades away as it is lived. The present moment is gradually erasing the people they once were, and they are losing contact with the things that gave their existence meaning, things like joy, sorrow, the ability to have relate to others and share their experiences, consciousness, and the ability to make others happy and plan for the future. This terrible disease is robbing them of all the things that make life what it is, that make up the experience of life, the human experience, until their life is reduced to a mere biological process. They are irreversibly losing their physical, social, mental and moral autonomy, in every sense of the word.

Wherever you are right now, I am thinking about you, Mom.

I am also thinking about Sandra Demontigny, who is suffering from early-onset dementia. She is fighting for patients who have this debilitating, incurable, incapacitating disease to have the right to self-determination. She is fighting for them to have the right to make an advance request for MAID after being diagnosed. People with dementia want to live as long as possible. They do not want to shorten their lives by requesting MAID while they are still mentally competent. They want to be able to receive it once they have become incapacitated, once they have reached their limit. They are seeking assurance that we will have the compassion needed to respect their final wishes. Fortunately, Quebec decided not to wait for the federal government to wake up. It passed a law, which took effect yesterday, that allows people to make an advance request.

I commend Sandra Demontigny for her courage, her determination and her efforts to assert patients' right to self-determination. That is what we are talking about. The principle of lifelong self-determination is enshrined in law. No one can violate a person's integrity. That being the case, why, at the most intimate moment of a person's life, the moment of their death, should the government get to decide what is best for them? I would remind my colleagues that the government's job is not to decide what is best for a patient. The government's job is to create conditions that are conducive to making free and informed choices. People need to be free to make their own choices.

The Liberals champion the freedom to choose when it comes to abortion, when it comes to a woman's right to control her own body, so how they can question a patient's prerogative to exercise their right to self-determination in a decision as personal as that of their own death? The Liberals are dithering and are still hesitant to amend the Criminal Code to make advance requests legal. The Prime Minister said yesterday that it was a deeply personal decision. If he recognizes that, why can he not put some substance behind his statement? I think I have demonstrated that this is indeed a deeply personal decision.

Why shelve the report of the Special Joint Committee on Medical Assistance in Dying? Why set up joint committees made up of senators and elected representatives, ask them to come up with a key recommendation, and then shelve their report? The committee even managed to convince a Quebec Conservative who agreed with these proposals. The government is finally waking up a year and a half later because it was waiting to see what Quebec would do. The government took a wait-and-see approach so it could see how Quebec would proceed. It was a good idea to look at the example of Quebec, which took a unanimous non-partisan approach. Ottawa could learn something from what happened in Quebec's parliament, which spoke with one voice.

The government is now refusing to amend the Criminal Code, even though we have made it easy to do so. The government is not the one that has been doing the work since 2021, or for the past year and a half. The Quebec National Assembly passed the Act Respecting End-of-Life Care on June 7, 2023. It is now November 2024, and this government is telling us that it needs to have conversations. Who does the government want to have those conversations with? We heard from many experts, groups and citizens. We received many briefs. Despite all that, the government feels it must continue to wait, wait until people are suffering.

The committee report states the following, and I quote:

...Sandra Demontigny eloquently and movingly shared with the committee the sense of peace that advance requests might provide in situations like hers...

These people can feel more at ease dealing with the challenges before them when they are safe in the knowledge that, once they have reached their limit of suffering, we will take care of them and respect their final wishes. That is what we call basic humanity.

Here is what Sandra Demontigny had to say, and I quote:

I am working to calm my vanishing brain and my troubled heart. I feel a need to be reassured about my future so that I can do a better job of living out my remaining days and coping with the more frequent trials I will be experiencing.

My plan is to make the most of my final years while life is still good, with a free mind and without fear.

If those words fail to strike a chord with members here, those members must be heartless and lacking compassion, perhaps because of sweeping ideological principles that they are not putting on the table.

This prompted the committee to say that the Carter decision needed to be respected. Under Carter, the government must not violate sick people's right to life with legislation that would force them to shorten their lives. We saw this in Carter, and it was reiterated in the Beaudoin decision. These people do not want to commit suicide.

That is what Sandra Demontigny told us. She said that she wanted to make the most of the years she has left, knowing that when she reaches her limit of suffering, she will be taken care of and will not have to go through the same appalling decline as her father. Until that moment comes, she wants to live. She does not want to commit suicide.

Is that clear? Who is more vulnerable than a person making this heartfelt plea?

When people say they want to strike a balance between preserving the autonomy of self-determination and protecting the most vulnerable, unless they have fallen down the rabbit hole of believing that everyone in the health care system is evil, it is impossible not to hear this plea.

Why is the government applying a double standard? This report was tabled in February 2023. The government ignored the key recommendation, but, because Bill C‑7 contained a Senate amendment regarding mental disorders and a deadline, the government did accept the committee's recommendation to take another look at the issue after experts had studied it for a year. The government then recommended waiting, because it does not believe that the entire country is ready for this. It accepted the recommendation and applied it, and the result was Bill C‑62. However, in the past year and a half, no bills have been drafted based on the committee's key recommendation on advance requests. If that is not an example of lacking courage and shirking responsibility, I do not know what is.

The minister is unable to understand that an advance request cannot take effect until a diagnosis has been made. It has been six months since the Quebec law was passed. I do not know what world I am living in. This is certainly not a sign of competence. He clearly finds the issue complex because he keeps inventing problems that should not exist.

We are not only criticizing. We went so far as to table a bill. Bill C‑390 offers the government a solution, because we are in suggestion mode, not just in opposition mode. This bill allows the provinces to pass their own legislation once they have debated the issue. Quebec has been juggling this issue, reflecting on MAID and doing something about it since 2009. Now, in 2024, it can start accepting advance requests. There is a law in Quebec. We have adopted a legislative framework. If the federal government thinks advance requests are too complicated, maybe it should look at Bill C‑390, which says it should go at the provinces' and legislative assemblies' pace. This is a debate that should be undertaken by each legislative assembly, by citizens and their representatives. Once they have debated the issue and established a legislative framework, they will then be able to accept advance requests for MAID. That is a very reasonable suggestion.

This is not preferential treatment for Quebec. It is an additional safeguard for the government. The idea is to amend the Criminal Code to simply say that, once a legislative assembly, a province, has adopted a legislative framework and a law, it can move ahead.

The administration of care is a matter for the provinces. End-of-life care is a matter for the provinces. The Criminal Code is a federal statute, and the federal government does not need to describe how things should be done. Furthermore, we are setting an example for all the other provinces. According to every poll conducted over the past three years, 83% to 85% of Canadians support advance requests, so I have to wonder where the political risk is. I feel like this government is afraid of its own shadow. It lacks the courage of its convictions, assuming it even has any convictions left.

I thought that freedom to choose was a cardinal Liberal Party belief that set it apart from the Conservatives, but no. I can criticize the Conservatives, but I will say one thing about them: We know where they stand and why, so we are able to position ourselves accordingly. As for the Liberals, there is no way of knowing what they think. They are dilettantes.

How can they be so unconcerned when it comes to an issue like this, an issue of human suffering? What are the Liberals waiting for? I can answer that question. What were the Conservatives waiting for in 2015, when the Carter decision forced Parliament to take a stand and an extension had to be sought? This Parliament has never been able to deal with the MAID issue except under a court injunction. The court had to order the government to change the law and the Criminal Code. Parliament has never taken the lead or even listened to patients and the public. Since 87% to 90% of Quebeckers support advance requests, it seems to me we should be moving forward.

Why is there a problem today? There is a problem because the Canadian Medical Protective Association has always said that physicians will be protected so long as they follow the most restrictive law. At certain times, Quebec had the most restrictive law, after the passage of Bill C‑7 and Bill C‑14. In Canada, there is no law like Quebec's. Quebec applies the Criminal Code and the regulations that explain how to proceed. Quebec ended up having to ensure that people like Ms. Gladu and Mr. Truchon could not access MAID. Bill C‑7 would have allowed this, so Quebec had to tweak its law.

I am appealing to people's sense of duty and humanity. I hope that my colleagues will set aside government paternalism and get on the same page as the people of Quebec and Canada. I suggest that the government take Bill C‑390 and make it a government bill.

Today, the government is claiming that a national conversation is needed. I thought that forming a special joint committee of senators and members from both chambers in a parliamentary democracy gave those committee members the standing to make recommendations that reflect what the public thinks.

I look forward to seeing what my colleagues have to say during this debate. I invite the government and the Prime Minister to quickly do their homework so they can get up to date on this file, allow advance requests and amend the Criminal Code to harmonize it with what is happening on the ground and eliminate any legal confusion.

Government Business No. 39—Proceedings on Bill C-64

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I listened attentively to what the health minister was saying, so I am glad to be the first person to rise on my side to maybe provide a rebuttal and also to reset the debate, because the debate is not directly about Bill C-64; it is about a programming motion.

When I listened to the minister's speech, I also had the time to compare it to his speech that he gave at second reading. The same three anecdotes he raised today were raised then. Two of the three are completely misleading, and one was a very personal experience of his that he raised, which is his right as a member and a minister.

However, this is about a programming motion that would guillotine debate in the House. It would order a committee of the House to basically consider a bill within 10 hours, a bill that would have profound impact on the structure of Canada's health care systems, plural because they are systems. Quebec has a different system than Alberta, than British Columbia, than Saskatchewan and than other provinces in Canada.

We know from much research that has already been done by CIHI, The Conference Board of Canada, Statistics Canada, and CLHIA, which is the life insurance trade association, that 97.2% of Canadians already have access or are eligible for access to an insurance benefit plan of some sort. I know that in my home province, we have Blue Cross, which is usually the insurer of last resort that provides a lot of the services that the minister talked about.

The worst part of all is that we would be programming a committee of the House to study what essentially amounts to a pamphlet of legislation. The minister talked about finding common ground and solutions. I have also heard other members of Parliament talk about how important committee work is to them. Now we would basically be guillotining and gag ordering a specific committee of the House, the Standing Committee on Health, to do its work in 10 hours.

That is why I asked a question for the health minister on why he felt the need to exclude himself from having to come to testify before the health committee. One would think that he would put himself before the members at committee and answer all of their questions on the reasoning behind C-64 and the wisdom of it, because it is not a national pharmacare plan. That is not what it would do. It would cover two very small areas of medicine.

I will note that in the minister's second reading speech about Bill C-64, he had all of one sentence devoted to rare disease drugs and rare disease patients, typically the source of the most expensive therapies, the most expensive drugs, on an individual basis, not on a broad basis. Typically most drug plans in the provinces, whether private or public, spend the most on things like the very basic medication for infections. Medications like amoxicillin or penicillin and variations thereof are the ones that are quite expensive because people get a lot of infections, so it it just a question of volume in those situations.

There is a lot of medication out there that is expensive because it is brand new; it is coming onto the market for the first time. Recently I learned about a new oncology drug that is going to be made available in the United States, but it is cutting-edge, specialized medicine made for the individual patient. The drug comes with a few tens of thousands of dollars of cost associated with its delivery. There will be some cancer centres in Canada that will not be able to have it available for patients, but it will be available to other patients in other parts of Canada. Oncology drugs would not be covered under the plan.

There would actually be nothing covered in the plan except for those two areas of medications, which are very specific ones as well. Like I said, there would be nothing for rare disease patients. The minister talked, in his original speech at second reading, though not today, about the $1.5 billion being devoted to rare disease drugs. That announcement was made in 2019, yet only now has some of the spending gone out, not to cover drug costs but to cover things like the creation of rare disease registries to get foundations, universities and private organizations to start up a rare disease registry specific to one individual drug.

There is often a problem in how the Liberals propose things. They say something, make claims, and then it takes years before anything actually happens. As an example, in 2019 there was an announcement. In 2024, still not a single rare disease drug has been covered by the $1.5 billion. It took five years of waiting. Rare disease patients cannot wait. In fact it was the Liberal government that cancelled the original rare disease strategy in 2016. At that time, the president of the Canadian Organizations for Rare Disorders, Durhane Wong-Rieger, said that it was the kiss of death for patients with rare diseases.

She is a literal ball of energy and an amazing woman, an amazing advocate for patients with rare diseases. This was in 2016. It took the government three years just to announce funding and five years after that to roll out a single dollar. Now the government wants to convince us that it needs to expedite Bill C-64 by programming and ordering the Standing Committee on Health to consider certain things but not others.

I will go through the programming motion, since the minister did not feel the need to even explain why this was necessary. He repeated, essentially, his second reading speech on why we need to expedite this so quickly. There were three days of debate in the House before there was a vote at the Senate and in the Standing Committee on Health. I looked at the work the Standing Committee on Health had done. It did not even have the chance to consider the bill. That is how quickly the government is now programming what is going on.

The first line of this programming motion is very simple: “the committee shall have the first priority for the use of House resources for the committee meetings”. It seems quite reasonable that it would be given first right to interpretation, rooms and catering services if the committee is expected to sit for hours and hours on end. I guess a programming motion would have to have that in it.

The second part is, “the committee shall meet between 3:30 p.m. and 8:30 p.m. on the two further sitting days following the adoption of this order to gather evidence from witnesses, provided that any meeting on a Friday may start at 12:00 p.m. for a duration of not more than five hours”. Essentially, that is saying there will be two more meetings of the Standing Committee on Health and 10 hours of testimony. There are countless members in the House who will say that, during consideration of a bill, witnesses will testify, explain an idea or perhaps a missing amendment or particular line in a bill between the French and the English, which happens on a fairly regular basis. They either do not match, do not make sense or there could be more added to a bill to clarify or constrain a bill. Ten hours is simply not enough for a bill that would have such a substantive impact.

According to the health minister, the Liberals are going to celebrate a bill with such a substantive and profound impact as some great achievement. I do not believe that. I believe this is a pamphlet. This is not national pharmacare. There is no spending associated with this bill. Every one of my constituents back home knows there is no spending associated with this bill. If the Liberals keep ramming the bill through at this pace and it passes through the Senate at some point in the future, not one single drug will be paid for through this legislation because there are no dollars associated with it. There is no, what we call, ministerial warrant from the Minister of Finance connected to this bill. There will be no medication paid for through this particular bill. That is why I do not understand why this programming motion is of such necessity when the committee has not even had a chance to consider it.

I understand perhaps it would be easier to tell Conservatives, members of the Bloc and independent members that they are slowing down the committee's work, that they are not allowing the committee to proceed with witness testimony or consider the contents of the bill, but that has not even happened yet. We have not even had a chance to invite witnesses to explain to us their views on the contents of the bill.

When the minister talks about finding common ground and solutions, he accuses the Conservatives of being against it. Of course we are against it. We voted against the bill, but that doesn't mean we cannot improve an F product and make it maybe an F+ product. I know that is not a grade in universities or colleges in Canada, but we can always make something terrible a little less terrible. This is essentially, like I said, a pamphlet. For me, it was easier to vote against it because I saw nothing for patients with rare diseases. That is not a surprise to anyone in this place.

I remember the original debate on an NDP private member's bill, which I believe was Bill C-340, if memory serves. It was on national pharmacare. At least the title was on national pharmacare, not the contents. It was put forward by the member for Vancouver Kingsway. He and I debated it for most of the day. I was all about access for patients with rare diseases, and I said that was why I could not vote for that bill at the time.

It is not a big surprise to many members of the House and members of the other place that I would be against a bill that has has a title of national pharmacare, but would not do anything for patients with rare diseases. Members know of a personal anecdote I have mentioned many times in the House. I have three living kids with a rare disease called Alport syndrome. One daughter passed away very young, at 39 days old, with a different rare disease. I always joke with my friends in the rare disease community that I am due. I should probably play the lottery as I would I have a decent chance of winning because both of those conditions are rare.

In the case of my living kids, it is a rare disease of the kidneys, CKD, a chronic kidney condition. In the case of my youngest daughter who passed away, she had Patau syndrome, which is a chromosomal condition and very, very rare.

If one knows a child with Down syndrome, one should hug them. They are very special little kids. My daughter had a condition that is considered much worse than Down's. Down's is survivable. There are a lot of very sweet kids who live with Down syndrome, and their families are made incredibly happy by them because they are sweet into the teen years, into their twenties, thirties and forties. One never has to go through those teenage years, as I am going through right now with one of my kids, where suddenly, as the dad, I know nothing and they know everything, which is okay. I will go through this three times in my life.

I will move on to the next part of the programming motion, which reads, “all amendments be submitted to the clerk of the committee by 4:00 p.m. on the second sitting day following the adoption of this order”.

We are quite fortunate there was unlimited time provided, I believe, for the first two speakers on a programming motion. Perhaps members are surprised I would rise on this, but I intend to use this time to explain why I do not like the programming motion and the defects with Bill C-64, and to remind the minister about what the summary of his own legislation says that it does, because it is the complete opposite of what the minister just explained to the House. It is the complete opposite from his second reading speech as well, so members can stay tuned for that part.

On these amendments, we are fortunate because we have a constituency week coming up. I can guarantee many of us will be sitting down and working with patient advocacy groups. We will be going to our stakeholder groups and meeting with our constituents. I have a few who have emailed me on this subject. I will be finding useful amendments to this bill that would improve it in my eyes and in the eyes of my constituents. We have the time.

Had we had a sitting week coming up, had there not been unlimited time for the first speaker on the official opposition side, we could have been rushed to provide amendments by 4 p.m. after the first day. That is an incredibly low amount of time considering this first came to the House February 29 and then the last vote was on April 16 before it was sent to the committee.

Doing a programming motion like this, or a gag order to the committee, is wrong. I do not agree with programming motions. I believe I voted against nearly all of them that ever came through the House. I believe the health minister was also the House leader at one point when Motion No. 16 was being moved through the House. There was also a previous one, and I believe it was a member for Waterloo who moved Motion No. 6, which would have programmed how committees work in the Standing Orders forevermore for the Houses.

I cannot base our opposition or our support for any particular motions and programming motions on good faith coming from that side because I simply do not believe the cabinet, the front-benchers. I do not believe them. There are many good-hearted backbenchers in the Liberal benches. They are easier to work with, I find, than those on the front bench. The front bench I just do not trust. I do not trust the front-benchers to do the right thing for Canadians. In fact, Canadians do not trust them. If we look at the polls, there is about a 20-point disparity, depending on which poll we consider, between what the government is polling at and what the official opposition is polling at.

I will move on to the next point, which reads, “amendments filed by independent members shall be deemed to have been proposed during the clause-by clause consideration of the bill”. I actually do not have a problem with that. Independent members should be treated like every other member of the House, especially during considerations of bills.

Now comes the next one, which gets gets quite technical:

the committee shall meet at 3:30 p.m., on the third sitting day following the adoption of this order to consider the bill at clause-by-clause, or 12:00 p.m. if on a Friday, and if the committee has not completed the clause-by-clause consideration of the bill by 8:30 p.m., or 5:00 p.m. if on a Friday, all remaining amendments submitted to the committee shall be deemed moved, the Chair shall put the question, forthwith and successively without further debate on all remaining clauses, amendments submitted to the committee as well as each and every question necessary to dispose of the clause-by-clause consideration of the bill, and the committee shall not adjourn the meeting until it has disposed of the bill...

This means that, once the 10 hours of testimony are done, once that particular portion of the committee's work is done, every single amendment has to be voted on immediately, with no debate for amendments. In those 10 hours, if witness testimony takes five or six or seven hours, we then have a few hours left over to consider and debate amendments. We could not even persuade the other side of the wisdom of the amendment. This is so profoundly wrong. I see this programming motion all the time when it comes to omnibus budget bills.

I will remind the House that the Liberal platforms in 2015 and 2019 promised not to do omnibus budget bills, yet they have done them repeatedly, over and over again. In fact, in Liberal budget 2023, they had section changes to clauses 500 to 504 on natural health products. That has nothing to do with the budget. There are no spending items related to it, but it was a regulatory expansion to apply rules for pharmaceuticals directly onto natural health products.

It caught a lot of people by surprise, including myself, that in a budget bill, which sometimes has hundreds of pages, one would do such a thing. They basically clip what they usually do at the finance committee, and now they have dropped it and ordered the Standing Committee on Health to do it in one particular way, in their way, their preferred way, with no debate on any amendments.

Why should one allow backbenchers from any of our political parties to freely consider the judgment and the argument being made by another member of another political party, individually or on behalf of their political movement, on the wisdom of a particular amendment to a government bill? I know, it would be shocking to even have that consideration.

It would be even more shocking for some members of the government benches to know that I have voted for government amendments at committee. I know. I hear “shame” from my side of the benches, but it happens. Sometimes they have a good idea. I am willing to consider good ideas. I am willing to. I have been on several committees over my time, from foreign affairs to finance to the Standing Joint Committee for the Scrutiny of Regulations. I am on the immigration committee and the Canada-China committee now, the select committee. I will vote for reasonable amendments. I will even talk to my own side to try to convince them if there is a reasonable, logical amendment that makes sense. Sometimes there is an argument made by a member of another party that actually makes sense. This section prevents that. There will be no debate on amendments. One is just supposed to vote on them.

Of course, what will happen is that there will be a question of having a recorded division on every single one of those votes. This means the committee will continue, likely, late into an evening, because it is basically programmed. To demonstrate that this is wrong and should not be done, I am fairly sure that there will be members of the committee who will want a recorded division on every single item so that we can go back to it later with our errors and mistakes and illogical situations that arise because two sections perhaps conflict with each other. This type of amendment process, clause by clause, is incredibly important, and we now will not be allowed to be given this opportunity.

The sixth portion of this guillotine gag order on the Standing Committee on Health says:

a member of the committee may report the bill to the House by depositing it with the Clerk of the House, who shall notify the House leaders of the recognized parties and independent members, and if the House stands adjourned, the report shall be deemed to have been duly presented to the House during the previous sitting for the purpose of Standing Order 76.1(1)

This is a fairly reasonable amendment that is often provided by members in other committees to make sure that, when reporting on a bill, the House leaders are informed, typically to go on the Notice Paper. I do not have a direct issue with this particular portion, apart from the fact that this is a programming motion, a gag order, that is going to guillotine a committee of the House without that committee even having had the chance to consider a bill.

The next section is section (b). It says:

not more than five hours shall be allotted to the consideration of the bill at report stage, and at the expiry of the time provided for the consideration of the said stage of the bill, or when no member rises to speak, whichever is earlier, any proceedings before the House shall be interrupted, and in turn every question necessary for the disposal of the said stage of the bill shall be put forthwith and successively, without further debate or amendment, and, if a recorded division is requested, the vote shall not be deferred...

It continues. There is another one, but I am going to stop right here. This essentially means that, when amendments come back from committee, they are sometimes ruled out of order. They cannot be considered at committee but they can be considered by the House because the House has control of its committees, and the House can decide whether certain amendments can be voted on. Those are typically then submitted to the Speaker.

This essentially says that this process will also be guillotined after five hours. I know they love gag orders. I know they love to guillotine debate. My hope is, too, that during this debate on the programming motion, they do not gag order the gag order. I would hate to see that. It would be like a double gagging of the orders of the House and really limiting debate.

They have done it before. They have done it on Bill C-7 and Bill C-14, the two medical assistance in dying bills. At different stages of those bill, they both programmed and then shut down debate on them. I have seen, plenty of times, allocation motions being moved by cabinet to force bills through the process on matters of conscience.

It is not as if they are technical bills where perhaps there is timeline the Liberals need to reach and where, for the proper administration of government, they can perhaps make an argument they can stand on, but for matters of conscience, to guillotine debate is wrong. In this particular case, I would say that this is not a matter of conscience. I think this is about administration of government services and what the contents of the bill are actually about versus what they are not about. When the Liberals impose a guillotine with time allocation and force the closure of debate, the major disadvantage to Canadians is that they cannot prepare themselves. They cannot organize themselves when they are opposed to particular ideas and when they want to ask questions like, “Why is my rare disease, my health condition or MS not covered in this bill? Why is diabetes covered?”

I know a lot of diabetics, and I am not picking on them directly. I am just asking a simple question. The most common rare disease is multiple sclerosis, or MS. A lot of people in my family have it, as well as friends, colleagues and co-workers. There are spouses of members on this side who have it. Therefore, why is that particular condition, and its medication, which is expensive medication, not in this particular piece of legislation?

It is a choice the government made, so why can we not debate that choice the government has made for those two particular conditions and the medications associated with them? If they are being covered, why not others? There are so many other types of medications, such as the most common ones: penicillin, amoxicillin and all the variations of the “-cillins”, because there are so many of them. Why are they not covered in this particular piece of legislation?

On this programming motion, should we put forward such an amendment to be considered at committee? If it is deemed non-votable at committee, why can it not be considered at report stage?

I guess I will only get through the programming motions, and I will have to come back later to finish talking about Bill C-64 and some of the things the minister said, as well as my concerns with the PMPRB, CADTH, pCPA and the entire architecture of drug approval in Canada.

The motion reads, “not more than one sitting day shall be allotted to the consideration of the bill at the third reading stage, and 15 minutes before the expiry of the time provided for Government Orders”, and it goes on like that, which basically means that there will be one day for final speeches, and then it will be done and sent to the other place. It is wrong to ram through a bill in this method, with bad faith being shown by the health minister, claiming that we were opposing it and not willing to consider things, when he has never bothered to listen.

Criminal Code

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, we have heard that a lot in this debate. We all want to be on the side of the angels. We all want to improve socio-economic conditions. The expert report does take structural vulnerabilities into account, and no assessor is authorized to grant a request for medical assistance in dying if there is any possibility that the request came about because of a structural vulnerability.

I paid close attention to my colleague's speech. Judging from the examples he gave, I gather he was in favour of Bill C‑14 for cases involving reasonably foreseeable death, but that he is against Bill C‑7 for people suffering from an incurable degenerative disease who are forced to cut their life short by suicide because their suffering has become intolerable. If Bill C‑7 is implemented, those people will be able to live until they reach the threshold of what they feel is tolerable.

Did I understand correctly that my colleague is against Bill C‑7 as it relates to degenerative diseases? I am curious, and I would like him to answer this question. He talked about it in his speech.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I am glad to be joining debate on Bill C-62. Off the top, I will mention that I will be voting for it. Like the shadow minister for justice on the Conservative side said, this is about protecting the vulnerable. Though the federal government has dropped the ball in this latest iteration of its legislation, these three years, I hope, will be taken to basically fix the mistakes that were made all the way back to Bill C-14. I want to talk a little about what brought us to this moment, and then refer to some constituents of mine who have emailed me over the last few months on the issue of assisted suicide.

I will also mention that I am sharing my time with the member for Mission—Matsqui—Fraser Canyon. I am sure he will add more to this debate.

To go back to the beginning, not too far to the beginning because I could get into Genesis, the Carter decision is what kicked off multiple debates that I have now been a part of. I have now seen this debate go from Bill C-14 to Bill C-7 to Bill C-62, and the attempts by my hon. colleague from Abbotsford, who, I think, tried to do right by vulnerable Canadians all across Canada to make sure that we would not see an expansion of the MAID provisions to those who are still suffering with mental health conditions.

The great thing about Hansard is that I was able to go all the way back and review what I had said on Bill C-14. I spent quite a bit of time complaining that the reasonably foreseeable clause would be knocked down by a court. It was knocked down by a court in the Truchon decision, because all our deaths are reasonably foreseeable; that is what living is all about. At the time, I had said that all of us who are born are born with one foot in our grave. One is assured one will die; one does not know just what it is, but it is reasonably foreseeable. I am just repeating it now. I know that it is morbid, but it is the truth. A lot of what we are dealing with here are issues of life and death and how one's death will happen. Therefore, at the time, this reasonably foreseeable clause would get knocked down, and it was knocked down in the Truchon decision.

My issues, just generally, are that, in a perfect world, this would not be necessary because people would not suffer. However, because this world is not perfect, people do suffer. People suffer in deep and different ways. Members know that I had a disabled daughter who passed away a few years ago. Had she lived longer, and I know at least one little girl in Calgary who has lived much longer with the same conditions my daughter had, she would be one of those vulnerable Canadians who would be facing the possibility that her physician, her specialist, might push for and might offer MAID.

I say “offer MAID”, but it seems so weird to say “offer MAID”, to offer something that I do not consider to be a medical service and to rush one's death sooner. Although we all die, as I said many Parliaments ago, the act of dying is not one that one does alone; it is done as a family, as a group of friends and with those loved ones around.

It is not something that happens in solitude. There are others who will miss one when one is gone. I know that it is difficult in a moment of suffering and a moment of great pain, or chronic pain, to believe it, to know it. A lot of the emails, the correspondence and the meetings I have had were with people who are worried about the assisted suicide MAID provisions, which the government has ineffectually dealt with through successive pieces of legislation. I think it was a grave error not to appeal the Truchon decision. I really do. I think it was a mistake. I said it to constituents at the time.

I have a Yiddish proverb, because I always do. They are great proverbs, and everybody should live by them and should know more of them. I just wish I could pronounce them in Yiddish: The truth never dies, but it is made to live as a beggar. This legislation is a beggar. This legislation should have been a permanent fix to the issues.

I think that Conservatives have suggested, both in committee and outside of committee, what some of those fixes would be. Although I disagree with an acronym, I will use RFND, reasonably foreseeable natural death. It should be limited to those who are terminally ill, where their death is foreseeable within the next six months, where there is a prognosis from a medical professional saying that one will indeed pass away.

For those most terrible conditions, I am thinking of a lot of cancers. My grandfather passed away from brain cancer in Canada, which brought my family to Canada. His death was very much reasonably foreseeable when it was terminal. There are others who have mental health conditions, which are caused by a physical condition. The mental health condition alone should not be the reason to seek assisted suicide.

Different Conservatives have mentioned, and I very much agree with this, that patients should be the ones requesting it. These are all things the government could have legislated into law. These are things that experts have said, and I want to read some of what the experts said in different committees.

Professor Trudo Lemmens and Mary Shariff persuasively rebutted a bunch of arguments that were made in Truchon. They noted again that reasonably foreseeable natural death applied to “all” persons, “not only to persons with disabilities”. “The judge in Truchon failed to appreciate how such a restriction reflects a constitutional duty to protect the equal value of the lives of all Canadians.”

I have read the Carter decision twice now. As many in the House know, this is something I take pride in saying that I am not a lawyer. I am not burdened with a legal education. I know the member for Fundy Royal is disappointed and that the member for St. Albert—Edmonton will be disappointed too, so I come to this as a layperson. Even the Carter decision did not say he had a right to die. It goes back to this idea, like I have said, that all of our deaths are reasonably foreseeable. It will happen; it is unavoidable in life.

These two experts said that the judge in Truchon made a mistake. This concept, this expertise, was then repeated in observations made by 72 disability rights organizations that penned a letter to the then justice minister. They said that reasonably foreseeable natural deaths are the ones where there is terminal illness that is coming up very quickly, and that this idea is an equalizing effect, guaranteeing a common thread among persons accessing MAID, assisted suicide, namely that they are dying within a very short time window. That is how I think this legislation should work. I am not saying there should be no MAID.

The Carter decision stands as a Supreme Court decision in Canada, so there has to be a provision of it in a method. It should be rare and should be restricted to the very few people for whom it was originally intended. I feel that Bill C-14 to Bill C-7 to the situation we are in today do not address that. That is why we have this legislation that is a beggar. It is not in the original form that it should be. The truth lies in abiding by what Carter decided.

Another one reads, “From a disability rights perspective, there is a grave concern that, if assisted dying is made available...regardless of whether they are close to death, a social assumption might follow (or be subtly reinforced) that it is better to be dead than to live with a disability.” That is a terrible message to send to persons with disabilities. I am thinking of my daughter, had she lived. That would have been a terrible message to send to her.

All three of my living kids have a chronic kidney condition. My boys will likely need a kidney transplants. What a terrible thing to tell them, that they are a burden on the medical situation and that maybe they should seek faster death. Is that what specialists are going to tell them when they are adults? I will not be in the room, but they will be in the room. Will that be pushed onto them? For those who are on dialysis, it is hard on their bodies to go three to four days a week to get dialysis in a hospital setting. I am not speaking of peritoneal dialysis that can be done in the home.

There have been lots of experts. The member for Fundy Royal explained a lot of what has been said on the issue. The government keeps erring in the wrong direction with more expansive legislation to allow more people to access something that was not the original intention of Carter. We should abide by Carter, as I mentioned before.

I have had constituents write to me. I just want to make sure that I read some of their thoughts into the record. Leanna wrote, “Please Halt the expansion of MAID to include those facing mental illness.” Catherine wrote, “As a parent who has seen my own children experience mental health challenges while in their teen years and early twenties, I am writing to express my deep concern about people with mental illness alone becoming eligible for medical assistance in dying. The move towards this will put countless vulnerable people at risk.”

Joe, in my riding, is a regular writer. I respond to most of his emails. I will send this to Joe just to make sure he knows I read his emails. His second and third points read, “By offering MAID for mental illness governments may put less money into treating mental illness.... Canadians may wish for MAID because of despair. They have not have been offered treatment for their mental illness.”

Cameron talked about a friend of his who is a nurse working in a mental health unit in Calgary. Mental health for him is all about seeing the intrinsic value of every human being, as celebrating the person not for what they contribute but for the beauty of their existence. He feels that once we stop seeing the dignity of one person, we will doubt our own worth and validity.

I know my time is running short, so I will not belabour this. I have heard comments from some members of the House who have tried to impugn a person's faith, religion or philosophical affiliations with whatever beliefs; although, all of us come to the House with our different beliefs. Some of them are sacred. Some of them are secular. It really does not matter where they come from, but all of us try to ascribe value to life, what that life is and what autonomy should be like.

To those members, I note that I did abstain from one vote that was specifically on advance directives because I have a constituent, Jim, who communicated with me over email that he and his spouse saw the experience of his mother, who passed away from Alzheimer's, and how terrible it was. In situations like that, it is incumbent upon the government to find a way to meet the requirements of the original Carter decision so that Jim and his spouse, when that time comes, can have their wishes met.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, we just witnessed a great NDP-Conservative coalition.

The member is reiterating the Conservatives' argument to the effect that the ruling in Gladu and Truchon was not challenged before the Supreme Court. However, the reason why it was not challenged before the Supreme Court is that people were suffering and Ms. Gladu and Mr. Truchon deserved to have relief. This was based on the Carter decision. However, the NDP voted against Bill C-14, which did not go far enough. I do not know why the member is being so inconsistent today.

I would like to know whether the member is aware that, basically, his party is trying hard not to say that it lacks courage, that it is backing down when it comes to mental illness and that it is throwing the ball back into the court of the Conservatives who, as they announced, are going to do away with all of this.

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I am thankful for the opportunity to speak about Bill C-62 and the extremely important issue of medical assistance in dying, or MAID, and mental illness.

I think all members can agree that this is a highly complex, quite sensitive and emotional issue, that raises divergent and deeply held views from the medical community, experts and the public at large. The questions of whether, how and when to expand eligibility for MAID to persons whose sole underlying medical condition is a mental illness are difficult; they do not have easy answers.

The federal government believes that eligibility for MAID should be expanded to such persons. However, such an expansion should not be rushed and should not occur before the health care system is ready to safely provide MAID in all cases where it is requested on mental illness grounds. This is why we have introduced Bill C-62, which proposes to extend the temporary mental illness exclusion by three years, until March 17, 2027. The bill also includes a provision requiring a parliamentary review prior to that date.

As members will recall, in 2015, the Supreme Court of Canada concluded in the Carter case that the Criminal Code’s absolute prohibition on physician-assisted death was unconstitutional. The Supreme Court held that physician-assisted dying must be permitted in some circumstances, namely, for competent adults who clearly consent to the termination of life and who have a grievous and irremediable medical condition. This decision led to the legalization of MAID in Canada one year later, in 2016, through Parliament’s enactment of former Bill C-14. Our original MAID law limited eligibility for MAID to competent adults with an eligible medical condition whose natural death was reasonably foreseeable. Our MAID framework was added to the Criminal Code and was made up of a stringent set of eligibility criteria, as well as procedural safeguards to prevent error and abuse in the provision of MAID.

A few years later, the “reasonable foreseeability of natural death” eligibility criterion was challenged in Quebec; in 2019, it was declared to be unconstitutional by the Superior Court of Quebec in the Truchon decision. As this was a trial-level decision, it was only applicable in Quebec. Nevertheless, the Attorney General of Canada did not appeal the decision; instead, the federal government made the policy decision to expand eligibility for MAID. This led to Parliament’s enactment of former Bill C-7 in 2021, which expanded eligibility for MAID to persons whose natural death is not reasonably foreseeable. This resulted in the removal of the eligibility criterion that a person’s death be reasonably foreseeable and the creation of two sets of procedural safeguards for the lawful provision of MAID.

The first track of safeguards applies to persons whose natural death is reasonably foreseeable; the second, more robust, track applies to persons whose natural death is not reasonably foreseeable. This second set of safeguards was created in recognition of the fact that requests for MAID by persons who are not at end of life are more complex. This is why a minimum of 90 days must be taken to assess a person for eligibility for MAID when their natural death is not reasonably foreseeable. This is not a reflection period; it is a minimum assessment period. This safeguard aims to respond to the additional challenges and concerns that may arise in the context of MAID assessments for persons whose natural death is not reasonably foreseeable. This includes whether the person’s suffering is caused by factors other than their medical condition, as well as whether there are ways of addressing their suffering other than through MAID.

This second set of safeguards also requires that two practitioners be satisfied that the person meets all the eligibility criteria, and if neither of them has expertise in the medical condition causing the person suffering, one of them must consult with a practitioner who does. Involving a practitioner with the relevant expertise aims to ensure that all treatment options are identified and explored.

Practitioners are also required to inform the person of available counselling services, mental health and disability support services, community services and palliative care; to offer them consultations with the relevant professionals; and to ensure that the person has given serious consideration to such alternative means to alleviate their suffering. Although this does not require a person to undertake treatments that may be unacceptable to them, it requires that they fully explore and weigh the risks and benefits of available treatment options.

Former Bill C-7, as originally introduced, permanently excluded eligibility for MAID on the basis of a mental illness alone. This was not because of the incorrect and harmful assumption that individuals who have a mental illness lack decision-making capacity or because of a failure to appreciate the severity of the suffering a mental illness can cause. Rather, this was done because of concerns about the inherent risks and complexities of permitting MAID for individuals who suffer solely from mental illness.

During its consideration of the bill, the Senate made an amendment that added a sunset provision that would repeal the mental illness exclusion 18 months later. The House of Commons accepted the amendment in principle, but changed the date of repeal to two years; in other words, the provision of MAID based on a mental illness alone was set to become lawful on March 17, 2023.

The decision to temporarily maintain the exclusion of eligibility was based on the recognition that additional study would be required to address the risks and complexities of permitting MAID in these circumstances. This is why the former bill also included a requirement for an independent expert review respecting recommended protocols, guidance and safeguards to apply to such requests for MAID.

Former Bill C-7 also required the creation of a joint parliamentary committee tasked with conducting a comprehensive review of the Criminal Code's MAID provisions and other MAID-related issues, including MAID and mental illness. The committee undertook this important work, and its interim report, which focused on MAID and mental illness, was tabled in June 2022. It urged the federal government to collaborate with regulators, professional associations, institutional committees and the provinces and territories to ensure that the recommendations of the expert panel were implemented in a timely manner.

The committee's second report was tabled in February 2023. The majority view expressed was that eligibility for MAID on the basis of a mental illness alone should be permitted. However, the final report also raised a key concern that more time was needed for standards to be developed and training to be undertaken before the law should permit a mental illness to ground a request for MAID. The federal government recognized the significant progress that had been made by the provinces and territories, stakeholders and the medical community in preparing for the expansion. However, it ultimately concluded more time was needed.

This is why we introduced Bill C-39, and Parliament enacted it. It extended the exclusion by one year, until March 17, 2024. This extension aimed to provide additional time for the dissemination and uptake of key resources by the medical and nursing communities. We thought it essential to prepare for the safe assessment and provision of MAID in all cases where a mental illness grounds a request for MAID. The committee expressed support for the extension in its second report.

I want to take a moment to recognize the work that the federal government has done during this extension to support the fulfillment of some of the expert panel’s recommendations. For instance, we amended the regulations for the monitoring of MAID last year to ensure comprehensive data collection and reporting. Such changes allow for data collection related to race, indigenous identity and disability of persons requesting MAID. These changes came into force in January 2023, and the first set of data will be captured in Health Canada’s 2024 annual report on MAID.

Moreover, Health Canada convened an independent MAID practice standards task group to develop a practice standard for MAID. In March 2023, the model MAID practice standard and supporting documents that provide guidance to support complex MAID assessments were released. Finally, Health Canada supported the Canadian Association of MAiD Assessors and Providers in the development of a Canadian MAID curriculum, which was launched in September 2023.

In Canada, certain aspects of MAID fall under federal jurisdiction and others fall under provincial and territorial jurisdiction. The federal government is responsible for the criminal law aspect, whereas the provinces and territories are responsible for the implementation of MAID within their health care delivery systems. Impressive progress has been made in preparing for the expansion by the March 2024 deadline. However, the provinces and territories have all expressed that they are not yet ready. For this reason, we are proposing to extend the temporary mental illness exclusion for another three years, until March 17, 2027.

The extension would allow more time for the provinces and territories, and their partners, to prepare their health care systems by implementing regulatory guidance and developing additional resources for their medical and nurse practitioners. It would also provide more time for medical and nurse practitioners to become familiar with the available training and supports. Our ultimate goal is to help ensure that the necessary protections are in place to protect the interests of individuals who may seek MAID on the basis of a mental illness alone.

We believe that this issue should not be rushed. Eligibility for MAID should not be expanded until the health care system is ready to safely provide MAID in these complex circumstances. I urge all members to support the bill so our partners can get this right.

[Helen Long]

What we've heard is what we heard in testimony in terms of this issue. We're not clinicians, so we're not able to participate in all of those discussions, but it was certainly made very clear by the individuals representing the regulatory authorities in the provincial health authorities that they are ready and certainly that individual clinicians are ready.

When we look to Bill C-14 and the beginning of MAID, there was no time like this given for the provinces to be prepared in the way they are today. We are probably readier now than we've ever been to move ahead with MAID.

Government Business No. 34—Proceedings on Bill C-62

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

Madam Speaker, here we are again at the eleventh hour. The government has waited on something that it has to put in place; otherwise, on March 17, people whose only condition is a mental illness will be able to apply for medical assistance in dying.

The Liberals are not virgins in the parliamentary process. They understand very well that, typically, for a bill to go through three readings in the House and through committee meetings, and then go to the red chamber, where a similar number of readings and committee meetings take place, takes about 18 months. If there is goodwill among all parties and we agree, it may be six months. It is ludicrous to me that less than two months before the deadline, the government put forward this legislation. It is really putting a gun to the head of opposition members, because if we decide not to pass the bill, on March 17 people who suffer only from a mental illness will be able to receive medical assistance in dying.

I have a lot of compassion for people suffering from mental illness. In many cases, they have suicidal thoughts and are not full of hope for the future, so it is easy for them to say in despair that there is no way out. However, a lot of people get better and go on to live full lives. They are not in a place where they can really take that decision.

It is not the first time the government has waited until the last minute. I remember when the medical assistance in dying legislation in Bill C-14 was introduced, there was a lot of pressure for us to get along and pass the bill. I would have more confidence if it were not for the fact that the government continually brings forward legislation that is unconstitutional. Then it goes through the courts to the Supreme Court and, like Bill C-69, is declared unconstitutional. The bill for the welfare of indigenous children was also declared unconstitutional. It is our job to give due process to bills and to make sure they are a good idea, rather than just rubber-stamping them and passing them along.

I do not want to have the consequence that people who are mentally ill would receive MAID if we do not pass this legislation in time, but we have no guarantee that the Senate is not going to delay the bill. There was a question for the member who gave the last speech about how the Senate may choose to block the bill. That would delay it even further and we would not make the timeline. It is not a sure thing that the bill is going to get across the line.

We have to look back to the Carter decision. We spent a lot of time talking about what the response would be, and it was the court's order that the criteria be an irremediable condition with imminent death. That is the path we started on. I was very concerned at the time because every recommendation from the special committee that studied this said that without good-quality palliative care, one really does not have a choice.

At that point in time, I found out that only 30% of Canadians had access to palliative care. That is what prompted me to bring forward my private member's bill to get consistent access to palliative care for all Canadians. That bill unanimously passed in the House. Since then, we have doubled access, from 30% to almost 60%, which is a great thing, but there is more to go. If people do not have good-quality palliative care, they really do not have a real choice.

The government needs to refocus itself. I saw in the report that after five years of progress on palliative care, there are still identified gaps. The government needs to pursue that with passion and aggressiveness because that is the answer. If people have good-quality palliative care, they do not choose medical assistance in dying, and that applies everywhere. I met today with some of the representatives from palliative care, and they informed me that when people go to hospice, nine out of 10 of them are asking for medical assistance in dying, but very few of them actually take advantage of it once they experience palliative care.

Why are nine out of 10 of them asking for medical assistance in dying? It is because the doctors are recommending it, and I do not have any confidence that the safeguards that were supposed to be in place are actually being adhered to. A doctor from the Liberal Party who spoke before me cited five examples that he is aware of where clearly people did not meet the conditions but were given medical assistance in dying.

Canada is on a very slippery slope. If we look at the history of countries that have implemented medical assistance in dying, the Netherlands was sort of at the forefront, and it took a while for it to experience a rise in the percentage of people who were dying from medical assistance in dying. However, last year in Canada, 4% of people who died did so by medical assistance in dying. We set a world record. We are top of the charts on killing people with medical assistance in dying.

I think this is absolutely the wrong direction, so to broaden medical assistance in dying to include people who are mentally ill is absolutely ill-informed, at the very least. I would say, without being insensitive, that people who are mentally ill are actually able to kill themselves. Sadly, in their despair, many of them are taking their lives every day. They do not need the government to enable them.

The Conservatives warned the government, when this ill-advised amendment came from the Senate, that this would happen. Instead of realizing the mistake and backing off, the Liberal government is kicking the can down the road for another three years, where the next government will deal with it, instead of recognizing that this is not a good idea.

Doctors are saying that 50% of the time they cannot even identify whether somebody's condition, when they suffer from mental illness, is irremediable. If that is the case, then half of the time, they are going to kill someone who might have gotten better. This is a totally bad idea. The government should stand up, say it realizes the mistake it has made and that it should have introduced legislation to eliminate that mistake. However, that is not where we are today. Today, here we are: If we do not make a decision and pass the bill in a hurry, people with mental illness are going to start dying from MAID on March 17.

I would say that there is a lot scope creep that has been suggested. Where do we stop? There has been a suggestion that if we approve those with mental illness, maybe minors should be added, or maybe the option of advance directive should be added. It looks like the solution to all of these things is death. We hear that homeless people are requesting medical assistance in dying. We hear that veterans are being advised to take medical assistance in dying. This is just scope creep and broadening who is dying in this way, without having proper controls in place. I do not think that is acceptable.

One of the things that has been totally ignored is the conscience rights of doctors. The federal government will always say it did not preclude that in its bill, but the fact is that provinces are forcing medical doctors and nurses to participate, even if it is against their religion and their conscience rights, and the federal government has done nothing to correct that situation. That is a problem.

The other thing I would say is that in the creep that is happening, they have created an express lane for the disabled. It is disgusting to the disabled community and disgusting to me that they would say that if someone is disabled, they should go to the front of the line. For the vulnerable, the mentally ill and the disabled, we need to protect those people; we need to stand up for their rights and know that we can give them hope.

I do not agree with the way this was brought forward. I think the government should have appealed the Truchon decision. When Quebec decided this needed to happen, the government should have said no, that it had thought about it, studied it and spent a long time on it. It should have said it was going to appeal that decision, because what it brought in at the beginning was at least better than the scope creep we are seeing now.

I have talked about the many examples of things that are not good with the legislation. Obviously, I do not want to see anymore people die. I will definitely work with the government to see the legislation pass as speedily as possible, and I encourage it to use the same leverage it used on Bill C-234 to help its Liberal-appointed senators do what it wants. I hope it does the same on this bill and that it receives speedy passage, and that we do not have people with mental illness being killed by the government.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Madam Speaker, it is possible that my colleague misunderstood me. What I said in my speech was that I voted for Bill C-14 because it was a reasonable response to what had to be addressed, which was the Carter decision. The reasonable foreseeability of death was a problem clause, and I thought so at the time. I thought it was awkward and perhaps not the best way to put it, so it was not a shock to me that it ended up being challenged on that basis. I think my colleague may have been overestimating my enthusiasm for Bill C-14, but I did support it, because something had to be done.

However, this reckless expansion that came after the Senate amendments to Bill C-7 goes way beyond this. No court was calling upon Parliament or forcing Parliament to expand the eligibility of MAID to those whose sole underlying health condition is mental illness.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, my colleague is claiming that Bill C-14 resulted in good legislation with its reasonably foreseeable natural death criterion. However, that did not even address the Carter ruling, since Ms. Carter did not have a condition that made her terminally ill. The Supreme Court ordered Parliament to regulate situations like those of Ms. Carter and Ms. Taylor. Limiting medical assistance in dying to people who are terminally ill completely ignores people like Ms. Gladu and Mr. Truchon, who had to go to court to assert their constitutional right. People have had to go on hunger strikes to meet the reasonably foreseeable natural death criterion.

Is that what my colleague calls compassion?

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Speaker, the member for Salaberry—Suroît is a tough act to follow. This is not easy, because we all have someone in mind when we talk about this. We have all lost loved ones over the past few months and years. We all have gone through different experiences. Some people request medical assistance in dying, others do not, but one thing is certain: this is a very sensitive topic. It is with great humility and sensitivity that I rise today to speak to Bill C-62, an act to amend An Act to amend the Criminal Code (medical assistance in dying), no. 2, something we have been talking about for a long time.

We must act by considering the fact that, currently, the Government of Quebec's Bill 11 does not include non-neurocognitive mental disorders as being eligible for medical assistance in dying and that Quebec wants to fill the administrative void surrounding the federal government's position on the subject of mental disorders relative to neurocognitive disorders. Therefore, I am not here to repeat my whip's testimony. I am here to provide some background and talk about Quebec's specificities. I will close by going into more detail about the Bloc's position.

First, in 2014, Quebec passed the Act Respecting End-of-Life care after five years of consultations and of working together across party lines. I want to emphasize that the work was non-partisan. In 2015, the Supreme Court ruling in Carter indicated that some provisions of the Criminal Code that prohibited medical assistance in dying contravened the Canadian Charter of Rights and Freedoms. In 2016, the Liberal government passed Bill C-14, in response to Carter. In 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, who claimed that excluding people whose death was not reasonably foreseeable from eligibility for medical assistance in dying was discriminatory. As a result, the court ordered that federal and provincial laws be amended before December 18, 2020.

In 2021, after a pandemic-related delay, Parliament passed Bill C‑7, which created two pathways to medical assistance in dying: One for those whose death is reasonably foreseeable and one for those whose death is not reasonably foreseeable. Quebec simply chose to drop the end-of-life criterion. Bill C‑7 required that an expert panel be created to review MAID and mental illness. The Expert Panel on MAID and Mental Illness was formed in August 2021 and produced a final report containing 19 recommendations. Recognizing that the legislation was flawed and that issues related to medical assistance in dying remained unresolved, Bill C-7 created the Special Joint Committee on Medical Assistance in Dying, composed of members of the Senate and members of the House of Commons, which had a five-part mandate.

The joint committee tabled an interim report on June 22, 2022. There was not much time between the tabling of the joint committee's report, which was initially expected in 2022, and the March 17, 2023, deadline for excluding people from MAID for mental illness, so members postponed eligibility for one year to allow the committee to finish its work. The goal was to give the professions involved more time to develop standards of practice. At last, in February 2024, the joint committee produced its final report. The report contains only one recommendation. Bill C‑62 implements the report's recommendation by postponing eligibility for MAID MD-SUMC, for mental disorders, for three years and by forcing the creation of a joint committee one year before the report.

Sections 241.1 to 241.4 of the Criminal Code govern medical assistance in dying in Canada. What is more, under the law, the government is required to oversee the use of medical assistance in dying via the Regulations for the Monitoring of Medical Assistance in Dying. I am providing all of this background to illustrate that the government could have and should have taken action a long time ago.

Second, in Quebec, medical assistance in dying is governed by the Act Respecting End-of-Life Care. The activities surrounding medical assistance in dying are supervised by the select committee on end-of-life care. In June 2023, the National Assembly of Quebec passed Bill 11 to expand access to medical assistance in dying in Quebec and harmonize Quebec's legislation with the Criminal Code. There are some notable changes to Quebec's legislation. Minister Sonia Bélanger and her colleagues Roberge and Jolin‑Barette held a press conference on February 7 calling on the government to include a provision in the Criminal Code that would allow Quebec to move forward with advance requests, because, even though Quebec's legislation allows it, the Criminal Code does not.

Although doctors who choose to go ahead with advance requests are unlikely to be prosecuted by Quebec's attorney general, the risk of a civil lawsuit is still there, and that will make many doctors think twice about granting advance requests. Quebec's National Assembly has passed a unanimous motion demanding that the federal government legislate on the issue.

Third, the Bloc Québécois will vote for the bill on the condition that the postponement is for one year, not three. The Bloc Québécois believes that eligibility for people suffering from mental disorders must be postponed so that Quebec, the provinces and professional bodies can create a framework for their MAID practices. However, it should not be postponed indefinitely. The Bloc Québécois believes that postponing eligibility by three years will prolong the suffering of individuals who could be eligible for MAID and is contrary to their rights as guaranteed by the charters. The Bloc Québécois wishes to point out that the report of the Expert Panel on MAID and Mental Illness, as well as the Collège des médecins du Québec, emphasized that the safeguards—namely irremediability, severe physical or mental suffering, and free and informed consent—currently provided for in the Criminal Code are sufficient to allow access to MAID where mental disorder is the only underlying condition.

In our supplementary opinion attached to the report of the Special Joint Committee on Medical Assistance in Dying, the Bloc Québécois points out that, even though preparations on the ground for medical assistance in dying when a mental disorder is the sole underlying medical condition are not yet complete across Canada, this does not change the fact that several professional associations, including the Collège des médecins du Québec and the Association des médecins psychiatres du Québec, would still like it to be made available in the future.

The Bloc Québécois also acknowledges the requests made by several provinces to postpone eligibility. It should be noted that many countries have adopted policies on medical assistance in dying specifically for mental disorders.

The Bloc Québécois deplores the government's failure to be proactive and the Conservatives' obstruction on the issue of medical assistance in dying when a mental disorder is the sole underlying medical condition and on the issue of advance requests. We fear for the patients who will have to turn to the courts to assert their rights while also bearing the burden of their illness.

Finally, the Bloc Québécois condemns the fact that this bill does not distinguish between mental disorders and neurodegenerative diseases, such as Alzheimer's and Parkinson's. Quebec's law makes that distinction. It would allow people suffering from the latter category to access medical assistance in dying, as advocated by the Quebec government. In the Bloc's opinion, the social consensus on these illnesses is stronger, and it would have liked to see the Criminal Code brought into line with Quebec's end-of-life care law by allowing advance requests.

In his supplementary opinion on MAID, the member for Montcalm, whom I would like to congratulate for all his work on this issue, went into great detail on the reasons that justify MAID when a mental disorder is the sole underlying condition. The position of the Collège des médecins du Québec perfectly sums up the importance of allowing advance requests for medical assistance in dying, as well as medical assistance in dying when a mental disorder is the sole underlying condition. While admitting it needs more time to ensure its members are ready, the Collège des médecins du Québec has established five guidelines for assessing eligibility for medical assistance in dying.

In conclusion, the Bloc Québécois has a humanist view of medical assistance in dying that is grounded in philosophical principles and ethical arguments that reflect the evolution of Quebec society. Medical assistance in dying recognizes the right of individuals to choose for themselves, to determine the conditions for a healthy and dignified life. Medical advances allow us to sustain life, but that does not preclude the need and right of the individual to define what is an acceptable life. Section 1 of the Quebec Charter of Human Rights and Freedoms states that every human being has a “right to life, and to personal security, inviolability and freedom”.

Quebec society believes that the right to life includes the right to die. In that context, we need to see medical assistance in dying as a right that gives the individual the option of avoiding terminal suffering and medical paternalism in order to maintain their dignity. By allowing medical assistance in dying, we allow people to choose how, when and where they want to pass away.

Medical assistance in dying only makes sense if the person's free and informed consent is respected. The word “free” means voluntary and without constraint, and the word “informed” means with all the information needed to make such a decision. Meeting this condition is necessary for accessing medical assistance in dying.

The principles we stand for concerning medical assistance in dying are equally valid in cases of mental illness. Let us not forget that the possibility of access to MAID does not mean automatic eligibility. However, when the Quebec select committee was doing its work, it made a distinction between mental disorders and neurodegenerative diseases. The commission concluded that although there was no consensus on mental disorders, there was a consensus on neurodegenerative diseases. With that in mind, the Quebec government opened the door to advance requests. Advance requests allow an individual to determine the conditions under which MAID should be administered when they have lost the capacity to consent because of their illness.

In its second report, the Special Joint Committee on Medical Assistance in Dying expressed its support for advance requests. All parties, except the Conservatives, who are against any form of medical assistance in dying, voted in favour of the recommendations.

As a final point, the federal government therefore has no reason to drag its feet or to deny Quebec's request.

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

Madam Speaker, I appreciate the opportunity to speak to this. Having been in this place for all the debates we have had, I have been trying to figure out the best way to explain to Canadians, if there is an argument here, why it is not between Liberals and Conservatives, or between Greens and NDP and Conservatives and the Bloc. It has actually been, from the very beginning, a struggle for Parliament to actually deal with an issue we have been kicking down the road for too long.

I mentioned earlier in debate, as the member for Saanich—Gulf Islands, the quiet and extraordinary courage of a single woman, Sue Rodriguez, who took her irremediable medical condition of suffering all the way to the Supreme Court of Canada and was denied the opportunity for what is generally called death with dignity. She had the procedure illegally. Those who were with her at the time would have been subject to criminal penalty as well, including my friend Svend Robinson, who at the time was member of Parliament in a different party from a different place.

It was a very fraught time, and the issue of medical assistance in dying kept coming back to me from constituents who were heartbroken that their parents or loved ones had to go through suffering. Quite often people would say to me they would not let a family pet go through this kind of suffering so why do we allow our moms and our dads to go through this when there is no prospect they are going to recover.

This finally went back to the Supreme Court of Canada for a different decision that came out of the Carter case. The Carter case, back in 2015, said that refusing to allow someone the legal option to seek medical assistance from their doctor in a situation where their illness is terminal is really a violation of section 7 charter rights. I only mention this because that was also with a deadline. We have to take action on this; we cannot just leave the matter. The Supreme Court of Canada has said that this provision of the Criminal Code is actually a charter violation. That means one cannot let it just sit there anymore.

It would take too much time, and my colleagues will be relieved to know I will not go through this chapter and verse, but it is a tough, tough issue for parliamentarians. At the time, as we started debating the first iteration of allowing for death with dignity, in Bill C-14, our first Minister of Justice to deal with this was the very honourable Jody Wilson-Raybould. She had to struggle with this. Our Minister of Health at the time, also very honourable, Jane Philpott, was struggling with this.

It occurred to me as the debate went on that what we had in Canada on this issue was essentially a professional dispute. The lawyers in Canada wanted to make sure that the charter was respected. The doctors in Canada said they did not want to be asked to figure out what “irremediable” meant and were not exactly ready for that. Therefore, subsequent revisions kept happening because, after all, in our first attempt to get medical assistance in dying right, we did not allow for advance directives. Therefore, we had subsequent court cases where people who had terminal cancer could not access MAID because they decided they better ask for it now, which was maybe months before death would occur naturally and months before a doctor could say, “Okay, you're ready now. Nod.” One had to be able to physically sign; the day of, one had to confirm one's procedure.

Again, I better not go back through all of this, but essentially the professional views of doctors pleading with parliamentarians outweighed the lawyers dealing with parliamentarians to say that we were probably still going to have charter violations, but it is better that we listen to the doctors and that they are ready. All of this ended up taking us back to fixing medical assistance in dying again to try to make it more humane, to try to respond to the concerns of Canadians from coast to coast that they wanted to be able to access an advance directive in a situation that fit the MAID template. This brought us to Bill C-7.

To some of the comments that were made in this place earlier today, the government and Parliament were under a deadline that was court imposed, not politically imposed, to oblige ourselves, as parliamentarians, to meet what the Supreme Court of Canada said the charter required us to do. We had a very tight timeline, and then the Senate did something I do not think anyone in the House expected.

Again, we had a professional dispute going on here. Doctors were saying they were not ready to extend this to people whose sole irremediable condition is mental illness. Public health professionals in addiction and mental health were saying they were not ready. However, with strong pressure and strong professional advice from the psychiatric community, the Senate decided we should extend MAID to those with an underlying condition that is only, and I do not say “only” as if it is a marginal or trivial matter, a crushingly painful and life-ending threat from mental illness.

We are walking this fine line. The line is even finer when we start realizing who is more likely to not be able to access mental health supports; they are the marginalized and the poor. Who is more likely to not be able to imagine continuing on in life with a crushing mental illness? It is again the marginalized communities. The disability community spoke with a loud voice saying not to extend MAID as they were worried enough that it was a slippery slope when Bill C-14 first came in, and now Bill C-7.

Here we are again with a court-imposed deadline. Let us be clear to Canadians watching today. Certainly, the provinces and many doctors and mental health professionals have spoken with one voice. If we do not act quickly to pass this legislation and if the Senate does not act quickly to get it to royal assent come March 17, then as a matter of reality, we are up against March 17, and medical assistance in dying would become available to people where mental illness is the sole underlying condition.

Is it irremediable? We are told by the experts that no one really knows how to answer that question. Yes, some of the psychiatric community says the safeguards are there and if three psychiatrists say that it is irremediable, then that is enough. However, we are all asking where the mental health supports are, particularly for those who are marginalized. Where is the access?

This is one that particularly perturbs me. I have had many people come to me from a community that has experience with using psilocybin, conventionally known as magic mushrooms, as a way to alleviate a mental health condition, which might otherwise be irremediable, with remarkable results. We know that Health Canada is currently accelerating trials on psilocybin. It strikes me as beyond a catch-22 that the authorities would say to those people and to their doctors, who think psilocybin could help them, when the alternative is that they are more likely to commit suicide, or if we do not act by March 17, they will have access to legal medical assistance in dying, and it would be too dangerous to let them try psilocybin, but the alternative is death. It seems to me that any medical risks from psilocybin pale in comparison to the irreversible reality of death. How can we let this happen? We cannot.

I think we need to discuss another thing in this place, which is societal assistance in living. We know what medical assistance in dying looks like, but what does societal assistance in living look like? It means ending poverty and bringing in a guaranteed livable income for all. It means access to mental health services in this country. It means a compassionate and caring approach that says to every Canadian, whether in the disability community, the indigenous communities or the youth who are struggling with addictions, that we hear them and will not fail them. That means, no matter how members feel about it, we have to pass this legislation expeditiously.

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

Madam Speaker, my friend, the member for Kelowna—Lake Country, and I share many of the concerns expressed today. This is one of those issues on which I would beg everyone in this place not to seek partisan advantage.

The divide we have here is really the most non-partisan thing of all: the structure of our Parliament, the Westminister system, whereby we still have the equivalent of the House of Lords; that is, the Senate. The Senate put in Bill C-14 that medical assistance in dying be available to those whose underlying medical condition is a mental health condition only. Everyone here, regardless of partisanship, is struggling to make sure Canadians do not seek access to medical assistance in dying if there is another option that allows them to continue to live. It is not partisan.

I would like comments from my hon. friend.

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

Madam Speaker, this has become an issue, because it was inserted in the legislation at Bill C-14 by the Senate. Does the hon. member have any knowledge of what attitude the Senate is going to take?

We are operating under the gun here. We have to do something before March 17. Do we have any indication of whether the Senate will, once the House dispatches this matter, take it up quickly?

Motion That Debate Be Not Further Adjourned

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, the minister did not answer one aspect of my question.

Why the double standard?

The minister had a full year to implement the recommendation of the Special Joint Committee on Medical Assistance in Dying concerning advance requests. An Ipsos poll of 3,500 people showed 85% support across Canada. If the minister does not know that, he is not staying on top of his file.

As far as postponement is concerned, the minister has implemented the recommendation to the letter. Three years is too long. He knows that. However, he could have added another dimension to Bill C‑62. He had a year to do it. Will he introduce legislation on advance requests, yes or no?

Bill C‑14 is bad legislation.

The minister says that he worked carefully. People have been forced to go on hunger strikes to meet the reasonably foreseeable natural death criterion. Is that what he means by protecting vulnerable people?

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

Mr. Speaker, I thank hon. Minister of Justice for sharing these comments with other members of the cabinet, particularly the Minister of Health.

This is perhaps the most difficult issue any of us will ever deal with as members of Parliament. Strangely enough, I will just add that, had she been alive when I was a member of Parliament, Sue Rodriguez, who went all the way to the Supreme Court of Canada for the right to die with dignity, would have been my constituent. She lived in North Saanich.

There is tremendous public support in my area for medical assistance in dying being available to Canadians. However, I have to say, when it came to Bill C-14 and extending it to where mental illness was the only underlying cause, I voted for that bill only because there was a time delay, and we should be ready before it comes into effect.

I support what the Minister of Justice just said. We know the provinces have spoken with one voice. I am very concerned that access to treatments for mental health are still not available and might push people toward seeking MAID because they cannot get access to something like psilocybin that could deal with their underlying causes.

I very much object to using time allocation. I do not think I have ever voted for time allocation in this place, but now I must because the court deadline is approaching; March 17 is soon. We need to make sure that we do not leave Canadians in this awful gap where we do not have anything in place, as a Parliament, to deal with the current crisis.

I offer those comments just to say that I will be voting differently from the way I typically have, but I still vigorously object to time allocation being used routinely.

Government Business No. 34—Proceedings on Bill C-62

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, let us try to calm down a bit.

In this debate, the government is basing itself on the Special Joint Committee on Medical Assistance in Dying for its amendment to Bill C‑62.

The Bloc Québécois would have liked to lend its support. The problem is that we believe that we should not indefinitely delay the possibility of medical assistance in dying for people with an irremediable mental disorder, when no psychiatrist worth their salt has been able to treat them or relieve their suffering. After 10, 20 or 30 years of suffering, the decision whether or not to request MAID should not lie with this person, who is supposed to determine whether the patient is eligible.

We asked for an amendment to the bill. Why take three years when, last year, we were told that it would take a year to make sure that MAID for people with mental disorders could be set up in a safe and appropriate manner? The main issue we have is that, in 2015, there was an election, but there was also the Carter decision. The government and this Parliament passed terrible legislation, similar to the one Quebec adopted a year earlier.

Quebec passed a law that only covers end-of-life cases, people who are terminally ill. I want to reiterate that, in the terminal phase of life, the process of dying has begun and is irreversible. People can be well taken care of in palliative care. Good palliative care, as described by Cicely Saunders at the time, is full, comprehensive, holistic support for people as they are dying. It involves adequately managing the person's pain and suffering, both physical and emotional, and supporting their family. All of this should be done in an environment that resembles a normal environment as much as possible. However, it is possible that, all of a sudden, in the midst of this process, the patient, who is slowly dying, will request MAID because, one day, they are feeling at peace and ready to let go. That is not a failure, in my opinion. It can be seen as successful palliative care. When my colleagues are about to depart this life, I hope that they will be calm and at peace. That is what I would wish for everyone.

So Quebec had taken those steps. Then in Parliament came the Carter decision, which stated that Ms. Carter was not at the end of her life, but she was suffering a great deal. It was therefore decided that depriving her of medical assistance in dying impinged on her right to life. Why? She was being forced to end her life prematurely, when the fact is that letting her decide what happened next would empower her. It was up to her to define when her suffering became intolerable.

It was a bad law. Bill C‑7 had to be introduced. When we began studying Bill C‑7, there was another factor that had to be considered; that was in 2021.

The Carter decision states that there cannot be an absolute prohibition on MAID simply because people belong to a particular group, one that is vulnerable. It must be assessed on a case-by-case basis.

The reality is that people can and do struggle with irremediable mental disorders. Irremediability is established through a rigorous process. During that process, practitioners must be certain that the person has never refused treatment that we know would have absolutely improved their situation.

There are indeed people whose mental disorders cause intolerable suffering, and psychiatry does not help them. If anyone here wants to claim otherwise, I would say that they lack intellectual integrity. Psychiatrists cannot cure everyone; it is impossible. That said, psychiatry is rife with medical paternalism.

That being said, what we wanted was for the government, whose Bill C‑62 is based on the work of the Special Joint Committee on Medical Assistance in Dying, to plan ahead for when it might have to introduce Bill C‑62 and include another key recommendation of the special joint committee in the bill. That recommendation was presented a year ago and was the subject of a consensus. One Conservative member even joined the majority. There is a consensus in favour of advance requests.

Why was that not included in the bill? It should have been anticipated. The government knew that the date would have to be pushed back. It had a year to introduce a measure in the House that would have also covered people suffering from dementia and Alzheimer's. Why did the government not do that? We asked the government why it was not doing so when it had the chance. Quebec drafted its own legislation. It is structured, rigorous and unanimously supported in Quebec.

An Ipsos poll shows that 85% of the Canadian population supports advance requests. In British Columbia, 84% supports advance requests. In Alberta, it is 84%; in Saskatchewan and Manitoba, it is 81%; in Ontario, it is 84%, in Quebec, it is 87%; in Atlantic Canada, it is 81%. I could go on. There are other figures. They vary. The results are based on a sample of 3,500 people. That is not nothing. When will the government take action? Why has it not heard this request? Why has it not spoken with Quebec, who has worked on this issue? Why did it not hear the unanimous will of the National Assembly, just last week? Why is it afraid of its own shadow? Why do the Liberals lack courage so?

The last time they lacked courage, we ended up with Bill C‑14. What is the problem with Bill C‑14? The real problem with Bill C‑14 is not a legal problem. The problem is for a patient who is suffering, who, to satisfy the reasonably foreseeable natural death criterion, has to go on a hunger strike. We have seen that. The problem is for people who, like Ms. Gladu and Mr. Truchon, have to fight for their constitutional rights in court. When I say there is a lack of courage, that is what I mean.

My only viewpoint is the viewpoint of patients who are suffering. The only thing I am standing for here is the suffering patients' right to self-determination. Patients had to fight an uphill battle against medical paternalism when it comes to MAID.

As I mentioned last week, there was a time when the palliative care that is so dear to the heart of my Conservative friends and that I personally consider to be very important was called passive euthanasia. Doctors obstinately used aggressive life-support measures because their duty was to save their patients. As we know, every doctor thought that they could save every patient back then. It was actually doctors suffering from cancer who started to assert their right to refuse treatment. Today, cessation and refusal of treatment are part of what are considered to be good medical practices.

Why are we not studying the bill today? The government is imposing a gag order. We will not be overly critical of this decision. I understand that this has to be done before March 17. We are not getting too worked up about this, but still, we have not consented and will not consent to this. Why not? It is because we wanted a bill that was based on the recommendations from the Special Joint Committee on Medical Assistance in Dying. I want answers from the government in that regard.

Why the delay in expanding medical assistance in dying to people with mental health issues? We did what the committee asked. Bill C‑62 even provides for the Special Joint Committee on Medical Assistance in Dying to reconvene in order to determine whether the groundwork has been laid. That is what we are doing. We basically took the recommendation and inserted it into the bill. Then, there is the issue of advance requests. There is a consensus on that across the country, but the government lacks the courage of its convictions.

The Liberals are afraid of demagoguery because there has been a lot of it on this issue. They are lumping everything together. However, at some point, they need to be consistent in their approach. The Liberals are well aware that the state's role is not to decide for the patient what is best for them when it comes to a decision as personal as one's own death. The state or the patient's neighbour is not the one who is going to die. The state's role is to determine the proper conditions and ensure that they are put in place so that patients can make a free and informed choice. If people are worried about abuse or the slippery slope when it comes to advance requests, then they should look at Quebec's law, which is a model to follow.

The government could have easily inserted elements of the Quebec law into its regulations. It is all well and good to say that the law is a little vague, but the amendment we are making to the medical assistance in dying legislation, expanding section 241 of the Criminal Code, is followed by a procedure, regulations on enforcing regulations. That is where the various safeguards are put in place.

There are standards of practice when it comes to mental disorders. A year ago, a committee began looking at standards of practice, and they will be sent to the regulatory bodies in each province, namely the colleges of physicians. Once we have clear guidelines and standards of practice and the criteria I was talking about earlier are met, someone in a suicidal crisis will not have access to medical assistance in dying.

It bears repeating, because I am hearing a lot of confusion over this. A suicidal person is not eligible for medical assistance in dying, even if they suffer from a mental disorder and are in suicidal crisis, and even if they have recently been admitted to care and diagnosed. I have often asked psychiatrists if they thought that giving access to medical assistance in dying to people with mental disorders could also provide an opportunity for prevention. Some people commit suicide and no one sees it coming. No one knows those individuals today, no physician took them on.

For example, knowing that MAID is an option, a person might come forward because they are suffering and want to exercise that option. Well, that person would not qualify. However, they would then be taken care of and get the treatment they need, since suicidal ideation is reversible. There is no question about that. However, it is not about those patients. When we asked the chair of the expert panel, psychiatrist Mona Gupta, how many patients in her practice would have been eligible, she told us of two or three patients over her entire practice. Still, these are people who are suffering.

When people talk about the fact that the resources are not there—the resources in terms of someone to assess capacity, for an independent psychiatrist to look at a case—I would point out that right now, the decision-making capacity of a person struggling with a mental disorder, but who has cancer, for example, is verified. Psychiatrists are currently assessing the decision-making capacity of people with a mental disorder and a comorbidity. Depending on their condition, practitioners are able to determine the decision-making capacity of these people who have a mental disorder.

The Supreme Court was clear: Not allowing these people to access MAID creates stigma. Not only does it stigmatize them, it discriminates against them. Why infantilize and weaponize people who have a mental disorder and who, in their entire existence, have not found treatment that can alleviate their suffering?

I rather like having discussions and debating with my Conservative colleagues. They have a sense of conviction, but there are some Conservatives who use scare tactics and conflate everything. It is not enough to repeat some 20 times that someone came to say that irremediability is hard to address. Everyone agrees. Even the expert panel starts with that. They did not hide that fact. In fact, they say that because irremediability is hard to establish there must be safeguards and precautionary principles put in place.

I therefore move the following amendment:

That the motion be amended in subparagraph (b)(ii):

(a) by adding after the words “be deemed referred to a committee of the whole,” the words “that an instruction be deemed to have been given to the committee granting it the power to expand the scope of the bill so as to take into account provincial medical assistance in dying frameworks for advance requests from persons who have an illness that could deprive them of the capacity to consent to care,”;

(b) by replacing the words “deemed reported without amendment” with the following: “deemed reported with the following amendments:

That the bill be amended by adding the following new section 241.21 to the Criminal Code:

New section 241.21

Medical assistance in dying eligibility criteria for advance requests

“241.21 The government of a province may establish a medical assistance in dying framework for advance requests from persons who have an illness that could deprive them of the capacity to consent to care, in accordance with the laws of that province.””; and

(c) by replacing the words “deemed concurred in at report stage” with the following: “deemed concurred in at report stage, as amended”.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, when it comes to MAID, this government is not exactly a shining example of proactivity. After the Carter decision, it took a long time for the government to table a half-decent bill. Bill C‑14 was pretty worthless. It was a poor imitation of the Quebec legislation and was far from addressing the crux of the Carter decision.

That being said, the issue of proactivity is still relevant. Regarding MAID for people with mental health conditions, a three-year delay was unnecessary; one year would have been enough. The government has been aware of that for a year, since it is basing its decision to kick it down the road on the consensus recommendations of the Special Joint Committee on Medical Assistance in Dying.

Why has the government not done anything on advance requests for the past year? Why is it dragging its feet? Why is it not basing its decision to go ahead with this on the joint committee's key recommendation?

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

Mr. Speaker, it is a pleasure to rise to speak to a very important issue. This is a deeply personal and complex issue, one that has had a great deal of debate in the House for number of years now.

We are not directly speaking to that. Rather, we are speaking to the motion that would enable the government to get the MAID issue resolved for the next few years. The motion would ensure that the legislation actually passes. I will give a little background on that.

There is a time limit for us to ultimately get Bill C-62 passed in order to fulfill our commitment to the court. Obviously, we want to keep the law validated, appropriately. The motion we have brought forward today would allow for the House, while providing some time for the Senate, to pass and give royal assent to the bill before the House breaks in March for a couple of weeks. In essence, it allows for a little more debate this week, when it will ultimately pass.

It would then afford the Senate, in the week following the break, the ability to deal with the legislation and hopefully pass it without amendment. This is very important, as that would then enable the legislation to receive royal assent before the deadline.

I know some members may be a little uncomfortable with respect to this programming motion before us today, the limitations that it puts on members and the importance of the subject matter itself. As some members may recall, last week I stood in my place and asked for unanimous consent to sit late in the evening. That way, members would have had more opportunity to have debate on this issue. Unfortunately, we did not get unanimous consent. As a direct result, we have to work within the time frame of when the House allows us to sit. As a result, in order to meet the deadline, we have brought in a programming motion.

I made reference to the very beginning, about when we started to talk about the issue of medical assistance in dying. It came up in 2015. A Supreme Court of Canada decision, Carter v. Canada, made it very clear that we, as a government, and Canadians, through the Charter of Rights, needed MAID legislation. That was decided midway through 2015, but no action was taken, knowing full well that we had to bring in a law to address what the Supreme Court had put in place.

We all know that an election took place. Shortly after that election, it was made very clear that as a government we needed to bring in the legislation. An approach was made to the Supreme Court to take into consideration what had taken place over the last number of months following its decision, including an election.

The Supreme Court ultimately provided grace to the House of Commons so that we could, in fact, get the necessary legislation brought forward to the chamber and ultimately passed. We did have to ask for yet another extension back then. I do not think that surprised anyone.

From the day we can recall, in 2015, there was a great deal of discussion that had taken place. In fact, I suspect, if one were to take a look at the different pieces of legislation, today, we call it Bill C-62, and the original legislation was Bill C-14. We have had legislation in between those bills, which the government had to bring into the House.

On occasion, when the government brings in legislation for debate, there is fairly extensive debate not only in the chamber but also in committees. I can remember, quite vividly, a lot of the debate, the issue for which the special committee was put together to deal with the issue and to provide some thoughts, recommendations and ideas to the chamber and the members who were directly involved.

There is no lack of interest or input from the many different stakeholders, of all different natures, in every region of the country. Everyone had an opinion on the issue. In the end, the amount of dialogue that went into the legislation and the creation of MAID, was probably greater than 90% of all other forms of legislation that come to the House.

We saw that in the passion of the debates presented at the time by members of Parliament on all sides of the House. It was not just Liberals, New Democrats, Conservatives or the Bloc, or even the leader of the Green Party at the time, where one could see the emotional toll of the debate. That is why I talk about it being of a very deep, personal nature. There are complex choices and decisions that have to be made on this.

When I reflect on that debate, there were tears inside the chamber. There were all sorts of emotions as members tried, in the best way they could, to explain why they were taking their positions on it. Different members voted for different reasons and so forth.

In the end, Bill C-14 ultimately passed, after many hours of debate inside and outside. When I say outside, I go even further than outside of standing committees. There were emails, correspondence and discussions that I had on this issue, and it was fairly intense. People wanted to know how I felt about it. I am sure all members of Parliament were questioned about what they had to say on the legislation.

I do have differing opinions from members across the way and maybe even, quite possibly, within my own caucus. I genuinely believe that the need for MAID is there. There is no question about that.

However, where I fall on the side that it seems to be acceptable, at least for a good percentage of people I represent, is to have trust and confidence in our system of health care professionals, social workers and support people whom family members go to when the time comes to make difficult decisions, such as another family member, a local pastor or anyone else. Having that confidence has allowed me to feel comfortable as we have gone through this legislation, virtually from day one.

There was a need for changes. To bring in substantive legislation for the first time that so profoundly impacts the lives of Canadians and to expect that the legislation would be perfect and would not require change is somewhat naive. That is in fact what took place. There was a need to make some changes to the legislation. That is why, ultimately, we had the second go-round of the legislation.

There was a fairly wide discussion on that second attempt and, through amendments, something that is now very challenging was brought in, which deals with mental health as a sole condition for MAID. I know that has stirred the emotions of a lot of members and, ultimately, when the legislation passed to allow it, there was a lot more resistance to it than there was to Bill C-14. It did not surprise me, because of the delicacy of the issue.

Again, I fell back to what I believe a vast majority of my constituents are comfortable with, which are the health care professionals and others, because I am not a medical doctor. I do not understand the issue to the same depth as do the different professionals. As a direct result, I feel more comfortable taking the same position as the government took on the issue.

However, we also need to recognize the reality that other jurisdictions are very concerned about the implementation and about the degree to which we are ready to implement the legislation that was passed. That is really the crux of it. Therefore, we have Bill C-62 today, which would allow for that ongoing exemption to continue. That would enable the system, which is large and complex, to ensure that everything is ready. Then, if the legislation takes effect, people would not be let down, and we would still be able to meet the constitutional requirements. Let us remember that the amendment to the original legislation, in part, came from an appeal court in the province of Quebec, which obligated members of the House to bring forward other legislation.

I know my friend opposite, from the Conservative Party, says that we had a choice and that we could have appealed that decision to the Supreme Court of Canada. As a number of them said, we could have attempted to kick the can down the road. Ultimately, it was a decision made and supported by a majority of members of Parliament in the House. Even though the Liberal government had a majority, when it came to Bill C-14, members know full well there were members from all sides who supported it.

Today we have a minority situation, and the only way we can pass legislation through to have the support of other political entities inside the chamber. I would like to think that what we learned through this process has enabled us to look at other things we have been able to do directly.

During many hours of the debates, people talked about palliative care, hospice care and about the lack of that type of care being provided to the people of Canada. It has been a genuine concern for many years, probably a good 20-plus years, where we needed to see more invested in hospice and in palliative care.

Far too often we see individuals who are panelled in our hospitals because there is no place for them to go outside of the hospital. If we look at what took place during the pandemic, we saw that care facilities had to close the doors to people from outside to protect those on the inside. Those on the inside were often dying prematurely, and we know that as fact. Organizations like the Canadian Forces or the Red Cross were involved.

If we take a look at the bigger holistic picture, are we collectively, and contrary to what some might say, it is not just Ottawa, doing enough to be able to deal with these social issues that Canadians have a high standard for? They want politicians of all political stripes and of all levels of government to invest more resources. I am talking about not only money, but also time and debate.

There are probably better ways in which we could spend some of the money that is spent in areas such as health care, social services and so forth. One could take a look at the process for someone who might, first, end up in a hospital situation, and while in the hospital, they find out that things are not good and that their life is going to come to an end in a relatively short time.

One of the things that happen is that hospitals can provide only so much in terms of treatment. There is no consistency within a province, let alone the nation, as to which individuals are being kept in the hospital. Because there are not enough supports in a home atmosphere and there is no other place for an individual to go, far too often they become panelled in a hospital facility in one form or another. I believe the debates we have seen on MAID amplify that.

These are the types of discussions and debates that we should be having, not only here in Ottawa but also in our communities and at the different legislatures. Quite frankly, there are some fairly significant stakeholders out there who also have to play a role, like non-profit organizations. That is what I recall about some of the discussions we have been having over the years in regard to MAID legislation. Unfortunately, as I pointed out, the original thoughts in regard to MAID and the need for us to bring in legislation and the types of debates that we saw then are in contrast to today, as it is becoming more of a politicized issue. Politics seems to be more important than the issue itself in some ways.

That is why at the very beginning I referred to the fact that it is not a good thing that we had to bring in a programming motion, but it is important that we do it today, because we were not successful at getting the consensus required to be able to sit longer to allow for a consensus to emerge as to how the legislation could pass through the system. However, we still have an opportunity. The motion talks about going to the Standing Committee on Health as the subject matter.

When this motion passes, it will enable the Standing Committee on Health, as its first priority in terms of the resources of the House, to meet. A minister will in fact be there for a good hour. There will be an opportunity to have a few other witnesses. It will ultimately have to go through the committee. If we can get this motion passed, after this legislation goes through committee it will come back here to the House of Commons for third reading later this week, before being dealt with in the Senate in the last week of February to March 1. That time frame will enable it to ultimately get the necessary royal assent in order for it to be enacted into law.

Based on what the legislation would actually do, I would think that the Conservatives, in particular, would support it. The essence of the legislation is to put in a three-year extension. It provides for particular provinces and jurisdictions to be able to get things in a better state of readiness, so that, at the end of that period of time, we are able to provide the types of services that are necessary. This means, in good part, that there will be ample time for us to continue to have that dialogue and debate, and if there is a need to do and bring forward other things, whether it is through private members' business or government business, that there are opportunities. However, I suspect, by passing Bill C-62, that a sound majority of the House will be content with the modernization, if I can put it that way, of the legislation.

In one part, it reminds me of the issue of the suicide crisis helpline, and I say that for two reasons.

One reason is that some members often will make reference to how the legislation as a whole is enabling individuals to virtually have suicide upon request, which is just not the case. We know that is not the case, and the members who say it know that is not the case but unfortunately we still see some members give that false impression. I find that to be somewhat unfortunate, because it is definitely misleading and does a disservice in terms of the legislation and the thorough process that we have gone through. I cannot imagine the number of hours, and we are talking three digits and more of hours of different types of discussions in many different forums. To try to simplify it by calling it “suicide on demand” does a great disservice to the legislation and to the law that we currently have in place.

The reason I bring up the suicide helpline is that someone indicated to me that there are people who, at times in their lives, give it thought. When they heard about the MAID legislation, they made inquiries, and because of those inquiries they were able to get the type of assistance that made things better for them. In other words, MAID legislation, on occasion, I would ultimately argue, has actually even saved lives.

Criminal Code

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I appreciate the comments of my colleague, who always speaks very calmly and moderately. It is a pleasure to serve with him.

The NDP voted against Bill C‑14, which did not address the Carter decision's requirements at all. Bill C‑7 met the Carter decision's requirements with additional changes that required hard work, to clarify the issue.

Is the NDP saying no to the idea of one day moving forward on mental disorders, or would it rather put the subject off indefinitely?

We could start working on this tomorrow morning, and I am convinced that within a year, we could come up with something very promising.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, that is an excellent question. In the supplementary report that I tabled, I note that, if we had had more time, we could have engaged with these people. By engaging with these people, we could have understood exactly what their concerns were.

A certain number of associations did tell us that everything was ready for us to do this. The member knows that. For example, the Association of Medical Assistance in Dying Assessors and Providers came and told us after Bill C‑14 and Bill C‑7 were introduced that not all doctors were trained to be MAID providers. There was only a small number and they would be able to meet the demand. When it comes to mental disorders, we are talking about an even smaller number still. The people from this association felt that they were able to do this safely. There was also the Canadian Psychiatric Association, the Canadian Bar Association, the Association des médecins psychiatres du Québec, the Federation of Medical Regulatory Authorities of Canada, the Nova Scotia department of health, and so on.

It comes down to the way people followed the debate and the way they debated within the governments because they sometimes have other concerns. I would have liked to hear them. The government did not call on us as soon as Parliament returned so that we could do a review and ask all of the questions we had. We could have even gone out into the community to see what was missing, but we were unable to.

Here is what I think: We could do it right now, in the next year. We need to work together, get out there and explain it, see what is going on, and share the guidelines. Then, if we need another year, we can take it. Waiting until 2027 to do this is definitely not a progressive way of going about it.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I never thought I would end up debating medical assistance in dying in the House again, or reliving what we went through when we passed Bill C‑14, a bad law. I never expected that the Liberals would again be in the same position, or show the same lack of courage they did with Bill C‑14, which was prescribed by the Carter-Taylor decision.

Quebec passed its legislation on end-of-life care before the Carter decision. In the Carter decision, the court ruled that Quebec had to revise its legislation to include more than end-of-life issues only. The Parliament of Canada, which had never considered this before, was also told that it had to address not only end-of-life issues, but also degenerative diseases like those afflicting Ms. Carter and Ms. Taylor. Ms. Carter had spinal stenosis and Ms. Taylor had amyotrophic lateral sclerosis. In its decision, the court ruled that Parliament had to legislate because both women's right to life was being infringed.

Why was their right to life being infringed? The right to life is not a minor right. This should be of interest to the Conservatives, who are pro-life. I am too, in that sense. The right to life was being infringed because these people had to shorten their lives when they would have liked to live until their suffering became intolerable.

As members of Parliament, as representatives of the state and the people, our duty is not to decide what the patient needs when it comes to an issue as personal as their death. The role of the state is to ensure the conditions needed for them to exercise free will, so that they can make a free and informed decision. That is the role of the state. Otherwise, we get into government paternalism.

I invite my Conservative colleague to do some reading in clinical ethics and not to limit himself to what psychiatrists in Ontario are saying. We know that psychiatrists are divided on the issue. In fact, if there is one discipline in which medical paternalism continues to reign, it is psychiatry. We would never have seen the progress that we have seen in clinical ethics if medical paternalism in general still ruled supreme.

What happened for patients to be given back control over their end of life? We find the answer to that question in the bioethics literature. In the past, some doctors who had cancer said they did not want treatment. Now, we have good medical practices, whereas in the past, aggressive treatment was the standard. The doctors said that they wanted to live the two years they had left without undergoing treatment that would leave them bedridden. They claimed that they wanted to spend quality time with their loved ones. It took doctors with cancer demanding that option for patients to be able to discuss these sorts of things with their own doctor. In the 1960s, there were patients who only found out that they were dying of an incurable disease and were in fact at the end of their life when the priest came to their room to administer the last rites. They were not even told that they were terminally ill. That was medical paternalism.

Over time, the right to die was granted. Patients were granted the right to die and the opportunity to refuse aggressive treatment. That is when we began providing the palliative care that is so important to my Conservative friends. Before that, palliative care was called passive euthanasia, and it was not allowed.

Medical paternalism has been gradually set aside. What has this led to?

It has led to the right to refuse life-saving treatment, to stop treatment. These are all rights we have today.

We have before us a bill that perpetuates suffering indefinitely for people with a severe mental disorder who have been unable to relieve their suffering through treatment. That is no mean feat. They have spent 10, 20, 30 years suffering, trying multiple treatments and being stigmatized by the society in which they live.

We are able to establish the decision-making capacity of people living with a severe mental disorder. For those capable of making decisions, the court told us that it would be discriminatory and stigmatizing if, just because they have a severe mental disorder causing suffering that psychiatry is unable to properly change or relieve, they were told what was best for them and that they should continue to suffer forever, while psychiatry need only provide a palliative care option until the end. That is what we are discussing today.

I will calm down. It is just that I heard some nonsense earlier.

Then what happens? There was Bill C‑7, which was rather cautious. It set a two-year deadline for creating an expert panel. Who read the report of the expert panel in the House? Who read it before voting? This is the second vote we are having on this subject. We have to read the report of the expert panel. Indeed, the irremediable aspect is something that is hard to implement. Admittedly, there is an additional difficulty, but the expert report does set out guidelines. That is what this is about.

Then the Liberals show up today with a clause they added that says we are going to work with an expert panel for two years and create a joint committee. The problem is that the joint committees have always been set up at the last minute, too close to the deadline.

When we submitted our report the last time, we were forced to admit that, before moving forward with the issue of mental disorders, we needed to assess the situation in the field. Even though I think the group that was supposed to work on it had developed important guidelines and standards of practice, it was obvious to me that there was still not quite enough time. Everyone told us so, including the Collège des médecins du Québec—I will have more to say later about its criteria and guidelines for proceeding that I find useful.

How is it that, a year ago, the government gave itself a one-year deadline and thought that would be enough time? A lot of work has been done in that year, yet the government is saying we should put it off until 2027.

We heard what the Conservatives just said. We can forget about MAID if they form government; they will put it off indefinitely. That means that people will continue to suffer indefinitely, and that suffering will be intolerable because psychiatry is unable to provide relief other than by rendering them virtually incapacitated. Somehow, people find that morally acceptable. I honestly do not know where the morality lies in that. Some people have very flexible morals. In any case, it has nothing to do with suffering.

When people claim that someone living with depression could have access to medical assistance in dying, it is simply not true. Just because someone applies for MAID does not mean they will be able to access it. The assessors will do their job. Stefanie Green was saying that a person in a suicidal crisis is not eligible for medical assistance in dying. Someone who raises their hand and says that they want MAID simply because we allow mental disorders to be eligible grounds for MAID would not have access to it because they have not received proper care.

However, there would be an opportunity for prevention, because we could provide treatment at that time. It is wrong to say that 90% of people who have suicidal ideation and commit suicide received proper care. No, they did not receive proper care. Very often, when people commit suicide, no one saw it coming at all.

What are we going to do? What are the Conservatives going to to with people who are desperate and suffering and who currently still have hope that we are going to consider their suffering and find a solution so that things are done properly and by the law? What do they think those individuals are going to do in their despair? Is suicide morally acceptable? Suicide attests to the failure of our system and our society. I will never, ever accept suicide. That is why, when we talk about medical assistance in dying, we are not in the same page at all.

A person who is feeling suicidal is not eligible. Someone who has just been taken into care and diagnosed is not eligible. Applications take structural vulnerabilities into account. Just because someone is poor and does not have access to care does not mean that they will be eligible for medical assistance in dying. They would not be eligible, because they would have to have tried every possible treatment. Someone who unjustifiably refuses treatment that could improve their condition will not be eligible. If accessible and effective treatments are available and the person refuses them, they are ineligible. If the assessors cannot agree that the criteria have been met, the person is not eligible either.

The Collège des médecins du Québec told us that it remains at the discussion stage, that it has established its guidelines and it still needs time in order to eventually get there. Personally, I think one year would have been enough, otherwise we might give up. We could end up being hypocritical and leave it to chance. We might as well flip a coin.

The Liberals need to work hard if they want to win the election. If not, they are going to be leaving the fate of those who are suffering in the hands of people who just told us today that this will not happen on their watch, that they support suffering for life everlasting, and that they know what is moral and right for these people.

The Quebec college of physicians said, and I quote, “the decision to grant MAID to someone with a mental disorder should not be viewed solely as an episode of care. Rather, the decision should be made following a fair and comprehensive assessment of the patient's situation.” We are talking about taking the time to establish the chronicity of the condition.

The college of physicians also set out a second condition. It said, and I quote, “the patient must not exhibit suicidal ideation, as with major depressive disorders”. It might be a good idea for the members of the Special Joint Committee on Medical Assistance in Dying to hear that, although they are on the same committee as I am and that was said in committee.

That is a far cry from the grandstanding Leader of the Opposition who stands up in the House and asks the Prime Minister, in prime time, whether medical assistance in dying is the only thing he has to offer those who are depressed and having a hard time making ends meet. That is a bit much.

The third criterion laid out by the college of physicians states that the patient must “experience intense and prolonged psychological suffering, as confirmed by severe symptoms and overall functional impairment, over a long period of time, leaving them with no hope that the weight of their situation will ease. This prevents them from being fulfilled and causes them to see their existence as devoid of meaning.”

The experts tell us that they cannot apply irremediability and suffering metrics to mental health, and that prevents them from creating a category as a grounds for MAID. It has to be done on a case-by-case basis. All questions of clinical ethics, in terms of clinical assessment, are examined on a case-by-case basis. Some seem to think that going on a case-by-case basis is hell and that it is not a rigorous process. It is very rigorous.

The fourth condition states, “the patient must have been receiving care and appropriate follow-up over an extensive period of time.” Access to care must have been available. Otherwise, no access to medical assistance in dying will be provided for mental disorders. It seems to me that we heard the same thing in committee. We heard the same criteria.

At some point, we have to have the courage of our convictions. I believe that we have to offer relief to people experiencing intolerable suffering, who have reached their limit. I also believe that we must not make decisions about their life or quality of life for them. They alone can decide what is tolerable or intolerable.

When people talk to me about a slippery slope, they seem to be working on the assumption that all health care workers are evil. However, people who work in health care need to be kind. As far as I know, gaining admission to medical school is not easy. I imagine that the selection criteria are quite strict and challenging. The same goes for nursing.

The fifth condition states, “requests [from social workers] must undergo a multidisciplinary assessment, including by the physician or specialized nurse practitioner in the field of mental health who has treated the individual”. This is in the case of a follow-up assessment, not in the midst an episode. A person cannot get medical assistance in dying simply by saying that their life no longer has any meaning. Making a request does not mean one is eligible.

The Collège des médecins du Québec concluded by saying, “Under these conditions, it would be possible, in the CMQ's view, to provide individuals suffering from a grievous and irreversible mental disorder with access to MAID. It is important to prevent situations where individuals opt for MAID out of desperation, because they do not have access to proper care or do not consider the care available to be acceptable, such as an extended stay in a facility without the prospect of gaining more autonomy.”

That is the exact opposite of the nonsense we heard earlier. We were told that this was like a house of horrors, that we were dealing with experts and doctors who simply wanted to harm people's physical integrity. We have to be careful.

To access MAID, the individual must first make a request, which is then followed by informed consent. When it comes to mental disorders, doctors currently perform a daily assessment of a person's decision-making capacity if they have a mental disorder and a comorbidity, an additional illness that is hastening their death. Everyone agrees that these people are capable of choosing and consenting to medical assistance in dying. MAID practitioners have long been determining the decision-making capacity of people with a mental disorder. Just because someone has a mental disorder does not mean that their right to self-determination and to make decisions should be violated. That is discrimination and stigmatization.

When people tell me they want to protect the vulnerable, I wonder who could be more vulnerable than someone who has suffered for decades with a mental disorder and has tried every treatment. Who could be more vulnerable than someone grappling with a paternalistic psychiatrist—I am choosing my words carefully—who thinks he knows better than his patient what treatment they need, then chains them to a palliative care pathway and throws away the key because he cannot bring himself to admit that he is unable to provide relief to his patient?

At committee, I put the question to some psychiatrists who told us we were on the wrong track. They admitted that, in 25 or 30 years of practice, they had seen some patients fall through the cracks. Indeed, it is for this small group of people who fall through the cracks in psychiatry that this expansion is necessary. We need to show a little humanity here in the House.

[Dr. Mona Gupta, Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual]

Thank you very much, Madam Chair, and thank you, all, for the invitation to meet with you today.

I'm a psychiatrist and bioethics researcher at the University of Montreal. I've had the opportunity and the privilege to be closely involved in the public conversation about assisted dying for persons with mental disorders as their sole underlying medical condition—MDSUMC for the rest of my remarks—since its beginning.

I served as a member of the CCA working group on MAID for MDSUMC mandated by Bill C-14. I chaired the federal expert panel on MAID and mental illness, mandated by Bill C-7. More recently, I led the work of Health Canada's MAID practice standards task group, and I also led the working group that developed CAMAP's educational module for MAID and mental disorders.

It is from this vantage point that I want to share some observations about readiness.

When the Government of Canada made the decision to include persons with mental disorders as their sole underlying medical condition on equal terms with all other medically ill suffering persons whose natural deaths were not reasonably foreseeable, it committed to do three things: constitute an expert panel on MAID and mental illness, strike a special joint parliamentary committee to further study the matter, and revise its data collection system. As we know, the federal government has fulfilled these commitments.

When the federal government made the decision to extend the exclusion for an additional year, it spoke about the need for extra time to ensure that two major deliverables—the CAMAP MAID curriculum and the model practice standard for MAID—were complete. As we know, these activities are complete. The standard has been in the hands of physicians and nurse regulators since April of this year, and they are adopting or adapting the standard as appropriate within their jurisdiction. The CAMAP MAID curriculum was launched in September 2023 and has been offered already, numerous times, to physicians and nurse practitioners.

Several other initiatives have occurred since December 2022, including a national MAID MDSUMC preparatory workshop with delegates from every province and territory, including MAID assessors, providers and psychiatrists. There has also been a national system readiness workshop to share knowledge about administrative processes.

Most provinces and territories are working with frontline clinicians, regulators and administrative authorities to ensure that clinical processes are appropriately tailored for requesters with mental disorders. I have provided several examples of these activities in my brief.

A few weeks ago, I taught the CAMAP MAID and mental disorders module to a group of about 20 psychiatrists, family physicians and nurse practitioners in Vancouver. Beforehand, the colleague co-leading the session, an experienced family physician and MAID assessor and provider, Dr. Tanja Daws, bounded up to me. Even though MAID MDSUMC is not allowed, she said, I've already had patients with all the same types of issues in the case studies we cover in the module.

What struck me about Dr. Daws' comment is that persons with mental disorders as their sole underlying condition who make requests for MAID will be in the careful hands of experienced clinicians who, over these last seven years, have already handled the full range of complexities in their MAID practice that MDSUMC requests may present. Her comment also confirms what the expert panel concluded, that the complexities so often attributed to mental disorders are not, in fact, unique to mental disorders and are already being handled in our MAID system today.

The work that has been undertaken on MAID MDSUMC since 2017 has been thorough, the processes transparent and collaborative. The Government of Canada has fulfilled every commitment concerning readiness that it made. It has also made unprecedented contributions to health care professional education and regulation, which well exceed the scope of its jurisdictional responsibilities.

As my colleagues Dr. Gamache and Dr. Grant know better than I, the other essential actors in health care and in the MAID system—regulators and professional associations—have been active concerning MAID since 2015. They will continue to fulfill their mandates. In the case of the regulators, this is guiding clinicians towards safe MAID practice in the public interest, and in the case of professional associations, ensuring their members are equipped to participate in MAID if they choose to do so.

By far, more thought, care and capacity building have been done for persons with mental disorders as their sole underlying medical condition than for any others. This is a good thing, and this work will have the added benefit of strengthening Canada's MAID system for all patients.

If you were to ask me what I need if tomorrow I had to assess MAID eligibility for a person with a mental disorder as their sole underlying medical condition, the answer is nothing. The work has been done. We are ready.

[Dr. Alison Freeland]

Thank you for that question. I'm just reflecting on it as an individual.

I work in Ontario, which is a complicated province. There are lots of different health care systems there. I think there is still work to be done at a local level to ensure that the entire system has created a coordinated point of access.

The encouraging thing is that where I am, there is now a provincial group looking at a community of practice around medical assistance in dying, particularly for a mental disorder. In Toronto, where I work, we now have a coordinated working group sponsored by the two local Toronto hospitals, which, again, is turning its mind to how to do this. It is represented by a number of different health professionals and includes psychiatry. In fact, the Toronto working group is co-chaired by two psychiatrists.

I think people are working hard knowing that there is a date in mind to get to a place of readiness and knowing that readiness is never going to be perfect. When we think about readiness in this context compared to when MAID came out way back with Bill C-14, there's been a lot more work done on the national approach around standards and available curriculum, and I think many different organizations are engaging health care teams around how to best understand this.

I am definitely not a MAID expansionist. I just truly believe that it's very stigmatizing—and this is my personal belief—to take a group of patients and say to them, “You can't even be considered for something because you have a mental illness.”

I believe that very few people would be found eligible should this go ahead with respect to mental illness. Ms. Birenbaum has clearly outlined all of the safeguards and processes we'd have to get through to get to that point.

Those would be my personal reflections, not the CPA's reflections.

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

Madam Speaker, today we are revisiting a subject that never seems to leave me in this place, which is medical assistance in dying. It has come up repeatedly: in the 42nd Parliament, in the 43rd Parliament and again in the 44th Parliament. I think it underlines the gravity of the nature of this subject matter.

I want to thank the member for Abbotsford for bringing forward this bill and for giving us as parliamentarians an opportunity to discuss this incredibly important subject.

What Bill C-314 is essentially going to do, for the constituents of Cowichan—Malahat—Langford who are watching this debate, is amend the Criminal Code to reverse what was done with Bill C-7 and specify that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying.

It is important to mention Bill C-7, because it is an important part of why we are here today. Bill C-7 was originally introduced in the 43rd Parliament. The government is, of course, required by law to issue a charter statement with its main pieces of legislation. In that charter statement, the Minister of Justice went to lengths to make people understand why the government had specifically excluded in the first draft of the bill why a person with a mental disorder as a sole underlying medical condition could not be eligible to receive medical assistance in dying.

The charter statement did say that the exclusion was not “based on a failure to appreciate the severity of the suffering that mental illness can produce”. Rather, as the statement took pains to say, it was “based on the inherent risks and complexity that the availability of MAID would present for individuals who suffer solely from mental illness.” It is important to understand we are not using the term “mental illness” anymore. Every text is now recommending that we use the term “mental disorder”.

There were three primary reasons given in the charter statement at that time. First, the charter statement said, “evidence suggests that screening for decision-making capacity is particularly difficult, and subject to a high degree of error”.

The charter statement went on to say, secondly, “mental illness is generally less predictable than physical illness in terms of the course the illness will take over time.” I think a lot of people can understand that. Someone may receive a diagnosis for a physical illness like cancer, which is particularly well known. We know a lot about cancer these days, and based on what part of the body it strikes, we can predict with a fairly certain amount of accuracy what a person's ability to survive it is based on how far it has progressed and so on. It is the same with other physical ailments. With mental disorders, on the other hand, there still are, indeed, a lot of unknowns.

Finally, that same charter statement went on to explain that the recent experience in the few countries that do allow it, and it did mention Belgium, Netherlands and Luxembourg, “has raised concerns”.

That was the charter statement at the time with the first draft of Bill C-7. Of course, When Bill C-7 went to the Senate, the Senate amended that part of the bill to allow a person with a mental disorder as a sole underlying medical condition to access MAID. There was some back-and-forth between the government and the Senate to establish a sunset clause so that it would not come into effect until March 17 of this year.

At the time, the New Democrats decided to vote against the Senate amendment because the requirements of the earlier Bill C-14 had not yet been met. We had not yet had a parliamentary committee to delve into these issues, and we felt that, despite the government having gone to all those lengths through its charter statement to explain its position, accepting an eleventh-hour Senate amendment without having done that important work was very much akin to putting the cart before the horse.

There was also Bill C-39, which was introduced earlier this year because we found that more time was needed. Whatever anyone's feelings are in this House with regard to people with mental disorders being able to access MAID, there was agreement that more time was needed. Therefore, Bill C-39 was passed in very short order in both Houses, and that delayed the implementation of it until March 17, 2024. That is the timeline we are on now.

I am rising to speak to this particular bill because of my experience with this file. Both in the 43rd Parliament and in this Parliament, I was the New Democratic member on the Special Joint Committee on Medical Assistance in Dying.

It was not an easy committee to be on. Let me just say that. For me personally, I constantly wrestled with two concepts: How do we as parliamentarians, with the power we have to change Canada's laws, find a way to honour the personal rights, capacity and autonomy of the individual versus the need of society to step up and protect the most vulnerable? Those were two great themes that were constantly a struggle for me personally when listening to all of the witnesses who came before the special joint committee on the five thematic areas we were charged with by this House and the Senate.

I would encourage people, if they have not done so already, to look at the good work done by the special joint committee, both the interim report, which specifically focused on this area, and the final report, which was tabled earlier this year and completed the committee's mandate. I also want to draw people's attention to the executive summary of the final report of the expert panel on medical assistance in dying and mental illness because there was some incredibly good work done in that as well. We did recognize the authors of that report. The report states:

That MAiD requests may mask profound unmet needs or conversely, that such requests may not be received with the seriousness they deserve, has been raised with respect to several historically marginalized populations (e.g., racialized groups, Indigenous peoples, persons living with disabilities, and sexual orientation and gender minorities). In the course of assessing a request for MAiD—regardless of the requester’s diagnoses—a clinician must carefully consider whether the person’s circumstances are a function of systemic inequality.

That is the warning sign that I think much of the medical community is struggling with.

People with mental disorders qualifying for MAID will be under track two of the MAID regime, because death is not a naturally foreseeable outcome. I would remind people that track two has safeguards in place:

request for MAID must be made in writing....

two independent doctors or nurse practitioners must provide an assessment and confirm that all of the eligibility requirements are met....

the person must be informed that they can withdraw their request at any time....

the person must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care....

I want to underline that last point. They have to be informed of the available and appropriate means, but we know that for a lot of marginalized populations, those are not always available.

I want to recognize my colleague from Courtenay—Alberni, who has called on the government to urgently fulfill its promise to establish a Canada mental health transfer. This is a very great need in our country. We can see it from coast to coast to coast. I can see it in my community of Cowichan—Malahat—Langford.

The question of Bill C-314 and the state of mental health care in Canada are two things weighing on me quite a bit. I am certainly going to take a lot of time to think about which way I want to go with this bill, but I appreciate the member for Abbotsford for bringing it forward and giving parliamentarians an opportunity to read the report and consider what this bill seeks to do.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I heard the member for Abbotsford say right out of the gate that his bill seeks to reaffirm the dignity and worth of each and every human life. Who could be against that?

The dignity of every human life, as I was trying to say to him earlier, depends on autonomy and respect for a person's self-determination. We may have good intentions, but if we claim to know what is good for a so-called vulnerable person because we think we know better than they do about what is good for them, because we mistake sympathy for compassion, if we decide through some sort of state or medical paternalism what is supposedly good for them, without considering the person's suffering at all, if we take away a person's self-determination, then we undermine their dignity. That is what I wanted to say, but my colleague did not understand.

That is the very foundation of our position. It is called ethical and political philosophy, not theology or any sort of religious ideology.

The preamble to the bill sets out its intentions: “Whereas Parliament considers it a priority to ensure that adequate supports are in place for the mental health of Canadians”. Who could be against that?

I see no problem with that, but it has nothing to do with the purpose of the bill. This can be done without saying that the mental disorder considered as a serious and irremediable medical condition is excluded. I will come back to that.

The second paragraph of the preamble states, “Whereas Parliament considers that vulnerable Canadians should receive suicide prevention counselling rather than access medical assistance in dying”. This really shows a lack of rigour.

All the experts spoke about this and we can even read it in the literature. It is a little twisted to associate suicide with medical assistance in dying. I heard the leader of the opposition make that link a few times during oral question period, but conceptually that is false. Medical assistance in dying is initiated when an individual expresses that that is what they want. It is not imposed. Above all, it is for situations where the person's condition is irreversible. As far as I know, no witness at committee told us that a suicidal state is not reversible. Furthermore, witnesses also told us that we should not conflate the two. This is not getting off to a good start.

When a request for medical assistance in dying cites a mental disorder as the reason, the first step is to establish whether the person suffering has been struggling with the mental disorder for 10, 20 or 30 years of their life. In the experts' report, which I hope my colleague has read, it says that a person exhibiting suicidal ideation would not be eligible. It is one thing to want or to request medical assistance in dying, and another to meet the eligibility criteria. This is essential.

A person who is depressed or in crisis will not necessarily receive medical assistance in dying. Moreover, the experts say that an assessor would never consider a request for medical assistance in dying from a person in a state of crisis. The patient would have to first exhaust all available treatments for alleviating their suffering, without refusing a single treatment capable of restoring their health.

As Dr. Black said, “One study estimated suicidal thinking as an 8% lifetime risk for adults in the Netherlands, yet 65 or 0.0004% of adults in the Netherlands have died of MAID in any given year due to psychiatric reasons.”

Now we have members talking about a potential slippery slope, citing Bill C-14 and ignoring the obligation given to us by the courts to proceed with passing Bill C-7. Bill C‑14 was a bad bill that confused the public. Is it respectful of human dignity to force people to go on a hunger strike to reach the standard of likely and reasonably foreseeable natural death? I think there is something a bit inhumane about that.

In order to reach a criterion that was unworkable for some, people had to actually go on a hunger strike. Others, like Ms. Gladu and Mr. Truchon, had to assert their rights in court. Members say they want to protect the vulnerable. They should start by not treating these people like children and not exploiting them for any purpose. They should instead think about their well-being.

Who is more vulnerable than someone who is suffering intolerably and is close to their tolerance threshold? Who are we to decide for them what their tolerance threshold should be? That is essentially what this is all about.

People want to live as long as possible. The court determined that these individuals' right to life was being infringed upon. I am sure the Conservatives have a lot to say about the right to life. The court found that by denying these individuals the right to medical assistance in dying, their ability to live as long as possible is being taken away. This prevents them from living until they reach their tolerance threshold. That is when we could provide care to them and proceed.

Without this assurance, what do many of these individuals do? They commit suicide prematurely, and this infringes on their right to life. This is indisputable, and it could not be considered reasonable in a free and democratic society, even if it went to the Supreme Court.

Some people always want to go to court. However, right now, people are suffering. While we are procrastinating, people are suffering. We have to put things into perspective.

The committee that considered the issue of mental illness as the sole underlying medical condition made a recommendation. That is why I think that Bill C-314 is premature, at the very least, if not irrelevant at this time.

I will read the committee's recommendation. It states, and I quote: “That, five months prior to the coming into force of eligibility for MAID where a mental disorder is the sole underlying medical condition, a Special Joint Committee on Medical Assistance in Dying be re-established by the House of Commons and the Senate in order to verify the degree of preparedness attained for a safe and adequate application of MAID (in MD-SUMC situations). Following this assessment, the Special Joint Committee will make its final recommendation to the House of Commons and the Senate.”

At the very least, I would have expected a debate to take place following the work of that committee. That is the least that could have been done. I invite my colleague from Abbotsford to read the report of the Special Joint Committee on Medical Assistance in Dying and especially the expert panel's report. The recommendations set out in the expert panel's report include criteria and guidelines that do not exist for other forms of MAID practice. He should feel reassured after reading those recommendations, and I am sure he will never talk about a slippery slope again.

[Gary Anandasangaree, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I thank the member for Abbotsford for bringing forward Bill C-314, an act to amend the Criminal Code regarding medical assistance in dying.

I acknowledge that we are gathered on the traditional unceded lands of the Algonquin people.

The bill before us proposes to indefinitely exclude persons whose sole underlying medical condition is a mental disorder from being eligible to receive medical assistance in dying, or MAID. I will be opposing the bill for reasons I will detail in my remarks. I want to start by providing a brief overview of MAID in Canada.

MAID was legalized in 2016 for persons whose natural death is reasonably foreseeable, through former Bill C-14. Four years later, in 2021, former Bill C-7 expanded eligibility for receiving MAID to persons whose natural death is not reasonably foreseeable. Former Bill C-7 also temporarily excluded, until March 2023, eligibility for receiving MAID on the basis of a mental illness alone.

Parliament decided that a temporary exclusion from eligibility for MAID where the sole underlying medical condition is a mental illness was necessary in recognition of the fact that such requests were complex and required additional study. This is why former Bill C-7 also required an independent expert review regarding recommended protocols, guidance and safeguards to apply to such requests. The expert panel on MAID and mental illness was created to undertake this review, and its final report was tabled in Parliament on May 13, 2022.

Former Bill C-7 also required the establishment of a joint parliamentary committee to conduct a comprehensive review of the Criminal Code MAID provisions and other related issues, including MAID and mental illness. The Special Joint Committee on MAID, or AMAD, took this review and tabled its final report in Parliament on February 15, 2023.

Our government extended the temporary exclusion to March 2024 through the enactment and coming into force of former Bill C-39. This was due to concerns about provincial and territorial readiness. It is important that we get this right.

I want to take a moment to point out that the intention has always been for the mental health exclusion to be temporary. This is a complex, sensitive and polarizing issue. Some very legitimate concerns have been raised.

However, I believe that the health care system will be ready for the safe provision of MAID where the sole underlying medical condition is a mental illness by March 2024. Significant progress has been made by our government, in collaboration with the provinces and territories and other stakeholders and experts, to prepare for this deadline.

We are not ignoring the concerns that have been raised. In fact, many of these concerns led to the one-year extension of the exclusion. We are moving in a prudent, measured way with the ultimate goal of ensuring that our MAID framework supports the autonomy of those who are eligible to receive MAID and protects those who may be vulnerable.

I will now turn to Bill C-314 and outline some of the technical issues.

As I stated previously, the bill proposes to indefinitely exclude eligibility for MAID based on a mental disorder alone. It would do this by replacing “mental illness” with “mental disorder” in subsection 241.2(2.1) of the Criminal Code.

There are two main issues with this approach. First, such a change may result in the unintended exclusion of persons with some medical conditions that are not currently excluded from eligibility for MAID. This is because “mental disorder” is a clinically defined term that practitioners have explained would likely capture all mental disorders included in the American Psychiatric Association's “Diagnostic and Statistical Manual of Mental Disorders”, or DSM-5, whereas “mental illness”, as it relates to MAID, is meant to capture mental disorders that are primarily treated within the domain of psychiatry.

“Mental illness” likely captures a smaller set of conditions than what would be captured by “mental disorder”. As such, making the switch in terminology without an accompanying definition may have the unintended consequence of excluding certain medical conditions that are not currently excluded from eligibility for MAID and that do not raise the same concerns as “mental illness” does in relation to MAID.

The second issue is that the term “mental disorder” is already defined in section 2 of the Criminal Code as “a disease of the mind”, and there is extensive case law interpreting what this means in the context of the “not criminally responsible” regime. Therefore, a switch in terminology in the Criminal Code MAID provisions without an accompanying definition may unintentionally complicate legislative interpretation and may also result in the existing case law interpretation of “mental disorder” and the “not criminally responsible” regime context being applied to the MAID context.

Although many experts and practitioners have noted a preference for the term “mental disorder” since it is a clinically defined term, this preference has already been expressed in the context of developing protocols, standards or guidance for MAID. It is important to remember that MAID is not just a health care issue. It is also a criminal law issue, and as I have just explained, things can get complicated in the legislative context given existing definitions and legal interpretations.

Finally, I simply want to point out that Bill C‑314 also restructures the exclusion set out in the Criminal Code but does not seem to change its application.

Currently, in order to be eligible for MAID, a person must have “a grievous and irremediable medical condition”, which is present when a person has a serious and incurable disease or disability, is in an advanced state of irreversible decline and is experiencing enduring and intolerable suffering, as per subsection 241.2(2).

Right now, a mental disorder is not considered an illness, disease or disability under the first part of the definition of a grievous and irremediable medical condition.

As such, a mental illness cannot satisfy the definition and therefore cannot be grounds for a request for MAID.

Under the proposed new exclusion, a mental disorder would not be considered a grievous and irremediable medical condition at all. In other words, it would exclude mental disorders from the whole of the definition, even though some of those aspects may well exist in the case of a mental disorder, namely intolerable suffering and an advanced state of decline. Although this new exclusion would operate slightly differently than the existing exclusion, it seems as though its effects would be the same.

I want to reiterate that Parliament considered this two years ago during its consideration of former Bill C-7 and decided that a MAID mental illness exclusion should be temporary. The point was reinforced by Parliament's enactment of former Bill C-39 this past March.

The expert panel on MAID and mental illness has tabled its final report, which notes that the existing MAID eligibility criteria and safeguards, supported by other key resources, provide an adequate framework for the provision of MAID where the sole underlying medical condition is a mental illness. Parliament considered the issues again via the Special Joint Committee on MAID, and the majority of members agreed with the expert panel's findings.

I urge members to join me in opposing the bill and not reverse Parliament's decision by unintentionally complicating legislative interpretation in the criminal law.

[Ed Fast, Conservative, Abbotsford, BC]

moved that Bill C-314, an act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Mr. Speaker, I am pleased to speak to my private member's bill, Bill C-314, the mental health protection act.

In its very essence, this bill is about reaffirming the dignity and worth of each and every human life. It is about recognizing that it is the most vulnerable among us, the disabled and the mentally ill, to whom we owe the greatest duty: to defend and protect their lives and to provide them with every possible opportunity to live life to the fullest.

Medically assisted suicide was legalized in Canada in 2015 by the Supreme Court's Carter decision and later under the Liberal government's Bill C-14. Under this legislation, medical assistance in dying, or MAID, as it is commonly called, was strictly limited to those consenting adults who had an incurable disease that caused enduring, intolerable suffering that could not be alleviated, and where natural death was reasonably foreseeable, which they call the foreseeability test.

At the time, the government and its supportive stakeholders assured Canadians that this was not a slippery slope, where the scope of MAID would continually be expanded to include more and more vulnerable Canadians. However, not surprisingly, in the intervening eight years since the Carter decision, the government has begun to expand Canada's MAID regime to include more and more defenceless Canadians, most particularly those living with disabilities.

In late 2019, a Quebec lower court judge in the Truchon case ruled that the foreseeability test I just mentioned was unconstitutional, requiring Parliament to respond with additional legislation. Sadly, the Liberal government chose not to appeal the Truchon case to the Supreme Court of Canada, presumably because the decision lined up with the Prime Minister's intent to dramatically expand assisted suicide to other vulnerable Canadians. This leaves us with the perverse situation in which the Supreme Court of Canada, the highest court in the country, has never been allowed to opine on whether the reasonable foreseeability test is constitutional.

In any event, the Liberal government responded to Truchon by tabling Bill C-7, which initially eliminated the foreseeability test but expressly excluded mentally ill persons from being caught up in its MAID regime. Here is what the justice minister said at the time:

The fact that there would be risk of ending the life of a person whose symptoms would have improved...is, in part, why we are of the view that it is safest not to permit MAID on the sole basis of mental illness.... There is also ongoing uncertainty and disagreement as to the potential impact on suicide prevention if MAID were made available to this group.

He went on to say:

...there is no consensus among experts on whether and how to proceed with MAID on the basis of mental illness alone. On a question of such importance and with so much uncertainty and expert disagreement, it is incumbent upon us to proceed with caution and prudence.

Those were our justice minister’s views until the unelected Senate suddenly introduced an amendment that expanded MAID to those Canadians whose sole underlying condition is mental illness. Sadly, the justice minister and the government accepted the amendment without protest and, overnight, became zealous proponents of assisted death for the mentally ill. What happened to the caution and prudence the minister was preaching? What about the impact on suicide prevention the minister was so concerned about? What happened to his view that it was safest not to permit MAID on the sole basis of mental illness?

I agree with the Minister of Justice on one thing, which is that, as he has said, this is indeed a complex issue and is deeply personal. It is deeply personal because it involves life, a precious human life.

I would remind the minister and his government that the issue is also profoundly simple; that is, the principle that all life, all human life is precious and worthy of defence and protection, especially for those who do not have the ability to speak for themselves and have no one to speak for them.

One of the primary functions of government is to protect its citizens, to protect life. In fact, the right to life is expressly enshrined in section 7 of our Charter of Rights. Sadly, the government's Bill C-7 fails to protect the lives of our most vulnerable. It removes the critical safeguards that the original euthanasia legislation included in response to the Carter decision. Removing those safeguards will have irreversible consequences for those who suffer from mental illnesses like depression.

What is equally disturbing is that the Liberal government has also signalled its intention to extend the so-called “treatment option” to minor children. That would arguably make Canada the most expansive, most liberal, assisted suicide jurisdiction in the world. Clearly we are on the slippery slope many of us warned about. Canadians have a right to conclude that the Liberal government has gone too far and too fast in its zeal to implement and expand the scope of assisted death.

My bill will reverse this momentum and repeal the government's decision to extend MAID to the mentally ill. It will put a full stop to the expansion of assisted suicide to mentally disordered persons. Let me be clear. My bill does not in any way reverse the rest of Canada’s MAID regime. Assisted death will remain available for those suffering from irremediable, incurable and intolerable illnesses and diseases. My bill is simply focused on reversing the government’s actions in expanding assisted suicide to include the mentally ill. It would arrest Canada’s slide into normalizing assisted death as an alternative treatment option, something so many of us had predicted would happen.

The evidence from mental health experts is very clear. Contrary to what our justice minister is now saying, there is absolutely no consensus in Canada that the mentally ill should be covered by Canada’s medically assisted death regime. In fact, here is what experts and other stakeholders in the mental health community are saying. John Maher, psychiatrist with Canadian Mental Health Association, states that:

Inducement to suicide while simultaneously denying mental health care to two-thirds of Canadians who urgently need it is an unconscionable failing.

Directly undermining suicide prevention efforts is an insidious and ablest perversion of our mental health care duty.

Drs. Ramona Coelho and Catherine Ferrier, co-founders of Physicians Together with Vulnerable Canadian, penned a statement that was endorsed by over 1,000 physicians. This is part of what it said, “Given that there is no medical evidence to reliably predict which patients with a mental illness will not get better, MAID for mental illness will end the lives of patients who would have recovered…Medicine …would fail in its mission if it were to deliberately end the lives of patients living with mental illness… Legislators must work towards safeguarding the lives of the most vulnerable including those placed at a greater disadvantage because of mental illness.”

Dr. Sonu Gaind, chief of the Department of Psychiatry at Sunnybrook Hospital, Toronto, stated, “The Ministers have provided false reassurances that we can somehow separate people who are suicidal from those who are seeking psychiatric euthanasia. That is simply not true. In my opinion, that is dangerous misinformation coming from our federal Minister of Justice and our federal Minister of Mental Health and Addictions providing a false sense of safety that does not exist.”

Trudo Lemmens, professor and chair in health law at the University of Toronto, said, “I urge Parliament to take very seriously how offering MAID for mental illness deprives disabled persons, particularly those with mental illness, from equal protection against premature death. Persons experiencing mental illness deserve to be protected against premature death by an unreserved focus on ensuring access to all required health care and social support services. Facilitating their death does exactly the opposite.”

Finally, Sephora Tang, psychiatrist and assistant professor in the Department of Psychiatry at University of Ottawa, said, “One cannot prevent suicide while at the same time facilitating it. Placing expectations upon mental health professionals to do both undermines the effective delivery of recovery-oriented mental health care. Canadians deserve to live in a country that is committed to safeguarding the right to life and security of every person. Current MAID legislation fails to achieve this overarching social good.”

Even Canada's justice minister has publicly acknowledged the fact that issues such as irremediability, competency and suicidality are not anywhere close to being resolved to justify such a major policy shift in favour of death. Furthermore, medically assisted death flies in the face of the government’s own promotion of suicide prevention programs, including the recent creation of a national 988 suicide hotline.

It cannot be both ways. It cannot claim, as the Liberal government has, that it wants to prevent suicide deaths on the one hand, when it actively promotes assisted suicide for the mentally ill on the other. Over the last eight years, many of us have expressed our concern and expectation that the Carter decision and BillC-14 would be expanded by future court decisions, and that these decisions would leave more and more vulnerable populations exposed to the reach of medically assisted suicide.

Our concerns were pooh-poohed. We were accused of fearmongering and of misrepresenting the intentions of this Liberal government. Yet, today, the Truchon decision and the travesty of Bill C-7 bear out our concerns. That is why more and more disability groups have set the alarm bells ringing and are vehemently opposing this legislation. They argue that this legislation amounts to a deadly form of discrimination, making it easier for persons with disabilities to die than to live.

We are hearing more and more reports of the poor and homeless approaching food banks to ask for assisted death, not because they are suffering from a grievous illness but because they do not want to go hungry and homeless. The headline in the British magazine The Spectator asked last year, “Why is Canada euthanising the poor?”

The response from some bioethicists appears to be, “Well, why not?” In fact, a new paper by two bioethicists at the University of Toronto makes the case that euthanizing the poor should be socially acceptable. That is indicative of the path on which our country finds itself. It is terrifying.

We also have verified reports of veterans suffering from PTSD who are being counselled by the Liberal government to consider medical assistance in dying rather than being provided with the treatment and supports they need to recover.

These are the vulnerable that the Liberal government promised to protect. Canadians have the right to ask whether this government is exercising the requisite caution and care to avoid unnecessary overreach and ensure that MAID is not abused or misapplied.

Let me conclude. My private member's bill, Bill C-314 gives all of us parliamentarians an opportunity to take a deep breath and reconsider the perilous road we have embarked upon. As I mentioned, my bill simply reverses the expansion of Canada’s assisted death laws to the mentally ill. At the very least, I would ask my colleagues to allow my bill, at second reading, to go to committee where there could be more discussion.

Have we gone too far and too fast with Canada's assisted suicide program? Will we evolve into a culture of death as the preferred option for those who suffer from mental illness or will we choose life?

I implore my colleagues to choose life. I wish them much wisdom as they make that choice.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, I want my constituents to know that I am staying in the riding to take care of my newborn, but I am happy to participate, in hybrid fashion, on their behalf on this very important subject.

Bill C-39, an act to amend the Criminal Code regarding medical assistance in dying, seeks to delay the expansion of medically assisted death to individuals whose sole condition is a mental illness. We are here today because of previous legislation in the last Parliament, Bill C-7, that responded to the Truchon decision and the justice minister's interpretation of it by removing critical safeguards to accessing MAID, particularly that death must be reasonably foreseeable. However, Bill C-7 contained an arbitrary deadline of March 17, 2023, to expand MAID to those whose sole condition is a mental illness, and now the government is seeking to delay that arbitrary deadline another year down the road.

As I do not want MAID to be offered to those who are solely suffering from a mental health issue, I will be supporting the bill, but I do so in the context of very big and life-altering concerns regarding the direction the Government of Canada has taken since the debate on MAID commenced in 2016.

The Conservatives believe that we should never give up on those experiencing mental illness and should always be focused on offering help and treatment rather than assisted death. The Conservatives will bring forward alternative proposals to support those with mental illness instead of the government's approach.

Going back to 2016, the preamble of Bill C-14 spoke about the vulnerability of persons. It states:

Whereas vulnerable persons must be protected from being induced, in moments of weakness, to end their lives

It also states:

Whereas suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities

Man, have we seen a lot of change in the last seven years.

Conservative members at the time, despite these assurances in Bill C-14, observed that the approach of the government was going down a slippery slope. The member for Selkirk—Interlake—Eastman highlighted a concern that has sadly now become a reality in Canada. He stated, “many believe that the policy will be used prematurely to end the lives of those who have become a burden to their families, society, or the medical system.”

At the time, because of big public concerns, many Liberal members were careful when it came to speaking about expanding MAID in the future. The former justice minister, Jody Wilson-Raybould, said, “In terms of eligibility, the policy choice made by the government was to focus on persons who are in an advanced state of irreversible decline and whose natural deaths have become reasonably foreseeable.” The current member for Lac-Saint-Louis said, “Bill C-14 would not normalize medically assisted dying as perhaps has occurred in Belgium and the Netherlands, the two most often cited examples of the slippery slope.”

In the last Parliament, in his charter considerations on Bill C-7, which expanded MAID to include those without a reasonably foreseeable death, the current Minister of Justice cited inherent risks and complexity as a reason not to expand MAID to those with mental illness as a sole condition. However, the Minister of Justice, unfortunately, as we find today, is speaking on both sides of this issue very irresponsibly. On the one hand, he communicated in the Bill C-7 charter consideration that due to the complexity and inherent risks, we should not be expanding MAID to those with mental illness as a sole condition. On the other hand, in the same bill, he included a sunset clause to expand MAID to these Canadians and said that his hands were tied by a Quebec court decision. However, not only has the government refused to challenge it at the Supreme Court, but leading legal experts in our country have stated that his interpretation of the decision is flawed.

After telling Canadians time and again that the legalization of MAID would not lead to a slippery slope by allowing death on demand for any citizen whenever they may want it, the government seems set on expanding MAID to anyone.

I plead with the backbench members of the Liberal Party to stand up against the justice minister today. You have more influence than any Canadians right now to stop what he is trying to do.

Do not forget that in 2016, on Bill C-14, he voted against the—

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I am glad to be joining this debate at this late hour. I understand this is an issue that is very close to many people's hearts, and a lot of members wanted to rise. I wanted to make sure I caught your eye on this one.

“The Lord rewards a good deed but maybe not right away.” That is a Yiddish proverb I have often heard. I have heard it in Polish. I love Yiddish proverbs, as many members know. Growing up in my family, my grandmother used to say them. She said them in Polish. It turns out that nearly all of them are Yiddish in their origin. That was something humorous I would talk to her about.

In this case, some members of the public think we have actually voted through things that we have not voted through. All we are doing here, directly in the summary of this legislation, is delaying making a final decision until March 17, 2024, on the repeal of the exclusion from eligibility for receiving medical assistance in dying in circumstances where the sole, the only, underlying medical condition identified in support of the request for medical assistance in dying is a mental illness.

I am prepared to speak on this piece of legislation as I have done in past Parliaments. I have been here since the 42nd Parliament, so I have been through the debate on Bill C-7, and the debate on Bill C-14.

Bill C-7 was originally the response to the Carter decision rendered by the Supreme Court of Canada. In it, the Supreme Court found that there was a constitutional right to seek an assisted suicide from a medical professional. It is an exemption to a part of the Criminal Code, but do not ask me to quote which section of the Criminal Code. I have, fortunately, not been burdened with a legal education, so I come at this with a layperson's eyes.

It provided an exemption. Sometimes, when I have a back-and-forth with constituents back home, I raise that point. It is an exclusion to that particular section of the Criminal Code. Then, it becomes incumbent on the federal government to put in place some measures to protect the vulnerable in society.

There were a few people who emailed me over the last few months to talk about that vulnerability, people from different sectors of our society, and how they would be affected. This is not a unanimity in my riding, but the vast majority of the people who contacted me are opposed to the extension of medical assistance in dying, or assisted suicide, for people with a mental illness, when it is the sole condition that they have. They have been very clear on this. Some of the emails are quite emotional. Some of them are a dissertation of what has happened to their family, essentially, and they give particular cases.

I want to do them justice by reading some of their thoughts without using their full names, just to protect their anonymity in the emails. I was also here for the debate on Bill C-14. I remember this debate quite vividly, because Bill C-14 came after the Truchon decision. In that decision, the court found that there was a wording we had used, irremediable or unforeseeable deaths. I remember debating in a previous Parliament and saying this would likely be struck down by the court. It was such a broad term that it could mean anything. It went beyond what the Carter decision said. It was struck down by a court. Let that be said to my friends who are lawyers. I am occasionally right on the law and about what the courts would do. They did strike it down in Bill C-14.

Now we are going back again. I understand that, today, the special committee on medical assistance in dying, which was struck by the House, finished its review and tabled the report. I have not yet had the time to completely review that report. To the constituents in my riding who have emailed me over the last few months as this issue has gained more traction, I want to read a part from Allison.

Allison wrote to me, “A family member with complex health conditions said she was asked so many times about it,...” it being medical assistance in dying, “...she wondered if her Dr. would get a commission for the procedure!! Where are the safeguards and regulations? Who protects vulnerable patients from being coerced by subtle suggestions?”

She goes on, “To be human is to experience pain, suffering and vulnerability. In my family, we have had people that have struggled with mental illness and recovered to live productive, healthy lives, thanks to support from family and community.” She is saying, “let us help you live better” should be the message we send people who are suffering from a mental health condition or a mental illness of some sort. I have known people in my life, around me, who have gone through that as well.

Lisa in my riding emailed me in December and said, “As a citizen who is deeply invested in the going ons with MAID and disability services in this country I keep current in what is happening and research.” She started off by saying that she is the mother of a child with a disability. Her son has no siblings and no close family to look out for him and advocate for him. She mentioned that once she and her husband are no longer alive, she is worried what type of country will be left behind for her son.

She uses some pretty harsh language, but it is parliamentary; I checked. She went on to say, “The way in which Canada has expanded MAID is nothing short of predatory, opportunistic and ableist.” Those are the words she uses. She asked some questions, and I do not have easy answers for her, but I will ask them openly here: “Why are they not being offered better mental health and physical health supports? Why is the government expanding MAID without first expanding holistic supports to our disabled people?”

She then says, “As a mother of a vulnerable child who one day will be left alone who may be exceptionally impressionable and dependant on our broken system I am deeply concerned about the expansion of MAID and its possible implications.” She implores us, “Do better Canada!” That was from Lisa in my riding.

Bev in my riding is very concerned about MAID being expanded to adolescents. I know that debate is going on concurrently. It is not directly in Bill C-39, because we are just talking about delaying for a year the approval of mental illnesses and mental health issues as the sole underlying conditions for applying for medical assistance in dying. However, in her email to me, she noted how vehemently opposed she is to MAID being expanded to adolescents or children and to making this expansion permanent in the law. She went on a bit, but some of it is not entirely parliamentary, so I will avoid violating the rules of the House.

Joe in my riding mentions the following: “We have already had someone in the Department of Veterans Affairs advocating Maid for those with PTSD. What terrible advice to give our veterans. Please do not proceed with eliminating those whose only problem is that they are mentally ill.” I have talked to Joe many times. He is what I would call one of my regulars, as he emails me quite often. He is very passionate about public education, I will add.

Cindy in my riding said, “At no point does a healthy family or community decide that one of its dearly beloved members is better dead than alive. The veneer of compassion is easily seen through.” She went on to make a point that really struck me:

It is indeed a slippery slope to offer MAID to the mentally ill, depressed, bipolar, and any other non-detectable illness—especially when removing the requirement that death be considered reasonably soon.

By expanding MAID in this way, the floodgates are opened for Canadians to easily choose despair over meaning in their lives.

This is the wrong direction for Canada, and an embarrassment on the international stage.

The last one I will read is from Shirley, which is very simple. She said, “Has the world gone mad?” She talks about expanding MAID to those who have a mental illness, expanding it to young people, and on and on.

Those are the types of emails I have been receiving, on top of phone calls, and those are the worries I wanted to express on the floor of the House.

Some are suffering and going through difficult times, and some are diagnosed with really serious chronic conditions that are essentially terminal, conditions like Alzheimer's and Lou Gehrig's disease. The original foundational decision that Carter was gripped with was what to do about ALS, an awful condition. It is degenerative, chronic and pretty much incurable. There are many therapies out there to delay the condition. There was a member in the 42nd Parliament, an honorary chair occupant for a day, Mauril Bélanger, who passed away from it. Since then, I have met others whose family members have passed away. What I think the judges and the court were trying get at is that these are the people we should be looking after.

I want to lay this before the House. When a doctor gives up on someone, they are much more likely to give up on themselves. I have seen this time and time again. I have also experienced it myself when my disabled daughter was so sick that the four doctors in the room termed the condition “not conducive to life”. There is nothing like being told this by physicians who are supposed to look after a child, and seeing, essentially, the gentle and subtle push that my constituents talked about, which is repeated over and over. There is also the consumption of resources. That will lead to more people using the system when they have other options. Resisting the urge to just give up is difficult to do at the best of times, and people need community and family support all around them.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Madam Speaker, I am proud to rise on behalf of my compassionate and caring residents of Renfrew—Nipissing—Pembroke. Like the majority of Canadians, my constituents strongly oppose state-sponsored suicide for those living with mental illness. That is why I will support the legislation to delay this from happening. This bill to delay providing assisted suicide is critical. It is a matter of life or death that this expansion be delayed.

Many Canadians are wondering, “How did we get here?” To describe this process as a slippery slope is to understate how greasy this rapid descent has been. How did we go from the Supreme Court reversing a precedent granting the right to die to those with incurable illnesses causing intolerable suffering and whose deaths are reasonably foreseeable to the point where the Quebec College of Physicians and Surgeons is advocating for the killing of newborn babies? How did we get here?

Obviously, first and foremost, the decision by the Supreme Court was to overturn the previous Supreme Court decisions and allow for a limited exception to the Criminal Code. The court found that the prohibition on assisted suicide is intended to protect vulnerable persons from being induced to die by suicide. The court ruled that the total ban on assisted suicide was overly broad because it also applied to non-vulnerable people and prevented them from receiving the assistance of a willing physician. The court said that it was up to Parliament to strike the right balance between Canadians suffering grievous and irremediable illness who want access to physician-assisted dying and those who may be put at risk by its legalization.

Then, Parliament debated legislation and Bill C-14 was passed in 2016. People whose deaths were reasonably foreseeable, meaning they were dying, and who were suffering intolerable pain could seek medical assistance. Despite widespread reservations, many Canadians view medical assistance in dying as compassionate.

Then, one judge said this was a violation of equality rights. The judge ruled that someone whose death was not reasonably foreseeable but who was suffering intolerable pain had the same right to assistance in dying. The progressive government did not appeal the case. It embraced the ruling and brought forth legislation to expand physician-assisted death to people who were not dying.

When that bill was before committee, the justice minister explained why physician-assisted suicide could not be expanded to include people whose sole condition was mental illness. The minister said there was no consensus. The bill then went to the Senate, where suddenly a secret consensus was discovered, unbeknownst to the medical community. The government flipped and flailed, and embraced this expansion to include mental illness.

The minister claimed the government would strike an expert panel to shape the necessary protocols to ensure that only the non-suicidal would be eligible for physician-assisted suicide. Last May, that expert panel returned with a protocol, albeit with two fewer members than when it started, after they resigned in protest. What did the expert panel have to say?

There is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient.

The expert panel, handpicked by the Liberal government, said it was impossible to make accurate predictions about future prognosis. Despite that admission, the Liberals still went ahead with recommending a protocol for allowing physician-assisted suicide for people whose sole condition is mental illness. The government claims it is listening to the experts, yet two of the experts on the panel resigned. They were prevented from providing a dissenting report. They are not the only experts speaking out.

I would encourage all my colleagues to get their hands on the article in the Globe and Mail, published last November, entitled “Canada will allow assisted dying for mental illness starting in March. Has there been enough time to get it right?”, written by Erin Anderssen. The article introduces readers to Dr. Madeline Li, a psychiatrist at Princess Margaret Cancer Centre. Many of my colleagues here may remember Dr. Li from her appearance before the Special Joint Committee on Medical Assistance in Dying. While the article touches on a number of the regressive aspects of expanding assisted suicide, I feel this passage is particularly relevant to our conversation:

But among the many experts who have lined up to express their objections to the direction and pace of Canada’s euthanasia laws, Dr. Li’s deserves particular attention. She led the creation of MAID protocols at the University Health Network, a group of Toronto-area hospitals that together form the largest health research group in the country. At the national association for MAID providers, she is the scientific lead currently developing the government-funded assisted-dying curriculum for doctors. She has administered assisted deaths directly to patients, and provided oversight to hundreds of cases as the MAID program lead at the UHN.

All that experience, she said in an interview, has made her personally opposed to expanding MAID for patients without a foreseeable death, especially those with mental illness. The debate among doctors has become too ideological, she said, and the current system doesn’t have enough safeguards to prevent unconscious bias from factoring into decisions.

Can doctors—a mostly healthy, privileged group of people living in a society that routinely stigmatizes people with disabilities—objectively judge what makes life worth living? Dr. Li says she once watched a doctor use an actuarial chart to calculate that an older woman seeking MAID after a fall had, on average, three years left to live; he approved her for MAID, over the objections of three other physicians. “What if it had been six?” she asked. “How many years is enough?”

Dr. Li worries that since many psychiatrists won’t participate in MAID, there will be “an echo chamber of a few assessors who will all practice in the same way,” leaning hard toward patient autonomy. Already, she argues, MAID assessments are too often focused on whether a patient is eligible for an assisted death, rather than exploring why a patient wants to die in the first place.

The federal expert panel recommended that decisions should be made on a case-by-case basis, with the doctor and patient reaching a shared understanding. But while the law requires that patients must give “serious consideration” to clinically recommended treatments to relieve their suffering, they can refuse those treatments if they don’t deem them “acceptable.”

For instance, Dr. Li described the case of patient in his 30s, who asked for an assisted death, even though multiple doctors said his cancer was curable. Two assessors approved him for MAID. Faced with his adamant refusal to get treatment, and his progressing condition, Dr. Li said she helped him die “against her better judgment.” If MAID didn’t exist as an option, she believes he would have gotten treatment, and still be alive.

The government and its hand-picked experts assure us they can devise protocols rigorous enough to prevent vulnerable people from receiving assisted suicide. The expert panel says that despite it being impossible for doctors to predict a future prognosis of mental illness, Canadians should trust the opinion of doctors in making a determination of intolerable mental suffering, yet Dr. Li, against her better judgment, went ahead with assisting in the death of a man in his 30s who had a treatable cancer.

Unlike cancer, where we can have an objective test to determine a prognosis, we are supposed to just trust the opinion of doctors. Dr. Li was of the opinion the young man's death was not foreseeable. His condition was treatable, yet she assisted in his suicide. She is opposed to expanding this. How reluctant will physicians who support assisted suicide be when assessing people with mental illness?

Finally, while Dr. Li feels the debate has become too ideological, Canadians following the debate in this House might be confused. We have seen social Conservatives, small “L” liberals and socialists all raising serious concerns. We all seem to have the same goal of the maximum amount of compassion and care, while protecting the vulnerable.

I imagine there are about three million Canadians who grow angry hearing the Minister of Justice centre this debate on balancing the protection of vulnerable Canadians while preserving individual autonomy. On this issue, the minister seems to be more concerned with the autonomy of individuals to make their own medical determinations, while less concerned with the impact on vulnerable people.

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

Mr. Speaker, in regard to what the last speaker said, I believe, whether it is today or the other evening, that the Conservative Party has been politicizing what is very much a personal issue. Are they bringing in vets?

I had the privilege and honour of serving in the Canadian Armed Forces. I marched with World War I and World War II veterans in a parade. After the parade of remembrance, we went to a legion where there were all sorts of discussions. One got an appreciation of the sacrifices that were made and the types of horrors they had to endure.

To use veterans in a manipulative way to try to give the impression that the Liberal government, let alone any member of this House, would support that any civil servant recommend to a veteran that they apply for MAID is absolutely ridiculous and uncalled for. It is a politicization that cannot be justified. If there is a civil servant working for Veterans Affairs, any civil servant, it is something we take very seriously. They should not be communicating with the public, especially not with veterans, knowing what veterans, not exclusively, often have to go through.

The member referenced the idea that the Prime Minister is not listening. I reflect on debates on Bill C-14, which was brought in back in 2016. The member for Charlottetown referenced the Supreme Court of Canada's decision. It obligates the House of Commons and all members of Parliament to deal with medical assistance in dying. There is no choice. We are a nation that operates with respect to the Supreme of Court of Canada, the rule of law, and that obligation for us to deal with it.

Let us look at the debates we had then, in contrast to what we heard the other day in the speech before mine. In 2016, members debated the then-Bill C-14 with a great deal of passion, and people expressed personal opinions in a very real way. I cannot recall the same sort of partisanship. In the debate the other night, the member said the Prime Minister was not listening to what groups were doing and he was forcing this bill through. We have a minority government. The government and the Prime Minister cannot force anything through, unless there is at least a buy-in by a majority of the members who sit in the House. How can the Prime Minister force something through?

What I hear from the other side is that mental health and depression will somehow qualify someone to be able to apply for MAID. That is not the case. Do the members know the difference between a medical illness, where someone works for years with a psychiatrist and is diagnosed as mentally ill, versus someone with a mental health issue?

Just because someone is depressed one day, or individuals might have some mental health issues, does not mean they are mentally ill as prescribed by a psychiatrist who individuals work with over months, if not years.

If someone wakes up today and they are not feeling good, and maybe there has been some depression over the last number of weeks and months, that does not mean they go to the hospital or somewhere and then they are told they can apply for MAID. That is not the way it works.

If one listened to the Conservatives, one would think it is like MAID on-demand, and it is not. Trying to give that false impression is doing a disservice to the debate, because they are not understanding the issue of what is being advocated for.

If someone has a serious depression issue because of a layoff, a marital breakdown or a death in the family, it does not mean they can apply for MAID. If their depression is that severe in a relatively short period of time and they apply for MAID, then they will find other supports they can get in touch with.

I would argue that there is another side of this debate we are not looking at. There are individuals who are wondering about MAID and are thinking about making contact as a direct result of knowing it is there, even though they would not be eligible to apply. We are talking about not months, but years, of working with a psychiatrist, where there is no remedy. After that, it still has to go through another process. We are talking about a very small percentage.

If the Conservatives want to talk about mental health in general, I am game for that. Regarding mental health, let us take a look at the agreement we just signed. It is over $196 billion. That will be millions of dollars going toward issues like mental health.

For the first time, there was a program, the Wellness Together Canada portal, which led to a direct service to Canadians dealing with mental health. It was put in by the Liberal government. Over two million people have been served through that portal. All of them have dealt with some form of mental health issue. Out of those people, there might be zero who would qualify to apply for MAID. It may be a very minuscule percentage, if any, of those who went through that portal. However, we would not think about that if we listened to the Conservative Party.

The Liberal government has raised the issue of mental health virtually from day one. During the pandemic, we put a program in place and we invested millions of dollars to provide support for people who are enduring mental health-related issues.

There is a difference between what we are talking about with MAID and the bigger picture of mental health in Canada. We know that. We have invested in it. We are talking about billions of dollars.

If we reflect on their debates, the Conservatives were even taking extra caution by having the extension. That is why all members in the House are standing up and saying they will vote in favour of it, because it is an extension.

The government is working with stakeholders and other members of the House, not just Liberal MPs, to ensure that we get it right. We have not drawn the same conclusion that the Conservative Party of Canada has. We recognize the issue of mental illness and what is coming from our courts.

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, as always, I want to thank the constituents of Niagara West for electing me to represent them in Parliament and be their voice in this place on the key issues of our country. What is more important than the bill we are discussing today, Bill C-39, respecting medical assistance in dying? We all know how sensitive and complex a topic this is. We as parliamentarians, with this bill, are dealing with the issue of literal life and death, which is a deeply personal decision, and that is as complex as it gets.

On both sides of the House, the focus and priority of all of us is to ensure that safeguards are always in place for the most vulnerable people in our society, particularly for those with mental health challenges. I believe that we are all trying to get this legislation right. Lives are at stake, and again, we need to get this right. We also have to keep in mind that we have to be respectful and accepting of the different perspectives on this issue.

Many folks from my community in Niagara West are people of faith, and they are struggling with this concept of doctor-assisted suicide. This issue is of particular importance to the thousands of my constituents who took the time to write letters, send emails and make phone calls to my office to express their views. This is an issue that is exceptionally difficult to accept for many Canadians across the country, including those in my riding of Niagara West.

The planned legal death of someone who is terminally ill is a very delicate matter to begin with, but to open up the door for more people to qualify on mental health grounds, to me and to many of my constituents, is even more troubling. These folks want to ensure that we, as the representatives in this place, safeguard human life in the aftermath of the Carter v. Canada Supreme Court decision.

There is also strong concern that people with mental health issues may be persuaded into ending their lives while they are in a state of personal suffering. That is wrong, and I am sure that we all want to prevent that kind of thing from ever happening to anyone. I am also concerned that there may be horrible stereotypes reinforced, such as that that a life with a mental health challenge is not a life worth living, or that living with it is a fate worse than death. This cannot happen.

I know it has already been discussed, but I would like to provide some information and context for my constituents who are not yet aware of how we got to this point and why we are currently discussing medical assistance in dying in Parliament.

On February 6, 2015, the Supreme Court of Canada ruled that grievously suffering patients had the right to ask for help in ending their lives. This was the Carter v. Canada decision. In other words, the Supreme Court made medical assistance in dying a legal right for Canadians under our Charter of Rights and Freedoms. The Supreme Court declared that paragraph 241(1)(b) and section 14 of the Criminal Code, which prohibited assistance in terminating life, infringed upon the charter rights of life, liberty and security of the person for individuals who wanted to access an assisted death. The Supreme Court decision was suspended for a year to give the government time to enact legislation that reconciled the Charter of Rights of individuals and patients. As a result, the government introduced Bill C-14 on April 14, 2016, and it received royal assent on June 17, 2016. Medical assistance in dying has been legal ever since.

An important fact to remember, once again, is that the legalization of assisted death began with the Supreme Court decision in Carter v. Canada. The last time I spoke to this issue, I reiterated my concern, and the concern expressed by thousands of my constituents, that there simply are not sufficient safeguards for those who are most vulnerable in relation to accessing medical assistance in dying. I feel the same today.

I believe my esteemed colleague from Calgary Nose Hill is absolutely correct. This week, she spoke to the same bill and said that she finds it reprehensible and an abdication of responsibility of every parliamentarian of every political stripe to allow medically assisted dying to be extended to Canadians with mental health challenges, given the abject, miserable state of mental health supports in Canada. She spoke about the difficulties in accessing mental health supports across the country, and I believe she is correct. Mental health services are not readily available. They are also very expensive. The availability of quality mental health services must be there across the country before we even start to consider this debate on legislation that allows folks experiencing mental health issues to seek medical assistance in dying.

Let us not forget something very important here: One of the symptoms of a mental health issue is the unfortunate thought of wishing to die. How can we not get our mental health care system in order first before we contemplate allowing folks to commit medically assisted suicide because of a potentially treatable mental health challenge? I cannot fathom a life being lost because of a treatable mental health issue that went untreated because of a lack of quality and available supports.

I am sure my hon. colleagues have also heard the story of an Ontario man who requested MAID, not because he wanted to die, but because he thought it was a preferable alternative to being homeless. Housing is another major issue the government has not adequately addressed. We should not be a country where folks who are homeless should live in such despair that they feel they have no option than to request medical assistance in dying.

In another story, a disabled Ontario woman applied for MAID after seven years of applying for affordable housing in Toronto with no luck. I think we are all in agreement that these types of cases should never happen.

I am also very concerned about the mental health of all Canadians, given the difficult times we are in. Inflation is at a generational high. The cost of groceries is up 11%. Half of Canadians are cutting back on groceries, and 20% of Canadians are skipping meals. The carbon tax is being tripled, adding unnecessary costs to families’ gas, grocery and home heating bills.

The average rent in Canada’s 10 largest cities is more than $2,200 a month, up more than $1,000 a month over the last eight years. Average monthly mortgage costs have more than doubled, now costing Canadians over $3,000 a month. We are seeing a record number of Canadians visiting food banks.

All of this takes a tremendous toll on the mental health of families, seniors and especially those suffering with mental illness and other vulnerable groups. Life was not exactly easy for many people before the pandemic, and it has certainly gotten worse with the inflationary crisis we are in. The important thing to remember here is that investments into mental health services must be made a top priority, because as we all agree, mental health is health.

Let us turn back to Bill C-39. I believe there should be strong safeguards to ensure those most vulnerable never fall through the cracks and end up on a list of people to be medically put to death before they have exhausted all avenues to live a meaningful life.

Let us be clear about something, medical assistance in dying is a tremendously difficult issue to debate. It is a highly emotional topic, and there are many factors and personal convictions that come into play. We agree on many things, but we also disagree strongly on others.

On this issue, specifically, we must respect and listen to one another’s views as we chart the course of our future and the future realities of those who are most vulnerable. We can either signal to them that we care by expanding mental health supports and investing in quality services, or we can unfortunately go down a dark path of allowing those who are struggling with treatable mental health challenges the opportunity to end their lives.

I support investing in our people by providing quality and easily accessible mental health treatments. However, this is not what the government’s Bill C-39 does. It seeks to delay, for one year, the implementation of provisions that would expand the availability of assisted dying to those whose sole underlying condition is mental illness. That is wrong.

Unfortunately, the Liberal government has brought forward this delay to their MAID expansion because they failed to heed the concerns of our Conservative members, mental health advocates and Canadians when they passed legislation in 2021. I personally do not believe that we should ever give up on those experiencing mental illness. According to the most recent polls, a majority of Canadians would agree with me.

A majority of Canadians oppose the government’s plan to offer assisted dying to patients with incurable mental illness. The Angus Reid poll shows 51% of respondents said they oppose the expansion of medical assistance in dying to Canadians whose sole condition is mental illness. In other words, 51% of Canadians believe that we should be focused on offering help and treatment rather that assisted death.

Having said all this, at this point we will be supporting this delay to prevent the immediate expansion of assisted death to those suffering with mental illness. In the near future, we will bring forward alternative proposals. My hope is that the we all uphold the original objective of the initial legislation, which was “to affirm the inherent and equal value of every person’s life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled.” That we must protect “vulnerable persons...from being induced, in moments of weakness, to end their lives.”

This issue is very important to me and to many of my constituents, and I look forward to working with all my colleagues, from all parties, to get this right.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you.

We talked about vulnerability. Is there anyone more vulnerable than someone who has an incurable illness causing them so much suffering that they have reached their breaking point? That is why I think the government wisely decided not to take the issue to the Supreme Court. People were going on hunger strikes in an attempt to satisfy the reasonably foreseeable natural death criterion because they could no longer take their suffering and desperately wanted access to MAID. That's horrendous.

My fellow members over here are critical of the judge's decision, but it established that the government's position infringed on the individual's right to life because, instead of providing assistance when the person could no longer tolerate their suffering, the system waited for them to commit suicide. The message that sends people is that suicide is their only option. It amounts to telling them to commit suicide because it's not our problem. On top of it all, those individuals had to take their fight all the way to the Supreme Court despite the intolerable suffering they were experiencing because of their illness. I don't think that is a government's role. A government's role is to make sure the conditions are in place so that people can exercise their freedom of choice.

That said, how many MAID bills, other than Bill C‑39, were private members' bills? None. Bills C‑14 and C‑7 came about in response to court decisions, because citizens were forced to defend their rights in court.

My Conservative colleagues say that, had they been in power, Ms. Gladu and Mr. Truchon would have never had access to MAID, nor would all the others who suffered and were granted access to MAID precisely thanks to Bill C‑7. It's probably worth asking who the most vulnerable members of society are. In my view, the vulnerable ones are those suffering from incurable illnesses who are denied MAID because the right-thinking government knows better than they do what's good for them. For what reason should they be denied that?

Throughout their lives, their right to self-determination is recognized. In biomedical contexts, they are told that no intervention can be provided without their free and informed consent. Then, at the most intimate moment of their lives, meaning death, the Conservatives would have the government make the decision for them because it knows best. It is not the government or their neighbour dying, it is the person themselves. I'm sorry, but I do not agree. I think the passage of Bill C‑7 was a good thing.

However, we need to make sure we are truly ready, because people have mental disorders and are suffering. Implementing this across the country isn't easy. There will be pushback, as there has been in Quebec. Some institutions don't want to provide MAID to people who are terminally ill, even though that criterion is the subject of a countrywide consensus. Patients are prevented from accessing MAID by those institutions. It's scandalous. It's shameful. We have to avoid that.

[Luc Thériault, Bloc, Montcalm, QC]

Bill C‑14 was a terrible bill, a bad copy of the Quebec bill and because of it, people like Ms. Gladu and Mr. Truchon were forced for a time to plead their case before the courts. These are people who had lived full lives, even if they were in a wheelchair, and who refused to be infantilized and considered as vulnerable people. They had put up with enough discrimination during the lives. They went all the way to the Supreme Court, whereas other people were obliged to stop eating and drinking in order to meet the criteria of a predictable natural death. That is horrible. A state cannot allow that.

That said, Bill C‑7 did rectify the problem and in order to get that bill passed, a compromise was made to include mental disorders. Senators said that the bill, which didn't include people suffering from mental disorders, contravened the Canadian Charter of Rights and Freedoms.

The prudent approach consisted of asking people who know what they are talking about, that is to say professionals and experts in the field of mental health and mental illness. Actually, the experts asked us to stop talking about “mental illness” and use the term “mental disorders”. Moreover, they presented us with 19 recommendations for providing access. I encourage you to read them.

Two years ago, I was one of those people who were sceptical about the inclusion. I read the report 20 times. I asked questions and I think that indeed, the prudent approach would be to pass Bill C‑39. That way, for example, a person who has been suffering from schizophrenia for 30 years and who, at certain times, has become a shell of a human being due to his or her medication, could have access to MAID upon request. However, we're not saying that this would apply to a young person, a minor even, who had tried to commit suicide. The report indicates that it would take decades before such a person would have access to MAID. The person's condition would have to be irreversible and all therapies would have to have been tried.

At some point, we will have to put things into perspective. I will be watching you, Minister, and I will be watching people who are telling us that we are ready. We are not ready right now. You stated that we will be ready to go forward in March. I don't think that will be the case. I don't know who was saying that it will be possible, but it was certainly not the members of the Canadian Association of MAiD, Assessors and Providers, CAMAP, who are putting together seven training modules.

That requires trainers, not assessors. People have to be ready on the ground so as not to make any mistakes. To avoid mistakes, we will have to implement two key recommendations of the report, recommendations 10 and 16. They will become safeguarding measures that go beyond what is being done currently in terms of MAID.

I do not have any more questions, but I am sick of hearing nonsense.

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

If I can just interject, I think there's been a pattern here, and that's why it's caused so much consternation among different members of Parliament. You introduced Bill C-7 before the statutory requirement of Bill C-14 had been met. There was a requirement in that bill for a statutory review of the legislation, but Bill C-7 came in.

I was a member of our Special Joint Committee on Medical Assistance in Dying in the 43rd Parliament and in this Parliament. It didn't get its work under way. It was interrupted by the election in 2021, so I can tell you, Minister, that in working on that committee we always felt under the gun having that sunset clause hanging over us. It was always hanging over us. That was a real issue.

However, I want to change to the expert panel that was convened by your government. The panel, in its report, said:

the existing MAiD eligibility criteria and safeguards buttressed by existing laws, standards, and practices in related areas of healthcare can provide an adequate structure for MAiD MD-SUMC so long as those are interpreted appropriately to take into consideration the specificity of mental disorders.

I want to know about that, because of course, in our existing Criminal Code, in order to meet all the eligibility requirements in section (e), they have to give “informed consent” and only after they have been informed of the means that are available.

I just want to get your interpretation of that, because being informed of something is one thing, but we know from many people who have testified that in many areas of Canada, some of these services just are not available or not available in a sufficient quantity.

Do you think your government might approach a change in the Criminal Code to change that term “informed”, or are you quite satisfied with what the expert panel has provided you?

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

Madam Speaker, when we were looking at Bill C-14 two Parliaments ago, there was a statutory requirement for a review. The government went ahead and introduced Bill C-7 before we ever did that review. It accepted the Senate amendment to its bill before it established the special joint committee, of which I was a member, both in the previous Parliament and in this one. We struggled with many of the issues the member highlighted in his speech. Two of the themes we were grappling with as a committee were respect for individual autonomy versus protection of the vulnerable.

I share the member's concerns with this. How, in his mind, do we try to rectify those two concepts, so that we are respecting a person's autonomy to make decisions that are in their own interest but also making sure that we as a society are protecting the most vulnerable?

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

Mr. Speaker, I want to say a huge thanks to my colleague and dear friend from Louis-Saint-Laurent for his speech. I totally agree with him.

Perhaps he would agree with me that in the debates on Bill C-14, the government promised to do more for palliative care, if I remember correctly. That was a few years ago. I think those promises have been broken.

I would like to hear what my colleague thinks.

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

Mr. Speaker, I appreciate the comments from the member opposite because, for the most part, I concur with what the member is saying. In the debate that took place in regard to Bill C-14, if the member looks at Hansard he will see that the issue of palliative care and hospice care was huge. Members on both sides of the House understood how important it was that we have that in our communities, as we did not want to see people using MAID as an escape because of not having that care.

Again, when I reflect on what we are talking about now, more and more members are talking about the issue of mental illness. It is good that we all have a consensus. No one is talking about depression as being something that would allow someone to apply for MAID. If they do apply, the doctors and medical professionals are not going to authorize something of that nature. We are talking about the extreme situations. That is my understanding.

It is good to hear those independent voices on this particular issue and, as much as possible, I would concur. I would just ask the member to continue to expand upon why it is important that we take the party politics out of it, because it is very much a personal issue.

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

Mr. Speaker, I want to begin by thanking my colleague, the hon. member for Kitchener Centre, for such a thoughtful speech, one that anticipates much of what I want to say.

We have not done enough in the year since Bill C-7 passed to know with any degree of certainty that we have lived up to our obligations when passing that act to fully study what it would mean to extend medical assistance in dying to those who are dealing with deep suffering that comes from a mental health issue, not from a medical diagnosis of traditional medicines, such as ALS, cancer or the other cases that moved us forward on this trajectory.

I want to briefly canvass what brought us here and the way in which the Parliament of Canada and the Supreme Court of Canada have dealt with medical assistance in dying, and I want to suggest, in closing, that when one looks to the Supreme Court of Canada for guidance, I do not believe we can say that the Supreme Court of Canada's guidance takes us to the availability of MAID in cases of deep mental health distress.

Going way back, as the member of Parliament for Saanich—Gulf Islands, I want to reflect on one of the champions, heroes or, as one might even say, martyrs on the issue of access to medical assistance in dying. I speak of Sue Rodriguez. She lived in North Saanich, in the electoral district that I am honoured to represent. She had ALS. She famously said, “[W]hose body is this? Who owns my life?” She went all the way to the Supreme Court of Canada back in 1993 in an effort to get access to the alleviation of suffering from a disease that would kill her. This was not in doubt. However, the Supreme Court of Canada, in 1993, denied her request.

As others have mentioned in this place over the last couple of days of discussion, a colleague and friend of many of ours and a dear friend of mine, Svend Robinson, stayed with Sue Rodriguez when a doctor assisted her illegally, and she took her own life, with the doctor's assistance, in probably the first public case of medical assistance in dying in Canada.

The courts took a long time to change, and that decision in 1993 was not changed until 2015 in the Carter case. In the Carter case, the Supreme Court of Canada found, taking a different view, that the charter rights in section 7 to life, liberty and security of the person were violated by not allowing a person to make such a decision and to have access to medical assistance in dying. The Carter case changed things by putting squarely to the Parliament of Canada that it had to deal with this.

I will quote from the Carter case. The Supreme Court of Canada said, “competent adults who seek such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering”. That was the basis for creating legal access to medical assistance in dying.

When Bill C-14 went through, I tried so hard to put forward amendments saying we have to allow advance directives. It was not right not to allow them for someone who knows they are terminally ill and are facing incredible suffering. It is their choice and they should be able to access medical assistance in dying with an advance directive. However, back when Bill C-14 went through, this was rejected. My amendments were rejected in the House as well. Similar amendments were then passed in the Senate, and we all recall it came back here without those amendments having been accepted.

Bill C-7 repaired that but opened the door to something entirely different. I do think it is entirely different to say that when people are suffering incredibly and intolerably due to a deep, chronic and unsolvable mental health condition, they should also have access to medical assistance in dying.

I will go back and say what the political promises were when we started down this road. I first want to address the medical conditions.

When Bill C-14 was first debated, a lot of members in this place were asking about palliative care: Would people choose medical assistance in dying if they had the option for palliative care? We heard many promises from the government benches that we would see increased funding for palliative care. That has not happened. That is one thing that concerns me greatly.

We have also heard, since we passed Bill C-7, that there would be more supports for mental health. That has not happened either.

What would we do if we were serious about making sure that every Canadian could exercise, fully, their rights, under section 7 of the charter, to life, liberty and security of the person?

At least, one would know that the health care system should be working well. I am pleased to see that the premiers accepted the federal offer today. I hope that the federal government will defend our public health care system with every ounce of its energy and make sure that the deals with the provinces are specific and tied to outcomes and results.

However, our health care system is in trouble. I was just talking to an incredible indigenous woman. I will not say her name; it was a private conversation. She is Cree. She lost a dear friend recently because that Cree dear friend could not get access to medical care in time to diagnose and treat her cancer. She leaves two small children behind.

The health care system in the country is not equal, any more than the litany of deeply racist and distressing conditions in which the system works against justice for indigenous peoples. We all know it. In the context of the health care system, how can we not know it?

In terms of mental health care supports, we know even more deeply that the suicide rates among youth in this country are a huge source of concern. We know that mental health issues have been worsened among our youth, through the pandemic, through isolation, through all kinds of things, through being preyed on by social media.

We know that our schools, universities and post-graduate programs are failing young people because they cannot get the mental health supports that they need when they need them. They need help to avoid addictions and to kick addictions. Our young people need so much help and we are failing them.

Opening up MAID is not a solution to solvable mental health care issues where we are just falling down on the job because we are not providing the mental health supports that we have promised over the years.

What would we do if we wanted to be serious about section 7 rights? We would bring in a guaranteed livable income, to ensure that no Canadian is living in poverty, poverty being the number one social determinant of ill health, in terms of physical health and mental health. We would address poverty and end it through guaranteed livable income.

We would do more, as I mentioned, for the end-of-life issues and access to palliative care. There is such a thing as having a good death. We do not like talking about death in our society. We are all supposed to be young and preferably sexy forever. Let us face it: people get old and it is a lovely experience. It is a good thing to be healthy in old age and enjoy it right up to the moment when whatever one thinks is going to happen to oneself happens: meet one's makers or feed the worms, whatever. A good death is a good thing.

Medical assistance in dying does give people that option of a good death, surrounded by family, feeling loved. I am very supportive of the work that we have done in Bill C-14 and half of what we did in Bill C-7, but where are the mental health supports?

Again, to the point that the hon. member for Timmins—James Bay made, I totally agree. I say yes to housing, to supports and to ending poverty.

However, I do think that we have to explore and open up. In the next year, let us get serious at looking at non-traditional therapies for people dealing with what appears to be irremediable depression. Do psychedelics make a difference? I am not going to prescribe. As the hon. member for Timmins—James Bay said, do not take health advice from politicians.

However, the evidence is coming in on using such products as psilocybin to actually trigger something that results not just in a bit less suffering and mental health conditions. There are certainly papers out there that are peer-reviewed and very interesting, that one can cure depression. I certainly would not want to turn my back on a potential cure and then embrace medical assistance in dying for people who could be cured.

Neither do I want to turn my back on people who are suffering and who are saying that we are making them wait another year and asking why we are doing that. These are not easy issues but these issues, life and death issues, are at the heart of the sacred and they are at the heart of our work in Parliament.

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

Mr. Speaker, I want to thank the hon member for Timmins—James Bay for such a heartfelt and sincere exploration of how it has made all of us feel in this place. I remember feeling entirely conflicted on the vote on Bill C-7, because I could not see how we could deny advance directives for people who had a terminal diagnosis and were told they had to wait for the day of their MAID procedure, and be of sound mind and confirm.

We knew that people were actually choosing MAID procedures earlier than they needed to because of the failure to have advance directives in Bill, C-14. I know, as I did vote for Bill C-7, that I was approving something to come into place automatically by default that I thought was wrong, so I thank the hon. member.

Has the member ever explored the ideas of things like psilocybin? There are mental health illnesses where the psychiatry profession says there is no hope for a person, they are chronically depressed and nothing will ever lift them out of it. Does the hon member for Timmins—James Bay have any thoughts about what other medical procedures could assist in lifting people out of the deepest of despairs?

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, I am pleased to be able to join this debate.

The underlying legislation of Bill C-39 is very simple. The government is simply asking that it be given more time to introduce safeguards, guidelines and professional practices that would allow assisted deaths to be administered in such a way that mistakes are not made. However, we already know that mistakes are being made under the current regime, so that should not give Canadians any confidence. In fact, Bill C-7, which is the bill that has given rise to this request for an extension, is just another case of the Liberal government getting it so wrong by failing to consult in advance and then, after the fact, trying to fix all the mistakes and fill in all the gaps.

This is another story of failure, and what I would like to do is explain a bit of the context. Members may recall that back in 2015 the Supreme Court of Canada, for the first time, opened up the door to legalized assisted suicide, and the Liberal government then responded with Bill C-14, which restricted MAID, or medical assistance in dying, to those who were at the end of their lives and living in intolerable, grievous pain. We were assured this was not a slippery slope that was intended to include other vulnerable Canadians in Canada's assisted death regime. That is what we were told. Many of us did not take the government at its word. We did push back, but the government passed the legislation anyway.

Sure enough, here we are, some eight years down the road, and our fears were confirmed when the Quebec court, in the Truchon case, ruled that limiting MAID to those whose natural death was reasonably foreseeable was unconstitutional. The government did not appeal that case, a seminal case because it is opening up a life-and-death piece of legislation and expanding it without a reference to the Supreme Court of Canada. I believe that was an abdication of responsibility in itself. Instead, the government chose to accept the ruling and move forward with Bill C-7, which ended up extending MAID to include, among others, the mentally ill.

I want to be clear here. I do note that the original Bill C-7, which was introduced by the justice minister, did not include the mentally ill in Canada's assisted suicide regime. However, when that piece of legislation, Bill C-7, went to the Senate, the other place, the senators inserted a provision expanding and extending assisted suicide to the mentally ill in Canada. When it came back to this House, the government, instead of pushing back, the way one would expect a government to do, simply rolled over and said it would accept it the way it was, and that is now becoming the law of the land.

Bill C-7 also provided that the mentally ill provisions of Bill C-7 would come into force in two years. That is the sunset clause some people talk about. During that period of time, proper safeguards and practice standards were to be put in place to ensure that mistakes were not made. Not surprisingly, as it is a Liberal government, it got to the end of the two years, and virtually nothing has been done. The government actually struck an expert panel to review this, but it did not give that panel the right to review the merits of the underlying assisted suicide regime in Canada.

There is also a joint parliamentary committee between the Senate and the House that is still reviewing these provisions, and I am looking forward to that report. However, again, the mandate of the committee did not include any real, substantive review and investigation into the substance of medically assisted suicide. All it was allowed to do was tinker around the edges to implement a policy that has life-and-death implications for many Canadians.

Here we are. We have no safeguards and there are no guidelines for our practitioners, but we support the bill because we are trying to push this down the road as far we can. I will mention why in a moment.

The woefully inadequate rollout of the government's MAID regime is a manifestation of a Liberal government that appears to be in disarray and whose ideology is moving Canada from a culture of life to a culture of death rather than providing the necessary resources to our most vulnerable. Many in the House have raised that issue and have asked this: Why is it even necessary to apply assisted suicide to the marginalized in Canada, the vulnerable? They ask because right now we are not providing them with the resources and supports they need to live a satisfying and joy-filled life.

What is really of concern is that numerous stakeholders have said they oppose Bill C-7. By the way, there is no broad consensus in Canada that we move forward with assisted suicide for the mentally ill. There is some consensus for MAID to be in place for other cases where there is extreme pain involved, but Canadians do not support extending it to the mentally ill.

What is also of concern is that the government has now signalled that it will go beyond the mentally ill and would like to include mature minor children in this regime. The government is charging ahead with a life-and-death policy that has increased Canada's momentum down the slippery slope that we had warned of.

Is death now seen as a more cost-effective way of managing the most vulnerable in our society? Many have posited that this is the case now. Canadians have a right to question whether their government can be trusted on issues of life and death. If this is being extended to the mentally ill and to mature minors, what about the indigent? What about the homeless? What about the drug addicted? What about veterans? We know that veterans have already been counselled by the government to consider MAID as an option to serve their needs and provide them with support. We know that people who are arriving at the food banks are asking where they can access MAID, because they do not want to live in poverty anymore. That is a reflection on us as parliamentarians. It is a reflection on our country, and we can do better.

There is, however, some good news, and I will end with it.

I recently tabled a private member's bill in the House, Bill C-314, the mental health protection act. It would reverse the Liberal government's reckless acceptance of the unelected Senate's assisted death amendments. It would arrest the dangerous momentum that the expansion of medically assisted death has triggered on the slippery slope. Under my bill, Canadians whose sole underlying medical condition is a mental disorder would not qualify for MAID. At the same time, the preamble to my bill calls upon the government to finally deliver the mental health supports that have repeatedly been promised in federal budget after federal budget but have never been delivered. This is the least we owe to those who struggle with mental illnesses such as depression.

In closing, to ensure that we do not implement the mental health provisions of Bill C-7 before the House has an opportunity to revisit my piece of legislation, we on this side are very supportive of moving forward and passing the bill expeditiously. It will buy another year and push the whole issue of the mentally ill down the road, and we will make sure that we implement private member's legislation that actually protects the most vulnerable.

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

Madam Speaker, our party has a diversity of views on many aspects of the euthanasia regime in this country. At various stages along the way, there have been Conservatives who have expressed different points of views and voted different ways. My past interventions are well on the record, and I think they have actually been borne out by the experience of this.

When we first debated Bill C-14, I said there was a slippery slope here and the so-called restrictions were not going to work and were not going to remain in place. We have slid quite far down that slippery slope, so I can certainly defend the positions I have taken historically.

I think the diversity of views within our party is often a source of strength, but our caucus is united in saying that this expansion of euthanasia to those with mental health challenges is not acceptable and is not justified. It is something we are united in opposing.

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

Mr. Speaker, it is an honour to stand to give my thoughts on Bill C-39. For those who are watching the debate today, this is the bill to amend the Criminal Code to delay, until March 17 of next year, the repeal of the exclusion from eligibility for receiving medical assistance in dying in circumstances where the sole underlying medical condition is a mental illness.

It has to be stated very clearly, because of the timeline with which we are dealing, that if this bill is not passed, the original sunset clause that was put in place by the old Bill C-7 will come into effect on March 17, which is just over a month away. It is for that reason that I will support the bill and will work with all parties to get the bill passed quickly.

Today's conversation has to happen within the context of the mental health crisis in Canada. We know and have heard, and this is not just from members of Parliament, from many advocates and stakeholders that there is an extreme lack of funding and resources. Clearly, there absolutely must be parity between physical and mental health in funding.

The Minister of Mental Health and Addictions has stated in the House that Canadians should have access to timely evidence-based, culturally appropriate and trauma-informed mental health and substance use services to support their well-being. With that I agree wholeheartedly, but words are not enough. We need to see the requisite resources and funding to follow through those words.

We know that beyond the Canada mental health transfer many advocates have long been calling for legislation to enshrine in law parity between mental and physical health. I am very glad today that I am giving my speech beside the hon. member for Courtenay—Alberni, who is our mental health and addictions critic and who has himself tabled Motion No. 67, which calls on the government to develop that legislation and to urgently fulfill its promise to establish that Canada mental health transfer.

In my own riding of Cowichan—Malahat—Langford, many of my fellow citizens are going through extreme struggles with the opioid crisis. They are dealing with trauma. They are dealing with underlying mental health challenges that are simply not being addressed. That is an extreme gap and the cause of an extreme amount of shame for a country as wealthy as Canada to be still having these conversations about the resources that need to be brought to bear in communities like mine.

I have been a member in the House since 2015, so this is now my third Parliament. I have been here for the entirety of the legislative journey of medical assistance in dying. I can remember Bill C-14 and the sometimes difficult debates we had in the House. That legislation was in response to the Carter decision in the Supreme Court, which basically said that to deny people this right was contrary to our charter. It therefore gave the government a timeline to address it with the appropriate legislation.

What is not often talked about with Bill C-14 is that there was a legislative requirement in that act when it received royal assent. There was a five-year statutory review of medical assistance in dying. Unfortunately, that never occurred before the government went ahead in the previous Parliament and introduced Bill C-7, which established a second track for people whose death was not reasonably foreseeable.

The context of today's speech and C-39 is the fact that we have a story here of the government in several instances putting the cart before the horse. It not only introduced Bill C-7 before a statutory review occurred, which was a requirement of Bill C-14, but it then went ahead and accepted a Senate amendment to the bill that ran contrary to its own charter statement. It did that pretty massive expansion to the law without establishing a special joint committee that was a requirement of Bill C-7.

I am intimately familiar with what this process has been because I have not only been a member of the House since 2015, I have not only participated in debate on Bill C-14 and on Bill C-7, but I have also been a member of the special joint committee, both in the previous Parliament and in this Parliament.

The message all along has been that this kind of a review should have occurred before we were dealing with a timeline crunch. It became quite obvious during the special joint committee that too many Canadians, too many professionals in our country had apprehension about mental disorders as the sole underlying medical condition for being able to access medical assistance in dying as early as next month. Hence, we have Bill C-39.

I want to go back to the original charter statement that the government released as a part of Bill C-7. That includes a number of important statements as to why the government felt, originally, that mental disorders should be excluded from accessing MAID. It did say in that charter statement that the exclusion was not based on the assumption that individuals who suffered from mental illness lacked decision-making capacity. It also said that the exclusion was also not based on a failure to appreciate the severity of the suffering that mental illness could produce. Rather, it was based on the inherent risks and complexity that the availability of MAID would present to those individuals.

First, that charter statement identified that the evidence suggested that screening for decision-making capacity was particularly difficult. It could be subject to a high degree of error. Second, the statement identified that mental illness was generally less predictable than physical illness with respect to the course that the illness may take over time. Finally, it highlighted the experience that a few of the countries that permitted MAID, namely Belgium, the Netherlands and Luxembourg, for the sole underlying medical condition of mental illness had and some of the concerns relating to the increasing number of these cases and the wide range of mental illnesses in respect to which MAID could be provided.

