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

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

Mr. Speaker, given the preamble in the old Bill C-14 expressly references conscience protections, given that section 241.2(9) of the Criminal Code, which was amended by his party at his party's suggestion in the last Parliament, also has conscience protections, given that paragraph 132 of the Carter decision references conscience protections and given that the section 2 protection in the charter is a bedrock foundational conscience protection, does the member, first, think that is sufficient with respect to conscience protections?

Second, is there any instance of an institution, of religious persuasion or otherwise, being forced to provide this, given those protections? I am aware of none.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, there are cases that I am aware of, to the member's last point. The reality is what happens on the ground. I have heard cases of people, medical professionals who do not want to participate and yet they felt harassed, pressured, criticized and those types of things. There are certain protections under the laws now, but they need to be strengthened, and in practice it needs to be expanded.

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Speaker, I thank my colleague for his speech, in which he talked about rights and freedoms.

I just want to know if he is aware of the ruling regarding Nicole Gladu and Jean Truchon, both of whom have degenerative diseases, in which Justice Christine Baudouin wrote that, “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.”

I would like to hear my colleague's thoughts on that.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, yes, I am aware of that. That is the part that I believe we should be pursuing now. The other changes that have been proposed, regarding the waiting period and some of these other things, should not be pursued now. The bulk of what is being proposed should wait until the consultation period in the summer. We need to deal with the request from the Quebec court and the ruling from the Quebec court. For the rest, I believe we should wait.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, I would like to talk about something that happened just a few minutes ago. Someone I know quite well contacted me, someone who is not currently eligible for medical assistance in dying under the legislation and would probably qualify under the new provisions. This person is in intolerable pain and suffering and has reached out to many people, asking for help.

I believe the reason the government has decided to proceed with some of these changes is to meet that need and help us reduce unnecessary suffering at the end of life. This is not someone who is being pressured. This is someone whose condition is deteriorating quite rapidly and is, as I said, in enormous pain. I ask the member to think about that motivation here for us to reach out and help those people and those families who are faced with this right now, not months from now.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, we can all think of many specific cases of people who are impacted by this. I still believe it is correct to wait for the review process to look at all these cases and make changes based on that.

The other issue that the member's question raises is the lack of palliative care. If there were more and better palliative care options, while I do not know about the specific case the member mentioned, then more people would have other options than MAID. I believe, though, that is another solution.

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

Mr. Speaker, in this debate, we hear that the safeguards we currently have are already not working. We know that quality palliative care is a necessary solution and we all see a lack of access, even a revocation of palliative care in my province.

The third thing is, unfortunately, the inability to ensure conscience rights protection. In my province of B.C., the former program director of palliative care had to resign when Fraser Health Authority imposed MAID in hospices. He believes that palliative care does not include euthanasia since palliative care, by definition, neither hastens nor postpones death.

Why is the government not working harder to ensure proper protection for patients and health care professionals?

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, that raises some very good points. It raises the issue of institutional conscience protection, and also the issue of better palliative care options in our country. Those are areas that we need to pursue just as vigorously as the government is pursuing the MAID legislation.

[Kamal Khera, Liberal, Parliamentary Secretary to the Minister of International Development]

Mr. Speaker, it is an honour to rise in this House to speak today about Bill C-7. This bill would amend the medical assistance in dying regime in the Criminal Code to address the Superior Court of Quebec's decision in the Truchon case. As members know, in September 2019, the Quebec Superior Court struck down the eligibility criterion of “reasonably foreseeable natural death” from the medical assistance in dying, or MAID, regime in the Criminal Code. Our government has made significant efforts to consult and engage with Canadians in order to inform the proposed approach to address this decision and amend the MAID regime in Canada.

An online consultation was launched, and over 300,000 responses were received from Canadians. In addition, the Minister of Justice and Attorney General of Canada, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion had the opportunity, along with their parliamentary secretaries, to meet with stakeholders and experts across the country during a series of round tables all over Canada. These consultations were an extremely important part of the development of Bill C-7.

Medical assistance in dying is a sensitive and challenging social issue that we are currently faced with, one that is deeply personal for very many people and for me personally. I worked as an oncology nurse at St. Joseph's hospital in Toronto and have seen end-of-life care first-hand. I have seen individuals making difficult end-of-life decisions for themselves or their loved ones, and I appreciate our government's decision to consult and listen carefully to Canadians on this issue.

