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

[Phil McColeman, Conservative, Brantford—Brant, ON]

Mr. Speaker, I am thankful for this time to speak on this incredibly important issue to all Canadians.

As I was leading into this speech, I reflected back on the debates on Bill C-14. On May 3, 2016, the House was debating the creation of a euthanasia and assisted suicide bill. At the time I spoke in the evening on May 3, I mentioned how this would probably be, in my career as a politician, a member of Parliament, having at that time served eight years and now in my 13th year, perhaps the most important speech that I would ever make.

When I look back on that speech today, I think I was wrong. I think perhaps this is the more important speech because at that time Parliament was faced with a court deadline as well to put into place legislation for euthanasia and assisted suicide. Like many countries around the world that have these bills, going back to the first legislation in the Netherlands in 2002 until today, I have seen the progression of what has happened in these countries as an example of what will happen on the slippery slope of this legislation.

I should say as well, as I did in 2016, I come at this with a very biased approach and that is because I am the father of a 34-year-old intellectually disabled son. My son was brain damaged at age two. He suffered irreversible damage that has caused him to lead a life with his parents as his caregivers his entire life. When the people and organizations that represent persons with disabilities speak, and they have spoken loudly, to the particular changes and amendments that the government is bringing forward in Bill C-7, they have said this is the worst possible scenario.

I interpret that from my lens as a parent in terms of protection for my son. Frankly, it causes me to reflect on what we are currently experiencing: the COVID-19 crisis. Just about every piece of communication that I receive, email, text, telephone call, whatever, usually starts with a sentence where that person says to me or I say to them, “I hope your family is safe”. Generally speaking, the salutation at the end of those communications is, “Stay safe”. I believe all parliamentarians have probably experienced the exact same thing.

One of the concerns of the disability community is this. What will happen to our children in their latter lives when we are no longer with them, when we can no longer care for and protect them? Therefore, the theme of my speech today is “Stay safe, my son”.

Let us look at the evolution of these laws across the world. I will read a few recent headlines that I found through my research coming into this today. “'What kind of society do you want to live in?': Inside the country where Down syndrome is disappearing”. This headline is from the BBC on October 14, “Netherlands backs euthanasia for terminally ill children under-12”.

Let me read a couple of excerpts from this article, which are fairly poignant considering today's discussion. The article begins, “The Dutch government has approved plans to allow euthanasia for terminally ill children aged between one and 12." Of the current law, it goes on to mention, “It is also legal for babies up to a year old [to be euthanized] with parental consent.

I could go on with more headlines, but I choose not to because I think members get the point. The point is this: Where do we stop? With Bill C-14 in its original form, the preamble said it all, which was, and I am sure the committee heard this, that there are many in society who say this bill does not go far enough and does not satisfy those who want wide open death-upon-request euthanasia laws. When we look at this, we must look at it from both sides, because both sides of this issue require our compassion.

I have spent time with three significant people in my life at the end of their lives. One is my mother, who was in extreme pain for a long period of time. I held her hand upon her death. I also watched a very good friend deteriorate from age 39 to age 41 before his death. As well, lately, a very good friend, who is choosing to end her life early, and who I had quite a frank conversation with out of total respect. All of them had been, or are in, the final stages of a terminal illness.

Compassion must go to people who are in situations that are unbearable. Fortunately, there are other alternatives. I happen to live in Brantford, Ontario, and we have one of the finest palliative care units in all of the country. People come to study it and look at it. They come to see it as an alternative. If we were to focus on something going forward that a government could do, but that it would perhaps not see as a priority, it could be to give people the resources to make a choice.

Let me get back to this discussion of the most vulnerable. They are persons with disabilities, and to name a few, they are autistic children, autistic adults and persons with brain damage, like my son. These are not mental illnesses, by the way. Some of these are genetic, such as Down Syndrome. There are some who have met a person with Down Syndrome who just lights up their life because of their complete innocence and their complete love, not only for others, but also for their own lives. There are many others who the disability community speaks for.

Bill C-7 undermines their precarious position. It takes and diminishes the few protections that existed in Bill C-14, and of course, this is what is being chosen, as per the votes up to this point, on this issue by the majority of members of Parliament.

To my son, I say, “Stay safe.” To the constituents of Charlottetown, I say, “Stay safe.” To the constituents with disabilities in Scarborough—Agincourt, I say, “Stay safe.” To all Canadians, I say, “Stay safe.”

The trajectory of where we are heading, and it is in that preamble to the legislation, is what is happening around the world. It is happening in society. People in legislatures are making the decisions for the rest of the country as to what the future will look like.

