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.

The House resumed from October 21 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.

Criminal Code

[Jenica Atwin, Green, Fredericton, NB]

Mr. Speaker, I recently celebrated one year since I became an MP. In my role, I have had the incredible opportunity to learn every day. I listen to people, organizations and advocates, and the discussion around medical assistance in dying is truly about listening. Today I will add my voice to an issue that affects us all.

Talking about death and dying is still taboo in our society, yet each of us must face it, not only for ourselves, but also for the ones we love. This conversation does not come easily, but for those whose time is closer than others, we owe it to them to listen and to act in passing this bill.

The debate on Bill C-7 has been passionate, emotional and raw, and rightly so. I wish to congratulate and offer my gratitude to each member of the House for their efforts on behalf of their constituents, family members and friends. Each of us has been speaking with our community members to learn their thoughts and hear their stories. Human agency has been on display, and the speeches before the House have shown professionalism and integrity, with a deep commitment to the fundamental rights of Canadians.

Sometimes we need a reminder that our constitution is a beautiful thing. It is the crux of why I am so proud to be Canadian, and why I feel so honoured to have the privilege to defend and uphold the Charter of Rights and Freedoms.

I remember first learning in depth about the charter as a grade 11 student. I remember the way it made me feel, the way it made me think about our lives and our interactions with one another, and the empowerment that it brought into focus. It was right around this time that I knew I wanted to some day to be involved in politics. While that seems like ages ago, it was only recently I learned about the urgency in amending our laws specifically concerning the issues within the legislation on medical assistance in dying and how it interacts with the charter.

I sat with it, without lived experience, and I thought of many what-if situations. I thought of the various scenarios and scary predicaments I would not want to face out of the risk of overstepping constitutional rights, if mistakes were made. I heard some of these same concerns from many stakeholders, from those who are concerned about how this would impact people living with disabilities or with suicidal ideation. I have listened to those concerns, and filtered this legislation through those important lenses. While I know some of these people may still disagree with me, I want them to know that I am confident this legislation strikes a balance and it will not have the impact they fear.

I also sought out opportunities to speak to individuals who had a personal connection to this legislation, and as it turns out, many people are willing to discuss their wish for dignity in dying, as well as their concerns about the current process and these proposed amendments. These individuals shared with me their efforts to pursue their right to bodily autonomy in their final moments on earth. In the powerful conversations I have had, the specific issues of advance requests and mental competency, as well as the discretionary role of a foreseeable death, were the exact hurdles to the peace of mind that would come from having control over their own death and final control over the pain.

There are Canadians right now who are suffering intolerably and enduringly. They already have do-not-resuscitate orders. They have made final wills and testaments, and have pre-paid for funeral arrangements. They have demonstrated their competence in preparing for death. They should be trusted to make a decision about the nature of their own death as well. If we rob them of this opportunity, then we have failed them. We have allowed our laws to overstep into bodily integrity and autonomy, an infringement of our protected right to security of the person.

I also want to address the language of “assisted suicide” and “euthanasia”. Our words are important, and it is important to remember that this bill is to amend a bill on medical assistance in dying. We know that a medical prognosis is the safeguard. It is the authoritative layer that protects individuals who are vulnerable.

The reality of the situation facing real Canadians is that co-occurring mental and physical illness is extremely common and should not be a barrier to anyone's right to bodily autonomy at the end of their life. Severe depression often accompanies other medical illnesses, and has a high rate of occurrence among persons with disabilities. As a further example, an individual may be bipolar and later develop terminal cancer. This pre-existing condition, likely to flare up in such a stressful time, cannot be the reason to deny the will of an individual to determine their final moments.

In conclusion, I remain firm that mental illness in Canada requires rapid access to effective mental health services, including in-person counselling and access to psychiatrists where necessary, as well as wraparound community supports. We also need to set national standards for long-term care to ensure that the facilities intended to house older adults are providing a quality of life that keeps them healthy and active throughout their later years, and we need to invest in robust palliative care to ensure there is dignity in living, even through those final difficult days.

