Bill C-7 (Historical)

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

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.

Criminal Code

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I can assure the member that there were thousands of people. Factoring in the surveying and the questionnaires that went out, I believe well over 300,000 Canadians participated in one way or another directly.

There were round tables and consultations in every region of the country, which included provincial governments, disability groups, doctors and nurses. Of course, there is the feedback MPs are bringing back. We also have the standing committee. I can assure the member that there will be good, healthy discussions there. I am being approached by constituents, so I am sure we are all being approached by constituents. At the end of the day, we still have another consultation coming up to do an overall review of everything.

[Bardish Chagger, Liberal, Minister of Diversity and Inclusion and Youth]

Madam Speaker, I appreciate the great work the member for Winnipeg North does in the House. I also appreciate his referring to the previous debate. I know his time often feels limited in this chamber. He had one more point to make, and I would be pleased to hear that point.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I thank the minister very much for that.

The point I want to make is with regard to permitting a waiver for the requirement to give final consent, in specific circumstances. Persons whose natural death is reasonably foreseeable who have been assessed as eligible for MAID and are at risk of losing capacity can make an arrangement with their practitioner in which they provide their consent in advance. This allows the practitioner to administer MAID on a specified day, even if the person has lost decision-making capacity.

There are some other issues related to that, but I thought it was a very important thing to get on the record.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I will be sharing my time with my very esteemed colleague from Shefford.

The debate we are having today must be handled with restraint, dignity and composure. Partisanship has no place here. This is a serious matter, and our decision will have significant repercussions on the lives of many, and perhaps even on our own lives one day, because we all have to leave this world sometime. It is inevitable.

The sad thing in all this is that, through decisions made in this very Parliament, our society has forced people who are suffering to suffer even more. People with severe medical conditions were forced to appeal to the justice system to have their most basic rights upheld. Worse yet, some had to go on a hunger strike to get access to medical assistance in dying by meeting the reasonably foreseeable death requirement. Do hon. members have any idea what we have asked these suffering patients to endure?

These long-suffering people coping with illness, trying to get through the day in unspeakable physical and psychological agony, were forced to go to court or put themselves in a position where their death was reasonably foreseeable. Everyone knows that the justice system is backed up. The costs and delays are typically unreasonable. These people had to endure a veritable ordeal because we made a decision for them.

We failed to make informed decisions that upheld individual liberty. It is a huge privilege to sit in this House, and with that privilege come serious responsibilities. We must honour our position. I want all members of the House to know that this time, we cannot fail. Courageous patients have had to fight the system to get us to make a wise, informed decision. The Superior Court of Quebec gave very clear directives. We must have the courage and vision to apply these directives and support this bill in principle, because it deserves to be improved in committee.

The Beaudoin decision in favour of Nicole Gladu and Jean Truchon is very clear: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu's rights to liberty and security, protected by section 7 of the Charter.”

We must read those last few lines carefully. They refer to the rights to life and freedom of choice. Which of us can presume to choose for someone else? I want to warn my colleagues against the temptation to think about themselves. I want to warn them against voting according to their own beliefs, philosophies or religion. Freedom to choose must be upheld, and in order to choose, we need options. The basis of the decision, which came after a very long wait and constant anguish, makes it very clear that this is about rights and freedoms. No one can choose for another person. We must remove the barriers so that everyone can live out their last moments in their own way, freely and without constraint. Of course, we must not fail to protect the most vulnerable, in accordance with the well-established rule, in medical practice, of free and informed consent. That means informed by exposure to all possible options, and free from any undue pressure.

This bill is a step in the right direction. It includes important precautionary measures and provides for the study of other important issues that need to be considered. Among other things, it would exclude people suffering solely from mental illness. I think that is a wise decision. This is an extremely complex issue that should be studied further. We cannot decide on this issue right now, hence the need to study it properly without skipping any steps.

We must also look at the issue of advance requests for persons newly diagnosed with a condition that may have an impact on their decision-making ability in the future. These are extremely sensitive issues that we must study with great care and a great deal of precaution. It is therefore wise not to include them for now.

Generally speaking, the purpose of this bill is to allow those suffering from degenerative, incurable diseases to have access to medical assistance in dying, whether natural death is reasonably foreseeable or not, except in cases of degenerative cognitive disease, as I was just saying.

