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.

Motions in amendment

[Arif Virani, Liberal, Parkdale—High Park, ON]

Madam Speaker, I appreciate the question from the member opposite. I want to point out two or three things.

First, there are quite a few protections for all doctors and nurses in the current legislation.

Second, they are quite free to discuss all options and the medical assistance in dying process before proceeding with that process. They are even encouraged to do so. That is exactly what is stated in the provisions concerning the second track, that is, in a situation where death is not reasonably foreseeable.

Third, in committee we discussed the position taken by the Canadian Nurses Association. It was noted that there is already a fairly wide range of protections for practitioners, whether nurses or doctors, against litigation or a complaint about their action, because they continue to have conscience rights, as well as the right to have an open discussion with their patients.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, as the saying goes, never two without three.

I rise today in the House of Commons to speak once again to the issue of medical assistance in dying as it pertains to Bill C-7, an act to amend the Criminal Code. However, this time we have a deadline set by Justice Baudouin, namely December 18, 2020, so there is a sense of urgency now.

I am likely repeating myself today, but many people here have had unique experiences involving the end of a loved one's life. I am thinking in particular of one of my old friends, Stéphane, who died in palliative care at a very young age, in his twenties. He was supported by the excellent Maison Au Diapason. He was one of the youngest patients to die there and one of the first as well. This type of assistance is essential and useful.

As the Bloc Québécois critic for the status of women and seniors, I naturally took a special interest in this bill. In this speech, I will be reminding everyone of all the work that my party has done on this important issue, while emphasizing the great sensitivity of Quebeckers when it comes to medical assistance in dying. I will conclude with the position that certain seniors' and women's groups have taken on this issue and the recommendations they made that are extremely useful, but that are already several years old. They too are starting to get impatient.

First, let's talk about the reason for this debate. In September 2019, the Superior Court of Quebec ruled in favour of Nicole Gladu and Jean Truchon, both of whom had incurable degenerative diseases. The court stated that one of the eligibility criteria for medical assistance in dying was too restrictive, both in the federal legislation covering MAID and in Quebec's Act respecting end-of-life care.

These two brave individuals, with whom I have mutual acquaintances, simply asked to be able to die with dignity, without needlessly prolonging their suffering. Mr. Truchon, who had cerebral palsy, had lost the use of all four limbs and had difficulty speaking. Ms. Gladu, who has post-polio syndrome, is not able to control her pain with medication and cannot stay in the same position for too long because of the constant pain. She has said that she loves life too much to settle for mere existence. That is what she said.

What we are talking about here is the criterion of a reasonably foreseeable death. Justice Christine Baudouin said it well in her ruling:

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.

That is the crux of our debate. These advocates had been denied medical assistance in dying because their death was not reasonably foreseeable, even though they had legitimately demonstrated their desire to stop suffering. Jean Truchon had chosen to die in June 2020, but he moved up the date because of the pandemic. Nicole Gladu is still living, and I commend her for her courage and determination.

The Bloc Québécois's position on this ethical issue is very clear, and I want to thank the member for Montcalm for his excellent work. I will not be as technical as him, but he showed us that we are capable of working together, and I thank him for all of the improvements that he made to this bill.

As many members have already pointed out, legislators did not do their job properly with the former 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 irreversible illnesses are not forced to go to court to access MAID. Do we really want to inflict more suffering on people who are already suffering greatly by forcing them to go to court for the right to make the very personal decision about their end of life? This will inevitably happen if we cannot figure out a way to cover cognitive degenerative diseases.

Obviously, we agree that we need to proceed with caution before including mental health issues, but that is not the issue today, since MAID in mental health-related cases was excluded from the bill. Once again, this matter was brought before the Standing Committee on Health via a motion moved by my colleague from Montcalm.

Second, I want to talk about how important Quebec is in this context. Quebec enacted the country's first legislation on this subject. Wanda Morris, a member of a B.C. group that advocates for the right to die with dignity, talked about how a committee that got the unanimous support of all parties in the National Assembly was a model for the rest of Canada. She said it was reassuring to see how it was working in Quebec and that people were happy to have the option to die with dignity.

However, it is important to know that this bill was first introduced by Véronique Hivon and that it was the fruit of many years of research and consultations with individuals, doctors, ethicists and patients. Whereas 79% of Quebeckers are in favour of medical assistance in dying, only 68% of people in the rest of Canada are. Those numbers are worth knowing and mentioning.

In 2015, when all parties in Quebec's National Assembly unanimously welcomed the Supreme Court's ruling on medical assistance in dying, Véronique Hivon had this to say:

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 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 in my role as the Bloc Québécois critic for status of women, gender equality and seniors. At this meeting, these brave women shared with me their concerns about this issue.

