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

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I want to come back to what was just said.

I do not know if my colleague agrees with me that there is a fundamental difference between palliative care and medical assistance in dying. Palliative care is provided through the health care system. If we want better palliative care, I think that the best way to get there is to provide the health care funding that the provinces want. We know that in the past, both the Liberals and the Conservatives slashed health care funding.

Does my colleague agree that if we want better palliative care, then we need better health care funding?

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

Mr. Speaker, I completely agree with my colleague from the Bloc Québécois. We must increase the level of service in the public health care system while also amending the Criminal Code to improve access to medical assistance in dying.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Mr. Speaker, I am glad my colleague brought up the history of Bill C-14 in the previous Parliament and the concerns that she and all of us in the NDP share. This bill did not match the findings of the court decision that brought us to deal with that.

The member did mention the 90-day period and I am wondering if she can expand on that. What does she think this is for? People are in intolerable suffering and asking them to wait another three months seems to be not right.

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

Mr. Speaker, in my analysis of Bill C-14, which may be right or wrong, it seemed to me the country's doctors were in a discussion and dispute with the country's lawyers. The lawyers were looking at it from the point of view of what the courts require of us and the doctors were saying they were not sure how they wanted to administer it. At that point, I think we let down individual human beings across Canada. I do not think we should do it again. I think the 90-day period is an arbitrary bureaucratic response to trying to find the balance points between those competing interests. What we should always be thinking about and what should be paramount is respecting the rights of individual Canadians at the point they are in irremediable suffering as confirmed by their physicians.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, this is the second time I have had the opportunity to speak to this legislation, Bill C-7, an act to amend the Criminal Code, medical assistance in dying, due to the Liberals proroguing Parliament. Unfortunately, my earlier concerns, such as the legislation going above and beyond the Superior Court of Quebec decision, have not been remedied. I was also on the justice committee when this was being dealt with before.

I have long believed the place for drafting legislation is in Parliament so I will not criticize the government for tabling this legislation. My critique of the government is it is using the Superior Court of Quebec decision to make other amendments to Bill C-14 instead of using the automatic five-year review to do so, which was spoken about here earlier.

No one better understands the reasons why this legislation is needed to respond to the Quebec Superior Court decision than the current Liberal Minister of Justice. In the previous Parliament, he voted against his own government's legislation because he foresaw that a court would strike down the previous provisions as he felt they were too rigid.

The member for Vancouver Granville, the then former minister of justice who drafted Bill C-14 at the time, was aware of this criticism and spoke directly to that issue in her opening remarks at the justice committee back in May 2016. She said, “In terms of eligibility, I am aware of the requirements that a person's natural death be 'reasonably foreseeable' has received some attention, including in terms of how it relates to the Carter decision. I would like to address these concerns.”

She went on to say that, “A person can be approaching a natural death based on medical circumstances that are not directly related to a serious, incurable illness. As well, eligibility does not depend on a person having a given amount of time remaining, such as a certain number of weeks or months to live, as in the United States.”

It was clear from her remarks she felt Bill C-14, the predecessor to this bill, struck the right balance.

As we are all too aware, there are always unique situations where the law cannot accurately predict every scenario. The former minister of justice understood the complexities and challenges the families, doctors and patients were going to face with this new MAID regime. She went to say at committee:

Reasonable foreseeability of death is ultimately a medical decision, and not a legal one, to be made by taking into account all of the person's medical circumstances, including the types and number of medical conditions, frailty, age, etc..... By defining the term “grievous and irremediable medical condition”, the bill would ensure that all competent adults who are in an irreversible decline while on a path toward their death would be able to choose a peaceful, medically assisted death, whether or not they suffer from a fatal or terminal condition.

The word that has caused considerable consternation with both individuals seeking MAID and their doctors is “competent”. As with many illnesses, the drugs needed to either treat or provide comfort can impede one's competencies. This will be an important issue as it relates to the legislation as the government is creating a process for advance requests for persons newly diagnosed with a condition that could affect their decision-making capacity in the future.

As Jane Philpott, the former health minister, said when drafting the original MAID legislation in 2016:

We faced similar challenges in considering the issue of advance directives. The Supreme Court did not deal with this issue in Carter, and the views of Canadians and stakeholders, as you know, are divided. I understand the hardship for those Canadians who fear that after being diagnosed with a disease such as dementia they may experience a decline that could compromise their dignity. This has led to pleas to allow people to make requests for medical assistance in dying well in advance of the time when the person is no longer competent to make or reaffirm a desire to accelerate their own death.

