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

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I am wondering about the question that was just asked.

I would like my colleague to clarify. When I am told about the vulnerability of persons living with disabilities I completely agree. However, the process that leads to medical assistance in dying requires clear consent. There are physician groups that are already working on this issue trying to determine the terms and conditions for such consent.

Does my colleague agree that some parliamentarians seem to want to drag out the debate to throw the baby out with the bath water?

[Carla Qualtrough, Liberal, Delta, BC]

Mr. Speaker, we are talking not only about changing the Criminal Code, but being very careful not to send a message to a very important group of our citizens that their lives are not as valuable as those of the rest of us. I want to ensure that, as we have this conversation, nothing we do sends that message. Everybody's life is of equal and inherent similar value.

Perhaps I misunderstood the question, but if people do not have a real choice at their disposal, as I suggested in my speaking notes, then we are not really giving them their full rights of equality.

[Matthew Green, NDP, Hamilton Centre, ON]

Mr. Speaker, the minister has just reminded us that everyone ought to have equal and inherent rights, but we know that throughout this pandemic the government has refused to prioritize the pursuit of a very equal life for people with disabilities.

I want to bring the voice of one of my constituents, Sarah Jama, who is part of a disability justice network, to ensure that her and their voices are heard. She states, “It is evident through our history of forced sterilization and institutionalization that the current crisis of deaths in long-term care homes and continued legislated poverty across this country that with the changes in the requirement for foreseeable death to MAID, what measures will our government put in place to adequately ensure that people with disabilities will not experience systemic or implicit coercion regarding their access to MAID and will this government finally prioritize the life of people with disabilities in this country as much as it has thoughtfully prioritized their access to death?”

[Carla Qualtrough, Liberal, Delta, BC]

Mr. Speaker, I thank Sarah for fighting the fight. I hear many of her views about how, historically, we have done wrong by this really marginalized group of citizens. We are taking every effort to do right by our citizens with disabilities. It started with the Accessible Canada Act, which put a disability lens on our pandemic response, resulting in a COVID disability advisory group, resulting in recommendations from that group as to how we could ensure that sufficient safeguards were put in place, resulting in a commitment in the Speech from the Throne to a direct payment to citizens with disabilities, the Canada disability benefit modelled after the GIS, so they can have the choice to not live in poverty, access to the services and supports they need to live with dignity. I promise Sarah that we are not giving up this fight.

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, today we are talking about Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying. While I realize this is a very sensitive and difficult issue, I want to be very clear that I will not be supporting the bill. I would like to take a few minutes to talk about why that is and to provide some context to all Canadians, specifically from my constituents in Niagara West.

On February 6, 2015, the Supreme Court of Canada ruled that grievously suffering patients had the right to ask for help in ending their lives. This was the Carter v. Canada decision. The court declared that paragraph 241(b) and section 14 of the Criminal Code, which prohibited assistance in terminating life, infringed upon the charter right to life, liberty and security of the person for individuals who want to access an assisted death.

The Supreme Court decision was suspended for a year to give the government time to enact legislation that reconciled the charter rights of individuals, doctors and patients. As a result, the government introduced Bill C-14 on April 14, 2016, which received royal assent on June 17, 2016. Medical assistance in dying has been legal since then.

On September 11 of last year, the Superior Court of Québec found that it was unconstitutional to limit access to medical assistance in dying to people nearing their end of life. Basically, the court said that the Criminal Code requirement that natural death should be reasonably foreseeable to get medical assistance in dying is against the rights and freedoms of Canadians as they are written in the charter. It is important to note this ruling will come into effect on December 18, 2020, unless a third extension is granted by the court.

The focus and priority of all of us in the chamber should be to ensure safeguards are always in place for the most vulnerable in our society. We also have to keep in mind that we need to be respectful and accepting of the conscience rights of physicians and health professionals. Doctors are trained to save lives, not to end them. I actually believe we should go a step further and protect the conscience rights of all health care professionals.

