Bill C-7 (Historical)

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

Criminal Code

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, with regard to timing, I was very disappointed that this decision came out on September 11, the day the last election was called. The government was given one month to appeal this decision in the middle of an election campaign. I do not believe that this gave Parliament an ample opportunity to review the bill outside of a very politically charged period to decide whether this decision should have been appealed to the Supreme Court, which was the court that created legalized assisted dying in this country.

I believe the Supreme Court has something to say on this matter, and we failed by not getting the Supreme Court to weigh in on it.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Mr. Speaker, I am pleased to rise today in support of Bill C-7, which proposes amendments to the Criminal Code's medical assistance in dying regime, in response to the Superior Court of Québec's Truchon decision. I will provide the context for the change.

As we know, in September 2019, the Superior Court of Québec struck down the federal and Quebec criteria that limit the access to MAID based on circumstances where death is reasonably foreseeable. The court, whose ruling only applies in Quebec, suspended its declaration of invalidity for six months, until March 11, 2020. On February 17, the Attorney General of Canada filed a motion to request a four-month extension to give Parliament the time needed to implement a response and ensure that the law across the country is consistent as it relates to the federal MAID regime.

I will provide a brief overview of the amendments to the Criminal Code that are being proposed under Bill C-7.

First, on the eligibility criteria, the bill would repeal the reasonably foreseeable natural death criteria and exclude persons whose sole underlying medical condition is a mental illness. Second, with regard to safeguards, the bill would create two sets of safeguards, depending on whether a person's death is reasonably foreseeable, while easing some existing safeguards and adding new ones for persons whose death is not reasonably foreseeable. Finally, the bill proposes to allow for a waiver of final consent on the day of the procedure in specific circumstances.

How did these changes materialize? The development of this legislation was informed by the Truchon decision; available Canadian and international reports, such as the December 2018 report of the Council of Canadian Academies; the experience of existing international regimes; and our government's recent consultation on MAID, held in January and early February.

The Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, along with their parliamentary secretaries, hosted several federal MAID round tables across the country. These events were attended by experts and stakeholders, including doctors, nurse practitioners, representatives from health regulatory bodies, legal experts, representatives of the disability community, indigenous representatives and other key stakeholders. They shared their experience and insight into MAID and its implementation in Canada over the last four years.

In parallel to these efforts, our government heard from over 300,000 Canadians who participated in the online public survey on MAID between January 23 and 27, 2020. There was an unprecedented number of respondents, reflecting the significance of this issue for Canadians. This kind of input is invaluable to government and, I am certain, was seriously considered by the ministers in the development of the bill.

I would like to provide a personal perspective on the issue of MAID in its previous iteration.

In 2015, when the Liberal government came to power, it was tasked by the Supreme Court to amend MAID. A special joint committee was established, involving both Houses and all parties. The special joint committee conducted an enormous amount of consultation and came up with a proposal. The then minister of justice and minister of health were presented with this proposal. Through intense discussions and consultations, the proposal was amended.

In my riding of Don Valley East, I did a consultation in the sanctuary of the Donway Covenant United Church. Various constituents, as well as other members from across Toronto, participated in the town hall. Members of CARP, the Canadian Association of Retired Persons, were also on the panel. It was an emotional meeting. I clearly remember one of my constituents, who was non-verbal and had to use her communication board, telling me that she wanted advance directives while she was lucid but could not predict whether she would be lucid in the foreseeable future.

In 2019, I had to do another presentation at a church in another riding. Here, overwhelmingly the audience was against the phrase “foreseeable future” and also wanted advance directives.

I am glad to see that some of the changes requested through consultations have now been incorporated. I look forward to the five-year review that is scheduled for June 2020 to see the discussions around advance directives.

I will now go to the bill itself and some of the changes it proposes to the eligibility criteria.

With regard to the proposed Criminal Code amendments in relation to eligibility, the bill proposes to make two changes to the current set of eligibility criteria for MAID. First, it would repeal the reasonable foreseeability of natural death criteria from the list of eligibility criteria in response to the Truchon ruling. That is good news for some of my constituents in Don Valley East. The legal effect of this amendment would be that those whose natural death is reasonably foreseeable and those whose natural death is not reasonably foreseeable would be eligible for MAID if they met all other eligible criteria.

Second, the bill proposes to exclude people whose sole underlying medical condition is mental illness. Many practitioners, stakeholders and experts have identified increased complexities regarding individuals seeking MAID whose sole underlying condition is mental illness. I suggest that this could be an item for Parliament to look at it in its upcoming mandatory five-year review of the MAID regime.

