An Act to amend the Criminal Code (medical assistance in dying)

This bill was previously introduced in the 43rd Parliament, 1st Session.

Sponsor

David Lametti  Liberal

Status

Considering amendments (House), as of Feb. 23, 2021

Subscribe to a feed (what's a feed?) of speeches and votes in the House related to Bill C-7.

Summary

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

This enactment amends the Criminal Code to, among other things,

(a) repeal the provision that requires a person’s natural death be reasonably foreseeable in order for them to be eligible for medical assistance in dying;

(b) specify that persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying;

(c) create two sets of safeguards that must be respected before medical assistance in dying may be provided to a person, the application of which depends on whether the person’s natural death is reasonably foreseeable;

(d) permit medical assistance in dying to be provided to a person who has been found eligible to receive it, whose natural death is reasonably foreseeable and who has lost the capacity to consent before medical assistance in dying is provided, on the basis of a prior agreement they entered into with the medical practitioner or nurse practitioner; and

(e) 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 that was provided to them under the provisions governing medical assistance in dying in order to cause their own death.

Elsewhere

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

Votes

Dec. 10, 2020 Passed 3rd reading and adoption of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying)
Dec. 3, 2020 Passed Concurrence at report stage of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying)
Dec. 3, 2020 Failed Bill C-7, An Act to amend the Criminal Code (medical assistance in dying) (report stage amendment)
Oct. 29, 2020 Passed 2nd reading of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying)

Criminal CodeGovernment Orders

February 23rd, 2021 / 10:30 a.m.
See context

LaSalle—Émard—Verdun Québec

Liberal

David Lametti LiberalMinister 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.

Criminal CodeGovernment Orders

February 23rd, 2021 / 10:50 a.m.
See context

Conservative

Michael Barrett Conservative Leeds—Grenville—Thousand Islands and Rideau Lakes, ON

Madam Speaker, today I am speaking again to the government's bill, Bill C-7. I join my Conservative colleagues in being the voice for those who do not have one, those who have been thoroughly ignored and cast aside. Throughout this bill's debate, many people from the disability community have cried out in fear that they will be victims of this deeply flawed bill. That is why we are here today. We are here to stand up for them and be the voice that the government cannot ignore.

The Liberals are in such a fevered rush to pass this bill that they completely rejected amendments Conservatives offered at committee that would have seen safeguards in place for the vulnerable among us. They are in such a rush because they want to meet some arbitrary deadline to avoid political embarrassment. When there are lives on the line and the stakes could not get any higher than life or death, the Liberals are worried about embarrassment. They are not worried about the people who stand to be victimized by this bill and the unnecessary deaths it would lead to, but about political embarrassment.

We might remind the Liberals that it was their government that prorogued Parliament and locked the doors to this place, all in the name of covering up for the Prime Minister's corruption and blocking the investigations happening across multiple committees. Where was the need for great haste then?

One might have thought that when the Liberals missed their first arbitrary deadline it might have given the proponents of this dangerous bill time for pause and reflection about what this means for the most vulnerable Canadians, but it seems to have had the opposite effect. We are now looking at yet another arbitrary deadline and a vastly expanded bill that would see exponentially more Canadians victimized when they are at their lowest.

The government had a second chance to reform this bill and do what needed to be done to protect the vulnerable. Instead, it tossed protections to the wayside. This legislation, by its very nature, requires caution and constant monitoring to ensure that vulnerable Canadians are not being coerced, neglected or abused because of Bill C-7.

We need to offer Canadians our best when it comes to important legislation. That means listening to their concerns, considering them, offering them multiple options and avenues, and continuing to refine the legislation. This is especially the case with Bill C-7 because we can never bring back those people who have received MAID. This is something that is final.

The previous MAID legislation required a parliamentary review of the law five years after it was passed. This review was to provide the opportunity to hear from Canadians about how MAID is working and to see if any changes should be made. It was expected that this review would start in 2020.

