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

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Madam Speaker, what we are saying is that we want to make the fairest decisions for each group of people.

People dealing with mental health issues are just as important as people with disabilities and people who are terminally ill and highly vulnerable.

This is a very sensitive debate, and people with mental health problems who are not capable of making decisions are excluded from this law.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Madam Speaker, I want to begin by saying that I was very touched to join my colleague in attending the commemoration of the great sacrifice of Canadian soldiers during the Second World War, in Caen, France.

I will put that aside for a moment.

I listened with interest to my colleague talk about the rights of handicapped people and how much the government cares for them. However, we saw complete indifference toward the crisis faced by handicapped people during the pandemic. We had to work hard and push the government to give a measly $600 to the most impoverished people when it was not going to give it. Handicapped people suffer extraordinary levels of poverty because they are marginalized from the workforce.

Given the fact that the Human Rights Commission had to call out the government on its lack of action and interest in supporting handicapped people during the pandemic, I would expect my colleague to recognize that the government needs to do a better job in addressing the rights of handicapped people so they can get through this unprecedented economic and medical catastrophe.

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Madam Speaker, it is a pleasure to rise to respond to my colleague who was also a travel companion in Normandy.

My colleague may be referring to the Speech from the Throne in which the Prime Minister put forward some very important decisions for persons with disabilities. We provided $600, but that has nothing to do with medical assistance in dying. However, I am pleased to inform him that we were there for persons with disabilities—

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

Resuming debate.

The hon. member for Shefford.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I would first like to mention that I will be sharing my time with the hon. member for Beauport—Limoilou.

I am speaking here in the House of Commons today about Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying.

Many people here have had unique experiences involving the end of a loved one’s life. Personally, my most recent experience was last year, when I held my father-in-law’s hand until we were sure that he could die without suffering. I realized then that not everyone is that lucky. I thought about my grandmother, who fought a long and painful battle with cancer for many years.

Naturally, as the Bloc Québécois critic for the status of women and seniors, I was contacted by a number of groups about this bill. I will therefore recap all of the work my party did on this important issue, while emphasizing the great sensitivity of Quebeckers when it comes to medical assistance in dying. I will conclude with the position of some seniors’ and women’s groups who have made extremely useful recommendations.

First, let us talk about the reason for this debate. In September 2019, the Superior Court of Quebec ruled in favour of Nicole Gladu and Jean Truchon, both suffering from incurable degenerative diseases, stating that one of the eligibility criteria for medical assistance in dying was too restrictive, both in the federal legislation covering MAID and in Quebec’s act respecting end-of-life care.

Two brave individuals, and I know people who knew them personally, simply asked to be able to die with dignity, without uselessly prolonging their pain. Suffering from cerebral palsy, Mr. Truchon lost the use of all four limbs and had difficulty speaking. Pain killers are no longer working for Ms. Gladu, who suffers from post polio syndrome, and she cannot remain in one position very long because of the constant pain. She said that she loves life too much to settle for mere existence.

What we are talking about here is the “reasonable foreseeability of natural death” requirement. Justice Christine Baudouin said it well in her ruling when she wrote that “The court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Mrs. Gladu's rights to liberty and security, protected by section 7 of the Charter.” That is the crux of this debate.

The defendants were challenging the fact that they had been denied access to medical assistance in dying because their death was not reasonably foreseeable, even though they had legitimately demonstrated their desire to stop suffering. Jean Truchon had chosen to die in June 2020, but he moved up the date of his death as a result the pandemic. Nicole Gladu is still living, and I commend her courage and determination.

The Bloc Québécois' position on this ethical question is clear. I thank the member for Montcalm for his excellent work and co-operation on this matter. I remind members that, as many have already pointed out, legislators did not do their job properly with Bill C-14. As a result, issues of a social and political nature are being brought before the courts.

