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 commend my colleague on his speech. Since he went off topic to talk about access to drinking water in indigenous communities, I will do the same and ask him a question about that. I share his outrage. It is absolutely unacceptable that indigenous communities do not have access to drinking water.

That said, being outraged is good, but taking action is always better. In that sense, I wonder why my colleague, who criticizes the Liberal government's decisions, earlier today supported that same government that has done nothing about drinking water access in indigenous communities.

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

Mr. Speaker, the member went from profound to as cheap as one can get. We are talking about the dignity of people. I bet the member has never seen the kind of poverty we see. Am I going to plunge the nation into an election because the little guy in the front from the Bloc said he wanted an election last spring? No, I have better issues to deal with.

If that member cannot understand the profound issues facing people in Neskantaga, I would say that we can see what happened. I have not heard anything from that member in terms of the horrific death of a woman in a hospital in Quebec.

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

Mr. Speaker, I want to thank the hon. member for a very moving statement. I know it is difficult, and I am usually persnickety about saying that any member speaking should speak to the topic before us. The Neskantaga First Nation situation, in that they may be facing an evacuation because of a lack of clean drinking water, draws into sharp focus why we need Parliament to continue to work in this place.

I specifically want to thank the member for his shared concern for a dear mutual friend of ours. When we started debating Bill C-7 last spring during the last Parliament, Angela Rickman sent me texts and emails asking us to bring her relief. She was suffering from ALS and wanted to be able to use medical assistance in dying, and we failed her. I would like my hon. colleague to add whatever he chooses on the desperate need for us to continue to act in Parliament.

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

Mr. Speaker, my hon. colleague and I shared a friend in Angela Rickman. She was a very powerful and profound woman who worked on the Hill and died much too young. I am glad the hon. member thought of her tonight.

We have to think of the people we know who are suffering and make sure we do this in a manner that respects them and respects our obligations under the law.

[Carla Qualtrough, Liberal, Minister of Employment]

Mr. Speaker, it is really an honour to participate in this important debate on Bill C-7, alongside my colleagues, the Minister of Justice and Attorney General of Canada, and the Minister of Health.

By way of background, in 2015, the Supreme Court of Canada struck down the sections of the Criminal Code that made assisted suicide illegal. In 2016, the federal law in medical assistance in dying came into effect. This law created an end-of-life regime, which limited access to medical assistance in dying to individuals whose deaths were reasonably foreseeable. A number of specific eligibility criteria were put into place, along with procedural safeguards.

As we all know, in September of 2019, the Superior Court of Quebec found it unconstitutional to limit the availability of medical assistance in dying to people whose deaths are reasonably foreseeable. The federal government has once again been tasked with changing the law.

In early 2020, the Government of Canada held consultations across the country. There was also an online survey that received almost 300,000 responses. The feedback was thoughtful, compassionate and candid. From my perspective as the minister responsible for disability inclusion, I am working to ensure that the voices of persons with disabilities are heard on this important issue.

Medical assistance in dying is a human rights issue. The proposed legislation recognizes the equality rights of personal autonomy, and the inherent and equal value of every life. Disability rights advocates have long fought for these rights. Being able to make decisions about one's own life is fundamental. There are many examples in our history of where the personal autonomy and equality of our citizens with disabilities has been threatened, denied or taken away. I can assure my colleagues that these concerns are top of mind as we undertake this important legislative work.

The proposed legislation before us explicitly recognizes equality rights. The preamble refers to the Charter of Rights and Freedoms, as well as Canada's obligations as a signatory to the United Nations Convention on the Rights of Persons with Disabilities. The preamble also expressly differentiates between these fundamental equality rights and the various societal interests and values we need to balance with this legislation, such as the important public health issue of suicide. To put it another way, we wanted to be clear that ensuring equality rights underpins this legislation.

