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

[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.