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.

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

Criminal Code

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Mr. Speaker, I am pleased to rise today to discuss Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying, or MAID.

As a physician, I took a keen interest when Parliament passed federal legislation in June 2016 to allow eligible Canadian adults to request medical assistance in dying. This was subsequent to the February 2015 Supreme Court of Canada ruling that parts of the Criminal Code would need to change to satisfy the Canadian Charter of Rights and Freedoms.

At the time, I was also a member of the provincial parliament in Ontario and was involved in how that province would ensure people would have their personal choice of access to medical assistance in dying, while also ensuring the conscience rights of health care providers would be respected. The actual implementation of MAID was our responsibility and was very carefully considered.

Working with provincial organizations like the College of Physicians and Surgeons of Ontario, we established policies to ensure that, should physicians have conscientious objections to administering MAID, systems were in place to provide appropriate care options to the patient. Consistent with the expectations set out in the college's professional obligations and human rights policy, physicians who decline to provide MAID due to a conscientious objection must do so in a manner that respects patient dignity and must not impede access to MAID.

They must communicate their objection to the patient directly and with sensitivity, informing the patient that the objection is due to personal and not clinical reasons. They must not express personal moral judgments about the beliefs, lifestyle, identity or characteristics of the patient. They must provide the patient with information about all options for care that may be available or appropriate to meet their clinical needs, concerns and/or wishes, and they must not withhold information about the existence of any procedure or treatment because it conflicts with their conscience or religious beliefs. They must not abandon the patient and must provide the patient with an effective referral. Physicians must make the effective referral in a timely manner and must not expose patients to adverse clinical outcomes due to a delay in making the effective referral.

While there is importance in ensuring widespread access to MAID, the law specifically acknowledges the conscience rights of health care providers and the role they may play in providing medical assistance in dying. As a physician who spent all of my time in clinical practice doing my best to preserve life, I feel this balance is working well, and the amendments proposed in Bill C-7 do not make any changes to any of this.

As a government, we remain committed to working with provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

What are the amendments that Bill C-7 proposes?

In response to the Superior Court of Quebec's Truchon decision, it repeals the MAID eligibility criterion that applies when a person's natural death is reasonably foreseeable. The criterion is the 10-day reflection period. One concern at the forefront is to ensure that measures are in place that provide safeguards for the MAID process. I believe Bill C-7 does precisely this. It proposes to create two sets of safeguards that must be respected before MAID is provided. For persons whose natural death is reasonably foreseeable, the existing safeguards, as amended by Bill C-7, would continue to apply. For persons whose natural death is not reasonably foreseeable, the existing safeguards with additional safeguards would apply.

I think we are all aware of the concern about increased risks where MAID is provided to persons who are not dying in the short term. That is why additional safeguards would apply where a person's natural death is not reasonably foreseeable. With these new safeguards, specific attention with respect to both time and expertise would be devoted to assessing requests for MAID and to ensuring those making the request are made aware of and seriously consider all other available means of relieving their suffering, including palliative care. In nearly half of the reported MAID deaths in Canada to date, the practitioner providing MAID had in fact consulted with at least one other health care professional in addition to the required second opinion from another practitioner. There is no question these practitioners are taking their responsibilities very seriously.

For those whose death is reasonably foreseeable, Bill C-7 most importantly proposes to eliminate the 10-day reflection period, which many practitioners say can prolong unbearable suffering.

The proposed amendments of the bill will allow waiver of final consent for persons whose natural death is reasonably foreseeable, who have been assessed and approved to receive MAID and who have made an arrangement with their practitioners for waiver of final consent because they are at risk of losing decision-making capacity before their chosen date to receive MAID.

We have heard many touching stories during the course of debate on this bill and situations like that of Audrey Parker, who chose to access MAID on November 1, 2018, despite her desire to see Christmas with her family. She feared that she would lose her capacity to give full consent before Christmas and so she requested MAID before then. Considering her case, we see the need for this amendment in real human terms. Ms. Parker, herself, stated:

I would like nothing more than to make it to Christmas, but if I become incompetent along the way, I will lose out on my choice of a beautiful, peaceful and, best of all, pain-free death.

Since the Truchon decision, our government has engaged in extensive consultations. Beginning in January of this year, over 300,000 Canadians took the time to participate in an online questionnaire on the subject. It should be noted that as part of this questionnaire, direct questions were asked about final consent for MAID. The following question was asked:

Imagine that a person makes a request for MAID, is found to be eligible, and is awaiting the procedure. A few days before the procedure, the person loses the capacity to make health care decisions, and cannot provide final consent immediately before the procedure. In your opinion, should a physician or nurse practitioner be allowed to provide MAID to a person in these circumstances?