I am supportive of doctors and health care providers who are not willing to leave their core ethics behind when they are at their patient's bedside. I do not believe it is appropriate to force a doctor or other health care provider to participate in assisted suicide. I also do not believe it is appropriate to hire or fire an employee based on their willingness to be involved in assisted suicide. Physicians who wish to follow their conscience on serious moral issues should be free to do so. Again, we need to be respectful and accepting of the conscience rights of physicians and health professionals.

The last time I voted on this issue, I went through the legislation, which at the time was Bill C-14, and I made a determination that it did not include sufficient safeguards for those most vulnerable, so I opposed it. I had the chance to examine the current bill before us today and I still do not think it has sufficient safeguards, so I will oppose it again.

Let us be clear about something. Medical assistance in dying is a tremendously difficult issue to debate. It absolutely is. It is a highly emotional topic for all sides, and there are many factors and personal convictions that come into play. In the House we agree on many things, but we also disagree strongly on others. The key is to respect one another in the process as we discuss sensitive issues, especially issues relating to human life. Medical assistance in dying has to do with some of the most vulnerable people in our society. That is why it is important we, as representatives of the people who voted for us, have utmost respect for all who have an opinion on this topic. This includes many folks in my riding of Niagara West who are people of faith and disagree with what this bill would do.

I would like to highlight some critical evidence from an expert who appeared before the Quebec superior court on this issue. Dr. Mark Sinyor is a Canadian psychiatrist widely recognized for his clinical expertise and research on suicide prevention. He was an expert witness in the case, who provided important testimony before the Quebec superior court.

In his 50-page affidavit, Dr. Sinyor detailed for the court the likely impact of expanding medical assistance in dying to those who are not at the end of their lives. He notes that under an expanded law, which is what we have in front of us here today, physicians would bring about a death that is not otherwise foreseeable. This is something that is exceptionally difficult to accept for many Canadians across the country and for many in my riding of Niagara West. Issues like the planned legal death of someone who is terminally ill is a very delicate matter to begin with, but to open up the door for more people to qualify for a planned death, a legal death, to me and to many of my constituents, is very troubling.

I would like to return to Dr. Sinyor again.

He talks about a well-established phenomenon referred to as suicide contagion. Dr. Sinyor explains that suicide contagion occurs “through a process called social learning in which vulnerable people identify with others who have had suicidal thoughts and/or behaviour.” He goes on to say, “Expansion of MAID to include suffering, not at the end of life is likely to lead to suicide contagion and higher suicide rates, and to have a negative impact on suicide prevention.”

Dr. Sinyor also talks about the extent to which many elderly people with chronic conditions and younger people with severe disabilities are impacted. He says that they “feel like a burden to their loved ones and that their families would be better off if they were dead.”

When one of our friends, of family members or loved ones is in a similar circumstance and they begin to think that they will be solving this problem of being a burden, knowing that this law will allow it, would it be more comfortable for us? My answer is no, I do not think it would be.

To quote Dr. Sinyor again, “Normalizing suicide death via MAID as a remedy for suffering not at the end of life is likely to increase suicide rates in Canada at a time where there is a universal consensus among public and mental health experts of the imperative to decrease suicide rates.”

In short, the bill would simply make it possible for a person to choose to access medical assistance to end their life, even if their death is not reasonably foreseeable. I am concerned for people with disabilities. I am concerned that, if passed, the legislation will allow people with disabilities to die with medical assistance because they have a disability.

Michael Bach, managing director for the Institute for Research and Development on Inclusion and Society confirms this, saying “people who are not at the end of life will nevertheless be able to access assisted death on the basis that their disability is grievous and irremediable and they experience suffering they find intolerable.” I am concerned that people with disabilities may be coerced into ending their life while they are in a state of personal suffering.

Michael Bach also said, “Negative stereotypes are an undeniable cause of disability-related disadvantage and suffering. The Quebec Superior Court struck a blow to social rights in Canada when it rejected the end of life requirement.”

One of Bach's most striking statements on this issue is that the court's decision “institutionalizes the idea that disability can justify terminating a life. Stereotypes don’t get much worse than that.”

