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

[Leah Gazan, NDP, Winnipeg Centre, MB]

Mr. Speaker, the Conservative Party has spoken a lot about dignity, but when I ask questions about providing a guaranteed liveable basic income, something being fought for and supported by the disability community to ensure people can live in dignity and have those choices, I am often met with no response.

I wonder if my colleague can share with me whether he supports a guaranteed liveable income, accessible and affordable social housing and other supports required to ensure people can live in dignity and do have choices.

[Pierre Poilievre, Conservative, Carleton, ON]

Mr. Speaker, we do support basic dignity in life for all people. When it comes to persons with disabilities, there are two ways that this can happen. Many persons with disabilities prefer to earn their income through work, and have the ability to do so. That is a statistical fact. A million Canadians with disabilities have jobs; 300,000 of them have severe disabilities and have jobs.

We should reform our benefit and tax system to let them keep more of their wages. Right now, if people with disabilities get jobs, in many cases they lose more in clawbacks and taxes than they gain from wages, effectively banning them from the workforce. Many in the disability community have spoken out against that.

I think of Mark Wafer, who is 80% deaf. He could not get a job when he was a kid, so he hired himself, started a business and opened five different Tim Hortons locations that employed 130 people with disabilities at full wages without government assistance, doing the same work but at a higher quality than the rest of his workforce. He had some of the highest performing Tim Hortons locations in the country by all the metrics, proving that people with disabilities have something to contribute, not just their lives but in their livelihoods. We should encourage and reward that.

[Chris Bittle, Liberal, Parliamentary Secretary to the Minister of Transport]

Mr. Speaker, I appreciate, and I have said this before, that members of the Conservative Party are standing up and supporting persons with disabilities. However, I am concerned when language gets added that death is being compelled by the state, which is not true, and that the Conservatives will stand up for the voiceless.

I would like to ask the hon. member about the voiceless person in the hospital bed who has suffered through cancer, who is sitting there for 10 days in excruciating suffering. Where is the voice of the Conservative Party for that person?

[Pierre Poilievre, Conservative, Carleton, ON]

Mr. Speaker, the first question is with respect to the compulsion of death. I will read a quote, “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” That is the Liberal member for Thunder Bay—Rainy River, himself a physician. The member should ask his Liberal colleague why he thinks this bill could ultimately compel people to die even when they do not want to.

Where is the support for people suffering in a hospital bed? We believe in strong palliative care so people receive the end-of-life care that permits them to live out their final days in dignity and to make a true choice rather than being compelled by a lack of alternatives.

[Raquel Dancho, Conservative, Kildonan—St. Paul, MB]

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

Can he tell us what the Conservatives' position was on the Truchon case and why the Conservatives took that stance?

[Pierre Poilievre, Conservative, Carleton, ON]

Mr. Speaker, to be honest, unfortunately, I did not hear the question, so I cannot answer it.

Conservatives would have appealed the Truchon decision. The government can appeal the ruling and even take it as far as the Supreme Court.

The government decided not to do that, however. It could have. That would have given all Canadians a chance to understand their rights in this regard.

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, what results from this bill is truly a matter of life and death. The decisions we make here always have some ripple effects on others, but this bill needs to be about protecting the rights of some of our most vulnerable.

It is from a place of deep conviction that I speak on Bill C-7. My hon. colleague for Thunder Bay—Rainy River echoed some of these concerns and convictions in a CBC article written by Kathleen Harris. He states:

I don't like voting against my party, but 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.

I find it heartbreaking that we are putting doctors and legislators in this position. As the member opposite suggests, the primary issue is protection of conscience rights for medical professionals, health care providers, and the rights of hospices and other institutions not wanting to cause the death of people in their care.

As a Maclean's editorial explains, many doctors who may be willing to expedite the natural process of dying, given their traditional role to relieve suffering, would likely be threatened by the qualitative and ethical distinction between hastening a death that is drawing near and ending a life that is expected to persist. This is a very valid point.

When one senator asked an expert witness whether it was true that medical professionals were leaving because of the lack of conscience rights, Dr. Leonie Herx replied that she knew of doctors who took early retirement for reasons of professional integrity or because of their own personal moral compass.

Do we want to harden the hearts of those who, because of their very own world view, cannot comply? These are people who feel that MAID is a betrayal of their professional commitment to save lives, a betrayal of their faith or a betrayal of their conscience.

