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

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

Madam Speaker, I thank the member for Beauport—Limoilou for her speech, and I would like to congratulate her for highlighting the autonomy of people with disabilities.

I would just like to add that the two people at the centre of the Truchon and Gladu ruling that we are discussing today had disabilities themselves, and the judge recognized their autonomy in making choices.

We have heard several times that our government made a mistake by not appealing the Truchon and Gladu ruling to the Supreme Court. When a provincial superior court decision is well developed, carefully analyzed, rigorous and clearly articulated, should we appeal the ruling to the Supreme Court, or should we take action, as our government is doing, to protect the dignity and autonomy of vulnerable people?

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

Madam Speaker, I thank my colleague for his question.

I am not a lawyer. However, in this case, a superior court handed down a ruling to address an unfair and unjust situation, where a right was taken away from people who were supposed to be treated equally. In my humble opinion, continuing the legal proceedings would only have added to the impression that these people are separate and different. They are full citizens, and they are entitled to be given our consideration and included in our reflections.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, the member mentioned that, in her opinion, there does not seem to be two classes of Canadians coming out of this. In the previous bill, there were two requirements: grievous and irremediable suffering, and reasonably foreseeable death. This bill would remove the reasonably foreseeable death requirement, therefore creating two classes of citizens. An individual who is suicidal and has no grievous and irremediable suffering would be given the host of services Canada provides to prevent suicide. A person who has a grievous and irremediable issue would be eligible for MAID.

Does the member not see that this bill would create two classes of citizens?

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

Madam Speaker, I thank my colleague for his question.

Nowhere in the bill does it say that someone who is suicidal can access MAID. On the contrary, the bill states that someone with a degenerative disability would have 90 days to reflect on their decision and would have the necessary support to ensure that they are not in a state of distress. The necessary safeguards are there to ensure that someone in a state of distress would get the help they need. Furthermore, the request may be denied if the assessment indicates that the problem lies elsewhere.

These are the same reasons for which mental health is not covered. We must start by providing support for mental health problems without giving people with mental illness access to MAID. A good assessment and good support are the safeguards in this bill.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Madam Speaker, my hon. colleague said that there is no way that a handicapped or disabled person could be given medical assistance in dying without their consent because, of course, they would write it on a piece of paper. Would the member not agree that there could be a number of factors put in there, from being put under pressure to feeling like they are a burden on society? Would the member not agree that there need to be protections to ensure that people are not being affected by other factors to ask for medical assistance in dying?

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

Madam Speaker, I have said it once and I will say it again: Yes, it is important to ensure that individuals make a free, informed decision and that they not be coerced. That is why the bill calls for a 90-day waiting period and support from a social worker.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, before I get started, I will let you know I am splitting my time with the member for Markham—Stouffville.

Today, I have the opportunity to participate in this debate on Bill C-7 from my riding in Guelph. Before I get going on the debate, I would like to recognize that Guelph is situated on the ancestral homelands of the Anishinabe people, specifically the traditional territories of the Mississaugas of the Credit First Nation.

I am proud our government has brought forward a bill that proposes changes that respond to the Superior Court of Quebec's September 2019 Truchon ruling. The proposed changes were informed by concerns and issues raised during consultations earlier this year in discussions with provincial, territorial and indigenous partners. As a result, we have had careful consideration of past experience with MAID in Canada.

I recognize medical assistance in dying is a deeply personal and complex issue. I have heard extensive feedback from my constituents on this topic as recently as this morning. During today's debate, we are hearing very personal stories from MPs that are very similar to what we heard when we first brought forward the legislation in Bill C-14. There are arguments for and against, which we need to recognize and look at.

Some of my constituents who have shared their support for these amendments and the swift passage of this bill have noted to me the importance of dying with dignity, as well as consistent and equal accessibility for all Canadians, as part of what our legislation needs to provide.

Earlier this year, I had a constituent reach out to me and share her personal story regarding medical assistance in dying. She told me that she felt very strongly about this issue because her husband of 56 years, John, had passed last December after four years of battling an illness and how appreciative she was that we had taken some first steps toward addressing these issues. She told me about the vibrant man John was, with a big heart, a successful career and an impressive education. She told me they had conversations about getting old together and how they would deal with aging, but these discussions did not include suffering or what might happen if the pain became too great. As John's illness progressed, he was moved into a long-term care facility where he spent the rest of his life. It was there that she saw so many others who were unable to be independent. She was saddened to see there was no dignity for these people, or for her husband John, as they were no longer able to look after their own personal needs. I saw this myself with my mother as she went through care in her last 10 years of life. The story of my constituent was one that conveys the importance of providing a diverse end-of-life option for Canadians that will help them provide the right decisions to be able to end their days with dignity, comfort and peace of mind.

Of course, there are two sides to this debate. I have heard from other people and received a lot of feedback that they understand we are coming at this as a deeply personal and sensitive topic for everyone, but are concerned these new amendments may impact the disability community, something we have discussed in the debate today, and the conscience rights of medical practitioners or our work toward improving palliative care. They all really do stitch together. While I am sympathetic to these concerns, I am also pleased to see our new legislation strikes the right balance of autonomy and protection of vulnerable people. This is thanks to many disability advocates who have participated actively throughout the consultation process, including specific round tables that focused on issues faced by the disability community. As was mentioned earlier in the debate, 300,000 people had input throughout the month of January 2020 to help us get to where we are today.

