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

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, the member's question is one that many people ask. My response is that a lot of people would make different choices if they had access to better palliative care. We know 70% of people across Canada do not have access to the palliative care they deserve. Even people with very uncomfortable and some would say intolerable diseases and situations, with the proper amount of palliative care, would have a different opinion than when confronted with the option of medical assistance in dying.

In fact, I spoke to a doctor at a function not that long ago. He said that when it came to MAID, they already had the technology to make people comfortable so they would not experience pain. They also could give them drugs. They had access to drugs that would also take away any psychological anxiety people may experience with their intolerable diseases. He said that there was no need for MAID.

[Greg Fergus, Liberal, Parliamentary Secretary to the President of the Treasury Board and to the Minister of Digital Government]

Mr. Speaker, I am very pleased to speak today in support of Bill C-7, which proposes amendments to the Criminal Code's medical assistance in dying regime in response to the Superior Court of Quebec's Truchon decision.

As members know, prior to the prorogation of Parliament, we introduced former Bill C-7, which proposed amendments to the MAID legislation and made it to second reading in the House. With the opening of this new session, we are reintroducing the same proposed changes as Bill C-7.

In September 2019, the Superior Court of Quebec struck down the federal and Quebec criteria limiting MAID to end-of-life circumstances. The court suspended its declaration of invalidity for six months, until March 11, 2020. In February, the Attorney General of Canada obtained an extension to provide enough time for Parliament to respond to the Quebec court's ruling and create a consistent MAID regime across the country.

Unfortunately, the disruptions to the parliamentary process resulting from COVID-19 made it impossible to meet this deadline. On June 29, the Superior Court of Quebec granted the request of the Attorney General of Canada for a second extension, until December 18, 2020.

Before I turn to the content of the bill, this legislation was informed by the Truchon decision itself, available Canadian international reports, the experience of existing international regimes and the government's consultations on medical aid in dying held in January and February earlier this year.

With respect to the consultations, the Minister of Justice, Minister of Health and Minister of Employment, Workforce Development and Disability Inclusion as well as their parliamentary secretaries hosted medical aid in dying round tables across the country. There were more than 125 stakeholders in attendance, including health regulatory bodies, legal experts, doctors, nurse practitioners, representatives of the disability community and indigenous representatives. They all shared their experiences and insights into MAID and its implementation in Canada over the last four years.

In parallel to these efforts, the government hosted an online public survey in January and received over 300,000 responses from people all across the country, an unprecedented number of responses, that reflects the significance of this issue for Canadians. A summary of the consultations was released in March as a “What We Heard Report”.

I would like to speak to the two proposed Criminal Code amendments in relation to eligibility for MAID.

First, the bill would amend the list of eligibility criteria so that it would no longer be necessary for a person’s natural death to be reasonably foreseeable. This change would respond directly to the Quebec Superior Court’s ruling in Truchon and Gladu.

Second, the amendments proposed in this bill would make persons whose sole underlying medical condition is a mental illness ineligible for MAID. Members may recall that the Council of Canadian Academies’ expert group on this issue could not come to a consensus on this question. This lack of agreement was also evident among participants at the MAID roundtables.

This complicated issue should be studied as part of the five-year parliamentary review of the medical aid in dying legislation.

With respect to applicable safeguards, the proposed Criminal Code amendments will create two different sets of safeguards, depending on whether the person's natural death is reasonably foreseeable or not. The first set of safeguards will continue to be tailored to the persons whose natural death is reasonably foreseeable where risks are reduced.

The second set of safeguards would be tailored to persons whose natural death is not reasonably foreseeable or who are not dying at all and would address the elevated risks associated with the diverse sources of suffering and vulnerability that could lead to a person who is not nearing death to seek access to medical aid in dying.

Bill C-7 proposes to use the “reasonable foreseeability of natural death” standard to determine which set of safeguards apply to a particular case.

In terms of those whose death is reasonably foreseeable, the bill proposes to ease some of the existing safeguards. Specifically, it would require that a medical aid in dying request be witnessed by one independent witness instead of two, and it would allow individuals who are paid to provide either health or personal care to act as an independent witness. Bill C-7 also proposes to repeal the 10-day mandatory reflection period.