This is a critical moment. It was a critical moment back in 2016. Again, we are faced with a critical moment. The priority has become a deadline set by a court, instead of the fullness of all voices being heard.

The parliamentary secretary can articulate the numbers. He can articulate the fact that there were so many submissions and individuals we were able to listen to. At this point in time, the people who represent the vast number of persons with disabilities and their families in this country are dead against this legislation. Let us be clear about that. Let us not try to sugar-coat this. This is where we are today.

What kind of society do we want? Where this leads to, frankly, is one of those headlines. As we take away the protections for individuals with disabilities, as this law does, we eventually lead society into the normal course of accepting that assisted suicide and euthanasia are natural things. We move toward being a society that starts to look at individuals as either being healthy in society's mind, and living fulfilling lives, or beings one of those who have been brought into this world, or has had something happen to them in this world, that puts them in this very precarious situation.

Is life easy for persons with disabilities and their caregivers? In most cases, it is not easy. We can attest to that. We have three healthy children, as well as our special needs son with disabilities. Part of the richness of life is the fact that the child who many would see as imperfect is the one who brings the most joy to life. They are the ones we must protect at all costs.

Why do we not spend the time to get this legislation right and make it airtight so their lives are never at risk? I do not believe this legislation does immediately put them at risk. Some would say this legislation is quite to the contrary, but looking to five, 10, or 20 years from now, when most of us here will no longer be in Parliament, it will be a new group of elected representatives looking to make changes down the road.

Is there anything in the international experience to tell us that this is not a continual, gradual and incremental deterioration of the protections for those who are the most vulnerable?

The other point that needs to be made is that persons with disabilities are a minority in our country. Over the 13 years I have been in Parliament, more time has been spent on legislation, members' statements, just name it, than communications from government about protecting minorities. This is a vulnerable, if not the most vulnerable, minority in society. It is definitely in the top grouping of the most vulnerable.

Disability knows no boundaries. We are involved with groups of people, and I represent the Six Nations of the Grand River, the largest first nation in Canada. We are helping aboriginal individuals from Six Nations who have children with disabilities. They feel very strongly about the fact that the few protections that exist need to not only be kept in place, but also enhanced and made airtight for their children.

In those debates in 2016, the member for Calgary Nose Hill said in her opening statement that this is about, “the sanctity of human life” and “defining the morality of our country.” I could not agree more wholeheartedly with those words.

I will finish my remarks by saying, “Stay safe, my son.”

[René Arseneault, Liberal, Parliamentary Secretary to the Minister of Economic Development and Official Languages (Atlantic Canada Opportunities Agency and Official Languages)]

Mr. Speaker, I want to thank our friend from Brantford—Brant for sharing his own experience.

I was one of the original members of the joint committee behind Bill C-14. Allow me to share a little background.

Bill C-14 was introduced in response to the unanimous ruling of the Supreme Court of Canada handed down in February 2014, when the Harper government was in power. The court gave the government 12 months to comply with the ruling. The Harper government, knowing that an election was coming in the spring of 2015, essentially did nothing. The Liberals won the 2015 election. We lost 10 precious months before cabinet was appointed as a result of the Conservative Party's inaction.

Politicians are often called upon to make decisions, and it is not always easy. The majority of members on our committee who opposed this bill said they were doing so to protect vulnerable people, which is something everyone wants to do.

Could my esteemed colleague tell us where in Bill C-14 or in Bill C-7, which we are debating today, it says that a minor with a head injury, cerebral palsy or Down's syndrome could request medical assistance in dying? I do not see that anywhere.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Mr. Speaker, I reflect back on a few comments made previously in debate by the parliamentary secretary, and in the question and answer period, which were that this is not a partisan issue. However, the only two people I have heard criticize a particular political party in this debate are the two members from the Liberal government side.

The member said the protections for persons with disabilities are in this legislation. He is wrong. That is why the disability community has spoken so loudly and broadly across this country, yet the government is not listening.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, I want to thank the member for Brantford—Brant for his speech today. He is a member for whom I have a great deal of respect.

One of the things that COVID and the debate on Bill C-7 have done is expose something that has been there for anyone to look at if they chose to. That is the way we treat people with disabilities. We have not organized our society in a way that allows people with disabilities to live to their fullest potential or to live in equality with the rest of Canadians.

Would the hon. member support a national program of income support for people with disabilities that would lift all people with disabilities out of poverty and take away those stark choices he has been talking about?

