An Act to amend the Criminal Code (medical assistance in dying)

This bill was previously introduced in the 43rd Parliament, 1st Session.

Sponsor

David Lametti  Liberal

Status

Second reading (House), as of Oct. 27, 2020

Subscribe to a feed (what's a feed?) of speeches and votes in the House related to Bill C-7.

Summary

This is from the published bill. The Library of Parliament often publishes better independent summaries.

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.

Elsewhere

All sorts of information on this bill is available at LEGISinfo, provided by the Library of Parliament. You can also read the full text of the bill.

Criminal CodeGovernment Orders

October 27th, 2020 / 12:45 p.m.
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Liberal

Majid Jowhari Liberal Richmond Hill, ON

Mr. Speaker, that is an important question. It is fair to acknowledge that we are living in very difficult times. COVID-19 has left an impact on not only Canadians but across the world. That is the reason we had to take a pause and really reflect on what we had learned since March or early February, when we became aware of this pandemic. We did that and we did it effectively.

We came back with a very strong Speech from the Throne that talked about mental health. We also now have the opportunity to reintroduce bills such as Bill C-6 and Bill C-7.

Criminal CodeGovernment Orders

October 27th, 2020 / 4 p.m.
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Green

Jenica Atwin Green Fredericton, NB

Mr. Speaker, I recently celebrated one year since I became an MP. In my role, I have had the incredible opportunity to learn every day. I listen to people, organizations and advocates, and the discussion around medical assistance in dying is truly about listening. Today I will add my voice to an issue that affects us all.

Talking about death and dying is still taboo in our society, yet each of us must face it, not only for ourselves, but also for the ones we love. This conversation does not come easily, but for those whose time is closer than others, we owe it to them to listen and to act in passing this bill.

The debate on Bill C-7 has been passionate, emotional and raw, and rightly so. I wish to congratulate and offer my gratitude to each member of the House for their efforts on behalf of their constituents, family members and friends. Each of us has been speaking with our community members to learn their thoughts and hear their stories. Human agency has been on display, and the speeches before the House have shown professionalism and integrity, with a deep commitment to the fundamental rights of Canadians.

Sometimes we need a reminder that our constitution is a beautiful thing. It is the crux of why I am so proud to be Canadian, and why I feel so honoured to have the privilege to defend and uphold the Charter of Rights and Freedoms.

I remember first learning in depth about the charter as a grade 11 student. I remember the way it made me feel, the way it made me think about our lives and our interactions with one another, and the empowerment that it brought into focus. It was right around this time that I knew I wanted to some day to be involved in politics. While that seems like ages ago, it was only recently I learned about the urgency in amending our laws specifically concerning the issues within the legislation on medical assistance in dying and how it interacts with the charter.

I sat with it, without lived experience, and I thought of many what-if situations. I thought of the various scenarios and scary predicaments I would not want to face out of the risk of overstepping constitutional rights, if mistakes were made. I heard some of these same concerns from many stakeholders, from those who are concerned about how this would impact people living with disabilities or with suicidal ideation. I have listened to those concerns, and filtered this legislation through those important lenses. While I know some of these people may still disagree with me, I want them to know that I am confident this legislation strikes a balance and it will not have the impact they fear.

I also sought out opportunities to speak to individuals who had a personal connection to this legislation, and as it turns out, many people are willing to discuss their wish for dignity in dying, as well as their concerns about the current process and these proposed amendments. These individuals shared with me their efforts to pursue their right to bodily autonomy in their final moments on earth. In the powerful conversations I have had, the specific issues of advance requests and mental competency, as well as the discretionary role of a foreseeable death, were the exact hurdles to the peace of mind that would come from having control over their own death and final control over the pain.

There are Canadians right now who are suffering intolerably and enduringly. They already have do-not-resuscitate orders. They have made final wills and testaments, and have pre-paid for funeral arrangements. They have demonstrated their competence in preparing for death. They should be trusted to make a decision about the nature of their own death as well. If we rob them of this opportunity, then we have failed them. We have allowed our laws to overstep into bodily integrity and autonomy, an infringement of our protected right to security of the person.

I also want to address the language of “assisted suicide” and “euthanasia”. Our words are important, and it is important to remember that this bill is to amend a bill on medical assistance in dying. We know that a medical prognosis is the safeguard. It is the authoritative layer that protects individuals who are vulnerable.

The reality of the situation facing real Canadians is that co-occurring mental and physical illness is extremely common and should not be a barrier to anyone's right to bodily autonomy at the end of their life. Severe depression often accompanies other medical illnesses, and has a high rate of occurrence among persons with disabilities. As a further example, an individual may be bipolar and later develop terminal cancer. This pre-existing condition, likely to flare up in such a stressful time, cannot be the reason to deny the will of an individual to determine their final moments.

In conclusion, I remain firm that mental illness in Canada requires rapid access to effective mental health services, including in-person counselling and access to psychiatrists where necessary, as well as wraparound community supports. We also need to set national standards for long-term care to ensure that the facilities intended to house older adults are providing a quality of life that keeps them healthy and active throughout their later years, and we need to invest in robust palliative care to ensure there is dignity in living, even through those final difficult days.

I think of Hospice Fredericton and the peaceful, beautiful experience people and their families have in that environment. The option to welcome death peacefully should be an option for those who want it. We must also value and listen to Canadians with disabilities and their advocates. We can do all of these things and still pass this bill.

I do not believe that MAID introduces the risk that some patients will be forced to receive this procedure against their wishes. There are preventive measures capable of eliminating this risk. I do believe that my duty to uphold the Charter of Rights and Freedoms means passing legislation like this to uphold security of the person for all Canadians at all moments during their lives.

I will be proudly voting for this legislation. This is about justice. It is about empathy. It is about choosing to respect one's wishes and not interfering in that decision. It is about giving peace of mind to people, so the final chapter in their lives can be written in confidence, and their story can be concluded according to their own volition.

Criminal CodeGovernment Orders

October 27th, 2020 / 4:15 p.m.
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Conservative

Brad Redekopp Conservative Saskatoon West, SK

Mr. Speaker, it is my privilege to speak in the House today on Bill C-7, the medical assistance in dying act. This legislation was previously introduced in Parliament back in January, and I had the privilege of speaking to it in February. The bill died with prorogation, which occurred so that the Liberal government could avoid questions about the WE scandal. This bill would amend the original MAID legislation from 2016.

MAID is a very touchy, personal and non-partisan issue, and everybody has different views on it. I have asked my constituents and most of them are opposed to this legislation. I am opposed to it and, therefore, will not be supporting it.

The question arises as to why we are here today. I believe there are two examples of Liberal inaction that have brought us to this point. The first is that a judge in Quebec struck down the reasonably foreseeable portion of the bill, which is commonly known as the Truchon case. Typically, in a case with such profound and life-altering consequences for Canadians, the federal government would appeal such a decision from a lower court, but in this case it chose not to do that. It is an example of the inaction that has led us to this place. The government should have appealed it to get a ruling from the Supreme Court.

A second example of inaction is the legislative parliamentary review that was scheduled for this past summer. Obviously, COVID threw a monkey wrench into that, but we have more or less figured out how to live with COVID and get things done, so there is really no reason why that parliamentary review could not be ongoing. However, because of the Liberal inaction on that, the review has not happened.

What is the real reason for this inaction? I believe the current justice minister voted against the legislation originally, back in 2016, not because he did not agree with the legislation but because it did not go far enough in his view.

The Liberal government talks about consulting with and listening to Canadians, but the truth is that it has its own agenda and wants to push that. The truth is that it did not want the parliamentary review. It wanted something that was less. The truth is that it had its own agenda and simply wanted to implement it. The Liberals will talk about the consultations they had with different groups and the fact they had over 300,000 responses to their website and polls, but a consultation is a very different thing from a parliamentary review. Consultations are easy to manipulate. They can be ignored. They provide cover for answering the question, “Did you consult with people?”, as the government can say that it did. However, that is very different from a parliamentary review.

That is why we are here. It is the Liberal government's agenda. It is not about listening to Canadians so much.