With respect to the second set of safeguards that would apply to those whose deaths are not reasonably foreseeable, in addition to the same witness requirement being eased, the following new and clarified safeguards would apply.

The first new safeguard would require a minimum period of 90 days for the assessment of a person’s eligibility. This safeguard reflects the need to ensure that the assessment takes the time needed to address the additional challenges and concerns that may arise in the context of assessing the MAID request of a person whose death is not foreseeable, and who may have many years or even decades left to live. These include, for example, considering whether the person’s suffering is caused by factors other than the medical condition and whether there are ways to address the suffering other than MAID.

The second new safeguard would require that one of the two mandatory eligibility assessments be conducted by a practitioner with expertise in the condition that is causing the person's suffering. This would require that all treatment options to be explored before medical aid in dying is provided, while avoiding the need for specialist involvement, which could pose a barrier in remote and rural areas.

The existing requirement for informed consent would be clarified in two ways. First, the person would have to receive information on available and appropriate services that could help address their situation. Second, the person and the practitioners would have to agree that reasonable means to alleviate the person's suffering had been seriously considered before medical aid in dying could be provided. These proposed safeguards reflect the seriousness of ending the life of someone who is not nearing death, the importance of protecting vulnerable individuals who may seek medical aid in dying and would support a fully informed decision in this regard.

The bill also proposes amendments that would allow people whose natural death is reasonably foreseeable and who have been assessed and approved for medical aid in dying to retain their ability to receive MAID if they lose the capacity to consent before the day of the procedure. Certain conditions would need to be met, including having a scheduled date for the procedure, that the person gives consent to receive MAID on that date even if they have lost capacity, and that the practitioner agrees to provide MAID on the patient's scheduled date or before if the capacity is lost before that time.

This bill, I believe, seeks to balance several interests and societal values, including the autonomy of persons who are eligible to receive medical aid in dying and the need to protect vulnerable persons from being induced to end their lives. It represents a significant paradigm shift, and I hope one that will meet the consensus of the members of this Parliament.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, I thank my colleague for his speech, but I am a little confused. He mentioned the different groups that were consulted and the 300,000 responses that were received, but it was my understanding that there was to be a legislative review of the MAID legislation this year in June, which did not happen and still has not happened. It almost seems like the government did not want to let the normal process happen and instead wanted to control it and provide the information it wanted, or perhaps the minister wanted to pursue his own agenda or his own vision.

Why did the government not deal with the Truchon issue that needed to be dealt with and leave the rest of the changes until after the proper legislative review had been completed as required by the legislation?

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Mr. Speaker, as the member will recall, back at the time the legislation was supposed to have been reviewed, Parliament had taken the extraordinary step of sitting in a reduced format in order to comply with the outbreak of COVID-19. As a result, any legislation, as had been agreed to by all House leaders, would deal uniquely with the issue of COVID-19.

That is also why the Minister of Justice sought to have an extension granted by the courts until the end of this year, knowing that when we got back in the fall we would be able to pick up where we left off in March and continue the evaluation going forward.

I would also like to reassure the member that the legislation provides an opportunity for us to review this in five years, so that we can once again take a look, take stock of the situation in terms of how it is being used or how it is not being used appropriately, and make changes accordingly.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, the Bloc Québécois shares our Liberal colleague's point of view.

I would like to ask him a question about something one of our Conservative colleagues said earlier. He tried to make a connection between suicide and medical assistance in dying. It seems to me that this kind of connection is more often made to align with a certain right-leaning and often religious way of thinking.

Knowing that Conservative Party members have already indicated they wanted a free vote on this issue, I would like to hear my colleague's thoughts on what might motivate a parliamentarian to vote against this kind of bill.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Mr. Speaker, I would like to thank my colleague from Jonquière for his question.

With all due respect, I have to say, this is a very difficult and very sensitive issue for many people.

This situation is intimately linked to one's personal values and religious values, which may be at odds with the values of freedom guaranteed in the Canadian charter and the Quebec charter. This is a very difficult debate for many people. I do not wish to trivialize the values he brings with him to Parliament.

