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

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

Madam Speaker, I definitely am in full support of my hon. colleague's very moving remarks. A disability advocate called my office this past week. She was very concerned about watering down protections for vulnerable people by removing the requirements on physicians and having a physician who specializes in the area being involved.

Is there any provision for social workers to be involved? Frankly, physicians are not always equipped to recognize when there might be undue family pressure or other intersectional pressures being put on the patient to make an assisted-death call. What are my hon. colleague's thoughts on that?

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

Madam Speaker, there needs to be clarity in that regard. We are hearing stories, but, as was mentioned, these things are not being brought forward and prosecuted or there are not enough safeguards in place to ensure people are not being coerced in that way. I have had individuals come to me in tears over that very issue. It is becoming commonplace that this is naturally something that is offered to a lot of individuals who are in end-of-life scenarios.

Palliative care is an opportunity for individuals to live their life thoroughly to the end, along with their family. When individuals make that choice, they should not be coerced. We really need to be careful of this.

[Anthony Housefather, Liberal, Parliamentary Secretary to the Minister of Labour]

Madam Speaker, I will be sharing my time with the hon. member for Oakville North—Burlington.

This is a very difficult bill and subject for us to deal with. In this case, the sanctity of life, something that all of us cherish, conflicts with the liberty interests protected under section 7 of the charter. This is one of those difficult times where we have to recognize that our own religious views, our own moral views are not the ones we can simply impose on Canadians. We have to recognize that charter rights are sacrosanct. Sometimes, as a member, those are difficult moments.

I personally have said before that I would not choose medically assisted dying for myself. Nor would I encourage family members to avail themselves of the opportunity for medically assisted dying. However, I also fully respect the right of every Canadian to choose for his or herself whether this right should be exercised personally.

In the Carter decision, the Supreme Court of Canada upheld that under section 7 of the charter, there was a certain subgroup of Canadians whose liberty interests were violated by the existing provisions in the Criminal Code on not assisting someone to commit suicide. The Supreme Court in Carter told us that there was a subsection of Canadians, those who were in constant enduring pain and suffering that could not be alleviated by medical treatment reasonably acceptable to them, who had the right to have their death hastened by having medical professionals assist them in doing so.

In the last Parliament, our government brought in Bill C-14. I had the privilege of being the chairman of the Standing Committee on Justice and Human Rights. We heard from a great cross-section of Canadians. We heard from those who represented the disabled community and those who believed in the right to die with dignity. We heard from members of the clergy from all faiths. We heard from university professors, lawyers and doctors. We heard from a great cross-section of Canadians who had very diverse and different opinions.

What we tried to do was craft a law that brought Canadian society together, that protected the vulnerable but yet still afforded everyone the right that the Supreme Court had recognized in Carter, which was the right to decide for one's self whether to terminate one's life in the event he or she was in enduring pain and suffering that could not be alleviated by medical treatment reasonably acceptable to that person.

As well, we had to recognize that when we dealt with the Carter decision in Bill C-14, Canada was at the beginning of a list of countries dealing with medically assisted dying. There were very few countries in the world that had gone where Canada was going. Belgium, Holland, Uruguay and a few American states were, but that was it. Canadian society needed to come to terms with medically assisted dying and learn more about the process before we went too far.

That is why, at the time, I supported a clause in the bill that said that medically assisted dying was limited to those whose end of their natural life was reasonably foreseeable. However, we knew that would change over time and that as Canadian society looked at the experience of medically assisted dying, the bill would come back for review before Parliament and would need to change.

At the justice committee, we proposed a number of important amendments to that bill. We inserted, by unanimous agreement at the committee, conscience rights to ensure that the doctors, nurses and pharmacists whose own beliefs would be offended by medically assisted dying were not compelled to participate in the process. We said that Parliament would need to review some subjects that we were not dealing with, such as the issue of mental illness on its own; the issue of mature minors; and, probably most important, the issue of advance directives for those suffering with dementia.

We also adopted a motion that palliative care had to be part of that review. People should have their death hastened because palliative care treatment is not available to them in Canada.