While I agree, I also agree that once this legislation is referred to the justice committee it would be prudent to revisit this issue with medical professionals who are experts on Alzheimer's and dementia-related illnesses.

We must bring in families and those who understand these types of illnesses so we can think through as many scenarios as possible. I would prefer Parliament get this right rather than a court striking down the legislation in the future as it could lead to the situation we find ourselves in today.

The other issue I want to touch on stems from the Truchon decision. The Superior Court of Quebec struck down Bill C-14's provision that death had to be reasonably foreseeable. One could argue the government should have appealed the superior court decision, as we have spoken about in other speeches and questions tonight. It would not be an unusual step as the Government of Canada appeals all sorts of lower court decisions.

While I was not expected to be consulted on the government's response to the Truchon case, there has been very little public discussion from the Liberals about the likelihood of prevailing at the Supreme Court. My only question would be this. If the government did appeal to the Supreme Court, could it have gotten a more limited and narrow ruling on the implications of deleting the reasonably foreseeable clause?

By completely removing this clause, even with a new set of safeguards, it will expand the list of people who might be eligible for MAID rather than just dealing with the specific concern raised in the Truchon case. The very reason the reasonably foreseeable clause was put in the original legislation was that the former ministers wanted a balance between personal autonomy and the protection of the vulnerable.

Obviously the Superior Court of Quebec did not approve of the balance the Liberals sought in Bill C-14. However, in response, we must be mindful of the unintended consequences of this legislation. I know every member of Parliament has been contacted by their constituents about the implications of removing reasonably foreseeable criteria.

There are varying degrees of concern, ranging from moral and ethical grounds to concerns about the role of the state in sanctioning MAID for individuals who are doing so out of the lack of proper palliative care services. The government has decided in this bill to continue to allow doctors and individuals to decide what constitutes a grievous and irremediable medical condition rather than provide a prescriptive list of eligibility criteria. As someone who believes in individual rights and in the judgment of medical experts, I agree with this approach. My only concern is that we have left it too vague.

The government could have eliminated the reasonably foreseeable clause and replaced the original criteria with something that would be deemed constitutional rather than what we have before us today. There are those with apprehensions that proceeding this way will lead to situations where individuals will seek MAID and even be able to proceed for reasons no one in Parliament intended it to. I, for one, would like to see the law as written and intended by the drafters be carried out accordingly.

That is one of my concerns that must be answered fully before we pass the legislation and send it to the Senate. While the legislation explicitly states that having a mental illness is not a serious and incurable illness, disease or disability, we must be prepared to withstand that court challenge.

To refer back to the 2016 debate on MAID, Jane Philpott, at the justice committee, said, “There is no denying that mental illness can cause profound suffering. However, illnesses such as chronic depression, cognitive disorders and schizophrenia raise particular concerns with respect to the matter of informed decision making.”

It goes without saying that there are deep divisions on the overall issue of MAID. What we find in this bill goes much further than deleting and replacing the phrase “reasonably foreseeable” in order to be compliant with the recent court decision. For example, the government is using safeguards which, I might add, is the actual language found within the presentation with which department officials briefed MPs. As it stands, patients must make a written request for MAID that is witnessed by two independent witnesses. In Bill C-7, this would be changed to one independent witness. I believe it is incumbent on the government to justify this change and outline the rationale why it needed to be amended.

Last, the government is also be removing the mandatory 10-day period after the written request is signed. Once again, this is a significant change that goes above and beyond what was required to be in compliance with the Superior Court of Quebec decision.

I have listened closely to the concerns of constituents about the bill, I support it going to committee for scrutiny and clarity. I want government to know I am committed to working with them constructively on the legislation.

[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, I appreciate the comments and concerns expressed by the member opposite. On the reasonably foreseeable clause, because of the decision of the Superior Court of Quebec, we find ourselves having to bring forward this legislation. However, when we brought in Bill C-14, there was this expectation from parliamentarians that changes would be on the horizon, that the debate did not stop when the bill passed in June 2016. Ongoing dialogue had taken place and some of that dialogue is reflected equally in the feedback we received in January from some 300,000 Canadians.

