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, I thank my colleague for her nuanced speech. I would also like to say how sorry I am about her mother-in-law's painful situation.

My colleague gave two examples. She spoke about her grandmother and her mother-in-law, and she mentioned the choice to see life through. I feel that goes without saying. I would like some clarification from her, because medical assistance in dying only occurs upon request. If the request is not made, it is understood that the right to live prevails.

I would like some clarification about what she presented as the right to live.

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

Mr. Speaker, there are stakeholder groups that represent Canadians with disabilities who are concerned that this legislation could diminish the value of the lives of people who live with severe disabilities. I believe that, in certain situations, social supports should be available to people living in those situations so that there is never any question that somebody is making a choice to end their life because of a lack of resources to live with dignity.

We spend a lot of time here talking about dying with dignity, but we also have to talk about living with dignity in a complementary way. I am talking about access to affordable housing for those living in poverty, especially for those who have disabilities who may not have the same access to opportunities for employment or success, and access to home care. These are all things that I believe people need to have in place in order to be in a position of empowerment when making the choice of how to proceed with either end of life or living with a severe disability.

I also think that in this place, as we are debating this issue, we need to reaffirm over and over again that those who have disabilities in Canada are equal in every way, and that we have a dual responsibility to ensure that they are supported and—

[The Deputy Speaker, Conservative, Bruce Stanton]

We have time for one more question.

The hon. member for Windsor West.

[Brian Masse, NDP, Windsor West, ON]

Mr. Speaker, I thank the member for Calgary Nose Hill for her intervention.

I am pleased that the member is supporting the bill to get to committee. Where does she think that could be an advantage to resolve some of these complex problems?

As a PSW, I can tell the member that a person's quality of care can often be affected by their income. What does the member think about that?

What should the Canada Health Act do regarding that? A person's income can affect how many service hours they get as an individual, which affects quality of life and the decisions they make beyond that.

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

Mr. Speaker, my colleague, as always, makes an excellent point. This is exactly what I am getting at.

As we are considering this bill, we should also be considering reviewing situations such as the member just raised: national legislation and a framework around palliative care, home care, etc. I believe that all these issues influence someone's decision on how to proceed. For people who are living in poverty, with no hope of employment, in isolation and without access to home care, their sense of suffering might be different than if those supports were in place.

The bottom line is that we have to act to give people agency to end their lives with dignity, but we also have to act to give people agency to live their lives with dignity. I hope the committee study, as well as the parliamentary review of the previous legislation, would aim to resolve that.

[Élisabeth Brière, Liberal, Parliamentary Secretary to the Minister of Economic Development and Official Languages (Economic Development Agency of Canada for the Regions of Quebec)]

Mr. Speaker, I am very happy to have an opportunity this evening to share my thoughts on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

This bill has generated a lot of debate. It is good to talk about this because it is extremely important. It is important because too many sick people are suffering, knowing they will never get well.

I worked with such people for a long time, and I can say that knowing them, learning about their struggles, and helping them through their ordeal fosters a much better understanding. It goes without saying that medical assistance in dying is a matter of societal choices, choices that must be carefully considered from all angles.

I strongly believe that the government did its homework before introducing Bill C-7, which is the outcome of a series of round tables with experts and stakeholders, as well as a number of public consultations. We had to go through this process after the Quebec Superior Court's decision in Truchon and Gladu, which found that limiting medical assistance in dying to persons whose death was reasonably foreseeable was unconstitutional.

Ms. Gladu and the late Mr. Truchon both suffered from incurable degenerative diseases but were not eligible for medical assistance in dying because their deaths were neither imminent nor reasonably foreseeable.

The government's Bill C-7 proposes significant changes. It broadens the eligibility criteria to include people whose natural death is not reasonably foreseeable, as was the case for Mr. Truchon and Ms. Gladu. It also adjusts certain safeguards, allowing patients to waive final consent, for example. These are significant changes.

Let us first consider the reasonably foreseeable death criterion. A number of MPs are concerned about removing this criterion because they believe it would make it too easy to access medical assistance in dying. There is also some concern that people with disabilities or mental illness will not be properly protected. Life is precious and has so much to offer. I believe in that, and the government believes in it, too.

Under the provisions of this bill, mental illness is not considered to be an illness, disease or disability. The bill also expressly excludes people seeking medical assistance in dying solely because of mental illness. The government knows that the best treatment for mental illness is effective therapy, so greater emphasis needs to be placed on enhancing preventive measures and support resources.

What exactly is a reasonably foreseeable death, anyway? It is an assessment of the amount of time between a person's current state of health and their death. It is not something that can be measured with a blood test or a thermometer. It requires a clinical judgment based on an exhaustive medical evaluation of the patient. The fact remains that it is a difficult and sometimes imprecise exercise, and that is why the amendment is necessary.