This bill takes the medically assisted dying regime, Bill C-14, a step further based on the Truchon decision. It held that the provisions we had put in the law about reasonably foreseeable death were not constitutional and that a subgroup of Canadians who may have many more years to live but were in constant pain, enduring interminable suffering, and could not have that alleviated by medical treatment reasonable acceptable to them also had the right to medically assisted dying.

This bill establishes that this group of people also have the right to medically assisted death in Canada, but also imposes additional safeguards on them, namely a 90-day waiting period. We understand that certain people, for example, may suffer a traumatic injury and need time to consider all their options and come to terms with their situation before finally going through with a medically assisted death.

Also, based on the Canadian experience, we are amending the bill to allow certain Canadians who are about to lose their ability to offer agreement to medically assisted dying, because they have lost their capacity to consent, to do an advance consent.

Some Canadians want to access medical assistance in dying knowing that they may still have a few more weeks to live. The only reason they want to access it sooner is that they do not want to lose their capacity to consent to medical assistance in dying.

Personally, I want these people to be able to continue to live and spend those last few weeks with their families. I do not want them to end their lives prematurely because they are worried about losing their capacity to consent to the procedure.

The amendment to the law, this bill that is before us, gives hope to this group. These people will have permission to sign a contract with their doctor indicating that they want to put an end to their life on a specific date, even if they lose the capacity to consent to medical assistance in dying in the meantime.

However, there is still a safeguard in the sense that if people who have lost their capacity to consent show through any action or words that they no longer wish to end their life, the doctor must then stop the procedure.

I strongly support the bill. I think Canadian society has evolved with respect to how we see medically assisted dying. As Canadians, we now have seen where the procedure works and where it does not work. We have seen which groups have been positively impacted and which groups have been left out and where we can improve on the procedure.

Following a great deal of consultation and national interest and seeing a change in how Canadian opinion sees medically assisted dying, this bill is the right one at the right time.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I had the privilege of serving with the hon. member for Mount Royal on the justice committee when we studied Bill C-14

The member rightfully talked about the process in which we heard from a diverse range of viewpoints. It is ironic that this legislation circumvents that opportunity to hear from a diverse range of viewpoints by pre-empting a legislative review, which should have started in June.

The hon. member will know that this decision goes well beyond the scope of the Truchon decision. One such area is with respect to advance consent, to which he alluded. Arguably this goes beyond the scope of the Carter decision inasmuch as Carter stated not once, not twice but on three occasions that a patient must clearly consent.

How can the hon. member defend that with respect to legislation that arguably goes beyond the scope of Carter? How can consent be truly meaningful if it is not contemporaneous?

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I want to say how much I enjoyed serving with my hon. colleague from St. Albert—Edmonton. He always brings a great deal of intelligence and rational thought to these situations.

First, as the House knows, the government and Parliament are not limited to simply creating a law that repeats the Carter decision; Parliament is perfectly entitled to go forward further and protect liberty interests that were not recognized in Carter. Nobody excludes the right of Parliament to go further than Carter.

Second, I believe that the legislative review on the subjects that we were supposed to review will continue to proceed. This law is a separate piece of legislation dealing with other subjects.

Finally, I would say that, regarding the issue of capacity to consent in advance to medically assisted dying, this is simply for somebody whose death is already foreseeable, coming up in the very near term, to agree with their doctor to end their life if they have lost the capacity to consent to further prolong their life, because otherwise they would make that decision more prematurely. I support it for that reason.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Madam Speaker, the Bloc Québécois agrees with the proposed amendments and welcomes them.

The issue that has not been addressed and that I think is important is advance consent. I would like to know where my colleague stands on that issue.

Would it not be a good idea for people who meet the criteria set out in the act to be able to give their consent in advance, as we do with organ donation, in the event that they are diagnosed with a degenerative disease? Is that an issue that was examined? If so, what is my colleague's position on that?

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I thank my hon. colleague from Rivière-du-Nord. He always provides an intelligent perspective to the debates.

To me, this is one of the three issues Parliament has to address. The first is the issue of mature minors, the second has to do with psychological illnesses only, and the third has to do with advance directives. I agree with the way in which the bill allows certain people to make an advance request.

The issue of advance directives is very complicated. If we allow people to give such a directive in advance, then we must put in place very clear and precise guidelines. This will certainly be part of our discussion during review of the legislation.