Would the member not agree that if we are opening the door at this point in time, it only makes sense to look at other things that could be done to improve the legislation overall.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, that is exactly what I was referring to when I said I would work collaboratively to try to improve this legislation. I know there were ongoing opportunities for change in Bill C-14 when it came up and went to committee.

My colleague has also forgotten that there was a five-year review which the government could have done a lot more with this past summer. We could have looked at a lot of the issues such as the 10-day issue versus the 90-day issue that my colleague from Saanich—Gulf Islands spoke of earlier. There is a real opportunity for improvements to be made in the bill and that review process, which was more or less forgotten, was one of those opportunities.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I thank my colleague for his speech.

I would also like to come back to the concept of reasonably foreseeable death. I think that this concept is problematic because, according to many health specialists, there is no foreseeable death for people who suffer from a degenerative disease. However, a person with a degenerative disease eventually loses the ability to provide informed consent. Consider, for example, people with Alzheimer's and related cognitive disorders.

Does my colleague not think that we should listen to the experts so we can improve the legislative process? The ones I heard from were of the opinion that this notion of reasonably foreseeable death is problematic. Does he agree with me?

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, I referred to that in my presentation. We need to get it to committee and bring experts forward, including doctors, people in the medical field and legal professions as well, so we get the legislation right and so it will withstand any kind of court challenges, as I referred to in my speech.

In answer to the member's question, I strongly believe we need to get it right this time, and we have the opportunity here to do that. It is a good opportunity for us to look at the types of circumstances around not just the 10-day area, but also on the other sections of foreseeable issues that were looked at in the bill.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Mr. Speaker, a wise person, John Wooden, once said, “If you don't have time to do it right, when will you have time to do it over?” The debate today is a perfect example of that.

Back in 2015, we were working against time to pass legislation, and now we have heard the hon. parliamentary secretary say this on a couple of occasions, and particularly this last time, that they found themselves having to bring forward this legislation because of a court judgment, because they did not get it right the first time. Here we are again, racing against time.

What the government could have done was challenge that ruling and heard from the Supreme Court in its wisdom. In parallel with that, we could have had a parliamentary committee study it, as mandated by the previous legislation, and we would have had a shot to get this right. Maybe the hon. member could speak to the importance of due process in getting legislation right.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, the member's question is so pertinent to the debate we are having on Bill C-7. It is an opportunity to get improvements to Bill C-14 and we need the opportunity to do that. Due process is what Parliament is all about and we need to have that opportunity in the House.

On the issues of grievous and irremediable medical conditions, as I said in my speech, we could have had an opportunity to put more definition into some of these issues. The foreseeable issues were just another one of those areas where we could have had more definition.

[Adam van Koeverden, Liberal, Parliamentary Secretary to the Minister of Diversity and Inclusion and Youth and to the Minister of Canadian Heritage (Sport)]

Mr. Speaker, it is an honour to stand in the House of Commons and participate in the second reading debate on Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

In developing these amendments, Canadians were widely consulted in January 2020. During these consultations, approximately 300,000 Canadians completed an online questionnaire. In addition, the Minister of Justice and Attorney General of Canada, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion met with experts and stakeholders in Halifax, Montreal, Toronto, Vancouver, Calgary, Winnipeg, Ottawa and Quebec City to discuss proposed revisions to Canada's medical assistance in dying framework. These experts and stakeholders included doctors, nurses, legal experts, national indigenous organizations and representatives from the disability community.

The high level of participation in both the questionnaire and the in-person sessions is a reflection of the importance of this issue to Canadians. Moreover, the results of consultations were critically important in shaping our government's approach to medically assisted dying as it evolves to reflect the needs of Canadians.

The bill would amend the Criminal Code to allow medical assistance in dying for people who wish to access a medically assisted death whether their natural death is reasonably foreseeable or not. The bill would remove the reasonable foreseeability of natural death from the list of eligibility criteria. It would also expressly exclude people seeking medical assistance in dying solely because of mental illness.

The bill proposes a two-track approach based on whether a person's natural death is reasonably foreseeable. Existing safeguards remain and are used for people whose death is reasonably foreseeable. In addition, new and modified safeguards would be applied to eligible persons whose death is not reasonably foreseeable.