A CBC article says it rather well:

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.

Many helpful voices express serious reservation with this bill. Constitutional lawyer and author Don Hutchinson explains that this bill does not provide a sound structure and protection for all people, especially those living with disabilities, chronic pain or mental illness.

The executive vice-president of Inclusion Canada told us that for the disabled community, Bill C-7 is their worst nightmare. Their “biggest fear has always been that having a disability would become an acceptable reason for state-provided suicide.”

Colleagues may say that will never happen. Many of us never thought that we would be here debating same-day MAID, yet here we are. We are hearing stories that are happening today even with the current legislation.

Palliative care consultant Dr. Herx described the experience of Candice Lewis, “a 25-year-old woman with a developmental disability and chronic medical problems”. When she entered the ER, a doctor approached her mother and suggested that she consider MAID for her daughter. She refused. The doctor promptly told her she was being selfish.

The disabled community has made it very clear, time and again, that they have suffered at the hands of our current legislation and they feel directly targeted by this new MAID legislation, as no other community is directly referred to in the proposed amendments to the current legislation.

Despite the holes in the current legislation adopted in 2016, the government is pushing for a further expansion to the eligibility of MAID at an alarming pace. Krista Carr, executive vice-president of Inclusion Canada, explains that the community of Canadians with disabilities and their families have long feared that “having a disability would become an acceptable reason for state-provided suicide”.

According to the Council of Canadian Academies, without its reasonably foreseeable natural death provision, Canada would become more permissive with respect to medical assistance in dying than any other jurisdiction in the world.

There are also the voices of Lemmens and Krakowitz-Broker. They explain that, unlike in any other country in the world, the new bill fails to explicitly require that all reasonable options be made available and tried before allowing physicians to end a patient's life. Even when that decision for MAID is made, we absolutely need to reserve the right for people to have a change of heart.

Dr. Leonie Herx, the past president of the Canadian Society of Palliative Care Physicians and chair of the division of palliative medicine at Queen's University, sees life stories every day that show how people can change their minds with respect to MAID. She refers to one beloved patient who arrived at her clinic asking for MAID, but quickly abandoned his quest after being assured of his worth and that he was not a burden.

Recently, the member for Vancouver Granville asked the justice minister in the House why the 10-day reflection period and reconfirmation of consent were waived in this proposed new legislation. She said that the removal of these safeguards was not required by the Truchon decision: the ruling the Liberals chose not to appeal.

I noted the member's comments with great interest, given that she was the former justice minister who brought forward the original bill to legalize MAID in Canada, known as Bill C-14. In response to her questions and other critics, the current justice minister replied that the 10-day waiting period only increased suffering and that he had even heard of people who stopped taking their medications during this period.

Ensuring that all Canadians have access to care needs to be our top priority to address the needs of suffering Canadians. Death cannot, and should not, be the only choice to end excessive suffering. I have talked to many health care providers who say that we have the tools and resources here in Canada to alleviate all kinds of suffering, and even to alleviate the anxiety of individuals facing imminent death.

John Diefenbaker once said, “Freedom is the right to be wrong, not the right to do wrong.” Canadians value our right to think freely, to consider our thoughts and opinions, and to change our minds if we so choose. The elimination of the 10-day reflection period and the requirement to reconfirm consent takes this option away from those facing this difficult situation. How are we preserving the right for people to change their minds when we waive the waiting period? It would seem that this bill makes the choice for MAID to be final and irreversible.

That is not what is reported in the “First Annual Report on Medical Assistance in Dying in Canada, 2019”. It says that 3.6% of the patients who made a written request for MAID subsequently withdrew that request. While that may not seem like a very significant number, to put it into context 263 people out of the 7,336 people who completed written requests later chose to change their minds because they had the opportunity to do that in the 10-day waiting period. That is 263 lives. Every single one of them deserved the right and the freedom to make that decision. This piece of legislation before us would take that right away from individuals.

Experts speaking to the Senate committee on Bill C-7 discussed how, in the proposed bill, MAID eligibility would apply to treatable diseases where death was not imminent. This is also where the bill adds a 90-day assessment period. It is no wonder that people with disabilities or chronic illnesses feel threatened by this legislation. This addition is especially concerning when people are faced with a sudden, dramatic life-changing illness or disability, as it often takes much longer than three months to gain a renewed perspective.

