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

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I concur with the hon. member for Victoria that the Senate has exceeded its mandate in going far beyond the scope of Bill C-7.

I have to say that I am shocked that the Attorney General did not reject outright the amendment with respect to mental illness being a sole criterion for eligibility for medical assistance in dying. Despite the fact there are a lot of things we do not know, one thing we do know is that of the 4,000 Canadians each year who die of suicide, 90% of them suffer from mental illness. The question becomes: How many persons with mental illness will suffer a premature death as a result of this legislation?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I am rising to speak on Bill C-7.

The legislation illustrates the dangers that arise when a government puts blind ideology ahead of evidence-based decision-making. The nightmare of this bill and that road that has led to it today began when the Quebec Superior Court judge issued the Truchon decision. In that decision, that lower court judge determined that the most important safeguard in Canada's medical assistance in dying regime, namely that death be reasonably foreseeable, was unconstitutional.

That decision, again, was by one judge in one province. It is not binding in any other province. It does not bind the Quebec Court of Appeal. Indeed, it is a non-binding decision.

In the face of that, one would have thought that the Attorney General, whose responsibility it is to uphold laws passed by Parliament, would appeal that decision. After all, we are talking about a decision that removes the most important safeguard that was part of the legislation was passed a mere three and a half years prior to the issuance of the Truchon decision.

Instead, the Attorney General put ideology ahead of the interests of vulnerable persons, and did something that is virtually unprecedented. The Attorney General did not appeal the decision and, instead, recklessly tabled Bill C-7, which eviscerates key safeguards, including the most important safeguard, namely that death be reasonably foreseeable. In so doing, the Attorney General seeks to radically transform Canada's medical assistance in dying regime from something where such assistance is deemed appropriate to deal with or address suffering in death to now providing death to deal with suffering in life.

In seeking to so radically transform Canada's medical assistance in dying regime, the Attorney General has pre-empted a mandated parliamentary review provided for under Bill C-14. The Attorney General has preceded with completely inadequate consultation, ignoring important voices that represent vulnerable Canadians and, most importantly, that represent Canada's disabilities rights community.

When 72 national disabilities rights organizations wrote to the Attorney General and pleaded with him to appeal the Truchon decision, he ignored them. Their pleas to this Attorney General have fallen on deaf ears.

Why is the disabilities rights community so concerned with Bill C-7 and, in particular, the removal of the criterion that death be reasonably foreseeable? Very simply, when that criterion or safeguard is removed, it means that someone who suffers from a degenerative disability could be eligible for that very reason, despite the fact they may have years, if not decades, to live.

The disabilities rights community, on that basis, has said, in clear and unequivocal terms, that they believe this bill stigmatizes persons with disabilities.

As Krista Carr, the executive vice president of Inclusion Canada, said, this “is our worst nightmare.” As Catherine Frazee, disabilities rights advocate and former Ontario human rights commissioner, said to the justice committee with respect to Bill C-7, “Why us?”

Why, in asking that question, is the government proceeding to discriminate against the rights of persons with disabilities by depriving them of protections against premature death afforded to all other Canadians outside of an end-of-life context? In so depriving those rights, specifically to persons with disabilities, significant questions have been raised about the constitutionality of Bill C-7 and whether it would, in fact, by discriminating against persons with disabilities, violate Section 15 of the charter. However, those questions and concerns were completely ignored by the Attorney General, who puts the ideology of ableism first.

So blinded is the Attorney General that he ignored not only concerns from the disabilities rights community, but also from the UN Special Rapporteur on the rights of persons with disabilities, who has said that this bill violates international human rights norms. So blinded by ideology is this Attorney General that he ignored the UN Commission on Human Rights, which the government is rather fond of, which has stated that this bill runs afoul of the Convention on the Rights of Persons with Disabilities, in particular article 10.

Just when one thought it could not get any worse, we learnt today with respect to the motion the Attorney General tabled in the House that it would, among other things, essentially accept, with some very minor tweaking, radical Senate amendments, including one that would provide that someone would be eligible for medical assistance in dying for having solely a mental illness. This is a radical change, and, despite the fact this issue has not been appropriately studied, the Attorney General has said it is now a fait accompli. This is despite the fact that we do not know how to predict irremediability in the case of mental illness; despite the fact that we do not know if someone's mental illness is the basis for their request or a symptom of their mental illness; and despite the fact that we do not know whether someone's mental health suffering could be alleviated by health and other social supports.

This bill is a reckless, dangerous piece of legislation that would put some of the most vulnerable persons in Canadian society at risk. It must be defeated.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Madam Speaker, I will be sharing my time with the member for St. Albert—Edmonton.

I have spoken to this issue twice in the House, the last time being December 4. I entitled that speech “Stay safe, my son”, because I do tell the personal story of being a father of a 34-year-old developmentally and intellectually disabled son who lives with us and is cared for by us. His name is Jordan.

In a larger way, my speech dealt with the removal of the safeguards for Canadians with disabilities and how the government is choosing to ignore and dismiss the concerns of disability groups across this country who have joined in arms in opposition to Bill C-7 because it fails to protect them and their safety in the long term. A quote that is most often used and referred to by the disability organizations is that this is the worst possible scenario.

After that speech, I discovered the United Nations office on human rights has stated that legislation extending euthanasia and assisted suicide to persons with disabilities “would institutionalize and legally authorize ableism”. For those who may need help with the word “ableism”, as I did, I went to the Oxford Dictionary and this is the official definition in it: “Discrimination in favour of able-bodied people.”

For full disclosure, I am a parliamentarian who sees Bill C-7 for what I think it is: the next step on the slippery slope in the MAID debate created originally by Bill C-14 in 2016. Today we are being asked by the Senate to make amendments to further remove safeguards for those living with mental illness. The Canadian Mental Health Association's CEO and spokesperson, Margaret Eaton, wrote to all parliamentarians, saying that “The exclusion of mental illness as the sole underlying cause for medical assistance in dying must be maintained to safeguard those living with mental illness.”

Understand that the Canadian Mental Health Association is the most extensive community in mental health across Canada, with a presence in 330 communities across every province and one territory. It provides advocacy, programs and resources that help prevent mental health problems and illnesses, support recovery and resilience and enable all Canadians to flourish and thrive. She goes on to explain the three compelling reasons that the exclusion of mental illness, as the sole underlying cause, was justified and urges all parliamentarians to oppose the Senate amendment that proposes to drop that protection for people with mental illness.

The slippery slope is the continual easing of restrictions and expansion of euthanasia to a day when society will be conditioned to accepting death upon request. Many of—

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, as I reviewed the amendments to Bill C-7 that have been proposed by the Senate, I was struck by how quickly some legislators have embraced radical, unstudied changes to Canada's medical assistance in dying. In many cases, the direction these amendments take Canada's MAID laws was rejected just a few short years ago.

When Parliament legalized medical assistance in dying in 2016, there was a commitment included in that legislation to review the impacts of the law five years after it received royal assent. That was June 17, 2016. We have not yet arrived at that five-year mark. We have not yet done a proper and thorough review of the original MAID legislation, yet now, before this review is even under way, not only are some in this place pushing to expand the accessibility and availability of MAID without the benefit of that study, but we are also considering amendments that disregard all the thoughtful and considered debate of this House, the Senate and the committees of each place that wrestled with this complex subject matter and initially chose not to go down the road that many of these new untested amendments would take us.