Expanding patients' right to request medical assistance in dying does not necessarily mean it will be administered. Requesting medical assistance in dying does not automatically mean it will be administered. Even if the legislation is changed by removing a criterion, the spirit in which it will be applied does not change.

Requests will be evaluated based on the other criteria in the legislation and the new safeguards that I will get to shortly.

The government's priority is to strike a balance between the autonomy of eligible persons, the protection of vulnerable persons from being induced to end their life, and the important public health issue of suicide.

We care about compassion and dignity for both the patients and the process. In fact, that is why, in the first version of the legislation, the government included safeguards that would support decision-making, reflect the finality of the act, provide robust procedural guarantees to prevent errors and abuse, and protect vulnerable people.

Nevertheless, experience has exposed some gaps, and that is why we are proposing that two of these measures be amended.

The first change is to eliminate the 10-day waiting period between the date the request is signed and the date on which medical assistance in dying is provided, for individuals whose death is reasonably foreseeable. This 10-day waiting period needlessly prolongs suffering. Patients who are worried about losing their cognitive abilities and no longer being able to provide final consent live in fear. They may even refuse to take their medication and sometimes choose to request medical assistance in dying earlier.

The patient's stress also extends to their loved ones, making those last moments more painful than they need to be. Being able to choose when to die allows patients to go with their head held high, bolstered by the presence of their loved ones. These patients show noticeable relief when they realize that no matter what happens, they will get medical assistance in dying, as requested.

Although reasonable foreseeable natural death is no longer an eligibility criterion, it will be used to help determine which safeguards will be applied to requests for medical assistance in dying.

For people whose death is not reasonably foreseeable, a period of at least 90 days will ensure that there is informed consent. The sources of suffering causing the patient to request medical assistance in dying must be verified. Furthermore, it must be verified that the decision is being made without any outside pressure or influence.

The assessment of the person's overall medical condition is even more rigorous. We may be withdrawing the criterion of reasonably foreseeable death, but that does not mean greater access to medical assistance in dying. The bill continues to ensure that there is proper protection for the process, our medical practitioners and, above all, our patients.

Having recently discussed the bill with palliative care specialists, I can confirm that the 10-day waiting period often negatively influences a patient's decision and that removing this provision will make their last moments more peaceful.

The second safeguard I want to discuss today is the waiver of final consent.

Under the current legislation, immediately before providing medical assistance in dying, the medical practitioner or nurse practitioner must ensure that the person gives express consent to receive medical assistance in dying and give the person an opportunity to withdraw their request. The government's amendment means that final consent can be waived if certain conditions are met, such as the loss of cognitive ability and the signature of a written agreement stating that medical assistance in dying will be administered on a specified date. This measure helps to ease patients' anxiety so they can take their medication, suffer less and set a later date.

It is important to note that this is not the same thing as an advance request, meaning a request for medical assistance in dying on an unspecified future date under particular circumstances. That type of request could be included in a notarized health care directive. Currently, a person can state in their health care directive whether they would want to undergo aggressive treatment and what that term means to them, but they cannot request medical assistance in dying in advance.

That is a more complex subject because, in such cases, a legal representative is being asked to make a decision on behalf of someone else. This issue will be examined by a parliamentary committee. The committee will also discuss other issues, such as medical assistance in dying for minors.

All these changes to the reasonably foreseeable death criterion and adjustments to the safeguards reflect the government's desire to keep doing better, to create a more dignified, freer and more progressive society. I therefore encourage all members to vote in favour of this bill.

I would like to conclude with a quote from the late Jean Truchon: “I ask you to try to understand me and not to judge me”.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Speaker, I would like to thank the parliamentary secretary for her speech.

She talks about proper choice, but also safeguards. I would suggest that having available palliative care as a safeguard does reflect a person's ability to make a choice.

During the original bill, I had the opportunity as well to consult with some of the top palliative care experts in Canada, some would say in the world. One is in my own riding. Her name is Dr. Gillian Gilchrist. She has been a palliative care expert since 1981. One of the things she mentioned to me was that, in all her years of practice, she had never had one patient ask for medical assistance in dying. She said that if people are given proper medication, especially with the newer medications today, they can be kept very comfortable until the very end of their lives.

We have heard a lot of arguments that we should be making this more available because of the pain involved. Does the member agree that proper palliative care being available is important for choice? With 70% of Canadians not having palliative care available, is it something the government should make a priority?

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Mr. Speaker, I thank the member for his comment. He makes a good point.

Palliative care is one aspect of end-of-life care. I would like to take a moment to acknowledge the vast expertise and excellent work of staff at palliative care homes, including homes in my riding, Sherbrooke.

It is true that palliative care is a good way for a person at the end of life to receive adequate care. Palliative care reduces suffering and guides people toward a natural death.

