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

[Arif Virani, Liberal, Parkdale—High Park, ON]

Mr. Speaker, I will take those points in order. In terms of the 10-day reflection period, what we heard overwhelmingly, whether at the round tables or from some of the 300,000 Canadians who contacted us, is that period is not required because it prolongs suffering.

We heard the minister say in his opening remarks that a sufficient amount of reflection has gone into the point when a patient actually puts in writing a request for MAID. The reflection has already occurred.

What we do not want is a situation where people are coming off of their medication to ensure they are maintaining a full capacity and prolonging suffering that we need to alleviate through this bill.

A questionnaire online is not the same thing as a parliamentary review, but the two are not addressing the same thing. What we are addressing here is a narrow amendment that deals with the Audrey Parker situation for somebody who is already assessed and approved. What the parliamentary review will do, as it rightfully needs to, is study three major areas: requests for mature minors, requests for when mental illness is a sole underlying condition and an advance directive, which is very qualitatively different from advanced consent.

[Louise Charbonneau, Bloc, Trois-Rivières, QC]

Mr. Speaker, I would like to thank my hon. colleague for taking a step in the right direction when it comes to medical assistance in dying. Offering Canadians a clear personal choice for a dignified death without suffering is certainly one of the most humane acts. Nevertheless, while the easing of certain requirements might facilitate access to this service, certain points need clarification.

My question is this: Beyond these cases described as having a reasonably foreseeable death, what about the issue of advance requests, for instance, for people with Alzheimer's?

[Arif Virani, Liberal, Parkdale—High Park, ON]

Mr. Speaker, I thank my colleague for her question and her comment.

Cases involving Alzheimer's and dementia raise questions regarding consent and capacity, some rather complex questions since they relate to the prognosis itself. These two types of cases will have to be examined in June as part of the review that Parliament is required to do under Bill C-14.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Mr. Speaker, the parliamentary secretary mentioned that advanced consent was different from advance directive. Could he elaborate on that?

[Arif Virani, Liberal, Parkdale—High Park, ON]

Mr. Speaker, advanced consent is a very important concept. Under the current regime, people who are approved for MAID have to give consent on the day they are meant to be provided MAID. What we now are proposing is that when that date arrives, if people do not have the capacity to provide an oral consent, they could do it in writing in advance. That is advanced consent.

What is not being proposed in the bill is an advance directive. If 30 years from now, I have a malady which I find intolerable in terms of my own suffering and I want to apply for and be given MAID, that would not be permitted under this law.

What is being proposed is that people who have already applied for MAID, have been granted eligibility and for whom the date has not yet arrived on which it is scheduled, on that date if they have lost capacity, they can provide it in writing.

[Kody Blois, Liberal, Kings—Hants, NS]

Mr. Speaker, as members know, on September 11, 2019, the Quebec Superior Court's decision in Truchon struck down the eligibility criterion of reasonably foreseeable natural death from the medical assistance in dying, MAID, regime in the Criminal Code. It is my sincere pleasure today to join the second reading debate on Bill C-7, which is the government's response to this ruling and which includes a revised safeguard framework.

Bill C-7 proposes amendments to the Criminal Code that would work to ensure consistent application of the MAID law across the country and would adjust the safeguards for a MAID regime that is no longer limited to end-of-life circumstances. Specifically, the bill would create two sets of safeguards to be followed before MAID is provided.

One set would be for individuals who are dying whose death is reasonably foreseeable; in which case, most of the existing safeguards would continue to apply, with a few being eased or removed. The second new set of safeguards would apply to individuals whose natural death is not reasonably foreseeable. That is why we are here today, to talk about this legislation given the fact of the decision from the Superior Court in Quebec.

This approach to differentiating between MAID requests is consistent with the view that providing MAID to people whose natural death is reasonably foreseeable presents less of a risk and is less complicated than providing MAID to those who are not on a clear trajectory toward death. It is sensible and appropriate that the assessment of a MAID request should be tailored to these different types of cases to account for the different types of risk that could arise.

For people who have requested MAID and whose natural death is reasonably foreseeable, amendments to the safeguards in this legislation include the removal of the mandatory 10-day reflection period, which, of course has been discussed quite widely in the speeches here today; a reduction in the number of independent witnesses; and a change regarding who can be independent witnesses.

Existing safeguards, such as the need for two independent practitioners who verify the person's eligibility and the need for the person to confirm consent immediately prior to the provision of MAID, will remain unchanged for those whose natural death is reasonably foreseeable. The exception is in specific circumstances where consent is given in advance. I am referring to Audrey's amendment, which is something that is very important to me, and was certainly highlighted given the fact that Audrey Parker was from Halifax in my home province.