The Council of Canadian Academies considered some of the amendments now being proposed, producing several reports in 2018. Former MP and health minister Dr. Jane Philpott and the member for Vancouver Granville wrote in a Maclean's article about the council's conclusions. The article states, “...there is very limited guidance on these issues because there are not enough places in the world that have allowed broader access to assistance in dying.”

That is the context in which we are having this discussion, so it is troubling that the Liberal government has essentially accepted the amendments to throw the doors wide open to MAID for patients with mental disorders, something the justice minister previously had said there was no consensus on. This is a significant reversal that the Liberals ought to explain to the thousands of Canadians who have expressed concerns about the expansion of MAID to those with mental illness.

I am certainly mindful of the fact that COVID-19 and the restrictions imposed by governments as a result have created a tenuous mental health situation in Canada. Loneliness, social isolation and reduced care for vulnerable populations are all very real concerns.

Law professor Trudo Lemmens and Leah Krakowitz-Broker wrote this in a piece for the CBC:

Introducing a social experiment by expanding MAID when people are more vulnerable than ever is not progressive policy making — it is reckless. In its desire to accommodate some who want to control the timing and manner of their death, it puts others at risk of premature death.

I am reflecting on the question of why we are even here at all. Why are we having this discussion before meeting the five-year commitment for the MAID review? It is because the Liberals chose not to appeal the ruling of a Quebec judge.

As Senator Plett said:

Bill C-7 is a result of the federal government choosing to cave in to the opinion of one judge in one province who decided to unilaterally strike down legislation which had been extensively debated and passed by both houses of parliament.

I am speaking, of course, about the Truchon decision in Quebec. The Liberals could have simply appealed the decision in recognition of the upcoming review. It would have allowed for a substantive and careful discussion about the impacts of opening the door to MAID for seriously vulnerable individuals. Even in the Truchon decision, the assumption was that there would be enforcement of strict requirements that ensure the capacity and informed consent of those requesting MAID. Bill C-7 removes some of those very safeguards, including the requirement that the patient remains competent until the very end.

Truchon was also premised on the conclusion that medical assistance in dying, as practised in Canada, is a strict and rigorous process that in itself displays no obvious weaknesses, but that simply has not been shown to be true. According to the chief coroner of Ontario's review of 2,000 MAID cases, case reviews have demonstrated compliance concerns with both the Criminal Code and regulatory body policy expectations, some of which have recurred over time. As well, according to the Quebec end-of-life commission, at least 62 cases in Quebec between 2015 and 2018 did not fully comply with federal and/or provincial law. How can we move forward like this without properly responding to these serious failings?

In one of our last debates in the House, when I suggested that if Bill C-7 were to pass as it was, even before the amendments by the Senate were added, it would be believed to be the most permissive bill with respect to MAID in any country in the world, one of my colleagues expressed surprise that I did not think it was a good thing, as if being the most permissive jurisdiction was somehow inherently a good thing. A law's success should be judged by its outcome, not its permissiveness.

Any time life is devalued or death is made easy, clearly, is not good. Life is to be valued and treasured as the gift it is, which is why we need to put our energy into supporting positive alternatives, such as strengthening a patient-focused palliative care service for all Canadians. There was unanimous agreement from the special joint committee studying physician-assisted death on the need for a pan-Canadian strategy on palliative care with dedicated funding.

Those suffering deserve the best possible care. After all, there is no real choice for Canadians facing end-of-life decisions without adequate palliative care options available to them.

As parliamentarians, we have a high calling to actively listen. Our obligation is to protect our most vulnerable citizens. Unfortunately, none of the proposed amendments addresses the serious concerns raised by disability advocates. As many in the House have mentioned during these debates, over 70 of Canada's leading disability rights organizations and advocates have expressed deep concerns regarding this bill. Therefore, so should we.

We should be especially concerned for disabled Canadians who lack socio-economic means and face a greater risk of coercion. If there is even a tacit suggestion that their lives are not worth living, we should care about the implications of that. Their lives matter. Canadians should never feel pressured or as though the law perceives their lives as a burden.

The Christian Legal Fellowship writes that by singling out life with a disability as the only existence deserving state-sanctioned termination, Bill C-7 perpetuates ableism in a most dangerous way.

We have already discussed in the House what UN experts have highlighted as a contradiction in Canada's international human rights obligations. We do not want to create a two-tiered system in which some would get suicide prevention and others get suicide assistance based on their disability status and specific vulnerabilities.

The justice committee was faced with very difficult stories where some of our most vulnerable felt pressured to accept MAID. Numerous groups were represented. Fifty religious organizations and faith leaders, including Jews, Muslims and Christians, expressed their opposition. Nine hundred physicians and 145 members of the legal community stated their positions.

It is not just the disabled who are vulnerable. Practising physicians fear that they will face legal charges if they refuse to participate in the deaths of their patients. There are blatant inequities and legitimate anxieties with this legislation.

Let us be clear: any inequities of support, systemic discrimination, family network or specific community should be addressed before people choose death. We need to make every accommodation for people to choose life, which is why I am perplexed by the Liberal government's decision to support the Senate amendments based on race-based data collection.

There is nothing wrong with collecting data to better inform policy, but we are sure going about this in an odd way. Rather than considering how expanded access to MAID would impact marginalized communities today, this amendment suggests we should investigate the impact when it is already too late for those many who have already accessed MAID.

This amendment seems to acknowledge that, but data may have a troubling story to tell us while opting to study that impact on the fly, before we understand what it will mean for the life-and-death decisions of the members of marginalized communities.

That being the case, we should refer back to the Council of Canadian Academies' expert panel, which identified a number of concerns associated with expanding MAID in this way. Its claim suggests that the data is predictable, as having a mental disorder is strongly correlated with certain social, economic and environmental inequalities such as poverty, unemployment, homelessness, social isolation, stigma and discrimination, and that people with mental disorders face impediments to accessing appropriate mental health care in Canada. Let us not wait for people to feel forced to make the choice of death to collect this data.

It has not taken long for us to forget the safeguards that we put in place for the protection of our most vulnerable just a few short years ago. I have expressed my deep concern for this bill a few times in the House. My conviction is that life is a gift to be valued. These amendments only heighten my deep concern.

Life is a gift. I am reminded of when my kids and grandkids brought home gifts that they had made at school. Sometimes they were not very attractive and, quite frankly, perhaps I was not the proudest to put them on my mantle or display them on my fridge, but they were gifts.

Life is a gift. I did not then take those gifts and give them back, saying that I did not really want their gifts because they did not look very nice. No matter what the gift looked like, no matter in what condition it was, it was a gift and I recognized the gift. I showed appreciation to my grandchildren for the expression of their love toward me. For each and every Canadian, life is a gift and we need to appreciate it for what it is. They do not all look the same and some life circumstances put some of our constituents and fellow citizens in situations that are not desirable, yet we have to recognize that life is precious and life is a gift.

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

Madam Speaker, I would like to mention Dr. Sonu Gaind, who is the co-director of the division of adult psychiatry and health systems and an associate professor in the department of psychiatry at the University of Toronto, where he has been a member of the faculty since 1999. During a consultation with medical professionals that I attended this past weekend, he indicated that the number of elderly people requesting MAID since COVID restrictions have been causing isolation and growing depression has grown from 1,200 to 21,000.