All lives have the same intrinsic value. That is a fundamental principle that we have to square with our societal values, including individual freedom of choice. Medical assistance in dying is part of a range of end-of-life care options that includes palliative care, and now medical assistance in dying.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I thank my colleague for her speech. I would like her to clarify something for me.

I do not know whether, like me, she noticed that since the beginning of the week some members have been making an unfortunate connection between palliative care and medical assistance in dying, conflating two completely different realities. Just because a person has access to medical assistance in dying does not mean that they do not have access to palliative care.

What is more, on many occasions, I also heard our Conservative colleagues establishing a connection between suicide and medical assistance in dying.

Does my colleague agree with me that these two very unfortunate connections are undermining the debate?

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Mr. Speaker, I agree with my colleague from Jonquière, and I want to congratulate him on his speech earlier this evening.

Indeed, that is a very important distinction, as I said in my previous answer. End-of-life care includes palliative care, and now we are adding medical assistance in dying.

As I said in my speech, I was close to the palliative care home in my riding. People do not go into a palliative care home seeking medical assistance in dying. When the palliative care facility in my riding was authorized to offer medical assistance in dying, it was clear that that was not intended to become the standard. So far, statistics show that this will is being respected.

People go into a palliative care home to receive palliative care. However, once suffering becomes intolerable and the normal protocols are no longer easing that suffering, medical assistance in dying is an option, an individual choice offered out of respect for freedom of choice.

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

Mr. Speaker, I am very honoured, as always, to rise in the House, particularly on such a profoundly important issue.

I am going to ask the Speaker's indulgence for a few minutes to speak about an issue that is occurring right now. I have learned that in Treaty No. 9 tonight families in Neskantaga First Nation are being evacuated because they have no access to water. For an Oji-Cree community in the middle of a pandemic to be willing to be flown out to an urban centre shows how severe the situation in Neskantaga is. I think every member in every party will understand the importance of bringing this forward.

One of the beautiful things we have said during the pandemic in Canada is that we are all in this together, but we are not, not in Canada. We have never all been together, not when it comes to the poverty, the casual degradation that indigenous people suffer and the systemic negligence of the most basic rights to life and dignity that Canadians take for granted as part of how this country is run. We cannot find a community that has suffered more than Neskantaga. For 25-plus years they have lived with unsafe water. That is a second generation growing up with improper water.

What does that mean? I remember meeting a beautiful young girl from Treaty No. 9. She had this incredible long, thick hair and she said she did not like to take a shower because it gave her blisters. That is what we put young people through in communities like Neskantaga. At age 13 or 14, they have to leave home because the federal government will not bother to give them a school. They have to go to a foreign culture in Thunder Bay. We know of the horrific treatment and abuse that indigenous children have suffered in Thunder Bay, the deaths of children in the rivers and the racist attacks, yet they have to leave their homes.

We are talking about something as profound as medical assistance in dying. However, when one has had to go to a hotel room in Thunder Bay to say sorry because a beautiful young girl from Neskantaga gave up hope at age 14, we could say this nation does a lot of work to assist in the dying and hopelessness. Tonight, in Neskantaga, after 25 years of not having water, where the schools cannot be opened because they cannot get water to the schools. They have had to shut the water system down. It is winter there and elders are going to the river and getting water in buckets.

Yes, this is Canada in 2020. Therefore, when I hear people say that we are all in this together, we could say it more clearly by saying we are all in this together, except when it comes to indigenous people, because they are at the back of the line again and again. I am not saying this from a partisan point of view. This was the primary program. Neskantaga was going to be fixed. We were told that by the Prime Minister. The previous prime minister put enormous amounts of money into water, yet the government continues to refuse to put in place the basic infrastructure that will support safe communities: the sewage lifts, the water pipes, the proper water treatment centres.

I am asking my colleagues tonight, in light of the crisis in Neskantaga and the risks people are taking by being flown out in the middle of a pandemic, to say we have to make the guarantee of access to clean water a fundamental human right. It has to be done, and it has to be done now. We cannot have any more nice words. We have all the beautiful words that come from the government, yet there are people who cannot even live in their own community because they do not have water. I am asking my colleagues to work with us to guarantee that the people in Neskantaga will be able to go home to safety, decency and water.

The issue of medical assistance in dying is an important conversation for us to have in the House. The last time we had this conversation, we were under the gun because it was a court decision that pushed the federal government to act. I had a number of concerns about the previous legislation. We knew it was not going to withstand a court challenge, yet the government went ahead with it. Now we have to come back and do it again. We need to work together because we have some fundamental principles that we have to protect in terms of how this moves forward.

I worked on a national palliative care strategy across the country before the last election. The one thing I have learned, and I saw this with my beautiful sister who died so young, is that the will to live is incredibly strong. People deal with an incredible amount of suffering, and they have the will to have family and have support. The right to die in dignity is a fundamental human right. Part of that is making sure we have a proper medical system in place to give people this support, so we have to have the provisions in place with this legislation.