The Council of Canadian Academies' experts group issued a report in 2018 on the same issue and could not come to a consensus on this question. The Government of Quebec has also announced that access to MAID for cases where mental illness is the sole underlying condition would be suspended and that a broad consultation process would be conducted on this issue.

Regarding safeguards, the public needs to know some of the safeguards that will protect the vulnerable. With respect to the applicable safeguards proposed, the proposed Criminal Code amendment would create two different sets of safeguards depending on whether a person's natural death is expected in the near term or not. The first set of safeguards would continue to be tailored to persons who have a reasonably foreseeable death where risks are reduced. The second set of safeguards would be tailored to persons whose death is not reasonably foreseeable and would address the elevated risks associated with the diverse sources of suffering and vulnerability that could lead a person who is not nearing death to seek access to MAID, such as loneliness, isolation, lack of adequate supports and hopelessness.

Bill C-7 proposes to use the reasonable foreseeability of natural death standard to determine which set of safeguards applies to a particular case. This standard would also determine whether a person who is assessed and approved for MAID but who risks dying before the day of the procedure can give consent in advance. I will be discussing that proposal shortly.

How will these safeguards be applied? Specifically, it would require that a MAID request be witnessed by one independent witness instead of two, and it would allow individuals who are paid to provide either health or personal care to act as an independent witness.

On the advance consent or directives, the bill proposes amendments that would allow people who have a reasonably foreseeable natural death, and who have been assessed and approved for MAID, to retain their ability to receive MAID if they lose the capacity to consent.

The bill represents a significant paradigm shift in Canada's legal landscape with regard to medical assistance in dying. I call on members to support this important legislation and send it to committee for further review.

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

Madam Speaker, the hon. member from the opposite side has gone on in length in regard to safeguards. There are currently safeguard infractions going on across Canada, without corresponding professional discipline being in place. We can go on and on about safeguards, but if the current ones do not work, why would we put in more or less? They are not working.

Let me point to the case of Mr. Roger Foley. He has had to open a GoFundMe in order to pay for his legal bills so he can get actual home care. He is a young man dying of cerebellar ataxia. He is suffering, and the government is keeping him away from proper care. He has been dehumanized, threatened, attacked and abused and his life has been completely devalued just because he is a person with disabilities.

Greater value is placed on access to MAID than access to alternatives that could alleviate a patient's intolerable suffering. MAID is being presented to patients as a preferred treatment option, rather than the very last resort once all other avenues have been exhausted.

Could the member opposite tell me how that is happening?

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Madam Speaker, I sympathize with the situation that the member opposite has brought to light, but I also need to advise her that the provincial jurisdiction controls the health care budget. We are doing things that are legally available because of certain issues that have been raised by the previous iteration of MAID. We have, as parliamentarians, responded to it from a legal perspective.

There are checks and balances in place. People break the law, like they break many laws. There is a judiciary process or there is a process within the health care practitioners that should be addressed.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Madam Speaker, in studying the bill, and I certainly plan supporting it and considering amendments when it gets to committee, one of the things I am wondering about is this. When people make that consent, and it is an advance consent, and there are safeguards, do the personal practitioners who have accepted that consent have to be the ones who administer the procedure later? What if something happens to those individuals and they are not available or they themselves have died?

How would we handle the loss of those who are present at the advance consent at the moment when the medical assistance in dying procedure is determined to be appropriate?

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Madam Speaker, the hon. member has raised a very good question. That is why the bill must go to committee for thorough discussion, so we ask the right questions, we get the right answers and we put checks and balances in place to address the situation that she has brought to light.

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

Madam Speaker, the present bill goes significantly beyond the immediate task of addressing the Quebec Superior Court's decision. A scheduled broader review of the bill was built into Bill C-14. The five-year period was deliberate. At that time, the government thought that to be an appropriate length of time to study the implementation of Bill C-14.

Why not just deal with the business of the problematic “foreseeability of death”, the words from Bill C-14, which I had problematic from the start? Why take this time to add the other portions rather than as part of the review that would have otherwise taken place next year?

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Madam Speaker, as I look at the bill, the foreseeable death was a very problematic issue for all my constituents. They wanted the advance directive, but it was not there.

When the Supreme Court gave its decision, it created a base. When the special joint committee created a report, that was the ceiling. We have to find a midway balance to ensure that we protect the vulnerable, but also allow those who seek assistance to get the assistance they need.

