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

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

Mr. Speaker, my Liberal colleagues continue to push the myth that there are only two choices here. Option one is horrific suffering and option two is euthanasia. However, there is a third option, which is the love in the form of palliative care that meets the true needs of the patients.

Why do the Liberals insist on only offering a binary solution, when our amazing health professionals want instead to offer the truly compassionate option of palliative care? Why are they pushing euthanasia ahead of palliative care?

[Kamal Khera, Liberal, Brampton West, ON]

Mr. Speaker, I want to correct the record. There are not two choices; there are many choices. It is about the choices of people who are going through the suffering at the end of their life. It is truly about that.

As someone who has worked with patients during their end of life and has provided palliative care to patients, I am their biggest advocate to ensuring we are working to provide more palliative care. That is not just in our hospitals and long-term care facilities, but also for people who want to be in their homes.

That is why our government has worked collaboratively with partners, such as the provinces and territories, to develop a framework on palliative care. To support this framework, our government is implementing a targeted action plan, which will help improve access to palliative care to underserved populations, families, supports, health care communities and communities.

In addition, it is important to talk about the fact that we provided $6 billion in federal funding directly to provinces and territories to support better home care and palliative care in our communities. We have been having this conversation.

I agree with the member opposite that we need to do more when it comes to palliative care and to ensure we work with our provinces and territories to make it a reality for every Canadian.

To say there are only two choices is misleading the House. It is about the choices of the patients, what they want, and respecting those choices.

[The Deputy Speaker, Conservative, Bruce Stanton]

Before resuming debate, I must inform hon. members that we have had five hours of debate on this motion. The maximum time allocated for all subsequent interventions shall be 10 minutes for speeches and five minutes for questions and comments.

The hon. member for North Island—Powell River.

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

Mr. Speaker, I am here today to talk to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

It is very interesting for me to be here in a new Parliament discussing something we spoke about in the last Parliament. I was a fairly new member when Bill C-14 was before the House. I had a lot of constituents calling my office, sending letters and emailing us on this very important issue. I spent a lot of hours responding to people, talking to them on the phone and hearing their stories. What I really respected was the thoughtfulness. There were concerns of course, which is legitimate, but there was a lot of hope for some people as well.

Here we are back at it again. It reminds me of a dear friend and loved one who used MAID in his journey. His name was Joey. When I think of the core issue and value we are discussing today, which for me is unnecessary suffering, I cannot help but think of Joey.

Joey had an illness that was slowly killing him. In fact, it was so painful for him that he made this decision. He rearranged his time of death so I could be there with him, which was a huge honour for me. I was so grateful for that.

I think about the process we went through together that day. It was a beautiful process, but it was also a hard process. Part of the reason why it was so hard was he could not take any of his pain medication that day. He had to be totally able to answer that question. After a lot of thoughtful discussion, he had to stay in pain all day. We spent the day with him, but it was hard to see him suffering.

When we look at the bill before us today, that is what I hope all Canadians and all parliamentarians remember. We are here ensure nobody goes through unnecessary suffering like that.

One of the things that really struck me about the day when Joey passed was his doctor came to be part of the process. His doctor had made a decision that he did not want to be in a role to administer MAID, but he came. There were a lot of tears and remembrance of the long-term relationship. We also have to talk about the length of time some of our doctors have known us. Some have known us for years in some cases, and in Joey's case that was the reality. Another doctor was there for the process, but Joey's doctor was with him. His loved ones were around him. It was a peaceful process when he left us.

Today we are here to do this important work. I hope this goes to committee. I have had discussions with doctors in my riding who administer this process and they have a lot of good things to say about the bill, as well as some concerns they would like addressed, and I hope that will happen.

As this process started, a lot of people started writing my office again. We did some outreach. We wanted to let people know that this would be coming up. We wanted them to know that there was a process for them to connect with us and give their feedback to the government on this issue. A lot of my constituents participated in the process online. Not only did they participate, they were very thoughtful to ensure that the information they submitted was also given to my office. In front of me, I have a small portion of the comments from the people who sent us information and shared their stories.

I want to be clear about something, and we have to remember this as we go through the legislation. I represent a rural and remote community. The doctors who provide this service sometimes spend the whole day travelling to the community to provide this very important service.

There are some specific barriers and we want to ensure that in all our legislation we do not let those people in rural and remote communities down.

There are three of these doctors in my region. The riding I represent is just under 60,000 square kilometres, it has several ferries and many small islands. The doctors in that area provide the total service for that area plus a portion of my neighbour's riding. They deliver the service to a huge number of people over a vast distance.

Message after message thanked those doctors. In fact, Dr. Daws, a doctor in my riding, was mentioned repeatedly for being compassionate and for helping people go through this process in a very respectful way. People wrote me before they were going to participate in MAID. They just wanted tell me that this doctor had been very helpful.

