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

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Madam Speaker, the member knows that mere hopelessness or experiencing depression because one has lost one's business in the pandemic would not make one eligible for MAID. Even drawing that connection to suggest one would have blood on one's hands, I think, is absurd.

I have a simple question. What are the criteria the Supreme Court established in Carter? It is very simple.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Madam Speaker, I want to repeat again so there is no misunderstanding that I raise these points today not to undermine anyone's values or perspective of MAID, but we are in a unique time when people are vulnerable. It would be a tragedy to see them inspired to choose suicide. Whether they seek MAID or not, the whole concept of suicide is dangerous right now in the times we are in.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Madam Speaker, we are debating a matter today of life and death. This is not an easy topic for anyone to think or talk about. I cannot imagine how much harder it is for people who find themselves in a position where they are faced with a choice between the two. It is a choice that directly affects suffering individuals. Each of their loved ones will also be affected. What makes it even more complicated and difficult is that it involves people having vulnerable moments and often, for many reasons, they were already disadvantaged members of our communities.

How we treat our most vulnerable neighbours reflects back on our personal and social character. It makes all the difference if someone who is struggling receives support to have a fulfilling and meaningful life, or if they are mistreated and neglected. It also gives the rest of us a good or bad example to follow in how we should treat each other. We have to consider all of this when it comes to Bill C-7. There are way too many problems with it, but for now I want to step back and focus on the heart of this issue.

Many brave and passionate voices from the disability community have stepped forward to call out the dangers of stigma and discrimination in the government's bill. One of those voices is Roger Foley's. He was born with a severe neurodegenerative disease and his condition got worse. He was denied the necessary supports for continuing to live at home. He has been speaking out about his troubling experiences while he is in hospital. According to him, the health care system has not provided him with any assisted home care team of his choosing. Instead, among other things, he has been offered the option of assisted suicide. From his hospital bed in London, Ontario, he told the justice committee his story and further said:

What is happening to vulnerable persons in Canada is so wrong. Assisted dying is easier to access than safe and appropriate disability supports to live.

Speaking from his experience living with a terminal illness, he had been calling for assisted life before he should ever have had to consider assisted death. The idea that the opposite could be true here in Canada should be unsettling for all of us. There is definitely a problem for the population with disabilities, in terms of aggravating stigma and discrimination towards them. Other people are at risk too.

If someone is thinking of ending their life, we know that it is most often related to mental health challenges or their emotional and social needs. Recently we heard the story of the late Nancy Russell, who was a senior living in long-term care during the COVID lockdown. She maintained an engaging and outgoing life. During the first wave, the usual activities she enjoyed were restricted. At one point, she was confined to her room for two weeks. Her family noticed an unmistakable decline in her life from the first wave. Her daughter was quoted in the media as recalling that:

It was contact with people that was like food to her, it was like oxygen. She would be just tired all the time because she was under-stimulated.

When news of a second wave came, along with the possibility of another lockdown, Nancy decided to apply for MAID. She was approved for it and died this past October. Her decision, within the larger issue of our response to COVID, is a separate discussion, but her daughter's words are important for us to consider in this different context. When deprived of our human needs, it is easy for someone to consider such an option. On the other hand, whenever these needs are met, it can have a remarkable effect.

I also want to talk about Harold, who passed away this summer. His daughter reached out to share with me the story of what happened near the end of his life when his wife, Barb, was visiting him. I will once again quote: “A COVID-19 restriction allowed window visits only. Because of being hearing impaired, he could see his wife Barb through the glass, but could not hear her. At times, staff were available to repeat Barb's words but not usually. Three weeks ago, Harold's life declined. Barb was informed she could come inside the facility to visit, provided she followed their protocols: masks, gloves, handwashing; only visit within his private room, etc. These preventative measures seemed reasonable. These visits continued for three days and each day Harold's health improved.”

She also included this reflection in her message, “Face-to-face physical and emotional contact directly influenced Harold's well-being, and now Barb is left with the lingering remorse that she was not allowed to hold her husband's hand as he breathed his last breath. It is well known that face-to-face human connection fuels wellness and, as end of life naturally draws near, the end for togetherness is just as real.”

She makes a good observation about the power of social and physical connection. Whether we are dealing with the case of Roger Foley's physical condition or emotional and relational suffering, we have to make sure that we do not misidentify any cries for help when somebody asks to die.

