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

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

Madam Speaker, the question from the member is an important one. One does not have to be in a rural area to not have access to medical practitioners who may have expertise. In speaking with Maureen Lush, I know there is only one doctor in Oakville who is available to perform MAID, and there is no one at all in Burlington.

I think it is very important that people have options and that we remove the stigma of MAID. Hopefully telling these stories will help to educate people on the right option for them and if this is the way they should proceed.

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I am very pleased to speak to the important Bill C-7. We need to know its origins to understand why we are at this point today.

In 2016, working on Bill C-14 was a rather difficult exercise given that the Liberal government was intent on bulldozing it through. I believe that is the right expression, because the government refused all amendments proposed by the different opposition parties, including the Conservative Party, the NDP and the Bloc Québécois.

The government put pressure on the Senate by giving it a deadline. The Senate wanted to improve the bill before the House voted on it. What was the end result? In September 2019, the Superior Court pointed out that the bill passed by the House was not adequate, especially with respect to the issue of the foreseeability of the date of the person's death.

That is where we find ourselves today. We are in the House debating an extremely sensitive subject, but we have not had much time to consult the experts.

Everyone has a different perspective on the issue, whether they are members of the House or members of the public in Quebec or elsewhere in Canada.

I wrote a speech, but I have decided not to read it. Instead, I would like to share my own experience with my colleagues.

The vote on Bill C-14 was the hardest vote I cast in my first four years in Ottawa.

On the one hand, I had some constituents asking me to vote in favour of the bill, while others wanted me to make sure that the legislation would protect the most vulnerable and honour the conscientious objection rights of medical practitioners. On the other hand, I had constituents going through a very difficult time with a loved one who was suffering and could not access MAID.

I did not sleep well the night before the vote. I knew that no matter which position I took, whatever I said in the House could be interpreted by the media and by Canadians. Allow me to explain. Some members voted against Bill C-14, and I would imagine that others will vote against Bill C-7. Members voting against the bill are doing so not because they are against it, but because they do not think it goes far enough.

The opposite is also true. Some members voted in favour of Bill C-14 in 2016 because they wanted to make sure people got the bare minimum. No matter which side we took, we had to explain something extremely sensitive, and I do not think a simple yes or no could accomplish that.

I often ask myself, who am I to decide for someone else? As lawmakers, it is our duty to protect the most vulnerable, especially if we remove the criterion of reasonably foreseeable natural death for access to MAID. This is reflected in the questions that some members have been asking in the House. I am sure it reflects the opinion of many Canadians who wonder what would happen if a person wanted to give advance written consent in case their situation changed over time. There is much more to this debate, and I do not think we are done talking about it.

Madam Speaker, I forgot to tell you that I will be sharing my time with the member for Calgary Signal Hill.

I am very concerned about ensuring that this bill enables all Canadians, wherever they may live in this country, to have access to the appropriate resources to make the right decision for their situation. The current pandemic has exposed the weaknesses in our health care systems. I doubt all Canadians in rural areas have access to specialists who can guide them and give them the right information so that they can make a decision based on their circumstances.

I am also very concerned about minors and vulnerable people. During the study of Bill C-14 in 2016, I had the opportunity to hear the testimony of two witnesses who had suffered accidents and endured the most traumatic ordeals a human being can experience. They told me that, had they had access to MAID back then, they probably would not have been talking to me that day because they had been in such a dark place at the time.

I know people who were there for the final moments when someone who was suffering asked for MAID. I am certainly concerned about all that, and it makes me wonder what the best solution is. Is it because we do not have the necessary palliative care resources? Is it because both the federal and provincial governments and health care facilities are making poor decisions? I am wondering about that.

I must say, I feel like we are rushing the process today, because has been quite a while since the courts asked Parliament to modernize this legislation after what happened in Quebec. This is a government that shut down Parliament under the pretext of being in a pandemic, as though we could not do more than one thing at a time. There are 338 MPs. Committees could have continued to sit. We could have heard from experts who could have explained this issue to us properly so we could make the right decision, the best decision.

Again, this is something that will not be easy for many of us. We have differing opinions within our party and elsewhere. However, I would like to note that I am proud of my party for letting me vote freely. I want to thank my leader for allowing this, without any pressure from my organization. I hope that all political parties will offer this choice, because this is a vote of conscience, and it is challenging for us to represent our constituents, who do not all share the same opinion. We also have our own conscience. For some, this is a matter of religion or beliefs, which means we may not all see eye to eye on this file.

