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

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Mr. Speaker, I would like to bring my colleague back to the very beginning, when we began this discussion in the previous Parliament and, remarkably, got a bill through.

I know it is hard to achieve perfection, but I am encouraged by the fact that a five-year review is in place. Does the member realize that there are many opposing views on this? We have heard them all. We are not working with underlying motives. We are working toward a good result for Canadians. Would the member agree with that?

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Mr. Speaker, I would agree. I must say I have grown and evolved around this issue. That is why I feel I can understand both perspectives on this issue. I have been very pleased in hearing the debate so far.

We have struck the right balance, but I understand why those who would want us to go further certainly would want us to do so. I can also appreciate the perspective of people who would want us to hold back a little.

It is not perfect, as my hon. colleague from the Hamilton area has said. However, we will not let perfection become the enemy of the good. We have a fair compromise that strikes the right balance.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, I am pleased to join the debate. The last several speakers raised some excellent points. It is good to see members bring different perspectives to this debate, and I hope to achieve that as well tonight.

I would like to say broadly at the outset that, in a binary world where one must say they are either in favour or not in favour of the availability of medical assistance in dying for people who are adults, mentally competent, grievously and irremediably ill and suffering cruelly from intolerable pain and anguish, I support the availability of assistance in dying for those people.

However, this bill and few bills we would consider in the House are as simple as a binary choice between two poles. Although we have had all kinds of different perspectives on this, the nuances and the details of this bill, as well as the bill that preceded it, Bill C-14, are very important. I enjoy these types of debates where we hear these points of view and can hopefully improve a bill before it is passed, if it is indeed the will of this Parliament to pass the bill.

I have ordinarily been highly critical of the government on a host of issues. I will take advantage of this moment to say that although there was much consternation to get to the final vote that occurred on Bill C-14 in the previous Parliament, there was something in that process that brought out what is good in Parliament. At that time, we had a lot of different perspectives on that bill. We had a bill that was tabled and amended. It was amended in this chamber. It had committee amendments, many of them, that were brought back and voted on by different parties, and we saw members of the Liberals' side who did not agree with their government for a variety of reasons. There were members, including me, who ultimately at third reading did vote with the government to support it.

That is what Parliament should do. It should bring out vigorous debate that really gets to the heart of an issue in order to have good legislation. I thought Bill C-14, at the time, was a reasonable, limited change to criminal law in Canada to both comply with the Carter decision and establish the availability of medical assistance in dying. Credit also should go to members who are no longer a part of the government: the member for Vancouver Granville, who was the minister of justice at the time; and Jane Philpott, who was the minister of health and who showed leadership at that time in debating Bill C-14.

The bill before us today was introduced ostensibly to deal with the Truchon decision and the Quebec superior court's striking down of the reasonable foreseeability phrase from Bill C-14. In this bill, the government has chosen to address other issues at this time. As has been pointed out, there was to be a five-year review, per the previous bill, that should have occurred this summer. I understand the crisis we are in, but let us also not forget we have a government that prorogued the House and prevented the House from examining critical legislation and issues that face Canadians.

The timing of the bill puts us up against something of a deadline looming in December over the Truchon decision, and here we are. December is not very far away when we talk about all the different stages a bill must go through to do it right, to allow all voices to be heard and to allow all members of Parliament to represent their constituents on this.

The bill introduces a few changes beyond addressing the reasonable foreseeability. I am not going to get into the details of that, because time is pressing. However, like most MPs, I have received a lot of correspondence and phone calls from the disability community and concerned citizens who have real reservations about any expansion of medical assistance in dying.

Some have argued from the point of view of a slippery slope and are concerned: Once changes are adopted, what comes after them? I understand the sincerity of these concerns. However, we have to examine the bill for what it says and what it does rather than what people might project into it.

Prior to the adoption of Bill C-14, I had four major concerns regarding medical assistance in dying: first, the assurance that quality palliative care be available to persons considering medical assistance in dying; second, strong safeguards for vulnerable Canadians, such as minors, the mentally ill and the disabled; third, the conscience protection for medical practitioners; and fourth, any changes that would expand the availability of medical assistance in dying be well considered, well thought out, carefully drafted and not rushed.