During the government's recent MAID consultations, stakeholders noted that the existing 10-day waiting period could result in the prolonged and unnecessary suffering of the patient. We can all appreciate some of the challenges that would present. Bill C-7 proposes to remove this requirement for people whose death is reasonably foreseeable. A patient who is in that situation and requesting MAID has likely thought and reflected about this particular decision for a considerable amount of time. Requiring the patient to wait an additional 10 days when his or her suffering is already unbearable is just unnecessary.

For both streams of the MAID request, it is proposed that the requirement for two independent witnesses to a patient's written request for MAID be changed so that only one is needed. The role of an independent witness is to attest to the fact that persons requesting MAID have signed and dated their MAID request themselves in a voluntary manner. The witness would not play a role with respect to the eligibility assessment, which is the responsibility of two independent practitioners, nor do witnesses confirm whether the safeguards required by the Criminal Code have been followed.

The current rules also exclude people like health care providers and personal support workers from being independent witnesses. This can create access barriers for individuals living in nursing homes or other residential settings who may have very few family or social networks.

Speaking from my own experience in my riding, that certainly can be the case, where individuals who are living in nursing homes or in these situations might not have a large family or friend network to be able to draw upon, and I think that is an important piece. Individuals who are paid to provide personal care or health care are likely to be among the limited number of personal contacts an individual living in a care institution may have, as I alluded to. The amendments to the MAID regime would allow a paid personal or health care worker to be an independent witness, which would increase access to MAID for this population. That is key.

For patients who are eligible for MAID but whose natural death is not reasonably foreseeable, the key piece of the Truchon decision, Bill C-7 proposes a separate set of safeguards in addition to the existing safeguards, such as written requests that are signed before an independent witness and confirmation of consent.

In situations where natural death is not reasonably foreseeable, there would be new requirements that focus on the need for additional time, expertise and information in these circumstances. I believe that is balanced in the way we move forward.

First, there would be a minimum assessment period of 90 days, which could be shortened if loss of capacity was imminent and the assessments were complete. Second, one of the assessing physicians would need to have expertise on the condition that is causing person's suffering.

There would also be two clarifications of the requirement for informed consent. First, the patient must be informed of the appropriate counselling, mental health supports, disability supports, community supports and palliative care options available to them, essentially outlining the availability of health care and supports that are there.

The second practitioner would need to agree with the patient that the reasonable means of alleviating their suffering have been discussed together and seriously considered, which is very important.

It is fair to say that the assessment of MAID requests by those whose death is not reasonably foreseeable can be more challenging, and can raise more concerns, than MAID requests by those who are dying or whose death is reasonably foreseeable. I think that certainly resonates with Her Majesty's loyal opposition and my colleagues on that side of the House.

For example, is their suffering caused by factors other than a medical condition, such as loneliness or lack of access to necessary supports? Are there ways of addressing the suffering, other than MAID? I think this really gets into the slippery slope in the sense that we are making sure that there are provisions in place to explore all options before an individual chooses to move forward with the process.

The new safeguards, the requirement of a minimum of 90 days and for one of the two assessors to have expertise in the source of a person's suffering, seek to ensure that enough time and the right kind of knowledge are devoted to exploring all relevant aspects of a person's situation, including whether there are treatments or services that could help reduce a person's suffering.

These are bolstered by the proposed requirement that practitioners discuss reasonable treatment options with the patient and be satisfied that the patient has weighed the risks and benefits of the available options. I think that is balanced and fair.

I think we can be confident that most of our practitioners, as part of their good medical practice, fully explore appropriate supports that are available and the available treatments in discussion with their patients. The proposed safeguards reinforce the importance of these good practices and will help to reduce risk to vulnerable persons, which I am sure we can all appreciate is a concern for members in the House.

I would like to conclude by stating that it is my belief that this bill strikes a delicate balance. We know that this is a challenging issue for many members, but it strikes a delicate balance between respecting personal autonomy and protecting vulnerable individuals.

MAID is a personal issue, and one that likely has or will touch many of us here today at some point in our lives. I, for one, am comforted by Bill C-7's proposed two-tier approach in terms of the safeguards. It is reasonable, and it is balanced.

Also, I want to go on record that I think Audrey's amendment makes sense. It was a gap under the former legislation. I have had many individuals reach out to my constituency office asking me to be a champion to make sure that Audrey's amendment was included in our revised legislation moving forward.