I am afraid that the bill may reinforce horrible stereotypes that a life with a disability is a life not worth living or that living with a disability is a fate worse than death. This cannot happen. I am also concerned that the suffering may not be caused by the disability but because of a lack of services and supports needed by many people with disabilities to lead a full life.

As an example, we have the story of Sean Tagert, a B.C. man who was living with ALS. Sean chose to access medical assistance in dying because he was unable to secure funding for the 24-hour care he needed to live in his home, in his community and raise his young son. The story is heartbreaking. This young man chose death because he was unable to get the proper care for his disability, and he left a young child behind.

It is so sad to hear stories like this. That is why I believe that providing high-quality palliative care is critical. Palliative care is so important because it puts patient care at the forefront of this discussion and not the patient's death. Palliative care helps improve the quality of life, reduces or relieves physical and psychological symptoms and supports the families and loved ones of those struggling with the condition. It could be provided in a variety of settings, including hospitals, at home, long-term care facilities and hospices.

The focus of palliative care is on respecting dignity and having compassion for human life. That in my view is the right approach. I do not think any of us in the chamber should ever underestimate the importance of this issue and its complexity. We all understand the delicate and sensitive nature of it. We all have views and we all know the views of our constituents. They sent us here to represent them, and that is what we are doing.

My hope is that we will all uphold the original objective of this legislation, and that is to affirm the inherent equal value of every person's life to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled. This bill does not do that, and for that reason I will be voting against it.

[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, I share the member's concern with respect to palliative care and how critically important it is that Ottawa continues to work with provinces to look at ways we can deliver a better service, particularly for some communities that have been neglected on this issue.

My question relates to the concerns of the member. We have health care professionals, families, friends and for some of the larger groups, such as the disabled, advocacy groups. I am wondering if the member might be underestimating the value they have to this debate. Once the bill gets to committee, we will hear a lot more on those issues.

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, as I have said before, I have talked to numerous people who have come to my office and whose homes I have gone to. When it comes to the disability community in particular, they are certainly very concerned about some of the things that underlie this, whether it is removing the 10-day waiting period or encouraging doctors to move forward proactively. There are a number of things and that is why a letter, signed by over 77 organizations, was sent to legislators that talks about the concerns that they have. We need to be very mindful of them.

[Matthew Green, NDP, Hamilton Centre, ON]

Mr. Speaker, we have heard today from our Conservative friends down the way stories of anguish, conversations and statements around the sanctity of life and safeguards. It is clear to me that this is not a critique particularly of MAID, but, rather, the condemnation of capitalism.

What does the member have to say about the privatization of mental health, the criminalization of addictions and the commodification of every basic necessity of life, to the point where almost complete and utter despair has caused people to be sentenced to live in deep poverty and have to, at the end of life, under coercion perhaps, contemplate this last and drastic step?

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, we realize this is a delicate issue. As I have said before, this is complicated and not easy. One of the things I wish the government had done more of, which we have talked about, and has been mentioned in other speeches and my speech, is the whole issue around palliative care.

We need to provide people options at the end of life. They may believe that is the only option they have. They may be in pain that is unbelievably difficult and believe that there is no way around it if they do not have proper pain medication, all these kinds of things. There are all kinds of communities that do not have access to these services. The first thing we should look at is how we should deal with this and how to provide those communities with these types of services.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Mr. Speaker, I was encouraged when I heard the Minister of Employment, Workforce Development and Disability Inclusion state that she felt it was not advisable for Canadians to have access to MAID more easily than supports for our disabled community. Could my hon. colleague comment on whether what is proposed in Bill C-7 makes that situation worse or better?

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, it goes back to what the member for Hamilton Centre said as well. What kinds of supports do we have for these individuals, people who are disabled and people who have addiction issues? The member for Hamilton Centre asked how to deal with people with addictions. We should be looking at helping these individuals as well. I do not believe it is one thing or the other. If we are going to be looking at things like this, at the very least we should have better supports for our disabled and for palliative care and that is where the focus should be in the short term, in my belief.

[Caroline Desbiens, Bloc, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, I commend my colleague on his speech, but I am very concerned about the position he is taking.

