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

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

Mr. Speaker, my question this evening is about options and appropriate and available supports. Earlier this evening, the hon. minister and member for Delta stated that accessing MAID should not be easier than accessing supports, in reference to people with disabilities. Is the government committed to increasing on a permanent basis, to provinces and territories, transfers for palliative care and mental health in conjunction with Bill C-7?

I ask this question because in my rural riding services are not equally distributed. Rural Canadians do not have access to palliative care, let alone mental health supports. What options will they have, especially in remote indigenous communities?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, I want to thank the member for his compassionate question but also my colleague, the Minister of Employment, for her work with Canadians with disabilities, to understand and to be able to advocate for the need for better services for all people who are living with disabilities. The member referenced supports for mental health and I will remind the member that in fact we have been supporting provinces and territories with billions of dollars in transfers specifically for mental health support. We have worked with provinces and territories all through COVID-19 in a way that demonstrates there is a lot more we could all do collectively to make access to services and supports available no matter where people live. I am extremely excited about, for example, the potential of virtual care in a way that can assist in those situations.

[Martin Champoux, Bloc, Drummond, QC]

Mr. Speaker, I thank the minister for her speech.

We all know that this is a sensitive topic. Some believe it should be debated longer so that we have the time to discuss it more thoroughly. Others believe that we need to move more quickly because people are waiting for us to legislate on the issue.

As I was saying, people know that this is a sensitive topic, but I also think that many people do not understand it properly or are intentionally conflating the issues. I am thinking, for example, about suicide, which is often associated with medical assistance in dying. We have also heard about the option of palliative care, which may be inadequate in some regions. That also needs to be looked at.

The minister spoke about the consultations she held with the health care community. What concerns did health care professionals raise regarding the implementation of legislation on medical assistance in dying?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, I thank my colleague from Drummond for such an insightful question. In fact, I found the consultations with the physicians extremely important in understanding both the value of providing MAID in their practices, giving people options for dignity at the end of their lives when it was very clear this was the choice they had made, but also the complications in trying to assess a person's condition and whether or not, for example, death was imminent. There was a number of issues that physicians raised specifically around some of the amendments that we are making.

One that was really poignant was the need for additional witnesses in a case where someone could be extremely elderly or isolated and had no one to vouch for them. They said that they did a very thorough job assessing these situations and they needed government to acknowledge the expertise they have.

[Paul Manly, Green, Nanaimo—Ladysmith, BC]

Mr. Speaker, I have a quick personal story. I witnessed the medically assisted death of my 90-year-old aunt a few months ago. I witnessed the process, the consultation and everything else, and it was a very caring, loving ceremony. What I have been hearing from constituents is that people with disabilities want to live with dignity, so they are feeling left out in a lot of ways. They are concerned about MAID but want to see better supports for people with disabilities, better supports for palliative care and better supports for people who are struggling in life.

I would like to ask the minister: what kind of measures is she putting in place? We have people with disabilities—

[The Deputy Speaker, Bruce Stanton]

The hon. Minister of Health, a short response if possible.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, I think the member for Nanaimo—Ladysmith really illustrates how this bill attempts to ensure that people have choice, autonomy and dignity at the ends of their lives, while also ensuring people must know of the supports that are available and have a reasonable expectation they will be advised of all of their options so they truly do have a choice. The work with the disability advisory group that the Minister of Disability Inclusion and I have had the privilege to do has highlighted for us that there is not a one-size-fits-all answer for the disability community, but that working together with them, we can enhance supports that will be meaningful and give people that true choice.

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

Mr. Speaker, Bill C-7 on medical assistance in dying is an important, sensitive and justifiable bill on a very difficult subject.

I am quite happy to be speaking at the end of the day, at the end of the debate. Before getting into my speech, I would like to lighten the mood for a moment and wish my young, beautiful daughter a happy 19th birthday. Last year she had to celebrate her 18th birthday on her own because her mother was on the campaign trail. This year she has to celebrate her 19th birthday on her own because her mother is in the House of Commons. I want to tell her that I love her and wish her a very happy 19th birthday. This will give us some energy to continue with the debate. It feels good to lighten the mood a bit and talk about our lives.

A year ago, I was elected in the riding of Beauport—Côte-de-Beaupré—Île d'Orléans—Charlevoix, and I was given a very important mandate: to represent, here in the House, Quebec's values in matters of culture, languages, the environment, the green economy and health. A year ago, I had no idea that I would be rising in the House and speaking to my distinguished colleagues in favour of Bill C-7 on medical assistance in dying. To be perfectly frank, this is not usually a topic we find easy to talk about.

