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

[Maryam Monsef, Liberal, Peterborough—Kawartha, ON]

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

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

Mr. Speaker, I am pleased to add my voice to the debate on Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying.

I want to start by reminding all members that this is important legislation. We as parliamentarians have a court-imposed deadline of December 18 to pass this legislation. This legislation would help prevent the suffering of Canadians. Even there were no court-imposed deadline, we would have a moral obligation to see it passed.

I am really disappointed, to be frank, to see my colleagues across the aisle delaying the bill, increasing the chances that the government misses the court-imposed deadline and prolongs the suffering of Canadians in denying them the autonomy to choose medical assistance in dying.

I am very disheartened to see members of the Conservative Party of Canada continue their delay tactics to slow this legislation. I saw it at the justice committee and we are seeing it again now. We know that the majority of Canadians believe that MAID is a basic human right. More than 300,000 people participated in consultations earlier this year.

The Quebec Superior Court's deadline is now two weeks away as of today. Conservatives are now trying to undermine the urgency of the situation. They are ignoring the very real consequences that their inaction could have on those who are suffering in this country. I think it is also important to remind members where the content of this legislation came from and the process the government went through in January in developing this legislation.

Bill C-7 was informed by the Truchon decision itself, Canadian and international reports, the experience of existing international regimes, and the government's consultations on MAID held in January and February of this year.

I had the opportunity to participate in some of these round tables that were hosted across the country including in my home of Toronto, where I am speaking from, and in Winnipeg. In these consultations, our team spoke with 125 stakeholders including regulatory bodies, legal experts, doctors, nurse practitioners, representatives of the disability community, and indigenous persons and their representatives. They shared their experiences and insights into MAID and its implementation in Canada over the last four years.

In order to get a broader public perspective, the government also hosted an online public survey. It received over 300,000 responses from people across the country. The summary of the consultations was released in March as a “what we heard” report. Our government did its homework in the creation of this legislation.

I would like to take the time to explain to all hon. colleagues what Bill C-7 proposes to change in our MAID regime so that we all start from the same common understanding of the legislation before us.

There are four main aspects to the bill. The first aspect concerns eligibility criteria and these changes are fairly straightforward. The eligibility criterion requiring a reasonably foreseeable natural death would be repealed. As I have already described, this change would in effect adopt the outcome of the Truchon decision for the whole of Canada.

This eligibility criterion makes Canada's current end-of-life regime available only when a practitioner can determine with confidence that a temporal connection to death exists, with some flexibility. In Truchon, the Quebec Superior Court told us that this criterion violated the charter rights of people whose death was not reasonably foreseeable, people like Mr. Truchon and Ms. Gladu.

To avoid prolonging the suffering of the applicants and other Canadians in similar situations, our government decided to accept the decision and amend the act for all of Canada.

The legislation would continue to require a voluntary request and informed consent from a person with decision-making capacity. These cornerstones of autonomy would ensure that MAID could be safely provided to Canadians who deem it to be the solution to their suffering, while guarding against persons being pressured into seeking MAID. We trust that individuals know best for themselves when they can no longer endure suffering, regardless of whether their natural death is reasonably foreseeable. We are committed to respecting this very personal choice of Canadians.

The second aspect of the bill is the safeguards. The bill would use the criterion of reasonably foreseeable natural death to create a two-track system. Those whose death is reasonably foreseeable would continue to benefit from the current safeguards with two changes. First, the 10-day reflection period would be repealed and a person would only need one independent witness to sign a MAID request instead of two. That independent witness would be someone who is paid to provide health and personal care services to the person requesting MAID. These changes are intended to alleviate barriers to access and to reduce suffering.

We heard from medical practitioners that these did not serve as safeguards, but only unnecessarily prolonged suffering for individuals who had made up their mind. It also created issues of accessing MAID in rural and remote areas.

Those people whose death is not reasonably foreseeable would benefit from an enhanced set of safeguards. In addition to those safeguards required where death is reasonably foreseeable, practitioners would have to assess a person's MAID request over a minimum assessment period of 90 days. If neither of those two MAID assessors has expertise in the condition that is causing the person's suffering, they would have to consult a practitioner who does. That is pursuant to the amendment that was helpfully proposed by the NDP member for Esquimalt—Saanich—Sooke at committee. The person requesting MAID must be informed of the means available to relieve their suffering, including mental health and disability support services, and be offered consultations with professionals who provide those services. Both practitioners have to discuss those means of relieving suffering with the person and be of the view that the person has seriously considered those means.

