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

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Mr. Speaker, I thank the member for his comment. He makes a good point.

Palliative care is one aspect of end-of-life care. I would like to take a moment to acknowledge the vast expertise and excellent work of staff at palliative care homes, including homes in my riding, Sherbrooke.

It is true that palliative care is a good way for a person at the end of life to receive adequate care. Palliative care reduces suffering and guides people toward a natural death.

All lives have the same intrinsic value. That is a fundamental principle that we have to square with our societal values, including individual freedom of choice. Medical assistance in dying is part of a range of end-of-life care options that includes palliative care, and now medical assistance in dying.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I thank my colleague for her speech. I would like her to clarify something for me.

I do not know whether, like me, she noticed that since the beginning of the week some members have been making an unfortunate connection between palliative care and medical assistance in dying, conflating two completely different realities. Just because a person has access to medical assistance in dying does not mean that they do not have access to palliative care.

What is more, on many occasions, I also heard our Conservative colleagues establishing a connection between suicide and medical assistance in dying.

Does my colleague agree with me that these two very unfortunate connections are undermining the debate?

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Mr. Speaker, I agree with my colleague from Jonquière, and I want to congratulate him on his speech earlier this evening.

Indeed, that is a very important distinction, as I said in my previous answer. End-of-life care includes palliative care, and now we are adding medical assistance in dying.

As I said in my speech, I was close to the palliative care home in my riding. People do not go into a palliative care home seeking medical assistance in dying. When the palliative care facility in my riding was authorized to offer medical assistance in dying, it was clear that that was not intended to become the standard. So far, statistics show that this will is being respected.

People go into a palliative care home to receive palliative care. However, once suffering becomes intolerable and the normal protocols are no longer easing that suffering, medical assistance in dying is an option, an individual choice offered out of respect for freedom of choice.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, I am very honoured, as always, to rise in the House, particularly on such a profoundly important issue.

I am going to ask the Speaker's indulgence for a few minutes to speak about an issue that is occurring right now. I have learned that in Treaty No. 9 tonight families in Neskantaga First Nation are being evacuated because they have no access to water. For an Oji-Cree community in the middle of a pandemic to be willing to be flown out to an urban centre shows how severe the situation in Neskantaga is. I think every member in every party will understand the importance of bringing this forward.

One of the beautiful things we have said during the pandemic in Canada is that we are all in this together, but we are not, not in Canada. We have never all been together, not when it comes to the poverty, the casual degradation that indigenous people suffer and the systemic negligence of the most basic rights to life and dignity that Canadians take for granted as part of how this country is run. We cannot find a community that has suffered more than Neskantaga. For 25-plus years they have lived with unsafe water. That is a second generation growing up with improper water.

What does that mean? I remember meeting a beautiful young girl from Treaty No. 9. She had this incredible long, thick hair and she said she did not like to take a shower because it gave her blisters. That is what we put young people through in communities like Neskantaga. At age 13 or 14, they have to leave home because the federal government will not bother to give them a school. They have to go to a foreign culture in Thunder Bay. We know of the horrific treatment and abuse that indigenous children have suffered in Thunder Bay, the deaths of children in the rivers and the racist attacks, yet they have to leave their homes.

We are talking about something as profound as medical assistance in dying. However, when one has had to go to a hotel room in Thunder Bay to say sorry because a beautiful young girl from Neskantaga gave up hope at age 14, we could say this nation does a lot of work to assist in the dying and hopelessness. Tonight, in Neskantaga, after 25 years of not having water, where the schools cannot be opened because they cannot get water to the schools. They have had to shut the water system down. It is winter there and elders are going to the river and getting water in buckets.

Yes, this is Canada in 2020. Therefore, when I hear people say that we are all in this together, we could say it more clearly by saying we are all in this together, except when it comes to indigenous people, because they are at the back of the line again and again. I am not saying this from a partisan point of view. This was the primary program. Neskantaga was going to be fixed. We were told that by the Prime Minister. The previous prime minister put enormous amounts of money into water, yet the government continues to refuse to put in place the basic infrastructure that will support safe communities: the sewage lifts, the water pipes, the proper water treatment centres.

I am asking my colleagues tonight, in light of the crisis in Neskantaga and the risks people are taking by being flown out in the middle of a pandemic, to say we have to make the guarantee of access to clean water a fundamental human right. It has to be done, and it has to be done now. We cannot have any more nice words. We have all the beautiful words that come from the government, yet there are people who cannot even live in their own community because they do not have water. I am asking my colleagues to work with us to guarantee that the people in Neskantaga will be able to go home to safety, decency and water.

