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

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Madam Speaker, I will be sharing my time with my colleague from Coquitlam—Port Coquitlam.

I am very happy to be taking part in this debate, which is a departure from our usual political and often partisan work as elected officials.

This is the third time in my parliamentary career that I have been asked to debate and vote on the issue of medical assistance in dying. I was a member of Quebec's National Assembly for seven years, and I have served here in the House of Commons since 2015 with the support of my constituents.

I was elected to the national assembly in 2008. As a member of that assembly, I participated in the first debate we had in Quebec on this issue, the first time in a Canadian legislature, in 2010.

I also was a participant in the debate we had four years ago in the House of Commons, when, for first time, we addressed the issue. Therefore, in my parliamentary life, this is the third time I will participate and vote on this very touchy, personal and non-partisan issue.

That is why I would like to remind the House of certain cardinal rules that should guide our actions as parliamentarians in this debate, which we believe should be totally non-partisan. Things may get tense at times, but debate must remain respectful.

Respecting the free vote should be one of the cardinal rules of this debate. In my view, there is no right or wrong position in this debate. There are only positions that we are comfortable with as human beings. Whether we are for or against, there is no partisan politics behind it. There is only the personal opinion that we hold, share and analyze.

Consequently, it is important to keep a completely open mind and respect the fact that certain colleagues from our own party may not share our point of view, while colleagues from other parties may. That is fine. There is nothing wrong with that, really. Some positions we adopt, and some positions we cannot be comfortable with. That is all.

We must respect the debate. We must respect personal opinions. We must respect the fact that there is no place for partisanship in this debate and that positions are neither right nor wrong. There are positions that we can agree with and others that we cannot. We must respect that.

There are also certain elements that we must bear in mind before we dive into this. In our opinion, the bill has some shortcomings.

First, we must respect the freedom of conscience of physicians who are called on to provide MAID. If a physician feels that they cannot in good conscience provide MAID, they should be able to say so and not have to proceed. I have spoken to many people in the context of this debate, in which I have been participating for a very long time. Everyone I have spoken to has told me that physicians can show a certain openness in some circumstances, but change their minds in others. Physicians should never be forced to act against their conscience.

Furthermore, we should always bear in mind that MAID, by its very nature, is the last level of health care that can be offered. We must never forget that the role of palliative care is to ensure that those who are ill can live with dignity even in tragic circumstances. Therefore, we must respect physicians' conscience and focus on palliative care.

Taking our time is another cardinal rule that must be respected in this type of debate.

Let me remind members that the first time this issue was addressed in Quebec, it took six full years, three different governments and three different premiers. There was a huge debate about it, a strong and wise debate. Each and every position had been clearly established by those people who participated in the debate. There is no rush. We must take our time.

For some people, we are talking about assisted suicide. It is a very touchy issue. The worst-case scenario is to rush it. Quebec spent six full years, and we should follow this example. It obviously will not take six years this time, but the first step took six full years.

Let's agree that this debate cannot be rushed.

Why are we debating Bill C-7 today?

When the House of Commons adopted Bill C-14 in 2016, I was a member of the committee that studied it. We knew then that Canadians would challenge parts of it and that there would be court rulings. That is exactly what happened on September 11, 2019, when the Quebec Superior Court struck down the notion of “reasonably foreseeable natural death” in the bill that became An Act to amend the Criminal Code and to make related amendments to other Acts regarding medical assistance in dying.

I did not know this before I looked it up, but it is interesting to note that the current Minister of Justice, a man for whom I have tremendous respect and esteem owing to his experience as a lawyer and a McGill University professor, voted against Bill C-14. Now, as Minister of Justice, he is sponsoring this bill as the federal government's response to the Quebec Superior Court's ruling. The bill addresses some of the issues but sets others aside.

The first fundamental element of Bill C-7 is that it eliminates the 10-day waiting period that the current law requires as a buffer between the person's decision and the operation itself, to ensure that the second opinion provided for under the act is in fact obtained. The court deemed this provision invalid, and the minister decided to accept that opinion.

Let's also not forget that the current law, which was passed four years ago, requires the provisions to be reviewed in just a few months, starting in June 2020.

The government decided to take note of the Superior Court of Québec ruling and act accordingly. That is its right. However, regardless of our views on the issue, we feel that this subject involves some truly fundamental questions and raises highly complex legal concerns. We think this ruling should have been appealed to the highest court in the land, so that the nine justices of the Supreme Court could study every possible ramification.

This bill sidesteps the issue of mental illness entirely. That is a very good thing, because in our view, it is extremely difficult to pinpoint the instant when a mental illness becomes irreversible, which can raise doubts about whether consent was given fully and freely.

As I said earlier, the worst thing we could do in this matter is move too fast. There is no rush. This concern may eventually be debated, but for now, let's take it one step at a time.

Since my time is almost up, I would just like to say that in this debate on such a delicate, sensitive issue, the worst thing we could do is plough full steam ahead and attack people's convictions instead of respecting their choices. Let's take the time to do things right on this extremely delicate and extremely important issue.

[Irek Kusmierczyk, Liberal, Windsor—Tecumseh, ON]

Mr. Speaker, that is an excellent question. If we read the preamble to Bill C-7, we will see the legislation's explicit desire to balance several interests and values: the autonomy of the person seeking a dignified death, the protection of vulnerable persons and the important public health issue that suicide represents.

I believe Bill C-7 achieves that balance by relaxing safeguards for Canadians who are at the end of life, but also strengthening safeguards and, just as important, strengthening supports for Canadians who have a grievous and irremediable medical condition and are in an advanced state of irreversible decline, but not necessarily at the end of life.

[Irek Kusmierczyk, Liberal, Parliamentary Secretary to the Minister of Employment]

Mr. Speaker, I will be sharing my time with the member for Beaches—East York.

It is an honour to stand up in the House of Commons and participate in the second reading debate for Bill C-7, an act to amend the Criminal Code to Canada's medical assistance in dying legislation.

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

These experts and stakeholders included doctors, nurses, legal experts, national indigenous organizations and representatives of the disability community. The high level of participation in both the questionnaire and the in-person sessions is a reflection of the importance of this issue to Canadians. Moreover, the results of the consultations were critically important in shaping the government's approach to medically assisted dying as it evolves to reflect the needs of Canadians.

This bill would amend the Criminal Code to allow medical assistance in dying for people who wish to relieve their suffering through a medically assisted death, whether their natural death is reasonably foreseeable or not.

This bill would remove the reasonable foreseeability of natural death from the list of eligibility criteria. It would also expressly exclude people seeking medical assistance in dying solely because of mental illness.

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

In the spirit of “nothing without us”, I would like to mention the government remains focused on addressing the concerns of the disability community around vulnerability and choice. The proposed changes to the legislation support greater autonomy and freedom of choice for eligible persons who wish to relieve their suffering by pursuing a medically assisted death.

At the same time, full consideration has been given to the protection of vulnerable persons and to respecting the equality rights and dignity of persons with disabilities. In short, this bill would maintain and strengthen safeguards to support fully informed decision-making, while also respecting individual autonomy.

In terms of advance consent, many participants were comfortable with implementing advance requests for those who have been assessed and approved for medically assisted dying, but are concerned about losing capacity before it is provided. This bill would allow people who risk losing decision-making capacity to make arrangements with their practitioner to receive medically assisted dying on their chosen date, even if they lose decision-making capacity before that date.

The bill would also make advance consent invalid if the person demonstrates refusal or resistance to the administration of medically assisted dying. The bill goes on to clarify that reflexes and other types of involuntary movements, such as response to touch or the insertion of a needle, would not constitute refusal or resistance.

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

I would like to take a moment to speak to the progress the government has made with respect to the rights of persons with disabilities in Canada. In fact, last year, the government enacted the Accessible Canada Act, which aims to create a barrier-free Canada through the proactive identification, removal and prevention of barriers to accessibility wherever Canadians interact with areas under federal jurisdiction.

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

That act also established National AccessAbility Week, a week dedicated to accessibility in late May and early June each year. National AccessAbility Week is an opportunity to promote inclusion and accessibility in communities and workplaces, and to celebrate the contributions of Canadians with disabilities.

It is also a time to recognize the efforts of individuals, communities and workplaces that are actively removing barriers to give Canadians of all abilities a better chance to succeed. The act applies to federally regulated organizations for now, but we know the culture shift will have a trickle-down effect, and that awareness and action on disability inclusion will increase across the country.

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

We recognize that disability inclusion requires more than legislation. That is why we are continuing to work with the disability community and other stakeholders to address stigma and bias. It is important to bring about a culture change to ensure that the important contributions made to Canada by persons with disabilities are recognized and valued on the same basis as those of other Canadians. Going forward, we will continue to focus on improving the social and economic inclusion of persons with disabilities.

We will continue to work hard to ensure that all people are treated with the dignity and respect they deserve, especially when it comes to deep and personal issues like ending life. It is imperative that the voices of all Canadians, including Canadians with disabilities, continue to be heard on the issue of medical assistance in dying.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I am pleased to join the debate on Bill C-7, an act to amend the Criminal Code, specifically section 241 of the Criminal Code. That is the provision of the Criminal Code that makes it illegal to counsel a person to commit suicide or to aid someone to do so.

In the absence of more recent amendments, in the previous Parliament there was Bill C-14 in response to the Carter decision by the Supreme Court of Canada. In that case the court found that the plaintiffs' charter rights had been infringed upon by a strict interpretation of section 241.

Interestingly, Bill C-14 from the previous Parliament stated, as one of its objectives in paragraph six of the preamble:

...permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance between the autonomy of persons who seek medical assistance in dying, on one hand, and the interests of vulnerable persons...on the other;

The relevant provisions in the Criminal Code included that language. It states that qualifications for MAID, including with respect to the person:

their natural death has become reasonably foreseeable, taking into account all of their medical circumstances....

All of this is about to change because of the Truchon decision.

I am speaking to Bill C-7, a bill that would eliminate the reasonable death foreseeability safeguard and expand MAID, medical assistance in dying, to a larger number of people. I have been encouraged to speak to the bill because of the many letters and the correspondence I have received from people in my constituency.

I have received some letters in support of expanding MAID, but the vast majority of the letters I have received encourage me to speak against expanding the availability of medical assistance in dying.

Correspondence that I am receiving from constituents repeat two basic themes. First is that the reasonable foreseeability of death safeguard should be maintained as an effective defence of societal interests and Canadian values. Second is that more should be done to expand palliative care services.

To quote one person, let Canada be a society that is known for its modern and advanced palliative care services and not as a country that has ever expanding use of medical assistance in dying. We should alleviate the suffering, not eliminate the sufferer.

