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

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for his question. We are talking about the second consent, which we do not agree with. We believe that, in some cases, 10 days is already too long. It is a long time to suffer. In the case of advance consent, there is a way to avoid the 10-day period, which can be too long for some people.

[Laurel Collins, NDP, Victoria, BC]

Madam Speaker, many Canadians know someone who has experienced intolerable suffering, and most Canadians support these changes.

I am curious about one piece of the legislation, which is that people will be required to have two practitioners, one having expertise specifically in the medical condition that the person has. I am curious to hear the member's thoughts on the barriers that people from rural and remote communities might face, given this requirement.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, death knows no borders. As already mentioned, we must ensure that there are no obstacles in rural areas. We will have to examine all the obstacles that prevent equal access to a dignified end for everyone, no matter their postal code.

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

Madam Speaker, I would like to thank the member opposite. I want to ask a question regarding a point raised once again by the member for Sherwood Park—Fort Saskatchewan, who talked about patients being pressured and the possibility of doctors influencing people. The evidence that we examined during our consultations does not support that position.

I wonder if the member has any information on how the medical profession operates in Quebec. For our part, we found that doctors always show great professionalism, vigilance and circumspection when broaching the subject with patients.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for his question. Personally, I have heard more about doctors showing a great deal of compassion for their patients and wanting them to be able to end their lives with dignity than the reverse. Personally, I have not heard of many, or really any, cases of undue pressure. Doctors take the Hippocratic oath, which provides patients with a great deal of protection.

However, just because I have not heard about something does not mean it does not exist. If it ever does happen, it must be reported. That could be discussed in committee. I think we need to let doctors do their job, which is about compassion more than anything else.

[Anthony Housefather, Liberal, Parliamentary Secretary to the Minister of Labour]

Madam Speaker, I will be sharing my time with the hon. member for Pontiac.

I want to start by saying that this subject is no doubt difficult for many Canadians watching. It is one in which we try to reconcile our deeply held view that life is precious with the right to liberty and the right to make our own independent decisions. This is a place where parliamentarians need to reflect not only on our own values but on what our courts have said.

In the Carter decision, the Supreme Court determined that section 7 of the charter meant that our provisions in the Criminal Code on assisted suicide were invalid. It said there was a class of people who were entitled to have doctors and nurses assist them in dying, so in 2016, Parliament had to move forward with legislation.

I had the pleasure of being the chair of the Standing Committee on Justice and Human Rights at the time. I listened to witnesses who had a myriad of opinions. I listened to professionals from all sides, including doctors, nurses, psychologists, people representing the disabled, and groups that advocated the right to die with dignity. What we crafted was a law that attempted to bridge all of those gaps. We knew that this law would not be in place forever. We knew that we, as a society and a country, would learn from the experiences of that law and that we would move forward with changes.

Indeed, I was very pleased that the Standing Committee on Justice and Human Rights made some significant changes to the legislation. We carved out conscience protection for medical professionals so that they were not obliged to assist with medical assistance in dying if it violated their own conscience or their moral values. We said that the law needed to be looked at again five years later to look at various classes of people we had left out of the original law, such as mature minors and people suffering from mental illness, as well as to examine the issue of advance directives whereby people could make decisions before they declined into dementia.

We also required the review to look at palliative care and its availability across Canada, because the two issues are intrinsically tied together. We do not want people to ever make a decision that they need medically assisted death because they will be deprived of proper palliative care.

That review is coming up. I know that Canadians across the country will have the opportunity to pronounce on these issues.

However, our courts have made another decision.

In the Truchon-Gladu ruling in Quebec, the court ruled that a class of people were entitled to access medical assistance in dying in accordance with Carter. The legislation passed in 2016 had removed this class of people from the list of people eligible for medical assistance in dying. We must therefore remove the section that limits medical assistance in dying to people whose death is reasonably foreseeable. This amendment to the original law is designed to remove this class of people and to enable people who meet all of the other criteria to access medical assistance in dying, even if their death is not reasonably foreseeable.

I support that position because I have not only looked at the court decisions but have also walked the experience of Canadians over the last four years.