Personally, the thing I wrestle with the most is wondering who I am to decide what is best for someone who is suffering. I believe that is what will guide my decision on the day of the vote. I hope that I will be able to make the right decision and that all of us can then work with the government to put all the necessary resources in place to properly inform and educate the public, and provide everything we can to vulnerable people who are going through tough times with loved ones, so that they are adequately supported in making the best decision.

In closing, I hope that next time, we will have more time to talk about people who are not vulnerable, sick or about to die, but still want to express advance consent.

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

Madam Speaker, I thank the member for Richmond—Arthabaska for his very frank and candid comments.

I would just like to clarify something. He mentioned that the Liberal Party did not accept the other parties' amendments. That is not quite accurate, because during the debate on Bill C-14, we accepted an amendment endorsed by all parties concerning medical practitioners' freedom of conscience and religion.

I would also like to point out that Bill C-7 does allow for advance consent, but not advance directives. The issue of advance directives will be dealt with in the comprehensive review, which will take place every five years.

I would also like to point out that there is a 90-day waiting period to eliminate the impulsiveness my colleague pointed out in his speech. For example, when a minor has an accident, we do not want them to make an impulsive decision on this matter.

Does the member opposite believe that having a specialist is necessary? For example, Mr. Truchon, who was from Quebec just like the member opposite, had cerebral palsy. Our party believes that a physician must have the requisite expertise to treat and advise patients before they make their decision.

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I thank my colleague for his question and for the clarifications he provided.

I do think that some expertise will be required. This is a very big decision for patients and their loved ones. There is the whole issue of grieving, a whole process. Yes, it makes sense that the doctor would be a specialist in the individual's illness or disability. However, I wonder if everyone will have access to those resources during the decision-making process. The devil is in the details, as they say. This shows just how urgent it is to deal with the matter of medical assistance in dying and, in particular, Bill C-7.

[Martin Champoux, Bloc, Drummond, QC]

Madam Speaker, this is a particularly meaningful day to talk about this sensitive issue. Yesterday, October 18, marked the first anniversary of the passing of my aunt Claire, who chose to access medical assistance in dying. She was not looking to end her life, but she simply wanted to choose how she would put an end to her suffering and to do so with dignity. I think that the word “dignity” is important, because that is what we are talking about here.

I heard the speech by my colleague from Richmond—Arthabaska, and I appreciated the considerable sensitivity he showed in expressing his concerns. The topic of palliative care is a very important one.

If every patient across the country had fair and equal access to palliative care, would my colleague agree to remove the element of final consent, so that people with degenerative diseases could make a decision several weeks or months in advance, or even years, before their unforeseeable, yet inevitable, death?

Could my colleague speak to that?

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I thank my colleague for his question.

At the end of my speech, I talked about reflecting on the notion of who am I to decide on behalf of someone else going through such a terrible ordeal. I had those discussions, that very debate, more than once with friends over dinner. Some of those friends were going through this situation with their mother or father, or a brother or sister. This is what is really giving me pause right now.

Ultimately, I should allow these individuals to have access to this resource. I am not sure “resource” is the right word; I should say, people should have this as one of their options.

I do want to ensure, however, that the government does everything it can to protect vulnerable people if the time ever comes in their life that they want to end it. It should not have to come to that, and that is what I am wrestling with at the moment.

Ultimately, I hope to be able to let go and vote in favour of this bill, as my colleague mentioned earlier, to let everyone decide for themselves.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Madam Speaker, it is an honour to participate in the debate on Bill C-7, which will amend the Criminal Code.

As someone who travels four or five hours to get to Ottawa on a regular basis, often I sit in Parliament and ask, “Do my constituents really care about what we are talking about?” I am pleased today to participate because I believe that this is a subject matter that every Canadian feels strongly about, one way or another, and that potentially could impact every Canadian. I feel very honoured to participate in this debate today.

We are doing so because the Supreme Court deemed certain provisions of the original medical assistance in dying legislation, MAID, to be unconstitutional. That provision, deeming death must be reasonably foreseeable, is being withdrawn in Bill C-7. The second important piece of this bill is the removal of the 10-day waiting period. In my remarks today, I want to address both of those changes.

First, I would like to state at the outset that I support the bill. In contrast to some others who have spoken, I do not believe the government should have appealed the Supreme Court decision. While I commend the government for finally bringing forward this legislation, it is unfortunate that the Liberals are only acting when being made to do so by the courts. This is somewhat of a repeat of four years ago when the government was forced by the courts to introduce the original MAID legislation.