Other members have spoken to this, and I am certainly pleased to see that in there. If anyone knows Audrey Parker's situation, they would know of the challenge it presented to her and her family, and we do not want to have people in Canada who are forced to make that decision.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, one of the things that my constituents have expressed to me, when we have a conversation around MAID, is that palliative care gets put on the back burner when we are talking about MAID. Rather than investing in palliative care for people who deserve high-quality palliative care, they would instead be offered MAID as an alternative. I am wondering if the member would be willing to share with the House if his constituents had expressed the same concern.

[Kody Blois, Liberal, Kings—Hants, NS]

Mr. Speaker, I have not heard that specifically. That is not to suggest that my constituents are not concerned about the thoughts the member has put forward.

He mentioned palliative care. My position is that of course we need to continue to support palliative care for the individuals who want to move forward in that process. This legislation ensures that individuals who are going through considerable suffering have the means available to them to make a conscious choice themselves. Our courts have said that this is the direction we need to go, and I believe this legislation strikes a proper balance.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, it was interesting to hear a Liberal member express his support for a two-tiered structure within our health care system. I would ask him to further develop his comments about the advance consent issue.

It would seem reasonable for the government to have included, or to accept at the amendment stage, an amendment requiring people who have previously expressed a desire for euthanasia to, at the time they are to receive it, at least be told what is going on. It would give them some opportunity to show whether they accept what they had asked for in the past. One might ask to have something in the future and then change one's mind. It seems reasonable to me that patients, even those with a limited capacity, be informed and in some sense consulted, even in their lower state of capacity.

Would the member be willing to support that kind of change to ensure that people's lives are not taken at a time when they do not want it to be taken?

[Kody Blois, Liberal, Kings—Hants, NS]

Mr. Speaker, the member opposite mentioned two-tiered health care. I will say on record that I do not support two-tiered health care. My remarks spoke to the two different safeguards we moved forward. I think that is important to note.

The member talked about the advance directive. I had cited Audrey Parker as an example. The member opposite's suggestion that there are no proper safeguards in place, in my mind, is not a fallacy, but there are provisions in the legislation that allow an individual to withdraw a prior advance requirement in this regard. They would also allow individuals who get to a non-verbal state to physically communicate and illustrate that they do not want to move forward with it. Again, it strikes a proper balance.

I would ask the member opposite to look into Audrey Parker's case. He should ask himself whether we should not be allowing people to make this conscious choice when they are going through so much suffering, enough to end their life early, that they get to the point they no longer have the capacity to make it. I think it is important they have a choice.

[Pat Finnigan, Liberal, Miramichi—Grand Lake, NB]

Mr. Speaker, I have had many calls regarding MAID, and many of my constituents are in favour of it. Some are concerned that this could be risky for people who might be vulnerable in their hours of pain. What safeguards would the member say we have in place that guarantee, whether for religious beliefs or other reasons, people are not coerced or pushed into making a decision they may not be in the right state to make?

[Kody Blois, Liberal, Kings—Hants, NS]

Mr. Speaker, I thank my hon. colleague for the things he pointed out. He mentioned that, by and large, the constituents in his riding support this. We can all recognize that this is a delicate issue. It is an issue that many Canadians have different feelings about and is evolving over time. Even in the last five years, Canadians' values regarding this type of legislation have evolved.

To the member's question on the safeguards that are in place, as I mentioned in my speech, this legislation would ensure, particularly when death is not reasonably foreseeable, that there are multiple opportunities for practitioners and other individuals to consult with the people who are contemplating this to ensure that all other avenues are explored and all options are available before individuals make what is really a crucial choice.

[The Deputy Speaker, Conservative, Bruce Stanton]

Before we resume debate with the hon. member for Sherwood Park—Fort Saskatchewan, I will let him know there are about six minutes remaining in the time for debate this afternoon. He will have his remaining time when the House gets back to debate on the question.

Resuming debate, the hon. member for Sherwood Park—Fort Saskatchewan.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, some members have been asking me today about what is on my forehead. Do not worry, it is not the remnants of an inappropriate Arabian Nights costume and it is not the result of slipping and falling while changing a child's diaper. These are ashes. Once a year on what we call Ash Wednesday to mark the beginning of Lent, Catholics receive blessed ashes on their forehead and may be told, “Remember that you are dust, and unto dust you shall return.”

Although I oppose the bill, I will note that there is something poetic about discussing death on Ash Wednesday. I have had many conversations with passionate advocates of euthanasia-assisted suicide. They tell me that we should not be afraid of death, that death is a natural part of life. I agree with them that death ought not to be feared. However important we think we are in the House, from dust we came and to dust we shall return.

The tendency of modernity is to seek autonomy from and control over the world around us and to feel, as technology improves, that we are bound by fewer and fewer of the things that bound us in the past, this in both a physical and a moral sense.

