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

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

Mr. Speaker, as parliamentarians it is incumbent upon us to draft responsible legislation that protects the sanctity of life, protects those contemplating suicide and protects vulnerable peoples. These are principles that were outlined in the preamble to Bill C-14, the landmark legislation that governs assisted dying in this country. These are principles that, although largely restated in Bill C-7, are being watered down and undermined by this legislation.

As recently as the early 1990s, in the landmark Rodriguez case, the court ruled that there was no constitutional right to assisted dying in this country. The Carter decision overruled that previous decision, and now Parliament has the difficult task of balancing the autonomy of Canadians with our responsibility to create safeguards for vulnerable Canadians. It is one of our most sacred responsibilities to protect the lives of our citizens. We need to get laws on assisted dying right.

The adoption of medical assistance in dying after the 2015 election is an event I am very familiar with. I had the honour of serving under the member for St. Albert—Edmonton as he took the lead as the Conservative vice-chair of the Special Joint Committee on Physician-Assisted Dying. During this time, I was involved in all aspects of the committee that was making recommendations on a new law. I heard from all the witnesses, and I listened to all deliberations regarding what direction our country should take.

That committee recommended a radical departure with very few safeguards. These recommendations did not reflect the testimony of experts, but instead the political agenda of special interests.

The Conservative minority report provided at the joint committee was entrenched firmly in the principles of the Supreme Court's decision in Carter, and included recommendations that were laid out by key witnesses, such as the former president of the Canadian Psychiatric Association, Dr. Karandeep Sonu Gaind. It outlined key principles for us on the issue of physician-assisted dying.

These included not accepting the provision that assistance in dying be provided to those under the age of 18, in line with the Carter decision, which stated that only competent adults should be allowed access to assisted dying. We also did not accept the extension of medical assistance in dying for those suffering exclusively from mental illnesses. We did not believe that any mental illness is irremediable, as the Canadian Psychiatric Association stated.

We also did not believe in the validity of advance directives to allow Canadians to consent to an assisted death far in advance of its administration. This change would stand opposed to the express will of the Supreme Court of Canada, which ruled that consent must be contemporaneous with the time of death.

We also recognized the lessons of the Quebec experience, as the first jurisdiction in this country to legalize euthanasia. In its regime, medical assistance in dying could only be rendered on adults with a severe, incurable physical illness, characterized by an advanced state of irreversible decline.

I believe many Canadians can sympathize with this limited exception for assistance in dying; however, even these safeguards have proved to be short-lived. Barely five years later, the courts and the government have decided that these safeguards are far too restrictive.

How did we get here today? Barely had the ink dried on Bill C-14 before proponents of expanded assisted dying launched their campaign to eliminate necessary safeguards.

As a Conservative who strongly believes in the sanctity of human life, Bill C-14 was a difficult pill to swallow. However, it was one that I believed upheld many of the values that I hold and the values that many of my constituents hold.

The previous legislation recognized that we must tread carefully with this new reality of assisted dying. It introduced safeguards that limited mature minors, those with exclusively mental illnesses and those whose deaths were not reasonably foreseeable.

I believe this is where the majority of Canadians are, and I believe the government largely got the balance right under Bill C-14. Unfortunately, there are a radical, vocal few who want to undermine even these protections and push this country headlong into a permissive regime for assisted dying, a regime that, as we know from international experience, has resulted in the deaths of vulnerable people.

If we continue to go down this road and liberalize all safeguards, we will continue to see mistakes and deliberate actions that end the lives of vulnerable people. This new legislation outlined in Bill C-7, although not taking these large, radical steps that I outlined, is opening the door to a wider radical departure from principles like the protection of the vulnerable and the sanctity of human life.

I am particularly concerned about the inclusion of the term and policy of advance consent.

The Supreme Court of Canada was very clear, crystal clear, that an assisted death should only be administered with the consent of a person at the time of death. We know that there are some cases where people fear losing their capacity to end their lives. However, we cannot allow the precedent of advance consent to gain legitimacy in our system. Advance consent in this legislation I believe is a Trojan horse designed to build the legal case to accept the adoption of advance directives.

Advance directives are a concept by which people can direct the actions of medical professionals after they have ceased to have the capacity to consent to an assisted death. Many Canadians are familiar with DNRs: do-not-resuscitate orders. DNRs are a completely ethical and morally acceptable practice, whereby a patient can designate that no action should be taken to attempt resuscitation. By respecting the will of the patient and not acting, medical professionals are allowing the patient to die a natural death. Medical professionals can also hasten the natural death of their patient through pain remediation. I believe this is also an acceptable practice.

I support do-not-resuscitate orders, and I think many Canadians are being deliberately misled into believing that an advance directive is the moral and ethical equivalent of a DNR. It is not. An advance directive does not ask medical professionals to withhold action allowing a natural death. It requires medical professionals to take direct action to immediately end the life of the patient.

This is a leap in practice that goes far beyond what I believe is ethical. It undermines one of the greatest medical principles: first, do no harm. I can imagine, in a not-so-distant future, someone with dementia or Alzheimer's who had previously written an advance directive, believing that life would be not worth living with this disease. Imagine in the future that we had the medical expertise and the breakthrough pharmaceuticals that could make life better for those suffering. How can someone consent to have life end without contemporaneous consent at the time of death, when they cannot know what their quality of life will be?

It introduces a high level of subjectivity to the question about what kind of life is a life worth living. This is a dangerous question that will lead us down a lethal road, a road that I do not think anyone wants to go down today. I believe it is unethical and dangerous to allow someone's life to be ended by an advance directive or consent, even with the meagre protections offered in Bill C-7, which includes a provision that no resistance be shown. There is still a threat of abuse. If people are unable to understand and consent to death, how are they supposed to know to resist when someone comes to administer their death?

Parliament is being rushed into liberalizing a practice that is not even half a decade old. Its members lack the experience, the data and the moral understanding to press forward with such a life-and-death issue. I am disappointed that the government abdicated its responsibility to stand up for vulnerable people when it chose not even to appeal the Quebec court's decision to the Supreme Court of Canada. What better court to clarify what safeguards are acceptable than the very court that originally dealt with these significant matters?

Instead, the government has given Parliament little time to contemplate such an important issue. Canadians are still catching up to the reality of assisted dying being legal in this country, and now we are foolishly pressing forward before we can fully understand the impacts of this legalization.

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

Mr. Speaker, I rise today to address Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

Assisted dying is the leading moral and ethical issue of our time. Previously respected traditions supporting the sanctity of all human life until natural death have been tossed aside, most recently with the Supreme Court's decision in the landmark Carter case.

As parliamentarians, it is incumbent upon us to draft responsible legislation that protects the sanctity of life, protects those contemplating suicide and protects vulnerable peoples. These are principles outlined in the preamble to Bill C-14, the landmark legislation that governs assisted dying in this country. These are principles, although restated largely in Bill C-7, that are being watered down and undermined by this legislation.