I think of Hospice Fredericton and the peaceful, beautiful experience people and their families have in that environment. The option to welcome death peacefully should be an option for those who want it. We must also value and listen to Canadians with disabilities and their advocates. We can do all of these things and still pass this bill.

I do not believe that MAID introduces the risk that some patients will be forced to receive this procedure against their wishes. There are preventive measures capable of eliminating this risk. I do believe that my duty to uphold the Charter of Rights and Freedoms means passing legislation like this to uphold security of the person for all Canadians at all moments during their lives.

I will be proudly voting for this legislation. This is about justice. It is about empathy. It is about choosing to respect one's wishes and not interfering in that decision. It is about giving peace of mind to people, so the final chapter in their lives can be written in confidence, and their story can be concluded according to their own volition.

[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, this is very important legislation, which, in essence, comes out of a court ruling. The debate in the House really began on this issue after the last federal election, again due to a Supreme Court ruling. Listening to the many speeches on this has been very touching. I suspect it will receive unanimous support, at least I am hopeful it will.

In debate, a lot of members have been talking about related issues, such as the importance of palliative care and the need to do more in that area. To that extent, I would ask my colleague what her thoughts are on how important it is for the federal government to be working with provincial governments in dealing with some of the issues we have before us, including palliative care.

[Jenica Atwin, Green, Fredericton, NB]

Mr. Speaker, it makes me think about where I am in my life and what the future could possibly hold. I know it really comes down to that choice. I hope that at that point in my life, there is effective palliative care to ensure that I have the choice to live with dignity until the end, if that is what is best for me as an individual.

Absolutely, we need to do far more, and we need to collaborate with our provincial counterparts. This is a huge piece of why I also advocate for an increased health transfer for Atlantic provinces. We know we have an aging population. This is an issue we must confront, but the other piece is to ensure dignity in dying as well.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Speaker, my colleague across the way gave a great speech. I want to talk a little more about palliative care, as I am obviously a passionate advocate.

My mother passed away this past week, and she was fortunate enough to have excellent palliative care, as we do in Sarnia—Lambton. The government made a good beginning on the palliative care framework and starting down that path, but it has really not put a lot of muscle in it since then, especially during the COVID pandemic with so many people needing palliative care at the end. We need to have that to ensure people can make that choice.

I wonder if the member could share her thoughts on what the government ought to do to boost its efforts in this area.

[Jenica Atwin, Green, Fredericton, NB]

Mr. Speaker, my condolences to the member and her family on their loss.

This continues from what I have been saying, but I think it is important for us as opposition members to continue to hold the government accountable on some of these promises and initiatives. We hear great things in some of the speeches of members opposite, and in the throne speech, but we need to see the action in the legislation that correlates. I will certainly do all I can to push for better palliative care across this country.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Mr. Speaker, I thank my colleague from Fredericton for her comments.

My question is very simple. What would she like to see added to this bill? Does she think the bill goes far enough? How could we improve it to enhance the quality of end-of-life care for people who need it?

[Jenica Atwin, Green, Fredericton, NB]

Mr. Speaker, for me, one of the key issues that has been brought forward by constituents is the concept of irremedial mental illness and how this might impact people's ability to follow through with their wishes.

As an advocate for mental health supports, it is such an important question and I want to be really careful and clear. As I mentioned, co-occurring disorders often exist, and that should not be a reason for someone to not be able to pursue dignity in death when experiencing another physical illness. It is a very specific issue, and I hope to see that addressed and the legislation changed.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, it is my privilege to speak in the House today on Bill C-7, the medical assistance in dying act. This legislation was previously introduced in Parliament back in January, and I had the privilege of speaking to it in February. The bill died with prorogation, which occurred so that the Liberal government could avoid questions about the WE scandal. This bill would amend the original MAID legislation from 2016.

MAID is a very touchy, personal and non-partisan issue, and everybody has different views on it. I have asked my constituents and most of them are opposed to this legislation. I am opposed to it and, therefore, will not be supporting it.

The question arises as to why we are here today. I believe there are two examples of Liberal inaction that have brought us to this point. The first is that a judge in Quebec struck down the reasonably foreseeable portion of the bill, which is commonly known as the Truchon case. Typically, in a case with such profound and life-altering consequences for Canadians, the federal government would appeal such a decision from a lower court, but in this case it chose not to do that. It is an example of the inaction that has led us to this place. The government should have appealed it to get a ruling from the Supreme Court.