I would point out that 2020 has come and gone. We now find ourselves in 2021. We have not seen any such review, and we are here debating a wide expansion of eligibility for MAID with the removal of safeguards for the vulnerable. The government has acted hastily and ignored the legislative review process in which safeguards for the vulnerable could have been strengthened. It chose to not undertake a proper review and went ahead with removing important safeguards.

We have heard from several witnesses who have attested to the fact that under the current MAID legislation they have been taken advantage of and made to feel increasingly vulnerable. We heard from Roger Foley. He is a man living with serious disabilities, a caretaker for his father when he battled cancer, who became subjected to coercion into assisted death by abuse, neglect, lack of care and threats.

We also heard from the national executive director for the DisAbled Women's Network Canada, who told Ruth's story. It was a story of a woman living with a disability who is not dying, but her inability to access proper care has left her considering MAID.

Moreover, the executive vice-president at Inclusion Canada told us that Bill C-7 is the disabled community's worst nightmare. Their biggest fear has always been that having a disability would become an acceptable reason for state-provided suicide. The disabled community has made it clear time and time again that they feel directly targeted by this new MAID legislation, that their lives are worth so little that they are better off to be dead than to live with a disability.

Despite the review of the MAID legislation never happening, here we are debating its expansion through Bill C-7, with the rationale being this bill is stated to reflect a societal consensus informed by views and concerns raised by Canadians, experts, practitioners, stakeholders, indigenous groups as well as provinces and territories during public consultations undertaken in January and February 2020. As Bill C-7 was originally proposed in February 2020, how could we have accessed a societal consensus on this in such a short period of time?

This brings us to the actual survey the Minister of Justice so often references in defending this bill. Many Canadians were deeply concerned about the ambiguity of the survey and online consultation that took place. Many of the questions were very ambiguous, and some people had an incredibly difficult time answering the questions, as they had to consent to different premises from what they believed.

Dr. Heidi Janz of the Council of Canadians with Disabilities gave her thoughts on the consultation process, stating:

I believe the consultation was moderately extensive; however, I believe that the consultation was geared towards a predetermined outcome. That is evident by the types of questions that were asked in the online survey and which seemed to be assuming that MAID would be expanded.

The government has missed the review of its prior legislation, having removed safeguards, and according to Dr. Janz, had consultations that seemed to have a predetermined outcome. We really have to wonder if proper consultations took place and the feedback given was acted on, or if the outcomes may have been predetermined.

The government must know that this is a deeply flawed piece of legislation by now. We know that the Minister of Employment, Workforce Development and Disability Inclusion realizes the serious issues with this bill in reference to Roger Foley's story and of other vulnerable Canadians when she said before the Senate committee:

I absolutely acknowledge and am quite preoccupied by the power imbalance between practitioners and patients, particularly patients who have been in systems that have discriminated against them and ignored their voices their entire lives. I have grave concerns with the particular circumstances of the individual that you spoke of. Quite frankly, I can tell you, he is not alone. I regularly hear from families who are appalled by the fact that they take their child, potentially their older child [in] and are offered unprovoked MAID. I think that has to stop. That’s a matter of practice, I would suggest, and we need to get at that through our regulations, through working with our medical associations.

What does it say when the minister tasked with inclusion of the disability community in Canada makes a statement like that, yet the government carries on full steam ahead with this bill while rejecting good amendments? What does that say to Canadians who are living with a disability? Does it reaffirm their inherent human dignity or does it say that we do not particularly care about them or their opinions?

It seems like the member for Thunder Bay—Rainy River, who sits on the government side of the House, gets it. He is concerned for the well-being of the vulnerable and the potential victims of this bill. He said, “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.”

He went to say:

My biggest concern, as somebody who has spent my whole life trying to avoid accidentally killing people, is that we don't end up using MAID for people who don't really want to die.... I think, with a bit of time, people may come around to the fact that there are reasons they want to live.