As recently as the early 1990s, the Supreme Court ruled in the Rodriguez case that there was no constitutional right to assisted dying in this country. The Carter decision overruled that previous decision, and now Parliament has been tasked to take on the difficult task of balancing the autonomy of Canadians with protecting vulnerable people.

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.

Alleged Premature Disclosure of Private Member's Bill

[Rob Moore, Conservative, Fundy Royal, NB]

Mr. Speaker, the hon. member mentioned that he did not want to waste the time of the House, yet he went on, when we are debating medical assistance in dying, on a question of privilege about a private member's bill. I would point him back to earlier this week when the entire contents of Bill C-7, medical assistance in dying, was in a CP story the morning before the bill was introduced. This is just for his reference.

Criminal Code

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, it gives me great pleasure to once again rise in this House and speak to Bill C-7, an act to amend the Criminal Code (medical assistance in dying). This bill proposes amendments to the Criminal Code provisions on medical assistance in dying, or MAID, in response to the Superior Court of Québec Truchon decision, which struck down the eligibility criterion that natural death be reasonably foreseeable.

I would like to highlight five major components that stood out for me.

First, it repeals the condition that a person's natural death be reasonably foreseeable, with the exception of patients whose sole underlying condition is mental health issues.

Second, it introduces new safeguards in addition to existing ones for patients whose natural death is not reasonably foreseeable.

Third, it permits the waiver of the requirement for final consent, allowing patients to provide consent to health care practitioners in advance, in the event that their death is naturally foreseeable and they are at risk of losing capacity to consent.

Fourth, it permits the waiver of the requirement for final consent if a patient chooses MAID by self-administration, in case complications arise following self-administration, such as a loss of capacity.

Fifth, it modifies the MAID monitoring regime to require that health care providers and pharmacy technicians provide regulated information when assessing a patient's eligibility or when dispensing a substance for MAID.

Over the last two days, many of my colleagues from both sides of this House intervened on a fair number of details. It gives me great pleasure to see that there is broad agreement that this legislation, with these amendments, gets voted in and move to the committee for further study.

I rose in this House during the 42nd Parliament back in 2016, and shared my experience, which dealt with the tragic loss of my father as a result of stage 4 cancer back in 2014. Such assistance was not available to us and we saw the loss of dignity. We saw the loss of the person I called “my hero” losing the capacity to be able to function and lead our family, as well as the fact that his desire would have been met, had we had this type of assistance available.

Also, as the chair of the all-party mental health caucus, I have been advocating, and our caucus has been advocating, for the consideration of mental health and the exclusion of that. I am pleased to see that that remains.

As I was listening attentively to the interventions over the last two days, at times there were questions raised about why it took so long. Considering that, and considering that we are almost halfway through this debate, I decided to focus my intervention mainly on the journey that our government has gone through over the last four years. The key concepts within that journey are the challenges that we are faced with; the stakeholders that we engaged with; the consultations during the studies; and the implementation, successes and challenges we have had.

Having said that, since the introduction of the legislation for medical assistance in dying in 2016, we have witnessed a steady increase in the number of Canadians and health care providers who have adopted this new regime. We have seen a relatively smooth integration of MAID assessments and delivery in end-of-life care service available across the country.

The enactment of this historic legislation was just the beginning of our efforts. Our government has since been very active in supporting the implementation of MAID across Canada. The 2016 legislation included clear directives for action, including the need for government to initiate independent reviews on three complex issues not addressed in the bill back in 2016. Some of my colleagues before me touched on those complex issues.

Rather than proceed too hastily, Parliament felt that it required more study and a review of available evidence. The government tasked the Council of Canadian Academies with undertaking these studies and that is where the journey started.

The resulting report tabled in Parliament in 2018 reflected an extensive review of academic and policy research, stakeholder submissions and international expertise in all three areas. It documented a range of perspectives from health care professionals, academic disciplines, advocacy groups and indigenous leaders; hence, the stakeholders that we have engaged with. We expect dialogue on these issues to continue during the parliamentary review and, as I have indicated, I hope that everyone in the House votes for this so that we can move it to committee and continue this dialogue.

Taking into account our federal system and division of responsibility for health care and criminal law, the federal government developed the monitoring and reporting regime to collect valuable information about requests for and the provision of MAID. In all other jurisdictions permitting assisted dying, there is an oversight and monitoring mechanism in place. The roles and responsibilities of these monitoring regimes vary.

In the wake of this monumental shift toward legalized assisted dying, Canadians wanted to know what kind of uptake there would be. Some were keen to know how accessible MAID would be across this vast country. Others want to know how safeguards would be applied and if there were protections in place for the vulnerable. Our government worked quickly with the provinces and territories to establish an interim reporting system, collecting and reporting on the best data available.

I want to acknowledge our provincial and territorial partners that had the challenging task of arranging safe access to MAID services from scratch, in a short period of time and in collaboration with multiple partners, such as health care providers, professional associations and health care delivery institutions. This tremendous task involved setting standards of practice for physicians, nurse practitioners and pharmacists to support the consistent and safe delivery of MAID within a legally sound framework. It also helped minimize the disparity to access in rural and urban areas.

Our government produced four interim reports using data voluntarily transferred by providers and various jurisdictions from 2016 until the creation of the permanent regime in late 2018. These reports covered a six-month period and provided information on the number of MAID deaths, patient demographic information, underlying medical conditions and predicted MAID requests.

In reviewing these reports, we know that the awareness of MAID as a legal option is growing. There appears to be a growing comfort among health care providers. In the interim period, our government worked to establish a permanent national monitoring and reporting system as considered in Bill C-14.

Through stakeholder consultation and collaboration with provinces and territories, the government enacted federal monitoring regulations in late 2018. These regulations set out the reporting requirements for all physicians, nurse practitioners and pharmacists who participate in MAID. We were mindful of balancing the need for information while limiting the reporting burden on health care providers and avoiding duplication of effort. This system has been operating for just over a year. Late this spring, our government plans to release the first annual report using data from this new monitoring system.

Budget 2017 announced $11 billion over 10 years to support home and community care services, including palliative care, mental health and addiction services; $6 billion was specifically allocated to those services I talked about. In 2019, our government worked with all the provinces and territories to develop the framework for palliative care in Canada, which I consider a cornerstone of this bill.

Over the last three and half years that MAID has been available, our government has worked to support a smooth integration into the health care system based on the foundation I have just laid out. On the evidence that we have gathered, we have put together a bill that represents the Truchon decision and addresses other issues where there is clear consensus and a reasonable path forward. It is my hope that, after due consideration and debate, we move this bill to committee.

I will close by saying that I support this bill and I thank all members for intervening on this topic.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, I am here today to talk to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

It is very interesting for me to be here in a new Parliament discussing something we spoke about in the last Parliament. I was a fairly new member when Bill C-14 was before the House. I had a lot of constituents calling my office, sending letters and emailing us on this very important issue. I spent a lot of hours responding to people, talking to them on the phone and hearing their stories. What I really respected was the thoughtfulness. There were concerns of course, which is legitimate, but there was a lot of hope for some people as well.