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.

A brief submitted in 2010, or 10 years ago, to the Select Committee on Dying with Dignity, explained that the last moments are not always difficult because there are standards to guide medical practice and medical advances help relieve pain. However, despite everyone's goodwill, some people do have unfortunate experiences. Consequently, to prevent prolonged agony from depriving some people of their dignity and control over their lives, there are those calling for as a last resort the right to die with dignity, or the right to die at a time of one's choosing with assistance in this last stage.

Another brief pointed out that there have been four separate attempts to introduce similar legislation, specifically in 1994, 2005, 2008 and 2009, but these bills have never gone further than first reading. This needs to pass.

I will now read the conclusion from the AFEAS brief, as it is really powerful:

Over the next few months, AFEAS members will continue to reflect on the framework in which individuals losing their autonomy or suffering from an incurable, disabling illness, or experiencing acute physical or mental pain without any prospect of relief will be able to clearly and unequivocally express their desire to stop fighting to live and seek assistance to die.

Establishing the framework in which these decisions are made will be critical to ensuring that abuse cannot occur. The guidelines must be clear and precise so that all individuals can freely express their own choices, without any constraints and with full knowledge of all available options. It will be essential that all end-of-life services, including palliative care, be available and effective throughout Quebec so that patients have a real choice and do not feel forced to accept a “default” option because of a lack of adequate services or undue pressure from others.

I will also close now, in the hope that all of these comments and the lived experiences of the people in Quebec who made the request and wanted to die with dignity will afford Bill C-7 the same unanimous support from all members of the House of Commons so that we may all freely choose when we die. Let's take action.

[Arif Virani, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I really appreciated the comments and speech from the hon. member on the other side.

On a number of occasions, here in the House today and in the Standing Committee on Justice and Human Rights, it has been suggested that we are wrong not to appeal the Truchon decision to the Supreme Court of Canada.

On this side of the House, we believe that Justice Baudouin's ruling in Truchon and Gladu was well documented, well expressed and well supported by the evidence.

What does the member think about the possibility of appealing this decision to the Supreme Court? Would that risk prolonging the pain and suffering of Canadians?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for his comments.

I remind members that we have a deadline: December 18, 2020. This is our deadline to appeal the decision to the Supreme Court, after the original deadline was extended because of the COVID-19 crisis.

However, I think we are ready to make a decision. Everyone in the House can move this forward and pass the bill.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Madam Speaker, I thank the member for Shefford for her excellent speech.

She mentioned my colleague from Joliette, Véronique Hivon, who did outstanding work in the Quebec National Assembly. She did politics differently. She talked to every party and said that they all needed to put partisanship aside, because this matter was too important.

Does my colleague from Shefford believe that the same kind of work has been done here, in the House?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my hon. colleague from Joliette for the question.

Unfortunately, that was not the case. I recently had some conversations with Ms. Hivon and she looks forward to seeing this file come to a close. She brought this legislation to Quebec City with a lot of heart and passion.

I do not want to pass judgment, but it is too bad that here in the House certain religious beliefs have coloured the debate on medical assistance in dying and delayed passage of the bill. There was not the same unanimity in the House of Commons as there was in the National Assembly.

It is a shame because this file should go beyond our political persuasions. This issue should be rooted in science and based on the advice of ethicists, doctors and experts. I think everyone has the right to choose freely how they will die, and that goes beyond beliefs. People who do not want to use medical assistance in dying can make that choice, and the bill allows for that.

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

Madam Speaker, I thank the hon. member for Shefford for bringing the individual situations of the plaintiffs in the Truchon case before the House again and for recognizing their bravery.

My question has to do with the unfortunate line I have heard in public, and even from some members of the official opposition, that somehow we have no obligation in Parliament to meet the deadline imposed by the decision of Madam Justice Beaudoin in the Truchon case. Not meeting that deadline would have serious consequences in Quebec.

I would like to hear the hon. member's comments on the question of the importance of meeting the court deadline.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for the question.

Indeed, the Superior Court of Quebec ordered federal and provincial legislation to be changed. That was supposed to be done before March 11, 2020. An extended deadline was granted by Justice Christine Baudouin and the deadline was pushed to December 18. I think there will be problems if we do not meet the December 18 deadline. That is why we must all move forward together and meet this deadline to avoid the problems that will come up if we do not comply with Justice Baudouin's order.

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

Madam Speaker, I thank my Bloc Québécois colleague for her very interesting and very important speech.

The details she shared about Jean Truchon's case enabled us to understand the situation and the plans that have to be made in such a case. As my friend from Esquimalt—Saanich—Sooke said, we really have to understand the importance and wisdom of Justice Baudouin's decision.

