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

[Rachel Bendayan, Liberal, Outremont, QC]

Madam Speaker, I have spoken to a few doctors who have told me they themselves are uncomfortable with the procedure. They have a system in place that appears to be working in which they can refer to their colleagues, other practitioners, in order to perform medical assistance in dying. That appears to be working for some.

I am not aware, of course, of the situation of all medical practitioners across the country, but I certainly was comforted to hear from a number of doctors who, for different reasons, including religious beliefs, do not feel comfortable with this. There is a process in place for referrals.

I would also note that medical practitioners do have the moral obligation to—

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

Order. The parliamentary secretary.

[Stéphane Lauzon, Liberal, Parliamentary Secretary to the Minister of Seniors]

Madam Speaker, I am so pleased to be able to speak to Bill C-7, which seeks to amend Canada's medical assistance in dying legislation.

This is officially one of the hardest decisions I have had to make since entering politics, first at the municipal level in 2009 and then at the federal level. I never used to get my family involved in my decision-making. However, on this issue, I decided to get my wife and adult daughters to sit down with me at the kitchen table for a frank and serious family discussion.

Our government has been working on this bill since 2019. We have had discussions about the future and the choices that we need to make as parents. These discussions were extremely difficult. I know that this is an issue that hits very close to home for Canadians, but we do not talk about it in public very much. However, medical assistance in dying is a very complex and very serious issue for me.

Yesterday, when I came back from my run, a neighbour was waiting on my doorstep. We had an intense discussion, a very good discussion, on medical assistance in dying. He had just been diagnosed with ALS and was very emotional, which made me very emotional. He asked me if I had voted for or against the bill the last time. Because I understood that an individual's right to choose is very important, I voted in favour of the bill. This time too, I agree with the amendments proposed by the Quebec courts.

I have deviated somewhat from my speech, but events like these give us an opportunity to reflect on the reasons we are here. This subject has not been talked about very much in the House, and some opposition members have asked why it is up to all of us here to make these decisions. It just so happens that we chose to be decision-makers and that sometimes we have to make tough choices like this one.

We immediately embarked on an inclusive process with the provinces and territories in response to recent court rulings about MAID rules. We held extensive consultations. We talked to doctors, organizations, vulnerable people and eligible individuals. The consultations were part of our government's progressive approach to ensuring that the federal framework reflects evolving views and Canadians' needs. That is how we always make decisions here in the House. Our goal is always to improve Canadians' lives and be as fair as possible.

We were particularly focused on making sure that people with disabilities could express their views on the subject. People with disabilities are extremely important to me, given my past experience as parliamentary secretary to the minister responsible for persons with disabilities. That was an incredible experience, and we drafted the first accessibility act, which is near and dear to my heart.

Bill C-7 would amend the Criminal Code provisions respecting medical assistance in dying to provide greater autonomy and freedom of choice to eligible individuals seeking medical assistance in dying.

Protecting vulnerable individuals and respecting the right of people with disabilities to equality and dignity are essential considerations. More specifically, this bill would broaden medical assistance in dying to people with irremediable medical conditions who are in an irreversible decline but are not at the end of life.

The bill also proposes excluding persons whose sole underlying condition is a mental illness, introducing a host of safeguards for persons whose death is not reasonably foreseeable while maintaining and relaxing existing safeguards for persons whose death is reasonably foreseeable.

The bill also proposes permitting persons whose death is reasonably foreseeable and who were deemed eligible for medical assistance in dying to provide consent in advance of the time of the procedure even if they lose the capacity to consent prior to the day specified in the arrangement with the medical practitioner.

Supporting and advancing disability inclusion is not new for our government. From day one, we have been committed to achieving these objectives and have improved our programs to better respond to the needs of persons with disabilities. It should be noted that the Government of Canada fully respects the equality rights of Canadians with disabilities. That is why we have been working hard since 2015 to advance the accessibility and inclusion of persons with disabilities.

