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

[David Lametti, Liberal, Minister of Justice]

moved that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Madam Speaker, I am pleased to rise today to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

The bill proposes a legislative response to the Superior Court of Quebec's Truchon decision, as well as some other changes to the Criminal Code provisions that set out Canada's medical assistance in dying regime.

In June 2016, former Bill C-14 amended the Criminal Code to create Canada's first law on medical assistance in dying, or MAID. The legislation created exemptions to Criminal Code offences so that individuals suffering unbearably and nearing the end of their lives could die peacefully and with the help of a physician or nurse practitioner, rather than in agony or in circumstances that they considered undignified.

This significant change in our criminal law was indicative of the value that Canadians ascribed to having choices, including about the manner and timing of their deaths when suffering in the dying process was intolerable. The most recent data obtained by the federal MAID-monitoring regime indicates that over 13,000 Canadians have received MAID since it has become decriminalized.

We are now proposing another important change to our criminal law. In Truchon and Gladu, the Quebec Superior Court ruled that it was unconstitutional to limit access to medical assistance in dying to persons whose death is reasonably foreseeable.

We decided not to appeal the decision because we want to reduce the suffering of people waiting for medical assistance in dying.

When we announced our decision not to appeal the ruling, our government also committed to changing the eligibility criteria for medical assistance in dying throughout Canada to ensure that criminal law is consistent nationwide.

Application of the court's ruling, which is limited to Quebec, was suspended for six months. The deadline is March 12. Because these issues are so important and because we want to ensure that our laws are consistent all across Canada, we have asked the court for a four-month extension, which would give Parliament time to thoroughly consider and debate the amendments proposed in this bill. There was a hearing yesterday regarding this request.

Consulting Canadians about the next phase of medical assistance in dying in Canada was crucial to drafting this bill. That is why we launched a two-week public consultation on January 13. The level of participation was unprecedented. We received over 300,000 responses, an indication of how important this issue is to Canadians.

At the same time, together with the Minister of Health, the Minister of Employment, Workforce Development and Disability Inclusion and our parliamentary secretaries, we held 10 round-table discussions across the country between January 13 and February 3.

This included round tables in Halifax, Quebec City, Montreal, Ottawa, Toronto, Winnipeg, Calgary and Vancouver. We met over 125 individuals, including doctors, nurse practitioners, legal experts, members of the disability community, indigenous peoples, and representatives of health regulatory bodies and civil organizations.

We are grateful to all who participated in the round tables. Their shared expertise and experiences were of immense value in developing this bill. I have no doubt that many will continue to engage in the parliamentary process as witnesses before committees.

The results of this consultation process will be published shortly in a “what we heard” report. We heard views on many different topics, but I would like to mention just a few.

From the public online consultations we heard that, while the majority of respondents think the current safeguards are adequate to prevent abuse, in a MAID regime that is expanded to persons who are not dying in the near term, a majority of respondents also thought it would be important to require additional safeguards in such a broader regime. Many round-table participants suggested two separate sets of safeguards in an expanded regime. Others shared their experiences with existing safeguards as they apply to those who are near the end of their lives.

Specifically, many felt that the requirement for two witnesses when a person's written request was made was too onerous and afforded little protection, and that the 10-day reflection period unnecessarily prolonged suffering.

Informed by these in-depth consultations, and by the Canadian experience with medical assistance in dying to date, along with many other sources of information, Bill C-7 proposes to respond to the Truchon decision by adjusting both the eligibility requirements and the safeguards. It also proposes to enable patients in certain circumstances to waive the requirement for final consent so that they do not lose their access to MAID.

We know there are other issues about which many Canadians still feel strongly but which are not subject to the Superior Court of Québec's deadline, such as eligibility in cases where mental illness is the sole underlying condition, advanced requests and mature minors. These will be examined in the course of the upcoming parliamentary review.

Before describing the proposed amendments, I would like to address the concerns we heard from many in the disability community following the Truchon decision and during our consultations. Disability groups were very clear that, for them, removing the end-of-life limit on MAID would create a law that holds disability as a valid reason for ending a life and reinforces the false perception that disability is equivalent to a life of suffering.

Our government is sensitive to these concerns. We strongly support the equality of all Canadians, no matter their situation, and we categorically reject the idea that living with a disability is a fate worse than death. However, we are also mindful of the need to balance these concerns, along with others that have been expressed, with other important interests and societal values, in particular the importance of individual choice.

The bill's objectives are therefore to recognize the autonomy of individuals to choose MAID as a means of relieving intolerable suffering, regardless of their proximity to natural death, while at the same time protecting vulnerable persons, recognizing that suicide is an important public health issue and affirming the inherent and equal value of every person's life. More concretely, Bill C-7 proposes to expand eligibility for medical assistance in dying beyond the end-of-life context by repealing the eligibility criteria requiring that natural death be reasonably foreseeable.

Recognizing that intolerable suffering also arises outside of the end-of-life context and that Canadians want to have choices, medical assistance in dying would be become available to all those who are intolerably suffering; who have a serious and incurable illness, disease or disability; and who are in an advanced state of irreversible decline in capability, without regard to whether they are dying in the short term.

At this time, the bill proposes that persons whose sole underlying condition is a mental illness not be eligible for medical assistance in dying. First, we are subject to a court-imposed deadline and this matter requires more in-depth review and debate. We have learned that the trajectory of a mental illness is more difficult to predict than that of most physical illnesses. This means that there is a greater risk of providing medical assistance in dying to people whose condition could improve.

It is also more difficult to carry out competency assessments for individuals with a mental illness. In the case of some mental illnesses, the desire to die is itself a symptom of the illness, which makes it particularly difficult to determine whether the individual's request is truly voluntary.

Like the Government of Quebec, we are of the opinion that we need to continue consultations, discussions and policy development on the issue of MAID requests based solely on mental illness.

The parliamentary review that will be launched next June will be an appropriate forum for examining these issues, without the time constraints of the court-imposed deadline.

I would now like to turn my remarks to the question of safeguards. Many experts believe there are greater risks in assessing requests for MAID from individuals who are not nearing the end of their life. We agree. While these individuals would have a choice to seek MAID, the bill proposes that these requests be treated with greater sensitivity and care.

Accordingly, the bill proposes two streams, or two sets of safeguards. To distinguish these cases the bill proposes to use the concept of reasonably foreseeable natural death. Let me be clear on this point. Not having a reasonably foreseeable death would no longer be grounds for rejecting a MAID request; however, it would be used to determine which of the two sets of safeguards are required in a given case.

As enacted by Parliament in 2016, reasonable foreseeability of natural death refers to a death that is expected in the relative near term. It means that in light of all the person's medical circumstances, his or her death is expected in a relatively short period of time. Natural death is not reasonably foreseeable just because an individual is diagnosed with a condition that will eventually cause death many years or decades into the future.

In practice we know that practitioners are more comfortable prognosticating when death is expected in shorter time frames. The standard of reasonably foreseeable natural death provides flexibility in a way that maximum fixed prognosis would not. The standard also has the advantage of using language that practitioners have become familiar with over the last four years.

Those who are dying in the short or near term would benefit from the current set of safeguards in the Criminal Code, which the bill proposes to change in two ways.

First, the 10-day reflection period would be eliminated. We heard during the consultations that most persons have already given their MAID request a lot of thought by the time they sign their written request, resulting in the reflection period unnecessarily prolonging suffering.

Second, the requirement for two independent witnesses would be amended so that only one independent witness to the written MAID request is required. Further, we have added an exception so that health care and personal care workers who are not the person's provider or assessor would now be able to act as an independent witness.

Again, we heard that it is difficult for some who live in long-term care facilities or in remote areas to locate two independent witnesses. The purpose of the independent witness is simply to verify the identity of the person signing the request. The witness is not involved in the assessment process.

For persons whose death is not reasonably foreseeable, the existing safeguards would all apply with some additional ones. Specifically, the bill proposes a minimum 90-day assessment period, which will help ensure that practitioners spend sufficient time exploring the various dimensions of the person's MAID request, which, outside the end-of-life context, could be motivated by different sources of suffering requiring greater attention.

Also, at least one of the practitioners assessing eligibility would have to have expertise in the condition that is causing the person's intolerable suffering. The safeguard aims to prevent people from obtaining MAID when something could have been done to relieve their suffering or improve their condition.

The bill would also clarify the notion of informed consent for these kinds of cases.

First, a person who is not dying would have to be informed of the means available to relieve suffering, including counselling services, mental health and disability support services, community services, and palliative care, and be offered consultations with professionals that provide these services.

Second, the practitioners and the person would also have to agree that these means of relieving their suffering were discussed and seriously considered.

The bill also proposes to allow people whose death is reasonably foreseeable and who are eligible for medical assistance in dying to give prior consent if they risk losing capacity to consent before the date set for MAID. At present, the Criminal Code requires the practitioner to ensure, immediately before MAID is provided, that the person gives express consent to receiving MAID.

The bill would enable a patient who has already been assessed and approved to enter into an advance consent arrangement with their physician that sets out all the relevant details, including the date selected for the provision of MAID and the fact that the person consents to receiving MAID in case they lose the capacity to consent by the day in question.

Although this scenario was not covered in Truchon, experts told the government that it presents relatively little complexity and risk. Doctors also told us they would be comfortable with the idea of providing MAID under such circumstances.

To our government, compassion means ensuring that people waiting for MAID do not lose their opportunity to die in the manner or on the date of their choosing just because their medical condition robs them of the capacity to make decisions in their final days.

Another narrow form of advance consent would also be allowed in the unlikely event that complications arise after a person who has been assessed and approved self-administers a substance intended to cause their death and loses the capacity to consent to MAID, but does not die.

The patient and their physician could enter into an arrangement in advance, stipulating that the physician would be present at the time the patient self-administers the substance and would administer a substance to cause the patient's death in case the patient loses their capacity but does not die.

The data show that there have been very few cases of self-administration so far, perhaps due to fears of possible complications stemming from self-administration of a substance. Offering such an option could provide greater reassurance and allow more Canadians to choose this form of medical assistance in dying.

There are other changes in the bill that my colleagues will speak to, including changes to enhanced data collection and the monitoring regime that brings accountability and transparency to the practice of MAID in Canada.

A transitional provision would ensure that patients who have already signed their request when the bill comes into force would not be required to undergo any additional safeguards set out in the bill. At the same time, they would be able to benefit from the safeguards that would be eased, such as the elimination of the 10-day reflection period and the possibility of preparing an advance consent arrangement if it applies to that person's situation. We are committed to making the process as easy on patients as possible.

I would also like to briefly discuss the constitutionality of the bill. I have examined the bill as required by the Department of Justice Act. This involved consideration of the objectives and features of the bill. I am confident that the bill responds to the Truchon ruling in a way that respects the charter.

As is required by the Department of Justice Act, I will table a charter statement in the near future, which will lay out some of the key considerations that informed the review of the bill for inconsistency with the charter. This will serve to better inform parliamentary debate on this important piece of legislation.

I will conclude by thanking all those who participated in the consultations on medical assistance in dying and who contributed to the drafting of this bill. Bill C-7's proposed amendments to Canada's medical assistance in dying regime represent a fundamental policy shift, with the regime becoming less about end-of-life care and more about autonomy and alleviating intolerable suffering.

I look forward to working with all members of both chambers to ensure Bill C-7 is passed.

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

Madam Speaker, from my perspective, the elimination of certain stages dramatically changes the potential context for a person receiving euthanasia or assisted suicide.

Right now, the requirements to have a couple of independent witnesses and a little waiting period address the possible risk related to somebody who, for a few hours or a relatively short period of time, feels in the depths of despair and then recovers. The idea of the existing safeguards is to ensure that a person is not pushed into this decision without family members around, without talking to anybody, as it can be the result of a thought process that could last for a relatively short period of time.

The minister knows that in certain circumstances the 10-day waiting period can be waived already. Why is the minister removing safeguards like additional witnesses and the 10-day waiting period, which occurs most of the time but not all the time? Why is he creating a situation in which people could, as a result of a relatively short-term sense of vulnerability and thought process, make a decision they might at any other time in their life not make?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank the hon. member for his interest in this matter.

What we heard in consultation after consultation across Canada is that the two safeguards in the current legislation are not doing their job as safeguards. All they did was add intolerable suffering on the person.

The two independent witnesses are merely there to witness the identity of the person who asks for MAID. In the decision to seek MAID, the assessments are all done prior to that by the medical professionals involved and the patient. This is really just a pro forma step. Having two witnesses, particularly for older people in remote areas of Canada who perhaps do not have any family left, became an unbearable impediment.

The 10-day reflection period came after the decision to have MAID. What happened is that people would, in some cases, not take their pain medication in order to not lose the capacity to make a final decision 10 days later.

It was believed virtually unanimously, among the experts, patients and others, that we should remove these two impediments, because they simply were not acting as safeguards and were increasing suffering.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Madam Speaker, I would like to begin by saying that the Bloc Québécois supports the principle of this bill. It is a step in the right direction, especially since the bill repeals the provision that requires a person's natural death to be reasonably foreseeable in order for them to be eligible for medical assistance in dying.

I recently met one of my constituents, Caroline Parent, a woman in her 40s who seemed quite engaged and active. Ms. Parent told me that she feels trapped in her own body and hopeless about her life. That was a very powerful day. Her story was overwhelming. She told me that she had gotten to the point of planning a trip to Switzerland, where medical assistance in dying is accessible, and planned to return in the luggage hold. This was a harrowing story, and I am pleased to see that this bill is making some progress in this respect.

I do want to mention that the Bloc Québécois thinks the notion of advance consent should be considered. We are also wondering about the possibility of eliminating final consent in cases in which the person's death is not reasonably foreseeable, as is the case with degenerative diseases like Alzheimer's, for example.

What does the minister think about that?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank my hon. colleague for the question. Obviously that is a very important question. We asked questions like that on the online form and we also asked them during roundtables and consultation panels we hosted across Canada, including in Quebec City and Montreal.

What we heard is that there is still a lot of work to do. There is some public sympathy for such measures, but these are very complex issues. There are still some unknowns and situations in which doctors and nurses do not feel comfortable with the potential framework.

It is a question we will address during parliamentary review. Studies are under way. Quebec commissioned a study and we commissioned one from the Council of Canadian Academies. This question is one of the elements we will look at, but for now that is a step we are not prepared to recommend.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, I remember being in this place during the debate on Bill C-14 and reading through the Carter decision, which was very clear. There was also, of course, the important work that was done by the special joint committee of both the House and the other place.

When I was speaking to Bill C-14 in 2016, I knew the inclusion of the “reasonably foreseeable” aspect of the law was going to cause us problems, and here we are. I am sure the justice minister is feeling some closure, because he was one of four Liberals who voted against that bill. I am sure he is getting some satisfaction in revisiting this now.

I am pleased to report that the New Democrats support the bill in principle. However, we have a number of concerns, specifically with the assessment period for those whose natural death is not reasonably foreseeable but who are facing intolerable suffering. The bill sets up a period of 90 days. We have already heard from some physicians who have concerns with the fact that they have to tell patients to bear their illness and suffer for another 90 days.

Could the Minister of Justice inform the House on how the Liberals came up with that number? How did they determine that 90 days is the right amount of time?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank the hon. member for his very kind comments and the general support of his party.

We decided to have two regimes in order to keep doctors and nurses on board who were familiar with the original regime and add the possibility for others. There is a different set of balances in the non-end-of-life scenario. We heard from people who see themselves as vulnerable or susceptible to influence, like people living with disabilities for example, at round tables and this was an existential question for them.

This is the assessment period; it is not a reflection period. We have eliminated all reflection periods. This is the period of time in which the doctor or the nurse practitioner is assessing the condition with the patient. There are other proactive things the doctor or nurse practitioner has to do. We wanted to give an adequate amount of time for reflection. Some jurisdictions have six months in this scenario. We shortened that. We wanted to give enough time for adequate reflection. With catastrophic injury, for example, the first reaction is often that a person would rather die, but with time, a very short period of time, and after assessing the possibilities for life, a person makes a different decision.

This is really just adding to the assessment period, making sure that there is adequate discussion, adequate informing of the possibilities and consideration of the possibilities, while still understanding that people are suffering intolerably. We understand that, but feel this is an appropriate period that is not too long. It is certainly not as long as some of the other examples.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I remember that as we went through the very difficult discussions on Bill C-14, within the Catholic community in Guelph, to which I belong, there were a lot of concerns around advance directives and conscience rights and the protection of conscience rights within the Catholic community in particular. I remember that at the time I was asked a few times whether we were going down a slippery slope.

I want to be able to say to my community that we are looking to handle this legislation in a compassionate way that protects rights, but I would rather hear it from the minister so that I can take an authoritative comment on that back to my community.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I too am a practising Catholic, so these kinds of questions are very important to me.

This is about choice and reducing suffering. These are choices that have already been made. The pun is not intended. The point in the first scenario, in the known scenario, the end-of-life scenario, is to ease restrictions that were not doing any work. In the non-end-of-life scenario, the point is, again, to make sure that informed choice happens. That is why we think we have struck the appropriate balance.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I would like to seek unanimous consent to split my time with the hon. member for Mission—Matsqui—Fraser Canyon.

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

Is that agreed?

[Some hon. members]

Agreed.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, it is a great pleasure today to rise as the shadow minister of justice for the official opposition to speak to the government's Bill C-7. As I rise to speak on this bill, I do so with concern over some of the contents within it and even over the way it was presented to the House this week when, unfortunately, many of us read about the contents of the bill in the media, rather than seeing it first in this House.

The bill was intended to be a response to the Quebec Superior Court decision that was made on September 11, 2019. The decision stated that the law as it stood was too restrictive around the requirement for death to be reasonably foreseeable. The official opposition called on the government at the time to appeal the decision to the Supreme Court of Canada in order for Parliament to receive clarity about the parameters in which we would legislate, but the bill was introduced without that clarity.

Not only was the bill introduced without that clarity, but it goes far beyond what was required to meet the Quebec Superior Court's decision. I believe that is an affront to this Parliament, because when the previous bill, Bill C-14, was passed in the 42nd Parliament, the wisdom of this Parliament required that there be a statutory review of our assisted dying regime in Canada. That statutory review was and is to take place in June of this year.

It is in that review period that parliamentarians would be able to go more into depth on how the government's legislation has worked over the past several years and on how best to proceed. Rather than wait for that review, as it should have done, the government has decided to start making amendments to the legislation now, avoiding the in-depth review that is to take place shortly.

The reality is that when we are talking about this legislation, we are literally talking about the matter of life and death. This is an incredibly sensitive issue. Members on all sides of the house have diverse opinions on it, and it is because of this diversity of opinions and because of the sensitivity of this issue that the Quebec Superior Court decision should have been appealed to the Supreme Court of Canada for further clarity. However, as the government has now opened this legislation up, it is upon us as legislators to now highlight other matters that should be addressed and included.

My office has heard plenty from concerned Canadians about the lack of protection for conscience rights for health care professionals. This is particularly important now that the government is broadening medical assistance in dying to include individuals whose death is not reasonably foreseeable. Expanding medical assistance in dying to more patients could in fact diminish the number of medical professionals willing to take part in the process. The fact is that this expanded access could result in a heavy emotional burden on those health care providers.

None of us here can fully appreciate the burden put on those health care providers currently working in the system and providing medical assistance in dying. The fact is that there is nothing about ensuring proper support to health care professionals who provide this service and there continue to be no penalties for pressuring a medical professional into providing medical assistance in dying, nor are there penalties for punishing or penalizing a medical professional who does not participate in medical assistance in dying. This means there continues to be no real protection for conscience rights for health care professionals.

The issue of advance directives, now rebranded as a “waiver of final consent” by this government, is a complex one that poses questions of ethics and safety and issues with oversight. The fact that the legislation legalizing this is half a page of a bill shows a lack of care given to this issue. This issue rightly should have been discussed as part of the parliamentary review to take place this summer.

The process for the creation and execution of this agreement remains ambiguous. Further, there is a lack of clarity on the process for proceeding with an advance directive agreement upon the date selected. The process will only be stopped if a patient expresses a form of resistance, but we do not know what that looks like. What if they are simply confused or groggy at the time? Under the legislation, unless they resist, the process will still proceed.

The bill also removes the 10-day waiting requirement when a person's death is reasonably foreseeable. When I read in media reports before the bill was tabled that this would be included, I, like many of many of my colleagues and parliamentarians, questioned as to what prompted its removal. I still remain incredibly concerned as to why this was included. This is particularly true because there was already the ability to remove the 10-day waiting period if a person's death or loss of capacity to consent was imminent, so why proceed with the removal of a safeguard that Parliament saw fit to include in the previous legislation?

It is also confusing that Bill C-7 requires a 90-day waiting period when a patient's death is not reasonably foreseeable. Why add an extended wait period for one, but remove the wait period entirely for the other?

On the issue of whether a death is reasonably foreseeable or not reasonably foreseeable, there is no clarification or guidance for health care professionals. As a result, it is not up to them to make the determination as to what category to put a patient under. That determination will decide whether a patient can access medical assistance in dying immediately or if they will require a 90-day waiting period. This is an extraordinary amount of pressure that the government is putting on health care professionals across this country.

The changing of witness requirements under this legislation has also been mentioned. The law requires only one independent witness, which is down from two.

All of these changes lead to an expansion of the law in Canada far beyond what was addressed in the Quebec court decision, an expansion that should have required deeper reflection through the study that is to take place this summer.

For a moment, let us speak to a point that seems to be lost in this conversation: palliative care services in this country.

The reality is if the choice is between a lack of quality palliative care and medically assisted dying, that really is no choice at all. Unfortunately, over the past number of years there have been instances of patients feeling they were forced to choose death because of a lack of palliative care.

The story of Archie Rolland comes to mind. Archie was a Montreal landscape architect who chose to end his life rather than continue suffering at a long-term care facility that was failing to provide him adequate care.

He had ALS and had his life upended when he was forced to move from a Montreal hospital that specialized in treating patients with severe respiratory ailments to a long-term care facility for geriatric patients. Mr. Rolland did not want to go, but he was transferred against his wishes. He called the system “inhuman”. He felt he was not getting adequate care, so he chose death.

I do not think that this is any real choice at all. We must have the discussion in this country about palliative care because people must not feel forced into a decision on medically assisted death. Mr. Rolland's story makes it clear that there was a failure of the system to provide him with adequate care. We risk medically assisted death being seen as some sort of bureaucratic solution for people who require an extra level of care. In a country like Canada, that is simply not acceptable. The government risks expanding a culture of not valuing life, and we should all agree in this place that we must place value on human life.

In closing, the bill disrespects Parliament and the parliamentary process. With Bill C-14, parliamentarians did a significant amount of work in the House and committee in an attempt to build consensus. The work was challenged by the Quebec Superior Court, but rather than defending the will of elected representatives in court, the Liberals immediately backed down.

Now the Liberals are responding not just to that decision but are also undoing the work of the joint committee on Bill C-14 by adding new measures.

Many of these issues should be dealt with in the summer when we have our scheduled parliamentary review. This is a complex matter that requires proper scrutiny and debate.

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

Madam Speaker, I thank the member opposite for his contribution to today's debate and I welcome him back to the House.

I will begin by correcting about five errors in the member's speech and then I will ask him a question.

The first point is with respect to the Truchon decision. It was not appealed, first because we agree with the substance of the decision and secondly because we disagree with prolonging the suffering of Mr. Truchon or Ms. Gladu or people like them.

The second point is with respect to health care providers and the potential of a chilling effect being exacted upon them. It is a valid point, and that is why we have entrenched important safeguards in the legislation, such as the requirement for advanced consent to be done in writing.

The third point is on people being pressured as medical practitioners to engage in this practice, which is patently false. Bill C-14 has conscience rights entrenched in its preamble and in the body of the bill, and the Carter decision, in its penultimate paragraph, said that the charter protections under section 2 for freedom of religion does not compel any health care practitioner in this country to provide this service.

With regard to the member's attempt at an analogy between the 90-day assessment period and the 10-day reflection period, they are different qualitative matters. Reflection is not assessment.

The member raised a very valid point about palliative care. We agree and understand that palliative care must be robust and we fully support the idea, which is why this government put $6 billion into home care, including palliative care, two budgets ago. Does the member agree that this was a useful investment?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I thank the parliamentary secretary for his question. He covered a lot of ground.

If the government agreed with the decision, and that is the basis for not appealing it, then why was that not in the original legislation to begin with?

All too often we see on the other side of the House a willingness to let the courts do the work that is rightly the work of Parliament, and we are seeing that again here. One court decision is made in one province, and then the government will hide behind that decision rather than appeal it to the Supreme Court of Canada as it should.

Now the government has brought in legislation that goes far beyond what this court was dealing with, which is reasonable foreseeability of death. That again should have been dealt with in the review that is coming up this summer, when all parliamentarians can get input from their constituents and from experts on this issue.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, I would draw the member's attention to what is known as Audrey's amendment in the legislation. One of the challenges is the requirement for final consent at the time the assistance is rendered. This forces a lot of people who have already been assessed and approved for medical assistance in dying to make a very cruel choice when they are faced with the possible loss of competence, which would make them unable to give consent. Sometimes they are forced to go earlier or risk not being able to receive the assistance they need in order avoid continuing to live with intolerable suffering.

I wonder if my colleague can inform the House if Conservatives support this particular aspect of the bill, which would demonstrably help people who are facing end of life avoid this cruel choice.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, in Bill C-14 from the previous Parliament, the decision was made not to include advance directives, meaning that someone would have to give consent at the time of medically assisted death. That is why, in the previous legislation, someone would have to consent and then give a further consent at the time of medically assisted death.

The bill before us would change that. This is a major expansion of Canada's laws on assisted dying. It was done under the premise of a response to an unrelated court decision in Quebec.

There is a reason parliamentarians and the House put in place a statutory review of this regime: so that we can consider new measures and look at what is working and see what is not working. This is why the whole discussion on this aspect of consent should have been done in the course of the statutory review.

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

It is my duty pursuant to Standing Order 38 to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Brandon—Souris, carbon pricing; the hon. member for Nanaimo—Ladysmith, indigenous affairs; the hon. member for Battlefords—Lloydminster, agriculture and agri-food.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, when this House opens most days, we take a moment to pray, reflect and ensure our words and our jobs of representing Canadians are done to our utmost ability. We are honoured to be in the people's House. My personal prayer today is that my words reflect the severity of Bill C-7, a very serious subject.

I have been closely following the Liberals' terrifying progress as they work to embed the practice of efficient death in our medical system. In January they held MAID legislative consultations online for a total of only two weeks; two weeks to hear from the public on legislation that is truly a matter of life or death.

There is a mandatory five-year review set for this June for our MAID law, but instead of working within that timeline, the Liberals have let one ruling from one Quebec judge dictate the legislative direction for the entirety of Canada. At minimum, this issue should have been referred to the Supreme Court of Canada.

I am fearful of the current justice minister who voted against MAID in the previous Parliament, not because he was against it, but because he felt it did not go far enough. That is the driving force behind some of these drastic changes.

As the Liberals have just tabled the bill this week, I have only had a short period of time to begin digesting it. I need to stress to the House today that these are my preliminary thoughts. In my opinion, this is a needlessly rushed process on a sensitive, significant issue that does touch every Canadian.

For the first four months of my term, I have heard from many concerned constituents, advocacy groups, differently abled individuals and organizations, and those in the medical profession.

What I need to emphasize at the outset of my time here tonight is the innate value of every human being, regardless of ability. I want to speak directly to those who are in physical pain, those in mental anguish and those who feel they are a burden. Everyone is loved, everyone is valuable and everyone is made in the image of God. There is a place in our society for patients in unbearable suffering with no possibility of recovery to be provided with end-of-life options. We owe this to Canadians. Autonomy and personal wishes do need to be respected.

There is a paradox, in that suffering is both hard and good. Everyone who suffers deserves our love, our care and access to appropriate palliative care. I will touch on palliative care in a moment, but presently I will address this bill, raise some of the concerns I have with it from my initial reading and voice the concerns of those it affects directly from whom I have heard, including our medical professionals and the vulnerable or disabled of our society.

Numerous organizations like Canadian Physicians for Life and Canadian Society for Palliative Care Physicians have raised numerous significant issues with Bill C-7. The organizations cite specific concerns with clauses of the bill and also relay an overarching general concern about how the proposed legislation erodes the trust that vulnerable people should be able to have in the medical profession.

We seek out medical aid when we are at the lowest, most vulnerable points in our lives. Vulnerable Canadians must be able to find protection within the medical community. In an ironic, tragic twist, the preamble of the bill recognizes the importance of protecting vulnerable persons from being encouraged to end their lives, but does nothing to support what should be foundational in our health care system.

The bill itself drops many of the already too few safeguards around MAID and places vulnerable people at an increased risk.

Point one is that the reasonably foreseeable natural death criteria has been removed, which would drastically reinvent MAID. It would no longer be an alternative to a painful death, but an alternative to a painful life.

Point two is that independent oversight has been reduced. Where two witness signatures were previously required on a patient's written request for MAID, the requirement would now be one. The bar would be lowered even further as that individual, that supposedly independent witness, can be the person paid to take care of someone, that is, medical staff.

Point three is that disturbingly, Bill C-7 also does away with the previous 10-day waiting period for those whose natural death is reasonably foreseeable.

Under Bill C-7, one could be diagnosed and killed all in one day, with no opportunity for reflection or discussion with friends or family members. That is what this bill would do.

Point four is that the bill would also legalize physician-assisted suicide by advance request through a waiver of final consent and drop the requirement for consent to be given twice before MAID is performed. The existing law requires consent at the time eligibility is granted and again before termination of life occurs. Under the new law, once consent would be given, there would be no need for medical staff to confirm it before administering a lethal injection.

Can someone consent in advance to being killed once they reach a state they fear but which they are not experiencing now and, in fact, have never experienced? Once a person has signed an advance request and has lost capacity to consent to medical treatment, at what point should euthanasia take place? At what point should a person be killed?

In a technical briefing yesterday, officials were pushed to explain how MAID would be administered and what safeguards would be in place for the day, the hour, the minute euthanasia would be carried out. Shockingly, the legislation would only require one medical practitioner to be present. Therefore, even if an individual attempted to withdraw consent, there would be no mechanism to ensure their wishes were respected. One medical professional should not be permitted to conduct euthanasia alone. This would not ensure accountability and, in my opinion, is completely unacceptable.

Additionally, there is no provision for individuals to be able to seek doctors who would not counsel MAID as a treatment option. In fact, there is no mechanism for physicians to opt out of providing MAID or any conscience protections for medical professionals who refuse to participate in MAID or do not wish to refer a patient.

We are seeing this in British Columbia, where the Delta Hospice Society has been denied funding for refusing to offer MAID services. With this in mind, how then are individuals able to trust that the doctor will really care for their well-being? The frightening thing is that pro-MAID health care providers are not waiting for people to raise the possibility of euthanasia. In fact, we are hearing first-hand accounts of individuals who have been encouraged to pursue this option unprompted.

What about section 241 of the Criminal Code, which counts it an offence to counsel a person to commit suicide? Those staring at the precipice of potential death should not have the entire medical establishment looming behind them to pursue a certain option.

This brings me back to palliative care and the dismal record on caring for Canadians at end of life. There is nothing in the bill and little tangible government action taken to approve access to palliative care. The Conservative dissenting opinion from the committee's review of previous MAID legislation states, ”A genuinely autonomous choice for a person to end their life is not possible if they are not offered palliative care as they will see their choice as only intolerable suffering or PAD [physician-assisted death].”

The Canadian Hospice and Palliative Care Association estimates that fewer than 30% of Canadians who need it have access to palliative services. The Conservative Party recognized this need in its 2019 platform and a Conservative government would implement the framework on palliative care in Canada.

As I referenced the Canadian Hospice and Palliative Care Association, I need to make one its points crystal clear, which is that MAID is not part of hospice palliative care. It is not an extension of palliative care, nor is it one of the tools in the palliative care basket. Health care articles, the general media and, sadly, politicians continue to conflate and thus misrepresent these two fundamentally different practices.

Hospice palliative care focuses on improving quality of life and symptom management through holistic, person-centred care for those living with life-threatening conditions.

In conclusion, at my first reading, I am disappointed to say that the Liberal government's proposed legislation to amend MAID sadly misses the mark on many levels. It had the opportunity to increase safeguards for the vulnerable, provide conscience right for medical practitioners, implement protections for those living with mental illness and address many more legislative inadequacies. I hope that in the spirit of this minority government the suggested amendments coming from all sides of the House will be welcomed graciously and thoughtfully.

To my constituents, I am opposed to these changes and will urgently seek their feedback. Many of them live with stories and experiences on both sides of this issue and I need to hear from all of them.

To reiterate, to those who are in physical pain, who are in mental anguish and who feel they are a burden, they are loved, they are valuable and they are made in the image of God.

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

Madam Speaker, I am going to offer four clarifications and then ask the member a question.

The first clarification is that, with respect to the conscience rights and whether they exist, they do exist in three places and I outlined them already: in the preamble, in subsection 241.2(9) of what was then C-14 and in the Carter jurisprudence. I think that is important, because this member is urging us to return to Supreme Court jurisprudence.

The second is about withdrawal of consent. Can it be done? Yes it can, through non-verbal means. That is entrenched in this bill.

The third is that the notion that people can die “all in one day”, and I am quoting the member opposite, is actually patently inaccurate in terms of the empirical evidence. There are two independent medical practitioners, completely divorced from the people who verify the identity of an individual, who determine the eligibility. Those people take some time to do so. It does not happen “all in one day.”

Finally, the issue about the independent witness going from one to two is simply to reduce one of the barriers.

If the concern is for ensuring that the autonomy and dignity of all individuals are entrenched here, does the member opposite agree that when the court, in Carter and in the Truchon decision, talks about ensuring that intolerable suffering is no longer continued, and that the dignity of those people who are making a personal choice about how they choose to exit this life should that be respected in the context of this legislation?

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, this legislation was tabled on Monday. We are Wednesday in the House of Commons, and the changes being made are so drastic that all sides of this House need to take time to properly understand the impact of what is before us today, and properly understand that this is going to change our society in major ways. We do not know the full effect of what is going to take place now.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I was listening to my Conservative colleague and wondering whether I had understood him correctly and whether the interpretation had faithfully rendered his argument.

I heard that the medical establishment would push for death in the case of someone who is terminally ill. If the medical establishment could do what my Conservative colleague is suggesting, that would constitute criminal wrongdoing and the perpetrators would be immediately discharged. There are codes of ethics for that. I am not sure if that is what the hon. member was saying or if the interpretation was inaccurate.

I agree with my colleague that palliative care is needed. However, is he claiming that palliative care is the answer in every case? Does he know that palliative care does not adequately relieve pain and suffering in some terminally ill patients?

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, what I was referring to was what I heard in my riding, that medical practitioners were raising MAID without MAID being raised by the patient. That is what I was referring to.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Madam Speaker, the hon. member had mentioned that we should be informed in the House. I am wondering if the hon. member thought it would be wise, perhaps prior to the release of the legislation to the media, for the government to provide us with the results of their consultation, because I do not believe we have it.

Would that consultation be helpful for us?

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, yes, I think it is irresponsible on the part of the government to have tabled this legislation without hearing back from Canadians. As I mentioned in my remarks, two weeks for Canadians to respond to such important legislation was not sufficient, especially when we compare the all-party process of 2016 with what is happening now. This is not acceptable for Canadians, and I know for a fact that more Canadians wanted to have a voice on this. Canadians from all sides of the issue wanted to be able to share their perspectives with the government in good faith, and they were not given that opportunity.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, it is with some emotion that I rise in the House today to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

We are debating Bill C-7 today because the legislators who were here four years ago did not do their job properly when they debated Bill C-14. We do not live in a democracy run by judges. We are the ones that make the laws and who must make the voices of citizens heard, particularly the voices of those who are suffering. All judges do is interpret the grammar of justice. They look at the laws and people's rights and freedoms and determine whether the infringements are reasonable or not. However, before Bill C-14 was introduced, two courts told us that, according to the law, the Criminal Code infringes on the right to life and the right to liberty and security of those who are ill and suffering, are struggling with unbearable pain or have a terminal illness.

Today, I hope that we will seize the opportunity that is given to us. I hope that we will extend the debate until June because this is a serious subject. I hope that we will have a calm, rational debate.

I will start by saying that I am sure my colleagues in the House all have good intentions. They want to do good. They have kind hearts. I am sure that their behaviour throughout the debate will reflect the very values they are advocating, namely benevolence and caring. However, we cannot be benevolent and want what is best for a terminally ill person if we refuse to listen to what that person has to say before they die.

All I want is for us to understand what is at stake here, I am referring to the law, which my Conservative friends have always put on a pedestal. The value of autonomy is conferred by law through the principle of self-determination, especially with regard to medical care. I will come back to that.

I will take a moment in this debate on such a crucial and delicate issue to say that I hope all my colleagues get to cross the threshold of death peacefully, quietly and painlessly. That is my wish for everyone, because the best fate we can wish on another human being is to find peace, to let go and to receive what is known as good palliative care if they are terminally ill with an irreversible ailment. More on that later.

Today we are discussing the autonomy conferred by law through the principle of self-determination. In the biomedical context, there is a rule. A value gives rise to a principle, which in this case is self-determination. This principle gives rise to a specific rule, namely the rule of free, informed consent. The rule about free, informed consent to treatment has never been challenged in emergency situations.

Why would it be any different for human beings experiencing intolerable suffering due to an irreversible illness or condition?

Why would it be any different for competent individuals who are neither depressed nor suicidal and who have expressed a desire to live fully until they reach the limit of what they can tolerate?

I therefore invite my colleagues to join me in a debate on autonomy and self-determination. If someone shows up at an emergency room, they cannot be treated without their consent. Everyone has the right to refuse treatment, by the way.

In the Carter decision, which led to Bill C-7, the Supreme Court ruled that the provisions prohibiting medical assistance in dying violated the right to life, liberty and security of the person. People like Ms. Gladu, Mr. Truchon, Ms. Carter and Ms. Taylor have not reached the end-of-life stage. They might not even be in the terminal phase of their illness. That does not mean they have not reached, or are not in the process of reaching, the limit of what they can tolerate.

The court stated that those provisions were effectively shortening the lives of such individuals, that they violated their right to life by inciting them to commit the act before they were ready. That is the issue that we are called upon to address. There is no issue for people who are terminally ill. The issue we need to address as legislators has to do with people whose death is not reasonably foreseeable and imminent.

The bill proposes that a person who is not terminally ill must consent twice and be bound by a 90-day period. I really wanted to talk about advance consent. I imagine we will do so eventually. That is about all that is missing from the bill. Clearly the Bloc Québécois is in favour of passing this bill in principle.

What we want is respect for the moral autonomy of the dying. We often speak of dying with dignity. Dying with dignity does not mean having a sanitized death. That is not it. The dignity of a person is derived from their freedom to choose and respect for their free will. That is what it means to be a human being. When that is violated, we violate the dignity of the human being. Whether the death is unpleasant or not is not the issue. The crux of the matter is to allow the human being to make a decision about the end of their life.

Unfortunately, in the past, we won the right to die rather than undergo aggressive therapies. At the time, we called this passive euthanasia. The person was left to die without death being the intent. Palliative care was still in its infancy. There was a great fear of administering one last fatal dose of medication, which always ends up causing death, because palliative care provides care.

Human beings won the right to die rather than undergo aggressive therapies. People did not die of cancer; the therapies killed them. Experiments were conducted on human beings. Doctors led the way to ensure that they would have quality of life if they were to be struck by cancer. They did not want to receive treatments that would make them ill for a year when they only had two years to live.

The right to die won out over aggressive treatment plans. That idea evolved and became palliative care.

For a long time, palliative care was thought of as the only solution that would allow someone to die with dignity. However, in the past 30 years, were there people living with terminal illnesses, dying a slow, agonizing death, who did not receive all of the palliative care they needed until the end of their life, if that was what they wanted?

First, we need to look at whether palliative care is accessible. There is an increase in requests for medical assistance in dying. Bioethics talks about clinical ethics, in which the patient comes first. It is about listening. Sometimes, even the best palliative care in the world, with the best framework in the world, cannot alleviate someone's suffering.

That is true for Ms. Gladu and for Mr. Truchon, but those people are not suicidal. They want to live as long as possible. When they want to die, they may be given anti-depressants. They will be of sound mind when they make their decision. That decision will be reversible. I was listening to Ms. Gladu the other day. What does she want? She wants freedom of choice. In many cases, once people have that choice, they have so much respect for their dignity that they are no longer in such a hurry. That reduces suffering tremendously. That is the issue we are dealing with.

We must not sidestep this issue on the grounds that we want to move swiftly. I have a lot of questions about the bill because it does not address degenerative cognitive disease. I think a person with Alzheimer's should have the opportunity to make an advance request.

These are predictable diseases. Doctors can tell patients how they will progress. People with these diseases often remain of sound mind for years. Eventually, they become forgetful. In the end, they die not of the disease itself but of complications from being bedridden or immobilized or conditions other than that disease. This bill does not take those people into account.

What I would hate is to see a repeat of what happened with Bill C-14. The reasonably foreseeable natural death criterion was established, and it was supposed to protect vulnerable people.

Is there anyone more vulnerable than someone who is suffering from intolerable pain, who is living with an incurable illness and who is being told to go to court for the right to choose and to die with dignity?

Is there anything more important and more intimately personal for an individual? It is not as though the person's neighbour is going to die for them.

I have a hard time understanding our Conservative colleagues' argument that the state must decide for an individual, when they are so economically libertarian.

In 1957, Pope Pius XII was a pioneer. He said that we must stop claiming that only God can decide whether we should die a slow death. At a certain point, he made it possible for us to sanction palliative care.

Today, let us not pit palliative care and medical assistance in dying against each other, regardless of whether we are talking about a degenerative disease or an illness that causes extreme pain but is not terminal. Let us not pit those two realities against each other. Respect for human dignity includes proper support when one is dying, which requires doctors to have the humility to recognize that they cannot always help people manage their pain adequately.

Our society recognizes people's right to self-determination throughout their lifetime but takes it away from them at the most intimate moment of their lives. In so doing, we think that we know what is best for people or that we are doing the right thing, when we are actually undermining human dignity. There is no more important moment in a person's life than their death. Learning to live is learning to die. Learning to die is learning to live. I say that because the clock starts ticking the moment the doctor cuts the umbilical cord.

I appeal to my colleagues' humanity. I am a staunch democrat, humanist and, of course, sovereignist. I am all of those things, but one does not take precedence over the other when it comes to problems like this.

I am not saying that the federal government should have challenged that ruling because it came from a Quebec court. In any case, it is a court under federal jurisdiction that rendered that decision.

This ruling challenges us as legislators to do our job and stop off-loading the problems, the ethical, social and political questions to the courts. We have a job to do as legislators.

There is a sociology of law. In a society, the law evolves with people's consciences. I know I am straying from the technical details of the bill. However, I said from the outset that we agree in principle and on the grounds for discussion of this bill. I apologize for being overly philosophical today, but that is where the substance of the debate lies; it is ethical and it is political in the noblest sense of these words. Indeed, it is up to us to make the laws to ensure the well-being of all. It is a philosophical debate and, in a way, a theological debate that leads us to the law. However, regardless of how much time we spend on this, let us use substantive arguments.

When I hear arguments to the effect that this is a slippery slope, I think about the study of Bill C-14, during the last Parliament, when some people were practically saying that nursing homes and long-term care facilities would become euthanasia machines. I do not know of any evil people who work in health care, in any position. If such a person exists, then let them be fired, because they have no place there. I am not buying the slippery slope argument.

We must assume from the outset that all stakeholders in the health system are caring and compassionate. Yes, they sometimes experience difficulties. With just a slight increase in health transfers, they could provide better care and there might be more palliative care units in hospitals. Even though I do not believe that palliative care is the only solution, that is what people have been saying for 50 years. It makes no sense that there are not more palliative care units.

Not everyone asks for MAID. I talk a lot about those who do not pose a problem. In Quebec, where the Quebec law is in effect, the obligation to meet the criterion of a reasonably foreseeable natural death forces people to go to court or to go on hunger strikes. This criterion was unconscionable, and the courts handed down an appropriate ruling in that regard.

Therefore, I appeal to my colleagues' humanity.

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

Madam Speaker, I truly appreciated my hon. Bloc Québécois colleague's speech. He spoke very eloquently about the balance we hope to strike between protecting the vulnerable and respecting the dignity and autonomy of people who want more control over their manner of dying. The member mentioned that.

I also want to point out that medically assisted deaths accounted for only 1.89% of all deaths in Canada in 2018. I would like to ask the member a question that was raised by the member for Mission—Matsqui—Fraser Canyon. He said that we did not listen carefully enough to what Canadians want. In fact, we launched a questionnaire that garnered 300,000 responses, most of which supported expanded access to medical assistance in dying.

What does the member opposite think Quebeckers and Canadians want with regard to the possibility of expanding access and eliminating obstacles to medical assistance in dying?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I think the government was sort of playing with fire with respect to the time frame. We do indeed want an extension. I think the debate that is starting today will help the courts give us that extension. After all, the courts do not make the law, and I think it is worth spending at least four months on this.

I think we can get this done because we have experience. We dealt with the issue of medical assistance in dying as part of end-of-life care. Quebec did that without having to amend the Criminal Code. Then the Carter decision came out. I am eager for the committee to be set up. I think we can produce a first draft that I hope will be followed by a review of the legislation focusing on sensitive issues, which could be done immediately after a bill is passed.

I am quite pleased that the government was wise enough not to extend medical assistance in dying to individuals with a mental illness. However, the problem has not been resolved. When someone continues to suffer, despite years of treatment, to the point where they are considering death as the only possible relief, that is a failure for the medical profession in terms of mental health. There is no palliative care in mental health. This issue needs to be raised and addressed. Although I am pleased that it was not included, I do think it warrants careful analysis. That is why I proposed that the Standing Committee on Health examine the issue. We will see whether my colleagues agree.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, the speech of my colleague from the Bloc was very passionate speech. I very much enjoyed listening to it.

When we looked at this issue in the previous Parliament, what was very clear back then was the Carter decision. What was very clear back then were the recommendations of the special joint committee. What was not very clear was why the government at the time had inserted the clause that required a reasonably foreseeable death. During my speech on Bill C-14 in 2016, I knew that clause would force us to come back and revisit this issue.

Parliament did look at this issue, we did deliberate and a number of parliamentarians at the time identified this as a problem. Then I see the Truchon decision, and that simply forces Parliament to clean up its act, to actually get the job done properly this time.

Who are we to impose our values on people who have gone through the suffering, who are being forced to live with these medical conditions? We have no idea what kind of a world they are living in. The member is very right that it is about treating their life with dignity and also allowing them to die with dignity in what is an incredibly personal choice.

I want to get my colleague's thoughts on a particular section of the bill that sets the assessment period at 90 days. For someone whose death is not reasonably foreseeable, but is facing intolerable suffering, what does he think of the 90-day period? The New Democratic caucus has already heard from physicians who have great concern that they may have to force their patients to wait an additional 90 days when it is already quite obvious the suffering is very grave.

Could my colleague provide us with his thoughts on that section of the bill?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, we will need to look at this scenario in detail. Earlier I said that the patient comes first.

My Conservative colleague claims that it would be possible for everything to happen in one day. That is not how it works. I did support eliminating the 10-day waiting period, however. We need to get this right. Depending on the illness in question, there will have to be a process. It is a matter of prevention.

What is the current process? Take Ms. Gladu, who, if I am not mistaken, said in her interviews that she is going forward. For her, another 90 days will be complicated. She is suffering. However, for someone who has just been diagnosed, the 90-day period is completely acceptable. There will have to be some flexibility.

Renowned bioethicist David Roy said that the patient comes first and that clinical studies are opportunities to hear what patients are saying. These studies allow us to make humane adjustments, in line with rules and legislation, to an individual's end-of-life care.

I am open to looking into all of that. Even though it appears simple, a discussion about days, about a 30-day waiting period, is very complex.

I hope we will be able to count on my colleague's support to improve the bill.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, the member's presentation was very thoughtful and intelligent. He has presented us with a very personal choice that each of us will have at some point in our life and death experience, some of us through suffering and some of us through other ways. I am sure we will be passing in different ways.

However, there is the protection of people who might have to make a decision based on their experience, based on where they are in their life, then coming to the end through suffering. I was with my mother when she was going through some of the struggles of the end of life experience and she really had trouble with the final moment.

Could the hon. member talk about our role in the decision-making process as members of Parliament, in which we try to represent different experiences of faith, different experiences of people, different experiences of suffering, and the role we have in providing freedom of choice for the people we are representing?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, at this point, I do not see anything in the bill that disregards or disrespects any faith.

Some people decide to die with the help of palliative care and nothing else. That kind of care can slow down the dying process. Sometimes people are admitted in an emergency and get sent home because the care is so good their condition improves.

People will have a choice. This is about freedom of choice. Both options will be available. People will exercise their free will and their freedom of choice. That is truly what it means to respect a person's dignity.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, it is quite incredible to be revisiting this issue. I can remember when the debate on Bill C-14 went on, back in 2016. There were some amazing speeches uttered in Centre Block during that time. This truly was an issue that had a profound effect on so many members in the chamber but, we know, also on so many members of our society.

I was honoured in 2017 to serve as our party's justice critic. I am pleased to again be serving in the role as the deputy justice critic for the NDP. I have always felt that this particular critic role brings with it a very great weight of responsibility, especially when we are dealing with the Criminal Code. I do not think there is any other statute in Canada that has such a profound effect on people when they violate any of its provisions. It also gives a lot of guidance, as is the case in medical assistance in dying, over the parameters that are set up.

Regarding medical assistance in dying I, like many members in the chamber, received a lot of correspondence on the issue back in 2016, both from constituents who were against it and from constituents who wanted me to take up the cause.

I think that is the challenge that we as members of Parliament face on a regular basis. We have to look at our constituents' wishes, but they are not always very clear cut. We have to try to balance those with our own personal views on the subject and, at the end of the day, try to be accountable for the decisions we have made on behalf of our constituents in this place.

When it comes to an issue as complex as medical assistance in dying, I fundamentally believe that we must go beyond partisanship and work together with a compassionate lens. Ultimately, we must make sure that Canadians can die with dignity, compassion and fairness, and without excessive suffering.

I am pleased to see the introduction of Bill C-7 as part of the effort to help those who are looking to end their unnecessary suffering as they face the end of life. Bill C-7 is coming to us as a result of a decision in a Quebec court. For me personally, and for many members of the New Democratic caucus, it was quite evident in 2016 when we were debating Bill C-14 that this issue would come back to us. We knew it was only a matter of time.

I can remember referring, in the debates on Bill C-14, quite clearly to the Carter decision, which was handed down by the Supreme Court on February 6, 2015, in the final months of the 41st Parliament, when the Harper government was in power.

When the present Liberal government came to power in 2015, this was one of the major challenges it was faced with, because there was an impending deadline and there was a real rush to get in legislation that was going to respect the Carter decision.

I want to give a shout-out to two of my colleagues, Murray Rankin and Brigitte Sansoucy. As members of the New Democratic caucus, they sat on the special joint committee that looked at this issue as a result of the Carter decision, and presented the committee's recommendations to the House of Commons.

When we look at the Carter decision, which really started this whole process rolling just over five years ago now, we can see that they felt the prohibition on allowing people to take their own lives because of suffering violated their Charter rights. I will just quote from the ruling. It was stated that:

Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

It went on to say:

An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.

Thus, it violates section 7 of the Charter of Rights and Freedoms. Just to read it into the record, so that everyone is quite clear on what we are referring to, section 7 reads that:

Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

What Carter was clearly explaining to people was that by not allowing people this option, by keeping them in a state of constant suffering, of basically confining them to their bodies, we were in fact violating their section 7 rights. That was the clear message that was delivered to Parliament.

There is always a careful dance between our courts and the legislature. The courts, of course, are very much responsible for interpreting the law, but also finding when such a law runs contrary to our Constitution. They also recognize that Parliament has its role to play as the lawmakers, as the one institution that can amend the law based on people's wishes. That was the task that was handed to us at the beginning of the 42nd Parliament.

When that special joint committee with the other place was formed, there were some clear recommendations that directly followed from the Carter decision. Recommendation number two, which I will read into the record, was as follows:

That medical assistance in dying be available to individuals with terminal and non-terminal grievous and irremediable medical conditions that cause enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

The problem that led us to where we are today was the fact that Bill C-14, as a government bill, decided to insert a reference to “reasonably foreseeable death”. This meant that if one had a medical condition for which death was not reasonably foreseeable, one could not qualify for medical assistance in dying.

Also, as a part of that special joint committee's recommendations, it did touch on the subject of advanced directives which is also, I am glad to see, addressed in Bill C-7.

The Truchon decision of 2019, in the Superior Court of Quebec, involved two plaintiffs who were each suffering from grave and incurable medical conditions that caused tremendous suffering and a total loss of autonomy.

They were 74-year-old Nicole Gladu, who used a wheelchair and had post-polio syndrome, which is a condition that weakened her muscles and reactivated her childhood scoliosis. She had difficulty breathing and was in constant pain. As well, there was 51-year-old Jean Truchon, who was born with cerebral palsy and no longer had the use of his four limbs. He lost the use of his only working limb back in 2012, due to severe spinal stenosis that left him almost completely paralyzed and caused painful spasms. He gave up most of his activities and went into assisted living since there was little he could do by himself.

Both of these individuals were refused medical assistance in dying under the Quebec legislation regarding end-of-life care as they were not at the end of their lives. Their deaths were not reasonably foreseeable.

With those grave medical conditions, they were prisoners in their own bodies but unable to find any relief. Really the heart of the matter here is how we, as an institution, respect individual autonomy. We can only imagine the pain and suffering they were going through on an hourly basis. When two individuals have arrived at this decision and obviously had the time to think about it, I think it is incumbent upon us to respect that, but more importantly to respect the fact that we have had a court look into this and determine that their charter rights were fundamentally violated.

That brings me through the long journey over the last five years to Bill C-7.

I am pleased to see the bill introduced. The Minister of Justice was one of four Liberals who voted against Bill C-14. I think he is now have a moment where it has come full circle. Now, as the Minister of Justice, I hope he feels some satisfaction in bringing in corrective measures to address the problems he saw as a Liberal member of Parliament back in 2016, when he voted against the government's legislation at the time.

As is required by the decision of the Quebec court, Bill C-7 will expand access to medical assistance in dying to those whose death is not reasonably foreseeable. I can assure the House that we are providing our support to the bill in principle at second reading. However, we will be doing our due diligence when it reaches the Standing Committee on Justice to ensure that access to medical assistance in dying has not been unreasonably restricted for those whose death is not reasonably foreseeable by the addition of the new conditions in the legislation.

We also want to ensure the standard of eligibility for receiving medical assistance in dying remains high. We remain disappointed that there has been no commitment by the minister to refer the question of the adequacy of the safeguards against pressure to seek medical assistance in dying to the formal legislative review, which will begin in June, again at the Standing Committee on Justice. Perhaps the government can hear those words, reflect upon them and address our concerns with respect to that aspect.

Going into some of the finer details of the bill, essentially there is a two-track process in Bill C-7. There is one for those whose death is reasonably foreseeable and one for those whose death is not reasonably foreseeable.

For the one where death is reasonably foreseeable, the 10-day waiting period is removed; the number of independent witnesses required for the written request is reduced from two to one; a paid professional or health care worker can be an independent witness; and the creation of a waiver of final consent.

For the second track, which is ultimately the part of the bill that is responding to the decision from the Quebec court, a few more restrictions are in place. The first big one, which will warrant some further study at committee, requires a minimum 90-day assessment period, which I think the legislation states can be shortened if loss of capacity is imminent and the assessments have been completed.

However, as I have said in previous questions and comments, we have already heard from some members of the medical community. They say that the 90-day assessment requirement may mean their patients have to endure another 90 days of suffering. For physicians, who take the Hippocratic oath to do no harm, if their patients are experiencing harm every day because of that suffering, that weighs very heavily on their conscience.

There are some other specifics in that other track process that I do not think warrant going into too much detail at this stage. The Standing Committee on Justice do that.

I also want to touch on another aspect of Bill C-7, which is the advance directive. This is known as the Audrey Parker amendment. It refers to Audrey Parker, a Halifax woman who was diagnosed with stage four breast cancer, which metastasized to her bones and a tumour on her brain. She spent the last weeks of her life raising awareness about the challenges facing Canadians who had been assessed and approved for assisted dying. She opted to die earlier than she would have otherwise wanted to. The legal requirement in the existing legislation is that the suffering person has to be competent immediately before the life-ending treatment is administered.

That presents a number of problems. If someone has already been approved for medical assistance in dying within the tight confines of what is written in Bill C-7, he or she can give that advance directive so that those wishes will be fulfilled even if there is a loss of competency. It would remove a sense of pressure that could be brought to bear on individuals who may feel compelled to take their life earlier, while they still have competency and the ability to act on their own directive. Therefore, I think this is a particularly important section of this legislation that should be noted, and I certainly look forward to seeing what kind of testimony we hear at the justice committee.

I have received some correspondence with respect to the Audrey Parker amendment. I have an email here from a constituent. She sent me a copy of her letter to the justice minister. She states:

These steps ensure that the patient qualifies for medical assistance in dying under the law, making the late-stage consent requirement unnecessary — and puts an enormous physical and emotional strain on people who are at risk of suddenly losing capacity, or who need heavy medications to manage their pain.

Most importantly, this unfair requirement means that people in the Assessed and Approved category are faced with a cruel choice: access assisted dying now, or wait longer and risk losing out on their right to a peaceful death.

Right now, dying people are ending their lives far earlier than they would like, or are refusing adequate pain care out of fear that they will lose out on their right to a peaceful death. This is an unacceptable burden for anyone to bear, and it is a clear and grave violation of Canadians' Charter rights.

That is just an example of some of the correspondence I have received on that particular aspect. It is actually really nice and refreshing to hear someone lay it out quite clearly because I think if we were to visit any riding we would all have constituents who have faced those pressures.

This is weighty subject matter. I know that in this chamber and indeed across this great country there are going to be multiple views on whether we are in fact going down the right path.

In moments like this when we are called upon to make these momentous decisions, we are required to look inside ourselves and to switch more from sympathy to empathy. I see this difference between the two. Sympathy is feeling sorry for someone else, while empathy is trying to put oneself in that person's shoes in order to view the world as she or he sees it.

The truth is that the members of this chamber who are lucky enough to have their health and to lead privileged lives cannot adequately express or feel what it is like to live in a body that feels like a prison and to know that kind of suffering. My ultimate view of this bill, and what guides me in the direction we need to take, is that it is about trying to make sure we can give people the dignity in death that they had in life, to respect their autonomy, to respect their choice and to make sure that their charter rights are not violated.

I conclude by stating that the New Democrats will be supporting this bill at second reading, with the full realization that the committee work is before us, which will be a real opportunity to hear from members of the public and witnesses. Hopefully, when this bill returns to the House we will have a product that we all feel we have done our best on and that lives up to the important wishes of our constituents who are living with these incredible amounts of suffering.

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

Mr. Speaker, I want to thank the member for Cowichan—Malahat—Langford for his contributions in the previous Parliament and for his contributions now and forthcoming at justice committee. I would also like to thank him for his and his party's general support of the bill.

The member cited at great length both the Carter decision and section 7 itself, reading it into the record, and that is important.

I want to put to him something that was raised earlier in the context of this debate by the member for Fundy Royal, where it was effectively put to us that not only are we seeking to comply with Truchon but we are actually going beyond Truchon. That was a reference to which the member had just left off in his comments when he talked about the advance consent regime in the Audrey Parker amendment.

In terms of everything that I have heard in my riding and the round tables that we have had around the country, this is where Canadians are, that in the context of a person who is assessed and approved is merely waiting for the date of his or her passing to allow them to have a regime where they could provide consent in advance is important step forward. I wonder if the member could comment on that. It is not squarely within the Truchon decision, but I firmly believe that is where Canadians are asking us to go and that is why it is in the legislation. Does the member agree?

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Yes, Mr. Speaker. We canvass the Canadian public, particularly with respect to the Audrey Parker section of this legislation and we explain to Canadians the really horrible choice that a lot of people might find themselves in. These are people who had qualified for medical assistance in dying but may not, under the current legislation, be eligible to receive it because they lose competency. Just imagine the amount of fear and pressure that must bring to them to either heavily medicate themselves to try and maintain that competency or maybe pressure to use medical assistance in dying much earlier than they are actually prepared to do.

With this particular section, allowing someone who is in such a state to give that advance directive is quite reasonable. More importantly, it respects the autonomy of that individual and the incredibly important and weighty decision that they have to make to do such a thing.

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

Mr. Speaker, I want to pick up on the question of advance consent. It is important to note that there is nothing in the legislation which requires the person to be consulted or informed of what is going on at the point at which he or she receives euthanasia if they had entered into the agreement in advance. This raises a concern.

If I sign an agreement asking for euthanasia on May 1, and at that point maybe I have lost capacity but I still have a certain general awareness of what is going on around me, should I not at least be asked at that point, told what is going on, and have my general comfort level with what is happening to me at that time assessed? It seems to me reasonable that we would ensure as much as possible there is some element of contemporaneous consent as well. Would the member agree with that?

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, the safeguards that need to be in place for medical assistance in dying are incredibly important. We want to make sure that at all stages patients, should they change their mind, have a way of opting out.

If the member has particular concerns with how Bill C-7 is currently written and is concerned that there is not enough addressing the concerns he just brought up, perhaps there will be an opportunity for some slight amendments at committee. I am sure that myself and the member for Esquimalt—Saanich—Sooke, who serves as our main justice critic, would be willing to look at his proposed amendments to see what he proposes to make that particular section of the bill stronger.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Mr. Speaker, I want to thank my hon. colleague for his speech. I really appreciated the words he used, especially when he was talking about empathy.

Prior to that, my colleague from Montcalm also delivered a wonderful speech. He talked about our role as parliamentarians. I see how the two speeches intersect. As parliamentarians, should the work we do not be driven by empathy?

I want to compare what we are doing to what happened in Quebec's National Assembly when this bill was passed. The bill was introduced by the Liberals, but the bill's sponsor was a Parti Québécois member, Véronique Hivon. She took a non-partisan approach to drafting the bill.

Does my colleague believe we should take our cue from what happened in Quebec's National Assembly and adopt the same approach here in the House of Commons as we work on this bill?

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I agree with the member. As I said in my opening remarks, this is a subject with such weight and importance to so many people across this country, whether they live in Nova Scotia, Quebec or in my home province of British Columbia. We owe it not only to ourselves in this chamber but to the people we represent to treat this subject with the respect it deserves.

As a member of Parliament who served in the previous Parliament, I was, by and large, quite impressed with the tone of debate on Bill C-14. I know there were some disagreements on the bill, but members ultimately tried to bring their disagreements and respective positions on the bill to the floor with as much respect as possible. During many of the speeches in this place at the time, members who were here will remember that the chamber was so silent we could hear a pin drop, because we knew how important the bill was to members speaking and, more importantly, to their constituents watching back home.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, I would like to thank the member for Cowichan—Malahat—Langford for his dignified and important speech on a subject that we admit is difficult for many people and is extremely important.

I know the member is extremely close to his riding on both sides of Malahat, from Langford up to Cowichan, and that he is home every weekend speaking to his constituents. I am very interested to know what his constituents have told him through this process. He brings a lot of experience and wisdom to this particular issue and the bill. What have people back home been telling him about the approach that Parliament should take?

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I have already received some correspondence on this particular bill. A number of people back home have already organized a community meeting with me on this legislation when I am back in the riding during the constituency week next week. It is a group that had a lot of concerns with Bill C-14. Based on their faith, they had some real concerns with it.

I knew when I walked into the room to meet with them the first time that we were not going to walk out in agreement with each other. However, I think we surprised each other with how respectful we were. We walked out of there respecting each other's positions, with a sure knowledge that we had each given this issue some deep thought. I expect that the same tone of conversation will happen again when I meet with them next week to discuss this bill.

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

Mr. Speaker, I had the privilege of serving on the justice committee with the member for Cowichan—Malahat—Langford in the last Parliament. I had the benefit of serving as the vice-chair of the Special Joint Committee on Physician-Assisted Dying and then served on the justice committee following that, when it dealt with Bill C-14.

I acknowledge that the circumstances Audrey Parker and others like her found themselves in presents a real, difficult challenge from the legal, moral and ethical standpoint. However, a regime that provides for advance directives does cause me some level of concern.

In the Carter decision, the Supreme Court of Canada made clear that there must be clear consent. How can there be clear consent absent contemporaneous consent on something that is ultimately irreversible when carried out?

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, that is a fantastic question from my colleague and I do not know if I can provide an easy answer. This is the struggle we have before us.

The Carter decision clearly outlines that consent has to be as straightforward as the member discussed. However, at the same time, I am presented with examples of people like Audrey Parker and others who felt pressured to take their lives early because that was when they could give consent. That is the struggle we find ourselves in: How do we balance a court decision with what we know are real and very current examples of suffering? I will admit that I do not have an easy answer to that, but this is the task we have been charged with.

I can only say that we have to go forward. We have to send the bill to committee. We have to hear from members of the Canadian public and experts involved in this particular aspect of the Criminal Code. We have to use our best judgment to arrive at a decision that we believe reflects not only our values but also the values of the people who sent us here to deliberate on their behalf.

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

Mr. Speaker, I will be splitting my time with my colleague, the member for Kings—Hants.

I am pleased to rise today to speak to Bill C-7. I have some prepared remarks, and during the course of my comments, I will try to sprinkle in some responses to some of the various issues that have already been raised.

Clearly, we are here because there was a decision of the Quebec Superior Court in the Truchon case. This decision struck down a particular criterion under both the Quebec regime and the Canadian regime with respect to the end-of-life nature of medical assistance in dying, this being the reasonable foreseeability of natural death criterion, in particular at the national level.

The court's ruling only applies in Quebec. We heard the minister speaking about this. He suspended its declaration of invalidity for a period of six months, until March 11. It is important for this chamber to understand that on February 17 of this year, the Attorney General of Canada filed a motion to request an extension to give Parliament sufficient time to enact an appropriate response to ensure consistency in the criminal law. That motion was actually debated yesterday, and a decision from the court is forthcoming.

Before I go into some of the details in this bill, I want to start off with two important provisions related to conscience protection that were raised by members of the official opposition in the context of this debate. I want the record to be crystal clear that conscience protections are robust in this country and are entrenched in the law.

The first location is in the preamble to the old Bill C-14, which I will read. It states, “Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms”.

I have had further questions from members of the official opposition about why it is only in the preamble and not in the statute. That assertion is wrong, because it is in the statute. Section 9 on page 8 of the old Bill C-14, which amended subsection 241.2(9) of the Criminal Code, says “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

The third point I will read is from the Carter decision of the Supreme Court, which has been the subject of extensive discussion in this chamber thus far. I am reading from paragraph 132 of the majority reasons in Carter. The court states “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

Those are three instances. One is jurisprudential and the other two are statutory. The fourth one is of course the broad penumbra that is cast by section 2 of the charter, which protects freedom of conscience for all Canadians, including those who practice medicine. Therefore, the assertion that somehow conscience rights are not protected or are somehow being eroded is categorically false.

Another point in terms of what is being addressed in today's debate is the notion that a culture of overly facilitating medical assistance in dying is upon us, and that somehow this government bill is pushing us further toward predatory practices by health care practitioners or toward disavowing the right to life, liberty and security of persons who are vulnerable, including persons with disabilities. That is categorically false and is not commensurate with what is in evidence.

The evidence we have is readily available in the technical briefing that was already provided to all members of Parliament. It is that in total, 13,000 MAID-assisted deaths have happened in this country in the last four years. The average age of people who are accessing MAID is 75 years old. It is being accessed equally by men and women, 51% by men and 49% by women. The most common medical condition is cancer, followed by neurological conditions, in that 67% of all people who access it have cancer. Second come neurological conditions and third come cardiovascular conditions.

Very importantly, in the most recent year of analysis, a grand total of 5,444 people accessed MAID in this country. That represents 1.89% of all deaths in this country. I read that into the record because I think it is important for people to understand that there is not some sort of culture of medical assistance in dying that is being foisted upon unwitting individuals. I will elaborate on my reasons going forward.

I would like to talk about some aspects of the bill. The eligibility criteria have changed, as the Minister of Justice pointed out.

There are two series of safeguards. The first applies to cases in which the person's death is reasonably foreseeable, while the other applies when death is not reasonably foreseeable. The bill would add new safeguards to that second category.

Lastly, the bill allows a person to waive final consent on the day of the procedure in certain circumstances.

I will return to that in a few moments.

Much has been made about the consultation process, including some comments by the member for Mission—Matsqui—Fraser Canyon about it being a rushed procedure and that the government is not adequately listening to Canadians. I have great respect for all members in the House who are participating in this debate and raising a number of very personal, ethical, legal and moral issues. I understand that; the government understands that.

However, to assert that the consultation was not robust is again categorically false. We heard from 125 different individuals, who are experts in this field, whether they are delivering it or acting on behalf of disabled individuals, and from nurses, doctors, etc. We heard from 300,000 Canadians through their responses to a questionnaire that outlined the various scenarios.

The views of those individuals were quite concrete in the direction they were seeking. They wanted to be empowered in terms of their autonomy, dignity and their choices. They were seeking less obstacles to what had evolved to become an overly restrictive regime, as identified by the court in Truchon. That important feature must be canvassed here. What is important to understand is that the input received was critical to the development of the bill.

As part of the proposed amendments to the Criminal Code, the reasonably foreseeable death provision will be removed from the eligibility criteria. This is in response to the Truchon decision.

In terms of legal impact, this amendment would mean that people whose death is not reasonably foreseeable would be eligible for medical assistance in dying if they meet all of the other eligibility criteria.

This is very important.

The bill proposes to exclude persons whose sole underlying condition is mental illness. This has been touched upon by different people who have already intervened in the context of this debate. This is important, as was outlined by the minister. It recognizes the increased complexities and risks associated with such cases, which were highlighted by many practitioners, stakeholders and experts at the main round tables.

What is very important is that the Canadian Mental Health Association supports the position we are taking with respect to excluding mental illness as a sole underlying condition to render someone eligible for MAID.

This complex issue must be examined carefully as part of the parliamentary review of the legislation on medical assistance in dying, which is to start in June of this year, as the minister himself mentioned.

Importantly, the Government of Quebec has also announced the exact same study for the exact same provision, that the issue of mental illness as a sole underlying condition is complex. Issues of consent and capacity and issues of properly being able to diagnose and have a prognosis are critical.