I want to recognize the amazing health care providers in our country who provide this service, who do it in a sensitive and beautiful way. They are with people at one of the most precious moments.

I want to talk about Margaret who told us about her nephew. Her nephew had participated in MAID and that this was his decision. The biggest issue for her was the lack of the advance consent clause. He was given a choice of either going through this process two months earlier or not at all. Due to the medication he would have to take for his illness, it would automatically disqualify him from having the capacity to provide the consent.

This is the biggest issue for me, because people were having to leave sooner than they wanted to because they were afraid they would lose the capacity to give their consent.

I think of Megan who wrote about the experience her family went through. They were present for a friend's death. She said:

I fully support the idea of giving prior consent for MAID in case one is unable to give that consent immediately prior to the procedure, or in case one is in considerable pain and discomfort and would go through the process more calmly with adequate pain control at the end.

This really resonated with my experience with Joey, watching him suffer physically, and waiting for the relief. It was really hard. This is so important as we go through this process.

I think about Dolores, who sent me a beautiful message about ensuring the process was clear for people, wanting to have the accessibility to this be very clear and easy, and in an information package. Her biggest concern was that her family physician did not believe in this process and would not give her the information she needed to make the decision. She said that it would be good to have an information package that was a little more effective, so when a doctor was struggling with that personal choice, it would not impact the patient.

As a parliamentarian, these are the moments when I really respect the role I have on a whole new level, when people are telling me about the precious experiences they have had in their lives.

Another family talked about its father-in-law who spent seven years with dementia and was very well cared for, but in his last year, he rapidly deteriorated. His dignity plummeted. A loving son said that he was convinced that if he could have projected how his final years of deterioration would happen, he would have chosen MAID as an option, if it was available to him.

Then there is Milt whose wife is in a care home. Because of her Alzheimer's, she will not be able to express herself. He is so concerned that she will suffer way too long and he does not want to see that.

Another family talked about a friend who had cancer of the brain. Then she had a stroke. After her stroke, she was concerned that if she had a second stroke, she would be unable to state her wishes. Because of that, she participated in MAID sooner than she would have wanted.

This is a precious decision people make. It is a decision they make with their loved ones and their health professionals. I will be supporting the bill because I do not believe in people suffering unnecessarily. There are some challenges in the bill that I hope are clarified, especially looking at the realities for rural and remote communities. However, when people tell these personal stories, we hear again and again that they do not want to see people suffer, that they do not want to see people lose their dignity and that they want to ensure their wishes are honoured.

I am happy to be here to talk to the bill. I want to thank all of my constituents who have reached out to me. I always appreciate these beautiful stories that people share and some of the hard ones.

[Larry Bagnell, Liberal, Parliamentary Secretary to the Minister of Economic Development and Official Languages (Canadian Northern Economic Development Agency)]

Mr. Speaker, I would like to thank the member for her very heartfelt speech. It is one of the best ones I have heard, because she provided us with her personal opinion.

She mentioned that what is important to her is that people do not have to end their life earlier than they need to because they are not competent. The other major positive item is people who do not have access to MAID at all right now and that the bill would make it available to them.

The member mentioned at the beginning of her speech that she had some suggestions from health care professionals. I wonder if she could outline some of those to us.

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

Mr. Speaker, some of the things that I have heard from professionals in my riding are around language, for example, who will get to decide what a specialist is. There is some of that language, especially again for rural and remote communities. Who are they identifying? If somebody has had condition for a long time, obviously that individual has met with a specialist. What is that process?

Another issue is the 90 days and the concern about how long that is going to take, again coming back to people suffering in profound ways and wanting to make a decision. We have to look at some of those numbers.

Language is the biggest part. We need to make sure as always that legislation is as clear as possible, that we understand what we are legislating so that the language matches the practice.

Hopefully some of those things can be fixed. I believe they can. I hope that everyone in this place is aware of what we are here to do, and that is to obey the law. We are here today because of the court decision in Quebec, while also making sure that we are supporting people and their access, and that we are preventing suffering at all costs.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Mr. Speaker, I listened intently to the member. I appreciate her heartfelt comments. We work together on veterans committee.

I would like to talk to her about that dynamic specifically here. The bill states that the patient's death no longer must be “reasonably foreseeable” but requires patients to still have a “grievous and irremediable medical condition”.

The member and I appreciate our veterans but we are deeply concerned about the number of them who are choosing to end their lives because they do not feel well when they come back home. It is antithetical to try to prevent them from taking their own lives and yet telling them this is an opportunity to do so.

