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

[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?

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

Mr. Speaker, miracles never cease. Maybe this is the beginning of a dramatic change in things. Time will tell.

Regardless, the specific comments by the member for Timmins—James Bay that really were kind of “aha” moments for me was when he said that Bill C-7, even as previously written, and certainly with these proposed amendments, would make people living with disabilities in some sense second-class citizens when accessing our health care systems, as we would put them on a different track. He said it would create “a second track of humanhood in this country”, which is something that all of us should be seized with, especially in response to the repeated testimony of many organizations that represent Canadians with disabilities, as well as organizations representing Canadians dealing with mental health challenges.

We are here debating Senate amendments to Bill C-7, and specifically debating an amendment by my colleague that would try to change the government's response to the largest substantive amendment by the Senate that the government is proposing to agree with. I will delve particularly into the issues of that amendment. However, first of all, the government is using all kinds of arguments today, and previously, about how this has been a long time coming, that it has been debated extensively. I want to respond specifically by commenting a little on the journey that brought us here with this legislation, because we have really taken all kinds of twists and turns far from where this conversation on this particular bill started.

Allegedly, the genesis of this conversation was a lower court decision in Quebec that dealt specifically with the issue of reasonable foreseeability, and not the issue we are talking about today. It is a different issue that dealt with the issue of whether somebody should be able to access euthanasia if their death is not reasonably foreseeable. This court said that a person should be able to access euthanasia in that case. The government, contrary to advice from us, decided not to appeal that ruling. Importantly, the government could have proceeded with appealing that ruling and then used the window of time available to consider a different legislative response. However, the government created for itself a sharp timeline through its decision to not repeal that ruling.

Subsequent to that, this justice minister brought forward a piece of legislation that deals with many issues related to euthanasia far beyond the parameters of that court decision. The court decision dealt with reasonable foreseeability. I believe that if the government had proposed a piece of legislation that dealt with, and only with, the question of reasonable foreseeability and left other issues for other pieces of legislation, then that bill would have long passed and we would not be talking about fourth extensions, new court deadlines and so forth.

The reason we are in a situation where the bill has not yet passed is that, effectively, the government created an omnibus bill by tacking onto the issue of dealing with reasonable foreseeability many other, unrelated issues: questions of advance consent, questions of removing existing safeguards, questions around the 10-day reflection period. There were many different issues that had to be discussed as the result of the government's decision to put forward legislation, most of which were completely unrelated to the Truchon decision.

I think that, in a very misleading way, the government tried to create this artificial timeline link to the Truchon decision for all sorts of issues that have absolutely nothing to do with the Truchon decision, and there is very little basis for debating that reality. The government could have focused its response to the Truchon decision on the issues raised by that decision, and likely would have been able to justify a more aggressive timeline with respect to the bill, because there would not have been so many issues that needed to be discussed.

The government put all of those additional issues into Bill C-7 while failing to move forward with a mandated legislative review. The previous bill, Bill C-14, had mandated that there would be a legislative review. The government has not moved forward on that at all, and instead packed all of these other issues into Bill C-7. Then we had debate in the House, we had committee hearings and all the way along the government was trying to create as much urgency as it could, saying that “We have to move this forward because of the Truchon decision”, even though there was extra content riding on that issue, far more than was dealt with in the original Truchon decision.

The justice committee held a very limited number of hearings, I think it was only four, on all of the issues raised by Bill C-7. Despite that limited time, many people came forward to express significant concerns and opposition. There were physicians, mental health experts and people representing those in the disability community, and not a single stakeholder representing the disability community expressed support for this legislation. Not only were so many people coming forward to those committee hearings, but there also were over 100 written briefs submitted to the justice committee by individuals or groups who took the time to express their perspective and, generally, their concern about this legislation.

The justice committee moved so quickly that it is a veritable certainty that members did not have any reasonable opportunity to review those briefs. In fact, many of those briefs were initially rejected by the committee; then subsequently, thanks to the good work of my colleague from St. Albert—Edmonton, those briefs were formally received, but the committee then immediately proceeded into clause-by-clause consideration of the bill without allowing time to review the content of the briefs.