I just want to emphasize how important this bill is for reducing suffering across Canada. This bill will finally—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Alexandra Mendes]

Unfortunately, I have to ask the member for Shefford to keep her comment very brief.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her comment.

She stressed the importance of this bill. Its primary purpose is to reduce everyone's suffering. Death is unavoidable. It is part of life. We are born and we know that, ultimately, we will die. We do not choose the moment of our birth, but—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Alexandra Mendes]

Resuming debate.

The hon. member for Esquimalt—Saanich—Sooke.

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

Madam Speaker, I am very surprised we are debating these two motions from the official opposition again in the House when these had been dealt with in committee. Without reflecting on the past decision of the Speaker, I have some concerns with respect to future precedence in declaring something particularly important, that it not open the Chair to the accusation of having a position on a particular question.

With that aside, I will turn to what is now before us.

Everyone in the House has sincerely held beliefs on this very important and difficult question of how we deal with end of life in Canada. It is important we all be careful not to impute motives to our fellow members in this debate however difficult that may be for us to do.

Turning to the content of these two motions, and again, I am surprised we are having a redo in the House.

Motion No. 2 talks about what is referred to officially as reflection period. What happens in actual fact is that those who request medical assistance in dying, where death is reasonably foreseeable, go through a very long and involved process with their spiritual advisers, their family and with the clinicians who are advising them on the end-of-life issues.

It is important to note that people are not choosing to end their lives when asking for medical assistance in dying. What they are doing is attempting to establish how they will deal with their inevitable death and to maintain their personal autonomy and control over the way that plays out. The New Democrats, in debate on medical assistance in dying, have always stated our priority is to keep in mind that what medical assistance in dying is designed to do is to reduce unnecessary suffering and not unduly prolong that suffering.

It is not just suffering for the patients, although that is one of the qualifications for being able to apply for medical assistance in dying, patients must be suffering intolerably, but also to reduce suffering for the families that are forced to bear witness to the suffering their loved ones are undergoing as they approach end of life.

What we have heard very clearly from those who are assessing and providing medical assistance is dying is that this 10-day period is not really a reflection period. It is a period that is imposed as a waiting period.

When I hear hon. members talk about people changing their minds, we need to look very carefully at what the evidence actually says. Yes, people who apply for medical assistance in dying do sometimes withdraw that request, but they almost always do so during the assessment period. Very few people do so during the waiting period. Of course, at any time they can still withdraw that consent, right up to the last moment.

Medical assessors and providers, as well as families, have said that the real impact of having such a 10-day period is simply to prolong suffering for everyone. When we look at the statistics on when those who applied for medical assistance in dying actually set a date for that assistance to be provided, we find that 50% or more of those are between the 11th and 14th day. In other words, they are being forced to wait out this period before they can assess medical assistance in dying.

It is very important we recognize that we may, and I believe we have, inadvertently prolong suffering through this so-called reflection period. Again, I remind members that we have heard again and again that this is not a snap decision people make; it is a decision that has been well considered with their families, spiritual advisers and with the physicians involved.

Motion No. 3 deals with those whose death is not reasonably foreseeable. It is important we remind ourselves that the condition of death being reasonably foreseeable was, in effect, taken out of medical assistance in dying legislation by the Truchon decision, not by Bill C-7.

The importance of Bill C-7 is that it would establish some special procedures that would be appropriate to those whose death is not reasonably foreseeable. In that case, it set a minimum period for assessment, which was set at 90 days. Again, people are calling this a reflection period. It is not a reflection period. Nor is it a deadline by which medical assistance in dying must be carried out.

The bill would set a minimum time for assessment. If the clinicians and the patient involved believe the assessment should take longer, it can take longer than the 90 days. Therefore, the 90 days is in fact an arbitrary number. I do not think it is reflected in any medical science. Extending that to 120 has that risk, once again, of inadvertently and unintentionally prolonging suffering for those who are at the end of life.

I will not go on too long today, but it is important that we not confuse suicide with medical assistance in dying. Suicide is very serious, and I send my condolences to all those who have lost loved ones.

Medical assistance in dying is not about taking one's own life. It is about the situation when one's life is ending and how one maintains a dignified end to that life and is able to do so without prolonging suffering. We have heard again and again from families and practitioners that no one involved in medical assistance in dying wants anyone to die. They are simply dealing with the realities that medical conditions have presented to them. With that, I will end my comments.

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Alexandra Mendes]

The hon. member will have five minutes of questions after Oral Questions.

The House resumed consideration of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), as reported with amendments from the committee, and of the motions in Group No. 1.