I share many of the concerns raised by members of the disability community, but we have to deal with this issue and not forget the broader purpose of ensuring the availability of medical assistance in dying. It is not merely to comply with court rulings. We must do this out of a sense of compassion for adults who are grievously ill, intolerably suffering and are of sound mind, and who, of their own free will and volition, wish to obtain medical assistance in dying.

I would not support the bill if I thought it was a clear threat to disabled Canadians or if the bill would lead us into a path where medical assistance in dying is offered as an alternative to palliative care or an alternative to treatment. I do not see that in the bill as is. Recalling the experience of Bill C-14, I assume that the bill will be thoroughly studied and that the committee, after it hears testimony from experts and concerned Canadians, will bring amendments back to the House that may offer better assurance to the disabled community and others.

I am inclined to see the bill go forward as far as committee so that we can have a robust, thorough examination of the bill, and so that as parliamentarians, we can do our legislative jobs to ensure that the best bill possible is brought back to Parliament. I look forward to that and assume that we will have this debate.

I am still a little concerned, though. My colleague from Hull—Aylmer mentioned the five-year review and that a committee hearing would constitute that review. This is what it sounded like he was saying, and this does not seem to be in the spirit of what was passed by the House in Bill C-14. However, there is clearly much work to do in this area, and I hope we will have time for a robust, full and proper hearing of the bill at committee so that when the bill comes back to the chamber at third reading, it will give assurances to those who have raised concerns about medical assistance in dying, in particular to the disabled community.

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

Mr. Speaker, I thank my hon. colleague for participating in the debate and for his speech, which is very much appreciated.

I take it that he will vote in favour of the bill. I know that some of his colleagues may be opposed to the bill. However, I will not directly mention the Conservative members who will be voting against this bill.

I learned that 52 religious groups have launched a coordinated campaign against Bill C-7.

It is called “Religious Leaders in Canada oppose Bill C-7”.

Fifty-two religious groups are opposed to the bill.

They include Canadian Assemblies of God, Canadian Conference of Catholic Bishops, Evangelical Free Church of Canada and Canadian Baptists of Western Canada.

There are 48 other groups that are also against it.

I just want to ask my colleague if he believes that the religious principles of some people should be set aside when it is a matter of respecting the choice of all Canadians.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, one of the four major concerns I have about the notion of medical assistance in dying relates to the conscience protection for practitioners. I think what the member was drilling to in the question is making sure that the conscience of professionals in the medical field is protected. I support wholeheartedly groups that have this concern. That is one of the main areas of concern I have with the bill.

I certainly recognize that there are very strong feelings on the bill all around. The responsibility of this Parliament is to try to get it right, satisfy the judgments that have already been delivered and get a bill that, broadly speaking—

[The Deputy Speaker, Bruce Stanton]

The hon. member for Saanich—Gulf Islands.

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

Mr. Speaker, I want to commend my hon. colleague from Calgary Rocky Ridge for a thoughtful speech that did not fall into the trap of partisanship. This is a very difficult issue, and having been part of the debates in Parliament since the first version of medical assistance in dying came forward, I have been taken with how we as a chamber have approached the issue respectfully from all sides.

This is a comment; I am not putting a question to my hon. colleague, so he can amplify his points. I am deeply grateful that he is drawing a line where he does not see evidence of moving into an area that would put people with disabilities at risk or moving into an area that would make him uncomfortable. This does more than make sure we are within the law and respecting the rights of individuals who legitimately need medical assistance in dying.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, I thank the member for her comments, but I do have these concerns that members of the disability community have raised. It is critical to me, before I vote at third reading in support of the bill, that the protections for the disabled community remain, that we do not enter into scenarios where medical assistance in dying is foisted on somebody and that this will remain merely for those who seek it as a result of grievous cruelty and suffering from an irremediable condition.

[Martin Shields, Conservative, Bow River, AB]

Mr. Speaker, I think this has to do with the sense of a court deadline. Our Parliament is constructing legislation. We are working on it. I refuse to accept the idea of being blackmailed into not doing a full and thorough review. We did not do one with Bill C-14. I think the courts would fully understand.