We had this urgency created by the government's decision to pile issues on top of the Truchon decision that were unrelated to the decision. Then we had extremely limited consultations by the justice committee, as the government tried to use this trick as a justification for pushing the legislation through as quickly as possible.

However, throughout those conversations at the justice committee, the government was clear that its bill and its policy was not to allow euthanasia when the primary underlying complaint is mental health challenges. The Parliamentary Secretary to the Minister of Justice and others have repeatedly spoken about this aspect of the legislation, namely, that it includes an exception clearly specifying that mental health challenges should not be a basis to receive euthanasia.

On that point, the government was right, and even if members have questions about the substantive value of that position, they should appreciate how the question of whether those dealing with mental health challenges as their primary complaint should receive euthanasia is a completely separate question from the issues raised by the Truchon decision.

The bill then went through committee, came back to the House and Conservatives expressed their perspective. The vast majority of our caucus voted against this legislation. We voted in favour of report stage amendments. There was an extension of hours to accommodate the speeches. The bill then went to the Senate and the Senate has now tried to dramatically further expand the bill.

As we all know, the unelected Senate, made up now overwhelmingly of individuals who have no party affiliation and who were appointed by the current Prime Minister, undertook a study that went far beyond the scope of the existing bill and recommended a radical expansion, certainly beyond what stakeholders and the public were looking for, and beyond what had ever been considered or debated by the House of Commons.

Whatever very legitimate criticisms one might have of the old model of the Senate, made up of non-elected people with strong party affiliations and who are not directly accountable, at least there was some mechanism of accountability through political parties. However, now we have in the Senate a vast majority of individuals who are not connected to any political party, who are not identifiable in terms political affiliations, and who are appointed by the Prime Minister without any consultation with other parties, without any kind of oversight, and who then exercise a defining power over legislation. That is a huge problem that we have to grapple with.

Part of how we could grapple with it in the House of Commons is by having the courage, when we receive amendments from the Senate that go far beyond the scope of anything considered in the original debate on the bill, never mind what was in Truchon, to say “no” to them. We could say that we appreciate the review work that has taken place, but at the end of the day, Canadians elect members of the House of Commons who are empowered to study issues in detail and to hear from Canadians and to come to conclusions.

The Senate can study and make recommendations, but, at the end of the day, what the government is now proposing by adopting the amendment proposed by the Senate with respect to mental health as its position is that the people's House, the House of Commons, should adopt in a single day something that the government had up until now said was not its policy, something that is clearly very complex and requires further study.

Not only is it unrelated to Bill C-7, but it is also completely unrelated and light years away from anything contemplated in the Truchon decision, which dealt very narrowly with the question of reasonable foreseeability.

We have this particular issue of the Truchon decision, with Bill C-7 piling many other issues on top of it, and now we have the Senate piling so many additional issues on top of that, including its proposed amendment on advance directives for those who are healthy. Somehow we, in the House of Commons, are supposed to change our position on this fundamental issue, with no study and no review at committee and the government seems to want this to happen in a single day.

I will go further than that in terms of the process. I was up last night preparing information, looking for the data. It was certainly well after 9:30 p.m. Eastern time, closer to 10:00 p.m. that the Order Paper was published. It was only then that it was evident what the government's position was. The government expects that if it takes a position on this substantive, really earth-shattering issue for Canadians dealing with mental health challenges and their family members, that members will see it and adopt that position, or in any event vote on it, all within a single day.

What a profound degeneration of our democratic institutions the government is trying to preside over. There are many other examples that we could talk about. We could talk about the lack of respect by the government for motions passed by the House of Commons on various other issues.

What we see before us right now is a government, that did not win the popular vote in the last election, telling us to, in a single day, adopt a series of changes that were proposed by a Senate made up of independents that the Liberals appointed primarily, and is complaining about members wanting to engage in these issues at greater depth.

The direction the government is taking our democracy is very troubling. I hope that members would stand with us, at least members from all opposition parties, in insisting that the government do so much better on this and support the amendment put forward by my colleague that we are debating right now that rejects this very substantive amendment from the Senate and, instead, say that if the government wants to change its policy with respect to euthanasia for those dealing with mental health challenges, it should at least propose that as part of a legislative package not constrained by a court timeline, and that the House could take the time required to study it at committee, to assess those issues and to move forward, instead of this artificial timeline created by the pairing of the Truchon decision with all of these other issues.