My father had Alzheimer's and passed away two and a half weeks ago. When he was barely able to still control his thoughts, he looked at my mom and his words were, “Will you take care of me?”. That was nine years ago. The palliative care he had, the love that he had in that circumstance I cannot imagine, even though he was down to nothing, not honouring the fact of life and death in that circumstance the way it was.

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

Mr. Speaker, I thank the member for the work that she does with me on veterans committee. I too share a deep concern and admiration for the people who have served this country.

My colleague knows some of the things that I would like to see done to support our veterans. She hears me in committee talking about the supports that need to be in place.

When I look at this legislation, I keep coming back to the fact that people have a fundamental right to make a decision that works for them. I deeply appreciate the story my colleague shared about her father and her loved one. I remember the years that I spent as a hospice volunteer, sitting with people who were ready to go. I would be in the hospital with families and with people as they were going through that process. I was honoured to have been a part of some beautiful moments. Just bringing people food and reminding them to eat when they were going through that incredibly sad time is something I will never forget. I also remember people starving themselves and refusing all help because they so wanted to be out of their body. They wanted to be out of their pain and their suffering.

When we look at this process, we have to honour all decisions, and that is what I am hoping to see through this legislation.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, it gives me great pleasure to once again rise in this House and speak to Bill C-7, an act to amend the Criminal Code (medical assistance in dying). This bill proposes amendments to the Criminal Code provisions on medical assistance in dying, or MAID, in response to the Superior Court of Quebec Truchon decision, which struck down the eligibility criterion that natural death be reasonably foreseeable.

I would like to highlight five major components that stood out for me.

First, it repeals the condition that a person's natural death be reasonably foreseeable, with the exception of patients whose sole underlying condition is mental health issues.

Second, it introduces new safeguards in addition to existing ones for patients whose natural death is not reasonably foreseeable.

Third, it permits the waiver of the requirement for final consent, allowing patients to provide consent to health care practitioners in advance, in the event that their death is naturally foreseeable and they are at risk of losing capacity to consent.

Fourth, it permits the waiver of the requirement for final consent if a patient chooses MAID by self-administration, in case complications arise following self-administration, such as a loss of capacity.

Fifth, it modifies the MAID monitoring regime to require that health care providers and pharmacy technicians provide regulated information when assessing a patient's eligibility or when dispensing a substance for MAID.

Over the last two days, many of my colleagues from both sides of this House intervened on a fair number of details. It gives me great pleasure to see that there is broad agreement that this legislation, with these amendments, gets voted in and move to the committee for further study.

I rose in this House during the 42nd Parliament back in 2016, and shared my experience, which dealt with the tragic loss of my father as a result of stage 4 cancer back in 2014. Such assistance was not available to us and we saw the loss of dignity. We saw the loss of the person I called “my hero” losing the capacity to be able to function and lead our family, as well as the fact that his desire would have been met, had we had this type of assistance available.

Also, as the chair of the all-party mental health caucus, I have been advocating, and our caucus has been advocating, for the consideration of mental health and the exclusion of that. I am pleased to see that that remains.

As I was listening attentively to the interventions over the last two days, at times there were questions raised about why it took so long. Considering that, and considering that we are almost halfway through this debate, I decided to focus my intervention mainly on the journey that our government has gone through over the last four years. The key concepts within that journey are the challenges that we are faced with; the stakeholders that we engaged with; the consultations during the studies; and the implementation, successes and challenges we have had.

Having said that, since the introduction of the legislation for medical assistance in dying in 2016, we have witnessed a steady increase in the number of Canadians and health care providers who have adopted this new regime. We have seen a relatively smooth integration of MAID assessments and delivery in end-of-life care service available across the country.

The enactment of this historic legislation was just the beginning of our efforts. Our government has since been very active in supporting the implementation of MAID across Canada. The 2016 legislation included clear directives for action, including the need for government to initiate independent reviews on three complex issues not addressed in the bill back in 2016. Some of my colleagues before me touched on those complex issues.

Rather than proceed too hastily, Parliament felt that it required more study and a review of available evidence. The government tasked the Council of Canadian Academies with undertaking these studies and that is where the journey started.

The resulting report tabled in Parliament in 2018 reflected an extensive review of academic and policy research, stakeholder submissions and international expertise in all three areas. It documented a range of perspectives from health care professionals, academic disciplines, advocacy groups and indigenous leaders; hence, the stakeholders that we have engaged with. We expect dialogue on these issues to continue during the parliamentary review and, as I have indicated, I hope that everyone in the House votes for this so that we can move it to committee and continue this dialogue.

Taking into account our federal system and division of responsibility for health care and criminal law, the federal government developed the monitoring and reporting regime to collect valuable information about requests for and the provision of MAID. In all other jurisdictions permitting assisted dying, there is an oversight and monitoring mechanism in place. The roles and responsibilities of these monitoring regimes vary.