Does this not illustrate the exact concern of the member in regard to Bill C-7 being brought forward to this House during such a challenging time for all Canadians, and especially for our most vulnerable?

[Gord Johns, NDP, Courtenay—Alberni, BC]

Madam Speaker, one thing we have heard about are the challenges created by the current medical assistance in dying legislation with the requirement for final consent at the time the assistance is rendered. We know that this requirement often forces those who are already assessed and approved for medical assistance in dying to make a cruel choice when faced with the possible loss of competence that would make them unable to give consent. They are either forced to go early or risk not being able to receive the assistance they need to avoid continuing to live with intolerable suffering.

I think about Julie Briese in my riding, who has brought to attention concerns around her husband Wayne, who is challenged with Alzheimer's. In that camp, they are making that difficult decision of whether to go early. We know Audrey Parker campaigned to make Canadians aware of this problem and that Bill C-7 would fix that by creating a waiver of consent.

Does my colleague agree, and do the Conservatives support Audrey's amendment and support helping those facing end of life to avoid this cruel choice?

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

Mr. Speaker, my hon. colleague did have a fantastic speech just prior to question period and I believe that her time wrapped up with the beginning of question period.

We once again find ourselves debating one of those issues that should cause each and every member of Parliament to take pause. These are literally issues of life and death. We are debating medical assistance in dying. I have had the opportunity to enter into discussion now a number of times on the subject and I am pleased to be able to do so again on the amendment that my colleague made to the report back from the Senate, some of whose changes I would suggest are troubling ones from the deliberations that took place in that other place.

Before jumping into this, I would like to discuss some context, as I do every time I discuss this issue. Early on in the last campaign when I was not even elected, I was door-knocking in a community in my constituency where I happened to knock on the door of a physician. This was pre-COVID times. It is hard to believe that we are now a year into the pandemic. The sort of campaigning we did in 2019 seems such a long time ago.

Nobody actually answered the door. I was walking back down the driveway to the front yard and somebody called out from the backyard. I went to the fence and ended up having a lengthy conversation. What I find very interesting is that this particular physician articulated some of the concerns regarding this and other issues that he faces in the medical profession as a doctor in a small, rural community in Alberta. He outlined some of the concerns regarding medical assistance in dying.

I will not deny that I have positions on this issue that I have developed over my time in both politics, studying this and on many other issues, but what was very interesting as I reflect back on these comments is this physician outlined a whole series of concerns. In politics, they say one should not spend more than a couple minutes at the door, but I wanted to give this gentleman the time to outline his concerns. He outlined to me, ironically, some of the concerns that we are debating today with a suggestion about the slippery slope argument.

I followed closely some of the debates that took place in the last Parliament and issues around the initial court cases that led to Parliament being tasked with creating a framework in the last Parliament, and then some of the continuation of that. What I find very interesting is how accurately this doctor predicted some of the significant challenges that we are now facing. This is me paraphrasing this conversation from a number of years ago now, but he outlined that very activist, vocal causes are skewing the national conversation on ensuring that those who need protection most in our society are protected.

Here we are today. I had the honour of being elected and have a seat in this amazing chamber, the place of democratic discourse in our country. Here we are and I look at both the contents of what came back from the Senate and the various discussions had regarding Bill C-7 over the last number of months. It is very troubling that this gentleman was almost prophetic in the way he talked about these issues and some of the groups of people who are being affected in this framework that could lead to direct discrimination and how some of their voices are being ignored.

I find it very interesting. In fact, I had the opportunity earlier today to ask the Minister of Justice, after his opening remarks, a question about consultations. I was troubled by his response, although it was passionate, and I grant him that passion. We are all passionate about various issues, especially ones of such a personal nature as this. The minister went on to talk about how we need to address the suffering, but failed to truly answer why the government did not go down the path of appealing this decision to a higher court, which would have allowed for greater certainty on the type of legislation that would be enacted and ensure that it could be done in a way that we do not find ourselves here again in maybe a number of years, or sooner than that.

It is troubling, again in the words of the physician back in that driveway during my first campaign running for office about a year and a half ago, that the very vocal activist causes are getting a disproportionate amount of airtime. I bring that up because we have seen an evolution in this debate from what was discussed in the last Parliament and the very valid concerns that some of my current and former colleagues had, some of whom have retired, or whom I count as friends, like the member whose board I sat on while going to university, the late Mark Warawa, all of whom have defended life with passion in this place. However, where we find ourselves today is the definition of a slippery slope, and that is incredibly concerning to me.

It is incumbent upon all of us to ensure that we take seriously our obligation to debate, discuss and try to come up with the best outcome possible to serve, protect and ensure that Canadians are not placed in a position they should not be in. This issue would probably be in the top five and maybe even the top three of the issues I hear about. I hear feedback on every side of this debate, which is good. That is called democracy. It is called discourse and is exactly what the point is. It is why we are organized into parties and represent different regions of the country.

Each of us brings a different level of expertise, and I joke often that the only job requirement for a member of Parliament is that one happens to get more votes than the other guy. It is incredible the strength of our democracy is in the diversity that results from that. It is that diversity of opinions that forces us to take pause and debate these very important issues.

I will go back now to the consultations that the minister undertook on this issue back in the early sitting weeks of Parliament before prorogation. I spoke to many constituents, was sent emails and cc'd on others, and I found it very troubling to hear from a number of them that the so-called consultations were being conducted in a way that would confirm the objective of those who wrote the consultation piece. That is the antithesis of what we try to do here. In some cases, individuals with passionate perspectives on this subject felt they could not even participate in the consultations because of the way they were formatted. I find that was a troubling start to this process.

We have seen saw the Minister of Justice's comments, in addition to those of others in the government, about this as we have been going through this process. It was debated after prorogation, which of course slowed everything down. We lost about 35 sitting days. Whenever the government says that the Conservatives ought to hurry up because they are delaying the process, I will point out that 35 legislative days were lost in this place for it to do its job.

It is not just the two days that the members opposite like to suggest; it is 35 sitting days. The context for that deflates any argument that the other side would suggest on this, that we should simply rush something like this. There was the ability to appeal this to a higher court. When discussing this matter with one of my colleagues, it seems like the Liberals were not even aware that it could have been appealed to a higher court, among some other notable instances where there is a troubling lack of information.

An evolution has taken place from when the minister first stood up. When questions first started being asked last fall, he said that they had found the consensus, making clear definitive declarations, saying that they had consulted, that they had listened to the consultations and they did their job. That was being said by the government and the minister.

As questions were asked and as committee discussions went on both in the House of Commons and the committee, and then the pre-study and debate of the bill in the other place, we saw the government language change quite a bit. There was acknowledgement of a diversity of opinions. A lot of the diversity of these opinions was not respected in the beginning until there was a groundswell of concern. My office received hundreds, maybe thousands, of pieces of correspondence showing concern on this issue.

There are very few issues that garner this type correspondence, but this was one of those issues. In fact, people would call and tell me that they did not vote for me, but that they were concerned with the direction the government was taking. I heard from indigenous people. They told me that this went against the very fundamentals of their world view. Disability advocates are deeply concerned about an ableist-type mentality within the country, which could have very troubling consequences. We have the utmost responsibility to take these things very seriously.