I am going to read quotes from two people who each made the effort to write me a letter.

The first is Dr. den Hollander, who states:

If Canada must allow MAiD in some form (and I wish it didn't), it is incumbent upon us to ensure that it is rare. Eligibility requirements should be tightened, not loosened. More safeguards are necessary, not fewer. Enforcement must be scrupulous, not relaxed. Without these protections, vulnerable people will be pressured by family members, friends and medical practitioners to MAiD.

The second is a woman named Ramona. She works in health care, including palliative care. She quotes a person to whose care she attended, and who died in the Langley Hospice facility, as saying, “I want to live well while I'm dying.” Ramona goes on to comment, “Surely this is what health care was created for, to support people while they are alive, not to speed up their death.”

This is the tenor of the input I am receiving from my constituents.

Behind Bill C-7 is the Superior Court decision in Truchon. The plaintiffs in that case argued that their constitutional rights had been infringed upon by the now amended section 241 of the Criminal Code. They argued that the Carter decision, on which Bill C-14 was based, did not require that a person's end of life be reasonably foreseeable, and that is a true statement. That is not what the Carter decision required.

Secondly, they argued that the legislated end of life requirement violated the right to equality, under section 15 of the charter, and the right to life, liberty and security of the person, under section 7 of the charter. The federal government, acting through the Attorney General's office, did the right thing at that time. It defended its law. That is what the Attorney General should do. Bill C-14 was the well-considered opinion of the previous Parliament. It was the law. The Attorney General must defend the law.

Remarkably, the Quebec Superior Court refused to accept the arguments advanced by the Attorney General. The Quebec Superior Court said that the court cannot accept the first two objectives advanced by the Attorney General regarding the affirmation of the inherent and equal value of every person's life and the importance of preventing suicide.

In the opinion of the justice writing that decision, those two principles were not the underlying philosophy of Bill C-14. It was all about protecting vulnerable persons from being induced, in moments of weakness, to end their lives.

Remarkably, the Attorney General of Canada did not appeal that decision. That is what should have been done. Any self-respecting Attorney General would appeal a decision that attacked the laws of Parliament. This Attorney General elected not to do that. Now we are in this position where we are under pressure to amend the law, when we should instead be following the directive of Bill C-14, and that is to have a comprehensive review of the whole legislation.

That is what we should be doing. What is the rush? The rush is caused by the Attorney General's failure to appeal this decision. It should have been tested through the court system, up to the Supreme Court of Canada.

With the reasonable foreseeability of death safeguard down, this is what we have left. An applicant for MAID qualifies if he or she has a serious and incurable illness, disease or disability; is in an advanced state of decline; or their physical or psychological suffering is intolerable to them, which is a completely subjective test. The reasonable foreseeability of death criteria is now gone.

Let us just test this against a couple of hypothetical situations. We can imagine that a person has Parkinson's or MS, or was in a terrible accident and is a paraplegic. Under this new regime, if it becomes the law, people who are not dying but who meet all the other criteria, however subjective they may be, will qualify for state-sanctioned suicide. One of my constituents has said that we should let Canada be a society that is known for its modern and advanced palliative care services, and not as a country that has ever-expanding use of medical assistance in dying.

[Patty Hajdu, Liberal, Minister of Health]

Mr. Speaker, I am very pleased to rise in the House today to address Bill C-7 and to speak to our proposed changes to Canada's medical assistance in dying legislation.

The proposed measures respond to the Superior Court of Québec's Truchon decision, in which it ruled that it is unconstitutional to deny access to medical assistance in dying to individuals who meet all the other eligibility criteria but are not near the end of life.

In responding to this ruling, the Government of Canada has had the opportunity to consider some additional measures for which there is strong support. That is why we are proposing changes that will help clarify and add precision to Canada's medical assistance in dying legislation.

Over the past few months, I have had the honour of listening to many Canadians, and it was important for me as the Minister of Health to hear first-hand what they had to say. My colleagues and I hosted a series of round tables and heard from more than 125 experts, academics, ethicists, doctors, nurse practitioners, members of the disability community, indigenous groups and key stakeholders. I also engaged my provincial and territorial colleagues, and my officials worked closely with their counterparts across the country.

In January, I was in Calgary and spoke to Cynthia Clark, who saw her husband through the process of medically assisted death last summer. Her perspective, as well as those of so many others with first-hand experience were invaluable.

I also listened to practitioners who have been providing medical assistance in death in a very thoughtful, compassionate way over the last four years. They had a lot to say about what was working well but also about what was not working well.

We heard many personal stories like Cynthia's, and they helped shape the changes that we are proposing today. In addition, the feedback received from our online consultation was astounding. In two weeks we had more than 300,000 responses.

It is clear that certain aspects could be improved in order to facilitate access, protect the vulnerable and respect personal choice.

With this bill, I think we have achieved a balanced approach that reflects the best interests of all Canadians.

Protecting the safety of vulnerable people while respecting the autonomy of Canadians remains our central objective. That is why the bill proposes a two-track approach to safeguards, based on whether or not a person's death is reasonably foreseeable.

Reasonable foreseeability of natural death would no longer be a requirement for determining whether a person can access medical assistance in dying. It would, however, be used to guide practitioners in determining which safeguards to apply. This is consistent with what we heard at the round table meetings.

Providers involved in assessing the eligibility of applicants for a medically assisted death told us they have a good understanding of the concept and are comfortable applying it. Under the amended law, they would use reasonable foreseeability of natural death to determine not eligibility, but rather which safeguards would apply.

For those whose death is reasonably foreseeable, we would ease some of the pre-existing safeguards. Under the current system, there is a requirement for a 10-day reflection period. We are proposing to eliminate this reflection period. For those who are at the end of their life, the decision to request medical assistance in dying is well considered, and this additional period only serves to prolong suffering unnecessarily.

The current system also requires that two independent witnesses confirm that the person who has signed a request for medical assistance in dying is who they claim to be and that no fraud has occurred, such as the forging of someone's signature. During our consultations, we heard that this requirement was a significant barrier for many people at the end of their life.

We propose requiring only one witness and allowing this witness to be a paid personal or health care provider. These individuals naturally would be excluded from acting as a witness if they are a beneficiary of the person's will or if they would receive a financial or material benefit from the person's death. Anyone involved in assessing or providing medical assistance in dying would continue to be ineligible to serve as a witness.

For those whose death is not reasonably foreseeable, we would create a new, more robust set of safeguards. We think it is important, even while improving access, to ensure that people who are suffering but who are not dying are given full and careful consideration as they assess whether or not to pursue an assisted death.

Strengthened safeguards would also serve to protect vulnerable individuals. For example, the bill proposes a minimum period of 90 days for assessing a MAID request in the case of a non-imminent death. This period would allow for exploration, discussion and consideration of options to alleviate suffering by the person seeking medical assistance in dying and with the practitioner.

The bill would also require that the person requesting MAID be provided with information on available counselling, mental health supports, disability supports and palliative care as part of the informed consent process.

We know that the majority of practitioners are already ensuring that their patients are aware of all of the supports and options that are available to them. This provision underscores the importance of the doctor-patient relationship. It allows for a practitioner and a patient to decide whether medical assistance in dying is the right step and provides sufficient time for the patient to discuss and consider other treatment options, which is crucial for patients weighing this kind of decision. This provision supports fully informed decision-making and individual autonomy.

Under the current legislation, those who become incapacitated lose their eligibility for medical assistance in dying because the person must give their consent immediately before the procedure. This means that some individuals deemed eligible for medical assistance in dying have chosen to end their lives earlier than they wanted out of fear of losing the opportunity to receive this service.

That is why we are proposing to include a waiver of final consent for persons whose death is reasonably foreseeable and who have been assessed and approved to receive medical assistance in dying. Individuals at the end of their life who risk losing their decision-making capacity before their chosen date would have an avenue to receive MAID without worrying that loss of their decision-making capacity before their chosen date would disqualify them. Support for this amendment is strong among stakeholders, Canadians and health practitioners.

Canada has had four years to reflect on the current MAID legislation passed in June 2016, and there are many complex issues that require further study.

In December of 2016, the Government of Canada asked the Council of Canadian Academies to conduct independent reviews on three specific types of requests for medical assistance in dying that are currently outside of the scope of the law: requests by mature minors, advance requests and requests where a mental disorder is the sole underlying medical condition.

The Council of Canadian Academies convened a multidisciplinary panel of 43 experts to review an extensive body of evidence, including Canadian and international academic and policy research.

We tabled those reports in Parliament in December 2018. They provide us with a thorough, thoughtful examination of these very difficult subjects. I encourage all members to read those reports as we continue our deliberations on the proposed legislative amendments and the parliamentary review that will be conducted later this year.

There is agreement among experts that allowing advance requests for people with illnesses such as Alzheimer's disease well before they would otherwise be deemed eligible is very complex and will require careful consideration and consultation before it could be included in legislation.

During the round tables I heard directly from health care providers who expressed discomfort because they have seen patients who, as their position progressed, might not have the same desire for medical assistance in dying as when they were first diagnosed. The Council of Canadian Academies' expert panel report on advance requests came to the same conclusion.

At the same time, we know that many Canadians have expressed an interest in advance requests so that they could have the comfort of knowing that they could avoid extreme suffering at some future date.

For all these reasons, we believe this issue deserves deeper examination through parliamentary review. That will be our opportunity to tackle questions that are profound and difficult to answer, even for practitioners who have been providing this service over the past four years.

The proposed changes to the medical assistance in dying legislation would exclude persons if mental illness is the sole underlying medical condition.

This does not mean that people with mental illness are ineligible; it means that mental illness cannot be the sole underlying condition. This is another complex aspect that warrants a more thorough discussion.

Since the federal legislation came into force in 2016, Health Canada has released four federal interim reports that provide more information on how the legislation is being implemented across the country.

In November 2018, we implemented regulations that resulted in the creation of a permanent monitoring regime that sets out obligations for reporting on medical assistance in dying cases by doctors, nurse practitioners and pharmacists. The first monitoring report under these regulations is expected to be released in spring 2020.

Since MAID legislation was enacted in 2016, more than 13,000 Canadians have chosen this option of a medically assisted death. This is not unexpected. We have seen a gradual increase in the numbers over the last three years. The number of MAID deaths in Canada, slightly under 2% of all deaths, is in line with international regimes. The increasing use of MAID is largely a result of enhanced awareness of it as a legal option and greater acceptance by Canadians.

The federal government recognizes that public reporting is critical to ensuring transparency and also to ensuring public trust in the legislation. That is why we are proposing changes to expand data collection to help provide a more complete picture of medical assistance in dying in Canada.