I think there is a consensus. However, I want to respect all viewpoints. Our colleague from Manitoba shared his perspective and our colleague from Toronto shared a different one. We must try to balance the two and use common sense.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Mr. Speaker, I would like to bring my colleague back to the very beginning, when we began this discussion in the previous Parliament and, remarkably, got a bill through.

I know it is hard to achieve perfection, but I am encouraged by the fact that a five-year review is in place. Does the member realize that there are many opposing views on this? We have heard them all. We are not working with underlying motives. We are working toward a good result for Canadians. Would the member agree with that?

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Mr. Speaker, I would agree. I must say I have grown and evolved around this issue. That is why I feel I can understand both perspectives on this issue. I have been very pleased in hearing the debate so far.

We have struck the right balance, but I understand why those who would want us to go further certainly would want us to do so. I can also appreciate the perspective of people who would want us to hold back a little.

It is not perfect, as my hon. colleague from the Hamilton area has said. However, we will not let perfection become the enemy of the good. We have a fair compromise that strikes the right balance.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, I am pleased to join the debate. The last several speakers raised some excellent points. It is good to see members bring different perspectives to this debate, and I hope to achieve that as well tonight.

I would like to say broadly at the outset that, in a binary world where one must say they are either in favour or not in favour of the availability of medical assistance in dying for people who are adults, mentally competent, grievously and irremediably ill and suffering cruelly from intolerable pain and anguish, I support the availability of assistance in dying for those people.

However, this bill and few bills we would consider in the House are as simple as a binary choice between two poles. Although we have had all kinds of different perspectives on this, the nuances and the details of this bill, as well as the bill that preceded it, Bill C-14, are very important. I enjoy these types of debates where we hear these points of view and can hopefully improve a bill before it is passed, if it is indeed the will of this Parliament to pass the bill.

I have ordinarily been highly critical of the government on a host of issues. I will take advantage of this moment to say that although there was much consternation to get to the final vote that occurred on Bill C-14 in the previous Parliament, there was something in that process that brought out what is good in Parliament. At that time, we had a lot of different perspectives on that bill. We had a bill that was tabled and amended. It was amended in this chamber. It had committee amendments, many of them, that were brought back and voted on by different parties, and we saw members of the Liberals' side who did not agree with their government for a variety of reasons. There were members, including me, who ultimately at third reading did vote with the government to support it.

That is what Parliament should do. It should bring out vigorous debate that really gets to the heart of an issue in order to have good legislation. I thought Bill C-14, at the time, was a reasonable limited change to criminal law in Canada to both comply with the Carter decision and establish the availability of medical assistance in dying. Credit also should go to members who are no longer a part of the government: the member for Vancouver Granville, who was the minister of justice at the time; and Jane Philpott, who was the minister of health and who showed leadership at that time in debating Bill C-14.

The bill before us today was introduced ostensibly to deal with the Truchon decision and the Quebec superior court's striking down of the reasonable foreseeability phrase from Bill C-14. In this bill, the government has chosen to address other issues at this time. As has been pointed out, there was to be a five-year review, per the previous bill, that should have occurred this summer. I understand the crisis we are in, but let us also not forget we have a government that prorogued the House and prevented the House from examining critical legislation and issues that face Canadians.

The timing of the bill puts us up against something of a deadline looming in December over the Truchon decision, and here we are. December is not very far away when we talk about all the different stages a bill must go through to do it right, to allow all voices to be heard and to allow all members of Parliament to represent their constituents on this.

The bill introduces a few changes beyond addressing the reasonable foreseeability. I am not going to get into the details of that, because time is passing. However, like most MPs, I have received a lot of correspondence and phone calls from the disability community and concerned citizens who have real reservations about any expansion of medical assistance in dying.

Some have argued from the point of view of a slippery slope and are concerned: Once changes are adopted, what comes after them? I understand the sincerity of these concerns. However, we have to examine the bill for what it says and what it does rather than what people might project into it.

Prior to the adoption of Bill C-14, I had four major concerns regarding medical assistance in dying: first, the assurance that quality palliative care be available to persons considering medical assistance in dying; second, strong safeguards for vulnerable Canadians, such as minors, the mentally ill and the disabled; third, the conscience protection for medical practitioners; and fourth, any changes that would expand the availability of medical assistance in dying be well considered, well thought out, carefully drafted and not rushed.