For example, in 2018, we acceded to the optional protocol to the Convention on the Rights of Persons with Disabilities. This means that Canadians have additional recourse for filing a complaint with the UN Committee on the Rights of Persons with Disabilities if they believe their rights under the convention have been violated.

In July 2019, we passed the Accessible Canada Act, which we are in the process of bringing into force. This legislation is considered one of the most important advances in federal legislation on human rights for persons with disabilities in more than 30 years.

In 2019, we also launched the accessibility strategy for the public service of Canada, in order to make the public service more accessible and inclusive. In addition, we improved data collection, in particular regarding indigenous people with disabilities. We recognize that integrating people with disabilities is about more than simply passing a law, and we are working with these people and other stakeholders to combat stigmas and prejudices. The culture needs to change so that the significant contributions made by Canadians with disabilities are recognized and valued as much as those of other Canadians.

Bill C-7 gives vulnerable people new, concrete safeguards against pressure and coercion, to ensure that MAID remains an informed, voluntary decision.

Today, as Parliamentary Secretary to the Minister of Seniors, I see that this has once again become a hot topic in my riding and in our discussions. I see how important it is to give people the right to make their own end-of-life choices. Fundamentally, we hope to strike a fair balance between respecting the individual autonomy of people who request MAID and protecting vulnerable people. We want this measure to be as compassionate as possible.

[Claude DeBellefeuille, Bloc, Salaberry—Suroît, QC]

I want my colleague to know that I really appreciated his speech.

In the bill and in practice, there has been a lot of talk about importance of the role doctors play when someone makes the final decision to request medical assistance in dying. However, we must not overlook the caring presence of the social workers who support these individuals throughout the process, allowing them, as my colleague said, to make an informed decision and fully and knowingly consent. The presence of a social worker is an important part of the support provided to individuals and families, as this decision is often made as a family.

I would like to hear my colleague's thoughts on the arguments raised since this morning in favour of an individual's right to express their wishes in advance when they are diagnosed, know that death is inevitable and want to plan how they will leave this world. Would my colleague support including a way to express one's wishes in advance in this legislation?

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Madam Speaker, I would like to thank my colleague for her question.

It is an excellent question. Any avenue for helping vulnerable people and helping those who want to support access to MAID is appropriate. All we want is to have federal legislation that provides a framework for all the regulations to ensure that there is a system in place in every province and territory of Canada so that people have the fairest opportunity to make a decision.

However, if the provinces want to implement any measures, given that health is a provincial jurisdiction and that Quebec asked for the legislation to be amended, we will always be there to support the best outcome for the vulnerable.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, I am concerned that this bill would create two classes of Canadians. In one case, able-bodied persons suffering from mental illness would be provided with suicide prevention; in the other case, persons who happen to be in wheelchairs would be eligible for MAID.

Is the member not concerned that this bill would create two classes of Canadians?

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Madam Speaker, what we are saying is that we want to make the fairest decisions for each group of people.

People dealing with mental health issues are just as important as people with disabilities and people who are terminally ill and highly vulnerable.

This is a very sensitive debate, and people with mental health problems who are not capable of making decisions are excluded from this law.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Madam Speaker, I want to begin by saying that I was very touched to join my colleague in attending the commemoration of the great sacrifice of Canadian soldiers during the Second World War, in Caen, France.

I will put that aside for a moment.

I listened with interest to my colleague talk about the rights of handicapped people and how much the government cares for them. However, we saw complete indifference toward the crisis faced by handicapped people during the pandemic. We had to work hard and push the government to give a measly $600 to the most impoverished people when it was not going to give it. Handicapped people suffer extraordinary levels of poverty because they are marginalized from the workforce.

Given the fact that the Human Rights Commission had to call out the government on its lack of action and interest in supporting handicapped people during the pandemic, I would expect my colleague to recognize that the government needs to do a better job in addressing the rights of handicapped people so they can get through this unprecedented economic and medical catastrophe.

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Madam Speaker, it is a pleasure to rise to respond to my colleague who was also a travel companion in Normandy.