Those issues of process are of critical importance, but I now want to comment on the specific issues raised by this amendment, that is, the government's proposal now to allow euthanasia for people whose primary and only health challenge is a mental health challenge.

All of us, including me, have people in our lives who are close to us, either friends or family members, who have suffered from or are suffering from mental health challenges. I am sure many, if not most, if not all members of the House have had a conversation with someone in their life who comes to them and says, “I don't think I can go on. The pain I am experiencing....”

In those situations, I think for all of us, how we love those people and try to support them is by trying to show them that are loved and valued and that their lives are worth living.

We invest so much time and energy into suicide-prevention education. We try to tell younger people, older people and people of all ages that their lives are valuable, that they are loved and that their lives are worth living. We recognize that for those who are really in the depths of experiencing mental health challenges, it may feel like there is no treatment and there is no going on. However, mental health authorities have said in this country that mental health challenges are not incurable, that it gets better, that there are ways forward and that there are ways of managing, responding to and even fully addressing these kinds of challenges. We as individuals try to send the message to others in these moments of real, existential pain that they are loved and valued, and that there are ways of managing and addressing their pain.

This amendment would radically change that reality. It would take us from a world in which the emphasis is on suicide prevention for those who experience these challenges to a world in which a person who feels that they are in the depths of despair can go to a health care practitioner and say, “This is what I am experiencing. I think I cannot go on.” Instead of affirming to the person that life is worth living, that they can be supported and that it does get better, the person would be told that their options are having a practitioner work with them to try to make things better or having the state facilitate their desire for suicide.

What message does it send if we go from a dynamic of suicide prevention to one in which some people experience suicide prevention and others experience suicide facilitation? What if somebody who is in the real depths of existential pain and going through deep challenges is called upon to choose between suicide prevention and suicide facilitation?

We had a unanimous consent motion adopted by the House to have a national 988 suicide prevention line. What message would it send to people if Parliament were to pass the amendment proposed by the Senate? What message would it send to people in that situation? I wonder what message it would send to young people who are dealing with these challenges.

Of course, the current legislative framework is that euthanasia is only available to those who are 18 years of age and older. That is also being considered as part of a review, so we cannot bank on that remaining a reality if this passes.

I asked what kind of message it would send to young people facing these challenges if we told them that it was acceptable to society for the state to facilitate suicidal ideation for adults, and that the solution was some kind of state-coordinated suicide facilitation. It really is horrible, in terms of the direction it would take us and the example that it would send.

Former Liberal MP Robert-Falcon Ouellette spoke eloquently and shared his perspective, from his indigenous culture and values, about what was so wrong about the government's original Bill C-14. He and I had a town hall in my riding together: a Liberal MP and a Conservative MP. We talked about many issues, most of which we disagreed on but some of which we agreed on. He made the point of asking what message it would send to younger people when older people are told that death is the solution. The values that he brought to the table underline the need for listening to Canadians on this issue. They underline the need for stronger consultation with indigenous communities.

As one previous witness told the committee on Bill C-7, indigenous Canadians are looking for medically assisted life. People with disabilities and mental health challenges would say the same thing: What they are looking for is medical assistance in living, not this rushed track, for those who are dealing with mental health challenges, toward suicide facilitation.

This needs more debate. I believe the amendment from my colleague should be supported to defeat the Senate amendment so that we can do more to protect people in vulnerable situations across the spectrum of challenges, and so that we do not, as the member for Timmins—James Bay spoke about, create a dynamic in this country where those living with disabilities are viewed or treated by our medical system as second-class citizens.

I look forward to the continuing conversation and to questions from my colleagues. Again, we need to do something like that.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I would like to first recognize that the member for Timmins—James Bay is such a stand-up MP for his constituents, and I always appreciate his interventions, especially on this subject matter.