However, something happened that gave me the courage to get more involved in this issue of late, and so, despite everything, I am pleased to do so. This is not an easy debate because what we are doing will have a major influence on the fate of courageous individuals with conditions that cause them extreme and irremediable pain and suffering that will never end.

To help us do this work, we must turn to our own experience. I will share some of my own experiences that, sad as they are, will put a human face on this afternoon's debate.

As an only child, I accompanied my parents on the sad and often difficult path leading to the end of life. My father was the captain of a schooner, a small wooden boat, that he sailed on the St. Lawrence. His entire life he claimed that his schooner was a leaky boat and that he had to learn to sail in order not to drown.

His lung specialist told him that he was going to drown, that the cancer would drown his lungs and that he would suffocate to death. My father had a great deal of character and thought that he had not worked all his life without drowning to then die by drowning. That was out of the question. He wanted the doctors to find a solution. Surprisingly, he was told that, in his particular case, he had to right to a medical protocol involving sedation to avoid a situation of imminent death, respiratory distress. On the morning of August 12, 2010, he decided that he could not go on, that his condition was deteriorating, that he wanted relief. He was relieved to learn that he would not die by drowning, because he could avail himself of the protocol on the day that he decided that he could take no more. He passed away peacefully and serenely.

My mother was not as lucky. She had pancreatic cancer and died in excruciating pain. She was dehydrated and her stomach was perforated by the disease. She was in palliative care for 17 days. In her case, palliative care could not ease her suffering. Use of the respiratory distress protocol was not an option, even though there was plenty of distress for her, me and all her health care providers. In short, there are many ways to die, but in her case, morphine never did any good. Her heart was too good, too strong and it resisted. It resisted for far too long, much longer than the specialists could have predicted.

My experience with my parents is certainly just as valid as those of my dear colleagues. It allowed me to compare what it means to die when you can control how things happen and the consequences, and what it means to die in desperation without any way to ease the pain.

I now want to talk about my friend Sophie, who died on Saturday. Sophie was 39 years old and had two young children aged 11 and 13. Sophie had cystinosis, a nasty disease that took her sight, then her ability to swallow, and finally her kidney function. She had had a kidney transplant, was part of an American research program and had access to some new potential medications developed in the United States, which were able to help some people with the same disease. Unfortunately for her, the disease had progressed too far. The experimental treatments did not work, in spite of the 100 pills a day she had to swallow, at a cost of $300,000 a year.

I share my friend Sophie's story because it needs to be heard here today. When her condition started to get worse, she wanted to request medical assistance in dying. She had already started the process and started filling out the mountain of paperwork, as she called it. Unfortunately, even with the help of her loved ones and her doctor, she did not have the time to go through with it, because she suffocated and collapsed, dying in front of her powerless, terrorized and unprepared young children, who will forever be traumatized by these memories. This happened on Saturday at 6 p.m. in Quebec City.

Things could have been very different for our dear Sophie and her two children. Simplified access to medical assistance in dying based on criteria that suited her situation could have given her children a chance to say goodbye to their mother, to hold her in their arms and to be with her as she passed away quietly and serenely. Their experience of death, while deeply sorrowful, could have been tempered by the dignity and peace that only medical assistance in dying can provide in some cases clearly defined by law and the experts when given the chance.

Bill C-7 is a step in the right direction. We must make it so that other people suffering from degenerative or incurable diseases need not go to court to challenge the eligibility criteria for medical assistance in dying. This bill is a step in the right direction because a person's eligibility for medical assistance in dying no longer hinges on their death being reasonably foreseeable.

The complexity and diversity of Sophie's symptoms made it impossible for her death to be reasonably foreseeable and to know what would ultimately be her cause of death. Everyone around her knew that her only hope of dying with dignity and without suffering was quick and easy access to medical assistance in dying after obtaining the appropriate medical opinion.

Sophie's story will not be reported in the papers or on television. Maybe it will be shared a bit on the family's social media, but Sophie is the perfect example of what we have failed to do so far.

On behalf of all those who are sick and waiting for medical assistance to die in peace and with dignity, I call on all hon. members to stop playing games and acting superior to those around you, and drop all the political strategies that often animate and sometimes drag out our debates. I ask each one of these people to take a deep breath on behalf of all those we have yet to help who are anxiously waiting and hoping that our good collective judgment will help us reach a consensus. Let us set aside all the parliamentary back and forth and let us be guided instead by our humanity and compassion.

[Brenda Shanahan, Liberal, Châteauguay—Lacolle, QC]

Mr. Speaker, I thank my colleague for her very moving speech. I really got a sense of her friend's sadness, but also her courage, and that of her friend's family, as she shared their story.

Five years ago, I served on the Special Joint Committee on Physician-Assisted Dying. We were inspired by how this issue evolved in Quebec, and I even remember attending a meeting with Véronique Hivon and Pierre Moreau. It was quite controversial, but it was very important to have that discussion. Quebec has really been a leader on this issue.

