Bill C-7 (Historical)

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

This enactment amends the Criminal Code to, among other things,
(a) repeal the provision that requires a person’s natural death be reasonably foreseeable in order for them to be eligible for medical assistance in dying;
(b) specify that persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying;
(c) create two sets of safeguards that must be respected before medical assistance in dying may be provided to a person, the application of which depends on whether the person’s natural death is reasonably foreseeable;
(d) permit medical assistance in dying to be provided to a person who has been found eligible to receive it, whose natural death is reasonably foreseeable and who has lost the capacity to consent before medical assistance in dying is provided, on the basis of a prior agreement they entered into with the medical practitioner or nurse practitioner; and
(e) permit medical assistance in dying to be provided to a person who has lost the capacity to consent to it as a result of the self-administration of a substance that was provided to them under the provisions governing medical assistance in dying in order to cause their own death.

Criminal Code

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, again that is a great point to raise. I remember having a meeting maybe a month and a half ago, before new restrictions came in Alberta, with about 20 or so constituents. Every single one had a story of a suicide they were connected to: a co-worker, a family member or somebody they knew in their neighbourhood. The youngest that I was told about was a 14-year-old who had committed suicide.

There is this great and deep harm being done to people's mental health because of this pandemic and everything that joins with it. I did a Standing Order 31 statement on it just a week ago. Over 2,000 more suicides are expected in Canada and legislation like this does not make it any simpler for people who will find themselves in emergency care units and who will be perhaps in despair about the situation that they find themselves in. It is an excellent question.

[Damien Kurek, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, it is an honour to enter into the debate on what is such an important issue. I attempted to enter into debate on Friday but due to some technical difficulties and the challenges that we all face regarding COVID, I was not able to. Therefore, I am pleased to be able to join the report stage debate on Bill C-7.

I am going to attempt to address a number of different issues throughout my remarks today, acknowledging the fact that this is an incredibly sensitive subject on which there is a diversity of opinions, views and perspectives. Importantly, I feel that diversity needs to be respected.

I would bring to members' attention a couple of comments that the Minister of Justice made in question period earlier today. He said something like that there are diverse and evolving views on this, and that is absolutely true. However, it was the next statement that was incredibly troubling to me and, I know, incredibly troubling to many who have participated in this debate. Certainly, the hundreds of constituents whom I have heard from on this matter are troubled as well. The minister went on to say that this “does represent a consensus”. It is incredibly troubling that the minister would use language as definite as that to basically shut down what is valid debate on such an important subject, a subject that is literally life and death.

To use a specific example of the diversity of views that exist on this subject, I posted on my Facebook page the other day a question posed by the member for Vancouver Granville, the former Liberal justice minister, about this very issue, on which that member's perspective is very different from the current Liberal justice minister's. In the myriad of responses, both on Facebook and those that came into my office, I found it incredible how many people reached out to provide feedback and say what they hoped the bill would include and what they hoped it would not include, and many more wanted to provide input.

The minister talked about how the Liberals heard from 300,000 Canadians, and that is great. I forwarded the consultation information to many constituents who were curious about this when those consultations took place. I find it very interesting because, in fact, in many cases I had constituents who forwarded the information they sent to the minister on the consultation also to me. I am afraid, certainly from the perspective of those people in Battle River—Crowfoot who also reached out to me, that this legislation does not address the diversity of views that exist. I could continue on this particular subject, but I think the definite nature in which the government rushed this legislation through is troubling further.

Notwithstanding the proroguing of Parliament, which is a subject that I have litigated in this chamber prior to this point, and certainly we will hear a lot more about that, especially as we enter into what will cut off my questions and comments time, the fall economic update. However, the fact is that this legislation is being rushed through. There were many further witnesses who would have provided valuable input to the discussion regarding this bill in committee. There was a whole series of amendments, and many good amendments. In fact, the two amendments that are being considered at report stage deserve valid consideration. They are two eminently reasonable amendments that would ensure that there are safeguards put in place so that Canadians are protected. I sat in on the justice committee for a short time and listened in on more of the debate. There is much more that should have been said.

I find it troubling that, in typical Liberal fashion, they seem to have manufactured a level of urgency. This was introduced in the last Parliament. They prorogued Parliament and then said it had to be done and there was only a short time frame in order to do it or else there would be significant consequences. It is that manufactured urgency that does not lead to the best public policy outcomes. This is incumbent upon all parliamentarians.

