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

[The Deputy Speaker, Bruce Stanton]

The hon. member for Prince George—Peace River—Northern Rockies had four minutes remaining in his time when the House last took up debate on the question. We will now go to him by video conference.

The hon. member for Prince George—Peace River—Northern Rockies.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Mr. Speaker, in case I do not have time at the end, I would like to wish you, your family and those at the table a very merry Christmas.

I would like to finish up my speech on Bill C-7 and my concerns. What highlights it more than my speaking for another four minutes are quotes from key individuals.

The Liberal member of Parliament for Thunder Bay—Rainy River, a doctor, said:

...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....

My biggest concern, as someone 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.

I will go to another quote from another current Liberal member of Parliament, the member for Delta, British Columbia, who said, “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”.

The individual is Roger Foley in this case. The quote comes from a Senate committee. She continued, “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 [medical assistance in dying]. 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.”

Here we see highlighted, even by our very own colleagues across the way in the Liberal Party, grave concerns about the current bill and the way it is written.

I will go to another quote from another doctor, Dr. Catherine Ferrier, who said:

To leave to doctors the decision about providing [medical assistance in dying] to anyone who meets the criteria is to entrust them with life-and-death decisions for millions of people in a vulnerable position. Doctors have the same limitations as everyone else does, which may include unconscious bias towards [medical assistance in dying] as an option and against living in certain situations. No one should [ever] have that power.

It should be made clear in the law that [medical assistance in dying] is not a medical treatment on the same level with real treatments. It's not a standard of care. It should be a last resort when all other reasonable options have failed.

I have one last quote by Dr. Trudo Lemmens and Leah Krakowitz-Broker from an op-ed, which states:

...unlike any other country in the world, the new bill fails to explicitly require that all reasonable...options be made available and tried first, before allowing physicians to end a patient’s life.

In other words, the bill makes dying easier than living.

Rather than instilling hope and helping to build resilience by focusing on options for living, health care providers will now be asked to discuss an early death.

The conversation I have heard far too many times from concerned citizens is that we have put our seniors, our disabled community and other communities in an abhorrent situation where they have to choose between treatment or death, based on the outside pressures of costs, burdens to their family and so forth. These are choices that should never have to be made by those who should be treated the best in our society.

It has been said many times in the House, over 300 times I know from our side and others, that this bill needs to change before it is—

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

I will let you further your arguments during the questions and comments.

Questions and comments, the hon. parliamentary secretary.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Madam Speaker, when I look at Bill C-7, what I see is a reflection of the will of tens of thousands of Canadians in all regions of our country. I see reflections that come from the Supreme Court of Canada from six years ago and the many hours of discussions and debates, which are into the hundreds if not thousands, inside the chamber and at committees, in the House of Commons and the Senate. At some point, we need to recognize that, yes, there are going to be arguments on both sides of the issue, but at some point it does need to pass.

Does he not recognize the value of the deadline imposed by the Superior Court of Québec? Does the Conservative Party have any respect for that decision by the Superior Court of Québec?

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Madam Speaker, what the member across the way needs to understand is that we are legislators. We are sent here by our constituents to represent them and to represent their concerns. They have clearly spoken, across Canada, about their concerns with respect to the bill as it is written. We have suggested amendments to fix it the best way we possibly can and the current Liberal government has thrown them out and rejected them all. I would suggest to the member across the way that he listen to the constituents across Canada, hear their concerns and fix the bill.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Speaker, my hon. colleague, from my neck of the woods, handled that last question far more respectfully than I would have. I would have passed it back to the parliamentary secretary, saying that while the Liberals had months to be able to do this and push it forward, they prorogued for six weeks. If this was such an urgent matter for them, they would have done it.

We are sent here as legislators. We are sent here to be the voices of our electors. We are also sent here to be the voices of those who do not have a voice. I am someone who has an adult child with a disability, and I will get into that more in my speech tomorrow. Our job as parents is always to protect them. I can see both sides, because I have a father-in-law who is living beside me in palliative care right now. I have had many family members who have struggled with cancer.

Should we not be doing everything in our power to step back and take a reflective look at this piece of legislation to ensure that those fundamental core protections for our most vulnerable are in place before we move forward?

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Madam Speaker, I thank the hon. member, who is a good friend and colleague. Absolutely, as a parent of four children myself, it is our responsibility. We feel that responsibility especially with this bill.

I have senior parents who are still alive today. My dad is 86 and mom is 76. I am deeply concerned that they would ever be put in the position to have to make that decision. There are seniors who maybe do not have children who can care for them like I can. They may be put in a position where they are pressured to make a decision to end their lives as opposed to taking treatment or further care, not wanting to be perceived as a burden. It is a shame that we would even put them in that position. No Canadian should ever have to make the decision between treatment and physician-assisted suicide or medical assistance in dying. That should never happen.