In addition to being deeply personal, the issue of medical assistance in dying is also legally and ethically complex, which is why it was so important for our government to meet with experts, stakeholders and practitioners during the round tables. Our government listened. It listened to the health care experts, doctors, nurses, legal scholars and regulators, but most importantly, it listened to Canadians. The bill takes into account what was learned during these consultations and responds to the Truchon ruling by proposing amendments to the Criminal Code that would ensure consistency of the MAID law across the country by broadening eligibility, and adjusting the safeguards accordingly, for a MAID regime that is no longer limited to end-of-life circumstances.

Bill C-7 proposes to amend the Criminal Code in response to the Truchon ruling in three ways.

The first is by expanding eligibility to those whose natural death is not reasonably foreseeable but who are still experiencing intolerable suffering. This will give those who are suffering in a wider range of situations the choice of a medically assisted death.

At the same time, the amendments would exclude those suffering from only a mental illness. This is in response to very specific concerns voiced by experts and mental health professionals about eligibility on the basis of a mental illness. Many members will also recall that during the study of former Bill C-14, the government asked the Council of Canadian Academies to look into such cases. The experts in this field could not come to a consensus on this very complicated issue in their report on the subject, which was released and tabled in this chamber in December 2018.

Our government recognizes that the unique considerations for the availability of MAID for individuals experiencing suffering only from mental illness requires further discussion and public debate. I believe the parliamentary review that will begin in June 2020 is the appropriate forum for the further consultation and deliberation that are needed before considering any changes in this regard.

The second main feature of this bill is the creation of two sets of safeguards to be followed before medical assistance in dying is provided, depending on whether a person's natural death is reasonably foreseeable or not.

The bill would continue to use the expression “reasonably foreseeable natural death” as the element that determines which safeguards to use. This approach for a MAID request is consistent with the view that medical assistance in dying for people whose natural death is not reasonably foreseeable presents more complexity. Many experts believe that the assessment of a request should be tailored to these different types of cases.

New safeguards for those whose natural death is not reasonably foreseeable will focus on ensuring that assessments take adequate time and involve the relevant expertise to detect and address the sources of the person's suffering. They will also ensure that people receive information about the appropriate and available services and options to improve their quality of life. They will need to give serious consideration to those options before concluding that medical assistance in dying is the choice for them.

Finally, the bill would relax some of the existing safeguards, in particular for those whose natural death is reasonably foreseeable. Those whose deaths are reasonably foreseeable will not need to undergo the 10-day reflection period. These individuals have already given a lot of thought to their request before they made it, and requiring them to wait another 10 days after they have been approved for medical assistance in dying may prolong their suffering unnecessarily.

Just as importantly, the bill proposes to permit the requirement of final consent to be waived in the case of people whose natural death is reasonably foreseeable when certain conditions are met. These conditions are that the patient's death must be reasonably foreseeable; they must have been assessed and approved for medical assistance in dying in accordance with all safeguards; they are at risk of losing decision-making capacity before their preferred date to receive medical assistance in dying; and they have a written arrangement with their practitioner, in which they have given consent in advance to medical assistance in dying being administered if they lose capacity, and in which the practitioner agrees to provide medical assistance in dying on their preferred date, or earlier, if they can no longer provide the final consent.

These proposed amendments would also clarify that practitioners would not be allowed, in this situation, to provide medical assistance in dying if the patient demonstrates refusal or resistance by words, sounds or gestures.

For individuals whose natural death is not reasonably foreseeable, the remaining criteria defining the grievous and irremediable medical condition in the Criminal code would expand eligibility to medical assistance in dying to people with a wide range of conditions. A grievous and irremediable medical condition is defined in the code as a serious and incurable illness, disease or disability; an advanced state of irreversible decline in capacity; or intolerable suffering that cannot be alleviated under conditions that the person considers acceptable.

This means that a grievous and irremediable medical condition could include conditions producing chronic pain or other symptoms. Canada's medical assistance in dying regime would move away from being an end-of-life regime to becoming a regime in which MAID could be chosen to relieve unbearable suffering that occurs outside of the dying process.

To conclude, the bill before us today proposes the amendments required by the Truchon decision. It also reflects what we heard in 300,000 responses to the online consultation. This is what we heard from stakeholders when the ministers and parliamentary secretaries held consultations from coast to coast to coast. It takes into account the opinions and input of health care professionals, doctors, nurses, legal scholars, provincial regulators, civil society, non-governmental advocacy organizations and those with lived experiences. The bill strives to achieve a balance between respecting personal autonomy and protecting vulnerable individuals. Perhaps most importantly, it respects the equality rights of all Canadians.