What do I think about this legislation? Let us start with my constituents. In January, I sent out a mailer and since then my office has received over 400 contacts on this issue through phone calls, emails and letters. Two-thirds of those contacts are opposed to the legislation. I also received a lot of feedback on the rights of health care workers, asking if they have the right to say no to euthanizing someone. As this is an issue of conscience protection, are they free to not participate? Are they free of penalty or harassment?

Also, the conscience objection of institutions is another thing that must be protected, because an institution is far more than bricks and mortar. An institution is made up of the people and the values of those people who are invested in that institution.

Right here in Saskatoon we have St. Paul's Hospital. It is a Catholic hospital managed by the Catholic bishops of Saskatchewan. In our province, hospitals are allowed to choose which services they wish to perform. This hospital operates on the basis of the Catholic faith and has chosen to not perform MAID. The hospital respects a patient's right to choose, however, so if a patient wishes to have MAID, it will help transfer that patient to another hospital.

Instead of MAID, St. Paul's is very well known for its amazing palliative care. In fact, it is the only location in the city. My own mother-in-law was a patient there. In her case, MAID was not requested nor desired and she was fortunate enough to get one of only 12 palliative care beds in the city. She received amazing care as she came to the end of her life. Notice I said 12 beds. Since she has been in there it has added 13 more, so there are 25 palliative care beds for all of northern Saskatchewan, which just is not enough. In fact, 70% of Canadians do not have access to palliative care. I would hope that lack of palliative care would not force people into MAID as their only option.

I would also note that St. Paul's Hospital built its existing and new palliative care facilities all on its own and raised all the money to build the units. Is this not exactly the behaviour that we want to encourage? However, now, because of the lack of conscience protection, the hospital is being sued by activists to provide MAID. A hospital well known for amazing palliative care is forced to defend itself in court because it will not provide euthanasia.

I think that several Supreme Court cases are instructive here. In 2015, in the Loyola case, the court said, “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 said, “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 protection free from harassment and consequences.

As I said, MAID is a very touchy, personal and non-partisan issue. One can always find examples of people for whom MAID is a difficult but welcomed option. Unfortunately, those simple examples are the minority. Most often, it is far more complicated than that. The stories I have heard reflect these complications. I have heard of cases where families are caught by surprise and forced to deal with the aftermath, cases where a person is at a particularly low point in their health but under the legislation before us would be able to request and receive MAID with no waiting period, and other cases where physicians or hospital officials apply pressure on individuals to consider MAID.

I am concerned about the removal of the waiting period. Canadians with serious illness could receive a lethal injection on the same day they receive their diagnosis. I am concerned that people, in a time of very high stress, will make a life-ending choice. Many provinces have a cooling-off period for the purchase of something major, whether it is a car, appliance or something like that. A cooling-off period is there to prevent one from making a terrible decision. Does it not make sense to provide a cooling-off period before MAID? I mean, this is the most significant decision that a person could make.

Of course, there are specific cases where a waiting period is not required, but the current legislation already allows doctors to waive this waiting period. During COVID, we shut down our economy on the advice of doctors. Surely we can trust doctors to waive cooling-off periods if it is required.

I am very proud of our Conservative Party. The vote on Bill C-7 will be a free vote and not a whipped vote. Each of us Conservative MPs will be able to vote our conscience and, once again, I am going to be sending out a mailer at the end of this month to ask the people of Saskatoon West for their opinions. I will make sure that the House knows those results at third reading.

I am reminded of something that a constituent told me back in February. He said that we needed to slow this down, not speed it up. I agree with him. Yes, we need to deal with the Quebec court decision, but that only requires one change. Let us wait for a proper, legislated parliamentary review. 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, and let us leave the 10-day waiting period and the ability to create exceptions the way it is right now.

I would like to slow this down.

Criminal CodeGovernment Orders

October 27th, 2020 / 4:25 p.m.
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Conservative

Rosemarie Falk Conservative Battlefords—Lloydminster, SK

Mr. Speaker, it is a privilege for me to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying. As parliamentarians, it is so important that we are mindful that the decisions that are made in this place have a real-life impact on Canadians, and the life-and-death implications of this particular legislation only make it more important that we approach it with great seriousness and sensitivity.

I approach this subject through the lens of placing tremendous value on every single person's life, and through my own deeply held conviction that every life is valuable and worthy of protection until the point of natural death. As demonstrated throughout this debate, we, as members of Parliament, hold diverse opinions on this subject and many of us approach it with deeply held convictions. The diversity of viewpoints is undoubtedly a reflection of the diverse views among Canadians.

Where I hope we can at a minimum find common ground, is on the importance of protecting vulnerable Canadians. That is why, to me, it is so important to have the opportunity to speak to this legislation: If that is our shared goal, there are significant areas where this legislation misses the mark.

This legislation takes many steps to broaden the eligibility for medical assistance in dying and removes safeguards that were previously put in place. While I recognize that this legislation is in response to the Quebec Superior Court decision in the Truchon case, the legislation introduced by the current Liberal government goes much further than the court decision required. We know that many Canadians were disappointed that the Liberals chose not to appeal the Quebec Superior Court decision to the Supreme Court of Canada. Among those who were vocal in their plea to the justice minister to appeal it were physicians from across Canada and many advocacy groups for Canadians with disabilities.

It is disappointing that the decision was not appealed, but perhaps it is even worse that the Liberals took this opportunity to make significant changes to the legislative framework of MAID prior to the mandated parliamentary review. The medical assistance in dying law that came into effect in 2016 required a parliamentary review of its provisions and of the state of palliative care in Canada. As you know, Mr. Speaker, this review was scheduled to start this summer. The significant changes proposed in Bill C-7 undermine the parliamentary review that has yet to commence. They also undermine our ability as parliamentarians to review changes to MAID with the full knowledge of a comprehensive review.

The Truchon decision struck down the “reasonably foreseeable natural death” criterion, but in considering the proposed legislation we are also considering many legislative changes outside the scope of that decision. We are putting the cart before the horse by forging ahead with fewer safeguards when the personal experiences shared, and the concerns raised by Canadians and relevant stakeholders, should give us all reason to pause in loosening safeguards.

We, as parliamentarians, have a responsibility and a duty to ensure that medically assisted deaths are not driven by lack of access to palliative care or by economic or social vulnerability. Ensuring adequate access to health care services and supports should be our number one priority. Palliative care is a main component of that. Through pain management and psychological, emotional and practical support, palliative care helps to reduce suffering and improves the quality of life for a person with a life-limiting illness. Ongoing gaps in access to, and quality of, palliative care in Canada need to be addressed. With an aging population, the demand for palliative care is increasing. As it is, there are not nearly enough health care providers who specialize in palliative care. If the existing gaps are not addressed, they will only grow.

A 2018 report by the Canadian Institute for Health Information found that while 75% of Canadians would prefer to die at home, only 15% of Canadians had access to palliative care or home-care services. Quality palliative care offers an individual facing a life-limiting illness dignity in living.

In addition to palliative care, we should also be looking at access to, and the quality of, other supports like long-term care, disability support and counselling. If we cannot first ensure dignity in living, there cannot be dignity in dying.

We know that medically assisted deaths are most common among seniors. While that might be expected, given the realities of aging, we must also acknowledge the potential for vulnerabilities. We owe it to Canada's seniors, who have helped build and shape this country, to ensure that they are cared for in their older years. We know that it is families and friends who most often take on the caregiving role. In fact, when options like palliative care are unavailable, caregivers step up to support them.

We need safeguards in place to ensure that seniors are not choosing medically assisted death because they feel like they are a burden on the health care system or a burden to their friends or their families. Ultimately, the best safeguard we can put in place to protect vulnerable seniors is to ensure that they have adequate and appropriate supports for a good quality of life. Without these, there is no real choice.

To help ensure that seniors, and any individuals for that matter, are not led to choose MAID out of concern that they are a burden, it is important that they do not feel pressured to do so. First-hand accounts from Canadians who have had medically assisted death suggested, without them seeking it, are extremely troubling. Offering MAID to someone who has not sought it sends a message. When a person is at a low point or in a fragile state of mind, prompting them to pursue MAID may suggest to them that their life is less valuable or has lost value. It might also suggest that they are a burden to society or to their family.

