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

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Mr. Speaker, I want to thank my colleague for his speech. I listened closely and he was sensitive and respectful of all the ways to look at this bill and of all the MPs who might be opposed to it. I think that is the way to approach this type of issue.

We experienced that in Quebec City. The leadership of Véronique Hivon led to a multi-partisan consensus at the National Assembly, resulting in smooth passage of the bill for the good of our constituents.

We know that we are taking a step in the right direction with this bill. My hon. colleague and his party think that we should go further. How much further does he think we should go?

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I do not want to presuppose the work that is going to be done at committee and that is why I placed such important emphasis in my remarks about getting this bill to committee. The committee study of this bill has to be very detailed and there has to be a very broad cross-section of witnesses to inform our work as parliamentarians. I am sure there will be quite an extensive list of witnesses who wish to speak to this bill. I hope members of the committee will take note of what is heard at committee, deliberate in an appropriate manner and report the bill back, something that reflects the importance of all of the deliberations.

The House resumed consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, I apologize in advance if there is noise in the background; it is either traffic or my kids, so I have chosen traffic.

I want to start first by speaking to what is at stake with Bill C-7 and with the medical assistance in dying framework overall. What is at stake fundamentally is, first, alleviating intolerable, cruel suffering. The Supreme Court and other courts have spoken about the cruel choice that individuals face in the circumstance where they have a sound mind, they are of capacity and can make these decisions themselves, where they are suffering from an illness that is not going to go away and when they are suffering in an intolerable way. Forcing that suffering upon individuals is cruel and we have to be cognizant of the fact that this is first and foremost about alleviating suffering, but it is about alleviating suffering within the context of empowering and respecting one's personal autonomy.

This is fundamentally about individual rights, and our job fundamentally is to respect those individual rights, to protect those individual rights, to ensure that we end suffering in the course of protecting those individual rights and to make sure that we fulfill the promise of section 7 as it has been interpreted and upheld by our courts, not only in the unanimous Carter decision by the Supreme Court, but also by other courts, like the Alberta Court of Appeal and more.

Now, this bill is important, because it addresses a long-standing concern with Bill C-14. It addresses the concern that we had not answered the call from the Supreme Court adequately. We had added an additional criterion unnecessarily. We had basically said that if people are suffering intolerably and they can absolutely make this choice for themselves, they have capacity, and they have an irremediable condition, an effectively incurable illness, they cannot access this regime if they are not near the end of life or there is not path dependency, but they know the trajectory they are on, even if they are already intolerably suffering.

That, obviously, was unconstitutional. The courts determined that to be so. The government rightly opted not to appeal that decision, and here we are.

Importantly, we have actually gone beyond what the court has mandated in pursuit of individual rights and respect for our charter, as we have said in the case of Audrey Parker, a woman who chose to end her life earlier than she had wanted to. She wanted to get through the holiday season, but she also did not want to lose capacity and then lose the option. She did not want to lose ability to end her life and her suffering. She did not want to lose the possibility of death with dignity, so she chose to end her life before she wanted to. Thankfully, we have actually gone above and beyond what the court has mandated us to do, and we have provided one form of advance request to ensure that individuals, like in Audrey's case, do not end their life before they would like to.

This bill, on those two fronts, is positive. There are some challenges. That is not going to stop me from supporting this legislation at second reading, but it does give one pause. I think we, as parliamentarians, have to be very careful about adding additional exclusions to accessing the MAID regime. That is what this bill would do, unfortunately. I have heard others speak to the issue of mental illness, and there are reasons to proceed cautiously, but there are not good reasons for blanket exclusions. In fact, we potentially render the bill unconstitutional with blanket exclusions, just as we did with exclusions in Bill C-14.

I hope at committee there is expert testimony on this piece, and I hope we get this right. I will give an example specifically on mental illness. In 2016, there was a case at the Alberta Court of Appeal. A woman, identified as E.F., had capacity, she was suffering intolerably, it was irremediable, she had consulted with her family and she had made the decision to end her life. She was able to do so, thankfully, because of the Alberta Court of Appeal applying the Carter decision by the Supreme Court. If the federal justice department had gotten its way in that case, it would have read down Carter to mean only terminal illness. Of course, they said that is not the case. Then we saw, through Bill C-14, that our government tried to impose that kind of criteria, and the court subsequently struck it down. The justice department lost that leg of the argument.