I will move to some of the comments that have been made. It is important for people understand that the safeguards are under two tracks. Those safeguards respond to persons whose deaths are reasonably foreseeable and those whose death is not.

With respect to some of the aspects raised in the context of today's debate, we have have taken the 10-day period of reflection out of the legislation. This was put squarely into issue by the member for Fundy Royal when he asked about the basis for doing that. The basis for it was that the safeguard was not doing the work it was meant to do. As opposed to protecting vulnerability, it was actually increasing the vulnerability of individuals insofar as it was prolonging suffering in some instances.

We heard, and the minister commented on this, that some people were so concerned about the inability to provide their final consent after 10 days that they would stop taking their pain medication, which was creating further suffering, just to maintain the ability to provide that final consent.

On the question raised by the member for Sherwood Park—Fort Saskatchewan most recently with respect to how one assures informed consent is applied when it has not been solicited actively, I have two responses. This is with regard to the advanced consent regime.

The government is conscious of the Audrey Parker situation and we are seized with it. When people have been assessed and approved for this procedure and when they make a determination that they want to access it and provide consent in writing, that consent would be sufficient.

In direct response to the member for Sherwood Park—Fort Saskatchewan, could it be vitiated? Yes. First, if the person has not lost capacity, consent could be vitiated. Second, it could be done by a physical gesture that would be interpreted to fully and finally eliminate that consent for the purposes of the practitioners.

The bill strikes a balance and the balance is important. We are conscious that a compassionate response that protects vulnerable individuals and also respects their dignity and autonomy is critical and what is required by the Constitution.

That is what this bill represents and I am very hopeful, as the member from the Bloc Québécois pointed out, that we can achieve all-party consensus on that very fundamental point.

[Rob Moore, Conservative, Fundy Royal, NB]

Mr. Speaker, specifically on the 10-day cooling off period, does the parliamentary secretary acknowledge that under the current legislation, if necessary, those 10 days could be waived? That was a safeguard put in place by this Parliament and has been taken out in haste.

I would like the parliamentary secretary to comment on a couple of facts that deal with this Parliament. First, a two-week online consultation is not a parliamentary review. Bill C-14 called for a parliamentary review that was to take place this summer before we expand our regime in Canada around medically assisted dying. The Liberal government has jumped ahead with a vast expansion of the legislation without the benefit of that review.

Does the parliamentary secretary see a two-week online consultation having some equivalency with a parliamentary review?

[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.

The House resumed from February 26, 2020 consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

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

Mr. Speaker, we are debating a bill today that strips away safeguards from the existing regime for euthanasia and assisted suicide. Debate started yesterday, and I want to continue in the line I was talking about.

Yesterday, I spoke about some of the philosophical problems underlining the government's desire to remove safeguards. Those philosophical ideas are clearly best understood in the realities of life under legal euthanasia and assisted suicide, in the experience of people and families who have been affected by it and in the concerns of people who will be further impacted by the proposed expansion of the practice and removal of safeguards.

The fact is that the expectation at the time of the Carter decision was for a legal regime that would apply narrowly. However, we have seen the alarmingly rapid process of expansion at the level of policy and practice continuing with this legislation. Given that this bill comes ahead of a scheduled statutory review, it looks like the pace of expansion of removal of safeguards and enlarging eligibility will continue apace even after this. Rates of identified euthanasia and assisted suicide have gone up dramatically every year since legalization, from about a thousand in 2016 to over five times that in 2019. Those rate increases show no sign of abating.

More and more horror stories are coming out about how the current regime has already changed the dynamics of our health care system. My grandmother was a Holocaust survivor, so I know about the long-standing traumatic effects that stay with many survivors for the rest of their lives. One instance of euthanasia at the Louis Brier nursing home in Vancouver, a Jewish facility that has Holocaust survivors among its clientele, was particularly traumatic for residents and staff.

Doctor Ellen Wiebe met with Barry Hyman and his family in the spring of 2018 and determined that he met all the criteria. She later went to the nursing home and closed his door without informing or consulting with nursing home staff. Hyman was killed by Dr. Wiebe on the evening of June 29, without any consultation with his primary caregivers at the nursing home. Perhaps Dr. Wiebe had good intentions, but someone sneaking into a nursing home and then asking us to trust her own notes as evidence of consent raises serious concerns.

Dr. Keselman, CEO of the Louis Brier nursing home, agrees. He said:

Imagine the implications for our staff and our residents and their families. We have a lot of Holocaust survivors. To have a doctor sneak in and kill someone without telling anyone. They’re going to feel like they’re at risk when you learn someone was sneaking in and killing someone.

Clearly Dr. Wiebe, in this case, was pushing the envelope. I doubt most doctors would behave in such a fashion, but we do see from analyses that have taken place in other countries that a small number of activist, pro-euthanasia physicians are overrepresented in cases with problems. A majority of doctors are trying to do the right thing, but a lot of death can flow from the choices of a small number of envelope-pushers.

In a paper studying cases of euthanasia in Holland between 2012 and 2016, bioethicists David Miller and Scott Kim of the U.S. National Institutes of Health noted significant problems in the application of these laws for vulnerable people, if the screws were not tightened properly.

During that period, Miller and Kim found 33 cases in which doctors had broken at least one rule while killing someone, though apparently none of these justified prosecution. Miller and Kim specifically identified the overrepresentation of certain activist doctors in cases that raised red flags.

I spoke in the House in 2016 about another case in Canada, where a physician declared a depressed person eligible for euthanasia even before examining that person, because the patient “could easily get bed sores and then die of infection”. A person's death was, prior to examination, declared reasonably foreseeable because the person could theoretically die from an as-yet-uncontracted bedsore infection.

It is striking that we have these cases to look to at all in Canada, given the massive data collection gaps. There is no requirement for advance legal review to determine if criteria are being met. There are no national standards on tracking data. In fact, in many cases when a patient dies as a result of euthanasia, their death certificate will not even indicate that as the cause of death.

People who have had bad experiences cannot tell their stories in most cases. The data that the government refers to is severely constrained by these realities. We tried, during the debate on the last euthanasia bill, to push for mechanisms for better data collection and reporting to ensure evaluation and protection was possible, but at the time unfortunately the government did not listen.

Those who have had negative experiences and have lived are understandably reluctant to speak out. However, I want to share one story, with permission, of someone close to me who had a negative interaction with the system after this regime began. This is Taylor's story.

Taylor Hyatt is a twentysomething former member of my staff. She has cerebral palsy. She is vibrant, accomplished and full of life. She went to the hospital a couple of years ago with cold symptoms. She was told that she would probably need some oxygen and was asked if she wanted that. She replied, “Yes, of course”, but then the doctors pressed her on the point by asking if she was sure. Taylor was asked if she was sure she wanted oxygen. She just had pneumonia.

When we look at the government's proposal to further expand euthanasia and assisted suicide, and to expand eligibility criteria and remove the small number of safeguards that exist, we need to ask the same question: Is it sure?

As these cases illustrate, we have particular reason to be concerned about cases in which people receive euthanasia or assisted suicide immediately or alone. If multiple family members and health care staff can see, over a period of time, that a person is clear in the desire to have life end, then there is less risk of vulnerability or abuse.

Imagine a case, though, in which children visit their mother in hospital on a Monday. It seems like she is having a good day and she makes no mention of wanting to die. She is experiencing some pain, but the nurse says she has promising ideas about how to manage that pain. The nurse says she thinks she needs to adjust the levels of a few things that should settle the pain down, and she will work on that as soon as the doctor has a chance to see her. The children leave on Monday feeling reassured.

Then the children are informed on Wednesday that their mother is dead. They are told that when she met with the doctor, she was in extreme pain and expressed the desire to die, so she was killed right away. They did not get a chance to say goodbye and they do not know if the doctor got it right or wrong.

Perhaps their mother really wanted to die, but maybe she was just experiencing a temporary low point from which she would have recovered. Her children will never know the details or the situation. Because of the absence of witnesses and legal review, there is very little evidence left behind. If their mother really wanted to die, she could, but would it be so unreasonable for the doctor to have given it a few days for the children to have been able to talk to her about her wishes?

This particular case is exactly where we should focus our concerns as we look at this legislation. The current legal system requires at least two independent witnesses who are not paid personnel, and there is a 10-day reflection period. I would underline, as members have said and as the government has generally failed to acknowledge, that there is already a mechanism by which the 10-day reflection period can be waived.

However, the 10-day period sets out a rule of general practice that is open to variation. It establishes the general and important principle that people should not have their lives taken as a result of a fleeting sense of hopelessness or because their medication levels are off for a period of time.

It makes no sense, as the government is proposing to do, to reduce the number of witnesses and remove the reflection period when there are already provisions for waiving it and managing that effectively in different situations.

Other members may have had these same experiences. I can tell them I had a close friend dealing with depression a few years ago and his state of mind would fluctuate dramatically from day to day. On certain days, he could not imagine going on, while on other days he would feel, in his words, like himself again.

Recognizing the realities of fluctuations and the development of people's experiences, it is horrifying to me that someone could opt for, and receive, euthanasia or assisted suicide within a few hours without independent witnesses or any reflection period. Therefore, the government must remove the clauses of this bill that reduce witnesses and eliminate that reflection period.

The government has included a clause in this bill dealing with so-called advance consent. The mechanism is that I, as a patient meeting the criteria, might ask to die on June 1, even if I had lost capacity. My consent right now would suffice for the taking of my life on June 1. However, the legislation contains no requirement that I be asked how I feel on June 1.

Suppose that I am facing a loss of capacity and I am afraid of the implications of that loss of capacity, not knowing what it would be like to mentally regress in the way that doctors have predicted that I will. Suppose that, in light of this fear, I sign on to advance consent but then, on June 1, while I have indeed lost substantial capacity, I actually have a much higher quality of life than I expected to have.

Should the advance consent that I have provided, in ignorance of my future circumstances, overrule my feelings in that moment? This is not just idle speculation.

Let me read from an article in the The Washington Post about a Dutch case involving an advance directive. It states:

The patient, referred to in official documents only as “2016-85”, had made an advanced directive requesting euthanasia in case of dementia. But the directive was ambiguously worded, and she was no longer able to clarify her wishes by the time she was placed in a nursing home—though her husband did request euthanasia for her.

Despite the lack of a clear expression from the patient, a physician concluded her suffering was unbearable and incurable—though there was no terminal physical illness—and prepared a lethal injection.

To ensure the patient's compliance, the doctor gave her coffee spiked with a sedative, and, when the woman still recoiled from the needle, asked family members to hold her down. After 15 minutes were spent by the doctor trying to find a vein, the lethal infusion flowed.

The government has tried in this legislation to avoid this most extreme case by saying that advanced consent would only apply to a particular date and that the procedure should not proceed if the patient was clearly refusing euthanasia. Unfortunately, the space left for abuse is still massive.

In the case just given, suppose the patient was given stronger sedatives so she was completely unaware of what was happening, and therefore offered no resistance. That would be allowed under the framework established by this legislation. It does not require that patients be informed or consulted at the time of their death. If they have provided advanced consent, that is considered sufficient.

In virtually every case, the requirement for contemporaneous consent is important in our law and is a necessary part of autonomy. If I am to be truly free, then I must be free from the directives of my past self. My past self should not irrevocably be able to bind my future actions.

Even so, it may be possible to still allow advanced consent, but to have some mechanism through an amendment to ensure that a patient, even with limited capacity, is informed and consulted at the time when his or her life is to be taken. I would encourage the government to consider that.

The government should be open to considering these problems and these fixes, taking out sections of the bill that dangerously remove safeguards and strengthening the section on advanced consent to ensure a patient is informed and consulted contemporaneously.

Finally, on the point of safeguards, let us go back and reflect on what the purposes of safeguards are.

Some members will feel that meaningful safeguards are not necessary because we should trust medical professionals and patients to get it right. The parliamentary secretary has used general data about trends in this area to suggest that there are no problems with abuse.

Let us be very clear that the reason we have safeguards is not to deal with general cases, but is precisely to deal with exceptional cases. Even if there are not problems in the vast majority of cases, we try to introduce reasonable verification mechanisms, because those verification mechanisms will catch instances of abuse and cases where vulnerable people might be pushed toward a death they do not want.

The reason we need law enforcement is not because most people are lawbreakers, but because some people are lawbreakers. The reason we have fire departments and expansive rules and protocols around fire prevention is not because most houses are on fire, but it is because some houses could catch fire.

I hope we will see through this debate that the safeguards in the current legal region really are a minimum and that we can provide reasonable safeguards like a short reflection period that can be waived and a requirement for independent witnesses which, like sprinkler systems in this room and security guards watching over us, insulate us against the possibility of something going very wrong.

For the sake of the vulnerable, let us not fire the security and rip the sprinklers out of our system just to make an ideological point.

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

Mr. Speaker, I want to point out four matters and lower the tone a bit. We need to talk about facts as opposed to emotional arguments.

My first point is to clarify that depressed individuals are not subject to this regime. We have specifically included a carve out for mental illness as a sole condition.

My second point is that the data collection the member seeks is being beefed up by this very bill.

My third point is that hyperbole has entered into this debate about people being “killed right away”. The notion of having a written consent witnessed by an independent witness and then the eligibility being verified by two independent practitioners, and that occurring in a matter of minutes or hours, is categorically false. That is not the way the system currently operates.

My fourth point is that it is an absolute red herring to raise a case based in Holland, which as has advanced directives for ailments such as dementia. We do not have dementia within the penumbra of ailments subject to this regime. We are also not proposing advanced directives; we are proposing advanced consent.

The member has raised, in some instances, concerns about what he perceives to be patients who are suffering or doctors who are acting aggressively. Those are important cases. If the member has cases, he should have those cases brought to the attention of either disciplinary bodies, regulated physicians or to law enforcement, because those should be enforced.

In fact, what we have is evidence to the contrary, that doctors are not practising this overly aggressively. In fact, there is a small of pool of doctors that—

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

Mr. Speaker, the member should know that the last legislation included a good faith exception, that a doctor who did not follow all the rules, but still acted in “good faith” would escape prosecution. Cases have been referred to disciplinary bodies, but there is a limited capacity to actually prosecute people who are, in the case, described as going into a nursing home and taking someone's life, without any consultation with the surrounding staff. These cases raise significant concern.

The member says that we should lower the tone and avoid hyperbole and then criticizes me for bringing up specific cases in Canada and in other countries that have similar legal regimes. The government should look at these cases and consider them before moving forward.

It is right to bring up the Dutch case, and I acknowledge the differences in the proposed regime in Canada from the Dutch regime. However, I pointed out very specifically that there was no requirement in the existing legislation for the person to be asked in the moment. I would beg the government to introduce that additional requirement for some contemporaneous consultation with the patients. After all, what does it have to lose? There very much is the possibility of someone being killed right away under the proposed legislation.

If the parliamentary secretary is so opposed to that characterization of the legislation, then why not leave in some waiting period? If he says that because of all the administrative requirements, inevitably there would be some delay, then leave the waiting period to consider—

[The Deputy Speaker, Conservative, Bruce Stanton]

Order, please. Questions and comments, the hon. member for Thérèse-De Blainville.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Mr. Speaker, I listened carefully to the member's remarks.

I have some important questions for him. I felt like his remarks were unrelated to the bill before us.

In my former life, I was a nurse. As I listened to the member, I got the sense that his stories were designed to appeal to our emotions. They seemed to suggest that health professionals are malicious rather than benevolent, but that is not true. I heard the member talk about doctors sneaking into care facilities to kill people. That seems a bit far-fetched to me. If something that terrible really happened, I hope my colleagues brought it to the attention of the appropriate authorities.

That is not at all what this bill sets out to do. The bill was improved thanks to two people who went to court. We are looking at how we can broaden the scope of the bill to include people who are suffering but are not necessarily at the end of their lives.

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

Mr. Speaker, simply put, the record will show that the member's characterization of my remarks is not at all accurate.

Let me just re-emphasize a point that I made. The very purpose of safeguards is to deal with the exceptional case. I agree that the vast majority of health care practitioners are not only well-intentioned, but also are not trying to push the envelope in any way. However, the data I cited suggests that in other jurisdictions we have seen how a relatively large number of problematic cases can emerge from the actions of perhaps also well-intentioned but definitely envelope-pushing physicians, who go beyond the intention of the legislature with respect to this bill.

The parliamentary secretary had some points that I wanted to get back to very quickly.

It is true that the legislation excludes depression as a sole condition, but it does not exclude people who suffer from depression from accessing it. In a previous Parliament, the member for St. Albert—Edmonton tried to introduce an amendment, whereby if someone was suffering from depression as well as other conditions, there would at least be a psychiatric assessment—

[The Deputy Speaker, Conservative, Bruce Stanton]

Order, please. I prefer not to have to interrupt hon. members when they are in the midst of their speeches, but there are many members who wish to participate in this time for questions and comments. I am stopping the clock here right now, so we are not going to take any more time away from the member.

It would help if members would direct their attention to the Chair in the midst of questions and comments. It would give me a chance to signal where we are in timing. Although there is nothing codified with respect to the limit for the time members should take to pose their questions or to respond, we will usually gauge the time by the number of people who are rising. If members see a lot of people standing up in questions and comments, perhaps they could keep their comments a little shorter. We will do our best to regulate that so we can get more members participating.

Just as a final reminder, questions and comments are for that purpose. I appreciate that members are trying also to get time in debate, and we will try to honour that as best we can. However, it is not a time for speeches; it is more for posing a question or a reflection on what the member has just said in his or her speech.

Questions and comments, the hon. member for South Okanagan—West Kootenay.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Mr. Speaker, I need some clarification from my colleague. He finished his speech by talking about final consent. The act currently requires final consent at the time people are assessed and then they have to give final consent when that order proceeds. This has forced patients to make a cruel choice.

Once patients are assessed as being eligible for medical assistance in dying, they have to decide if they should do it right away, while they have the competence and can give an answer, or if they set a date in the future to allow themselves and their families to do all the things they want to do, but then risk that they are not competent and cannot answer and the procedure would not go ahead. I have a friend having to make that cruel decision.

Therefore, could the member clarify his statement about fixing advance consent?

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

Mr. Speaker, I have two points in response.

In the context of advance consent, it is important to note that people do not know precisely what their experience will be. They may get a prognosis and think they will feel a certain way about things at that point in time. It is important to underline that the reason we generally do not have advanced consent is because people do not always know what their experience of that will be.

Nonetheless, I want to be very clear. What I would propose as a middle way between having no advanced consent and the advanced consent regime proposed in the legislation is to allow people to give advanced consent, but to still require, even at the point at which they may have lost capacity, some contemporaneous consultation with them, so even at a point of reduced capacity they are told what is happening and will be given the opportunity to assent or not. Even at the point at which they have lost capacity, it is still fair to them to give them some information about what is happening in order to give them the ability to express their objection, if they are able to in the context of limited capacity.

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

Mr. Speaker, it would appear to me that the very concept of medical assistance in dying is the concept to which my friend from Sherwood Park—Fort Saskatchewan objects. The courts have ruled that it is a violation of our charter rights as Canadians not to have access to medical assistance in dying. I know it is a very difficult and fraught topic.

I would ask the member this quite directly, not to a hypothetical. Thinking of Audrey Parker of Nova Scotia, who knew she was terminally ill and who choose to end her life earlier because she was denied an advanced directive, would he agree that these sets of amendments to the Criminal Code are fair and within the context of what the courts have directed us to do?

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

Mr. Speaker, there have been various court decisions dealing with this broader topic, but I am not aware of court decisions dealing specifically with the issue of advanced consent.

Clearly the case of Ms. Audrey Parker should evoke a thoughtful response from us. I am not aware of all the medical details of the case. Many people have opinions about the case who also may not be aware of all the details, or the context or the information she received. Therefore, I do not feel comfortable giving an answer in the House of Commons about what should or should not happen in a particular individual's case.

We can, as members of Parliament, try to work together to find consensus, or to have our cake and eat it too, to use the expression. If it is the will of the majority, we can have some mechanism of advanced consent, but still require contemporaneous consent at the point at which somebody's life will be taken. That is very important. We would not want a situation where some people have their lives taken while they are unaware they are being taken or do not want it to happen.

I will just tease the member a little by pointing out that there was a court of appeal decision in Alberta opposing the carbon tax, and I hope she shares my enthusiasm for court decisions in that case as well. Some dialogue with the courts is maybe reasonable.

[Patty Hajdu, Liberal, Minister of Health]

Mr. Speaker, I am very pleased to rise in the House today to address Bill C-7 and to speak to our proposed changes to Canada's medical assistance in dying legislation.

The proposed measures respond to the Superior Court of Quebec's Truchon decision, in which it ruled that it is unconstitutional to deny access to medical assistance in dying to individuals who meet all the other eligibility criteria but are not near the end of life.

In responding to this ruling, the Government of Canada has had the opportunity to consider some additional measures for which there is strong support. That is why we are proposing changes that will help clarify and add precision to Canada's medical assistance in dying legislation.

Over the past few months, I have had the honour of listening to many Canadians, and it was important for me as the Minister of Health to hear first-hand what they had to say. My colleagues and I hosted a series of round tables and heard from more than 125 experts, academics, ethicists, doctors, nurse practitioners, members of the disability community, indigenous groups and key stakeholders. I also engaged my provincial and territorial colleagues, and my officials worked closely with their counterparts across the country.

In January, I was in Calgary and spoke to Cynthia Clark, who saw her husband through the process of medically assisted death last summer. Her perspective, as well as those of so many others with first-hand experience were invaluable.

I also listened to practitioners who have been providing medical assistance in death in a very thoughtful, compassionate way over the last four years. They had a lot to say about what was working well but also about what was not working well.

We heard many personal stories like Cynthia's, and they helped shape the changes that we are proposing today. In addition, the feedback received from our online consultation was astounding. In two weeks we had more than 300,000 responses.

It is clear that certain aspects could be improved in order to facilitate access, protect the vulnerable and respect personal choice.

With this bill, I think we have achieved a balanced approach that reflects the best interests of all Canadians.

Protecting the safety of vulnerable people while respecting the autonomy of Canadians remains our central objective. That is why the bill proposes a two-track approach to safeguards, based on whether or not a person's death is reasonably foreseeable.

Reasonable foreseeability of natural death would no longer be a requirement for determining whether a person can access medical assistance in dying. It would, however, be used to guide practitioners in determining which safeguards to apply. This is consistent with what we heard at the round table meetings.

Providers involved in assessing the eligibility of applicants for a medically assisted death told us they have a good understanding of the concept and are comfortable applying it. Under the amended law, they would use reasonable foreseeability of natural death to determine not eligibility, but rather which safeguards would apply.

For those whose death is reasonably foreseeable, we would ease some of the pre-existing safeguards. Under the current system, there is a requirement for a 10-day reflection period. We are proposing to eliminate this reflection period. For those who are at the end of their life, the decision to request medical assistance in dying is well considered, and this additional period only serves to prolong suffering unnecessarily.

The current system also requires that two independent witnesses confirm that the person who has signed a request for medical assistance in dying is who they claim to be and that no fraud has occurred, such as the forging of someone's signature. During our consultations, we heard that this requirement was a significant barrier for many people at the end of their life.

We propose requiring only one witness and allowing this witness to be a paid personal or health care provider. These individuals naturally would be excluded from acting as a witness if they are a beneficiary of the person's will or if they would receive a financial or material benefit from the person's death. Anyone involved in assessing or providing medical assistance in dying would continue to be ineligible to serve as a witness.

For those whose death is not reasonably foreseeable, we would create a new, more robust set of safeguards. We think it is important, even while improving access, to ensure that people who are suffering but who are not dying are given full and careful consideration as they assess whether or not to pursue an assisted death.

Strengthened safeguards would also serve to protect vulnerable individuals. For example, the bill proposes a minimum period of 90 days for assessing a MAID request in the case of a non-imminent death. This period would allow for exploration, discussion and consideration of options to alleviate suffering by the person seeking medical assistance in dying and with the practitioner.

The bill would also require that the person requesting MAID be provided with information on available counselling, mental health supports, disability supports and palliative care as part of the informed consent process.

We know that the majority of practitioners are already ensuring that their patients are aware of all of the supports and options that are available to them. This provision underscores the importance of the doctor-patient relationship. It allows for a practitioner and a patient to decide whether medical assistance in dying is the right step and provides sufficient time for the patient to discuss and consider other treatment options, which is crucial for patients weighing this kind of decision. This provision supports fully informed decision-making and individual autonomy.

Under the current legislation, those who become incapacitated lose their eligibility for medical assistance in dying because the person must give their consent immediately before the procedure. This means that some individuals deemed eligible for medical assistance in dying have chosen to end their lives earlier than they wanted out of fear of losing the opportunity to receive this service.

That is why we are proposing to include a waiver of final consent for persons whose death is reasonably foreseeable and who have been assessed and approved to receive medical assistance in dying. Individuals at the end of their life who risk losing their decision-making capacity before their chosen date would have an avenue to receive MAID without worrying that loss of their decision-making capacity before their chosen date would disqualify them. Support for this amendment is strong among stakeholders, Canadians and health practitioners.

Canada has had four years to reflect on the current MAID legislation passed in June 2016, and there are many complex issues that require further study.

In December of 2016, the Government of Canada asked the Council of Canadian Academies to conduct independent reviews on three specific types of requests for medical assistance in dying that are currently outside of the scope of the law: requests by mature minors, advance requests and requests where a mental disorder is the sole underlying medical condition.

The Council of Canadian Academies convened a multidisciplinary panel of 43 experts to review an extensive body of evidence, including Canadian and international academic and policy research.

We tabled those reports in Parliament in December 2018. They provide us with a thorough, thoughtful examination of these very difficult subjects. I encourage all members to read those reports as we continue our deliberations on the proposed legislative amendments and the parliamentary review that will be conducted later this year.

There is agreement among experts that allowing advance requests for people with illnesses such as Alzheimer's disease well before they would otherwise be deemed eligible is very complex and will require careful consideration and consultation before it could be included in legislation.

During the round tables I heard directly from health care providers who expressed discomfort because they have seen patients who, as their position progressed, might not have the same desire for medical assistance in dying as when they were first diagnosed. The Council of Canadian Academies' expert panel report on advance requests came to the same conclusion.

At the same time, we know that many Canadians have expressed an interest in advance requests so that they could have the comfort of knowing that they could avoid extreme suffering at some future date.

For all these reasons, we believe this issue deserves deeper examination through parliamentary review. That will be our opportunity to tackle questions that are profound and difficult to answer, even for practitioners who have been providing this service over the past four years.

The proposed changes to the medical assistance in dying legislation would exclude persons if mental illness is the sole underlying medical condition.

This does not mean that people with mental illness are ineligible; it means that mental illness cannot be the sole underlying condition. This is another complex aspect that warrants a more thorough discussion.

Since the federal legislation came into force in 2016, Health Canada has released four federal interim reports that provide more information on how the legislation is being implemented across the country.

In November 2018, we implemented regulations that resulted in the creation of a permanent monitoring regime that sets out obligations for reporting on medical assistance in dying cases by doctors, nurse practitioners and pharmacists. The first monitoring report under these regulations is expected to be released in spring 2020 .

Since MAID legislation was enacted in 2016, more than 13,000 Canadians have chosen this option of a medically assisted death. This is not unexpected. We have seen a gradual increase in the numbers over the last three years. The number of MAID deaths in Canada, slightly under 2% of all deaths, is in line with international regimes. The increasing use of MAID is largely a result of enhanced awareness of it as a legal option and greater acceptance by Canadians.

The federal government recognizes that public reporting is critical to ensuring transparency and also to ensuring public trust in the legislation. That is why we are proposing changes to expand data collection to help provide a more complete picture of medical assistance in dying in Canada.

Under the current legislation, only practitioners who receive a written request for MAID and pharmacists who dispense a MAID substance are required to provide information, but it has become clear that capturing information based solely on written requests for MAID received by physicians and nurse practitioners has resulted in an incomplete picture on who is requesting MAID across the country, and why.

The amended legislation would authorize new regulations to be developed in partnership with provinces and territories to allow for the collection of data on all assessments for MAID, and this would include those undertaken by other health professionals on the care team. It also clearly aligns with the original intent of the legislation to collect information on all requests for, and cases of, MAID in Canada.

I think we can agree that Canadians with life-limiting illnesses deserve the best quality of life possible as they approach the end of their lives. Palliative care and end-of-life care provide patients with relief from the pain and distress associated with a life-threatening illness. Supporting home care and palliative care is a key priority in our ongoing efforts to improve our health care system.

Through budget 2017, we made historic new investments in health care to improve access to mental health and addiction services, as well as home and community care, including palliative care.

To further support access to palliative care across the country, the government worked closely with provinces, territories, and stakeholders to develop the framework on palliative care in Canada, which we tabled in Parliament in 2018. We have released an action plan to support each of the priority areas identified in the framework.

I want to assure the House that the proposed bill responds to concerns identified by practitioners and experts through the round table discussions.

I will continue to work closely with the provinces, territories and key partners to support the implementation of the proposed legislative amendments, if they pass in Parliament.

This includes working with provinces, territories, health system partners and regulatory bodies to support best practices and information sharing on clinical guidance and other aspects of implementation, which includes training and retrospective reviews.

I have a great deal of respect for the practitioners who have been providing this service over the last four years with immense diligence and a huge amount of compassion. Their experiences have helped us craft legislation that much better meets the needs of Canadians. This law is constructed in a way that supports autonomy, but it includes the flexibility to allow a practitioner and a patient to work more closely together.

Medical assistance in dying is a complex and deeply personal issue. In tabling these changes, our government has considered carefully the need for personal autonomy and the protection of vulnerable people.

There is strong public support for change, and I believe we have found an approach that reflects the best interests of all Canadians. I urge all members of the House to support the proposed changes.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Mr. Speaker, the minister said Canadians who are deciding whether they wish to receive medical assistance in dying are often experiencing prolonged suffering. The problem is that their prolonged suffering is due to a lack of palliative care. We were promised $3 billion would go to palliative care. Our dear member Mark Warawa spent nine days in hospital before he even saw a palliative care doctor.

I am wondering how on God's green earth we think that loosening these guidelines is a better way to ensure the best quality of life for Canadians.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, as the member opposite knows, we have made historic investments through provinces and territories to improve a range of health care services, including palliative care.

As I mentioned in my speech, it has been an honour to be part of a government that understands that having a strong framework and having actions that we can take together to improve palliative care at the end of life are very important to all of us, especially since we have an aging population that will require more of those services.

It is also equally important to recognize that Canadians have very loudly said, and courts have agreed, that they deserve to have autonomy at the end of their lives, and that includes the choice to use medical assistance in dying.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, I just want to comment on access to palliative care, which is indeed very important.

I would remind the House that the Conservatives were the first to cut health transfers. If health transfers had been as high as 25 cents per dollar, there might have been even greater access to palliative care.

That being said, the minister has introduced a bill that responds in all respects to the Baudoin ruling and to the condition raised with regard to the state of health of Ms. Gladu and Mr. Truchon, who were denied the possibility to choose. True freedom of choice requires that there be options.

The minister says that practitioners are able to discern when people with Alzheimer's who initially seemed in favour of medical assistance in dying may have changed their minds along the way. If doctors are able to discern that these people have changed their minds along the way, then why are they not eligible, like Ms. Gladu and Mr. Truchon?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, I thank my colleague for the question.

I agree with him that it will take a long time to recover from a decade that lacked investment in health care across this country under the former Conservative government. We are doing our best to make up for lost time.

In the case of conditions such as Alzheimer's, where people have to anticipate how they might feel if they have a condition, it is much harder to do those assessments. We heard this from practitioners who work very closely with patients in all kinds of situations. They said that when people anticipate how they might feel when suffering from a particular condition, they can be dramatically wrong. When people arrive there, they do not have the kinds of feelings they might think they have when they have, for example, a traumatic injury.

For this reason, we believe that advance requests require further study so we understand the implications from a patient perspective and a practitioner perspective.

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

Mr. Speaker, I would like to thank the hon. minister for her work on the coronavirus crisis. She has been very clear on a number of issues.

I am concerned with this debate. When I was working on the palliative care motion, our Parliament voted and everyone supported the issue of palliative care. I met with groups across the country about end of life. What we heard again and again about dignity in dying and the rights of people was they needed the right to access palliative care. I heard that from every group I met with. However, the only movement we have seen from the government was mandated by the Supreme Court.

I understand we had to put this legislation in place, but I am still concerned. The Parliament of Canada voted on a national palliative care strategy to work with the provinces and territories and put in place the opportunity for people to truly die with dignity next to their families in a much more healing and holistic manner, yet we have only heard a lot of talk about that and only as an addendum to the conversation about assisted dying. We have seen no resources or commitment on palliative care.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, I remind the member that, through budget 2017, Canada made historic new investments in health care, which included $11 billion over 10 years to improve access to mental health and addiction services, as well as home and community care, including palliative care. In August of 2019, Health Canada released an action plan that defines federal activities and the next steps linked to the framework on palliative care in Canada.

There are a number of actions we need to take collaboratively with the provinces and territories. We will continue to work with everybody, including the provinces and territories, to ensure that we improve the quality and availability of palliative care for all Canadians.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, the minister mentioned there are safeguards in place for the mentally ill or people who only suffer from mental health issues. What specific protections have been put in place? From my review, there is no requirement that an assessment by a psychiatrist be done on someone who might be experiencing, for example, severe depression.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, the proposed legislation excludes people whose sole condition is an underlying mental illness. That is because we still do not know enough about how a desire to receive medical assistance in dying might interact with a mental illness. This in no way negates the suffering felt by people who are struggling with mental illness. I have personally worked with people who have severe mental illness and I fully understand that their suffering can be immense. However, we know that, as part of the expression of a variety of different mental illnesses, the desire to end one's life is one of those components.

For that reason, we believe this is deserving of extra review through the parliamentary review scheduled in June.

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

Mr. Speaker, this topic has come up quite often in the round of questions to the hon. minister. The legislation before us includes, where appropriate, ensuring that a patient has been informed of other means of alleviating suffering, including mental health services, counselling services and palliative care.

I wish to ask the minister again for some specifics. We clearly are nowhere near making any of these areas adequate. It is fine for the legislation to say that patients may be advised of access to these things, but access is inadequate.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, as the Minister of Health, part of my job is to improve access to health care across Canada. It certainly would not be in my mandate letter to improve this if we thought that everything was perfect.

We know that work is under way with the provinces and territories. I mentioned the $10-billion investment that happened a couple of years ago. Obviously, access to primary care and improving supports for addiction and treatment in communities are the kinds of things the Prime Minister has asked me to do in my mandate. We also know that Canadians want autonomy at the time of their death, so there is an important balance we have to strike.

We have to make sure that we continue to work on ensuring that Canadians have equal access to services all across the country. The legislation says that people need to be made aware of services available to them in their communities so that they are fully aware that the choice they are making truly reflects their own particular circumstances.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Mr. Speaker, I certainly applaud the intent and where we are going with the changes to the legislation.

At the end of the day, we pass a lot of money to the provinces and we expect them to do certain things with it. Ensuring that palliative care and all of the other services are available is important.

Is there a federal-provincial group ensuring that a fair amount of the funding we continue to transfer gets to the very areas we want so that people have access to palliative care and other resources?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, absolutely. There is a federal-provincial-territorial working group that works very closely to determine how we can create equal access to services across Canada and how to make sure the investments we make result in differences in people's access to care independent of where they live. The group ensures we work together to uphold the Canada Health Act.

As we know, the Prime Minister takes this very seriously, as do I. As I have recently tabled my findings under the Canada Health Act, we will be pursuing with provinces and territories their obligation to make sure they are providing the services that have been afforded to all of us throughout the history of health care in this country.

[The Deputy Speaker, Conservative, Bruce Stanton]

Before resuming debate, I would like to compliment hon. members on their participation and co-operation during the period for questions and comments. It was excellent.

The hon. member for Dufferin—Caledon.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, I am happy to stand today to add my voice to this debate. I think it is a particularly important debate. It is an important subject, and I think there are a lot of issues that need to be discussed.

I am going to confine my comments to issues I have with the bill, things I am concerned about, and my genuine belief that the government will take a very collaborative approach to this legislation. If we take a collaborative approach to this legislation, Canadians will have trust and faith that we developed legislation to actually address their needs and protect their concerns.

Speaking of concerns, I have a number of them. I will start off by talking about what I consider to be a significant lack of consultation.

This legislation will come up for review in June. It is the five-year mandated review of the legislation. My understanding is that the government has applied for a four-month extension with respect to the implementation of this legislation, which the Quebec court struck down.

If we have this four-month extension and have the mandated review of the legislation scheduled in June, what is the rush? Why have we rushed to introduce legislation prior to that mandatory review, which would, of course, be extensive and broad and far more in depth than any consultation that has been done with respect to the current legislation? My understanding is that there was only about two weeks of public consultation for this legislation. In my opinion, that is woefully deficient given the gravity of the topic we are discussing today.

This is my first real concern. What is the hurry? What is the rush? The court has given us more time to do this, and I believe we should be taking the time to go through the mandatory review and consult with Canadians, and then decide on the path forward. That is my number one concern.

I want to mention that I will be sharing my time with the member for Langley—Aldergrove. My thanks to the page for bringing that to my attention. She is doing an excellent job.

The next thing I want to talk about is palliative care. The minister has made comments in the House today espousing the great investments that are being made by the government in health care, but has not really talked about any specific investments with respect to palliative care. I think that is a critical thing to look at when we discuss this legislation. I want to remind the minister that Bill C-277, an act providing for the development of a framework on palliative care in Canada, was passed in the previous Parliament in 2017, and clearly states in the preamble:

Whereas the Final Report stated that a request for physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available to alleviate a person’s suffering;

This was passed by Parliament, so if we are looking to expand the scope of medically assisted death without also expanding the availability of palliative care, we are doing an incredible disservice to Canadians, because the availability of palliative care in this country is poor at best. I am going to speak about this personally just for a moment.

Both of my parents suffered from terminal cancer. My mother was not able to get into a palliative care facility because there was no palliative care facility available for her, so she passed away in the hospital. My father was also not able to get into palliative care, but fortunately his illness was longer than my mother's, or unfortunately, depending on how one looks at it, and we were able to get private home care that eased his suffering and made sure he was being taken care of. However, there was no way that he was going to be able to get into palliative care within the scope of his illness.

This is affecting Canadians from coast to coast to coast, and the minister has rushed to introduce this bill. Why would the minister not have introduced corollary legislation, or legislation in tandem, or announced increases in funding for palliative care?

In my riding of Dufferin—Caledon, there is a fantastic hospice for palliative care. It is called Bethell Hospice. It only has approximately 15 beds. That is the palliative care option in my riding. For approximately 200,000 people, there are 15 palliative care beds.

Members can imagine that there is a significant number of people who are not able to get into palliative care. Therefore, the option of medically assisted death becomes far more attractive for someone who is not able to enter into a palliative care facility.

I will repeat that it is clearly a violation of legislation that was passed by the House. When people do not have the option for proper palliative care, their consent for a medically assisted death is significantly in question. I am extraordinarily concerned by the lack of any plan by the government to deal with investments in palliative care.

The minister has suggested that there are significant safeguards in place for people who suffer from any type of mental illness. However, I am not sure what those safeguards are. She suggested that just having that condition would exclude someone from obtaining a medically assisted death. What is the definition of that? How are we proving that is the only issue?

There is no requirement for individuals to go to a psychiatrist in order to assess that they are not suffering from a severe bout of depression. In my own life, I have gone through extraordinary stages and phases of depression during which I actually did not want to live anymore. I was not seeing a psychiatrist at the time. Would I have then been able to avail myself of these services while I was in a period of particular darkness? We know that mental health is an issue that is rampant throughout this country.

Again, I will go back to my first point, which is: Why are we rushing to do this? Why are we not taking the time to go through the five-year review? We need to take the time to find ways to make sure we are safeguarding all Canadians in providing them the option of medically assisted death, if they want it, but also ensuring that people who are choosing this, maybe because of a lack of palliative care, or maybe because of underlying mental health issues, are going to be protected.

These are some of the major concerns I have with respect to this piece of legislation.

Going back to the consultation, two weeks for online submissions with respect to concerns by Canadians is not anywhere near a sufficient amount of consultation. My understanding is that it was mostly online submissions. This is not a way to get the pulse of Canadians with respect to a very significant issue that is going on in this country. I will continue to ask why there was not a longer or broader consultation.

I know this matter will be studied at committee, but having been a member of Parliament now for going on five and a half years, I understand the extreme limitations at committee. We will often have a panel of six witnesses. Those six witnesses will each get their 10-minute statement, and then members of Parliament might get a six-minute intervention to try and raise an issue.

If one is going to suggest that a committee study will be far broader in scope, or somewhat more encompassing than the mandatory statutory five-year review, I will respectfully disagree with that submission.

Committees absolutely do great work, but they also suffer from an extreme pressure of legislation and time. To suggest that one or two weeks or three meetings at committee is sufficient time to analyze, debate and discuss this legislation, I do not think that is the correct answer. We should be putting this legislation off until we have the mandatory five-year review in June, which would allow us to have a far more expansive discussion with respect to all of the issues that are being discussed in the legislation.

These are my comments and concerns with respect to the legislation. I certainly hope the government will listen to these concerns, act collaboratively and co-operatively, and not try to drive this legislation through without listening to legitimate concerns that are being raised by members of the opposition.

[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 want to pick up on the member's points regarding the issue of palliative care.

During the debates in the last session there was a great deal of emotion that was expressed, and I valued and appreciated the contributions by members. I think members from all sides of the House were really trying to get a better understanding of the important subject matter that we were debating.

The member is quite right when it comes to palliative care. Whether it is the national government or the provincial governments who ultimately administer health care, we need to do a much better job on palliative care.

I wonder if my friend from across the way can provide some additional thoughts. I would ask him to look specifically at areas of the country where palliative care is nowhere near where it should or could be compared to other areas of the country. I am thinking of rural versus urban and even variations between urban centres.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, I appreciate the point being raised. Yes, access to palliative care across this country is a huge issue. In fact, we are making the situation worse with the government deciding to take away funding from palliative care centres that do not offer medically assisted death as part of the suite of services that they offer. We are losing palliative care beds across the country as a result of that decision.

I am hopeful that the members hearing this topic being raised by members of the opposition will take it back and look at reversing it. The last thing we need in this country is fewer palliative care beds.

I would encourage the member to speak to his leader and to cabinet and get them working on a national palliative care strategy and investing money to ensure we have equal access to palliative care across the country.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, I would like to reassure my Conservative colleague.

A psychiatrist must absolutely conduct a mental health assessment of the person who is dying or suffering. Family doctors are able to prescribe antidepressants to treat depression. Sometimes, a doctor may have to tell a patient that there are no further treatments available and then refer that patient to palliative care to ease their suffering. If the patient immediately says that they want to access MAID, the doctor will prescribe antidepressants, because there are steps to go through long before a patient can access MAID.

I have a hard time understanding the problem my Conservative colleague sees, since the bill excludes mental illness.

Everyone thinks that pain relief in palliative care is common practice, regardless of whether the patient is receiving care. This is called a good medical practice. Relief is provided for pain. No terminal patient receiving good care that manages pain is forced to ask for medical assistance in dying. Patients who request it do so by choice. This choice is necessary, and for there to be a choice, there need to be options.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, I am not disputing that people should have options. That is certainly the whole point of the legislation. I am not arguing against that. What I am suggesting is that there are not sufficient safeguards in place, from my perspective.

While the member might say that going to see a family doctor to talk about depression is an excellent way to be treated for depression, I can say from my experience that it is absolutely not a good option. My family doctor and most family doctors are completely incapable of treating someone for depression. Yes, they might be able to prescribe a medication, but medication is not the answer to all depression.

My concern, and we are here to raise concerns, is that this is not properly addressed in this legislation. I do not believe there are proper safeguards in place. That is something we should be discussing here during debate, at committee and certainly in the five-year review that will take place in June.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I am pleased to join the debate on Bill C-7, an act to amend the Criminal Code, specifically section 241 of the Criminal Code. That is the provision of the Criminal Code that makes it illegal to counsel a person to commit suicide or to aid someone to do so.

In the absence of more recent amendments, in the previous Parliament there was Bill C-14 in response to the Carter decision by the Supreme Court of Canada. In that case the court found that the plaintiffs' charter rights had been infringed upon by a strict interpretation of section 241.

Interestingly, Bill C-14 from the previous Parliament stated, as one of its objectives in paragraph six of the preamble:

...permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance between the autonomy of persons who seek medical assistance in dying, on one hand, and the interests of vulnerable persons...on the other;

The relevant provisions in the Criminal Code included that language. It states that qualifications for MAID, including with respect to the person:

their natural death has become reasonably foreseeable, taking into account all of their medical circumstances....

All of this is about to change because of the Truchon decision.

I am speaking to Bill C-7, a bill that would eliminate the reasonable death forseeability safeguard and expand MAID, medical assistance in dying, to a larger number of people. I have been encouraged to speak to the bill because of the many letters and correspondence I have received from people in my constituency.

I have received some letters in support of expanding MAID, but the vast majority of the letters I have received encourage me to speak against expanding the availability of medical assistance in dying.

Correspondence that I am receiving from constituents repeat two basic themes. First is that the reasonable forseeability of death safeguard should be maintained as an effective defence of societal interests and Canadian values. Second is that more should be done to expand palliative care services.

To quote one person, let Canada be a society that is known for its modern and advanced palliative care services and not as a country that has ever expanding use of medical assistance in dying. We should alleviate the suffering, not eliminate the sufferer.

I am going to read quotes from two people who each made the effort to write me a letter.

The first is Dr. den Hollander, who states:

If Canada must allow MAiD in some form (and I wish it didn't), it is incumbent upon us to ensure that it is rare. Eligibility requirements should be tightened, not loosened. More safeguards are necessary, not fewer. Enforcement must be scrupulous, not relaxed. Without these protections, vulnerable people will be pressured by family members, friends and medical practitioners to MAiD.

The second is a woman named Ramona. She works in health care, including palliative care. She quotes a person to whose care she attended, and who died in the Langley Hospice facility, as saying, “I want to live well while I'm dying.” Ramona goes on to comment, “Surely this is what health care was created for, to support people while they are alive, not to speed up their death.”

This is the tenor of the input I am receiving from my constituents.

Behind Bill C-7 is the Superior Court decision in Truchon. The plaintiffs in that case argued that their constitutional rights had been infringed upon by the now amended section 241 of the Criminal Code. They argued that the Carter decision, on which Bill C-14 was based, did not require that a person's end of life be reasonably foreseeable, and that is a true statement. That is not what the Carter decision required.

Secondly, they argued that the legislated end of life requirement violated the right to equality, under section 15 of the charter, and the right to life, liberty and security of the person, under section 7 of the charter. The federal government, acting through the Attorney General's office, did the right thing at that time. It defended its law. That is what the Attorney General should do. Bill C-14 was the well-considered opinion of the previous Parliament. It was the law. The Attorney General must defend the law.

Remarkably, the Quebec Superior Court refused to accept the arguments advanced by the Attorney General. The Quebec Superior Court said that the court cannot accept the first two objectives advanced by the Attorney General regarding the affirmation of the inherent and equal value of every person's life and the importance of preventing suicide.

In the opinion of the justice writing that decision, those two principles were not the underlying philosophy of Bill C-14. It was all about protecting vulnerable persons from being induced, in moments of weakness, to end their lives.

Remarkably, the Attorney General of Canada did not appeal that decision. That is what should have been done. Any self-respecting Attorney General would appeal a decision that attacked the laws of Parliament. This Attorney General elected not to do that. Now we are in this position where we are under pressure to amend the law, when we should instead be following the directive of Bill C-14, and that is to have a comprehensive review of the whole legislation.

That is what we should be doing. What is the rush? The rush is caused by the Attorney General's failure to appeal this decision. It should have been tested through the court system, up to the Supreme Court of Canada.

With the reasonable foreseeability of death safeguard down, this is what we have left. An applicant for MAID qualifies if he or she has a serious and incurable illness, disease or disability; is in an advanced state of decline; or their physical or psychological suffering is intolerable to them, which is a completely subjective test. The reasonable foreseeability of death criteria is now gone.

Let us just test this against a couple of hypothetical situations. We can imagine that a person has Parkinson's or MS, or was in a terrible accident and is a paraplegic. Under this new regime, if it becomes the law, people who are not dying but who meet all the other criteria, however subjective they may be, will qualify for state-sanctioned suicide. One of my constituents has said that we should let Canada be a society that is known for its modern and advanced palliative care services, and not as a country that has ever-expanding use of medical assistance in dying.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, I rise on a point of order, and I apologize to the member for interrupting his questions and answers.

Mr. Speaker, there have been discussions among the parties, and, if you seek it, I am hopeful that you will find unanimous consent for the following: That, notwithstanding any Standing Order or usual practices of the House, Bill C-4, an act to implement the agreement between Canada, the United States of America and the United Mexican States, reported back earlier today, be permitted to be considered by the House tomorrow at report stage.

[The Deputy Speaker, Conservative, Bruce Stanton]

Does the hon. parliamentary secretary have the unanimous consent of the House to propose this motion?

[Some hon. members]

Agreed.

No.

[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, in addressing the bill, the member opposite made reference to the fact that he was quite disappointed that the federal government did not appeal the decision from the Superior Court of Quebec.

Does the member feel that, if the government looks at a Superior Court ruling, it would be a viable option for the Government of Canada and the Attorney General to forgo going to the Supreme Court to appeal, and instead make the changes that are being requested?

That is why we see the legislation that we have before us.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, Bill C-14 was the well-considered response of the previous Parliament to a Supreme Court of Canada decision, the Carter decision. Bill C-14 became the law, it was incorporated into the Criminal Code of Canada.

I am of the opinion that the Attorney General should defend the laws of the country. The law was only three years old and was a well-considered decision of Parliament. The Attorney General should defend the laws of Parliament.

[Laurel Collins, NDP, Victoria, BC]

Mr. Speaker, can the member comment on whether the Conservatives support Audrey's amendment and helping families to avoid the kind of cruel suffering and difficult choices people often face when they are looking at imminent end-of-life situations and potentially not being able to give consent farther down the road?

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I believe people should have choice, but choice should be a real choice. Palliative care is the right way to go. Somebody who wrote to me said that we should let Canada be known as a country of advanced palliative care, not as a country of an ever-expanding provision of MAID.

I understand people suffer and may not be able to give concurrent consent, however this country can certainly invest more money in advanced palliative care, which would relieve suffering to a very large degree. We should work on alleviating the suffering, not eliminating the sufferer.

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

Mr. Speaker, there are many different provisions in this legislation. One of them that I thought was interesting is that in the case of someone whose death is not reasonably foreseeable, the government is saying that one of the two physicians involved in the consultations has to have some expertise in the ailment. It is interesting because this did not appear in any of the other cases. It seems to me reasonable to have this safeguard not just for the case where death is not reasonably foreseeable.

In all cases, at least one of the physicians consulting should actually have some particular expertise about the ailment. Physicians deal with a wide variety of things, so the person who knows particularly well the disease should be involved in the consultation. To me, that seems very reasonable, and I wonder what the member thinks of that. I hope the government might be willing to apply this safeguard not just in one of the two streams, but across the board.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, it stands to reason that I would support anything that would improve and enhance informed consent. The doctor giving the advice to the suffering patient should indeed be an expert in the field. I would also support any argument that would put in that additional safeguard for both streams, patients whose death is reasonably foreseeable as well as those whose death is not reasonably foreseeable. It stands to reason I would support that, and I hope the government would support it.

[Irek Kusmierczyk, Liberal, Parliamentary Secretary to the Minister of Employment]

Mr. Speaker, I will be sharing my time with the member for Beaches—East York.

It is an honour to stand up in the House of Commons and participate in the second reading debate for Bill C-7, an act to amend the Criminal Code to Canada's medical assistance in dying legislation.

In developing these amendments, Canadians were widely consulted in January 2020. During these consultations, approximately 300,000 Canadians completed an online questionnaire. In addition, the Minister of Justice and Attorney General, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion met with stakeholders in Halifax, Montreal, Toronto, Vancouver, Calgary, Winnipeg, Ottawa and Quebec City to discuss proposed revisions to Canada's medical assistance in dying framework.

These experts and stakeholders included doctors, nurses, legal experts, national indigenous organizations and representatives of the disability community. The high level of participation in both the questionnaire and the in-person sessions is a reflection of the importance of this issue to Canadians. Moreover, the results of the consultations were critically important in shaping the government's approach to medically assisted dying as it evolves to reflect the needs of Canadians.

This bill would amend the Criminal Code to allow medical assistance in dying for people who wish to relieve their suffering through a medically assisted death, whether their natural death is reasonably foreseeable or not.

This bill would remove the reasonable foreseeability of natural death from the list of eligibility criteria. It would also expressly exclude people seeking medical assistance in dying solely because of mental illness.

The bill proposes a two-track approach based on whether a person's natural death is reasonably foreseeable. Existing safeguards remain and are eased for those whose death is reasonably foreseeable. In addition, new and modified safeguards would be applied to eligible persons whose death is not reasonably foreseeable.

In the spirit of “nothing without us”, I would like to mention the government remains focused on addressing the concerns of the disability community around vulnerability and choice. The proposed changes to the legislation support greater autonomy and freedom of choice for eligible persons who wish to relieve their suffering by pursuing a medically assisted death.

At the same time, full consideration has been given to the protection of vulnerable persons and to respecting the equality rights and dignity of persons with disabilities. In short, this bill would maintain and strengthen safeguards to support fully informed decision-making, while also respecting individual autonomy.

In terms of advance consent, many participants were comfortable with implementing advance requests for those who have been assessed and approved for medically assisted dying, but are concerned about losing capacity before it is provided. This bill would allow people who risk losing decision-making capacity to make arrangements with their practitioner to receive medically assisted dying on their chosen date, even if they lose decision-making capacity before that date.

The bill would also make advance consent invalid if the person demonstrates refusal or resistance to the administration of medically assisted dying. The bill goes on to clarify that reflexes and other types of involuntary movements, such as response to touch or the insertion of a needle, would not constitute refusal or resistance.

In addition, the bill would allow eligible persons who choose to self-administer to provide advance consent for a physician to administer a substance to cause their death if self-administration fails and causes them to lose capacity. This type of advance consent would be available for all eligible persons, regardless of their prognosis.

I would like to take a moment to speak to the progress the government has made with respect to the rights of persons with disabilities in Canada. In fact, last year, the government enacted the Accessible Canada Act, which aims to create a barrier-free Canada through the proactive identification, removal and prevention of barriers to accessibility wherever Canadians interact with areas under federal jurisdiction.

The act is one of the most significant advances in disability rights since the charter in 1982 and is designed to inspire a cultural transformation for disability inclusion and accessibility in Canada. The act created Accessibility Standards Canada, a new organization that will create and revise accessibility standards, and support and promote innovative accessibility research. The CEO and board of directors were appointed and operations began last summer.

That act also established National AccessAbility Week, a week dedicated to accessibility in late May and early June each year. National AccessAbility Week is an opportunity to promote inclusion and accessibility in communities and workplaces, and to celebrate the contributions of Canadians with disabilities.

It is also a time to recognize the efforts of individuals, communities and workplaces that are actively removing barriers to give Canadians of all abilities a better chance to succeed. The act applies to federally regulated organizations for now, but we know the culture shift will have a trickle-down effect, and that awareness and action on disability inclusion will increase across the country.

Our government is taking real action to address the rights of persons with disabilities. The careful writing of Bill C-7 is a testament to that. Representatives of disability organizations and leading disability scholars participated in consultations across the country. Their input informed the reforms proposed in the bill.

We recognize that disability inclusion requires more than legislation. That is why we are continuing to work with the disability community and other stakeholders to address stigma and bias. It is important to bring about a culture change to ensure that the important contributions made to Canada by persons with disabilities are recognized and valued on the same basis as those of other Canadians. Going forward, we will continue to focus on improving the social and economic inclusion of persons with disabilities.

We will continue to work hard to ensure that all people are treated with the dignity and respect they deserve, especially when it comes to deep and personal issues like ending life. It is imperative that the voices of all Canadians, including Canadians with disabilities, continue to be heard on the issue of medical assistance in dying.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Mr. Speaker, my esteemed colleague mentioned the extensive two-week online public consultations that happened. I felt the questionnaire was extremely lean, so I held a town hall in my riding with more than 100 participants and we went through the online survey question by question.

It was clear that regular Canadians were being asked to make decisions on highly nuanced questions that were much more appropriate for health care professionals with clinical knowledge to answer. Many chose not to fill in their multiple choice options because of the biased slant of the questions. They chose instead to fill in the comments section to ensure their true answer was recorded without the ability for bias.

When will we have access to the 300,000 responses, most especially the written comments?

[Irek Kusmierczyk, Liberal, Windsor—Tecumseh, ON]

Mr. Speaker, I thank the hon. member for the excellent question and the concerns that have been raised in the House. Again, we know this is an incredibly complex issue and an incredibly personal issue. Our priority was to listen to Canadians, which is why we conducted extensive consultations with doctors, nurses, the disability community and vulnerable populations across the country. We received over 300,000 responses to a survey that asked Canadians their opinion on MAID.

The legislation before us is of course a reflection of the Quebec Superior Court decision on Truchon, but we firmly believe that it is also a reflection of Canadian voices from coast to coast to coast through those extensive consultations. In terms of accessing the survey results, I do not have that information now but I am happy to provide that information to the hon. member outside of the House.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Mr. Speaker, one thing the NDP is concerned about with this legislation is that people with unendurable suffering face a 90-day period of assessment.

We are wondering where that number comes from. Who gave the Liberals that advice? It would seem that in this situation people seeking this treatment would very much appreciate a more rapid response.

[Irek Kusmierczyk, Liberal, Windsor—Tecumseh, ON]

Mr. Speaker, that is an excellent question. If we read the preamble to Bill C-7, we will see the legislation's explicit desire to balance several interests and values: the autonomy of the person seeking a dignified death, the protection of vulnerable persons and the important public health issue that suicide represents.

I believe Bill C-7 achieves that balance by relaxing safeguards for Canadians who are at the end of life, but also strengthening safeguards and, just as important, strengthening supports for Canadians who have a grievous and irremediable medical condition and are in an advanced state of irreversible decline, but not necessarily at the end of life.

[Blaine Calkins, Conservative, Red Deer—Lacombe, AB]

Mr. Speaker, given the fact that the government, and he is a member of the government caucus, has chosen to accept the decision of a Quebec court rather than appealing it to the Supreme Court of Canada, I would guess the rationale would be based on a sense of urgency to deal with this issue.

I am wondering if I can count on my hon. friend across the way to make the same point in his caucus meeting about the decision in Alberta that the carbon tax is out of jurisdiction, and that the government will accept the Alberta court's decision as much as it is willing to accept the Quebec court's decision on this matter.

[Irek Kusmierczyk, Liberal, Windsor—Tecumseh, ON]

Mr. Speaker, I am not sure the question is cogent to this incredibly personal, complex and emotional discussion we are having in the House, but what I can say is that our government remains committed to protecting vulnerable individuals and to protecting the equality, value and self-worth of all Canadians.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, we have a unique opportunity to fix our assisted dying laws and to protect the individual right of all Canadians to make such a fundamental and deeply personal choice for themselves.

I opposed the assisted dying laws in the last Parliament because they were too restrictive. They were not in keeping with the Supreme Court's decision in Carter and I believed them to be unconstitutional, and here we are. A Quebec court found the law to be unconstitutional and we agreed, rightly, to abide by that decision. We have another chance to get it right.

As we look forward to what getting it right looks like, we should also look behind us at the Supreme Court's decision in Carter.

Those in the House have talked about striking a balance between the fundamental freedom of individuals to choose for themselves and the autonomy of the individual to make such a deeply personal choice, and protecting vulnerable persons.

For people who read the Supreme Court's decision in Carter, they will know that the Supreme Court struck that balance with a number of safeguards that look like this: to be eligible for assisted dying, one needs to be suffering intolerably and in an enduring way; one needs to be in a grievous and irremediable condition, an incurable illness; and the individual in question needs to be competent and to clearly consent.

The government in the last Parliament incorrectly, in my view, added an additional criterion for eligibility that one's death needed to be reasonably foreseeable. That is unnecessarily and unduly restrictive. I will get to a court case in particular that explains this in greater detail.

There are two core injustices that the new law proposes to fix. First, the question of removing the “reasonably foreseeable” requirement as a matter of eligibility, and also addressing the case of Audrey Parker.

We had another fundamental injustice where an individual who was eligible for MAID took her life earlier than she otherwise would have, lost time in her life that she otherwise would have spent with her family and loved ones. She was worried about losing competence and being unable to give consent near the very end, despite the fact that was exactly what she wanted.

The Council of Canadian Academies identified three levels of advance request: where an individual is already eligible for MAID, such as in the Audrey Parker case; where an individual has been diagnosed and is not yet eligible, but is on the path towards eligibility; and where someone has not yet been diagnosed, so is farther from eligibility for MAID. In this case we have identified a solution to one of those categories, but we ought to solve advance requests more broadly going forward.

Is the law perfect? No, but it is worthy of our support at second reading. However, there are a number of concerns worth highlighting.

First, while a reasonably foreseeable death is no longer a criterion of eligibility, there are additional hurdles for individuals to pass if their death is not within the near future. One of two practitioners assessing eligibility must have expertise in the condition. Although that sounds very reasonable in theory, my only question for committee members as they look at this is to ensure that is not an impossible barrier in practice, particularly for those in rural communities where such expertise may not exist at all times.

There is also a minimum, and I would say somewhat arbitrary, period of 90 days for the assessment of the request. It looks like a backdoor cooling-off period. It would make far more sense for us to have no time limit and the assessment to be done in the ordinary course, or at least a much shorter time period, because we are talking about people who are suffering incredibly and are competent to make the decision for themselves.

Does it cure the case for Audrey Parker? I think largely it does, but I worry if the main procedure must be scheduled already, what does that mean? If Audrey Parker was in a situation to say, “I am not exactly sure what the time period will be. I know it is not now but I know it will be soon”, is she to have scheduled a particular date, which would make her eligible for the advance request, or are we going to put people in a situation where they are scheduling something earlier than they otherwise would?

Mental health is a real challenge because we are building an additional criterion into this legislation that says:

For the purposes of MAID eligibility, a mental illness is not a “serious and incurable illness, disease or disability”...

It sounds reasonable on its face in many ways, because we can immediately imagine a situation where mental illness impinges upon one's ability to give consent, impinges upon one's ability to conduct himself or herself as a competent person, but that is not always the case.

I am aware of some opposition from the Conservative benches. I am also aware of the number of Conservative MPs who come from Alberta. Therefore, want to quote a case from the Alberta Court of Appeal from 2016.

This is about a 58-year old women, identified as E.F., with severe conversion and psychogenic movement disorders.

The court wrote:

She suffers from involuntary muscle spasms that radiate from her face through the sides and top of her head and into her shoulders, causing her severe and constant pain and migraines. Her eyelid muscles have spasmed shut...Her digestive system is ineffective... She has significant trouble sleeping and...is non-ambulatory...While her condition is diagnosed as a psychiatric one, her capacity and her cognitive ability to make informed decisions, including providing consent to terminating her life, are unimpaired.

This women was eligible to take advantage of MAID because we did not yet have an unconstitutional law in place to prevent her from accessing the regime. The Alberta Court of Appeal determined this woman was competent and was able to consent for herself. It noted further that she had consulted with her husband and adult children, who were all in support.

I worry that if we look at restricting mental illness completely, even if it does not impinge upon people's consent or their ability to conduct themselves as competent persons, we are telling those individuals that they are unable to make fundamental and deeply personal choices for themselves and that they have fewer rights than we do. That cannot possibly be right in this society.

This was a recurring problem for the justice department. When it argued the case of E.F. and lost at the Alberta Court of Appeal. it argued that the current criteria meant that terminal illness was required. The court said no. It argued that illness for a psychiatric condition should be deemed ineligible. Again, it lost in the Alberta Court of Appeal.

Therefore, if we are to respect the Carter decision and the precedent in case law since the Carter decision, I do not think we ought to have such a categorical exclusion in our law.

In Carter, the Supreme Court noted:

It is a crime in Canada to assist another person in ending her own life. As a result, people who are grievously and irremediably ill cannot seek a physician’s assistance in dying and may be condemned to a life of severe and intolerable suffering. A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.

The Alberta Court of Appeal stated, “The cruelty in the situation is there regardless of whether the illness causing the suffering may be classified as terminal”, and certainly continues to be there regardless of whether the suffering has, as its primary focus, a psychiatric disorder.

As a final note on this subject, this law, if carried forward without an amendment, will treat mental illness as lesser than physical illness, a stigma we have worked hard to combat in other settings.

As I said previously, we have to tackle advance direct requests more seriously than we have in this legislation. I know there is an ability to have this broader conversation later this year, as we revisit this conversation. I certainly think if people are diagnosed with a condition and they can clearly see where it is heading, they should be able to determine their futures. I would want to, as a matter of my fundamental freedoms, be able to determine my future. Also, in directing our own futures, we ought to be able to provide advance requests more broadly and more easily, even if we have not been diagnosed.

I recognize the Council of Canadian Academies has identified that we need certainty. How do we provide certainty? Through sunset clauses. If we have not revisited and re-upped our commitment to our advance request within a certain period of time, then it would fall away. That would allow for certainty to take hold.

There are other things we could look to in the law, including mature minors, because minors have the ability to make life-changing decisions in medical contexts in other settings outside of MAID. However, in the end, this law needs to ensure that anyone eligible for MAID, pursuant to the Carter criteria, continues to be eligible for MAID through this law. It is a matter of fundamental freedoms and dignity in the end.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, the Liberal government has sent a clear message to the provinces that euthanasia access is a priority over palliative care, as we can see from the fact that the Liberals are letting a Quebec lower court judge steer the way forward for the rest of Canada. We can also see, on the opposite side of the country, that the Fraser Health Authority in British Columbia leads the charge by revoking funding for hospice care beds and is confiscating private charitable donations for the implementation of MAID access.

Why is the government not fighting to ensure quality palliative care access before euthanasia?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Madam Speaker, I trust the member heard me when I quoted not only the Supreme Court, which the Quebec Court was reiterating the Supreme Court's criteria, but also the Alberta Court of Appeal, which was again reiterating the Supreme Court's criteria.

The dichotomy between palliative care and death with dignity is so completely false. Of course a government ought to be focused on providing all the options for people at the end of their lives to ensure there is dignity. However, in the end, the government has no right to take away my fundamental individual choice.

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

Madam Speaker, I listened with great interest to my hon. colleague, for whom I have a great deal of respect.

On the issue of the advance directive, when we think in advance, I think all the individuals I have ever known have talked about how they want to go and how they want to be. My friend was going to sit in the snow, listen to Bob Dylan and drink a bottle of whiskey on his last day. It is a great way to go, but we do not end up getting those options.

When we are faced with death, and I saw this with my sister and her horrific suffering, and her husband just before that, both very young, the will to live is so incredibly strong. People do not realize how much they want to live and how much they want to stay.

I know this is not so much the purview of the bill, but I want to ask about the reasonable limits of advance directives so we are not signing off and saying, “In future if it happens, this is how I want it to be”. When it happens, we are in a very different place and in a different world than we ever imagined we would be.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Madam Speaker, this is by far the most complicated area. There are some easy cases, like the Audrey Parker case, where people are already eligible for MAID, they understand their condition and it is very clear an advance request ought to be in place. It is harder, but still fairly straightforward, when people are diagnosed with a disease and there is a short-term trajectory when they can see that they are going to deteriorate significantly.

It is much harder when a person is not diagnosed at all. I am 35. Would I put an advance request in right now? How could that be intelligible? How could we make sense of that? There are two things to say to that.

I mentioned sunset clauses. If we are requiring certainty, individuals would have to revisit their advance requests and uphold those requests. There has to be a window of time when it would then fall away and not be legally valid.

The other thing to note is that the Supreme Court's criteria are also pretty key here. I cannot just say an advance request for anything of which I am eligible to die. I still have to be in a condition that is an incurable illness and where there is grievous, intolerable and enduring suffering. These are incredibly important safeguards to keep in mind.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Madam Speaker, I appreciate the member's comments on this and many other matters. I raise an issue with his suggesting the false dichotomy between palliative care and this legislation. In fact, in the previous Parliament, the House passed legislation in the preamble, which very clearly said:

Whereas the Final Report stated that a request for physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available to alleviate a person’s suffering;....

This is a critical issue. Access to palliative care is critically short in the country, so there is no false dichotomy. Why is the member's government not putting together a pan-Canadian strategy on palliative care and investing the money necessary so we have that?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Madam Speaker, the member should know that we have invested billions of dollars through bilateral agreements with provinces and we have set a priority of home care, including palliative care. The member should know that health care, fundamentally, and the delivery of palliative are within the provincial jurisdiction. The member should also know that in the end, regardless of whether there is palliative care, this is a question of whether individuals have a right to make such a deeply personal choice for themselves. Does the member believe in liberty or not?

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Madam Speaker, I will be sharing my time with my colleague from Coquitlam—Port Coquitlam.

I am very happy to be taking part in this debate, which is a departure from our usual political and often partisan work as elected officials.

This is the third time in my parliamentary career that I have been asked to debate and vote on the issue of medical assistance in dying. I was a member of Quebec's National Assembly for seven years, and I have served here in the House of Commons since 2015 with the support of my constituents.

I was elected to the national assembly in 2008. As a member of that assembly, I participated in the first debate we had in Quebec on this issue, the first time in a Canadian legislature, in 2010.

I also was a participant in the debate we had four years ago in the House of Commons, when, for first time, we addressed the issue. Therefore, in my parliamentary life, this is the third time I will participate and vote on this very touchy, personal and non-partisan issue.

That is why I would like to remind the House of certain cardinal rules that should guide our actions as parliamentarians in this debate, which we believe should be totally non-partisan. Things may get tense at times, but debate must remain respectful.

Respecting the free vote should be one of the cardinal rules of this debate. In my view, there is no right or wrong position in this debate. There are only positions that we are comfortable with as human beings. Whether we are for or against, there is no partisan politics behind it. There is only the personal opinion that we hold, share and analyze.

Consequently, it is important to keep a completely open mind and respect the fact that certain colleagues from our own party may not share our point of view, while colleagues from other parties may. That is fine. There is nothing wrong with that, really. Some positions we adopt, and some positions we cannot be comfortable with. That is all.

We must respect the debate. We must respect personal opinions. We must respect the fact that there is no place for partisanship in this debate and that positions are neither right nor wrong. There are positions that we can agree with and others that we cannot. We must respect that.