As legislators, we should be looking to ensure that no person is counselled or pressured into MAID. Unfortunately, the legislation before us takes a step further away from ensuring that, perhaps unintentionally. It does this by no longer requiring that there be two independent unpaid witnesses. If passed, it would require one single witness. This independent witness could also be a paid personal or health care worker. This leaves the door open for individuals to be presented with the option of MAID unprompted, in the presence of no other witnesses.

The same individual who counsels a vulnerable person to consider MAID could also serve as one of their independent witnesses. In a vulnerable state, a person could easily be made to feel that they are a burden, and that prompting could lead them to feel pressured to end their life. With the absence of a second witness, this decision could be made without the knowledge of the individual's family.

The proposed legislation also significantly broadens eligibility by allowing for advance consent. Advance consent would allow a medical practitioner to proceed with MAID without a person's consent immediately before administering it. While consent is deemed invalidated if a person demonstrates, by words or gestures, refusal or resistance to a procedure, this assessment is solely up to the practitioner administering it. This leaves space for errors. By solely placing that responsibility on practitioners, it does them a disservice, just as the absence of conscience rights for health care workers in the existing or proposed legislation does them a disservice as well.

There is a finality to death. We cannot afford to leave room for error. As legislators, we have the responsibility to think about how every individual will be impacted by this legislation, because every life is valuable. We have to be mindful of not reinforcing negative stereotypes about illness, age or ability. We cannot undermine suicide prevention efforts or devalue human life. We have to ensure that meaningful alternatives to MAID not only exist, but that they are readily available. Above all, we have to first ensure the protection of vulnerable Canadians. We cannot allow individual autonomy to outweigh their protection.

Criminal CodeGovernment Orders

October 27th, 2020 / 4:45 p.m.
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Conservative

Tako Van Popta Conservative Langley—Aldergrove, BC

Mr. Speaker, I am pleased to join the debate today on Bill C-7, an act to amend the Criminal Code. Specifically Bill C-7 would amend section 241 of the Criminal Code, the provision that makes it illegal for a person to help someone else commit suicide. This section of the code was amended by the last Parliament in response to a Supreme Court of Canada decision in 2015, the Carter decision.

Bill C-14, a 2016 bill, stated that one of its objectives was, “permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance.” I would agree with that. The relevant operative provision in the act then sets out the criteria for determining whether a person qualifies for MAID, including that with respect to that person “their natural death has become reasonably foreseeable, taking into account all of their medical circumstances.” However, all of this is about to change if the government has its way with the current draft legislation, Bill C-7.

I am speaking to that bill because I have been encouraged by many of my constituents. Admittedly I have received some letters in support of the government's initiative to expand the reach of MAID, but the vast majority have encouraged me to speak in favour of leaving the law as it is or further restricting access to MAID.

The correspondence I have received in favour of keeping up the safeguards fall into two categories. First, the reasonably foreseeable death safeguard should stay in place. Second, more should be done to expand palliative care services. It was pointed out to me by many that many seniors and other people with serious diseases did not have good ready access to adequate palliative care.

I will quote Rebecca, one of the letter writers, “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 MAID.” As a proud Canadian, I agree with that statement.

What is behind the current Bill C-7 is the 2019 Quebec Superior Court decision in Truchon. The plaintiffs in that case challenged the constitutionality of the then three-year-old law, arguing that their charter rights had been violated. The federal government, acting through the Attorney General's office at that time, did the right thing. It defended the law, which is what we would expect an Attorney General to do for Canada's laws.

The AG argued as follows, setting out the three main objectives of Bill C-14, which are still relevant today or at least they should be.

First, it is important to affirm the inherent and equal value of every person's life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled. Second, suicide is a significant health issue. Third, vulnerable people must be protected from being induced in moments of weakness to end their lives. I think we would all agree with that.

However, the Quebec court did not. It refused to accept the first two principles as representing the objectives of the law. It said, “the Court cannot accept the two first 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.”

Having thrown aside those principles, it was easy for the court then to decide that the law needed to be changed. Remarkably, the current Attorney General did not appeal that decision. Instead the Liberals are now hastening to amend the legislation to eliminate the reasonable foreseeability of death safeguard.

With the reasonable foreseeability of death safeguard down, this is what we now have left. First, the applicant for MAID has a serious and incurable disease, illness or disability. Second, they are in an advanced state of decline. Third, their psychological or physical suffering is intolerable to them, which is completely a subjective test.

For example, people with Parkinson's, or MS or quadriplegic patients would check off all those boxes. If they had psychological suffering on top of that, they would be eligible for MAID.

Under this new regime, if it becomes law, people who are not dying but who meet all the other criteria will satisfy the requirements for state-sanctioned assisted dying.

I want to reiterate what Rebecca from my riding said. She said, “Let Canada be a society that is known for its modern and palliative care services and not as a country that has ever expanding use of MAID.”

I know the law will be amended. It must be to satisfy the Truchon decision. However, I will point out four things that I hope the committee will take into consideration in improving Bill C-7.

My first point is that the 10-day reflection period for the track one patients, those whose death is reasonably foreseeable, should come back. It should be there. That was not a requirement of Truchon and I do not believe that Bill C-7 is improved by taking that10-day reflection period out. For track two applicants for MAID, people who death is not reasonably foreseeable, there is a 90-day reflection period, and I agree with that.

The second point I want to make is about the 90-day reflection period. I agree with it, but the wording is inadequate. I would recommend to the committee that it amend the 90-day reflection period clause to be the same as the 10-day reflection period clause, but with the necessary change in wording.

My third point is that Bill C-7 would reduce the number of witnesses required for a patient's written directive for MAID. There is absolutely no requirement for that at all and it is certainly not an improvement. Many of the legal documents, including last wills and testaments, require two witnesses as a safeguard against coercion and that should be maintained.

The fourth improvement is that the provision in Bill C-7 saying that a patient's request for MAID must be voluntary without coercion should be expanded to prohibit the attending physician or other health care professional from being the first to raise the availability of MAID option. MAID should never be presented as just another option because in some circumstances, that in itself, would be coercive.

When Bill C-7 was first introduced into the House back in January, COVID-19 had not hit us yet. Since then, many seniors have died of this virus and many others are in isolation. I have seen first-hand the devastating effect isolation has on the mental and physical well-being of seniors, my father-in-law included, as it would for any person. We are created to be social creatures after all.

As my constituent Sarah told me in a very thoughtfully drafted, “[Bill C-7] will put many elderly Canadians, isolated and lonely in their long term care homes, at greater risk of being considered eligible for MAiD. That is not how we should be caring for our seniors!”

Let us use our experience with COVID-19 as a lens to have a very careful review of this draft legislation to reconfirm our commitment to value life and to build as many safeguards as we can around our most vulnerable citizens.

Criminal CodeGovernment Orders

October 27th, 2020 / 5:15 p.m.
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Conservative

Tamara Jansen Conservative Cloverdale—Langley City, BC

Mr. Speaker, today I am pleased to present my maiden speech to advocate on behalf of those who cannot advocate for themselves. It is truly a privilege to be a voice for them. Some of them will even be voices from beyond the grave.

I call on my colleagues today to truly stop a moment and hear the cri de coeur from those who are still among us and from those calling to use from the next life. They should take a moment to listen to what we here in the House have done to destroy the value of their lives, to exclude them from society and to encourage them to exit the stage rather than wait for the curtain to fall once the final act is finished.

I will begin by introducing members to Roger Foley. As a young man, Roger was a musician and creator. He loved life, and it showed. However, in his early thirties, Roger was diagnosed with cerebellar ataxia, a debilitating disease that has stolen away his physical abilities one function at a time. Roger is now completely reliant on care providers for every necessity of life.