Then, in E.F., they put forward the argument that it could not be an underlying psychiatric condition on its own, but that is exactly what E.F.'s was, an underlying psychiatric condition. The court said that this underlying psychiatric condition, which manifested itself in great significant pain in the documented evidence, did not affect her capacity to make a decision. She was of sound mind.

In E.F., the Alberta Court of Appeal went beyond that. As to the consideration whether MAID should be available to people with mental illness as their sole underlying condition, the Alberta Court of Appeal, in E.F., said that the Supreme Court, in Carter, had canvassed this conversation, this discussion and this concern. Unanimously, they had determined that it was not an additional exclusion. It was not a factor to exclude, and not an additional criterion for eligibility, for those with mental illnesses and those with physical illnesses, so long as they meet the specific criterion of an irremediable condition of intolerable suffering and that they have capacity. It may be that one is depressed, or it may be that one is suffering from a mental health issue such that it impinges upon one's capacity to consent, but in other cases it clearly does not. In E.F., it did not. The justice lawyers lost that case, yet here we are.

In Bill C-14, the government added an additional criterion of close-to-terminal illness and reasonably foreseeable death, and it was struck down. Here, the justice department is adding that second argument from E.F. that it already lost in the courts, and is adding a blanket exclusion for mental illness. As a matter of constitutionality, I would say that if this excludes the case of E.F., which it does, then it creates a ready constitutional challenge. I will be reading the Charter statement from the justice department very closely. I am not suggesting that we do not proceed cautiously, but a blanket exclusion on mental health, when there is a case like E.F. before the court, is likely to render this law unconstitutional, and that has to be addressed by the committee.

The second piece I want to flag is the two tracks. If one's death is reasonably foreseeable, then there is no additional track. There is not even a 10-day waiting period. That 10-day waiting period has been waived, although there was not great concern even with that 10-day waiting period. There is this dual track now, if one's death is not reasonably foreseeable, where one waits 90 days. This is what we are telling people in those circumstances. I have spoken to family members who are affected by this, and they are absolutely challenged by these circumstances when one is already intolerably suffering: They are suffering from a condition that is not going to go away, and they are making this decision themselves, having capacity. If we respect personal autonomy at all, surely a fundamental life decision like this is one that we have to respect, and we are telling these individuals that they have to wait another 90 days, and not just suffer but suffer intolerably for another 90 days. It is inexplicable that we are asking people to suffer intolerably for that length of time. Those are the two specific issues that need to be addressed at committee in a serious way in order to make this bill not only constitutional, but to make it the best bill that it can be.

I wish we had dealt with this last item, because the idea of constantly revisiting this conversation instead of just getting it right for Canadians in need is frustrating. I mentioned Audrey Parker, and we are addressing one type of advance request. However, I do wish that, in the course of this legislation, we had answered the second type of advance request, in which an individual has been diagnosed and is not yet suffering intolerably, but that future is not so far away. Those individuals should also be in a place where they can make an advance request, if we are to respect their autonomy and respect their wishes.

I just wish politics did not get in the way. That is what this is. This bill is a cautionary step. It does not go as far as it could because of politics. I know Conservative members will say it goes too far and others will say we have to be concerned about vulnerable Canadians. We know we can protect vulnerable Canadians and respect people's individual choices at the same time, and I wish politics did not get in the way of alleviating suffering. I wish politics did not get in the way of respecting and protecting individual rights. We like to say we are the party of the Charter. I wish we carried through that promise and demanded greater respect for individual rights in the course of Bill C-7.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Speaker, I have been getting phone calls basically on both sides of the issue. I am having some people, as our colleague said, saying it is not going far enough. Other people are saying that it is going way too far.

I would like to talk about one of my constituents, Carol, who had a very respectful conversation with me. She totally respects the rights of physicians who do not want to participate, and people who do not want assistance in death. However, she has some concerns about advance directives, and my colleague touched on this. His comment at the end was very important. He said it is important that we get it right.