As I was listening to him speak, I was imagining all the people who are waiting for relief and thinking about how upset they must be to see that this bill is still not making any progress.

I would like to ask my colleague whether he has ever met someone who had no choice but to obtain medical assistance in dying to put an end to their suffering. In his life, has he ever met anyone who had no other option?

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, it has been my experience in talking to constituents over the years that there are a lot of people who do not understand what is available out there. It has also been my experience in my time of being elected to the House of Commons and talking to my other colleagues from across the country that there are still a lot of programs that are not available to people across the country.

We are in great shape in Niagara. I am very grateful that we have a hospice, and very grateful that we have organized agencies that administer palliative care. I really believe that we should be looking at these options. These are things that we should be focusing on at this point in time, and I believe that we should be finding supports for these individuals.

[The Deputy Speaker, Bruce Stanton]

Now we will go to the hon. Minister of Health. My apologies, I think the change was at our end, but we have it right this time.

Resuming debate, the hon. Minister of Health.

[Patty Hajdu, Liberal, Minister of Health]

No worries, Mr. Speaker. With virtual Parliament, all members of the House of Commons and, of course, you, Mr. Speaker, and your team, should be really proud of the work that we have done to keep Parliament functioning.

I am so happy to speak to the House today to address Bill C-7. I have been listening to the debate quite closely. I have to say that I am so impressed by the passion and compassion that I have heard in all of my colleagues' voices in talking about this very personal and very emotional topic.

In responding to the ruling of the Superior Court of Quebec on Truchon, we have had the opportunity to consider measures for which there is strong public support, and that is why we are proposing changes that will help clarify and strengthen Canada's medical assistance in dying legislation that is in place today.

Canadians have shared their views since we had passed the original legislation in 2016. Earlier this year, I had the opportunity to listen to their opinions and ideas. I also listened to the practitioners who have been providing these services over the past four years. I have to say, on a personal note, that the stories of both groups really were very moving, but particularly from the practitioners who have been using the legislation to provide choice to patients who oftentimes had been suffering terminally for a very long time. It is very clear that their compassion and expertise is something we should all be very proud of and grateful for as Canadians. However, it is also clear, through those conversations, that certain aspects of the current legislation could be altered to improve access, protect the vulnerable and respect this personal choice that is at the foundation of the legislation. With this bill, I think that we achieve a balanced approach that reflects the best interest of all Canadians.

The proposed changes to this bill have been informed by years of study and consultation. In December 2016, we asked the Council of Canadian Academies to review three types of requests for medical assistance in dying that are currently outside the scope of the law: requests by mature minors, advance requests and requests where a mental disorder is the sole underlying condition. As part of our analysis, we also consulted a number of other sources, including evidence submitted before the court in Truchon, as well as domestic and international research.

Medical assistance in dying is a complex and deeply personal issue, as so many of my colleagues have illustrated in their remarks. We knew that before going forward with changes to the current law, we needed to hear from Canadians. We held public and online consultations for Canadians to participate to complement our discussions among cabinet ministers, medical experts and other stakeholders in the country.

Protecting the safety of vulnerable people, a focus of many of the comments today, while respecting the autonomy of Canadians, another key aspect that was so important in our consultations, remain our central objectives. That is why the bill proposes a two-track approach to safeguards based on whether or not a person's death is reasonably foreseeable. The bill would no longer make reasonably foreseeable natural death the basis for determining eligibility, but it would use it to establish whether a more rigorous set of safeguards should be applied.

If a person's death is reasonably foreseeable, a set of safeguards similar to the existing regime would apply, but after hearing Canadians' feedback on the barriers that some of those original safeguards pose to those seeking medical assistance in dying, some of the conditions have been changed. I will expand on the specifics of the bill's proposed changes to these safeguards in this case.

For those whose death is reasonably foreseeable, we would ease some of the pre-existing safeguards that we know have not served their purpose of protection. For example, under the current system, there is a requirement for a 10-day reflection period. Health care providers and family members, those who have been through this and have shared their loved ones' stories, have told us that the safeguard often prolongs the suffering of individuals who have already given extensive consideration to their decision to request medical assistance in dying. As a result, the proposed bill would remove this requirement.