I will mention one more important aspect of the preamble that frames this proposed legislation, which is the importance of taking an approach to disability inclusion based in human rights. With these words, we are committing to using human rights principles to guide the development and implementation of our systems, programs and processes. This is important because the full realization of the rights we enshrine in law is predicated on having systems and structures in place that do not themselves create barriers, discriminate or infringe upon these rights.

I will digress here for a moment to take us back to June of 2019. That month, this House unanimously passed the Accessible Canada Act, which I believe to be the most significant advancement in disability rights since the Charter. Section 6 of the Accessible Canada Act sets out guiding principles, which include that everyone “must be treated with dignity”, everyone “must have meaningful options and be free to make their own choices,” and everyone “must have the same opportunity to make for themselves the lives that they are able and wish to have regardless of their disabilities”.

Another guiding principle states, “laws, policies, programs, services and structures must take into account the disabilities of persons, the different ways that persons interact with their environment and the multiple and intersecting forms of marginalization and discrimination faced by [individuals]”.

These principles must also guide us as we tackle the important task of responding to the 2019 Superior Court of Quebec decision. As this House has heard, Bill C-7 proposes a two-track approach to medical assistance in dying, with less or more stringent safeguards depending on whether a person's death is reasonably foreseeable.

The House has heard about the safeguards when death is reasonably foreseeable, and it is our hope that these will allow for dignified end-of-life decision-making. I will focus my attention on the new track where MAID is permitted even though the individual's death is not reasonably foreseeable. As I mentioned, in these situations there are heightened safeguards. These include the requirement that two independent doctors or nurse practitioners assess and confirm eligibility, with one of these having expertise in the individual's medical condition.

It is also required that the individual be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability services, community services and palliative care, and that the individual be offered consultations with professionals who provide these services. The individual and their medical practitioner must have discussed these measures and agree the individual has seriously considered them.

Finally, the eligibility assessment must take a minimum of 90 days, unless loss of capacity is imminent.

As we look to broaden access to MAID as directed by the court, we are very aware of the need for Canadians to know their options, to ensure their consent was informed and to have a real choice. I spoke earlier about equality rights and personal autonomy. I also spoke about taking a human rights-based approach to disability inclusion, having meaningful options and having the opportunity to make a good life for one's self. If our systems, processes, programs and services do not offer these options, and if our citizens do not see these options are available to them, then their equality rights are not being fully realized.

This proposed legislation recognizes the significant role that social, mental health, disability and community support services play in the full realization of equality rights. Accessing MAID should not be easier than accessing disability supports. The new legislation makes it the responsibility of the medical practitioner to ensure that the individual is made aware of the supports available to them because the harsh reality is that many Canadians with disabilities are not living with dignity. They are not properly supported. They face barriers to inclusion and regularly experience discrimination.

We have seen during this pandemic how many of our systems fall far short of truly supporting and including all Canadians. Canadians with disabilities are rightfully calling for governments to address these inequities, and we must.

In the recent Speech from the Throne, our government committed to a disability inclusion plan. This will include a Canada disability benefit modelled after the GIS, an employment strategy, and a modernized approach to eligibility for Government of Canada disability programs and services. The disability inclusion plan is an important next step in advancing the rights and inclusion of person with disabilities. I look forward to sharing more on this with the House and all Canadians in the coming months.

Before concluding, I will mention the need for robust federal monitoring and data collection on MAID. We need a reliable national dataset that promotes accountability and improves the transparency of implementation. Quite frankly, we also need to better understand who is accessing MAID and why. This is of the utmost importance to the disability community. It is incumbent upon all of us to ensure the regulations that flow from this legislation allow for fulsome data analysis.

We have before us legislation that seeks to balance making medical assistance in dying available, without undue obstacles to those who choose it, and having safeguards to ensure this decision is truly informed and voluntary. A truly progressive medical assistance in dying law is one that recognizes, without compromise, the equality rights of everyone.

I am thankful for the opportunity to contribute to this debate.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Mr. Speaker, I listened intently to the hon. member's speech, as I always do when my friend speaks. I wish we had the time for the committee do its study. I wish that the government had taken the time to challenge the decision of the court in the Supreme Court if only to get the best advice we could before we moved forward with legislation like this.