Here we are back at it again. It reminds me of a dear friend and loved one who used MAID in his journey. His name was Joey. When I think of the core issue and value we are discussing today, which for me is unnecessary suffering, I cannot help but think of Joey.

Joey had an illness that was slowly killing him. In fact, it was so painful for him that he made this decision. He rearranged his time of death so I could be there with him, which was a huge honour for me. I was so grateful for that.

I think about the process we went through together that day. It was a beautiful process, but it was also a hard process. Part of the reason why it was so hard was he could not take any of his pain medication that day. He had to be totally able to answer that question. After a lot of thoughtful discussion, he had to stay in pain all day. We spent the day with him, but it was hard to see him suffering.

When we look at the bill before us today, that is what I hope all Canadians and all parliamentarians remember. We are here ensure nobody goes through unnecessary suffering like that.

One of the things that really struck me about the day when Joey passed was his doctor came to be part of the process. His doctor had made a decision that he did not want to be in a role to administer MAID, but he came. There were a lot of tears and remembrance of the long-term relationship. We also have to talk about the length of time some of our doctors have known us. Some have known us for years in some cases, and in Joey's case that was the reality. Another doctor was there for the process, but Joey's doctor was with him. His loved ones were around him. It was a peaceful process when he left us.

Today we are here to do this important work. I hope this goes to committee. I have had discussions with doctors in my riding who administer this process and they have a lot of good things to say about the bill, as well as some concerns they would like addressed, and I hope that will happen.

As this process started, a lot of people started writing my office again. We did some outreach. We wanted to let people know that this would be coming up. We wanted them to know that there was a process for them to connect with us and give their feedback to the government on this issue. A lot of my constituents participated in the process online. Not only did they participate, they were very thoughtful to ensure that the information they submitted was also given to my office. In front of me, I have a small portion of the comments from the people who sent us information and shared their stories.

I want to be clear about something, and we have to remember this as we go through the legislation. I represent a rural and remote community. The doctors who provide this service sometimes spend the whole day travelling to the community to provide this very important service.

There are some specific barriers and we want to ensure that in all our legislation we do not let those people in rural and remote communities down.

There are three of these doctors in my region. The riding I represent is just under 60,000 square kilometres, it has several ferries and many small islands. The doctors in that area provide the total service for that area plus a portion of my neighbour's riding. They deliver the service to a huge number of people over a vast distance.

Message after message thanked those doctors. In fact, Dr. Daws, a doctor in my riding, was mentioned repeatedly for being compassionate and for helping people go through this process in a very respectful way. People wrote me before they were going to participate in MAID. They just wanted tell me that this doctor had been very helpful.

I want to recognize the amazing health care providers in our country who provide this service, who do it in a sensitive and beautiful way. They are with people at one of the most precious moments.

I want to talk about Margaret who told us about her nephew. Her nephew had participated in MAID and that this was his decision. The biggest issue for her was the lack of the advance consent clause. He was given a choice of either going through this process two months earlier or not at all. Due to the medication he would have to take for his illness, it would automatically disqualify him from having the capacity to provide the consent.

This is the biggest issue for me, because people were having to leave sooner than they wanted to because they were afraid they would lose the capacity to give their consent.

I think of Megan who wrote about the experience her family went through. They were present for a friend's death. She said:

I fully support the idea of giving prior consent for MAID in case one is unable to give that consent immediately prior to the procedure, or in case one is in considerable pain and discomfort and would go through the process more calmly with adequate pain control at the end.

This really resonated with my experience with Joey, watching him suffer physically, and waiting for the relief. It was really hard. This is so important as we go through this process.

I think about Dolores, who sent me a beautiful message about ensuring the process was clear for people, wanting to have the accessibility to this be very clear and easy, and in an information package. Her biggest concern was that her family physician did not believe in this process and would not give her the information she needed to make the decision. She said that it would be good to have an information package that was a little more effective, so when a doctor was struggling with that personal choice, it would not impact the patient.

As a parliamentarian, these are the moments when I really respect the role I have on a whole new level, when people are telling me about the precious experiences they have had in their lives.

Another family talked about its father-in-law who spent seven years with dementia and was very well cared for, but in his last year, he rapidly deteriorated. His dignity plummeted. A loving son said that he was convinced that if he could have projected how his final years of deterioration would happen, he would have chosen MAID as an option, if it was available to him.

Then there is Milt whose wife is in a care home. Because of her Alzheimer's, she will not be able to express herself. He is so concerned that she will suffer way too long and he does not want to see that.

Another family talked about a friend who had cancer of the brain. Then she had a stroke. After her stroke, she was concerned that if she had a second stroke, she would be unable to state her wishes. Because of that, she participated in MAID sooner than she would have wanted.

This is a precious decision people make. It is a decision they make with their loved ones and their health professionals. I will be supporting the bill because I do not believe in people suffering unnecessarily. There are some challenges in the bill that I hope are clarified, especially looking at the realities for rural and remote communities. However, when people tell these personal stories, we hear again and again that they do not want to see people suffer, that they do not want to see people lose their dignity and that they want to ensure their wishes are honoured.

I am happy to be here to talk to the bill. I want to thank all of my constituents who have reached out to me. I always appreciate these beautiful stories that people share and some of the hard ones.

[Kamal Khera, Liberal, Parliamentary Secretary to the Minister of International Development]

Mr. Speaker, it is an honour to rise in this House to speak today about Bill C-7. This bill would amend the medical assistance in dying regime in the Criminal Code to address the Superior Court of Québec's decision in the Truchon case. As members know, in September 2019, the Quebec Superior Court struck down the eligibility criterion of “reasonably foreseeable natural death” from the medical assistance in dying, or MAID, regime in the Criminal Code. Our government has made significant efforts to consult and engage with Canadians in order to inform the proposed approach to address this decision and amend the MAID regime in Canada.

An online consultation was launched, and over 300,000 responses were received from Canadians. 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 had the opportunity, along with their parliamentary secretaries, to meet with stakeholders and experts across the country during a series of round tables all over Canada. These consultations were an extremely important part of the development of Bill C-7.

Medical assistance in dying is a sensitive and challenging social issue that we are currently faced with, one that is deeply personal for very many people and for me personally. I worked as an oncology nurse at St. Joseph's hospital in Toronto and have seen end-of-life care first-hand. I have seen individuals making difficult end-of-life decisions for themselves or their loved ones, and I appreciate our government's decision to consult and listen carefully to Canadians on this issue.