[Phil McColeman, Conservative, Brantford—Brant, ON]

Mr. Speaker, I, too, have a great deal of respect for the member who is asking this question. It is a great question.

There are supports needed for all families and for support workers, as well as for individuals with disabilities who choose to live on their own. In many of the provinces, believe it or not, they are sufficient.

I totally agree with the member. We need to set, for society, a moral compass on this issue. The government cannot look at this Parliament as solving this problem. We must set a tone and a future that guarantees, airtight, that persons with disabilities will live fulfilling lives, and that we will treat them as they are: as one of the most vulnerable minorities in our society.

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

Mr. Speaker, I would like to thank my colleague for illuminating, from the heart, what we have been talking about in this debate.

I know he mentioned that his riding has excellent palliative care, but the reality is that across Canada, 70% of people have no access to palliative care. The government unanimously supported my palliative care bill to put a framework in place to get consistent access. Now it has backed down on all its promises to put money behind it so that people would actually have a choice, as the Carter decision outlined.

Could the member describe how he sees the government's response on palliative care?

[Phil McColeman, Conservative, Brantford—Brant, ON]

Mr. Speaker, I thank my colleague, first of all, for her work on this issue, and for her passion for those I know she has personally worked with as the member of Parliament for Sarnia—Lambton.

I wish I could bring all of Parliament to the palliative care facility in my community. It is, without question, one of the most brilliant and well-thought-out places in which a person can choose a path to the end of life with dignity, and can have family and the community participate. I have spent many hours at this facility as a member of Parliament, visiting members of my community who are in their last days. It is one of the most rewarding and wonderful experiences of life.

Death is part of life, and should be celebrated as someone comes toward the end. They may be in great pain—

[The Deputy Speaker, Bruce Stanton]

We will continue with questions and comments. The hon. member for Fredericton.

[Jenica Atwin, Green, Fredericton, NB]

Mr. Speaker, I encourage the member to continue his response here, if he wishes. I appreciate the personal contributions so much. It is so important for us to understand.

I was not here for the previous discussion around this bill, and here we are in a very difficult position again. I have studied it. I have consulted with my riding. I have consulted with many people who are accessing MAID, and with people in the disability community who have concerns.

I was very comfortable with where I landed in support of this bill. However, I come from a position of privilege. I want the member to be comfortable as a parent, and I want the member's son to be safe as well.

Is it the interpretation that the member is worried about: that people will see people with disabilities as experiencing suffering? The bill is focusing on someone who is in pain. I am just wondering, is the interpretation and the application of law for those in the disability community the concern? I just need to understand where the fears are really coming from.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Mr. Speaker, I appreciate that very personal question.

The fear comes from this. Parents and caregivers, and the community in general around persons with disabilities, know that there will come a time in their lives when that care may deteriorate, and society no longer values persons it interprets as being imperfect. If we look at the trajectory of euthanasia and assisted-suicide legislation around the world, that is indeed the direction it is going.

It is going in the direction of this. It may not be now, through this piece of legislation. Perhaps there may be good intent, and I hope there is, but eventually, we as legislators must decide there are lines we cannot cross. That is why I say, “Stay safe, my son,” because I will no longer be here to keep him safe, and that is the fear of most parents.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, I come at it from the very same position as my hon. colleague from Brantford—Brant. I am choking up. I know both sides of it. Right next door to me, my father-in-law is in palliative care. We have been looking after him for six months. I also have a 32-year-old daughter who lives with a cognitive disability, and we worry every day. We worry every day that they go outside. We worry every day, when I go to work, that somehow someone is going to take advantage of them, and that we will not be there to protect them.

I wonder if I could get my hon. colleague to expand a bit on the fear that parents have and the fact that we are not always there. There will come a day when we are not there, so we have to do everything in our power. I said in the last session that Bill C-14 was perhaps the most important piece of legislation in our lifetime and our generation, but as a parent of somebody with a disability this is so important.

I ask my colleague to expand a bit more on the fear that we have for our children.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Mr. Speaker, I would elaborate more if I had the time, and I will personally elaborate more with my colleague.

However, we must come to grips with this. Society is not well equipped for this, frankly. The legislature is not equipped. We, as legislators, are not well equipped to set a course that protects the most vulnerable. I agree with protecting minorities. This applies to the most vulnerable. This bill, Bill C-7, would take away protections. That is why the disability community has spoken out.

I thank you, Mr. Speaker, for your time and indulgence.

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 third time and passed.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, this is the last stage of debate before Bill C-7 is passed.