Members can see that Kristine Cowley, who injured her spine 33 years ago, now has a doctorate and is a professor at a university, was a wheelchair track Paralympian, is married and has three children and has travelled extensively, all of which was done after her accident. She shared that it took her five years after her spinal cord injury to feel great again. She said:

To all outward appearances, I am a ‘successful’ person living and contributing to our community. But I’d be lying if I told you...that I was good to go within 3 months of my injury when I was discharged from the hospital. In fact, it was a few years before I was able to open my eyes in the morning and feel good.

Then there is the story of David Shannon. David suffered a spinal cord injury in a rugby scrum when he was 18 years old. After his accident, he said that he lay in bed close to death more times than he wished to contemplate. David has gone on to have a career in non-governmental organization leadership and a law practice focused on human rights and health law. David wrote:

...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. I've made it to the North Pole and planted an accessible parking sign. I’ve written a book, performed in plays and on TV. I’ve received my law degree and been a Human Rights Commissioner. And I am an Order of Ontario and Order of Canada recipient. I’ve loved and been loved. My proudest accomplishment is that I lived.

How many stories like those of Kris or David will not happen because of this dangerous bill? How many stories of resilience and great Canadian comebacks will not happen because people will be offered death before proper care when they are at their lowest?

The Minister of Justice called my colleagues and me who are standing up and speaking for the voiceless and the vulnerable a “rump element” of the Conservative caucus. Now, that rump represents nearly one-third of this Parliament and represents Canadians from the Maritimes to the west coast and all points in-between who will always stand up for the vulnerable. I would remind the minister that he and his colleagues have silenced the voices that we are speaking for. He can try to silence the disabled community who cry in fear for their future, but he cannot silence our voices. He will not silence my voice.

Does the minister believe that the people we are fighting for are also a rump of Canadian society? Does he believe that Canadians living with a disability are a rump element? That is what it looks like to me. The disrespect and the eye-rolling coming from the Liberals when the disability community has tried to voice their concerns really is something to behold.

Death will be offered to Canadians before they are given proper access to meaningful care, the care they need to feel good again. We need to re-evaluate our priorities and shift our focus to reaffirming the inherent human dignity of all people, and especially those who are vulnerable. It is our duty to keep their preferential option in mind as we make decisions in this place. It is quite clear that Bill C-7 does not have the preferential option for the vulnerable in mind and does absolutely nothing to affirm the human dignity of the vulnerable.

We will offer death to people when they are at their lowest, after an injury resulting in a disability when hope seems lost and they are in the depths of despair. Instead of offering help and treatment and care, we will offer death. Despair can be transient. It can come and it can go. During the low points, people need support. Really, it is as simple as that.

We must ensure that people have access to the care they need first, to ensure that they can make an informed decision when it comes to life and death. Anything short of that is not just, and may be a form of coercion in and of itself. That says nothing of the damage that will be done by the sunset clause added to this bill, that demands that provisions be made to administer MAID to those who have mental illness.

This came as a shocking revelation given the difficulty people have in accessing mental health treatment across this country. Without adequate care, illnesses that are treatable can appear not to be. We, again, are seeing people being offered death before they are being offered care. Right now, 6,000 people with the most severe forms of mental illness are waiting up to five years to get the specialized treatment they need to reduce symptoms, learn to cope and to feel better.

Instead of working to better those systems, to give people the help they need when they need it most, the government is striving to offer them death. When appearing before the Senate, Dr. John Maher, a psychiatrist who works only with people who have the most severe and persistent mental illness, said:

Clinical relationships are already being profoundly undermined. My patients are asking: “Why try to recover when MAID is coming and I will be able to choose death?” Some of my patients keep asking for MAID while they are getting better but can’t recognize that yet.

That speaks to the need for better and more accessible mental health treatments in this country. People with mental illness should not feel the need to end their lives for lack of treatment and the hope this can bring.