On a similar point, I want to make sure we consider the great potential for struggling Canadians to not find the help they might desperately need. For the justice committee study on Bill C-7, physicians, together with vulnerable Canadians, submitted a statement signed by doctors from every province. As of today, over 1,000 signatures are on that document. They explained the problem this way:

The shock of a sudden illness, or an accident resulting in disability, can lead patients into feelings of anger, depression and guilt for requiring care—emotions that, with proper support and attention, can resolve over time. The care and encouragement shown by physicians may be the most powerful force in overcoming despair and providing hope. Unfortunately, patients can no longer unconditionally trust their medical professional to advocate for their life when they are at their weakest and most vulnerable.

The lack of available alternatives and support could only make it more difficult. The same statement notes the following:

We live in a country where the wait time to see a psychiatrist in certain areas is 4-8 times longer than the 90-day waiting period proposed in the bill for those whose natural death is not considered “reasonably foreseeable”, and where 70% of citizens nearing the end of life still have no access to basic palliative care services. Yet MAID has been deemed an essential service under the Canada Health Act and palliative care has not. This bill creates the conditions for cheap and easy death through euthanasia or assisted suicide.

Without addressing the root causes of suffering or actually providing someone with different options, it is impossible for a real choice to be made.

Finally, I share the concerns of advocates for people with disabilities and for other causes, that this bill would help to normalize suicide in situations similar to the stories I have shared and more generally.

In 2020 and beyond, there is a real risk for an increase of suicidal thinking. This year has pushed many to the brink of despair. Now is the time for us to live up to our international reputation as a nation of compassion and caring. We should offer those who are struggling a helping hand, not a cold shoulder of indifference.

In my province of Saskatchewan, in particular, there is a suicide crisis in parts of the indigenous community. I know that many indigenous leaders and communities have raised this concern in regard to the expansion of assisted suicide. In 2016, during the last debate in Parliament to legalize assisted suicide for the first time, the former Liberal member for Winnipeg Centre, Robert-Falcon Ouellette, spoke about the impacts that he believed this would have on indigenous communities.

One of the overarching themes from his speech was that by allowing suicide to become a way out of suffering, we are encouraging a spirit of death in indigenous communities. Rather than telling indigenous peoples that if they are suffering their lives are no longer of value, we should first improve the conditions of their lives and help them carry their burdens.

It is hard to know where to begin with fixing the government's plan for assisted suicide. Bill C-7 rapidly expands the framework of MAID, at a rate never seen before. In this effort, the government has ignored its own framework set in Bill C-14 and the advice of hundreds, and even thousands, of medical professionals.

Where is the expansion of palliative care and other support? How long before we go even further in offering assisted death without first better providing people assisted life?

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

Madam Speaker, I find this debate very emotional. These are life-and-death circumstances that we are talking about, and there is a finality to this. When somebody dies, they have died. They are not coming back.

I believe that we need to balance personal autonomy with the protection of vulnerable people. A concern that I have is in regard to palliative care, and even its advocates. If somebody is a vulnerable person, maybe they have no family and maybe they have no friends. Maybe they have a disability and have been admitted to a hospital or are living in a long-term care facility. It is very troubling to me that MAID could be offered and nobody would be there to advocate for them. It is very concerning to me that it could be proposed.

Could the member talk about palliative care, and how we need more access? There was no five-year review from the previous legislation. Could the member comment on the need for more palliative care across Canada, and especially in rural and remote regions?

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Madam Speaker, palliative care is such an important part of our society and we are lacking greatly in that area. In particular, I grew up in a rural and remote community as well and there was just not the option for palliative care there. People were moving out of their communities, out of their homes and away from their families. Quite honestly, families are the primary caregivers whom people need and want to have with them when they are in palliative care, but they also need access to those facilities. I find it so alarming that here we are, today, prioritizing medical assistance in dying instead of prioritizing palliative care in the country.

[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, during the debate on this important issue, we often hear reference to palliative care and how critically important that is. It is encouraging, to a certain degree, to hear the Conservatives talk about why we need to enhance and ensure we have an extensive palliative care system.

What role does the member believe the federal government has in looking at ways we can improve and expand palliative care in Canada? Does the Conservative Party believe we should be playing a stronger role in that?

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Madam Speaker, the first thing we need to do is listen to the advocates for palliative care. They have very compelling testimony for enhanced and expanded palliative care. We also need to ensure that we work hand in hand with the provinces. The federal government has a role to play, particularly in ensuring that the infrastructure for palliative care facilities can be built in our small towns and rural and remote communities and ensuring that people of all communities have access to quality palliative care.

[Caroline Desbiens, Bloc, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Madam Speaker, I believe that what we are doing is admirable, since these are major issues of life or death.

I commend everyone here today. What they are putting forward is very well reasoned and carefully contemplated. Personally, I like to connect with people. What concerns me about this prolonged debated is time. I know that we must take our time with an issue like this, but we must also rely on what we have learned.