Additionally, our law specifically acknowledges the conscience rights of health care providers and the role they play in providing medical assistance in dying. These new amendments do not make changes to these rights and I know we will continue to work with provinces and territories to support access to medical assistance in dying while also respecting the personal convictions of health care providers.

However, the most common concern I have heard from my constituents is the need to prioritize palliative care over medical assistance in dying.

It is really the end-of-life care that we are talking about in both cases. In palliative care, Canadians are approaching the end of their life, and they deserve to receive care in the setting of their choice and to live out their days in comfort and dignity. They also deserve the freedom to make this fundamental decision about life and death without fear of their personal choice being obstructed by politics or government.

In Guelph, we are very blessed to have a wonderful palliative care facility that has been growing over the years as people recognize this as an option towards the end-of-life care that they are looking for.

However, 70% of Canadians are left without access to adequate palliative care. We have the responsibility to act in the interests of patients and their families, which is why our government supports access to both palliative care and medical assistance in dying. End-of-life issues are as diverse as Canadians themselves, and these issues also change throughout the course of medical needs and procedures that are available.

It is our responsibility as a government to provide as many options as possible for Canadians, so that they can take these deeply personal choices and make them on their own. That is why our government has worked collaboratively with partners, such as the provinces and territories, to develop a framework on palliative care. To support this framework, our government is implementing a targeted action plan that will help to improve access to palliative care for underserved populations; support families, health care providers and communities; and look at the funding that is needed to be able to execute our plans.

I would like to take this opportunity to thank Hospice Wellington and its executive director, Pat Stuart for the amazing work they do to support our most vulnerable citizens, including through palliative care.

I would also like to thank the constituents of Guelph who have personally reached out to me over the last several months to share their feedback, suggestions and personal stories around medical assistance in dying. I look forward to continuing to engage with my colleagues on this important subject and with my constituents, so that we can work to create a system that is responsive to the needs of patients, and creates an environment that can create comfort and reassurance for patients and their families.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Madam Speaker, I wish to thank my hon. colleague for his perspective on this issue. Indeed, I want to thank all of the members from both sides of the aisle who have shared on this deeply important topic.

My concern, and the member raised it, as did several of the previous speakers, is about the concerns expressed by the most vulnerable in our society, the disabled. They wrote, one month after the Truchon decision, to the Attorney General, 72 groups of them, pleading that this case be appealed to the Supreme Court for several reasons, that would buy time for a proper consultation process as part of the review, and that their voices would be further heard.

Could my hon. colleague please comment on why this process has been chosen superior over the voices and wishes of 72 representatives of the disabled community?

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I thank the hon. member for Chatham-Kent—Leamington, where we also have family members. As we have these discussions, we do see the cross-ties across Canada as we look at these issues.

The disability community is involved with the consultation process and will continue to be involved. We are reacting to the Superior Court ruling from Quebec, where we do need to look at some amendments. When we can get those in place, we will do the further review of Bill C-14, which will include the broader issues the member has mentioned.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, I will continue on in this vein.

I am concerned that the bill creates two classes of Canadian citizens: one, where if they are attempting suicide, suicide prevention measures will be given to them; and, two, another class of citizens who have a grievous and irremediable condition and who will be offered MAID.

Is the member not concerned with the two classes of Canadian citizens?

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, similar to colleagues on both sides of the aisle, I do not see this as an issue of dividing Canadians, I see this as an issue to be able to reach all types of Canadians, coming from different experiences and different health needs. We will be addressing the needs of all Canadians through this bill, as well as through ongoing legislative review of this legislation.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Madam Speaker, I know that my hon. colleague is a sincere man. That is why I was very disturbed by something I thought I heard him say, about some people at the end stage of their lives, that their lives were simply not dignified. Who is he to say that their lives were not dignified?

Would the member state unequivocally that all human lives, regardless of what condition or how they are at the end of their lives, are always dignified?

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I apologize if I left that impression with the hon. member. All life is dignified in Canada.

When my mother was passing away in Winnipeg I spent her last few days with her. Family members were looking at the question of how long to keep the machine going. My mom, in a moment of lucidity, came back to me when my brothers and sisters were out of the room and she said to me, “It's part of my decision as well, dear.”

The people who make those decisions have to be dignified and respected, so that their decisions are included in the legislation. In fact, this legislation is central to their decisions and not the decisions of family members or others.

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

Madam Speaker, what concerns me is that I have been in the House for many years, and twice now we have had to respond to court decisions in regard to end-of-life legislation.

I brought forward, in the previous Parliament, a motion for a palliative care strategy that received support from every member of Parliament. I heard many of my Liberal colleagues get up to say great things about it and then we never saw any action on it. The concern I have is that, in all of the work I have done with palliative care groups across the country and with people I knew very closely who have died, the will to live is so incredibly strong.

What we do not have ever, it seems, at the federal level is the willingness to make sure that we have standards in place to ensure the dignity of people in their final days and months, to ensure there are proper pain medications, supports and strategies in place. Here we are once again talking about amending the right-to-die legislation, but we have never ever gotten serious about responding to Parliament's call for support for people who want to die with dignity at their own time through palliative care.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I do not mean to talk down to the hon. member across the way because I would not do that.

The courts make decisions that then come back to Parliament so that we can review the decisions we have made on legislation to see whether further amendments are needed. This is a case where a court is telling us that there are further amendments needed. We agree with the court and are going forward with Bill C-7, so that we can make the amendments to try to satisfy the needs of the—