I share many of the concerns raised by members of the disability community, but we have to deal with this issue and not forget the broader purpose of ensuring the availability of medical assistance in dying. It is not merely to comply with court rulings. We must do this out of a sense of compassion for adults who are grievously ill, intolerably suffering and are of sound mind, and who, of their own free will and volition, wish to obtain medical assistance in dying.

I would not support the bill if I thought it was a clear threat to disabled Canadians or if the bill would lead us into a path where medical assistance in dying is offered as an alternative to palliative care or an alternative to treatment. I do not see that in the bill as is. Recalling the experience of Bill C-14, I assume that the bill will be thoroughly studied and that the committee, after it hears testimony from experts and concerned Canadians, will bring amendments back to the House that may offer better assurance to the disabled community and others.

I am inclined to see the bill go forward as far as committee so that we can have a robust, thorough examination of the bill, and so that as parliamentarians, we can do our legislative jobs to ensure that the best bill possible is brought back to Parliament. I look forward to that and assume that we will have this debate.

I am still a little concerned, though. My colleague from Hull—Aylmer mentioned the five-year review and that a committee hearing would constitute that review. This is what it sounded like he was saying, and this does not seem to be in the spirit of what was passed by the House in Bill C-14. However, there is clearly much work to do in this area, and I hope we will have time for a robust, full and proper hearing of the bill at committee so that when the bill comes back to the chamber at third reading, it will give assurances to those who have raised concerns about medical assistance in dying, in particular to the disabled community.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Mr. Speaker, I thank my hon. colleague for participating in the debate and for his speech, which is very much appreciated.

I take it that he will vote in favour of the bill. I know that some of his colleagues may be opposed to the bill. However, I will not directly mention the Conservative members who will be voting against this bill.

I learned that 52 religious groups have launched a coordinated campaign against Bill C-7.

It is called “Religious Leaders in Canada oppose Bill C-7”.

Fifty-two religious groups are opposed to the bill.

They include Canadian Assemblies of God, Canadian Conference of Catholic Bishops, Evangelical Free Church of Canada and Canadian Baptists of Western Canada.

There are 48 other groups that are also against it.

I just want to ask my colleague if he believes that the religious principles of some people should be set aside when it is a matter of respecting the choice of all Canadians.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, one of the four major concerns I have about the notion of medical assistance in dying relates to the conscience protection for practitioners. I think what the member was drilling to in the question is making sure that the conscience of professionals in the medical field is protected. I support wholeheartedly groups that have this concern. That is one of the main areas of concern I have with the bill.

I certainly recognize that there are very strong feelings on the bill all around. The responsibility of this Parliament is to try to get it right, satisfy the judgments that have already been delivered and get a bill that, broadly speaking—

[The Deputy Speaker, Conservative, Bruce Stanton]

Questions and comments, by video conference, the hon. member for Saanich—Gulf Islands.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, I want to commend my hon. colleague from Calgary Rocky Ridge for a thoughtful speech that did not fall into the trap of partisanship. This is a very difficult issue, and having been part of the debates in Parliament since the first version of medical assistance in dying came forward, I have been taken with how we as a chamber have approached the issue respectfully from all sides.

This is a comment; I am not putting a question to my hon. colleague, so he can amplify his points. I am deeply grateful that he is drawing a line where he does not see evidence of moving into an area that would put people with disabilities at risk or moving into an area that would make him uncomfortable. This does more than make sure we are within the law and respecting the rights of individuals who legitimately need medical assistance in dying.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, I thank the member for her comments, but I do have these concerns that members of the disability community have raised. It is critical to me, before I vote at third reading in support of the bill, that the protections for the disabled community remain, that we do not enter into scenarios where medical assistance in dying is foisted on somebody and that this will remain merely for those who seek it as a result of grievous cruelty and suffering from an irremediable condition.

[Martin Shields, Conservative, Bow River, AB]

Mr. Speaker, I think this has to do with the sense of a court deadline. Our Parliament is constructing legislation. We are working on it. I refuse to accept the idea of being blackmailed into not doing a full and thorough review. We did not do one with Bill C-14. I think the courts would fully understand.

Would my colleague respond to this deadline, which is really blackmailing us into a rush?