The issue of medical assistance in dying is an important conversation for us to have in the House. The last time we had this conversation, we were under the gun because it was a court decision that pushed the federal government to act. I had a number of concerns about the previous legislation. We knew it was not going to withstand a court challenge, yet the government went ahead with it. Now we have to come back and do it again. We need to work together because we have some fundamental principles that we have to protect in terms of how this moves forward.

I worked on a national palliative care strategy across the country before the last election. The one thing I have learned, and I saw this with my beautiful sister who died so young, is that the will to live is incredibly strong. People deal with an incredible amount of suffering, and they have the will to have family and have support. The right to die in dignity is a fundamental human right. Part of that is making sure we have a proper medical system in place to give people this support, so we have to have the provisions in place with this legislation.

Nobody's claim of dealing with someone who is dying is more precious than anyone else's. In our lives, it is the most intimate thing we can be involved in, and those deaths can actually be good deaths, deaths of dignity and of hope, where families are together. The day my sister died, as my mom said the rosary I sang Danny Boy for her because that is how we go out in our culture. It was terrible to see my sister go, but we came together and it was beautiful.

There are deaths that do not have dignity, and deaths of suffering. It is incumbent upon the House to make sure that the legislation in place meets a number of steps in the right to dignity, but also that it makes sure that people who are making this choice are not doing it because they feel they have been neglected or they are in a substandard seniors home, as we have seen with so many of our seniors in Quebec and Ontario who died in the pandemic. People must actually have dignity, and if they are in a home, there must be support for them so that they do not have to make that choice.

I will agree with my Conservative colleagues and all the people I have talked to in all the work I have done with palliative care, that if that choice has to be made, it is one that people do not want to make. People want to go out in a way that allows them as much time as possible. However, when that decision is made, as it is a right upheld in the courts, we have to make sure that the provisions are there to allow it to be done properly, to allow it to be done so that people are of a mind that they understand what they are doing and that they can do this in a way that meets the test of a caring society.

To that end, we have seen a staggering number of our elders die without dignity in this pandemic. It has exposed the fact that we do not put investments into care for our elders and they have suffered needlessly. That we had to send in the army to keep people from dying is a fundamental failing of our system for seniors and their health.

Of course, it is not just seniors who have to make this decision. My sister died much too young. Her husband died at 42, and he was one of the greatest people I have ever met. People die at different ages, and some of those deaths are very difficult.

I am very pleased to say that we will support the bill being sent to committee because it is at committee where we will hear witness testimony. We need to hear from the experts. We need to have a conversation and start to make sure that in the legislation, which we are compelled to bring forward because of the Quebec superior court decision, we meet the tests of the court and we meet the tests of dignity.

Again, I do not believe this needs to be a partisan issue, where a party is going to be on one side or the other. We have to put first the rights of the individual and their dignity, and the support for their family, because death should never be a lonely act. Death has to be part of family and community, and when it is, it can actually be a moment of real grace and learning.

The New Democrats are supporting the motion to send the bill to committee to be studied. We want to make sure that we get it right this time so that we do not have to change it for the next court decision.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, first, I appreciate the member's bringing to the attention of the House the situation in regard to the evacuation. I very much appreciate the sensitivity of the issue, as we move on to yet another very sensitive issue that has been debated for a number of days now. It is very much an emotional time when we have these types of debates.

When we first brought in legislation, and I am referring to the House in its entirety when I say that because the legislation came as a result of a Supreme Court decision, the general feeling back then was that there would be a need for us to come back and look at the legislation. What we are doing today is making changes to the original piece and there are a few changes. I wonder if the member would want to provide his thoughts on any of the specific changes, or any thoughts in regard to specific amendments that he would like to see.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, even though we are being ordered to because of the Superior Court of Quebec decision, it is important that we do revisit legislation. What we anticipated may not be the case out in the field.

In terms of the request for medical assistance in dying be done in writing and signed by an independent witness, the request can be made after the person is informed they have a grievous and irremediable medical condition, and a professional or health care worker can serve as that witness. That is interesting. I would like to have that tested with people in the field who can let us know whether that will meet the need of ensuring we have adequate safeguards.

The fact that the person must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health services and palliative care, is important. However, we have to be able to test that at committee. Is that a reality that people are going to have in rural areas? What about for people who do not have a larger family unit to support them? I am looking forward to seeing how these will be tested at committee.

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

Mr. Speaker, I thank the member for his commitment to standing up for his constituents, particularly his indigenous constituents.

When the government is reducing some of the safeguards regarding the number of witnesses needed and the kinds of witnesses needed, I become very concerned. If we are not including social workers in the decision-making process, how are we ensuring that those who are going through the process of requesting MAID are truly doing it in a way that is of their own volition? Physicians are not always equipped to recognize these situations.

What about increasing safeguards by bringing in social workers so we can ensure it is truly a free choice that people are making?