We need to make sure that people who have serious, irreversible illnesses are not forced to go to court to access MAID. Do we really want to inflict more suffering on people who are already suffering greatly by forcing them to go to court for the right to make the very personal decision about their end of life? This will inevitably happen if we cannot figure out a way to cover cognitive degenerative diseases.

Obviously, we agree that we need to proceed with caution before including mental health issues, but that is not the issue today. The exclusion from the bill of eligibility for medical assistance in dying for individuals suffering solely from a mental illness requires further reflection, study and consultation, which will be completed at the Standing Committee on Health as soon as the motion that has already been moved by my colleague from Montcalm is adopted.

I would like to remind members of the important role Quebec played on this issue. Quebec was the first jurisdiction in Canada to pass legislation on this issue.

Wanda Morris, a representative of a B.C. group that advocates for the right to die with dignity, pointed out that the committee studying the issue had the unanimous support of all the parties in the National Assembly. This should be a model for the rest of Canada. Ms. Morris said she felt confident after seeing how it would work in Quebec and seeing that people were pleased to have the option of dying with dignity. The Quebec legislation, which was spearheaded by Véronique Hivon, was the result of years of research and consultation with physicians, ethicists, patients and the public. It has been reported that 79% of Quebeckers support medical assistance in dying, compared to 68% in the rest of Canada. That is important to point out.

In 2015, when the political parties in the National Assembly unanimously applauded the Supreme Court ruling on MAID, Véronique Hivon stated:

Today is truly a great day for people who are ill, for people who are at the end of their lives, for Quebec and for all Quebeckers who participated in...this profoundly democratic debate that the National Assembly had the courage to initiate in 2009. I believe that, collectively, Quebec has really paved the way, and we have done so in the best possible way, in a non-partisan, totally democratic way.

In this time of crisis, we must work together constructively to put people's well-being first. This is not about which has greater merit: palliative care or medical assistance in dying. This is about being able to offer both, to offer a choice. That is why I would like to remind the House that health transfers must be increased to 35% because Quebec and the provinces are the ones who know their regions' needs best and are in the best position to minimize disparity among the regions.

I would now like to tell the House about a meeting I had with the Association féminine d'éducation et d'action sociale, or AFEAS, in my role as critic for seniors and status of women. During the meeting, the AFEAS shared its concerns about this issue with me. I will quote the AFEAS 2018-19 issue guide:

Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly....

As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope....

This procedure cannot be accessed by individuals who are not at the end of life....People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.

That meeting took place last January. Last week I received a call from the president, reminding me how important this bill is, not only to her members but to all Quebeckers and Canadians. Work on this bill must continue in committee so the necessary improvements can be made.

Before being elected, I was a project manager responsible for raising awareness about elder abuse and bullying. I used to teach that violating people's rights is a form of abuse, that any attack on rights and freedoms, including the failure to recognize an individual's capacity to consent and to accept or refuse medical treatment, is a form of abuse. In 2020, a focus on proper treatment is long overdue.

Let me conclude by saying that I hope all of these comments and all of Quebec's lived experiences, in terms of respecting people who request and choose to die with dignity, will encourage all members of the House of Commons to give their unanimous support to Bill C-7 and to medical assistance in dying. Let's show some empathy for everyone who is suffering. Let's give them the choice. It is said that we do not choose to be born, but once we are, the cycle of life begins. Let's ensure that we ourselves have the choice to die with dignity in accordance with our own final wishes. This bill is long overdue. We need to act.

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

Madam Speaker, I thank the hon. member for Shefford for her speech and her very analytical and honest comments.

I have two simple questions for her since she took part in today's debate. It was said that consultations on Bill C-7 were inadequate. In my opinion that is absolutely not true, given that we have already heard from 300,000 people. I would like her thoughts on that.

The other question I want to ask her has to do with the dignity and autonomy of the person who wants to receive medical assistance in dying. Will changing the number of witnesses from two to just one independent witness and eliminating the 10-day waiting period improve or diminish the dignity of a person who has opted for medical assistance in dying?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for the question.