Those suffering near the end of life should not have to resort to the courts before government acts. I guess one could say, however, that late is better than never, and it is certainly better than endless appeals of the decisions.

Four years ago when the original bill was introduced in the House, I made a special effort to obtain the collective views of my constituents. While I personally supported the original legislation, I also wanted my vote to reflect the feelings of my constituents. I reached out extensively to survey my constituents through phone calls, emails, Facebook and direct mail.

The responses at that time were from all age brackets and all demographics. The end result was 77% of several thousand respondents supported the legislation. Ironically, that number is awfully close to the percentage of support I received in the general election just one year ago. I am confident that a similar survey today would yield the same results, and the majority of my constituents would be supportive of the changes being proposed in the bill.

What I heard from constituents reflected my own personal views. While I respect some deeply held views from constituents who do not support MAID, I am of the belief that I, and only I, should determine how much pain and suffering is reasonable for me when end of life is near. I do not believe any institution or government should deny me my constitutional right.

Some medical professionals do not support MAID, and that is their constitutional prerogative. Those advocating against these changes feel those rights are not adequately protected in the legislation. That may be legally correct, but medical professionals not wanting to administer MAID clearly have a professional responsibility to refer patients. In Alberta, the website for Alberta Health Services has a listing of doctors who are willing to perform MAID. If it is the view of a medical professional that he or she is not prepared to perform MAID, they can make a referral.

The second important piece of this bill is removing the 10-day waiting period. I also support this. The contention that someone who is suffering to the extent that they ask for MAID one day will simply wake up a few days later and change their mind, I do not agree with. In my view all the 10-day period provided for was additional suffering and an opportunity, for those who oppose MAID on fundamental principles, to try to change the patient's mind. In my view, both are wrong.

I am sure most MPs are receiving the same emails I am getting, many from constituents asking that I support the legislation and others who are opposed. I have no issue with those opposed to MAID. Where I do take issue is with some of the rationales that are being used. Medical professionals' conscience rights is one, and I have spoken to that.

Others claim the legislation would take us down the slippery slope of other countries, where euthanasia is available to children and those with mental illness. Clearly those are red herrings because this legislation would do none of that. Others are asking for more study, another delay tactic, similar to appealing the court decisions. It is more work for lawyers, less satisfaction for those suffering.

Increased funding for palliative care has also been raised as an option by those opposing this legislation. Enhancing palliative care is always welcome, but in my view is not directly related to this issue. We are talking here about people wanting to end excruciating pain and suffering. These people are not asking for their pain and suffering to be made more comfortable.

Our health care system must do both things well. It must allow for people to live with dignity and receive excellent care as they reach the end of their lives. In addition, the provision of health care is a provincial responsibility, and I do not believe it should be part of this discussion.

Since the original MAID legislation was passed four years ago, I have taken a special interest in this issue. Unlike some other members who spoke earlier, I have not attended a death where someone has chosen MAID. However, I have had dozens of constituents make a real effort to tell me they experienced MAID with a loved one and that it was very special and appropriate. They personally thanked me, as someone charged with making laws in this country, for making this provision available at end of life for their loved one.

I have not had one constituent call me to say how bad this experience was. In almost all cases, these same constituents have said that society needs to go further. In fact, many constituents seem to believe advance consent already exists. They cannot believe they are not allowed to prepare a legal document, while of sound mind, that would provide their loved ones with guidance in the event they are nearing their end of life but are no longer of sound mind. For that reason, it is critical the minister get on with his public consultation on a broader review of MAID, which was promised some time ago.

The minister needs to find out what Canadians want and not make those suffering take years to go through the court system to get change. Like most things, the Liberals blame COVID. However, there are many ways of seeking input from the public regarding other changes to MAID, and the minister needs to get this discussion moving now.

In summary, I look forward to the bill being studied in committee. I know there will be those opposed to the bill and those in favour making presentations, and all need to be heard. For me personally, I have consulted and listened to my constituents and feel very comfortable voting in favour of the legislation.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, the member for Calgary Signal Hill is the member of Parliament for my brother, and I appreciate the effort he is putting forward in reaching out to his constituents to find out what they are thinking on the issue. Our role as members of Parliament is to put aside where we may want to head in favour of finding out from our constituents how we can best represent them.