Over 78% of participants said yes, that a person in these circumstances should be allowed to receive medical assistance in dying.

In addition to the online questionnaire, the Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion hosted a series of 10 in-person round tables across the country, from January 13 to February 3 of this year. These round tables allowed the ministers to hear from over 125 experts and stakeholders, including doctors, nurse practitioners, health regulatory bodies, key health stakeholders, legal experts, civil organizations and, of course, the disability community.

The ministers also hosted a separate round table focused on receiving specific feedback from indigenous practitioners and community leaders.

The importance of palliative care continues to be raised in these discussions. Our government recognizes the need for quality and appropriate palliative care, which is why it 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, which will help to improve access to palliative care for underserved populations and support families, health care providers and communities. In addition, our government is providing $6 billion in federal funding directly to provinces and territories to support better home and community care, including palliative care.

There is no question that MAID is a very important consideration for all of us. This is an issue about which all Canadians care. I know in my riding of Markham—Stouffville, it is a concern that a significant number of my constituents have shared with me. This matter is extremely complex and further discussion will be needed during a future parliamentary review of the previous Bill C-14.

There is a medical aphorism attributed to Sir William Osler, a Canadian who is considered the father of modern medicine and internationally recognized, that says that a physician's duty is to “cure sometimes, relieve often, comfort always.” Our MAID legislation provides comfort to those facing death. For now, let us move forward with Bill C-7 and provide compassionate care to those in need.

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

Madam Speaker, if I heard right, I heard the member say that she had practised previously as a physician. She also expressed the view that the requirement in Ontario for effective referral was consistent with conscience protection. That is the view she expressed.

If the member happened to be practising medicine in a jurisdiction that allowed female genital mutilation, would she be willing to provide an effective referral for someone seeking that service?

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Madam Speaker, I fail to see how the example given by the member opposite relates to Bill C-7.

What I am saying is that the relationship between patients and their practitioners is one that should be based on trust and clear communication and that health care providers should always do their very best to provide that type of compassionate care to their patients, and to discuss the matter as necessary and refer individuals to specialists in the particular area. This is the normal practice of medicine.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Speaker, the Bloc Québécois was the first to introduce a bill on this matter. I am thinking of two of our members, who have now passed on. One is Francine Lalonde, who introduced a bill on this topic, and the second is Father Gravel, who was bullied by certain religious lobbies, which even wrote to the Vatican to have him removed from his position and driven out of the Catholic Church. I will spare you the details, but that was not easy for him. I will think of these two, who are dear to my heart, when we vote on this bill.

I thank my colleague for her speech. Does she not think that we need to address the notion of advance consent, which is not in this bill, as quickly as possible?

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Madam Speaker, the whole issue around the advance directives, which I think my colleague opposite was referring to, is one that comes up in conversations with my constituents. A number of Canadians are very concerned about the possibility. In most of the conversations I have had people are in favour.

Bill C-7 at the moment is taking one step forward. This is a good improvement to the existing legislation. As I understand it, there may very well be a parliamentary review of the existing Bill C-14 and I have no doubt that these types of discussions will occur at that time.

[Darren Fisher, Liberal, Parliamentary Secretary to the Minister of Health]

Madam Speaker, I know the Audrey Parker situation so well and I want to thank the member for putting those words into Hansard one more time, because they are so important as it pertains to Bill C-7.

I wonder if the member could tell me her personal opinion on whether the bill provides the level of safeguards that the Canadian public will be comfortable with and need?

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Madam Speaker, I believe the required safeguards are there. Clearly there is a balance between individual choice and the fact that there could be perhaps some second thoughts in discussion with an individual, a change of heart in essence, as to what the individual might choose to do. There is the 90-day period of reflection. The assessment is very thorough. There is nothing in Bill C-7 that endangers those safeguards. We have them under the current legislation and they are preserved in this bill.

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

Madam Speaker, it really amazes me how quickly we have gotten here. The 2015 election was five years ago today. One of the first issues we dealt with in that Parliament was a new law that legalized euthanasia. The government came up with a new term for it, calling it medical assistance in dying. At that time, the then minister of health and the then minister of justice said that it was a finely tuned balance where there was the right mix of safeguards and opportunities. Of course, as a result of the SNC-Lavalin scandal, both of those ministers were kicked out of the Liberal cabinet and the Liberal Party, but they along with their colleagues said that this was a necessary balance that was struck.

What was built into the process as well was a legislative review five years later. However, the government jumped the gun on that legislative review. It said that before the legislative review, it would remove some of the safeguards that were thought to be vital less than four years ago and would do that ahead of any review. The fig leaf the government used to do that was the Truchon decision in Quebec. This decision dealt with a very specific issue, the question of reasonable foreseeability.