Dr. Maher went on to say:

Determining whether a particular psychiatric disease is irremediable is impossible; people recover after 2 years and after 15 years. I have repeatedly [have] psychiatrists refer patients to me where I am told they will never get better; yet they have all improved symptom control and reduced suffering when they finally get intensive care.

We need to help people get better and to give them hope, not do everything we can to make death the easiest path for them.

I urge my colleagues on all sides of the House to reaffirm the dignity that is inherent and inalienable in all people, in every person, and to keep the preferential option for the vulnerable in mind. That option is care and support, not death.

I will continue to fight and speak up for the voiceless and those who will be victimized by this bill. We must ensure that someone's worst day is not their last.

At this time, I move:

That the motion be amended by:

(a) replacing the words “agrees with amendment 1(a)(ii) made by the Senate” with “respectfully disagrees with amendment 1(a)(ii) made by the Senate because, in the Justice Department's own words, it 'could be seen as undermining suicide prevention initiatives and normalizing death as a solution to many forms of suffering'”;

(b) deleting all the words beginning with the words “as a consequence” and concluding with the words “receive the report”; and

(c) replacing the words “section 6 be amended by replacing the words '18 months after' with the words 'on the second anniversary of'” with “section 6 be deleted”.

Criminal CodeGovernment Orders

February 23rd, 2021 / 11:20 a.m.
See context

Conservative

Michael Barrett Conservative Leeds—Grenville—Thousand Islands and Rideau Lakes, ON

Madam Speaker, the original legislation that came before Bill C-7 required that a review be exercised by the government. That was not a suggestion: That was the instruction of this place, of parliamentarians, to the government. The Liberals did not complete the review the first time. It is concerning when we are being asked to advance legislation under the commitment that there will be a committee, there will be more review and more study.

Why do we not get it right before we pass the legislation? The government has tools in its toolbox to review this and to get it right in advance.

Criminal CodeGovernment Orders

February 23rd, 2021 / 11:25 a.m.
See context

Bloc

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—

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February 23rd, 2021 / 11:55 a.m.
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Bloc

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—

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February 23rd, 2021 / 11:55 a.m.
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NDP

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.

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February 23rd, 2021 / 12:15 p.m.
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NDP

Alistair MacGregor NDP Cowichan—Malahat—Langford, BC

Mr. Speaker, I certainly appreciate the parliamentary secretary's comment about the many hours of debate on both Bill C-14 and Bill C-7 and I am also sensitive to the court deadlines.

That said, it was the government's choice to bring forward a motion that is going to, in my view, substantially alter Bill C-7 with the sunset clause on mental health. By that very action, the government is probably going to provoke much more debate in the House because, as the parliamentary secretary will know, the House already took time to pass a version of the bill. The very fact that the government chose to bring in a sunset clause is going to provoke a lot more debate. That is beyond my control.

The other thing I would note is that I wish the government had been a bit more respectful and had introduced this bill for debate tomorrow so that individual caucuses could have had the opportunity to have a thorough discussion of their concerns around the table.

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February 23rd, 2021 / 12:20 p.m.
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NDP

Alistair MacGregor NDP Cowichan—Malahat—Langford, BC

Mr. Speaker, when we look at the disability community and persons suffering from mental health issues, it is important for us to remember that they are not one solid block of people. There are a variety of opinions and approaches to this subject, both within the disability community and among persons who suffer from mental health challenges. I am very wary when a group says it speaks on behalf of an identifiable group, because we know that opinions on the subject are quite varied.

In terms of how we go forward, I am not ultimately going to be able to decide that. That decision is going to be up to the House, but I would refer my hon. colleague back to the answer I gave to the parliamentary secretary: The government chose to bring in a motion that agrees with a substantive amendment, and I think that in itself is going to provoke much more debate and may even serve to ultimately delay the passage of Bill C-7.

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February 23rd, 2021 / 12:20 p.m.
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NDP

Alistair MacGregor NDP Cowichan—Malahat—Langford, BC

Mr. Speaker, I would like to first recognize that the member for Timmins—James Bay is such a stand-up MP for his constituents, and I always appreciate his interventions, especially on this subject matter.