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, during this debate time, we have an opportunity as legislators to ensure that we carefully and thoughtfully examine Bill C-7 with the best interests of Canadians in mind.

On September 11, 2019, the Superior Court of Québec found that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life. Although the current bill before the House, Bill C-7, responds to the court's ruling, it goes far beyond the scope of Quebec's decision and it weakens the important safeguards that have been put in place under Bill C-14.

Since the Liberals put this legislation forward, I have heard from hundreds of my constituents in a matter of days. They have shared with me that they are very concerned about the bill.

I will use my time today to share a number of the concerns they have raised and to issue a thoughtful word of caution to this place.

First, there is a parliamentary review of the original legislation scheduled for June. The question has to be asked. Why are we rushing to expand the scope of the current legislation?

We are literally discussing life and death issues. Death, something so final, deserves just a little of our time, our attention and due diligence.

The government's original legislation went through a very lengthy consultation process. This time, however, the consultation only lasted a couple of weeks. That is not the sole concern I have. In addition to that, when I look at this survey, the questions that were asked were quite vague and the multiple choice answers that were provided were drafted in such a way that the party in power could interpret those answers to the secure findings it desired. It was unclear and therefore unhelpful, if we really are going to respect the voices of Canadians.

However, the fact that this survey was so unhelpful goes to show that the current government was not interested in hearing from Canadians. The current government was interested in pushing through its agenda and therefore being able to twist and manipulate the survey data to its end, which is absolutely wrong.

It is wrong, because it goes against the very essence of this place, which is 338 common people representing common people. This place exists for us to deliberate the issues that matter most in our country and to speak up on behalf of Canadians. Unfortunately, what we have before us is a bill that represents the Liberal agenda rather than the voices of the Canadian people. This is wrong.

With legislation of this magnitude, I would urge the members of the House to slow the process down, to consult extensively and for us to come back to the table.

I cannot think of another responsibility we carry as legislators that is more crucial, more obligatory than our duty to protect the most vulnerable in Canadian society. Therefore, we have to take every effort to alleviate any possibility for abuse or misuse based on what is in this bill or based on what is left out of the legislation.

My Conservative colleagues have raised many concerns and have given multiple examples where extreme liberties have been taken with physician-assisted suicide where there are looser restrictions in place. I do not wish to rehash all those examples here today, but I certainly will draw the House's attention to a few.

Sadly, members across the floor have disregarded many of those examples provided by my Conservative colleagues. They have suggested that the differing jurisdictions and rules should deem these cases irrelevant in this place.

We have the opportunity and even the duty to learn from other countries and the way they have legislated, to learn from cases within our own country and to make changes that are necessary to properly protect Canadians.

It is undeniable that as one's medical condition progresses, the individual inevitably become more vulnerable. It is our responsibility to stand up for the vulnerable.

Individuals could lose their ability to speak, to move autonomously or they could lack the coherent and cognitive ability to be able to interact correctly. When an individual reaches this state, this is precisely when the safeguards around MAID, medical assistance in dying, should be strong enough to keep them safe rather than weak enough to make them vulnerable.

The proposed change in the bill would allow for advance directive, which takes away the need for the patient to consent immediately before having medical assistance in dying administered. This proposed change is alarming and dangerous as well to the Canadian public.

When we are faced with difficult physical ailments, they often fluctuate in intensity and as they do, our decision-making ability shifts. Think for example about people who are suffering from terminal cancer. They have been advised by medical professionals that their quality of life is likely to deteriorate to a certain degree by a specific date. Let us say that does not happen. Those cancer patients who want to avoid unnecessary pain have already given the date on which their lives will be terminated.

Changes take place. What if the diagnosis the doctor gave was not right? What if those patients have actually fared much better? Health care professionals could in fact euthanize these individuals at any point without needing to obtain consent immediately before death is administered.

This should concern all of us because of the vulnerability that is in place here. There should be a requirement for contemporaneous consent. We cannot allow one's former self to dictate the will of his or her present self. Minds change, circumstances change, so final consent is an absolute necessity.

This example has been raised in the House at least once before, but it is worth raising again because it is close to home.

Taylor Hyatt is a staffer on the Hill. I had the opportunity to interact with her personally. She has a linguistics degree from Carleton University. She lives on her own and she loves her life. Taylor has cerebral palsy and is restricted to a wheelchair. She lives an incredible life and contributes to Canadian society in a multitude of ways.