Under the current legislation, only practitioners who receive a written request for MAID and pharmacists who dispense a MAID substance are required to provide information, but it has become clear that capturing information based solely on written requests for MAID received by physicians and nurse practitioners has resulted in an incomplete picture on who is requesting MAID across the country, and why.

The amended legislation would authorize new regulations to be developed in partnership with provinces and territories to allow for the collection of data on all assessments for MAID, and this would include those undertaken by other health professionals on the care team. It also clearly aligns with the original intent of the legislation to collect information on all requests for, and cases of, MAID in Canada.

I think we can agree that Canadians with life-limiting illnesses deserve the best quality of life possible as they approach the end of their lives. Palliative care and end-of-life care provide patients with relief from the pain and distress associated with a life-threatening illness. Supporting home care and palliative care is a key priority in our ongoing efforts to improve our health care system.

Through budget 2017, we made historic new investments in health care to improve access to mental health and addiction services, as well as home and community care, including palliative care.

To further support access to palliative care across the country, the government worked closely with provinces, territories, and stakeholders to develop the framework on palliative care in Canada, which we tabled in Parliament in 2018. We have released an action plan to support each of the priority areas identified in the framework.

I want to assure the House that the proposed bill responds to concerns identified by practitioners and experts through the round table discussions.

I will continue to work closely with the provinces, territories and key partners to support the implementation of the proposed legislative amendments, if they pass in Parliament.

This includes working with provinces, territories, health system partners and regulatory bodies to support best practices and information sharing on clinical guidance and other aspects of implementation, which includes training and retrospective reviews.

I have a great deal of respect for the practitioners who have been providing this service over the last four years with immense diligence and a huge amount of compassion. Their experiences have helped us craft legislation that much better meets the needs of Canadians. This law is constructed in a way that supports autonomy, but it includes the flexibility to allow a practitioner and a patient to work more closely together.

Medical assistance in dying is a complex and deeply personal issue. In tabling these changes, our government has considered carefully the need for personal autonomy and the protection of vulnerable people.

There is strong public support for change, and I believe we have found an approach that reflects the best interests of all Canadians. I urge all members of the House to support the proposed changes.

The House resumed from February 26, 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.

[Kody Blois, Liberal, Kings—Hants, NS]

Mr. Speaker, as members know, on September 11, 2019, the Quebec Superior Court's decision in Truchon struck down the eligibility criterion of reasonably foreseeable natural death from the medical assistance in dying, MAID, regime in the Criminal Code. It is my sincere pleasure today to join the second reading debate on Bill C-7, which is the government's response to this ruling and which includes a revised safeguard framework.

Bill C-7 proposes amendments to the Criminal Code that would work to ensure consistent application of the MAID law across the country and would adjust the safeguards for a MAID regime that is no longer limited to end-of-life circumstances. Specifically, the bill would create two sets of safeguards to be followed before MAID is provided.

One set would be for individuals who are dying whose death is reasonably foreseeable; in which case, most of the existing safeguards would continue to apply, with a few being eased or removed. The second new set of safeguards would apply to individuals whose natural death is not reasonably foreseeable. That is why we are here today, to talk about this legislation given the fact of the decision from the Superior Court in Quebec.

This approach to differentiating between MAID requests is consistent with the view that providing MAID to people whose natural death is reasonably foreseeable presents less of a risk and is less complicated than providing MAID to those who are not on a clear trajectory toward death. It is sensible and appropriate that the assessment of a MAID request should be tailored to these different types of cases to account for the different types of risk that could arise.

For people who have requested MAID and whose natural death is reasonably foreseeable, amendments to the safeguards in this legislation include the removal of the mandatory 10-day reflection period, which, of course has been discussed quite widely in the speeches here today; a reduction in the number of independent witnesses; and a change regarding who can be independent witnesses.

Existing safeguards, such as the need for two independent practitioners who verify the person's eligibility and the need for the person to confirm consent immediately prior to the provision of MAID, will remain unchanged for those whose natural death is reasonably foreseeable. The exception is in specific circumstances where consent is given in advance. I am referring to Audrey's amendment, which is something that is very important to me, and was certainly highlighted given the fact that Audrey Parker was from Halifax in my home province.

During the government's recent MAID consultations, stakeholders noted that the existing 10-day waiting period could result in the prolonged and unnecessary suffering of the patient. We can all appreciate some of the challenges that would present. Bill C-7 proposes to remove this requirement for people whose death is reasonably foreseeable. A patient who is in that situation and requesting MAID has likely thought and reflected about this particular decision for a considerable amount of time. Requiring the patient to wait an additional 10 days when his or her suffering is already unbearable is just unnecessary.

For both streams of the MAID request, it is proposed that the requirement for two independent witnesses to a patient's written request for MAID be changed so that only one is needed. The role of an independent witness is to attest to the fact that persons requesting MAID have signed and dated their MAID request themselves in a voluntary manner. The witness would not play a role with respect to the eligibility assessment, which is the responsibility of two independent practitioners, nor do witnesses confirm whether the safeguards required by the Criminal Code have been followed.

The current rules also exclude people like health care providers and personal support workers from being independent witnesses. This can create access barriers for individuals living in nursing homes or other residential settings who may have very few family or social networks.

Speaking from my own experience in my riding, that certainly can be the case, where individuals who are living in nursing homes or in these situations might not have a large family or friend network to be able to draw upon, and I think that is an important piece. Individuals who are paid to provide personal care or health care are likely to be among the limited number of personal contacts an individual living in a care institution may have, as I alluded to. The amendments to the MAID regime would allow a paid personal or health care worker to be an independent witness, which would increase access to MAID for this population. That is key.

For patients who are eligible for MAID but whose natural death is not reasonably foreseeable, the key piece of the Truchon decision, Bill C-7 proposes a separate set of safeguards in addition to the existing safeguards, such as written requests that are signed before an independent witness and confirmation of consent.

In situations where natural death is not reasonably foreseeable, there would be new requirements that focus on the need for additional time, expertise and information in these circumstances. I believe that is balanced in the way we move forward.

First, there would be a minimum assessment period of 90 days, which could be shortened if loss of capacity was imminent and the assessments were complete. Second, one of the assessing physicians would need to have expertise on the condition that is causing the person's suffering.

There would also be two clarifications of the requirement for informed consent. First, the patient must be informed of the appropriate counselling, mental health supports, disability supports, community supports and palliative care options available to them, essentially outlining the availability of health care and supports that are there.

The second practitioner would need to agree with the patient that the reasonable means of alleviating their suffering have been discussed together and seriously considered, which is very important.

It is fair to say that the assessment of MAID requests by those whose death is not reasonably foreseeable can be more challenging, and can raise more concerns, than MAID requests by those who are dying or whose death is reasonably foreseeable. I think that certainly resonates with Her Majesty's loyal opposition and my colleagues on that side of the House.

For example, is their suffering caused by factors other than a medical condition, such as loneliness or lack of access to necessary supports? Are there ways of addressing the suffering, other than MAID? I think this really gets into the slippery slope in the sense that we are making sure that there are provisions in place to explore all options before an individual chooses to move forward with the process.

The new safeguards, the requirement of a minimum of 90 days and for one of the two assessors to have expertise in the source of a person's suffering, seek to ensure that enough time and the right kind of knowledge are devoted to exploring all relevant aspects of a person's situation, including whether there are treatments or services that could help reduce a person's suffering.

These are bolstered by the proposed requirement that practitioners discuss reasonable treatment options with the patient and be satisfied that the patient has weighed the risks and benefits of the available options. I think that is balanced and fair.

I think we can be confident that most of our practitioners, as part of their good medical practice, fully explore appropriate supports that are available and the available treatments in discussion with their patients. The proposed safeguards reinforce the importance of these good practices and will help to reduce risk to vulnerable persons, which I am sure we can all appreciate is a concern for members in the House.

I would like to conclude by stating that it is my belief that this bill strikes a delicate balance. We know that this is a challenging issue for many members, but it strikes a delicate balance between respecting personal autonomy and protecting vulnerable individuals.

MAID is a personal issue, and one that likely has or will touch many of us here today at some point in our lives. I, for one, am comforted by Bill C-7's proposed two-tier approach in terms of the safeguards. It is reasonable, and it is balanced.

Also, I want to go on record that I think Audrey's amendment makes sense. It was a gap under the former legislation. I have had many individuals reach out to my constituency office asking me to be a champion to make sure that Audrey's amendment was included in our revised legislation moving forward.

Other members have spoken to this, and I am certainly pleased to see that in there. If anyone knows Audrey Parker's situation, they would know of the challenge it presented to her and her family, and we do not want to have people in Canada who are forced to make that decision.

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

Mr. Speaker, I will be splitting my time with my colleague, the member for Kings—Hants.

I am pleased to rise today to speak to Bill C-7. I have some prepared remarks, and during the course of my comments, I will try to sprinkle in some responses to some of the various issues that have already been raised.

Clearly, we are here because there was a decision of the Quebec Superior Court in the Truchon case. This decision struck down a particular criterion under both the Quebec regime and the Canadian regime with respect to the end-of-life nature of medical assistance in dying, this being the reasonable foreseeability of natural death criterion, in particular at the national level.

The court's ruling only applies in Quebec. We heard the minister speaking about this. He suspended its declaration of invalidity for a period of six months, until March 11. It is important for this chamber to understand that on February 17 of this year, the Attorney General of Canada filed a motion to request an extension to give Parliament sufficient time to enact an appropriate response to ensure consistency in the criminal law. That motion was actually debated yesterday, and a decision from the court is forthcoming.

Before I go into some of the details in this bill, I want to start off with two important provisions related to conscience protection that were raised by members of the official opposition in the context of this debate. I want the record to be crystal clear that conscience protections are robust in this country and are entrenched in the law.

The first location is in the preamble to the old Bill C-14, which I will read. It states, “Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms”.

I have had further questions from members of the official opposition about why it is only in the preamble and not in the statute. That assertion is wrong, because it is in the statute. Section 9 on page 8 of the old Bill C-14, which amended subsection 241.2(9) of the Criminal Code, says “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

The third point I will read is from the Carter decision of the Supreme Court, which has been the subject of extensive discussion in this chamber thus far. I am reading from paragraph 132 of the majority reasons in Carter. The court states “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

Those are three instances. One is jurisprudential and the other two are statutory. The fourth one is of course the broad penumbra that is cast by section 2 of the charter, which protects freedom of conscience for all Canadians, including those who practise medicine. Therefore, the assertion that somehow conscience rights are not protected or are somehow being eroded is categorically false.

Another point in terms of what is being addressed in today's debate is the notion that a culture of overly facilitating medical assistance in dying is upon us, and that somehow this government bill is pushing us further toward predatory practices by health care practitioners or toward disavowing the right to life, liberty and security of persons who are vulnerable, including persons with disabilities. That is categorically false and is not commensurate with what is in evidence.