Would my colleague respond to this deadline, which is really blackmailing us into a rush?

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, the hon. member for Bow River makes a great point, and I did touch on the review in my speech.

The committee hearing on the bill is not a substitute for the fulsome review that was promised in Bill C-14. I am concerned about the rushed timeline, and I identified in my remarks that for the bill to be fully supported at third reading, things must be done properly. It has to be drafted and worded carefully and thoughtfully, following a proper and robust consultation by the appropriate parliamentary committee.

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

Mr. Speaker, it is interesting that the last question has brought us to the issue of urgency and why this is pressing.

We had this bill before us in the spring, before we adjourned and before COVID-19 took over our parliamentary process. We now have the process, for which I am grateful to all parties, that allows us to debate controversial legislation, to have votes at a distance, to respect the threat of COVID-19 and to protect public health.

When debating this bill before we adjourned, I was getting emails in the House from one of my best friends, who was dying of ALS. She asked me if there was any chance we would make changes to the bill for advance directives in time to help her. I deeply regret that we were unable to get this bill passed last spring, when my friend, Angela Rickman, could have benefited from access to medical assistance in dying. She died in a situation of suffering that would have been her wish to avoid. Now, as we debate this, a member of my own family is wondering whether we can get this bill through quickly enough so that they are not put in the impossible situation that Audrey Parker found herself in. I will reflect further on Audrey Parker later.

There is urgency, whether driven by courts or by compassion. We know as legislators, as our friend from Beaches—East York just commented a few speeches ago, that we have, at this point, repeatedly passed legislation that did not meet the judicial thresholds and frameworks that have been set before us in order to ensure that the legislation we pass on medical assistance in dying meets previous court decisions. I know everybody is deeply affected by their own constituents, their own personal experiences and their frameworks of religious traditions or lack thereof, but I hope we all come to this with open hearts, recognizing that this is a crucially important issue, one that I hope our Parliament will handle better than we have in the past. Let us make sure we pass legislation that does meet the constitutional requirements that have been put before us, if for no other reason than making sure we do not have to continually return to improve our legislation. Ensuring it meets the bar that was set for us by our courts has to be paramount.

I happen to come from a constituency where, overwhelmingly, constituents have wanted to see medical assistance in dying legalized for many years. My colleagues in the chamber and watching remotely will remember the name Sue Rodriguez. Sue Rodriguez was a resident in my constituency, in North Saanich. Her first effort, which was, of course, the case she brought forward, was the first time the Supreme Court of Canada ruled, by a very narrow margin, that medical assistance in dying would not be allowed in Canada. That was back in 1993, and it was by a vote of five to four that the Supreme Court denied her final wish. She was able to access illegal assistance from a doctor who remains unknown, but God bless him, and she achieved medical assistance in her own death in February 1994. It was not a situation we would want any of our loved ones to find themselves in, unable to find the help legally and choosing to find someone willing to help otherwise.

The next set of cases, of course, bring us to more recent cases, the ones we talk about in Parliament today, and particularly the one that brought us to Bill C-14 in the previous Parliament, brought forward after the 2015 election. The names of the ministers who were involved have been referenced several times: the hon. member for Vancouver Granville and, of course, the former minister of health, Jane Philpott.

I lamented then, in this place, that the Carter decision of the Supreme Court of Canada was not being respected fully in the legislation that we were debating. I was able, in clause by clause consideration at committee, to bring forward amendments, which were rejected there, to do away with the requirement that someone be capable and competent on the day of the procedure to confirm their desire for medical assistance in dying.

It is that requirement that drove Audrey Parker to have to get medical assistance in dying before the moment she really wanted to, for fear that she would be unable to provide that consent through the vagaries of the disease or the pain-killing drugs. We know Audrey Parker's story. It was related to us today earlier by the current member for Markham—Stouffville and by the member for Dartmouth—Cole Harbour, who knows the Audrey Parker story well.

She died November 1, 2018, nearly two years ago, saying that this Parliament had let her down through the requirement that she be competent the day of the procedure to confirm that it was, indeed, her wish. This was impractical. Even as we worked in Parliament on Bill C-14, we knew from the language in the Carter decision of the Supreme Court of Canada that this was a violation of patients' constitutional rights.