Again, it really highlighted the fact that precaution was the necessary mode that was required before we embarked on this path. However, the government in its wisdom decided to accept a late stage Senate amendment to the bill after the House, full of its duly elected members, had given a final vote on Bill C-7. As a member at that time, I could not bring myself to accept that Senate amendment. Therefore, I ended up voting against the final version of Bill C-7 because of that.

It also needs to be said, when we are going over the history, that the special joint committee that was a requirement of Bill C-7 got a very late start. It was first brought into being just before the summer recess in 2021. We only had a few meetings before the summer of 2021 and we had the unnecessary election, launched solely at the request of the Prime Minister, in August of that year. This completely wiped out anything that was happening during the 43rd Parliament. That Parliament ceased to exist, and all of the committees that were a part of it did as well.

The new Parliament, the 44th, reconvened later that year, but it was not until around April or May of 2022 that serious discussions started coming together and we could actually get the special joint committee reformed. Again, we have to put that in the context of the impending deadline of March 17, 2023.

An incredible amount of time was wasted, not only from an unnecessary election but also from the delays of getting that committee up and running. We had to twice request an extension of our mandate from both houses of Parliament because the timelines we had been given were completely unrealistic, not only in hearing from as wide a range as possible of witnesses but also in producing a report that would reflect the gravity of the subject matter with which we were entrusted. That has to be highlighted in the debate today on Bill C-39.

I also think it is important because there have been a few narratives around this legislation. It is important to go back to understand what the Criminal Code actually says, and also to put that in the context of the definition of irremediability.

It is important that, in order to be eligible for medical assistance in dying, a person has to meet all of the following criteria: they have to make sure that they are in fact eligible for health services in the province they reside in, they have to be at least 18 years of age and capable of making decisions with respect to their own health, they have to have a grievous and irremediable medical condition, and they have to have made a voluntary request. All these conditions must be satisfied. A person must also give informed consent to receive medical assistance in dying, after having been informed of the means available to relieve their suffering, including palliative care.

Now we get to the definition of a grievous and irremediable medical condition as outlined in the Criminal Code. A person has to meet the following criteria for that definition: it has to be a serious and incurable illness, disease or disability; they have to be in an advanced state of irreversible decline in capability; and that illness, disease or disability, or that state of decline, has to be causing them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.

Those are the definitions in the Criminal Code, so despite the narratives we hear out there, those conditions must be met or the person administering MAID will have committed a crime. They will be in violation of the Criminal Code of Canada and will get the appropriate punishment as a result.

One of the difficulties is the fact that the term “irremediable” is not a medical or scientific term. It is a term that finds its definition within the Criminal Code. If we go to scientific or medical literature, it is a difficult term to define, and that, I think, is why we are seeing a lot of the apprehension around accessing MAID for mental disorders where the sole underlying medical condition is a mental disorder.

Some witnesses who appeared before our committee expressed the opinion that this should not be permitted, because there cannot be any certainty with respect to the incurability of a mental disorder. However, other witnesses told us that certainty is not required and that there are ways to consider irremediability, for example by looking at the years of treatment that people have had and whether any responses of the patient have actually been positive.

We also have to understand that the respect for personal autonomy in all of this is paramount, and it is has to be a treatment that is acceptable to the individual receiving it. They not only have to express informed consent, but it has to be something acceptable to them as a person.

I now want to talk a little about the special joint committee, which I have had the honour of being a member of, as I previously mentioned.

I think it is important to underline that our committee has struggled with the question of how to balance individual autonomy with protections for the vulnerable. We were tasked with looking at five themes through the passage of Bill C-7 and the motion that guided our work from both the House of Commons and the Senate: how we institute protections for persons with disabilities; the state of palliative care in Canada; advance requests; mature minors; and, of course, the subject of today, mental disorders as a sole underlying medical condition and their eligibility with respect to applying for medical assistance in dying.

Our final report is due to be tabled in the House this Friday, February 17. We wrapped up our committee meetings last week and finally approved a draft report. That draft report, as I speak, is going to translation services so that it can be ready for tabling here in the House, and so we will be able to meet the deadline that was given to us.

Before we did that work, we had others who did some important work ahead of us. We had the expert panel that was established. They also wrestled with major concerns, such as incurability, irreversibility, capacity and suicidality, and of course the intersection between structural vulnerability, mental disorder and medical assistance in dying.

That panel report, an important precursor to our work as a special joint committee, did state that assessors in medical assistance in dying should be able to establish incurability and irreversibility with reference to treatment attempts made; the impacts of those treatments; and the severity of the illness, disease or disability. The incurability of a mental disorder cannot be established in the absence of extensive attempts at interventions with therapeutic aims.

This means that someone who has not had access to adequate care would not be eligible for MAID. Therefore, MAID could never be used as a substitute for good psychiatric care. I think that is an important thing we have to realize. There will be safeguards in place, not only with the Criminal Code, but also, we hope, with the standards of practice.

For patients who are considering this, we want to make sure that there has been a long track record of attempts to deal with their illnesses. At the same time, we have heard very clearly that there are many Canadians and many professionals who feel that additional time is needed to make sure we get this right.

One of the witnesses before our special joint committee was the chair of the Government of Quebec's Select Committee on the Evolution of the Act respecting end-of-life care. She explained that Quebec had decided that MAID for mental disorders as a sole underlying medical condition should not be permitted at this time because of the challenges of determining irremediability, as well as the lack of social consensus. Another level of government, this time the Province of Quebec, is also underlining the concerns that many members of Parliament are expressing here today.

I mentioned the final report that will be tabled in the House, but our committee did release an interim report. That interim report was specifically on this subject matter. I will read from our conclusion. It states:

We must have standards of practice, clear guidelines, adequate training for practitioners, comprehensive patient assessments and meaningful oversight in place for the case of [medical assistance in dying for mental disorders as the sole underlying medical condition]. This task will require the efforts and collaboration of regulators, professional associations, institutional committees and all levels of governments and these actors need to be engaged and supported in this important work.

Although some work is already underway to implement the recommendations of the Expert panel, there is concern that more remains to be done to ensure that all necessary steps have been taken to be ready by the March 2023 deadline...

Again, in our interim report, our special joint committee was already, at that time, expressing concern with the upcoming deadline, and I think it is a smart move that we are moving ahead with Bill C-39. If we back that up with the testimony we heard at committee, we had a number of different witnesses who clearly expressed that they had troubles with this deadline and that those standards of practice were not yet ready.

It needs to be underlined again that, if Bill C-39 is not passed, the original sunset clause of March 17 will come into effect. My vote for this bill is occurring because of that very fact. This is aside from the broader conversation we need to have about medical assistance in dying in general. It is support for a bill that is going to extend the deadline by one year so we can make sure that we get these standards of practice right, so we have the necessary time to engage with the broader community.

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

Mr. Speaker, let me just say from the outset what a pleasure it was to serve on the special joint committee with the member for Montcalm, both in the last Parliament and in this one. I always appreciated his very thoughtful interventions and I could tell that he always came to committee quite well prepared.

The member and I have been here since 2015. He will remember that in the original bill, Bill C-14, there was a statutory requirement for a five-year review. We know that Bill C-7 was introduced before that review happened and that the government decided to accept a Senate amendment before it had a chance to establish a special joint committee. That process, that timeline, underlines why Bill C-39 is necessary now.

I wonder if my hon. colleague would just reflect on what has led us to this point and why Bill C-39 is necessary, and for this House to pass it quickly, because of the impending deadline and the fact that we do need to have some space to make sure we are getting these standards right. It is extremely important.

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

Mr. Speaker, like the minister, I have been here since 2015, so I have seen the entire legislative journey of medical assistance in dying, and I have also been the NDP's member on the special joint committee, both in the last Parliament and this one.

Back when Bill C-14 was passed, there was a requirement in that act for a statutory review of the legislation. We did have Bill C-7, and the government did accept the Senate amendment, even though it was contrary to its own charter statement on the matter. It was only after that that we established the special joint committee, which was then delayed by the 2021 election and did not get up and going until May of last year.

In the context of that, I think the Liberals have, in some instances, put the cart before the horse before we have had the appropriate review, but I would also like to hear his comments because there is a crisis in funding for mental health in this country. We have had the Canadian Mental Health Association talk about this. I would like to hear from the justice minister that his government can make a commitment to bring mental health care funding up on par with that of physical care. There is a real crisis, not only in my community, but also in communities from coast to coast to coast. I think that is going to be an important component of this conversation.

[David Lametti, Liberal, Minister of Justice and Attorney General of Canada]

moved that Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Mr. Speaker, I rise today to speak to Bill C-39, an act to amend an act to amend the Criminal Code regarding medical assistance in dying. This bill would extend the exclusion of eligibility for receiving medical assistance in dying, or MAID, in circumstances where the sole underlying medical condition for MAID is a mental illness. The main objective of this bill is to ensure the safe assessment and provision of MAID in all circumstances where a mental illness forms the basis for a request for MAID.

An extension of the exclusion of MAID eligibility in these circumstances would help ensure health care system readiness by, among other things, allowing more time for the dissemination and uptake of key resources by the medical and nursing communities, including MAID assessors and providers. It would also give the federal government more time to meaningfully consider the report of the Special Joint Committee on Medical Assistance in Dying, or AMAD, which is expected this week.

My remarks today will focus on the legislative history of MAID in this country. I want to be clear that medical assistance in dying is a right, as affirmed by the Supreme Court.

In its 2015 Carter v. Canada decision, the Supreme Court of Canada ruled that the sections of the Criminal Code prohibiting physicians from assisting in the consensual death of another person were unconstitutional. In response, in 2016, our government tabled former Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.

The basic purpose of the bill was to give Canadians nearing the end of life who are experiencing intolerable and unbearable suffering the option to obtain medical assistance in dying. The bill was passed two months later, when medical assistance in dying, or MAID, became legal in Canada for people whose natural death was reasonably foreseeable. It included procedural safeguards in order to ensure that the person’s request for medical assistance in dying was free and informed, and to protect the most vulnerable.

In 2019, in Truchon v. the Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. One year later, in response, we introduced a second bill on medical assistance in dying, the former Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

Former Bill C-7 expanded eligibility to receive MAID to persons whose natural death was not reasonably foreseeable. It did so by creating a separate, more stringent set of procedural safeguards that must be satisfied before MAID can be provided. The government proposed, and Parliament supported, these stringent procedural safeguards in recognition of the increased complexities of making MAID available to people who are not otherwise in an end-of-life scenario.

Some of these additional safeguards include a minimum 90-day period for assessing eligibility, during which careful consideration is given to the nature of the person's suffering and whether there is treatment or alternative means available to relieve that suffering. This safeguard effectively prohibits a practitioner from determining that a person is eligible to receive MAID in fewer than 90 days.

Another additional safeguard is the requirement that one of the practitioners assessing eligibility for MAID has expertise in the underlying condition causing the person's suffering or that they must consult with a practitioner who does. The assessing practitioners must also ensure that the person be informed of the alternative means available to address their suffering, such as counselling services, mental health and disability support services, community services and palliative care. It is not enough just to discuss treatment alternatives. They must ensure the person has been offered consultations with relevant professionals who provide those services or care. In addition, both practitioners must agree that the person gave serious consideration to treatment options and alternatives.

The former Bill C-7 extended eligibility to medical assistance in dying to people whose death is not reasonably foreseeable. However, it temporarily excluded mental illness on its own as a ground for eligibility to MAID. In other words, the bill excluded from eligibility for medical assistance in dying cases where a person's sole underlying medical condition is a mental illness. That temporary exclusion from eligibility stems from the recognition that, in those cases, requests for medical assistance in dying were complex and required further review.

In the meantime, the Expert Panel on MAID and Mental Illness conducted an independent review of the protocols, guidance and safeguards recommended in cases where a mental illness is the ground for a request for medical assistance in dying. The expert panel’s final report was tabled in Parliament on May 13, 2022.

The Special Joint Committee on Medical Assistance in Dying also completed its parliamentary review of the provisions of the Criminal Code relating to medical assistance in dying and their application, as well as other related issues, including mental health. We eagerly look forward to the special joint committee’s final report, expected on Friday, February 17.

I would also like to highlight the excellent work of the expert panel, ably led by Dr. Mona Gupta.

This temporary period of ineligibility was set in law to last two years. It will expire on March 17 unless this legal requirement is amended by law. This bill would do just that, and proposes to extend this period of ineligibility for one year, until March 17, 2024.

As I stated at the outset of my remarks, this extension is needed to ensure the safe assessment and provision of MAID in circumstances where a mental illness forms the sole basis of a request for MAID. It is clear that the assessment and provision of MAID in circumstances where a mental illness is the sole ground for requesting MAID raises particular complexities, including difficulties with assessing whether the mental illness is in fact irremediable and the potential impact of suicidal ideation on such requests.

That is why, when some Canadians, experts and members of the medical community called on the federal government to extend the temporary period of ineligibility to make sure the system was ready, we listened. We listened, we examined the situation carefully and we determined that more time was needed to get this right.

As for the state of readiness of the health care system, I would like to take a moment to highlight the great progress that has been made toward the safe delivery of MAID in those circumstances. For example, standards of practice are being developed for the assessment of complex requests for medical assistance in dying, including requests where mental illness is the sole underlying medical condition. Those standards of practice will be adapted or adopted by clinical regulatory bodies and by clinicians in the provinces and territories. These standards are being developed and will be completed in March 2023.

In addition, since October 2021, the Canadian Association of MAiD Assessors and Providers, or CAMAP, has been developing an accredited study program for health professionals. Once completed, that program will include seven training modules on various topics related to the assessment and delivery of medical assistance in dying, including on how to assess requests for medical assistance in dying, assess capacity and vulnerability, and manage complex and chronic situations. That program should be finalized and ready to be implemented next fall.

This progress was achieved through our government's leadership and collaboration with the health system's partners, such as the provincial and territorial governments, professional health organizations, our government's regulatory agencies, clinicians and organizations such as CAMAP.

The Regulations for the Monitoring of Medical Assistance in Dying, which set out the requirements for the presentation of reports on MAID, came into force in November 2018.

These regulations were recently revised to significantly improve the collection of data and reporting on MAID. More specifically, the regulations now provide for the collection of data on race, indigenous identity and any disability of the person. The revised regulations came into force in January 2023, and the information about activities related to medical assistance in dying in 2023 will be published in 2024 in Health Canada's annual MAID report.

I think we can all agree that substantial progress has been made. However, in my opinion, a little more time is needed to ensure the safe assessment and provision of MAID in all cases where a mental illness is the sole basis for a request for MAID.

I want to be clear that mental illness can cause the same level of suffering that physical illness can cause. We are aware that there are persons who are suffering intolerably as a result of their mental illnesses who were waiting to become eligible to receive MAID in March 2023. We recognize that these persons will be disappointed by an extension of ineligibility, and we sympathize with them. I want to emphasize that I believe this extension is necessary to ensure the safe provision of MAID in all cases where a mental illness forms the basis of the request for MAID. We need this extension to ensure that any changes we make are done in a prudent and measured way.

I want to turn now to the more technical part of Bill C-39 and briefly explain how the bill proposes to extend the mental illness exclusion. As I stated earlier in my remarks, former Bill C-7 expanded MAID eligibility to persons whose natural death was not reasonably foreseeable. It also included a provision that temporarily excluded eligibility in circumstances where a mental illness formed the basis of the request for MAID. Bill C-39 would delay the repeal of the mental illness exclusion. This would mean that the period of ineligibility for receiving MAID, in circumstances where the only medical condition identified in support of the request for MAID is a mental illness, would remain in place for an extra year, until March 17, 2024.

I want to reiterate that we need more time before eligibility is expanded in this matter. We need more time to ensure the readiness of the health care system, and more time to consider meaningfully and to potentially act on AMAD's recommendations. This is why I urge members to swiftly support the passage of this bill. It is imperative that it be enacted before March 17. If it is not, MAID will become lawful automatically in these circumstances. It is essential that this bill receive royal assent so that this does not happen before we are confident that MAID can be provided safely in these circumstances. I trust that all colleagues in this place will want to make that happen.

The safety of Canadians must come first. That is why we are taking the additional time necessary to get this right. Protecting the safety and security of vulnerable people and supporting individual autonomy and freedom of choice are central to Canada's MAID regime. We all know that MAID is a very complex personal issue, so it is not surprising that there is a lot of debate. It should go without saying that seeking MAID is a decision that one does not make lightly. I know from speaking with members of the medical community that they take both their critical role in the process and their professional duties toward patients extremely seriously. I trust that medical professionals have their patients' interests at heart, and this sometimes involves supporting their patients' wishes for a planned, dignified ending that is free of suffering.

Once again, I strongly believe that an extension of the exclusion of MAID eligibility in this circumstance is necessary to ensure the health care system's readiness and to give the government more time to meaningfully consider and to potentially implement the AMAD recommendations. I remind the House that those recommendations are expected just one month before the current mental illness exclusion is set to expire. Therefore, I implore all members to support this bill.

[Ed Fast, Conservative, Abbotsford, BC]

moved for leave to introduce Bill C-314, An Act to amend the Criminal Code (medical assistance in dying).

Madam Speaker, I am pleased to table today the mental health protection act. As members know, medically assisted suicide was legalized in Canada in 2016. Under Bill C-14, medical assistance was expressly limited to capable adults who have an irremediable disease that causes enduring and intolerable suffering that cannot be alleviated, and when their natural death is reasonably foreseeable.

At the time, the government and its supportive stakeholders assured Canadians that this would not lead to a slippery slope on which the scope of MAID would be continually be expanded to include other Canadians. Not surprisingly, in the intervening seven years, the government has expanded the scope of MAID by de facto extending its scope to those who are not dying, but who are living with disabilities.

More recently, the government expanded MAID to include mentally ill persons and also signalled its intention to extend this right to mature minor children. Clearly, we are on the slippery slope many of us had warned about, and Canadians have a right to ask who is next. Will it be the drug addicted, the indigent, the homeless, or needy veterans? What about willing seniors who are tired of life? Where does it end?

My bill would reverse this momentum and repeal the government's decision to extend MAID to the mentally ill. The evidence from mental health experts is very clear. There is no consensus in Canada that the mentally ill should be covered by Canada's medically assisted death regime. Issues of irremediability, competency and suicidality are not anywhere close enough to being resolved to justify this major policy shift in favour of death.

Let me be clear: My bill does not, in any way, reverse the rest of Canada's MAID regime. Instead, it arrests Canada's slide down the slippery slope of assisted suicide, which so many of us had predicted would happen. I would respectfully ask that all of my parliamentary colleagues give thoughtful consideration to my bill, and join me in protecting and supporting the most vulnerable in our society.

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

[Dr. Tim Stainton, Director, Canadian Institute for Inclusion and Citizenship, University of British Columbia, As an Individual]

Thank you, Mr. Chair, and members of the committee, for the opportunity to speak to you tonight.

I have reflected many times on the process surrounding Bill C-7. The failure to appeal the Truchon decision was shocking given the significance and scope of its impact.

As Bill C-7 worked its way through Parliament, some 200 disability organizations, including all of the major national bodies, were clear and united in their opposition, warning the government of the threat it posed to disabled people and other vulnerable populations. Numerous witnesses shared their concerns, often with compelling personal narratives. In addition, serious concerns were raised by three UN human rights experts. Not only were all of these concerns ignored, but the bill was massively expanded by a Senate amendment to require the inclusion of mental illness within two years—a significant expansion on the original intent of Bill C-7—without study or review.

Despite this, on March 17, 2021, Bill C-7 received royal assent after the government invoked closure to cut off debate.

It's hard to imagine a similar overwhelming dismissal if we were discussing any other equity group, were they were to voice unified concerns over a bill and were backed by UN human rights experts. Why this was the case can only be explained by recognizing a deep, pervasive and often unconscious ableism that pervades Canadian society.

Canada’s euthanasia and assisted suicide laws have always been about balancing individual autonomy to decide when to end one’s life and the protection of the vulnerable. Subsequent to the passage of Bill C-14, it would seem that protection of the vulnerable has largely been ignored in favour of an increasingly atomistic interpretation of autonomy.

It is somewhat ironic that as we come out of an unprecedented era of COVID-19 where we were all asked to make sacrifices of some of our personal autonomy in favour of broad protection for the whole of society, in the debate on euthanasia and assisted suicide we persist in privileging a view of autonomy more akin to one used by those who railed against the vaccine mandate as an infringement on their individual liberty.

John Stuart Mill, one of the fiercest defenders of individual liberty, provided an analogy for when interference with individual autonomy was permissible. He wrote that if a man is trying to cross a bridge that is unsafe, it is permissible to impede his progress as he does not wish to fall into the river, but rather his will is to cross the bridge.

This committee will be aware of the numerous reports of disabled persons who do not desire to end their lives, but feel they no longer have tenable options given the crushing demands of poverty, forced institutionalization and the lack of necessary services and supports. They are our bridge crossers. They do not wish to fall into the abyss, but without the repairs to the bridge—ending poverty, ending unwanted institutionalization and improving our disability and mental health supports—they feel they have no other option. Rather than restraining them, as Mill suggests, we are shepherding them to the edge and over through MAID.

I'm also concerned as to where this all ends, given the rapid and ill-considered expansion that will be making Canada the world leader in cases of assisted suicide and euthanasia in a mere six years. I worry that we will soon see calls for legalizing the killing of disabled people who are unable to formally consent at the request of their parents or guardians.

Sadly, we know from public reaction to things like the murder of Tracy Latimer and many other cases that so-called “mercy killing” has widespread public support.

If we continue to weaken the need for direct consent through permitting advance directives and allowing children to be euthanized, it is a very small step to involuntary euthanasia of disabled people who are considered unable to consent.

I have a son with an intellectual disability. He cannot directly tell you the value of his life, but he shows us every day in his accomplishments, his laughter, his smile, and those he touches, yet I know that most people who see him in passing assume his life is one of tragedy, suffering and dependency. These people would see an end to his life as a mercy. The Canada I want to believe we live in would value, support and celebrate his life. I increasingly fear it is becoming one that seeks only to end it.

Thank you.

[Dr. Jennifer Gibson]

Thank you for the question. I think it builds on your previous one.

If we think about it, there's the legislation. The clinical guidelines being developed by those who are best equipped, as clinicians, to inform what the practice may look like are going to be important. However, there are other actors who we want to be thinking about.

One key actor here—whom I know has been identified at this committee and who surfaces fairly frequently—is the substitute decision-maker. They play such an essential role in this process. Dr. Reiner's process that he's outlined is very well suited to supporting a substitute decision-maker to be well equipped with an understanding of why a patient may be seeking an advance request, and to be able to be part of that deliberative process. That is an actor. I think there are other actors who have essential roles to play in ensuring that the system around this works well.

A strength of the original Bill C-14, our original legislation, was that there was a monitoring system in place. We were able to track and understand what was going on in the practice and be able to guide continuing policy evolution. However, that is high level, and it often uses quantitative data in reporting statistics. It's very helpful at a population level, but we need to go further down.

Some of the other opportunities we have to strengthen this system as a whole are to continue to foster the types of research that Dr. Reiner has been pursuing and to continue to foster the learning and the training of health professionals that Dr. Perrot is sharing as well. Everyone is in.

Judges Act

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

Mr. Speaker, it is a great pleasure to have the opportunity to speak today on Bill C‑9, right after my friend, the member for Battle River—Crowfoot.

I want to begin by entering this debate midstream and responding to some of the comments that I was hearing in the questions and comments period immediately prior to my speech, before shifting into some of the other comments I want to make specifically about this legislation.

A favourite subject of the member for Winnipeg North is legislative timing and the processes of the House, and I must confess that it is a subject I enjoy engaging in dialogue about as well. However, I think he is always selective in his presentation of the story when it comes to the timing or process of legislation. There are a number of different aspects to that. In particular, he is essentially telling my colleague that we should not be debating this bill because he wants the bill to move forward on a certain timeline.

It is important for everybody listening to know that it is the sole prerogative of the government to schedule the legislation it is moving forward for debate in the time slots we have for presenting it, which is the vast majority of the parliamentary calender. The government needs to set aside some time for opposition days, where opposition parties put forward motions, and there is the possibility for members to move concurrence of committee reports. However, those are quite constrained given the time that those debates take. Of course, there is also Private Members' Business.

There are therefore some opportunities outside of government for legislation, policy or motions to be put forward for debate in the House, but the vast majority of the time is available to the government to schedule at their sole discretion. It is the government that makes decisions about which bills are priorities and which bills to put forward. If it wants a bill to advance, then I think it has an obligation to schedule it for enough days of debate so that debate can be brought to a conclusion. That principle applies for Bill C-9, as it does for any other bill.

What we often see the government do is fail to prioritize a bill within its own allocation of time. Then it acts mystified about the fact that it is not moving based on some artificial timeline that it has set. We saw this with Bill C-22, where the government scheduled it for one day of debate, did not schedule it for weeks afterwards and then asked why the bill was not moving forward. Of course, debate concluded the next time it was scheduled, but it would have moved forward faster if the government had chosen to prioritize it.

I detect the same string of argumentation again here from my friend from Winnipeg North. He is keen to see Bill C-9 move forward, apparently, but not keen enough to have successfully lobbied his House leader to schedule this bill and put it forward on a larger number of days. Friday is a very short day relative to the time we get.

I wanted to spend a few minutes on that particular point because I know it comes up again and again, and to pre-empt, in a sense, what I suspect will be a question from my friend from Winnipeg North, although I will say that I did appreciate him tabling a petition relating to Bill S-223 on organ harvesting. I hope that is a bill the foreign affairs committee will prioritize for deliberation and move forward, because as members know, it has been a long time.

Having responded to that, I want to add my voice to the comments by my friend from Battle River—Crowfoot pertaining to the larger issues of trust in our institutions and independence. We are talking today, in the context of Bill C-9, about certain circumstances, events and comments that have impacted trust and faith in the judiciary, and I think we need to affirm the importance of institutions.

We want to see that our institutions are trusted, but we also want our institutions to be worthy of that trust. Sometimes what we hear from some members is a call to trust institutions without being willing to note when there have been significant problems in the conduct of individuals in those institutions. I think the issue raised by the opposition House leader today with respect to interference by the government in a criminal case is another important issue in the ongoing conversation about trust in our institutions and the actions of government. Acts of interference by the government certainly do have an impact on how our institutions are perceived and the degree to which they are trusted. These matters of interference and the independence of institutions are important in their own right, but they are also important in terms of how they contribute to the level of trust that Canadians can reasonably have, in light of the facts, in the institutions that are so critical for holding our public life together.

Bill C-9, the piece of legislation we are debating today, is, on the face of it, a relatively technical piece of legislation, although as members know, every technical piece of legislation has interesting philosophical issues and questions underneath it. The legislation is about making changes to the mechanisms or processes that are in place around judicial discipline, or the discipline of judges. I will just read the summary. It states:

This enactment amends the Judges Act to replace the process through which the conduct of federally appointed judges is reviewed by the Canadian Judicial Council. It establishes a new process for reviewing allegations of misconduct that are not serious enough to warrant a judge's removal from office and makes changes to the process by which recommendations regarding removal from office can be made to the Minister of Justice. As with the provisions it replaces, this new process also applies to persons, other than judges, who are appointed under an Act of Parliament to hold office during good behaviour.

It creates mechanisms by which individuals who have been appointed to hold office, pending “good behaviour”, could be considered not to have fulfilled the standards required around good behaviour and could therefore be removed from office and/or face other mechanisms of discipline. I think the details and mechanics of these mechanisms are extremely important, and are things that will be important not only for the House to consider but for committee to go into further.

After reading through the legislation, one thing I found quite interesting was the presence of a review panel of lay people who, by design, cannot have any legal background. It is always interesting to me when there is this balance where, on the one hand, there are aspects of our judicial system where we demand a certain level of expertise, and then on the other hand, there are certain places where, I think for good, understandable reasons, we demand a lack of expertise formally and in practice as a means of saying that we want some people involved in the decision-making who are non-experts.

I recall a quotation from former British prime minister Clement Attlee, who talked about how he wanted his ministers not to be experts on the subjects they were ministers of. I know that is a bit of a parenthetical question, but it is one that has been debated over the years regarding various kinds of appointments.

In any event, this legislation includes a specific, designated role in the termination process for lay people. I want to note as well the justifications by which a judge could be removed from office. Proposed section 80 says, “For the purposes of this Division, the removal from office of a judge is justified only” for these reasons:

(a) infirmity;

(b) misconduct;

(c) failure in the due execution of judicial office;

(d) the judge is in a position that a reasonable, fair-minded and informed observer would consider to be incompatible with the due execution of judicial office.

These are, in some ways, notionally objective criteria, but naturally there is going to be some level of subjectivity in how they will be applied.

There is a history to the consideration of this issue, and there is a history to the discussion of judicial misconduct that touches on some very important and sensitive issues. In my time as a member of Parliament, there has been a fair bit of discussion specifically around the issue of comments by judges dealing with cases of sexual assault. There was a judge who made some very offensive and outrageous comments in the context of a sexual assault trial that he was presiding over. That provoked a lot of conversation about the reality that someone is not rendered all-knowing and all-virtuous simply by the fact that they have received a judicial appointment, and that maybe there is a legitimate place for saying that someone, by their comments or lack of understanding certain things, is no longer fit to be a judge.

How do we preserve the principle of judicial independence, the principle that judges should be making decisions based on the facts of a case and the law rather than making decisions as democratic legislators do, based on other factors, including public opinion? How do we preserve that principle of judicial independence and also say that there are certain societal norms and values that we would like to see reflected in the conduct and statements of judges? There is a point at which a person can go beyond the pale and simply no longer be suited to that position as a function of some of their comments.

There have been a number of ways of getting at this issue. One was from former Conservative leader Rona Ambrose, who put forward a private member's bill, in 2016 or the first half of the 42nd Parliament, that sought to promote judicial education around sexual assault. That is one way of dealing with comments like this: We can say that maybe it is simply about a lack of knowledge and education.

That bill did not pass in Parliament, but a similar bill was put forward and was passed in the 43rd Parliament. As I said at the time, I think we need to recognize the importance of education around these issues, but also recognize that education is not always the full solution. I think there is a lot of data to suggest that when we mandate certain kinds of training courses, for some people it is a meaningful opportunity for them to learn about the matter at hand, but for other people it is just a matter of checking the boxes that are required. Whether it is a meaningful engagement exercise or a box-checking exercise depends somewhat on the way the material is presented, but a lot of it will depend simply on the disposition of the individual and how willing the individual is to substantively engage with the matter at play.

My conclusion is that the proposal from Rona Ambrose about judicial education was very important and worthwhile, but it does not solve the whole problem of either judicial misconduct or potential issues where a judge is making comments in the context of a trial that are very offensive to the victim and to society at large.

That is some of the history of the issue, but there are also other potential issues. This is not just about comments judges make in trials; it could also be about concerns over personal corruption and other things that could be at play in the context of judicial discipline. This is a piece of legislation that, coming out of that long-running public discussion, seeks to make refinements to the processes around judicial discipline.

One thing I would like to note about this discussion is that it presumes the personal fallibility of judges. Maybe it should be fairly obvious, but with the way some of our Canadian debates have proceeded, maybe it is not so obvious that judges are human beings. They have the potential to develop great expertise, great virtue and commitment to their work.

Judges also, like any other human beings, have the potential for grave errors in reasoning, as well as moral errors of various kinds, including misconduct or corruption. They are human beings, are fallible and can make mistakes in various kinds of situations or ways. The heavy criticism of former justice Robin Camp, some of the subsequent discourse and arguments for judicial education the government has supported, and the very existence of this legislation, affirm the reality of judicial fallibility. However, at other times when we are having debates about criminal justice issues and how we respond to particular kinds of charter litigation, the discourse in the House seems to presume something else, which is the infallibility of judges.

It was very striking to me, when I was first elected as a member of Parliament, that we were, on the one hand, dealing with this whole question of former justice Robin Camp and the issues around judicial fallibility, but on the other hand we had members making comments about at the time Bill C-14, which followed the Carter decision of the Supreme Court, where it was repeated that this was a unanimous court decision. Therefore, our goal as a legislature should simply be to interpret the wisdom we were given from this wise council's vision.

I have a great deal of respect for the role the Supreme Court plays in our democracy, but I also think it is legitimate to disagree with decisions that the courts have made. Part of the process of democratic deliberation is recognizing that, if judges can be personally fallible regarding their own conduct, fallible in the sense of making inappropriate comments in a sexual assault case, then they can also be fallible in there determinations about the appropriate sentence and balance of rights that emerge from a series of arguments about how to interpret given facts in light of the charter.

The fact there is diversity in courts of dissent underlines the potential fallibility of judges, and I think we should, in our Canadian democratic discourse, seek to affirm the importance of judicial independence, and the respect that is owed to that institution, while also recognizing that judges make all kinds of mistakes and that Parliament has a role to deliberate about substantive questions of justice and human dignity and to engage in a constructive and healthy back and forth when it comes to decisions, legislation and how we respond to that.

I could cite other cases that brings this issue to the fore, but I see that I am up against my time to some extent. Therefore, I am grateful for the opportunity to address the issues around Bill C-9, to share a bit of the history, and to underline that, for me, one of the lessons coming out of this is to let us acknowledge that judges are human beings. They have an important job to do, but it is legitimate to disagree with and debate the determinations that are made, and to use constitutional tools that affirm the rights and the role of the legislature when it comes to establishing and advancing common values that are determined through democratic deliberation.

Canada Disability Benefit Act

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

Madam Speaker, I appreciate the opportunity to speak to Bill C-22 and, more broadly, to the situation confronting Canadians living with disabilities.

Bill C-22 proposes a new federal financial benefit for Canadians living with disabilities, however, it does not actually define many aspects of the structure of this benefit. I will be voting in favour of the legislation, because I agree with the principle of providing the support, but I am concerned about some of the lacking substance with respect to how this benefit would actually work.

Increasingly, we see from the government a desire to limit the actual work of Parliament in defining the nature and scope of programs. Instead, the government wants a blank cheque from Parliament, legislation that authorizes ministers to shape and define a program independently, according to their discretion.

In general, this is not a good way for governments to operate in a democracy and, in particular, I do not think the Liberal government has shown itself trustworthy when it comes to working out the details of critical programs.

When it comes to the structure of this benefit, the government's message is “just trust us.” From a government that cannot figure out how to deliver passports in a timely manner, cannot address the affordability crisis in Canada and cannot secure our borders, the message of “just trust us” seems rather hollow.

I have two specific concerns about the prospective structure of this program that I do want to highlight.

First, I share the concern of many about how this program would interact with other existing programs, including those provided at the provincial level. If a new federal benefit leads to a loss of eligibility for other existing benefits, then it would leave people worse off overall. It is not inevitable that this would be the case, but this is a matter that will require careful and respectful dialogue with other levels of government and hard work at every stage, hard work that the government has not always been prepared to do.

At this point, the government is passing broad framework legislation without ensuring that it will actually leave Canadians with disabilities better off in every case. The government does not have to wait for this legislation to pass to begin those discussions and I would encourage it to actually engage those discussions now about protecting existing benefits, because aspects of those dialogues may inform suggested amendments.

The second concern I have is that it is critically important that the structure of this benefit program protects access for Canadians with disabilities who are working or are trying to get into work. Even with existing benefit programs at other levels, certain Canadians with disabilities may find themselves in a position where entering the workforce actually leaves them worse off. It is critically important that work always leaves people better off financially.

Supporting Canadians, including Canadians living with disabilities, in being able to access meaningful work has long been a key priority for Conservatives.

Why is this important? Overwhelmingly, Canadians of all backgrounds and circumstances want to be able to work and are happier and more fulfilled if they are able to work. In this context, by work, I do not just mean commodified work, but work of any sort, where individuals exert themselves in order to contribute positively to the world around them.

The science of happiness and fulfillment measurement shows us that work generally makes people happier by providing them with meaning and with a workplace-based community, and with a greater level of power and agency. Quite apart from the notably important income-earning properties of work, work also provides meaning and happiness, totally independent of whether it generates income.

Think tank Cardus has done excellent work on this question of work and disability. It has found that most Canadians living with disabilities want to work or want to work more, but it has also found that the vast majority of public policy, focus and money has been toward income support as opposed to supports that help people get into work.

The critical point about work support and income support is that they are not mutually exclusive. In fact, often, they are necessarily complementary. Some people require income support in order to afford the resources and transportation required to find and get a job in the first place. If income supports are withdrawn immediately once people work or start work, they may not be able to afford vital necessities, as well as the things they need to sustain them in their new job.

Having both fulfilling work and steady income are vital for human happiness and fulfillment. Having income without work or work without income are both, in a sense, problematic.

Of course, having income is not just about fulfillment and happiness; it is about basic survival. Canadians with disabilities need income to take care of their own needs and the needs of those they love.

For most of us, work comes with earning income. However, when benefit programs are poorly structured, people may actually be forced to choose between work and income, because benefits are cut off or income is lost as a result of working. In such cases, given how essential income is for survival, people will understandably choose income over work if they are forced to choose between these things. It is cruel and pointless to force people to make this choice, to choose between the happiness associated with work and receiving the financial support that they need.

Income supports for Canadians with disabilities can and should go hand in hand with workplace support, only peeling those income supports back gradually when it is clear that income support is not required because of the level that an individual is able to work.

We saw an example of this terrible choice between work and income during the pandemic with the poorly constructed CERB program. Unemployed Canadians who were accessing CERB, and who were then offered part-time work, were in many cases actually worse off financially if they took that work because part-time work would push them over the threshold for CERB eligibility, even if they were not earning close to what they would have been entitled to receive under CERB. Thus people were forced to remain out of work in order to access the resources they needed to support their families.

Not only does it make zero financial or economic sense to create a financial disincentive to work, but it also puts people in the painful position of needing to choose between the happiness and dignity that come from work on the one hand and from financial security on the other hand. That is why we feel it is very important that this new federal program be structured in such a way that Canadians with disabilities, many of whom can and do work, or want to work, are not rendered worse off by entering the work force.

There is nothing in the text of the bill that would suggest it could not be structured in a way to ensure that work always pays, but the past record of the government gives us significant cause for concern. In the 42nd Parliament, the member for Carleton, now the leader of the Conservative Party, proposed Bill C-395, a bill specifically designed to address this problem of work sometimes bringing about a loss in benefits for Canadians living with disabilities.

Bill C-395 would have amended the Federal-Provincial Fiscal Arrangements Act to ensure that, in negotiations around transfers and the construction of benefits for Canadians living with disabilities, people with disabilities would not lose more through taxation and the reduction of benefits than they gain as a result of working. It would have protected Canadians with disabilities from these kinds of perverse situations where they would have to choose between the happiness that comes from work or the financial security that comes from government benefits.

If Bill C-395 were the law of the land, we could then pass this bill, even as written, with the confidence that the benefits constructed would leave people better off, but when it came to a vote on Bill C-395, Liberals actually opposed it. Liberals opposed the common-sense proposal from our leader to ensure that Canadians who work are better off as a result of the money they earn.

Sadly, Liberals do not seem to appreciate the value, dignity and happiness that comes from hard work. I am not sure if it can be found in the scope of this legislation as written, but I would welcome amendments that would capture the spirit of our leader's past work to protect Canadians with disabilities from being punished for working.

Parenthetically, I want to say something directly to employers about hiring Canadians with disabilities. Research done by Cardus shows that many employers have an exaggerated perception of the cost associated with accommodation. Cardus' work shows that including and accommodating employees with disabilities is often much cheaper than employers initially expect and that funding may be available from different levels of government for businesses, including small businesses, seeking to accommodate customers and employees living with disabilities.

Further, as our leader has previously shared in the context of speaking to Bill C-395, there are many cases of Canadians with disabilities who make incredible, committed and loyal employees who bring unique competencies for the workplace. Governments have a responsibility to ensure that poorly structured benefit programs do not undermine the ability of Canadians to access work, but employers also need to lead in pushing aside stereotypes and recognizing the contributions that Canadians with disabilities can make to their workplace. Many employers are already doing this, and I congratulate those who are doing this already.

Those were the main points I wanted to make on Bill C-22, but it is also very important to speak to the context of the legislation, which is the significant negative impacts on the lives of Canadians living with disabilities that flow from the government's radical ableist approach to euthanasia, the so-called MAID regime. We simply cannot have a conversation about financial benefits separate from a recognition that the biggest threat to the lives of Canadians living with disabilities is that those without disabilities are much more likely to be offered suicide prevention and recovery support, while our brothers and sisters, cousins and friends who are living with disabilities are being denied those supports and actively pushed towards death, even if they are saying they do not want it.

Among those who support legal euthanasia around the world, Canada is still increasingly seen as a cautionary tale, a warning of what not to do. In this vein, I want to start with a bit of history. Euthanasia in Canada started with Bill C-14, which was passed in the 42nd Parliament. This legislation affixed the name “medical assistance in dying” to what had previously been called euthanasia, the process of doctors killing a consenting patient. That legislation sought to define a regime whereby people could choose hastened death if their death was deemed reasonably foreseeable.

I criticized the legislation at the time for, among other things, not being sufficiently clear about what was actually meant by “reasonably foreseeable”. Indeed, there were significant abuses, even in the immediate aftermath of the passage of the legislation, whereby doctors determined someone's death to be reasonably foreseeable based on a string of hypotheticals when a person had nothing approaching a terminal condition.

For example, back in 2016, I highlighted a case in Vancouver where a physician declared a depressed person eligible for euthanasia without examining the individual because that patient “could easily get bed sores and then die of infection”. A person's death was, prior to examination, declared reasonably foreseeable because the person could theoretically die from an as yet uncontracted bed sore infection if they were bed bound as a result of the depression. These were the kinds of perverse outcomes that were possible even in 2016 as a result of a lack of safeguards and the ambiguity around what was meant by “reasonably foreseeable”.

The current rules allow someone also to consult many different physicians before finding two who will approve. Therefore, if 20 or 200 doctors say no, the criteria are not met, but then two say yes, the criteria are met, then the killing of the patient can proceed. The ambiguity and the opportunity to consult multiple doctors before getting the desired result means that, indeed, the holes were, and still are, large enough to drive a truck through. These were the pre-existing problems that were already, in particular, raising concerns of the disability community. The lack of clarity around what were and were not circumstances where death was reasonably foreseeable opened the door for people who were living with disabilities to be encouraged to pursue MAID, even if they did not want to, and even if they were actually not eligible.

Members do not have to take my word for it because the minister responsible for this legislation, the Minister of Employment, Workforce Development and Disability Inclusion of Canada, during a subsequent discussion of Bill C-7, said, “I regularly hear from families who are appalled by the fact that they take their child, potentially their older child and are offered unprovoked MAID. I think that has to stop.” That is from a minister in the government. This was already the context following the passage of Bill C-14 and prior to the passage of Bill C-7.

The road to Bill C-7 was much more contrived than the road to bill C-14. The already nebulous reasonable foreseeability clause was challenged and a lower court in one province proposed to overturn this restriction. The federal government could have appealed that lower court decision and, indeed, had a strong basis for doing so. An appeal would, at the very least, have given parliamentarians more time to consider a broad range of legislative options. Instead, the government made a political choice to embrace the lower court ruling and the artificial timeline it created, pushing medical assistance in dying for Canadians with disabilities. This was not about following a court ruling. This was about something the government could have appealed, but wanted to use the court ruling to advocate for a long-standing objective.

Following this contrived process, the government put forward Bill C-7, which was rightly opposed by all of the leading organizations representing Canadians living with disabilities, as well as by domestic and international human rights authorities.

Krista Carr from Inclusion Canada said, “Inclusion Canada has advocated for safeguards in MAID since we intervened in the Carter case. Our biggest fear has always been that having a disability would become an acceptable reason for state-provided suicide. Bill C-7 is our worst nightmare.” She continued, “By having a disability itself under Bill C-7 as the justification for the termination of life, the very essence of the Charter of Rights and Freedoms would be shattered. Discrimination on the basis of disability would once again be entrenched in Canadian law.”

She said further that the “singling out of one particular...group” of people based on their personal characteristics, which happen to be protected under the Charter of Rights and Freedoms, and to use those as grounds to justify the termination of the lives of the people who have those characteristics is just wrong, and that we would never consider doing this for any other group of people, including those who are indigenous, racialized or LGBTQ.

Dr. Heidi Janz from the Council of Canadians with Disabilities said:

People with disabilities are at a higher risk of suicide due to systemic and internalized ableism, yet they face substantial barriers when trying to access suicide prevention services. Medical professionals overlook typical sources of stress. Problems arising from relationship breakdowns, depression and isolation are wrongly attributed to disability. The removal of “reasonably foreseeable” natural death as a limiting eligibility criterion for the provision of MAID will result in people with disabilities seeking MAID as an ultimate capitulation to a lifetime of ableist oppression.

Finally, Bonnie Brayton from the DisAbled Women's Network of Canada pointed out, “Bill C-7, is sadly lacking in any meaningful public consultation with any people with disabilities despite how much more profoundly it could affect anyone who lives with a disability.” The disability community overwhelmingly opposed Bill C-7 and has repeatedly raised concerns about negative pressure and coercion impacting Canadians living with disabilities.

What about autonomy? The government would argue that Bill C-7 provides people with disabilities the option of medically facilitated death, but they do not have to chose that option. It is just another option that people have. To this, I would note that autonomy is always expressed in a social, legal and economic context. The context is that many Canadians living with disabilities struggle to access the key supports and services they need.

We do not have sufficient workplace supports in place and there are gaps in terms of community and income supports. In that context, the law and the medical system say to a person living with a disability that they have a simple way out and they can choose to die. If someone is at a point of existential agony and they have a disability, then the system will offer them death as a supposed solution.

In effect, if a person like me, without a disability, is experiencing existential distress and suicidal ideation, and if I were to discuss that distress with a doctor, I would be offered suicide prevention. However, if a person with a disability, the same as me in every other respect, is experiencing the same existential distress and suicidal ideations, and they discuss their distress with a doctor, they will be offered suicide facilitation by that same medical system.

That difference in the way the law and the health system treat those living with and without disabilities obviously sends a message to everyone involved in those interactions about whose life the law and the health system deem to be more or less worth living. The Liberal government has built a staircase to suicide prevention and a ramp to suicide facilitation.

As much as members opposite would like to say that this is about autonomy, the social and legal context that the government has created is not neutral and it is, in fact, discriminatory. Disability rights groups overwhelmingly see this reality, which is why they have been diametrically opposed to the approach of the government, and so much for “nothing about us without us”.

Canadians with disabilities feel devalued by a system that offers them easy death and does not offer them critical supports to live. Sadly, the mentality of the medical system is changing as well in response to these legal changes. The House has heard from many witnesses at different times and in different communities where patients were repeatedly pushed toward death and even called selfish for rejecting that option.

I will quote the minister again who said herself, “I regularly hear from families who are appalled by the fact that they take their child, potentially their older child and are offered unprovoked MAID. I think that has to stop.”

In response to the testimony we heard, Conservatives sought to amend Bill C-7 to guarantee that a physician or other health care worker would not raise euthanasia or MAID with a patient, unless the patient raises it first. This amendment would have ensured that, for instance, a person with a disability who goes to the doctor for something unrelated would not be offered facilitated death out of the blue. This would have solved the problem the minister identified, but the government opposed this—

[Spencer Hawkswell, President and Chief Executive Officer, TheraPsil]

Thank you.

I'm a patient-rights advocate and the CEO at TheraPsil, a non-profit dedicated to supporting patients in accessing psilocybin, a substance commonly found in what's otherwise known as magic mushrooms that has an amazing ability to help people through the therapeutic process. It usually has been used in studies to help people with end-of-life distress.

I'm here today to advocate on behalf of a number of our constituents and patients who have the right to die in Canada with medical assistance in dying, but currently are being denied their right to try psilocybin. Specifically, I will refer to a patient, Janis Hughes, who is a 65-year-old woman in Manitoba with stage 4 breast cancer and an advocate with a two-year prognosis who in her own words states, “It is not only patronizing but an infringement upon my charter rights to have a Canadian government deny me access to psilocybin, a substance that has helped me with my palliative care treatment and end-of-life distress while allowing me at the same time only one alternative—medical assistance in dying.”

To relate what this has to do with MAID, it is about improving palliative care and adjunct or prior therapies.

The last time psilocybin was brought up in this meeting, it was shot down as a pseudo-science for its lack of research and not having much to do with medical assistance in dying. However, first in relation to the research, I might remind everyone that there is actually quite a bit of research behind psilocybin, specific research coming out of Johns Hopkins and NYU, that far surpasses much of the research that was done for medical cannabis and perhaps medical assistance in dying. These were both legalized on the basis of human rights, and that is what we are talking about here today—a human rights issue in need of compassion.

Second, to answer how MAID is connected to the psilocybin issue, the people whom I represent, such as Ms. Hughes, are directly affected by this committee. Psilocybin access is currently available through the special access program to those who have failed every other treatment, leaving MAID as one of their only alternatives if psilocybin is not allowed. This represents a woeful incongruity in our health care system. I believe that if this committee is made aware of this incongruity, they may see a situation in which we're allowing people to die before they're able to try substances such as psilocybin that might help them alleviate end-of-life distress and help with their palliative care before MAID.

Where is the compassion? Why is there not a more patient-centred approach when constituents and stakeholders of the actions of this committee are being told that they are being denied prior or adjunct treatments to MAID?

I am personally a big supporter of medical assistance in dying and have agreed with everything I've heard so far. We must move it forward quickly, but we must also see it in the context of palliative care in Canada, especially where patients are being denied access to other therapies.

Bill C-14 and Bill C-7 required establishing this committee in the House of Commons and Senate to conduct a comprehensive review of the Criminal Code, MAID provisions and their application and issues relating to mental illness and the state of palliative care in Canada. I believe that we are talking about the state of palliative care in Canada.

I am here to defend Canadians with mental illness and those struggling to receive adequate palliative care. Our health care system prides itself on being patient-centred and giving people the right to die after the Carter proclamation—if you don't have the right to die, then whose body is it? At the same time, it will limit these same Canadians by expanding MAID while ignoring issues related to adjunct or prior treatments, such as psilocybin access.

I believe that this is unconscionable. Given the constituents affected by this committee, this review will be subject to broader options relating to medical death while their request to seek treatment such as psilocybin to better their quality of life is being ignored.

I don't believe that the members of this committee should let such a thing happen. I'm asking for your compassion and support for people like Janis. I believe that Canadians who have the right to die should similarly have the right to try psilocybin and perhaps other controlled substances prior to MAID.

I believe, however, that we should start with psilocybin access, given the robust research. We should expect this to increase to other treatments and substances that may hold other grounding.

I'm urging this committee to add in its report that regulations for medical psilocybin access for those seeking MAID should be given a priority and that it should be a possible prior treatment for a number of Canadians seeking this. I do not intend in any way to slow down any of the other work that is being done on MAID and on other issues; rather, I encourage the expansion of other alternative treatments at the same time. Again, I am referring to psilocybin.

I am here to defend people like Ms. Janis Hughes and hundreds of other patients who have reached out to our organization and who are feeling disheartened that we might make MAID available in as little as three days while someone like Ms. Hughes has waited seven months for access to psilocybin and has been forced to break the law to access it.

I do not believe that this reflects well upon the state of palliative care in Canada, and I believe that, similar to the comments made by Dr. Downar, this is simply a reflection of other therapies—adjunct and prior therapies—that need to be made available while our MAID committee is expanding possible options for medical assistance in dying.

Please consider it. Thank you.

[Dr. Michael Trew]

Thank you.

I think I like the wording of the expert panel for sharing. I think that is a bit of a shift from how most people read Bill C-14.

[Dr. Michael Trew, Clinical Associate Professor, University of Calgary, As an Individual]

Thank you for inviting me to speak today.

With regard to a few words about my relevant background, I've been a clinical psychiatrist for 40 years in Calgary, with a special interest in the interplay between mental disorders and physical disorders. I am a clinical associate professor at the University of Calgary. I am the former chief medical officer of addiction and mental health at Alberta Health Services.

I chaired the Alberta Health Services non life-limiting expert panel from 2016 to 2018. I'm a member of the Canadian Psychiatric Association task group on MAID in mental disorders as the sole underlying medical condition. I am also a member of the Canadian Association of MAID Assessors and Providers, and I have provided psychiatric assessment primarily as it regards capacity in community settings.

In general terms, I respect and agree with the overall goals of Bill C-14 and Bill C-7,, along with the “Final Report of the Expert Panel on MAID and Mental Illness”.

In my view, mental disorders have long been seen as separate and distinct from physical disorders. I believe that any ongoing distinction between mental disorders and physical disorders in MAID-regulated legislation is unlikely to stand up to court review.

From my own clinical experience, I can describe cases that most people would agree represent appropriate use of MAID for people who have a mental disorder as their sole underlying medical condition. I can also report cases that most people would be very uncomfortable with if MAID for mental disorders were provided.

The challenge is to identify a reliable assessment system to make these determinations. Failure to generate such a system invites risks, including substantial variability from jurisdiction to jurisdiction, the risk of providing too much or too little MAID for mental disorders, the attendant ethical distress for providers and survivors, and MAID shopping.

In my view, the courts have judged on the most extreme cases, those with very strong and reasonable plaintiffs. These cases of extreme suffering and disability have established the principles that underlie MAID in general. Looking at them now, they seem relatively black and white, while some of the track two cases—and I anticipate many of the mental disorder as the sole underlying medical condition cases—will be very nuanced and grey in their details.

Not all of our requesters are or will be very reasonable. The level of complexity, combined with the current practice, which has emphasized for good reasons the independence of assessments, calls for some consideration of the processes and the expectations going forward.

The drive for MAID in the first place was largely driven by a person-centred, human rights-based approach. Bill C-14 largely focused on the question of not whether a person was going to die soon, but how and when they would die soon. I believe we have seen this taken up largely by individuals who are used to a high degree of personal control in their lives and choose to take this step at the time of their death. It has been very well received, and providers and survivors have attested to the relief and thanks that most would see as signs of success. The completion rate has been high in this group, once the formal request was made.

The anticipated situation for MAID with mental disorders being the sole underlying medical condition is very different. The Benelux experience reports a completion rate in the ranges of 0.5% to 4.5%, while our current overall Canadian completion rate in 2021 was reported to be 81%. This means an entirely different expectation is set for assessors, as well as providers, for those who request MAID for mental disorders.

I anticipate that this will be seen by some as being overly paternalistic. This may invite further court challenges unless the overlying administration is very carefully set and appropriate training is provided in concert across the country.

I appreciate the wording of the expert panel in describing shared decision-making. I believe we also need to build in the appropriate room for discussion between assessors after their first assessment in order to have the full opportunity to discuss these challenging cases. As noted above, while this is not explicitly banned in the legislation, the emphasis on independence of assessment leaves the impression that talking between assessors after their first meeting may not be acceptable.

I also appreciate the expert panel's recommendation for involvement of treatment teams as part of this expanded process.

I would recommend—

Protection of Freedom of Conscience Act

[Mark Gerretsen, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons (Senate)]

Madam Speaker, I am pleased to participate in the debate on Bill C-230, the protection of freedom of conscience act. I appreciate the contributions of the member for Carlton Trail-Eagle Creek to medical assistance in dying, or MAID, which is a complex and deeply personal issue to many Canadians.

First, I want to acknowledge that the aim of the bill, which is to support the conscience rights of health care professionals, is indeed laudable. The government has always supported conscience rights, which is why, since the very beginning of Canada's MAID framework in a former bill, Bill C-14, these rights have been specifically recognized and acknowledged. However, at the same time, the criminal law is a blunt instrument that should be reserved for the most serious situations.

In my remarks today, I want to raise some questions about whether new offences are an appropriate solution to the legitimate concerns raised by the bill's sponsor. In this regard, it bears recalling the primary reason the criminal law is concerned with MAID in the first place, which is to provide the necessary exemptions to ensure that persons who choose to provide or assist in providing MAID do not face criminal consequences for doing so. The MAID provisions found in the Criminal Code were carefully crafted to respect the autonomy of Canadians, respond to the evolving issues and protect vulnerable persons. In other words, the involvement of criminal law is necessary to permit MAID while ensuring it is carried out in a safe, responsible manner.

However, Bill C-230 seeks to involve the criminal law in two very different ways: first, to create a new MAID-specific intimidation offence, and second, to create an employment sanctions offence. With respect to the former, the intimidation offence, it is worth reiterating that the Criminal Code already provides provisions for several offences that would be available to respond to situations where a health care professional is a victim of coercive or threatening behaviour, including the intimidation offence in section 423 and the extortion offence in section 346.

To me, it is not evident that an additional specific offence is required to protect conscience rights. I should also say that I am not aware of any evidence of health care professionals facing threatening circumstances in the context of refusing to provide MAID or that there is a specific gap that needs to be filled in our law.

I have taken note of the fact that the proposed intimidation offence in Bill C-230 would be a summary conviction offence, which, if enacted, would stand out from other intimidation offences in the Criminal Code. The existing offences are either straight indictable or hybrid offences. In addition to being duplicative of existing offences, the fact that the proposed intimidation offence would only be prosecutable by summary conviction may suggest that intimidating conduct is less serious in a MAID context, which seems counterintuitive.

To further highlight why I have concerns about creating a specific intimidation offence as proposed by Bill C-230, I would like to draw members' attention to a recent example that offers a clear contrast. Last year, as members will recall, unfortunately in some parts of our country there was a threatening atmosphere of intimidation present for many health care professionals who were simply trying to go to work and care for members of their communities during the pandemic. That is why the government responded with Bill C-3, an act to amend the Criminal Code and the Canada Labour Code, which provided new criminal law tools to protect all health care workers and all Canadians who are seeking their care.

I believe Bill C-3 was an appropriate criminal law response to the credible threats to the safety and security of health care professionals and Canadians, but I am not convinced that a similar response is necessary when it comes to the situation of conscience rights and the provision of MAID. It seems to me that the charter and existing criminal law offences already provide the necessary protections for those rights, alongside the specific provision in the current MAID framework that expressly states that nothing in the federal law compels an individual to provide or assist in providing MAID. There is simply no obvious need to supplement what already exists.

Turning to the employment sanctions offence, I am struggling with Bill C-230's proposal to create a new offence that would exclusively target employers who dismiss or refuse to employ health care professionals who choose not to provide MAID. Moreover, in my view, Bill C-230's employment sanctions offence would not address the concerns described in the bill's preamble regarding conscience rights and certain requirements for professionals to make effective referrals for MAID.

As members are aware, in some jurisdictions, the professional orders that regulate health care professions have established requirements that their members provide effective referrals for MAID. While there have been cases where these requirements were challenged, the courts, including the Court of Appeal for Ontario, have upheld them, noting that this is a difficult issue that involves taking into consideration the conscience rights of professionals and the needs of their patients.

I do not believe it would be constructive for Parliament to intervene by creating a new criminal offence such as the one proposed by the bill. Rather, a more productive approach is for the government to continue its efforts to work closely with the provinces and territories on the implementation of MAID in a manner that supports persons who may be considering it and the health care professionals who provide exceptional care to their patients.

For the reasons I have mentioned, I have significant concerns with Bill C-230. While I agree wholeheartedly with protecting the conscience rights of all health care professionals, including those who choose to participate or refuse to participate in MAID, I am not persuaded that the two offences proposed in the bill are necessary or desirable.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Right. I was going to get to that in a moment, so I'll go there now.

If a patient has terminal cancer but also has a mental disorder, as the law currently stands and as it did under Bill C-14 and Bill C-7, that person could qualify for MAID solely on the basis of the cancer diagnosis, but if they are not excluded from having access because they also have a mental disorder. That's the state of the law, correct?

[Ellen Cohen]

First, I would like to see the government push the deadline back because it's unrealistic. I signed on in June and we didn't start our first meeting until the end of August, so it was rushed. I understand that your panel and this process is being rushed as well. I'm not sure what the hurry is.

I know that we made many recommendations. Dr. Wieman remarked on Dr. Goulet's experience in Manitoba as a MAID assessor. We talked about teams. She talked about having a great team. I think there needs to be some kind of thought into how people....

It's difficult for doctors, as I understand, as well. I clearly understood that as I was sitting at the panel. I understand the difficulties, but I think that if the government is going to move forward, they need to help support the medical community to develop the processes collectively. There needs to be a standard across the country so that things don't go off course.

Mental health legislation went off course. Every province does it differently. What I witnessed in Bill C-14 was that every province monitored differently and some of the provinces had “unknown” categories. Way too many people were dying from unknown—

[Trish Nichols]

Well, we have criteria for MAID. In Bill C-14, there are definite criteria for MAID, and Alan did not meet the criteria for MAID, medically or according to the laws that are set by legislation. He did not meet those. He didn't meet the criteria, because he didn't have a foreseeable death. He was admitted under the Mental Health Act as a danger to himself.

I don't know.... There needs to be a law put in place to protect people from being administered and put into a hospital against their will, don't you think, for that in itself? Then, to actually be offered MAID, and transferred and bounced around a hospital, and kept from his family....

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

Thank you very much, Madam Co-Chair.

Mrs. Nichols, I'd like to start with you. I'll echo the words of my colleagues in thanking you for coming before our committee and sharing a very personal story about Alan.

For Alan, in 2019, it would have been under the old Bill C-14 regime.

[Gary Nichols]

I don't want to see MAID expanded until the safeguards are actually enforced, because there was a safeguard in Bill C-14, and that didn't help my brother. So—

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

Just to be clear, because you talked about changing the law, I want it to be very clear for you, and for whoever is listening to this, that this committee is not talking about a piece of active legislation. We're conducting a study into this, which, hopefully, will inform decisions going forward. As of currently, there is no legislation before the Parliament of Canada that is looking at changing the Criminal Code with respect to medical assistance in dying, just so you're very clear on that.

The other question I had was with regard to Bill C-14 and Bill C-7. Bill C-7 opened up that other track: where death is not “reasonably foreseeable”. I'm just wondering.... It's a very personal decision. For children under the age of 18, if they do have an incurable disease, and if it is quite evident that every day of their life they are going through intolerable suffering, are you personally opposed to that child ever getting medical assistance in dying?

Or would you be open to it if you'd had a conversation with the parents and everyone knew that this was an incurable situation and the child was suffering? I'm just curious about your personal views on that particular aspect of the Bill C-14 track, the original track.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you, Madam Co-Chair.

Dr. Coelho, can you elaborate a little more on the case of the first patient you cited, who suffered from a stroke and was granted medical assistance in dying under the Bill C‑14 regime, despite not having a terminal diagnosis as required by law under Bill C‑14?

[Dr. Mona Gupta]

I'll say, slightly tongue-in-cheek, that compared to the time frame of C-14 and C-7, this is loads of time, whereas those changes happened very quickly.

I want to come back to my opening remark, which is that we're already doing it. We're already evaluating requesters who have histories of suicide attempts. We're already evaluating requesters who have serious histories of mental disorder. I'm not so concerned about the preparedness of the assessor and provider community. I think the training that's being developed is excellent. I think practitioners should pursue it, but I'm not so worried about that.

Your question about consultation with indigenous peoples is a good one. As I said, I really think it's for indigenous communities to say how they think we should move forward and not have a unified vision that gets imposed upon them.

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

Thank you very much, Madam Joint Chair.

Dr. Gupta, thank you so very much for joining our committee today and helping guide us through some very difficult issues. I appreciate the report that we now have to refer to as we commence our study.

I've been a member of Parliament since 2015 now. I was there for the Bill C-14 and Bill C-7 debates. For me, the problem with this whole process is that it seems, with the amendments that were made by the Senate to C-7, which effectively are going to allow for mental illness as an underlying condition by March of next year, it's also a situation where we've put the cart before the horse. We're involved in this very in-depth study, but we're working with an impending deadline that is now less than a year away. You've talked a lot about the fact that we need to make sure every option is available.

Before I get to supplementary questions, though, my first question to you is this: What was it like for the expert review panel working under the knowledge that you had this deadline? Did you feel a sense of pressure? How did that inform your work, knowing that in March of next year this is now going to be a part of the Criminal Code and allowed?

[Stan Kutcher]

Thank you very much, Mr. Chair.

I have a question for Dr. Black and then for Dr. Freeland.

Let's follow the suicide rate discussion.

Since Bill C-14 came into Canadian play, there has been lots and lots of public discussion about MAID in the media—all over the place in Canada. What has happened to suicide rates in Canada since MAID was introduced, generally and specifically to the population of those over 50 or so, who would more generally seek MAID?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you very much, Mr. Chair.

I know that we are scheduled to go in camera to consider two motions, but I would submit that just in the interest of time, so that we wouldn't have to log in again, there would be some merit in not going in camera. Speaking to my specific motion, at least, I think it would be appropriate that the motion be considered out of camera, in public.

It's a motion requesting that this committee dedicate six hours to the study of the effectiveness, compliance and enforceability of existing safeguards under the Bill C-14 and Bill C-7 regimes.

[Dr. Derryck Smith]

I'm talking about the reliability of psychiatric diagnoses. There's good research that shows that psychiatric diagnoses are as reliable as other medical diagnoses. This is in spite of the fact that we don't have biological markers like blood tests or X-rays to make psychiatric diagnoses. The reason for that is that the brain's a very complicated organ and we don't understand it.

However, the courts have certainly relied on psychiatric diagnoses over many years. In fact, the Truchon case in Quebec, which ended up with Bill C-7 being introduced, relied extensively on psychiatric diagnosis. The madam justice found that a psychiatrist can make accurate diagnoses.

In my opening statements—which you have—I've included a table showing that, compared to other medical diagnoses, psychiatric diagnoses are just as reliable.

The second thing I want to talk about is whether psychiatric illness is irremediable. Mental illness usually isn't a terminal illness, unless you're looking at conditions like Alzheimer's. Under current law, one does not have to have a terminal illness as a requirement for MAID.

I think it's instructive to look at the case of A.B. from Ontario, where a judge granted MAID for a woman who had osteoarthritis. This is not a condition that is terminal or usually results in death. The judge agreed to providing MAID for A.B. because she looked at the whole person. One cannot look just at a diagnosis. You have to understand the nature of the human experience of the person who's sitting in front of you. Don't rely entirely on what the diagnosis is. It's the person that we're interested in here.

In a more recent decision, Justice Baudouin granted Jean Truchon, a disabled man, his request for MAID. In the judgment—which I'm sure you've had—on paragraph 466 it says, “The physicians involved are able to distinguish a suicidal patient from a patient seeking medical assistance in dying.” That was one of her conclusions.

Unlike the previous witness, I think, when it's tried in a court of law, the judge has accepted that psychiatrists can distinguish between suicidal thinking and people who are seeking MAID. I'm in agreement with that.

Now, “irremediable” is a term that's used when there are no more treatments available that are “acceptable” to the patient. Under law, the patient cannot be forced to take any types of treatments that are available. They must agree. If a person refuses additional treatment, I would, therefore, consider them to be irremediable. One of the major controversies in psychiatry is whether people with depression should be forced to have electroconvulsive therapy. I think the law is quite clear. The patient must agree. If they don't agree and there are no other treatments available, then the person has an irremediable condition.

We're not talking here about people who have been depressed for a day or have had six months of distress. We're talking about people who have been psychiatrically ill for years and have tried many different treatments—medication, psychotherapy and so on. All of the cases you've heard quoted from the Netherlands are chronic patients with many years of treatment.

The next thing I want to speak about is whether the vulnerable need protection. Again, this has been tried in court with both the Carter case and Truchon case. There is no evidence that vulnerable people are at risk for MAID. In fact, if you look at the actual people who are receiving MAID, they are typically white, well educated and well off. You could easily argue that the marginalized communities are disadvantaged because they're not accessing MAID. In the Truchon case, Justice Baudouin equally found that the disadvantaged are not being taken advantage of and you must do each case at a time.

I thought I would talk to you about the two cases I've been involved with.

One was a woman, E.F. This was extensively reviewed by Madam Justice Baudouin in her judgment. E.F. was a woman with a conversion disorder. She had the condition for about 10 years. It's a complicated psychiatric neurological condition. In the end, a justice in the Queen's Bench granted her MAID. The Attorney General of Canada appealed it and the court of appeal granted it based entirely on the psychiatric diagnosis.

That was before Bill C-14, when the rules flowed out of the Carter decision. We know from Carter that psychiatric illness was not an exclusion.

If you look carefully at Bill C-14, there is nothing that excludes psychiatric patients. Again, this was a finding from Madam Justice Baudouin in the Truchon case.

I, personally, was involved with a woman who was in her forties. She'd had an eating disorder for many years. She'd had every known treatment. The family was richly resourced. She'd been to treatment centres in the United States. I interviewed her and her father, who was a retired Supreme Court justice. Her father said knowingly that he understood the situation and it broke his heart to agree with his daughter that she needed an assisted death. In the end, it was his opinion that she should have an assisted death. After a full assessment program, she did have an assisted death. Those are the only two patients that I've been personally involved with.

The numbers across Canada up to this point are enormously small and they will, incidentally, continue to be small as well. If we look at the Benelux countries, there are very few patients who actually get approved for psychiatric illness leading to MAID, so we don't have to worry about a tsunami of psychiatric patients lining up, applying for MAID and being approved for that.

[Pamela Wallin, Senator, Saskatchewan, CSG]

Thank you, Co-Chair.

I think many people seeking MAID are less able than they once were. Some may be disabled or have become disabled, and some may be contemplating suicide reluctantly because they don't have the option of MAID. I think we have to be very careful in our discussions here that we do some fact-checking. I think it's risky that we accuse MAID providers, licensed medical professionals in this country, of coercing people into MAID, of imposing MAID on people, of making offers of MAID in exchange for freedom. These are matters of law, the courts have ruled on this and the governments have responded by writing very carefully crafted legislation, so I want us to be very cautious in that.

I want to go to Mr. Adams, if I could, because you have been through that process, both attempting to do so under Bill C-14 and then again under Bill C-7. You said that you thought it was an intense process. Give us a couple of examples. Do you think you could have walked in and said, I have nowhere to live, or I'm part of a minority group, please give me MAID, and they would have responded?

[Andrew Adams]

The first time I tried to apply for MAID, the process was shut down fairly quickly. Initially, I had been considering applying under the interim court ruling that was there before the actual C‑14 bill was passed. As soon as it became clear that C‑14 was going to limit eligibility, I was basically told that it's just not going to go forward. I sort of stopped trying after that for awhile.

Bill C-7 then passed and I reached out to my local health authority. Through that coordination centre, I was put in touch with a doctor and went through the 90 days. That was quite a lengthy assessment. The consultation with the third party—the specialist—was very thorough. I did more tests than I had ever done before. This specialist has dealt with me for a number of years, so they know me, know my condition and know what I've tried.

I went through all of the other measures in the law and was found eligible. I waited some time and then I eventually got a second approval as well.

One of the doctors was part of my initial exploration of C‑14 and clearly had different conclusions for these two different bills.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Thank you.

Lived experiences are important for all of us on this committee for the reasons we've heard. I'm wondering if you would be willing to sort of take us through the process you went through after C‑14 and after C-7, so we have a better understanding of how it works.

Were you dealing with same group of medical practitioners on both occasions?

[Andrew Adams]

I had initially applied when C‑14 had passed.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Did you apply for MAID after Bill C‑14 was passed or did you apply only after C-7 came into force?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you, Madam Chair.

I would like to move a motion that I have put on notice. It reads:

That, the committee dedicate six hours to study the effectiveness, compliance, and enforceability of the legislated safeguards for Medical Assistance in Dying in Canada under both the C-14 and C-7 regimes.

That is the motion. I believe it is important that a review of the existing safeguards and instances of possible abuse and coercion be done by the committee. I would note that pursuant to Bill C-14, there was to be a retrospective review of the provisions in Bill C-14. That review never took place.

There have been a number of well-publicized instances of potential abuse, including recently. A 51-year-old London, Ontario, woman accessed medical assistance in dying after she could not find adequate housing—

[Dr. Georges L'Espérance, President and Neurosurgeon, Quebec Association for the Right to Die with Dignity]

Thank you, Madam Chair and Mr. Chair.

Senators and members of Parliament, the Quebec Association for the Right to Die with Dignity thanks you for holding this meeting.

I am a neurosurgeon retired from surgical practice and now an active provider of medical assistance in dying. Our suggestions here are intended as principles that should guide all thinking on such matters as personal self-determination, respect for expressed wishes and values and dignity in life and death without medical paternalism or religious or ideological dogmatism.

Our brief has been forwarded to you and contains numerous hyperlinks.

Today I will outline our thoughts on advance requests for medical assistance in dying and say a word about two other equally important topics.

All capable persons who have received a diagnosis of cognitive neurodegenerative disease should, while all their faculties are intact, be able to indicate by an advance request that they wish to obtain medical assistance in dying at such time as they deem appropriate for them, based on their values, regardless of their cognitive state at that time. That position is supported by nearly 80% of Quebeckers, according to a scientific survey conducted by the Collège des médecins du Québec in fall 2021.

In February 2016, during consideration of Bill C‑14 within these walls, that's also precisely what was clearly spelled out in recommendation 7 of the report prepared by the Special Joint Committee on Medical Assistance in Dying, consisting of senators and members of Parliament.

In Quebec, a transpartisan special committee of the National Assembly tabled an informative report on this subject, which you have no doubt seen, on December 8, 2021.

As a neurosurgeon, and like many clinical experts, I want to point out here that what some call a “happy dementia” is an oxymoron used to describe the condition of a human being who is no longer what he was during his life. Claiming that such an individual may have changed his mind about seeking medical assistance in dying because he seems cheery and fine, whereas, by definition, he is no longer the same person, may seem like an insult to that person's intelligence and, especially, to the person himself, like a negation of the personality he had initially and throughout his life.

I also want to state that medical assistance in dying does not compete with palliative care in any way but is an additional compassionate tool in end‑of‑life care. Medical assistance in dying takes absolutely nothing away from palliative care, financially or otherwise, and requires the presence of a physician or nurse for only a few hours in total, at no cost to the system.

An absence of physical suffering can in no way preclude future existential suffering that the person may express while still capable of doing so. It is important to note that eligibility for medical assistance in dying brings serenity and peace of mind and enables those afflicted to live fully in the present without experiencing anxious thoughts of a long road of suffering and loss of dignity as a result of a disease that leads inevitably to a slow death.

Those of you who may have experienced the pain of seeing a loved one disappear into the abyss of dementia will definitely not want to experience the same long existence without living that is the reality of dementia.

Our recommendation is that medical assistance in dying by advance request be authorized upon confirmation of a diagnosis of cognitive degenerative disease and at the time the person has decided in advance by designating a representative.

Mental health disorders taken together are a real disease that causes undeniable suffering. Continuing to rule out mental health issues can only lead to legal challenges, a process that is complex and unacceptable for the patient concerned. Our recommendation is that medical assistance in dying be accessible by March 2023 for persons with mental health problems based on strict clinical eligibility criteria to be established with experts in the mental health field.

We also recommend that persons with significant cognitive impairment be completely and permanently disqualified from receiving medical assistance in dying, except where there is absolute certainty that the person's decision-making ability is intact.

Lastly, it is the association's view that medical assistance in dying must be extended immediately to mature minors 14 to 18 years of age. We recommend that medical assistance in dying be accessible to mature minors suffering from an incurable physical pathology, but not to those suffering from mental health pathologies.

Thank you.

I will answer your questions as best I can, based on my knowledge.

[James S. Cowan]

In the brief that we'll be filing in the next few days, we go into our recommended safeguards in some detail. We recommend for advance requests both when there is a diagnosis and when there is no diagnosis, in this case with more strict safeguards. The main difference is that we recognize that without a diagnosis, the request ought to be time-limited. I think one of our colleagues on the panel mentioned that specifically. We would agree. We would suggest a five-year period and suggest that such a request would need to be renewed every five years in order to be considered at a later stage.

The safeguards that in place now in Bill C-14, as modified by Bill C-7, are very strict and I think are perfectly fine.

[James S. Cowan]

It's good to see you again, Mr. MacGregor.

I only add that we go back to this being about the patient and about the individual. It's a clinical assessment by a medical professional as to competence. Medical professionals make these kinds of assessments every day in their practices. They're well versed and well trained in assessing competence, and if there is any doubt, then obviously they don't certify the compliance with the strict criteria that are set forth in legislation.

The legislation, as originally in Bill C-14 and then as modified by Bill C-7, has very strict criteria, very strict safeguards. I think there was significant improvement in Bill C-7, because some of the safeguards that we thought about or that Parliament put in place back when we began this journey turned out to be burdens or barriers rather than safeguards, so they were properly modified last year.

I think that as we learn more about the evolution of MAID in Canada, we have lots of experience here in Canada and, as I said in my remarks, there is simply no evidence of abuse, of coercion, and it is, as I said, about the individual's decision. It's not about what other people might think that decision ought to be.

[Dr. James Downar, Critical Care and Palliative Care Physician, As an Individual]

Thank you very much.

I'll try to keep my comments as brief as I can. I've already sent in some notes for people to follow.

I'm the head of the division of palliative care at the University of Ottawa. I have a clinical research chair in palliative and end-of-life care and a master's degree in ethics.

I've taken an interest in this issue for some time, have served as an expert witness in different cases involving medical assistance in dying and have developed educational materials for medical assistance in dying for different jurisdictions, including Canada and Australia. I've also led a few studies looking at MAID and people who receive medical assistance in dying to understand a bit about their experience and about who these individuals are, but I'm not here representing any organization or agency.

I've previously spoken in favour of legalization of medical assistance in dying, but I'm not here to promote MAID and certainly not to advocate for any position on any of the remaining issues before Parliament about mature minors, advance directives, etc.

The main points I would like to make today really are that I'm very grateful to say that funding for palliative care and support for palliative care research is improving and that there have been some notable successes in that regard. I really want to thank Parliament and Health Canada for that, but I really emphasize the need to continue doing this and to reduce barriers so that we can improve the way we treat suffering among the dying.

I've heard a lot of comments in the previous sessions about the social determinants of health and the vulnerable. I think it's very important to say that we really do need to address social determinants of health, including housing, food security, pharmacare and dental care, because these are important to the health of all Canadians. I think it's important to recognize that these measures are really not about medical assistance in dying at all, because structurally vulnerable individuals are already far less likely to use medical assistance in dying than anybody else. We should do these things simply because they're a good idea and the right thing to do.

There are a lot of narratives about medical assistance in dying in Canada. These are generally driven by ideological or political aims that really have nothing to do with saving lives or protecting the vulnerable. I think we've learned an awful lot over the past 20 years about how medical assistance in dying is provided in different countries, including Canada, and who is requesting it and who is receiving it.

What we know very much is that it is not what has previously been thought. It is heavily driven by something known as existential distress. This is a type of suffering for which we have very little or nothing to offer. We really should be attempting to understand this type of suffering better, to identify new forms of treatment and to support research into identifying new forms of treatment for it, so that we can address this suffering as really the root cause of MAID requests. I think that's something on which everybody—as controversial as this issue might be—can agree.

Finally, I'd like to also mention that our experience through Bill C-14 and Bill C-7has been that Parliament, in the past, has really been unwilling to address medical assistance in dying and key issues in a proactive way, preferring to let the courts strike down laws and leave the government to replace them. This unfortunately happens usually in a very partisan process—a bit of a circus, almost—in an accelerated time frame and with predictable results.

I really love that there's now a committee like this that's going to be studying some of the important issues and reviewing things. I would really encourage a committee like this to continue operating to try to make sure that the remaining questions about medical assistance in dying are handled in a way similar to what Quebec's parliament does: proactively addressing questions, studying them thoroughly, forming committees to really review evidence and then developing nuanced answers. I'm not suggesting that we should go the same way Quebec has on any issue. I'm simply admiring its process and encouraging us to follow it.

I think we can get into some further discussions around some of the drivers, but I really want to emphasize that there is absolutely no data suggesting that the practice of MAID at this point is driven to any degree by poor access to palliative care, socio-economic deprivation or any isolation. Quite the contrary: The people who receive MAID almost invariably have excellent access and are receiving palliative care far more than the average population. They tend to be very wealthy, privileged, non-institutionalized and married, not widowed or single.

The national reviews on this have shown that the number of people who received MAID and who had trouble accessing disability services and palliative care services is tiny—absolutely minuscule. That's very reassuring. Obviously, it could be even lower than 1% or 3%, but that's pretty good. Certainly, it would not be accurate to say that it's being driven by a lack of access to services.

I really want to emphasize a bit of information about the research and the successes that have been found in research—

[Dr. Leonie Herx]

Certainly there is renewed attention, as you said, on the importance of palliative care, and it was indeed positioned, by both the Supreme Court and in the Bill C-14 legislation, as something that could alleviate suffering that might lead to a request for hastened death. We were so fortunate to have supported, through the Canadian Society of Palliative Care Physicians, Bill C-277, which created the national framework for palliative care. What that really allowed us to do was to put together all the good work that's been done across the country, informed by international standards, to solidify what we need to achieve in Canada to make palliative care a reality.

Unfortunately, we haven't really done anything further than to put a framework on paper. What we need is the money and the infrastructure to get the boots on the ground. We now have clearly defined national competencies for all professionals who provide a palliative approach to care for their patients and for the specialist training that is needed, but they are not embedded into curricula across the country. We do not have quality standards to evaluate what palliative care is happening across the country. That goes back to the Health Canada data. We just don't know what's happening and who's providing the care, although now we have these credentialing programs.

We need a national system that's linked to Accreditation Canada's standards and that's administered so that provinces collect data on outcomes for patients that is patient-reported. We also need the quality standards to make sure that provinces are accountable for improving both the quality of palliative care and the access to it. Achieving that will take a sustained investment of resources over time to get those trainings embedded, to get the standards up and to hold the provinces accountable through accreditation standards. That's absolutely needed, and we haven't seen any of that. There was no money in the last federal budget, and that needs to change. At least 95% of Canadians don't want to die via an assisted death, so let's put some money into supporting the needs of all those people who don't want MAID.

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

Thank you, Madam Co-Chair.

Dr. Herx, maybe I'll start with you. I was a member of Parliament in the 42nd Parliament when the original debate on Bill C-14 was going on in 2016. I remember the very passionate debates in the House during that time. Opinions voiced by members spanned the entire spectrum. Concurrently with that debate, there was also an acknowledgement that we as a country needed to do better in terms of giving patients palliative care options. In my own community in the Cowichan Valley on Vancouver Island, Cowichan Hospice has benefited tremendously from the building of a new palliative care centre, which has expanded the number of beds that are available.

I want to take a little walk down memory lane with you over the last number of years.

The original Bill C-14 was passed in 2016. We had all-party support in 2017 for the palliative care framework. Dr. Herx, when you saw that renewed focus on palliative care in Canada that came first in 2016 with the debate on Bill C-14 and then with the passing of the palliative care framework, did you see an improvement in 2017, 2018, and 2019, and then did it just ebb? Have we just lost the plot a bit, and do we need to refocus the attention a bit? I want to get a sense from you of what those previous years were like.

[Stanley Kutcher]

Thank you very much, Chair.

Ms. Hoffman, you mentioned earlier in the discussion that consensus around MAID has not been a phenomenon all the way through this process. Is there any way you could give us some idea of the numbers or the proportion of medical practitioners, let's say when Bill C-14 came into place, who were comfortable with and supported MAID, and then the percentage of those who didn't? In the palliative care community, what was that proportion when MAID was first introduced? Has that changed? Has there been a change in the consensus over time?

[Jay Potter, Acting Senior Counsel, Department of Justice]

Good afternoon, and thank you, members of the committee. My name is Jay Potter. I'll be giving remarks from Justice Canada today.

I'm pleased to be here to support your review of medical assistance in dying. My comments will be consistent with those of Ms. Klineberg from last year and will provide an overview of the federal MAID framework and highlight some considerations that you may wish to bear in mind as you study the complex and important issues that are before you.

As you know, our law has evolved considerably since the 2015 decision of Carter by the Supreme Court of Canada. In less than a decade, the law's approach has transformed from an absolute prohibition on MAID in all circumstances to a sophisticated regime that permits it as a legitimate response to intolerable medical suffering, while also providing for eligibility criteria, procedural safeguards and a monitoring regime to protect vulnerable persons.

Thousands of Canadians have accessed MAID, most of whom did so under the initial framework set out by former Bill C-14. As you all know, that framework changed last year through former Bill C-7, which responded to the Truchon decision.

The most significant change made by former Bill C-7 was to eligibility criteria. The law now permits MAID irrespective of whether or not a person's natural death is reasonably foreseeable, but that concept is used to determine the procedural safeguards that will apply to a request. There's also a temporary exclusion for requests where a mental illness is the sole underlying medical condition, which will expire in March of 2023.

There were also a number of changes made to procedural safeguards, including providing for a waiver of final consent, which allows MAID to be provided to an incapable person in certain defined circumstances: specifically, where such a person has a reasonably foreseeable death and, while they had capacity, they requested MAID, were assessed and approved for it, had scheduled the procedure for a specific date and agreed with their practitioner to receive MAID on or before that date if they lost capacity.

As you move forward with your work, it may be helpful to recall that the framework governing MAID is shared between the federal and provincial governments. Parliament is responsible for the criminal law, which is the foundation for the federal framework, and the Criminal Code provides exemptions from offences of culpable homicide and assisting suicide so that practitioners and those who support them are not criminally liable for providing or being involved in the lawful provision of MAID. The criteria and safeguards form the key elements of those exemptions.

In contrast, the delivery of health services is generally a matter of provincial responsibility. This includes organizing access to MAID, the regulation of health care professionals and enforcement, whether that be at the professional disciplinary level or with respect to the enforcement of the criminal law. As a matter of health law, provinces or professional regulatory bodies could supplement the federal framework with additional requirements concerning MAID; however, they could generally not permit something that falls outside of the exemptions. That type of change would require federal legislation.

Relatedly, I would note that the issue of advance requests for MAID raises particular complexity in this regard. The criminal law exemptions are oriented towards a single point in time, which is when the practitioner administers a substance to cause a person's death or provides them with a lethal substance for self-administration. In an advance request scenario, a second point in time is relevant, too, which is when the request is prepared by the person who at that time is not immediately seeking MAID. This earlier point in time does not obviously involve the commission of a criminal offence that requires an exemption, so there's legal complexity in considering how the criminal law might provide for procedural safeguards or other requirements to govern it. Those would ordinarily be matters of health law.

Finally, in support of your study, I would remind the committee of the three reports of the Council of Canadian Academies. These were prepared pursuant to former Bill C-14 and address many of the issues that are before you. No doubt you'll also be interested in the forthcoming recommendations of the expert panel on MAID and mental illness, which was established last year to consider safeguards, protocols and guidance for the provision of MAID in those circumstances.

Those conclude my opening remarks. I'd be pleased as well, with my colleagues, to respond to the committee's questions.

Thank you.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I rise in strong support of Bill C-230, the protection of freedom of conscience act, introduced by my friend, the member for Carlton Trail—Eagle Creek.

The bill before us is much-needed legislation to protect the charter rights of medical professionals who conscientiously object to providing or otherwise participating in medical assistance in dying. I want to commend the member for her steadfast leadership in championing conscience rights and for bringing this bill back to the House, as she introduced a similar bill that died on the Order Paper in the last Parliament.

Medical assistance in dying raises profound legal, moral and ethical questions. The trial judge in the Carter decision, which struck down the Criminal Code prohibition against physician-assisted death, stated, “The evidence shows that thoughtful and well-motivated people can and have come to different conclusions about whether physician-assisted death can be ethically justifiable.” This is true of patients, and it is true of medical professionals.

Medical professionals have a duty to do what is in the best interest of their patients and to provide the best possible advice based upon their judgment and experience, all of which are grounded on moral and professional convictions. In the case of medical assistance in dying, there are professional, moral and ethical considerations of the highest weight.

In the Carter decision, the Supreme Court predicated its decision on two things: a willing patient and, as importantly, a willing physician. At paragraph 132 of the Carter decision, the court said that nothing in its pronouncement would compel medical professionals to participate in MAID. The court went further in stating that, “However, we note...in addressing the topic of physician participation...that a physician’s decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief.” In other words, again, it requires a willing patient and a willing physician.

Now, there are those who would say that this legislation is redundant, that it is not needed, and that in terms of medical assistance in dying, conscience rights of medical professionals are already protected. They would point to the pronouncement in Carter. They might also cite Bill C-14, which includes a preamble that expressly recognizes conscience rights as well as a “for greater certainty” clause in the Criminal Code, which simply provides that “for greater certainty, nothing in this section compels an individual” to provide MAID.

While the intention of Parliament was to protect the conscience rights of medical professionals when Bill C-14 was debated and passed—and I was there for, and actively participated in, that debate and the study of that bill at committee—in practice, conscience protections and the rights of medical professionals are not being respected across Canada. There is a gap, and that is why, when Bill C-7 was studied at the justice committee, we heard from medical professionals who expressed serious concerns about pressure and coercion in providing MAID.

Indeed, the Ontario Medical Association wrote to our committee and specifically called on the committee to amend Bill C-7 to provide greater conscience protections for medical professionals, given that the “for greater certainty” clause, although better than nothing, simply does not have teeth. It is not enforceable. In that context, while the Criminal Code does not compel a medical professional to provide MAID, there is nothing in the Criminal Code that specifically protects medical professionals when they are pressured or coerced to provide MAID. This bill addresses that gap and would close it by establishing two targeted offences; namely, it would make it an offence to intimidate or coerce a medical professional with regard to providing or participating in MAID, and secondly, it would make it an offence to dismiss or refuse to hire a medical professional solely on the grounds that they object to participating in MAID.

While this legislation would protect the rights of medical professionals, it must also be emphasized that this bill would just as much protect the rights of patients. The bill would protect the rights of patients by protecting the physician-patient relationship. It would do so by safeguarding the ability of medical professionals to provide their best advice and judgment, free of pressure and free of coercion, to a patient who is considering medical assistance in dying. It would protect patients by protecting their right to a second opinion. There can be no second opinion, or at least a guarantee of a second opinion, in the face of coercion or pressure to provide medical assistance in dying. There can be no second opinion when the only choice offered to a patient is medical assistance in dying as a result of pressure and coercion.

The need to safeguard the patient-physican relationship, which this bill works toward achieving, is all the more needed in the face of the radical expansion of medical assistance in dying in Canada with the passage of Bill C-7, which removes critical safeguards, including the criterion that death be reasonably foreseeable and opens the door to medical assistance in dying for persons who are suffering solely from a mental illness, even though it is never possible to predict when someone who is suffering from mental illness can get better. It is never possible to predict irremediability in the case of a solely mental illness. As a result of the removal of those critical safeguards, vulnerable patients are put at greater risk.

When the conscience rights of medical professionals to exercise their best judgment are protected free of intimidation and coercion, the rights of patients are equally protected. This is a timely, targeted and necessary piece of legislation that would protect the rights of medical professionals and their charter rights and the rights of patients. I urge its passage.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I am pleased though a bit surprised to be speaking on Bill C-230. Less than a year ago, on May 27, 2021, we were in the House debating Bill C-268, the very same bill from the very same member for Carlton Trail—Eagle Creek. While I am a bit in awe of the member's ability to place so highly in the random draw for Private Members' Business in two successive Parliaments, I am also at a bit of a loss to explain why the member would squander her luck on this bill.

There are two reasons I say this. As MPs we get limited opportunities to place bills directly before the House. I had that opportunity in 2013, and I used it to put forward Bill C-279, which sought to add gender identity and gender expression to the list of prohibited grounds for discrimination in the Canadian human rights code and in the hate crime section of the Criminal Code. Though many thought it unlikely, the bill did pass the House with support from MPs from all parties. It took a lot of work to put together that coalition of MPs. While my bill followed a somewhat torturous path, there was always a path forward and it became law.

I wonder why it is that having heard so clearly, in speeches less than a year ago, that there was limited, if any, support for this bill outside her own party, the member for Carlton Trail—Eagle Creek has brought it back again. Since there is nothing to indicate any change of circumstances or any change of heart, this bill will go nowhere this time as well. Failing to bring forth a bill that might have some prospect for passing or reintroducing this bill instead of bringing forward a new bill presenting ideas not already debated here in the House leads me to call reintroducing this bill, at best, a missed opportunity.

The second reason I have for declaring the reintroduction of this bill a lost opportunity has to do with the bill itself. This bill picks up a tiny portion of the extensive and important debates on medical assistance in dying that took place on Bill C-14 in Parliament in 2016 and again on C-7 in the last Parliament. It seeks to take one small and very debatable point and turn it into a wedge issue in the House.

We are waiting for the Special Joint Committee on Medical Assistance in Dying to get down to work on outstanding important and critical issues around medical assistance in dying, but as that committee has yet to get under way, I want to take this opportunity today to restate the principle that has guided New Democrats through these debates.

We believe that medical assistance in dying is an important tool for helping to end unnecessary suffering for patients facing end-of-life issues and for avoiding the unnecessary suffering of their families, who have to accompany them on this journey. This is the reason New Democrats will always defend the right of access to information about MAID and access to the service for all those who qualify for assistance in dying and choose to proceed.

In the debate on Bill C-7, many issues arose concerning the challenges Canadians face at the end of life, some of which Bill C-7 addressed directly and some which have not yet been addressed. Two important concerns were front and centre, and these, for me, were the most important. The first was to help alleviate unnecessary suffering by eliminating the waiting period, which was a cause of great concern for patients who feared loss of capacity before they could complete the waiting period and thus make them ineligible for medical assistance in dying and forced to consider suffering.

The second was a change allowing a waiver of final consent. This is a provision I know quite well, personally, as a friend of mine chose to go earlier than she would have liked because of a brain tumour and her fear that she would lose capacity to consent at the last moment and, in doing so, have to continue making her family suffer.

A second challenge was also debated in Bill C-7. How do we preserve as much autonomy as possible for Canadians who are dying? Most of the issues related to this still have to be dealt with at the special joint committee. This includes questions of advance directives, the question of access to MAID for those with mental illness and for mature minors, and whether protections for people with disabilities from being pressured to seek MAID are adequate. I remain frustrated with the delays in dealing with these very important issues. The bill before us is not one of those.

A third challenge that came up in the debate on Bill C-7 was access to services at the end of life. We learned there are a great many gaps in services in our Canadian health care system for those who are facing death. There are gaps in diagnostic and treatment services depending on where one lives, whether it is a major city with excellent facilities or a rural and remote area. We learned of important gaps in palliative care.

However, instead of addressing these challenges, the challenges of autonomy and the challenges of access to services, Bill C-230 is about something else altogether. What this bill would do is override a patient's right to access information about and to have access to legally provided medical services, based on the personal beliefs of a service provider.

Let me put that in plain language. Let us suppose there are a variety of treatments available to a patient. It does not really matter in this case what they are. If a medical professional believes that one of them should not be available, this bill says there is no obligation on that professional to make sure patients find out all the options available to them. Professional organizations, like colleges of physicians and surgeons, and colleges of nurses, have found this to be unethical behaviour, so they require doctors, to varying degrees, to refer patients to someone who is supportive of those services and who is available to provide those services.

This requirement to refer exists in its strictest form in Ontario as the right of patients to an effective referral, meaning a referral to a health care professional who is available, capable and willing to provide that service. This has been upheld by the courts as a reasonable compromise between the rights of patients' access to medical issues and the conscience rights of service providers. That is the main reason I cannot support this bill. If passed, it would result, on a very real and practical basis, in the denial of access to necessary health services for many Canadians.

Many communities have a very limited number of doctors and if one of those doctors, or even more than one of those doctors, is unwilling to let their patients find out about medical assistance in dying, then we are condemning those Canadians to suffer at the end of life in ways that other Canadians would not have to suffer. No health care professionals are in fact required by law to participate, and that is why I find titling this bill “intimidation of health care professionals” disingenuous at best. Is requiring a referral actually participation in medical assistance in dying? Clearly it is not, and trying to torque a requirement to provide information into participation helps no one understand the real issues of conscience involved in medical assistance in dying.

An equally important reason for opposing this bill is the dangerous precedent that this bill would set. Its role as a potentially precedent-setting bill has already been noted by anti-choice advocates who have been vocal in their support for this bill. They recognize that it would provide a precedent for denying referrals for access to contraception and abortion services, and I want to point out that denials of service and denials of information are very real in our existing Canadian medical care system.

This bill would also be a very bad precedent for current attempts to deny transgender minors the counselling and medical services they need to affirm who they are. Without access to services that others may think are inappropriate, this will leave families with trans minors struggling to find the information and support that their kids really need. If this kind of precedent is allowed, medical professionals would not have to provide a referral to someone who would be providing a medically necessary service.

As I approach the end of my comments today, I cannot end without mentioning yet another unfortunate precedent set in this bill, and that is its use of inflammatory language. I have no doubt, as I said in my question to the sponsor of this bill, of her personal convictions and their strength. However, as sincere as they may be, the language used in this bill conjures up a spectre of the use of violence to intimidate medical professionals, something of which there is absolutely no evidence of happening in Canada. Invoking the spectre of violent intimidation is certainly not conducive to an informed debate on the real issues that are in question here.

I will close my comments today by restating that, on principle, New Democrats are opposed to any legislation that would limit access to Canadians seeking information about or the service of medical assistance in dying. No matter how strong the beliefs others may hold, this right exists to access medically necessary services. There is no doubt that the end of life is a difficult moment for all families, and medical assistance in dying, I still believe, is an important way of ending unnecessary suffering both for patients and families at the end of life. I would not like to see anyone denied access to information they need to make a choice that protects their own autonomy of how their lives end. At this point, let me salute the health care professionals who assist patients and their families through this very difficult process.

Once again, I lament the tendency of not just this member but, indeed, many Conservative members of the House to use private member's bills for scoring political points and sharpening divisions in the House—

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

moved that Bill C-230, An Act to amend the Criminal Code (intimidation of health care professionals), be read the second time and referred to a committee.

Mr. Speaker, it is a privilege to rise today to begin the debate on my private member's bill, Bill C-230, the protection of freedom of conscience act. This bill revives my private member's bill, which died on the Order Paper, from the last Parliament, with some slight modifications.

I would be remiss if I did not once again acknowledge that this bill is built on the hard work and determination of former members of Parliament. The first bill proposed to address this issue was introduced by the late Mark Warawa in 2016. His bill did not proceed because of the government's introduction of Bill C-14. After Bill C-14 was passed into law, my former colleague David Anderson introduced his private member's bill, Bill C-418, during the 42nd Parliament. However, that bill also died on the Order Paper when the general election was called in 2019.

I would like to thank all those who have been championing this issue for many years and their willingness to work with me. Experts throughout Canada have provided information and advice, while thousands of grassroots Canadians voiced their support for protecting our fundamental freedoms. I would also like to thank the Library of Parliament for its timely, diligent and expert research, which helped inform this proposed legislation.

For the purposes of this debate, I think it is important to understand conscience. There are numerous definitions of conscience, but they are consistent in defining it as an individual’s inner sense of knowing the difference between what is right and wrong and allowing that knowledge to guide their behaviour. The Canadian Charter of Rights and Freedoms, under the heading of “Fundamental Freedoms”, in subsection 2(a) states that everyone has the fundamental freedom of conscience. In this way, Bill C-230 is straightforward. It seeks to add two new offences to the Criminal Code of Canada. I will read the summary so members will know what they are:

This enactment amends the Criminal Code to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of medical assistance in dying.

It also makes it an offence to dismiss from employment or to refuse to employ a medical practitioner, nurse practitioner, pharmacist or other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of medical assistance in dying.

This bill is a response to calls from disability rights groups, first nations, the Ontario Medical Association, legal experts and many medical and mental health professionals to protect conscience rights. It ensures that medical professionals who choose not to take part in or refer a patient for assisted suicide or medical assistance in dying will never be forced or coerced to violate their freedoms as stated in the charter.

Previous Parliaments have passed laws that created the unintended consequence of doctors and medical professionals being forced to participate in providing a patient's death, regardless of whether they believe it is in their best interest. Bill C-14 and Bill C-7 created a federal standard for medical assistance in dying and assisted suicide but not for conscience protections.

By way of background, sections 241.1 to 241.4 of the Criminal Code of Canada deal with the provision of medical assistance in dying. These sections are in part VIII of the code. It deals with offences against the person and reputation, which include offences such as homicide, kidnapping, assault and many more. Subsection 241(1) of the Criminal Code still makes it a criminal offence to counsel or aid in a suicide. It reads:

Everyone is guilty of an indictable offence and liable to imprisonment for a term of not more than 14 years who, whether suicide ensues or not,

(a) counsels a person to die by suicide or abets a person in dying by suicide; or

(b) aids a person to die by suicide.

When creating the exemption allowing for MAID, the government had to create an exemption to this prohibition on counselling or aiding in suicide. This then leads to the untenable claim that the Criminal Code already protects the conscience rights of medical professionals.

Some claim that the clarification clause, section 241.2 (9) of the Criminal Code, somehow protects conscience rights. It states:

For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.

While I understand why some would want to think it protects conscience rights, I believe they are sadly mistaken. While I appreciate and support this inclusion in the Criminal Code, it only addresses one side of the coin. This clause only confirms that the Criminal Code is not the source of compulsion to participate in medical assistance in dying.

For the Criminal Code to have any teeth on this issue, it should articulate that it is an offence to compel someone to provide, or assist in providing, medical assistance in dying against their will. Compelling someone to participate in MAID can and does happen, which is why I have brought forward this legislation and why it needs to pass.

Regarding jurisdictional questions about this bill, as I mentioned earlier, this bill proposes that two new offences be added to the Criminal Code of Canada to address intimidation, dismissal from employment or refusal to employ a medical professional. This is similar to section 425 of the Criminal Code, which addresses the same actions taken by an employer to compel employees with respect to belonging to or organizing a union. I would suggest that if it is appropriate to have section 425 in the Criminal Code, it is reasonable to include the amendments I am proposing.

I would also submit that it is inaccurate to argue that conscience rights legislation somehow interferes with the role of the provinces while, at the same time, believing that the legalization of medical assistance in dying does not. Ensuring that conscience rights are protected is the responsibility of Parliament and of the Government of Canada, which is why I introduced this bill and why it should be passed.

Additionally, provinces can introduce their own conscience rights legislation for medical professionals. For example, Manitoba has passed simple and clear legislation in this regard, and I would encourage all provincial legislatures and parliaments to follow Manitoba’s example.

While the text of this bill focuses on the conscience rights of medical professionals, this legislation also serves to protect the right of patients to receive a second opinion. What do I mean by this? If all doctors are forced to propose MAID as a treatment option to their patients, this one-size-fits-all approach would give Canadian patients less choice, not more.

Additionally, individuals who object to MAID would be deterred from entering the medical profession altogether. Patients would no longer be able to seek a second opinion for their end-of-life care. In this way, conscience rights for medical professionals not only protect medical professionals and their patients, but they also protect our health care system.

Without conscience rights, doctors are constrained to provide, or refer their patients to receive, medical assistance in dying, regardless of whether it is their professional opinion that it is in the best interest of the patient. This concern for the patient’s best interest does not mean that a medical professional objects to medical assistance in dying in all cases, just that in his or her opinion it is not an option that should have to be offered in every case. This became especially pertinent to the medical community with the passage of Bill C-7.

To highlight the impact of the removal of the safeguard that death be reasonably foreseeable, I would like to quote from a recent column published online in Policy Options magazine which states the following:

Many injuries and physical illnesses are indeed accompanied by temporary depression and suicidal thinking. For example, research demonstrates increased risk of suicide for two years after a spinal cord injury. This suicidality overwhelmingly ends with adaptation and recovery support. Offering death to anyone during a period of transient increased suicidality is, in our view, unethical and violates the standard of medical care by which physicians must abide.

The fact that the newly expanded law may facilitate death in those circumstances of increased suicidal thinking is, in and of itself, problematic.

Some have tried to frame conscience rights as the rights of the patient versus the rights of the doctor. Nothing could be further from the truth.

Health care is fundamentally about the doctor-patient relationship. For example, take the psychiatrist who supports MAID in certain circumstances, but in a certain case has spent 15 years counselling a patient who suffers from bouts of depression and suicidality. For 15 years, they have built understanding and trust. What would happen if that patient, suffering from a bout of suicidality, should demand assisted suicide? Under current law, that psychiatrist would be forced to refer that patient to someone else so he or she could die. They must do this, despite knowing that the suicidal thoughts are temporary and that otherwise the patient is joyful and loves his or her life. Ending that patient's life would be wrong, but the psychiatrist’s hands are tied. This should not be what passes for medical care in Canada.

Some might claim that there are safeguards in place to prevent such tragedies, but I would ask them if they are absolutely sure. With the passage of Bill C-7, many safeguards for medical professionals were removed. We are talking about ending a human life. There is no room for uncertainty when a life hangs in the balance.

Additionally, should the first line of safeguards not be the expertise of the medical professionals who know their patients best? If those medical professionals do not believe death is the answer, should we not at least consider if they are right? However, this then leads to the concern some raise that protecting the conscience rights of medical professionals will block access to those who truly want it. I would suggest this is both misleading and nothing but baseless fearmongering. Medical assistance in dying and assisted suicide are readily available throughout all of Canada. There are information phone lines, hospitals staffed with willing medical professionals, even email addresses to help set up appointments. In a word, MAID has become the status quo. It is available.

The Canadian Medical Association also stated clearly that conscience protections would not affect access because there were more than enough physicians willing to offer MAID. Therefore, common sense should tell us that the charter rights of medical professionals are breached when they are forced to either offer or refer assisted suicide or medical assistance in dying. Surely, we have the capacity to both ensure access to MAID while still protecting the fundamental charter right to freedom of conscience.

Finally, some have suggested that medical professionals should leave their morality at the door. I do not believe we want this to happen. For example, we would all want and expect doctors to be bound by their morals if they were offered a bribe to move someone up on a waiting list. If we hold our medical professionals to a higher standard, we cannot then tell them to ignore their personal moral standards. Further, while discussing the issue of conscience rights with a doctor, she told me that, in the absence of conscience protection, the group with the most to lose are the patients, and they are the ones we are trying to help. This bill protects the doctor-patient relationship by ensuring that doctors and other medical professionals are always able to recommend and provide the care they believe is best for their patients. Patients need this bill to pass. Canada’s medical professionals need this bill to pass.

Over the past two years, we have seen just how important our health care system is and how critical the medical professionals who work in that system are to Canadians and our way of life. We need to create a work environment for medical professionals that protects them, supports them, and encourages them to continue in the critical work they do.

In closing, I encourage all members to support passage of the protection of freedom of conscience act.

Alleged Premature Disclosure of Contents of Bill C-10

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

Mr. Speaker, I am very pleased to participate in today's debate.

However, I want to raise a very serious concern about what we call a question of privilege.

I am rising on a question of privilege regarding the premature disclosure of the content of Bill C-10, an act respecting certain measures related to COVID-19, by the Prime Minister himself while it was on notice and before it was introduced and tabled in the House of Commons. On Saturday, a special Order Paper was published that contained the notice for Bill C-10.

As members know, according to our Standing Orders, notices of bills must be very succinct. In this case, the notice was. It gave the title of the bill and the number, Bill C-10.

Yesterday at noon, the Prime Minister held a press conference in front of his house. Incidentally, we were able to see that, despite the fact that he and his two children have COVID-19, he is doing well. That is good.

However, he said a lot more about Bill C-10 than what was written in the notice.

In fact, CTV, in a publication following the press conference, noted that the Prime Minister provided a bit more detail about the bill's contents beyond its title. Those details provided by the Prime Minister were as follows: “We'll be introducing legislation to ensure we continue providing as many rapid tests as possible to the provinces and territories.”

Yesterday, after question period and the Prime Minister's press conference, Bill C‑10 was introduced during Routine Proceedings. At that very moment, it became clear to us and to all Canadians that what the Prime Minister had said was exactly what was in the bill.

The bill authorizes the Minister of Health to make payments of up to $2.5 billion out of the consolidated revenue fund in relation to the coronavirus disease 2019, well known as COVID-19, tests. It also authorizes the Minister of Health to transfer COVID-19 tests and instruments used in relation to those tests to the provinces and territories and to the bodies and persons in Canada.

The Prime Minister talked about Bill C‑10 in detail at the press conference before the bill was introduced. In our view, that is a breach of trust under the rules that govern us.

The Prime Minister's disrespect for Parliament goes beyond just the premature disclosure of a bill. The Prime Minister, having wasted so much time with a prorogation, followed by an expensive and unnecessary election, is trying to play catch-up by leaning on the opposition to co-operate and fast-track his bill.

In an attempt to show some goodwill, his House leader provided embargoed copies to the House leaders of the opposition. For our part, and for the part of all opposition parties, we did respect the fact that we cannot make any comment publicly about the bill. That is the way to do it. Unfortunately, yesterday the Prime Minister did not respect that situation.

On March 10, 2020, you commented on the premature disclosure of Bill C‑7 on medical assistance in dying. You said the following:

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

...

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

On April 19, 2016, the Speaker found there was a prima facie question of privilege regarding a similar bill, namely Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, respecting medical assistance in dying. He said the following:

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

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

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

The Speaker at that time found another case of contempt on October 15, 2001, again involving the media being briefed on the contents of a bill prior to the legislation being introduced in the House. The precedents are very clear in these matters. The Prime Minister is in contempt of the House for disclosing the content of Bill C-10 while it was on notice and prior to being introduced in the House.

In conclusion, I would like to point out that this issue of COVID tests was part of the opening round of questions during the first question period my leader attended in September 2020 after becoming the leader of the official opposition. This issue is a really serious one and we care about this situation. It may have taken the Prime Minister a while to get it and I understand he now needs help to hurry things along, but he does himself no favours by thumbing his nose at the privileges of this House and the goodwill of the opposition parties by playing by his own rules.

This practice has gotten him into trouble before. On more than one occasion, he ran into difficulty with the Ethics Commissioner. The commissioner found in 2019 that he breached ethics rules. The Prime Minister had tried in 2018 to undermine a decision by federal prosecutors allowing a construction company, the SNC-Lavalin Group, to face a corrupt trial. The Ethics Commissioner also sanctioned him in December 2017, ruling that he broke conflict of interest rules when he accepted a vacation on the Aga Khan's private island in 2016.

I could go on and on, but to quickly get to the point and pursue a resolution to this matter, I ask, Madam Speaker, that you find a prima facie case of privilege. I am prepared to move the appropriate motion.

Protection of Freedom of Conscience Act

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, it is an honour to rise in strong support for Bill C-268.

This is a straightforward piece of legislation, the objective of which is extremely important, namely to ensure that the charter rights of health professionals who conscientiously object to participating in medical assistance in dying, or MAID, are protected, charter rights that include freedom of religion and freedom of conscience, those rights being not any rights but fundamental freedoms guaranteed under the charter.

For that, I want to commend my colleague, the hon. member for Carlton Trail—Eagle Creek, for her steadfast leadership in bringing forward this timely and targeted bill to address an issue of charter infringements on health care professionals. I would also acknowledge my former colleagues Mark Warawa and David Anderson for their leadership in bringing forward similar pieces of legislation in previous Parliaments.

Contrary to the assertion of the Parliamentary Secretary to the Minister of Justice, the infringement of charter rights of health professionals is not a hypothetical. It is real. It is happening in Canada and has been happening since the Supreme Court of Canada struck down the blanket Criminal Code prohibition against physician-assisted death in the Carter decision.

Many health professionals have been pressured or coerced into participating in MAID, notwithstanding their conscientious objection to doing so. At the justice committee, on Bill C-7, we heard many witnesses who came forward and spoke about serious concerns about coercion and pressure, the need for clarity in the law and a set national standard. That is precisely what this legislation seeks to do by amending the Criminal Code to see that no one will lawfully be able to coerce or pressure health care professionals for the purpose of compelling them to participate in MAID, or refuse to hire or terminate one's employment on the basis of a health care professional objecting to MAID.

The Parliamentary Secretary to the Minister of Justice made reference to Bill C-14 in his speech. It is a piece of legislation that I am very familiar with, because I sat on the special joint committee leading up to Bill C-14, and I sat on the justice committee when Bill C-14 was studied. At that time, there was much discussion around protecting conscience rights.

The parliamentary secretary is correct that the preamble of the bill was amended to include an expressed recognition of conscience rights. He is further correct to note that at subsection 241.2(9) of the Criminal Code, there is a “for greater certainty” clause that simply provides that no one shall be compelled to participate in MAID.

In that broad sense, there was an expressed intention of Parliament to protect health care professionals. However, what is missing is teeth. There is no enforceability mechanism provided for in the legislation. That was something that I saw as a problem at the time, and it has borne out to be so. That is precisely what this bill seeks to do, to fill that very real void.

The Parliamentary Secretary to the Minister of Justice as well as my colleague, the member for Esquimalt—Saanich—Sooke, spoke at varying lengths about the Ontario Court of Appeal decision in Christian Medical and Dental Society of Canada v. the College of Physicians and Surgeons of Ontario and the issue of access, that somehow this bill would interfere or undermine access to medical assistance in dying.

I say two things to those who would raise the issue of access. Manitoba passed Bill 34, which provides for conscience protections, not dissimilar to what this bill proposes. There has not been one instance that has been brought forward where access has prevented a willing patient from accessing MAID in that province, a law that has been on the books for more than four years. With respect to the Ontario Court of Appeal's decision, although the court, in its analysis, looked at hypothetical issues around access, the court actually incorporated the divisional court's finding into its ruling. The divisional court said on the question of physicians who object on the basis of conscience, “...there was no direct evidence that access to health care is a problem caused by physicians' religious objections to providing care”. There we have it right from the Ontario Court of Appeal that on the issue of access, when it came to providing direct evidence, it simply was not there. At the justice committee, when we studied Bill C-7, it was not there either.

When we talk about the Carter decision, it is important to emphasize that it is predicated upon two things: number one, that there be a willing patient; and, number two, and equally important, that there be a willing physician. Too often over the last five years, we have focused singularly on the issue of a willing patient, which is very important, to the exclusion of a willing physician notwithstanding charter rights of those physicians that are very much at play.

In the Carter decision, the Supreme Court did expressly acknowledge the rights of health care professionals in terms of freedom of religion and freedom of conscience, but the court actually went further. The court warned against compelling health care professionals to provide or otherwise participate in MAID. More specifically, at paragraph 132 of the Carter decision, the court said:

However, we note...in addressing the topic of physician participation...that a physician’s decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief.

Now, the foundational principles that underlie freedom of religion and freedom of conscience, guaranteed under paragraph 2(a) of the charter, were set out in the Big M Drug Mart Ltd. decision; and, in enunciating those principles, this is what the Supreme Court had to say:

Freedom can primarily be characterized by the absence of coercion or constraint. If a person is compelled by the state or the will of another to a course of action or inaction which he would not otherwise have chosen, he is not acting of his own volition and he cannot be said to be truly free.... Coercion includes indirect forms of control which determine or limit alternative courses of conduct available to others.

Those are precisely the principles that this bill seeks to uphold and on that basis I urge its passage.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I am pleased to speak today to Bill C-268.

This bill picks up a tiny portion of the extensive and important debates on medical assistance in dying that took place on Bill C-14 in the previous Parliament in 2016 and again on Bill C-7 in this Parliament. I want to start today by restating the principle that has guided the New Democrats through these debates.

We believe that medical assistance in dying is an important tool for helping to end unnecessary suffering for patients facing end of life issues and for avoiding the unnecessary suffering of their families, who have to accompany them on this journey. This is the reason the New Democrats will always defend the right of access to information about MAID and access to the service for all those who qualify for assistance and choose to proceed.

In the debate on Bill C-7, many issues arose concerning the challenges Canadians face at the end of life, some of which Bill C-7 addressed and some of which have not yet been addressed. Two important concerns were front and centre, and these, for me, were very important. The first was to help alleviate unnecessary suffering by eliminating the waiting period, which was a cause of great concern for patients who feared loss of capacity before they could complete the waiting period, as this would make them ineligible for medical assistance in dying. The second was allowing a waiver of final consent, which deals with the same issue. It was often known as “Audrey's amendment”. This is a provision that I knew quite personally, as a friend of mine chose to go earlier than she would have liked because of a brain tumour and her fear that she would lose capacity to consent at the last moment. Bill C-7 would make some important improvements on eliminating suffering at the end of life.

A second challenge was debated: How do we preserve as much autonomy as possible for Canadians who are dying? Most of the issues related to this still have to be dealt with at the special joint committee on medical assistance in dying that will begin its work next Monday. This includes questions of advance directives and whether protections for people with disabilities from being pressured to seek MAID are adequate. I was disappointed that Conservative senators spent a lot of time holding up the establishment of this new joint committee. It was very frustrating because the five-year statutory review of Bill C-14 was supposed to have started over a year ago. However, it is good news that this committee will commence its first regular meeting next Monday and will deal with the outstanding issues that were not dealt with in Bill C-7.

A third challenge that came up in the debate on Bill C-7 was access to services at the end of life. We learned there are a great many gaps in services in our Canadian health system for those who are facing death. There are gaps in diagnostic and treatment services, depending on where one lives, whether it is in a major city with excellent facilities or in a rural and remote area. We learned of important gaps in palliative care. Again, depending on where one lives, access to palliative care is highly variable. Of course, we also learned of gaps in the ability to access information about medical assistance in dying and the ability to access the service.

There are some very important questions here about the absence of services in rural and remote areas, about the inadequacy of services and about the shortage of trained professionals. Very important to me was the testimony we often heard about the complete absence of culturally appropriate services for indigenous Canadians and for new Canadians from different cultural backgrounds.

However, instead of addressing these challenges, the challenges of autonomy and the challenges of access to services, Bill C-268 is about something else. What this bill would do is override a patient's right to access information about, and to have access to, legally provided medical services, based on the personal beliefs of a service provider.

Let us put that in plain language. Let us suppose there are a variety of treatments available to a patient. It does not really matter in this case what they are. If a medical professional believes that one of them should not be available, this bill says there is no obligation to make sure patients find out all the options available to them. Professional organizations like colleges of physicians and surgeons and colleges of nurses have found this to be unethical behaviour, so they have required doctors, to varying degrees, to refer patients to someone who is supportive of those services and is accessible to them.

This requirement to refer, as mentioned in a previous speech, has been upheld by the courts. That is the main reason I cannot support this bill. It would result, on a practical basis, in the denial of access to necessary health services for many Canadians.

Many communities have a very limited number of doctors, and if one of those doctors, or even more than one of those doctors, is unwilling to let their patients find out about medical assistance in dying, then we are condemning those Canadians to suffer at their end of life in ways that other Canadians would not have to suffer. No health care professionals are, in fact, required by the law to participate. It is the professional associations who require some form of referral. Whether a referral is actually participation, I will grant to author of this bill, is debatable. I do not really believe it is.

An equally important reason for opposing this bill is the dangerous precedents that this bill would set. Its role as a potentially precedent-setting bill has already been noted by anti-choice advocates who have been vocal in their support of this bill. They recognize it would provide a precedent for denying referrals for access to contraception and abortion services. I want to point out that denials of service and denials of information are very real in our existing Canadian medical care system.

Just this year, Providence Health Care, which runs St. Paul's Hospital in Vancouver and is building a new hospital with $1.3 billion of public money, announced that in this new facility, abortion and contraceptive services will not be provided, nor will medical assistance in dying. I find this particularly problematic. I know of several cases in Vancouver where those who wished to access medical assistance in dying were forced to leave the hospital where they were being cared for and transfer to another facility, at a time when they and their families were already in a great deal of distress.

This bill would also be a very bad precedent for the current attempts to deny trans minors the counselling and medical services they need to affirm who they are. Without access to the services that others may think are appropriate, this will leave families with trans minors struggling to find the information and support their kids need. If this kind of precedent is allowed, medical professionals would not have to provide a referral to someone who would be providing a medically necessary service.

As a gay man who lived through the AIDS epidemic, I am also concerned about any precedent that allows the denial of access to medically necessary services. The AIDS crisis was generally ignored by the public, and treatment for those suffering from HIV and AIDS was regularly denied to members of my community, who quite often suffered very painful and tragic deaths as a result of that.

As I approach the end of my comments today, I cannot end without mentioning yet another unfortunate precedent set in this bill, and that is its use of inflammatory language. I have no doubt, as I said in my question to the sponsor of this bill, of her personal convictions and their strength.

However, as sincere they may be, the language used in this bill conjures up a spectre of the use of violence to intimidate medical professionals, something of which there is no evidence of happening in Canada. Using the kind of language that involves violence is certainly not conducive to an informed debate on the real principles that are in question here.

I will close my comments today by restating that on principle, New Democrats are opposed to any legislation that would limit access for Canadians to medically necessary services based on the personal beliefs of others, no matter how strong the beliefs the others hold are. There is a right in this country to access legal medical services, and that right can only be effective when, as professional organizations have recognized, doctors who do not wish to participate make referrals to doctors who will provide those services.

There is no doubt that the end of life is a difficult moment for all families and medical assistance in dying, I still believe, is an important way of ending unnecessary suffering, both for patients and families at the end of life. I would not like to see anyone denied access to the information they need to make a choice that protects their own autonomy about how their lives end.

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

Madam Speaker, I rise today to speak to Bill C-268, the protection of freedom of conscience act.

This bill proposes to create two new offences to protect the freedom of conscience of health care professionals in the context of medical assistance in dying, or MAID. The first offence would prohibit using violence or threats of violence, coercion or any other form of intimidation to compel a health care professional to take part in MAID. The second offence proposed would criminalize persons who refuse to employ or dismiss from employment health care professionals because they refuse to take part in MAID.

Protecting the freedom of conscience of our health care professionals is obviously a laudable goal. We have all recently debated Bill C-7, which amended the Criminal Code's MAID regime to remove the reasonably foreseeable death criterion. Some Canadians are very much in favour of MAID for anyone with decision-making capacity, others are profoundly opposed to it in any circumstance and many have opinions that fall somewhere in between those two positions. Many of my constituents in Parkdale—High Park, for example, are largely in favour of MAID, in favour of providing autonomy to Canadians and to empowering them with the tools to reduce suffering, with important safeguards being put in place to protect those who are vulnerable.

Our government understands that medical assistance in dying is deeply complex and personal. We were proud to have passed Bill C-7 in March of this year, which responded to the Superior Court of Quebec's September 2019 Truchon ruling and to the emerging societal consensus on the specific issues relating to MAID. We remain committed as a government to protecting vulnerable individuals and the equality rights of all Canadians, while supporting the autonomy of eligible persons to seek medical assistance in dying. We are working with the provinces and territories to implement the changes in Bill C-7 and ensure adequate access to health care support services and medical assistance in dying to all Canadians who wish to seek it.

This range of views also exists among health care professionals who are the ones directly involved in MAID, whether it be providing MAID, assessing a person's eligibility, dispensing the substances, being consulted or supporting the patient. Clearly there are practitioners who do not want to be involved in MAID at all and there are others who find meaning in responding to the wishes of their patients who are suffering by providing MAID.

Let us get to the heart of what is being moved by the member opposite. The Canadian Charter of Rights and Freedoms protects freedom of conscience and religion from government interference. That is subsection 2(a) of Canada's charter. That freedom is subject to reasonable limits prescribed by law that can be justified in a free and democratic society. It is important to keep in mind that the charter, not the Criminal Code, is the source of that constitutional protection for freedom of conscience and freedom of religion.

I also think it is critical to underscore that the Criminal Code does not in any way compel anyone's participation in MAID. Let me be crystal clear on this point, because it was raised by the member opposite. Concerns about conscience protection also arose in 2016 when she and I were both members of this House, when we enacted Canada's first MAID regime. In order to be abundantly clear, while the preamble already articulated this, our government supported an amendment to Bill C-14, which added to the Criminal Code. I am going to read it for the purposes of clarity. This amendment was to subsection 9 of section 241.2, which states, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” We have the charter, we have the preamble and now we have subsection 9.

This provision exists to protect the conscience rights of medical practitioners, but it will not stop there. The entire MAID regime was prompted by the Supreme Court's decision in Carter. I will read from paragraph 132 of the decision of the court, which said, “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.” The court itself has been crystal clear on this issue.

When I asked the member, in the context of the debate this evening, whether there is any evidence of criminal prosecutions against institutions that are compelling physicians or nurses to provide MAID, instances of a wrongful dismissal suit or a human rights complaint, the member was not able to provide a single instance of such a situation arising, which begs the question whether there is actually an acute problem that the member is trying to address or whether, apropos of the question posed by my Bloc colleague, this legislation is simply an attempt to address a broader concern about MAID generally that perhaps is held by the member opposite and members of her caucus.

While there may be requirements for practitioners to participate in MAID in some form, it is at the level of regulation of these practitioners as professionals. That was raised by the member for Esquimalt—Saanich—Sooke. For example, in Ontario, The College of Physicians and Surgeons has an effective referral policy for MAID. It requires that practitioners refer their patients in good faith to a non-objecting, available and accessible physician or agency if they do not personally want to participate in medical assistance in dying. That policy was challenged in court under subsection 2(a) of the charter, the very provision that I put to members in this chamber. In 2019, the Court of Appeal for Ontario upheld the policy and that policy was never taken to any higher level of court afterward. That is the highest example of a court ruling in this country on whether effective referral violates the charter. It does not, according to Canadian jurisprudence.

This is one example of an effective referral policy from a regulatory body created by provincial legislation that aims to reconcile patient access to MAID with physicians' freedom to refuse participating in MAID. As the Ontario Court of Appeal noted, it is a solution that is neither perfect for the patients nor perfect for the practitioners, when questions like MAID raise difficult moral issues that are hard to reconcile with absolute perfection.

I would also note that neither of the offences the bill proposes would have an impact on an effective referral policy from a regulatory body. Such policies are not using violence, threats or intimidation to compel participation in MAID and the colleges that would issue them are not the health care professionals' employers. The offences proposed in this bill are not aligned with that particular objective of the bill.

I also have some questions about the proposed offences. The offence of intimidation reflects an opinion that I think we all hold. Health care professionals should not be the victims of violence, threats of violence or intimidation, whether it is to force them to provide medical assistance in dying or for any other reason. That is such a fundamental principle that the Criminal Code already sets out offences that prohibit such behaviour, regardless of who the victim is and regardless of the objective of the violence, threats or intimidation.

What is more, we have not heard about any doctors being forced by threats, violence or intimidation to provide medical assistance in dying, or MAID. Although the offence of intimidation set out in Bill C-268 may send a message regarding the importance of not engaging in such behaviour to force a health care professional to provide MAID, it would duplicate the offences currently set out in the Criminal Code, such as assault, uttering threats, extortion and intimidation. In fact, it would not provide any additional protection and seems to target a problem that we have no proof even exists.

The employment sanctions offence raises questions about the appropriateness of using the criminal law, which is a very blunt tool that brings about significant consequences, including the deprivation of liberty to punishing employers who refuse to hire or who would fire health care professionals because they did not want to take part in MAID.

Again, I think many of us would agree that practitioners should not face employment consequences if they object to participate in medical assistance in dying, but this seems to me like an improper use of the criminal law to try and push feelings of conscience and religion in the workplace.

I reiterate that our government is committed to the protection of health care workers, now more than ever, given how much they have worked for Canadians during this pandemic. As well, we are committed to ensuring that all Canadians have access to the right of medical assistance in dying. Our government is proud of what we have achieved in Bill C-14 in the last Parliament, and Bill C-7 in this Parliament.

I look forward to working with the Special Joint Committee on Medical Assistance in Dying to review where medical assistance in dying in Canada will be going with respect to the laws on MAID in Canada and recommending any necessary changes.

I urge all members to keep these things in mind as we continue our study of Bill C-268, a private member's bill.

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

Madam Speaker, in light of the extensive protection for conscience rights in the charter; in the statute originally passed, Bill C-14, which the member opposite mentioned; and in the Carter decision, I am personally unaware of a single instance of a prosecution having been levied against an institution for compelling a doctor or nurse to provide MAID.

I wonder if the member opposite can provide this House a single example of such a prosecution, a human rights complaint at the provincial level or a wrongful dismissal suit. I am struggling to understand the problem she is trying to identify and address with this private member's bill.

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

moved that Bill C-268, An Act to amend the Criminal Code (intimidation of health care professionals), be read the second time and referred to a committee.

Madam Speaker, I am proud to rise today to begin the debate on my private member's bill, Bill C-268, the protection of freedom of conscience act. I would be remiss if I did not acknowledge this bill is built on the hard work and determination of former members of Parliament. The first iteration that sought to address this issue was introduced by the late Mark Warawa in 2016, but it did not progress when the government introduced Bill C-14.

I do consider it a tremendous honour that my bill is the same number, C-268, as his was. After Bill C-14 was passed into law, my former colleague David Anderson introduced his private member's bill, Bill C-418, which died on the Order Paper when the election was called in 2019.

I would like to thank all those who have been championing this issue for many years and for their willingness to work with me.

Experts throughout Canada provided information and advice, while thousands of Canadians have voiced their support for protecting our fundamental freedoms. While there are numerous dictionaries that define conscience, they are consistent in defining it as an individual's inner sense of knowing the difference between what is right and wrong and that guides their behaviour.

An article by Cardus called “The Imperative of Conscience Rights” references the following:

“Conscience” traces to the Latin conscientia, and is related to the Greek synderesis. While conscientia refers to the application of our moral knowledge to particular situations, synderesis refers to the moral awareness built into each person and that urges us to do good and avoid evil.

Bill C-268 is straightforward as it seeks to enshrine in law a minimum national standard of conscience protections for medical professionals while respecting the jurisdiction of my provincial colleagues to expand on it. It is a response to calls from disability rights groups, first nations, the Ontario Medical Association and many hundreds of medical and mental health professionals to protect conscience rights.

It would ensure the medical professionals who choose to not take part in, or refer a patient for, assisted suicide or medical assistance in dying would never be forced by violence, threats, coercion or loss of employment to violate the freedoms protected in section 2(a) of the charter. This bill also serves to protect the rights of patients to receive a second opinion, and by doing so, would protect our health care system.

In my consultations, I spoke with disability rights advocate Heidi Janz. She told me about being born in the Soviet Union. Doctors told her parents that Heidi would never walk, talk or think and that she would be dependent on others for the rest of her short life. They told her parents to put her into an institution and forget they ever had her. Heidi Janz has severe cerebral palsy.

Her parents did not listen to the dominant narrative of their day. They loved their daughter and believed her life had value. Eventually, they found the support they needed. Today, Dr. Heidi Janz holds a Ph.D. and is an adjunct professor of ethics at the University of Alberta. In her spare time she is a playwright and author, and somehow, despite how busy her life is, she also serves as the chair of the ending of life ethics committee for the Council of Canadians with Disabilities.

Dr. Janz is a remarkable woman. While some might pity her, she will have none of it. She says that everyone talks about how bad it must be to have a disability, but that she chooses daily to live in opposition to that narrative. She also says that disabled people can be so much more than their diagnosis, and that she is proof of that fact.

If it had been up to the dominant view of her day, she would never have had the chance to disprove that narrative. If her parents did not have the option to find the help they wanted to get that crucial second opinion, none of my colleagues in this place would be hearing about this marvellous woman. This is not just a theoretical story.

In a similar vein, earlier this year the Minister of Crown-Indigenous Relations, who is a doctor herself, wrote to her constituents about her experience of ageism in our health care system as it related to her 93-year-old father.

While I will not repeat the whole story, I will just quote her last two sentences:

My Dad got better without needing the ICU, but I remember thinking that as an MD I had been able to firmly take a stand. I worried that other families wouldn’t have been able to question the clear ageism in the choices being put in front of them.

The minister's father and all Canadians have the right to find a doctor who will offer them hope, offer them another choice, offer them a second opinion. All Canadians deserve that same right.

Now, this is anything but a guarantee in Canada. We have passed laws that have the unintended consequence of forcing doctors and medical professionals to provide patients death, regardless of whether they believe it is in their patient's best interest. Bill C-14 and Bill C-7 create a federal standard for medical assistance in dying and assisted suicide, but not for conscience protections. Despite the claims of some, it is patently absurd to argue that a conscience rights bill would somehow interfere with the role of the provinces while the legalization of medical assistance in dying does not.

We are speaking of the very first fundamental freedom laid out in the charter. Ensuring that conscience rights are protected is the responsibility of Parliament and of the Government of Canada, which is why I introduced this bill and why it should be passed. Above all, it is the right thing to do for patients and medical professionals.

Some have tried to frame conscience rights as the rights of the patient versus the rights of the doctor. Nothing could be further from the truth. In fact, conscience rights are critical to how our health care system works. Patients have the right to a second opinion, but there can be no second opinion if every medical professional is forced to provide the exact same list of options.

Health care is fundamentally about the doctor-patient relationship. Take the case of a psychiatrist who supports MAID in certain circumstances, but who has spent 15 years counselling a patient who suffers from bouts of depression and suicidality. For 15 years, they have built up an understanding and trust. What would happen if that patient, suffering from a bout of suicidality, should demand assisted suicide? Under the current law, that psychiatrist would be forced to refer the patient to someone else so that the patient could die. The psychiatrist must do this, despite knowing that the suicidal thoughts are temporary, that otherwise the patient is joyful and loves life, and that ending that life is wrong. The psychiatrist's hands are tied. Is that what passes for medical care?

Some might claim that there are safeguards in place to prevent such tragedies, but I ask, are members completely sure? With the passage of Bill C-7, many of the safeguards have been removed. We are talking about ending a human life. There is no room for “maybe” when a life hangs in the balance. Should the first line of safeguards not be the expertise of the medical professionals who know best? If they do not believe death is the answer, should we not at least consider if they are right? This is, after all, a matter of life and death.

Medical assistance in dying and assisted suicide are readily available throughout all of Canada. There are information phone lines, hospitals staffed with willing medical professionals, even email addresses to help set up appointments. In a word, MAID is becoming the status quo. To claim that protecting the conscience rights of medical professionals will somehow block access for those who truly want it is both misleading and nothing but baseless fearmongering.

The Canadian Medical Association stated clearly that conscience protections would not affect access, because there were more than enough physicians willing to offer MAID. This is further reinforced by a McGill study that showed that 71% of recent medical school graduates would be willing to offer MAID.

Every court case on the subject, as well as common sense, has stated clearly that the charter rights of medical professionals are breached when they are forced to either offer or refer assisted suicide or medical assistance in dying. Surely, we are clever enough to ensure access to MAID while still protecting the fundamental charter right to freedom of conscience.

I believe it is no accident that former prime minister, Pierre Trudeau, placed conscience rights as the first of the enumerated rights in our charter. It is an acknowledgement that the state cannot and should not attempt to force any one of us to do what we believe is immoral.

Dozens of first nations leaders wrote to every MP and senator. They said that, “Given our history with the negative consequences of colonialism and the involuntary imposition of cultural values and ideas, we believe that people should not be compelled to provide or facilitate in the provision of MAiD.”

We claim to be a pluralistic, free society. If that is true, it demands of us a tolerance of the moral views of others. Some have argued that protections already exist in Bill C-14. While I applaud the former minister of justice, the hon. member for Vancouver Granville, for ensuring that conscience rights were acknowledged in that legislation, acknowledgement is no longer enough. There are examples of medical professionals being forced or bullied into participation in assisted suicide against their conscience.

Dr. Ellen Warner, an oncologist who has served her patients for 30 years, told me about her experiences. She said:

I think it will shock Canadians to hear of healthcare providers being coerced into participating in MAID, yet such coercion has been happening frequently. A brilliant colleague of mine was bullied into becoming the physician legally responsible for MAID on his hospital ward. It was a great loss to us when he left for a different position. Two other co-workers told me that, despite strong, moral objections, they would carry out MAID if asked to do so for fear of losing their jobs. At one of our staff meetings, a psychiatrist stood up and announced that any physician who does not actively support MAID should not be working at our hospital.

Finally, some have suggested that medical professionals should leave their morality at the door. However, no one truly believes or wants that. As an example, no one would want a doctor to forget their morality if they were offered a bribe to move someone up on a waiting list. If we hold our medical professionals to a higher standard, we cannot then tell them to ignore their personal moral standards. As Dr. Ellen Warner stated, “In the absence of conscience protection, the group with the most to lose are the patients—the people we are all trying to help,”

This bill would protect the doctor-patient relationship by ensuring that doctors and other medical professionals are always able to recommend and provide the care they believe is best for their patient. Canadians need this bill to pass. Canada's medical professionals need this bill to pass. Additionally, they will need individual provincial governments to protect their rights through provincial regulations and legislation.

I encourage all members in this place to do our part and pass the protection of freedom of conscience act.

Alleged Premature Disclosure of Private Member's Bill

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Mr. Speaker, I rise on a question of privilege concerning the premature disclosure of the contents of Bill C-288, an act to amend the Companies’ Creditors Arrangement Act. This bill is sponsored by the member for Sudbury.

On Sunday, April 18, 2021, the Toronto Star posted an article entitled “Liberal MP's bill aims to keep turmoil at Laurentian University from happening at other schools”. The member is quoted in the article disclosing the contents of his bill. The problem is that the bill, which was on notice at the time the article was published, was not introduced until Monday, April 19, 2021. The article attributes several statements to the member for Sudbury. The article says:

“I’m going to add post-secondary institutions to the exemptions for institutions that cannot avail themselves of CCAA protection. It’s as simple as that,” [the member stated], referring to the Companies’ Creditors Arrangement Act, which allows for court protection during financial restructuring....

The article also quotes the member as saying:

“This includes additional financial support from our CCAA lender in order to continue to operate as Laurentian implements its plans to position the university for long-term sustainability and a basis for recovery for its creditors and stakeholders.”

On March 10, 2020, the Speaker, ruled a prima facie case of privilege following the premature disclosure of the contents of Bill C-7, an act to amend the Criminal Code (medical assistance in dying). The Speaker said:

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

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

On April 19, 2016, the Speaker, in finding a prima facie case of privilege regarding the premature disclosure of contents of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying), stated:

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

Another question of privilege was raised on March 19, 2001, regarding a similar matter. Speaker Milliken, on page 1840 of the House of Commons debates, supported this principle and said:

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

In addition, there was another case of contempt on October 15, 2001, where the Department of Justice briefed the media on the contents of a bill prior to the legislation being introduced in the House.

Given the contents of the article, and that it was published before Bill C-288, an act to amend the Companies’ Creditors Arrangement Act, was introduced in the House, I ask that you find a prima facie case of privilege. I am prepared to move the appropriate motion.

Motion in Relation to Senate Amendments

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, several times, I have been touched by the speeches and have been able to understand where my Conservative colleagues are coming from. I am in favour of any speech urging more social measures to help the most vulnerable and marginalized people.

When we consider the position of the Conservatives, who voted against Bill C-14 and Bill C-7, we get the impression that the only solution for dying with dignity is palliative care.

Unfortunately, palliative care and suicide prevention require investments in health and social services. How can the Conservatives get so worked up over the idea that these conditions could be trivialized, when they made cuts to health transfers, reducing the escalator from 6% to 3%? It takes money to offer social services, suicide prevention services and access to care. I cannot follow their logic.

For 50 years, holding up palliative care as the only solution has not resolved the end-of-life issue, as they know full well. Why do the Conservatives not sit down with us in 30 days? They could invite anyone they like, and we could have a cross-party discussion to find solutions.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I just want to let you know that the interpretation has not come through a few times now, so I do not hear you when you call on me. I am sorry.

My colleague wants us to keep studying this issue. I agree with him, but the motion before us would enable us to bring in the people he is talking about and engage in a multi-party thought process about the best solutions.

What does he have to say to Sandra Demontigny, who was diagnosed with early-onset Alzheimer's and very much wants the right to make an advance request?

What does he have to say to Ms. Gladu, who had to take her fight to court and won in the end? Ms. Gladu said that Bill C-14, which the member voted against because it was too much for him, violated her right to life because it forced her to cut her life short.

What does he have to say to those people?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I will be splitting my time with the member for South Surrey—White Rock.

Madam Speaker, it has been very interesting to hear the Liberal speakers today on this sad day when the Liberals have brought in closure on what is a very important life-or-death amendment from the Senate, and to hear the Liberals spinning their wheels and making up excuses and pretending that past studies on other bills dealing with medical assistance in dying somehow should be taken and counted in support of the huge expansion suggested by the Senate, which has only had a very few hours of consideration in the House before this closure motion today.

For those who are watching, closure by the government means that members of Parliament will not be able to further debate or further study the application of medical assistance in dying to those suffering with mental illness.

It is important to have a bit of context on this because when the Minister of Justice appeared at our justice committee when we were studying this bill, we did not hear from those in the community dealing with suicide prevention and with mental illness because that was not an aspect of the bill. The minister at the time said that there was no consensus in Canada when it comes to mental illness, and there was no consensus among physicians when it comes to mental illness; yet now, a few months later, the Liberals are ramming this through today in a very unfortunate and contemptuous way.

I expect that desperation we hear in the voices of Liberal members is because they are getting the same emails, phone calls and messages that the rest of us are getting. These messages are from those who are fighting for vulnerable people, those who are fighting for people with depression and people suffering from mental illness, saying, “Please do not pass this Senate, and now Liberal government, amendment”.

From the beginning the government has mismanaged this issue. The Liberals say that Bill C-7 was originally aimed at responding to the Quebec Superior Court decision from 2019. Conservatives, at the time, said very clearly that the government should defend its law and should have appealed this decision to the Supreme Court of Canada. Instead, the Minister of Justice, who himself voted against Bill C-14 on medical assistance in dying because it did not go far enough, saw this as an opportunity to rapidly expand the medical assistance in dying regime under the cover of responding to that Quebec court decision.

I disagree with the position of the Liberals not to appeal this to the Supreme Court. As the Conservatives said, that would have given Parliament clarity on how to legislate going forward. However, the Liberals took the highly unusual approach of not defending their own legislation. If the Liberals simply wanted to respond to the Quebec court decision, they would and could have done that. They chose not to do that. Instead, today, they are trying to ram through this bill that goes dramatically beyond that. It is very clear that the Liberal government sees the work of Parliament as a nuisance and that anything other than complete acceptance of its legislation must be opposed.

When this bill was first introduced just over a year ago, it was done one week after the government had already asked for its first extension from the Quebec court decision. Therefore, the Liberals were already failing to meet the court deadline that they said was their goal. Then, rather than introduce a bill that simply addressed the Quebec court decision, the Liberals introduced a far more expansive bill that requires a significantly greater amount of scrutiny by Parliament.

Under Bill C-14, the government's original MAID legislation, a legislative review was required five years after the bill received royal assent. That was scheduled to take place last year. This review would have looked at the impacts of Bill C-14 and would have provided insight on how to proceed forward. Let me be clear: Rather than allow Parliament to do that work first, the government decided to expand MAID legislation in Bill C-7. Again, rather than simply responding to the court decision and allowing Parliament to do the work necessary to study this issue, the Liberals overreacted and brought in expansive new legislation.

The government ended up receiving an extension from March 11 to July 11, 2020, and, with the COVID outbreak, Parliament's scrutiny was limited for a number of months. As time ticked toward July 11, it was apparent that yet again the Liberals would not be able to ram their bill through Parliament, and another extension was requested on June 11, this time for December 18, 2020. When Parliament eventually resumed in September 2020, we could have had the opportunity to debate Bill C-7, but of course we were, ironically, prevented from doing so by the Liberals who are now so keen on passing Bill C-7, because they prorogued Parliament, wiping the legislative slate clean. We all know this was done to avoid scrutiny of the WE scandal to protect the Prime Minister and other senior members of cabinet.

Based on the communications over the past couple of days, one would expect that the Liberals may have had a sense of urgency to reintroduce Bill C-7, instead they did not introduce Bill C-7 again in the first week or the second week. It took the Liberals until the third week of Parliament after they prorogued to actually reintroduce Bill C-7.

The Liberals have set themselves up time and time again to miss their own deadlines, and they have set themselves up for failure, but now there is this rapid rush. however, as has been pointed out, this is an entirely new bill that has come back from the Senate because it includes what was explicitly excluded by our House of Commons, which is made up of elected members of Parliament from all across this country. The mental illness component was specifically and deliberately excluded, and now it is being added in.

By including mental illness as a sole underlying condition to be eligible for MAID, the government wants to expand MAID even further in a way that is a complete 180° turn from Bill C-7 as it was introduced a year ago. This is a completely different bill than was originally debated in the House. As the vice-chair of the justice committee, I know we did not seek to hear from experts on this topic because the government's bill explicitly said expanding medical death to those with mental illness was not being considered. Now, at this last stage of the bill, the government is recklessly accepting a dramatic expansion of the bill, an expansion to which the Minister of Justice himself said there was no consensus.

What are people saying on this mental illness issue? It is unfortunate because Canadians are not going to be able to be engaged and participate in this conversation before we vote on the matter tonight. However, for those of us who are listening, the CEO of the Mental Health Association sounded alarm bells in an article urging all members of Parliament to please vote against the Senate amendments. Her point in the article is that MAID should not be broadened to those with mental illness until at least the health care system adequately responds to mental health needs of Canadians.

She highlights that it is not possible to determine whether any particular case of mental illness represents an advance state of decline and capabilities that cannot be reversed. She concluded her article writing, “We have to cure our ailing mental health system in Canada before we even begin to consider mental illness incurable.”

In a CBC, Dr. Mark Sinyor, a psychiatrist and associate professor of psychiatry at the University of Toronto recently wrote, “As a scientist, I have to be open to the possibility that all of the claims advanced by MAID advocates are accurate. But enacting law, one which literally governs life or death decisions, based on a possibility isn't good enough.”

He continued, “In other areas of medicine, thoughtful scientists typically devote whole careers to meticulously studying benefits and harms of treatments before rolling them out. Here, that proven approach has inexplicably been replaced with hand-waving and moralizing.”

We know that it is our job as members of Parliament to study these things and hear about them at committee from experts, those that are directly impacted, before passing new legislation. We heard this week at a press conference from Wayne Wegner. He told his story of struggling with mental illness. Wayne had a series of difficulties in life that led him to a very dark place, and he urged members of Parliament to please vote against this legislation.

In conclusion, this is not how we should be operating. We should not be dealing with closure today. We should be listening to persons with disabilities and persons suffering from mental illness issues and their advocates. We should all do our jobs as members of Parliament and listen first before we act. That is our duty.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Madam Speaker, I can appreciate the gravity of the debate that has been taking place on this very important piece of legislation. It is nothing new to members, no matter what side of the aisle they are on. Those who have been around for the last four or five years have literally seen hundreds, if not thousands, of hours of debate and discussion when we factor in what has taken place in the Senate and its committees, the hours of debate in second reading and third reading, the committee hearings and the special committee hearings.

An amazing amount of consultation has taken place, in particular, with the current minister responsible for the legislation. I know the parliamentary secretary to this particular ministry has done a phenomenal job in terms of reaching out and explaining the many complicated aspects of this legislation, and comparing it with what had taken place previously.

The issue of medical assistance in dying has been on the floor of the House and in our communities for years. We are in this position now because of a specific superior court ruling from the province of Quebec. I think the deadline is now the end of the month. This is the second or third, and final, extension, as has been made very clear. I believe that we need to have legislation dealing with medical assistance in dying and that it needs to comply with our courts. I very much support the rule of law in our democratic system.

I understand there are extremes on either side of the issue. There are those who, for personal and passionate reasons, believe that we should not have the legislation and those who, for personal and passionate reasons, believe that we have to have the legislation. I have chosen the side of supporting the legislation. I made that determination for a number of reasons. I respect the debates that have taken place over the years. I have seen tears on the floor of the House of Commons as MPs plead their position on MAID, at times with a great deal of passion. It is not easy for many, if not all, members of Parliament to ultimately make that determination.

We have heard from our constituents by email, by Canada Post, by telephone and by public meeting. Many of our constituents are following this issue and want us to make a decision from their viewpoint. What I have often found when speaking to constituents is that they understand why we are in the position we are in today. Some would ultimately not want to see this legislation pass, period. They are prepared to use whatever mechanisms they can. I am referring, in particular, to members of the official opposition. They will take whatever actions they can to prevent the passage of this legislation.

When asking a question of the Minister of Justice earlier, I indicated I had listened to many hours of debate on this issue, and I had posed questions to other members.

Let it be put on the record clearly that I believe there are members within the Conservative caucus who do not want this legislation to pass, period. End of story. As a whole, the Conservative Party has taken the position that it wants to continue debate and has somehow drawn the conclusion that it is inappropriate for the government to move closure. I want to highlight two aspects of that, because I think it is very misleading for the Conservatives to try to give the impression in any way that the Government of Canada has not been listening to Canadians, or is trying to ram through legislation.

First, we are in a minority government. We could not be doing this without the support of a majority of the members sitting in the House of Commons. That means that many opposition members are supporting the need to allow this legislation to come to a vote. I suspect, when it does come to a vote, that some of the Conservatives who voted against allowing it to come to a vote will vote in favour of the legislation, so the Conservatives are using the rules to try to prevent that. It is important to recognize that it is not just the government saying the official opposition is being irresponsible with respect to this legislation.

Second, the Conservatives are saying they want more debate and that is what this is all about. They do not want the government to bring in closure. That is just not true. That is not the case. I do not believe that for a moment. Those who are following the debate need to understand and appreciate that the Conservative Party of Canada was offered not once, not twice, but on three separate occasions the opportunity to continue to debate this issue for hours on the floor of the House of Commons. The Conservatives said no to every opportunity they were provided for additional debate. That clearly demonstrates that the Conservative Party is not interested in having more debate time; rather, it wants to filibuster this legislation. In one sense, the Conservatives would be very happy if we debated this bill every day. If we accommodated their so-called desire, they would criticize us for not having more debate on other government bills.

There is a finite amount of time on the floor of the House of Commons. In my opinion, the Conservative Party continues to abuse the opportunity to allow for healthy debate. With Bill C-7, we are talking about life and death. There are examples I could give that further show what I believe has been a very destructive attitude by the Conservative Party of Canada when it comes to the proceedings in the House.

If it were not for shaming the Conservative Party of Canada, some of the legislation and other things that have taken place in the last 24 hours would not have occurred. If Canadians understood the tactics the Conservative Party is using, I believe they would be outraged.

Today is about life or death and Bill C-7. On other occasions, and I would cite Bill C-14 as an excellent example, there were hours and days of debate. I suspect there were probably more days of debate on Bill C-14 than there were on a budget bill, and more speakers than on a budget bill. Conservatives wanted to talk it out. I believe we finally got it through because they were shamed into doing so.

Bill C-7, as I indicated at the beginning, concerns a complex and deeply personal issue. It is about reducing suffering, among other things. In previous debates on this issue, I have shared with the House my own experiences of the passing of my father at Riverview and of my grandmother in palliative care at St. Boniface Hospital.

In these debates, there has been a great deal of discussion about what else we could do. For example, the importance of hospice care and the issues of long-term care, recognizing the federal government has a role to play in those areas—

Justice

[David Lametti, Liberal, Minister of Justice]

Mr. Speaker, I thank the hon. member for his question on this very sensitive and important topic and the very important bill that is currently before the House. We have, with mental illness, a very sensitive and serious challenge. We have proposed a committee of experts to look at it and to give us guidance moving forward, and in recomposing the parliamentary committee to review what was Bill C-14, passed in 2016, we are sticking to our original plan to look at that question with all seriousness.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Minister.

I know we all have a responsibility to move forward together, and I know you and I haven't seen 100% eye to eye on the issue of Bill C-7. The world wouldn't be a very interesting place if we all agreed 100% of the time.

However, on this, I really strongly feel the wishes of this House of Commons and even your testimony.... I respect you and your opinion—the opinion that would have been backed by the charter analysis conducted by the Department of Justice—that, in fact, the bill as presented and as studied in the Senate was, in your opinion, constitutional.

With this amendment to include those.... I know we all share Bell's Let's Talk; we all urge people who are struggling with mental illness to try to get the help they need, to talk to friends and to reach out. I'm looking at a list that was sent to me: the Canadian Hospice Palliative Care Association, the Canadian Institute for Inclusion and Citizenship, Communication Disabilities Access Canada, Inclusion Canada, the British Columbia Aboriginal Network on Disability Society, the Council of Canadians with Disabilities, and the list goes on. There are well over a hundred individual organizations that are asking members of Parliament to please, at this point, not include mental illness. As you said, Minister, we should have started this study a year ago under Bill C-14 on possible expansions to MAID, but this is putting the cart way before the horse.

I appreciate the response you gave—that Liberal members will be given a free vote—and I hope they support Canadians with disabilities on this.

Minister, I have only 30 seconds, so I just have a quick question on consecutive sentences. The Quebec Court of Appeal reduced the sentence of the man who murdered six people in the Quebec City mosque to 25 years without parole rather than 40, after striking down consecutive sentences. Do you intend to defend this law?

Thank you, Minister.

Alleged Premature Disclosure of Contents of Bill C-22—Speaker's Ruling

[The Speaker, Liberal, Anthony Rota]

I am now ready to rule on the question of privilege raised on February 19 by the member for Fundy Royal concerning the alleged premature disclosure of the contents of Bill C-22, An Act to amend the Criminal Code and the Controlled Drugs and Substances Act.

During his intervention, the member said that a CBC article posted online at 8:47 a.m. on February 18 described the details of Bill C-22 although it had not yet been submitted to the House. The member referred to the contents of the article, which he said discussed a number of the measures contained in the bill and boasted about the reliability of its sources. The Chair notes that the article had already been updated by the time the issue was raised. To be clear, with regard to this ruling, the Speaker considered the initial version of the article, which was published at the time of introduction and first reading of the bill.

After reviewing a series of precedents on the issue, the member said he also believed that the Minister of Justice's actions were contemptuous and that he had ignored the will of the House.

In response, the member for Kingston and the Islands informed the House that the office of the Minister of Justice had not shared the contents of the bill with the CBC journalist before its introduction. The member explained that he believed that the ministers' mandate letters sometimes allowed journalists to deduce the contents of bills on notice. After reviewing the contents of the article in question and comparing it with Bill C-22, the member argued that the article was sometimes inaccurate and even incomplete. In his opinion, the article was written by using a government source who was not familiar with the contents of the bill or by making conjectures based on previous policy statements. Finally, the member for Kingston and the Islands, basing himself on a ruling made on June 8, 2017, said that it is a prima facie case of privilege in such cases when the government admits that the leak occurred, but not when the government does not acknowledge a leak. In this case, the member stated that if the contents of the bill were disclosed prematurely, the government was not responsible.

As the member for Fundy Royal pointed out during his intervention, it is a recognized principle that the House must be the first to learn the details of new legislative measures. That is why both government bills and private members' bills are confidential from the moment they are put on notice until they are tabled in the House. Speaker Milliken's ruling of March 19, 2001, which the member for Fundy Royal mentioned, provides a good summary of the importance of respecting this rule:

The convention of the confidentiality of bills on notice is necessary, not only so that members themselves may be well informed, but also because of the pre-eminent rule which the House plays and must play in the legislative affairs of the nation.

That being said, when the Chair is called on to determine whether there is a prima facie case of privilege, it must take into consideration the extent to which a member was hampered in performing their parliamentary functions and whether the alleged facts are an offence against the dignity of Parliament.

In the case before us, an exhaustive review of the intervention by the member for Fundy Royal does not reveal exactly which aspects of Bill C-22 were supposedly shared with CBC for the article in question, nor did the member point out any similarities in language between the article and the bill to demonstrate that precise details of the bill were apparently disclosed to the media in a deliberate and premature fashion. The member for Kingston and the Islands pointed out inaccuracies in the article and differences from the bill.

When it is determined that there is a prima facie case of privilege, the usual work of the House is immediately set aside in order to debate the question of privilege and decide on the response. Given the serious consequences for proceedings, it is not enough to say that the breach of privilege or contempt may have occurred, nor to cite precedence in the matter while implying that the government is presumably in the habit of acting in this way. The allegations must be clear and convincing for the Chair.

As well, I believe it is important to mention that the distinction that the member for Kingston and the Islands wishes to make between questions of privilege that are a prima facie case of privilege and those that are not—simply because the government admits or does not admit that a leak has occurred—is not that clear. While there is indeed a well-established practice that a member must be taken at their word, the fact remains that the government's stating that it is not responsible for the premature disclosure of a bill is not in itself sufficient to convince the Chair. I would add that the source of the information is one factor among others and that it is important first and foremost to determine whether precise details were provided before the House was made aware of them. The Chair must thus take into consideration all the information before it and reach a conclusion based on the facts presented by the members.

The two precedents most like the current situation to which the two members referred are those that my immediate predecessor and I rendered with respect to Bill C-14 and Bill C-7 on medical assistance in dying. In these two cases, in light of the facts presented, it was clear that the information had been shared with the media before the bills were tabled in the House. In the case of Bill C-14, the Government offered no competing explanation. In the case of Bill C-7, it was clear that the anonymous source had spoken with the media despite the fact they were well acquainted with our customs and practices in the matter. That is not the case this time with Bill C-22.

Thus, in this case, in light of what has been presented, the Chair is not convinced that the question of privilege raised by the member for Fundy Royal is a prima facie case of privilege.

I thank the members for their attention.

Criminal Code

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I want recognize the contributions by the member for Montcalm to the debate and to the justice committee during the study of Bill C-7 as well bill Bill C-14.

With respect to the Conservative position, it is one of a free vote both on Bill C-14 and Bill C-7.

I did oppose Bill C-14, because I had some significant concerns at the time that it did not go far enough to protect Canadians who are at risk, and we have seen evidence of that. We heard from witnesses to that effect, including Roger Foley, who was pressured into undertaking medical assistance in dying, because his health care workers determined that he was too much of a burden. I think that case illustrates the fact that Bill C-14 did not provide sufficient safeguards to protect the vulnerable, and the legislation before us does away with them almost entirely.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I have heard my colleague make many interventions on this issue. He took part in the clause by clause review of the bill and he is very eloquent.

However, the Conservatives voted against the former Bill C-14. According to my colleague, this bill contained an unbelievable safeguard, but Justice Baudoin declared it unconstitutional. The Conservatives also voted against the current Bill C-7.

Am I wrong to say that the Conservatives' position is that palliative care is the only acceptable option for end-of-life?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I am rising to speak on Bill C-7.

The legislation illustrates the dangers that arise when a government puts blind ideology ahead of evidence-based decision-making. The nightmare of this bill and that road that has led to it today began when the Quebec Superior Court judge issued the Truchon decision. In that decision, that lower court judge determined that the most important safeguard in Canada's medical assistance in dying regime, namely that death be reasonably foreseeable, was unconstitutional.

That decision, again, was by one judge in one province. It is not binding in any other province. It does not bind the Quebec Court of Appeal. Indeed, it is a non-binding decision.

In the face of that, one would have thought that the Attorney General, whose responsibility it is to uphold laws passed by Parliament, would appeal that decision. After all, we are talking about a decision that removes the most important safeguard that was part of the legislation was passed a mere three and a half years prior to the issuance of the Truchon decision.

Instead, the Attorney General put ideology ahead of the interests of vulnerable persons, and did something that is virtually unprecedented. The Attorney General did not appeal the decision and, instead, recklessly tabled Bill C-7, which eviscerates key safeguards, including the most important safeguard, namely that death be reasonably foreseeable. In so doing, the Attorney General seeks to radically transform Canada's medical assistance in dying regime from something where such assistance is deemed appropriate to deal with or address suffering in death to now providing death to deal with suffering in life.

In seeking to so radically transform Canada's medical assistance in dying regime, the Attorney General has pre-empted a mandated parliamentary review provided for under Bill C-14. The Attorney General has preceded with completely inadequate consultation, ignoring important voices that represent vulnerable Canadians and, most importantly, that represent Canada's disabilities rights community.

When 72 national disabilities rights organizations wrote to the Attorney General and pleaded with him to appeal the Truchon decision, he ignored them. Their pleas to this Attorney General have fallen on deaf ears.

Why is the disabilities rights community so concerned with Bill C-7 and, in particular, the removal of the criterion that death be reasonably foreseeable? Very simply, when that criterion or safeguard is removed, it means that someone who suffers from a degenerative disability could be eligible for that very reason, despite the fact they may have years, if not decades, to live.

The disabilities rights community, on that basis, has said, in clear and unequivocal terms, that they believe this bill stigmatizes persons with disabilities.

As Krista Carr, the executive vice president of Inclusion Canada, said, this “is our worst nightmare”. As Catherine Frazee, disabilities rights advocate and former Ontario human rights commissioner, said to the justice committee with respect to Bill C-7, “Why us?”

Why, in asking that question, is the government proceeding to discriminate against the rights of persons with disabilities by depriving them of protections against premature death afforded to all other Canadians outside of an end-of-life context? In so depriving those rights, specifically to persons with disabilities, significant questions have been raised about the constitutionality of Bill C-7 and whether it would, in fact, by discriminating against persons with disabilities, violate Section 15 of the charter. However, those questions and concerns were completely ignored by the Attorney General, who puts the ideology of ableism first.

So blinded is the Attorney General that he ignored not only concerns from the disabilities rights community, but also from the UN Special Rapporteur on the rights of persons with disabilities, who has said that this bill violates international human rights norms. So blinded by ideology is this Attorney General that he ignored the UN Commission on Human Rights, which the government is rather fond of, which has stated that this bill runs afoul of the Convention on the Rights of Persons with Disabilities, in particular article 10.

Just when one thought it could not get any worse, we learnt today with respect to the motion the Attorney General tabled in the House that it would, among other things, essentially accept, with some very minor tweaking, radical Senate amendments, including one that would provide that someone would be eligible for medical assistance in dying for having solely a mental illness. This is a radical change, and, despite the fact this issue has not been appropriately studied, the Attorney General has said it is now a fait accompli. This is despite the fact that we do not know how to predict irremediability in the case of mental illness; despite the fact that we do not know if someone's mental illness is the basis for their request or a symptom of their mental illness; and despite the fact that we do not know whether someone's mental health suffering could be alleviated by health and other social supports.

This bill is a reckless, dangerous piece of legislation that would put some of the most vulnerable persons in Canadian society at risk. It must be defeated.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Madam Speaker, I will be sharing my time with the member for St. Albert—Edmonton.

I have spoken to this issue twice in the House, the last time being December 4. I entitled that speech “Stay safe, my son”, because I do tell the personal story of being a father of a 34-year-old developmentally and intellectually disabled son who lives with us and is cared for by us. His name is Jordan.

In a larger way, my speech dealt with the removal of the safeguards for Canadians with disabilities and how the government is choosing to ignore and dismiss the concerns of disability groups across this country who have joined in arms in opposition to Bill C-7 because it fails to protect them and their safety in the long term. A quote that is most often used and referred to by the disability organizations is that this is the worst possible scenario.

After that speech, I discovered the United Nations office on human rights has stated that legislation extending euthanasia and assisted suicide to persons with disabilities “would institutionalize and legally authorize ableism”. For those who may need help with the word “ableism”, as I did, I went to the Oxford Dictionary and this is the official definition in it: “Discrimination in favour of able-bodied people.”

For full disclosure, I am a parliamentarian who sees Bill C-7 for what I think it is: the next step on the slippery slope in the MAID debate created originally by Bill C-14 in 2016. Today we are being asked by the Senate to make amendments to further remove safeguards for those living with mental illness. The Canadian Mental Health Association's CEO and spokesperson, Margaret Eaton, wrote to all parliamentarians, saying that “The exclusion of mental illness as the sole underlying cause for medical assistance in dying must be maintained to safeguard those living with mental illness.”

Understand that the Canadian Mental Health Association is the most extensive community in mental health across Canada, with a presence in 330 communities across every province and one territory. It provides advocacy, programs and resources that help prevent mental health problems and illnesses, support recovery and resilience and enable all Canadians to flourish and thrive. She goes on to explain the three compelling reasons that the exclusion of mental illness, as the sole underlying cause, was justified and urges all parliamentarians to oppose the Senate amendment that proposes to drop that protection for people with mental illness.

The slippery slope is the continual easing of restrictions and expansion of euthanasia to a day when society will be conditioned to accepting death upon request. Many of—

Alleged Premature Disclosure of Contents of Bill C-22

[Mark Gerretsen, Liberal, Kingston and the Islands, ON]

Mr. Speaker, on a point of order, I am rising to speak to the alleged premature disclosure of the content of Bill C-22, an act to amend the Criminal Code and the Controlled Drugs and Substances Act.

My colleague, the hon. member for Fundy Royal, rose in the House on February 19 to allege that the content of the bill was divulged by the government in a CBC news story during the notice period. In his intervention he cited a Speaker's ruling on March 10, 2020, respecting the premature disclosure of Bill C-7 and Bill C-14, both dealing with medical assistance in dying. In those cases, the government acknowledged that some content was disclosed during the notice period, and as a result, the Speaker found there was a prima facie breach of privilege.

The case before the House on Bill C-22 is indeed different. I have discussed this matter with the office of the Minister of Justice, and they have confirmed to me that a CBC reporter did inquire about the content of the bill while it was on notice. The office explained to the reporter that since the bill was on notice, they could not comment on the content of the bill until it had been properly introduced in the House.

The government, in 2015, promised to make public mandate letters for the ministers, a significant departure from the secrecy around those key policy commitment documents from previous governments. As a result of the publication of the mandate letters, reporters are able to use the language from these letters to try to telegraph what the government bill on notice may contain.

I take umbrage with the member for Fundy Royal's assertion: “We are being asked once again to deal with the contemptuous actions of the Minister of Justice and his justice team.” The member should ensure that he has the facts on his side before casting such aspersions on any member of the House. It is neither decorous nor responsible.

Now let me deal with the matter directly.

Bill C-22 has three main policy thrusts: repealing mandatory minimum penalties in the Controlled Drugs and Substances Act and the Criminal Code, increasing the availability of conditional sentence orders and evidence-based diversion from simple possession offences. The article the member refers to and relies on for his argument was not correct in its description of all three elements and therefore resides in the realm of speculation.

When we get into the details of the article in comparison with the bill, the story gets the content wrong. Let me walk members through the content of the article.

On drugs, the article is rife with speculation. The 2019 mandate letter for the Minister of Justice states, “Make drug treatment courts the default option for first-time non-violent offenders charged exclusively with simple possession to help drug users get quick access to treatment and to prevent more serious crimes.” The reporting on this item seems to be speculative based on the title of the bill. Moreover, the bill does not contain measures dealing with drug treatment courts.

I will note for the benefit of members that the evidence-based diversion measures in the bill are entirely distinct from drug treatment courts. Drug treatment courts require non-violent offenders to plead guilty, and judge-mandated supervision has no relation to what is proposed in the bill. In fact, the bill seeks to avoid the laying of charges in the prosecution of simple possession cases in the first place, if appropriate.

The bill also proposes a principled approach for police and prosecutors to consider before laying or pursuing a charge of the offence of simple drug possession. This includes the possibility of referral to various treatment programs or social supports and/or empowering police and prosecutors to provide a warning or to take no action with respect to the potential offender instead.

On mandatory minimum penalties, the article states that the government will revisit the mandatory minimum penalties for drug-related offences. In fact, upon inspection of the bill, the government is proposing to remove all mandatory minimums related to the drug offences, as well as removing mandatory minimums for 14 other offences in the Criminal Code.

There is no mention in the article of conditional sentence orders, which are a key policy element of the bill. In addition, there is nothing in the bill that provides for reforms concerning restorative justice specifically. The article infers that the bill contains elements relating to restorative justice, based on the mandate letter commitment, previous public statements and commitments made in regard to the fall economic statement.

One can only assume two outcomes here based on the fact that the article did not accurately describe the contents of the bill. First, the reporter spoke to a government source who was not familiar with the content of the bill. The second outcome, which is perhaps more likely, is that the government did not publicly comment on the bill during the notice period and, as a result, the reporter had no other recourse but to speculate on the content of the bill based on previous policy statements.

I will turn now very quickly to the relevant precedents on the disclosure of the content of a bill during the notice period. In instances where government has acknowledged that an official of the government prematurely disclosed the content of a bill during the notice period, Speakers have found a prima facie case of breach of privilege. However, when the government has not disclosed the content of a bill during the notice period, Speakers have been reluctant to find a prima facie case of breach of privilege. On June 8, 2017, the Speaker referred to the distinction as follows:

When ruling on a similar question of privilege on April 19, 2016, I found a prima facie case of privilege in relation to the premature disclosure of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying). In that particular case, the government had acknowledged the premature disclosure of the bill while assuring the House that this had not been authorized and would not happen again. In other words, the facts were undisputed.

That is not the case with the situation before us. The parliamentary secretary has assured the House that the government did not share the bill before it was introduced in the House but conceded that extensive consultations were conducted. Nor is the Chair confronted with a situation where a formal briefing session was provided to the media but not to members.

Finally, it is a long established practice to take members at their word, and the Chair, in view of this particular set of circumstances, is prepared to accept the explanation of the Parliamentary Secretary to the Leader of the Government in the House of Commons.

In conclusion, I submit that if the content of the bill was prematurely divulged during the notice period, it did not emanate from the government side.

Criminal Code

[Tom Kmiec, Conservative, Calgary Shepard, AB]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I will now turn to the third amendment.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The judge went on, in paragraph 681:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I also try to use section 7 of the charter to guide myself, the fact that it is explicitly written that everyone has the right to life, liberty and security of the person and the right not to be deprived thereof, except in accordance with the principles of fundamental justice. Essentially it means that people have a right to control their own bodily integrity. It is engaged whenever the state tries to interfere with personal autonomy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Luc Thériault, Bloc, Montcalm, QC]

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

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

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

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

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

[Luc Thériault, Bloc, Montcalm, QC]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[David Lametti, Liberal, Minister of Justice]

moved:

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

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

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

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

proposes that, with respect to amendment 2:

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

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

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

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

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

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

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

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

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

“Independent Review

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

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

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

proposes that, with respect to amendment 3:

section 5 be amended by replacing it with the following:

“Review

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Alleged Premature Disclosure of Contents of Bill C-22

[Rob Moore, Conservative, Fundy Royal, NB]

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

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

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

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

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

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

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

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

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

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

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

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

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

Criminal Code

[Ted Falk, Conservative, Provencher, MB]

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

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

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

[Ted Falk, Conservative, Provencher, MB]

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

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

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

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

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

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

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

A CBC article says it rather well:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, my colleague is absolutely right about the importance of conscience protections for physicians, which is why we brought forward amendments to this bill to provide for conscience protections.

The members across the way say, “Nothing to see here. No need for such protections.” They point to a recognition of conscience protections being in the preamble of Bill C-14. Could the member speak to that?

Second, I would note that the Carter decision, paragraph 132 states:

Nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.

Yet that is happening in Ontario, violating the charter rights of physicians.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Madam Speaker, before I begin my speech, I would like to attempt to bring this room to a place of peace. I know this is a very sensitive topic and we all have our ideas and our passions. Some of us have different ideologies on this, but I think it is beautiful that these heated debates are happening because that is what is required to work through an issue like this. Life is not simple. It is complicated. When there are challenges, they require us to be real and work through our emotions and ideas until we come to a place where there is agreement and a compromise that everyone can agree on.

Throughout the debate, I have heard my party being accused of filibustering or trying to delay passage of this bill. I find that heartbreaking, because this issue has to do with life and death. As was stated many times, death is final and irreversible. It can impact people beyond the scope of those who are seeking it.

Rather than attack the motivation of other members on this topic, I would like to ask all members to continue in our debates, understanding that this is a very complicated issue. We can have discussions that are real, but avoid comments like the minister made about the religious right, which I found offensive.

Hope is a journey. It is not something that can be bought like going through a drive-thru to buy McDonald's. Hope is something that accumulates over time and for different reasons, for different people. It requires a huge scope of places that the person who is struggling for hope goes through. It requires a full course to arrive at the doorstep of someone who is suffering, and sometimes it arrives unannounced.

One thing I find troubling about this bill, any time I have debated on it, has been the perspective of hope. Hope is the most sacred gift we have as human beings. Life is not perfect. We go through life struggling, but the beauty of the human spirit is our determination to triumph over adversity. We see things like this among so many people who come close to committing suicide. Look at someone like Christopher Reeve: a famous actor who played a superhero. Everyone looked to him as Superman, yet because of a riding accident he lost many faculties and contemplated suicide. With support in his very limited way of living, he was able to live out the rest of his life. His ability to overcome his challenges made him a greater hero.

I am not saying this to belittle suffering. When I was 17, my father was taken to emergency in the hospital because his heart had stopped. His heart had been beating irregularly and at one point it actually stopped. When I arrived at his hospital room I saw his slippers, but he was not in his bed. His roommate said to tread quietly as my father was in an urgent emergency crisis. I stepped away. I was frightened, as a 17-year-old. Because his heart had stopped beating, they were taking him for emergency surgery.

The most traumatizing aspect of this experience was witnessing him jolting and screaming in pain because of the electric shocks being applied to him. It was a very painful experience to watch. When I was talking with my father about this bill recently, he said that in those moments he counted about 10 shocks before he passed out.

He said it was the most tormenting experience he had had in his life, that it felt like someone had taken a hammer and was beating him down, and that he could not stop it or control it. He said that the only reason he fought through this to stay alive was the thought that he had three daughters to take care of. That gave him hope. Fortunately, he lived on. He has a pacemaker, and he is all right.

The reason I bring this up is to acknowledge that sometimes suffering is painful. I picture my father going through that every day to the point that he really wanted to die, and I am applying this to those who are legitimately seeking MAID. That law passed. This was debated in 2016 as Bill C-14, and it passed. The purpose, as I perceive it, was to offer a dignified death to those who would seek it.

I have great concerns with some of the details on safeguards removed from this bill. I fear that this removes access to hope even more. We have heard many experiences and stories, some coming from the justice committee. The time that is required when a person is suffering from something like a spinal cord injury can be more than 90 days, for them to regain that trajectory of having hope and wanting to live. Granted, it would be very painful and I would never want to be in that situation, but there are those who overcome.

This bill would allow a person who has just suffered a life-changing spinal cord injury, for example, to end their life just 90 days after the catastrophic event that caused the injury. When a person is at their most vulnerable, experiencing unimaginable stress, a doctor could be forced to suggest ending their life. That is the option there.

From my understanding from doctors and witness testimony on the record at the justice committee, suicidal ideation after a catastrophic medical episode is very common. There is the possibility, with good care and support, that these transient suicidal thoughts could often take longer than 90 days to overcome. In recent weeks we have heard many of these stories of people who went through serious personal tragedy, but who have ended up living amazing lives and doing incredible things on the other side of it.

I would like to share the story of David Shannon. David suffered a spinal cord injury in a rugby scrum when he was 18 years old. He shared that after his accident, he lay in bed, close to death more times than he wishes to contemplate. He went on to have a career in a non-governmental organization with leadership, and he practises law. He said:

... I have accomplished a lot in my life. I've crossed our great country by the power of my wheelchair — coast to coast. I've jumped out of an airplane at over 25,000 feet.

It explains all the things he was able to do because he chose to live.

My fear is that removing these safeguards will create that truncation of hope that requires that full course for a person to regain their trajectory. If that is truncated, the big question is, “What if?”

This morning, in a CBC article, about a member of the Liberal government:

He said he worries the resulting legislation may not address people who are "transient" in their wish to terminate their lives, such as someone who has a permanent disability or who now needs chronic care. Those feelings of anguish can fade over time as they adjust to a changed reality, he said.

I think, with a bit of time, people may come around to the fact that there are reasons they want to live.

I want to thank my colleagues for their heated debate. I appreciate where they are coming from, but I would like to ask each one to take a moment of deep thought and ask if it is not worth protecting and safeguarding hope so that people have that opportunity through a longer time period to rediscover hope and have a chance to live past that darkness and move into a place of light.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Madam Speaker, I feel honoured tonight to be speaking to Bill C-7 given the many great speeches by my Conservative colleagues, who are concerned about our citizens and especially those in the disability and senior communities.

I speak today deeply concerned about Bill C-7 and the changes being proposed in the legislation. I know this is an emotional issue for everyone, and it is an important discussion we are having this evening. Any legislation that is introduced in Parliament requires a thorough review, but this is especially true for bills that are literally matters of life and death.

It is my firm belief that the federal government should have appealed to the Supreme Court to get certainty on the framework within which Parliament can legislate. Unfortunately, that did not happen, so here we are with a rushed bill that puts the lives of our most vulnerable at risk.

Make no mistake: As a Christian I am firmly against the use of medically assisted dying. That said, I understand that the courts have made a ruling and the legislation is required. However, we must ensure that this type of legislation includes safeguards for the most vulnerable in our society and for the conscience rights of physicians and health professionals.

That is why we Conservatives introduced a number of reasonable amendments to reinstate protections that the Liberal government has simply removed, which is troubling. These include reinstating a 10-day reflection period when death is reasonably foreseeable, extending the reflection period when death is not reasonably foreseeable, protecting vulnerable patients by requiring that the patient be the one who first requests information on medical assistance in dying and protecting the conscience rights of health care professionals.

It is unfortunate that these amendments have been rejected by the government. I am deeply concerned that this legislation will allow assisted death for Canadians who are not dying by removing the requirement that a person's death must be reasonably foreseeable for them to be eligible for assisted suicide and euthanasia.

My dad is 86 and my mom is 76, and as the son of two elderly Canadians, I am very concerned about what this would mean for our nation's seniors and the positions they may be put in when trying to access health care. Will they be placed in a position where they will have to decide between care and ending their lives because of outside pressure? As the bill expands medically assisted dying further, there is a risk that palliative care will suffer and, as a result, patients will view medically assisted dying as a better option.

I know Canadians share my concerns. It must be said that every national disability organization in Canada opposes this legislation. Krista Carr, executive vice-president of Inclusion Canada, said at committee, “Bill C-7 is our worst nightmare.” These organizations caution that removing the end of life requirement discriminates against those who are disabled and puts their lives at even greater risk. Ms. Carr notes:

The end-of-life requirement was the only safeguard whereby disability was not the sole criterion. By having a disability itself under Bill C-7 as the justification for the termination of life, the very essence of the Charter of Rights and Freedoms would be shattered. Discrimination on the basis of disability would once again be entrenched in Canadian law.

It is shameful that in the Liberal government's rush to pass the bill before Christmas, it continues to neglect to address legitimate concerns being raised by persons with disabilities.

I am also deeply concerned about the limited protections for the conscience rights of our medical professionals. While some doctors and health care workers may have been comfortable with medically assisted dying under Bill C-14, the continued expansion may cause them to rethink their participation.

Others who have always been against medically assisted dying are already feeling the pressure to go against what they believe. As the Physicians Alliance Against Euthanasia said in a news release just last March, “The pressure has been intense for many physicians, especially amongst palliative specialists, some leaving their profession even before this latest development. Descriptions were made of toxic practice environments and fear of discipline by medical regulators.”

Members of the justice committee have heard first-hand from disability advocates vehemently opposed to Bill C-7 and its rapid expansion of medical assistance in dying. They argue it amounts to a deadly form of discrimination, making it easier for persons with disabilities to die than live. It is shameful.

Health care professionals have also spoken out, concerned not only about their conscience rights but also about the speed at which the government is trying to pass Bill C-7. To quote Adam Taylor about the lack of consultation on this legislation, “As an emergency and family doctor, I know the importance of consultation, along with the day to day experiences and sufferings of Canadians which cannot be ignored. I'm terrifically concerned about this.” Even so, here we are, and the Liberals are continuing to push through the bill, ignoring concerns of those who would be directly affected by these changes. Again, it is shameful.

As the Evangelical Fellowship of Canada said in its submission to the House of Commons Standing Committee on Justice and Human Rights, we must carefully consider the impact of Bill C-7 and the concerns being raised by many Canadians, particularly Canadians with disabilities. The legislation, not to mention the human lives the bill would negatively affect, is too important to be rushed.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, we know that physicians are very concerned about conscience protections for medical practitioners. Right from the beginning, with Bill C-14, many stressed that this should be part of Bill C-7, yet the Liberal government has totally ignored it and punted it down to the provinces. I believe it is impacting palliative care and impacting people's perspectives of serving in the medical profession. I would just like some comments from the member in that regard.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Madam Speaker, I knew entering federal politics would mean participating in many very important debates in the House, but speaking on matters of life and death brings that to a whole new level. As someone who comes from a small city in northern Saskatchewan and now has the privilege of representing the entire northern 52% of Saskatchewan, I hope to bring somewhat of a unique perspective to this debate.