The evidence we have is readily available in the technical briefing that was already provided to all members of Parliament. It is that in total, 13,000 MAID-assisted deaths have happened in this country in the last four years. The average age of people who are accessing MAID is 75 years old. It is being accessed equally by men and women, 51% by men and 49% by women. The most common medical condition is cancer, followed by neurological conditions, in that 67% of all people who access it have cancer. Second come neurological conditions and third come cardiovascular conditions.

Very importantly, in the most recent year of analysis, a grand total of 5,444 people accessed MAID in this country. That represents 1.89% of all deaths in this country. I read that into the record because I think it is important for people to understand that there is not some sort of culture of medical assistance in dying that is being foisted upon unwitting individuals. I will elaborate on my reasons going forward.

I would like to talk about some aspects of the bill. The eligibility criteria have changed, as the Minister of Justice pointed out.

There are two series of safeguards. The first applies to cases in which the person's death is reasonably foreseeable, while the other applies when death is not reasonably foreseeable. The bill would add new safeguards to that second category.

Lastly, the bill allows a person to waive final consent on the day of the procedure in certain circumstances.

I will return to that in a few moments.

Much has been made about the consultation process, including some comments by the member for Mission—Matsqui—Fraser Canyon about it being a rushed procedure and that the government is not adequately listening to Canadians. I have great respect for all members in the House who are participating in this debate and raising a number of very personal, ethical, legal and moral issues. I understand that; the government understands that.

However, to assert that the consultation was not robust is again categorically false. We heard from 125 different individuals, who are experts in this field, whether they are delivering it or acting on behalf of disabled individuals, and from nurses, doctors, etc. We heard from 300,000 Canadians through their responses to a questionnaire that outlined the various scenarios.

The views of those individuals were quite concrete in the direction they were seeking. They wanted to be empowered in terms of their autonomy, dignity and their choices. They were seeking less obstacles to what had evolved to become an overly restrictive regime, as identified by the court in Truchon. That important feature must be canvassed here. What is important to understand is that the input received was critical to the development of the bill.

As part of the proposed amendments to the Criminal Code, the reasonably foreseeable death provision will be removed from the eligibility criteria. This is in response to the Truchon decision.

In terms of legal impact, this amendment would mean that people whose death is not reasonably foreseeable would be eligible for medical assistance in dying if they meet all of the other eligibility criteria.

This is very important.

The bill proposes to exclude persons whose sole underlying condition is mental illness. This has been touched upon by different people who have already intervened in the context of this debate. This is important, as was outlined by the minister. It recognizes the increased complexities and risks associated with such cases, which were highlighted by many practitioners, stakeholders and experts at the main round tables.

What is very important is that the Canadian Mental Health Association supports the position we are taking with respect to excluding mental illness as a sole underlying condition to render someone eligible for MAID.

This complex issue must be examined carefully as part of the parliamentary review of the legislation on medical assistance in dying, which is to start in June of this year, as the minister himself mentioned.

Importantly, the Government of Quebec has also announced the exact same study for the exact same provision, that the issue of mental illness as a sole underlying condition is complex. Issues of consent and capacity and issues of properly being able to diagnose and have a prognosis are critical.

I will move to some of the comments that have been made. It is important for people understand that the safeguards are under two tracks. Those safeguards respond to persons whose deaths are reasonably foreseeable and those whose death is not.

With respect to some of the aspects raised in the context of today's debate, we have taken the 10-day period of reflection out of the legislation. This was put squarely into issue by the member for Fundy Royal when he asked about the basis for doing that. The basis for it was that the safeguard was not doing the work it was meant to do. As opposed to protecting vulnerability, it was actually increasing the vulnerability of individuals insofar as it was prolonging suffering in some instances.

We heard, and the minister commented on this, that some people were so concerned about the inability to provide their final consent after 10 days that they would stop taking their pain medication, which was creating further suffering, just to maintain the ability to provide that final consent.

On the question raised by the member for Sherwood Park—Fort Saskatchewan most recently with respect to how one assures informed consent is applied when it has not been solicited actively, I have two responses. This is with regard to the advanced consent regime.

The government is conscious of the Audrey Parker situation and we are seized with it. When people have been assessed and approved for this procedure and when they make a determination that they want to access it and provide consent in writing, that consent would be sufficient.

In direct response to the member for Sherwood Park—Fort Saskatchewan, could it be vitiated? Yes. First, if the person has not lost capacity, consent could be vitiated. Second, it could be done by a physical gesture that would be interpreted to fully and finally eliminate that consent for the purposes of the practitioners.

The bill strikes a balance and the balance is important. We are conscious that a compassionate response that protects vulnerable individuals and also respects their dignity and autonomy is critical and what is required by the Constitution.

That is what this bill represents and I am very hopeful, as the member from the Bloc Québécois pointed out, that we can achieve all-party consensus on that very fundamental point.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, the safeguards that need to be in place for medical assistance in dying are incredibly important. We want to make sure that at all stages patients, should they change their mind, have a way of opting out.

If the member has particular concerns with how Bill C-7 is currently written and is concerned that there is not enough addressing the concerns he just brought up, perhaps there will be an opportunity for some slight amendments at committee. I am sure that myself and the member for Esquimalt—Saanich—Sooke, who serves as our main justice critic, would be willing to look at his proposed amendments to see what he proposes to make that particular section of the bill stronger.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, it is quite incredible to be revisiting this issue. I can remember when the debate on Bill C-14 went on, back in 2016. There were some amazing speeches uttered in Centre Block during that time. This truly was an issue that had a profound effect on so many members in the chamber but, we know, also on so many members of our society.

I was honoured in 2017 to serve as our party's justice critic. I am pleased to again be serving in the role as the deputy justice critic for the NDP. I have always felt that this particular critic role brings with it a very great weight of responsibility, especially when we are dealing with the Criminal Code. I do not think there is any other statute in Canada that has such a profound effect on people when they violate any of its provisions. It also gives a lot of guidance, as is the case in medical assistance in dying, over the parameters that are set up.

Regarding medical assistance in dying I, like many members in the chamber, received a lot of correspondence on the issue back in 2016, both from constituents who were against it and from constituents who wanted me to take up the cause.

I think that is the challenge that we as members of Parliament face on a regular basis. We have to look at our constituents' wishes, but they are not always very clear cut. We have to try to balance those with our own personal views on the subject and, at the end of the day, try to be accountable for the decisions we have made on behalf of our constituents in this place.

When it comes to an issue as complex as medical assistance in dying, I fundamentally believe that we must go beyond partisanship and work together with a compassionate lens. Ultimately, we must make sure that Canadians can die with dignity, compassion and fairness, and without excessive suffering.

I am pleased to see the introduction of Bill C-7 as part of the effort to help those who are looking to end their unnecessary suffering as they face the end of life. Bill C-7 is coming to us as a result of a decision in a Quebec court. For me personally, and for many members of the New Democratic caucus, it was quite evident in 2016 when we were debating Bill C-14 that this issue would come back to us. We knew it was only a matter of time.

I can remember referring, in the debates on Bill C-14, quite clearly to the Carter decision, which was handed down by the Supreme Court on February 6, 2015, in the final months of the 41st Parliament, when the Harper government was in power.

When the present Liberal government came to power in 2015, this was one of the major challenges it was faced with, because there was an impending deadline and there was a real rush to get in legislation that was going to respect the Carter decision.

I want to give a shout-out to two of my colleagues, Murray Rankin and Brigitte Sansoucy. As members of the New Democratic caucus, they sat on the special joint committee that looked at this issue as a result of the Carter decision, and presented the committee's recommendations to the House of Commons.

When we look at the Carter decision, which really started this whole process rolling just over five years ago now, we can see that they felt the prohibition on allowing people to take their own lives because of suffering violated their Charter rights. I will just quote from the ruling. It was stated that:

Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

It went on to say:

An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.

Thus, it violates section 7 of the Charter of Rights and Freedoms. Just to read it into the record, so that everyone is quite clear on what we are referring to, section 7 reads that:

Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

What Carter was clearly explaining to people was that by not allowing people this option, by keeping them in a state of constant suffering, of basically confining them to their bodies, we were in fact violating their section 7 rights. That was the clear message that was delivered to Parliament.

There is always a careful dance between our courts and the legislature. The courts, of course, are very much responsible for interpreting the law, but also finding when such a law runs contrary to our Constitution. They also recognize that Parliament has its role to play as the lawmakers, as the one institution that can amend the law based on people's wishes. That was the task that was handed to us at the beginning of the 42nd Parliament.

When that special joint committee with the other place was formed, there were some clear recommendations that directly followed from the Carter decision. Recommendation number two, which I will read into the record, was as follows:

That medical assistance in dying be available to individuals with terminal and non-terminal grievous and irremediable medical conditions that cause enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

The problem that led us to where we are today was the fact that Bill C-14, as a government bill, decided to insert a reference to “reasonably foreseeable death”. This meant that if one had a medical condition for which death was not reasonably foreseeable, one could not qualify for medical assistance in dying.

Also, as a part of that special joint committee's recommendations, it did touch on the subject of advanced directives which is also, I am glad to see, addressed in Bill C-7.

The Truchon decision of 2019, in the Superior Court of Québec, involved two plaintiffs who were each suffering from grave and incurable medical conditions that caused tremendous suffering and a total loss of autonomy.

They were 74-year-old Nicole Gladu, who used a wheelchair and had post-polio syndrome, which is a condition that weakened her muscles and reactivated her childhood scoliosis. She had difficulty breathing and was in constant pain. As well, there was 51-year-old Jean Truchon, who was born with cerebral palsy and no longer had the use of his four limbs. He lost the use of his only working limb back in 2012, due to severe spinal stenosis that left him almost completely paralyzed and caused painful spasms. He gave up most of his activities and went into assisted living since there was little he could do by himself.

Both of these individuals were refused medical assistance in dying under the Quebec legislation regarding end-of-life care as they were not at the end of their lives. Their deaths were not reasonably foreseeable.

With those grave medical conditions, they were prisoners in their own bodies but unable to find any relief. Really the heart of the matter here is how we, as an institution, respect individual autonomy. We can only imagine the pain and suffering they were going through on an hourly basis. When two individuals have arrived at this decision and obviously had the time to think about it, I think it is incumbent upon us to respect that, but more importantly to respect the fact that we have had a court look into this and determine that their charter rights were fundamentally violated.

That brings me through the long journey over the last five years to Bill C-7.