There are also certain elements that we must bear in mind before we dive into this. In our opinion, the bill has some shortcomings.

First, we must respect the freedom of conscience of physicians who are called on to provide MAID. If a physician feels that they cannot in good conscience provide MAID, they should be able to say so and not have to proceed. I have spoken to many people in the context of this debate, in which I have been participating for a very long time. Everyone I have spoken to has told me that physicians can show a certain openness in some circumstances, but change their minds in others. Physicians should never be forced to act against their conscience.

Furthermore, we should always bear in mind that MAID, by its very nature, is the last level of health care that can be offered. We must never forget that the role of palliative care is to ensure that those who are ill can live with dignity even in tragic circumstances. Therefore, we must respect physicians' conscience and focus on palliative care.

Taking our time is another cardinal rule that must be respected in this type of debate.

Let me remind members that the first time this issue was addressed in Quebec, it took six full years, three different governments and three different premiers. There was a huge debate about it, a strong and wise debate. Each and every position had been clearly established by those people who participated in the debate. There is no rush. We must take our time.

For some people, we are talking about assisted suicide. It is a very touchy issue. The worst-case scenario is to rush it. Quebec spent six full years, and we should follow this example. It obviously will not take six years this time, but the first step took six full years.

Let's agree that this debate cannot be rushed.

Why are we debating Bill C-7 today?

When the House of Commons adopted Bill C-14 in 2016, I was a member of the committee that studied it. We knew then that Canadians would challenge parts of it and that there would be court rulings. That is exactly what happened on September 11, 2019, when the Quebec Superior Court struck down the notion of “reasonably foreseeable natural death” in the bill that became An Act to amend the Criminal Code and to make related amendments to other Acts regarding medical assistance in dying.

I did not know this before I looked it up, but it is interesting to note that the current Minister of Justice, a man for whom I have tremendous respect and esteem owing to his experience as a lawyer and a McGill University professor, voted against Bill C-14. Now, as Minister of Justice, he is sponsoring this bill as the federal government's response to the Quebec Superior Court's ruling. The bill addresses some of the issues but sets others aside.

The first fundamental element of Bill C-7 is that it eliminates the 10-day waiting period that the current law requires as a buffer between the person's decision and the operation itself, to ensure that the second opinion provided for under the act is in fact obtained. The court deemed this provision invalid, and the minister decided to accept that opinion.

Let's also not forget that the current law, which was passed four years ago, requires the provisions to be reviewed in just a few months, starting in June 2020.

The government decided to take note of the Superior Court of Quebec ruling and act accordingly. That is its right. However, regardless of our views on the issue, we feel that this subject involves some truly fundamental questions and raises highly complex legal concerns. We think this ruling should have been appealed to the highest court in the land, so that the nine justices of the Supreme Court could study every possible ramification.

This bill sidesteps the issue of mental illness entirely. That is a very good thing, because in our view, it is extremely difficult to pinpoint the instant when a mental illness becomes irreversible, which can raise doubts about whether consent was given fully and freely.

As I said earlier, the worst thing we could do in this matter is move too fast. There is no rush. This concern may eventually be debated, but for now, let's take it one step at a time.

Since my time is almost up, I would just like to say that in this debate on such a delicate, sensitive issue, the worst thing we could do is plough full steam ahead and attack people's convictions instead of respecting their choices. Let's take the time to do things right on this extremely delicate and extremely important issue.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I appreciated my Conservative colleague's speech. We do need to focus on the common good. However, I did not understand his position, apart from his plea that we take the time to do things right.

He knows very well that it will not be easy to take that time because, while we are taking our time, there are people who are suffering, people who have no choice, people who want to give their free and enlightened consent about their condition. However, the state that we represent here is not respecting their wishes and giving them the option to relieve their suffering.

What is my colleague's position on giving people like Ms. Gladu and Mr. Truchon access to medical assistance in dying?

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Madam Speaker, I agree with the principle behind that. It is important to keep that in mind.

My colleague was a member of the Quebec National Assembly. Four years ago, I worked with him on this bill. My colleague knows full well that we need to take action because there are people who are suffering right now. He also knows very well that, in Quebec, we did things right. It took six years of work to get the job done.

During that six-year period, there were people who were suffering and who would have liked to have access to this sort of care, but we took the time to do things right. Similarly, four years ago, in 2015, when we were just elected, we passed similar legislation under a very tight deadline because the Supreme Court ordered us to do so, but we still did not completely rush the debate.

I agree with my colleague when he says that there are people who are suffering right now. However, there were also people who were suffering in the six years that it took us to do our job properly in the Quebec National Assembly. I do not think that anyone in Quebec or Canada can say that we did not do our job properly in Quebec during the six years that we took to study this extremely delicate subject.

[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]

Madam Speaker, as a former provincial representative, my friend understands and appreciates the important role that provincial governments play in the administration of health care and in providing services. One of those very critical services is palliative care. We hear a great deal of debate on that particular issue. The federal government also plays a role in ensuring that there is quality palliative care throughout the country, to the extent possible.

I wonder if my colleague could provide his thoughts on how Ottawa needs to work with the other jurisdictions to ensure that the best possible palliative care is available.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Madam Speaker, as I said in my speech, it is important to put an emphasis on palliative care. We are really talking about people's lives. It is not an easy task, but the responsibility of any government is to be sure that those who suffer have access to palliative care.

Obviously this is provincial jurisdiction, and the provinces should do something on this, but on the other hand, it would have been better if the bill had put more emphasis on palliative care, as we did four years ago. It was very important for us on the committee to address this issue, and we hope that the government will take care of palliative care.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, Quebec worked very hard, within its jurisdiction, and chose to include medical assistance in dying as part of a continuum of care, something individuals can request when they are terminally ill. Such care is a provincial responsibility.

Now we are talking about the Criminal Code. Two separate courts have independently asked legislators to intervene regarding assisted suicide in cases where people are suffering but are not terminally ill.

I asked my colleague if he thinks the bill addresses the specific needs of Ms. Gladu and Mr. Truchon, and if he agrees with the two court rulings.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Madam Speaker, yes, I think I already said so. Perhaps he did not hear me.

The fact is, when it comes to issues like this one, the government should have taken its time. There was an initial ruling that came from one court, and there will be others. I think the government has a responsibility to bring this matter before the superior courts to be sure that all legal aspects are assessed by the best legal minds in the country, in other words, the Supreme Court.

That said, personally, I agree.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Madam Speaker, Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying, is one that I believe was written with the intention of providing compassion to those who are suffering through an unfathomable, unbearable degree of pain by allowing a lawful, expedited termination of their suffering and granting access to a dignified death. The intention is kind. I see an urgency from the government to extend this expression of compassion to those who are suffering beyond comprehension.

However, from the perspective of a visionary and a lawmaker who cares for the long-term wellness and prosperity of our country, I would like to invite all members of the House to pause and bring into our dialogue the long-term effect of this bill and the impact of this bill on the guiding principles of lawmaking going forward.

I do not stand to speak on this bill with the moral authority of one who has reached a point of suffering equal to those who may be applying for MAID. I do not think most members of the House here have the personal experience to speak on that level. However, I do stand here to speak on this issue because there has been a force in my life that carried me through some very dark nights of the soul when adversity, pain and repeated cycles of injustice were poignant enough to wear down my will to fight and to try, sometimes causing me to question the value of my existence.

I have seen this force raise addicts, cancer patients and those experiencing deep depression from deep pits of psychological paralysis and darkness. This force transcends the distinctions of race, gender, socio-economic background, etc. It is almost as vital as life itself. It is a force that is central to the existence of the human race, and that force is called “hope”. While hope is easier to access for some than others, for others it may be almost impossible, because their painful experience is choking the light from their vision.

As caring individuals, as communities and as a nation that prides itself on compassion, it is our duty to turn over every stone to help others find hope when they can no longer access it themselves. Hope is a journey that demands an unrelenting search until it is found.

We saw it with Terry Fox. He is a national symbol of hope, because despite his painful struggle with cancer, he made the sacrifice he made with his cross-country campaign for cancer research because he was in search of hope and giving that hope to others. The story of his triumph over adversity, though his life was tragically truncated at such a young age, still continues to champion Canadians today, as Canadians respond by revering him as a national hero, because we value hope. We have seen the power of hope that compelled Terry to pass the finish line of his last breath.

We see hope whenever we see Team Canada send our paralympians to the Olympics. Many of them have overcome deep physical, emotional and mental suffering. Their focus, discipline and excellence have helped them to overcome their challenges.

Our nation is built on a foundation that values the sustenance of life and the right to prosper. We invest millions of dollars every year in first responders, medical services, infrastructure and laws to protect the survival, sustenance and prosperity of the people.

However, expediting the administration of death is counterintuitive to the inner reach for hope in the human condition. Our very Constitution is founded on the principles of the value of human life, the prosperity of each human being and each one's access to the opportunity to flourish.

While deep with the intentions of compassion and the appropriation of dignity, intervening with easier access to MAID opens a door to a very complicated path of further suffering, even for those who live on.

I would like to bring to the attention of the House the story of a man named Alan Nichols, from my province of British Columbia. As reported by CTV this past September, his family has stressed that Alan struggled with depression and should not have qualified for assisted death.

Alan's brother Gary told CTV:

He didn't have a life-threatening disease. He was capable of getting around. He was capable of doing almost anything that you had to do to survive.

Like many Canadians, Alan's life was altered dramatically when his father passed away. Especially since his father had been so involved in his life, his father's death made him particularly vulnerable, and he stopped taking antidepressants and became more angry and isolated:

Not going out in public, not seeing anybody, not eating properly.

This is how Gary described it.

Alan's family knows that he rid his home of furniture, apart from a bed and chair, and that he would refuse medication and food because of his depression. Another disturbing aspect to Alan's story is that despite his family's attempts to be involved in his life and an advocate for his life, his family members report that the hospital staff would not share information with them and shut them out from hearing the key facts.

There is more to this story, but I will leave it at that. This is accessible information.

The point I would like to illustrate here is that this is a very complicated issue. It is one that touches something so deep and necessary to our existence and our country, and that is hope. All because of the irreversibility of death, there is little intervention that can be done afterward when hope is terminated because there is no breath to receive the assistance of hope.

Rather than be in a rush to legislate this bill, we should focus on tackling things like the epidemic of suicide among first nations communities and youth. We should also focus on giving Canadians better access to mental health care so Canadians have greater access to hope when faced with situations of suffering, as people who are suffering so much consider MAID. We must do this until there are enough measures to show the flourishing of hope and human prosperity to counter a potential culture of death from capturing our nation, if we are to be too swift and lenient in our decisions surrounding issues of death.

It pains me to watch others suffer, but it also pains me to think that as lawmakers, our focus is on expediting access to death rather than expediting access to hope.

My statement in the House today is to inspire all members of this House to not only consider the dignity of the people suffering seeking release through death, but the dignity of existence and human prosperity for the long term.

Removing the mandatory 10-day waiting period reduces protections for vulnerable members of society. The government's original legislation, Bill C-14, went though extensive consultation. It is scheduled for parliamentary review this summer. I would ask the Liberal government to respect the process and allow the review to proceed rather than rush this very sensitive and complex issue in legislation. Let us give this time because death is irreversible.

I have decided to look at this bill through a filter of hope and preserving a culture of hope, as being a force that guides the laws we make not only today but for decades and centuries to come. Therefore, I stand today in the name of hope and invite my colleagues across all aisles to examine this bill through the lenses of hope and preserving hope in our country.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, I wanted to applaud my colleague's courage and recognize that every word she spoke today is probably the same words that all of us as parliamentarians have spoken. Hope is eternal. Hope is what gives us all the energy to fight the battles we have in our lives and in our family's lives. We must never eliminate that hope people want to have in various aspects in their lives.

When we dealt with this bill previously, it was amazingly complicated, as my hon. colleague mentioned. It was probably one of the most difficult issues I have had to deal with in my 20-some years as a parliamentarian. By listening to people, like my colleague and others, we try to find the way that reflects the feelings of so many people.

Investing more money makes sure that there are programs that offer hope, whether we are talking about mental health, palliative care or so many other avenues. We are trying to ensure that everybody has hope and that they do not want to give it up and that we have given them every opportunity possible to access that help.

Does my colleague feel there is still a tremendous lack of those services in the areas she represents?

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Madam Speaker, I appreciate the member's compassionate remarks. I am very emotional right now because it is a very important issue for everyone, and in some way or another we are all impacted by it. I have spent time on the front lines. I believe, whether it is in the area I represent or anywhere else in Canada, there is a lack of access to counselling and mental health care that would, as I mentioned in my speech, give tools to Canadians to work through their struggles, adversity and pains to access more hope before moving in the direction of medical assistance in dying.

I understand fully the implications of compassion that this piece of legislation is wanting to present, but because of the irreversibility of death, I feel time is needed. Preventatively and for the long-term future of our country, we must deal with all those other areas with greater care and time.

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

Madam Speech, we do not hear the word hope very often in this place and it is something that is very important. I would like to make two comments. One is that death is hard, death is very hard, but it does not mean it is without hope. When my sister died it was brutal, it was unfair, but it was life. We brought her out in the old Celtic way with singing and celebration because that is what we do. There is hope in that and hope has to be about compassion and doing what is right.

Second, I would like to ask my hon. colleague about the lack of action she mentioned on the horrific suicide crisis we are facing. Year in, year out we are losing hundreds of young people. We lose young people in my region all the time and it never seems to be a priority. When I hear the Prime Minister talk about losing patience, I think of the patience that has been lost by children as young as nine years old, 10 years old and 11 years old who do not even believe that this country cares about them enough that their lives are worth living.

What does my hon. colleague think we can do to address the horrific hopelessness in so many young people who are giving up?

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Madam Speaker, first of all, there needs to be more dialogue and long-term solutions that are thought out, but we need action. We cannot just have good intentions, we need to put them into action. I look forward to the opportunity to working with anyone across the aisle on trying to bring more action in helping to take care of our youth in relation to suicide or mental health issues.

[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]

Madam Speaker, I rise today to address a very important piece of legislation. Looking at it, I could not help but reflect on the previous debates that we had and the process in the development of Bill C-14, which led us to the point where we are today.

If members who were not here want to get a good sense of how thorough the debate and discussions were, I recommend they take a look at some of the comments in the standing committees, the many lead-up discussions, different presentations and the pre-study that was conducted.

I enjoyed listening to the debates then, because like the member who just spoke said, we heard a lot of personal stories. When people ask me what I enjoy about being in the chamber, it is the different types of debates that we have. These are the ones, like the debate today, that I learn from. I appreciate the stories that come before the House.

We are all concerned about protecting vulnerable individuals in our society. At the same time, it is important as legislators to have a role to support the eligible person to be able to seek medical assistance in dying. It is a very difficult issue.

A good number of us felt with the passing of Bill C-14 that we had something that would move us forward. Even during the height of that discussion, there was a feeling that in a number of years we should review it and take a look at what has transpired in the previous years. We are quickly getting to that point.

However, last September, a Superior Court in Quebec made a determination. Members of the Conservative Party say maybe we should have appealed that decision. I respect that opinion. I do not necessarily believe that would have been the best direction for the government. The direction we have chosen is to make changes to the legislation now, in the hope that we will better serve Canadians.

Having said that, once we get into the summer months, there is going to be a great deal of discussion because it is mandated. When I think of the Bill C-14 debate, and I will provide some personal thoughts on the issue of palliative care, I would like to see us talk about the issue of mental illness. I am hoping that, when we do that comprehensive review, we incorporate that along with palliative care.

I am sure I am not unique and that all 338 members would concur when we think of health care in Canada, there are a couple of issues at our doors: the issue of mental health care services and palliative care services. I used to be the health care critic 15 years ago in Manitoba. We did not have the same sort of dialogue that we hear in the last number of years on those two critically important issues.

British Columbia many years ago elevated the issue of mental illness and made it a separate ministry. There was a minister of health and a minister of mental health illnesses.

I say that because, more and more, provinces are aware of the issue and the importance of mental illness. The Government of Canada has invested hundreds of millions of dollars over the last number of years, and continues to invest in mental illness and palliative care across the country. We are on a very strong footing when we look at where we are today.

We need to reflect on what brought us here. There were many consultations: literally thousands of people were engaged and many hours of debate and dialogue took place. It could have been in the thousands of hours. I do not know that for a fact, but I am sure that, between the time committees met on second reading of Bill C-14, the amount of consultation with Canadians in all regions of the country and the responses received via all sorts of mediums, hundreds of thousands of Canadians in all regions of our country were able to weigh in on this issue.

If we advance to January of this year, again there were consultations and round tables that took us to the different regions of Canada. There was the survey that has been referenced already today on several occasions. Approximately 300,000 Canadians were engaged in that particular survey at the beginning of the year. I do not know if all of the results have gone public to date, but I trust the individuals who helped formulate the legislation we are debating today did their homework in terms of consultations and incorporating all of the ideas. I know the Department of Justice and the Department of Health are following this debate and listening to what members have to say.

From a personal perspective, based on experiences I have garnered over the years, there are two concerns I want to express. One is with regard to health care services and the other deals with the legislation itself. Let me expand on both points.

If we were to ask Canadians what makes them feel good about being Canadian, we would often hear our health care services. I suspect this is probably number one. I referenced mental illness and palliative care. I have witnessed first-hand the evolution of palliative care.

My grandmother was in the St. Boniface Hospital, and many hospitals in our country have palliative care sections. Many of them panel seniors, in particular, who cannot get the quality care necessary in personal care home facilities or the supports they need in their communities and in their homes, so they end up going into hospitals and are panelled.

Many of them will go into palliative care because there are no designated palliative care units in health care facilities, so they end up in hospitals. My grandmother was one of them. She had terminal cancer, and we watched as the weeks went by. Family members visited and it was very difficult on them.

We had a very special relationship, as we all do with our grandparents. Many of us wondered why she had to be in a hospital. Even though it was kind of sectioned off from the emergency department and other aspects of the hospital, she was still in a hospital. It is a different type of a situation, and not necessarily the most comfortable.

Ultimately, my grandmother passed. Then, a number of years later, I had the personal experience of being there for my father in the days prior to his passing. He had to go from home into a hospital, and we were very fortunate that we were able to get him into the Riverview Health Centre. In that centre, with its large windows and beautiful atmosphere, you get the feeling that the type of care is very different.

I reflect on that. I was there at the moment of my father's passing, and we had discussions a number of days prior when he was in fear of what was going to happen, because he witnessed what had taken place with his mother, my grandma, at the St. Boniface Hospital. He did not have that choice, but we talked about having that choice.

I think, knowing my father, he would have been very happy with the way in which he ultimately passed. I really attribute it to his world-class treatment at that particular facility, and I kind of wish that my grandmother had the same sort of atmosphere. Not to take away from the fantastic work that those health care providers and others did at the St. Boniface Hospital, but it was a totally different atmosphere.

During the Bill C-14 debate, we heard many stories like the one we just heard from the member opposite. They are very touching, they are compelling and they make us ask what we can do here in Ottawa to ensure that we have the best quality of health care services we can possibly provide.

It is one of the reasons I am very passionate on the issue of the national framework. It does not have to be a system where we have one thing in British Columbia and another in Atlantic Canada or in the province of Quebec, or in provinces that do not have the same economic means or the same sort of treasury to provide the type of service that they should. This is where the national government has a role to play.

When I listen to comments inside the House with regard to where we might want to go from here, or very serious concerns about the current legislation, I would suggest that we reflect on what we are going to be able to potentially do in the coming months, when we have the opportunity.

Unlike in the Manitoba legislature, our standing committees can be exceptionally effective. It is truly amazing, the type of authority, ability and participation that we can witness if we are prepared to park our partisan hats at the door and try to do what is best for Canadians on this issue. If we can take a look at what took place, with regard to C-14, there is absolutely no doubt in my mind that we can do that.

If members listened to the previous speaker, they would get a sense of what was taking place when we had the debates on C-14. Whether it is in the health standing committee or whatever it is that we come up with collectively, with representation from all the parties, I would encourage them to take into consideration the possibility of going outside of Ottawa.

Maybe we should look at different regions and see what some of these other provinces are doing, and maybe tour some of the palliative care facilities. There is a great variance.

We need to look. If I reflect on the province of Manitoba, we should take a look at what is happening in Winkler, Flin Flon or Winnipeg. We should take a look at the difference between Riverview Health Centre and what takes place in the Seven Oaks hospital.

Where, and what role, can we play as a national government to ensure that we are maximizing the benefits of providing the type of palliative care that Canadians expect and deserve, given the limitations that we actually have? Only the national government can do that. I suggest it is going to be in a very important role.

Earlier today, the standing committee on trade tabled the CUSMA deal, the trade agreement between Canada, the United States and Mexico. Many of the members were taking pictures of that particular committee, feeling very positive in terms of what they had been able to accomplish.

My challenge to the health committee, if that is going to be the standing committee, is to take that role very seriously in terms of the potentially life-changing report it could produce for Canadians.

I truly believe that the will is there to support what that committee is hoping to accomplish. It is just as significant as, and maybe even more important than, the report tabled today by the trade committee, which from what I understand was supported unanimously by all members of the House. If one listens to the speeches thus far, I do not think anyone would dispute what I said in regard to it.

I really encourage the standing committee, in the strongest way I can, to look at the mental illness issue using the same principles I talked about regarding palliative care. It is such a critically important issue, and Ottawa needs to play a stronger national leadership role on that. Hopefully that will happen, but because of time I am only going to highlight a few very brief points.

The proposed amendments would allow for a waiver of final consent for persons whose natural death is reasonably foreseeable, in the sense that they have been assessed and approved to receive medical assistance in dying, and have made arrangements with their practitioners for a waiver of final consent in certain situations because they were at risk of losing decision-making capacity by their chosen date to receive MAID.

I also want to highlight that the government is very aware of the concerns about the increased risks when MAID is provided to persons who are not dying in the short term. The bill, therefore, proposes additional safeguards that would apply when a person's natural death is not reasonably foreseeable.

These new safeguards aim to ensure that sufficient time and expertise are devoted to exploring requests for MAID from persons whose natural death is not reasonably foreseeable and that such people are made aware of, and seriously consider, available means for relieving their suffering.

There is another really important part to me, but maybe I will do it in the question-and-answer period.

[David Sweet, Conservative, Flamborough—Glanbrook, ON]

Madam Speaker, I do not often take the chance to speak for my colleagues on this side of the House, but I will right now with regard to the strategy the government is taking on this important issue of medical assistance in dying.

In 2015, in the last election, the Liberals made a commitment that they would invest $3 billion in palliative care to make sure that palliative care across the country was as available as medical assistance in dying. To date, they have not fulfilled that commitment.

The problem we have with modifying the medical assistance in dying legislation is that those who would like to have palliative and hospice care, to feel loved all the way through to the end of their life with the assistance of medicines that would relieve their pain, do not have the capability to experience that. They should have equal rights to those who want medical assistance in dying.

Why have the Liberals not delivered on their promise and why will they not commit to that today?

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I have a couple of quick points on that matter.

First, I do not necessarily concede to the member in terms of the commitment he has referenced. Record amounts of money have been transferred to the provinces to deal with health care. A historic number of dollars has flowed to the provinces. A significant amount of that has been allocated to palliative care, although I really do not know the actual dollar figure.

For the second point, I will pick up on the first point to try to alleviate the concerns the member has. I talked about the importance of having the committee go forward into the summer, and part of its discussion and study should take into consideration what sort of financial role Ottawa could be playing to support this. As I said, we want to make sure there is a sense of equity among the provinces. I think part of that study, which we will be having in the coming months, also needs to take into consideration the issue of the costs of palliative care.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Madam Speaker, the NDP is, in general, fairly happy with this new legislation because it would fix some of the real problems we saw in the original legislation, which we debated and passed in the last Parliament in reaction to the Supreme Court ruling. The Liberal government at that time ignored some very important parts of that Supreme Court ruling and just forged ahead with its own version of what it thought was best, and here we are, four years later, redoing everything.

I wonder if the member could comment on that. Should we not have done it right the first time and not put all of these people, who are suffering so much, through additional duress for these past years?

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, as the member knows, there was a debate process, and the passage of Bill C-14 ultimately received, I believe, unanimous support from the House. However, there is no doubt that during that dialogue there were some differing opinions. The government at the time genuinely felt that this was the best way to proceed. Some wanted the government to go a little further. It is one of the reasons why we recognized back then that this was the type of issue, given the nature of the legislation, we wanted to come back to. Even if the Superior Court in Quebec had not made the ruling it did back in September of last year, the House would have reviewed the process.

The decision by the Superior Court of Quebec allows us to speed up on this very important issue, and that is why the government has chosen to bring forward the bill. It might change to a certain degree, and we will wait and see what happens once it gets to committee, but even at the conclusion of the bill, we will still have this future study, which is a good thing.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the Parliamentary Secretary to the Leader of the Government in the House of Commons gave a very interesting speech.

As lawmakers, we must focus on what we are responsible for and the object of the court's ruling. We must amend the Criminal Code. Although I share my colleague's concerns about good palliative care and its accessibility, palliative care is not in the Criminal Code and does not fall within the federal government's jurisdiction.

Does he not agree that one way to increase the availability and accessibility of palliative care for those who need it, but who would not benefit from it, would be to provide access to MAID?

First and foremost, the solution would be for the government to respond favourably to the request from the premiers of all provinces and Quebec that it increase health transfers to 5.2%.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I believe it is important that the Government of Canada, no matter its political partisanship into the future, should always provide financial support for health care across Canada. A part of that also includes recognizing that the national government has a role to play in ensuring that the Canada Health Act is implemented and that we look at areas of health care, like mental health and palliative care. I think there is an expectation among Canadians that the national government is doing that.

I am glad to say that we have a government that is working with the provinces to support, where it can, the delivery of good-quality health care services from coast to coast to coast.

[Damien Kurek, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, it seems that the bill goes far beyond the scope of the court decision. That is a big concern, but my question is about the consultation period.

There was a tremendous amount of response. I had dozens of constituents who wished to get involved but, for one reason or another, were unable to participate in the consultation process. Why was the consultation process so limited in terms of time and only online? Many challenges have resulted from what I think was an inadequate consultation period on such a serious issue.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I can assure the member that there were thousands of people. Factoring in the surveying and the questionnaires that went out, I believe well over 300,000 Canadians participated in one way or another directly.

There were round tables and consultations in every region of the country, which included provincial governments, disability groups, doctors and nurses. Of course, there is the feedback MPs are bringing back. We also have the standing committee. I can assure the member that there will be good, healthy discussions there. I am being approached by constituents, so I am sure we are all being approached by constituents. At the end of the day, we still have another consultation coming up to do an overall review of everything.

[Bardish Chagger, Liberal, Minister of Diversity and Inclusion and Youth]

Madam Speaker, I appreciate the great work the member for Winnipeg North does in the House. I also appreciate his referring to the previous debate. I know his time often feels limited in this chamber. He had one more point to make, and I would be pleased to hear that point.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I thank the minister very much for that.

The point I want to make is with regard to permitting a waiver for the requirement to give final consent, in specific circumstances. Persons whose natural death is reasonably foreseeable who have been assessed as eligible for MAID and are at risk of losing capacity can make an arrangement with their practitioner in which they provide their consent in advance. This allows the practitioner to administer MAID on a specified day, even if the person has lost decision-making capacity.

There are some other issues related to that, but I thought it was a very important thing to get on the record.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I will be sharing my time with my very esteemed colleague from Shefford.

The debate we are having today must be handled with restraint, dignity and composure. Partisanship has no place here. This is a serious matter, and our decision will have significant repercussions on the lives of many, and perhaps even on our own lives one day, because we all have to leave this world sometime. It is inevitable.

The sad thing in all this is that, through decisions made in this very Parliament, our society has forced people who are suffering to suffer even more. People with severe medical conditions were forced to appeal to the justice system to have their most basic rights upheld. Worse yet, some had to go on a hunger strike to get access to medical assistance in dying by meeting the reasonably foreseeable death requirement. Do hon. members have any idea what we have asked these suffering patients to endure?

These long-suffering people coping with illness, trying to get through the day in unspeakable physical and psychological agony, were forced to go to court or put themselves in a position where their death was reasonably foreseeable. Everyone knows that the justice system is backed up. The costs and delays are typically unreasonable. These people had to endure a veritable ordeal because we made a decision for them.

We failed to make informed decisions that upheld individual liberty. It is a huge privilege to sit in this House, and with that privilege come serious responsibilities. We must honour our position. I want all members of the House to know that this time, we cannot fail. Courageous patients have had to fight the system to get us to make a wise, informed decision. The Superior Court of Quebec gave very clear directives. We must have the courage and vision to apply these directives and support this bill in principle, because it deserves to be improved in committee.

The Beaudoin decision in favour of Nicole Gladu and Jean Truchon is very clear: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu's rights to liberty and security, protected by section 7 of the Charter.”

We must read those last few lines carefully. They refer to the rights to life and freedom of choice. Which of us can presume to choose for someone else? I want to warn my colleagues against the temptation to think about themselves. I want to warn them against voting according to their own beliefs, philosophies or religion. Freedom to choose must be upheld, and in order to choose, we need options. The basis of the decision, which came after a very long wait and constant anguish, makes it very clear that this is about rights and freedoms. No one can choose for another person. We must remove the barriers so that everyone can live out their last moments in their own way, freely and without constraint. Of course, we must not fail to protect the most vulnerable, in accordance with the well-established rule, in medical practice, of free and informed consent. That means informed by exposure to all possible options, and free from any undue pressure.

This bill is a step in the right direction. It includes important precautionary measures and provides for the study of other important issues that need to be considered. Among other things, it would exclude people suffering solely from mental illness. I think that is a wise decision. This is an extremely complex issue that should be studied further. We cannot decide on this issue right now, hence the need to study it properly without skipping any steps.

We must also look at the issue of advance requests for persons newly diagnosed with a condition that may have an impact on their decision-making ability in the future. These are extremely sensitive issues that we must study with great care and a great deal of precaution. It is therefore wise not to include them for now.

Generally speaking, the purpose of this bill is to allow those suffering from degenerative, incurable diseases to have access to medical assistance in dying, whether natural death is reasonably foreseeable or not, except in cases of degenerative cognitive disease, as I was just saying.

For people whose death is reasonably foreseeable, this is about relaxing the rules by eliminating the 10-day waiting period between the written request and the administration of MAID. The 10-day waiting period may be waived if a person has been assessed and their request for MAID has been approved and arrangements have been made with their practitioner to obtain a waiver of final consent because the patient is at risk of losing their capacity to make a decision as the disease progresses or with the administration of pain-relief medication. That way, when making the request for MAID, the patient can agree to waive consent the second time if their pain is beyond treatment, even with care.

This last measure allows the person to live longer with a reasonable quality of life. The person therefore does not have to feel like they have to rush to request MAID out of fear of losing their capacity to do so.

For people whose death is not reasonably foreseeable, there is a 90-day delay between the request and the provision of the MAID service, unless assessments have been made and the loss of capacity is imminent. This time period must therefore be applied in a reasonable and reasoned manner. Who among us can guarantee that 90 days will be enough for some? Who among us can say whether 90 days will be too long a hell to endure for others? We are entitled to question the application of this delay. No one can say. That is why this clause and this entire bill will have to be implemented in a sensible, flexible and intelligent way. Practitioners are in the best position to determine what is valid and what is not when they work together with their patients, listen to them and, of course, treat them humanely. Ultimately, the priority must be the patients themselves, their well-being and their dignity.

I remind all members that although we are talking about dignity, this is above all about rights and freedoms. Every person at end of life must have options, and that individual is the only one who should be able to make that choice. We must not impose our own values and opinions. We must simply ensure that we provide a suitable framework regulating the practice of and the right to medical assistance in dying. We must respect the freedom of the individual. That is fundamental.

I urge all parliamentarians in the House to consider the huge responsibility we must shoulder. We hold in our hands the fate of hundreds of thousands of people. Not only is the end-of-life suffering of these people in our hands, but the suffering and anguish of their family members is as well. It is horrific to watch a loved one suffer at end of life and to feel helpless. Some members of the House may be thinking about personal choices. As I mentioned earlier, we need to figure out a reasonable framework for this very complex act and, through all of this, maintain freedom of choice for these individuals.

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

Madam Speaker, I thank the hon. member for his comments. I have some questions for him.

During the debates today and yesterday, a lot was said about some MAID practitioners. I would like to know whether the member heard the same concerns raised by the Conservatives about doctors who pressure patients too aggressively.

My second question has to do with the fact that mental illness is not included in the bill and that we will be studying it, as the member mentioned. I would like to hear his thoughts on the fact that the Government of Quebec also decided to study whether mental illness should be an underlying condition.

I would like to hear his thoughts on those two questions.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I thank my hon. colleague. His questions are valid.

I will start by answering his second question.

With respect to mental illness, the Government of Quebec chose to study the issue more thoroughly before including it in the law. If two separate lawmaking bodies are making the same choices, that strongly suggests we are on the right path. I think it is a reasonable decision. Laws as impactful as MAID legislation must be drafted very carefully.

With respect to doctors' policies, I heard the horror stories some of our colleagues shared with the House. It is important to note that the medical profession is extremely well regulated. We need to make sure this bill provides a solid framework.

Some MPs shared examples of real cases with us, and I would encourage them to report those cases. I believe such cases are rare exceptions.

By far, most health professionals, including doctors, nurses and attendants, are dedicated to and care deeply about the well-being of their patients. They will take every possible precaution to ensure that the patient's choice is free and informed. As I said, for patients to make free and informed choices, they must be made aware of their options.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, the hon. member mentioned that much debate went on regarding euthanasia back in 2016, which obviously led to the current safeguards. Unfortunately, there has been absolutely no significant enforcement against infractions. The safeguards are regularly ignored. I have an example from the town hall that I held.

A constituent in my riding had a personal experience. A young married father with children was diagnosed with terminal brain cancer and had 12 months to live. He suffered depression, went to a psychiatrist and the psychiatrist offered him MAID. He immediately stopped going to that psychiatrist.

I would like to know why would we loosen the safeguards, which are clearly not working in the first place and seem to be completely impossible to enforce?

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I thank my esteemed colleague for his question, which was also quite relevant.

I mentioned earlier that the law must include safeguards. However, this is not a matter of euthanasia but of medical assistance in dying. I believe that those are two fundamentally different things. It is clear that we will have to provide an appropriate legal framework.

I would like to add that this is why we need to take the time to examine the bill properly in committee. I encourage my colleague to raise those points in committee so that they are properly examined and to invite witnesses, including the people affected by this case. That will help us clarify this situation.

[Laurel Collins, NDP, Victoria, BC]

Madam Speaker, I want to thank the member across the way for highlighting the responsibility we as members of Parliament have in our choices, that we have a responsibility to reduce suffering but also ensure people do not end their lives before they want to and that Audrey's amendment would give people the opportunity to live longer and to make the choice.

I want to ask the member specifically about the 90-day requirement for that second track and the potential it has to prolong people's suffering.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I thank my colleague for her question.

That is why I took several minutes to talk about the 90-day period. Given the complexity of the decision that we will have to make, I think it is important that the law give the practitioner and the person the flexibility—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

I am sorry to interrupt the member, but his time is up.

The hon. member for Shefford.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, it is with great humility that I rise in the House today to speak to Bill C-7, an act to amend the Criminal Code with regard to medical assistance in dying.

Many MPs have very personal stories about the end of life of one of their loved ones. As the Bloc Québécois critic for seniors, it goes without saying that I have heard my share. Therefore, in my speech, I will recall the work done by the Bloc on this issue, the sensitivity that exists in Quebec regarding medical assistance in dying and, finally, the position of certain groups of seniors and women who have come to meet with me.

First, let me go over the context again. In September 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, both suffering from a serious degenerative disease, stating that one of the eligibility criteria for medical assistance in dying is too restrictive. This criterion, that of “reasonably foreseeable natural death”, is found in the federal government's Act to amend the Criminal Code and to make related amendments to other Acts with regard to medical assistance in dying, and the provincial government's Act respecting end-of-life care.

Justice Christine Baudoin said it well in her ruling when she wrote: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu’s rights to liberty and security, protected by section 7 of the Charter.” Those two individuals had argued that they were being denied medical assistance in dying because their deaths were not imminent.

Let me now remind the House of the Bloc Québécois's position and highlight the outstanding work of the member for Montcalm, to whom I offer my deepest sympathies. I want to thank him for the work he has done on this file because, as he quite rightly pointed out, legislators did not do their job properly with Bill C-14. As a result, issues of a social and political nature are being brought before the courts. We need to make sure that people who have serious, irreversible illnesses are not forced to go to court to access MAID. That would be terrible, and yet that is what will happen if we cannot figure out a way to cover degenerative cognitive diseases.

However, we believe that it is important to be very cautious before making any decisions on questions related to mental health. That is why we are relieved that the bill does not address eligibility for MAID for individuals suffering solely from a mental illness. Indeed, this issue requires further reflection, study and consultation, which will be completed at the Standing Committee on Health as soon as the motion moved by my colleague from Montcalm is adopted.

For the second part of my speech, I would like to talk about Quebec's sentiments on this whole issue. Quebec was the first jurisdiction in Canada to pass legislation on medical assistance in dying. Wanda Morris, a representative of a B.C. group that advocates for the right to die with dignity, pointed out that the committee studying the issue had the unanimous support of all the parties in the National Assembly. This should be a model for the rest of Canada.

Ms. Morris said she felt confident after seeing how it would work in Quebec and seeing that people were pleased to have the option of dying with dignity. The Quebec legislation, which was spearheaded by Véronique Hivon, was the result of years of research and consultation with physicians, patients and the public. It has been reported that 79% of Quebeckers support medical assistance in dying, compared to 68% in the rest of Canada.

In 2015, when the political parties in the National Assembly unanimously applauded the Supreme Court ruling on MAID, Véronique Hivon stated:

Today is truly a great day for people who are ill, for people who are at the end of their lives, for Quebec and for all Quebeckers who participated in...this profoundly democratic debate that the National Assembly had the courage to initiate in 2009....I believe that, collectively, Quebec has really paved the way, and we have done so in the best possible way, in a non-partisan, totally democratic way.

For the third part of my speech, I would like to tell you about a meeting I had with the Association féminine d'éducation et d'action sociale, or AFEAS, in my role as critic for seniors and status of women. During the meeting, the AFEAS shared with me its concerns with MAID. I will quote the AFEAS 2018-19 issue guide:

Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly....As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope....This process cannot be accessed by individuals who are not at the end of life....People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.

Many people are not eligible for MAID because of the federal law governing the practice, which was imposed by a court ruling in February 2015. Four years after Carter, individuals whose quality of life is severely compromised by degenerative diseases are still being forced to ask the courts for permission to end their suffering.

In February 2015, the Supreme Court even struck down two sections of the Criminal Code prohibiting Canadian doctors from administering MAID. In Carter, the highest court in the land stated that a competent adult who clearly consents to the termination of life is eligible for MAID if that person “has a grievous and irremediable medical condition...that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition”.

According to the AFEAS, the Supreme Court's criteria were very broad. In drafting the MAID eligibility criteria, the Government of Canada included the concept of reasonably foreseeable natural death only for people at the end of life, which excludes a significant number of people who are experiencing intolerable physical and mental suffering.

The entire process is based on the intensity of the suffering as assessed by a doctor and a panel of experts. The sick person's own assessment is not always taken into account. There are no compassionate criteria among the requirements for obtaining MAID. A person may be at the end of their life and be unable to make the request themselves because they cannot communicate. The law applies only to people who are able to give their free and informed consent up until the very end, which could be terribly traumatic and even cruel to those who have been suffering for years.

With regard to advance consent, the AFEAS spoke about the case of Audrey Parker, a woman from Halifax who died with medical assistance on November 1, 2018. She made a video three days before her death. In that three-minute video, she said that she would like nothing more than to make it to Christmas, but that if she became incompetent along the way, she would lose out on her choice of a beautiful, peaceful and, best of all, pain-free death.

The Barreau du Québec believes that the law should be amended to comply with the criteria set out in Carter and thus prevent court challenges from being filed by people who should not have to carry such a burden.

A panel of experts has studied this issue and recommends, under certain conditions, ending the suffering of patients who have previously expressed their wish to receive medical assistance in dying, but who subsequently become incapable of expressing their consent, in particular people with various forms of dementia or cognitive loss such as Alzheimer's disease. This is why AFEAS is asking, with respect to human rights, that the process of medical assistance in dying be based more on the rights of individuals and on respect for their wishes.

With respect to reasonably foreseeable natural death, it requested that the reference to “reasonably foreseeable natural death” be removed from the eligibility criteria. With respect to advance consent, it asked that the person's informed consent be respected and that it be given in advance. Also on the subject of advance consent, it asked that the consent anticipated, stated and recorded by the person be recognized.

In conclusion, today's debate demonstrates the need to act so that people suffering from degenerative and incurable diseases are no longer forced to go before the courts to challenge the terms and conditions surrounding eligibility for medical assistance in dying, and so that we can ensure the best possible continuum of care.

Let's take action so that everyone can die with dignity.

[Bardish Chagger, Liberal, Minister of Diversity and Inclusion and Youth]

Madam Speaker, I support a number of the comments made by the hon. member opposite. I support moving this bill forward and sending it to committee so that members can study it in depth.

I am wondering what advice the hon. member would give to people concerned about or opposed to this bill.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her question. First, we have to listen to them. As already mentioned, if there are cases and concerns, we have to be able to document them and submit them to the committee. I will be meeting next week with a group that has concerns about this bill. I will listen to them and try to reassure them because I believe that there is a broad consensus that this bill must move forward.

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

Madam Speaker, I want to ask specifically about one issue my colleague did not address in her speech, which is the issue of the 10-day waiting period.

The existing framework involves a 10-day reflection period. The value of that is that people who are maybe at a particularly low point do not make the decision and then go through with the decision in a short period of time. There should be a mechanism, a time period, to ensure that they really are intent on moving forward with it.

At the same time, the existing system already has a mechanism by which this reflection period could be waived. In extreme circumstances it could be waived, but generally speaking, the 10-day reflection period ensures that people are not pressured into it in a short space in time.

Would the member be willing to support the idea of maintaining that 10-day reflection period in order to protect vulnerable people who might be pushed through this decision too quickly?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for his question. We are talking about the second consent, which we do not agree with. We believe that, in some cases, 10 days is already too long. It is a long time to suffer. In the case of advance consent, there is a way to avoid the 10-day period, which can be too long for some people.

[Laurel Collins, NDP, Victoria, BC]

Madam Speaker, many Canadians know someone who has experienced intolerable suffering, and most Canadians support these changes.

I am curious about one piece of the legislation, which is that people will be required to have two practitioners, one having expertise specifically in the medical condition that the person has. I am curious to hear the member's thoughts on the barriers that people from rural and remote communities might face, given this requirement.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, death knows no borders. As already mentioned, we must ensure that there are no obstacles in rural areas. We will have to examine all the obstacles that prevent equal access to a dignified end for everyone, no matter their postal code.

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

Madam Speaker, I would like to thank the member opposite. I want to ask a question regarding a point raised once again by the member for Sherwood Park—Fort Saskatchewan, who talked about patients being pressured and the possibility of doctors influencing people. The evidence that we examined during our consultations does not support that position.

I wonder if the member has any information on how the medical profession operates in Quebec. For our part, we found that doctors always show great professionalism, vigilance and circumspection when broaching the subject with patients.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for his question. Personally, I have heard more about doctors showing a great deal of compassion for their patients and wanting them to be able to end their lives with dignity than the reverse. Personally, I have not heard of many, or really any, cases of undue pressure. Doctors take the Hippocratic oath, which provides patients with a great deal of protection.

However, just because I have not heard about something does not mean it does not exist. If it ever does happen, it must be reported. That could be discussed in committee. I think we need to let doctors do their job, which is about compassion more than anything else.

[Anthony Housefather, Liberal, Parliamentary Secretary to the Minister of Labour]

Madam Speaker, I will be sharing my time with the hon. member for Pontiac.

I want to start by saying that this subject is no doubt difficult for many Canadians watching. It is one in which we try to reconcile our deeply held view that life is precious with the right to liberty and the right to make our own independent decisions. This is a place where parliamentarians need to reflect not only on our own values but on what our courts have said.

In the Carter decision, the Supreme Court determined that section 7 of the charter meant that our provisions in the Criminal Code on assisted suicide were invalid. It said there was a class of people who were entitled to have doctors and nurses assist them in dying, so in 2016, Parliament had to move forward with legislation.

I had the pleasure of being the chair of the Standing Committee on Justice and Human Rights at the time. I listened to witnesses who had a myriad of opinions. I listened to professionals from all sides, including doctors, nurses, psychologists, people representing the disabled, and groups that advocated the right to die with dignity. What we crafted was a law that attempted to bridge all of those gaps. We knew that this law would not be in place forever. We knew that we, as a society and a country, would learn from the experiences of that law and that we would move forward with changes.

Indeed, I was very pleased that the Standing Committee on Justice and Human Rights made some significant changes to the legislation. We carved out conscience protection for medical professionals so that they were not obliged to assist with medical assistance in dying if it violated their own conscience or their moral values. We said that the law needed to be looked at again five years later to look at various classes of people we had left out of the original law, such as mature minors and people suffering from mental illness, as well as to examine the issue of advance directives whereby people could make decisions before they declined into dementia.

We also required the review to look at palliative care and its availability across Canada, because the two issues are intrinsically tied together. We do not want people to ever make a decision that they need medically assisted death because they will be deprived of proper palliative care.

That review is coming up. I know that Canadians across the country will have the opportunity to pronounce on these issues.

However, our courts have made another decision.

In the Truchon-Gladu ruling in Quebec, the court ruled that a class of people were entitled to access medical assistance in dying in accordance with Carter. The legislation passed in 2016 had removed this class of people from the list of people eligible for medical assistance in dying. We must therefore remove the section that limits medical assistance in dying to people whose death is reasonably foreseeable. This amendment to the original law is designed to remove this class of people and to enable people who meet all of the other criteria to access medical assistance in dying, even if their death is not reasonably foreseeable.

I support that position because I have not only looked at the court decisions but have also walked the experience of Canadians over the last four years.

We have heard of people who were enduring grave suffering and who should have been entitled to medical assistance in dying because they met every aspect of the law, except that no one could say with reasonable certainty that their death would happen in the near future. We heard, from Canadians everywhere in Canada who fall under that class, that this is unfair. The courts in the Truchon case and in a number of other cases have hinted that this requirement is unconstitutional, so the government is moving forward to respect the court's decision in Truchon and remove from the law the requirement for death to be reasonably foreseeable.

However, the government is also adapting the law to deal with other difficulties that have arisen.

We never talked about, or if we did, it was rare, the issue of people deciding to prematurely end their lives because they were worried they would lose capacity at a future date. People should not shorten their lives because they are worried that a month later they will no longer have the capability or capacity to make that decision under the terms of the law. If it will give people an extra two or three weeks or an extra month with their family, we should do that.

Therefore, the law is being amended to allow people to offer consent to a medically assisted death even if they lose capacity, but it also establishes safeguards. In the event they get to that date and they no longer wish to have medically assisted dying, even if they have lost capacity, by any word, any gesture that is not involuntary, then the pre-consent will disappear.

I want to clarify this, because it has been talked about a great deal today. This is not an advance directive. These are people who already know exactly what their illness is, they are already suffering from this illness, they are in an advanced state of decline, they have no ability to relieve their pain by medical treatment reasonably accessible to them and they have, after being reviewed by two medical professionals and declaring before an independent witness, decided they want to offer consent to end their lives on a certain date, even if they have lost the capacity to consent.

This is a really important change, and I credit the government for doing so.

I also want to look at the issue of how we have handled that class of people whose death is not reasonably foreseeable. We have established a 90-day waiting period in that case. We have not made this something that could happen in the 10 days that was previously reflected under the law. We have done so with due seriousness. We understand the differences and the challenges that the issue poses for people when their death is not imminent.

For example, people could have a catastrophic event that occurs and their circumstances change suddenly. We want them to have a proper reflection period before moving forward with medically assisted dying. We also understand and have made the exception for those people who may lose the capacity to consent during that 90-day period.

The amendments to the bill reflect well where Canadian society has gone.

I do want to say that when we passed the legislation in 2016, very few jurisdictions around the world allowed medical assistance in dying. It existed in Belgium, the Netherlands, Uruguay and five or six U.S. states.

We were one of the first countries in the world to allow medical assistance in dying. For that reason, we chose to take things slowly.

This new amendment to the original law takes us to a place where Canadian society has moved. Canadian society, much more than in 2016, accepts and supports medically assisted dying, because they have watched the practice happen. We have seen the challenges we have confronted with the existing law and we have taken steps to improve the law and comply with the Truchon decision.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, we hear that the current Liberal government is not aware of any infractions against the current euthanasia safeguards.

I have mentioned a few today, but I would also like to include the very public story of Roger Foley, who became a national story after being offered, repeatedly, by his hospital careworkers euthanasia rather than suitable home care.

The current safeguards are not working. Why would we even start to loosen restrictions when we clearly cannot enforce the ones we already have?

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I have faith in health care professionals across Canada, including nurses and doctors. I believe that the great majority of physicians and nurses in the country are dedicated professionals who do their jobs appropriately and follow the law.

In those cases where physicians or nurse practitioners have violated the law, I strongly suggest that members report them to the professional order of their province and to the police, and justice should prevail.

I clearly agree that medical assistance in dying is a decision of the person, but it is a decision of last resort. I believe palliative care is a priority, and everyone should have access to good palliative care in the country.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I commend my colleague for his thoughtful speech.

I would like to give him the chance to elaborate on the 90-day period he was referring to, as opposed to the 10-day period. We are all aware that each situation will be vastly different, including when it comes to capacity and the deadlines people are facing. We all want to avoid having a person die too soon out of fear of not being able to provide clear consent at a later date.

In my colleague's view, what sort of flexibility might be included in the 90-day period?

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I greatly appreciate my colleague's question. I also commend him for his speech.

In my view, we must make a distinction between people whose death is reasonably foreseeable and those whose death is not reasonably foreseeable. I believe the 90-day period could be 75 days or 120 days. I believe that 90 days is a good compromise, but there is an exception. For people who obtain all the necessary authorizations from a doctor to have access to medical assistance in dying and who will lose the capacity to consent, there is an exception in the legislation that allows the waiting period to be shorter than 90 days. I believe that is a good step forward. I imagine we could propose amendments on this at the Standing Committee on Justice and Human Rights. Those amendments will be studied by the committee.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Madam Speaker, the NDP is relatively happy with the new bill. We think it should have been done this way in the first place, four years ago.

One of the concerns we have, and this was also brought up by the Liberal member for Beaches—East York, is that with this new track for people who experience intolerable suffering, they will have to get an opinion from a specialist. Specialists are not easily seen in many parts of Canada, rural and northern parts. These are people at the end of their lives and intolerably suffering.

We are worried this will restrict the ability of these Canadians to have the same medical service other Canadians have.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, in 2016 at committee, the requirement to see a specialist was suggested by a number of the groups that appeared. It would be a specialist in the area of the condition the person had.

Concerns were expressed that two doctors, or a nurse practitioner and a doctor, who did not have expertise in the condition would not be able to properly assess the individual. When we are talking about people whose death is not reasonably foreseeable, I do not believe this is outside the bounds. This is a reasonable way to approach the situation. With video conference and consultations, there are ways to reach remote communities. The person does not have to be in the room with the patient.

[William Amos, Liberal, Parliamentary Secretary to Minister of Innovation]

Madam Speaker, I am pleased to rise on the topic of Bill C-7, as we embark on what I expect will be quite a lively and passionate discussion about issues that Canadians care deeply about and certainly my Pontiac constituents. I heard from them for several years on this topic, regular correspondence, regular discussions at the door, so I appreciate this opportunity to discuss certain aspects of our government's proposed changes to the federal MAID legislation.

It is timely to share some of the insights from three important studies on very complex and sensitive issues that were not included in the 2016 federal legislation. These are requests by people for whom mental illness is their sole underlying medical condition, advance requests and requests by mature minors. I hope we will get to all three of them, but may only get to the first two.

When Bill C-14 was debated in 2016, parliamentarians had difficulty finding common ground on how to address these types of requests within Canada's first assisted dying regime. Understandably, given the challenging nature of these issues and the limited time that was available, due to the Supreme Court's timeline, to deliver on acceptable approaches for Canada, parliamentarians collectively decided that more in-depth study and review of the evidence was needed.

The legislation in 2016 therefore included requirements for the government to undertake independent reviews. There were strict timelines set out in Bill C-14 and the studies that needed to be commissioned had to be done within six months of the coming into force of Canada's new legislation on assisted dying and the government was obliged to table the final reports on the studies within a further two years. Both of these timelines were met.

In December 2016, the government asked the Council of Canadian Academies, CCA, an independent organization that undertakes evidence-based expert study, to inform our public policy development and to take on these studies that were required by legislation. The resulting reports were tabled in December 2018, documenting extensive review of academic and policy research, stakeholder submissions and international experience in the three subject areas.

They also included a broad range of perspectives from relevant health care professions, diverse academic disciplines, advocacy groups, indigenous elders, essentially the whole of Canadian perspective was brought to bear. In accordance with the CCA practice, they did not in fact contain recommendations.

Two of the reports, one on request by individuals where mental illness is the sole underlying condition and the report on advance requests have been particularly informative during the development of our government's response to the Quebec's Superior Court decision in Truchon.

I will first talk about mental illness. Under the current law, very few persons with mental illness as the primary source of their suffering are likely to be eligible for MAID. This is because most mental illnesses do not cause a person's natural death to be reasonably foreseeable.

Removing the reasonably foreseeable natural death criterion introduces the possibility for persons with mental illness to be deemed eligible for MAID, if they meet the remaining criteria.

During the recent federal round-table consultations held on MAID, we heard many concerns from participants who felt that not enough is known to safely extend eligibility for MAID to people whose suffering is caused by a mental illness alone. They felt that the issue required further examination.

We also know that there is generally very little support for expanding eligibility among mental health care practitioners, such as psychiatrists and psychologists, and by organizations representing people with mental illness. The CCA report on this issue noted a number of challenges associated with the delivery of MAID to persons with a mental illness.

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

The hon. member will have five minutes to complete his remarks after oral questions.

The House resumed consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[William Amos, Liberal, Parliamentary Secretary to Minister of Innovation]

Mr. Speaker, I will continue to speak to the report of the Council of Canadian Academies on the provision of medical assistance in dying to those struggling with mental illness.

The complexity of the issue is reflected in the fact that the members of the Council of Canadian Academies working group had vastly different opinions on the subject. On the one hand, the reports note that symptoms of mental disorder can impair cognitive abilities, making it more difficult to understand or appreciate the nature and consequences of treatment decisions.

The word “incurable” is not generally used by clinicians in the context of mental disorders, which makes it difficult to assess the condition of a person with “irremediable” health problems under the current legislation.

On the other hand, the report points out that the autonomy rights of an individual with a mental illness must be respected. The report cites the experiences of Belgium and the Netherlands, which permit assisted dying for psychiatric conditions, with additional safeguards. However, the report also acknowledges that assisted dying for persons with mental illnesses in these jurisdictions remains controversial, and the public debate is ongoing. Ultimately, the working group could not reach consensus on ways to address complexities and mitigate risks associated with mental illness and medical assistance in dying.

On the topic of advance requests, the Council of Canadian Academies report on advance requests also documents considerable evidence and provided many instructive findings on an issue of great interest and concern to many Canadians. Particularly in our riding, this was an issue I heard a lot about.

An advance request is a request for assisted dying made well in advance and in anticipation of the time when the person making the request may face suffering and other circumstances that may make them eligible for medical assistance in death. An advance request would set out conditions under which an individual requests MAID to be provided at a future date. Advance requests are premised on the likelihood that when people's health circumstances deteriorate to the point where they would want an assisted death, they would no longer have the capacity to affirm their decision immediately before receiving medical assistance in dying. In other words, that critical requirement of giving final consent would not be possible.

Many people express the desire to make an advance request so they have the comfort of knowing they will be able to avoid a lengthy period of grievous suffering for themselves and for their families. This is in the event they succumb to an illness that could leave them severely impaired and lacking cognitive capacity for a lengthy time period.

The CCA report helped unpack advance requests, in a way that really was helpful, by outlining several scenarios of increasing complexity. The first scenario involves an individual at the end of life who has been assessed as eligible for medical assistance in dying, but fears losing capacity while waiting to receive it. This is the situation experienced by Audrey Parker from Nova Scotia who chose to receive MAID earlier than she had wanted in fear of losing her eligibility status.

The second scenario involves an individual who has been diagnosed with a serious condition, but does not yet qualify for medical assistance in dying.

The third scenario involves an individual who wants to plan for various future outcomes, prior to any diagnosis.

The report indicated that when the request is farther in advance of the procedure, it becomes more challenging for health care providers to be certain that the request still reflects the wishes of the individual. The report found that the first scenario poses the least risk and is relatively straightforward. Canadians expressed a great deal of support for this scenario in the federal consultations and it is also widely supported by experts and practitioners.

Our proposed amendments in Bill C-7 would permit this type of advance request. This means that an individual who has a reasonably foreseeable natural death, and who is assessed and approved for medical assistance in dying, can wait for their chosen date without worrying about losing decision-making capacity. If the person does lose capacity prior to that date, they would still receive medical assistance in dying on the requested date or earlier, as expressed in their advance wish. It also means that individuals no longer need to reduce required pain medications and endure additional suffering in order to maintain their capacity to consent right before the procedure.

However, the other two scenarios, where significantly more time passes between preparing a request and medical assistance in dying provision, are far more complex and challenging.

I want to point out that we have definitely made movement on that first aspect. It is in those other two aspects where there is significantly more debate, and those need to be taken care of by Parliament in the coming months, which is exactly what this bill provides for.

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

Mr. Speaker, it is really interesting that this member actually makes very explicit the slippery slope that so many people are concerned about, because when C-14 first came out, the ministers at the time defended it as representing a finely tuned balance between access and safeguards.

Now, we have legislation that removes safeguards and this member talks about the possibility of new legislation very soon after the statutory review in June that would remove further safeguards. We have seen dramatic increases in the rate of people accessing euthanasia in each of the last four years.

I wonder if people should be reasonably skeptical when the government talks about the balance that it is trying to establish, when every single time this comes up, they want to remove more and more of the safeguards.

I will pick on one safeguard, the idea that there could be a 10-day waiting period, one that can be waived in certain circumstances, but by and large is in place. That seems to be eminently reasonable. There is also the idea that there should be two witnesses who observe the consent. These basic safeguards, the 10-day waiting period that could be waived and two witnesses, are very reasonable things that the government wants to do away with.

It makes me wonder, in the next iteration of this legislation, what safeguards at that point will the government remove. How many safeguards do they intend to take away? What is wrong with having some checks and balances in place protecting vulnerable people?

[William Amos, Liberal, Pontiac, QC]

Mr. Speaker, this country has been going through an ongoing discussion on this issue. This precedes the Carter decision. It goes even beyond the Rodriguez case. We have been having this conversation about what are the appropriate ways to secure the life, liberty and security of the person while also respecting his or her dignity. This is not a question of removing safeguards. This is a question of ensuring that Canada has a properly progressing discussion about issues that are very difficult.

Granted, the bill brought in 2016 was brought with significant time pressures and there was a significant and robust discussion, but we left room for further discussion. That was the whole purpose of the reports that were prepared by the Council of Canadian Academies, so that further reflection could be provided. That was done, and those reports have really helped this legislation bring forward better proposals.

[Paul Manly, Green, Nanaimo—Ladysmith, BC]

Mr. Speaker, listening to the debate today, one of the things we need to do as a Parliament is to make sure we have national standards for palliative care and a national mental health strategy that ties the provinces to the Canada Health Act and makes sure provinces spend money in these areas, so that those are not concerns going forward with this act.

My question is about the final consent waiver, proposed subsection (3.2). It seems that it is tied directly to entering an agreement in writing with a medical practitioner or a nurse practitioner. That medical practitioner or nurse practitioner would administer a substance to cause the patient's death on a specific date. I am just wondering whether it is actually tied to that practitioner or whether it could be transferred to another practitioner, in the case where that medical practitioner with whom the patient made the agreement is unable to go forward with those wishes at that time, when the patient needs medical assistance in dying.

[William Amos, Liberal, Pontiac, QC]

Mr. Speaker, I must confess that is an aspect of this bill that I do not know enough about. I am going to have to go back and discuss that with the Minister of Health and the Minister of Justice because it does raise an interesting question. Canadians do have access to different health practitioners. Rather than saying something that I do not know much about, I would rather reserve comment, thank the member for his question and then have a discussion with him separately.

[Jean-Yves Duclos, Liberal, President of the Treasury Board]

First of all, Mr. Speaker, I would like to thank the hon. member for Pontiac and congratulate him for his great sensitivity, his ability to listen and his deep sense of humanity when he speaks to this very important issue.

I would like to quickly ask him to talk about the twofold objective we want to achieve, namely the protection of vulnerable people and access to greater dignity through greater freedom of choice for those who are experiencing tremendous suffering.

[William Amos, Liberal, Pontiac, QC]

Mr. Speaker, I thank my esteemed colleague for his question. This certainly is a very sensitive subject. It is a complex and deeply personal issue.

That is what comes through when I talk to people in the Pontiac. Everyone is concerned not only about their own future and their own health, but also the health and future of their family members and loved ones. We need to strike a balance between societal needs. The Government of Canada remains committed to protecting vulnerable individuals on the one hand and every Canadian's right to equality on the other. We need to safeguard eligible individuals' autonomy in requesting MAID. We also have to protect families and individuals who are not competent to make that decision. It is not easy. I am proud of our government for bringing in legislation on this issue.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, I will be sharing my time today with my colleague, the member for Saskatoon West.

As a new member of the justice committee, I look forward to the issues that we will be dealing with in this new Parliament. While I am not a lawyer, nor do I have any desire to become one, I hope my contributions and insight on the issues of the day will help in rebuilding trust in our judicial system.

I am fully aware that many Canadians have serious concerns. Many are looking for solutions that will keep our communities safe, and they want us to begin the process of rebuilding the public's confidence in our justice system.

The legislation we are dealing with today is about one of those issues that almost every Canadian has heard of and will be, undoubtedly, following in the news. As a member of the Conservative caucus, I can debate this legislation and vote on it as I see fit. It is my intent to improve this legislation and to do the best I can in representing the good people of Brandon—Souris.

Like many Canadians, I find discussing the implications of medical assistance in dying challenging. There is no sugar-coating the fact that, for many people, it is extremely difficult to openly discuss the issue of death. As a result of to the Carter decision, it was left up to Parliament in 2016 to determine the appropriate legislative response in order to be compliant with section 7 of the charter. It must also be said that the Carter decision was specifically limited to a competent adult who gave her consent in receiving medical assistance in dying.

When we were seized with dealing with the legislation, many members of Parliament felt the government's response did not go far enough. One of the Liberal MPs who voted against the legislation was none other than the Minister of Justice. Some members were quite concerned about the lack of clarity, such as in the term “reasonably foreseeable”, which was left undefined. Other members wanted Parliament to supersede the Carter decision.

Disagreement is not new in this place. It is to be expected in Parliament, with members from all political stripes and backgrounds. I would argue that our democracy is much better served having such divergent views as to guarantee that every position is fleshed out.

When we debated Bill C-14, our Conservative caucus studied the legislation with the rigour that Canadians demanded of us. We asked the tough questions, we put forward amendments and we did what we were sent here to do, which was to ensure the concerns of our constituents were put front and centre. It is my sincere hope that we once again invest the necessary time on this and be as inclusive as we can so that all Canadians have their say on Bill C-7.

It goes without saying that there are deep divisions on the overall issue of medical assistance in dying. I know every member of Parliament is hearing from constituents on this issue, and in the past couple of weeks numerous petitions have been sent to all members' offices. I would also note that in the election, I received inquiries on the future of the legislation and on whether Parliament would be reviewing it anytime soon.

One of the elements in the original legislation was to have an automatic review, which will be undertaken this summer. It is notable that the legislation now before us has pre-empted the automatic review on a few matters. This upcoming review will be far more comprehensive than the two-week online survey used for Bill C-7.

From what many were expecting, the legislation that was set to be introduced was to respond to the Superior Court of Quebec's ruling. We now know that this is not the case. In fact, yesterday during debate, the parliamentary secretary of justice acknowledged that the Liberals did go above and beyond, because that is what he thinks Canadians want. While that may be his opinion, it is concerning that the larger changes found within Bill C-7 could have been dealt with in the larger review this summer.

What we are debating today has numerous changes that go much further than deleting and replacing the phrase “reasonably foreseeable” in order to be compliant with the recent court decision. For example, the government is easing safeguards, which I might add is the actual language found within the presentation with which departmental officials briefed MPs.

As it stands, patients must make a written request for MAID that is witnessed by two independent witnesses. In Bill C-7, this has been changed to one independent witness. I believe it is incumbent on the government to justify this change and to outline the rationale for why it needed to be amended. The government is also removing the mandatory 10-day period after the written request is signed. Once again, this is a significant change that goes above and beyond what was required for the law to be in compliance with the Quebec Superior Court decision.

It is my intent to invite as many experts, health care professionals and provincial governments to committee to ask them about the proposed changes and to determine if they are in fact needed. We must be cognizant that MAID still has the necessary safeguards in place to protect the vulnerable.

I want to put on the record that many of the issues we raised in the last Parliament, such as enshrining conscience legislation in law for medical practitioners, has fallen on deaf ears. This was an almost universal position among my Conservative colleagues, and the Liberal government of the day did not adopt those measures.

We were also quite adamant about improving access to palliative care. Even though the delivery of health care falls under the purview of provincial governments, we passed a private members' bill to implement an action plan. My colleague from Sarnia—Lambton, who worked hard to get this legislation passed, is very disappointed that the government's five-year action plan failed to commit enough resources or outline a clear set of measurable outcomes. In a rural riding like mine, there are not enough palliative care services available. My heart goes out to those families who must send loved ones to a different community in the final days of their lives.

As a champion of rural Canada, I know first-hand the unique challenges that millions of people face every day due to their isolation or remoteness. I want to give the benefit of the doubt to the government that it is committed to rural Canadians, but its record says something completely different. While these issues cannot be fixed in this legislation, we cannot treat them in isolation while discussing MAID.

In closing, I want the government to know I am committed to working with it constructively on this legislation. I will ensure that the concerns of my constituents are heard. We know there is nothing more precious than the gift of life: to live freely, to live safely and to live healthy and happily. It is our collective responsibility to do what we can to improve the quality of life of all Canadians.

I look forward to what my colleagues have to say on this legislation, and if it is sent to our justice committee, we will do our due diligence to listen to witnesses and improve it where possible.

[Larry Bagnell, Liberal, Parliamentary Secretary to the Minister of Economic Development and Official Languages (Canadian Northern Economic Development Agency)]

Mr. Speaker, I enjoy working the member on the Standing Committee of Parliamentarians of the Arctic Region. He gave a very positive speech.

I wanted to reply to a couple of items. Why now, before that major review of the act in June? We had no choice; the Supreme Court ordered it. Concerning the 10-day period, medical practitioners suggested that a person may be incapable in those 10 days, so it was not necessary. That was a bit problematic, as was getting two signatures.

On palliative care, I agree 100% with the member. That is one of the reasons why in the last budget, for the first time in history, we added $6 billion to help the provinces with palliative care. I hope it is working toward exactly what the member would like.

Could the member let me know, as I think about this bill, what his constituents said to him about the MAID legislation?

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, my colleague from Yukon and I have worked together on the Standing Committee of Parliamentarians of the Arctic Region for a while. Someday I will have to go up to Whitehorse to see how he operates.

The people in my riding have given me differing directions on this particular issue. As I said in my speech, there are many people with different ideas on how this should be done and on whether it should be done at all. I have received petitions from hundreds of people on both sides of this issue.

We will be listening intently, and as I said, if it comes to the justice committee, which I am a member of, we will be looking for input from the witnesses in the way I outlined and making sure we improve the bill wherever we can.

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

Mr. Speaker, I want to thank my colleague for his speech.

I would like to know why my colleague does not like the idea of having a single witness present while MAID is being administered. Usually, at this important time in their lives, sick people are surrounded by family members, and therefore by love and affection.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, the only thing I can say on that is that the two signatures acted as a safeguard. That was in place before, and now it would be one. There is also a shortening of the time frame for the reflection period. I think we need to hear from witnesses as to whether that should have stayed where it was or gone forward, but the government has put it in the bill to move it in that direction. I am not saying that one witness is not enough. I am just saying that the safeguards need to be in place to protect those who are vulnerable.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, obviously the original medical assistance in dying legislation was about limiting the amount of unnecessary suffering when people are facing end-of-life issues, both for the individual and for the families.

One part of the legislation that has been brought forward has been referred to as “Audrey's amendment”, named after Audrey Parker, a woman in Nova Scotia, who felt forced to choose an earlier death than she would have liked and ended up missing a last Christmas with her family because she felt she might lose competence and not be able to give consent at the end.

The bill that has come forward provides that those who have been assessed and approved can give instruction to a doctor so that if they lose competence before their wishes are carried out, they can receive assistance and not have to make the ugly choice to go sooner than they would like. Does the member support that provision?

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, I want to assure my New Democrat colleague that this is an area of concern. There is no doubt that the situation he outlined is of great importance in determining the situation before us. It will be coming back to our committee. I look forward to working with him on it as well, as he is a member of the justice committee.

At this point I want to make sure we hear from as many witnesses as we can. I have already heard from many in my area who are quite supportive of that and of having the 90-day before going forward. This is one of the changes to “reasonably foreseeable” put in the bill, and I support the part of the bill that would allow them to do that.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, today I rise to speak on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

My office has received about 135 phone calls, emails or letters so far on this issue, and I recognize that this is a very touchy, personal and non-partisan issue.

I will begin with a quick bit of history. The MAID legislation came into law in June 2016. Recently, one judge in Quebec ruled that the wording in the legislation on “foreseeable death” was too restrictive. The Liberal government was very quick to accept this ruling. It chose not to appeal, and instead moved to rewrite the legislation taking into account the decision of the court.

This caused me to compare this ruling to the recent Alberta court ruling in which four judges found the carbon tax to be unconstitutional. It made me wonder if the government is going to be as quick to accept the Alberta court ruling as well and not appeal it, but that is a digression.