Our society is highly educated. Our scientists are up to date. In our society we have the ability to get the tools we need to do things properly. I want to ask you, are you questioning the abilities of our leading scientists, our doctors and our experts in medical assistance in dying?

[The Assistant Deputy Speaker, Carol Hughes]

I would remind the hon. member to address the Chair.

The hon. member for Cypress Hills—Grasslands.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Madam Speaker, I am not one to doubt scientists and people who have committed their life to their field. However, what we are missing is prioritizing people's right to live, their right to life. We are missing that as we have this discussion today.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, I am really honoured to be standing in the House as we debate this very important bill, Bill C-7, in response to the Truchon v. the Attorney General of Canada.

My husband and I were discussing this last night. I can recall the night of the vote on Bill C-14. I had held town halls in my riding, sent post cards, all these different things. It was about a fifty-fifty split among constituents who wanted to see MAID pass. That day I voted for that bill. I thought there were some very important provisions in it which we had to talk about. However, as we move forward with Bill C-7, I have strong concerns.

I decided to return to the speech I made in 2016, and I wanted to share an excerpt of it. We have been going back to people's speeches to see where they were at that time. I am pretty much where I was in 2016 with respect to better safeguards. I will quote from my speech on May 20, 2016:

My role as a parliamentarian is to do the fact-finding, speaking to the constituents I represent, and making sure that I get the right message to make this decision and do what is right for my constituency and all Canadians. From that, I decided to do a lot of town halls ... I sent letters ... one-on-one meetings ... I also received many email ... campaigns.

After that, I received a letter from Dr. Carroll Harder, a physician in my riding. I want to share her from 2016 email. She wrote:

I am e-mailing in response to your letter I received requesting information on my concerns about Bill C-14. Thank you for requesting physician input. I certainly appreciate having the opportunity to weigh-in as a stakeholder in these decisions. This topic is obviously very important to me and I am trying to understand all of the implications of this for me and for my patients.

I appreciate the steps that have been put in place to provide checks and balances that will hopefully prevent abuse of this system by family or health care providers. I am concerned that many groups are calling for less restrictions than those that are currently in place dictating who applies for this and who is ineligible. I would ask that you, as our representative, continue to advocate for stringent restrictions with multiple layers of accountability to prevent abuse of this legislation.

Based on that foundation, I started to look at Bill C-7. I have watched the hours and hours of committee business. Excellent amendments were proposed but were turned down. I thought my vote would be yes, but I have turned it into a no. I have not been swayed by the government and I have not been swayed by anything other than those disability groups that are very concerned about the bill. Then I go back to where I was in 2016. The point is that our job is to protect all Canadians. Our job is to represent Canadians.

What I see in the bill just does not fit. When I look at what the doctor has requested and at all the testimony from the justice committee, I do not think we are doing due justice. Tomorrow we will be celebrating International Day for Persons with Disabilities. We are not doing them justice. We are not listening to them and that is why I have this huge concern.

Unfortunately, because these amendments were left out of the bill, I have changed my vote to no. We had a great opportunity to make this a better bill in committee.

I take all these social issues to heart. I speak to people and they help make these decisions. I think about a gentleman whom I just spoke to on Saturday, Rick Arkell. I recall speaking to Rick years and years ago when I was constituency assistant working for Joe Preston. I recall him calling the office. When I spoke to him on Saturday, he said he wanted MAID.

I know that when I voted on Bill C-14 and made that decision to support, it was the right decision. However, when he and I talked about this, he too understood why I could not move forward on this. This gentleman has multiple complications such as diabetes and heart issues. When combined, they are making his life very difficult. I asked him if he could please send me some more information because I wanted to share his story. This story is not about people who do not want it; it is about people who do want, but ensuring precautions are there.

Instead of his being upset with me for saying I was going to vote against it, he asked how he could help because he knew we wanted better legislation. It comes down to that.

This is a very sad story. As I spoke to him on Saturday, I was not sure what my next steps were. I was not sure if I should go over there and try to counsel him or if I should be a parliamentarian and just ensure that the legislation was right. I am still caught on that.

For a number of years he has been trying to get medical assistance in dying under Bill C-14. This is his email:

“My euthanasia target is 60 days or less. I value and respect your point, however, I most assuredly am not going to enjoy the summer or any time thereafter and God willing, I will be dead in six months or less, whether by MAID, naturally or do it yourself. I have taken 250,000 milligrams of acetaminophen prior to our meeting as I did with Dr. Kay, thinking of the tears, groaning, crying in pain, stumbling and face plants, which were not necessary in fact, not to mention I was attempting to demonstrate that I can live independently. I do the same any day. I go out in public, appointments, shopping, etc. As I mentioned, I am not seeking immediate death since I am working to get my affairs in order as quickly as possible and to find homes for my cats. In order to do that, I need to remain independent. In the interim, I am seeking ways to cope such as I showed you. I still definitely want to seek assurance and peace of mind that MAID approval would provide.”

