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

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, frankly, it seems to me that appeals brought before the Supreme Court are often used as an excuse to shirk our duty as legislators.

I know that when it comes to issues that touch on individuals' moral values, debate can be a bit trickier, but we must have the courage to take a stand. That is our role as legislators. We cannot just turn to the courts every time the going gets tough. Unfortunately, that often happens. I hope that will not be the case in the debate we are having right now.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, I am a little confused. The member spoke about Weber and being detached. He mentioned not allowing personal beliefs and things such as religion to influence decisions that we make here in this House.

On the one hand, I understand what the member is saying in the sense that we do need to keep the values and opinions of all of our constituents and all Canadians at the forefront. However, at the same time, each of us have our own beliefs and our own opinions.

I have a question for the member. Does he think it is possible that having 338 individuals, all with different beliefs and opinions, coming together to make decisions is a way to actually improve legislation, rather than being more robotic and not allowing personal beliefs into the process?

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I really do not think that Max Weber was implying that we are robots and that we must act like robots.

When Weber speaks of distance, he means that I cannot apply my values when dealing with an issue that affects the fundamental rights of others. If I were to do so, I would limit the freedoms of those individuals on the basis of my own values. That is what Weber meant.

In the context of the “dying with dignity” bill, I cannot use my religious beliefs to justify limiting the freedom of individuals who can access medical assistance in dying because they have a deteriorating health condition, because one day they will no longer be capable of giving their consent.

I cannot curtail their freedoms based on my moral principles. I believe that this should guide us in our debate. This does not mean that we leave our values behind, but that certain principles must lead us to greater fairness and greater equality.

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, this is absolutely a very important issue for many Canadians.

When the House of Commons debated Bill C-14, I, too, along with my NDP colleagues, voted against that bill because there were many flaws within it. From there, many constituents wrote to me with heartbreaking stories. In fact, one constituent talked about how his mother had to end her life early because she was very worried that if she waited she might lose the faculty to provide informed consent. Those are the kinds of stories that absolutely move us.

To that end, with respect to advance requests as stipulated in the bill before us today, I wonder what the member's thoughts are. Does the member support advance requests?

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I think that advance requests are essential for people with degenerative diseases. We need to balance our personal beliefs with scientific facts. The medical sector is providing guidance.

Numerous reports have been submitted to the Select Committee on Dying with Dignity at the Quebec National Assembly. There is a whole process to manage medical assistance in dying. The decision-making process is very complex, so this is not done in isolation. I think that a person must be able to give consent to an action when they are fully aware. Not allowing this would infringe of some individuals' freedoms.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Mr. Speaker, I appreciate the opportunity to speak to Bill C-7, a very important bill that proposes to amend the Criminal Code provisions on medical assistance in dying, MAID.

It took me a long while to decide that I was going to speak to this bill. In fact, when I first learned that we would be debating this legislation this month, I decided I was not going to speak to it at all because I do not do very well with these topics. I have a very difficult time accepting that life eventually comes to an end, especially the life of those closest to me. In fact, I can come to terms and accept that my own life will end at some point, but I cannot deal with the thought of losing those closest to me.

Some of my colleagues' speeches earlier this week brought me to tears. When someone has strong feelings about a given topic, it generally means that they have something to say about it and that the topic should be discussed.

Canadians must know that, if they are eligible, they have been able to access MAID since June 2016. To be eligible for MAID right now, the person must meet all of the following criteria: They must be at least 18 years of age, be mentally competent, have a grievous and irremediable medical condition, make a voluntary request for medical assistance in dying that is not the result of outside pressure or influence, and give informed consent to receive medical assistance in dying.

Furthermore, in order to be considered as having a grievous and irremediable medical condition, those seeking MAID must meet all of the following criteria: have a serious illness, disease or disability; be in an advanced state of decline that cannot be reversed; experience unbearable physical or mental suffering from the illness or state of decline that cannot be relieved under conditions that the person considers acceptable; and, lastly, be at a point where natural death has become reasonably foreseeable.

Bill C-7 proposes to repeal the MAID eligibility criteria by modifying the criteria that must be met to be considered to have a grievous and irremediable medical condition so that it includes persons whose natural death is not reasonably foreseeable.

Furthermore, the bill proposes to specify that those whose sole underlying medical condition is a mental illness are not eligible for MAID.

Last, it proposes to create two sets of safeguards that must be respected before MAID is provided. The first set of safeguards would apply to persons whose natural death is reasonably foreseeable and these would be the existing safeguards that have been in effect since 2016. The second set of safeguards would be for persons whose natural death is not reasonably foreseeable. These would include existing safeguards as well as additional ones that would apply.