In addition to being deeply personal, the issue of medical assistance in dying is also legally and ethically complex, which is why it was so important for our government to meet with experts, stakeholders and practitioners during the round tables. Our government listened. It listened to the health care experts, doctors, nurses, legal scholars and regulators, but most importantly, it listened to Canadians. The bill takes into account what was learned during these consultations and responds to the Truchon ruling by proposing amendments to the Criminal Code that would ensure consistency of the MAID law across the country by broadening eligibility, and adjusting the safeguards accordingly, for a MAID regime that is no longer limited to end-of-life circumstances.

Bill C-7 proposes to amend the Criminal Code in response to the Truchon ruling in three ways.

The first is by expanding eligibility to those whose natural death is not reasonably foreseeable but who are still experiencing intolerable suffering. This will give those who are suffering in a wider range of situations the choice of a medically assisted death.

At the same time, the amendments would exclude those suffering from only a mental illness. This is in response to very specific concerns voiced by experts and mental health professionals about eligibility on the basis of a mental illness. Many members will also recall that during the study of former Bill C-14, the government asked the Council of Canadian Academies to look into such cases. The experts in this field could not come to a consensus on this very complicated issue in their report on the subject, which was released and tabled in this chamber in December 2018.

Our government recognizes that the unique considerations for the availability of MAID for individuals experiencing suffering only from mental illness requires further discussion and public debate. I believe the parliamentary review that will begin in June 2020 is the appropriate forum for the further consultation and deliberation that are needed before considering any changes in this regard.

The second main feature of this bill is the creation of two sets of safeguards to be followed before medical assistance in dying is provided, depending on whether a person's natural death is reasonably foreseeable or not.

The bill would continue to use the expression “reasonably foreseeable natural death” as the element that determines which safeguards to use. This approach for a MAID request is consistent with the view that medical assistance in dying for people whose natural death is not reasonably foreseeable presents more complexity. Many experts believe that the assessment of a request should be tailored to these different types of cases.

New safeguards for those whose natural death is not reasonably foreseeable will focus on ensuring that assessments take adequate time and involve the relevant expertise to detect and address the sources of the person's suffering. They will also ensure that people receive information about the appropriate and available services and options to improve their quality of life. They will need to give serious consideration to those options before concluding that medical assistance in dying is the choice for them.

Finally, the bill would relax some of the existing safeguards, in particular for those whose natural death is reasonably foreseeable. Those whose deaths are reasonably foreseeable will not need to undergo the 10-day reflection period. These individuals have already given a lot of thought to their request before they made it, and requiring them to wait another 10 days after they have been approved for medical assistance in dying may prolong their suffering unnecessarily.

Just as importantly, the bill proposes to permit the requirement of final consent to be waived in the case of people whose natural death is reasonably foreseeable when certain conditions are met. These conditions are that the patient's death must be reasonably foreseeable; they must have been assessed and approved for medical assistance in dying in accordance with all safeguards; they are at risk of losing decision-making capacity before their preferred date to receive medical assistance in dying; and they have a written arrangement with their practitioner, in which they have given consent in advance to medical assistance in dying being administered if they lose capacity, and in which the practitioner agrees to provide medical assistance in dying on their preferred date, or earlier, if they can no longer provide the final consent.

These proposed amendments would also clarify that practitioners would not be allowed, in this situation, to provide medical assistance in dying if the patient demonstrates refusal or resistance by words, sounds or gestures.

For individuals whose natural death is not reasonably foreseeable, the remaining criteria defining the grievous and irremediable medical condition in the Criminal code would expand eligibility to medical assistance in dying to people with a wide range of conditions. A grievous and irremediable medical condition is defined in the code as a serious and incurable illness, disease or disability; an advanced state of irreversible decline in capacity; or intolerable suffering that cannot be alleviated under conditions that the person considers acceptable.

This means that a grievous and irremediable medical condition could include conditions producing chronic pain or other symptoms. Canada's medical assistance in dying regime would move away from being an end-of-life regime to becoming a regime in which MAID could be chosen to relieve unbearable suffering that occurs outside of the dying process.

To conclude, the bill before us today proposes the amendments required by the Truchon decision. It also reflects what we heard in 300,000 responses to the online consultation. This is what we heard from stakeholders when the ministers and parliamentary secretaries held consultations from coast to coast to coast. It takes into account the opinions and input of health care professionals, doctors, nurses, legal scholars, provincial regulators, civil society, non-governmental advocacy organizations and those with lived experiences. The bill strives to achieve a balance between respecting personal autonomy and protecting vulnerable individuals. Perhaps most importantly, it respects the equality rights of all Canadians.

For those reasons, I call on the members of the House to support this bill, send it to committee where it can be looked at even more thoroughly and make this a reality in Canada.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, today I rise to speak on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

My office has received about 135 phone calls, emails or letters so far on this issue, and I recognize that this is a very touchy, personal and non-partisan issue.

I will begin with a quick bit of history. The MAID legislation came into law in June 2016. Recently, one judge in Quebec ruled that the wording in the legislation on “foreseeable death” was too restrictive. The Liberal government was very quick to accept this ruling. It chose not to appeal, and instead moved to rewrite the legislation taking into account the decision of the court.

This caused me to compare this ruling to the recent Alberta court ruling in which four judges found the carbon tax to be unconstitutional. It made me wonder if the government is going to be as quick to accept the Alberta court ruling as well and not appeal it, but that is a digression.

As I said, MAID is a very touchy, personal and non-partisan issue. One can always find examples of people for whom MAID legislation is a difficult but welcome option. Unfortunately, those simple examples are usually in the minority. Far more often, it is much more complicated than that. The stories I have heard reflect these complications, such as the case where families are caught by surprise with a death and then forced to deal with the aftermath of that.

There are cases where a person is at a particularly low point in their health but, under this proposed legislation, would be able to request and receive MAID with no waiting period. There are cases where physicians or hospital officials apply pressure on individuals to consider MAID. For example, Roger Foley, an Ontario man who is suffering from an incurable neurological disease, said that the medical staff repeatedly offered him MAID, despite his repeated requests to live at home.

There is also the B.C. case of Ms. S. Dr. Wiebe lamented the profound suffering of Ms. S. but felt that Ms. S. was not eligible for an assisted death. Then, unfortunately, Ms. S. decided to starve herself. Dr. Wiebe and another doctor then determined that, due to the severe malnutrition and dehydration of Ms. S., her natural death was reasonably foreseeable, so Dr. Wiebe euthanized her on March 2017.

According to a Globe and Mail article, this case is the first to be made public in which a medical regulator has ruled on the contentious question of whether doctors should grant assisted death to patients who only satisfy all the criteria of the federal law after they have stopped eating and drinking.

It is not difficult to imagine a situation where a hospital will, for reasons of efficiency, encourage its staff to suggest MAID to patients with chronically difficult and complex cases. It is not a simple problem. It is a very complex problem.

What bothers me about this is that the government is pre-empting the parliamentary review process that was specified in the legislation. We know that the current justice minister voted against the party on the original legislation because he felt that it did not go far enough. Now, as justice minister, he is able to make the changes that he desired. This is troubling, because he is choosing to pre-empt the legislated review process and get his desired changes into legislation without consultation.