It is no wonder the former health minister, Dr. Jane Philpott, and the member of Parliament for Vancouver Granville wrote an editorial for Maclean's urging Parliament to proceed with caution, and questioning whether there was enough medical and social evidence to even understand the implications of these potential changes.

Saying that we are at a defining moment in history by approving this bill without further amendments is not an overstatement. I am thankful for the opportunity to highlight these very real risks, and I want to urge the Liberal government to address the bill's serious challenges.

[Rachel Bendayan, Liberal, Parliamentary Secretary to the Minister of Small Business]

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

I would like to start with a comment. My colleague seems to be saying that having one of the world's most progressive policies on medical assistance in dying is a bad thing. I disagree. We are a progressive society and proud of it.

To clarify my colleague's and the Conservatives' position once and for all, I would like to know if he is against the idea of medical assistance in dying or if he is against the amendments and our government's response to the Quebec Superior Court's decision.

I believe the amendments we have proposed will improve the existing act, and I would like my colleague to tell us if he is against the idea of MAID itself, which, I would remind him, is the law currently in effect here in Canada.

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, for the record, I want to restate that I voted against Bill C-14 when it came before the House four years ago. We have come to a difficult spot as a country and as a nation when we diminish the value of life.

I believe that all life is important. This piece of legislation, based on the ruling in the Truchon decision in Quebec, goes much further than that ruling suggests. It also does not provide the proper protection for conscience rights for medical professionals. It takes away that 10-day reflection period. That is an important note to make because as I said, 263 people changed their minds during that 10-day reflection period. This bill removes it. This is same-day death being proposed by the Liberals.

If someone is having a bad day facing an illness that they think is unbearable and degenerative, and for whatever reason they request medical assistance in dying, they do not have the 10-day reflection period to see whether that was the right decision. Under this legislation, that decision would be permanent and final.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, I want to thank the member for Provencher for standing up for life and promoting life. I have lamented the fact that the Liberal government has had a singular focus on facilitating and speeding up death rather than promoting life.

I notice that my colleague did not have time to address the issue of palliative care, which is something the Liberal government promised four years ago it was going to champion. The Liberals suggested they were going to invest $6 billion in palliative care, then we found out that it was going to cover the whole country. Then they said it was over 10 years. They promised it in 2015, 2017 and 2019. There has been virtually nothing done to make sure people who have painful diseases and are suffering are still able to live lives that are productive and joyful.

Perhaps my colleague could comment on that, and the role palliative care should be playing in delivering support for these people who need our support.

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, I thank the member for Abbotsford who I know shares the passion, as I do, that life is important and that we need to value life right from conception to natural death. That is an important fundamental principle that needs to be enshrined here in Canada.

I recently sat with local doctor Curtis Krahn and his wife at an event, and we talked about end-of-life and dying. Shortly after I was elected, a few years back, my mother was very ill with cancer. Dr. Krahn's wife, who is a registered nurse, was one of the chief palliative care providers in our community. She was very gracious with my mother. At the event, Dr. Krahn told me clearly that we have the resources, the tools and the medications to make people comfortable in end-of-life situations and when people are suffering. Often people become quite anxious as they are approaching their final days. He said, “We can even take away their anxiousness. We have medication that can do that as well.”

I know that the government made some very lofty promises when it came to palliative care, and it failed miserably to deliver on those promises. Seventy per cent of people, when given the option of being provided with palliative care, would choose to live rather than to accept MAID.

[Corey Tochor, Conservative, Saskatoon—University, SK]

Mr. Speaker, it is an honour to enter into the debate.

This is the first time I am speaking to Bill C-7. What drives my desire to speak today is the fact that we would take away the safeguards that were rightfully put in place to protect people from quick decisions and unnecessary death in Canada. This weighs on me because there are two individuals who I have witnessed pass away.

A good friend of mine, Scott Clarkson, had cancer. At thirty years old, he had a child, but unfortunately he succumbed to cancer. I watched as the angels who work in palliative care cared for him until the end. I think about the extra days he had with his son and his wife, but I know that Scott had tough days where it seemed pretty dark and bleak.

However, the bill, with its current safeguards, could catch an individual on a bad day, even without facing certain death, be it cancer or other conditions. On an off day, Scott might have been convinced that medically assisted dying was something for him. This is where I have an issue with the government not taking the amendment to include the 10-day reflection period. We all have tough days, but without the safeguard of a pause, there may have been times when Scott would have succumbed to the pain and made a different decision, and that would have resulted in less time with his wife and son.