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, one of the things that frustrated me with the Supreme Court decision was that I felt it put an unfair restriction on the review of Parliament. Because this was a profound piece of legislation, we needed the opportunity to have enough witnesses.

I do not believe this is something that should be dragged out, but as parliamentarians, we need to ensure we have an adequate number of witnesses to bring forward enough points of view that we can ensure the proper details are in this legislation. I do not know the details of what goes on in a medical relationship. I am not that person, but I have sat at the deathbed of many people. I want to make sure it is done right.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I commend my colleague on his speech. Since he went off topic to talk about access to drinking water in indigenous communities, I will do the same and ask him a question about that. I share his outrage. It is absolutely unacceptable that indigenous communities do not have access to drinking water.

That said, being outraged is good, but taking action is always better. In that sense, I wonder why my colleague, who criticizes the Liberal government's decisions, earlier today supported that same government that has done nothing about drinking water access in indigenous communities.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, the member went from profound to as cheap as one can get. We are talking about the dignity of people. I bet the member has never seen the kind of poverty we see. Am I going to plunge the nation into an election because the little guy in the front from the Bloc said he wanted an election last spring? No, I have better issues to deal with.

If that member cannot understand the profound issues facing people in Neskantaga, I would say that we can see what happened. I have not heard anything from that member in terms of the horrific death of a woman in a hospital in Quebec.

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

Mr. Speaker, I want to thank the hon. member for a very moving statement. I know it is difficult, and I am usually persnickety about saying that any member speaking should speak to the topic before us. The Neskantaga First Nation situation, in that they may be facing an evacuation because of a lack of clean drinking water, draws into sharp focus why we need Parliament to continue to work in this place.

I specifically want to thank the member for his shared concern for a dear mutual friend of ours. When we started debating Bill C-7 last spring during the last Parliament, Angela Rickman sent me texts and emails asking us to bring her relief. She was suffering from ALS and wanted to be able to use medical assistance in dying, and we failed her. I would like my hon. colleague to add whatever he chooses on the desperate need for us to continue to act in Parliament.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, my hon. colleague and I shared a friend in Angela Rickman. She was a very powerful and profound woman who worked on the Hill and died much too young. I am glad the hon. member thought of her tonight.

We have to think of the people we know who are suffering and make sure we do this in a manner that respects them and respects our obligations under the law.

[Carla Qualtrough, Liberal, Minister of Employment]

Mr. Speaker, it is really an honour to participate in this important debate on Bill C-7, alongside my colleagues, the Minister of Justice and Attorney General of Canada, and the Minister of Health.

By way of background, in 2015, the Supreme Court of Canada struck down the sections of the Criminal Code that made assisted suicide illegal. In 2016, the federal law in medical assistance in dying came into effect. This law created an end-of-life regime, which limited access to medical assistance in dying to individuals whose deaths were reasonably foreseeable. A number of specific eligibility criteria were put into place, along with procedural safeguards.

As we all know, in September of 2019, the Superior Court of Quebec found it unconstitutional to limit the availability of medical assistance in dying to people whose deaths are reasonably foreseeable. The federal government has once again been tasked with changing the law.

In early 2020, the Government of Canada held consultations across the country. There was also an online survey that received almost 300,000 responses. The feedback was thoughtful, compassionate and candid. From my perspective as the minister responsible for disability inclusion, I am working to ensure that the voices of persons with disabilities are heard on this important issue.

Medical assistance in dying is a human rights issue. The proposed legislation recognizes the equality rights of personal autonomy, and the inherent and equal value of every life. Disability rights advocates have long fought for these rights. Being able to make decisions about one's own life is fundamental. There are many examples in our history of where the personal autonomy and equality of our citizens with disabilities has been threatened, denied or taken away. I can assure my colleagues that these concerns are top of mind as we undertake this important legislative work.

The proposed legislation before us explicitly recognizes equality rights. The preamble refers to the Charter of Rights and Freedoms, as well as Canada's obligations as a signatory to the United Nations Convention on the Rights of Persons with Disabilities. The preamble also expressly differentiates between these fundamental equality rights and the various societal interests and values we need to balance with this legislation, such as the important public health issue of suicide. To put it another way, we wanted to be clear that ensuring equality rights underpins this legislation.

I will mention one more important aspect of the preamble that frames this proposed legislation, which is the importance of taking an approach to disability inclusion based in human rights. With these words, we are committing to using human rights principles to guide the development and implementation of our systems, programs and processes. This is important because the full realization of the rights we enshrine in law is predicated on having systems and structures in place that do not themselves create barriers, discriminate or infringe upon these rights.