In ages past and in other parts of the world, the idea that death was a solution to suffering was unthinkable because life was full of suffering and suffering was taken for granted. Hunger and disease were rampant and uncontrollable for the vast majority of human history. People had to find meaning and purpose independent of their physical circumstances and they recognized profound limits on their ability to control the world around them.

Our age is unique in its expectation for control, so much of the demand for euthanasia and assisted suicide is not about suffering, but it is about control. Most physical suffering can be addressed through effective pain management and palliative care. Illness and the use of pain management may involve the loss of autonomy and control or a change in capacity, which can be very scary.

The good news, belied by our modern assumptions, is that people often adapt to unexpected circumstances. While we want to control our lives in advance, we can often find meaning and happiness in circumstances that we had thought would be unendurable.

I did my master's dissertation on happiness measurement. One of the insights of this burgeoning field is that measurable happiness levels often adapt in negative circumstances much more and much faster than most people think. I might think that going mute would make me very unhappy, but if I did go mute, there is data to suggest that I would find ways of adapting and that my happiness would not be impacted nearly as much as I thought it might in advance. Of course, other people's happiness might be impacted if I went mute as well.

Part of our desire to control all aspects of our life is our tragic disinterest in generational wisdom. Many cultures, including first nations cultures here in Canada, revere elders for their experience and wisdom and give them pride of place in families and community. It is no surprise, in light of their reverence for the elderly, that many first nations people oppose this expansion. My friend, former Liberal MP Robert-Falcon Ouellette, once reflected that it sends dangerous message to young people when older people choose suicide.

Also on the question of autonomy, I think many of us would find that what makes life most worth living is not our sense of autonomy, but rather our presence in meaningful communities that affirm human dignity. We need to think about the impacts on communities that flow from this expanded euthanasia regime.

Suffering together has often been part of our experience of community. It is a tragedy that too often we shut people who are suffering out of public spaces. This loss of community rather than the initial cause is likely a source of great suffering and pain as well.

Think back to a time when we accompanied someone as they suffered. Unique, meaningful moments happen because of the intimacies that exist in moments of vulnerability and dependency. When people fear that they may be a burden, we need to say to them, “no, we love you, you are not a burden and rather we desire to share your burdens with you”. We cannot be a society characterized by happiness and meaning if we are not composed of communities of people who are willing to suffer with each other. The very word “compassion” comes from the Latin for “suffer with”.

In any event, we do not talk often enough about death. Nobody wants to be reminded that one day they will die and probably after, not before, their opinions have ceased to be of interest to anyone outside their family. There has been a lot of discussion in the context of the bill about the notion that for some people at certain points in time, death is or is not reasonably foreseeable. Surely death is reasonably foreseeable for all of us and hopefully we speak and we vote in a way that allows us to face our mortality with confidence.

It is good to recognize our own limitations and to seek joy and meaning in the midst of the inherent unpredictability of life while pushing for greater supports for those seeking to adapt to new and challenging circumstances.

We need better support for the inclusion of people with disabilities, and we desperately need improvements to pain management and palliative care. We must build communities. We must be a society which seeks to share each other's burdens so that nobody needs to feel like they are a burden.

In the time I have left, I want to note some of the history of this bill. Prior to 2015 we had various bills proposed in this place on this issue. In every case it was a majority of Conservatives, Liberals and New Democrats who opposed it. The legal situation changed in 2015 when the Supreme Court overturned the existing law. The expectation at the time of Carter was for a legal regime that would apply narrowly.

Some were concerned about this decision, arguing that any opening of the door on this issue would lead to a slippery slope once the sacred principle that doctors should do no harm was violated. Rates would escalate, safeguards would be ignored, and patients would feel pressure toward euthanasia and assisted suicide during moments of extreme vulnerability.

Others thought that it would be possible to allow this practice without initiating a slippery slope. They thought it would be possible to carve out a narrow hole in the usual practice of medicine that would remain narrow and limited.

In reality, the slide down the slippery slope has been dramatic, with annual rates increasing by five times between 2016 and 2019. I wonder if members have thought about how high they want this number to go. We are hearing many horror stories about people's experiences with the health care system in the context of euthanasia.

I look forward to sharing more of my concerns with the specific provisions of this legislation, as well as sharing some of those stories, when the House returns to this issue at the next point.

[The Deputy Speaker, Conservative, Bruce Stanton]

The member for Sherwood Park—Fort Saskatchewan will have 13 and a half minutes remaining in his time for his remarks when the House gets back to debate on the question, and then the usual 10-minute period for questions and comments.