In the interest of time, I will not address all of the safeguards that have been put in place. Rather, I will just focus on those that have been added recently.

A person whose death is not reasonably foreseeable must talk to a doctor about the options available to them to ease their suffering. The two parties must agree that they seriously examined all the possible options, including palliative care and mental health support, before making a decision to apply for medical assistance in dying.

Two independent doctors or nurse practitioners must provide an assessment and confirm that all the eligibility criteria have been met. This eligibility assessment period must take at least 90 days, unless the person is at risk of losing their mental capacity before that time is up. In such cases, the assessment must be a priority and completed before that deadline.

Bill C-7 seeks to respect the personal autonomy and freedom of choice for those seeking access to MAID while, at the same time, protecting vulnerable people and the equality rights of all Canadians. It aims to reduce unnecessary suffering. This issue is a deeply personal one. In fact, we saw from consultations held earlier this year that there was a wide array of opinions and feedback received. Many people were opposed to the idea of MAID altogether, while many others believed the safeguards were too restrictive and made it difficult for some people to receive MAID.

This is a profoundly personal matter for all those involved. I do not think that it is for anyone who has never faced death or end-of-life suffering to judge or determine whether this should be a right and for whom it should be a right. We all have a certain pain threshold, but it is not the same for everyone. We are talking about excruciating physical pain. Who then is in a position to say to what extent such pain can be tolerated?

MAID legislation was passed in 2016 with the intention of ending suffering for those facing death, those who do not have a chance to improve their medical condition. It was passed because the MPs in this chamber thought it would be the right thing to do: to give people the choice to receive MAID if they felt they needed it. Nobody is forced to go down that path, it is a choice, but legislators basically deemed it the right thing to do and the humanitarian thing to do to allow someone in that situation to receive medical assistance in dying.

If this was the humanitarian thing to do for people whose death is reasonably foreseeable, then it only makes sense that those suffering from an illness and experiencing unbearable pain whose death is not reasonably foreseeable and may be five or 10 years away should also be granted those rights. They should also have access to MAID if they have exhausted all other options and have decided with their medical practitioner that this is the way to go.

Again, it is extremely important that we remember this is a choice of the person who is suffering. However, it is also critical to give those in a position to provide medical assistance in dying, such as physicians and nurse practitioners, the choice to refer their patients to someone who is willing to administer MAID if they themselves are not. If administering MAID does not coincide with their values or religious beliefs, it must not be expected of them.

With that being said, it is important for everyone to respect the religious beliefs and values of all Canadians. As such, I completely understand that some may perceive the act of receiving medical assistance in dying as committing a sin. They have the right to die of natural causes if that is their will. In my own religion, this would technically be problematic for me. However, I feel comfortable knowing that if it ever comes to a point where I am in a situation where I am suffering, I have no chance of recovery and I am only going to get worse with time, I will at least have the choice.

One of my colleagues across the aisle in his speech earlier today spoke about an amazing comeback story of someone who was in a terrible situation, but who was on the road to recovery. My colleague was grateful that this person stuck it through and fought to survive. It is important to remember that those who will be eligible to receive MAID will have been assessed by two medical practitioners and both will have determined that the person's medical condition would never improve. If there is a chance for recovery, the person would not be eligible for MAID in the first place.

I understand that not everybody in the House will vote on this bill in the same way and I fully respect everyone's personal choice on this matter, because, once again, it is an extremely personal issue. All members are trying their best to represent their ridings and constituents in the best way they know how. I will be voting in favour of this bill because I do not believe it is my place to get in the way of someone receiving the kind of relief that MAID offers.

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

Mr. Speaker, this bill goes well beyond the scope of Truchon and in so doing, it removes a number of safeguards, including safeguards in which there was a fair bit of consensus some four years ago. I say that having served as the vice-chair of the Special Committee Joint Committee on Physician-Assisted Dying.

One of those safeguards is the requirement that there be two witnesses. That was not controversial four years ago and yet, in this bill, it is removed. In that regard, it provides a lesser safeguard for medical assistance in dying than validating that of a will, which requires two witnesses. Can my colleague explain the removal of the safeguard?

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Mr. Speaker, as we saw in a lot of the feedback received during consultations, many people did think that a lot of the safeguards were preventing many people from receiving the right to receive MAID in their final moments or in times when they did not see a recovery and they saw their condition getting worse with time. Not everybody has a family, not everybody has a lot of people in their close circle. Obviously, I believe in protecting Canadians, but at the same time in making sure that everybody has equal access to rights. This obviously gives more accessibility to more people.