Is there anything else my colleague would like to see addressed in this process regarding medical assistance in dying, this very important choice?

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

Mr. Speaker, in response, I will say what I hope not to see. I do not want to see any wandering discourse meant to sweep this under the rug.

I also want everyone here to acknowledge that we are but humble humans, not experts. We will hear from the experts in committee, experts who will guide us on what useful, appropriate tools should be included in the bill.

We must not use urgency as an excuse to rush this. Once again, I am thinking of those who must have nothing better to do at the moment and are listening to us on ParlVU. They are probably thinking that we should stop talking and get on with it already.

[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 want to add to the member's comments, which are very much appreciated. She puts faces and reality to the legislation we are debating today.

It was not that long ago, back in 2015, that we had to bring in legislation. We have been seeing it evolve, and in many ways it cannot evolve fast enough. We could take a look at the province of Quebec, for example. In certain areas, they are further advanced than other parts of Canada. That is one of the benefits of the federation. I agree with the member: I would ultimately like to see the bill go to committee, because I think a lot of stakeholders are interested in contributing to the discussion.

This is more of a comment than a question.

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

Mr. Speaker, since I am probably coming to the end of my time, I would like to commend my esteemed colleague, Véronique Hivon, who worked very hard to ensure that Quebec led the way in medical assistance in dying. It now sets the standard. I take this opportunity to acknowledge her.

I will also take this opportunity to say that Quebec is often a source of inspiration. In this case, that is probably even more true. I hope that everyone will look to Quebec's example in passing this legislation.

[Martin Champoux, Bloc, Drummond, QC]

Mr. Speaker, like my colleague opposite, the member for Winnipeg North, I want to add to my colleague's speech.

I, too, have some touching stories that are often hard to talk about because it is such an emotional subject. I want to congratulate my colleague for her very poignant speech. These stories humanize the debate and show us the situations that we are making decisions about.

In my riding, a woman who had fought to obtain MAID passed away last year. She did not have time to complete the process. As my colleague said, we must stand together to ensure that people who are dying have the right to die with dignity.

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

Mr. Speaker, once the bill is passed, we will put our faith in eminent experts who are much more knowledgeable than we are, thanks to a university system that is supported by our tax dollars. They will testify in committee, and we will listen to them. We will improve the bill, to make sure that the act is fair and easy to implement.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

Mr. Speaker, I appreciate the opportunity to rise and speak this evening on Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying, or MAID.

The meaning and consequence of this bill should weigh heavily on all Canadian parliamentarians. Today we are debating the competing interests of individual autonomy and the sanctity of human life. We are addressing the suffering of our loved ones, the dignity of the elderly and disabled and the moral, legal and ethical concerns that are inextricably tied to medically assisted death. We are setting out the rules, standards and boundaries by which Canadian doctors and nurses can, at a patient's request, terminate life. This cannot be taken lightly and it is not legislation that should be rushed, but that is the predicament that this Parliament finds itself in.

In 2016, the Liberal government passed Bill C-14, legalizing MAID. Last year, in the case of Truchon v. Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. Contrary to the requests of my Conservative colleagues and many advocacy groups, the Attorney General, who bears the responsibility of upholding laws passed in Parliament, chose not to appeal the ruling in Truchon. It is difficult for me to understand how something as essential to life as one's departure from it is not important enough for the Liberal government to appeal. This is something that should have had both comment and decision from the Supreme Court of Canada.

Because of the Liberal government's inaction, we are now working up against a December 18 Quebec-court-imposed deadline to enact a legislative response for the whole country. Its declaration of constitutional invalidity expires on that date. I want to assure my constituents in South Surrey—White Rock and all Canadians that, as a member of Parliament and a member of the Standing Committee on Justice and Human Rights, I will stand up for their shared values and beliefs and work tirelessly to ensure the amendments proposed in Bill C-7, and their consequences, are carefully studied and considered despite the impending December deadline.

Turning now to the substance of Bill C-7, I am concerned that the bill, as written, is too broad and lacks the safeguards necessary to protect Canada's most vulnerable populations. Let me be clear. The removal of the “reasonably foreseeable” standard will significantly increase the number of Canadians eligible for MAID. The breadth of qualifying conditions widens considerably under Bill C-7. For anyone who initially opposed MAID on slippery slope concerns, it appears we are now sliding down that proverbial hill. Will we eventually follow the Netherlands' lead, which recently ended up in its announced plans to offer MAID to children under 12?

As a group of physicians recently put in a letter to the Minister of Justice and Attorney General of Canada, urging an appeal of the Truchon decision, “Canada will have moved well beyond allowing an autonomous life-ending decision at the end of life into the realm of death on demand for almost any reason at any time.”