My question is regarding the speed of reaction. The legislation we introduced last time was a result of a lot of discussion and consultation. The consultations reached 300,000 throughout January of this year. We are being very careful to go one step at a time to avoid slippery slopes.

Could the hon. member talk about the importance of avoiding those slippery slopes by taking the proper amount of time to do the consultations we need?

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Madam Speaker, I am suggesting we need to launch these consultations that have been promised because there are Canadians who believe this particular legislation could be even further enhanced. The Liberal government needs to get on with these consultations and listen to Canadians.

As mentioned, at the end of the day we are here to represent our constituents. When I did my survey, I did not know how my constituents were going to react. Even though I felt strongly about this particular issue, I wanted to make sure I was representing their views, and I believe in both cases that was the case.

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

Madam Speaker, I will be sharing my time with my esteemed colleague from Argenteuil—La Petite-Nation.

It is with great emotion that I rise in the House to speak to the bill on medical assistance in dying.

First, this bill is the result of a decision handed down by the Superior Court of Quebec. I am very familiar with that court. I had the great honour and responsibility of arguing cases before it in my previous life. Barreau du Québec lawyers have the privilege of working with one of the best courts in the world.

This court rendered a decision and rather than appealing it, the Liberal government said yes. Quebec will once again be leading the way for the rest of the country. Our progressive and forward-looking Quebec will guide Canada. That makes me proud both as a lawyer and a federal government MP from Quebec.

The purpose of Bill C-7 is to ensure that people like Ms. Gladu and Mr. Truchon have the same rights, opportunities and freedoms as those who are facing an imminent or reasonably foreseeable death.

The ruling in Truchon found the eligibility criteria of reasonably foreseeable natural death to be unconstitutional. Our government also agrees that MAID should be available to relieve suffering and pain from serious medical conditions and is now proposing through this legislation to amend the Criminal Code so that Canadians can end their lives with medical assistance if that is the right choice for them. To accomplish this, Bill C-7 proposes to repeal the requirement that natural death be reasonably foreseeable, opening up access to those who are suffering in a wider set of circumstances.

The changes to the legislation propose to create two pathways in terms of the procedures that must be followed to assess a request for medical assistance in dying. While I do not have time to get into the details of the two regimes in full, there are a number of points that I wish to highlight today.

For those people who are suffering intolerably from a serious medical condition, but whose death is not reasonably foreseeable, the safeguards put in place emphasize the importance of ensuring that sufficient time is taken to evaluate the request. A minimum of 90 days will be needed so that the person can be assessed by a doctor who has some experience with this condition, which will help to ensure that the person gets all of the information, services and tools that might help them improve their quality of life.

Bill C-7 also creates new safeguards with respect to consent. Individuals requesting an assessment for medical assistance in dying give their consent, of course. Clearly, they also give their consent to receive MAID when they officially sign their request. However, what matters most is consent when MAID is about to be administered. There must be no doubt as to the person's desire to receive MAID at the moment they receive it. Doctors will be more comfortable proceeding under those circumstances.

Depending on their illness, some individuals risk losing their capacity to give consent between the time they are approved for MAID and the day they would like to receive it. Although we expect that most people are ready for MAID rather quickly once their request is approved, some people may wish to wait for a specific event such as a child's wedding or the birth of a grandchild. Those who wish to wait before going ahead with MAID are caught in an impossible situation if there is the risk of losing capacity. Either they wait for their special family event and risk losing their ability to die as they wish, or they move up the date of the intervention and miss a very important moment with their family and friends.

Therefore, this bill will enable individuals in real danger of losing their capacity to consent prior to the day specified for administration of MAID to make special arrangements with their practitioner. Such arrangements must be made in writing. The doctor and the individual must work together to come to an agreement that works for both of them. This safeguard is important for individuals as well as for doctors because they are the ones who bear the tremendous burden of ending someone's life.

The bill addresses another difficult situation.

Let us suppose that, when the day comes, the person has lost their capacity to consent to MAID, but remains conscious and alert, although not competent. Let us also suppose that they act in such a way or make gestures clearly indicating that they do not want to receive MAID. The bill addresses this situation—which we obviously hope will be rare—by clearly stating that the physician must not proceed because, in this case, it is no longer what the person wants.

The concept of freedom of choice, for me, remains central to all of this. I watched my grandmother suffer from Alzheimer's. Not long after I was born she was diagnosed, and when I was very young she used to repeat the same stories over and over again to me, about her own life and the life lessons that she wanted to pass on. She would tell me about how she used to work two and then three jobs, taking shifts overnight in order to buy her family's first home and provide a better life for her children. What that repetition instilled in me was certainly an understanding that my grandmother was probably the strongest woman I knew, that she was a force of nature.