[Eric Melillo, Conservative, Kenora, ON]

Madam Speaker, I appreciate a lot of what my colleague had to say on this matter. One of the things he mentioned was the importance of having all health care options available, including palliative care and a stronger support system for those who are struggling and potentially nearing the end of their lives.

I wonder if the member has any comments on the current situation, particularly in northern and remote regions, concerning health care options and how important it is to ensure that all those options are available for people.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Madam Speaker, that is a great question. What I would have preferred to see in a bill like Bill C-7 would be something to deal with palliative care and other treatments, even before considering a bill like this.

Again, as was brought up by my colleague previously, the government prorogued Parliament, yet things like palliative care for people who are ill, especially in northern communities, is a big gap. We do not see where the government is actually caring for those northern communities. As the former critic for northern affairs, we saw a big absence of care in the north. We should be looking at all forms of care and dealing with those first before we ever consider a bill like Bill C-7.

[David Lametti, Liberal, Minister of Justice]

Madam Speaker, I would also like to wish you, as well as the table officers, pages and everyone who works in this building, happy holidays.

[Member spoke in Portuguese as follows:]

Feliz Natal!

It is with great pleasure that I speak to Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying. First, I want to express my sincere gratitude to the members of the Standing Committee on Justice and Human Rights for their excellent work on this difficult matter and to all the witnesses who appeared before the committee and for their compelling testimony.

Unfortunately, the Conservatives have made it clear that they are not interested in improving the bill. They want to stop it from moving forward, all this while people continue to suffer across the country. In creating this important piece of legislation, we consulted with over 300,000 Canadians, including key stakeholders. At every opportunity we acknowledged that this was a complex and personal issue, and that we would respect the different views of parliamentarians and Canadians.

During these consultations I engaged with many disability advocates and experts who participated in most of the 10 round tables I hosted across the country in January and February, along with my colleagues, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion.

Two of the engagements I was involved with focused exclusively on the disabilities community, one in Vancouver at a round table with disabilities groups and another forum in Ottawa organized by the Canadian Association for Community Living, now Inclusion Canada, and the Council of Canadians with Disabilities in January, entitled End of Life, Equality and Disability: A National Forum on Medical Assistance in Dying.

During these consultations our government heard the voices of individuals with disabilities and degenerative illnesses who shared their perspectives and concerns, including those who believe that limiting medical assistance in dying to those who are dying is a violation of their rights and self-determination. These were individuals like Mr. Truchon and Madam Gladu, who initiated legal proceedings alleging that being precluded from accessing MAID violated their charter rights and deprived them of their preferred way of responding to intolerable suffering. Also Julia Lamb in Vancouver said quite clearly that she spoke for herself and that the leadership of the disability community did not speak for her.

We respect those voices from the disability community, which are as diverse as any community. These interventions had a direct impact on the structure of the legislation, including the non-end-of-life regime with additional safeguards as well as the substantive safeguards themselves, which affirm autonomy but balance safeguards for people who may have been in a vulnerable position. We heard those voices and we incorporated it into the very legislation that we proposed.

We also heard a clear consensus during the consultations that the additional 10-day reflection period—

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Madam Speaker, I rise on a point of order. I apologize to the minister, but it is very clear that members attending virtually are purposely opening their mikes to add comments, which is not allowed. The Speaker has ruled on that many times. The same member has done it throughout question period today, and I would ask you to speak to that member to ensure that there is decorum in the House and that we are all allowed to listen to the speeches that are happening.

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

Yes, I do appreciate that sometimes it is an accident, and sometimes it is on purpose. I would remind members who are listening in through video conference to please keep their microphones on mute.

The hon. minister.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, we also heard a clear consensus during the consultations that the additional 10-day reflection period in the end-of-life regime was not serving its intended function, but instead was prolonging patients' suffering. In fact, many practitioners and families of those who had gone through the process of MAID shared heart-wrenching stories of patients who had stopped taking their pain medication for fear of losing their capacity to consent to the procedure. This is certainly not the outcome that Parliament intended in 2016.

I will go into more details about some of the safeguards the bill provides, but before I do, I want to say that, given their expressed concerns around safeguards, I do not understand the frankly irresponsible actions the Conservatives are taking in delaying this legislation, knowing full well the risks that could result in Quebec from a legal void. If we reach the court deadline and nothing has changed, there will be no adequate safeguards in Quebec for those whose deaths are not reasonably foreseeable. In addition, Quebeckers will not be able to benefit from the modifications that we are making to reduce suffering. I am unsure how the Conservatives can accept that as a possible outcome if their main concern is safeguards.