As we stand here in Ottawa and debate this legislation, there are several communities in my riding dealing with very high suicide rates. Makwa Sahgaiehcan First Nation, a community of about a thousand people, has over 100 community members currently on suicide watch.

There are long-term care home and palliative care shortages across the country, but this is even more true in northern and remote communities. We need to consider what message we, as legislators, are sending to these vulnerable communities when we go way beyond the Supreme Court of Canada's Carter decision by removing safeguards that would protect Canada's most vulnerable.

The government is now seeking to play an active role rather than a passive role in the end of Canadians' lives. I find this extremely troubling and implore my colleagues on the other side of the aisle to allow the necessary time to consider the truly long-term ramifications of the legislation and to listen to all the voices speaking out on it. This does not need to be done with unnecessary hurry.

There are two main topics I want to address when it comes to Bill C-7. Number one is the impact passing the legislation will have on indigenous communities, and number two is the importance of safeguards to protect Canada's most vulnerable.

I do not stand here pretending for one moment to speak on behalf of indigenous people in Canada. However, over my lifetime I have developed relationships with many first nations and Métis people in northern Saskatchewan and over the year I have discussed this issue of assisted dying with many of them. There is a great worry among the leadership of these nations that legitimizing suicide in our culture will have grave impacts on their younger generations as well as those who are nearing the end of their lives.

These concerns were actually raised during debate in the last Parliament by Liberal MP Robert-Falcon Ouellette during his speech on what was then Bill C-14. He said:

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?

Mr. Ouellette then goes on to share a very personal and difficult story of hardship he and his siblings faced as young children, which led him to nearly take his own life. He goes on to say:

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.

Speaking to CBC during the debate on Bill C-14, Senator Murray Sinclair shared similar views. He said:

From the indigenous perspective, ending one’s own life was not encouraged, in fact it was discouraged and there are teachings in my community, Ojibwa teachings, around whether or not you will be able to travel to the spirit world in the proper way or a ceremony could be done for you if you make the decision to end your life without good reason.

In speaking to his colleagues in the Senate, Senator Sinclair, speaking about younger people, said:

It will not take much for a young, vulnerable person to believe that their situation is intolerable to them and, therefore, we need to ensure the message we send to the Canadian public with this legislation is that this is not a right that should be easily exercised or that we are embracing.

First nations people in northern Saskatchewan, Mr. Ouellette from Manitoba and Senator Murray Sinclair are not alone. Tyler White, chief executive officer for the Siksika Health Services, as well as Dr. Thomas Fung, a lead physician of the same nation, are sounding alarms in response to the legislation. During an interview with CTV, Mr. White said, “The expansion of MAID sends a contradictory message to our peoples that some individuals should receive suicide prevention, while others suicide assistance.”

In a letter shared with my office, Mr. White and Dr. Fung told the story of a patient who suffers from a lung disease that causes him to become easily short of breath, even when doing simple household tasks. This patient uses a walker but cannot walk for more than a couple of minutes without gasping for breath. While the man's condition is incurable, he could certainly have an improved quality of life if he had access to funding to support his home oxygen, but he was just out of the range of being approved for funding. Dr. Fung concluded by writing that under Bill C-7, this patient would have qualified for assisted death when it should be clear to all that there are other ways to relieve this man's suffering and improve his quality of life. Patients like Dr. Fung's deserve better.

In a country as developed and resourceful as Canada, we cannot allow ourselves to abandon people like this. Our health care system is the pride of many Canadians, but that is because of universality of access to life-saving treatments, not the universal admissibility to a physician-administered death.

I want to talk for a minute about the safeguards for vulnerable Canadians and how the legislation would fail to provide them. I am not a lawyer, but thankfully the Leader of the Opposition is. We are probably all glad that is the case, that I am not the lawyer. I was glad to be in the House during this speech on Bill C-7 this morning.

Leaning on his legal expertise, allow me to repeat some of what he said regarding previous litigation surrounding assisted death, because it struck me as very important. He said, “All of them talked about the role of the state in protecting the decisionally vulnerable, as they were called, people who could be pushed into end-of-life treatment because they felt they were a burden. This has been talked about since the 1990s, and this Attorney General is removing the safeguards from our regime. Every ounce of case law on the issue of assisted dying, euthanasia or assisted suicide talks about protecting those vulnerable.”

Speaking of protecting the vulnerable, the leader also said, “All major disability groups in Canada agree with the compassionate and reasonable position being presented by my Conservative colleagues. I am very proud of the advocacy we have shown. We have also been joined by legal scholars, indigenous leaders and people working with people with mental health issues.” I wholeheartedly echo the comments made by my hon. friend this morning and repeat the need for the government to step back from its repealing of the provisions that would ensure a 10-day waiting period, as well as two witnesses.

As a matter of fact, regarding the 10-day waiting period, a senior employee of the AFN shared on Twitter recently, “This ten day period literally saved a member of family’s life. MAID must be accessible but also account for clear and thoughtful consent. The Liberals should rethink this.”

In closing, I want to completely acknowledge that both sides of this debate are coming from a point of view of compassion. I understand that the government has approached the drafting of the legislation in good faith, but the reality is that it has fallen short of its duty to Canadians. That is why I will be voting against this dangerous bill and I hope that my colleagues on the other side of the aisle will reconsider their support for it as well.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I am pleased to rise once again to speak to Bill C-7, the government's medical assistance in dying legislation. I do acknowledge that this is an incredibly complex subject matter for which there are many diverse views.

With that said, the way in which the government and the Attorney General have handled the legislation is a lesson in what not to do, having regard for the gravity of the legislation. I say that having full respect for the Minister of Justice and Attorney General. I believe he is a sincere and intelligent individual who is compassionate and does want to do what he believes to be right.

That said, when the Minister of Justice spoke in the House at second reading, he indicated that there were widespread consultations and that out of those consultations there was a consensus. Neither are true.

The consultations that the minister spoke about were largely over the course of one month in January of this year. They were online consultations that excluded vulnerable segments of the population, including persons with mobility, cognitive or visual impairments, persons without access to the Internet and persons living in remote and northern communities. Their voices were not heard or were not heard as easily as a result of the online consultation process that started and ended within roughly a period of one month.

Not only that, but the consultations were said to have had a predetermined outcome. In other words, the minister had an idea of the legislation that he sought to craft and he used the process as a way of getting the answers that he had hoped to receive.

Do not take my word for that. Take the words of the persons who were involved in the consultation process, including Heidi Janz of the Council of Canadians with Disabilities, or Dr. Catherine Frazee, the former chief commissioner of the Ontario Human Rights Commission and a leading advocate for persons with disabilities. They said that the consultations were predetermined when they appeared before the justice committee.

What about the consensus that supposedly arose out of these so-called extensive consultations that simply were not so? We know that out of those consultations just about every national disabilities rights organization opposes this bill. As we speak, they are calling on the minister and the government to put this bill on pause. We know that more than 1,100 physicians have penned a letter expressing their opposition. Concerns were expressed by the U.N. Special Rapporteur on the rights of persons with disabilities.

Just about every witnesses, if not every witness other than the minister himself, who appeared before the Senate legal and constitutional affairs committee that held hearings the last couple of weeks, panned the bill. No one, it seems, is happy with the bill. So much for the minister's assertion at second reading in the House that there was a consensus. There was no consensus, because there was no meaningful consultation, and there was a predetermined result that has resulted in legislation that just about everyone in one way, shape or form has been highly critical of.

I heard over the course of the debate members of the government and other parties talk about this issue in a context as if there were no risks, “Get out of the way, let the patients make their choice and throw out safeguards, because otherwise one is infringing on individual autonomy.” The Supreme Court of Canada recognized in Carter that “there are risks, to be sure”, at paragraph 105 of the Carter decision, and the court talked about how those risks can be “'very substantially minimized through a carefully-designed system' that imposes strict limits that are scrupulously monitored and enforced”. That is what the Supreme Court of Canada said.

When we talk about those risks, one need look no further than the case of Roger Foley, who is severely disabled, requires 24-hour care and is in a hospital facility in London, Ontario. I will read what he said about his experience, because it really is quite shocking. When he came before the justice committee, he talked about what can happen when there are insufficient safeguards, and we are talking about safeguards that are in Bill C-14 which are now being further removed by Bill C-7. He said:

I have been coerced into assisted death by abuse, neglect, lack of care and threats. For example, at a time when I was advocating for assistance to live and for self-directed home care, the hospital ethicist and nurses were trying to coerce me into an assisted death by threatening to charge me $1,800 per day or force-discharge me without the care I needed to live. I felt pressured by these staff raising assisted dying rather than relieving my suffering with dignified and compassionate care.

In the face of that, we put forward an amendment to say that this must patient-initiated. The minister responsible for disability inclusion said that she had grave concerns about what happened to Roger Foley, and she has heard about this regularly. Yet, even in the face of that evidence, the government rejected that very common-sense amendment, rejected other amendments and instead moved recklessly ahead. We are now in this untenable situation where the most vulnerable persons in our society could be put at risk. It really is unfortunate that it has panned out this way. I can only hope that the Senate will bring forward substantive amendments to this deeply flawed legislation.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Madam Speaker, it gives me no pleasure to rise yet again to oppose this deeply flawed and dangerous legislation, Bill C-7. The Liberals have been complaining in the media that they think the Conservatives are holding up the legislation and that they are going to miss their court-imposed deadline of December 18, but they really have no one but themselves to blame. Conservatives are doing our constitutionally mandated job to hold the Liberal government accountable on its legislation.

Looking at the record over these past eight months, it is clear that my party has bent over backwards to give the Liberals the breathing room to implement emergency economic aid and other COVID-related measures. We have been very co-operative. We have also seen a great deal of government legislation move fairly quickly through the House just this fall, and in a minority Parliament at that.

Let us look at the Liberal record on moving the legislation forward. From the very beginning, the government really made its own bed on this one when it refused to defend its own legislation, Bill C-14, which was just passed in the last Parliament. Even some of its own members said on Twitter that the legislation was unconstitutional, admitting they felt it was unconstitutional even when they were voting for it, but they did not use the opportunity to appeal the legislation to the Supreme Court. That shows me that it was the government's intent to use the courts to circumvent Parliament.

Parliament was mandated, under Bill C-14, to conduct a thorough review of medical assistance in dying and that review was to occur next year. It is important to have these sorts of reviews built into legislation because when we talk about something as serious as medical assistance in dying, which is a novel legislation, a new innovation in our social fabric, Canadian people really have not had adequate time to digest how they feel about the legislation and to examine their lived experiences.

A five-year review was a very adequate provision to give Canadians a bit of time to assess the bill and then have Parliament make recommendations and possibly changes to the legislation so that we could fix the bill, whether that meant tightening up some things that were prone to abuse or maybe loosening up the legislation in cases where it was needed. However, with the Liberal government's desire to short-circuit the legislative process and the will of the previous Parliament, it chose to fast-track the legislation by not choosing to appeal it to the Supreme Court. I believe this was done very purposely to ensure the legislation would pass before a review took place.

If the review had gone forward, as we have seen from the Council of Canadian Academies, there are a lot of questions about the practice of the legislation and how it has been carried out over the past few years. Abuses have been raised in committee and in the House repeatedly, yet in the legislation the government has taken no efforts to take those experiences and make this a safer piece of legislation for vulnerable people.

Going to the next example of why the government's problem is one it made itself, with the COVID-19 pandemic, which I agree was not the government's fault, it was required to request several extensions of the bill. The courts were willing to approve those extensions and, in late summer, Liberals chose to prorogue Parliament. By proroguing Parliament, they made the choice to clear the decks of all of their legislation, start from the beginning and send us back to the drawing board. By doing that, they delayed the legislation further. For the Liberal government to claim that Conservatives are holding up the bill when what we are doing is our constitutionally mandated job, especially on an issue as important as life and death, it does not ring true.

Another example is that if the bill was so important for the government to get passed so quickly, why was it not the first justice bill it put forward? Bill C-3 was passed in a very expeditious manner with all parties' support in the House. It was passed, largely, with the support of committee and minimal amendments. Even in that expedited manner, that delayed the government's legislation by weeks. The Liberals are talking and complaining about how Conservatives are allegedly delaying the legislation, but it was their own choices that resulted in the delay of the legislation.

We are left today with the government complaining that the Conservatives are doing their job. We are doing our job by criticizing the Liberals' legislation. We are holding them to account. We are championing the rights of vulnerable people. We will never apologize for doing what our constituents have sent us here to do, which is to stand up for their deeply held beliefs, to stand up for their concerns and to stand up for vulnerable people.

Vulnerable Canadians made their desires known and their concerns known very loudly and clearly at the committee. I am pleased to see that the other place has had more time to hear from witnesses. I believe it has heard from over 80 witnesses, the vast majority of whom are opposed to the legislation. Frankly, in the House, we only had four committee meetings for this very important legislation, so I am pleased that the Senate is taking its responsibility seriously and thoroughly examining the bill and hearing from vulnerable people and others who are concerned about the legislation.

The members of these communities were afraid of Bill C-14. They were assured by the government that they would be protected and that there were protections for people with mental illnesses from accessing it. There were protections for children. There was the reasonably foreseeable death requirement, which was touted as a great protection for the disabled community. I can tell members that what they are saying is that they are terrified by what they see in this bill from the Liberal government.

I read today on CBC that the Minister of Justice appears to be in a showdown with disabled groups who are demanding a halt to the bill. The idea that the Minister of Justice, whose role is to uphold the Charter of Rights and Freedoms for Canadians, is fighting and ignoring the pleas of disabled and other vulnerable Canadians is just plain wrong.

Conservatives have been listening and we have been fighting for these vulnerable Canadians. It appears that nobody else is willing to fight for them. That is what we will do. We are fighting for these vulnerable Canadians. We are not being intransigent about this bill. Conservatives have a wide range of perspectives on this issue. We have put forward, as a party, some very common-sense amendments that do not undermine the legality of medical assistance in dying as a general practice but will do a lot to assuage the fears of vulnerable Canadians.

Some of these common-sense amendments proposed at committee included protecting patients from undue coercion. By coercion, people immediately draw up images of doctors in deeply immoral situations pushing medical assistance in dying on vulnerable people who are isolated from loved ones and family members. I am not trying to say that is happening. Frankly, I think what we have seen is that it is a lot more benign than that. It is not doctors aggressively pushing medical assistance in dying on people.

Someone may be in a situation where there is a power imbalance, and as a disabled person, other vulnerable person or a person who is older, they might not have family members or access to supports like social workers and psychologists. In this situation, they trust their doctors and that is a good thing because our doctors work very hard and they are very professional. However, if someone has that trust relationship with their doctor and the doctor comes and asks if they have considered medical assistance in dying, that could seem very benign for an average person. If I was in a situation like that and the doctor came to me, I would say no thanks, but we never know what someone else is going through and what challenges they are facing.

If they do not have someone to turn to, they can feel like the doctor is looking out for their best interests and the doctor is suggesting that they consider medical assistance in dying, so maybe the doctor is right and maybe that person should consider it. In this case, we recognize there is a power imbalance. At committee, we suggested putting forward some very strong protections to say that health care professionals should in no way be presenting medical assistance in dying as an option to patients. This is a basic protection.

This is something we talked about with the last bill. I was actually very disturbed, during debate at second reading, when a Liberal member stood up and talked about a couple they knew who had not ever considered medical assistance in dying. It was a very touching story. The member nonchalantly said that the doctor came in, passed them a brochure and asked if they had ever considered medical assistance in dying. The member, I think, thought that this was an innocuous and benign situation, but for me and for people in disabled and vulnerable communities, it was very scary that they could be put into this situation without adequate supports. They might feel like they were being coerced into a decision.

We also wanted to put in some stronger protections around a period of reflection. I think the period of reflection is key because, even in the government's own reports on medical assistance in dying, there were many cases in which people did not receive disability supports, and they received MAID while still not receiving disability supports. There were people waiting to get palliative care who had not received access to palliative care who also received medical assistance in dying.

It clearly illustrates that the government is not putting the resources in to help disabled Canadians, or to help Canadians who need palliative care. If we shorten the timeline or eliminate the timeline all together, we are really losing an opportunity for people to access these wonderful services that can make the end of life much more peaceful.

One of the sad things about debating this bill today is that I feel like I am being forced to defend the status quo, implemented in the last Parliament under Bill C-14. I was not a big fan of Bill C-14, and as legislation it has proved time and again to fail to protect vulnerable people. It certainly did not protect the prisoners who underwent medical assistance in dying.

This issue was raised by the Office of the Correctional Investigator, and it has deep moral and ethical problems. Prisoners really have no power. He raised a case in which a prisoner was coming close to the end of life and wanted to die peacefully in the community with access to palliative care. They were denied the opportunity to do so, and then chose MAID instead. I think the correctional investigator was very astute in bringing that up. In situations where somebody does not have a right to determine their own manner of death or the manner that leads up to their death, how can they be given a choice to access medical assistance in dying? That raises some big issues.

In numerous cases, people were largely not sick with anything. In one case in the Globe and Mail a number of years ago, an elderly couple in their nineties wanted to die together. According to the article, they were not suffering from any pre-existing conditions, except arthritis, but it was ruled that because they were so old their deaths were reasonably foreseeable. That is really troubling. Medical professionals have raised the point that a reasonably foreseeable death is not actually defined in any medical journal. There is no definition of “reasonably foreseeable.” It is so subjective. One thing that I would have liked to see with this legislation was for the government to come forward with an actual medical definition of “reasonably foreseeable.” Instead, it has chosen to eliminate this language altogether, which waters down the protections.

Bill C-14 did not save people who were suffering from mental illness from receiving medical assistance in dying. There was a case in Chilliwack where somebody who had a history of depression was able to access medical assistance in dying in an expedited manner. Their family was not informed until very late into the process and they were not able to intervene and explain that this person, while they did have a reasonably foreseeable condition, also suffered from depression and other challenges and that maybe, with a social worker or a psychologist, those things could have been worked out and medical assistance in dying could have been avoided.

It is clear to me that we are removing even the barest of protections. We are removing this adequate reflection period and making this legislation, which is already prone to abuses, even more open with this new legislation.

The government claims this new bill is safe because it is explicitly denying people who are suffering exclusively from a mental illness from receiving MAID. When the previous legislation was brought in, even though I was not a member of the House at the time, I sat in on a lot of meetings. It is interesting that, in committee appearances and at the joint special committee, Dr. Sonu Gaind from the Canadian Psychiatric Association was very hesitant to endorse medical assistance in dying for people suffering from mental illnesses, especially exclusively mental illnesses. Their testimony said that they do not treat any mental illness as if it is untreatable. There is always a treatment. Sometimes it is a very difficult treatment or an ongoing treatment, but society must never accept that there is not a way to treat mental illness. The alternative is that we stop helping people and that they seek medical assistance in dying.

It is tricky when the government talks about excluding MAID for people with exclusively mental illness, but we are seeing that too many people who might qualify for medical assistance in dying because they have a physical condition and a reasonably foreseeable death also have a mental illness.

Where doctors are involved, they are very well educated but they are not necessarily educated in all aspects of health. Not every doctor is a psychologist or qualified to make mental illness determinations. How do we know that somebody who might have a reasonably foreseeable death, and who might have a previous condition, is not depressed and seeking medical assistance in dying for the purpose of their mental illness?

Under this legislation, there is no protection for those people seeking medical assistance in dying. While the government may say they qualify because they have a grievous and irremediable condition, we need to have more protections to ensure that people with mental illnesses are not seeking medical assistance in dying in the heat of the moment. Maybe they have had an incident that has led them to want it, and given more time to reflect maybe they could be dissuaded from seeking it.

There are no mechanisms, as I said. I am not going to just criticize, I am going to put forward actual, concrete ways I think we could make this legislation better. Unfortunately, it does not seem the government is in the mood to accept too many amendments from the Conservative side, but I will go ahead and say them anyway. We should require social workers and psychologists to be involved with decisions where underlying mental health issues, or issues related to access to income supports or to poverty, might be identified.

I was very disturbed to read in Maclean's magazine that some people are seeking medical assistance in dying because they are living in poverty. That was never written in the legislation. That was never intended as a purpose for medical assistance in dying. By including these important medical professionals, we could make it much more difficult for people to get medical assistance in dying who might not make that decision if it was between them and a doctor.

That leads me to one of my final points. The government is removing some of the witness requirements. Under the previous legislation, an independent witness who was apart from the medical process was required to be involved. That would provide accountability to ensure that doctors and health care professionals were crossing all their t's and dotting all their i's to make sure that this was a completely kosher procedure. By removing the independent witness requirement, it is leaving the decision up to a doctor and the patient.

I am going to be opposing this legislation. I look forward to the other place coming back with some very strong amendments. I look forward to debating those amendments again, and getting the best possible legislation that will protect vulnerable people in this country.

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, my colleague from Yorkton—Melville has referenced the issue of the steep slippery slope on which we find ourselves. Back when Bill C-14 was being debated in the House, many of us had concerns it was indeed a slippery slope and we were generally mocked and accused of fearmongering. Today, here we are. In fact, it is very clear it was a steep slippery slope.

It is the vulnerable in Canada who are being exposed to medically assisted death. I would ask the member to comment on the assurances from the government that those with mental health issues, children and other vulnerable Canadians will not be exposed to this in the future and that they will be fully protected under the legislation.

I would like her comments on whether she takes those words at face value or questions them.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I consider it an honour to speak for a third time on Bill C-7 as the bill would dramatically expand access to assisted death in our country.

I rise again to represent the thousands of voices across the country who feel that the bill puts them in crosshairs. I am referring to vulnerable Canadians living with disabilities and disabling conditions who believe they have been targeted. They have told us that this legislation singles them out by providing them with a special path to assisted death. They want us in this place to know their lives matter. This is the last opportunity for members of the House to legislate Bill C-7 to ensure their best interests are considered.

I want to use my time today to reiterate what has been a common theme throughout my interventions on Bill C-7. The Liberals are moving to impose sweeping consequential legislation despite what they have been clearly told by Parliament and Canadians. Yes, they have even ignored their own legislation.

The government should not have moved to implement the bill before the parliamentary review of Bill C-14, which was slated to take place before the end of June next year. It should have done that first. We do not yet have a clear enough picture of the impact a Canada-wide MAID regime has had on our country. Five years is not remotely enough time to take stock of trends, abuse and the impact of MAID on charter-protected conscience rights.

I remember the words of the former member for Winnipeg Centre, Robert-Falcon Ouellette, during debate on Bill C-14. In his view, the Liberals should have delayed the implementation of the Canada-wide MAID regime for at least five to 10 years until it could be adequately determined what the impact of assisted death would be in all communities across our vast and diverse country. Mr. Ouellette spoke against adding fuel to the suicide crisis that had taken such a heartbreaking toll on reserves.

Tyler White, CEO of Siksika Health Services, said recently that Bill C-7 ran the risk of undoing the work that indigenous elders had done to curb the frequency of suicides among indigenous youth. What message does Bill C-7 send these young people? If indigenous advocates believe that Bill C-14 was a step in the wrong direction, why is the government taking things even further with Bill C-7? What is the purpose of rushing this?

I also remember the elements of the Bill C-14 debate pertaining to instances of MAID abuse in other parts of the world. This is key. The Belgian model, which Bill C-14 was modelled after, is known for its abuse. In Belgium and the Netherlands, MAID laws, once limited to mentally competent, terminally ill adults, now include adults and children with mental deficiencies, severely disabled individuals and even those with treatable psychiatric conditions, such as anorexia and depression. Between 2012 and 2017, the Netherlands alone saw a 600% increase in euthanasia, which was sought to address psychiatric conditions.

When was the government planning to take a hard look at Canada's MAID regime and how we could prevent this kind of abuse in the future? The Minister of Justice says that it is in the works and part of the plan. Why was it not done first? This is the cart before the horse. It is the tail wagging the dog.

By ignoring a five-year review, the government has also cast aside the concerns of physicians. We cannot ignore the monumental importance medical professionals place on their Hippocratic oath, such is true of Dr. Ramona Coelho, a champion of conscience rights in her field. She told former MP David Anderson at the end of the Parliament, “Doctors know the importance of conscience rights to protect themselves and their patients..people like me who are being pressured to leave family medicine. I know palliative care doctors in Ontario who have stopped practising. I know nurses in institutions who are feeling bullied…shift their focus, or retire early ...The pressure is there, and we are looking for relief.”

It saddens me that the government has yet to establish conscience protections for medical practitioners who do not wish to violate their conscience while at a patient's beside. This bill is asking doctors to go far beyond what Bill C-14 even asked them to do. In Dr. Coelho's words, “it is my conscience that pushes me to go the extra mile, and I think patient care will suffer if doctors are not allowed to live with integrity and follow their conscience.”

It is because of this risk of abuse on many fronts that many of us on this side of the House walked away from the Bill C-14 debate with an unpleasant feeling in our gut, one that suggested that the implementation of the MAID regime had started Canada down a very slippery slope to a culture of death on demand. We are at Bill C-7 today.

However, there was an ever-present light at the end of the tunnel with Bill C-14. The five-year review was important to members of the House and indeed to all Canadians. It is shameful we find ourselves ramming through this legislation before this review is even started.

On that note, I realize that the Liberals are frustrated that my colleagues and I have been so diligent in vocalizing the outpouring of concern from disabled Canadians, concerned medical professionals and those whose personal beliefs conflict with the bill. That is our responsibility.

The Liberals desperately want to speed up the passage of this life and death legislation. They want to meet the deadline imposed by the Quebec Superior Court, a deadline they could have met comfortably if the House had sat in May and June and the Prime Minister had not prorogued Parliament in August.

In a way, this is beside the point. The December 18 deadline is arbitrary, as was the deadline for Bill C-14. As legislators, our mandate is to pass the best legislation possible for all Canadians. I underscore the words “all Canadians”.

The bill has barely been studied as the Standing Committee on Justice and Human Rights only held four meetings of hearings. Many witnesses and briefs were denied a voice because of this. Of course, the Liberals certainly could have, should have and still could appeal the Quebec Superior Court decision. We could have struck a balance in good faith of what Canadians actually wanted when it came to end-of-life decisions.

As I said in a previous debate, four years since the passage of Bill C-14 has allowed Canadians to further process the idea of assisted death. Almost 80% of Canadians believe it should be easier to make end-of-life decisions for themselves. That number is seven points higher than it was four years ago upon the passage of Bill C-14.

At the same time, Canadians are unwavering in their support of strong safeguards for the most vulnerable in our society as well as conscience protections for medical professionals. They are unwavering. According to an Angus Reid Institute poll released last month, the same majority of Canadians who desire empowerment in their end-of-life decisions want Parliament to weigh the risks of MAID for those living with mental health issues such as depression.

Sixty-nine per cent of Canadians fear depressed individuals could see MAID as a means to escape dealing with the underlying cause of their condition. Of those surveyed, 65% want Parliament and the courts to consider MAID's impact on the elderly and those with disabilities. They fear death-on-demand could encourage these Canadians to seek it as a means of ending their perceived burden on others. This perceived feeling is being encouraged and more research needs to be done.

Sixty-two per cent of Canadians want Parliament and the courts to examine the potential impact of MAID on our health care system. There is a danger that increased reliance on assisted death will lead policy-makers to begin neglecting long-term and palliative care. I am being gracious in saying “begin”, because, in my view, we can see this discouraging trend unfolding already.

Seventy per cent of Canadians continue to live without access to palliative care, while the government has failed to invest the $3 billion it promised to help in closing that gap. Clearly there is a discrepancy.

Canadians are equally as outspoken when it comes to conscience protection for doctors or those whose faith bars their participation in MAID. Fifty-seven per cent agree that nursing homes and hospices with conscientious objections should be able to deny MAID to those who request it. The Canadian Medical Association has indicated that 23,000 doctors are available to provide this service, which is more than enough across Canada. We need to protect our conscience protections.

Canadians want to see reasonable safeguards maintained in Bill C-7. They want to see Parliament legislate with their interests in mind, their interests, not those of the courts. They want to see the House continue to give credence to the views of medical professionals and those with disabilities.

Regrettably, judging by what we have seen through debate, Bill C-7 is another example of the government allowing the courts to legislate for Canadians. This bill is not reflective of what Canadians hold dear: Care and compassion for all, regardless of age, disabilities or religious beliefs.

Public health and economic safeguards have been the highest priority of the House throughout the pandemic. That is why so many in this place and across the country find Bill C-7's attack on end-of-life safeguards so painfully ironic and troubling. It is for this reason I cannot and will not support the bill.

[René Arseneault, Liberal, Parliamentary Secretary to the Minister of Economic Development and Official Languages (Atlantic Canada Opportunities Agency and Official Languages)]

Madam Speaker, I have listened with great interest to the debate on Bill C-7, having myself been a member of the joint committee behind Bill C-14.

I heard my colleague say that he has the utmost respect for the Supreme Court of Canada. I would remind him that we cannot talk about Bill C-7 without first talking about Bill C-14, since Bill C-7 is the logical and natural continuation of Bill C-14. On top of that, the Supreme Court of Canada, in which my colleague has great confidence, issued a unanimous ruling in Carter.

Is it not entirely reasonable to keep to the Carter decision, for example, since the Truchon decision addresses in some ways the gaps in Bill C-14, to accept that Bill C-7 finally closes the loop of the Carter case and Bill C-14?

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Madam Speaker, I will be sharing my time with the member for Cypress Hills—Grasslands.

Here we are on December 8, 2020, only 10 days away from a deadline imposed on Parliament by the Quebec Superior Court from the Truchon decision. The Liberal side of the House is suggesting that perhaps it is the fault of members of the Conservative Party for delaying progress on this very important topic. I take exception to that.

How did we come to this point in the first place? Our leader spoke this morning and he raised this topic, and so I am just going to repeat some of what he said. First of all, there was the failure of the current Attorney General to appeal this decision of the Quebec Superior Court. It is a lower court. In my opinion it was a wrong decision, and it should have been appealed, first of all, to the Quebec Court of Appeal. We would have had the benefit of the wisdom of that bench. Subsequently it should have been appealed, like all important constitutional issues, at the Supreme Court of Canada. I have the deepest respect for the Supreme Court of Canada and the constitutional expertise and scholarship that has come out of that court. The Attorney General has missed that opportunity to be able to engage the Supreme Court of Canada in the discussion on this very important topic.

Parliament, as our leader said, is the top court of the land. We are sovereign. We can make and unmake any laws that we want, provided that they are within the four walls of the Constitution of this country. That is the dialogue that we should have had with the Supreme Court of Canada. That, sadly, will not be happening on this topic.

The second very important point is prorogation. We had been making good progress on Bill C-7. We were talking about this back in February and March already. Prorogation happened, and the debate had to go right back to square one. How is that our fault? Why did the Liberal government decide on prorogation? It was not for any good policy considerations. It was strictly for political considerations, so we are not going to wear that. The Liberal government is going to wear that.

Another point that I would like to raise is that if Bill C-7 reacted in the narrow way that the Truchon decision required, this debate would be much shorter and faster, but the government has decided to take the opportunity to expand the debate. The Liberals are suggesting that we are disrespecting the Truchon decision and the Quebec Superior Court by raising these issues. We are not the ones who are raising the additional issues; it is the government in its Bill C-7 that is doing so. If Bill C-7 was just about the Truchon decision, then it would not be talking about removing the 10-day reflection period. The “First Annual Report on Medical Assistance in Dying in Canada, 2019”, just recently published by Health Canada, has told us that, of the 7,336 MAID applications in 2019, 236 of the applicants changed their minds during the 10-day reflection period. Obviously, that 10-day reflection is there for a purpose. It is serving that purpose very well. Why would we be removing that?

Furthermore, Bill C-7 has introduced the concept of advance directives and, consequently, the elimination of contemporaneous consent by the person who is asking for the medical assistance in dying. That would be shifting the final decision away from the person receiving medical assistance in dying to the person who would now be going to apply it. We are no further ahead. I do not think that is an improvement.

Then, there is the other requirement, removing the second witness. What is that about? Why is that so important? There are so many legal documents that require two witnesses, wills for example, to make sure that there is not coercion on the part of people who might benefit. In the case of wills, the beneficiaries of the will might benefit. It is a long-standing legal principle that two witnesses be required. These changes are significant, and disability groups across the country have told us so loudly and clearly.

Of the many groups that appeared before the committee hearings, not one of the disability groups was in favour of Bill C-7 and the removal of these protections. That is why we are at an impasse in this eleventh hour.

Mr. Neil Belanger, executive director of the British Columbia Aboriginal Network on Disability Society, commented on a newly released document entitled “In Plain Sight”, commissioned by British Columbia's minister of health, the Hon. Adrian Dix, to review indigenous-specific racism in British Columbia's health care system. Although it is a review of B.C.'s health care system, the principles in it would apply right across Canada. Mr. Belanger and the group that he represents are concerned about the proposed removal of safeguards. He said:

There is no debating the systemic racism and discrimination within Canada’s health systems, and the experiences and deaths of Indigenous peoples when seeking care. We all would be remiss to believe that this somehow would not permeate into MAID.

He went on to say in his testimony before the Senate committee that:

...the Government of Canada has failed to engage the Indigenous peoples of Canada living with disabilities, Elders, and Indigenous Leadership in relation to MAID on any tangible level. This lack of engagement is contrary to the government’s stated commitment to reconciliation, UNDRIP, and the CRPD.

Other disability groups are saying the same, yet this government is refusing to listen. Mr. Belanger takes this a step further. He and the organization for which he speaks advocate sticking with the end-of-life criteria already in place after the Carter decision and after Bill C-14, which was the well-considered opinion of Parliament just four and a half years ago.

Recently, when Mr. Belanger's organization presented to the Senate committee on legal and constitutional affairs on Bill C-7, he said that:

[BCANDS]...stands with our sister disability organizations and countless others across Canada in calling for the removal of Track 2 in the proposal changes to Bill C-7, and limiting access to MAID to the end of life criteria...

Track 2 is medical assistance for those people whose death is not reasonably foreseeable.

People may state the obvious: that this is all water under the bridge and that the Truchon decision said that it is unconstitutional. To go back to my original comments, that decision should have been appealed, and it was not. I am going to have to tell Mr. Belanger that the debate has been had already. This government has sadly treated as a settled constitutional principle that it is unconstitutional for any law of this country to refuse medical assistance in dying to those who meet all the other criteria, but are not dying.

This is a fundamental shift that was not debated. This government has stated on many occasions that it had broad consultations and 300,000 people responded, but the one question it never asked was if people agreed that medical assistance in dying should be given to those whose death was not reasonably foreseeable. The fundamental question was never asked. That is not a true consultation, in my opinion. It is a pretext for advancing a legislative agenda that had been preconceived. It has been said on several occasions in the House during this debate that the current Attorney General voted against Bill C-14 four years ago because it did not address that, and did not expand MAID to that point. This is the current Attorney General imposing his will on Parliament and forestalling that very important debate.

The first report by Health Canada on the state of medical assistance in dying stated that roughly 2% of Canadians in 2019 used medical assistance to die. That is the average across the country, but it is much lower in some provinces. It is the average in Quebec and far above the average in British Columbia.

Why is that? Is it because there are more sick people or old people—

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, I am thankful for the opportunity to again speak to the bill. There were a lot of things that I wanted to say the first time around at report stage that I could not share because we ran out of time, but hopefully I will be able to conclude my remarks today.

I am splitting my time with the member for Northumberland—Peterborough South.

The Leader of the Opposition spoke in the House earlier today and talked about how Bill C-7 is moving our country from a regime of assisted death to a regime of assisted suicide. We presently have in place former Bill C-14, which was brought in as a response to the Carter decision. That bill recognized the fact that the Supreme Court said that medically assisted death was a right but needed to be surrounded by guardrails, by safeguards that would ensure that the most vulnerable in Canada do not end up dying when they have an opportunity to live a productive life.

The Carter decision resulted in legislation that imposed a requirement that death needed to be reasonably foreseeable. The legislation before us eliminates that and a whole bunch of other safeguards that the original legislation was intended to keep in place.

Why are we at this place in the first place? Members in the House know that a lower court from Quebec, one single judge, ruled in the Truchon case that the reasonable foreseeability aspect of Bill C-14 violated the Charter of Rights. It was unconstitutional. This is a lower court from Quebec, one single judge, making a life and death decision for Canadians across the country.

One would expect, from a Liberal government that takes veterans to court and takes first nations to the Supreme Court of Canada, that this life and death decision would be appealed. The Truchon case would be appealed through to the Supreme Court so that we could have the Supreme Court, which articulated the Carter decision, comment on whether reasonable foreseeability was in fact constitutional.

Instead the Liberal government said, no, it was not going to appeal and in fact it would simply respond to the Truchon case and do exactly as that single judge of a lower court asked it to do. The Liberals eliminated reasonable foreseeability from Canada's medical assistance in dying regime. That is why we are here.

Members may recall, when C-14 first came forward, when the Carter decision had to be responded to, that parliamentarians noted the fact that this represented the crest of a steep, slippery slope toward making assisted suicide available to a broader and broader group of vulnerable Canadians. That was the concern that we expressed at the time and, quite frankly, some people mocked us. They said we were fearmongering. They pooh-poohed our concerns. Today, here we are and our concerns have been borne out.

Last time I did not get a chance to read into the record a letter from a doctor in my community of Abbotsford, Dr. James Warkentin, who expressed his concerns about the legislation. He says, “I appreciate your invitation to write to you regarding C-7. As a family physician, the decriminalization of medical assistance in dying in 2016 struck me at my core. How could killing someone one day cost me my licence and send me to jail, and the next day be expected of me to provide? Furthermore, how could our most vulnerable be protected from the pressure to end their life one day and then have state-sanctioned avenues the next?” He went on to reference the six reasons why over 1,000 Canadian physicians have signed a letter opposing Bill C-7.

In a moment I am going to read that letter into the record, because I believe those judges would appreciate having that letter on the record so it is very clear that many medical professionals across the country oppose Bill C-7, which would remove many of the safeguards, the guard rails, the protections for the vulnerable which were originally intended under the Carter decision.

The letter begins like this:

This bill, expanding “medical assistance in dying” (MAiD) to virtually everyone who is sick and suffering in Canada, will, if passed in its current form, make our country the world leader in administering death.

As medical doctors, we feel compelled to voice our dismay at how individuals who have little lived experience of the realities involved in the everyday practice of medicine suddenly and fundamentally changed the nature of medicine by decriminalizing euthanasia and assisted suicide.

As a side note, when they refer to “individuals who have little lived experience of the realities involved in the everyday practice of medicine”, they are referring to us, the Parliamentarians in the House. It goes on:

Unfortunately, our patients are the ones who suffer the most from the consequences of this ill-devised scheme. The shock of a sudden illness, or an accident resulting in disability, can lead patients into feelings of anger, depression, and guilt for requiring care - emotions that, with proper support and attention, can resolve over time. The care and encouragement shown by physicians may be the most powerful force in overcoming despair and providing hope. Unfortunately, patients can no longer unconditionally trust their medical professional to advocate for their life when they are at their weakest and most vulnerable. Suddenly, a lethal injection becomes part of a repertoire of interventions offered to end their pain and suffering.

Bill C-7 would allow those who are not dying to end their lives by a lethal injection at the hands of a doctor or nurse practitioner. Shockingly, most of the safeguards that Parliament deemed necessary in 2016 to protect the lives of vulnerable individuals from a wrongful death are being removed. Under the new bill, an individual whose natural death is considered to be “reasonably foreseeable” could be diagnosed, assessed and euthanized all in one day. We are very concerned that removing the 10- day reflection period and other safeguards will lead to an increase in coerced or tragically unconsidered deaths.

The reckless removal of safeguards previously deemed essential will place desperately vulnerable patients directly in harm’s way and may cost them their very lives....

Our profession has been coerced into facilitating suicide rather than preventing it, for ever-increasing numbers of citizens. We watch in utter dismay and horror at how the nature of our medical profession has been so quickly destroyed by the creation of misguided laws.

That is an excerpt from a letter from over 1,000 physicians in Canada. It does go on, but I do not have time to complete it.

That is the perspective coming from our medical profession across the country and it is the disability groups, medical professionals, faith groups, palliative care advocates and first nations that are all calling for more caution before expanding assisted suicide, yet the government has refused to listen to those concerns.

At the committee, our Conservative opposition members brought forward numerous amendments that would have addressed some of the failings of the legislation, that would have reinstated the protections for which the vulnerable within our country have called. Seventy-two disability groups oppose this legislation. They want more protections, yet they are not there.

I encourage my colleagues across the way to please give this legislation more time. Give us an opportunity to get this right.

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

Madam Speaker, it is with a great deal of emotion that I rise again in the House to speak to this extremely sensitive issue, medical assistance in dying.

In this speech I will highlight the parliamentary and judicial reality. As the House leader of the official opposition, I have a thing or two to say about that. In fact, I have quite a few things to say about that. I will talk about the reasons why we are gathered today to talk about Bill C-7 at third reading stage. I will also address the substance of the issue, that is, my position and that of my colleagues.

Before I begin, I would like to make certain things clear: this is a topic that leaves no room for partisanship. On this file there are no good guys or bad guys, good positions or bad positions, good votes or bad votes. There are just positions that we are comfortable with, that we believe in and are prepared to defend personally as individuals. This topic may be terribly divisive, just as it may be a golden opportunity to have an intelligent conversation that is above all respectful of differing opinions.

As you well know, Madam Speaker, I do really enjoy political battles. I do not hate the arguments and the counter-arguments. On the contrary, it is part of politics. However, there are issues that do not lend themselves to this.

As far as I am concerned, when we talk about assisted dying situations, the issue is not a partisan one. There are no bad guys and good guys. There are no good votes or bad votes. There are only votes and positions in which we are comfortable. Where we stand firm on that is being respectful to our counterparts. This is the issue, and this is why I want to address it. While sometimes, the House knows, I like to be a little aggressive in my comments, in this case I will try to do my best to be modest, because I want to be respectful to each and every position.

Bill C-7 responds to a decision of the Quebec Superior Court. However, this is not the first time that medical assistance in dying has been addressed.

Members will recall that the province of Quebec was the first to begin working on this issue, which led to the passage of a law on medical assistance in dying. Unfortunately, or fortunately, I know what I am talking about because I was a member of the National Assembly of Quebec. In passing, I was elected for the first time 12 years ago on this day. As a provincial representative, I worked for six years on this sensitive issue under three ministers and three different governments.

I want to be clear. This issue can be dealt with in a non-partisan way, and the proof is that three premiers—Premier Charest, Premier Marois and Premier Couillard—in two different political parties led the parliamentary work that resulted in the adoption of the first provincial law on medical assistance in dying in Canada. I would like to point out that this was done under the leadership of a premier who was a physician, Dr. Philippe Couillard. I was there.

Then came the Supreme Court of Canada's decision in Carter, again, on medical assistance in dying. The federal government had to decide how to define and set the federal criteria for medical assistance in dying. Prime minister Stephen Harper, recognizing that the federal government was on the verge of an election campaign, rightly decided, with the support of the other political parties, not to address this issue. That was the right thing to do.

As I said earlier, this issue is not a partisan one. That is why former prime minister Harper did the right thing and put it aside during the campaign in 2015. Then the new government elected, which could have been Conservative, NDP or Liberal, would table a new bill. I have been part of that discussion. I have been part of that committee.

The government was well advised to create a cross-party and, more importantly, joint parliamentary committee, which had both senators and members of Parliament as members.

I had the honour of sitting on that committee, at the request of my then leader, the Hon. Rosa Ambrose. I had the privilege of having very interesting and fascinating conversations with Canadians across the country who had different points of view. We came to a consensus in the form of Bill C-14. I want to be clear about the use of “consensus”, because the way democracy works, and this is a good thing, means that some people are in favour while others are against.

Bill C-14 was passed in the House of Commons five years ago. This bill included a clause that could be considered a sunset clause, since it required that parliamentarians review the legislation.

It was inevitable that this issue would end up before the courts, and it did. A Quebec Superior Court judge issued a decision in Truchon v. Attorney General of Canada on September 11, 2019.

Through the Minister of Justice, the federal government immediately reviewed the decision, decided to hold an online consultation and introduced a bill in the House of Commons in February. As we see it, that was the first major mistake. I have nothing against the judge or the Quebec Superior Court. Every court has its own responsibilities and makes its own decisions. The judge was appointed to that court in 2017, which was a good thing, and she was appointed to the Court of Appeal on November 20, which was a very good thing.

Every aspect of this issue is sensitive. No matter which law we pass, there will be legal challenges. The better approach, the more responsible, respectful, reasonable approach, would have been for the government to appeal the ruling and then take it to the Supreme Court. As my colleague from Alberta quite rightly said earlier, the Constitution says that every province has a superior court and a court of appeal before cases reach the Supreme Court.

For that purpose, we need to have the highest degree of evaluation. In that specific case, the Superior Court of Quebec is good, but it is not enough. We need to be sure of our judgment on that. That is why the government should have appealed the decision and then let the Supreme Court judges decide what is good and right based on the law, based on our Constitution and based on our Canadian history that we are proud of. That is how it works.

However, that is not how it went. The government decided to call the shots right now. I heard my colleague from Winnipeg North. He is always articulate and always passionate, but with all due respect, I do not agree with him. Just because we are appealing this decision to the appeal court and then the Supreme Court, that does not mean we pay no respect to the Superior Court of Quebec.

It is simply a matter of respecting the judicial process as it is set out in our Constitution, particularly when it comes to an issue as sensitive as medical assistance in dying. Regardless of the law that is passed here, we can expect it to be challenged.

It would have been far better to draft legislation based on a Supreme Court decision, as we did five years ago, rather than on a Superior Court decision. I say that with all due respect for Justice Baudouin, who was just recently appointed to the appeal court by the Liberal minister, and for the Quebec Superior Court, which plays an important, essential and extremely serious role in our justice system.

A debate took place in the House of Commons. This was well before COVID-19, before the words “in-person meeting” became part of our everyday vocabulary and at a time when the word “zoom” referred to a camera lens and not to a way of holding meetings. In short, we have adopted a lot of new concepts in 2020.

Getting back to what I was saying, Bill C-7 was introduced in the House of Commons on February 24 following the decision rendered on September 11, 2019, and the subsequent government consultations. On February 26 and 27, we began debate at second reading. We followed the usual regular, rigorous process. Discussions were held. Things were being done in a reasonable manner, even though it would have been preferable if this matter had been brought before the Supreme Court.

Then COVID-19 happened. The government did what it had to do, that is, it postponed the study of this bill and sought an extension from the court because of the delay. The court agreed. Parliament resumed in September, and that is when the government made a serious mistake. I will come back to that later.

Now let's get to the substance of Bill C-7. As I said earlier, there will not be unanimity on this bill because society is not unanimous. That is the very foundation of democracy. That is why we are here in the House of Commons. Some people are for, and some are against. Some people are right-leaning, and some are left-leaning. Some people are sovereignists, and some are federalists. Society is not a monolithic block. The beauty of society lies in all its different textures. That is the democracy that we must preserve. That is why we need to have intelligent debates in the House of Commons.

That is why, during the analysis, our party proposed two amendments that are entirely respectful and reasonable and that seek to protect the most vulnerable people in our society. The amendments essentially call for the 10-day reflection period to be restored when death is reasonably foreseeable, and for the 90-day reflection period to be increased to 120 days when death is not reasonably foreseeable. The purpose of those amendments is to ensure that individuals who choose to act have enough time to look into their hearts and make the decision that feels right.

That is why prestigious organizations have spoken out against Bill C-7. The Canadian Psychiatric Association has expressed very serious reservations. The Canadian Bar Association has said that it has conditional reservations about this bill. The Council of Canadians with Disabilities opposed the bill. Groups like Living with Dignity, a Quebec-based network, and Inclusion Canada have spoken out against the bill. Indigenous spiritual leaders have expressed very serious reservations. In short, society has spoken, and that is what makes for an interesting debate.

We needed to have a proper debate, with people on both sides of the issue. That is why we would have liked the debate to run its course, without the very heavy influence of the deadline imposed by the Quebec Superior Court.

I will now talk about our work in Parliament, which is essential. I mentioned that Bill C-7 was introduced in February, before COVID-19 and the return of the House. However, the government decided to prorogue Parliament. We know that the Prime Minister made this decision because he was not pleased with the work being done by our MPs on the parliamentary committees studying ethics and WE Charity. The more the work progressed, the more things were heating up for the Prime Minister. He therefore decided to prorogue Parliament.

This prorogation put an end to all committee and House work, and the study of Bill C-7 had to start all over again. As a result, we lost 24 days of parliamentary time. Had we not had this prorogation, we would have resumed on September 21, not on September 23 with the throne speech. Furthermore, had we started on September 21, we would not have lost all the work that had already been done so far on the bill, which adds up to 24 additional sitting days.

The government has the power to prorogue Parliament. Even if I accept the prorogation, why did the government wait so long to introduce Bill C-7? Today we are being told that the Superior Court's December 18 deadline is fast approaching and that we need to hurry up so the Senate can pass the bill in time.

The government presented its throne speech on September 23. When was Bill C-7 introduced? It could have been introduced on September 24, like Bill C-2 was. It could have been introduced on September 25, like Bill C-3, the bill on judges, was. However, this bill was introduced on October 5, costing us seven parliamentary sitting days.

Now, the government is lecturing us, claiming that the Conservatives will not stop talking for talking's sake and that we are wasting time. No. The government has full control over the agenda, and it is the one that decided to prorogue Parliament, wasting 24 days of parliamentary time. On top of the prorogation, this government wasted seven sitting days before introducing this bill, even though it knew full well that everything had to be finished by the Superior Court's December 18 deadline.

Consequently, I will never accept responsibility for the fact that we are still not done, a week and a half out from the December 18 deadline set by the Quebec Superior Court. The government is entirely responsible for this situation, and I will never allow it to accuse us of causing delays.

Not once have Conservative members acted petty, not at second reading, not in committee, not at report stage and not at third reading. Some members support this issue and others oppose it, but we have always expressed our opinions in an appropriate, respectful way.

We never used filibusters or any other rule to be sure that we would let it go, without any decision made. We were respectful, because this issue calls for being respectful. We did it correctly. I am very proud to be the House Leader of the Official Opposition, because members on this side of the House, the official opposition, did a tremendous job at each and every stage. Conservative members were very serious; they were very parliamentary; they did it correctly.

That is the opposite of what the Liberals did at the Standing Committee on Finance, where they engaged in systematic obstruction for over 16 hours to prevent the committee from studying ethics scandals, and at the Standing Committee on Access to Information, Privacy and Ethics, where the Liberals engaged in almost 40 hours of obstruction over the course of 10 meetings. That is what I call wasting time. We have done serious, diligent work here, and we are very proud of that.

As I said, the government that is being held hostage by that date, December 18. If ever this bill were not passed by Canada's Parliament, including the Senate, by December 18, what would happen? Bill C-14 will continue to apply, and the Truchon ruling will apply in Quebec.

Basically, the regime proposed in Bill C-7 would not apply, but life would go on, no pun intended. People will keep doing what needs to be done, as they have done from the start, except that the Truchon decision will apply in Quebec and Bill C-14 will apply in the rest of Canada.

I would like to talk about one final, but critical, issue.

With regard to freedom of speech and freedom of vote, I am very proud to be the House Leader of the Conservative Party. On this issue, each and every Conservative member has the right to vote on his or own belief. The best proof of that is that my leader, the future prime minister of Canada, the member of Parliament for Durham, voted against and I did for. This is what democracy is all about.

In our party, we have people who are against, like my leader, and there is me, the official opposition House leader, who voted for. That is what democracy is all about. We should fight for that. Even if I disagree with some of my colleagues and even if all my colleagues behind are not pleased to see that I will vote in favour, so what?

We are the only party to preserve that tool that is so important, that tool that can fight cynicism in politics. I am proud to be part of that team.

During the vote on the amendment, there were even Conservative members who voted against the entirely reasonable amendments that we proposed. When it came time to vote on the report, 13 Conservative members voted with the government on this bill. I was one of those members. There were six Quebeckers, seven members from outside Quebec, anglophones, francophones, people from the east and west and even neighbours. I voted in favour, but my neighbour from Portneuf—Jacques-Cartier, who is right next to me, voted against.

Let us celebrate this democracy. Let us celebrate this parliamentary system. Let us celebrate full freedom of conscience when it comes time to vote on these issues. Most of all, let us rightly stand up for the work of parliamentarians and vigorously condemn the fact that this government has been dragging its feet, which is why we ended up here with little time to spare.

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, the bulk of the original criteria under Bill C-14, I believe, remain under Bill C-7.

In order to pursue a medically assisted death, a person must satisfy the following eligibility criteria: They must be, of course, of majority age. They must be able to make health care decisions for themselves. They must make a voluntary request for MAID that is not the result of external pressure, for example, from a health care professional or a family member. They must give informed consent after they have received all of the information they need to make their decision, including a medical diagnosis, available forms of treatment and available options to relieve suffering including palliative care. They must have a grievous and irremediable medical condition, meaning that the person has a serious and incurable illness, disease or disability, is in an advanced state of decline in capabilities that cannot be reversed, and experiences unbearable physical or physiological suffering from an illness, disease or state of decline that cannot be relieved under conditions that the person considers acceptable.

Does my hon. colleague support the ability to access medical assistance in dying for people who fulfill those criteria?

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

Madam Speaker, we are now at the third reading stage of C-7. This means all the amendments that will be considered by the House have now been considered, and we must now pronounce on the final version of the bill and its effects.

Before I speak about this bill in final form, I want to respond directly to what I see as the government's principal argument for this legislation and other similar legislation. It tells us this is all about choice: the choice of individuals to live as they choose and die as they choose. The idea is that moral judgments about good living and good dying ought to be made by the person doing the living and dying, as opposed to by someone else, because the individual is uniquely qualified to make judgments about their own happiness and someone outside their skin simply cannot make those judgments as well.

This is the one serious argument people use to advance this bill and others like it. We should of course appreciate the existence of other unserious arguments, such as the assertion that, “The courts told us to,” or, “This is what people we have consulted told us to do.”

A small part of this bill responds to a lower court decision, but most of it has been invented, out of thin air, by the government and whoever it consulted or did not consult. Over a thousand physicians have signed a letter opposing this bill, and every single disability rights organization that has spoken out about this bill has spoken in opposition to it. These are unserious arguments stemming from unserious readings of court decisions and unserious consultation.

The serious argument made in support of this bill, as I have stated, is that people ought to have the choice to make decisions about their living and dying because they know what will lead to their happiness better than anyone else. This is the argument, but we should also notice how those who use this argument ultimately choose to apply it selectively. Even while suggesting it is all about choice, they insist on changing the words we use to describe the choice in order to make us feel better about it.

The phrase “medical assistance in dying” was invented at the time Bill C-14 was proposed, and is not a phrase used in other countries to describe the phenomenon of doctors killing their patients. If this is really about choice, why do we have to invent new pseudo-terms to make ourselves feel better about that choice?

If I asked members point blank whether they think a person should be able to commit suicide, I am sure many would respond that this is not suicide. It is completely different, as it is medical assistance in dying. Formally, what is meant by medical assistance in dying is facilitated suicide, or killing in a medical context. We claim to be focused on choice, but we still are uncomfortable enough with the choice that we have to invent new words to describe it.

Some members do not like the use of the word “euthanasia” to describe the phenomenon of doctors and nurses killing their patients after being asked to do so. The Minister of Health told the Standing Committee on Justice and Human Rights that phrases “referring to this bill as 'euthanasia' legislation, which I have heard in the House of Commons, are incredibly demeaning to the dignity of people”.

The health minister may be interested to know the word euthanasia actually comes from two Greek words: “eu”, meaning well, and “thanatos”, meaning death. The term euthanasia means “good death”, and is itself a sanitization of the concept of killing. If the term is misleading, it is not because it is too harsh but because it is too gentle. As we have heard, not all cases of assisted suicide can reasonably be called good deaths by any definition.

Notice that the word euthanasia is never used to describe the administration of the death penalty. The term was invented in order to sanitize the idea of the medicalized killing of a consenting person. It is instructive that a sanitized term for this practice, once people had a full social awareness of its meaning and reality, had to be replaced by a new sanitized term to further obscure the true nature of what is taking place.

No doubt, in 20 or 30 years, the term MAID will be thought gauche and replaced with another, more up-to-date sanitization of a term that no longer makes us feel better about something we naturally feel uncomfortable about. The point is that if this all about choice, and if we are comfortable with this choice, why are we not comfortable speaking plainly about sick people committing suicide and about doctors killing their patients when asked to do so? Would that not be a more plain and accurate description of the choice that many wish to defend?

If there is a practice or activity that people are uncomfortable seeing depicted or hearing described accurately, perhaps we should ask ourselves why we feel uncomfortable instead of demanding that the images and descriptions be put aside.

Members should observe as well that the idea of a choice to die, or a right to die, is being advocated for selectively. Some people have a right to die and some people do not, apparently, so we have to ask why this principle is being selectively applied.

Suppose that I, an able-bodied healthy white man, experienced some great personal tragedy such as the death of a child or the breakup of my marriage. It is possible that following such an event I might start to experience extreme existential pain and suicidal ideation. If I then went to a doctor to share the feelings I was experiencing, I would not be presented with MAID as a way out of the challenges I was facing. The way I look, my health status and other characteristics I have would signal to the doctor that my life was worth living. We know it to be true that when a young, able-bodied person chooses to die, those around them will say, “What a tragedy. He had so much to live for.”

The argument for a choice to die does not apply to those who society believes should not choose to die, even if such people are sincere in their expression of pain, in their sense that their pain is irremediable and in their desire not to continue living, but what of a person who is older, who is disabled, who does not fit the stereotypical social mould of someone who has a lot to live for, presents themself to the health care system experiencing existential pain and suicidal ideation?

We know from testimony from the justice committee that people in this situation are offered and even pressured to opt for MAID. People who are elderly or living with disabilities are often offered and pushed to take MAID without asking for it. This is the testimony given over and over again at the justice committee and confirmed by the minister responsible for disability inclusion, who acknowledged how concerned she is about people with disabilities being regularly and proactively offered MAID that they do not want.

We see here an important and revealing contradiction in the application of the principle of choice. For some in society, death is seen as an unreasonable choice and is actively discouraged. For others, death is seen as a desirable choice and is actively encouraged. This is not just a debate about choice, therefore. Rather, it is a debate about how the architecture of choice is set up differently for different people, based on whether others assess their lives as being worth living.

This is what leaders in the disability community are deeply concerned about: how this legislation includes them and only them in the additional category of those for whom we think death is a reasonable course of action.

Suppose that of my four children one had a disability and suppose that I taught three of my children to always press on because life is beautiful, but I told the fourth child that they should consider death if they ever faced circumstance that they could not handle. Do colleagues think that situation would make my fourth child feel privileged by the special offer of choice or do colleagues think she would feel devalued by the fact that I thought death was uniquely an option for her, based on the presumption that her life was not worth living?

Choices do not exist in a social vacuum. When we speak about choice, we recognize that people are making choices between available options and the nature of those available options is constructed by the society in which they live.

I used to think that people were always better off with more options, that just like a menu at a restaurant, we are always better off with more options available to us: the longer the menu, the better. If I do not like any of the new options available, then no problem. I do not have to choose them, but I should not begrudge other people the opportunity to have more choices available to them, even if I do not like those choices. Nobody is made worse off by the lengthening of the menu. Then I realized that it was not that simple. If I am in a restaurant and the only options available are chicken or beef then, arguably, yes, I am better off with the addition of more items on the menu; a fish option, a vegetarian dish, etc., but there is also a case in which the existence of certain options on the menu fundamentally changes the nature of the experience.

Suppose that while travelling, I encounter a restaurant that offers a human flesh sandwich in addition to the usual fare. It is fairly safe that I would not stay and order in that restaurant even if I had no intention of ordering the human flesh sandwich. It is unlikely that any members of this House would feel comfortable eating in such a restaurant, even if all they planned to eat was the filet mignon. That example illustrates the way that the offer of an additional option can actually change one's entire experience of a place or environment. A person with a disability who is offered death has a very different experience of health care from a person who is consistently offered life-affirming care.

The fact that people are offered or encouraged toward certain choices, and that some people are offered those choices and others are not, changes the entire experience of health care for many people. Part of the response to this brave new world of so-called medical assistance in dying is that people are seeking safe spaces where they can receive care that is life-affirming. There are still many people in this country who have about as much interest in receiving care in an environment where death is being offered as they do in eating at a restaurant where cannibalism is offered. Such people should be free to receive care in a hospice where life is the only choice and where they feel safe from the possibility of pressure of a momentary weakness or from the sense that they are an unnecessary burden. Some are still looking for care that is animated by the conviction that all lives are always worth living, but perversely, those who claim to champion choice are actually attacking these safe spaces. With the absence of conscience protection in this or any other legislation like it, doctors are being forced out of their profession and life-affirming hospice care is being shut down.

We wonder why we have a crisis in long-term care in this country. Maybe it has something to do with the fact that so many of the people in organizations that have historically operated in this space are being pushed out because of a lack of conscience protection. Protecting the conscience rights of physicians and institutions is not just about the rights of providers. It is about the right, indeed the choice, of patients to receive care in a certain kind of environment if that is their desire.

I know from the many conversations that I have had with constituents, including those who are very supportive of the expansion of MAID, that the present realities of the social architecture of choice are top of mind for them during their advocacy. In other words, they want more euthanasia because they find the alternative intolerable. An absence of good care, an absence of effective pain management, an absence of support to live in a way that accords with their sense of dignity and a sense of resignation about these realities leaves them to want to be able to end it all, rather than endure under undesirable conditions, but those conditions could themselves be changed. The expansion of euthanasia, along with continuing pressure on all health care institutions to offer it, will further erode the life-affirming nature of care that people receive.

I remember once having a long conversation with a constituent who explained to me her reasons for advocating for expanded euthanasia. She emphasized the classic arguments about choice and control, and then shared with me a story of being in a care situation and struggling to have a bowel movement unaided. She went to the nursing station for help, and unfortunately was met with a gruff and unempathetic response. Her memory of the sense of indignity she felt, struggling for a long time on her own, and then seeking the help of a person who seemed uncaring and disgusted, was clearly a part of her thought process about the circumstances under which she would want to die.

While I can identify with her feelings in the moment, I think the solution is to give people the choice of compassionate care. It is a tragedy that people are considering death because of moments of perceived indignity that can be quite directly resolved.

Many older people who are considering death say that they do not want to be a burden on others. This is expressed as a matter of choice, but it is also revealing about the architecture of choice. It is generally unheard of for children to insist on paying rent to their parents or living independently because they do not want to be a burden. Certainly, I have never heard such sentiments from my children.

Why are elderly people made to feel like they might be a burden, while children are not? Again, this is an issue of social context. If children were constantly told from a young age that they were a great burden to their parents, that they were costing them money that could be spent on other things, and that they were interrupting their social lives, then children would likely start to worry about being a burden.

Conversely, if seniors and people with disabilities were constantly affirmed for their value and their ability to contribute to society, constantly told that they hold the key to our future rather than constantly being told about the burden they impose, then of course they would be more likely to choose life instead of death.

This is not just a question of choice. It is a question of the social architecture of choice that leads people to make different choices in different kinds of situations based on the limited options in front of them and based on the way that different options impact each other.

To underline this with one further point, it should not escape the notice of members that the government's Bill C-6, the proposed ban on conversion therapy, is built on the premise that people cannot consent to something that is contrary to their human dignity. Although I have concerns about the text of Bill C-6 as written, I agree with the principle that conversion therapy is wrong and should not be allowed.

In light of both Bill C-6 and Bill C-7, it remains unclear to me what the government's view is on the ability of a person to consent to harm. Is it the view of the government that people should be able to voluntarily consent to things that harm them? Looking at these bills together, we might conclude the government finds it okay for people to consent to death but not okay for people to consent to certain things that are deemed worse than death. However, this subjective categorization of certain harms as being worse than others clearly may contradict an individual's own subjective sense of what things are more harmful than others.

It is time for us, as parliamentarians, to talk about the choices that elderly people and people living with disabilities have in front of them, and to give them options besides death, to move from a narrow focus on questions of choice to a discussion of the architecture of choice that puts people in impossible and painful situations. A good society is not just one that gives people the formal right to make choices between different alternatives. It is one that ensures that those alternatives are sufficiently robust so that individuals are able to make choices that truly lead to happiness. Of course not all choices lead to happiness.

People can make choices that they think will lead to happiness, but do not. This is especially serious when a decision is final and irreversible. The wider community has a reasonable interest in ensuring that a person making that choice has at least all of the information in front of them, taking into consideration the fact that people can and often do adapt to new circumstances over time. A belief in the pursuit of happiness entails a belief in freedom but also a belief in the value of encouraging the considered use of freedom through due reflection.

Having reflected on the application of the concept of choice in this context, I would now like to make a few additional comments about the provisions of this bill and the timing of it. This bill proposes to eliminate the requirement that death be reasonably foreseeable for those seeking euthanasia and puts those for whom death is not reasonably foreseeable on a second track with some distinct requirements. The reconsideration of the question of reasonable foreseeability was provoked by a court decision in Quebec, the Truchon decision, which the government could have chosen to appeal but did not.

This bill deals with more than this question. It also arbitrarily eliminates a number of safeguards that have nothing to do with the Truchon decision. It eliminates the 10-day reflection period. It reduces the required number of witnesses. It eliminates the requirement for contemporaneous consent. The removal of the 10-day reflection period in particular has led experts to point out that this opens the door to same-day death, to a situation where a patient could request and receive euthanasia on the same day.

Some members of this House have strenuously objected to the use of this term. Same-day death is a jarring idea that someone's worst day could be their last, and that temporary suicidal ideation could lead to immediate death. However, those who find this term uncomfortable must face up to the fact that the legislation as written contains no parameters for those for whom death is deemed reasonably foreseeable.

If members believe that time parameters exist, then they should point to where they exist in law. If members believe that time parameters should exist, then they should have supported their reintroduction into the bill. As the law stands before us now, there are no legislated requirements around timelines for those for whom death is reasonably foreseeable.

At third reading, members must choose whether or not they will vote for same-day death in Canada. As Wilberforce said:

You may choose to look the other way but you can never say again that you did not know.

The Conservatives have proposed reasonable amendments to reintroduce the reflection period, introduce a shorter reflection period and reintroduce requirements around contemporaneous consent and independent witnesses, in particular, recognizing the different experiences people with disabilities have reported with respect to the health care system. We also introduced a requirement that health care practitioners only discuss euthanasia if it is brought up by the patient first. These safeguards matter and would protect vulnerable people by reducing their risk of being rushed and pressured into vulnerable situations.

In response to our call for safeguards, the government said it trusts health care practitioners and these rules are not required. The purpose of a safeguard is not to respond to what may be the average case, but to establish a minimum standard. We are talking about 100,000 people in this country whose professional qualifications would allow them to administer euthanasia. Are those 100,000 so uniquely virtuous or trustworthy they do not need laws to regulate their behaviour while the rest of us do? I believe most people in medicine are doing their best to selflessly serve others, but one needs only listen to the testimony at the justice committee to realize some of those who are providing health care have fallen short of that call. All of us need laws to regulate our behaviour to some extent. If we need regulations, then how can we expect those 100,000 people to be different? Are there no bad apples? I am not arguing they should be subject to unique suspicion, but that they simply need rules and laws to guide their actions like the rest of us do. People charged with taking another person's life should do so within strictly defined parameters for their own good and that of everyone else. I trust doctors just as I trust police officers, but they still need regulations and oversight. We recognize there are some bad apples on our police forces and if we need safeguards for police officers in light of their power to take life, then we also need safeguards for those in power to take life in a medical context.

The government has been working very hard to push the narrative about timing, claiming the Conservatives are responsible for delaying this bill. It should stand to reason that if the government wants us to invest in rapidly passing its bill, it must proceed to persuade us that it is a good bill, which it has not done. The Truchon decision requires a response, but matters would be much simpler if the bill only focused on a response to Truchon instead of a variety of other changes. As it is, we are forced to consider all of the elements together, not just the narrow part that responds to Truchon. This is the government's choice, not ours.

Let us also take stock of how we have come so close to the court deadline. This legislation was presented in February. In May and June, the Conservatives wanted the House to sit in a modified form, but the government refused to allow it. Then it killed its own bill by proroguing in August. All of these moves pushed us into the mid-fall before the bill was considered. It then received a mere four meetings of witness testimony at the justice committee. The government's approach to this legislation has been to delay until the last minute and then demand urgency instead of a considered review. Let us be clear that this is a political tactic designed to subject these radical changes to as little debate as possible.

As a high school student, I had the honour of participating in a special MLA for a Day program at the Alberta legislature. At one of our meetings, a seasoned Progressive Conservative minister explained to us how legislation was passed. Students were surprised by the length and complexity of the process. They asked why it took so long and could the process not be shortened a bit. The minister told us he was glad it took so long because one of the fastest pieces of legislation to ever pass in the Alberta legislature was the Sexual Sterilization Act of 1928, which allowed the government to sterilize people with disabilities against their will based on the analysis that they imposed an undue burden on society. Legislators at that time should have taken more time to listen to people with disabilities and considered the implications of what they were doing. The point that when we are in too much of a hurry to make decisions we risk undermining the fundamental rights of our fellow human beings, in particular, those living with disabilities, has stuck with me to this day.

Those of us on this side of the House who are raising concerns and demanding that time be taken to consider this bill and appropriate safeguards be put in place are on the right side of history. As was the case with the Sexual Sterilization Act of 1928, when this bill is repealed in five or 50 years, I will proudly tell my grandchildren that I took a stand for the universal immutable dignity of every human being.

Justice

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, the Liberals are frustrated that my colleagues and I have been so diligent in vocalizing the concerns of disabled Canadians and medical professionals in regard to Bill C-7. However, the Liberal government ignored its own legislation to review Bill C-14; held the House hostage in May and June; prorogued Parliament in August; limited the justice committee to four hearings, blocking written submissions; and chose not to appeal the deadline imposed by the Quebec superior court.

Why does the Prime Minister not want to create legislation that shows compassion for all Canadians?

Criminal Code

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, there are few, if any, issues that have come before Parliament that more clearly touch on our fundamental values as Canadians than medical assistance in dying.

Let me start today by restating what I said at the beginning of my speech in favour of Bill C-7 at second reading. When it comes to medical assistance in dying, the priority for New Democrats has always been, and remains, avoiding unnecessary suffering being inflicted on those who are already afflicted with terminal illnesses, and at the same time also avoiding prolonging suffering for the families who must bear witness to the suffering of their loved ones.

Here we are in late December, up against the deadline set by the Superior Court of Québec in the Truchon case. It does not really matter whose fault that is. Some of this delay was obviously due to COVID, but a good measure of the delay was due to the Liberals proroguing Parliament.

To me, it is manifestly unacceptable to hear some members arguing that we do not have to meet the deadline because it would “only affect Quebec.” In any case, the time has come for the House to act on Bill C-7. It is also time to act on another task as well. Not only has our consideration of the bill been delayed, but equally important, the five-year statutory review of the original medical assistance in dying legislation, Bill C-14, is now long overdue.

Members will know that some of us called on the government to get this review under way much earlier this year, so that it could have helped guide the consideration of Bill C-7. Again, COVID and prorogation intervened.

When it comes to medical assistance in dying, Parliament had two tasks before us. One was the need to amend the MAID legislation to conform with the charter as required by the Superior Court of Québec ruling. This ruling found the current law too restrictive, and that was in fact the very reason New Democrats voted against Bill C-14 at the original vote.

Making MAID laws conform to this ruling is, of course, the central purpose of Bill C-7. However, as I said, the second task with regard to medical assistance in dying was to conduct that statutory review of the broader issues, having had four years of experience with it.

As a result of growing increasingly concerned while waiting for the government to get the review under way, on October 8, I introduced Motion No. 51. My motion called for the creation of a special committee of the House of Commons to conduct this review. Special committees have some advantages when it comes to reviews of this kind. They are granted comparatively unlimited resources by the House and are not bound by the four hour per week schedule specified for standing committees, like the justice committee.

They are mandated to work on a single task, so they are not subject to the kinds of delays that can occur in standing committees, like the justice committee, where dealing with legislation must always, necessarily, take precedence over studies. Of course, special committees can make recommendations for actions needed beyond the confines of Bill C-7 or beyond the narrow court decisions.

Indeed, it was a special committee that made the original recommendations to the House that became Bill C-14. To be clear, this broader legislative review of issues arising out of medical assistance in dying was mandated in the original legislation and was supposed to start last June at the latest. It should have taken place, and would have taken place, whether or not there was a court decision in Quebec.

Bill C-14 required that the review specifically look at the question of advance requests or advance directives, requests from mature minors and requests where mental illness is the sole underlying condition. However, New Democrats have argued from the beginning that the mandate of that statutory review was missing a key element. That is why my motion called for a special committee with an expanded mandate to include the question of whether the safeguards in our medical assistance in dying legislation are adequate to protect the most vulnerable among us.

I am happy to say that I believe all parties now seem to agree that the mandate should be expanded to include this question. I am still not sure why the government is so adverse to a special committee, but I think it will find that members of the justice committee would reluctantly agree to the justice committee undertaking this review, as long as it had the expanded mandate. Though, of course, I will still worry that time, resources and the agenda of the standing committee may be too limited to do justice to the task.

Previously I have spoken about the issues of medical assistance in dying on very personal and very practical terms. I have spoken about my mother's fears of being trapped in a hospital bed while suffering and no longer knowing her family. I have spoken of a friend who chose medical assistance in dying much earlier than she might otherwise have done out of fear of losing her capacity to give final consent because of her growing brain tumour.

Now, in addition to these personal experiences, as a member of the justice committee I have had the privilege of talking to dozens of Canadians over Zoom, of hearing dozens of witnesses in committee and of reading even more briefs on medical assistance in dying.

I have been particularly and equally touched by the stories of families whose loved ones chose medical assistance in dying over prolonged suffering and the stories from those medical practitioners who provide that medical assistance in dying. My conversations with these families and with these doctors helped me understand how medical assistance in dying operates in real life. These conversations have made it clear to me that the current legislation has some unintended and cruel consequences. This was evident even before the Quebec court ruling.

Those who listened carefully to the terminally ill, their families and the practitioners providing medical assistance knew well that our current law often inflicts and prolongs unnecessary suffering. Bill C-7 addresses three of those cases of unnecessary and prolonged suffering. While it was not strictly required to do so by the Truchon decision, I rightly think the bill does take on that task of reducing suffering.

Most important to me, Bill C-7 will end the spectre of patients like Audrey Parker of Nova Scotia, who felt she had to leave early and choose an earlier date for receiving medical assistance in dying because of her fear of losing the competence required to give consent at the moment the assistance is rendered. Audrey Parker felt she had no choice but to miss one last Christmas with her family. I think we all owe her thanks for making her personal struggle public so that others would not have to face the same awful choice.

Bill C-7 will fix this by waiving the requirement for final consent for those already assessed and approved for medical assistance in dying. This waiver of final consent takes away that need for any person, and let me stress this again, who has already decided to request medical assistance in dying and has already been assessed and approved for that assistance. It will prevent them from having to go early in order to avoid the loss of competence that would prevent them from receiving the end to their suffering and the end of to their family's suffering that they desire.

Whether one supports waiving the requirement of consent at the moment assisted dying is provided or does not support that, Bill C-7 does not open the door wide to advance consent or advance directive. It is simply providing that waiver of final consent for those already assessed and approved. The topic of advance requests remains part of the mandate of the special committee I would like to see doing the statutory review.

This is a question of great concern to many of my constituents. In fact, it is the single thing I have heard the most about from my constituents. They are concerned about maintaining their autonomy and decision-making over how their end of life takes place. They want to make sure that their wishes are respected. I have to say that my discussions with practitioners providing medical assistance in dying have persuaded me that this question is not so simple as it appears on first look. As I have said, this will remain an important question for a statutory review to address, but it is not part of Bill C-7.

A second cause of unnecessary suffering that Bill C-7 will also eliminate is the mandatory 10-day waiting or, as it is sometimes called, reflection period. The evidence provided in the report of the Association of Medical Assistance in Dying Assessors and Providers shows that nearly half the patients receiving medical assistance in dying chose to do so on or about the 11th day. What does that tell us? It tells us that they their suffering was prolonged simply to meet that statutory waiting period of 10 days.

I know concerns have been raised by members of Parliament about people changing their minds, but the statistics on people changing their minds about medical assistance in dying show that people do that during the assessment period, before they are actually approved. What the waiting period does is it makes patients hold out for days longer on what has already been assessed as intolerable suffering just to meet the statutory requirements. All patients are made to spend this time suffering and few if any are actually reflecting on the situation, because at this point to relieve the pain they are heavily sedated. If we truly respect the agency of patients who are terminal and suffering, then we ought not to impose a cruel waiting period.

Let me say as an aside how disappointed I have been to hear some members of Parliament alleging that Bill C-7 somehow creates the possibility of what they call “same-day dying”. It does nothing of the kind.

That would only be possible if the medical professionals involved skipped their duties and their professional responsibilities as prescribed in law and in their own professional codes of conduct. That is what it would take to produce such a result. Making this false allegation is insulting to the patients and the medical practitioners who provide this service. It demonstrates how little those who use that term know about the actual process of medical assistance in dying.

Another misleading “fact” that has often been cited in this debate occurs when members ask how can anyone support Bill C-7 when “doctors oppose it”. What those members are referring to is a petition submitted to the justice committee, a petition signed by more than 700 physicians. What this selective siding ignores is that the Canadian Medical Association, which represents more than 70,000 doctors, has come out squarely in favour of Bill C-7. That is nearly 100 times as many doctors as those who signed the petition.

Let me point to another positive change in Bill C-7 that reduces suffering, which has been willfully misconstrued: the reduction of the requirement that two independent people witness the signature of the patient requesting medical assistance in dying.

This change was suggested by practitioners as a result of the experience they have already had will Bill C-14. Clinicians and families often found the process of identifying a second independent witness was difficult, especially in rural and remote areas, because of the requirement of independence. It often also raised privacy concerns, as it involved an extra person in this process.

We must remember that the purpose of witnesses is only to verify the identity of the person making the request. Two independent medical assessors have already been involved each and every step of the way throughout the process. They have already had to certify the patient's eligibility for MAID. Practitioners have said this second witness provision is unduly restrictive and, again, often only ends up unnecessarily prolonging suffering.

At this point, I want to turn to some of the specific concerns about Bill C-7 that were raised at the justice committee.

The first concern is about the removal of the requirement that death be reasonably foreseeable in order for someone to proceed with medical assistance in dying. Of course, this provision was removed by the Quebec court decision, not by Bill C-7.

Bill C-7 makes sure that medical assistance in dying legislation conforms with the decision of the court. It said limiting medical assistance in dying to cases where death was imminent was a violation of the Charter rights of patients whose death might not be on the immediate horizon but whose condition left them in intolerable suffering.

Bill C-7 creates a second track for those whose death is not imminent and specifies a second set of requirements and safeguards appropriate for the second track. The decision about whether the reasonable foreseeable provision should be removed is not made by Bill C-7. It is a decision made by the Quebec courts. I believe this is consistent with the Carter decision.

I want to take a moment to address those who say there is no need to meet the deadline opposed by the Quebec Superior Court. I remind them that without Bill C-7, those whose death is not reasonably foreseeable will come under the existing requirements immediately and will be without any of the conditions specified in Bill C-7 as appropriate for the second track. Regardless of whether people believe the safeguards are adequate, I ask them to understand that if we do not meet the deadline, there are no safeguards in the second track at all.

I believe most of us accept that there are good reasons to differentiate between the two tracks and to have additional requirements appropriate for those whose death is not imminent. Bill C-7 rightly sets out a more restrictive process and therefore requires more time for assessment and decision-making for the second track.

In addition, it does not set a reflection period of 90 days. It sets an assessment period of 90 days. That is an important distinction. It is not a maximum of 90 days; it is a minimum of 90 days. I do not think we should get confused on that point.

The second concern I want to address is a very important concern of the disability advocates: with the removal of the requirement that death be imminent, there will be pressure on the vulnerable in our society to choose medical assistance in dying.

Nothing in Bill C-7 changes the very high standards set in the original Bill C-14 for receiving medical assistance in dying. To receive this assistance, patients must have a condition that is incurable, must be in an advanced state of irreversible decline and must face intolerable suffering. This means Bill C-7 does not open the door wide, as some have suggested.

However, let me be clear here. I do not, in any way, wish to dismiss the concerns of the disability community over their vulnerability. That is why I have been calling for an expanded mandate of the statutory review so that we require it to consider the question of whether safeguards to protect the vulnerable in our medical assistance in dying legislation are adequate. Again, this may require us to look beyond the narrow confines of the medical assistance in dying legislation to other health legislation and other social support legislation.

That is why my colleague, the member for Elmwood—Transcona, and I have just delivered today a joint letter to the Minister of Disability Inclusion calling for a new national income support program, set at $2,200 per month, for all persons with disabilities. This would be a single, national program to replace the patchwork of provincial programs that rarely come close to the amount that we have all now acknowledged with CERB as the minimum necessary. Providing such a benefit would be an important step toward a guaranteed basic income for all Canadians. More importantly, in the context of the bill, this would provide support at a level that would help avoid placing persons with disabilities in a position where dying looks like a better option than living without the supports they need.

Failure to provide the necessary resources to ensure that everyone can enjoy full and equal participation in life is a long-standing and ongoing black mark on the federal Parliament and all provincial parliaments. We have only to look at the failure to deliver additional assistance promptly to persons with disabilities during this pandemic to remind ourselves how often we forget about those living with disabilities.

As we consider how to recover from the pandemic, I hope we can adopt this proposed federal program that would provide all people with disabilities the equivalent of a living wage. This would be an important step toward relieving the fears about having to make a terrible choice eventually with medical assistance in dying.

Given the speeches from all parties stressing the need to take the situation of people with disabilities seriously, and in light of the Quebec Superior Court decision, I believe we should be able to marshal immediate support for this proposal in a minority Parliament. It would be an important step in mending the gaps in our social safety net that COVID has revealed. COVID has taught us that we can roll out income support programs quickly when we really want to do so.

As I near the end of my time, let me take a moment to address one last phenomena I observed in our committee discussions and one that I found very disturbing. It was the tendency of some members to mix together issues of suicide and medical assistance in dying. These are two completely different issues, distinct both medically and morally.

Medical assistance in dying does not provide a way to take one's own life. The testimony from physicians and families involved in medical assistance in dying told us very clearly that no one involved in medical assistance in dying wants anyone to die: not the families, not the physicians and certainly not the patients themselves. Medical assistance in dying is about those who are already dying and are far along that path and in intolerable suffering. It is about them being able to have control about how their life ends and when that suffering for them and their family will come to an end. It is not about choosing to die.

The New Democrats continue to support Bill C-7, as it contains significant measures that will help bring an end to unnecessary suffering and provide the necessary safeguards in the second track for those whose deaths is not reasonably foreseeable. It will do so in time to meet the deadline hopefully imposed in the Truchon decision.

We will continue to demand that we get started on the statutory review, which should already have begun. Proceeding with Bill C-7 without proceeding with the review is only getting half the job done on medical assistance in dying. At the same time, it potentially undermines public support for medical assistance in dying, which so far has only continued to grow.

In conclusion, I want to say again that I believe as a society we must do a better job of providing for the most vulnerable among us and those who are differently abled. In the case of the tragic deficiencies in end-of-life care and in the lived experiences of people with disabilities, COVID has taught us how much further we have to go toward a fully compassionate and fully equal society. I urge all parliamentarians not to ignore those lessons.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, this is the last stage of debate before Bill C-7 is passed.

I would like to remind members of the first thing I said when we began the clause-by-clause study of the bill. I said that we must not forget that while we are debating, people are suffering and are waiting for the results of our efforts. Today, I would say that they want to know whether we will take care of them and listen to their voices, or whether they will once again have to bear the burden of going before the courts to have their final wishes heard.

I also said that I was certain, from the start of the debate on Bill C-7, that all parliamentarians in the House were caring and compassionate, but that we are could not be caring and compassionate if we infringed on the autonomy of a person who is dying or suffering and has reached their breaking point.

I have to say that I am disappointed by the Conservatives' attitude. It is one thing to want to make a point, but it is another to engage in what amounts to filibustering. However, what bothers me even more is that they seem to be claiming that they know better than the person who is dying what is best for them. I cannot make such a claim. I prefer to give the person the choice, and my role as a legislator is to preserve that choice.

Unfortunately, the Conservatives are practising government-imposed moral paternalism, which is odd because they are economic libertarians. That means they want less government intervention in the economy, yet they also want full government intervention in a matter as intimate as our own death.

The Conservatives are practising government paternalism, but they are not alone, because we have heard some practitioners say and demonstrate that in 2020, they still apply a medical paternalism that I would describe as appalling. Why on earth are these omniscient practitioners doing that? How are they better equipped than a person who is dying or a suffering patient who has reached their threshold of tolerance to know what is best for them? Only God knows, but they do not mention that.

Those few medical practitioners continue to frustrate us to this day because they practise in Quebec. Five years after Quebec's Act Respecting End-of-Life Care was passed, they consider palliative care and medical assistance in dying to be mutually exclusive, when they are and should be complementary, since medical assistance in dying is part of the care continuum under Quebec's end-of-life care legislation. However, that is still not enough. They believe that the patient must change their mind if they request medical assistance in dying, and they say they manage to make them change their minds. They have no qualms about saying that they would not want to refer the request for medical assistance in dying to a doctor who can perform the procedure, even though that is enshrined in Quebec law. They say they are obviously doing it for the good of the patient, even though they refuse to listen to the patient and heed their wishes.

That is the testimony that provides the basis for the Conservatives' filibustering. They claim to know better than the dying patient what is best for them. That is not caring. That is a violation of the principle of self-determination.

I will let the 88% of Quebeckers who support the freedom to choose medical assistance in dying judge the Conservative Party's position and attitude. However, what I heard in committee worries me, because five years after Quebec adopted its end-of-life care legislation, some institutions can and do circumvent the law, as was the case before the Morgentaler decision, to hinder someone from receiving medical assistance in dying. I was shocked to hear that.

If a patient is no longer receiving aggressive treatment and has finally been given the right to die, which is known as palliative care, I hope that this patient will not be subjected to aggressive palliative care.

Dying with dignity implies respect for human dignity. It is not an intellectual conceit; it is intrinsic. Treating people as ends in themselves and not as mere means involves respecting a person's capacity for self-determination, free will and freedom to choose. A person must never be subjected to an analysis or an ideology, religious or otherwise. A person is the master of their own destiny.

Furthermore, self-determination is enshrined in law. No one can undermine our intellectual or bodily integrity or our self-determination without our free and informed consent, even in an emergency.

That means that when a sick patient is at their most vulnerable, when they are suffering and dying and have reached the point where they can bear no more, the person at their bedside must not impose their own ideology on that person, be it religious or otherwise.

That is why they say in clinical ethics that the patient comes first. The patient's wishes, which are based on how much they are suffering, need to be heard. Palliative care providers should not see medical assistance in dying as a failure. If a palliative care patient, who is irreversibly committed to dying, wakes up one morning completely at peace and ready to let go, then the palliative care provider should not see that patient's request for medical assistance in dying as a failure.

I have said it before and I will say it again: I hope that, when they are on the threshold of death, all my parliamentary colleagues will be able to feel that peace and let go with a clear conscience. That is the best we can hope for for any human being.

Bill C-7 responds to the Gladu-Truchon ruling. The courts determined the appropriate response by examining the limits of the government's power to intervene in end-of-life decisions in Carter and Gladu-Truchon. The courts told us that the provisions of the Criminal Code infringed on the right to life, liberty and security of the person.

They infringe on the right to life—that says a lot—because they cause people who are suffering to shorten their lives through suicide, which is decriminalized in Canada, rather than waiting for the moment when their threshold of tolerance of tolerance is reached. This is significant.

During the committee deliberations, I heard people say that 90 days is not long enough. In saying that, they were assuming that someone who has a degenerative disease of any sort might wake up one morning and suddenly decide they want medical assistance in dying, without having ever discussed it with their doctor or health care professionals throughout their care process. It is as though they thought this all came out of a Cracker Jack box one morning and the person was wondering whether they could access medical assistance in dying that very moment or whether 90 days was enough time to be sure of that decision. That is not how it happens in real life.

The right to life is not something to be cast aside lightly. People want to live as long as possible. People want to live, and when they receive a diagnosis and are in a suicidal state, they can be treated to reverse that state. When someone finds out that they have cancer they are not going to tell their doctor that they want medical assistance in dying. They are going to ask what can be done to help and when their treatment will begin. Sometimes it takes 15 or 20 years, and other times the cancer is more aggressive, but there comes a point when the doctor announces that all treatments have been exhausted and it is time to begin the palliative stage. In any case, this does not happen overnight.

If someone who receives such a diagnosis tells their doctor they want medical assistance in dying, the doctor will prescribe anti-depressants and tell the patient that they will take care of them. They will tell the patient to get their affairs in order and talk to the family. They are not going to provide medical assistance in dying. That is not how it works. Sometimes in committee I would hear people describe catastrophic scenarios out of some sort of house of horrors, as if that were how things happened.

Bill C-7 is based on principles the Bloc Québécois believes in. Who can dispute the fact that death is the most intimate moment in a human being's life? Neither the state nor my neighbour will die in my place. The decision can only be made by the person requesting it, not by the family or anyone else.

The criteria must of course be met. We in the Bloc Québécois have confidence in our health workers. We have confidence in our health professionals. There is something that I find rather perplexing. Just this Tuesday, the Conservatives supported our motion that commended the work, dedication, care and concern of health workers and health professionals. However, when it comes to the most intimate decision a human being can make, to decide one's own death and not to suffer, and when it comes to respecting a person's right to self-determination, the Conservatives no longer have confidence in them. They believe that there are people who may have bad intentions.

If there are people who are not well-intentioned or caring in the health system, let us show them the door right away. I would also say that if there are any health professionals who claim to know better than the patient who is at the end of the process and who has made the choice that is right for them, it is time they reflected or took a course on respect for human dignity.

Throughout this debate, I have gotten the sense that some people are against freedom of choice. When people support freedom of choice, that does not mean they want to get rid of palliative care and go around signing all kinds of people up for MAID. What we are saying is that an individual who wants to die at the end of the process should be able to do so. MAID should apply to people whose suffering is intolerable and cannot be alleviated.

Yes, Bill C-7 leaves a number of things unresolved. There are two main elements here. One major improvement is that Bill C-7 tossed out the reasonably foreseeable natural death criterion, which is not a medically valid criterion. That is understandable. However, it was retained for use in defining two safeguards. I would have liked to see a more specific definition of “reasonably foreseeable death”.

For terminally ill people, there is a safeguard of up to 10 days, and a second consent may not be necessary. In cases like Ms. Gladu's, Mr. Truchon's and Ms. Carter's, where death is not reasonably foreseeable, it is supposed to be 90 days. I would have liked some clarification on this criterion because doctors need things to be clear and specific. I do not know why this criterion was brought back. There is always room for improvement.

The bill removes the need for second consent to put an end to people's suffering when palliative care no longer eases their pain, when death is irreversible and the process has already begun. That seems like a good thing to me.

Bill C-7 obviously excludes mental illness as an eligible reason when it is the sole underlying medical condition. It also does not cover all of the issues associated with advance requests, particularly in the case of neurodegenerative diseases, or the issue of mature minors.

Under Bill C-14, a parliamentary committee was to examine those provisions and the matter of palliative care last summer. Today, the Bloc Québécois is calling for that review to begin as soon as possible, not in in five years or even one year, because there are people who are suffering. What is more, this time, we must not make them bear the burden of having to go to court to be heard. Who is more vulnerable than a person who is enduring unbearable pain, who has reached or is about to reach the limit of what they can endure and who has to decide to go before the courts to make their voice heard?

It is time for us as legislators to take up the torch, show some leadership and do our job. The courts can issue orders for us to do something, but obviously when they do there is a fixed timeline. Right now, we have a deadline to meet, December 18. I really hope that we can pass this bill and begin the review process so that we can deal with the sensitive issues that are not addressed by Bill C-7.

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

Mr. Speaker, I come at it from the very same position as my hon. colleague from Brantford—Brant. I am choking up. I know both sides of it. Right next door to me, my father-in-law is in palliative care. We have been looking after him for six months. I also have a 32-year-old daughter who lives with a cognitive disability, and we worry every day. We worry every day that they go outside. We worry every day, when I go to work, that somehow someone is going to take advantage of them, and that we will not be there to protect them.

I wonder if I could get my hon. colleague to expand a bit on the fear that parents have and the fact that we are not always there. There will come a day when we are not there, so we have to do everything in our power. I said in the last session that Bill C-14 was perhaps the most important piece of legislation in our lifetime and our generation, but as a parent of somebody with a disability this is so important.

I ask my colleague to expand a bit more on the fear that we have for our children.

[René Arseneault, Liberal, Parliamentary Secretary to the Minister of Economic Development and Official Languages (Atlantic Canada Opportunities Agency and Official Languages)]

Mr. Speaker, I want to thank our friend from Brantford—Brant for sharing his own experience.

I was one of the original members of the joint committee behind Bill C-14. Allow me to share a little background.

Bill C-14 was introduced in response to the unanimous ruling of the Supreme Court of Canada handed down in February 2014, when the Harper government was in power. The court gave the government 12 months to comply with the ruling. The Harper government, knowing that an election was coming in the spring of 2015, essentially did nothing. The Liberals won the 2015 election. We lost 10 precious months before cabinet was appointed as a result of the Conservative Party's inaction.

Politicians are often called upon to make decisions, and it is not always easy. The majority of members on our committee who opposed this bill said they were doing so to protect vulnerable people, which is something everyone wants to do.

Could my esteemed colleague tell us where in Bill C-14 or in Bill C-7, which we are debating today, it says that a minor with a head injury, cerebral palsy or Down's syndrome could request medical assistance in dying? I do not see that anywhere.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Mr. Speaker, I am thankful for this time to speak on this incredibly important issue to all Canadians.

As I was leading into this speech, I reflected back on the debates on Bill C-14. On May 3, 2016, the House was debating the creation of an euthanasia and assisted suicide bill. At the time I spoke in the evening on May 3, I mentioned how this would probably be, in my career as a politician, a member of Parliament, having at that time served eight years and now in my 13th year, perhaps the most important speech that I would ever make.

When I look back on that speech today, I think I was wrong. I think perhaps this is the more important speech because at that time Parliament was faced with a court deadline as well to put into place legislation for euthanasia and assisted suicide. Like many countries around the world that have these bills, going back to the first legislation in the Netherlands in 2002 until today, I have seen the progression of what has happened in these countries as an example of what will happen on the slippery slope of this legislation.

I should say as well, as I did in 2016, I come at this with a very biased approach and that is because I am the father of a 34-year-old intellectually disabled son. My son was brain damaged at age two. He suffered irreversible damage that has caused him to lead a life with his parents as his caregivers his entire life. When the people and organizations that represent persons with disabilities speak, and they have spoken loudly, to the particular changes and amendments that the government is bringing forward in Bill C-7, they have said this is the worst possible scenario.

I interpret that from my lens as a parent in terms of protection for my son. Frankly, it causes me to reflect on what we are currently experiencing: the COVID-19 crisis. Just about every piece of communication that I receive, email, text, telephone call, whatever, usually starts with a sentence where that person says to me or I say to them, “I hope your family is safe”. Generally speaking, the salutation at the end of those communications is, “Stay safe”. I believe all parliamentarians have probably experienced the exact same thing.

One of the concerns of the disability community is this. What will happen to our children in their latter lives when we are no longer with them, when we can no longer care for and protect them? Therefore, the theme of my speech today is “Stay safe, my son”.

Let us look at the evolution of these laws across the world. I will read a few recent headlines that I found through my research coming into this today. “'What kind of society do you want to live in?': Inside the country where Down syndrome is disappearing”. This headline is from the BBC on October 14, “Netherlands backs euthanasia for terminally ill children under-12”.

Let me read a couple of excerpts from this article, which are fairly poignant considering today's discussion. The article begins, “The Dutch government has approved plans to allow euthanasia for terminally ill children aged between one and 12." Of the current law, it goes on to mention, “It is also legal for babies up to a year old [to be euthanized] with parental consent.

I could go on with more headlines, but I choose not to because I think members get the point. The point is this: Where do we stop? With Bill C-14 in its original form, the preamble said it all, which was, and I am sure the committee heard this, that there are many in society who say this bill does not go far enough and does not satisfy those who want wide open death-upon-request euthanasia laws. When we look at this, we must look at it from both sides, because both sides of this issue require our compassion.

I have spent time with three significant people in my life at the end of their lives. One is my mother, who was in extreme pain for a long period of time. I held held her hand upon her death. I also watched a very good friend deteriorate from age 39 to age 41 before his death. As well, lately, a very good friend, who is choosing to end her life early, and who I had quite a frank conversation with out of total respect. All of them had been, or are in, the final stages of a terminal illness.

Compassion must go to people who are in situations that are unbearable. Fortunately, there are other alternatives. I happen to live in Brantford, Ontario, and we have one of the finest palliative care units in all of the country. People come to study it and look at it. They come to see it as an alternative. If we were to focus on something going forward that a government could do, but that it would perhaps not see as a priority, it could be to give people the resources to make a choice.

Let me get back to this discussion of the most vulnerable. They are persons with disabilities, and to name a few, they are autistic children, autistic adults and persons with brain damage, like my son. These are not mental illnesses, by the way. Some of these are genetic, such as Down Syndrome. There are some who have met a person with Down Syndrome who just lights up their life because of their complete innocence and their complete love, not only for others, but also for their own lives. There are many others who the disability community speaks for.

Bill C-7 undermines their precarious position. It takes and diminishes the few protections that existed in Bill C-14, and of course, this is what is being chosen, as per the votes up to this point, on this issue by the majority of members of Parliament.

To my son, I say, “Stay safe.” To the constituents of Charlottetown, I say, “Stay safe.” To the constituents with disabilities in Scarborough—Agincourt, I say, “Stay safe.” To all Canadians, I say, “Stay safe.”

The trajectory of where we are heading, and it is in that preamble to the legislation, is what is happening around the world. It is happening in society. People in legislatures are making the decisions for the rest of the country as to what the future will look like.

This is a critical moment. It was a critical moment back in 2016. Again, we are faced with a critical moment. The priority has become a deadline set by a court, instead of the fullness of all voices being heard.

The parliamentary secretary can articulate the numbers. He can articulate the fact that there were so many submissions and individuals we were able to listen to. At this point in time, the people who represent the vast number of persons with disabilities and their families in this country are dead against this legislation. Let us be clear about that. Let us not try to sugar-coat this. This is where we are today.

What kind of society do we want? Where this leads to, frankly, is one of those headlines. As we take away the protections for individuals with disabilities, as this law does, we eventually lead society into the normal course of accepting that assisted suicide and euthanasia are natural things. We move toward being a society that starts to look at individuals as either being healthy in society's mind, and living fulfilling lives, or beings one of those who have been brought into this world, or has had something happen to them in this world, that puts them in this very precarious situation.

Is life easy for persons with disabilities and their caregivers? In most cases, it is not easy. We can attest to that. We have three healthy children, as well as our special needs son with disabilities. Part of the richness of life is the fact that the child who many would see as imperfect is the one who brings the most joy to life. They are the ones we must protect at all costs.

Why do we not spend the time to get this legislation right and make it airtight so their lives are never at risk? I do not believe this legislation does immediately put them at risk. Some would say this legislation is quite to the contrary, but looking to five, 10, or 20 years from now, when most of us here will no longer be in Parliament, it will be a new group of elected representatives looking to make changes down the road.

Is there anything in the international experience to tell us that this is not a continual, gradual and incremental deterioration of the protections for those who are the most vulnerable?

The other point that needs to be made is that persons with disabilities are a minority in our country. Over the 13 years I have been in Parliament, more time has been spent on legislation, members' statements, just name it, than communications from government about protecting minorities. This is a vulnerable, if not the most vulnerable, minority in society. It is definitely in the top grouping of the most vulnerable.

Disability knows no boundaries. We are involved with groups of people, and I represent the Six Nations of the Grand River, the largest first nation in Canada. We are helping aboriginal individuals from Six Nations who have children with disabilities. They feel very strongly about the fact that the few protections that exist need to not only be kept in place, but also enhanced and made airtight for their children.

In those debates in 2016, the member for Calgary Nose Hill said in her opening statement that this is about, “the sanctity of human life” and “defining the morality of our country.” I could not agree more wholeheartedly with those words.

I will finish my remarks by saying, “Stay safe, my son.”

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

Mr. Speaker, I am pleased to add my voice to the debate on Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying.

I want to start by reminding all members that this is important legislation. We as parliamentarians have a court-imposed deadline of December 18 to pass this legislation. This legislation would help prevent the suffering of Canadians. Even there were no court-imposed deadline, we would have a moral obligation to see it passed.

I am really disappointed, to be frank, to see my colleagues across the aisle delaying the bill, increasing the chances that the government misses the court-imposed deadline and prolongs the suffering of Canadians in denying them the autonomy to choose medical assistance in dying.

I am very disheartened to see members of the Conservative Party of Canada continue their delay tactics to slow this legislation. I saw it at the justice committee and we are seeing it again now. We know that the majority of Canadians believe that MAID is a basic human right. More than 300,000 people participated in consultations earlier this year.

The Quebec Superior Court's deadline is now two weeks away as of today. Conservatives are now trying to undermine the urgency of the situation. They are ignoring the very real consequences that their inaction could have on those who are suffering in this country. I think it is also important to remind members where the content of this legislation came from and the process the government went through in January in developing this legislation.

Bill C-7 was informed by the Truchon decision itself, Canadian and international reports, the experience of existing international regimes, and the government's consultations on MAID held in January and February of this year.

I had the opportunity to participate in some of these round tables that were hosted across the country including in my home of Toronto, where I am speaking from, and in Winnipeg. In these consultations, our team spoke with 125 stakeholders including regulatory bodies, legal experts, doctors, nurse practitioners, representatives of the disability community, and indigenous persons and their representatives. They shared their experiences and insights into MAID and its implementation in Canada over the last four years.

In order to get a broader public perspective, the government also hosted an online public survey. It received over 300,000 responses from people across the country. The summary of the consultations was released in March as a “what we heard” report. Our government did its homework in the creation of this legislation.

I would like to take the time to explain to all hon. colleagues what Bill C-7 proposes to change in our MAID regime so that we all start from the same common understanding of the legislation before us.

There are four main aspects to the bill. The first aspect concerns eligibility criteria and these changes are fairly straightforward. The eligibility criterion requiring a reasonably foreseeable natural death would be repealed. As I have already described, this change would in effect adopt the outcome of the Truchon decision for the whole of Canada.

This eligibility criterion makes Canada's current end-of-life regime available only when a practitioner can determine with confidence that a temporal connection to death exists, with some flexibility. In Truchon, the Quebec Superior Court told us that this criterion violated the charter rights of people whose death was not reasonably foreseeable, people like Mr. Truchon and Ms. Gladu.

To avoid prolonging the suffering of the applicants and other Canadians in similar situations, our government decided to accept the decision and amend the act for all of Canada.

The legislation would continue to require a voluntary request and informed consent from a person with decision-making capacity. These cornerstones of autonomy would ensure that MAID could be safely provided to Canadians who deem it to be the solution to their suffering, while guarding against persons being pressured into seeking MAID. We trust that individuals know best for themselves when they can no longer endure suffering, regardless of whether their natural death is reasonably foreseeable. We are committed to respecting this very personal choice of Canadians.

The second aspect of the bill is the safeguards. The bill would use the criterion of reasonably foreseeable natural death to create a two-track system. Those whose death is reasonably foreseeable would continue to benefit from the current safeguards with two changes. First, the 10-day reflection period would be repealed and a person would only need one independent witness to sign a MAID request instead of two. That independent witness would be someone who is paid to provide health and personal care services to the person requesting MAID. These changes are intended to alleviate barriers to access and to reduce suffering.

We heard from medical practitioners that these did not serve as safeguards, but only unnecessarily prolonged suffering for individuals who had made up their mind. It also created issues of accessing MAID in rural and remote areas.

Those people whose death is not reasonably foreseeable would benefit from an enhanced set of safeguards. In addition to those safeguards required where death is reasonably foreseeable, practitioners would have to assess a person's MAID request over a minimum assessment period of 90 days. If neither of those two MAID assessors has expertise in the condition that is causing the person's suffering, they would have to consult a practitioner who does. That is pursuant to the amendment that was helpfully proposed by the NDP member for Esquimalt—Saanich—Sooke at committee. The person requesting MAID must be informed of the means available to relieve their suffering, including mental health and disability support services, and be offered consultations with professionals who provide those services. Both practitioners have to discuss those means of relieving suffering with the person and be of the view that the person has seriously considered those means.

In terms of the broad approach to the bill, the third aspect of Bill C-7 is that of the limited change around advance consent. This one is unrelated to changes in eligibility criteria, but instead seeks to address an unfair situation that arises when a person is approved for MAID but loses decision-making capacity and cannot consent to the MAID procedure immediately before it would be provided, despite the request having been approved and the procedure already planned. Members probably know the reason for this amendment best through the story of Audrey Parker, the Canadian woman whose case we heard so much about a bit more than a year ago who had to schedule her MAID procedure earlier than she would have wanted, out of fear of losing decision-making capacity before her preferred date to receive MAID.

In my view, Bill C-7 takes the right approach by proposing to allow the waiver of final consent only in cases where the person's death is reasonably foreseeable and only when he or she has already been found eligible for medical assistance in dying and is waiting for the procedure to take place, but risks losing the capacity to provide final consent.

According to practitioners and people like Audrey Parker, this is exactly the kind of situation that forces people to make a cruel choice if they risk losing their capacity to give consent before receiving medical assistance in dying. That is the one, very specific scenario this bill proposes to address, since it presents the least amount of uncertainty in terms of patients' autonomous choices and the least ethical and practical complexity.

I know this is an important issue for Canadians, and I am committed to working with all parliamentarians to begin the parliamentary review of the medical assistance in dying regime as soon as possible after Bill C-7 has made its way through the parliamentary process. I have no doubt that the issue of advance requests will be an important part of that review.

The fourth and final category of amendments that the bill proposes targets the monitoring regime. The changes would allow the collection of information in a wider range of circumstances, including information about preliminary assessments that might be undertaken before a request is put in writing. Consultations will take place before these regulations are amended. An amendment at committee based on an amendment proposed by the hon. member for Nanaimo—Ladysmith of the Green Party would require that the Minister of Health consult with the minister responsible for the status of persons with disabilities in carrying out their reporting obligations; again, another helpful amendment that was proposed at the committee stage.

Medical assistance in dying has always been a very difficult issue that generates a variety of opinions on all sides of the issue. It strikes deeply to all Canadians' personal morals and sensibilities. We understand this. As such, it requires different interests to be considered. I firmly believe that Bill C-7 does exactly that. The law will continue to require informed consent and a voluntary request made by a person with decision-making capacity, while also creating a more robust set of safeguards where the person's natural death is not reasonably foreseeable. These safeguards require significant attention to be paid to all of the alternatives that might help alleviate suffering on the part of a person whose death is not reasonably foreseeable. We believe such a regime can work safely by guarding against overt and subtle pressures to seek MAID, while providing autonomy to a greater number of Canadians to make this important choice for themselves.

I would like to return for a moment to the topic of safeguards, specifically when it comes to those whose death is not reasonably foreseeable. It is very important to remind members of this House what these safeguards are and why we believe that they are adequate.

This legislation proposes a distinct set of procedural safeguards that are tailored to the risks associated with assistance in dying for persons whose death is not reasonably foreseeable. Ending the lives of those whose suffering is based on their experience of their quality of life is different from offering a peaceful death when the dying process would otherwise be painful or prolonged, or would erode a person's sense of their own dignity. Bill C-7 therefore proposes a more robust set of safeguards where natural death is not reasonably foreseeable. Safeguards for those whose death is not reasonably foreseeable would be built around the existing safeguards, but contain enhancements over the previous Bill C-14, which was passed in the 42nd Parliament. Importantly, the medical assessments of a person's eligibility must span at least 90 days.

I mentioned this earlier, but I want to emphasize, as there appeared to be some confusion around this at the Standing Committee on Justice and Human Rights, and elsewhere. This period of 90 days is not a waiting period or a reflection period. This is not a requirement that the person wait 90 days after they are approved. Rather, it is a stipulation that practitioners must, over at least a period of three full months, fully explore the person's medical condition and the nature and causes of their suffering, and work with them to identify reasonable treatment or other support options they must discuss with the person. The person seeking MAID is not required to undergo any treatments. It would be an intrusion into the individual's autonomy to force them into any sort of treatment, but as we embark on this new expansion of the MAID regime, we believe we can collectively move forward safely, if we can be satisfied that available options have been brought to the person's attention and given serious consideration.

All of these safeguards reflect the irreversible nature of ending someone's life and the very serious nature of medical assistance in dying, which needs to continue to be strictly regulated, especially given the broadening of the regime. As stated by the Canadian Medical Association, which welcomed our government's staged approach, the proposed MAID amendments are “a prudent step forward”. Bill C-7 proposes to further support individual autonomy while also protecting vulnerable persons and ensuring that careful consideration will be given to those challenging issues. For these reasons, among others, I strongly encourage members of this House to support this legislation and to support its passage through this House and Parliament to meet the court deadline of December 18.

I also want to remind members of the upcoming parliamentary review. Through the course of the consultations, and then through the committee process, we did hear of a number of issues that need to be reviewed and addressed, but need more thorough study than could be done in the time required to meet the court-imposed deadline. Parliament will have ample time to review all of these issues, and I think it is important that we do so, but we need to get this legislation passed as well.

Bill C-14, from the previous Parliament, called for Parliament to conduct a review and specifically mentions the state of palliative care. We expect this review will also include important issues such as mature minors, mental illness as the sole underlying condition and advance requests. By no means would I expect this to be a closed list, either. This is a broad issue and we would hope to hear from many Canadians on a wide variety of subjects relating to MAID. Having heard from many witnesses and spoken to many Canadians on Bill C-7, I know there are diverse views on this issue. They are all difficult issues, and I look forward to the parliamentary review and hearing from many more Canadians on the subject and seeing what the review has to say.

As I said at the beginning of my speech, I am very disappointed and concerned by my colleagues across the way and their lack of respect for the court deadline imposed on us by the Superior Court of Quebec to pass this legislation. I believe we have an obligation as parliamentarians to do everything we can to try to meet the deadline of the court. Canadians want this legislation. Quebeckers want this legislation. I am really unclear on why my colleagues across the way are showing disrespect for the will not only of the court, but of all Canadians. They have been slowing and delaying debate unnecessarily, and I am very concerned by what this says about how much they value the rule of law and the will of Canadians.

I want to thank my colleagues who serve with me on the justice committee for their work on helping us in a smooth and efficient committee process on this legislation. I look forward to this House giving the same consideration to the legislation. Again, I want to emphasize to my colleagues the importance of moving quickly. I look forward to continuing the debate on Bill C-7, but also to its ultimate passage in time for Parliament to meet the court-imposed obligation.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, there is such concern in my heart for the fact that the government is choosing on so many occasions to go over and above its own responsibilities within the realm of our Parliament, where 338 members made the decision to bring Bill C-14 forward with the understanding that the proper oversight would take place. This is a huge issue for Canada and we have a responsibility as parliamentarians to do the due research to find out how well it has been functioning and if it has been abused. We are clearly hearing stories over and over again now and yet the government has chosen to move ahead and rush this.

Those who wanted to speak to that review have had to try to make their voices heard and known in the midst of the presentation of Bill C-7. We know that many of them were shut down at committee. Testimony time was not extended and very many reports and dockets were not submitted because there was not time. Thank goodness that time is being taken in the Senate. I feel that the government has abused its responsibilities.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I am thankful for the opportunity to speak again to Bill C-7, an act to amend the Criminal Code (medical assistance in dying) at report stage.

I will touch on two key amendments the Conservatives were seeking, namely to maintain the reflection period of 10 clear days between when the request for MAID is signed and then received, and to extend the assessment period from 90 to 120 days for those whose death is not reasonably foreseeable. Originally, these were amendments we put forward at committee. In fact, these are just two of several amendments we worked really hard to achieve in good faith. They were all rejected by the Liberals.

Therefore, I would first contend that the bill we have received back from the committee demonstrates a lack of concern for the voices of opposition, and not merely those of our Conservative opposition, but rather those of the differently abled and the medical experts whose concerns we compassionately championed. We must thoughtfully consider the alarm of Canadians who are passionately opposed to what Bill C-7 is now proposing.

Bill C-7 would eliminate the requirement of waiting 10 clear days after being approved for the procedure, effectively allowing for a system of death on demand. As we heard at committee, this is troubling for those whose lives have been affected by disability. For those who want to live with dignity, Bill C-7 presents and very clear and present danger. That is what they are saying.

Let us refer to what witnesses told us at committee.

Roger Foley, who lives with a severe neurodegenerative disease, told the committee this:

With the Assisted Dying Regime in Canada, I have experienced a lack of care and assistance for which I need to live.... I have been abused and berated because I have disabilities, and told my care needs are too much work. My life has been devalued. I have been coerced into assisted death by the abuse, neglect, lack of care and threats.

Mr. Foley went on to say, “Assisted Dying is easier to access than safe and appropriate disability supports to live!... You have turned your back on disabled and elderly Canadians!” I found that very difficult to hear.

Dr. Ewan Goligher, a physician-scientist, was clear in his assertion that Bill C-7 singles out those with disabilities when, in many cases, death can be prevented. He said:

Bill C-7 declares that an entire class of people—those with physical disabilities—are potentially appropriate for suicide, that their lives are potentially not worth living. Indeed, were it not for their disability, we would not be willing to end them. I cannot imagine a more degrading and discriminatory message for our society to communicate to our fellow citizens living with disabilities.

As the CBC similarly noted, “While reflecting understandable empathy for often-severe suffering, the bill conforms to an ableist presumption that a life with disability or chronic illness is less worth living.”

Krista Carr, executive vice-president of Inclusion Canada, spoke on behalf of families of those with intellectual disabilities who fear their loved ones will be left without a choice. She said, “families now fear that their family members will be encouraged to end their lives. Rather than addressing their suffering, as we do for every other Canadian who tries to end their suffering through suicide, their lives are now judged as not worth saving.”

This claim by Ms. Carr was reinforced by the testimony of Taylor Hyatt, who bravely shared a personal story. Having been admitted to the ER with difficulty breathing, she was advised by the doctor that an infection she had could require oxygen. Ms. Hyatt enthusiastically agreed to the use of oxygen, but found it troubling that her answer came as a surprise to the doctor. I know Taylor and she is full of energy and life. It was at this point that Taylor came to a stark realization. She said:

In that moment, I would have been able to refuse treatment and be permitted to die. Or, in a moment of weakness, bought into the stereotype that my life wasn't worth living and requested and received a lethal injection. Breathing supports would be considered standard treatment for a non-disabled person in my situation, especially somebody in their mid-20s as I was.... If this bill goes through, how many more disabled people at their lowest moments could have a drastically different and decidedly unwanted ending to their story?

We on this side of the House recognize that Canadians' tolerance for assisted dying has evolved over the past four and a half years. In fact, a 2020 Angus Reid Institute poll found that four in five Canadians believe that it should be easier to make their own end-of-life-decisions, compared with 73% four years ago. However, the same poll found that 65% believe the option of assisted suicide and euthanasia has the potential to intensify pressure on those with disabilities to choose death as a means to avoid being a burden to others. They want lawmakers and the courts to give significant weight to this concern.

In my view, C-7 abandons the concerns of witnesses and the majority view of Canadians. Appropriate safeguards, such as the 10-day reflection period and a 120-day assessment period for those whose death is not reasonably foreseeable, are absolutely warranted, so why are the Liberals denying this?

My second point as to why the bill should not proceed is that it is the government’s clear intention to go beyond the scope of the Quebec Court of Appeal’s Truchon decision.

One of the key elements of the bill, for me, is the about-face the government has taken. Less than five years ago, Bill C-14 was passed. It was a bill that I, and many in my party, have opposed in principle from its introduction to the present day. However, many Canadians took solace in the fact that Bill C-14 contained a vital element of parliamentary accountability. Clause 10 mandated a five-year review, wherein the provisions of the assisted suicide law, as well as the state of palliative care in Canada, would be fulsomely studied by the House of Commons and Senate before the end of June 2021. This was our responsibility.

This vital element of Bill C-14 has been ignored by the government. As parliamentarians, we have now been tasked to consider a massive expansion of assisted suicide and euthanasia without a clear enough understanding of Bill C-14’s effectiveness, enforceability and areas of acute concern.

It bears repeating something from my speech in October. Rather than appeal Truchon to the Supreme Court of Canada or wait for the all-important five-year review of assisted death in Canada, the Liberals have chosen to run with the Truchon decision and legislate on an expansion of assisted death for the entire country. Not only that, but the bill far exceeds the scope of Truchon.

Indeed, during Oral Questions on November 23, the member for Vancouver Granville, the former minister of justice and attorney general, and author of the original MAID legislation, called into question the government’s effort to eliminate the 10-day reflection period and reconfirmation of consent through Bill C-7. She said:

Nothing in the Truchon decision of the Quebec Court of Appeal, which the government chose not to appeal, requires this, and the Supreme Court of Canada, in Carter, insisted on the requirement of clear consent. Palliative care physicians, disability advocates and other experts insist that this is an important safeguard, and, like other legislated MAID reports on mature minors and mental disorder, advance requests also raise significant challenges.

The government clearly has its own agenda here. The Liberals appear determined to eliminate safeguards for the most vulnerable when they were not instructed to do so. This is coupled with the fact that the House has not had the benefit of a fulsome study of the original MAID legislation. The House should proceed with the adoption of our very reasonable amendments, as Canadians want them.

Finally, I would like to reiterate a point from my last intervention on the bill. The Liberals continue to lag on a national strategy for palliative care, but at the same time they are moving forward on more accessibility to MAID. The Liberals broke their promise to invest $3 billion in long-term care, including palliative care, and have yet to bring Canadians the national strategy on palliative care they promised and agreed to. Just as 80% of Canadians believe it should be easier to make end-of-life decisions, 70% of Canadians continue to live without any access to palliative care. That is why the Liberals’ approach is nonsensical.

The Angus Reid poll found that 62% of Canadians want those in this place to give due attention to the concern that our health care system might begin to ignore long-term care and chronic disease among the elderly as MAID becomes more widely accessible and routine. We are seeing this happen.

Furthermore, seven in 10 Canadians want us, as lawmakers, to consider whether increased access to assisted suicide and euthanasia will mean less investment in traditional palliative care. I dread that, but in my view that situation is already unfolding.

I refer to the Delta Hospice Society, where 10 hospice beds are at risk of being defunded because of its refusal to provide assisted suicide to its patients. The Delta Hospice Society believes that MAID is distinct from, and violates the very purpose of, the palliative care that it is very proud to provide. Indeed, President Angelina Ireland has been clear that the intention is not to overturn MAID. The society is not a threat. It only wants to uphold its approach to the end-of-life care that so many Canadians want and deserve but do not have access to.

A majority of Canadians would side with the position of the Delta Hospice Society. Again referring to the Angus Reid poll, 55% of Canadians reported religious hospitals should be free to refuse to participate in MAID on moral grounds.

Any attempt to cheapen the value of palliative care should be of concern to the House. In the words of Dr. Goligher:

The goal of health care is to help the patient flourish. Palliative care is about helping the patients flourish even as they go through the dying process. I think anything that accelerates or hastens that process and doesn't give the opportunity for reflection and so on is of serious concern.

MAID is antithetical—

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, I am really honoured to be standing in the House as we debate this very important bill, Bill C-7, in response to the Truchon v. the Attorney General of Canada.

My husband and I were discussing this last night. I can recall the night of the vote on Bill C-14. I had held town halls in my riding, sent post cards, all these different things. It was about a fifty-fifty split among constituents who wanted to see MAID pass. That day I voted for that bill. I thought there were some very important provisions in it which we had to talk about. However, as we move forward with Bill C-7, I have strong concerns.

I decided to return to the speech I made in 2016, and I wanted to share an excerpt of it. We have been going back to people's speeches to see where they were at that time. I am pretty much where I was in 2016 with respect to better safeguards. I will quote from my speech on May 20, 2016:

My role as a parliamentarian is to do the fact-finding, speaking to the constituents I represent, and making sure that I get the right message to make this decision and do what is right for my constituency and all Canadians. From that, I decided to do a lot of town halls ... I sent letters ... one-on-one meetings ... I also received many email ... campaigns.

After that, I received a letter from Dr. Carroll Harder, a physician in my riding. I want to share her from 2016 email. She wrote:

I am e-mailing in response to your letter I received requesting information on my concerns about Bill C-14. Thank you for requesting physician input. I certainly appreciate having the opportunity to weigh-in as a stakeholder in these decisions. This topic is obviously very important to me and I am trying to understand all of the implications of this for me and for my patients.

I appreciate the steps that have been put in place to provide checks and balances that will hopefully prevent abuse of this system by family or health care providers. I am concerned that many groups are calling for less restrictions than those that are currently in place dictating who applies for this and who is ineligible. I would ask that you, as our representative, continue to advocate for stringent restrictions with multiple layers of accountability to prevent abuse of this legislation.

Based on that foundation, I started to look at Bill C-7. I have watched the hours and hours of committee business. Excellent amendments were proposed but were turned down. I thought my vote would be yes, but I have turned it into a no. I have not been swayed by the government and I have not been swayed by anything other than those disability groups that are very concerned about the bill. Then I go back to where I was in 2016. The point is that our job is to protect all Canadians. Our job is to represent Canadians.

What I see in the bill just does not fit. When I look at what the doctor has requested and at all the testimony from the justice committee, I do not think we are doing due justice. Tomorrow we will be celebrating International Day for Persons with Disabilities. We are not doing them justice. We are not listening to them and that is why I have this huge concern.

Unfortunately, because these amendments were left out of the bill, I have changed my vote to no. We had a great opportunity to make this a better bill in committee.

I take all these social issues to heart. I speak to people and they help make these decisions. I think about a gentleman whom I just spoke to on Saturday, Rick Arkell. I recall speaking to Rick years and years ago when I was constituency assistant working for Joe Preston. I recall him calling the office. When I spoke to him on Saturday, he said he wanted MAID.

I know that when I voted on Bill C-14 and made that decision to support, it was the right decision. However, when he and I talked about this, he too understood why I could not move forward on this. This gentleman has multiple complications such as diabetes and heart issues. When combined, they are making his life very difficult. I asked him if he could please send me some more information because I wanted to share his story. This story is not about people who do not want it; it is about people who do want, but ensuring precautions are there.

Instead of his being upset with me for saying I was going to vote against it, he asked how he could help because he knew we wanted better legislation. It comes down to that.

This is a very sad story. As I spoke to him on Saturday, I was not sure what my next steps were. I was not sure if I should go over there and try to counsel him or if I should be a parliamentarian and just ensure that the legislation was right. I am still caught on that.

For a number of years he has been trying to get medical assistance in dying under Bill C-14. This is his email:

“My euthanasia target is 60 days or less. I value and respect your point, however, I most assuredly am not going to enjoy the summer or any time thereafter and God willing, I will be dead in six months or less, whether by MAID, naturally or do it yourself. I have taken 250,000 milligrams of acetaminophen prior to our meeting as I did with Dr. Kay, thinking of the tears, groaning, crying in pain, stumbling and face plants, which were not necessary in fact, not to mention I was attempting to demonstrate that I can live independently. I do the same any day. I go out in public, appointments, shopping, etc. As I mentioned, I am not seeking immediate death since I am working to get my affairs in order as quickly as possible and to find homes for my cats. In order to do that, I need to remain independent. In the interim, I am seeking ways to cope such as I showed you. I still definitely want to seek assurance and peace of mind that MAID approval would provide.”

It is really interesting because we are talking today about witnesses and all those different things that are necessary to ensure people can go through this process.

We talked about palliative care. I am watching this man who is suffering, who does not have an option because palliative care is not available. We can sit here and say that MAID is very different. MAID is different if people cannot get it and do not have palliative care. That is why people say let us go for MAID because there is nothing better.

We just heard it from my friend from Port Moody—Coquitlam. She talked about someone who was willing to go through MAID rather than being in lockdown any longer. Those are huge concerns and we need to listen to that. These are people's stories. We need good legislation and we do not need to put them at more risk. That is what I see in the bill.

When we have had disabilities groups come forward, when the Senate, under a pre-committee study, has 91 different people testifying against this legislation, that should tell us something. It is not one or two people from specific groups who are talking. They are Canadians and Canadian families that are bringing forward their personal stories on what they go through each and every day. We are not making this right. By making MAID a better program so people can get it easier is one thing. However, we should ensure we have a full program that allows choice. I am fearful that this does not offer choice. It offers a choice to take MAID or to live uncomfortably. When I look at Rick, I think this is what is happening to him.

I am also very fortunate because I represent the great organization ARCH. ARCH is located in the community of Lambeth in London. It wrote to senators, and I want to leave members with this:

Dear Senators,

ARCH Disability Law Centre (“ARCH”) makes this submission as part of your pre-study of Bill C-7 – An Act to amend the Criminal Code (medical assistance in dying).

ARCH is a legal clinic dedicated to defending and advancing the rights of persons with disabilities in Ontario. ARCH also advocates for the rights of persons with disabilities nationally and internationally. ARCH has expertise in Canadian human rights and equality rights law as it relates to persons with disabilities, national and provincial accessibility laws...

I recognize that I do not have a lot of time, so I will sum this us. ARCH is extremely concerned with this. It put forward concerns because it was looking at effective safeguards, which it does not see in the bill. It is clear to me that if people are telling us that this is not going to work for them, and there is a whole lot of them, then we should start listening. That is why I am concerned with the government moving forward with the legislation without including the amendments that have been put forward. It is not doing what is best for Canadians.

I will continue to encourage the government to please think again. Do what is best for all Canadians and let us put the interests of all Canadians first.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Madam Speaker, it is an honour for me to rise in the House today as one of 338 federal lawmakers in Canada whose duty it is to make good laws that will have a positive impact on the lives of Canadians now and for generations to come.

The weight of my duties as an MP have become more evident as I have been serving my constituents through the pandemic. Canadians have been struggling intensely for nine months as a microscopic organism called the coronavirus has caused us to shut down our lives and institutions on so many levels.

Today, as I speak on Bill C-7, an act to amend the Criminal Code on medical assistance in dying, the weight of my parliamentary role is compounded because what I say today may be the most important thing I have spoken about in the 12 months I have been an MP. Today, I am compelled to speak from the depths of my heart, conscience and love for my fellow humans, and nothing less, because the very flow of life and death in our nation is in my hands and the hands of each member of this House through Bill C-7.

Bill C-7 came about after the Superior Court of Quebec struck down the reasonably foreseeable natural death clause of this legislation as unconstitutional. This ruling resulted from a case of two individuals with degenerative diseases, Truchon and Gladu, who had sought to repeal this provision in the law and access MAID. The judge asserted what the plaintiffs were really looking was for the law to recognize equally the suffering, dignity and, ultimately, autonomy of people who, like them, are affected by serious and irremediable health problems without any hierarchy, whether death is near or not.

Bill C-7 would eliminate the clause that requires a 10-day waiting period between when MAID is requested and when it can be administered when death is reasonably foreseeable. Bill C-14, the original MAID bill that was given royal assent on June 17, 2016, already allowed for this period to be waived under specific circumstances, which are if two medical practitioners are both of the opinion that the person's death or the loss of their capacity to provide informed consent is imminent, or any shorter period is considered more appropriate by the first medical practitioner or nurse practitioner in the circumstances.

Many lawyers, doctors, families and advocates for individuals with disabilities feel Bill C-7 has gone beyond what the ruling in the Truchon-Gladu case called for. They feel Bill C-7 is discriminatory to the disabled and risks the abuse of MAID.

Amy Hasbrouck, a representative from the group Not Dead Yet, said this about the court ruling in a press interview: “Basically this decision is saying that as far as society's concerned, it's better to be dead than disabled”. Hasbrouck feels governments should improve services for people with severe disabilities to help improve their quality of life and allow them to continue living in their own homes.

This bill has also raised the concern of deepened challenges on the conscience rights of doctors. There are limited protections for the conscience rights of medical professionals already, and loosening restrictions will cause greater strife to those already uncomfortable with MAID. Throughout the debate, Bill C-7 has raised a lot of concern that as it expands MAID accessibility, it risks palliative care suffering. As a result, patients will view MAID as a better option. Unless there is more focus on improving and expanding palliative care so that palliative care is more accessible, MAID may appear to be the more practical solution for Canadians.

I now speak on Bill C-7 as a potential trigger to another pandemic within a pandemic. Canadians are currently experiencing multiple pandemics within the pandemic. They are struggling with depression and anxiety about their future because of economic uncertainties and collapse. They are facing social isolation. Although uncertain about the full ramifications of the coronavirus, in order to prioritize and protect the health and safety of Canadians, multiple tiers of government across our nation opted to take drastic measures throughout the pandemic with lockdowns and travel restrictions, which have infringed on some civil rights.

Social isolation is putting seniors in a mental health crisis. Recently, Nancy Russell, a 90-year-old woman living in a seniors home, chose MAID because she did not want to go through another lockdown or isolation this winter. According to some MAID practitioners, there is a trend of more reports of seniors interested in MAID and accelerating their timelines because of COVID.

I would like to ask each member in the House this: Is the passing Bill C-7, with its safeguards removed, during a pandemic, when Canadians are vulnerable to depression and suicide, a responsible and timely action? The government had the option to appeal this, but it chose not to.

I fully appreciate that the debate on Bill C-7 brings issues of compassion, dignified death, suffering and personal rights into a complex but profound discourse. Medically assisted death is complex, and debates on human rights are important, but in this time of severe and drastic measures to protect lives and keep Canadians safe from a virus that has the potential to take many lives, the government has entered into emergency mode. It has put health and safety above many important things.

We have allowed the economy to fall apart to flatten the curve and save lives. Canadians put a precedent on saving lives over some basic rights.

Rights do not exist in a vacuum. They exist to support the overarching vision and mandate, which I hope unifies all of us in the House, which is to protect the lives, sustenance and flourishing of humans; to ensure all people, regardless of who they are, their behaviour, ideology or capacity, to be functional in life; to protect their existence and sustenance needs; and to provide individuals with fair opportunities to dream and make the most of their lives. I understand the principles of debate and rights, but in the context of this pandemic we are facing, my humanity and my heart burn like a mother bear for the lives of Canadians.

In a recent report from the Canadian Mental Health Association, 3,800 Canadians died in 2018-19 after being admitted into hospitals for self-harm. With the stress, hopelessness and trauma created by the pandemic, that number is on the rise, especially for the most vulnerable.

In a survey held by CMHA in May during lockdowns, 38% of the people surveyed said that their mental health had declined due to COVID-19, 6% had suicidal thoughts and 2% had tried to harm themselves in response to COVID-19. Based on this survey, if there are 30 million adult Canadians, then it would mean that 1.8 million adult Canadians have had suicidal thoughts and 600,000 have tried to harm themselves as a result of the challenges caused by the pandemic.

The count for the number of Canadians who have died from COVID-19 is 12,211 from yesterday's numbers. If only 6% of the 3,000 Canadians who participated in the survey had suicidal thoughts, that would still be 180 people. What does that translate to in Canada's entire population?

More survey results show that not everyone is affected equally. While 6% of the general population have had suicidal thoughts since the outbreak of COVID-19, suicidal contemplation has been happening with 18% of people already struggling with their mental health, 15% of people with a disability, 14% of people with low incomes and 16% of people who are indigenous. This is not fair.

This is the question I would like to ask all members: Do we, as members, take mental health seriously? Do we recognize that extraordinary suicide prevention must be part of our COVID response? Do we see the danger of passing a bill such as Bill C-7 in the context of a pandemic where we see rising numbers of mental health challenges and suicidal contemplation?

The mental health side of the pandemic does not end with a vaccine, because healing from trauma and financial restoration takes time. What is the message we want to send to the Canadian public right now as parliamentarians? In the name of saving lives, we have allowed families to be separated, and we have allowed businesses and institutions to be pulverized, but what support are we providing to counter the depression and hopelessness that comes from these drastic measures? We should be more focused on creating more access to counselling and mental health support.

For those who say that mental health is a provincial issue, I would say to them that mental health is a serious issue and one that all tiers of government must come to the table to discuss and implement solutions for. We have a responsibility as lawmakers to look at the big picture and understand the time we are in right now.

We do not see suicides reported, but all of us know someone, whether directly or by one or two degrees of separation, who has attempted or committed suicide. Let us be sober. The bill before us could open doors to a suicide pandemic during this pandemic. Our duty is to pass legislation that protects the life, sustenance and flourishing of our fellow humans and not make them more vulnerable and susceptible to death.

Canadians need hope. Will my colleagues, with a clear conscience, be able to say that they did everything they could to prevent suicide? Will they be able to say with conviction that they had helped someone find hope and not have to resort to death?

I want to be wrong. I hope there is no suicide pandemic, which the unpredictable waves and lockdowns of COVID-19 would exacerbate, but the government has chosen to put the priority of saving lives at a high cost. Were the drastic measures reasonable or too severe? I think most Canadians would say that saving lives was worth it. Will it be worth saving lives by stopping the spread of a culture of suicide through a bill like Bill C-7 during this pandemic?

The very life breath of Canadians are in our hands right now. I cannot support the bill in the name of mental health and saving lives in this pandemic. I do not want blood on my hands for the death of any Canadians who were inspired by the passing of Bill C-7 to cope with mental health challenges and hopelessness during the pandemic, especially when we do not have enough to give them more hope.

Being a parliamentarian comes with responsibility. Ideology comes with responsibility. Legislation comes with responsibility. Legislation is not separate from the current plight Canadians face. I encourage every member to examine this bill, recognizing there is not enough hope to safeguard against the dangers of Bill C-7.

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, I apologize for the difficulties we were having.

I do not believe that I was speaking about the uncertainty of a physician's diagnosis. I have been speaking about the safeguards that are being removed from this piece of legislation that allow for an individual to take time to reflect on the diagnosis they have received and to have conversations, not only with their family and friends but to look for a second opinion should they wish to do so.

With regard to how we ensure that federal legislation and provincial legislation work well together, we have previous legislation that has been in place since Bill C-14. We now see where a judge has made a ruling that the government should have appealed.

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, I appreciate the opportunity to speak at report stage of Bill C-7, an act to amend the Criminal Code, medical assistance in dying, with which the government is seeking to dramatically expand the existing euthanasia regime in Canada.

The government claimed to want to protect vulnerable Canadians. It claimed to be open to our amendments. I see no evidence whatsoever for either of these claims.

Despite knowing full well the concerns that numerous groups had, including those disability rights groups, with the pre-prorogation version of the bill, the minister reintroduced the exact same legislation word for word. In fact, the bill even has the same number. The minister refused to pre-emptively adopt any of the proposed amendments, and has hidden behind the Truchon decision throughout this debate.

What of the Truchon decision? First, it is beyond unacceptable that the Liberal government did not appeal the Truchon decision to the Supreme Court. Truchon struck down vital protections for vulnerable Canadians, protections that this very government put in less than five years ago. Not only would appealing this decision have brought necessary clarity to the legal status of federal euthanasia legislation, it was also the right thing to do.

Instead, the minister used the Truchon decision, which struck down the reasonably foreseeable death requirement in the province of Quebec, to justify a wholesale abandonment of euthanasia safeguards put in place by the previous minister, the member for Vancouver Granville, and the creation of an advanced consent framework, open to any number of abuses.

That member for Vancouver Granville raised these concerns in this place. She said:

Nothing in the Truchon decision...and the Supreme Court of Canada, in Carter, insisted on the requirement of clear consent. Palliative care physicians, disability advocates and other experts insist that this is an important safeguard, and, like other legislated MAID reports on mature minors and mental disorder, advance requests also raise significant challenges.

However, the minister refuses to listen. A statutory review of the impacts of Bill C-14, required by law, has not been undertaken. That review is mandatory to ensure that the safeguards in place are effectively protecting the elderly and infirm Canadians from manipulation and abuse. Instead of waiting to make these changes until the mandatory review was completed, the Minister of Justice pushed forward his own ideological stamps. He blindly pushed Canadians into the dark instead of the light. Sadly, I am not surprised the minister would push this ideology on vulnerable Canadians. When Bill C-14 was introduced, after all, he opposed his own government's legislation. Now, as the minister, he is refusing to listen.

It has always been my priority and that of my colleagues to ensure that any legislation on euthanasia and assisted suicide includes strong safeguards for the most vulnerable in our society as well as for the conscience rights of health professionals. This is clearly not the minister's priority. Instead, by allowing advanced directives for assisted suicide without any legal assurance that individuals will have the opportunity to change their minds and with Liberal members voting down an amendment that would have required those seeking euthanasia to be given an opportunity to refuse it on the day in question, could mean that people could be legally euthanized in their sleep without any opportunity for them to change their mind. This is horrifying. How can the Liberals possibly justify this?

Inclusion Canada, a disability rights organization, has stated that the legislation is its worst nightmare and that it is a moral affront to equate euthanasia to an equality right. The minister still refuses to listen.

The most egregious, in my view, is the removal of the 10-day waiting period and the need for two independent witnesses. The Liberals also voted against a seven-day-waiting period amendment proposed at committee. They made a deliberate choice to strike down one of the most important safeguards for vulnerable people facing uncertain medical prognosis and have opened Pandora's box to same-day death.

Each of us can think of someone in our lives, perhaps a friend, a grandparent or even a spouse, who has received a serious medical diagnosis. The emotional impact of hearing that news can be overwhelming for both the patients and their families. It can cause depression, anxiety and a great fear of the unknown, especially now in the face of the ongoing pandemic.

Many of us can also think of loved ones who have received terminal diagnoses, only to beat their illness and live for years afterward. However, with the safeguards of two independent witnesses and a 10-day waiting period gone, such stories will be fewer and further between. Without a mandated length of time to collect themselves, to receive support from their families and to learn about treatment options or get second opinions, some people will make emotional decisions based on fear.

Taylor Hyatt, a young woman with a visible disability, shared her experience while suffering from pneumonia and in need of oxygen to help her to breathe. She said:

After taking a cab to the nearest hospital, I was immediately admitted. A couple hours – and many tests – later, the doctor was no closer to finding out what caused my illness. When she finally came to see me, at about 11pm, she said: “The only thing we know is that this infection affects your breathing. You may need oxygen. Is that something you’d want?” My answer was: “Well, of course!” She seemed surprised maybe, or unconvinced, so she asked again: “Are you sure?” I replied, “Well, of course!

Any non-disabled person would have received oxygen immediately, but instead the doctor asked her twice, leaving Taylor to believe that the doctor assumed that because she was disabled she may not want to live. What if Taylor had felt overwhelmed that day and requested euthanasia in a moment of weakness? At the time, she would have had 10 days to reconsider this choice. If this bill passes, she could have died that day and the world would have lost a great warrior for the rights of disabled Canadians. How can we allow for the legal possibility of such a tragedy?

Every Canadian should feel great shame for these failures. We are and we must be better than this. Every great or good society is judged by how it treats those deemed to be the least among them. How can we claim to be either great or good if we treat the Taylor Hyatts of our nation as if their lives are less valuable than our own. We must protect the innate dignity of every human life, knowing that nothing, not time, not illness, not disability, can ever take that dignity away.

Still, the minister refuses to listen. He is ignoring the statutory review but only to weaken protections, not to strengthen them. Not only has he torn down protections for vulnerable Canadians, he has placed medical professionals into an even more precarious position than the current regime by expanding the eligibility and thereby the number of medical professionals who are impacted. The Liberal members voted down an amendment that would have protected the charter rights of medical professionals, trampling their rights in the rush to a predetermined ideological end goal.

Tens of thousands of doctors believe, truly and wholeheartedly, that taking part in an assisted suicide breaches their calling to do no harm. Those beliefs are protected in our charter, but not in this, nor in any other federal legislation regarding euthanasia. Such a glaring omission makes it clear that this minister's priority is not to protect the rights of Canadian citizens but to push his ideology as far as possible. That is something I cannot and will not support.

I would plead with the other place to take the time needed for a sober second thought, removed as they are from the minister's ideological fixation, because the minister is refusing to listen.

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

Madam Speaker, it is a pleasure to be here today because a lot of things need to be said about Bill C-7. For those who are not aware, it is an act to amend the Criminal Code with respect to medical assistance in dying.

Members know I was in Parliament when Bill C-14, the predecessor of this bill, was debated. I heard the debate and discussions about the safeguards that needed to be put in place to make sure we did not go down the slippery slope that many other countries went down when they began to allow assisted suicide and branched further into euthanizing individuals.

Knowing all the discussion and thought that went into the reaction to the Carter case, I am very troubled and disappointed that when the Quebec lower court ruled the reasonably foreseeable death provision was unconstitutional or would not be accepted in Quebec courts, the government did not put this forward to the Supreme Court. I feel as though the Supreme Court was involved in the Carter decision in the first place, as it laid out the provisions it thought would be reasonable. A reasonably foreseeable death was one of them, so this should have gone back to it for commentary before coming to this place.

With that in mind, I am also disappointed that the government has not moved forward on the palliative care provisions that were also a clear recommendation from the special committee that studied the Carter decision. It said that without good quality palliative care, we do not have a real choice.

As members know, I brought a private member's bill to the House on this, which was unanimously supported here and in the Senate. I worked with the health minister of the day to put together a framework across Canada to get consistent access to palliative care for all Canadians, because 70% of Canadians have no access to it. As per the Carter decision and the special committee, if we do not have good quality palliative care, we really do not have a choice.

I was disappointed to not even see “palliative care” mentioned in the fall economic update. The words were not even there. The fact the government would prioritize expanding medical assistance in dying without the input of the Supreme Court and without putting provisions of palliative care in place seems to be the wrong priority. Let us let people live as well as they can for as long as they can instead of encouraging them to die. I think that is where we as compassionate Canadians want to go.

Another thing the Liberal government fell down on is the choice not to do the five-year review. When Bill C-14 came through, one of its provisions was about looking at the situation after five years so we would understand whether or not the rules that were put in place were being followed, were adequate and met the intended purpose. That was not done. This was a perfect opportunity for the government to do that work, because we heard anecdotally that in many cases across Canada, the existing rules and safeguards have not been followed. We need to get a quantitative analysis on that and understand how these things could happen and how we can prevent them from happening in the future.

It is disturbing, then, that the government has decided, without doing the five-year review, to make changes to what is happening with respect to medical assistance in dying beyond what was asked for by the Quebec courts. Doing something without reviewing what one already has in place is irresponsible, in my view.

Given that, I have some concerns. The government has removed many of the safeguards put in place in the bill to keep those unfortunate things that we worried about when we were discussing C-14 from happening. For example, there is the 10-day cooling-off period. As anyone who has had relatives suffering through irremediable conditions knows, they have good days and bad days, and on the bad days they can feel like they want to die.

My mother just died in October. At the very end, she was in a lot of pain. I talked to her about medical assistance in dying and it was not something she wanted; she wanted palliative care. I am fortunate that in Sarnia—Lambton we have palliative care. One day she told me she was really thinking about it, but the next day it was not something she wanted, so I really think that 10-day cooling-off period was an important safeguard.

I am sympathetic with one of the changes that was put in, although it should have been put in after the five-year review. It says that once people have signed off on all the documents and the independent witnesses and others who understand the condition have dotted all the i's and crossed the t's, a person perhaps will not be able to give consent immediately before the procedure. I saw this in my mother's situation. At the end, she would not have been able to verbally communicate or even write to indicate her choice, should that have been her choice.

However, removing the 10-day safeguard was a mistake. The Conservatives brought an amendment to try to put it back in and explained why it was important, but it was not received.

The other thing I found troubling was the removal of the independent witnesses. We cannot even get a will without having an independent witness. It seems to me that for something as important as determining one's date of death, it should be a provision.

In Ontario, there is another difficulty, which has to do with conscience rights. There are people who do not want to participate in medical assistance in dying for religious reasons or for personal reasons of conscience, and that is their charter right. This means they do not want to participate in the act and do not want to refer. They do not want to have anything to do with it. In Ontario, medical people are being forced to at least refer. That is still a violation of their conscience rights, and it is troubling that in the debates on Bill C-7, when I asked these questions the Parliamentary Secretary to the Minister of Justice said there are plenty of safeguards in there and it is okay. No, it is not okay. They are still violating rights of conscience and that needs to be addressed as well.

A modified advance consent was opened up to allow people to indicate, 90 days in advance, that they want to have this procedure. Advance consent was studied by one of the committees chartered by Parliament. Its recommendations said that a lot of things need to be considered before we go down the advance consent path. The government has not really done its five-year review, and I remember the member for Vancouver Granville commenting on this very point. There is a lot to be thought out there, and if we do not do it correctly, we will once again have a situation where the intent of the bill is not going to be met. There are going to be new violations in the way we have heard anecdotally, and that will not be a very good situation.

I was happy to see in Bill C-7 the clarification to indicate that if the sole underlying medical condition is mental illness, individuals are not eligible for medical assistance in dying, although there is some controversy there. I have heard from groups across Canada that are calling on the government to allow individuals whose underlying suffering condition is mental illness to receive medical assistance in dying. I think it is not a good idea, and I believe this is in line with what was said by the committee that studied this part of medical assistance in dying. It said many of the mental illness conditions, such as depression, could be treated. These are treatable conditions, not irremediable conditions, and some are glad to see this loophole closed.

The bill intends to:

permit medical assistance in dying to be provided to a person who has lost the capacity to consent to it as a result of the self-administration of a substance

We talked about this when Bill C-14 was in this place. At that time, we were not sure about the method of application of medical assistance in dying, whether it could be done with a prescription or not, and there was a concern: What if the procedure went wrong and a person cannot give consent? What do we do then? I am glad to see that situation was addressed in the bill.

Overall, those are my concerns with Bill C-7, and I think the government needs to go back to the drawing board on it. As 50% of the Canadian public seem to be concerned about the existing bill, such as people with disabilities and mental illness, let us go back to the drawing board.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I am very pleased to be joining the debate on this issue. It is an important one, and I want to make sure I reflect what my constituents have been telling me on Bill C-7. The vast majority of them want me to vote against this legislation because it would remove a great many safeguards. It would also, in my view, violate some of the intentions set out in the debate we undertook on Bill C-14.

I remember this was a deeply, deeply personal issue for many parliamentarians in the last Parliament, and it is a deeply personal issue to many of my constituents now. They have stories of loved ones who have grievous chronic conditions and were found to be ineligible because of the way Bill C-14 was structured, but they found solace in the fact Carter had paved the way at the Supreme Court to allow for this exemption to the assisted suicide provisions in the Criminal Code. While this is a debate that is deeply personal to parliamentarians and constituents, the law is not, and the law has to be as clear as possible.

In preparing for this debate, I went back and looked at Hansard to see what I had said previously on this. I had problems with the term “reasonably foreseeable”. I could foresee that a judge at some point would strike down this provision. That is exactly what I raised as an issue with Bill C-14 at the time, and it continues to be an issue in Bill C-7.

“Grievous and irremediable” is the term used in paragraph 127 of the Carter decision. I am always worried when I start quoting decisions of various judges, as I remember it was H. L. Mencken who said that judges are simply law students who grade their own exams.

However, I went through the Carter and Truchon decisions again in preparation for this after hearing the excellent contributions at second reading debate by my colleague, the member for St. Albert—Edmonton. He rightly pointed out that this should have been appealed to the Supreme Court, the original judicial body that decides the laws of the land and if they conform with our Constitution.

Paragraph 682 of the Truchon decision reads:

Individuals in the same position as Mr. Truchon must be allowed to exercise full autonomy not only at the end of life, but also at any moment during their life, even if this means death, where the other eligibility conditions for medical assistance in dying are met.

Looking at the Carter decision, it does not conform to Truchon. Again, this should have been appealed to a higher court. Bill C-7 goes far beyond what was in the Truchon decision and what that single Justice Baudouin said. I really think the government did a great disservice to Canadians by not appealing the decision in order to get a final verdict for parliamentarians to be able to legislate on this question. At the end of the day, we are supposed to be the ones who legislate on behalf of our constituents.

I have concerns many of the safeguards we have talked about are being eliminated. There is a doctor in Calgary, Dr. Thomas Bouchard, who said that the way the government is legislating on this question is reckless. As well, the timeline is incredibly rushed. I would much rather hear from more parliamentarians in the chamber reflecting on the views they are hearing from their constituents, so we can get this right the second time around, now that we are relying on the Truchon decision in the matter.

The UN rapporteur on the rights of persons with disabilities said that MAID violates the right to life of persons with disabilities. I had a disabled daughter who passed away in the last Parliament, and I cannot but think that had she been able to grow up to be an adult that she would have been placed in an awful situation. I likely would have been her guardian in her later years, and I would have been placed in a situation looking after a loved one who would be rendered eligible for MAID. I cannot be there all the time.

I have had many constituents tell me they are concerned about their minor children and whether, once they have grown up and become adults, they will be able to be with them all the time to ensure that, when they go to the hospital with a medical condition, MAID is not pushed onto them. My constituents are concerned that MAID may be pushed on them because palliative care options may not be there. They are concerned the chronic conditions that are found to be grievous, irremediable and cannot be cured with current medical technology would lead to them being pushed into MAID by physicians, whether rightly or wrongly.

My colleague from Foothills and my colleague from Abbotsford raised excellent points, and I do not want to retread on the same matters they spoke about.

Constituents in my riding have constantly told me that they understand the debate on whether medical assistance in dying should exist in Canada. It was settled in the previous Parliament in Bill C-14. The question before us is what types of safeguards need to be place.

In the Truchon decision rendered by Justice Beaudoin, it says that it should be open to people beyond what the Carter decision of the Supreme Court said. This is the box that Parliament should legislate within. We have to be conscious of that. Just as I have issues with death needing to be reasonably foreseeable, there were ways that we could have fixed those issues, but not with what is in Bill C-7. It goes far beyond what Truchon called for in any of the sections. In reading the decision, I do not see Bill C-7 meeting those goals.

Every single step in the process is a safeguard for that a person. They may change their mind, reflect on the questions, or obtain access to better palliative care or new technologies that render care for them better and simpler, or perhaps relieve them of a chronic condition.

I am thinking of my other three live-in kids, who have a chronic kidney condition called Alport Syndrome. It is incurable right now, and it leads to kidney failure eventually. I do not know if many members have spoken to those who are on dialysis, but it is deeply unpleasant.

I know one person on dialysis who does half marathons. I have walked 100 kilometres in the Kidney March right next to Said, who lives in my riding. He is a two-time kidney transplant recipient. He told me how difficult dialysis is and how one's mental health suffers from it.

He explained the difficulties around it, but he persevered and went through it. I think of my children in the future. If a cure is never found for their Alport Syndrome, and they are on dialysis or waiting for a kidney transplant, what will the options set before them be? What will be the safeguards available for them when the time comes and perhaps they want to make decisions and a choice like that.

I have had constituents who are surprised by their family members having made a request for medical assistance in dying at the hospital. They were completely unaware of. That should be taken into account. That is why the 10-day cool down period allows family members to be in the know.

All of our deaths are reasonably foreseeable. That was my complaint on Bill C-14 in the last Parliament. However, we do not have to die alone, and family is there for those types of difficult places. I was there for my daughter when she passed away. Even though we may consider this debate difficult, after a judicial decision, we have to get it right. Our personal views should be set aside. What our constituents believe to be the right thing to do in this matter matters the most.

I am trying to reflect what I have heard from my constituents who have express deep concerns over the lack of safeguards. Too many of them are being eliminated merely four years after the previous legislation was passed in Parliament. This is probably going to be the most important debate that many of us have in the scope of our parliamentary careers. I know that is what I will think after my time in Parliament is done. This will have been the capstone, the greatest, most important debate.

I want to reflect what my constituents have said. While dying with dignity is a slogan I have often heard, so is living with dignity. We have to ensure we put the resources and the time. We have to ensure the ability to protect our physicians and nurse practitioners, who are providing this service in the different provinces and territories, and that proper safeguards are in place, so that those who are vulnerable, those who are disabled, are not looked upon as the next person for whom MAID should be offered.

Safeguards are important. This legislation does not meet the expectations of my constituents. I will have to vote against it.

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

Madam Speaker, by way of clarification, amendments were accepted at committee. One was by the NDP with respect to accessing expertise in rural and remote communities and one by the Green party in respect to ensuring consultation happens between the Minister of Health and the Minister of Disability Inclusion.

Over the last couple of days we have heard a lot of debate on safeguards and why some safeguards are being eased while others are being increased. What I would put to the member is that we have the benefit now of four years of data after the advent of Bill C-14 in the last Parliament. What that data has shown us, and what the results have shown us, is that some of the safeguards were not doing the work they were intended to do.

The 10-day reflection period, for example, was prolonging suffering among those who were availing themselves of MAID because some were ensuring they would be able to provide final consent on that 10th day by depriving themselves of their own pain sedation medication.

Does the member agree that, in certain instances, safeguards like that need to be revisited and altered to address the need to be compassionate and alleviate suffering?

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, of all the pieces of legislation that I have debated in the House over the years, this one, Bill C-7, more than any other, deeply distresses me.

Four years ago when the Supreme Court created the right to assisted suicide in Carter, whether we liked it or not it became the law of the land. The court also set out the parameters of what that right entailed, and those parameters were addressed in Bill C-14 with the appropriate safeguards built in. Among those safeguards the most important was, arguably, that death had to be reasonably foreseeable in order to qualify for medical assistance in dying, or MAID.

Fast forward to 2019. In a puzzling decision from a Quebec court, a single judge ruled in Truchon that parts of the federal law on MAID were unconstitutional because, in her view, they were too restrictive. Among the safeguards deemed too restrictive was the requirement that death be reasonably foreseeable. One single judge of a lower court made a decision for all of Canada that was literally about life and death. What is worse, the Liberal government chose not to appeal this decision to the Supreme Court. Canadians have a right to ask the Prime Minister why not. Instead of appealing the case to determine whether the nine justices of the Supreme Court agreed with the lower court judge, this government immediately brought forward new legislation, presumably because Truchon reflected the Prime Minister's own ideology.

The new bill is a dramatic departure from the protections included in the original MAID legislation. It has confirmed the fears of many: that the initial legislation represented the crest of a steep, slippery slope towards a much more expansive and dangerous approach to euthanasia.

One of the primary functions of government is to protect the lives of its citizens. In fact, the right to life is expressly enshrined in our charter. Sadly, the bill before us fails to protect the lives of our most vulnerable. It would remove the critical safeguards contained in the original MAID legislation. Removing these safeguards would have irreversible consequences. What is deeply disturbing is that Liberal MPs steadfastly refused to allow additional hours of debate to ensure that the law would reflect the will of Canadians, and they obstinately refused to accept reasonable amendments to Bill C-7 that were brought forward by our Conservative MPs.

These amendments were supported by a broad cross-section of stakeholders and included things such as leaving in place the 10-day reflection period before choosing death, ensuring the right to withdraw consent and protecting vulnerable patients by requiring the patient to be the one who first requested information on MAID. These were eminently sensible amendments that supported the autonomy of the individual while protecting the vulnerable, so it is fair to ask why the Liberal government did not support these amendments and why there is a rush to ram this legislation through the justice committee.

The Truchon case also highlights the role that judicial creep plays in the evolution of social policy in Canada. Four years ago, many of us expressed great apprehension that the original Bill C-14 would be expanded by future court decisions, and that these decisions would leave more vulnerable populations exposed to the reach of medically assisted suicide. Although our concerns were summarily dismissed at that time, Truchon and Bill C-7 have fully borne out our concerns, which is why more and more disability groups, I believe around 72, have set the alarm bells ringing and are vehemently opposing this legislation. They argue that this legislation amounts to “a deadly form of discrimination”, making it easier for disabled persons to die than to live. Again, piece by piece, the protections for the vulnerable that were promised in the original assisted suicide bill are being stripped away. In the future, things can only get worse unless we say a clear no to Bill C-7.

I have great sympathy for our fellow citizens who suffer from intolerable pain and are pleading for relief. Concern and compassion are hallmarks of life in Canada, and are qualities I hope we never discourage or disparage. However, I would also hope the primary focus of care for these individuals, at least in the first instance, would always be a higher level of palliative care.

What the government has done instead is focus on expanding the opportunities for Canadians to end their lives rather than improve them. This bill would allow Canadians with a mental illness or other disability to end their lives through assisted death even if they were nowhere near death. The government's own annual reporting revealed that, last year, 87 disabled Canadians who died with medical assistance had been denied access to critical disability support services. That is simply unacceptable. Canadians with disabilities deserve better.

To fully understand the slippery slope I referenced earlier, one need only look to the recent report from Dr. Ivan Zinger, Canada's chief correctional investigator, who exposed deep flaws in our current MAID regime as manifested in Canada's prisons. He cites the case of one terminally ill prisoner who was serving a two-year sentence. The inmate sought compassionate early parole to die a natural death in his community. Parole was denied. He then sought and received an assisted death. This is a gross misapplication of assisted suicide, and raises important questions about whether the government is adequately supporting Canadians who are facing difficult end-of-life decisions. Dr. Zinger has called for an absolute moratorium on all assisted suicide in Canada's prisons.

More broadly, I call into question whether the government is exercising the requisite caution and care to avoid unnecessary overreach and ensure that MAID is not abused or misapplied.

Equally disturbing is the concern that MAID would increasingly be used by the poor to escape their dire circumstances. A recent article in Maclean's, entitled “Dying for the Right to Live”, concluded that some disabled Canadians were considering MAID because they “simply cannot afford to keep on living.” The article referenced Susan, which is not her real name, who explained that because she had dietary restrictions food banks were not an option for her, and that a livable income was literally a matter of life and death. She said:

An increase [in income support] is the only thing that could save my life. I have no other reason to want to apply for assisted suicide, other than I simply cannot afford to keep on living.

How many other Susans are out there, for whom expanded availability of MAID represents a quick exit out of their circumstances? Who is next, children or perhaps Canadians struggling with mental illness who ask for assisted suicide because they fear being a burden to their family and friends? These are the vulnerable the Liberal government promised to protect. Members will recall that when the former minister of justice originally tabled MAID, she emphatically declared, “we need to be absolutely confident that we would not be putting vulnerable people at risk”, yet here we are today chipping away at the very protections that were so blithely guaranteed by our Liberal colleagues not so long ago.

I do not believe that Canadians expected that assisted suicide would be extended to those not terminally ill or near death, nor do I believe they would support MAID being used to displace a commitment to deliver a higher level of palliative care in our country. Similarly, I do not believe Canadians are in any way comfortable with the idea that our country would shirk its responsibility to the indigent by providing MAID as an escape from abject poverty.

For something as final as death and something as precious as life, should we not be taking a greater amount of time and care in debating and implementing the end-of-life options for Canadians? Instead of ushering in a new world of options for Canadians to seek death, should we not be doing our very best to incent Canadians to choose life?

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, when I last rose in the House to speak to the matter of physician-assisted death in 2016, I noted that the legislation then before us, Bill C-14, was neither the alpha nor the omega in the continuing conversations on the topic that Canadians have had for decades.

The Supreme Court had forced that legislative moment on reluctant politicians with the Carter decision, although the conversation had been simmering across society from the last century into this one.

However, in 2016, Bill C-14 brought us nowhere near where the Supreme Court had ruled Parliament must go. It was an interim step. It was a very cautious first step that was driven home with the Truchon-Gladu ruling in Quebec, which ordered that a class of people denied eligibility for medical assistance in dying by Bill C-14 were indeed entitled to access medical assistance in accordance with the Carter ruling.

The legislation before us now, Bill C-7, as amended in committee, under-amended I believe, and I will get to that in a moment, goes considerably beyond Truchon-Gladu. That said, the past five years of medically assisted death has brought Canadian society to a much more accepting place than in 2016; that increased acceptance of the practice justifies the additional provisions included in Bill C-7.

To my point that Bill C-7 was under-amended by the justice committee, the Conservatives hold that, for a variety of reasons, not least of which the WE scandal prorogation that wasted six valuable weeks in the summer, Bill C-7 has been indecently rushed through committee with not nearly adequate consultation. In the shadow of time allocation, signalled by the Liberal House leader last Thursday, it seems it will be denied adequate debate now during report stage.

This flawed process makes even more important the separate full and comprehensive parliamentary review of medically assisted death demanded by Bill C-14.

At committee, the Conservatives proposed nine amendments to better protect vulnerable groups, reasonable amendments, all rejected by the Liberals, but amendments which I hope Senate colleagues will consider in the upper house. I say that with some expectation of that actually happening as a result of testimony before the Senate's legal affairs committee last week by the Minister of Employment, Workforce Development and Disability Inclusion. In fact, the minister endorsed exactly the same point as was proposed by one of the Conservative amendments, which was voted down by Liberal members of the House justice committee. She said, unambiguously, that health practitioners should not be allowed to discuss the issue of assisted dying until a patient asked.

Admittedly, this is a particularly difficult issue and one of context. I understand why anyone, but particularly a person with disabilities might feel improperly, even terrifyingly pressured, depending on how the matter is raised by a doctor. There is quite a difference between a physician informing of a range of choices facing a seriously ill patient and directly recommending assisted death.

The Canadian Nurses Association advised the Senate committee that the law should explicitly allow doctors to raise the issue with patients, as did the Canadian Association of Medical Assistance in Death Assessors and Providers. Dr. Stefanie Green told the committee that it would be unprofessional not to lay all the options on the table. I am sure we will all follow Senate dealings on this question very closely.

The disability inclusion minister testified as well before the Senate committee that she was open to considering an amendment to Bill C-7 that would impose a 12-month sunset clause on the proposed ban on individuals suffering solely from mental illnesses to seek an assisted death. Legal experts have made it abundantly clear that if that clause remains in Bill C-7, it is destined, almost certainly, to return to the Supreme Court where it will almost certainly be found to be unconstitutional. This is another consideration to watch closely.

Over the years since Bill C-14 was passed, and now as Bill C-7 is being rushed to law, a dark cloud has hung over discussion and debate, and that is the government's still unkept promise, a broken promise actually, to better provide choice, a meaningful alternative to physician-assisted death.

In 2015, the Liberals made a campaign commitment to invest $3 billion in long-term care, including palliative care. In fact, the importance of access to palliative care and end-of-life decision-making was one of the few unanimous points of agreement in the special joint committee's report to Parliament in February, 2016.

The government promised to expand the availability of accessible, affordable, acceptable palliative care for all those who for reason of conscience, faith or choice decided not to avail themselves of physician-assisted death. The Liberals' inconsistency in the matter of choice in other circumstances aside, this is a promise that must be fulfilled. It is essential that hospice and palliative care capacity in the country be vastly expanded to provide for those who would choose a meaningful alternative to MAID.

As I said in the House four years ago, my personal decision, which will determine my vote on this legislation, is a product of three individuals and their experiences and my own.

In my previous life as a journalist, I followed closely the unsuccessful legal crusade of Sue Rodriguez, as ALS steadily increased its smothering, deadly grip on her. I was seized by her rhetorical question posed to all Canadians, “If I cannot give consent to my own death, whose body is this? Who owns my life?”

When I first came to Parliament 12 years ago, I became close to another thoughtful, courageous Canadian, a fellow MP, the Hon. Steven Fletcher, Canada's first quadriplegic MP, re-elected three times. Steven did not give up after a life-changing accident. He met immense challenges and he overcame them.

However, in two private members' bills tabled several years ago, which I seconded, and in testimony before the justice committee in January 2016, Steven made a powerfully convincing argument for self-determination to one day make a final decision. Steven argued for a law by which an individual could make one's own decision based on one's own morals and ethics, but under guarantee there would be no pressure on that person from society, family, friends, or the facility in which he or she might be.

I was also powerfully persuaded by the tragically tortuous passing of my brother-in-law, a brilliant academic, by Alzheimer's. I informed the House during debate on Bill C-14 that should such an end one day face me, I would surely compose an advance directive and that one way or the other it would be fulfilled.

Finally, as a cancer survivor, I have had many hours of reflection during treatment and since to personally ponder the issues involved in medically assisted death and Sue Rodriguez' quite powerful rhetorical question: Who owns my life?

I am honoured to participate in this debate on Bill C-7 as I was with Bill C-14. Bill C-7 would correct the major deficiencies of the original legislation, but it is still deficient. Whatever happens in the Senate, I hope the parliamentary review, which should have occurred before consideration and passage of Bill C-7, will now more thoroughly examine this evolving law and properly lead to eventual amendments, chief among them measures to better ensure protection of Canada's most vulnerable.

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

Madam Speaker, I think it is unfortunate and inaccurate to conflate the idea of discrimination in this context.

First, the charter of rights requires that persons with disabilities be able to make the exact same decisions about their body and their passing as persons with ability, which is what the Truchon decision references.

Second, there is reference to conscience protection rights in the Carter decision, and I have already referenced that. Also, there is a reference to it in the preamble of the previous bill, Bill C-14, and I referenced that. Out of an abundance of caution after amendments that, I believe, were moved by the member for St. Albert—Edmonton in the last Parliament for further clarity, a further amendment was made with respect to conscience rights in Bill C-14. To purport that conscience rights are not protected in this legislative scheme is categorically false.

There have been assertions of a culture of coercion or encouragement towards accessing MAID on the part of practitioners. Is the member aware of any instances, not just in her province but anywhere in this country, where such instances of coercive behaviour of medical practitioners has resulted in a prosecution under the Criminal Code?

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

Madam Speaker, as a point of clarification, there are four protections for conscience rights in this regime: the preamble, section 9 of the former Bill C-14, section 2 of the Charter and paragraph 132 of the Carter decision.

In terms of persons with disabilities and respecting their autonomy, I refer the member opposite to the comments of Senator Petitclerc, former Conservative minister Steven Fletcher, and many others who have indicated that there is a heterogeneity of views among the disability community.

Last, the question I would put to the member opposite comes from the Truchon decision at paragraph 678. The court addressed the issue of the competence and dignity of persons with disabilities and said:

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

That is the court in Truchon disavowing the previous regime and requiring this Parliament to extend the regime to ensure the competence, dignity and autonomy of persons with disabilities.

I was wondering if the member opposite would care to comment on that paragraph.

Motions in amendment

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, as the saying goes, never two without three.

I rise today in the House of Commons to speak once again to the issue of medical assistance in dying as it pertains to Bill C-7, an act to amend the Criminal Code. However, this time we have a deadline set by Justice Baudouin, namely December 18, 2020, so there is a sense of urgency now.

I am likely repeating myself today, but many people here have had unique experiences involving the end of a loved one's life. I am thinking in particular of one of my old friends, Stéphane, who died in palliative care at a very young age, in his twenties. He was supported by the excellent Maison Au Diapason. He was one of the youngest patients to die there and one of the first as well. This type of assistance is essential and useful.

As the Bloc Québécois critic for the status of women and seniors, I naturally took a special interest in this bill. In this speech, I will be reminding everyone of all the work that my party has done on this important issue, while emphasizing the great sensitivity of Quebeckers when it comes to medical assistance in dying. I will conclude with the position that certain seniors' and women's groups have taken on this issue and the recommendations they made that are extremely useful, but that are already several years old. They too are starting to get impatient.

First, let's talk about the reason for this debate. In September 2019, the Superior Court of Quebec ruled in favour of Nicole Gladu and Jean Truchon, both of whom had incurable degenerative diseases. The court stated that one of the eligibility criteria for medical assistance in dying was too restrictive, both in the federal legislation covering MAID and in Quebec's Act respecting end-of-life care.

These two brave individuals, with whom I have mutual acquaintances, simply asked to be able to die with dignity, without needlessly prolonging their suffering. Mr. Truchon, who had cerebral palsy, had lost the use of all four limbs and had difficulty speaking. Ms. Gladu, who has post-polio syndrome, is not able to control her pain with medication and cannot stay in the same position for too long because of the constant pain. She has said that she loves life too much to settle for mere existence. That is what she said.

What we are talking about here is the criterion of a reasonably foreseeable death. Justice Christine Baudouin said it well in her ruling:

The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu's rights to liberty and security, protected by section 7 of the Charter.

That is the crux of our debate. These advocates had been denied medical assistance in dying because their death was not reasonably foreseeable, even though they had legitimately demonstrated their desire to stop suffering. Jean Truchon had chosen to die in June 2020, but he moved up the date because of the pandemic. Nicole Gladu is still living, and I commend her for her courage and determination.

The Bloc Québécois's position on this ethical issue is very clear, and I want to thank the member for Montcalm for his excellent work. I will not be as technical as him, but he showed us that we are capable of working together, and I thank him for all of the improvements that he made to this bill.

As many members have already pointed out, legislators did not do their job properly with the former Bill C-14. As a result, issues of a social and political nature are being brought before the courts. We need to make sure that people who have irreversible illnesses are not forced to go to court to access MAID. Do we really want to inflict more suffering on people who are already suffering greatly by forcing them to go to court for the right to make the very personal decision about their end of life? This will inevitably happen if we cannot figure out a way to cover cognitive degenerative diseases.

Obviously, we agree that we need to proceed with caution before including mental health issues, but that is not the issue today, since MAID in mental health-related cases was excluded from the bill. Once again, this matter was brought before the Standing Committee on Health via a motion moved by my colleague from Montcalm.

Second, I want to talk about how important Quebec is in this context. Quebec enacted the country's first legislation on this subject. Wanda Morris, a member of a B.C. group that advocates for the right to die with dignity, talked about how a committee that got the unanimous support of all parties in the National Assembly was a model for the rest of Canada. She said it was reassuring to see how it was working in Quebec and that people were happy to have the option to die with dignity.

However, it is important to know that this bill was first introduced by Véronique Hivon and that it was the fruit of many years of research and consultations with individuals, doctors, ethicists and patients. Whereas 79% of Quebeckers are in favour of medical assistance in dying, only 68% of people in the rest of Canada are. Those numbers are worth knowing and mentioning.

In 2015, when all parties in Quebec's National Assembly unanimously welcomed the Supreme Court's ruling on medical assistance in dying, Véronique Hivon had this to say:

Today is truly a great day for people who are ill, for people who are at the end of their lives...for Quebec and for all Quebeckers who participated in this democratic debate...that the National Assembly had the courage to initiate in 2009.

I believe that, collectively, Quebec has really paved the way, and and we have done so in the best possible way, in a non-partisan, totally democratic way.

For the third part of my speech, I would like to tell you about a meeting I had with the Association féminine d'éducation et d'action sociale in my role as the Bloc Québécois critic for status of women, gender equality and seniors. At this meeting, these brave women shared with me their concerns about this issue.

I will quote the AFEAS 2018-19 issue guide:

Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly. ... As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope. ... This process cannot be accessed by individuals who are not at the end of life. ... People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.

A brief submitted in 2010, or 10 years ago, to the Select Committee on Dying with Dignity, explained that the last moments are not always difficult because there are standards to guide medical practice and medical advances help relieve pain. However, despite everyone's goodwill, some people do have unfortunate experiences. Consequently, to prevent prolonged agony from depriving some people of their dignity and control over their lives, there are those calling for as a last resort the right to die with dignity, or the right to die at a time of one's choosing with assistance in this last stage.

Another brief pointed out that there have been four separate attempts to introduce similar legislation, specifically in 1994, 2005, 2008 and 2009, but these bills have never gone further than first reading. This needs to pass.

I will now read the conclusion from the AFEAS brief, as it is really powerful:

Over the next few months, AFEAS members will continue to reflect on the framework in which individuals losing their autonomy or suffering from an incurable, disabling illness, or experiencing acute physical or mental pain without any prospect of relief will be able to clearly and unequivocally express their desire to stop fighting to live and seek assistance to die.

Establishing the framework in which these decisions are made will be critical to ensuring that abuse cannot occur. The guidelines must be clear and precise so that all individuals can freely express their own choices, without any constraints and with full knowledge of all available options. It will be essential that all end-of-life services, including palliative care, be available and effective throughout Quebec so that patients have a real choice and do not feel forced to accept a “default” option because of a lack of adequate services or undue pressure from others.

I will also close now, in the hope that all of these comments and the lived experiences of the people in Quebec who made the request and wanted to die with dignity will afford Bill C-7 the same unanimous support from all members of the House of Commons so that we may all freely choose when we die. Let's take action.

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

Madam Speaker, I thank the member for his contributions today and in this Parliament. I offer my sympathies to him for the loss within his family.

The point I was making earlier in this debate was simply to reflect what we heard during the consultations. The 10-day reflection period is entrenched in the old Bill C-14. When Canada was embarking on this for the first time in its history, it was deemed necessary to do the work of ensuring that consideration and time for reflection was available.

What we have found four years after the fact, after extensive consultations, is that the goal of that 10-day reflection period was not actually doing what it was intended to do. As an unintended consequence it was actually prolonging suffering.

The point underscoring this difference in views on either side of the House is that when people get to the stage of asking for medical assistance in dying, they have already reflected upon it. They have already considered it and have gotten to that point after very appropriate and measured determination.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I would note that Madam Justice Baudouin, in rendering her decision and finding that the reasonably foreseeable criteria contravened section 7 and section 15 of the charter, based her analysis on only one objective of Bill C-14, namely to protect vulnerable persons from being induced in a moment of weakness to ending their lives.

The justice ignored other objectives of law, including the sanctity of life, dignity of the elderly and disabled, and suicide prevention. On that basis alone, the decision should have been appealed.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

moved:

Motion No. 2

That Bill C-7, in Clause 1, be amended by deleting lines 25 to 31 on page 3.

Motion No. 3

That Bill C-7, in Clause 1, be amended by replacing line 8 on page 5 with the following:

“(i) ensure that there are at least 120 clear days between”.

Madam Speaker, I am pleased to rise to speak at report stage of Bill C-7 and, in particular, with respect to the two very modest amendments that we in the official opposition have put forward to the legislation, namely, to maintain a 10-day reflection period and to extend the reflection period of 90 days to 100 days where death is not reasonably foreseeable. Both of these amendments are supported by the evidence that was heard at the justice committee in what was otherwise a very rushed process. It need not have been this way and it should not have been this way.

One year ago, the Attorney General should have done what we on this side of the House called on the Attorney General to do, and that was to appeal the Truchon decision. That would have provided clarity in the law and it would have provided Parliament with time to appropriately respond legislatively if necessary, but the Attorney General did not do that. Instead, he rushed ahead with legislation purportedly aimed at responding to the Truchon decision, legislation, I might add, that was introduced with very little consultation.

The legislation went well beyond responding to the Truchon decision. The legislation fundamentally changes the medical assistance in dying regime that was passed in this Parliament a mere four and a half years ago and in so doing, the Attorney General and the government pre-empted a legislative review that was mandated by Bill C-14.

As a result, what we have is a rushed process to deal with a shoddy piece of legislation that recklessly puts vulnerable Canadians at risk. It is why virtually every disability rights organization in Canada opposes this bill. Indeed, 72 national disability rights organizations wrote to the Attorney General and pleaded with him to appeal the Truchon decision. Those pleas fell on deaf ears.

More than 1,000 physicians have penned a letter to the Attorney General opposing this bill. The UN Special Rapporteur on the rights of persons with disabilities expressed concern about Canada's medical assistance in dying regime and questioned whether Canada in fact was living up to its international obligations under the Convention on the Rights of Persons with Disabilities.

I will quote Krista Carr, the executive vice-president of Inclusion Canada, an organization that represents the rights of persons with disabilities, who said this of Bill C-7, “Bill C-7 is our worst nightmare.”

Catherine Frazee, professor at Ryerson University, former chief commissioner of the Ontario Human Rights Commission and a leading advocate for the rights of persons with disabilities, said “our equality is, right now, on the line” with respect to Bill C-7. She noted that the careful balance between individual autonomy and equality carved out in Bill C-14 had been up-ended in Bill C-7.

Dr. Heidi Janz of the Council of Canadians with Disabilities said:

Bill C-7 would enshrine a legal form of ableism into Canadian law by making medical assistance in dying a legally sanctioned substitute for the provision of community-based supports to assist people with disabilities to live.

You must ensure that MAID does not weaponize systemic ableism in Canada.

In the face of those concerns right across the spectrum from physicians and experts to persons with disabilities and their advocates, we, on this side, thought it appropriate we proceed in a cautious and deliberate way, having regard for the complexity of the issue, the lack of consultation and the very short time frame before us to consider the radical changes brought forward by the government in Bill C-7.

Therefore, at the Standing Committee on Justice and Human Rights we put forward reasonable amendments, including maintaining a 10-day reflection period, having regard for the fact that people do change their minds and having regard for the feedback that was provided.

We put forward an amendment to ensure there be two independent witnesses. When one executes a will, one needs two witnesses. One would expect that at the very least there would be a safeguard at least as robust as in the case of executing a will when we are talking about ending one's life, but no, the government removed that safeguard.

We put forward an amendment to extend the reflection period where death is not reasonably foreseeable from 90 days to 120 days, having regard for the fact it is often not even possible to access palliative care or other supports within 90 days. What good is a reflection period of 90 days if one does not have access to alternatives within such a time frame? That amendment was rejected by the government.

Consistent with what the Minister of Disability Inclusion said, and having regard for the horrific evidence we heard of Roger Foley, who was coerced into making a request for medical assistance in dying, which he recorded, this should always be patient-initiated so coercion is limited and to guard against that.

In closing, let me just say that what we have is a piece of legislation that does the opposite of what the Supreme Court called on Parliament to do in Carter, namely to provide for a carefully designed and monitored system of safeguards. This legislation eviscerates those safeguards, and on that basis, is unsupportable. It needs to be defeated out of hand.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

Thank you, Mr. Thériault, for moving this amendment.

I think it's an interesting amendment. I think it's a timely amendment. It just raises a number of concerns that I have, and I do have some questions about the amendment.

Mr. Maloney just referenced our committee's having to deal with this, but my reading of this is that the amendment as proposed by Mr. Thériault says that “their application must be undertaken by any committee of the Senate, the House of Commons or both Houses of Parliament that may be designated or established for that purpose.” It says “designated or established”, similar language to what's used in Bill C-14. We, the justice committee, would not necessarily be the committee tasked with this review.

The reason why it's important, I think, to consider this amendment is that we're moving at lightning speed on a brand-new-to-Canada area of law. Up until Bill C-14, providing assisted dying was strictly prohibited within our Criminal Code. This is what's being amended and what was amended with Bill C-14. Bill C-14 was a response to court decisions, and Bill C-14, which was passed by the previous Liberal government, involved a mandatory five-year review. It used similar language to this amendment. It was not prescriptive as to whether it would be a review conducted by a joint committee of both Houses, a specified committee within the House of Commons, or a new committee put together for the purpose of the review.

As we know, that review, which was to take place this past summer, did not take place. Could a review have taken place in some capacity? Well, we were able to do a lot of things this summer. We all recognize the challenges faced with COVID. However, here's why it's important. The minister has signalled a number of topics for the review: minors, persons whose underlying issue is mental health only and not some other disability or injury, advance directives. You'd think that a review like that would inform new legislation. Unfortunately, with the decision in Quebec.... That was not appealed to the Quebec Court of Appeal, and it was not appealed to the Supreme Court of Canada.

The position I would take is that, when you have new legislation, part of the role.... We have a joint.... In Canada, we have a Minister of Justice and an Attorney General. The Minister of Justice is responsible for justice legislation, like what we have before us today, but the Attorney General has a distinct responsibility as well. The Attorney General's job, among other things, is to defend, within the court system, Government of Canada legislation. The Attorney General did not do that. In fact, at the first opportunity....