I will digress here for a moment to take us back to June of 2019. That month, this House unanimously passed the Accessible Canada Act, which I believe to be the most significant advancement in disability rights since the Charter. Section 6 of the Accessible Canada Act sets out guiding principles, which include that everyone “must be treated with dignity”, everyone “must have meaningful options and be free to make their own choices,” and everyone “must have the same opportunity to make for themselves the lives that they are able and wish to have regardless of their disabilities”.

Another guiding principle states, “laws, policies, programs, services and structures must take into account the disabilities of persons, the different ways that persons interact with their environment and the multiple and intersecting forms of marginalization and discrimination faced by [individuals]”.

These principles must also guide us as we tackle the important task of responding to the 2019 Superior Court of Quebec decision. As this House has heard, Bill C-7 proposes a two-track approach to medical assistance in dying, with less or more stringent safeguards depending on whether a person's death is reasonably foreseeable.

The House has heard about the safeguards when death is reasonably foreseeable, and it is our hope that these will allow for dignified end-of-life decision-making. I will focus my attention on the new track where MAID is permitted even though the individual's death is not reasonably foreseeable. As I mentioned, in these situations there are heightened safeguards. These include the requirement that two independent doctors or nurse practitioners assess and confirm eligibility, with one of these having expertise in the individual's medical condition.

It is also required that the individual be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability services, community services and palliative care, and that the individual be offered consultations with professionals who provide these services. The individual and their medical practitioner must have discussed these measures and agree the individual has seriously considered them.

Finally, the eligibility assessment must take a minimum of 90 days, unless loss of capacity is imminent.

As we look to broaden access to MAID as directed by the court, we are very aware of the need for Canadians to know their options, to ensure their consent was informed and to have a real choice. I spoke earlier about equality rights and personal autonomy. I also spoke about taking a human rights-based approach to disability inclusion, having meaningful options and having the opportunity to make a good life for oneself. If our systems, processes, programs and services do not offer these options, and if our citizens do not see these options are available to them, then their equality rights are not being fully realized.

This proposed legislation recognizes the significant role that social, mental health, disability and community support services play in the full realization of equality rights. Accessing MAID should not be easier than accessing disability supports. The new legislation makes it the responsibility of the medical practitioner to ensure that the individual is made aware of the supports available to them because the harsh reality is that many Canadians with disabilities are not living with dignity. They are not properly supported. They face barriers to inclusion and regularly experience discrimination.

We have seen during this pandemic how many of our systems fall far short of truly supporting and including all Canadians. Canadians with disabilities are rightfully calling for governments to address these inequities, and we must.

In the recent Speech from the Throne, our government committed to a disability inclusion plan. This will include a Canada disability benefit modelled after the GIS, an employment strategy, and a modernized approach to eligibility for Government of Canada disability programs and services. The disability inclusion plan is an important next step in advancing the rights and inclusion of person with disabilities. I look forward to sharing more on this with the House and all Canadians in the coming months.

Before concluding, I will mention the need for robust federal monitoring and data collection on MAID. We need a reliable national dataset that promotes accountability and improves the transparency of implementation. Quite frankly, we also need to better understand who is accessing MAID and why. This is of the utmost importance to the disability community. It is incumbent upon all of us to ensure the regulations that flow from this legislation allow for fulsome data analysis.

We have before us legislation that seeks to balance making medical assistance in dying available, without undue obstacles to those who choose it, and having safeguards to ensure this decision is truly informed and voluntary. A truly progressive medical assistance in dying law is one that recognizes, without compromise, the equality rights of everyone.

I am thankful for the opportunity to contribute to this debate.

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

Mr. Speaker, I listened intently to the hon. member's speech, as I always do when my friend speaks. I wish we had the time for the committee do its study. I wish that the government had taken the time to challenge the decision of the court in the Supreme Court if only to get the best advice we could before we moved forward with legislation like this.

I think about the disability community. Both of us know the disability community very well, and we have heard significant concerns from that community. This is a complex issue, and issues related to communications for those with disabilities are also complex. There are many in the disability community who would say that their voices are not being heard right now and they do not feel they have agency right now because of the way society views them. They feel this legislation is coming too fast, too quickly, too soon. I wonder what kind of commitment the hon. member will make to those in the disability community to make sure their voices are heard.

[Carla Qualtrough, Liberal, Delta, BC]

Mr. Speaker, I thank the hon. member for his collaboration and partnership in advancing issues related to disability.

This is a very complicated, complex and deeply personal issue. I have been committed since the beginning to living by our commitment to a “nothing about us without us” perspective by ensuring members of the disability community have voices at every table around decisions like this.

My COVID disability advisory group has been digging in on this. I know we will have robust presentations at committee from members of the disability community. My bottom line is that I will do whatever it takes to ensure these voices are heard.