When I was about seven or eight she forgot who I was, she forgot who everybody was, and I had to very painfully remind her every time I saw her. By the time I was 10 she no longer remembered language at all, and it was just humming, which I still somehow found very soothing, comforting and somehow okay. The degradation from there continued; her eyes no longer opened at all, she was in a wheelchair, the humming had completely stopped and when I was 15 the only muscles that worked were reflexive ones. Even if nothing else in her body moved, she would chew food if it was put into her mouth. It took two people to move her from her wheelchair to her bed or to change her, and this situation went on like this for 10 years.

As a teenager I used to wonder constantly what it would feel like to be trapped in a body like that, wondering if that was really the same strong woman in there or not. It was 10 years of listening to hushed voices in the kitchen saying, “...but there's nothing we can do.”

I do not know for sure, of course, what my grandmother would have decided for herself, but I do know for sure what I would want. For those who would decide something different for themselves, or for whom their beliefs are contrary to assisted dying, this framework provides everyone with the freedom to decide for themselves.

It is not a crime under the Criminal Code to take one's own life. It is a crime to take someone else's. The changes proposed would ensure that those people who need and who would like doctors to help them in order to end their life with dignity, at the time that they choose, can do so.

MAID is certainly one of the most challenging social issues in our society, which is made up of people with very diverse viewpoints and needs. I believe that this bill would achieve the right balance between the freedoms and rights of those who are dying and who are seeking a peaceful medically assisted death and our medical practitioners who need a clear framework for timing and consent.

I call on all members of this House to support Bill C-7.

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

Madam Speaker, when I think about this, and about the importance of choice, I am thinking about the horrible situation that has been uncovered in long-term care homes across this country. I am thinking of a gentleman named Roger Foley from London, Ontario, who has a degrading neurological condition. He is not being adequately supported by our health care system. He is not getting assisted living, and so how can people be truly given a choice when their choice is between living horribly in a health care system that does not support people or having medical assistance in dying?

Would the member not agree that we need to invest more in our health care system and more in improving the lives of our seniors and those with diseases before pushing forward and liberalizing assisted dying?

[Rachel Bendayan, Liberal, Outremont, QC]

Madam Speaker, I do not disagree with him. I do believe that we need to ensure that the quality of life that is available to our elderly and the people who are living in assisted-living homes and centres across the country allows them to have the option of living with dignity, but I do not believe the two are mutually exclusive.

Our government has invested in health care recently. We have made numerous transfers to the provinces in order to make sure that our seniors are being cared for, and we will continue to do so, but that does not mean that medical assistance in dying should not move forward at the same time.

[Julie Vignola, Bloc, Beauport—Limoilou, QC]

Madam Speaker, I want to thank my colleague for her speech, which was very personal and very moving. I just want to pick up on the idea of the foreseeability of death.

Alzheimer's follows a certain progression. My colleague's grandmother went through that progression, as have some other people I know. People can experience different forms of dementia with aging, and some are more difficult than others.

With that in mind, would it be good to include the possibility of advance requests for medical assistance in dying in Bill C-7, along with very specific criteria?

[Rachel Bendayan, Liberal, Outremont, QC]

Madam Speaker, I thank my colleague for her question.

We need to keep this conversation going. We need to ask Canadians what they think and what they would be comfortable with. That is certainly not out of the question, but at this point in time, I think we have presented something that not only responds to the Quebec Superior Court's ruling but also meets the demands of those seeking medical assistance in dying.

I certainly think more needs to be done. I know this is a very real concern in Quebec. My constituents also ask me about this. I think we need to keep the conversation going and see how we can move forward into the future.

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

Madam Speaker, I appreciated the words of my colleague across the floor. My father passed away in February just before COVID from Alzheimer's, after nine long years in care. However, I also do know what his desire was. The member spoke of choice. That, I think, is the issue here, right down to the choice for doctors.

The member talked about making sure safeguards are in place. What about doctors who do not feel they can go forward in participating in this? They are not being properly protected across our country. As well, the Canadian Society of Palliative Care Physicians has made it clear that euthanasia and palliative care are two very distinct things.

How does the member feel about her government's position on palliative care? Would she be willing to say that those two things are very distinct and should exist independently?