I am pleased to see the bill introduced. The Minister of Justice was one of four Liberals who voted against Bill C-14. I think he is now having a moment where it has come full circle. Now, as the Minister of Justice, I hope he feels some satisfaction in bringing in corrective measures to address the problems he saw as a Liberal member of Parliament back in 2016, when he voted against the government's legislation at the time.

As is required by the decision of the Quebec court, Bill C-7 will expand access to medical assistance in dying to those whose death is not reasonably foreseeable. I can assure the House that we are providing our support to the bill in principle at second reading. However, we will be doing our due diligence when it reaches the Standing Committee on Justice to ensure that access to medical assistance in dying has not been unreasonably restricted for those whose death is not reasonably foreseeable by the addition of the new conditions in the legislation.

We also want to ensure the standard of eligibility for receiving medical assistance in dying remains high. We remain disappointed that there has been no commitment by the minister to refer the question of the adequacy of the safeguards against pressure to seek medical assistance in dying to the formal legislative review, which will begin in June, again at the Standing Committee on Justice. Perhaps the government can hear those words, reflect upon them and address our concerns with respect to that aspect.

Going into some of the finer details of the bill, essentially there is a two-track process in Bill C-7. There is one for those whose death is reasonably foreseeable and one for those whose death is not reasonably foreseeable.

For the one where death is reasonably foreseeable, the 10-day waiting period is removed; the number of independent witnesses required for the written request is reduced from two to one; a paid professional or health care worker can be an independent witness; and the creation of a waiver of final consent.

For the second track, which is ultimately the part of the bill that is responding to the decision from the Quebec court, a few more restrictions are in place. The first big one, which will warrant some further study at committee, requires a minimum 90-day assessment period, which I think the legislation states can be shortened if loss of capacity is imminent and the assessments have been completed.

However, as I have said in previous questions and comments, we have already heard from some members of the medical community. They say that the 90-day assessment requirement may mean their patients have to endure another 90 days of suffering. For physicians, who take the Hippocratic oath to do no harm, if their patients are experiencing harm every day because of that suffering, that weighs very heavily on their conscience.

There are some other specifics in that other track process that I do not think warrant going into too much detail at this stage. The Standing Committee on Justice will do that.

I also want to touch on another aspect of Bill C-7, which is the advance directive. This is known as the Audrey Parker amendment. It refers to Audrey Parker, a Halifax woman who was diagnosed with stage four breast cancer, which metastasized to her bones and a tumour on her brain. She spent the last weeks of her life raising awareness about the challenges facing Canadians who had been assessed and approved for assisted dying. She opted to die earlier than she would have otherwise wanted to. The legal requirement in the existing legislation is that the suffering person has to be competent immediately before the life-ending treatment is administered.

That presents a number of problems. If someone has already been approved for medical assistance in dying within the tight confines of what is written in Bill C-7, he or she can give that advance directive so that those wishes will be fulfilled even if there is a loss of competency. It would remove a sense of pressure that could be brought to bear on individuals who may feel compelled to take their life earlier, while they still have competency and the ability to act on their own directive. Therefore, I think this is a particularly important section of this legislation that should be noted, and I certainly look forward to seeing what kind of testimony we hear at the justice committee.

I have received some correspondence with respect to the Audrey Parker amendment. I have an email here from a constituent. She sent me a copy of her letter to the justice minister. She states:

These steps ensure that the patient qualifies for medical assistance in dying under the law, making the late-stage consent requirement unnecessary — and puts an enormous physical and emotional strain on people who are at risk of suddenly losing capacity, or who need heavy medications to manage their pain.

Most importantly, this unfair requirement means that people in the Assessed and Approved category are faced with a cruel choice: access assisted dying now, or wait longer and risk losing out on their right to a peaceful death.

Right now, dying people are ending their lives far earlier than they would like, or are refusing adequate pain care out of fear that they will lose out on their right to a peaceful death. This is an unacceptable burden for anyone to bear, and it is a clear and grave violation of Canadians' Charter rights.

That is just an example of some of the correspondence I have received on that particular aspect. It is actually really nice and refreshing to hear someone lay it out quite clearly because I think if we were to visit any riding we would all have constituents who have faced those pressures.

This is weighty subject matter. I know that in this chamber and indeed across this great country there are going to be multiple views on whether we are in fact going down the right path.

In moments like this when we are called upon to make these momentous decisions, we are required to look inside ourselves and to switch more from sympathy to empathy. I see this difference between the two. Sympathy is feeling sorry for someone else, while empathy is trying to put oneself in that person's shoes in order to view the world as she or he sees it.

The truth is that the members of this chamber who are lucky enough to have their health and to lead privileged lives cannot adequately express or feel what it is like to live in a body that feels like a prison and to know that kind of suffering. My ultimate view of this bill, and what guides me in the direction we need to take, is that it is about trying to make sure we can give people the dignity in death that they had in life, to respect their autonomy, to respect their choice and to make sure that their charter rights are not violated.

I conclude by stating that the New Democrats will be supporting this bill at second reading, with the full realization that the committee work is before us, which will be a real opportunity to hear from members of the public and witnesses. Hopefully, when this bill returns to the House we will have a product that we all feel we have done our best on and that lives up to the important wishes of our constituents who are living with these incredible amounts of suffering.

[Luc Thériault, Bloc, Montcalm, QC]

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

We are debating Bill C-7 today because the legislators who were here four years ago did not do their job properly when they debated Bill C-14. We do not live in a democracy run by judges. We are the ones that make the laws and who must make the voices of citizens heard, particularly the voices of those who are suffering. All judges do is interpret the grammar of justice. They look at the laws and people's rights and freedoms and determine whether the infringements are reasonable or not. However, before Bill C-14 was introduced, two courts told us that, according to the law, the Criminal Code infringes on the right to life and the right to liberty and security of those who are ill and suffering, are struggling with unbearable pain or have a terminal illness.

Today, I hope that we will seize the opportunity that is given to us. I hope that we will extend the debate until June because this is a serious subject. I hope that we will have a calm, rational debate.

I will start by saying that I am sure my colleagues in the House all have good intentions. They want to do good. They have kind hearts. I am sure that their behaviour throughout the debate will reflect the very values they are advocating, namely benevolence and caring. However, we cannot be benevolent and want what is best for a terminally ill person if we refuse to listen to what that person has to say before they die.

All I want is for us to understand what is at stake here, I am referring to the law, which my Conservative friends have always put on a pedestal. The value of autonomy is conferred by law through the principle of self-determination, especially with regard to medical care. I will come back to that.

I will take a moment in this debate on such a crucial and delicate issue to say that I hope all my colleagues get to cross the threshold of death peacefully, quietly and painlessly. That is my wish for everyone, because the best fate we can wish on another human being is to find peace, to let go and to receive what is known as good palliative care if they are terminally ill with an irreversible ailment. More on that later.

Today we are discussing the autonomy conferred by law through the principle of self-determination. In the biomedical context, there is a rule. A value gives rise to a principle, which in this case is self-determination. This principle gives rise to a specific rule, namely the rule of free, informed consent. The rule about free, informed consent to treatment has never been challenged in emergency situations.

Why would it be any different for human beings experiencing intolerable suffering due to an irreversible illness or condition?

Why would it be any different for competent individuals who are neither depressed nor suicidal and who have expressed a desire to live fully until they reach the limit of what they can tolerate?

I therefore invite my colleagues to join me in a debate on autonomy and self-determination. If someone shows up at an emergency room, they cannot be treated without their consent. Everyone has the right to refuse treatment, by the way.

In the Carter decision, which led to Bill C-7, the Supreme Court ruled that the provisions prohibiting medical assistance in dying violated the right to life, liberty and security of the person. People like Ms. Gladu, Mr. Truchon, Ms. Carter and Ms. Taylor have not reached the end-of-life stage. They might not even be in the terminal phase of their illness. That does not mean they have not reached, or are not in the process of reaching, the limit of what they can tolerate.

The court stated that those provisions were effectively shortening the lives of such individuals, that they violated their right to life by inciting them to commit the act before they were ready. That is the issue that we are called upon to address. There is no issue for people who are terminally ill. The issue we need to address as legislators has to do with people whose death is not reasonably foreseeable and imminent.

The bill proposes that a person who is not terminally ill must consent twice and be bound by a 90-day period. I really wanted to talk about advance consent. I imagine we will do so eventually. That is about all that is missing from the bill. Clearly the Bloc Québécois is in favour of passing this bill in principle.

What we want is respect for the moral autonomy of the dying. We often speak of dying with dignity. Dying with dignity does not mean having a sanitized death. That is not it. The dignity of a person is derived from their freedom to choose and respect for their free will. That is what it means to be a human being. When that is violated, we violate the dignity of the human being. Whether the death is unpleasant or not is not the issue. The crux of the matter is to allow the human being to make a decision about the end of their life.

Unfortunately, in the past, we won the right to die rather than undergo aggressive therapies. At the time, we called this passive euthanasia. The person was left to die without death being the intent. Palliative care was still in its infancy. There was a great fear of administering one last fatal dose of medication, which always ends up causing death, because palliative care provides care.

Human beings won the right to die rather than undergo aggressive therapies. People did not die of cancer; the therapies killed them. Experiments were conducted on human beings. Doctors led the way to ensure that they would have quality of life if they were to be struck by cancer. They did not want to receive treatments that would make them ill for a year when they only had two years to live.

The right to die won out over aggressive treatment plans. That idea evolved and became palliative care.

For a long time, palliative care was thought of as the only solution that would allow someone to die with dignity. However, in the past 30 years, were there people living with terminal illnesses, dying a slow, agonizing death, who did not receive all of the palliative care they needed until the end of their life, if that was what they wanted?

First, we need to look at whether palliative care is accessible. There is an increase in requests for medical assistance in dying. Bioethics talks about clinical ethics, in which the patient comes first. It is about listening. Sometimes, even the best palliative care in the world, with the best framework in the world, cannot alleviate someone's suffering.

That is true for Ms. Gladu and for Mr. Truchon, but those people are not suicidal. They want to live as long as possible. When they want to die, they may be given anti-depressants. They will be of sound mind when they make their decision. That decision will be reversible. I was listening to Ms. Gladu the other day. What does she want? She wants freedom of choice. In many cases, once people have that choice, they have so much respect for their dignity that they are no longer in such a hurry. That reduces suffering tremendously. That is the issue we are dealing with.

We must not sidestep this issue on the grounds that we want to move swiftly. I have a lot of questions about the bill because it does not address degenerative cognitive disease. I think a person with Alzheimer's should have the opportunity to make an advance request.

These are predictable diseases. Doctors can tell patients how they will progress. People with these diseases often remain of sound mind for years. Eventually, they become forgetful. In the end, they die not of the disease itself but of complications from being bedridden or immobilized or conditions other than that disease. This bill does not take those people into account.