He is very right that we are not here to relitigate the main provisions of Bill C-7, but we do have to discuss what is a very substantive amendment to the bill by the unelected and unaccountable Senate, and that essentially is what is provoking debate on whether or not we agree as a House that the mental health exclusion section of this bill needs to be sunsetted.

If Liberals and Conservatives honestly cared so deeply about the plight of persons with disabilities, they would have agreed to the letter sent by the member for Elmwood—Transcona and the member for Esquimalt—Saanich—Sooke when they wrote to the minister asking that a monthly amount of $2,200 be awarded to all persons with disabilities to make their lives measurably better.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, when we look at the disability community and persons suffering from mental health issues, it is important for us to remember that they are not one solid bloc of people. There are a variety of opinions and approaches to this subject, both within the disability community and among persons who suffer from mental health challenges. I am very wary when a group says it speaks on behalf of an identifiable group, because we know that opinions on the subject are quite varied.

In terms of how we go forward, I am not ultimately going to be able to decide that. That decision is going to be up to the House, but I would refer my hon. colleague back to the answer I gave to the parliamentary secretary: The government chose to bring in a motion that agrees with a substantive amendment, and I think that in itself is going to provoke much more debate and may even serve to ultimately delay the passage of Bill C-7.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I certainly appreciate the parliamentary secretary's comment about the many hours of debate on both Bill C-14 and Bill C-7 and I am also sensitive to the court deadlines.

That said, it was the government's choice to bring forward a motion that is going to, in my view, substantially alter Bill C-7 with the sunset clause on mental health. By that very action, the government is probably going to provoke much more debate in the House because, as the parliamentary secretary will know, the House already took time to pass a version of the bill. The very fact that the government chose to bring in a sunset clause is going to provoke a lot more debate. That is beyond my control.

The other thing I would note is that I wish the government had been a bit more respectful and had introduced this bill for debate tomorrow so that individual caucuses could have had the opportunity to have a thorough discussion of their concerns around the table.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, we certainly are dealing with a very sensitive subject matter with today. This Parliament and the last Parliament both have had quite a long journey in dealing with the substance and subject matter of medical assistance in dying.

I know that I along with many of my colleagues in all parties have been recipients of a huge amount of correspondence on this subject matter, both from organized groups across the country and our very own constituents. It can be hard as a member of Parliament to find one's own way through all of that, because the feedback we receive and the strong passions are evident on both sides of the argument. I was a witness to that with Bill C-14 and, of course, it has been replayed for Bill C-7.

There have been difficult conversations with constituents. I have constituents who feel the government legislation does not go far enough. They felt that way for Bill C-14 and some feel the same way for Bill C-7. Others feel it goes too far and establishes dangerous precedents. It can be tough, but in those conversations I have had with my constituents, I have always tried to guide myself with the difference between sympathy and empathy. With sympathy, we can feel sorry for one's situation in life, but we are still looking at another person's situation with our own biases and world view, whereas true empathy, which is very much required when we are dealing with medical assistance in dying, is to try to put ourselves into that other people's shoes, to try to see the world from their point of view, to see exactly why these issues and matters are so important to them.

I also try to use section 7 of the charter to guide myself, the fact that it is explicitly written that everyone has the right to life, liberty and security of the person and the right not to be deprived thereof, except in accordance with the principles of fundamental justice. Essentially it means that people have a right to control their own bodily integrity. It is engaged whenever the state tries to interfere with personal autonomy.

This is really the crux of the matter. It is personal autonomy, a person's decision on how he or she is going to meet the end of his or her life. For those of us who are blessed to lead healthy lives, who are not intolerably suffering from a grievous and irremediable medical condition, we really cannot know what other people's lives are like. We do not know what it is like for those people to not have autonomy over their own bodily functions or their bodily integrity, so to speak.

In today's debate, one thing should be very clear. The House of Commons has already spoken to Bill C-7. We have already decided on what we want to do as the people's elected representatives. Of course, the Senate has reviewed the final third reading version of the bill that we sent to it and the Senate sent it back to us with some of its recommendations. This is not the time or the place to go over old arguments that were already dealt with by the House. This is really a time for us to focus exclusively on what the Senate has brought to us.