In terms of the broad approach to the bill, the third aspect of Bill C-7 is that of the limited change around advance consent. This one is unrelated to changes in eligibility criteria, but instead seeks to address an unfair situation that arises when a person is approved for MAID but loses decision-making capacity and cannot consent to the MAID procedure immediately before it would be provided, despite the request having been approved and the procedure already planned. Members probably know the reason for this amendment best through the story of Audrey Parker, the Canadian woman whose case we heard so much about a bit more than a year ago who had to schedule her MAID procedure earlier than she would have wanted, out of fear of losing decision-making capacity before her preferred date to receive MAID.

In my view, Bill C-7 takes the right approach by proposing to allow the waiver of final consent only in cases where the person's death is reasonably foreseeable and only when he or she has already been found eligible for medical assistance in dying and is waiting for the procedure to take place, but risks losing the capacity to provide final consent.

According to practitioners and people like Audrey Parker, this is exactly the kind of situation that forces people to make a cruel choice if they risk losing their capacity to give consent before receiving medical assistance in dying. That is the one, very specific scenario this bill proposes to address, since it presents the least amount of uncertainty in terms of patients' autonomous choices and the least ethical and practical complexity.

I know this is an important issue for Canadians, and I am committed to working with all parliamentarians to begin the parliamentary review of the medical assistance in dying regime as soon as possible after Bill C-7 has made its way through the parliamentary process. I have no doubt that the issue of advance requests will be an important part of that review.

The fourth and final category of amendments that the bill proposes targets the monitoring regime. The changes would allow the collection of information in a wider range of circumstances, including information about preliminary assessments that might be undertaken before a request is put in writing. Consultations will take place before these regulations are amended. An amendment at committee based on an amendment proposed by the hon. member for Nanaimo—Ladysmith of the Green Party would require that the Minister of Health consult with the minister responsible for the status of persons with disabilities in carrying out their reporting obligations; again, another helpful amendment that was proposed at the committee stage.

Medical assistance in dying has always been a very difficult issue that generates a variety of opinions on all sides of the issue. It strikes deeply to all Canadians' personal morals and sensibilities. We understand this. As such, it requires different interests to be considered. I firmly believe that Bill C-7 does exactly that. The law will continue to require informed consent and a voluntary request made by a person with decision-making capacity, while also creating a more robust set of safeguards where the person's natural death is not reasonably foreseeable. These safeguards require significant attention to be paid to all of the alternatives that might help alleviate suffering on the part of a person whose death is not reasonably foreseeable. We believe such a regime can work safely by guarding against overt and subtle pressures to seek MAID, while providing autonomy to a greater number of Canadians to make this important choice for themselves.

I would like to return for a moment to the topic of safeguards, specifically when it comes to those whose death is not reasonably foreseeable. It is very important to remind members of this House what these safeguards are and why we believe that they are adequate.

This legislation proposes a distinct set of procedural safeguards that are tailored to the risks associated with assistance in dying for persons whose death is not reasonably foreseeable. Ending the lives of those whose suffering is based on their experience of their quality of life is different from offering a peaceful death when the dying process would otherwise be painful or prolonged, or would erode a person's sense of their own dignity. Bill C-7 therefore proposes a more robust set of safeguards where natural death is not reasonably foreseeable. Safeguards for those whose death is not reasonably foreseeable would be built around the existing safeguards, but contain enhancements over the previous Bill C-14, which was passed in the 42nd Parliament. Importantly, the medical assessments of a person's eligibility must span at least 90 days.

I mentioned this earlier, but I want to emphasize, as there appeared to be some confusion around this at the Standing Committee on Justice and Human Rights, and elsewhere. This period of 90 days is not a waiting period or a reflection period. This is not a requirement that the person wait 90 days after they are approved. Rather, it is a stipulation that practitioners must, over at least a period of three full months, fully explore the person's medical condition and the nature and causes of their suffering, and work with them to identify reasonable treatment or other support options they must discuss with the person. The person seeking MAID is not required to undergo any treatments. It would be an intrusion into the individual's autonomy to force them into any sort of treatment, but as we embark on this new expansion of the MAID regime, we believe we can collectively move forward safely, if we can be satisfied that available options have been brought to the person's attention and given serious consideration.

All of these safeguards reflect the irreversible nature of ending someone's life and the very serious nature of medical assistance in dying, which needs to continue to be strictly regulated, especially given the broadening of the regime. As stated by the Canadian Medical Association, which welcomed our government's staged approach, the proposed MAID amendments are “a prudent step forward”. Bill C-7 proposes to further support individual autonomy while also protecting vulnerable persons and ensuring that careful consideration will be given to those challenging issues. For these reasons, among others, I strongly encourage members of this House to support this legislation and to support its passage through this House and Parliament to meet the court deadline of December 18.