In the summer of 2018, after almost dying from a life-threatening case of food poisoning he contracted in long-term care, Roger was trying desperately to access funding for patient-directed care to hire and train his own consistent caregiver in his own home, as opposed to living in a hospital or in long-term care with rotating staff who do not understand his specific care needs. Members may remember Roger as the man who recorded his caregivers offering him euthanasia as an easy way out of his suffering. As we heard in the recording, the nurse says, “You don’t have to do it in some dramatic manner. You can apply for assisted—you know.” The nurse could not even bring himself to utter the word “euthanasia”, yet there he was, against Canadian law and all moral and ethical standards, offering a desperate man an easy way out. It was problem solved. However, Roger is a fighter, and even though he was overwhelmingly desperate, Roger decided he wanted to fight this injustice on behalf of himself and all our vulnerable brothers and sisters.

Roger's path intersected with mine early this year at the beginning of my time on the health committee. In preparation for a study on palliative care in Canada and a review of the euthanasia regime, issues that I thought would soon be on the table for discussion, I reached out to him and his lawyer for his perspective as someone within the system. I finally had a chance to speak via telephone with Roger while he was in Victoria Hospital in a private ward getting good care. While not in his preferred setting of his own home, I found him to be very open and engaging. His knowledge of the issue of euthanasia and the danger it posed for the vulnerable was enlightening. Just before we hung up that night, I said to Roger, “I wish you were on the committee because you are so much more equipped to speak to this issue than I am,” and we agreed to speak again soon.

Then COVID-19 hit, and Roger Foley's world changed completely. Roger was repeatedly transferred between units where there was little room for lift equipment and insufficient staffing for his specialized care. Living at the mercy of care attendants who are pressed for time was agonizingly difficult. Roger has very little in his life that is in his own control, but one thing he can do is swallow when offered food, with a certain technique. His head needs to be tipped at just the right angle, and the spoon needs to be offered in just the right way. For Roger, the ability to swallow affords him a feeling of independence. It may seem like a little thing to us, but to Roger it means a whole lot.

When the hospital wanted to feed him with a feeding tube to minimize the care hours required, his mental health took a turn for the worse. On May 15, Roger's brother filed a complaint with the ombudsman on Roger's behalf, yet things just got worse. Roger was suddenly informed that he would be transferred to the long-term care facility that had led to his original food poisoning and hospitalization. Understandably, Roger refused the transfer, begging instead, if not allowed self-directed care, to go back to his original unit, where staff knew him and his needs well. The hospital ignored his request, insisting that it was not safe for him because of COVID and that he needed to transfer.

The night before the transfer was to take place, Roger became completely desperate. He had not been sleeping, due to his fear and anxiety of being transferred. He became so distressed that he told his caregivers that he would throw himself off the gurney if they tried to transfer him the following morning. With no hope of help in sight, Roger reached out to his brother. His brother reached out to his lawyer. His lawyer reached out to me.

That evening we spent three hours on a conference call with Roger, encouraging him to be positive, to keep up the faith and to stay the course on behalf of those in the disabled community who would not have his strength and courage. All the while, I was attempting to contact the hospital administrators on another phone to beg them to back down and to warn them that Roger was possibly suicidal and needed them to reconsider for his mental health's sake.

Suddenly, I could hear on the phone in the room with Roger a new voice. The voice introduced herself as the hospital's mental health personnel, there to administer the 10-question suicide checklist on Roger. She began with her first question, attempting to gauge his distress level. Roger told her that he had no intention of answering her questions, since it was her and her bosses' fault he was in so much distress. She tried over and over, and he refused until she finally left the room in a huff.

The House heard me right; the mental health professional was so annoyed that Roger refused to answer her suicide checklist, she left the room and never returned. I was absolutely dumbfounded on the other side of the line, sitting helpless in my office in Langley. All these able-bodied health care professionals were able to leave the room freely. Everyone could could leave as they pleased, except Roger. Roger was trapped.

When we finally got some assurances that a trusted doctor would come and talk to Roger, and it encouraged him to try to rest, I hung up the phone, I had no idea what was going to happen in the morning. I was helpless, but not nearly as helpless as Roger. I can tell members that it was with great relief in the morning that Roger had indeed received an intervention through a trusted doctor and was getting proper care and nutrition. However, this event was a life changer for me. It dawned on me that without the help of his lawyer, who stayed on the phone with us the entire time, Roger's story may have ended quite differently. I wondered how many others in the country are at risk under this new MAID regime. How many vulnerable disabled are offered euthanasia when they are at their weakest? I made it my mission to find out.

What did I find out? I found out that Roger's case is by no means an isolated case. We can see this sort of abuse happening across the country. Take, for example, Jonathan Marchand: 43 years old, suffering from muscular dystrophy and living confined to bed in a nursing home in Quebec. He produced a video from his hospital room which he released on YouTube in response to living in long-term care during the pandemic. Jonathan states “Increasingly, euthanasia is offered as a solution to institutionalization. The idea is if you don't want to go into a long-term facility and die a slow death, then we are going to help you kill yourself. And those ideas are based on false assumptions about people with disabilities - like our lives are not worth living, that it's better to be dead than to have a disability - but it's not true!” He says that he decided that he would not go ahead with euthanasia, but would fight to get out of that place. Jonathan said, “In a world where there will be no empathy for people who need more help, it would be terrible. It would be something out of the nightmare of the Third Reich.”

Bill C-7 is an absolute nightmare that is facing disabled Canadians. Many are already afraid to go to hospital for fear they will be treated differently from the able-bodied. With the implementation of MAID in 2015, the community braced itself for the slippery slope ahead. Everyone said they were just overreacting. They said that safeguards were in place and euthanasia was meant to be safe and rare. We jump to 2020, and here we are racing down the hill at breakneck speed. In consultation with the disabled community, they have expressed firm opposition to this bill.

They explain that with the wording of Bill C-7, the Liberal government is proposing to set up two lines. Line one is for the able-bodied, who, in times of extreme distress, will be offered suicide prevention. Line two is for the disabled, who, in moments of weakness that they all endure as life ebbs and flows, will be offered assisted suicide, because their lives are not worth living, they are told. Add to all that the fact that current safeguards have already been proven completely ineffective. There is a complete lack of accountability structures to ensure abuses do not occur, and yet we are being asked to loosen restrictions even more. Where is the palliative care that was promised? Where is the review that was supposed to have happened? What are the Liberals afraid of finding out? Is it that in actual fact MAID has led to coercive deaths across our country, which go on undetected daily?

I stand here on behalf of all those who cry out for compassion and dignity as they travel a very tough road filled with complex care needs and physical ailments that require far more from us as a society. I stand here as the voice of Roger in Toronto, Jonathan in Quebec, Raymond Bourbonnais, Candice Lewis, Sean Tagert, Archie Rolland and so many more who we may never know.

“Lean on me.” That is what I want all of us to say here in this House—

Criminal CodeGovernment Orders

October 21st, 2020 / 4:40 p.m.
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Milton Ontario

Liberal

Adam van Koeverden LiberalParliamentary Secretary to the Minister of Diversity and Inclusion and Youth and to the Minister of Canadian Heritage (Sport)

Mr. Speaker, it is an honour to virtually join the debate in the House of Commons and participate in the second reading debate on Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

I will take a moment to speak to the progress that our government has made with respect to the rights of persons with disabilities in Canada.

Last year, we 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 advancements in disability rights since the charter in 1982 and it is designed to inspire a cultural transformation toward disability inclusion and accessibility in Canada. The act created Accessibility Standards Canada, an organization that will create and revise accessibility standards and support and promote innovative accessibility research. The CEO and board of directors were appointed and the 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.

Our government is taking real action to address the rights of persons with a disability. 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 and their input informed the reforms proposed in this bill.

We recognize that disability inclusion requires more than legislation and that is why we are continuing to work with the disability community and stakeholders to address stigma and bias. It is important to bring about cultural change to ensure that the important contributions made to Canada by persons with a disability are recognized and valued on the same basis as other Canadians.