As I said, MAID is a very touchy, personal and non-partisan issue. One can always find examples of people for whom MAID legislation is a difficult but welcome option. Unfortunately, those simple examples are usually in the minority. Far more often, it is much more complicated than that. The stories I have heard reflect these complications, such as the case where families are caught by surprise with a death and then forced to deal with the aftermath of that.

There are cases where a person is at a particularly low point in their health but, under this proposed legislation, would be able to request and receive MAID with no waiting period. There are cases where physicians or hospital officials apply pressure on individuals to consider MAID. For example, Roger Foley, an Ontario man who is suffering from an incurable neurological disease, said that the medical staff repeatedly offered him MAID, despite his repeated requests to live at home.

There is also the B.C. case of Ms. S. Dr. Wiebe lamented the profound suffering of Ms. S. but felt that Ms. S. was not eligible for an assisted death. Then, unfortunately, Ms. S. decided to starve herself. Dr. Wiebe and another doctor then determined that, due to the severe malnutrition and dehydration of Ms. S., her natural death was reasonably foreseeable, so Dr. Wiebe euthanized her on March 2017.

According to a Globe and Mail article, this case is the first to be made public in which a medical regulator has ruled on the contentious question of whether doctors should grant assisted death to patients who only satisfy all the criteria of the federal law after they have stopped eating and drinking.

It is not difficult to imagine a situation where a hospital will, for reasons of efficiency, encourage its staff to suggest MAID to patients with chronically difficult and complex cases. It is not a simple problem. It is a very complex problem.

What bothers me about this is that the government is pre-empting the parliamentary review process that was specified in the legislation. We know that the current justice minister voted against the party on the original legislation because he felt that it did not go far enough. Now, as justice minister, he is able to make the changes that he desired. This is troubling, because he is choosing to pre-empt the legislated review process and get his desired changes into legislation without consultation.

The existing law mandates the review of the legislation every five years, and the review will happen in just a few months.

Why is the government is such a rush to make substantive changes to this legislation and pre-empt the legislated review process?

To me, it makes far more sense to deal with the specific issue raised by the Quebec judge only, then do a proper consultation with Canadians this summer and propose changes based on that. Instead, the government had an extensive online survey that lasted two weeks. While it received a lot of responses, I think it just proves that there is great interest, and Canadians have a lot to say about this issue. So far, the results of these responses have not been shared, and I ask for these responses to be shared. I call on the government to do the right thing and leave any changes beyond what the Quebec judge has asked for until the completion of the review process later this year.

Since we are talking about changes to this legislation, I want to talk about palliative care. There are calls for a pan-Canadian strategy on palliative care. I think it is convenient to point to the provinces and say that this is their problem, but there cannot be a full end-of-life strategy without funds and laws around palliative care.

The government broke a key election promise to invest $3 billion in long-term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making.

I have a personal example from Saskatoon, which has 12 palliative care beds for an area with over 300,000 people.

My mother-in-law had a terminal disease. In her case, MAID was neither requested nor desired. She was fortunate in that her death was relatively quick, and by some miracle she was able to get one of those 12 beds in Saskatoon.

It should not take a miracle to get good end-of-life care. It should not be that MAID is the only reasonable solution at the end of life because palliative care is not available. Therefore, I call on the government to put as much effort into palliative care as it has into MAID.

Another significant area of concern is conscience protection. Physicians and health professionals must be given strong conscience rights. They must be free to not participate and be free of penalty or harassment for making that choice. They must also be free to not be required to refer to another health professional. They must have full conscience protection.

Further, it must be recognized that the conscience objection of institutions must be protected. Institutions are not bricks and mortar. They are collections of people with values. Therefore, institutions must also be given the right of conscience protection. Several Supreme Court cases are instructive here.

The Supreme Court in 2015, in the Loyola case, stated:

Religious freedom under the Charter must therefore account for the socially embedded nature of religious belief, and the deep linkages between this belief and its manifestation through communal institutions and traditions.

In another 2015 decision, the Supreme Court stated:

A neutral public space free from coercion, pressure and judgment on the part of public authorities in matters of spirituality is intended to protect every person’s freedom and dignity, and it helps preserve and promote the multicultural nature of Canadian society.

We must respect the multicultural nature of Canadian society. We must respect both medical professionals and institutions, and allow them to have full conscience protections free from harassment and consequences.

There are some specific changes proposed that I am concerned about. The current legislation includes a 10-day waiting period between when MAID is requested and when it can be administered. The current legislation already allows for this waiting period to be waived. It states that if two medical practitioners:

...are both of the opinion that the person's death, or the loss of their capacity to provide informed consent, is imminent—any shorter period that the first medical practitioner or nurse practitioner considers appropriate [can be used] in the circumstances.

There already is a provision to deal with this issue. There is no need to make changes. The situation has been contemplated and addressed in the current legislation.

Another area of concern is the lack of safeguards for the mentally ill. Mental illness is a very complex situation. Patients diagnosed with an underlying mental health challenge are not required to undergo a psychiatric assessment by a psychiatric professional to determine whether they have the capacity to consent.

There is no one-size-fits-all solution to the issues of mental health. However, it is not difficult to imagine a scenario in which a person is in a particularly dark period and considers MAID. It may well be that with proper professional help that person can work through the darkness and emerge a bit better. This may not always be the case, but that is why having a general waiting period is so important. It eliminates the ability of medical professionals or others to make a quick decision that they regret.

A poll in January found that Saskatchewan and Manitoba had the lowest support in the country for MAID. In 2018, in Saskatchewan, only 67 of 172 applicants for MAID actually received medically assisted death. Some were declined, some withdrew and some died before the request could be completed.

In summary, I would make the following observations. Most importantly, in the words of a constituent I spoke with this week, “We need to slow this down, not speed it up.” Yes, we need to deal with the Quebec court decision, but that only requires one change. There is a legislated review that will happen this summer.

Let us wait for a proper consultation and use that lens to view any proposed changes. Let us have a pan-Canadian strategy for palliative care. Let us put full conscience protection in place for physicians and health care professionals. Let us put conscience protection in place for institutions. Let us leave the 10-day waiting period and the ability to create exceptions the way it is. Let us deal with the Quebec court decision and leave the rest until after the legislated review this summer. Let us slow this down.

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

Mr. Speaker, given the preamble in the old Bill C-14 expressly references conscience protections, given that section 241.2(9) of the Criminal Code, which was amended by his party at his party's suggestion in the last Parliament, also has conscience protections, given that paragraph 132 of the Carter decision references conscience protections and given that the section 2 protection in the charter is a bedrock foundational conscience protection, does the member, first, think that is sufficient with respect to conscience protections?

Second, is there any instance of an institution, of religious persuasion or otherwise, being forced to provide this, given those protections? I am aware of none.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, there are cases that I am aware of, to the member's last point. The reality is what happens on the ground. I have heard cases of people, medical professionals who do not want to participate and yet they felt harassed, pressured, criticized and those types of things. There are certain protections under the laws now, but they need to be strengthened, and in practice it needs to be expanded.

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Speaker, I thank my colleague for his speech, in which he talked about rights and freedoms.

I just want to know if he is aware of the ruling regarding Nicole Gladu and Jean Truchon, both of whom have degenerative diseases, in which Justice Christine Baudouin wrote that, “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu’s rights to liberty and security, protected by section 7 of the Charter.”

I would like to hear my colleague's thoughts on that.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, yes, I am aware of that. That is the part that I believe we should be pursuing now. The other changes that have been proposed, regarding the waiting period and some of these other things, should not be pursued now. The bulk of what is being proposed should wait until the consultation period in the summer. We need to deal with the request from the Quebec court and the ruling from the Quebec court. For the rest, I believe we should wait.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, I would like to talk about something that happened just a few minutes ago. Someone I know quite well contacted me, someone who is not currently eligible for medical assistance in dying under the legislation and would probably qualify under the new provisions. This person is in intolerable pain and suffering and has reached out to many people, asking for help.

I believe the reason the government has decided to proceed with some of these changes is to meet that need and help us reduce unnecessary suffering at the end of life. This is not someone who is being pressured. This is someone whose condition is deteriorating quite rapidly and is, as I said, in enormous pain. I ask the member to think about that motivation here for us to reach out and help those people and those families who are faced with this right now, not months from now.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, we can all think of many specific cases of people who are impacted by this. I still believe it is correct to wait for the review process to look at all these cases and make changes based on that.

The other issue that the member's question raises is the lack of palliative care. If there were more and better palliative care options, while I do not know about the specific case the member mentioned, then more people would have other options than MAID. I believe, though, that is another solution.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Mr. Speaker, in this debate, we hear that the safeguards we currently have are already not working. We know that quality palliative care is a necessary solution and we all see a lack of access, even a revocation of palliative care in my province.

The third thing is, unfortunately, the inability to ensure conscience rights protection. In my province of B.C., the former program director of palliative care had to resign when Fraser Health Authority imposed MAID in hospices. He believes that palliative care does not include euthanasia since palliative care, by definition, neither hastens nor postpones death.

Why is the government not working harder to ensure proper protection for patients and health care professionals?

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, that raises some very good points. It raises the issue of institutional conscience protection, and also the issue of better palliative care options in our country. Those are areas that we need to pursue just as vigorously as the government is pursuing the MAID legislation.

[Kamal Khera, Liberal, Parliamentary Secretary to the Minister of International Development]

Mr. Speaker, it is an honour to rise in this House to speak today about Bill C-7. This bill would amend the medical assistance in dying regime in the Criminal Code to address the Superior Court of Quebec's decision in the Truchon case. As members know, in September 2019, the Quebec Superior Court struck down the eligibility criterion of “reasonably foreseeable natural death” from the medical assistance in dying, or MAID, regime in the Criminal Code. Our government has made significant efforts to consult and engage with Canadians in order to inform the proposed approach to address this decision and amend the MAID regime in Canada.

An online consultation was launched, and over 300,000 responses were received from Canadians. In addition, the Minister of Justice and Attorney General of Canada, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion had the opportunity, along with their parliamentary secretaries, to meet with stakeholders and experts across the country during a series of round tables all over Canada. These consultations were an extremely important part of the development of Bill C-7.

Medical assistance in dying is a sensitive and challenging social issue that we are currently faced with, one that is deeply personal for very many people and for me personally. I worked as an oncology nurse at St. Joseph's hospital in Toronto and have seen end-of-life care first-hand. I have seen individuals making difficult end-of-life decisions for themselves or their loved ones, and I appreciate our government's decision to consult and listen carefully to Canadians on this issue.

In addition to being deeply personal, the issue of medical assistance in dying is also legally and ethically complex, which is why it was so important for our government to meet with experts, stakeholders and practitioners during the round tables. Our government listened. It listened to the health care experts, doctors, nurses, legal scholars and regulators, but most importantly, it listened to Canadians. The bill takes into account what was learned during these consultations and responds to the Truchon ruling by proposing amendments to the Criminal Code that would ensure consistency of the MAID law across the country by broadening eligibility, and adjusting the safeguards accordingly, for a MAID regime that is no longer limited to end-of-life circumstances.

Bill C-7 proposes to amend the Criminal Code in response to the Truchon ruling in three ways.

The first is by expanding eligibility to those whose natural death is not reasonably foreseeable but who are still experiencing intolerable suffering. This will give those who are suffering in a wider range of situations the choice of a medically assisted death.

At the same time, the amendments would exclude those suffering from only a mental illness. This is in response to very specific concerns voiced by experts and mental health professionals about eligibility on the basis of a mental illness. Many members will also recall that during the study of former Bill C-14, the government asked the Council of Canadian Academies to look into such cases. The experts in this field could not come to a consensus on this very complicated issue in their report on the subject, which was released and tabled in this chamber in December 2018.

Our government recognizes that the unique considerations for the availability of MAID for individuals experiencing suffering only from mental illness requires further discussion and public debate. I believe the parliamentary review that will begin in June 2020 is the appropriate forum for the further consultation and deliberation that are needed before considering any changes in this regard.

The second main feature of this bill is the creation of two sets of safeguards to be followed before medical assistance in dying is provided, depending on whether a person's natural death is reasonably foreseeable or not.

The bill would continue to use the expression “reasonably foreseeable natural death” as the element that determines which safeguards to use. This approach for a MAID request is consistent with the view that medical assistance in dying for people whose natural death is not reasonably foreseeable presents more complexity. Many experts believe that the assessment of a request should be tailored to these different types of cases.

New safeguards for those whose natural death is not reasonably foreseeable will focus on ensuring that assessments take adequate time and involve the relevant expertise to detect and address the sources of the person's suffering. They will also ensure that people receive information about the appropriate and available services and options to improve their quality of life. They will need to give serious consideration to those options before concluding that medical assistance in dying is the choice for them.

Finally, the bill would relax some of the existing safeguards, in particular for those whose natural death is reasonably foreseeable. Those whose deaths are reasonably foreseeable will not need to undergo the 10-day reflection period. These individuals have already given a lot of thought to their request before they made it, and requiring them to wait another 10 days after they have been approved for medical assistance in dying may prolong their suffering unnecessarily.

Just as importantly, the bill proposes to permit the requirement of final consent to be waived in the case of people whose natural death is reasonably foreseeable when certain conditions are met. These conditions are that the patient's death must be reasonably foreseeable; they must have been assessed and approved for medical assistance in dying in accordance with all safeguards; they are at risk of losing decision-making capacity before their preferred date to receive medical assistance in dying; and they have a written arrangement with their practitioner, in which they have given consent in advance to medical assistance in dying being administered if they lose capacity, and in which the practitioner agrees to provide medical assistance in dying on their preferred date, or earlier, if they can no longer provide the final consent.

These proposed amendments would also clarify that practitioners would not be allowed, in this situation, to provide medical assistance in dying if the patient demonstrates refusal or resistance by words, sounds or gestures.

For individuals whose natural death is not reasonably foreseeable, the remaining criteria defining the grievous and irremediable medical condition in the Criminal code would expand eligibility to medical assistance in dying to people with a wide range of conditions. A grievous and irremediable medical condition is defined in the code as a serious and incurable illness, disease or disability; an advanced state of irreversible decline in capacity; or intolerable suffering that cannot be alleviated under conditions that the person considers acceptable.

This means that a grievous and irremediable medical condition could include conditions producing chronic pain or other symptoms. Canada's medical assistance in dying regime would move away from being an end-of-life regime to becoming a regime in which MAID could be chosen to relieve unbearable suffering that occurs outside of the dying process.

To conclude, the bill before us today proposes the amendments required by the Truchon decision. It also reflects what we heard in 300,000 responses to the online consultation. This is what we heard from stakeholders when the ministers and parliamentary secretaries held consultations from coast to coast to coast. It takes into account the opinions and input of health care professionals, doctors, nurses, legal scholars, provincial regulators, civil society, non-governmental advocacy organizations and those with lived experiences. The bill strives to achieve a balance between respecting personal autonomy and protecting vulnerable individuals. Perhaps most importantly, it respects the equality rights of all Canadians.

For those reasons, I call on the members of the House to support this bill, send it to committee where it can be looked at even more thoroughly and make this a reality in Canada.

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

Mr. Speaker, I want to comment and pose a question to the member around one of the strands in today's debate.

Members on our side have raised the need for safeguards because of the risk of abuse. Responding to an argument that was not made, government members have said they trust health care professionals to make good decisions in the vast majority of cases.

Of course, we also trust health care providers to make good decisions, to have good intentions and to do all they can to stay within the bounds of a patient's well-being in the vast majority of cases. However, the reason we have safeguards is to deal with that small minority of cases in which someone could actually lose his or her life as a result of pressure, as a result of a proper review not taking place, or as a result of being rushed into decisions in less than ideal circumstances.

We talked about examples of this small minority of cases in which human lives are still very much in the balance. Because of this need to have safeguards for these situations, would the member accept that a default to a 10-day reflection period would provide some degree of insulation against the possible risk of someone in a dark moment, in a short-term thinking process, opting for something that on balance they would actually not opt for with the proper engagement of their full support structure?

The 10-day reflection period can be waived in extreme circumstances already, so what is wrong with a 10-day reflection period?

[Kamal Khera, Liberal, Brampton West, ON]

Mr. Speaker, I know this is very complex and a very personal issue. For those whose death is reasonably foreseeable, the bill proposes to eliminate the 10-day reflection period, 10 days that many practitioners say can prolong unbearable suffering. It is about patients and about the individuals and their rights.

The requirement for two independent witnesses, which many experts indicated created difficulties for certain types of patients, would also be eased for eligible persons. Health care workers would be able to act as independent witnesses, provided that they are not the provider or the assessor.

[Lloyd Longfield, Liberal, Guelph, ON]

Mr. Speaker, I thank the hon. member for Brampton West both for her speech today and for work as a health professional. Listening to her, I wonder what her patients must be thinking of her as she speaks now in the House on their behalf.

I have had many conversations with constituents who are facing the need to have this legislation improved. In December, I spoke to a person who had a best friend who was trying to access medical assistance in dying, and he also had a brother who was trying to access medical assistance in dying. The reasons that led them both to that were ultimately the pain they were feeling and the loss of independence and dignity, and not foreseeable death.

The voices that really resonate at the end of the day are the people who are trying to access services or family members who know their situation. It is important that we give priority to the voices of the people whose rights are being denied under the current legislation.

Could the hon. member comment on how important it is that we protect the freedoms of the people we are serving who are trying to access this type of service?

[Kamal Khera, Liberal, Brampton West, ON]

Mr. Speaker, I would like to thank my colleague for his ongoing advocacy on this issue, and we have had many conversations about it.

It is very personal for me to speak on this issue, as I have in the past when the debate on medical assistance in dying first came to this chamber in 2015. Just before the election in 2015, I was a registered nurse. I am still a registered nurse working in oncology, working with patients to provide them with palliative care and helping them during their end of life.

Those rights are what we are protecting today. I think the member in his question answered his own question, so I would like to thank him for that. I think the bill does just that. I hope that all members of the House pass the bill and take it to committee, where there may be some discussion on how to make it better.

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

Mr. Speaker, I thank my distinguished colleague for her speech.

Yesterday, I stated in the House that certain aspects of this bill need to be clarified. Similarly, I noted that the provision dealing with the eligibility of mature minors, which we have talked very little about here, is to be reviewed.

I would like to know how my esteemed colleague would define the term “mature minors”.

[Kamal Khera, Liberal, Brampton West, ON]

Mr. Speaker, my colleague raises a very important question. As I have said before, this is a very complex and personal issue. It raises many difficult conversations, not just in this place but throughout the country. Whether it is around mature minors or mental health, we are ensuring that we work with provinces and territories to continue to invest in palliative care. We want to ensure people have the end-of-life care they need and deserve.

It is important to ensure we protect people when it comes to mental health issues or mature minors. We need to have that broader discussion. That is why I hope we can take this bill to committee to have those conversations. I know that in June 2020 there will be a broader discussion on this very topic.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Mr. Speaker, my Liberal colleagues continue to push the myth that there are only two choices here. Option one is horrific suffering and option two is euthanasia. However, there is a third option, which is the love in the form of palliative care that meets the true needs of the patients.

Why do the Liberals insist on only offering a binary solution, when our amazing health professionals want instead to offer the truly compassionate option of palliative care? Why are they pushing euthanasia ahead of palliative care?

[Kamal Khera, Liberal, Brampton West, ON]

Mr. Speaker, I want to correct the record. There are not two choices; there are many choices. It is about the choices of people who are going through the suffering at the end of their life. It is truly about that.

As someone who has worked with patients during their end of life and has provided palliative care to patients, I am their biggest advocate to ensuring we are working to provide more palliative care. That is not just in our hospitals and long-term care facilities, but also for people who want to be in their homes.

That is why our government has worked collaboratively with partners, such as the provinces and territories, to develop a framework on palliative care. To support this framework, our government is implementing a targeted action plan, which will help improve access to palliative care to underserved populations, families, supports, health care communities and communities.

In addition, it is important to talk about the fact that we provided $6 billion in federal funding directly to provinces and territories to support better home care and palliative care in our communities. We have been having this conversation.

I agree with the member opposite that we need to do more when it comes to palliative care and to ensure we work with our provinces and territories to make it a reality for every Canadian.

To say there are only two choices is misleading the House. It is about the choices of the patients, what they want, and respecting those choices.

[The Deputy Speaker, Conservative, Bruce Stanton]

Before resuming debate, I must inform hon. members that we have had five hours of debate on this motion. The maximum time allocated for all subsequent interventions shall be 10 minutes for speeches and five minutes for questions and comments.

The hon. member for North Island—Powell River.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, I am here today to talk to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

It is very interesting for me to be here in a new Parliament discussing something we spoke about in the last Parliament. I was a fairly new member when Bill C-14 was before the House. I had a lot of constituents calling my office, sending letters and emailing us on this very important issue. I spent a lot of hours responding to people, talking to them on the phone and hearing their stories. What I really respected was the thoughtfulness. There were concerns of course, which is legitimate, but there was a lot of hope for some people as well.

Here we are back at it again. It reminds me of a dear friend and loved one who used MAID in his journey. His name was Joey. When I think of the core issue and value we are discussing today, which for me is unnecessary suffering, I cannot help but think of Joey.

Joey had an illness that was slowly killing him. In fact, it was so painful for him that he made this decision. He rearranged his time of death so I could be there with him, which was a huge honour for me. I was so grateful for that.

I think about the process we went through together that day. It was a beautiful process, but it was also a hard process. Part of the reason why it was so hard was he could not take any of his pain medication that day. He had to be totally able to answer that question. After a lot of thoughtful discussion, he had to stay in pain all day. We spent the day with him, but it was hard to see him suffering.

When we look at the bill before us today, that is what I hope all Canadians and all parliamentarians remember. We are here ensure nobody goes through unnecessary suffering like that.

One of the things that really struck me about the day when Joey passed was his doctor came to be part of the process. His doctor had made a decision that he did not want to be in a role to administer MAID, but he came. There were a lot of tears and remembrance of the long-term relationship. We also have to talk about the length of time some of our doctors have known us. Some have known us for years in some cases, and in Joey's case that was the reality. Another doctor was there for the process, but Joey's doctor was with him. His loved ones were around him. It was a peaceful process when he left us.

Today we are here to do this important work. I hope this goes to committee. I have had discussions with doctors in my riding who administer this process and they have a lot of good things to say about the bill, as well as some concerns they would like addressed, and I hope that will happen.

As this process started, a lot of people started writing my office again. We did some outreach. We wanted to let people know that this would be coming up. We wanted them to know that there was a process for them to connect with us and give their feedback to the government on this issue. A lot of my constituents participated in the process online. Not only did they participate, they were very thoughtful to ensure that the information they submitted was also given to my office. In front of me, I have a small portion of the comments from the people who sent us information and shared their stories.

I want to be clear about something, and we have to remember this as we go through the legislation. I represent a rural and remote community. The doctors who provide this service sometimes spend the whole day travelling to the community to provide this very important service.

There are some specific barriers and we want to ensure that in all our legislation we do not let those people in rural and remote communities down.

There are three of these doctors in my region. The riding I represent is just under 60,000 square kilometres, it has several ferries and many small islands. The doctors in that area provide the total service for that area plus a portion of my neighbour's riding. They deliver the service to a huge number of people over a vast distance.

Message after message thanked those doctors. In fact, Dr. Daws, a doctor in my riding, was mentioned repeatedly for being compassionate and for helping people go through this process in a very respectful way. People wrote me before they were going to participate in MAID. They just wanted tell me that this doctor had been very helpful.

I want to recognize the amazing health care providers in our country who provide this service, who do it in a sensitive and beautiful way. They are with people at one of the most precious moments.

I want to talk about Margaret who told us about her nephew. Her nephew had participated in MAID and that this was his decision. The biggest issue for her was the lack of the advance consent clause. He was given a choice of either going through this process two months earlier or not at all. Due to the medication he would have to take for his illness, it would automatically disqualify him from having the capacity to provide the consent.

This is the biggest issue for me, because people were having to leave sooner than they wanted to because they were afraid they would lose the capacity to give their consent.

I think of Megan who wrote about the experience her family went through. They were present for a friend's death. She said:

I fully support the idea of giving prior consent for MAID in case one is unable to give that consent immediately prior to the procedure, or in case one is in considerable pain and discomfort and would go through the process more calmly with adequate pain control at the end.

This really resonated with my experience with Joey, watching him suffer physically, and waiting for the relief. It was really hard. This is so important as we go through this process.

I think about Dolores, who sent me a beautiful message about ensuring the process was clear for people, wanting to have the accessibility to this be very clear and easy, and in an information package. Her biggest concern was that her family physician did not believe in this process and would not give her the information she needed to make the decision. She said that it would be good to have an information package that was a little more effective, so when a doctor was struggling with that personal choice, it would not impact the patient.

As a parliamentarian, these are the moments when I really respect the role I have on a whole new level, when people are telling me about the precious experiences they have had in their lives.

Another family talked about its father-in-law who spent seven years with dementia and was very well cared for, but in his last year, he rapidly deteriorated. His dignity plummeted. A loving son said that he was convinced that if he could have projected how his final years of deterioration would happen, he would have chosen MAID as an option, if it was available to him.

Then there is Milt whose wife is in a care home. Because of her Alzheimer's, she will not be able to express herself. He is so concerned that she will suffer way too long and he does not want to see that.

Another family talked about a friend who had cancer of the brain. Then she had a stroke. After her stroke, she was concerned that if she had a second stroke, she would be unable to state her wishes. Because of that, she participated in MAID sooner than she would have wanted.

This is a precious decision people make. It is a decision they make with their loved ones and their health professionals. I will be supporting the bill because I do not believe in people suffering unnecessarily. There are some challenges in the bill that I hope are clarified, especially looking at the realities for rural and remote communities. However, when people tell these personal stories, we hear again and again that they do not want to see people suffer, that they do not want to see people lose their dignity and that they want to ensure their wishes are honoured.

I am happy to be here to talk to the bill. I want to thank all of my constituents who have reached out to me. I always appreciate these beautiful stories that people share and some of the hard ones.

[Larry Bagnell, Liberal, Parliamentary Secretary to the Minister of Economic Development and Official Languages (Canadian Northern Economic Development Agency)]

Mr. Speaker, I would like to thank the member for her very heartfelt speech. It is one of the best ones I have heard, because she provided us with her personal opinion.

She mentioned that what is important to her is that people do not have to end their life earlier than they need to because they are not competent. The other major positive item is people who do not have access to MAID at all right now and that the bill would make it available to them.

The member mentioned at the beginning of her speech that she had some suggestions from health care professionals. I wonder if she could outline some of those to us.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, some of the things that I have heard from professionals in my riding are around language, for example, who will get to decide what a specialist is. There is some of that language, especially again for rural and remote communities. Who are they identifying? If somebody has had condition for a long time, obviously that individual has met with a specialist. What is that process?

Another issue is the 90 days and the concern about how long that is going to take, again coming back to people suffering in profound ways and wanting to make a decision. We have to look at some of those numbers.

Language is the biggest part. We need to make sure as always that legislation is as clear as possible, that we understand what we are legislating so that the language matches the practice.

Hopefully some of those things can be fixed. I believe they can. I hope that everyone in this place is aware of what we are here to do, and that is to obey the law. We are here today because of the court decision in Quebec, while also making sure that we are supporting people and their access, and that we are preventing suffering at all costs.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Mr. Speaker, I listened intently to the member. I appreciate her heartfelt comments. We work together on veterans committee.

I would like to talk to her about that dynamic specifically here. The bill states that the patient's death no longer must be “reasonably foreseeable” but requires patients to still have a “grievous and irremediable medical condition”.

The member and I appreciate our veterans but we are deeply concerned about the number of them who are choosing to end their lives because they do not feel well when they come back home. It is antithetical to try to prevent them from taking their own lives and yet telling them this is an opportunity to do so.

My father had Alzheimer's and passed away two and a half weeks ago. When he was barely able to still control his thoughts, he looked at my mom and his words were, “Will you take care of me?”. That was nine years ago. The palliative care he had, the love that he had in that circumstance I cannot imagine, even though he was down to nothing, not honouring the fact of life and death in that circumstance the way it was.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, I thank the member for the work that she does with me on veterans committee. I too share a deep concern and admiration for the people who have served this country.

My colleague knows some of the things that I would like to see done to support our veterans. She hears me in committee talking about the supports that need to be in place.

When I look at this legislation, I keep coming back to the fact that people have a fundamental right to make a decision that works for them. I deeply appreciate the story my colleague shared about her father and her loved one. I remember the years that I spent as a hospice volunteer, sitting with people who were ready to go. I would be in the hospital with families and with people as they were going through that process. I was honoured to have been a part of some beautiful moments. Just bringing people food and reminding them to eat when they were going through that incredibly sad time is something I will never forget. I also remember people starving themselves and refusing all help because they so wanted to be out of their body. They wanted to be out of their pain and their suffering.

When we look at this process, we have to honour all decisions, and that is what I am hoping to see through this legislation.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, it gives me great pleasure to once again rise in this House and speak to Bill C-7, an act to amend the Criminal Code (medical assistance in dying). This bill proposes amendments to the Criminal Code provisions on medical assistance in dying, or MAID, in response to the Superior Court of Quebec Truchon decision, which struck down the eligibility criterion that natural death be reasonably foreseeable.

I would like to highlight five major components that stood out for me.

First, it repeals the condition that a person's natural death be reasonably foreseeable, with the exception of patients whose sole underlying condition is mental health issues.

Second, it introduces new safeguards in addition to existing ones for patients whose natural death is not reasonably foreseeable.

Third, it permits the waiver of the requirement for final consent, allowing patients to provide consent to health care practitioners in advance, in the event that their death is naturally foreseeable and they are at risk of losing capacity to consent.

Fourth, it permits the waiver of the requirement for final consent if a patient chooses MAID by self-administration, in case complications arise following self-administration, such as a loss of capacity.

Fifth, it modifies the MAID monitoring regime to require that health care providers and pharmacy technicians provide regulated information when assessing a patient's eligibility or when dispensing a substance for MAID.

Over the last two days, many of my colleagues from both sides of this House intervened on a fair number of details. It gives me great pleasure to see that there is broad agreement that this legislation, with these amendments, gets voted in and move to the committee for further study.

I rose in this House during the 42nd Parliament back in 2016, and shared my experience, which dealt with the tragic loss of my father as a result of stage 4 cancer back in 2014. Such assistance was not available to us and we saw the loss of dignity. We saw the loss of the person I called “my hero” losing the capacity to be able to function and lead our family, as well as the fact that his desire would have been met, had we had this type of assistance available.

Also, as the chair of the all-party mental health caucus, I have been advocating, and our caucus has been advocating, for the consideration of mental health and the exclusion of that. I am pleased to see that that remains.

As I was listening attentively to the interventions over the last two days, at times there were questions raised about why it took so long. Considering that, and considering that we are almost halfway through this debate, I decided to focus my intervention mainly on the journey that our government has gone through over the last four years. The key concepts within that journey are the challenges that we are faced with; the stakeholders that we engaged with; the consultations during the studies; and the implementation, successes and challenges we have had.

Having said that, since the introduction of the legislation for medical assistance in dying in 2016, we have witnessed a steady increase in the number of Canadians and health care providers who have adopted this new regime. We have seen a relatively smooth integration of MAID assessments and delivery in end-of-life care service available across the country.

The enactment of this historic legislation was just the beginning of our efforts. Our government has since been very active in supporting the implementation of MAID across Canada. The 2016 legislation included clear directives for action, including the need for government to initiate independent reviews on three complex issues not addressed in the bill back in 2016. Some of my colleagues before me touched on those complex issues.

Rather than proceed too hastily, Parliament felt that it required more study and a review of available evidence. The government tasked the Council of Canadian Academies with undertaking these studies and that is where the journey started.

The resulting report tabled in Parliament in 2018 reflected an extensive review of academic and policy research, stakeholder submissions and international expertise in all three areas. It documented a range of perspectives from health care professionals, academic disciplines, advocacy groups and indigenous leaders; hence, the stakeholders that we have engaged with. We expect dialogue on these issues to continue during the parliamentary review and, as I have indicated, I hope that everyone in the House votes for this so that we can move it to committee and continue this dialogue.

Taking into account our federal system and division of responsibility for health care and criminal law, the federal government developed the monitoring and reporting regime to collect valuable information about requests for and the provision of MAID. In all other jurisdictions permitting assisted dying, there is an oversight and monitoring mechanism in place. The roles and responsibilities of these monitoring regimes vary.

In the wake of this monumental shift toward legalized assisted dying, Canadians wanted to know what kind of uptake there would be. Some were keen to know how accessible MAID would be across this vast country. Others want to know how safeguards would be applied and if there were protections in place for the vulnerable. Our government worked quickly with the provinces and territories to establish an interim reporting system, collecting and reporting on the best data available.

I want to acknowledge our provincial and territorial partners that had the challenging task of arranging safe access to MAID services from scratch, in a short period of time and in collaboration with multiple partners, such as health care providers, professional associations and health care delivery institutions. This tremendous task involved setting standards of practice for physicians, nurse practitioners and pharmacists to support the consistent and safe delivery of MAID within a legally sound framework. It also helped minimize the disparity to access in rural and urban areas.

Our government produced four interim reports using data voluntarily transferred by providers and various jurisdictions from 2016 until the creation of the permanent regime in late 2018. These reports covered a six-month period and provided information on the number of MAID deaths, patient demographic information, underlying medical conditions and predicted MAID requests.

In reviewing these reports, we know that the awareness of MAID as a legal option is growing. There appears to be a growing comfort among health care providers. In the interim period, our government worked to establish a permanent national monitoring and reporting system as considered in Bill C-14.

Through stakeholder consultation and collaboration with provinces and territories, the government enacted federal monitoring regulations in late 2018. These regulations set out the reporting requirements for all physicians, nurse practitioners and pharmacists who participate in MAID. We were mindful of balancing the need for information while limiting the reporting burden on health care providers and avoiding duplication of effort. This system has been operating for just over a year. Late this spring, our government plans to release the first annual report using data from this new monitoring system.

Budget 2017 announced $11 billion over 10 years to support home and community care services, including palliative care, mental health and addiction services; $6 billion was specifically allocated to those services I talked about. In 2019, our government worked with all the provinces and territories to develop the framework for palliative care in Canada, which I consider a cornerstone of this bill.

Over the last three and half years that MAID has been available, our government has worked to support a smooth integration into the health care system based on the foundation I have just laid out. On the evidence that we have gathered, we have put together a bill that represents the Truchon decision and addresses other issues where there is clear consensus and a reasonable path forward. It is my hope that, after due consideration and debate, we move this bill to committee.

I will close by saying that I support this bill and I thank all members for intervening on this topic.

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

Mr. Speaker, I did support Bill C-14 and voted for it in the last Parliament. I thought that it did strike the right balance and that it had a very limited application. However, I was troubled at the time about the reasonable foreseeability words, which I thought would likely be litigated, and indeed they were.

I would ask the member this: Why not now simply deal with the narrow issue of the court only? There was a reason, at the time, to have a full five-year period before revisiting a significant expansion. The reason was to collect a broad volume of data to examine how Bill C-14 would be implemented. Why the expansion beyond the narrow issue of the court decision?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, as the hon. member mentioned, we had the opportunity to only deal with the narrow amendments required to respond to the Superior Court of Québec on the Truchon case.

I believe I went through the list of stakeholders who have engaged in the consultation. Through that consultation and that journey, we heard about other areas that we needed to address. We found this was an opportune time to not only address the areas that we are mandated to by the court, but also table other potential amendments to let our stakeholders know that we have listened, and send it to committee where we have the opportunity to study it further.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Mr. Speaker, I thank my colleague for his speech.

The NDP will also support this bill so it can be referred to committee for study in order to improve it and perhaps correct some of its flaws.

I am personally concerned about the issue of people dealing with degenerative illnesses that affect not the body but rather the spirit or intellect, such as Alzheimer's.

Why would it not be possible for a bill such as this one to provide for the possibility of drafting an advance directive, together with the medical staff, which could be renewed every six months in the case of someone who has already been diagnosed with Alzheimer's?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, let me thank the member for supporting the bill and giving it the opportunity to be studied in committee. I am sure this will be one of the areas we will spend a fair amount of time on.

Having said that, it is best that we look at it from a holistic point of view and consider all the options available. This is one of the options that I think it would be worthwhile considering and looking into. I am looking forward to the member's input at committee.

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

Mr. Speaker, I want to ask the member about the 10-day waiting period. Right now, there is a 10-day reflection period; however, that reflection period can already be waived in certain circumstances.

It is a good default that some time is spent in consideration and that it is not a person who decides in the morning they want to be euthanised and then it is taken care of right away. There should be some period of reflection.

Would the member not agree that in most cases that is sensible?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, the member has raised this point in other interventions. I agree that there needs to be that 10-day period. The beauty of this bill going to committee is it gives us an opportunity to discuss that in further detail.

However, personally from my position, I think we need to consider that as part of the safeguard.

[The Deputy Speaker, Conservative, Bruce Stanton]

It is my duty pursuant to Standing Order 38 to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Sherwood Park—Fort Saskatchewan, Public Safety; the hon. member for Leeds—Grenville—Thousand Islands and Rideau Lakes, Ethics.

The House resumed consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

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

Mr. Speaker, I rise today to address Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

Assisted dying is the leading moral and ethical issue of our time. Previously respected traditions supporting the sanctity of all human life until natural death have been tossed aside, most recently with the Supreme Court's decision in the landmark Carter case.

As parliamentarians, it is incumbent upon us to draft responsible legislation that protects the sanctity of life, protects those contemplating suicide and protects vulnerable peoples. These are principles outlined in the preamble to Bill C-14, the landmark legislation that governs assisted dying in this country. These are principles, although restated largely in Bill C-7, that are being watered down and undermined by this legislation.

As recently as the early 1990s, the Supreme Court ruled in the Rodriguez case that there was no constitutional right to assisted dying in this country. The Carter decision overruled that previous decision, and now Parliament has been tasked to take on the difficult task of balancing the autonomy of Canadians with protecting vulnerable people.

[The Deputy Speaker, Conservative, Bruce Stanton]

Order. The hon. member for Shefford on a point of order.

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Speaker, I cannot hear the interpreters.

[The Deputy Speaker, Conservative, Bruce Stanton]

Thank you for drawing our attention to the problem with the interpretation service, a very important tool for the members of the House.

Resuming debate. The hon. member for Sturgeon River—Parkland.

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

Mr. Speaker, would I be able to restart for the benefit of my colleagues?

[The Deputy Speaker, Conservative, Bruce Stanton]

Perhaps the member could go back about 30 seconds and pick it up from there.

The hon. member.

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

Mr. Speaker, as parliamentarians it is incumbent upon us to draft responsible legislation that protects the sanctity of life, protects those contemplating suicide and protects vulnerable peoples. These are principles that were outlined in the preamble to Bill C-14, the landmark legislation that governs assisted dying in this country. These are principles that, although largely restated in Bill C-7, are being watered down and undermined by this legislation.

As recently as the early 1990s, in the landmark Rodriguez case, the court ruled that there was no constitutional right to assisted dying in this country. The Carter decision overruled that previous decision, and now Parliament has the difficult task of balancing the autonomy of Canadians with our responsibility to create safeguards for vulnerable Canadians. It is one of our most sacred responsibilities to protect the lives of our citizens. We need to get laws on assisted dying right.

The adoption of medical assistance in dying after the 2015 election is an event I am very familiar with. I had the honour of serving under the member for St. Albert—Edmonton as he took the lead as the Conservative vice-chair of the Special Joint Committee on Physician-Assisted Dying. During this time, I was involved in all aspects of the committee that was making recommendations on a new law. I heard from all the witnesses, and I listened to all deliberations regarding what direction our country should take.

That committee recommended a radical departure with very few safeguards. These recommendations did not reflect the testimony of experts, but instead the political agenda of special interests.

The Conservative minority report provided at the joint committee was entrenched firmly in the principles of the Supreme Court's decision in Carter, and included recommendations that were laid out by key witnesses, such as the former president of the Canadian Psychiatric Association, Dr. Karandeep Sonu Gaind. It outlined key principles for us on the issue of physician-assisted dying.

These included not accepting the provision that assistance in dying be provided to those under the age of 18, in line with the Carter decision, which stated that only competent adults should be allowed access to assisted dying. We also did not accept the extension of medical assistance in dying for those suffering exclusively from mental illnesses. We did not believe that any mental illness is irremediable, as the Canadian Psychiatric Association stated.

We also did not believe in the validity of advance directives to allow Canadians to consent to an assisted death far in advance of its administration. This change would stand opposed to the express will of the Supreme Court of Canada, which ruled that consent must be contemporaneous with the time of death.

We also recognized the lessons of the Quebec experience, as the first jurisdiction in this country to legalize euthanasia. In its regime, medical assistance in dying could only be rendered on adults with a severe, incurable physical illness, characterized by an advanced state of irreversible decline.

I believe many Canadians can sympathize with this limited exception for assistance in dying; however, even these safeguards have proved to be short-lived. Barely five years later, the courts and the government have decided that these safeguards are far too restrictive.

How did we get here today? Barely had the ink dried on Bill C-14 before proponents of expanded assisted dying launched their campaign to eliminate necessary safeguards.

As a Conservative who strongly believes in the sanctity of human life, Bill C-14 was a difficult pill to swallow. However, it was one that I believed upheld many of the values that I hold and the values that many of my constituents hold.

The previous legislation recognized that we must tread carefully with this new reality of assisted dying. It introduced safeguards that limited mature minors, those with exclusively mental illnesses and those whose deaths were not reasonably foreseeable.

I believe this is where the majority of Canadians are, and I believe the government largely got the balance right under Bill C-14. Unfortunately, there are a radical, vocal few who want to undermine even these protections and push this country headlong into a permissive regime for assisted dying, a regime that, as we know from international experience, has resulted in the deaths of vulnerable people.

If we continue to go down this road and liberalize all safeguards, we will continue to see mistakes and deliberate actions that end the lives of vulnerable people. This new legislation outlined in Bill C-7, although not taking these large, radical steps that I outlined, is opening the door to a wider radical departure from principles like the protection of the vulnerable and the sanctity of human life.

I am particularly concerned about the inclusion of the term and policy of advance consent.

The Supreme Court of Canada was very clear, crystal clear, that an assisted death should only be administered with the consent of a person at the time of death. We know that there are some cases where people fear losing their capacity to end their lives. However, we cannot allow the precedent of advance consent to gain legitimacy in our system. Advance consent in this legislation I believe is a Trojan horse designed to build the legal case to accept the adoption of advance directives.

Advance directives are a concept by which people can direct the actions of medical professionals after they have ceased to have the capacity to consent to an assisted death. Many Canadians are familiar with DNRs: do-not-resuscitate orders. DNRs are a completely ethical and morally acceptable practice, whereby a patient can designate that no action should be taken to attempt resuscitation. By respecting the will of the patient and not acting, medical professionals are allowing the patient to die a natural death. Medical professionals can also hasten the natural death of their patient through pain remediation. I believe this is also an acceptable practice.

I support do-not-resuscitate orders, and I think many Canadians are being deliberately misled into believing that an advance directive is the moral and ethical equivalent of a DNR. It is not. An advance directive does not ask medical professionals to withhold action allowing a natural death. It requires medical professionals to take direct action to immediately end the life of the patient.

This is a leap in practice that goes far beyond what I believe is ethical. It undermines one of the greatest medical principles: first, do no harm. I can imagine, in a not-so-distant future, someone with dementia or Alzheimer's who had previously written an advance directive, believing that life would be not worth living with this disease. Imagine in the future that we had the medical expertise and the breakthrough pharmaceuticals that could make life better for those suffering. How can someone consent to have life end without contemporaneous consent at the time of death, when they cannot know what their quality of life will be?

It introduces a high level of subjectivity to the question about what kind of life is a life worth living. This is a dangerous question that will lead us down a lethal road, a road that I do not think anyone wants to go down today. I believe it is unethical and dangerous to allow someone's life to be ended by an advance directive or consent, even with the meagre protections offered in Bill C-7, which includes a provision that no resistance be shown. There is still a threat of abuse. If people are unable to understand and consent to death, how are they supposed to know to resist when someone comes to administer their death?

Parliament is being rushed into liberalizing a practice that is not even half a decade old. Its members lack the experience, the data and the moral understanding to press forward with such a life-and-death issue. I am disappointed that the government abdicated its responsibility to stand up for vulnerable people when it chose not even to appeal the Quebec court's decision to the Supreme Court of Canada. What better court to clarify what safeguards are acceptable than the very court that originally dealt with these significant matters?

Instead, the government has given Parliament little time to contemplate such an important issue. Canadians are still catching up to the reality of assisted dying being legal in this country, and now we are foolishly pressing forward before we can fully understand the impacts of this legalization.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Mr. Speaker, since the member has obviously informed himself over the last number of years about the various forms of medically assisted dying, I want to ask him whether there has been any statistical pattern developed over the time that it has been a legal concept.

Do we know what the numbers are, where the weaknesses and strengths are? Is there material he could share with the House that gives us some pattern of who is asking, what is being asked for and when it is being asked?

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

Mr. Speaker, I believe many of the cases we have seen where people have requested medical assistance in dying are cases that the majority of Canadians can sympathize with, and even support. What I am not saying here today is that we should be repealing all the laws on medical assistance in dying. I am saying we must be very cautious going forward.

I have read some statistical information regarding the socio-economic status of those seeking an assisted death. They tend to be in the wealthier range. I believe the numbers are slightly more than 6,000 people have sought out an assisted death.

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Speaker, I thank my colleague for his speech.

He used the word “euthanasia”, but there is a difference between euthanasia and medical assistance in dying. This bill is not about euthanasia.

Furthermore, I am sure that we can improve palliative care services and include that in a continuum of care for dying with dignity, and that includes medical assistance in dying.

I would like to hear his thoughts on that.

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

Mr. Speaker, when the Conservatives were coming up with their minority report in the previous Parliament, the experience of Quebec weighed heavily on where they came in on this. It took six years in multiple legislatures in Quebec to come up with a law on this matter, and when Quebec came up with this law, it was stringent and there were strong protections for vulnerable people.

The cases where people are unable to consent to their death do, I believe, meet the definition of euthanasia. An assisted death occurs when somebody is participating with it up until the point that his or her life is actually ended. When somebody cannot consent to an assisted death, I believe that meets the definition of euthanasia.

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

Mr. Speaker, I am afraid I disagree with the general tone of the approach taken by the hon. member. These changes are much-needed to respond to not only court decisions, but analyses of our charter rights to ensure that Canadians are not taking their own lives or finding the opportunity for medical assistance in dying prematurely, out of fear that they will be unable to give consent under the strictures of our current legislation.

I ask the hon. member, as well as those in the Conservative benches who think this is being rushed, how he suggests we deal with the fact that the courts in Quebec have ruled in Truchon that the law, as it currently exists, will be suspended March 11.

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

Mr. Speaker, with regard to timing, I was very disappointed that this decision came out on September 11, the day the last election was called. The government was given one month to appeal this decision in the middle of an election campaign. I do not believe that this gave Parliament an ample opportunity to review the bill outside of a very politically charged period to decide whether this decision should have been appealed to the Supreme Court, which was the court that created legalized assisted dying in this country.

I believe the Supreme Court has something to say on this matter, and we failed by not getting the Supreme Court to weigh in on it.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

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

As we know, in September 2019, the Superior Court of Quebec struck down the federal and Quebec criteria that limit the access to MAID based on circumstances where death is reasonably foreseeable. The court, whose ruling only applies in Quebec, suspended its declaration of invalidity for six months, until March 11, 2020. On February 17, the Attorney General of Canada filed a motion to request a four-month extension to give Parliament the time needed to implement a response and ensure that the law across the country is consistent as it relates to the federal MAID regime.

I will provide a brief overview of the amendments to the Criminal Code that are being proposed under Bill C-7.

First, on the eligibility criteria, the bill would repeal the reasonably foreseeable natural death criteria and exclude persons whose sole underlying medical condition is a mental illness. Second, with regard to safeguards, the bill would create two sets of safeguards, depending on whether a person's death is reasonably foreseeable, while easing some existing safeguards and adding new ones for persons whose death is not reasonably foreseeable. Finally, the bill proposes to allow for a waiver of final consent on the day of the procedure in specific circumstances.

How did these changes materialize? The development of this legislation was informed by the Truchon decision; available Canadian and international reports, such as the December 2018 report of the Council of Canadian Academies; the experience of existing international regimes; and our government's recent consultation on MAID, held in January and early February.

The Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, along with their parliamentary secretaries, hosted several federal MAID round tables across the country. These events were attended by experts and stakeholders, including doctors, nurse practitioners, representatives from health regulatory bodies, legal experts, representatives of the disability community, indigenous representatives and other key stakeholders. They shared their experience and insight into MAID and its implementation in Canada over the last four years.

In parallel to these efforts, our government heard from over 300,000 Canadians who participated in the online public survey on MAID between January 23 and 27, 2020. There was an unprecedented number of respondents, reflecting the significance of this issue for Canadians. This kind of input is invaluable to government and, I am certain, was seriously considered by the ministers in the development of the bill.

I would like to provide a personal perspective on the issue of MAID in its previous iteration.

In 2015, when the Liberal government came to power, it was tasked by the Supreme Court to amend MAID. A special joint committee was established, involving both Houses and all parties. The special joint committee conducted an enormous amount of consultation and came up with a proposal. The then minister of justice and minister of health were presented with this proposal. Through intense discussions and consultations, the proposal was amended.

In my riding of Don Valley East, I did a consultation in the sanctuary of the Donway Covenant United Church. Various constituents, as well as other members from across Toronto, participated in the town hall. Members of CARP, the Canadian Association of Retired Persons, were also on the panel. It was an emotional meeting. I clearly remember one of my constituents, who was non-verbal and had to use her communication board, telling me that she wanted advance directives while she was lucid but could not predict whether she would be lucid in the foreseeable future.

In 2019, I had to do another presentation at a church in another riding. Here, overwhelmingly the audience was against the phrase “foreseeable future” and also wanted advance directives.

I am glad to see that some of the changes requested through consultations have now been incorporated. I look forward to the five-year review that is scheduled for June 2020 to see the discussions around advance directives.

I will now go to the bill itself and some of the changes it proposes to the eligibility criteria.

With regard to the proposed Criminal Code amendments in relation to eligibility, the bill proposes to make two changes to the current set of eligibility criteria for MAID. First, it would repeal the reasonable foreseeability of natural death criteria from the list of eligibility criteria in response to the Truchon ruling. That is good news for some of my constituents in Don Valley East. The legal effect of this amendment would be that those whose natural death is reasonably foreseeable and those whose natural death is not reasonably foreseeable would be eligible for MAID if they met all other eligible criteria.

Second, the bill proposes to exclude people whose sole underlying medical condition is mental illness. Many practitioners, stakeholders and experts have identified increased complexities regarding individuals seeking MAID whose sole underlying condition is mental illness. I suggest that this could be an item for Parliament to look at it in its upcoming mandatory five-year review of the MAID regime.

The Council of Canadian Academies' experts group issued a report in 2018 on the same issue and could not come to a consensus on this question. The Government of Quebec has also announced that access to MAID for cases where mental illness is the sole underlying condition would be suspended and that a broad consultation process would be conducted on this issue.

Regarding safeguards, the public needs to know some of the safeguards that will protect the vulnerable. With respect to the applicable safeguards proposed, the proposed Criminal Code amendment would create two different sets of safeguards depending on whether a person's natural death is expected in the near term or not. The first set of safeguards would continue to be tailored to persons who have a reasonably foreseeable death where risks are reduced. The second set of safeguards would be tailored to persons whose death is not reasonably foreseeable and would address the elevated risks associated with the diverse sources of suffering and vulnerability that could lead a person who is not nearing death to seek access to MAID, such as loneliness, isolation, lack of adequate supports and hopelessness.

Bill C-7 proposes to use the reasonable foreseeability of natural death standard to determine which set of safeguards applies to a particular case. This standard would also determine whether a person who is assessed and approved for MAID but who risks dying before the day of the procedure can give consent in advance. I will be discussing that proposal shortly.

How will these safeguards be applied? Specifically, it would require that a MAID request be witnessed by one independent witness instead of two, and it would allow individuals who are paid to provide either health or personal care to act as an independent witness.

On the advance consent or directives, the bill proposes amendments that would allow people who have a reasonably foreseeable natural death, and who have been assessed and approved for MAID, to retain their ability to receive MAID if they lose the capacity to consent.

The bill represents a significant paradigm shift in Canada's legal landscape with regard to medical assistance in dying. I call on members to support this important legislation and send it to committee for further review.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, the hon. member from the opposite side has gone on in length in regard to safeguards. There are currently safeguard infractions going on across Canada, without corresponding professional discipline being in place. We can go on and on about safeguards, but if the current ones do not work, why would we put in more or less? They are not working.

Let me point to the case of Mr. Roger Foley. He has had to open a GoFundMe in order to pay for his legal bills so he can get actual home care. He is a young man dying of cerebellar ataxia. He is suffering, and the government is keeping him away from proper care. He has been dehumanized, threatened, attacked and abused and his life has been completely devalued just because he is a person with disabilities.

Greater value is placed on access to MAID than access to alternatives that could alleviate a patient's intolerable suffering. MAID is being presented to patients as a preferred treatment option, rather than the very last resort once all other avenues have been exhausted.

Could the member opposite tell me how that is happening?

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Madam Speaker, I sympathize with the situation that the member opposite has brought to light, but I also need to advise her that the provincial jurisdiction controls the health care budget. We are doing things that are legally available because of certain issues that have been raised by the previous iteration of MAID. We have, as parliamentarians, responded to it from a legal perspective.

There are checks and balances in place. People break the law, like they break many laws. There is a judiciary process or there is a process within the health care practitioners that should be addressed.

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

Madam Speaker, in studying the bill, and I certainly plan supporting it and considering amendments when it gets to committee, one of the things I am wondering about is this. When people make that consent, and it is an advance consent, and there are safeguards, do the personal practitioners who have accepted that consent have to be the ones who administer the procedure later? What if something happens to those individuals and they are not available or they themselves have died.

How would we handle the loss of those who are present at the advance consent at the moment when the medical assistance in dying procedure is determined to be appropriate?

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Madam Speaker, the hon. member has raised a very good question. That is why the bill must go to committee for thorough discussion, so we ask the right questions, we get the right answers and we put checks and balances in place to address the situation that she has brought to light.

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

Madam Speaker, the present bill goes significantly beyond the immediate task of addressing the Quebec Superior Court's decision. A scheduled broader review of the bill was built in to Bill C-14. The five-year period was deliberate. At that time, the government thought that to be an appropriate length of time to study the implementation of Bill C-14.

Why not just deal with the business of the problematic “foreseeability of death”, the words from Bill C-14, which I had problematic from the start? Why take this time to add the other portions rather than as part of the review that would have otherwise taken place next year?

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Madam Speaker, as I look at the bill, the foreseeable death was a very problematic issue for all my constituents. They wanted the advance directive, but it was not there.

When the Supreme Court gave its decision, it created a base. When the special joint committee created a report, that was the ceiling. We have to find a midway balance to ensure that we protect the vulnerable, but also allow those who seek assistance to get the assistance they need.

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, during this debate time, we have an opportunity as legislators to ensure that we carefully and thoughtfully examine Bill C-7 with the best interests of Canadians in mind.

On September 11, 2019, the Superior Court of Quebec found that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life. Although the current bill before the House, Bill C-7, responds to the court's ruling, it goes far beyond the scope of Quebec's decision and it weakens the important safeguards that have been put in place under Bill C-14.

Since the Liberals put this legislation forward, I have heard from hundreds of my constituents in a matter of days. They have shared with me that they are very concerned about the bill.

I will use my time today to share a number of the concerns they have raised and to issue a thoughtful word of caution to this place.

First, there is a parliamentary review of the original legislation scheduled for June. The question has to be asked. Why are we rushing to expand the scope of the current legislation?

We are literally discussing life and death issues. Death, something so final, deserves just a little of our time, our attention and due diligence.

The government's original legislation went through a very lengthy consultation process. This time, however, the consultation only lasted a couple of weeks. That is not the sole concern I have. In addition to that, when I look at this survey, the questions that were asked were quite vague and the multiple choice answers that were provided were drafted in such a way that the party in power could interpret those answers to the secure findings it desired. It was unclear and therefore unhelpful, if we really are going to respect the voices of Canadians.

However, the fact that this survey was so unhelpful goes to show that the current government was not interested in hearing from Canadians. The current government was interested in pushing through its agenda and therefore being able to twist and manipulate the survey data to its end, which is absolutely wrong.

It is wrong, because it goes against the very essence of this place, which is 338 common people representing common people. This place exists for us to deliberate the issues that matter most in our country and to speak up on behalf of Canadians. Unfortunately, what we have before us is a bill that represents the Liberal agenda rather than the voices of the Canadian people. This is wrong.

With legislation of this magnitude, I would urge the members of the House to slow the process down, to consult extensively and for us to come back to the table.

I cannot think of another responsibility we carry as legislators that is more crucial, more obligatory than our duty to protect the most vulnerable in Canadian society. Therefore, we have to take every effort to alleviate any possibility for abuse or misuse based on what is in this bill or based on what is left out of the legislation.

My Conservative colleagues have raised many concerns and have given multiple examples where extreme liberties have been taken with physician-assisted suicide where there are looser restrictions in place. I do not wish to rehash all those examples here today, but I certainly will draw the House's attention to a few.

Sadly, members across the floor have disregarded many of those examples provided by my Conservative colleagues. They have suggested that the differing jurisdictions and rules should deem these cases irrelevant in this place.

We have the opportunity and even the duty to learn from other countries and the way they have legislated, to learn from cases within our own country and to make changes that are necessary to properly protect Canadians.

It is undeniable that as one's medical condition progresses, the individual inevitably become more vulnerable. It is our responsibility to stand up for the vulnerable.

Individuals could lose their ability to speak, to move autonomously or they could lack the coherent and cognitive ability to be able to interact correctly. When an individual reaches this state, this is precisely when the safeguards around MAID, medical assistance in dying, should be strong enough to keep them safe rather than weak enough to make them vulnerable.

The proposed change in the bill would allow for advanced directive, which takes away the need for the patient to consent immediately before having medical assistance in dying administered. This proposed change is alarming and dangerous as well to the Canadian public.

When we are faced with difficult physical ailments, they often fluctuate in intensity and as they do, our decision-making ability shifts. Think for example about people who are suffering from terminal cancer. They have been advised by medical professionals that their quality of life is likely to deteriorate to a certain degree by a specific date. Let us say that does not happen. Those cancer patients who want to avoid unnecessary pain have already given the date on which their lives will be terminated.

Changes take place. What if the diagnosis the doctor gave was not right? What if those patients have actually faired much better? Health care professionals could in fact euthanize these individuals at any point without needing to obtain consent immediately before death is administered.

This should concern all of us because of the vulnerability that is in place here. There should be a requirement for contemporaneous consent. We cannot allow one's former self to dictate the will of his or her present self. Minds change, circumstances change, so final consent is an absolute necessity.

This example has been raised in the House at least once before, but it is worth raising again because it is close to home.

Taylor Hyatt is a staffer on the Hill. I had the opportunity to interact with her personally. She has a linguistics degree from Carleton University. She lives on her own and she loves her life. Taylor has cerebral palsy and is restricted to a wheelchair. She lives an incredible life and contributes to Canadian society in a multitude of ways.

Two years ago Taylor went to the hospital because she was feeling quite ill. The doctors did some tests and they said that whatever it was it really was affecting her breathing, and if it came to it, should they administer oxygen.

Taylor was quite surprised at the question. Of course she would want oxygen, that seems like a very basic thing. It is not like it was life support or something that people often take, those decisions of that magnitude, quite seriously. It was the simple administration of oxygen. A few seconds later, the doctor asked "Are you sure?", and he said it in such a way that he was actually applying pressure on her to reconsider her decision, as if to say that her life lacked the value that she felt it had.

That is atrocious. If we are sending that message to the most vulnerable in our society, then what have we become?

I would like to also address one other thing, and that is the need for palliative care. If we are going to talk about administering death to Canadians, then why are we not having a conversation around long-term care? If we are going to talk about the dignity of a human life, then what about those who want to live a dignified life right up until their last breath?

Why is the government not moving forward with the plan it promised to put in place with regard to palliative care? Why is it not spending the money that needs to be spent on preserving the dignity of those who wish to choose this type of death? These are essential questions with which the House must wrestle.

I would caution those within this place to take a step back, because we want our country to be one that supports all people.

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

Madam Speaker, I thank the member opposite for her contributions. I will clarify on a couple of points and then I will ask the member a question.

The first point the member raised was about looking at other jurisdictions. We have done exactly that. We evaluated this regime against every jurisdiction that permits medical assistance in dying.

With respect to the member's point that changes have been made that were not needed by Truchon, this is both a less restrictive regime and also a more restrictive regime, depending on whether a person's prospect of death is reasonably foreseeable. In the context of whether there are increased procedural safeguards, when someone's death is not approaching imminently, there is a 90-day assessment period and also a period in which an expert doctor must be involved.

The member opposite expressed considerable concern with respect to the advance consent regime and the Audrey Parker amendment, as it is colloquially known. Is the member willing to address the fact that failing to amend this legislation and address the concerns in terms of Audrey Parker actually leads to premature deaths such as Audrey Parker's, which is a violation of section 7, according to the jurisprudence?

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, I once again would caution this House. If we are going to talk about advance consent, that is one thing; but if we are going to remove the need to give final consent to the issuance of death, that is another thing.

We are talking about an individual who is going to have his or her life ended. That is very final. It might be good for the medical practitioner to ask the question as to whether that patient is sure that it is indeed what he or she wants in that moment. This is common sense.

I actually take offence at the question from the member opposite, because it is an incredible degradation of human life.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her speech.

However, end of life situations can be difficult. Despite the high-quality care and support offered to people at end of life, it is possible that, for a small number of people, palliative care might not sufficiently alleviate all of their suffering. End-of-life legislation allows medical professionals to offer another choice to patients when all therapeutic, curative and palliative options have been deemed insufficient and they would prefer to die rather than continue to suffer.

I would like to hear my colleague's thoughts on that.

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, before this House is a piece of legislation having to do with medical assistance in dying. This process has been discussed for the last four and a half years. Of course, there was legislation put in place, Bill C-14, in 2016. That legislation allowed for medical assistance in dying in Canada. That is covered.

My question is this: Where are the millions of dollars that were promised for palliative care?

To the hon. member's point, this country exists on the precedent that there is choice, but if people have the choice for euthanasia, then where is the choice to live until their last breath in a place where they are cared for and where they are pain-free? That is called palliative care, and the current government has failed to deliver on that. By not doing so, it has actually forced a number of people to choose euthanasia when they would not normally choose that, but because their pain levels are so high and because palliative care is not offered, they choose death.

That is wrong.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I listened to the speech by the member for Lethbridge with great interest and I respect her very strong feelings on this issue. When she points out that the government is making changes that were not demanded by the courts, I would like to point out that there are many Canadians and Canadian families who are dealing with issues of intolerable suffering at the end of life who are asking for changes like Audrey's amendment, and they are asking for them right now.

As I mentioned earlier, because this debate is going on today, I have had someone I know quite well contact me to say they wish this bill would move quickly because it would assist them in making a choice in maintaining their control at the end of their life. They are facing intolerable suffering that cannot be alleviated.

While I agree with the member that we need more and better palliative care, we are dealing with the demand from individuals and families to make sure we avoid unnecessary suffering at the end of life.

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, that was more of a statement than a question. The hon. member and I would agree that yes, absolutely, palliative care is necessary. It should be an option for all Canadians, and that would be the most respectful thing to do for the Canadian population.

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

Madam Speaker, it is an honour to speak today to Bill C-7 regarding medical assistance in dying. This is the second time, the first being in the last Parliament, that I have had the opportunity to take part in the debate on this absolutely essential legislation on such a difficult subject.

This bill represents a major improvement and reflects some of the amendments that I made but that failed in the House, in the 42nd Parliament. Some of those amendments, in fact, were picked up and approved by the Senate.

I want to stop and reflect on the trajectory of this issue in Canada.

As identified when I rose in my place, I am a member of Parliament for Saanich—Gulf Islands and I believe that Saanich—Gulf Islands may have more constituents concerned with and calling for medical assistance in dying than perhaps any other riding in Canada. There are two active death-with-dignity groups within my community, one on Salt Spring Island and one on the Saanich Peninsula, and I think it is for a very simple reason.

Feelings run high, and honestly, my constituents persuaded me in 2011 and 2012 that I had to stand up for ensuring that there was access to medical assistance in dying and stand up for removing the Criminal Code punishments for people who, motivated by compassion and basic human dignity, assisted someone who was dealing with unbearable suffering in their last days and weeks.

The reason that my community is so very implicated in this issue is that Sue Rodriguez was a resident of North Saanich. She was unable to take her own life due to the effects of ALS, but she was able to find a doctor, who remains anonymous to this day, who assisted her in ending her own life.

It is clear that many people in my riding support the measures in Bill C-7, as they did supported Bill C-14 in the previous Parliament.

This is about helping to alleviate suffering through medical assistance in dying. This difficult and very serious situation is unfair to anyone.

Sue Rodriguez went to court, so it is also a trajectory of court cases. The Supreme Court of Canada ruled in 1993 against Sue Rodriguez. She was suffering from ALS. ALS runs as a thread through what I want to talk about today. Sue was losing ability and had lost ability to speak, to swallow and to walk. We know the trajectory of ALS. She asked the court to change the law and she was unsuccessful. That was in 1993. By the way, it was a very close decision. It was five to four, a very close decision. She died a year later, on February 12, 1994.

Then we take it to 22 years later. That is how slowly the laws evolve. It takes a while. The Supreme Court of Canada and the laws of Canada evolve to meet the changing circumstances. I think part of the reason is that we also realize now, unlike 20, 30, 40, 50 years ago, that we can prolong lives and sufferings through miracle advancements in medical science, but before we passed this law in the 42nd Parliament, we were denying people death with dignity and the ability to control their own decision-making about the timing of their own death.

Along came the Carter decision, finally, in 2015. Twenty-two years after the Supreme Court of Canada decision in Rodriguez, we had the decision in Carter. I felt very strongly when we debated the bill for medical assistance in dying in this place in the last Parliament, the 42nd Parliament, that our legislative efforts fell far short of what the Supreme Court of Canada ruled in Carter.

I felt quite sure, and said many times in this place, that the legislation we were passing, while an improvement, would not stand up to legal scrutiny and would be ruled unconstitutional by the courts. Now we have the decision that came out last September in the Truchon case, and again a court has given us a deadline to come up with an improvement. It is being called Audrey's amendment. Certainly a lot of people have identified with that situation, and their hearts have been broken by knowing that medical assistance in dying was out of the reach of people who were suffering gravely but feared they would not be able to form the required consent on the day of the procedure.

I think the bill before us is a substantial improvement, and it really reflects on how courts grapple with this issue and how society grapples with it.

I have to say that in the 42nd Parliament, I found the debate remarkably respectful. Across all parties, we recognized that these are serious matters of life and death, not to be trifled with and not to be turned into partisan debate. The reality is that in this legislation we do make amends for some mistakes in the previous bill.

I always find it rather odd that we have to find that a person's natural death is “reasonably foreseeable”. I do not think any of us in this place fancy ourselves immortal. All of our deaths are entirely foreseeable; we just do not know exactly the time and place in which they will occur.

Doctors of those who are suffering from a terminal illness are not even able to say the reasonably foreseeable date. What does it mean to be reasonably foreseeable? We put people in a stricture where even if they knew they had a terminal illness, such as ALS, they could not necessarily get aid from this legislation and they could not necessarily give advance consent to a doctor to indicate that they did not want to go through what they knew lay ahead of them.

One of my best friends emailed earlier today to ask me to stand up and fight this bill, because she is dying with ALS and she did not think the bill would cover her. I spoke to the Minister of Justice to confirm that I was reading the bill correctly and that, yes, they were thinking specifically of people with ALS.

Our friend who used to sit in that chair, Mauril Bélanger, was lost to us so quickly through ALS. My friend, who is losing the ability of speech, is in a chair and has tubes in her stomach that cause enormous pain. She knows that her lungs will give out, so she is emailing me while we are having this debate. I was really relieved to talk to the Minister of Justice and realize that I am reading the bill correctly, that my friend can get the help that is needed to be assessed and be able to say that she wants consent in advance.

However, I do think that there are some areas for amendments that should be made here, and I wish we had more time. I hope the court will give us the additional four months, but we do not know that.

Some of the bogeymen that have been raised here today I think are considered in the bill. We do have the requisite safeguards to keep vulnerable people safe. No one can give permission for medical assistance in dying other than the patients themselves. They still have to meet very tight criteria. They have to have a sworn witness. They have to have a doctor. The bill also provides that on the day of the procedure, if a person indicates that they have changed their mind, they are completely allowed and of course have the right to indicate that they have changed their mind through all sorts of gestures and words, but not through any involuntary gestures. I think the bill is drafted as well as it can be, but we will continue to consider it in the amendments at clause-by-clause consideration.

The bill does continue to ensure that the death is reasonably foreseeable, and there may be some complications there in the language. I note concerns from Dr. Jocelyn Downie at Dalhousie University, who is one of Canada's leading experts in this field, and I want to hear her evidence. I hope that she will be a witness, and I am sure she will be, as well as Dr. Stefanie Green, the president of the Canadian Association of MAID Assessors and Providers. We want to make sure we get the language right.

I will close by thanking the Minister of Justice and the government for following through and hearing the cries of Audrey, from Halifax, that her death be not in vain.

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

Madam Speaker, I want to thank the hon. member for Saanich—Gulf Islands for her contributions today and every day in this chamber for so many years.

The member led us through a very eloquent chronological history of the status of the jurisprudence, from Sue Rodriguez to the Carter decision to the Truchon decision, as well as the idea of Parliament keeping up with and responding to the law.

There has been debate, and it is fair debate, in this chamber over the last two days about how we are attempting to exceed the Truchon decision in some respects by wading into the area of advance directives and addressing what is now becoming known as the Audrey Parker amendment.

I would like to have the member's sense and thoughts about trying to get in front of the courts, at least on this occasion, and whether that is a prudent step in terms of empowering and respecting the dignity of people who are in such precarious positions and want to maintain some control over their final days.

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

Madam Speaker, I do not think we are getting ahead of the law. I think the advance consent, the Audrey Parker amendment, within this legislation is exactly within the four corners of the decision in Carter. The question of when one's rights as a human being, under the Charter of Rights and Freedoms, are impinged was directly related, in Carter, to having to foreshorten one's own life because one knew one might not be able to consent later.