I also want to remind members of the upcoming parliamentary review. Through the course of the consultations, and then through the committee process, we did hear of a number of issues that need to be reviewed and addressed, but need more thorough study than could be done in the time required to meet the court-imposed deadline. Parliament will have ample time to review all of these issues, and I think it is important that we do so, but we need to get this legislation passed as well.

Bill C-14, from the previous Parliament, called for Parliament to conduct a review and specifically mentions the state of palliative care. We expect this review will also include important issues such as mature minors, mental illness as the sole underlying condition and advance requests. By no means would I expect this to be a closed list, either. This is a broad issue and we would hope to hear from many Canadians on a wide variety of subjects relating to MAID. Having heard from many witnesses and spoken to many Canadians on Bill C-7, I know there are diverse views on this issue. They are all difficult issues, and I look forward to the parliamentary review and hearing from many more Canadians on the subject and seeing what the review has to say.

As I said at the beginning of my speech, I am very disappointed and concerned by my colleagues across the way and their lack of respect for the court deadline imposed on us by the Superior Court of Quebec to pass this legislation. I believe we have an obligation as parliamentarians to do everything we can to try to meet the deadline of the court. Canadians want this legislation. Quebeckers want this legislation. I am really unclear on why my colleagues across the way are showing disrespect for the will not only of the court, but of all Canadians. They have been slowing and delaying debate unnecessarily, and I am very concerned by what this says about how much they value the rule of law and the will of Canadians.

I want to thank my colleagues who serve with me on the justice committee for their work on helping us in a smooth and efficient committee process on this legislation. I look forward to this House giving the same consideration to the legislation. Again, I want to emphasize to my colleagues the importance of moving quickly. I look forward to continuing the debate on Bill C-7, but also to its ultimate passage in time for Parliament to meet the court-imposed obligation.

[Rob Moore, Conservative, Fundy Royal, NB]

Mr. Speaker, I do want to point out that not one of the amendments that were proposed by our Conservative party at committee was adopted. We proposed those amendments in good faith, and we proposed them with the support of the persons with disabilities community. Krista Carr, executive vice-president of Inclusion Canada, a group that represents persons with disabilities, said that Bill C-7 represents the “worst nightmare” for persons with disabilities.

I want to ask my hon. friend why they did not listen to the persons with disabilities community and why he is talking about delays, when it was his government that prorogued the House and caused Bill C-7 to have to have a complete restart.

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

Mr. Speaker, I thank the member opposite for his contributions in committee, and I will answer his questions.

The Conservative Party amendments that were proposed undercut the heart of what the bill is about, which is ensuring that there is a compassionate response to medical assistance in dying and that a person's autonomy is protected.

With respect to persons with disabilities, we had extensive consultations with persons with disabilities. We heard that there is heterogeneity among that community. We heard from Senator Petitclerc, who indicated the exact same thing. She and former minister Steven Fletcher of the Conservative Party, both themselves persons with disabilities, indicated that it is not for certain groups to speak on behalf of the entirety of persons with disabilities.

Madame Gladu and Monsieur Truchon were themselves persons with disabilities. The court found, in the Truchon case, that in order to protect their autonomy and their competence, the bill must be revised, which is why it is being revised to ensure that the competence of all people, including persons with disabilities, is respected.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Mr. Speaker, it is a bit sad to hear this morning's debate. On one hand, some people are saying that the opposition parties are holding up the process, and there is in fact one opposition party that is purposely delaying it, which I think is shameful. On the other hand, other members are saying that the Liberals prorogued Parliament for five weeks for no reason other than to cover up a scandal. Both sides are right. I am letting them know that this morning.

I think that citizens expect more when we are debating legislation as important and fundamental as this, the law on medical assistance in dying. People who are suffering terribly have had to fight for many years in court. This bill seems reasonable to me, and I think it should be passed quickly.

Could my Liberal Party colleague reassure the Conservative members about the safeguards included in the bill to ensure that we can trust the professionals who are on the ground and who are able to judge the situations? We need to trust our own people.

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

Mr. Speaker, I thank the member for his question, and I am pleased that the Bloc Québécois is supporting this bill.

With regard to the judgment of professionals on the ground, whether it be doctors or nurses, we know that they treat people and assess their autonomy and their informed consent. Bill C-7 gives these professionals more leeway to exercise their judgment.

What I mean by that is that in cases where death is not reasonably foreseeable, there is a waiting period of at least 90 days during which all aspects of the person's situation must be assessed. There has to be an opportunity to treat the person. All tools and options must be provided. As a result—

[The Deputy Speaker, Bruce Stanton]

We will continue with questions and comments.

The hon. member for Esquimalt—Saanich—Sooke.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, I would like to thank the member for Parkdale—High Park for his speech today and for his diligent work on Bill C-7.