This is why we need to revisit the bill. I encourage the government to please consider some of the reasonable amendments that we put forward, such as the 10-day reflection period.

The other person I think of is standing over my shoulder today, my father, who passed away during the summer. There were times when it must have been tough for him, but he was always a very positive man and believed that there were better days ahead, so much so that the month before he passed away after battling cancer for three years, he renewed his driver's licence for five years. He was always thinking that there were positive days ahead and that there were reasons to live. However, there were tough days, and I wonder what would have happened if the bill had passed in its current state and on one of those days my father might have made a different decision.

He was mentally stable right to the end and had great palliative care with some great doctors and nurses, but on a day when maybe family was not around, he might have thought it was right for him. My father died the same month as his 75th birthday, and without that reflection period, he may not have enjoyed that birthday with his family, and they may not have had that extra time with him.

These are the reasons I have entered into the debate today for the first time, to speak against Bill C-7. Primarily it is the issue that, at committee, no amendments were taken, and if we do not have safeguards in place there will be abuse. There will be individuals who decide to end their lives because of whatever pain and suffering they are in. That pain and suffering might end for them, but it passes on to their loved ones who are left to deal with those feelings. That is why we need to pause, go back to committee and draft a bill that has safeguards.

Other members have talked about all the people who have grave concerns about this bill and what it would do for people with disabilities. I think it is ironic that we are in the middle of a pandemic and we are asking health professionals and all Canadians to do whatever they can to save lives, and in the meantime parliamentarians are debating and are going to be passing, but hopefully not anytime soon, the opening up and lessening of restrictions on medical assistance in dying.

My colleague, the member for Cariboo—Prince George, is championing the cause of a national 988 suicide prevention hotline. This is not a partisan issue, and I encourage all parliamentarians to get behind that initiative. We would like to save the lives of people who are maybe finding themselves in tough situations. That is a noble cause.

We are talking about helping people, and unfortunately some are people with mental health issues who are committing suicide, we are trying to prevent those losses and the pain of those families. However, at the same time we are making people's ability to get a medically assisted death that much easier. I just cannot agree with that.

This is the first time I am speaking to the bill because of the personal nature of this. This is a tough subject. I entered into the debate so that we could understand who we represent. I represent Saskatoon—University, and the majority of my constituents want the safeguards to stay in place.

In conclusion, I implore the people of Canada, if they think we need safeguards, to contact their Liberal member of Parliament and in a respectful way please ask for some of the restrictions that were in place to be reintroduced on the bill. If we can come together in a respectful manner and find solutions, that is what Canadians want to do in the trying year of 2020, to find ways to bridge the gaps in our society. If we do not do this, if we do not consider other people's opinions and other views, I believe our society would be headed in the wrong direction, and the division we have seen in other parts of the world would come to Canada.

I plead with all reasonable people on the other side of the aisle to pause this. Let us go back to the drawing board, and let us make sure we have the safeguards in place to protect lives.

[Chris Bittle, Liberal, Parliamentary Secretary to the Minister of Transport]

Mr. Speaker, I would like to thank the hon. member for his speech. There has been a number of speeches today of people sharing some really personal stories about what they have gone through, what friends and family have gone through. It really adds to the debate, and I want thank the member for that. It shows that we all come from different perspectives.

Perhaps this goes a little into the weeds on this, but the Parliament of Canada has legalized medical assistance in dying, making it a medical procedure. A lot of the concerns that have been raised by members of the Conservative Party are with respect to what doctors are doing. Is that not the role of the province and the role of the colleges to regulate those professions? Should that not be left out of the hands of the federal Parliament?

[Corey Tochor, Conservative, Saskatoon—University, SK]

Mr. Speaker, I believe that is what our role is as federal members of Parliament, to debate important legislation like this.

In my office right now, I got an email this morning from a Dr. McCartney. He was talking about his desire not to be forced into this medical procedure, as it was called. Not to get into the weeds, but there are many other physicians who have deep issues with MAID. If we do not get this right, we may see physicians leaving the practice that they love, and Canada will be a lesser country because of it.

We need all hands on deck, especially during—

[The Deputy Speaker, Bruce Stanton]

Questions and comments, the hon. member for Winnipeg Centre.