We have heard of people who were enduring grave suffering and who should have been entitled to medical assistance in dying because they met every aspect of the law, except that no one could say with reasonable certainty that their death would happen in the near future. We heard, from Canadians everywhere in Canada who fall under that class, that this is unfair. The courts in the Truchon case and in a number of other cases have hinted that this requirement is unconstitutional, so the government is moving forward to respect the court's decision in Truchon and remove from the law the requirement for death to be reasonably foreseeable.

However, the government is also adapting the law to deal with other difficulties that have arisen.

We never talked about, or if we did, it was rare, the issue of people deciding to prematurely end their lives because they were worried they would lose capacity at a future date. People should not shorten their lives because they are worried that a month later they will no longer have the capability or capacity to make that decision under the terms of the law. If it will give people an extra two or three weeks or an extra month with their family, we should do that.

Therefore, the law is being amended to allow people to offer consent to a medically assisted death even if they lose capacity, but it also establishes safeguards. In the event they get to that date and they no longer wish to have medically assisted dying, even if they have lost capacity, by any word, any gesture that is not involuntary, then the pre-consent will disappear.

I want to clarify this, because it has been talked about a great deal today. This is not an advance directive. These are people who already know exactly what their illness is, they are already suffering from this illness, they are in an advanced state of decline, they have no ability to relieve their pain by medical treatment reasonably accessible to them and they have, after being reviewed by two medical professionals and declaring before an independent witness, decided they want to offer consent to end their lives on a certain date, even if they have lost the capacity to consent.

This is a really important change, and I credit the government for doing so.

I also want to look at the issue of how we have handled that class of people whose death is not reasonably foreseeable. We have established a 90-day waiting period in that case. We have not made this something that could happen in the 10 days that was previously reflected under the law. We have done so with due seriousness. We understand the differences and the challenges that the issue poses for people when their death is not imminent.

For example, people could have a catastrophic event that occurs and their circumstances change suddenly. We want them to have a proper reflection period before moving forward with medically assisted dying. We also understand and have made the exception for those people who may lose the capacity to consent during that 90-day period.

The amendments to the bill reflect well where Canadian society has gone.

I do want to say that when we passed the legislation in 2016, very few jurisdictions around the world allowed medical assistance in dying. It existed in Belgium, the Netherlands, Uruguay and five or six U.S. states.

We were one of the first countries in the world to allow medical assistance in dying. For that reason, we chose to take things slowly.

This new amendment to the original law takes us to a place where Canadian society has moved. Canadian society, much more than in 2016, accepts and supports medically assisted dying, because they have watched the practice happen. We have seen the challenges we have confronted with the existing law and we have taken steps to improve the law and comply with the Truchon decision.

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

Madam Speaker, we hear that the current Liberal government is not aware of any infractions against the current euthanasia safeguards.

I have mentioned a few today, but I would also like to include the very public story of Roger Foley, who became a national story after being offered, repeatedly, by his hospital careworkers euthanasia rather than suitable home care.

The current safeguards are not working. Why would we even start to loosen restrictions when we clearly cannot enforce the ones we already have?

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I have faith in health care professionals across Canada, including nurses and doctors. I believe that the great majority of physicians and nurses in the country are dedicated professionals who do their jobs appropriately and follow the law.

In those cases where physicians or nurse practitioners have violated the law, I strongly suggest that members report them to the professional order of their province and to the police, and justice should prevail.

I clearly agree that medical assistance in dying is a decision of the person, but it is a decision of last resort. I believe palliative care is a priority, and everyone should have access to good palliative care in the country.

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

Madam Speaker, I commend my colleague for his thoughtful speech.

I would like to give him the chance to elaborate on the 90-day period he was referring to, as opposed to the 10-day period. We are all aware that each situation will be vastly different, including when it comes to capacity and the deadlines people are facing. We all want to avoid having a person die too soon out of fear of not being able to provide clear consent at a later date.

In my colleague's view, what sort of flexibility might be included in the 90-day period?

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I greatly appreciate my colleague's question. I also commend him for his speech.

In my view, we must make a distinction between people whose death is reasonably foreseeable and those whose death is not reasonably foreseeable. I believe the 90-day period could be 75 days or 120 days. I believe that 90 days is a good compromise, but there is an exception. For people who obtain all the necessary authorizations from a doctor to have access to medical assistance in dying and who will lose the capacity to consent, there is an exception in the legislation that allows the waiting period to be shorter than 90 days. I believe that is a good step forward. I imagine we could propose amendments on this at the Standing Committee on Justice and Human Rights. Those amendments will be studied by the committee.