It is really interesting because we are talking today about witnesses and all those different things that are necessary to ensure people can go through this process.

We talked about palliative care. I am watching this man who is suffering, who does not have an option because palliative care is not available. We can sit here and say that MAID is very different. MAID is different if people cannot get it and do not have palliative care. That is why people say let us go for MAID because there is nothing better.

We just heard it from my friend from Port Moody—Coquitlam. She talked about someone who was willing to go through MAID rather than being in lockdown any longer. Those are huge concerns and we need to listen to that. These are people's stories. We need good legislation and we do not need to put them at more risk. That is what I see in the bill.

When we have had disabilities groups come forward, when the Senate, under a pre-committee study, has 91 different people testifying against this legislation, that should tell us something. It is not one or two people from specific groups who are talking. They are Canadians and Canadian families that are bringing forward their personal stories on what they go through each and every day. We are not making this right. By making MAID a better program so people can get it easier is one thing. However, we should ensure we have a full program that allows choice. I am fearful that this does not offer choice. It offers a choice to take MAID or to live uncomfortably. When I look at Rick, I think this is what is happening to him.

I am also very fortunate because I represent the great organization ARCH. ARCH is located in the community of Lambeth in London. It wrote to senators, and I want to leave members with this:

Dear Senators,

ARCH Disability Law Centre (“ARCH”) makes this submission as part of your pre-study of Bill C-7 – An Act to amend the Criminal Code (medical assistance in dying).

ARCH is a legal clinic dedicated to defending and advancing the rights of persons with disabilities in Ontario. ARCH also advocates for the rights of persons with disabilities nationally and internationally. ARCH has expertise in Canadian human rights and equality rights law as it relates to persons with disabilities, national and provincial accessibility laws...

I recognize that I do not have a lot of time, so I will sum this up. ARCH is extremely concerned with this. It put forward concerns because it was looking at effective safeguards, which it does not see in the bill. It is clear to me that if people are telling us that this is not going to work for them, and there is a whole lot of them, then we should start listening. That is why I am concerned with the government moving forward with the legislation without including the amendments that have been put forward. It is not doing what is best for Canadians.

I will continue to encourage the government to please think again. Do what is best for all Canadians and let us put the interests of all Canadians first.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Madam Speaker, we know that part of the fear and anxiety for people in the disability community, who oftentimes are living in poverty and without the resources they need to live in dignity, is that they are going to be faced with a really impossible choice between a life of poverty and suffering or a premature death. While Parliament cannot change the Truchon decision, one of the things we can do is put in place appropriate income supports for people living with disabilities so they are not forced to live below the poverty line.

Would the member support the federal government moving to establish a disability income support program that would ensure that any person living with a disability in Canada would not forced to live below the poverty line?

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, I think this is one of the things we see. As I indicated, I was a constituency assistant for 11 years, so I had the opportunity to see a lot of Canadians who were on the Ontario disability support program, had benefits through WSIB or had Canada pension plan disability benefits. This is not a lot of money.

We know that the cost of living has increased substantially, especially through the COVID-19 pandemic, so this needs to be reassessed. Lots of people are living without the means to have a proper roof over their heads, while paying their bills, putting food on their tables and enjoying life.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I thank my colleague for always telling us about what the people in her riding are talking about.

With respect to this legislation, I wonder if she could talk about the people in long-term care, who have been very isolated in this pandemic. I want to pick up on the theme that my colleague from Coquitlam—Port Coquitlam mentioned about the dangers there, as people like them might want to take advantage of assisted suicide.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, that is one of the concerns we are seeing. We know there have been many challenges during this pandemic, specifically with mental health and people who are in isolation.

I can look within my own family. My parents are not in long-term care but they are 80 and 84. I worry about their isolation within their own home, given the fact that they are not leaving their home very often. I think my mom has left twice in the last eight months. I can only imagine what it is like for residents in long-term care homes, where people are not able to come in to see them. They are not able to see their grandchildren. A lot of times, the spark of their lives is their family.

We have to work urgently to make sure we are dealing with rapid testing for COVID-19 and make sure that all of the supports for people living with disabilities or in long-term care homes are taken care of. We need to do better, and I am afraid we are not doing it under the government.