So, you have a brand new, shiny bill—created with a majority Liberal government—called Bill C-14. It provides for medical assistance in dying. It has a number of safeguards. It includes a requirement that one's death must be reasonably foreseeable. Well, the court decision struck down that aspect and said that, no, a person's death does not have to be reasonably foreseeable. Instead of seeking clarification, instead of defending the legislation....

There's a reason why, at the limited committee meetings we had, we heard overwhelmingly from the persons with disabilities community about their concerns with Bill C-7. Many of those people we heard from, including individuals who appeared before this committee, would not have been eligible for assisted dying under Bill C-14, but now would be eligible under Bill C-7. They're concerned with the message that sends to their community.

This is why this provision is important. The government did not initiate. The government still hasn't initiated.

Provincial legislatures are up and running. The House of Commons is up and running; we're having this committee here today. People are used to meeting virtually. To my understanding, all of our witnesses at this committee on this bill and future bills are going to be, by and large, appearing remotely. We heard from physicians, from people in the disability community, from MAID assessors, from MAID providers, from psychiatrists and from a broad spectrum of Canadians. Other parliamentary committees, even today, are doing the same type of thing that we are doing.

This legislative responsibility that we had in Bill C-14 to have a committee look at the state of assisted dying in Canada five years after the passage of Bill C-14 was supposed to have been completed already. It hasn't even started, and now we hear that maybe it will start in January.

Some of the things that were supposed to be studied in this review are things that we're dealing with on Bill C-7 right now. The Truchon decision did not deal with advance directives, but this legislation has advance directives in it. The Truchon decision did not say that the 10-day reflection period was unconstitutional. It didn't say that having two witnesses, two doctors, including a doctor who specializes in the ailment that the person has.... It didn't raise any of those things. It didn't say there was anything wrong with them, yet those changes are included in Bill C-7.

We could debate whether we agree or don't agree with those changes, but what is not subject to debate is that those changes were necessary to respond to the Quebec court decision. They simply were not. They were added into this legislation.

Parliament, in its wisdom, in passing Bill C-14 said that after five years we're going to study this. Implicit in that is that the study would inform future legislation. Instead, five years later we have new legislation that raises tremendous concerns across Canada.

I certainly went into this study with a open mind to look into Bill C-7. We heard from witnesses. The more I hear, the more concerns I have. We have palliative care doctors saying that there is no protection for conscience rights and that there is no protection for people who have had MAID suggested to them, maybe repeatedly, when it's not something they are considering. The disability community said that this makes them second-class citizens and that this is a “nightmare” scenario. Those are their words, not mine. Those are the words we heard from enabling accessibility and from other groups like Canadians with Disabilities. We heard from Roger Foley, a person who took the time to appear before this committee to make the case. It was a very selfless action on his part because he is doing this for people who are going to be in his situation in the future.

We have to listen to those voices.

The five-year thing didn't work, because here we are. Yes, we know there were issues this summer, but here we are and November is almost over. We're coming into December. There is no reason this study couldn't have started. The reason it hasn't started is that maybe they don't want to hear what it has to say before they pass more legislation, like Bill C-7.

In a vacuum, where we did not have the benefit of this study, we have Bill C-7. How many days did we spend studying Bill C-7? Four. This relates directly to the amendment being proposed by Mr. Thériault. We had four days to study something that profoundly changes the law in our country—completely different. Should Bill C-7 become law, the law when it comes to assisted dying in Canada will be profoundly different than it is today. That's without any debate. There's no argument that what we're doing right now is going to have a profound impact.

As a parliamentarian, I did not participate in the debate or the votes on Bill C-14. I would have liked, though, to have the benefit of that parliamentary study, whether it was the justice committee, a hybrid committee, or a committee of the Senate and the House. I would have liked to have the benefit of a robust study, hearing from a variety of witnesses who could have informed us in our deliberations now.

Without the benefit of that, we have this committee. In this committee, we took four days. The first day was taken up by the ministers, who, of course, enthusiastically supported their legislation. Of course they do. This isn't a partisan thing, because when we were in government, we would enthusiastically support our bills.

I haven't seen a sincere effort to reach across the aisle and say that we recognize the diversity of our country, that we recognize there are 338 elected parliamentarians who are all here to do a job, that we recognize that we are all equals around the table and that no one party, mine included, has a lock on good ideas. Every party represented here today, if we're honest with ourselves, may bring things of value to the table.

We have moved, and we have talked about 10 Conservative amendments. None of our amendments would have been earth-shattering. Some of them, in fact, just put back safeguards that the Liberal government itself saw fit to put into Bill C-14. I want to be abundantly clear that without even the benefit of this parliamentary review that's in Bill C-14, the government, the same government that passed Bill C-14, the Liberal government, is peeling away the safeguards that it included in Bill C-14.

Some people might say they don't work. How do you arrive at that conclusion without the benefit of the parliamentary study that you saw fit? People like to cite different groups. We can all do that. When we all do that, I think it should inform our decision-making. It doesn't mean any one group is 100% right, and I don't believe any one group that we heard in our limited testimony is 100% wrong.

Frankly, when I see the receptiveness of the government to some of the very fair, well-thought-out and appropriate amendments the Conservatives raised.... I hope it's not leading to the conclusion that the Liberals feel they know it all and they have a lock on good ideas. I'm willing to agree with some of the amendments from other parties, and I happen to agree with this one.

I agree with BQ-4, because I hope we're not banging our heads against the wall. If the government ignored a five-year study, well, maybe it will ignore a one-year study. They ignored the one that was supposed to take place after five years; maybe they'll ignore this one, which is supposed to take place after 12 months.

I hope this isn't the case. I hope we can send the message that if there is any area of law that deserves safeguards, that deserves a deliberate look at the implications in the application of the law, it's assisted dying. There's no question about that. It's literally life or death. It may not be the group that's here today. It may be some future parliamentarians, but I want future parliamentarians to be informed by a robust study before they make new decisions and amendments.

Frankly, those of us on the justice committee right now did not have the benefit of that type of study. I refuse to accept that the four days that we spent on witness testimony—the first day being the ministers—was a robust study of this bill. It wasn't. This bill and the people who appeared before it.... How about the people who didn't get to appear? How about the Canadians who didn't get to appear? They didn't have their say. I know some of them have been sending in briefs that help to inform us as parliamentarians.

We can't have the thinking that one group knows best or that one party knows best. We're not going to properly study things before making legislation. That cuts across party lines. It doesn't benefit any of us. It does a disservice to Canadians if we think we can do up a first draft of legislation, put a stamp on it and say it's good to go and it doesn't really matter what people have to say about it. Frankly, that's what we saw this time. I think four days was clearly not enough. We've been saying that all along.

Now we're studying it clause by clause, but we're studying it clause by clause with the limited benefit of the limited testimony we've heard. The testimony we have heard leads me to the conclusion that the safeguards that were in Bill C-14 should have stayed in Bill C-7. They should not have been stripped out. Further expansion of MAID in Canada should have followed only after a robust parliamentary study, as was contemplated in Bill C-14. We, as parliamentarians, have an obligation to put in those safeguards, which include review of the legislation, so that we can protect the people.

I believe everyone around the table wants to protect vulnerable Canadians. We may all have a different approach to that, but there's absolutely no harm in including a parliamentary review.

I support this amendment. I believe it sends the right message, and I think it will also help inform future parliamentarians on future legislation dealing with MAID. We, this group, this current justice committee here in November 2020, did not have the benefit of this type of review. I hope future parliamentarians do have the benefit of this type of review. That is why I am pleased to support BQ-4.

Thank you, Madam Chair.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Thank you, Madam Chair, and thank you, Mr. Thériault, for introducing this proposed amendment.

I understand where you're coming from, but my concerns are on a couple of different levels. But for the pandemic, there would have been a review undertaken already with respect to Bill C-14, as was required by the legislation. It's unfortunate that it wasn't able to go ahead in a timely manner, but we all know the reasons why, and I don't think anybody really takes issue with it too strenuously, at least I hope so. To the extent that this amendment is in response to that delay, I think it's unnecessary.

On another level, I think it may be a bit overzealous in the sense that if we were to apply a one year-review criterion to every piece of legislation that this committee or other committees pass, that's all we would spend our time doing—reviewing legislation that has been passed within the last 12 to 18 months, which speaks for itself as being unnecessary.

My understanding is that there's going to be a review taking place—likely as soon as early in the new year. By necessity—and I think we just heard this confirmed—that will include all aspects of this legislation, including many of the issues, if not all of the issues, that we've been talking about during the course of the last eight meetings. In addition to that, we'll be discussing and reviewing other aspects of the legislation as well, which will necessitate and involve further widespread consultation.

All of this is to say that, although I appreciate your amendment and I empathize with your motivation, in the circumstances we're currently in it's unnecessary, on the one hand, and on the other hand, it may be placing too heavy an obligation on this committee.

Thank you, Madam Chair.

[Luc Thériault, Bloc, Montcalm, QC]

I understood that mental health would not necessarily be excluded from the review under section 10 of Bill C-14.

[Joanne Klineberg]

That's an interesting question.

I think the scope of the requirement depends on the words you choose as parliamentarians. If the requirement written into the new bill is to review the bill and other related matters, I believe it will be allowed.

For example, one committee had requested that the state of palliative care be studied during the parliamentary review, even though it was not expressly set out in Bill C-14. As parliamentarians, you can make it a requirement for you to review whatever you want.

[Joanne Klineberg]

Thank you, Madam Chair.

As we at the Department of Justice understand it, the requirement in the previous Bill C-14 to conduct a parliamentary review early in the fifth year after the act comes into force still applies. The fact that we have a new bill amending sections of the Criminal Code does not change the requirement in the previous Bill C-14.

As we understand it, a single parliamentary review is required, not a review every five years. We see no reason to believe that this requirement would be precluded or affected by Bill C-7.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Chair, this amendment was intended to be preventive, because, when the minister appeared before the committee, he told us that he absolutely wanted the act to be reviewed quickly so that all the sensitive aspects ignored in Bill C-7 could be studied. One of those aspects was that Bill C-7 excluded the whole issue of mental illness.

Therefore, the purpose of my amendment is to look not only at mental illness, but also at neurodegenerative diseases, which had also been dropped from the bill. When we studied these diseases, we received witnesses who were even willing to move the discussion further even more. They said that they agreed with passing Bill C-7 to amend the Criminal Code, meaning Bill C-14, but that we should then get to work quickly to deal with those issues.

There was also the whole issue of mature minors. It is the contention of the Canadian Bar Association and of Mr. Ménard that the Carter decision, the Baudouin decision, and the court go much further: they imply that mature minors, mentally ill persons and persons suffering from neurodegenerative diseases should have access to medical assistance in dying.

I was asking myself the following question, which is perhaps for the department's legal experts.

Since Bill C-7 does not provide for a review of the act, does this automatically fall under section 10 of Bill C-14, which provides for a review of the act every five years?

If the act is amended, it becomes a new act. Does the new act mean a five-year delay before the review is undertaken?

In that sense, my amendment seeks to prevent us from studying and discussing the sensitive issues ignored in Bill C-7 in four or five years, when we have reached an agreement and the minister has come to testify. This had to be done quickly, since Bill C-14 already contained a provision that should have prompted us to review the act last summer.

I would like someone to answer my questions. That is why I introduced this section. I was told that I could not table a section like that because it would be too early and we could not review Bill C-7.

Bill C-7 is not legislation in itself. It is one part of a piece of legislation called the Criminal Code. Right now, court judgments are telling legislators that they are ignoring a major part of the problem and the people involved. If we don't want to end up with legislation that will be challenged in the Supreme Court once again, or slapped with a court order, we should already be at work, discussing it ourselves, and taking responsibility.

If people with neurodegenerative diseases heard today that the act would be reviewed in four or five years because that is what section 10 says, they would certainly challenge it in the Supreme Court. However, depending on how the legal community interprets section 10, my amendment would allow the act to be reviewed and considered now, after Bill C-7 is passed.

Keep in mind that I had asked the minister if he agreed.

The minister told me that he did and that it was a matter of agreement among the House leaders. I thought that was sort of weak as an answer or an intention. That is why I am introducing this amendment today. I did not have the answers to the questions I am asking you and I did not want to take any chances.

Who will give me answers? I want answers. I don't want to just be told it's out of order.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you very much, Madam Chair.

I speak in strong support of CPC amendment 8.

I think it's important for those who are watching these proceedings to read CPC amendment 8. It simply provides that “on the day specified in the written arrangement referred to in [the] subparagraph”—namely the advanced request—“the person is reminded by the medical practitioner or nurse practitioner that they entered into that arrangement and is provided with the opportunity to demonstrate refusal to have the substance administered or resistance to its administration”.

I would be surprised if there could be any opposition to this subamendment, that someone who has made a request in advance would somehow not be provided an opportunity to withdraw that request.

Ms. Findlay, in her submissions, noted that in the Carter decision, the Supreme Court of Canada stated not once, not twice but on three occasions that to qualify for medical assistance in dying they must clearly consent. The defining paragraph of the Carter decision reads as follows:

...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.

It says, “clearly consents”. What does “clearly consent” mean? It means that it must be affirmative. It must be positive.

I would submit that, constitutionally speaking, the provision for any form of advance consent is questionable. It falls well outside the scope of the Carter decision and this amendment simply provides for there to be at least some opportunity for the patient to demonstrate that they consent, to the degree that they have that ability.

This is all the more important, given that we speak about “reasonably foreseeable”. This should not be confused with “end of life”, at least as far as how reasonably foreseeable has been interpreted since Bill C-14 was passed.

It's true that in the province of Quebec reasonably foreseeable had tended to be interpreted in an end-of-life context, but that is not the case in other provinces. Part of the reason reasonably foreseeable had been interpreted in an end-of-life context in the province of Quebec was the language in Bill 52 passed by the National Assembly of Quebec prior to the passage of Bill C-14.

Given that reasonably foreseeable can and has been interpreted to sometimes mean that someone could have not weeks to live but months, and maybe even more than a year, illustrates the fact that now that we have legislation that provides that someone who could have months, or potentially a year or even longer than a year, in terms of at least how medical assistance in dying and how reasonably foreseeable has been interpreted in practice, it is absolutely essential that such a person at least be reminded that they made the request at a date they selected that, again, could have been a year away. I would make note of that fact.

I would also note that we heard a lot of evidence at this committee about how persons who request medical assistance in dying in some instances end up changing their minds. I would note in that regard that the federal government's own recently released first annual report on medical assistance in dying in Canada revealed that out of 7,336 written requests for MAID that were reported in 2019, 263 were withdrawn by the patient, predominantly because they changed their mind. Of these 263 requests, 20.2% took place immediately before the MAID procedure was to be performed.

Frankly, if that doesn't demonstrate the necessity of requiring that the patient be reminded of their request and have the full opportunity to withdraw their consent, then I don't know what does.

I would further add, just in terms of why this very limited and, I would submit, inadequate safeguard.... It is nonetheless an improvement on what this bill provides for, which is no safeguards, or completely inadequate safeguards, when it comes to this very problematic area of advance requests. I would cite the expert panel working group of the Council of Canadian Academies. I've cited before the 2018 expert panel working group of the Council of Canadian Academies, and I'll cite it here this evening. They had a report, a comprehensive report, identifying a number of concerns in allowing patients to make an advance request. The expert panel working group noted a lack of consensus. The expert panel working group noted that there was a lack of consensus, more particularly amongst experts, on “which situations, if any, are suitable for allowing (advance requests) for MAiD”.

One of the things that were noted by the expert panel is that there is simply a lack of data to fully understand the impacts of how this practice works.

In that regard, I should note that, although there are many on this committee who to talk about medical assistance in dying as if it is just a leading practice that is widely accepted everywhere, Canada is one of the few jurisdictions in the world that has any form of medical assistance in dying. Indeed, just 2% of the population in the western world lives in a jurisdiction with any type of medical assistance in dying. Of the very few jurisdictions that offer medical assistance in dying, just four jurisdictions provide for advance requests.

We really are heading into uncharted territory. Even in the Netherlands it is controversial and has not been truly settled.

When you think about the Supreme Court of Canada decision, the Carter decision, which is the Supreme Court decision that guides us, it sets out the parameters under which we, as parliamentarians, must legislate. The Supreme Court of Canada recognized expressly in the decision that vulnerable persons could be put at risk as a result of medical assistance in dying, which is why the Supreme Court went out of its way on those three occasions in its decision to say that a patient who requests medical assistance in dying “clearly consents”.

What's more, the Supreme Court determined that only with a carefully designed and monitored system of safeguards could there be assurance that those inherent risks would be sufficiently minimized. When the Supreme Court of Canada has all but said that advance requests fall outside the scope of what the Supreme Court envisioned in terms of laying out the parameters to which we, as a Parliament, responded by way of Bill C-14, surely simply putting it to someone, reminding them of their request, is the least we could be doing as we head down this very uncharted path, as we strip away safeguards that are, I believe, key, and that witnesses before our committee have said are key.

One of the things we heard was the tremendous amount of concern from the disabilities rights community, concern from all the way up to the UN special rapporteur.

We have a responsibility, a duty, to ensure that when we pass legislation in this area, we do absolutely everything necessary and appropriate to ensure that vulnerable persons are not unduly coerced, that there is true and meaningful consent, not only at the time the request is made but also at the time the request is carried out.

When we have a regime, however limited, for advance requests, that assurance of consent is simply not there. It's eviscerated. This would at least provide some level of protection, albeit very limited, to ensure that this patient clearly and truly is consenting to a procedure that is permanent and irreversible.

Looking specifically at the circumstances faced by vulnerable persons, the report of the Council of Canadian Academies noted that many Canadians face barriers to health care access. It wasn't just that panel. We heard that over and over again from the very limited time we had to hear from witnesses during the study of this radical piece of legislation that fundamentally changes the medical assistance in dying regime in Canada.

The report noted that, when it comes to barriers to access health care, particularly long-term care, when we speak of palliative care, persons who are marginalized and don't have community supports, family supports or social supports are disproportionately affected.

The expert panel working group of 2018 noted that:

People with a prognosis that includes future loss of capacity anticipate vulnerability due to factors over which they do not have direct control, including societal stigma, caregiver stress, and availability of adequate home and residential care. These factors could influence deliberations about MAID and ARs for MAID.

It's important to read that excerpt from the expert panel in some context to this bill. As the expert panel notes, marginalized persons are at greater risk than others. They are making such a request because they don't see an alternative. They don't have care supports, so they see it as simply either continuing to endure suffering or making a request to end their lives, which should concern all of us because that is not a meaningful and true choice.

When you take those concerns affecting vulnerable persons and you put it in context with the rest of this bill, in circumstances where death is reasonably foreseeable, you have a bill that takes away any sort of reflection period, and a bill that takes away the requirement that there be two witnesses.

You have a bill that takes away the safeguard that there be two independent witnesses and provides that a witness could be someone who is a medical professional who is attending to the care of that patient. That creates issues around implicit coercion.

I want to be very clear that I don't think there are very many medical professionals—if there are any, it would be a very small minority—who would ever want to coerce a patient. That's why I say implicit coercion or unintended coercion due to a power imbalance. Then we received here before this committee some very disturbing testimony where there was in fact real coercion. Mr. Foley came here and gave very compelling evidence about what happened to him.

Taking all of that into account, with the removal of safeguards that were otherwise there to protect marginalized persons particularly, and then you open the door to making an advance request, at the very least—

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

Thank you very much, Madam Chair.

First of all, it's a pleasure to join you here at the justice committee. I have been following the debates in the House on this bill, as well as here at committee from a distance. I appreciate the opportunity to join the conversation.

I salute the work of all the members on this committee because having heard some of the testimony from people like Mr. Foley and others, it is very powerful testimony. I know not every member has been in a position, maybe because of their party, where they've been able to let on to have been moved by that testimony, but it can't help but have moved all of us to some extent as we see it. I just want to recognize, not the toll in the usual sense maybe but the emotional toll that these conversations are taking on all of us.

I was part of the debate, in a much greater sense, the first time this bill went through. I proposed a number of amendments myself at the justice committee.

My grandfather who was in a home passed away around the same time that this debate was going through the House, so all of us as well, as we contextualize what's happening, I know we are thinking about the things that may be happening or have happened in our own lives. That's particularly poignant, given all those who are suffering as a result of the isolation associated with the public health measures that need to be in place right now.

I recall specifically four years ago when this was being discussed, the importance of the question of advance consent. This amendment speaks to maybe trying to find a middle ground on the question of advance consent. The arguments of those in favour of advance consent—and these arguments were made at the time in the House—said that a person who perceives what their future would look like under certain circumstances and does not want that future, but also if that future takes place in a context where they're cognitively not able to rise to that legal standard of decision-making, there is some sense in which, if they're able to make the decision in advance, they should be able to.

That's the argument behind it, that somebody who experiences cognitive decline, as well as an increase in the pain they're feeling, shouldn't be prevented from making a decision that they would want to make if they were able to make that decision. In the absence of being able to have that decision take place in the moment, the idea of advance consent is that we would, in a sense, substitute the decision-making in advance. That is the logic, the ideal that is being aspired to.

Although the government decided not to proceed at the time, I think they were quite persuaded by some of the arguments made around the Audrey Parker case. This case was used to make the argument that if a person is not able to consent in advance about some future point, then they will make the choice to die before they would like to die.

What's striking about that case to me is that the law as it was written, Bill C-14, is supposed to only apply in a case where a person is in that moment experiencing serious and irremediable suffering. I always had a hard time in my mind squaring the circle of how it is that a person says, yes, they were experiencing serious and irremediable suffering in the moment and also wanted to be able to choose the moment to die, but they wanted it to be at such and such a point in the future, and not at this point.

I'm not taking away from the sincerity of a person who makes that decision in that moment. I'm just saying it was a hard thing for me to understand, but this was the direction of the argument.

On the other hand, those who were concerned about advance consent.... I was one of them. I made a few different arguments and I think those arguments still apply in the context of this amendment.

First of all, a person who makes a decision in the moment—who actions consent in the moment—is the only kind of consent we accept in law. I cannot consent in a way that binds my future self to some action. In the spirit of liberty and in the spirit of autonomy, we do see future selves as being distinct from present selves. There is a sense in which I am the same person I was five years ago, but there's also a sense in which I am a different person from the person I was five years ago. The person I was five years ago—let's say at the time the bill was first being debated—might have different thoughts about the issue, might have made different decisions and might have engaged the parliamentary process in a different way, and so forth.

The difference in the self I am now and the self I was then is that I have learned new things. I have also adapted to new circumstances. Things that I thought would be easy maybe turned out more difficult. Things that I thought would be difficult maybe turned out easier than I thought. The decisions I make today in the moment respond to the circumstances that I find myself in and the evolution or the changes that I may have gone through in between that point in the past and the point now.

We can all accept that as a general principle in the course of our lives, which is why we generally say in many different contexts that consent is consent in the moment. It's when you say yes to something in the moment. If you say yes to something and then a few minutes later you say, no, you don't actually want to proceed, then the present decision to say no overrules the previous yes. People change their minds. They absorb new information. They feel differently and they feel in ways that they didn't expect they would feel under certain circumstances.

What is true as a general principle is true in a particular way for those who have experienced some dramatic change in their life, like the onset of a disease or some kind of dramatic change in their health status. People don't really know how their life would be different if something that has been a big part of their life or something that they have taken for granted suddenly ceases to be there.

There's a lot of data around this. Part of what interested me about this whole question of advance consent versus present consent is that I did my master's dissertation on the idea that you could measure happiness. It is a really interesting field and important for how we benchmark our social goals and so forth.

One of the things about the happiness data is that people adapt to dramatically new circumstances in ways that they don't expect. That adaptation varies dramatically across different kinds of circumstances. A person might expect that if they were to get into an accident and have a disability and a change in their function, that person might, before that happened, expect that it would have a much greater impact on their quality of life. That's often the case, actually, for physical disability. At least, that is what the data suggests, that what they might expect as the loss of well-being that they would receive as a result of experiencing a physical disability is actually much less than the actual loss of well-being.

I'm certainly not an athlete, but suppose I was. I might think that if such and such a thing happened to me I wouldn't be able to do all these things that I liked doing and therefore my life would be so dramatically different it would be hardly bearable. Then at that future point, having been through a process of adaptation, having taken on new interests and having developed new hobbies, I may find myself thinking that, actually, I wish that accident or whatever it was hadn't happened to me, but my ability to adapt to the circumstances that I've been through is much greater than I thought it would be.

That's not the case in every case, and there is wide variation in terms of the way different things impact different people.

The point is that it's very hard to predict. If you ask me to make an advance directive, if I were to get this illness, if I were to have this particular kind of loss of functioning, and if I were to experience this change in my life, at what point and under what circumstances would I want medical assistance in dying? That current self projecting what the desires would be of that future self would be so imprecise to what my actual experiences were in the moment when I actually had those changes take place.

This is the core problem, at least with the idea of an advance directive. At the time, we were talking about this four years ago. There was advocacy for the idea of an advance directive, which is where a person could say—

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

I'm happy to move CPC-8.

CPC-8 requires that we inform a patient of advance consent before proceeding with MAID. This amendment would require in the case of advance consent that a health care provider inform a patient of their advance consent on the day that assisted dying is to take place and, if possible, give them an opportunity to respond and indicate whether they would wish to proceed or not. This amendment is supported by important stakeholders, including the Canadian Society of Palliative Care Physicians.

The concept of advance consent is something that has been debated but was included in Bill C-7, even though it was not required in a response to the Truchon decision. The position that I feel would have been appropriate was to have appealed this decision. Instead, the government took the opportunity to respond in Bill C-7 to the decision. It did not just respond to the decision, but went beyond responding to the decision. The decision of the Superior Court of Québec said that it was unconstitutional and violated the person's rights that death had to be reasonably foreseeable.

We don't know what the Court of Appeal would have done with that decision. We don't know what the Supreme Court of Canada would have done with that decision. The decision could very well have been overturned. It could have been found that there was no violation of rights. We don't know that because the decision wasn't appealed and the government did not defend its own legislation.

The government didn't just respond to the court decision. A number of the amendments that we've put forward, including this one, relate to the removal of safeguards that were included in Bill C-14, but there are also new concepts included in Bill C-7, which include a waiver of final consent. It means that if a person has lost the ability to consent, the person can waive that and still receive MAID. What this amendment would do is to take the steps necessary to see if contemporaneous consent can be given before MAID is provided.

I've mentioned the Canadian Society for Palliative Care Physicians. They've had a number of recommendations. I spoke about a couple of their recommendations in some of our other amendments. I want to draw your attention to their third recommendation, which is “to maintain [the] requirement for capacity to consent at the time of provision of MAiD”. They say:

A person should be able to change their decision up until the time of the procedure. The proposed changes in Bill C-7...remove that opportunity from a person who loses capacity after previous consent. Furthermore, the determination of whether or not a person does wish to withdraw their request after losing capacity to consent by way of words, sounds or gestures, is problematic in its potential subjectivity and may put clinicians in a precarious situation by having to interpret these responses. MAiD may be requested simply because the level of care required by the patient who has lost capacity exceeds what is currently being provided.

We've already discussed the issue of palliative care, but this is in the context of their recommendation, which is to not include the waiver of the final consent. That's not what this amendment is about, but this amendment speaks to the concern that's being raised by palliative care physicians. It is that we should, if possible, inform the patient who has given advance consent before proceeding. We should make an endeavour to get that response of whether to proceed or not proceed before taking the steps that would end this person's life.

I appreciate this recommendation. It's a recommendation that the palliative care physicians support. It's a safeguard amendment that would provide.... I don't think we can ever take lightly the gravity of the type of legislation we're dealing with, and this does involve a person's life and death decisions. Every possible safeguard should be put in place.

That is why I'm moving CPC-8. The Canadian Society of Palliative Care Physicians feels that this type of amendment is a responsible one. I ask that committee members to consider this amendment and to consider the source of the support for this amendment: physicians who are dealing with people in end-of-life situations.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

I'd like to move CPC-7. To be clear, I am moving it and I am speaking only for myself when I speak with regard to CPC-7.

I'm sure that we've all read the legislation. In Bill C-7—and a number of people have consulted with some individuals on it—there doesn't seem to be clarity around when the 90-day reflection period begins. It's incumbent upon us to have certainty in our legislation. We've chosen vagueness when it comes to reasonable foreseeability. There are some terms that are certain, such as the 90-day reflection period. We're saying that it's 90 days. We just defeated an amendment that would have made it 120 days.

CPC-7 amends Bill C-7 to read:

ensure that there are at least 90 clear days between the day on which the request under paragraph (b) was signed by or on behalf of the person and the day on which medical assistance in dying is provided to them or — if the assessments have been completed and they and the medical practitioner or nurse practitioner referred to in paragraph (e) are both of the opinion that the loss of the person’s capacity to provide consent to receive medical assistance in dying is imminent — any shorter period that the first medical practitioner or nurse practitioner considers appropriate in the circumstances;

That last part is relevant to our previous debate in that the 90-day period can be shortened. However, what's not clear in Bill C-7 is when the 90-day period starts. This particular amendment provides that certainty.

This is important because, as has been mentioned, we're dealing with decisions around life and death. We're dealing with something where doctors, nurses, health care providers, family members and individuals who may be considering MAID need to have certainty around the process.

Part of the certainty around the process involves safeguards. The government, in Bill C-14, included a number of safeguards. Some of those safeguards involved the period of reflection. The period of reflection enables an individual, upon requesting MAID.... It gives the person time to change his or her mind, to consider further circumstances, to have a period of reflection. That period in Bill C-14 was 10 days. That was seen as appropriate.

We have to remember that one of the requirements in Bill C-14 was that death had to be reasonably foreseeable. Following the Truchon decision—this was a Quebec Superior Court decision—we argued that the government at the time should appeal the decision in order to provide more certainty around the law. Normally, especially with a new law such as Bill C-14, it's incumbent upon the Attorney General and the government to defend its legislation. We argued that.... There I am, using the word “we” again, Madam Chair. I'll say that I argued. I argued that we should have appealed that decision, that this would have been the right thing to do. Instead, the government brought forward Bill C-7.

Bill C-7 includes a 90-day reflection period for individuals who are seeking MAID where death is not reasonably foreseeable. What Bill C-7 doesn't include is explicit and certain terminology that can be universally understood about when that 90 days starts. It's not clear whether it's when a person has been formally assessed for eligibility for MAID or when they're informed that they are eligible for MAID. It's quite unclear.

We want to provide that certainty, and we want to provide that it is at a moment in time when the person—and this should be the start point—has specifically requested MAID. That is when that point should begin. That point should only end, of course, after the full 90 days is complete. We had argued that 120 days would be more appropriate and that was defeated, so it's when the 90 days is complete.

I'm happy to move CPC-7, and I'm happy to answer any questions that committee members may have on this amendment.

Thank you, Madam Chair.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

It is perhaps appropriate to recall the context of this bill. Many things are being said, and at a certain point, they completely confuse the basic issue.

Suicide in Canada is decriminalized. Assisted suicide is still a criminal offence, barring certain exceptions. We did not decide that this evening. Rather, the courts told us that the legislation violated the right to life. There was Bill C-14 and, before that, the Carter decision, which led to Bill C-14. Mr. Lewis says that we are encouraging suicidal people to commit suicide. However, it is quite the opposite.

I cannot fathom how the justices in the Carter decision, who told lawmakers to go back and do their homework, would react. How would Justice Baudouin react to the comments I have just heard, which are an all-out assault on the courts' interpretation that led them to tell lawmakers that the current legislation violates the right to life of people with irremediable conditions and intolerable pain and suffering? The courts are of the opinion that people are currently being compelled to act before they would want to do so, meaning when they have passed the point of what is tolerable for them. According to the current legislation, they are being compelled to commit suicide; that's what the Superior Court said. They are being compelled to end their lives prematurely.

I really want us to try to justify a rather straightforward amendment that we could have voted on pretty quickly, but here we are. We need to respond to the court's ruling with Bill C-7. We must return to the fundamental issue. The court told us not to violate the right to life of people with irremediable conditions experiencing intolerable suffering. They want to live until they have passed the point of what is tolerable for them.

That does not happen after an accident. Someone who has an accident tomorrow morning and becomes quadriplegic might become suicidal and would receive care for that state. Over the course of their care—because we do provide care for people—they could one day decide to request MAID, and that request will then be assessed according to the safeguards set out here.

Out of respect for the work we must do, let's not confuse the basic issue. I know that we are presenting all the arguments we can, but the purpose is not at all to encourage any suicidal state. Let me repeat that suicidal states are reversible. We are talking about access to medical assistance in dying and a person's ability to make that decision, which is not made lightly. People at that stage will have exhausted all other options over the course of their care. Paragraph 241.2(3.1)(g) ensures that people will recognize the full range of care available to them and all options they have.

I'm ready to vote.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair. I was just going to move it, but I'll speak to it then as well, per your invitation.

What CPC-6 does is it.... To back up a bit, as you know, in Bill C-7, we have two tracks, one where death is reasonably foreseeable and one where death is not reasonably foreseeable.

We've already dealt with the fact that we have not defined “reasonable foreseeability”. On the track where death is not reasonably foreseeable, there are a number of safeguards that are in place.

On the track where death is reasonably foreseeable, we know that the 10-day reflection period that Parliament included in Bill C-14 is being eliminated. On the track where death is not reasonably foreseeable, the government has put in place a 90-day reflection period. It's interesting that on the one hand there's a reflection period being eliminated and that, on the other hand, there's a 90-day reflection period.

Our amendment CPC-6 would ensure that rather than “90 days”, there are “120 clear days between the day on which the first assessment under this subsection of whether the person meets the criteria set out”, and the point when they can receive medical assistance in dying. In effect, it extends the reflection period when death is not reasonably foreseeable.

The basis for our proposing this is based on testimony that we heard. All of us, as members of Parliament, know that access to health care is an issue probably in all of our ridings and among all of our constituents. Particularly now with COVID, we're seeing even more delays in the system.

I mentioned them before, but the Canadian Society of Palliative Care Physicians specifically points out that under the proposed two-track system, where death is not reasonably foreseeable, the 90-day assessment period may not provide sufficient time for a person to receive appropriate palliative care or other supports needed to reduce suffering and live with dignity.

We also heard from other physicians who are specialists. We heard from MAID assessors quite a bit. These are specialists who deal with any variety of injury as well as sicknesses that people who may now be eligible for MAID would have to be dealing with. The feedback we had from those physicians as well as the physicians who deal with palliative care is that 90 days may not be sufficient. Upon studying this and consulting, and then based on the witness testimony we heard, we proposed this amendment that would increase this by a modest amount.

Is 120 days the exact right number? Is 90 days the right number? We don't know. What we do know from the testimony we heard about the 90 days is that it's not enough. Therefore, 120 days is a step in the right direction.

I mentioned the physicians who deal with palliative care, but we also received a submission from Physicians Together for Vulnerable Canadians. That is the submission that had over 800 signatures, not from MAID assessors but from physicians who deal with any variety of sickness that people may be dealing with. I want to draw the committee's attention to the second page. They say, “We live in a country where the wait time to see a psychiatrist...is 4-8 times longer than the 90-day waiting period”. Just for psychiatric care, the waiting list puts someone beyond the 90 days. What they're saying is that for situations where death is not reasonably foreseeable, the 90 days is woefully inadequate.

We've heard testimony that people within that 90 days can have ups and downs. The government acknowledges that some period of reflection is appropriate when death is not reasonably foreseeable, but what we're hearing overwhelmingly from physicians and from palliative care physicians is that 90 days is not an adequate reflection period.

Wherever you stand on the issue of assisted death where death is not reasonably foreseeable, ensuring we have the right safeguards should be something that we can all agree on, and the evidence we're seeing is that 90 days is not satisfactory. That's why our amendment would increase it to 120 days, which still may not be adequate, but we are proposing a number that recognizes that 90 is not enough in the hope that members of the committee would see it for what it is. It is a reasonable effort, where death is not reasonably foreseeable, to provide further safeguards for people who are at a very vulnerable point in their lives, to make sure they get the medical assistance that they can get and that we have more time for the provision of health care services to take effect—let alone to see those specialists—but also to have some movement towards recovery, hopefully.

We heard testimony at committee about individuals involved in a significant accident, for example, and someone who could be rendered paraplegic. This 90 days is not going to give them the time to see what opportunities they could have. That is why I'm asking that committee members consider this very reasonable amendment to increase from 90 days to 120 days the reflection time when death is not reasonably foreseeable.

I thank committee members for their consideration, Madam Chair.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you very much, Madam Chair. I too would like to express my support for Mr. Manly's amendment. I believe it is very reasonable and, in some respects, a modest amendment.

We heard over and over again from witnesses, particularly those representing persons with disabilities, of the inadequacy of the provision, in the context of where death is not reasonably foreseeable, to merely inform a patient of alternatives. To merely inform a patient without requiring them to seek any alternatives or without any guarantee of seeing that they have access to those alternatives puts vulnerable people at risk, vulnerable people who are often in their most vulnerable state upon making a request for medical assistance in dying.

I would note that the minister has often said, and others have said, that when someone makes a request for medical assistance in dying, they have long thought through the process and it's therefore somehow important that it be expedited, which I don't quite understand. When we're speaking about where death is not reasonably foreseeable, it opens the door to persons who might have had an accident or a traumatic event or a diagnosis that causes them to have their life literally turned upside down. We heard evidence of suicidal ideation, particularly in circumstances where people have bad news or where they are experiencing significant pain and suffering, without having an opportunity to identify or determine what possible treatments might be available to them.

I would note that Dr. Catherine Ferrier appeared before this committee. I'm going to read this into the record because I think it's important in the context of this motion. She is a physician who has worked since 1984 in the geriatric clinic at McGill University Health Centre. She noted in her testimony that:

The suicide rate after traumatic spinal cord injury is [five] times that of the general population for five years. Those who choose suicide may not [have a diagnosable depression] or [be] incapable of decision-making. Their options have been tragically narrowed, and it takes a long time to readjust, but people do. After five years, the rate is the same as that of the general population. They need protection from their despair. That's why our society responds to suicidal desires with prevention. That's why [it makes no sense to] allow MAID after 90 days [for people who are not near the end of life].

She objects to the 90-day period. One can debate that. I, too, don't agree with the 90-day period. With respect to Mr. Manly's amendment, I've cited one example, but there are many other examples of people who suffer from a disease or illness who have much higher suicide rates until after a period of time when they can adjust. It speaks, therefore, to the importance of the amendment, to not just provide information but to see that they can get appropriate consultations.

I would note that this amendment is consistent in some ways with what was said in the final report of the External Panel on Options for a Legislative Response to Carter v. Canada.

That report, which was very important when we were giving consideration to Bill C-14, said “a request for a physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available to alleviate a person's suffering.” Surely someone should, at the very least, be required to go through a consultation in circumstances where death is not reasonably foreseeable.

I would note that Canada, by going down this road, would be an outlier in the world. We would have, arguably, the most permissive regime in the world. I would note that in the Netherlands, for example, a physician must confirm that there are no other potential means to relieve suffering before administering medical assistance in dying to a patient. Here we would provide merely information but no obligation to ensure that the person could truly make an informed decision. You can't make a truly informed decision and you can't exercise your autonomy if the choice is simply intolerable suffering versus medical assistance in dying.

I believe that Mr. Manly's amendment, for all of those reasons, makes sense.

I will say I find it troubling that when we have heard from 72 national organizations representing persons with disabilities and the rights of persons with disabilities, when we have heard concerns expressed by the UN special rapporteur on the rights of persons with disabilities and when we have heard questions asked about Canada's compliance with its international obligations under the Convention on the Rights of Persons with Disabilities, including article 10, that the members on the government side have given short shrift to all of those concerns. I would just—

[Rob Moore, Conservative, Fundy Royal, NB]

Speaking to the amendment as amended, I didn't hear much testimony in this regard. It seems the very opposite of a safeguard. I realize this is a moving target, because we're all hearing about this new language and getting a translation of it in English and French in real time.

We've heard how MAID providers, as Mr. Garrison said, are enthusiastic about removing the 10-day reflection period, while palliative care doctors are in favour of maintaining it and having a reflection period. Persons with disabilities are in favour of having a reflection period. Here we have a situation where the legislation requires that there be “a written opinion confirming that the person meets all of the criteria set out in subsection (1)”, and that be provided by someone with expertise in the condition the person is suffering. What this amendment would do is say the MAID provider would get a written opinion from a medical practitioner or a nurse practitioner confirming the person meets the requirement.

At first blush, the way I take that, the safeguards were here under Bill C-14, and now we're moving them down in Bill C-7. This amendment just chips away at another safeguard.

We've already discussed, on a previous amendment of ours, when death is not reasonably foreseeable, requiring someone with expertise in the person's condition to be one of the two physicians.

Here again, we're putting the MAID provider in the position of the go-between, between the patient and someone with expertise in the patient's condition. To me, that's not acceptable, and I would be voting against amendment NDP-2 as amended by the government.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair

I am not aware of what ideology Ms. Findlay is referring to. I would like her to put a name to my ideology, other than its respect for human dignity. I don't think it has anything to do with ideology, but rather the principles that underpin our lawful society. When one is in favour of respect for human dignity, it is essential for it to go beyond the merely theoretical. That is why the law enshrines the principle of human self-determination in its biomedical decisions. No one can cause harm to someone without their free—with an emphasis on the word “free”—and informed consent.

Once a person has come to a decision, why would you have to give them more time, you ask? If they have changed their mind, that's their decision. We should also avoid the other side of the coin, by which I mean people who don't want medical assistance in dying to be administered at all in their hospital or institution. There are not a lot of MAID practitioners.

Let's consider a terminally ill patient who has battled cancer for 20 years and has been in palliative care for a year. There is no cure. One day, the patient ends up in emergency because the body can no longer function. If for 20 years it had been clear in that patient's mind that this was what they wanted and preferred, perhaps there might be a change of heart once they find themselves in an optimal palliative care context. Nothing in Bill C-7 or Bill C-14 prevents anyone from changing their mind. But the courts told us otherwise when they ruled that Bill C-14 and the Criminal Code infringed the right to life of the person.

Things need to be put back into perspective. I have a lot of respect for religious authorities, but when I am quoted comments made by a cardinal in a clause-by-clause debate, and told these should be included in the minutes, I get the impression that we are swinging back to the other extreme.

Respect for human dignity implies that we treat other humans as an end, and never as a means of imposing an ideology on them, whether religious or otherwise, or an authority other than their own. No authority other than that of the person dying, or the person suffering from an incurable illness causing intolerable pain, should determine on their behalf what level of pain is tolerable to them.

That is what we are talking about today. Everything possible to alleviate pain during the transition to death; that is what we are pursuing. The fact that some people assume, in support of some ideology, that a person in the throes of death needs more time, leads me to believe that perhaps they would like that person to die before the medical assistance in dying begins.

I do not wish to continue to impugn their motives, but would like my Conservative colleagues to respond in kind. The only principle guiding our deliberations today is respect for human dignity, which requires total respect for people's right to self-determination. Throughout our lives, the law protects our self-determination. Why should the state withdraw this principle at the most private moment of a human being's life? That is the substantive issue here.

We are trying to make it easier for people not to suffer and to have their wishes respected. Some witnesses, practicians and doctors who proffer palliative care came to tell us that they knew better than the patients what was good for them. They tried to make patients change their mind because they felt that the patients were not assessing their own condition properly and that they should be allowed to die only at the end of their anguish.

That is not the kind of medical practice I want to promote. I can tell you that if a patient decides to die only at the end of the road, I will be there to help because that was their decision. The bill does not prevent anyone from dying a natural death.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

A couple of my points were made by others and I promise I won't remake them. I do want to respond to MP Garrison, who mentioned that assessors and providers of MAID are in favour of waiving the 10-day reflection period.

Consultation went into Bill C-14. We were supposed to have a parliamentary legislative review this past summer that would look back on what the Canadian experience has been in dealing with assisted dying. Based on consultation on Bill C-14 and based on international norms, Parliament put in a 10-day reflection period that could be waived when appropriate.

Now the Liberal government has put in a 90-day reflection period when death is not reasonably foreseeable, but we'll get to that later. This 10-day reflection period is important. Mr. Garrison mentioned individuals who, on the 11th day, received MAID. That's not taking into account the people who, within that reflection period, decide not to go through with MAID.

As Mr. Cooper pointed out, this happens, and we have to give people that opportunity if we believe that life is important and every life is important, as we heard from individuals in the persons with disabilities community. I felt the value of their lives as they presented at our committee. Their perspective is important. Their lives are important.

We know overwhelmingly that people can and do change their mind about assisted death. It happens. This has been characterized as people who have days or weeks or hours to live. That is not what this is about. This is about, in some cases, people who could have years to live.

The least we can do as a safeguard.... We're putting in place this regime. Everywhere else has safeguards. We need to have safeguards. This was a safeguard that was seen as appropriate just a few years ago. This is not something new. This is something that existed in the previous legislation and we want to make sure we maintain that.

We can talk about assessors and providers of MAID. Well, I'm also talking about the Council of Canadians with Disabilities. I'm talking about the Canadian Society of Palliative Care Physicians. These are physicians who deal, day in and day out, with end-of-life issues. Those physicians are saying to maintain this 10-day reflection period. I don't know how we as a committee can just ignore that and cherry-pick the odd thing that we agree with from people who have a completely different perspective, being the assessors and providers of MAID. Maybe the assessors and providers of MAID should not be the ultimate authority on all things dealing with MAID, including the safeguards and the 10-day reflection period.

We need to have a balanced approach. We've listened to the assessors and providers. I also want to listen to people with disabilities, other specialists and palliative care physicians. We cannot make this a closed club where the only people we listen to are the ones who provide MAID. That is not how this does work and it's not how it should work.

I'll leave it at that, Madam Chair. I thank everyone for their contribution to the discussion on this amendment.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you, Madam Chair.

I would just like to add that providing for same-day death or entertaining that possibility, as Bill C-7 would allow for, I believe is virtually unprecedented in any other jurisdiction.

I recall that when we considered the reflection period during the debate around Bill C-14 at the time, we were looking at a 14- or 15-day reflection period, and the government brought forward an amendment to reduce that to 10 days. Even a 14- or 15-day period, as I recall, was significantly less than that which was provided for in the Benelux countries, where the waiting period, at least as of 2016, was in the range of 30 days.

We really are heading down uncharted waters. I think any time we legislate on this issue, in which there are so many complexities and we're dealing with vulnerable persons who are at their most vulnerable state in life in many instances, we need to proceed with care and caution, having regard for the evidence before our committee and having regard for the data coming out of the province of Quebec.

I believe it is imperative that we maintain a reflection period and not go down an uncharted path.

Thank you.

[Chris Lewis, Conservative, Essex, ON]

Thank you, Madam Chair.

I have just a couple of very brief comments. The first one is that I was a firefighter, a first responder, for seven and a half years, so of course I went to a lot of car accidents and I went to a lot of fires, but I was equally a paramedic as well and responded to a lot of folks who had DNR orders. At the time, the fire department I was part of didn't recognize DNR orders, so we would send them to the hospital.

I will tell you that, in my seven and a half years in the small town in which I was a firefighter, on more than one occasion I did meet somebody on the street, a cancer survivor, who upon going to the hospital actually found a new specialist, a new treatment and indeed survived.

My point is this. I think we'd all agree that at the very least we'd have what I call the 24-hour rule. This is now somebody's life, and life deserves, at the very least, a 10-day reflection period.

Again, I go back to my time served in the fire department. I've seen this. I've been part of it. I've seen people who have been in a coma with the doctors saying to pull the plug, and 18 days later they have woken up with thumbs-up and are living a normal life today.

Because I have seen it, because it's first-hand for me, I really don't understand why we would not have that 10-day reflection period at the very least to talk it through. It is absolutely vital.

The last point I would make is that this was the Liberals' legislation through Bill C-14 and if they don't believe now that we need a 10-day reflection period, are they suggesting they were wrong when they put this legislation forward in the first place?

Thank you, Chair.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

I support this amendment.

The Supreme Court of Canada in the Carter decision contemplated a carefully designed and monitored system of safeguards. Bill C-7 removes one of the key safeguards provided for in Bill C-14, Parliament's response to the Carter decision, and that is a reflection period.

If you look at the legislation as it is currently drafted, it could provide a scenario where there is same-day death and there is virtually no reflection. It is important to note that people do change their minds. Indeed, in the Truchon decision, evidence before the Quebec Superior Court indicated that in the province of Quebec, between December 2015 and March 2018, some 167 written requests were made and subsequently withdrawn by patients, because they had changed their minds. That equals approximately 7% of all MAID requests in the province of Quebec.

I believe this data underscores the need for a reflection period.

With the issue surrounding the loss of capacity, this is already addressed in the existing legislation, in Bill C-14, whereby that period can be shortened where necessary, but that should be limited. It should be the exception; it should not be the rule.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

I think this amendment ignores an important fact. Those who have reached this point in their lives where their medical condition has dealt them a bad hand, we might say, and who are suffering intolerably, have been consulting with their doctors, some for many months. This is not something that happens in any rapid fashion.

We heard from the assessors and providers who carefully monitored what was happening under Bill C-14. They told us very clearly that this does inflict unnecessary suffering. In fact, when you look at statistics about the 10-day waiting period, a very large proportion, over half, of the medically assisted dying occurs on the 11th day. That tells me we are forcing people to wait, and forcing them to suffer in a way that's not necessary if we are truly compassionate.

I will be opposing this amendment.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

I'd like to first move CPC-4.

I'll reflect back on Bill C-14, which was adopted five years ago. It required that individuals be given the opportunity to change their mind after a request was made. This is where death is reasonably foreseeable, but it doesn't mean it's imminent. It doesn't mean it's within weeks. In fact, as we've seen from some cases, it could be years.

In the limited testimony we've had, it became a theme that people can change their mind. We tossed around this idea of life or death. People have said, “This is a life-or-death situation” when often it isn't, but in this case we are literally dealing with life or death.

The majority Liberal government that introduced Bill C-14 put in place a requirement that there be:

...10 clear days between the day on which the request was signed by or on behalf of the person and the day on which the medical assistance in dying is provided or—

It means that if you've signed and said, “I would like to have medical assistance in death”, there would be 10 clear days. There was a reason why that was put in place by the Liberal government.

—if they and the other medical practitioner or nurse practitioner referred to in paragraph (e) are both of the opinion that the person’s death, or the loss of their capacity to provide informed consent, is imminent—any shorter period that the first medical practitioner or nurse practitioner considers appropriate in the circumstances....

When we've discussed this, I've heard other colleagues say, “Sometimes this was just making people wait for no reason.” Well, Bill C-14 provided for that scenario. The 10 days could be waived in circumstances where death is imminent. If someone is going to pass away in two days or a day, no, there does not have to be a 10-day reflection period. Remember we're dealing with cases where an individual may have years to live, and what we're saying is to take that 10-day reflection period. There's a reason it was put in place.

Now we have two tracks—death reasonably foreseeable and death not reasonably foreseeable—without a definition of “reasonably foreseeable”. If someone falls into the other track, there is a 90-day reflection period. If someone falls into death being reasonably foreseeable, under Bill C-14, there was a 10-day reflection period that could be waived. Bill C-7 strips that out. Some may say that it's unnecessary suffering and so on, but what they don't say is that the 10-day period could be waived.

I want to list a few organizations, and every one of us is familiar with these organizations: the Canadian Society of Palliative Care Physicians, the Council of Canadians with Disabilities, and Inclusion Canada. We heard testimony from Inclusion Canada's executive vice-president. The persons with disabilities communities are in favour of this being reinstated. Palliative care physicians, who are end-of-life physicians, are in favour of this being reinstated.

We're not asking for anything earth-shattering here. Some of the safeguards that were put in place by the previous government were just that. They were safeguards to protect the vulnerable. One of them was this 10-day reflection period. Bill C-7 takes it out. This amendment simply keeps it in, and it keeps in the possibility that the 10 days can be waived when death is imminent.

I thank you for your consideration of this amendment.

[Rob Moore, Conservative, Fundy Royal, NB]

Sure. I hadn't planned to actually speak again, but Mr. Thériault made some points that I don't think are on point with what's being proposed here.

He mentions a scenario where someone has hours or weeks to live. Just by the discussion around his own amendment, around reasonable foreseeability of death, we already know that under the previous bill, Bill C-14, individuals with a prognosis of living for well over a year have received assisted dying. We're not being overly prescriptive here, but we have to recognize that some of the individuals who may, depending on the assessment, fall under reasonable foreseeability of death may still have quite a bit of time to live naturally.

What we're saying is, in the wisdom of what the government has put in place under individuals whose death is not reasonably foreseeable, there are going to be people who fall in the margins on both sides of that issue, of that line, that ill-defined line. We've chosen today not to even attempt to define what “reasonable foreseeability” is.

In light of that, I think it's abundantly clear that in the consultation with the physicians one of them should have an expertise in the person's ailment. Whatever that ailment is, we're asking that one physician have that consultation with the patient.

This is not about people who have days to live. This is about people who could have years to live. This requirement has been adopted by the government on their other track. Based on the testimony that we've heard, I think it's abundantly clear that it's important and relevant for those throughout the MAID regime, not just on one track but throughout, that there should be a requirement that they have a consultation with a physician who knows something about their ailment. The risk otherwise is just too great, in my view, for abuse of this system.

I'll leave it at that. Thanks, everyone, for your consideration of the amendment.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you, Madam Chair. I will speak in support of this amendment.

I want to reiterate a point that Ms. Findlay made, also as a lawyer, that in order to execute a valid will, two witnesses are required. Here we're talking about the most significant procedure that could be undertaken in someone's life, namely to end their life, and the safeguard required would be less than that which is required to execute a valid will.

I can say that when Bill C-14 was debated, there was widespread consensus around the need for there to be two witnesses, and not only two witnesses, but two independent witnesses.

The legislation that the government has put forward not only removes the very common-sense requirement that there be two witnesses, but it goes further than that and removes the requirement that there be independent witnesses. Indeed, under Bill C-7, someone attending to a patient's health could be a witness. That obviously raises concerns around conflict of interest, coercion—subtle coercion, unintended coercion—having regard for the power imbalance that exists, for example, between a medical health professional and a patient, particularly vulnerable persons.

The evidence that we heard at committee, in the very limited hearings we held on this bill, was overwhelming in terms of support for maintaining this safeguard, including from the Canadian palliative care association, among other witnesses.

I have not seen any convincing evidence to demonstrate that the witness requirement in any significant way impedes access to physician-assisted dying. On that basis, I believe this is an important safeguard to protecting vulnerable persons. That was backed up by the evidence. On that basis, I hope that this committee sees fit to pass this amendment.

Thank you, Madam Chair.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair. I'd like to move this amendment.

What our amendment would do here is the following.

Bill C-14 required two independent witnesses. Parliament, in its wisdom, with a brand new regime of medically assisted dying, included that requirement. To me, when you're dealing literally with life and death, it makes sense that there would be that requirement for two independent witnesses.

What Bill C-7 does is remove the requirement for two independent witnesses.

In listening to stakeholder interventions on this bill, particularly the Canadian Society of Palliative Care Physicians, which represents the physicians and others who are dealing with people at end of life, we hear a lot of talk about how it's not a true decision if you don't have appropriate palliative care. A lot of people pay lip service to palliative care, but any one of us, if it's someone we know, is going to want that person to have the best palliative care opportunities as possible in an end-of-life situation.

The Canadian Society of Palliative Care Physicians supports this amendment that would maintain the requirement for two independent witnesses. You can imagine, with the different dynamics of how, when we're talking about assisted dying and about Bill C-7.... Bill C-7 dramatically—dramatically—changes the law in Canada when it comes to assisted dying because, in fact, now people don't have to be, as we would have thought before, at end of life. They may have a prognosis that says they have 30 years to live or that says they have 20 years to live.

So, in light of that expansion, I think it's important that we maintain safeguards that make sense. To me, it makes abundant sense to have two independent witnesses, to have the request, as the Criminal Code says, “signed...by the person—or by another person under subsection (4)—before two independent witnesses who then also signed and dated the request”.

I can tell you, as someone who has dealt with legal matters before, that you don't want to have one witness to something anyway. Having two witnesses eliminates any degree of uncertainty that could exist. There are always going to be challenges, but I think of...for the.... In Parliament's wisdom under a Liberal majority government when Bill C-14 came forward, there was the requirement.

This amendment is not earth-shattering. It is as modest as possible, and it's saying, “You know what? Let's maintain that safeguard.” That's what this was couched as; it's a safeguard.

We've heard testimony that we're dealing with the most vulnerable in Canadian society, that we're dealing with people who are in very difficult times, that we're dealing with literal life-or-death decisions, so let's maintain the safeguard.

That's why I'm moving this amendment, CPC-2.

Thank you, Madam Chair.

[Rob Moore, Conservative, Fundy Royal, NB]

Thanks, Madam Chair. I think I was in the midst of speaking to this particular amendment when the last meeting ended.

I think for all of us this is an opportunity to provide some clarity—clarity grounded in witness testimony. Some of the testimony I've been receiving on this bill has been around a phrase that was really under Bill C-14 and is now under Bill C-7, and it's so important. That's the phrase “reasonably foreseeable”. There is no definition of reasonably foreseeable.

I heard argument on this particular amendment, BQ-3, that somehow it could possibly be less certainty. I think it's just the opposite. It's abundantly clear that just the opposite would be true. By we as parliamentarians putting in this amount of “12 months”, we have....

It's paramount to this bill, because it involves which track someone who is seeking medical assistance in dying will be going on. We say in Bill C-7 that if your death is reasonably foreseeable, then there are certain safeguards in place—fewer safeguards than were there under Bill C-14. Under Bill C-14 there were the safeguards that there had to be two independent witnesses and a 10-day reflection period. Other safeguards that in fact were in Bill C-14 are taken out in Bill C-7.

If your death is not reasonably foreseeable, then you're on another track. Those of us who have studied this bill know this. The whole bill turns on reasonable foreseeability. In my readings on this, and from speaking with physicians and hearing and reading briefs from physicians and from those in the disability community, as well as hearing of some cases where I think the definition of reasonably foreseeable has been stretched to its absolute maximum of someone's imagination, I think it is incumbent upon us to provide some degree of certainty over what we mean, as a Parliament, as legislators, when we say reasonably foreseeable.

This particular amendment talks about the “prognosis of 12 months or less” remaining. I think this makes abundant sense. I want to thank the member for bringing it forward.

You know, there are people who are watching, of course, the committee deliberations. I haven't made it a secret that I think there should have been more time to hear witness testimony. I really think, if we're honest with ourselves about what we heard around the table, what we heard from members of the disability community, it was an eye-opener for everybody. Whether we're willing to admit that or not, I think it was an eye-opener. I would like to have explored some of these issues further with them.

We were presented with the perspective that somehow in the physician community there is overwhelming support for this bill, but then, as we studied it, we realized, no, that's not the case. I mean, every one of us, as committee members, received a letter signed by 800 or 900 physicians. That's a huge number. Someone said, well, that's not as many as there are in all of Canada. Of course not; but if 900 physicians sign a letter, then I, as a member of Parliament, am going to take notice of that.

Based on the feedback that I've seen, I really think we're doing our job by being a bit more certain in what we mean. I mean, “reasonable foreseeability”—that kind of language is wide open. To the best extent possible, we should give certainty in our laws.

If you're travelling down the highway and you see a sign that says, "Your speed is reasonable”, what does that mean? Does that mean 70? Does it mean 90? Does it mean 130 kilometres an hour? I know for me, it might mean something different than it means for you. “Be reasonable.”

“Well officer, I was being reasonable.”

“No, you weren't being reasonable.”

Who decides what's reasonably foreseeable?

I'm in New Brunswick and I recognize we're a big country. We had a big discussion this morning on how big the country is and how it covers many time zones. In New Brunswick, on most highways, it doesn't say, “Be reasonable”. It says 110 kilometres an hour. I know if I'm over that, I'm speeding. If I'm at 110 or under, I'm not speeding. I think that makes sense. I also think it makes sense for us to define in some way what reasonable foreseeability means. That's why I'd like to speak in favour of BQ-3.

Thank you.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you very much, Madam Chair.

I wish to speak in support of the points that have been raised by Ms. Findlay.

I want to say, at the outset, that I have a lot of respect for you, Madam Chair. We served on the justice committee through the entirety of the last Parliament. I know you as a colleague and as someone who, I believe, is doing your best to try to work co-operatively with members and to make this committee work as best as possible.

In the last Parliament, in the justice committee, we dealt with some pretty significant pieces of legislation, including the predecessor to Bill C-7, namely Bill C-14. Throughout, there were certainly disagreements on policy and broad issues.

One of the things I really appreciated about this committee was that we could look at the issues and the legislation before us in a serious way. That didn't mean putting aside partisanship, because there are legitimate differences. However, we worked together in a collegial way. I believe all members of the committee, regardless of their perspectives, worked in good faith together.

I guess what is disappointing—again, with the greatest of respect I have for you—is that, as Mr. Moore said, we are based upon a rules-based system. We need to respect members' schedules and their time commitments.

In the five years now that I've been a member of Parliament, I have never been in a situation where the chair of a committee unilaterally called a meeting prior to the agreed-upon schedule. I talked to Mr. Moore last night, who served here for 11 years, from 2004 until 2015, and then since 2019. That's 12 years in this place. He noted that he had never seen anything quite like this.

In terms of my schedule, this has actually caused quite a bit of disruption. In fact, I had a press conference that had been scheduled for 10 a.m. It was ready to go. There were a number of stakeholders who were prepared to attend that press conference at that scheduled time.

I happened to find out about this scheduling change around six o'clock last night. I happened to find out from another member, whom I was working with to coordinate the press conference. As a result, we had to completely rearrange the schedules of multiple individuals, causing considerable inconvenience.

Had I not been moving ahead with a press conference, I might not have even heard that the committee schedule had been changed. It's true that you sent out an email, but I think there should be a reasonable expectation amongst all members that we shouldn't have to look at our email every 10 minutes or every hour, because somewhere out of thin air a committee meeting is going to be called.

Indeed, in terms of this committee's schedule, the whips of all parties had agreed that committees that fit within our time slot are to meet no earlier than 11 a.m. Part of the reason for that is time zone issues and the considerable issues they cause for members who are living on the west coast—a three-hour time zone change. Ms. Findlay had to be here at 7 a.m.. Had I not been here in Ottawa, it would have been 8 a.m. for me in Edmonton.

I guess what this illustrates—again, this is not out of any disrespect to you, Madam Chair—is the process involving Bill C-7. At every step of the way, the government has sought to ram this legislation through without meaningful consultation with experts, with physicians, with key stakeholders. We've had four meetings, which have provided limited opportunity to hear from witnesses on a whole range of concerns that have been raised, from the disabilities rights community, from many health professionals, from the UN special rapporteur on the rights of persons with disabilities.

We have seen, and in fact the press conference I held today.... This is a point I want to raise after we deal with the question of privilege brought forward by Ms. Findlay, about the voices of physicians who sought to submit briefs to this committee, but whose briefs were rejected because of an arbitrary deadline to submit briefs that no one knew about, other than perhaps the Liberals. This speaks to a process that is fundamentally flawed, and it cannot stand.

I hope, Madam Chair, you will take seriously the concerns that have been raised—I believe, in good faith—by my colleagues, in particular Ms. Findlay, who has raised a number of substantive points, and that going forward we will govern ourselves in such a way that we abide by schedules.

At the very least, in the circumstances, it would seem to me appropriate that the vice-chairs would have been consulted, but even that didn't happen. And so, here we are: members spread out across the country having to completely rearrange our schedules to deal with what is one of the most complex and important issues before Parliament.

I think the point of privilege raised by Ms. Findlay needs to be dealt with, and going forward I think there needs to be an assurance provided to all members that we will stick to the allotted schedule. If we simply stick to the allotted schedule, I think we will prevent these issues from arising.

We've had issues, as Mr. Moore noted, when the meeting went over schedule. I know that in part sometimes it was because of your effort to accommodate members; nonetheless, it creates issues.

Again, I hope that going forward we will abide by our schedules, and that with that understanding we can work in a collegial way—disagreeing when necessary, but having a level of respect that I think is so important if this committee is to function in a way that I think all Canadians hope it will as we deal with the very important issues that are before our committee.

Thank you, Madam Chair.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

An individual's ability to access MAID does not hinge on this particular amendment. This amendment, as I understand it, is to fill the legislative vacuum that is being created with this legislation. If we asked every member of this committee and everyone participating today to define someone whose death is reasonably foreseeable, we could get 32 different answers because this legislation doesn't get the job done. It's not precise. It's our job, wherever we're able, to provide precise direction, especially on a piece of legislation that is literally dealing with life or death.

Bill C-7 opens up Canada's assisted dying regime. Originally, under C-14, someone's death had to be reasonably foreseeable. Bill C-7 says that, no, your death does not have to be reasonably foreseeable in order to access MAID. This means that someone who is not dying, as we may think of, someone who may have 10, 15, 20, 30 years to live, is eligible to receive MAID under Bill C-7.

It is incumbent upon us, I believe, to try to be a bit more precise. We've seen scenarios where someone is given six months to live, two years to live. That happens all the time. These are the calls that doctors make. I don't accept that saying 12 months is somehow making any more difficult a situation than just throwing something up against the wall, which is what we're doing with reasonable foreseeability—no one knows what that means. In a country of over 30 million people, with doctors in all of our provinces and territories with decisions that have to be made that are literally life and death, we're saying, “We don't know what to say. You guys figure it out.” We could have grave inconsistencies throughout the country when it comes to which track someone would be on with regard to assisted dying. There are different safeguards on different tracks, so it matters whether someone's death is reasonably foreseeable or not as to which track they fall into.

I think this is a reasonable amendment. I think it enables us to do our job as legislators to have a bit more precision—quite a bit more precision—in the legislation that we're dealing with. It's for that reason that I will be supporting this amendment to define “reasonably foreseeable” as 12 months. I listened to the testimony as members did, Madam Chair. I've seen some of the submissions. There is no definition of what reasonable foreseeability is, and that, in my view, is not acceptable. It's for those reasons that I will be supporting this amendment.

Thank you.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

I want to echo the points Mr. Cooper just made.

Mr. Garrison mentioned or, I guess, presupposed how some future court may look at this. It's a reminder of how we came to be in this situation in the first place, when the court decision, the Truchon decision, significantly changed what was a brand new piece of legislation, which was Bill C-14. It was less than five years old and hadn't even had its first review. That decision said that someone no longer needed to be in a situation in which death was reasonably foreseeable. The government, rather than appealing the decision, instead immediately dropped any efforts to defend its own legislation and then introduced Bill C-7.

I don't think the consultation with the disability community, with persons living with disabilities, has been robust enough. I say that based on the four days of testimony we had. On one particular day, a number of the groups represented spoke for Canadians who are living with disabilities. As Mr. Cooper just put it, we have an obligation and we have international obligations to do the right thing. The message we heard back is that people are going to be put in a position based only on their being a person living with disability, which puts them at a disadvantage compared to everyone else.

I think quite the opposite. Unfortunately, this bill singles this group out. We've been hearing that loud and clear, if members of the committee have been getting the same correspondence I've been getting, from groups from coast to coast, local groups as well as national groups, representing Canadians living with disabilities, who find some of these amendments to be an affront to them as Canadians who are seeking to be wholly involved with all that our country has to offer.

That's why I think we have an opportunity here. I'm just asking members of the committee to really think openly about what we heard and about what Mr. Manly has very thoughtfully put forward. I'm reading every word of his amendment, and to me it speaks exactly to “deprivation, social disadvantage, lack of support or perceived discrimination”. What this amendment is saying is that the decision to receive assisted dying cannot be the result of one of those conditions. How can we as committee members in good conscience not support an amendment that responds so directly to the testimony we heard and that provides an element of safety? We're going to get to other amendments later that were.... While Bill C-14 had protections in place for Canadians under our assisted dying regime, some of those protections are being pulled out with Bill C-7.

I think this amendment is a thoughtful way of saying, “We're listening and we're acting cautiously. We're proceeding with caution and we, above all, are going to take every step necessary to protect the rights and the ability of persons living with disability to be fully engaged in our society.” I know committee members heard what I heard: that this bill is in danger of really hurting a lot of Canadians living with disability and how they see themselves as participants in Canadian society.

I think this amendment, if we could all support it, Madam Chair, would go a long way to saying that we heard and that we were listening when they took the time to appear before us as witnesses.

[Philippe Méla]

Thank you, Madam Chair and Mr. Moore.

CPC-1 basically adds to proposed new section 241.5, which is described in CPC-10 on page 19 of the package.

As you point out, it basically criminalizes the activity of compelling health professionals to provide medical assistance in dying. The bill does not create a criminal regime. Unlike Bill C-14, which was creating a new criminal regime for all sorts of activities related to medical assistance in dying, Bill C-7 doesn't do that. Therefore, the amendment would go beyond the scope of what the bill does.

[Rob Moore, Conservative, Fundy Royal, NB]

Yes, it's on the amendment, Madam Chair.

My concern with this is that, in fact, this has everything to do with palliative care. The testimony we heard on the bill at committee certainly was that the quality of palliative care can have a direct impact on a person's approach to assisted dying.

Witnesses told us about a number of factors that go into that decision. Palliative care was certainly front and centre as a significant factor. In fact, when we talk about a person's choice to pursue assisted dying or not, it was presented to us that it's not a true choice if a person does not have access to palliative care, so I'd disagree.

I think this particular provision amends the Criminal Code. That was what was required when we brought in Bill C-14, and indeed in Bill C-7. It was required that some provisions in the Criminal Code be amended when it comes to counselling someone. The legislation touches on any number of factors dealing with consultation and dealing with the expertise of individual physicians.

It's quite clear to me that this particular amendment should be ruled in order.

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

Thank you for that, Madam Chair.

My understanding is that when we go back in the medical assistance in dying regime to when we enacted Bill C-14, we find there was a subsection added to the Criminal Code. We added subsection 241(5.1) to section 241, and that sets out the offences of counselling and aiding a person to die by suicide. We did that under Bill C-14 in 2016. What that subsection does is clarify that it's not an offence for various health care practitioners, including some who cannot provide MAID, such as social workers, to provide information to a person about the lawful provision of MAID. This amendment seeks to specify that no offence is committed when such information is provided to a person who didn't ask for that information in the first instance.

What I understood is that because Bill C-7 doesn't propose to amend section 241 of the code, as such it is likely outside the scope of the bill. That is, I think, what you were driving at with your ruling. However, given that your ruling has been overturned by the members of the committee, I'm happy to debate the substance of it.

Welcome to the Department of Justice officials and the Department of Health officials. I'll make some submissions, but I'll also invite the lawyers from the Department of Justice to opine on it as well.

The first point is simply that we all understand the important work that all of the practitioners are doing, be they nurses or physicians. That should be stated on the record. We appreciated the submissions from the Canadian Nurses Association in that regard. Medical regulators or colleges are the ones to turn to when reconciling the competing interests from a medical practice point of view. That's the first point.

However, here we're dealing with the criminal law, and that's what Bill C-7 is all about. From my perspective, there's currently no current problem to address because when you trigger the criminal law, it's not actually the providing of information but the intention of the person who is doing the providing that is at issue. Merely providing information about MAID one way or the other doesn't amount to counselling or abetting somebody to die by suicide. Counselling or abetting somebody to die by suicide requires an intention to encourage or persuade someone to die by suicide or MAID, whether or not they actually carry it out, which is important. Whether or not a patient requested information about MAID is not directly relevant to the guilt or innocence of somebody who provides that information. The intention of the person who provides the information is the critical factor.

On that basis, I don't think this amendment is addressing an issue that arises properly under the scope of the criminal law as it is currently constituted, because it is about the action of the individual as opposed to the intent of the individual. The intent of the individual is also critical to the evaluation of the crime, if a crime is deemed to have been committed, and that crime can be committed independently of whether the person actually passes or not.

Those would be my perspectives. I'm wondering if Ms. Klineberg or Ms. Quesnel might want to weigh in on this from a departmental perspective.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

I would like to thank the witnesses for their valuable contributions. I will address Dr. Naud, Judge Rochon and Mr. Roberge.

Mr. Roberge, do you believe that Bill C-7 would lead to as clear a challenge as with Bill C-14? Are there provisions in Bill C-7 that could infringe on the rights guaranteed under section 7 of the Canadian Charter of Rights and Freedoms and therefore be challenged in court? I am not asking for a thesis in response, just your quick impressions.

[André Rochon, Retired Justice of the Québec Court of Appeal, As an Individual]

Ladies and gentlemen, thank you for your invitation and for this opportunity to share with you our committee's thoughts on advance requests for medical assistance in dying.

In the name of a strong consensus in the country and in order to protect the autonomy and dignity of the person, I propose that the bill before you be amended immediately to give any person suffering from a major neurocognitive disorder such as Alzheimer's the right to MAID. The urgency of the matter is clear to me. In this regard, allow me to provide a brief reminder of the elements that led us here.

In 2015, the Carter decision set out the cardinal rule that, in exercising an individual's right to life, liberty and security of the person, every person must be free to make his or her own fundamental decisions without interference by the state.

Bill C-14 was passed in 2016. It provides for the formation of an expert panel to study three situations, including that of advance requests for MAID.

In 2018, this expert panel stated the following regarding advance requests:

Having some assurance that their request for MAID would be honoured could provide comfort and relieve anxiety and distress at end of life for those who make this choice.

…

Allowing ARs for MAID might have an impact on the way society values people with capacity loss, increasing stigma and signalling that it is acceptable to consider a life with capacity loss as one not worth living.

In the face of the suffering and distress of all those who receive such a diagnosis, the question is no longer whether the compassion of Canadian society should grant us MAID. The time has come to define the parameters for the granting of this assistance and to put in place guidelines both to ensure the protection of potentially vulnerable people and to respect the clearly expressed will of the person affected.

So when a person receives such a diagnosis, which is likely to progress to severe dementia, they must be allowed to give an advance directive to request MAID when their situation has reached a serious and irreversible stage, provided that the person meets the following criteria: a) they are eligible for government health care; b) they are at least 18 years of age; c) they must be able to express their will freely, without external coercion or undue influence, and must not suffer from a mental condition that affects their judgment; d) a physician must certify that the person meets the above criteria when signing the advance directive.

To be valid, this directive must be renewed in writing after a six-month waiting period from the signature of the initial directive, ensuring that the four previous conditions are still met. This period is an important guideline, which provides a sufficient period of reflection for the person affected and ensures that the decision was not made impulsively or without sufficient reflection.

It goes without saying that this directive may be revoked at any time in writing, as long as the person is capable of doing so. The representative may ask the multidisciplinary team to begin the evaluation process as soon as it has reason to believe that the advanced stage of the disease is reached.

As an added precaution, the directive should be written in a prescribed form. I have appended to my presentation synopsis a template of this directive.

What you are being asked to do today is to provide a choice for anyone diagnosed with an Alzheimer's-type neurocognitive disorder. It isn't a matter of imposing a course of action, but rather of putting in place the necessary guidelines for exercising this choice.

Inspired by our values, this citizen is asking the government to come to their aid and provide them with the necessary care to relieve their suffering, preserve their dignity and respect their decision.

Thank you.

[Dr. Jennifer Gibson, Director and Sun Life Financial Chair in Bioethics, University of Toronto Joint Centre for Bioethics, As an Individual]

Thank you so much for the invitation to join you today. As noted, I'm affiliated with the University of Toronto, but in 2015 I co-chaired the provincial-territorial expert advisory group on physician-assisted dying. In 2017-18, I was co-chair of the Council of Canadian Academies' expert panel on medical assistance in dying, and chaired the working group on advance requests for MAID. Today I am speaking as an individual drawing from these experiences and my disciplinary background in ethics and health policy.

I had the privilege to meet with this committee in spring 2016 in relation to Bill C-14. Over the last few weeks, I've been reflecting on how much has changed in four and a half years and how better prepared we are to contemplate amendments to the legislative framework for MAID in Canada with some confidence. In 2016, we did not have any Canadian experience to draw from, and relied on experience from other jurisdictions. We did not yet have systems and care processes in place to offer MAID to eligible persons and needed to build these. We did not know what actual effect the introduction of MAID would have on Canadians. Would it displace palliative care? Would it make people more vulnerable and not less?

Today, with the benefit of almost five years' experience, we have learned that MAID can be provided safely and compassionately to Canadians. We have Canadian evidence to draw from. We have the lived experience of Canadian families, caregivers and clinicians to shed light on its practice. We have heard from community groups and individual citizens about how, and to what extent, MAID fits within a continuum of supports for persons who are suffering.

Bill C-14 sought to outline a legislative framework, including eligibility criteria and procedural safeguards, but sought ultimately, to the greatest extent possible, to respond to Canadians' suffering whilst balancing the autonomy of persons seeking MAID on the one hand and the interests of vulnerable persons in need of protection and those of society on the other. The project of striking the right balance of these values-based commitments continues today.

Many of the comments from witnesses and organizations who have appeared before this committee have drawn attention to the suitability and appropriateness of key safeguards, both those that are in the current legislative framework and those that are being contemplated in Bill C-7. Such current safeguards, such as the 10-day reflection period and the requirement of final consent, were introduced in order to ensure that only those Canadians who wished MAID actually received it and to protect and promote their autonomy.

Experience of the last four and a half years has shown that the effect of the safeguard may not have been what was originally intended. On the one hand, we have heard from clinicians about some patients who have forgone pain medication and endured preventable suffering in order to sustain their capacity to provide final consent. On the other hand, we have also learned from clinicians, families and caregivers that persons seeking MAID are most often not ambivalent about their choice. In the words of a member of the public who emailed me in December 2015 and who was facing a life-limiting illness, “no patient is going to reach such a decision and request lightly”. Hence, the removal of the 10 clear days and final consent seemed to be a good step forward toward striking a new, appropriate balance in safeguarding Canadians who have already been found eligible for MAID.

There is little doubt about the importance of safeguards to protect vulnerable persons who might, as per the original preamble to Bill C-14, be induced in moments of weakness to end their lives. A lesson we may draw from our experience of the last four and half years is that in developing safeguards, we must be especially attentive to the potential impact of the safeguards, notwithstanding their intent to protect. We must be especially wary of a safeguard if it may reasonably have the effect of rendering some persons more vulnerable. The protection of vulnerable persons turns on safeguarding competence, voluntariness and consent. Exclusion of otherwise competent persons may be justifiable in limited circumstances if there is a strong case to be made from the perspective of justice. Failing this, though, these exclusions violate the autonomy of competent persons of such groups and unjustly force these individuals to remain in a state of enduring and intolerable suffering.

For these reasons, we may wish to consider whether the 90-day reflection period will, in fact, be protective or may instead contribute toward enduring suffering of persons who are already found to be eligible for medical assistance in dying.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you very much, Madam Chair.

Let me just say, as the Conservative who was at the subcommittee meeting, that at no time was it my position that four meetings followed by two meetings of clause-by-clause was adequate. I think, based upon the testimony that we heard today, it's become clearer that it is insufficient and that more time is required.

I know, having served on the Special Joint Committee on Physician-Assisted Dying and then on the justice committee with you, Madam Chair, during the study of Bill C-14, that there was a very thorough process. It not only resulted in more meetings, but longer panels.

This is a very condensed process. It's one of the most complex areas that Parliament could possibly legislate. I think Mr. Moore's motion to simply require an additional two meetings would provide an opportunity for this committee to do its due diligence without, in any significant way, running up against the clock that the government is concerned about.

Again, with respect to that clock, the government wouldn't be in this situation had it chosen not to prorogue Parliament. Thank you.

[Dr. Catherine Frazee]

Absolutely. There was a delicate balance between autonomy and equality struck in Bill C-14. If Bill C-7 proceeds, that delicate balance will simply no longer exist. It is a nightmare scenario, both in terms of the message it will send and in its immediate consequences.

Sorry.

[Rob Moore, Conservative, Fundy Royal, NB]

Dr. Frazee, we heard prior testimony today from Krista Carr from Inclusion Canada. She described this situation now as the “worst nightmare”. That's pretty strong language for those persons with disabilities. What is the government missing here in what I think is an overreach in this response?

Our position was that this should have been appealed. It was a lower court decision in Quebec and it should have been appealed. When you have a brand new bill, as Bill C-14 was, it's the government's responsibility to defend its legislation and at the first instance, it gave up on its own legislation and the safeguards that were in it.

I'd ask you to speak to why this would be described as the worst nightmare for those persons with disabilities.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

Thank you again to all of the witnesses. There has been very informed and relevant testimony today. It raises grave concerns with me about the sufficiency of the amount of time the government has put forward to deal with this legislation. I feel that we should be having more meetings of this committee because we're hearing new perspectives now that we haven't heard in previous testimony.

It's been put out there that there's been some kind of unanimity and great support among the medical community, but, Dr. Frazee, we've seen a letter signed by almost 800 doctors who have expressed serious concerns about how Bill C-7 opens up the medical assistance in dying regime in Canada. I want you to comment specifically on something.

Bill C-14 had a number of safeguards in it. After the Truchon decision, the government responded with Bill C-7, but in doing so, it has stripped out a number of safeguards that it didn't have to: the 10-day reflection period, the requirement that there be two witnesses—things that could provide an element of safeguard for those who are engaged in this process. I'd like your comments on that, because I think it's greatly troubling when we see safeguards that were put in place very recently and then, at the first instance, we're stripping them away.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

I will be quick, as I have only six minutes.

I first want to say to all the witnesses that I am very sensitive to their plea for better care. It is essential to continue calling for this. As I have already said several times, deficiency, whatever kind it may be, does not have to lead to a disability. A disability is a social issue, but a deficiency is not. So I am very sensitive to this fight and to what you have told us today.

However, the terms must be defined. Mr. Racicot, I really like the name of your network, Living With Dignity. It seems to me that living with dignity is above all about having the ability to exercise at any time our freedom of choice, our free will, our capacity for self-determination, especially in medical decisions. The idea is to be able to give free and enlightened consent without anyone affecting it.

That said, I have seen two issues in your brief's conclusion, and I will read to you the penultimate paragraph:

This legislative project, like those that paved the way for euthanasia in this country, gives the false impression that a person's dignity is essentially dependent on his or her autonomy. By administering medical assistance in dying to the person who requests it, one would supposedly respect his or her dignity (a dignity, however, that is inherent in every person, irrespective of their degree of autonomy). In such a discourse, it is implied that in order to die with dignity one must necessarily die earlier, from a death that is administered, chosen and above all anticipated. What a sad state of affairs.

It is indeed a sad state of affairs. However, the issue is that the Quebec Superior Court itself struck down legislation currently in force that stems from former Bill C-14 and evoked the same reasons—that it was forcing the individual to commit suicide, to put an end to their life before they had even reached their own tolerance threshold, which was violating the individual's right to life.

It should be pointed out that the autonomy discussed here is not physical in nature. I hope that is not what you are referring to. In fact, physical autonomy is only a condition fostering moral autonomy. Psychological autonomy is a necessary condition. When an individual loses their cognitive abilities, they can make no moral, practical or adequate judgment, so they cannot provide their free and enlightened consent.

You will agree with me that physical deficiency has nothing to do with autonomy, as defended here, in this bill. I hope you will not confuse all this.

[Michel Racicot]

Thank you, Madam Chair.

As a lawyer and former president of the Living With Dignity network, I thank you for giving us this opportunity to share some observations. I will be very brief, as everything else is provided in our brief.

The Living With Dignity network was founded in 2010. This is a citizen network of over 5,000 allies that is closely following the evolution of end-of-life care in Quebec and in Canada. We have been there for all the stages, including the latest cases such as Lamb and Truchon.

Unfortunately, since the provisions on medical assistance in dying came into force in 2015 in Quebec, and in 2016 in the rest of Canada, we have been seeing increased relaxing of the safeguard measures, be it stemming from court rulings or the interpretation of those who implement medical assistance in dying.

We understand that the Government of Canada must now amend its legislation, but Bill C-7 goes much further by making numerous changes to safeguards that had, however, been deemed necessary in June 2016. I feel it is really dangerous and rushed to do this right now, during a pandemic, when the consequences of the current safeguards have not been analyzed in the review of current legislative provisions, which should begin soon. So we are asking that those safeguards be kept for everyone who is at the end of their life.

Concerning provisions that affect those who are not at the end of their life, we have heard the message from the entire community of persons with disabilities and their advocacy groups. They raised the same issue on Bill C-14 when the Senate proposed removing the end-of-life criterion. They are mostly ignored now, given the proposed amendments.

It is hard to understand how the federal Parliament can adopt the proposed measures, which would make Canada the most permissive country in that area, while making fine statements of principle in the preamble of Bill C-7, as it had done in the preamble of Bill C-14.

Finally, given certain court rulings that have undermined caregivers' conscientious objection, especially in Ontario, it would be desirable for the current legislative provisions to be strengthened to clearly stipulate that nothing in this bill can force anyone not only to practise medical assistance in dying or to assist someone in that practice, but also to refer an individual who is asking for medical assistance in dying to a colleague who does provide that service.

[Dr. Heidi Janz]

Justice committee, I appear before you as the chair of the Ending-of-Life Ethics Committee of the Council of Canadians with Disabilities, a national organization with a mandate to preserve and promote the human rights of people with disabilities.

I feel compelled to spend a few precious moments of my allotted time to register my concern, indeed my alarm, at the breakneck speed at which this committee is operating. This committee has been convened to study the potential impacts of expanding eligibility for medical aid in dying to include ill and disabled people who are not dying. Those in charge of this committee are very aggressively rushing the important and complex work of the committee. All of this is happening in the middle of a global pandemic, when our focus as a country has been on taking measures to protect the lives of our most vulnerable citizens. At best, this is extremely ironic; at worst, it is hypocritical, irresponsible and extremely unethical.

As someone who relies on assisted and augmentative communication, I had to request additional time beyond the two and a half minutes allotted for my testimony. This incident illustrates the reality of systemic ableism within a society designed by, and for, typically functioning people. Ableism causes the support needs of people with disabilities to be viewed as excessive and unsustainable. This has enormous and very dangerous implications for the expansion of MAID.

Disability scholar Veronica Chouinard defines ableism as “ideas, practices, institutions, and social relations that presume able-bodiedness, and by so doing, construct persons with disabilities as marginalized...and largely invisible 'others'.” Like racism and sexism, ableism classifies entire groups of people as “less than”, and perpetuates harmful stereotypes, misconceptions and generalizations about people with disabilities. Unlike racism or sexism, however, ableism remains, in the words of Canadian disability scholar Gregor Wolbring, “one of the most societally entrenched and accepted isms.”

People with disabilities are at a higher risk of suicide due to systemic and internalized ableism, yet they face substantial barriers when trying to access suicide prevention services. Medical professionals overlook typical sources of stress. Problems arising from relationship breakdowns, depression and isolation are wrongly attributed to disability. The removal of “reasonably foreseeable” natural death as a limiting eligibility criterion for the provision of MAID will result in people with disabilities seeking MAID as an ultimate capitulation to a lifetime of ableist oppression. In a truly just and progressive society, suicide prevention measures should be applied equally to all people.

More and more Canadians with disabilities find themselves in extreme financial distress as the pandemic drives up costs while already meagre provincial income supports remain stagnant. What’s more, some provinces have recently been publicly musing about reducing, or altogether scrapping, their income support programs for people with disabilities. Recent news reports indicate that some people with disabilities living in poverty are being driven to end their lives through MAID because they lack the means to survive. Physicians report that patients with disabilities are requesting MAID upon learning that the wait time for accessible housing with the supports they require is 10 years or more.

Given the demonstrated ongoing prevalence of ableism in Canada, the Council of Canadians with Disabilities is recommending the following amendments to Bill C-7 in hopes of limiting the bill’s capacity to weaponize ableism in this country.

One, the receipt of adequate housing, income support, palliative care and home-based services should be prerequisite eligibility requirement for MAID. The onus for providing these supports at the level required must fall on governments. A person with disabilities should never bear the burden of trying to lobby for adequate supports.

Two, refer to the Supreme Court of Canada, by way of constitutional reference, Bill C-14’s existing protections limiting MAID to cases where a person’s natural death is reasonably foreseeable.

Three, any changes to Canada’s MAID law must meaningfully respond to last year’s end of mission statement by the United Nations special rapporteur on the rights of persons with disabilities, wherein Ms. Catalina Devandas-Aguilar communicated her serious concerns about “significant shortcomings in the way [all levels of Canadian government] respect, protect and fulfill the rights of persons with disabilities”. Specifically, she noted that there was a lack of “protocol...to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assistive dying”, and that she had received “worrisome claims about persons with disabilities in institutions being pressured to seek medical assistance in dying, and practitioners not formally reporting cases involving persons with disabilities”.

Four, Canada's amended medical assistance in dying law should follow the judicial directive of the SCC in the Carter decision, which required a “carefully-designed system” that imposes stringent limits that are “scrupulously monitored and enforced.”

Five, remove Bill C-7's provision allowing a disabled person's health care or personal care provider to be an eligible witness to that person's request for MAID.

Six, retain Bill C-14's mandatory 10-day waiting period requirement, as it currently stands, and the requirement for independent verification of all MAID requests by two witnesses.

Seven, in response to the prevalence of medical ableism, add language to Bill C-7 that will ensure that all discussions surrounding MAID are patient-led and not prematurely initiated by the physician.

Eight, remove Bill C-7's provisions waiving Bill C-14's important and necessary final consent requirements.

Bill C-7 would enshrine a legal form of ableism into Canadian law by making medical assistance in dying a legally sanctioned substitute for the provision of community-based supports to assist people with disabilities to live. The Council of Canadians with Disabilities, along with the entire disability rights community in Canada, is therefore pleading with policy-makers to rethink and revise Bill C-7 in light of the reality of systemic ableism. You must ensure that MAID does not weaponize systemic ableism in Canada.

Thank you.

[Dr. Ewan Goligher, Assistant Professor, Interdepartmental Division of Critical Care Medicine, University of Toronto, As an Individual]

Madam Chair and honourable members of the committee, I speak to you as an academic physician-scientist, a critical care specialist who frequently provides end-of-life care, as the father of a child with physical disabilities, and as a very concerned Canadian citizen. I wish to address you specifically on the ethics of moral objection to euthanasia.

The first patient I was ever asked to examine in medical school was a young man with profound disability from primary progressive multiple sclerosis. I will call him Nathan, though that was not his real name. Nathan was paralyzed from the neck down, bed-bound, and blind. As I interviewed him, he began to speak of his experience as a person living with serious disability. He spoke especially of the deep loneliness that he felt, the isolation from the rest of the world, the absence of meaningful friendship. His pain was primarily not that of physical suffering but of deep despair of ever enjoying meaningful human contact or relational intimacy.

All these years later, I wonder if Nathan would have considered seeking a doctor’s help to commit suicide. I invite each of you to imagine that you are the one to fulfill that wish for someone like him. You place the intravenous line. You inject the sedation to put him to sleep. You inject the paralytic agent to halt his breathing. Within minutes his heart stops and he is gone. His loneliness and hopelessness are ended, and so is he.

We must all agree that this patient’s loneliness and despair are tragic. We all agree that he deserves the very highest level of care and compassion, that we must work to uphold his dignity and his quality of life. Yet with respect to the ethics of causing his death, many, like me, find a variety of important reasons to object to participating in such an act. First, we argue that euthanasia devalues the patient by treating them as a means to an end. In order to make Nathan’s suffering go away, we would make him go away. We intentionally target and end his person in order to resolve his loneliness and despair. In doing so, we are treating him—his person—as a means to an end, rather than as an end in himself. True respect for the intrinsic and incalculable worth of persons requires that they always be treated as ends in themselves. We do not destroy that which we regard as profoundly and intrinsically valuable.

Second, since respect for persons is the moral foundation of the duty to respect autonomy, by treating persons as means to ends we undermine the very basis for respecting their autonomy. If persons can intentionally be rendered non-persons, then what makes their autonomy inviolable?

Third, in participating in the patient’s act of suicide and causing his death, we are implicitly declaring that we agree that his life is not worth living. We are affirming his perception that his existence is no longer desirable, that we are supportive of his non-existence. Nathan’s loneliness and despair highlight the way that even while we may be autonomous, we are also deeply dependent on others for affirmation and value.

Bill C-7 declares that an entire class of people—those with physical disabilities—are potentially appropriate for suicide, that their lives are potentially not worth living. Indeed, were it not for their disability, we would not be willing to end them. I cannot imagine a more degrading and discriminatory message for our society to communicate to our fellow citizens living with disabilities.

Now, reasonable people may disagree over the ethics of euthanasia. Given the concerns raised here, it is understandable and eminently reasonable that many physicians and nurses object to participating in the provision of euthanasia in general, and to those with disabilities in particular. Contrary to the claims of some, objecting to euthanasia is not motivated by selfish concern for personal moral sensibilities, but rather by a profound moral concern to uphold the value of the patient and to maintain high-quality medical care.

Moreover, the Canadian experience has shown that protecting conscience presents no obstruction to patient access. Bill C-7 should be modified to clearly ensure that Canadians’ fundamental freedoms of conscience are upheld and supported in ways that Bill C-14 failed to accomplish.

Finally, I implore you to ensure that if this law is passed, it requires that the physical, social, psychological, existential and spiritual needs of patients like Nathan have been thoroughly and systematically addressed before they are considered to be eligible for euthanasia. He and others like him deserve the best opportunity for living before they conclude that their existence is pointless and should be ended.

Thank you for your consideration.

[Roger Foley]

The current safeguards are already failing under Bill C-14. Taking away those safeguards, there's absolutely no way to protect vulnerable and disabled persons from a wrongful assisted death. I'm disabled, and I know that if you pass Bill C-7, I won't survive and there'll be thousands of wrongful deaths. You'll see the numbers pile up. So I urge you to please not allow this regime to continue to slide.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you very much, Madam Chair, and thank you, witnesses, for your very helpful testimony.

I want to direct my first question to Mr. Sikkema and Mr. Schutten, as well as Mr. Berger.

In the Supreme Court's Carter decision, the court adopted the pronouncement of the trial judge, wherein the trial judge stated that risks associated with physician-assisted death “can be identified and very substantially minimized through a carefully-designed system” that imposes strict limits.

We have heard some fairly compelling testimony about how vulnerable persons could be put at risk as a result of the removal of important safeguards passed in Bill C-14. Can you speak to any charter issues that you see in that context, Mr. Sikkema, Mr. Schutten or Mr. Berger?

[John Sikkema]

My apologies to the translators.

Our current law, as amended by Bill C-14, is already interpreted to allow doctors to euthanize patients who have a decade or more of life ahead. Our current law already fails to prevent doctors from suggesting MAID without being asked, or at least listing it as an option, which can send a powerful message to the sick and disabled that someone thinks their life isn't worth living.

Bill C-7 not only fails to address those problems, as identified by the United Nations special rapporteur, among others, but it makes them worse. If Bill C-7 passes, it will be possible for a person with a serious illness to go to their doctor's office, have their doctor suggest MAID as an option for them, have the doctor's secretary pop in to witness a written request and then be killed as soon as the second opinion is acquired. Of course the doctor would have to mention other options, but that's just the basic rule of informed consent.

That's the fast and easy track. The slow track isn't much better. For those in the ambiguous category of not reasonably foreseeable death, Bill C-7 says that other options should be discussed and consultations offered, which isn't much, and one would think that such basic steps should already be there for the fast-track cases.

As for the 90-day waiting period, palliative care physicians have already pointed out that it's inadequate because it often takes longer to help people manage their symptoms and to find satisfactory treatments, and so on. We share that concern. We would also point out that the 90-day waiting period is itself ambiguous given that it begins, not on the day a written request is signed and dated, as with the 10-day waiting period that would be cut, but on the day the doctor begins to assess a patient's eligibility, which could be months earlier.

Many people seem to think further expansion of euthanasia is inevitable. This is not true. The Carter decision was very limited in scope, as the court stated at the beginning and end of its decision. This is about Ms. Taylor and persons in her position. She was near death with a known fatal illness and the court said, “We make no pronouncement on other situations where physician-assisted dying may be sought”, at the end of its judgment. It bookended its judgment with those things.

The lone judge who decided Truchon failed to appreciate this and failed to recognize Parliament's objectives in limiting MAID to the end-of-life context. It is the responsibility of Parliament and this committee to listen to the concerns of all parties, including disability rights advocates, palliative care physicians and others; to be clear about its objectives; to defend them against a particular judge; and to enact more responsible policies.

Thank you very much.

[Dr. Leonie Herx, Palliative Medicine Consultant, As an Individual]

Thank you, Madame Chair, and thank you to the committee for having me today.

Good afternoon. My name is Dr. Leonie Herx. I'm a palliative medicine specialist, associate professor and head of palliative care at Queen's University. I'm the immediate past president of the Canadian Society of Palliative Care Physicians and I've been on their board of directors for the past eight years. I'm also an adviser to the Vulnerable Persons Standard, an internationally recognized evidence-based framework that outlines the safeguards necessary to protect vulnerable persons who may be subject to coercion and abuse in a system for medically administered death.

I come before you today to share concerns that are not mine alone, concerns that are shared by many physicians across Canada, as evidenced by the 959, and counting, physicians from all medical specialties who have signed our MAID to MAD petition that was submitted to this committee. In the Carter v. Canada ruling, the Supreme Court stated that a carefully designed and monitored system of safeguards would limit risk to vulnerable persons. In our recent publication in the World Medical Journal in April 2020, my palliative medicine colleagues and I documented concerns and reviewed evidence of errors and harm occurring under the current Bill C-14 MAID regime. A copy of our paper has been submitted to you as well.

Bill C-7 proposes to further reduce these safeguards and put more Canadians at risk of wrongful death. Year after year, there have been documented cases of non-compliance and misapplication of the law and policy with respect to MAID in Canada. The chief coroner of Ontario, the end-of-life care commission in Quebec and, very recently, the correctional investigator of Canada have all reported on these issues.

We also see instances of vulnerable patients being told by their health care team that they should consider a medically administered death because the cost of their care is too great. Roger Foley, from London, Ontario, required 24-hour care that was not able to be provided in his home. While living at the hospital, an administrator suggested that he get MAID, not out of compassion for his circumstances but out of concern for the cost of his care on the system. This conversation was recorded and, of course, has been widely shared.

MAID has also been suggested when the health care team perceives an individual as not having value. While receiving emergency treatment in hospital, Candice Lewis, a 25-year-old woman with a developmental disability and chronic medical problems, had a doctor approach her mother and suggest that she consider MAID for her daughter. Her mother said they were not interested in MAID, and the doctor told her she was being selfish. The doctor then tried to convince Candice herself that she should get MAID. Because Candice felt scared, she asked to go home. The family complied and took her home, feeling that it was unsafe to stay in the hospital.

The UN special rapporteur on the rights of persons with disabilities issued a concern after a recent trip to Canada in 2019. She stated that she was “extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective” and that there was a lack of protocol “to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assisted dying.”

We have seen countless patients whose hope and resilience were restored when their basic care needs were met. We know that many people request medically administered death out of fear of being a burden to others. This demoralization and sense of being a burden is amplified when real options to support living do not exist.

If we are trying to make a medically administered death regime safer for Canadians, then we should look to the Victoria, Australia, legislation, which employs stringent safeguards to address important issues such as the risks of coercion. I've included sections of the legislation in my written brief for your reference. In the Victoria legislation, doctors must not bring up assisted death to a patient unless they ask about it. This is especially important for persons who already feel they are a burden and less valued in society as a result of systemic discrimination.

Bill C-7 is written in such a way that a patient could choose to die before they have actually received therapies that we know in medicine have a high likelihood for recovery or relief of suffering. In other countries where MAID is legalized, it is most often only available for those who are dying. Regardless, all other jurisdictions require that physicians determine that there are no other options of care left to pursue. It is a last resort only.

Physicians who know that there are reasonable treatment options for their patients have a professional duty to instill hope and support resilience and not to stimulate a desire to die. My professional integrity as a physician compels me to offer recommendations to promote the health and well-being of my patients. If I am required to present death as an option alongside evidence-based standards of medical care, this compromises my ability to provide good care to my patients. Doctors need to be able to work with integrity and have our consciences' rights respected.

For the sake of vulnerable Canadians and the practice of medicine, I urge this committee to make significant amendments to this proposed legislation.

Thank you.

[Dr. Ann Collins, President, Canadian Medical Association]

Thank you, Madam Chair. It's my honour to appear before you today.

I am Dr. Ann Collins. Over the past three decades in practising medicine, I have taught family medicine, run a family practice, served with the Canadian Armed Forces and worked in nursing home care. Today, in my capacity as president of the Canadian Medical Association, I represent our 80,000 physician members.

In studying Bill C-7, it is incumbent upon us now to consider the effects on patients that the passing of this bill will have, as well as the effects on the medical professionals who provide medical assistance in dying, MAID.

When the original MAID legislation was developed as Bill C-14, the CMA was a leading stakeholder. We have continued that commitment with Bill C-7. Having examined Bill C-7, we know that in a myriad of ways, the results of our extensive consultations with our members align with the findings of the government's round tables.

Fundamentally, the CMA supports the government's prudent and measured approach to responding to the Truchon-Gladu decision. This thoughtful and staged process undertaken by the government is consistent with the CMA's position for a balanced approach to MAID.

Nicole Gladu, whose name is now inextricably tied to the decision, spoke as pointedly as perhaps anyone could when she affirmed that it is up to people like her “to decide if we prefer the quality of life to the quantity of life”. Not everyone may agree with this sentiment, but few can argue that it is a powerful reminder of the real stakeholders when it comes to considerations of this bill. This applies just as critically to those who are currently MAID providers and those who will become providers. They are our members, but we can't lose sight of the fact that we must all support both patients and providers.

Through our consultations, we learned that many physicians felt that clarity was lacking. Recent federal efforts to provide greater clarity for physicians are exceedingly welcome. The CMA is pleased to see new, non-legislative measures lending more consistency to the delivering of MAID across the country. The quality and availability of care, including palliative care, mental health care, care for those suffering from chronic illness and care for persons with disabilities to ensure that patients have access to other appropriate health care services is crucial.

The CMA holds firm on our convictions on MAID from Bill C-14 to Bill C-7. We believe, first, that the choice of those Canadians who are eligible should be respected. Second, we must protect the rights of vulnerable Canadians. This demands strict attention to safeguards. Finally, an environment must exist that insists that practitioners abide by their moral commitments.

These three tenets remain equally valid. Our consultations with members demonstrate strong support for allowing advance requests by eligible patients who may lose capacity before MAID can be provided. The CMA believes in the importance of safeguards to protect the rights of vulnerable Canadians and those who are eligible to seek MAID. The CMA also supports expanding data collection to provide a more thorough account of MAID in Canada; however, this effort must not create an undue administrative burden on physicians.

The CMA views as problematic the language in the bill that explicitly excludes mental illness from being considered an illness, disease or disability, and it has the potential to be stigmatizing to those living with a mental illness. We trust that Parliament will carefully consider the specific language used in the bill.

Finally, the CMA endorses the government's staged approach to carefully examine more complex issues. However, we must move forward to ensure practitioners are given the tools that will be required to safely administer MAID on a wider spectrum, such as support for developing clinical practice guidelines that aid physicians in exercising sound clinical judgment. Such guidance would also serve to reinforce consistency in the application of the legal criteria.

In conclusion, Madam Chair, allow me to thank the committee for the invitation to participate in today's proceedings and to share the perspective of Canada's physicians. The pursuit of a painless and dignified end of life is a noble one. The assurance that the providers of this privilege are supported is an ethical imperative.

[James S. Cowan]

Thank you very much for the opportunity, Madam Chair and Mr. Garrison. Sorry for the technical difficulties.

Perhaps I could just conclude on a couple of points.

Dying with Dignity Canada is concerned about the express exclusion from Bill C-7 of those with mental illness and believes this exclusion to be stigmatizing, discriminatory and likely unconstitutional.

It's worth recalling the words of Justice Baudouin in the Truchon decision. She said:

The vulnerability of a person requesting medical assistance in dying must be assessed exclusively on a case-by-case basis, according to the characteristics of the person and not based on a reference group of so-called “vulnerable persons”.

She went on to say that “the patient’s ability to understand and to consent is ultimately the decisive factor, in addition to the other legal criteria”.

I have one other point, if I may. We strongly believe that the five-year parliamentary review of the MAID legislation and the state of palliative care in Canada, which was scheduled to begin in June 2020, should commence as quickly as possible following the disposition of Bill C-7. More specifically, we expect that the three areas identified for further study in Bill C-14 and addressed in the Council of Canadian Academies report, namely advance requests, mental illness and mature minors, will be considered during that review.

From our perspective, the most pressing of those three areas is the area of advance requests, something that 85% of Canadians support, as confirmed both by our own research and by the government’s consultation. Today, over half a million Canadians live with dementia, and there's no place for them in our current legislation.

[Dr. Tanja Daws]

I have a very different viewpoint.

In my experience as a MAID provider, especially for people with disabilities and even advanced illnesses, such as multiple sclerosis, the entire treatment team had been obstructing patients' access to care, and actually inducing traumatic stress in those patients and their families with their personal views that patients should keep on trying when they have really reached the end of the line, after years or decades of illness.

My patients with disabilities who qualify for MAID under Bill C-14 have told me multiple times that they abandoned health care because their practitioners continued to force upon them the concepts of continuing to struggle when they were done.

We found that, initially, providers of health care, including family physicians and specialists, would abandon patient care. That stopped after provincial regulations from colleges made it clear that this was not okay. We now actually find that patients abandon their health care workers and vote with their feet, and actually compromise their disability care and their palliative care. As MAID providers, we then pick that up, and work on that from scratch before we even start to make progress.

There are other unintended outcomes when people who think they're doing the right thing to protect their patient actually take it too far, and there are always two sides to a coin.

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

Thank you.

In terms of addressing what I feel is unfairness and not accurate information, the position was put by Dr. Coelho that an amendment needs to be made to this legislation to address conscience rights. In fact, Bill C-14 was amended at committee and validated in Parliament. Subsection 241.2(9) of the old Bill C-14, now in the Criminal Code, says, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” It is in the legislation now. It's also in the preamble. It's also in section 2 of the charter, and it's also in paragraph 132 of the Carter decision, where the court went to great lengths to indicate that no medical practitioner would be forced to provide a service they don't wish to.

In my mind, Dr. Coelho, it seems the concern is actually with the direct referral regime, which has been actually upheld in litigation in your own province of Ontario, where it was deemed to be held constitutional in the approach that is currently done. Direct referrals also occur with respect to any other provisions or treatments that doctors don't feel they want to provide themselves.

Perhaps you could respond to that in 45 seconds, and then give Dr. Daws the time to do the same. Thank you.

[Dr. Tanja Daws, Family Physician, As an Individual]

Thank you for allowing me to speak.

I'm a family physician from Vancouver Island, servicing rural communities. I have been a physician for 20 years in total and have done MAID since 2016.

I want to thank Parliament for the time it has given to study Bill C-7, because I know that for some it will seem to never be safe enough. From reading House of Commons Debates notes, I could see that for many there were specific fears relating to disability, vulnerability and slippery slopes, and frustration by other members that the bill never seems to go far enough.

I want to specifically focus on two issues, but in my brief I did provide more information specifically addressing the MAID process as to how we assess patients and the nuance and detail involved. I share the same practice profile as my colleague and can state that in the four years of doing MAID I have never seen vulnerable patients being abused. That is something that we are specifically looking for in MAID assessment. We spend much more time than we spend with regular patients—over months, if needed—to come to eligibility decisions, even if there was just a 10-day wait period in the past.

As MAID providers, we bring an added level in that many are palliative care physicians and many work with disabled patients to start with, and we feel that our moral grit is strong enough to ensure that we are another layer of comfort and care for those patients, more so than just being MAID assessors.

I want to take the time to spend some attention on two separate issues that I think will flow forward on a practical level in MAID from Bill C-7. The first is around the clarification of expertise.

In this brief, I wanted to focus on the fact that family physicians and nurse practitioners provide the majority of the backbone of Canadian health care by doing primary care and also by being co-pilots with our specialty colleagues. Where “expertise” is mentioned in the bill, we realize with appreciation that it's not to change the equitable access to MAID, but rather to ensure that people are more in place to assess these patients thoroughly, especially when we talk about vulnerability and disability.

I do, however, feel that most family physicians, specifically those who deal with these people for decades of knowing them, for decades as their primary caregivers, are probably in the best position to help them. Most MAID providers come from this field, the same as nurse practitioners. In medicine, when you feel you are not equipped medically or knowledge-wise, or you feel you're missing something, that's when you always phone a friend and refer to a specialist or another colleague.

I don't think that in MAID assessments that process will be different. We have shown that in the MAID community more MAID providers have done palliative care courses, and we are all looking at courses to help us with cultural sensitivity as well as with vulnerability and sensitivity. We are all willing to do training to ensure that we will have enhanced skills to make it safer.

I do think the one thing that will be very difficult with how expertise is defined in Bill C-7 is that it may be very difficult in some illnesses to have a MAID assessor feel that they are an expert. It may be impossible, for instance, to find a neurologist who is willing to be an expert and be a MAID assessor.

I would like to propose the idea to the committee that perhaps the two MAID assessors, if they feel they are at the expert level, could continue in that role, but where they feel that none of them could be expert enough, they could perhaps refer to a third expert, such as an addiction specialist or a pain specialist. They are not actual specialities per se, like surgery, but they can ask for a consultant opinion, which is pretty much what we are doing at the moment with Bill C-14, when we refer patients for a formal capacity assessment. Their assessors, who are usually psychiatrists or geriatric psychiatrists, are not comfortable being MAID assessors or providers, but they're happy to be consultants.

Third, I would just like to address, in terms of the final waiver, that the specified day as a choice for patients can provoke unintended harm by causing anxiety. It's very hard to write down a day, but patients may be more comfortable writing down a period that they would give for that advance consent. This should also be transferable to other providers, as we do have holidays and conferences, or we may be in COVID quarantine, and another provider may have to act on that waiver.

Finally, we are concerned with obstruction from third parties, as in the recent Nova Scotia case. If we deem that the patient is not suffering and the family agrees, then we can stand back.

[Luc Thériault, Bloc, Montcalm, QC]

I will be brief.

Minister, Mr. Garrison raised an important issue: the bill is worthy of merit, but it leaves a number of delicate elements behind.

The legislative amendments enacted by Bill C-14 were supposed to be reviewed in the summer of 2020. Similarly, I imagine that you could commit to the consideration continuing, after Bill C-7 passes, to work on weak points, as a number of stakeholders from various backgrounds would like.

Wouldn't that be a positive compromise to reconcile Mr. Garrison's position with yours? Would you commit today to us looking into those delicate elements following the passage of Bill C-7?

[Luc Thériault, Bloc, Montcalm, QC]

What practicians need is clear legislation. Yet the criterion of reasonably predictable natural death was not a clear criterion. It lent itself to numerous interpretations and excluded people such as Ms. Gladu and Mr. Truchon, who then won the case. Mr. Truchon used medical assistance in dying. That criterion probably did not pass the test in Ms. Carter's case. Had there been certainty that Bill C-14 passed the test, the Supreme Court would have been asked for its opinion.

Let's now move forward. The patient is the standard, but they have to be heard.

Currently, palliative care is sometimes being pitted against medical assistance in dying. Because resources allocated to palliative care are lacking, proponents of that care are opposed to medical assistance in dying. To them, that's an escape route that lacks the necessary guidelines. There could be some division in that area.

Have you noted this opposition between palliative care and medical assistance in dying, in the sense that proponents of palliative care find that not enough is being done, while this was meant to be the solution for dying with dignity?

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

Ministers, respected colleagues, welcome.

I would like to begin by saying that, while we are asking questions to clarify this bill's intentions, people are suffering. People have been suffering since Bill C-14 was passed. We cannot ignore this.

In her ruling, judge Baudoin stated that this suffering was unreasonable under section 1 of the Canadian Charter of Rights and Freedoms. What is more, she said that Bill C-14 was a violation of a fundamental right set out in section 7 of the charter: the patient is entitled not only to safety, but to life. Owing to legislative provisions, the patient was being forced to shorten their life, out of fear of no longer being able to give their consent after losing their faculties. Minister Lametti talked about Ms. Parker's case. That is what we must take into account, and that is the perspective we should use in our work today.

Over the course of this debate and this study, two philosophical views will clash: on the one hand, paternalism of the state, which manifests in medical paternalism; on the other hand, a vision based on the legal principle whereby all individuals are entitled to self-determination.

The question we should ask ourselves is the following: what are the limits of the state intervention power at a patient's most intimate moment in life? Why would the state meddle in a patient's decision that concerns their own death, that has to do with their right to self-determination?

Contrary to my Conservative colleague, I would today like to congratulate Minister Lametti for putting forward this bill, which I feel has a broad consensus.

Mr. Lametti, do you have any figures showing the acceptability of Bill C-7 across Canada and Quebec? I know that Quebec has a broad consensus, but is that the case elsewhere in the country?

[Rob Moore, Conservative, Fundy Royal, NB]

Thanks, Minister.

Madam Chair, this government decided not to defend its own legislation at the first instance, which is incredibly unusual and, in fact, offensive to Parliament, which passed the legislation.

Minister, we know that rather than appealing the Superior Court decision, you chose, instead, to introduce this bill, which in fact goes far beyond simply responding to the decision. This was all done before a parliamentary review that was supposed to take place under your government's own legislation.

Why did your government choose to skip an important parliamentary review that was supposed to look at MAID in the Canadian context after Bill C-14 was passed? Why did you skip that review and, instead, go beyond what was required in the Truchon decision?

Criminal Code

[Mel Arnold, Conservative, North Okanagan—Shuswap, BC]

Mr. Speaker, I certainly agree with the member that the review of the original Bill C-14, medical assistance in dying, needs to take place so there is a proper review of what has been happening since 2016 when it passed. As we move forward with this bill, we certainly need to be cautious and review it, because what we are dealing with here as legislators is the life and death of other people.

[Mel Arnold, Conservative, North Okanagan—Shuswap, BC]

Mr. Speaker, it is an honour to rise and speak in this House on Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

Each and every time that I speak in this House, I am reminded that the opportunity has been entrusted to me by the citizens of North Okanagan—Shuswap, first in 2015, and again in 2019. It is roughly five years now since I arrived in this place for the first time and I still remember the anticipation I experienced as I approached my work as a member of Parliament. I still carry great appreciation for the opportunity to serve the people of North Okanagan—Shuswap and, indeed, all Canadians.

Each and every member of this House has been entrusted by their constituents to represent all constituents, and this is a responsibility that I hope all members keep as a guiding principle as we undertake our work. I do not think anyone could be fully prepared for what the role of being an MP entails and the unexpected situations that arise, but I will say that I came here with an open mind, eager to listen and committed to doing my very best to represent the constituents of North Okanagan—Shuswap.

Shortly after the 2015 federal election, Bill C-14 on medical assistance in dying was introduced to the 42nd Parliament. In fairly short order, Bill C-14 was debated and passed. As members will recall, Bill C-14 was passed in response to the Supreme Court decision that ruled that adults with grievous and irremediable medical conditions are entitled to physician-assisted suicide, as it was termed at the time.

Over the time that was allotted for debate and committee study of the original Bill C-14 legislation, I took the opportunity to hear from constituents and took what I heard at that time to form my position on the legislation at hand. Since then, I have continued to listen to constituents on all sides of this debate in an effort to ensure that I am aware of their many differing viewpoints. I have heard from many who believe in the sanctity of all human life and believe the time of life and death is to be decided by a greater power than any of us possess. I have also heard from others with various incurable health conditions who want the ability to choose an appropriate time so that they are able to pass with dignity, and the ability to choose when to say a final goodbye.

While listening to and pondering the various personal beliefs and scenarios shared by constituents, I have also reflected on my own personal experience and how fortunate many of us are that we have not had to make the very difficult, personal decision that many Canadians face every day.

I would like to share what weighed heavily on my mind during the debate and considerations, back in 2016, and remains with me today as we revisit this topic in the legislature. My mother had developed dementia over a period of years before her passing. At first, we did not recognize the symptoms or maybe we did not want to actually acknowledge that they were there, but as time went on Mom became more forgetful. At first it was just that she would end up with multiple jugs of milk in the fridge because each time she went to the grocery store she simply remembered that she needed milk and not the fact that she had just bought some the day before.

As time progressed, her memory got worse and eventually she moved into a full-care home where she was safe and cared for. Initially it was only her short-term memory that faded away and she could still remember many things from earlier in her life and about her family, but that gradually changed. One thing we did notice in the last few months of her life was that she no longer used the telephone. It would ring but she was not able to put the pieces together to pick it up and talk to whoever was calling. The phone had been a big part of her life as she would always call all of her children, grandchildren and great-grandchildren on our birthdays, but for a number of months she was no longer able to remember phone numbers, what the telephone was for, or how to start a conversation.

At the time of what turned out to be her last Christmas, we made plans to have her home for Christmas dinner and we all looked forward to the day. Then on Christmas morning, we got a call from the care home. They said she had come down with the flu and would not be able to go out. We managed to get through Christmas Day but were concerned the illness was more than she could take in her frail condition.

The next day we were surprised when the care home called and said my mom was doing much better that day and asked if we wanted to come for a visit. We headed out, knowing that mom might not be looking or feeling her best because she had been ill.

We walked into the room that day and were totally taken aback. She was sitting up, fully articulate and waiting for us. We were shocked when she started conversations like someone had turned back the clock two years on her dementia. She told us how she felt bad she had not been able to go out and do any Christmas shopping for the grandchildren and many other things she had not been able to communicate for months.

When we returned home later that day, our answering machine was full of messages from my five siblings all wondering what was going on with mom. She had picked up the phone and called each of them from the numbers in her head and had extensive conversations with each of them.

We were all in shock from this remarkable recovery of her memory and the restoration of her mental function from what had been considered incurable. Unfortunately, the recovery was temporary and only lasted about 24 hours, but nonetheless it was a complete reversal of her dementia for that period of time. To this day, no one has been able to explain how or why this happened. We wondered, at the time, and still wonder today if there may be a cure just around the corner.

This is only one scenario, and in the time since medical assistance in dying became legal, I have heard from constituents and observed cases where family members have been quite open about their aging parent or terminally ill family member. They have been open about how, at some point, the parent or family member is no longer the person they once were and no longer wants to carry on. I have heard how they want to be able to make the choice and should not be denied that choice.

In considering the legislation before us today, we must consider all of the people and lives that will be affected by our decision. It is a very difficult task when we are not able to hear all of the different scenarios, learn the details about symptoms and reasons for personal choices.

That is why I urge all members to consider what safeguards should be in place and if safeguards are not in the current text of bill, can it be amended so that our decision respects the needs and rights of our constituents and Canadians.

I will continue to open my mind and listen to what I hear from my constituents. I expect I might hear cases like mine where we were fortunate that when mom passed peacefully in her sleep a few months later, we did not have to make those difficult decisions. There are cases where a cure might be found soon for someone who is incurable today. There are cases where there is no hope for recovery and someone wants to ensure dignity is retained.

There are many other personal situations out there and as legislators, we must remember that. We have a duty to consider more than just our own personal opinions or those of the people close to us. We must be considerate of those who will be tasked with carrying out what we legislate. We must guard against any loophole or opportunity for this legislation to be exploited or abused, because we are literally legislating on matters of life and death here. Let us consider all of that in our deliberations.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, before getting into the details of the proposed legislation in front of us, I first want to make sure that in the House we avoid a common misunderstanding that seems to come up whenever people strongly disagree with assisted suicide or related issues. Quite often, someone in favour of allowing assisted suicide or removing safeguards will express compassion and empathy for those who are suffering. In saying this, I am not questioning their feelings or their sincerity; nobody wants to suffer or watch their loved ones go through terrible pain. What I am saying here, for everyone's benefit, is that those who are opposed to it or who want to support safeguards have a deep sense of compassion and empathy for those who are suffering. In other words, our human feelings of compassion by themselves do not automatically lead to one position or another.

Along with my wife, I have watched four grandparents pass away, and at present we have another one who is living in palliative care. Each time I have witnessed and cared for family members as they go through difficult health problems, I am reminded of the importance of always affirming a dying person's dignity while they live out the last part of their life.

For the past year, we have had widespread awareness of and concern for how the spread of COVID-19 could devastate seniors and others who are more vulnerable because of medical conditions. For the most part, these are the same people who are at risk and would be even more so under this new law. Along with everything else we could learn from 2020, I hope we can improve our medical practices and strengthen safeguards for the most vulnerable in every area, including this one.

As we continue to debate Bill C-7, it is important for all of us to take a moment to carefully consider its wider impact and unintended consequences. If passed, the new law will significantly expand the number of Canadians who will be eligible for assisted suicide. Whether we agree with these changes or not, it is clear that they are major and fundamental.

It was only a few years ago that Parliament passed Bill C-14, which created the legal framework for what it called “medical assistance in dying”. Previously, the Criminal Code had considered it a serious crime to either kill a patient or participate in a patient's suicide. While amending the section on culpable homicide and defining eligibility, it presented MAID as the narrow exception.

At the time, the former justice minister, with the same sense of transparency for which she later fell out of favour with the Liberal government, publicly stated, “We recognize that medical assistance in dying will in many respects fundamentally change our medical culture and our society.” It was true for what happened back then, and now we are adding some more major changes before the last ones were ever properly reviewed. There was supposed to be an official review of the MAID system, but that has not happened.

Without having a thorough and careful review, we are supposed to proceed with Bill C-7 anyway. So far, in the current session, we have started debating this bill for part of only four days. I hope there will be much more time than this for considering this bill at every stage, especially when it is studied by the justice committee. There is so much that should be said, and the amount of time we all have to work with is too limited.

I share the deep concern of many Canadians who recognize that this bill undermines our country's commitment to upholding and protecting the equal value of each human life. More particularly, there needs to be even more attention given to how assisted suicide, especially in the way this bill handles it, affects the lives and social well-being of people with disabilities.

Over the past year, the idea of systemic discrimination has come to the forefront of our public discourse in Canada, in the U.S. and around the world. To help us better reflect on how it can relate to this discussion, we can look to the work of Dr. Laverne Jacobs. Dr. Jacobs is a law professor at the University of Windsor. She has approached the issue with her legal expertise and speaks from her experience as a Black woman living with disabilities in Canada.

As part of a longer presentation about MAID back in January, she compared and related the experiences of minority communities. She said, “What's particularly troubling about any system or any structure of systemic discrimination is that once ideas that are harmful to a minority group have been legislated into law, it is very difficult to convince the general public that they are not stigma-inducing or ultimately discriminatory. So in both cases, in both the case of racial inequality in the U.S. and the case of MAID here in Canada, we're dealing with the stigmatization of a historically disadvantaged group.”

In an article on the subject of MAID, Dr. Jacobs wrote:

More explicitly, while the MAID law indeed requires consent, these irreversible choices about ending a life are made in a complex social, cultural and health-care context, where lack of access to adequate care, lack of social support and overall ableist stigma have an impact on the choices people with disabilities may have.

In the same article, she also said:

There are also concerns, fuelled by developments in the few countries that provide access to MAID outside the end-of-life context, that being elderly and fragile is increasingly accepted as a reason for a physician-assisted death and that this may create subtle pressure.

This is a small sample of her work, and Parliament would do well to take a closer look at the rest of her comments.

Loss, especially one of this nature, directs and shapes people's actions and attitudes. We cannot say that people with disabilities and other vulnerable populations have not told us this and explained how this bill will inevitably hurt them. Many other advocates and members of the disability community have been speaking out with similar fears, but they were not heard when they called for the government to appeal the Quebec Superior Court ruling. They have also been ignored when it comes to the problems in Bill C-7.

Bill C-7 has to do with life and death, which are ultimate realities. It is reasonable to expect that altering the way our institutions and culture approach the most consequential matters will have wide-ranging effects across all of society. It is hard, if not impossible, to imagine where we will end up if we follow this path.

In my remaining time, I want to highlight some of these problems.

Most notably, Bill C-7 removes the reasonably foreseeable natural death criterion, which is very concerning to me. I am concerned that removing it will normalize suicide over time. Without appealing the decision, the government is going beyond what the Quebec Superior Court ruled.

As one example, the government wants to allow for advance directives. As I have said before, there has been no thorough review of MAID as it currently operates. I am also not aware of any specific study about the risks and problems associated with a process for advance directives. That should happen well before we ever consider enacting it.

Advance requests raise difficult questions. For example, I have to wonder: Could someone consent in advance to be killed once they reach a state they fear but have never experienced, like living with advanced dementia? Further, once someone has signed an advance request and lost the capacity to consent to medical treatment, at what point exactly would their life be terminated? More alarming to me is this: If a non-capable person seems to resist a lethal injection, can the physician still proceed with the injection if the physician believes that the resistance is not due to any understanding on the patients's part that the injection will kill them? Bill C-7 states that apparent resistance means a doctor must not proceed but clarifies that involuntary responses to contact is not resistance. This raises another question. How does a doctor determine if the response to contact is involuntary?

Given that advance requests raise serious ethical issues, oversight challenges and safety risks, legalizing advance directives in the way that Bill C-7 would is irresponsible. This is the position we are left with when we are not trying to create effective accountability mechanisms and when we have insufficient data.

I am also troubled that Bill C-7 would remove the 10-day waiting period. Frankly, I find this disturbing. The 10-day waiting period in Bill C-14 already had a built-in exemption for those whose death or loss of capacity to consent was imminent, and as such, I cannot understand why the removal of this waiting period is necessary or prudent. On the contrary, I find it negligent.

It is well established that the desire to die is often transient. Suffering individuals have ups and downs throughout the day, throughout the week and throughout the year. No one should be able to make a death or life decision when at their most vulnerable point. The 10-day waiting period effectively allows a patient to reconsider their decision and take the time to speak with loved ones. This is critical.

Finally, I want to add that I believe the bill should add a provision that prohibits medical practitioners from discussing MAID unless the patient explicitly asks. We must not underestimate the power of pressure and suggestion, no matter how subtle, especially when it is combined with social stigma, as I mentioned before.

Journalist Ben Mattlin, who suffers from spinal muscular atrophy, wrote this in the New York Times:

I’ve lived so close to death for so long that I know how thin and porous the border between coercion and free choice is, how easy it is for someone to inadvertently influence you to feel devalued and hopeless—to pressure you ever so slightly but decidedly into being “reasonable,” to unburdening others, to “letting go.”

Perhaps, as advocates contend, you can’t understand why anyone would push for assisted-suicide legislation until you’ve seen a loved one suffer. But you also can’t truly conceive of the many subtle forces—invariably well meaning, kindhearted, even gentle, yet as persuasive as a tsunami—that emerge when your physical autonomy is hopelessly compromised.

Despite Mattlin's significant physical disability, he is a father, husband, author and journalist. He has a successful life and knows what he wants. He is less vulnerable than others who might be more easily persuaded that MAID is their best option. In this way, voluntary MAID is the start of a slippery slope that leads to involuntary MAID.

[Chris Lewis, Conservative, Essex, ON]

Mr. Speaker, I rise today to speak to Bill C-7, which proposes to remove safeguards contained in the existing Criminal Code provisions for medical assistance in dying, as well as to expand eligibility. This is a grave matter and one that should not be treated lightly. Its impacts will be significant, especially for vulnerable Canadians. It is important that we get this right.

Before I get into the substantive issues contained in this bill, I would like to add my voice to those of the people who previously urged the Minister of Justice to appeal the Quebec Superior Court's ruling to the Supreme Court. One month after the Quebec Superior Court decision, 72 organizations that help Canadians with disabilities wrote to the minister, calling on him to appeal the decision. Less than a week later, 300 physicians signed a similar letter and since then, many others have voiced their concerns as well.

Referring it to the Supreme Court would have been the more prudent course of action, as it would have provided Parliament with a framework within which it could legislate. Alas, those many voices, as well as those of my Conservative colleagues in the House, went unheeded.

Further, when Parliament passed Bill C-14 in 2016, the legislation required a parliamentary review of its provisions to commence at the start of the fifth year following royal assent. That review, which was also to include a study of the state of palliative care in Canada, could have taken place this past summer but, instead, the government opted to shut down Parliament. That was time squandered.

There was much wisdom in including a mandatory review when Bill C-14 was adopted. Now, instead of giving this matter the thorough attention benefiting its gravity, parliamentarians are being asked to rush legislation through to meet the judicial deadline of December 18, unless, of course, a third extension is sought and granted. We call that putting the cart before the horse. It is therefore vital, in the short time we have to review these changes to the MAID clauses in the Criminal Code, that we hear from as many Canadians as possible from all walks of life, and especially those likely to be most impacted by any expansion of the current laws.

There are two changes to the existing law that are most troubling. The first is the repeal of the provision that requires that a person's natural death be reasonably foreseeable and its replacement with the words “grievous” and “irremediable”. The other is the elimination of the clause requiring a 10-day waiting period between when MAID is requested and when it can be administered. These changes need careful study. What will the unintended consequences be?

Moving forward, the priority of the Conservative Party is ensuring this type of legislation includes safeguards for the most vulnerable in our society, as well as for the conscience rights of physicians and all other health care professionals. One concern in that regard is ensuring adequate safeguards to protect those who may not have the ability to consent. Many of those involved in the care and advocacy for citizens with disabilities are sounding the alarm. We would be well advised to heed them.

I would like to quote from the letter from 72 advocacy groups written to the Minister of Justice just last fall. They were among those who urged the minister to appeal the Quebec Superior Court's decision in Truchon and Gladu. These are their words:

When the original medical assistance in dying legislation was debated in Parliament, there was a clear understanding that MAiD must have limits; that individual rights must be balanced with protections not only for our most vulnerable citizens, but for our society as well. One of the most important foundations of our Canadian identity is that we are a caring, compassionate country. We...place a high premium on being inclusive and tolerant while working hard toward the accommodation and integration of minority members of our communities. And yet, if the Quebec decision is allowed to stand [or as it stands now codified in the law], we will be in serious danger of losing this fundamental element of our Canadian identity. Our neighbours and our loved ones living with disabilities already continually experience the devaluation of their lives. They are frequently told—often bluntly—that they would be “better off dead.”

The letter makes the point that the unintended consequences would be to “...erode provincial health responsibilities for expert clinical care and social support of citizens who are fragile.”

It is crucial that adequate safeguards are included in Bill C-7, and that will be one of my highest priorities. Another concern worth repeating is removal of the end of life criterion. As the Council of Canadians with Disabilities stated in its October 2000 letter to the Minister of Justice, “Without the equalizing effect of the end of life criterion, which guarantees that the common thread between all persons who access an assisted death in Canada is that they are all dying,” with the proposed changes, “...persons with disabilities will be able to gain access ultimately because they have a disability.”

A worse stereotype could not be institutionalized in law: that disability-related suffering, largely caused by a lack of support and equality, justifies the termination of a person's life.

I now want to take some time to address the need for palliative care in Canada and the importance of such end of life care. As mentioned previously, a study of palliative care was to be included in a mandated parliamentary review. This should have happened before Parliament took action to expand the current Criminal Code provisions. Again, I would like to turn to the experts on this: the doctors and other health care professionals who provide end of life care and face these life-and-death decisions every day.

The Canadian Society of Palliative Care Physicians strongly advocates for the prioritization of adequate investment in, and enhancement of, palliative care services. Without access to high quality palliative care, some patients who are suffering may feel that MAID is their only option because their suffering has been inadequately addressed, or they perceive that their families or social supports must carry an excessive burden. Data regarding availability, access, quality and types of special palliative care, for example, are essential not only for those requesting or receiving MAID, but in general in order to better inform areas for improvement. Palliative care should remain distinct from MAID to ensure clarity, and to avoid risk of confusion and the potential for people to refuse palliative care services because they may confuse them with MAID.

During my consultations on Bill C-7, the doctors I have spoken with have stressed that palliative care is more than providing access to morphine, and that the public needs to be educated on this. As well, concern was expressed that elder abuse and financial motives, such as inheritance, could contribute to an abuse of MAID. Another concern is the temptation to save health care dollars with MAID. It is easy to conclude that MAID is more cost effective than continuing care. This raises ethical questions about its potential overuse, particularly as the previous safeguards are being lifted.

These are all serious concerns. I look forward to hearing what the doctors and health professionals on the front lines recommend as we move forward. I would also like to make a brief comment about the need for conscience protection for physicians. Doctors are concerned that they will be forced to administer MAID. I have been advised that the Ontario College of Physicians has created a policy that doctors have to arrange a referral. Some doctors have confided to me that they are considering leaving their profession over this. Suffice to say that physicians should have their freedom of conscience protected, and that this fundamental freedom needs to be codified in law as has been done in Australia.

In closing, I urge the House to take our responsibility to review this legislation seriously and to do as thorough a job as possible, keeping uppermost in mind those most affected by the decisions that we make. As those 300 physicians said in their letter to the Minister of Justice, “For all patients who seek an assisted death, we must ask first if they have had access to adequate and funded social and living supports, as well as exemplary health care and symptom management, in order to assure that they are not seeking an assisted death.” I think we can and must do better.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I will start with the second question first. I agree that more money and resources should go to palliative care. People should be given a real choice. If the choice is between intolerable suffering or seeking medical assistance in dying, that is not a real choice.

As for conflating medical assistance in dying with suicide, the point that I was making was that Bill C-14 amended section 241 of the Criminal Code, which is the provision dealing with suicide.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I am pleased to join the debate today on Bill C-7, an act to amend the Criminal Code. Specifically Bill C-7 would amend section 241 of the Criminal Code, the provision that makes it illegal for a person to help someone else commit suicide. This section of the code was amended by the last Parliament in response to a Supreme Court of Canada decision in 2015, the Carter decision.

Bill C-14, a 2016 bill, stated that one of its objectives was, “permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance.” I would agree with that. The relevant operative provision in the act then sets out the criteria for determining whether a person qualifies for MAID, including that with respect to that person “their natural death has become reasonably foreseeable, taking into account all of their medical circumstances.” However, all of this is about to change if the government has its way with the current draft legislation, Bill C-7.

I am speaking to that bill because I have been encouraged by many of my constituents. Admittedly I have received some letters in support of the government's initiative to expand the reach of MAID, but the vast majority have encouraged me to speak in favour of leaving the law as it is or further restricting access to MAID.

The correspondence I have received in favour of keeping up the safeguards fall into two categories. First, the reasonably foreseeable death safeguard should stay in place. Second, more should be done to expand palliative care services. It was pointed out to me by many that many seniors and other people with serious diseases did not have good ready access to adequate palliative care.

I will quote Rebecca, one of the letter writers, “Let Canada be a society that is known for its modern and advanced palliative care services and not as a country that has ever-expanding use of MAID.” As a proud Canadian, I agree with that statement.

What is behind the current Bill C-7 is the 2019 Quebec Superior Court decision in Truchon. The plaintiffs in that case challenged the constitutionality of the then three-year-old law, arguing that their charter rights had been violated. The federal government, acting through the Attorney General's office at that time, did the right thing. It defended the law, which is what we would expect an Attorney General to do for Canada's laws.

The AG argued as follows, setting out the three main objectives of Bill C-14, which are still relevant today or at least they should be.

First, it is important to affirm the inherent and equal value of every person's life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled. Second, suicide is a significant health issue. Third, vulnerable people must be protected from being induced in moments of weakness to end their lives. I think we would all agree with that.

However, the Quebec court did not. It refused to accept the first two principles as representing the objectives of the law. It said, “the Court cannot accept the two first objectives advanced by the Attorney General regarding the affirmation of the inherent and equal value of every person’s life and the importance of preventing suicide.”

Having thrown aside those principles, it was easy for the court then to decide that the law needed to be changed. Remarkably, the current Attorney General did not appeal that decision. Instead the Liberals are now hastening to amend the legislation to eliminate the reasonable foreseeability of death safeguard.

With the reasonable foreseeability of death safeguard down, this is what we now have left. First, the applicant for MAID has a serious and incurable disease, illness or disability. Second, they are in an advanced state of decline. Third, their psychological or physical suffering is intolerable to them, which is completely a subjective test.

For example, people with Parkinson's, or MS or quadriplegic patients would check off all those boxes. If they had psychological suffering on top of that, they would be eligible for MAID.

Under this new regime, if it becomes law, people who are not dying but who meet all the other criteria will satisfy the requirements for state-sanctioned assisted dying.

I want to reiterate what Rebecca from my riding said. She said, “Let Canada be a society that is known for its modern and palliative care services and not as a country that has ever expanding use of MAID.”

I know the law will be amended. It must be to satisfy the Truchon decision. However, I will point out four things that I hope the committee will take into consideration in improving Bill C-7.

My first point is that the 10-day reflection period for the track one patients, those whose death is reasonably foreseeable, should come back. It should be there. That was not a requirement of Truchon and I do not believe that Bill C-7 is improved by taking that10-day reflection period out. For track two applicants for MAID, people who death is not reasonably foreseeable, there is a 90-day reflection period, and I agree with that.

The second point I want to make is about the 90-day reflection period. I agree with it, but the wording is inadequate. I would recommend to the committee that it amend the 90-day reflection period clause to be the same as the 10-day reflection period clause, but with the necessary change in wording.

My third point is that Bill C-7 would reduce the number of witnesses required for a patient's written directive for MAID. There is absolutely no requirement for that at all and it is certainly not an improvement. Many of the legal documents, including last wills and testaments, require two witnesses as a safeguard against coercion and that should be maintained.

The fourth improvement is that the provision in Bill C-7 saying that a patient's request for MAID must be voluntary without coercion should be expanded to prohibit the attending physician or other health care professional from being the first to raise the availability of MAID option. MAID should never be presented as just another option because in some circumstances, that in itself, would be coercive.

When Bill C-7 was first introduced into the House back in January, COVID-19 had not hit us yet. Since then, many seniors have died of this virus and many others are in isolation. I have seen first-hand the devastating effect isolation has on the mental and physical well-being of seniors, my father-in-law included, as it would for any person. We are created to be social creatures after all.

As my constituent Sarah told me in a very thoughtfully drafted, “[Bill C-7] will put many elderly Canadians, isolated and lonely in their long term care homes, at greater risk of being considered eligible for MAiD. That is not how we should be caring for our seniors!”

Let us use our experience with COVID-19 as a lens to have a very careful review of this draft legislation to reconfirm our commitment to value life and to build as many safeguards as we can around our most vulnerable citizens.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Mr. Speaker, I thank my colleague for his speech. I wonder if we are wasting our time today.

Yesterday, we were talking about conversion therapy, a file Quebec has been a leader on, but still has to wait for Ottawa. We are always trailing behind Ottawa because we are always waiting for Ottawa to get moving and get on board. Today we are talking about medical assistance in dying because a decision was made in Quebec, which is ahead of the curve there too. We have come back to Ottawa to work on this file again. If Quebec were independent we would not be wasting our time duplicating our work on these types of files.

I want to come back to my colleague's speech. Legislators did not do their job when it comes to former Bill C-14 on medical assistance in dying. That is why we are here today. We have to come back to this file because the Bloc Québécois's proposed amendments in 2016 to avoid bringing the courts into social and political issues were rejected. We are coming back to it today because a decision was made by the Quebec Superior Court.

I would like to hear what my colleague has to say about people who have a serious irreversible illness and are essentially forced to go to court. These people are already sick and have to fight the system to be able to access medical assistance in dying. Sometimes they even have to go on a hunger strike to be heard.

My colleague talked about dignity earlier. Does she see any dignity or humanity in putting people in this position?

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, I will be splitting my time with my colleague from Fundy Royal.

I want to start by saying that there is nothing more important in life than being true to oneself. People only live once and there are no mulligans or do-overs. During one's short time on this earth if one can find love and, in return, be loved back, there are no words to appropriately describe that partnership. Likewise, little is as important to the core of one's being than the ability to express who one truly is.

At this very moment, there are LGBTQ2 Canadians who are listening to us debate this legislation while they are struggling to be who they are. Some are afraid of what others will think or say. Some are concerned people will disown them or think less of them. Some think there is something wrong with them. Here is the thing: There is nothing wrong with them.

Just two weeks ago, it was National Coming Out Day. Every year, people across the country come out and say they are proud of who they are. When many people shared this with their closest family and friends, they did something brave, which was to tell the world who they were. It has not always been that way. During the 19th century, same-sex activity between consenting adults was considered a crime punishable by imprisonment. The mental health professionals of that era deemed homosexuality as a mental illness. If we fast-forward to modern times, it was not too long ago when people had to live in the shadows. Many were targeted. They were discriminated against because of who they dated or fell in love with. Some lost their jobs or were looked over for a promotion.

While we have made tremendous strides toward equality, there is more work to be done. As a Conservative, I have advocated for fundamental freedoms my entire life: freedom of speech, freedom of religion, freedom of conscience, freedom of assembly and association, and that every individual has the right to equal protection and equal benefit of the law without discrimination. Those are not just words. They are in our Charter of Rights.

I support the end goal of the legislation before us today because I am a Conservative. Back in 2016, I voted in favour of Bill C-16, which amended the Canadian Human Rights Act to add gender identity and gender expression to the list of prohibited grounds for discrimination. We know that transgender Canadians face elevated levels of sexual violence. They have been bullied and have had to face discrimination in applying for jobs and securing housing. Many within the transgender community have taken their own lives due to depression and feeling that there was no future.

I believe in the right of individuals to live their lives as they see fit. Liberty as defined by the Oxford Dictionary is:

The state of being free within society from oppressive restrictions imposed by authority on one's way of life, behavior, or political views.

The spirit of liberty must be renewed in all of us, for if we waver or deny our fellow citizens the same freedoms that we so cherish, we will have failed to protect them in their time of need. If we are free to decide where we work, go to school, practice our religion and whom we vote for, then it is within that spirit that people must be free to be who they are. We must protect them from those who wish they were someone else.

In almost every other example of trampling on one's fundamental freedoms, such as forcing someone against their will to change religions or their political allegiances, there would be an uproar and rightfully so.

At its very core, the end goal of this legislation is to defend freedom. As a Conservative, I believe that we as parliamentarians have a role to do just that.

During this debate, and inevitably at the justice committee, we will get into the finer details such as the definition of conversion therapy, as explained in the bill. For those who worry that this legislation would criminalize private conversations, spiritual guidance or infringe on religious liberties, the best approach to resolve those concerns is to specifically carve out what the legislation does not do. When there are concerns about the clarity or implications of a bill, the obvious remedy is to provide them those reassurances.

For example, back in 2016, when we were debating Bill C-14, the government's medical assistance in dying legislation, the phrase “does not” was used six times to provide clarity for what the legislation covered and what it did not cover. If we take that same approach to this legislation, we immediately resolve many questions while improving the bill. In fact, we do not have to look too far as the government's own press release contains some of the language that we could insert into the bill to alleviate concerns.

When the original legislation was tabled on March 9, the Liberals' press release stated that the legislation “would not criminalise private conversations in which personal views on sexual orientation, sexual feelings or gender identity are expressed such as where teachers, school counsellors, pastoral counsellors, faith leaders, doctors, mental health professionals, friends or family members”.

Inserting this clarification in the bill would go a long way to better clarify what would be fenced off from the five new proposed Criminal Code offences. It is my sincere hope that the Minister of Justice reaches out to his fellow MPs and incorporates their views and insights, particularly when he needs the support of opposition parties.

If the Liberal government is determined to ignore the following advice, it was due to its own political calculations, as I believe there is a path to garner even further support from all MPs regardless of their political persuasion. As the leader of the official opposition said, we will put forward amendments. We want the legislation to be crystal clear in its intentions and ensure that it meets its intended goal, which is to ban the practice of forcing individuals and minors to undergo conversion therapy.

Since my good friend from Durham became the leader of the official opposition, I have been impressed with his message and how he is building bridges to those who have not traditionally seen themselves as Conservatives, which includes those in the LGBTQ2 community. I know he is sincere in getting this legislation right. He wants to ensure that no Canadian is ever forced to undergo this dangerous and discredited practice that has already hurt so many.

According to a study released by the Community-Based Research Centre, as many as one in five sexual-minority men has experienced sexual orientation change efforts. The long-lasting harm done to survivors is real and far too many Canadians have taken their lives. Both the Canadian Psychiatric Association and the Canadian Psychological Association oppose any therapy that tries to change a person's sexual orientation. Expert after expert has proven that conversion therapy can lead to depression, anxiety, drug use, homelessness and suicide. No longer will people be forced against their will to change who they are.

When this legislation is referred to the justice committee, I know the members will hear the horror stories from Canadians who have been unjustifiably subjected to this harmful practice. They will hear how close people went to the very edge of committing self-harm.

Let me be clear: For the millions of Canadians who are part of Canada's LGBTQ2 community, being who they are is not a defect, it is not an illness and it is certainly not something that needs to be changed. The expression of their identity and uniqueness is welcomed and celebrated in Brandon—Souris, throughout Manitoba and across Canada. This bill is not merely symbolic. It is an important step forward in protecting and upholding Canadians' charter rights. This is about ensuring that all Canadians can live their lives as they see fit.

It is with that in mind that we must turn our efforts to making sure we get this right. I urge every MP to review the legislation and to put our collective heads together to ensure the definition of conversion therapy as defined in this legislation is succinct and will meet its intended goal for the benefit of all Canadians.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

Mr. Speaker, I appreciate the opportunity to rise and speak this evening on Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), or MAID.

The meaning and consequence of this bill should weigh heavily on all Canadian parliamentarians. Today we are debating the competing interests of individual autonomy and the sanctity of human life. We are addressing the suffering of our loved ones, the dignity of the elderly and disabled and the moral, legal and ethical concerns that are inextricably tied to medically assisted death. We are setting out the rules, standards and boundaries by which Canadian doctors and nurses can, at a patient's request, terminate life. This cannot be taken lightly and it is not legislation that should be rushed, but that is the predicament that this Parliament finds itself in.

In 2016, the Liberal government passed Bill C-14, legalizing MAID. Last year, in the case of Truchon v. Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. Contrary to the requests of my Conservative colleagues and many advocacy groups, the Attorney General, who bears the responsibility of upholding laws passed in Parliament, chose not to appeal the ruling in Truchon. It is difficult for me to understand how something as essential to life as one's departure from it is not important enough for the Liberal government to appeal. This is something that should have had both comment and decision from the Supreme Court of Canada.

Because of the Liberal government's inaction, we are now working up against a December 18 Quebec-court-imposed deadline to enact a legislative response for the whole country. Its declaration of constitutional invalidity expires on that date. I want to assure my constituents in South Surrey—White Rock and all Canadians that, as a member of Parliament and a member of the Standing Committee on Justice and Human Rights, I will stand up for their shared values and beliefs and work tirelessly to ensure the amendments proposed in Bill C-7, and their consequences, are carefully studied and considered despite the impending December deadline.

Turning now to the substance of Bill C-7, I am concerned that the bill, as written, is too broad and lacks the safeguards necessary to protect Canada's most vulnerable populations. Let me be clear. The removal of the “reasonably foreseeable” standard will significantly increase the number of Canadians eligible for MAID. The breadth of qualifying conditions widens considerably under Bill C-7. For anyone who initially opposed MAID on slippery slope concerns, it appears we are now sliding down that proverbial hill. Will we eventually follow the Netherlands' lead, which recently ended up in its announced plans to offer MAID to children under 12?

As a group of physicians recently put in a letter to the Minister of Justice and Attorney General of Canada, urging an appeal of the Truchon decision, “Canada will have moved well beyond allowing an autonomous life-ending decision at the end of life into the realm of death on demand for almost any reason at any time.”

We know, from Health Canada's annual report published in July, that 2% of deaths in Canada in 2019 were medically assisted.

How much higher would that number be under Bill C-7, and how many Canadians would be eligible for MAID without the “reasonably foreseeable” requirement? Both questions must be answered.

If this is in fact the direction in which Parliament decides to take this legislation, we need more safeguards to protect the more vulnerable, not fewer. As written, Bill C-7 redefines who qualifies for the end-of-life procedure and strips away some of the protections put in place a mere four years ago.

One such amendment is the elimination of the mandatory 10-day reflection period. Under the original legislation, unless an exception applied, individuals wishing to receive MAID had to wait a period of 10 days after submitting their signed requests. In most instances, the waiting period makes sense. It ensures time for reflection before taking the irreversible action of ending one's life.

We know from Quebec's annual end-of-life care reports that since 2015, over 300 patients in Quebec alone changed their mind after requesting medical assistance in dying. In any event, exceptions already exist under the original law for those whose death is fast approaching and for people who will soon lose the capacity required to provide the necessary informed consent. Why then remove this 10-day reflection period?

Bill C-7 also takes aim at another safeguard included in the previous laws, reducing the number of independent witnesses needed to sign and date the candidate's application for MAID, from two to one.

This amendment would now apply to the newly eligible class of persons who are not faced with reasonably foreseeable or imminent death. Contrary to statements made in the House by the member for Winnipeg North, this is a real concern for many.

As a civil litigation lawyer, I have had my fair share of exposure to all sorts of legal documents requiring the signatures of independent witnesses to ensure both authenticity and true intent: wills, divorces, financial disclosures, affidavits and mortgages, to name a few. To express one's intentions in a will in B.C., a person must have two independent witnesses not named in the will to witness the authenticity of their signature and their intention at the time of signing. If these requirements are there to safeguard intentions regarding possessions, should they not also be there to safeguard a person's intentions regarding the method and timing of their death?

It should be noted that Bill C-7 does include a 90-day assessment period and directive that applicants be informed of available alternative treatments, but will these safeguards sufficiently protect our most vulnerable populations? When does the 90-day period begin? Is it recorded?

Another piece of the bill that I have difficulty with is that it allows patients who may lose capacity before the end-of-life procedure is performed to give their final consent in advance. This troubles me for the same reasons discussed before with respect to the 10-day waiting period. As we have seen, people do change their minds.

In recent weeks, we have heard from many representative groups that have expressed concern about the decision in Truchon. The Council of Canadians with Disabilities, the Canadian Mental Health Association, the ARCH Disability Law Centre and others have articulated the concern that making individuals with disabilities who are not facing imminent death eligible for MAID would be harmful to the disabled community at large, affirming the untrue stereotype that a life with disabilities is not worth living.

We must pause to reflect on that. Those who are passionate advocates for Canadians with disabilities are very concerned about the direction these court and policy decisions are taking us, yet the Liberal government moves forward.

There still exists the legal concept of undue influence. Who are most susceptible to undue influence and coercion? It is the vulnerable. We have also heard from hundreds of physicians who share a concern that some patients have chosen the path of MAID due to the suffering caused by a lack of proper supports. A tragic example is from B.C., where a father suffering from Lou Gehrig's disease chose to undergo the end-of-life procedure because he did not receive the support and resources he so desperately needed.

The government is not listening to the heartbreaking stories of these ALS sufferers and their cries for the fast-tracking of life-lengthening and life-sustaining hopeful therapies that we cannot get in Canada. Is the government giving those sufferers and Canadians true options? We need compassion, yes, but compassion takes many forms.

Hospices are not readily available to all Canadians as an alternative. A good friend of mine died a couple of years ago of inoperable brain cancer. He was a doctor. In his case, he very carefully weighed MAID as opposed to living in hospice. He chose hospice because it extended his life for five months, which he could spend with his family. They were okay with his deterioration because they loved him, and they wanted to support him and be with him. However, he had that true option.

If we are going to expand the legislation, the government should equally ensure robust support for the vulnerable, hospice care and hopeful therapies are available. Everyone matters.

Finally, I would like to reflect on the health care professionals who are asked to implement this proposed law. We are now celebrating our doctors and nurses for their tireless efforts to keep our country healthy and safe. We should also ensure that they have the ability to decide whether this is compatible with their will or beliefs, and not be mistreated for any refusal to administer it.

To conclude, I have heard from constituents in my riding who are on both sides of this argument. I ask my colleagues to really take the necessary time to study the bill and reflect on these proposed amendments, especially as they affect the most vulnerable. We must be compassionate but we must also respect human life.

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, today we are talking about Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying. While I realize this is a very sensitive and difficult issue, I want to be very clear that I will not be supporting the bill. I would like to take a few minutes to talk about why that is and to provide some context to all Canadians, specifically from my constituents in Niagara West.

On February 6, 2015, the Supreme Court of Canada ruled that grievously suffering patients had the right to ask for help in ending their lives. This was the Carter v. Canada decision. The court declared that paragraph 241(b) and section 14 of the Criminal Code, which prohibited assistance in terminating life, infringed upon the charter right to life, liberty and security of the person for individuals who want to access an assisted death.

The Supreme Court decision was suspended for a year to give the government time to enact legislation that reconciled the charter rights of individuals, doctors and patients. As a result, the government introduced Bill C-14 on April 14, 2016, which received royal assent on June 17, 2016. Medical assistance in dying has been legal since then.

On September 11 of last year, the Superior Court of Québec found that it was unconstitutional to limit access to medical assistance in dying to people nearing their end of life. Basically, the court said that the Criminal Code requirement that natural death should be reasonably foreseeable to get medical assistance in dying is against the rights and freedoms of Canadians as they are written in the charter. It is important to note this ruling will come into effect on December 18, 2020, unless a third extension is granted by the court.

The focus and priority of all of us in the chamber should be to ensure safeguards are always in place for the most vulnerable in our society. We also have to keep in mind that we need to be respectful and accepting of the conscience rights of physicians and health professionals. Doctors are trained to save lives, not to end them. I actually believe we should go a step further and protect the conscience rights of all health care professionals.

I am supportive of doctors and health care providers who are not willing to leave their core ethics behind when they are at their patient's bedside. I do not believe it is appropriate to force a doctor or other health care provider to participate in assisted suicide. I also do not believe it is appropriate to hire or fire an employee based on their willingness to be involved in assisted suicide. Physicians who wish to follow their conscience on serious moral issues should be free to do so. Again, we need to be respectful and accepting of the conscience rights of physicians and health professionals.

The last time I voted on this issue, I went through the legislation, which at the time was Bill C-14, and I made a determination that it did not include sufficient safeguards for those most vulnerable, so I opposed it. I had the chance to examine the current bill before us today and I still do not think it has sufficient safeguards, so I will oppose it again.

Let us be clear about something. Medical assistance in dying is a tremendously difficult issue to debate. It absolutely is. It is a highly emotional topic for all sides, and there are many factors and personal convictions that come into play. In the House we agree on many things, but we also disagree strongly on others. The key is to respect one another in the process as we discuss sensitive issues, especially issues relating to human life. Medical assistance in dying has to do with some of the most vulnerable people in our society. That is why it is important we, as representatives of the people who voted for us, have utmost respect for all who have an opinion on this topic. This includes many folks in my riding of Niagara West who are people of faith and disagree with what this bill would do.

I would like to highlight some critical evidence from an expert who appeared before the Quebec superior court on this issue. Dr. Mark Sinyor is a Canadian psychiatrist widely recognized for his clinical expertise and research on suicide prevention. He was an expert witness in the case, who provided important testimony before the Quebec superior court.

In his 50-page affidavit, Dr. Sinyor detailed for the court the likely impact of expanding medical assistance in dying to those who are not at the end of their lives. He notes that under an expanded law, which is what we have in front of us here today, physicians would bring about a death that is not otherwise foreseeable. This is something that is exceptionally difficult to accept for many Canadians across the country and for many in my riding of Niagara West. Issues like the planned legal death of someone who is terminally ill is a very delicate matter to begin with, but to open up the door for more people to qualify for a planned death, a legal death, to me and to many of my constituents, is very troubling.

I would like to return to Dr. Sinyor again.

He talks about a well-established phenomenon referred to as suicide contagion. Dr. Sinyor explains that suicide contagion occurs “through a process called social learning in which vulnerable people identify with others who have had suicidal thoughts and/or behaviour.” He goes on to say, “Expansion of MAID to include suffering, not at the end of life is likely to lead to suicide contagion and higher suicide rates, and to have a negative impact on suicide prevention.”

Dr. Sinyor also talks about the extent to which many elderly people with chronic conditions and younger people with severe disabilities are impacted. He says that they “feel like a burden to their loved ones and that their families would be better off if they were dead.”

When one of our friends, of family members or loved ones is in a similar circumstance and they begin to think that they will be solving this problem of being a burden, knowing that this law will allow it, would it be more comfortable for us? My answer is no, I do not think it would be.

To quote Dr. Sinyor again, “Normalizing suicide death via MAID as a remedy for suffering not at the end of life is likely to increase suicide rates in Canada at a time where there is a universal consensus among public and mental health experts of the imperative to decrease suicide rates.”

In short, the bill would simply make it possible for a person to choose to access medical assistance to end their life, even if their death is not reasonably foreseeable. I am concerned for people with disabilities. I am concerned that, if passed, the legislation will allow people with disabilities to die with medical assistance because they have a disability.

Michael Bach, managing director for the Institute for Research and Development on Inclusion and Society confirms this, saying “people who are not at the end of life will nevertheless be able to access assisted death on the basis that their disability is grievous and irremediable and they experience suffering they find intolerable.” I am concerned that people with disabilities may be coerced into ending their life while they are in a state of personal suffering.

Michael Bach also said, “Negative stereotypes are an undeniable cause of disability-related disadvantage and suffering. The Quebec Superior Court struck a blow to social rights in Canada when it rejected the end of life requirement.”

One of Bach's most striking statements on this issue is that the court's decision “institutionalizes the idea that disability can justify terminating a life. Stereotypes don’t get much worse than that.”

I am afraid that the bill may reinforce horrible stereotypes that a life with a disability is a life not worth living or that living with a disability is a fate worse than death. This cannot happen. I am also concerned that the suffering may not be caused by the disability but because of a lack of services and supports needed by many people with disabilities to lead a full life.

As an example, we have the story of Sean Tagert, a B.C. man who was living with ALS. Sean chose to access medical assistance in dying because he was unable to secure funding for the 24-hour care he needed to live in his home, in his community and raise his young son. The story is heartbreaking. This young man chose death because he was unable to get the proper care for his disability, and he left a young child behind.

It is so sad to hear stories like this. That is why I believe that providing high-quality palliative care is critical. Palliative care is so important because it puts patient care at the forefront of this discussion and not the patient's death. Palliative care helps improve the quality of life, reduces or relieves physical and psychological symptoms and supports the families and loved ones of those struggling with the condition. It could be provided in a variety of settings, including hospitals, at home, long-term care facilities and hospices.

The focus of palliative care is on respecting dignity and having compassion for human life. That in my view is the right approach. I do not think any of us in the chamber should ever underestimate the importance of this issue and its complexity. We all understand the delicate and sensitive nature of it. We all have views and we all know the views of our constituents. They sent us here to represent them, and that is what we are doing.

My hope is that we will all uphold the original objective of this legislation, and that is to affirm the inherent equal value of every person's life to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled. This bill does not do that, and for that reason I will be voting against it.

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

Mr. Speaker, I thank the member for Calgary Nose Hill for her analysis and for her very pointed and personal remarks today.

I am going to put a question to her that has been raised by some of her Conservative colleagues and was, in fact, raised in her speech.

When the member canvassed some of the pros and cons and related what she was hearing from constituents, she mentioned conscience rights. I find that criticism a little confusing, and am trying to understand it, because conscience rights are protected in the preamble of the old Bill C-14, in the text of Bill C-14, in section 2 of the Canadian Charter and even in the Carter decision, which is what got us all here. The Carter decision states, in paragraph 132, that, “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

I am wondering if the member for Calgary Nose Hill could flesh out what she understands to be the conscience rights concerns, because I believe that they are fully protected in the jurisprudence and in the statute.

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, this is absolutely a very important issue for many Canadians.

When the House of Commons debated Bill C-14, I, too, along with my NDP colleagues, voted against that bill because there were many flaws within it. From there, many constituents wrote to me with heartbreaking stories. In fact, one constituent talked about how his mother had to end her life early because she was very worried that if she waited she might lose the faculty to provide informed consent. Those are the kinds of stories that absolutely move us.

To that end, with respect to advance requests as stipulated in the bill before us today, I wonder what the member's thoughts are. Does the member support advance requests?

[Hedy Fry, Liberal, Vancouver Centre, BC]

Madam Speaker, I am really pleased to speak to this bill, Bill C-7, in its current form, mostly because I did not support the original bill, Bill C-14, from four years ago. I did not support it because I felt that it did not reflect the intent of the Supreme Court of Canada's ruling in Carter. I also felt, as a family physician who practised medicine for 20 years, that it did not act in the best interest of my patients.

As a family physician, I walked with my patients through many things: through the joys of having a baby, of giving birth and of marriage, but also through the difficult, challenging and painful times when they struggled with excruciating incurable diseases and with knowing they were going to die because of a terminal illness. They had to work with their families, who may or may not have wanted them to go through with this. I held their hand and walked with them, so this bill has a very personal meaning. That is why I am pleased to speak to it now.

I like the bill in this form in many ways, though there are a couple of things that have not happened in it that I would like to see. The first thing I am pleased with is that it removes the clause saying natural death has to be reasonably foreseeable. It was very difficult for physicians to understand what exactly that meant. If the clause meant only people who were going to die soon, it did not reflect the Carter decision by the Supreme Court, because it did not look at issues of incurable disease or intractable pain and suffering. This bill addresses that, I think, in that it is distinguishing what we mean by natural death becoming reasonably foreseeable. In other words, I think it recognizes that if a natural death, because of a disease or a terminal illness, is going to be foreseeable within maybe a week or two, then a person does not need to go through the 10-day reflection period that was asked for earlier on. However, if it is a longer period of time, maybe four months or so, a person can continue to reflect on whether this is what they really need.

I also like that it has brought back something called advance directives. It is interesting to note that long before medical assistance in dying was considered, physicians had advance directives. This is at the heart of a doctor-patient relationship. They would sit down with patients and go through all of the things patients faced and their concerns, especially if they were diagnosed with a serious and terminal illness, and they would say what they would like to do if something happened. That would be in writing, between the doctor and the patient. I was present when families of patients who were dying, in great pain and suffering and under the deep stress of this, would debate the decisions they had made earlier with their physician. Putting this back in means that we are respecting patients' desires. Regardless of their mental capacity at the time of their dying, we are respecting what they originally wanted, if they still want it, not having other people rule on their decision.

Inherent in everything I dealt with regarding patients who were terminally ill or had an intractable and incurable disease is that they wanted to die with dignity. Dying with dignity cannot be understated. Dying with dignity means that people can choose how they die, where they die and the manner in which they live with the suffering of dying and the mental anguish of leaving their loved ones. This is a deeply personal thing that patients face. It is impacted by their religion, it is impacted by their ethics and it is impacted by their family situation. It therefore has to be done on a case-by-case basis, and having an advanced directive with a physician is always a really important thing in that regard. That had been removed in the last bill and I am glad to see it back. It took the decision away from the patient and gave it to the state, at the end of the day, and now it is back with the patient.

I want to applaud the inherent compassion I see in this bill. I think it is really important. The deeply held desire of every single patient I knew, regardless of whether they chose to have medical assistance in dying or not, was the ability to die with dignity. The patient's ability to choose where they die is really important. Do they want to die at home in bed? Do they want to die in a palliative care unit, where they have become accustomed to spending their last days? Do they want to die in a hospital? Most patients do not want to die in a hospital. They want to be surrounded by their loved ones.

The government is giving $6 billion to provide home and palliative care resources to the provinces, because it is the responsibility of provinces. They can facilitate this deeply held desire to die with dignity and help patients make this choice at a time when the ability to do so is often impacted by extreme pain and suffering and the extreme mental anguish of knowing they have to leave their loved ones. It simplifies this in a great way, and that is a compassionate thing.

There are some areas that can be improved, and one of them is the singling out of mental illness and disability as a sole diagnosis. I agree with everyone who has spoken in the House today, and with the desire of a lot people, to recognize that mentally ill people should not be put away and should not be allowed to simply decide they want to pass on because the people they live with think they are a burden. It is really important to also look at this from the perspective of the disabled.

I know the minister has taken a lot of time to speak with the disability community and physicians. This government is committed to dealing with mental health and illness. My colleague from the Conservative Party told a very moving story earlier about a particular woman who was contemplating suicide. Giving people options when they are depressed or disabled that let them know there are other options for them, that there is a better life available to them, is inherent to this bill.

The minister is going to look at this aspect and consult broadly with the disability community once again as he is looking at the legislative parts of the bill and the regulations. This is really important. Remember, if we single out mental illness and disability as a sole diagnosis, we may be contravening section 15 of the charter. It assumes that, because someone has a mental illness or is disabled, they do not have the right to make a decision regarding their own life and pain and suffering, whether it be mental or not. The idea that this issue will be addressed in work with the provinces, health care providers and the disability community is really important. The safeguards will be worked out. I will be really clearly involved in making sure they are worked out so they can be put into place to protect mentally ill people and people who are disabled.

I want to quote Justice Baudouin in the Truchon decision: “The vulnerability of a person requesting medical assistance in dying must be assessed exclusively on a case-by-case basis, according to the characteristics of the person and not based on a reference group of so-called ‘vulnerable persons’.” Justice Baudouin also added that the patient’s ability to understand and consent should ultimately be the deciding factor with a physician, along with looking at all of the legal criteria.

Those safeguards must be in place, but we should not assume we can make decisions for people who, because of mental illness and disability, may wish to get medical assistance in dying. Intractable pain and suffering is not merely physical; it can also be mental. With the help of good psychiatrists and good support systems, we will be able to put those safeguards in place.

This bill has come a long way in rectifying many concerns that some medical practitioners have raised. It is important that it respects the right of a medical practitioner or a health care provider to use their own ethics and religion to decide whether they wish to perform medical assistance in dying or not. I am—

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, that is exactly what I was referring to when I said I would work collaboratively to try to improve this legislation. I know there were ongoing opportunities for change in Bill C-14 when it came up and went to committee.

My colleague has also forgotten that there was a five-year review which the government could have done a lot more with this past summer. We could have looked at a lot of the issues such as the 10-day issue versus the 90-day issue that my colleague from Saanich—Gulf Islands spoke of earlier. There is a real opportunity for improvements to be made in the bill and that review process, which was more or less forgotten, was one of those opportunities.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, I appreciate the comments and concerns expressed by the member opposite. On the reasonably foreseeable clause, because of the decision of the Superior Court of Quebec, we find ourselves having to bring forward this legislation. However, when we brought in Bill C-14, there was this expectation from parliamentarians that changes would be on the horizon, that the debate did not stop when the bill passed in June 2016. Ongoing dialogue had taken place and some of that dialogue is reflected equally in the feedback we received in January from some 300,000 Canadians.

Would the member not agree that if we are opening the door at this point in time, it only makes sense to look at other things that could be done to improve the legislation overall.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, this is the second time I have had the opportunity to speak to this legislation, Bill C-7, an act to amend the Criminal Code, medical assistance in dying, due to the Liberals proroguing Parliament. Unfortunately, my earlier concerns, such as the legislation going above and beyond the Superior Court of Quebec decision, have not been remedied. I was also on the justice committee when this was being dealt with before.

I have long believed the place for drafting legislation is in Parliament so I will not criticize the government for tabling this legislation. My critique of the government is it is using the Superior Court of Quebec decision to make other amendments to Bill C-14 instead of using the automatic five-year review to do so, which was spoken about here earlier.

No one better understands the reasons why this legislation is needed to respond to the Quebec Superior Court decision than the current Liberal Minister of Justice. In the previous Parliament, he voted against his own government's legislation because he foresaw that a court would strike down the previous provisions as he felt they were too rigid.

The member for Vancouver Granville, the then former minister of justice who drafted Bill C-14 at the time, was aware of this criticism and spoke directly to that issue in her opening remarks at the justice committee back in May 2016. She said, “In terms of eligibility, I am aware of the requirements that a person's natural death be 'reasonably foreseeable' has received some attention, including in terms of how it relates to the Carter decision. I would like to address these concerns.”

She went on to say that, “A person can be approaching a natural death based on medical circumstances that are not directly related to a serious, incurable illness. As well, eligibility does not depend on a person having a given amount of time remaining, such as a certain number of weeks or months to live, as in the United States.”

It was clear from her remarks she felt Bill C-14, the predecessor to this bill, struck the right balance.

As we are all too aware, there are always unique situations where the law cannot accurately predict every scenario. The former minister of justice understood the complexities and challenges the families, doctors and patients were going to face with this new MAID regime. She went to say at committee:

Reasonable foreseeability of death is ultimately a medical decision, and not a legal one, to be made by taking into account all of the person's medical circumstances, including the types and number of medical conditions, frailty, age, etc..... By defining the term “grievous and irremediable medical condition”, the bill would ensure that all competent adults who are in an irreversible decline while on a path toward their death would be able to choose a peaceful, medically assisted death, whether or not they suffer from a fatal or terminal condition.

The word that has caused considerable consternation with both individuals seeking MAID and their doctors is “competent”. As with many illnesses, the drugs needed to either treat or provide comfort can impede one's competencies. This will be an important issue as it relates to the legislation as the government is creating a process for advance requests for persons newly diagnosed with a condition that could affect their decision-making capacity in the future.

As Jane Philpott, the former health minister, said when drafting the original MAID legislation in 2016:

We faced similar challenges in considering the issue of advance directives. The Supreme Court did not deal with this issue in Carter, and the views of Canadians and stakeholders, as you know, are divided. I understand the hardship for those Canadians who fear that after being diagnosed with a disease such as dementia they may experience a decline that could compromise their dignity. This has led to pleas to allow people to make requests for medical assistance in dying well in advance of the time when the person is no longer competent to make or reaffirm a desire to accelerate their own death.

While I agree, I also agree that once this legislation is referred to the justice committee it would be prudent to revisit this issue with medical professionals who are experts on Alzheimer's and dementia-related illnesses.

We must bring in families and those who understand these types of illnesses so we can think through as many scenarios as possible. I would prefer Parliament get this right rather than a court striking down the legislation in the future as it could lead to the situation we find ourselves in today.

The other issue I want to touch on stems from the Truchon decision. The Superior Court of Quebec struck down Bill C-14's provision that death had to be reasonably foreseeable. One could argue the government should have appealed the superior court decision, as we have spoken about in other speeches and questions tonight. It would not be an unusual step as the Government of Canada appeals all sorts of lower court decisions.

While I was not expected to be consulted on the government's response to the Truchon case, there has been very little public discussion from the Liberals about the likelihood of prevailing at the Supreme Court. My only question would be this. If the government did appeal to the Supreme Court, could it have gotten a more limited and narrow ruling on the implications of deleting the reasonably foreseeable clause?

By completely removing this clause, even with a new set of safeguards, it will expand the list of people who might be eligible for MAID rather than just dealing with the specific concern raised in the Truchon case. The very reason the reasonably foreseeable clause was put in the original legislation was that the former ministers wanted a balance between personal autonomy and the protection of the vulnerable.

Obviously the Superior Court of Quebec did not approve of the balance the Liberals sought in Bill C-14. However, in response, we must be mindful of the unintended consequences of this legislation. I know every member of Parliament has been contacted by their constituents about the implications of removing reasonably foreseeable criteria.

There are varying degrees of concern, ranging from moral and ethical grounds to concerns about the role of the state in sanctioning MAID for individuals who are doing so out of the lack of proper palliative care services. The government has decided in this bill to continue to allow doctors and individuals to decide what constitutes a grievous and irremediable medical condition rather than provide a prescriptive list of eligibility criteria. As someone who believes in individual rights and in the judgment of medical experts, I agree with this approach. My only concern is that we have left it too vague.

The government could have eliminated the reasonably foreseeable clause and replaced the original criteria with something that would be deemed constitutional rather than what we have before us today. There are those with apprehensions that proceeding this way will lead to situations where individuals will seek MAID and even be able to proceed for reasons no one in Parliament intended it to. I, for one, would like to see the law as written and intended by the drafters be carried out accordingly.

That is one of my concerns that must be answered fully before we pass the legislation and send it to the Senate. While the legislation explicitly states that having a mental illness is not a serious and incurable illness, disease or disability, we must be prepared to withstand that court challenge.

To refer back to the 2016 debate on MAID, Jane Philpott, at the justice committee, said, “There is no denying that mental illness can cause profound suffering. However, illnesses such as chronic depression, cognitive disorders and schizophrenia raise particular concerns with respect to the matter of informed decision making.”

It goes without saying that there are deep divisions on the overall issue of MAID. What we find in this bill goes much further than deleting and replacing the phrase “reasonably foreseeable” in order to be compliant with the recent court decision. For example, the government is using safeguards which, I might add, is the actual language found within the presentation with which department officials briefed MPs. As it stands, patients must make a written request for MAID that is witnessed by two independent witnesses. In Bill C-7, this would be changed to one independent witness. I believe it is incumbent on the government to justify this change and outline the rationale why it needed to be amended.

Last, the government is also be removing the mandatory 10-day period after the written request is signed. Once again, this is a significant change that goes above and beyond what was required to be in compliance with the Superior Court of Quebec decision.

I have listened closely to the concerns of constituents about the bill, I support it going to committee for scrutiny and clarity. I want government to know I am committed to working with them constructively on the legislation.

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

Mr. Speaker, in my analysis of Bill C-14, which may be right or wrong, it seemed to me the country's doctors were in a discussion and dispute with the country's lawyers. The lawyers were looking at it from the point of view of what the courts require of us and the doctors were saying they were not sure how they wanted to administer it. At that point, I think we let down individual human beings across Canada. I do not think we should do it again. I think the 90-day period is an arbitrary bureaucratic response to trying to find the balance points between those competing interests. What we should always be thinking about and what should be paramount is respecting the rights of individual Canadians at the point they are in irremediable suffering as confirmed by their physicians.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Mr. Speaker, I am glad my colleague brought up the history of Bill C-14 in the previous Parliament and the concerns that she and all of us in the NDP share. This bill did not match the findings of the court decision that brought us to deal with that.

The member did mention the 90-day period and I am wondering if she can expand on that. What does she think this is for? People are in intolerable suffering and asking them to wait another three months seems to be not right.

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

Mr. Speaker, it is interesting that the last question has brought us to the issue of urgency and why this is pressing.

We had this bill before us in the spring, before we adjourned and before COVID-19 took over our parliamentary process. We now have the process, for which I am grateful to all parties, that allows us to debate controversial legislation, to have votes at a distance, to respect the threat of COVID-19 and to protect public health.

When debating this bill before we adjourned, I was getting emails in the House from one of my best friends, who was dying of ALS. She asked me if there was any chance we would make changes to the bill for advance directives in time to help her. I deeply regret that we were unable to get this bill passed last spring, when my friend, Angela Rickman, could have benefited from access to medical assistance in dying. She died in a situation of suffering that would have been her wish to avoid. Now, as we debate this, a member of my own family is wondering whether we can get this bill through quickly enough so that they are not put in the impossible situation that Audrey Parker found herself in. I will reflect further on Audrey Parker later.

There is urgency, whether driven by courts or by compassion. We know as legislators, as our friend from Beaches—East York just commented a few speeches ago, that we have, at this point, repeatedly passed legislation that did not meet the judicial thresholds and frameworks that have been set before us in order to ensure that the legislation we pass on medical assistance in dying meets previous court decisions. I know everybody is deeply affected by their own constituents, their own personal experiences and their frameworks of religious traditions or lack thereof, but I hope we all come to this with open hearts, recognizing that this is a crucially important issue, one that I hope our Parliament will handle better than we have in the past. Let us make sure we pass legislation that does meet the constitutional requirements that have been put before us, if for no other reason than making sure we do not have to continually return to improve our legislation. Ensuring it meets the bar that was set for us by our courts has to be paramount.

I happen to come from a constituency where, overwhelmingly, constituents have wanted to see medical assistance in dying legalized for many years. My colleagues in the chamber and watching remotely will remember the name Sue Rodriguez. Sue Rodriguez was a resident in my constituency, in North Saanich. Her first effort, which was, of course, the case she brought forward, was the first time the Supreme Court of Canada ruled, by a very narrow margin, that medical assistance in dying would not be allowed in Canada. That was back in 1993, and it was by a vote of five to four that the Supreme Court denied her final wish. She was able to access illegal assistance from a doctor who remains unknown, but God bless him, and she achieved medical assistance in her own death in February 1994. It was not a situation we would want any of our loved ones to find themselves in, unable to find the help legally and choosing to find someone willing to help otherwise.

The next set of cases, of course, bring us to more recent cases, the ones we talk about in Parliament today, and particularly the one that brought us to Bill C-14 in the previous Parliament, brought forward after the 2015 election. The names of the ministers who were involved have been referenced several times: the hon. member for Vancouver Granville and, of course, the former minister of health, Jane Philpott.

I lamented then, in this place, that the Carter decision of the Supreme Court of Canada was not being respected fully in the legislation that we were debating. I was able, in clause by clause consideration at committee, to bring forward amendments, which were rejected there, to do away with the requirement that someone be capable and competent on the day of the procedure to confirm their desire for medical assistance in dying.

It is that requirement that drove Audrey Parker to have to get medical assistance in dying before the moment she really wanted to, for fear that she would be unable to provide that consent through the vagaries of the disease or the pain-killing drugs. We know Audrey Parker's story. It was related to us today earlier by the current member for Markham—Stouffville and by the member for Dartmouth—Cole Harbour, who knows the Audrey Parker story well.

She died November 1, 2018, nearly two years ago, saying that this Parliament had let her down through the requirement that she be competent the day of the procedure to confirm that it was, indeed, her wish. This was impractical. Even as we worked in Parliament on Bill C-14, we knew from the language in the Carter decision of the Supreme Court of Canada that this was a violation of patients' constitutional rights.

When the bill got to the Senate, I was very pleased that the amendments I put forward in clause by clause, which had been rejected in the House, were taken up and approved by the Senate. However, as we will recall, when the bill came back from the Senate, the government rejected the amendments to deal with ensuring that people would have access to medical assistance in dying and to deny patients access to an advance directive. Predictably, here we are.

As many of us argued in Parliament in the first round of debates on Bill C-14 on medical assistance in dying, we were not, as a Parliament, passing legislation that was likely to survive a court challenge. There was not much prescience or crystal ball-gazing to know it. We knew it if we read our legislation and compared it to the reasoning in the Carter decision. Here we are now with a new decision, the Truchon decision from the Quebec Superior Court, and we are going back to amend the legislation.

What we are doing, of course, is making sure that people in a situation where they do face a terminal illness and their doctors know that they cannot survive this illness will be able to access an advance directive. Again this was the Carter decision. The Carter decision was full square about facing irremediable suffering and accessing medical assistance in dying. Clearly in this legislation, we have said mental illness is not going to be covered, that mental health issues will not be considered an illness that can be considered irremediable in the context of this legislation. We will very likely have to come back and revisit that.

Certainly, as this legislation goes forward from this vote at second reading to committee, I hope we will find a way to amend the legislation to remove the 90-day timeline around assessing someone's irremediable state of suffering. I support what the member for Beaches—East York has said on this. It does not appear at all to be a humane decision or within what the courts have already told us to insist on that 90-day period.

There are some things that have been argued today in this House that I want to draw attention to because I would hate for Canadians to think that this bill was as cavalier as some would have us believe. Some have said that this bill would allow for “death on demand”. That was one phrase used by one hon. colleague. It's important to know that the bill says quite the contrary.

One of my friends in the House said this bill does not make any effort to allow someone to change their mind the day of the procedure. I urge colleagues to look at subclause (3.1)(d). It is very clear. They should also look at subclauses (3.2), (3.4) and (3.5). Throughout the bill, there are many points at which it is very clear that people have the ability to say, and doctors have the requirement to verify that people have the ability, even on an advance directive, to subsequently change their minds. That is a very clear set of provisions in the legislation, as I said, particularly under subclause (3). To clarify again, in subclause (3.1)(d), it is very clear that one has to ensure that people have been informed that they may, at any time and in any manner, withdraw their request. That is the context throughout this bill.