Eliminating the 10 days is a matter of dignity. This will allow some people to avoid suffering for days unnecessarily. As far as the committee work is concerned, we are aware that there is a world of difference between Bill C-14 and Bill C-7.

It is already planned, but the committee will have to address the issues of advance requests, which is something many seniors' groups are calling for, particularly for some people with degenerative diseases. There is also the issue of mental health and that of minors.

There are more issues that need to be studied, and I know that the committee will do the most exceptional work possible with input from all parties.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, the Canadian Society of Palliative Care Physicians has put out a statement, indicating that euthanasia-assisted suicide is distinct from palliative care. We talk about choice and opportunity here, knowing that 70% of Canadians have absolutely no access to palliative care, yet it is part of this conglomerate of other options that are presented within the bill on euthanasia.

What is the member's perspective on the need for palliative care in Canada and should it be considered distinct from euthanasia?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her question.

I already addressed this in my speech. We must remember that it is important that we not pit palliative care against medical assistance in dying. We must continue to ensure that Quebec and the provinces receive the money they need for their health care systems through health transfers. Palliative care just like medical assistance in dying are part of a continuum of care. It is truly important to provide choice. I have already mentioned that.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Madam Speaker, I thank my colleague for her speech.

We agree on the fact that people must be given the choice. They must be able to leave this life with dignity and avoid useless suffering. However, there is a provision in the bill that concerns us a little, and that is the fact that the physician must have expertise or specific knowledge of the person's illness.

In the case of people living in rural or remote areas, there may not be a physician with knowledge of a rare illness. Would that not be an obstacle to accessing this right?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, that is one more reason to ensure that health care systems across Quebec and Canada have adequate funding through health transfers, as we have pointed out. This would give people access to specialists who could weigh in. That is why the government must increase health transfers and ensure that people everywhere have better access to care.

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

Madam Speaker, I agree entirely with my hon. colleague from the Bloc Québécois.

I wonder if there could be a response to an earlier question posed in the debate, which suggested that this legislation would open the door to seeing the possibility of medical assistance in dying for those who were not facing death but who were facing mental illness. As I read the legislation, that is specifically not contemplated here.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her question.

I remind members that the notion of mental health is not addressed in this bill because my colleague, the member for Montcalm, pointed out the need to be careful when dealing with such a sensitive issue as mental health.

[Julie Vignola, Bloc, Beauport—Limoilou, QC]

Madam Speaker, no one likes to talk about death. It reminds us that we are mortal, as are the people we love and the people we are emotionally attached to. We do not like to feel negative emotions. Our brain reacts negatively to these emotions by releasing hormones that make us panic.

Death is such a difficult subject that most people worry when a loved one starts talking about wills, last wishes or funeral plans. They worry about the person’s health, when that person is only trying to plan for the future. This may sound ghoulish, but life always ends in death. Our entire lives are planned, starting with our parents planning our education and then us planning our careers, moves, children, and so on. We can plan for death and funeral arrangements the same way, even if we do not have suicidal tendencies.

For there to be death, there has to have been life. We have a short time on this planet, so we need to act responsibly, not only for ourselves, but also for the generations to come. We are only borrowing this planet. The place where we live is temporary.

I listened to my colleagues’ arguments last week, and I also read a lot about medical assistance in dying. I even discussed it with my father. I love my father. I hope that he will be with us for a very long time. I am a daddy’s girl. Unfortunately, my father’s wishes are currently impossible. He told me that, if he were to be diagnosed with a degenerative disease and told what was going to happen, he would like to be able to tell his doctor, at a certain point in the progression of the disease, that he wanted medical assistance in dying and that he did not want to linger.

For now, that is impossible. It is something to think about.

Even if these discussions about our loved ones’ final moments are difficult, we need to have them. They are important. They ensure that we can respect the person’s wishes to the very end. It does not mean that the person will necessarily opt for medical assistance in dying. It means that we will know what the person really wants at the end. It can also prevent families from being torn apart.