In fact, I find it interesting that the parliamentary secretary to the House leader was just talking to one of my other Conservative colleagues. He asked how long we planned to drag this out. It is concerning that on a question as important as this, including life and death for the most vulnerable among us, the government would think it is an opportunity to rush legislation through. It is incredibly concerning that they would demonstrate what seems to be such flagrant disregard for the diversity of perspectives that exist.

There is no question, as I have read the bill carefully and, as I said before, followed the committee proceedings very carefully, that we need to ensure that the most vulnerable among us are protected. I listened carefully to a press conference that included some disability advocates and professionals from indigenous communities in our country. They were addressing specifically the direction the bill was taking. It is incredibly concerning that it seems those perspectives were not heard in the Liberals' forcing through of this legislation.

In a community where there is already a suicide epidemic, the government is pushing through something that goes contrary to the value of life that these indigenous folks were talking about. It is incredibly concerning that those issues are not being addressed effectively. We have heard from health care professionals who say the lack of safeguards provide an opportunity for this to be abused. There is nothing more final than death. It is absolutely essential that we get this right.

When I was walking to go sit in at the justice committee, I was speaking with a friend on my cellphone and he asked what we were debating today. I said medical assistance in dying. We talked about that. What I find interesting is a statement he shared with me. He said, “Isn't it something that you are literally going to debate something like life and death?” We all need to take incredibly seriously the information that is put before us.

I did want to touch very briefly on how it seems the legislation fails to acknowledge them and almost creates two classes of Canadians, specifically when it comes to the protections and safeguards that need to be in place regarding Canadians who have disabilities.

I am absolutely thrilled to have many folks in my life with a wide range of disabilities. There is a young man who comes into my office who has a disability and he is an absolute joy. He volunteers and he loves to come in and help his member of Parliament. He calls himself my special campaign manager. He is an incredibly valued part of my constituency. I had classmates who had disabilities. There are many perspectives across this country.

The unintended consequences of this bill being rushed through, with its wording being ambiguous, is that it could have significant consequences in the way we approach a subject as important as this. It leads to the fact that those who are most vulnerable within our society may feel the most significant consequences of not having appropriate safeguards in place.

I see my time is coming to a conclusion and I know there are very pressing subjects to discuss further. I would just finish by saying this: Let us all take seriously what I would suggest is one of the most important aspects of our job as parliamentarians, which is to ensure that Canadians are protected and can live with dignity.

With that, I will be unable to support the bill and would encourage members to carefully consider it as we go forward.

[The Speaker, Anthony Rota]

It being 4 p.m., pursuant to order made Wednesday, November 25, I now invite the hon. Deputy Prime Minister and Minister of Finance to make a statement.

The House resumed from November 30 consideration of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), as reported (with amendments) from the committee, and of the motions in Group No. 1.

[The Assistant Deputy Speaker, Carol Hughes]

I wish to inform the House that because of the deferred recorded division, Government Orders will be extended by 40 minutes.

The hon. member for Battle River—Crowfoot had five minutes of questions and comments remaining.

Questions and comments, the hon. member for Sherwood Park—Fort Saskatchewan.

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

Madam Speaker, I wonder if my colleague can share with this House in particular his concerns about the possibility of same-day death if these amendments are not passed. These amendments include reintroducing a 10-day reflection period. Without this 10-day reflection period, there would be absolutely no time requirements. There is an assessment that would have to take place, but there would be no time limit on that.

There would be no legislated limit on how quickly a person could go through this process without that reflection period, which would create the possibility of a very quick turnaround time and someone not having the opportunity to reflect and really consider what their situation is. I wonder if the member can comment on that.

[Damien Kurek, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, I would be happy to comment. Let me first note it is certainly interesting to do a speech one day and then answer questions the next, but it does not diminish the importance of this issue.

The ability to possibly access same-day death is certainly a great concern I have and that I have heard from many of my constituents about. My hon. colleague made a comment in one of his speeches that certainly resonated with me, and it is something I heard from a number of my constituents as well, when he said that one's worst day should not be one's last day.

There are safeguards required to ensure Canada's medical assistance in dying framework is strong and protects the most vulnerable among us. I believe the priority of all members of Parliament needs to be to ensure that is in fact the case.

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

Madam Speaker, in the speeches we have heard, a number of Conservatives have made the point that living should not be harder than dying. I wonder if that means the Conservatives are ready to support a guaranteed livable income to ensure that no Canadian lives in poverty or has economic disadvantage affecting their ability to make the best of their life.