It is important to note that nothing in Bill C-7 is going to change the very high standards set out in the original Bill C-14. To receive medical assistance in dying, patients need to have a condition that is incurable. They must be in a state of irreversible decline and they must be facing intolerable suffering. The door is not being opened wide, as some have suggested. Those basic parameters are still in place.

When we are dealing with this subject matter, it is important to note that most Canadians know someone who has been affected by intolerable suffering at the end of his or her life. Generally, my caucus has been supportive of this bill because it does respond to the need to reduce that unnecessary suffering at the end of life. As I alluded to, section 7 of the charter helps to preserve the autonomy of decision-making for individuals.

I made reference to the fact that most Canadians know someone who has been affected by a disease and intolerable suffering. I have had that personal experience as well with a close family member, and that happened at a time before we had medical assistance in dying. It was a long-drawn-out battle with cancer. It can be hard on the family members too, because they have to watch a beloved family member suffer, in some cases for several months, before the end mercifully does come.

It is a very weighty subject matter, and I want to approach today's debate with that firmly in mind.

I was first elected in 2015, so I was a member of the 42nd Parliament. I was there for all the Bill C-14 debate, which was forced upon Parliament at the time by the Supreme Court of Canada's decision in Carter. We, as New Democrats, ultimately did not support Bill C-14, because we felt the bill at the time was too restrictive. I remember referring to the fact that the courts would force this bill back before Parliament, and that happened with the Quebec Superior Court.

I do not want to dwell too long on this history, but one thing that is very important to mention, in the context of today's debate, is that Bill C-14 had a provision in clause 10, which mandated that a legislative review had to happen at the beginning of the fifth year. I will read it out for my hon. colleagues. Clause 10 reads as follows:

At the start of the fifth year after the day on which this Act receives royal assent, the provisions enacted by this Act are to be referred to the committee of the Senate, of the House of Commons or of both Houses of Parliament that may be designated or established for the purpose of reviewing the provisions.

That is very clear language, and the beginning of the fifth year was in June 2020. We are almost at the end of February 2021.

The reason I raise this is that this important legislation review would have dealt with a lot of the questions the House is now considering and debating. It almost feels like we are building parts of the plane as we are flying. Many of these debatable items that are going on with Bill C-7 need a very careful study. They need to have the timeline afforded to them so we can hear from Canadians across the country, from expert witnesses and actually craft a law that responds to those very important bits of feedback.

I also want to take this opportunity to recognize my friend and colleague, the member for Esquimalt—Saanich—Sooke, a neighbouring riding of mine. He has long recognized this legislative requirement of Bill C-14. He has raised it with the Minister of Justice on several occasions.

Due to his frustration at the government's inaction on this front, he introduced Motion No. 51, which would establish a special committee of the House to include a review that would not be limited to but would expand on several issues. It would have looked at requests for medical assistance in dying by mature minors, advanced requests and, most important, requests where mental illness was the sole underlying medical condition. The committee would also be charged with looking at the state of palliative care, the adequacy of safeguards against pressure on the vulnerable and so on. If we had such a committee in place, already looking at these issues, then we may have had some answers to these important questions by this point.

I will move on to what the Senate has sent back to the House. I was reviewing some of the transcripts from the Senate, some from its legal and constitutional affairs committee, but also from its third reading of the bill.

The Senate legal and constitutional affairs committee decided to report back to the main body of the Senate with no amendments to the bill but some observations. The substantive amendments to the bill all came at third reading. For example, there was a proposed change to the wording of subsection 1(2) for mental illness to include a neurocognitive disorder, looking at advanced requests and so on.

Today, we are dealing with the government's response to those amendments. The government has crafted a motion for the House to consider on what amendments it agrees with, those it does not and those it wants to amend. The Senate disagreed with the expanded definition for the exclusion of mental illness. The government's motion disagrees with the advanced request part of it.

However, as a quick summary, the government motion agrees to the sunset clause for the mental health exclusion. Instead of 18 months, the government has proposed it be expanded to two years after royal assent. Essentially this legislation, once it becomes a statute of Canada, if passed in this manner, will have a ticking clock of two years for a committee to come up with the appropriate safeguards in place.