For people whose death is reasonably foreseeable, this is about relaxing the rules by eliminating the 10-day waiting period between the written request and the administration of MAID. The 10-day waiting period may be waived if a person has been assessed and their request for MAID has been approved and arrangements have been made with their practitioner to obtain a waiver of final consent because the patient is at risk of losing their capacity to make a decision as the disease progresses or with the administration of pain-relief medication. That way, when making the request for MAID, the patient can agree to waive consent the second time if their pain is beyond treatment, even with care.

This last measure allows the person to live longer with a reasonable quality of life. The person therefore does not have to feel like they have to rush to request MAID out of fear of losing their capacity to do so.

For people whose death is not reasonably foreseeable, there is a 90-day delay between the request and the provision of the MAID service, unless assessments have been made and the loss of capacity is imminent. This time period must therefore be applied in a reasonable and reasoned manner. Who among us can guarantee that 90 days will be enough for some? Who among us can say whether 90 days will be too long a hell to endure for others? We are entitled to question the application of this delay. No one can say. That is why this clause and this entire bill will have to be implemented in a sensible, flexible and intelligent way. Practitioners are in the best position to determine what is valid and what is not when they work together with their patients, listen to them and, of course, treat them humanely. Ultimately, the priority must be the patients themselves, their well-being and their dignity.

I remind all members that although we are talking about dignity, this is above all about rights and freedoms. Every person at end of life must have options, and that individual is the only one who should be able to make that choice. We must not impose our own values and opinions. We must simply ensure that we provide a suitable framework regulating the practice of and the right to medical assistance in dying. We must respect the freedom of the individual. That is fundamental.

I urge all parliamentarians in the House to consider the huge responsibility we must shoulder. We hold in our hands the fate of hundreds of thousands of people. Not only is the end-of-life suffering of these people in our hands, but the suffering and anguish of their family members is as well. It is horrific to watch a loved one suffer at end of life and to feel helpless. Some members of the House may be thinking about personal choices. As I mentioned earlier, we need to figure out a reasonable framework for this very complex act and, through all of this, maintain freedom of choice for these individuals.

[Arif Virani, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I thank the hon. member for his comments. I have some questions for him.

During the debates today and yesterday, a lot was said about some MAID practitioners. I would like to know whether the member heard the same concerns raised by the Conservatives about doctors who pressure patients too aggressively.

My second question has to do with the fact that mental illness is not included in the bill and that we will be studying it, as the member mentioned. I would like to hear his thoughts on the fact that the Government of Quebec also decided to study whether mental illness should be an underlying condition.

I would like to hear his thoughts on those two questions.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I thank my hon. colleague. His questions are valid.

I will start by answering his second question.

With respect to mental illness, the Government of Quebec chose to study the issue more thoroughly before including it in the law. If two separate lawmaking bodies are making the same choices, that strongly suggests we are on the right path. I think it is a reasonable decision. Laws as impactful as MAID legislation must be drafted very carefully.

With respect to doctors' policies, I heard the horror stories some of our colleagues shared with the House. It is important to note that the medical profession is extremely well regulated. We need to make sure this bill provides a solid framework.

Some MPs shared examples of real cases with us, and I would encourage them to report those cases. I believe such cases are rare exceptions.

By far, most health professionals, including doctors, nurses and attendants, are dedicated to and care deeply about the well-being of their patients. They will take every possible precaution to ensure that the patient's choice is free and informed. As I said, for patients to make free and informed choices, they must be made aware of their options.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, the hon. member mentioned that much debate went on regarding euthanasia back in 2016, which obviously led to the current safeguards. Unfortunately, there has been absolutely no significant enforcement against infractions. The safeguards are regularly ignored. I have an example from the town hall that I held.

A constituent in my riding had a personal experience. A young married father with children was diagnosed with terminal brain cancer and had 12 months to live. He suffered depression, went to a psychiatrist and the psychiatrist offered him MAID. He immediately stopped going to that psychiatrist.

I would like to know why would we loosen the safeguards, which are clearly not working in the first place and seem to be completely impossible to enforce?

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I thank my esteemed colleague for his question, which was also quite relevant.