[Damien Kurek, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, I would simply say this: We are debating a bill that dramatically changes the framework for Canada's medical assistance in dying legislation. This bill was introduced prior to Parliament being prorogued and it is being rushed through. We have heard time and time again from experts. In fact, the Senate just wrapped up hearing from 85 different witnesses about how there is a tremendous amount of concern on this bill from all perspectives. For the justice minister to come and make the declarations he has, saying that somehow they have reached a consensus, is absolutely inappropriate.

Certainly, as we debate this bill, we need to focus on ensuring that Canadians are protected and that Parliament gets this right. This is a question literally of life and death for Canadians. Parliament has to get this right and it has to be fulsomely debated to ensure that we are able to get that balance struck appropriately.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, could the hon. member comment on what he is hearing, in terms of a reaction, from his constituents on this amended bill?

[Damien Kurek, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, I have heard from many constituents on this matter, quite frankly, from all sides of the debate saying two things. The first is that there is a tremendous amount of concern with the bill as it was presented and as it has been presented to this House. The second is that a lot of the very reasonable amendments put forward in committee were not adopted.

Certainly, that has posed a great deal of concern. I have heard from hundreds of constituents who have brought these very serious concerns to my attention. I am proud to stand for their interests in this debate on such an important subject.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, it is a pleasure to be here today because a lot of things need to be said about Bill C-7. For those who are not aware, it is an act to amend the Criminal Code with respect to medical assistance in dying.

Members know I was in Parliament when Bill C-14, the predecessor of this bill, was debated. I heard the debate and discussions about the safeguards that needed to be put in place to make sure we did not go down the slippery slope that many other countries went down when they began to allow assisted suicide and branched further into euthanizing individuals.

Knowing all the discussion and thought that went into the reaction to the Carter case, I am very troubled and disappointed that when the Quebec lower court ruled the reasonably foreseeable death provision was unconstitutional or would not be accepted in Quebec courts, the government did not put this forward to the Supreme Court. I feel as though the Supreme Court was involved in the Carter decision in the first place, as it laid out the provisions it thought would be reasonable. A reasonably foreseeable death was one of them, so this should have gone back to it for commentary before coming to this place.

With that in mind, I am also disappointed that the government has not moved forward on the palliative care provisions that were also a clear recommendation from the special committee that studied the Carter decision. It said that without good quality palliative care, we do not have a real choice.

As members know, I brought a private member's bill to the House on this, which was unanimously supported here and in the Senate. I worked with the health minister of the day to put together a framework across Canada to get consistent access to palliative care for all Canadians, because 70% of Canadians have no access to it. As per the Carter decision and the special committee, if we do not have good quality palliative care, we really do not have a choice.

I was disappointed to not even see “palliative care” mentioned in the fall economic update. The words were not even there. The fact the government would prioritize expanding medical assistance in dying without the input of the Supreme Court and without putting provisions of palliative care in place seems to be the wrong priority. Let us let people live as well as they can for as long as they can instead of encouraging them to die. I think that is where we as compassionate Canadians want to go.

Another thing the Liberal government fell down on is the choice not to do the five-year review. When Bill C-14 came through, one of its provisions was about looking at the situation after five years so we would understand whether or not the rules that were put in place were being followed, were adequate and met the intended purpose. That was not done. This was a perfect opportunity for the government to do that work, because we heard anecdotally that in many cases across Canada, the existing rules and safeguards have not been followed. We need to get a quantitative analysis on that and understand how these things could happen and how we can prevent them from happening in the future.

It is disturbing, then, that the government has decided, without doing the five-year review, to make changes to what is happening with respect to medical assistance in dying beyond what was asked for by the Quebec courts. Doing something without reviewing what one already has in place is irresponsible, in my view.

Given that, I have some concerns. The government has removed many of the safeguards put in place in the bill to keep those unfortunate things that we worried about when we were discussing C-14 from happening. For example, there is the 10-day cooling-off period. As anyone who has had relatives suffering through irremediable conditions knows, they have good days and bad days, and on the bad days they can feel like they want to die.

My mother just died in October. At the very end, she was in a lot of pain. I talked to her about medical assistance in dying and it was not something she wanted; she wanted palliative care. I am fortunate that in Sarnia—Lambton we have palliative care. One day she told me she was really thinking about it, but the next day it was not something she wanted, so I really think that 10-day cooling-off period was an important safeguard.