I would say we may be slightly ahead of a court decision striking the current law down, but we are not getting ahead of the law. We are finally meeting it.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, the hon. member asked what the trajectory is of the issue of euthanasia in this country, and I thank her for asking. It is really important that we make a concise assessment of where we are going with this legislation.

It is clear that this bill is ensuring that our country will prioritize euthanasia access, while allowing palliative care to take a back seat. As we know, a request for physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available.

Is the hon. member willing to admit that palliative care in this country is abysmal, and dwindling more and more every day, due to the government's desire to push euthanasia as the preferred treatment option?

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

Madam Speaker, to the hon. member for Cloverdale—Langley City, not only am I not willing to admit it, I think the assertion is absurd. I think the assertion is offensive. Nobody in this place, regardless of party, would place euthanasia as a desired outcome over a full range of choices.

It does not require admitting anything. I asked the Minister of Health earlier in this place whether she would agree that services are not adequate for the provision of counselling, mental health services and, of course, assistance in having access to the facilities that make palliative care so much desired and so much preferred for patients and families across Canada.

I would urge the hon. member to rethink this. One cannot allege that the lack of services in palliative care is due to anyone's desire to push death over adequate care. I think the very notion is outrageous.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Madam Speaker, I find it quite incredible that the official opposition is suggesting that the government wants to favour euthanasia over palliative care. I find that quite shocking.

There is one issue that concerns me in relation to people with Alzheimer's disease. Unlike physically degenerative diseases, Alzheimer's disease can last for years. How does my colleague view the possibility of advance consent?

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

Madam Speaker, I hope my answer will be brief. I thank my colleague from Rosemont—La Petite-Patrie.

These are such complex issues that I would prefer to wait for the review that is scheduled to take place soon, five years after the current act came into force. My own father died of Alzheimer's, and I am not sure what he would have done if he had this option. I want to take the time to think about it.

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, I appreciate the opportunity to speak on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, which was introduced earlier this week and dramatically expands the existing euthanasia regime in Canada.

This bill was introduced in response to a ruling made September 11, 2019, where the Superior Court of Quebec found, in Truchon versus the Attorney General of Canada, that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life.

I believe it is completely unacceptable that the government did not appeal the Truchon decision to the Supreme Court. Truchon struck down vital protections for vulnerable Canadians that the Liberal government put in place less than five years ago. Appealing this decision would have allowed us to get certainty on the framework within which Parliament can legislate.

The summary of the bill states that it amends the Criminal Code to:

among other things,

(a) repeal the provision that requires a person's natural death to be reasonably foreseeable in order for them to be eligible for medical assistance in dying...

It excludes mental health as an eligible reason to receive assisted suicide. It creates two sets of safeguards that must be respected before medical assistance in dying may be provided, which differ in application depending on whether death is reasonably foreseeable. It also creates an advance directive wherein a medical practitioner can proceed with assisted suicide without consent immediately before administering it, assuming all other criteria are met and the patient enters into an arrangement in writing with a medical practitioner or a nurse practitioner to cause death on a specified day.

While these changes are significant, it is the other things where I will focus most of my attention. In responding to Bill C-14 in the last Parliament and now to this bill, it has always been our priority, on this side of the House, to ensure that legislation permitting euthanasia and assisted suicide includes safeguards for the most vulnerable in our society, as well as for the conscience rights of physicians and allied health professionals.

Of all the proposed changes, I am most concerned about the removal of the 10-day waiting period. This was not a change mandated by Truchon. Rather, it is a deliberate choice by the Liberal government to strike down one of the most important safeguards for vulnerable people facing uncertain medical prognoses.

Nearly every one of us can think of someone in their lives, perhaps a friend, a grandparent or even a spouse, who has received a serious diagnosis. The emotional impact of hearing that news can be overwhelming for both the patients and their families. It can cause depression, anxiety and a great fear of the unknown.

I am sure many of us can also think of people we know who have received terminal diagnoses and went on to beat their illness and live for years afterwards. However, with the safeguard of a 10-day waiting period gone, such stories may be fewer and farther between.

Without having to take the time to come to terms with their situation, to speak to their families and to learn about treatment options from their doctors, many people will make emotional decisions based on fear.

Another amendment removes the need for two independent witnesses and allows health care workers to act as witnesses. People may not even hear another voice offering a different solution.

By making these changes, we diminish the extremely important role legislators play in contemplating all of the unintended outcomes and consequences and then protecting against them. We know very well that the current euthanasia regime has serious problems, that it has been abused and that it has been used as a tool of desperation after the failures of government.

Sean Tagert suffered from an advanced case of ALS that left him completely paralyzed, unable to speak and reliant on a ventilator. Despite these challenges, Tagert fought to stay alive so he could watch his son, whom he spoke of in lengthy Facebook posts, grow up.

Sean required 24-hour in-home medical assistance to stay alive. Initially the health care system provided him only 15 hours, leaving Sean to somehow pay hundreds of dollars each day. Eventually, even that was too much for the health authority. Health care authorities told Sean that he would no longer receive funding for home care, leaving as his only option institutional care at a facility hours away, separated from family and removed from the son he called his reason for living.

Sean appealed, but to no avail. He was going to lose his home care. Mr. Tagert fought long and hard for the rights of persons with disabilities and their families but in the end, he was driven by his desperate circumstances to believe that assisted suicide was his only option. He was “worn out”, in his own words. On August 6, 2019, he ended his life.

I am going to read from the statement his family posted at that time:

We would ask, on Sean's behalf, that the government recognize the serious problems in its treatment of ALS patients and their families, and find real solutions for those already suffering unimaginably.

“Real solutions” does not mean removing the safeguards for those who are the most vulnerable. It means providing true alternatives, be that palliative care, in-home care or the unique care needed.

It is not enough to simply put in legislation as we find here in proposed paragraph 241.2(3.1)(g), under Safeguards:

...[to] ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care and has been offered consultations with relevant professionals who provide those services or...care.

If we have no intention of ensuring that those services are being funded or are even available, we have failed.

I note that the current federal government broke a key election commitment to invest $3 billion in long-term care, including palliative care. Access to palliative care is an essential part of end-of-life decision making. That point has been made over and over during this debate.

People should never be put in a position where they believe death is the only solution available to them. We are, and we must be, better than that. We must protect every human life with a jealousy born of the knowledge that each person is unique, and has an innate dignity that nothing, not time, not illness nor disability, can ever take away.

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

Madam Speaker, I have one point of clarification and then one question for the hon. member.

I thank her for her comments today. The point of clarification is that the contribution, actually two budgets ago by the government, to palliative care and long-term care was $6 billion, not $3 billion.

I have a question. There are safeguards. The member opposite mentioned a catastrophic event or a diagnosis that could be shocking to an individual. That is exactly what we have contemplated by creating a second track for people whose death is not imminent and people whose death is not reasonably foreseeable.

The legislation entrenches a 90-day assessment period, a period of time when the person must be informed of counselling, mental health supports, disability supports, community services and palliative care, and then an acknowledgement from the medical practitioner that the person has appropriately considered those options.

Is that the exact type of response that the member opposite feels is required to ensure people are not making this decision, which is a permanent decision, with undue haste?

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, I would suggest that one of the safeguards that I feel should have been left in the legislation was the 10-day period of reflection. I think that was very important to leave in this legislation, as I mentioned in my remarks.

The observations have already been made that this could be waived, and I recognize that. However, I think any time we can keep a safeguard in place that allows individuals that sober second thought, we should do that.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her speech.

I would like to remind her that medical assistance in dying is an intervention allowed only in exceptional cases, under very strict conditions. Access to this intervention is strictly regulated by law.

Bill C-7 will not bring about an unreasonable increase in MAID cases. According to a report of Quebec's commission on end-of-life care, from December 10, 2015, to March 31, 2018, a total of 830 requests for MAID were denied for various reasons, including the death of the person before the procedure, the withdrawal of the request by the sick person or a death that was not reasonably expected.

In short, there is nothing in Bill C-7 that will cause a substantial increase in requests for medical assistance in dying.

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, I do not think there was a question there. However, my hon. colleague made some observations about whether access to MAID has increased in her province.

I will state again something I said in the remarks I made. I believe it is incumbent upon legislators, who have been given the very important role of putting legislation in place, to always look at legislation to understand and try to address any unintended consequences and then protect against them. Leaving safeguards in place that do not unduly create duress should be the route we choose to take.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I want to ask the member about what I think is an unintended consequence of Bill C-14. It is the situation where people are forced to choose to go early because they are afraid of losing competence at the last minute, something the new bill addresses.

There are many examples of it across the country, I have one example that is very close to me. I have friend who wanted to see family and relatives and spend some time doing last things because she had a very serious brain tumour. She chose to go earlier because she feared losing competence.

That is an unintended consequence of the current legislation. People should be able to make that choice and have an orderly and dignified end to their lives. Does the member not see that as an unintended consequence?

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, when Bill C-14 was introduced in the previous Parliament, the decision was made to not include advance directives. I think that was purposeful. Had we been allowed to deal with the issues that the Truchon case identified and keep all of these other issues in mind for the statutory review that is being contemplated, it would have allowed us far more time to look at the legislation, see what was and was not working and have a timely and comprehensive study of Bill C-14.

[Darren Fisher, Liberal, Parliamentary Secretary to the Minister of Health]

Madam Speaker, medical assistance in dying, or MAID, is complex. It is a deeply personal and difficult topic, yet this past January alone, more than 300,000 Canadians took part in the online public consultation to have their say. Many others, including experts and family members of loved ones who received MAID, took part in round-table discussions.

We also heard how the legislation is working from many of the conscientious health care providers involved in delivering this service. Canadians are engaged and aware of the importance of bringing the compassionate, sensible measures contained within Bill C-7, an act to amend the Criminal Code (medical assistance in dying).

This bill builds on the foundation laid by the current legislation on MAID, passed by Parliament in June 2016, and extends eligibility for MAID to persons who, while suffering intolerably, may not be at the end of life. This bill respects the Truchon decision and supports the autonomy of Canadians wanting to make an informed choice to end the suffering they face as a result of serious illness, regardless of whether their condition is life-threatening in the near term.

Respecting the autonomy of Canadians while protecting the safety of vulnerable people remains our central objective. That is why Bill C-7 proposes a two-track approach to safeguards, based on whether or not a person's death is reasonably foreseeable.

We have proposed to ease certain safeguards that had the unintended consequence of creating a barrier for someone accessing MAID whose death is deemed reasonably foreseeable, and we will introduce new and modified safeguards for eligible persons whose death is not reasonably foreseeable.

Bill C-7 would permit the waiving of final consent for persons at the end of life who have been already assessed and approved to receive MAID, but who are at risk of losing their decision-making capacity before it can be provided. There was very strong support for this type of amendment from Canadians, experts, health care providers and their professional regulating bodies.

Our government recognizes the importance of data and science-based evidence in the decision-making process. That is why this bill proposes that we expand data collection through the federal monitoring regime to provide a more complete picture of MAID in Canada.

I would like to note that following the Truchon decision there has been widespread speculation about the potential for persons solely with mental illness to be eligible for MAID. However, many stakeholders in the mental health community have expressed deep concern about this possibility. They feel this option directly conflicts with important treatment principles, which are that there is always hope for recovery and that people can live fulfilling lives with a mental illness.

From the perspective of many health care providers and many health care specialists, assessing eligibility for such individuals poses numerous challenges. Mental illnesses are not generally considered to be incurable, which is a requirement under the current law. In addition, the trajectory of such conditions can be more difficult to predict.

In light of the multiple challenges we heard and the lack of support from the practitioner community who would bear the responsibility for conducting eligibility assessments, this bill does not permit MAID for persons whose sole medical condition is a mental illness.

This decision was not taken lightly. It in no way implies that suffering associated with mental illness is any less severe or more tolerable than that associated with another medical condition, such as one arising from a physical condition. Rather, this decision reflects the many uncertainties underlying this question and a concern that allowing MAID in these circumstances could place Canadians at risk.

We recognize that there are proponents who support MAID eligibility for persons solely with a mental illness. However, in light of the Quebec court decision and the compressed time frame for legislative amendments, there is insufficient time to fully address this topic and determine whether a regime that allows access to MAID for persons whose sole underlying condition is a mental illness is viable.

For these reasons, we are adopting an incremental and cautious approach. It is our view that this issue should be explored as part of the parliamentary review process, which is expected to begin later this year.

It is easy as parliamentarians and as legislators to lose the human element of what we do and to focus on talking points and politics, but these compassionate and sensible measures have come from extensive consultation with Canadians, experts and folks who have lived with the unintended consequences of the original legislation.

These are folks like the late Audrey Parker, a Nova Scotian who wanted to spend just one last Christmas with her family but ended her life through MAID two months prior, while she could still give consent.

I want to take this time to read some of Audrey Parker's final posts into the record so they will be preserved in Hansard, because this legislation includes her amendment. As my colleagues in the House debate, discuss and study the bill, I want them to remember that there are many folks like Audrey across Canada who deserve this autonomy and this compassion.

She said:

“This is my last note to you. I can tell you I loved my life so much and I have no regrets. I feel like I’m leaving as my best self and I’m ready to see what happens when I die today. I’m hoping for something exciting to happen but I guess I won’t know until the time is here.

“The one thing I’m happiest about, is that I finally found ‘my people’ during my lifetime. I’ve even met new people that I already adore near the end of my journey so it’s never too late for anything in life.

“In the spirit of teaching and sharing, I’d like to leave you with some words that explain my position with MAID.

“When the MP’s debated MAID federally, someone decided to add late stage consent as a fail-safe to ensure no one dies at the hand of another.

“There are four categories of MAID candidates.... Of the four categories, the only one that is cut and dried is my category of Assessed and Approved. We are terminal, suffering outrageous pain and there is no time frame with using MAID. The kicker that makes it difficult is the late stage consent.

“As I near my death today, it is even more evident than ever before, that late stage consent has got to be amended and removed from MAID in Canada for my category of end users.”

“Dying is a messy business. I can’t predict when cancer will move into my brain matter or when something else big happens to make me more unwell. I and only I can make that decision for myself. It’s about living out every extra day that I can. No one including my doctor knows what the right day to die will be. Only I can know that as I wake each day. I’m not going to wait until I lose myself.... I wanted to make it to Christmas and New Year’s Eve... my favorite time of the year but I lost that opportunity because of a poorly thought out federal law.

“Had late stage consent been abolished, I simply would have taken my life one day at a time. If I noticed I was losing capacity, I would have taken control myself....and called my doctor to come assist me with my death. All I have to give is 24 hours notice so she can pick up the drugs from the drug store in my neighborhood. We were totally organized but the law tied our hands.

“This decision has to come from the patient. No one else. That’s why we the dying should be living day to day until we have to leave by invoking MAID.

“Be happy everyone and be kind to others.... Audrey.”

I ask that all members in the House support Bill C-7.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Madam Speaker, obviously everyone is very touched by the testimony of our colleague.

The member talked about his support for the bill. I too support it. However, I have concerns with the timeline.

I was part of the National Assembly of Quebec when it became the first legislator in Canada to adopt a bill about this issue. It took us six full years. I was part of the committee that worked on the bill that the House of Commons adopted four years ago. It took us six full months.

As far as I am concerned, there is obviously a rush for some people, but does the member think we should take all the time necessary and do all the consultation necessary to achieve the best bill possible?

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Madam Speaker, I want to thank the member, who has spoken passionately about this matter. I heard you in the House in 2014 and now, and I thank you for that.

Someone in the House said that we should proceed with caution. Someone else, a very smart man in this room, said we did that in 2015, and people suffered.

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

Madam Speaker, obviously this debate engages all of our emotions and often from both sides. We have heard the testimony that the member shared. I shared in my speech a story of a woman who had her life taken in very sketchy circumstances. It was at a hospice in Vancouver, where someone took that person's life and said it was based on a demand for euthanasia and that the testimony was based on her own notes, but there had been no consultation with, or awareness by, the local staff.

We struggle with cases that involve major concern, cases that exist on all sides of this issue. I hope that through the amending process we may be able to find some common ground.

The member spoke specifically about the issue of advance consent. I think we should have some mechanism in that advance consent section to ensure that there is contemporaneous consultation with the patient. We know of other cases in which someone gave an advance directive and then had their life taken while they did not want that to happen.

Is there a way to meet in the middle and have a requirement for some kind of contemporaneous consent, even in the context of an advance directive?

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Madam Speaker, this is one of those things that is hugely complex and affects everyone differently. We all have different approaches and different beliefs in this room about how we should approach this issue. I do not know whether we can find common ground. I think we found common ground or at least met in the mushy middle in 2015, and we let people down.

I salute the medical practitioners in this country who are assisting Canadians with end of life, whether it be palliative care or MAID. It is important that we see everyone's side to this situation and respect everyone's thoughts and beliefs. I have constituents on both sides of this issue.

I had a very bad joke I used in 2015 when we were talking about this. There is no yes or no. I said there are 50 shades of grey. Only a couple of people chuckled at that joke, and no one got it clearly in this room either.

It is one of those very complex issues on which people do not fall on one side or the other. We could ask 100 people and have 100 different perspectives.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

Resuming debate, the hon. member for Northumberland—Peterborough South.

Unfortunately, I will have to interrupt the member at some point. He will be able to continue his speech at a later date.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Madam Speaker, all of the speeches in the House come from a great place. On my side of the House we value life, and that is meritorious. We have heard other perspectives that talk about ending suffering and that truly has merit, so I appreciate all of the speeches that have taken place on such an important topic.

I know members have gone over this, but just for clarity I want to go over the background for medically assisted suicide in Canada. The 2015 Carter case was a landmark decision for the Supreme Court of Canada. The previous prohibition for assisted suicide was challenged as contrary to the Charter of Rights and Freedoms. In a unanimous decision, the court abolished the provision in the Criminal Code, thereby giving mentally competent Canadians who were suffering intolerably the right to medical assistance in dying when they had provided clear consent.

In June 2016, the first legislation on medical assistance in dying was passed in Canada's Parliament. In the recent 2019 Truchon decision, the Superior Court of Quebec considered the constitutionality and Quebec's requirements in accessing MAID. The plaintiffs in the Truchon case were suffering from grave and incurable medical conditions that were causing tremendous suffering and a total loss of autonomy. However, they had each been refused MAID under the legislation in Quebec and federally. Because they were not at the end of life for the Quebec legislation and federally, death was not reasonably foreseeable.

Madam Justice Baudouin held that “reasonably foreseeable natural death” in the federal provisions infringed the plaintiff's fundamental rights under sections 7 and 15 of the charter. The court declared the impugned provisions unconstitutional. In a surprising and, in my mind, incorrect decision, the government chose not to challenge this decision, thereby getting guidance from higher courts such as the Supreme Court. By not challenging this legislation, the Liberal government was admitting that the legislation the House passed was deeply flawed.

The court's decision in Truchon gave the government until March 2020, which is now in the process of being extended, to amend the legislation to remove the reasonable foreseeability of death criteria from the MAID legislation. Prior to the introduction of this bill, the government conducted a narrow consultation process, limiting its consultations to urban centres and online surveys.

The minister noted several times, in his address to the House, that the provisions of Bill C-7 were the result of this process. However, he will not share that consultation with Parliament. This lack of respect is disheartening, and counterproductive to open and meaningful dialogue. I wish the government would stop playing games with such important topics and share the information it has with this minority Parliament.

Given that there is a limited timeline, that we are in a minority Parliament, and that MAID legislation will be subject to a complete review this summer, I would have expected the government to take a limited approach. Rather, the government has chosen to take a very different approach. The legislation makes substantial changes to the MAID eligibility far and beyond what is required to the Truchon decision.

[David Lametti, Liberal, Minister of Justice]

moved that Bill C-7, an act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Madam Speaker, I am pleased to speak today about Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, MAID. The bill before the House today is identical to former Bill C-7, which I was proud to have introduced in February following significant consultation among Canadians and experts. I believe this bill reflects a consensus among Canadians and I call on all of my colleagues in this place to support its timely passage.

As members will recall, this bill proposes a legislative response to the Quebec Superior Court's ruling in Truchon and Gladu, in which the court ruled that it is unconstitutional to limit MAID to persons whose death is reasonably foreseeable. That declaration of invalidity, which applies only in Quebec, was initially suspended for six months and subsequently extended by four months, such that it would have come into effect on July 12.

We were all working toward that deadline when this bill was initially introduced. As with many other aspects of our lives, the COVID-19 pandemic disrupted our usual parliamentary activities and it became impossible to meet the July deadline. As Attorney General, I asked for a further extension, which the court granted, until December 18, 2020.

Even though the ruling in Truchon and Gladu was suspended, Quebeckers who are experiencing intolerable suffering and who meet all the eligibility criteria except that of reasonably foreseeable death can apply to the court for an exemption that would allow a practitioner to provide medical assistance in dying despite Parliament not yet having amended the legislation.

Six exemptions have been granted since Justice Baudouin handed down her ruling in September 2019, and others are under review. The availability of exemptions limits the impact of the suspension of the ruling in Quebec.

I would like to take a moment to note the passing of Mr. Truchon, one of the plaintiffs in the case that led to these important changes to our medical assistance in dying regime. Like many Canadians, Mr. Truchon was concerned about the impact of the pandemic on his quality of life in addition to the suffering caused by his medical condition. He want the option to obtain medical assistance in dying, which he did in April. I would like to express my deepest condolences to his loved ones.

The bill before members today, four years after the enactment of Canada's first medical assistance in dying provisions in 2016, proposes a significant change to Canada's MAID regime in broadening eligibility to persons whose natural death is not reasonably foreseeable.

The 2016 amendments were, themselves, a historic change in our criminal law. They created exemptions to some of the most serious criminal offences, which aim to protect one of our most fundamental values, that of human life. These exemptions sought to protect and promote another of our most cherished values, individual freedom, and more specifically, the freedom to decide when enough medical suffering is enough and to choose when and how one's life should end.

Health Canada's first annual report on medical assistance in dying in Canada released this past July indicates that since then nearly 14,000 Canadians have received MAID. In 2019, MAID accounted for 2% of deaths in Canada.

The requirement for reasonably foreseeable natural death was part of a MAID regime that was adopted in 2016. However, we decided not to appeal the Truchon and Gladu decision because we agreed that medical assistance in dying should be available as a means to address intolerable suffering outside of the end-of-life context. To ensure the consistency of criminal law across the country, we committed to amending the Criminal Code.

Before amending the Criminal Code, we conducted an extensive consultation with Canadians. We gathered responses from 300,000 people through an online questionnaire. My colleagues, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, our parliamentary secretaries and I also held round tables across Canada with over 125 experts and stakeholders. The summary of these activities can be viewed on the website of the Department of Justice.

Based on these consultations and other sources of information, the bill proposes adjusting both the eligibility criteria and the procedural safeguards to respond to the decision rendered in Truchon and Gladu. The bill also proposes allowing patients to waive the requirement to give final consent in specific circumstances so that they do not lose their access to medical assistance in dying.

We know that Canadians are also concerned about other issues that are not addressed in this bill. I am thinking, in particular, of access to medical assistance in dying on the basis of mental illness. I am also thinking about advance requests for medical assistance in dying for people who are not yet suffering but fear they will be after they have lost their ability to request this assistance and who want to making their wishes known before that happens.

The upcoming parliamentary review of the medical assistance in dying regime and of the state of palliative care in Canada will provide an opportunity to give these complex issues the time and attention they deserve. It is up to Parliament to determine the scope of this review and when to conduct it.

COVID-19 has delayed this important review, but I am confident that Parliament will undertake it as soon as possible. That being said, our government's top priority is to meet the deadline set by the Quebec Superior Court in the Truchon and Gladu case.

Before I discuss the contents of the bill in more detail, I would like to note the important concerns of many individuals in the disability community about changing Canada's MAID policy from a way to avoid a painful death to a means of relieving intolerable suffering. It is crucial that these concerns not be forgotten as we resume our debate. In the view of many disability groups, a MAID regime that does not limit eligibility to those whose death is already reasonably foreseeable enshrines in law the erroneous view that disability itself is a valid reason for ending life. We have also heard from individuals living with disabilities, like Mr. Truchon and Ms. Gladu, that autonomy in how they choose to live and die is paramount. These are complex and nuanced points of view.

Let me be absolutely clear. Our government supports the equality of all Canadians without exception and categorically rejects the notion that a life with a disability is one that is not worth living or worse than death itself. I believe the fundamental principle that all lives have equal and intrinsic value can be balanced with other important interests and societal values, in particular, the importance of individual choice for Canadians. This balance is at the heart of the bill's objectives, which are to recognize the autonomy of individuals to choose MAID as a means for relieving intolerable suffering, regardless of the foreseeability of their natural death, while at the same time protecting vulnerable persons, recognizing that suicide is an important public health issue and affirming the inherent and equal value of every person's life.

I will now go into the specifics of various elements of the bill.

The bill proposes to expand eligibility for medical assistance in dying by repealing the criteria for a reasonably foreseeable natural death. Medical assistance in dying would therefore be available to people suffering unbearable pain, who have a serious and incurable disease, infection or disability, and whose medical condition is characterized by an advanced and irreversible decline in their capacity.

This removal of “reasonable foreseeability of natural death” from the eligibility criteria would mean that some persons whose only condition is a mental illness could be eligible for MAID. However, the bill proposes to exclude mental illness on its own as a grounds for MAID eligibility.

Our consultations and the report of the Council of Canadian Academies that studied this issue indicated that the trajectory of mental illness is more difficult to predict than that of most physical illnesses, that spontaneous improvement is possible, and that a desire to die and an impaired perception of one's circumstances are symptoms, themselves, of some mental illnesses.

This means that it would be very difficult to determine when, if ever, it is appropriate to grant someone's request that their life be ended solely on the basis of mental illness. In no way does this suggest that persons with a mental illness necessarily lack the decision-making capacity to consent to MAID, or that the suffering associated with a mental illness is of a lesser degree than the suffering associated with physical illness.

During second reading debate of former Bill C-7, some members noted their support for this exclusion while others raised concerns. This issue requires much more thought and debate. We feel the parliamentary review of the MAID legislation would be an appropriate forum for this.

The bill also proposes changes to the safeguards, since the existing safeguards were designed to protect persons whose death is reasonably foreseeable.

Expanding eligibility requires changes to the safeguards, since many experts believe there are greater risks in assessing applications for medical assistance in dying from individuals whose death is not reasonably foreseeable.

The bill therefore proposes two sets of safeguards. Each applies whether natural death is reasonably foreseeable or not. This is the only role that the concept of reasonably foreseeable death would play in the new regime. It would no longer constitute grounds for refusing a request for medical assistance in dying.

Reasonable foreseeability of natural death, or RFND, refers to a temporal but flexible connection between the person's overall medical circumstances and their anticipated death. It allows for clinical judgment, as it requires a comprehensive individual assessment that does not have a result in a specific prognosis and clearly does not require death to be imminent.

Individuals may decline towards death along trajectories of greater or lesser predictability. As such, RFND is not defined by a maximum or minimum prognosis, but it does require a temporal link to death in the sense that the person is approaching the end of their life in the near term.

We kept the RFND standard because it provides flexibility in relation to the difficult and imprecise exercise of anticipating when natural death might occur. A natural death that is expected within six to 12 months certainly meets the RFND standard. That was made clear when Parliament adopted Bill C-14 as an end-of-life regime. It did not impose a six- to 12-month prognosis requirement to preserve flexibility, but it still considered such timelines to be within the meaning of RFND.

A person's death may also be foreseeable in the temporal sense over longer periods, depending on the particular circumstances under consideration. However, having an illness that will cause death several years in the future would not normally meet the condition of RFND.

Safeguards for those whose deaths are reasonably foreseeable are based on safeguards that currently exist with two changes. First, the 10-day reflection period would be eliminated. Second, the request for medical assistance in dying will no longer require the signature of two independent witnesses, just one.

A person paid to provide health care services or personal care who is not involved in the assessment of the person's eligibility for medical assistance in dying can now act as an independent witness.

During second reading of former Bill C-7, some hon. members expressed concern about removing some of the safeguards.

Allow me to assure hon. members that these changes are based on the comments we received during our consultations and follow through on them.

For those whose natural death is foreseeable, many of whom spend a long time seriously thinking about what they want to do, the 10-day reflection period might unduly prolong their suffering.

We also learned that people who live in long-term care facilities or in remote regions may have difficulty finding two independent witnesses. These difficulties are exacerbated by the pandemic. The independent witness confirms the identity of the person, but does not participate in assessing their eligibility for medical assistance in dying. Only one person is required for meeting that safety objective.

Newly eligible persons whose death is not reasonably foreseeable would benefit from additional safeguards, the purpose of which is to ensure that sufficient time and expertise is devoted to the assessment of their MAID request. Where death is not reasonably foreseeable, the suffering motivating a MAID request may be due to a broader range of sources that warrant greater attention before someone's life is prematurely ended, to reduce the risk of providing MAID when there is a possibility of alleviating the person's suffering.

Specifically, the bill proposes a minimum 90-day assessment period, which would require that at least one of the practitioners assessing eligibility has expertise in the condition that is causing the person's intolerable suffering. A formal specialization or certification by a medical college would not be required. The bill would also require that a person whose death is not reasonably foreseeable be informed of and offered available means to relieve suffering, such as mental health and disability supports. In addition, the practitioner would have to be satisfied that those other means of relieving suffering have been seriously considered.

These are clarifications to the existing requirement of informed consent. It is our hope that these steps are already taken in all cases, but the Criminal Code would explicitly require them for those whose death is not reasonably foreseeable.

In addition to changes in response to the decision in Truchon and Gladu, the bill would let a person whose natural death is reasonably foreseeable and who has been deemed eligible to receive MAID to waive final consent if there is a risk they will lose the capacity to consent before the date on which they chose to receive MAID.

At present, the Criminal Code requires that, immediately before providing MAID, the practitioner must ensure that the person has given express consent to MAID and that they have the opportunity to withdraw their request. This safeguard, which attests to the irreversible nature of death and the importance of obtaining consent at the point of ending life, simply cannot be met if the person has lost the capacity to consent. This seems unfair when a person has been deemed eligible and was awaiting the procedure. In such cases, the rule could push some individuals to obtain medical assistance in dying earlier than they wanted to.

Under the amendments proposed in the bill, a person whose death is foreseeable, who has already been assessed and approved for MAID and has decided they want to receive it, could make an advance consent arrangement with their practitioner, setting out the date for the provision of MAID and their consent to MAID if they no longer have the capacity to consent at that later point.

According to round table participants and experts who looked at this question for the Council of Canadian Academies' 2018 reports, providing for advance consent in this way presents relatively little complexity or risk, and some practitioners have indicated they would be relatively comfortable providing MAID under such circumstances.

The bill does not propose to permit advance requests in contrast to what I have just described as advance consent. Advance requests are documents that may be provided at some future unknown date, if and when a set of expected circumstances materializes and when the person is no longer able to give consent. This issue is significantly more complex and challenging, and it will be examined during the parliamentary review.

Finally, the bill would enhance the monitoring regime, which is crucial for accountability and transparency. I have examined the bill for charter compliance and I am confident that it responds to the Truchon ruling in a way that respects the charter. I will soon table a charter statement that sets out key considerations about the bill's potential impacts on charter rights and freedoms.

In conclusion, these important amendments seek to guarantee that medical assistance in dying—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

We must now proceed to questions and comments.

The hon. member for St. Albert—Edmonton.

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

Madam Speaker, needless to say, this is an incredibly complex area. While Bill C-7 purports to respond to the Truchon decision, it goes considerably beyond the scope of Truchon, and in so doing, removes a number of safeguards that Parliament, in its wisdom, passed four short years ago. In so doing, it would pre-empt a legislative review, where there would have been an opportunity to thoroughly examine all of the issues before experts and to take into account the comprehensive reports of the Council of Canadian Academies.

Why would the government choose to pre-empt a legislative review and instead proceed in a rushed way, in the face of the expiration of a stay on the declaration of constitutional invalidity effective December—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

The hon. minister.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank the hon. member for his participation and concern, over the last four years, with respect to this issue.

As the hon. member has pointed out, we are responding primarily to the Truchon decision, but we used the opportunity to make a certain number of other modifications where there was a clear consensus among Canadians. We consulted widely with MAID service providers and with families who had gone through the process. There was a universal conclusion that the 10-day waiting period was only a source of suffering, that people who decided to have MAID had made the decision and the 10 days only prolonged suffering. I continue to hear that. The witness requirement was actually becoming an impediment for people in regions and in long-term care facilities to access MAID, so we decided to change that now.

[Christine Normandin, Bloc, Saint-Jean, QC]

Madam Speaker, I thank my colleague for his exhaustive overview of the bill before us today. We are pleased to be able to work together on this bill, which speaks to the very needs of Quebeckers and Canadians.

I would like to hear the minister's thoughts on how he expects all members in committee to work together so that we can meet the December 18 deadline for the final legislation. I hope that our work will be constructive and that we will thoroughly examine the issues. We must not forget that the objective is for fewer people to suffer while awaiting a final piece of legislation.

Could the minister tell us how he hopes this will work and how he plans to make it happen? I believe we have chosen not to include mental illness for the time being. There is not necessarily a consensus on this issue. I would like to hear what he hopes to see from parliamentarians.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank my hon. colleague for her question.

Issues relating to minors, mental health and advance requests are complex ones. We will give these issues the consideration they deserve in a parliamentary review, which was already set out in the 2016 legislation.

I hope that we will have the co-operation of our colleagues in this chamber and in the other place. There is clearly a strong consensus across the country, including in Quebec, for measures like the ones we are proposing. We will ensure that parliamentarians work together to meet the deadlines.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I want to start by thanking the minister for the co-operative and open dialogue that he and I have maintained on the bill and many other matters in the justice area. I also want to thank him for bringing the bill back promptly, because the concern of the New Democrats has always been that we not inadvertently prolong suffering for those who are at the end of life and for their families.

I do have a concern that the minister seems to have dropped the review off the edge of the agenda here. We are talking about the bill, but the work we need to do also includes the broader review. I placed an order on the motion paper today suggesting that we establish a special committee to deal with these broader issues. The minister made many references to the review without talking about a schedule or how we would accomplish this review.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank the hon. member for his work and his collaboration. I think there is a question in there, which I am going to try to answer.

I will look at the motion. I am open to discussing the parameters of the review with my parliamentary colleagues from all sides of the House and, indeed, the other house. I am certainly open to discussing the parameters of the review as we move forward.

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

Madam Speaker, I wanted to touch on the consultations that took place around the country, some of which I was privileged to take part in, along with some of the other parliamentary secretaries assisting the ministers working on this file. I want to ask the minister if he could comment on the influence of the Audrey Parker case, and what that means in the context of persons who would have been approved of a proceeding but not had the time to wait until they can give that final consent. What does that do in terms of this issue of people availing themselves of MAID prematurely?

As a second point, I would ask the minister to clarify whether this new bill would affect at all the conscience rights of medical practitioners, in terms of their being compelled to provide medical assistance in dying.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank my hon. colleague for his work on this and various other aspects of our file.

I will answer the second question first. Conscience rights were protected in the bill. They were protected in 2016 in the original bill. They were reinforced by parliamentary committee, and they are maintained in the current bill.

With respect to Audrey Parker's amendment, colleagues will remember that this is the case of a woman in Halifax who had been evaluated and approved for MAID, but was at the end of her life and afraid of losing her capacity, so instead of being able to spend another Christmas with her family, she opted to take MAID earlier. We have incorporated what is, in effect, Audrey Parker's amendment into the legislation. There was widespread support for it across Canada, and I described it in my earlier remarks.

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

Madam Speaker, the minister's comments about conscience protection are totally false.

He knows, or should know, that the College of Physicians and Surgeons of Ontario policy, which pre-existed this, in combination with the law the government brought in, effectively requires physicians to either provide or refer for euthanasia in certain situations. He also should know that hospices, including one in B.C., are being forced to close, reducing the number of palliative care beds because of their lack of desire to provide euthanasia. So much for protecting patients' autonomy. If patients want to receive care in an environment that does not include euthanasia, they should have the freedom and autonomy to do so.

In addition to that, I want to ask the minister quickly about the 10-day reflection period. The member for Richmond Hill, from the minister's own caucus, said that the 10-day reflection period is necessary. The minister knows as well that this reflection period can be waived in certain extraordinary circumstances already.

Why not leave the reflection period in place, as members of his own caucus are calling on him to do, recognizing that it can already be waived in certain extreme situations?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, with respect to the 10-day period, once again, we heard in our consultations across Canada from families, from people who have experience with MAID and from MAID service providers that all the 10-day waiting period did was add to people's suffering. It was characterized as inhumane, and we are taking it out.

I would also properly characterize the issue, which I feel my hon. colleague has failed to do. This is a charter right. It was held in the Carter case that this was a charter right, and the 2016 legislation enforced the charter right. A medical service provider is never forced to participate in this himself or herself.

The member is correct. He underplayed the words “under certain circumstances”, but those are, in fact, crucial. Under certain circumstances, where the person's charter right to access the service would be endangered, a medical practitioner has to give a reference. However, that is the extent of it, and that is entirely in balance with our charter provision. I would humbly submit that the hon. member's mischaracterization is erroneous.

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

Madam Speaker, I am pleased to rise to speak on Bill C-7, an act to amend the Criminal Code respecting medical assistance in dying.

At the outset, I will say that the subject of medical assistance in dying is perhaps one of the most complex issues that could come before Parliament. Profound moral, legal and ethical questions are raised. Medical assistance in dying raises questions of individual autonomy, the need to respect the sanctity of life and the need to protect vulnerable persons, among other considerations.

It is no wonder that Canadians have such profound, deeply held and diverse views on this subject matter. After all, when we are talking about physician-assisted dying, we are talking about issues that literally concern life and death. When we, as parliamentarians, give consideration to an appropriate framework that provides safeguards, we must do so with regard to the fact that we are talking about a procedure that, when carried out, is irreversible. The patient dies. It is indeed a weighty subject of profound importance.

I am certainly informed of the complexity of the issue through my experience of having, in the last Parliament, served as the vice-chair of the Special Joint Committee on Physician-Assisted Dying. This committee was tasked with reviewing the Carter decision of the Supreme Court, which struck down the blanket Criminal Code prohibition and tasked Parliament and the committee with putting forward recommendations for a legislative response. I then sat on the justice committee, which studied Bill C-14, the government's legislative response. In that regard, I am in the unique position of having been through the process from start to finish, from the study of the Carter decision of the special joint committee through to the passage of Bill C-14 in June 2016.

The bill before us purportedly responds to the Truchon decision of the Superior Court of Quebec, which struck down an important component of Bill C-14, namely, that in order to qualify for medical assistance in dying, one's death must be reasonably foreseeable. When the Truchon decision was issued in September 2019, we on this side of the House in the official opposition called on the Attorney General to do the right thing and appeal the decision. We did this for a number of reasons.

To begin with, it is the responsibility of the Attorney General to uphold laws passed by Parliament. The law passed by Parliament was Bill C-14. I would note that the law had been passed a mere three years prior to the issuance of the Truchon decision. It was passed after a comprehensive review of the Carter decision and a comprehensive review of possibilities for a legislative framework. Therefore, in the end, Bill C-14 was a carefully thought-out and debated piece of legislation. One would think that in the face of that, the minister would have appealed the decision.

In addition to that, when one, having respect for this place and the laws passed by Parliament, actually looks at the Truchon decision and the reasoning of Madam Justice Baudouin, it should be all the more apparent the need to appeal the decision. Madam Justice Baudouin, in concluding that the reasonable foreseeability criterion contravened section 7 and section 15 of the charter, was driven, arguably, by a restrictive interpretation of the purpose of the law. Indeed, Madam Justice Baudouin reached her conclusion by singularly focusing on one objective of the law, namely, to protect vulnerable persons from being induced in a moment of weakness to ending their life.

However, that was not the only objective of the legislation. When one looks at the preamble of Bill C-7, it expressly provides for other objectives, including the sanctity of life, the dignity of the elderly and disabled, and suicide prevention, yet the judge in Truchon focused exclusively on only one of those objectives.

What Parliament sought to do in providing for a reasonably foreseeable criterion was to respond to what the Supreme Court called upon Parliament to do, namely, to strike a balance between individual autonomy and the need to respect vulnerable persons.

The Attorney General, moments ago, stood in this place and said that the government chose not to appeal the decision because it agreed with the substance of the decision. That is quite interesting because only four years ago, three years before the minister decided not to appeal the decision, ministers on that side of the House emphasized how critical the reasonably foreseeable criterion is to provide and ensure effective safeguards to protect the most vulnerable.

To that end I would quote the former health minister, Jane Philpott, who, on June 16, 2016 stated:

We are concerned with the Senate's recommendation for the removal of the clause that recommends that this be considered only in the face of natural death being reasonably foreseeable because of the fact that people with mental illness, among others, would not be adequately protected.

Then there are the comments of the then attorney general, the hon. member for Vancouver Granville, who introduced Bill C-14 and stated:

There are other compelling reasons for there to be a requirement that the person's natural death be reasonably foreseeable. First, it provides a fair way to restrict eligibility without making assisted dying available to almost everyone. Second, restricting eligibility in this way is necessary to protect the vulnerable.

In the face of those objectives, it is quite a departure and quite convenient for the minister to say that he was going to effectively abdicate his responsibility as attorney general to uphold the laws passed by Parliament by allowing a single decision of a single lower court judge in one province of this country to stand. The Attorney General acknowledged, and we should make no mistake about it, that the effect of Truchon and its codification, by way of this piece of legislation, significantly transforms the medical assistance in dying framework in Canada.

At the time of the Carter decision and when this House, four short years ago, debated Bill C-14, medical assistance in dying was thought to be an exception to the rule, not the rule. It was thought to be appropriate in certain circumstances in an end-of-life context, where one who was suffering intolerably could, upon providing clear consent, hasten their death.

With this legislation, it would now be appropriate to terminate human life even in the absence of a terminal illness and even in circumstances where the suffering is medically manageable. That is a radical transformation, and it creates a number of complexities around issues of suffering that might be psychological or existential and outside of an end-of-life context. When one removes the reasonably foreseeable criterion, all that is left is that one must have a serious disease, illness or disability, be in state of decline, and be suffering physically or psychologically as a result.

When one removes an end-of-life, or reasonably foreseeable, component, that already arguably subjective test becomes a whole lot more subjective, and that has the potential to put vulnerable persons' lives at risk. One can see that with those broad parameters, persons with degenerative disabilities could have their lives terminated, notwithstanding that they may have years, if not decades, to live. That has caused enormous concern in the disability community across Canada.

One month after the Truchon decision was issued, some 72 organizations from across Canada, representing a cross-section of the disability community, wrote to the Attorney General and pleaded with him to appeal the Truchon decision. They did so out of concern that persons with disabilities could be put at risk and have their lives prematurely ended.

The writers of the letter noted that the legislation could arguably contravene article 10 of the UN Convention on the Rights of Persons with Disabilities, which provides that persons with disabilities should be treated equally under the law. They note that persons with disabilities could be treated unequally because one could have medical assistance in dying made available to them for no other reason than they happen to be disabled.

It should be noted that the UN rapporteur on the rights of persons with disabilities sounded the alarm when she said she was, “extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective.” From a disability perspective, that plea fell on deaf ears on the part of the Attorney General in terms of his failure to appeal the Truchon decision.

In light of what a significant change this legislation means, it is unfortunate that it has come to this, because appealing the decision would have allowed for time. It would have allowed time for Parliament to take into consideration the significant complexities associated with this change, a mere four years after Parliament had legislated a comprehensive regime, and it would have provided clarity in terms of informing Parliament about the scope of the framework upon which Parliament can legislate.

However, instead of taking the appropriate time to ensure that any legislative change respects the charter, because respecting the charter, including life, means protecting vulnerable persons, we are here with a profoundly significant piece of legislation being rushed. It is being rushed in the face of the expiration of the stay on the declaration of constitutional invalidity, effective this December.

While the Attorney General and the government emphasized the Truchon decision, it must be noted that this legislation goes well beyond the scope of Truchon. It removes important safeguards, including the 10-day reflection period. It removes the requirement that there be two witnesses to confirm that a person made the request of their own free will and that the request reflected their true consent. It provides for a complex advanced consent regime, one of those complex areas when it comes to medical assistance in dying policy, and it does all of this pre-empting what Parliament had determined, called upon and legislated in Bill C-14; namely, a legislative review that was supposed to take place this spring, but is not going ahead.

Now we are in this rushed process, instead of having an opportunity for members of Parliament to come together to hear from expert witnesses, to review the state of the law, to give consideration to the comprehensive reports of the Council of Canadian Academies and to receive diverse feedback on all of these issues. It need not have been this way. It should not have been this way, and it is regrettable that the government has so recklessly put us in this position by rushing through legislation that, arguably, could put vulnerable Canadians at risk and remove critical safeguards.

[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]

Madam Speaker, I agree with the importance of the legislation and the issue at hand. The intent of the government back in February was to ensure there would be more debate and the opportunity for us to explore the matter at hand further. No one anticipated what was going to happen with the coronavirus, and that has changed all aspects of our society. The legislation is before us because a court is obligating us to move as quickly as we can on it.

Would the member not agree that in many ways, during the first debate we had years ago on the legislation, there was still opportunity for us to have critical input? Does he have amendments that he would like to bring forward on this legislation?

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

Madam Speaker, to answer the question from the parliamentary secretary to the government House leader directly: The issue of amendments will be studied at the justice committee, and it is possible amendments could be brought forward.

With respect to the court decision, I will say this. Nothing in the Truchon decision necessitated this rushed legislation. The government could have appealed it and chose not to. What is more, the government has legislated on matters that the court in Truchon, and Madam Justice Beaudoin was very explicit, confined to the question of being reasonably foreseeable.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Speaker, I thank my colleague for his speech.

The Bloc Québécois is in favour of the bill, as are the NDP and the government, obviously. However, we still do not know whether the Conservatives will support this bill.

In Quebec City, we saw a good example of how all the parties decided to pass a bill without resorting to partisanship and attacking each other. Unfortunately, I get the feeling that this bill will not pass unanimously in the House.

Does my hon. colleague agree that the bill will not be passed unanimously because of the many religious lobbies that are putting pressure on some Conservative members?

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

Madam Speaker, In response to the hon. member for Lac-Saint-Jean, I simply reject the premise of his question. I have to say I have never viewed this as a partisan issue. This is a complex legal, moral and ethical issue.

I had the privilege of serving on the special joint committee with my friend, the hon. member for Louis-Saint-Laurent, and the late hon. member for Langley. We had different philosophical views on a number of issues, but we came together to follow the law and put forward what we thought were the best possible recommendations for safeguards to do what the Supreme Court called on us to do, which was to protect vulnerable persons while at the same time respecting individual autonomy. That is exactly how I will approach Bill C-7.

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

The member will have a little over five minutes of questions after Question Period.

We will now go to Statements by Members, and the hon. member for Newmarket—Aurora.

The House resumed consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[Chris Bittle, Liberal, Parliamentary Secretary to the Minister of Transport]

Madam Speaker, I know the member and I had a lot of debates four years ago when we discussed this on the justice committee.

Conscience rights for doctors have come up a bit in his remarks and in other members' remarks as well. I was hoping we could take it back to our profession. As a lawyer, and as a civil litigator, I have had a number of individuals whom I met with and, through my own conscience, I did not want to take on their cases, but I was required by the Law Society of Ontario to refer those individuals on, even though I may not have wanted them to succeed or have success in their cases.

I was wondering if that was the same case in Alberta, and why is it different in that particular case? Should doctors not be required to refer patients on?

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

Madam Speaker, yes, it is correct that the member and I did serve on the justice committee together during the deliberation and study on Bill C-14.

When we speak about conscience protections, they are fundamentally important. It is important to remember that the Supreme Court of Canada, in the Carter decision, did recognize that Canadians have a right, in certain circumstances, to physician-assisted dying, but at the same time the court expressly stated that no physician should be compelled to provide the procedure. It is important that the Carter decision be respected.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I listened with interest to the hon. member's speech before question period, and I respect that his concerns about Bill C-7 are based on deeply held convictions. Therefore, I wonder whether he would support my attempt to get the government to start the broader review of the bill in parallel with Bill C-7, according to the motion I placed on the Order Paper earlier today.

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

Madam Speaker, that is something I will give consideration to, but what is disappointing is that it has come to this. It need not have been so. The government could have very easily proceeded with a legislative review that would have been able to address all of the underlying issues associated with the bill, instead they have opted for a rushed process.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, when Bill C-14 was discussed, I did warn the House that if we look to other countries and how they enacted medical assistance in dying, we would see that they began with death rates in their countries of less than 1% and grew to 8%, through people not following the safeguards. It seems to me that the government, in the new version, has removed all of the safeguards: the reasonably foreseeable death provision, the independent two witness provision, the 10-day cooling-off period provision and asking for consent immediately prior.

Would the member agree that all the safeguards have been removed, or are there ones that still remain in place?

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

Madam Speaker, I can say that some of the key safeguards that were deemed to be essential in Bill C-14 have been removed. The member speaks about the 10-day reflection period. It is unclear why that was removed when the law, as it stands, currently provides an exception for cases where the lack of capacity to consent is imminent. That would provide for a shorter reflection period, so it is unclear why the government would choose to remove it altogether.

With respect to the removal of the need for providing two witnesses, the need is now to provide only one witness, which is in fact a lesser safeguard than what is required when a testator executes a will.

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

Madam Speaker, in respect of the most recent intervention by the member for Sarnia—Lambton, the provisions, in terms of complying with Truchon, have eased in terms of safeguards. Other safeguards have actually been enhanced. Therefore, when someone's death is not reasonably foreseeable, we now have a situation where one of the two practitioners assessing eligibility must have expertise in the specific condition that is causing the person's suffering.

As well, we have a minimum 90-day period of assessment from the date of the request to the date of the actual delivery of the service, which is not something that is contemplated by the Truchon decision. It is an additional safeguard that has been put in place.

I would ask the member to comment on those components, as well as the components that address palliative care and the need to understand that palliative care is provided as an option, and physicians are to deem that option has been entertained by the individual applicant, which is an additional feature of this bill.

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

Madam Speaker, in the interest of time, I will address the issue of palliative care and simply state that it was recognized that the absence of palliative care denies a patient true autonomy to make an informed choice. The government has to do a better job when it comes to establishing comprehensive palliative care across the country.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I rise today in the House to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying. It is long overdue.

I want to start by saying that the Bloc Québécois is in favour of adopting the principle of this bill, because it clarifies two aspects of medical assistance in dying.

The first has to do with access to medical assistance in dying when death is imminent, meaning that the person is terminal and is receiving palliative care before receiving medical assistance in dying. At least, I hope that is the case, because people in palliative care are not always the ones to request medical assistance in dying. I will come back to this.

The second aspect has to do with people for whom death is not imminent, who were denied access to medical assistance in dying as a result of the “reasonably foreseeable natural death” clause in Bill C-14. The court struck down this criterion, which was the key safeguard. This is what Bill C-7 is designed to fix, and we are happy about that.

As we begin debating the underlying principles of Bill C-7, it will come as no surprise that I am discussing them. It is precisely because we, as lawmakers, did not do our job four years ago when we were studying Bill C-14, that we find ourselves debating Bill C-7 today.

This is a democracy, and parliamentarians, not judges, must make the laws. We, the representatives of the people, the lawmakers, must be the voice of Canadians, especially those who are suffering. Judges only interpret the grammar of justice. They examine the laws we make, as well as the rights and freedoms, and determine whether a potential infringement of rights and freedoms is reasonable or not.

In this case, the court has handed down its ruling: The provisions of the current law, the former Bill C-14, are an unreasonable infringement of rights and freedoms. Furthermore, before Bill C-7 was tabled, two courts had ruled that the Criminal Code, amended by Bill C-14, violated the right to life, liberty and security of the sick person suffering intolerably or with a terminal illness.

We have to be clear about the issue at the heart of this debate: before being legal, this is an ethical debate. On one side of this debate is the paternalistic vision of the state and medical practice, while on the other side is a vision based on the autonomy of the individual and its corollary, the principle of self-determination. I know that all my colleagues in the House have good intentions. They want to do good, they want the best for patients and they are caring. I am sure that during this entire debate they will reflect the very values they are advocating and they will be just as caring and compassionate about the interests of patients.

However, we cannot claim to be caring and compassionate, in other words wanting to do good and what is best for an individual who has reached their breaking point at the end-of-life stage, if we are interfering with that individual's autonomy and self-determination, and if we refuse to respect their wishes on something as personal as their own death. The literature is clear on this.

The basic question is this: What business does the state have interfering in a decision as personal as my own death? My life is my own, as is my death. No one else, and certainly not the state, is going to die in my place. The courts had to reframe the limits of the state's power to intervene because we did not do our job properly.

All I want is for us to understand what is at stake here. I am referring to the law, which my Conservative friends often put up on a pedestal. The value of autonomy is conferred by law through the principle of self-determination, especially with regard to medical care. That is what I want to discuss here today with my colleagues. Let's talk about the autonomy bestowed on a person by law through the principle of self-determination.

In the biomedical context, the principle of self-determination is associated with an inviolable rule, namely the rule of free, informed consent. The rule regarding free, informed consent to treatment has never been challenged in emergency situations. Patients always have the right to refuse treatment.

My question for my colleagues is this: Why would it be any different for human beings experiencing intolerable suffering due to an irreversible illness or condition? Why would it be any different for competent individuals who are neither depressed nor suicidal and who have expressed a desire to live fully until they reach the limit of what they can tolerate?

In the Carter decision, which led to Bill C-7, the Supreme Court ruled that the provisions prohibiting medical assistance in dying violated the right to life, liberty and security of the person. People like Ms. Gladu, Mr. Truchon, Ms. Carter and Ms. Taylor have not reached the end-of-life stage. They might not even be in the terminal phase of their illness. That does not mean they have not reached, or are not in the process of reaching, the limit of what they can tolerate.

The court stated that the restrictive provisions in Bill C-14 were effectively shortening the lives of such individuals, that they violated their right to life by inciting them to commit the act before they were ready. That is what needs to be fixed right here, right now. Bill C-14 did a fairly good job covering the end-of-life care for terminally ill patients whose death was reasonably foreseeable, with the exception of the requirement for a second consent, which is sometimes not necessary and means that people suffer even though they gave their informed consent.

There is no issue for people who are terminally ill. The dying process has already begun and is irreversible. Death is imminent and foreseeable. The issue we need to address as legislators has to do with people whose death is not reasonably foreseeable and imminent. Under Bill C-14, Ms. Carter, Ms. Taylor, Ms. Gladu and Mr. Truchon were ignored.

What we, the members of the Bloc Québécois, want is respect for the moral autonomy of the dying. We often hear the expression “dying with dignity”. I must point out that dying with dignity does not mean having a sanitized death. That is not what it means to die with dignity. The dignity of a person is derived from their freedom to choose and respect for their free will. That is what it means to be a human being. That is what it means to respect a human being. When that is violated, we violate the dignity of the human being.

Whether the death is unpleasant or not is not the issue. The crux of the matter is to allow the human being to make a decision about the end of their life. Unfortunately, in the past, we won the right to die rather than undergo aggressive therapies. At the time, this was called passive euthanasia. The person was left to die without much attention and without death being the intent. Palliative care was still in its infancy. There was a great fear of administering one last fatal dose of medication, but it always ends up causing death. Because palliative care is still care, it does not strictly count as passive euthanasia.

Patients won the right to die rather than undergo aggressive therapies, because people did not use to die from cancer; they died from the treatment. Medical paternalism has at times gone too far and has been less than helpful.

Today's patient-practitioner relationship prioritizes collaboration, negotiation and respect for the patient's choice. Patients alone can assess their quality of life, and that must be respected, which is why medical professionals must be transparent with their diagnoses.

Patients won the battle for the right to die rather than undergo aggressive treatment, and that evolved into palliative care as we know it. For a long time, palliative care was thought of as the only solution that would allow people to die with dignity, but if that is the case, why is it still so hard for people to get that care? If that is the solution, why is there still such a shortage of palliative care units?

Sometimes, even the best, most carefully managed palliative care in the world cannot alleviate people's suffering. Bioethics teaches practitioners to remember that patients come first, and that means listening to them.

That is true for Ms. Rodriguez, Ms. Carter, Ms. Taylor and Mr. Truchon, and it is true for Ms. Gladu and many others who have continued to suffer throughout this pandemic while they wait for us to do our job. Contrary to what some people think, these individuals are not suicidal. They want to live as long as possible.

I watched a very interesting interview with Ms. Gladu. What did she say to us? What did she want? She wanted the freedom to choose. Having this freedom greatly diminishes the suffering and anguish.

With Bill C-14, the government said its intention was to protect the most vulnerable. Is there anyone more vulnerable than a person who is suffering from intolerable pain, who is living with an incurable illness and who is being told to go to court for the right to choose and to die with dignity? Is there anything more important and more intimately personal for an individual than their own death?

I have a hard time understanding my Conservative colleagues' argument that the state must decide for an individual, when they are so economically libertarian. Several Conservatives felt that Bill C-14 went too far. The courts said that it did not go far enough and that it violated fundamental rights.

Elected members of the National Assembly of Quebec advanced the debate without pitting palliative care against medical assistance in dying. They chose to include requests for assistance in dying as part of a continuum of end-of-life care that is consistent with palliative care. Whether we are talking about a degenerative disease or an illness that causes extreme pain but is not terminal, let us not pit those two realities against each other. Respect for human dignity includes proper support when one is dying, which requires doctors to have the humility to recognize that they cannot always help people manage their pain adequately.

Our society recognizes people's right to self-determination throughout their lifetime but takes it away from them at the most intimate moment of their lives. In so doing, we think that we know what is best for people or that we are doing the right thing, when we are actually undermining human dignity, their freedom to choose.

There is no more important moment in a person's life than their death. Learning to live is learning to die. Learning to die is learning to live. I say that because the clock starts ticking the moment the doctor cuts the umbilical cord.

The Carter decision and the Baudouin ruling sent us back to the drawing board. We need to do our job as legislators and stop off-loading the problems and the ethical, social and political questions onto the courts. We have a job to do as legislators.

There is a sociology of law. In a society, the law evolves with people's consciences. I know I am straying from the technical details of the bill, but we will have plenty of time to discuss them in committee.

The bill proposes that a person who is not terminally ill must consent twice and be bound by a 90-day period. I really wanted to talk about advance consent, since that is about all that is missing from the bill.

Bill C-7 does not address degenerative cognitive diseases, which are predictable diseases. Doctors can tell patients how they will progress. People with these diseases often remain of sound mind for years and do not appear to be sick, but eventually, they become forgetful and then die. They can also experience complications from being bedridden or immobilized or conditions other than that disease. I think a person with Alzheimer's, for example, should have the opportunity to make an advance request. This bill does not take those people into account.

Still, I said at the outset that we agreed on the principle and the grounds for discussing this bill. We will have time to talk about these issues. I urge my colleagues to bring substantive arguments to the debate on the adoption in principle of medical assistance in dying.

I remember when the previous Parliament studied Bill C-14. I heard arguments about how we were putting ourselves on a slippery slope. Some people were practically saying that long-term care homes would turn into euthanasia factories. If evil people are working in our health system, they should be fired, no matter what job they do, because they have no business there. I am not buying the argument that this is a slippery slope because people are evil.

We must assume from the outset that everyone working in the health care system is caring and compassionate. Increased health transfers would enable these people to provide better care, and maybe there would be more palliative care units in hospitals. Even though people have been saying for 50 years that palliative care is the only solution, I do not believe it is. It makes no sense that people do not have better access to palliative care in this day and age.

I would like to end my speech, which I trust was a substantive one, with a wish for all of us, here in the House, concerning the delicate issue of the end-of-life. I sincerely hope—which is what the patients who turned to the courts were hoping for—to face death serenely, peacefully and without suffering. That is my wish for everyone, because that is the best wish we can make for a human being. We should imagine ourselves being at peace on our death bed and being able to let go because we have palliative care to support us in our journey towards death. That is the best wish we can make for a human being.

I am therefore calling for a debate on both the substance and the principles. I am also appealing to the humanity of all my colleagues so we can finally provide an adequate response to all those who are suffering and have been waiting for far too long.

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

Madam Speaker, I would like to congratulate my colleague, the member for Montcalm, for his very honest, very direct and very analytical speech.

I would simply like to highlight a theme he raised, the protection of individual autonomy and also of vulnerable persons. We are proposing to eliminate the 10-day waiting period because our consultations indicated that, in reality, this waiting period does not safeguard anyone; rather, it prolongs their suffering because vulnerable people want to act without delay, certainly faster than after 10 days. What does the member think of the idea of eliminating this 10-day period, and will this help better protect vulnerable persons?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, as I noted, this aspect of the bill seems perfectly adequate.

Far too often people who were dying, who were at the end-of-life stage, still had to wait another 10 days. Sometimes that second consent meant reducing sedation to be sure that the person understood exactly what was at stake. Sometimes the sedation is reduced so much that the person ends up suffering for no reason because everything that had already been done was clarified several times. Indeed, it was an unnecessary safeguard that made people suffer unnecessarily.

I think there are also contextual issues. If they have any doubts about doing what needs to be done, practitioners are also able to get that certainty in a clear and precise way. I think that is an important addition to Bill C-7.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I listened with great interest and care to the member's speech. It was an important contribution.

I know the member is aware that the original legislation, Bill C-14, required a broader legislative review of medical assistance in dying. That review was supposed to start in June.

Will the member and members of the Bloc be supporting efforts to get this broader review going in parallel with Bill C-7?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, absolutely, as critic on the matter, that is what I wanted in February. There are some issues that remain on hold and that should be discussed at greater length during the legislative review. I hope that review will start as soon as possible.

[Christine Normandin, Bloc, Saint-Jean, QC]

Madam Speaker, I thank my colleague for his speech, which was compassionate and inspiring, not to mention very well put together and documented. I am very proud that he is our colleague.

He spoke about the fact that, without the bill, some people would resort to the courts to finally win their case. Another option for some would be to go abroad to obtain MAID.

In this context, does he believe that the bill provides a better framework for MAID and ensures that everyone has equal access and that finances are not an impediment?

Those with the means to go abroad can do so even if they are far from their family and home, whereas others cannot. In a context of harm reduction, shaping the bill ourselves and offering it to everyone, rather than trying to make it impossible to do something, which is in any event somewhat inevitable—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

The hon. member for Montcalm.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, that is a very good interpretation of the positive effects of the bill.

We must absolutely ensure that people are supported when they are about to die so they may have a better death. In addition to the issue of money, I find that going abroad is not an appealing or adequate solution. It is an interesting point.

However, I believe that we should further expand access to MAID with advance requests. I find that is an important element that is missing from the bill.

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

Madam Speaker, I want to ask the member a question respecting advance consent. In the bill, there is no time limit in which that consent would expire. If contemporaneous consent is no longer required, does the hon. member see the need for a time limit in terms of the validity of such a waiver to guard against someone who, hypothetically, could make a request well in advance and have the procedure carried out while very ill without their knowing?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the bill does not provide for advance requests. There is just a 90-day waiting period for people who are not terminally ill but who are in a situation like Ms. Gladu's or Mr. Truchon's. There is a 90-day waiting period after medical assistance in dying is requested. Bill C-7 does not cover the issue of advance requests.

We are going to amend the bill for people with degenerative diseases. At that point, I think we can talk about what kind of provisions would cover that aspect of dying with dignity.

[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]

Madam Speaker, I appreciate the member's comments about the importance of people to share their real thoughts on such an important issue. In the last go-around we had a great deal of discussion about palliative care, which I hope to address further at an opportune time. One of the benefits of having this debate is that we become a little more sensitized to some of the other things that we could be doing. Palliative care for me is really important.

Does my colleague have any further thoughts on the issue of palliative care? Communities do need to focus more resources in that area.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the funny thing is that people have been saying it is the only solution for 50 years now. Why is it that some hospitals still do not provide palliative care because there is a shortage of units?

Nowadays, in some hospitals, people who request medical assistance in dying cannot experience that end-of-life journey in a palliative care unit, even though palliative care is supposed to be end-of-life care and relief from pain and suffering in an environment that supports human dignity. How is that possible?

We must not think of palliative care and MAID as being mutually exclusive. It is a continuum of care that should be available to these patients. Those who are not terminally ill, for whom the dying process has not already begun and is not irreversible, are also entitled to a suitable environment. Bill C-7 makes that possible, and much more clearly than Bill C-14 did.

That was not possible under Bill C-14, with its unassailable reasonably foreseeable natural death criterion, which the court said undermined patients' right to life.

The House resumed consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, let me start by saying how much I would rather be in the House today than at home managing a small raise hand function on the screen and our own barking dogs. More seriously, let me say how much I would rather have completed this debate in March when it comes to avoiding or preventing unnecessary suffering.

COVID-19 has required us all to make adjustments. Obviously the adjustments we have to make as parliamentarians pale in comparison to the experience of most Canadians, especially those who have lost loved ones to COVID-19; those who have lost their livelihoods; those who are still struggling to make ends meet, to keep a roof over their head and to put food on the table; and those who are struggling with the pandemic while contending with life-threatening illnesses.

Let me also preface my remarks on Bill C-7 with a few words on why we find Bill C-7 before the House at all. There is a tendency by both the Liberals and Conservatives to emphasize that we are here because of a deadline imposed for changes in medical assistance in dying by the Quebec Superior Court decision in the Truchon case. That is true technically.

However, it obscures the role of the plaintiffs in that case, Jean Truchon and Nicole Gladu, who went to court to contest the provisions of Bill C-14, which they found violated their charter rights by causing or prolonging unnecessary suffering for those at the end of life and for denying individuals autonomy of decision-making over the end of their own lives.

I actually want to thank the plaintiffs today who brought us here, and also to stop for a moment to express my condolences to the family of Mr. Truchon, who left Canada a better place as a result of his attempt to improve the way we deal with medical assistance in dying, when he left us in April.

When it comes to medical assistance in dying, for New Democrats, our priority has always been, and remains, avoiding unnecessary suffering being inflicted on those who are already suffering from terminal illnesses and at the same time avoiding prolonging suffering for their families who have to bear witness to that suffering.

We were glad to see this legislation come forward in February, very promptly for a new government, but we are disappointed that we are here in October, starting over again. Some of this delay was due to COVID-19, but the blame for this delay lays equally at the feet of the Liberals for proroguing the House.

In February, there was recognition by all parties that there were two pieces of work outstanding on medical assistance in dying. First was the need to amend Bill C-7 to conform with the charter as demanded by the Quebec Superior Court ruling in the Truchon case, which found the current law too restrictive. This is the very reason New Democrats voted against Bill C-14 when it originally came before the House.

Even before the court ruling, there were many calling for changes. Those who listened carefully to the terminally ill, their families and practitioners providing the medical assistance knew well the unnecessary suffering that was being inflicted, and continues to be inflicted by our current law.

The second task with regard to medical assistance in dying was to conduct a legislative review of the broader issues around MAID after four years of our experience with it. This is not to be confused with a normal review of the specific legislative changes proposed in Bill C-7. This broader legislative review of the issues arising out of medical assistance in dying was mandated in the original legislation and was supposed to start this June.

Bill C-14 required that the review specifically look at the question of advance requests, requests from mature minors and requests where mental illness is the sole underlying condition, but it was not to be limited to those topics.

I am disappointed that the second task appears to have fallen off the agenda for the Minister of Justice. Early this morning I asked him to commit to starting this broader review in parallel with the examination of the changes in Bill C-7. As I told him then, I put Motion M-51 on the Order Paper today to create a special committee of the House that could conduct this broader review at the same time as the justice committee deals with the urgent changes needed and required because of the court decision and because of the unnecessary suffering inflicted by our current law.

I want to talk about each of these two tasks in more human and practical terms by starting with very personal stories, one for each of these. It is clear to me that the current legislation has some unintended and cruel consequences. These were clearly demonstrated by what happened to a very good friend of mine.

On January 1, 2019, I went to a traditional New Year's levee in one of the communities in my riding. When I arrived, I was not surprised to be greeted enthusiastically by someone I had become close friends with over 10 years involvement in public life together. I was surprised, however, to see her right arm was in a sling.

I am not going to name this friend today because I did not seek formal permission from her family to do so, but I am telling her story today as I trust she would want her unfortunate experience with medical assistance in dying to make a difference.

When I asked my friend what was happening, she recounted how, suddenly and inexplicably, she began having trouble using her arm over the holidays and that she was going to have it checked out as soon as possible. A month later, she began to see other symptoms and she found out that she had an inoperable brain tumour the size of a raisin but growing, growing slowly but growing nonetheless. This was a condition that would prove to be painful, debilitating and terminal.

As her condition rapidly deteriorated, she began to make plans for her end of life. Just four short months after a diagnosis, my partner and I received an invitation to what she was calling a masquerade ball in her honour. My friend was incredibly brave and never lost her sense of humour or her love of life right up to the end.

On that Saturday, she checked herself out of the hospital to celebrate her life with us that night. Rather than, as she joked, allowing us to get together after she was gone and talk about her then, she preferred to see us before and to hear what we had to say before she had to leave. Just days later, we found out she was gone. With her death, we were not only deprived of a larger-than-life member of the local arts community. We were also deprived of a friend whose enthusiasm for life had always been infectious.

Why such a sudden exit? The current law requires that those who have already been assessed and approved for medical assistance in dying be competent when the final moment to receive that assistance comes. Therefore, my friend was forced to depart weeks if not months early because she feared the loss of competence that might result from her brain tumour if she waited too long, and that this loss of competence would prevent her receiving medical assistance in dying and thus inflict weeks or months of suffering on her as the patient but also, more important to her, weeks of suffering on her family and friends who would be forced to witness a prolonged dying.

Bill C-7 would fix this by removing the requirement for final consent for those who are already assessed and approved for medical assistance in dying. This would take away the need to go early in order to avoid the loss of competence that now prevents receiving medical assistance in dying.

The bill would also make the process more straightforward in several other ways. It would do so by taking away the mandatory 10-day waiting period, reducing the number of witnesses required from two to one and expanding who could serve as a witness. These are all things practitioners have told us are unduly restrictive and only end up unnecessarily prolonging suffering.

Right now, I should take a moment to thank four doctors who have been kind enough to share with me their experiences in providing, or not providing in some cases, medical assistance in dying to hundreds of patients. Again, I will not name them today to respect their privacy, but my conversations with these four incredible people have helped me understand how medical assistance in dying operates in real life.