This debate is very personally for a lot of us. I know there has been some emotion expressed in that regard, and this is part of an issue that is as important as this. As Conservatives, we have a free vote on this issue and we see a diversity of opinions within our caucus. That is great; that is democracy.

I do not know exactly where other parties stand on this, but certainly the autonomy of the member of Parliament is a constitutionally enabled thing here, which is often forgotten, certainly by our media and in the education of our parliamentary system. I emphasis for all those listening and on Zoom that the autonomy of the member of Parliament is one of the keystones of our democratic system. It needs to be respected. However, that is a bit of a segue.

This is an incredibly personal issue. Everybody has had an experience. I too have sat with loved ones during some of their last breaths. I have seen the consequences and I understand why this can be so emotional.

When I look at this in terms of the context of what we are debating today and the amendment that has been proposed in the government's response to the Senate amendments, important steps are taken to ensure that those among us who are most vulnerable are protected. My colleague from Leeds—Grenville—Thousand Islands and Rideau Lakes spoke to that. It strikes at a good-faith attempt by the Conservatives to try to move the dial on a host of what many have pointed out are problematic aspects of what took place in the other place.

Let me take a brief moment to commend some of my Conservative colleagues in the other place. I have spoken with them about the process and in some cases their great disappointment and utter surprise at what they hoped to accomplish going into those deliberations and what resulted. I do commend the Conservatives who sat around that table. I will note that they have some of the most personal connections to this issue. When hearing those stories, it certainly strikes right at the heart.

We are now tasked with having to come to a place where we develop a framework. The government likely has the support to get the bill passed. We have introduced an amendment to the government's response to try to address some of the challenges that we have heard. This is not about some ideological parade to try to make our points known. This is about trying to address some of the challenges that we have with the bill and specifically the response.

When we introduce an amendment, it is important for debate in this place to acknowledge the ability to improve upon legislation, to address deeply problematic aspects of it, to try in good faith to add a level of protection to the most vulnerable within our society, to ensure that we are not creating a situation where a medical assistance in dying regime ends up pushing people to a decision that there is no coming back from, trying to take some small steps to help move the bill in a direction that at least addresses some of these very serious concerns. For those who are watching, I would refer them to some of my earlier speeches on the matter.

This is what we are attempting to do today. Specifically, I would mention the irony in which we find ourselves. The House unanimously supported a motion for a 988 suicide prevention helpline, which was absolutely the right thing to do. I was proud to support that. However, this is not just an ideological thing, but many have suggested the bill moves medical assistance in dying, assisted suicide, euthanasia, however it is defined, in a direction that many, including myself, suggest is very concerning. There is an irony between supporting suicide prevention and a regime that may unintentionally, I certainly hope unintentionally, result in what could be catastrophic for our country.

There is a need for palliative care. I mentioned the late Mark Warawa. He is an example of living his faith. He announced he would not run in the next election. He was going to become a chaplain to help people through the end of their life. He ended up being diagnosed with a very fast-moving cancer. He ended up living out the very example of why palliative care is so important.

We find ourselves in the middle of a pandemic where disproportionately those affected are our seniors and those most at risk, yet we are debating something where we need to ensure there are safeguards in place. That the tragic irony is certainly not something I think anyone here would like his or her legacy to be, that while discussing and debating COVID supports in response, that we would also enable something that could be abused and would result in the end of life for vulnerable Canadians.

The House resumed consideration of the motion in relation to the amendments made by the Senate to Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), and of the amendment.

Alleged Premature Disclosure of Contents of Bill C-22

[Mark Gerretsen, Liberal, Kingston and the Islands, ON]

Mr. Speaker, on a point of order, I am rising to speak to the alleged premature disclosure of the content of Bill C-22, an act to amend the Criminal Code and the Controlled Drugs and Substances Act.

My colleague, the hon. member for Fundy Royal, rose in the House on February 19 to allege that the content of the bill was divulged by the government in a CBC news story during the notice period. In his intervention he cited a Speaker's ruling on March 10, 2020, respecting the premature disclosure of Bill C-7 and Bill C-14, both dealing with medical assistance in dying. In those cases, the government acknowledged that some content was disclosed during the notice period, and as a result, the Speaker found there was a prima facie breach of privilege.

The case before the House on Bill C-22 is indeed different. I have discussed this matter with the office of the Minister of Justice, and they have confirmed to me that a CBC reporter did inquire about the content of the bill while it was on notice. The office explained to the reporter that since the bill was on notice, they could not comment on the content of the bill until it had been properly introduced in the House.

The government, in 2015, promised to make public mandate letters for the ministers, a significant departure from the secrecy around those key policy commitment documents from previous governments. As a result of the publication of the mandate letters, reporters are able to use the language from these letters to try to telegraph what the government bill on notice may contain.

I take umbrage with the member for Fundy Royal's assertion: “We are being asked once again to deal with the contemptuous actions of the Minister of Justice and his justice team.” The member should ensure that he has the facts on his side before casting such aspersions on any member of the House. It is neither decorous nor responsible.

Now let me deal with the matter directly.

Bill C-22 has three main policy thrusts: repealing mandatory minimum penalties in the Controlled Drugs and Substances Act and the Criminal Code, increasing the availability of conditional sentence orders and evidence-based diversion from simple possession offences. The article the member refers to and relies on for his argument was not correct in its description of all three elements and therefore resides in the realm of speculation.

When we get into the details of the article in comparison with the bill, the story gets the content wrong. Let me walk members through the content of the article.

On drugs, the article is rife with speculation. The 2019 mandate letter for the Minister of Justice states, “Make drug treatment courts the default option for first-time non-violent offenders charged exclusively with simple possession to help drug users get quick access to treatment and to prevent more serious crimes.” The reporting on this item seems to be speculative based on the title of the bill. Moreover, the bill does not contain measures dealing with drug treatment courts.

I will note for the benefit of members that the evidence-based diversion measures in the bill are entirely distinct from drug treatment courts. Drug treatment courts require non-violent offenders to plead guilty, and judge-mandated supervision has no relation to what is proposed in the bill. In fact, the bill seeks to avoid the laying of charges in the prosecution of simple possession cases in the first place, if appropriate.

The bill also proposes a principled approach for police and prosecutors to consider before laying or pursuing a charge of the offence of simple drug possession. This includes the possibility of referral to various treatment programs or social supports and/or empowering police and prosecutors to provide a warning or to take no action with respect to the potential offender instead.

On mandatory minimum penalties, the article states that the government will revisit the mandatory minimum penalties for drug-related offences. In fact, upon inspection of the bill, the government is proposing to remove all mandatory minimums related to the drug offences, as well as removing mandatory minimums for 14 other offences in the Criminal Code.

There is no mention in the article of conditional sentence orders, which are a key policy element of the bill. In addition, there is nothing in the bill that provides for reforms concerning restorative justice specifically. The article implies that the bill contains elements relating to restorative justice, based on the mandate letter commitment, previous public statements and commitments made in regard to the fall economic statement.

One can only assume two outcomes here based on the fact that the article did not accurately describe the contents of the bill. First, the reporter spoke to a government source who was not familiar with the content of the bill. The second outcome, which is perhaps more likely, is that the government did not publicly comment on the bill during the notice period and, as a result, the reporter had no other recourse but to speculate on the content of the bill based on previous policy statements.