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, Bill C-7 sets the assessment period at 90 days for those whose natural death is not reasonably foreseeable, but are facing intolerable suffering. Does the member agree with the 90-day assessment and does she know how the government came up with the 90-day period?

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Mr. Speaker, I personally do not know how that number came up, however, I know that if someone's mental capacity is at the risk of being lost in that 90-day period, it will not take 90 days. However, I would imagine that, for somebody who does have many more years ahead of them and does not have a reasonably foreseeable death, perhaps more reflection needs to be done before actually going through with this kind of thing. I do agree with the 90 days. I think that people need to have enough time to really think about this issue and whether this is the route they want to take and to really consider all other options available before finally going with this one.

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

Mr. Speaker, when the government is talking about things like intolerable pain or unbearable pain, I think we can all agree that for some people it is a very fluid, subjective statement. Therefore, if we are basing it on subjectivity, what can be intolerable pain for one person could be a case of depression for someone else. Is the government not really admitting that it is opening the door in the future for people to get an assisted death for any and every reason because the criteria it is setting are just so subjective for people?

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Mr. Speaker, the bill also proposes to ensure that mental illness is not a reason to go ahead with MAID and that people who suffer solely from a mental illness will not be eligible for MAID. That has been taken into account. I still agree that this is something that people should have the choice to decide for themselves.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Mr. Speaker, today I am pleased to speak to Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), which I will refer to as MAID throughout the course of my speech.

This can be a difficult issue for many to address because it intersects several issues in society. First of all, there are taboos, and societal norms associated with those taboos, around discussing dying, religious beliefs, social supports, or the lack thereof, related to people who are in difficult or life-threatening situations, love and compassion for one another, and the agency that each of us has to direct our future.

I would like to explain what this bill would do, what I am hearing from my constituents on this issue, my approach to addressing this legislation and my decision on how I will be proceeding on their behalf.

As has been mentioned in many speeches, this bill builds on previous legislation that allowed for legal, medically assisted dying in Canada. This bill would amend legislation to remove the “natural death has become foreseeable” clause, meaning that reasonably foreseeable death would not be a criteria for accessing MAID. Of course, this comes after a decision in the Quebec Superior Court ruled that reasonably foreseeable provisions violated section 7 of Charter rights to life, liberty and security of the person. It eliminates MAID access to those who only have mental illness as an underlying condition. My understanding is that the Minister of Justice said this would be addressed in the parliamentary review of this legislation.

It would also create a second set of safeguards for people accessing MAID without a reasonably foreseeable death clause including that, for both those whose deaths are foreseeable and those whose are not, this bill would change the Criminal Code so that only one witness is needed to sign the MAID request, rather than the two currently needed. It would eliminate the 10-day waiting period for MAID and its administration for those with foreseeable deaths. For those without foreseeable deaths, Bill C-7 would create a 90-day waiting period request. There is a bit more technicality. It builds on legislation that has already been passed in this place.

I want to outline some of the things I have been hearing from my constituents on both sides of this issue. The response in my office has been pretty evenly split between people advocating for these changes and against them.

Those in support of this bill have been writing to my office on the need to exercise personal autonomy, which would be the agency issue that I mentioned. The constitutional right to make choices about end-of-life access to medicine and health care should be part of a health care option that is available to Canadians. There is a need to ensure that, in our country, we have the ability to die with dignity: to look at death as part of the life process, and to ensure that the continuum of care involves a death with dignity. Also, there is a need to normalize and end the stigma surrounding death, and to respect individuals' and families' desire to end unbearable suffering.

Those who have issues with this bill have mentioned consent by minors and those who have mental illnesses, and what the nature of consent is in those situations. There are concerns that it is not clearly defined. There are concerns about how this legislation would impact the nature of consent in jurisprudence, as well as religious concerns around life, and doctors' conscience rights. There are concerns around repealing the 10-day waiting period and also allowing medical professionals to shorten the 90-day waiting period if the capacity to consent would be lost. I have heard those concerns.

This is my approach to addressing this legislation. As a legislator, it is my duty to ensure that individuals have the ability to use their agency in their choice on medical decisions, regardless of my personal proclivities. I will be supporting this bill through to the committee stage. I understand that there may be amendments proposed.