For those reasons, I call on the members of the House to support this bill, send it to committee where it can be looked at even more thoroughly and make this a reality in Canada.

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

Mr. Speaker, I want to comment and pose a question to the member around one of the strands in today's debate.

Members on our side have raised the need for safeguards because of the risk of abuse. Responding to an argument that was not made, government members have said they trust health care professionals to make good decisions in the vast majority of cases.

Of course, we also trust health care providers to make good decisions, to have good intentions and to do all they can to stay within the bounds of a patient's well-being in the vast majority of cases. However, the reason we have safeguards is to deal with that small minority of cases in which someone could actually lose his or her life as a result of pressure, as a result of a proper review not taking place, or as a result of being rushed into decisions in less than ideal circumstances.

We talked about examples of this small minority of cases in which human lives are still very much in the balance. Because of this need to have safeguards for these situations, would the member accept that a default to a 10-day reflection period would provide some degree of insulation against the possible risk of someone in a dark moment, in a short-term thinking process, opting for something that on balance they would actually not opt for with the proper engagement of their full support structure?

The 10-day reflection period can be waived in extreme circumstances already, so what is wrong with a 10-day reflection period?

[Kamal Khera, Liberal, Brampton West, ON]

Mr. Speaker, I know this is very complex and a very personal issue. For those whose death is reasonably foreseeable, the bill proposes to eliminate the 10-day reflection period, 10 days that many practitioners say can prolong unbearable suffering. It is about patients and about the individuals and their rights.

The requirement for two independent witnesses, which many experts indicated created difficulties for certain types of patients, would also be eased for eligible persons. Health care workers would be able to act as independent witnesses, provided that they are not the provider or the assessor.

[Lloyd Longfield, Liberal, Guelph, ON]

Mr. Speaker, I thank the hon. member for Brampton West both for her speech today and for work as a health professional. Listening to her, I wonder what her patients must be thinking of her as she speaks now in the House on their behalf.

I have had many conversations with constituents who are facing the need to have this legislation improved. In December, I spoke to a person who had a best friend who was trying to access medical assistance in dying, and he also had a brother who was trying to access medical assistance in dying. The reasons that led them both to that were ultimately the pain they were feeling and the loss of independence and dignity, and not foreseeable death.

The voices that really resonate at the end of the day are the people who are trying to access services or family members who know their situation. It is important that we give priority to the voices of the people whose rights are being denied under the current legislation.

Could the hon. member comment on how important it is that we protect the freedoms of the people we are serving who are trying to access this type of service?

[Kamal Khera, Liberal, Brampton West, ON]

Mr. Speaker, I would like to thank my colleague for his ongoing advocacy on this issue, and we have had many conversations about it.

It is very personal for me to speak on this issue, as I have in the past when the debate on medical assistance in dying first came to this chamber in 2015. Just before the election in 2015, I was a registered nurse. I am still a registered nurse working in oncology, working with patients to provide them with palliative care and helping them during their end of life.

Those rights are what we are protecting today. I think the member in his question answered his own question, so I would like to thank him for that. I think the bill does just that. I hope that all members of the House pass the bill and take it to committee, where there may be some discussion on how to make it better.

[Louise Charbonneau, Bloc, Trois-Rivières, QC]

Mr. Speaker, I thank my distinguished colleague for her speech.

Yesterday, I stated in the House that certain aspects of this bill need to be clarified. Similarly, I noted that the provision dealing with the eligibility of mature minors, which we have talked very little about here, is to be reviewed.

I would like to know how my esteemed colleague would define the term “mature minors”.

[Kamal Khera, Liberal, Brampton West, ON]

Mr. Speaker, my colleague raises a very important question. As I have said before, this is a very complex and personal issue. It raises many difficult conversations, not just in this place but throughout the country. Whether it is around mature minors or mental health, we are ensuring that we work with provinces and territories to continue to invest in palliative care. We want to ensure people have the end-of-life care they need and deserve.

It is important to ensure we protect people when it comes to mental health issues or mature minors. We need to have that broader discussion. That is why I hope we can take this bill to committee to have those conversations. I know that in June 2020 there will be a broader discussion on this very topic.