The existing law mandates the review of the legislation every five years, and the review will happen in just a few months.

Why is the government is such a rush to make substantive changes to this legislation and pre-empt the legislated review process?

To me, it makes far more sense to deal with the specific issue raised by the Quebec judge only, then do a proper consultation with Canadians this summer and propose changes based on that. Instead, the government had an extensive online survey that lasted two weeks. While it received a lot of responses, I think it just proves that there is great interest, and Canadians have a lot to say about this issue. So far, the results of these responses have not been shared, and I ask for these responses to be shared. I call on the government to do the right thing and leave any changes beyond what the Quebec judge has asked for until the completion of the review process later this year.

Since we are talking about changes to this legislation, I want to talk about palliative care. There are calls for a pan-Canadian strategy on palliative care. I think it is convenient to point to the provinces and say that this is their problem, but there cannot be a full end-of-life strategy without funds and laws around palliative care.

The government broke a key election promise to invest $3 billion in long-term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making.

I have a personal example from Saskatoon, which has 12 palliative care beds for an area with over 300,000 people.

My mother-in-law had a terminal disease. In her case, MAID was neither requested nor desired. She was fortunate in that her death was relatively quick, and by some miracle she was able to get one of those 12 beds in Saskatoon.

It should not take a miracle to get good end-of-life care. It should not be that MAID is the only reasonable solution at the end of life because palliative care is not available. Therefore, I call on the government to put as much effort into palliative care as it has into MAID.

Another significant area of concern is conscience protection. Physicians and health professionals must be given strong conscience rights. They must be free to not participate and be free of penalty or harassment for making that choice. They must also be free to not be required to refer to another health professional. They must have full conscience protection.

Further, it must be recognized that the conscience objection of institutions must be protected. Institutions are not bricks and mortar. They are collections of people with values. Therefore, institutions must also be given the right of conscience protection. Several Supreme Court cases are instructive here.

The Supreme Court in 2015, in the Loyola case, stated:

Religious freedom under the Charter must therefore account for the socially embedded nature of religious belief, and the deep linkages between this belief and its manifestation through communal institutions and traditions.

In another 2015 decision, the Supreme Court stated:

A neutral public space free from coercion, pressure and judgment on the part of public authorities in matters of spirituality is intended to protect every person’s freedom and dignity, and it helps preserve and promote the multicultural nature of Canadian society.

We must respect the multicultural nature of Canadian society. We must respect both medical professionals and institutions, and allow them to have full conscience protections free from harassment and consequences.

There are some specific changes proposed that I am concerned about. The current legislation includes a 10-day waiting period between when MAID is requested and when it can be administered. The current legislation already allows for this waiting period to be waived. It states that if two medical practitioners:

...are both of the opinion that the person's death, or the loss of their capacity to provide informed consent, is imminent—any shorter period that the first medical practitioner or nurse practitioner considers appropriate [can be used] in the circumstances.

There already is a provision to deal with this issue. There is no need to make changes. The situation has been contemplated and addressed in the current legislation.

Another area of concern is the lack of safeguards for the mentally ill. Mental illness is a very complex situation. Patients diagnosed with an underlying mental health challenge are not required to undergo a psychiatric assessment by a psychiatric professional to determine whether they have the capacity to consent.

There is no one-size-fits-all solution to the issues of mental health. However, it is not difficult to imagine a scenario in which a person is in a particularly dark period and considers MAID. It may well be that with proper professional help that person can work through the darkness and emerge a bit better. This may not always be the case, but that is why having a general waiting period is so important. It eliminates the ability of medical professionals or others to make a quick decision that they regret.

A poll in January found that Saskatchewan and Manitoba had the lowest support in the country for MAID. In 2018, in Saskatchewan, only 67 of 172 applicants for MAID actually received medically assisted death. Some were declined, some withdrew and some died before the request could be completed.

In summary, I would make the following observations. Most importantly, in the words of a constituent I spoke with this week, “We need to slow this down, not speed it up.” Yes, we need to deal with the Quebec court decision, but that only requires one change. There is a legislated review that will happen this summer.

Let us wait for a proper consultation and use that lens to view any proposed changes. Let us have a pan-Canadian strategy for palliative care. Let us put full conscience protection in place for physicians and health care professionals. Let us put conscience protection in place for institutions. Let us leave the 10-day waiting period and the ability to create exceptions the way it is. Let us deal with the Quebec court decision and leave the rest until after the legislated review this summer. Let us slow this down.

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

Mr. Speaker, I will be sharing my time today with my colleague, the member for Saskatoon West.

As a new member of the justice committee, I look forward to the issues that we will be dealing with in this new Parliament. While I am not a lawyer, nor do I have any desire to become one, I hope my contributions and insight on the issues of the day will help in rebuilding trust in our judicial system.

I am fully aware that many Canadians have serious concerns. Many are looking for solutions that will keep our communities safe, and they want us to begin the process of rebuilding the public's confidence in our justice system.

The legislation we are dealing with today is about one of those issues that almost every Canadian has heard of and will be, undoubtedly, following in the news. As a member of the Conservative caucus, I can debate this legislation and vote on it as I see fit. It is my intent to improve this legislation and to do the best I can in representing the good people of Brandon—Souris.

Like many Canadians, I find discussing the implications of medical assistance in dying challenging. There is no sugar-coating the fact that, for many people, it is extremely difficult to openly discuss the issue of death. As a result of the Carter decision, it was left up to Parliament in 2016 to determine the appropriate legislative response in order to be compliant with section 7 of the charter. It must also be said that the Carter decision was specifically limited to a competent adult who gave her consent in receiving medical assistance in dying.

When we were seized with dealing with the legislation, many members of Parliament felt the government's response did not go far enough. One of the Liberal MPs who voted against the legislation was none other than the Minister of Justice. Some members were quite concerned about the lack of clarity, such as in the term “reasonably foreseeable”, which was left undefined. Other members wanted Parliament to supersede the Carter decision.

Disagreement is not new in this place. It is to be expected in Parliament, with members from all political stripes and backgrounds. I would argue that our democracy is much better served having such divergent views as to guarantee that every position is fleshed out.

When we debated Bill C-14, our Conservative caucus studied the legislation with the rigour that Canadians demanded of us. We asked the tough questions, we put forward amendments and we did what we were sent here to do, which was to ensure the concerns of our constituents were put front and centre. It is my sincere hope that we once again invest the necessary time on this and be as inclusive as we can so that all Canadians have their say on Bill C-7.

It goes without saying that there are deep divisions on the overall issue of medical assistance in dying. I know every member of Parliament is hearing from constituents on this issue, and in the past couple of weeks numerous petitions have been sent to all members' offices. I would also note that in the election, I received inquiries on the future of the legislation and on whether Parliament would be reviewing it anytime soon.