I should mention one other change in Bill C-7 that would have more substantial impacts. That is the removal of the requirement that death be imminent before one can receive medical assistance in dying. Bill C-7 then sets out a more restrictive process than that for those whose death is imminent and where there is more time for assessment and decision-making. However, I should emphasize, Bill C-7 still maintains the high standards set in the original legislation that in order to receive medical assistance in dying patients must have a condition that is incurable, must be in a state of irreversible decline and must face intolerable suffering. This means that Bill C-7 would not open the door for medical assistance in dying quite as wide as some have suggested.

My second story, also very personal, deals with one of the broader issues that the review of MAID was supposed to deal with. This story is my mother's story. My mum passed away just short of five years ago, during the debate on MAID. This is a story I have told before during the debate on the original bill, but one which still lacks resolution.

My mother had always been very clear with my sister and me about her wishes regarding the end of her life. For her, it was simple. She asked us that if she ended up bedridden, unable to shower or feed herself, and did not know who we were, then to please let her go. She suffered from dementia and other underlying conditions that were complicated by a serious fall and, fortunately for her, she was not forced to endure for long those conditions she had feared.

Unfortunately, the kind of advance directive or advance request that my mother had wanted to give is still not allowed under the existing legislation. I know many in my community, and more specifically, many in my own social circles, fear just such an outcome and feel that they should be able to make their own end-of-life wishes known and have them respected, just as they are now when it comes to questions of refusal of medical treatment. I tend to be of the same opinion. However, my discussions with practitioners providing medical assistance in dying have persuaded me that this question is not as simple as it appears on its face. This remains one of the important issues the legislative review of the current legislation can address and is mandated to address by Bill C-14.

As I mentioned earlier, there were other issues that were assigned to this broader review in the original Bill C-14, including requests from mature minors and requests for mental illness as the sole underlying condition, but one concern was missed. Let me take a moment now to address the concerns of disability advocates that, with the removal of the requirement that death be imminent, there will be pressure on the vulnerable in our society to choose medical assistance in dying.

First and foremost, as a society we can and must do better in offering support to people with disabilities. Failure to provide necessary resources to ensure that everyone can enjoy full and equal participation in life is a current and ongoing black mark on all of us. We have only to look at the failure to deliver additional assistance promptly to persons with disabilities during this pandemic to remind ourselves how often we forget about those living with disabilities. However, we should not dismiss the concerns of the disability community about medical assistance in dying out of hand. The legislative review is the place for us to consider seriously the question of whether the existing safeguards preventing pressure on the vulnerable to choose medical assistance in dying are, in fact, sufficient.

Before I conclude, I want to remind members that, as a society, we must do better in the job of end-of-life care. Again, COVID has demonstrated the tragic deficiencies in long-term care in ways I hope we will not ignore.

New Democrats will support the bill and help expedite its passage in order to bring an end to unnecessary suffering and to meet the deadline imposed by the Quebec court in the Truchon decision, but this support has always been predicated on going forward with a larger review without delay.

I have drafted a motion, Motion No. 151, which I have tabled today. I look forward to hearing a positive response from the government on this. We have just heard a positive response from the Bloc, and I am hoping for a positive response from the Conservatives.

Proceeding with Bill C-7 without proceeding with the broader review is only getting half the job done on medical assistance in dying. At the same time, failure to conduct the broader review potentially undermines public support for medical assistance in dying, which, so far, has only continued to grow. In fact, I believe this is one of the most important questions that could ever come before Parliament.

I look forward to the debate on the specific improvements that we can make to Bill C-7, but I urge all of us to consider undertaking the broader review of issues around medical assistance in dying without delay.

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

Madam Speaker, I thank the member for Esquimalt—Saanich—Sooke for his comments today, his work on the justice committee, his support for this legislation and also for underscoring the important role that the litigants have played in the evolution of this.

I would highlight the theme that the member raised when he talked about the sanctity of life. It is quite clear for those who have read the jurisprudence, and I know that he has, that in both the Carter and Truchon decisions the courts talked about the notion that the charter protection of the right to life under section 7 means that when people are prematurely considering availing themselves of medical assistance in dying because they worry about being able to give that final consent and having the capacity to give that final consent, when they take their lives prematurely, it actually violates their charter rights. This was outlined in both the Carter and Truchon cases.

I wonder if the member opposite could comment on that aspect of the decision, because it is very important in terms of the protection of the vulnerable, which is one of the things the legislation is attempting to address.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I believe Bill C-7 raises an important question around consent at the final moment. As I said from the very personal story of my friend, I got a picture of how this works in real life.

We can talk about the court decisions, but today I was hoping to introduce the reality of the family and friends of those who are facing unbearable suffering at the end of life and who are really looking to us to make the improvements they are calling for, to make sure we do not unnecessarily prolong suffering and that we do not unnecessarily inflict it on the families of those patients.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Madam Speaker, since the bill has come in a second time in two sessions of Parliament, I would like to ask how important is it for the government to listen a bit more this time and to take all the amendments from different parties into consideration to make sure that the bill would be the bill we are all looking for and Canadians are looking for.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, there are two tasks here. The first is to look at the amendments to medical assistance in dying legislation in Bill C-7 to make sure that they both conform to the requirements of the court decisions and the charter, but also to make sure they reflect the lived experience of people dealing with medical assistance in dying.

The second part is the broader review. I hope we get support from the Conservatives to start this parallel review that can look at the larger questions around medical assistance in dying and make recommendations to Parliament, if necessary, for further legislation.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, Bill C-7 proposes removing the requirement for final consent for eligible individuals whose natural death is reasonably foreseeable.

This requirement could result in a person not receiving enough sedatives to relieve their pain because they need to be fully competent at the time of the second consent.

I would like to know my colleague's thoughts on whether we should also consider the possibility of granting the right to waive final consent in cases where natural death is not foreseeable.

Should we be considering the issue of advance consent, for example, to ensure that people suffering from degenerative or incurable diseases do not have to go before the courts to challenge the terms and conditions surrounding eligibility for medical assistance in dying?

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, the goal here is to avoid unnecessary suffering, so I am very supportive of providing for the waiver for final consent and eliminating the 10-day waiting period.

When it comes to advance directives, I tend to be in favour of people being able to make their instructions for end of life and have them respected. As I said, my talk with practitioners has convinced me that we need a broader debate about the issues around advance directives, and that is why I hope to see this parallel broader review start along with the consideration of Bill C-7.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Madam Speaker, I appreciate the honouring of the stories. I have had a dear loved one choose to use MAID for the next step in his journey. It was a very painful and beautiful day for the loved ones who were with him. One of the things I remember distinctly is that his doctor of over 30 years was a very strong Christian. He felt he could not take that step, but still showed up and held hands with him in his final moments. I remember feeling such respect and love in that room.

When we talk about the subject, the most important thing is the unnecessary suffering. We need to end that, not only for the person experiencing it but for the pressure of watching their loved ones go through that unnecessary suffering.

Could the member speak more about how important this broader review is? When we look at advance directives and vulnerable populations, all of us in the House, regardless of our point of view, want there to be a thoughtful discussion that provides this place with very thoughtful responses and actions we can take in the future.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I thank the member for North Island—Powell River for also sharing her personal experience with medical assistance in dying.

My background is as an academic and as a member of Parliament. I think we have the same tendency to get into the legal details and forget about the lived experiences that lie behind these kinds of cases and issues. By having a broader review of the issue around medical assistance in dying, we can help build a consensus about appropriate measures when it comes to advance directives and making sure that vulnerable populations are not under undue pressure. This review was mandated by the original legislation and was seen as an important part of the way we consider the experience we have actually had with medical assistance in dying. I am disappointed the government seems to have let this fall off its agenda and is leaving it to the rest of us in Parliament to push forward with this review.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, my question for the member has to do with the disabled. He made a comment about the disabled and in the legislation it looks like there is a different treatment of disabled people to other people. I am concerned about that. I wonder if the member is also concerned.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, the hon. member's question reflects something that I think is very important, which is that when concerns by a community are raised they be fully explored and fully considered, not just dismissed out of hand, regardless of what our own personal opinions are on those concerns. The place I believe we should do that is in the broader review conducted by the House that I suggested in the motion I tabled today. I want us to hear from the disabled community and its advocates and to think carefully about the issues they are raising. I want to make sure the safeguards we have in place to prevent vulnerable people from being pressured into selecting medical assistance in dying are actually adequate.

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

Madam Speaker, I will be splitting my time with the member for Glengarry—Prescott—Russell.

I am pleased today to speak on Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying.

As members know, clearly we are here because of the decision of the Quebec Superior Court in the Truchon case. That decision struck down a particular criterion under both the Quebec and Canadian regimes with respect to the end-of-life nature of medical assistance in dying, which is the reasonable foreseeability of natural death criterion, in particular, at the national level.

I will agree with some of the members we have heard from today that this is perhaps the most important issue we have faced in the last five years of this Parliament, both in the last Parliament and today. Fine-tuning the approach to medical assistance in dying is something that is intensely personal, but also intensely important to all of us in the chamber and to all Canadians.

What we should know at the outset is that the court's ruling in Truchon applies only in Quebec. We heard the minister speak about this. The court suspended its declaration of invalidity for a period of six months, until March 11.

It is important for this chamber to recall that on February 17 of this year, the Attorney General of Canada filed a motion to request an extension to give Parliament sufficient time to enact an appropriate response to ensure consistency in the criminal law. Given the circumstances of COVID and the pandemic, an extension was further sought and granted in June until December 18 of this year. Therefore, December 18 is the new deadline.

Before I go into some of the details in the bill, I want to start out with two important provisions that relate to conscience protection. This was raised in today's debate and was also raised in the context of an earlier debate on this bill in a previous parliamentary session. I think it is critical the record be crystal clear that conscience protections are robust in this country and are entrenched in law.

I am responding here to questions that were raised by the member for Sherwood Park—Fort Saskatchewan. The first location for conscience protections is in the preamble to the old bill, Bill C-14, which states, “Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms”.

I have had further questions from members of the official opposition about why it is only in the preamble and not in the statute. That assertion is categorically incorrect, because conscience protections are in the statute itself. Section 9, page 8, of Bill C-14, which amended the Criminal Code, states, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

Lastly, the third point I will refer to is from the Carter decision of the Supreme Court, which has been the subject of extensive discussion in this chamber thus far. I am reading from paragraph 132 of the majority reasons in Carter. The court states, “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

Those are the three instances where the freedoms set out in section 2 of the charter are taken into account. One is jurisprudential and the other two are statutory. The fourth one is of course section 2 of the charter, which protects freedom of conscience for all Canadians, including those who practice medicine. Therefore, the assertion that somehow conscience rights are not protected or are somehow being eroded is categorically false.

Another point on what is being addressed in today's debate is the notion that a culture of overly facilitating medical assistance in dying is upon us. Here I am referencing some of the interventions made again by the official opposition, particularly the member for Sarnia—Lambton, that somehow this government bill is pushing us further toward predatory practices by health care practitioners or toward disavowing the right to life, liberty and the security of persons who are vulnerable, including persons with disabilities. That is categorically false and is not commensurate with what is in the evidence.

The evidence that we have is that, in total, nearly 14,000 medical assistance in dying deaths have happened in the country in the last four years. The average age of the people accessing MAID is 75 years old. It is being accessed equally by men and women, 51% of the time by men and 49% of the time by women. The most common medical condition is cancer, followed by neurological conditions. In that 67% of all people who access it have cancer; second, come neurological conditions; and third, come cardiovascular conditions.

Very important, in the most recent year of analysis, a grand total of 5,444 people accessed MAID in this country. That represents 1.89% of all deaths in the country. I am saying that specifically for the purposes of the debate, because it is important for Canadians to understand that there is not some sort of culture of medical assistance in dying that is being foisted upon unwitting individuals. I will elaborate upon this going forward.

I would like to address a few aspects of this bill. The eligibility criteria have changed, as the Minister of Justice mentioned this morning.

There are two sets of safeguards. One applies when the individual's death is reasonably foreseeable, while the other applies when it is not. The bill adds new safeguards for this second category.

The bill proposes allowing final consent to be waived on the day of the procedure in exceptional circumstances.

Earlier in the year, the minister, along with the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, as well as myself and other parliamentary secretaries, conducted a very vast consultation process. We heard from 125 individuals, who are experts in this field, whether they are delivering it or acting on behalf of disabled individuals, from nurses, doctors, etc. We also heard from 300,000 Canadians through their responses to a questionnaire that outlined various scenarios.

The views of those individuals were quite concrete in the direction they were seeking. They wanted to be empowered in terms of their autonomy, dignity and their choices. They were seeking fewer obstacles to what had evolved to become an overly restrictive regime, as identified by the court in Truchon. That important feature must be canvassed here. What is important to understand is that the input received was critical to the development of the bill.

As part of the proposed amendments to the Criminal Code, the reasonably foreseeable death provision will be removed from the eligibility criteria. This is in response to the Truchon decision.

In terms of legal impact, this amendment would mean that people whose death is not reasonably foreseeable would be eligible for medical assistance in dying if they meet all of the other eligibility criteria.

This point is very important. The bill proposes to exclude persons whose sole underlying condition is mental illness. This has been touched upon by different people who have already intervened in the context of today's debate and in previous debates in the previous session of Parliament. This is important, as was outlined by the minister this morning. It recognizes the increased complexities and risks associated with such cases, which were highlighted by many practitioners, stakeholders and experts at the main round tables.

What is also very important is that the Canadian Mental Health Association supports the position we are taking with respect to excluding mental illness as a sole underlying condition. This complex issue must be examined carefully as part of the parliamentary review of the legislation on medical assistance in dying.

Importantly, the Government of Québec has also announced the exact same study for the exact same provision in the context of mental illness. Issues of consent and capacity and properly being able to diagnose this and having a prognosis are critical.

I will move to some of the comments that have been made. It is important for people to understand the safeguards are under two tracks. Those safeguards respond to persons whose deaths are reasonably foreseeable and those whose death is not.

With respect to some of the aspects raised in the context of today's debate, please understand we have taken the 10-day period of reflection out of the legislation. The basis for this was that the safeguard was not doing the work it was meant to do. As opposed to protecting those who were vulnerable, it was increasing vulnerability insofar as it was prolonging suffering.

We have heard some people were so concerned about their inability to provide their final consent after 10 days that they would stop taking their pain medication, which was simply creating further suffering just to maintain the ability to provide final consent.

With respect to how we can ensure informed consent is applied when it has not been solicited actively, there are two responses. This is with regard to the advanced consent regime.

The government is conscious of the Audrey Parker situation and we are seized with it. When people have been assessed and approved for this procedure and when they make a determination they want to access it and provide consent in writing, that consent would be sufficient.

In direct response to whether it could be vitiated, yes it could. First, if the person has not lost capacity, consent could be vitiated. Second, it could be done by a physical gesture that could be interpreted to fully and finally eliminate that consent for the purposes of the practitioners. That is in response to a question posed by the member for St. Albert—Edmonton.

This bill strikes a balance and the balance is important, a compassionate response that protects vulnerable people, respects their dignity and autonomy and what is required by the Constitution. I am very hopeful we can achieve all-party consensus on this fundamental issue.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I would like to talk a bit more about the conscience protections. The hon. member mentioned it was in the preamble, in section 9 and in the charter. Why then does the government not immediately address the situation existing in Ontario, where physicians and nurses are being forced to participate in MAID even if it is against their religious beliefs?

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

Madam Speaker, I will clarify that it is in a fourth place as well. It is in the penultimate paragraph of the Carter decision.

The reason the government is not intervening in respect to a jurisprudential decision in Ontario is because that jurisprudential decision complies with the charter. The regime in Ontario is that a person is not compelled to provide this service, as the court has indicated, but providing a referral is required, pursuant to the rules enacted by the College of Physicians and Surgeons of Ontario. That was deemed constitutionally compliant. That is sufficient for the purposes of protecting the Charter of Rights at issue.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Speaker, I want to thank my colleague for his speech. I appreciated his knowledge on the topic and his compassion in all this. It is very important.

The Bloc Québécois supports the bill in principle, as my colleague said earlier. I appreciate the fact that we can work together in a non-partisan way.

However, we believe that the bill may not go far enough in certain respects.

Does my colleague believe that the issue of advance consent should have been covered in this bill?

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

Madam Speaker, I thank my colleague for this question and thank the Bloc Québécois for its support.

The notion of advance consent was put into this bill because it was necessary to accommodate Audrey Parker's request, which was covered extensively by Canadian media.

We must maintain an individual's autonomy and respect their choice, but also avoid prolonging their suffering or making a decision that would lead to premature death.

In English terms, it is the notion of not having someone accelerate and go to their death prematurely, simply because they had to wait for the ability to provide that final consent. That is the reason why we decided to insert it as consenting to the regime.

[Gord Johns, NDP, Courtenay—Alberni, BC]

Madam Speaker, first, we are pleased to see the reintroduction of Bill C-7 as part of the effort to end unnecessary suffering for those who are facing the end of life. I had a note from Jule Briese. She cited that her husband, Wayne, who is challenged with Alzheimer's, currently meets the criteria for medical assistance in dying as long as his window of capacity for informed consent does not narrow, preventing this. He has ongoing appointments at three-month intervals with his geriatric psychiatrist to assess his capacity for consent. She cites that this is extremely stressful, and could result in having to make this choice sooner rather than later. Legalizing advance requests for those with dementia to make the choice for MAID compassionately supports the individual's right to end-of-life choice guaranteed by the Canadian Charter of Rights and Freedoms.

Could the parliamentary secretary speak to Julie and Wayne, and talk about how this legislation is going to help them? We certainly do not want him to have to choose to end his life prematurely, and this is a directive he would like to have fixed in the bill.

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

Madam Speaker, I thank the member for this point and the case he is raising about Julie and her spouse. It underscores the very sensitive and delicate nature of what we are facing. What I can say in all candour is that we had a regime that had been deemed overly restrictive by courts. We have expanded the regime to allow for greater accessibility to medical assistance in dying. The notion of an advance consent is applicable here, but not yet an advance directive. That is something that was studied by the academic council when it looked at three separate areas. It would form part of the parliamentary review, and it is something that merits scrutiny. The safeguards that need to be put in place are that much more rigorous. That is why it is not inserted into this bill, but is something that obviously merits a lot of scrutiny and consideration going forward.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, before I begin, I want to wish you a happy Thanksgiving.

I appreciate this opportunity to discuss the Government of Canada's consultation process to inform amendments to the federal legislation on medical assistance in dying. My colleagues who hosted the round tables, the Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, had the privilege of hearing the perspectives of experts and other key stakeholders.

In September of last year, the Superior Court of Quebec handed down its decision in the Truchon and Gladu case.

The court found that the eligibility criteria of the federal and Quebec provincial legislation on medical assistance in dying that required a person to be at the point of reasonable foreseeable natural death, or at the end of life, were unconstitutional.

The federal government did not appeal the Truchon decision. Despite the short time frame, our government felt it was critical that any amendments to the law should be informed by evidence and feedback provided by Canadians, provincial and territorial governments, and key stakeholders.

That is why, during January and early February, our government launched an online public consultation and hosted round tables with stakeholders from across the country. During this process, participants shared their views on key aspects of the law governing MAID, including eligibility requirements, safeguards and advance requests. An online survey led by the Department of Justice ran for two weeks in January. The survey closed with over 300,000 responses: the largest number of responses the department has ever seen for any public consultation.

Our government also hosted a series of 10 roundtable meetings in eight cities across the country. More than one hundred participants representing nearly every province attended these national and regional meetings, including academic experts, health care providers, medical and nursing regulators and other stakeholders. While the meetings included some representation from indigenous communities, a specific roundtable was also held with indigenous stakeholders.

Our government’s ultimate objective is to have a law that facilitates access for those who are eligible for MAID, and provides protections for vulnerable people.

Feedback from both the online survey and round table discussions indicated wide support for removing the eligibility requirement that an individual's natural death be reasonably foreseeable. There is general comfort among Canadians and stakeholders with the idea that MAID should be available to eligible individuals who are suffering intolerably, but not necessarily at the end of their life.

Many organizations representing persons with disabilities expressed concerns about the removal of the requirement for reasonably foreseeable natural death, pointing to the potential for societal harm if disability were to be seen as a reason to terminate life.

Concerns were raised about extending MAID to include specific medical conditions where individuals may be more vulnerable, in particular, to those with mental illness. Most felt it was too early to allow MAID for persons with mental illness as their sole underlying medical condition and advocated taking additional time to study this issue.

The concerns about access to medically assisted death for individuals whose sole underlying medical condition was a mental illness were consistent with the findings of the Council of Canadian Academies report on this topic. As mandated by the 2016 legislation, our government commissioned three independent reviews on topics that were not included in the law at the time: requests by mature minors, advance requests and requests where a mental illness is the sole underlying condition. Of the council's three reports, the one addressing mental illness was the source of the greatest divergence among the experts. Ultimately, they could not reach consensus on ways to address the complexities and mitigate the risk associated with mental illness and MAID.

Many round table participants expressed support for creating a two-track system of safeguards, depending on whether a person's death is reasonably foreseeable. Many respondents to the online survey were open to the idea of some stronger safeguards for people who are suffering but not dying.

The proposed legislative changes include new or modified safeguards for individuals when their death is not reasonably foreseeable. It is proposed that one of the physicians or nurse practitioners assessing an individual's eligibility for MAID would need to have expertise in the individual's medical condition. In addition, individuals would be subject to a 90-day assessment period to ensure enough time is devoted to exploring relevant aspects of the person’s situation and to discussing possible options to alleviate their suffering.

During the round tables, participants expressed overwhelming support for removing the current requirement for two persons to witness an individual's MAID request. They cited the difficulties in finding independent witnesses based on the current definition in the law, which excludes health care providers and personal support workers.

Many individuals living in nursing homes or other residential settings have limited family or social networks. The amended legislation would reduce the required number of witnesses to one, and would not permit individuals who are paid to provide personal care or health care to take on this role. Anyone in a position to benefit financially, or in any material way, from the person's death would not be allowed to act as a witness.

The witness's role is strictly to confirm that the person seeking MAID has actually signed the request themselves. Safeguards, such as ensuring that the person signed the request voluntarily, are the responsibility of the practitioner who provides MAID, not the witness. We also clearly heard that there is no obvious benefit to the 10-day reflection period. We are proposing to remove this requirement from the legislation.

The third area of consultation was on the issue of advance requests. This is also one of the topics studied by the Council of Canadian Academies as part of their independent reviews.

Although many people speak of advance requests in general terms, the issue can be very different depending on an individual's situation relative to a diagnosis and when they are eligible for MAID.

The CCA report pointed out that not all advance requests are created equal and outlined several scenarios. It noted the most straightforward scenario is where an individual is nearing death, and has been found eligible for MAID, but fears losing capacity to consent prior to the procedure.

This was the case, for example, in the widely publicized case of Audrey Parker: the Nova Scotia woman battling late-stage breast cancer. She feared that she would lose the ability to provide consent later on, before the date she ideally wished to have the medically assisted death she was authorized to receive.

A more complicated scenario arises when an individual has been diagnosed with a disease such as Alzheimer's, but has not yet come to the point where their circumstances make them eligible for MAID. However, the person may wish to outline the conditions under which they would like MAID to be provided in the future, when they no longer have capacity to provide final consent.

Nearly 80% of respondents to the online survey agreed that the revised law should allow for advance requests in both scenarios. However, there were concerns about allowing advance requests post-diagnosis. There was near unanimous support to refer this more complex scenario to consideration during the parliamentary review process.

The amendments we are proposing reflect the overwhelming support for the first scenario by permitting individuals who have been assessed as eligible for MAID, and whose death is reasonably foreseeable, to provide consent in advance if they lose capacity before their preferred date.

Our government is committed to maintaining an ongoing dialogue with indigenous groups on the topic of MAID, to ensure their families and their many diverse voices continue to be heard.

Lastly, it is important to note that, across the board, participants in the round table consultations all agreed on the importance of having appropriate health and social supports in place, including palliative care, assistance for persons with disabilities and mental health services, to protect against individuals choosing assisted dying due to the lack of adequate supports to live a dignified life.

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

Madam Speaker, my question for my friend from Glengarry—Prescott—Russell is with respect to advance consent. The legislation provides for advance consent in certain circumstances in which a patient might lose their capacity.

When we studied the issue of advance consent under Bill C-14, the Canadian Medical Association noted that it was an extremely complex area. The expert panel's final report from the Council of Canadian Academies noted that there are significant knowledge gaps and a lack of consensus with respect to administering euthanasia, or medical assistance in dying, when a patient has lost capacity.

Why would the government include that in this bill, rather than allow a more thorough legislative review to take place, which it has pre-empted?

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, I certainly was not a member of the justice committee, but I do believe the rationale for including the advance consent in this particular case was because of the Audrey Parker case in Nova Scotia.

I can also say that the Canadian Medical Association, I believe, is supporting this particular legislation in accordance with what we are presenting today.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, as I know from his frequent interventions at the agriculture committee, the member for Glengarry—Prescott—Russell proudly represents a rural riding. My question is centred on that very fact.

As the member knows, the new second track for accessing medical assistance in dying requires that one of the two medical practitioners assessing the person has expertise in the condition from which the person is suffering.

How is this going to play out for Canadians who live in rural or remote areas, and who may not have access to that kind of expertise? How can we ensure that the provisions of this bill make sure that Canadians, regardless of where they live, have access to that kind of expertise?

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, the previous bill required two witnesses and this bill only requires one witness. This was actually raised with the Minister of Justice. I believe this will correct the issues that arose from the previous bill, Bill C-14. The current bill strikes the right balance to make sure there is access to a doctor or nurse who has knowledge of the particular patients in question.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, I would like my colleague to comment on the possibility of granting the right to waive final consent when natural death is not foreseeable.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, quite frankly, I have no opinion on the matter and will therefore rely on the experts.

I know the Bloc Québécois and the NDP support the bill. The Standing Committee on Justice and Human Rights will have an opportunity to examine this more thoroughly in the coming weeks.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, my question for the hon. member has to do with the cool-off period, the 10-day provision that was previously there. It was to address, as I recall, when people are seriously ill and suffering. They can be depressed. One day they feel great and the next day they do not. That is why the 10-day period was put in. I am not sure what the rationale was for taking this out. Perhaps the member could comment on that.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, I believe it was taken out because, in terms of practicality, it served no purpose. The Minister of Justice and many of our colleagues heard from families, now that we have been living with Bill C-14 for over three years, about the 10-day period. Patients who have already made the decision that they need medical assistance consulted with their doctors, nurses and families about that extra 10-day period. Why is not 15 days? Why is it not five days instead of 10? They said it served no purpose.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I will be splitting my time with the member for Sarnia—Lambton.

It is my pleasure as shadow minister for justice for the official opposition to use this opportunity to speak to the proposed legislation before us. It is important legislation. We have been hearing points from both sides of the House on Bill C-7, which impacts many Canadians. In fact, it impacts us all. This is a piece of legislation that deals with life and death, and there is probably nothing more important that we could be talking about today.

Any time we, as legislators, are asked to review and analyze legislation like this, it is critical that we take the time to get it right, and this is part of the problem. As we have heard many times over the course of the last year, we should not be dealing with this legislation today because the Minister of Justice and this government should have appealed that decision.

This is what was being called for by those in the medical community, those in the disability community and individuals across the country after that decision came out in Quebec. The right thing to do, which is what our party, the Conservative Party, called on the government to do, would have been to appeal that decision.

What we have been left with is a patchwork across our country. We have been left with confusion. We should have had the certainty of an appeal to the Supreme Court of Canada on something this important. Instead, the government took the Superior Court of Quebec decision, responded to it and, in my view, went far beyond what was required to respond to that decision. I will discuss some of those things.

The bill was introduced as a response to a Superior Court of Quebec decision made on September 11, 2019. That decision found that the law was too restrictive in the requirement for death to be reasonably foreseeable in order to access medical assistance in dying. At the time, we called upon the government to appeal this decision to the Supreme Court.

As we debate the bill before us, we still do not have the clarity that we could have had if the government had appealed that decision. Rather than defend its own legislation, this government has used this as an opportunity to broaden assistance in dying legislation in this country without doing the fundamental consultation and homework necessary to get an important decision like this right. Even in the previous legislation, Bill C-14, there was to be a mandatory review of assistance in dying legislation and what flowed from it, which was to take place this past summer. This government circumvented all of that with this new legislation.

When the government passed Bill C-14 in the 42nd Parliament, it required this review to be conducted this year. The review was to analyze the state of assistance in dying in Canada in a comprehensive way, and instead of waiting for that, we see with this legislation the government going far beyond what had to be done to respond to the Quebec court decision.

This topic is a very sensitive issue for many in the House who have personal experience with it and, indeed, it is a sensitive issue for many Canadians. We ask that all members on each side of the House be aware of this. While there may be disagreements, we are each here to represent our constituents and arrive at legislation that best protects Canadians.

I have heard directly from many Canadians who are concerned about the lack of protection for conscience rights for health care professionals in both the bill before us and the original MAID legislation. As the government looks to broaden the legislation further, it becomes even more important that the conscience rights of health care professionals are protected. By further expanding medical assistance in dying, the government risks reducing the number of medical professionals willing to take part in this process. It is also important to note that this expanded access could result in a heavy emotional burden on those health care providers, as we head into uncharted territory with the bill.

We, as members of Parliament, cannot appreciate the burden that this has put on health care providers who are working in this system and providing medical assistance in dying.

Further, there are very few protections in place for medical professionals who do not want to participate in the process and may be penalized, as a result, by an employer. This is a point that I raised when Bill C-7 was introduced earlier this year, and it is disappointing to see that it was not corrected in this version of the bill.

This brings me to my next point about standing up for Canadians with disabilities. The 10-day waiting period, which could already be waived in the legislation for extenuating circumstances, has been removed. I heard the chief justice say today that removing the 10-day waiting period was universally accepted in his consultations across the country. I wonder who he has been talking to.

Yesterday I spoke with a group that represents those with disabilities across the country at Inclusion Canada. Those in that group said that they are in favour of maintaining the 10-day waiting period, and their role is to stand up for individuals with disabilities. It is interesting to note that they called on the minister of justice at the time to appeal the decision of the Quebec court. They said that medical assistance in dying must have limits. Individual rights must be balanced with protections, not only for our most vulnerable citizens, but also for society as well.

One of the most important foundations of our Canadian society and identity is that we are a caring, compassionate country. For those with disabilities, their experience now is that they are told, often bluntly, that they would be better off dead. The Foley case in London, Ontario, is one example of this. This decision, if it remains unquestioned, will simply erode provincial health responsibilities for expert clinical care and social support for people who are fragile.

The Minister of Justice would also be familiar with a letter written to him on October 4, 2019, which was signed by over 70 organizations that stand up for Canadians with disabilities from coast to coast to coast. They wrote that they found the decision by the Superior Court of Quebec to be very concerning. One of the reasons for this concern was that the decision failed to respect Parliament's authority to balance the interests of the individuals with the interests of society, effectively limiting Parliament's capacity to pursue social targets, such as substantive equality and inclusion.

They describe the decision as a dangerous precedent, writing, “The Supreme Court must weigh in on this flawed analysis. The decision will entrench stereotypes and exacerbate stigma further for Canadians with disabilities.” The letter continues, and I agree, “[We] must avoid sending a message that having a disability is a fate worse than death.... Canada must appeal the decision to prevent additional stereotyping”. The letter concluded by urging the government to appeal the decision to the Supreme Court.

Again, the letter was signed by over 70 organizations, including the Council for Canadians with Disabilities, the Canadian Association for Community Living, Disability Law Centre, People First of Canada and the Canadian Mental Health Association. I mention this because it underscores how we need to get this legislation right.

Last November, the Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Care Physicians issued a call to action due to ongoing confusion in the general public regarding hospice, palliative care and MAID. Quite frankly, palliative care focuses on improving the quality of life and symptoms through a person-centred approach for those living with life-threatening conditions.

The federal government should be looking for ways to improve further palliative care across Canada, as was committed to many times by the government. In their call to action, the groups I mentioned state, “Less than 30% of Canadians have access to high quality hospice palliative care, yet more than 90% of all deaths in Canada would benefit from it.”

I want to stress my previous point that this is an important issue for many Canadians. On matters of literal life or death, we need to take our responsibilities as legislators—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

Questions and comments, the hon. Parliamentary Secretary to the Minister of Justice and Attorney General of Canada.

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

Madam Speaker, I thank the hon. member opposite, the official opposition critic, for his work at the committee and his work today in the chamber.

As an observation, it seems some parties opposite feel we are either taking this too far, as expressed by the official opposition, or not taking it far enough, for example, by entertaining advance directives. Clearly the proposal before the House is one that is a middle approach, a prudent approach and one that is constitutionally compliant.

The points raised about the disability community are well taken. Those are important points, and the minister addressed these points about the importance of equality and supports for those with disabilities. That is exactly what the consultations revealed.

The member opposite used the phrase “without doing consultations”. The evidence shows, and this is available on the Department of Justice website, that we heard from 300,000 Canadians, had 125 experts and ten meetings around the country. Is that kind of consultative exercise exactly the type the member has asked us to undertake?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I thank hon. parliamentary secretary for his work on the justice committee and on this file.

It is one thing to consult, but it is another thing to listen and hear what people are saying. We are hearing, loud and clear, from those in the disabilities community that this legislation, and these are their words, not mine, leads us to a society that says their disabilities are a fate worse than death. They want to see more protections in the legislation.

The hon. parliamentary secretary or the minister could pick up the phone and speak with Inclusion Canada or any one of the 70 signatories to that letter to hear about what they would like to see included in legislation safeguards to protect the most vulnerable in our society.

[Christine Normandin, Bloc, Saint-Jean, QC]

Mr. Speaker, I thank my colleague for his speech. I heard him mention that the government should have appealed the ruling and that, practically speaking, parliamentarians are somewhat muzzled by the courts.

He makes it sound like medical assistance in dying is going to be imposed on people with disabilities, whereas, in my view, this is more about a patient-centred approach. This is about giving patients options, not imposing anything.

I would like to hear my colleague's thoughts on what I just said. Did I misunderstand him? Does he not think it is more coercive to deny patients this right? Does he really think anyone wants to impose medical assistance in dying on people who could ultimately have a choice?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, normally with a case like this, which comes from one province's courts, a case of national importance, the responsible thing to do for certainty, because we are a federation, would be to appeal the decision to a higher court and, indeed, on a decision this important that impacts our criminal law would be to appeal the decision to the Supreme Court of Canada.

We are listening to organizations that represent those with disabilities. They say that the failure to appeal the decision, the failure to pre-empt the study that was to take place this summer on assistance in dying legislation and the desire of the government to push something out right after there was one decision on it, pushing new legislation that goes beyond what the decision called for, is an affront to those persons with disabilities.

We are listening to them, and those are their words on this bill.

[Marc Dalton, Conservative, Pitt Meadows—Maple Ridge, BC]

Madam Speaker, this being Mental Health Week, could the member comment on the challenges people are facing in our nation right now? This year one in five are suffering from mental health issues.

What are the implications of this new legislation for people with mental health issues?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I thank the hon. member for the reminder to all of us that it is Mental Health Week.

We are hearing from those who suffer from mental health issues, from those in the disability community and from a broad range of people. This legislation literally deals with life or death. As the member rightly pointed out, as we have seen over the last several months with the COVID-19 crisis, mental health issues have been brought to the forefront. We need to ensure that even—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

Resuming debate, the hon. member for Sarnia—Lambton.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I am happy to have the opportunity to rise today to speak to Bill C-7. It is a very serious matter. As the member for Fundy Royal just mentioned, it is a matter of life and death. I was part of the debate on the original bill, Bill C-14, and I am familiar with a number of the issues with that bill.

It is very disturbing to me. I understand with the Quebec court decision the government had to make a response of some sort, but the previous bill required them to do a fulsome parliamentary review, which was supposed to take effect this past summer. The government refused to let Parliament sit this summer and do the kind of fulsome work that needed to be done.

It is actually quite irresponsible that when the government introduced Bill C-7, instead of just addressing what was time sensitive in responding to the Quebec decision, it went further and took actions without doing that fulsome review of how things have been going with Bill C-14 in the last number of years.

For those watching at home who are not familiar with Bill C-7, the bill would repeal the provision that requires a person's death to be reasonably foreseeable. In addition to that, it would specify that people whose sole underlying condition is mental illness are not eligible for medical assistance in dying. It would create two sets of safeguards that have to be respected before medical assistance in dying can be provided to a person, and it would permit medical assistance in dying to be provided to a person who has been found eligible to receive it and whose death is reasonably foreseeable but who has lost the capacity to consent before the medical assistance in dying is provided. That is sort of an advance consent, and we will talk a bit more about that.

Bill C-14 was not without some issues that were not addressed in the previous legislation and will probably be considered in the fulsome review. There was a question about whether minors should be able to receive medical assistance in dying. There was significant discussion about advance consent. A lot of Canadians were demanding it, and I will talk a bit about some of the considerations that may have kept the government from moving ahead at that time. There was discussion of those who are not mentally competent to give consent. There have been a number of speeches today mentioning people with dementia, for example. That is another area where there was work done by the Council of Canadian Academies, the CCA. It did fulsome reports on a number of these things, and I will talk a bit about what was found.

There was discussion today about the protection of conscience rights, and I do not agree necessarily with the Parliamentary Secretary to the Minister of Justice. I see the charter provisions that were put into Bill C-14, but forcing somebody to refer, when they do not want to have anything to do with the process at all, is actually violating their rights. I am not a fan of violating one person's rights to give another person their rights. That is not good, so we need to have more discussion about that.

In its report, the special committee that studied the Carter decision said that, without good-quality palliative care, people really cannot make a true decision. They really do not have a choice. Obviously I have been an advocate for palliative care. My private member's bill, Bill C-277, on palliative care, was unanimously passed in the House and in the Senate. The government did a good job of putting the framework in place to get consistent access for all Canadians to palliative care.

The problem is that, once the framework was in, the government has since really not pushed ahead. There are 70% of Canadians who have no access to good-quality palliative care. Especially in the time of COVID, where people are dying, it is becoming even more important. The government needs to take action to up its game on palliative care to make it more available to Canadians.

There is an opportunity and a responsibility for the government to show leadership in how palliative care is being implemented in Canada. Right now, for example, British Columbia is violating the World Health Organization's requirements for where MAID should be performed. It has specifically said that palliative care is a different thing from medical assistance in dying and that they should not be performed at the same location because of a tendency by people wanting palliative care to be afraid that they will accidentally receive medical assistance in dying against their wishes. There is an opportunity for the government to revisit that and I am hopeful that it will.

With respect to the Council of Canadian Academies, many issues were studied. On the advance directives and advance consent issue, we see in this legislation that the government is allowing people who believe their conditions are going to decline and are eligible to receive medical assistance in dying to have a 90-day advance consent. It is not clear to me in the legislation when the 90 days start. Is it when patients first have discussions with their physicians? When does the clock start? That is a clarification that is needed in the legislation.

When the council looked at advance directives, it said there were a few difficulties. The first one was how to prove people have informed consent, what the criteria are and what the definition is of that. Therefore, that would have to be addressed. Who decides what is intolerable suffering, especially if the person has lost capacity? That is another question that needs to be and should be considered in this fulsome review that is required and that I would have preferred to have had before this bill came forward.

As a point of information, Belgium and Luxembourg only allow an advance directive when a person is permanently unconscious. That is the only way they will allow a person to have an advance directive in place: If they become permanently unconscious, they will receive medical assistance in dying.

On the issue of minors, “mature minors” would have to be defined. In Quebec, that is defined as people aged 14 to 17. However, we have to make sure they have the capacity to make medical decisions and confirm they understand that it is voluntary and they are not under duress. There are not many jurisdictions that have extended this to mature minors. The Netherlands does allow people aged 12 to 16, with parental permission, to have medical assistance in dying, and those aged 16 to 18 with parental consultation. Belgium allows it if the person is terminal, but pediatric palliative care has to be provided as an option. Therefore, there needs to be further discussion on that one.

Then there are those who suffer from mental illness. I was very pleased to see that it is clear in this legislation that they would not be eligible. It was very controversial. The council that studied it could not agree. There was discussion about the capability for informed consent and the fact that people with depression could have good and bad days and may change their minds, which again points to the need for some kind of cooling-off period. The Netherlands allows this but for dementia only, and there is still a lot of controversy about that.

The safeguards that were in the bill originally seem to have been removed. I am not a fan of doing that because I would say that if we remove the conditions that have to be met in order to get something, more people will take advantage of it. I am concerned with a broader creep on this, but I am sure there will be fulsome discussion about this at committee.

In Canada, everyone has the freedom to express themselves, to believe what they want and to choose what they want, and we should treat everyone's individual choices with respect.

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

Madam Speaker, I know the member for Sarnia—Lambton as an advocate of science and palliative care, which she raised today and is an important point. The question I would put to her is an observation about the current state of palliative care in Canada.

The government has invested $11 billion in accommodation of home care and mental illness care, which includes targeted money directly for palliative care. It is not just supplying the programming but ensuring that palliative care is provided to those seeking MAID. That is in track two, where someone's death is not reasonably foreseeable. The new requirements are that a person must be informed of counselling, mental health supports, disability supports and palliative care. Further, the practitioner must agree with the person that they have discussed and appropriately considered receiving means of alleviating their suffering before anything can be acted upon.

I know the member has talked about safeguards throughout today's debate. Do those address some of her important concerns about palliative care?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, these are absolutely the kinds of supports that are needed, but the reality is that they are not actually in place everywhere. This makes a huge difference.

I will give an example from the first year after Bill C-14 came into law. Sarnia—Lambton has a huge capacity for palliative care. We have a hospice with 20 beds. There are also beds in the hospital, and we have home care. We have an integrated palliative care system. There were two requests for medical assistance in dying in the first year. London, just an hour away, has a population that is about three times larger than Sarnia's population. It had 300 requests for MAID because it does not have adequate palliative care services.

The government can help out with establishing hospice. The virtual palliative care work that has started is very helpful, especially in rural and remote areas, but it of course requires broadband Internet access. The government can also use some of the successful models, like using paramedics in their off hours, to deliver palliative care. These things could really boost the existence of the supports people are being counselled about, and then people could take advantage of them.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, if I understand correctly, my colleague thinks the Truchon and Gladu decision should have been appealed. These two individuals were refused medical assistance in dying because their deaths were not reasonably foreseeable. They both have serious degenerative diseases. People in this situation are forced to either wait or go to court.

I would like my colleague's opinion on this.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I do not have an opinion one way or the other. Quebec has its jurisdiction and its courts make decisions, but when the government has to respond to a decision, that needs to be the focus. I do not disagree with the member for Fundy Royal, who said that the government should have taken this to the Supreme Court. This is a very serious issue, not something to be decided in a rush.

There will be continual petitioning by those who want everyone to have access to medical assistance in dying. I expect the people I talked about in my speech, including minors and those who are mentally ill, will be continually legally petitioning to expand the scope, which I do not personally support.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, today's debate is forcing all parliamentarians to step into another person's shoes and have empathy for the grievous conditions that they are suffering through. That is difficult, especially when we are lucky enough to have our health.

I understand the member's concerns with the bill, but that being said, there are a lot of people in Canada watching today's debate. Does my colleague see a value in the second reading vote on the bill to get it to committee so that we can further dissect the provisions she sees as problematic and maybe come up with some amendments?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, there are certainly amendments that must happen to fix the things that are wrong in the bill. I look forward to that discussion at committee.

[Chris Bittle, Liberal, Parliamentary Secretary to the Minister of Transport]

Madam Speaker, before I begin, I would like to state that I am splitting my time with the hon. member for Winnipeg North.

We have a serious issue before us, the issue of Bill C-7. It has been an excellent debate so far and an excellent opportunity for members on all sides to talk about this issue because it goes to our morality and to our own conscience, and we are hearing from all sides about this. I want to say that we got it wrong with the last piece of legislation; we got it wrong with Bill C-14. I want to commend the Attorney General for coming forward with Bill C-7.

I would also like to recognize a few members who were vocal advocates, working on the justice committee with Murray Rankin at the time; the hon. member for Saanich—Gulf Islands; my friend, the hon. member for Don Valley West and many other members of the Liberal caucus who tried to advance medical assistance in dying so that it would be constitutional.

I am here today to speak in support of Bill C-7, which proposes amendments to medical assistance in dying legislation. Members are aware that the Superior Court of Quebec found the eligibility criterion of reasonably foreseeable natural death from the Criminal Code made legislation to be unconstitutional. The court delayed the effect of the ruling to allow both the federal and Quebec legislatures to respond. The government has agreed with this basic principle of this decision and is now proposing to amend the Criminal Code.

Bill C-7 proposes to repeal the requirement that natural death be reasonably foreseeable. It would create two sets of safeguards: one for those whose death is reasonably foreseeable and another for everyone else. Some of the existing safeguards for those who are dying would be relaxed, and for everyone else there would be a different set of safeguards based on the current ones with some additions and clarifications.

Bill C-7 proposes to continue to use the expression, “reasonably foreseeable” natural death, but as an element that determines which set of safeguards to use and not to use it as an eligibility criterion, which was the issue in the Truchon case.

The proposal to distinguish MAID requests on the basis of whether a person's death is reasonably foreseeable is consistent with the view that MAID for people whose death is reasonably foreseeable presents less risk and complexity than other circumstances, and that the assessment of requests should be tailored to these different types of cases. Having a reasonably foreseeable natural death would also be a critical element for another proposed amendment in the bill. Currently, the MAID law requires the practitioner to give the patient the opportunity to withdraw consent or to affirm their consent just before MAID is provided.

This requirement for final consent is a safeguard; however, it has also caused some MAID patients to choose to end their lives earlier for fear of losing their capacity to provide final consent and, sadly, for some to be denied MAID entirely after losing capacity. I would also like to point out that others chose to decrease their intake of painkillers prior to MAID being provided, to ensure they retained capacity to consent, which leads to an increase in suffering.

BillC-7 would allow for a possible waiver of requirement for final consent for individuals whose death is reasonably foreseeable but where there are fewest risks and complexities in providing MAID to a person who is no longer able to consent. Permitting this proposed waiver of final consent would respond to scenarios like that of Audrey Parker of Nova Scotia, who was diagnosed with terminal cancer that had spread to her brain leaving her uncertain as to how long she would have the capacity to consent. Because she feared losing capacity before her preferred date to receive MAID, she scheduled MAID and ended her life earlier than she wanted. She openly expressed how she felt unfairly forced by the limitations of the MAID law to schedule MAID sooner than preferred and called for amendments to the Criminal Code so that others like her would not be denied the freedom to choose their preferred date to receive medical assistance in dying.

I would recommend that all members listen to the speech in the previous session from the hon. member for Dartmouth—Cole Harbour. I believe Audrey Parker was a constituent of his. He powerfully used her own words to show us where we went wrong, the impacts our failures in the previous legislation had led to, and the impacts on her life. We owe it to people like Audrey Parker, who have been assessed and approved for MAID, to respect their need for freedom in making end-of-life choices. As a compassionate society, we know we can do better to support these individuals. These amendments seek to do just that.

Waiving final consent is, however, an ethically complex question. This is because it involves MAID being administered to a person who is no longer able to consent, or to withdraw the consent they previously gave. Bill C-7 proposes a new approach for patients whose death is reasonably foreseeable, who are assessed and approved for MAID when they have the capacity, and who make very specific arrangements with their practitioner in which they give consent in advance to MAID being administered on a specific day, even if they have lost capacity by that day.

I fully support permitting advance consent for this group of individuals, but at the same time, I note that certain protections must be in place. Specifically, if on the specified day for MAID, the patient has lost their capacity and they nonetheless actively show signs of resistance to the MAID procedure, or behave in a way that indicates a refusal, the practitioner must not follow through on the procedure.

Medical practitioners at the round table expressed concerns in relation to the emotional burden that could arise from such situations, for them and for family members. They talked of possible disagreement with family members on whether to end the life of a person who appears to resist the procedure. A similar situation led to the prosecution of a MAID provider in the Netherlands and made headlines around the world. That situation is what we wish to avoid here in Canada.

That is why Bill C-7 proposes an additional provision that states that signs of resistance from the patient would make the advanced consent invalid on the specific day and going forward. While an incapable person could no longer withdraw their consent from a legal perspective, given their track record and decision-making capacity, it is proposed that MAID not be permitted under this circumstance. The approach provides much needed clarity for practitioners and family members that MAID be prohibited if the patient is resisting. The bill would also make it clear that an anticipated reflexive response, like flinching when the needle is inserted, does not count as resistance.

It is important to be clear, however, that this amendment is not about advance requests. Advance requests for MAID refer to a situation in which a person puts in writing they would want to receive MAID at some later date when they are not able to consent to it, if circumstances arise that they predict would cause them unbearable suffering.

In this situation, a person is not asking for MAID now. Instead, they are putting in writing that they want it at a later date on the basis of anticipated suffering that has not yet happened. The most likely scenario would involve people who are diagnosed with conditions that could lead to dementia, such as Alzheimer's. These people would want to have a plan in place if their worst fears should come to pass.

Bill C-7 does not propose to allow MAID on the basis of advance requests. MAID in these circumstances would be extremely complex, would avoid ethical challenges and would require more time to consider such measures. In speaking to the Attorney General, I voiced my concern that we need to spend more time considering these measures. I hope that the issue will be studied during further upcoming parliamentary review of the MAID legislation.

Taking more time to study advance requests is consistent with the approach of the Government of Quebec, which is also moving forward to hold public consultations on the issue so that all of its dimensions can be better understood.

MAID is one of the most sensitive and challenging social issues we are currently faced with. Recognizing how deeply personal this issue is to so many people, and to so many members of this place, the government has listened carefully to the diverse opinions of Canadians and has considered the expertise shared by experts, MAID providers and other experts in the development of this important piece of legislation. Bill C-7 responds to the Superior Court of Quebec ruling, but it also achieves balance that respects personal autonomy, while protecting the vulnerable as well as equity rights for all Canadians.

For these reasons, I call on all members to support the bill.

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, I want to confirm to the House that the parliamentary secretary, in his speech, spoke the truth when he said that the Liberals got it wrong, because the Liberals did get it wrong. I was on the justice committee with the hon. member when Bill C-14 was before it, and the Conservatives presented over 100 amendments that would have strengthened the bill and provided proper safeguards, all of which were rejected by the Liberal government of the day. One thing that did get passed was the requirement for a mandatory review after five years, but the government has circumvented the requirement with a few consultations, which is completely inappropriate and should be unacceptable to the House.

Health care professionals in my riding are continually asking for better health care conscience protection rights for health care professionals. They have looked at the legislation and do not feel it is there. We have heard the Liberals argue that it is there and that it is adequate, but the health care professionals in my riding, including doctors and nurses, say it is not adequate. I would like the member to respond to that.

[Chris Bittle, Liberal, St. Catharines, ON]

Madam Speaker, perhaps the hon. member forgets that we had witnesses come before the committee and I asked them about this time after time. Can the member name me one time in Canadian history when a doctor has been forced to do a medical procedure against their will? No one, in the history of this country, has been made to do that.

I appreciate the member's revisionist history that suggests the Conservative amendments would have made the bill constitutional. On the contrary, they would have made it worse.

This is a more progressive way to move forward to protect the constitutional rights of Canadians. We still need to do more, and I look forward to the parliamentary review in the near future.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, I commend my colleague on his speech. I found it very interesting to hear him talk about consent and the requirement for final consent, which forced some people to apply for medical assistance in dying earlier than anticipated.

Perhaps my colleague agrees with the idea of expanding the concept of waiving final consent so that there is a type of advance consent, including in cases where natural death is not foreseeable. I would like his opinion on that.

Can he provide a concrete example of how we might proceed?

[Chris Bittle, Liberal, St. Catharines, ON]

Madam Speaker, I believe the parliamentary review that was enshrined in the legislation needs to move forward. We have to focus on this piece of legislation right now, but we need to do better. This legislation is a big step forward, but there is a lot more work that still needs to be done.

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

Madam Speaker, I remember in the first go around, back in 2016, the controversy and the various points of view that were brought forward, including by my colleague from St. Catharines. I remember speaking to people in my riding about how proud I was that we were able to come forward with the bill. We heard some positive statistics earlier about people whose suffering was ended through the bill we brought forward.

I would ask my friend from St. Catharines about the point of view that we need to be exactly perfect when we come forward with Canada's legislation on assisted dying. At least we are at a point now that we can consider some very good things that have happened and a way of improving them.

[Chris Bittle, Liberal, St. Catharines, ON]

Madam Speaker, I appreciate the hon. member's comments. However, I look at this in a different way, because many of these concerns were brought to the attention of the decision-makers previously. Those voices were ignored and people suffered unnecessarily. I take this as a personal loss and wish my voice could have been stronger to prevent that suffering. We took a step forward with the previous legislation, but we need to keep taking steps forward.

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

The motion that the House do now adjourn is deemed to have been adopted. Accordingly the House stands adjourned until Monday, October 19, at 11 a.m. pursuant to Standing Orders 28(2) and 24(1).

Happy Thanksgiving, everyone.

(The House adjourned at 2:31 p.m.)

The House resumed from October 9 consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[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, allow me the opportunity to reflect on what has brought us to this point.

Shortly after the 2015 election, a number of pieces of legislation were brought before the House. One of those pieces was Bill C-14, a direct response to courts and the many concerns Canadians had with regard to the issue of dying with medical assistance. The issue was thoroughly discussed and debated. A lot of dialogue took place inside and outside the chamber, and, in fact, across the country. The number of Canadians who were engaged in the legislation was extraordinarily high. That was reinforced earlier this year, but I will get to that particular point later.

Back in January or February 2016, there was a great deal of dialogue taking place. Bill C-14 ultimately passed just prior to the summer break, in June 2016. At the time, parliamentarians recognized that there would be a need to make some modifications. In fact, within the legislation we passed, we created the opportunity for us to review it.

It should come as no surprise to anyone that the issue continues today. Even without legislation, dialogue has been taking place among members of Parliament and constituents. I have had ongoing feedback on the issue, in particular through emails, since 2016. People have expressed concerns and issues with the legislation.

The Superior Court of Quebec made a determination on the legislation, which ultimately dictated that we had to bring in Bill C-7. We had initially introduced the bill earlier this year, I think in February. Prior to its being introduced, Canadians were once again formally called upon to provide their thoughts on the issue. It was amazing that in a relatively short time span, we heard from in excess of 300,000 Canadians. People from all across the nation responded to provide their thoughts and ideas on what they would like to see the government and members of Parliament deal with on this very important issue.

We were very hopeful that a committee would have the opportunity to meet and review the legislation, with the idea of looking at ways it might be changed. Then came the pandemic. As we all know, the focus and attention of Canadians changed, just as the House's priorities had to change, in order to respond to the COVID-19 pandemic. As a direct result, we lost the opportunity for that parliamentary group or committee to get together to review the past legislation, and in fact even the legislation that was being proposed in January or February.

Fast-forward to where we are today. Bill C-7 responds to a decision of the Superior Court of Quebec. It is a reasonable and acceptable piece of legislation that, in this form, makes some changes. It deals with some very difficult issues. For example, it drops the number of days of waiting from 10, after a person is approved and in a near-death situation. I believe this will generally receive good support from all sides of the House. There is the reduction of witnesses from two to one. From what little debate there has been thus far, I believe this has the potential to receive good support. The criteria that a person's death must be reasonably foreseeable is an issue that no doubt will be talked about at great length, both in the chamber and at committee. There are other aspects of this legislation that I find very compelling, and I am very interested to hear what people have to say about them.

A big concern I have is the idea that someone is able to provide consent today but, as an illness or a disease continues, might be prevented from being able to give consent knowingly later, thereby disallowing them from having medical assistance in passing. I know many Canadians share that concern. I am expecting to see a good, healthy discussion on that, whether inside the chamber, in committees or in our constituencies, where we receive feedback.

There is the issue of mental illness and the severity of it. This area is worth ongoing exploration, in different ways. As a former member of the Manitoba legislative assembly, I remember that often when we talked about spending money in health care, mental illness was nowhere near being part of the discussion. In fact, it was a very dear friend of mine, Dr. Gulzar Cheema, who raised this issue at a time when very few people raised it. In general, it is something we need to debate more.

I suspect that as we continue the debate, whether in the chamber or at committee, we will see that it is very emotional for a number of people. I know first-hand how important palliative care is, through the experience of the passing of family, in particular my grandmother and my father. I am very grateful for the Riverview Health Centre in Winnipeg for the service in palliative care they provided. To be there at the passing of my father meant a great deal for me personally, as I knew that when he was there he had the love and care of professionals who deal with people who are passing on. A person has to have a very special heart to deal with that. I had a similar experience with my grandmother, at St. Boniface Hospital. They are two totally different institutions, but the thing they have in common is the supports that are there.

I believe we need to do more in the area of palliative care, and I would love to see more discussion, more debate and more action on the issue. I believe the federal government has a role to play in that area too.

To conclude, I will emphasize for members that here is an opportunity for us not only to look at the core of the issue and have discussions, but to look at some of the issues surrounding end of life and the circumstances that, either directly or indirectly, we are all somewhat familiar with.

[Eric Melillo, Conservative, Kenora, ON]

Madam Speaker, one of the things the member mentioned was improvements to palliative care. I think it is important to note that northern regions of the country and rural and remote regions, particularly indigenous communities in my riding, are chronically underserved in health care delivery.

What does the government plan to do to ensure that residents of indigenous communities, and northern and remote communities, have access to all health care options, including palliative care?

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, that is an excellent question, and that is why it is so important that Ottawa work with provincial jurisdictions. Health care, which incorporates palliative care, is administered by the provinces. The palliative care units that we often talk about are administered through our provinces. Ottawa has a role to play through standards and financial support.

We can learn a lot from the provinces. Some provinces deal with health care in different ways, such as urban versus rural. There are opportunities for us not to reinvent the wheel, but rather to look at who is doing it best: look for best practices and ensure that there is some sense of a national standard so that, when our loved ones need palliative care, their ending days are appropriately taken care of.

[Julie Vignola, Bloc, Beauport—Limoilou, QC]

Madam Speaker, this bill is one more step toward more equitable situation-dependent access to medical assistance in dying. This weekend, I had a conversation with my father. I believe there is an issue here with respect to foreseeability.

Take, for example, a person diagnosed with a very serious terminal illness who may nevertheless live for months or years. Can that person ask their doctor now to administer medical assistance in dying once the disease has progressed to a particular stage, even though that person may be incapable of requesting MAID once that time comes?

Will that be possible?

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I do not necessarily know all of the details. Within the legislation, from what I understand, the issue of second consent is important, as is the impact that it has on people who have a deteriorating illness. Today, they might be in a position to give consent, but in their dying days they might not be in that same position.

I believe there is an attempt to deal directly with that issue within the legislation. It is a good question, and I suspect it will be asked once it hits the committee stage.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Madam Speaker, this is a very important conversation to be having, and I appreciate all of the interventions that have been made by members of the House.

One of my questions is around that second track of accessing MAID, which requires that one of the two medical practitioners assessing the person has expertise in that condition. Considering that in Alberta, in particular, there are many communities where doctors have been leaving because of current fights with our provincial government, how will the government deal with the fact that some people will not be able to access doctors? Those doctors are not working in remote or rural communities right now, for that second track of the MAID.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, we need to go to my first answer, where I recognized that Ottawa needs to work with the provinces, particularly the different departments and ministries of health, to ensure that there is a sense of fairness and equity, no matter what region of the nation people are in.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, this is such an important debate that we are having here today, and I thank members for sharing their stories.

This is a very personal debate. I recall speaking on Bill C-14 when I first joined Parliament. I talked about my own experiences with death. I have watched other families go through these issues as well. We talked about how we could be part of making those last few days, months, and sometimes years work well and make sure of the necessary resources.

I am coming to this debate speaking from two sides, and am almost sitting on the fence on this. I am bringing forward a letter from Richard Sitzes, who is the chair of Our Choice Matters, part of Community Living Elgin. I would like to read this letter into Hansard, because I think it is very important to hear the voices and concerns of those who are disabled. I am also going to read some Twitter posts from the late Mike Sloan. Other people have covered this, and those in London would know that Mike Sloan passed away on January 20, 2020, with medical assistance in dying. He had a very difficult time, but he shared his experiences through his Twitter feed. Because of my work here in Parliament with those with disabilities, I had started a relationship with him and discussed what life looked like and how we were to move forward.

I will begin with the letter from Richard Sitzes, chair of Our Choice Matters, which is a self-advocate group. He writes:

I'm a constituent in your riding and live in St. Thomas, and am very concerned about Bill C-7 and the changes to Canada's law on medical assistance in dying (MAID). I'm worried about the negative impacts this bill will have for people who have a disability in our riding.

As chair of the Our Choice Matters self advocate group, supported by Community Living Elgin, I am speaking on behalf of our group. In Canada, many people think that their having a disability causes suffering, but people who have a disability say that it is the lack of supports, not disability, that causes them to suffer. We fear that Bill C-7 will make this situation even worse.

Right now, Canadians can only access MAID if they are suffering and close to death. Bill C-7 will make it possible for a person who has a disability to choose medical assistance to die, even if they are not close to death. We strongly believe that removing the end-of-life requirement will increase negative ideas and discrimination against people who have a disability. It will grow the idea that life with a disability is not worth living. We are afraid that people who have a disability will feel pressured to end their lives even if they are not close to death. This has already happened in Canada, and it will get worse because of Bill C-7.

We believe that the federal government should make it easier for people with disabilities to live good lives, not end them. For the safety of people who have a disability, MAID must be available only to people who are close to death. We strongly oppose Bill C-7 and ask that you oppose this legislation.

I was fortunate to follow up on this letter with Richard last week. He has been a volunteer, not only in my office but in our community, for decades. He is a person we see at every volunteer opportunity. He is there at community events to lend a hand. He looks at his life and recognizes that he has so much to give to our community. I have never met a kinder soul in my life. He just wants to help and at the same time wants to be heard. Having had the opportunity to sit down and talk to Richard, I know his concern is that he will not be the person making that choice, but that it will be made for him. He told me that he did not know who would have the final choice. This is something that Richard, who just celebrated his 60th birthday on August 15, is very concerned with. When I look at Richard, I do not see his life as being worth any less than mine. He has so much to offer to all Canadians. I hope we recognize it is imperative that we have appropriate safeguards for people like Richard who have so much to offer.

On the other side, there are some positives as well. This is where I want to talk about Mike Sloan. He was able to share with Canadians, especially in my region, his everyday struggles of living with cancer. As I indicated, I had created a bond with Mike over the last number of years. When he called to tell me he had cancer, the two of us talked about what he would be going through.

Mike had decided that he was going to die with medical assistance. Watching his death, I can understand why. I understand the struggles that he went through, and want to read some of the things that were put on his Twitter feed.

Madam Speaker, how much time do I have, given that I talk so much?

[The Assistant Deputy Speaker, Mrs. Alexandra Mendès]

Five minutes.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Fantastic. Okay, that is great.

I want to talk about Mike. There was a CTV interview done with Mike back in early January. Mike had already pinned to his desk area his plans for his own funeral, with the date to be determined. He knew what he wanted in life. He was also a very strong advocate for those with disabilities, but when he got cancer he knew that there were going to be struggles. It was not just his mental capacity he was concerned with, but the physical pain he was going through.

I want to start off with the day of Mike's death: January 20. Bob Smith, a Rogers TV host in the London area, wrote:

Mike Sloan passed peacefully at 1:25 pm EST via MAID. He asked me...to let you know. I was with him at the end, holding his hand. He thanks you all for your support on this journey. His last words were, “Tell Chub I love him.”

Chub was Mike's cat. If anyone knew Mike, Chub got him through each and every day. Chub could always be relied on because some days were a little harder than others.

Going back to January 18, Mike wrote, “When it's getting too frightening to drink liquids because they may simply spit back up or choke me, you know, let's be honest about choices here.” To me that statement by him is extremely impactful. Another day he talked about being afraid to get in the shower. He was afraid of falling in the shower. He would get in and fall and started thinking that even though he was a young guy he might need a bench. He was going through all of those different issues each and every day.

Mike was diagnosed with stage four thyroid cancer in February of 2019. He tweeted about his experiences with palliative care and the care he received. It was interesting for anyone to watch this as he would show his belly, which had different things attached for his pain medication. The thing that was so incredible about this man, for any of the other members from the London area, is that he had an incredible sense of humour. He would post a picture of his belly tied to a medical bag that he called his “little purse,” which contained his pain medication. He would also show the different tubes that he would inject the medication in to make the pain go away. He was in absolute pain.

He wrote on January 7, “I've never died before, so I don't know what it feels like, but if agonizing pain, difficulty breathing, a fever and inability to sleep are symptoms, I'm getting there.” This was a man who did not fear death, but recognized that it was going to happen. He was also a man who would go into the hospital and just be released. What was actually really comical was when he went in with shortness of breath and walked out saying he was being released with pneumonia, but was walking and doing well.

Thinking of Mike, we have to find the right balance. We have to find the balance so that the Mike Sloans and the Richard Sitzes of this world have their wishes honoured. I recognize that this is a very difficult decision for many members of Parliament.

I can tell my colleagues that my vote on Bill C-14 was the most difficult vote I ever made. One of the most important things was that there were safeguards to make sure that the family, individual and entire team involved in medical assistance in dying all knew what they were getting into. It is really important that we make sure that those safeguards are in place and use strong caution with Bill C-7 as to whether this may open a new can of worms.

I am very proud to talk about this because it needs to be debated. There is no wrong or right answer. It is about finding a balance for all Canadians.

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

Madam Speaker, my thanks to the hon. member for Elgin—Middlesex—London for her contributions to this debate and in the past years. She raised a very important point when she related the story about Richard. I want to state at the outset that obviously our government values all lives, including the lives of persons with disabilities. We have reflected that in the supports we have put in place. Those lives are also protected by the Constitution.

I put this to the member for Elgin—Middlesex—London, because she ended by talking about safeguards. I actually raised the issue about pressure being put on individuals during my consultations with various members of the medical establishment. They indicated to me that in the province of Ontario, for example, not a single prosecution had happened in the case of a doctor alleged to have pressured an individual. I put that out there for context.

How does the member feel about the safeguards put in place where the decision has to be the decision of the individual? It has to be in writing and it has to be witnessed. Counselling and supports must be provided to such an individual, including disability supports.

Do those address at least some of Richard's concerns?

I appreciate it is a difficult situation and I can see the member struggling with it, but I just put that out there as part of the conversation about this important bill.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, the safeguards are something I am concerned about. Last night, while driving to Ottawa, I listened to a podcast from The Ottawa Hospital and the doctor on it talked about the first time—I'm sorry, that was probably another interview I listened to. Yesterday I listened to six hours of interviews on this.

Not a single person has gone to court, nor have any physicians received judgments or charges based on whether persons were fragile enough to die. There is a whole variety there. One of my concerns is, as we know and as the member from Edmonton indicated, that there are not enough resources.

I am in a smaller community as well. For people to get an appointment with a psychiatrist in my area usually takes nine to 12 months. When people are going through this, they have a really short window in which to receive this type of support. By reducing some of the time frames, we will not be able to provide the services that are really important for the patients, the Canadians, who are making this difficult decision.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her presentation. I appreciate her sensitivity on this matter and would like to hear her thoughts on the following.

My colleague just mentioned the importance of making sure everyone has access to health care. I would like to go back to an important aspect of this bill.

Would she agree that we need to stop putting palliative care and medical assistance in dying at odds with one another?

The two are not mutually exclusive. In other words, people should be allowed to choose medical assistance in dying if they so wish, just as people who want palliative care should be able to receive it for as long as possible. This might require an increase in health transfers.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, we know that the member for Sarnia—Lambton put forward a bill and worked with the late honourable Mark Warawa on palliative care. We can do both. We can walk and chew gum, and we should increase our efforts in palliative care.

My Aunt Catherine passed away in hospice. It was a very important time for her family to be there and celebrate her life, but we have to recognize that not everyone has these options. Palliative care is something we should be working on, and the member is right that we should be doing both.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Madam Speaker, it is so wonderful to hear the member for Elgin—Middlesex—London bring in the human element that is so critical to this debate.

One of the challenges created by the current medical assistance in dying legislation is the requirement for final consent at the time the assistance is rendered. This forces patients to make a cruel choice when faced with a possible loss of competence that would make them unable to give consent. They are forced to either go earlier or risk not being able to receive the assistance they need.

Audrey Parker campaigned to make Canadians aware of this problem, and Bill C-7 would fix it by creating a waiver of final consent. I would ask the member this: Do the Conservatives support Audrey's amendment, which would help those facing the end of life to avoid this cruel choice?

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, I am very fortunate to be in a caucus where these issues are discussed and where we all have different ideas. I know where I stand, but I may be different than my neighbours on both sides. One just does not know. However, everybody should have the opportunity to have those discussions.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I am pleased to rise today, but I find it difficult to be speaking to another attempt by the Liberal government to endanger the most vulnerable in our society.

After just four years, when the original euthanasia and assisted suicide legislation came in through Bill C-14, we find ourselves considering legislation that would further loosen restrictions, eliminate safeguards and confuse our country's understanding of the sanctity of life and the government's role in end-of-life decisions. Once again, we have been told that in order to uphold the charter rights of some we must endanger the rights and freedoms of others.

I did not support Bill C-14 for many reasons. The first is the fact that the Supreme Court of Canada invoked such controversial and flawed legislation, which has been proven to be poorly applied around the world. The Liberals also chose to broaden the scope of the legislation, going far beyond the Carter decision. Another reason is that it has been placed ahead of and continues to overshadow any significant palliative care initiative.

In 2019, the Prime Minister promised to expand eligibility criteria, and on September 11 of last year, the Superior Court of Quebec ruled that it is unconstitutional to limit assisted suicide or euthanasia only to those whose death is reasonably foreseeable. Without even appealing the ruling and seeking the advice of the Supreme Court, which has been long occupied with this matter, the Liberals accepted the ruling. They are now rushing to change the law for our entire country.

They gave Canadians a mere two weeks to have their views heard on this deeply personal and complicated issue through a flawed online consultation questionnaire. The use of convoluted and biased language left little to the imagination in terms of how the government planned to legislate assisted death. I too tried to fill it out, and I would argue that many opposed would have been discouraged in participating due solely to the language used.

With such a flawed method, and with no idea if the feedback even remotely reflects the actual views of Canadians, how can the government proceed with this legislation in good faith? This is a rhetorical question because it does not seem to matter to these Liberals. It is clear they used this brief window for feedback to satiate the need for a consultative process.

We also know the government ignored its own timeline for a review of the original assisted suicide legislation, Bill C-14. It was planned for this summer, and instead, we have been presented with this reckless legislation. In the midst of COVID, this was still something very important. Without a proper review and without input from the Supreme Court, this House has been asked to greatly broaden the scope of assisted suicide and euthanasia without a clear enough understanding of whether the current regime is being consistently interpreted or properly enforced.