I mentioned earlier that the law must include safeguards. However, this is not a matter of euthanasia but of medical assistance in dying. I believe that those are two fundamentally different things. It is clear that we will have to provide an appropriate legal framework.

I would like to add that this is why we need to take the time to examine the bill properly in committee. I encourage my colleague to raise those points in committee so that they are properly examined and to invite witnesses, including the people affected by this case. That will help us clarify this situation.

[Laurel Collins, NDP, Victoria, BC]

Madam Speaker, I want to thank the member across the way for highlighting the responsibility we as members of Parliament have in our choices, that we have a responsibility to reduce suffering but also ensure people do not end their lives before they want to and that Audrey's amendment would give people the opportunity to live longer and to make the choice.

I want to ask the member specifically about the 90-day requirement for that second track and the potential it has to prolong people's suffering.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I thank my colleague for her question.

That is why I took several minutes to talk about the 90-day period. Given the complexity of the decision that we will have to make, I think it is important that the law give the practitioner and the person the flexibility—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

I am sorry to interrupt the member, but his time is up.

The hon. member for Shefford.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, it is with great humility that I rise in the House today to speak to Bill C-7, an act to amend the Criminal Code with regard to medical assistance in dying.

Many MPs have very personal stories about the end of life of one of their loved ones. As the Bloc Québécois critic for seniors, it goes without saying that I have heard my share. Therefore, in my speech, I will recall the work done by the Bloc on this issue, the sensitivity that exists in Quebec regarding medical assistance in dying and, finally, the position of certain groups of seniors and women who have come to meet with me.

First, let me go over the context again. In September 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, both suffering from a serious degenerative disease, stating that one of the eligibility criteria for medical assistance in dying is too restrictive. This criterion, that of “reasonably foreseeable natural death”, is found in the federal government's Act to amend the Criminal Code and to make related amendments to other Acts with regard to medical assistance in dying, and the provincial government's Act respecting end-of-life care.

Justice Christine Baudoin said it well in her ruling when she wrote: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu’s rights to liberty and security, protected by section 7 of the Charter.” Those two individuals had argued that they were being denied medical assistance in dying because their deaths were not imminent.

Let me now remind the House of the Bloc Québécois's position and highlight the outstanding work of the member for Montcalm, to whom I offer my deepest sympathies. I want to thank him for the work he has done on this file because, as he quite rightly pointed out, legislators did not do their job properly with Bill C-14. As a result, issues of a social and political nature are being brought before the courts. We need to make sure that people who have serious, irreversible illnesses are not forced to go to court to access MAID. That would be terrible, and yet that is what will happen if we cannot figure out a way to cover degenerative cognitive diseases.

However, we believe that it is important to be very cautious before making any decisions on questions related to mental health. That is why we are relieved that the bill does not address eligibility for MAID for individuals suffering solely from a mental illness. Indeed, this issue requires further reflection, study and consultation, which will be completed at the Standing Committee on Health as soon as the motion moved by my colleague from Montcalm is adopted.

For the second part of my speech, I would like to talk about Quebec's sentiments on this whole issue. Quebec was the first jurisdiction in Canada to pass legislation on medical assistance in dying. Wanda Morris, a representative of a B.C. group that advocates for the right to die with dignity, pointed out that the committee studying the issue had the unanimous support of all the parties in the National Assembly. This should be a model for the rest of Canada.

Ms. Morris said she felt confident after seeing how it would work in Quebec and seeing that people were pleased to have the option of dying with dignity. The Quebec legislation, which was spearheaded by Véronique Hivon, was the result of years of research and consultation with physicians, patients and the public. It has been reported that 79% of Quebeckers support medical assistance in dying, compared to 68% in the rest of Canada.

In 2015, when the political parties in the National Assembly unanimously applauded the Supreme Court ruling on MAID, Véronique Hivon stated:

Today is truly a great day for people who are ill, for people who are at the end of their lives, for Quebec and for all Quebeckers who participated in...this profoundly democratic debate that the National Assembly had the courage to initiate in 2009....I believe that, collectively, Quebec has really paved the way, and we have done so in the best possible way, in a non-partisan, totally democratic way.