My colleague may be referring to the Speech from the Throne in which the Prime Minister put forward some very important decisions for persons with disabilities. We provided $600, but that has nothing to do with medical assistance in dying. However, I am pleased to inform him that we were there for persons with disabilities—

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

Resuming debate.

The hon. member for Shefford.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I would first like to mention that I will be sharing my time with the hon. member for Beauport—Limoilou.

I am speaking here in the House of Commons today about Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying.

Many people here have had unique experiences involving the end of a loved one’s life. Personally, my most recent experience was last year, when I held my father-in-law’s hand until we were sure that he could die without suffering. I realized then that not everyone is that lucky. I thought about my grandmother, who fought a long and painful battle with cancer for many years.

Naturally, as the Bloc québécois critic for the status of women and seniors, I was contacted by a number of groups about this bill. I will therefore recap all of the work my party did on this important issue, while emphasizing the great sensitivity of Quebeckers when it comes to medical assistance in dying. I will conclude with the position of some seniors’ and women’s groups who have made extremely useful recommendations.

First, let us talk about the reason for this debate. In September 2019, the Superior Court of Quebec ruled in favour of Nicole Gladu and Jean Truchon, both suffering from incurable degenerative diseases, stating that one of the eligibility criteria for medical assistance in dying was too restrictive, both in the federal legislation covering MAID and in Quebec’s act respecting end-of-life care.

Two brave individuals, and I know people who knew them personally, simply asked to be able to die with dignity, without uselessly prolonging their pain. Suffering from cerebral palsy, Mr. Truchon lost the use of all four limbs and had difficulty speaking. Pain killers are no longer working for Ms. Gladu, who suffers from post polio syndrome, and she cannot remain in one position very long because of the constant pain. She said that she loves life too much to settle for mere existence.

What we are talking about here is the “reasonable foreseeability of natural death” requirement. Justice Christine Baudouin said it well in her ruling when she wrote that “The court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Mrs. Gladu's rights to liberty and security, protected by section 7 of the Charter.” That is the crux of this debate.

The defendants were challenging the fact that they had been denied access to medical assistance in dying because their death was not reasonably foreseeable, even though they had legitimately demonstrated their desire to stop suffering. Jean Truchon had chosen to die in June 2020, but he moved up the date of his death as a result the pandemic. Nicole Gladu is still living, and I commend her courage and determination.

The Bloc Québécois' position on this ethical question is clear. I thank the member for Montcalm for his excellent work and co-operation on this matter. I remind members that, as many have already pointed out, legislators did not do their job properly with Bill C-14. As a result, issues of a social and political nature are being brought before the courts.

We need to make sure that people who have serious, irreversible illnesses are not forced to go to court to access MAID. Do we really want to inflict more suffering on people who are already suffering greatly by forcing them to go to court for the right to make the very personal decision about their end of life? This will inevitably happen if we cannot figure out a way to cover cognitive degenerative diseases.

Obviously, we agree that we need to proceed with caution before including mental health issues, but that is not the issue today. The exclusion from the bill of eligibility for medical assistance in dying for individuals suffering solely from a mental illness requires further reflection, study and consultation, which will be completed at the Standing Committee on Health as soon as the motion that has already been moved by my colleague from Montcalm is adopted.

I would like to remind members of the important role Quebec played on this issue. Quebec was the first jurisdiction in Canada to pass legislation on this issue.

Wanda Morris, a representative of a B.C. group that advocates for the right to die with dignity, pointed out that the committee studying the issue had the unanimous support of all the parties in the National Assembly. This should be a model for the rest of Canada. Ms. Morris said she felt confident after seeing how it would work in Quebec and seeing that people were pleased to have the option of dying with dignity. The Quebec legislation, which was spearheaded by Véronique Hivon, was the result of years of research and consultation with physicians, ethicists, patients and the public. It has been reported that 79% of Quebeckers support medical assistance in dying, compared to 68% in the rest of Canada. That is important to point out.