I know my time is at an end. I just want to say that I support this bill and I hope we pass it as quickly as possible. People are suffering and they want us to act.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, the hon. member for Bow River makes a great point, and I did touch on the review in my speech.

The committee hearing on the bill is not a substitute for the fulsome review that was promised in Bill C-14. I am concerned about the rushed timeline, and I identified in my remarks that for the bill to be fully supported at third reading, things must be done properly. It has to be drafted and worded carefully and thoughtfully, following a proper and robust consultation by the appropriate parliamentary committee.

[Martin Shields, Conservative, Bow River, AB]

Mr. Speaker, I think this has to do with the sense of a court deadline. Our Parliament is constructing legislation. We are working on it. I refuse to accept the idea of being blackmailed into not doing a full and thorough review. We did not do one with Bill C-14. I think the courts would fully understand.

Would my colleague respond to this deadline, which is really blackmailing us into a rush?

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, I am pleased to join the debate. The last several speakers raised some excellent points. It is good to see members bring different perspectives to this debate, and I hope to achieve that as well tonight.

I would like to say broadly at the outset that, in a binary world where one must say they are either in favour or not in favour of the availability of medical assistance in dying for people who are adults, mentally competent, grievously and irremediably ill and suffering cruelly from intolerable pain and anguish, I support the availability of assistance in dying for those people.

However, this bill and few bills we would consider in the House are as simple as a binary choice between two poles. Although we have had all kinds of different perspectives on this, the nuances and the details of this bill, as well as the bill that preceded it, Bill C-14, are very important. I enjoy these types of debates where we hear these points of view and can hopefully improve a bill before it is passed, if it is indeed the will of this Parliament to pass the bill.

I have ordinarily been highly critical of the government on a host of issues. I will take advantage of this moment to say that although there was much consternation to get to the final vote that occurred on Bill C-14 in the previous Parliament, there was something in that process that brought out what is good in Parliament. At that time, we had a lot of different perspectives on that bill. We had a bill that was tabled and amended. It was amended in this chamber. It had committee amendments, many of them, that were brought back and voted on by different parties, and we saw members of the Liberals' side who did not agree with their government for a variety of reasons. There were members, including me, who ultimately at third reading did vote with the government to support it.

That is what Parliament should do. It should bring out vigorous debate that really gets to the heart of an issue in order to have good legislation. I thought Bill C-14, at the time, was a reasonable limited change to criminal law in Canada to both comply with the Carter decision and establish the availability of medical assistance in dying. Credit also should go to members who are no longer a part of the government: the member for Vancouver Granville, who was the minister of justice at the time; and Jane Philpott, who was the minister of health and who showed leadership at that time in debating Bill C-14.

The bill before us today was introduced ostensibly to deal with the Truchon decision and the Quebec superior court's striking down of the reasonable foreseeability phrase from Bill C-14. In this bill, the government has chosen to address other issues at this time. As has been pointed out, there was to be a five-year review, per the previous bill, that should have occurred this summer. I understand the crisis we are in, but let us also not forget we have a government that prorogued the House and prevented the House from examining critical legislation and issues that face Canadians.

The timing of the bill puts us up against something of a deadline looming in December over the Truchon decision, and here we are. December is not very far away when we talk about all the different stages a bill must go through to do it right, to allow all voices to be heard and to allow all members of Parliament to represent their constituents on this.

The bill introduces a few changes beyond addressing the reasonable foreseeability. I am not going to get into the details of that, because time is passing. However, like most MPs, I have received a lot of correspondence and phone calls from the disability community and concerned citizens who have real reservations about any expansion of medical assistance in dying.

Some have argued from the point of view of a slippery slope and are concerned: Once changes are adopted, what comes after them? I understand the sincerity of these concerns. However, we have to examine the bill for what it says and what it does rather than what people might project into it.

Prior to the adoption of Bill C-14, I had four major concerns regarding medical assistance in dying: first, the assurance that quality palliative care be available to persons considering medical assistance in dying; second, strong safeguards for vulnerable Canadians, such as minors, the mentally ill and the disabled; third, the conscience protection for medical practitioners; and fourth, any changes that would expand the availability of medical assistance in dying be well considered, well thought out, carefully drafted and not rushed.

I share many of the concerns raised by members of the disability community, but we have to deal with this issue and not forget the broader purpose of ensuring the availability of medical assistance in dying. It is not merely to comply with court rulings. We must do this out of a sense of compassion for adults who are grievously ill, intolerably suffering and are of sound mind, and who, of their own free will and volition, wish to obtain medical assistance in dying.

I would not support the bill if I thought it was a clear threat to disabled Canadians or if the bill would lead us into a path where medical assistance in dying is offered as an alternative to palliative care or an alternative to treatment. I do not see that in the bill as is. Recalling the experience of Bill C-14, I assume that the bill will be thoroughly studied and that the committee, after it hears testimony from experts and concerned Canadians, will bring amendments back to the House that may offer better assurance to the disabled community and others.

I am inclined to see the bill go forward as far as committee so that we can have a robust, thorough examination of the bill, and so that as parliamentarians, we can do our legislative jobs to ensure that the best bill possible is brought back to Parliament. I look forward to that and assume that we will have this debate.

I am still a little concerned, though. My colleague from Hull—Aylmer mentioned the five-year review and that a committee hearing would constitute that review. This is what it sounded like he was saying, and this does not seem to be in the spirit of what was passed by the House in Bill C-14. However, there is clearly much work to do in this area, and I hope we will have time for a robust, full and proper hearing of the bill at committee so that when the bill comes back to the chamber at third reading, it will give assurances to those who have raised concerns about medical assistance in dying, in particular to the disabled community.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, I remember quite well the former member for Winnipeg Centre and his speech on Bill C-14. One of the things I can recall from the Bill C-14 debate was there were a lot of examples, real-life stories. I say that because it is important for us to recognize the seriousness of the legislation we are debating. Ultimately it will go to committee, where there will be opportunities to have that dialogue and who knows what it will eventually come back as.

Does the member believe the bill is moving us in the right direction?

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, it is a privilege to have this opportunity to rise and speak on Bill C-7, an act to amend the Criminal Code (medical assistance in dying).

Not long ago, we in the House debated the merits of Bill C-14. I was a member of the justice committee when the committee was seized with doing that. That opened the door to physician-assisted death in Canada.

I want to begin my speech today with the same words that I used to open my speech on that bill:

I believe in the sanctity of life, and I believe that all life, from conception right through to natural death, has value, has worth, and has purpose.

A pastor friend of mine told me a story that had happened just prior to the passing of Bill C-14 in 2016. A woman the pastor knew who had battled stage four cancer for 10 years, savouring every moment of that time with her grandbabies and family, was told by one of her care workers, “I bet you cannot wait for the assisted-suicide bill to pass.” The pastor recalled the desperation in her tears when she called to recount her story, asking, “Has my life only become a burden to society?”

After the legislation was in effect, another woman was reunited with her childhood sweetheart and engaged to get married when her fiancé discovered that he had stage four cancer. Together they mustered up every possible hope for a future together, only to have their hopes dimmed by repeated offers for medical assistance in dying.

As the House now considers an expansion of MAID, I think it remains vitally important that the worth of every person is reaffirmed and underscored. It must be our priority in this place to remind every Canadian that they have value regardless of their age. They have value regardless of their ability. Their dignity is not determined by their suffering or their autonomy. It is intrinsic. It is inherent. Their lives are worth living.

I think these statements are important, because the reality is that every time we talk about expanding access to MAID, we send a troubling message to those who may be vulnerable: the idea that, if certain conditions or factors are present, somehow a person's life has less worth; the idea that ending a person's life is a mere medical decision among any number of medical decisions.

Expanding eligibility cannot be about removing safeguards and fundamentally redefining the nature and role of assisted death. This bill intends to offer assisted dying to individuals who are not dying, whose lives are still viable. This is a contentious issue that has been raised by multiple legal voices because assisted death was previously sold as an option only when death was imminent, or reasonably foreseeable.

In just four short years, we have embarked beyond that final stage of suffering. The whole health care system is feeling the pressure for acceptance of MAID, says Nicole Scheidl. Doctors and medical staff are feeling this pressure. Scheidl adds that the most terrifying thing about MAID is how it will impact the future of medicine, as only doctors comfortable with MAID will go into medicine, unless perhaps some provision is made for conscience rights.

Cardus executive vice-president Ray Pennings warns us that Bill C-7 does not take the protection of conscience rights seriously. He writes:

Conscience rights are Charter rights...including the rights of medical professionals not to participate in MAID in any way and the rights of hospices and other institutions not to cause the deaths of people in their care.

There are other valid concerns as well: psychological suffering in combination with other permanent injuries potentially justified under MAID, the elimination of the 10-day waiting period, the requirement for only one independent witness as opposed to two, the waiving of final consent, and also that a witness cannot be a primary caregiver.

Even in its current form internationally, MAID raises flags. When the United Nations Special Rapporteur on the rights of persons with disabilities visited Canada in 2019, she noted that she was extremely concerned about the implementation of MAID from a disability perspective. She flagged that:

there is no protocol in place to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assistive dying.

She highlighted:

...claims about persons with disabilities in institutions being pressured to seek medical assistance in dying, and practitioners not formally reporting cases involving persons with disabilities.

Her advice was to:

put into place adequate safeguards to ensure that persons with disabilities do not request assistive dying simply because of the absence of community-based alternatives and palliative care.

Instead, Bill C-7 goes the opposite direction in order to expand eligibility.

Let us not forget that every choice we make has a ripple effect of different magnitudes. Mother Teresa once said, “I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” The world can be changed for better or worse. When vulnerable people start feeling like they are only a burden to society because of our actions, we need to consider what kind of culture we are creating.

Kory Earle, the president of People First of Canada, a national organization representing people with intellectual disabilities, expresses his concern that everything is already more difficult for people with intellectual disabilities, including exclusion, isolation, housing, resources when abused, education, securing jobs, social lives and finding friends. He further adds that even their word in court is not considered credible. Mr. Earle explains, “everything, and I mean EVERYTHING, is more difficult for people with intellectual disabilities. Many, many other things should be made easier. This [assisted death] is not one of them.”

Passing Bill C-7 is sending a message that individuals with disabilities are no longer safe. This concern is echoed in a joint statement by over 140 lawyers who fear the perception this bill gives, if even unintentional, the perception that life with a disability is inferior and if ratified by law, we diminish the choice to live with dignity and exasperates systemic discrimination.

On top of this, Canada has tragic statistics around suicide. An average of 10 people die by suicide every day. Statistics reveal that nine of those 10 individuals faced a mental health problem or illness. I know and appreciate that those suffering solely from mental illnesses are not eligible for MAID under Bill C-7, but we are nonetheless sending a devastatingly mixed message.

The former Liberal member for Winnipeg Centre raised these concerns when we were first considering Bill C-14. As he observed the rash of suicides in several first nations communities at that time, he expressed concern that, “we haven't thought out the complete ramifications that a decision like this might have on indigenous communities that seem to be suffering greatly.”

In his speech, he shared one of his memories as a six-year-old child. His family was facing serious financial hardship, forcing his mother to go off in search of work. He and his younger brother were to stay with their father, who he described as “a residential school survivor, an alcoholic, and a member of gangs” with a “terrible temper”.

The rest I will quote directly from the former member. He said:

I remember climbing a tree in the back yard and wrapping a rope around my neck at the age of six... 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 must be mindful of the messages we send through this debate and always affirm life, but we must also do more than just offer words. We need to ensure that individuals facing end of life have access to the end-of-life care they deserve.

There are important questions we need to be asking to ensure those who are suffering truly have a choice between living well and pursuing MAID. For example, how do we better love those who live in unbearable pain, whatever form that pain takes? Feeling loved gives inherent strength to those losing hope. How do we show people how their lives teach us? How do their contributions strengthen us as individuals and a society? How do we instill in all people that they are not a bother, a financial burden or a disruption to deal with, but that their life is treasured? We must foster this type of society that affirms life and the pursuit of well-being.

As four physicians suggested in the National Post in response to the proposed legislation, increasing health care personnel, improving our quality of care, enhancing our palliative care options and ensure quicker access to psychiatric care would all be more advisable. Instead, we are “fast-tracking death on demand and dismantling the...[earlier] safeguards that were put in place to protect the vulnerable.”

We have all heard that only 30% of Canadians have access to palliative care and disability supports, which is possibly why there were 50 religious leaders who wrote an open letter urging us to consider that. It states:

Palliative care administered with unwavering compassion, generosity and skill expresses the best of who we are. Rather than withdrawing from those who are not far from leaving us, we must embrace them even more tightly, helping them to find meaning up to the last moments of life. This is how we build compassionate communities.

Furthermore, the joint statement by 140 lawyers explains that singling out non-life threatening illness and disability as eligibility criteria for assisted death—

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

Mr. Speaker, I apologize in advance if there is noise in the background; it is either traffic or my kids, so I have chosen traffic.

I want to start first by speaking to what is at stake with Bill C-7 and with the medical assistance in dying framework overall. What is at stake fundamentally is, first, alleviating intolerable, cruel suffering. The Supreme Court and other courts have spoken about the cruel choice that individuals face in the circumstance where they have a sound mind, they are of capacity and can make these decisions themselves, where they are suffering from an illness that is not going to go away and when they are suffering in an intolerable way. Forcing that suffering upon individuals is cruel and we have to be cognizant of the fact that this is first and foremost about alleviating suffering, but it is about alleviating suffering within the context of empowering and respecting one's personal autonomy.

This is fundamentally about individual rights, and our job fundamentally is to respect those individual rights, to protect those individual rights, to ensure that we end suffering in the course of protecting those individual rights and to make sure that we fulfill the promise of section 7 as it has been interpreted and upheld by our courts, not only in the unanimous Carter decision by the Supreme Court, but also by other courts, like the Alberta Court of Appeal and more.

Now, this bill is important, because it addresses a long-standing concern with Bill C-14. It addresses the concern that we had not answered the call from the Supreme Court adequately. We had added an additional criterion unnecessarily. We had basically said that if people are suffering intolerably and they can absolutely make this choice for themselves, they have capacity, and they have an irremediable condition, an effectively incurable illness, they cannot access this regime if they are not near the end of life or there is not path dependency, but they know the trajectory they are on, even if they are already intolerably suffering.

That, obviously, was unconstitutional. The courts determined that to be so. The government rightly opted not to appeal that decision, and here we are.

Importantly, we have actually gone beyond what the court has mandated in pursuit of individual rights and respect for our charter, as we have said in the case of Audrey Parker, a woman who chose to end her life earlier than she had wanted to. She wanted to get through the holiday season, but she also did not want to lose capacity and then lose the option. She did not want to lose ability to end her life and her suffering. She did not want to lose the possibility of death with dignity, so she chose to end her life before she wanted to. Thankfully, we have actually gone above and beyond what the court has mandated us to do, and we have provided one form of advance request to ensure that individuals, like in Audrey's case, do not end their life before they would like to.

This bill, on those two fronts, is positive. There are some challenges. That is not going to stop me from supporting this legislation at second reading, but it does give one pause. I think we, as parliamentarians, have to be very careful about adding additional exclusions to accessing the MAID regime. That is what this bill would do, unfortunately. I have heard others speak to the issue of mental illness, and there are reasons to proceed cautiously, but there are not good reasons for blanket exclusions. In fact, we potentially render the bill unconstitutional with blanket exclusions, just as we did with exclusions in Bill C-14.

I hope at committee there is expert testimony on this piece, and I hope we get this right. I will give an example specifically on mental illness. In 2016, there was a case at the Alberta Court of Appeal. A woman, identified as E.F., had capacity, she was suffering intolerably, it was irremediable, she had consulted with her family and she had made the decision to end her life. She was able to do so, thankfully, because of the Alberta Court of Appeal applying the Carter decision by the Supreme Court. If the federal justice department had gotten its way in that case, it would have read down Carter to mean only terminal illness. Of course, they said that is not the case. Then we saw, through Bill C-14, that our government tried to impose that kind of criteria, and the court subsequently struck it down. The justice department lost that leg of the argument.

Then, in E.F., they put forward the argument that it could not be an underlying psychiatric condition on its own, but that is exactly what E.F.'s was, an underlying psychiatric condition. The court said that this underlying psychiatric condition, which manifested itself in great significant pain in the documented evidence, did not affect her capacity to make a decision. She was of sound mind.

In E.F., the Alberta Court of Appeal went beyond that. As to the consideration whether MAID should be available to people with mental illness as their sole underlying condition, the Alberta Court of Appeal, in E.F., said that the Supreme Court, in Carter, had canvassed this conversation, this discussion and this concern. Unanimously, they had determined that it was not an additional exclusion. It was not a factor to exclude, and not an additional criterion for eligibility, for those with mental illnesses and those with physical illnesses, so long as they meet the specific criterion of an irremediable condition of intolerable suffering and that they have capacity. It may be that one is depressed, or it may be that one is suffering from a mental health issue such that it impinges upon one's capacity to consent, but in other cases it clearly does not. In E.F., it did not. The justice lawyers lost that case, yet here we are.

In Bill C-14, the government added an additional criterion of close-to-terminal illness and reasonably foreseeable death, and it was struck down. Here, the justice department is adding that second argument from E.F. that it already lost in the courts, and is adding a blanket exclusion for mental illness. As a matter of constitutionality, I would say that if this excludes the case of E.F., which it does, then it creates a ready constitutional challenge. I will be reading the Charter statement from the justice department very closely. I am not suggesting that we do not proceed cautiously, but a blanket exclusion on mental health, when there is a case like E.F. before the court, is likely to render this law unconstitutional, and that has to be addressed by the committee.

The second piece I want to flag is the two tracks. If one's death is reasonably foreseeable, then there is no additional track. There is not even a 10-day waiting period. That 10-day waiting period has been waived, although there was not great concern even with that 10-day waiting period. There is this dual track now, if one's death is not reasonably foreseeable, where one waits 90 days. This is what we are telling people in those circumstances. I have spoken to family members who are affected by this, and they are absolutely challenged by these circumstances when one is already intolerably suffering: They are suffering from a condition that is not going to go away, and they are making this decision themselves, having capacity. If we respect personal autonomy at all, surely a fundamental life decision like this is one that we have to respect, and we are telling these individuals that they have to wait another 90 days, and not just suffer but suffer intolerably for another 90 days. It is inexplicable that we are asking people to suffer intolerably for that length of time. Those are the two specific issues that need to be addressed at committee in a serious way in order to make this bill not only constitutional, but to make it the best bill that it can be.

I wish we had dealt with this last item, because the idea of constantly revisiting this conversation instead of just getting it right for Canadians in need is frustrating. I mentioned Audrey Parker, and we are addressing one type of advance request. However, I do wish that, in the course of this legislation, we had answered the second type of advance request, in which an individual has been diagnosed and is not yet suffering intolerably, but that future is not so far away. Those individuals should also be in a place where they can make an advance request, if we are to respect their autonomy and respect their wishes.

I just wish politics did not get in the way. That is what this is. This bill is a cautionary step. It does not go as far as it could because of politics. I know Conservative members will say it goes too far and others will say we have to be concerned about vulnerable Canadians. We know we can protect vulnerable Canadians and respect people's individual choices at the same time, and I wish politics did not get in the way of alleviating suffering. I wish politics did not get in the way of respecting and protecting individual rights. We like to say we are the party of the Charter. I wish we carried through that promise and demanded greater respect for individual rights in the course of Bill C-7.

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

Madam Speaker, it is a real pleasure for me to be joining the debate today, from my riding, on Bill C-7. I find myself in a unique position because, having given a speech on this very same bill earlier this year, I see we now find ourselves still at second reading for what, I would argue, is absolutely the most important piece of legislation we have before us at this time.

I was also one of the members of Parliament who had the honour of participating in the previous debate on Bill C-14 during the 42nd Parliament. I can remember very much the debates that went on in 2016 and the amount of attention that was given to that piece of legislation. We had an expert committee. We had a special joint committee. There were many hours spent, both in the House of Commons and at the Standing Committee on Justice and Human Rights, on that important piece of legislation because it made a monumental amendment to the Criminal Code in recognition of a very important Supreme Court ruling that forced Parliament to finally take the necessary action.

I remember, during that time, we in the New Democratic caucus ultimately voted against Bill C-14, but we always took the time to explain to people that we were ultimately supportive of what the overall aims of the bill were. Our major problem of the time was that the bill was too restrictive. I remember very well in 2016 referencing a particular section of the bill that I knew would be challenged by the court. Lo and behold, here we are in the year 2020, and we are revisiting that problematic section and having to fix a mistake that was made very clearly four years ago.

It is good to see Bill C-7, and it is good to see that we are complying with challenges that were made before the courts, this time coming in response to the Truchon decision by the Superior Court of Quebec. I know that we are operating under quite a tight deadline. That being said, I still think Parliament has to do a full job on this bill. As parliamentarians, whether we support the legislation, have problems with it or are opposed to it, we owe it to the people of Canada to give this debate as full a discussion and time as Bill C-14 had.

At this time, in particular for the benefit of the people of Cowichan—Malahat—Langford, it is important to underline why we are here discussing this. It really centres on the Charter of Rights and Freedoms, notably sections 7 and 15.

I am increasingly seeing section 7 as probably the most important part of the charter or one of the most important parts, because so many cases seem to be coming forward that directly reference section 7. I know it it is open to interpretation, but if we go along with successive court rulings, my own personal view on the subject is that it is a very important section because it is ultimately making the case that every person in Canada has the right to autonomy over their own body. That is why it is such an important section. If we truly believe in the rights of individuals to make decisions for themselves over what goes on with their own bodies, section 7 is incredibly important. It is really life, liberty and security of the person. That is the part that has to be underlined.

We also have to mention section 15 of the Charter of Rights and Freedoms, which guarantees quality before and under the law and makes sure people are free from discrimination. Why those two sections have such an important bearing in this case is that this bill is trying to make sure people have the right to say what goes on with their own bodies and that in making that decision they are not going to be discriminated against.

I have been listening to the debates on Bill C-7, both from the previous week and today. I acknowledge that many members are bringing forward some concerns with the bill, and I understand and want to validate those concerns. I do not believe we have to make the debate on Bill C-7 an overly partisan issue. That is why I made the comment at the beginning that it is important that all members of Parliament, no matter what party they belong to, be given the chance to fully air their views.

I believe the bill passes muster at second reading and deserves a vote of confidence at this stage of debate, because if there are particular sections of the bill that need further attention, that work is best done at the Standing Committee on Justice and Human Rights.

I fully understand that many members have raised concerns about the removal of safeguards. I have heard many members talk about the state of palliative care in Canada, whether there is enough being done with suicide prevention and so on, and I am very sympathetic to those. I think every member of Parliament, no matter what part of the country we are fortunate enough to represent, can relate to those concerns. We can relate to the concerns that we have received through email correspondence, letters, phone calls and speaking with our constituents face to face.

I am lucky enough to have a hospice undergoing major construction right now. There is a new hospice being built in the Cowichan Valley. I am really glad to see that the level of palliative care in my home riding is going to be significantly better than it was, but of course more can always be done.

Ultimately what is guiding me in this is that it is quite impossible for me, as a member of Parliament who is lucky enough to have his health and not have a grievous and irremediable medical condition, to really understand the level of suffering some individuals in Canada go through. When we are talking about the bill, the struggle we have before us is to not subject other people to our own values, whether those are guided by religious beliefs or the way we were raised and so on. It is quite impossible for people who are healthy and lucky enough to have all of their faculties to understand what the day-to-day life existence is of people who are suffering from one of these incurable and irremediable medical conditions.

Therefore, what is guiding me and members of the New Democratic caucus is an overall goal of trying to ease that suffering, to respect those people's section 7 rights and to understand that they should have the ability to live their lives in dignity and make a determination as to how they want to exit this world. I know it is an uncomfortable debate for many people to have, but that is what is going to be guiding me through these deliberations. I hope it is something all members can take note of.

Following on the speech my colleague, the member for Esquimalt—Saanich—Sooke, gave the other day concerning the legislative review that was part of the former Bill C-14, I want to draw the attention of members to the fact that this was a requirement of Bill C-14. The member for Esquimalt—Saanich—Sooke has put forward a proposal through his private member's motion, Motion No. 51, that will establish a special committee to look at how the legislation is doing. That is something Parliament can easily do while we are deliberating the provisions of Bill C-7. The creation of such a special committee to look at how Bill C-14 has been enacted over the last four years is really important.

This goes back to my first point that, yes we are operating under deadlines, yes we have had people waiting for some time, but, ultimately, it is critically important that we let Parliament deliberate this issue to the fullest extent possible.

With that, I conclude my remarks and look forward to any questions my colleagues may have.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, it is my honour and privilege to join this debate today, though it is a sad one for me. I remember coming to this place. We passed Bill C-14 right off the get-go. It is where I cut my teeth in politics, I would say. At the time, we mentioned that this was a slippery slope. We had seen it in the Netherlands. Currently the government there is passing legislation to allow children under the age of 12 to be euthanized. They are working with what's called the Groningen protocol, where it is not the individual but a group of doctors making the decision as to who gets to live and who gets to die. Here, we saw that this erosion of protection began virtually as the ink was drying on the original bill. We have seen the government not uphold the wishes of this Parliament. We have seen a junior court strike down the law, calling it unconstitutional.

This is where I have some frustration. The ink was not even dry on the bill when it was being challenged in the courts. It had just passed through the House of Commons. It is incumbent upon the executive branch of government to defend the decisions of this place, whether the government agrees with a court or not, and this was a brand new law that had just been thoroughly discussed in this place. We had worked hard for the amendments. For the government to abandon all the work we had done and decide that a junior court decision stood and that it was not going to appeal it to a higher court, like the Supreme Court, was an abdication of the executive branch's responsibility, and I definitely want to acknowledge my frustration that the government did not appeal this court decision.

That said, this bill is much broader than the court decision, and I would argue that we continue down the slippery slope. When Bill C-14 was introduced, I remember talking about the slippery slope and being assured it was not a thing. Yet here we are, removing safeguards from the bill.

This bill definitely makes two classes of Canadians. Across the country, we see a big emphasis on suicide prevention. Every level of government in this country has suicide prevention strategies. We see community groups getting together to run hotlines. Facebook has a warning system to help folks who are considering suicide. Facebook will even identify them and notify people who are close to them that their friend is not feeling well. The American military has worked with Facebook as well, to identify veterans who are considering suicide. We see throughout Canadian society that there is very much a focus on preventing suicide.

Where does that comes into play in this bill? It would create two levels of Canadians. In one case, there are able-bodied, otherwise healthy people suffering from mental illness who are considering suicide. All of those suicide-prevention apparatuses come to their aid. We even have bridges in this country that have nets to catch people in case they jump. All of that stuff comes to the aid of those particular people. However, for sick people who have a grievous and irremediable condition, that stuff is optional and they can request death. They can go to their doctor and say they are not feeling well and are suffering, and that their grievous and irremediable condition has affected their mental health and they are having suicidal thoughts. Then suddenly they are eligible for assisted suicide.

This creates two classes of people. If they are otherwise healthy, suicide prevention is granted to them; if they have an underlying grievous and irremediable condition, they are eligible for, as the government likes to call it, medical assistance in dying or assisted suicide. That is what this bill would do.

Prior to this bill, there was a requirement that a person's death be reasonably foreseeable. I remember that when we were discussing this, we found it to be kind of nebulous. What did that mean? There was no timeline on it. I remember we said that for a death to be reasonably foreseeable, it would have to be in six months or within a year. Those were amendments we brought forward. The government did not go for them back then. Now we see the courts are taking that off and the government is not even defending it. That is definitely one of the concerns we have. We are creating two classes of citizens: one for which suicide prevention is available and one for which it is optional.

The other thing I want to talk about is an amendment we brought to the original bill, one that I think would be an improvement on this bill. It is the need for video verification. In the current rendition of the bill, the timelines have been reduced or eliminated altogether, from the time of the request to the time when MAID is administered. There is a concern that family members may not be convinced that their loved one requested MAID and that they were giving consent at the moment thereof. There has been a suggestion by some groups that there be a video recording of the administration of MAID. That is an amendment I would seek at committee. We would definitely like to see something like this.

Lastly, we would like to see the government work to enhance assistance in living. With COVID, many of our old folks in seniors care facilities are not able to see their loved ones because of restrictions on movements and not being able to travel. The military had to be called in to deal with some of the situations. We talk a lot in this place about dying with dignity, but maybe it is time that we started focusing on living with dignity, having a dignified life, taking care of our elders and being part of a family.

I have talked to folks who have been working in the old folks homes lately and it has been a rough job. They say the loneliness is a major issue in old folks homes these days. The loneliness leads to mental health issues, and if those mental health issues are not addressed, people will become suicidal and will request MAID for loneliness. Is that what we really want in this country? Assistance in living is something we have to be concerned about.

This also deals with palliative care. Palliative care is something the government pays lip service to. We have called for national strategies on this. We have called for money to be put into it. In the absence of palliative care, there is no real choice. There is no ability for somebody to say that this is what they are choosing. Palliative care is an acknowledgement that while there is, humanly speaking, nothing more we can do, we can make a person comfortable and allow them to be surrounded by friends and family as they leave this earth. We would very much like to see the government pursue a significant improvement in palliative care, rather than allowing the elderly members of our families to vanish into an old folks home, where we are not allowed to visit them at this point, to die of loneliness and be offered MAID as the first available option.

This bill has many concerns. It is the first evidence of the slippery slope that is happening in the euthanasia debate, and I definitely wanted to raise that concern. I am also concerned that this bill creates two classes of citizens, as I clearly outlined. I am looking forward to the government making some amendments to the bill and look forward to being able to participate in those discussions at committee.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Mr. Speaker, I am pleased to rise today to discuss Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying, or MAID.

As a physician, I took a keen interest when Parliament passed federal legislation in June 2016 to allow eligible Canadian adults to request medical assistance in dying. This was subsequent to the February 2015 Supreme Court of Canada ruling that parts of the Criminal Code would need to change to satisfy the Canadian Charter of Rights and Freedoms.

At the time, I was also a member of the provincial parliament in Ontario and was involved in how that province would ensure people would have their personal choice of access to medical assistance in dying, while also ensuring the conscience rights of health care providers would be respected. The actual implementation of MAID was our responsibility and was very carefully considered.

Working with provincial organizations like the College of Physicians and Surgeons of Ontario, we established policies to ensure that, should physicians have conscientious objections to administering MAID, systems were in place to provide appropriate care options to the patient. Consistent with the expectations set out in the college's professional obligations and human rights policy, physicians who decline to provide MAID due to a conscientious objection must do so in a manner that respects patient dignity and must not impede access to MAID.

They must communicate their objection to the patient directly and with sensitivity, informing the patient that the objection is due to personal and not clinical reasons. They must not express personal moral judgments about the beliefs, lifestyle, identity or characteristics of the patient. They must provide the patient with information about all options for care that may be available or appropriate to meet their clinical needs, concerns and/or wishes, and they must not withhold information about the existence of any procedure or treatment because it conflicts with their conscience or religious beliefs. They must not abandon the patient and must provide the patient with an effective referral. Physicians must make the effective referral in a timely manner and must not expose patients to adverse clinical outcomes due to a delay in making the effective referral.

While there is importance in ensuring widespread access to MAID, the law specifically acknowledges the conscience rights of health care providers and the role they may play in providing medical assistance in dying. As a physician who spent all of my time in clinical practice doing my best to preserve life, I feel this balance is working well, and the amendments proposed in Bill C-7 do not make any changes to any of this.

As a government, we remain committed to working with provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

What are the amendments that Bill C-7 proposes?

In response to the Superior Court of Quebec's Truchon decision, it repeals the MAID eligibility criterion that applies when a person's natural death is reasonably foreseeable. The criterion is the 10-day reflection period. One concern at the forefront is to ensure that measures are in place that provide safeguards for the MAID process. I believe Bill C-7 does precisely this. It proposes to create two sets of safeguards that must be respected before MAID is provided. For persons whose natural death is reasonably foreseeable, the existing safeguards, as amended by Bill C-7, would continue to apply. For persons whose natural death is not reasonably foreseeable, the existing safeguards with additional safeguards would apply.

I think we are all aware of the concern about increased risks where MAID is provided to persons who are not dying in the short term. That is why additional safeguards would apply where a person's natural death is not reasonably foreseeable. With these new safeguards, specific attention with respect to both time and expertise would be devoted to assessing requests for MAID and to ensuring those making the request are made aware of and seriously consider all other available means of relieving their suffering, including palliative care. In nearly half of the reported MAID deaths in Canada to date, the practitioner providing MAID had in fact consulted with at least one other health care professional in addition to the required second opinion from another practitioner. There is no question these practitioners are taking their responsibilities very seriously.

For those whose death is reasonably foreseeable, Bill C-7 most importantly proposes to eliminate the 10-day reflection period, which many practitioners say can prolong unbearable suffering.

The proposed amendments of the bill will allow waiver of final consent for persons whose natural death is reasonably foreseeable, who have been assessed and approved to receive MAID and who have made an arrangement with their practitioners for waiver of final consent because they are at risk of losing decision-making capacity before their chosen date to receive MAID.

We have heard many touching stories during the course of debate on this bill and situations like that of Audrey Parker, who chose to access MAID on November 1, 2018, despite her desire to see Christmas with her family. She feared that she would lose her capacity to give full consent before Christmas and so she requested MAID before then. Considering her case, we see the need for this amendment in real human terms. Ms. Parker, herself, stated:

I would like nothing more than to make it to Christmas, but if I become incompetent along the way, I will lose out on my choice of a beautiful, peaceful and, best of all, pain-free death.

Since the Truchon decision, our government has engaged in extensive consultations. Beginning in January of this year, over 300,000 Canadians took the time to participate in an online questionnaire on the subject. It should be noted that as part of this questionnaire, direct questions were asked about final consent for MAID. The following question was asked:

Imagine that a person makes a request for MAID, is found to be eligible, and is awaiting the procedure. A few days before the procedure, the person loses the capacity to make health care decisions, and cannot provide final consent immediately before the procedure. In your opinion, should a physician or nurse practitioner be allowed to provide MAID to a person in these circumstances?

Over 78% of participants said yes, that a person in these circumstances should be allowed to receive medical assistance in dying.

In addition to the online questionnaire, the Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion hosted a series of 10 in-person round tables across the country, from January 13 to February 3 of this year. These round tables allowed the ministers to hear from over 125 experts and stakeholders, including doctors, nurse practitioners, health regulatory bodies, key health stakeholders, legal experts, civil organizations and, of course, the disability community.

The ministers also hosted a separate round table focused on receiving specific feedback from indigenous practitioners and community leaders.

The importance of palliative care continues to be raised in these discussions. Our government recognizes the need for quality and appropriate palliative care, which is why it has worked collaboratively with partners, such as the provinces and territories, to develop a framework on palliative care. To support this framework, our government is implementing a targeted action plan, which will help to improve access to palliative care for underserved populations and support families, health care providers and communities. In addition, our government is providing $6 billion in federal funding directly to provinces and territories to support better home and community care, including palliative care.

There is no question that MAID is a very important consideration for all of us. This is an issue about which all Canadians care. I know in my riding of Markham—Stouffville, it is a concern that a significant number of my constituents have shared with me. This matter is extremely complex and further discussion will be needed during a future parliamentary review of the previous Bill C-14.

There is a medical aphorism attributed to Sir William Osler, a Canadian who is considered the father of modern medicine and internationally recognized, that says that a physician's duty is to “cure sometimes, relieve often, comfort always.” Our MAID legislation provides comfort to those facing death. For now, let us move forward with Bill C-7 and provide compassionate care to those in need.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I thank the hon. member for Chatham-Kent—Leamington, where we also have family members. As we have these discussions, we do see the cross-ties across Canada as we look at these issues.

The disability community is involved with the consultation process and will continue to be involved. We are reacting to the Superior Court ruling from Quebec, where we do need to look at some amendments. When we can get those in place, we will do the further review of Bill C-14, which will include the broader issues the member has mentioned.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, before I get started, I will let you know I am splitting my time with the member for Markham—Stouffville.

Today, I have the opportunity to participate in this debate on Bill C-7 from my riding in Guelph. Before I get going on the debate, I would like to recognize that Guelph is situated on the ancestral homelands of the Anishinabe people, specifically the traditional territories of the Mississaugas of the Credit First Nation.

I am proud our government has brought forward a bill that proposes changes that respond to the Superior Court of Quebec's September 2019 Truchon ruling. The proposed changes were informed by concerns and issues raised during consultations earlier this year in discussions with provincial, territorial and indigenous partners. As a result, we have had careful consideration of past experience with MAID in Canada.

I recognize medical assistance in dying is a deeply personal and complex issue. I have heard extensive feedback from my constituents on this topic as recently as this morning. During today's debate, we are hearing very personal stories from MPs that are very similar to what we heard when we first brought forward the legislation in Bill C-14. There are arguments for and against, which we need to recognize and look at.

Some of my constituents who have shared their support for these amendments and the swift passage of this bill have noted to me the importance of dying with dignity, as well as consistent and equal accessibility for all Canadians, as part of what our legislation needs to provide.

Earlier this year, I had a constituent reach out to me and share her personal story regarding medical assistance in dying. She told me that she felt very strongly about this issue because her husband of 56 years, John, had passed last December after four years of battling an illness and how appreciative she was that we had taken some first steps toward addressing these issues. She told me about the vibrant man John was, with a big heart, a successful career and an impressive education. She told me they had conversations about getting old together and how they would deal with aging, but these discussions did not include suffering or what might happen if the pain became too great. As John's illness progressed, he was moved into a long-term care facility where he spent the rest of his life. It was there that she saw so many others who were unable to be independent. She was saddened to see there was no dignity for these people, or for her husband John, as they were no longer able to look after their own personal needs. I saw this myself with my mother as she went through care in her last 10 years of life. The story of my constituent was one that conveys the importance of providing a diverse end-of-life option for Canadians that will help them provide the right decisions to be able to end their days with dignity, comfort and peace of mind.

Of course, there are two sides to this debate. I have heard from other people and received a lot of feedback that they understand we are coming at this as a deeply personal and sensitive topic for everyone, but are concerned these new amendments may impact the disability community, something we have discussed in the debate today, and the conscience rights of medical practitioners or our work toward improving palliative care. They all really do stitch together. While I am sympathetic to these concerns, I am also pleased to see our new legislation strikes the right balance of autonomy and protection of vulnerable people. This is thanks to many disability advocates who have participated actively throughout the consultation process, including specific round tables that focused on issues faced by the disability community. As was mentioned earlier in the debate, 300,000 people had input throughout the month of January 2020 to help us get to where we are today.

Additionally, our law specifically acknowledges the conscience rights of health care providers and the role they play in providing medical assistance in dying. These new amendments do not make changes to these rights and I know we will continue to work with provinces and territories to support access to medical assistance in dying while also respecting the personal convictions of health care providers.

However, the most common concern I have heard from my constituents is the need to prioritize palliative care over medical assistance in dying.

It is really the end-of-life care that we are talking about in both cases. In palliative care, Canadians are approaching the end of their life, and they deserve to receive care in the setting of their choice and to live out their days in comfort and dignity. They also deserve the freedom to make this fundamental decision about life and death without fear of their personal choice being obstructed by politics or government.

In Guelph, we are very blessed to have a wonderful palliative care facility that has been growing over the years as people recognize this as an option towards the end-of-life care that they are looking for.

However, 70% of Canadians are left without access to adequate palliative care. We have the responsibility to act in the interests of patients and their families, which is why our government supports access to both palliative care and medical assistance in dying. End-of-life issues are as diverse as Canadians themselves, and these issues also change throughout the course of medical needs and procedures that are available.

It is our responsibility as a government to provide as many options as possible for Canadians, so that they can take these deeply personal choices and make them on their own. That is why our government has worked collaboratively with partners, such as the provinces and territories, to develop a framework on palliative care. To support this framework, our government is implementing a targeted action plan that will help to improve access to palliative care for underserved populations; support families, health care providers and communities; and look at the funding that is needed to be able to execute our plans.

I would like to take this opportunity to thank Hospice Wellington and its executive director, Pat Stuart for the amazing work they do to support our most vulnerable citizens, including through palliative care.

I would also like to thank the constituents of Guelph who have personally reached out to me over the last several months to share their feedback, suggestions and personal stories around medical assistance in dying. I look forward to continuing to engage with my colleagues on this important subject and with my constituents, so that we can work to create a system that is responsive to the needs of patients, and creates an environment that can create comfort and reassurance for patients and their families.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for the question.

Eliminating the 10 days is a matter of dignity. This will allow some people to avoid suffering for days unnecessarily. As far as the committee work is concerned, we are aware that there is a world of difference between Bill C-14 and Bill C-7.

It is already planned, but the committee will have to address the issues of advance requests, which is something many seniors' groups are calling for, particularly for some people with degenerative diseases. There is also the issue of mental health and that of minors.

There are more issues that need to be studied, and I know that the committee will do the most exceptional work possible with input from all parties.

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

Madam Speaker, I thank the member for Richmond—Arthabaska for his very frank and candid comments.

I would just like to clarify something. He mentioned that the Liberal Party did not accept the other parties' amendments. That is not quite accurate, because during the debate on Bill C-14, we accepted an amendment endorsed by all parties concerning medical practitioners' freedom of conscience and religion.

I would also like to point out that Bill C-7 does allow for advance consent, but not advance directives. The issue of advance directives will be dealt with in the comprehensive review, which will take place every five years.

I would also like to point out that there is a 90-day waiting period to eliminate the impulsiveness my colleague pointed out in his speech. For example, when a minor has an accident, we do not want them to make an impulsive decision on this matter.

Does the member opposite believe that having a specialist is necessary? For example, Mr. Truchon, who was from Quebec just like the member opposite, had cerebral palsy. Our party believes that a physician must have the requisite expertise to treat and advise patients before they make their decision.

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I am very pleased to speak to the important Bill C-7. We need to know its origins to understand why we are at this point today.

In 2016, working on Bill C-14 was a rather difficult exercise given that the Liberal government was intent on bulldozing it through. I believe that is the right expression, because the government refused all amendments proposed by the different opposition parties, including the Conservative Party, the NDP and the Bloc Québécois.

The government put pressure on the Senate by giving it a deadline. The Senate wanted to improve the bill before the House voted on it. What was the end result? In September 2019, the Superior Court pointed out that the bill passed by the House was not adequate, especially with respect to the issue of the foreseeability of the date of the person's death.

That is where we find ourselves today. We are in the House debating an extremely sensitive subject, but we have not had much time to consult the experts.

Everyone has a different perspective on the issue, whether they are members of the House or members of the public in Quebec or elsewhere in Canada.

I wrote a speech, but I have decided not to read it. Instead, I would like to share my own experience with my colleagues.

The vote on Bill C-14 was the hardest vote I cast in my first four years in Ottawa.

On the one hand, I had some constituents asking me to vote in favour of the bill, while others wanted me to make sure that the legislation would protect the most vulnerable and honour the conscientious objection rights of medical practitioners. On the other hand, I had constituents going through a very difficult time with a loved one who was suffering and could not access MAID.

I did not sleep well the night before the vote. I knew that no matter which position I took, whatever I said in the House could be interpreted by the media and by Canadians. Allow me to explain. Some members voted against Bill C-14, and I would imagine that others will vote against Bill C-7. Members voting against the bill are doing so not because they are against it, but because they do not think it goes far enough.

The opposite is also true. Some members voted in favour of Bill C-14 in 2016 because they wanted to make sure people got the bare minimum. No matter which side we took, we had to explain something extremely sensitive, and I do not think a simple yes or no could accomplish that.

I often ask myself, who am I to decide for someone else? As lawmakers, it is our duty to protect the most vulnerable, especially if we remove the criterion of reasonably foreseeable natural death for access to MAID. This is reflected in the questions that some members have been asking in the House. I am sure it reflects the opinion of many Canadians who wonder what would happen if a person wanted to give advance written consent in case their situation changed over time. There is much more to this debate, and I do not think we are done talking about it.

Madam Speaker, I forgot to tell you that I will be sharing my time with the member for Calgary Signal Hill.

I am very concerned about ensuring that this bill enables all Canadians, wherever they may live in this country, to have access to the appropriate resources to make the right decision for their situation. The current pandemic has exposed the weaknesses in our health care systems. I doubt all Canadians in rural areas have access to specialists who can guide them and give them the right information so that they can make a decision based on their circumstances.

I am also very concerned about minors and vulnerable people. During the study of Bill C-14 in 2016, I had the opportunity to hear the testimony of two witnesses who had suffered accidents and endured the most traumatic ordeals a human being can experience. They told me that, had they had access to MAID back then, they probably would not have been talking to me that day because they had been in such a dark place at the time.

I know people who were there for the final moments when someone who was suffering asked for MAID. I am certainly concerned about all that, and it makes me wonder what the best solution is. Is it because we do not have the necessary palliative care resources? Is it because both the federal and provincial governments and health care facilities are making poor decisions? I am wondering about that.

I must say, I feel like we are rushing the process today, because has been quite a while since the courts asked Parliament to modernize this legislation after what happened in Quebec. This is a government that shut down Parliament under the pretext of being in a pandemic, as though we could not do more than one thing at a time. There are 338 MPs. Committees could have continued to sit. We could have heard from experts who could have explained this issue to us properly so we could make the right decision, the best decision.

Again, this is something that will not be easy for many of us. We have differing opinions within our party and elsewhere. However, I would like to note that I am proud of my party for letting me vote freely. I want to thank my leader for allowing this, without any pressure from my organization. I hope that all political parties will offer this choice, because this is a vote of conscience, and it is challenging for us to represent our constituents, who do not all share the same opinion. We also have our own conscience. For some, this is a matter of religion or beliefs, which means we may not all see eye to eye on this file.

Personally, the thing I wrestle with the most is wondering who I am to decide what is best for someone who is suffering. I believe that is what will guide my decision on the day of the vote. I hope that I will be able to make the right decision and that all of us can then work with the government to put all the necessary resources in place to properly inform and educate the public, and provide everything we can to vulnerable people who are going through tough times with loved ones, so that they are adequately supported in making the best decision.

In closing, I hope that next time, we will have more time to talk about people who are not vulnerable, sick or about to die, but still want to express advance consent.

[Pam Damoff, Liberal, Parliamentary Secretary to the Minister of Indigenous Services]

Madam Speaker, it is a pleasure to follow the wise words of my colleague, the member for Mount Royal.

I am pleased to speak in favour of Bill C-7, an act to amend the Criminal Code, medical assistance in dying. As hon. members know, this bill responds to the Superior Court of Québec decision that struck down the eligibility criteria that naturally occurring death be reasonably foreseeable.

In the last Parliament, I spoke during debate on the original MAID legislation. At that time, I talked about the need for us to have conversations with loved ones about death and dying. “Death” is a word that elicits strong emotions. We celebrate life, we embrace life and we talk about living. However, we avoid talking about death. We shy away from those conversations because they make us uncomfortable. I know there are those who feel this legislation goes too far. However, regardless of where people fall on this legislation, I think we can all agree that the way we deal with and talk about death needs improvement.

Whether a grievously ill patient chooses to die at home or in a palliative care facility or chooses medical assistance in dying, we should be having these conversations sooner and lovingly assisting those who are ill in the end of their life. These decisions are often made during a health crisis. Ideally, each of us should be engaged in advanced care planning.

I would like to share the story of Bob Lush, an incredible man, respected lawyer and my friend. Bob and his wife Maureen shared a love and bond that was obvious to all who met them. Bob died on March 17. This summer I had lunch with Maureen and she shared with me the decision they took to use MAID. With Maureen's permission, I would like to share Bob's story.

Bob had been diagnosed with multiple system atrophy and pulmonary fibrosis. He also exhibited symptoms of Parkinson’s. While his body was failing him, his mind was as sharp as ever. Over time, these serious health issues would worsen, which led his doctors to tell him that he was palliative and that there was nothing more they could do. A palliative care nurse asked if they had thought about MAID and provided them with a brochure. It was not an option they had considered before, but Bob and Maureen together decided that this option would be the most loving way for Bob to leave this earth. I cannot possibly put into words the tremendous love these two shared.

Maureen described for me Bob's last days. They chose March 17. All medical equipment was removed from Bob's room and it was filled with flowers and candles. They loved listening to James Taylor's “American Standard” album, and it was playing. Maureen and Bob's son John were by his side. As Moon River played, the doctor administered the MAID drugs. Bob closed his eyes and peacefully, painlessly and humanely passed away. To hear Maureen describe it, I could hear both the love in her voice and the sadness of losing Bob, but she had no regrets and, in fact, wanted Bob's story to be shared so that other families could consider this option for their loved one, if it was the right decision for them.

The legislation before us here today would update our MAID laws in several ways. The bill would maintain existing safeguards and ease certain safeguards for eligible persons whose death is reasonably foreseeable. New and modified safeguards would be introduced for eligible persons whose death is not reasonably foreseeable. Persons whose natural death is reasonably foreseeable, who have been assessed as being eligible for MAID and who are at risk of losing capacity, can make an arrangement with their practitioners in which they provide their consent in advance, which allows the practitioner to administer MAID on a specified day, even if the person has lost their decision-making capacity.

For persons who choose MAID by self-administration, a person could waive in advance the requirement for final consent in case complications arise following self-administration, leading to loss of capacity but not death. These new safeguards would exclude eligibility for individuals suffering solely from mental illness. It would also allow the waiver of final consent for eligible persons whose natural death is reasonably foreseeable and who may lose capacity to consent before MAID can be provided.

This legislation would also expand data collection through the federal monitoring regime to provide a more complete picture of medical assistance in dying in Canada. These are important changes and ones that have been called for since 2016, when the government responded to the Carter decision with its original legislation.

Since MAID became legal in June 2016, there have been more than 13,000 reported medically assisted deaths in Canada. This figure is based on voluntarily reported data from the provinces and territories prior to November 1, 2018; and the data collected under the new monitoring regime after that date. MAID deaths as a percentage of all deaths in Canada remains consistent with other international assisted-dying regimes.

The government undertook extensive consultation in order to update the MAID legislation. In January and February 2020, the Government of Canada engaged with provinces, territories, Canadians, indigenous groups, key stakeholders, experts and practitioners to receive their feedback on expanding Canada's MAID framework. Over 300,000 Canadians participated in online public consultations between January 13 and January 27 of this year.

It is important to recognize that MAID is not the right option for everyone. We still have work to do to educate Canadians about end-of-life options. When the former Bill C-14 was debated in the House, I spoke about palliative care and the need to educate Canadians about it as an end-of-life option. I was pleased the Senate amended our original bill to include palliative care in the legislation. Our government has worked collaboratively with partners, including the provinces and territories, to develop a framework on palliative care. We are implementing a targeted action plan of providing $6 billion directly to provinces and territories to better support home and community care, including palliative care.

I would like to share once again Bonnie Tompkins' story, a story I shared in 2016 during debate on the original MAID legislation. She is currently compassionate communities national lead for Pallium Canada, a national non-profit organization focused on building professional and community capacity to help improve the quality and accessibility of palliative care in Canada.

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 in Burlington and was educated on the options available—

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I had the privilege of serving with the hon. member for Mount Royal on the justice committee when we studied Bill C-14

The member rightfully talked about the process in which we heard from a diverse range of viewpoints. It is ironic that this legislation circumvents that opportunity to hear from a diverse range of viewpoints by pre-empting a legislative review, which should have started in June.

The hon. member will know that this decision goes well beyond the scope of the Truchon decision. One such area is with respect to advance consent, to which he alluded. Arguably this goes beyond the scope of the Carter decision inasmuch as Carter stated not once, not twice but on three occasions that a patient must clearly consent.

How can the hon. member defend that with respect to legislation that arguably goes beyond the scope of Carter? How can consent be truly meaningful if it is not contemporaneous?

[Anthony Housefather, Liberal, Parliamentary Secretary to the Minister of Labour]

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

This is a very difficult bill and subject for us to deal with. In this case, the sanctity of life, something that all of us cherish, conflicts with the liberty interests protected under section 7 of the charter. This is one of those difficult times where we have to recognize that our own religious views, our own moral views are not the ones we can simply impose on Canadians. We have to recognize that charter rights are sacrosanct. Sometimes, as a member, those are difficult moments.

I personally have said before that I would not choose medically assisted dying for myself. Nor would I encourage family members to avail themselves of the opportunity for medically assisted dying. However, I also fully respect the right of every Canadian to choose for his or herself whether this right should be exercised personally.

In the Carter decision, the Supreme Court of Canada upheld that under section 7 of the charter, there was a certain subgroup of Canadians whose liberty interests were violated by the existing provisions in the Criminal Code on not assisting someone to commit suicide. The Supreme Court in Carter told us that there was a subsection of Canadians, those who were in constant enduring pain and suffering that could not be alleviated by medical treatment reasonably acceptable to them, who had the right to have their death hastened by having medical professionals assist them in doing so.

In the last Parliament, our government brought in Bill C-14. I had the privilege of being the chairman of the Standing Committee on Justice and Human Rights. We heard from a great cross-section of Canadians. We heard from those who represented the disabled community and those who believed in the right to die with dignity. We heard from members of the clergy from all faiths. We heard from university professors, lawyers and doctors. We heard from a great cross-section of Canadians who had very diverse and different opinions.

What we tried to do was craft a law that brought Canadian society together, that protected the vulnerable but yet still afforded everyone the right that the Supreme Court had recognized in Carter, which was the right to decide for one's self whether to terminate one's life in the event he or she was in enduring pain and suffering that could not be alleviated by medical treatment reasonably acceptable to that person.

As well, we had to recognize that when we dealt with the Carter decision in Bill C-14, Canada was at the beginning of a list of countries dealing with medically assisted dying. There were very few countries in the world that had gone where Canada was going. Belgium, Holland, Uruguay and a few American states were, but that was it. Canadian society needed to come to terms with medically assisted dying and learn more about the process before we went too far.

That is why, at the time, I supported a clause in the bill that said that medically assisted dying was limited to those whose end of their natural life was reasonably foreseeable. However, we knew that would change over time and that as Canadian society looked at the experience of medically assisted dying, the bill would come back for review before Parliament and would need to change.

At the justice committee, we proposed a number of important amendments to that bill. We inserted, by unanimous agreement at the committee, conscience rights to ensure that the doctors, nurses and pharmacists whose own beliefs would be offended by medically assisted dying were not compelled to participate in the process. We said that Parliament would need to review some subjects that we were not dealing with, such as the issue of mental illness on its own; the issue of mature minors; and, probably most important, the issue of advance directives for those suffering with dementia.

We also adopted a motion that palliative care had to be part of that review. People should have their death hastened because palliative care treatment is not available to them in Canada.

This bill takes the medically assisted dying regime, Bill C-14, a step further based on the Truchon decision. It held that the provisions we had put in the law about reasonably foreseeable death were not constitutional and that a subgroup of Canadians who may have many more years to live but were in constant pain, enduring interminable suffering, and could not have that alleviated by medical treatment reasonable acceptable to them also had the right to medically assisted dying.

This bill establishes that this group of people also have the right to medically assisted death in Canada, but also imposes additional safeguards on them, namely a 90-day waiting period. We understand that certain people, for example, may suffer a traumatic injury and need time to consider all their options and come to terms with their situation before finally going through with a medically assisted death.

Also, based on the Canadian experience, we are amending the bill to allow certain Canadians who are about to lose their ability to offer agreement to medically assisted dying, because they have lost their capacity to consent, to do an advance consent.

Some Canadians want to access medical assistance in dying knowing that they may still have a few more weeks to live. The only reason they want to access it sooner is that they do not want to lose their capacity to consent to medical assistance in dying.

Personally, I want these people to be able to continue to live and spend those last few weeks with their families. I do not want them to end their lives prematurely because they are worried about losing their capacity to consent to the procedure.

The amendment to the law, this bill that is before us, gives hope to this group. These people will have permission to sign a contract with their doctor indicating that they want to put an end to their life on a specific date, even if they lose the capacity to consent to medical assistance in dying in the meantime.

However, there is still a safeguard in the sense that if people who have lost their capacity to consent show through any action or words that they no longer wish to end their life, the doctor must then stop the procedure.

I strongly support the bill. I think Canadian society has evolved with respect to how we see medically assisted dying. As Canadians, we now have seen where the procedure works and where it does not work. We have seen which groups have been positively impacted and which groups have been left out and where we can improve on the procedure.

Following a great deal of consultation and national interest and seeing a change in how Canadian opinion sees medically assisted dying, this bill is the right one at the right time.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, a legal framework was presented in Bill C-14. However, the Canadian Society of Palliative Care Physicians has said that there is creep where palliative care facilities are being shut down because the physicians do not feel they should be providing assisted suicide or euthanasia, and their rights are being trampled upon. Many people in our country choose not to go that route. Their rights and their protections need to be in place as well.

That is why we need a better focus on palliative care. We cannot say that we are giving people an option when people do not have an option. The government committed to a national strategy on palliative care and it is our responsibility as national legislators to make it very clear that palliative care is distinct from euthanasia.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I am pleased to rise today, but I find it difficult to be speaking to another attempt by the Liberal government to endanger the most vulnerable in our society.

After just four years, when the original euthanasia and assisted suicide legislation came in through Bill C-14, we find ourselves considering legislation that would further loosen restrictions, eliminate safeguards and confuse our country's understanding of the sanctity of life and the government's role in end-of-life decisions. Once again, we have been told that in order to uphold the charter rights of some we must endanger the rights and freedoms of others.

I did not support Bill C-14 for many reasons. The first is the fact that the Supreme Court of Canada invoked such controversial and flawed legislation, which has been proven to be poorly applied around the world. The Liberals also chose to broaden the scope of the legislation, going far beyond the Carter decision. Another reason is that it has been placed ahead of and continues to overshadow any significant palliative care initiative.

In 2019, the Prime Minister promised to expand eligibility criteria, and on September 11 of last year, the Superior Court of Quebec ruled that it is unconstitutional to limit assisted suicide or euthanasia only to those whose death is reasonably foreseeable. Without even appealing the ruling and seeking the advice of the Supreme Court, which has been long occupied with this matter, the Liberals accepted the ruling. They are now rushing to change the law for our entire country.

They gave Canadians a mere two weeks to have their views heard on this deeply personal and complicated issue through a flawed online consultation questionnaire. The use of convoluted and biased language left little to the imagination in terms of how the government planned to legislate assisted death. I too tried to fill it out, and I would argue that many opposed would have been discouraged in participating due solely to the language used.

With such a flawed method, and with no idea if the feedback even remotely reflects the actual views of Canadians, how can the government proceed with this legislation in good faith? This is a rhetorical question because it does not seem to matter to these Liberals. It is clear they used this brief window for feedback to satiate the need for a consultative process.

We also know the government ignored its own timeline for a review of the original assisted suicide legislation, Bill C-14. It was planned for this summer, and instead, we have been presented with this reckless legislation. In the midst of COVID, this was still something very important. Without a proper review and without input from the Supreme Court, this House has been asked to greatly broaden the scope of assisted suicide and euthanasia without a clear enough understanding of whether the current regime is being consistently interpreted or properly enforced.

Bill C-7 is being rushed through. This is concerning. When reading through this bill, I see elements that go beyond the scope of the Superior Court of Quebec's decision, namely, Bill C-7 would eliminate the 10-day waiting period between the date the request is signed and the day on which the procedure is carried out.

The application of the law pertaining to those whose death is reasonably foreseeable has been problematic from the very start of this debate. We know a person's reasonably foreseeable death is a flexible estimation, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time they have remaining. The elimination of the 10-day waiting period for persons whose death is reasonably foreseeable would create the conditions for someone with an indeterminate length of time remaining in their life, possibly years, to be rushed to the decision to receive assisted suicide and euthanasia.

Aside from simply eliminating what most Canadians would consider to be a reasonable period of reflection, this element of the bill also ignores the possibility of medical advances and improved treatment methods in an incredibly innovative medical science environment. As Cardinal Collins has said, Bill C-7 creates the conditions where an individual can seek a medically assisted death faster than the wait time for a gym membership or a condominium purchase.

I also see no logical reason why the government would reduce the number of independent witnesses required for when the request is signed. It is down from two to one. The government has even relaxed the definition of someone who may serve as a witness, including medical professionals or personal care workers, even those who are paid to provide euthanasia and assisted suicide on a daily basis. This is in clause 1(8).

Surely we can agree that, for the vast majority of those requesting euthanasia and assisted suicide, the requirement for two independent individuals to witness a request to end a life is a reasonable safeguard. How do the Liberals plan to properly protect patients from potential malpractice? How does the government plan on ensuring requesters are presented with a myriad of treatment options rather than just one opinion?

The legislation continues as a series of safeguards the medical practitioner must adhere to before providing assisted suicide to those whose death is not reasonably foreseeable. One of these safeguards would require a medical practitioner to discuss with the person the means available to relieve their suffering, including palliative care.

The safeguard is even weaker for those whose death is reasonably foreseeable, requiring the medical practitioner to merely inform the person of these vital options. The government failed to follow through on its promise to invest $3 billion in long-term care, which includes palliative care. There does not appear to be any political will whatsoever to improve palliative care.

Canadians have also been calling on the government for a long-awaited national strategy for palliative care. There is a thirst among Canadians for real solutions to end-of-life care. The government seems all too willing to ignore the 70% of Canadians without access to palliative care and, instead, attempts to impose on them a flawed, one-size-fits-all regime. We can already see the consequences of pushing forward an assisted dying agenda when there is little regard for palliative care.

In British Columbia, the Delta Hospice Society was stripped of 94% of its operating budget for refusing to provide euthanasia in a facility intended for the provision of palliative care. Despite repeated attempts to defend its Charter-protected, faith-based objection to being required to provide euthanasia and reach a compromise in good faith, 10 hospice care beds are now at risk and will be surely defunded.

Why do the Liberals continue to ignore the voices of those who have a different perspective on the issue of end-of-life care? People who seek hospice care are seeking it for a reason. They do not desire a medically assisted death. In effect, what has happened in B.C. is an attempt to redefine what constitutes palliative care.

In fact, the Fraser Health Authority's decision flies in the face of the Canadian Society of Palliative Care Physicians, which has clarified that euthanasia and assisted suicide are distinct from palliative care. I caution Canadians not to regard the Delta Hospice Society's situation as an isolated one. The government has shown little interest in supporting hospice care, and I would not be surprised by further attacks on the ability of Canadians to chose to end their lives naturally.

In The Globe and Mail, Sarah Gray put it well, stating, “The hospice isn’t a place where people come to die. It is where they come to live — to live well for the little time they have left. It is a place of celebration, connection, comfort and support. It is a place of safety for the dying and the grieving.” In Cardinal Collins' words, let us work to create a “culture of care”, rather than rush toward a culture of “death on demand”.

The government would also be wise to recall that much of the debate on Bill C-14 revolved around calls for a solid framework of conscience protection for medical practitioners involved throughout the end-of-life process. At committee, witnesses stated that the protection of conscience should be included in the government's legislative response to Carter v. Canada.

The Canadian Medical Association confirmed conscience protection for physicians would not affect access to physician-assisted suicide or euthanasia. Its statistics indicated that 30% of physicians across Canada, or 24,000, are willing to provide it. I live in a rural area of Canada, and I can assure members there are many provisions that are not available to me directly where I live.

Unfortunately, the Liberals failed to defend the conscience rights of Canadians in Bill C-14. I also found it disappointing that they failed to support, in the last Parliament, critical legislation put forward by David Anderson in Bill C-418, the protection of freedom of conscience act. It would have made it a criminal offence to intimidate or force a medical professional to be involved in the procedure. It would also have made it a criminal offence to fire or refuse to employ a medical professional who refuses to take part directly or indirectly in MAID.

Here we are four years later, and Bill C-7 is also void of any provisions that would protect the section 2 rights of Canadians. In Canada, everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms. No one has the right to demand all services from all providers in all circumstances. As David stated, protections are needed for doctors and health care providers who are not willing to leave their core ethics behind when they are at a patient's bedside. Access to euthanasia and conscientious objection are not mutually exclusive.

We, as legislators, must ask ourselves where the Liberals will draw the line. There will always be the voices of those in our society who feel that the limitations and safeguards are too stringent. When will it be enough for the Liberal government? How far are they willing to go? What message are we sending to the most vulnerable and fragile in our society?

Over the last five years I have advocated for our veterans. I know there are countless veterans who appear able to cope with debilitating physical injuries, but they are extremely vulnerable in their mental health. We are all concerned about the number of them choosing to end their lives by suicide because of complications after serving our country. It is antithetical to try to prevent them from taking their own lives, yet tell them that there are government-designed opportunities to do so.

Bill C-7 fails to provide conscience protection, fails to protect the vulnerable and fails to fulfill the need—

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Fantastic. Okay, that is great.

I want to talk about Mike. There was a CTV interview done with Mike back in early January. Mike had already pinned to his desk area his plans for his own funeral, with the date to be determined. He knew what he wanted in life. He was also a very strong advocate for those with disabilities, but when he got cancer he knew that there were going to be struggles. It was not just his mental capacity he was concerned with, but the physical pain he was going through.

I want to start off with the day of Mike's death: January 20. Bob Smith, a Rogers TV host in the London area, wrote:

Mike Sloan passed peacefully at 1:25 pm EST via MAID. He asked me...to let you know. I was with him at the end, holding his hand. He thanks you all for your support on this journey. His last words were, “Tell Chub I love him.”

Chub was Mike's cat. If anyone knew Mike, Chub got him through each and every day. Chub could always be relied on because some days were a little harder than others.

Going back to January 18, Mike wrote, “When it's getting too frightening to drink liquids because they may simply spit back up or choke me, you know, let's be honest about choices here.” To me that statement by him is extremely impactful. Another day he talked about being afraid to get in the shower. He was afraid of falling in the shower. He would get in and fall and started thinking that even though he was a young guy he might need a bench. He was going through all of those different issues each and every day.

Mike was diagnosed with stage four thyroid cancer in February of 2019. He tweeted about his experiences with palliative care and the care he received. It was interesting for anyone to watch this as he would show his belly, which had different things attached for his pain medication. The thing that was so incredible about this man, for any of the other members from the London area, is that he had an incredible sense of humour. He would post a picture of his belly tied to a medical bag that he called his “little purse,” which contained his pain medication. He would also show the different tubes that he would inject the medication in to make the pain go away. He was in absolute pain.

He wrote on January 7, “I've never died before, so I don't know what it feels like, but if agonizing pain, difficulty breathing, a fever and inability to sleep are symptoms, I'm getting there.” This was a man who did not fear death, but recognized that it was going to happen. He was also a man who would go into the hospital and just be released. What was actually really comical was when he went in with shortness of breath and walked out saying he was being released with pneumonia, but was walking and doing well.

Thinking of Mike, we have to find the right balance. We have to find the balance so that the Mike Sloans and the Richard Sitzes of this world have their wishes honoured. I recognize that this is a very difficult decision for many members of Parliament.

I can tell my colleagues that my vote on Bill C-14 was the most difficult vote I ever made. One of the most important things was that there were safeguards to make sure that the family, individual and entire team involved in medical assistance in dying all knew what they were getting into. It is really important that we make sure that those safeguards are in place and use strong caution with Bill C-7 as to whether this may open a new can of worms.

I am very proud to talk about this because it needs to be debated. There is no wrong or right answer. It is about finding a balance for all Canadians.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, this is such an important debate that we are having here today, and I thank members for sharing their stories.

This is a very personal debate. I recall speaking on Bill C-14 when I first joined Parliament. I talked about my own experiences with death. I have watched other families go through these issues as well. We talked about how we could be part of making those last few days, months, and sometimes years work well and make sure of the necessary resources.

I am coming to this debate speaking from two sides, and am almost sitting on the fence on this. I am bringing forward a letter from Richard Sitzes, who is the chair of Our Choice Matters, part of Community Living Elgin. I would like to read this letter into Hansard, because I think it is very important to hear the voices and concerns of those who are disabled. I am also going to read some Twitter posts from the late Mike Sloan. Other people have covered this, and those in London would know that Mike Sloan passed away on January 20, 2020, with medical assistance in dying. He had a very difficult time, but he shared his experiences through his Twitter feed. Because of my work here in Parliament with those with disabilities, I had started a relationship with him and discussed what life looked like and how we were to move forward.

I will begin with the letter from Richard Sitzes, chair of Our Choice Matters, which is a self-advocate group. He writes:

I'm a constituent in your riding and live in St. Thomas, and am very concerned about Bill C-7 and the changes to Canada's law on medical assistance in dying (MAID). I'm worried about the negative impacts this bill will have for people who have a disability in our riding.

As chair of the Our Choice Matters self advocate group, supported by Community Living Elgin, I am speaking on behalf of our group. In Canada, many people think that their having a disability causes suffering, but people who have a disability say that it is the lack of supports, not disability, that causes them to suffer. We fear that Bill C-7 will make this situation even worse.

Right now, Canadians can only access MAID if they are suffering and close to death. Bill C-7 will make it possible for a person who has a disability to choose medical assistance to die, even if they are not close to death. We strongly believe that removing the end-of-life requirement will increase negative ideas and discrimination against people who have a disability. It will grow the idea that life with a disability is not worth living. We are afraid that people who have a disability will feel pressured to end their lives even if they are not close to death. This has already happened in Canada, and it will get worse because of Bill C-7.

We believe that the federal government should make it easier for people with disabilities to live good lives, not end them. For the safety of people who have a disability, MAID must be available only to people who are close to death. We strongly oppose Bill C-7 and ask that you oppose this legislation.

I was fortunate to follow up on this letter with Richard last week. He has been a volunteer, not only in my office but in our community, for decades. He is a person we see at every volunteer opportunity. He is there at community events to lend a hand. He looks at his life and recognizes that he has so much to give to our community. I have never met a kinder soul in my life. He just wants to help and at the same time wants to be heard. Having had the opportunity to sit down and talk to Richard, I know his concern is that he will not be the person making that choice, but that it will be made for him. He told me that he did not know who would have the final choice. This is something that Richard, who just celebrated his 60th birthday on August 15, is very concerned with. When I look at Richard, I do not see his life as being worth any less than mine. He has so much to offer to all Canadians. I hope we recognize it is imperative that we have appropriate safeguards for people like Richard who have so much to offer.

On the other side, there are some positives as well. This is where I want to talk about Mike Sloan. He was able to share with Canadians, especially in my region, his everyday struggles of living with cancer. As I indicated, I had created a bond with Mike over the last number of years. When he called to tell me he had cancer, the two of us talked about what he would be going through.

Mike had decided that he was going to die with medical assistance. Watching his death, I can understand why. I understand the struggles that he went through, and want to read some of the things that were put on his Twitter feed.

Madam Speaker, how much time do I have, given that I talk so much?

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, allow me the opportunity to reflect on what has brought us to this point.

Shortly after the 2015 election, a number of pieces of legislation were brought before the House. One of those pieces was Bill C-14, a direct response to courts and the many concerns Canadians had with regard to the issue of dying with medical assistance. The issue was thoroughly discussed and debated. A lot of dialogue took place inside and outside the chamber, and, in fact, across the country. The number of Canadians who were engaged in the legislation was extraordinarily high. That was reinforced earlier this year, but I will get to that particular point later.

Back in January or February 2016, there was a great deal of dialogue taking place. Bill C-14 ultimately passed just prior to the summer break, in June 2016. At the time, parliamentarians recognized that there would be a need to make some modifications. In fact, within the legislation we passed, we created the opportunity for us to review it.

It should come as no surprise to anyone that the issue continues today. Even without legislation, dialogue has been taking place among members of Parliament and constituents. I have had ongoing feedback on the issue, in particular through emails, since 2016. People have expressed concerns and issues with the legislation.

The Superior Court of Quebec made a determination on the legislation, which ultimately dictated that we had to bring in Bill C-7. We had initially introduced the bill earlier this year, I think in February. Prior to its being introduced, Canadians were once again formally called upon to provide their thoughts on the issue. It was amazing that in a relatively short time span, we heard from in excess of 300,000 Canadians. People from all across the nation responded to provide their thoughts and ideas on what they would like to see the government and members of Parliament deal with on this very important issue.

We were very hopeful that a committee would have the opportunity to meet and review the legislation, with the idea of looking at ways it might be changed. Then came the pandemic. As we all know, the focus and attention of Canadians changed, just as the House's priorities had to change, in order to respond to the COVID-19 pandemic. As a direct result, we lost the opportunity for that parliamentary group or committee to get together to review the past legislation, and in fact even the legislation that was being proposed in January or February.

Fast-forward to where we are today. Bill C-7 responds to a decision of the Superior Court of Quebec. It is a reasonable and acceptable piece of legislation that, in this form, makes some changes. It deals with some very difficult issues. For example, it drops the number of days of waiting from 10, after a person is approved and in a near-death situation. I believe this will generally receive good support from all sides of the House. There is the reduction of witnesses from two to one. From what little debate there has been thus far, I believe this has the potential to receive good support. The criteria that a person's death must be reasonably foreseeable is an issue that no doubt will be talked about at great length, both in the chamber and at committee. There are other aspects of this legislation that I find very compelling, and I am very interested to hear what people have to say about them.

A big concern I have is the idea that someone is able to provide consent today but, as an illness or a disease continues, might be prevented from being able to give consent knowingly later, thereby disallowing them from having medical assistance in passing. I know many Canadians share that concern. I am expecting to see a good, healthy discussion on that, whether inside the chamber, in committees or in our constituencies, where we receive feedback.

There is the issue of mental illness and the severity of it. This area is worth ongoing exploration, in different ways. As a former member of the Manitoba legislative assembly, I remember that often when we talked about spending money in health care, mental illness was nowhere near being part of the discussion. In fact, it was a very dear friend of mine, Dr. Gulzar Cheema, who raised this issue at a time when very few people raised it. In general, it is something we need to debate more.

I suspect that as we continue the debate, whether in the chamber or at committee, we will see that it is very emotional for a number of people. I know first-hand how important palliative care is, through the experience of the passing of family, in particular my grandmother and my father. I am very grateful for the Riverview Health Centre in Winnipeg for the service in palliative care they provided. To be there at the passing of my father meant a great deal for me personally, as I knew that when he was there he had the love and care of professionals who deal with people who are passing on. A person has to have a very special heart to deal with that. I had a similar experience with my grandmother, at St. Boniface Hospital. They are two totally different institutions, but the thing they have in common is the supports that are there.

I believe we need to do more in the area of palliative care, and I would love to see more discussion, more debate and more action on the issue. I believe the federal government has a role to play in that area too.

To conclude, I will emphasize for members that here is an opportunity for us not only to look at the core of the issue and have discussions, but to look at some of the issues surrounding end of life and the circumstances that, either directly or indirectly, we are all somewhat familiar with.

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, I want to confirm to the House that the parliamentary secretary, in his speech, spoke the truth when he said that the Liberals got it wrong, because the Liberals did get it wrong. I was on the justice committee with the hon. member when Bill C-14 was before it, and the Conservatives presented over 100 amendments that would have strengthened the bill and provided proper safeguards, all of which were rejected by the Liberal government of the day. One thing that did get passed was the requirement for a mandatory review after five years, but the government has circumvented the requirement with a few consultations, which is completely inappropriate and should be unacceptable to the House.

Health care professionals in my riding are continually asking for better health care conscience protection rights for health care professionals. They have looked at the legislation and do not feel it is there. We have heard the Liberals argue that it is there and that it is adequate, but the health care professionals in my riding, including doctors and nurses, say it is not adequate. I would like the member to respond to that.

[Chris Bittle, Liberal, Parliamentary Secretary to the Minister of Transport]

Madam Speaker, before I begin, I would like to state that I am splitting my time with the hon. member for Winnipeg North.

We have a serious issue before us, the issue of Bill C-7. It has been an excellent debate so far and an excellent opportunity for members on all sides to talk about this issue because it goes to our morality and to our own conscience, and we are hearing from all sides about this. I want to say that we got it wrong with the last piece of legislation; we got it wrong with Bill C-14. I want to commend the Attorney General for coming forward with Bill C-7.

I would also like to recognize a few members who were vocal advocates, working on the justice committee with Murray Rankin at the time; the hon. member for Saanich—Gulf Islands; my friend, the hon. member for Don Valley West and many other members of the Liberal caucus who tried to advance medical assistance in dying so that it would be constitutional.

I am here today to speak in support of Bill C-7, which proposes amendments to medical assistance in dying legislation. Members are aware that the Superior Court of Quebec found the eligibility criterion of reasonably foreseeable natural death from the Criminal Code made legislation to be unconstitutional. The court delayed the effect of the ruling to allow both the federal and Quebec legislatures to respond. The government has agreed with this basic principle of this decision and is now proposing to amend the Criminal Code.

Bill C-7 proposes to repeal the requirement that natural death be reasonably foreseeable. It would create two sets of safeguards: one for those whose death is reasonably foreseeable and another for everyone else. Some of the existing safeguards for those who are dying would be relaxed, and for everyone else there would be a different set of safeguards based on the current ones with some additions and clarifications.

Bill C-7 proposes to continue to use the expression, “reasonably foreseeable” natural death, but as an element that determines which set of safeguards to use and not to use it as an eligibility criterion, which was the issue in the Truchon case.

The proposal to distinguish MAID requests on the basis of whether a person's death is reasonably foreseeable is consistent with the view that MAID for people whose death is reasonably foreseeable presents less risk and complexity than other circumstances, and that the assessment of requests should be tailored to these different types of cases. Having a reasonably foreseeable natural death would also be a critical element for another proposed amendment in the bill. Currently, the MAID law requires the practitioner to give the patient the opportunity to withdraw consent or to affirm their consent just before MAID is provided.

This requirement for final consent is a safeguard; however, it has also caused some MAID patients to choose to end their lives earlier for fear of losing their capacity to provide final consent and, sadly, for some to be denied MAID entirely after losing capacity. I would also like to point out that others chose to decrease their intake of painkillers prior to MAID being provided, to ensure they retained capacity to consent, which leads to an increase in suffering.

BillC-7 would allow for a possible waiver of requirement for final consent for individuals whose death is reasonably foreseeable but where there are fewest risks and complexities in providing MAID to a person who is no longer able to consent. Permitting this proposed waiver of final consent would respond to scenarios like that of Audrey Parker of Nova Scotia, who was diagnosed with terminal cancer that had spread to her brain leaving her uncertain as to how long she would have the capacity to consent. Because she feared losing capacity before her preferred date to receive MAID, she scheduled MAID and ended her life earlier than she wanted. She openly expressed how she felt unfairly forced by the limitations of the MAID law to schedule MAID sooner than preferred and called for amendments to the Criminal Code so that others like her would not be denied the freedom to choose their preferred date to receive medical assistance in dying.

I would recommend that all members listen to the speech in the previous session from the hon. member for Dartmouth—Cole Harbour. I believe Audrey Parker was a constituent of his. He powerfully used her own words to show us where we went wrong, the impacts our failures in the previous legislation had led to, and the impacts on her life. We owe it to people like Audrey Parker, who have been assessed and approved for MAID, to respect their need for freedom in making end-of-life choices. As a compassionate society, we know we can do better to support these individuals. These amendments seek to do just that.

Waiving final consent is, however, an ethically complex question. This is because it involves MAID being administered to a person who is no longer able to consent, or to withdraw the consent they previously gave. Bill C-7 proposes a new approach for patients whose death is reasonably foreseeable, who are assessed and approved for MAID when they have the capacity, and who make very specific arrangements with their practitioner in which they give consent in advance to MAID being administered on a specific day, even if they have lost capacity by that day.

I fully support permitting advance consent for this group of individuals, but at the same time, I note that certain protections must be in place. Specifically, if on the specified day for MAID, the patient has lost their capacity and they nonetheless actively show signs of resistance to the MAID procedure, or behave in a way that indicates a refusal, the practitioner must not follow through on the procedure.

Medical practitioners at the round table expressed concerns in relation to the emotional burden that could arise from such situations, for them and for family members. They talked of possible disagreement with family members on whether to end the life of a person who appears to resist the procedure. A similar situation led to the prosecution of a MAID provider in the Netherlands and made headlines around the world. That situation is what we wish to avoid here in Canada.

That is why Bill C-7 proposes an additional provision that states that signs of resistance from the patient would make the advanced consent invalid on the specific day and going forward. While an incapable person could no longer withdraw their consent from a legal perspective, given their track record and decision-making capacity, it is proposed that MAID not be permitted under this circumstance. The approach provides much needed clarity for practitioners and family members that MAID be prohibited if the patient is resisting. The bill would also make it clear that an anticipated reflexive response, like flinching when the needle is inserted, does not count as resistance.

It is important to be clear, however, that this amendment is not about advance requests. Advance requests for MAID refer to a situation in which a person puts in writing they would want to receive MAID at some later date when they are not able to consent to it, if circumstances arise that they predict would cause them unbearable suffering.

In this situation, a person is not asking for MAID now. Instead, they are putting in writing that they want it at a later date on the basis of anticipated suffering that has not yet happened. The most likely scenario would involve people who are diagnosed with conditions that could lead to dementia, such as Alzheimer's. These people would want to have a plan in place if their worst fears should come to pass.

Bill C-7 does not propose to allow MAID on the basis of advance requests. MAID in these circumstances would be extremely complex, would avoid ethical challenges and would require more time to consider such measures. In speaking to the Attorney General, I voiced my concern that we need to spend more time considering these measures. I hope that the issue will be studied during further upcoming parliamentary review of the MAID legislation.

Taking more time to study advance requests is consistent with the approach of the Government of Quebec, which is also moving forward to hold public consultations on the issue so that all of its dimensions can be better understood.

MAID is one of the most sensitive and challenging social issues we are currently faced with. Recognizing how deeply personal this issue is to so many people, and to so many members of this place, the government has listened carefully to the diverse opinions of Canadians and has considered the expertise shared by experts, MAID providers and other experts in the development of this important piece of legislation. Bill C-7 responds to the Superior Court of Quebec ruling, but it also achieves balance that respects personal autonomy, while protecting the vulnerable as well as equity rights for all Canadians.

For these reasons, I call on all members to support the bill.

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

Madam Speaker, these are absolutely the kinds of supports that are needed, but the reality is that they are not actually in place everywhere. This makes a huge difference.

I will give an example from the first year after Bill C-14 came into law. Sarnia—Lambton has a huge capacity for palliative care. We have a hospice with 20 beds. There are also beds in the hospital, and we have home care. We have an integrated palliative care system. There were two requests for medical assistance in dying in the first year. London, just an hour away, has a population that is about three times larger than Sarnia's population. It had 300 requests for MAID because it does not have adequate palliative care services.

The government can help out with establishing hospice. The virtual palliative care work that has started is very helpful, especially in rural and remote areas, but it of course requires broadband Internet access. The government can also use some of the successful models, like using paramedics in their off hours, to deliver palliative care. These things could really boost the existence of the supports people are being counselled about, and then people could take advantage of them.

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

Madam Speaker, I am happy to have the opportunity to rise today to speak to Bill C-7. It is a very serious matter. As the member for Fundy Royal just mentioned, it is a matter of life and death. I was part of the debate on the original bill, Bill C-14, and I am familiar with a number of the issues with that bill.

It is very disturbing to me. I understand with the Quebec court decision the government had to make a response of some sort, but the previous bill required them to do a fulsome parliamentary review, which was supposed to take effect this past summer. The government refused to let Parliament sit this summer and do the kind of fulsome work that needed to be done.

It is actually quite irresponsible that when the government introduced Bill C-7, instead of just addressing what was time sensitive in responding to the Quebec decision, it went further and took actions without doing that fulsome review of how things have been going with Bill C-14 in the last number of years.

For those watching at home who are not familiar with Bill C-7, the bill would repeal the provision that requires a person's death to be reasonably foreseeable. In addition to that, it would specify that people whose sole underlying condition is mental illness are not eligible for medical assistance in dying. It would create two sets of safeguards that have to be respected before medical assistance in dying can be provided to a person, and it would permit medical assistance in dying to be provided to a person who has been found eligible to receive it and whose death is reasonably foreseeable but who has lost the capacity to consent before the medical assistance in dying is provided. That is sort of an advance consent, and we will talk a bit more about that.

Bill C-14 was not without some issues that were not addressed in the previous legislation and will probably be considered in the fulsome review. There was a question about whether minors should be able to receive medical assistance in dying. There was significant discussion about advance consent. A lot of Canadians were demanding it, and I will talk a bit about some of the considerations that may have kept the government from moving ahead at that time. There was discussion of those who are not mentally competent to give consent. There have been a number of speeches today mentioning people with dementia, for example. That is another area where there was work done by the Council of Canadian Academies, the CCA. It did fulsome reports on a number of these things, and I will talk a bit about what was found.

There was discussion today about the protection of conscience rights, and I do not agree necessarily with the Parliamentary Secretary to the Minister of Justice. I see the charter provisions that were put into Bill C-14, but forcing somebody to refer, when they do not want to have anything to do with the process at all, is actually violating their rights. I am not a fan of violating one person's rights to give another person their rights. That is not good, so we need to have more discussion about that.

In its report, the special committee that studied the Carter decision said that, without good-quality palliative care, people really cannot make a true decision. They really do not have a choice. Obviously I have been an advocate for palliative care. My private member's bill, Bill C-277, on palliative care, was unanimously passed in the House and in the Senate. The government did a good job of putting the framework in place to get consistent access for all Canadians to palliative care.

The problem is that, once the framework was in, the government has since really not pushed ahead. There are 70% of Canadians who have no access to good-quality palliative care. Especially in the time of COVID, where people are dying, it is becoming even more important. The government needs to take action to up its game on palliative care to make it more available to Canadians.

There is an opportunity and a responsibility for the government to show leadership in how palliative care is being implemented in Canada. Right now, for example, British Columbia is violating the World Health Organization's requirements for where MAID should be performed. It has specifically said that palliative care is a different thing from medical assistance in dying and that they should not be performed at the same location because of a tendency by people wanting palliative care to be afraid that they will accidentally receive medical assistance in dying against their wishes. There is an opportunity for the government to revisit that and I am hopeful that it will.

With respect to the Council of Canadian Academies, many issues were studied. On the advance directives and advance consent issue, we see in this legislation that the government is allowing people who believe their conditions are going to decline and are eligible to receive medical assistance in dying to have a 90-day advance consent. It is not clear to me in the legislation when the 90 days start. Is it when patients first have discussions with their physicians? When does the clock start? That is a clarification that is needed in the legislation.

When the council looked at advance directives, it said there were a few difficulties. The first one was how to prove people have informed consent, what the criteria are and what the definition is of that. Therefore, that would have to be addressed. Who decides what is intolerable suffering, especially if the person has lost capacity? That is another question that needs to be and should be considered in this fulsome review that is required and that I would have preferred to have had before this bill came forward.

As a point of information, Belgium and Luxembourg only allow an advance directive when a person is permanently unconscious. That is the only way they will allow a person to have an advance directive in place: If they become permanently unconscious, they will receive medical assistance in dying.

On the issue of minors, “mature minors” would have to be defined. In Quebec, that is defined as people aged 14 to 17. However, we have to make sure they have the capacity to make medical decisions and confirm they understand that it is voluntary and they are not under duress. There are not many jurisdictions that have extended this to mature minors. The Netherlands does allow people aged 12 to 16, with parental permission, to have medical assistance in dying, and those aged 16 to 18 with parental consultation. Belgium allows it if the person is terminal, but pediatric palliative care has to be provided as an option. Therefore, there needs to be further discussion on that one.

Then there are those who suffer from mental illness. I was very pleased to see that it is clear in this legislation that they would not be eligible. It was very controversial. The council that studied it could not agree. There was discussion about the capability for informed consent and the fact that people with depression could have good and bad days and may change their minds, which again points to the need for some kind of cooling-off period. The Netherlands allows this but for dementia only, and there is still a lot of controversy about that.

The safeguards that were in the bill originally seem to have been removed. I am not a fan of doing that because I would say that if we remove the conditions that have to be met in order to get something, more people will take advantage of it. I am concerned with a broader creep on this, but I am sure there will be fulsome discussion about this at committee.

In Canada, everyone has the freedom to express themselves, to believe what they want and to choose what they want, and we should treat everyone's individual choices with respect.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I will be splitting my time with the member for Sarnia—Lambton.

It is my pleasure as shadow minister for justice for the official opposition to use this opportunity to speak to the proposed legislation before us. It is important legislation. We have been hearing points from both sides of the House on Bill C-7, which impacts many Canadians. In fact, it impacts us all. This is a piece of legislation that deals with life and death, and there is probably nothing more important that we could be talking about today.

Any time we, as legislators, are asked to review and analyze legislation like this, it is critical that we take the time to get it right, and this is part of the problem. As we have heard many times over the course of the last year, we should not be dealing with this legislation today because the Minister of Justice and this government should have appealed that decision.

This is what was being called for by those in the medical community, those in the disability community and individuals across the country after that decision came out in Quebec. The right thing to do, which is what our party, the Conservative Party, called on the government to do, would have been to appeal that decision.

What we have been left with is a patchwork across our country. We have been left with confusion. We should have had the certainty of an appeal to the Supreme Court of Canada on something this important. Instead, the government took the Superior Court of Quebec decision, responded to it and, in my view, went far beyond what was required to respond to that decision. I will discuss some of those things.

The bill was introduced as a response to a Superior Court of Quebec decision made on September 11, 2019. That decision found that the law was too restrictive in the requirement for death to be reasonably foreseeable in order to access medical assistance in dying. At the time, we called upon the government to appeal this decision to the Supreme Court.

As we debate the bill before us, we still do not have the clarity that we could have had if the government had appealed that decision. Rather than defend its own legislation, this government has used this as an opportunity to broaden assistance in dying legislation in this country without doing the fundamental consultation and homework necessary to get an important decision like this right. Even in the previous legislation, Bill C-14, there was to be a mandatory review of assistance in dying legislation and what flowed from it, which was to take place this past summer. This government circumvented all of that with this new legislation.

When the government passed Bill C-14 in the 42nd Parliament, it required this review to be conducted this year. The review was to analyze the state of assistance in dying in Canada in a comprehensive way, and instead of waiting for that, we see with this legislation the government going far beyond what had to be done to respond to the Quebec court decision.

This topic is a very sensitive issue for many in the House who have personal experience with it and, indeed, it is a sensitive issue for many Canadians. We ask that all members on each side of the House be aware of this. While there may be disagreements, we are each here to represent our constituents and arrive at legislation that best protects Canadians.

I have heard directly from many Canadians who are concerned about the lack of protection for conscience rights for health care professionals in both the bill before us and the original MAID legislation. As the government looks to broaden the legislation further, it becomes even more important that the conscience rights of health care professionals are protected. By further expanding medical assistance in dying, the government risks reducing the number of medical professionals willing to take part in this process. It is also important to note that this expanded access could result in a heavy emotional burden on those health care providers, as we head into uncharted territory with the bill.

We, as members of Parliament, cannot appreciate the burden that this has put on health care providers who are working in this system and providing medical assistance in dying.

Further, there are very few protections in place for medical professionals who do not want to participate in the process and may be penalized, as a result, by an employer. This is a point that I raised when Bill C-7 was introduced earlier this year, and it is disappointing to see that it was not corrected in this version of the bill.

This brings me to my next point about standing up for Canadians with disabilities. The 10-day waiting period, which could already be waived in the legislation for extenuating circumstances, has been removed. I heard the chief justice say today that removing the 10-day waiting period was universally accepted in his consultations across the country. I wonder who he has been talking to.

Yesterday I spoke with a group that represents those with disabilities across the country at Inclusion Canada. Those in that group said that they are in favour of maintaining the 10-day waiting period, and their role is to stand up for individuals with disabilities. It is interesting to note that they called on the minister of justice at the time to appeal the decision of the Quebec court. They said that medical assistance in dying must have limits. Individual rights must be balanced with protections, not only for our most vulnerable citizens, but also for society as well.

One of the most important foundations of our Canadian society and identity is that we are a caring, compassionate country. For those with disabilities, their experience now is that they are told, often bluntly, that they would be better off dead. The Foley case in London, Ontario, is one example of this. This decision, if it remains unquestioned, will simply erode provincial health responsibilities for expert clinical care and social support for people who are fragile.

The Minister of Justice would also be familiar with a letter written to him on October 4, 2019, which was signed by over 70 organizations that stand up for Canadians with disabilities from coast to coast to coast. They wrote that they found the decision by the Superior Court of Quebec to be very concerning. One of the reasons for this concern was that the decision failed to respect Parliament's authority to balance the interests of the individuals with the interests of society, effectively limiting Parliament's capacity to pursue social targets, such as substantive equality and inclusion.

They describe the decision as a dangerous precedent, writing, “The Supreme Court must weigh in on this flawed analysis. The decision will entrench stereotypes and exacerbate stigma further for Canadians with disabilities.” The letter continues, and I agree, “[We] must avoid sending a message that having a disability is a fate worse than death.... Canada must appeal the decision to prevent additional stereotyping”. The letter concluded by urging the government to appeal the decision to the Supreme Court.

Again, the letter was signed by over 70 organizations, including the Council for Canadians with Disabilities, the Canadian Association for Community Living, Disability Law Centre, People First of Canada and the Canadian Mental Health Association. I mention this because it underscores how we need to get this legislation right.

Last November, the Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Care Physicians issued a call to action due to ongoing confusion in the general public regarding hospice, palliative care and MAID. Quite frankly, palliative care focuses on improving the quality of life and symptoms through a person-centred approach for those living with life-threatening conditions.

The federal government should be looking for ways to improve further palliative care across Canada, as was committed to many times by the government. In their call to action, the groups I mentioned state, “Less than 30% of Canadians have access to high quality hospice palliative care, yet more than 90% of all deaths in Canada would benefit from it.”

I want to stress my previous point that this is an important issue for many Canadians. On matters of literal life or death, we need to take our responsibilities as legislators—

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, I believe it was taken out because, in terms of practicality, it served no purpose. The Minister of Justice and many of our colleagues heard from families, now that we have been living with Bill C-14 for over three years, about the 10-day period. Patients who have already made the decision that they need medical assistance consulted with their doctors, nurses and families about that extra 10-day period. Why is not 15 days? Why is it not five days instead of 10? They said it served no purpose.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, the previous bill required two witnesses and this bill only requires one witness. This was actually raised with the Minister of Justice. I believe this will correct the issues that arose from the previous bill, Bill C-14. The current bill strikes the right balance to make sure there is access to a doctor or nurse who has knowledge of the particular patients in question.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, my question for my friend from Glengarry—Prescott—Russell is with respect to advance consent. The legislation provides for advance consent in certain circumstances in which a patient might lose their capacity.

When we studied the issue of advance consent under Bill C-14, the Canadian Medical Association noted that it was an extremely complex area. The expert panel's final report from the Council of Canadian Academies noted that there are significant knowledge gaps and a lack of consensus with respect to administering euthanasia, or medical assistance in dying, when a patient has lost capacity.

Why would the government include that in this bill, rather than allow a more thorough legislative review to take place, which it has pre-empted?

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

Madam Speaker, I will be splitting my time with the member for Glengarry—Prescott—Russell.

I am pleased today to speak on Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying.

As members know, clearly we are here because of the decision of the Quebec Superior Court in the Truchon case. That decision struck down a particular criterion under both the Quebec and Canadian regimes with respect to the end-of-life nature of medical assistance in dying, which is the reasonable foreseeability of natural death criterion, in particular, at the national level.

I will agree with some of the members we have heard from today that this is perhaps the most important issue we have faced in the last five years of this Parliament, both in the last Parliament and today. Fine-tuning the approach to medical assistance in dying is something that is intensely personal, but also intensely important to all of us in the chamber and to all Canadians.

What we should know at the outset is that the court's ruling in Truchon applies only in Quebec. We heard the minister speak about this. The court suspended its declaration of invalidity for a period of six months, until March 11.

It is important for this chamber to recall that on February 17 of this year, the Attorney General of Canada filed a motion to request an extension to give Parliament sufficient time to enact an appropriate response to ensure consistency in the criminal law. Given the circumstances of COVID and the pandemic, an extension was further sought and granted in June until December 18 of this year. Therefore, December 18 is the new deadline.

Before I go into some of the details in the bill, I want to start out with two important provisions that relate to conscience protection. This was raised in today's debate and was also raised in the context of an earlier debate on this bill in a previous parliamentary session. I think it is critical the record be crystal clear that conscience protections are robust in this country and are entrenched in law.

I am responding here to questions that were raised by the member for Sherwood Park—Fort Saskatchewan. The first location for conscience protections is in the preamble to the old bill, Bill C-14, which states, “Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms”.

I have had further questions from members of the official opposition about why it is only in the preamble and not in the statute. That assertion is categorically incorrect, because conscience protections are in the statute itself. Section 9, page 8, of Bill C-14, which amended the Criminal Code, states, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

Lastly, the third point I will refer to is from the Carter decision of the Supreme Court, which has been the subject of extensive discussion in this chamber thus far. I am reading from paragraph 132 of the majority reasons in Carter. The court states, “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

Those are the three instances where the freedoms set out in section 2 of the charter are taken into account. One is jurisprudential and the other two are statutory. The fourth one is of course section 2 of the charter, which protects freedom of conscience for all Canadians, including those who practice medicine. Therefore, the assertion that somehow conscience rights are not protected or are somehow being eroded is categorically false.

Another point on what is being addressed in today's debate is the notion that a culture of overly facilitating medical assistance in dying is upon us. Here I am referencing some of the interventions made again by the official opposition, particularly the member for Sarnia—Lambton, that somehow this government bill is pushing us further toward predatory practices by health care practitioners or toward disavowing the right to life, liberty and the security of persons who are vulnerable, including persons with disabilities. That is categorically false and is not commensurate with what is in the evidence.

The evidence that we have is that, in total, nearly 14,000 medical assistance in dying deaths have happened in the country in the last four years. The average age of the people accessing MAID is 75 years old. It is being accessed equally by men and women, 51% of the time by men and 49% of the time by women. The most common medical condition is cancer, followed by neurological conditions. In that 67% of all people who access it have cancer; second, come neurological conditions; and third, come cardiovascular conditions.

Very important, in the most recent year of analysis, a grand total of 5,444 people accessed MAID in this country. That represents 1.89% of all deaths in the country. I am saying that specifically for the purposes of the debate, because it is important for Canadians to understand that there is not some sort of culture of medical assistance in dying that is being foisted upon unwitting individuals. I will elaborate upon this going forward.

I would like to address a few aspects of this bill. The eligibility criteria have changed, as the Minister of Justice mentioned this morning.

There are two sets of safeguards. One applies when the individual's death is reasonably foreseeable, while the other applies when it is not. The bill adds new safeguards for this second category.

The bill proposes allowing final consent to be waived on the day of the procedure in exceptional circumstances.

Earlier in the year, the minister, along with the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, as well as myself and other parliamentary secretaries, conducted a very vast consultation process. We heard from 125 individuals, who are experts in this field, whether they are delivering it or acting on behalf of disabled individuals, from nurses, doctors, etc. We also heard from 300,000 Canadians through their responses to a questionnaire that outlined various scenarios.

The views of those individuals were quite concrete in the direction they were seeking. They wanted to be empowered in terms of their autonomy, dignity and their choices. They were seeking fewer obstacles to what had evolved to become an overly restrictive regime, as identified by the court in Truchon. That important feature must be canvassed here. What is important to understand is that the input received was critical to the development of the bill.

As part of the proposed amendments to the Criminal Code, the reasonably foreseeable death provision will be removed from the eligibility criteria. This is in response to the Truchon decision.

In terms of legal impact, this amendment would mean that people whose death is not reasonably foreseeable would be eligible for medical assistance in dying if they meet all of the other eligibility criteria.

This point is very important. The bill proposes to exclude persons whose sole underlying condition is mental illness. This has been touched upon by different people who have already intervened in the context of today's debate and in previous debates in the previous session of Parliament. This is important, as was outlined by the minister this morning. It recognizes the increased complexities and risks associated with such cases, which were highlighted by many practitioners, stakeholders and experts at the main round tables.

What is also very important is that the Canadian Mental Health Association supports the position we are taking with respect to excluding mental illness as a sole underlying condition. This complex issue must be examined carefully as part of the parliamentary review of the legislation on medical assistance in dying.

Importantly, the Government of Québec has also announced the exact same study for the exact same provision in the context of mental illness. Issues of consent and capacity and properly being able to diagnose this and having a prognosis are critical.

I will move to some of the comments that have been made. It is important for people to understand the safeguards are under two tracks. Those safeguards respond to persons whose deaths are reasonably foreseeable and those whose death is not.

With respect to some of the aspects raised in the context of today's debate, please understand we have taken the 10-day period of reflection out of the legislation. The basis for this was that the safeguard was not doing the work it was meant to do. As opposed to protecting those who were vulnerable, it was increasing vulnerability insofar as it was prolonging suffering.

We have heard some people were so concerned about their inability to provide their final consent after 10 days that they would stop taking their pain medication, which was simply creating further suffering just to maintain the ability to provide final consent.

With respect to how we can ensure informed consent is applied when it has not been solicited actively, there are two responses. This is with regard to the advanced consent regime.

The government is conscious of the Audrey Parker situation and we are seized with it. When people have been assessed and approved for this procedure and when they make a determination they want to access it and provide consent in writing, that consent would be sufficient.

In direct response to whether it could be vitiated, yes it could. First, if the person has not lost capacity, consent could be vitiated. Second, it could be done by a physical gesture that could be interpreted to fully and finally eliminate that consent for the purposes of the practitioners. That is in response to a question posed by the member for St. Albert—Edmonton.

This bill strikes a balance and the balance is important, a compassionate response that protects vulnerable people, respects their dignity and autonomy and what is required by the Constitution. I am very hopeful we can achieve all-party consensus on this fundamental issue.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, let me start by saying how much I would rather be in the House today than at home managing a small raise hand function on the screen and our own barking dogs. More seriously, let me say how much I would rather have completed this debate in March when it comes to avoiding or preventing unnecessary suffering.

COVID-19 has required us all to make adjustments. Obviously the adjustments we have to make as parliamentarians pale in comparison to the experience of most Canadians, especially those who have lost loved ones to COVID-19; those who have lost their livelihoods; those who are still struggling to make ends meet, to keep a roof over their head and to put food on the table; and those who are struggling with the pandemic while contending with life-threatening illnesses.

Let me also preface my remarks on Bill C-7 with a few words on why we find Bill C-7 before the House at all. There is a tendency by both the Liberals and Conservatives to emphasize that we are here because of a deadline imposed for changes in medical assistance in dying by the Quebec Superior Court decision in the Truchon case. That is true technically.

However, it obscures the role of the plaintiffs in that case, Jean Truchon and Nicole Gladu, who went to court to contest the provisions of Bill C-14, which they found violated their charter rights by causing or prolonging unnecessary suffering for those at the end of life and for denying individuals autonomy of decision-making over the end of their own lives.

I actually want to thank the plaintiffs today who brought us here, and also to stop for a moment to express my condolences to the family of Mr. Truchon, who left Canada a better place as a result of his attempt to improve the way we deal with medical assistance in dying, when he left us in April.

When it comes to medical assistance in dying, for New Democrats, our priority has always been, and remains, avoiding unnecessary suffering being inflicted on those who are already suffering from terminal illnesses and at the same time avoiding prolonging suffering for their families who have to bear witness to that suffering.

We were glad to see this legislation come forward in February, very promptly for a new government, but we are disappointed that we are here in October, starting over again. Some of this delay was due to COVID-19, but the blame for this delay lays equally at the feet of the Liberals for proroguing the House.

In February, there was recognition by all parties that there were two pieces of work outstanding on medical assistance in dying. First was the need to amend Bill C-7 to conform with the charter as demanded by the Quebec Superior Court ruling in the Truchon case, which found the current law too restrictive. This is the very reason New Democrats voted against Bill C-14 when it originally came before the House.

Even before the court ruling, there were many calling for changes. Those who listened carefully to the terminally ill, their families and practitioners providing the medical assistance knew well the unnecessary suffering that was being inflicted, and continues to be inflicted by our current law.

The second task with regard to medical assistance in dying was to conduct a legislative review of the broader issues around MAID after four years of our experience with it. This is not to be confused with a normal review of the specific legislative changes proposed in Bill C-7. This broader legislative review of the issues arising out of medical assistance in dying was mandated in the original legislation and was supposed to start this June.

Bill C-14 required that the review specifically look at the question of advance requests, requests from mature minors and requests where mental illness is the sole underlying condition, but it was not to be limited to those topics.

I am disappointed that the second task appears to have fallen off the agenda for the Minister of Justice. Early this morning I asked him to commit to starting this broader review in parallel with the examination of the changes in Bill C-7. As I told him then, I put Motion M-51 on the Order Paper today to create a special committee of the House that could conduct this broader review at the same time as the justice committee deals with the urgent changes needed and required because of the court decision and because of the unnecessary suffering inflicted by our current law.

I want to talk about each of these two tasks in more human and practical terms by starting with very personal stories, one for each of these. It is clear to me that the current legislation has some unintended and cruel consequences. These were clearly demonstrated by what happened to a very good friend of mine.

On January 1, 2019, I went to a traditional New Year's levee in one of the communities in my riding. When I arrived, I was not surprised to be greeted enthusiastically by someone I had become close friends with over 10 years involvement in public life together. I was surprised, however, to see her right arm was in a sling.

I am not going to name this friend today because I did not seek formal permission from her family to do so, but I am telling her story today as I trust she would want her unfortunate experience with medical assistance in dying to make a difference.

When I asked my friend what was happening, she recounted how, suddenly and inexplicably, she began having trouble using her arm over the holidays and that she was going to have it checked out as soon as possible. A month later, she began to see other symptoms and she found out that she had an inoperable brain tumour the size of a raisin but growing, growing slowly but growing nonetheless. This was a condition that would prove to be painful, debilitating and terminal.

As her condition rapidly deteriorated, she began to make plans for her end of life. Just four short months after a diagnosis, my partner and I received an invitation to what she was calling a masquerade ball in her honour. My friend was incredibly brave and never lost her sense of humour or her love of life right up to the end.

On that Saturday, she checked herself out of the hospital to celebrate her life with us that night. Rather than, as she joked, allowing us to get together after she was gone and talk about her then, she preferred to see us before and to hear what we had to say before she had to leave. Just days later, we found out she was gone. With her death, we were not only deprived of a larger-than-life member of the local arts community. We were also deprived of a friend whose enthusiasm for life had always been infectious.

Why such a sudden exit? The current law requires that those who have already been assessed and approved for medical assistance in dying be competent when the final moment to receive that assistance comes. Therefore, my friend was forced to depart weeks if not months early because she feared the loss of competence that might result from her brain tumour if she waited too long, and that this loss of competence would prevent her receiving medical assistance in dying and thus inflict weeks or months of suffering on her as the patient but also, more important to her, weeks of suffering on her family and friends who would be forced to witness a prolonged dying.

Bill C-7 would fix this by removing the requirement for final consent for those who are already assessed and approved for medical assistance in dying. This would take away the need to go early in order to avoid the loss of competence that now prevents receiving medical assistance in dying.

The bill would also make the process more straightforward in several other ways. It would do so by taking away the mandatory 10-day waiting period, reducing the number of witnesses required from two to one and expanding who could serve as a witness. These are all things practitioners have told us are unduly restrictive and only end up unnecessarily prolonging suffering.

Right now, I should take a moment to thank four doctors who have been kind enough to share with me their experiences in providing, or not providing in some cases, medical assistance in dying to hundreds of patients. Again, I will not name them today to respect their privacy, but my conversations with these four incredible people have helped me understand how medical assistance in dying operates in real life.

I should mention one other change in Bill C-7 that would have more substantial impacts. That is the removal of the requirement that death be imminent before one can receive medical assistance in dying. Bill C-7 then sets out a more restrictive process than that for those whose death is imminent and where there is more time for assessment and decision-making. However, I should emphasize, Bill C-7 still maintains the high standards set in the original legislation that in order to receive medical assistance in dying patients must have a condition that is incurable, must be in a state of irreversible decline and must face intolerable suffering. This means that Bill C-7 would not open the door for medical assistance in dying quite as wide as some have suggested.

My second story, also very personal, deals with one of the broader issues that the review of MAID was supposed to deal with. This story is my mother's story. My mum passed away just short of five years ago, during the debate on MAID. This is a story I have told before during the debate on the original bill, but one which still lacks resolution.

My mother had always been very clear with my sister and me about her wishes regarding the end of her life. For her, it was simple. She asked us that if she ended up bedridden, unable to shower or feed herself, and did not know who we were, then to please let her go. She suffered from dementia and other underlying conditions that were complicated by a serious fall and, fortunately for her, she was not forced to endure for long those conditions she had feared.

Unfortunately, the kind of advance directive or advance request that my mother had wanted to give is still not allowed under the existing legislation. I know many in my community, and more specifically, many in my own social circles, fear just such an outcome and feel that they should be able to make their own end-of-life wishes known and have them respected, just as they are now when it comes to questions of refusal of medical treatment. I tend to be of the same opinion. However, my discussions with practitioners providing medical assistance in dying have persuaded me that this question is not as simple as it appears on its face. This remains one of the important issues the legislative review of the current legislation can address and is mandated to address by Bill C-14.

As I mentioned earlier, there were other issues that were assigned to this broader review in the original Bill C-14, including requests from mature minors and requests for mental illness as the sole underlying condition, but one concern was missed. Let me take a moment now to address the concerns of disability advocates that, with the removal of the requirement that death be imminent, there will be pressure on the vulnerable in our society to choose medical assistance in dying.

First and foremost, as a society we can and must do better in offering support to people with disabilities. Failure to provide necessary resources to ensure that everyone can enjoy full and equal participation in life is a current and ongoing black mark on all of us. We have only to look at the failure to deliver additional assistance promptly to persons with disabilities during this pandemic to remind ourselves how often we forget about those living with disabilities. However, we should not dismiss the concerns of the disability community about medical assistance in dying out of hand. The legislative review is the place for us to consider seriously the question of whether the existing safeguards preventing pressure on the vulnerable to choose medical assistance in dying are, in fact, sufficient.

Before I conclude, I want to remind members that, as a society, we must do better in the job of end-of-life care. Again, COVID has demonstrated the tragic deficiencies in long-term care in ways I hope we will not ignore.

New Democrats will support the bill and help expedite its passage in order to bring an end to unnecessary suffering and to meet the deadline imposed by the Quebec court in the Truchon decision, but this support has always been predicated on going forward with a larger review without delay.

I have drafted a motion, Motion No. 151, which I have tabled today. I look forward to hearing a positive response from the government on this. We have just heard a positive response from the Bloc, and I am hoping for a positive response from the Conservatives.

Proceeding with Bill C-7 without proceeding with the broader review is only getting half the job done on medical assistance in dying. At the same time, failure to conduct the broader review potentially undermines public support for medical assistance in dying, which, so far, has only continued to grow. In fact, I believe this is one of the most important questions that could ever come before Parliament.

I look forward to the debate on the specific improvements that we can make to Bill C-7, but I urge all of us to consider undertaking the broader review of issues around medical assistance in dying without delay.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the funny thing is that people have been saying it is the only solution for 50 years now. Why is it that some hospitals still do not provide palliative care because there is a shortage of units?

Nowadays, in some hospitals, people who request medical assistance in dying cannot experience that end-of-life journey in a palliative care unit, even though palliative care is supposed to be end-of-life care and relief from pain and suffering in an environment that supports human dignity. How is that possible?

We must not think of palliative care and MAID as being mutually exclusive. It is a continuum of care that should be available to these patients. Those who are not terminally ill, for whom the dying process has not already begun and is not irreversible, are also entitled to a suitable environment. Bill C-7 makes that possible, and much more clearly than Bill C-14 did.

That was not possible under Bill C-14, with its unassailable reasonably foreseeable natural death criterion, which the court said undermined patients' right to life.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I listened with great interest and care to the member's speech. It was an important contribution.

I know the member is aware that the original legislation, Bill C-14, required a broader legislative review of medical assistance in dying. That review was supposed to start in June.

Will the member and members of the Bloc be supporting efforts to get this broader review going in parallel with Bill C-7?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I rise today in the House to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying. It is long overdue.

I want to start by saying that the Bloc Québécois is in favour of adopting the principle of this bill, because it clarifies two aspects of medical assistance in dying.

The first has to do with access to medical assistance in dying when death is imminent, meaning that the person is terminal and is receiving palliative care before receiving medical assistance in dying. At least, I hope that is the case, because people in palliative care are not always the ones to request medical assistance in dying. I will come back to this.

The second aspect has to do with people for whom death is not imminent, who were denied access to medical assistance in dying as a result of the “reasonably foreseeable natural death” clause in Bill C-14. The court struck down this criterion, which was the key safeguard. This is what Bill C-7 is designed to fix, and we are happy about that.

As we begin debating the underlying principles of Bill C-7, it will come as no surprise that I am discussing them. It is precisely because we, as lawmakers, did not do our job four years ago when we were studying Bill C-14, that we find ourselves debating Bill C-7 today.

This is a democracy, and parliamentarians, not judges, must make the laws. We, the representatives of the people, the lawmakers, must be the voice of Canadians, especially those who are suffering. Judges only interpret the grammar of justice. They examine the laws we make, as well as the rights and freedoms, and determine whether a potential infringement of rights and freedoms is reasonable or not.

In this case, the court has handed down its ruling: The provisions of the current law, the former Bill C-14, are an unreasonable infringement of rights and freedoms. Furthermore, before Bill C-7 was tabled, two courts had ruled that the Criminal Code, amended by Bill C-14, violated the right to life, liberty and security of the sick person suffering intolerably or with a terminal illness.

We have to be clear about the issue at the heart of this debate: before being legal, this is an ethical debate. On one side of this debate is the paternalistic vision of the state and medical practice, while on the other side is a vision based on the autonomy of the individual and its corollary, the principle of self-determination. I know that all my colleagues in the House have good intentions. They want to do good, they want the best for patients and they are caring. I am sure that during this entire debate they will reflect the very values they are advocating and they will be just as caring and compassionate about the interests of patients.

However, we cannot claim to be caring and compassionate, in other words wanting to do good and what is best for an individual who has reached their breaking point at the end-of-life stage, if we are interfering with that individual's autonomy and self-determination, and if we refuse to respect their wishes on something as personal as their own death. The literature is clear on this.

The basic question is this: What business does the state have interfering in a decision as personal as my own death? My life is my own, as is my death. No one else, and certainly not the state, is going to die in my place. The courts had to reframe the limits of the state's power to intervene because we did not do our job properly.

All I want is for us to understand what is at stake here. I am referring to the law, which my Conservative friends often put up on a pedestal. The value of autonomy is conferred by law through the principle of self-determination, especially with regard to medical care. That is what I want to discuss here today with my colleagues. Let's talk about the autonomy bestowed on a person by law through the principle of self-determination.

In the biomedical context, the principle of self-determination is associated with an inviolable rule, namely the rule of free, informed consent. The rule regarding free, informed consent to treatment has never been challenged in emergency situations. Patients always have the right to refuse treatment.

My question for my colleagues is this: Why would it be any different for human beings experiencing intolerable suffering due to an irreversible illness or condition? Why would it be any different for competent individuals who are neither depressed nor suicidal and who have expressed a desire to live fully until they reach the limit of what they can tolerate?

In the Carter decision, which led to Bill C-7, the Supreme Court ruled that the provisions prohibiting medical assistance in dying violated the right to life, liberty and security of the person. People like Ms. Gladu, Mr. Truchon, Ms. Carter and Ms. Taylor have not reached the end-of-life stage. They might not even be in the terminal phase of their illness. That does not mean they have not reached, or are not in the process of reaching, the limit of what they can tolerate.

The court stated that the restrictive provisions in Bill C-14 were effectively shortening the lives of such individuals, that they violated their right to life by inciting them to commit the act before they were ready. That is what needs to be fixed right here, right now. Bill C-14 did a fairly good job covering the end-of-life care for terminally ill patients whose death was reasonably foreseeable, with the exception of the requirement for a second consent, which is sometimes not necessary and means that people suffer even though they gave their informed consent.

There is no issue for people who are terminally ill. The dying process has already begun and is irreversible. Death is imminent and foreseeable. The issue we need to address as legislators has to do with people whose death is not reasonably foreseeable and imminent. Under Bill C-14, Ms. Carter, Ms. Taylor, Ms. Gladu and Mr. Truchon were ignored.

What we, the members of the Bloc Québécois, want is respect for the moral autonomy of the dying. We often hear the expression “dying with dignity”. I must point out that dying with dignity does not mean having a sanitized death. That is not what it means to die with dignity. The dignity of a person is derived from their freedom to choose and respect for their free will. That is what it means to be a human being. That is what it means to respect a human being. When that is violated, we violate the dignity of the human being.

Whether the death is unpleasant or not is not the issue. The crux of the matter is to allow the human being to make a decision about the end of their life. Unfortunately, in the past, we won the right to die rather than undergo aggressive therapies. At the time, this was called passive euthanasia. The person was left to die without much attention and without death being the intent. Palliative care was still in its infancy. There was a great fear of administering one last fatal dose of medication, but it always ends up causing death. Because palliative care is still care, it does not strictly count as passive euthanasia.

Patients won the right to die rather than undergo aggressive therapies, because people did not use to die from cancer; they died from the treatment. Medical paternalism has at times gone too far and has been less than helpful.

Today's patient-practitioner relationship prioritizes collaboration, negotiation and respect for the patient's choice. Patients alone can assess their quality of life, and that must be respected, which is why medical professionals must be transparent with their diagnoses.

Patients won the battle for the right to die rather than undergo aggressive treatment, and that evolved into palliative care as we know it. For a long time, palliative care was thought of as the only solution that would allow people to die with dignity, but if that is the case, why is it still so hard for people to get that care? If that is the solution, why is there still such a shortage of palliative care units?

Sometimes, even the best, most carefully managed palliative care in the world cannot alleviate people's suffering. Bioethics teaches practitioners to remember that patients come first, and that means listening to them.

That is true for Ms. Rodriguez, Ms. Carter, Ms. Taylor and Mr. Truchon, and it is true for Ms. Gladu and many others who have continued to suffer throughout this pandemic while they wait for us to do our job. Contrary to what some people think, these individuals are not suicidal. They want to live as long as possible.

I watched a very interesting interview with Ms. Gladu. What did she say to us? What did she want? She wanted the freedom to choose. Having this freedom greatly diminishes the suffering and anguish.

With Bill C-14, the government said its intention was to protect the most vulnerable. Is there anyone more vulnerable than a person who is suffering from intolerable pain, who is living with an incurable illness and who is being told to go to court for the right to choose and to die with dignity? Is there anything more important and more intimately personal for an individual than their own death?

I have a hard time understanding my Conservative colleagues' argument that the state must decide for an individual, when they are so economically libertarian. Several Conservatives felt that Bill C-14 went too far. The courts said that it did not go far enough and that it violated fundamental rights.

Elected members of the National Assembly of Quebec advanced the debate without pitting palliative care against medical assistance in dying. They chose to include requests for assistance in dying as part of a continuum of end-of-life care that is consistent with palliative care. Whether we are talking about a degenerative disease or an illness that causes extreme pain but is not terminal, let us not pit those two realities against each other. Respect for human dignity includes proper support when one is dying, which requires doctors to have the humility to recognize that they cannot always help people manage their pain adequately.

Our society recognizes people's right to self-determination throughout their lifetime but takes it away from them at the most intimate moment of their lives. In so doing, we think that we know what is best for people or that we are doing the right thing, when we are actually undermining human dignity, their freedom to choose.

There is no more important moment in a person's life than their death. Learning to live is learning to die. Learning to die is learning to live. I say that because the clock starts ticking the moment the doctor cuts the umbilical cord.

The Carter decision and the Baudouin ruling sent us back to the drawing board. We need to do our job as legislators and stop off-loading the problems and the ethical, social and political questions onto the courts. We have a job to do as legislators.

There is a sociology of law. In a society, the law evolves with people's consciences. I know I am straying from the technical details of the bill, but we will have plenty of time to discuss them in committee.

The bill proposes that a person who is not terminally ill must consent twice and be bound by a 90-day period. I really wanted to talk about advance consent, since that is about all that is missing from the bill.

Bill C-7 does not address degenerative cognitive diseases, which are predictable diseases. Doctors can tell patients how they will progress. People with these diseases often remain of sound mind for years and do not appear to be sick, but eventually, they become forgetful and then die. They can also experience complications from being bedridden or immobilized or conditions other than that disease. I think a person with Alzheimer's, for example, should have the opportunity to make an advance request. This bill does not take those people into account.

Still, I said at the outset that we agreed on the principle and the grounds for discussing this bill. We will have time to talk about these issues. I urge my colleagues to bring substantive arguments to the debate on the adoption in principle of medical assistance in dying.

I remember when the previous Parliament studied Bill C-14. I heard arguments about how we were putting ourselves on a slippery slope. Some people were practically saying that long-term care homes would turn into euthanasia factories. If evil people are working in our health system, they should be fired, no matter what job they do, because they have no business there. I am not buying the argument that this is a slippery slope because people are evil.

We must assume from the outset that everyone working in the health care system is caring and compassionate. Increased health transfers would enable these people to provide better care, and maybe there would be more palliative care units in hospitals. Even though people have been saying for 50 years that palliative care is the only solution, I do not believe it is. It makes no sense that people do not have better access to palliative care in this day and age.

I would like to end my speech, which I trust was a substantive one, with a wish for all of us, here in the House, concerning the delicate issue of the end-of-life. I sincerely hope—which is what the patients who turned to the courts were hoping for—to face death serenely, peacefully and without suffering. That is my wish for everyone, because that is the best wish we can make for a human being. We should imagine ourselves being at peace on our death bed and being able to let go because we have palliative care to support us in our journey towards death. That is the best wish we can make for a human being.

I am therefore calling for a debate on both the substance and the principles. I am also appealing to the humanity of all my colleagues so we can finally provide an adequate response to all those who are suffering and have been waiting for far too long.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I can say that some of the key safeguards that were deemed to be essential in Bill C-14 have been removed. The member speaks about the 10-day reflection period. It is unclear why that was removed when the law, as it stands, currently provides an exception for cases where the lack of capacity to consent is imminent. That would provide for a shorter reflection period, so it is unclear why the government would choose to remove it altogether.

With respect to the removal of the need for providing two witnesses, the need is now to provide only one witness, which is in fact a lesser safeguard than what is required when a testator executes a will.

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

Madam Speaker, when Bill C-14 was discussed, I did warn the House that if we look to other countries and how they enacted medical assistance in dying, we would see that they began with death rates in their countries of less than 1% and grew to 8%, through people not following the safeguards. It seems to me that the government, in the new version, has removed all of the safeguards: the reasonably foreseeable death provision, the independent two witness provision, the 10-day cooling-off period provision and asking for consent immediately prior.

Would the member agree that all the safeguards have been removed, or are there ones that still remain in place?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, yes, it is correct that the member and I did serve on the justice committee together during the deliberation and study on Bill C-14.

When we speak about conscience protections, they are fundamentally important. It is important to remember that the Supreme Court of Canada, in the Carter decision, did recognize that Canadians have a right, in certain circumstances, to physician-assisted dying, but at the same time the court expressly stated that no physician should be compelled to provide the procedure. It is important that the Carter decision be respected.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I am pleased to rise to speak on Bill C-7, an act to amend the Criminal Code respecting medical assistance in dying.

At the outset, I will say that the subject of medical assistance in dying is perhaps one of the most complex issues that could come before Parliament. Profound moral, legal and ethical questions are raised. Medical assistance in dying raises questions of individual autonomy, the need to respect the sanctity of life and the need to protect vulnerable persons, among other considerations.

It is no wonder that Canadians have such profound, deeply held and diverse views on this subject matter. After all, when we are talking about physician-assisted dying, we are talking about issues that literally concern life and death. When we, as parliamentarians, give consideration to an appropriate framework that provides safeguards, we must do so with regard to the fact that we are talking about a procedure that, when carried out, is irreversible. The patient dies. It is indeed a weighty subject of profound importance.

I am certainly informed of the complexity of the issue through my experience of having, in the last Parliament, served as the vice-chair of the Special Joint Committee on Physician-Assisted Dying. This committee was tasked with reviewing the Carter decision of the Supreme Court, which struck down the blanket Criminal Code prohibition and tasked Parliament and the committee with putting forward recommendations for a legislative response. I then sat on the justice committee, which studied Bill C-14, the government's legislative response. In that regard, I am in the unique position of having been through the process from start to finish, from the study of the Carter decision of the special joint committee through to the passage of Bill C-14 in June 2016.

The bill before us purportedly responds to the Truchon decision of the Superior Court of Quebec, which struck down an important component of Bill C-14, namely, that in order to qualify for medical assistance in dying, one's death must be reasonably foreseeable. When the Truchon decision was issued in September 2019, we on this side of the House in the official opposition called on the Attorney General to do the right thing and appeal the decision. We did this for a number of reasons.

To begin with, it is the responsibility of the Attorney General to uphold laws passed by Parliament. The law passed by Parliament was Bill C-14. I would note that the law had been passed a mere three years prior to the issuance of the Truchon decision. It was passed after a comprehensive review of the Carter decision and a comprehensive review of possibilities for a legislative framework. Therefore, in the end, Bill C-14 was a carefully thought-out and debated piece of legislation. One would think that in the face of that, the minister would have appealed the decision.

In addition to that, when one, having respect for this place and the laws passed by Parliament, actually looks at the Truchon decision and the reasoning of Madam Justice Baudouin, it should be all the more apparent the need to appeal the decision. Madam Justice Baudouin, in concluding that the reasonable foreseeability criterion contravened section 7 and section 15 of the charter, was driven, arguably, by a restrictive interpretation of the purpose of the law. Indeed, Madam Justice Baudouin reached her conclusion by singularly focusing on one objective of the law, namely, to protect vulnerable persons from being induced in a moment of weakness to ending their life.

However, that was not the only objective of the legislation. When one looks at the preamble of Bill C-7, it expressly provides for other objectives, including the sanctity of life, the dignity of the elderly and disabled, and suicide prevention, yet the judge in Truchon focused exclusively on only one of those objectives.

What Parliament sought to do in providing for a reasonably foreseeable criterion was to respond to what the Supreme Court called upon Parliament to do, namely, to strike a balance between individual autonomy and the need to respect vulnerable persons.

The Attorney General, moments ago, stood in this place and said that the government chose not to appeal the decision because it agreed with the substance of the decision. That is quite interesting because only four years ago, three years before the minister decided not to appeal the decision, ministers on that side of the House emphasized how critical the reasonably foreseeable criterion is to provide and ensure effective safeguards to protect the most vulnerable.

To that end I would quote the former health minister, Jane Philpott, who, on June 16, 2016 stated:

We are concerned with the Senate's recommendation for the removal of the clause that recommends that this be considered only in the face of natural death being reasonably foreseeable because of the fact that people with mental illness, among others, would not be adequately protected.

Then there are the comments of the then attorney general, the hon. member for Vancouver Granville, who introduced Bill C-14 and stated:

There are other compelling reasons for there to be a requirement that the person's natural death be reasonably foreseeable. First, it provides a fair way to restrict eligibility without making assisted dying available to almost everyone. Second, restricting eligibility in this way is necessary to protect the vulnerable.

In the face of those objectives, it is quite a departure and quite convenient for the minister to say that he was going to effectively abdicate his responsibility as attorney general to uphold the laws passed by Parliament by allowing a single decision of a single lower court judge in one province of this country to stand. The Attorney General acknowledged, and we should make no mistake about it, that the effect of Truchon and its codification, by way of this piece of legislation, significantly transforms the medical assistance in dying framework in Canada.

At the time of the Carter decision and when this House, four short years ago, debated Bill C-14, medical assistance in dying was thought to be an exception to the rule, not the rule. It was thought to be appropriate in certain circumstances in an end-of-life context, where one who was suffering intolerably could, upon providing clear consent, hasten their death.

With this legislation, it would now be appropriate to terminate human life even in the absence of a terminal illness and even in circumstances where the suffering is medically manageable. That is a radical transformation, and it creates a number of complexities around issues of suffering that might be psychological or existential and outside of an end-of-life context. When one removes the reasonably foreseeable criterion, all that is left is that one must have a serious disease, illness or disability, be in state of decline, and be suffering physically or psychologically as a result.

When one removes an end-of-life, or reasonably foreseeable, component, that already arguably subjective test becomes a whole lot more subjective, and that has the potential to put vulnerable persons' lives at risk. One can see that with those broad parameters, persons with degenerative disabilities could have their lives terminated, notwithstanding that they may have years, if not decades, to live. That has caused enormous concern in the disability community across Canada.

One month after the Truchon decision was issued, some 72 organizations from across Canada, representing a cross-section of the disability community, wrote to the Attorney General and pleaded with him to appeal the Truchon decision. They did so out of concern that persons with disabilities could be put at risk and have their lives prematurely ended.

The writers of the letter noted that the legislation could arguably contravene article 10 of the UN Convention on the Rights of Persons with Disabilities, which provides that persons with disabilities should be treated equally under the law. They note that persons with disabilities could be treated unequally because one could have medical assistance in dying made available to them for no other reason than they happen to be disabled.

It should be noted that the UN rapporteur on the rights of persons with disabilities sounded the alarm when she said she was, “extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective.” From a disability perspective, that plea fell on deaf ears on the part of the Attorney General in terms of his failure to appeal the Truchon decision.

In light of what a significant change this legislation means, it is unfortunate that it has come to this, because appealing the decision would have allowed for time. It would have allowed time for Parliament to take into consideration the significant complexities associated with this change, a mere four years after Parliament had legislated a comprehensive regime, and it would have provided clarity in terms of informing Parliament about the scope of the framework upon which Parliament can legislate.

However, instead of taking the appropriate time to ensure that any legislative change respects the charter, because respecting the charter, including life, means protecting vulnerable persons, we are here with a profoundly significant piece of legislation being rushed. It is being rushed in the face of the expiration of the stay on the declaration of constitutional invalidity, effective this December.

While the Attorney General and the government emphasized the Truchon decision, it must be noted that this legislation goes well beyond the scope of Truchon. It removes important safeguards, including the 10-day reflection period. It removes the requirement that there be two witnesses to confirm that a person made the request of their own free will and that the request reflected their true consent. It provides for a complex advanced consent regime, one of those complex areas when it comes to medical assistance in dying policy, and it does all of this pre-empting what Parliament had determined, called upon and legislated in Bill C-14; namely, a legislative review that was supposed to take place this spring, but is not going ahead.

Now we are in this rushed process, instead of having an opportunity for members of Parliament to come together to hear from expert witnesses, to review the state of the law, to give consideration to the comprehensive reports of the Council of Canadian Academies and to receive diverse feedback on all of these issues. It need not have been this way. It should not have been this way, and it is regrettable that the government has so recklessly put us in this position by rushing through legislation that, arguably, could put vulnerable Canadians at risk and remove critical safeguards.

[David Lametti, Liberal, Minister of Justice]

moved that Bill C-7, an act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Madam Speaker, I am pleased to speak today about Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, MAID. The bill before the House today is identical to former Bill C-7, which I was proud to have introduced in February following significant consultation among Canadians and experts. I believe this bill reflects a consensus among Canadians and I call on all of my colleagues in this place to support its timely passage.

As members will recall, this bill proposes a legislative response to the Quebec Superior Court's ruling in Truchon and Gladu, in which the court ruled that it is unconstitutional to limit MAID to persons whose death is reasonably foreseeable. That declaration of invalidity, which applies only in Quebec, was initially suspended for six months and subsequently extended by four months, such that it would have come into effect on July 12.

We were all working toward that deadline when this bill was initially introduced. As with many other aspects of our lives, the COVID-19 pandemic disrupted our usual parliamentary activities and it became impossible to meet the July deadline. As Attorney General, I asked for a further extension, which the court granted, until December 18, 2020.

Even though the ruling in Truchon and Gladu was suspended, Quebeckers who are experiencing intolerable suffering and who meet all the eligibility criteria except that of reasonably foreseeable death can apply to the court for an exemption that would allow a practitioner to provide medical assistance in dying despite Parliament not yet having amended the legislation.

Six exemptions have been granted since Justice Baudouin handed down her ruling in September 2019, and others are under review. The availability of exemptions limits the impact of the suspension of the ruling in Quebec.

I would like to take a moment to note the passing of Mr. Truchon, one of the plaintiffs in the case that led to these important changes to our medical assistance in dying regime. Like many Canadians, Mr. Truchon was concerned about the impact of the pandemic on his quality of life in addition to the suffering caused by his medical condition. He want the option to obtain medical assistance in dying, which he did in April. I would like to express my deepest condolences to his loved ones.

The bill before members today, four years after the enactment of Canada's first medical assistance in dying provisions in 2016, proposes a significant change to Canada's MAID regime in broadening eligibility to persons whose natural death is not reasonably foreseeable.

The 2016 amendments were, themselves, a historic change in our criminal law. They created exemptions to some of the most serious criminal offences, which aim to protect one of our most fundamental values, that of human life. These exemptions sought to protect and promote another of our most cherished values, individual freedom, and more specifically, the freedom to decide when enough medical suffering is enough and to choose when and how one's life should end.

Health Canada's first annual report on medical assistance in dying in Canada released this past July indicates that since then nearly 14,000 Canadians have received MAID. In 2019, MAID accounted for 2% of deaths in Canada.

The requirement for reasonably foreseeable natural death was part of a MAID regime that was adopted in 2016. However, we decided not to appeal the Truchon and Gladu decision because we agreed that medical assistance in dying should be available as a means to address intolerable suffering outside of the end-of-life context. To ensure the consistency of criminal law across the country, we committed to amending the Criminal Code.

Before amending the Criminal Code, we conducted an extensive consultation with Canadians. We gathered responses from 300,000 people through an online questionnaire. My colleagues, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, our parliamentary secretaries and I also held round tables across Canada with over 125 experts and stakeholders. The summary of these activities can be viewed on the website of the Department of Justice.

Based on these consultations and other sources of information, the bill proposes adjusting both the eligibility criteria and the procedural safeguards to respond to the decision rendered in Truchon and Gladu. The bill also proposes allowing patients to waive the requirement to give final consent in specific circumstances so that they do not lose their access to medical assistance in dying.

We know that Canadians are also concerned about other issues that are not addressed in this bill. I am thinking, in particular, of access to medical assistance in dying on the basis of mental illness. I am also thinking about advance requests for medical assistance in dying for people who are not yet suffering but fear they will be after they have lost their ability to request this assistance and who want to making their wishes known before that happens.

The upcoming parliamentary review of the medical assistance in dying regime and of the state of palliative care in Canada will provide an opportunity to give these complex issues the time and attention they deserve. It is up to Parliament to determine the scope of this review and when to conduct it.

COVID-19 has delayed this important review, but I am confident that Parliament will undertake it as soon as possible. That being said, our government's top priority is to meet the deadline set by the Quebec Superior Court in the Truchon and Gladu case.

Before I discuss the contents of the bill in more detail, I would like to note the important concerns of many individuals in the disability community about changing Canada's MAID policy from a way to avoid a painful death to a means of relieving intolerable suffering. It is crucial that these concerns not be forgotten as we resume our debate. In the view of many disability groups, a MAID regime that does not limit eligibility to those whose death is already reasonably foreseeable enshrines in law the erroneous view that disability itself is a valid reason for ending life. We have also heard from individuals living with disabilities, like Mr. Truchon and Ms. Gladu, that autonomy in how they choose to live and die is paramount. These are complex and nuanced points of view.

Let me be absolutely clear. Our government supports the equality of all Canadians without exception and categorically rejects the notion that a life with a disability is one that is not worth living or worse than death itself. I believe the fundamental principle that all lives have equal and intrinsic value can be balanced with other important interests and societal values, in particular, the importance of individual choice for Canadians. This balance is at the heart of the bill's objectives, which are to recognize the autonomy of individuals to choose MAID as a means for relieving intolerable suffering, regardless of the foreseeability of their natural death, while at the same time protecting vulnerable persons, recognizing that suicide is an important public health issue and affirming the inherent and equal value of every person's life.

I will now go into the specifics of various elements of the bill.

The bill proposes to expand eligibility for medical assistance in dying by repealing the criteria for a reasonably foreseeable natural death. Medical assistance in dying would therefore be available to people suffering unbearable pain, who have a serious and incurable disease, infection or disability, and whose medical condition is characterized by an advanced and irreversible decline in their capacity.

This removal of “reasonable foreseeability of natural death” from the eligibility criteria would mean that some persons whose only condition is a mental illness could be eligible for MAID. However, the bill proposes to exclude mental illness on its own as a grounds for MAID eligibility.

Our consultations and the report of the Council of Canadian Academies that studied this issue indicated that the trajectory of mental illness is more difficult to predict than that of most physical illnesses, that spontaneous improvement is possible, and that a desire to die and an impaired perception of one's circumstances are symptoms, themselves, of some mental illnesses.

This means that it would be very difficult to determine when, if ever, it is appropriate to grant someone's request that their life be ended solely on the basis of mental illness. In no way does this suggest that persons with a mental illness necessarily lack the decision-making capacity to consent to MAID, or that the suffering associated with a mental illness is of a lesser degree than the suffering associated with physical illness.

During second reading debate of former Bill C-7, some members noted their support for this exclusion while others raised concerns. This issue requires much more thought and debate. We feel the parliamentary review of the MAID legislation would be an appropriate forum for this.

The bill also proposes changes to the safeguards, since the existing safeguards were designed to protect persons whose death is reasonably foreseeable.

Expanding eligibility requires changes to the safeguards, since many experts believe there are greater risks in assessing applications for medical assistance in dying from individuals whose death is not reasonably foreseeable.

The bill therefore proposes two sets of safeguards. Each applies whether natural death is reasonably foreseeable or not. This is the only role that the concept of reasonably foreseeable death would play in the new regime. It would no longer constitute grounds for refusing a request for medical assistance in dying.

Reasonable foreseeability of natural death, or RFND, refers to a temporal but flexible connection between the person's overall medical circumstances and their anticipated death. It allows for clinical judgment, as it requires a comprehensive individual assessment that does not have a result in a specific prognosis and clearly does not require death to be imminent.

Individuals may decline towards death along trajectories of greater or lesser predictability. As such, RFND is not defined by a maximum or minimum prognosis, but it does require a temporal link to death in the sense that the person is approaching the end of their life in the near term.

We kept the RFND standard because it provides flexibility in relation to the difficult and imprecise exercise of anticipating when natural death might occur. A natural death that is expected within six to 12 months certainly meets the RFND standard. That was made clear when Parliament adopted Bill C-14 as an end-of-life regime. It did not impose a six- to 12-month prognosis requirement to preserve flexibility, but it still considered such timelines to be within the meaning of RFND.

A person's death may also be foreseeable in the temporal sense over longer periods, depending on the particular circumstances under consideration. However, having an illness that will cause death several years in the future would not normally meet the condition of RFND.

Safeguards for those whose deaths are reasonably foreseeable are based on safeguards that currently exist with two changes. First, the 10-day reflection period would be eliminated. Second, the request for medical assistance in dying will no longer require the signature of two independent witnesses, just one.

A person paid to provide health care services or personal care who is not involved in the assessment of the person's eligibility for medical assistance in dying can now act as an independent witness.

During second reading of former Bill C-7, some hon. members expressed concern about removing some of the safeguards.

Allow me to assure hon. members that these changes are based on the comments we received during our consultations and follow through on them.

For those whose natural death is foreseeable, many of whom spend a long time seriously thinking about what they want to do, the 10-day reflection period might unduly prolong their suffering.

We also learned that people who live in long-term care facilities or in remote regions may have difficulty finding two independent witnesses. These difficulties are exacerbated by the pandemic. The independent witness confirms the identity of the person, but does not participate in assessing their eligibility for medical assistance in dying. Only one person is required for meeting that safety objective.

Newly eligible persons whose death is not reasonably foreseeable would benefit from additional safeguards, the purpose of which is to ensure that sufficient time and expertise is devoted to the assessment of their MAID request. Where death is not reasonably foreseeable, the suffering motivating a MAID request may be due to a broader range of sources that warrant greater attention before someone's life is prematurely ended, to reduce the risk of providing MAID when there is a possibility of alleviating the person's suffering.

Specifically, the bill proposes a minimum 90-day assessment period, which would require that at least one of the practitioners assessing eligibility has expertise in the condition that is causing the person's intolerable suffering. A formal specialization or certification by a medical college would not be required. The bill would also require that a person whose death is not reasonably foreseeable be informed of and offered available means to relieve suffering, such as mental health and disability supports. In addition, the practitioner would have to be satisfied that those other means of relieving suffering have been seriously considered.

These are clarifications to the existing requirement of informed consent. It is our hope that these steps are already taken in all cases, but the Criminal Code would explicitly require them for those whose death is not reasonably foreseeable.

In addition to changes in response to the decision in Truchon and Gladu, the bill would let a person whose natural death is reasonably foreseeable and who has been deemed eligible to receive MAID to waive final consent if there is a risk they will lose the capacity to consent before the date on which they chose to receive MAID.

At present, the Criminal Code requires that, immediately before providing MAID, the practitioner must ensure that the person has given express consent to MAID and that they have the opportunity to withdraw their request. This safeguard, which attests to the irreversible nature of death and the importance of obtaining consent at the point of ending life, simply cannot be met if the person has lost the capacity to consent. This seems unfair when a person has been deemed eligible and was awaiting the procedure. In such cases, the rule could push some individuals to obtain medical assistance in dying earlier than they wanted to.

Under the amendments proposed in the bill, a person whose death is foreseeable, who has already been assessed and approved for MAID and has decided they want to receive it, could make an advance consent arrangement with their practitioner, setting out the date for the provision of MAID and their consent to MAID if they no longer have the capacity to consent at that later point.

According to round table participants and experts who looked at this question for the Council of Canadian Academies' 2018 reports, providing for advance consent in this way presents relatively little complexity or risk, and some practitioners have indicated they would be relatively comfortable providing MAID under such circumstances.

The bill does not propose to permit advance requests in contrast to what I have just described as advance consent. Advance requests are documents that may be provided at some future unknown date, if and when a set of expected circumstances materializes and when the person is no longer able to give consent. This issue is significantly more complex and challenging, and it will be examined during the parliamentary review.

Finally, the bill would enhance the monitoring regime, which is crucial for accountability and transparency. I have examined the bill for charter compliance and I am confident that it responds to the Truchon ruling in a way that respects the charter. I will soon table a charter statement that sets out key considerations about the bill's potential impacts on charter rights and freedoms.

In conclusion, these important amendments seek to guarantee that medical assistance in dying—

Reference to Standing Committee on Procedure and House Affairs

[Rob Moore, Conservative, Fundy Royal, NB]

moved:

That the matter of the premature disclosure of the contents of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying) be referred to the Standing Committee on Procedure and House Affairs.

Mr. Speaker, thank you for your finding that a breach of our privileges did exist in this case in the leaking of the contents of Bill C-7 to the media before members of the House could see the bill.

There is a reason why we have rules in this place to protect the rights and the privileges of members of Parliament in this place on all sides of the House, so that we are able to do the job that we were elected to do, which is to represent our constituents, to pass legislation and to debate. Those are the things that we have been given the ability to do by our constituents. When we have government departments, government members that do not abide by the rules of the House, it undermines not just those members in the opposition, it undermines all of us.

It is well-established practice in the House that when a bill is on notice for introduction, the House has the first right to the contents of the bill. Everyone in the House knows this. We know that the House is paramount when it comes to the introduction of the legislation, but if there is any one department in the whole of government that we would expect would know the rules around the laws and procedures in the House, that department would be the justice department, the department tasked with making laws that impact the lives of all Canadians. That department knows better. That is a department filled with hundreds if not thousands of lawyers and legal minds that know better.

Let us say they did not know better. Just like with any one of our children, sometimes if they make a mistake we correct them. Maybe if they make a second mistake, we will correct them again. By the third time around, we expect that they know the rules.

This is the fourth time there has been found a breach of our privileges in the House that was made by the Department of Justice. In fact, the last ruling on this matter was also on the previous legislation around medical assistance in dying. It was even the same legislation.

The article that was put forward within The Canadian Press had very detailed and specific information contained in the bill. That is why this breach of privilege has been found.

The reporters and those who were leaking know that contempt has occurred by revealing later in the article that, "The sources spoke on condition of anonymity because they were not authorized to reveal details of the bill prior to its tabling in the House of Commons this afternoon."

There is no doubt in anyone's mind that those who were leaking this information from the Department of Justice or some other arm of government knew exactly what they were doing when they did it. What they thought about this place is not much, because we have rules, and they thumbed their nose at the rules that we have.

After the sources indicated to the reporter that they were aware of their guilty actions, they boldly and defiantly continued their affront to Parliament by providing even more detail of the bill. Quoting again from that article, “Sources say today's bill will not deal with broader issues that were excluded in the new law and that must be considered as part of a parliamentary review of the law that is to begin this summer.” Again, bang on with what was in the bill.

We saw the news articles and we thought we knew what had happened, another leak from the Department of Justice, another affront to this Parliament, another breach of all of our collective privileges, but again we had to read the bill to find out whether in fact that was the case.

We carefully reviewed the contents of Bill C-7 following its introduction in the House. When I and other members of Parliament got to see the bill for the first time, others in the media had seen the bill in its entirety for hours before.

The details reported by The Canadian Press hours earlier were indeed contained in Bill C-7. Ironically, over and over, the first precedent that I had quoted earlier was from the last Parliament, brought to the Speaker's attention on April 14, 2016, and in regard to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).

The department in question is being absolutely recidivist. It is not taking seriously the consequences and the rulings of Speakers. The Speaker in 2016 found that there was, in fact, a prima facie case of privilege regarding Bill C-14 and said:

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

The Speaker's concluding remarks in 2016 were as follows:

In this instance, the chair must conclude that the House's right of first access to legislative information was not respected. The chair appreciates the chief government whip's assertion that no one in the government was authorized to publicly release the specific details of the bill before its introduction. Still, it did happen, and these kinds of incidents cause grave concern among hon. members. I believe it is a good reason why extra care should be taken to ensure that matters that ought properly to be brought to the House first do not in any way get out in the public domain prematurely.

On October 4, 2010, on page 4711 of the House of Commons Debates, Speaker Milliken noted:

It is indisputable that it is a well-established practice and accepted convention that this House has the right of first access to the text of bills that it will consider.

This all goes back to my point about the Department of Justice not taking seriously the rules of this House. The one department that ought to know best about the rules of this House is now a four-time offender, with breaches of privileges found by successive Speakers over the last several years, sometimes over the same bill subject matters. The House, and the rules of the House, are being completely ignored.

The Speaker found another case of contempt on October 15, 2001, after, and members are not going to believe this, the Department of Justice briefed the media on the contents of a bill prior to the legislation being introduced in the House.

Maybe, in this minority House, members can finally take this department and this Minister of Justice's office to account and to task for their continuous disrespect of the privileges and the rights of this place, and the rights of all Canadians who send us as members of Parliament to do good work on their behalf.

Alleged Premature Disclosure of Two Bills—Speaker's Ruling

[The Speaker, Liberal, Anthony Rota]

I am ready to rule on the questions of privilege raised on February 25 by the member for Fundy Royal and on February 27 by the Parliamentary Secretary to the Leader of the Government in the House of Commons concerning the premature disclosure of two bills.

Allow me first to recapitulate the arguments presented by the two members.

On February 25, 2020, the member for Fundy Royal raised a question of privilege regarding a Canadian Press article published online on February 24 that detailed specific information contained in Bill C-7, an act to amend the Criminal Code with regard to medical assistance in dying, even before it was introduced in the House by the Minister of Justice. The member quoted from the article in question, which mentioned that anonymous sources allegedly discussed the contents of the bill with the journalist while knowing full well that doing so contravened the practices of the House. The member for Fundy Royal feels that this premature disclosure of the bill constitutes a breach of his privileges and contempt of the House.

On February 27, the Parliamentary Secretary to the Leader of the Government in the House of Commons raised a question of privilege also concerning the premature disclosure of a bill.

During this intervention, the parliamentary secretary said that a bill entitled “an act to amend the Criminal Code (unlawfully imported firearms)”, put on notice on February 21 by the member for Markham—Unionville, was also the subject of an article published on February 24 in iPolitics before it was introduced in the House. On February 25, the member put another bill on notice, one with a slightly different title, “an act to amend the Criminal Code (possession of unlawfully imported firearms)”. The bill became Bill C-238 after it was introduced on February 27.

The parliamentary secretary feels that the provisions of Bill C-238 correspond to what was described in the iPolitics article, and he presumed, therefore, that the two bills are in large measure the same. The parliamentary secretary suggested that this disclosure contravenes the principle that members are the first to know the contents of a bill. Since a breach of privilege was apparently committed, he suggested referring the matter to the Standing Committee on Procedure and House Affairs.

On February 28, the member for Markham—Unionville apologized and admitted that he had indeed discussed the contents of the first bill with fellow members and journalists. He said that he had acted in ignorance of the rule prohibiting discussion of bills on notice before they are introduced in the House. He also explained the reasons for the change in title between the two bills.

The same day, the parliamentary secretary to the leader of the government in the House presented his most sincere apologies for the premature disclosure of Bill C-7, saying in passing that no one within the government had been authorized to discuss the bill before its introduction in the House.

I believe that the whole matter can be summarized as follows.

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

Second, in his apology, the member for Markham—Unionville made it clear that his two bills on firearms were substantially the same, apart from the slightly different titles. It seems clear to the Chair, therefore, that the member also discussed a bill before its introduction. It matters little that the bill in question was subsequently withdrawn and never introduced in the House.

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

In this case, it is clear that the content of the bills, both the private member's bill and the government bill, were revealed to the media before their introduction and first reading. The question now is to determine whether the disclosure of these bills was a breach of the House’s privilege and whether mitigating circumstances should be considered.

In this instance, I am prepared to give the benefit of the doubt to the member for Markham—Unionville when he says that he was unaware of the rules regarding the confidentiality of bills on notice. I believe that his remarks were sincere and that he believed he was advancing his cause in a legitimate fashion.

My analysis is different for the question of privilege raised by the member for Fundy Royal concerning government Bill C-7. Permit me to quote a part of the article at the heart of this matter:

The sources spoke on condition of anonymity because they were not authorized to reveal details of the bill prior to its tabling in the House of Commons this afternoon.

Everything indicates that the act was deliberate. It is difficult to posit a misunderstanding or ignorance of the rules in this case.

On April 19, 2016, my predecessor, faced with a similar situation regarding the premature disclosure of Bill C-14 on medical assistance in dying, found a prima facie case of privilege in a decision that can be located on pages 2442 and 2443 of the Debates.

In light of the information provided by the member for Fundy Royal, the precedents and the current practice in this matter, the Chair notes the existence of sufficient grounds to conclude that there was a prima facie breach of the privilege of the House and the members and their right to be the first to know the contents of Bill C-7.

Consequently, I now invite the member for Fundy Royal to move the appropriate motion.

Opposition Motion—Additional Allotted Days

[John Nater, Conservative, Perth—Wellington, ON]

Madam Speaker, “Parliament is more than procedure – it is the custodian of the nation’s freedom.” Those words were spoken by the great defender of parliamentary democracy, the Right Hon. John George Diefenbaker.

Today, we find ourselves called upon to once again stand in support of this great institution, to once again stand for the right of opposition parliamentarians to hold the government to account.

Many Canadians may not be closely following the business of supply. They may not closely follow the allotted days, or the opposition days, that are often called in Parliament. However, these days, in which the agenda of the House falls to the opposition parties, are absolutely essential to our great parliamentary democracy. We as the opposition, both the official opposition and the other opposition parties, have the right to bring forward matters that we feel are important to our constituents and to all Canadians.

Beauchesne's Parliamentary Rules and Forms, sixth edition, states “The Opposition prerogative is very broad in the use of the allotted day and ought not to be interfered with except on the clearest and most certain procedural grounds.”

We have brought forward this opposition day motion on this day for very important reasons. The Liberal government decided to punish the official opposition by giving us a short parliamentary day, a short day when only two full speaking slots would be allocated to the opposition parties.

The Liberal government seems to have forgotten that it is among the weakest governing mandate in Canadian history. The Liberals forget that they actually lost the popular vote in the last election and Canadians saw fit to return them with a minority of seats in this place.

Bosc and Gagnon states the following, on page 855:

The setting aside of a specified number of sitting days on which the opposition chooses the subject of debate derives from the tradition which holds that Parliament does not grant supply until the opposition has had an opportunity to demonstrate why it should be refused.

In other words, before we as the opposition can consent to the continued funding of the government, we must, and we will, have the opportunity to raise our concerns in this place. We will not be silenced. We will not accept that the government, and only the government, has a legitimate voice in this place.

I would remind members of the Liberal party that they are first and foremost members of the legislative branch of government. Those who do not sit in cabinet are not members of the executive branch. They are parliamentarians and parliamentarians first and foremost. They too should be concerned that the members of the executive branch of government are the ones who are trying to control the debate of this very place.

I ought not to need to remind the government of its legislative record and its mismanagement of House time in the previous Parliament. At the time of dissolution, it had left at least 17 government bills lying on the Order Paper. This is in spite of the fact that it used time allocation on dozens of occasions. On top of that, there were 13 motions for closure and 40 motions to proceed to orders of the day, thereby bypassing the opportunity for opposition MPs to move concurrence motions or to table petitions on behalf of the constituents in each of our 338 ridings across the country.

Today's debate is about returning the House to the people, to give the official opposition, the Bloc Québécois and the New Democratic Party each one additional opposition day during the supply period, to give each of these parties the opportunity to raise the issues before granting supply to the Liberal government.

I do not need to remind the House either about the disregard we have seen in the past by the Liberal Party to this institution.

In the previous Parliament, on one of its very first bills, Bill C-14, the medical assistance in dying act, the Liberal government was found to have contravened the rights and privileges of the House by leaking the contents to the media before it was tabled for all parliamentarians to see. Old habits die hard, because it appears it did that once again this time with Bill C-7, the amendments to medical assistance in dying.

The Conservatives do not need to remind the Liberals either about the impacts they bring upon themselves when they attempt to use draconian measures to shut down debate in the House. We all remember Motion No. 6, when they tried to unilaterally take control of every mechanism for debate in the House. We do not need to remind the Liberals of the standing order standoff, when they tried to diminish the opportunity for the opposition to hold the government to account by unilaterally changing the rules of the House. It fell to the Conservatives, as the official opposition, and the third party, the New Democrats, to ensure we were that line of defence, that we were that thin line of the wedge to prevent the Liberal government from doing that.

In fact, in the previous Parliament, during a debate in this very House on a question of privilege, one of the most significant matters with which the House can be seized, a Liberal member of Parliament, the member for Brossard—Saint-Lambert, stood in the House, used a procedural measure to move to orders of the day and killed that debate. However, our Parliament is stronger than any one Liberal member of Parliament. At that time, the Speaker saw fit to return that question of privilege to the House so members of Parliament could have their voices heard.

We see this time and again with the Liberal government. At every opportunity it has to do the right thing, it goes the opposite direction.

That brings me to the events we have seen just in the last couple of weeks on the new NAFTA. It is not a great deal and it is not the worst deal; it is somewhere in between. We are the party of free trade and we support the implementation of the new NAFTA despite its imperfections. However, to hear the Deputy Prime Minister state publicly and in this place that the Conservative Party was somehow trying to delay the new NAFTA is an insult to the opposition and to the House of Commons.

Just yesterday, my colleague, the opposition House leader, gave the Liberals the opportunity to right their wrong by bringing forward NAFTA today. We could be debating NAFTA today and I could be raising the concerns of the people of Perth—Wellington, the farmers, the manufacturers, individuals who have concerns with the bill, However, the Liberals did not budge. In fact, speaking for the government, the parliamentary secretary to the government House leader said no, that the government would not be willing to bring NAFTA forward. That is unacceptable.

We stand here today debating this opposition motion, a motion that gives the rights and responsibilities of the House back to all its members. I encourage all members to stand for their parliamentary privilege, to stand for democracy and vote in favour of this motion.

Criminal Code

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, when Bill C-14 was introduced in the previous Parliament, the decision was made to not include advance directives. I think that was purposeful. Had we been allowed to deal with the issues that the Truchon case identified and keep all of these other issues in mind for the statutory review that is being contemplated, it would have allowed us far more time to look at the legislation, see what was and was not working and have a timely and comprehensive study of Bill C-14.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I want to ask the member about what I think is an unintended consequence of Bill C-14. It is the situation where people are forced to choose to go early because they are afraid of losing competence at the last minute, something the new bill addresses.

There are many examples of it across the country, I have one example that is very close to me. I have friend who wanted to see family and relatives and spend some time doing last things because she had a very serious brain tumour. She chose to go earlier because she feared losing competence.

That is an unintended consequence of the current legislation. People should be able to make that choice and have an orderly and dignified end to their lives. Does the member not see that as an unintended consequence?

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, I appreciate the opportunity to speak on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, which was introduced earlier this week and dramatically expands the existing euthanasia regime in Canada.

This bill was introduced in response to a ruling made September 11, 2019, where the Superior Court of Quebec found, in Truchon versus the Attorney General of Canada, that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life.

I believe it is completely unacceptable that the government did not appeal the Truchon decision to the Supreme Court. Truchon struck down vital protections for vulnerable Canadians that the Liberal government put in place less than five years ago. Appealing this decision would have allowed us to get certainty on the framework within which Parliament can legislate.

The summary of the bill states that it amends the Criminal Code to:

among other things,

(a) repeal the provision that requires a person's natural death to be reasonably foreseeable in order for them to be eligible for medical assistance in dying...

It excludes mental health as an eligible reason to receive assisted suicide. It creates two sets of safeguards that must be respected before medical assistance in dying may be provided, which differ in application depending on whether death is reasonably foreseeable. It also creates an advance directive wherein a medical practitioner can proceed with assisted suicide without consent immediately before administering it, assuming all other criteria are met and the patient enters into an arrangement in writing with a medical practitioner or a nurse practitioner to cause death on a specified day.

While these changes are significant, it is the other things where I will focus most of my attention. In responding to Bill C-14 in the last Parliament and now to this bill, it has always been our priority, on this side of the House, to ensure that legislation permitting euthanasia and assisted suicide includes safeguards for the most vulnerable in our society, as well as for the conscience rights of physicians and allied health professionals.

Of all the proposed changes, I am most concerned about the removal of the 10-day waiting period. This was not a change mandated by Truchon. Rather, it is a deliberate choice by the Liberal government to strike down one of the most important safeguards for vulnerable people facing uncertain medical prognoses.

Nearly every one of us can think of someone in their lives, perhaps a friend, a grandparent or even a spouse, who has received a serious diagnosis. The emotional impact of hearing that news can be overwhelming for both the patients and their families. It can cause depression, anxiety and a great fear of the unknown.

I am sure many of us can also think of people we know who have received terminal diagnoses and went on to beat their illness and live for years afterwards. However, with the safeguard of a 10-day waiting period gone, such stories may be fewer and farther between.

Without having to take the time to come to terms with their situation, to speak to their families and to learn about treatment options from their doctors, many people will make emotional decisions based on fear.

Another amendment removes the need for two independent witnesses and allows health care workers to act as witnesses. People may not even hear another voice offering a different solution.

By making these changes, we diminish the extremely important role legislators play in contemplating all of the unintended outcomes and consequences and then protecting against them. We know very well that the current euthanasia regime has serious problems, that it has been abused and that it has been used as a tool of desperation after the failures of government.

Sean Tagert suffered from an advanced case of ALS that left him completely paralyzed, unable to speak and reliant on a ventilator. Despite these challenges, Tagert fought to stay alive so he could watch his son, whom he spoke of in lengthy Facebook posts, grow up.

Sean required 24-hour in-home medical assistance to stay alive. Initially the health care system provided him only 15 hours, leaving Sean to somehow pay hundreds of dollars each day. Eventually, even that was too much for the health authority. Health care authorities told Sean that he would no longer receive funding for home care, leaving as his only option institutional care at a facility hours away, separated from family and removed from the son he called his reason for living.

Sean appealed, but to no avail. He was going to lose his home care. Mr. Tagert fought long and hard for the rights of persons with disabilities and their families but in the end, he was driven by his desperate circumstances to believe that assisted suicide was his only option. He was “worn out”, in his own words. On August 6, 2019, he ended his life.

I am going to read from the statement his family posted at that time:

We would ask, on Sean's behalf, that the government recognize the serious problems in its treatment of ALS patients and their families, and find real solutions for those already suffering unimaginably.

“Real solutions” does not mean removing the safeguards for those who are the most vulnerable. It means providing true alternatives, be that palliative care, in-home care or the unique care needed.

It is not enough to simply put in legislation as we find here in proposed paragraph 241.2(3.1)(g), under Safeguards:

...[to] ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care and has been offered consultations with relevant professionals who provide those services or...care.

If we have no intention of ensuring that those services are being funded or are even available, we have failed.

I note that the current federal government broke a key election commitment to invest $3 billion in long-term care, including palliative care. Access to palliative care is an essential part of end-of-life decision making. That point has been made over and over during this debate.

People should never be put in a position where they believe death is the only solution available to them. We are, and we must be, better than that. We must protect every human life with a jealousy born of the knowledge that each person is unique, and has an innate dignity that nothing, not time, not illness nor disability, can ever take away.

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

Madam Speaker, it is an honour to speak today to Bill C-7 regarding medical assistance in dying. This is the second time, the first being in the last Parliament, that I have had the opportunity to take part in the debate on this absolutely essential legislation on such a difficult subject.

This bill represents a major improvement and reflects some of the amendments that I made but that failed in the House, in the 42nd Parliament. Some of those amendments, in fact, were picked up and approved by the Senate.

I want to stop and reflect on the trajectory of this issue in Canada.

As identified when I rose in my place, I am a member of Parliament for Saanich—Gulf Islands and I believe that Saanich—Gulf Islands may have more constituents concerned with and calling for medical assistance in dying than perhaps any other riding in Canada. There are two active death-with-dignity groups within my community, one on Salt Spring Island and one on the Saanich Peninsula, and I think it is for a very simple reason.

Feelings run high, and honestly, my constituents persuaded me in 2011 and 2012 that I had to stand up for ensuring that there was access to medical assistance in dying and stand up for removing the Criminal Code punishments for people who, motivated by compassion and basic human dignity, assisted someone who was dealing with unbearable suffering in their last days and weeks.

The reason that my community is so very implicated in this issue is that Sue Rodriguez was a resident of North Saanich. She was unable to take her own life due to the effects of ALS, but she was able to find a doctor, who remains anonymous to this day, who assisted her in ending her own life.

It is clear that many people in my riding support the measures in Bill C-7, as they did supported Bill C-14 in the previous Parliament.

This is about helping to alleviate suffering through medical assistance in dying. This difficult and very serious situation is unfair to anyone.

Sue Rodriguez went to court, so it is also a trajectory of court cases. The Supreme Court of Canada ruled in 1993 against Sue Rodriguez. She was suffering from ALS. ALS runs as a thread through what I want to talk about today. Sue was losing ability and had lost ability to speak, to swallow and to walk. We know the trajectory of ALS. She asked the court to change the law and she was unsuccessful. That was in 1993. By the way, it was a very close decision. It was five to four, a very close decision. She died a year later, on February 12, 1994.

Then we take it to 22 years later. That is how slowly the laws evolve. It takes a while. The Supreme Court of Canada and the laws of Canada evolve to meet the changing circumstances. I think part of the reason is that we also realize now, unlike 20, 30, 40, 50 years ago, that we can prolong lives and sufferings through miracle advancements in medical science, but before we passed this law in the 42nd Parliament, we were denying people death with dignity and the ability to control their own decision-making about the timing of their own death.

Along came the Carter decision, finally, in 2015. Twenty-two years after the Supreme Court of Canada decision in Rodriguez, we had the decision in Carter. I felt very strongly when we debated the bill for medical assistance in dying in this place in the last Parliament, the 42nd Parliament, that our legislative efforts fell far short of what the Supreme Court of Canada ruled in Carter.

I felt quite sure, and said many times in this place, that the legislation we were passing, while an improvement, would not stand up to legal scrutiny and would be ruled unconstitutional by the courts. Now we have the decision that came out last September in the Truchon case, and again a court has given us a deadline to come up with an improvement. It is being called Audrey's amendment. Certainly a lot of people have identified with that situation, and their hearts have been broken by knowing that medical assistance in dying was out of the reach of people who were suffering gravely but feared they would not be able to form the required consent on the day of the procedure.

I think the bill before us is a substantial improvement, and it really reflects on how courts grapple with this issue and how society grapples with it.

I have to say that in the 42nd Parliament, I found the debate remarkably respectful. Across all parties, we recognized that these are serious matters of life and death, not to be trifled with and not to be turned into partisan debate. The reality is that in this legislation we do make amends for some mistakes in the previous bill.

I always find it rather odd that we have to find that a person's natural death is “reasonably foreseeable”. I do not think any of us in this place fancy ourselves immortal. All of our deaths are entirely foreseeable; we just do not know exactly the time and place in which they will occur.

Doctors of those who are suffering from a terminal illness are not even able to say the reasonably foreseeable date. What does it mean to be reasonably foreseeable? We put people in a stricture where even if they knew they had a terminal illness, such as ALS, they could not necessarily get aid from this legislation and they could not necessarily give advance consent to a doctor to indicate that they did not want to go through what they knew lay ahead of them.

One of my best friends emailed earlier today to ask me to stand up and fight this bill, because she is dying with ALS and she did not think the bill would cover her. I spoke to the Minister of Justice to confirm that I was reading the bill correctly and that, yes, they were thinking specifically of people with ALS.

Our friend who used to sit in that chair, Mauril Bélanger, was lost to us so quickly through ALS. My friend, who is losing the ability of speech, is in a chair and has tubes in her stomach that cause enormous pain. She knows that her lungs will give out, so she is emailing me while we are having this debate. I was really relieved to talk to the Minister of Justice and realize that I am reading the bill correctly, that my friend can get the help that is needed to be assessed and be able to say that she wants consent in advance.

However, I do think that there are some areas for amendments that should be made here, and I wish we had more time. I hope the court will give us the additional four months, but we do not know that.

Some of the bogeymen that have been raised here today I think are considered in the bill. We do have the requisite safeguards to keep vulnerable people safe. No one can give permission for medical assistance in dying other than the patients themselves. They still have to meet very tight criteria. They have to have a sworn witness. They have to have a doctor. The bill also provides that on the day of the procedure, if a person indicates that they have changed their mind, they are completely allowed and of course have the right to indicate that they have changed their mind through all sorts of gestures and words, but not through any involuntary gestures. I think the bill is drafted as well as it can be, but we will continue to consider it in the amendments at clause-by-clause consideration.

The bill does continue to ensure that the death is reasonably foreseeable, and there may be some complications there in the language. I note concerns from Dr. Jocelyn Downie at Dalhousie University, who is one of Canada's leading experts in this field, and I want to hear her evidence. I hope that she will be a witness, and I am sure she will be, as well as Dr. Stefanie Green, the president of the Canadian Association of MAID Assessors and Providers. We want to make sure we get the language right.

I will close by thanking the Minister of Justice and the government for following through and hearing the cries of Audrey, from Halifax, that her death be not in vain.

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, before this House is a piece of legislation having to do with medical assistance in dying. This process has been discussed for the last four and a half years. Of course, there was legislation put in place, Bill C-14, in 2016. That legislation allowed for medical assistance in dying in Canada. That is covered.

My question is this: Where are the millions of dollars that were promised for palliative care?

To the hon. member's point, this country exists on the precedent that there is choice, but if people have the choice for euthanasia, then where is the choice to live until their last breath in a place where they are cared for and where they are pain-free? That is called palliative care, and the current government has failed to deliver on that. By not doing so, it has actually forced a number of people to choose euthanasia when they would not normally choose that, but because their pain levels are so high and because palliative care is not offered, they choose death.

That is wrong.

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, during this debate time, we have an opportunity as legislators to ensure that we carefully and thoughtfully examine Bill C-7 with the best interests of Canadians in mind.

On September 11, 2019, the Superior Court of Quebec found that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life. Although the current bill before the House, Bill C-7, responds to the court's ruling, it goes far beyond the scope of Quebec's decision and it weakens the important safeguards that have been put in place under Bill C-14.

Since the Liberals put this legislation forward, I have heard from hundreds of my constituents in a matter of days. They have shared with me that they are very concerned about the bill.

I will use my time today to share a number of the concerns they have raised and to issue a thoughtful word of caution to this place.

First, there is a parliamentary review of the original legislation scheduled for June. The question has to be asked. Why are we rushing to expand the scope of the current legislation?

We are literally discussing life and death issues. Death, something so final, deserves just a little of our time, our attention and due diligence.

The government's original legislation went through a very lengthy consultation process. This time, however, the consultation only lasted a couple of weeks. That is not the sole concern I have. In addition to that, when I look at this survey, the questions that were asked were quite vague and the multiple choice answers that were provided were drafted in such a way that the party in power could interpret those answers to the secure findings it desired. It was unclear and therefore unhelpful, if we really are going to respect the voices of Canadians.

However, the fact that this survey was so unhelpful goes to show that the current government was not interested in hearing from Canadians. The current government was interested in pushing through its agenda and therefore being able to twist and manipulate the survey data to its end, which is absolutely wrong.

It is wrong, because it goes against the very essence of this place, which is 338 common people representing common people. This place exists for us to deliberate the issues that matter most in our country and to speak up on behalf of Canadians. Unfortunately, what we have before us is a bill that represents the Liberal agenda rather than the voices of the Canadian people. This is wrong.

With legislation of this magnitude, I would urge the members of the House to slow the process down, to consult extensively and for us to come back to the table.

I cannot think of another responsibility we carry as legislators that is more crucial, more obligatory than our duty to protect the most vulnerable in Canadian society. Therefore, we have to take every effort to alleviate any possibility for abuse or misuse based on what is in this bill or based on what is left out of the legislation.

My Conservative colleagues have raised many concerns and have given multiple examples where extreme liberties have been taken with physician-assisted suicide where there are looser restrictions in place. I do not wish to rehash all those examples here today, but I certainly will draw the House's attention to a few.

Sadly, members across the floor have disregarded many of those examples provided by my Conservative colleagues. They have suggested that the differing jurisdictions and rules should deem these cases irrelevant in this place.

We have the opportunity and even the duty to learn from other countries and the way they have legislated, to learn from cases within our own country and to make changes that are necessary to properly protect Canadians.

It is undeniable that as one's medical condition progresses, the individual inevitably become more vulnerable. It is our responsibility to stand up for the vulnerable.

Individuals could lose their ability to speak, to move autonomously or they could lack the coherent and cognitive ability to be able to interact correctly. When an individual reaches this state, this is precisely when the safeguards around MAID, medical assistance in dying, should be strong enough to keep them safe rather than weak enough to make them vulnerable.

The proposed change in the bill would allow for advanced directive, which takes away the need for the patient to consent immediately before having medical assistance in dying administered. This proposed change is alarming and dangerous as well to the Canadian public.

When we are faced with difficult physical ailments, they often fluctuate in intensity and as they do, our decision-making ability shifts. Think for example about people who are suffering from terminal cancer. They have been advised by medical professionals that their quality of life is likely to deteriorate to a certain degree by a specific date. Let us say that does not happen. Those cancer patients who want to avoid unnecessary pain have already given the date on which their lives will be terminated.

Changes take place. What if the diagnosis the doctor gave was not right? What if those patients have actually faired much better? Health care professionals could in fact euthanize these individuals at any point without needing to obtain consent immediately before death is administered.

This should concern all of us because of the vulnerability that is in place here. There should be a requirement for contemporaneous consent. We cannot allow one's former self to dictate the will of his or her present self. Minds change, circumstances change, so final consent is an absolute necessity.

This example has been raised in the House at least once before, but it is worth raising again because it is close to home.

Taylor Hyatt is a staffer on the Hill. I had the opportunity to interact with her personally. She has a linguistics degree from Carleton University. She lives on her own and she loves her life. Taylor has cerebral palsy and is restricted to a wheelchair. She lives an incredible life and contributes to Canadian society in a multitude of ways.

Two years ago Taylor went to the hospital because she was feeling quite ill. The doctors did some tests and they said that whatever it was it really was affecting her breathing, and if it came to it, should they administer oxygen.

Taylor was quite surprised at the question. Of course she would want oxygen, that seems like a very basic thing. It is not like it was life support or something that people often take, those decisions of that magnitude, quite seriously. It was the simple administration of oxygen. A few seconds later, the doctor asked "Are you sure?", and he said it in such a way that he was actually applying pressure on her to reconsider her decision, as if to say that her life lacked the value that she felt it had.

That is atrocious. If we are sending that message to the most vulnerable in our society, then what have we become?

I would like to also address one other thing, and that is the need for palliative care. If we are going to talk about administering death to Canadians, then why are we not having a conversation around long-term care? If we are going to talk about the dignity of a human life, then what about those who want to live a dignified life right up until their last breath?

Why is the government not moving forward with the plan it promised to put in place with regard to palliative care? Why is it not spending the money that needs to be spent on preserving the dignity of those who wish to choose this type of death? These are essential questions with which the House must wrestle.

I would caution those within this place to take a step back, because we want our country to be one that supports all people.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Madam Speaker, the present bill goes significantly beyond the immediate task of addressing the Quebec Superior Court's decision. A scheduled broader review of the bill was built in to Bill C-14. The five-year period was deliberate. At that time, the government thought that to be an appropriate length of time to study the implementation of Bill C-14.

Why not just deal with the business of the problematic “foreseeability of death”, the words from Bill C-14, which I had problematic from the start? Why take this time to add the other portions rather than as part of the review that would have otherwise taken place next year?

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, as parliamentarians it is incumbent upon us to draft responsible legislation that protects the sanctity of life, protects those contemplating suicide and protects vulnerable peoples. These are principles that were outlined in the preamble to Bill C-14, the landmark legislation that governs assisted dying in this country. These are principles that, although largely restated in Bill C-7, are being watered down and undermined by this legislation.

As recently as the early 1990s, in the landmark Rodriguez case, the court ruled that there was no constitutional right to assisted dying in this country. The Carter decision overruled that previous decision, and now Parliament has the difficult task of balancing the autonomy of Canadians with our responsibility to create safeguards for vulnerable Canadians. It is one of our most sacred responsibilities to protect the lives of our citizens. We need to get laws on assisted dying right.

The adoption of medical assistance in dying after the 2015 election is an event I am very familiar with. I had the honour of serving under the member for St. Albert—Edmonton as he took the lead as the Conservative vice-chair of the Special Joint Committee on Physician-Assisted Dying. During this time, I was involved in all aspects of the committee that was making recommendations on a new law. I heard from all the witnesses, and I listened to all deliberations regarding what direction our country should take.

That committee recommended a radical departure with very few safeguards. These recommendations did not reflect the testimony of experts, but instead the political agenda of special interests.

The Conservative minority report provided at the joint committee was entrenched firmly in the principles of the Supreme Court's decision in Carter, and included recommendations that were laid out by key witnesses, such as the former president of the Canadian Psychiatric Association, Dr. Karandeep Sonu Gaind. It outlined key principles for us on the issue of physician-assisted dying.

These included not accepting the provision that assistance in dying be provided to those under the age of 18, in line with the Carter decision, which stated that only competent adults should be allowed access to assisted dying. We also did not accept the extension of medical assistance in dying for those suffering exclusively from mental illnesses. We did not believe that any mental illness is irremediable, as the Canadian Psychiatric Association stated.

We also did not believe in the validity of advance directives to allow Canadians to consent to an assisted death far in advance of its administration. This change would stand opposed to the express will of the Supreme Court of Canada, which ruled that consent must be contemporaneous with the time of death.

We also recognized the lessons of the Quebec experience, as the first jurisdiction in this country to legalize euthanasia. In its regime, medical assistance in dying could only be rendered on adults with a severe, incurable physical illness, characterized by an advanced state of irreversible decline.

I believe many Canadians can sympathize with this limited exception for assistance in dying; however, even these safeguards have proved to be short-lived. Barely five years later, the courts and the government have decided that these safeguards are far too restrictive.

How did we get here today? Barely had the ink dried on Bill C-14 before proponents of expanded assisted dying launched their campaign to eliminate necessary safeguards.

As a Conservative who strongly believes in the sanctity of human life, Bill C-14 was a difficult pill to swallow. However, it was one that I believed upheld many of the values that I hold and the values that many of my constituents hold.

The previous legislation recognized that we must tread carefully with this new reality of assisted dying. It introduced safeguards that limited mature minors, those with exclusively mental illnesses and those whose deaths were not reasonably foreseeable.

I believe this is where the majority of Canadians are, and I believe the government largely got the balance right under Bill C-14. Unfortunately, there are a radical, vocal few who want to undermine even these protections and push this country headlong into a permissive regime for assisted dying, a regime that, as we know from international experience, has resulted in the deaths of vulnerable people.

If we continue to go down this road and liberalize all safeguards, we will continue to see mistakes and deliberate actions that end the lives of vulnerable people. This new legislation outlined in Bill C-7, although not taking these large, radical steps that I outlined, is opening the door to a wider radical departure from principles like the protection of the vulnerable and the sanctity of human life.

I am particularly concerned about the inclusion of the term and policy of advance consent.

The Supreme Court of Canada was very clear, crystal clear, that an assisted death should only be administered with the consent of a person at the time of death. We know that there are some cases where people fear losing their capacity to end their lives. However, we cannot allow the precedent of advance consent to gain legitimacy in our system. Advance consent in this legislation I believe is a Trojan horse designed to build the legal case to accept the adoption of advance directives.

Advance directives are a concept by which people can direct the actions of medical professionals after they have ceased to have the capacity to consent to an assisted death. Many Canadians are familiar with DNRs: do-not-resuscitate orders. DNRs are a completely ethical and morally acceptable practice, whereby a patient can designate that no action should be taken to attempt resuscitation. By respecting the will of the patient and not acting, medical professionals are allowing the patient to die a natural death. Medical professionals can also hasten the natural death of their patient through pain remediation. I believe this is also an acceptable practice.

I support do-not-resuscitate orders, and I think many Canadians are being deliberately misled into believing that an advance directive is the moral and ethical equivalent of a DNR. It is not. An advance directive does not ask medical professionals to withhold action allowing a natural death. It requires medical professionals to take direct action to immediately end the life of the patient.

This is a leap in practice that goes far beyond what I believe is ethical. It undermines one of the greatest medical principles: first, do no harm. I can imagine, in a not-so-distant future, someone with dementia or Alzheimer's who had previously written an advance directive, believing that life would be not worth living with this disease. Imagine in the future that we had the medical expertise and the breakthrough pharmaceuticals that could make life better for those suffering. How can someone consent to have life end without contemporaneous consent at the time of death, when they cannot know what their quality of life will be?

It introduces a high level of subjectivity to the question about what kind of life is a life worth living. This is a dangerous question that will lead us down a lethal road, a road that I do not think anyone wants to go down today. I believe it is unethical and dangerous to allow someone's life to be ended by an advance directive or consent, even with the meagre protections offered in Bill C-7, which includes a provision that no resistance be shown. There is still a threat of abuse. If people are unable to understand and consent to death, how are they supposed to know to resist when someone comes to administer their death?

Parliament is being rushed into liberalizing a practice that is not even half a decade old. Its members lack the experience, the data and the moral understanding to press forward with such a life-and-death issue. I am disappointed that the government abdicated its responsibility to stand up for vulnerable people when it chose not even to appeal the Quebec court's decision to the Supreme Court of Canada. What better court to clarify what safeguards are acceptable than the very court that originally dealt with these significant matters?

Instead, the government has given Parliament little time to contemplate such an important issue. Canadians are still catching up to the reality of assisted dying being legal in this country, and now we are foolishly pressing forward before we can fully understand the impacts of this legalization.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, I rise today to address Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

Assisted dying is the leading moral and ethical issue of our time. Previously respected traditions supporting the sanctity of all human life until natural death have been tossed aside, most recently with the Supreme Court's decision in the landmark Carter case.