I will turn now very quickly to the relevant precedents on the disclosure of the content of a bill during the notice period. In instances where government has acknowledged that an official of the government prematurely disclosed the content of a bill during the notice period, Speakers have found a prima facie case of breach of privilege. However, when the government has not disclosed the content of a bill during the notice period, Speakers have been reluctant to find a prima facie case of breach of privilege. On June 8, 2017, the Speaker referred to the distinction as follows:

When ruling on a similar question of privilege on April 19, 2016, I found a prima facie case of privilege in relation to the premature disclosure of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying). In that particular case, the government had acknowledged the premature disclosure of the bill while assuring the House that this had not been authorized and would not happen again. In other words, the facts were undisputed.

That is not the case with the situation before us. The parliamentary secretary has assured the House that the government did not share the bill before it was introduced in the House but conceded that extensive consultations were conducted. Nor is the Chair confronted with a situation where a formal briefing session was provided to the media but not to members.

Finally, it is a long established practice to take members at their word, and the Chair, in view of this particular set of circumstances, is prepared to accept the explanation of the Parliamentary Secretary to the Leader of the Government in the House of Commons.

In conclusion, I submit that if the content of the bill was prematurely divulged during the notice period, it did not emanate from the government side.

Criminal Code

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Mr. Speaker, the member gave a great speech, laying out a very empathetic case for why the Senate's amendments should be rejected. The debate I have heard so far is not about the amendments the House has already made within Bill C-7 to the original Bill C-14. I disagreed with the House and voted in the minority because I felt that our response to the Truchon decision went too far at the time.

What the Senate has done is to go far, far beyond what the original debate was in the House and the witness testimony that we heard and the considerations in the justice committee. Could the member perhaps just comment on that point?

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

Mr. Speaker, it is 100% guaranteed that we will kill people who would have gotten better. That is a statement made by a well-respected Canadian psychiatrist this weekend at an emergency Bill C-7 meeting I cobbled together in response to this Frankenstein bill that we are now debating here in the House. How the Senate managed to change the bill from what it was to what it is completely boggles the mind.

The bill is now so deadly that not only are the disability community and the indigenous community crying out against it, but the mental health community and the geriatric professionals have joined in sounding alarm bells against the extreme danger this bill poses to the most marginalized in our communities.

Some in the Senate in the Liberals' group of wealthy, worried well people have decided that their wishes far outweigh any harm that may come to the vulnerable who cannot afford or cannot access the kind of care that powerful individuals can.

Let us take the issue of advance directives. Senator Pamela Wallin stated, “As someone with a history of dementia in my family, I seek the peace of mind that an advance request—and consent to it—will provide.” I would like to pose a question. Does Senator Wallin's peace of mind carry more weight than the premature deaths of frail seniors that will result if this amendment becomes law?

Imagine a person—for example, Senator Wallin—possibly dealing with dementia at some future time who has reached the stage at which her advance directive authorizes her death. Imagine that she is completely unaware of her cognizant deficits and is living happily with her loving family or in a top-notch residential setting somewhere in Canada. Who will give the MAID order? How will Ms. Wallin's caregivers explain this to her? Will that directive take precedence over her current wishes and those of everyone around her?

Imagine now a family that is less loving, one that is fighting over the inheritance while mother is still alive, fighting over how much is spent in paying for nursing care. This is a common scenario, as many professionals witness. Now who will give the MAID order, and in whose interest?

Now imagine there is no family and that the administration at the nursing home is under orders from the ministry to find beds for patients to be transferred from the hospital. There are already horror stories from around the world where advance directives for euthanasia exist as an option, stories of doctors trying to sedate their patients by putting sedatives in their coffee or stories like that of a 74-year-old Alzheimer's patient from the Netherlands whose family had to hold her down as she was struggling so that the doctor could administer the lethal cocktail.

I learned in a conversation with Dr. Catherine Ferrier, who works with dementia patients, that often when a person is suffering with dementia, it is their family who are most distressed. Patients themselves are often content, even happy. The point I am trying to make here is that it is impossible to know the exact wishes of someone who is suffering with dementia. Someone who is young and healthy can imagine what they would want for themselves if they were to decline in that way, but they do not know what that future self, in a state of mind that they do not understand, would actually wish for.

I am terrified for vulnerable Canadians who want to live despite an earlier wish to die. They will not be able to communicate their desires, and their families and caregivers may pressure them to die to remove a burden from their own lives. I implore my colleagues to remember that our duty is to promote the safety and well-being of all Canadians, especially those most marginalized, not to calm the worried well.

The Council of Canadian Academies' expert panel working group on advance requests for MAID found that relatives of patients with dementia generally support euthanasia if an AED exists, but when they are faced with a decision to follow an AED, most decide against it. Many experts now favour, instead of a directive giving specific instructions, a process of reflection on broad health care goals, conversations with loved ones and the designation of a proxy decision-maker.

Listening to those who advocate MAID by advance request for patients with dementia, our first reaction should be horror at the demeaning and discriminatory terms in which they are depicted. To state that people who no longer recognize family members, are bedridden or are dependent for hygiene or feeding have lost their dignity is a marginalizing and ableist depiction. Dignity is never lost, but it can be either affirmed or denied.

Let us tackle the first myth, the myth that people deserve death with dignity and that MAID provides that. The fact is that this debate has distorted what dignity means. Dignity means to deserve honour or respect. What MAID advocates mean by “loss of dignity” is a loss of control, a loss of superficial appearance, a loss of self-critical judgment. They have tragically subverted the most dignified acts of all: unfailing love and deep respect for each other in all life circumstances. Bathing my dying grandmother, whispered conversations on the threshold of death, silent reflection and presence through a long night waiting for a last breath: These are the moments of greatest dignity. Dignity is found within our relationships. It is about whether someone looks at us and treats us with respect, rather than with subtle disdain or prejudice or by making us feel that we are bothering them.

Dignity is not about the means of death. Dying with dignity means dying in a milieu of care, love, kindness and respect. Anyone who says all these things are not present in a natural death setting simply does not understand what dignity is.

However, wait; the senators, the Liberals, Jocelyn Downie and all their friends at Dying with Dignity will cry, “No one will be euthanized under this legislation who has not already freely consented to it.”

The notion of consent by advance directive is not that simple. The vulnerability and power imbalance that is present between the parties is glaringly obvious. However, advertising campaigns and media have been busy creating a fantasy world for Canadians that pretends that the use of a physician in ending the life of someone not near death is compassionate and respects autonomy. We read in the paper about parties being organized to celebrate the last moments of life with balloons and symphony music playing in the background. We can see by the few statistics that are being reported that the glorification of euthanasia provides encouragement for those who are already unsure of their value or feel a burden to their loved ones, regardless of the fact that they are not near death.

In actual fact, what we are able to provide families with amounts to moral absolution. With this bill, we are offering to make legal what is illegal in every other country around the globe. Let me repeat that: There is no other country on the planet that allows death administered by a doctor to someone who is not imminently about to die if they have not first been given treatment. Canada, with the implementation of this legislation, will be the only country in the world where access to alternative treatments is not even required in order to qualify for death by physician.

Not only are the changes to the euthanasia regime that will come with the Senate amendments unprecedented from a legal and moral perspective, but they are also unheard of from a medical perspective. This bill would require doctors who work with patients suffering from mental illness to prescribe death, with no evidence, no data, no statistics to prove that it is an effective or beneficial treatment. There has been no due diligence done by the medical community to support the idea that MAID belongs in the tool box of mental health professionals. It is politicians, motivated by ideology and not by evidence, who have forced it upon them.