In 2015, when the political parties in the National Assembly unanimously applauded the Supreme Court ruling on MAID, Véronique Hivon stated:

Today is truly a great day for people who are ill, for people who are at the end of their lives, for Quebec and for all Quebeckers who participated in...this profoundly democratic debate that the National Assembly had the courage to initiate in 2009. I believe that, collectively, Quebec has really paved the way, and we have done so in the best possible way, in a non-partisan, totally democratic way.

In this time of crisis, we must work together constructively to put people's well-being first. This is not about which has greater merit: palliative care or medical assistance in dying. This is about being able to offer both, to offer a choice. That is why I would like to remind the House that health transfers must be increased to 35% because Quebec and the provinces are the ones who know their regions' needs best and are in the best position to minimize disparity among the regions.

I would now like to tell the House about a meeting I had with the Association féminine d'éducation et d'action sociale, or AFEAS, in my role as critic for seniors and status of women. During the meeting, the AFEAS shared its concerns about this issue with me. I will quote the AFEAS 2018-19 issue guide:

Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly....

As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope....

This procedure cannot be accessed by individuals who are not at the end of life....People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.

That meeting took place last January. Last week I received a call from the president, reminding me how important this bill is, not only to her members but to all Quebeckers and Canadians. Work on this bill must continue in committee so the necessary improvements can be made.

Before being elected, I was a project manager responsible for raising awareness about elder abuse and bullying. I used to teach that violating people's rights is a form of abuse, that any attack on rights and freedoms, including the failure to recognize an individual's capacity to consent and to accept or refuse medical treatment, is a form of abuse. In 2020, a focus on proper treatment is long overdue.

Let me conclude by saying that I hope all of these comments and all of Quebec's lived experiences, in terms of respecting people who request and choose to die with dignity, will encourage all members of the House of Commons to give their unanimous support to Bill C-7 and to medical assistance in dying. Let's show some empathy for everyone who is suffering. Let's give them the choice. It is said that we do not choose to be born, but once we are, the cycle of life begins. Let's ensure that we ourselves have the choice to die with dignity in accordance with our own final wishes. This bill is long overdue. We need to act.

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

Madam Speaker, I thank the hon. member for Shefford for her speech and her very analytical and honest comments.

I have two simple questions for her since she took part in today's debate. It was said that consultations on Bill C-7 were inadequate. In my opinion that is absolutely not true, given that we have already heard from 300,000 people. I would like her thoughts on that.

The other question I want to ask her has to do with the dignity and autonomy of the person who wants to receive medical assistance in dying. Will changing the number of witnesses from two to just one independent witness and eliminating the 10-day waiting period improve or diminish the dignity of a person who has opted for medical assistance in dying?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for the question.

Eliminating the 10 days is a matter of dignity. This will allow some people to avoid suffering for days unnecessarily. As far as the committee work is concerned, we are aware that there is a world of difference between Bill C-14 and Bill C-7.

It is already planned, but the committee will have to address the issues of advance requests, which is something many seniors' groups are calling for, particularly for some people with degenerative diseases. There is also the issue of mental health and that of minors.

There are more issues that need to be studied, and I know that the committee will do the most exceptional work possible with input from all parties.

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

Madam Speaker, the Canadian Society of Palliative Care Physicians has put out a statement, indicating that euthanasia-assisted suicide is distinct from palliative care. We talk about choice and opportunity here, knowing that 70% of Canadians have absolutely no access to palliative care, yet it is part of this conglomerate of other options that are presented within the bill on euthanasia.

What is the member's perspective on the need for palliative care in Canada and should it be considered distinct from euthanasia?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her question.

I already addressed this in my speech. We must remember that it is important that we not pit palliative care against medical assistance in dying. We must continue to ensure that Quebec and the provinces receive the money they need for their health care systems through health transfers. Palliative care just like medical assistance in dying are part of a continuum of care. It is truly important to provide choice. I have already mentioned that.