As parliamentarians, it is incumbent upon us to draft responsible legislation that protects the sanctity of life, protects those contemplating suicide and protects vulnerable peoples. These are principles outlined in the preamble to Bill C-14, the landmark legislation that governs assisted dying in this country. These are principles, although restated largely in Bill C-7, that are being watered down and undermined by this legislation.

As recently as the early 1990s, the Supreme Court ruled in the Rodriguez case that there was no constitutional right to assisted dying in this country. The Carter decision overruled that previous decision, and now Parliament has been tasked to take on the difficult task of balancing the autonomy of Canadians with protecting vulnerable people.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, I did support Bill C-14 and voted for it in the last Parliament. I thought that it did strike the right balance and that it had a very limited application. However, I was troubled at the time about the reasonable foreseeability words, which I thought would likely be litigated, and indeed they were.

I would ask the member this: Why not now simply deal with the narrow issue of the court only? There was a reason, at the time, to have a full five-year period before revisiting a significant expansion. The reason was to collect a broad volume of data to examine how Bill C-14 would be implemented. Why the expansion beyond the narrow issue of the court decision?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, it gives me great pleasure to once again rise in this House and speak to Bill C-7, an act to amend the Criminal Code (medical assistance in dying). This bill proposes amendments to the Criminal Code provisions on medical assistance in dying, or MAID, in response to the Superior Court of Quebec Truchon decision, which struck down the eligibility criterion that natural death be reasonably foreseeable.

I would like to highlight five major components that stood out for me.

First, it repeals the condition that a person's natural death be reasonably foreseeable, with the exception of patients whose sole underlying condition is mental health issues.

Second, it introduces new safeguards in addition to existing ones for patients whose natural death is not reasonably foreseeable.

Third, it permits the waiver of the requirement for final consent, allowing patients to provide consent to health care practitioners in advance, in the event that their death is naturally foreseeable and they are at risk of losing capacity to consent.

Fourth, it permits the waiver of the requirement for final consent if a patient chooses MAID by self-administration, in case complications arise following self-administration, such as a loss of capacity.

Fifth, it modifies the MAID monitoring regime to require that health care providers and pharmacy technicians provide regulated information when assessing a patient's eligibility or when dispensing a substance for MAID.

Over the last two days, many of my colleagues from both sides of this House intervened on a fair number of details. It gives me great pleasure to see that there is broad agreement that this legislation, with these amendments, gets voted in and move to the committee for further study.

I rose in this House during the 42nd Parliament back in 2016, and shared my experience, which dealt with the tragic loss of my father as a result of stage 4 cancer back in 2014. Such assistance was not available to us and we saw the loss of dignity. We saw the loss of the person I called “my hero” losing the capacity to be able to function and lead our family, as well as the fact that his desire would have been met, had we had this type of assistance available.

Also, as the chair of the all-party mental health caucus, I have been advocating, and our caucus has been advocating, for the consideration of mental health and the exclusion of that. I am pleased to see that that remains.

As I was listening attentively to the interventions over the last two days, at times there were questions raised about why it took so long. Considering that, and considering that we are almost halfway through this debate, I decided to focus my intervention mainly on the journey that our government has gone through over the last four years. The key concepts within that journey are the challenges that we are faced with; the stakeholders that we engaged with; the consultations during the studies; and the implementation, successes and challenges we have had.

Having said that, since the introduction of the legislation for medical assistance in dying in 2016, we have witnessed a steady increase in the number of Canadians and health care providers who have adopted this new regime. We have seen a relatively smooth integration of MAID assessments and delivery in end-of-life care service available across the country.

The enactment of this historic legislation was just the beginning of our efforts. Our government has since been very active in supporting the implementation of MAID across Canada. The 2016 legislation included clear directives for action, including the need for government to initiate independent reviews on three complex issues not addressed in the bill back in 2016. Some of my colleagues before me touched on those complex issues.

Rather than proceed too hastily, Parliament felt that it required more study and a review of available evidence. The government tasked the Council of Canadian Academies with undertaking these studies and that is where the journey started.

The resulting report tabled in Parliament in 2018 reflected an extensive review of academic and policy research, stakeholder submissions and international expertise in all three areas. It documented a range of perspectives from health care professionals, academic disciplines, advocacy groups and indigenous leaders; hence, the stakeholders that we have engaged with. We expect dialogue on these issues to continue during the parliamentary review and, as I have indicated, I hope that everyone in the House votes for this so that we can move it to committee and continue this dialogue.

Taking into account our federal system and division of responsibility for health care and criminal law, the federal government developed the monitoring and reporting regime to collect valuable information about requests for and the provision of MAID. In all other jurisdictions permitting assisted dying, there is an oversight and monitoring mechanism in place. The roles and responsibilities of these monitoring regimes vary.

In the wake of this monumental shift toward legalized assisted dying, Canadians wanted to know what kind of uptake there would be. Some were keen to know how accessible MAID would be across this vast country. Others want to know how safeguards would be applied and if there were protections in place for the vulnerable. Our government worked quickly with the provinces and territories to establish an interim reporting system, collecting and reporting on the best data available.

I want to acknowledge our provincial and territorial partners that had the challenging task of arranging safe access to MAID services from scratch, in a short period of time and in collaboration with multiple partners, such as health care providers, professional associations and health care delivery institutions. This tremendous task involved setting standards of practice for physicians, nurse practitioners and pharmacists to support the consistent and safe delivery of MAID within a legally sound framework. It also helped minimize the disparity to access in rural and urban areas.

Our government produced four interim reports using data voluntarily transferred by providers and various jurisdictions from 2016 until the creation of the permanent regime in late 2018. These reports covered a six-month period and provided information on the number of MAID deaths, patient demographic information, underlying medical conditions and predicted MAID requests.

In reviewing these reports, we know that the awareness of MAID as a legal option is growing. There appears to be a growing comfort among health care providers. In the interim period, our government worked to establish a permanent national monitoring and reporting system as considered in Bill C-14.

Through stakeholder consultation and collaboration with provinces and territories, the government enacted federal monitoring regulations in late 2018. These regulations set out the reporting requirements for all physicians, nurse practitioners and pharmacists who participate in MAID. We were mindful of balancing the need for information while limiting the reporting burden on health care providers and avoiding duplication of effort. This system has been operating for just over a year. Late this spring, our government plans to release the first annual report using data from this new monitoring system.

Budget 2017 announced $11 billion over 10 years to support home and community care services, including palliative care, mental health and addiction services; $6 billion was specifically allocated to those services I talked about. In 2019, our government worked with all the provinces and territories to develop the framework for palliative care in Canada, which I consider a cornerstone of this bill.

Over the last three and half years that MAID has been available, our government has worked to support a smooth integration into the health care system based on the foundation I have just laid out. On the evidence that we have gathered, we have put together a bill that represents the Truchon decision and addresses other issues where there is clear consensus and a reasonable path forward. It is my hope that, after due consideration and debate, we move this bill to committee.

I will close by saying that I support this bill and I thank all members for intervening on this topic.

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

Mr. Speaker, I am here today to talk to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

It is very interesting for me to be here in a new Parliament discussing something we spoke about in the last Parliament. I was a fairly new member when Bill C-14 was before the House. I had a lot of constituents calling my office, sending letters and emailing us on this very important issue. I spent a lot of hours responding to people, talking to them on the phone and hearing their stories. What I really respected was the thoughtfulness. There were concerns of course, which is legitimate, but there was a lot of hope for some people as well.

Here we are back at it again. It reminds me of a dear friend and loved one who used MAID in his journey. His name was Joey. When I think of the core issue and value we are discussing today, which for me is unnecessary suffering, I cannot help but think of Joey.

Joey had an illness that was slowly killing him. In fact, it was so painful for him that he made this decision. He rearranged his time of death so I could be there with him, which was a huge honour for me. I was so grateful for that.

I think about the process we went through together that day. It was a beautiful process, but it was also a hard process. Part of the reason why it was so hard was he could not take any of his pain medication that day. He had to be totally able to answer that question. After a lot of thoughtful discussion, he had to stay in pain all day. We spent the day with him, but it was hard to see him suffering.

When we look at the bill before us today, that is what I hope all Canadians and all parliamentarians remember. We are here ensure nobody goes through unnecessary suffering like that.

One of the things that really struck me about the day when Joey passed was his doctor came to be part of the process. His doctor had made a decision that he did not want to be in a role to administer MAID, but he came. There were a lot of tears and remembrance of the long-term relationship. We also have to talk about the length of time some of our doctors have known us. Some have known us for years in some cases, and in Joey's case that was the reality. Another doctor was there for the process, but Joey's doctor was with him. His loved ones were around him. It was a peaceful process when he left us.

Today we are here to do this important work. I hope this goes to committee. I have had discussions with doctors in my riding who administer this process and they have a lot of good things to say about the bill, as well as some concerns they would like addressed, and I hope that will happen.

As this process started, a lot of people started writing my office again. We did some outreach. We wanted to let people know that this would be coming up. We wanted them to know that there was a process for them to connect with us and give their feedback to the government on this issue. A lot of my constituents participated in the process online. Not only did they participate, they were very thoughtful to ensure that the information they submitted was also given to my office. In front of me, I have a small portion of the comments from the people who sent us information and shared their stories.

I want to be clear about something, and we have to remember this as we go through the legislation. I represent a rural and remote community. The doctors who provide this service sometimes spend the whole day travelling to the community to provide this very important service.

There are some specific barriers and we want to ensure that in all our legislation we do not let those people in rural and remote communities down.

There are three of these doctors in my region. The riding I represent is just under 60,000 square kilometres, it has several ferries and many small islands. The doctors in that area provide the total service for that area plus a portion of my neighbour's riding. They deliver the service to a huge number of people over a vast distance.

Message after message thanked those doctors. In fact, Dr. Daws, a doctor in my riding, was mentioned repeatedly for being compassionate and for helping people go through this process in a very respectful way. People wrote me before they were going to participate in MAID. They just wanted tell me that this doctor had been very helpful.

I want to recognize the amazing health care providers in our country who provide this service, who do it in a sensitive and beautiful way. They are with people at one of the most precious moments.

I want to talk about Margaret who told us about her nephew. Her nephew had participated in MAID and that this was his decision. The biggest issue for her was the lack of the advance consent clause. He was given a choice of either going through this process two months earlier or not at all. Due to the medication he would have to take for his illness, it would automatically disqualify him from having the capacity to provide the consent.

This is the biggest issue for me, because people were having to leave sooner than they wanted to because they were afraid they would lose the capacity to give their consent.

I think of Megan who wrote about the experience her family went through. They were present for a friend's death. She said:

I fully support the idea of giving prior consent for MAID in case one is unable to give that consent immediately prior to the procedure, or in case one is in considerable pain and discomfort and would go through the process more calmly with adequate pain control at the end.

This really resonated with my experience with Joey, watching him suffer physically, and waiting for the relief. It was really hard. This is so important as we go through this process.

I think about Dolores, who sent me a beautiful message about ensuring the process was clear for people, wanting to have the accessibility to this be very clear and easy, and in an information package. Her biggest concern was that her family physician did not believe in this process and would not give her the information she needed to make the decision. She said that it would be good to have an information package that was a little more effective, so when a doctor was struggling with that personal choice, it would not impact the patient.

As a parliamentarian, these are the moments when I really respect the role I have on a whole new level, when people are telling me about the precious experiences they have had in their lives.

Another family talked about its father-in-law who spent seven years with dementia and was very well cared for, but in his last year, he rapidly deteriorated. His dignity plummeted. A loving son said that he was convinced that if he could have projected how his final years of deterioration would happen, he would have chosen MAID as an option, if it was available to him.

Then there is Milt whose wife is in a care home. Because of her Alzheimer's, she will not be able to express herself. He is so concerned that she will suffer way too long and he does not want to see that.

Another family talked about a friend who had cancer of the brain. Then she had a stroke. After her stroke, she was concerned that if she had a second stroke, she would be unable to state her wishes. Because of that, she participated in MAID sooner than she would have wanted.

This is a precious decision people make. It is a decision they make with their loved ones and their health professionals. I will be supporting the bill because I do not believe in people suffering unnecessarily. There are some challenges in the bill that I hope are clarified, especially looking at the realities for rural and remote communities. However, when people tell these personal stories, we hear again and again that they do not want to see people suffer, that they do not want to see people lose their dignity and that they want to ensure their wishes are honoured.

I am happy to be here to talk to the bill. I want to thank all of my constituents who have reached out to me. I always appreciate these beautiful stories that people share and some of the hard ones.

[Kamal Khera, Liberal, Parliamentary Secretary to the Minister of International Development]

Mr. Speaker, it is an honour to rise in this House to speak today about Bill C-7. This bill would amend the medical assistance in dying regime in the Criminal Code to address the Superior Court of Quebec's decision in the Truchon case. As members know, in September 2019, the Quebec Superior Court struck down the eligibility criterion of “reasonably foreseeable natural death” from the medical assistance in dying, or MAID, regime in the Criminal Code. Our government has made significant efforts to consult and engage with Canadians in order to inform the proposed approach to address this decision and amend the MAID regime in Canada.

An online consultation was launched, and over 300,000 responses were received from Canadians. In addition, the Minister of Justice and Attorney General of Canada, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion had the opportunity, along with their parliamentary secretaries, to meet with stakeholders and experts across the country during a series of round tables all over Canada. These consultations were an extremely important part of the development of Bill C-7.

Medical assistance in dying is a sensitive and challenging social issue that we are currently faced with, one that is deeply personal for very many people and for me personally. I worked as an oncology nurse at St. Joseph's hospital in Toronto and have seen end-of-life care first-hand. I have seen individuals making difficult end-of-life decisions for themselves or their loved ones, and I appreciate our government's decision to consult and listen carefully to Canadians on this issue.

In addition to being deeply personal, the issue of medical assistance in dying is also legally and ethically complex, which is why it was so important for our government to meet with experts, stakeholders and practitioners during the round tables. Our government listened. It listened to the health care experts, doctors, nurses, legal scholars and regulators, but most importantly, it listened to Canadians. The bill takes into account what was learned during these consultations and responds to the Truchon ruling by proposing amendments to the Criminal Code that would ensure consistency of the MAID law across the country by broadening eligibility, and adjusting the safeguards accordingly, for a MAID regime that is no longer limited to end-of-life circumstances.

Bill C-7 proposes to amend the Criminal Code in response to the Truchon ruling in three ways.

The first is by expanding eligibility to those whose natural death is not reasonably foreseeable but who are still experiencing intolerable suffering. This will give those who are suffering in a wider range of situations the choice of a medically assisted death.

At the same time, the amendments would exclude those suffering from only a mental illness. This is in response to very specific concerns voiced by experts and mental health professionals about eligibility on the basis of a mental illness. Many members will also recall that during the study of former Bill C-14, the government asked the Council of Canadian Academies to look into such cases. The experts in this field could not come to a consensus on this very complicated issue in their report on the subject, which was released and tabled in this chamber in December 2018.

Our government recognizes that the unique considerations for the availability of MAID for individuals experiencing suffering only from mental illness requires further discussion and public debate. I believe the parliamentary review that will begin in June 2020 is the appropriate forum for the further consultation and deliberation that are needed before considering any changes in this regard.

The second main feature of this bill is the creation of two sets of safeguards to be followed before medical assistance in dying is provided, depending on whether a person's natural death is reasonably foreseeable or not.

The bill would continue to use the expression “reasonably foreseeable natural death” as the element that determines which safeguards to use. This approach for a MAID request is consistent with the view that medical assistance in dying for people whose natural death is not reasonably foreseeable presents more complexity. Many experts believe that the assessment of a request should be tailored to these different types of cases.

New safeguards for those whose natural death is not reasonably foreseeable will focus on ensuring that assessments take adequate time and involve the relevant expertise to detect and address the sources of the person's suffering. They will also ensure that people receive information about the appropriate and available services and options to improve their quality of life. They will need to give serious consideration to those options before concluding that medical assistance in dying is the choice for them.

Finally, the bill would relax some of the existing safeguards, in particular for those whose natural death is reasonably foreseeable. Those whose deaths are reasonably foreseeable will not need to undergo the 10-day reflection period. These individuals have already given a lot of thought to their request before they made it, and requiring them to wait another 10 days after they have been approved for medical assistance in dying may prolong their suffering unnecessarily.

Just as importantly, the bill proposes to permit the requirement of final consent to be waived in the case of people whose natural death is reasonably foreseeable when certain conditions are met. These conditions are that the patient's death must be reasonably foreseeable; they must have been assessed and approved for medical assistance in dying in accordance with all safeguards; they are at risk of losing decision-making capacity before their preferred date to receive medical assistance in dying; and they have a written arrangement with their practitioner, in which they have given consent in advance to medical assistance in dying being administered if they lose capacity, and in which the practitioner agrees to provide medical assistance in dying on their preferred date, or earlier, if they can no longer provide the final consent.

These proposed amendments would also clarify that practitioners would not be allowed, in this situation, to provide medical assistance in dying if the patient demonstrates refusal or resistance by words, sounds or gestures.

For individuals whose natural death is not reasonably foreseeable, the remaining criteria defining the grievous and irremediable medical condition in the Criminal code would expand eligibility to medical assistance in dying to people with a wide range of conditions. A grievous and irremediable medical condition is defined in the code as a serious and incurable illness, disease or disability; an advanced state of irreversible decline in capacity; or intolerable suffering that cannot be alleviated under conditions that the person considers acceptable.

This means that a grievous and irremediable medical condition could include conditions producing chronic pain or other symptoms. Canada's medical assistance in dying regime would move away from being an end-of-life regime to becoming a regime in which MAID could be chosen to relieve unbearable suffering that occurs outside of the dying process.

To conclude, the bill before us today proposes the amendments required by the Truchon decision. It also reflects what we heard in 300,000 responses to the online consultation. This is what we heard from stakeholders when the ministers and parliamentary secretaries held consultations from coast to coast to coast. It takes into account the opinions and input of health care professionals, doctors, nurses, legal scholars, provincial regulators, civil society, non-governmental advocacy organizations and those with lived experiences. The bill strives to achieve a balance between respecting personal autonomy and protecting vulnerable individuals. Perhaps most importantly, it respects the equality rights of all Canadians.

For those reasons, I call on the members of the House to support this bill, send it to committee where it can be looked at even more thoroughly and make this a reality in Canada.

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

Mr. Speaker, given the preamble in the old Bill C-14 expressly references conscience protections, given that section 241.2(9) of the Criminal Code, which was amended by his party at his party's suggestion in the last Parliament, also has conscience protections, given that paragraph 132 of the Carter decision references conscience protections and given that the section 2 protection in the charter is a bedrock foundational conscience protection, does the member, first, think that is sufficient with respect to conscience protections?

Second, is there any instance of an institution, of religious persuasion or otherwise, being forced to provide this, given those protections? I am aware of none.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, I will be sharing my time today with my colleague, the member for Saskatoon West.

As a new member of the justice committee, I look forward to the issues that we will be dealing with in this new Parliament. While I am not a lawyer, nor do I have any desire to become one, I hope my contributions and insight on the issues of the day will help in rebuilding trust in our judicial system.

I am fully aware that many Canadians have serious concerns. Many are looking for solutions that will keep our communities safe, and they want us to begin the process of rebuilding the public's confidence in our justice system.

The legislation we are dealing with today is about one of those issues that almost every Canadian has heard of and will be, undoubtedly, following in the news. As a member of the Conservative caucus, I can debate this legislation and vote on it as I see fit. It is my intent to improve this legislation and to do the best I can in representing the good people of Brandon—Souris.

Like many Canadians, I find discussing the implications of medical assistance in dying challenging. There is no sugar-coating the fact that, for many people, it is extremely difficult to openly discuss the issue of death. As a result of to the Carter decision, it was left up to Parliament in 2016 to determine the appropriate legislative response in order to be compliant with section 7 of the charter. It must also be said that the Carter decision was specifically limited to a competent adult who gave her consent in receiving medical assistance in dying.

When we were seized with dealing with the legislation, many members of Parliament felt the government's response did not go far enough. One of the Liberal MPs who voted against the legislation was none other than the Minister of Justice. Some members were quite concerned about the lack of clarity, such as in the term “reasonably foreseeable”, which was left undefined. Other members wanted Parliament to supersede the Carter decision.

Disagreement is not new in this place. It is to be expected in Parliament, with members from all political stripes and backgrounds. I would argue that our democracy is much better served having such divergent views as to guarantee that every position is fleshed out.

When we debated Bill C-14, our Conservative caucus studied the legislation with the rigour that Canadians demanded of us. We asked the tough questions, we put forward amendments and we did what we were sent here to do, which was to ensure the concerns of our constituents were put front and centre. It is my sincere hope that we once again invest the necessary time on this and be as inclusive as we can so that all Canadians have their say on Bill C-7.

It goes without saying that there are deep divisions on the overall issue of medical assistance in dying. I know every member of Parliament is hearing from constituents on this issue, and in the past couple of weeks numerous petitions have been sent to all members' offices. I would also note that in the election, I received inquiries on the future of the legislation and on whether Parliament would be reviewing it anytime soon.

One of the elements in the original legislation was to have an automatic review, which will be undertaken this summer. It is notable that the legislation now before us has pre-empted the automatic review on a few matters. This upcoming review will be far more comprehensive than the two-week online survey used for Bill C-7.

From what many were expecting, the legislation that was set to be introduced was to respond to the Superior Court of Quebec's ruling. We now know that this is not the case. In fact, yesterday during debate, the parliamentary secretary of justice acknowledged that the Liberals did go above and beyond, because that is what he thinks Canadians want. While that may be his opinion, it is concerning that the larger changes found within Bill C-7 could have been dealt with in the larger review this summer.

What we are debating today has numerous changes that go much further than deleting and replacing the phrase “reasonably foreseeable” in order to be compliant with the recent court decision. For example, the government is easing safeguards, which I might add is the actual language found within the presentation with which departmental officials briefed MPs.

As it stands, patients must make a written request for MAID that is witnessed by two independent witnesses. In Bill C-7, this has been changed to one independent witness. I believe it is incumbent on the government to justify this change and to outline the rationale for why it needed to be amended. The government is also removing the mandatory 10-day period after the written request is signed. Once again, this is a significant change that goes above and beyond what was required for the law to be in compliance with the Quebec Superior Court decision.

It is my intent to invite as many experts, health care professionals and provincial governments to committee to ask them about the proposed changes and to determine if they are in fact needed. We must be cognizant that MAID still has the necessary safeguards in place to protect the vulnerable.

I want to put on the record that many of the issues we raised in the last Parliament, such as enshrining conscience legislation in law for medical practitioners, has fallen on deaf ears. This was an almost universal position among my Conservative colleagues, and the Liberal government of the day did not adopt those measures.

We were also quite adamant about improving access to palliative care. Even though the delivery of health care falls under the purview of provincial governments, we passed a private members' bill to implement an action plan. My colleague from Sarnia—Lambton, who worked hard to get this legislation passed, is very disappointed that the government's five-year action plan failed to commit enough resources or outline a clear set of measurable outcomes. In a rural riding like mine, there are not enough palliative care services available. My heart goes out to those families who must send loved ones to a different community in the final days of their lives.

As a champion of rural Canada, I know first-hand the unique challenges that millions of people face every day due to their isolation or remoteness. I want to give the benefit of the doubt to the government that it is committed to rural Canadians, but its record says something completely different. While these issues cannot be fixed in this legislation, we cannot treat them in isolation while discussing MAID.

In closing, I want the government to know I am committed to working with it constructively on this legislation. I will ensure that the concerns of my constituents are heard. We know there is nothing more precious than the gift of life: to live freely, to live safely and to live healthy and happily. It is our collective responsibility to do what we can to improve the quality of life of all Canadians.

I look forward to what my colleagues have to say on this legislation, and if it is sent to our justice committee, we will do our due diligence to listen to witnesses and improve it where possible.

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

Mr. Speaker, it is really interesting that this member actually makes very explicit the slippery slope that so many people are concerned about, because when C-14 first came out, the ministers at the time defended it as representing a finely tuned balance between access and safeguards.

Now, we have legislation that removes safeguards and this member talks about the possibility of new legislation very soon after the statutory review in June that would remove further safeguards. We have seen dramatic increases in the rate of people accessing euthanasia in each of the last four years.

I wonder if people should be reasonably skeptical when the government talks about the balance that it is trying to establish, when every single time this comes up, they want to remove more and more of the safeguards.

I will pick on one safeguard, the idea that there could be a 10-day waiting period, one that can be waived in certain circumstances, but by and large is in place. That seems to be eminently reasonable. There is also the idea that there should be two witnesses who observe the consent. These basic safeguards, the 10-day waiting period that could be waived and two witnesses, are very reasonable things that the government wants to do away with.

It makes me wonder, in the next iteration of this legislation, what safeguards at that point will the government remove. How many safeguards do they intend to take away? What is wrong with having some checks and balances in place protecting vulnerable people?

[William Amos, Liberal, Parliamentary Secretary to Minister of Innovation]

Madam Speaker, I am pleased to rise on the topic of Bill C-7, as we embark on what I expect will be quite a lively and passionate discussion about issues that Canadians care deeply about and certainly my Pontiac constituents. I heard from them for several years on this topic, regular correspondence, regular discussions at the door, so I appreciate this opportunity to discuss certain aspects of our government's proposed changes to the federal MAID legislation.

It is timely to share some of the insights from three important studies on very complex and sensitive issues that were not included in the 2016 federal legislation. These are requests by people for whom mental illness is their sole underlying medical condition, advance requests and requests by mature minors. I hope we will get to all three of them, but may only get to the first two.

When Bill C-14 was debated in 2016, parliamentarians had difficulty finding common ground on how to address these types of requests within Canada's first assisted dying regime. Understandably, given the challenging nature of these issues and the limited time that was available, due to the Supreme Court's timeline, to deliver on acceptable approaches for Canada, parliamentarians collectively decided that more in-depth study and review of the evidence was needed.

The legislation in 2016 therefore included requirements for the government to undertake independent reviews. There were strict timelines set out in Bill C-14 and the studies that needed to be commissioned had to be done within six months of the coming into force of Canada's new legislation on assisted dying and the government was obliged to table the final reports on the studies within a further two years. Both of these timelines were met.

In December 2016, the government asked the Council of Canadian Academies, CCA, an independent organization that undertakes evidence-based expert study, to inform our public policy development and to take on these studies that were required by legislation. The resulting reports were tabled in December 2018, documenting extensive review of academic and policy research, stakeholder submissions and international experience in the three subject areas.

They also included a broad range of perspectives from relevant health care professions, diverse academic disciplines, advocacy groups, indigenous elders, essentially the whole of Canadian perspective was brought to bear. In accordance with the CCA practice, they did not in fact contain recommendations.

Two of the reports, one on request by individuals where mental illness is the sole underlying condition and the report on advance requests have been particularly informative during the development of our government's response to the Quebec's Superior Court decision in Truchon.

I will first talk about mental illness. Under the current law, very few persons with mental illness as the primary source of their suffering are likely to be eligible for MAID. This is because most mental illnesses do not cause a person's natural death to be reasonably foreseeable.

Removing the reasonably foreseeable natural death criterion introduces the possibility for persons with mental illness to be deemed eligible for MAID, if they meet the remaining criteria.

During the recent federal round-table consultations held on MAID, we heard many concerns from participants who felt that not enough is known to safely extend eligibility for MAID to people whose suffering is caused by a mental illness alone. They felt that the issue required further examination.

We also know that there is generally very little support for expanding eligibility among mental health care practitioners, such as psychiatrists and psychologists, and by organizations representing people with mental illness. The CCA report on this issue noted a number of challenges associated with the delivery of MAID to persons with a mental illness.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, it is with great humility that I rise in the House today to speak to Bill C-7, an act to amend the Criminal Code with regard to medical assistance in dying.

Many MPs have very personal stories about the end of life of one of their loved ones. As the Bloc Québécois critic for seniors, it goes without saying that I have heard my share. Therefore, in my speech, I will recall the work done by the Bloc on this issue, the sensitivity that exists in Quebec regarding medical assistance in dying and, finally, the position of certain groups of seniors and women who have come to meet with me.

First, let me go over the context again. In September 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, both suffering from a serious degenerative disease, stating that one of the eligibility criteria for medical assistance in dying is too restrictive. This criterion, that of “reasonably foreseeable natural death”, is found in the federal government's Act to amend the Criminal Code and to make related amendments to other Acts with regard to medical assistance in dying, and the provincial government's Act respecting end-of-life care.

Justice Christine Baudoin said it well in her ruling when she wrote: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu’s rights to liberty and security, protected by section 7 of the Charter.” Those two individuals had argued that they were being denied medical assistance in dying because their deaths were not imminent.

Let me now remind the House of the Bloc Québécois's position and highlight the outstanding work of the member for Montcalm, to whom I offer my deepest sympathies. I want to thank him for the work he has done on this file because, as he quite rightly pointed out, legislators did not do their job properly with Bill C-14. As a result, issues of a social and political nature are being brought before the courts. We need to make sure that people who have serious, irreversible illnesses are not forced to go to court to access MAID. That would be terrible, and yet that is what will happen if we cannot figure out a way to cover degenerative cognitive diseases.

However, we believe that it is important to be very cautious before making any decisions on questions related to mental health. That is why we are relieved that the bill does not address eligibility for MAID for individuals suffering solely from a mental illness. Indeed, this issue requires further reflection, study and consultation, which will be completed at the Standing Committee on Health as soon as the motion moved by my colleague from Montcalm is adopted.

For the second part of my speech, I would like to talk about Quebec's sentiments on this whole issue. Quebec was the first jurisdiction in Canada to pass legislation on medical assistance in dying. Wanda Morris, a representative of a B.C. group that advocates for the right to die with dignity, pointed out that the committee studying the issue had the unanimous support of all the parties in the National Assembly. This should be a model for the rest of Canada.

Ms. Morris said she felt confident after seeing how it would work in Quebec and seeing that people were pleased to have the option of dying with dignity. The Quebec legislation, which was spearheaded by Véronique Hivon, was the result of years of research and consultation with physicians, patients and the public. It has been reported that 79% of Quebeckers support medical assistance in dying, compared to 68% in the rest of Canada.

In 2015, when the political parties in the National Assembly unanimously applauded the Supreme Court ruling on MAID, Véronique Hivon stated:

Today is truly a great day for people who are ill, for people who are at the end of their lives, for Quebec and for all Quebeckers who participated in...this profoundly democratic debate that the National Assembly had the courage to initiate in 2009....I believe that, collectively, Quebec has really paved the way, and we have done so in the best possible way, in a non-partisan, totally democratic way.

For the third part of my speech, I would like to tell you about a meeting I had with the Association féminine d'éducation et d'action sociale, or AFEAS, in my role as critic for seniors and status of women. During the meeting, the AFEAS shared with me its concerns with MAID. I will quote the AFEAS 2018-19 issue guide:

Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly....As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope....This process cannot be accessed by individuals who are not at the end of life....People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.

Many people are not eligible for MAID because of the federal law governing the practice, which was imposed by a court ruling in February 2015. Four years after Carter, individuals whose quality of life is severely compromised by degenerative diseases are still being forced to ask the courts for permission to end their suffering.

In February 2015, the Supreme Court even struck down two sections of the Criminal Code prohibiting Canadian doctors from administering MAID. In Carter, the highest court in the land stated that a competent adult who clearly consents to the termination of life is eligible for MAID if that person “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”.

According to the AFEAS, the Supreme Court's criteria were very broad. In drafting the MAID eligibility criteria, the Government of Canada included the concept of reasonably foreseeable natural death only for people at the end of life, which excludes a significant number of people who are experiencing intolerable physical and mental suffering.

The entire process is based on the intensity of the suffering as assessed by a doctor and a panel of experts. The sick person's own assessment is not always taken into account. There are no compassionate criteria among the requirements for obtaining MAID. A person may be at the end of their life and be unable to make the request themselves because they cannot communicate. The law applies only to people who are able to give their free and informed consent up until the very end, which could be terribly traumatic and even cruel to those who have been suffering for years.

With regard to advance consent, the AFEAS spoke about the case of Audrey Parker, a woman from Halifax who died with medical assistance on November 1, 2018. She made a video three days before her death. In that three-minute video, she said that she would like nothing more than to make it to Christmas, but that if she became incompetent along the way, she would lose out on her choice of a beautiful, peaceful and, best of all, pain-free death.

The Barreau du Québec believes that the law should be amended to comply with the criteria set out in Carter and thus prevent court challenges from being filed by people who should not have to carry such a burden.

A panel of experts has studied this issue and recommends, under certain conditions, ending the suffering of patients who have previously expressed their wish to receive medical assistance in dying, but who subsequently become incapable of expressing their consent, in particular people with various forms of dementia or cognitive loss such as Alzheimer's disease. This is why AFEAS is asking, with respect to human rights, that the process of medical assistance in dying be based more on the rights of individuals and on respect for their wishes.

With respect to reasonably foreseeable natural death, it requested that the reference to “reasonably foreseeable natural death” be removed from the eligibility criteria. With respect to advance consent, it asked that the person's informed consent be respected and that it be given in advance. Also on the subject of advance consent, it asked that the consent anticipated, stated and recorded by the person be recognized.

In conclusion, today's debate demonstrates the need to act so that people suffering from degenerative and incurable diseases are no longer forced to go before the courts to challenge the terms and conditions surrounding eligibility for medical assistance in dying, and so that we can ensure the best possible continuum of care.

Let's take action so that everyone can die with dignity.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, as the member knows, there was a debate process, and the passage of Bill C-14 ultimately received, I believe, unanimous support from the House. However, there is no doubt that during that dialogue there were some differing opinions. The government at the time genuinely felt that this was the best way to proceed. Some wanted the government to go a little further. It is one of the reasons why we recognized back then that this was the type of issue, given the nature of the legislation, we wanted to come back to. Even if the Superior Court in Quebec had not made the ruling it did back in September of last year, the House would have reviewed the process.

The decision by the Superior Court of Quebec allows us to speed up on this very important issue, and that is why the government has chosen to bring forward the bill. It might change to a certain degree, and we will wait and see what happens once it gets to committee, but even at the conclusion of the bill, we will still have this future study, which is a good thing.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Madam Speaker, I rise today to address a very important piece of legislation. Looking at it, I could not help but reflect on the previous debates that we had and the process in the development of Bill C-14, which led us to the point where we are today.

If members who were not here want to get a good sense of how thorough the debate and discussions were, I recommend they take a look at some of the comments in the standing committees, the many lead-up discussions, different presentations and the pre-study that was conducted.

I enjoyed listening to the debates then, because like the member who just spoke said, we heard a lot of personal stories. When people ask me what I enjoy about being in the chamber, it is the different types of debates that we have. These are the ones, like the debate today, that I learn from. I appreciate the stories that come before the House.

We are all concerned about protecting vulnerable individuals in our society. At the same time, it is important as legislators to have a role to support the eligible person to be able to seek medical assistance in dying. It is a very difficult issue.

A good number of us felt with the passing of Bill C-14 that we had something that would move us forward. Even during the height of that discussion, there was a feeling that in a number of years we should review it and take a look at what has transpired in the previous years. We are quickly getting to that point.

However, last September, a Superior Court in Quebec made a determination. Members of the Conservative Party say maybe we should have appealed that decision. I respect that opinion. I do not necessarily believe that would have been the best direction for the government. The direction we have chosen is to make changes to the legislation now, in the hope that we will better serve Canadians.

Having said that, once we get into the summer months, there is going to be a great deal of discussion because it is mandated. When I think of the Bill C-14 debate, and I will provide some personal thoughts on the issue of palliative care, I would like to see us talk about the issue of mental illness. I am hoping that, when we do that comprehensive review, we incorporate that along with palliative care.

I am sure I am not unique and that all 338 members would concur when we think of health care in Canada, there are a couple of issues at our doors: the issue of mental health care services and palliative care services. I used to be the health care critic 15 years ago in Manitoba. We did not have the same sort of dialogue that we hear in the last number of years on those two critically important issues.

British Columbia many years ago elevated the issue of mental illness and made it a separate ministry. There was a minister of health and a minister of mental health illnesses.

I say that because, more and more, provinces are aware of the issue and the importance of mental illness. The Government of Canada has invested hundreds of millions of dollars over the last number of years, and continues to invest in mental illness and palliative care across the country. We are on a very strong footing when we look at where we are today.

We need to reflect on what brought us here. There were many consultations: literally thousands of people were engaged and many hours of debate and dialogue took place. It could have been in the thousands of hours. I do not know that for a fact, but I am sure that, between the time committees met on second reading of Bill C-14, the amount of consultation with Canadians in all regions of the country and the responses received via all sorts of mediums, hundreds of thousands of Canadians in all regions of our country were able to weigh in on this issue.

If we advance to January of this year, again there were consultations and round tables that took us to the different regions of Canada. There was the survey that has been referenced already today on several occasions. Approximately 300,000 Canadians were engaged in that particular survey at the beginning of the year. I do not know if all of the results have gone public to date, but I trust the individuals who helped formulate the legislation we are debating today did their homework in terms of consultations and incorporating all of the ideas. I know the Department of Justice and the Department of Health are following this debate and listening to what members have to say.

From a personal perspective, based on experiences I have garnered over the years, there are two concerns I want to express. One is with regard to health care services and the other deals with the legislation itself. Let me expand on both points.

If we were to ask Canadians what makes them feel good about being Canadian, we would often hear our health care services. I suspect this is probably number one. I referenced mental illness and palliative care. I have witnessed first-hand the evolution of palliative care.

My grandmother was in the St. Boniface Hospital, and many hospitals in our country have palliative care sections. Many of them panel seniors, in particular, who cannot get the quality care necessary in personal care home facilities or the supports they need in their communities and in their homes, so they end up going into hospitals and are panelled.

Many of them will go into palliative care because there are no designated palliative care units in health care facilities, so they end up in hospitals. My grandmother was one of them. She had terminal cancer, and we watched as the weeks went by. Family members visited and it was very difficult on them.

We had a very special relationship, as we all do with our grandparents. Many of us wondered why she had to be in a hospital. Even though it was kind of sectioned off from the emergency department and other aspects of the hospital, she was still in a hospital. It is a different type of a situation, and not necessarily the most comfortable.

Ultimately, my grandmother passed. Then, a number of years later, I had the personal experience of being there for my father in the days prior to his passing. He had to go from home into a hospital, and we were very fortunate that we were able to get him into the Riverview Health Centre. In that centre, with its large windows and beautiful atmosphere, you get the feeling that the type of care is very different.

I reflect on that. I was there at the moment of my father's passing, and we had discussions a number of days prior when he was in fear of what was going to happen, because he witnessed what had taken place with his mother, my grandma, at the St. Boniface Hospital. He did not have that choice, but we talked about having that choice.

I think, knowing my father, he would have been very happy with the way in which he ultimately passed. I really attribute it to his world-class treatment at that particular facility, and I kind of wish that my grandmother had the same sort of atmosphere. Not to take away from the fantastic work that those health care providers and others did at the St. Boniface Hospital, but it was a totally different atmosphere.

During the Bill C-14 debate, we heard many stories like the one we just heard from the member opposite. They are very touching, they are compelling and they make us ask what we can do here in Ottawa to ensure that we have the best quality of health care services we can possibly provide.

It is one of the reasons I am very passionate on the issue of the national framework. It does not have to be a system where we have one thing in British Columbia and another in Atlantic Canada or in the province of Quebec, or in provinces that do not have the same economic means or the same sort of treasury to provide the type of service that they should. This is where the national government has a role to play.

When I listen to comments inside the House with regard to where we might want to go from here, or very serious concerns about the current legislation, I would suggest that we reflect on what we are going to be able to potentially do in the coming months, when we have the opportunity.

Unlike in the Manitoba legislature, our standing committees can be exceptionally effective. It is truly amazing, the type of authority, ability and participation that we can witness if we are prepared to park our partisan hats at the door and try to do what is best for Canadians on this issue. If we can take a look at what took place, with regard to C-14, there is absolutely no doubt in my mind that we can do that.

If members listened to the previous speaker, they would get a sense of what was taking place when we had the debates on C-14. Whether it is in the health standing committee or whatever it is that we come up with collectively, with representation from all the parties, I would encourage them to take into consideration the possibility of going outside of Ottawa.

Maybe we should look at different regions and see what some of these other provinces are doing, and maybe tour some of the palliative care facilities. There is a great variance.

We need to look. If I reflect on the province of Manitoba, we should take a look at what is happening in Winkler, Flin Flon or Winnipeg. We should take a look at the difference between Riverview Health Centre and what takes place in the Seven Oaks hospital.

Where, and what role, can we play as a national government to ensure that we are maximizing the benefits of providing the type of palliative care that Canadians expect and deserve, given the limitations that we actually have? Only the national government can do that. I suggest it is going to be in a very important role.

Earlier today, the standing committee on trade tabled the CUSMA deal, the trade agreement between Canada, the United States and Mexico. Many of the members were taking pictures of that particular committee, feeling very positive in terms of what they had been able to accomplish.

My challenge to the health committee, if that is going to be the standing committee, is to take that role very seriously in terms of the potentially life-changing report it could produce for Canadians.

I truly believe that the will is there to support what that committee is hoping to accomplish. It is just as significant as, and maybe even more important than, the report tabled today by the trade committee, which from what I understand was supported unanimously by all members of the House. If one listens to the speeches thus far, I do not think anyone would dispute what I said in regard to it.

I really encourage the standing committee, in the strongest way I can, to look at the mental illness issue using the same principles I talked about regarding palliative care. It is such a critically important issue, and Ottawa needs to play a stronger national leadership role on that. Hopefully that will happen, but because of time I am only going to highlight a few very brief points.

The proposed amendments would allow for a waiver of final consent for persons whose natural death is reasonably foreseeable, in the sense that they have been assessed and approved to receive medical assistance in dying, and have made arrangements with their practitioners for a waiver of final consent in certain situations because they were at risk of losing decision-making capacity by their chosen date to receive MAID.

I also want to highlight that the government is very aware of the concerns about the increased risks when MAID is provided to persons who are not dying in the short term. The bill, therefore, proposes additional safeguards that would apply when a person's natural death is not reasonably foreseeable.

These new safeguards aim to ensure that sufficient time and expertise are devoted to exploring requests for MAID from persons whose natural death is not reasonably foreseeable and that such people are made aware of, and seriously consider, available means for relieving their suffering.

There is another really important part to me, but maybe I will do it in the question-and-answer period.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Madam Speaker, Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying, is one that I believe was written with the intention of providing compassion to those who are suffering through an unfathomable, unbearable degree of pain by allowing a lawful, expedited termination of their suffering and granting access to a dignified death. The intention is kind. I see an urgency from the government to extend this expression of compassion to those who are suffering beyond comprehension.

However, from the perspective of a visionary and a lawmaker who cares for the long-term wellness and prosperity of our country, I would like to invite all members of the House to pause and bring into our dialogue the long-term effect of this bill and the impact of this bill on the guiding principles of lawmaking going forward.

I do not stand to speak on this bill with the moral authority of one who has reached a point of suffering equal to those who may be applying for MAID. I do not think most members of the House here have the personal experience to speak on that level. However, I do stand here to speak on this issue because there has been a force in my life that carried me through some very dark nights of the soul when adversity, pain and repeated cycles of injustice were poignant enough to wear down my will to fight and to try, sometimes causing me to question the value of my existence.

I have seen this force raise addicts, cancer patients and those experiencing deep depression from deep pits of psychological paralysis and darkness. This force transcends the distinctions of race, gender, socio-economic background, etc. It is almost as vital as life itself. It is a force that is central to the existence of the human race, and that force is called “hope”. While hope is easier to access for some than others, for others it may be almost impossible, because their painful experience is choking the light from their vision.

As caring individuals, as communities and as a nation that prides itself on compassion, it is our duty to turn over every stone to help others find hope when they can no longer access it themselves. Hope is a journey that demands an unrelenting search until it is found.

We saw it with Terry Fox. He is a national symbol of hope, because despite his painful struggle with cancer, he made the sacrifice he made with his cross-country campaign for cancer research because he was in search of hope and giving that hope to others. The story of his triumph over adversity, though his life was tragically truncated at such a young age, still continues to champion Canadians today, as Canadians respond by revering him as a national hero, because we value hope. We have seen the power of hope that compelled Terry to pass the finish line of his last breath.

We see hope whenever we see Team Canada send our paralympians to the Olympics. Many of them have overcome deep physical, emotional and mental suffering. Their focus, discipline and excellence have helped them to overcome their challenges.

Our nation is built on a foundation that values the sustenance of life and the right to prosper. We invest millions of dollars every year in first responders, medical services, infrastructure and laws to protect the survival, sustenance and prosperity of the people.

However, expediting the administration of death is counterintuitive to the inner reach for hope in the human condition. Our very Constitution is founded on the principles of the value of human life, the prosperity of each human being and each one's access to the opportunity to flourish.

While deep with the intentions of compassion and the appropriation of dignity, intervening with easier access to MAID opens a door to a very complicated path of further suffering, even for those who live on.

I would like to bring to the attention of the House the story of a man named Alan Nichols, from my province of British Columbia. As reported by CTV this past September, his family has stressed that Alan struggled with depression and should not have qualified for assisted death.

Alan's brother Gary told CTV:

He didn't have a life-threatening disease. He was capable of getting around. He was capable of doing almost anything that you had to do to survive.

Like many Canadians, Alan's life was altered dramatically when his father passed away. Especially since his father had been so involved in his life, his father's death made him particularly vulnerable, and he stopped taking antidepressants and became more angry and isolated:

Not going out in public, not seeing anybody, not eating properly.

This is how Gary described it.

Alan's family knows that he rid his home of furniture, apart from a bed and chair, and that he would refuse medication and food because of his depression. Another disturbing aspect to Alan's story is that despite his family's attempts to be involved in his life and an advocate for his life, his family members report that the hospital staff would not share information with them and shut them out from hearing the key facts.

There is more to this story, but I will leave it at that. This is accessible information.

The point I would like to illustrate here is that this is a very complicated issue. It is one that touches something so deep and necessary to our existence and our country, and that is hope. All because of the irreversibility of death, there is little intervention that can be done afterward when hope is terminated because there is no breath to receive the assistance of hope.

Rather than be in a rush to legislate this bill, we should focus on tackling things like the epidemic of suicide among first nations communities and youth. We should also focus on giving Canadians better access to mental health care so Canadians have greater access to hope when faced with situations of suffering, as people who are suffering so much consider MAID. We must do this until there are enough measures to show the flourishing of hope and human prosperity to counter a potential culture of death from capturing our nation, if we are to be too swift and lenient in our decisions surrounding issues of death.

It pains me to watch others suffer, but it also pains me to think that as lawmakers, our focus is on expediting access to death rather than expediting access to hope.

My statement in the House today is to inspire all members of this House to not only consider the dignity of the people suffering seeking release through death, but the dignity of existence and human prosperity for the long term.

Removing the mandatory 10-day waiting period reduces protections for vulnerable members of society. The government's original legislation, Bill C-14, went though extensive consultation. It is scheduled for parliamentary review this summer. I would ask the Liberal government to respect the process and allow the review to proceed rather than rush this very sensitive and complex issue in legislation. Let us give this time because death is irreversible.

I have decided to look at this bill through a filter of hope and preserving a culture of hope, as being a force that guides the laws we make not only today but for decades and centuries to come. Therefore, I stand today in the name of hope and invite my colleagues across all aisles to examine this bill through the lenses of hope and preserving hope in our country.

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

Madam Speaker, I will be sharing my time with my colleague from Coquitlam—Port Coquitlam.

I am very happy to be taking part in this debate, which is a departure from our usual political and often partisan work as elected officials.

This is the third time in my parliamentary career that I have been asked to debate and vote on the issue of medical assistance in dying. I was a member of Quebec's National Assembly for seven years, and I have served here in the House of Commons since 2015 with the support of my constituents.

I was elected to the national assembly in 2008. As a member of that assembly, I participated in the first debate we had in Quebec on this issue, the first time in a Canadian legislature, in 2010.

I also was a participant in the debate we had four years ago in the House of Commons, when, for first time, we addressed the issue. Therefore, in my parliamentary life, this is the third time I will participate and vote on this very touchy, personal and non-partisan issue.

That is why I would like to remind the House of certain cardinal rules that should guide our actions as parliamentarians in this debate, which we believe should be totally non-partisan. Things may get tense at times, but debate must remain respectful.

Respecting the free vote should be one of the cardinal rules of this debate. In my view, there is no right or wrong position in this debate. There are only positions that we are comfortable with as human beings. Whether we are for or against, there is no partisan politics behind it. There is only the personal opinion that we hold, share and analyze.

Consequently, it is important to keep a completely open mind and respect the fact that certain colleagues from our own party may not share our point of view, while colleagues from other parties may. That is fine. There is nothing wrong with that, really. Some positions we adopt, and some positions we cannot be comfortable with. That is all.

We must respect the debate. We must respect personal opinions. We must respect the fact that there is no place for partisanship in this debate and that positions are neither right nor wrong. There are positions that we can agree with and others that we cannot. We must respect that.

There are also certain elements that we must bear in mind before we dive into this. In our opinion, the bill has some shortcomings.

First, we must respect the freedom of conscience of physicians who are called on to provide MAID. If a physician feels that they cannot in good conscience provide MAID, they should be able to say so and not have to proceed. I have spoken to many people in the context of this debate, in which I have been participating for a very long time. Everyone I have spoken to has told me that physicians can show a certain openness in some circumstances, but change their minds in others. Physicians should never be forced to act against their conscience.

Furthermore, we should always bear in mind that MAID, by its very nature, is the last level of health care that can be offered. We must never forget that the role of palliative care is to ensure that those who are ill can live with dignity even in tragic circumstances. Therefore, we must respect physicians' conscience and focus on palliative care.

Taking our time is another cardinal rule that must be respected in this type of debate.

Let me remind members that the first time this issue was addressed in Quebec, it took six full years, three different governments and three different premiers. There was a huge debate about it, a strong and wise debate. Each and every position had been clearly established by those people who participated in the debate. There is no rush. We must take our time.

For some people, we are talking about assisted suicide. It is a very touchy issue. The worst-case scenario is to rush it. Quebec spent six full years, and we should follow this example. It obviously will not take six years this time, but the first step took six full years.

Let's agree that this debate cannot be rushed.

Why are we debating Bill C-7 today?

When the House of Commons adopted Bill C-14 in 2016, I was a member of the committee that studied it. We knew then that Canadians would challenge parts of it and that there would be court rulings. That is exactly what happened on September 11, 2019, when the Quebec Superior Court struck down the notion of “reasonably foreseeable natural death” in the bill that became An Act to amend the Criminal Code and to make related amendments to other Acts regarding medical assistance in dying.

I did not know this before I looked it up, but it is interesting to note that the current Minister of Justice, a man for whom I have tremendous respect and esteem owing to his experience as a lawyer and a McGill University professor, voted against Bill C-14. Now, as Minister of Justice, he is sponsoring this bill as the federal government's response to the Quebec Superior Court's ruling. The bill addresses some of the issues but sets others aside.

The first fundamental element of Bill C-7 is that it eliminates the 10-day waiting period that the current law requires as a buffer between the person's decision and the operation itself, to ensure that the second opinion provided for under the act is in fact obtained. The court deemed this provision invalid, and the minister decided to accept that opinion.

Let's also not forget that the current law, which was passed four years ago, requires the provisions to be reviewed in just a few months, starting in June 2020.

The government decided to take note of the Superior Court of Quebec ruling and act accordingly. That is its right. However, regardless of our views on the issue, we feel that this subject involves some truly fundamental questions and raises highly complex legal concerns. We think this ruling should have been appealed to the highest court in the land, so that the nine justices of the Supreme Court could study every possible ramification.

This bill sidesteps the issue of mental illness entirely. That is a very good thing, because in our view, it is extremely difficult to pinpoint the instant when a mental illness becomes irreversible, which can raise doubts about whether consent was given fully and freely.

As I said earlier, the worst thing we could do in this matter is move too fast. There is no rush. This concern may eventually be debated, but for now, let's take it one step at a time.

Since my time is almost up, I would just like to say that in this debate on such a delicate, sensitive issue, the worst thing we could do is plough full steam ahead and attack people's convictions instead of respecting their choices. Let's take the time to do things right on this extremely delicate and extremely important issue.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, Bill C-14 was the well-considered response of the previous Parliament to a Supreme Court of Canada decision, the Carter decision. Bill C-14 became the law, it was incorporated into the Criminal Code of Canada.

I am of the opinion that the Attorney General should defend the laws of the country. The law was only three years old and was a well-considered decision of Parliament. The Attorney General should defend the laws of Parliament.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I am pleased to join the debate on Bill C-7, an act to amend the Criminal Code, specifically section 241 of the Criminal Code. That is the provision of the Criminal Code that makes it illegal to counsel a person to commit suicide or to aid someone to do so.

In the absence of more recent amendments, in the previous Parliament there was Bill C-14 in response to the Carter decision by the Supreme Court of Canada. In that case the court found that the plaintiffs' charter rights had been infringed upon by a strict interpretation of section 241.

Interestingly, Bill C-14 from the previous Parliament stated, as one of its objectives in paragraph six of the preamble:

...permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance between the autonomy of persons who seek medical assistance in dying, on one hand, and the interests of vulnerable persons...on the other;

The relevant provisions in the Criminal Code included that language. It states that qualifications for MAID, including with respect to the person:

their natural death has become reasonably foreseeable, taking into account all of their medical circumstances....

All of this is about to change because of the Truchon decision.

I am speaking to Bill C-7, a bill that would eliminate the reasonable death forseeability safeguard and expand MAID, medical assistance in dying, to a larger number of people. I have been encouraged to speak to the bill because of the many letters and correspondence I have received from people in my constituency.

I have received some letters in support of expanding MAID, but the vast majority of the letters I have received encourage me to speak against expanding the availability of medical assistance in dying.

Correspondence that I am receiving from constituents repeat two basic themes. First is that the reasonable forseeability of death safeguard should be maintained as an effective defence of societal interests and Canadian values. Second is that more should be done to expand palliative care services.

To quote one person, let Canada be a society that is known for its modern and advanced palliative care services and not as a country that has ever expanding use of medical assistance in dying. We should alleviate the suffering, not eliminate the sufferer.

I am going to read quotes from two people who each made the effort to write me a letter.

The first is Dr. den Hollander, who states:

If Canada must allow MAiD in some form (and I wish it didn't), it is incumbent upon us to ensure that it is rare. Eligibility requirements should be tightened, not loosened. More safeguards are necessary, not fewer. Enforcement must be scrupulous, not relaxed. Without these protections, vulnerable people will be pressured by family members, friends and medical practitioners to MAiD.

The second is a woman named Ramona. She works in health care, including palliative care. She quotes a person to whose care she attended, and who died in the Langley Hospice facility, as saying, “I want to live well while I'm dying.” Ramona goes on to comment, “Surely this is what health care was created for, to support people while they are alive, not to speed up their death.”

This is the tenor of the input I am receiving from my constituents.

Behind Bill C-7 is the Superior Court decision in Truchon. The plaintiffs in that case argued that their constitutional rights had been infringed upon by the now amended section 241 of the Criminal Code. They argued that the Carter decision, on which Bill C-14 was based, did not require that a person's end of life be reasonably foreseeable, and that is a true statement. That is not what the Carter decision required.

Secondly, they argued that the legislated end of life requirement violated the right to equality, under section 15 of the charter, and the right to life, liberty and security of the person, under section 7 of the charter. The federal government, acting through the Attorney General's office, did the right thing at that time. It defended its law. That is what the Attorney General should do. Bill C-14 was the well-considered opinion of the previous Parliament. It was the law. The Attorney General must defend the law.

Remarkably, the Quebec Superior Court refused to accept the arguments advanced by the Attorney General. The Quebec Superior Court said that the court cannot accept the first two objectives advanced by the Attorney General regarding the affirmation of the inherent and equal value of every person's life and the importance of preventing suicide.

In the opinion of the justice writing that decision, those two principles were not the underlying philosophy of Bill C-14. It was all about protecting vulnerable persons from being induced, in moments of weakness, to end their lives.

Remarkably, the Attorney General of Canada did not appeal that decision. That is what should have been done. Any self-respecting Attorney General would appeal a decision that attacked the laws of Parliament. This Attorney General elected not to do that. Now we are in this position where we are under pressure to amend the law, when we should instead be following the directive of Bill C-14, and that is to have a comprehensive review of the whole legislation.

That is what we should be doing. What is the rush? The rush is caused by the Attorney General's failure to appeal this decision. It should have been tested through the court system, up to the Supreme Court of Canada.

With the reasonable foreseeability of death safeguard down, this is what we have left. An applicant for MAID qualifies if he or she has a serious and incurable illness, disease or disability; is in an advanced state of decline; or their physical or psychological suffering is intolerable to them, which is a completely subjective test. The reasonable foreseeability of death criteria is now gone.

Let us just test this against a couple of hypothetical situations. We can imagine that a person has Parkinson's or MS, or was in a terrible accident and is a paraplegic. Under this new regime, if it becomes the law, people who are not dying but who meet all the other criteria, however subjective they may be, will qualify for state-sanctioned suicide. One of my constituents has said that we should let Canada be a society that is known for its modern and advanced palliative care services, and not as a country that has ever-expanding use of medical assistance in dying.

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

Mr. Speaker, I thank my colleague for her question and her comment.

Cases involving Alzheimer's and dementia raise questions regarding consent and capacity, some rather complex questions since they relate to the prognosis itself. These two types of cases will have to be examined in June as part of the review that Parliament is required to do under Bill C-14.

[Rob Moore, Conservative, Fundy Royal, NB]

Mr. Speaker, specifically on the 10-day cooling off period, does the parliamentary secretary acknowledge that under the current legislation, if necessary, those 10 days could be waived? That was a safeguard put in place by this Parliament and has been taken out in haste.

I would like the parliamentary secretary to comment on a couple of facts that deal with this Parliament. First, a two-week online consultation is not a parliamentary review. Bill C-14 called for a parliamentary review that was to take place this summer before we expand our regime in Canada around medically assisted dying. The Liberal government has jumped ahead with a vast expansion of the legislation without the benefit of that review.

Does the parliamentary secretary see a two-week online consultation having some equivalency with a parliamentary review?

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

Mr. Speaker, I will be splitting my time with my colleague, the member for Kings—Hants.

I am pleased to rise today to speak to Bill C-7. I have some prepared remarks, and during the course of my comments, I will try to sprinkle in some responses to some of the various issues that have already been raised.

Clearly, we are here because there was a decision of the Quebec Superior Court in the Truchon case. This decision struck down a particular criterion under both the Quebec regime and the Canadian regime with respect to the end-of-life nature of medical assistance in dying, this being the reasonable foreseeability of natural death criterion, in particular at the national level.

The court's ruling only applies in Quebec. We heard the minister speaking about this. He suspended its declaration of invalidity for a period of six months, until March 11. It is important for this chamber to understand that on February 17 of this year, the Attorney General of Canada filed a motion to request an extension to give Parliament sufficient time to enact an appropriate response to ensure consistency in the criminal law. That motion was actually debated yesterday, and a decision from the court is forthcoming.

Before I go into some of the details in this bill, I want to start off with two important provisions related to conscience protection that were raised by members of the official opposition in the context of this debate. I want the record to be crystal clear that conscience protections are robust in this country and are entrenched in the law.

The first location is in the preamble to the old Bill C-14, which I will read. It states, “Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms”.

I have had further questions from members of the official opposition about why it is only in the preamble and not in the statute. That assertion is wrong, because it is in the statute. Section 9 on page 8 of the old Bill C-14, which amended subsection 241.2(9) of the Criminal Code, says “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

The third point I will read is from the Carter decision of the Supreme Court, which has been the subject of extensive discussion in this chamber thus far. I am reading from paragraph 132 of the majority reasons in Carter. The court states “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

Those are three instances. One is jurisprudential and the other two are statutory. The fourth one is of course the broad penumbra that is cast by section 2 of the charter, which protects freedom of conscience for all Canadians, including those who practice medicine. Therefore, the assertion that somehow conscience rights are not protected or are somehow being eroded is categorically false.

Another point in terms of what is being addressed in today's debate is the notion that a culture of overly facilitating medical assistance in dying is upon us, and that somehow this government bill is pushing us further toward predatory practices by health care practitioners or toward disavowing the right to life, liberty and security of persons who are vulnerable, including persons with disabilities. That is categorically false and is not commensurate with what is in evidence.

The evidence we have is readily available in the technical briefing that was already provided to all members of Parliament. It is that in total, 13,000 MAID-assisted deaths have happened in this country in the last four years. The average age of people who are accessing MAID is 75 years old. It is being accessed equally by men and women, 51% by men and 49% by women. The most common medical condition is cancer, followed by neurological conditions, in that 67% of all people who access it have cancer. Second come neurological conditions and third come cardiovascular conditions.

Very importantly, in the most recent year of analysis, a grand total of 5,444 people accessed MAID in this country. That represents 1.89% of all deaths in this country. I read that into the record because I think it is important for people to understand that there is not some sort of culture of medical assistance in dying that is being foisted upon unwitting individuals. I will elaborate on my reasons going forward.

I would like to talk about some aspects of the bill. The eligibility criteria have changed, as the Minister of Justice pointed out.

There are two series of safeguards. The first applies to cases in which the person's death is reasonably foreseeable, while the other applies when death is not reasonably foreseeable. The bill would add new safeguards to that second category.

Lastly, the bill allows a person to waive final consent on the day of the procedure in certain circumstances.

I will return to that in a few moments.

Much has been made about the consultation process, including some comments by the member for Mission—Matsqui—Fraser Canyon about it being a rushed procedure and that the government is not adequately listening to Canadians. I have great respect for all members in the House who are participating in this debate and raising a number of very personal, ethical, legal and moral issues. I understand that; the government understands that.

However, to assert that the consultation was not robust is again categorically false. We heard from 125 different individuals, who are experts in this field, whether they are delivering it or acting on behalf of disabled individuals, and from nurses, doctors, etc. We heard from 300,000 Canadians through their responses to a questionnaire that outlined the various scenarios.

The views of those individuals were quite concrete in the direction they were seeking. They wanted to be empowered in terms of their autonomy, dignity and their choices. They were seeking less obstacles to what had evolved to become an overly restrictive regime, as identified by the court in Truchon. That important feature must be canvassed here. What is important to understand is that the input received was critical to the development of the bill.

As part of the proposed amendments to the Criminal Code, the reasonably foreseeable death provision will be removed from the eligibility criteria. This is in response to the Truchon decision.

In terms of legal impact, this amendment would mean that people whose death is not reasonably foreseeable would be eligible for medical assistance in dying if they meet all of the other eligibility criteria.

This is very important.

The bill proposes to exclude persons whose sole underlying condition is mental illness. This has been touched upon by different people who have already intervened in the context of this debate. This is important, as was outlined by the minister. It recognizes the increased complexities and risks associated with such cases, which were highlighted by many practitioners, stakeholders and experts at the main round tables.

What is very important is that the Canadian Mental Health Association supports the position we are taking with respect to excluding mental illness as a sole underlying condition to render someone eligible for MAID.

This complex issue must be examined carefully as part of the parliamentary review of the legislation on medical assistance in dying, which is to start in June of this year, as the minister himself mentioned.

Importantly, the Government of Quebec has also announced the exact same study for the exact same provision, that the issue of mental illness as a sole underlying condition is complex. Issues of consent and capacity and issues of properly being able to diagnose and have a prognosis are critical.

I will move to some of the comments that have been made. It is important for people understand that the safeguards are under two tracks. Those safeguards respond to persons whose deaths are reasonably foreseeable and those whose death is not.

With respect to some of the aspects raised in the context of today's debate, we have have taken the 10-day period of reflection out of the legislation. This was put squarely into issue by the member for Fundy Royal when he asked about the basis for doing that. The basis for it was that the safeguard was not doing the work it was meant to do. As opposed to protecting vulnerability, it was actually increasing the vulnerability of individuals insofar as it was prolonging suffering in some instances.

We heard, and the minister commented on this, that some people were so concerned about the inability to provide their final consent after 10 days that they would stop taking their pain medication, which was creating further suffering, just to maintain the ability to provide that final consent.

On the question raised by the member for Sherwood Park—Fort Saskatchewan most recently with respect to how one assures informed consent is applied when it has not been solicited actively, I have two responses. This is with regard to the advanced consent regime.

The government is conscious of the Audrey Parker situation and we are seized with it. When people have been assessed and approved for this procedure and when they make a determination that they want to access it and provide consent in writing, that consent would be sufficient.

In direct response to the member for Sherwood Park—Fort Saskatchewan, could it be vitiated? Yes. First, if the person has not lost capacity, consent could be vitiated. Second, it could be done by a physical gesture that would be interpreted to fully and finally eliminate that consent for the purposes of the practitioners.

The bill strikes a balance and the balance is important. We are conscious that a compassionate response that protects vulnerable individuals and also respects their dignity and autonomy is critical and what is required by the Constitution.

That is what this bill represents and I am very hopeful, as the member from the Bloc Québécois pointed out, that we can achieve all-party consensus on that very fundamental point.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Mr. Speaker, I had the privilege of serving on the justice committee with the member for Cowichan—Malahat—Langford in the last Parliament. I had the benefit of serving as the vice-chair of the Special Joint Committee on Physician-Assisted Dying and then served on the justice committee following that, when it dealt with Bill C-14.

I acknowledge that the circumstances Audrey Parker and others like her found themselves in presents a real, difficult challenge from the legal, moral and ethical standpoint. However, a regime that provides for advance directives does cause me some level of concern.

In the Carter decision, the Supreme Court of Canada made clear that there must be clear consent. How can there be clear consent absent contemporaneous consent on something that is ultimately irreversible when carried out?

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

Mr. Speaker, I have already received some correspondence on this particular bill. A number of people back home have already organized a community meeting with me on this legislation when I am back in the riding during the constituency week next week. It is a group that had a lot of concerns with Bill C-14. Based on their faith, they had some real concerns with it.

I knew when I walked into the room to meet with them the first time that we were not going to walk out in agreement with each other. However, I think we surprised each other with how respectful we were. We walked out of there respecting each other's positions, with a sure knowledge that we had each given this issue some deep thought. I expect that the same tone of conversation will happen again when I meet with them next week to discuss this bill.

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

Mr. Speaker, I agree with the member. As I said in my opening remarks, this is a subject with such weight and importance to so many people across this country, whether they live in Nova Scotia, Quebec or in my home province of British Columbia. We owe it not only to ourselves in this chamber but to the people we represent to treat this subject with the respect it deserves.

As a member of Parliament who served in the previous Parliament, I was, by and large, quite impressed with the tone of debate on Bill C-14. I know there were some disagreements on the bill, but members ultimately tried to bring their disagreements and respective positions on the bill to the floor with as much respect as possible. During many of the speeches in this place at the time, members who were here will remember that the chamber was so silent we could hear a pin drop, because we knew how important the bill was to members speaking and, more importantly, to their constituents watching back home.

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

Madam Speaker, it is quite incredible to be revisiting this issue. I can remember when the debate on Bill C-14 went on, back in 2016. There were some amazing speeches uttered in Centre Block during that time. This truly was an issue that had a profound effect on so many members in the chamber but, we know, also on so many members of our society.

I was honoured in 2017 to serve as our party's justice critic. I am pleased to again be serving in the role as the deputy justice critic for the NDP. I have always felt that this particular critic role brings with it a very great weight of responsibility, especially when we are dealing with the Criminal Code. I do not think there is any other statute in Canada that has such a profound effect on people when they violate any of its provisions. It also gives a lot of guidance, as is the case in medical assistance in dying, over the parameters that are set up.

Regarding medical assistance in dying I, like many members in the chamber, received a lot of correspondence on the issue back in 2016, both from constituents who were against it and from constituents who wanted me to take up the cause.

I think that is the challenge that we as members of Parliament face on a regular basis. We have to look at our constituents' wishes, but they are not always very clear cut. We have to try to balance those with our own personal views on the subject and, at the end of the day, try to be accountable for the decisions we have made on behalf of our constituents in this place.

When it comes to an issue as complex as medical assistance in dying, I fundamentally believe that we must go beyond partisanship and work together with a compassionate lens. Ultimately, we must make sure that Canadians can die with dignity, compassion and fairness, and without excessive suffering.

I am pleased to see the introduction of Bill C-7 as part of the effort to help those who are looking to end their unnecessary suffering as they face the end of life. Bill C-7 is coming to us as a result of a decision in a Quebec court. For me personally, and for many members of the New Democratic caucus, it was quite evident in 2016 when we were debating Bill C-14 that this issue would come back to us. We knew it was only a matter of time.

I can remember referring, in the debates on Bill C-14, quite clearly to the Carter decision, which was handed down by the Supreme Court on February 6, 2015, in the final months of the 41st Parliament, when the Harper government was in power.

When the present Liberal government came to power in 2015, this was one of the major challenges it was faced with, because there was an impending deadline and there was a real rush to get in legislation that was going to respect the Carter decision.

I want to give a shout-out to two of my colleagues, Murray Rankin and Brigitte Sansoucy. As members of the New Democratic caucus, they sat on the special joint committee that looked at this issue as a result of the Carter decision, and presented the committee's recommendations to the House of Commons.

When we look at the Carter decision, which really started this whole process rolling just over five years ago now, we can see that they felt the prohibition on allowing people to take their own lives because of suffering violated their Charter rights. I will just quote from the ruling. It was stated that:

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.

It went on to say:

An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.

Thus, it violates section 7 of the Charter of Rights and Freedoms. Just to read it into the record, so that everyone is quite clear on what we are referring to, section 7 reads that:

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

What Carter was clearly explaining to people was that by not allowing people this option, by keeping them in a state of constant suffering, of basically confining them to their bodies, we were in fact violating their section 7 rights. That was the clear message that was delivered to Parliament.

There is always a careful dance between our courts and the legislature. The courts, of course, are very much responsible for interpreting the law, but also finding when such a law runs contrary to our Constitution. They also recognize that Parliament has its role to play as the lawmakers, as the one institution that can amend the law based on people's wishes. That was the task that was handed to us at the beginning of the 42nd Parliament.

When that special joint committee with the other place was formed, there were some clear recommendations that directly followed from the Carter decision. Recommendation number two, which I will read into the record, was as follows:

That medical assistance in dying be available to individuals with terminal and non-terminal grievous and irremediable medical conditions that cause enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

The problem that led us to where we are today was the fact that Bill C-14, as a government bill, decided to insert a reference to “reasonably foreseeable death”. This meant that if one had a medical condition for which death was not reasonably foreseeable, one could not qualify for medical assistance in dying.

Also, as a part of that special joint committee's recommendations, it did touch on the subject of advanced directives which is also, I am glad to see, addressed in Bill C-7.

The Truchon decision of 2019, in the Superior Court of Quebec, involved two plaintiffs who were each suffering from grave and incurable medical conditions that caused tremendous suffering and a total loss of autonomy.

They were 74-year-old Nicole Gladu, who used a wheelchair and had post-polio syndrome, which is a condition that weakened her muscles and reactivated her childhood scoliosis. She had difficulty breathing and was in constant pain. As well, there was 51-year-old Jean Truchon, who was born with cerebral palsy and no longer had the use of his four limbs. He lost the use of his only working limb back in 2012, due to severe spinal stenosis that left him almost completely paralyzed and caused painful spasms. He gave up most of his activities and went into assisted living since there was little he could do by himself.

Both of these individuals were refused medical assistance in dying under the Quebec legislation regarding end-of-life care as they were not at the end of their lives. Their deaths were not reasonably foreseeable.

With those grave medical conditions, they were prisoners in their own bodies but unable to find any relief. Really the heart of the matter here is how we, as an institution, respect individual autonomy. We can only imagine the pain and suffering they were going through on an hourly basis. When two individuals have arrived at this decision and obviously had the time to think about it, I think it is incumbent upon us to respect that, but more importantly to respect the fact that we have had a court look into this and determine that their charter rights were fundamentally violated.

That brings me through the long journey over the last five years to Bill C-7.

I am pleased to see the bill introduced. The Minister of Justice was one of four Liberals who voted against Bill C-14. I think he is now have a moment where it has come full circle. Now, as the Minister of Justice, I hope he feels some satisfaction in bringing in corrective measures to address the problems he saw as a Liberal member of Parliament back in 2016, when he voted against the government's legislation at the time.

As is required by the decision of the Quebec court, Bill C-7 will expand access to medical assistance in dying to those whose death is not reasonably foreseeable. I can assure the House that we are providing our support to the bill in principle at second reading. However, we will be doing our due diligence when it reaches the Standing Committee on Justice to ensure that access to medical assistance in dying has not been unreasonably restricted for those whose death is not reasonably foreseeable by the addition of the new conditions in the legislation.

We also want to ensure the standard of eligibility for receiving medical assistance in dying remains high. We remain disappointed that there has been no commitment by the minister to refer the question of the adequacy of the safeguards against pressure to seek medical assistance in dying to the formal legislative review, which will begin in June, again at the Standing Committee on Justice. Perhaps the government can hear those words, reflect upon them and address our concerns with respect to that aspect.

Going into some of the finer details of the bill, essentially there is a two-track process in Bill C-7. There is one for those whose death is reasonably foreseeable and one for those whose death is not reasonably foreseeable.

For the one where death is reasonably foreseeable, the 10-day waiting period is removed; the number of independent witnesses required for the written request is reduced from two to one; a paid professional or health care worker can be an independent witness; and the creation of a waiver of final consent.

For the second track, which is ultimately the part of the bill that is responding to the decision from the Quebec court, a few more restrictions are in place. The first big one, which will warrant some further study at committee, requires a minimum 90-day assessment period, which I think the legislation states can be shortened if loss of capacity is imminent and the assessments have been completed.

However, as I have said in previous questions and comments, we have already heard from some members of the medical community. They say that the 90-day assessment requirement may mean their patients have to endure another 90 days of suffering. For physicians, who take the Hippocratic oath to do no harm, if their patients are experiencing harm every day because of that suffering, that weighs very heavily on their conscience.

There are some other specifics in that other track process that I do not think warrant going into too much detail at this stage. The Standing Committee on Justice do that.

I also want to touch on another aspect of Bill C-7, which is the advance directive. This is known as the Audrey Parker amendment. It refers to Audrey Parker, a Halifax woman who was diagnosed with stage four breast cancer, which metastasized to her bones and a tumour on her brain. She spent the last weeks of her life raising awareness about the challenges facing Canadians who had been assessed and approved for assisted dying. She opted to die earlier than she would have otherwise wanted to. The legal requirement in the existing legislation is that the suffering person has to be competent immediately before the life-ending treatment is administered.

That presents a number of problems. If someone has already been approved for medical assistance in dying within the tight confines of what is written in Bill C-7, he or she can give that advance directive so that those wishes will be fulfilled even if there is a loss of competency. It would remove a sense of pressure that could be brought to bear on individuals who may feel compelled to take their life earlier, while they still have competency and the ability to act on their own directive. Therefore, I think this is a particularly important section of this legislation that should be noted, and I certainly look forward to seeing what kind of testimony we hear at the justice committee.

I have received some correspondence with respect to the Audrey Parker amendment. I have an email here from a constituent. She sent me a copy of her letter to the justice minister. She states:

These steps ensure that the patient qualifies for medical assistance in dying under the law, making the late-stage consent requirement unnecessary — and puts an enormous physical and emotional strain on people who are at risk of suddenly losing capacity, or who need heavy medications to manage their pain.

Most importantly, this unfair requirement means that people in the Assessed and Approved category are faced with a cruel choice: access assisted dying now, or wait longer and risk losing out on their right to a peaceful death.

Right now, dying people are ending their lives far earlier than they would like, or are refusing adequate pain care out of fear that they will lose out on their right to a peaceful death. This is an unacceptable burden for anyone to bear, and it is a clear and grave violation of Canadians' Charter rights.

That is just an example of some of the correspondence I have received on that particular aspect. It is actually really nice and refreshing to hear someone lay it out quite clearly because I think if we were to visit any riding we would all have constituents who have faced those pressures.

This is weighty subject matter. I know that in this chamber and indeed across this great country there are going to be multiple views on whether we are in fact going down the right path.

In moments like this when we are called upon to make these momentous decisions, we are required to look inside ourselves and to switch more from sympathy to empathy. I see this difference between the two. Sympathy is feeling sorry for someone else, while empathy is trying to put oneself in that person's shoes in order to view the world as she or he sees it.

The truth is that the members of this chamber who are lucky enough to have their health and to lead privileged lives cannot adequately express or feel what it is like to live in a body that feels like a prison and to know that kind of suffering. My ultimate view of this bill, and what guides me in the direction we need to take, is that it is about trying to make sure we can give people the dignity in death that they had in life, to respect their autonomy, to respect their choice and to make sure that their charter rights are not violated.

I conclude by stating that the New Democrats will be supporting this bill at second reading, with the full realization that the committee work is before us, which will be a real opportunity to hear from members of the public and witnesses. Hopefully, when this bill returns to the House we will have a product that we all feel we have done our best on and that lives up to the important wishes of our constituents who are living with these incredible amounts of suffering.

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

Madam Speaker, the speech of my colleague from the Bloc was very passionate speech. I very much enjoyed listening to it.

When we looked at this issue in the previous Parliament, what was very clear back then was the Carter decision. What was very clear back then were the recommendations of the special joint committee. What was not very clear was why the government at the time had inserted the clause that required a reasonably foreseeable death. During my speech on Bill C-14 in 2016, I knew that clause would force us to come back and revisit this issue.

Parliament did look at this issue, we did deliberate and a number of parliamentarians at the time identified this as a problem. Then I see the Truchon decision, and that simply forces Parliament to clean up its act, to actually get the job done properly this time.

Who are we to impose our values on people who have gone through the suffering, who are being forced to live with these medical conditions? We have no idea what kind of a world they are living in. The member is very right that it is about treating their life with dignity and also allowing them to die with dignity in what is an incredibly personal choice.

I want to get my colleague's thoughts on a particular section of the bill that sets the assessment period at 90 days. For someone whose death is not reasonably foreseeable, but is facing intolerable suffering, what does he think of the 90-day period? The New Democratic caucus has already heard from physicians who have great concern that they may have to force their patients to wait an additional 90 days when it is already quite obvious the suffering is very grave.

Could my colleague provide us with his thoughts on that section of the bill?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, it is with some emotion that I rise in the House today to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

We are debating Bill C-7 today because the legislators who were here four years ago did not do their job properly when they debated Bill C-14. We do not live in a democracy run by judges. We are the ones that make the laws and who must make the voices of citizens heard, particularly the voices of those who are suffering. All judges do is interpret the grammar of justice. They look at the laws and people's rights and freedoms and determine whether the infringements are reasonable or not. However, before Bill C-14 was introduced, two courts told us that, according to the law, the Criminal Code infringes on the right to life and the right to liberty and security of those who are ill and suffering, are struggling with unbearable pain or have a terminal illness.

Today, I hope that we will seize the opportunity that is given to us. I hope that we will extend the debate until June because this is a serious subject. I hope that we will have a calm, rational debate.

I will start by saying that I am sure my colleagues in the House all have good intentions. They want to do good. They have kind hearts. I am sure that their behaviour throughout the debate will reflect the very values they are advocating, namely benevolence and caring. However, we cannot be benevolent and want what is best for a terminally ill person if we refuse to listen to what that person has to say before they die.

All I want is for us to understand what is at stake here, I am referring to the law, which my Conservative friends have always put on a pedestal. The value of autonomy is conferred by law through the principle of self-determination, especially with regard to medical care. I will come back to that.

I will take a moment in this debate on such a crucial and delicate issue to say that I hope all my colleagues get to cross the threshold of death peacefully, quietly and painlessly. That is my wish for everyone, because the best fate we can wish on another human being is to find peace, to let go and to receive what is known as good palliative care if they are terminally ill with an irreversible ailment. More on that later.

Today we are discussing the autonomy conferred by law through the principle of self-determination. In the biomedical context, there is a rule. A value gives rise to a principle, which in this case is self-determination. This principle gives rise to a specific rule, namely the rule of free, informed consent. The rule about free, informed consent to treatment has never been challenged in emergency situations.

Why would it be any different for human beings experiencing intolerable suffering due to an irreversible illness or condition?

Why would it be any different for competent individuals who are neither depressed nor suicidal and who have expressed a desire to live fully until they reach the limit of what they can tolerate?

I therefore invite my colleagues to join me in a debate on autonomy and self-determination. If someone shows up at an emergency room, they cannot be treated without their consent. Everyone has the right to refuse treatment, by the way.

In the Carter decision, which led to Bill C-7, the Supreme Court ruled that the provisions prohibiting medical assistance in dying violated the right to life, liberty and security of the person. People like Ms. Gladu, Mr. Truchon, Ms. Carter and Ms. Taylor have not reached the end-of-life stage. They might not even be in the terminal phase of their illness. That does not mean they have not reached, or are not in the process of reaching, the limit of what they can tolerate.

The court stated that those provisions were effectively shortening the lives of such individuals, that they violated their right to life by inciting them to commit the act before they were ready. That is the issue that we are called upon to address. There is no issue for people who are terminally ill. The issue we need to address as legislators has to do with people whose death is not reasonably foreseeable and imminent.

The bill proposes that a person who is not terminally ill must consent twice and be bound by a 90-day period. I really wanted to talk about advance consent. I imagine we will do so eventually. That is about all that is missing from the bill. Clearly the Bloc Québécois is in favour of passing this bill in principle.

What we want is respect for the moral autonomy of the dying. We often speak of dying with dignity. Dying with dignity does not mean having a sanitized death. That is not it. The dignity of a person is derived from their freedom to choose and respect for their free will. That is what it means to be a human being. When that is violated, we violate the dignity of the human being. Whether the death is unpleasant or not is not the issue. The crux of the matter is to allow the human being to make a decision about the end of their life.

Unfortunately, in the past, we won the right to die rather than undergo aggressive therapies. At the time, we called this passive euthanasia. The person was left to die without death being the intent. Palliative care was still in its infancy. There was a great fear of administering one last fatal dose of medication, which always ends up causing death, because palliative care provides care.

Human beings won the right to die rather than undergo aggressive therapies. People did not die of cancer; the therapies killed them. Experiments were conducted on human beings. Doctors led the way to ensure that they would have quality of life if they were to be struck by cancer. They did not want to receive treatments that would make them ill for a year when they only had two years to live.

The right to die won out over aggressive treatment plans. That idea evolved and became palliative care.

For a long time, palliative care was thought of as the only solution that would allow someone to die with dignity. However, in the past 30 years, were there people living with terminal illnesses, dying a slow, agonizing death, who did not receive all of the palliative care they needed until the end of their life, if that was what they wanted?

First, we need to look at whether palliative care is accessible. There is an increase in requests for medical assistance in dying. Bioethics talks about clinical ethics, in which the patient comes first. It is about listening. Sometimes, even the best palliative care in the world, with the best framework in the world, cannot alleviate someone's suffering.

That is true for Ms. Gladu and for Mr. Truchon, but those people are not suicidal. They want to live as long as possible. When they want to die, they may be given anti-depressants. They will be of sound mind when they make their decision. That decision will be reversible. I was listening to Ms. Gladu the other day. What does she want? She wants freedom of choice. In many cases, once people have that choice, they have so much respect for their dignity that they are no longer in such a hurry. That reduces suffering tremendously. That is the issue we are dealing with.

We must not sidestep this issue on the grounds that we want to move swiftly. I have a lot of questions about the bill because it does not address degenerative cognitive disease. I think a person with Alzheimer's should have the opportunity to make an advance request.

These are predictable diseases. Doctors can tell patients how they will progress. People with these diseases often remain of sound mind for years. Eventually, they become forgetful. In the end, they die not of the disease itself but of complications from being bedridden or immobilized or conditions other than that disease. This bill does not take those people into account.

What I would hate is to see a repeat of what happened with Bill C-14. The reasonably foreseeable natural death criterion was established, and it was supposed to protect vulnerable people.

Is there anyone more vulnerable than someone who is suffering from intolerable pain, who is living with an incurable illness and who is being told to go to court for the right to choose and to die with dignity?

Is there anything more important and more intimately personal for an individual? It is not as though the person's neighbour is going to die for them.

I have a hard time understanding our Conservative colleagues' argument that the state must decide for an individual, when they are so economically libertarian.

In 1957, Pope Pius XII was a pioneer. He said that we must stop claiming that only God can decide whether we should die a slow death. At a certain point, he made it possible for us to sanction palliative care.

Today, let us not pit palliative care and medical assistance in dying against each other, regardless of whether we are talking about a degenerative disease or an illness that causes extreme pain but is not terminal. Let us not pit those two realities against each other. Respect for human dignity includes proper support when one is dying, which requires doctors to have the humility to recognize that they cannot always help people manage their pain adequately.

Our society recognizes people's right to self-determination throughout their lifetime but takes it away from them at the most intimate moment of their lives. In so doing, we think that we know what is best for people or that we are doing the right thing, when we are actually undermining human dignity. There is no more important moment in a person's life than their death. Learning to live is learning to die. Learning to die is learning to live. I say that because the clock starts ticking the moment the doctor cuts the umbilical cord.

I appeal to my colleagues' humanity. I am a staunch democrat, humanist and, of course, sovereignist. I am all of those things, but one does not take precedence over the other when it comes to problems like this.

I am not saying that the federal government should have challenged that ruling because it came from a Quebec court. In any case, it is a court under federal jurisdiction that rendered that decision.

This ruling challenges us as legislators to do our job and stop off-loading the problems, the ethical, social and political questions to the courts. We have a job to do as legislators.

There is a sociology of law. In a society, the law evolves with people's consciences. I know I am straying from the technical details of the bill. However, I said from the outset that we agree in principle and on the grounds for discussion of this bill. I apologize for being overly philosophical today, but that is where the substance of the debate lies; it is ethical and it is political in the noblest sense of these words. Indeed, it is up to us to make the laws to ensure the well-being of all. It is a philosophical debate and, in a way, a theological debate that leads us to the law. However, regardless of how much time we spend on this, let us use substantive arguments.

When I hear arguments to the effect that this is a slippery slope, I think about the study of Bill C-14, during the last Parliament, when some people were practically saying that nursing homes and long-term care facilities would become euthanasia machines. I do not know of any evil people who work in health care, in any position. If such a person exists, then let them be fired, because they have no place there. I am not buying the slippery slope argument.

We must assume from the outset that all stakeholders in the health system are caring and compassionate. Yes, they sometimes experience difficulties. With just a slight increase in health transfers, they could provide better care and there might be more palliative care units in hospitals. Even though I do not believe that palliative care is the only solution, that is what people have been saying for 50 years. It makes no sense that there are not more palliative care units.

Not everyone asks for MAID. I talk a lot about those who do not pose a problem. In Quebec, where the Quebec law is in effect, the obligation to meet the criterion of a reasonably foreseeable natural death forces people to go to court or to go on hunger strikes. This criterion was unconscionable, and the courts handed down an appropriate ruling in that regard.

Therefore, I appeal to my colleagues' humanity.

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

Madam Speaker, I am going to offer four clarifications and then ask the member a question.

The first clarification is that, with respect to the conscience rights and whether they exist, they do exist in three places and I outlined them already: in the preamble, in subsection 241.2(9) of what was then C-14 and in the Carter jurisprudence. I think that is important, because this member is urging us to return to Supreme Court jurisprudence.

The second is about withdrawal of consent. Can it be done? Yes it can, through non-verbal means. That is entrenched in this bill.

The third is that the notion that people can die “all in one day”, and I am quoting the member opposite, is actually patently inaccurate in terms of the empirical evidence. There are two independent medical practitioners, completely divorced from the people who verify the identity of an individual, who determine the eligibility. Those people take some time to do so. It does not happen “all in one day.”

Finally, the issue about the independent witness going from one to two is simply to reduce one of the barriers.

If the concern is for ensuring that the autonomy and dignity of all individuals are entrenched here, does the member opposite agree that when the court, in Carter and in the Truchon decision, talks about ensuring that intolerable suffering is no longer continued, and that the dignity of those people who are making a personal choice about how they choose to exit this life should that be respected in the context of this legislation?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, in Bill C-14 from the previous Parliament, the decision was made not to include advance directives, meaning that someone would have to give consent at the time of medically assisted death. That is why, in the previous legislation, someone would have to consent and then give a further consent at the time of medically assisted death.

The bill before us would change that. This is a major expansion of Canada's laws on assisted dying. It was done under the premise of a response to an unrelated court decision in Quebec.

There is a reason parliamentarians and the House put in place a statutory review of this regime: so that we can consider new measures and look at what is working and see what is not working. This is why the whole discussion on this aspect of consent should have been done in the course of the statutory review.

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

Madam Speaker, I thank the member opposite for his contribution to today's debate and I welcome him back to the House.

I will begin by correcting about five errors in the member's speech and then I will ask him a question.

The first point is with respect to the Truchon decision. It was not appealed, first because we agree with the substance of the decision and secondly because we disagree with prolonging the suffering of Mr. Truchon or Ms. Gladu or people like them.

The second point is with respect to health care providers and the potential of a chilling effect being exacted upon them. It is a valid point, and that is why we have entrenched important safeguards in the legislation, such as the requirement for advanced consent to be done in writing.

The third point is on people being pressured as medical practitioners to engage in this practice, which is patently false. Bill C-14 has conscience rights entrenched in its preamble and in the body of the bill, and the Carter decision, in its penultimate paragraph, said that the charter protections under section 2 for freedom of religion does not compel any health care practitioner in this country to provide this service.

With regard to the member's attempt at an analogy between the 90-day assessment period and the 10-day reflection period, they are different qualitative matters. Reflection is not assessment.

The member raised a very valid point about palliative care. We agree and understand that palliative care must be robust and we fully support the idea, which is why this government put $6 billion into home care, including palliative care, two budgets ago. Does the member agree that this was a useful investment?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, it is a great pleasure today to rise as the shadow minister of justice for the official opposition to speak to the government's Bill C-7. As I rise to speak on this bill, I do so with concern over some of the contents within it and even over the way it was presented to the House this week when, unfortunately, many of us read about the contents of the bill in the media, rather than seeing it first in this House.

The bill was intended to be a response to the Quebec Superior Court decision that was made on September 11, 2019. The decision stated that the law as it stood was too restrictive around the requirement for death to be reasonably foreseeable. The official opposition called on the government at the time to appeal the decision to the Supreme Court of Canada in order for Parliament to receive clarity about the parameters in which we would legislate, but the bill was introduced without that clarity.

Not only was the bill introduced without that clarity, but it goes far beyond what was required to meet the Quebec Superior Court's decision. I believe that is an affront to this Parliament, because when the previous bill, Bill C-14, was passed in the 42nd Parliament, the wisdom of this Parliament required that there be a statutory review of our assisted dying regime in Canada. That statutory review was and is to take place in June of this year.

It is in that review period that parliamentarians would be able to go more into depth on how the government's legislation has worked over the past several years and on how best to proceed. Rather than wait for that review, as it should have done, the government has decided to start making amendments to the legislation now, avoiding the in-depth review that is to take place shortly.

The reality is that when we are talking about this legislation, we are literally talking about the matter of life and death. This is an incredibly sensitive issue. Members on all sides of the house have diverse opinions on it, and it is because of this diversity of opinions and because of the sensitivity of this issue that the Quebec Superior Court decision should have been appealed to the Supreme Court of Canada for further clarity. However, as the government has now opened this legislation up, it is upon us as legislators to now highlight other matters that should be addressed and included.

My office has heard plenty from concerned Canadians about the lack of protection for conscience rights for health care professionals. This is particularly important now that the government is broadening medical assistance in dying to include individuals whose death is not reasonably foreseeable. Expanding medical assistance in dying to more patients could in fact diminish the number of medical professionals willing to take part in the process. The fact is that this expanded access could result in a heavy emotional burden on those health care providers.

None of us here can fully appreciate the burden put on those health care providers currently working in the system and providing medical assistance in dying. The fact is that there is nothing about ensuring proper support to health care professionals who provide this service and there continue to be no penalties for pressuring a medical professional into providing medical assistance in dying, nor are there penalties for punishing or penalizing a medical professional who does not participate in medical assistance in dying. This means there continues to be no real protection for conscience rights for health care professionals.

The issue of advance directives, now rebranded as a “waiver of final consent” by this government, is a complex one that poses questions of ethics and safety and issues with oversight. The fact that the legislation legalizing this is half a page of a bill shows a lack of care given to this issue. This issue rightly should have been discussed as part of the parliamentary review to take place this summer.

The process for the creation and execution of this agreement remains ambiguous. Further, there is a lack of clarity on the process for proceeding with an advance directive agreement upon the date selected. The process will only be stopped if a patient expresses a form of resistance, but we do not know what that looks like. What if they are simply confused or groggy at the time? Under the legislation, unless they resist, the process will still proceed.

The bill also removes the 10-day waiting requirement when a person's death is reasonably foreseeable. When I read in media reports before the bill was tabled that this would be included, I, like many of many of my colleagues and parliamentarians, questioned as to what prompted its removal. I still remain incredibly concerned as to why this was included. This is particularly true because there was already the ability to remove the 10-day waiting period if a person's death or loss of capacity to consent was imminent, so why proceed with the removal of a safeguard that Parliament saw fit to include in the previous legislation?

It is also confusing that Bill C-7 requires a 90-day waiting period when a patient's death is not reasonably foreseeable. Why add an extended wait period for one, but remove the wait period entirely for the other?

On the issue of whether a death is reasonably foreseeable or not reasonably foreseeable, there is no clarification or guidance for health care professionals. As a result, it is not up to them to make the determination as to what category to put a patient under. That determination will decide whether a patient can access medical assistance in dying immediately or if they will require a 90-day waiting period. This is an extraordinary amount of pressure that the government is putting on health care professionals across this country.

The changing of witness requirements under this legislation has also been mentioned. The law requires only one independent witness, which is down from two.

All of these changes lead to an expansion of the law in Canada far beyond what was addressed in the Quebec court decision, an expansion that should have required deeper reflection through the study that is to take place this summer.

For a moment, let us speak to a point that seems to be lost in this conversation: palliative care services in this country.

The reality is if the choice is between a lack of quality palliative care and medically assisted dying, that really is no choice at all. Unfortunately, over the past number of years there have been instances of patients feeling they were forced to choose death because of a lack of palliative care.

The story of Archie Rolland comes to mind. Archie was a Montreal landscape architect who chose to end his life rather than continue suffering at a long-term care facility that was failing to provide him adequate care.

He had ALS and had his life upended when he was forced to move from a Montreal hospital that specialized in treating patients with severe respiratory ailments to a long-term care facility for geriatric patients. Mr. Rolland did not want to go, but he was transferred against his wishes. He called the system “inhuman”. He felt he was not getting adequate care, so he chose death.

I do not think that this is any real choice at all. We must have the discussion in this country about palliative care because people must not feel forced into a decision on medically assisted death. Mr. Rolland's story makes it clear that there was a failure of the system to provide him with adequate care. We risk medically assisted death being seen as some sort of bureaucratic solution for people who require an extra level of care. In a country like Canada, that is simply not acceptable. The government risks expanding a culture of not valuing life, and we should all agree in this place that we must place value on human life.

In closing, the bill disrespects Parliament and the parliamentary process. With Bill C-14, parliamentarians did a significant amount of work in the House and committee in an attempt to build consensus. The work was challenged by the Quebec Superior Court, but rather than defending the will of elected representatives in court, the Liberals immediately backed down.

Now the Liberals are responding not just to that decision but are also undoing the work of the joint committee on Bill C-14 by adding new measures.

Many of these issues should be dealt with in the summer when we have our scheduled parliamentary review. This is a complex matter that requires proper scrutiny and debate.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I remember that as we went through the very difficult discussions on Bill C-14, within the Catholic community in Guelph, to which I belong, there were a lot of concerns around advance directives and conscience rights and the protection of conscience rights within the Catholic community in particular. I remember that at the time I was asked a few times whether we were going down a slippery slope.

I want to be able to say to my community that we are looking to handle this legislation in a compassionate way that protects rights, but I would rather hear it from the minister so that I can take an authoritative comment on that back to my community.

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

Madam Speaker, I remember being in this place during the debate on Bill C-14 and reading through the Carter decision, which was very clear. There was also, of course, the important work that was done by the special joint committee of both the House and the other place.

When I was speaking to Bill C-14 in 2016, I knew the inclusion of the “reasonably foreseeable” aspect of the law was going to cause us problems, and here we are. I am sure the justice minister is feeling some closure, because he was one of four Liberals who voted against that bill. I am sure he is getting some satisfaction in revisiting this now.

I am pleased to report that the New Democrats support the bill in principle. However, we have a number of concerns, specifically with the assessment period for those whose natural death is not reasonably foreseeable but who are facing intolerable suffering. The bill sets up a period of 90 days. We have already heard from some physicians who have concerns with the fact that they have to tell patients to bear their illness and suffer for another 90 days.

Could the Minister of Justice inform the House on how the Liberals came up with that number? How did they determine that 90 days is the right amount of time?

[David Lametti, Liberal, Minister of Justice]

moved that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Madam Speaker, I am pleased to rise today to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

The bill proposes a legislative response to the Superior Court of Quebec's Truchon decision, as well as some other changes to the Criminal Code provisions that set out Canada's medical assistance in dying regime.

In June 2016, former Bill C-14 amended the Criminal Code to create Canada's first law on medical assistance in dying, or MAID. The legislation created exemptions to Criminal Code offences so that individuals suffering unbearably and nearing the end of their lives could die peacefully and with the help of a physician or nurse practitioner, rather than in agony or in circumstances that they considered undignified.

This significant change in our criminal law was indicative of the value that Canadians ascribed to having choices, including about the manner and timing of their deaths when suffering in the dying process was intolerable. The most recent data obtained by the federal MAID-monitoring regime indicates that over 13,000 Canadians have received MAID since it has become decriminalized.

We are now proposing another important change to our criminal law. In Truchon and Gladu, the Quebec Superior Court ruled that it was unconstitutional to limit access to medical assistance in dying to persons whose death is reasonably foreseeable.

We decided not to appeal the decision because we want to reduce the suffering of people waiting for medical assistance in dying.

When we announced our decision not to appeal the ruling, our government also committed to changing the eligibility criteria for medical assistance in dying throughout Canada to ensure that criminal law is consistent nationwide.

Application of the court's ruling, which is limited to Quebec, was suspended for six months. The deadline is March 12. Because these issues are so important and because we want to ensure that our laws are consistent all across Canada, we have asked the court for a four-month extension, which would give Parliament time to thoroughly consider and debate the amendments proposed in this bill. There was a hearing yesterday regarding this request.

Consulting Canadians about the next phase of medical assistance in dying in Canada was crucial to drafting this bill. That is why we launched a two-week public consultation on January 13. The level of participation was unprecedented. We received over 300,000 responses, an indication of how important this issue is to Canadians.

At the same time, together with the Minister of Health, the Minister of Employment, Workforce Development and Disability Inclusion and our parliamentary secretaries, we held 10 round-table discussions across the country between January 13 and February 3.

This included round tables in Halifax, Quebec City, Montreal, Ottawa, Toronto, Winnipeg, Calgary and Vancouver. We met over 125 individuals, including doctors, nurse practitioners, legal experts, members of the disability community, indigenous peoples, and representatives of health regulatory bodies and civil organizations.

We are grateful to all who participated in the round tables. Their shared expertise and experiences were of immense value in developing this bill. I have no doubt that many will continue to engage in the parliamentary process as witnesses before committees.

The results of this consultation process will be published shortly in a “what we heard” report. We heard views on many different topics, but I would like to mention just a few.

From the public online consultations we heard that, while the majority of respondents think the current safeguards are adequate to prevent abuse, in a MAID regime that is expanded to persons who are not dying in the near term, a majority of respondents also thought it would be important to require additional safeguards in such a broader regime. Many round-table participants suggested two separate sets of safeguards in an expanded regime. Others shared their experiences with existing safeguards as they apply to those who are near the end of their lives.

Specifically, many felt that the requirement for two witnesses when a person's written request was made was too onerous and afforded little protection, and that the 10-day reflection period unnecessarily prolonged suffering.

Informed by these in-depth consultations, and by the Canadian experience with medical assistance in dying to date, along with many other sources of information, Bill C-7 proposes to respond to the Truchon decision by adjusting both the eligibility requirements and the safeguards. It also proposes to enable patients in certain circumstances to waive the requirement for final consent so that they do not lose their access to MAID.

We know there are other issues about which many Canadians still feel strongly but which are not subject to the Superior Court of Québec's deadline, such as eligibility in cases where mental illness is the sole underlying condition, advanced requests and mature minors. These will be examined in the course of the upcoming parliamentary review.

Before describing the proposed amendments, I would like to address the concerns we heard from many in the disability community following the Truchon decision and during our consultations. Disability groups were very clear that, for them, removing the end-of-life limit on MAID would create a law that holds disability as a valid reason for ending a life and reinforces the false perception that disability is equivalent to a life of suffering.

Our government is sensitive to these concerns. We strongly support the equality of all Canadians, no matter their situation, and we categorically reject the idea that living with a disability is a fate worse than death. However, we are also mindful of the need to balance these concerns, along with others that have been expressed, with other important interests and societal values, in particular the importance of individual choice.

The bill's objectives are therefore to recognize the autonomy of individuals to choose MAID as a means of relieving intolerable suffering, regardless of their proximity to natural death, while at the same time protecting vulnerable persons, recognizing that suicide is an important public health issue and affirming the inherent and equal value of every person's life. More concretely, Bill C-7 proposes to expand eligibility for medical assistance in dying beyond the end-of-life context by repealing the eligibility criteria requiring that natural death be reasonably foreseeable.

Recognizing that intolerable suffering also arises outside of the end-of-life context and that Canadians want to have choices, medical assistance in dying would be become available to all those who are intolerably suffering; who have a serious and incurable illness, disease or disability; and who are in an advanced state of irreversible decline in capability, without regard to whether they are dying in the short term.

At this time, the bill proposes that persons whose sole underlying condition is a mental illness not be eligible for medical assistance in dying. First, we are subject to a court-imposed deadline and this matter requires more in-depth review and debate. We have learned that the trajectory of a mental illness is more difficult to predict than that of most physical illnesses. This means that there is a greater risk of providing medical assistance in dying to people whose condition could improve.

It is also more difficult to carry out competency assessments for individuals with a mental illness. In the case of some mental illnesses, the desire to die is itself a symptom of the illness, which makes it particularly difficult to determine whether the individual's request is truly voluntary.

Like the Government of Quebec, we are of the opinion that we need to continue consultations, discussions and policy development on the issue of MAID requests based solely on mental illness.

The parliamentary review that will be launched next June will be an appropriate forum for examining these issues, without the time constraints of the court-imposed deadline.

I would now like to turn my remarks to the question of safeguards. Many experts believe there are greater risks in assessing requests for MAID from individuals who are not nearing the end of their life. We agree. While these individuals would have a choice to seek MAID, the bill proposes that these requests be treated with greater sensitivity and care.

Accordingly, the bill proposes two streams, or two sets of safeguards. To distinguish these cases the bill proposes to use the concept of reasonably foreseeable natural death. Let me be clear on this point. Not having a reasonably foreseeable death would no longer be grounds for rejecting a MAID request; however, it would be used to determine which of the two sets of safeguards are required in a given case.

As enacted by Parliament in 2016, reasonable foreseeability of natural death refers to a death that is expected in the relative near term. It means that in light of all the person's medical circumstances, his or her death is expected in a relatively short period of time. Natural death is not reasonably foreseeable just because an individual is diagnosed with a condition that will eventually cause death many years or decades into the future.

In practice we know that practitioners are more comfortable prognosticating when death is expected in shorter time frames. The standard of reasonably foreseeable natural death provides flexibility in a way that maximum fixed prognosis would not. The standard also has the advantage of using language that practitioners have become familiar with over the last four years.

Those who are dying in the short or near term would benefit from the current set of safeguards in the Criminal Code, which the bill proposes to change in two ways.

First, the 10-day reflection period would be eliminated. We heard during the consultations that most persons have already given their MAID request a lot of thought by the time they sign their written request, resulting in the reflection period unnecessarily prolonging suffering.

Second, the requirement for two independent witnesses would be amended so that only one independent witness to the written MAID request is required. Further, we have added an exception so that health care and personal care workers who are not the person's provider or assessor would now be able to act as an independent witness.

Again, we heard that it is difficult for some who live in long-term care facilities or in remote areas to locate two independent witnesses. The purpose of the independent witness is simply to verify the identity of the person signing the request. The witness is not involved in the assessment process.

For persons whose death is not reasonably foreseeable, the existing safeguards would all apply with some additional ones. Specifically, the bill proposes a minimum 90-day assessment period, which will help ensure that practitioners spend sufficient time exploring the various dimensions of the person's MAID request, which, outside the end-of-life context, could be motivated by different sources of suffering requiring greater attention.

Also, at least one of the practitioners assessing eligibility would have to have expertise in the condition that is causing the person's intolerable suffering. The safeguard aims to prevent people from obtaining MAID when something could have been done to relieve their suffering or improve their condition.

The bill would also clarify the notion of informed consent for these kinds of cases.

First, a person who is not dying would have to be informed of the means available to relieve suffering, including counselling services, mental health and disability support services, community services, and palliative care, and be offered consultations with professionals that provide these services.

Second, the practitioners and the person would also have to agree that these means of relieving their suffering were discussed and seriously considered.

The bill also proposes to allow people whose death is reasonably foreseeable and who are eligible for medical assistance in dying to give prior consent if they risk losing capacity to consent before the date set for MAID. At present, the Criminal Code requires the practitioner to ensure, immediately before MAID is provided, that the person gives express consent to receiving MAID.

The bill would enable a patient who has already been assessed and approved to enter into an advance consent arrangement with their physician that sets out all the relevant details, including the date selected for the provision of MAID and the fact that the person consents to receiving MAID in case they lose the capacity to consent by the day in question.

Although this scenario was not covered in Truchon, experts told the government that it presents relatively little complexity and risk. Doctors also told us they would be comfortable with the idea of providing MAID under such circumstances.

To our government, compassion means ensuring that people waiting for MAID do not lose their opportunity to die in the manner or on the date of their choosing just because their medical condition robs them of the capacity to make decisions in their final days.

Another narrow form of advance consent would also be allowed in the unlikely event that complications arise after a person who has been assessed and approved self-administers a substance intended to cause their death and loses the capacity to consent to MAID, but does not die.

The patient and their physician could enter into an arrangement in advance, stipulating that the physician would be present at the time the patient self-administers the substance and would administer a substance to cause the patient's death in case the patient loses their capacity but does not die.

The data show that there have been very few cases of self-administration so far, perhaps due to fears of possible complications stemming from self-administration of a substance. Offering such an option could provide greater reassurance and allow more Canadians to choose this form of medical assistance in dying.

There are other changes in the bill that my colleagues will speak to, including changes to enhanced data collection and the monitoring regime that brings accountability and transparency to the practice of MAID in Canada.

A transitional provision would ensure that patients who have already signed their request when the bill comes into force would not be required to undergo any additional safeguards set out in the bill. At the same time, they would be able to benefit from the safeguards that would be eased, such as the elimination of the 10-day reflection period and the possibility of preparing an advance consent arrangement if it applies to that person's situation. We are committed to making the process as easy on patients as possible.

I would also like to briefly discuss the constitutionality of the bill. I have examined the bill as required by the Department of Justice Act. This involved consideration of the objectives and features of the bill. I am confident that the bill responds to the Truchon ruling in a way that respects the charter.

As is required by the Department of Justice Act, I will table a charter statement in the near future, which will lay out some of the key considerations that informed the review of the bill for inconsistency with the charter. This will serve to better inform parliamentary debate on this important piece of legislation.

I will conclude by thanking all those who participated in the consultations on medical assistance in dying and who contributed to the drafting of this bill. Bill C-7's proposed amendments to Canada's medical assistance in dying regime represent a fundamental policy shift, with the regime becoming less about end-of-life care and more about autonomy and alleviating intolerable suffering.

I look forward to working with all members of both chambers to ensure Bill C-7 is passed.

Alleged Premature Disclosure of Contents of Bill C-7

[Rob Moore, Conservative, Fundy Royal, NB]

Mr. Speaker, I rise on a question of privilege today concerning the premature disclosure of the contents of Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, introduced yesterday.

As you know, it is a well-established practice in the House that, when a bill is on notice for introduction, the House has the first right to the contents of that legislation.

In a report circulated prior to question period, and hours before Bill C-7 was read a first time in the House, the Canadian Press published an article that detailed specific information contained in Bill C-7.

In the article it states:

The bill [would] scrap a provision in the law that allows only those already near death to receive medical assistance in dying—as ordered by a Quebec court last fall....

Sources say it will drop the requirement that a person must wait 10 days after being approved for an assisted death before receiving the procedure. And it will drop the requirement that a person must be able to give consent a second time immediately prior to receiving the procedure.

The reporter gives credence to the fact that contempt has occurred by revealing later in the article:

The sources spoke on condition of anonymity because they were not authorized to reveal details of the bill prior to its tabling in the House of Commons this afternoon.

After the sources indicated to the reporter that they were aware of their guilty actions, they boldly and defiantly continued their affront to Parliament by providing even more detail of the bill.

I quote again from the article, which states:

Sources say today's bill will not deal with broader issues that were excluded in the new law and that must be considered as part of a parliamentary review of the law that is to begin this summer.

Those issues include whether mature minors and those suffering only from mental [illness] should be eligible and whether people who fear losing mental capacity due to conditions like dementia should be able to make advance requests for medical assistance in dying.

It will, however, propose a measure intended to deal with a situation in which a person is given consent and who has been approved for an assisted death loses the mental capacity to give consent a second time immediately prior to receiving the procedure.

After carefully reviewing the contents of Bill C-7 following its introduction in the House, when I and other members of Parliament got to see the bill for the very first time, the details reported by the Canadian Press hours earlier were indeed contained in Bill C-7.

Ironically, my first precedent to present to you is from the last Parliament, brought to the Speaker's attention on April 14, 2016. It was with respect to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.

It would appear that the Liberal justice team just has not learned any lessons as it was pointed out on April 14, 2016, as I am pointing out today on Bill C-7, that specific and detailed information contained in Bill C-14 was reported in a newspaper article and elsewhere in the media before the bill had been introduced in the House.

On April 19, 2016, the Speaker found that there was in fact a prima facie case of privilege regarding Bill C-14. He stated:

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

The Speaker's concluding remark on April 19, 2016, was as follows:

In this instance, the chair must conclude that the House's right of first access to legislative information was not respected. The chair appreciates the chief government whip's assertion that no one in the government was authorized to publicly release the specific details of the bill before its introduction. Still, it did happen, and these kinds of incidents cause grave concern among hon. members. I believe it is a good reason why extra care should be taken to ensure that matters that ought properly to be brought to the House first do not in any way get out in the public domain prematurely.

On October 4, 2010, on page 4711 of the House of Commons Debates, Speaker Milliken noted:

It is indisputable that it is a well-established practice and accepted convention that this House has the right of first access to the text of bills that it will consider.

Getting back to my point about the Liberal justice team not learning any lessons, there was a similar case from March 19, 2001, regarding the Department of Justice briefing the media on a bill before members of Parliament. In that reading, Speaker Milliken said, at page 1840 of the House of Commons Debates:

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

The Speaker found another case of contempt on October 15, 2001, after the Department of Justice again briefed the media on the contents of a bill prior to the legislation being introduced in the House.

Maybe, in this minority House, members can finally take these characters in the Minister of Justice's office to task for their continuous disrespect of this Parliament. Given the facts presented and the clear precedents on this matter, I believe, Mr. Speaker, you should have no trouble in finding a prima facie case of privilege. In that event, I am prepared to move the appropriate motion.

Physician-Assisted Dying

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, I rise today to present a petition on behalf of many of my constituents, who are calling on the government to support the passage of Bill C-418, a bill that seeks to reaffirm our fundamental rights found in the Charter of Rights and Freedoms, those being the rights to conscience and religious freedom. They are calling for these changes because in the wake of the passage of Bill C-14 regarding medical assistance in dying, there is a lack of clarity on what the rights are of medical professionals and medical institutions regarding conscience rights on these very contentious social issues.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, I have 17 petitions to present from seven provinces, including my own province of Saskatchewan.

The petitions address the issue of Bill C-14, which prohibits compelling health care providers or institutions to provide medical assistance in dying but lacks clarity for effective enforcement.

Bill C-418 would provide that protection and make it an offence to intimidate a health care professional for the purpose of compelling him or her to take part in the provision of assisted suicide or to affect his or her employment.

The petitioners call on the Government of Canada to ensure that the conscience rights of medical personnel are protected by passing Bill C-418.

Protection of Freedom of Conscience Act

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Mr. Speaker, I am extremely pleased to speak today to Bill C-418 tabled by the member for Cypress Hills—Grasslands in 2018.

Bill C-418, an act to amend the Criminal Code (medical assistance in dying), would amend the Criminal Code to create two new offences aimed at protecting the freedom and conscience of health care professionals who object to participating in or providing medical assistance in dying.

One proposed offence would focus on intimidating or threatening behaviour aimed at forcing a health care professional to participate in the provision of medical assistance in dying against their wishes.

The other proposed offence would prohibit an employer from punishing a health care professional because he or she objects to participating in the provision of medical assistance in dying, either by firing the individual or refusing to hire them.

This legislation proposes to build on Bill C-14 that Parliament adopted nearly three years ago. Bill C-14 amended the Criminal Code to legalize medical assistance in dying in response to the Supreme Court decision in Carter v. Canada, 2015.

These Criminal Code amendments created new exceptions for the offence of culpable homicide and aiding a person to die by suicide. The exceptions permit medical professionals to bring about a peaceful death for patients who can no longer endure the physical pain or psychological suffering they experience toward the end of their life.

We must keep in mind the seriousness of this behaviour. Health care providers are being asked to end life. This was not just prohibited by the criminal law until very recently, but also expressly prohibited by medical ethics.

These are just some of the reasons why medical assistance in dying is a deeply personal and difficult issue, implicating many values of the highest order of importance in our society. I am speaking of fundamental societal values, such as equality, individual autonomy, respect for life, protection of vulnerable persons, dignity and compassion.

Medical assistance in dying also implicates the conscience rights of medical professionals. This is the fundamental value that I understand motivates Bill C-418.

In its reports on certain types of requests for medical assistance in dying, which were tabled in the House only a few months ago by the Minister of Justice and the Minister of Health, the Council of Canadian Academies said that a person’s individual life experience, values and beliefs inform their perceptions about the question of medical assistance in dying.

While we all share certain experiences and values, each of us also has our our own unique experiences. This diversity of life experience, as the Council of Canadian Academies alludes to, gives each of us our own unique way of ordering the importance of the values in circumstances when they come into conflict.

Members of the chamber have no doubt seen firsthand this diversity of views in the letters they have received from constituents, or through conversations they have heard from coast to coast to coast. Many may have read the testimonies or written submissions that Canadians and organizations made to our justice and human rights committee while it was studying former Bill C-14.

Canadians have expressed a wide spectrum of perspectives and views on the issue. Some may resonate with our own personal beliefs and some may differ with them greatly. Many consider the question of health care providers' conscience rights and how they might be balanced against the rights of patients who are suffering unbearably and who choose medical assistance in dying.

While former Bill C-14 amended the criminal law to enable health care providers to respond to the wishes of patients who seek assistance in dying, it also made clear that it did not compel providers to provide or participate in the activity. This is stated in both the preamble of the bill and the relevant Criminal Code provisions.

Before this, the question of conscience protections was directly raised before the Supreme Court in the Carter case. In paragraph 132 of its ruling, the Supreme Court addressed several aspects of this question.

First, it explained that nothing in its ruling would compel physicians to provide assistance in dying, because its ruling simply rendered the old criminal prohibition invalid. This is consistent with the approach Parliament adopted in former Bill C-14, namely that in permitting medical and nurse practitioners to participate in medical assistance in dying, the criminal law does not compel them to do so.

The court did acknowledge that a physician's decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief. It concluded by underlining that the charter rights of patients and physicians would need to be reconciled.

Members of Parliament should not forget that medical assistance in dying is a complex issue with many facets and for which there are complementary spheres of responsibility. While Parliament is responsible for criminal law, provincial legislatures are responsible for the delivery of health care services and medical colleges and similar bodies are responsible for the regulation of health care professionals.

Medical assistance in dying is very new in Canada. On the ground, our health care systems and institutions are still adapting to the change. Some new laws and policies in the provincial domain have been developed, while others may still be under development.

ln terms of data, former Bill C-14 required the Minister of Health to put in place regulations for monitoring medical assistance in dying based on mandatory reports from health care providers. After a period of development and public consultation, this regime came into force on November 1, 2018. The first report is expected in 2020. lt may shed light on the quantity and quality of cases where practitioners who are asked to provide assistance in dying transfer care of the patient for reasons of conscientious objection.

In the meantime, Health Canada has released interim reports based on information voluntarily shared by the provinces.

According to the most recent report, released on April 25, 2019, over 6,700 Canadians have obtained an assisted death. That is a rather amazing figure.

There has also been some independent research conducted in Canada. One study, which is entitled “Exploring Canadian Physicians' Experiences Providing Medical Assistance in Dying: A Qualitative Study”, found that, in some cases, providers who participate in medical assistance in dying reported that it negatively affected their working relationships with colleagues. This finding is just as alarming as the prospect that practitioners would be physically threatened in order to coerce them into participating.

I ask members of this chamber, and all Canadians, to be respectful of the beliefs, values and perspectives held by others, even when they differ vastly from their own opinions. There is no single right answer when values collide. Our way forward must be a journey in which we engage, listen and try to accommodate, not threaten or provoke conflict.

I am pleased that Bill C-418 again gives us an opportunity to discuss medical assistance in dying and also focus on the vital importance of respecting differences and diversity. I urge all members to approach this bill and ongoing public and policy debates on medical assistance in dying with open minds.

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, right now many medical practitioners face the real threat of being discriminated against because of their deeply held ethical or moral beliefs.

Bill C-418 proposes to amend the Criminal Code to extend protection to those who choose not to provide or effectively provide medical assistance in dying by making it a punishable offence to use violence, threats of violence, coercion or any other form of intimidation to force a health care professional to participate in euthanasia.

The bill was brought forward by my colleague, the member for Cypress Hills—Grasslands. I wish to commend him for his noble efforts.

Two years ago, it was against the law for a doctor to take the life of a patient. In fact, one would think it unimaginable due to the oath a doctor takes. Medical assistance in dying was considered murder and any doctor who carried it out was deemed responsible for manslaughter.

It is now two years later. Medical assistance in dying is now permitted under Canadian law. However, medical professionals and Canadians from many backgrounds do not wish to participate in any form as it goes against their conscience.

While Bill C-14, the bill that makes medical assistance in dying legal within our country, advocates for those wishing to participate in the practice, it neglects or altogether fails to protect the medical practitioners whose conscience would be violated if they had to participate. This is a big problem as the professional judgment of many doctors still affirms that good medical care does not include hastening death.

Under section 2 of the Canadian Charter of Rights and Freedoms, Canadians are free to follow the religion of their choice. They are guaranteed the freedom of thought, freedom of belief and freedom of expression. These are considered fundamental freedoms in Canada. Nevertheless, Bill C-14 leaves physicians and Canadians of faith completely unprotected.

In Carter, the Supreme Court of Canada explicitly stated that the legalization of euthanasia did not entail a duty of physicians to provide it. It was not supposed to be forced upon them. To pay lip service to this ruling, this place, the House of Commons, put within Bill C-14 subsection section 241.2, which states, “nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

Despite these words, which is exactly what they are, simply words, the current government outright refused to put conscience protections within the federal legislation. This was despite the fact that many witnesses came forward to committee during this time and asked for conscience protections to be explicitly placed within Bill C-14.

I sat there during those committee meetings and listened to that testimony. I was one of the individuals who advocated for those conscience protections. There is absolutely no reason why they should not have been a part of the legislation. However, they are not, so it requires this private member's bill, Bill C-418, in order to adequately protect the conscience of our medical practitioners in the Canadian system.

Canadians should never be put in a situation where they feel they are forced to choose between their careers or beliefs. We live in Canada. We have a Charter of Rights and Freedoms. We should be able to engage in the career of our choice and have our ethical and moral values respected. We should be able to function according to our conscience. Currently, that is not the case. Those protections are not granted to medical practitioners the way they should be. Therefore, I call on the House to make a change, as is the member who sponsored this private member's bill.

Canada is a religiously plural and multicultural society. It allows its citizens to live out their lives according to their conscience, beliefs and values. In this country, freedom is our strength. I know the Prime Minister likes to talk a lot about how diversity is our strength. Sure, it contributes to it, but only when our freedom is intact and respects that diversity that exists. As soon as that freedom is attacked, diversity fails; diversity is no more.

Bill C-418 would restore such freedom of religion and conscience. It acts to defend medical professionals who act in good conscience and within their constitutional rights to not participate in medical assistance in dying. It should be argued that this bill addresses a legislative gap that was left by the current government. It completes the work the Supreme Court asked this place to do.

This bill is about protecting the very foundation of our country, Canada's religiously, plural and multicultural society, one that we are so proud of, happy to belong to and defend in this place as elected officials.

In 2016, medical assistance in dying became legal under law in Canada. As stated, that was Bill C-14. Just prior to that, in 2014, the Supreme Court ruled that to prohibit medical assistance in dying was actually a violation of section 7 within the Charter of Rights and Freedoms, the right to life, liberty and security of the person who wished to die. As a result, the Criminal Code was amended by the current government, which again is Bill C-14.

This has created a significant problem for many Canadians within the medical field, but it was not supposed to be this way.

When the Supreme Court of Canada ruled that the prohibition of medical assistance in dying was unconstitutional and needed to be fixed, it was stated that the legalization of medical assistance in dying did not compel or entail a duty for a physician to provide it. However, nothing was done to protect religious medical professionals from being forced to carry out this practice.

As a result, many practitioners across the country are calling on this place to make a further amendment to the Criminal Code in order to ensure their rights are respected. Their right to freedom and to act according to their conscience must be respected.

The argument often used is that medical practitioners can just refer their patients to another medical doctor, who will then provide the service. However, it should be noted that for some it is against their conscience even to refer someone to another medical practitioner. Those beliefs must also be respected.

Regional associations and regulatory bodies across the country have introduced regulations that strong-arm medical practitioners whose religious beliefs do not allow them to practise euthanasia in any capacity whatsoever.

In 2016, the College of Physicians and Surgeons of Ontario adopted a medical assistance in dying policy requiring medical professionals, who would not provide medical assistance in dying themselves, to provide an effective referral. This policy was challenged by religious groups.

A group of more 1,500 Canadians came together and challenged this regulatory decision. They said that it violated their constitutional rights, their rights to freedom of religion and conscience. Unfortunately, on May 15, the Court of Appeal for Ontario ruled that religious physicians and medical professionals must provide effective referrals if they themselves would not be involved with medical assistance in dying. It went on to say that those medical practitioners who believed this violated their conscience could go and find a job within the medical profession where medical assistance in dying would not be required of them.

That is incredibly demeaning to those individuals who have gone through years of training and who, with great dedication and commitment to their patients, have served. These are the women and men who have been trained as medical professionals and it is their conscience that motivates them and compels them to function with dignity, respect and honour and to provide the utmost level of care to their patients. Now they are being punished for holding those beliefs, for holding that level of dignity, respect and honour for their patients.

Again, I would plead that it does not have to be this way, that a change can be made to the Criminal Code that would in fact protect the conscience rights of these medical practitioners who, because of their deeply-seeded beliefs, are not able to participate in any way in medical assistance in dying.

I ask that the House rightly respond to the Supreme Court's decision in the Carter v. Canada case and put this change within the Criminal Code to rightly respond to that decision.

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

Madam Speaker, it is a pleasure to speak today to Bill C-418, the protection of freedom of conscience act. The bill proposes to create two new Criminal Code offences, an “intimidation offence” as well as an “employment sanctions offence”. Those offences would seek to protect health care professionals' freedom of conscience by prohibiting the use of intimidation to compel practitioners to provide medical assistance in dying and by prohibiting employers from dismissing practitioners for refusing to take part in medical assistance in dying.

Canada's medical assistance in dying legislation came into force almost three years ago, in June 2016. It allows adults who are suffering unbearably while on a trajectory towards death to seek the help of a medical practitioner or nurse practitioner in choosing a more peaceful death. Recently released data from Health Canada's fourth interim report reveals that as of October 31, 2018, more than 6,700 Canadians have received medical assistance in dying.

Addressing this issue and any matter of constitutional law in the House is always a pleasure for any lawyer in the House, and particularly for me who practised in this area for 15 years prior to entering the chamber.

Medical assistance in dying has been and continues to be a complicated and contentious issue. That is a given. It raises questions in relation to fundamental values about how we want to live and die as autonomous individuals, how vulnerable individuals must be afforded protection under the law and also about how we relate to each other as members of Canadian society.

The complexity of this issue warrants thorough reflection on the many points of view that inform it. Even within this place, different sets of values inform different positions taken when we debated former Bill C-14 at length.

For instance, as a result of the rich debate that took place, the legislation included a requirement that three independent studies be completed on topics that were particularly complex and beyond the scope of the former Bill C-14, namely, medical assistance in dying for mature minors, advance requests and requests where the sole underlying medical condition is a mental disorder.

The Council of Canadian Academies undertook the monumental task of canvassing the available evidence on these questions and produced three in-depth reports that will continue to inform the dialogue between the public and policy makers. Importantly, the reports themselves set out a variety of points of view among experts on these three issues.

Many members would also know there is ongoing charter litigation right now in the courts in Canada involving the eligibility criteria set out in the medical assistance and dying amendments to the Criminal Code that were passed three years before. These are ongoing matters.

It would be inappropriate to comment on them specifically, but I mention their existence to highlight the different fundamental values that medical assistance in dying implicates and that the legislation seeks to reconcile: supporting individual autonomy, protecting society's most vulnerable individuals and protecting broader societal values that go beyond an individual's desire to control their own death, such as the equality of all lives and the prevention of suicide.

We have seen in the opening comments of this debate the issue of the reconciliation of the charter rights held by the practitioners whose rights are being espoused by the member opposite from Cypress Hills—Grasslands, and also by the patients in the medical system, as was raised in the question by the member for Don Valley West and the member for Victoria.

As these complementary values underpin the particular Criminal Code exemptions that Parliament enacted to permit medical assistance in dying, they also play out on the ground. Indeed, just as Canadians in general may have different points of view about what medical assistance in dying should look like in Canada, so do the persons who are directly involved in this new practice, namely, our health care professionals, and in particular, the medical and nurse practitioners who are permitted to provide medical assistance in dying.

It is to be expected, and indeed Parliament heard, that this diverse group of professionals holds equally diverse views on medical assistance in dying. Our government firmly believes that medical and nurse practitioners, as well as other health care professionals involved in a patient’s care team, should not be forced to participate in the provision of medical assistance in dying.

Providing medical assistance in dying is a gesture with the most serious of consequences. Some health care practitioners view it as an important part of their practice that relieves a patient’s intolerable suffering when approaching death. Others view it as contrary to their conscience, religious beliefs or their professional role. Other health care practitioners might support the availability of medical assistance in dying in principle but simply not wish to be involved in the practice themselves. Our government supports and respects all of these different viewpoints.

It is crucial to note that in Canada the legal framework for medical assistance in dying is primarily one of criminal law. Parliament enacted careful exemptions to the offences of homicide and aiding suicide. This means that medical assistance in dying is permitted, but no one is compelled by the criminal law to provide it.

With the utmost clarity in this regard, the House of Commons Standing Committee on Justice and Human Rights adopted an amendment to what was then Bill C-14, adding a new subsection 241.2(9) to the Criminal Code of Canada that clearly states that nothing in the medical assistance in dying provisions compels health care professionals or practitioners to participate in medical assistance in dying.

It is also critically important, since we are debating constitutional law, to keep in mind that paragraph 2(a) of the charter protects freedom of conscience and religion and guards against unjustified government interference in one's religious beliefs and freedom of conscience. We know that. The law reflects that. The Carter decision of the Supreme Court of Canada incorporated that. I will read part of paragraph 132 of the majority decision in Carter, which says that “nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying”. Those words entered Bill C-14 and were further strengthened by the amendment proposed by the justice committee and voted on in Parliament.

Our government is mindful that the availability of medical assistance in dying in Canada may cause tensions in professional settings among medical and nurse practitioners who hold different views on this very topic. Strained relationships with colleagues were noted by the physicians who participated in a 2018 study published in the Journal of Pain Symptom Management, including physicians who are willing providers of medical assistance in dying but who work in environments that are predominantly opposed to medical assistance in dying. This example highlights the unique challenges that medical and nurse practitioners might face when they work in an environment with a majority or institutional view of medical assistance in dying that is different from their own.

In addition, eligible patient access to medical assistance in dying has to be reconciled with practitioners' conscience rights. This is the reconciliation that was raised in the context of this debate and in the Carter decision, and that has been reconciled within the framework of Bill C-14 as passed.

Importantly, provinces and territories have responsibility over the provision of health care and the regulation of professionals within their jurisdiction, and they face this complex task. In a context where we are debating constitutional law, it is important not just to look at the charter but also at the division of powers in the Constitution Act of 1867. When we are talking about regulating aspects of physicians in this country, that is germane to the jurisdiction of the various provinces mentioned in some of the responses by the member for Cypress Hills—Grasslands.

At the federal level, the Minister of Health has recently put in place regulations establishing a permanent monitoring regime for medical assistance in dying. The regime came into effect on November 1st, 2018. It will gather valuable data about written requests for medical assistance in dying and the patient making this request, but also about the reasons why a medical practitioner who received a written request referred the patient or transferred their care to another practitioner, including whether it was because providing medical assistance in dying or assessing someone for eligibility would be contrary to their conscience or religious beliefs.

National, consistent data about the number of requests for medical assistance in dying that are transferred because of a practitioner’s beliefs will inform Canadians about the breadth of this issue.

In addition, the medical assistance in dying legislation itself provided for a five-year parliamentary review of all of its provisions and the state of palliative care in this country. This review could begin as of June 2020. It will no doubt be informed by the comprehensive reports produced by the Council of Canadian Academies and any other available evidence about the Canadian experience, including that of health care practitioners involved in or affected by medical assistance in dying.

I wish to reiterate our government's respect for health care professionals' diverse points of view and beliefs about medical assistance in dying. We know that they hold their patients—

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

moved that Bill C-418, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Madam Speaker, the first thing I would like to do is to thank the many people across Canada who have shown up to work on this bill. It has caught on across the country. It has restored my faith in the good judgment of Canadians and, hopefully, we will see that same good sense shown in the House and we can have some restored faith here as well.

I am here today to speak to Bill C-418, which is the protection of freedom of conscience act. I need to point out again that I am surprised at the way this has caught on and caught the attention of the Canadian public. We should thank many Canadians and groups for whom this is an important issue for their work on publicizing and advancing conscience rights in Canada.

To begin to understand Bill C-418, we need to back up a bit. The Charter of Rights and Freedoms has a number of sections in it. Section 1, of course, guarantees our rights and freedoms. However, immediately following that is section 2, which declares the most fundamental rights, and that begins with freedom of conscience and religion. In 2015, the Carter decision in the Supreme Court said that although section 7 of the charter provides for the right to die, it also explicitly said that no one is required to participate in or be part of it.

We then came to Bill C-14, the government's assisted suicide bill. It is a bill that attracted much attention and controversy and laid out the groundwork for the first round of assisted suicide legislation in Canada. Whether they call it euthanasia, medically assisted dying or assisted suicide, they are all different names for the same thing. Medical practitioners were divided on the issue of participating in ending the lives of Canadians. Whether we supported Bill C-14 or not, it was clear that many within the medical community were very concerned. They did not and still do not want to participate in this activity.

When Bill C-14 was passed, it included subsection 241.2(9) which did say, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” That was not adequate because it did not lay out an offence, there was no framework for it and there was no penalty in Bill C-14 if someone violated that. It ended up being nothing more than a statement in Bill C-14.

While the Liberal talking points have repeated this, and the Liberals also claim that everyone has freedom of conscience and religion under section 2 of the charter, this is not the reality that medical personnel are facing across Canada. In spite of the fact that on the surface the charter, Carter and Bill C-14 supposedly agree, the reality is that physicians and medical personnel in this country are being pressured to participate in something with which they fundamentally disagree and there is no protection provided to them.

Conscience forms the basis of medical professionals' motivation to pursue their particular field. Doctors practise every day with the knowledge that it is their conscience that motivates them to test the limits of their knowledge and skill. Medical professionals know that patient care will suffer if they are deprived of the ability to live with integrity and to follow their consciences. They know the importance of these beliefs to them and their patients better than anyone else.

For a great many Canadian doctors, the core of their conscience prohibits their participation in taking a life. Indeed, many doctors remain devoted to the black and white of the ancient Hippocratic oath, a pledge that prohibits the administration of a poison to anyone. Through the availability of assisted suicide on demand across Canada, threats to conscience are no longer confined to the theoretical or to the rhetoric of the courtrooms. They are increasingly present in the examination room as well.

That is why I believe it is time to take action in defence of conscience rights that have stood the test of time for generations. Therefore, Bill C-418 seeks to amend the Criminal Code to do two things.

The first is to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of physician-assisted suicide.

The second provision makes it an offence to dismiss from employment or to refuse to employ a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of physician-assisted suicide.

My bill would provide the teeth that Bill C-14 acutely lacks. The Liberals' attempt to provide protection for doctors consisted solely of a rudimentary clause, which stated, as I said earlier, that nothing compels someone to provide or assist. However, the provision lacked the teeth needed for its effective enforcement, as evidenced by the ongoing pressure that is being exerted on physicians, particularly by their regulating bodies.

I guess the question is whether these protections are really necessary, and I would say that they are. Throughout the legislative process, I have spoken to doctors who feel overt pressure to leave family medicine because of their conscientious beliefs. I have heard of palliative care doctors in Ontario who have stopped practising altogether. Nurses who feel increasingly bullied are choosing to shift their focus or retire early. I have had personal conversations with people who work in old folks' homes who explain they do not want to participate in this but are increasingly feeling pressured to do so. The pressure on these professionals exists and they are looking for relief.

What is more, regional associations such as the College of Physicians and Surgeons of Ontario have introduced regulations compelling conscientiously objecting physicians to participate by providing what they call “effective referrals” for physician-assisted suicide. A recent court decision has upheld this directive, contravening the assurances provided in Carter v. Canada and creating an even more urgent need among physicians for protection. This is in spite of the fact that in this situation in Ontario I am told that the majority of physicians support an allowance for conscientious objections, but the college has not taken that position.

As strange as it sounds, the recent court decision refers to the college's suggestion that if physicians do not like to participate then they can find other areas of medicine to take up. This is unusual, particularly in a situation where we have such a shortage of physicians and medical services. The college suggests that if they do not like participating they can take up things like sleep medicine, hair restoration, sport and exercise medicine, skin disorders, obesity medicine, aviation examinations, travel medicine or perhaps become a medical health officer.

For many of us across this country, particularly those of us in rural areas, we know there is an increasing lack of physicians in an increasingly challenged medical system. I find it passing strange that the college would be the one suggesting such a thing for its physicians. The answer does not have to be to do it, find someone else to do it or get out of medicine. Medical personnel and resources are scarce. Why would one try to force people into doing what they believe to be wrong? The example of the province of Manitoba and its conscientious objection legislation shows there does not need to be compulsion in the medical system when it comes to this issue.

My bill does not address the social acceptability of euthanasia and assisted suicide; that is not the point of it. Protecting physicians' conscience rights is not at all a physicians versus patients scenario. By protecting physicians' conscience rights, patients' rights are enhanced. Bill C-418 is about protecting the fundamental freedom of conscience and religion guaranteed to all Canadians in the Charter of Rights and Freedoms.

Parliamentarians from all parties cannot ignore the groundswell of support this bill has received from average Canadians who believe it is time to stand up for doctors and health care providers who are not willing to leave their core ethics behind when they are at a patient's bedside. This is not theoretical. I have had photos sent to me of the revolving TV screens that we see in hospital wards, with pictures of what seems to be a physician's hand gently resting on the arm of a senior citizen, touting assisted suicide as a medical service whereby physicians or nurse practitioners help patients fulfill their wish to end their suffering and a phone number is provided. Interestingly, it makes no mention of palliative care or other ways to reduce pain and suffering. It makes no mention of access to counselling.

With government, the courts and health care facilities promoting access as a right, should not those who object be allowed to have that fundamental freedom of conscience that is so important?

I want to close with a quote from “The Imperative of Conscience Rights” by the CRFI. They write:

The outcomes of the current controversies that engage freedom of conscience will not only signal the extent to which Canadians can conscientiously participate in public life—in other words, whether they can live in alignment with who they are and what they stand for in matters of morality. These outcomes will also speak volumes about who we are and what we stand for—as a society. Suppressing beliefs with which we disagree or that we find offensive in the name of tolerance and liberalism is a contradiction in terms. The fact that the state has deemed something legal does not remove a person’s freedom to express her moral opposition to it. This freedom is not absolute, but its roots—integrity, identity, and dignity—are necessary for human flourishing. These roots must therefore be top of mind whenever limitations on freedom of conscience are proposed. We believe that governments should only limit this human right if there is a compelling justification.

Accessible Canada Act

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

Mr. Speaker, it is a pleasure for me to rise in the House today to address Bill C-81, an important piece of legislation that recognizes and affirms the inherent dignity of all people regardless of disability. It seeks to create the kind of policy environment and framework that facilitate full participation in every aspect of Canadian life for Canadians who have disabilities.

Those watching can be assured of the support of all parties in this House for this legislation. Today we will discuss some missed opportunities and some related issues on which we have not agreed with the government's actions. Specifically, for instance, we will discuss some of the issues around employment. We had a private member's bill from my friend, the member for Carleton, that dealt with facilitating the full involvement of Canadians with disabilities in terms of employment. There are areas of disagreement among the parties in terms of the best way to move forward and the best way to affirm these principles.

Nonetheless, those watching should know that we in the opposition, and all parties, are supportive of moving forward with this legislation. Whether the bill passes today or tomorrow, I am not sure of the exact timeline. However, I think we will certainly see this bill pass into law before the election. It will be good news and a positive step.

Before getting into some of the substance of the legislation, I want to pick up on something said by my colleague, the member for Foothills. He has done a lot of great work on this bill on our side, as have the member for Edmonton—Wetaskiwin and other members who have been part of the process. The member for Foothills pointed out that amendments for this bill that were put forward at the committee level by Conservatives, as well as by other opposition parties, were not supported by government MPs at the time of the initial study by the House of Commons committee. That is an important point, that they were not supported at that stage.

Notwithstanding disagreements about some of the particulars around amendments, we have supported this bill at every stage. After the bill passed third reading, it went to the Senate. The Senate made a number of amendments that reflected the same concerns that Conservative members of the House had been hearing from the stakeholder community, those representing Canadians with disabilities. Those same concerns that we heard were also heard by the Senate, and they were part of the discussion that happened in the context of that Senate committee.

The bill was amended somewhat at the Senate, and then it was brought back to the House. Now we are debating whether to agree to and support those Senate amendments. I think members will find, generally speaking, support across the parties for the Senate amendments, which make improvements on the text of the bill as it was.

Those who are watching should note how this legislative process works through the details, and how senators were able to be more influential over the legislative outcome than members of the House were. The government would not accept amendments that came from members of the House, but then accepted those same amendments that came from members of the Senate.

We have seen this in a number of cases. I recall Bill C-14, to which an amendment around palliative care was proposed. Actually it was not even just proposed at committee; it was voted on by all members in the chamber at that time. It was voted down. Then, in similar form, it was proposed by Senator Plett, and it passed in the Senate. It was then accepted as part of a subsequent message from the House of Commons.

We see this process happening, in general, in this Parliament, because of the relative lack of independence that we sometimes see in committees and the way committees are unfortunately quite controlled, and the relative independence of the Senate, certainly relative to the House of Commons. It is not as independent as maybe some like to claim, but it is relatively independent compared to the actions of members, especially government members, in the House of Commons. Senate action actually has a greater practical impact on the legislative process.

Again, although I am happy to see the incorporation of these amendments, I think we should be concerned about that, just as a matter of legislative process. We want this House and its elected members of Parliament to be strong in the exercise of their responsibilities.

Nonetheless, although we raise questions and highlight some of the means by which some of these issues have come forward, we are pleased to see these amendments. They reflect issues that have been raised by the stakeholder community and by members of Parliament from our party and, I believe, other parties as well.

With that said about matters of process, let me turn now to the particulars of the legislation, Bill C-81, that is before us. To summarize the content of the bill, in a nutshell, it is essentially about requiring regulated entities, that is, the public service and federally regulated workplaces, to develop accessibility plans. It also requires that the content of those plans be regulated and enforced.

As the minister and others have pointed out in some of the remarks they have made during this process, very often our human rights processes are complaints based. That is, complaints issues are considered when there is a violation or a potential violation of somebody's rights. A complaint is then made, and an adjudication happens around that complaint.

A point that the minister has made, and she is quite right in making it, is that this approach is not the full realization. It is important that people have those avenues available to them, but it is not the full extent of what we would like to see in this context. Rather, we would prefer to see a proactive approach, where we are ensuring the protection of rights from the beginning and not merely putting in place a system that allows complaints to be adjudicated after people's rights have been violated.

Seeking to have regulated entities develop plans, prepare and publish those plans, implement them and facilitate their enforcement creates the conditions for a more proactive approach to these issues, rather than simply a reactive approach. That is wise, worthwhile and something that all parties support. It would establish proactive compliance and enforcement mechanisms. These plans must be multi-year and involve the setting of goals, reporting requirements, mechanisms for investigation and a variety of processes that seek to ensure the realization of those plans to the fullest possible extent.

This legislation would also create an organization called CASDO, the Canadian accessibility standards development organization, and allocate $290 million over the next six years for its creation. This organization would work within the government to create regulations related to various aspects of the legislation around the built environment, employment, service delivery, information and communications technology, transportation and procurement, and always with the goal of the full integration of people with disabilities, facilitating their full participation within society, without barriers.

Failure to meet standards set by CASDO would lead to fines. It should be noted that the action of CASDO would be within federally regulated entities and directly within the federal government only. Nonetheless, the hope is that this legislation would involve the setting of standards that would then be adopted and become useful across all facets of Canadian society, including those outside the federally regulated workforce. There would also be 5,000 Canadians with disabilities hired for the public service, which is also encouraging to see. Our party, as people have seen, has been vocal on the issue of ensuring that those who have disabilities are not arbitrarily excluded from the public service.

This is the broad framework of the bill. It puts in place some mechanisms and processes to ensure there are no barriers to participation in society for people with disabilities.

Today we are in the process of debating issues related to proposed Senate amendments. The minister has spoken, and I would like to highlight the various Senate amendments that we are considering. Although the Senate did not incorporate all the changes that had been proposed at committee, in the House or that had been suggested by the broader disability community, all the changes that were made were reflective of those particular concerns.

First is the issue of including in this legislation a timeline for the realization of a barrier-free Canada; that timeline is 2040. The goal is that this work would be completed, taken fully to fruition, by 2040. The amendments also seek to clarify, though, that the setting of that deadline is not an excuse to wait until the proverbial night before to get the homework done. Rather, the amendments are to ensure the work is done by that point. They create that timeline or deadline but do not seek to permit any kind of delay or preservation of barriers in the name of it not being 2040 yet. That is an important element as well.

Growing up, I was always taught that deadlines are the mother of invention and that more gets done when there is the focusing effect of an upcoming deadline, so the work of the community and the Senate to ensure that there is a timeline in place for the implementation of these measures is quite commendable and important.

Another area of amendment from the Senate was that it asked that intersectionality be taken into consideration in this account. Amendments were put forward to recognize the multiple and intersectional forms of discrimination, the fact that people with disabilities may face discrimination as a result of an intersectional reality. Therefore, the planned response to barriers needs to be a response that takes that circumstance into consideration. We recognize that reality. We recognize the importance of the various plans that are put forward by regulated entities to recognize that intersectionality is part of the dynamic.

Further, the amendments put forward by the Senate seek to address the issue of preserving the existing human rights of people with disabilities. This was really more of a clarification, but the testimony heard in the House, as well as by the Senate committee, emphasized the importance of this clarification, recognizing that there are already obligations under various human rights codes, in particular in the case of federal entities under the Canadian Human Rights Act and other federal laws. Various groups highlighted the importance of clarifying that the new framework put forward with this bill does not in any way derogate from the existing recognized rights and obligations that are enumerated as part of those existing human rights codes. We recognize that aspect as important as well.

Through other amendments, the Senate sought to protect existing rights in the context of passengers with disabilities through the Canadian Transportation Agency.

The expectation is that many of the complaints would come through the Canadian Transportation Agency. This was put forward by people in the disability community. It is therefore important for the legislation to create enforceable standards around the action that this body must take in the removal of barriers. This is an important piece as well.

On the specific issue of transportation, I want to read briefly from a briefing from ARCH Disability Law Centre. It said the following:

However, subsection 172(2), a provision that is currently in the Canada Transportation Act, effectively means that once the CTA make these regulations and transportation providers, like airlines, comply with these regulations, they do not need to do anything more.

This is problematic because the regulations that the CTA sets may not meet the duty to accommodate protections that people with disabilities have under human rights law.

Under subsection 172(2), if a passenger with a disability complains to the CTA that an airline or other transportation provider should have accommodated his or her disability, the case would fail if the airline complied with CTA regulations. A more detailed analysis of this is available in the final legal report.

The committee did not repeal subsection 172(2), but adopted an amendment which would change it. The proposed amendment allows the CTA to find that there is a barrier to accessibility even if the transportation provider has complied with the CTA regulations. For passengers with disabilities, this means they can file a complaint with the CTA that they face an undue barrier in the federal transportation system and insist the transportation provider do more than what the CTA regulation requires.

The passenger with a disability could win his or her case even if the transportation provider complied with all CTA regulations. However, the CTA could only order the transportation provider to take corrective measures. The CTA could not order the transportation provider to pay the person damages or money compensation. This is different from other complaints to the CTA about inaccessibility of the federal transportation system. Generally, for these other complaints, the CTA can order the transportation provider to take corrective measures and to pay damages to the person.

Essentially, the argument that is being made is that although the amendment would improve the section, there still would be a gap. People in the community expect transportation companies, airlines, rail lines etc. to accommodate those with disabilities. The concern is that these entities might be able to say that they have met the standards of the regulations so they do not have to do anything more if in fact the case may be that they could and should do more to accommodate the full participation of a person with a disability.

The Senate amendment says that the CTA could well find that the transportation provider should have done more even if it attained the minimum standards set by the regulation, but it could not award damages in this case. That is an improvement made through the work of the Senate, but as the discussion around this illustrates, there is still a gap in what was asked for and what was expected.

The next amendment is around the issue of sign language. The legislation recognizes specific forms of sign language: American sign language, Quebec sign language and indigenous sign languages. It recognizes these as primary languages used by deaf persons in Canada. This has been an issue that the deaf community in particular has been long advocating on, and it has the support of all other stakeholders as well.

We have had many discussions in the House about the importance of language. We recently had a debate on indigenous languages, a legislative framework around indigenous languages, the importance of our two official languages and the experience and culture that are tied to the use of language in that context.

As well, I think we all recognize that the recognition of sign language is part of that picture as well as part of a broader, deeper appreciation of the way in which language is tied to culture and experience. Of course, for people who are limited in their ability to communicate in other ways, it is particularly necessary. It does have significance and meaning beyond the necessity of communicating in that form.

These are some of the amendments the Senate has adopted to the bill. They do not address all the issues that people in the stakeholder community and the wider community have been looking for, but they are steps forward and are things that are well supported by all members of Parliament. We are hopeful this will go forward and we will be able to see movement to get these amendments through.

In my remarks today I want to frame a little of the discussion around who the bill is for. In other words, why are the technical elements I have explained important and who do they matter to specifically.

In that context, I want to make a few remarks about Jean Vanier, about his vision of inclusion, but of something much bigger and greater than inclusion. As we talk about these issues, he is a figure on whom all of us should reflect. He is certainly the greatest known champion of people with disabilities.

He passed away earlier this month. His death was met with recognition and tributes from all aspects of our politics and many different aspects of Canadian society. He was a revolutionary figure practically in how he sought to facilitate the inclusion in society of people with disabilities. However, he was also a revolutionary figure intellectually. His experience as a philosopher and his way of thinking informed and contributed to his work. He was described in biographies as a philosopher and a humanitarian, which is an optimal and necessary combination. It is dangerous to be a philosopher without being a humanitarian and it is dangerous to think of oneself as a humanitarian without some attention to the philosophical roots of humanitarian work. We see that intimate connection between the ideas Jean Vanier sought to advance and the practices he championed.

Jean Vanier came from a privileged family. His parents were well known as well. He was born when his father was part of a diplomatic mission. He had a military career as well, but then he pursued a doctorate in philosophy. His dissertation would position much of the work he would do later. His dissertation was on happiness as principle and the end of Aristotelian ethics.

I feel a connection to that because I did my Masters dissertation on happiness measurement, which was also significantly influenced by Aristotle. The question of happiness is under-discussed in politics. It is important for a lot of the legislation. He was someone who brought in a philosophical framework to the work he did that was rooted in Aristotelian concepts of happiness. In the meantime, he drew on Aristotle's conception of happiness, which is different from a contemporary concept of happiness. This influenced his work with Canadians with disabilities.

Jean Vanier's desire for disabled people was not merely that they experience formal, structural inclusion or be able to get into the same spaces as everyone else. Rather, his desire was for them to experience love and happiness through community and friendship. Therefore, he sought to build communities of disabled and non-disabled people living together in meaningful friendship.

Vanier wrote this:

The cry of people with disabilities was a very simple cry: Do you love me? That's what they were asking. And that awoke something deep within me because that was also my fundamental cry.

He noted that the pursuit of recognition of their humanity, happiness and love was what people with disabilities were seeking, which was often denied to them by a structure that did not affirm their dignity. The thing they were seeking was the same thing that all people were seeking and that in fact they could and they would seek that together. That was Vanier's wisdom and vision.

He developed into his work, and would write subsequently about them, concepts of happiness informed by his work with people with disabilities. He drew very much on Aristotle's concept of happiness. Aristotle, writing in Greek, obviously uses the word “eudemonia”, which more directly is translated “the life well lived”. He argued in that context against notions of happiness that were more pleasure-based, more rooted in happenstance, the random benefit of good fortune generally in material terms. He had a richer understanding and appreciation of what happiness was.

Aristotle argues, and Vanier follows him in this sense, for the connection between virtue and happiness, that virtues are the qualities of character that allow life to be lived well.

We know as members of Parliament and as human beings that so much of human striving is in pursuit of happiness. We do not always agree on what that is or on how we strive for it, but so much of life is about striving for happiness.

More recently, our side has been very much influenced by the utilitarian school of thought, which argues that happiness is about pleasure over pain. This was the core of Bentham's concept of utilitarianism. Mill formerly follows it, but he reinserts aspects of Aristotle's definition of happiness with arguments that the cultivation of higher levels of happiness requires the development of a certain nobleness of character.

Vanier's passion for philosophy and the idea of happiness continued throughout his life. In 2001, he wrote “Made for Happiness: Discovering the Meaning of Life with Aristotle”. In it he talks about three utilitarian virtues: love, wisdom and justice. I want to read a quote from the book in which he talks about the importance of friendship and love as part of friendship.

He states:

Through friendship I communicated in the consciousness that my friend has of his own existence. For in the same way that we feel that we are alive and exist through activity and derive pleasure from it, so, through friendship, we feel our friend live and exist. And the union is so profound that the goodness of the life of our friend extends to us and gives us pleasure. In friendship there is almost a communion, a merging of two beings and their rightful good. The friend is an other self. Everything that I experience, he experiences.... In this friendship we continue to be two, but we are one in a great and noble activity that we accomplish together. Consciousness of the goodness of my friend fills me with just as much joy as if it were my own. My friend's happiness becomes my happiness.

This was his philosophical concept of friendship that was essential for happiness, facilitated by the virtue of love. It informed his practical vision for building communities that would include disabled and non-disabled people. We could call that inclusion, but it is a much richer and deeper concept of inclusion than a formal one. It is that we live in communities of love, good will and solidarity for each other with real friendship. We see others as another self and we identify with that kind of love for others. It is part of his concept of happiness, which entails friendship and living together while in community.

Jean Vanier, as I said, brought a rich concept of happiness, love and friendship into his work with disabled people. He saw people in institutions when he was living in Paris at the time of the founding of the L'Arche movement, who were being maintained poorly in the worst instance. He saw that very often the attitude towards the disabled resulted, in the worst instance, in people being maintained poorly, and in the best instance people being treated a little bit better in terms of their material condition. However, the real need was for the humanity of all people to be affirmed through communities of meaningful friendship and love, through which people were pursuing happiness together. That was his vision.

The radical practical idea started with Vanier personally getting a house and moving in with people who had disabilities. He saw that this was not merely an act of service done by him for other people; rather, it was about the development of shared community. He saw how through this reality of shared community he could learn from those people he was living with. He wanted other people who did not have disabilities to be able to learn and grow through these communities and friendships, which were meaningful and pursuing happiness together.

Jean Vanier said that “L'Arche and Faith and Light have been part of a real revolution.” So often in the past, people with intellectual disabilities were seen as a source of shame for their parents, or even in some situations as a punishment from God. Their parents and carers have often been seen as wonderful people, even holy, for looking after people “like them”. Today, it is becoming clear that it is people with intellectual disabilities who humanize us and heal us if we enter into real friendship with them. They are in no way a punishment from God, but rather a path toward God.

He understood that people with disabilities are in their fullest and most complete sense people. They are human beings with the same dignity and value as anyone else. They have both needs and things to contribute, which is obviously the situation of us all. Those needs and contributions are realized through meaningful community. He also understood that the value of social structures replicating insights and benefits of family-like structures.

I was recently in Bogotá, where I had a chance to visit SOS Children's Village to see some of the work they were doing. They made a very interesting point to me about the way we care for children who cannot be cared for by their families. I think it is a similar insight to Jean Vanier, which is that institutions' formal structures do not work nearly as well as, let us say, family-like structures. The way SOS works, at least in Columbia where I was, is that children are put into environments designed to be family-like. They are in homes. They have parents looking after them. Although they are not able to be with their own families, they experience a support structure that is meaningfully similar to that of a family and that leverages the kind of love, connection and friendship that is important in family structures. That was understood by Jean Vanier when he sought to do the same thing in how he structured the L'Arche movement with meaningful family-like communities where people would live together in communities of love and friendship.

Very shortly before he died, Jean Vanier received the Templeton Prize, which is a great international honour. He spoke about the work he did and the ideas and vision behind it. It showed us the kinds of sensibilities that should animate our work in this area. I want to read from part of his acceptance speech for the Templeton prize. He said:

L’Arche and Faith and Light have been part of a real revolution; so often in the past people with intellectual disabilities were seen as a source of shame for their parents, or even in some situations, as a punishment from God. Their parents and carers have often been seen as wonderful people, even holy, for looking after people “like them”. Today it is becoming clear that it is people with intellectual disabilities who can humanise us, and heal us, if we enter into a real friendship with them. They are in no way a punishment of God but rather a path towards God....

To be with is to live side by side, it is enter into mutual relationships of friendship and concern. It is to laugh and to cry together, it is to mutually transform each other. Each person becomes a gift for the other, revealing to each other that we are all part of a huge and wonderful family, the family of God. We are all profoundly the same as human beings, but also profoundly different, we all have our special gifts and unique mission in our lives.

This wonderful family, from its earliest origins and since then with all those who have been spread over this planet from generation to generation, is composed of people of different cultures and abilities, each of whom have their strength and their weakness, and each of whom is precious.

The evolution of this family from the earliest days until today certainly has entailed wars, violence, and the endless seeking of domination and more possessions. It is also an evolution wherein prophets of peace have continued to cry out for “peace, peace”, calling people together to meet each other as beautiful and precious.

Many of us in our world continue to yearn for peace, and for unity. However so many of us remain stuck in our cultures where we are caught up fighting to win and to have more. How can we become free of the culture that incites people, not to responsibilities to the human family and to the common good, but to individual success and to domination over others? How can we get rid of the tentacles and the shackles of this culture, to become free to be ourselves, free of our oversized egos and compulsions, free to love others as they are, different yet the same?

To be with is also to eat together, as Jesus invited us: “When you give a meal don’t invite your family, friends or rich neighbour, but invite the poor and the lame, the disabled and the blind, and you shall be blessed.” To become blessed, says Jesus, is to invite the poor to our table (Luke 14).

Let us be very clear that it is not the guests who are blessed because they enjoy good food at a party, but rather the host is blessed by his encounter with the poor. Why is the host called blessed? Isn’t it because his heart will be transformed as he is touched by the wonderful gifts of the spirit hidden in the hearts of the poor? This has been the gift of my own personal journey and those of many others. We have been led by those who are weak onto the road of the blessedness of love, of humility and of peacemaking.

To be transformed, first we must meet people who are different, not our family, friends and neighbours who are like us. Let us meet across differences—intellectual, cultural, national, racial, religious and other differences. Then from this initial meeting we can begin to build community and places of belonging together.

Community is never called to be a closed group, where people are hiding behind barriers of group identity, interested only in their own welfare or their own vision, as if it is the only one or the best. It cannot be a prison or a fortress. Unfortunately, for a long time this was the rather closed vision of different churches and religions. Each one thought itself the best, with all knowledge and truth. Hence, there was no communication or dialogue between them.

Isn’t there a danger that we close ourselves up in our own professional, religious or family groups where we never meet those who are different?

Community, on the other hand, is a place of togetherness in spite of differences, of people united in love and open to all other people. A community then is like a fountain or a shining light, where a way of life is being lived and revealed, open to others and attractive to them. It is a place of peace, revealing a way to peace and to unity for the human family.

Community is a place of belonging where each person can grow to become fully him or herself. It is belonging for becoming.

We belong to each other so that each member can become more human, more loving, more free, more open to others, particularly to those who are different. When each member can develop their unique gifts and help others to develop theirs, members are no longer in competition but in collaboration, in cooperation and in mutual support.

To become is not to prove I am better than you, but rather supporting together each other in opening up our hearts. Thus community is a place of transformation. Community is a place of belonging where each one may be transformed and find human fulfilment.

What alternatives do we have for human growth? Belonging which is too rigid stifles becoming; on the other hand too much individual growth or becoming without belonging can become fighting to get to the top, or else it can become loneliness and anguish. To win is always to be lonely, and of course nobody wins for long.

Community then is not a closed group but a way of life that helps each person to grow to human fulfillment. The two key elements of community are mission and mutual caring for each one. We come together for a purpose that is the mission, and also to be a sign of love or rather to grow in love for each another. It is a mission that defines why we are together, and being together we learn to love one another.

At L’Arche and Faith and Light our mission is to provide community where the most fragile person is the heart of the community, and can grow in their humanity and in their capacity to love.

Community then becomes a place where we learn how to love each other. To grow in love is a long and difficult journey, and it takes time. L’Arche and Faith and Light are not just places where we do good to people with intellectual disabilities. They are places of relationship, where we grow in love together.

But what is love? This word has been flung around for all sorts of emotional experiences as well as acts of bravery of solders, fighting out of love for their country. For me, love is to recognize that the other person is a person, is precious, is important and has value. Each one has a gift to bring to others. Each one has his or her mission in the larger family of humanity. Each one reveals the secret face of God.

We need each other, to grow in this sacred love, which implies love of those who are different, of those who get my goat and drive me up the wall, because of difference of ideas, temperament, culture, approach and so on. Community is a place where we rub up against each other’s sore spots.

Hopefully we can in this way rub off some of the tiresome and sour traits of our characters, so that we can become our real selves. To love then is to see in the other, the heart of the person hidden under all that annoys us. That is why to love, in the words of St Paul, is to be patient, which is to wait, and to hold on. It is to believe and to trust that under all the mess in the other person is their secret being, their heart.

In L’Arche some of the people we welcome have deep anguish and even violence. They are difficult to live with in community. We have to be patient and to believe that their true self will gradually emerge. We also have to be patient with ourselves as well, and believe that if we try to love and become open to a spirituality of love, our own true selves will also gradually emerge. If we love, if we truly love other people and believe in them, then they are transformed, and we also will be transformed.

Community then is a place of healing, of transformation, and of humanising people. It’s a place where we are commissioned to grow in love, and in forgiveness, and this is real work. If you don’t want to be transformed and to grow in love, then don’t partake in community! When we find the strength to accept people as they are and to meet them in their secret being, they open us up to love.

These remarks by Jean Vanier are so profound and so critical, not just to this particular debate but to all of the debates we have in this place, because they talk about the way in which we can and do live in community with each other. That is, we understand the balance, if you will, or the necessary combination for belonging and becoming and the importance of having open-ended communities where we invite other people in and seek to learn from them.

The relationship we have with people who come from different backgrounds, people who are disabled or people who may have been historically disadvantaged for a variety of reasons is not to feel that they are in need of somebody else's charity, but, rather, to include each other in full community and recognize the way in which we become in community, we belong in community and we learn from each other.

This is something I have observed in my own interactions with members of my family. I have a beautiful cousin who has Down's syndrome. She was one of the flower girls at my wedding. I will always remember a story that my uncle told. It was a story about how he had learned from her, and sharing the story was a way in which we all learned from her. It was about a time when he and his children were at a hospital, where there was a lady, whatever her circumstances were or whatever bad news she had just heard, standing outside a hospital room crying. My uncle told his children that they should mind their own business, make sure they do not stare, walk past and move on. While he was giving these instructions, it was too late. His daughter Anastasia had already wrapped her arms around the woman who was crying, hugging her and crying with her.

This is an example of the kind of response by somebody who may not have the same socially programmed inhibitions that tell us not to interfere in each other's lives, but, rather, had an unbridled openness and empathy that led her to immediately show love in this way for this total stranger. It was her capacity for unlimited love and pursuit of community that opened my uncle's eyes and my eyes through that story to things that maybe I needed to learn, things that maybe we all need to learn, through greater community with people who have developmental differences and different kinds of experiences, but have so much to contribute.

That is the idea and philosophy of Jean Vanier. That is what the objectives of this bill are all about.

We need to remember that putting in place a framework that seeks to create a country that is free from barriers—

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

Thank you, Mr. Ehsassi.

Let's continue on this theme.

I'll confess to you that I found a bit puzzling, Mr. Rosenblood, your opening submissions about paragraph 319(3)(b), first because the preamble of the Constitution talks about the supremacy of God and the rule of law, and second because it's well known in law that we carve out accommodation or exemptions for religious or conscience beliefs, most recently in the one issue that I think all of us will remember for our entire parliamentary careers—medical assistance in dying—wherein you had a direct conflict within people who felt, pursuant to their conscience, that they didn't want to be compelled to perform a certain type of medical procedure. That was enunciated in the penultimate paragraph of the Carter decision, since you're citing Supreme Court case law. It's also entrenched in Bill C-14.

I just put that forth as a talking point.

You also mentioned, Mr. Rosenblood, that you're cautioning us not to act quickly. I would actually say to you, if you were listening to the people earlier, that there's a real need to act quickly. I think the need to act quickly is that people are being radicalized towards violence online in Canada—that's part of the court record in the Bissonnette sentencing hearing—and around the planet. I think it is incumbent upon us to act quickly.

I was also a bit puzzled by your citation of a dissenting decision in Keegstra, rather than the unanimous decision of the Supreme Court in more recent jurisprudence, which is Whatcott, in which Rothstein, writing for the entire court, upheld section 13 of the Canadian Human Rights Act as striking the appropriate balance.

There's no doubt that balance needs to be struck. The question I have for you, then, is this: Is section 13 of the CHRA, whose analogue was upheld in Whatcott in a unanimous 6-0 decision by the Supreme Court, the right balance? If it isn't, what's needed? Is what is needed what would effectively be a redundant but perhaps necessary political paragraph that simply says, “Nothing in the aforementioned passages derogates from the constitutionally held right to freedom of expression held by all individuals within Canada under section 2(b)”?

Physician-Assisted Dying

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, it is my honour to rise to today to present e-petition 1854, medical assistance in dying, initiated by Dana Livingstone from Sooke, B.C., in my riding. The petition has received more than 2,600 signatures.

The petitioners point out that the Supreme Court of Canada ruling in 2015, Carter v. Canada, established medical assistance in dying as a right for Canadians, but Bill C-14, as passed through the House of Commons, excluded advanced directives.

The petitioners call on the House of Commons to amend subsection 241.2 (3) of the Criminal Code to allow Canadians to make advanced requests for medical assistance in dying. This would be of great of assistance to those individuals who suffer from degenerative conditions like Alzheimer's or other causes of dementia and are denied their right to that medical assistance.

Criminal Code

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

Mr. Speaker, excuse me while I shed a few tears for the troubles of being in a majority government. The parliamentary secretary should have an inkling of understanding, because he once sat in this corner, of the vast amount of power a majority government wields in this place. Frankly, I find it inexcusable at this stage in the 42nd Parliament that the only substantive justice bills that have been passed by the current government are Bill C-14, which was the result of a court-ordered deadline, and Bill C-46, which, of course, was the companion bill to Bill C-45.

Our contention on this side of the House has been that it would have been unnecessary to even use time allocation if the government had taken the non-contentious parts of Bill C-32, which was rolled into Bill C-39, which was rolled into another bill, and made those a standalone bill. For example, we have provisions in the Criminal Code such as challenging someone to a duel, possessing crime comics and fraudulently practising witchcraft. For decades, legal scholars have complained that these faithful reproductions in the Criminal Code lead to confusion. It should have been no secret to officials in the justice department that as soon as the justice minister assumed her mandate, we could have moved ahead with a bill to get rid of those inoperable, redundant sections of the Criminal Code, probably with unanimous consent.

Looking back at the last three years of the government's legislative agenda, particularly with justice bills, would the parliamentary secretary not agree with me that it would have been smarter to package the non-contentious reforms of the Criminal Code in a standalone bill, rather than having us, at this stage, at three years, with not a single reform of the Criminal Code yet passed by this Parliament?

Consideration of Senate Amendments

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

Madam Speaker, I am very happy to be participating in today's debate on Bill C-51. I find it unfortunate, however, that the government has again had to resort to time allocation on a justice bill. The bill passed the House of Commons. I was certainly one of the members who voted in favour of it. However, I find myself in the awkward position of actually agreeing with what the Senate has done to the bill, because it very much mirrors the attempt I made at the justice committee last year to codify the nature of consent and provide a bit more definition in the Criminal Code.

Before I get to the Senate amendments more specifically, I want to talk more generally about the government's record on justice bills. While I do have a great deal of respect for the Minister of Justice and I very much agreed at the start of the government's mandate with what she was attempting to do, the pace of legislative change from the Minister of Justice has been anything but satisfactory. We started off with Bill C-14. It received a lot of attention and debate in Canada, as it should have, but we have to remember that the only reason the government moved ahead with Bill C-14 and we passed it in 2016 was that the government was operating under a Supreme Court imposed deadline. There was really no choice in the matter. Furthermore, when Bill C-14 was passed, we very nearly had a standoff with the Senate because of the provision in the bill about reasonable death occurring in a predetermined amount of time. We knew that that particular section would be challenged in the court system.

The other substantive piece of legislation the government has passed is Bill C-46, which was designed to move in conjunction with Bill C-45. Of course, Bill C-46 was problematic because the government has now removed the need for reasonable suspicion for police officers to administer a Breathalyzer test. They can basically do it whenever a person is legally stopped, whether it be for a broken tail light or for not stopping completely at a stop sign. If an officer has a Breathalyzer test on their person, they can demand a breath sample right then and there, without the need for reasonable suspicion. I have seen mandatory alcohol screening operate in other countries, notably Australia.

In my attempt to amend that bill, I stated that if we were going to apply such a draconian measure, it should be applied equally, because if we start giving police officers the ability to decide when or where to test someone, we know from the statistics, notably from the City of Toronto, that people of a certain skin colour are more apt to be stopped by the police than others. If such a provision were to be implemented, it should be applied equally at all times.

Moving on, there is Bill C-28, which deals with the victim surcharge, but is still languishing in purgatory at first reading.

The government then moved forward with a number of cleanups of the Criminal Code, the so-called zombie or inoperative provisions and the many redundant sections of the Criminal Code. That is the thing about the Criminal Code: It is littered with out-of-date provisions that are inoperable because of Supreme Court or appellate court rulings, but they are still faithfully reprinted every single year because Parliament has not done its work to clean up the Criminal Code. As my college the member for St. Albert—Edmonton has noted, it has led to some very bad consequences, notably in the Travis Vader case, where the judge used an inoperative section of the Criminal Code to convict someone. That conviction was then overturned. So these section do have very real consequences.

My contention has always been with section 159, which was brought forward in Bill C-32. Bill C-32 was then swallowed up by Bill C-39. Then Bill C-39 was swallowed up by Bill C-75, which has only just passed the House and now has to clear the Senate. We have no idea how much longer that is going to take. The House is about to rise for the Christmas break. We will be back functioning at the end of January, but Bill C-75 is a gigantic omnibus bill and full of provisions that make it a very contentious bill.

My argument has always been that for such an ambitious legislative agenda, especially if we are going to clean up the Criminal Code as Bill C-51 proposes to do, I contend that the Minister of Justice, had she had a good strategy in dealing with the parliamentary timetable and calendar and how this place actually works, would have bundled up the non-contentious issues in Bill C-39 and Bill C-32, which was morphed into Bill C-75, together with the non-contentious issues of Bill C-51 and made it a stand-alone bill, and we could have done that work.

These are issues that we cannot really argue against because it is a moot point; the Supreme Court has already ruled, so keeping them in the Criminal Code just leads to further confusion. Here we are, three years into the government's mandate, and the Criminal Code has still not been cleaned up to this day. For an ambitious legislative agenda, that leaves a lot to be desired. I heard Michael Spratt, who regularly appears as a witness before the justice committee, describe Bill C-51 as dealing with the lowest of the low-hanging fruit. Therefore, if we had been serious, we could have made some very reasonable progress on that. Be that as it may, we have Bill C-51 before us and we have to go over it.

Before I get into the specific amendments brought forward by the Senate, I think it is worth going over some of the things we are talking about. Among the things Bill C-51 would repeal is the offence of challenging someone to a duel. It used to be illegal to provoke someone to fight a duel or to accept the challenge. We will get rid of that section because it obviously reflects an earlier time in Canada's history. It is the reason why in this place we are two sword lengths apart. Members of parliament in the U.K. used to go into that place with swords on their hips. The bill would also get rid of section 143 dealing with advertizing a reward for the return of stolen property. It would get rid of section 163, dealing with the possession of crime comics, a legacy of a 1948 bill by a member who thought that crime comics negatively influenced kids by encouraging them to commit crimes, and that they were not a part of a good upbringing. The section on blasphemous libel would be dropped. Fraudulently pretending to practise witchcraft is probably one of my favourite ones.

While Bill C-51 is making some much needed changes to sections of the Criminal Code, as I said earlier, we would not be arguing these cases in the House three years into the mandate of the current government if the bills had been bundled up into a single bill, which I am sure could have had royal assent by now.

We did have a very interesting discussion at the justice committee on section 176. When I first read Bill C-51 and it mentioned that this section would be repealed, I read right over it. However, when hearing witnesses at committee, it became quite apparent that section 176 had a lot of very deep meaning to select religious groups. After hearing all of that testimony about the importance of having section 176 remain in the code, I am glad to see that the committee members were able to work together to polish the language to ensure that it would now be applicable to all religious faiths, and not just single out the Christian faith. Now, if someone were to interrupt the religious proceedings of any faith, that would be dealt with appropriately under section 176.

The heart of the matter before us is the Senate amendments to Bill C-51. As I mentioned, it is kind of awkward for a New Democrat to be recognizing the work of the Senate. I value the people who sit as senators. I know there are some very determined people who certainly try to do their best there. My problem has always been with a 21st century democracy like Canada having an unelected and unaccountable upper house. I have to face the electorate for the decisions I make and the words I say in this place, and for what the Senate as a whole does.

I am going to be rejecting the government's motion on Bill C-51, because I agree with the substance of what the Senate was attempting to do in Bill C-51. It very much reflects some of the testimony that I heard at committee, and I have also reviewed some of the Senate Hansard transcripts of the debates it had on Bill C-51. While it is true that the amendments were not passed at the legal and constitutional affairs committee of the Senate, they were passed at the third reading stage. When we see the transcripts, we can see that the hon. senators in the other place were trying to codify what they saw as some missing aspects of the bill.

If we look at the heart of the matter, it comes down to the Supreme Court decision in R. v. J.A. The Supreme Court ruling reads:

When the complainant loses consciousness, she loses the ability to either oppose or consent to the sexual activity that occurs. Finding that such a person is consenting would effectively negate the right of the complainant to change her mind at any point in the sexual encounter.

In some situations, the concept of consent Parliament has adopted may seem unrealistic. However, it would be inappropriate for this Court to carve out exceptions to the concept of consent when doing so would undermine Parliament’s choice. This concept of consent produces just results in the vast majority of cases and has proved to be of great value in combating stereotypes that have historically existed. In the absence of a constitutional challenge, the appropriate body to alter the law on consent in relation to sexual assault is Parliament, should it deem this necessary.

The court in a sense is recognizing the very important part that Parliament plays in this. One thing I have learned during my time as our party's justice critic is that, in looking at the Criminal Code, ultimately, we in this place are responsible for drafting and implementing the law and it comes down to the courts to interpret it. There is this kind of back and forth. When the justice aspect of the government and the parliamentary part of it work in tandem like that, we hopefully arrive at a place where the law is reflective of today's society.

However, it is not only the J.A. decision that we should be looking at. On October 30, which coincidentally was the very same day that the Senate sent the bill back to the House, there was a decision in the Alberta Court of Appeal, R. v. W.L.S. In that particular case, an acquittal on sexual assault charges was overturned by the Court of Appeal. The Court of Appeal acknowledged in its decision that the complainant was incapable of consenting.

Senator Kim Pate provided us with a message. She said:

In regard to our discussions concerning Bill C-51, I write to draw your attention to the recent case of the Alberta Court of Appeal, concerning the law of incapacity to consent to sexual activity. Please find a copy of this case attached.

The Alberta Court of Appeal heard this case on October 30, the same day the Senate passed the amendments to Bill C-51. The court overturned the trial decision on the grounds that the trial judge had wrongly held that nothing short of unconsciousness was sufficient to establish incapacity. While this erroneous understanding of the law was rectified on appeal in this case, as we know, the vast majority of cases are never appealed. The trial judge's decision demonstrates the very error, fed by harmful stereotypes about victims of sexual assault, that many of us are concerned the original words of Bill C-51 risks encouraging.

Senator Kim Pate is basically acknowledging that there is a role for Parliament to play in providing a more explicit definition of consent, what it means and when consent is not given. While I am certainly one of those people who trusts in the power and ability of judges to make decisions, the judicial discretion, I align that thinking more with the decisions that they make and not in the interpretation of the Criminal Code. There is room in some parts of the Criminal Code to be very specific so that there is no judicial discretion, and that we are very clear on what consent means and what it does not mean.

Turning to the actual Senate amendments, they would be adding specificity in both clause 10 and clause 19. Basically, those particular aspects want to ensure:

(b) the complainant is incapable of consenting to the activity in question for any reason, including, but not limited to, the fact that they are

(i) unable to understand the nature, circumstances, risks and consequences of the sexual activity in question,

(ii) unable to understand that they have the choice to engage in the sexual activity in question or not, or

(iii) unable to affirmatively express agreement to the sexual activity in question by words or by active conduct;

Adding this kind of specificity to the Criminal Code is very much a good thing. In paragraph (b), it says “including, but not limited to”. I think adding that kind of specificity will help with certain cases. From the very interesting Senate deliberations on this subject at third reading, we can see that senators were not very happy with how Bill C-51 left a bit of a hole.

We have made much of the witness testimony at the Standing Committee on Justice and Human Rights. Professor Janine Benedet did look at this particular aspect of the Criminal Code. As I said in my exchange with the member for Mount Royal, one thing she stated was:

Any clarification we can give will be beneficial. It doesn't have to be an exhaustive list, but there has to be the idea that consent has to be informed, that you have to have the ability to understand that you can refuse—because some individuals with intellectual disabilities do not know they can say no to sexual activity—and that it has to be your actual agreement. Those are all things that can be read into the code as it's currently written, but sometimes are not fully realized in the cases we see.

Adding that specific part would be very much in line with what Professor Benedet was saying at the committee. That is why I will be rejecting the government's motion and voting in favour of the Senate amendments.

Turning to the Senate deliberations on this bill, in some of that debate it was said that R. v. J.A. outlines the requirement for active consent. However, the Senate very much found that without the specific amendment by Senator Pate to Bill C-51, we would have failed to capture the scope of consent laid out for us by the Supreme Court, supported by experts in the law of sexual assault in Canada.

Feminist experts in sexual assault law have advised that the inclusion of the word “unconscious” risks creating a false threshold for the capacity to consent. There were also deliberations that the current wording in Bill C-51 poses a serious risk that women who are intoxicated would be blamed if they are sexually assaulted. They would not be protected by this bill.

Further, some have noted that the weakness is in the definition of what constitutes non-consent. According to a legal expert who provides sexual consent training to judges, there is not enough precedent or awareness among judges to believe that the proposed wording in clause 10 and clause 19 of the bill is clear enough.

I see my time is running out, but I will end with some of the really scary statistics we face as a country. Statistics Canada estimates that some 636,000 self-reported sexual assaults took place in Canada in 2014. Shockingly, it also estimates that as few as one in 20 were actually reported to police. Those are statistics which should give us great pause and lead us to ask ourselves what more we could be doing. The Senate amendments are very much in faith with trying to keep that.

I would also note that this is probably one of the last opportunities I will have to rise in this particular chamber to give a speech. I want to acknowledge the history of this place and what an honour it has been for me, in my short three years here, to have served in this House of Commons chamber. I know we will be going forward to West Block, and an admirable job has been done there.

I finish by wishing all my colleagues a merry Christmas. I hope they have a fantastic holiday season with friends and family, and that we come back in 2019 refreshed and ready to do our work on behalf of Canadians.

Medical Assistance in Dying

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Mr. Speaker, again, medical assistance in dying is a deeply complex, sensitive and deeply personal matter for individuals who are seeking to access medical assistance in dying.

Our government introduced Bill C-14 in response to the Supreme Court of Canada's decision in Jordan. We are confident that our legislation strikes the right balance between protecting vulnerable people and respecting the personal autonomy of individuals, as well as recognizing the conscience right of health care practitioners.

We will continue to have a conversation around medical assistance and dying. We have commissioned three reviews according to the legislation, which look at complex issues.

Alleged Premature Disclosure of Immigration Levels Plan

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Madam Speaker, in relation to the question of privilege I raised earlier today. I have some important additional information that I would like to put on the record.

I want to put on the record an email exchange I had with a reporter today. This exchange began at approximately 3:20 p.m. It is in regard to the immigration levels plan that was tabled by the minister at approximately 4 p.m. today.

The exchange began with, “Hi, I'm hoping to connect with [the member for Nose Hill] this afternoon to get her reaction to the government's levels plan numbers and also to the fact the CBSA has been asked to step up its removals. Could she give me a call.” I responded with “Were the levels tabled today? I must have missed it.”

The exchange said, “Sorry no, but they will be. It would have happened by now but for this point of order. Just looking to set up a quick interview for after they are tabled.” I responded with, “Do you have a copy? I am happy to comment, but it would help to see them first.”

In addition to this email exchange, there was a follow-up phone conversation between my staff and the reporter, which occurred at 3:45 p.m., and again the minister tabled the levels plan at 4:00 p.m. This is a first draft transcription.