What I would hate is to see a repeat of what happened with Bill C-14. The reasonably foreseeable natural death criterion was established, and it was supposed to protect vulnerable people.

Is there anyone more vulnerable than someone who is suffering from intolerable pain, who is living with an incurable illness and who is being told to go to court for the right to choose and to die with dignity?

Is there anything more important and more intimately personal for an individual? It is not as though the person's neighbour is going to die for them.

I have a hard time understanding our Conservative colleagues' argument that the state must decide for an individual, when they are so economically libertarian.

In 1957, Pope Pius XII was a pioneer. He said that we must stop claiming that only God can decide whether we should die a slow death. At a certain point, he made it possible for us to sanction palliative care.

Today, let us not pit palliative care and medical assistance in dying against each other, regardless of whether we are talking about a degenerative disease or an illness that causes extreme pain but is not terminal. Let us not pit those two realities against each other. Respect for human dignity includes proper support when one is dying, which requires doctors to have the humility to recognize that they cannot always help people manage their pain adequately.

Our society recognizes people's right to self-determination throughout their lifetime but takes it away from them at the most intimate moment of their lives. In so doing, we think that we know what is best for people or that we are doing the right thing, when we are actually undermining human dignity. There is no more important moment in a person's life than their death. Learning to live is learning to die. Learning to die is learning to live. I say that because the clock starts ticking the moment the doctor cuts the umbilical cord.

I appeal to my colleagues' humanity. I am a staunch democrat, humanist and, of course, sovereignist. I am all of those things, but one does not take precedence over the other when it comes to problems like this.

I am not saying that the federal government should have challenged that ruling because it came from a Quebec court. In any case, it is a court under federal jurisdiction that rendered that decision.

This ruling challenges us as legislators to do our job and stop off-loading the problems, the ethical, social and political questions to the courts. We have a job to do as legislators.

There is a sociology of law. In a society, the law evolves with people's consciences. I know I am straying from the technical details of the bill. However, I said from the outset that we agree in principle and on the grounds for discussion of this bill. I apologize for being overly philosophical today, but that is where the substance of the debate lies; it is ethical and it is political in the noblest sense of these words. Indeed, it is up to us to make the laws to ensure the well-being of all. It is a philosophical debate and, in a way, a theological debate that leads us to the law. However, regardless of how much time we spend on this, let us use substantive arguments.

When I hear arguments to the effect that this is a slippery slope, I think about the study of Bill C-14, during the last Parliament, when some people were practically saying that nursing homes and long-term care facilities would become euthanasia machines. I do not know of any evil people who work in health care, in any position. If such a person exists, then let them be fired, because they have no place there. I am not buying the slippery slope argument.

We must assume from the outset that all stakeholders in the health system are caring and compassionate. Yes, they sometimes experience difficulties. With just a slight increase in health transfers, they could provide better care and there might be more palliative care units in hospitals. Even though I do not believe that palliative care is the only solution, that is what people have been saying for 50 years. It makes no sense that there are not more palliative care units.

Not everyone asks for MAID. I talk a lot about those who do not pose a problem. In Quebec, where the Quebec law is in effect, the obligation to meet the criterion of a reasonably foreseeable natural death forces people to go to court or to go on hunger strikes. This criterion was unconscionable, and the courts handed down an appropriate ruling in that regard.

Therefore, I appeal to my colleagues' humanity.

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

Madam Speaker, when this House opens most days, we take a moment to pray, reflect and ensure our words and our jobs of representing Canadians are done to our utmost ability. We are honoured to be in the people's House. My personal prayer today is that my words reflect the severity of Bill C-7, a very serious subject.

I have been closely following the Liberals' terrifying progress as they work to embed the practice of efficient death in our medical system. In January they held MAID legislative consultations online for a total of only two weeks; two weeks to hear from the public on legislation that is truly a matter of life or death.

There is a mandatory five-year review set for this June for our MAID law, but instead of working within that timeline, the Liberals have let one ruling from one Quebec judge dictate the legislative direction for the entirety of Canada. At minimum, this issue should have been referred to the Supreme Court of Canada.

I am fearful of the current justice minister who voted against MAID in the previous Parliament, not because he was against it, but because he felt it did not go far enough. That is the driving force behind some of these drastic changes.

As the Liberals have just tabled the bill this week, I have only had a short period of time to begin digesting it. I need to stress to the House today that these are my preliminary thoughts. In my opinion, this is a needlessly rushed process on a sensitive, significant issue that does touch every Canadian.

For the first four months of my term, I have heard from many concerned constituents, advocacy groups, differently abled individuals and organizations, and those in the medical profession.

What I need to emphasize at the outset of my time here tonight is the innate value of every human being, regardless of ability. I want to speak directly to those who are in physical pain, those in mental anguish and those who feel they are a burden. Everyone is loved, everyone is valuable and everyone is made in the image of God. There is a place in our society for patients in unbearable suffering with no possibility of recovery to be provided with end-of-life options. We owe this to Canadians. Autonomy and personal wishes do need to be respected.

There is a paradox, in that suffering is both hard and good. Everyone who suffers deserves our love, our care and access to appropriate palliative care. I will touch on palliative care in a moment, but presently I will address this bill, raise some of the concerns I have with it from my initial reading and voice the concerns of those it affects directly from whom I have heard, including our medical professionals and the vulnerable or disabled of our society.

Numerous organizations like Canadian Physicians for Life and Canadian Society for Palliative Care Physicians have raised numerous significant issues with Bill C-7. The organizations cite specific concerns with clauses of the bill and also relay an overarching general concern about how the proposed legislation erodes the trust that vulnerable people should be able to have in the medical profession.

We seek out medical aid when we are at the lowest, most vulnerable points in our lives. Vulnerable Canadians must be able to find protection within the medical community. In an ironic, tragic twist, the preamble of the bill recognizes the importance of protecting vulnerable persons from being encouraged to end their lives, but does nothing to support what should be foundational in our health care system.

The bill itself drops many of the already too few safeguards around MAID and places vulnerable people at an increased risk.

Point one is that the reasonably foreseeable natural death criteria has been removed, which would drastically reinvent MAID. It would no longer be an alternative to a painful death, but an alternative to a painful life.

Point two is that independent oversight has been reduced. Where two witness signatures were previously required on a patient's written request for MAID, the requirement would now be one. The bar would be lowered even further as that individual, that supposedly independent witness, can be the person paid to take care of someone, that is, medical staff.

Point three is that disturbingly, Bill C-7 also does away with the previous 10-day waiting period for those whose natural death is reasonably foreseeable.

Under Bill C-7, one could be diagnosed and killed all in one day, with no opportunity for reflection or discussion with friends or family members. That is what this bill would do.

Point four is that the bill would also legalize physician-assisted suicide by advance request through a waiver of final consent and drop the requirement for consent to be given twice before MAID is performed. The existing law requires consent at the time eligibility is granted and again before termination of life occurs. Under the new law, once consent would be given, there would be no need for medical staff to confirm it before administering a lethal injection.

Can someone consent in advance to being killed once they reach a state they fear but which they are not experiencing now and, in fact, have never experienced? Once a person has signed an advance request and has lost capacity to consent to medical treatment, at what point should euthanasia take place? At what point should a person be killed?

In a technical briefing yesterday, officials were pushed to explain how MAID would be administered and what safeguards would be in place for the day, the hour, the minute euthanasia would be carried out. Shockingly, the legislation would only require one medical practitioner to be present. Therefore, even if an individual attempted to withdraw consent, there would be no mechanism to ensure their wishes were respected. One medical professional should not be permitted to conduct euthanasia alone. This would not ensure accountability and, in my opinion, is completely unacceptable.

Additionally, there is no provision for individuals to be able to seek doctors who would not counsel MAID as a treatment option. In fact, there is no mechanism for physicians to opt out of providing MAID or any conscience protections for medical professionals who refuse to participate in MAID or do not wish to refer a patient.

We are seeing this in British Columbia, where the Delta Hospice Society has been denied funding for refusing to offer MAID services. With this in mind, how then are individuals able to trust that the doctor will really care for their well-being? The frightening thing is that pro-MAID health care providers are not waiting for people to raise the possibility of euthanasia. In fact, we are hearing first-hand accounts of individuals who have been encouraged to pursue this option unprompted.

What about section 241 of the Criminal Code, which counts it an offence to counsel a person to commit suicide? Those staring at the precipice of potential death should not have the entire medical establishment looming behind them to pursue a certain option.

This brings me back to palliative care and the dismal record on caring for Canadians at end of life. There is nothing in the bill and little tangible government action taken to approve access to palliative care. The Conservative dissenting opinion from the committee's review of previous MAID legislation states, ”A genuinely autonomous choice for a person to end their life is not possible if they are not offered palliative care as they will see their choice as only intolerable suffering or PAD [physician-assisted death].”

The Canadian Hospice and Palliative Care Association estimates that fewer than 30% of Canadians who need it have access to palliative services. The Conservative Party recognized this need in its 2019 platform and a Conservative government would implement the framework on palliative care in Canada.

As I referenced the Canadian Hospice and Palliative Care Association, I need to make one its points crystal clear, which is that MAID is not part of hospice palliative care. It is not an extension of palliative care, nor is it one of the tools in the palliative care basket. Health care articles, the general media and, sadly, politicians continue to conflate and thus misrepresent these two fundamentally different practices.

Hospice palliative care focuses on improving quality of life and symptom management through holistic, person-centred care for those living with life-threatening conditions.

In conclusion, at my first reading, I am disappointed to say that the Liberal government's proposed legislation to amend MAID sadly misses the mark on many levels. It had the opportunity to increase safeguards for the vulnerable, provide conscience right for medical practitioners, implement protections for those living with mental illness and address many more legislative inadequacies. I hope that in the spirit of this minority government the suggested amendments coming from all sides of the House will be welcomed graciously and thoughtfully.

To my constituents, I am opposed to these changes and will urgently seek their feedback. Many of them live with stories and experiences on both sides of this issue and I need to hear from all of them.

To reiterate, to those who are in physical pain, who are in mental anguish and who feel they are a burden, they are loved, they are valuable and they are made in the image of God.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, it is a great pleasure today to rise as the shadow minister of justice for the official opposition to speak to the government's Bill C-7. As I rise to speak on this bill, I do so with concern over some of the contents within it and even over the way it was presented to the House this week when, unfortunately, many of us read about the contents of the bill in the media, rather than seeing it first in this House.

The bill was intended to be a response to the Quebec Superior Court decision that was made on September 11, 2019. The decision stated that the law as it stood was too restrictive around the requirement for death to be reasonably foreseeable. The official opposition called on the government at the time to appeal the decision to the Supreme Court of Canada in order for Parliament to receive clarity about the parameters in which we would legislate, but the bill was introduced without that clarity.