I would like to remind members of the first thing I said when we began the clause-by-clause study of the bill. I said that we must not forget that while we are debating, people are suffering and are waiting for the results of our efforts. Today, I would say that they want to know whether we will take care of them and listen to their voices, or whether they will once again have to bear the burden of going before the courts to have their final wishes heard.

I also said that I was certain, from the start of the debate on Bill C-7, that all parliamentarians in the House were caring and compassionate, but that we could not be caring and compassionate if we infringed on the autonomy of a person who is dying or suffering and has reached their breaking point.

I have to say that I am disappointed by the Conservatives' attitude. It is one thing to want to make a point, but it is another to engage in what amounts to filibustering. However, what bothers me even more is that they seem to be claiming that they know better than the person who is dying what is best for them. I cannot make such a claim. I prefer to give the person the choice, and my role as a legislator is to preserve that choice.

Unfortunately, the Conservatives are practising government-imposed moral paternalism, which is odd because they are economic libertarians. That means they want less government intervention in the economy, yet they also want full government intervention in a matter as intimate as our own death.

The Conservatives are practising government paternalism, but they are not alone, because we have heard some practitioners say and demonstrate that in 2020, they still apply a medical paternalism that I would describe as appalling. Why on earth are these omniscient practitioners doing that? How are they better equipped than a person who is dying or a suffering patient who has reached their threshold of tolerance to know what is best for them? Only God knows, but they do not mention that.

Those few medical practitioners continue to frustrate us to this day because they practise in Quebec. Five years after Quebec's Act Respecting End-of-Life Care was passed, they consider palliative care and medical assistance in dying to be mutually exclusive, when they are and should be complementary, since medical assistance in dying is part of the care continuum under Quebec's end-of-life care legislation. However, that is still not enough. They believe that the patient must change their mind if they request medical assistance in dying, and they say they manage to make them change their minds. They have no qualms about saying that they would not want to refer the request for medical assistance in dying to a doctor who can perform the procedure, even though that is enshrined in Quebec law. They say they are obviously doing it for the good of the patient, even though they refuse to listen to the patient and heed their wishes.

That is the testimony that provides the basis for the Conservatives' filibustering. They claim to know better than the dying patient what is best for them. That is not caring. That is a violation of the principle of self-determination.

I will let the 88% of Quebeckers who support the freedom to choose medical assistance in dying judge the Conservative Party's position and attitude. However, what I heard in committee worries me, because five years after Quebec adopted its end-of-life care legislation, some institutions can and do circumvent the law, as was the case before the Morgentaler decision, to hinder someone from receiving medical assistance in dying. I was shocked to hear that.

If a patient is no longer receiving aggressive treatment and has finally been given the right to die, which is known as palliative care, I hope that this patient will not be subjected to aggressive palliative care.

Dying with dignity implies respect for human dignity. It is not an intellectual conceit; it is intrinsic. Treating people as ends in themselves and not as mere means involves respecting a person's capacity for self-determination, free will and freedom to choose. A person must never be subjected to an analysis or an ideology, religious or otherwise. A person is the master of their own destiny.

Furthermore, self-determination is enshrined in law. No one can undermine our intellectual or bodily integrity or our self-determination without our free and informed consent, even in an emergency.

That means that when a sick patient is at their most vulnerable, when they are suffering and dying and have reached the point where they can bear no more, the person at their bedside must not impose their own ideology on that person, be it religious or otherwise.

That is why they say in clinical ethics that the patient comes first. The patient's wishes, which are based on how much they are suffering, need to be heard. Palliative care providers should not see medical assistance in dying as a failure. If a palliative care patient, who is irreversibly committed to dying, wakes up one morning completely at peace and ready to let go, then the palliative care provider should not see that patient's request for medical assistance in dying as a failure.

I have said it before and I will say it again: I hope that, when they are on the threshold of death, all my parliamentary colleagues will be able to feel that peace and let go with a clear conscience. That is the best we can hope for for any human being.

Bill C-7 responds to the Gladu-Truchon ruling. The courts determined the appropriate response by examining the limits of the government's power to intervene in end-of-life decisions in Carter and Gladu-Truchon. The courts told us that the provisions of the Criminal Code infringed on the right to life, liberty and security of the person.

They infringe on the right to life—that says a lot—because they cause people who are suffering to shorten their lives through suicide, which is decriminalized in Canada, rather than waiting for the moment when their threshold of tolerance is reached. This is significant.