The reporter said, “I did just did get a little bit of a heads-up on what they were so that I could have something ready to move on the wire when it is tabled just in case.” My assistant said, “Oh okay I see.” “So that's where I was expecting that it would have been tabled by now but there's a point of order that obviously is taking up more time than usual.” My assistant said, “Okay I guess I will have to flip on the House in a second here but I'm so—okay, do you have some of the information and we're just kind of waiting now to see when they'll table it I guess.” Then the reporter said, “It's just kind of a continuation of what they did last year, like a three-year plan and it will go up to 350,000 in 2021.” I will note that a story was published that included details on the levels plan at 4:30 p.m. today.

I am also happy to provide the Speaker with copies of this information, if he so requests.

As you know, Madam Speaker, there is no provision for information to be given to journalists ahead of a member of Parliament and there are numerous precedents, particularly in regard to legislation. I will give one example. On April 19, 2016, the Speaker found a prima facie case of privilege after the leader of the opposition pointed out that specific and detailed information contained in Bill C-14 was given to the media ahead of the House and members of Parliament.

During that discussion, Speaker Milliken's ruling was referenced of March 19, 2001, when he said, “To deny to members information concerning business that is about to come before the House, while at the same time providing such information to media that will likely be questioning members about that business, is a situation that the Chair cannot condone.” In that 2001 case, my former colleague, Vic Toews, was called by a reporter for comment on a bill not yet tabled. He was embarrassed by the exchange. The facts in that scenario are identical to this situation. Again I would point out that this was business that was put in front of the House this afternoon with regard to the levels plan.

My colleague, the member for Milton, was also recently questioned by a reporter over information the journalist was given, but she was denied. The Speaker is still deliberating on that matter. Today, I have been put in that same position.

We have had two other rulings by the Speaker recently that I believe are relevant. On March 20, following a complaint from the hon. member for Abbotsford that the media and stakeholders received a briefing five hours before members on Bill C-69, an omnibus bill of 377 pages, this was the Speaker's comment on the matter, “there is a rightful expectation that those responsible for the information should do their utmost to ensure members’ access to it. Not respecting this expectation does a disservice to all. It is particularly disconcerting when the government gives priority to the media over the members of Parliament.”

Only one month later, on April 17, the hon. member for Niagara Falls brought to the Speaker's attention evidence that the CBC received information on Bill C-75 ahead of members, allowing it to post an article online only eight minutes after the bill was introduced. What the government did to the member for Niagara Falls with Bill C-75 I believe I have evidence that it has done the same thing to me, but concrete evidence that this was done ahead of it being tabled in the House of Commons with respect to the information contained in the levels plan tabled by the minister today. In the Speaker's ruling on this matter on May 7, 2018, the Speaker indicated how troubled he was that some of the members had an experience of feeling disadvantaged in their ability to fulfill their duties and that members should never have to even so much as wonder if they were not the first to receive the information from the government.

I have one final point. Given this pattern of the government on this matter and given that leaking information to the media has become part of its routine communication strategy, there comes a time, particularly when a government persists in behaviour that has caught the attention of the Speaker much too often, as I have just laid out, that another warning will not be good enough. Sometimes members deserve to be given the benefit of the doubt when they feel that their privileges have been breached. In this situation, I am again happy to provide concrete proof of the information that I have put on the record today.

There are precedents for this that I would like to offer the Speaker. In Maingot, second edition, Parliamentary Privilege in Canada, page 227, he states:

In the final analysis, in areas of doubt, the Speaker asks simply:

Does the act complained of appear at first sight to be a breach of privilege...or to put it shortly, has the Member an arguable point? If the Speaker feels any doubt on the question, he should...leave it to the House.

In a ruling of October 24, 1966, at page 9005 of Debates, the Speaker said:

In considering this matter I ask myself, what is the duty of the Speaker in cases of doubt? If we take into consideration that at the moment the Speaker is not asked to render a decision as to whether or not the article complained of constitutes a breach of privilege...considering also the Speaker is the guardian of the rules, right and privileges of the house and of its members and that he cannot deprive them of such privileges when there is uncertainty in his mind...I think at this preliminary stage of the proceedings the doubt which I have in my mind should be interpreted to the benefit of the member.

I am not being critical of the journalists in this regard, because I believe they were just doing their job. The problem I have is the minister tabled this afternoon a 43-page document. I am the shadow minister for citizenship and immigration. Immigration is a topic of great concern and consternation in the public at this point of time. The minister tabled a 43-page document. The media was given an advance copy of the information contained in the document and then I was asked for comment.

I understand that some members of the media might feel like this is routine proceedings, that somehow they should be given information so they can put a story out and be newsy. I would argue that it is the opposite. It is the job of the media to respond to deliberations of Parliament and that my right as a parliamentarian with respect to being able to digest and critically evaluate information that is put in front of the House supersedes the government wanting to have a positive communications strategy or any journalist wanting to sell a paper.

This is also something journalists should be asking themselves in terms of standards. Is it right to be publishing stories on a 43-page document and asking for comments when clearly they have had the information and a member of Parliament whose task is critically evaluating it and providing comment on it does not? I would argue no.

However, going back to my point of privilege. There is no manner by which any of our rules give journalists the right to have information prior to a member of Parliament. Therefore, I ask you, Madam Speaker, to find a prima facie case of privilege. I would ask, in your ruling, to understand how one can provide comment on a 43-page document on detailed immigration policy that affects the number of people that Canada will allow into this country and under what assumption when the journalists already have this. Why should they be given the right to review that information when I am not? That is wrong.

Therefore, I ask you to find a prima facie case of privilege, Madam Speaker. I believe it is there. Should you find such, I would be prepared to move the appropriate motion.

Alleged Premature Disclosure of Contents of Bill C-75

[Rob Nicholson, Conservative, Niagara Falls, ON]

Mr. Speaker, I rise on a question of privilege concerning the premature disclosure of the contents of Bill C-75, an act to amend the Criminal Code, the Youth Criminal Justice Act and other acts and to make consequential amendments.

The Minister of Justice introduced the bill on Holy Thursday, before the Easter long weekend, on March 29, 2018, at 12:11 p.m. At 12:19 p.m., eight minutes after the minister introduced the bill, CBC posted an article entitled “Liberals propose major criminal justice changes to unclog Canada's courts”.

The article goes into detail about Bill C-75 to make a prima facie case that CBC had prior knowledge of the contents of Bill C-75 before it was introduced.

For example, the article states that “The Liberal government tabled a major bill today to reform Canada's criminal justice system”, saying it contained measures designed to close gaps in the system and speed up court proceedings, including putting an end to preliminary inquiries except for the most serious crimes that carry a life sentence. It said, “The changes also include an end to peremptory challenges in jury selection” and that another proposed reform of the bill will “impose a reverse onus on bail applications by people who have a history of [domestic] abuse, which would require them to justify their release following a charge.”

Bill C-75 is an omnibus bill containing 302 pages. While I appreciate the quality of journalism at the CBC, I do not think anyone can believe that someone could read 302 pages, analyze what was read, write an article, and then post the article on the Internet with various links in just eight minutes. If such extraordinary human capabilities exist at CBC or if unknown technology exists to make this happen, then the Standing Committee on Procedure and House Affairs would like to hear about it.

All I am asking of you, Mr. Speaker, is to find a prima facie case on the question of privilege to allow a motion to be moved instructing the Standing Committee on Procedure and House Affairs to look into this matter.

On March 21, 1978, at page 3,975 of Debates, Mr. Speaker Jerome quoted a British procedure committee report of 1967, which states in part:

...the Speaker should ask himself, when he has to decide whether to grant precedence over other public business to a motion which a Member who has complained of some act or conduct as constituting a breach of privilege desires to move, should be, not--do I consider that, assuming that the facts are as stated, the act or conduct constitutes a breach of privilege, but could it reasonably be held to be a breach of privilege, or to put it shortly, has the Member an arguable point? If the Speaker feels any doubt on the question, he should, in my view, leave it to the House.

Now, whether it be superhuman capabilities or advanced unknown technology available only to the media, it is unacceptable for members of Parliament to be left behind playing catch-up while the public debate on a government bill takes place outside the House, minutes after its introduction, between a well-briefed media and a well-briefed Minister of Justice.

It has become an established practice in this House that when a bill is on notice for introduction, the House has the first right to the contents of that legislation.

On April 14, 2016, the former opposition leader and current Leader of the Opposition raised a question concerning the premature disclosure of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

The Leader of the Opposition pointed out that specific and detailed information contained in Bill C-14 was reported in a newspaper article and elsewhere in the media before the bill had been introduced in the House. The member stressed the need for members to access information in order to fulfill their parliamentary responsibilities, as well as the respect required for the essential role of the House in legislative matters.

On April 19, 2016, the Speaker agreed with the Leader of the Opposition and found that there was indeed a prima facia case of privilege regarding Bill C-14. He said:

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

The Speaker's concluding remarks on April 19, 2016, were as follows:

In this instance, the chair must conclude that the House's right of first access to legislative information was not respected. The chair appreciates the chief government whip's assertion that no one in the government was authorized to publicly release the specific details of the bill before its introduction. Still, it did happen, and these kinds of incidents cause grave concern among hon. members. I believe it is a good reason why extra care should be taken to ensure that matters that ought properly to be brought to the House first do not in any way get out in the public domain prematurely.

On October 4, 2010, on page 4,711 of the House of Commons Debates, Speaker Milliken said:

It is indisputable that it is a well-established practice and accepted convention that this House has the right of first access to the text of bills that it will consider.

There was a similar case March 19, 2001, regarding the Department of Justice briefing the media on a bill before members of Parliament. This was referenced by the Leader of the Opposition in his submission on the Bill C-14 case, in which he quoted Speaker Milliken as saying, at page 1,840 of the House of Commons Debates:

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

The Speaker found another case of contempt on October 15, 2001, after the Department of Justice briefed the media on the contents of a bill prior to the legislation being introduced in the House. The leak of Bill C-75 is another example of the government's disregard for Parliament and its role in the legislative process. It is important that we in the opposition call out the government for these abuses of Parliament and place before the Chair any breaches of the privileges of the House of Commons.

Speaker Milliken said:

To deny to members information concerning business that is about to come before the House, while at the same time providing such information to media that will likely be questioning members about that business, is a situation that the Chair cannot condone.

You, Mr. Speaker, said, on March 20 of this year:

...respecting members’ needs for timely and accurate information remains essential. There is no question that the work of members of Parliament is made more difficult without expeditious access to legislative information. Given this reality, there is a rightful expectation that those responsible for the information should do their utmost to ensure members’ access to it. Not respecting this expectation does a disservice to all. It is particularly disconcerting when the government gives priority to the media over the members of Parliament.

Given the facts presented and the clear precedents on this matter, I believe, Mr. Speaker, you should have no trouble in finding a prima facie question of privilege. In that event, I am prepared to move the appropriate motion.

Physician-Assisted Dying

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

Mr. Speaker, the second petition also refers to Bill C-14 and highlights the issue of conscience protection.

The petitioners point out that committees heard testimony from numerous witnesses with respect to the importance of conscience protection for health care professionals, physicians, nurses, and institutions. The petitioners state that they should be protected from coercion or intimidation with respect to providing assisted suicide. Sadly, this is happening in British Columbia, the first province to permit this, which is forcing hospice facilities to have assisted suicide and euthanasia.

The petitioners call on the government for legislation which would cover conscience protection.

Palliative Care

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

Mr. Speaker, I am honoured to present two petitions today.

The first petition is related to palliative care. In this petition the petitioners highlight the importance of palliative care. They point out the passage of Bill C-14, the assisted suicide euthanasia bill, and the importance of palliative care being available to every Canadian resident that needs it. They also point out that the person must be able to clearly choose life or death.

The petitioners also point out that palliative care never hastens or prolongs death but makes the person comfortable in the last hours of life.

Physician-Assisted Dying

[Diane Finley, Conservative, Haldimand—Norfolk, ON]

Mr. Speaker, I am pleased to present a petition on behalf of constituents in my riding of Haldimand—Norfolk who are concerned about the lack of religious protection for medical professionals in Bill C-14, medical assistance in dying, and Bill C-51, clause 14. As it stands, clause 14 would remove the only provision in the Criminal Code that directly protects the rights of individuals to freely practise their religion, whatever that religion may be.

The petition calls on the government to enact a policy that would provide the review of any legislation, ensuring it does not impinge upon the religious rights of Christians.

Medical Assistance in Dying

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Mr. Speaker, on May 2, I rose in the House to ask questions about the impartiality of the working group set up by the government to study the issue of advance requests and broadening eligibility for medical assistance in dying.

The appointment of Dr. Harvey Schipper as chair of the working group was accepted by the minister, even though Dr. Schipper opposed medical assistance in dying and advance requests.

This appointment was also criticized by several stakeholders. Even though Dr. Harvey Schipper stepped down from his position and was replaced by Marie Deschamps, the issue of medical assistance in dying, and especially advance requests, is still current.

The former health minister, the hon. member for Markham—Stouffville, promised to strike committees to study the issue of incapacity and advance requests, cases where medical assistance in dying was denied and not administered in the past year, and the issue of mature minors, to determine if a minor suffering from an incurable or painful illness can request medical assistance in dying. However, once again, there has been no decisive action from the Liberal government.

Once again, Quebec is ahead of the federal government on this issue. In 2013, it tabled a working group report on incapacity and struck a committee to handle advance requests and broaden eligibility for medical assistance in dying. However, Quebec's efforts are hampered by its compliance with federal legislation, even though it is essential that provinces and territories work in close collaboration with the federal government to avoid an over-hasty approach, as is the case in this situation.

I sat on the Special Joint Committee on Physician-Assisted Dying, and many of our recommendations were not taken into consideration when the federal law was drafted.

I am also concerned about people who are ill and suffering but are no longer able to request medical assistance in dying because they have a mental illness or dementia, such as Alzheimer's-related dementia. A decision needs to be made on the issue of advance consent and whether a person with dementia or mental illness can make an advance request while they are still in full possession of their mental faculties, before the disease progresses.

That is a critical issue that the government must address, particularly following the compassionate killing of Jocelyne Lizotte by her husband. It is also vitally important that citizens have faith in the system and feel as though they have the guidance they need to avoid any possible abuse.

According to Bill C-14, there are many criteria that a person must meet in order to be eligible for medical assistance in dying. For example, they must be at the end of their life, have a serious and incurable illness, be in an advanced state of decline, be enduring physical or psychological suffering, and so on. The most shocking is the criteria of reasonably foreseeable death. The government must clarify that provision, which does not make any sense.

Obviously, we are all going to die one day. The Liberal government is not telling us anything that we do not already know. It is unacceptable that people who are ill have to go back to the courts to assert their right to die in dignity because they do not clearly meet all of the criteria. We must not forget that medical assistance in dying is a right and that those who are ill and suffering and who want to die in dignity do not have the strength to fight for that right.

I am well aware that this is sensitive issue, but doing nothing is not going to solve the problem. When will the Liberal government truly take into account the issues of advance requests, mature minors, and people who are not capable of asking for medical assistance in dying? When will it actually set up those committees? We look forward to seeing results.

Opposition Motion—Canadian Economy

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

Mr. Speaker, let me thank my friend from Victoria and the third-party House leader for his very generous comments.

From my perspective, it cuts both ways. It was in fact his generosity, as the New Democratic Party justice critic who was willing to come to speak in a government member's riding on a highly controversial bill, Bill C-14, that demonstrated the strength of this House. If members actually look at our voting records, we voted at almost opposite ends on all the amendments and the main motion throughout, yet we could engage in a civil debate in my constituency and engage with constituents who had a diverse array of views on that particular subject matter.

That is exactly the point I was trying to make earlier. Parliament is a place of disagreement in terms of the debate, but we do not have to be disagreeable. My friend from Victoria is a shining example of exactly that, and I thank him for his friendship.

Alleged Premature Disclosure of Contents of Bill C-49—Speaker's Ruling

[The Speaker, Liberal, Geoff Regan]

I am now prepared to rule on the question of privilege raised on May 17, by the hon. member for Carlton Trail—Eagle Creek concerning the alleged premature disclosure of the contents of Bill C-49, an act to amend the Canada Transportation Act and other acts respecting transportation and to make related and consequential amendments to other acts.

I would like to thank the hon. member for Carlton Trail—Eagle Creek for having raised this matter, as well as the Parliamentary Secretary to the Leader of the Government in the House of Commons and the hon. member for Elmwood—Transcona for their submissions.

In raising this question of privilege, the member for Carlton Trail—Eagle Creek explained that the media had made public specific details contained in Bill C-49 before it was introduced in the House. By drawing comparisons between what was revealed in several news reports from Monday, May 15 and the contents of the bill which was introduced in the House on Tuesday, May 16, she alleged that the required confidentiality before the unveiling of the legislation in the House was simply not respected and members' privileges were breached as a result.

The member stated her belief that this was not due to a simple accidental leak but, rather, was the result of a systemic advance briefing of the media.

For his part, the Parliamentary Secretary to the Government House Leader contended that at no time had the government prematurely divulged any details of Bill C-49; rather, it had simply held extensive consultations on the review of the Canada Transportation Act, as is the government’s prerogative. He added that the minister and his staff were clearly aware of the need for confidentiality, declining to comment on any specifics of the bill when asked by the media.

The right of the House to first access to legislation is one of our oldest conventions. It does and must, however, coexist with the need of governments to consult widely, with the public and stakeholders alike, on issues and policies in the preparation of legislation. Speaker Parent explained on February 21, 2000, at page 3767 of Debates:

Although the members of the House should always be the first ones to examine legislation after it has been introduced and read the first time, this rule must be balanced against the need for the government to consult both experts and the public when developing its legislative proposals.

When ruling on a similar matter on November 1, 2006, Speaker Milliken concluded that the government had not divulged confidential information on the bill, nor the bill itself, but rather had engaged in consultations prior to finalizing the legislation in question. At the same time, he explained at page 4540 of the House of Commons Debates:

The key procedural point...is that once a bill has been placed on notice, it must remain confidential until introduced in the House.

In acknowledging this important nuance, he made room for both consultation and confidentiality, but also saw the distinction between the two.

In the case before us, the Chair is asked to determine if the level of detail reported upon by various media outlets in advance of the tabling in the House of Bill C-49 constitutes sufficient proof of a leak of the contents of this bill, and thus constitutes a prima facie breach of the member's privileges. In examining the bill, and noting the obvious similarities to the information cited in the media, the Chair can appreciate the seriousness of the matter raised.

When ruling on a similar question of privilege on April 19, 2016, I found a prima facie case of privilege in relation to the premature disclosure of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying). In that particular case, the government had acknowledged the premature disclosure of the bill while assuring the House that this had not been authorized and would not happen again. In other words, the facts were undisputed.

That is not the case with the situation before us. The parliamentary secretary has assured the House that the government did not share the bill before it was introduced in the House but conceded that extensive consultations were conducted. Nor is the Chair confronted with a situation where a formal briefing session was provided to the media but not to members.

Finally, it is a long established practice to take members at their word, and the Chair, in view of this particular set of circumstances, is prepared to accept the explanation of the Parliamentary Secretary to the Leader of the Government in the House of Commons.

In the absence of evidence that members have been prevented from conducting their parliamentary functions due to the premature release of the bill itself, I cannot find that a prima facie case of privilege exists in this case.

Framework on Palliative Care in Canada Act

[Kelly McCauley, Conservative, Edmonton West, AB]

Madam Speaker, I am proud to rise today in support of Bill C-277, which calls for the development of a framework to increase access to palliative care. I would like to personally thank the member for Sarnia—Lambton for introducing this private member's bill.

Years ago, while I was living in Victoria, I had the honour of serving as the president of the Greater Victoria Eldercare Foundation, Vancouver Island's largest seniors foundation, supporting six extended care hospitals. The Greater Victoria Eldercare Foundation, under my good friend executive director Lori McLeod, has developed leading community programs to assist seniors, including the annual Embrace Aging month, with initiative raising awareness about the wealth of resources and opportunities available year-round to help seniors and their families navigate the journey of aging.

I was pleased to hear recently that it has added additional palliative care facilities at its Glengarry facility. It was through my involvement with the Eldercare Foundation that I encountered first-hand the many issues that seniors and their families face now: the difficulty of obtaining proper care for seniors, proper facilities, and proper understanding of the unique situations and issues they face. I owe a lot to the many volunteers and staff whom I worked with at the Greater Victoria Eldercare Foundation, and I know they too would be supporting this excellent bill.

Alleviating the suffering of Canadians is a collective duty of the House, regardless of political agenda or party affiliation. Whether in hospitals or at home, Canadians should not have to go without the care they need simply because there is not sufficient support. Our society is capable of providing the best care for our citizens, and Bill C-277 provides a framework to utilize and implement these resources. This bill helps to promote good health while preserving the independence of Canadians in need of health support. As a Conservative, I am a proud supporter of this bill, which will invest in long-term and palliative care, which the Liberals have failed to do despite their many promises.

In 2015, the Supreme Court of Canada's decision in Carter v. Canada established that Canadians have a right to physician-assisted dying. We debated Bill C-14, and while I opposed the legislation, the House and Senate passed it and it received royal assent almost a year ago. One of the key aspects of the Carter decision, however, was its call for an advancement of palliative care as a means of increasing Canadians' access to compassionate health care. The Carter decision is intended to ensure that Canadians can make a legitimate choice regarding their own health care, and one of those options is to receive adequate palliative care, care that is focused on providing individuals who have a terminal illness with relief from pain, physical and mental stress, and the symptoms of their illness. It is intended to ensure that those who are at the end of their life can pass peacefully, with dignity and without pain.

The Carter decision enabled Canadians to pursue assisted dying, but it also established an obligation on the government to ensure all Canadians can access proper, adequate, and compassionate end-of-life care. Right now, we are not getting the job done. We are not in any imagination fulfilling our obligations as a society in caring for those in need of care. For example, a survey of pre-licensure pain curricula in the health science faculties of 10 Canadian universities shows many would-be doctors receive less training in pain management than their counterparts in veterinary medicine. I am sure my dog Hailey, who is no doubt at home on my couch right now as I speak, finds this reassuring, but as someone formerly involved in senior care, I find it quite distressing.

A survey of more than 1,100 doctors and nurses shows that those who treat fewer terminally ill patients, therefore knowing the least about symptom management, are most likely to be in favour of assisted suicide, while those with more experience in symptom management and end-of-life care tend to oppose it. Dr. Max Chochinov, a noted specialist on palliative care, explains that the will to live is directly inverse to the amount of pain, and that loss of dignity drives wanting to die and treatment of pain can improve sense of dignity.

We also have to remember the impact of terminal illness on a family: the emotional, physical, and financial struggle of caring for a loved one at the end of their life. Under the current regime, it is up to families to carry the overwhelming bulk of this burden. This system is not fair. People should not have to choose between paying bills and caring for their spouse, their parents, or their siblings.

We have heard horror stories time and time again from families who were completely ambushed by palliative and in-home care costs after their loved one got sick, and these instances are becoming more and more common. The health minister herself has acknowledged many times that Canada has a deficit in access to quality palliative care, yet despite her pledges to do more and provide more, she has neglected to take meaningful action to date. Canada's population as a whole is growing older, and seniors now outnumber children.

I said before in my speech to the RRIF financial security act—another bill that would have helped seniors, which the Liberals voted against—that we need to be ready to have the proper programs and mechanisms in place to adapt to our shifting demographics.

A recent Globe and Mail article states that, according to the 2016 census, we have seen “the largest increase in the share of seniors since the first census after Confederation”. Across Canada, the increase in the share of seniors since the 2011 census “was the largest observed since 1871—a clear sign that Canada’s population is aging at a faster pace”. That figure is projected to rise even more in the coming years. The proportion of those aged 65 and older climbed to 17% of Canada's population. This is not a new phenomenon obviously.

A September 2015 Statistics Canada report noted that, by 2024, 20% of our population will be over the age of 65, so we need action plans in place to address this shift, this massive wave that is going to be overtaking our health care systems. The provinces are going to be faced with an epidemic soon enough of people trying to access systems that are not capable of supporting the demand. Less than 30% of Canadians have access to this vital service, which allows them to choose to live as well as they can for as long as they can.

It is time for the government to fulfill its obligations to provide quality palliative care to all Canadians. This framework answers some of those calls, and it represents the needs of the aging population across Canada, including those in Edmonton West. The percentage of individuals in Edmonton aged 65 or older has risen to 14%, a significant figure representing thousands of individuals who will benefit from universal palliative care.

I know this bill will serve the aging population in my own riding, particularly those who find comfort in knowing that their family members and loved ones will receive the best care. No one should have to suffer through ailments alone, without the support of well-trained and compassionate health care practitioners.

Bill C-277 is required to define the services covered, to bring standard training requirements for the various levels of care providers, to come up with a plan and a mechanism to ensure consistent access for all Canadians, and to collect the data to ensure success. Good palliative care can cover a wide range of services, such as acute care, hospice care, home care, crisis care, and spiritual and psychological counselling. The creation and implementation of a palliative care framework will give Canadians access to high-quality palliative care through hospitals, home care, long-term care facilities, and residential hospices.

We need to ensure that our communities support the aging population with respect and dignity. As parliamentarians elected by our respective communities, reacting to this shift should be a priority and cannot be ignored. When I introduced my private member's bill last fall, which sought to help seniors who were being disproportionately targeted by an outdated tax measure, I heard from countless seniors across Canada who felt they were being left behind. While it is important to ensure the provinces are not pigeonholed by federal legislation, we need to acknowledge a legislative gap when we see one. Seniors need help, and no amount of discussion papers, working groups, or committee meetings will make this issue go away. We know what the issue is and we need action.

Bill C-277 is a step toward providing the much-needed support for seniors today and seniors to be. Palliative care is good, compassionate, and meaningful. Providing access to quality and affordable palliative care can help make painful decisions a little more manageable for those suffering from a terminal illness. It can also significantly help the families of those suffering, who carry the disproportionate financial and emotional burden of end-of-life care. The government needs to pass this legislation to begin the development of a framework on increasing access to palliative care.

When the Supreme Court's decision in Carter v. Canada was delivered, it included a significant and serious obligation on the government to ensure that Canadians could make a real decision on their end-of-life care. The ability to make that decision requires that the options are actually available, and today's unfortunate reality is that our palliative care system is inadequate.

As I mentioned, I would like to thank the member for Sarnia—Lambton for bringing this fantastic private member's bill forward. I am very pleased to hear my colleagues in the NDP speak so favourably toward this, and to hear that they will be supporting it. I am extremely proud that I and other members of the Conservative caucus will be supporting this very important bill.

Resuming debate

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

Mr. Speaker, the debate concerning motion No. 14 is not about having a problem with working until midnight each evening—except, obviously, on topics raised by the opposition. I agree with what the Parliamentary Secretary to the Leader of the Government in the House of Commons said in the House yesterday, that most of us are already working every day on a similar schedule.

In my previous career, I was already used to long hours. When I ran a global business, my European colleagues began calling me at 4 a.m., and my days would often stretch until midnight. This was necessary so I could meet with my employees and people in the plants and businesses in the Pacific region I was responsible for.

As the head of a North American refining and petrochemical company, I realized that maintaining customer relations and meeting deadlines to submit applications made for very long days.

The Liberal government said it wanted to make Parliament more family friendly in order to encourage women to get into politics. I support encouraging more women to get into politics, but I do not believe that many women would choose to work until midnight each evening, away from their kids.

Now, why did this government introduce such a motion, when theoretically it should oppose it?

As I have said, I am not opposed to working long hours. I said earlier today, and will say it again, Einstein was quoted as saying that the definition of insanity was repeating the same action hoping for a different result. The government has not accomplished a lot in the way of legislation. If we think about the 19 bills that have passed versus 52 in the same time frame when the Conservatives were in power, really not much has been accomplished. There is no prioritization of what is coming forward.

I want to take a moment to talk about what has already passed because it shows something important.

So far in Parliament the transparency for first nations has been removed with Bill C-1. Bill C-2 gave back to the middle class $932 a year in taxes and then Bill C-26 increased their CPP payments by $1,100 a year, with no benefit. Bill C-10 gave Air Canada a deal to get maintenance jobs out of Canada and escape a lawsuit. Bill C-14, medically assisted dying, was passed without protecting the rights of conscience. Bill C-17 addressed environmental items for Yukon. Bill C-18 was environmental change for Rouge Park in Toronto. Bill C-30 was a CETA deal that now has to be renegotiated with Brexit happening. Bill C-31 was the trade deal with Ukraine. The rest were all maintenance budget items that needed to be done. That is all we have accomplished in 18 months of the Liberal government's agenda. Everything else is lost in process, being amended in the Senate, and not coming forward.

What is the government going to achieve by making us sit every night until midnight, which, as I said, I am fully willing to do? I really do not think it is getting anywhere. Why is it not getting anywhere? Because it does not listen to the opposition's points of view.

The job of the opposition is to bring reasoned and intelligent arguments on why a government proposal is not good for Canada and to make helpful suggestions about what would make it better.

When bills are sent to committee, the committee's job is to make helpful suggestions and amendments that would make them something all Canadians could embrace. That is really what is happening. The government is not accepting amendments, not listening when the opposition talks, and again and again, when things go to the Senate, the Senate comes up with the same amendments and spends more time studying them, doing exactly the same thing that committees of the House are supposed to do. That is one problem.

Another problem is that there has to be trust when parties work together.

I am going to compare the antics that I see happening here with what I see in the business world. In the business world, people work together. People have to be able to trust one another when they make deals. They have to be able to follow up on things as they said they would.

From what I have seen, the opposition House leaders are trying to work with the government House leader but she is not keeping up her end of what she has agreed to. Every day I watch her stand in the House and misrepresent to Canadians that she just has a discussion paper, when really a motion has been rammed through PROC. I have seen her avoid answering questions that she is accountable to answer.

I would suggest that there has been a huge erosion of trust in the government House leader and sometimes that cannot be fixed in order to restore the ability to work together. The government should really consider changing up that position and coming back to a place where we can work together and trust that agreements that are made, amendments that are suggested, and motions that are brought forward are as agreed. That is really important.

There is another point that I would like to make that has not been discussed much here. I have listened to the debate on Motion No. 14 and I have heard a lot about the blame game. I hear from the Liberals that when Stephen Harper's government was in place, it did this bad thing or that bad thing, or whatever. Honestly, two-thirds of the Parliament are new. Some of us were not here in the previous Parliament. We have an opportunity to do things differently now. If we think something was previously done wrong, we have the opportunity to do it differently in the future.

When items come up in the business climate, not everything needs the same amount of time to be talked about. I have sat in the House and heard Liberal members stand up and say they support such and such a bill and I have heard Conservative members and NDP members stand up and say they do too, and then we talk about it for days.

This is not the way we should be spending our time. If the government had not squandered all of the time in that way, we would have more time and we would not have to sit late. In the same way, there are things that need to be discussed longer that cannot be rammed through, things such as the budget bill that has been combined with the infrastructure bank. When comments come forward, the government needs to lead. It needs to separate those things out so that the things that can be quickly passed get passed on. When I say passed on, I am saying that if we all agree on a bill at first reading and we do not need to change anything, then the legislation should be sent right away to the Senate. Why are we spending time doing second and third reading and committee and everything else? We need to be able to update some of the processes here.

I am not about just criticizing without providing recommendations for how I think we could make this better. Here are my recommendations, which I think the government could use to change some of the things that it is doing and which would result in getting legislation passed through in a better way.

When it comes to the rules of the House, I see an opportunity to modernize those rules but a change would need to honour the tradition of Parliament and have all-party consensus or at least the consensus of a majority of members to change things, because those things influence our democracy and they are important. Doing some of those things would, as the suggestions I have made about passing things we all agree on and everything else, clear the legislative agenda in a way that would move things forward more positively.

I also would reiterate that you have to have someone working with the opposition leaders who can be trusted, and I think that trust is broken.

The other point I would make is about amendments that are brought forward and are agreed to by the opposition members. It is not often that the NDP and the Conservatives play on the same team and sing from the same song sheet. That does not usually happen but lately it has happened a lot. When that happens, it should be a signal to government that this is an amendment that Canadians want to see.

The government needs to say what it is going to do and then it needs to own up to it. Some of the credibility loss that has happened has happened because the government said it was going to do something and then it did not. The government maintained it was going to be open and transparent and then facts have been hidden or things have not been well represented. The government said it was going to be accountable but then every day when we stand up and ask questions we get the shell game. It does not answer our questions, and this would not be acceptable in the business world.

These are some of the things that would help to get the legislative agenda flowing through. As a member of the opposition, I want to see the right things happen for Canada and I am willing to work with the government to see that happen.

Alleged Premature Disclosure of Contents of Bill C-49

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Mr. Speaker, I am rising on a question of privilege concerning the leak of the contents of Bill C-49, an act to amend the Canada Transportation Act and other acts respecting transportation and to make related and consequential amendments to other acts, which was introduced yesterday. It has become an established practice in the House that when a bill is on notice for introduction, the House has the first right to know the contents of that legislation.

As Speaker Milliken explained on March 19, 2001, at page 1840 of the Debates:

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

The required confidentiality expected before the unveiling of this bill was simply not respected due to the government's so-called pre-positioning for Bill C-49 earlier this week.

Allow me to explain.

First, for context, all the information the House had when a notice for the bill was tabled Friday afternoon was that it would bear the long title, “An Act to amend the Canada Transportation Act and other Acts respecting transportation and to make related and consequential amendments to other Acts”. Considering the wide scope of the activities of Transport Canada, a title like this one could be used with respect to any mode of transport or any type of activity the department undertakes. However, despite the ambiguous bill title, yesterday's Toronto Star revealed that this legislation would be called the “Transportation Modernization Act” and reported many of the bill's details. That short title, set out in clause 1, only became known to us once the bill was tabled, well after yesterday's Toronto Star had gone to print.

Furthermore, the CBC website, on Monday evening, stated, “The...government will introduce legislation for a passenger bill of rights Tuesday in a move that will set a national standard for how airline passengers are treated in Canada”. The bill's summary reads, on page 2:

With respect to air transportation, it amends the Canada Transportation Act to require the Canadian Transportation Agency to make regulations establishing a new air passenger rights regime and to authorize the Governor in Council to make regulations requiring air carriers and other persons providing services in relation to air transportation to report on different aspects of their performance with respect to passenger experience or quality of service.

CTV National News offered more information to its viewers on this legislation during its broadcast Monday night. It stated, “CTV News has learned the government will mandate minimum levels of reimbursement for travel disruptions and lost luggage.” I was watching the news at the time and was extremely surprised to see such detail being made public for a bill that had not yet been made public in Parliament. Later in the same CTV report, I heard, “Under the bill Transport Minister...will table tomorrow, airlines would provide clear and transparent rules so passengers know when they're entitled to compensation; airlines would compensate travellers for flights delayed or cancelled, though not for weather or air traffic...”

Turning to clause 19 of Bill C-49, we see that CTV News was reporting on the proposed new paragraphs 86.11(1)(a),(b), and (c) of the bill.

Meanwhile, on CBC's The National, viewers were told, “CBC News has learned the legislation is also expected to stop airlines from charging parents extra to sit with their kids.” In this case, CBC was reporting on the proposed new paragraph 86.11(1)(d) from the bill, which says, “respecting the carrier’s obligation to facilitate the assignment of seats to children under the age of 14 years in close proximity to a parent, guardian or tutor at no additional cost.” This is specific detail of the legislation that could not have been guessed at ahead of time by the CBC. Details of the bill were clearly leaked.

Furthermore, the CBC report noted “don't expect exact compensation levels tomorrow. They won't be written into the law.”

If you were watching CTV Monday night, Mr. Speaker, you would have known that “The exact rates for compensation under the new rules will be set at a later date by the Canadian Transportation Agency and reviewed regularly.”

This was in reference to the proposed new subsection 86.11(1) of the bill, which reads, “The Agency shall, after consulting with the Minister, make regulations in relation to flights to, from and within Canada, including connecting flights.”

It is clear this was no simple, accidental leak, though that would also be inexcusable, but, rather, this appears to be the result of a systemic advance briefing of the media about pending legislation as there would be no other way for them to know such specific detail about the bill. Details such as airlines not being able to charge extra for parents to sit next to their children, or that the fines would not be detailed in the bill, or that airlines would be forced to compensate travellers for delays and missed flights could only be known by the media as a result of a leak.

As the Conservative Party critic for transport, I cannot hold the government to account if I learn about the content of the legislation through the news and not through Parliament. That is why this is so important.

As Speaker Milliken said in the ruling I cited earlier:

To deny to Members information concerning business that is about to come before the House, while at the same time providing such information to media that will likely be questioning Members about that business, is a situation that the Chair cannot condone.

Speaker Milliken also found a prima facie case of privilege in connection with advance leaks to the media about a bill to be introduced, on page 6085 of the Debates for October 15, 2001.

Indeed, Mr. Speaker, you also had occasion to find a prima facie case of privilege last year, on April 19, 2016, on the premature disclosure of the contents of Bill C-14, the assisted dying bill. On page 2443 of Debates, the Chair stated:

In this instance, the chair must conclude that the House's right of first access to legislative information was not respected. The chair appreciates the chief government whip's assertion that no one in the government was authorized to publicly release the specific details of the bill before its introduction. Still, it did happen, and these kinds of incidents cause grave concern among hon. members. I believe it is a good reason why extra care should be taken to ensure that matters that ought properly to be brought to the House first do not in any way get out in the public domain prematurely.

Thus, the available precedents lead me to conclude that this incident constitutes a prima facie question of privilege...

The House considered and passed a motion to refer that matter to the procedure and House affairs committee, which has yet to report on the situation. I understand it was last considered in September, when the Liberal majority voted down a number of motions intended to allow the committee's investigation to continue.

It is incumbent upon us, as the opposition, to call out the government for these abuses of Parliament, and to place before the Chair any perceived breaches of the privileges of the House of Commons, since you, Mr. Speaker, are the defender of the rights and privileges of the House.

Based on the facts I have presented, and the clear precedents on this matter, I believe you should have no trouble in finding a prima facie case of privilege.

[Ted Falk, Conservative, Provencher, MB]

Thank you, Minister, for coming to the committee.

I was recently watching a panel discussion in which you and the Minister of Health were discussing the proposed marijuana legislation. I forget who the host was. Of particular interest to me was a comment you made, that you had not ever been a cannabis user, nor did you expect to be after this legislation was passed.

I have two questions for you.

First, why is it not a good thing for you, but it's okay for others—even for the youth of our society—to have access to cannabis as a recreational drug? I commend you for your personal position.

Second, I'm looking at the legislation your government has presented so far in the last year and a half, which you say you're very proud of. Bill C-14, the medical assistance in dying legislation, now allows Canadians to legally have their lives terminated with the assistance of a physician. Bill C-16 addresses what I think is an imaginary gap in both our Canadian Human Rights Act and our Criminal Code. Bill C-32 repeals section 159 of the Criminal Code, which addresses anal sex. Bill C-37, which repeals the Respect for Communities Act, will now make it easier for safe injection sites to be located in different communities across Canada. The most recent one, Bill C-45, is of course on the legalization of marijuana.

My question on all those issues is, I think, quite simple. These pieces of legislation seem to have a particular theme to them. I'm wondering what it is that motivates your government to, in my opinion, be so bent on and recklessly determined to destroy our social and moral fabric?

Framework on Palliative Care in Canada Act

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

Mr. Speaker, when it comes to the assisted dying legislation, the important thing to note is that the committee that studied the Carter decision said that without good palliative care, we do not have a real choice. For many Canadians who are in places where they have nothing, they are suffering horribly in pain, and they really do not have a choice.

We want people to have a choice. We have heard many examples and testimonies. I have heard stories that would make us cry, of people who went into palliative care and were able, in a pain-free way, to enjoy their last moments with their families, living much longer than many had anticipated and much better than many had anticipated.

Although Bill C-14 was more to address the Criminal Code with respect to assisted dying legislation, I think this bill brings the framework for palliative care and starts to build on the various aspects of that.

I appreciate the minister working with the provinces, because that will be key. We know that the provinces implement the work and the government funds the work, so there is an opportunity to partner with them to get a really great result for Canadians.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Right. Exactly.

There are times when we will not be able to agree. I think the government should have the right occasionally, not always.... My worry with this document is that it will become an “always”.

With regard to programming, as it is explained here, I'll get to the reason it's a bad idea. The examples used do not translate well to our House of Commons. I'm worried that it will become a permanent feature of this House and a permanent feature at the committee level. We already see it during committee of the whole: we don't actually debate directly the amendments; everything is on division, as much of the work the committee of the whole used to do is now done at the committee level.

Is it an anachronism? You could have an entire study on whether committee of the whole still serves a relevant purpose, but it should not be done within the context of this, rushed by June 2.

As Mr. Christopherson said when he was here—and I see that Mr. Donnelly has joined us—I simply don't see what the rush is to do it by June 2, with such a massive change to the way the House, Parliament, gets through its business.

To get back to the point, it's not the government's business, it's Parliament's business. They come to us for approval and we grant our approval when we so wish. The government represents the crown, after all. They're acting on behalf of the crown. We shouldn't be automatically accepting of everything they propose, even those members of the government caucus.

I had discussions with certain members on Bill C-14, and I'm sure they were kind enough to pass on my comments to the justice minister, because I saw some of what I had mentioned in private appear in the bill. I still appreciate very much that it was done.

Those types of opportunities will vanish, because we will have been programmed. Why would we then come to talk to government caucus members in the hopes of having influence over government legislation? The process is predetermined. The fate of the government bill is assured. When it gets to the Senate, who knows? They have a different way of doing things. They are more independent now—autonomous maybe. Our Senate is now turning into something more like the U.S. Senate.

For all those individuals who complain about the gridlock in the American system, just be careful: 10 or 15 years from now, Canada might have exactly the same type of problems, with senators holding up appointments, senators holding up bills, senators filibustering in the Senate for excessive amounts of time or passing huge amounts of legislation in Senate bills and them sending them to us to deal with during private members time. We will simply not have rules in place to deal with the volume, just as has happened in the U.S. system when they don't have a House leader to lead these issues through on behalf of the government because they're all independent thinkers.

I'll mention, because I have a few examples I want to use, how they changed their rules and the regrets many of them have after they change sides. Someday the government caucus will be on this side, as the opposition caucus, not as a government caucus. I don't think you just switch sides like that. But you'll be on our side.

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

Thank you, Mr. Chair. It's good that you're being recognized. Part of this is about preserving your ability, as a private member, to bring back at some point that excellent bill on FASD. Hopefully, we'll get that passed.

I would like to thank the interpreters. It must make their job especially tough when I speak French.

I was speaking about the balance between the House and the Senate. I don't think any member here would disagree in principle that the democratically elected House should, in a certain sense, be the primary decision-making House. The purpose of the Senate is to provide that review and sober second thought, propose amendments, and send those amendments back to the House for consideration.

If we found ourselves in a situation where a person who was deciding if they would rather be a member of the elected House or a member of the Senate, and they thought, I would prefer the Senate because then I'll have more influence on policy, that would be a very unfortunate situation. It would have the potential to create all kinds of other perverse incentives, where members of the House of Commons would be, through their behaviour in the House of Commons, seeking appointment to the Senate. Yet we find ourselves in such a situation already, because of the desire of the Prime Minister to create a non-partisan Senate, and effectively, through these Standing Orders changes imposed unilaterally, a more partisan House of Commons. So then the role of the member in the House of Commons is weakened and more likely to be subsumed into the role of the party, while the role of the senator is strengthened.

I've described a case example, Bill C-14, in which effectively the same amendment became law because it passed in the Senate, even though it was rejected in the House of Commons. There are other examples. We had a change made in the Senate, I would argue a positive change, but nonetheless a change that happened in the Senate. I believe it was Bill C-4, which was the government's legislation with respect to unions. The amendment in the Senate was designed to protect the right of workers to have a secret ballot. Of course, in the House of Commons the opposition took that position, but it wasn't passed. Yet it passed in the Senate even though Conservatives don't have a majority in the Senate. That was a good amendment that passed in the Senate.

While we're seeing this trend towards a more non-partisan Senate, let's make sure we are strengthening and not weakening the roles of members of Parliament. Unfortunately we see, through all of the changes proposed to the Standing Orders, an effort to relatively weaken the role of members of Parliament and to strengthen the role of the government.

If we proceed under a framework established by the amendment, or under a different model, because, as our House leader has discussed, there's a range of different ways in which we could have this discussion that ensure there is a consensus of parties.... It could happen at this committee, in the form of the motion with the amendment. It could happen in a different forum set up specifically for that purpose. It is important that we ensure the protection of the role of private members. There are all kinds of ideas that are not at all touched on in this discussion paper, which I think, actually—

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

If she believed in answering questions, that's something she could implement herself unilaterally, and we wouldn't mind in that particular case. The issue is that, again, we see this discussion paper focusing on issues that are, in some cases, not even best adjudicated in the context of the Standing Orders. Certainly, however, these are questions that we would expect to be raised by somebody who is focused on the interests of the government in the context of that discussion, in the context of that interaction.

I think this is the reality coming out of our experience with two “Prime Minister's question times” that have unfolded before our eyes. Actually, the fact that this has happened clearly makes the opposition's point—namely, that the Prime Minister can do this without changes to the Standing Orders. According to our conventions, the Standing Orders don't police who does and does not answer questions in general. Clearly, the principal concern of opposition members is the quality of the responses.

If I were asking a question, a substantive policy question, and the Prime Minister was simply going to throw out the kinds of non-answers we got today, I would probably say I'd rather hear from the parliamentary secretary on that issue, assuming the parliamentary secretary knows the file and can answer the question. The Prime Minister should know these files and should be able to answer these questions.

There was a justice issue, and I believe it had to do with Wynn's law, although I could be wrong. There was a justice issue that the Prime Minister was asked about in a town hall. He basically said he didn't know the position himself, but he trusted the justice minister. Well, what's the point of having Prime Minister's question times if the Prime Minister is going to say that? He hasn't said it in the House, but he said it in a town hall. He said he didn't really know why he took that position, but he trusted his minister in the matter. It's all well and good for the Prime Minister to trust his ministers, but he should be able to give a reasonable public account of the positions that his government has taken on issues, especially if they're positions that have, presumably, gone through some kind of a cabinet discussion process. Yet this was a very important issue that was sloughed off on the basis of his trust in his minister

We have to be legitimately concerned about the quality of responses. My perception so far, not that I was overly enamoured by the quality of responses we were receiving initially, is that the quality of responses we received in these Prime Minister's question times were actually much lower. It's much more narrowed to a small set of talking points. We have the flagrant refusal to answer questions, for example, in the case of the ethics issues raised.

I'm not naive enough to think that these are problems we could solve through the Standing Orders. We cannot fully prescribe in the Standing Orders the degree of substantiveness we would like to see from ministers in responses to questions. Ultimately, it's up to the people of Canada to consider and evaluate the quality of the responses given by the government and to take that information into consideration when they decide whom to support in the next election.

If we're talking about changes to the Standing Orders, the kinds of changes, the direction of changes we're talking about, is striking. That brings me back to the point I was making before Mr. MacGregor jumped in, and that is this issue of modernization. What does “modernization” mean? If it means fewer answers, then I'm against it. If it means more power to the government and less power, or no power, for the opposition to hold them accountable, I'm against it. If modernization means the opposition doesn't have the ability to be involved in decisions about changes to the Standing Orders, then I'm against modernization.

I'm for modernization, however, if it means passing this amendment and having a constructive conversation, a conversation based on established ground rules, a conversation among members of Parliament to come to a conclusion we can all get behind, a conclusion that moves the Standing Orders in ways we all agree on. I guess I'm using some of that progressivist language with a view to moving this forward, but I'm doing so in the interest of making improvements to the Standing Orders.

That's the kind of modernization that I'm in favour of, modernization that empowers individual members of Parliament, modernization that gives us a greater ability to bring forward private members' bills and see them debated and voted on. Right now it's a relatively small number of members of Parliament, even in a four-year Parliament, who actually have a chance to bring a private member's bill to a vote. If we're talking about changes that make it possible for more members of Parliament to do that, then that is the kind of modernization that I'm in favour of. But I don't think anybody here on either side of these questions could say, just based on the word, if they are for or against modernization.

As we try to come to constructive conclusions here, we should rightly be suspicious of the kind of wording that's used if it doesn't actually mean anything. We should use words that are clearly defined that mean something in the context of our discourse. That is a pretty fundamental thing for us to ask for when we're hearing proposals from the government House leader.

One other thing that I don't think has been discussed thus far by anyone at this committee is the relationship between Standing Orders' changes in the House of Commons. and the way in which those are done, and the Senate, and the relative power and influence of the House of Commons and the Senate. It is interesting in the present time we're seeing proposals for very dramatic changes to the way the House of Commons works and to the way the Senate works, both in the name of modernization. What's striking to me, though, is how those changes actually move in opposite directions.

I don't know that anybody has dug into this or commented on this, but it was something that was obvious to me right away as a member of Parliament because I was very involved in the debates around Bill C-14, the government's euthanasia legislation. Right from the start, that process involved both the House of Commons and the Senate; and given the government's desire to move this forward quite quickly, the work with the Senate was quite important. A joint committee of the House and the Senate did an initial study on the question of euthanasia and reported back to both Houses in a report. There was a dissenting report. Then following on that there was legislation brought forward.

The process was that legislation was brought forward in the House of Commons. It was debated. Eventually the government invoked time allocation. Then there was a vote on time allocation, a vote on the motion. It went to committee. There was a whole host of amendments proposed at committee. I proposed 13 amendments, three of which passed, the rest of which were rejected. The changes that were accepted were fairly minor and didn't save the bill, not by a long shot from my perspective.

I was able to propose four report stage amendments in the House and they were all defeated. In and of itself, that was relatively rare. The Standing Orders provide for report stage amendments only in very rare cases, but because of the exceptional importance of this issue, the sensitivity of it as well as the differences of opinion within different parties, I made a case to the Speaker. Other members made a case to the Speaker, and he ruled yes, you could have report stage amendments.

There were report stage amendments. There was a vote on those, and I was up all night sending emails to other members, trying to encourage them to vote in favour of my amendments. A few members of the government did vote in favour of my amendments, but at most there were five or six votes on the government side for any of the amendment proposals that I put forward. All of the opposition amendments on the floor of the House were defeated.

The amendments were passed. Bill C-14 was then passed at third reading, and this is the important point of contrast. Then Bill C-14 was sent to the Senate, and there were a substantial number of amendments to Bill C-14 that were passed in the Senate, one of which was very similar to an amendment that I had moved at report stage in the House that was defeated. The amendment dealt with people receiving information about palliative care options as part of the process leading up to their receiving euthanasia.

The bill went through the House of Commons. There were a number of amendments, one of which was very substantial and would have very dramatically liberalized the eligibility criteria. Although I felt the eligibility criteria were quite ambiguous in any event, and it wasn't clear that there was actually that much substantive difference from the liberalization advocated by the Senate and the original version, nonetheless the perception was, and certainly linguistically, there was a significant liberalization of that process. Then this went back to the House. There was a motion in the House to support some of the Senate amendments but not others.

What was striking right at that point was the government did not want to bring in some of those Senate amendments, in particular that dramatic, more liberalizing one, but they agreed to support some of the Senate amendments including, in particular, the one that I had moved. It wasn't the same but it was a similar one to the one I had moved and it had been voted against at report stage. The government understood that they wanted to get this legislation through the Senate and it wouldn't have been that strategic for them to just reject all the Senate amendments. They wanted to reject some, but not all.

This came back to the House. The government proposed this motion to support some of the Senate amendments, not others, and then send the bill back, in a somewhat amended form, to the Senate. That all happened on one day. I think it was a Thursday, right before the session was ending in June. That motion passed.

At the time, if I remember right, all of the government members, perhaps with the exception of a small handful, voted in favour of that government motion to support some of those Senate amendments, even though those same members had voted against one of those amendments when it came from me at report stage. Then the revised version of Bill C-14 went back to the Senate, and there was a proposal to re-amend it. That proposal was defeated, and then the bill was passed as it was, as it had been received from the House. Bill C-14 was passed and it went for royal assent, and it became law. That's what happened.

What is striking about that process is the fact that I, as an elected member of Parliament, had effectively much less leverage in that legislative process than a senator who moved that same amendment. I think it's very clear, given that the government would not accept the amendment when it came from a member in the House but did accept it, ultimately, when it came through the Senate, that government members, generally speaking, within the House vote together. There is an effort, further even from where we were at the time of the Bill C-14 debate—and it's represented in this discussion paper—to strengthen the centralization of the structure in the House of Commons to make it that much easier for the government to push through legislation without having the opportunity for extended interventions at committee. It will allow the government to do programming, and so on and so forth.

You have all these things that the government is doing, which have a centralizing effect in the context of the House of Commons. At the same time, the discussion in the context of the Senate is the opposite. The government doesn't even have a government leader in the Senate. They have a government representative who, to be fair, is for all intents and purposes likely the same thing. I'm not an expert on the Senate, but it's clear that the emphasis with the Senate is on empowering individual senators to act more independently, in a non-partisan manner, and to be able to deviate from what would be the direction of their party. You have all these different groups in the Senate. We still have a Conservative caucus in the Senate, but then you have these Senate Liberals, who are supposedly independent—depends on the day— and then you have the independent Independents group. Then you have people who are independent of the Senate, independent Senate Liberals and the independent Independent caucus.

It's confusing, obviously, but it is the kind of environment in which individual members, in a House of 100 members, can actually exert a lot of leverage. If a member can, on an individual basis, persuade their colleagues to support something, then it can pass in the Senate. Then it puts a lot of pressure on the government to adopt all or some of those changes, as we saw happen with Bill C-14. But if an individual member of the House of Commons puts forward an idea, an amendment to legislation, very likely the way things operate is that members will vote along party lines and that proposal will be shut down.

We should be concerned about the roles of individual members of Parliament, but I think we should be particularly concerned if by these two forces of reform or modernization, which are actually opposite forces—the empowering of individuals within the Senate and the strengthening of efficiency of the centre in the House of Commons—we're actually increasing that disparity in power and influence over the legislative process between members of the Senate and members of the House of Commons.

I think the Senate is important. The Senate has an important job to do. It was striking to me as a new member of Parliament, right away being involved in that Bill C-14 debate and finding that appointed senators—people who were put there by a prime minister, who did not have to win an election and in many cases had never sought election—actually had more influence over what kind of legislation ultimately became law. That was clear in the instances of the amendments we dealt with on Bill C-14. There was a greater influence there from the Senate members than from the House of Commons.

When we look at Standing Orders changes, how we make those changes, and who's involved in making those changes, we have to be particularly sensitive to the kinds of changes that are happening in the Senate if we want to ensure that we have an environment in which the elected House of Commons is the most important House. In principle, we would all accept the idea that the House of Commons—the elected House, and not just the House as a whole over the Senate but individual members of the House—should have more of an influence than individual members of the Senate.

Of course, some members have advocated the abolition of the Senate; others might favour moving to an elected Senate. Those are larger debates that require changes to the Constitution. What we do in the Standing Orders has an impact on the relative influence of the House and the Senate, and we need to be cognizant of that in the discussion here.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Collectively, we know there has to be a government legislative agenda. The opposition's job is always to react to what the government is doing. You set the agenda. You, in a sense, are the executive—not you as individual members—because you are members of the government caucus. It's about ensuring balance, and about understanding which bills are considered controversial, which ones need more debate, which ones could use less debate, and how we can afford additional debate. What are the mechanisms by which both the government and the opposition can let it be known that they choose to have more debate on a particular issue, or want to have that debate? If you introduce the kind of programming that this proposal has in it without sufficient review, without sufficient study, and I believe without sufficient witnesses coming in, then I'm afraid you will not strike that right balance and you will lose as parliamentarians, not as members of the government caucus. It may not be in this Parliament, but in the Parliament after this one, and the one after that.

There are bills that are not controversial. We have seen our ability in the House to quickly pass bills, such as the Marrakesh treaty bill, because we were in agreement. We agreed with the contents and the principles. When we do that, we move it forward. Likewise, debate has collapsed at times on particular pieces of legislation, such as Bill C-6 in the House of Commons, because no member chose to rise and speak to it or debate it further. It simply proceeded to the next stage in the House.

We don't have to be geniuses to realize that a single member can cause a lot of havoc for any government or opposition on any bill. What we do need, though, is a sense of co-operation. We can build that co-operation at the committee level especially. That's why we didn't simply vote against the motion. We proposed a reasonable amendment that would improve the original motion, one that we could move forward with in terms of its contents. I still believe it's reasonable. The contents of our amendment are pretty reasonable.

We saw with Bill C-14 that the government used time allocation several times. On that particular bill, I disagreed with time allocation being used, because it was an issue of conscience for many of us. Our constituents, or many of them, thought it was an issue of conscience. That bill in itself was a response to a Supreme Court decision, so we as parliamentarians were being asked by the government to respond to it. That was their proposal, to implement what they thought would be a means of abiding by the strictures of the Supreme Court decision. We were free, then, to deliberate to the fullest extent possible on behalf of our constituents. I think it was an error to use time allocation in that situation. Again, that was the government's call to make.

There was some debate, and in my opinion not enough debate. At the committee stage, I'll give great credit to Mr. Housefather, the chair of the committee at the time. He made it possible for every member there to have their amendments considered. I know that he gave me consideration for my amendments that I proposed at committee. To his credit, he allowed me that opportunity.

I don't know what the outcome will be of this report, nor should I know. There should be a study of some of these ideas here. Our ideas on the changes to the Standing Orders have been debated before, but I would caution you about changing the way in which committees work too readily, too quickly, and surrendering your rights as parliamentarians to be heard at committee. We moved it from the House of Commons in 1969 into the committees to have freewheeling debates, to move from generalists to specialists on specific issues. If you allow the types of rules that exist in the House of Commons to be moved into committee, you will lose on that. You will lose the ability to differ with your party when you need to, to be independent thinkers in general, because potentially there could be limits on the type of debate you could have. There could be limits on the types of motions you could put forward. They could program the committee so that it works a certain way, so that when every member has spoken, it simply moves on to the next stage. I don't think we win when we do that.

All of us were elected within a political party. There are no true independents in this House. Even Mr. Tootoo was elected as a member of the Liberal Party of Canada, although now he is free to pursue whatever objectives he has as a parliamentarian. That is his right.

I don't think it suits us to so readily and so quickly change the way these committees work without getting unanimous agreement among ourselves.

I see that Mr. Garrison is here for the New Democrats. I know they would agree with me that we fight hard at committee for the other members of our caucuses who may not be able to sit through the committee because of scheduling reasons. We do this on their behalf, not just for our constituents. There are also our fellow caucus members who may have an interest in a particular issue. We need mandates from our caucuses, because when we speak there, we don't speak just for ourselves and our constituencies. We also speak on behalf of our fellow caucus members.

Again, from the Debates, at one point, one of the members said, “Trust me, if a debate collapses on a particular bill, it might be because there is no one who wants to talk about it.” That is very true.

When we are allotted our 10 minutes in the House of Commons, you don't need to use the full 10 minutes. I've seen members use less than that. They rise, make an excellent point, sit down, and then do a Q and A with a member who chooses to pursue a line of questioning or make a commentary. If we policed ourselves more often, we could find opportunities like that to be faster and more efficient, but you won't achieve that by changing the rules just because sometimes people don't police themselves.

Here's what we should do. Let's try to get some substantial rule changes in our Standing Orders without resorting to forcing it past the opposition. We are opposed to making changes without being sufficiently consulted and without being able to say to not do A, B or C, because it will constrain us as an opposition from being able to fulfill our constitutional obligation to loyally oppose.

As I mentioned before—and will now, maybe for the benefit of some of the members who have joined us this afternoon—you are not my adversaries. You are not my enemies. You are fellow parliamentarians. I am not here to win political points at your expense. I am here to debate you and to deliberate with you. You will disagree with me and I will disagree with you. At the end of the day, in terms of your political affiliation, you will likely vote with your caucus. I accept that, but we can have that deliberation between us. Don't take away all the tools I have to make a point on behalf of my constituency, or on my behalf if I have an issue of conscience I need to raise, or on behalf of my caucus members who may not be able to sit around the table.

There are proposals in here to add members of other parties as ex officio members so they could question witnesses. Right now, we have two hours. Typically, most committees meet over a two-hour period. I've actually asked why the meetings are two hours. I don't know if anybody has ever wondered why we have two-hour committee meetings. Why are they scheduled in two-hour blocks? Is there something about three hours or two and a half hours that doesn't work? In the business world, a two-hour meeting would be called a two-hour waste of time, typically. It would have to be pretty substantial business to have a two-hour meeting with multiple presenters. Engineering companies may do it if there's a complicated project with drawings on the table.

What I have been told—maybe this is apocryphal—is that the two-hour scheduling was done before we gained the buildings that were added to the precinct, and the two-hour windows allowed for every single committee to be scheduled during the day. They would schedule them all in a row. There weren't as many committee rooms as there are now, so they scheduled them one after another and the two-hour blocks made it all work.

Do we need two-hour committee meetings all the time? I know that at times the chairs have finished meetings early. Chairs obviously have longer meetings at times. Small changes to the rules like that are worthy of consideration, but we should come to them by unanimous agreement.

Making this place more functional doesn't require us to surrender our ability as parliamentarians to keep the government accountable, which you want to do also. I've been told by many experienced members, veteran members, and even members of the government and previous governments, that sometimes when considering the main estimates, and even during debates on supplementary estimates, they have discovered things in the documents that they didn't even realize were contradictions or errors.

I remember doing estimates at the provincial legislature in Alberta. Sometimes there would be inaccuracies. There would be typos that would have to be explained. Sometimes the civil servants had not removed a certain thing that they had specifically been asked to remove because it was no longer part of the agenda of the government, and it was only realized through considering the main estimates. The committees are the opportunities to review those estimates. If we program the committees to limit how much we can speak, we'll lose that opportunity. We really do very little of it in the House.

There is a provision that the estimates are automatically passed at a certain point, debated or not and considered or not. There, we have already surrendered part of the core job of a parliamentarian, which is to review how the government spends money.

The President of the Treasury Board is proposing changes to when and how the estimates are considered, so I know that it's already being considered by the government in its proposals to Parliament. This is something that parliamentarians have talked about in the past. The main estimates are done on a cash accounting basis. The government does accrual accounting. The fiscal years don't match.

I remember being at the chamber of commerce when we invited the deputy parliamentary budget officer to come to Calgary and explain this problem to us. He made a fantastic presentation to our tax and economic affairs committee and really convinced the people who were there, business people, about the errors and mistakes that could occur and the difficulty in tracking how government spends money.

Earlier, I mentioned the second chamber. I am moving on to page 5571 of the Debates. I won't go through all of them, because I'd like to move on to a few more articles and the debates from 1991, when there was an attempt to force through changes to the Standing Orders without unanimous agreement, and go through how adversarial it became at that time between members of the government and members of the opposition.

There are two last points I'll make on the debates. This concept of a second chamber, like they have in the United Kingdom, I think is unnecessary. What we need to do is fill the chamber with the members we already have. The best debates I have seen have happened when there were more members in the chamber who got engaged because there was an engaging speaker making a point that perhaps someone hadn't made, who was perhaps doing it in a tongue-in-cheek way, or who perhaps grabbed the attention of another group of parliamentarians. Then there is an easygoing back-and-forth, a flow of conversation and debate.

I don't believe that we need a second chamber. I know that it was mentioned by some members in the debate on October 6, and I know that part of this original motion is to consider what members have mentioned.

Here's what I signed up for. No one forced me to run. I wasn't forced into this by my wife—definitely not my wife—and I wasn't forced into this by constituents or by the local Conservative association. We've all signed up for a job that involves gruelling travel. We have all heard people talk of working 15-hour days and working on weekends. For some of us, it's a very long trip back home. We all campaigned for 78 days in the last election for people to grant us this: to earn the privilege to sit here as parliamentarians and serve in the House. I try to keep my complaining about the work-life balance to a minimum.

I campaigned vigorously against New Democratic and Liberal opponents in my riding who wanted to do exactly the same thing. They were signing up for exactly the same type of job. What I don't want members of the cabinet to say is that to save our work-life balance they're going to reduce our sitting time by 20% and reapportion the hours to another time. I don't think that would help this place work. I don't think it would improve debate. I don't think it would improve work-life balance. How about they let parliamentarians decide about their work-life balance?

If I remember correctly, it was this committee that did not pursue recommending doing away with Friday sittings, but it reappears here for consideration. I know that Mr. Simms has offered a different perspective, which is to do a full normal day on Friday. I've offered my perspective that perhaps what we could do is bring back committees of the House to take their debates to the House for a day. They would be automatically pre-scheduled so that everybody would know that the foreign affairs committee would come in for three hours and the members of the committee would be expected to be there, perhaps on a motion to debate a report or an issue.

It's an option, but I haven't studied it enough. I haven't considered it enough to understand the ramifications of doing that. I don't think you have enough time to complete a report by June 2 and get consensus at this table without passing our amendment to the motion. You will need that done in order to get that across.

There are many people who work in different occupations, such as the military, or who work in Fort McMurray, who travel quite a bit, are away from their families, and don't get a say in their work-life balance. It's imposed upon them by their employers. Our employers are our constituents, the taxpayers of Canada. In a group, they pay us to be here to work on their behalf as parliamentarians first, not members of our caucuses first.

I defend the interests of my constituents because nobody else here exists to do that. As I've mentioned, I have the second largest riding in Canada. Nobody else is going to represent it here but me. That's the best I can do on their behalf. Within five years—and likely within four years, because that's the law—there will be an election, and I will be held to account for my performance in the House. A great thing about our democracy is that individual voters can use whatever metric they want to rate us. They can ask us if we have missed a lot of votes, if we have been present in the House, or if we have spoken enough. I hope they will feel that I have spoken enough.

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

The 21st century.

That's what Mr. de Burgh Graham said. Actually, I wish I'd been here to hear his intervention last week.

It's interesting when we see the suggestion about making electronic voting. I think it's important that we have members of Parliament in the House. We're doing it right around the clock and we're having votes. I think Ms. Sahota said that it was a good thing she didn't bring her family, because it would have interfered with her family time.

I understand what it's like to have your family nearby and get a vote called or whatever. But this is what we signed up for. I never want to take away somebody's family time. I think you heard earlier how passionate I am about my kids. I did things differently in my previous role. This job has allowed me, has afforded me, to be a better father, as a matter of fact. Regardless of whether I'm away from home or whatever, I think we know what we're getting ourselves into when we're doing it.

Getting back to the votes, electronic voting may be a way to modernize it, but there has to be a different way. I think you have to stand to be counted. I think members of Parliament have to be able to stand, on the record, whether they are for something or against it. That's what the electors want us to do.

One thing that my electors asked me on the doorstep was this: “If something's against your party policy, but we in Cariboo—Prince George feel very strongly for it, how will you vote?” You have to vote your conscience. You have to vote your electors. Ultimately, it's not me.

I want to bring you back to Bill C-14, which dealt with physician-assisted death. We spent a lot of time debating other things, considering the amount of time we spent on a piece of legislation that I feel is probably one of the most important pieces of legislation our Parliament would see. Do you want to know why? It was because closure was invoked on it, which I think is sad.

People asked me how I was going to vote. Regardless of my personal beliefs, I listened to my constituents.

I consulted a good friend of mine who is a minister, and I said that I didn't think there was enough time for me as an elected official, that I didn't think there was anything to prepare somebody to be able to really understand the magnitude of voting on something such as that. I was struggling with it, so I went to my minister and asked for guidance.

I heard from our constituents loud and clear, and it varied, but overwhelmingly I heard that.... When we're talking about invoking closure on important debates, I think it's important.... I don't know how many days we debated the question of changing the words to our national anthem. I think we debated that longer than physician-assisted death. To me, for fundamental pieces of legislation such as that, invoking closure on something because you don't like the way the conversation is going.... We heard on the other side that they were indeed twisted in how they were going to vote as well. We've seen that a number of times.

Mr. Chair, I can't talk about what we did as government, but we have seen that over the course of the last 18 or 16 months this government has invoked closure a lot of times because they didn't like the message they were hearing. They didn't like the fact they were getting, perhaps, even some opposing views within their own caucus. I think that is shameful.

We need to make sure that the voices of our electors are never silenced, that we have the ability to bring those forth. Whether we like the answer or not, I think that is important to do. There are things I may not always agree with on the other side, or even within our own caucus, but I listen and respect those views, recognizing that they are the constituents' views of the members. I do my very best to try to educate myself on why somebody feels that way, and I think that's important.

I read Ms. May's paper. As I said, I try to understand all points of view. I can honestly say that, while I may not always agree with Ms. May, there are some things that she says in here that really resonate with me. On electronic voting, she states, “For my part, as the leader of an unrecognized, but nationally engaged parliamentary party, I find the current voting system valuable in many ways.” I agree with this. It is important that members be physically present. Voting from our offices or our home ridings is not an acceptable option, and it is a dereliction of duty. I truly believe that. It opens it up for manipulation.

This is my saying this. I think what we need to do is to make sure that members of Parliament can't absolve themselves of the responsibility of voting. We must not make it easier for them to say, “I wasn't there, I didn't vote on it”, or “somebody else pressed the button”. Instead, stand and be counted. If you are truly there to represent your electors and your riding, find a way to get yourself to the Hill and vote, and be on the record for how you feel.

I want to go back to some of the comments that we've heard regarding the opposition. Again, I don't know the history, but has there ever been a time when the Conservatives and the NDP have co-authored a paper and signed it, and the leaders have stood together on something and had a unified voice? Probably not in the last 10 years, anyway.

This is what the government of the day has done. It's managed to actually unite, for the most part, the full opposition. We've got a letter here from last week written by the Honourable Candice Bergen, our opposition House leader, and Murray Rankin, the NDP House leader, talking about modernizing the House. It brought forth a 2001 motion to create the Special Committee on the Modernization and Improvement of the Procedures of the House of Commons. I'm not going to go into this because I think it's been read to death. But what I'm going to say is that I think it's interesting that I see a lot of kind of grumpy people, angry at what the opposition is doing. They say, “Can you imagine the gall of the opposition to do all these different moves and manoeuvres, and shame on them”. Well, who started this, Mr. Chair? All you've done is galvanized us on this, which is great because for once the guns are pointed squarely across the way and not askew a little bit, because I see that sometimes too. I think it's important that it this on the record as well.

Mr. Chair, it's interesting when we go down the path that we've gotten to at this point. I'm sure every member of the government or the Liberal Party.... And it's all backbench; we don't see any ministers here. Of course, they're busy doing whatever they're doing. Far be it from them to come to talk about their ways, what they think would change or modernize the House. I know they're busy doing things. I'm being facetious. It has been the backbench folks, the newbies who have really been holding up the end for the government—and you, of course, Mr. Chair, who have been doing a great job. I think it is very commendable.

I would love to be a fly on the wall in your conversations behind closed doors. I really would. I'm sure it's not all roses, bouquets, rainbows, and unicorns, because I know that you've got some very strong, well-meaning, very smart, very capable members of Parliament who perhaps don't get a chance to say as much as they would like, or don't get a chance to be the voice of their ridings as much as they'd like. As a matter of fact, just before Christmas, there was a member of Parliament who stood up—and forgive me, because I don't know his name; I should know his name—and was heckling me, and I was looking across the way. It was the first words I think he had said in the House in the 14 months after being elected. I thought, “Is that the best you've got after being elected for 14 months?” It was the first time he was able to stand in the House and be on record. That's the point that we've said. I've stood up a number of times in the House to say—and I'm saying it over and over again here—that the 338 members of Parliament, incredible, strong, well meaning, capable, elected from all walks of life, bring differing points of view and perspectives to this House.

I'll use the Prime Minister's words against him here, that “Canadians know our country is made stronger because of our diversity, not in spite of it.” Does that ring true, that everyone around the table has a say because we come at it from different vantage points? We've probably got people who have been CEOs of major corporations. We've got scientists and microbiologists or marine biologists, and we've got people from all walks of life. We've got ministers. We've got an astronaut, for heaven sakes. So we've got people around the table who are from all walks of life, who bring us different points of view. Can't we come to some form of consensus or be trusted to sit around the table and come up with something or find ways of making things different and better?

It's interesting, too, Mr. Chair—

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

Mr. Graham really wants me to cross the floor. I suppose I could then join the large number of Liberal members voting against the government. That's not going to happen, just to put all my cards on the table.

Speaking of all my cards being on the table, I would like to continue where we left off last night, or rather earlier this morning, with the important issues that we're dealing with. Our discussion was in the context of a notice of motion that came forward from Mr. Simms, and I should say that the motion came forward in a way that I don't think is respectful of the tone and of the way in which we typically operate within this place.

We had the release of a discussion paper that, as I think others have reflected, isn't so much about discussion as it is about dictating. It's just supposedly to raise some issues and some questions and some matters for consideration, but then, very immediately, it was followed during a constituency work week by a notice of motion. On the day before the budget, the government wanted to move forward with this motion that would have involved a study of the issues in this so-called discussion paper about the so-called modernization of the Standing Orders. They thought that somehow the boundaries of that study had to be determined the day before the budget.

Of course, we know that Canadians are legitimately weighing out. They are looking at the budget, looking at how much this government will increase their tax bill by and at how much debt will be left to the next generation. In the midst of that, we have something happening that I think was designed to slide in under that discussion and prevent us from really giving it the scrutiny it deserved.

What did we on this side of the House do? Not just our party but all on this side of the House, including our good colleagues in the New Democratic Party, stood up and said “no”. We said it was not right for the elected government of the day to do this. They do enjoy a certain mandate to implement aspects of their policy agenda, but it is not right for them to try to unilaterally change the way in which our parliamentary institutions function.

That has been the pattern with this government. It has met with strong opposition in every case. Initially the government thought they could unilaterally change the way in which elections occur, the process by which they take place, in a way that would work to their advantage. The opposition stood up and said “no”. We were eventually unified in saying that you cannot, as one party, change the rules of the game. You have to engage with others in the process.

This is exactly what our amendment speaks to. This is a continuation, another step in what we've already seen so far from this government. First of all, they wanted to change the way in which elections occur without meaningfully engaging Canadians or meaningfully engaging their representatives, except for those who were part of their party. Even then, we sometimes have good reason to doubt how meaningful the engagement is, even within the government caucus, given the responses we see in terms of things that happen in the House as a result of that.

Now that they've backed away from that, we see them effectively doing something very similar. They're trying to change the rules of our parliamentary processes, again unilaterally, again proceeding in a way that is not set up to be respectful of individual members of Parliament and those other voices who need to be represented in that discussion as well.

It is interesting that there is a clear similarity, a clear parallel, in terms of the kinds of arguments that are being used by members of this government in this context. My colleague Mr. Reid, on the electoral reform file, would ask repeatedly of Minister Monsef in the House of Commons, “Why won't you commit to a referendum? Why won't you commit to the wider public engagement that we would expect to take place?” Those were the questions that he asked, and the response—to the extent that the questions were answered at all—was always something in the form of “Let's put aside these questions of process and let's talk about the substance.”

We ought not jump to a discussion of substance without really prefacing that with a meaningful discussion of how the discussion will proceed, the process by which it will unfold. Yes, I am as eager as members on the other side are to have a discussion about how we move forward with respect to our Standing Orders, but that has to be done in the context established by the amendment. You can see a parallel to that in the call for a referendum that came from the opposition before. It was us—not just us as the Conservative caucus, but the united perspective of the opposition—saying, “You cannot change the rules of the game on your own.” That is not what Canadians elect governments to do.

Canadians elect governments, or members of Parliament, to be precise, and members of Parliament then coalesce to define who the government is. Through that process of selection, Canadians identify a government that they expect to make policy decisions and to propose laws for debate and discussion. At the same time, though, I think Canadians expect governments of the day to leave intact the basic framework that allows for ongoing, fair, democratic competition. To the extent that changes are necessary in that interaction—either changes to the way in which people are elected or changes to the processes of the parliamentary activities that we're a part of—any time there are proposals for change, it is not good enough that one player in the game decides that they want to make those changes.

I don't want to reduce what we do here to a sports analogy, because what we do here is much more important and consequential, but I think members would clearly understand that if one combatant in a sporting event were to set the rules of the game, the other side might have some real, significant, and legitimate concerns about that. The way in which democracy is supposed to work is that there is a set of ground rules that are identified, independent of the particular interests—and certainly independent of the narrow, immediate interests—of one particular party. Those ground rules are established with a wide degree of social consensus.

In the context of electoral reform, we said it was important that it occur through a referendum. In the context of changes that are proposed to the Standing Orders, it is important that the discussion occur through the meaningful engagement of members of Parliament. That means members of Parliament of all parties, including all members of the government and all members of the opposition.

What we have sought is an amendment that reflects the expectation that Canadians have of fairness in our democratic processes, where the framework, the ground rules, and the context in which we operate are not simply established or pronounced upon in a definitive way by one player in the game.

There have to be meaningful mechanisms for the opposition to advance their concerns, to bring them forward and discuss them. It's not surprising to me that we see, unfortunately, this repeated pattern from the government of seeking to make changes not just to policy, not just to decisions of the government, but also to that underlying substructure of democracy. Moreover, they want to to do so in a way that does not reflect our normal processes and traditions, that doesn't reflect our normal expectations of fairness. We see this in the approach they took on electoral reform, which they immediately pulled back from once they realized they had lost the public debate.

I'll say something to members of the government on this discussion of the Standing Orders. You did not win the issue of electoral reform in the way that many in the government wanted to, because Canadians rose up and objected. They spoke out clearly about the problems and the concerns they had with the things that were going on.

The public response on that issue was overwhelming. This is a new issue. This is something that the government started trying to push forward at committee yesterday. Looking at the comments people are making and at the level of engagement we are seeing on social media, I perceive this issue, and specifically the issue of the amendments we are bringing forward, to be one that is garnering very substantial public concern and consideration.

There is a reasonable expectation from the public as people discuss these issues. There is an increasing level of engagement from the public on this issue, and members probably are noticing it as they check their emails. I know we were here late last night, into the wee hours of this morning, and many of us had caucuses to attend, but I would encourage members while they are here to ask their staffers if we are hearing from people on this issue from within our own ridings. Already there has been a very strong response to this issue. People who didn't even know I was here last night have been writing to me about things they've heard from other people and are saying they hope I am engaged in this process.

This is the kind of issue Canadians want to get engaged in, because Canadians take our parliamentary institutions very seriously. They also have an intuitive sense of procedural fairness and the importance of people being engaged, of all parties being engaged, not just because there are different individual perspectives that are important, but also because we are speaking in a way that is reflective of the people who represent us, and the people who represent us—not just those from Liberal ridings who may not be heard in this process, but all Canadians—deserve to have some say over the way our democracy works.

In the government's opposition to the amendment, we see their desire to limit the ability of the opposition to have a meaningful say on the kinds of changes to the Standing Orders that would come forward. We also see in the specific proposals for change that are coming from the government a desire to remove all of those meaningful tools that the opposition has for challenging the government. There is nothing in this proposed so-called modernization that takes away the ability of a member to speak maybe once, if they can get a slot, for a limited amount of time, but in every case they remove those provisions that allow members of the opposition the strong and meaningful opportunity, on issues of vital concern to their constituents and to the nation, to stand up in a more pronounced and fundamental way and say no.

It removes the ability, for example, of members of Parliament to talk for more than a very limited period of time in the context of committees. That's obviously a problem, because the committee can be the one place where members of Parliament, generally those who sit on particular committees, will have a particular interest or degree of expertise in specific areas. This discussion paper proposes to limit the ability of not just members of the opposition but also members of the government to stand up—I guess we normally speak sitting down at committees, but to metaphorically stand up—and object in a way that is clear, effective, and pronounced.

As I look at the text of this discussion paper, and I've read through it a number of times, I see some real dissonance between the tone of the discussion, the stated objectives, and the way in which this government is proceeding vis-à-vis the amendment and the changes they are proposing to bring about. For example, as I said earlier, this discussion paper refers to modernization without clarity or definition, but it also refers to some words that are, in and of themselves, good words: “greater accountability, transparency and relevance”. How in the world, though, does removing the ability of the opposition to have a say, either with respect to the ground rules or with respect to the actual ongoing deliberations of the House, promote greater accountability? How does removing one question period every week, even if the time is reapportioned—because you are still removing the opportunity for accountability five days a week—provide what is stated as an objective, greater accountability?

It states:

Parliament must adapt to a changing and evolving...landscape and should respond to demands of greater accountability, transparency and relevance.

Greater accountability, transparency, and relevance: these are all important things, yet the way in which the government is proceeding—today, this morning, yesterday—is fundamentally at odds with the objectives we discussed here.

It was in fact our party that pushed to have these discussions in public. It was our advocacy that said Canadians have to see, in a clear way, what's going on and what the government is trying to do, which is to remove the ability of the opposition to be an effective force, and to do it in a way that doesn't give the opportunity for the opposition to be meaningfully and effectively engaged in this discussion.

Incidentally, to further support my point about public engagement on this issue, I'll just say that members saw me doing a Facebook Live about 20 minutes ago, before this committee. I had some technical difficulties because I had my camera facing the wrong way initially. That often happens with me. You might be able to tell my ability with technology by my comments about the concept of modernization, but I have figured out Facebook Live, and in 20 minutes we've already had 19 shares. That's a little less than a share per minute. I don't normally get that much traffic on the videos I post, not even on something as contentious as motion number 103, so we are seeing a high level of engagement from the public on this issue.

I think members of the government would do well to note that, and to realize that when they talk about things like greater accountability, transparency, and relevance, Canadians are already scrutinizing what we are doing here. When it comes to the government's desire to limit the conversation by not supporting the amendment, by not allowing the opposition to be meaningfully engaged in that discussion, we see that the public, who are much more able to be engaged because of social media, whether members of the government like it or not, are already reacting to that and being very clear about the kinds of concerns they have as that happens.

There is something in the introduction to the discussion paper that I neglected to draw attention to last night. The introduction talks about the recalibration of the minority and majority, and yet the process envisioned by the government is one in which that recalibration is undertaken unilaterally, where you have one member of the process doing that recalibration.

The discussion paper also says, “This balance is in need of constant attention and periodic adjustment to reflect the will of the House and of the people it serves.” Isn't that exactly what we in the opposition are talking about and are seeking to do through this amendment? This is to ensure that any recalibration or balance that takes place reflects “the will of the House and the people it serves”.

Let's be very clear about what that needs to mean. As the government was keen to talk about, at least until recently, we have a majority government that was not elected with a majority of the popular vote. That's fair. That's how our system works. That doesn't in any way take away from their legitimacy to govern, but it does speak to the fact that we need to have a little bit more of a multipartisan approach if we are to meaningfully talk about the will of the people that the House is supposed to serve, especially when we make changes that shift the underlying substructure of our democratic discussions.

It is striking to me how in this discussion paper you have the nominal recognition of the need for periodic adjustment to reflect the will of the House and the people that it serves, and yet you have a motion that seeks to allow the government House leader's vision to be unilaterally imposed on the House and on the opposition.

When we speak about the will of the House, some members might suggest that could be just a majority of the House. After all, the House can vote, and the government has a majority, so they can carry the vote on the basis of their majority. Doesn't that reflect the will of the House?

Well, I would say that the will of the House should be expressed in different ways that are appropriate to the kind of situation that is being adjudicated.

If we were to have a public whipped standing vote on the selection of the Speaker, I would consider that inappropriate. I would consider that an inappropriate expression of the will of the House in the context of that institution. It is important for the Speaker both to be neutral and to be seen to be neutral. Although formally the process of a whipped standing vote right at the beginning of Parliament would mean that the Speaker would be chosen by a majority, I think it would undermine the principle of the will of the House.

This is recognized in the Standing Orders, which for different kinds of things prescribe different kinds of numbers for the will of the House. Obviously, for the passage of legislation, there is a requirement that there be a majority of those voting who support it. On certain other matters there are different metrics or requirements. There are certain things that the House can only do through unanimous consent. There are certain things the House can do through a majority, but which need to have a proper notice given in advance.

There are certain things that can occur in the House that require a certain threshold to be passed. I am thinking of Standing Order 53 and Standing Order 56.1, standing orders that allow motions to be put forward that are deemed adopted if a certain number of members do not stand to object. In the case of Standing Order 56.1, the government can put forward a motion, and if the opposition fails to stand 25—well, it wouldn't have to be the opposition, of course—if 25 members of Parliament fail to stand, then the motion is deemed adopted. That is to deal with changes to the normal procedural mechanisms of the House.

Standing Order 53, which we had use of on Bill C-14 last spring, allows the government to seek to suspend the normal notice process that takes place for the discussion of a bill. Certainly we would not want the normal notice process to be suspended with a simple majority of the House, but I think it is sensible and right that we're willing to accept that even if there are a couple of members who object—and for the purposes of Standing Order 53, it's not 25 members but 10 members—the government can proceed with something for which there hasn't been the normal notice given, if the will of the House is for that to be done in the way that I have described.

This is the central point. The will of the House is a concept that I think requires a certain degree of proper collaboration in response to the specific events that we are dealing with. Yes, there has to be periodic adjustment, but there has to be an acceptance of the way in which that periodic adjustment takes place that meaningfully reflects the will of the House.

I think the amendment that we in the opposition have put forward reflects an appropriate concept of the will of the House in the context of this type of decision. We accept, as is well established in Standing Orders 56.1 and 53, and elsewhere in the Standing Orders, the use of unanimous consent motions in general, which would be another example of certain situations, especially procedural things, wherein a simple majority is not enough, because if we are shifting the procedural ground of the House, and the government can do that simply with a majority vote, then that puts at risk all of the subsequent discussion that should be occurring on substantive legislation.

It's not just out of sort of parliamentary nerdiness and navel-gazing that we are concerned about questions around the Standing Orders and process. It is, rather, because those things provide the substructure for discussion of substantive issues that matter to Canadians and that inform their lives in a real and practical way.

It's a reality that government legislation may have unintended consequences. It may contain mistakes, and that's why the process of parliamentary scrutiny is so important. That's why the role of all members of the government caucus, not just the cabinet, and the role of the opposition are so important: it's because our ability to engage in a meaningful way in the discussion is a bulwark against the kinds of mistakes or unintended consequences that can occur in legislation.

We need to protect that substructure and we actually, I believe, for the most part, need to have a higher standard of support for making changes to that substructure—yes, to protect it, but also to protect the meaningful policy decisions and outcomes that stand upon that framework. That's something that is particularly important.

Further, there are certain things, certain further acknowledgements in the discussion paper that while ultimately recommending changes that would be injurious to our institutions and, indeed, to a proper understanding of the role of the opposition and of all members of Parliament in that institution, that I think should point in the direction of support for the amendment that we are defending today.

I draw the attention of members to a sentence on page two, partway down the first paragraph, when it's discussing some of the issues of the deliberative function of the House. It acknowledges, “Every issue is unique and requires an amount of debate that is commensurate to the significance of the matter before the House.” This is very true. There are some issues that require less discussion; there are some issues that require more discussion. What has been striking to me in witnessing the way in which this Parliament has operated is that we've often seen efforts to curtail debate on some of those most substantive and sensitive areas where surely we can recognize the need, or we should recognize the need, for very extensive discussion.

The first time that this government proposed time allocation or closure was with respect to Bill C-14, the government's euthanasia legislation. Although, as I'm told, previous governments have used time allocation from time to time, this was a unique case on an issue of fundamental values and conscience. There were significant differences of opinion within every party, and certainly within the two largest parties, and the government moved forward with time allocation on that issue.

This speaks to some of the problems around that whole area of discussion. It also should remind us, when we're properly calibrating the discussion in the House, to recognize the differences between different kinds of legislation and recognize that different kinds of legislation require different amounts of debate, especially on legislation on which there may be broad agreement among the parties that it's something that's okay to move faster on. However, the significance of the matter, the relative time that is required for discussion in the House, is also something that we can't speak of as having a certain ontological objectivity. It is not, strictly speaking, an objective point with regard to how much discussion is required on certain items of legislation. Members of different parties will disagree based on what they're hearing from their constituents.

A recent example of this, to compare what the Conservatives and the NDP were saying, was the discussion around the government's pre-clearance legislation. I can't recall exactly the number of that bill. Our view was that this was legislation that was good, which we could support. It was a government bill. Our caucus was supportive of the government's approach with respect to pre-clearance. The NDP was not. The NDP had some grave concerns. The NDP wanted in particular to ensure that they were able to be fully engaged in the discussion. Notably, when time allocation came up on that bill, our Conservative caucus joined with the NDP in opposing the imposition of time allocation on that point. We recognized that from the perspective of the NDP, the time commensurate to the significance of the discussion of the issue had not been given. What you see today, and what you've seen on matters like this around the management of the time of the House, is some real agreement among parties with obviously very different broader philosophies.

As we think about this issue of the way in which time is allocated, this speaks to very important rules about how the House operates. Yes, individual parties, but also individual members, have an opportunity to meaningfully put forward and discuss the concerns they have. The absence of an ability to do that, the absence of the ability for the opposition to have a role, as envisioned by the study in the absence of the amendment, can obviously create some real problems with respect to the way that balance is set up.

The normal process for making changes to the Standing Orders, as well as for figuring out the time that is allocated to different things, is for discussions to occur among House leaders. There is provision in the Standing Orders—and I think there should be provision in the Standing Orders—for the government to move motions around the allocation of time when they feel there is urgency in moving a measure forward, but the important point is that those motions create an avenue, an opportunity, for public debate and discussion around the use of that procedure and create some accountability and scrutiny of that process.

The way in which the government is proceeding here really seeks to limit or minimize the debate that would normally occur around that.

Later on in the introduction to the discussion paper, the government House leader lays out some proposed reasons for these changes. As we discuss how to do the study and the level of engagement we would expect from members with respect to unanimity or not, we need to take on board and consider the reasons that have been put forward.

The discussion paper speaks about the need to ensure members have a better balance, and to encourage under-represented segments of society to seek elected office.

We should be quite aware and critical of the fact that very often this government uses references to minority and other under-represented segments of society to impose its own interests. We saw this with electoral reform, where they objected to the idea of a referendum. It seemed to be on the basis that we have to ensure that the full range of diverse voices be heard, but we never got an answer as to why a referendum would exclude a full diversity of voices.

Referendums, in fact, would generally make it easier for people to engage who may otherwise be unable to participate in the kinds of consultations that don't involve the simplicity of being able to cast a direct ballot. A red flag should go off in our minds when the government uses this reference to under-represented segments of society, if it is in the context of a broader plan to simply impose its own agenda and, perversely, weaken the ability of the full range of voices to be heard in the process.

The first point of justification that the government House leader puts forward for wanting to proceed in this direction is the comment, “to ensure Members have a better balance”. I'm not entirely sure what “a better balance” means—especially when we have a normative word like “better”—when what is envisioned by the approach the government has taken is that we're going to have a balance that is entirely conceived of and determined by the government on the ways in which Standing Orders operate and debate proceeds. The system that is envisioned is one in which the government decides before the fact how much debate is going to be allowed or not allowed on any given provision, so it's not at all clear to me what is meant there by “balance”.

On the other hand, perhaps better balance isn't speaking so much in this context of the calibration between the role of government and opposition. Rather, it's speaking about the kind of balance that members might want to have between their duties, their families, and other things in their private life. As we think about the Standing Orders in that context, there are a lot of options that we could identify that could enhance the effectiveness of representation while facilitating an optimal balance, but the engagement of those changes shouldn't be something that the government House leader does unilaterally. Of course, the government House leader is in practice a bit removed from the practical life of other members of Parliament, because the government House leader has far more staff. They have certain resources at their disposal, a driver, and so forth, that other members of Parliament don't have.

I'm not objecting to that. I'm simply saying that if you want to have a discussion about the kind of balance that can be achieved in practice for members of Parliament, you'd better make sure that you're actually engaging the full range of voices of members of Parliament.

Now, the kind of balance that is necessary in the life of a member of Parliament will be different for the government and for the opposition members, because government and opposition members have different kinds of responsibilities. In the government, of course, members have access to a greater spectrum of staff support. There are larger budgets on the government side for those kinds of things. Opposition has to spend that much more time on the kind of research and analysis that's happening within our own offices. That impacts the kind of balance we can have.

On the other hand, there are different responsibilities that may be particular to the life of a government member of Parliament, who is probably more involved in making announcements. Committee chairs, not always but generally, are members of the government. Parliamentary secretaries have another set of associated responsibilities that are different from those of other members of Parliament. This issue of balance for members of Parliament is different depending not just on whether you sit in government or opposition but also on which party you are in and what kinds of responsibilities you have within your party. Perhaps there's an issue between recognized parties and unrecognized groups. Then, of course, there's the issue of independents.

In a discussion of what constitutes a better balance, I think it should be obvious that we would want to engage the full and broad range of voices in that discussion. That's exactly the opportunity that is established in the context of this amendment. If the amendment were to pass, it would ensure that we would hear from the different kinds of perspectives that are raised by all members of Parliament as we discuss this important question of balance.

These issues of what constitutes balance will vary within parties, but they will also vary across regions. I mean “region” in the sense of the part of the country you're from or the kind of riding you have, whether you represent an urban or a rural riding. I think the kinds of expectations and the kinds of work we do for our constituents vary widely, depending on the kind of constituency we have. Some of us have to spend much more time travelling. Some of us may have a relatively greater volume of immigration casework to do. Any discussion of balance shouldn't reflect just one political party, not just because it shouldn't reflect only one party's political interests but also because it shouldn't reflect just one regional type of perspective. It should be a conversation that is inclusive.

Sometimes when we see the policy decisions of this government, it strikes us that there isn't really an appreciation of the dynamics happening in more rural parts of Canada, and that's across the board. That's something that needs to be taken into consideration when we think about the kinds of balance and the kinds of activities involved in representation for all members of Parliament. That's why it's important for us to ensure that as we undertake discussions of what balance looks like, we have a greater level of that full engagement.

Mr. Chair, I don't want to put members on the spot here, but I notice that there's a declining number of members at the table. I'm open to a brief suspension, if that is what members want.

I'm happy to continue with my remarks, but we have a pretty small number of members at the table right now.

[Colin Carrie, Conservative, Oshawa, ON]

One of my worries is that you could “initiate” something within six months or a year, but then you don't finish it or you don't do anything else, whereas “convene” means that you'd actually get everybody together and do something to develop the framework. The way I see it, “initiate” may be a start, but it may not give us anything as far as a final conclusion of it is concerned.

Would we be able to add a friendly amendment so that we initiate the consultations within six months but we have a full meeting within the year? Or could we put some type of timeline in there so that the minister knows that we are taking this seriously?

One of the challenges or push-backs we had when we did Bill C-14 was that a lot of people expected a palliative care type of framework to be initiated at the same time. I'm just worried that “initiate” gives a kind of open end to it.

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

I'd be very interested in that. It would provide us with some context for understanding what can actually be done.

The other point I'd make is that like a lot of things, you can say that the rules aren't perfect and that they provide for what some people might consider an abuse. But any time someone stretches the rules, there's a public debate about it. When a government uses time allocation, as they are allowed to do according to the rules, there is a public conversation about that. When the government brings in omnibus legislation, it's ultimately up to the public to evaluate, on the basis of what they're hearing about the bill, whether it is a proper use of the legislative process.

We can look for ways in which people within this place, committees, the Speaker, and perhaps other bodies make and enforce rules. There is some political accountability there as well. This speaks to some of the complexity around omnibus bills.

Here is the argument the government House leader uses for the approach in the discussion paper. She says:

This approach would allow for the divided bills to be debated together at second reading, report stage and third reading but would be subject to separate votes at each stage. In addition, the divided bills could be sent to separate committees if the subject matter of the bills warranted such action.

I'm a little bit confused about what the intention is, because this document speaks of dividing bills, but then it says “this approach would allow for the divided bills to be debated together at second reading, report stage and third reading”. I don't quite know what that means. If you have separate bills, then you have separate bills, which means that they are debated on different days. They're not only voted separately but are debated at separate times. Perhaps something else is meant by this, that the divided bills would be debated relatively close to each other. That's one thing, but it makes me wonder, looking at the text in this discussion paper, if what's actually envisioned by the government House leader is not a full separation of bills but something in between, a sort of semi-separation. There would be separate votes but not actually the separation of them.

I will say that there's a very simple solution to the feeling that you need to vote for a bill that contains elements you like and don't like. That is simply the question of report stage amendments. The process we follow, generally speaking, is to have fewer and fewer report stage amendments. There was a time when report stage amendments could be brought forward fairly easily, but then the change was to say that report stage amendments could be moved in the House only if they couldn't have been moved in committee or in certain exceptional circumstances.

Changes have been made to now allow members of non-recognized parties and independents to move amendments at committee. It's interesting that some people, Ms. May in particular, have objected to this on the basis that the only effect of allowing them to move amendments in committee is that it prevents them from moving amendments in the House at report stage. I argued when we discussed this at committee that really, this is a question of what privileges members have in relation to each other, because if members of non-recognized parties can move amendments at report stage and members of recognized parties cannot, that introduces a certain advantage for members of non-recognized parties.

The process, over time, has been to tighten allowing the movement of amendments at report stage. It isn't clear whether what the House leader is concerned about is dividing the bills in terms of debate or dividing them in terms of having separate votes. You could just reverse that trend and have greater latitude for the moving of report stage amendments.

The interesting thing is that it's up to the Speaker already in those exceptional circumstances. As I talked about in the context of Bill C-14, there are provisions in the Standing Orders that allow the Speaker, in exceptional circumstances, to allow the consideration of report stage amendments, even if they've already been considered at committee, but only in exceptional circumstances dealing with issues of a certain importance.

Yes, one might say that it's difficult to ask the Speaker to evaluate the relative importance of bills that come before the House and decide that these are important enough to have report stage amendments and those are not. Certainly, in the case of the euthanasia legislation, Bill C-14, I think it was quite obvious that this was an issue of grave importance for the House and for all Canadians, so the Speaker allowed report stage amendments to be made, even report stage amendments that had already been moved at committee, so we had report stage votes.

Of course, when you have report stage votes, that takes a bit more time. There's a potential interaction between this and the provisions on electronic voting. I'm not ready to take a definitive position one way or the other on electronic voting, but part of the concern about report stage amendments and having a whole host of report stage amendments is the amount of time they would take in the House. When people can constantly move forward a whole bunch of report stage amendments, then on all legislation you could have a massive amount of time spent voting at report stage. That would make the business of the House very difficult in terms of proceeding in an effective way. If you had procedures for electronic voting, perhaps it would be easier to introduce more report stage amendments, which would also address some of these concerns about omnibus legislation, because at least you would have separate votes taking place.

On the other hand, there are still some fundamental problems, legitimate questions, at least, with electronic voting. In the same podcast I referenced earlier in my remarks, Kady O'Malley talked about the fact that she was opposed to electronic voting, because she felt that the kind of democratic accountability exercise associated with members standing and voting was important.

If you had a whole list of report stage amendments, and you were voting on them electronically, and it happened every time, I would worry that it would, in a sense, increase the amount of effective control political parties had over members, because it would be impractical for every member to know all the details of every report stage amendment in the event that there was a very large volume of report stage amendments coming forward.

The solutions to this are not easy, but it is possible that more votes at report stage would go some way to addressing some of these concerns.

The theme I keep coming back to when I talk about changes to the Standing Orders is that there is an inclination by some to say that we have to, not quite burn the whole House down and rebuild it, but fundamentally re-engineer this place to make improvements. I don't think we need to fundamentally re-engineer this place to make improvements. I think we can make certain improvements that leverage the existing strengths we have. Rather than creating a completely new process for the adjudication of omnibus bills, using report stage amendments more would use a procedure we already have to greater effect.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

I think that's a point worth remembering. The parties have compromised in the past on different issues. Maybe we all didn't get what we wanted.

I remember the debate on Bill C-14. I have very strict views on that Bill C-14 debate, on how it proceeded and how time allocation was used. I deeply disagreed with it, so I took every opportunity to debate. That is probably the issue I got the most emails and phone calls on.

I happen to live in a riding—I think the only riding in Canada—with two large mega-churches in it, with thousands of members there every single weekend. They're a faith-based community—there are different ones they belong to—and they were coming to me on a regular basis with very specific views. I think I'm one of only five backbench members of Parliament who proposed amendments at committee. When this process is done, if another piece of legislation like Bill C-14 comes down.... I don't know what you will decide by June 2, but it might be that in the next Parliament or in a future Parliament I won't be able to have that opportunity. I don't know. It's not clear to me. You don't build trust with a lack of clarity, and you also don't build compromise, because then we don't know what you actually want to achieve and we don't know where you want to go.

That's our issue here. This amendment, if you choose to pass it, will begin to build trust again. It will get us to the point where we can have some form of consensus. We can co-operate again. Then we can get to the moment of compromise.

Perhaps you won't get everything you want in terms of all the changes to the Standing Orders. Different members have different ideas about the changes to the Standing Orders. I told Mr. Genuis, to his shock, that there are ideas he has about how the Standing Orders orders should be changed that I disagree with. I have other considerations, especially around private members' business. I think there should be more of it. I think it's important for every member, when they're elected to Parliament, to get at least one chance—one chance—to have their motion or private member's bill heard and debated in the House.

Now, whether or not the debate gets to the final end is secondary to me, or at this point it is. I could be persuaded, but I think it should still come to at least a first vote or a first debate. I think that's really important for members of Parliament.

I drew the short straw. I probably will not have my private member's bill heard until much later in this Parliament. Perhaps I won't.

I see Mr. Chan pointing to himself. Do you have a worse number than I do, or a better one?

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

This is interesting.

The way in which Mr. Graham has described this proposal would be to render the House of Commons even more like a television studio than it already is. The idea would be that there are red dots and you look at this camera or that camera. Of course, that's not really the tradition or the convention. You would normally be looking at other members and engaging them in conversation, or looking at the person to whom you're speaking.

The introduction of cameras was about showing the public what was going on in the House. One of the things people didn't necessarily expect was how much the presence of cameras would change the way in which debates unfolded. It was this deliberative body which was open to the public. The written records were obviously published. Journalists would attend the sessions and write about them. Members of the general public would attend as well. With the introduction of cameras, it has become one in which members are sensitive to always being on camera, and there is a greater emphasis on look, presentation, and form as opposed to substance.

This is a good example of how, when you talk about modernization and change, the kinds of things you might think are just part of the modern world, they actually can have distorting effects on the way in which that institution works. To quote Kevin Lamoureux, “distortative effects” result from those changes.

Mr. Graham's proposal is interesting, but I worry about the impact of this additional initiative that would further change the way in which the House of Commons works in terms of the extent to which it's a television studio versus effectively a deliberative body. I don't think it's realistic or desirable to go back and remove the cameras, but I think we should be sensitive to changes that may have an effect and may not be the ones we are going for. It speaks to the need for that wider engagement of members of Parliament from all parties in the discussion. There may be things that are not even of a partisan or strategic nature, which members of the opposition, members who are more experienced, perhaps, or not, may be aware of which may not necessarily reflect the concerns of members of the government.

One of the problems with having decisions made unilaterally, especially by a new government of predominantly brand new MPs, is that you don't draw into that experience that comes from a larger number of veteran members in other parties. I think it's still the case that the longest serving current member of Parliament is a member of an unrecognized party, a member of the Bloc. It is generally going to be the case that there will be more veterans on the opposition benches than on the government benches. If you have a party that was recently in power and then has gone to the opposition, you are going to have some new members, but you're likely to have a lot of returning members. Whereas, when a party substantially grows its caucus, as has happened with this government—this government was in a third party position, and it went from being the third party to being government—a vast majority of members of Parliament on the government side, and I think the vast majority of ministers, certainly the government House leader, are new members of Parliament.

Part of the importance of engaging the opposition, and you see it in the example of cameras and what their effect would be, is actually tapping into the experience and institutional knowledge that exist in this place. If the House leader were effectively allowed to make these changes unilaterally, it would be the government but with the ability of the leadership team to add and remove members to and from the committee at will. That process, as we see with this discussion paper, would be highly directed by the House leader. Effectively, you have someone who has, to this point, been a member of Parliament for less than two years, who wants to fundamentally dictate the terms of the so-called modernization, the changes, perhaps the revolution, that they wish to see to the Standing Orders. That's quite a striking point that we would see that level, that type, and that magnitude of change undertaken without engaging the experience that exists in all parts of the House.

I don't mean to suggest that new members can't have valid points about the Standing Orders. I'm a new member myself, obviously. I've been a member for as long as the government House leader has been. New members may see things from a different perspective and be willing to put forward ideas for certain kinds of changes that maybe those who have been here for a very long time are less likely to see as necessary.

There is a balance that needs to be struck between hearing the voices of new members and hearing the voices of members who have been here for a longer period of time and who have a level of context and experience that informs the approach that they take. It's that balance that is achieved by this amendment. It is an amendment that speaks to the question of balance between government and opposition, but I would argue to a range of different kinds of balances that need to exist in the deliberative process that's unfolding. It's a balance between government and opposition, between major parties and minor parties, between recognized and unrecognized parties, between those on the front bench and those who are not part of the front bench, whether in government or in general throughout the House. This would be a balance between newer members and experienced members, members who have different kinds of experience.

Of course, some of the members here look at the Standing Orders from the experience of having been former political staff. I was a political staffer at one time, and you do see the Standing Orders in a bit of a different way when you are navigating them. In my case, I was involved in a number of different positions with different aspects of the Standing Orders. In one case it was question period preparation, and in another case it was working with parliamentary committees.

There are obviously things about the mechanisms of this House that staff experience which may be less part of the reality of members of Parliament. This is because we often rely on our staff to support us when we have specific questions to ask, or when there are specific kinds of motions that might need to be brought forward in that context.

It's about the multiplicity of voices that we can ensure are engaged if we have the widest number of voices included with different kinds of experience. We have members who have been former political staffers. We have members who look at this place with a relatively fresh set of eyes. You might have people who look at the Standing Orders from the perspective of operating procedures that they've seen in private sector work places, in terms of processes that we follow, hours, sitting processes, and balance of work, how this place squares with the way things operate in the private sector.

We have members, and Mr. Christopherson is one of them, who came to this place from other legislatures, and who have experience at the provincial level. In some cases we have people who have been involved at the municipal level. The kind of perspective they bring to a discussion of the Standing Orders is going to be different still. It's going to be informed by the experience they had as part of a different legislature. It's all these different perspectives, these variations and experience, that inform the way members think about the kinds of questions that are in front of us. It's important that we listen and engage those voices.

I don't know if we have any members of Parliament who were former senators. We have senators who were former members of Parliament. I know we've had people who have stepped back from the Senate to run to be members of Parliament, but I don't know if we've ever had someone who has gone that way. That's another set of experiences that you draw on when you have the full range of voices involved.

The kind of study we could do at this committee on the basis of the amendment would be one in which we are assured that not only are all of these different voices heard formally, that we have lots of people who are able to speak, but then the discussion that members of Parliament have after that is one that incorporates those voices in a substantive way. If you have members from different parties who are part of that discussion and are represented in it, you necessarily will achieve a better outcome given the diversity that would come to the fore.

One issue the discussion paper addresses and one which I mentioned before but in a different context, because this was before the government's introduction of the budget implementation bill, is the issue of omnibus bills. I have a hard time understanding what the government's position is on omnibus bills. The Prime Minister in question period yesterday was trying to carve out this distinction between good omnibus bills and bad omnibus bills. A good omnibus bill, it seems, in the eyes of the Prime Minister, is one proposed by a Liberal government; a bad one is one proposed by a Conservative government. We would understand that he would have that perspective, of course. We all tend to prefer legislation proposed by our own side, but the question of the degree of “omnibus-ness”—I don't know if that is a word—is not dependent on the party that brings it forward. To me, some of the discussion in the discussion paper suggests that there is a binary.... It's either an omnibus bill or it's not an omnibus bill.

The reality is we see many different kinds of bills that come before the House that deal with different kinds of provisions that do not necessarily have to be included in the same bill but have some common thread to them. Those are bills that maybe move a step in the direction of being an omnibus bill but don't go all the way.

One bill we dealt with was on the response to the opioid crisis in Canada. This wasn't an issue on which we agreed with the NDP, but in the Conservative caucus we felt that this bill combined certain kinds of provisions that shouldn't have been combined. There were many provisions in that bill that we were very supportive of, that dealt with things like more effective enforcement, addressing pill presses. These kinds of things we thought were not only good measures but needed to be expedited. However, the legislation also included provisions that dealt with the community consultation process around putting in place what we call supervised injection sites, and what the government increasingly likes to call safe consumption sites, which is a little misleading as far as the terminology goes.

In any event, the legislation, in addition to those positive things we all agreed on, dealt with the government's proposal to remove most of the requirements around engaging with communities before constructing a supervised injection site. We looked at the bill and said there were some things in it that were not only worth supporting but were important and required the fastest possible movement through the House, but there was another part of the bill that we were totally opposed to.

The government House leader in her discussion paper talks about an omnibus bill being one where members might want to vote for a part of it but not for another part of it. That's the reality of almost all legislation that comes before the House. Someone somewhere is going to agree with part of it but not another part of it. Unless you only have legislation that has one provision in it, that makes one specific change in one clause, which would be pretty unrealistic in terms of the efficiency of the House, any time you have legislation that makes multiple policy changes, you're going to have members who will like some parts of it and not other parts of it.

Yesterday I talked about the debate around Bill C-14, the government's euthanasia legislation. Aside from the fact that there were a whole host of different provisions in this legislation, there were two very distinct issues that needed to be adjudicated. Unfortunately, they were often mixed up in the public conversation. There was a question of the eligibility criteria, who was eligible to seek euthanasia, and there was a question on the safeguards, the administrative requirements that had to be met before someone could seek euthanasia. The point is these were two different questions. Someone could conceivably believe in more open eligibility criteria and fewer safeguards, but someone could also believe, let's say, in a more open, more liberal eligibility criteria while also having more safeguards in place. You have these different kinds of philosophical questions and different kinds of provisions that are wrapped up in the same piece of legislation.

Of course, in a formal sense, no one would say that Bill C-14 was an omnibus bill. It was a bill that set the terms for the legalization of euthanasia and assisted suicide. In that sense, we could accept, relatively speaking, that it was on one thing, but it was a step in the omnibus direction, at least according to the way in which omnibus bills are defined by the government's discussion paper. The government's discussion paper suggests that an omnibus bill is one in which some members might like some provisions and not others.

What happened with the legislation around the opioid crisis—I can't remember the number of the bill offhand—was that a point of order was raised seeking unanimous consent to split the bill. This was proposed by the Conservative caucus, I think by Mr. Colin Carrie, our health critic. It would have created two separate bills. One of those bills would have dealt with the provisions we all agreed on, and that bill would have moved along immediately. It may well have moved along to the end of third reading right at that point. Certainly, it would have gone all the way to committee. It would have separated off the controversial provisions.

The benefit of that approach, actually, is that it would not have slowed anything down, but would have sped up the process. It would have allowed for the immediate passage of the provisions on which we all agreed. Those provisions could have started doing their work and having a positive impact, whereas the controversial provisions could have continued to be debated.

This is particularly sensible when you consider the way in which the House and the Senate interact. If you have two separate bills that both go to the Senate, and the Senate amends one of them and not the other, then only the bill that was amended has to come back to the House, while the other, if it passes in the Senate in the same form it did in the House, goes on from there to receive royal assent. If all of those provisions are wrapped up in the same bill, then all of those provisions have to come back to the House again.

In cases where the opposition is prepared to expedite certain provisions...and as we saw with this particular bill there was a substantial public interest in the government supporting the splitting of that bill, yet they didn't. Unanimous consent was denied for that proposal.

This is telling of the government's actual views on bills that, although they may not be omnibus bills in the full sense, have a component of “omnibus-ness” to them. The government, in a reasonable case like that, was not willing to allow the splitting of a bill in a way that would have very much reflected the public interest with the timeline the public wanted to see. That did not happen because of a refusal of the request for unanimous consent. That refusal, of course, came from the government side. This is telling about the approach being taken for omnibus bills already.

I think we now have examples from this government of actual full-blown omnibus legislation. You would be very hard-pressed to identify a single, credible, philosophical distinction in terms of the degree of “omnibus-ness”, let's say, between the kinds of omnibus bills that the previous government brought in and the kinds of omnibus bills that this government is bringing in.

We have a budget implementation bill—I have my notes here on it—that changes over 20 statutes and runs to over 300 pages. The Prime Minister's defence of that is identical to what was said, I think quite correctly, about the budget implementation bills that were brought forward by the previous government. When you have a whole bunch of measures that are related to the budget, the implementation of the government's fiscal plan, then there is a common thread. These are not entirely unrelated elements. They deal with the economic plan of the government.

That's fair enough, but of course almost anything in terms of government policy has some relationship to the economy. It likely relates to questions of social values as well, but almost anything has some relationship to the economy. Immigration has an impact on the economy. Social policy, drug policy, criminal justice, all of these things have some impact on the economy, or at the very least they involve questions of government expenditure.

That is true of every policy area. The government said in the election that they were opposed to omnibus bills, and now they are redefining their opposition to say that the omnibus bills they are opposed to are only those that have provisions that have absolutely no plausible relationship to each other. That is a pretty substantial stretch in terms of what we were actually talking about with omnibus bills.

We should, in good faith, look for ways to divide bills when we can, especially if there is a willingness of the opposition to expedite certain aspects of the bill that they agree with, but it's never going to be—and I think the government realizes this by now, if they didn't already—an exact science in terms of what does or does not constitute an omnibus bill. This is what raises some questions in terms of the proposal in the discussion paper for the Speaker to split the bill, because if you ask the Speaker to do something, the Speaker being a non-partisan person within the House in the context of that function, you have to give them some criteria. On what basis would they decide to split a bill or not to split a bill? If we can't even arrive, through discussion here, at clarity about what is a bad kind or an acceptable kind of omnibus bill, then we are effectively putting the Speaker in an almost impossible position.

What is clear with respect to omnibus legislation is that the government is breaking a promise here. The government said that they would get rid of omnibus legislation, but they are moving forward with something that is clearly quite similar, not in substance, of course, but in form, to what we saw from successive governments over our recent history.

It's an important question how we should handle the issue of budgets and budget implementation bills, because they are always going to deal with a variety of measures. They're going to have to. If we want the government to bring forward a budget every year, and it should, then there will be lots of different policy areas covered in that budget. You couldn't have a budget that talked only about some things and not others. It would have to cover all the things that are within the ambit of the activities of the federal government.

When it comes to omnibus legislation and questions of reform, we can look at other kinds of potential reforms that would provide the kind of scrutiny of those documents that the public and many members want to see, without being unrealistic about what a budget has to be. It's interesting that the only substantive kind of legislation on which a number of days is prescribed for debate in the Standing Orders is the budget itself. It's either four or five days for the budget to be debated, and after that it's the end of the budget debate. That is automatically put in place.

If you think about the breadth of measures that are covered in a budget, and the number of statutes the government is going to change over the course of a year, it's likely, it seems, with the projector that we have in place here.... Sorry, I lost my train of thought.

With the number of days we have, and with the record of this government with respect to the Standing Orders and how they've unfolded, we are likely to see more changes to statutes made through the omnibus budget implementation bill than changes to statutes in all the rest of the bills that the government brings forward. It's interesting to think just how important that process is, and yet we limit it to a relatively small number of days—I can't remember exactly whether it's four or five days—and we are discussing changes to statutes that outweigh all the changes to statutes that may well happen for the rest of the year.

Maybe one change to the Standing Orders we need to look at is allocating more days to the discussion of the budget. Maybe that would address some of the concerns that members have around ensuring that there is proper scrutiny relative to the relatively long budget documents that we're seeing. That would be one possible change.

Another change we might want to consider, and one which I think would be worthwhile for all members from all parties to deliberate and pronounce on, would be a process by which all committees, or at least a larger number of committees, studied the budget. Right now, the process is that the finance committee does pre-budget consultations. The finance committee looks at the budget implementation bill. We don't have a provision for the same bill being referred to multiple committees. What if we had all of the committees of the House, or at least most of the committees, do some degree of study—

Motions in amendment

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

Mr. Speaker, it is my honour to rise today to speak to Bill C-22. I had not thought that we would see government amendments at report stage that undo a lot of the good work that has been done by the committee.

I approach this issue by first saying I support the creation of a national security committee of parliamentarians. I learned a great deal about the intelligence business, the security business, and where Canada stands within our Five Eyes partners, in the efforts to fight Bill C-51 in the last Parliament. I still hope that the review that is being undertaken right now by the Minister of Public Safety and Emergency Preparedness and the Minister of Justice will lead to massive changes in the five different bills, and others, that were amended through that omnibus bill known as Bill C-51, which set up CSIS, for the first time since its creation, as a body that can “disrupt” thoughts, act as having a kinetic function, as the experts call it.

There is nothing right now within our security agencies that ensures that there is any oversight, unlike our other Five Eyes partners, as the hon. government House leader mentioned. We do not have any oversight for a number of the bodies at all. We have no oversight for CSIS. There had been oversight of CSIS up until the moment of omnibus Bill C-38 in the spring of 2012, which eliminated an adviser to the Minister of Public Safety to warn him or her if CSIS was going amok. That position was eliminated, so there is no oversight of CSIS; rather, there is review of CSIS. There is no oversight of the RCMP; rather, there is review of the RCMP. There is neither oversight nor review of the Canada Border Services Agency. For the Communications Security Establishment Canada, which is a very strange body that collects and downloads massive amounts of metadata, there is neither oversight nor review.

We have all of these different intelligence agencies, therefore, it is of critical importance that we do two things. We must rein in and undo the damage and the potential chaos created for security agencies by Bill C-51. I say this parenthetically. I want to get to Bill C-22. However, I need to say that my opposition to what was done in the 41st Parliament in what was known as Bill C-51 was not exclusively with respect to concerns about civil liberties. Those are concerns, but I have heard from security experts in the course of a review of that bill. It is clear to me that, failing to ensure coordination between and among all of these agencies, while giving CSIS the right to be active in kinetic operations, to be able to have CSIS offer people they are surveilling basically a get-out-of-jail-free card, a prospective guarantee that they will never be arrested or put into the judicial system, without any alert to the RCMP that this has happened, the one hand will not know what the other is doing. The creation of the national security committee of parliamentarians will not address that threat, although we will have to address this concern. It has been one that has been well known since the inquiry into the Air India disaster where if there had been coordination enforced between the different security agencies, that disaster, the single largest terrorist act on Canadian soil ever, could have been avoided. That was certainly the opinion of the Air India inquiry.

Coming back to Bill C-22, I support the creation of a committee of parliamentarians. However, I am baffled by the changes that have just taken place. I turn to the leading Canadian experts in this, Kent Roach and Craig Forcese, professors of law, both of whom played a role in the Air India inquiry. They are the authoritative experts to whom I turn. Certainly, Professor Craig Forcese is baffled by the limitation on what parliamentarians will be allowed to know. I mentioned in my question earlier to the government House leader that these restrictions do not apply to the people who serve on the Security Intelligence Review Committee, SIRC, to which civilian non-elected people are appointed. For the purpose of pointing out that the appointment process can have gaps with respect to security, let us not forget that former Prime Minister Stephen Harper appointed the now late committed fraudster Arthur Porter as the chair of SIRC. Arthur Porter did not have the restrictions that Bill C-22 would now put on parliamentarians, who are elected, who take an oath, and who have an understanding of their responsibilities.

My amendment to the bill is to delete section 12, which is the section that limits the MPs' access to parliamentary privilege. It is what Craig Forcese has called the triple lock on what MPs and senators are allowed to know.

Parliamentarians sitting on this committee have already sworn allegiance to Canada. They will go through security checks. The way the bill is currently written, it is not as though there is no check on their access to information or risk of their revealing information. The Canada Evidence Act would apply, section 38. Even as these government amendments are rolling forward, Professor Forcese has noted that it would be probably better to rely on court and the Canada Evidence Act than on these very restrictive moves in terms of what parliamentarians can know, an overly generous discretion on the point of what ministers can withhold, as well as getting rid of what was a very good amendment achieved in committee of giving the committee subpoena powers.

I have to say that it is just simply baffling that the government has taken such a restrictive view on what parliamentarians can be allowed to know. I will just note that this is from an article by Professor Forcese titled, “Stronger Bill C-22 Goes Back to the House”. This was before the government amendments came forward. He noted that, “C-22 committee members will be surrendering parliamentary privileges and will be permanently bound by secrecy under the Security of Information Act (and therefore subject to criminal sanction for violating secrecy rules).”

I think the government, with all due respect, has overreacted to very good amendments that were passed by the committee, and this is a larger point as well. We are often told in this place that we should rush legislation through second reading so that it can go to committee where the committee will do the good work. We now have a fair litany of times where the Liberal government, with its majority, has decided to ignore the good work of committees.

The first was, of course, the committee that dealt with medically assisted death. That advice was completely overlooked in the drafting of Bill C-14. We have the committee work, on the committee on which I served, the Special Parliamentary Committee on Electoral Reform, and that is a very sad story because we need to get back to that, but very good work was done.

For the first time since 1867, when the British North America Act said Canada will use the voting system from Westminster until such time as its Parliament chooses its own voting system, we had Parliament recommend a voting system and a way forward, and that was rejected. Now this committee's work has been rejected and, I think, hastily.

There is a way forward here. There is an appropriate balance. I do believe that the parliamentary committee struck that balance, and it is really important to remember that what the committee is looking at is already protected in many ways.

The U.K. parliamentary committee has never had a problem with breaching secrecy. One of the experts who testified in Bill C-51, Joe Fogarty from U.K. MI5, testified that there just simply were not problems. Parliamentarians instructed with the duty to maintain confidentiality have done so.

I also point out the precedent that the New Zealand Parliament has a very similar committee, and the New Zealand members of Parliament who serve on that committee do not have to surrender parliamentary privilege. It is explicitly preserved under the New Zealand model.

It leaves one wondering why the government has chosen to undo the good work of committee, further undermining the proper role of legislated deliberation in committee coming back to this place at report stage, doing serious damage to the work that was done by the committee, leaving, I fear, greater uncertainty as to how the committee will function and still wondering why is it that in taking measures to restrict the information that parliamentarians have, the independent expert national security review bodies, SIRC and the CSE commissioner, are not given the same set of handcuffs.

I do not think it makes sense. I urge the government to reconsider and accept my amendment.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Webber said I could ask one really quick question, so I know I don't have a lot of time.

First, Dr. Pereira, I want to thank you for your compassion and commitment, because this is something Canadians are going to be dealing with. I think we're at a crossroads here, so it's a very timely bill and it's very timely for you to be here.

I know Bill C-14 concerned a lot of Canadians, and my colleague brought up the question about choice. Just so that moving forward we're doing the right thing, could you outline some of the current barriers to accessing palliative care services that Canadians face?

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you very much.

Bill C-14 came into effect in June. Of course, it allows for medical assistance in dying, but it doesn't protect a person's choice of palliative care when only 15% to 30% of Canadians have access. Can you comment on how this bill will take care of people's right to choose?

[Rachael Thomas, Conservative, Lethbridge, AB]

I'm sorry; I meant Bill C-14.

With that, we have given people the option to choose physician assistance in dying. At the same time, however, we have not given them the option to choose access to palliative care should they choose to die without medical assistance and simply want to be pain-free in an environment of comfort when they do die.

In my estimation, then, I would say that our present legislation and of course our lack of palliative care are creating a problem in Canada, and that problem is a lack of choice. I wonder if you can comment on that further.

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

It was Bill C-14.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you, Mr. Chair.

Thank you, Ms. Gladu, for this excellent bill, which focuses on the patient and not the administrative aspects. It is important, however, for me to properly understand the definitions. You were talking about that earlier with Mr. Davies. In the case of a number of definitions, they pull in opposite directions and ultimately cast a very wide net.

In terms of palliative care, it involves addressing something. For example, there could be a patient who does not require care or daily monitoring for their quality of life. The term “palliative care” often refers to end-of-life care. Its purpose is to improve a patient's quality of life at the end of their life when they are suffering from a serious illness that is difficult to control or whose outcome is known.

That is why this is naturally, although not systematically, related to Bill C-14, which pertains to medically-assisted dying. I would like to hear your understanding of the term. Care for the elderly is one thing, but palliative care is something else, and end-of-life care is something else again.

What is your understanding of it?

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

Well, certainly the special committee that studied the Carter decision did recommend that you needed to have palliative care in order to have a choice. I can't speculate, but Bill C-14 was a criminal bill, so it may be that the government preferred not to muddy the waters and put health things into the criminal bill. That's why this bill is such a great idea for the government. It will be able to do palliative care, which was clearly a recommended outcome from the special committee.

[Colin Carrie, Conservative, Oshawa, ON]

I have one more question. You and all members around the table will remember all the work that was done on Bill C-14. We had a lot of concerns from people around the country. There were concerns about lack of palliative care and end-of-life options. There was a lot of deliberation on the fact that if you have an efficient palliative care program, many people don't choose to go into assisted suicide or take options along that line.

Do you think the government should have made an investment into palliative care and home care in conjunction with or prior to Bill C-14? Do you think we're being tardy here?

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

That's an excellent question. Actually, when we first started discussing this, it was during the time Bill C-14 came forward. I was made aware of the 2011 committee, the all-parliamentary committee that studied it. I was able to consult with them on the work they had done and their recommendations, and then they put me in touch with people across the country who are working in palliative care, working in a similar way to try to get a consistent service across the country.

I had the opportunity to sit with members of various hospices and talk to palliative care specialists, nurses, people who receive the palliative care, and home care workers to understand what they saw as the biggest need and how—if the federal government was going to act—they'd prefer to see that.

Then when I drafted the bill, I was able to review it with all the various stakeholders so they could see the language in the bill and be able to support it.

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

That's excellent.

Thank you and good morning.

I thank the committee for the opportunity to appear today and for the unanimous support the bill received at second reading.

I think this bill is timely. Our population is aging and only 30% of Canadians currently have access to any type of palliative care service. The special committee that studied the Carter decision on assisted dying stated that without quality palliative care, a true choice was not possible.

I was surprised to find out that not every location in Canada has the benefits of the integrated palliative care that is offered in my home riding of Sarnia—Lambton, where we have more than five palliative care specialists, palliative beds in hospital and in hospice, and an excellent network of home care, counselling, and crisis response services.

I began to ask about this. I found that an all-parliamentary committee in the 2011 session had studied palliative care and brought forward a report with recommendations. Although a motion was made, not much further action occurred.

With an aging population, the implementation of Bill C-14, and the desire to innovate and to get more out of the health care dollars that we invest in our system, we can see that the time is right for this bill,

Bill C-277 proposes a framework for palliative care in Canada, including a definition of the services to be covered, a definition of the training required at the different levels of service provision, care for those giving palliative care services, collection of appropriate data, and the development of a plan to get consistent access to palliative care for all Canadians.

During debate, amendments were suggested to add first nations to those covered by this framework and to ensure that the language of the bill reflects the proper balance of provincial and federal jurisdictions. I'm very happy to work with the committee should they choose to adopt these or any other changes.

My theme today will be to explain the sections of the bill and recommend to the committee how I see the framework proceeding.

I'll start with services to be covered.

Palliative care can begin more than a year before end-of-life care, and end-of-life care is defined as the last two weeks of life. Pain control, including the cost of the drugs, along with spiritual and emotional counselling, home care, hospice care, and home crisis intervention are the basic services that I would like to see covered. Today some of these are covered in part, and only in some provinces. Others are not covered at all. It's important to note that the costs associated with palliative care in hospital can be $1,200 a day, versus $400 a day in hospice and $200 a day, on average, in home care.

As compared to intensive care, palliative care in a hospital could save our health system between $7,000 and $8,000 per patient. Recent data suggests that, in Ontario, transferring just 10% of end-of-life patients from intensive care to home care could yield $9 million in savings annually. That is a better use of health care dollars in order to get better results for Canadians.

The second part is with regard to training. Different levels of training are required for the various types of care providers. There is currently a shortage of palliative care specialists in Canada. We have 200, versus a need for at least 600.

General practitioners receive two months of palliative care training as part of their medical degree. Registered nurses may not receive any palliative care training at all, but they should take training as offered today by organizations like Pallium Canada or equivalent.

Home care providers and personal support workers, when trained, would provide a cost-savings delivery model that would be effective, especially in remote regions where innovative solutions to delivering service will be needed. More registered nurses, RPNs, and personal support workers will be needed with our aging demographic. As the provinces are introducing training, it would be wise to set a standard terminology, set the training requirements, and have interprovincial recognition of those standards.

We also need measures to support those who are giving palliative care services. As you can appreciate, watching people die and seeing the emotional and physical agony they are in can bring symptoms similar to PTSD, and there is some need to provide support in the care system for those people, as well as for care providers who may be needing respite and rest. It's important to consider them.

Moreover, the lack of data on the need for palliative care, the total average cost, and the breakdown of services should be addressed by collecting data in order to standardize and monitor the provision of palliative care services.

I encourage you to consult the Minister of Health, who already has some ideas on what she would like to see in this regard.

With respect to research data, there's not really even a baseline of how many people are in need of palliative care or how much palliative care can be expected to cost per person. These are the kinds of numbers we would like to benchmark and monitor.

We also need a plan to develop consistent access for all Canadians. This is one of the most important parts of this framework.

The plan should have several pillars. We've already talked about the trained resources that will be needed. Second, infrastructure will be needed to achieve consistent access for all. There's an opportunity for the government to put money into building hospices and palliative care centres. Canada has about 30 hospices compared to the United States, which has 1,300. Building this infrastructure will create jobs and will address a need.

Finally, in order to service rural and remote communities in Canada, use of innovative ideas will be needed. One such idea is the virtual palliative care centre in Winnipeg, where home care nurses or doctors can call in on a 24-7 basis and get access to palliative care specialists who can guide remote treatment. Web and Skype consults will rely on the government's current infrastructure plan to address Internet in the rural and remote north. Training paramedics, nurses, and home care workers in palliative care and combining this with the fly-in crisis response teams has been shown to work effectively in other parts of Canada, and doing so should be levered as part of the overall plan.

Choosing the mechanism to implement this framework is also important. There are various options. One of them is to add palliative care to the services covered by the Canada Health Act. Another option would be to include palliative care in the new health accord. A final possibility would be to create a government palliative care program to fund the infrastructure, establish training standards, and work with the provinces to implement best practices.

I think any one of these options could work. There are probably other mechanisms I have not thought of, but it is up to the government to provide direction on implementation through the budget.

The $3 billion that is currently promised in the 2016 budget is a good start and I hope to see more in the 2017 budget.

The government should leverage the many national organizations that have supported this bill, each of which has solutions to help deliver the services. These organizations include the Canadian Medical Association, the Canadian Cancer Society, the Canadian Nurses Association, the Canadian Society of Palliative Care Physicians, Pallium Canada, ARPA, the Canadian Hospice Palliative Care Association, and many other member hospices, such as Bruyère Continuing Care, St. Joseph's Hospice, West Island Palliative Care Residence, the Heart and Stroke Foundation, the Kidney Foundation, the ALS Society, and the Canadian Association of Occupational Therapists, as well as the more than 50 member organizations of the Quality End-of-Life Care Coalition of Canada and the many faith organizations across the country, including the Canadian Conference of Catholic Bishops.

In addition, coming up with a standard definition of services to be covered and of the training requirements will be a priority, as provinces are already progressing in their offerings in different ways. Now is the time to act to address this important issue so that Canadians can choose to live as well as they can for as long as they can.

I appreciate your time. I'd be happy to answer any of your questions, and I look forward to our discussion.

Thank you.

Preclearance Act, 2016

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

Mr. Speaker, it is a pleasure for me to rise today to speak to Bill C-23 and to argue in support of the reasoned amendment by my colleague, the member for Beloeil—Chambly. His amendment instructs the House to decline to give second reading to the bill because of several important reasons, which I will be happy to explore later in my speech.

I also want to note that it is very unfortunate we are conducting this debate today under a time allocation passed by the Liberal government earlier today.

The tone of this debate on the legislation has heated up considerably over the past few days during which it has been debated. In particular, there have been some misleading and grossly exaggerated statements from Liberal members of Parliament. There has been a general mischaracterization of the NDP's concerns, combined with over-the-top and fiercely partisan attacks, which have at times sunk this debate to a new low.

I hope to raise the tone of this debate with reasoned arguments against letting Bill C-23 pass at second reading.

Let me make one point perfectly clear. The New Democrats are in favour of measures that will facilitate fluid movement across the U.S. border, but not at the expense of human rights, respect for privacy of Canadians, and Canada's sovereignty.

I support pre-clearance as it currently operates. In fact, I have used the service several times in my life at the Vancouver International Airport when travelling to the United States, and it certainly works well as it currently exists.

I understand that pre-clearance is an important part of the Canada-U.S. relationship and to the free flow of trade and travellers between our two countries, but the provisions contained in Bill C-23 are too problematic for me to give my support.

Bill C-23 neglects to take into account the climate of uncertainty at the border following the discriminatory policies and executive orders of the Trump administration. Canada and the United States signed the agreement on land, rail, marine, and air transport preclearance on March 16, 2015, under the previous Harper government.

Bill C-23 was introduced by the Minister of Public Safety and Emergency Preparedness on June 17, 2016. There was little fanfare at the time, as Parliament was more consumed by Bill C-14's progress through the Senate, and we were certainly all looking forward to the upcoming visit of then President Obama and his address to the House of Commons, which I think we can all agree was a tremendous speech.

The times have changed dramatically since that time, and they provide an even starker contrast to the reasons why this bill is so problematic. The Liberals are moving ahead with the agreement signed under Obama's presidency as if everything was simply business as usual. However, we must take into account the change in U.S. leadership.

The legislation was problematic before the inauguration of President Trump, but recent discriminatory orders and invasions of privacy now leave no doubt about the potential dangers and abuses that will result from the agreement. This is a president who excels at making statements with no empirical evidence to back them up. The most recent example is his shocking allegation that former President Obama ordered wiretaps on his phone during the election.

This man has little understanding of what a warrant is, of the checks and balances of the United States system, the constitution, and he has undermined the judiciary of the United States on repeated occurrences.

The U.S. customs and border protection agency is the largest federal law enforcement agency of the United States Department of Homeland Security. It is an extremely powerful arm of the executive branch of government, but it is now headed by someone who I do not think is fit for that office.

Agencies take their cue from the people at the top. This is a fact. Bill C-23 is proposing to give more power to foreign agents that are lead by an administration that routinely uses fear, lies, and personal attacks on its political opponents to advance its agenda. I cannot, in good conscience, support such a bill.

The third point I wish to address are the increased powers that Bill C-23 would provide for U.S. officers on Canadian soil, provisions regarding carrying of firearms, the power to conduct strip searches, detention, and interrogation.

In particular, I feel strongly that it is unacceptable to see officers of a foreign country who are in a position of authority bear and ultimately use firearms in the performance of their duties on Canadian soil. As is provided for in the summary of the bill, part 3 of the enactment makes related amendments to the Criminal Code to provide the United States pre-clearance officers with an exemption from criminal liability under the Criminal Code and the Firearms Act with respect to carriage of firearms and other regulated items. Bill C-23 would violate our precious Canadian sovereignty by increasing the powers of American pre-clearance officers on Canadian soil with respect to carrying firearms and by not properly defining a criminal liability framework.

There are those within the Liberal and Conservative ranks who dismiss this concern or see it as simply irrelevant. In fact, repeated speakers from the Liberal Party have used rather poor reasoning, in that U.S. agents would only be granted firearms if their Canadian counterparts were similarly armed in the same area. This sidesteps the issue and avoids the question as to why this measure is necessary.

I fully realize that with the combined Liberal and Conservative support for the bill, it is most definitely going to pass second reading. The troubling thing for me is that not one Liberal or Conservative MP has bothered to raise any concerns about this erosion of Canadian sovereignty.

The Liberals like to call themselves the party of the charter, but not one of them has addressed Canadians' concerns about being interrogated, detained, or turned back at the border based on race, religion, travel history, or birth place, as a result of policies that may contravene the Canadian Charter of Rights and Freedoms. The Liberals have also failed to speak up about the lack of provisions protecting the rights and freedoms of transgendered persons during strip searches, in spite of the government's support for Bill C-16.

The Conservatives like to wrap themselves in the flag, and they talk a good game when it comes to protecting our border and our sovereignty, but not one of them has stood to address the fact that we would be giving more powers to agents of a foreign government on Canadian soil.

The final point I want to make is that Canada Border Services agents and the RCMP are filled with great men and women, who do their job in a most capable way every day. They are required to take the oath of allegiance before they can assume their duties as uniformed officers. Allegiance is given to the crown and other institutions that the sovereign represents within the federal and provincial spheres, including the state, its constitution, and traditions. On the other hand, U.S. customs and border patrol agents give their oath of allegiance to the United States Constitution and promise to faithfully discharge their duties in the office that they are about to enter, which is fully an institution of the United States government. This is the crux of the problem. United States officials operating on Canadian soil owe their allegiance to a foreign government, and yet we are prepared to give them powerful new measures, such as carrying firearms on our sovereign soil.

I think that borders matter and that they certainly need to be treated with respect. Also, sovereignty matters and precedents matter. Therefore, I think this is a slippery slope. If we pass Bill C-23, if we allow agents of a foreign government to operate on our soil in this matter, what more demands will be presented at a future instance from the United States government?

All I ask hon. members to do is pause and think about the wishes of their constituents. Did their constituents send them to this place to pass legislation to give agents of a foreign government the power to carry firearms on Canadian soil? This is a real sticking point for me, and I know from the correspondence that I and many of my colleagues have received that this is a major concern. We will certainly be raising it at every opportunity that we can.

Framework on Palliative Care in Canada Act

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

I am sorry, Mr. Speaker. It was a slip of the tongue.

Among other things, the motion called for the government to work with the provinces and territories on a flexible integrated model of palliative care by establishing a universal right to palliative care and by implementing a pan-Canadian palliative and end-of-life care strategy that would be tied to dedicated funding.

As I said, we expected this funding to be in the government's first budget but it was not. Here we are in the House debating a private member's bill from a member of the Conservative caucus, which indicates to me that we are at a momentous point in time. There is broad agreement across party lines on this issue and so it is time to face our responsibility to governance that makes progress on human rights and end-of-life care. That we are ready to be progressive on palliative care is momentous and I applaud my hon. colleague for utilizing her private member's bill for this noble initiative.

I was disconcerted when the previous Conservative government eliminated the federally funded national secretariat on palliative end-of-life care. Had it left the support funding intact, maybe we would not be discussing this matter today but would have a resolution and the member for Sarnia—Lambton would not have had to table this bill. I am sure she has other noble causes she could turn her attention to.

As for the current government, the Liberals have had ample opportunity to enshrine quality palliative care as a right for all Canadians, no matter where they live. They could have developed a national strategy that would have eased the burden on both the dying and their families on one end and health care providers on the other, but it was not a priority. I am still flabbergasted when I think of the callousness demonstrated as debate on Bill C-14 was introduced with absolutely no indication that anyone in the government understood the responsibility to secure end-of-life care standards for human beings.

The most significant reason I asked to speak to the bill today was I wanted to lament the unnecessary suffering in the reality of our systemic inadequacies. A national strategy would address these sufferings. I want to hear in person the government's rationale for choosing not to act on this issue.

The New Democrats were surprised to find that the 2016 federal budget contained zero federal funds earmarked for palliative care, especially after we fought for the joint committee on physician-assisted dying to incorporate palliative care.

Given the lack of health care spending in the federal budget, it is no surprise that palliative care was missing. Hopefully by now all of us understand this, that home care is very relevant to this issue. The fact that the Liberal promise of $3 billion for home care turned out to be fiction is also very disconcerting as we take stock of our health care system, its mandate and purpose and know that to move forward we have to include palliative care options that patients and their families deserve to expect.

The Canadian Cancer Society has stated that improvements to the palliative care system in Canada are desperately needed. Without clear national standards and accountabilities, individual jurisdictions are left to develop their own policies, programs, and guidelines, resulting in inconsistent or inadequate access across the country.

In Ontario, for instance, 40% of cancer patients do not receive a palliative assessment in their last year of life. In some regions of Atlantic and Western Canada, administrative data showed that less than half of people who died in a hospital received palliative care. Remarkably, there are many jurisdictions in the country where we do not even know how many Canadians receive quality palliative care. We lack consistent and ongoing data collection at a systematic level, which leaves us unable to more effectively hold our health care systems accountable to make positive changes.

Also, it is not just an issue of data collection. It is vital that any national palliative care strategy takes into account the geographic, regional, and cultural diversity of urban and rural Canada. It must respect our diverse cultural, spiritual, and familial needs, including Canada's first nations, Inuit, and Métis people.

According to Dr. Mary Lou Kelley, research chair in palliative care at Lakehead University in Thunder Bay, the federal health care dollars that would help indigenous people receive end-of-life care at home have not kept up with the increasing demand. Health care for first nations is the responsibility of the federal government, and it does provide some home care services, but the system was never designed to provide complex health care to people with chronic or advanced terminal diseases.

Members might imagine my disappointment that the words “indigenous”, “first nations”, “Inuit”, or “Métis” do not appear anywhere in the text of Bill C-227. However, that is not a deal breaker because it is something that can be addressed meaningfully as we move forward on a national strategy.

New Democrats believe strongly that any legislation that deals with the matter of palliative care must take into account the geographical, regional, and cultural diversity of our urban and rural Canada, and Canada's first nations, Inuit, and Métis people.

As our population ages, palliative care will become an ever-increasing function of the health care system. The federal government needs to support health care workers with the training and resources necessary to deliver it all across Canada. All Canadians deserve to live their final days in dignity and comfort. That is why there is an urgent need to address the significant disparities that remain across Canada with respect to end-of-life care, quality of care, and out-of-pocket costs.

For years now, New Democrats have worked to improve palliative care services for patients and their families. As the party that founded public health care in Canada—

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Mr. Speaker, anyone who has watched a loved one suffer through the ordeal of a terminal illness understands the profound importance of palliative and hospice care on behalf of the patient and for the families and loved ones.

I join my caucus in stressing, over the course of this debate, the fundamental right we also stressed in debate on Bill C-14. The New Democrats believe that every Canadian has a right to high quality end-of-life care.

According to the government's own mortality projections, the mortality rate will increase by 33% by 2020, making the need for palliative care as a thoughtfully laid out national strategy an increasingly urgent one, even more imperative within the context of medical-assisted dying.

Current, nearly 25% of the total cost of palliative care is borne by families, and significant disparities remain across Canada with respect to access to end-of-life care, quality of care and those out of pocket expenses. At least 50% of hospice palliative care services are funded by charitable donations, which continues to restrict the size, scope and access Canadians have to palliative programs.

Very few Canadian provinces have designated hospice palliative care as a core service under their provincial health plan. In the remaining provinces, hospice palliative care may be included in provincial home care budgets or other health service budgets, leaving the funding vulnerable to redistribution and cuts. That is why the New Democrats believe we must have a national strategy that can protect the palliative care of Canadians who have access to it, expand access to care for Canadians who do not have it, and improve the quality and affordability of care for all.

I am happy today to speak in support of the bill.

The New Democrats were surprised to find this year's federal budget contained zero federal funds earmarked for palliative care, especially after we fought to incorporate palliative care into the Liberal majority joint committee report on physician assisted dying.

Earlier this year, New Democrat Charlie Angus tabled Motion No. 46, which would accomplish much of what this bill would.

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

Mr. Speaker, I am pleased to rise in the House today to support my colleague, the member for Sarnia—Lambton, and her Bill C-277, an act providing for the development of a framework on palliative care in Canada.

Before continuing, I must first congratulate my colleague for her hard work since she was elected in 2015, and for earning the title of most collegial MP. She was awarded that title by her colleagues in the House, from all parties, when the prize was given by Maclean's and L'Actualité last fall. It speaks to the unstinting work done by my colleague, particularly on her present bill.

We are therefore very happy to have an engineer in our Conservative caucus as opposition science critic. That is why I am happy to speak today in support of her Bill C-277, a bill that has attracted attention from key health care stakeholders in my riding, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup.

Like a number of rural ridings in Canada, we find that we have an aging population, and we can already anticipate that the demand for palliative care will rise considerably over the coming years. It has already started. It is therefore important to talk about it and give ourselves time to be well prepared.

Following a Supreme Court decision in Carter, last year, this Parliament passed Bill C-14, which provided a legislative framework for physician-assisted dying. Although the bill was well received by some people who wanted to avail themselves of this right, others had some concerns, because they wanted to make sure that this was not the only option available. In my riding, just like elsewhere in Canada, this is a real question: will we provide only a bill like that, or will we provide other types of care? The other types of care are much needed.

As my colleague from Sarnia—Lambton noted, in the final report of the external committee on options for a legislative response to Carter v. Canada, the Supreme Court stated that a request for physician-assisted death cannot be truly voluntary if the proper palliative care is not available to alleviate the suffering of patients.

This is where we are today. The bill proposed by my colleague seeks to improve the options available to Canadians at the end of their lives. It truly seeks to encourage consultations and dialogue with the provinces to develop a national framework so that palliative care is a real option. In fact, the plan highlights the importance of having access to palliative care of higher quality than what is currently available.

It is important that our seniors and other people with terminal illnesses are protected with healthy, safe, and comfortable options in the last stages of their lives if they do not wish to avail themselves of medical assistance in dying. This is an extremely important point. People must have access to high-quality care to be able to live as long as possible in palliative care facilities. This will prevent many people from even thinking about requesting that their lives be terminated. The dignity of people depends on it.

I would like to highlight the incredible work done in my riding by the Maison Desjardins de soins palliatifs in Rivière-du-Loup, which has provided an enormous amount of care since it opened in 2009. I should also mention the mission of the Fondation Hélène-Caron, which will soon be serving the region of Montmagny and l'Islet through the Maison d'Hélène. Passing Bill C-277 will send a message to organizations like those, all across Canada, that their work is recognized and greatly appreciated.

Last month, Dr. Louise La Fontaine, vice-president of the Société québécoise des médecins en soins palliatifs and a resident of Notre-Dame-du-Portage in my riding, wrote to me to say that Canadians across the country have joined together to draw attention to the importance of palliative care.

She recommends that a national policy be developed in order to considerably improve the quality and consistency of palliative care and access to it. She recommends examining and assessing new models of integrated care, broadening accreditation standards throughout the entire health network, and focusing on areas such as symptom management and advance care planning. Practitioners must also be trained so that they can work in accordance with the various models for integrating palliative care into the management of severe chronic illness.

That is convenient because many of the things she mentioned would be part of the legislative framework if my colleague's Bill C-277 passes.

By asking the Minister of Health to consult with her provincial counterparts, we can ensure that every region of Canada is included in the discussion and that best practices and innovative ideas in the palliative care field are shared. I want to emphasize that because it is an extremely important aspect of the bill. My colleague who just spoke mentioned first nations. Canadian regions differ from one another, of course. One feature of this bill is that it takes all those differences into account and creates a framework for sharing the good practices that some regions are using and looking at which ones would work elsewhere.

I encourage all of my parliamentary colleagues to join me in supporting Bill C-277 so that we can help people across our great nation. If passed, this legislative framework will meet their medical needs and give us a plan that reflects the looming new demographic reality.

I will close by saying that the Lower St. Lawrence region, where my hometown of La Pocatière is located, is the oldest in Canada. What my colleague wants to put in place to facilitate the aging of the population affects us in particular. The bill proposes to provide quality care and enable people to make a fully informed and conscious decision, and to live out their days in an environment where their dignity will be respected.

My brother-in-law died last year after having cancer for seven years. He was treated at a hospice in the Eastern Townships. I had the opportunity to visit him twice. My sister stayed with him for three months.

The Eastern Townships, where Magog and Sherbrooke are located, is well developed. The care offered in the region is already excellent. The experience that these people have developed over the years can most certainly be shared with Canada's other regions.

From what I could see, the quality of care that my brother-in-law received was incredible. I think it is important to mention that.

My colleague came to my riding last week. Our plan was to have her come to my riding to visit palliative care homes, but unfortunately, the weather did not co-operate. I want to thank her for making the effort to meet with my constituents, who have spent a great deal of energy and time fundraising. Palliative care homes are often autonomous thanks to the donations they receive. Donations keep these homes open and operating, as is the case in Rivière-du-Loup.

In Montmagny, Hélène Caron, who is in charge of the project, has cancer. She gives a lot of her time to ensuring that this home exists. It is not a self-serving gesture. She devotes her time to the people and the good of her community.

The bill is unifying. I think that all parties should support it and see it through. Then we could have a national framework for all palliative care homes and the necessary funding to ensure that they are operational.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you, Mr. Chair.

Thank you to the witnesses.

It's good to see you again, Dr. Forbes. I think you appeared numerous times on Bill C-14.

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

Mr. Speaker, it is with great pleasure that I rise in the House today and speak in favour of Bill C-277, An Act providing for the development of a framework on palliative care in Canada.

Over the past 10 years I have served in this place, palliative care has been one of the issues that I have spent a lot of time on, and so I would like to thank my colleague, the hon. member for Sarnia—Lambton, for introducing this bill and taking up this great cause at this crucial time in Canadian history.

This legislation is essential for two fundamental reasons. First, it addresses a major gap in our Canadian health care system. The vast majority of Canadians do not have access to an essential health care service, palliative care. Second, in a post-Carter decision Canada, we need to understand the realities and questions Canadians now face when nearing the end of their lives.

My roles and experiences as co-founder of the parliamentary committee on palliative and compassionate care, as a member of the joint committee on assisted suicide and euthanasia, and as an advocate for suicide prevention throughout the last decade, inside the chamber and outside, have all ultimately shaped how I approach this subject, my deep conviction that we need to do better, and that we need to see this legislation passed and implemented as soon as possible.

I would also like to add that as a Christian, the value of life from conception until natural death, and the recognition that life is a sacred gift from God also shape how I approach the topic of sustaining comfortable living for those suffering in their last days.

I would like to begin with a quote from Jean Vanier, founder of L'Arche Canada, as recorded in the final report of the parliamentary committee on palliative and compassionate care entitled, “Not to be Forgotten”:

Each of us is fragile, with deep needs for both love and a sense of belonging. We begin and end our lives vulnerable and dependent, requiring others to care for us.... In our states of dependence, our need cries out for attention and care. If this need is well received, it calls forth the powers of love in others, and creates unity around us, the gifts of the vulnerable to our world. If our cry and our need are unmet, we remain alone and in anguish.... The danger in our culture of productivity and achievement is that we easily dismiss and ignore as unproductive the gifts and the beauty of our most vulnerable members, and we do so at our own peril, dehumanizing ourselves.

The question that we all need to ask ourselves is this: Will we now withhold from our society the love, the care, the attention for our most vulnerable, and in the process dehumanize not only those who need our care, but also ourselves, we, who should be providing that care?

As our committee report, “Not to be Forgotten”, states:

Adequate palliative and end-of-life care becomes more essential as the numbers of Canadians requiring these services grows. Canada is not providing adequate palliative and end-of-life care for all who need it.

In Canada, only 16% to 30% of those who need it, receive palliative care. If that is a failing grade in any ordinary exam, how much more so is it in the context of our dying fellow citizens, friends, and relatives? This is not merely a failing grade, this is a disastrous failing grade. Our report went on to say:

Despite efforts made by palliative care providers, Canadians have a long way to go to meet our goal of quality end-of-life care. Canadians in all parts of our country should be able to get effective palliation of their pain and symptoms, and have their psycho-social and spiritual needs addressed.

So the question is this. What quality of life do we want to provide for Canadians? The provision of proper palliative care is absolutely essential if we are truly serious about maximizing the quality of life of all Canadians, who find themselves in need of these additional supports at a time when they are most vulnerable.

As our report states:

We recommend that the federal government in collaboration with the provinces and territories implement a right to home care, long term care and palliative care, for all residents of Canada, equal to the current rights in the Canada Health Act, to those services defined as “insured health services”, including hospital services, physician services and surgical dental services.

Bill C-277 follows up that same expectation in stating:

The Minister of Health must, in consultation with the representatives of the provincial and territorial governments responsible for health, as well as with palliative care providers, develop and implement a framework designed to give Canadians access to palliative care—provided through hospitals, home care, long-term care facilities and residential hospices—that, among other things,

(f) evaluates the advisability of amending the Canada Health Act to include palliative care services provided through home care, long term care facilities and residential hospices.

In a post-Carter Canada, we need to realize that the environment in which people approach the end of life has changed drastically. According to researchers Tang and Crane, “The risk of suicide doubles for people with chronic pain”.

Now that people have access to medically-assisted suicide, I would argue that there is a high probability that this number may drastically increase as the Canadian population ages and experiences higher rates of chronic pain as outlined above. However, we know that good palliative care can eliminate 99% of all pain.

The heart of the issue, outlined well by the expert panel appointed by our previous Conservative government, is that a request for physician-assisted suicide cannot truly be voluntary if the option of proper palliative care is not readily available to alleviate a person's suffering. While palliative care is not exclusively for the terminally ill, terminally ill Canadians must be given the choice to live as well as they can for as long as they can.

The government has failed to address this gap in our medical system, either through Bill C-14 or budget 2016. Current provincial and territorial approaches to the delivery of palliative care are fragmented. Federal leadership is needed to ensure that all Canadians have access to the same services and quality of care.

There are almost always problems in gaining access to palliative, and a good part of the reason is the lack of medical practitioners who feel qualified to provide state-of-the-art palliative care. There are not enough opportunities to access proper training. Recently, a large medical school in Ontario had 169 applicants for elective time, specifically devoted to study palliative care, yet there was only room for 35 of those applicants to be placed in the program. This problem needs to be corrected.

Again, from the report Not to be Forgotten:

Dr. Valerie Schulz of the Schulich School of Medicine in London Ontario has developed a simple and effective way to get medical students interested in palliative care. Each year 12 students from the undergraduate program become hospice volunteers. Undergoing 30 hours of training, each being mentored by an experienced hospice volunteer; they visit clients in their homes. The experience is priceless for the future doctors, as it gives them a chance to meet and converse with people outside the clinical environment, and without the need to bring a clinical perspective to the relationship. They relate to the hospice clients as persons, learning how they feel and react to the prospect of dying. Friendships are formed, and lessons learned, which will be of lifelong value to the future doctors in terms of person centred care. The clients also are transformed, touched that a future doctor would care enough to spend time with them in a companion role. This program is worth emulation, and broader application.

If larger numbers of medical and other health care students across Canada were able to experience one-on-one relationships as hospice volunteers, the positive effects on our medical culture would be immense. However, we need our medical schools to increase available training options for those students who want access to the specialized training.

Bill C-277 is a step in the right direction in protecting vulnerable Canadians. It builds on the non-partisan unanimously supported work of previous parliamentarians, and I hope all parties will be supporting this historic legislation.

Finally, let me quote from an anonymous author as it relates to palliative care, “To cure sometimes, to relieve often, and to comfort always. This is our work”.

[Kamal Khera, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I am pleased to stand today to discuss Bill C-277, an act providing for the development of a framework on palliative care in Canada. With the introduction of this bill, the member for Sarnia—Lambton has taken a significant step forward in our national dialogue on palliative and end of life care, and I want to thank the member for bringing this forward. I appreciate the opportunity to provide some reflections on this extremely important initiative.

Palliative care is an issue that is gaining increasing attention across our country. This was further magnified by discussions on end-of-life care options that occurred earlier this year when medical assistance in dying became a legal option. Views on this matter differ, but we can all agree that patients should have access to a full range of care options to treat pain and other symptoms at the end of their life.

Palliative care is an approach to health care that focuses on the needs of patients who live with life-threatening conditions as well as on their families. Research shows that it can have a significant impact on improving quality of life for patients, while reducing the stress and burden on their families. As demographics in Canada shift, the need for end-of-life care is increasing. Canadians have been loud and clear in calling for access to high-quality care for those who are approaching the end of their life.

Before being elected as a member of Parliament, I had the privilege of being an oncology nurse at St. Joseph's Health Centre. I have actively provided palliative care to many patients and I have seen first hand the impact that good quality palliative care has on patients at the end of their lives and their families.

While palliative care has been improving in Canada, we know there is still much work to be done. Some studies have reported that as few as 16% to 30% of dying Canadians have access to palliative care, depending on where they live in the country.

More recently, a study by Health Quality Ontario found that 40% of Ontarians who died in 2014-15 had not received a palliative care service. Access often depends on physician referrals, the availability of services, and the awareness of care options among patients and their families. The Ontario study found that most patients did not start receiving palliative care until the last months of their lives. This is a concern because early access can be critical, if not the most important, for maintaining the best possible quality of life for a patient. The study also found that fewer than half of the patients who received palliative care received it at home. Most of us want to stay in our homes and communities for as long as possible. When asked, the majority of Canadians said that they would prefer to spend their last days at home. In spite of this, close to two-thirds of deaths in our country are still happening in hospitals.

The Canadian Cancer Society issued a report this year called “Right to Care: Palliative care for all Canadians”. It highlighted a number of gaps, and barriers to palliative care in Canada, such as a lack of standards, limited data, insufficient training for providers, and inadequate support for caregivers.

This study and others like it show that now is the time to work together on addressing these gaps. As was said many times during the debate on Bill C-14, improving palliative care is a priority for our government. In fact, the preamble of this bill clearly signals our intent to support improvements to a range of end of life care services in Canada.

Canadians need real options that respect their plans and preferences for care in what is often a very difficult stage of life. It is obvious that Canadians are looking to their governments to make this happen. Stakeholders, including the Canadian Medical Association, the Canadian Hospice Palliative Care Association, the Quality End of Life Care Coalition of Canada, the Canadian Nurses Association, and the Canadian Cancer Society, have all called for national leadership in the area of palliative care, and we have been listening.

Our government believes that Bill C-277 would provide us with a timely opportunity to take a leadership role on this issue. We support the creation of a framework for palliative care.

I would like to recognize the efforts of the member for Sarnia—Lambton in putting forward such a thoughtful proposal for what this framework could look like. However, in considering this bill, I would urge each member to also consider the need to respect jurisdictional roles and responsibilities in this area. As we know, health is a shared responsibility in our country, with most of the responsibility for delivering care falling under the purview of the provinces and territories. Most provincial and territorial governments already have some form of a palliative care strategy, plan, or framework, or have policies or programs in place to support palliative care. Several provinces recently dedicated funding to improve palliative care services in their respective jurisdictions.

The bill needs to be better aligned with the scope of federal roles and responsibilities in relation to palliative care, and we will be introducing amendments to that effect. The government is well positioned to complement, bolster, and spread the important work under way across the country by provincial and territorial governments, as well as stakeholders across the health care sector.

I believe that amendments could be made that would achieve this objective while respecting the spirit of the bill. As we all know, the government provides provincial and territorial governments with long-term funding for health care. Our government made a platform commitment to provide $3 billion to provinces and territories to deliver more and better home care services for Canadians, including those who need palliative care. This commitment is being pursued in the context of the health accord. Negotiations with provinces and territories are ongoing, and I am optimistic that, in the future, there may be synergies with a proposed framework.

The division of responsibilities for health between the government and provinces and territories presents us with both challenges and opportunities. If we move forward with implementing this bill, it will be important to talk to provincial and territorial governments and key stakeholders on the appropriate scope of a palliative care framework.

It will also be important for us to learn from the significant body of work on palliative care that has been published in recent years. This includes reports from Parliament, provincial and territorial advisory bodies, and stakeholders, such as the Canadian Medical Association.

One key example is the Canadian Hospice Palliative Care Association's 2015 report, “The Way Forward,” which seeks to integrate a palliative approach to care throughout the health care system.

I would like to close by thanking the House for the opportunity to reflect on the importance of this bill, and to offer some considerations as we move forward, reviewing it in greater detail. I believe that a framework for palliative care is the right approach for Canada. I look forward to further discussion on what that framework should look like, so that we can all have better access to palliative care for all Canadians. Once again, I thank the member for bringing this extremely important piece of legislation to this House.

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

Mr. Speaker, as the member knows, I am bringing a fresh perspective to this place. All of the members of the Conservative Party will be supporting this bill, because we recognize that all Canadians need this.

When we studied Bill C-14 this year, we heard all of the witnesses and the people who were providing input say that we need to have good palliative care if we are going to have a true choice. To find out that 70% of Canadians have no access to any kind of palliative care was astounding to me. Therefore, I am happy to say that we will support this, and that is a change.

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

moved that Bill C-277, an act providing for the development of a framework on palliative care in Canada, be read the second time and referred to a committee.

Mr. Speaker, today, I am pleased to stand before the House to bring a private member's bill that would benefit not only my riding of Sarnia—Lambton, but all Canadians.

All of us will eventually come to the end of our lives. We all want to ensure that we live as well as we can for as long as we can. That is why Canadians need proper palliative and end-of-life care. Bill C-277 would provide a framework for palliative care in Canada.

Last parliamentary session, the Parliamentary Committee on Palliative and Compassionate Care studied the matter and came forward with recommendations. This bill is the result of those recommendations.

The committee published an excellent report outlining the current Canadian situation with respect to palliative care. The preamble for my bill is directly pulled from its report. This committee did a complete assessment of current palliative care options in Canada and identified specific areas and needs to be addressed. The report outlined the importance of strong and consistent palliative care options in Canada as well as the necessity of a framework under which to conduct these efforts.

This bill is also timely since, as a result of the Carter decision on assisted dying, the external committee report also recommended that palliative care be available to all Canadians.

The final report of the external committee on options for a legislative response to Carter v. Canada emphasized the importance of palliative care in the context of medically-assisted dying. It stated that a request for medically-assisted death could not be truly voluntary if the option of proper palliative care was not available to alleviate a person's suffering.

As we all can attest, each of the parties in the House has shown itself to be in favour of implementing a palliative care program in Canada, but very little has been formally announced. We can all agree on the importance of palliative care as well as the importance of making these measures accessible, in a consistent fashion, to all Canadians who need them.

Bill C-277 would define the services to be covered. It would establish standard training requirements for the various levels of service providers. It would come with a plan to achieve consistent access to palliative care for all Canadians. It would define the mechanism by which this is best achieved, with the measurements and data needed to track success.

Canada has an ever-growing number of individuals of all ages experiencing chronic and terminal conditions. Good palliative care covers a wide range of services, such as acute care, hospice care, home care, crisis care, and spiritual and psychological counselling.

A palliative philosophy of care is needed to address a whole variety of needs through an adapted and patient-centred process. The creation and implementation of a palliative care framework would give Canadians access to consistent, high-quality palliative care through hospitals, home care, long-term care facilities, as well as through residential hospices.

When we look at the current palliative care system, we can recognize the work that needs to be done. Current programs are evolving provincially and many are fragmented with little consistency and communication between the parts. A palliative care framework will bring these fragmented parts together in an effort to create a more cohesive, patient-based program, with a common definition of services covered, training standards, and a plan to ensure equal access for all.

There is a need for governance of the consistent implementation and monitoring of palliative and home care. This would require clear and open communication between federal and provincial governments as well as medical practitioners, institutions, and patients.

I would like to acknowledge the Canadian Medical Association, the Canadian Cancer Society, the Canadian Nurses Association, the Canadian Society of Palliative Care Physicians, Pallium Canada, ARPA, the Canadian Hospice Palliative Care Association, and many of their member hospices, like Bruyère Continuing Care, St. Joseph's Hospice, and West Island Palliative Care Residence, the Heart and Stroke Foundation of Canada, the Kidney Foundation, the ALS Society, the Canadian Association of Occupational Therapists, and the more than 50 organization members of the Quality End-of-Life Care Coalition of Canada for their ongoing promotion and support of this bill.

It is through organizations and groups like these that we can integrate palliative care into the current health care system and make a true difference in the lives of Canadians.

Support from across Canada is also evident in the 83 petitions on palliative care that have been presented to the House in this session alone. Thousands of letters have been received by members of Parliament on all sides of the House.

The current palliative care options in Canada are simply inadequate and do not meet the needs of Canadians.

In 2011, it is estimated that only 16% to 30% of those in need were receiving proper palliative and end-of-life care. Our current health care system favours short-term acute care, which it does extremely well. However, it lacks the capacity and the funding to properly, and consistently, provide quality long-term palliative and end-of-life care. The cost of acute care is four times that of hospice palliative care, so there is an opportunity to provide more of this kind of care for less money.

Regional accessibility is also an important issue. Currently, palliative care options are available in most heavily populated regions. However, the availability of palliative care in remote or less populated areas is often very limited or non-existent. There is a pressing need for a plan to address how to provide services to these areas. The region where you live should have no impact on whether palliative care is or is not available to you.

Palliative care would also offer an enhanced quality of life for those who, for various reasons, do not choose medically assisted dying. Data in countries that offer assisted dying shows that where good palliative care is available, 95% of people choose to live as well as they can for as long as they can. Palliative care will provide an option that would be preferable to many medical practitioners, nurse practitioners, and health care institutions that for religious and conscience reasons would prefer to help their patients live well.

With those 65 and older making up approximately 15% of the Canadian population, the geriatric and palliative care needs of Canadians will only increase. Palliative care can be cost efficiently delivered within the home or in community-based systems, such as hospices, nursing homes, and long-term care homes.

Funding palliative care in homes and in stand-alone facilities will alleviate pressure on hospitals and free up many much-needed hospital beds.

The proper training of medical practitioners and nurse practitioners is an important step in creating a comprehensive and well-equipped palliative care structure. On average, medical and nursing students spend as little as 20 hours of their four years of study learning about palliative and end-of-life care. In 2011, there were fewer than 200 geriatricians in Canada. Today, the estimated need is upwards of 600.

This bill will also have a positive impact on the lives of caregivers. In 2011, there were an estimated 4 million to 5 million family caregivers in Canada, who contribute $25 billion to the Canadian economy. These same caregivers often have a heavier financial burden and have to miss one or more months of work because of their duties. Family caregivers provide 80% of all home care in Canada, and 77% of these caregivers are women.

This might seem like a lot of statistics, but these numbers are not to be taken lightly. Caregivers experience financial, social, and physical burdens that can have lasting effects on their lives. I quote the Canadian Cancer Society when I say that “Canadian caregivers are the invisible backbone of the health care system, providing $25 billion in unpaid care”.

This added support will encourage palliative care in the home, which has been demonstrated to be beneficial for everyone involved. Allowing patients to stay in their homes for as long as possible is a wise and compassionate choice that should be offered to every Canadian.

As we can imagine, long-term data on the subject is hard to come by. What data we do have shows that Canada has a lot of work to do in the field of palliative care. Dr. Fred McGinn, of the Hospice Society of Halifax, calculated that in 2011 there were over 200 residential hospices in the United Kingdom and over 1,300 residential hospices in the United States. However, there were only 30 free-standing residential hospices in Canada.

Canada needs to develop its capacity for residential and hospice palliative care. In terms of actual spending, it costs between $600 and $800 a day to have a palliative care bed in a hospital. Comparatively, it costs only $55 a day to have palliative care beds at home. In-between these, it costs $200 to $300 a day to have a palliative care bed in hospice. In extreme cases, it could cost upward of $1,200 a day for beds in acute care in hospital while a patient is awaiting other accommodations, so it would be much more cost-effective to fund quality at-home and in-hospice palliative care beds over beds in hospitals.

Our lack of data and research on palliative care is why I believe it is essential we include further research and data collection in the bill. Many other UN countries have or have had laws in place with regard to palliative care.

A report from the United Nations and World Wide Palliative Care Alliance suggests that the cost of care at end of life, measures between 25% and 30% of all medical expenditures. Shockingly in Canada, 50% of palliative care funding currently has to come from charitable donations. This report determined that overall, the utilization of hospital based and in-home based hospice and palliative care services significantly reduced the cost of care, while providing equal if not better quality care for patients.

In this House, the government has stated it would allocate $3 billion to home care and to palliative care over the next four years.

This bill to create an overarching framework guaranteeing quality palliative care would provide an ideal complimentary legislation to Bill C-14 in the sense that it will take into account the concerns expressed by health professionals all while creating a quality palliative care strategy. Having end-of-life options gives patients a real choice in an already difficult situation.

Establishing a clear and comprehensive palliative care framework will allow patients to make well-informed decisions about how they spend their remaining time with family and friends.

I believe that my riding of Sarnia—Lambton is an excellent example of palliative care done right. One in five residents of Sarnia is 65 or over, and this number is on the rise. Sarnia is considered to be ahead of many communities with its 10-bed hospice and eight to 10-bed hospital palliative care unit. We have more than five palliative care specialists in our area, and as a community, Sarnia—Lambton has many institutions and groups that support and deliver palliative care, such as St. Joseph's Hospice, the Bluewater Health Palliative Care Unit, and the Erie St. Clair Community Care Access Centre and the VON.

Unfortunately, resources such as these are not abundant everywhere. This has been attributed to a lack of medical training and personnel in this field and a lack of funding. A very small number of Canadians in need of palliative care are able to receive it. With less than 30% of Canadians having access to quality palliative care, concrete changes need to be made.

As a large portion of our population approaches retirement, the issue will just continue to grow. I am looking to create a framework to implement consistent and quality palliative care across Canada. No Canadian should be denied these essential end of life programs and services because of their region or their finances. Every Canadian deserves the right to be able to end their life in peace and comfort knowing that they had the final choice. The bill will result in Canadians having that real choice.

I would once again like to thank the numerous groups, organizations and hospices for their support. After all, 95% of people who have good palliative choose to live as well as they can for as long as they can. I believe every Canadian should be given that option, so let us join together with one voice to call for quality palliative care as a right of all Canadians by supporting Bill C-277.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you, Mr. Chair.

Thank you to the witnesses. In particular it's great to see Mr. Oliphant and Senator Cowan. We spent so much time on Bill C-14.

I want to commend you, Senator Cowan and Mr. Oliphant, for putting forward this legislation. It is a fact that Canada is the only jurisdiction in the G7 without legislation to protect individuals against genetic discrimination. Certainly this will go a long way to closing that gap.

I would like to follow up on Mr. Falk's question. Looking at the Canadian Human Rights Act, I am a little unclear as to whether cases have been have been dismissed. I know, for example, if you look at the Canadian Human Rights Act one of the prohibitive grounds of discrimination is disability. Has disability been interpreted in the context of genetic discrimination, and if so, what have the outcomes of those cases been?

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

Senator Cowan, I'd like to open by congratulating you for getting to this stage. You've been working on this issue for a long time, going through the Senate. Last week I was talking to school groups in my riding and outlining the process, the very long route a bill must take before it reaches royal assent. I think we have to respect the version of the bill that we have before us because it has gone through all that scrutiny in the Senate, and you've had the witnesses at the human rights committee. I'm concerned, like my colleague Mr. Nicholson. We have started to hear rumours that the government may have reservations about this bill. In fact, hearing that gives me a sense of déjà vu with you two because of Bill C-14. It feels we are here again.

Senator Cowan, can you provide this committee with examples of where federal criminal law power is currently in statute, but may seem to be in provincial areas? I know there are examples where federal criminal law power is used extensively, and in some cases where it may seem to impinge on provincial jurisdiction, but has been accepted as constitutional.

Salaries Act

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Mr. Speaker, I rise today to speak to Bill C-24, an act to amend the Salaries Act and to make a consequential amendment to the Financial Administration Act.

The bill can be broken down into three major components: the legal creation of eight new Liberal ministerial positions, including three ministers; the elimination of six regional development agency ministers; and the amendment to the Salaries Act so that all ministers are paid equally.

Before I start speaking directly to these points, I want to share with everyone the importance of economic development agencies. I have seen first hand in my own riding the positive impact of federal economic agencies, and more specifically, of the Federal Economic Development Agency for Southern Ontario.

In 2009, the federal government created FedDev Ontario. Prime Minister Stephen Harper announced this agency, recognizing the global recession and the specific challenges in every region of the country. The agency was created to deal with the specific and distinct needs of southern Ontario, tailored to the priorities of the region. The agency was developed as a tool to help businesses and communities succeed with necessary resources.

At the time, the prime minister appointed the hon. Gary Goodyear to tour and engage workers, businesses, and community leaders. Gary was a member of Parliament from Cambridge who not only represented the area but was able to see the issues first hand and work with leaders to create solutions for the economic downturn.

Through the creation of this agency, many incredible opportunities came to fruition, and over $1 billion was provided over five years. Mr. Goodyear's job was to work with the departments and account for putting programs into action, working to expedite funding for economic development, diversification, and community development.

Programs included under FedDev Ontario were the community adjustment fund, the National Research Council industrial research assistance program, the community futures program, and the Business Development Bank of Canada.

Overall, the agency's mandate was aimed at addressing the short-term economic needs of the communities hit hard by the economic recession. FedDev was able to announce a number of important initiatives, including an $8-million investment to build an air cargo terminal at the London International Airport and improvements to Highway 8 in co-operation with the Province of Ontario.

All that being said, I believe that we have a very competent minister currently at the helm, but I believe that expecting one minister to personally oversee all the important projects that fall under his portfolio is asking for failure. I believe that we need to have someone accountable for all the money that floats through these agencies who has knowledge of an area and the specific needs of that area.

Although I have travelled this beautiful country a bit, l recognize the vast differences from region to region. The needs of Atlantic Canada are vastly different from those of Alberta, yet currently they both need assistance. They need someone on the ground advocating on their behalf and recognizing what works best in their own communities. I feel that it is not the time to have one minister accountable for all the money and all the projects. I think this is reckless and poorly thought out, regardless of the efforts of the current minister.

That leads me to point number one: the creation of eight new Liberal ministerial positions. We see the government chopping the important positions at the economic development agencies yet creating new positions when we do not even know what they are for. Maybe if the government could share its plans for what the ministers are, it might get greater support from the opposition. Instead, it is proposing these new positions with no information.

The government is asking for a blank cheque payable to someone for something. Does that sound transparent? I would urge the government to just tell us. Let Canadians know what it is doing and why. These are simple requests, but instead, we are being asked to support Bill C-24 with no further information. The ministers have not yet been named. We have no idea what they will be doing, and we have no idea why they will be doing it.

The government was elected one year ago today on slogans like “transparency”, and today I am speaking and questioning the government on its plans. I thought I would be silly and maybe help the government with the meaning of transparency, using the ever so competent source, Wikipedia, which says, “Transparency is operating in such a way that it is easy for others to see what actions are performed.”

If Wikipedia gets it, why does the Liberal government not? Why are we voting on something in the House of Commons that is so unclear? Why are we voting blindly on an issue? The Liberals are asking us to support something about which we have no idea. Truly, it is sounds like something I would say to my husband in the car. If I am not positive about the outcome, I usually say to him, “Trust me”. I know then that it is between him and me, not 30 million taxpayers, and that I can therefore be accountable to him.

However, we are being asked to give carte blanche authorization for something we do not know about, so the words, “trust me”, just cannot matter. When we are asking the government to give us some sort of ideas, we should be privy to what those requests are, especially when there are three new ministers that will be set up.

Finally, I would like to touch on the ministerial equality proposal. The Prime Minister proudly announced his gender-equal cabinet. Shortly afterwards, it was pointed out that he had appointed only women to junior ministerial positions. I am 100% supportive of the idea of gender equality, but as many of our colleagues have pointed out, the solution to this “oops” is taking all of the junior ministers and giving them more money. Any woman fighting for gender equality sees the holes in this solution.

Let us just break this down to the simple facts. These are the following portfolios that are currently junior ministers: the Minister of all Francophonie, the Minister of Science, Minister of Small Business and Tourism, the Minister of Sports and Persons with Disabilities, and the Minister of the Status of Women. All of these positions are very important and necessary, but the Prime Minister is trying to end the gender gap in his own cabinet by saying these positions are equal to those of senior ministers.

This is not about gender parity; it is about saving face and protecting his reputation as a feminist. I find his solution quite an overreach and very degrading. Each of these women in their portfolios works hard, but if we asked them, not one would say they have a job that is equivalent to the Minister of Finance or the Minister of National Defence. There is a very big difference.

In our caucus, members who were previously in these positions speak frankly and honestly. Their roles are very different and their portfolios are much smaller and focused. The role of senior minister comes with a deputy minister and a larger departmental budget, as this is needed.

This one-tier approach is not modernizing and I question whether this is about gender parity or ministerial parity. Truly, this is neither. This is not about pay equity or equal pay for equal work, as my NDP colleague had clearly pointed out in her opening speech last week.

Let us look at this in simple terms. We talk of this as being about all ministers at the cabinet table having equal jobs. Let us be honest. I will take this back to something I have a lot of experience with, which is the restaurant business. If I am looking at a restaurant, I would look at the different roles that were set up. We would have the executive chef, the sous chef, the order cook, the manager of the front of the house, the servers and bartenders. We would have everyone. At the end of the day, everyone needs to work to make this restaurant work and every single person has a very important job to do, but the onus will be on the executive chef and the manager. Although the executive chef is out there doing the meals and doing the meal planning, the sous chef will be cutting celery and carrots.

We are trying to say that some of these small roles are not as small as they seem. The thing I have problems with is that when we look at this, we all need everyone to work together at the cabinet table and be equal, but that does not mean their jobs are equal. We cannot compare what a person does as an executive chef or a minister to what a sous chef does or to what a junior minister may do. I am not trying to say that these roles are not very important, because they are, but at the end of the day, let us look at the work.

We talked about ministerial parity; let us now talk about work parity. Do we see these ministers doing the same amount of work that the ministers of state are doing? I think the answer is very clear and it is no.

Would I truly want to be the Minister of Finance setting up a budget for 2017 and also having to do a full forecast? That is a lot of work. Would I want to be the Minister of Justice who has to deal with almost every single bill that comes through the House of Commons? Absolutely not. Those are overwhelming things.

On the other side, I do recognize the importance of these junior roles, but saying they are not junior roles does not make them more senior. I really appreciate all of the work that we have done. We have just come out of an excellent 2016 Olympics, but does that make the Minister of Sports' role as important as the role of the Minister of Finance?

I want to show that huge difference because there is a huge difference. I think for us to say there is not would be rude, and the only reason that some people are not willing to say so is that she is a woman. Therefore, we have to say that it is an equal role. It truly is not an equal role.

We also look at the Minister of Status of Women, for whom I have great respect. She does an excellent job going around and checking important things about women throughout the country, including violence against women. Once again, is that role as great as that of the Minister of Justice? I am using these two women for comparison's sake, because they have different roles but are both female. Let us look at the two of them as equals.

We have the Minister of Justice, who was recently involved with a huge bill like Bill C-14. She is dealing with different aboriginal issues, with the Minister of Indigenous and Northern Affairs, and with health issues. She is dealing with so many different things. We have to recognize that the job of the Minister of State for the Status of Women is a very focused one and does not include all of what the Minister of Justice may do.

I also look at the Minister of Health. I have great respect for her and the work she has to do. We have to understand how comprehensive her job is, not only working on her own role but working with all of the provinces.

We are sitting here talking about job parity, but this is not about job parity because if it were about job parity, we would be looking at equal work, and this is not equal work.

If I were in small business and paying everyone the same, I would go bankrupt. Our government has to look at this as not being about equal work. This is about a time when the Prime Minister last year appointed his cabinet, which was scrutinized through the lens of his statement that his cabinet was gender-equal. The media pointed out that he truly did not have a gender-equal cabinet so because some of those ministers were ministers of state. Therefore, we are now giving large increases to those ministers of state, chopping off the words “of state”, and saying that they are equal. Let us be honest. Changing the name of minister of state and making it “minister” and not increasing the workload and saying that they are the same as everyone else who is sitting along that front bench is not true. I think we all have to sit back and see that.

I asked a question earlier of my colleague the parliamentary secretary, because I know that in my own region I have an excellent parliamentary secretary who works very hard. I sit there, and before I question the minister of state, I am thinking “How is this going to roll out?” Although I know she works very hard, should I expect that in time the parliamentary secretaries are going to be saying, “I do a lot of work as well because when the minister is not here I sit here on Fridays, and when the minister is not available I take a lot of the calls and requests”.