A second example of inaction is the legislative parliamentary review that was scheduled for this past summer. Obviously, COVID threw a monkey wrench into that, but we have more or less figured out how to live with COVID and get things done, so there is really no reason why that parliamentary review could not be ongoing. However, because of the Liberal inaction on that, the review has not happened.

What is the real reason for this inaction? I believe the current justice minister voted against the legislation originally, back in 2016, not because he did not agree with the legislation but because it did not go far enough in his view.

The Liberal government talks about consulting with and listening to Canadians, but the truth is that it has its own agenda and wants to push that. The truth is that it did not want the parliamentary review. It wanted something that was less. The truth is that it had its own agenda and simply wanted to implement it. The Liberals will talk about the consultations they had with different groups and the fact they had over 300,000 responses to their website and polls, but a consultation is a very different thing from a parliamentary review. Consultations are easy to manipulate. They can be ignored. They provide cover for answering the question, “Did you consult with people?”, as the government can say that it did. However, that is very different from a parliamentary review.

That is why we are here. It is the Liberal government's agenda. It is not about listening to Canadians so much.

What do I think about this legislation? Let us start with my constituents. In January, I sent out a mailer and since then my office has received over 400 contacts on this issue through phone calls, emails and letters. Two-thirds of those contacts are opposed to the legislation. I also received a lot of feedback on the rights of health care workers, asking if they have the right to say no to euthanizing someone. As this is an issue of conscience protection, are they free to not participate? Are they free of penalty or harassment?

Also, the conscience objection of institutions is another thing that must be protected, because an institution is far more than bricks and mortar. An institution is made up of the people and the values of those people who are invested in that institution.

Right here in Saskatoon we have St. Paul's Hospital. It is a Catholic hospital managed by the Catholic bishops of Saskatchewan. In our province, hospitals are allowed to choose which services they wish to perform. This hospital operates on the basis of the Catholic faith and has chosen to not perform MAID. The hospital respects a patient's right to choose, however, so if a patient wishes to have MAID, it will help transfer that patient to another hospital.

Instead of MAID, St. Paul's is very well known for its amazing palliative care. In fact, it is the only location in the city. My own mother-in-law was a patient there. In her case, MAID was not requested nor desired and she was fortunate enough to get one of only 12 palliative care beds in the city. She received amazing care as she came to the end of her life. Notice I said 12 beds. Since she has been in there it has added 13 more, so there are 25 palliative care beds for all of northern Saskatchewan, which just is not enough. In fact, 70% of Canadians do not have access to palliative care. I would hope that lack of palliative care would not force people into MAID as their only option.

I would also note that St. Paul's Hospital built its existing and new palliative care facilities all on its own and raised all the money to build the units. Is this not exactly the behaviour that we want to encourage? However, now, because of the lack of conscience protection, the hospital is being sued by activists to provide MAID. A hospital well known for amazing palliative care is forced to defend itself in court because it will not provide euthanasia.

I think that several Supreme Court cases are instructive here. In 2015, in the Loyola case, the court said, “Religious freedom under the Charter must therefore account for the socially embedded nature of religious belief, and the deep linkages between this belief and its manifestation through communal institutions and traditions.” In another 2015 decision, the Supreme Court said, “A neutral public space free from coercion, pressure and judgment on the part of public authorities in matters of spirituality is intended to protect every person’s freedom and dignity, and it helps preserve and promote the multicultural nature of Canadian society.”

We must respect the multicultural nature of Canadian society. We must respect both medical professionals and institutions, and allow them to have full conscience protection free from harassment and consequences.

As I said, MAID is a very touchy, personal and non-partisan issue. One can always find examples of people for whom MAID is a difficult but welcomed option. Unfortunately, those simple examples are the minority. Most often, it is far more complicated than that. The stories I have heard reflect these complications. I have heard of cases where families are caught by surprise and forced to deal with the aftermath, cases where a person is at a particularly low point in their health but under the legislation before us would be able to request and receive MAID with no waiting period, and other cases where physicians or hospital officials apply pressure on individuals to consider MAID.