Bill C-7 is being rushed through. This is concerning. When reading through this bill, I see elements that go beyond the scope of the Superior Court of Quebec's decision, namely, Bill C-7 would eliminate the 10-day waiting period between the date the request is signed and the day on which the procedure is carried out.

The application of the law pertaining to those whose death is reasonably foreseeable has been problematic from the very start of this debate. We know a person's reasonably foreseeable death is a flexible estimation, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time they have remaining. The elimination of the 10-day waiting period for persons whose death is reasonably foreseeable would create the conditions for someone with an indeterminate length of time remaining in their life, possibly years, to be rushed to the decision to receive assisted suicide and euthanasia.

Aside from simply eliminating what most Canadians would consider to be a reasonable period of reflection, this element of the bill also ignores the possibility of medical advances and improved treatment methods in an incredibly innovative medical science environment. As Cardinal Collins has said, Bill C-7 creates the conditions where an individual can seek a medically assisted death faster than the wait time for a gym membership or a condominium purchase.

I also see no logical reason why the government would reduce the number of independent witnesses required for when the request is signed. It is down from two to one. The government has even relaxed the definition of someone who may serve as a witness, including medical professionals or personal care workers, even those who are paid to provide euthanasia and assisted suicide on a daily basis. This is in clause 1(8).

Surely we can agree that, for the vast majority of those requesting euthanasia and assisted suicide, the requirement for two independent individuals to witness a request to end a life is a reasonable safeguard. How do the Liberals plan to properly protect patients from potential malpractice? How does the government plan on ensuring requesters are presented with a myriad of treatment options rather than just one opinion?

The legislation continues as a series of safeguards the medical practitioner must adhere to before providing assisted suicide to those whose death is not reasonably foreseeable. One of these safeguards would require a medical practitioner to discuss with the person the means available to relieve their suffering, including palliative care.

The safeguard is even weaker for those whose death is reasonably foreseeable, requiring the medical practitioner to merely inform the person of these vital options. The government failed to follow through on its promise to invest $3 billion in long-term care, which includes palliative care. There does not appear to be any political will whatsoever to improve palliative care.

Canadians have also been calling on the government for a long-awaited national strategy for palliative care. There is a thirst among Canadians for real solutions to end-of-life care. The government seems all too willing to ignore the 70% of Canadians without access to palliative care and, instead, attempts to impose on them a flawed, one-size-fits-all regime. We can already see the consequences of pushing forward an assisted dying agenda when there is little regard for palliative care.

In British Columbia, the Delta Hospice Society was stripped of 94% of its operating budget for refusing to provide euthanasia in a facility intended for the provision of palliative care. Despite repeated attempts to defend its Charter-protected, faith-based objection to being required to provide euthanasia and reach a compromise in good faith, 10 hospice care beds are now at risk and will be surely defunded.

Why do the Liberals continue to ignore the voices of those who have a different perspective on the issue of end-of-life care? People who seek hospice care are seeking it for a reason. They do not desire a medically assisted death. In effect, what has happened in B.C. is an attempt to redefine what constitutes palliative care.

In fact, the Fraser Health Authority's decision flies in the face of the Canadian Society of Palliative Care Physicians, which has clarified that euthanasia and assisted suicide are distinct from palliative care. I caution Canadians not to regard the Delta Hospice Society's situation as an isolated one. The government has shown little interest in supporting hospice care, and I would not be surprised by further attacks on the ability of Canadians to chose to end their lives naturally.

In The Globe and Mail, Sarah Gray put it well, stating, “The hospice isn’t a place where people come to die. It is where they come to live — to live well for the little time they have left. It is a place of celebration, connection, comfort and support. It is a place of safety for the dying and the grieving.” In Cardinal Collins' words, let us work to create a “culture of care”, rather than rush toward a culture of “death on demand”.

The government would also be wise to recall that much of the debate on Bill C-14 revolved around calls for a solid framework of conscience protection for medical practitioners involved throughout the end-of-life process. At committee, witnesses stated that the protection of conscience should be included in the government's legislative response to Carter v. Canada.

The Canadian Medical Association confirmed conscience protection for physicians would not affect access to physician-assisted suicide or euthanasia. Its statistics indicated that 30% of physicians across Canada, or 24,000, are willing to provide it. I live in a rural area of Canada, and I can assure members there are many provisions that are not available to me directly where I live.

Unfortunately, the Liberals failed to defend the conscience rights of Canadians in Bill C-14. I also found it disappointing that they failed to support, in the last Parliament, critical legislation put forward by David Anderson in Bill C-418, the protection of freedom of conscience act. It would have made it a criminal offence to intimidate or force a medical professional to be involved in the procedure. It would also have made it a criminal offence to fire or refuse to employ a medical professional who refuses to take part directly or indirectly in MAID.

Here we are four years later, and Bill C-7 is also void of any provisions that would protect the section 2 rights of Canadians. In Canada, everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms. No one has the right to demand all services from all providers in all circumstances. As David stated, protections are needed for doctors and health care providers who are not willing to leave their core ethics behind when they are at a patient's bedside. Access to euthanasia and conscientious objection are not mutually exclusive.

We, as legislators, must ask ourselves where the Liberals will draw the line. There will always be the voices of those in our society who feel that the limitations and safeguards are too stringent. When will it be enough for the Liberal government? How far are they willing to go? What message are we sending to the most vulnerable and fragile in our society?

Over the last five years I have advocated for our veterans. I know there are countless veterans who appear able to cope with debilitating physical injuries, but they are extremely vulnerable in their mental health. We are all concerned about the number of them choosing to end their lives by suicide because of complications after serving our country. It is antithetical to try to prevent them from taking their own lives, yet tell them that there are government-designed opportunities to do so.

Bill C-7 fails to provide conscience protection, fails to protect the vulnerable and fails to fulfill the need—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

Questions and comments, the hon. member for Guelph.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, unfortunately I found a lot of partisan comments in the member's intervention in contrast to the comments from the member for Elgin—Middlesex—London. This as a non-partisan issue.

I was visiting businesses in downtown Guelph this morning and I spoke with one of the business owners. He talked about his parents in England, how they had gone through this choice and how other countries provided ways in which people who faced death could control their exit through proper legislation.

I wonder if the member could comment on getting the personal comments directly from people who face those choices, even posthumously, as the member for Elgin—Middlesex—London presented to us, and should we should be looking at including those comments in the committee's study should we be able to get the bill to committee?

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I would disagree with the member's comments. I totally agree with the member for Elgin—Middlesex—London. We are on the same page on this.

That being said, we have approached it from two different perspectives. On the personal side, I hear those things all the time. The concern is that at what point do we come to a decision on what the responsibility of the government is. I understand we want choice, but the problem is that there are not enough safeguards for those individuals, where it is creeping into a sense that their rights and privileges under the charter are being challenged. That is what I expressed here. Right now we are at the place where we are the line between those who want a certain thing and those who do not. Someone's rights will be trampled if we do not deal with this very carefully.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Madam Speaker, as citizens, we should all agree that it is important to prevent needless suffering at end of life and that it should be up to individuals to decide how they want to end their lives with dignity. However, we also need a legal framework to ensure that doctors can act within the law without being faulted after the fact for having helped someone end their life.

Would my colleague not agree that doctors need a legal framework to be able to do this work?

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, a legal framework was presented in Bill C-14. However, the Canadian Society of Palliative Care Physicians has said that there is creep where palliative care facilities are being shut down because the physicians do not feel they should be providing assisted suicide or euthanasia, and their rights are being trampled upon. Many people in our country choose not to go that route. Their rights and their protections need to be in place as well.

That is why we need a better focus on palliative care. We cannot say that we are giving people an option when people do not have an option. The government committed to a national strategy on palliative care and it is our responsibility as national legislators to make it very clear that palliative care is distinct from euthanasia.

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

Madam Speaker, I definitely am in full support of my hon. colleague's very moving remarks. A disability advocate called my office this past week. She was very concerned about watering down protections for vulnerable people by removing the requirements on physicians and having a physician who specializes in the area being involved.

Is there any provision for social workers to be involved? Frankly, physicians are not always equipped to recognize when there might be undue family pressure or other intersectional pressures being put on the patient to make an assisted-death call. What are my hon. colleague's thoughts on that?

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, there needs to be clarity in that regard. We are hearing stories, but, as was mentioned, these things are not being brought forward and prosecuted or there are not enough safeguards in place to ensure people are not being coerced in that way. I have had individuals come to me in tears over that very issue. It is becoming commonplace that this is naturally something that is offered to a lot of individuals who are in end-of-life scenarios.

Palliative care is an opportunity for individuals to live their life thoroughly to the end, along with their family. When individuals make that choice, they should not be coerced. We really need to be careful of this.

[Anthony Housefather, Liberal, Parliamentary Secretary to the Minister of Labour]

Madam Speaker, I will be sharing my time with the hon. member for Oakville North—Burlington.

This is a very difficult bill and subject for us to deal with. In this case, the sanctity of life, something that all of us cherish, conflicts with the liberty interests protected under section 7 of the charter. This is one of those difficult times where we have to recognize that our own religious views, our own moral views are not the ones we can simply impose on Canadians. We have to recognize that charter rights are sacrosanct. Sometimes, as a member, those are difficult moments.

I personally have said before that I would not choose medically assisted dying for myself. Nor would I encourage family members to avail themselves of the opportunity for medically assisted dying. However, I also fully respect the right of every Canadian to choose for his or herself whether this right should be exercised personally.

In the Carter decision, the Supreme Court of Canada upheld that under section 7 of the charter, there was a certain subgroup of Canadians whose liberty interests were violated by the existing provisions in the Criminal Code on not assisting someone to commit suicide. The Supreme Court in Carter told us that there was a subsection of Canadians, those who were in constant enduring pain and suffering that could not be alleviated by medical treatment reasonably acceptable to them, who had the right to have their death hastened by having medical professionals assist them in doing so.

In the last Parliament, our government brought in Bill C-14. I had the privilege of being the chairman of the Standing Committee on Justice and Human Rights. We heard from a great cross-section of Canadians. We heard from those who represented the disabled community and those who believed in the right to die with dignity. We heard from members of the clergy from all faiths. We heard from university professors, lawyers and doctors. We heard from a great cross-section of Canadians who had very diverse and different opinions.

What we tried to do was craft a law that brought Canadian society together, that protected the vulnerable but yet still afforded everyone the right that the Supreme Court had recognized in Carter, which was the right to decide for one's self whether to terminate one's life in the event he or she was in enduring pain and suffering that could not be alleviated by medical treatment reasonably acceptable to that person.

As well, we had to recognize that when we dealt with the Carter decision in Bill C-14, Canada was at the beginning of a list of countries dealing with medically assisted dying. There were very few countries in the world that had gone where Canada was going. Belgium, Holland, Uruguay and a few American states were, but that was it. Canadian society needed to come to terms with medically assisted dying and learn more about the process before we went too far.

That is why, at the time, I supported a clause in the bill that said that medically assisted dying was limited to those whose end of their natural life was reasonably foreseeable. However, we knew that would change over time and that as Canadian society looked at the experience of medically assisted dying, the bill would come back for review before Parliament and would need to change.

At the justice committee, we proposed a number of important amendments to that bill. We inserted, by unanimous agreement at the committee, conscience rights to ensure that the doctors, nurses and pharmacists whose own beliefs would be offended by medically assisted dying were not compelled to participate in the process. We said that Parliament would need to review some subjects that we were not dealing with, such as the issue of mental illness on its own; the issue of mature minors; and, probably most important, the issue of advance directives for those suffering with dementia.

We also adopted a motion that palliative care had to be part of that review. People should have their death hastened because palliative care treatment is not available to them in Canada.

This bill takes the medically assisted dying regime, Bill C-14, a step further based on the Truchon decision. It held that the provisions we had put in the law about reasonably foreseeable death were not constitutional and that a subgroup of Canadians who may have many more years to live but were in constant pain, enduring interminable suffering, and could not have that alleviated by medical treatment reasonable acceptable to them also had the right to medically assisted dying.

This bill establishes that this group of people also have the right to medically assisted death in Canada, but also imposes additional safeguards on them, namely a 90-day waiting period. We understand that certain people, for example, may suffer a traumatic injury and need time to consider all their options and come to terms with their situation before finally going through with a medically assisted death.

Also, based on the Canadian experience, we are amending the bill to allow certain Canadians who are about to lose their ability to offer agreement to medically assisted dying, because they have lost their capacity to consent, to do an advance consent.

Some Canadians want to access medical assistance in dying knowing that they may still have a few more weeks to live. The only reason they want to access it sooner is that they do not want to lose their capacity to consent to medical assistance in dying.

Personally, I want these people to be able to continue to live and spend those last few weeks with their families. I do not want them to end their lives prematurely because they are worried about losing their capacity to consent to the procedure.

The amendment to the law, this bill that is before us, gives hope to this group. These people will have permission to sign a contract with their doctor indicating that they want to put an end to their life on a specific date, even if they lose the capacity to consent to medical assistance in dying in the meantime.

However, there is still a safeguard in the sense that if people who have lost their capacity to consent show through any action or words that they no longer wish to end their life, the doctor must then stop the procedure.

I strongly support the bill. I think Canadian society has evolved with respect to how we see medically assisted dying. As Canadians, we now have seen where the procedure works and where it does not work. We have seen which groups have been positively impacted and which groups have been left out and where we can improve on the procedure.

Following a great deal of consultation and national interest and seeing a change in how Canadian opinion sees medically assisted dying, this bill is the right one at the right time.

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

Madam Speaker, I had the privilege of serving with the hon. member for Mount Royal on the justice committee when we studied Bill C-14

The member rightfully talked about the process in which we heard from a diverse range of viewpoints. It is ironic that this legislation circumvents that opportunity to hear from a diverse range of viewpoints by pre-empting a legislative review, which should have started in June.

The hon. member will know that this decision goes well beyond the scope of the Truchon decision. One such area is with respect to advance consent, to which he alluded. Arguably this goes beyond the scope of the Carter decision inasmuch as Carter stated not once, not twice but on three occasions that a patient must clearly consent.

How can the hon. member defend that with respect to legislation that arguably goes beyond the scope of Carter? How can consent be truly meaningful if it is not contemporaneous?

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I want to say how much I enjoyed serving with my hon. colleague from St. Albert—Edmonton. He always brings a great deal of intelligence and rational thought to these situations.

First, as the House knows, the government and Parliament are not limited to simply creating a law that repeats the Carter decision; Parliament is perfectly entitled to go forward further and protect liberty interests that were not recognized in Carter. Nobody excludes the right of Parliament to go further than Carter.

Second, I believe that the legislative review on the subjects that we were supposed to review will continue to proceed. This law is a separate piece of legislation dealing with other subjects.

Finally, I would say that, regarding the issue of capacity to consent in advance to medically assisted dying, this is simply for somebody whose death is already foreseeable, coming up in the very near term, to agree with their doctor to end their life if they have lost the capacity to consent to further prolong their life, because otherwise they would make that decision more prematurely. I support it for that reason.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Madam Speaker, the Bloc Québécois agrees with the proposed amendments and welcomes them.

The issue that has not been addressed and that I think is important is advance consent. I would like to know where my colleague stands on that issue.

Would it not be a good idea for people who meet the criteria set out in the act to be able to give their consent in advance, as we do with organ donation, in the event that they are diagnosed with a degenerative disease? Is that an issue that was examined? If so, what is my colleague's position on that?

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I thank my hon. colleague from Rivière-du-Nord. He always provides an intelligent perspective to the debates.

To me, this is one of the three issues Parliament has to address. The first is the issue of mature minors, the second has to do with psychological illnesses only, and the third has to do with advance directives. I agree with the way in which the bill allows certain people to make an advance request.

The issue of advance directives is very complicated. If we allow people to give such a directive in advance, then we must put in place very clear and precise guidelines. This will certainly be part of our discussion during review of the legislation.

[Pam Damoff, Liberal, Parliamentary Secretary to the Minister of Indigenous Services]

Madam Speaker, it is a pleasure to follow the wise words of my colleague, the member for Mount Royal.

I am pleased to speak in favour of Bill C-7, an act to amend the Criminal Code, medical assistance in dying. As hon. members know, this bill responds to the Superior Court of Québec decision that struck down the eligibility criteria that naturally occurring death be reasonably foreseeable.

In the last Parliament, I spoke during debate on the original MAID legislation. At that time, I talked about the need for us to have conversations with loved ones about death and dying. “Death” is a word that elicits strong emotions. We celebrate life, we embrace life and we talk about living. However, we avoid talking about death. We shy away from those conversations because they make us uncomfortable. I know there are those who feel this legislation goes too far. However, regardless of where people fall on this legislation, I think we can all agree that the way we deal with and talk about death needs improvement.

Whether a grievously ill patient chooses to die at home or in a palliative care facility or chooses medical assistance in dying, we should be having these conversations sooner and lovingly assisting those who are ill in the end of their life. These decisions are often made during a health crisis. Ideally, each of us should be engaged in advanced care planning.

I would like to share the story of Bob Lush, an incredible man, respected lawyer and my friend. Bob and his wife Maureen shared a love and bond that was obvious to all who met them. Bob died on March 17. This summer I had lunch with Maureen and she shared with me the decision they took to use MAID. With Maureen's permission, I would like to share Bob's story.

Bob had been diagnosed with multiple system atrophy and pulmonary fibrosis. He also exhibited symptoms of Parkinson’s. While his body was failing him, his mind was as sharp as ever. Over time, these serious health issues would worsen, which led his doctors to tell him that he was palliative and that there was nothing more they could do. A palliative care nurse asked if they had thought about MAID and provided them with a brochure. It was not an option they had considered before, but Bob and Maureen together decided that this option would be the most loving way for Bob to leave this earth. I cannot possibly put into words the tremendous love these two shared.

Maureen described for me Bob's last days. They chose March 17. All medical equipment was removed from Bob's room and it was filled with flowers and candles. They loved listening to James Taylor's “American Standard” album, and it was playing. Maureen and Bob's son John were by his side. As Moon River played, the doctor administered the MAID drugs. Bob closed his eyes and peacefully, painlessly and humanely passed away. To hear Maureen describe it, I could hear both the love in her voice and the sadness of losing Bob, but she had no regrets and, in fact, wanted Bob's story to be shared so that other families could consider this option for their loved one, if it was the right decision for them.

The legislation before us here today would update our MAID laws in several ways. The bill would maintain existing safeguards and ease certain safeguards for eligible persons whose death is reasonably foreseeable. New and modified safeguards would be introduced for eligible persons whose death is not reasonably foreseeable. Persons whose natural death is reasonably foreseeable, who have been assessed as being eligible for MAID and who are at risk of losing capacity, can make an arrangement with their practitioners in which they provide their consent in advance, which allows the practitioner to administer MAID on a specified day, even if the person has lost their decision-making capacity.

For persons who choose MAID by self-administration, a person could waive in advance the requirement for final consent in case complications arise following self-administration, leading to loss of capacity but not death. These new safeguards would exclude eligibility for individuals suffering solely from mental illness. It would also allow the waiver of final consent for eligible persons whose natural death is reasonably foreseeable and who may lose capacity to consent before MAID can be provided.

This legislation would also expand data collection through the federal monitoring regime to provide a more complete picture of medical assistance in dying in Canada. These are important changes and ones that have been called for since 2016, when the government responded to the Carter decision with its original legislation.

Since MAID became legal in June 2016, there have been more than 13,000 reported medically assisted deaths in Canada. This figure is based on voluntarily reported data from the provinces and territories prior to November 1, 2018; and the data collected under the new monitoring regime after that date. MAID deaths as a percentage of all deaths in Canada remains consistent with other international assisted-dying regimes.

The government undertook extensive consultation in order to update the MAID legislation. In January and February 2020, the Government of Canada engaged with provinces, territories, Canadians, indigenous groups, key stakeholders, experts and practitioners to receive their feedback on expanding Canada's MAID framework. Over 300,000 Canadians participated in online public consultations between January 13 and January 27 of this year.

It is important to recognize that MAID is not the right option for everyone. We still have work to do to educate Canadians about end-of-life options. When the former Bill C-14 was debated in the House, I spoke about palliative care and the need to educate Canadians about it as an end-of-life option. I was pleased the Senate amended our original bill to include palliative care in the legislation. Our government has worked collaboratively with partners, including the provinces and territories, to develop a framework on palliative care. We are implementing a targeted action plan of providing $6 billion directly to provinces and territories to better support home and community care, including palliative care.

I would like to share once again Bonnie Tompkins' story, a story I shared in 2016 during debate on the original MAID legislation. She is currently compassionate communities national lead for Pallium Canada, a national non-profit organization focused on building professional and community capacity to help improve the quality and accessibility of palliative care in Canada.

When her fiancé, Ian, was diagnosed with terminal cancer, he was adamant that he wanted medical assistance in dying. As is common, his biggest concern was the burden he would place on loved ones as his illness progressed. After he saw Carpenter Hospice in Burlington and was educated on the options available—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

We seem to have lost the connection with the hon. parliamentary secretary.

The hon. parliamentary secretary has about two minutes left.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Palliative care is something that too few people consider, let alone discuss with their loved ones. Just as Bob Lush's decision was the right one for him, so too was Ian's. These are deeply personal and extremely hard decisions that people make as they near the end of their lives.

This legislation today would address concerns about eligibility for MAID and allow more people who wish to use MAID to do so. I want to applaud the Minister of Justice for his leadership on this bill; as well as the Minister of Health; and the Minister of Employment, Workforce Development and Disability Inclusion. I would also like to give a shout-out to the member for Don Valley West, who chaired the committee in 2016 that reviewed options for MAID legislation and that laid the groundwork for where we are today.

It is my hope that all members of the House will support this important legislation.

[Colin Carrie, Conservative, Oshawa, ON]

Madam Speaker, I want to thank my colleague, especially for sharing those personal thoughts with us because this issue we are debating today is a very personal matter.

I wanted my colleague to comment on a statement by her colleague, the member for Mount Royal, who said in his speech that nobody should have their death accelerated due to lack of palliative care.

We know that my colleague from Sarnia—Lambton brought forward a private member's bill that was in response to this decision, that was basically to allow Canadians to live as well as they can, for as long as they can. This private member's bill was dedicated to providing a national palliative care action plan.

I wonder if my colleague could comment on the government's response to providing appropriate palliative care so people do not have to choose medical assistance in dying, considering that approximately 70% of Canadians do not have access to appropriate palliative care.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Madam Speaker, I thank the member for his question, and I also applaud my colleague, the member for Sarnia—Lambton,, for her advocacy on this issue.

One of the problems is that people do not know what palliative care is and what is available, as the story I told about Bonnie Tompkins's fiancé demonstrates. People need to be educated on it, but not going into palliative care does not automatically mean they are choosing medical assistance in dying. That logic is flawed, in my opinion.

There is a need for more education on all aspects of people ending their lives. I think there are conversations that need to be had between families and loved ones so that when or if they become ill, families will know what options are available. As I described in Bob Lush's story, had a nurse not provided information on MAID, the family could never have chosen that option.

Our government is committed to palliative care.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, the bill proposes removing the requirement of final consent for eligible people whose natural death is reasonably foreseeable.

Would it not be appropriate to allow for advance consent and waive final consent for people with degenerative, incurable diseases? What are my colleague's thoughts on that?

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Madam Speaker, these are indeed very difficult conversation to be having, and that was certainly discussed in 2016. My understanding is that part of the parliamentary review that is to take place on this legislation is about the issue the member has described regarding the people who have a terminal illness and want to provide direction and demands. It is something Parliament needs to look at, and we need to have a fulsome discussion on how we proceed if we choose to proceed on that.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Madam Speaker, I thank my colleague for her very compassionate and heartfelt speech. It was very moving.

I have a question about requiring a person with an incurable disease to obtain permission from a medical practitioner specializing in the disease in order to get access to medical assistance in dying. In the case of people living in rural or remote regions that do not always have the appropriate medical specialists, does this requirement not constitute an impediment?

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Madam Speaker, the question from the member is an important one. One does not have to be in a rural area to not have access to medical practitioners who may have expertise. In speaking with Maureen Lush, I know there is only one doctor in Oakville who is available to perform MAID, and there is no one at all in Burlington.

I think it is very important that people have options and that we remove the stigma of MAID. Hopefully telling these stories will help to educate people on the right option for them and if this is the way they should proceed.

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I am very pleased to speak to the important Bill C-7. We need to know its origins to understand why we are at this point today.

In 2016, working on Bill C-14 was a rather difficult exercise given that the Liberal government was intent on bulldozing it through. I believe that is the right expression, because the government refused all amendments proposed by the different opposition parties, including the Conservative Party, the NDP and the Bloc Québécois.

The government put pressure on the Senate by giving it a deadline. The Senate wanted to improve the bill before the House voted on it. What was the end result? In September 2019, the Superior Court pointed out that the bill passed by the House was not adequate, especially with respect to the issue of the foreseeability of the date of the person's death.

That is where we find ourselves today. We are in the House debating an extremely sensitive subject, but we have not had much time to consult the experts.

Everyone has a different perspective on the issue, whether they are members of the House or members of the public in Quebec or elsewhere in Canada.

I wrote a speech, but I have decided not to read it. Instead, I would like to share my own experience with my colleagues.

The vote on Bill C-14 was the hardest vote I cast in my first four years in Ottawa.

On the one hand, I had some constituents asking me to vote in favour of the bill, while others wanted me to make sure that the legislation would protect the most vulnerable and honour the conscientious objection rights of medical practitioners. On the other hand, I had constituents going through a very difficult time with a loved one who was suffering and could not access MAID.

I did not sleep well the night before the vote. I knew that no matter which position I took, whatever I said in the House could be interpreted by the media and by Canadians. Allow me to explain. Some members voted against Bill C-14, and I would imagine that others will vote against Bill C-7. Members voting against the bill are doing so not because they are against it, but because they do not think it goes far enough.

The opposite is also true. Some members voted in favour of Bill C-14 in 2016 because they wanted to make sure people got the bare minimum. No matter which side we took, we had to explain something extremely sensitive, and I do not think a simple yes or no could accomplish that.

I often ask myself, who am I to decide for someone else? As lawmakers, it is our duty to protect the most vulnerable, especially if we remove the criterion of reasonably foreseeable natural death for access to MAID. This is reflected in the questions that some members have been asking in the House. I am sure it reflects the opinion of many Canadians who wonder what would happen if a person wanted to give advance written consent in case their situation changed over time. There is much more to this debate, and I do not think we are done talking about it.

Madam Speaker, I forgot to tell you that I will be sharing my time with the member for Calgary Signal Hill.

I am very concerned about ensuring that this bill enables all Canadians, wherever they may live in this country, to have access to the appropriate resources to make the right decision for their situation. The current pandemic has exposed the weaknesses in our health care systems. I doubt all Canadians in rural areas have access to specialists who can guide them and give them the right information so that they can make a decision based on their circumstances.

I am also very concerned about minors and vulnerable people. During the study of Bill C-14 in 2016, I had the opportunity to hear the testimony of two witnesses who had suffered accidents and endured the most traumatic ordeals a human being can experience. They told me that, had they had access to MAID back then, they probably would not have been talking to me that day because they had been in such a dark place at the time.

I know people who were there for the final moments when someone who was suffering asked for MAID. I am certainly concerned about all that, and it makes me wonder what the best solution is. Is it because we do not have the necessary palliative care resources? Is it because both the federal and provincial governments and health care facilities are making poor decisions? I am wondering about that.

I must say, I feel like we are rushing the process today, because has been quite a while since the courts asked Parliament to modernize this legislation after what happened in Quebec. This is a government that shut down Parliament under the pretext of being in a pandemic, as though we could not do more than one thing at a time. There are 338 MPs. Committees could have continued to sit. We could have heard from experts who could have explained this issue to us properly so we could make the right decision, the best decision.

Again, this is something that will not be easy for many of us. We have differing opinions within our party and elsewhere. However, I would like to note that I am proud of my party for letting me vote freely. I want to thank my leader for allowing this, without any pressure from my organization. I hope that all political parties will offer this choice, because this is a vote of conscience, and it is challenging for us to represent our constituents, who do not all share the same opinion. We also have our own conscience. For some, this is a matter of religion or beliefs, which means we may not all see eye to eye on this file.

Personally, the thing I wrestle with the most is wondering who I am to decide what is best for someone who is suffering. I believe that is what will guide my decision on the day of the vote. I hope that I will be able to make the right decision and that all of us can then work with the government to put all the necessary resources in place to properly inform and educate the public, and provide everything we can to vulnerable people who are going through tough times with loved ones, so that they are adequately supported in making the best decision.

In closing, I hope that next time, we will have more time to talk about people who are not vulnerable, sick or about to die, but still want to express advance consent.

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

Madam Speaker, I thank the member for Richmond—Arthabaska for his very frank and candid comments.

I would just like to clarify something. He mentioned that the Liberal Party did not accept the other parties' amendments. That is not quite accurate, because during the debate on Bill C-14, we accepted an amendment endorsed by all parties concerning medical practitioners' freedom of conscience and religion.

I would also like to point out that Bill C-7 does allow for advance consent, but not advance directives. The issue of advance directives will be dealt with in the comprehensive review, which will take place every five years.

I would also like to point out that there is a 90-day waiting period to eliminate the impulsiveness my colleague pointed out in his speech. For example, when a minor has an accident, we do not want them to make an impulsive decision on this matter.

Does the member opposite believe that having a specialist is necessary? For example, Mr. Truchon, who was from Quebec just like the member opposite, had cerebral palsy. Our party believes that a physician must have the requisite expertise to treat and advise patients before they make their decision.

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I thank my colleague for his question and for the clarifications he provided.

I do think that some expertise will be required. This is a very big decision for patients and their loved ones. There is the whole issue of grieving, a whole process. Yes, it makes sense that the doctor would be a specialist in the individual's illness or disability. However, I wonder if everyone will have access to those resources during the decision-making process. The devil is in the details, as they say. This shows just how urgent it is to deal with the matter of medical assistance in dying and, in particular, Bill C-7.

[Martin Champoux, Bloc, Drummond, QC]

Madam Speaker, this is a particularly meaningful day to talk about this sensitive issue. Yesterday, October 18, marked the first anniversary of the passing of my aunt Claire, who chose to access medical assistance in dying. She was not looking to end her life, but she simply wanted to choose how she would put an end to her suffering and to do so with dignity. I think that the word “dignity” is important, because that is what we are talking about here.

I heard the speech by my colleague from Richmond—Arthabaska, and I appreciated the considerable sensitivity he showed in expressing his concerns. The topic of palliative care is a very important one.

If every patient across the country had fair and equal access to palliative care, would my colleague agree to remove the element of final consent, so that people with degenerative diseases could make a decision several weeks or months in advance, or even years, before their unforeseeable, yet inevitable, death?

Could my colleague speak to that?

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I thank my colleague for his question.

At the end of my speech, I talked about reflecting on the notion of who am I to decide on behalf of someone else going through such a terrible ordeal. I had those discussions, that very debate, more than once with friends over dinner. Some of those friends were going through this situation with their mother or father, or a brother or sister. This is what is really giving me pause right now.

Ultimately, I should allow these individuals to have access to this resource. I am not sure “resource” is the right word; I should say, people should have this as one of their options.

I do want to ensure, however, that the government does everything it can to protect vulnerable people if the time ever comes in their life that they want to end it. It should not have to come to that, and that is what I am wrestling with at the moment.

Ultimately, I hope to be able to let go and vote in favour of this bill, as my colleague mentioned earlier, to let everyone decide for themselves.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Madam Speaker, it is an honour to participate in the debate on Bill C-7, which will amend the Criminal Code.

As someone who travels four or five hours to get to Ottawa on a regular basis, often I sit in Parliament and ask, “Do my constituents really care about what we are talking about?” I am pleased today to participate because I believe that this is a subject matter that every Canadian feels strongly about, one way or another, and that potentially could impact every Canadian. I feel very honoured to participate in this debate today.

We are doing so because the Supreme Court deemed certain provisions of the original medical assistance in dying legislation, MAID, to be unconstitutional. That provision, deeming death must be reasonably foreseeable, is being withdrawn in Bill C-7. The second important piece of this bill is the removal of the 10-day waiting period. In my remarks today, I want to address both of those changes.

First, I would like to state at the outset that I support the bill. In contrast to some others who have spoken, I do not believe the government should have appealed the Supreme Court decision. While I commend the government for finally bringing forward this legislation, it is unfortunate that the Liberals are only acting when being made to do so by the courts. This is somewhat of a repeat of four years ago when the government was forced by the courts to introduce the original MAID legislation.

Those suffering near the end of life should not have to resort to the courts before government acts. I guess one could say, however, that late is better than never, and it is certainly better than endless appeals of the decisions.

Four years ago when the original bill was introduced in the House, I made a special effort to obtain the collective views of my constituents. While I personally supported the original legislation, I also wanted my vote to reflect the feelings of my constituents. I reached out extensively to survey my constituents through phone calls, emails, Facebook and direct mail.

The responses at that time were from all age brackets and all demographics. The end result was 77% of several thousand respondents supported the legislation. Ironically, that number is awfully close to the percentage of support I received in the general election just one year ago. I am confident that a similar survey today would yield the same results, and the majority of my constituents would be supportive of the changes being proposed in the bill.

What I heard from constituents reflected my own personal views. While I respect some deeply held views from constituents who do not support MAID, I am of the belief that I, and only I, should determine how much pain and suffering is reasonable for me when end of life is near. I do not believe any institution or government should deny me my constitutional right.

Some medical professionals do not support MAID, and that is their constitutional prerogative. Those advocating against these changes feel those rights are not adequately protected in the legislation. That may be legally correct, but medical professionals not wanting to administer MAID clearly have a professional responsibility to refer patients. In Alberta, the website for Alberta Health Services has a listing of doctors who are willing to perform MAID. If it is the view of a medical professional that he or she is not prepared to perform MAID, they can make a referral.

The second important piece of this bill is removing the 10-day waiting period. I also support this. The contention that someone who is suffering to the extent that they ask for MAID one day will simply wake up a few days later and change their mind, I do not agree with. In my view all the 10-day period provided for was additional suffering and an opportunity, for those who oppose MAID on fundamental principles, to try to change the patient's mind. In my view, both are wrong.

I am sure most MPs are receiving the same emails I am getting, many from constituents asking that I support the legislation and others who are opposed. I have no issue with those opposed to MAID. Where I do take issue is with some of the rationales that are being used. Medical professionals' conscience rights is one, and I have spoken to that.

Others claim the legislation would take us down the slippery slope of other countries, where euthanasia is available to children and those with mental illness. Clearly those are red herrings because this legislation would do none of that. Others are asking for more study, another delay tactic, similar to appealing the court decisions. It is more work for lawyers, less satisfaction for those suffering.

Increased funding for palliative care has also been raised as an option by those opposing this legislation. Enhancing palliative care is always welcome, but in my view is not directly related to this issue. We are talking here about people wanting to end excruciating pain and suffering. These people are not asking for their pain and suffering to be made more comfortable.

Our health care system must do both things well. It must allow for people to live with dignity and receive excellent care as they reach the end of their lives. In addition, the provision of health care is a provincial responsibility, and I do not believe it should be part of this discussion.

Since the original MAID legislation was passed four years ago, I have taken a special interest in this issue. Unlike some other members who spoke earlier, I have not attended a death where someone has chosen MAID. However, I have had dozens of constituents make a real effort to tell me they experienced MAID with a loved one and that it was very special and appropriate. They personally thanked me, as someone charged with making laws in this country, for making this provision available at end of life for their loved one.

I have not had one constituent call me to say how bad this experience was. In almost all cases, these same constituents have said that society needs to go further. In fact, many constituents seem to believe advance consent already exists. They cannot believe they are not allowed to prepare a legal document, while of sound mind, that would provide their loved ones with guidance in the event they are nearing their end of life but are no longer of sound mind. For that reason, it is critical the minister get on with his public consultation on a broader review of MAID, which was promised some time ago.

The minister needs to find out what Canadians want and not make those suffering take years to go through the court system to get change. Like most things, the Liberals blame COVID. However, there are many ways of seeking input from the public regarding other changes to MAID, and the minister needs to get this discussion moving now.

In summary, I look forward to the bill being studied in committee. I know there will be those opposed to the bill and those in favour making presentations, and all need to be heard. For me personally, I have consulted and listened to my constituents and feel very comfortable voting in favour of the legislation.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, the member for Calgary Signal Hill is the member of Parliament for my brother, and I appreciate the effort he is putting forward in reaching out to his constituents to find out what they are thinking on the issue. Our role as members of Parliament is to put aside where we may want to head in favour of finding out from our constituents how we can best represent them.

My question is regarding the speed of reaction. The legislation we introduced last time was a result of a lot of discussion and consultation. The consultations reached 300,000 throughout January of this year. We are being very careful to go one step at a time to avoid slippery slopes.

Could the hon. member talk about the importance of avoiding those slippery slopes by taking the proper amount of time to do the consultations we need?

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Madam Speaker, I am suggesting we need to launch these consultations that have been promised because there are Canadians who believe this particular legislation could be even further enhanced. The Liberal government needs to get on with these consultations and listen to Canadians.

As mentioned, at the end of the day we are here to represent our constituents. When I did my survey, I did not know how my constituents were going to react. Even though I felt strongly about this particular issue, I wanted to make sure I was representing their views, and I believe in both cases that was the case.

[Rachel Bendayan, Liberal, Parliamentary Secretary to the Minister of Small Business]

Madam Speaker, I will be sharing my time with my esteemed colleague from Argenteuil—La Petite-Nation.

It is with great emotion that I rise in the House to speak to the bill on medical assistance in dying.

First, this bill is the result of a decision handed down by the Superior Court of Quebec. I am very familiar with that court. I had the great honour and responsibility of arguing cases before it in my previous life. Barreau du Québec lawyers have the privilege of working with one of the best courts in the world.

This court rendered a decision and rather than appealing it, the Liberal government said yes. Quebec will once again be leading the way for the rest of the country. Our progressive and forward-looking Quebec will guide Canada. That makes me proud both as a lawyer and a federal government MP from Quebec.

The purpose of Bill C-7 is to ensure that people like Ms. Gladu and Mr. Truchon have the same rights, opportunities and freedoms as those who are facing an imminent or reasonably foreseeable death.

The ruling in Truchon found the eligibility criteria of reasonably foreseeable natural death to be unconstitutional. Our government also agrees that MAID should be available to relieve suffering and pain from serious medical conditions and is now proposing through this legislation to amend the Criminal Code so that Canadians can end their lives with medical assistance if that is the right choice for them. To accomplish this, Bill C-7 proposes to repeal the requirement that natural death be reasonably foreseeable, opening up access to those who are suffering in a wider set of circumstances.

The changes to the legislation propose to create two pathways in terms of the procedures that must be followed to assess a request for medical assistance in dying. While I do not have time to get into the details of the two regimes in full, there are a number of points that I wish to highlight today.

For those people who are suffering intolerably from a serious medical condition, but whose death is not reasonably foreseeable, the safeguards put in place emphasize the importance of ensuring that sufficient time is taken to evaluate the request. A minimum of 90 days will be needed so that the person can be assessed by a doctor who has some experience with this condition, which will help to ensure that the person gets all of the information, services and tools that might help them improve their quality of life.

Bill C-7 also creates new safeguards with respect to consent. Individuals requesting an assessment for medical assistance in dying give their consent, of course. Clearly, they also give their consent to receive MAID when they officially sign their request. However, what matters most is consent when MAID is about to be administered. There must be no doubt as to the person's desire to receive MAID at the moment they receive it. Doctors will be more comfortable proceeding under those circumstances.

Depending on their illness, some individuals risk losing their capacity to give consent between the time they are approved for MAID and the day they would like to receive it. Although we expect that most people are ready for MAID rather quickly once their request is approved, some people may wish to wait for a specific event such as a child's wedding or the birth of a grandchild. Those who wish to wait before going ahead with MAID are caught in an impossible situation if there is the risk of losing capacity. Either they wait for their special family event and risk losing their ability to die as they wish, or they move up the date of the intervention and miss a very important moment with their family and friends.

Therefore, this bill will enable individuals in real danger of losing their capacity to consent prior to the day specified for administration of MAID to make special arrangements with their practitioner. Such arrangements must be made in writing. The doctor and the individual must work together to come to an agreement that works for both of them. This safeguard is important for individuals as well as for doctors because they are the ones who bear the tremendous burden of ending someone's life.

The bill addresses another difficult situation.

Let us suppose that, when the day comes, the person has lost their capacity to consent to MAID, but remains conscious and alert, although not competent. Let us also suppose that they act in such a way or make gestures clearly indicating that they do not want to receive MAID. The bill addresses this situation—which we obviously hope will be rare—by clearly stating that the physician must not proceed because, in this case, it is no longer what the person wants.

The concept of freedom of choice, for me, remains central to all of this. I watched my grandmother suffer from Alzheimer's. Not long after I was born she was diagnosed, and when I was very young she used to repeat the same stories over and over again to me, about her own life and the life lessons that she wanted to pass on. She would tell me about how she used to work two and then three jobs, taking shifts overnight in order to buy her family's first home and provide a better life for her children. What that repetition instilled in me was certainly an understanding that my grandmother was probably the strongest woman I knew, that she was a force of nature.

When I was about seven or eight she forgot who I was, she forgot who everybody was, and I had to very painfully remind her every time I saw her. By the time I was 10 she no longer remembered language at all, and it was just humming, which I still somehow found very soothing, comforting and somehow okay. The degradation from there continued; her eyes no longer opened at all, she was in a wheelchair, the humming had completely stopped and when I was 15 the only muscles that worked were reflexive ones. Even if nothing else in her body moved, she would chew food if it was put into her mouth. It took two people to move her from her wheelchair to her bed or to change her, and this situation went on like this for 10 years.

As a teenager I used to wonder constantly what it would feel like to be trapped in a body like that, wondering if that was really the same strong woman in there or not. It was 10 years of listening to hushed voices in the kitchen saying, “...but there's nothing we can do.”

I do not know for sure, of course, what my grandmother would have decided for herself, but I do know for sure what I would want. For those who would decide something different for themselves, or for whom their beliefs are contrary to assisted dying, this framework provides everyone with the freedom to decide for themselves.

It is not a crime under the Criminal Code to take one's own life. It is a crime to take someone else's. The changes proposed would ensure that those people who need and who would like doctors to help them in order to end their life with dignity, at the time that they choose, can do so.

MAID is certainly one of the most challenging social issues in our society, which is made up of people with very diverse viewpoints and needs. I believe that this bill would achieve the right balance between the freedoms and rights of those who are dying and who are seeking a peaceful medically assisted death and our medical practitioners who need a clear framework for timing and consent.

I call on all members of this House to support Bill C-7.

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

Madam Speaker, when I think about this, and about the importance of choice, I am thinking about the horrible situation that has been uncovered in long-term care homes across this country. I am thinking of a gentleman named Roger Foley from London, Ontario, who has a degrading neurological condition. He is not being adequately supported by our health care system. He is not getting assisted living, and so how can people be truly given a choice when their choice is between living horribly in a health care system that does not support people or having medical assistance in dying?

Would the member not agree that we need to invest more in our health care system and more in improving the lives of our seniors and those with diseases before pushing forward and liberalizing assisted dying?

[Rachel Bendayan, Liberal, Outremont, QC]

Madam Speaker, I do not disagree with him. I do believe that we need to ensure that the quality of life that is available to our elderly and the people who are living in assisted-living homes and centres across the country allows them to have the option of living with dignity, but I do not believe the two are mutually exclusive.

Our government has invested in health care recently. We have made numerous transfers to the provinces in order to make sure that our seniors are being cared for, and we will continue to do so, but that does not mean that medical assistance in dying should not move forward at the same time.

[Julie Vignola, Bloc, Beauport—Limoilou, QC]

Madam Speaker, I want to thank my colleague for her speech, which was very personal and very moving. I just want to pick up on the idea of the foreseeability of death.

Alzheimer's follows a certain progression. My colleague's grandmother went through that progression, as have some other people I know. People can experience different forms of dementia with aging, and some are more difficult than others.

With that in mind, would it be good to include the possibility of advance requests for medical assistance in dying in Bill C-7, along with very specific criteria?

[Rachel Bendayan, Liberal, Outremont, QC]

Madam Speaker, I thank my colleague for her question.

We need to keep this conversation going. We need to ask Canadians what they think and what they would be comfortable with. That is certainly not out of the question, but at this point in time, I think we have presented something that not only responds to the Quebec Superior Court's ruling but also meets the demands of those seeking medical assistance in dying.

I certainly think more needs to be done. I know this is a very real concern in Quebec. My constituents also ask me about this. I think we need to keep the conversation going and see how we can move forward into the future.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I appreciated the words of my colleague across the floor. My father passed away in February just before COVID from Alzheimer's, after nine long years in care. However, I also do know what his desire was. The member spoke of choice. That, I think, is the issue here, right down to the choice for doctors.

The member talked about making sure safeguards are in place. What about doctors who do not feel they can go forward in participating in this? They are not being properly protected across our country. As well, the Canadian Society of Palliative Care Physicians has made it clear that euthanasia and palliative care are two very distinct things.

How does the member feel about her government's position on palliative care? Would she be willing to say that those two things are very distinct and should exist independently?

[Rachel Bendayan, Liberal, Outremont, QC]

Madam Speaker, I have spoken to a few doctors who have told me they themselves are uncomfortable with the procedure. They have a system in place that appears to be working in which they can refer to their colleagues, other practitioners, in order to perform medical assistance in dying. That appears to be working for some.

I am not aware, of course, of the situation of all medical practitioners across the country, but I certainly was comforted to hear from a number of doctors who, for different reasons, including religious beliefs, do not feel comfortable with this. There is a process in place for referrals.

I would also note that medical practitioners do have the moral obligation to—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

Order. The parliamentary secretary.

[Stéphane Lauzon, Liberal, Parliamentary Secretary to the Minister of Seniors]

Madam Speaker, I am so pleased to be able to speak to Bill C-7, which seeks to amend Canada's medical assistance in dying legislation.

This is officially one of the hardest decisions I have had to make since entering politics, first at the municipal level in 2009 and then at the federal level. I never used to get my family involved in my decision-making. However, on this issue, I decided to get my wife and adult daughters to sit down with me at the kitchen table for a frank and serious family discussion.

Our government has been working on this bill since 2019. We have had discussions about the future and the choices that we need to make as parents. These discussions were extremely difficult. I know that this is an issue that hits very close to home for Canadians, but we do not talk about it in public very much. However, medical assistance in dying is a very complex and very serious issue for me.

Yesterday, when I came back from my run, a neighbour was waiting on my doorstep. We had an intense discussion, a very good discussion, on medical assistance in dying. He had just been diagnosed with ALS and was very emotional, which made me very emotional. He asked me if I had voted for or against the bill the last time. Because I understood that an individual's right to choose is very important, I voted in favour of the bill. This time too, I agree with the amendments proposed by the Quebec courts.

I have deviated somewhat from my speech, but events like these give us an opportunity to reflect on the reasons we are here. This subject has not been talked about very much in the House, and some opposition members have asked why it is up to all of us here to make these decisions. It just so happens that we chose to be decision-makers and that sometimes we have to make tough choices like this one.

We immediately embarked on an inclusive process with the provinces and territories in response to recent court rulings about MAID rules. We held extensive consultations. We talked to doctors, organizations, vulnerable people and eligible individuals. The consultations were part of our government's progressive approach to ensuring that the federal framework reflects evolving views and Canadians' needs. That is how we always make decisions here in the House. Our goal is always to improve Canadians' lives and be as fair as possible.

We were particularly focused on making sure that people with disabilities could express their views on the subject. People with disabilities are extremely important to me, given my past experience as parliamentary secretary to the minister responsible for persons with disabilities. That was an incredible experience, and we drafted the first accessibility act, which is near and dear to my heart.

Bill C-7 would amend the Criminal Code provisions respecting medical assistance in dying to provide greater autonomy and freedom of choice to eligible individuals seeking medical assistance in dying.

Protecting vulnerable individuals and respecting the right of people with disabilities to equality and dignity are essential considerations. More specifically, this bill would broaden medical assistance in dying to people with irremediable medical conditions who are in an irreversible decline but are not at the end of life.

The bill also proposes excluding persons whose sole underlying condition is a mental illness, introducing a host of safeguards for persons whose death is not reasonably foreseeable while maintaining and relaxing existing safeguards for persons whose death is reasonably foreseeable.

The bill also proposes permitting persons whose death is reasonably foreseeable and who were deemed eligible for medical assistance in dying to provide consent in advance of the time of the procedure even if they lose the capacity to consent prior to the day specified in the arrangement with the medical practitioner.

Supporting and advancing disability inclusion is not new for our government. From day one, we have been committed to achieving these objectives and have improved our programs to better respond to the needs of persons with disabilities. It should be noted that the Government of Canada fully respects the equality rights of Canadians with disabilities. That is why we have been working hard since 2015 to advance the accessibility and inclusion of persons with disabilities.

For example, in 2018, we acceded to the optional protocol to the Convention on the Rights of Persons with Disabilities. This means that Canadians have additional recourse for filing a complaint with the UN Committee on the Rights of Persons with Disabilities if they believe their rights under the convention have been violated.

In July 2019, we passed the Accessible Canada Act, which we are in the process of bringing into force. This legislation is considered one of the most important advances in federal legislation on human rights for persons with disabilities in more than 30 years.

In 2019, we also launched the accessibility strategy for the public service of Canada, in order to make the public service more accessible and inclusive. In addition, we improved data collection, in particular regarding indigenous people with disabilities. We recognize that integrating people with disabilities is about more than simply passing a law, and we are working with these people and other stakeholders to combat stigmas and prejudices. The culture needs to change so that the significant contributions made by Canadians with disabilities are recognized and valued as much as those of other Canadians.

Bill C-7 gives vulnerable people new, concrete safeguards against pressure and coercion, to ensure that MAID remains an informed, voluntary decision.

Today, as Parliamentary Secretary to the Minister of Seniors, I see that this has once again become a hot topic in my riding and in our discussions. I see how important it is to give people the right to make their own end-of-life choices. Fundamentally, we hope to strike a fair balance between respecting the individual autonomy of people who request MAID and protecting vulnerable people. We want this measure to be as compassionate as possible.

[Claude DeBellefeuille, Bloc, Salaberry—Suroît, QC]

I want my colleague to know that I really appreciated his speech.

In the bill and in practice, there has been a lot of talk about importance of the role doctors play when someone makes the final decision to request medical assistance in dying. However, we must not overlook the caring presence of the social workers who support these individuals throughout the process, allowing them, as my colleague said, to make an informed decision and fully and knowingly consent. The presence of a social worker is an important part of the support provided to individuals and families, as this decision is often made as a family.

I would like to hear my colleague's thoughts on the arguments raised since this morning in favour of an individual's right to express their wishes in advance when they are diagnosed, know that death is inevitable and want to plan how they will leave this world. Would my colleague support including a way to express one's wishes in advance in this legislation?

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Madam Speaker, I would like to thank my colleague for her question.

It is an excellent question. Any avenue for helping vulnerable people and helping those who want to support access to MAID is appropriate. All we want is to have federal legislation that provides a framework for all the regulations to ensure that there is a system in place in every province and territory of Canada so that people have the fairest opportunity to make a decision.

However, if the provinces want to implement any measures, given that health is a provincial jurisdiction and that Quebec asked for the legislation to be amended, we will always be there to support the best outcome for the vulnerable.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, I am concerned that this bill would create two classes of Canadians. In one case, able-bodied persons suffering from mental illness would be provided with suicide prevention; in the other case, persons who happen to be in wheelchairs would be eligible for MAID.

Is the member not concerned that this bill would create two classes of Canadians?

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Madam Speaker, what we are saying is that we want to make the fairest decisions for each group of people.

People dealing with mental health issues are just as important as people with disabilities and people who are terminally ill and highly vulnerable.

This is a very sensitive debate, and people with mental health problems who are not capable of making decisions are excluded from this law.

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

Madam Speaker, I want to begin by saying that I was very touched to join my colleague in attending the commemoration of the great sacrifice of Canadian soldiers during the Second World War, in Caen, France.

I will put that aside for a moment.

I listened with interest to my colleague talk about the rights of handicapped people and how much the government cares for them. However, we saw complete indifference toward the crisis faced by handicapped people during the pandemic. We had to work hard and push the government to give a measly $600 to the most impoverished people when it was not going to give it. Handicapped people suffer extraordinary levels of poverty because they are marginalized from the workforce.

Given the fact that the Human Rights Commission had to call out the government on its lack of action and interest in supporting handicapped people during the pandemic, I would expect my colleague to recognize that the government needs to do a better job in addressing the rights of handicapped people so they can get through this unprecedented economic and medical catastrophe.

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Madam Speaker, it is a pleasure to rise to respond to my colleague who was also a travel companion in Normandy.

My colleague may be referring to the Speech from the Throne in which the Prime Minister put forward some very important decisions for persons with disabilities. We provided $600, but that has nothing to do with medical assistance in dying. However, I am pleased to inform him that we were there for persons with disabilities—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

Resuming debate.

The hon. member for Shefford.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I would first like to mention that I will be sharing my time with the hon. member for Beauport—Limoilou.

I am speaking here in the House of Commons today about Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying.

Many people here have had unique experiences involving the end of a loved one’s life. Personally, my most recent experience was last year, when I held my father-in-law’s hand until we were sure that he could die without suffering. I realized then that not everyone is that lucky. I thought about my grandmother, who fought a long and painful battle with cancer for many years.

Naturally, as the Bloc québécois critic for the status of women and seniors, I was contacted by a number of groups about this bill. I will therefore recap all of the work my party did on this important issue, while emphasizing the great sensitivity of Quebeckers when it comes to medical assistance in dying. I will conclude with the position of some seniors’ and women’s groups who have made extremely useful recommendations.

First, let us talk about the reason for this debate. In September 2019, the Superior Court of Quebec ruled in favour of Nicole Gladu and Jean Truchon, both suffering from incurable degenerative diseases, stating that one of the eligibility criteria for medical assistance in dying was too restrictive, both in the federal legislation covering MAID and in Quebec’s act respecting end-of-life care.

Two brave individuals, and I know people who knew them personally, simply asked to be able to die with dignity, without uselessly prolonging their pain. Suffering from cerebral palsy, Mr. Truchon lost the use of all four limbs and had difficulty speaking. Pain killers are no longer working for Ms. Gladu, who suffers from post polio syndrome, and she cannot remain in one position very long because of the constant pain. She said that she loves life too much to settle for mere existence.

What we are talking about here is the “reasonable foreseeability of natural death” requirement. Justice Christine Baudouin said it well in her ruling when she wrote that “The court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Mrs. Gladu's rights to liberty and security, protected by section 7 of the Charter.” That is the crux of this debate.

The defendants were challenging the fact that they had been denied access to medical assistance in dying because their death was not reasonably foreseeable, even though they had legitimately demonstrated their desire to stop suffering. Jean Truchon had chosen to die in June 2020, but he moved up the date of his death as a result the pandemic. Nicole Gladu is still living, and I commend her courage and determination.

The Bloc Québécois' position on this ethical question is clear. I thank the member for Montcalm for his excellent work and co-operation on this matter. I remind members that, as many have already pointed out, legislators did not do their job properly with Bill C-14. As a result, issues of a social and political nature are being brought before the courts.

We need to make sure that people who have serious, irreversible illnesses are not forced to go to court to access MAID. Do we really want to inflict more suffering on people who are already suffering greatly by forcing them to go to court for the right to make the very personal decision about their end of life? This will inevitably happen if we cannot figure out a way to cover cognitive degenerative diseases.

Obviously, we agree that we need to proceed with caution before including mental health issues, but that is not the issue today. The exclusion from the bill of eligibility for medical assistance in dying for individuals suffering solely from a mental illness requires further reflection, study and consultation, which will be completed at the Standing Committee on Health as soon as the motion that has already been moved by my colleague from Montcalm is adopted.

I would like to remind members of the important role Quebec played on this issue. Quebec was the first jurisdiction in Canada to pass legislation on this issue.

Wanda Morris, a representative of a B.C. group that advocates for the right to die with dignity, pointed out that the committee studying the issue had the unanimous support of all the parties in the National Assembly. This should be a model for the rest of Canada. Ms. Morris said she felt confident after seeing how it would work in Quebec and seeing that people were pleased to have the option of dying with dignity. The Quebec legislation, which was spearheaded by Véronique Hivon, was the result of years of research and consultation with physicians, ethicists, patients and the public. It has been reported that 79% of Quebeckers support medical assistance in dying, compared to 68% in the rest of Canada. That is important to point out.

In 2015, when the political parties in the National Assembly unanimously applauded the Supreme Court ruling on MAID, Véronique Hivon stated:

Today is truly a great day for people who are ill, for people who are at the end of their lives, for Quebec and for all Quebeckers who participated in...this profoundly democratic debate that the National Assembly had the courage to initiate in 2009. I believe that, collectively, Quebec has really paved the way, and we have done so in the best possible way, in a non-partisan, totally democratic way.

In this time of crisis, we must work together constructively to put people's well-being first. This is not about which has greater merit: palliative care or medical assistance in dying. This is about being able to offer both, to offer a choice. That is why I would like to remind the House that health transfers must be increased to 35% because Quebec and the provinces are the ones who know their regions' needs best and are in the best position to minimize disparity among the regions.

I would now like to tell the House about a meeting I had with the Association féminine d'éducation et d'action sociale, or AFEAS, in my role as critic for seniors and status of women. During the meeting, the AFEAS shared its concerns about this issue with me. I will quote the AFEAS 2018-19 issue guide:

Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly....

As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope....

This procedure cannot be accessed by individuals who are not at the end of life....People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.

That meeting took place last January. Last week I received a call from the president, reminding me how important this bill is, not only to her members but to all Quebeckers and Canadians. Work on this bill must continue in committee so the necessary improvements can be made.

Before being elected, I was a project manager responsible for raising awareness about elder abuse and bullying. I used to teach that violating people's rights is a form of abuse, that any attack on rights and freedoms, including the failure to recognize an individual's capacity to consent and to accept or refuse medical treatment, is a form of abuse. In 2020, a focus on proper treatment is long overdue.

Let me conclude by saying that I hope all of these comments and all of Quebec's lived experiences, in terms of respecting people who request and choose to die with dignity, will encourage all members of the House of Commons to give their unanimous support to Bill C-7 and to medical assistance in dying. Let's show some empathy for everyone who is suffering. Let's give them the choice. It is said that we do not choose to be born, but once we are, the cycle of life begins. Let's ensure that we ourselves have the choice to die with dignity in accordance with our own final wishes. This bill is long overdue. We need to act.

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

Madam Speaker, I thank the hon. member for Shefford for her speech and her very analytical and honest comments.

I have two simple questions for her since she took part in today's debate. It was said that consultations on Bill C-7 were inadequate. In my opinion that is absolutely not true, given that we have already heard from 300,000 people. I would like her thoughts on that.

The other question I want to ask her has to do with the dignity and autonomy of the person who wants to receive medical assistance in dying. Will changing the number of witnesses from two to just one independent witness and eliminating the 10-day waiting period improve or diminish the dignity of a person who has opted for medical assistance in dying?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for the question.

Eliminating the 10 days is a matter of dignity. This will allow some people to avoid suffering for days unnecessarily. As far as the committee work is concerned, we are aware that there is a world of difference between Bill C-14 and Bill C-7.

It is already planned, but the committee will have to address the issues of advance requests, which is something many seniors' groups are calling for, particularly for some people with degenerative diseases. There is also the issue of mental health and that of minors.

There are more issues that need to be studied, and I know that the committee will do the most exceptional work possible with input from all parties.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, the Canadian Society of Palliative Care Physicians has put out a statement, indicating that euthanasia-assisted suicide is distinct from palliative care. We talk about choice and opportunity here, knowing that 70% of Canadians have absolutely no access to palliative care, yet it is part of this conglomerate of other options that are presented within the bill on euthanasia.

What is the member's perspective on the need for palliative care in Canada and should it be considered distinct from euthanasia?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her question.

I already addressed this in my speech. We must remember that it is important that we not pit palliative care against medical assistance in dying. We must continue to ensure that Quebec and the provinces receive the money they need for their health care systems through health transfers. Palliative care just like medical assistance in dying are part of a continuum of care. It is truly important to provide choice. I have already mentioned that.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Madam Speaker, I thank my colleague for her speech.

We agree on the fact that people must be given the choice. They must be able to leave this life with dignity and avoid useless suffering. However, there is a provision in the bill that concerns us a little, and that is the fact that the physician must have expertise or specific knowledge of the person's illness.

In the case of people living in rural or remote areas, there may not be a physician with knowledge of a rare illness. Would that not be an obstacle to accessing this right?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, that is one more reason to ensure that health care systems across Quebec and Canada have adequate funding through health transfers, as we have pointed out. This would give people access to specialists who could weigh in. That is why the government must increase health transfers and ensure that people everywhere have better access to care.

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

Madam Speaker, I agree entirely with my hon. colleague from the Bloc Québécois.

I wonder if there could be a response to an earlier question posed in the debate, which suggested that this legislation would open the door to seeing the possibility of medical assistance in dying for those who were not facing death but who were facing mental illness. As I read the legislation, that is specifically not contemplated here.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her question.

I remind members that the notion of mental health is not addressed in this bill because my colleague, the member for Montcalm, pointed out the need to be careful when dealing with such a sensitive issue as mental health.

[Julie Vignola, Bloc, Beauport—Limoilou, QC]

Madam Speaker, no one likes to talk about death. It reminds us that we are mortal, as are the people we love and the people we are emotionally attached to. We do not like to feel negative emotions. Our brain reacts negatively to these emotions by releasing hormones that make us panic.

Death is such a difficult subject that most people worry when a loved one starts talking about wills, last wishes or funeral plans. They worry about the person’s health, when that person is only trying to plan for the future. This may sound ghoulish, but life always ends in death. Our entire lives are planned, starting with our parents planning our education and then us planning our careers, moves, children, and so on. We can plan for death and funeral arrangements the same way, even if we do not have suicidal tendencies.

For there to be death, there has to have been life. We have a short time on this planet, so we need to act responsibly, not only for ourselves, but also for the generations to come. We are only borrowing this planet. The place where we live is temporary.

I listened to my colleagues’ arguments last week, and I also read a lot about medical assistance in dying. I even discussed it with my father. I love my father. I hope that he will be with us for a very long time. I am a daddy’s girl. Unfortunately, my father’s wishes are currently impossible. He told me that, if he were to be diagnosed with a degenerative disease and told what was going to happen, he would like to be able to tell his doctor, at a certain point in the progression of the disease, that he wanted medical assistance in dying and that he did not want to linger.

For now, that is impossible. It is something to think about.

Even if these discussions about our loved ones’ final moments are difficult, we need to have them. They are important. They ensure that we can respect the person’s wishes to the very end. It does not mean that the person will necessarily opt for medical assistance in dying. It means that we will know what the person really wants at the end. It can also prevent families from being torn apart.

One of the points raised by my colleagues was the fear expressed by several disability advocacy organizations that people with disabilities will be urged to get medical assistance in dying. I must admit that I, too, was concerned before I read the bill.

Once I read the bill, I saw that the request for medical assistance in dying must be made in writing by the person in question, and that it can be withdrawn at any time. When the substance is being administered, if the person gestures or speaks in a way that appears to be expressing a change of heart, everything stops there. That is the case not only for people with disabilities, but also for people whose death is foreseeable.

The Canadian Charter of Rights and Freedoms states that people with disabilities have the same rights as people without disabilities. This implies that they have the right to life, and that they are entitled to receive the treatments appropriate to their condition. Why would they not also have the right to medical assistance in dying if they meet the criteria clearly indicated in the bill? Do people with disabilities not have the right to decide for themselves simply because they have a disability? I find that unacceptable. I reject the idea. People with disabilities are capable of making their own decisions. They are rational beings. This has nothing to do with making decisions for other people.

It has to do with allowing people the right to make their own decisions concerning their own death.

I would add that other safeguards have been put in place, namely the three-month wait time with support services. My colleagues talked about that. It is not always easy to get in touch with a doctor or social worker, for example. I used to live in the regions. My doctor was a general practitioner. However, I do not think anyone ever had a better doctor because, when the time came to pick up the phone and call a specialist, he was the first to do so. Nothing could stop him. I wish everyone had that kind of doctor.

All of this makes me think that people with disabilities are not at risk. They will decide for themselves, they will have the same rights and responsibilities as people who do not have disabilities and for whom death is foreseeable.

I read that people are concerned that doctors will suggest medical assistance in dying based simply on a person’s disability. The very idea is repulsive, since doctors would not encourage patients to die. They would first try to relieve their pain and make suggestions for how to live with their condition. Beyond that, according to the bill, it is not up to the doctor to decide, but the patient. Doctors assess the situation and the request. Their role is not to suggest but to inform. It is the patient’s role to request and suggest.

I also read that some people believe that opening up medical assistance in dying to people with disabilities might suggest that their lives are not worth living. I have read and re-read the bill, and nowhere does it say that the life of a person with a disability is not worth living. Did anyone here tell Stephen Hawking that his life was not worth living? Did anyone tell any of our Paralympic athletes that their life was not worth living?

I am getting worked up because I have a little cousin who suffers from severe cerebral palsy. She barely speaks, but when she wants something, she knows how to make herself clear. She will never be able to request medical assistance in dying. Given her personality, I am convinced that, even if she could speak, she would not request it, because she is a ray of sunshine, because she is the person in our family who always believes that everything is good, everything is right and, at the end of the day, we can get through whatever life throws at us. I love her. She makes us see the beauty of laughter and closeness.

Although her life is complicated, it is certainly worth living. Therefore, saying that the bill is suggesting that the lives of people with disabilities are not worth living is yet another despicable point that was made.

The bill’s preamble states that life and the dignity of seniors and people with disabilities must be respected and that suicide must be prevented. I agree. To deny people with disabilities who are capable of making the choice the right to decide whether to receive medical assistance in dying is to deny them their dignity. Are we prepared to do that?

That amounts to treating these people as if they were less important, as if they were incapable of making decisions because of their disability. The very idea is repulsive to me.

Not everyone with a disability will request medical assistance in dying, just as not everyone without a disability will request it. Medical assistance in dying is an exceptional measure. It is not the rule. It is a choice that is fundamentally personal and that should not in any way be imposed by another person.

Some called in particular for the withdrawal of the 10-day wait period for people whose death is foreseeable.

Once again, I have very personal reasons for supporting that withdrawal.

I had an aunt who was quite the character. She spent five years fighting cancer and receiving treatments, some of them experimental. At some point, she could no longer stand it, and asked for medical assistance in dying. Because of the 10-day wait period, she died the day before she was to receive the drug to help her die—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

I am sorry, but the time has expired.

The Parliamentary Secretary to the Minister of Justice.

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

Madam Speaker, I thank the member for Beauport—Limoilou for her speech, and I would like to congratulate her for highlighting the autonomy of people with disabilities.

I would just like to add that the two people at the centre of the Truchon and Gladu ruling that we are discussing today had disabilities themselves, and the judge recognized their autonomy in making choices.

We have heard several times that our government made a mistake by not appealing the Truchon and Gladu ruling to the Supreme Court. When a provincial superior court decision is well developed, carefully analyzed, rigorous and clearly articulated, should we appeal the ruling to the Supreme Court, or should we take action, as our government is doing, to protect the dignity and autonomy of vulnerable people?

[Julie Vignola, Bloc, Beauport—Limoilou, QC]

Madam Speaker, I thank my colleague for his question.

I am not a lawyer. However, in this case, a superior court handed down a ruling to address an unfair and unjust situation, where a right was taken away from people who were supposed to be treated equally. In my humble opinion, continuing the legal proceedings would only have added to the impression that these people are separate and different. They are full citizens, and they are entitled to be given our consideration and included in our reflections.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, the member mentioned that, in her opinion, there does not seem to be two classes of Canadians coming out of this. In the previous bill, there were two requirements: grievous and irremediable suffering, and reasonably foreseeable death. This bill would remove the reasonably foreseeable death requirement, therefore creating two classes of citizens. An individual who is suicidal and has no grievous and irremediable suffering would be given the host of services Canada provides to prevent suicide. A person who has a grievous and irremediable issue would be eligible for MAID.

Does the member not see that this bill would create two classes of citizens?

[Julie Vignola, Bloc, Beauport—Limoilou, QC]

Madam Speaker, I thank my colleague for his question.

Nowhere in the bill does it say that someone who is suicidal can access MAID. On the contrary, the bill states that someone with a degenerative disability would have 90 days to reflect on their decision and would have the necessary support to ensure that they are not in a state of distress. The necessary safeguards are there to ensure that someone in a state of distress would get the help they need. Furthermore, the request may be denied if the assessment indicates that the problem lies elsewhere.

These are the same reasons for which mental health is not covered. We must start by providing support for mental health problems without giving people with mental illness access to MAID. A good assessment and good support are the safeguards in this bill.

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

Madam Speaker, my hon. colleague said that there is no way that a handicapped or disabled person could be given medical assistance in dying without their consent because, of course, they would write it on a piece of paper. Would the member not agree that there could be a number of factors put in there, from being put under pressure to feeling like they are a burden on society? Would the member not agree that there need to be protections to ensure that people are not being affected by other factors to ask for medical assistance in dying?

[Julie Vignola, Bloc, Beauport—Limoilou, QC]

Madam Speaker, I have said it once and I will say it again: Yes, it is important to ensure that individuals make a free, informed decision and that they not be coerced. That is why the bill calls for a 90-day waiting period and support from a social worker.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, before I get started, I will let you know I am splitting my time with the member for Markham—Stouffville.

Today, I have the opportunity to participate in this debate on Bill C-7 from my riding in Guelph. Before I get going on the debate, I would like to recognize that Guelph is situated on the ancestral homelands of the Anishinabe people, specifically the traditional territories of the Mississaugas of the Credit First Nation.

I am proud our government has brought forward a bill that proposes changes that respond to the Superior Court of Quebec's September 2019 Truchon ruling. The proposed changes were informed by concerns and issues raised during consultations earlier this year in discussions with provincial, territorial and indigenous partners. As a result, we have had careful consideration of past experience with MAID in Canada.

I recognize medical assistance in dying is a deeply personal and complex issue. I have heard extensive feedback from my constituents on this topic as recently as this morning. During today's debate, we are hearing very personal stories from MPs that are very similar to what we heard when we first brought forward the legislation in Bill C-14. There are arguments for and against, which we need to recognize and look at.