What is going to happen? Is this going to be a snowball effect so that the next thing we know, even a critic like me will get a raise? To me, that does not sound right. Our work is as members of Parliament and we are elected to come here, making the amount of money that we do. Yes, they got a cabinet position; congratulations, they get more money. But at the same time, they are working hard and all members of Parliament should be working hard for all Canadians.

I want to go back to the three main topics here. We are talking about removing the regional ministers, which I feel is very unnecessary. As I indicated, even in my own hometown we have seen great things done because of the impact and the knowledge of those ministers. I am not going to sit here and say that the minister is not doing a great job, but he has a huge role. By having people under those regional agencies, they have first-hand experience and knowledge of those particular files and how they can see Canadians in economic development.

The other issue is the mystery three ministers that we discussed. We talk about transparency. We need to see that transparency. If the current government wants us to support three more ministers, tell us why, tell us who, and tell us what they are going to be doing in the future and how they are going to benefit all Canadians.

Finally, on the issue of ministerial parity that I just wrapped up on, if we break down all of the issues involved and really look at them, I want all of the government members and every member here saying, “Is this the right bill to support?” I cannot support a bill when there are so many unknowns. I cannot support a bill when there is talk of parity that really is not parity. As well, I cannot support a bill when I know that as a result, we will be cutting the Canada Economic Development for Quebec Regions agency, the Canadian Northern Economic Development Agency minister, the Federal Economic Development Agency for Southern Ontario minister, the Federal Economic Development Initiative in Northern Ontario minister, the Atlantic Canada Opportunities Agency minister, as well as the Western Economic Diversification Canada minister. All of them have great tasks and great roles. I think it is very important that they continue to sit at the cabinet table to have that impact and to be able to advocate for their regions in the current cabinet and government.

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

I'm a rookie member of Parliament. One thing you learn quickly about this job is that it's very much a balance between being a trustee and being a delegate. Sometimes it's somewhere in the middle. On some very important questions, like Bill C-14, I consulted very widely with my constituents for their opinions, but for the day-to-day stuff, I think the electors who sent me to Ottawa trust my ability as a member of Parliament to make the right decisions, and I will be held accountable in 2019 for those decisions.

I want this committee to make a firm recommendation. Otherwise, what's the point? We've spent a lot of money. We've spent a lot of time on the road. I appreciate the fact that you've echoed that.

If this committee, by consensus, because it is based proportionally on the votes we received in the election and not on our seats, gives a clear recommendation, do you think the government should proceed with legislation next year instead of going to the people? What's your opinion on that?

[Blake Richards, Conservative, Banff—Airdrie, AB]

Yes. Thanks, Mr. Chair.

The next motion would be:

That the Procedure and House Affairs committee invite the Director of Communications to the Prime Minister to appear to answer all questions related to its study on the question of privilege related to “the matter of the premature disclosure of the contents of Bill C-14, (An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)”.

Again, Mr. Chair, I will remind members.... I know there was some objection to calling officials from the Prime Minister's Office. If that's their only objection, I certainly would be willing to call the Prime Minister himself, if that's something they would prefer, but someone should be held accountable.

When the Minister of Justice was here, it was made clear several times in her remarks that, as she indicated, people in the Prime Minister's Office had access to this piece of legislation. If there was in fact a leak of what was in the bill or key themes that were not going to be in the bill, which would both require knowledge of the bill, this may have been a very likely source. The communications department in the Prime Minister's Office would be a likely source. That is why we would move to call the director of communications.

Again, if the government feels more comfortable with the elected officials having accountability, we'd be happy to make a motion to move that the Prime Minister himself come before the committee, but we felt that this was an appropriate way to deal with it. We certainly hope that, given what I think is now their fourth opportunity to have the actions match the words, Mr. Chair, the government members will choose to, on their fourth opportunity, vote to see the opportunity for accountability and transparency on the part of their government.

[Blake Richards, Conservative, Banff—Airdrie, AB]

Thank you, Mr. Chair.

The next motion would be:

That the Procedure and House Affairs committee invite the Leader of the Government in the House of Commons to appear to answer all questions related to its study on the question of privilege related to “the matter of the premature disclosure of the contents of Bill C-14 (An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)”.

To speak very briefly to it, Mr. Chair, I've listened to the arguments being made by the government today and in previous meetings. To me, it just seems like an attempt to make some kind of cover for the fact that they are not wanting to have.... It was made quite clear to us that there were other people who had access to this.

We called the Minister of Justice and were able to clear up the clouds over her head. Obviously, in this case of the Leader of the Government in the House of Commons, when we're talking about legislation being tabled, that's often a department that would have access to the legislation. Give them the opportunity to come in and to clear the names of the government House leader at the time and those in the government House leader's office. Give them the opportunity to clear those names and clear up the clouds hanging over their heads.

Again, we can always hope that the government members will choose to have the words of their whip match the actions of their government to do everything they can to ensure this won't happen again.

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

I want to thank Mr. Richards for his contribution to the debate. I would simply put, just for the benefit of everyone who is present, the government's response, again simply because we haven't visited this matter since last June.

To be honest, from what I'd heard from the official opposition, I haven't actually seen any new evidence that would make me change, at least in my case, my particular position with respect to the matter that's before this committee, that is, the question of whether, in fact, the actual contents of Bill C-14 were prematurely disclosed in terms of the actual substantive bill itself being in the public before it appeared before Parliament.

I would agree that it is problematic that someone would discuss the broad parameters of legislation in advance of its being tabled in the House. But, again, the distinction in what makes it a matter of privilege is that the actual bill itself is in the possession of someone prior to it being tabled in the House. To date, there still remains absolutely no evidence before this committee that that actually took place. That is the distinguishing point from previous cases of privilege where it was established that there was in fact a breach of members' privileges. That is the distinction that exists in this particular case. We simply do not have the evidence before us that the bill was, in fact, in the hands of this reporter from The Globe and Mail before it was tabled in the House. We have a media report that there was a conversation. But that is all.

To me there is a fundamental distinction between that conversation and the actual substantive bill itself being in the possession of the reporter. On that basis, I still remain of the position that this is not a matter that constitutes a breach of privilege, and that has been the position of the government. Again, I point out that there is no specific reference in the media reports of the specific contents of the bill being quoted. Again, it's high-level information that was reported. As I said, I don't think that is a proper practice, but it does not mean that it is a breach of privilege. It remains my position that until the bill was actually tabled before the House, there was in fact no breach of members' privileges.

If my friend has something or some other evidence that he could table to suggest that was not the case, then we would be prepared to look at it, but from my perspective right now, that is not the case. And so, from my perspective, it simply remains to be nothing more than an attempt to go fishing. That's my view.

I think we are prepared, if my friend is prepared to do so, to allow his six motions to come before this committee now for a vote.

[Blake Richards, Conservative, Banff—Airdrie, AB]

I think given the indications we had in June from the government members that they planned to kill this and not try to be accountable or transparent in regard to the leak of the Bill C-14 contents, what I will do is make some of my points in relation to the motion as well as the amendment because I'm concerned that they will just simply choose to vote down the amendment and therefore kill the motion.

What I want to do, Mr. Chair, is to start with a little bit of a review of parliamentary privilege itself.

Physician-Assisted Dying

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I am tabling a petition today signed by many constituents of Winnipeg North.

This petition deals with Bill C-14. Just to provide assurances to those who have signed this petition, many of the issues raised in the petition were in fact debated through the process. I look forward to having another debate on it in a few years.

Opposition Motion—Appointments to the Supreme Court

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

Mr. Speaker, this really is real change from the member across the way, is it not? However, more seriously, we have heard the Liberals try to use this argument before. In question period, we essentially heard the Duffy defence from the government House leader, who said that the government was acting within the rules. However, I think Canadians expect respect for our institutions. That is what we have consistently provided as an opposition and what we are calling for in the context of this motion.

I will not say that the previous government was perfect in every respect, but in the last year we have seen things like Motion No. 6, which went far beyond anything that was ever contemplated under the previous government. We have seen things like the invocation of closure on Bill C-14, on euthanasia, which is a deeply sensitive issue. There was no history under the previous government of bringing in closure on fundamental issues of conscience. That is very clear. In a very short time, the current government has come in promising so-called real change and has delivered—

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

[The Speaker, Liberal, Geoff Regan]

It being 3:09 p.m., the House will now proceed to the taking of the deferred recorded division on the amendment to the motion to concur in the Senate amendments to Bill C-14.

Call in the members.

Physician-Assisted Dying

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Mr. Speaker, I have said many times in the House that I am confident that this bill is constitutional. We have worked hard on an extremely complex issue to find the right and necessary balance between personal autonomy and protecting the vulnerable. There are multiple objectives contained within Bill C-14. It is the right approach for Canada right now, and we look forward, hopefully soon, to having our legislation in place.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, the amendments to Bill C-14 are now before the House. We have another chance to pass a bill that respects the right to medical assistance in dying.

Will this government accept our amendment to make this bill constitutional, instead of forcing Canadians who are suffering to fight for years in court?

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

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

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

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

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

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

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

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

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

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

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

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

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

[Anthony Housefather, Liberal, Mount Royal, QC]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Jane Philpott, Liberal, Markham—Stouffville, ON]

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

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

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Madam Speaker, we have over the last few weeks heard reports from many experts that Kay Carter, whose case before the Supreme Court of Canada brought this important issue to us, would not be eligible for physician-assisted dying under Bill C-14 as it now stands.

I would like the minister to comment on that. Does she disagree with that position? Does it not reflect on the confusion that the bill as it has been crafted has caused in the debate?

[Jane Philpott, Liberal, Minister of Health]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Murray Rankin, NDP, Victoria, BC]

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

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

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

[Murray Rankin, NDP, Victoria, BC]

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

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

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

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

[Murray Rankin, NDP, Victoria, BC]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Here is what the court went on to add:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I move:

That the motion be amended by:

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

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

[Jamie Schmale, Conservative, Haliburton—Kawartha Lakes—Brock, ON]

Very good. I like that.

I will have to focus here. I didn't get much sleep last night. I had my windows open and I live in a noisy neighbourhood. There was a cat meowing all night long, and it wouldn't stop meowing. It gave me lots of time to think, if I can get my head together here.

I will continue with quoting the ethics guidelines from the Canadian Association of Journalists, “We make sure to retain the original context of all quotations or clips, striving to convey the original tone”, which we are seeing in these articles. “Our reporting and editing will not change the meaning of a statement or exclude important qualifiers.”

It's in the ethics guidelines, right there; they do not change the meaning or statement. Look at the articles. If this is not a leak, why are the stories so close together? Why does the wording of both stories show statement of fact rather than just speculation?

I will quote here from March 19, 2001. At that time, the Speaker ruled on a question of privilege regarding an incident whereby the media was briefed on a justice bill, Bill C-15, before the members of Parliament. The Speaker indicated that there were two important issues in that case: “the matter of the embargoed briefing to the media and the issue of members' access to information required to fulfil their duties.”

In that ruling, the Speaker said:

In preparing legislation, the government may wish to hold extensive consultations and such consultations may be held entirely at the government’s discretion. However, with respect to material to be placed before parliament, the House must take precedence.... The convention of the confidentiality of bills on notice is necessary, not only so that members themselves may be well informed, but also because of the pre-eminent rule which the House plays and must play in the legislative affairs of the nation.... To deny to members information concerning business that is about to come before the House, while at the same time providing such information to media that will likely be questioning members about that business, is a situation that the Chair cannot condone.

Mr. Chair, I think we find ourselves in the same type of situation.

This bill was probably the most important bill I will get to vote on in this term, in this Parliament, and—if the voters are willing to return me to this place, which I hope they are—probably in my entire career. Nothing will be as wide-reaching as this bill, the magnitude of this bill.

By the way, I did a constituency referendum on Bill C-14. Of almost 4,000 returned ballots, 78% voted in favour of Bill C-14. It was a good experience to do that and consult the constituents. My riding, Mr. Chair, is not as big as yours, but as the House was sitting at the time, it was a way to consult a large number of constituents in a small to medium-sized area in that short period of time and get a fairly accurate reading of constituents. Everybody, regardless of how they voted, had the opportunity to tell me how to vote. The range of comments was very good, lots of good feedback. People were telling me to vote yes or no based on a wide range of reasons, whether they saw a family member suffer—

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

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

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

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

[The Chair, Liberal, Larry Bagnell]

We'll keep on if the House isn't sitting, if members want to go.

I've mentioned to the parties that we have a letter that we should, out of courtesy, resolve before the summer. We'll distribute the analysis of it electronically to you and hopefully we'll deal with it before the summer somehow. That would be in camera, to protect the privacy of the person.

We will resume consideration of Mr. Richard's motion concerning the study of the question of privilege on Bill C-14. We're still on the same motion as in the previous meeting.

Seeing no hands, I will note that Mr. Schmale was in the middle of a long oratory that he hadn't quite finished and would like to continue. After that, Mr. Richards and Mr. Reid are still on the list.

Go ahead, Mr. Schmale.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

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

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

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

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

[Luc Thériault, Bloc, Montcalm, QC]

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

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

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

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

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

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

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

[Murray Rankin, NDP, Victoria, BC]

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

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

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

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

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

[Jody Wilson-Raybould, Liberal, Minister of Justice]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Criminal Code

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

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

Therefore, pursuant to Standing Order 53, I move:

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

Message from the Senate

[Andrew Leslie, Liberal, Orléans, ON]

Mr. Speaker, I rise on a point of order. Should you consult with the other parties, I believe you will find unanimous consent that notwithstanding any standing or special order or usual practice of the House, when orders of the day are called later this day, a minister of the Crown be authorized to move without notice a motion relating to Senate amendments to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, medical assistance in dying.

[The Speaker, Liberal, Geoff Regan]

I have the honour to inform the House that a message has been received from the Senate informing this House that the Senate has passed Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), with amendments to which the concurrence of this House is desired. Copies of the amendments are available at the table.

Opposition Motion—Internal trade

[Randy Hoback, Conservative, Prince Albert, SK]

Mr. Speaker, I would like to thank all my colleagues for this important debate. I would like to acknowledge my colleague from British Columbia for the work he has done on freeing wine across Canada. I understand now his campaign to free beer is also very popular among Canadians. It is something we should continue moving forward on as we start to liberate the Canadian economy from provincial trade barriers.

I want to talk about bales. No, this is not a Liberal speech that is irrelevant to the topic. This is actually a very relevant example of what happens with interprovincial trade barriers and regulations.

Mr. Speaker, I will be sharing my time with the member for Barrie—Innisfil. He has a very important topic he wants to talk about also.

One might ask what hay bales have to do with interprovincial trade barriers. Actually, this is a very real story. In August 2003, we had a horrible frost on my farm. It took out my crop. It cost me and many of my neighbours in the area of millions of dollars. For myself alone, it cost me about a quarter of a million dollars in one night.

When a farmer has an established crop and that happens, he looks at what he can do to salvage that income. We worked with our local agriculture officials and they realized that canola, for example, made great horse feed. We did everything right and we baled that crop. We salvaged it. Then we went on the Internet, Western Producer, and places like that and we sold that crop. We sold it into Alberta. It worked out great. The horse guys in Alberta were happy. We were happy. Everything was happy-go-lucky. We got everything baled and ready to ship the crop into Alberta. The trucks hit the border, and who would have known that the regulations for a trailer in Alberta when hauling hay are different? It required a different coloured sign and different symbols on the wide load signs, and different permits.

For farmers, they look at this and ask “What are you talking about? If it's safe to haul in Saskatchewan why can't it be safe to haul in Alberta, or be funded?” A neighbour gets a fine, then another neighbour gets a fine. All of a sudden the guys from Alberta are saying it is not worth the hassle to buy the hay from Saskatchewan, even though they really need it because of the drought. However, because of the interprovincial trade barriers, the regulations that were put in place, it made that move impossible to happen.

That is just one example of how a barrier like this really restricts the flow of goods across our country. It is a very real example of what costs people thousands and thousands of dollars for no reason at all. The roads were not made any safer by having different regulations. They were not improved. There was no issue other than the fact that Alberta wanted to do it one way, and Saskatchewan's NDP government at the time wanted to do it another way.

It went the other way also, when we had stuff coming back from Alberta to Saskatchewan, we had to get a permit. The Saskatchewan NDP government at the time said it did not want to get rid of the permits because they were a good cash cow. We have to remember that back at that time all our kids were moving to Alberta, so the NDP was looking for any type of taxation it could get. This was one way to do it.

When we look at that we realize that is a direct impact on what can happen when we have improper trade regulations.

I sit on the trade committee. I was actually the former chair of the trade committee. I always find it really interesting when we bring in different producers from around Canada to talk about trade. They say we need trade, that it is very important. When we ask about internal trade they say it is actually easier for them to sell their stuff in Washington than to take it out of B.C. and sell it in Alberta.

We have to scratch our heads and ask if this make sense. What is the logic behind that? What are we really trying to accomplish as a country, as a confederation, when it is easier to export our goods than to sell them next door in our own country? Those things need to be eliminated. The Comeau case really provides the government with a unique opportunity to be involved in helping eliminate barriers.

We have heard speeches here in the House today talking about how this case is probably going to go to the Supreme Court and be ruled upon by the Supreme Court. The provinces should be very worried about that. They should be so worried they might want to negotiate something beforehand to put some stability in place, so that it is done in such a way that the barriers are actually removed.

The federal government has a chance to show tremendous leadership on this file if it so chooses. Keep in mind, I am also on the trade committee that has been consulting and delaying TPP passage. Let us face it, the Liberals are going to let Hillary Clinton and Donald Trump actually write our foreign trade policy. If the Liberals would not write their own foreign trade policy, why would they write their policy here in Canada? They will just vacate that to provinces and accept whatever comes out of it. That way they are not responsible. Why show leadership? They are not used to doing that.

Another example of silliness in this market, I think, is that all of us here in Ottawa sneak across to Quebec and go to Costco. I can buy beef there, bread, wine, and beer. I can buy beer, but I better not bring it back to Ontario where I live because then I would be breaking the law. I would be like Al Capone. However, that beer in Quebec is the exact same beer that is in Ontario. It is just as safe, brewed probably in the same factory, but yet for some reason we have a barrier to prevent that from happening. It does not make sense. Canadians cannot figure that one out. The reality is, they are just ignoring it and doing it anyway.

A colleague from the NDP just stated the exact same thing. We have already seen wine shipments going across Canada, breaking these barriers as we speak. In reality, Canadians are already doing what the market should be allowed to do, and that is trade interprovincially, free.

We look at legislation, and the Liberals say we should not use litigation to solve this; we should actually negotiate and wait until negotiations move forward. Like I said previously, we could use this court case to enhance our argument in that process if we want to go through a consulting process, but litigation is a valid form for settling this. When we are breaking somebody's constitutional right, that is what the courts are there to do, whether we like it or not.

We have a perfect example of where that has happened here, right in front of us in the Senate today. Bill C-14 is because of litigation. It is because the court did not like the way the law was written. I do not agree with the court. I do not necessarily like it, but litigation was the process that was used that sent it back to this House to rewrite the law. It is valid. In fact, the government is doing it through C-14 as we speak. To say that we should not do it that way just does not make sense. It is hypocritical. It is already happening.

The reality is, the courts are there to actually protect the rights of Canadians, so in this scenario, Canadians feel that they should be able to trade freely among the provinces. I should be able to go to B.C. and sell some stuff, and the member from Kelowna should be able to come back to Prince Albert and sell his goods. As long as they meet the safety requirements, as long as they are safe, where is the issue? Why do we have these barriers?

If we looked at them more closely, I think we would see there is a good reason to get rid of them, and I will give credit to the western provinces. They actually showed some leadership on this. The New West Partnership, Premier Wall, showed lots of leadership in trying to identify what these barriers are and remove them.

Labour mobility, getting rid of the situation that we had with trucks hauling hay across the border. These things need to be eliminated, and I want to congratulate the provinces that have taken this seriously because it just happens that those are the provinces that are doing very well in this confederation. Saskatchewan has a growing, booming economy, regardless of what is happening in the oil and gas sector, what is happening everywhere else. It is still holding its own.

If we want to do economic stimulus, if we want to boost this economy without spending a dime, let us deal with these. This is one thing the Liberals could do and it would not cost them a dime, but the impact across this country would be spread and felt immediately.

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

Mr. Speaker, I am pleased to rise today to speak to the motion moved by my colleague, the member for Central Okanagan—Similkameen—Nicola. This motion has been affectionately dubbed “free the beer”.

As a new member of Parliament, I must say that it is truly motivating to listen to an experienced parliamentarian like the member for Abbotsford.

This member just shared his vast experience as a minister in the previous government. His words were very inspiring, as was his belief in the importance of eliminating trade barriers.

He is an inspiration to us, and he should also serve as an inspiration to the new government, which should be taking advantage of the experience this member gained by negotiating numerous free trade agreements with other countries. These negotiations were successfully carried out by our colleague from Abbotsford, and I applaud him for that. By way of tribute, I would say:

He was fast and efficient.

I will admit that using beer as the foundation of a motion on the liberalization of internal trade is a little unexpected.

However, for the benefit of those who have been tuning in since the start of the day and who have heard about the Comeau case, but who do not really know what we are talking about right now in the House, I would like to recap because I think it can be useful to look at why the motion came to be and explain how we got to where we are.

This is about a citizen of New Brunswick, Gérard Comeau, and his fight for justice, which highlighted how difficult it is for Canadians to trade freely within our country's borders. Mr. Comeau singlehandedly broke down the barriers to internal trade.

I found a good summary of Mr. Comeau's story in an editorial. The title of the publication made me smile: it is called “Bières et plaisirs”, or “Beer and other pleasures”.

Even so, it is a very serious editorial. It recounts Mr. Comeau's story, which I will now share with the House of Commons and all of the Canadians who are tuned in.

Gérard Comeau was arrested in October 2012 in possession of 14 cases of beer and three bottles of liquor. He had just done some shopping on the Quebec side of the border. In October 2012, Gérard Comeau committed an illegal act: purchasing a quantity of alcohol over the authorized limit in another province, not in a licensed establishment.

According to the Government of New Brunswick and other Canadian governments, alcohol is under provincial jurisdiction.

Here is more from the editorial in “Bières et plaisirs”:

All residents of New Brunswick buy their alcohol in provincially owned licensed establishments: outlets of the New Brunswick Liquor Corporation, also known as the liquor commission.

That is the law as enacted in 1928, a year after the commission was created. Laws governing the sale of alcohol were enacted around that time across Canada. The goal was to protect each province's market....Many New Brunswickers prefer to buy their alcohol in Quebec, where prices are much lower. The Province of New Brunswick sometimes applies high mark-ups to wine, beer, and spirits sold in its stores.

The article goes on to say:

After receiving a guilty verdict, Gérard Comeau decided to take his case to the New Brunswick provincial court. His argument was simple: the Fathers of Confederation passed a law that stipulates that the provinces of Canada must allow interprovincial free trade, a law that was written long before all of Canada's post-prohibition laws, and one that remains in effect all across Canada....The court found in favour of Gérard Comeau. The judge ruled that the provincial law was unconstitutional. Gérard Comeau was found not guilty.

Our motion today is very clear. It recognizes one of the key elements of the vision of Canada's founding fathers:

That the House: (a) recognize that it is a constitutional right for Canadians to trade with Canadians; (b) re-affirm that the Fathers of Confederation expressed this constitutional right in Section 121 of the Constitution Act, 1867 which reads: “All Articles of the Growth, Produce, or Manufacture of any one of the Provinces shall, from and after the Union, be admitted free into each of the other Provinces”...

The wording is very clear.

I think that the article in Bières et plaisirs is a good summary of the Comeau case, but also many other cases involving countless Canadians who travel across our country and would like to take advantage of a free market here at home. It took a New Brunswick man standing up for his rights to remind us, the elected representatives of this great country, that we have an important role to play to preserve the spirit of our Constitution.

We are talking about beer here, but the Fathers of Confederation were clear:

121. All Articles of the Growth, Produce, or Manufacture of any one of the Provinces shall, from and after the Union, be admitted free into each of the other Provinces.

It is simple. I am sure that most Canadians did not even know that some provinces put up so many barriers that hinder interprovincial trade. I can understand them, because we form a single great country made up of extremely dynamic provinces and territories. We all want to improve the economy of our regions, and it is rather amazing to realize here that Canadians do not always have the right to do business with one another as they would like.

The Minister of Innovation, Science and Economic Development said this morning in the House that he prefers that any disputes be settled by negotiations between the provinces. Despite years of negotiations, it seems that the agreement the minister would like to negotiate is not possible. On this side of the House, we believe that this government does not have the leadership required to arrive at such an agreement. It is all well and good to say that the government wants to promote trade and reach an agreement with the provinces. However, at the first opportunity this government does the opposite.

Take the example of Bill C-10, which was supposed to meet Quebec's and Manitoba's expectations. By invoking closure, the government rammed through a bill that forces the legal action against Air Canada to be dropped. Lo and behold, two provinces asked us not to act too quickly because they cannot conclude their agreement as negotiated if the threat of court action, which is on their side, disappears. The government ignored the provinces' requests.

Another example is Bill C-14. The Quebec Minister of Health said that Bill C-14 was inadequate. Even so, the Liberals went ahead and imposed a gag order so that parliamentarians could not express their views.

That does not bode well for the federal-provincial negotiations under this government. Since it took office, the Liberal government has shown leadership and interest in only two things: running an ever-growing deficit and increasing the tax burden on small businesses. The Liberals have done a good job on those things.

Today, the Liberal government has a unique opportunity to do something tangible to help small businesses and, once again, it is turning its back on them by relying on a negotiation process with an unknown timeline. We are skeptical about the results of that. The second part of my colleague's motion is clear. It states:

[That the House:] (c) recognize that the recent Comeau decision in New Brunswick creates a unique opportunity to seek constitutional clarity on Section 121 from the Supreme Court of Canada; and that therefore, the House call on the government to refer the Comeau decision and its evidence to the Supreme Court for constitutional clarification of Section 121.

That would finally make it possible to set clear guidelines for trade between the provinces.

Creating more free trade in Canada is not a partisan issue. The issue here is what is fair. Canadian businesses do not want their government to tell them with whom they can and cannot do business. Businesses should be able to sell their products across Canada, and consumers should have more choices on the market.

In my member's statement today, I spoke about young entrepreneurs in Quebec. Three thousand young entrepreneurs in Quebec will make deals and work hard to sell their products and share their passions. Three thousand of them will open their own small business. Imagine telling them that they cannot do business with their neighbour because they are not on the same street. They are in the same city, same province, and even same country. These are the kinds of barriers we want to eliminate. We want to eliminate them to enable small and medium-sized businesses to do business, create wealth, and drive our economy.

I will wrap up quickly and say that this was the will of the Fathers of Confederation. The government has a unique opportunity to take action. I hope it will seize this opportunity to do away with empty rhetoric and to finally take real action for small businesses in Canada. For all these reasons, I urge the government to join me in supporting this motion to free the beer.

Physician-Assisted Dying

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Mr. Speaker, I completely reject the premise of the questions that have been proposed. All of the discussions and the considerations by the Court of Appeal in Alberta and others were considering personal exemptions with respect to medical assistance in dying. They were not considering Bill C-14.

The Supreme Court of Canada rendered its decision in Carter. We are complying with the Carter decision in doing our jobs and putting in place a complex framework for medical assistance in dying in this country. The question is whether this bill is constitutional, and I submit that it is.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, the Minister of Justice insisted Bill C-14 complied with the Carter decision, but courts in Alberta and Ontario disagree. She argued the bill was constitutional, but then Canada's leading expert on constitutional law said that was not so. Now the minister is changing her tune again, saying the bill does not have to comply with the Supreme Court of Canada ruling, forgetting, it seems, that the case was based on section 7 of the Charter of Rights and Freedoms.

Why is the minister trying to ram through a law that, according to the Supreme Court of Canada decision, would take away Canadians' charter rights?

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Mr. Speaker, I was pleased to release an addendum to the explanatory paper that we released previously with respect to Bill C-14, to provide additional information to parliamentarians who are considering this important piece of legislation. In considering very carefully the Carter decision, Bill C-14 would comply with the Carter decision. The Carter decision stated that a complete prohibition on medical assistance in dying is unconstitutional, and the court left it up to Parliament to put in place medical assistance in dying in this country. That is exactly what we would do in this legislation.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Mr. Speaker, the government is clearly all over the map with its bill on medical assistance in dying.

After assuring us that Bill C-14 complied with the Supreme Court's decision, the Minister of Justice is now telling us that her bill does not need to comply with the decision and that it only needs to comply with the charter. However, the Supreme Court based its decision on the charter.

Why this new take? Did the government finally realize that its bill does not comply with Carter or with the charter?

[Scott Reid, Conservative, Lanark—Frontenac—Kingston, ON]

I want to talk to you about why I think this motion is important and why I think the members of the committee should support it.

Let me start by going back to what the Speaker indicated in his ruling that there was a prima facie case of privilege. When he made his ruling in April he was responding to a matter of privilege that had been raised on April 14 in response to the leak of the story on April 12 to Laura Stone at The Globe and Mail. The Speaker made a point of indicating that the issue of “provenance”—that's the term he used—meaning where the leak came from, finding the source of the leak, ought to be the focus of our investigation, not what we are now focusing upon.

About halfway through his remarks he said, dealing with an earlier case, that “no doubt existed as to the provenance of the leak”, referring to a previous leak that had occurred back in 2010. He's emphasizing that the source of the leak is of key importance. Looking back at previous Speakers' rulings, I find that in dealing with a similar situation back in 2001, Speaker Milliken also emphasized the importance of seeking out the provenance, the source, of the leak. Once again, this was at that time a piece of legislation, Bill C-36, the anti-terrorism act.

Mr. Chair, you were in the House when that arose, as I was.

It was a matter of equal importance from the point of view of Canadians at that time to the stature that Bill C-14 has in the public consciousness today. Some of the content was leaked. The member for Winnipeg—Transcona, at that time it would have been Bill Blaikie, argued that the Speaker ought to investigate.

The Speaker, while he appreciated this input, corrected Mr. Blaikie in the following words:

The hon. member for Winnipeg—Transcona in his remarks tried to assist the Chair by suggesting that it was for the Chair to investigate the matter and come up with the name of the culprit and so on. I respect his opinion of course in all matters, but in this matter I think his view is perhaps wrong. There is a body that is well equipped to commit acts of inquisition, and that is the Standing Committee on Procedure and House Affairs.... Accordingly, in my view this is a matter which ought to be sent to the committee.

Of course, he then went on to rule that a prima facie case of privilege having been found, the matter should be further investigated by the procedure and House affairs committee, by this committee.

The point to be emphasized is there is a body that is ideally suited—I wish he had not used the phrase “commit active inquisition” because, clearly, our goal is not to be the Spanish Inquisition—to inquire, to engage in matters that require further inquiry.

We are the body that does inquiries. Doing inquiries for the purpose of discovering the source of leaks is what we do when leaks of legislation have occurred. To further emphasize how important this was, I am once again turning back to Bill C-36. I wonder if I could also draw the attention of members of this committee to the words spoken by Don Boudria, who at the time was the Liberal House leader. To be clear, the Liberals were in government, he was the House leader, legislation of his government had been leaked out.

He made the following comment prior to the Speaker making his ruling. He said, with respect to Bill C-36, that:

On Saturday I saw extracts from the bill in the media. They were not all factually correct but enough of them were that it caused me to be as concerned as the hon. member

—he's referring to some other member who'd raised the matter—

when raising this question in the House. I cannot say much more other than to apologize on behalf of whoever is guilty of this. I use the word guilty because that is what comes to mind, given the respect that I have for this institution. Anyone who breaches that respect is guilty of an offence in my book. The problem is that we do not know who it is.

So here we have the government House leader, who has just seen a leak occur on his watch, making it very clear that he thinks it's appropriate to determine the identity of the individual.

That's the first point to be made. It is our job to find the individual. It is our job to find the individual because the privileges of the House have been breached. It is not part of that investigation to try to predetermine whether or not the leak was deliberate or unintentional. I have my own views on that subject. I've shared them with the committee in the past. This looks far too much like the kind of information that I would have included in a deliberate leak had I been in the business of deliberately leaking information. That is to say, it very neatly shaped the story that came out of the media. The focus was on the bill not going far enough as opposed to the bill going too far. That is the kind of thing one does when one is trying to engage in leaking for the purpose of redirecting conversation and shaping public discourse.

That being said, that does not, as yet, point us in any particular direction. We do know, based on the testimony we heard from one witness, the Minister of Justice, that she has firmly and absolutely.... In response to my question, when I simply asked her, “Are you the source of the leak?”, she said no. We take her at her word. I take her at her word; I thought the rest of her testimony actually indicated very clearly.... I should be careful what I say here; it indicated to me, in a way that satisfied me, in my subjective judgment.... That's a bit different from being clear, but it was subjectively satisfying to me that she was not the source of the leak.

Indeed, I think her willingness to appear here, at a time when she really is arguably the busiest person in Canada, indicated to me that she was anxious to clear her name and make a point—i.e., that whoever else is the source of this, I am not, and I don't have information as to who is; that is to say, it was not leaked by somebody else with my sign-off, active or passive.

I accept that, but that doesn't mean that the acceptance, active or passive, of other individuals was not involved. Indeed, that is the likeliest scenario. I think when we see a reluctance to allow anybody else to come forward, or indeed to explore which individuals might be responsible, be they officials or be they elected people, it indicates a desire to prevent the truth from being found.

Why would that be, Mr. Chair? Most obviously—indeed, it's the only plausible explanation I can have—it was a deliberate leak. Moreover, a search for the truth revealed that it was not a leak that can be pinned on some low-level individual. No low-level individual can be thrown under the bus and thereby end the story. When we can't find some enlisted soldier to use as a sacrificial lamb when one of the generals is implicated, we start stonewalling. That's what this looks like to me.

Now, I want to come back to a point that Mr. Chan had been making. Mr. Chan said that, well, the text of the bill was not actually leaked, that what we had instead was negative information, information about what wasn't in the bill. Therefore, previous rulings where we talk about the text ought not to be treated as being as important.

Just to be clear about this, I'm returning now to a ruling that Speaker Milliken gave on October 4, 2010. If one turns to page 4711 of the House of Commons Debates—I know we all have our copies with us right now—you'll be able to read Speaker Milliken having said: “It is indisputable that it is a well-established practice and accepted convention that this House has the right of first access to the text of bills that it will consider”.

I think Mr. Chan is arguing that this convention should be understood very narrowly. As long as I don't use the words in the text when I'm making my leak, if I am, say, a minister of the crown or a communications person for one of the ministers of the crown, then no real breach has occurred because under this narrow and technical construction, the actual text is still seen first in the House. If I use words that are somewhat different or if I don't have them in the correct order, as they were in the bill, then I haven't leaked the text of the bill.

This narrow and technical construction, Mr. Chairman, of course is incorrect. The law can sometimes be interpreted narrowly and technically. That is not the interpretive doctrine that the Supreme Court currently, typically, uses, either for constitutional or ordinary textual interpretation, but it has been a respectable doctrine of interpretation in the past, in certain situations where the overbroad reading of the statute could result in an act of injustice.

I'm going to loop back here for a second, so you can see the point of the distinction I'm driving at. In one famous case from the 18th century that is cited in Blackstone, Parliament passed a law indicating that the death penalty was to be applied for any rustling or theft of cattle.

In the language of the 18th century—the English language evolved, of course, as did the French language and other languages—the word “cattle” sometimes was taken in the sense that we would use it today to mean cows, bovines, but “cattle” was also meant sometimes as a term for all livestock. Faced with the situation of an individual who had stolen or poached some other animal—I think sheep, but I'm not sure—the court chose to give a narrow and technical construction to the word “cattle” and said it interpreted the word “cattle” as narrowly as it could, to mean only cows. This was a sheep. This individual would not hang.

I'm not sure what happened to that individual. They probably got transported to Australia or something lesser, but nonetheless it was perhaps not desirable.

Then Parliament passed a new law saying in this act, the word “cattle” meant all livestock, thereby making it clear that they wanted people who poached anything to be hanged.

That general practice of using narrow and technical construction for criminal law, although it has been eroded to some degree in recent decades, remains a way of dealing with situations where the law could wind up causing acts of injustice were it interpreted by using the opposite practice, which is known sometimes as “large and liberal” construction—“construction” means “interpretation”, by the way. The term the Supreme Court likes to use, “purposive” construction, that is to say we interpret this, whatever the words are, to bring fulfillment to the action that was intended.

That's the law. We're dealing here with a convention or practice. There is no such thing as a narrow construction of a convention or practice. It's all about intention. There is no looking at the letter of a convention and ignoring its spirit. It is all spirit. And interpreting the spirit of the law, or a practice or convention, inevitably means giving it a broad construction.

This gets expressed in a number of ways in House of Commons debates, particularly in rulings of the Speaker. The Speaker points out, for example, that you cannot do by the back door that which you cannot do by the front door. In the same way, if I want to address a question to the Prime Minister, I have to refer to him as “the Prime Minister”, not as “Prime Minister Trudeau” or “Mr. Trudeau”. I can call him “my honourable colleague”, “the right honourable gentleman”, and so on, as long as I don't use his name. That's the direct rule. But I can't get around it. I can't enter through the back door by saying, “Today's Globe and Mail says that Prime Minister Trudeau...”, saying that I'm quoting somebody else, so it's not me; it's them. I've tried to come through the back door when the front door was shut. I have tried to find a way of interpreting a practice narrowly, when it ought to be interpreted broadly.

All right. So now you can see the point I'm getting at. We have a practice, a convention, relating to the text not being leaked. It is a well-established practice. It applies to words that don't actually contain chunks of the text, but that have the same effect. I wanted to make that point very clearly, but I would actually go further. In regard to this talk of negative versus positive information coming out, unless the entire text of the relevant sections of Bill C-14 had been released to Laura Stone, it would have been impossible to summarize that which was being left out of the legislation, if you follow. This is all about, “Here's what the government won't be doing. Here's why people who feel very strongly that the legislation should go further ought to be upset. Here's why people who feel the legislation ought not go as far as the parliamentary committee had recommended ought to feel that the government is responding to their concerns”, which after all, is the entire communications exercise of the leak.

That can only be accomplished by indicating that which was absent from the bill. As I pointed out to the minister when she was here—and she made the same point about only negative information being contained—that actually was a greater disclosure of information. I can know only part of the government's plans and leak that positive information about what's in the bill. I could be someone who was only privy to one part of the legislation. But in order to say this or that is actually absent from the bill, I must be familiar with the entire bill, the whole of the bill.

I would make the suggestion to you that only relatively senior individuals in the government, be they people who are actually elected officials or people who serve those officials in a staff capacity, would have had access to all of this information. We haven't ascertained who those people are. It is not an infinite list. It is a finite list. It is a list the government could provide us with if we passed this motion. This is information the government would have to provide us with. And that, I suspect, is the real reason—although one should never attribute motives in this business—that the Liberal members of this committee have been instructed to try to ensure that this motion does not pass. Their goal is, of course, to make sure that the “guilty” parties—to use the term that Don Boudria, Liberal House leader, used 15 years ago—are not found.

That, of course, leaves them at liberty to do the same darned thing all over again. If the approach is going to be that when these matters come before this committee, this committee then kills them quietly, then this committee effectively ensures that contempt of Parliament can happen, and those who engage in that contempt get away scot-free.

Once that pattern has been established, once it is clear that there is no punishment for acting in contempt of Parliament in this particular manner, then they can do it all over again the next time it serves their communications goals to act in contempt of Parliament and release information in this manner or in some similar manner. That's a very worrying thing.

Mr. Chair, I now want to turn to the question of whether this was a deliberate versus an accidental leak. As you know, I've already editorialized to some degree on this. I thought I would explore in a bit more detail why this is important, and the point I'm about to make emphasizes the importance of passing this motion.

I've pointed out that the very fact that the Liberals would like to shut this down suggests that it's someone higher up. It also suggests deliberate intent. After all, if it was an accident, we would be able to determine what the accident was and we could ensure that hole was plugged. Someone could say, “Mea culpa, I'm upset”.

They might say something similar to what Don Boudria said. Let me go back and give you a bit more of what Don Boudria said in 2001, because it is striking. He admits that he is not in complete control of what's going on and is frustrated by that fact. So on October 15, 2001 Don Boudria said, and I quote:

Last Friday afternoon I received a copy of Bill C-36. As is my role as Leader of the Government in the House of Commons, I do what is known as a review of the bill. I took precautions then and earlier with the minister and all of her staff to ensure that the bill was not in any way given to the media or otherwise. I was given that assurance by everyone I spoke to.

This is the part I quoted from before, but I want you to go back and look at what was said by the House leader at the time explaining how it works.

Is his role as leader of the government in the House of Commons, he does what is known as a review of the bill. At some point before it is released to the House of Commons, not way in advance, he gets to see a copy of the bill and, as is the case with Bill C-14, you're dealing with a piece of legislation that is both high profile and also urgent. It has been pulled together in a hurry.

He sees it a few days before it is released. Part of his job, which he stresses, is to make sure that nothing has been given to the media by the minister or any of her staff. The minister he's referring to is the then Minister of Justice, Anne McLellan, and, of course, her staff, and he was given assurances. The House leader was then and is now in possession of the assurances of individuals that they did not leak it. Unless, of course, somebody said they did leak it.

There are several possibilities here. Either, one, the House leader Dominic LeBlanc was given assurances from everybody that no leak had occurred, and one of them lied to him; or two, he was informed by one of them, but the others wouldn't have known that in fact a leak was going to happen or had already happened—it was in the works, and so he was part of it—or three, he and his office were themselves a part of the strategy to leak the information.

I don't know which of those three scenarios is correct. I do accept vis-à-vis the Minister of Justice and her officials, unless they are working behind her back, which I suspect is not the case, that they are not the source of things. But someone is the source of things because the leak exists; the leak was there in The Globe and Mail on April 12. It was a deliberate leak, unless some kind of scenario exists that I'm having trouble imagining, and the House leader is very likely to have known about it.

The House leader should be before this committee to clarify that and, just as we did with the Minister of Justice, we would take him at his word if he says he knew nothing. We would not say, “Minister, you're lying”. We all understand that, if he were lying, that would be itself a contempt of Parliament, and the kind of contempt of Parliament that ends a career if it's ever demonstrated to be the case.

The justice minister's awareness of the severity of deliberately and overtly lying to a committee of Parliament is one of the reasons I take comfort in her words. I take very seriously her words, because she is, as we all can see, a very intelligent person who is not going to do something that stupidly self-destructive.

He should be here. He will be on the distribution list, for sure. He should be here testifying before this committee. He could go further, I believe, than any other person in bringing clarity to where and when this deliberate leak was planned, who was involved in it, and what their strategy was. I guarantee that sunlight—and they say that sunlight is the best disinfectant—will bring an end to future leaks of this sort because no one will want to go through that again. That is the reason we want to have him and other people on the list here, or at any rate to know who they are so we can figure which of those individuals should come here.

Let me make one last point about the desire of the Liberal committee members, or the Liberal whip, to vote down this motion which is critical to actually determining the provenance of this leak. As we've found with the recent matter of privilege on the Prime Minister's physical contact with the member for Berthier-Maskinongé, the committee is in a position to make a ruling and to report back to the House on contempt of Parliament, whether we believe it happened or not, and, if so, how—that is, the details—and perhaps recommendations as to how to ensure that this sort of thing doesn't happen again.

We also have the ability to just say that no report is necessary. This was actually new information to me as of that meeting, and the record of my interaction with Mr. Christopherson in which I tried to determine what course of action we should have, and of my interaction with the clerk in which I tried to find out the rules in this matter, are a matter of public record.

The option of determining that there's nothing here to see not merely ends the possibility of reporting back to the House, but the possibility of dissenting opinions. It ends any investigation. As such, I would make the suggestion that it has the practical effect of giving licence, of saying to the government, “You got away with it. There was an insignificant little hearing, which produced no result and then got shut down through the simple act of the government exercising its majority to reject any new motions to bring forward witnesses.” That's all the punishment there is, so they may be able to get away with this.

I mean, the idea that a convention or practice is permanent and that it can never be eroded is incorrect. Normally the idea that conventions, whether constitutional conventions—and that's my area of specialization—usages, practices that exist in the House, are permanent and lock themselves in is actually not guaranteed. Normally, they do. Normally a convention or practice is an act of self-restraint that is not actually written down in the rules but is accepted as a norm of behaviour and is sanctioned by the overriding body, demonstrating its disapprobation. Normally these things become stricter and stronger with time. If you look at our day compared with 50 years ago, 50 years ago compared with a century ago, and a century ago compared with two centuries ago, you'll find that the conventions are becoming, on the whole, stronger.

These conventions impose restraints upon all of us to abide by the norms of civilized behaviour—or the norms of “respectful” behaviour perhaps is the right term to use—that cause us to restrain ourselves in ways that are not written down in the rules. Those norms become stronger with time, on the whole, but they can go in reverse. One of the roles of this committee ought to be to try and ensure they do not go in reverse and that we do not find ourselves chipping away at, or eroding, a convention, so that something that was not considered respectful behaviour or acceptable behaviour in the past comes to be tolerated in the present.

I would submit that if we're looking on the grand scale of things, then this erosion of self-restraint is one of the things we see happening, for example, in wartime. They always say “truth is the first victim in any war”. The need to shut down openness for strategic reasons becomes one of the victims of war even in the best and most civilized countries, and even when we are fighting for the most just of causes, as we were in the Second World War. In the midst of that war we did things that we are not proud of and that we now recognize were wrong. While I do not make an analogy here, the purpose of the analogy is simply to point out how conventions can erode. I do note that the way in which we acted toward one subgroup in our population at that time was unacceptable.

One could point to other conventions, perhaps at a more benign level, but let me make a clear example here of a constitutional convention in the United States. It was initiated by George Washington, and it developed over the decades, that no president ought to serve more than two terms in office. That was the convention that was respected by every president up to Franklin Roosevelt, who in 1940 ran for a third term because there was a crisis in the nation with an impending war. The United States was still not out of the Great Depression. Nobody thinks that Franklin Roosevelt was not a great man, but after he passed away, a decision was made and concurred with by two-thirds of the members of each of the two houses of Congress, as well as by the legislatures of three-fourths of the states, that in the future no person should be able to serve as president for more than two terms, and that was put into their Constitution.

There was a minor exception made for someone who had served less than half of a previous term of a previous president. Such an individual could serve two terms plus that half term, and Lyndon Johnson considered taking advantage of that in 1968 before announcing that he would not be contesting the 1968 presidential election.

The point I'm making is that conventions can be rolled back, and that what is true with a constitutional convention is also true with a parliamentary practice.

I think what we are seeing here is an attempt on the part of the government to roll back a practice and to say that a practice that has always been understood and interpreted robustly ought to be—“ought” is the wrong term, because it implies they think this is of value—or they can get away with, if they do the right things, restricting or narrowing a practice that is respectful of the House. They can say, “As long as it's not the text, it's okay, we can get away with it”, or that, “If we get caught, then we'll just take this to committee, and we'll kill it quietly.”

We have been given the task of looking for the “guilty” party, in Don Boudria's words, and seeking out the provenance, in Speaker Milliken and Speaker Regan's words, of the leak. Their words, the Liberal's words and Mr. Chan's words, are that this isn't necessary. The Speaker says it's necessary, or recommends it to us, but they say it's not necessary. Past practice has been to take this very seriously, but meh, they say it's not necessary because of a technical argument that there was no revelation of the actual text, even though, clearly, the leak is of a greater scope than if the text had actually been leaked.

Maybe they're right. Maybe they can get away with this. That's how it happens. People drop their guard, either because they feel it's an emergency, for example, in a time of war, or as with the Anti-terrorism Act, in a time of national crisis.

Returning to that bill, Mr. Chair, I voted against that bill. I voted against it because I held a constituency referendum, similar to the one I held on Bill C-14, and the majority of my constituents said to vote against it. They told me to vote against it because it lacked a sunset clause.

We said in a time of crisis that we were willing to suspend some of our traditional civil liberties in the pursuit of terrorists, in the pursuit of those who are willing to do the kind of horrible thing that was done on September 11 and that, in another way, with another weapon, was done just last weekend in Orlando and has been done a thousand different times, a thousand different ways, in the intervening decade and a half. My goodness, those of us who lived through September 11 and those who are living through all of the subsequent horrors visited upon us—whether in London with the subway bombings, or in Paris with the nightclub attack, or in Orlando with this recent outrage against humanity, or any of the others that have slipped my mind because there are so many—can be sympathetic to that goal of saying that we have bigger fish to fry and we can set aside some of these safeguards we have put in place.

But even then, in rural, conservative, law-and-order Lanark County, a majority of people thought it was too much of a price to pay. So they instructed me to vote against that.

I voted not only against the government but also against my party. Four of us from the old Canadian Alliance broke party ranks and voted against it, along with the NDP caucus who also voted against it. I thought that was important.

There is no similar crisis driving this particular breach of the practices of the House. Don't misunderstand me. There actually was a looming deadline—now passed—on June 6, that if we did not have a new piece of legislation in place, the relevant provisions of the Criminal Code would cease to be in force and effect, and so there was an urgent deadline in that sense.

The urgent deadline having passed, we are not actually faced with the prospect of physicians euthanizing people in the streets, which some fearmongers seemed to be afraid was going to happen. But that wasn't what this leak was about. This leak wasn't about somehow assisting the government to deal with that impending crisis, real or artificial.

This was about trying to shape the debate. This was about manipulating public opinion. This was about manipulating the thoughts in peoples' heads. This was about misdirection. This was about the abuse of public discourse. This was about someone saying that he or she has a whole package of information and is going to selectively put out part of that information, going to put it out in a way so that nobody can confirm the truth or accuracy of it, going to put it out in a newspaper with national reach, going to put out this leak in a way that will get picked up by all media, going to shape this debate.

This is not information. This is misinformation. Although virtually every word in this is true, this is about misinformation.

It is striking to me, Mr. Chair, and it should be striking to any objective observer, that one of the minister's defences—and this should not be taken as being terribly serious—was that, after all, part of the leak is inaccurate. It's not correct, so that's okay as a defence. Now, I think you know my response to that. My response to that is that it would almost certainly have been a verbal leak. Laura Stone would have received an email or a phone call saying let's get together. I assume they either met somewhere or had a conversation over the phone with Laura Stone then taking notes, but she was not left with a copy of the legislation, and nobody wrote down or took dictation.

The likeliest explanation is that Laura Stone...and I could be wrong, because maybe she was and is an expert on the details of the ins and outs of assisted suicide, but even if she were, she very likely just made a slight wording error. But a minor correction to the wording makes this correct in every detail.

That is what happened, and it is most regrettable that we are being told that this is not important, that this is something we should just drop. Also, to be clear, this is something we can expect to recur in the future.

Turning now to the great poet, T.S. Elliot, do you remember he talks about how freedom dies when civilization dies, not with a bang, but with a whimper? It's a thousand little whimpers, our failing to respond vigorously. Our failing to try to keep committee meetings going when we're faced with the stone wall we see across the way here, that would be one of the whimpers. That is the reason, Mr. Chair, that we are attempting to exercise the only weapon we have on this side of the aisle, which is public opinion to try to draw attention by dragging out this debate to the fact that debate is about to be shut down; to the fact that open inquiry is about to be shut down; to the fact that silence is about to reign on how one deals with contempt of Parliament.

No one doubts that a contempt of Parliament took place. The question now is whether it's worthwhile taking the valuable time of this committee, or whatever the argument is, to look at this contempt. Matters of privilege are in fact the primary matter this committee looks at. Sometimes they're of a technical nature, sometimes they are not, but they're the primary matter and they take priority. That is a practice long established with us and written into our rules. It is done because we understand that the erosion of these privileges, a little bit at a time, and sometimes by someone who has a very high rating in the public opinion polls at that moment, nevertheless results in the stripping away of those norms of respectful behaviour that are the basis on which our success as an institution is founded.

The way you will have to deal with this in the long run, if the government gets away with this, is that at some point in the future you will have to take your norm of appropriate behaviour and write it into the rules. It's a hard thing to do because once you switch something from being a norm to being the black letter of the rules, it becomes highly mechanistic—a matter that we are all aware of—and something that we're dealing with consensually in the MP code of conduct with regard to issues like gifts and so on. An attempt was made there to put something into a formalized code. The need to be punctilious in our respect for every detail of that code has created its own set of problems. But that is how you deal with it when you can no longer rely on the usages, the conventions, and the practices to provide guidance.

I didn't want to take up all the committee's time. I merely wanted to lay out the arguments. I thought it would be best to be as fulsome as possible.

Perhaps with that, Mr. Chair, I can terminate my remarks. I look forward to the contributions others may have to this discussion.

Thank you.

[Blake Richards, Conservative, Banff—Airdrie, AB]

Thank you, Mr. Chair.

As all members of the committee would know, I've brought notices of motion for a number of motions in regard to our study on the premature disclosure of the contents of Bill C-14.

For context, I'm going to read the motions I have. Then I'll be moving one of the motions, Mr. Chair.

The first of those motions would read as follows: That, in relation to its study on the question of privilege related to the matter of the premature disclosure of the contents of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) and pursuant to the Handling and Safeguarding of Classified and Protected Information and Assets guidelines, and the requirement to maintain a distribution list of all SECRET information, the Standing Committee on Procedure and House Affairs request that the Government provide a full distribution list of all persons who had access to any copies of the legislation on Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) prior to its introduction, to the Committee no later than June 21, 2016.

The other motions are as follows: That the Procedure and House Affairs Committee invite the Minister of Health to appear no later than June 21st, 2016, to answer all questions related to its study on the question of privilege related to “the matter of the premature disclosure of the contents of Bill C-14...”. The motion goes on to cite the rest of the title of the bill.

Also: That the Procedure and House Affairs committee invite the Chief of Staff to the Prime Minister to appear no later than June 21, 2016, to answer all questions related to its study on the question of privilege related to “the matter of the premature disclosure of the contents of Bill C-14...”.

Also: That the Procedure and House Affairs Committee invite the Leader of the Government in the House of Commons to appear no later than June 21, 2016, to answer all questions related to its study on the question of privilege related to “the matter of the premature disclosure of the contents of Bill C-14...”.

Finally: That the Procedure and House Affairs Committee invite the Director of Communications to the Prime Minister to appear no later than June 21, 2016, to answer all questions related to its study on the question of privilege related to “the matter of the premature disclosure of the contents of Bill C-14...”.

Now, I just wanted to make sure to read all of those into the record so there would be context to the motion that I will move, Mr. Chair, and I appreciate your indulging me on this.

I wanted to take a few moments to explain this. I think it's easier for members to understand the rationale behind all of the motions prior to moving the first one. Then we can have some discussion about that and, hopefully, proceed with our proper study of the matter to ensure that we are doing our due diligence here.

It was made quite clear when the justice minister appeared before us and mentioned numerous times that her department was certainly not the only department or agency that in fact had disclosure of the contents of the bill prior to it being tabled in the House of Commons, of course. That's not really any great surprise, but she did mention very specifically a number of times the Minister of Health and that department, and also the Prime Minister's Office. Those were two that she made quite clear.

To that, I've added also the Leader of the Government in the House of Commons, simply because obviously we're all aware that the House leaders and their offices have the direction or control in terms of what happens and comes forward in the House of Commons. Obviously, they would be consulted and would be in the loop on these things in everything that is coming forward in terms of the government's legislative agenda, so this seemed like a logical one.

I do believe that when she was appearing before us the minister also once or twice mentioned the Treasury Board president, but when we're looking at this, I feel that the Prime Minister's Office seemed to be the one that was indicated most often. Also, in all honesty, in looking at who would be most directly involved in this, obviously it would be at Health and in the Prime Minister's Office, outside of Justice, where the most involvement in this bill would have been.

Also, I think that when we're looking at dealing with the media or journalists, the most obvious place would be a communications shop, I suspect, as it would often deal with the media and be looking at communication strategies. So if there were a deliberate strategy to leak this, it would often come from those departments.

That is the reason there is no indication by me or anyone else in the official opposition that these specific individuals were the source of the leak, but certainly there are people who are answerable for those departments, and much like the Minister of Justice, it would be appropriate for them to answer for whether any kind of determination was made, any kind of investigation done, as to whether the source of the leak came from their specific ministry, department, or agency. That is the reason for choosing to call those specific witnesses.

The minister indicated a number of times that a number of individuals had access to the legislation prior to its being released. If you look at the guidelines for the handling and safeguarding of classified and protected information and assets, which would obviously include bills prior to their being released to the House of Commons—if you look under section 502 of those guidelines, a number would be indicated for each copy as one of the criteria for handling secret information. They would have to show the copy number on the face of each copy and maintain a distribution list. Clearly a distribution list is maintained for these documents, and that is why we believe it is appropriate for that list to be released to this committee so the committee is aware of who else might have had access.

Obviously, our job that we've been tasked with by the House of Commons through the Speaker is to try to do our very best, to do all the due diligence that we possibly can, to ensure that we determine the source of the leak and to try to ensure that we prevent this kind of thing from happening again and take any measures necessary to do that. It is important that we do our best to determine who would have had access to these and to have the people who are answerable—for what anyone being honest would have to admit would be the most likely sources—testify, given that they would be the people who would be dealing most with the media. We would certainly call them, much as we did with the Minister of Justice. The government side agreed to have the Minister of Justice here, and the same principle would certainly apply.

I can't understand why anyone wouldn't want to have these other departments and agencies that had full access to the contents of the bill come here to defend the actions of their department or ministry and make sure they have shown an accounting for any efforts they have made to investigate and determine that there was no source of the leak. I would think that no one on the government side would want to have that cloud hang over the Prime Minister or the Prime Minister's Office, or the Minister of Health either, I'm sure, and so for us to do anything but bring someone to be accountable for the Prime Minister's Office, the Minister of Health, and their departments and their ministry offices, we all, including the government side, would want them to have the opportunity to come and ensure that they have given us all an accounting for what due diligence, what types of investigation, they have done.

If we were to do anything else, the effect would be to leave some kind of a cloud, or cast some kind of doubt over the Prime Minister or the Prime Minister's Office and the Minister of Health's office. We certainly wouldn't want to see that. No one would want to see that, and we want to ensure we do our best due diligence to ensure that doesn't happen. If there is nothing to hide of course they would be more than willing to appear, and I would certainly hope that would be the case.

Mr. Chair, we'll move these motions one at a time as that's required, but the one that needs to be moved first would be the motion to ask that the distribution lists be provided. Would you like me to read that one back? It's been read into the record. It's been provided on notice. Do I need to read it again?

Opposition Motion — Decriminalization of Marijuana Possession

[Anthony Housefather, Liberal, Mount Royal, QC]

Mr. Speaker, I will be sharing my time with my hon. colleague from Saint-Léonard—Saint-Michel.

The member is definitely the best dressed member in this chamber.

Given that this is the first time I have risen today, I want to express my condolences to the victims, their families, and their friends for the horrible murder, terrorist act, hate crime, which occurred in Orlando. We were all very touched by what happened and very disconcerted. It is hard for many of us today to concentrate on the motion when we think of the crimes that ISIS is perpetuating, and now we are talking about marijuana.

Let me be blunt. I was not one of the cool kids in high school. I never tried marijuana. To be honest, I am glad that I did not. It is not my style to smoke, drink, or to use drugs, but I also understand that it is not my right to impose my own views and my own values on all Canadians. I respect and accept the fact that our party has proposed making marijuana use legal. As part of that, we also said that we were going to regulate and restrict.

While I appreciate the motion put forward by my hon. friend and colleague from Victoria, and I highly value his intellect and love working with him, I disagree with the perspective that we are going to simply decriminalize without looking at the other two very important facts: regulation and restriction.

The motion makes no distinction between 14-year-olds and 40-year-olds. It does not say that decriminalization is going to occur only for adults. It is saying decriminalization is going to occur for everyone. One of the things that is incredibly important to me is keeping marijuana out of the hands of children. Marijuana use is not without its effects.

As we all know, it can make people slightly loopy for a certain period of time, but there are also ties to breathing disorders, mental health issues, and particularly for young people whose brains are still developing, marijuana is a dangerous substance. It is not something we want to be widely distributed to our children. However, if we are going to decriminalize without dealing with how marijuana is distributed, without dealing with how we are going to keep it out of the hands of kids, we are going to enter into problems that are not anticipated by the motion.

I do understand, with a competent adult who is looking at a government that says we are going to make this legal, that we would have a certain sympathy for the fact that they are going to be prosecuted and get a criminal record. However, at the same time in my view, the law is the law is the law. Whether we agree with the law or do not agree with the law, whether we believe that a law is going to be rescinded or not, it does not mean we do not have a duty to respect the law as it is. As such, my sympathy for the people we have been talking about today is slightly muted, because they should be, just like the rest of us, respecting the law. That is what we are supposed to do until such time as the law is changed.

The NDP has raised Bill C-14 and I also want to raise Bill C-14 because one of the things this government was criticized for was the quick process that led to Bill C-14. However, in the case of Bill C-14, there was a very good reason. There was a Supreme Court deadline of June 6. In the case of marijuana, there is no deadline.

The key studies and the commentaries that we have had from the states in the United States that have legalized marijuana use, in particular Colorado, among others, has been that we should take the correct time frame to put in place the right measures to go along with legalization. We should not be rushing this.

Not only do we need to have the regulatory rules in place, but we need to have the infrastructure in place. We need to have those people who are ready to legally distribute marijuana. We need to have the police forces and judiciary prepared for the way we are going to treat this. We need to have the educational resources available for how we are going to go into the schools and explain to our young people why they should not be using marijuana and try to disincentivize them from doing so.

One of the things that is also troubling to me around the idea of accepting the motion is the question of regulation of the product itself.

We have heard from many Canadians, including the hon. member for Outremont in 2012, who talked about the fact that there was marijuana in our country that was very hard marijuana and was dangerous to health. If we are going to legalize marijuana, or even decriminalize it, we need to have standards in place to talk about how it is grown and how to prevent contaminants from getting into it to ensure the marijuana used is safe to consume, to the extent possible.

We need to talk about packaging, distribution, and how we get this out of the hands of organized crime. My fear is that, if the motion is adopted as is, who will everyone buy from? The producers of medical marijuana are not authorized to sell it to those without a prescription. There is nothing in the motion to talk about how the distribution channels would work. As such, my concern is that those people who are currently illegally distributing marijuana across Canada, basically organized crime, are going to have freer licence to go into our schools and talk to our young people about how it is not criminal to possess small amounts and encourage them to buy from them. Once that happens, what other drugs are these people in organized crime selling? How will this stop someone who starts with marijuana from moving toward harder drugs that are also sold by the same distributor, if we are going to call the Mafia that?

This is of enormous concern for me because right now in Canada we have the highest rate of minors using marijuana of 29 countries. Therefore, whatever we do in terms of the legalization process, an important part has to be how we are going to keep it out of the hands of our young people.

I have heard the argument, and respect it, that police forces going after adult possessors of small amounts of marijuana takes police away from more important things they could be doing. I completely agree with this. I do not agree that decriminalization would have the same effect, because it still means these people should be ticketed. It still means prosecutions and the officers would be going to court. The answer is not decriminalization. It is legalization, but legalization with strict enforcement mechanisms, proper surveillance, and supervision.

I am very happy that we have an expert in our government in the area of marijuana use. The hon. parliamentary secretary to the Minister of Justice is going to be leading us in this effort with his incredible former experience as the police chief of Toronto.

[Robert Aubin, NDP, Trois-Rivières, QC]

Mr. Speaker, it seems to me that, since debate on this topic began today, the discussion has been all over the map, which is probably normal with such a delicate topic.

Despite the fact that we are talking about marijuana, which is commonly known as a soft drug, some people are worried about abuse. I would like to come back to the key aspect of the motion so that we know what we are talking about. I would particularly like to draw members' attention to point (a), which is the heart of the NDP's proposal. It reads:

That the House: (a) recognize the contradiction of continuing to give Canadian criminal records for simple possession of marijuana after the government has stated that it should not be a crime;

We are talking about simple possession of marijuana. That is the situation we have been put in since the most recent election campaign. During that campaign, I often told the people who asked my opinion on the dreams, promises, and commitments of the Liberal party to be careful because everyone knows that the Liberals tend to signal left during the election campaign and then turn right when they take office. As a result, we are now in a situation where Canadians' dreams have been shattered. There are many examples of that.

For example, we could talk about all those people who were thrilled at the prospect of a tax cut that would give them more money and help them make ends meet. Once the Liberals came to power, very few people actually benefited from a tax cut, and those who received the largest tax cuts were already among the wealthiest Canadians.

Seniors in my riding were especially attracted by the idea of investments in home care. There was nothing in the budget about that. On the environment, people were saying that they could finally see light at the end of the tunnel. The Liberal government made the same commitments as the previous government in Paris. We can clearly see that on all counts, there is a gap, actually it is an abyss, between the vision presented during the campaign and what the government is currently doing.

In the case of marijuana, I would say that there is an even greater gap, if that is possible. The Liberals told everyone that they would quickly legalize marijuana. However, that is not the case. What people continue to believe, especially adolescents, whom I really understand, is that they are invincible. In fact, I have spent most of my life in touch with adolescence, first as an adolescent myself and then as a teacher of adolescents for 25 years. When we think about our adolescence, which for most people in the House was not as long ago as mine, we can remember often having the feeling of being invincible. When we are adolescents, the things we do are not risky, and we believe everything will be fine. If we try smoking a joint, we are not going to be arrested, because that only happens to other people.

The reality is quite different, and thousands of Quebeckers and Canadians who want to try smoking a joint or consuming an edible, such as a muffin or what have you, run the risk of ending up with a criminal record. They could end up with a criminal record, even though the Liberals made a promise and said that no one in our society should end up with a criminal record for simple possession of marijuana. Therein lies the contradiction and the confusion surrounding this issue we are trying to resolve with the very simple approach of decriminalizing marijuana. The majority agrees on this measure, and we are not talking about 50% plus 1 of Canadians. We are talking about 68% of Canadians who agree with decriminalizing simple possession of marijuana. I would remind members that we are talking about simple possession.

I must admit that the issues are diametrically opposed, but I have a hard time understanding the Liberals' inconsistent approach.

In recent weeks, we have talked a lot about Bill C-14 on medical assistance in dying. We heard that even though the Supreme Court issued a clear unanimous ruling, society was not ready and we needed to move forward slowly. As a result, the Liberals proposed the criterion of reasonably foreseeable natural death, which has been challenged in both the House and the Senate.

Small steps are necessary in the case of medical assistance in dying, but in the case of simple possession of marijuana, small steps are apparently not needed. In that case, the government wants to go full bore. Legalization needs to happen immediately, which is completely impossible. We need to forget about that. All we have been promised is that a bill will be introduced in 2017. Some Liberal members are saying that it could be introduced later, and, rarely, someone says that it could be introduced earlier. We hear nothing about consistency.

We need a bill to deal with the drug issue once and for all, but the first step is to implement a simple, easy-to-understand measure for everyone. Say a teenager is influenced by a group of friends or just wants to try this once. We need to make sure our measure eliminates the possibility of ruining that teenager's life with a record that will make finding a job or travelling much more difficult. We know that teenagers are tempted to try new things. There is a disconnect there.

I would like to talk about my own transition from childhood to adolescence. In my day, things might have seemed simpler because becoming a man or daring to do the forbidden meant trying to smoke. Cigarettes could be had for a penny, back when we still had pennies.

Obviously, that has changed. Each generation is better educated than the last, and we now have very clear evidence about the dangers of cigarettes. Cigarette consumption has decreased markedly, but the battle is not yet won. Some young people still choose to smoke, and they need to be shown the negative health effects of that choice.

Right now, the legal system spends $4 million on cases that may result in records for teenagers. If we used that money to educate young people about this, we could make tremendous progress. Contrary to what my dearly departed mother believed, one toke does not a hard-drug addict make. It is a long way from the former to the latter, and we can easily interrupt that progression with health education.

Since time is running out, I will close by painting a picture of the situation using some statistics. We invest $4 million in our justice system every year, and 80% of the offences that have to be processed involve simple possession of cannabis. If members want to talk about organized crime and everything else, so be it. However, 80% of offences are related to simple possession of marijuana. That amounts to 66,000 arrests a year and 22,000 people who risk getting a criminal record.

As I said earlier, 68% of Canadians are calling on us to take this first step, go ahead with decriminalization, and work on education so that experimentation remains just that, experimentation.

What is even clearer is that all of the parties are slowly coming around to the NDP's approach, which we first proposed a number of years ago.

I see I am out of time. I will end there, as I will have an opportunity to continue through questions.

Canadian Organ Donor Registry Act

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, thanks to the member for Calgary Confederation's contributions at the provincial legislature in Alberta, the province has an electronic organ and tissue donor registry of which I am a donor. I subscribed myself thanks to that new system that he introduced. He is also one of the very few members of the legislative assembly when he served there who actually passed two private members' bills. I hope that fortune and that ability passes on to the member for Edmonton Manning who is pushing for a very wise bill on organ and tissue donor registry.

I have a Yiddish proverb to share with the House, “He who looks for light work goes very tired to bed.” I view the government's response to this private member's bill as a search for that light work. Personal stories on organ donor registries and about specific issues of public policy seem to have a higher impact on the backbench members of the government who might be allowed a free vote on this.

Let me share my personal story. I have three kids. My two oldest kids, Maximilian and Jolie, will both need some day the donation of a kidney to continue living. It is inevitable. There is no cure for the condition that they have called Alport syndrome and they were born with it. For a parent who has to experience that, it is profound and changes one's outlook on life. That is why I became a donor. That is why I became involved in the Kidney Foundation of Canada as a board member for the southern Alberta chapter as well.

Through that involvement I met lots of people on the Kidney March, a three-day 100 kilometre walk through beautiful Kananaskis country. I shared tents with organ donors and experienced people doing dialysis in the camp at night. They would do a 25-kilometre walk and then do dialysis in the camp, and then start completely fresh the next day because the dialysis cleaned out all the by-products in the body that come from exercise. They literally could walk another 30 kilometres the next day and they were not as tired.

I met incredible people with incredible stories of perseverance and strength. They want something like this bill. They need something like this. I met a gentleman who lost both of his kidneys on a trip to Morocco with his friends. He had an emergency flight back to Canada and they were able to save his life, but he is on a second kidney donation now. He does marathons across North America. He is literally the first one to finish the 100-kilometre walk. I tried to keep up with him and I am able-bodied and younger, but I had a tough time keeping up with him. On the second day it is a 38-kilometre walk and he finished first. It is incredible what people can achieve.

I am thinking of my kids and what they went through from the moment of diagnosis and the doctors explaining what would happen to them. An organ and tissue donor registry is the first step. We are not talking about creating an entirely new registry, we are talking about coordinating the actions being done in the different provinces. I know we already have three of these and they coordinate different facets of this. That is why I think this private member's bill goes beyond that and talks about an actual strategy on organ donation and lays out nine further points for a national strategy.

Most strategists talk about simply ideas, a principle, a thought that, although important, does not have what the member for Edmonton Manning has included here, which is nine specific areas that we could look at. I have met with specialists in this field across Canada. They are surgeons responsible for explaining to family members that their loved one is deceased or they are the ones doing the organ donation procedures. All of them say that these nine areas are an improvement that we can lend to the system, so why not legislate on it because that is what we are here to do, to pass good laws and make sure bad ones do not pass.

When I read the Parliamentary Secretary to the Minister of Health's argument, I found three excuses I want to highlight and explain why they are not good excuses.

The duplicating of existing initiatives was one excuse. This does not duplicate. We can simply repurpose current work to meet the demands of this legislation. To say they would duplicate would indicate that work is already being done, but national organ and tissue donation rates are nothing to be proud of. They have barely improved over time. Real improvements would be to go after the structural issues and bottlenecks in the system.

Furthermore, this is probably the absolute weakest argument that can be made, because if we are already doing the work, then why not seek the path of least resistance, agree with the legislation, and simply pass it so it can be studied at committee. To say that there are existing initiatives basically says this legislation simply encapsulates what already exists, which is fine, but let us move on to the next point.

The other one the parliamentary secretary mentioned was the shift in responsibilities. She mentioned consent, confidentiality, health policies, and procedures that they are, indeed, mostly within provincial jurisdictions. My issue with that is this. Is there not a better way to coordinate it, perhaps by doing it formally, maybe in a voluntary system, which the member for Edmonton Manning included in his private member's bill? Section 5 of the law creates a voluntary opt-in, so it is optional for the provinces to participate in this. Success will breed a willingness to participate as well, so that as these different parts begin to do their work, as donation rates improve and there is success, more provinces will want to participate. Although it is within their jurisdiction, there is a voluntary component.

Provinces can voluntarily coordinate with the federal government and other provinces in order to improve the system. I will give the example of pensions. Pensions are a provincial jurisdiction, not federal. The Canada pension plan is coordinated across all provinces in Canada. Why can we not do the same thing? The same principle applies. It is not a shifting of responsibility to the federal government, saying we want a national pension plan that is transferrable from province to province; it is simply the coordination of work.

When I worked at the provincial legislature and orders in council were passed, it was basically with the consent of the different provinces and consultation with the federal government about the coordination of the pension plan, to make sure that the provincial laws and regulations that were passed were consistent across the board so that Canadians who moved across the country would have the same pension plan system, wherever they went. Why can we not have that for organ and tissue donation systems? It makes sense and I do not understand where the problem is. I do not understand why this would have been brought up as an issue.

The third point that the parliamentary secretary made was about the privacy of persons due to the collection of related personal health information. I have run into this a few times now. This was probably the most bizarre reasoning at committee. In clause by clause on Bill C-14, I wanted to introduce an amendment on written consent before the procedure, and I was told that this would impede the privacy of the person involved.

Privacy should never be used as a bottleneck or a pit trap for public policy improvements, especially when people can voluntarily surrender their privacy for the sake of a public policy goal that they agree with. We are not going after people who do not want to donate, we are trying to make it easier for people who do want to donate, to be connected with individuals who need organ or tissue donations because their lives are in danger or they have medical conditions that require organ donations.

Of course, this is voluntary and privacy should not be used in this way as an excuse not to do something, especially when the individuals involved want to help. I meet countless living donors who are so happy to have contributed to and extended someone else's life. The connection between donors and the people they have donated to is very deep. I have seen this countless times. I saw this at the Kidney March as well.

Those in need of organ or tissue donations will not stand for this type of bureaucratic logjamming. I find it is straight out of Yes, Minister. It is like we have seen this all before. It is worthy of Sir Humphrey Appleby saying that policy administration is different from the administration of the policy, and we cannot encapsulate this in the legislation. If it is being done already, let us put in the legislation. If we can coordinate better, let us do it through legislation.

Again, I do not see a reason why we cannot do this. None of the parliamentary secretary's objections, to me, stand up to scrutiny. I would urge the backbench government MPs, where I sometimes find kindred spirits, to support this bill. Let us take it to committee. If there are amendments to be made, we can do it there.

Physician-Assisted Dying

[Ruth Ellen Brosseau, NDP, Berthier—Maskinongé, QC]

Mr. Speaker, Bill C-14 violates Canadians' rights, and it is truly appalling to see this government making excuses.

The Prime Minister promised to do things differently, to make decisions based on facts, and to listen to experts. Instead, he chose to play politics, limit debate in the House, and refuse to work with the opposition on an issue as important as medical assistance in dying.

Does the Prime Minister realize that he is doing the exact same thing as the former Conservative government?

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

Mr. Speaker, we believe that this bill is the best approach to guarantee that dying patients' rights are respected and to ensure that vulnerable people and the conscience rights of health care professionals are protected.

An amendment that removes the reasonably foreseeable criterion will jeopardize the delicate careful balance we have struck in Bill C-14.

[Ruth Ellen Brosseau, NDP, Berthier—Maskinongé, QC]

Mr. Speaker, the government needs to get things straight and brave the storm. The amendment passed in the Senate would bring the bill in line with the Supreme Court's decision.

As experts and the Alberta Court of Appeal have said, without this amendment, Bill C-14 does not pass the charter test and will once again be challenged in court. We need to do things right with a bill that is so important to Canadians.

Will the government act responsibly and amend Bill C-14?

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

Mr. Speaker, we believe that we have struck the right balance in Bill C-14 between protecting the vulnerable and the conscience rights of health care professionals, and also providing access to medical assistance in dying and protecting personal autonomy.

There is a diversity of opinion as to whether the bill goes too far or not far enough. There is not unanimity with respect to its constitutionality. There is a delicate careful balance that has been struck. We believe it is the best solution for Canada at this time.

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

Mr. Speaker, indigenous women deserve answers, not reading from a website.

The Prime Minister promised to do politics differently, and on Bill C-14 he said that he would accept good faith amendments. Instead, the Prime Minister has disrespected Canada's top legal experts, flouted court rulings in Alberta and Ontario, and rejected good faith amendments every step of the way.

Given the seriousness of the situation, Canadians deserve better. Will the Liberals finally stop putting politics ahead of policy, stop trying to ram through an unconstitutional bill, and work with us to fix Bill C-14 so that it will be a charter-compliant bill that respects the rights of Canadians and respects the Supreme Court of this country?

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Mr. Speaker, the amendment that the Senate voted on last night reflects and puts forward a substantive amendment to Bill C-14. We sought to thoughtfully consider this complex matter to ensure we respected the rights of all Canadians and balanced those rights, balanced personal autonomy with respect for the vulnerable.

This is a momentous change in our country in what we are doing with respect to medical assistance in dying. We need to take a responsible approach that is reasonable, and this is what we have found in Bill C-14.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, the Senate amended Bill C-14 by deleting the criterion of reasonably foreseeable death in order to allow the most vulnerable to have access to medical assistance in dying. That is what the Barreau du Québec, the lawyers for the Carter family, the eminent constitutional law expert Peter Hogg, the Bloc Québécois, and the NDP were calling for all along.

Why is the Minister of Justice intent on withdrawing the right to self-determination from the most vulnerable people in society, the people suffering from a grievous and irremediable illness, disease, or disability that causes intolerable suffering?

[Ruth Ellen Brosseau, NDP, Berthier—Maskinongé, QC]

Mr. Speaker, the government needs to stop providing false information.

We can protect vulnerable people and respect the rights of Canadians. The government rejected all of the opposition's proposals to make Bill C-14 consistent with the charter and Carter. As a result, the Senate is making the same proposals. If the bill is not amended, it will be challenged.

How can the Liberals justify forcing people who are sick and vulnerable to go to court to protect their rights?

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Mr. Speaker, I disagree with the premise of the question. The reality is, with respect to the court decisions from Alberta and otherwise, that those court decisions were with respect to specific amendments that were in place prior to June 6. They were not decisions with respect to Bill C-14, the legislation we have put forward.

The Supreme Court of Canada provided great deference to Parliament to put in place the necessary and balanced approach to medical assistance in dying, and that is exactly what we have done in Bill C-14.

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Mr. Speaker, I am pleased to stand up and speak to medical assistance in dying, Bill C-14, the legislation we put forward to provide a national framework for medical assistance in dying in this country. This national framework would provide and strike the right balance between personal autonomy and protection of the vulnerable. This is a significant step forward for us as a country. It certainly respects rights, balances rights, and is justifiable and responsible in terms of the time frame we had to put it in place.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

I certainly wouldn't impart on this honourable committee what the next steps would be, but what I would like to do, given that the time is running out, is assure this committee that breaches of privilege are taken and should be taken incredibly seriously, and all individuals who had access to Bill C-14 and its developmental documents have the necessary security clearances. We have the substantial policies of the Privy Council Office that ensure we abide by the security provisions to ensure that confidential documents remain in the confidence of the Queen's Privy Council. I'm confident that those were followed across the board.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

There may be comparisons. Reflecting on this particular circumstance with respect to this proposed piece of legislation, the conversation of physician- assisted dying, medical assistance in dying in the context of the proposed legislation, Bill C-14 , has been a conversation that we've been having in an expansive way at least for the last seven months.

The special joint committee has been having that conversation and I as the minister who has been tasked to work on this legislation has been involved as much as I can in the development of the legislation, sharing information with Canadians about the thoughts that were being put into the legislation, ensuring that we do our part, hearing as many voices as we can to find balance in personal autonomy and the protection of the vulnerable.

These are words that I have used in advance of the tabling of the legislation and continue to use today, although now that the legislation has been tabled, I can go into detail about how we found and sought to find that balance in Bill C-14. I have been speaking to that balance all along.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Nothing has come to my attention that there was premature disclosure of Bill C-14, and my department in no way, shape, or form would disclose such a sensitive piece of legislation.

[Ruby Sahota, Liberal, Brampton North, ON]

Thank you, Minister. I appreciate your being clear on the topic of members' privilege here today. Could I clarify some other things with you?

We're talking about whether there was a breach of a member's privilege and whether the article or what was contained in the article rises to that definition of a breach of a member's privilege. I'd like to get your opinion on whether you think there was a premature disclosure of Bill C-14.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Sure. I became aware of this discussion, the article, the breach of privilege that was talked about, in the House of Commons after I came back from a press conference around Bill C-14. I was in the House and heard the chief government whip speak. Like every member of this committee and all members in the House of Commons, I take privilege very seriously, so it was a concern to me, absolutely.

At that point, I engaged in discussions over BlackBerry, called my staff in my office, spoke with all members of my exempt staff who have the security clearance to view cabinet documents, and also spoke with my deputy minister, whom I advised of the situation. He of course had already read the article. We ensured, through our conversations with exempt staff and our departmental officials, that this was a serious concern, but we confirmed that we had followed all security measures as articulated in the policies that the Privy Council Office has.

[Scott Reid, Conservative, Lanark—Frontenac—Kingston, ON]

In case you were wondering, we had a constituency referendum, and 67% of my constituents voted in favour of Bill C-14, on what I thought was an objectively worded question. So there you are.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

If I could, Mr. Chair, I want to thank the member for the thoughtful nature in which he engaged with his constituents around Bill C-14.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Certainly. Thank you for the question.

The article that we're talking about said that the bill will exclude those who only experience mental suffering, such as people with psychiatric conditions, and this was according to that source familiar with the legislation.

I'm pleased to speak about Bill C-14 and the eligibility criteria that we have put into the legislation. The eligibility criteria does not necessarily exclude people suffering from mental illness or psychiatric conditions, but it contains a number of criteria that need to be met and circumstances in terms of the individual patient's situation and health concerns that need to be read in a comprehensive way. A person who has medical conditions, including a psychiatric condition or a mental illness, is not precluded from qualifying to meet the eligibility criteria in medical assistance in dying. A person who's suffering from a mental illness or a psychiatric condition alone would have more difficulty in qualifying. The reality in what we've done in the legislation is to look through amendments, and otherwise that we ensure that we study mental illness and we learn the risks and the benefits with respect to that, and that study in the proposed legislation has a commencement timeline of six months.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Thank you for the question, and again, thank you for the study that you're undertaking.

As I said in my remarks, there were some aspects in the article that was written on the 12th that reflected some of the excluded parts of Bill C-14, those being mature minors, advance directives or requests, and persons suffering from mental illness alone. What the article reflected mostly was what was not included in the legislation. As I commented, the specific provisions in terms of eligibility, safeguards, and monitoring weren't mentioned in the article.

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

Thank you, Chair. I may be sharing my time with Ms. Sahota.

Thank you, Minister. Our study here is based on a finding of a prima facie case of breach of privilege by the Speaker, which, as we all know, refers to...at first glance, at first appearance, that there may have been a breach here.

You mentioned in your opening remarks that the article that is the basis of this motion contains inaccuracies about the bill. It did not obviously contain the bill itself. The title of our study refers to the premature disclosure of the contents in Bill C-14 on a prima facie basis.

In your view, Minister, were the contents of Bill C-14, in fact, prematurely disclosed?

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Thank you to all honourable members here for the opportunity to appear before committee to address the alleged breach of privilege with respect to Bill C-14, a matter that I take incredibly seriously.

First, I'd like to speak to various measures and policies that are followed by my department and my exempt staff to protect legislation prior to its introduction. I want to be very clear that none of my staff nor any of my officials were involved in any alleged leaks in this matter. Second, I want to highlight that the drafting of legislation spanned several departments and agencies. Third, I'll turn briefly to the article in question.

To begin, I can assure my honourable colleagues that my department and my exempt staff take the safeguarding of information regarding the contents of all bills intended for introduction very seriously, and they adhere to all relevant policies and procedures.

My departmental officials, through my deputy minister, are instructed to follow all precautions as outlined in “A Drafter's Guide to Cabinet Documents” and the policy on security of cabinet confidences, both of which can be found on the Privy Council Office website. According to the PCO policy on security of cabinet confidences, draft bills, with the exception of versions used for public consultation, upon agreement of cabinet, are deemed confidence of the Queen's Privy Council. These documents must be marked, handled, and safeguarded accordingly. Documents may only be handled by those with valid security clearance at the appropriate level, and a valid need to know the information to perform their duties. Restricted access to cabinet confidences extends to all stages of drafting.

The following individuals are considered to have a need to know status: employees who are responsible for developing policy and for developing proposals for the minister; ministerial and departmental personnel supporting a minister on a particular policy proposal or issue that is the subject of cabinet discussion; central agency employees who help advance policies and proposals brought forward by departments of sponsoring minister; and legal advisers providing advice relating to a policy proposal or issue that is the subject of a cabinet discussion.

As per PCO policy, these individuals are required to use appropriate means, including IT systems, to prepare, store, and transmit cabinet confidences; mark cabinet confidence information at the appropriate level of sensitivity, and with the caption “Confidence of the Queen's Privy Council” on every page of the document; handle such information in restricted access areas; use security equipment and procedures approved for the level of sensitivity of the information to transport, transmit, store, and dispose of cabinet confidences on paper or in electronic format; ensure that the information is not discussed with, viewed, or overheard by unauthorized individuals; and refrain from discussing such information on cellular telephones or wireless devices, unless approved security means are used.

All my departmental officials who worked on this draft legislation, as well as all of my exempt staff, had valid security clearance at appropriate levels.

As a general practice, any security incident involving cabinet confidences, however slight, must be immediately reported to the responsible departmental security officer. This would include unauthorized disclosures, loss, theft, transmission, and discussion over non-secure channels, unaccounted documents, and other actual or suspected compromises. The departmental security officer, in turn, must immediately report the incident to the PCO security operations division. Unless directed otherwise by PCO, the departmental security officer is expected to conduct an initial administrative inquiry to determine what happened and to identify corrective action.

Generally, an inquiry would include an examination of the circumstances surrounding the incident; if possible, the source of the unauthorized disclosure; the adequacy of the departmental procedures for the protection of sensitive information; an assessment of injury to the national interest arising from the compromise; and an outline of corrective measures that have been or will be put in place to minimize the risk of similar occurrences in the future.

The Clerk of the Privy Council and Secretary to the Cabinet, after consultation with the appropriate department heads, may involve the RCMP. The RCMP will then determine if there is sufficient grounds to investigate. Where appropriate, department heads are responsible for applying sanctions.

Let me be clear. I have spoken with my deputy minister and I can assure you that my department follows all necessary precautions. In this particular matter, I can assure you that no breach of information nor evidence of such a breach was reported from departmental staff, and therefore, no internal inquiry was initiated.

Further, I can personally assure you that I spoke to all of my exempt staff about this matter, and none of them were involved in any breach of information. I believe and trust my departmental officials and my staff, and I take them at their word.

Second, honourable colleagues, it's worth remembering that this sensitive piece of legislation was not crafted by the Department of Justice alone. My department worked closely and collaboratively with officials in other departments, and my exempt staff worked with their counterparts in other offices.

Further, as per PCO guidelines, drafts of memorandums to cabinet containing specific policy recommendations were shared with central agencies and other departments and agencies to solicit feedback and to address any potential concerns from various policy perspectives. As the Minister of Justice, I certainly cannot speak on behalf of other departments or agencies.

Third, I want to briefly address the article in question. As you know, on April 12, 2016, public notice was given for the introduction of Bill C-14 in two day's time. Like my honourable colleagues, I was dismayed to learn that the article was published in The Globe and Mail that same day and made reference to specific aspects of the bill, mainly what would not be included in the legislation, and to a source familiar with the legislation who was not authorized to publicly speak about the bill.

Let me be clear. I did not know the identity of the source at that time, nor do I know it sitting here today.

What I can offer, honourable colleagues, is that the few details about the bill in this article are not entirely accurate, and this inconsistency between the bill and the article may be relevant to your investigation.

Specifically, the article begins by stating that the bill will exclude those who only experience mental suffering, such as people with psychiatric conditions. While it is the case that those who suffer from mental illness alone may not be likely in practical terms to qualify for medical assistance in dying, pursuant to the eligibility criteria set out in Bill C-14 as it was originally drafted and tabled in the House, the proposed legislation in no way categorically excludes such individuals. It is possible, although unlikely, that someone who only experiences mental suffering could meet all of the eligibility criteria, and therefore be able to obtain medical assistance in dying under the proposed scheme.

It is also worth noting that the article mostly speaks to what will not be in Bill C-14 and does not disclose major elements of the bill. For example, it does not address items like the eligibility criteria, the safeguards, and the monitoring regime proposed in the legislation.

Finally, I would highlight that I'm quoted toward the end of the article referring to various principles that our government sought to balance with this legislation, but of course, refusing to go into any detail about its contents.

In conclusion, honourable colleagues, let me assure you that my department, my staff, and I take this issue incredibly seriously. All matters of privilege implicate the foundational principles of our constitutional democracy, and so I commend you on the work you are doing, and I am happy to participate and take questions.

Thank you, Mr. Chair.

[The Chair, Liberal, Larry Bagnell]

I'm going to read the mechanics so it's out of the way.

Good afternoon. We are in the 27th meeting of the Standing Committee on Procedure and House Affairs for the first session of the 42nd Parliament. This part of the meeting is televised.

We are resuming our study of the question of privilege related to the premature disclosure of the contents of Bill C-14.

Mr. Reid had asked a question of the researcher on similar types of cases in New Zealand, the U.K., and Australia. The quick answers, unless you want to hear them from the researcher, are that Australia hasn't answered yet, and New Zealand and the U.K. do not have similar provisions. It's totally different. He's going to send you a briefing note with the details of that, if that's okay.

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

Mr. Speaker, I have a very complex petition here. It is regarding Bill C-14 to legalize euthanasia and assisted suicide, which the government has brought forward.

The petitioners state that the killing of people is not a genuine health care solution. The undersigned residents of Canada ask the House of Commons to vote against Bill C-14 and instead to invoke the charter's notwithstanding clause which allows parliamentarians to ignore bad judicial decisions.

[Thomas Mulcair, NDP, Outremont, QC]

Mr. Speaker, the Liberals did not take action immediately. They waited until April to introduce their bill.

Bill C-14 is unconstitutional. It would be challenged for years in the courts. The Carter family has said it feels betrayed by the government and by the Prime Minister. Here in the House, the Prime Minister refused to accept amendments that would fix the bill and make it charter compliant.

I have a simple question. Is the Prime Minister going to accept those exact changes if they now come from the unelected Senate?

The Environment

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, the Prime Minister misled the House during question period when he said that the NDP had a whipped vote on Bill C-14. He knows that is not the case. He knows on this side of the House, it was a free vote.

However, the NDP caucus is united in its determination that Bill C-14, as it is, is—

Physician-Assisted Dying

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Mr. Speaker, we are incredibly mindful of the deadline of the Supreme Court of Canada. It is incumbent upon parliamentarians to put in place a national framework around our medical assistance in dying to ensure that there are the appropriate and necessary safeguards in place, to ensure certainty for medical practitioners, and to ensure that there is access for patients who want to access medical assistance in dying.

This is an incredibly complex discussion. We have certainly listened to the voices of Canadians, and it is the voices of Canadians who have contributed toward Bill C-14.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Mr. Speaker, the medical assistance in dying bill is historic. The government should have done the right thing.

That is exactly what it did not do. Knowing the timeline was tight, it nevertheless waited until April to introduce its bill. It refused to listen to the experts.

Today, Peter Hogg, one of Canada's most respected constitutional experts, once again said that Bill C-14 would not pass the test in terms of the charter or the Carter decision.

When will the Liberals change course and do the right thing?

[Justin Trudeau, Liberal, Prime Minister]

Mr. Speaker, what Canadians expect of this government is to make sure that we are both defending the rights and freedoms of Canadians while protecting the most vulnerable, and that is exactly the balance that we have struck with Bill C-14.

Throughout we have been open to amendments, including accepting amendments from opposition members. We look forward to hearing the deliberations that the Senate is carrying forward on this same piece of legislation.

We are ensuring that this big step that Canada is taking, despite people who think it goes too far and others who think it does not go far enough, is done the right way.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, it is not just Quebec that is protesting. Peter Hogg, Canada's foremost constitutional scholar, today testified that Bill C-14 fails to respect the Carter decision and will undoubtedly be struck down as soon as it gets to court. He said that the government cannot turn around and exclude a group of people that the Supreme Court clearly ruled have these charter rights.

It is never too late for the government to do the right thing. Will the Liberals finally respect the charter and announce that they are willing to fix the bill?

[Justin Trudeau, Liberal, Prime Minister]

Mr. Speaker, as part of the debates on Bill C-14, we listened to many politicians from all the different parties share their views.

However, we did more than that. We listened to doctors and Canadians. We consulted the public at large, across the country, to ensure that this important and transformative measure regarding medical assistance in dying would be properly designed to uphold Canadians' rights and freedoms while protecting the most vulnerable.

That is the balance we have struck, and we are proud of it.

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

Mr. Speaker, the government had the chance to do things differently with Bill C-14, but it decided to ignore experts, not to work with the opposition, and to limit debate.

Warnings were coming in from all over. Quebec's health and social services minister called Bill C-14 unenforceable. He thinks that the notion of reasonably foreseeable death is medically unfeasible and he refuses to include it in Quebec's law.

Will the government finally realize that Bill C-14 must be amended?

[Justin Trudeau, Liberal, Prime Minister]

Mr. Speaker, if there was ever an example of the reforms that the Liberal Party made to the Senate over the past years removing partisanship and patronage from that place, there is no better example than the NDP highlighting the great work that the Senate is doing weighing in on an important piece of legislation.

I thank the hon. member for her comments about the excellent work done by the independent voices in the Senate, and I look forward to hearing what the Senate has to say about Bill C-14 when it returns to us.

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

Mr. Speaker, Senate Liberal leader James Cowan has now joined the growing number of Canadians saying that Bill C-14 is likely unconstitutional. Cowan said that this government legislation is so flawed that Canadians would be better off with no legislation at all. This bill does not respect the Supreme Court's decision, and it will be tied up in courts for years.

Instead of ramming through Bill C-14, will the government listen to James Cowan and work on getting the bill right the first time?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Mr. Speaker, with one more sitting day after today before the stay on the declaration of constitutional invalidity expires, it is now clear that the government cannot meet the June 6 deadline to pass Bill C-14. The Minister of Justice has rightly warned of a legal vacuum absent the legislation, and yet the minister could do something to stop that legal vacuum from arising, namely by applying to the Supreme Court for a short-term extension of the stay to allow time for Parliament to pass legislation. However, the minister has done nothing. She has been all talk and no action. As a result, on June 7, there will be no certainty for patients, no certainty for physicians, and no protections for the vulnerable.

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

Mr. Speaker, over the past several months, the Liberal government has refused to amend Bill C-14 legislation in order to provide adequate conscience protection for medical professionals and health care institutions.

They also voted against our opposition day motion that would have guaranteed these professionals their charter right freedom of conscience. Repeatedly we have heard the government indicate that we can count on provincial regulatory bodies to provide conscience protection. However, as we have seen, the Royal College of Physicians and Surgeons of Ontario and the College of Physicians and Surgeons of Saskatchewan have both indicated that there is an expectation on the part of their medical professionals to refer for the practice of physician-assisted suicide.

Enough is enough. Constituents in my riding have been crystal clear. This bill must include clear, ironclad conscience protections for health care professionals and institutions. I hope the Liberal government will listen to Canadians and do the right thing.

[Jamie Schmale, Conservative, Haliburton—Kawartha Lakes—Brock, ON]

In June, I think that was the goal. We wanted to deal with this hopefully before we rose by the end of June. I think it's quite upsetting. We gave her lots of notice. We gave her weeks in advance of the meeting. We meet for an hour. I don't think that's a whole lot of time. Bill C-14 is dealt with; it's through the House, anyway.

For her to give us an hour of her time on an issue the governing party feels is a priority to get off the plate, or on the plate, depending on if there's something there.... The fact that she has decided she can't meet before the end of June goes contradictory to what we've been talking about. Let's deal with this. Let's find out if there's something there, and if there is, let's deal with it and let's get through it as fast as possible.

To keep this on the agenda over and over again and drag this out.... Now it's going to go on through the summer, and we'll have to deal with it in September and October when we return. That we just can't find an hour is pretty disappointing, I think.

Air Canada Public Participation Act

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, I am pleased to be here today for report stage of Bill C-10, an act to amend the Air Canada Public Participation Act and to provide for certain other measures.

Governments, and especially new governments, have to set priorities and decide what they want to achieve during the length of their mandate.

Each party campaigns on a platform that is expected to serve as a road map for its early days as a government. Over the course of the campaign, parties make dozens of commitments. Upon taking office, a government must decide which commitments it wants to prioritize. A government must make decisions on what it wants to do right away, what it will do in six months, in two years, and what it will never do. On occasion, the Supreme Court will force the government to introduce legislation, as has been the case with Bill C-7 and Bill C-14.

Other pieces of legislation, like the budget, are presented each year. Because new governments like to check items off of the list of fulfilled campaign commitments during the first year, we often see legislation that reflects their campaign commitments. However, Liberal campaign commitments, like restoring mail delivery, have been pushed back on the priority list with the promise of consultations. Additional funding for the CBC has been pushed down the list of priorities because of a lengthy consultation process. A response to VIA Rail's proposal to build a dedicated track between Toronto and Montreal will take three years due to consultations.

It took the Liberals seven months to create a committee to enact consultations on electoral reform that is effectively identical to every House of Commons committee, and whose recommendations will be both non-binding and, like the preferred option of the Prime Minister, a ranked ballot.

The Minister of Transport has decided to spend an entire year consulting on the recommendations of the Emerson report, which was itself the product of 18 months of consultations with the entire transportation industry.

On so many issues, the Liberal government has pushed back making a decision to a later date.

However, with Bill C-10, we have none of that. What we have is a bill that came out of nowhere and was not the product of any consultations. Why is the government being so inconsistent?

The Parliamentary Secretary to the Minister of Transport confirmed, during its second reading debate, that she was rushing this bill through so that the stakeholders could provide input during the committee stage. She was outsourcing her government's consultative responsibilities to committee. A parliamentary committee studying a bill is not a consultative body. Its purpose is to probe the bill for weaknesses and address these weaknesses through amendments if the majority of the members agree.

Witnesses at committee, including the Government of Quebec and the Government of Manitoba, highlighted a number of obvious weaknesses in the legislation. The opposition proposed amendments to address some of these problems. In the case of Bill C-10, the Liberal majority did not accept any of these amendments to the legislation.

If the purpose of sending the bill to committee so quickly was so that the stakeholders could provide input on the legislation, then why did the Liberal members ignore the recommendations? This illustrates more inconsistency on behalf of the government.

While all of us support a regulatory environment that allows for a viable legacy carrier in Canada and affordable air travel, I do not think a single Liberal candidate campaigned on reducing Air Canada's maintenance obligations as they are described in the Air Canada Public Participation Act.

Considering the government appears to be in no rush to do anything else, its incredible haste to get this legislation that came out of nowhere passed before the summer has opened up a pandora's box of questions. By now most members are aware that in 2013 the Government of Quebec, with the Government of Manitoba as an intervenor, brought Air Canada to court to challenge the carrier's assertion that it was fulfilling its maintenance obligations under the Air Canada Public Participation Act. The Quebec Superior Court, presided over by Justice Castonguay, ruled on the side of the Attorney General of Quebec. Consequently, Air Canada appealed this decision to the Court of Appeal of Quebec, and that court upheld the lower court's ruling in November 2015. On January 5, 2016, Air Canada announced that it would challenge that ruling in front of the Supreme Court. Less than two months later, Air Canada began negotiating with Quebec and Manitoba to end litigation, starting with the signing of a letter of intent to purchase 45 C Series aircraft. Whether Air Canada decided it would lose its appeal in front of the Supreme Court or the Government of Canada prodded it to make a purchase of the at the time troubled C Series aircraft, the carrier started to propose real commitments to keep some of its overhaul maintenance work in Quebec and Manitoba.

As the Government of Quebec has recently placed over $1 billion U.S. into the C Series program, it was obviously pleased to see Air Canada make the first major purchase of the aircraft.

This point cannot be made clear enough. Air Canada was forced to negotiate a settlement with Quebec and Manitoba because the carrier lost in court.

What Air Canada has proposed to settle its lawsuit in the case of Quebec is the purchase of the C Series and a commitment to undertaking maintenance of these aircraft for 20 years in the province. Air Canada also proposed to create a centre of excellence in aircraft maintenance in Quebec. In the case of Manitoba, Air Canada announced a willingness to transfer about 150 jobs from other parts of the country to Winnipeg. It is worth noting that these are not new jobs, merely work that is being shuffled from one part of Canada to another.

These Air Canada commitments to do maintenance work on narrow body aircraft in Canada are good, but these are not listed in the act we are debating today. Air Canada is making these commitments because it lost in court on the Air Canada Public Participation Act.

The Provinces of Quebec and Manitoba understand that if the law is repealed, as is being proposed by the Liberals, then their negotiating position with Air Canada will be swept out from under them. That is why both provinces explicitly asked the Standing Committee on Transport, Infrastructure and Communities during the study of the bill to only allow this legislation to pass upon conclusion of their litigation against Air Canada. These calls came on deaf ears.

None of the Liberal members at the committee questioned the statements by Manitoba's deputy premier or Quebec's minister of the economy asking for more time, or attempted to justify the prompt passage of this legislation. The Minister of Transport's own officials also confirmed at committee that there was no legal or technical reason why speedy passage of the legislation was necessary.

Therefore, here we are. We have a bill in front of us that two provincial governments have asked for its coming into force to be delayed, and there are huge questions concerning why it is being rushed through Parliament so quickly ahead of the rest of the Liberal agenda.

We also have the problem that the Liberals are missing an important opportunity to make Air Canada and the entire aerospace sector annually more competitive. The Emerson report, which I mentioned earlier in my remarks, made a number of good suggestions that would stimulate the aerospace sector while maintaining jobs in Canada. For example, the government could tie all airport improvement fees to specific projects, explicit sunset provisions, which would ensure that these fees are to fund a specific project and not the airport's overall operations. They could look at overhauling the airport security model to mirror those used at major international airports, like London's Heathrow or Amsterdam's Schiphol, which have clear customer service standards and much lower delivery costs.

However, the bill does not do any of that, and we have not heard any indications from the Minister of Transport that measures to improve the competitiveness of the entire airline industry are forthcoming.

I look forward to questions from the government and opposition members.

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

Mr. Speaker, I am pleased to rise in the House to speak, perhaps for the last time, to Bill C-10, an act to amend the Air Canada Public Participation Act and to provide for certain other measures. There are very few other measures, as this is a small bill.

I will be sharing my time with the hon. member for Elgin—Middlesex—London. I am sure that her speech will be very good and that she will have a lot to say about Bill C-10.

We have had many opportunities to speak to Bill C-10 over the past few weeks. We had the opportunity to hear the government say all sorts of things about the importance of Bill C-10 and the need to act swiftly. However, when we asked for the real reasons behind the urgency, which led the government to adopt a time allocation motion for Bill C-10, we got no response. The government says one thing and does another or, in many cases, does nothing.

From the beginning our only question has remained unanswered. We really wanted a justification for the time allocation motion. Why the need to pass Bill C-10 now, when at the beginning of this Parliament there was no urgency?

We asked the question in the House during question period and also in committee. We never received a single sensible answer explaining why Bill C-10 had to be passed so quickly.

I searched books, history, and everywhere in order to understand how the government could justify adopting a time allocation motion for a bill like C-10. I finally found the answer. It is in the Liberal Party of Canada's DNA that I found the reason for the urgent need to take action on Bill C-10.

The government says that it is open and transparent. That can be found in the Speech from the Throne, which states:

...the Government is committed to open and transparent government. ...[the Government] will promote more open debate...it will not resort to devices like prorogation and omnibus bills to avoid scrutiny.

A time allocation motion is a device. We have had the opportunity to look at the budget bill, which is also an omnibus bill. The government says one thing and does another, or does nothing at all. That is what I discovered when I analyzed the process for Bill C-10, , which has brought us here today.

The government has adopted a number of time allocation motions. I am thinking of Bill C-10, Bill C-14, Motion No. 6, and the electoral reform that the government wants to unilaterally impose using its majority. So much for openness and transparency.

With regard to Bill C-10, in just a few months, we have seen the government, for no real reason at all, decide to lose some of its credibility with the provinces. How? The government announced on a number of occasions that it wanted to usher in a new era of improved relations with the provinces.

In the throne speech, the government also said the following three times regarding three files:

To give Canadians a more secure retirement, the Government will work with the provinces and territories.... To create more opportunities for young Canadians...the Government will work with the provinces and territories.... And to support the health and well-being of all Canadians, the Government will begin work with the provinces and territories...

Those three excerpts from the throne speech show the government's willingness to work with the provinces and territories and its interest in doing so. However, the government says one thing and does another, or does nothing at all. We are seeing it again. We saw it yesterday. The government has said a number of times that it is listening to the provinces and wants to work with them.

Yesterday, the Quebec minister of health and social services spoke about another bill, Bill C-14. What did Mr. Barrette have to say about Bill C-14? He said that it was unenforceable and that, given the current context, he would be very careful about going forward with Bill C-14. He added that, personally, for professional and governmental reasons, he does not think it is a good idea to go forward with Bill C-14. Mr. Barrette is a minister in a province with which the government wants to build good relations. However, the government moved a time allocation motion on Bill C-14. The government is not letting members of Parliament speak about it.

I have other examples, but I do not have the time to share them all in four minutes. When Bill C-10 was first debated in committee, Minister Garneau talked about good relationships with the provinces in his speech:

In light of this development [Air Canada's commitment to creating centres of excellence], the Government of Quebec and Air Canada announced an agreement to discontinue the litigation...

Given all these positive developments, we believe this is the perfect time to modernize the Air Canada Public Participation Act...

Minister Garneau said that this was what the provinces wanted, but that is not true. I do not want to say that it is not true, but it is misleading. This may appear to be the case, but that is my interpretation.

Criminal Code

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Mr. Speaker, the hon. member urged us at the end of his speech to vote for Bill C-14. I would like to ask him if he could outline three good reasons why we should.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

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

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

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

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

This enactment would amend the Criminal Code to, among other things: (a) create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process; (b) specify the criteria for eligibility, and the safeguards that must be respected, before medical assistance in dying may be provided to a person; (c) require that medical practitioners and nurse practitioners who receive requests for, and pharmacists who dispense substances further to, medical assistance in dying; provide information for the purpose of monitoring medical assistance in dying; authorize the minister of health to make regulations respecting that information; and, (d) create new offences for failing to comply with the safeguards, for forging or destroying documents related to medical assistance in dying, for failing to provide the required information and for contravening the regulations. This enactment also makes related amendments to other statues being affected.

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

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

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

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

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

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

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

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

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

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

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

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

....this enactment provides for a parliamentary review of its provisions and of the state of palliative care in Canada to commence at the start of the fifth year following the day on which it receives royal assent.

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

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

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 third time and passed.

[Majid Jowhari, Liberal, Richmond Hill, ON]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

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

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

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

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

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

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

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

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

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

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

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

Then prime minister Pierre Elliott Trudeau agreed when he said:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Randeep Sarai, Liberal, Surrey Centre, BC]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 third time and passed.

Physician-Assisted Dying

[Justin Trudeau, Liberal, Prime Minister]

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

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

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

[Thomas Mulcair, NDP, Outremont, QC]

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

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

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

[Justin Trudeau, Liberal, Prime Minister]

Mr. Speaker, first, Bill C-14 does comply with the Charter of Rights and the Supreme Court's rulings. That is exactly what we have been maintaining for a long time now.

Second, as of June 6, Canadians will not have the framework provided by the Supreme Court while we work on this bill. That is why it is so important to ensure that we have a framework on June 6 that will protect the vulnerable, while safeguarding Canadians' rights and freedoms.

[Thomas Mulcair, NDP, Outremont, QC]

Mr. Speaker, once again, the government is refusing to work with the opposition to make Bill C-14 consistent with the Supreme Court decision and the Canadian Charter of Rights. The reality is that medical assistance in dying is currently possible under the Supreme Court's criteria.

Yesterday, a court granted a woman in Manitoba the right to seek medical assistance in dying. In the meantime, the government is insisting on limiting access to it.

Why is the government insisting on moving forward with this bill, knowing that it does not comply with the Charter of Rights?

Criminal Code

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

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

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

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

[Jane Philpott, Liberal, Minister of Health]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Luc Thériault, Bloc, Montcalm, QC]

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

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

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

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

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

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

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

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

The bill would legislate these actions as an "exemption" from—an exception to—prosecution for the Criminal Code offences of culpable homicide and assisted suicide that would otherwise be committed. Treating medically assisted dying as an exception will help to ensure, as is essential, that it does not become part of the norm for how Canadians die;

In other words, Bill C-14 would not normalize medically assisted dying as perhaps has occurred in Belgium and the Netherlands, the two most often cited examples of the slippery slope.

Dr. Sommerville goes on to say that:

Recognizing medically assisted dying as an exception also helps to establish that access to it is not a right but rather, under certain conditions, an immunity from prosecution for a criminal offence....

This approach, she further states, “carries an important anti-suicide public health message.”

I would add that the government has taken care to emphasize this message in the bill's preamble, which acknowledges that “suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities”.

I am not a doctor who deals with life and death on a daily basis and I have never been at death's door.

Like every one of us here, I am an elected member trying to make the best possible decision in the context of the undeniable reality that the Supreme Court made a unanimous decision in the heart-rending Carter case.

The court's decision requires Parliament to create a new legal framework to regulate a specific aspect of end of life. If we fail to do our jobs now, the result will be a partial legal and regulatory vacuum. To quote the Ontario Hospital Association, if the bill is not passed by June 6, “Assisted dying would be lawful where it is provided in accordance with the parameters established by the Court and provincial regulatory bodies.”

The parameters set out by the court are fairly general. The court did not offer precise prescriptions for what an operative medical assistance in dying framework should look like. It is not the role of the courts to be so prescriptive.

This is not to say that I do not have concerns in voting for this legislation. Absent a Supreme Court ruling, and had the issue been raised once again through a private member's bill, I would very likely not have voted for medical assistance in dying. I have already, in the past, voted against a private member's bill on doctor-assisted suicide.

However, we do have a Supreme Court decision that creates a requirement to act. The Prime Minister and the Minister of Justice and the Minister of Health have, in my view, acted wisely in taking a cautious approach to the issue, notwithstanding the excellent work of the special joint committee under the capable and intelligent stewardship of my friend and colleague the member for Don Valley West.

The bill may not be perfect, but I believe it would be a mistake to suggest that it leaves a wide-open field in medically assisted dying, a fear expressed to me by many thoughtful constituents committed in the highest degree to the protection of human life.

Bill C-14 would establish numerous criteria to be met before access to medically assisted dying could be granted. In addition to being 18 years of age, the person must have a grievous and irremediable medical condition that meets four distinct criteria: the illness, disease, or disability must be serious and incurable; the individual must be in an advanced state of irreversible decline; moreover, the illness must be causing enduring physical or psychological suffering that is intolerable; and natural death must be said to be reasonably foreseeable. In addition, the person must make a voluntary request that is free from external pressure and that is the result of informed consent.

The bill also includes a number of safeguards, and the individual must make a request in writing or through another reliable means. If the request is being signed by a proxy, that proxy must be at least 18 years of age and understand the nature of the request. The request must be made after the person has been informed that his or her natural death has become reasonably foreseeable.

The request must be signed and dated before two independent witnesses, and in turn, these witnesses must not consciously be beneficiaries, financial or in any other material way, of the individual making the request, and they must not be directly involved in providing personal care to the person making the request.

Two medical practitioners must provide a written opinion confirming that the person meets the eligibility criteria, and these medical practitioners must be independent. For example, one cannot be a supervisor of the other or a mentor of the other.

Crucially, the person must be informed that he or she has an opportunity to withdraw the request at any time.

All of this said, I am not at all convinced that medical assistance in dying is a serene and dignified phenomenon, even if often depicted in this way. I suspect that complications may arise. This is why it is crucial and to the government's credit that the bill allows for monitoring of medical assistance in dying through detailed reporting.

A few years ago, a handful of parliamentarians, including the members for Kitchener—Conestoga and Carlton Trail—Eagle Creek, the former members for Newmarket—Aurora, Guelph, and Windsor—Tecumseh, and myself, wondered about enhancing and improving palliative care in Canada.

We joined the committee on compassionate and palliative care and produced a report. The silver lining in this debate is that palliative care is receiving a degree of attention never before seen in this chamber or in national discourse at large.

It is my sincere hope that, once quality palliative care of the kind provided by the West Island Palliative Care Residence is available through appropriate federal and provincial funding to all Canadians approaching death, this legislation will become somewhat of a relic, and medical assistance in dying will no longer be considered the default option in relieving end of life pain and suffering.

In this regard, I am heartened that, in addition to the government's existing commitment to do more to fund palliative care, the bill makes specific reference to this commitment. The advent of universally available quality palliative care will hopefully one day be seen as the high-water mark in the measure of a truly just society.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Madam Speaker, we are dealing with a closure motion today that allows very few members of Parliament to speak. We saw a couple of weeks ago that the government pulled Bill C-14 from the Order Paper a number of times when members of Parliament wanted to speak on it.

We saw, as well, a government refusing even the ability yesterday, under closure, knowing that we had a vote on Monday evening, to allow members of Parliament to speak during the day. It defies logic that a non-partisan bill of this nature would be treated so reprehensibly by the government.

Given all of the concerns raised by legal and medical professionals, their communities, the concerns about the lack of constitutionality of the bill, which has now been pointed out in two court decisions, why does the member think the government is trying to ram through this bill in such a partisan and inappropriate way?

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Madam Speaker, I rise somewhat concerned today that I am finally, for the first time, able to speak to Bill C-14. We are at third reading. This bill has been rammed through the House. The Liberals have brought in closure time and again with this bill. Every time it was debated, whether at second reading or report stage, I was not available, or the time was so constrained and the list of speakers of the members of Parliament was so long, that I could not get on the list. Finally, I am able to speak today to Bill C-14 to reflect my concerns and those of my constituents on this bill.

When closure is used in dealing with issues of conscience like we are dealing with today with respect to physician-assisted death or doctor-assisted suicide, whatever we want to call it, we need to take the time to have the debate. We need to have the discussion among parliamentarians and talk to the appropriate experts to ensure that we get this right. If the Liberals rush this bill through the legislative process in the House and if they try to do it in the Senate, I can guarantee that mistakes will be made and this bill will be facing court challenges in a relatively short period of time.

I also have to reflect what my friend from the riding of Provencher said today. It is extremely disappointing that so many reasonable amendments were presented by members of the opposition parties, and not one of them found their way into this bill at report stage last night. That truly is disappointing.

In my riding of Selkirk—Interlake—Eastman, the topic of physician-assisted suicide is divisive, as it is right across the country. The majority of constituents who have contacted my office have been opposed to this policy, on two fronts: first, many people have deeply held moral, ethical, and religious beliefs that are strongly against assisted suicide; and, second, many believe that the policy will be used prematurely to end the lives of those who have become a burden to their families, society, or the medical system.

It is important to note that the Liberals broke a key election promise to invest $3 billion into long term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making. There was unanimous agreement on the Special Joint Committee on Physician-Assisted Dying and among stakeholders, including the Canadian Medical Association, on the need for a pan-Canadian strategy on palliative care, with dedicated funding. This would be an important step forward for Canada. It is something that the Liberals have glossed over in favour of introducing this legislation in a very careless and expeditious manner.

Many medical doctors, nurses, and health care professionals are conflicted with the ethical and moral conundrum that assisted suicide presents, as it runs counter to the modern adaptation of the Hippocratic oath. The University of Ottawa captures the challenge of this principle. It states:

Given the complexity of medicine in the 21st century, an ancient oath cannot possibly encompass current values. Therefore, the significance of the Hippocratic Oath does not reside in its specific guidelines, but rather, in its symbolism of an ideal: the selfless dedication to the preservation of human life.

I would stress “the preservation of human life”.

Although the Canadian Medical Association in the last year has turned its back on its previous position on physician-assisted suicide, the Supreme Court of Canada went to great lengths and grasped at straws to change its position from its previous rulings as to whether there should be exemptions offered for physician-assisted suicide.

The Canadian Medical Association is a member of the World Medical Assembly, which adopted a resolution back in 1992 on this. It revised it slightly in 2005, but reaffirmed it in April of 2015 in Oslo. It states:

Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.

Quite clearly, the World Medical Association, doctors and physicians from right around the globe, is saying that this is unethical.

As has been pointed out, we are quite concerned from our side, and I am in particular, about the charter rights under sections on the freedom of conscience. As has been noted, there was a minor amendment made to Bill C-14 in the preamble to allow for the protection of individuals but not of institutions. Is it strong enough to be considered legal in a case that goes before the courts, the Canadian Human Rights Commission, or one of the provincial human rights commissions, if section 2 is defined in the preamble but is not actually in the clauses of the legislation itself?

Institutions would be exempt, and I know that some members have had conversations with people at some institutions who are very concerned about this. I looked to the St. Boniface General Hospital in Winnipeg, a Catholic-run hospital. They are quite concerned that they, as an institution, will have to violate their own religious and moral beliefs to provide assisted suicide. They believe in the sanctity of life, as many of us on our side do also.

Like most Canadians, I have watched loved ones succumb to lengthy and chronic debilitating illnesses. Dying with dignity is desired by all Canadians. Unfortunately, only a handful of us will die in our sleep with minimal discomfort or pain. I do not believe that we should institute a policy that will provide physician-assisted suicide to every Canadian when they are near their end of life. Dying with dignity does not apply only to physician-assisted suicide. Expanding and improving palliative care services is by far the better public policy, and should be a priority of all health care providers across this country. I am recommitting to working with like-minded Canadians and policy-makers, and parliamentarians right here, who want to enhance palliative care in Manitoba and across the country. My wife Kelly works as a nurse in a personal care home and provides palliative care services all the time. She agrees that strengthening palliative care services will allow more Canadians to die with dignity.

I have met with the Manitoba League of Persons with Disabilities and talked to Carlos Sosa, who is the Manitoba representative on the Council of Canadians with Disabilities. They are very concerned with the way that Bill C-14 is laid out right now because it would do little to address the concerns of the vulnerable and how the law would deal with people in the disabled community. In particular, the bill would not provide for an assessment of vulnerabilities that may induce a person to assist and seek an assisted suicide. It does not have an expedited prior review and authorization by a judge or independent body with expertise in fields of health care, ethics, and law. This was one of the amendments we brought forward last night, and it was defeated.

Rhonda Wiebe, who is the co-chair of the Canadian Council of Disabilities end of life ethics committee, said:

In the Carter decision, the Supreme Court of Canada gave the Government of Canada two assignments (1) develop a regime to provide dying people access to assisted suicide and (2) protect vulnerable Canadians who at a time of weakness may be influenced to accept medical aid in dying. Unfortunately, [Bill] C-14 has some serious gaps when it comes to protecting the vulnerable..... Canada must do enough to protect people like [her] and other Canadians with disabilities who can be made vulnerable by both [their] health conditions and [their] social and economic circumstances.

I am privileged to belong to a political party that allows for free votes on issues of moral and religious beliefs. On policies such as physician-assisted suicide, Conservative members are free to either reflect the will of their constituents or to vote according to their personal beliefs. As someone with very strong Christian values, I cannot support Bill C-14. Bill C-14 needs better protection in place for youth under the age of 18, and safeguards for those who are vulnerable, including those who are dealing with mental health challenges.

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, I want to start by saying that I will be splitting my time with the member for Selkirk—Interlake.

I want to say right from the outset that I am conceptually opposed to Bill C-14. I believe in the sanctity of life, and I believe that all life, from conception right through to natural death, has value, has worth, and has purpose.

As a sitting member of the committee for justice and human rights, I spent several weeks together with the committee in significant and lengthy meetings examining Bill C-14. We spent long days listening to witness testimony from experts and organizations from all over the country, and then doing a clause-by-clause analysis of the bill. Despite the many concerns voiced again and again by witnesses, there were no meaningful amendments made to the bill.

Bill C-14 is called medical assistance in dying, but make no mistake, Bill C-14 is physician-assisted suicide. It is important that we make this distinction. The gravity of the bill should not be undermined by the colourful wording. The bill would change Canada forever, and it would be naive to think that Canada's most vulnerable people would not be at risk under the bill in its present state. This is the most significant social re-engineering bill in the past 25 years, because it changes how we view the sanctity of life.

The Supreme Court was very clear that physician-assisted suicide is not a charter right, but it is an exemption that could be provided on an exception basis providing individuals meet certain criteria. The person must be a competent adult who clearly consents to the termination of life, who has a grievous and irremediable medical condition, including an illness, disease, or disability that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

Bill C-14 clearly goes beyond the Supreme Court decision with a mandate to study making physician-assisted suicide available to mature minors, exploring the concept of advance directives, and providing physician-assisted suicide to mentally disabled individuals. This is just not acceptable.

The committee heard testimony from approximately 42 individuals and/or groups who all have a vested interest in this issue. Over 100 amendments were presented to committee based on evidence from witness testimony provided to committee. Sadly, the Liberals did not present any substantive amendments, and in fact, voted against any meaningful amendments presented by any of the opposition parties. The Conservatives presented many thoughtful amendments that would have strengthened the bill and added important safeguards, as they did last night at report stage. This is a missed opportunity.

Let me highlight just a few of these missed amendments, these missed opportunities.

These amendments included things like assuring that only trained and qualified medical practitioners, in other words physicians, would assess the individual and administer the lethal cocktail that would eventually procure death. The way the legislation is presently drafted, it would allow a person to obtain the lethal drug from pharmacists, take it home, self-administer, and procure their own death. This worries me, and it should worry every Canadian. Witnesses presented testimony that in other jurisdictions that permit this practice, 30% to 40% of prescriptions for death go unused.

What happens to these unused drugs? What if the drugs fall into the wrong hands? What if the drugs were not administered properly? What if they did not take all of it and complications set in as a result? How can we be sure that the individuals were not at some point pressured into it? There are just way too many unanswered questions in the bill.

The bill would also make it near impossible for medical practitioners to monitor and report on subsequent events. Did the patient self-administer the drug or did the patient die from an illness? How do we ensure that we have the correct data to track euthanasia in Canada? These are valid concerns being voiced by Canadians, and it could have been addressed in the amendments that we proposed at committee.

The Liberals are unwilling to consider an amendment to ensure physician supervision during the procedure.

In addition, Bill C-14 allows for nurse practitioners to provide medical assistance in dying. There are substantial differences between a medical practitioner and a nurse practitioner, including the length of time spent training and the ability to prescribe various narcotics, yet suddenly, in this bill, we are affording them the ability to assess an individual's eligibility for physician-assisted suicide and prescribe life-ending cocktails, which is in stark contrast to the typical expectations we have of nurse practitioners.

This goes too far and is another issue we sought to address in the bill. Again, this is a missed opportunity.

We also provided an amendment that would have removed psychological suffering as an eligibility consideration for physician-assisted suicide. This, quite simply, leaves too much room for interpretation. Allowing for psychological suffering as an eligibility consideration is the start of a very slippery slope in terms of who can receive physician-assisted suicide and for what purpose.

We also suggested that “reasonably foreseeable death”, as defined in the bill, would be replaced with imminent death or at least death expected within 30 days. We heard testimony from witnesses on either end of the spectrum raising various concerns about this wording. “Reasonably foreseeable” in one physician's eyes could be completely different in the eyes of another. This will certainly open the door to uncertainty among patients and practitioners, and will definitely lead to subsequent lawsuits.

To further strengthen safeguards, we proposed an amendment requiring that prior judicial review had occurred to ensure that all criteria for physician-assisted suicide eligibility had been met.

Dr. Will Johnston, chair of the Euthanasia Prevention Coalition of British Columbia, came to testify before committee. He said the following:

...although it might be assumed, nowhere specifies that doctors must actually examine the patient, the extent to which they must do so, or the extent that doctors must inquire into the internal and external factors that create vulnerability for the patient.

Dr. Johnston brings forward a valuable consideration. Bill C-14 does not stipulate to what degree a patient should be examined nor does it require examination of the factors creating vulnerability for the patient.

In addition, we know that this is a complicated matter and difficult to address in legislation. Every individual and every disease presents a different set of challenges. Judicial oversight would ensure that individuals meet all the criteria given their unique set of circumstances and would further protect Canada's most vulnerable people. Again, this very reasonable amendment was rejected.

We also put forward a request that palliative care consultation be included as a criterion for seeking physician-assisted death. Patients would be made aware of all options available to them and ensure palliative care options were understood, offered, and available.

We heard time and again in committee that access to palliative care is a problem in this country. We also heard that palliative care, especially chronic pain treatment and counselling services, is very successful at alleviating the suffering, depression, and anxiety, things that lead people to wish to hasten their death.

The minister spoke on palliative care, and insisted that palliative care and physician-assisted suicide go hand in hand, yet the committee refused to adopt palliative care consultations as a prerequisite component in the bill.

The Canadian Society of Palliative Care Physicians outlined the issue well before committee. They wrote:

In order to ensure that medically assisted death is not our first or only response to human suffering, we need to build in an explicit legal requirement to identify, explore and record the sources of a person’s suffering and attempt to address the motivations of his/her request for death. This should not be undertaken as a screening or determination process, but rather an opportunity to ensure that a person who requests an assisted death is fully informed of available options for treatment.... The Bill should be amended to incorporate a meaningful right for patients to be informed of the full range of available treatments, technologies and supports that could ease their suffering, whatever its source.

Palliative care consultations would protect patients and ensure that physician-assisted death does not become the first response to human suffering. I cannot understand why the government would not want to ensure patients have sought out all other alternatives before requesting physician-assisted death.

One of the things we were very clear about, which the evidence produced over and over again in committee, was the whole need for conscience rights protection, not only for individuals but institutions. This came across as a large concern. We presented several amendments to committee that would have met the concern of many institutions and individuals that may be forced or required to offer this service. These amendments were all rejected, not only at committee but they were rejected here last night at report stage as well. We find that unacceptable.

[Scott Reid, Conservative, Lanark—Frontenac—Kingston, ON]

I'm still going to move that we invite these individuals. The possibility also exists, and this worries me, that the minister would say truthfully, “I don't know, someone else handled that stuff”, but that reason would be insufficient. The minister did have a lot on her plate and may genuinely not know. I'm going to keep these names before us, but I do take the point to very much welcome the minister's presence here. In fairness to the minister, we might want to wait until Bill C-14 has been dealt with, because she does have something else on her plate at the moment.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, I thank my hon. colleague for that great question. Yes, the committee did great work. Without federal legislation in place, Canadians would face an uncertain situation. I respect the views, but the job is about representing our Constitution and Canadians' views in this place. It is also about passing evidence-based policies that benefit Canadians. The people of Brampton South elected me to be their voice here, to bring a different approach, and to implement our government's better plan. Bill C-14 is the right bill at the right time. It is the best approach. We need checks and balances. That is why the committee did a great job. Even the CMA said that. The Canadian Medical Association has pointed out that in the Carter decision, the “...parameters are vague in the extreme, and contain absolutely no clinical direction whatsoever”.

The term “grievous and irremediable” which is used by the court is not a medical term, so we need more clarification for that. That is why the committee did great work. We listened to all the consultations and this is the right bill. We have listened to all Canadians, and this is the right bill that we have to bring.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, I am humbled to stand in this place and take this opportunity to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

I will be splitting my time with the member for Kenora.

I know that this issue is very personal to Canadians. It is about quality of life and dignity. It is about autonomy. Most of all, it is about compassion.

I listened to many people in the constituency of Brampton South on this issue. I heard support from most people in my riding. I also heard sincere and heartfelt concerns, particularly from our Orthodox-based communities. I appreciate their conviction, and that they have raised their voices with respect to this important issue.

I will use my time today to explain why I will be voting for this important legislation.

My heart goes out to all of those suffering and their family members, who are facing circumstances I cannot imagine. I think we can agree that it is those who are suffering, and their families, who this debate should be about. I hope that hon. members will not forget that fact. We must lean toward a compassionate approach for those who are affected. This is a serious matter and a complex issue. Therefore, we must find the right balance.

Our government must address this now. The Supreme Court made a unanimous decision, and soon there will be a legislative vacuum.

I think we can agree that a patchwork approach by the provinces would be the wrong approach. We would be ignoring our responsibility to show national leadership on this matter.

The framework laid out in Bill C-14 provides a solid, focused and detailed plan, which will meet the June 6 deadline set out by the court. Let me explain why.

Permitting medical assistance in dying will extend more control to eligible terminally ill patients on how to live out their last days. This legislation also provides important safeguards and limitations. It requires the Minister of Health and the Minister of Justice, in consultation with the provinces, to create regulations that will protect all of those involved.

By permitting medical assistance in dying for competent adults, whose deaths are reasonably foreseeable, I believe we are striking the right balance between the patients' autonomy who seek this medical assistance and the interests of patients in need of protection.

It is important to note that this bill does not stand alone. I would point out the critical work of improving palliative care in this country. The ideas of medical assistance in dying and a strong palliative care system are not in conflict. Rather, the two are complementary and are both important issues to address. That is why I am proud that the Minister of Health has recommitted to home care and palliative care improvements in response to a question that I asked during question period on May 2. In her reply to my question, the minister quoted Dr. Atul Gawande, who talked about how people want not only a good death but a good life to the very end. The minister reiterated her commitment to palliative care and providing dignity when Canadians are suffering. She announced how she will work with the provinces to ensure the high quality care of all Canadians. She also brought up how the Government of Canada is committed to an investment of $3 billion over four years to support that goal of palliative care and home care improvements. I commend this step forward.

We cannot view assisted dying legislation separate from investments in our health care system. Quality palliative care is a critical priority of this government. Indeed, as our government renegotiates the health accord with the provinces, I look forward to seeing palliative care discussed. The work with the provinces, territories, and stakeholders is essential to providing options to end-of-life care.

My background is as a research coordinator and diabetes educator. I know how the roles and views of physicians and nurse practitioners are vital to this issue. As a member of the health committee, and someone who worked in the health care field for almost 20 years, I understand the importance of consulting the people on the front lines. Physicians and nurse practitioners are central to the end-of-life process. Their conscience rights will be respected in this legislation. We are working on the best way to ensure their views are always taken into account.

The rules in this legislation are clear and eligibility has been carefully defined. I want to be clear. There is nothing in the legislation that would compel any medical practitioner or authorized nurse practitioner to provide medical assistance in dying. The legislation is meant to balance access to medical assistance in dying while respecting the personal convictions of health care providers. This is about finding the right balance.

Canadians are looking to their doctors and nurses to provide health care and to help them maintain their quality of life. However, when the quality is no longer attainable, Canadians want to know that their health care providers will also help them when their choice is a dignified end to their lives.

We have struck the right balance in my view by having proper procedural safeguards. Access to medical assistance in dying would only be available to those who meet the following conditions: be a mentally competent adult who is at an advanced state of irreversible decline in capability; have a serious and incurable illness, disease, or disability; experience enduring and intolerable suffering; and whose death is reasonably foreseeable.

It will also remain a crime to assist a person either in dying or in causing a person's death in a situation other than lawful medical assistance in dying. Protective measures are a key part of the legislation to ensure that eligible patients have given informed consent. Patients have to make a written request for medical assistance in dying and have it signed by two independent witnesses. Two independent medical opinions have to confirm that the patient meets all the criteria. These first two criteria are intended to ensure that requests for medical assistance in dying are truly voluntary, that they reflect the wishes of the patient, and are not made as a result of external pressure.

Our evidence-based approach will include regulating, monitoring, and reporting. This monitoring and reporting system will also be able to signal any issues or unexpected consequences. We want Canadians to see a system that is functioning and preventing abuses or errors. This will build up confidence and allow Canadians to make informed decisions about how the system should operate.

I appreciate how other members have spoken about how we will look to international models in terms of ways to work with the provinces and territories. This end-of-life coordination system will respect the role of the provinces, while providing access and respecting peoples' rights.

I want to recognize the work of the committees and the senators who have studied this matter and made recommendations around this debate. These recommendations and testimony from those on all sides of this issue should be taken into account. There have been a number of informative and heartfelt speeches by fellow members who I also want to take a moment to applaud. I also thank the Minister of Justice and the Minister of Health for their work in introducing the legislation.

Bill C-14 strikes a proper balance in view of the Supreme Court of Canada's decision and provides a needed legal framework. As parliamentarians we have the final say on behalf of the people we serve who elected us to be their voice. This is a debate that engages our morality, our sense of justice, and our compassion. It asks tough questions of our legal and medical systems.

We have talked to one another and heard some touching stories. We have reflected on how this issue affects all of us. It has called on us to hear the stories coming from the prospective Canadians who are suffering. It is often all too easy to forget what we would do if we were in their shoes. We often fail to truly appreciate the perspective and experience of those diagnosed with a terminal illness. Their dignity is challenged more and more as they reach their end.

We need to pass this legislation at the soonest possible opportunity. I hope all members will support the bill with me.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, palliative care is something that the former and present members for Windsor—Tecumseh have been pushing passionately in the House, in the justice committee, and in the Senate-House mixed committee.

It is something we wished to see enshrined in this bill. We were disappointed there was not a dollar of money in the federal budget for palliative care, despite promises during the campaign. We were, however, able to get an amendment through in the preamble to Bill C-14 that at least addresses the urgent requirement for palliative care.

The Minister of Health, herself, has pointed out that less than 30% have access to palliative care in Canada. That is connected—it must be so connected—with this bill that we need to do much better on that score.

I just hope the government actually puts its money where its mouth is and comes up, in the health accords, with meaningful help for palliative care and hospice care from coast to coast to coast. It is so urgently needed.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I am not clear to this moment on why the government is so bent on passing a law that so many believe to be unconstitutional.

I frankly do not understand why the very thoughtful amendments were rejected yesterday. This was purported to be a free vote, but I did not see more than a few Liberal members stand against this bill.

Tonight, I understand we will be voting at third reading. This is the opportunity for members, particularly those concerned about rule of law, to come forward and vote against a bill that is patently unconstitutional, to get it right for Canadians, and protect those individuals who had their rights given to them, clearly, in the Carter case and would now see those rights taken away by Bill C-14.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I thank the parliamentary secretary for his perspective on this, and I am sorry he is disappointed. We are trying to do our best for Canadians to get a bill in place that will not find suffering Canadians lined up at the Supreme Court doorstep as soon as we pass it. That is why we are doing this, and we hope people will support that initiative.

To talk about a legal vacuum is misleading, with great respect. We already have every college of physicians and surgeons across the land involved in having safeguards in place. Yes, having Bill C-14 on June 6 would be preferable to not having Bill C-14 on June 6, but having knowingly passed a law that is unconstitutional would be even worse. Let us take the time, I say, to get it right, not to get it done right now.

[Scott Reid, Conservative, Lanark—Frontenac—Kingston, ON]

Sorry. I wouldn't have eaten into Mr. Graham's time if I'd known I was about to go next.

It seems we're moving into debate here. The rules seem to me to be quite clear in this matter, and this does constitute a breach of privilege. We can review the rules.

I think what is being asserted by the Liberals is that a convention has developed of saying that if the rules are violated in this way, it's just a pro forma violation. We can all live with it. We ought not to be objecting to it. Conventions do from time to time develop, both that something that is formally prohibited is in practice permitted and the reverse. Something that is formally permitted is beyond the pale of acceptable behaviour. That then becomes something that is prohibited and practised. We all get the point that if the Governor General started vetoing laws, which in theory he could do legally, we would start looking for a replacement Governor General because he would have gone beyond what is conventionally acceptable behaviour.

I think the Liberals are arguing that a convention has developed. I'm willing to accept that the Liberals have developed this kind of conventional point of view because they did not move questions of privilege when these items they've pointed to.... I think Mr. Graham's case is less convincing than Ms. Vandenbeld's, but that's why I've asked to see the articles, so I can see if the facts correspond with the assertions.

If they failed to move questions of privilege at that point, that suggests that they'd accepted a certain way of behaving, which they now seek to turn into a modus vivendi, a way of operating, all the time in the future. If we say this was okay, then we are saying that this will happen every time. This will become the standard of behaviour. The Liberal government will always be releasing select details—not all the details came out— of its legislation ahead of time. I accept the fact that they will not be doing this on budgets, as clearly there's a very strict rule that we all accept in that regard, but it looks to me as though they are trying to move in that direction.

Therefore I implore colleagues not to go in the direction of saying that this was okay and that this is somehow what the new standard should be. That is effectively saying that Parliament, the House of Commons, will be sidelined. This will be the status quo from now on. Indeed, that is the exact assertion that the Liberals are making right now, that the Liberals were advised to make. Your research bureau did good work and got you those points, but it was an unacceptable practice. If it ever happened in the past, it's unacceptable now. Our convention should be to say Parliament, the House of Commons, is where legislation is revealed.

Let's be clear about the leak that occurred with regard to Bill C-14. It was meant to turn the debate in a certain direction. It was meant to have the effect of causing opposition on the side saying the bill doesn't go far enough to gel rather than opposition on the side saying that the bill goes too far. It's a very clever and, I might say, a very successful communications strategy based on what's happened since that time. But it gutted Parliament's role in this process. It was unacceptable. It was wrong. There is no excuse for it happening. I come down on the side of saying the convention should be that we follow the letter of the rules and not that we deviate from them.

That's all I have to say. Thank you.

[Ruby Sahota, Liberal, Brampton North, ON]

From reading some of the snippets of the media reports regarding Bill C-14, we've been talking a lot about not what's in the bill, but what may not be in the bill. Could this be perhaps seen as journalists' speculation at times around talk that has been discussed?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I am honoured today to speak to Bill C-14 at third reading.

Four months ago, I walked into the first meeting of a special House and Senate committee, created to advise the government on its response to the Supreme Court of Canada's decision in the Carter case. We worked long hours and late nights, respectfully and constructively with all parties and involving both chambers. We heard from witnesses and experts from across Canada and from all walks of life.

As we worked, I know that many of us thought of those who had struggled and suffered for the right to control their own lives at the end: people like Sue Rodriguez, who died in 1994 after losing her battle with ALS and losing her battle in the Supreme Court of Canada a year before. I recognized important contributors like Svend Robinson, member of Parliament, in that earlier battle. I think of people like Kay and Lee Carter, Hollis Johnson, William Shoichet, and Gloria Taylor, who fought valiantly and won in the court last year.

The work of the Special Joint Committee on Physician-Assisted Dying proved that a thoughtful and respectful debate was possible, but more than that it proved that a well-crafted bill could win the support of all parties and members of both Houses. I say that because a broad majority of us from all parties and both chambers agreed on 21 recommendations to the current government. I never imagined that I would be standing here now to oppose this bill.

This government bill ignores or rejects the majority of recommendations of that joint House and Senate committee. I am proud of those recommendations. It is true that many would have required great political courage, but all of them faithfully followed the evidence we received from the majority of experts who appeared before us. For example, I sought to have advance requests accepted by people who may lose the ability to provide competent consent at the end. The vast majority of Canadians told us that they want that. However, not only does this bill reject those recommendations, the bill would defy the Supreme Court ruling, fall short of its requirements, and therefore would violate the Charter of Rights and Freedoms for suffering Canadians.

That is the opinion of the Canadian Bar Association, the Barreau du Québec, and many others. That was the ruling of the Alberta Court of Appeal a couple of weeks ago, and just days ago, a court in Ontario echoed the Alberta decision. Justice Paul Perell of the Ontario Superior Court of Justice ruled that the Supreme Court's basis for an assisted death “is the threat the medical condition poses to a person's life and its interference with the quality of that person's life”. He went on to say, “There is no requirement...that a medical condition be terminal or life threatening.”

Despite this, time and again the current government has limited debate and tried to strong-arm a flawed bill through this chamber.

To be sure, this is a complex and sensitive issue, but not a partisan one. The Supreme Court has given us as parliamentarians an opportunity, not an ultimatum, to craft legislation that is consistent with the Carter decision. As is so often the case in this debate, we ought to look at exactly what the court said. Here is what they said, in paragraph 126 of the decision: “It is for Parliament and the provincial legislatures to respond, should they so choose, by enacting legislation consistent with the constitutional parameters set out in these reasons.”

Today the Minister of Justice again suggested that the court instructed us to enact a bill by a particular date. The court said the opposite. Each of us as parliamentarians, facing a free vote, has a simple question to answer: Does this bill obey the constitutional parameters set out by the Supreme Court in Carter? In my submission, that is the only question. If it does not, if it fails that test, then this House is being asked to knowingly infringe the charter rights of suffering Canadians and to enshrine that violation in law.

The Supreme Court of Canada established that all adult competent Canadians suffering intolerably from a grievous and irremediable medical condition have the right to choose assistance in dying. The government would have us honour that right only for patients nearing the end of life.

The Canadian Bar Association has said that such a restriction does not meet the floor of rights established by the court. The Barreau du Québec has said the same, and so has the Canadian Council of Criminal Defence Lawyers, the BC Civil Liberties Association, and many other respected legal organizations.

I suggested removing this line to help the bill comply with the court and the charter, but that idea was rejected by the Liberal majority. Now the Alberta Court of Appeal has ruled unanimously that the government's interpretation of Carter is simply wrong. In a crucial decision that the court wrote a couple of weeks ago, it said:

Carter 2015 does not require that the applicant be terminally ill.... The decision itself is clear. [...] The interpretation urged on us by [the Department of Justice] is not sustainable having regard to the fundamental premise of the Carter case itself....

This is a devastating indictment of the very argument that the government has relied upon to defend Bill C-14 against this rising chorus of critics. Surely that ruling should give us all pause. However, still some will argue that the Supreme Court cannot be obeyed right away, that medical reality dictates a balanced approach.

The government's restrictions have raised eyebrows in the medical community as well. The federation representing every medical regulatory authority in Canada has called this bill's end-to-life requirement “too vague to be understood or applied by the medical profession and too ambiguous to be regulated effectively”.

The College of Physicians and Surgeons of Ontario called it inconsistent with Carter and likely to cause confusion among physicians. The Canadian Nurses Association suggested going back to the words of the Supreme Court, as I have done in this place. If that were done, this controversial line could simply be deleted. I proposed doing exactly that, and my amendments were rejected by the Liberal majority on the Standing Committee on Justice and Human Rights.

Not only are medical groups concerned about the bill, many were not even consulted. According to testimony in the Senate, neither the Federation of Medical Regulatory Authorities of Canada nor any of the provincial or territorial colleges were consulted in the drafting of the bill.

We have a bill in which a few key lines have drawn heavy fire from both the legal and medical communities. These lines could be written on a napkin. They could easily be deleted, as my amendments would have done, and replaced with the exact words of our Supreme Court. Who could resist and oppose that in good faith? However, the government has refused precisely to do that.

On the first day of committee hearings, a Liberal member asked the Minister of Justice a simple question: “Have we sought outside counsel to ensure charter compliance of this bill?” The minister chose not to answer, citing only her personal confidence in the bill. Clearly, no independent confirmation of its charter compliance has been found.

I appreciate what the minister told this House recently, that no one has a monopoly on interpreting the charter. Of course, the minister is right, but I am afraid that the outlier here is not the critics; it is the government. The Canadian and Quebec bar associations, eminent legal and medical experts, the lead counsel in Carter, all are saying that the bill does not obey the Supreme Court of Canada's ruling.

Against that array, the government stands almost alone, brandishing a backgrounder from the Department of Justice and refusing to refer the question to the Supreme Court, or even to obtain an independent legal opinion.

Now the Alberta Court of Appeal has unanimously rejected the government's argument that the Supreme Court limited its ruling to end-of-life patients. Let me repeat: A provincial court of appeal has already ruled that the government's narrow and selective reading of Carter, the legal argument that supports this bill, is not consistent with the Supreme Court's ruling and therefore infringes a patient's charter rights.

Now we are being asked to enshrine that violation in law, and with what justification? No argument has been made for the bill's compliance with Carter and the charter. The minister is right that Bill C-14's many critics cannot simply assert that the bill is not constitutional, but neither can the government simply assert that it is. No one can claim to know the inner thoughts of our Supreme Court justices, but neither can the government continue to suggest that the intention of their ruling is somehow opaque or unknowable. The ruling was not an ink blot test, it was quite clear. The court was looking at the law with the same objective as the bill, to protect specific vulnerable individuals suffering during moments of weakness. The court found that the previous ban was overbroad because it caught people outside of that class, competent people who were not vulnerable and therefore deserved to have their autonomy respected.

That would remain true under Bill C-14. An entire class of competent adult Canadians would be condemned to intolerable suffering and denied recourse to assistance in dying. They may be forced to end their lives prematurely or violently. These are the same violations of section 7 rights identified already by the court in Carter. Although the court in Carter did not choose to proceed to an analysis of a section 15 infringement, the equality rights provision, the trial judge did. She concluded that the prohibition “imposed a disproportionate burden on persons with physical disabilities, as only they are restricted to self-imposed starvation and dehydration in order to take their own lives”.

As Quebec's minister of health warned us when he spoke out against the bill, this is precisely the same cruel option that will soon face patients if Bill C-14's end-of-life clause is not deleted. It is shameful that the bill leaves suffering Canadians in that cruel position.

At committee, I pressed the Department of Justice on this point. I told them the story of Tony Nicklinson. This story comes from an affidavit filed in the Carter case. During a business trip to Athens, Mr. Nicklinson suffered a severe stroke that caused what is called locked-in syndrome. In this state, he could not move a single muscle of his body except his eyelids. His healthy active mind was trapped in an unresponsive body, without remedy, without hope, and perhaps for decades more. He said he could not even drink and smoke in the hopes of shortening his life. Mr. Nicklinson wrote this in an affidavit, one blink at a time. He told the court this:

The flaw in the argument is the assumption that we all want to live whatever the cost in terms of quality of life when this is clearly not the case. I want to make that choice for myself. What prevents me is the fact that I am too disabled to take my won life and unlike an able bodied persons I need help to die.

By all means protect the vulnerable (by vulnerable I mean those who cannot make decisions for themselves,) just don't include me. I am not vulnerable. I don't need help or protection from death or from those who would help me - if the legal consequences were not so huge....

I am asking for my right to choose when and how to die to be respected. I know that many people feel that they will have failed if someone like me takes his own life and that life is sacred at all costs. I do not agree with that view. Surely the right and decent thing to do would be to empower people so that they can make the choice for themselves.

Mr. Nicklinson did not live in a place which empowered him to make that choice. He did not have the option of medical assistance to die peacefully, and so he starved himself to death. If he were alive today, Bill C-14 would offer him no hope, no respect for his autonomy.

This is the point I made to the Department of Justice. I was told that I was wrong. I was told that Mr. Nicklinson would not have to starve himself to death in Canada. He would just have to starve until a doctor declared his life “reasonably foreseeable”. Those are the words used in Bill C-14.

This is what we are talking about when we say that the bill infringes on the Charter of Rights and Freedoms for Canadians. Quebec's minister of health warned the government that the bill would force competent, consenting patients to endure starvation to win from the current government the rights that were already granted to them in the Carter case.

The court found the previous ban unconstitutional, not only because it violated the rights of competent patients but also because it was unnecessary. A better system was possible. Vulnerability, it said, could be assessed on an individual basis, and well-designed safeguards are capable of protecting the vulnerable. With these facts, the court could see no justification for continuing to deny the autonomy of whole classes of competent patients, like Mr. Nicklinson.

There is still no justification. In fact, the last refuge for the government would be to accept what is now clear, that Bill C-14 does not meet the test of the Supreme Court, and to argue that somehow it is necessary to violate the charter or even wise, because the safeguards the Liberals have developed are too weak to handle more complex cases. The bill is flawed, and I cannot accept that argument.

I was proud to serve on the joint House-Senate committee that offered recommendations to the government before the drafting of Bill C-14. We studied best practices around the world and recommended many of the robust safeguards found in the bill. Above all, I have great confidence in the care and professionalism of Canadian medical practitioners, and so I cannot accept that the Supreme Court was wrong in saying that well-designed safeguards can protect vulnerable people. I cannot accept that this regime is so weak—or Canadian doctors so careless—that it cannot be trusted to faithfully uphold the full charter rights of patients and to filter out those who are not able to make this choice.

Therefore, I am left with a simple conclusion. Enacting the bill would revoke from an entire class of competent and suffering adult Canadians the rights established for them by the Supreme Court. It would do so in a manner that is neither medically necessary nor legally justified.

I have sought to amend the bill and have seen those solutions rejected. I have requested independent constitutional analysis, and found none. I have called on the government to refer it to the Supreme Court of Canada, and it has not. Now I cannot, as a lawyer and a parliamentarian, support the enactment of a law that I believe would be unconstitutional from the outset. To vote for Bill C-14, against the charter rights of suffering patients—and I know some of them by name—I cannot do.

The government may try to excuse the bill's imperfections as inevitable in the circumstances, and I know there are members here who recognize that the bill is flawed but have been told they simply have to pass it by June 6.

Let us be clear about what happens on June 6. The absolute ban on medically assisted dying will not be restored, nor will the offences that prevented it, such as aiding suicide, disappear from the code. In other words, crime will not become legal, nor will medical assistance in dying become illegal. Rather, an exemption will open for patients and physicians acting within the parameters of the Carter decision. Of course, every provincial regulator has made rules to deal with safeguards over the last year anyway. They are ready to go. A federal law is not necessary to provide basic access and safeguards.

I call on my colleagues across the aisle, with whom I have worked constructively and collaboratively, to give real meaning to this free vote, to prove by their example what Canadians know to be true, that the final word on our constitutional rights comes not from the PMO but from the Supreme Court of Canada.

I move:

That the motion be amended by deleting all the words after the word “That” and substituting the following:

“Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be not now read a third time but be referred back to the Standing Committee on Justice and Human Rights for the purpose of reconsidering Clause 3 with a view to ensuring that the eligibility criteria contained therein are consistent with the constitutional parameters set out by the Supreme Court in its Carter v. Canada decision.”

[David Christopherson, NDP, Hamilton Centre, ON]

Thank you, Chair, and thank you both for your attendance today.

Having been around the mulberry bush on this one quite a number of times, I don't have a lot of questions. Most of my questions would come up as a matter of detail when circumstances arise. I may not even need all my seven minutes in this particular round. I know. It will be the second time by the way.

Chair, as much as you'll allow it, and I look to your discretion to guide me, given the fact that on April 14, Bill C-14 was introduced, that was the day of the leak. The chief government whip acknowledged there was a leak and apologized. At least it was reported. The notes say unreservedly, and I take them at face value. When you ask the question, who benefits, it's pretty clear it's the government. Nobody else benefited from this leak. Quite frankly it would be difficult for anybody other than the government to have the information to leak in the first place.

Has the government initiated any kind of a review themselves? It's clear one of their own has leaked this. Can somebody over there give me some kind of an answer, Chair?

[The Chair, Liberal, Larry Bagnell]

You've been invited to address Bill C-14 today if you want to address the.... I'll leave it up to you. I know you weren't prepared.

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Mr. Speaker, I would like to ask my colleague a question in light of so much wasted opportunity to discuss and really develop a meaningful piece of legislation that all of us could have an opportunity to weigh in on.

I really want to hear a little more about the importance of a palliative care strategy. I found it appalling that we were introducing the bill with such a lack of information. It was almost insensitive that we would be discussing something like Bill C-14 without any real, meaningful, tangible information regarding not just palliative care but enforcing the Canada Health Act in terms of home care.

I wonder if the member could expand on what some of the real tangible actions would be in a palliative care strategy that he would like to see happen in light of this.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, I rise in the House today to speak on an issue that may very well be one of the most significant, important social issues that this Parliament, in the life of this government, will ever face. This is not a matter that I take lightly, the issue of life or death.

Over the last few months, I have had the opportunity to speak with constituents in my riding. I have read the letters and emails they have written in. I have consulted with spiritual leaders from many faiths in the communities within my riding. I have sat through every single minute of this debate, because the magnitude of the legislation is something that deserves our thoughtful consideration. It is also something that has been weighing heavily on me, because regardless of my personal beliefs, I represent the tens of thousands of friends and families in the beautiful riding of Cariboo—Prince George.

For years I have worked toward my dream of becoming a member of Parliament, because I knew this opportunity would afford me the chance to make a difference, to be part of meaningful change, and to leave our country better for generations to come, but nothing truly prepares one to vote on a piece of legislation of this magnitude.

I am at the age and the point in my life where, unfortunately, I have seen my fair share of human suffering. It is a true test of humans to watch a loved one, a friend, or even a stranger, who is faced with intolerable suffering with no hope of recovery.

It is a reality that physician-assisted suicide will indeed become law. This we know is true. In 2015, the Supreme Court of Canada issued a landmark ruling in Carter v. Canada, stating that the laws preventing Kay Carter from ending her life in Canada were contrary to the Charter of Rights and Freedoms.

Kay Carter was a schoolteacher, a wife, and a mother. She was suffering from severe spinal stenosis, a disease that was making it impossible for her to move her body. She was 89, and because medical assistance in dying was illegal in Canada, Carter and her family travelled to a Swiss medical clinic, where she chose to end her life in 2010.

It is not in dispute that Carter was faced with intolerable suffering, but Carter's family and their lawyer have publicly stated that they believe that Kay Carter would have been ineligible for medical assistance in dying under Bill C-14. Therefore, my question for my colleagues across the floor is this. If this legislation was built to address the decision of Carter v. Canada, then why would it likely exclude the very case that opened the door for physician-assisted suicide in our country?

Many have expressed their concerns that this legislation is unconstitutional. Benoît Pelletier, a professor from the University of Ottawa, appeared before the special committee tasked with studying assisted suicide. He said that people suffering with illnesses that are terminal or cause intolerable suffering are at risk of being encouraged to seek an assisted death. He also said:

...all persons are potentially vulnerable. Being vulnerable does not disqualify a person...from seeking an assisted death, but it does put that person at risk of being induced to request a death....

This is among the most troubling testimony. Beyond legal implications, the opposition to Bill C-14 crosses party lines. We have heard from Conservative, Liberal, and NDP members, as well as concerned senators, multiple witnesses, and organizations such as the B.C. Civil Liberties Association, the Alberta Court of Appeal, and the Canadian Bar Association. At the core of our democracy is the ability to have thoughtful debate and discussion on a wide range of issues. Some of these issues are easier to address than others. Sometimes there is a unanimous consensus, and sometimes there is not.

We need to acknowledge in cases where there is not consensus that more work needs to be done, amendments need to be considered, and a majority control of the House should not be used to thwart dissenting opinions, especially on an issue of this scope and magnitude.

Dealing with the sanctity of life and death should be cause for more consultation, more discussion, and more debate than that over a pipeline or a budget. We have debated this for approximately 20 hours. Over half of the Conservative caucus has not had the opportunity to debate this subject. Even more of my Liberal colleagues have not had the opportunity to speak on this. It is concerning to me that on a piece of legislation of this magnitude, my Liberal colleagues have not had the opportunity to speak on this. It would appear from the outset that perhaps the Liberal backbenches are, indeed, being muzzled on this important piece of legislation.

Quebec took six years in successive legislative assemblies to develop its physician-assisted suicide law, six years of consultations and commitment to ensure its bill was not just good enough but one that captured most, if not all, concerns and safeguards.

Time and again, we have heard it is good enough at this point. To me, good enough is not good enough when we are talking about life and death. I am a firm believer that it is better to miss a deadline than to get such an impactful piece of public policy wrong. This piece of legislation is likely the most important law in our generation.

The Liberal government should allow all members to speak on behalf of their constituents and engage in further necessary consultations in order to get the legislation right, because the alternative is passing a deeply flawed and in my opinion unconstitutional piece of legislation. Passing Bill C-14 in this manner will result in court challenges that will further deadlock the work of the House and parliamentarians in having a workable document that protects the most vulnerable members of society from abuse.

The debate on assisted suicide over the last few months has opened the door to some of the alternatives that also need to be considered when speaking about Bill C-14. Palliative care is a critical component of this issue. We must always ensure that a proper palliative care strategy is in place. While the government likes to talk about this being core and an important piece in its budget and in moving forward, it has not even been mentioned once in the most current budget.

To ensure that individuals are well informed about their end-of-life options not only physically but to deal with their emotions, palliative care needs to be a viable end-of-life choice. At a time when assisted dying is a hotly contested issue, it is important to engage in conversations around palliative care to ensure that people are making the best decisions to improve their quality of life. We need to protect our most vulnerable.

As I mentioned previously during this debate, I am a father of a mature child who is cognitively challenged. While a healthy and productive member of the community, who I am extremely proud of, my daughter could not, today, make an informed consent, let alone if she was dealing with a grievous and terminal disease.

We also need to consider the medical professionals, the doctors and nurses, who went into their chosen fields to save lives, to improve lives, to ensure that lives are not lost and continue to be healthy. We need to ensure that these individuals are also protected and that the responsibility for this is not downloaded to the provinces. We need to ensure that this piece of legislation does not become a vehicle for those suffering with mental health issues to end their pain or that physician-assisted suicide is not chosen or forced due to obligation or feelings of burden.

Catherine Frazee, professor emerita at the school of disability studies at Ryerson University, said it best when she stated:

At the heart of this debate, we must choose between competing visions of our social fabric. Shall we uncritically submit to the voracious demands of individual liberty no matter what the social cost? Or shall we agree that there are limits to individual freedom, limits that serve all of us when we are vulnerable and in decline?

When we start deconstructing the foundation upon which our society is built, the social fabric, we need to ensure that proper safeguards are in place, a system of checks and balances. This system is not built overnight and it is not built through a limited debate and time allocation. It is built through listening, learning, and acknowledging a wide variety of viewpoints, stories, and opinions, through co-operation and thoughtful analysis and acceptance of amendments, none of which seem to be in line with the Liberal government's priorities.

I would like to thank our colleagues from all sides who have shared their experiences with us over the course of this debate. I appreciate each and every one of their views and their openness in sharing these deeply personal experiences, and I thank those in my riding of Cariboo—Prince George, the countless numbers, who have shared with me their views and experiences.

I would also like to thank the members of the committee who worked tirelessly towards a solution. I thank each of them for taking the time to voice their feelings on this important piece of legislation.

For the reasons I stated throughout my speech, I will not be able to support Bill C-14 as it currently stands.

[The Chair, Liberal, Larry Bagnell]

The other one, as you can probably guess, is a student. A lot of MPs are being shadowed today by students, and Maris is here. Welcome.

We welcome Marc Bosc, Acting Clerk and Philippe Dufresne, the Law Clerk and Parliamentary Counsel, and our visitors.

Just so the committee knows, our long-awaited family-friendly interim draft report will come out on Thursday afternoon. It's in translation.

In terms of our first item of business for this morning, for anyone who wasn't here at the time, we have already had the Clerk and the Law Clerk here to give their opening remarks on the question of privilege on Bill C-14, but they had just got through their opening remarks when we got called to a vote. They're back to do that question and answer round. In the second hour, we'll do the other question of privilege. More than likely, it's committee business. We'll do that in the second hour, as well as any other committee business people want to do.

Without further ado, I think we'll go to the first round. We'll start with Mr. Chan.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, that is the salient question: what happens on June 6? I asked for a report from the Library of Parliament. It said that it will be the Carter decision and that it will be applied differently across Canada. In each province it will be the College of Physicians and Surgeons that will determine that. In Ontario, it will be required by physicians whereas in some provinces it will not be. In some provinces the provincial government will be engaged and in others it may not. Therefore, we will have a hodgepodge of how this will be applied across Canada. That is not in the interests of Canadians. Therefore, we need to pass this. Legislation is required. The problem is that Bill C-14 needs to be amended. It has some big holes in it. I hope the government will co-operate and listen to members of the opposition and listen to Canadians and fix Bill C-14.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I want to thank the Minister of Justice for being here today to speak in the House and for sharing her perspective and the government's perspective on Bill C-14. I found her to be always available and very thoughtful, and I thank her for her involvement.

I have been honoured to be part of the joint committee that dealt with the bill starting in January. I was also part of the justice committee when Bill C-14 was sent there. As the minister said, the opinions on this issue of assisted suicide are very diverse. Within each of the parties it is very diverse. However, I want to thank all members of Parliament for being respectful and working together on this important issue.

We are dealing with this issue because of the Carter decision. The Supreme Court said in the Carter decision that this must be allowed. The Criminal Code will be amended, and it is up to Parliament to come up with safeguards, not that this is permitted. However, the Supreme Court decided that we are to create safeguards.

We have also heard that 84% of Canadians want this. However, that statement that we have often heard is a little misleading, because 84% of Canadians do support this under certain criteria, and that criteria is that the illness is terminal, and the person is suffering terribly and repeatedly asks to have assisted suicide to end their suffering. Therefore, it is important to remember that it is under certain conditions.

I have consulted with my constituents on this issue. I sent out a householder, and I was very thorough and non-partisan. The householder I sent out provided a background and laid out all the different issues that Parliament is having to deal with: conscience protection, palliative care, who can provide this service, should there be judicial oversight, should the cause of death be listed for data collection as assisted suicide or euthanasia, mature minors, and on and on.

I had response to this householder, and one week ago, I had our second town hall meeting on this. In both cases, we had a huge response from the constituents. Actually, we have had more of a response to this issue through emails, phone calls, letters, and responses to the householder. We have had more responses on this than on any other issue in the last 12 and a half years that I have been a member of Parliament. People are very engaged and understand what the issues are and the challenges that the House faces.

Again, I thank the Minister of Justice, but as a critique, I think the government could have approached this a little differently, instead of dominating the committee structures, instead of bringing in time allocation, and instead of saying no to all the amendments.

The minister spoke about the 16 amendments, which, of course, were Liberal amendments. Of the amendments, there was one that the Conservative Party and the NDP at committee agreed with, and that was on conscience protection. We asked that all physicians, health care professionals, nurse practitioners, pharmacists, or anybody who is a health care professional who does not want to be involved with this have the right to say no. However, the government turned down that amendment.

The fact is, the parliamentary secretaries in the committee talked to each of the members on that committee and told them that the Liberals were not going to support that. Then the parliamentary secretary of justice actually spoke at the committee and said that the government did not support amending like that.

As the Minister of Justice just said, the government is going to leave it to negotiating with the provinces, and download that responsibility to the provinces. However, what we are doing in Bill C-14 is amending the Criminal Code of Canada. Prior to the Carter decision, it was illegal to assist anybody in a suicide. It was legal to commit suicide but illegal to assist somebody. It was considered homicide if someone assisted somebody.

Under the Carter decision a physician can, under certain conditions, provide assistance in a suicide and euthanasia. That amendment to the Criminal Code also could be elaborated on to say that it would be a criminal offence to force health care professionals or any individuals through coercion or intimidation, to participate in the death of another individual against their will. That is what we suggested.

When Bill C-14 gets referred to the Senate it will have to deal with it. I believe the Senate will refer this legislation back to the House. It is going to refuse to accept Bill C-14 the way it is and it will provide proper conscience protection for physicians.

We heard from the Canadian Medical Association that 70% of physicians in Canada do not want to be a part of this. They do not want to be forced through coercion, intimidation, or threats that they will no longer be able to practise at this or that hospital if they do not participate.

In a National Post article called “'Killing' patients vs. 'doing their job': Sharp division of opinion on whether doctors should be required to assist in suicide”, a doctor says she has been practising medicine for 37 years. The family doctor has decided not to renew her medical licence in June of this year. Dr. Naylor has no desire to quit medicine but she says she is appalled at the thought of being forced to refer. Dr. Burke, who practises physical medicine and rehabilitation in Windsor Ontario, said he is renewing his medical licence in Michigan where assisted suicide is illegal.

I have heard this at town hall meetings across the country and at the two I had in my own community. A young medical student asked me if physicians were going to be forced to do this and I said that there is a good possibility because in Bill C-14 the government is leaving it up to the provinces. We have already heard that the College of Physicians and Surgeons of Ontario will require physicians to effectively refer, which means that a doctor must follow that person through the whole process to make sure he or she does get euthanized if that is what the individual requested. The doctor must participate.

Physicians across this country, like those I just mentioned, are going to refuse to participate, saying they are now of retirement age and will retire or will relocate to another jurisdiction where they will not be forced to be a part of this, which goes against their conscience. A shortage of physicians and nurses will create a medical emergency in Canada. We will have a shortage of physicians and nurses in Canada because they will be forced to participate in something that goes against their conscience.

The government has an opportunity to do the right thing. It refused to do it in the House so it will be left to the Senate. The Senate will decide and it will amend Bill C-14. It will come back to the House in an amended form. We do not know how long that will take but it is obvious that the June 6 deadline will not be met. I hope the government will play differently then and will co-operate with the Senate and not strike down its amendments.

It is better to have Bill C-14 than nothing but it does need to be amended. The government needs to be more open-minded and congenial and work within this parliamentary environment and come up with legislation that represents where Canadians are at on this issue, not where the government is at.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Mr. Speaker, in terms of amendments, 16 have been made to Bill C-14, which have strengthened the proposed legislation with respect to seeking to draw the balance between personal autonomy with protection of the vulnerable and ensuring that we do as much as we can to protect the conscience rights of medical practitioners.

I recognize the member's multiple submissions to the House on this legislation. I also recognize the tremendous experience of years of discussions that the province of Quebec has had with respect to putting in place its own laws.

With respect to Kay Carter, I am absolutely certain that Ms. Carter would qualify under the eligibility regime as presented in Bill C-14. We specifically ensured that we provided a broader definition around what grievous and irremediable meant and we put in place eligibility criteria that would ensure there would be flexibility in our regime and provide medical practitioners with the ability to engage with their patients. They are the most familiar with their patients and by virtue of that relationship can determine whether there is eligibility or not.

[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 third time and passed.

Mr. Speaker, I want to begin today by acknowledging the contributions of all members of the House, in particular, the members of the Standing Committee on Justice and Human Rights, for how they have approached our debate on Bill C-14.

It is clear that members from all parties have engaged closely with their constituents, members of other parties, and their own experiences to make thoughtful and genuine contributions to our country's conversation on medical assistance in dying. This is one of the most important issues that this Parliament will address.

Bill C-14 represents the government's policy choice to address medical assistance in dying, a choice that is fully informed by consultations with Canadians and experts and takes into account all the interests and values surrounding this matter.

When the Carter decision came down in February 2015, one debate ended and another began. It was no longer a question of whether Canada would permit medical assistance in dying, but rather it was about how our country would do it.

Bill C-14 would create a statutory framework for medical assistance in dying that considers the perspectives of those who may wish to access it; those who are concerned about its consequences, including vulnerable persons who could be put at risk by the legalization of this practice; and those who may be asked to provide the assistance.

While the Carter decision told us that an absolute prohibition in the former law went too far, it did not tell us how medical assistance in dying should be implemented. The Supreme Court of Canada acknowledged that the issue “involves complex issues of social policy and a number of competing societal values”. The court stated that it:

emphasized that there may be a number of possible solutions to a particular social problem, and suggested that a “complex regulatory response” to a social ill will garner a high degree of deference.

The challenge facing Parliament is about setting new boundaries. Who should be eligible for medical assistance in dying; what safeguards should be required; how will it be monitored; and what issues require more study?

A proposed law that answers these questions must comply with the charter, but that does not require replicating the Carter decision. The Supreme Court of Canada has recognized that the relationship between the courts and Parliament should be one of dialogue. Just as Parliament must respect the court's ruling, so too must the court respect Parliament's determination of how to craft a statutory scheme in response to the court's judgment.

It is helpful to know how this dialogue has played out in previous instances. For example, in R. v. O'Connor, a 1995 charter challenge in a sexual assault case, the Supreme Court mandated the disclosure of therapeutic records in the Crown's possession and set out a common law procedure for the production of these records.

In response, Parliament enacted a statutory disclosure regime that differed in significant ways from the court's approach. The court upheld the constitutionality of that statutory regime, noting that it could not be presumed, just because Parliament's scheme looked different from what the court had envisioned, that it was unconstitutional.

Instead, there is this dialogue between the legislative branch and the courts. The court can provide the general parameters for a response, but it is for Parliament to craft the regime. Details of that regime matter because they necessarily engage fundamental choices of our rights and values and reconciling the tensions that sometimes exist between them.

In developing a response to the Carter decision, the government was called on to simultaneously promote autonomy, protect the vulnerable, affirm life, prevent suicide, support persons with disabilities, respect freedom of conscience, and fully consider many other valuable interests. As we went about this, we remained mindful of our constitutional framework and the divided jurisdiction between Parliament and the provinces and territories.

In weighing these values and making these policy choices, we were not alone. In the past number of months the national conversation on medical assistance in dying has been rich and fulsome, and no doubt it will continue.

Following the introduction of Bill C-14, the relevant standing committees of Parliament, including the justice and human rights committee and the Senate legal and constitutional affairs committee, which conducted the pre-study of the bill, have heard diverse perspectives from stakeholders and experts on all aspects of medical assistance in dying. Bill C-14 strikes a balance regarding eligibility and safeguards, as well as setting out what the federal law should do and what should be left to the provinces and territories to regulate.

Not everyone agrees with these policy choices. Still, I am confident that the decisions fall squarely within the range of alternatives that are legally open to Parliament to adopt. It would have been easy for the government to cut and paste the language from the court's decision into a new federal statute, but such an approach would have meant ignoring all the consultations and evidence that I have just referenced. It would also have fallen far short of developing a complex regulatory regime to balance competing interests, which the court said was the task of Parliament to craft and not the courts.

That evidence, presented over the past year, confirms that medical assistance in dying may pose risks to the vulnerable, even in circumstances where there is a general consensus that the person should be eligible for the procedure. That is why the bill provides for significant procedural safeguards, even when all of the eligibility criteria are met. This is why the bill would also put in place the necessary legal framework to monitor how medical assistance in dying is implemented in Canada.

In terms of eligibility, the policy choice made by the government was to focus on persons who are in an advanced state of irreversible decline and whose natural deaths have become reasonably foreseeable.

Recall that medical assistance in dying is exceptional because, from a criminal law perspective, it is a situation where one person actively and knowingly participates in the death of another. We criminalize and strongly condemn this conduct in all other circumstances. The only place in our criminal law where this conduct is justified is in self-defence, where individuals are permitted to take a life but only in order to save their own life or someone else's. While medical assistance in dying has medical and health law aspects to it, we cannot lose sight of this dimension either, because it is the criminal law power that is the primary source of Parliament's jurisdiction to address this issue, and it was the criminal law that, before the Carter decision, stood in the way of medical assistance in dying.

Having given careful consideration to the risks that may be posed when anyone, even a physician or nurse practitioner, is permitted to end another person's life, the balance reflected in Bill C-14 is that medical assistance in dying should be a choice for Canadians about how they die, so that they may have access to a peaceful passing. The bill would create a complex regulatory regime to respect this choice and ensure it is exercised in a voluntary and fully informed manner. Equally, the criteria ensure that, for Canadians who are not declining toward death, the focus of medicine remains on improving life, not ending it.

We also recognize that there are those who believe that the law should permit access to medical assistance in dying in other situations. The government heard these concerns loudly and clearly. The Standing Committee on Justice and Human Rights amended the bill to ensure that one or more independent reviews be initiated within six months of the bill receiving royal assent to further examine issues around the eligibility for mature minors, advance requests, and requests where a mental illness is the sole underlying medical condition.

We welcome this amendment and want to emphasize that we will remain open-minded to the evidence that these reviews gather and as Canadian data begins to be generated on how medical assistance in dying is actually working.

The decision to study these three issues further is supported by people who work with patients day in and day out in these three areas, who have been some of the most prominent voices calling for Parliament to proceed with caution.

With respect to mature minors, the Canadian Paediatric Society, represented by Dawn Davies, testified before the Senate committee that there “is simply not enough information to reach an enlightened decision” on this matter and that “It is appropriate that the first iteration of legislation on physician-assisted death does not include...minors”.

She also stated that there have not been sufficient consultations on this issue. The usual capacity and assessment processes, which Bill C-14 supports as appropriate for adults, may not be the right approach for mature minors. We need to consider this issue further.

Advance requests is another area where additional evidence is needed. We have heard many times over the past year that advance requests are likely to be sought in circumstances where persons are suffering from diseases such as Alzheimer's or dementia, but even the Alzheimer Society of Canada has stated in its public position paper that medical assistance in dying should only be possible when a person is competent at the time the assistance is administered. It says that advance requests not only pose risks to vulnerable patients, but they could also contribute to false stereotypes, undermining its message that it is possible to live well with this disease. Further study on this issue is the right policy.

On mental illness as a sole condition motivating a request for assisted dying, it is not surprising that reputable individuals and organizations, including the Centre for Addiction and Mental Health and the Mental Health Commission of Canada, support further study before legislating in this area. Moving forward in this way does not deny the suffering that these illnesses can cause. Rather, it ensures that we get it right and protect some of the most vulnerable and stigmatized persons in our society. For these reasons, I believe that Bill C-14 represents the right policy choices to answer the difficult questions the Supreme Court of Canada left for us as parliamentarians to resolve for 36 million Canadians.

I will now turn to the legal considerations, which play a crucial role in this seminal piece of legislation.

A consistent area of discussion has been around whether Bill C-14 is constitutional. As the Minister of Justice and Attorney General of Canada, I am of the firm opinion that the bill is consistent with the charter and is a justifiable response to the Carter decision.

Bill C-14's eligibility criteria directly respond to the Carter decision. They clarify the intended scope of eligibility, acknowledging the submission of the Canadian Medical Association, which represents 83,000 physicians who will, with nurse practitioners, be responsible for implementing and applying this law in their daily practice. This organization has stated that the language in the bill is a significant improvement over what it views, from a medical perspective, as the court's unworkable term “grievous and irremediable”.

What was the scope of the Carter decision? I appreciate that there are many differing interpretations of the decision, and I acknowledge that the Alberta Court of Appeal recently read Carter in a broad way, while some judges in the Superior Court of Ontario have read it more narrowly. I believe that the Carter decision was about the factual circumstances of that case. At the end of the day, Bill C-14 will be measured against the charter as a whole and not the Carter case. As the Alberta Court of Appeal recognized, “the interpretation and constitutionality of eventual legislation should obviously wait until the legislation has been enacted”.

Bill C-14 addresses both dimensions of section 7 of the charter, respect for autonomy and respect for life. The bill would strike a new balance between these interests through a comprehensive regulatory regime, which would receive deference from the courts. The proposed law would respect individual autonomy for persons who choose medical assistance in dying, but would do so in a careful manner that preserves other crucial objectives: promoting suicide prevention, preventing social stigma of life with a disability, and protecting society's most vulnerable persons from a risk of premature involuntary death.

While Bill C-14 requires that an eligible person be on a trajectory toward death, the flexibility purposefully built into the bill's criteria would allow medical practitioners to respond to a wide variety of medical circumstances, not just predictable diseases that are subject to fixed prognoses of life left to live.

Indeed, unlike some U.S. state regimes that require a specific prognosis, Bill C-14 does not require a strict relationship between the medical condition and the cause of the person's reasonably foreseeable death.

I do not agree with those who say that the Carter decision means that Parliament is constitutionally mandated to enact one of, if not the broadest, assisted dying regimes in the world, and that Parliament has little scope to consider other societal interests aside from autonomy. The court acknowledged that medically assisted death involved complex issues of social policy in a number of competing interests. In matters of this nature, the charter analysis takes into account the fact that there is no single manifestly correct balance of competing interests that are engaged. Deference will be shown, provided that Parliament's solution falls within the range of reasonable alternatives.

Bill C-14 is reasonable. It would provide people who are in a path towards death a choice that would respect their wish to die with dignity. Equally, it would limit medical assistance in dying to persons in these types of circumstances in order to prevent the normalization of suicide, protect vulnerable persons who were disproportionately at risk of inducement to suicide, and affirm the equal value of every person's life.

This balancing of interests addresses the inherent risks associated with permitting medical assistance in dying, and represents what the trial judge in Carter described as a “carefully- designed system imposing stringent limits that were scrupulously monitored and enforced”. Such a system is necessary because the suffering that can lead someone to request assisted dying does not just come from the condition; it also comes from how our society too often treats people with such conditions.

Under an approach where any serious medical condition is eligible, the law would be saying that an assisted death could be an acceptable treatment for a soldier with post traumatic stress disorder, a young person who suffered a spinal cord injury in an accident, or a survivor whose mind was haunted by memories of sexual abuse.

These are difficult but necessary situations to talk about, because cases like these are the unavoidable consequence of an assisted dying law where the only limit on eligibility is an individual's subjective experience of suffering.

As both the justice and human rights committee and the senate committee heard from several witnesses, the risk to vulnerable people, as well the crucial objectives of suicide prevention and affirming the value of the lives of all Canadians could be greatly increased unless eligibility was limited to persons who were approaching the end of their lives.

As I said, when Bill C-14 was introduced, assisted dying is a matter that touches us all and challenges us all. Divergent views on the bill remain, but we have a responsibility to act for all Canadians. The interim court approval process ends on June 6. If there is no legislation in place at that time, medical assistance in dying will lack a legal framework outside of the province of Quebec.

There is even uncertainty as to whether the court's remedy in Carter, if it came into force on June 6 in place of a statutory regime, would have the legal effect of completely striking down the existing criminal law that prohibits consensual killings and the aiding of suicides outside of an assisted dying context.

While most medical regulators have published interim guidelines, there would be no mandatory or consistent national safeguards. It could be possible, for example, for a physician to end a mature minor's life, depending on the province. Different jurisdictions require different numbers of witnesses, and some provide no waiting period at all.

Uncertainty around Carter parameters would persist and likely lead to inconsistent results in who would be found to be eligible, even between medical practitioners in the same jurisdictions.

We have a choice: To have a statutory framework in place with all of the national-level safeguards and protections that I have described, or having none. Bill C-14 reflects the kind of society we should aspire to be, one that respects individual autonomy and one that affirms that the lives of all Canadians have inherent value and are equally entitled to the protection of the law.

I call on all members of the House to support Bill C-14.

Physician-Assisted Dying

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Mr. Speaker, I am honoured today to present a petition signed by hundreds of Ontarians regarding Bill C-14, requesting consideration and accommodation for medical practitioners, stringent legislation, as well as sufficient time for consultation.

[Robert Sopuck, Conservative, Dauphin—Swan River—Neepawa, MB]

Mr. Speaker, I have the honour to present a petition on behalf of the Family Action Coalition, signed by citizens from right across Manitoba.

The petitioners request that the government allows sufficient time for broad consultation on Bill C-14, that there are sufficient protections for the vulnerable, and that conscience rights for health care providers are protected.

[Rachael Thomas, Conservative, Lethbridge, AB]

Mr. Speaker, the other petition I present in the House today is a lengthy petition from members all across the province of Alberta, my home province.

The petitioners are coming forward with the Family Action Coalition with regard to Bill C-14. They are asking for stringent safeguards to be put in place on behalf of the vulnerable. They are asking for conscience protection for medical practitioners, and they are also calling on the government to consult widely with regard to Bill C-14.

[Dan Albas, Conservative, Central Okanagan—Similkameen—Nicola, BC]

Mr. Speaker, I am pleased to rise to present a petition on behalf of constituents right across British Columbia. The Family Action Coalition has put together a petition outlining that there should be adequate safeguards in any legislation, such as Bill C-14, that parliamentarians should seek to consult in a timely and robust way, as well as to make sure that conscience rights are protected.