One of the points raised by my colleagues was the fear expressed by several disability advocacy organizations that people with disabilities will be urged to get medical assistance in dying. I must admit that I, too, was concerned before I read the bill.

Once I read the bill, I saw that the request for medical assistance in dying must be made in writing by the person in question, and that it can be withdrawn at any time. When the substance is being administered, if the person gestures or speaks in a way that appears to be expressing a change of heart, everything stops there. That is the case not only for people with disabilities, but also for people whose death is foreseeable.

The Canadian Charter of Rights and Freedoms states that people with disabilities have the same rights as people without disabilities. This implies that they have the right to life, and that they are entitled to receive the treatments appropriate to their condition. Why would they not also have the right to medical assistance in dying if they meet the criteria clearly indicated in the bill? Do people with disabilities not have the right to decide for themselves simply because they have a disability? I find that unacceptable. I reject the idea. People with disabilities are capable of making their own decisions. They are rational beings. This has nothing to do with making decisions for other people.

It has to do with allowing people the right to make their own decisions concerning their own death.

I would add that other safeguards have been put in place, namely the three-month wait time with support services. My colleagues talked about that. It is not always easy to get in touch with a doctor or social worker, for example. I used to live in the regions. My doctor was a general practitioner. However, I do not think anyone ever had a better doctor because, when the time came to pick up the phone and call a specialist, he was the first to do so. Nothing could stop him. I wish everyone had that kind of doctor.

All of this makes me think that people with disabilities are not at risk. They will decide for themselves, they will have the same rights and responsibilities as people who do not have disabilities and for whom death is foreseeable.

I read that people are concerned that doctors will suggest medical assistance in dying based simply on a person’s disability. The very idea is repulsive, since doctors would not encourage patients to die. They would first try to relieve their pain and make suggestions for how to live with their condition. Beyond that, according to the bill, it is not up to the doctor to decide, but the patient. Doctors assess the situation and the request. Their role is not to suggest but to inform. It is the patient’s role to request and suggest.

I also read that some people believe that opening up medical assistance in dying to people with disabilities might suggest that their lives are not worth living. I have read and re-read the bill, and nowhere does it say that the life of a person with a disability is not worth living. Did anyone here tell Stephen Hawking that his life was not worth living? Did anyone tell any of our Paralympic athletes that their life was not worth living?

I am getting worked up because I have a little cousin who suffers from severe cerebral palsy. She barely speaks, but when she wants something, she knows how to make herself clear. She will never be able to request medical assistance in dying. Given her personality, I am convinced that, even if she could speak, she would not request it, because she is a ray of sunshine, because she is the person in our family who always believes that everything is good, everything is right and, at the end of the day, we can get through whatever life throws at us. I love her. She makes us see the beauty of laughter and closeness.

Although her life is complicated, it is certainly worth living. Therefore, saying that the bill is suggesting that the lives of people with disabilities are not worth living is yet another despicable point that was made.

The bill’s preamble states that life and the dignity of seniors and people with disabilities must be respected and that suicide must be prevented. I agree. To deny people with disabilities who are capable of making the choice the right to decide whether to receive medical assistance in dying is to deny them their dignity. Are we prepared to do that?

That amounts to treating these people as if they were less important, as if they were incapable of making decisions because of their disability. The very idea is repulsive to me.

Not everyone with a disability will request medical assistance in dying, just as not everyone without a disability will request it. Medical assistance in dying is an exceptional measure. It is not the rule. It is a choice that is fundamentally personal and that should not in any way be imposed by another person.

Some called in particular for the withdrawal of the 10-day wait period for people whose death is foreseeable.

Once again, I have very personal reasons for supporting that withdrawal.

I had an aunt who was quite the character. She spent five years fighting cancer and receiving treatments, some of them experimental. At some point, she could no longer stand it, and asked for medical assistance in dying. Because of the 10-day wait period, she died the day before she was to receive the drug to help her die—

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

I am sorry, but the time has expired.

The Parliamentary Secretary to the Minister of Justice.