For the third part of my speech, I would like to tell you about a meeting I had with the Association féminine d'éducation et d'action sociale, or AFEAS, in my role as critic for seniors and status of women. During the meeting, the AFEAS shared with me its concerns with MAID. I will quote the AFEAS 2018-19 issue guide:

Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly....As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope....This process cannot be accessed by individuals who are not at the end of life....People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.

Many people are not eligible for MAID because of the federal law governing the practice, which was imposed by a court ruling in February 2015. Four years after Carter, individuals whose quality of life is severely compromised by degenerative diseases are still being forced to ask the courts for permission to end their suffering.

In February 2015, the Supreme Court even struck down two sections of the Criminal Code prohibiting Canadian doctors from administering MAID. In Carter, the highest court in the land stated that a competent adult who clearly consents to the termination of life is eligible for MAID if that person “has a grievous and irremediable medical condition...that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition”.

According to the AFEAS, the Supreme Court's criteria were very broad. In drafting the MAID eligibility criteria, the Government of Canada included the concept of reasonably foreseeable natural death only for people at the end of life, which excludes a significant number of people who are experiencing intolerable physical and mental suffering.

The entire process is based on the intensity of the suffering as assessed by a doctor and a panel of experts. The sick person's own assessment is not always taken into account. There are no compassionate criteria among the requirements for obtaining MAID. A person may be at the end of their life and be unable to make the request themselves because they cannot communicate. The law applies only to people who are able to give their free and informed consent up until the very end, which could be terribly traumatic and even cruel to those who have been suffering for years.

With regard to advance consent, the AFEAS spoke about the case of Audrey Parker, a woman from Halifax who died with medical assistance on November 1, 2018. She made a video three days before her death. In that three-minute video, she said that she would like nothing more than to make it to Christmas, but that if she became incompetent along the way, she would lose out on her choice of a beautiful, peaceful and, best of all, pain-free death.

The Barreau du Québec believes that the law should be amended to comply with the criteria set out in Carter and thus prevent court challenges from being filed by people who should not have to carry such a burden.

A panel of experts has studied this issue and recommends, under certain conditions, ending the suffering of patients who have previously expressed their wish to receive medical assistance in dying, but who subsequently become incapable of expressing their consent, in particular people with various forms of dementia or cognitive loss such as Alzheimer's disease. This is why AFEAS is asking, with respect to human rights, that the process of medical assistance in dying be based more on the rights of individuals and on respect for their wishes.

With respect to reasonably foreseeable natural death, it requested that the reference to “reasonably foreseeable natural death” be removed from the eligibility criteria. With respect to advance consent, it asked that the person's informed consent be respected and that it be given in advance. Also on the subject of advance consent, it asked that the consent anticipated, stated and recorded by the person be recognized.

In conclusion, today's debate demonstrates the need to act so that people suffering from degenerative and incurable diseases are no longer forced to go before the courts to challenge the terms and conditions surrounding eligibility for medical assistance in dying, and so that we can ensure the best possible continuum of care.

Let's take action so that everyone can die with dignity.

[Bardish Chagger, Liberal, Minister of Diversity and Inclusion and Youth]

Madam Speaker, I support a number of the comments made by the hon. member opposite. I support moving this bill forward and sending it to committee so that members can study it in depth.

I am wondering what advice the hon. member would give to people concerned about or opposed to this bill.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her question. First, we have to listen to them. As already mentioned, if there are cases and concerns, we have to be able to document them and submit them to the committee. I will be meeting next week with a group that has concerns about this bill. I will listen to them and try to reassure them because I believe that there is a broad consensus that this bill must move forward.

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

Madam Speaker, I want to ask specifically about one issue my colleague did not address in her speech, which is the issue of the 10-day waiting period.

The existing framework involves a 10-day reflection period. The value of that is that people who are maybe at a particularly low point do not make the decision and then go through with the decision in a short period of time. There should be a mechanism, a time period, to ensure that they really are intent on moving forward with it.

At the same time, the existing system already has a mechanism by which this reflection period could be waived. In extreme circumstances it could be waived, but generally speaking, the 10-day reflection period ensures that people are not pressured into it in a short space in time.

Would the member be willing to support the idea of maintaining that 10-day reflection period in order to protect vulnerable people who might be pushed through this decision too quickly?