In the wake of this monumental shift toward legalized assisted dying, Canadians wanted to know what kind of uptake there would be. Some were keen to know how accessible MAID would be across this vast country. Others want to know how safeguards would be applied and if there were protections in place for the vulnerable. Our government worked quickly with the provinces and territories to establish an interim reporting system, collecting and reporting on the best data available.

I want to acknowledge our provincial and territorial partners that had the challenging task of arranging safe access to MAID services from scratch, in a short period of time and in collaboration with multiple partners, such as health care providers, professional associations and health care delivery institutions. This tremendous task involved setting standards of practice for physicians, nurse practitioners and pharmacists to support the consistent and safe delivery of MAID within a legally sound framework. It also helped minimize the disparity to access in rural and urban areas.

Our government produced four interim reports using data voluntarily transferred by providers and various jurisdictions from 2016 until the creation of the permanent regime in late 2018. These reports covered a six-month period and provided information on the number of MAID deaths, patient demographic information, underlying medical conditions and predicted MAID requests.

In reviewing these reports, we know that the awareness of MAID as a legal option is growing. There appears to be a growing comfort among health care providers. In the interim period, our government worked to establish a permanent national monitoring and reporting system as considered in Bill C-14.

Through stakeholder consultation and collaboration with provinces and territories, the government enacted federal monitoring regulations in late 2018. These regulations set out the reporting requirements for all physicians, nurse practitioners and pharmacists who participate in MAID. We were mindful of balancing the need for information while limiting the reporting burden on health care providers and avoiding duplication of effort. This system has been operating for just over a year. Late this spring, our government plans to release the first annual report using data from this new monitoring system.

Budget 2017 announced $11 billion over 10 years to support home and community care services, including palliative care, mental health and addiction services; $6 billion was specifically allocated to those services I talked about. In 2019, our government worked with all the provinces and territories to develop the framework for palliative care in Canada, which I consider a cornerstone of this bill.

Over the last three and half years that MAID has been available, our government has worked to support a smooth integration into the health care system based on the foundation I have just laid out. On the evidence that we have gathered, we have put together a bill that represents the Truchon decision and addresses other issues where there is clear consensus and a reasonable path forward. It is my hope that, after due consideration and debate, we move this bill to committee.

I will close by saying that I support this bill and I thank all members for intervening on this topic.

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

Mr. Speaker, I did support Bill C-14 and voted for it in the last Parliament. I thought that it did strike the right balance and that it had a very limited application. However, I was troubled at the time about the reasonable foreseeability words, which I thought would likely be litigated, and indeed they were.

I would ask the member this: Why not now simply deal with the narrow issue of the court only? There was a reason, at the time, to have a full five-year period before revisiting a significant expansion. The reason was to collect a broad volume of data to examine how Bill C-14 would be implemented. Why the expansion beyond the narrow issue of the court decision?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, as the hon. member mentioned, we had the opportunity to only deal with the narrow amendments required to respond to the Superior Court of Québec on the Truchon case.

I believe I went through the list of stakeholders who have engaged in the consultation. Through that consultation and that journey, we heard about other areas that we needed to address. We found this was an opportune time to not only address the areas that we are mandated to by the court, but also table other potential amendments to let our stakeholders know that we have listened, and send it to committee where we have the opportunity to study it further.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Mr. Speaker, I thank my colleague for his speech.

The NDP will also support this bill so it can be referred to committee for study in order to improve it and perhaps correct some of its flaws.

I am personally concerned about the issue of people dealing with degenerative illnesses that affect not the body but rather the spirit or intellect, such as Alzheimer's.

Why would it not be possible for a bill such as this one to provide for the possibility of drafting an advance directive, together with the medical staff, which could be renewed every six months in the case of someone who has already been diagnosed with Alzheimer's?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, let me thank the member for supporting the bill and giving it the opportunity to be studied in committee. I am sure this will be one of the areas we will spend a fair amount of time on.

Having said that, it is best that we look at it from a holistic point of view and consider all the options available. This is one of the options that I think it would be worthwhile considering and looking into. I am looking forward to the member's input at committee.

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

Mr. Speaker, I want to ask the member about the 10-day waiting period. Right now, there is a 10-day reflection period; however, that reflection period can already be waived in certain circumstances.

It is a good default that some time is spent in consideration and that it is not a person who decides in the morning they want to be euthanised and then it is taken care of right away. There should be some period of reflection.

Would the member not agree that in most cases that is sensible?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, the member has raised this point in other interventions. I agree that there needs to be that 10-day period. The beauty of this bill going to committee is it gives us an opportunity to discuss that in further detail.

However, personally from my position, I think we need to consider that as part of the safeguard.