The government's motion in response to the Senate also mandates that the minister is to set up a committee of experts to work on mental health protocols. It requires a voluntary collection of data based on indigenous identity, race and disability. It sets up a joint committee to do the legislative review, starting 30 days after royal assent.

The most substantive part of the government's motion that really stands out to me is the fact the government is agreeing to the sunset clause on the mental health exclusion. The reason it stands out for me is because when Bill C-7 was originally proposed to the House, the government's own charter statement made some very strong references to why mental health, as an underlying condition, was to be excluded. For the government to backtrack on that and agree to a sunset clause stands out to me.

I acknowledge that we will have two years, but with such a substantive change to the law, it would make sense to me as a legislator to have a specific committee set up to look at all the things we need to look at to make this bill appropriate and proper so it fits will all the important safeguards we need to have in place. I am a bit wary of having that timeline put on the House and forcing us to do these things.

My Conservative colleague before me has now proposed an amendment to the government's motion. Basically, the Conservatives are proposing to get rid of the sunset clause. That is the most substantive thing. At first glance, that seems reasonable, but because I have only really had about 10 minutes to adequately review what the Conservatives have proposed, I would like more time to refer back to that in later days.

I mentioned the charter statement the government initially brought out for Bill C-7. I would like to read a highlighted section of that charter statement where it reasons why it wants to exclude the mental health provisions in the bill. It says, “evidence suggests that screening for decision-making capacity is particularly difficult, and subject to a high degree of error.” It further says, “mental illness is generally less predictable than physical illness.” It also highlights some concerns from other countries that permitted medical assistance in dying for mental illness, namely Belgium, the Netherlands and Luxembourg.

I want to make it clear that I am not necessarily of the opinion that mental health should be excluded, full stop. What I am saying and what I am arguing is that we need to have an appropriate review of all of this incredibly weighty subject matter before we dive into actually changing the legislation.

This is backed up by the work that was done in the House of Commons' very own Standing Committee on Justice and Human Rights. The justice committee heard that the protocols and safeguards for medical assistance in dying for those with mental illness do not exist and that it would take a significant amount of time to develop them from a clinical perspective. The fact is that if the committee's work on mental health is not complete within two years, that clause will be sunset. I have a real problem with us putting that part up front before we do the hard work at committee.

If I were to summarize my speech, the real issue I have is that I do not believe we should have a substantive expansion of what Bill C-7 purported to do when the bill was passed by the House. I do not think we should have any expansion to it before we have had those reviews in place.

I realize that in some cases, the Senate does like to provide feedback to the House, and there have been several instances of amendments being proposed by the Senate. The real issue I have, the elephant in the room, is that the Senate is still an unelected and unaccountable body.

As members of Parliament, we have to face our constituents. We are accountable to the people who elected us. Whenever the next election comes, the people of my riding of Cowichan—Malahat—Langford are going to judge me on how well I did my job. It is the same for every single member of Parliament who sits in the House of Commons. We have to be accountable for the things we say in the House and how we vote. Senators do not have to do that. I know there are a lot of honourable people who serve in that institution, but they are free from that accountability mechanism. The real problem I have is that I firmly believe the House must always be the final arbiter in the decisions that are made, because the people of Canada elected us to make the laws on their behalf.

In response to the many concerns I have heard raised, both in the House and in correspondence from the disability community, I would like to leave my colleagues with some thoughts. If we are rightly concerned about how persons with disabilities are currently living in Canada and what their quality of life is like, rather than focusing so much on Bill C-7 and medical assistance in dying, why do we not take this opportunity to start enacting reforms and enacting policies to make their lives better? If we look at the income supports that are out there for persons with disabilities and the amount of money they get to scrape by every month, we see a shameful record on our country, and it is something that we need to fix.

We have already acknowledged through the pandemic and through COVID-19 response measures that individuals should be receiving $2,000 a month to get by, but we do not afford that to persons with disabilities. Even when the House had an opportunity to get financial aid to that group of people in Canada, it took us over six months to do so. That is a shameful record, and it is something that the House really needs to concentrate on if we are going to adequately and meaningfully address that issue.

I appreciate having had this opportunity to speak to Bill C-7 and I welcome any questions and comments that my colleagues may have.