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

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

Mr. Speaker, it is a privilege for me to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying. As parliamentarians, it is so important that we are mindful that the decisions that are made in this place have a real-life impact on Canadians, and the life-and-death implications of this particular legislation only make it more important that we approach it with great seriousness and sensitivity.

I approach this subject through the lens of placing tremendous value on every single person's life, and through my own deeply held conviction that every life is valuable and worthy of protection until the point of natural death. As demonstrated throughout this debate, we, as members of Parliament, hold diverse opinions on this subject and many of us approach it with deeply held convictions. The diversity of viewpoints is undoubtedly a reflection of the diverse views among Canadians.

Where I hope we can at a minimum find common ground, is on the importance of protecting vulnerable Canadians. That is why, to me, it is so important to have the opportunity to speak to this legislation: If that is our shared goal, there are significant areas where this legislation misses the mark.

This legislation takes many steps to broaden the eligibility for medical assistance in dying and removes safeguards that were previously put in place. While I recognize that this legislation is in response to the Quebec Superior Court decision in the Truchon case, the legislation introduced by the current Liberal government goes much further than the court decision required. We know that many Canadians were disappointed that the Liberals chose not to appeal the Quebec Superior Court decision to the Supreme Court of Canada. Among those who were vocal in their plea to the justice minister to appeal it were physicians from across Canada and many advocacy groups for Canadians with disabilities.

It is disappointing that the decision was not appealed, but perhaps it is even worse that the Liberals took this opportunity to make significant changes to the legislative framework of MAID prior to the mandated parliamentary review. The medical assistance in dying law that came into effect in 2016 required a parliamentary review of its provisions and of the state of palliative care in Canada. As you know, Mr. Speaker, this review was scheduled to start this summer. The significant changes proposed in Bill C-7 undermine the parliamentary review that has yet to commence. They also undermine our ability as parliamentarians to review changes to MAID with the full knowledge of a comprehensive review.

The Truchon decision struck down the “reasonably foreseeable natural death” criterion, but in considering the proposed legislation we are also considering many legislative changes outside the scope of that decision. We are putting the cart before the horse by forging ahead with fewer safeguards when the personal experiences shared, and the concerns raised by Canadians and relevant stakeholders, should give us all reason to pause in loosening safeguards.

We, as parliamentarians, have a responsibility and a duty to ensure that medically assisted deaths are not driven by lack of access to palliative care or by economic or social vulnerability. Ensuring adequate access to health care services and supports should be our number one priority. Palliative care is a main component of that. Through pain management and psychological, emotional and practical support, palliative care helps to reduce suffering and improves the quality of life for a person with a life-limiting illness. Ongoing gaps in access to, and quality of, palliative care in Canada need to be addressed. With an aging population, the demand for palliative care is increasing. As it is, there are not nearly enough health care providers who specialize in palliative care. If the existing gaps are not addressed, they will only grow.

A 2018 report by the Canadian Institute for Health Information found that while 75% of Canadians would prefer to die at home, only 15% of Canadians had access to palliative care or home-care services. Quality palliative care offers an individual facing a life-limiting illness dignity in living.

In addition to palliative care, we should also be looking at access to, and the quality of, other supports like long-term care, disability support and counselling. If we cannot first ensure dignity in living, there cannot be dignity in dying.

We know that medically assisted deaths are most common among seniors. While that might be expected, given the realities of aging, we must also acknowledge the potential for vulnerabilities. We owe it to Canada's seniors, who have helped build and shape this country, to ensure that they are cared for in their older years. We know that it is families and friends who most often take on the caregiving role. In fact, when options like palliative care are unavailable, caregivers step up to support them.

We need safeguards in place to ensure that seniors are not choosing medically assisted death because they feel like they are a burden on the health care system or a burden to their friends or their families. Ultimately, the best safeguard we can put in place to protect vulnerable seniors is to ensure that they have adequate and appropriate supports for a good quality of life. Without these, there is no real choice.