Going forward, we will continue to focus on improving the social and economic inclusion of persons with a disability. This means moving forward with our commitment to build on the progress we have made over the past months and years with the development of a disability inclusion plan. This disability inclusion plan would include important initiatives like a new Canadian disability benefit modelled after the GIS for seniors, a robust employment strategy for Canadians with disabilities and a better process to determine eligibility for government programs and benefits. We all benefit when everyone can participate equally in our economy and society.

We will continue to work hard to ensure that every person in Canada is treated with the dignity and respect they deserve, especially when it comes to the deep and personal issue; that is ending one's life. It is imperative that the voices of all Canadians, including persons with a disability, continue to be heard on the issue of medical assistance in dying.

Criminal CodeGovernment Orders

October 21st, 2020 / 5 p.m.
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Liberal

Hedy Fry Liberal Vancouver Centre, BC

Madam Speaker, I am really pleased to speak to this bill, Bill C-7, in its current form, mostly because I did not support the original bill, Bill C-14, from four years ago. I did not support it because I felt that it did not reflect the intent of the Supreme Court of Canada's ruling in Carter. I also felt, as a family physician who practised medicine for 20 years, that it did not act in the best interest of my patients.

As a family physician, I walked with my patients through many things: through the joys of having a baby, of giving birth and of marriage, but also through the difficult, challenging and painful times when they struggled with excruciating incurable diseases and with knowing they were going to die because of a terminal illness. They had to work with their families, who may or may not have wanted them to go through with this. I held their hand and walked with them, so this bill has a very personal meaning. That is why I am pleased to speak to it now.

I like the bill in this form in many ways, though there are a couple of things that have not happened in it that I would like to see. The first thing I am pleased with is that it removes the clause saying natural death has to be reasonably foreseeable. It was very difficult for physicians to understand what exactly that meant. If the clause meant only people who were going to die soon, it did not reflect the Carter decision by the Supreme Court, because it did not look at issues of incurable disease or intractable pain and suffering. This bill addresses that, I think, in that it is distinguishing what we mean by natural death becoming reasonably foreseeable. In other words, I think it recognizes that if a natural death, because of a disease or a terminal illness, is going to be foreseeable within maybe a week or two, then a person does not need to go through the 10-day reflection period that was asked for earlier on. However, if it is a longer period of time, maybe four months or so, a person can continue to reflect on whether this is what they really need.

I also like that it has brought back something called advance directives. It is interesting to note that long before medical assistance in dying was considered, physicians had advance directives. This is at the heart of a doctor-patient relationship. They would sit down with patients and go through all of the things patients faced and their concerns, especially if they were diagnosed with a serious and terminal illness, and they would say what they would like to do if something happened. That would be in writing, between the doctor and the patient. I was present when families of patients who were dying, in great pain and suffering and under the deep stress of this, would debate the decisions they had made earlier with their physician. Putting this back in means that we are respecting patients' desires. Regardless of their mental capacity at the time of their dying, we are respecting what they originally wanted, if they still want it, not having other people rule on their decision.

Inherent in everything I dealt with regarding patients who were terminally ill or had an intractable and incurable disease is that they wanted to die with dignity. Dying with dignity cannot be understated. Dying with dignity means that people can choose how they die, where they die and the manner in which they live with the suffering of dying and the mental anguish of leaving their loved ones. This is a deeply personal thing that patients face. It is impacted by their religion, it is impacted by their ethics and it is impacted by their family situation. It therefore has to be done on a case-by-case basis, and having an advanced directive with a physician is always a really important thing in that regard. That had been removed in the last bill and I am glad to see it back. It took the decision away from the patient and gave it to the state, at the end of the day, and now it is back with the patient.

I want to applaud the inherent compassion I see in this bill. I think it is really important. The deeply held desire of every single patient I knew, regardless of whether they chose to have medical assistance in dying or not, was the ability to die with dignity. The patient's ability to choose where they die is really important. Do they want to die at home in bed? Do they want to die in a palliative care unit, where they have become accustomed to spending their last days? Do they want to die in a hospital? Most patients do not want to die in a hospital. They want to be surrounded by their loved ones.

The government is giving $6 billion to provide home and palliative care resources to the provinces, because it is the responsibility of provinces. They can facilitate this deeply held desire to die with dignity and help patients make this choice at a time when the ability to do so is often impacted by extreme pain and suffering and the extreme mental anguish of knowing they have to leave their loved ones. It simplifies this in a great way, and that is a compassionate thing.

There are some areas that can be improved, and one of them is the singling out of mental illness and disability as a sole diagnosis. I agree with everyone who has spoken in the House today, and with the desire of a lot people, to recognize that mentally ill people should not be put away and should not be allowed to simply decide they want to pass on because the people they live with think they are a burden. It is really important to also look at this from the perspective of the disabled.

I know the minister has taken a lot of time to speak with the disability community and physicians. This government is committed to dealing with mental health and illness. My colleague from the Conservative Party told a very moving story earlier about a particular woman who was contemplating suicide. Giving people options when they are depressed or disabled that let them know there are other options for them, that there is a better life available to them, is inherent to this bill.

The minister is going to look at this aspect and consult broadly with the disability community once again as he is looking at the legislative parts of the bill and the regulations. This is really important. Remember, if we single out mental illness and disability as a sole diagnosis, we may be contravening section 15 of the charter. It assumes that, because someone has a mental illness or is disabled, they do not have the right to make a decision regarding their own life and pain and suffering, whether it be mental or not. The idea that this issue will be addressed in work with the provinces, health care providers and the disability community is really important. The safeguards will be worked out. I will be really clearly involved in making sure they are worked out so they can be put into place to protect mentally ill people and people who are disabled.

I want to quote Justice Baudouin in the Truchon decision: “The vulnerability of a person requesting medical assistance in dying must be assessed exclusively on a case-by-case basis, according to the characteristics of the person and not based on a reference group of so-called ‘vulnerable persons’.” Justice Baudouin also added that the patient’s ability to understand and consent should ultimately be the deciding factor with a physician, along with looking at all of the legal criteria.

Those safeguards must be in place, but we should not assume we can make decisions for people who, because of mental illness and disability, may wish to get medical assistance in dying. Intractable pain and suffering is not merely physical; it can also be mental. With the help of good psychiatrists and good support systems, we will be able to put those safeguards in place.

This bill has come a long way in rectifying many concerns that some medical practitioners have raised. It is important that it respects the right of a medical practitioner or a health care provider to use their own ethics and religion to decide whether they wish to perform medical assistance in dying or not. I am—

Criminal CodeGovernment Orders

October 21st, 2020 / 5:20 p.m.
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Bloc

Mario Simard Bloc Jonquière, QC

Madam Speaker, medical assistance in dying is a sensitive issue that needs to be discussed calmly. It is a difficult subject, let's face it. It is especially difficult because, like all matters dealing with human dignity, any answers we might offer are a reflection of our own values, our beliefs, our way of defining what we see as right and wrong.

That is precisely where the potential pitfalls lie for us parliamentarians as we grapple with moral issues like medical assistance in dying, abortion and same-sex marriage. Relying solely on our own values in the legislative process is tantamount to subjecting the freedom of others to the dictates of our individual consciences. In this case, medical assistance in dying raises the kind of impossible questions that political thought has been considering since the dawn of the modern era. This issue compels us to seek a delicate balance between power, knowledge and freedom.

Everyone knows that, as parliamentarians, we have been given a certain power by our constituents. This legislative power means we have the ability to restrict the rights of our peers through legal prohibitions, directly affecting their freedom. However, it does not necessarily follow that we have all the knowledge to apply that power in a fair manner. To avoid any abuse, we must be humble enough to acknowledge that we are not experts in everything, even though we have to speak to everything.

Max Weber, the father of modern sociology, may provide valuable support to the legislator who is concerned about using their power properly. In his essay “Politics as a Vocation”, Weber says this about the career of politics:

Well, first of all the career of politics grants a feeling of power. The knowledge of influencing men, of participating in power over them, and above all, the feeling of holding in one's hands a nerve fiber of historically important events....

Weber then asks a very perceptive question that applies remarkably well to the debate on medical assistance in dying. He says, “What kind of man must one be if he is to be allowed to put his hand on the wheel of history?” Putting one's hand on the wheel of history evokes the idea that a legislator can change the course of society, as happened with same-sex marriage and abortion.