As far as advance directives, does the member actually think that this piece of legislation in front of us today addresses those, and does he feel that it is still supportable?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, it is supportable, particularly at second reading. The Council of Canadian Academies identified three kinds of advance requests. One is as in the case of Audrey Parker, which I mentioned, where someone not only is diagnosed but is already suffering intolerably. This bill would address that issue, and I am glad that it would.

The second issue, which I think is easy to address and has been recommended up and down by every expert who has looked at this, is when one has already been diagnosed but is not yet subject to intolerable suffering. We ought to provide an advance request for that as well. We could address it with sunset clauses if folks are concerned.

The third issue is when someone has not yet been diagnosed. I would argue that we could probably get there, but I think, at a minimum, we should address the second advance request where someone has already been diagnosed, but is not yet suffering intolerably. That would have been a relatively straightforward one to address. Given the time period we have had, especially in the course of COVID, I wish this had been better addressed in this bill, as well.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Mr. Speaker, I want to begin by acknowledging my colleague's ability to focus and to find work-life balance in these difficult times. I would also like to commend the progressive values that he brings to many of his interventions, including at the Standing Committee on Industry, Science and Technology and in the current debate.

I wanted to address the end of his speech and give him a chance to elaborate.

Does my colleague agree with the possibility of granting the right to waive final consent in cases where natural death is unforeseeable? How might we further facilitate this step for the victims of this mechanism?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, the advantage of any view that respects personal autonomy is that one is not tied to a decision one has made: one can always revisit it. The importance of advance requests is that people might lose capacity. If one is suffering intolerably, as in the case of Audrey Parker, but is so worried that she is not going to be able to make a decision to end her life and access death with dignity because she might lose capacity, then we, of course, need an advance request and that is exactly what this bill would provide.

As for the second category, where an individual has been diagnosed and has not yet begun to suffer intolerably, when they have made it very clear that this is what they want as a matter of personal autonomy, we have to respect that as well. Of course, if we are to respect personal autonomy, one can always withdraw when one has the capacity to do so.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Mr. Speaker, my colleague's comments were very thoughtful and certainly resonated with me. My father-in-law is currently in a situation where he cannot give consent any longer. He is trapped in a situation that we know he would not want to be in, so a lot of the comments the member brought forward really resonate with me.

At the beginning of his comments, the member talked a lot about intolerable suffering and the need to alleviate that intolerable suffering. I am wondering if he could talk a bit about where we came up with the 90 days.

Where did the Liberal government come up with 90 days as the amount of time we should make people wait, in intolerable suffering, before they can get relief?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, I can honestly say I have no idea, and I do not think the 90 days are justified in the end. I think the committee should examine this timeline and correct it. I hope, when this bill comes back to the House for third reading, that we have avoided the blanket exclusion for mental illness. If need be, we can add a sunset clause to that provision to give the government more time, if necessary, but I hope we avoid the blanket exclusion indefinitely. Second, I hope that we cure that 90-day period and reduce it significantly. We cannot possibly want Canadians who are still of sound mind to suffer intolerably for such an extended period of time.

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, it is a privilege to have this opportunity to rise and speak on Bill C-7, an act to amend the Criminal Code (medical assistance in dying).

Not long ago, we in the House debated the merits of Bill C-14. I was a member of the justice committee when the committee was seized with doing that. That opened the door to physician-assisted death in Canada.

I want to begin my speech today with the same words that I used to open my speech on that bill:

I believe in the sanctity of life, and I believe that all life, from conception right through to natural death, has value, has worth, and has purpose.

A pastor friend of mine told me a story that had happened just prior to the passing of Bill C-14 in 2016. A woman the pastor knew who had battled stage four cancer for 10 years, savouring every moment of that time with her grandbabies and family, was told by one of her care workers, “I bet you cannot wait for the assisted-suicide bill to pass.” The pastor recalled the desperation in her tears when she called to recount her story, asking, “Has my life only become a burden to society?”