Some of my constituents who have shared their support for these amendments and the swift passage of this bill have noted to me the importance of dying with dignity, as well as consistent and equal accessibility for all Canadians, as part of what our legislation needs to provide.

Earlier this year, I had a constituent reach out to me and share her personal story regarding medical assistance in dying. She told me that she felt very strongly about this issue because her husband of 56 years, John, had passed last December after four years of battling an illness and how appreciative she was that we had taken some first steps toward addressing these issues. She told me about the vibrant man John was, with a big heart, a successful career and an impressive education. She told me they had conversations about getting old together and how they would deal with aging, but these discussions did not include suffering or what might happen if the pain became too great. As John's illness progressed, he was moved into a long-term care facility where he spent the rest of his life. It was there that she saw so many others who were unable to be independent. She was saddened to see there was no dignity for these people, or for her husband John, as they were no longer able to look after their own personal needs. I saw this myself with my mother as she went through care in her last 10 years of life. The story of my constituent was one that conveys the importance of providing a diverse end-of-life option for Canadians that will help them provide the right decisions to be able to end their days with dignity, comfort and peace of mind.

Of course, there are two sides to this debate. I have heard from other people and received a lot of feedback that they understand we are coming at this as a deeply personal and sensitive topic for everyone, but are concerned these new amendments may impact the disability community, something we have discussed in the debate today, and the conscience rights of medical practitioners or our work toward improving palliative care. They all really do stitch together. While I am sympathetic to these concerns, I am also pleased to see our new legislation strikes the right balance of autonomy and protection of vulnerable people. This is thanks to many disability advocates who have participated actively throughout the consultation process, including specific round tables that focused on issues faced by the disability community. As was mentioned earlier in the debate, 300,000 people had input throughout the month of January 2020 to help us get to where we are today.

Additionally, our law specifically acknowledges the conscience rights of health care providers and the role they play in providing medical assistance in dying. These new amendments do not make changes to these rights and I know we will continue to work with provinces and territories to support access to medical assistance in dying while also respecting the personal convictions of health care providers.

However, the most common concern I have heard from my constituents is the need to prioritize palliative care over medical assistance in dying.

It is really the end-of-life care that we are talking about in both cases. In palliative care, Canadians are approaching the end of their life, and they deserve to receive care in the setting of their choice and to live out their days in comfort and dignity. They also deserve the freedom to make this fundamental decision about life and death without fear of their personal choice being obstructed by politics or government.

In Guelph, we are very blessed to have a wonderful palliative care facility that has been growing over the years as people recognize this as an option towards the end-of-life care that they are looking for.

However, 70% of Canadians are left without access to adequate palliative care. We have the responsibility to act in the interests of patients and their families, which is why our government supports access to both palliative care and medical assistance in dying. End-of-life issues are as diverse as Canadians themselves, and these issues also change throughout the course of medical needs and procedures that are available.

It is our responsibility as a government to provide as many options as possible for Canadians, so that they can take these deeply personal choices and make them on their own. That is why our government has worked collaboratively with partners, such as the provinces and territories, to develop a framework on palliative care. To support this framework, our government is implementing a targeted action plan that will help to improve access to palliative care for underserved populations; support families, health care providers and communities; and look at the funding that is needed to be able to execute our plans.

I would like to take this opportunity to thank Hospice Wellington and its executive director, Pat Stuart for the amazing work they do to support our most vulnerable citizens, including through palliative care.

I would also like to thank the constituents of Guelph who have personally reached out to me over the last several months to share their feedback, suggestions and personal stories around medical assistance in dying. I look forward to continuing to engage with my colleagues on this important subject and with my constituents, so that we can work to create a system that is responsive to the needs of patients, and creates an environment that can create comfort and reassurance for patients and their families.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Madam Speaker, I wish to thank my hon. colleague for his perspective on this issue. Indeed, I want to thank all of the members from both sides of the aisle who have shared on this deeply important topic.

My concern, and the member raised it, as did several of the previous speakers, is about the concerns expressed by the most vulnerable in our society, the disabled. They wrote, one month after the Truchon decision, to the Attorney General, 72 groups of them, pleading that this case be appealed to the Supreme Court for several reasons, that would buy time for a proper consultation process as part of the review, and that their voices would be further heard.

Could my hon. colleague please comment on why this process has been chosen superior over the voices and wishes of 72 representatives of the disabled community?

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I thank the hon. member for Chatham-Kent—Leamington, where we also have family members. As we have these discussions, we do see the cross-ties across Canada as we look at these issues.

The disability community is involved with the consultation process and will continue to be involved. We are reacting to the Superior Court ruling from Quebec, where we do need to look at some amendments. When we can get those in place, we will do the further review of Bill C-14, which will include the broader issues the member has mentioned.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, I will continue on in this vein.

I am concerned that the bill creates two classes of Canadian citizens: one, where if they are attempting suicide, suicide prevention measures will be given to them; and, two, another class of citizens who have a grievous and irremediable condition and who will be offered MAID.

Is the member not concerned with the two classes of Canadian citizens?

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, similar to colleagues on both sides of the aisle, I do not see this as an issue of dividing Canadians, I see this as an issue to be able to reach all types of Canadians, coming from different experiences and different health needs. We will be addressing the needs of all Canadians through this bill, as well as through ongoing legislative review of this legislation.

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

Madam Speaker, I know that my hon. colleague is a sincere man. That is why I was very disturbed by something I thought I heard him say, about some people at the end stage of their lives, that their lives were simply not dignified. Who is he to say that their lives were not dignified?

Would the member state unequivocally that all human lives, regardless of what condition or how they are at the end of their lives, are always dignified?

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I apologize if I left that impression with the hon. member. All life is dignified in Canada.

When my mother was passing away in Winnipeg I spent her last few days with her. Family members were looking at the question of how long to keep the machine going. My mom, in a moment of lucidity, came back to me when my brothers and sisters were out of the room and she said to me, “It's part of my decision as well, dear.”

The people who make those decisions have to be dignified and respected, so that their decisions are included in the legislation. In fact, this legislation is central to their decisions and not the decisions of family members or others.

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

Madam Speaker, what concerns me is that I have been in the House for many years, and twice now we have had to respond to court decisions in regard to end-of-life legislation.

I brought forward, in the previous Parliament, a motion for a palliative care strategy that received support from every member of Parliament. I heard many of my Liberal colleagues get up to say great things about it and then we never saw any action on it. The concern I have is that, in all of the work I have done with palliative care groups across the country and with people I knew very closely who have died, the will to live is so incredibly strong.

What we do not have ever, it seems, at the federal level is the willingness to make sure that we have standards in place to ensure the dignity of people in their final days and months, to ensure there are proper pain medications, supports and strategies in place. Here we are once again talking about amending the right-to-die legislation, but we have never ever gotten serious about responding to Parliament's call for support for people who want to die with dignity at their own time through palliative care.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I do not mean to talk down to the hon. member across the way because I would not do that.

The courts make decisions that then come back to Parliament so that we can review the decisions we have made on legislation to see whether further amendments are needed. This is a case where a court is telling us that there are further amendments needed. We agree with the court and are going forward with Bill C-7, so that we can make the amendments to try to satisfy the needs of the—

The House resumed consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Mr. Speaker, I am pleased to rise today to discuss Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying, or MAID.

As a physician, I took a keen interest when Parliament passed federal legislation in June 2016 to allow eligible Canadian adults to request medical assistance in dying. This was subsequent to the February 2015 Supreme Court of Canada ruling that parts of the Criminal Code would need to change to satisfy the Canadian Charter of Rights and Freedoms.

At the time, I was also a member of the provincial parliament in Ontario and was involved in how that province would ensure people would have their personal choice of access to medical assistance in dying, while also ensuring the conscience rights of health care providers would be respected. The actual implementation of MAID was our responsibility and was very carefully considered.

Working with provincial organizations like the College of Physicians and Surgeons of Ontario, we established policies to ensure that, should physicians have conscientious objections to administering MAID, systems were in place to provide appropriate care options to the patient. Consistent with the expectations set out in the college's professional obligations and human rights policy, physicians who decline to provide MAID due to a conscientious objection must do so in a manner that respects patient dignity and must not impede access to MAID.

They must communicate their objection to the patient directly and with sensitivity, informing the patient that the objection is due to personal and not clinical reasons. They must not express personal moral judgments about the beliefs, lifestyle, identity or characteristics of the patient. They must provide the patient with information about all options for care that may be available or appropriate to meet their clinical needs, concerns and/or wishes, and they must not withhold information about the existence of any procedure or treatment because it conflicts with their conscience or religious beliefs. They must not abandon the patient and must provide the patient with an effective referral. Physicians must make the effective referral in a timely manner and must not expose patients to adverse clinical outcomes due to a delay in making the effective referral.

While there is importance in ensuring widespread access to MAID, the law specifically acknowledges the conscience rights of health care providers and the role they may play in providing medical assistance in dying. As a physician who spent all of my time in clinical practice doing my best to preserve life, I feel this balance is working well, and the amendments proposed in Bill C-7 do not make any changes to any of this.

As a government, we remain committed to working with provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

What are the amendments that Bill C-7 proposes?

In response to the Superior Court of Quebec's Truchon decision, it repeals the MAID eligibility criterion that applies when a person's natural death is reasonably foreseeable. The criterion is the 10-day reflection period. One concern at the forefront is to ensure that measures are in place that provide safeguards for the MAID process. I believe Bill C-7 does precisely this. It proposes to create two sets of safeguards that must be respected before MAID is provided. For persons whose natural death is reasonably foreseeable, the existing safeguards, as amended by Bill C-7, would continue to apply. For persons whose natural death is not reasonably foreseeable, the existing safeguards with additional safeguards would apply.

I think we are all aware of the concern about increased risks where MAID is provided to persons who are not dying in the short term. That is why additional safeguards would apply where a person's natural death is not reasonably foreseeable. With these new safeguards, specific attention with respect to both time and expertise would be devoted to assessing requests for MAID and to ensuring those making the request are made aware of and seriously consider all other available means of relieving their suffering, including palliative care. In nearly half of the reported MAID deaths in Canada to date, the practitioner providing MAID had in fact consulted with at least one other health care professional in addition to the required second opinion from another practitioner. There is no question these practitioners are taking their responsibilities very seriously.

For those whose death is reasonably foreseeable, Bill C-7 most importantly proposes to eliminate the 10-day reflection period, which many practitioners say can prolong unbearable suffering.

The proposed amendments of the bill will allow waiver of final consent for persons whose natural death is reasonably foreseeable, who have been assessed and approved to receive MAID and who have made an arrangement with their practitioners for waiver of final consent because they are at risk of losing decision-making capacity before their chosen date to receive MAID.

We have heard many touching stories during the course of debate on this bill and situations like that of Audrey Parker, who chose to access MAID on November 1, 2018, despite her desire to see Christmas with her family. She feared that she would lose her capacity to give full consent before Christmas and so she requested MAID before then. Considering her case, we see the need for this amendment in real human terms. Ms. Parker, herself, stated:

I would like nothing more than to make it to Christmas, but if I become incompetent along the way, I will lose out on my choice of a beautiful, peaceful and, best of all, pain-free death.

Since the Truchon decision, our government has engaged in extensive consultations. Beginning in January of this year, over 300,000 Canadians took the time to participate in an online questionnaire on the subject. It should be noted that as part of this questionnaire, direct questions were asked about final consent for MAID. The following question was asked:

Imagine that a person makes a request for MAID, is found to be eligible, and is awaiting the procedure. A few days before the procedure, the person loses the capacity to make health care decisions, and cannot provide final consent immediately before the procedure. In your opinion, should a physician or nurse practitioner be allowed to provide MAID to a person in these circumstances?

Over 78% of participants said yes, that a person in these circumstances should be allowed to receive medical assistance in dying.

In addition to the online questionnaire, the Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion hosted a series of 10 in-person round tables across the country, from January 13 to February 3 of this year. These round tables allowed the ministers to hear from over 125 experts and stakeholders, including doctors, nurse practitioners, health regulatory bodies, key health stakeholders, legal experts, civil organizations and, of course, the disability community.

The ministers also hosted a separate round table focused on receiving specific feedback from indigenous practitioners and community leaders.

The importance of palliative care continues to be raised in these discussions. Our government recognizes the need for quality and appropriate palliative care, which is why it has worked collaboratively with partners, such as the provinces and territories, to develop a framework on palliative care. To support this framework, our government is implementing a targeted action plan, which will help to improve access to palliative care for underserved populations and support families, health care providers and communities. In addition, our government is providing $6 billion in federal funding directly to provinces and territories to support better home and community care, including palliative care.

There is no question that MAID is a very important consideration for all of us. This is an issue about which all Canadians care. I know in my riding of Markham—Stouffville, it is a concern that a significant number of my constituents have shared with me. This matter is extremely complex and further discussion will be needed during a future parliamentary review of the previous Bill C-14.

There is a medical aphorism attributed to Sir William Osler, a Canadian who is considered the father of modern medicine and internationally recognized, that says that a physician's duty is to “cure sometimes, relieve often, comfort always.” Our MAID legislation provides comfort to those facing death. For now, let us move forward with Bill C-7 and provide compassionate care to those in need.

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

Madam Speaker, if I heard right, I heard the member say that she had practised previously as a physician. She also expressed the view that the requirement in Ontario for effective referral was consistent with conscience protection. That is the view she expressed.

If the member happened to be practising medicine in a jurisdiction that allowed female genital mutilation, would she be willing to provide an effective referral for someone seeking that service?

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Madam Speaker, I fail to see how the example given by the member opposite relates to Bill C-7.

What I am saying is that the relationship between patients and their practitioners is one that should be based on trust and clear communication and that health care providers should always do their very best to provide that type of compassionate care to their patients, and to discuss the matter as necessary and refer individuals to specialists in the particular area. This is the normal practice of medicine.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Speaker, the Bloc Québécois was the first to introduce a bill on this matter. I am thinking of two of our members, who have now passed on. One is Francine Lalonde, who introduced a bill on this topic, and the second is Father Gravel, who was bullied by certain religious lobbies, which even wrote to the Vatican to have him removed from his position and driven out of the Catholic Church. I will spare you the details, but that was not easy for him. I will think of these two, who are dear to my heart, when we vote on this bill.

I thank my colleague for her speech. Does she not think that we need to address the notion of advance consent, which is not in this bill, as quickly as possible?

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Madam Speaker, the whole issue around the advance directives, which I think my colleague opposite was referring to, is one that comes up in conversations with my constituents. A number of Canadians are very concerned about the possibility. In most of the conversations I have had people are in favour.

Bill C-7 at the moment is taking one step forward. This is a good improvement to the existing legislation. As I understand it, there may very well be a parliamentary review of the existing Bill C-14 and I have no doubt that these types of discussions will occur at that time.

[Darren Fisher, Liberal, Parliamentary Secretary to the Minister of Health]

Madam Speaker, I know the Audrey Parker situation so well and I want to thank the member for putting those words into Hansard one more time, because they are so important as it pertains to Bill C-7.

I wonder if the member could tell me her personal opinion on whether the bill provides the level of safeguards that the Canadian public will be comfortable with and need?

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Madam Speaker, I believe the required safeguards are there. Clearly there is a balance between individual choice and the fact that there could be perhaps some second thoughts in discussion with an individual, a change of heart in essence, as to what the individual might choose to do. There is the 90-day period of reflection. The assessment is very thorough. There is nothing in Bill C-7 that endangers those safeguards. We have them under the current legislation and they are preserved in this bill.

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

Madam Speaker, it really amazes me how quickly we have gotten here. The 2015 election was five years ago today. One of the first issues we dealt with in that Parliament was a new law that legalized euthanasia. The government came up with a new term for it, calling it medical assistance in dying. At that time, the then minister of health and the then minister of justice said that it was a finely-tuned balance where there was the right mix of safeguards and opportunities. Of course, as a result of the SNC-Lavalin scandal, both of those ministers were kicked out of the Liberal cabinet and the Liberal Party, but they along with their colleagues said that this was a necessary balance that was struck.

What was built into the process as well was a legislative review five years later. However, the government jumped the gun on that legislative review. It said that before the legislative review, it would remove some of the safeguards that were thought to be vital less than four years ago and would do that ahead of any review. The fig leaf the government used to do that was the Truchon decision in Quebec. This decision dealt with a very specific issue, the question of reasonable foreseeability.

It was a political choice for the government not to appeal that decision because it did not want to. It wanted to be able to justify, ahead of the timeline set by the legislative review, moving forward with the removal of safeguards that it had said quite recently were vital. Then it packed into the legislation a number of critical changes that had absolutely nothing to do with the content of the Truchon decision.

My colleagues have spoken eloquently about the specific issues around removing reasonable foreseeability and the concerns raised by people in the disability community. I want to focus on the aspects of this legislation that have absolutely nothing to do with the court decision to which it is supposedly responding.

This legislation will bring us, for the first time, three things about which Canadians should be very concerned. First, it will bring us same-day death, the opportunity to receive death on the same day a person requests it. Second, it will bring us death without contemporaneous consent. It will bring us a situation where people will have their lives taken without being consulted in the moment. Third, it will bring death without the presence of independent witnesses.

I am opposed on all three counts. I do not think we should have same-day death. I do not think we should have death without contemporaneous consent or any kind of contemporaneous consultation. I do not think we should have death without independent witnesses present.

Let us talk about same-day death. Right now there is a 10-day reflection period. Let us be very clear that the law already allows that reflection period to be waived in certain circumstances. The waiving of that reflection period is not a long, arduous process. If the physicians involved say that because of the particular circumstances in this case that the 10-day reflection period should be waived, that 10-day reflection period can be waived, but it is a default. It says that on balance, except in exceptional circumstances, the 10-day reflection period between when a person requests death and receives it is a reasonable frame of time. I think we can all understand that people who are going through challenging circumstances and major changes in their lives will feel intense feelings of pain, suffering and angst in a moment. Those are real sincere feelings, but they might feel differently in a different space with a little time and opportunity for reflection.

I would like us to be the kind of country where if people say that they have had enough and that they want to die, instead of being told okay, let us do it right now, they are told that we have this mechanism of review of consideration, take that time and even that review process can be waived. That is eminently reasonable.

What we do not want in the country is a situation where I might go visit an elderly relative on Wednesday and seems totally fine. Then I come back on Friday and find that the person requested death yesterday and received death on the same day. We should leave in place a default of a 10-day reflection period. It is not only members on this side of the House who feel that way. I raised the question during questions and comments before prorogation. Even the member for Richmond Hill said that he supported leaving in place the 10-day reflection period.

I know other Liberals believe this as well, and I would challenge them to do the right thing and recognize the need for this amendment to remove same-day death. It just is not safe. It is dangerous. It is rife with abuse. It does not allow people the time and space to consider carefully in consultation with family members. The 10-day reflection period can be waived, but it is an important default to have in place.

Secondly, we have a proposal on this legislation, and it has nothing to do with the Truchon decision, for death without contemporaneous consent. What this means is that a person could say in advance, “I want you to take my life on December 31, and if I don't have capacity then go ahead and take my life anyway.” There is no requirement in this legislation, on that future date set, for there to be any kind of consultation with the patient. In other words, a person, in whatever state of mind, could not even be told. They could have something slipped in their coffee without being told in advance. They could have their life taken without being asked in the moment.

Members are giving me looks. They should look at the legislation. There is no requirement in the legislation for the patient to be told what is happening while it is happening. I would, at a minimum, propose we amend the legislation to say that if somebody has provided advance consent, that at least at the moment the action is happening the person administering it be required to tell them what is happening, and that the person is given the opportunity to, in that moment and regardless of their state of capacity, be able to offer some kind of objection if that is the way they feel. There is nothing in the legislation, as it is written right now, for a person to be told what is happening or asked their opinion in any way in the moment their life is being taken.

I do not believe that, as a matter of principle, it is consistent with the ethics of choice and autonomy for my past self to be able to bind my future self. Garnett Genuis on October 19, 2020 might want a future version of myself to behave in a certain fashion, but that future version of myself should still have autonomy to make choices that contradict something that my past self wished for, especially in cases where disease and disability are involved where people adapt to circumstances. They adapt in ways perhaps they do not expect.

The third point I want to talk about is that this legislation would bring us death without independent witnesses. It would remove a requirement for independent witnesses to be involved. I just do not see the purpose of that. Why not leave in place a requirement for independent witnesses? It ensures there are not abuses.

When I finish my remarks, I am going to be sharing my time today with the excellent member for Peace River—Westlock.

People advancing this legislation say it is about choice. I would say, in the context of choice, let us recognize the context and the architecture in which choice is made and let us protect people's ability to make a genuinely autonomous choice. Is that fair enough? Is same-day death consistent with giving people real choice, that the moment they ask for death they receive it right away, or is it more consistent with choice that they have the time and the space to reflect?

Is it consistent with choice to remove the requirement for contemporaneous consent? I do not think so. Is it consistent with choice to remove independent witnesses who can verify what is happening?

Same-day death, death without contemporaneous consent and death without independent witnesses are moving us in a dangerous direction that will leave people vulnerable. In the government's defence of this legislation, it says it held lots of consultations and that virtually everybody it talked to agreed with it. I doubt it. We have already had over 400 physicians sign a letter raising objections to this. We have had a joint letter sent by many faith leaders from different communities across the country. We had over 70 representatives from the disability community come out against this bill.

May I say that the government runs consultations that involve loaded questions: questions that presuppose a particular result. One of my colleagues once talked about another consultation the government did as being like a dating website designed by Fidel Castro. When one asks loaded questions, there will be no meaningful result to the consultation. We are going to have what we have right now, which is hundreds of physicians and dozens of leaders from the disability community speaking out.

Finally, is it not sad that the only time we talk about palliative care in the House is when we are bringing in more euthanasia and removing vital safeguards? That is the only time the government pays lip service to palliative care. It is so eager for assisted dying but it is taking no action on assisted living, and it does not appreciate that if people do not have proper assisted living and palliative care available, then they do not have a meaningful choice. People have read the reports about what is happening with seniors care in this country.

People do not have a meaningful choice when they do not have access to the care that they want and need. Let us do more for assisted living, instead of removing vital safeguards that protect people around the assisted dying regime.

[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]

Madam Speaker, I must say right at the beginning that numerous members of Parliament, at least on the Liberal benches, have talked about the importance of palliative care. It has been incorporated in many ways, whether in budget issues or the throne speech.

When we talk about this particular piece of legislation, the member is upset over two or three aspects of it. I can appreciate that. I suspect the bill will eventually get to committee and in a minority situation, the member will be afforded the opportunity to bring forward ideas and changes that he would like to see with the legislation.

Would the member not agree that having this discussion, and having it go to committee, is a good thing to do? In regard to input, at the beginning of the year over 300,000 Canadians provided input on this legislation.

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

Madam Speaker, I already spoke about the flaws in the government's consultation process. If this bill gets to committee, I certainly look forward to the opportunity to raise these amendments around removing the provisions dealing with same-day death, around removing the provisions that deal with death without contemporaneous consent, and around removing provisions that deal with death without independent witnesses. I hope government members and members of other parties will listen to those proposals, recognizing that those aspects of the bill have nothing to do with the court decision that this bill is supposedly responding to.

The member is right to say that Liberals often speak about palliative care during debates about expanding euthanasia. However, what I have failed to see is action. How about they bring forward legislation on palliative care? How about they bring forward legislation on improving access to assisted living, instead of paying lip service—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

The hon. member for Jonquière.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, I listened carefully to my colleague's speech. He shared a number of concerns, but I have to wonder what is behind them.

All members know that this bill is based on principles, and I think principles are behind his concerns. My colleague should know that our own personal principles should not violate someone else's principles. This is even more important in the case of dying with dignity. We cannot force our religious beliefs on others who may not necessarily share those beliefs.

One part of my colleague's speech about choice stood out to me. He said that people should have autonomy to make choices. I would remind the member that the word “autonomy” derives from the two Greek words “auto” and “nomos”, meaning “to be ruled by one's own laws”. It is up to an individual to decide whether to end their own life. It seems to me that any attempt to impede that decision would be made under false pretences.

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

Madam Speaker, I would welcome the opportunity to speak with my colleague at great length, perhaps outside of the House, about our religious views and how all of our basic a priori assumptions about human dignity and human value may inform things we are talking about.

We might find ourselves agreeing on the importance of some application of autonomy. I do not think removing the requirement for contemporaneous consent is consistent with autonomy. I do not think that if a person, at a low moment, says they want to die today, removing any possibility of a reflection period is consistent with autonomy. The values of autonomy should engage people in expressing their considered judgment over time with all the information in a situation where they have alternatives.

If we tell someone their only choice is between living in a cockroach-infested facility and death, they are more likely to choose death than if they are given a real, humane, living with dignity alternative. Let us agree on the importance of autonomy, but let us recognize that the architecture of choice informs the choices that are and are not available to people. We can do better by giving them a context in which to make a life-affirming choice, if that is what they wish.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Madam Speaker, we are not leading the way with this bill. We are already lagging behind. Hundreds of people have been dying in needless pain for years. We have the opportunity to take a step forward and let people die with dignity. It is not about moving from a cockroach-infested room to a clean one. It is not the same thing. People are prisoners in their own bodies and suffering needlessly.

Why should they not be able to make that decision?

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

Madam Speaker, the member referred to court decisions. Again, the focus of my remarks was on aspects of this legislation that have nothing to do with court decisions. I want us to remove same-day death, to remove death without contemporaneous consent, and to remove death without independent witnesses. I think all three of those are reasonable changes, and none of them would interact with a court decision that was made.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, it is my honour and privilege to join this debate today, though it is a sad one for me. I remember coming to this place. We passed Bill C-14 right off the get-go. It is where I cut my teeth in politics, I would say. At the time, we mentioned that this was a slippery slope. We had seen it in the Netherlands. Currently the government there is passing legislation to allow children under the age of 12 to be euthanized. They are working with what's called the Groningen protocol, where it is not the individual but a group of doctors making the decision as to who gets to live and who gets to die. Here, we saw that this erosion of protection began virtually as the ink was drying on the original bill. We have seen the government not uphold the wishes of this Parliament. We have seen a junior court strike down the law, calling it unconstitutional.

This is where I have some frustration. The ink was not even dry on the bill when it was being challenged in the courts. It had just passed through the House of Commons. It is incumbent upon the executive branch of government to defend the decisions of this place, whether the government agrees with a court or not, and this was a brand new law that had just been thoroughly discussed in this place. We had worked hard for the amendments. For the government to abandon all the work we had done and decide that a junior court decision stood and that it was not going to appeal it to a higher court, like the Supreme Court, was an abdication of the executive branch's responsibility, and I definitely want to acknowledge my frustration that the government did not appeal this court decision.

That said, this bill is much broader than the court decision, and I would argue that we continue down the slippery slope. When Bill C-14 was introduced, I remember talking about the slippery slope and being assured it was not a thing. Yet here we are, removing safeguards from the bill.

This bill definitely makes two classes of Canadians. Across the country, we see a big emphasis on suicide prevention. Every level of government in this country has suicide prevention strategies. We see community groups getting together to run hotlines. Facebook has a warning system to help folks who are considering suicide. Facebook will even identify them and notify people who are close to them that their friend is not feeling well. The American military has worked with Facebook as well, to identify veterans who are considering suicide. We see throughout Canadian society that there is very much a focus on preventing suicide.

Where does that comes into play in this bill? It would create two levels of Canadians. In one case, there are able-bodied, otherwise healthy people suffering from mental illness who are considering suicide. All of those suicide-prevention apparatuses come to their aid. We even have bridges in this country that have nets to catch people in case they jump. All of that stuff comes to the aid of those particular people. However, for sick people who have a grievous and irremediable condition, that stuff is optional and they can request death. They can go to their doctor and say they are not feeling well and are suffering, and that their grievous and irremediable condition has affected their mental health and they are having suicidal thoughts. Then suddenly they are eligible for assisted suicide.

This creates two classes of people. If they are otherwise healthy, suicide prevention is granted to them; if they have an underlying grievous and irremediable condition, they are eligible for, as the government likes to call it, medical assistance in dying or assisted suicide. That is what this bill would do.

Prior to this bill, there was a requirement that a person's death be reasonably foreseeable. I remember that when we were discussing this, we found it to be kind of nebulous. What did that mean? There was no timeline on it. I remember we said that for a death to be reasonably foreseeable, it would have to be in six months or within a year. Those were amendments we brought forward. The government did not go for them back then. Now we see the courts are taking that off and the government is not even defending it. That is definitely one of the concerns we have. We are creating two classes of citizens: one for which suicide prevention is available and one for which it is optional.

The other thing I want to talk about is an amendment we brought to the original bill, one that I think would be an improvement on this bill. It is the need for video verification. In the current rendition of the bill, the timelines have been reduced or eliminated altogether, from the time of the request to the time when MAID is administered. There is a concern that family members may not be convinced that their loved one requested MAID and that they were giving consent at the moment thereof. There has been a suggestion by some groups that there be a video recording of the administration of MAID. That is an amendment I would seek at committee. We would definitely like to see something like this.

Lastly, we would like to see the government work to enhance assistance in living. With COVID, many of our old folks in seniors care facilities are not able to see their loved ones because of restrictions on movements and not being able to travel. The military had to be called in to deal with some of the situations. We talk a lot in this place about dying with dignity, but maybe it is time that we started focusing on living with dignity, having a dignified life, taking care of our elders and being part of a family.

I have talked to folks who have been working in the old folks homes lately and it has been a rough job. They say the loneliness is a major issue in old folks homes these days. The loneliness leads to mental health issues, and if those mental health issues are not addressed, people will become suicidal and will request MAID for loneliness. Is that what we really want in this country? Assistance in living is something we have to be concerned about.

This also deals with palliative care. Palliative care is something the government pays lip service to. We have called for national strategies on this. We have called for money to be put into it. In the absence of palliative care, there is no real choice. There is no ability for somebody to say that this is what they are choosing. Palliative care is an acknowledgement that while there is, humanly speaking, nothing more we can do, we can make a person comfortable and allow them to be surrounded by friends and family as they leave this earth. We would very much like to see the government pursue a significant improvement in palliative care, rather than allowing the elderly members of our families to vanish into an old folks home, where we are not allowed to visit them at this point, to die of loneliness and be offered MAID as the first available option.

This bill has many concerns. It is the first evidence of the slippery slope that is happening in the euthanasia debate, and I definitely wanted to raise that concern. I am also concerned that this bill creates two classes of citizens, as I clearly outlined. I am looking forward to the government making some amendments to the bill and look forward to being able to participate in those discussions at committee.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Madam Speaker, of course, no one is going to disagree with improving the lives of our seniors through better palliative care, but the soft paternalism that ran through those comments is completely fabricated, as though if we just focus on assisted living and just provide additional support, nobody in any position is going to want to end their life and exercise personal autonomy and individual rights. There are individuals who are suffering intolerably, people who are of sound capacity and mind to make decisions about their own lives. They are suffering from an effectively incurable illness and some members want to take those rights away.

My question is simple. Has the member read the Supreme Court's unanimous decision in Carter, and if he has, what about the criteria established for eligibility does he disagree with?

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, I was pointing out that with Bill C-14, we entered a slippery slope, as the safeguards had been removed. Bill C-14 is the law of the land. I am merely pointing out that we are now removing the reasonably foreseeable requirement. We are not improving the safeguards at all with the bill. In fact, we are removing safeguards. In the absence of palliative care, in the absence of a true choice, that leaves folks with no choice at all.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Speaker, I believe that two of my hon. Conservative colleagues in a row have spoken to us about palliative care and care in long-term care facilities, such as CHSLDs in Quebec. It seems to me that they are trying to sidetrack the debate. We are talking here about medical assistance in dying. The two are not related. They seem to be saying that, if we had better palliative care services, then there would be no need for this bill. That does not make any sense.

However, if they want to go there, then I would tell my hon. colleague that his party was in office from 2006 to 2015 and the provinces were not granted the increased health transfers that the Quebec and other provincial premiers are calling for. In fact, the Conservatives made cuts to those transfers. It seems to me that this party, which is lecturing us on palliative care, had a role to play in the fact that the provinces do not have enough money to manage their jurisdictions.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, I would say that is fake news. Under Stephen Harper, health transfers actually increased. Under Stephen Harper, the sovereignty of the provinces was improved. Under Stephen Harper, the separatist movements across this country were diminished, both in the member's province and in my province. Under the current government, divisions run deep across this country and separatist movements are growing not only in his province, but also in mine.

[Eric Melillo, Conservative, Kenora, ON]

Madam Speaker, as I mentioned earlier in this debate, unfortunately in a lot of the rural and remote communities and the many indigenous communities in my riding, and I imagine in the hon. member's riding as well, there is not an equitable access to health care services. That includes palliative care, unfortunately, in many circumstances.

I am wondering if the member could speak to how important palliative care and all these health services are for every single Canadian.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, across Canada palliative care is inconsistent. We are looking for some guidelines from the federal government on what palliative care should look like, with standardization across the country. We want funding to be dedicated to it. We also want the conscience rights of folks and organizations working in health care to be protected. In the Delta Hospice Society case, for example, the provincial health authority is forcing its ideology upon a hospice that is quite convinced that MAID has no place whatsoever in hospice care.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, I am delighted to speak today to Bill C-7, an act to amend the Criminal Code, medical assistance in dying. Its proposed Criminal Code amendments to the medical assistance in dying regime are a true reflection of the value we as Canadians ascribe to individual autonomy.

I wish today to address a specific aspect of Bill C-7, which is the exclusion from eligibility for medical assistance in dying, or MAID, of those whose sole underlying medical condition is a mental illness. This is an aspect of the bill that has already attracted some attention, and I am grateful for the opportunity to make these remarks to provide context around the government's choice to not extend medical assistance in dying in this area at this time.

The government has heard from various sources that there are unique risks and complexities associated with medical assistance in dying on the basis of mental illness alone. These include the report of the Council of Canadian Academies' expert panel on medical assistance in dying where a mental disorder is the sole underlying medical condition, as well as the experts the ministers consulted in recent round tables on medical assistance in dying.

In this Canadian-made context, very specific concerns have been raised in relation to mental illness, those illnesses that affect how a person perceives themselves, their environment, their place within it and sometimes their future. The first main concern is that the trajectory of mental illnesses is harder to predict than that of other illnesses. Unlike some dementia and intellectual disabilities, the underlying causes of mental illness remain largely unknown. Mental illnesses can spontaneously remit or can be difficult to treat for years until one treatment or one social intervention works and improves quality of life, reducing that person's suffering.

For example, we learned from the Council of Canadian Academies' report that an important percentage of persons living with borderline personality disorder will see their symptoms go away as they age, and some people with problematic substance use disorders also spontaneously remit. Experts disagreed on whether a mental illness can ever truly be considered incurable. Indeed, the Canadian Mental Health Association has indicated, “CMHA does not believe that mental illnesses are irremediable, though they may be grievous or unbearable [and] there is always the hope of recovery.”

A second main area of concern is that the desire to die can be a symptom of some mental illnesses. Here I address specifically the concerns just raised by the member for Peace River—Westlock around suicide. I acknowledge and recognize his sincere concern. Having a mental illness is, indeed, a significant risk factor for suicide.

This underscores the difficulty of assessing the voluntariness of a MAID request from a person who may be experiencing a desire to die as a symptom of mental illness. Some practitioners also raised the concern that an expanded MAID regime could negatively impact suicide prevention efforts if MAID were a legal option in response to suffering caused by mental illness alone, both at the level of public messaging and at the individual clinical level.

The Council of Canadian Academies' expert panel also noted the particularly troubling situation of suicide rates in indigenous populations. This is an issue that concerns us all deeply. It was the expert panel's view that the potential impact of MAID where a mental illness is a sole underlying condition, if any, on suicide prevention efforts must be explored more deeply with indigenous people.

By contrast, there are other conditions affecting the brain that do not raise these same concerns. For example, the trajectory of cognitive impairments such as Alzheimer's, Huntington's Disease or other neurodegenerative diseases is more easily predicted, in large part because the underlying pathology is better understood.

Intellectual disabilities are a permanent state and there are no concerns with an unpredictable illness trajectory or a person's perception of their place in the world being affected. Indeed, many do not consider such conditions to be a mental illness or mental disorder. While they may raise other concerns, these are likely more properly addressed by assessments of decision-making capacity.

On the other hand, those who live with mental illness can experience unimaginable suffering and even physical pain. There is no question that the suffering that some with mental illness endure can be intolerable. Some who suffer from both physical and mental illness have said that, if they were able to choose, they would easily choose to endure the physical pain if the mental anguish could end. It is understandable that there is no consensus on this issue.

The group of experts the Council of Canadian Academies recruited could not agree on several fundamental questions, including whether it is possible to have a valid and reliable method of distinguishing between suicide and an autonomous decision for medical assistance in dying where a mental illness is the sole underlying medical condition.

A subset of the Council of Canadian Academies' expert panel, the Halifax group, recently recommended that the MAID regime should not exclude persons whose sole underlying medical condition is a mental illness. Instead, there should be a legislative requirement that the decision to die be well considered to ensure that a MAID request is well thought out and not impulsive. Others say that to exclude those with mental illness only perpetuates stigma and discrimination.

On the other hand, another subset of the Council of Canadian Academies' experts, the expert advisory group on MAID, recommended that the MAID regime acknowledge that, at this time, it is not possible to determine that a mental illness is irremediable or that a state of decline due to a mental illness is irreversible. Therefore, persons whose sole underlying medical condition is a mental illness could not fulfill the current MAID eligibility requirements.

Given these diametrically opposed points of view from experts, it would not be prudent to permit eligibility for medical assistance in dying where a mental illness is the sole underlying medical condition at this time without more study and deliberation.

We, as legislators, are not experts in mental illness. Let us, instead, take the time to listen closely to what experts have to say on such an important topic, where the consequences of a decision are irreversible.

The parliamentary review will provide an opportunity to hear from experts and others, and allow parliamentarians to carefully consider, without the time pressure of responding to the Truchon decision, whether and how medical assistance in dying could safely be extended to persons whose sole underlying medical condition is a mental illness.

The government understands very well that mental illnesses can and does cause intolerable suffering. By excluding persons whose sole underlying medical condition is a mental illness, we are not seeking to send a message that this suffering is lesser, that persons struggling with a mental illness cannot make decisions for themselves, or that their autonomy to choose when and how to die matters less.

Instead, we are taking a pause and acknowledging that this very complicated question needs more time, careful consideration and requires us to proceed prudently. The Province of Quebec is adopting a similar approach, though not through legislative amendments. I think this is wise, and we will be paying close attention to the consultations taking place in that province as well.

[Eric Melillo, Conservative, Kenora, ON]

Madam Speaker, the member mentioned mental illness quite a bit, however, he did not go into a lot of detail.

Does the member believe that if someone's sole underlying condition is mental illness, they should be able to receive MAID?

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, I thank the member for the question, although I think that was the full focus of my speech, the contention that people whose sole medical condition is a mental illness should not be eligible for MAID at this time.

We absolutely need to consider this. It is a very complex issue. We need to consider it much more thoroughly than we have the ability or capacity to do at this time in response to the Truchon decision.

I would refer the member to my speech. We will happily consider the matter very rigorously as we go forward.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Madam Speaker, my Liberal colleague's position is quite fair. We in the Bloc Québécois also agree that those whose sole medical condition is a mental illness should not be included in this bill.

This is such a sensitive matter, I think it is important to send a clear message that we are capable of moving forward in our reflection.

We must not sweep this under the rug because that would be dangerous, as my colleague, the member for Montcalm, has already said. We need to be able to get ahead of this, rather than waiting for the courts to tell us what to do.

Aside from looking at what Quebec is doing, I would like to hear my colleague's thoughts on how we too can start proactively reflecting on this.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, we know that part of the original legislation for medical assistance in dying provided for a review at the five-year mark, and we are coming up to that time. It is very important we exercise that opportunity to look deeply into questions of this kind and canvass them very thoroughly, because it is, as the member noted, a very serious and delicate question. It is very complex.

We need to examine all aspects of it, as well as the other aspects of medical assistance in dying, to make sure that as we move forward we can adapt and move forward correctly on this very important bill.

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

Madam Speaker, I found this was a very challenging speech. I appreciate the member's thoughtfulness in approaching the issue, which this bill does not touch. It is important to confirm for Canadians that, in looking at the new version and the amendments, mental illness is not to be considered an illness within the context of medical assistance in dying.

Does the member think that we will evolve our understanding of certain kinds of mental illness? It seems to me that he is suggesting that we may in fact revisit this topic in the future.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, yes, I absolutely believe the proper place to deal with this question is during the more fulsome review that should be forthcoming. It is certainly my understanding that mental illness, as a sole underlying factor, would exclude a person from the regime of medical assistance in dying.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I was glad that the member brought up mental health conditions. He was very attentive to the language being proposed in this legislation and how we would deal with it going forward. This piece of legislation goes much further than Justice Baudouin mentioned in her judicial decision where she struck down section 241.2(2)(d) specifically on death being reasonably foreseeable. I do not have a question for the member. I just want to bring this up and hear his commentary on it.

“Reasonably foreseeable” was something I criticized in the last Parliament when this was being debated. I could foresee this exact situation in which different reasonable people could interpret it in very different ways. We already see this going on all over the country. Different provinces have interpreted it differently in their health systems. I want to hear the member's commentary on that.

In this debate so far, people have mentioned incurable diseases. The minister mentioned it as well. Three of my living kids have an incurable disease called Alport syndrome. It leads to a chronic kidney condition, and in the case of males, it will eventually require a kidney transplant. In most cases it is also associated with the underlying risk of depression and social isolation. It is incurable today. That does not mean it will be incurable tomorrow.

Diseases change and their statuses change. Things that were incurable 100 years ago and were considered lifelong conditions change over time as medical technology catches up. Our knowledge matches the necessity of the time we live in. That is my commentary on the member's speech.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, my understanding on this bill regarding a trajectory for an immediately foreseeable death is that, in some cases, the requirement has been reduced, but in other cases, it remains in place. It depends on the nature of the person's underlying condition.

I certainly look forward to what I am sure will be a robust debate on medical assistance in dying when the review happens. I had the honour to participate on the Standing Committee on Justice and Human Rights when the original bill was brought forward. I certainly recognize some of the questions we are dealing with now we also dealt with then, and we did the best we could. It is very helpful that in light of experience and court decisions, we can review those decisions. It is a great opportunity, as we move forward, to embrace fully the upcoming review.

[Martin Shields, Conservative, Bow River, AB]

Madam Speaker, I very much appreciate the commentary that I have heard from my colleagues about this very significant issue today.

One of the things I remember doing in a past life is working with doctors on “do not resuscitate” orders. It became very difficult for doctors, whose oath it is to save lives, to have this type of discussion. They would do anything to get out of a “do not resuscitate” order. They did not want to touch it or undo it, because they were ending up with all sorts of complications with family members and relatives. All sorts of different things would happen with this type of situation.

Does my hon. colleague feel the legislation would protect mental health with what is basically a “do not resuscitate” order in a different language?

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, I would like to first note that medical assistance in dying and a “do not resuscitate” order are fundamentally vastly different concepts.

In any event, I believe the checks and balances that are currently in the legislation around mental illness will prevail as we go forward, because this bill would not extend medical assistance in dying to people whose sole underlying condition is mental illness. That is an important distinction and it is a very important one to consider fully and robustly as we go forward. I refer all members to the opportunity that will present itself as we review the totality of the medical assistance in dying regime at its legislated juncture.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, it is a real pleasure for me to be joining the debate today, from my riding, on Bill C-7. I find myself in a unique position because, having given a speech on this very same bill earlier this year, I see we now find ourselves still at second reading for what, I would argue, is absolutely the most important piece of legislation we have before us at this time.

I was also one of the members of Parliament who had the honour of participating in the previous debate on Bill C-14 during the 42nd Parliament. I can remember very much the debates that went on in 2016 and the amount of attention that was given to that piece of legislation. We had an expert committee. We had a special joint committee. There were many hours spent, both in the House of Commons and at the Standing Committee on Justice and Human Rights, on that important piece of legislation because it made a monumental amendment to the Criminal Code in recognition of a very important Supreme Court ruling that forced Parliament to finally take the necessary action.

I remember, during that time, we in the New Democratic caucus ultimately voted against Bill C-14, but we always took the time to explain to people that we were ultimately supportive of what the overall aims of the bill were. Our major problem of the time was that the bill was too restrictive. I remember very well in 2016 referencing a particular section of the bill that I knew would be challenged by the court. Lo and behold, here we are in the year 2020, and we are revisiting that problematic section and having to fix a mistake that was made very clearly four years ago.

It is good to see Bill C-7, and it is good to see that we are complying with challenges that were made before the courts, this time coming in response to the Truchon decision by the Superior Court of Quebec. I know that we are operating under quite a tight deadline. That being said, I still think Parliament has to do a full job on this bill. As parliamentarians, whether we support the legislation, have problems with it or are opposed to it, we owe it to the people of Canada to give this debate as full a discussion and time as Bill C-14 had.

At this time, in particular for the benefit of the people of Cowichan—Malahat—Langford, it is important to underline why we are here discussing this. It really centres on the Charter of Rights and Freedoms, notably sections 7 and 15.

I am increasingly seeing section 7 as probably the most important part of the charter or one of the most important parts, because so many cases seem to be coming forward that directly reference section 7. I know it it is open to interpretation, but if we go along with successive court rulings, my own personal view on the subject is that it is a very important section because it is ultimately making the case that every person in Canada has the right to autonomy over their own body. That is why it is such an important section. If we truly believe in the rights of individuals to make decisions for themselves over what goes on with their own bodies, section 7 is incredibly important. It is really life, liberty and security of the person. That is the part that has to be underlined.

We also have to mention section 15 of the Charter of Rights and Freedoms, which guarantees quality before and under the law and makes sure people are free from discrimination. Why those two sections have such an important bearing in this case is that this bill is trying to make sure people have the right to say what goes on with their own bodies and that in making that decision they are not going to be discriminated against.

I have been listening to the debates on Bill C-7, both from the previous week and today. I acknowledge that many members are bringing forward some concerns with the bill, and I understand and want to validate those concerns. I do not believe we have to make the debate on Bill C-7 an overly partisan issue. That is why I made the comment at the beginning that it is important that all members of Parliament, no matter what party they belong to, be given the chance to fully air their views.

I believe the bill passes muster at second reading and deserves a vote of confidence at this stage of debate, because if there are particular sections of the bill that need further attention, that work is best done at the Standing Committee on Justice and Human Rights.

I fully understand that many members have raised concerns about the removal of safeguards. I have heard many members talk about the state of palliative care in Canada, whether there is enough being done with suicide prevention and so on, and I am very sympathetic to those. I think every member of Parliament, no matter what part of the country we are fortunate enough to represent, can relate to those concerns. We can relate to the concerns that we have received through email correspondence, letters, phone calls and speaking with our constituents face to face.

I am lucky enough to have a hospice undergoing major construction right now. There is a new hospice being built in the Cowichan Valley. I am really glad to see that the level of palliative care in my home riding is going to be significantly better than it was, but of course more can always be done.

Ultimately what is guiding me in this is that it is quite impossible for me, as a member of Parliament who is lucky enough to have his health and not have a grievous and irremediable medical condition, to really understand the level of suffering some individuals in Canada go through. When we are talking about the bill, the struggle we have before us is to not subject other people to our own values, whether those are guided by religious beliefs or the way we were raised and so on. It is quite impossible for people who are healthy and lucky enough to have all of their faculties to understand what the day-to-day life existence is of people who are suffering from one of these incurable and irremediable medical conditions.

Therefore, what is guiding me and members of the New Democratic caucus is an overall goal of trying to ease that suffering, to respect those people's section 7 rights and to understand that they should have the ability to live their lives in dignity and make a determination as to how they want to exit this world. I know it is an uncomfortable debate for many people to have, but that is what is going to be guiding me through these deliberations. I hope it is something all members can take note of.

Following on the speech my colleague, the member for Esquimalt—Saanich—Sooke, gave the other day concerning the legislative review that was part of the former Bill C-14, I want to draw the attention of members to the fact that this was a requirement of Bill C-14. The member for Esquimalt—Saanich—Sooke has put forward a proposal through his private member's motion, Motion No. 51, that will establish a special committee to look at how the legislation is doing. That is something Parliament can easily do while we are deliberating the provisions of Bill C-7. The creation of such a special committee to look at how Bill C-14 has been enacted over the last four years is really important.

This goes back to my first point that, yes we are operating under deadlines, yes we have had people waiting for some time, but, ultimately, it is critically important that we let Parliament deliberate this issue to the fullest extent possible.

With that, I conclude my remarks and look forward to any questions my colleagues may have.

[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]

Madam Speaker, I think it is important for us to recognize that, at times, inside the chamber some very difficult debates take place. However, the importance of this legislation cannot be underestimated. Over the last number of years, through consultation, through a court decision, we have come to this point, and I think we are on the right track.

The member made reference to palliative care, and a number of members have made reference to the importance of palliative care. I wonder if he could provide some further thoughts in terms of how the federal government's role in palliative care could make a difference in terms of quality of life for seniors across the country.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I will first acknowledge that the delivery of health care services does fall under provincial jurisdiction, but that being said, I have always been an advocate for a strong, federal leadership role in health. After all, we do have some control over health policy through the Canada Health Act.

The real opportunity for the federal government is to make sure that every part of Canada, no matter what province someone finds themselves residing in, has access to the same kinds of standards nationwide. I think that is the real strength of the federal government. It is to make sure that someone living in Prince Edward Island can access the same level of care as someone in my beautiful province of British Columbia.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Mr. Speaker, I certainly appreciated what the member had to say, and I am especially excited to hear that he has a new hospice being built in his riding. However, I am sure he is aware that 70% of Canadians have no access to palliative care right now. It is contravening in my mind to think that we are somehow saying to people that they have this choice and here is another choice, but, truthfully, one of them does not exist.

As well, I am sure the member is aware that the Delta Hospice has lost its funding and is losing the ability to run the hospice on the basis that the government has said that it must provide euthanasia along with palliative care, yet the Canadian Society for Palliative Care Physicians has indicated that these are antithetical and totally separate. I am wondering if he is aware of what is going to be happening with the hospice that he just mentioned being built in his own riding.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I have been very fortunate to have a good working relationship with the team that has been behind the Cowichan Hospice over the last number of years. Of course, our community is absolutely overjoyed to see the project moving ahead and seeing that it is going to be such an important part of going forward.

In the 42nd Parliament, the House passed a motion expressing that more palliative care was needed. However, when it comes to the difficult decisions that are made over where the funding goes, I would draw the member back to the importance of individual rights as outlined under section 7. Ultimately, our focus needs to be on patients and ending unnecessary suffering, which is why I drew such importance to section 7 when it comes to these important decisions.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Mr. Speaker, I want to thank my colleague for his speech. I listened closely and he was sensitive and respectful of all the ways to look at this bill and of all the MPs who might be opposed to it. I think that is the way to approach this type of issue.

We experienced that in Quebec City. The leadership of Véronique Hivon led to a multi-partisan consensus at the National Assembly, resulting in smooth passage of the bill for the good of our constituents.

We know that we are taking a step in the right direction with this bill. My hon. colleague and his party think that we should go further. How much further does he think we should go?

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I do not want to presuppose the work that is going to be done at committee and that is why I placed such important emphasis in my remarks about getting this bill to committee. The committee study of this bill has to be very detailed and there has to be a very broad cross-section of witnesses to inform our work as parliamentarians. I am sure there will be quite an extensive list of witnesses who wish to speak to this bill. I hope members of the committee will take note of what is heard at committee, deliberate in an appropriate manner and report the bill back, something that reflects the importance of all of the deliberations.

The House resumed consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, I apologize in advance if there is noise in the background; it is either traffic or my kids, so I have chosen traffic.

I want to start first by speaking to what is at stake with Bill C-7 and with the medical assistance in dying framework overall. What is at stake fundamentally is, first, alleviating intolerable, cruel suffering. The Supreme Court and other courts have spoken about the cruel choice that individuals face in the circumstance where they have a sound mind, they are of capacity and can make these decisions themselves, where they are suffering from an illness that is not going to go away and when they are suffering in an intolerable way. Forcing that suffering upon individuals is cruel and we have to be cognizant of the fact that this is first and foremost about alleviating suffering, but it is about alleviating suffering within the context of empowering and respecting one's personal autonomy.

This is fundamentally about individual rights, and our job fundamentally is to respect those individual rights, to protect those individual rights, to ensure that we end suffering in the course of protecting those individual rights and to make sure that we fulfill the promise of section 7 as it has been interpreted and upheld by our courts, not only in the unanimous Carter decision by the Supreme Court, but also by other courts, like the Alberta Court of Appeal and more.

Now, this bill is important, because it addresses a long-standing concern with Bill C-14. It addresses the concern that we had not answered the call from the Supreme Court adequately. We had added an additional criterion unnecessarily. We had basically said that if people are suffering intolerably and they can absolutely make this choice for themselves, they have capacity, and they have an irremediable condition, an effectively incurable illness, they cannot access this regime if they are not near the end of life or there is not path dependency, but they know the trajectory they are on, even if they are already intolerably suffering.

That, obviously, was unconstitutional. The courts determined that to be so. The government rightly opted not to appeal that decision, and here we are.

Importantly, we have actually gone beyond what the court has mandated in pursuit of individual rights and respect for our charter, as we have said in the case of Audrey Parker, a woman who chose to end her life earlier than she had wanted to. She wanted to get through the holiday season, but she also did not want to lose capacity and then lose the option. She did not want to lose ability to end her life and her suffering. She did not want to lose the possibility of death with dignity, so she chose to end her life before she wanted to. Thankfully, we have actually gone above and beyond what the court has mandated us to do, and we have provided one form of advance request to ensure that individuals, like in Audrey's case, do not end their life before they would like to.

This bill, on those two fronts, is positive. There are some challenges. That is not going to stop me from supporting this legislation at second reading, but it does give one pause. I think we, as parliamentarians, have to be very careful about adding additional exclusions to accessing the MAID regime. That is what this bill would do, unfortunately. I have heard others speak to the issue of mental illness, and there are reasons to proceed cautiously, but there are not good reasons for blanket exclusions. In fact, we potentially render the bill unconstitutional with blanket exclusions, just as we did with exclusions in Bill C-14.

I hope at committee there is expert testimony on this piece, and I hope we get this right. I will give an example specifically on mental illness. In 2016, there was a case at the Alberta Court of Appeal. A woman, identified as E.F., had capacity, she was suffering intolerably, it was irremediable, she had consulted with her family and she had made the decision to end her life. She was able to do so, thankfully, because of the Alberta Court of Appeal applying the Carter decision by the Supreme Court. If the federal justice department had gotten its way in that case, it would have read down Carter to mean only terminal illness. Of course, they said that is not the case. Then we saw, through Bill C-14, that our government tried to impose that kind of criteria, and the court subsequently struck it down. The justice department lost that leg of the argument.

Then, in E.F., they put forward the argument that it could not be an underlying psychiatric condition on its own, but that is exactly what E.F.'s was, an underlying psychiatric condition. The court said that this underlying psychiatric condition, which manifested itself in great significant pain in the documented evidence, did not affect her capacity to make a decision. She was of sound mind.

In E.F., the Alberta Court of Appeal went beyond that. As to the consideration whether MAID should be available to people with mental illness as their sole underlying condition, the Alberta Court of Appeal, in E.F., said that the Supreme Court, in Carter, had canvassed this conversation, this discussion and this concern. Unanimously, they had determined that it was not an additional exclusion. It was not a factor to exclude, and not an additional criterion for eligibility, for those with mental illnesses and those with physical illnesses, so long as they meet the specific criterion of an irremediable condition of intolerable suffering and that they have capacity. It may be that one is depressed, or it may be that one is suffering from a mental health issue such that it impinges upon one's capacity to consent, but in other cases it clearly does not. In E.F., it did not. The justice lawyers lost that case, yet here we are.

In Bill C-14, the government added an additional criterion of close-to-terminal illness and reasonably foreseeable death, and it was struck down. Here, the justice department is adding that second argument from E.F. that it already lost in the courts, and is adding a blanket exclusion for mental illness. As a matter of constitutionality, I would say that if this excludes the case of E.F., which it does, then it creates a ready constitutional challenge. I will be reading the Charter statement from the justice department very closely. I am not suggesting that we do not proceed cautiously, but a blanket exclusion on mental health, when there is a case like E.F. before the court, is likely to render this law unconstitutional, and that has to be addressed by the committee.

The second piece I want to flag is the two tracks. If one's death is reasonably foreseeable, then there is no additional track. There is not even a 10-day waiting period. That 10-day waiting period has been waived, although there was not great concern even with that 10-day waiting period. There is this dual track now, if one's death is not reasonably foreseeable, where one waits 90 days. This is what we are telling people in those circumstances. I have spoken to family members who are affected by this, and they are absolutely challenged by these circumstances when one is already intolerably suffering: They are suffering from a condition that is not going to go away, and they are making this decision themselves, having capacity. If we respect personal autonomy at all, surely a fundamental life decision like this is one that we have to respect, and we are telling these individuals that they have to wait another 90 days, and not just suffer but suffer intolerably for another 90 days. It is inexplicable that we are asking people to suffer intolerably for that length of time. Those are the two specific issues that need to be addressed at committee in a serious way in order to make this bill not only constitutional, but to make it the best bill that it can be.

I wish we had dealt with this last item, because the idea of constantly revisiting this conversation instead of just getting it right for Canadians in need is frustrating. I mentioned Audrey Parker, and we are addressing one type of advance request. However, I do wish that, in the course of this legislation, we had answered the second type of advance request, in which an individual has been diagnosed and is not yet suffering intolerably, but that future is not so far away. Those individuals should also be in a place where they can make an advance request, if we are to respect their autonomy and respect their wishes.

I just wish politics did not get in the way. That is what this is. This bill is a cautionary step. It does not go as far as it could because of politics. I know Conservative members will say it goes too far and others will say we have to be concerned about vulnerable Canadians. We know we can protect vulnerable Canadians and respect people's individual choices at the same time, and I wish politics did not get in the way of alleviating suffering. I wish politics did not get in the way of respecting and protecting individual rights. We like to say we are the party of the Charter. I wish we carried through that promise and demanded greater respect for individual rights in the course of Bill C-7.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Speaker, I have been getting phone calls basically on both sides of the issue. I am having some people, as our colleague said, saying it is not going far enough. Other people are saying that it is going way too far.

I would like to talk about one of my constituents, Carol, who had a very respectful conversation with me. She totally respects the rights of physicians who do not want to participate, and people who do not want assistance in death. However, she has some concerns about advance directives, and my colleague touched on this. His comment at the end was very important. He said it is important that we get it right.

As far as advance directives, does the member actually think that this piece of legislation in front of us today addresses those, and does he feel that it is still supportable?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, it is supportable, particularly at second reading. The Council of Canadian Academies identified three kinds of advance requests. One is as in the case of Audrey Parker, which I mentioned, where someone not only is diagnosed but is already suffering intolerably. This bill would address that issue, and I am glad that it would.

The second issue, which I think is easy to address and has been recommended up and down by every expert who has looked at this, is when one has already been diagnosed but is not yet subject to intolerable suffering. We ought to provide an advance request for that as well. We could address it with sunset clauses if folks are concerned.

The third issue is when someone has not yet been diagnosed. I would argue that we could probably get there, but I think, at a minimum, we should address the second advance request where someone has already been diagnosed, but is not yet suffering intolerably. That would have been a relatively straightforward one to address. Given the time period we have had, especially in the course of COVID, I wish this had been better addressed in this bill, as well.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Mr. Speaker, I want to begin by acknowledging my colleague's ability to focus and to find work-life balance in these difficult times. I would also like to commend the progressive values that he brings to many of his interventions, including at the Standing Committee on Industry, Science and Technology and in the current debate.

I wanted to address the end of his speech and give him a chance to elaborate.

Does my colleague agree with the possibility of granting the right to waive final consent in cases where natural death is unforeseeable? How might we further facilitate this step for the victims of this mechanism?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, the advantage of any view that respects personal autonomy is that one is not tied to a decision one has made: one can always revisit it. The importance of advance requests is that people might lose capacity. If one is suffering intolerably, as in the case of Audrey Parker, but is so worried that she is not going to be able to make a decision to end her life and access death with dignity because she might lose capacity, then we, of course, need an advance request and that is exactly what this bill would provide.

As for the second category, where an individual has been diagnosed and has not yet begun to suffer intolerably, when they have made it very clear that this is what they want as a matter of personal autonomy, we have to respect that as well. Of course, if we are to respect personal autonomy, one can always withdraw when one has the capacity to do so.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Mr. Speaker, my colleague's comments were very thoughtful and certainly resonated with me. My father-in-law is currently in a situation where he cannot give consent any longer. He is trapped in a situation that we know he would not want to be in, so a lot of the comments the member brought forward really resonate with me.

At the beginning of his comments, the member talked a lot about intolerable suffering and the need to alleviate that intolerable suffering. I am wondering if he could talk a bit about where we came up with the 90 days.

Where did the Liberal government come up with 90 days as the amount of time we should make people wait, in intolerable suffering, before they can get relief?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, I can honestly say I have no idea, and I do not think the 90 days are justified in the end. I think the committee should examine this timeline and correct it. I hope, when this bill comes back to the House for third reading, that we have avoided the blanket exclusion for mental illness. If need be, we can add a sunset clause to that provision to give the government more time, if necessary, but I hope we avoid the blanket exclusion indefinitely. Second, I hope that we cure that 90-day period and reduce it significantly. We cannot possibly want Canadians who are still of sound mind to suffer intolerably for such an extended period of time.

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, it is a privilege to have this opportunity to rise and speak on Bill C-7, an act to amend the Criminal Code (medical assistance in dying).

Not long ago, we in the House debated the merits of Bill C-14. I was a member of the justice committee when the committee was seized with doing that. That opened the door to physician-assisted death in Canada.

I want to begin my speech today with the same words that I used to open my speech on that bill:

I believe in the sanctity of life, and I believe that all life, from conception right through to natural death, has value, has worth, and has purpose.

A pastor friend of mine told me a story that had happened just prior to the passing of Bill C-14 in 2016. A woman the pastor knew who had battled stage four cancer for 10 years, savouring every moment of that time with her grandbabies and family, was told by one of her care workers, “I bet you cannot wait for the assisted-suicide bill to pass.” The pastor recalled the desperation in her tears when she called to recount her story, asking, “Has my life only become a burden to society?”

After the legislation was in effect, another woman was reunited with her childhood sweetheart and engaged to get married when her fiancé discovered that he had stage four cancer. Together they mustered up every possible hope for a future together, only to have their hopes dimmed by repeated offers for medical assistance in dying.

As the House now considers an expansion of MAID, I think it remains vitally important that the worth of every person is reaffirmed and underscored. It must be our priority in this place to remind every Canadian that they have value regardless of their age. They have value regardless of their ability. Their dignity is not determined by their suffering or their autonomy. It is intrinsic. It is inherent. Their lives are worth living.

I think these statements are important, because the reality is that every time we talk about expanding access to MAID, we send a troubling message to those who may be vulnerable: the idea that, if certain conditions or factors are present, somehow a person's life has less worth; the idea that ending a person's life is a mere medical decision among any number of medical decisions.

Expanding eligibility cannot be about removing safeguards and fundamentally redefining the nature and role of assisted death. This bill intends to offer assisted dying to individuals who are not dying, whose lives are still viable. This is a contentious issue that has been raised by multiple legal voices because assisted death was previously sold as an option only when death was imminent, or reasonably foreseeable.

In just four short years, we have embarked beyond that final stage of suffering. The whole health care system is feeling the pressure for acceptance of MAID, says Nicole Scheidl. Doctors and medical staff are feeling this pressure. Scheidl adds that the most terrifying thing about MAID is how it will impact the future of medicine, as only doctors comfortable with MAID will go into medicine, unless perhaps some provision is made for conscience rights.

Cardus executive vice-president Ray Pennings warns us that Bill C-7 does not take the protection of conscience rights seriously. He writes:

Conscience rights are Charter rights...including the rights of medical professionals not to participate in MAID in any way and the rights of hospices and other institutions not to cause the deaths of people in their care.

There are other valid concerns as well: psychological suffering in combination with other permanent injuries potentially justified under MAID, the elimination of the 10-day waiting period, the requirement for only one independent witness as opposed to two, the waiving of final consent, and also that a witness cannot be a primary caregiver.

Even in its current form internationally, MAID raises flags. When the United Nations Special Rapporteur on the rights of persons with disabilities visited Canada in 2019, she noted that she was extremely concerned about the implementation of MAID from a disability perspective. She flagged that:

there is no protocol in place to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assistive dying.

She highlighted:

...claims about persons with disabilities in institutions being pressured to seek medical assistance in dying, and practitioners not formally reporting cases involving persons with disabilities.

Her advice was to:

put into place adequate safeguards to ensure that persons with disabilities do not request assistive dying simply because of the absence of community-based alternatives and palliative care.

Instead, Bill C-7 goes the opposite direction in order to expand eligibility.

Let us not forget that every choice we make has a ripple effect of different magnitudes. Mother Teresa once said, “I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” The world can be changed for better or worse. When vulnerable people start feeling like they are only a burden to society because of our actions, we need to consider what kind of culture we are creating.

Kory Earle, the president of People First of Canada, a national organization representing people with intellectual disabilities, expresses his concern that everything is already more difficult for people with intellectual disabilities, including exclusion, isolation, housing, resources when abused, education, securing jobs, social lives and finding friends. He further adds that even their word in court is not considered credible. Mr. Earle explains, “everything, and I mean EVERYTHING, is more difficult for people with intellectual disabilities. Many, many other things should be made easier. This [assisted death] is not one of them.”

Passing Bill C-7 is sending a message that individuals with disabilities are no longer safe. This concern is echoed in a joint statement by over 140 lawyers who fear the perception this bill gives, if even unintentional, the perception that life with a disability is inferior and if ratified by law, we diminish the choice to live with dignity and exasperates systemic discrimination.

On top of this, Canada has tragic statistics around suicide. An average of 10 people die by suicide every day. Statistics reveal that nine of those 10 individuals faced a mental health problem or illness. I know and appreciate that those suffering solely from mental illnesses are not eligible for MAID under Bill C-7, but we are nonetheless sending a devastatingly mixed message.

The former Liberal member for Winnipeg Centre raised these concerns when we were first considering Bill C-14. As he observed the rash of suicides in several first nations communities at that time, he expressed concern that, “we haven't thought out the complete ramifications that a decision like this might have on indigenous communities that seem to be suffering greatly.”

In his speech, he shared one of his memories as a six-year-old child. His family was facing serious financial hardship, forcing his mother to go off in search of work. He and his younger brother were to stay with their father, who he described as “a residential school survivor, an alcoholic, and a member of gangs” with a “terrible temper”.

The rest I will quote directly from the former member. He said:

I remember climbing a tree in the back yard and wrapping a rope around my neck at the age of six... I wrapped that rope around my neck and thought, “Should I jump off into this universe, which is before me?” It was in that back yard that somehow I made the decision to climb down out of that tree and unwind that rope from around my neck.

If in my life I had seen, or I had known, that my grandmother had somehow used physician-assisted dying or physician-assisted suicide, or others in my family had completed the irreparable act, then it would have made it much more difficult for me to continue.

We must be mindful of the messages we send through this debate and always affirm life, but we must also do more than just offer words. We need to ensure that individuals facing end of life have access to the end-of-life care they deserve.

There are important questions we need to be asking to ensure those who are suffering truly have a choice between living well and pursuing MAID. For example, how do we better love those who live in unbearable pain, whatever form that pain takes? Feeling loved gives inherent strength to those losing hope. How do we show people how their lives teach us? How do their contributions strengthen us as individuals and a society? How do we instill in all people that they are not a bother, a financial burden or a disruption to deal with, but that their life is treasured? We must foster this type of society that affirms life and the pursuit of well-being.

As four physicians suggested in the National Post in response to the proposed legislation, increasing health care personnel, improving our quality of care, enhancing our palliative care options and ensure quicker access to psychiatric care would all be more advisable. Instead, we are “fast-tracking death on demand and dismantling the...[earlier] safeguards that were put in place to protect the vulnerable.”

We have all heard that only 30% of Canadians have access to palliative care and disability supports, which is possibly why there were 50 religious leaders who wrote an open letter urging us to consider that. It states:

Palliative care administered with unwavering compassion, generosity and skill expresses the best of who we are. Rather than withdrawing from those who are not far from leaving us, we must embrace them even more tightly, helping them to find meaning up to the last moments of life. This is how we build compassionate communities.

Furthermore, the joint statement by 140 lawyers explains that singling out non-life threatening illness and disability as eligibility criteria for assisted death—

[The Deputy Speaker, Conservative, Bruce Stanton]

I am sorry, we will have to finish there. The time has expired for the member's comments. He may be able to reflect on some of those ideas when he answers questions and comments.

Questions and comments, the hon. parliamentary secretary to the government House leader.

[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 remember quite well the former member for Winnipeg Centre and his speech on Bill C-14. One of the things I can recall from the Bill C-14 debate was there were a lot of examples, real-life stories. I say that because it is important for us to recognize the seriousness of the legislation we are debating. Ultimately it will go to committee, where there will be opportunities to have that dialogue and who knows what it will eventually come back as.

Does the member believe the bill is moving us in the right direction?

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, I do not believe the bill is moving us in the right direction. We should be strengthening the bill by adding additional safeguards for vulnerable people. It has been clearly demonstrated that people with disabilities are very concerned the bill does not go far enough to provide them the protection they are looking for.

I have heard from many health care providers, physicians, nurses and those who assist those health care professionals, who themselves are also health care professionals, express concerns that adequate conscience rights protections have not been built into the bill. It is something I have heard over and over in my riding and it is very important to health professionals. They want clearly articulated conscience rights protection inside the bill.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Mr. Speaker, I have a related question.

It is my understanding that, essentially, the member will vote against the bill for considerations that have more to do with religion and faith than with the bill before us.

When we talk about the right to life, and tell people that we have values, that dignity is intrinsic and that life is precious, does Bill C-7 not align with all that even though it is not perfect? With respect to their right to life and dignity, does a person who is suffering and who has an incurable disease not have the right to choose this solution after we have had a wide-ranging debate? Is that not a response? How is that not a response?

[Ted Falk, Conservative, Provencher, MB]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Brad Redekopp, Conservative, Saskatoon West, SK]

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

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

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

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

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

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

[Mario Simard, Bloc, Jonquière, QC]

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

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

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