How does one go about changing the course of society? Weber says that, first, we must determine what qualities a legislator must have to enable them to do justice to the power they exercise and to the responsibility that power imposes upon them. Weber states that there are two pre-eminent qualities for a politician: passion and a feeling of responsibility.

He means passion in the sense of matter-of-factness, of passionate devotion to a cause. For me and my political party, that cause is Quebec's independence. For the Conservatives, who knows. Perhaps it is balancing the budget or some form of social conservativism. For the Liberals, it is multiculturalism and conflicts of interest. Just kidding.

Weber cautions us. “[M]ere passion, however genuinely felt, is not enough...passion as devotion to a 'cause' also makes responsibility to this cause the guiding star of action.” This passion must to some extent be controlled by a form of responsibility.

Weber warns us because he believes that the legislator must be a man of reason. According to Weber, the lack of distance from our passion is one of the deadly sins of legislators. In the context of the bill on medical assistance in dying, this distance means that we cannot let certain interest groups or certain religious groups guide our discussions because we feel that they may withdraw their support for us. In short, Weber tells us that political favouritism disregards distance and this leads us to political incapacity.

Therefore, on the issue of medical assistance in dying, we must adopt this attitude of “distance” in the strongest sense of the word. This distance implies that, on a matter of human dignity, partisan and ideological considerations must take a back seat.

The topic of medical assistance in dying forces us to deal with the complex relationship between ethics and politics. According to Weber, ethics must not be used as justification. He believes that contorting ethics in an attempt to justify one's behaviour is wrong, which brings us to the struggle between two well-known positions: the ethics of responsibility and the ethics of conviction.

The ethics of conviction often manifests in religious beliefs, in being dogmatic about ideologies. This type of ethics is meant to establish a definitive truth that must be protected at all costs in order to achieve one's objective.

Weber said, “If the consequences of an action that flow from pure conviction are evil, then for him the responsibility lies not with the actor but with the world, the stupidity of other people, or the will of God”. He continues, “He who seeks the salvation of the soul, of his own and of others, should not seek it along the avenue of politics”, which seeks to solve quite different tasks.

The ethics of responsibility has us look at the potential consequences of our actions. It forces us to use our legislative power responsibly and to look beyond our allegiances and personal beliefs. We are meant to be conscious of our collective duty and to accept that the greater good comes before personal interests.

I would like to comment briefly on the ethics of responsibility, which is something Quebec is familiar with, from the Select Committee on Dying with Dignity. The members of the commission were mandated by the Quebec National Assembly to hold a rather unique public consultation process, in which the members travelled across Quebec to meet with experts and Quebeckers.

The Parti Québécois's Véronique Hivon took the lead on this file. She handled the process transparently and tackled difficult issues in the realms of medicine, law, philosophy, ethics, sociology and psychology. The committee's work resulted in the passage of the Act Respecting End-of-Life Care, which came into force on December 10, 2015, in Quebec.

I see a striking contrast between Quebec's approach, characterized by the ethics of responsibility, and the federal government's approach. At the time it was passed, the Quebec law went as far as it could without running afoul of the federal legislative framework. Quebec was proactive in engaging in this social debate, whereas the federal government has, so far anyway, simply been reacting to court rulings. This is the old “government of judges”. Governments would rather refer thorny issues to the courts than take a stand. Maybe they are trying to protect their beliefs or avoid offending certain religious groups. Still, parliamentarians have a job to do.

I will now come back to Carter, in which the Supreme Court overturned the Rodriguez decision in order to give greater weight to respect for integrity of the person and the individual's decision-making authority. This opened the door to medical assistance in dying.

Previously, when religious values were more prominent, this situation would have been impossible. In this case, the Supreme Court served as a driver of social progress, but we cannot always turn to the Supreme Court. This raises the following question: Is it normal for elected officials to lag behind on social change and leave it up to the courts to bring legislation in line with the reality of citizens? This is not the first time that members of the House of Commons have turned to the judiciary to avoid making tough decisions so as not to offend anyone. Take, for example, same-sex marriage.

The truth is that these social issues must be discussed in the House with compassion. Bill C-7 responds to a decision of the Quebec Superior Court, which ruled in favour of Ms. Gladu and Mr. Truchon, both suffering from serious degenerative diseases. They claimed that the reasonably foreseeable natural death criterion was too restrictive in both legislative regimes, the federal and the provincial.

We are all driven by our personal convictions, but our thinking must transcend those beliefs. We have a duty to act with empathy. People suffering from incurable degenerative diseases should not have to go to court to fight the terms and conditions of the administration of medical assistance in dying.

In my view, Bill C-7 will undoubtedly make medical assistance in dying more accessible. We should be relieved that the bill specifically excludes individuals suffering solely from a mental illness from eligibility for medical assistance in dying. I think everyone agrees that this aspect requires further reflection, study and consultation. However, as legislators, we do need to address the issue of advance consent. Many people who reach end of life risk losing their capacity to consent. We therefore need to find a way to respect their choice, too.

At the end of the day, it is fair to say that our reflections on a framework for medical assistance in dying relate to the fundamental freedom of individuals to determine their own condition. Our reflections must be guided by compassion.

I know some people have expressed strong reservations about medical assistance in dying. I can only hope that such personal beliefs will not be imposed on those already suffering.

Lastly, I hope the House will follow Quebec's lead and approach this issue with openness and empathy, rising above partisan lines.

Criminal CodeGovernment Orders

October 21st, 2020 / 5:35 p.m.
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Liberal

Emmanuella Lambropoulos Liberal Saint-Laurent, QC

Mr. Speaker, I appreciate the opportunity to speak to Bill C-7, a very important bill that proposes to amend the Criminal Code provisions on medical assistance in dying, MAID.

It took me a long while to decide that I was going to speak to this bill. In fact, when I first learned that we would be debating this legislation this month, I decided I was not going to speak to it at all because I do not do very well with these topics. I have a very difficult time accepting that life eventually comes to an end, especially the life of those closest to me. In fact, I can come to terms and accept that my own life will end at some point, but I cannot deal with the thought of losing those closest to me.

Some of my colleagues' speeches earlier this week brought me to tears. When someone has strong feelings about a given topic, it generally means that they have something to say about it and that the topic should be discussed.

Canadians must know that, if they are eligible, they have been able to access MAID since June 2016. To be eligible for MAID right now, the person must meet all of the following criteria: They must be at least 18 years of age, be mentally competent, have a grievous and irremediable medical condition, make a voluntary request for medical assistance in dying that is not the result of outside pressure or influence, and give informed consent to receive medical assistance in dying.

Furthermore, in order to be considered as having a grievous and irremediable medical condition, those seeking MAID must meet all of the following criteria: have a serious illness, disease or disability; be in an advanced state of decline that cannot be reversed; experience unbearable physical or mental suffering from the illness or state of decline that cannot be relieved under conditions that the person considers acceptable; and, lastly, be at a point where natural death has become reasonably foreseeable.

Bill C-7 proposes to repeal the MAID eligibility criteria by modifying the criteria that must be met to be considered to have a grievous and irremediable medical condition so that it includes persons whose natural death is not reasonably foreseeable.

Furthermore, the bill proposes to specify that those whose sole underlying medical condition is a mental illness are not eligible for MAID.

Last, it proposes to create two sets of safeguards that must be respected before MAID is provided. The first set of safeguards would apply to persons whose natural death is reasonably foreseeable and these would be the existing safeguards that have been in effect since 2016. The second set of safeguards would be for persons whose natural death is not reasonably foreseeable. These would include existing safeguards as well as additional ones that would apply.

In the interest of time, I will not address all of the safeguards that have been put in place. Rather, I will just focus on those that have been added recently.

A person whose death is not reasonably foreseeable must talk to a doctor about the options available to them to ease their suffering. The two parties must agree that they seriously examined all the possible options, including palliative care and mental health support, before making a decision to apply for medical assistance in dying.