One of the elements in the original legislation was to have an automatic review, which will be undertaken this summer. It is notable that the legislation now before us has pre-empted the automatic review on a few matters. This upcoming review will be far more comprehensive than the two-week online survey used for Bill C-7.

From what many were expecting, the legislation that was set to be introduced was to respond to the Superior Court of Québec's ruling. We now know that this is not the case. In fact, yesterday during debate, the parliamentary secretary of justice acknowledged that the Liberals did go above and beyond, because that is what he thinks Canadians want. While that may be his opinion, it is concerning that the larger changes found within Bill C-7 could have been dealt with in the larger review this summer.

What we are debating today has numerous changes that go 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 easing safeguards, which I might add is the actual language found within the presentation with which departmental 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 has been changed to one independent witness. I believe it is incumbent on the government to justify this change and to outline the rationale for why it needed to be amended. The government is also 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 for the law to be in compliance with the Quebec Superior Court decision.

It is my intent to invite as many experts, health care professionals and provincial governments to committee to ask them about the proposed changes and to determine if they are in fact needed. We must be cognizant that MAID still has the necessary safeguards in place to protect the vulnerable.

I want to put on the record that many of the issues we raised in the last Parliament, such as enshrining conscience legislation in law for medical practitioners, has fallen on deaf ears. This was an almost universal position among my Conservative colleagues, and the Liberal government of the day did not adopt those measures.

We were also quite adamant about improving access to palliative care. Even though the delivery of health care falls under the purview of provincial governments, we passed a private member's bill to implement an action plan. My colleague from Sarnia—Lambton, who worked hard to get this legislation passed, is very disappointed that the government's five-year action plan failed to commit enough resources or outline a clear set of measurable outcomes. In a rural riding like mine, there are not enough palliative care services available. My heart goes out to those families who must send loved ones to a different community in the final days of their lives.

As a champion of rural Canada, I know first-hand the unique challenges that millions of people face every day due to their isolation or remoteness. I want to give the benefit of the doubt to the government that it is committed to rural Canadians, but its record says something completely different. While these issues cannot be fixed in this legislation, we cannot treat them in isolation while discussing MAID.

In closing, I want the government to know I am committed to working with it constructively on this legislation. I will ensure that the concerns of my constituents are heard. We know there is nothing more precious than the gift of life: to live freely, to live safely and to live healthy and happily. It is our collective responsibility to do what we can to improve the quality of life of all Canadians.

I look forward to what my colleagues have to say on this legislation, and if it is sent to our justice committee, we will do our due diligence to listen to witnesses and improve it where possible.

[William Amos, Liberal, Parliamentary Secretary to Minister of Innovation]

Mr. Speaker, I will continue to speak to the report of the Council of Canadian Academies on the provision of medical assistance in dying to those struggling with mental illness.

The complexity of the issue is reflected in the fact that the members of the Council of Canadian Academies working group had vastly different opinions on the subject. On the one hand, the reports note that symptoms of mental disorder can impair cognitive abilities, making it more difficult to understand or appreciate the nature and consequences of treatment decisions.

The word “incurable” is not generally used by clinicians in the context of mental disorders, which makes it difficult to assess the condition of a person with “irremediable” health problems under the current legislation.

On the other hand, the report points out that the autonomy rights of an individual with a mental illness must be respected. The report cites the experiences of Belgium and the Netherlands, which permit assisted dying for psychiatric conditions, with additional safeguards. However, the report also acknowledges that assisted dying for persons with mental illnesses in these jurisdictions remains controversial, and the public debate is ongoing. Ultimately, the working group could not reach consensus on ways to address complexities and mitigate risks associated with mental illness and medical assistance in dying.

On the topic of advance requests, the Council of Canadian Academies report on advance requests also documents considerable evidence and provided many instructive findings on an issue of great interest and concern to many Canadians. Particularly in our riding, this was an issue I heard a lot about.

An advance request is a request for assisted dying made well in advance and in anticipation of the time when the person making the request may face suffering and other circumstances that may make them eligible for medical assistance in death. An advance request would set out conditions under which an individual requests MAID to be provided at a future date. Advance requests are premised on the likelihood that when people's health circumstances deteriorate to the point where they would want an assisted death, they would no longer have the capacity to affirm their decision immediately before receiving medical assistance in dying. In other words, that critical requirement of giving final consent would not be possible.

Many people express the desire to make an advance request so they have the comfort of knowing they will be able to avoid a lengthy period of grievous suffering for themselves and for their families. This is in the event they succumb to an illness that could leave them severely impaired and lacking cognitive capacity for a lengthy time period.

The CCA report helped unpack advance requests, in a way that really was helpful, by outlining several scenarios of increasing complexity. The first scenario involves an individual at the end of life who has been assessed as eligible for medical assistance in dying, but fears losing capacity while waiting to receive it. This is the situation experienced by Audrey Parker from Nova Scotia who chose to receive MAID earlier than she had wanted in fear of losing her eligibility status.

The second scenario involves an individual who has been diagnosed with a serious condition, but does not yet qualify for medical assistance in dying.

The third scenario involves an individual who wants to plan for various future outcomes, prior to any diagnosis.

The report indicated that when the request is farther in advance of the procedure, it becomes more challenging for health care providers to be certain that the request still reflects the wishes of the individual. The report found that the first scenario poses the least risk and is relatively straightforward. Canadians expressed a great deal of support for this scenario in the federal consultations and it is also widely supported by experts and practitioners.

Our proposed amendments in Bill C-7 would permit this type of advance request. This means that an individual who has a reasonably foreseeable natural death, and who is assessed and approved for medical assistance in dying, can wait for their chosen date without worrying about losing decision-making capacity. If the person does lose capacity prior to that date, they would still receive medical assistance in dying on the requested date or earlier, as expressed in their advance wish. It also means that individuals no longer need to reduce required pain medications and endure additional suffering in order to maintain their capacity to consent right before the procedure.

However, the other two scenarios, where significantly more time passes between preparing a request and medical assistance in dying provision, are far more complex and challenging.

I want to point out that we have definitely made movement on that first aspect. It is in those other two aspects where there is significantly more debate, and those need to be taken care of by Parliament in the coming months, which is exactly what this bill provides for.

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.

Business of the House

[Pablo Rodriguez, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, this afternoon, we will continue debate at second reading of Bill C-7 on medical assistance in dying.

Tomorrow will be an allotted day for the Conservative Party.

The House will then adjourn for one week, during which we will be in our ridings doing incredibly important work with our constituents.

Upon our return, we will deal with Bill C-4, an act to implement the agreement between Canada, the United States and Mexico, and Bill C-7, an act to amend the Criminal Code on medical assistance in dying.

Criminal Code

[William Amos, Liberal, Parliamentary Secretary to Minister of Innovation]

Madam Speaker, I am pleased to rise on the topic of Bill C-7, as we embark on what I expect will be quite a lively and passionate discussion about issues that Canadians care deeply about and certainly my Pontiac constituents. I heard from them for several years on this topic, regular correspondence, regular discussions at the door, so I appreciate this opportunity to discuss certain aspects of our government's proposed changes to the federal MAID legislation.