He is very right that we are not here to relitigate the main provisions of Bill C-7, but we do have to discuss what is a very substantive amendment to the bill by the unelected and unaccountable Senate, and that essentially is what is provoking debate on whether or not we agree as a House that the mental health exclusion section of this bill needs to be sunsetted.

If Liberals and Conservatives honestly cared so deeply about the plight of persons with disabilities, they would have agreed to the letter sent by the member for Elmwood—Transcona and the member for Esquimalt—Saanich—Sooke when they wrote to the minister asking that a monthly amount of $2,200 be awarded to all persons with disabilities to make their lives measurably better.

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February 23rd, 2021 / 12:25 p.m.
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Conservative

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.

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February 23rd, 2021 / 12:50 p.m.
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Bloc

Denis Trudel Bloc Longueuil—Saint-Hubert, QC

Mr. Speaker, I am having a hard time figuring out exactly where my Conservative colleagues stand this morning.

They think the process is being rushed and that things are moving too fast, yet the process itself includes a two-year period to thoroughly examine issues related to people with mental illness. I cannot tell if things are moving too quickly or too slowly for the Conservatives.

The other thing that is so exasperating about my Conservative friends is their use of the word “euthanasia”. In a debate on a topic this delicate and sensitive, people need to be careful about their word choices. Medical assistance in dying is a comprehensive approach to caring for people. The word “euthanasia” has a harsh, cruel connotation.

Here is my question. The Conservatives seem to think we should not pass Bill C-7 now. However, there are people suffering from very serious neurodegenerative diseases who are waiting for the go-ahead from Parliament to move forward in a complicated, complex and sensitive process. What does my colleague have to say to those people today?

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February 23rd, 2021 / 1 p.m.
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Parkdale—High Park Ontario

Liberal

Arif Virani LiberalParliamentary 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.

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February 23rd, 2021 / 1:25 p.m.
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Liberal

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.

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February 23rd, 2021 / 1:25 p.m.
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Green

Elizabeth May Green Saanich—Gulf Islands, BC

Mr. Speaker, I want to thank the hon. parliamentary secretary for a very helpful, thorough review of the government's views on what has now come to this place from the other place.

I also wanted to focus, as his last remarks did, on some of his personal beliefs around the situation and the context for people in the disability community, the context for people who are experiencing extreme depression. We have to put that context in economic terms. We know that people who are in the disability community are far more likely to fall below the poverty line than able-bodied Canadians. It is a really significant crisis.

We experienced in CERB the ability to send a cheque for $2,000 to people across the country. I want to ask the hon. member if it is not time to look at guaranteed livable income as part of the package of public health measures, because poverty is the single largest component of health. As a social determinant of health, poverty is the largest measure. I know it is slightly unrelated to the debate on Bill C-7, but can we not move to eradicate poverty?

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February 23rd, 2021 / 1:30 p.m.
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Conservative

Tamara Jansen Conservative Cloverdale—Langley City, BC

Mr. Speaker, it is 100% guaranteed that we will kill people who would have gotten better. That is a statement made by a well-respected Canadian psychiatrist this weekend at an emergency Bill C-7 meeting I cobbled together in response to this Frankenstein bill that we are now debating here in the House. How the Senate managed to change the bill from what it was to what it is completely boggles the mind.

The bill is now so deadly that not only are the disability community and the indigenous community crying out against it, but the mental health community and the geriatric professionals have joined in sounding alarm bells against the extreme danger this bill poses to the most marginalized in our communities.

Some in the Senate in the Liberals' group of wealthy, worried well people have decided that their wishes far outweigh any harm that may come to the vulnerable who cannot afford or cannot access the kind of care that powerful individuals can.

Let us take the issue of advance directives. Senator Pamela Wallin stated, “As someone with a history of dementia in my family, I seek the peace of mind that an advance request—and consent to it—will provide.” I would like to pose a question. Does Senator Wallin's peace of mind carry more weight than the premature deaths of frail seniors that will result if this amendment becomes law?