It was a political choice for the government not to appeal that decision because it did not want to. It wanted to be able to justify, ahead of the timeline set by the legislative review, moving forward with the removal of safeguards that it had said quite recently were vital. Then it packed into the legislation a number of critical changes that had absolutely nothing to do with the content of the Truchon decision.

My colleagues have spoken eloquently about the specific issues around removing reasonable foreseeability and the concerns raised by people in the disability community. I want to focus on the aspects of this legislation that have absolutely nothing to do with the court decision to which it is supposedly responding.

This legislation will bring us, for the first time, three things about which Canadians should be very concerned. First, it will bring us same-day death, the opportunity to receive death on the same day a person requests it. Second, it will bring us death without contemporaneous consent. It will bring us a situation where people will have their lives taken without being consulted in the moment. Third, it will bring death without the presence of independent witnesses.

I am opposed on all three counts. I do not think we should have same-day death. I do not think we should have death without contemporaneous consent or any kind of contemporaneous consultation. I do not think we should have death without independent witnesses present.

Let us talk about same-day death. Right now there is a 10-day reflection period. Let us be very clear that the law already allows that reflection period to be waived in certain circumstances. The waiving of that reflection period is not a long, arduous process. If the physicians involved say that because of the particular circumstances in this case that the 10-day reflection period should be waived, that 10-day reflection period can be waived, but it is a default. It says that on balance, except in exceptional circumstances, the 10-day reflection period between when a person requests death and receives it is a reasonable frame of time. I think we can all understand that people who are going through challenging circumstances and major changes in their lives will feel intense feelings of pain, suffering and angst in a moment. Those are real sincere feelings, but they might feel differently in a different space with a little time and opportunity for reflection.

I would like us to be the kind of country where if people say that they have had enough and that they want to die, instead of being told okay, let us do it right now, they are told that we have this mechanism of review of consideration, take that time and even that review process can be waived. That is eminently reasonable.

What we do not want in the country is a situation where I might go visit an elderly relative on Wednesday and seems totally fine. Then I come back on Friday and find that the person requested death yesterday and received death on the same day. We should leave in place a default of a 10-day reflection period. It is not only members on this side of the House who feel that way. I raised the question during questions and comments before prorogation. Even the member for Richmond Hill said that he supported leaving in place the 10-day reflection period.

I know other Liberals believe this as well, and I would challenge them to do the right thing and recognize the need for this amendment to remove same-day death. It just is not safe. It is dangerous. It is rife with abuse. It does not allow people the time and space to consider carefully in consultation with family members. The 10-day reflection period can be waived, but it is an important default to have in place.

Secondly, we have a proposal on this legislation, and it has nothing to do with the Truchon decision, for death without contemporaneous consent. What this means is that a person could say in advance, “I want you to take my life on December 31, and if I don't have capacity then go ahead and take my life anyway.” There is no requirement in this legislation, on that future date set, for there to be any kind of consultation with the patient. In other words, a person, in whatever state of mind, could not even be told. They could have something slipped in their coffee without being told in advance. They could have their life taken without being asked in the moment.

Members are giving me looks. They should look at the legislation. There is no requirement in the legislation for the patient to be told what is happening while it is happening. I would, at a minimum, propose we amend the legislation to say that if somebody has provided advance consent, that at least at the moment the action is happening the person administering it be required to tell them what is happening, and that the person is given the opportunity to, in that moment and regardless of their state of capacity, be able to offer some kind of objection if that is the way they feel. There is nothing in the legislation, as it is written right now, for a person to be told what is happening or asked their opinion in any way in the moment their life is being taken.

I do not believe that, as a matter of principle, it is consistent with the ethics of choice and autonomy for my past self to be able to bind my future self. Garnett Genuis on October 19, 2020 might want a future version of myself to behave in a certain fashion, but that future version of myself should still have autonomy to make choices that contradict something that my past self wished for, especially in cases where disease and disability are involved where people adapt to circumstances. They adapt in ways perhaps they do not expect.

The third point I want to talk about is that this legislation would bring us death without independent witnesses. It would remove a requirement for independent witnesses to be involved. I just do not see the purpose of that. Why not leave in place a requirement for independent witnesses? It ensures there are not abuses.

When I finish my remarks, I am going to be sharing my time today with the excellent member for Peace River—Westlock.

People advancing this legislation say it is about choice. I would say, in the context of choice, let us recognize the context and the architecture in which choice is made and let us protect people's ability to make a genuinely autonomous choice. Is that fair enough? Is same-day death consistent with giving people real choice, that the moment they ask for death they receive it right away, or is it more consistent with choice that they have the time and the space to reflect?