After the legislation was in effect, another woman was reunited with her childhood sweetheart and engaged to get married when her fiancé discovered that he had stage four cancer. Together they mustered up every possible hope for a future together, only to have their hopes dimmed by repeated offers for medical assistance in dying.

As the House now considers an expansion of MAID, I think it remains vitally important that the worth of every person is reaffirmed and underscored. It must be our priority in this place to remind every Canadian that they have value regardless of their age. They have value regardless of their ability. Their dignity is not determined by their suffering or their autonomy. It is intrinsic. It is inherent. Their lives are worth living.

I think these statements are important, because the reality is that every time we talk about expanding access to MAID, we send a troubling message to those who may be vulnerable: the idea that, if certain conditions or factors are present, somehow a person's life has less worth; the idea that ending a person's life is a mere medical decision among any number of medical decisions.

Expanding eligibility cannot be about removing safeguards and fundamentally redefining the nature and role of assisted death. This bill intends to offer assisted dying to individuals who are not dying, whose lives are still viable. This is a contentious issue that has been raised by multiple legal voices because assisted death was previously sold as an option only when death was imminent, or reasonably foreseeable.

In just four short years, we have embarked beyond that final stage of suffering. The whole health care system is feeling the pressure for acceptance of MAID, says Nicole Scheidl. Doctors and medical staff are feeling this pressure. Scheidl adds that the most terrifying thing about MAID is how it will impact the future of medicine, as only doctors comfortable with MAID will go into medicine, unless perhaps some provision is made for conscience rights.

Cardus executive vice-president Ray Pennings warns us that Bill C-7 does not take the protection of conscience rights seriously. He writes:

Conscience rights are Charter rights...including the rights of medical professionals not to participate in MAID in any way and the rights of hospices and other institutions not to cause the deaths of people in their care.

There are other valid concerns as well: psychological suffering in combination with other permanent injuries potentially justified under MAID, the elimination of the 10-day waiting period, the requirement for only one independent witness as opposed to two, the waiving of final consent, and also that a witness cannot be a primary caregiver.

Even in its current form internationally, MAID raises flags. When the United Nations Special Rapporteur on the rights of persons with disabilities visited Canada in 2019, she noted that she was extremely concerned about the implementation of MAID from a disability perspective. She flagged that:

there is no protocol in place to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assistive dying.

She highlighted:

...claims about persons with disabilities in institutions being pressured to seek medical assistance in dying, and practitioners not formally reporting cases involving persons with disabilities.

Her advice was to:

put into place adequate safeguards to ensure that persons with disabilities do not request assistive dying simply because of the absence of community-based alternatives and palliative care.

Instead, Bill C-7 goes the opposite direction in order to expand eligibility.

Let us not forget that every choice we make has a ripple effect of different magnitudes. Mother Teresa once said, “I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” The world can be changed for better or worse. When vulnerable people start feeling like they are only a burden to society because of our actions, we need to consider what kind of culture we are creating.

Kory Earle, the president of People First of Canada, a national organization representing people with intellectual disabilities, expresses his concern that everything is already more difficult for people with intellectual disabilities, including exclusion, isolation, housing, resources when abused, education, securing jobs, social lives and finding friends. He further adds that even their word in court is not considered credible. Mr. Earle explains, “everything, and I mean EVERYTHING, is more difficult for people with intellectual disabilities. Many, many other things should be made easier. This [assisted death] is not one of them.”

Passing Bill C-7 is sending a message that individuals with disabilities are no longer safe. This concern is echoed in a joint statement by over 140 lawyers who fear the perception this bill gives, if even unintentional, the perception that life with a disability is inferior and if ratified by law, we diminish the choice to live with dignity and exasperates systemic discrimination.

On top of this, Canada has tragic statistics around suicide. An average of 10 people die by suicide every day. Statistics reveal that nine of those 10 individuals faced a mental health problem or illness. I know and appreciate that those suffering solely from mental illnesses are not eligible for MAID under Bill C-7, but we are nonetheless sending a devastatingly mixed message.