Imagine a person—for example, Senator Wallin—possibly dealing with dementia at some future time who has reached the stage at which her advance directive authorizes her death. Imagine that she is completely unaware of her cognizant deficits and is living happily with her loving family or in a top-notch residential setting somewhere in Canada. Who will give the MAID order? How will Ms. Wallin's caregivers explain this to her? Will that directive take precedence over her current wishes and those of everyone around her?

Imagine now a family that is less loving, one that is fighting over the inheritance while mother is still alive, fighting over how much is spent in paying for nursing care. This is a common scenario, as many professionals witness. Now who will give the MAID order, and in whose interest?

Now imagine there is no family and that the administration at the nursing home is under orders from the ministry to find beds for patients to be transferred from the hospital. There are already horror stories from around the world where advance directives for euthanasia exist as an option, stories of doctors trying to sedate their patients by putting sedatives in their coffee or stories like that of a 74-year old Alzheimer's patient from the Netherlands whose family had to hold her down as she was struggling so that the doctor could administer the lethal cocktail.

I learned in a conversation with Dr. Catherine Ferrier, who works with dementia patients, that often when a person is suffering with dementia, it is their family who are most distressed. Patients themselves are often content, even happy. The point I am trying to make here is that it is impossible to know the exact wishes of someone who is suffering with dementia. Someone who is young and healthy can imagine what they would want for themselves if they were to decline in that way, but they do not know what that future self, in a state of mind that they do not understand, would actually wish for.

I am terrified for vulnerable Canadians who want to live despite an earlier wish to die. They will not be able to communicate their desires, and their families and caregivers may pressure them to die to remove a burden from their own lives. I implore my colleagues to remember that our duty is to promote the safety and well-being of all Canadians, especially those most marginalized, not to calm the worried well.

The Council of Canadian Academies' expert panel working group on advance requests for MAID found that relatives of patients with dementia generally support euthanasia if an AED exists, but when they are faced with a decision to follow an AED, most decide against it. Many experts now favour, instead of a directive giving specific instructions, a process of reflection on broad health care goals, conversations with loved ones and the designation of a proxy decision-maker.

Listening to those who advocate MAID by advance request for patients with dementia, our first reaction should be horror at the demeaning and discriminatory terms in which they are depicted. To state that people who no longer recognize family members, are bedridden or are dependent for hygiene or feeding have lost their dignity is a marginalizing and ableist depiction. Dignity is never lost, but it can be either affirmed or denied.

Let us tackle the first myth, the myth that people deserve death with dignity and that MAID provides that. The fact is that this debate has distorted what dignity means. Dignity means to deserve honour or respect. What MAID advocates mean by “loss of dignity” is a loss of control, a loss of superficial appearance, a loss of self-critical judgment. They have tragically subverted the most dignified acts of all: unfailing love and deep respect for each other in all life circumstances. Bathing my dying grandmother, whispered conversations on the threshold of death, silent reflection and presence through a long night waiting for a last breath: These are the moments of greatest dignity. Dignity is found within our relationships. It is about whether someone looks at us and treats us with respect, rather than with subtle disdain or prejudice or by making us feel that we are bothering them.

Dignity is not about the means of death. Dying with dignity means dying in a milieu of care, love, kindness and respect. Anyone who says all these things are not present in a natural death setting simply does not understand what dignity is.

However, wait; the senators, the Liberals, Jocelyn Downie and all their friends at Dying with Dignity will cry, “No one will be euthanized under this legislation who has not already freely consented to it.”

The notion of consent by advance directive is not that simple. The vulnerability and power imbalance that is present between the parties is glaringly obvious. However, advertising campaigns and media have been busy creating a fantasy world for Canadians that pretends that the use of a physician in ending the life of someone not near death is compassionate and respects autonomy. We read in the paper about parties being organized to celebrate the last moments of life with balloons and symphony music playing in the background. We can see by the few statistics that are being reported that the glorification of euthanasia provides encouragement for those who are already unsure of their value or feel a burden to their loved ones, regardless of the fact that they are not near death.