Not only was the bill introduced without that clarity, but it goes far beyond what was required to meet the Quebec Superior Court's decision. I believe that is an affront to this Parliament, because when the previous bill, Bill C-14, was passed in the 42nd Parliament, the wisdom of this Parliament required that there be a statutory review of our assisted dying regime in Canada. That statutory review was and is to take place in June of this year.

It is in that review period that parliamentarians would be able to go more into depth on how the government's legislation has worked over the past several years and on how best to proceed. Rather than wait for that review, as it should have done, the government has decided to start making amendments to the legislation now, avoiding the in-depth review that is to take place shortly.

The reality is that when we are talking about this legislation, we are literally talking about the matter of life and death. This is an incredibly sensitive issue. Members on all sides of the house have diverse opinions on it, and it is because of this diversity of opinions and because of the sensitivity of this issue that the Quebec Superior Court decision should have been appealed to the Supreme Court of Canada for further clarity. However, as the government has now opened this legislation up, it is upon us as legislators to now highlight other matters that should be addressed and included.

My office has heard plenty from concerned Canadians about the lack of protection for conscience rights for health care professionals. This is particularly important now that the government is broadening medical assistance in dying to include individuals whose death is not reasonably foreseeable. Expanding medical assistance in dying to more patients could in fact diminish the number of medical professionals willing to take part in the process. The fact is that this expanded access could result in a heavy emotional burden on those health care providers.

None of us here can fully appreciate the burden put on those health care providers currently working in the system and providing medical assistance in dying. The fact is that there is nothing about ensuring proper support to health care professionals who provide this service and there continue to be no penalties for pressuring a medical professional into providing medical assistance in dying, nor are there penalties for punishing or penalizing a medical professional who does not participate in medical assistance in dying. This means there continues to be no real protection for conscience rights for health care professionals.

The issue of advance directives, now rebranded as a “waiver of final consent” by this government, is a complex one that poses questions of ethics and safety and issues with oversight. The fact that the legislation legalizing this is half a page of a bill shows a lack of care given to this issue. This issue rightly should have been discussed as part of the parliamentary review to take place this summer.

The process for the creation and execution of this agreement remains ambiguous. Further, there is a lack of clarity on the process for proceeding with an advance directive agreement upon the date selected. The process will only be stopped if a patient expresses a form of resistance, but we do not know what that looks like. What if they are simply confused or groggy at the time? Under the legislation, unless they resist, the process will still proceed.

The bill also removes the 10-day waiting requirement when a person's death is reasonably foreseeable. When I read in media reports before the bill was tabled that this would be included, I, like many of my colleagues and parliamentarians, questioned as to what prompted its removal. I still remain incredibly concerned as to why this was included. This is particularly true because there was already the ability to remove the 10-day waiting period if a person's death or loss of capacity to consent was imminent, so why proceed with the removal of a safeguard that Parliament saw fit to include in the previous legislation?

It is also confusing that Bill C-7 requires a 90-day waiting period when a patient's death is not reasonably foreseeable. Why add an extended wait period for one, but remove the wait period entirely for the other?

On the issue of whether a death is reasonably foreseeable or not reasonably foreseeable, there is no clarification or guidance for health care professionals. As a result, it is not up to them to make the determination as to what category to put a patient under. That determination will decide whether a patient can access medical assistance in dying immediately or if they will require a 90-day waiting period. This is an extraordinary amount of pressure that the government is putting on health care professionals across this country.

The changing of witness requirements under this legislation has also been mentioned. The law requires only one independent witness, which is down from two.

All of these changes lead to an expansion of the law in Canada far beyond what was addressed in the Quebec court decision, an expansion that should have required deeper reflection through the study that is to take place this summer.

For a moment, let us speak to a point that seems to be lost in this conversation: palliative care services in this country.

The reality is if the choice is between a lack of quality palliative care and medically assisted dying, that really is no choice at all. Unfortunately, over the past number of years there have been instances of patients feeling they were forced to choose death because of a lack of palliative care.

The story of Archie Rolland comes to mind. Archie was a Montreal landscape architect who chose to end his life rather than continue suffering at a long-term care facility that was failing to provide him adequate care.

He had ALS and had his life upended when he was forced to move from a Montreal hospital that specialized in treating patients with severe respiratory ailments to a long-term care facility for geriatric patients. Mr. Rolland did not want to go, but he was transferred against his wishes. He called the system “inhuman”. He felt he was not getting adequate care, so he chose death.

I do not think that this is any real choice at all. We must have the discussion in this country about palliative care because people must not feel forced into a decision on medically assisted death. Mr. Rolland's story makes it clear that there was a failure of the system to provide him with adequate care. We risk medically assisted death being seen as some sort of bureaucratic solution for people who require an extra level of care. In a country like Canada, that is simply not acceptable. The government risks expanding a culture of not valuing life, and we should all agree in this place that we must place value on human life.

In closing, the bill disrespects Parliament and the parliamentary process. With Bill C-14, parliamentarians did a significant amount of work in the House and committee in an attempt to build consensus. The work was challenged by the Quebec Superior Court, but rather than defending the will of elected representatives in court, the Liberals immediately backed down.

Now the Liberals are responding not just to that decision but are also undoing the work of the joint committee on Bill C-14 by adding new measures.

Many of these issues should be dealt with in the summer when we have our scheduled parliamentary review. This is a complex matter that requires proper scrutiny and debate.

[David Lametti, Liberal, Minister of Justice]

moved 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.

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

The bill proposes a legislative response to the Superior Court of Québec's Truchon decision, as well as some other changes to the Criminal Code provisions that set out Canada's medical assistance in dying regime.

In June 2016, former Bill C-14 amended the Criminal Code to create Canada's first law on medical assistance in dying, or MAID. The legislation created exemptions to Criminal Code offences so that individuals suffering unbearably and nearing the end of their lives could die peacefully and with the help of a physician or nurse practitioner, rather than in agony or in circumstances that they considered undignified.

This significant change in our criminal law was indicative of the value that Canadians ascribed to having choices, including about the manner and timing of their deaths when suffering in the dying process was intolerable. The most recent data obtained by the federal MAID-monitoring regime indicates that over 13,000 Canadians have received MAID since it has become decriminalized.

We are now proposing another important change to our criminal law. In Truchon and Gladu, the Quebec Superior Court ruled that it was unconstitutional to limit access to medical assistance in dying to persons whose death is reasonably foreseeable.

We decided not to appeal the decision because we want to reduce the suffering of people waiting for medical assistance in dying.

When we announced our decision not to appeal the ruling, our government also committed to changing the eligibility criteria for medical assistance in dying throughout Canada to ensure that criminal law is consistent nationwide.

Application of the court's ruling, which is limited to Quebec, was suspended for six months. The deadline is March 12. Because these issues are so important and because we want to ensure that our laws are consistent all across Canada, we have asked the court for a four-month extension, which would give Parliament time to thoroughly consider and debate the amendments proposed in this bill. There was a hearing yesterday regarding this request.

Consulting Canadians about the next phase of medical assistance in dying in Canada was crucial to drafting this bill. That is why we launched a two-week public consultation on January 13. The level of participation was unprecedented. We received over 300,000 responses, an indication of how important this issue is to Canadians.

At the same time, together with the Minister of Health, the Minister of Employment, Workforce Development and Disability Inclusion and our parliamentary secretaries, we held 10 round-table discussions across the country between January 13 and February 3.

This included round tables in Halifax, Quebec City, Montreal, Ottawa, Toronto, Winnipeg, Calgary and Vancouver. We met over 125 individuals, including doctors, nurse practitioners, legal experts, members of the disability community, indigenous peoples, and representatives of health regulatory bodies and civil organizations.

We are grateful to all who participated in the round tables. Their shared expertise and experiences were of immense value in developing this bill. I have no doubt that many will continue to engage in the parliamentary process as witnesses before committees.

The results of this consultation process will be published shortly in a “what we heard” report. We heard views on many different topics, but I would like to mention just a few.

From the public online consultations we heard that, while the majority of respondents think the current safeguards are adequate to prevent abuse, in a MAID regime that is expanded to persons who are not dying in the near term, a majority of respondents also thought it would be important to require additional safeguards in such a broader regime. Many round-table participants suggested two separate sets of safeguards in an expanded regime. Others shared their experiences with existing safeguards as they apply to those who are near the end of their lives.

Specifically, many felt that the requirement for two witnesses when a person's written request was made was too onerous and afforded little protection, and that the 10-day reflection period unnecessarily prolonged suffering.

Informed by these in-depth consultations, and by the Canadian experience with medical assistance in dying to date, along with many other sources of information, Bill C-7 proposes to respond to the Truchon decision by adjusting both the eligibility requirements and the safeguards. It also proposes to enable patients in certain circumstances to waive the requirement for final consent so that they do not lose their access to MAID.

We know there are other issues about which many Canadians still feel strongly but which are not subject to the Superior Court of Québec's deadline, such as eligibility in cases where mental illness is the sole underlying condition, advanced requests and mature minors. These will be examined in the course of the upcoming parliamentary review.

Before describing the proposed amendments, I would like to address the concerns we heard from many in the disability community following the Truchon decision and during our consultations. Disability groups were very clear that, for them, removing the end-of-life limit on MAID would create a law that holds disability as a valid reason for ending a life and reinforces the false perception that disability is equivalent to a life of suffering.

Our government is sensitive to these concerns. We strongly support the equality of all Canadians, no matter their situation, and we categorically reject the idea that living with a disability is a fate worse than death. However, we are also mindful of the need to balance these concerns, along with others that have been expressed, with other important interests and societal values, in particular the importance of individual choice.

The bill's objectives are therefore to recognize the autonomy of individuals to choose MAID as a means of relieving intolerable suffering, regardless of their proximity to natural death, while at the same time protecting vulnerable persons, recognizing that suicide is an important public health issue and affirming the inherent and equal value of every person's life. More concretely, Bill C-7 proposes to expand eligibility for medical assistance in dying beyond the end-of-life context by repealing the eligibility criteria requiring that natural death be reasonably foreseeable.

Recognizing that intolerable suffering also arises outside of the end-of-life context and that Canadians want to have choices, medical assistance in dying would be become available to all those who are intolerably suffering; who have a serious and incurable illness, disease or disability; and who are in an advanced state of irreversible decline in capability, without regard to whether they are dying in the short term.

At this time, the bill proposes that persons whose sole underlying condition is a mental illness not be eligible for medical assistance in dying. First, we are subject to a court-imposed deadline and this matter requires more in-depth review and debate. We have learned that the trajectory of a mental illness is more difficult to predict than that of most physical illnesses. This means that there is a greater risk of providing medical assistance in dying to people whose condition could improve.