We know, from Health Canada's annual report published in July, that 2% of deaths in Canada in 2019 were medically assisted.

How much higher would that number be under Bill C-7, and how many Canadians would be eligible for MAID without the “reasonably foreseeable” requirement? Both questions must be answered.

If this is in fact the direction in which Parliament decides to take this legislation, we need more safeguards to protect the more vulnerable, not fewer. As written, Bill C-7 redefines who qualifies for the end-of-life procedure and strips away some of the protections put in place a mere four years ago.

One such amendment is the elimination of the mandatory 10-day reflection period. Under the original legislation, unless an exception applied, individuals wishing to receive MAID had to wait a period of 10 days after submitting their signed requests. In most instances, the waiting period makes sense. It ensures time for reflection before taking the irreversible action of ending one's life.

We know from Quebec's annual end-of-life care reports that since 2015, over 300 patients in Quebec alone changed their mind after requesting medical assistance in dying. In any event, exceptions already exist under the original law for those whose death is fast approaching and for people who will soon lose the capacity required to provide the necessary informed consent. Why then remove this 10-day reflection period?

Bill C-7 also takes aim at another safeguard included in the previous laws, reducing the number of independent witnesses needed to sign and date the candidate's application for MAID, from two to one.

This amendment would now apply to the newly eligible class of persons who are not faced with reasonably foreseeable or imminent death. Contrary to statements made in the House by the member for Winnipeg North, this is a real concern for many.

As a civil litigation lawyer, I have had my fair share of exposure to all sorts of legal documents requiring the signatures of independent witnesses to ensure both authenticity and true intent: wills, divorces, financial disclosures, affidavits and mortgages, to name a few. To express one's intentions in a will in B.C., a person must have two independent witnesses not named in the will to witness the authenticity of their signature and their intention at the time of signing. If these requirements are there to safeguard intentions regarding possessions, should they not also be there to safeguard a person's intentions regarding the method and timing of their death?

It should be noted that Bill C-7 does include a 90-day assessment period and directive that applicants be informed of available alternative treatments, but will these safeguards sufficiently protect our most vulnerable populations? When does the 90-day period begin? Is it recorded?

Another piece of the bill that I have difficulty with is that it allows patients who may lose capacity before the end-of-life procedure is performed to give their final consent in advance. This troubles me for the same reasons discussed before with respect to the 10-day waiting period. As we have seen, people do change their minds.

In recent weeks, we have heard from many representative groups that have expressed concern about the decision in Truchon. The Council of Canadians with Disabilities, the Canadian Mental Health Association, the ARCH Disability Law Centre and others have articulated the concern that making individuals with disabilities who are not facing imminent death eligible for MAID would be harmful to the disabled community at large, affirming the untrue stereotype that a life with disabilities is not worth living.

We must pause to reflect on that. Those who are passionate advocates for Canadians with disabilities are very concerned about the direction these court and policy decisions are taking us, yet the Liberal government moves forward.

There still exists the legal concept of undue influence. Who are most susceptible to undue influence and coercion? It is the vulnerable. We have also heard from hundreds of physicians who share a concern that some patients have chosen the path of MAID due to the suffering caused by a lack of proper supports. A tragic example is from B.C., where a father suffering from Lou Gehrig's disease chose to undergo the end-of-life procedure because he did not receive the support and resources he so desperately needed.

The government is not listening to the heartbreaking stories of these ALS sufferers and their cries for the fast-tracking of life-lengthening and life-sustaining hopeful therapies that we cannot get in Canada. Is the government giving those sufferers and Canadians true options? We need compassion, yes, but compassion takes many forms.

Hospices are not readily available to all Canadians as an alternative. A good friend of mine died a couple of years ago of inoperable brain cancer. He was a doctor. In his case, he very carefully weighed MAID as opposed to living in hospice. He chose hospice because it extended his life for five months, which he could spend with his family. They were okay with his deterioration because they loved him, and they wanted to support him and be with him. However, he had that true option.

If we are going to expand the legislation, the government should equally ensure robust support for the vulnerable, hospice care and hopeful therapies are available. Everyone matters.

Finally, I would like to reflect on the health care professionals who are asked to implement this proposed law. We are now celebrating our doctors and nurses for their tireless efforts to keep our country healthy and safe. We should also ensure that they have the ability to decide whether this is compatible with their will or beliefs, and not be mistreated for any refusal to administer it.

To conclude, I have heard from constituents in my riding who are on both sides of this argument. I ask my colleagues to really take the necessary time to study the bill and reflect on these proposed amendments, especially as they affect the most vulnerable. We must be compassionate but we must also respect human life.