Nobody's claim of dealing with someone who is dying is more precious than anyone else's. In our lives, it is the most intimate thing we can be involved in, and those deaths can actually be good deaths, deaths of dignity and of hope, where families are together. The day my sister died, as my mom said the rosary I sang Danny Boy for her because that is how we go out in our culture. It was terrible to see my sister go, but we came together and it was beautiful.

There are deaths that do not have dignity, and deaths of suffering. It is incumbent upon the House to make sure that the legislation in place meets a number of steps in the right to dignity, but also that it makes sure that people who are making this choice are not doing it because they feel they have been neglected or they are in a substandard seniors home, as we have seen with so many of our seniors in Quebec and Ontario who died in the pandemic. People must actually have dignity, and if they are in a home, there must be support for them so that they do not have to make that choice.

I will agree with my Conservative colleagues and all the people I have talked to in all the work I have done with palliative care, that if that choice has to be made, it is one that people do not want to make. People want to go out in a way that allows them as much time as possible. However, when that decision is made, as it is a right upheld in the courts, we have to make sure that the provisions are there to allow it to be done properly, to allow it to be done so that people are of a mind that they understand what they are doing and that they can do this in a way that meets the test of a caring society.

To that end, we have seen a staggering number of our elders die without dignity in this pandemic. It has exposed the fact that we do not put investments into care for our elders and they have suffered needlessly. That we had to send in the army to keep people from dying is a fundamental failing of our system for seniors and their health.

Of course, it is not just seniors who have to make this decision. My sister died much too young. Her husband died at 42, and he was one of the greatest people I have ever met. People die at different ages, and some of those deaths are very difficult.

I am very pleased to say that we will support the bill being sent to committee because it is at committee where we will hear witness testimony. We need to hear from the experts. We need to have a conversation and start to make sure that in the legislation, which we are compelled to bring forward because of the Quebec superior court decision, we meet the tests of the court and we meet the tests of dignity.

Again, I do not believe this needs to be a partisan issue, where a party is going to be on one side or the other. We have to put first the rights of the individual and their dignity, and the support for their family, because death should never be a lonely act. Death has to be part of family and community, and when it is, it can actually be a moment of real grace and learning.

The New Democrats are supporting the motion to send the bill to committee to be studied. We want to make sure that we get it right this time so that we do not have to change it for the next court decision.

[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, first, I appreciate the member's bringing to the attention of the House the situation in regard to the evacuation. I very much appreciate the sensitivity of the issue, as we move on to yet another very sensitive issue that has been debated for a number of days now. It is very much an emotional time when we have these types of debates.

When we first brought in legislation, and I am referring to the House in its entirety when I say that because the legislation came as a result of a Supreme Court decision, the general feeling back then was that there would be a need for us to come back and look at the legislation. What we are doing today is making changes to the original piece and there are a few changes. I wonder if the member would want to provide his thoughts on any of the specific changes, or any thoughts in regard to specific amendments that he would like to see.

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

Mr. Speaker, even though we are being ordered to because of the Superior Court of Quebec decision, it is important that we do revisit legislation. What we anticipated may not be the case out in the field.

In terms of the request for medical assistance in dying be done in writing and signed by an independent witness, the request can be made after the person is informed they have a grievous and irremediable medical condition, and a professional or health care worker can serve as that witness. That is interesting. I would like to have that tested with people in the field who can let us know whether that will meet the need of ensuring we have adequate safeguards.

The fact that the person must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health services and palliative care, is important. However, we have to be able to test that at committee. Is that a reality that people are going to have in rural areas? What about for people who do not have a larger family unit to support them? I am looking forward to seeing how these will be tested at committee.

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

Mr. Speaker, I thank the member for his commitment to standing up for his constituents, particularly his indigenous constituents.

When the government is reducing some of the safeguards regarding the number of witnesses needed and the kinds of witnesses needed, I become very concerned. If we are not including social workers in the decision-making process, how are we ensuring that those who are going through the process of requesting MAID are truly doing it in a way that is of their own volition? Physicians are not always equipped to recognize these situations.

What about increasing safeguards by bringing in social workers so we can ensure it is truly a free choice that people are making?

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

Mr. Speaker, one of the things that frustrated me with the Supreme Court decision was that I felt it put an unfair restriction on the review of Parliament. Because this was a profound piece of legislation, we needed the opportunity to have enough witnesses.

I do not believe this is something that should be dragged out, but as parliamentarians, we need to ensure we have an adequate amount of witnesses to bring forward enough points of view that we can ensure the proper details are in this legislation. I do not know the details of what goes on in a medical relationship. I am not that person, but I have sat at the deathbed of many people. I want to make sure it is done right.