It is timely to share some of the insights from three important studies on very complex and sensitive issues that were not included in the 2016 federal legislation. These are requests by people for whom mental illness is their sole underlying medical condition, advance requests and requests by mature minors. I hope we will get to all three of them, but may only get to the first two.

When Bill C-14 was debated in 2016, parliamentarians had difficulty finding common ground on how to address these types of requests within Canada's first assisted dying regime. Understandably, given the challenging nature of these issues and the limited time that was available, due to the Supreme Court's timeline, to deliver on acceptable approaches for Canada, parliamentarians collectively decided that more in-depth study and review of the evidence was needed.

The legislation in 2016 therefore included requirements for the government to undertake independent reviews. There were strict timelines set out in Bill C-14 and the studies that needed to be commissioned had to be done within six months of the coming into force of Canada's new legislation on assisted dying and the government was obliged to table the final reports on the studies within a further two years. Both of these timelines were met.

In December 2016, the government asked the Council of Canadian Academies, CCA, an independent organization that undertakes evidence-based expert study, to inform our public policy development and to take on these studies that were required by legislation. The resulting reports were tabled in December 2018, documenting extensive review of academic and policy research, stakeholder submissions and international experience in the three subject areas.

They also included a broad range of perspectives from relevant health care professions, diverse academic disciplines, advocacy groups, indigenous elders, essentially the whole of Canadian perspective was brought to bear. In accordance with the CCA practice, they did not in fact contain recommendations.

Two of the reports, one on request by individuals where mental illness is the sole underlying condition and the report on advance requests have been particularly informative during the development of our government's response to the Quebec's Superior Court decision in Truchon.

I will first talk about mental illness. Under the current law, very few persons with mental illness as the primary source of their suffering are likely to be eligible for MAID. This is because most mental illnesses do not cause a person's natural death to be reasonably foreseeable.

Removing the reasonably foreseeable natural death criterion introduces the possibility for persons with mental illness to be deemed eligible for MAID, if they meet the remaining criteria.

During the recent federal round-table consultations held on MAID, we heard many concerns from participants who felt that not enough is known to safely extend eligibility for MAID to people whose suffering is caused by a mental illness alone. They felt that the issue required further examination.

We also know that there is generally very little support for expanding eligibility among mental health care practitioners, such as psychiatrists and psychologists, and by organizations representing people with mental illness. The CCA report on this issue noted a number of challenges associated with the delivery of MAID to persons with a mental illness.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, it is with great humility that I rise in the House today to speak to Bill C-7, an act to amend the Criminal Code with regard to medical assistance in dying.

Many MPs have very personal stories about the end of life of one of their loved ones. As the Bloc Québécois critic for seniors, it goes without saying that I have heard my share. Therefore, in my speech, I will recall the work done by the Bloc on this issue, the sensitivity that exists in Quebec regarding medical assistance in dying and, finally, the position of certain groups of seniors and women who have come to meet with me.

First, let me go over the context again. In September 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, both suffering from a serious degenerative disease, stating that one of the eligibility criteria for medical assistance in dying is too restrictive. This criterion, that of “reasonably foreseeable natural death”, is found in the federal government's Act to amend the Criminal Code and to make related amendments to other Acts with regard to medical assistance in dying, and the provincial government's Act respecting end-of-life care.

Justice Christine Baudouin said it well in her ruling when she wrote: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu’s rights to liberty and security, protected by section 7 of the Charter.” Those two individuals had argued that they were being denied medical assistance in dying because their deaths were not imminent.

Let me now remind the House of the Bloc Québécois's position and highlight the outstanding work of the member for Montcalm, to whom I offer my deepest sympathies. I want to thank him for the work he has done on this file because, as he quite rightly pointed out, legislators did not do their job properly with Bill C-14. As a result, issues of a social and political nature are being brought before the courts. We need to make sure that people who have serious, irreversible illnesses are not forced to go to court to access MAID. That would be terrible, and yet that is what will happen if we cannot figure out a way to cover degenerative cognitive diseases.

However, we believe that it is important to be very cautious before making any decisions on questions related to mental health. That is why we are relieved that the bill does not address eligibility for MAID for individuals suffering solely from a mental illness. Indeed, this issue requires further reflection, study and consultation, which will be completed at the Standing Committee on Health as soon as the motion moved by my colleague from Montcalm is adopted.

For the second part of my speech, I would like to talk about Quebec's sentiments on this whole issue. Quebec was the first jurisdiction in Canada to pass legislation on medical assistance in dying. Wanda Morris, a representative of a B.C. group that advocates for the right to die with dignity, pointed out that the committee studying the issue had the unanimous support of all the parties in the National Assembly. This should be a model for the rest of Canada.

Ms. Morris said she felt confident after seeing how it would work in Quebec and seeing that people were pleased to have the option of dying with dignity. The Quebec legislation, which was spearheaded by Véronique Hivon, was the result of years of research and consultation with physicians, patients and the public. It has been reported that 79% of Quebeckers support medical assistance in dying, compared to 68% in the rest of Canada.

In 2015, when the political parties in the National Assembly unanimously applauded the Supreme Court ruling on MAID, Véronique Hivon stated:

Today is truly a great day for people who are ill, for people who are at the end of their lives, for Quebec and for all Quebeckers who participated in...this profoundly democratic debate that the National Assembly had the courage to initiate in 2009....I believe that, collectively, Quebec has really paved the way, and we have done so in the best possible way, in a non-partisan, totally democratic way.

For the third part of my speech, I would like to tell you about a meeting I had with the Association féminine d'éducation et d'action sociale, or AFEAS, in my role as critic for seniors and status of women. During the meeting, the AFEAS shared with me its concerns with MAID. I will quote the AFEAS 2018-19 issue guide:

Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly....As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope....This process cannot be accessed by individuals who are not at the end of life....People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.

Many people are not eligible for MAID because of the federal law governing the practice, which was imposed by a court ruling in February 2015. Four years after Carter, individuals whose quality of life is severely compromised by degenerative diseases are still being forced to ask the courts for permission to end their suffering.

In February 2015, the Supreme Court even struck down two sections of the Criminal Code prohibiting Canadian doctors from administering MAID. In Carter, the highest court in the land stated that a competent adult who clearly consents to the termination of life is eligible for MAID if that person “has a grievous and irremediable medical condition...that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

According to the AFEAS, the Supreme Court's criteria were very broad. In drafting the MAID eligibility criteria, the Government of Canada included the concept of reasonably foreseeable natural death only for people at the end of life, which excludes a significant number of people who are experiencing intolerable physical and mental suffering.