I think about the disability community. Both of us know the disability community very well, and we have heard significant concerns from that community. This is a complex issue, and issues related to communications for those with disabilities are also complex. There are many in the disability community who would say that their voices are not being heard right now and they do not feel they have agency right now because of the way society views them. They feel this legislation is coming too fast, too quickly, too soon. I wonder what kind of commitment the hon. member will make to those in the disability community to make sure their voices are heard.

[Carla Qualtrough, Liberal, Delta, BC]

Mr. Speaker, I thank the hon. member for his collaboration and partnership in advancing issues related to disability.

This is a very complicated, complex and deeply personal issue. I have been committed since the beginning to living by our commitment to a “nothing about us without us” perspective by ensuring members of the disability community have voices at every table around decisions like this.

My COVID disability advisory group has been digging in on this. I know we will have robust presentations at committee from members of the disability community. My bottom line is that I will do whatever it takes to ensure these voices are heard.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I am wondering about the question that was just asked.

I would like my colleague to clarify. When I am told about the vulnerability of persons living with disabilities I completely agree. However, the process that leads to medical assistance in dying requires clear consent. There are physician groups that are already working on this issue trying to determine the terms and conditions for such consent.

Does my colleague agree that some parliamentarians seem to want to drag out the debate to throw the baby out with the bath water?

[Carla Qualtrough, Liberal, Delta, BC]

Mr. Speaker, we are talking not only about changing the Criminal Code, but being very careful not to send a message to a very important group of our citizens that their lives are not as valuable as those of the rest of us. I want to ensure that as we have this conversation nothing we do sends that message. Everybody's life is of equal and inherent similar value.

Perhaps I misunderstood the question, but if people do not have a real choice at their disposal, as I suggested in my speaking notes, then we are not really giving them their full rights of equality.

[Matthew Green, NDP, Hamilton Centre, ON]

Mr. Speaker, the minister has just reminded us that everyone ought to have equal and inherent rights, but we know that throughout this pandemic the government has refused to prioritize the pursuit of a very equal life for people with disabilities.

I want to bring the voice of one of my constituents, Sarah Jama, who is part of a disability justice network, to ensure that her and their voices are heard. She states, “It is evident through our history of forced sterilization and institutionalization that the current crisis of deaths in long-term care homes and continued legislated poverty across this country that with the changes in the requirement for foreseeable death to MAID, what measures will our government put in place to adequately ensure that people with disabilities will not experience systemic or implicit coercion regarding their access to MAID and will this government finally prioritize the life of people with disabilities in this country as much as it has thoughtfully prioritized their access to death?”

[Carla Qualtrough, Liberal, Delta, BC]

Mr. Speaker, I thank Sarah for fighting the fight. I hear many of her views about how, historically, we have done wrong by this really marginalized group of citizens. We are taking every effort to do right by our citizens with disabilities. It started with the Accessible Canada Act, which put a disability lens on our pandemic response, resulting in a COVID disability advisory group, resulting in recommendations from that group as to how we could ensure that sufficient safeguards were put in place, resulting in a commitment in the Speech from the Throne to a direct payment to citizens with disabilities, the Canada disability benefit modelled after the GIS, so they can have the the choice to not live in poverty, access to the services and supports they need to live with dignity. I promise Sarah that we are not giving up this fight.

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, today we are talking about Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying. While I realize this is a very sensitive and difficult issue, I want to be very clear that I will not be supporting the bill. I would like to take a few minutes to talk about why that is and to provide some context to all Canadians, specifically from my constituents in Niagara West.

On February 6, 2015, the Supreme Court of Canada ruled that grievously suffering patients had the right to ask for help in ending their lives. This was the Carter v. Canada decision. The court declared that paragraph 241(b) and section 14 of the Criminal Code, which prohibited assistance in terminating life, infringed upon the charter right to life, liberty and security of the person for individuals who want to access an assisted death.