[Pam Damoff, Liberal, Parliamentary Secretary to the Minister of Indigenous Services]

Madam Speaker, it is a pleasure to follow the wise words of my colleague, the member for Mount Royal.

I am pleased to speak in favour of Bill C-7, an act to amend the Criminal Code, medical assistance in dying. As hon. members know, this bill responds to the Superior Court of Québec decision that struck down the eligibility criteria that naturally occurring death be reasonably foreseeable.

In the last Parliament, I spoke during debate on the original MAID legislation. At that time, I talked about the need for us to have conversations with loved ones about death and dying. “Death” is a word that elicits strong emotions. We celebrate life, we embrace life and we talk about living. However, we avoid talking about death. We shy away from those conversations because they make us uncomfortable. I know there are those who feel this legislation goes too far. However, regardless of where people fall on this legislation, I think we can all agree that the way we deal with and talk about death needs improvement.

Whether a grievously ill patient chooses to die at home or in a palliative care facility or chooses medical assistance in dying, we should be having these conversations sooner and lovingly assisting those who are ill in the end of their life. These decisions are often made during a health crisis. Ideally, each of us should be engaged in advanced care planning.

I would like to share the story of Bob Lush, an incredible man, respected lawyer and my friend. Bob and his wife Maureen shared a love and bond that was obvious to all who met them. Bob died on March 17. This summer I had lunch with Maureen and she shared with me the decision they took to use MAID. With Maureen's permission, I would like to share Bob's story.

Bob had been diagnosed with multiple system atrophy and pulmonary fibrosis. He also exhibited symptoms of Parkinson’s. While his body was failing him, his mind was as sharp as ever. Over time, these serious health issues would worsen, which led his doctors to tell him that he was palliative and that there was nothing more they could do. A palliative care nurse asked if they had thought about MAID and provided them with a brochure. It was not an option they had considered before, but Bob and Maureen together decided that this option would be the most loving way for Bob to leave this earth. I cannot possibly put into words the tremendous love these two shared.

Maureen described for me Bob's last days. They chose March 17. All medical equipment was removed from Bob's room and it was filled with flowers and candles. They loved listening to James Taylor's “American Standard” album, and it was playing. Maureen and Bob's son John were by his side. As Moon River played, the doctor administered the MAID drugs. Bob closed his eyes and peacefully, painlessly and humanely passed away. To hear Maureen describe it, I could hear both the love in her voice and the sadness of losing Bob, but she had no regrets and, in fact, wanted Bob's story to be shared so that other families could consider this option for their loved one, if it was the right decision for them.

The legislation before us here today would update our MAID laws in several ways. The bill would maintain existing safeguards and ease certain safeguards for eligible persons whose death is reasonably foreseeable. New and modified safeguards would be introduced for eligible persons whose death is not reasonably foreseeable. Persons whose natural death is reasonably foreseeable, who have been assessed as being eligible for MAID and who are at risk of losing capacity, can make an arrangement with their practitioners in which they provide their consent in advance, which allows the practitioner to administer MAID on a specified day, even if the person has lost their decision-making capacity.

For persons who choose MAID by self-administration, a person could waive in advance the requirement for final consent in case complications arise following self-administration, leading to loss of capacity but not death. These new safeguards would exclude eligibility for individuals suffering solely from mental illness. It would also allow the waiver of final consent for eligible persons whose natural death is reasonably foreseeable and who may lose capacity to consent before MAID can be provided.

This legislation would also expand data collection through the federal monitoring regime to provide a more complete picture of medical assistance in dying in Canada. These are important changes and ones that have been called for since 2016, when the government responded to the Carter decision with its original legislation.

Since MAID became legal in June 2016, there have been more than 13,000 reported medically assisted deaths in Canada. This figure is based on voluntarily reported data from the provinces and territories prior to November 1, 2018; and the data collected under the new monitoring regime after that date. MAID deaths as a percentage of all deaths in Canada remains consistent with other international assisted-dying regimes.

The government undertook extensive consultation in order to update the MAID legislation. In January and February 2020, the Government of Canada engaged with provinces, territories, Canadians, indigenous groups, key stakeholders, experts and practitioners to receive their feedback on expanding Canada's MAID framework. Over 300,000 Canadians participated in online public consultations between January 13 and January 27 of this year.