In actual fact, what we are able to provide families with amounts to moral absolution. With this bill, we are offering to make legal what is illegal in every other country around the globe. Let me repeat that: There is no other country on the planet that allows death administered by a doctor to someone who is not imminently about to die if they have not first been given treatment. Canada, with the implementation of this legislation, will be the only country in the world where access to alternative treatments is not even required in order to qualify for death by physician.

Not only are the changes to the euthanasia regime that will come with the Senate amendments unprecedented from a legal and moral perspective, but they are also unheard of from a medical perspective. This bill would require doctors who work with patients suffering from mental illness to prescribe death, with no evidence, no data, no statistics to prove that it is an effective or beneficial treatment. There has been no due diligence done by the medical community to support the idea that MAID belongs in the tool box of mental health professionals. It is politicians, motivated by ideology and not by evidence, who have forced it upon them.

I have been told by doctors who support MAID in principle that this bill will force them to act against their conscience and their Hippocratic Oath. It is one thing to conscientiously object, but it is something much worse when there is a lack of faith in the treatment they are forced to provide. To make the concept more clear, they explained that doctors do not prescribe cigarettes to patients because the health risks far outweigh the calming benefits of nicotine. These same doctors know that there is no evidence to support the idea that MAID is an acceptable medical treatment for mental illness. Thus, if this bill passes, doctors will be forced to provide, against their conscience, an unproven treatment that causes the demise of their patient.

Further, allowing MAID for mental illness in this bill makes the bill incoherent. On the one hand, it says that MAID can only be offered to those who are not dying if their condition is grievous and irremediable. On the other, it fails to acknowledge what psychiatrists know to be true; that it is impossible to know if a mental illness is irremediable. There are many cases of doctors who have thought that a patient's condition was irremediable, only to find that the patient got better. This means that the entire entry point of accessing medical assistance in dying is not satisfied for those who suffer from mental illness. That is why doctors are pleading with us, telling us that they are 100% certain that if we accept this amendment, we will kill people who would have gotten better. This bill would ensure that people would no longer be seeking to avoid a painful death, but, rather, to escape from a painful life.

It is also important to tackle the second myth being propagated by the Liberals and their friends at Dying with Dignity, and that is the myth that Bill C-7 is not discriminatory. Here are the facts. Canadian disability organizations, mental health organizations, indigenous organizations and the United Nations all say that Bill C-7 is absolutely discriminatory. The bill singles out vulnerable Canadians and offers them physician-assisted death without offering adequate disability supports or treatment to help them live full lives, free of the suffering caused by poor health care, poverty and stigma. It singles out persons with disabilities who are not terminally ill as fit for suicide completion. This will become a choice of desperation, not autonomy.

Let us understand what discrimination really is. It is pretending that all Canadians are equal in all ways. The obvious reality is that some of us face profound life challenges. We need laws that protect the disadvantaged. A law that offers death to one group and support and treatment to all others is the paradigm of discrimination. This law proclaims that a disabled Canadian or someone suffering with a mental health challenge should consider death instead of recovery. Vulnerable patients need protection from politicians and doctors who want to make it easier for them to die, while simultaneously denying access to appropriate health care supports. This is true discrimination.

Let us face it, there is a myriad of reasons that many organizations have come out opposing the bill.

Take as another example the testimony from Tyler White, CEO of Siksika Health Services, who stated:

MAID with its administration of a lethal substance with the intent to end a person's life is countercultural to our indigenous culture and practices. Our concept of health and wellness does not include the intentional ending of one's life. We recognize the dignity [of life] from its beginning to natural death, and efforts to suggest to our people that MAID is an appropriate end to life is a form of neo-colonialism. Extraordinary efforts have been made in suicide prevention in our communities and the expansion of MAID sends a contradictory message to our peoples that some individuals should receive suicide prevention, while others suicide assistance....