During the committee deliberations, I heard people say that 90 days is not long enough. In saying that, they were assuming that someone who has a degenerative disease of any sort might wake up one morning and suddenly decide they want medical assistance in dying, without having ever discussed it with their doctor or health care professionals throughout their care process. It is as though they thought this all came out of a Cracker Jack box one morning and the person was wondering whether they could access medical assistance in dying that very moment or whether 90 days was enough time to be sure of that decision. That is not how it happens in real life.

The right to life is not something to be cast aside lightly. People want to live as long as possible. People want to live, and when they receive a diagnosis and are in a suicidal state, they can be treated to reverse that state. When someone finds out that they have cancer they are not going to tell their doctor that they want medical assistance in dying. They are going to ask what can be done to help and when their treatment will begin. Sometimes it takes 15 or 20 years, and other times the cancer is more aggressive, but there comes a point when the doctor announces that all treatments have been exhausted and it is time to begin the palliative stage. In any case, this does not happen overnight.

If someone who receives such a diagnosis tells their doctor they want medical assistance in dying, the doctor will prescribe anti-depressants and tell the patient that they will take care of them. They will tell the patient to get their affairs in order and talk to the family. They are not going to provide medical assistance in dying. That is not how it works. Sometimes in committee I would hear people describe catastrophic scenarios out of some sort of house of horrors, as if that were how things happened.

Bill C-7 is based on principles the Bloc Québécois believes in. Who can dispute the fact that death is the most intimate moment in a human being's life? Neither the state nor my neighbour will die in my place. The decision can only be made by the person requesting it, not by the family or anyone else.

The criteria must of course be met. We in the Bloc Québécois have confidence in our health workers. We have confidence in our health professionals. There is something that I find rather perplexing. Just this Tuesday, the Conservatives supported our motion that commended the work, dedication, care and concern of health workers and health professionals. However, when it comes to the most intimate decision a human being can make, to decide one's own death and not to suffer, and when it comes to respecting a person's right to self-determination, the Conservatives no longer have confidence in them. They believe that there are people who may have bad intentions.

If there are people who are not well intentioned or caring in the health system, let us show them the door right away. I would also say that if there are any health professionals who claim to know better than the patient who is at the end of the process and who has made the choice that is right for them, it is time they reflected or took a course on respect for human dignity.

Throughout this debate, I have gotten the sense that some people are against freedom of choice. When people support freedom of choice, that does not mean they want to get rid of palliative care and go around signing all kinds of people up for MAID. What we are saying is that an individual who wants to die at the end of the process should be able to do so. MAID should apply to people whose suffering is intolerable and cannot be alleviated.

Yes, Bill C-7 leaves a number of things unresolved. There are two main elements here. One major improvement is that Bill C-7 tossed out the reasonably foreseeable natural death criterion, which is not a medically valid criterion. That is understandable. However, it was retained for use in defining two safeguards. I would have liked to see a more specific definition of “reasonably foreseeable death”.

For terminally ill people, there is a safeguard of up to 10 days, and a second consent may not be necessary. In cases like Ms. Gladu's, Mr. Truchon's and Ms. Carter's, where death is not reasonably foreseeable, it is supposed to be 90 days. I would have liked some clarification on this criterion because doctors need things to be clear and specific. I do not know why this criterion was brought back. There is always room for improvement.

The bill removes the need for second consent to put an end to people's suffering when palliative care no longer eases their pain, when death is irreversible and the process has already begun. That seems like a good thing to me.

Bill C-7 obviously excludes mental illness as an eligible reason when it is the sole underlying medical condition. It also does not cover all of the issues associated with advance requests, particularly in the case of neurodegenerative diseases, or the issue of mature minors.

Under Bill C-14, a parliamentary committee was to examine those provisions and the matter of palliative care last summer. Today, the Bloc Québécois is calling for that review to begin as soon as possible, not in five years or even one year, because there are people who are suffering. What is more, this time, we must not make them bear the burden of having to go to court to be heard. Who is more vulnerable than a person who is enduring unbearable pain, who has reached or is about to reach the limit of what they can endure and who has to decide to go before the courts to make their voice heard?

It is time for us as legislators to take up the torch, show some leadership and do our job. The courts can issue orders for us to do something, but obviously when they do there is a fixed timeline. Right now, we have a deadline to meet, December 18. I really hope that we can pass this bill and begin the review process so that we can deal with the sensitive issues that are not addressed by Bill C-7.

[The Acting Speaker, Gabriel Ste-Marie]

The parliamentary secretary to the government leader on a point of order.