I have been told by doctors who support MAID in principle that this bill will force them to act against their conscience and their Hippocratic Oath. It is one thing to conscientiously object, but it is something much worse when there is a lack of faith in the treatment they are forced to provide. To make the concept more clear, they explained that doctors do not prescribe cigarettes to patients because the health risks far outweigh the calming benefits of nicotine. These same doctors know that there is no evidence to support the idea that MAID is an acceptable medical treatment for mental illness. Thus, if this bill passes, doctors will be forced to provide, against their conscience, an unproven treatment that causes the demise of their patient.

Further, allowing MAID for mental illness in this bill makes the bill incoherent. On the one hand, it says that MAID can only be offered to those who are not dying if their condition is grievous and irremediable. On the other, it fails to acknowledge what psychiatrists know to be true; that it is impossible to know if a mental illness is irremediable. There are many cases of doctors who have thought that a patient's condition was irremediable, only to find that the patient got better. This means that the entire entry point of accessing medical assistance in dying is not satisfied for those who suffer from mental illness. That is why doctors are pleading with us, telling us that they are 100% certain that if we accept this amendment, we will kill people who would have gotten better. This bill would ensure that people would no longer be seeking to avoid a painful death, but, rather, to escape from a painful life.

It is also important to tackle the second myth being propagated by the Liberals and their friends at Dying with Dignity, and that is the myth that Bill C-7 is not discriminatory. Here are the facts. Canadian disability organizations, mental health organizations, indigenous organizations and the United Nations all say that Bill C-7 is absolutely discriminatory. The bill singles out vulnerable Canadians and offers them physician-assisted death without offering adequate disability supports or treatment to help them live full lives, free of the suffering caused by poor health care, poverty and stigma. It singles out persons with disabilities who are not terminally ill as fit for suicide completion. This will become a choice of desperation, not autonomy.

Let us understand what discrimination really is. It is pretending that all Canadians are equal in all ways. The obvious reality is that some of us face profound life challenges. We need laws that protect the disadvantaged. A law that offers death to one group and support and treatment to all others is the paradigm of discrimination. This law proclaims that a disabled Canadian or someone suffering with a mental health challenge should consider death instead of recovery. Vulnerable patients need protection from politicians and doctors who want to make it easier for them to die, while simultaneously denying access to appropriate health care supports. This is true discrimination.

Let us face it, there is a myriad of reasons that many organizations have come out opposing the bill.

Take as another example the testimony from Tyler White, CEO of Siksika Health Services, who stated:

MAID with its administration of a lethal substance with the intent to end a person's life is countercultural to our indigenous culture and practices. Our concept of health and wellness does not include the intentional ending of one's life. We recognize the dignity [of life] from its beginning to natural death, and efforts to suggest to our people that MAID is an appropriate end to life is a form of neo-colonialism. Extraordinary efforts have been made in suicide prevention in our communities and the expansion of MAID sends a contradictory message to our peoples that some individuals should receive suicide prevention, while others suicide assistance....

...Bill C-7 in its current form is the absence of protection for individuals working in our communities who do not wish to participate in MAID. We believe that our people should not be coerced to participate in non-indigenous practices against our conscience and will. And it is the kind of oppression that has been the source of much trauma in our history. The Truth and Reconciliation Commission of Canada calls upon those who can effect change within the Canadian health care system to recognize the value of aboriginal healing practices and for respecting indigenous people's right to self-determination in spiritual matters, including the right to practise our own traditions and customs. Bill C-7 should be amended such that those who opt to abstain from participating in MAID directly and indirectly will be protected to do so without discrimination in their employment in the health care system.

How about Margaret Eaton, national CEO of the Canadian Mental Health Association, who stated the following in a recent press release:

Anyone living with mental illness knows it can absolutely be grievous and...unbearable. However, what sets mental illness apart from all other types of suffering is that there always remains the hope of recovery. That’s why the Senate’s amendment to C-7, the assisted dying bill, is so concerning.

People with a mental health problem or illness need assistance to live and thrive, not hasten death.

The Canadian Mental Health Association...is urging MPs to vote against the amendments made by the Senate to C-7. In particular, the clause to start the clock on eventually allowing people to seek medical assistance in dying...with mental illness as a sole underlying cause.

Then there is the petition I received this morning from 130 psychiatrists, psychotherapists and mental health professionals, calling on us to reject the amendment which would include mental illness as a sole criterion for medical assistance in dying. It states:

Some persons with mental illness, that often includes symptoms of hopelessness and suicidal thinking, have long been recognized as potentially vulnerable to suicide inducement and, until now, have rightfully been excluded from eligibility for MAiD. Suicide prevention is recognized as a critical mental health service necessary to preserve life. Review of evidence...found that, unlike with MAiD for terminal illness, we cannot distinguish between those seeking MAiD for mental illness and suicidal individuals.

Over and over again, we have heard from medical professionals how disastrous the bill will be to the safety and security of their patients.

Therefore, the question begging to be asked is this. Why the rush? During the pandemic, the Liberals have made the passage of Bill C-7 their priority. However, the bill is not a high priority for Canadian citizens and it is safe to assume that the majority of Canadians know very little about Bill C-7 or its implications.

Canadians have been preoccupied with more pressing matters, such as keeping themselves and their loved ones alive during this pandemic. They have been concerned with keeping financially afloat, making rent and mortgage payments, keeping their jobs and keeping their businesses from going under.

However, throughout this time, the Liberals have been concerned with driving Bill C-7 to the post, perhaps with the hope of slipping one by a distracted public. This is one of the most serious changes of legislation in law undertaken in a long time, with far-reaching implications. It will surely change the character of the country and how life and death are viewed. It has, at the very least, the potential to cause individual and social harm and open up abuses that no safeguards can guarantee against.

I will end with one final quote from the Washington Post this week under the title “Canada is plunging toward a human rights disaster for disabled people”. It said:

This month, the Journal of Medicine & Philosophy found that in the 18 years since Belgium permitted this sort of euthanasia, the laws and regulations meant to protect patients from abuse “often fail to operate as such.” Much like in the Netherlands, the eligibility criteria had steadily expanded to the point where more and more people pursued it not for medical reasons but simply for “tiredness of life.”

Legalizing assisted death for disabled people only fortifies the underlying problem: Canada has long mistreated its disabled citizens. This bill is a workaround for that problem, not a solution.

I ask this one more time. If this bill is so good, why are the vulnerable, the poor, the disabled, our indigenous brothers and sisters feeling so threatened? Why do we want our hospitals to offer suicide prevention programs through one door and doctor-assisted suicide through the other? I beg my colleagues to hear the cries of those most vulnerable among us and reject the discriminatory and dangerous bill, Bill C-7.

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

Mr. Speaker, I want to thank the hon. parliamentary secretary for a very helpful, thorough review of the government's views on what has now come to this place from the other place.

I also wanted to focus, as his last remarks did, on some of his personal beliefs around the situation and the context for people in the disability community, the context for people who are experiencing extreme depression. We have to put that context in economic terms. We know that people who are in the disability community are far more likely to fall below the poverty line than able-bodied Canadians. It is a really significant crisis.