...Bill C-7 in its current form is the absence of protection for individuals working in our communities who do not wish to participate in MAID. We believe that our people should not be coerced to participate in non-indigenous practices against our conscience and will. And it is the kind of oppression that has been the source of much trauma in our history. The Truth and Reconciliation Commission of Canada calls upon those who can effect change within the Canadian health care system to recognize the value of aboriginal healing practices and for respecting indigenous people's right to self-determination in spiritual matters, including the right to practise our own traditions and customs. Bill C-7 should be amended such that those who opt to abstain from participating in MAID directly and indirectly will be protected to do so without discrimination in their employment in the health care system.

How about Margaret Eaton, national CEO of the Canadian Mental Health Association, who stated the following in a recent press release:

Anyone living with mental illness knows it can absolutely be grievous and...unbearable. However, what sets mental illness apart from all other types of suffering is that there always remains the hope of recovery. That’s why the Senate’s amendment to C-7, the assisted dying bill, is so concerning.

People with a mental health problem or illness need assistance to live and thrive, not hasten death.

The Canadian Mental Health Association...is urging MPs to vote against the amendments made by the Senate to C-7. In particular, the clause to start the clock on eventually allowing people to seek medical assistance in dying...with mental illness as a sole underlying cause.

Then there is the petition I received this morning from 130 psychiatrists, psychotherapists and mental health professionals, calling on us to reject the amendment which would include mental illness as a sole criterion for medical assistance in dying. It states:

Some persons with mental illness, that often includes symptoms of hopelessness and suicidal thinking, have long been recognized as potentially vulnerable to suicide inducement and, until now, have rightfully been excluded from eligibility for MAiD. Suicide prevention is recognized as a critical mental health service necessary to preserve life. Review of evidence...found that, unlike with MAiD for terminal illness, we cannot distinguish between those seeking MAiD for mental illness and suicidal individuals.

Over and over again, we have heard from medical professionals how disastrous the bill will be to the safety and security of their patients.

Therefore, the question begging to be asked is this. Why the rush? During the pandemic, the Liberals have made the passage of Bill C-7 their priority. However, the bill is not a high priority for Canadian citizens and it is safe to assume that the majority of Canadians know very little about Bill C-7 or its implications.

Canadians have been preoccupied with more pressing matters, such as keeping themselves and their loved ones alive during this pandemic. They have been concerned with keeping financially afloat, making rent and mortgage payments, keeping their jobs and keeping their businesses from going under.

However, throughout this time, the Liberals have been concerned with driving Bill C-7 to the post, perhaps with the hope of slipping one by a distracted public. This is one of the most serious changes of legislation in law undertaken in a long time, with far-reaching implications. It will surely change the character of the country and how life and death is viewed. It has, at the very least, the potential to cause individual and social harm and open up abuses that no safeguards can guarantee against.

I will end with one final quote from the Washington Post this week under the title “Canada is plunging toward a human rights disaster for disabled people”. It said:

This month, the Journal of Medicine & Philosophy found that in the 18 years since Belgium permitted this sort of euthanasia, the laws and regulations meant to protect patients from abuse “often fail to operate as such.” Much like in the Netherlands, the eligibility criteria had steadily expanded to the point where more and more people pursued it not for medical reasons but simply for “tiredness of life.”

Legalizing assisted death for disabled people only fortifies the underlying problem: Canada has long mistreated its disabled citizens. This bill is a workaround for that problem, not a solution.

I ask this one more time. If this bill is so good, why are the vulnerable, the poor, the disabled, our indigenous brothers and sisters feeling so threatened? Why do we want our hospitals to offer suicide prevention programs through one door and doctor-assisted suicide through the other? I beg my colleagues to hear the cries of those most vulnerable among us and reject the discriminatory and dangerous bill, Bill C-7.