In the Carter case, the Supreme Court found that the criminal prohibition of medical assistance in dying violated section 7 of the charter and could not be upheld under section 1, because a permissive structure with appropriate safeguards would achieve the legislative purpose of protecting vulnerable persons. The court expressly stated that it was the role of Parliament and provincial legislators to perform the difficult task of creating the regulatory regime that properly balanced competing societal interests.

The government believes that it is possible to respect the autonomy of Canadians in deciding when they have suffered enough while helping people with disabilities live full lives. I know that challenges exist when it comes to providing the care that everyone needs and the access to that care, but the solution is not to prevent people who are experiencing intolerable suffering from making an autonomous choice about one of the most fundamental aspects of their lives.

I am confident that the choice to provide enhanced safeguards for those whose death is not reasonably foreseeable is the prudent way to expand eligibility for medical assistance in dying. The safeguards for this group of newly eligible individuals are designed to ensure that sufficient time and expertise are devoted to the assessment of their request for medical assistance in dying. In these circumstances, it is essential to ensure that individuals are informed of other means of alleviating intolerable suffering because, ultimately, it is a question of putting an end to a life that could have lasted for many more years.

I know this is an important issue for Canadians, and I am committed to working with all parliamentarians to begin the parliamentary review of the medical assistance in dying regime as soon as possible after Bill C-7 has made its way through the parliamentary process. I have no doubt that the issue of advance requests will be an important part of that review.

I believe that Bill C-7 is one important and prudent step forward in ensuring greater respect for the autonomy of a broader category of Canadians who are suffering intolerably. It carefully balances competing interests and values in a context where reasonable, informed experts and stakeholders disagree in significant ways. It makes 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 stated, “that the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards.” That is exactly what Bill C-7 continues to do.

While a subject as important as MAID requires and deserves Parliament's appropriate consideration, I want to underscore the importance of timely and efficient consideration, and the political consequences of the Conservatives' current obstructionism. The Conservatives' delays will have a very real and direct impact on the individuals who seek to alleviate suffering through access to MAID. Individuals in circumstances similar to Audrey Parker's will face the awful choice of ending their lives early, rather than risk losing the capacity to consent.

Others will continue to face the procedural burden of mechanisms that families and practitioners have overwhelmingly told us are burdensome and no longer necessary. Still others who are experiencing intolerable suffering, and who have received all the necessary medical diagnoses, will remain ineligible as a direct result of the Conservatives' delay tactics.

On this last point, let me be clear about the dangers created by the Conservatives' attempts to run out the clock on the Quebec Superior Court's extension. There is absolutely no assurance that a Quebec court will grant further extensions to the current suspension of invalidity. If that suspension period expires without the passage of Bill C-7, Truchon will come into effect in Quebec without the benefit of the protections, standards and inclusions of our proposed bill, and without the benefits of our proposed bill to reduce suffering for people in the current regime.

I do not know why my official opposition colleagues feel no need to meet the deadline set by the Superior Court of Quebec and are delaying the passage of this legislation. Their actions are prolonging the unnecessary suffering of Canadians. I encourage them to allow the bill to make its way through the process so we can meet the courts' December 18 deadline.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Madam Speaker, I am very happy to hear from the Minister of Justice at third reading of this bill.

Like us, he knows that his right to speak must be upheld and that it is his duty as minister to exercise that right. That is exactly what our members are doing and what all members of the House of Commons can and must do.

This morning, I heard on CBC that a Liberal MP wants to vote against the bill. It makes no difference to me whether he votes for or against it. However, what I find disappointing is that this MP, whose primary job is to speak in the House, has not done so. Did his Liberal colleagues tell him to keep quiet because he is not on their side? If so, that is very disappointing.

My question for the minister is about the fact that he is accusing Conservatives of delaying the study of the bill when we are simply adhering to the Standing Orders and exercising our right to speak.

This bill was introduced in the House in February. We understand that a pandemic occurred, but that has nothing to do with this. However, I would like the minister to explain why his government shut Parliament down by proroguing it, which meant that we had to start all the parliamentary work all over again when we came back. If the government had not prorogued Parliament, it would have saved 24 days of parliamentary work. We could have picked up where we left off in February and we would have gained 24 extra days.

The minister is to blame for the fact that we do not have enough time. What is worse, even if we were to accept the fact that the government decided to suspend the work and close Parliament, why did the minister waste seven days after the opening of the House and the throne speech? Why did he not introduce the bill as soon—

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

I have to give the minister an opportunity to respond and allow others to ask questions.

The hon. minister.