When the bill got to the Senate, I was very pleased that the amendments I put forward in clause by clause, which had been rejected in the House, were taken up and approved by the Senate. However, as we will recall, when the bill came back from the Senate, the government rejected the amendments to deal with ensuring that people would have access to medical assistance in dying and to deny patients access to an advance directive. Predictably, here we are.

As many of us argued in Parliament in the first round of debates on Bill C-14 on medical assistance in dying, we were not, as a Parliament, passing legislation that was likely to survive a court challenge. There was not much prescience or crystal ball-gazing to know it. We knew it if we read our legislation and compared it to the reasoning in the Carter decision. Here we are now with a new decision, the Truchon decision from the Quebec Superior Court, and we are going back to amend the legislation.

What we are doing, of course, is making sure that people in a situation where they do face a terminal illness and their doctors know that they cannot survive this illness will be able to access an advance directive. Again this was the Carter decision. The Carter decision was full square about facing irremediable suffering and accessing medical assistance in dying. Clearly in this legislation, we have said mental illness is not going to be covered, that mental health issues will not be considered an illness that can be considered irremediable in the context of this legislation. We will very likely have to come back and revisit that.

Certainly, as this legislation goes forward from this vote at second reading to committee, I hope we will find a way to amend the legislation to remove the 90-day timeline around assessing someone's irremediable state of suffering. I support what the member for Beaches—East York has said on this. It does not appear at all to be a humane decision or within what the courts have already told us to insist on that 90-day period.

There are some things that have been argued today in this House that I want to draw attention to because I would hate for Canadians to think that this bill was as cavalier as some would have us believe. Some have said that this bill would allow for “death on demand”. That was one phrase used by one hon. colleague. It's important to know that the bill says quite the contrary.

One of my friends in the House said this bill does not make any effort to allow someone to change their mind the day of the procedure. I urge colleagues to look at subclause (3.1)(d). It is very clear. They should also look at subclauses (3.2), (3.4) and (3.5). Throughout the bill, there are many points at which it is very clear that people have the ability to say, and doctors have the requirement to verify that people have the ability, even on an advance directive, to subsequently change their minds. That is a very clear set of provisions in the legislation, as I said, particularly under subclause (3). To clarify again, in subclause (3.1)(d), it is very clear that one has to ensure that people have been informed that they may, at any time and in any manner, withdraw their request. That is the context throughout this bill.

I know my time is at an end. I just want to say that I support this bill and I hope we pass it as quickly as possible. People are suffering and they want us to act.

[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]

Mr. Speaker, it is important for us to recognize that back in 2015, shortly after the election, one of the challenges we had was to come up with new legislation dealing with medical assistance in dying. There was a general feeling that, yes, here we are at this particular point, but we will have to make some changes. Today, that is exactly what we are doing, but it is primarily being driven because of a court decision in the province of Quebec.

Could the member provide further thoughts in regard to the dropping of the 10-day waiting period for people who are near death?

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

Mr. Speaker, the legislation is clear that nothing happens in the blink of an eye. A lot of consideration must be given to the situation of each individual patient. The medical experts engaged must have specific knowledge of whatever particular irremediable condition is being raised. The question of eliminating a 10-day waiting period is not to make it on demand. There are still very significant stipulations and requirements that must be assessed and considered in advance of accepting that it is a case for medical assistance in dying.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Mr. Speaker, like a lot of members of Parliament, I consulted my constituents extensively on Bill C-7. One area of commonality everyone seemed to share was that the Government of Canada, we collectively as legislators, can do more for people to have more options when they reach a period in their life when death is foreseeable.

What would the member say about providing more supports for palliative care to give people that option? In many communities across Canada, we know that option just is not there.

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

Mr. Speaker, it is not either-or, but it is absolutely the case that we need to do far more. The provision of health care is provincial, but the federal government has responsibilities under the Canada Health Act and there is, of course, federal-provincial cost-sharing around health care.

We should make it a priority that we improve access to palliative care across Canada. I completely agree. I resist when I hear some of my hon. colleagues suggesting that the government has a preference for pushing people toward medical assistance in dying. That is not the case. That needs to be understood. We need both.