In the spirit of “nothing without us”, I would like to mention that our government remains focused on addressing the concerns of the disability community around vulnerability and choice. The proposed changes to the legislation supports greater autonomy and freedom of choice for eligible persons who wish to pursue a medically assisted death. At the same time, full consideration has been given to the protection of vulnerable persons and to respecting the equality rights and dignity of persons with a disability.

In short, the bill maintains and strengthens safeguards to support fully informed decision-making while also respecting individual autonomy. The bill would allow people who risk losing decision-making capacity to make arrangements with their practitioners to receive medically assisted dying on their chosen date even if they lose the decision-making capacity before that date. The bill would also make advance consent invalid if the person demonstrates refusal or resistance to the administration of medically assisted dying.

In addition, the bill would allow eligible persons who choose to self-administer to provide advance consent or for a physician to administer if self-administration fails and causes them to lose capacity. This type of advance consent would be available for eligible persons regardless of their prognosis.

I would also like to take a moment to speak to the progress our government has made with respect to the rights of persons with disabilities in Canada.

Last year, we enacted the Accessible Canada Act, which aims to create a barrier-free Canada through the proactive identification, removal and prevention of barriers to accessibility wherever Canadians interact within areas under federal jurisdiction. The act is one of the most significant advancements in disability rights since the charter in 1982 and is designed to inspire a cultural transformation toward disability inclusion and accessibility in Canada.

Knowing that I do not have that much time left, I would say that members of my community as well as members of my family and members of the greater Parkinson's and Alzheimer's community have been very vociferous on this issue, and both of those diseases affect people in my family. I am strongly in favour of the bill passing as quickly as possible.

The House resumed from October 19 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.

[The Speaker, Anthony Rota]

Before continuing, I wish to inform the House that because of the deferred recorded divisions, Government Orders will be extended by 81 minutes.

[Adam van Koeverden, Liberal, Parliamentary Secretary to the Minister of Diversity and Inclusion and Youth and to the Minister of Canadian Heritage (Sport)]

Mr. Speaker, it is an honour to virtually join the debate in the House of Commons and participate in the second reading debate on Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

I will take a moment to speak to the progress that our government has made with respect to the rights of persons with disabilities in Canada.

Last year, we enacted the Accessible Canada Act, which aims to create a barrier-free Canada through the proactive identification, removal and prevention of barriers to accessibility wherever Canadians interact with areas under federal jurisdiction.

The act is one of the most significant advancements in disability rights since the charter in 1982 and it is designed to inspire a cultural transformation toward disability inclusion and accessibility in Canada. The act created Accessibility Standards Canada, an organization that will create and revise accessibility standards and support and promote innovative accessibility research. The CEO and board of directors were appointed and the operations began last summer.

That act also established National AccessAbility Week, a week dedicated to accessibility in late May and early June each year. National AccessAbility Week is an opportunity to promote inclusion and accessibility in communities and workplaces and to celebrate the contributions of Canadians with disabilities. It is also a time to recognize the efforts of individuals, communities and workplaces that are actively removing barriers to give Canadians of all abilities a better chance to succeed.

Our government is taking real action to address the rights of persons with a disability. The careful writing of Bill C-7 is a testament to that. Representatives of disability organizations and leading disability scholars participated in consultations across the country and their input informed the reforms proposed in this bill.

We recognize that disability inclusion requires more than legislation and that is why we are continuing to work with the disability community and stakeholders to address stigma and bias. It is important to bring about cultural change to ensure that the important contributions made to Canada by persons with a disability are recognized and valued on the same basis as other Canadians.

Going forward, we will continue to focus on improving the social and economic inclusion of persons with a disability. This means moving forward with our commitment to build on the progress we have made over the past months and years with the development of a disability inclusion plan. This disability inclusion plan would include important initiatives like a new Canadian disability benefit modelled after the GIS for seniors, a robust employment strategy for Canadians with disabilities and a better process to determine eligibility for government programs and benefits. We all benefit when everyone can participate equally in our economy and society.

We will continue to work hard to ensure that every person in Canada is treated with the dignity and respect they deserve, especially when it comes to the deep and personal issue; that is ending one's life. It is imperative that the voices of all Canadians, including persons with a disability, continue to be heard on the issue of medical assistance in dying.