Two independent doctors or nurse practitioners must provide an assessment and confirm that all the eligibility criteria have been met. This eligibility assessment period must take at least 90 days, unless the person is at risk of losing their mental capacity before that time is up. In such cases, the assessment must be a priority and completed before that deadline.

Bill C-7 seeks to respect the personal autonomy and freedom of choice for those seeking access to MAID while, at the same time, protecting vulnerable people and the equality rights of all Canadians. It aims to reduce unnecessary suffering. This issue is a deeply personal one. In fact, we saw from consultations held earlier this year that there was a wide array of opinions and feedback received. Many people were opposed to the idea of MAID altogether, while many others believed the safeguards were too restrictive and made it difficult for some people to receive MAID.

This is a profoundly personal matter for all those involved. I do not think that it is for anyone who has never faced death or end-of-life suffering to judge or determine whether this should be a right and for whom it should be a right. We all have a certain pain threshold, but it is not the same for everyone. We are talking about excruciating physical pain. Who then is in a position to say to what extent such pain can be tolerated?

MAID legislation was passed in 2016 with the intention of ending suffering for those facing death, those who do not have a chance to improve their medical condition. It was passed because the MPs in this chamber thought it would be the right thing to do: to give people the choice to receive MAID if they felt they needed it. Nobody is forced to go down that path, it is a choice, but legislators basically deemed it the right thing to do and the humanitarian thing to do to allow someone in that situation to receive medical assistance in dying.

If this was the humanitarian thing to do for people whose death is reasonably foreseeable, then it only makes sense that those suffering from an illness and experiencing unbearable pain whose death is not reasonably foreseeable and may be five or 10 years away should also be granted those rights. They should also have access to MAID if they have exhausted all other options and have decided with their medical practitioner that this is the way to go.

Again, it is extremely important that we remember this is a choice of the person who is suffering. However, it is also critical to give those in a position to provide medical assistance in dying, such as physicians and nurse practitioners, the choice to refer their patients to someone who is willing to administer MAID if they themselves are not. If administering MAID does not coincide with their values or religious beliefs, it must not be expected of them.

With that being said, it is important for everyone to respect the religious beliefs and values of all Canadians. As such, I completely understand that some may perceive the act of receiving medical assistance in dying as committing a sin. They have the right to die of natural causes if that is their will. In my own religion, this would technically be problematic for me. However, I feel comfortable knowing that if it ever comes to a point where I am in a situation where I am suffering, I have no chance of recovery and I am only going to get worse with time, I will at least have the choice.

One of my colleagues across the aisle in his speech earlier today spoke about an amazing comeback story of someone who was in a terrible situation, but who was on the road to recovery. My colleague was grateful that this person stuck it through and fought to survive. It is important to remember that those who will be eligible to receive MAID will have been assessed by two medical practitioners and both will have determined that the person's medical condition would never improve. If there is a chance for recovery, the person would not be eligible for MAID in the first place.

I understand that not everybody in the House will vote on this bill in the same way and I fully respect everyone's personal choice on this matter, because, once again, it is an extremely personal issue. All members are trying their best to represent their ridings and constituents in the best way they know how. I will be voting in favour of this bill because I do not believe it is my place to get in the way of someone receiving the kind of relief that MAID offers.

Criminal CodeGovernment Orders

October 21st, 2020 / 5:45 p.m.
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Conservative

Michelle Rempel Conservative Calgary Nose Hill, AB

Mr. Speaker, today I am pleased to speak to Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), which I will refer to as MAID throughout the course of my speech.

This can be a difficult issue for many to address because it intersects several issues in society. First of all, there are taboos, and societal norms associated with those taboos, around discussing dying, religious beliefs, social supports, or the lack thereof, related to people who are in difficult or life-threatening situations, love and compassion for one another, and the agency that each of us has to direct our future.

I would like to explain what this bill would do, what I am hearing from my constituents on this issue, my approach to addressing this legislation and my decision on how I will be proceeding on their behalf.

As has been mentioned in many speeches, this bill builds on previous legislation that allowed for legal, medically assisted dying in Canada. This bill would amend legislation to remove the “natural death has become foreseeable” clause, meaning that reasonably foreseeable death would not be a criteria for accessing MAID. Of course, this comes after a decision in the Quebec Superior Court ruled that reasonably foreseeable provisions violated section 7 of Charter rights to life, liberty and security of the person. It eliminates MAID access to those who only have mental illness as an underlying condition. My understanding is that the Minister of Justice said this would be addressed in the parliamentary review of this legislation.

It would also create a second set of safeguards for people accessing MAID without a reasonably foreseeable death clause including that, for both those whose deaths are foreseeable and those whose are not, this bill would change the Criminal Code so that only one witness is needed to sign the MAID request, rather than the two currently needed. It would eliminate the 10-day waiting period for MAID and its administration for those with foreseeable deaths. For those without foreseeable deaths, Bill C-7 would create a 90-day waiting period request. There is a bit more technicality. It builds on legislation that has already been passed in this place.

I want to outline some of the things I have been hearing from my constituents on both sides of this issue. The response in my office has been pretty evenly split between people advocating for these changes and against them.

Those in support of this bill have been writing to my office on the need to exercise personal autonomy, which would be the agency issue that I mentioned. The constitutional right to make choices about end-of-life access to medicine and health care should be part of a health care option that is available to Canadians. There is a need to ensure that, in our country, we have the ability to die with dignity: to look at death as part of the life process, and to ensure that the continuum of care involves a death with dignity. Also, there is a need to normalize and end the stigma surrounding death, and to respect individuals' and families' desire to end unbearable suffering.

Those who have issues with this bill have mentioned consent by minors and those who have mental illnesses, and what the nature of consent is in those situations. There are concerns that it is not clearly defined. There are concerns about how this legislation would impact the nature of consent in jurisprudence, as well as religious concerns around life, and doctors' conscience rights. There are concerns around repealing the 10-day waiting period and also allowing medical professionals to shorten the 90-day waiting period if the capacity to consent would be lost. I have heard those concerns.

This is my approach to addressing this legislation. As a legislator, it is my duty to ensure that individuals have the ability to use their agency in their choice on medical decisions, regardless of my personal proclivities. I will be supporting this bill through to the committee stage. I understand that there may be amendments proposed.

At the same time, some of the concerns that constituents have raised in my community against this bill are valid. From my perspective, some concerns that I have are whether we have proper supports in place for people who might be considering MAID in a not-foreseeable-death situation. I am talking about social supports for those who are in situations of great disability: Do we have social supports for day-to-day living? What about poverty? Is it a determinant of mental health?

With respect to palliative care, I do not think our country has yet addressed that issue adequately. I would like to see complementary legislation on that issue so we can be assured as a society that, in proceeding with this legislation, people are in the position of exercising their agency: They are not making a decision based on desperation or on our failure as a society to provide them with adequate social supports.

Another question I would like to see the committee address is this. When a person has lost the capacity to give consent, who will decide what is intolerable suffering? We need to suss that out. There needs to be some path to that. Parliament needs to give some direction to that so it is not simply left to the courts in the future. I think Parliament has a role in this because, as I am bringing the concerns of my constituents, both for and against, this is the place to give direction to the courts on any future decisions, and I would like to see the committee address some of those issues.

Another concern is for those struggling with mental health issues, such as depression, when death is not reasonably foreseeable. How will this legislation impact them?

With respect to mature minors, determining their capacity to decide and voluntary choice, free from duress, are concerns that have been raised. I also have those concerns.

I want to re-emphasize that I do not feel many Canadians have appropriate access to palliative care across the country. This is not the fault of any medical association, but I feel as a society we often spend a lot of time focusing on getting to a diagnosis. We have spent a lot of time in this place talking about dying with dignity, but we do not talk about how to live with dignity, and the choice of a person to see their life through to its natural end. If we are talking about choice and agency, somebody who makes the choice to see their life through without medically assisted dying should have the right and capacity to make that choice knowing that we, as a society, are caring for them. We are not just offering this as an alternative: that the only way to end suffering is to provide this as an option.