During the round table discussions, we also heard that the existing requirement for two independent witnesses posed a barrier to those seeking medical assistance in dying, especially for those living in a care home or institution. We proposed only requiring one witness and allowing this witness to be a care provider. Those involved in assessing or providing medical assistance in dying would still not be eligible as witnesses.

Last, we heard from Canadians about the waiver of final consent.

Under the current legislation, a practitioner must ensure the person seeking and deemed eligible for MAID gives their express consent immediately before providing MAID. This is often referred to as the final consent and provides final confirmation of the person's desire to proceed with MAID.

This safeguard also prohibits MAID for individuals who have lost the capacity to provide final consent, regardless of how sure and definitive they were about their intention when they had capacity. This safeguard unintentionally created situations for individuals who had chosen to end their lives earlier than they wanted out of fear of losing the opportunity to receive MAID because of an impending loss of capacity.

I know many of members are aware and have spoken about Audrey Parker, who last year died and used her final days to advocate for changes to this very part of the legislation. In one of her last posts, she said, “the law has forced me to play a cruel game of chicken... I would like nothing more than to make it to Christmas, but if I become incompetent along the way, I will lose out on my choice of a beautiful, peaceful and, best of all, pain-free.”

Inspired by Audrey's memory, we are proposing to include a waiver of final consent for persons whose death is reasonably foreseeable, but who are at risk of losing decision-making capacity. As proposed in the bill, the individual would be able to provide written consent for their practitioner to administer MAID on a specified date.

In addition to easing certain safeguards, the bill also proposes strengthening others for those whose death is not reasonably foreseeable. We heard concerns from stakeholders and Canadians alike that eliminating the reasonable foreseeability of natural death requirement could result in increased risk for some people. Their concern is for people who are suffering, but not at the end of their life, who might make a choice that is not fully informed, with respect to treatments and supports. We think it is important while improving access to ensure vulnerable individuals are protected.

For example, the bill proposes a minimum period of 90 days for assessing the MAID requests in these circumstances. This period would allow for exploration, discussion and consideration of options by the person seeking MAID in collaboration with his or her practitioner. The bill would also require that the people requesting MAID in this circumstance be provided with information about the available counselling, mental health supports, disability supports and palliative care to ensure he or she were making an informed consent.

Following the Truchon decision, some have expressed concerns about individuals suffering solely from mental illness receiving MAID. Many clinicians argue that the trajectory of mental illnesses is harder to predict than that of physical disease. In light of this consideration, the wording of the bill precludes individuals suffering solely from a mental illness from accessing MAID. This proposed change does not mean that people will be excluded if they have a mental illness; it means that mental illness cannot be the only underlying medical condition. We anticipate that the issue of mental illness and medical assistance in dying will be further explored as part of the parliamentary review process.

There is also an agreement among experts that allowing advance requests for people with illnesses like Alzheimer's disease is very complex and would require careful consideration and consultation before it could be implemented.

During round table consultations, I heard from health care providers who were worried that because they had seen patients who, as their condition progressed, might not have had the same desire for MAID as when they were first diagnosed, it would be very difficult to assess these types of requests. The Council of Canadian Academies expert panel report on advance requests came to the same conclusion. For this reason we believe this topic is deserving of deeper examination through a parliamentary review. We need to approach this area with the careful consideration that it warrants.

Since MAID legislation was first enacted in 2016, nearly 14,000 Canadians have chosen the option of a medically assisted death, and this is not unexpected. We have seen a gradual increase in the numbers over the last three years, and Canada's experience is in line with other similar regimes around the world.

This is why we are also proposing changes to expand data collection to help provide a more complete picture of MAID in Canada. Today we are taking steps to clarify and add precision to Canada's medical assistance in dying legislation to respect the issues and the concerns raised by participants and numerous consultations about the need to place the personal autonomy and protection of vulnerable persons at the centre and the heart of this legislation.

I believe this legislation would improve the existing legislation, especially for those people whose health conditions lead them to consider this difficult decision. I urge all members of the House to support Bill C-7.