It is also more difficult to carry out competency assessments for individuals with a mental illness. In the case of some mental illnesses, the desire to die is itself a symptom of the illness, which makes it particularly difficult to determine whether the individual's request is truly voluntary.

Like the Government of Quebec, we are of the opinion that we need to continue consultations, discussions and policy development on the issue of MAID requests based solely on mental illness.

The parliamentary review that will be launched next June will be an appropriate forum for examining these issues, without the time constraints of the court-imposed deadline.

I would now like to turn my remarks to the question of safeguards. Many experts believe there are greater risks in assessing requests for MAID from individuals who are not nearing the end of their life. We agree. While these individuals would have a choice to seek MAID, the bill proposes that these requests be treated with greater sensitivity and care.

Accordingly, the bill proposes two streams, or two sets of safeguards. To distinguish these cases the bill proposes to use the concept of reasonably foreseeable natural death. Let me be clear on this point. Not having a reasonably foreseeable death would no longer be grounds for rejecting a MAID request; however, it would be used to determine which of the two sets of safeguards are required in a given case.

As enacted by Parliament in 2016, reasonable foreseeability of natural death refers to a death that is expected in the relative near term. It means that in light of all the person's medical circumstances, his or her death is expected in a relatively short period of time. Natural death is not reasonably foreseeable just because an individual is diagnosed with a condition that will eventually cause death many years or decades into the future.

In practice we know that practitioners are more comfortable prognosticating when death is expected in shorter time frames. The standard of reasonably foreseeable natural death provides flexibility in a way that maximum fixed prognosis would not. The standard also has the advantage of using language that practitioners have become familiar with over the last four years.

Those who are dying in the short or near term would benefit from the current set of safeguards in the Criminal Code, which the bill proposes to change in two ways.

First, the 10-day reflection period would be eliminated. We heard during the consultations that most persons have already given their MAID request a lot of thought by the time they sign their written request, resulting in the reflection period unnecessarily prolonging suffering.

Second, the requirement for two independent witnesses would be amended so that only one independent witness to the written MAID request is required. Further, we have added an exception so that health care and personal care workers who are not the person's provider or assessor would now be able to act as an independent witness.

Again, we heard that it is difficult for some who live in long-term care facilities or in remote areas to locate two independent witnesses. The purpose of the independent witness is simply to verify the identity of the person signing the request. The witness is not involved in the assessment process.

For persons whose death is not reasonably foreseeable, the existing safeguards would all apply with some additional ones. Specifically, the bill proposes a minimum 90-day assessment period, which will help ensure that practitioners spend sufficient time exploring the various dimensions of the person's MAID request, which, outside the end-of-life context, could be motivated by different sources of suffering requiring greater attention.

Also, at least one of the practitioners assessing eligibility would have to have expertise in the condition that is causing the person's intolerable suffering. The safeguard aims to prevent people from obtaining MAID when something could have been done to relieve their suffering or improve their condition.

The bill would also clarify the notion of informed consent for these kinds of cases.

First, a person who is not dying would have to be informed of the means available to relieve suffering, including counselling services, mental health and disability support services, community services, and palliative care, and be offered consultations with professionals that provide these services.

Second, the practitioners and the person would also have to agree that these means of relieving their suffering were discussed and seriously considered.

The bill also proposes to allow people whose death is reasonably foreseeable and who are eligible for medical assistance in dying to give prior consent if they risk losing capacity to consent before the date set for MAID. At present, the Criminal Code requires the practitioner to ensure, immediately before MAID is provided, that the person gives express consent to receiving MAID.

The bill would enable a patient who has already been assessed and approved to enter into an advance consent arrangement with their physician that sets out all the relevant details, including the date selected for the provision of MAID and the fact that the person consents to receiving MAID in case they lose the capacity to consent by the day in question.

Although this scenario was not covered in Truchon, experts told the government that it presents relatively little complexity and risk. Doctors also told us they would be comfortable with the idea of providing MAID under such circumstances.

To our government, compassion means ensuring that people waiting for MAID do not lose their opportunity to die in the manner or on the date of their choosing just because their medical condition robs them of the capacity to make decisions in their final days.

Another narrow form of advance consent would also be allowed in the unlikely event that complications arise after a person who has been assessed and approved self-administers a substance intended to cause their death and loses the capacity to consent to MAID, but does not die.

The patient and their physician could enter into an arrangement in advance, stipulating that the physician would be present at the time the patient self-administers the substance and would administer a substance to cause the patient's death in case the patient loses their capacity but does not die.

The data show that there have been very few cases of self-administration so far, perhaps due to fears of possible complications stemming from self-administration of a substance. Offering such an option could provide greater reassurance and allow more Canadians to choose this form of medical assistance in dying.

There are other changes in the bill that my colleagues will speak to, including changes to enhanced data collection and the monitoring regime that brings accountability and transparency to the practice of MAID in Canada.

A transitional provision would ensure that patients who have already signed their request when the bill comes into force would not be required to undergo any additional safeguards set out in the bill. At the same time, they would be able to benefit from the safeguards that would be eased, such as the elimination of the 10-day reflection period and the possibility of preparing an advance consent arrangement if it applies to that person's situation. We are committed to making the process as easy on patients as possible.

I would also like to briefly discuss the constitutionality of the bill. I have examined the bill as required by the Department of Justice Act. This involved consideration of the objectives and features of the bill. I am confident that the bill responds to the Truchon ruling in a way that respects the charter.

As is required by the Department of Justice Act, I will table a charter statement in the near future, which will lay out some of the key considerations that informed the review of the bill for inconsistency with the charter. This will serve to better inform parliamentary debate on this important piece of legislation.

I will conclude by thanking all those who participated in the consultations on medical assistance in dying and who contributed to the drafting of this bill. Bill C-7's proposed amendments to Canada's medical assistance in dying regime represent a fundamental policy shift, with the regime becoming less about end-of-life care and more about autonomy and alleviating intolerable suffering.

I look forward to working with all members of both chambers to ensure Bill C-7 is passed.

Alleged Premature Disclosure of Contents of Bill C-7

[Rob Moore, Conservative, Fundy Royal, NB]

Mr. Speaker, I rise on a question of privilege today concerning the premature disclosure of the contents of Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, introduced yesterday.

As you know, it is a well-established practice in the House that, when a bill is on notice for introduction, the House has the first right to the contents of that legislation.

In a report circulated prior to question period, and hours before Bill C-7 was read a first time in the House, the Canadian Press published an article that detailed specific information contained in Bill C-7.

In the article it states:

The bill [would] scrap a provision in the law that allows only those already near death to receive medical assistance in dying—as ordered by a Quebec court last fall....

Sources say it will drop the requirement that a person must wait 10 days after being approved for an assisted death before receiving the procedure. And it will drop the requirement that a person must be able to give consent a second time immediately prior to receiving the procedure.

The reporter gives credence to the fact that contempt has occurred by revealing later in the article:

The sources spoke on condition of anonymity because they were not authorized to reveal details of the bill prior to its tabling in the House of Commons this afternoon.

After the sources indicated to the reporter that they were aware of their guilty actions, they boldly and defiantly continued their affront to Parliament by providing even more detail of the bill.

I quote again from the article, which states:

Sources say today's bill will not deal with broader issues that were excluded in the new law and that must be considered as part of a parliamentary review of the law that is to begin this summer.

Those issues include whether mature minors and those suffering only from mental [illness] should be eligible and whether people who fear losing mental capacity due to conditions like dementia should be able to make advance requests for medical assistance in dying.

It will, however, propose a measure intended to deal with a situation in which a person is given consent and who has been approved for an assisted death loses the mental capacity to give consent a second time immediately prior to receiving the procedure.

After carefully reviewing the contents of Bill C-7 following its introduction in the House, when I and other members of Parliament got to see the bill for the very first time, the details reported by the Canadian Press hours earlier were indeed contained in Bill C-7.

Ironically, my first precedent to present to you is from the last Parliament, brought to the Speaker's attention on April 14, 2016. It was with respect to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.

It would appear that the Liberal justice team just has not learned any lessons as it was pointed out on April 14, 2016, as I am pointing out today on Bill C-7, that specific and detailed information contained in Bill C-14 was reported in a newspaper article and elsewhere in the media before the bill had been introduced in the House.

On April 19, 2016, the Speaker found that there was in fact a prima facie case of privilege regarding Bill C-14. He stated:

As honourable members know, one of my most important responsibilities as Speaker is to safeguard the rights and privileges of members, individually and collectively. Central to the matter before us today is the fact that, due to its pre-eminent role in the legislative process, the House cannot allow precise legislative information to be distributed to others before it has been made accessible to all members. Previous Speakers have regularly upheld not only this fundamental right, but also expectation, of the House.

The Speaker's concluding remark on April 19, 2016, was as follows:

In this instance, the chair must conclude that the House's right of first access to legislative information was not respected. The chair appreciates the chief government whip's assertion that no one in the government was authorized to publicly release the specific details of the bill before its introduction. Still, it did happen, and these kinds of incidents cause grave concern among hon. members. I believe it is a good reason why extra care should be taken to ensure that matters that ought properly to be brought to the House first do not in any way get out in the public domain prematurely.

On October 4, 2010, on page 4711 of the House of Commons Debates, Speaker Milliken noted:

It is indisputable that it is a well-established practice and accepted convention that this House has the right of first access to the text of bills that it will consider.

Getting back to my point about the Liberal justice team not learning any lessons, there was a similar case from March 19, 2001, regarding the Department of Justice briefing the media on a bill before members of Parliament. In that reading, Speaker Milliken said, at page 1840 of the House of Commons Debates:

In preparing legislation, the government may wish to hold extensive consultations and such consultations may be held entirely at the government's discretion. However, with respect to material to be placed before parliament, the House must take precedence. Once a bill has been placed on notice, whether it has been presented in a different form to a different session of parliament has no bearing and the bill is considered a new matter. The convention of the confidentiality of bills on notice is necessary, not only so that members themselves [will] be well informed, but also because of the pre-eminent [role] which the House plays and must play in the legislative affairs of the nation.

The Speaker found another case of contempt on October 15, 2001, after the Department of Justice again briefed the media on the contents of a bill prior to the legislation being introduced in the House.

Maybe, in this minority House, members can finally take these characters in the Minister of Justice's office to task for their continuous disrespect of this Parliament. Given the facts presented and the clear precedents on this matter, I believe, Mr. Speaker, you should have no trouble in finding a prima facie case of privilege. In that event, I am prepared to move the appropriate motion.