At the same time, some of the concerns that constituents have raised in my community against this bill are valid. From my perspective, some concerns that I have are whether we have proper supports in place for people who might be considering MAID in a not-foreseeable-death situation. I am talking about social supports for those who are in situations of great disability: Do we have social supports for day-to-day living? What about poverty? Is it a determinant of mental health?

With respect to palliative care, I do not think our country has yet addressed that issue adequately. I would like to see complementary legislation on that issue so we can be assured as a society that, in proceeding with this legislation, people are in the position of exercising their agency: They are not making a decision based on desperation or on our failure as a society to provide them with adequate social supports.

Another question I would like to see the committee address is this. When a person has lost the capacity to give consent, who will decide what is intolerable suffering? We need to suss that out. There needs to be some path to that. Parliament needs to give some direction to that so it is not simply left to the courts in the future. I think Parliament has a role in this because, as I am bringing the concerns of my constituents, both for and against, this is the place to give direction to the courts on any future decisions, and I would like to see the committee address some of those issues.

Another concern is for those struggling with mental health issues, such as depression, when death is not reasonably foreseeable. How will this legislation impact them?

With respect to mature minors, determining their capacity to decide and voluntary choice, free from duress, are concerns that have been raised. I also have those concerns.

I want to re-emphasize that I do not feel many Canadians have appropriate access to palliative care across the country. This is not the fault of any medical association, but I feel as a society we often spend a lot of time focusing on getting to a diagnosis. We have spent a lot of time in this place talking about dying with dignity, but we do not talk about how to live with dignity, and the choice of a person to see their life through to its natural end. If we are talking about choice and agency, somebody who makes the choice to see their life through without medically assisted dying should have the right and capacity to make that choice knowing that we, as a society, are caring for them. We are not just offering this as an alternative: that the only way to end suffering is to provide this as an option.

I give this nuanced answer because my own views on this have changed over the course of my term as a legislator with two very personal experiences. One experience was with both of my grandmothers, whose lives ended naturally. They both suffered from severe dementia. I do not think either of them would have chosen to have medically assisted dying because of their religious beliefs, but that option was not available to them, so I take that into consideration.

I am also living a situation right now, and she allowed me to share this, where earlier this year my mother-in-law, Debbie Garner, was diagnosed with a severe form of aggressive breast cancer. She has been fighting so hard and I feel so robbed because I just met this incredible woman a few years ago. She is fighting and giving it her all, but she lives in a jurisdiction where she does not have this option available to her. As part of her fight, she does not have the ability to exercise her agency in the way we are talking about, so this is now adding stress on her. She is doing everything she can to try and beat this disease, but the reality is there is a 50% chance, and probably greater with the form of cancer she has, that this will spread to her brain and leave her in a state I know she does not want to be in as a person. As a family member, I want to ensure that people in the position of my grandmother, who I know would have chosen to see her life through her way, have their wishes respected as do people in my mother-in-law's situation, who is saying she does not have the ability to exercise that choice, so she could use that agency as appropriately as possible.

That is my approach to this legislation. I would like to see this go forward to committee. I would like to see our society ensure that people have agency in both situations: that they are fully supported through the choice to see their life to its natural end, or are fully supported in a choice to end it with dignity and in a way that recognizes their own beliefs, their own agency and their own right to determination in these matters.

I thank the House for its time and I am happy to answer questions.

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

Mr. Speaker, I thank the member for Calgary Nose Hill for her analysis and for her very pointed and personal remarks today.

I am going to put a question to her that has been raised by some of her Conservative colleagues and was, in fact, raised in her speech.

When the member canvassed some of the pros and cons and related what she was hearing from constituents, she mentioned conscience rights. I find that criticism a little confusing, and am trying to understand it, because conscience rights are protected in the preamble of the old Bill C-14, in the text of Bill C-14, in section 2 of the Canadian Charter and even in the Carter decision, which is what got us all here. The Carter decision states, in paragraph 132, that, “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

I am wondering if the member for Calgary Nose Hill could flesh out what she understands to be the conscience rights concerns, because I believe that they are fully protected in the jurisprudence and in the statute.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Mr. Speaker, the member is correct in acknowledging that I raised that concern as something that is coming up in my constituency. I would argue that, because this is a common concern coming up in constituency offices across the country, the government has probably not explained this well enough to Canadians. I think that could be done with the parliamentary review on the previous bill in the previous Parliament, which should be happening. I find it unfortunate that the review could not have happened before this particular bill came forward.

With regard to my personal opinion on the issue of conscience, I do not believe that any Canadian should be denied the right to care at any point in time based on gender, sexuality, gender identity or in choice of agency in this situation.