I want to return to this question of timing that we have been kicking around in the questions here today. I have to say that COVID was partially responsible for the delay, but certainly the Liberal government's prorogation was a bigger cause for the delay in dealing with the bill.

I would ask the hon. member to return to the question he touched on a moment ago, which is this: What are the consequences for Quebec and for the rest of the country if we do not meet this deadline in Quebec, because Bill C-7 does provide some safeguards to implement the court decision?

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

Mr. Speaker, that is an excellent question and, again, I thank the member for Esquimalt—Saanich—Sooke for his contributions at committee and throughout this Parliament.

The consequences of not meeting the court-imposed deadline of December 18, in effect, would be that rather than a statute being the law of the land in Quebec, we would have the Truchon decision being the law of the land in Quebec, which means that there would be no safeguards whatsoever for those persons who are not at the end of life, whose death is not reasonably foreseeable, from accessing MAID.

If all parliamentarians agree, all 338 of us, that some safeguards are required, notwithstanding the disputes about safeguards, I would urge Canadians, as represented by these parliamentarians, to work expeditiously to ensure that safeguards are in place for persons who are not at the end of life but seek to avail themselves of medical assistance in dying.

[René Arseneault, Liberal, Parliamentary Secretary to the Minister of Economic Development and Official Languages (Atlantic Canada Opportunities Agency and Official Languages)]

Mr. Speaker, I thank the Parliamentary Secretary to the Minister of Justice.

When it comes to the concept of reasonably foreseeable death, how do we now reconcile the Truchon ruling with the Supreme Court of Canada ruling in Carter?

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

Mr. Speaker, I thank my colleague the parliamentary secretary for his very good question.

What we know is that in Truchon, the judge assessed the criteria in Carter and applied them to the situation of these two people who were living with disabilities but whose death was not reasonably foreseeable.

According to the judge, denying access to medical assistance in dying to persons in that situation was unconstitutional in that it constituted a violation of the rights guaranteed under sections 7 and 15 of the Canadian Charter of Rights and Freedoms.

That is what prompted us to introduce legislation that responds to what we have heard from more than 300,000 people.

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

Mr. Speaker, the member has pointed out that there are different opinions among people with disabilities and that is true in every community, of course. We both know that, for instance, in the Muslim community there are some people who express views about issues that the vast majority of that community find offensive. I think, generally speaking, government should listen to the representative organs of those communities, not cherry-pick one or two individuals it finds who may have a point of view that is not in keeping what the majority is saying. When all of the representative organizations who represent people with disabilities are raising big concerns, I think the government should take that seriously.

Just on the issue of timing, can the member acknowledge the fact that the Conservatives wanted the House to be able to sit in May and June. In addition to the issue of prorogation, the Liberal government chose not to allow the House to sit and consider legislation in May and June when it could have.

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

Mr. Speaker, I would respond to the member in a twofold manner.

The first point is that I think it is erroneous and misconstruing the positions at stake that we somehow, on this side of the House, are cherry-picking perspectives on any aspect of this bill. The consultations that we heard were vast and extensive from 125 experts and 300,000 individual Canadians. That is the first point. With respect to the views articulated by persons with disabilities, I would reiterate that the litigation that has prompted this legislative response was brought by persons with disabilities. Clearly persons with disabilities are seeking the same level of competence and autonomy that is available to able-bodied Canadians.

On the last point with respect to the timing, I am referring to what has transpired over the last four to six weeks, in terms of the committee process and now the House parliamentary process. Members are entitled to voice their views. Members are entitled to voice the views of their constituents. That is what a democracy is about. However, prolonging the suffering of Canadians is not in any of our interests and that is exactly what will transpire if the December 18 deadline is missed.

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

Mr. Speaker, I want to begin by thanking the parliamentary secretary for his speech and complimenting him on the quality of his efforts and his French.

Now, just because his French is good, it does not mean I agree with what he is saying, especially on the decisions his government has made.

We all know that this is a very sensitive topic and that there is no room for partisanship. As members of the House, every one of us here has to work diligently on this.

However, since this issue is literally about life or death, would it not have been better to have the Supreme Court of Canada as the court to rule definitively on this issue, to avoid any legal misunderstanding that might come up with this legislation?

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

Mr. Speaker, I thank my colleague across the aisle for his question and his work in this Parliament and the previous one.

This question has been raised a number of times. A government's job is to analyze a well-articulated, well-researched, thorough decision. It is not necessary to appeal a decision all the way to the end.

There are times when the government must take the lead, evaluate a decision and seize the opportunity to spare Canadians pointless suffering and pain by introducing a legislative response to a decision. This is one of those times. We think this is the best way to go.

As a government, we made this decision to avoid appealing the case to the Supreme Court, which could have taken another two, three or four years and prolonged people's suffering.