Two years ago Taylor went to the hospital because she was feeling quite ill. The doctors did some tests and they said that whatever it was it really was affecting her breathing, and if it came to it, should they administer oxygen.

Taylor was quite surprised at the question. Of course she would want oxygen, that seems like a very basic thing. It is not like it was life support or something that people often take, those decisions of that magnitude, quite seriously. It was the simple administration of oxygen. A few seconds later, the doctor asked "Are you sure?", and he said it in such a way that he was actually applying pressure on her to reconsider her decision, as if to say that her life lacked the value that she felt it had.

That is atrocious. If we are sending that message to the most vulnerable in our society, then what have we become?

I would like to also address one other thing, and that is the need for palliative care. If we are going to talk about administering death to Canadians, then why are we not having a conversation around long-term care? If we are going to talk about the dignity of a human life, then what about those who want to live a dignified life right up until their last breath?

Why is the government not moving forward with the plan it promised to put in place with regard to palliative care? Why is it not spending the money that needs to be spent on preserving the dignity of those who wish to choose this type of death? These are essential questions with which the House must wrestle.

I would caution those within this place to take a step back, because we want our country to be one that supports all people.

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

Madam Speaker, I thank the member opposite for her contributions. I will clarify on a couple of points and then I will ask the member a question.

The first point the member raised was about looking at other jurisdictions. We have done exactly that. We evaluated this regime against every jurisdiction that permits medical assistance in dying.

With respect to the member's point that changes have been made that were not needed by Truchon, this is both a less restrictive regime and also a more restrictive regime, depending on whether a person's prospect of death is reasonably foreseeable. In the context of whether there are increased procedural safeguards, when someone's death is not approaching imminently, there is a 90-day assessment period and also a period in which an expert doctor must be involved.

The member opposite expressed considerable concern with respect to the advance consent regime and the Audrey Parker amendment, as it is colloquially known. Is the member willing to address the fact that failing to amend this legislation and address the concerns in terms of Audrey Parker actually leads to premature deaths such as Audrey Parker's, which is a violation of section 7, according to the jurisprudence?

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, I once again would caution this House. If we are going to talk about advance consent, that is one thing; but if we are going to remove the need to give final consent to the issuance of death, that is another thing.

We are talking about an individual who is going to have his or her life ended. That is very final. It might be good for the medical practitioner to ask the question as to whether that patient is sure that it is indeed what he or she wants in that moment. This is common sense.

I actually take offence at the question from the member opposite, because it is an incredible degradation of human life.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her speech.

However, end of life situations can be difficult. Despite the high-quality care and support offered to people at end of life, it is possible that, for a small number of people, palliative care might not sufficiently alleviate all of their suffering. End-of-life legislation allows medical professionals to offer another choice to patients when all therapeutic, curative and palliative options have been deemed insufficient and they would prefer to die rather than continue to suffer.

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

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, before this House is a piece of legislation having to do with medical assistance in dying. This process has been discussed for the last four and a half years. Of course, there was legislation put in place, Bill C-14, in 2016. That legislation allowed for medical assistance in dying in Canada. That is covered.

My question is this: Where are the millions of dollars that were promised for palliative care?

To the hon. member's point, this country exists on the precedent that there is choice, but if people have the choice for euthanasia, then where is the choice to live until their last breath in a place where they are cared for and where they are pain-free? That is called palliative care, and the current government has failed to deliver on that. By not doing so, it has actually forced a number of people to choose euthanasia when they would not normally choose that, but because their pain levels are so high and because palliative care is not offered, they choose death.

That is wrong.

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

Madam Speaker, I listened to the speech by the member for Lethbridge with great interest and I respect her very strong feelings on this issue. When she points out that the government is making changes that were not demanded by the courts, I would like to point out that there are many Canadians and Canadian families who are dealing with issues of intolerable suffering at the end of life who are asking for changes like Audrey's amendment, and they are asking for them right now.

As I mentioned earlier, because this debate is going on today, I have had someone I know quite well contact me to say they wish this bill would move quickly because it would assist them in making a choice in maintaining their control at the end of their life. They are facing intolerable suffering that cannot be alleviated.

While I agree with the member that we need more and better palliative care, we are dealing with the demand from individuals and families to make sure we avoid unnecessary suffering at the end of life.

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, that was more of a statement than a question. The hon. member and I would agree that yes, absolutely, palliative care is necessary. It should be an option for all Canadians, and that would be the most respectful thing to do for the Canadian population.