I am concerned about the removal of the waiting period. Canadians with serious illness could receive a lethal injection on the same day they receive their diagnosis. I am concerned that people, in a time of very high stress, will make a life-ending choice. Many provinces have a cooling-off period for the purchase of something major, whether it is a car, appliance or something like that. A cooling-off period is there to prevent one from making a terrible decision. Does it not make sense to provide a cooling-off period before MAID? I mean, this is the most significant decision that a person could make.

Of course, there are specific cases where a waiting period is not required, but the current legislation already allows doctors to waive this waiting period. During COVID, we shut down our economy on the advice of doctors. Surely we can trust doctors to waive cooling-off periods if it is required.

I am very proud of our Conservative Party. The vote on Bill C-7 will be a free vote and not a whipped vote. Each of us Conservative MPs will be able to vote our conscience and, once again, I am going to be sending out a mailer at the end of this month to ask the people of Saskatoon West for their opinions. I will make sure that the House knows those results at third reading.

I am reminded of something that a constituent told me back in February. He said that we needed to slow this down, not speed it up. I agree with him. Yes, we need to deal with the Quebec court decision, but that only requires one change. Let us wait for a proper, legislated parliamentary review. Let us have a pan-Canadian strategy for palliative care. Let us put full conscience protection in place for physicians and health care professionals. Let us put conscience protection in place for institutions, and let us leave the 10-day waiting period and the ability to create exceptions the way it is right now.

I would like to slow this down.

[Ken McDonald, Liberal, Avalon, NL]

Mr. Speaker, the member mentioned palliative care in his speech and how the majority of his constituents are not in favour of MAID per se. Does the member believe that palliative care in itself is a form of MAID?

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, MAID is a very specific thing. Palliative care is a very different thing. Palliative care is natural. Palliative care is something that enhances the end-of-life position for a person.

The real issue with palliative care in Canada is the fact that 70% of Canadians do not have access to it. I believe there is a place for MAID in Canada, for sure, but I also believe that, as much time as we spend on that, we should spend even more on helping Canadians have access to good palliative care so that they have good options and a good way to live out the last days of their lives.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, my colleague's speech raised some concerns for me, particularly regarding terminology. When the term “euthanasia” is used, some specialists mean physician-assisted suicide. It is important to distinguish between suicide and medical assistance in dying. It seems to me that certain moral considerations are polluting the debate. As legislators, we have to put our obligation to respect individuals' choices ahead of these moral considerations.

Does my colleague not think we are limiting people's choices when we bring these moral considerations into play?

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, that is a very important point and I think it is at the heart of my concern about conscience protection. I believe different medical professionals and different individuals all have different opinions based on their backgrounds, faith and beliefs. We need the ability to provide the services Canadians want and need, but we also need protections for people for whom issues like this go against their conscience so that they have full protection in law not to be forced to do something that would go against their rights. It is very important that we allow for people for whom this is a conscience problem to have protection in law.

[Laurel Collins, NDP, Victoria, BC]

Mr. Speaker, the member called this a touchy issue and gave examples of people he had spoken to who oppose it. However, 300,000 people responded to the survey about this issue and a large majority, 86% of Canadians, support the Supreme Court of Canada's decision in Carter v. Canada, which recognizes medical assistance in dying as a right. Seven in 10 Canadians, 71%, support in some way the removing of the reasonably foreseeable requirement from the assisted dying legislation. Most Canadians know someone who has been affected by intolerable suffering at the end of their life. This bill would provide dignity to those who would not otherwise have it.

When the member talks about slowing down the legislation, how does he respond to people who do not have the time or who would live out their last days in intolerable pain?

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, this legislation does not provide that. The current legislation provides that. This legislation is simply changing and modifying the existing legislation. All of the things the member mentioned are in existence with the current legislation, with the exception of the reasonably foreseeable part. I do not have any disagreement with that. My disagreement is with the 10-day waiting period. I would like to see stronger protections of conscience, and I would like to see more focus put into palliative care.