The Supreme Court decision was suspended for a year to give the government time to enact legislation that reconciled the charter rights of individuals, doctors and patients. As a result, the government introduced Bill C-14 on April 14, 2016, which received royal assent on June 17, 2016. Medical assistance in dying has been legal since then.

On September 11 of last year, the Superior Court of Québec found that it was unconstitutional to limit access to medical assistance in dying to people nearing their end of life. Basically, the court said that the Criminal Code requirement that natural death should be reasonably foreseeable to get medical assistance in dying is against the rights and freedoms of Canadians as they are written in the charter. It is important to note this ruling will come into effect on December 18, 2020, unless a third extension is granted by the court.

The focus and priority of all of us in the chamber should be to ensure safeguards are always in place for the most vulnerable in our society. We also have to keep in mind that we need to be respectful and accepting of the conscience rights of physicians and health professionals. Doctors are trained to save lives, not to end them. I actually believe we should go a step further and protect the conscience rights of all health care professionals.

I am supportive of doctors and health care providers who are not willing to leave their core ethics behind when they are at their patient's bedside. I do not believe it is appropriate to force a doctor or other health care provider to participate in assisted suicide. I also do not believe it is appropriate to hire or fire an employee based on their willingness to be involved in assisted suicide. Physicians who wish to follow their conscience on serious moral issues should be free to do so. Again, we need to be respectful and accepting of the conscience rights of physicians and health professionals.

The last time I voted on this issue, I went through the legislation, which at the time was Bill C-14, and I made a determination that it did not include sufficient safeguards for those most vulnerable, so I opposed it. I had the chance to examine the current bill before us today and I still do not think it has sufficient safeguards, so I will oppose it again.

Let us be clear about something. Medical assistance in dying is a tremendously difficult issue to debate. It absolutely is. It is a highly emotional topic for all sides, and there are many factors and personal convictions that come into play. In the House we agree on many things, but we also disagree strongly on others. The key is to respect one another in the process as we discuss sensitive issues, especially issues relating to human life. Medical assistance in dying has to do with some of the most vulnerable people in our society. That is why it is important we, as representatives of the people who voted for us, have utmost respect for all who have an opinion on this topic. This includes many folks in my riding of Niagara West who are people of faith and disagree with what this bill would do.

I would like to highlight some critical evidence from an expert who appeared before the Quebec superior court on this issue. Dr. Mark Sinyor is a Canadian psychiatrist widely recognized for his clinical expertise and research on suicide prevention. He was an expert witness in the case, who provided important testimony before the Quebec superior court.

In his 50-page affidavit, Dr. Sinyor detailed for the court the likely impact of expanding medical assistance in dying to those who are not at the end of their lives. He notes that under an expanded law, which is what we have in front of us here today, physicians would bring about a death that is not otherwise foreseeable. This is something that is exceptionally difficult to accept for many Canadians across the country and for many in my riding of Niagara West. Issues like the planned legal death of someone who is terminally ill is a very delicate matter to begin with, but to open up the door for more people to qualify for a planned death, a legal death, to me and to many of my constituents, is very troubling.

I would like to return to Dr. Sinyor again.

He talks about a well-established phenomenon referred to as suicide contagion. Dr. Sinyor explains that suicide contagion occurs “through a process called social learning in which vulnerable people identify with others who have had suicidal thoughts and/or behaviour.” He goes on to say, “Expansion of MAID to include suffering, not at the end of life is likely to lead to suicide contagion and higher suicide rates, and to have a negative impact on suicide prevention.”

Dr. Sinyor also talks about the extent to which many elderly people with chronic conditions and younger people with severe disabilities are impacted. He says that they “feel like a burden to their loved ones and that their families would be better off if they were dead.”

When one of our friends, of family members or loved ones is in a similar circumstance and they begin to think that they will be solving this problem of being a burden, knowing that this law will allow it, would it be more comfortable for us? My answer is no, I do not think it would be.