The entire process is based on the intensity of the suffering as assessed by a doctor and a panel of experts. The sick person's own assessment is not always taken into account. There are no compassionate criteria among the requirements for obtaining MAID. A person may be at the end of their life and be unable to make the request themselves because they cannot communicate. The law applies only to people who are able to give their free and informed consent up until the very end, which could be terribly traumatic and even cruel to those who have been suffering for years.

With regard to advance consent, the AFEAS spoke about the case of Audrey Parker, a woman from Halifax who died with medical assistance on November 1, 2018. She made a video three days before her death. In that three-minute video, she said that she would like nothing more than to make it to Christmas, but that if she became incompetent along the way, she would lose out on her choice of a beautiful, peaceful and, best of all, pain-free death.

The Barreau du Québec believes that the law should be amended to comply with the criteria set out in Carter and thus prevent court challenges from being filed by people who should not have to carry such a burden.

A panel of experts has studied this issue and recommends, under certain conditions, ending the suffering of patients who have previously expressed their wish to receive medical assistance in dying, but who subsequently become incapable of expressing their consent, in particular people with various forms of dementia or cognitive loss such as Alzheimer's disease. This is why AFEAS is asking, with respect to human rights, that the process of medical assistance in dying be based more on the rights of individuals and on respect for their wishes.

With respect to reasonably foreseeable natural death, it requested that the reference to “reasonably foreseeable natural death” be removed from the eligibility criteria. With respect to advance consent, it asked that the person's informed consent be respected and that it be given in advance. Also on the subject of advance consent, it asked that the consent anticipated, stated and recorded by the person be recognized.

In conclusion, today's debate demonstrates the need to act so that people suffering from degenerative and incurable diseases are no longer forced to go before the courts to challenge the terms and conditions surrounding eligibility for medical assistance in dying, and so that we can ensure the best possible continuum of care.

Let's take action so that everyone can die with dignity.

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

Madam Speaker, Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying, is one that I believe was written with the intention of providing compassion to those who are suffering through an unfathomable, unbearable degree of pain by allowing a lawful, expedited termination of their suffering and granting access to a dignified death. The intention is kind. I see an urgency from the government to extend this expression of compassion to those who are suffering beyond comprehension.

However, from the perspective of a visionary and a lawmaker who cares for the long-term wellness and prosperity of our country, I would like to invite all members of the House to pause and bring into our dialogue the long-term effect of this bill and the impact of this bill on the guiding principles of lawmaking going forward.

I do not stand to speak on this bill with the moral authority of one who has reached a point of suffering equal to those who may be applying for MAID. I do not think most members of the House here have the personal experience to speak on that level. However, I do stand here to speak on this issue because there has been a force in my life that carried me through some very dark nights of the soul when adversity, pain and repeated cycles of injustice were poignant enough to wear down my will to fight and to try, sometimes causing me to question the value of my existence.

I have seen this force raise addicts, cancer patients and those experiencing deep depression from deep pits of psychological paralysis and darkness. This force transcends the distinctions of race, gender, socio-economic background, etc. It is almost as vital as life itself. It is a force that is central to the existence of the human race, and that force is called “hope”. While hope is easier to access for some than others, for others it may be almost impossible, because their painful experience is choking the light from their vision.

As caring individuals, as communities and as a nation that prides itself on compassion, it is our duty to turn over every stone to help others find hope when they can no longer access it themselves. Hope is a journey that demands an unrelenting search until it is found.

We saw it with Terry Fox. He is a national symbol of hope, because despite his painful struggle with cancer, he made the sacrifice he made with his cross-country campaign for cancer research because he was in search of hope and giving that hope to others. The story of his triumph over adversity, though his life was tragically truncated at such a young age, still continues to champion Canadians today, as Canadians respond by revering him as a national hero, because we value hope. We have seen the power of hope that compelled Terry to pass the finish line of his last breath.

We see hope whenever we see Team Canada send our Paralympians to the Olympics. Many of them have overcome deep physical, emotional and mental suffering. Their focus, discipline and excellence have helped them to overcome their challenges.

Our nation is built on a foundation that values the sustenance of life and the right to prosper. We invest millions of dollars every year in first responders, medical services, infrastructure and laws to protect the survival, sustenance and prosperity of the people.

However, expediting the administration of death is counterintuitive to the inner reach for hope in the human condition. Our very Constitution is founded on the principles of the value of human life, the prosperity of each human being and each one's access to the opportunity to flourish.

While deep with the intentions of compassion and the appropriation of dignity, intervening with easier access to MAID opens a door to a very complicated path of further suffering, even for those who live on.

I would like to bring to the attention of the House the story of a man named Alan Nichols, from my province of British Columbia. As reported by CTV this past September, his family has stressed that Alan struggled with depression and should not have qualified for assisted death.

Alan's brother Gary told CTV:

He didn't have a life-threatening disease. He was capable of getting around. He was capable of doing almost anything that you had to do to survive.

Like many Canadians, Alan's life was altered dramatically when his father passed away. Especially since his father had been so involved in his life, his father's death made him particularly vulnerable, and he stopped taking antidepressants and became more angry and isolated:

Not going out in public, not seeing anybody, not eating properly.

This is how Gary described it.

Alan's family knows that he rid his home of furniture, apart from a bed and chair, and that he would refuse medication and food because of his depression. Another disturbing aspect to Alan's story is that despite his family's attempts to be involved in his life and an advocate for his life, his family members report that the hospital staff would not share information with them and shut them out from hearing the key facts.

There is more to this story, but I will leave it at that. This is accessible information.

The point I would like to illustrate here is that this is a very complicated issue. It is one that touches something so deep and necessary to our existence and our country, and that is hope. All because of the irreversibility of death, there is little intervention that can be done afterward when hope is terminated because there is no breath to receive the assistance of hope.

Rather than be in a rush to legislate this bill, we should focus on tackling things like the epidemic of suicide among first nations communities and youth. We should also focus on giving Canadians better access to mental health care so Canadians have greater access to hope when faced with situations of suffering, as people who are suffering so much consider MAID. We must do this until there are enough measures to show the flourishing of hope and human prosperity to counter a potential culture of death from capturing our nation, if we are to be too swift and lenient in our decisions surrounding issues of death.

It pains me to watch others suffer, but it also pains me to think that as lawmakers, our focus is on expediting access to death rather than expediting access to hope.

My statement in the House today is to inspire all members of this House to not only consider the dignity of the people suffering seeking release through death, but the dignity of existence and human prosperity for the long term.

Removing the mandatory 10-day waiting period reduces protections for vulnerable members of society. The government's original legislation, Bill C-14, went through extensive consultation. It is scheduled for parliamentary review this summer. I would ask the Liberal government to respect the process and allow the review to proceed rather than rush this very sensitive and complex issue in legislation. Let us give this time because death is irreversible.

I have decided to look at this bill through a filter of hope and preserving a culture of hope, as being a force that guides the laws we make not only today but for decades and centuries to come. Therefore, I stand today in the name of hope and invite my colleagues across all aisles to examine this bill through the lenses of hope and preserving hope in our country.