We experienced in CERB the ability to send a cheque for $2,000 to people across the country. I want to ask the hon. member if it is not time to look at guaranteed livable income as part of the package of public health measures, because poverty is the single largest component of health. As a social determinant of health, poverty is the largest measure. I know it is slightly unrelated to the debate on Bill C-7, but can we not move to eradicate poverty?

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

Mr. Speaker, I know this is personal for others, just as it is personal for me. Obviously mental health touches all of us and all of our families, and it has touched my family.

That is a difficult question to answer, but what I would say is that I am comfortable trying to proceed incrementally as we have done, starting with Bill C-14 and now with Bill C-7, but doing it on the basis of having a lot of input from those in the medical community whose jobs are to diagnose, treat and provide support to those who are suffering from a mental illness.

What I cannot do, obviously, is put myself in the shoes of another person who, in terms of manifesting their autonomy, might be contemplating and considering taking such a step. That is difficult for me to do personally, but what I can do is ensure that I, as a parliamentarian, try to provide equal access to different options, including end-of-life options, to Canadians, should they choose to end their suffering.

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

Mr. Speaker, I am very pleased to participate in the consideration of the amendments proposed by the Senate to Bill C-7, which seeks to amend the Criminal Code provisions on medical assistance in dying.

Our colleagues did a lot of work on Bill C-7 and proposed reasoned amendments following careful deliberations. The Standing Senate Committee on Legal and Constitutional Affairs heard from a variety of witnesses as part of two different studies. I followed the debate at second and third reading and thought that the speeches given in the Senate reflected the range of perspectives shared by the many witnesses.

It is therefore with great respect for the work of the Senate that we are examining the amendments it is proposing to Bill C-7. As the minister explained, there are three amendments that we plan to support, with some adjustments.

The first relates to the collection and analysis of data about the race of persons seeking MAID. Let me say here that we have heard extensively in the House of Commons and the Senate about the need for better and more robust data collection with respect to MAID. That data has been collected since MAID first entered into the legislative landscape, but certainly improvements can be made.

It is important now, especially during Black History Month, to note that one of the Senate amendments proposes tracking the analysis of data on the race of persons who are accessing MAID. This is important because we have clearly seen a light shone on the important issue of systemic racism in Canada, North America and around the planet. We need to understand how racialized persons, because of their inherent vulnerability, may be disproportionately impacted by MAID and address that vulnerability with our legislative response.

I would say, however, as articulated by previous speakers, including the minister, that the amendment the government proposes to make to this portion of what the Senate is suggesting would make it more inclusive in light of all of the witness testimony given in both the House and the Senate. By that I mean in addition to race-based data, data about disability and indigenous identity would be collected and analyzed. This, of course, is important, especially and specifically as we broaden the MAID regime to circumstances where death is not reasonably foreseeable, in response to the Truchon decision, which creates the real possibility that people will seek and obtain MAID because of vulnerabilities in their lives as opposed to their health conditions. I am grateful to the Senate for proposing this important legislative change.

The second Senate amendment the government supports, with some adjustments, is the sunset clause that attaches to the mental illness exclusion. We heard extensively about this from the previous speaker and in other interventions that have been made. The Senate amendment proposes a sunset clause of 18 months. The government is suggesting that the sunset clause be extended to 24 months.

Second, and very importantly, we are requiring that the Minister of Justice and the Minister of Health ask a group of experts to make recommendations on safeguards, protocols and guidance for MAID on the basis of mental illness alone. Those experts would be required to report back to the ministers within one year, which would leave an additional year for the government to consider what safeguards should be legislated and for Parliament to consider things when enacting any subsequent legislation.

I want to give some context surrounding the sunset clause because it is obviously a pressing matter for today's debate and a pressing issue for all parliamentarians.

The government's position is that it needs more time to consider and enact safeguards for the population of people whose sole underlying condition is a mental illness. The Minister of Justice was always clear that the questions of whether MAID for mental illness should be allowed and, if so, what safeguards were needed would be studied in the course of an upcoming parliamentary review.

What the sunset clause would do, in combination with a requirement for an expert review, is commit to a definite timeline for eligibility of persons whose only medical condition is mental illness. This would reduce the risk that some Canadians would feel the need to challenge the exclusion before the courts should they believe it is unconstitutional. It would also provide them with the certainty that two years following royal assent of Bill C-7, eligibility on the basis of mental illness would be considered with the requisite safeguards attached.

This point about potential constitutional challenges is not an academic point alone. We know this is a complicated issue that balances competing constitutional rights. Obviously we know from the Truchon decision that there has been litigation with respect to the old Bill C-14, and virtually all observers recognize that there is very likely to be constitutional challenges related to the current bill, Bill C-7, should it be enacted. In fact, we heard testimony about this at a House of Commons standing committee. Some witnesses said the exclusion of mental illness alone could perhaps give rise to a section 15 challenge. We are trying to ensure that Canadians who are concerned about this exclusion would have a remedy that is not via the court process, but rather through the task force of experts and the parliamentary study that would follow therefrom.

We heard a lot from the previous member about evidence and whether the government believes in evidence-based approaches. I would reiterate for the record that absolutely we do, and some of that evidence relates to a very specific document in the submissions that were made by the Association des médecins psychiatres du Québec.

In November 2020, the Quebec association of psychiatrists, or AMPQ, published a very informative discussion paper on access to medical assistance in dying for people with mental illness, which underscores the reasons that the government believes that a 24-month sunset clause is needed.

The work of this association will no doubt be foundational to the expert review of this issue. It points to some possible solutions, but they are fairly complex. That is why we need to carefully consider solutions that could work nationally.

The association is of the view that whether a mental illness is incurable or not can “only be determined at the end of a long process, after attempting several treatments and assessing their effects.” The association further notes that before coming to a conclusion on eligibility a psychiatrist “should explore other aspects that shape the patient’s life experience and consider strategies to improve the social circumstances that add to the suffering.” This dovetails exactly with some of the interventions made in the last portion of the debate by members of the NDP, who talked about supports that surround a person's life circumstances, such as income security, housing security and so on.

Going back to the submission from the association, it notes, “Psychiatrists must be involved as both the first and second assessors”, and also notes, “access to psychiatric care varies significantly from one region to the next.”

In light of all of these considerations, the Association des médecins psychiatres du Québec suggests that we create a new administrative body with regional offices dedicated to MAID on the basis of mental illness that would coordinate such requests, identify MAID assessors and providers, and ensure access to psychiatrists. It also suggests that such an administrative body could monitor the assessment process in real time instead of after the fact.

I highlight this in some detail because I believe the association's discussion paper is focal to why we as a government believe that a 24-month sunset clause is needed. The work of the association will no doubt be foundational to the expert review of this issue. The paper points to possible solutions, some of which are fairly complex in nature, which underscores the need for careful consideration of what could work nationally. Further, I underscore that government and Parliament will need time to make decisions about which safeguards should be codified in federal MAID legislation as a matter of criminal law relating to mandatory access across the country.

I will now turn to the third amendment.

The third amendment being proposed by the Senate, which the government proposes to support with some modifications, relates to the notion of the parliamentary review. The government has repeatedly committed to facilitating the start of the parliamentary review required by Bill C-14 as soon as possible following the adoption of the current Bill C-7. Our proposed adjustments to the amendment proposed by the Senate would ensure that all of the relevant issues are front and centre for the joint parliamentary committee that would undertake this work. I underscore the notion that it is joint, because it would be a combined study by the Senate and the House of Commons, similar to what we saw prior to the advent of the original Bill C-14. Its mandate would look at things that were contemplated by the original intended review of Bill C-14, such as requests by mature minors and issues that relate to advance directives.