I give this nuanced answer because my own views on this have changed over the course of my term as a legislator with two very personal experiences. One experience was with both of my grandmothers, whose lives ended naturally. They both suffered from severe dementia. I do not think either of them would have chosen to have medically assisted dying because of their religious beliefs, but that option was not available to them, so I take that into consideration.

I am also living a situation right now, and she allowed me to share this, where earlier this year my mother-in-law, Debbie Garner, was diagnosed with a severe form of aggressive breast cancer. She has been fighting so hard and I feel so robbed because I just met this incredible woman a few years ago. She is fighting and giving it her all, but she lives in a jurisdiction where she does not have this option available to her. As part of her fight, she does not have the ability to exercise her agency in the way we are talking about, so this is now adding stress on her. She is doing everything she can to try and beat this disease, but the reality is there is a 50% chance, and probably greater with the form of cancer she has, that this will spread to her brain and leave her in a state I know she does not want to be in as a person. As a family member, I want to ensure that people in the position of my grandmother, who I know would have chosen to see her life through her way, have their wishes respected as do people in my mother-in-law's situation, who is saying she does not have the ability to exercise that choice, so she could use that agency as appropriately as possible.

That is my approach to this legislation. I would like to see this go forward to committee. I would like to see our society ensure that people have agency in both situations: that they are fully supported through the choice to see their life to its natural end, or are fully supported in a choice to end it with dignity and in a way that recognizes their own beliefs, their own agency and their own right to determination in these matters.

I thank the House for its time and I am happy to answer questions.

Criminal CodeGovernment Orders

October 21st, 2020 / 6:05 p.m.
See context

Sherbrooke Québec

Liberal

Élisabeth Brière LiberalParliamentary Secretary to the Minister of Economic Development and Official Languages (Economic Development Agency of Canada for the Regions of Quebec)

Mr. Speaker, I am very happy to have an opportunity this evening to share my thoughts on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

This bill has generated a lot of debate. It is good to talk about this because it is extremely important. It is important because too many sick people are suffering, knowing they will never get well.

I worked with such people for a long time, and I can say that knowing them, learning about their struggles, and helping them through their ordeal fosters a much better understanding. It goes without saying that medical assistance in dying is a matter of societal choices, choices that must be carefully considered from all angles.

I strongly believe that the government did its homework before introducing Bill C-7, which is the outcome of a series of round tables with experts and stakeholders, as well as a number of public consultations. We had to go through this process after the Quebec Superior Court's decision in Truchon and Gladu, which found that limiting medical assistance in dying to persons whose death was reasonably foreseeable was unconstitutional.

Ms. Gladu and the late Mr. Truchon both suffered from incurable degenerative diseases but were not eligible for medical assistance in dying because their deaths were neither imminent nor reasonably foreseeable.

The government's Bill C-7 proposes significant changes. It broadens the eligibility criteria to include people whose natural death is not reasonably foreseeable, as was the case for Mr. Truchon and Ms. Gladu. It also adjusts certain safeguards, allowing patients to waive final consent, for example. These are significant changes.

Let us first consider the reasonably foreseeable death criterion. A number of MPs are concerned about removing this criterion because they believe it would make it too easy to access medical assistance in dying. There is also some concern that people with disabilities or mental illness will not be properly protected. Life is precious and has so much to offer. I believe in that, and the government believes in it, too.

Under the provisions of this bill, mental illness is not considered to be an illness, disease or disability. The bill also expressly excludes people seeking medical assistance in dying solely because of mental illness. The government knows that the best treatment for mental illness is effective therapy, so greater emphasis needs to be placed on enhancing preventive measures and support resources.

What exactly is a reasonably foreseeable death, anyway? It is an assessment of the amount of time between a person's current state of health and their death. It is not something that can be measured with a blood test or a thermometer. It requires a clinical judgment based on an exhaustive medical evaluation of the patient. The fact remains that it is a difficult and sometimes imprecise exercise, and that is why the amendment is necessary.

Expanding patients' right to request medical assistance in dying does not necessarily mean it will be administered. Requesting medical assistance in dying does not automatically mean it will be administered. Even if the legislation is changed by removing a criterion, the spirit in which it will be applied does not change.

Requests will be evaluated based on the other criteria in the legislation and the new safeguards that I will get to shortly.

The government's priority is to strike a balance between the autonomy of eligible persons, the protection of vulnerable persons from being induced to end their life, and the important public health issue of suicide.

We care about compassion and dignity for both the patients and the process. In fact, that is why, in the first version of the legislation, the government included safeguards that would support decision-making, reflect the finality of the act, provide robust procedural guarantees to prevent errors and abuse, and protect vulnerable people.

Nevertheless, experience has exposed some gaps, and that is why we are proposing that two of these measures be amended.

The first change is to eliminate the 10-day waiting period between the date the request is signed and the date on which medical assistance in dying is provided, for individuals whose death is reasonably foreseeable. This 10-day waiting period needlessly prolongs suffering. Patients who are worried about losing their cognitive abilities and no longer being able to provide final consent live in fear. They may even refuse to take their medication and sometimes choose to request medical assistance in dying earlier.

The patient's stress also extends to their loved ones, making those last moments more painful than they need to be. Being able to choose when to die allows patients to go with their head held high, bolstered by the presence of their loved ones. These patients show noticeable relief when they realize that no matter what happens, they will get medical assistance in dying, as requested.

Although reasonable foreseeable natural death is no longer an eligibility criterion, it will be used to help determine which safeguards will be applied to requests for medical assistance in dying.

For people whose death is not reasonably foreseeable, a period of at least 90 days will ensure that there is informed consent. The sources of suffering causing the patient to request medical assistance in dying must be verified. Furthermore, it must be verified that the decision is being made without any outside pressure or influence.

The assessment of the person's overall medical condition is even more rigorous. We may be withdrawing the criterion of reasonably foreseeable death, but that does not mean greater access to medical assistance in dying. The bill continues to ensure that there is proper protection for the process, our medical practitioners and, above all, our patients.

Having recently discussed the bill with palliative care specialists, I can confirm that the 10-day waiting period often negatively influences a patient's decision and that removing this provision will make their last moments more peaceful.

The second safeguard I want to discuss today is the waiver of final consent.

Under the current legislation, immediately before providing medical assistance in dying, the medical practitioner or nurse practitioner must ensure that the person gives express consent to receive medical assistance in dying and give the person an opportunity to withdraw their request. The government's amendment means that final consent can be waived if certain conditions are met, such as the loss of cognitive ability and the signature of a written agreement stating that medical assistance in dying will be administered on a specified date. This measure helps to ease patients' anxiety so they can take their medication, suffer less and set a later date.

It is important to note that this is not the same thing as an advance request, meaning a request for medical assistance in dying on an unspecified future date under particular circumstances. That type of request could be included in a notarized health care directive. Currently, a person can state in their health care directive whether they would want to undergo aggressive treatment and what that term means to them, but they cannot request medical assistance in dying in advance.

That is a more complex subject because, in such cases, a legal representative is being asked to make a decision on behalf of someone else. This issue will be examined by a parliamentary committee. The committee will also discuss other issues, such as medical assistance in dying for minors.

All these changes to the reasonably foreseeable death criterion and adjustments to the safeguards reflect the government's desire to keep doing better, to create a more dignified, freer and more progressive society. I therefore encourage all members to vote in favour of this bill.

I would like to conclude with a quote from the late Jean Truchon: “I ask you to try to understand me and not to judge me”.

Criminal CodeGovernment Orders

October 21st, 2020 / 6:35 p.m.
See context

Green

Elizabeth May Green Saanich—Gulf Islands, BC

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

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

Criminal CodeGovernment Orders

October 21st, 2020 / 6:35 p.m.
See context

Delta B.C.

Liberal

Carla Qualtrough LiberalMinister of Employment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Criminal CodeGovernment Orders

October 21st, 2020 / 6:50 p.m.
See context

Conservative

Dean Allison Conservative Niagara West, ON

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

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

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

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

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

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

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

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

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

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

I would like to return to Dr. Sinyor again.

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

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

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

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

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

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

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

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

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

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

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

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

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