To quote Dr. Sinyor again, “Normalizing suicide death via MAID as a remedy for suffering not at the end of life is likely to increase suicide rates in Canada at a time where there is a universal consensus among public and mental health experts of the imperative to decrease suicide rates.”

In short, the bill would simply make it possible for a person to choose to access medical assistance to end their life, even if their death is not reasonably foreseeable. I am concerned for people with disabilities. I am concerned that, if passed, the legislation will allow people with disabilities to die with medical assistance because they have a disability.

Michael Bach, managing director for the Institute for Research and Development on Inclusion and Society confirms this, saying “people who are not at the end of life will nevertheless be able to access assisted death on the basis that their disability is grievous and irremediable and they experience suffering they find intolerable.” I am concerned that people with disabilities may be coerced into ending their life while they are in a state of personal suffering.

Michael Bach also said, “Negative stereotypes are an undeniable cause of disability-related disadvantage and suffering. The Quebec Superior Court struck a blow to social rights in Canada when it rejected the end of life requirement.”

One of Bach's most striking statements on this issue is that the court's decision “institutionalizes the idea that disability can justify terminating a life. Stereotypes don’t get much worse than that.”

I am afraid that the bill may reinforce horrible stereotypes that a life with a disability is a life not worth living or that living with a disability is a fate worse than death. This cannot happen. I am also concerned that the suffering may not be caused by the disability but because of a lack of services and supports needed by many people with disabilities to lead a full life.

As an example, we have the story of Sean Tagert, a B.C. man who was living with ALS. Sean chose to access medical assistance in dying because he was unable to secure funding for the 24-hour care he needed to live in his home, in his community and raise his young son. The story is heartbreaking. This young man chose death because he was unable to get the proper care for his disability, and he left a young child behind.

It is so sad to hear stories like this. That is why I believe that providing high-quality palliative care is critical. Palliative care is so important because it puts patient care at the forefront of this discussion and not the patient's death. Palliative care helps improve the quality of life, reduces or relieves physical and psychological symptoms and supports the families and loved ones of those struggling with the condition. It could be provided in a variety of settings, including hospitals, at home, long-term care facilities and hospices.

The focus of palliative care is on respecting dignity and having compassion for human life. That in my view is the right approach. I do not think any of us in the chamber should ever underestimate the importance of this issue and its complexity. We all understand the delicate and sensitive nature of it. We all have views and we all know the views of our constituents. They sent us here to represent them, and that is what we are doing.

My hope is that we will all uphold the original objective of this legislation, and that is to affirm the inherent equal value of every person's life to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled. This bill does not do that, and for that reason I will be voting against it.

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

Mr. Speaker, I share the member's concern with respect to palliative care and how critically important it is that Ottawa continues to work with provinces to look at ways we can deliver a better service, particularly for some communities that have been neglected on this issue.

My question relates to the concerns of the member. We have health care professionals, families, friends and for some of the larger groups, such as the disabled, advocacy groups. I am wondering if the member might be underestimating the value they have to this debate. Once the bill gets to committee, we will hear a lot more on those issues.

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, as I have said before, I have talked to numerous people who have come to my office and whose homes I have gone to. When it comes to the disability community in particular, they are certainly very concerned about some of the things that underlie this, whether it is removing the 10-day waiting period or encouraging doctors to move forward proactively. There are a number of things and that is why a letter, signed by over 77 organizations, was sent to legislators that talks about the concerns that they have. We need to be very mindful of them.

[Matthew Green, NDP, Hamilton Centre, ON]

Mr. Speaker, we have heard today from our Conservative friends down the way stories of anguish, conversations and statements around the sanctity of life and safeguards. It is clear to me that this is not a critique particularly of MAID, but, rather, the condemnation of capitalism.

What does the member have to say about the privatization of mental health, the criminalization of addictions and the commodification of every basic necessity of life, to the point where almost complete and utter despair has caused people to be sentenced to live in deep poverty and have to, at the end of life, under coercion perhaps, contemplate this last and drastic step?