In addition, we would include palliative care and safeguards for persons with disabilities within the scope of that mandatory joint parliamentary review by the Senate and the House. We also proposed to adjust the timelines, so they are both realistic in a pandemic environment but still ambitious, given the seriousness of the issues at hand. These are important features we feel would enable us to move forward in a collaborative manner involving the work of both Houses of Parliament, as well as the work of all legislators from various parties.

I would note parenthetically that, obviously, the member for Esquimalt—Saanich—Sooke has been very instrumental in leading the charge and a call for a study in Parliament of the previous bill, Bill C-14. Some of what we are proposing incorporates his views on the scope of what that review should look like.

Finally, there are two Senate amendments that, in the government's view, cannot be supported.

The first is the amendment to the mental illness exclusion itself. While I appreciate that some have advocated for greater clarity around what mental illness means in this context, the government is concerned that this particular amendment, as drafted by the Senate, implies that neurocognitive disorders are ordinarily understood as being mental illnesses, which, in fact, may not be the case. The federal government will work with its provincial and territorial counterparts to ensure a consistent application of the mental illness exclusion until it sunsets.

The second Senate amendment we propose to reject is the amendment to expand the waiver of final consent. Providing MAID in the absence of final consent is extraordinary and carries risks, and we acknowledge that. The Senate amendment goes beyond the scope and principle of Bill C-7, which would permit the waiver of final consent only in narrow circumstances that present the fewest risks. Any expansion of advance consent or proposal for advance requests, which are sometimes called advance directives, will involve greater risks and should be the object of careful consideration by the parliamentary review.

It has always been the notion that the issue of advance directives should be contemplated only after consideration by the broader parliamentary review. This was the case with the previous Bill C-14, and it is certainly the case now with what we are proposing as a government with respect to the parliamentary review that should ensue herefrom.

In the time I have remaining here, I would like to canvass a couple of points.

One is the notion that has arisen during the discourse of today's debate that somehow the government and de facto the Senate are somehow pursuing a route that is putting undue focus on facilitating an end of suffering, including facilitating the passing of an individual, as opposed to making the condition of life more viable and also more supported. That assertion is categorically false. The government's record over the last five and a half to six years speaks for itself in terms of the supports we have put in place, whether they are in long-term care, home care or supports for mental illness.

It relates to, as the previous member mentioned, a unanimous consent motion being passed regarding a suicide hotline. The supports we have put in place, such as the Canada health and social transfer, and a few intensive efforts to address home care and palliative care, are significant investments. We are ensuring that people are making such significant decisions based on the full understanding of what options are available to them and what supports are available to them. Can more be done? Of course, more can be done. I think that is what is important about what arises from a debate such as this.

The second thing I want to underscore is something that arose many times when Bill C-7 was in our chamber the first time, meaning its second and third readings prior to being sent to the Senate, which has again arisen today in the context of today's debate, and that is this idea that persons with disabilities are somehow being victimized, targeted or unfairly treated by this particular bill. I will raise a couple of important points, which I think are really important for all members of Parliament to understand. I have raised these points before, but I will reiterate them.

What we are talking about here is autonomy and the autonomy of individuals to make choices about the end of their lives and their passing, and that butts up against the need to protect vulnerable people. It is an important balance, and that is what is at the heart of this. This makes it probably the most difficult issue any of us have dealt with, at least it has been for me in my five and a half years as a parliamentarian. That being said, people need to understand that the case that was brought before the courts that we are responding to now was brought by two individuals: Monsieur Truchon and Madame Gladu.

Both suffered from disabilities, but because they were not near the end of their lives, they were prevented from accessing the MAID regime under Bill C-14. This is because it was, at that point and even now, until the law is potentially changed, an end-of-life only regime.

I want to read for members what the court analyzed with respect to that, because we have heard a lot in this discussion that somehow what we are trying to do in Bill C-7 is discriminatory of persons with disabilities. The notion of discrimination under section 15 was squarely in front of the court in the Truchon case, and what the court said is quite the opposite. I am quoting from paragraph 678 of the Truchon decision. The court said:

The requirement at issue reveals a legislative regime within which suffering takes a back seat to the temporal connection with death. Where natural death is not reasonably foreseeable, the consent in suffering of the disabled are worthy only of the sympathy of Parliament, which has adopted a protectionist policy toward every such person, regardless of his or her personal situation. As soon as death approaches, however, the state is prepared to recognize the right to autonomy. This is a flagrant contradiction of the fundamental principles concerning respect for the autonomy of competent people, and it is this unequal recognition of the right to autonomy and dignity that is discriminatory in this case.

The judge went on, in paragraph 681:

By seeking to counter only one of the stereotypes that the disabled face—vulnerability—the challenge provision perhaps perpetuates another probably more pernicious stereotype: the inability to consent fully to medical assistance in dying. Yet the evidence amply establishes that Mr. Truchon is fully capable of exercising fundamental choices concerning his life and his death. As a consequence, he is deprived of the exercise of these choices essential to his dignity as a human being, due to his personal characteristics that the challenged provision does not consider. He can neither commit suicide by a method of his choosing nor legally request this assistance.

I read this into the record to remind parliamentarians that discriminating against anyone in Canada should not be countenanced. However, what was squarely before the court was whether the old regime was discriminatory against persons with disabilities who want to make autonomous choices about their passing, but were not near the end of their lives. The court found, conclusively, that the old regime was discriminatory. That is what prompted this and other changes to the legislation.

I think it is very important to understand that. When I, and others, talk about the heterogeneity among people with disabilities, that is what we are driving at. It is not for Parliament, in my respectful view, to impede, limit or curtail the competence and autonomy of persons, including persons with disabilities, who want to make significant choices about how and in what manner to end their suffering.

I think a compassionate response by this Parliament, a response that entrenches dignity, requires us to do the opposite. I know it is difficult. I know it is moral. I know it is an issue fraught with a lot of personal conviction, and that it is a difficult task for many of us, but that is the task before us as parliamentarians. As somebody who is familiar with discrimination law, I wanted to correct the record, in terms of what I have heard in today's debate and previous debates, about how discrimination plays into the analysis.

[Denis Trudel, Bloc, Longueuil—Saint-Hubert, QC]

Mr. Speaker, I am having a hard time figuring out exactly where my Conservative colleagues stand this morning.

They think the process is being rushed and that things are moving too fast, yet the process itself includes a two-year period to thoroughly examine issues related to people with mental illness. I cannot tell if things are moving too quickly or too slowly for the Conservatives.

The other thing that is so exasperating about my Conservative friends is their use of the word “euthanasia”. In a debate on a topic this delicate and sensitive, people need to be careful about their word choices. Medical assistance in dying is a comprehensive approach to caring for people. The word “euthanasia” has a harsh, cruel connotation.

Here is my question. The Conservatives seem to think we should not pass Bill C-7 now. However, there are people suffering from very serious neurodegenerative diseases who are waiting for the go-ahead from Parliament to move forward in a complicated, complex and sensitive process. What does my colleague have to say to those people today?