Is it consistent with choice to remove the requirement for contemporaneous consent? I do not think so. Is it consistent with choice to remove independent witnesses who can verify what is happening?

Same-day death, death without contemporaneous consent and death without independent witnesses are moving us in a dangerous direction that will leave people vulnerable. In the government's defence of this legislation, it says it held lots of consultations and that virtually everybody it talked to agreed with it. I doubt it. We have already had over 400 physicians sign a letter raising objections to this. We have had a joint letter sent by many faith leaders from different communities across the country. We had over 70 representatives from the disability community come out against this bill.

May I say that the government runs consultations that involve loaded questions: questions that presuppose a particular result. One of my colleagues once talked about another consultation the government did as being like a dating website designed by Fidel Castro. When one asks loaded questions, there will be no meaningful result to the consultation. We are going to have what we have right now, which is hundreds of physicians and dozens of leaders from the disability community speaking out.

Finally, is it not sad that the only time we talk about palliative care in the House is when we are bringing in more euthanasia and removing vital safeguards? That is the only time the government pays lip service to palliative care. It is so eager for assisted dying but it is taking no action on assisted living, and it does not appreciate that if people do not have proper assisted living and palliative care available, then they do not have a meaningful choice. People have read the reports about what is happening with seniors care in this country.

People do not have a meaningful choice when they do not have access to the care that they want and need. Let us do more for assisted living, instead of removing vital safeguards that protect people around the assisted dying regime.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Madam Speaker, I must say right at the beginning that numerous members of Parliament, at least on the Liberal benches, have talked about the importance of palliative care. It has been incorporated in many ways, whether in budget issues or the throne speech.

When we talk about this particular piece of legislation, the member is upset over two or three aspects of it. I can appreciate that. I suspect the bill will eventually get to committee and in a minority situation, the member will be afforded the opportunity to bring forward ideas and changes that he would like to see with the legislation.

Would the member not agree that having this discussion, and having it go to committee, is a good thing to do? In regard to input, at the beginning of the year over 300,000 Canadians provided input on this legislation.

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

Madam Speaker, I already spoke about the flaws in the government's consultation process. If this bill gets to committee, I certainly look forward to the opportunity to raise these amendments around removing the provisions dealing with same-day death, around removing the provisions that deal with death without contemporaneous consent, and around removing provisions that deal with death without independent witnesses. I hope government members and members of other parties will listen to those proposals, recognizing that those aspects of the bill have nothing to do with the court decision that this bill is supposedly responding to.

The member is right to say that Liberals often speak about palliative care during debates about expanding euthanasia. However, what I have failed to see is action. How about they bring forward legislation on palliative care? How about they bring forward legislation on improving access to assisted living, instead of paying lip service—

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

The hon. member for La Pointe-de-l'Île.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, I listened carefully to my colleague's speech. He shared a number of concerns, but I have to wonder what is behind them.

All members know that this bill is based on principles, and I think principles are behind his concerns. My colleague should know that our own personal principles should not violate someone else's principles. This is even more important in the case of dying with dignity. We cannot force our religious beliefs on others who may not necessarily share those beliefs.

One part of my colleague's speech about choice stood out to me. He said that people should have autonomy to make choices. I would remind the member that the word “autonomy” derives from the two Greek words “auto” and “nomos”, meaning “to be ruled by one's own laws”. It is up to an individual to decide whether to end their own life. It seems to me that any attempt to impede that decision would be made under false pretences.

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

Madam Speaker, I would welcome the opportunity to speak with my colleague at great length, perhaps outside of the House, about our religious views and how all of our basic a priori assumptions about human dignity and human value may inform things we are talking about.

We might find ourselves agreeing on the importance of some application of autonomy. I do not think removing the requirement for contemporaneous consent is consistent with autonomy. I do not think that if a person, at a low moment, says they want to die today, removing any possibility of a reflection period is consistent with autonomy. The values of autonomy should engage people in expressing their considered judgment over time with all the information in a situation where they have alternatives.

If we tell someone their only choice is between living in a cockroach-infested facility and death, they are more likely to choose death than if they are given a real, humane, living with dignity alternative. Let us agree on the importance of autonomy, but let us recognize that the architecture of choice informs the choices that are and are not available to people. We can do better by giving them a context in which to make a life-affirming choice, if that is what they wish.

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

Madam Speaker, we are not leading the way with this bill. We are already lagging behind. Hundreds of people have been dying in needless pain for years. We have the opportunity to take a step forward and let people die with dignity. It is not about moving from a cockroach-infested room to a clean one. It is not the same thing. People are prisoners in their own bodies and suffering needlessly.

Why should they not be able to make that decision?