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

Madam Speaker, the NDP is relatively happy with the new bill. We think it should have been done this way in the first place, four years ago.

One of the concerns we have, and this was also brought up by the Liberal member for Beaches—East York, is that with this new track for people who experience intolerable suffering, they will have to get an opinion from a specialist. Specialists are not easily seen in many parts of Canada, rural and northern parts. These are people at the end of their lives and intolerably suffering.

We are worried this will restrict the ability of these Canadians to have the same medical service other Canadians have.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, in 2016 at committee, the requirement to see a specialist was suggested by a number of the groups that appeared. It would be a specialist in the area of the condition the person had.

Concerns were expressed that two doctors, or a nurse practitioner and a doctor, who did not have expertise in the condition would not be able to properly assess the individual. When we are talking about people whose death is not reasonably foreseeable, I do not believe this is outside the bounds. This is a reasonable way to approach the situation. With video conference and consultations, there are ways to reach remote communities. The person does not have to be in the room with the patient.

[William Amos, Liberal, Parliamentary Secretary to Minister of Innovation]

Madam Speaker, I am pleased to rise on the topic of Bill C-7, as we embark on what I expect will be quite a lively and passionate discussion about issues that Canadians care deeply about and certainly my Pontiac constituents. I heard from them for several years on this topic, regular correspondence, regular discussions at the door, so I appreciate this opportunity to discuss certain aspects of our government's proposed changes to the federal MAID legislation.

It is timely to share some of the insights from three important studies on very complex and sensitive issues that were not included in the 2016 federal legislation. These are requests by people for whom mental illness is their sole underlying medical condition, advance requests and requests by mature minors. I hope we will get to all three of them, but may only get to the first two.

When Bill C-14 was debated in 2016, parliamentarians had difficulty finding common ground on how to address these types of requests within Canada's first assisted dying regime. Understandably, given the challenging nature of these issues and the limited time that was available, due to the Supreme Court's timeline, to deliver on acceptable approaches for Canada, parliamentarians collectively decided that more in-depth study and review of the evidence was needed.

The legislation in 2016 therefore included requirements for the government to undertake independent reviews. There were strict timelines set out in Bill C-14 and the studies that needed to be commissioned had to be done within six months of the coming into force of Canada's new legislation on assisted dying and the government was obliged to table the final reports on the studies within a further two years. Both of these timelines were met.

In December 2016, the government asked the Council of Canadian Academies, CCA, an independent organization that undertakes evidence-based expert study, to inform our public policy development and to take on these studies that were required by legislation. The resulting reports were tabled in December 2018, documenting extensive review of academic and policy research, stakeholder submissions and international experience in the three subject areas.

They also included a broad range of perspectives from relevant health care professions, diverse academic disciplines, advocacy groups, indigenous elders, essentially the whole of Canadian perspective was brought to bear. In accordance with the CCA practice, they did not in fact contain recommendations.

Two of the reports, one on request by individuals where mental illness is the sole underlying condition and the report on advance requests have been particularly informative during the development of our government's response to the Quebec's Superior Court decision in Truchon.

I will first talk about mental illness. Under the current law, very few persons with mental illness as the primary source of their suffering are likely to be eligible for MAID. This is because most mental illnesses do not cause a person's natural death to be reasonably foreseeable.

Removing the reasonably foreseeable natural death criterion introduces the possibility for persons with mental illness to be deemed eligible for MAID, if they meet the remaining criteria.

During the recent federal round-table consultations held on MAID, we heard many concerns from participants who felt that not enough is known to safely extend eligibility for MAID to people whose suffering is caused by a mental illness alone. They felt that the issue required further examination.

We also know that there is generally very little support for expanding eligibility among mental health care practitioners, such as psychiatrists and psychologists, and by organizations representing people with mental illness. The CCA report on this issue noted a number of challenges associated with the delivery of MAID to persons with a mental illness.

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

The hon. member will have five minutes to complete his remarks after oral questions.

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