The former Liberal member for Winnipeg Centre raised these concerns when we were first considering Bill C-14. As he observed the rash of suicides in several first nations communities at that time, he expressed concern that, “we haven't thought out the complete ramifications that a decision like this might have on indigenous communities that seem to be suffering greatly.”

In his speech, he shared one of his memories as a six-year-old child. His family was facing serious financial hardship, forcing his mother to go off in search of work. He and his younger brother were to stay with their father, who he described as “a residential school survivor, an alcoholic, and a member of gangs” with a “terrible temper”.

The rest I will quote directly from the former member. He said:

I remember climbing a tree in the back yard and wrapping a rope around my neck at the age of six... I wrapped that rope around my neck and thought, “Should I jump off into this universe, which is before me?” It was in that back yard that somehow I made the decision to climb down out of that tree and unwind that rope from around my neck.

If in my life I had seen, or I had known, that my grandmother had somehow used physician-assisted dying or physician-assisted suicide, or others in my family had completed the irreparable act, then it would have made it much more difficult for me to continue.

We must be mindful of the messages we send through this debate and always affirm life, but we must also do more than just offer words. We need to ensure that individuals facing end of life have access to the end-of-life care they deserve.

There are important questions we need to be asking to ensure those who are suffering truly have a choice between living well and pursuing MAID. For example, how do we better love those who live in unbearable pain, whatever form that pain takes? Feeling loved gives inherent strength to those losing hope. How do we show people how their lives teach us? How do their contributions strengthen us as individuals and a society? How do we instill in all people that they are not a bother, a financial burden or a disruption to deal with, but that their life is treasured? We must foster this type of society that affirms life and the pursuit of well-being.

As four physicians suggested in the National Post in response to the proposed legislation, increasing health care personnel, improving our quality of care, enhancing our palliative care options and ensure quicker access to psychiatric care would all be more advisable. Instead, we are “fast-tracking death on demand and dismantling the...[earlier] safeguards that were put in place to protect the vulnerable.”

We have all heard that only 30% of Canadians have access to palliative care and disability supports, which is possibly why there were 50 religious leaders who wrote an open letter urging us to consider that. It states:

Palliative care administered with unwavering compassion, generosity and skill expresses the best of who we are. Rather than withdrawing from those who are not far from leaving us, we must embrace them even more tightly, helping them to find meaning up to the last moments of life. This is how we build compassionate communities.

Furthermore, the joint statement by 140 lawyers explains that singling out non-life threatening illness and disability as eligibility criteria for assisted death—

[The Deputy Speaker, Conservative, Bruce Stanton]

I am sorry, we will have to finish there. The time has expired for the member's comments. He may be able to reflect on some of those ideas when he answers questions and comments.

Questions and comments, the hon. parliamentary secretary to the government House leader.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, I remember quite well the former member for Winnipeg Centre and his speech on Bill C-14. One of the things I can recall from the Bill C-14 debate was there were a lot of examples, real-life stories. I say that because it is important for us to recognize the seriousness of the legislation we are debating. Ultimately it will go to committee, where there will be opportunities to have that dialogue and who knows what it will eventually come back as.

Does the member believe the bill is moving us in the right direction?

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, I do not believe the bill is moving us in the right direction. We should be strengthening the bill by adding additional safeguards for vulnerable people. It has been clearly demonstrated that people with disabilities are very concerned the bill does not go far enough to provide them the protection they are looking for.

I have heard from many health care providers, physicians, nurses and those who assist those health care professionals, who themselves are also health care professionals, express concerns that adequate conscience rights protections have not been built into the bill. It is something I have heard over and over in my riding and it is very important to health professionals. They want clearly articulated conscience rights protection inside the bill.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Mr. Speaker, I have a related question.

It is my understanding that, essentially, the member will vote against the bill for considerations that have more to do with religion and faith than with the bill before us.

When we talk about the right to life, and tell people that we have values, that dignity is intrinsic and that life is precious, does Bill C-7 not align with all that even though it is not perfect? With respect to their right to life and dignity, does a person who is suffering and who has an incurable disease not have the right to choose this solution after we have had a wide-ranging debate? Is that not a response? How is that not a response?