It is important to recognize that MAID is not the right option for everyone. We still have work to do to educate Canadians about end-of-life options. When the former Bill C-14 was debated in the House, I spoke about palliative care and the need to educate Canadians about it as an end-of-life option. I was pleased the Senate amended our original bill to include palliative care in the legislation. Our government has worked collaboratively with partners, including the provinces and territories, to develop a framework on palliative care. We are implementing a targeted action plan of providing $6 billion directly to provinces and territories to better support home and community care, including palliative care.

I would like to share once again Bonnie Tompkins' story, a story I shared in 2016 during debate on the original MAID legislation. She is currently compassionate communities national lead for Pallium Canada, a national non-profit organization focused on building professional and community capacity to help improve the quality and accessibility of palliative care in Canada.

When her fiancé, Ian, was diagnosed with terminal cancer, he was adamant that he wanted medical assistance in dying. As is common, his biggest concern was the burden he would place on loved ones as his illness progressed. After he saw Carpenter Hospice in Burlington and was educated on the options available—

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

We seem to have lost the connection with the hon. parliamentary secretary.

The hon. parliamentary secretary has about two minutes left.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Palliative care is something that too few people consider, let alone discuss with their loved ones. Just as Bob Lush's decision was the right one for him, so too was Ian's. These are deeply personal and extremely hard decisions that people make as they near the end of their lives.

This legislation today would address concerns about eligibility for MAID and allow more people who wish to use MAID to do so. I want to applaud the Minister of Justice for his leadership on this bill; as well as the Minister of Health; and the Minister of Employment, Workforce Development and Disability Inclusion. I would also like to give a shout-out to the member for Don Valley West, who chaired the committee in 2016 that reviewed options for MAID legislation and that laid the groundwork for where we are today.

It is my hope that all members of the House will support this important legislation.

[Colin Carrie, Conservative, Oshawa, ON]

Madam Speaker, I want to thank my colleague, especially for sharing those personal thoughts with us because this issue we are debating today is a very personal matter.

I wanted my colleague to comment on a statement by her colleague, the member for Mount Royal, who said in his speech that nobody should have their death accelerated due to lack of palliative care.

We know that my colleague from Sarnia—Lambton brought forward a private member's bill that was in response to this decision, that was basically to allow Canadians to live as well as they can, for as long as they can. This private member's bill was dedicated to providing a national palliative care action plan.

I wonder if my colleague could comment on the government's response to providing appropriate palliative care so people do not have to choose medical assistance in dying, considering that approximately 70% of Canadians do not have access to appropriate palliative care.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Madam Speaker, I thank the member for his question, and I also applaud my colleague, the member for Sarnia—Lambton,, for her advocacy on this issue.

One of the problems is that people do not know what palliative care is and what is available, as the story I told about Bonnie Tompkins's fiancé demonstrates. People need to be educated on it, but not going into palliative care does not automatically mean they are choosing medical assistance in dying. That logic is flawed, in my opinion.

There is a need for more education on all aspects of people ending their lives. I think there are conversations that need to be had between families and loved ones so that when or if they become ill, families will know what options are available. As I described in Bob Lush's story, had a nurse not provided information on MAID, the family could never have chosen that option.

Our government is committed to palliative care.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, the bill proposes removing the requirement of final consent for eligible people whose natural death is reasonably foreseeable.

Would it not be appropriate to allow for advance consent and waive final consent for people with degenerative, incurable diseases? What are my colleague's thoughts on that?

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Madam Speaker, these are indeed very difficult conversation to be having, and that was certainly discussed in 2016. My understanding is that part of the parliamentary review that is to take place on this legislation is about the issue the member has described regarding the people who have a terminal illness and want to provide direction and demands. It is something Parliament needs to look at, and we need to have a fulsome discussion on how we proceed if we choose to proceed on that.

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

Madam Speaker, I thank my colleague for her very compassionate and heartfelt speech. It was very moving.

I have a question about requiring a person with an incurable disease to obtain permission from a medical practitioner specializing in the disease in order to get access to medical assistance in dying. In the case of people living in rural or remote regions that do not always have the appropriate medical specialists, does this requirement not constitute an impediment?