I am sympathetic with one of the changes that was put in, although it should have been put in after the five-year review. It says that once people have signed off on all the documents and the independent witnesses and others who understand the condition have dotted all the i's and crossed the t's, a person perhaps will not be able to give consent immediately before the procedure. I saw this in my mother's situation. At the end, she would not have been able to verbally communicate or even write to indicate her choice, should that have been her choice.

However, removing the 10-day safeguard was a mistake. The Conservatives brought an amendment to try to put it back in and explained why it was important, but it was not received.

The other thing I found troubling was the removal of the independent witnesses. We cannot even get a will without having an independent witness. It seems to me that for something as important as determining one's date of death, it should be a provision.

In Ontario, there is another difficulty, which has to do with conscience rights. There are people who do not want to participate in medical assistance in dying for religious reasons or for personal reasons of conscience, and that is their charter right. This means they do not want to participate in the act and do not want to refer. They do not want to have anything to do with it. In Ontario, medical people are being forced to at least refer. That is still a violation of their conscience rights, and it is troubling that in the debates on Bill C-7, when I asked these questions the Parliamentary Secretary to the Minister of Justice said there are plenty of safeguards in there and it is okay. No, it is not okay. They are still violating rights of conscience and that needs to be addressed as well.

A modified advance consent was opened up to allow people to indicate, 90 days in advance, that they want to have this procedure. Advance consent was studied by one of the committees chartered by Parliament. Its recommendations said that a lot of things need to be considered before we go down the advance consent path. The government has not really done its five-year review, and I remember the member for Vancouver Granville commenting on this very point. There is a lot to be thought out there, and if we do not do it correctly, we will once again have a situation where the intent of the bill is not going to be met. There are going to be new violations in the way we have heard anecdotally, and that will not be a very good situation.

I was happy to see in Bill C-7 the clarification to indicate that if the sole underlying medical condition is mental illness, individuals are not eligible for medical assistance in dying, although there is some controversy there. I have heard from groups across Canada that are calling on the government to allow individuals whose underlying suffering condition is mental illness to receive medical assistance in dying. I think it is not a good idea, and I believe this is in line with what was said by the committee that studied this part of medical assistance in dying. It said many of the mental illness conditions, such as depression, could be treated. These are treatable conditions, not irremediable conditions, and some are glad to see this loophole closed.

The bill intends to:

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

We talked about this when Bill C-14 was in this place. At that time, we were not sure about the method of application of medical assistance in dying, whether it could be done with a prescription or not, and there was a concern: What if the procedure went wrong and a person cannot give consent? What do we do then? I am glad to see that situation was addressed in the bill.

Overall, those are my concerns with Bill C-7, and I think the government needs to go back to the drawing board on it. As 50% of the Canadian public seem to be concerned about the existing bill, such as people with disabilities and mental illness, let us go back to the drawing board.

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

Madam Speaker, in 2016, the Alberta Court of Appeal unanimously granted a 58-year-old woman, known as E.F., access to medical assistance in dying. She suffered from severe conversion disorder, which meant involuntary muscle spasms that radiated from her face causing her severe, constant pain and migraines. Her eyelid muscles spasmed shut, rendering her effectively blind. Her digestive system was ineffective and she went without eating for up to two days. She had trouble sleeping, and because of digestive problems she lost significant weight and muscle mass. She was not ambulatory a needed to be carried or use a wheelchair. Her quality of life, on the court's record, was non-existent. The court also noted that the applicant's husband and adult children were supportive of her decision.

Does the member agree that E.F. should have had access to medical assistance in dying?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I am not a lawyer, and I think these issues are best decided in the courts.

The Supreme Court, which studied the Carter decision originally, said there had to be an irremediable condition with a reasonably foreseeable death. Although there is definitely suffering in the situation described by the member, it does not seem like death was reasonably foreseeable, so it would not have met the Supreme Court's decision.

Until the Supreme Court has a chance to weigh in on the Quebec court's decision, it would be unrealistic for a person who is not a lawyer to weigh in.

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

Madam Speaker, I congratulate my colleague on her speech and I thank her for that. I want to express my sincere condolences on the loss of her mother. I know how that feels.

The member did raise some interesting issues. The act is slated for a comprehensive review in June. It will also prevent intense suffering.

This is certainly an emotional debate, but I would like to hear the member's thoughts on what happened with Nicole Gladu and Jean Truchon in Quebec.

I would like to know what she thinks of the court deadline. If this law is not passed, we will have inconsistent legislation.