To help ensure that seniors, and any individuals for that matter, are not led to choose MAID out of concern that they are a burden, it is important that they do not feel pressured to do so. First-hand accounts from Canadians who have had medically assisted death suggested, without them seeking it, are extremely troubling. Offering MAID to someone who has not sought it sends a message. When a person is at a low point or in a fragile state of mind, prompting them to pursue MAID may suggest to them that their life is less valuable or has lost value. It might also suggest that they are a burden to society or to their family.

As legislators, we should be looking to ensure that no person is counselled or pressured into MAID. Unfortunately, the legislation before us takes a step further away from ensuring that, perhaps unintentionally. It does this by no longer requiring that there be two independent unpaid witnesses. If passed, it would require one single witness. This independent witness could also be a paid personal or health care worker. This leaves the door open for individuals to be presented with the option of MAID unprompted, in the presence of no other witnesses.

The same individual who counsels a vulnerable person to consider MAID could also serve as one of their independent witnesses. In a vulnerable state, a person could easily be made to feel that they are a burden, and that prompting could lead them to feel pressured to end their life. With the absence of a second witness, this decision could be made without the knowledge of the individual's family.

The proposed legislation also significantly broadens eligibility by allowing for advance consent. Advance consent would allow a medical practitioner to proceed with MAID without a person's consent immediately before administering it. While consent is deemed invalidated if a person demonstrates, by words or gestures, refusal or resistance to a procedure, this assessment is solely up to the practitioner administering it. This leaves space for errors. By solely placing that responsibility on practitioners, it does them a disservice, just as the absence of conscience rights for health care workers in the existing or proposed legislation does them a disservice as well.

There is a finality to death. We cannot afford to leave room for error. As legislators, we have the responsibility to think about how every individual will be impacted by this legislation, because every life is valuable. We have to be mindful of not reinforcing negative stereotypes about illness, age or ability. We cannot undermine suicide prevention efforts or devalue human life. We have to ensure that meaningful alternatives to MAID not only exist, but that they are readily available. Above all, we have to first ensure the protection of vulnerable Canadians. We cannot allow individual autonomy to outweigh their protection.

[Lloyd Longfield, Liberal, Guelph, ON]

Mr. Speaker, I thank the hon. member for her contribution this afternoon.

Earlier in her speech, she talked about our role as members of Parliament. I wonder if she could comment on the role of the court systems that are also looking at legislation we put forward, and then ruling on it when it comes back to us for review, and looking at how we could make our legislation align with the court systems that we have in Canada.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

Mr. Speaker, this goes back to a speech I gave in this place earlier today, about not rushing things and making sure we take the time to listen to Canadians, stakeholders and experts.

Another good point that I mentioned in my speech is that there was supposed to be a review. The review has not happened. The Liberal government is bypassing that altogether.

Absolutely, COVID-19 has happened and things have changed a bit, but the review could have at least been started so that this legislation could then be tabled.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Mr. Speaker, I thank my colleague for his speech. I wonder if we are wasting our time today.

Yesterday, we were talking about conversion therapy, a file Quebec has been a leader on, but still has to wait for Ottawa. We are always trailing behind Ottawa because we are always waiting for Ottawa to get moving and get on board. Today we are talking about medical assistance in dying because a decision was made in Quebec, which is ahead of the curve there too. We have come back to Ottawa to work on this file again. If Quebec were independent we would not be wasting our time duplicating our work on these types of files.

I want to come back to my colleague's speech. Legislators did not do their job when it comes to former Bill C-14 on medical assistance in dying. That is why we are here today. We have to come back to this file because the Bloc Québécois's proposed amendments in 2016 to avoid bringing the courts into social and political issues were rejected. We are coming back to it today because a decision was made by the Quebec Superior Court.

I would like to hear what my colleague has to say about people who have a serious irreversible illness and are essentially forced to go to court. These people are already sick and have to fight the system to be able to access medical assistance in dying. Sometimes they even have to go on a hunger strike to be heard.

My colleague talked about dignity earlier. Does she see any dignity or humanity in putting people in this position?

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

Mr. Speaker, this goes back, again, to the fact that these matters cannot be partisan. These are matters of conscience. We need to be hearing from our constituents and making sure that our conscience is also reflected.

We cannot be bringing forward amendments and having them just be shut down because we are not from the governing party. We need to work together.

I believe every life has immense value. If we put funds and resources into palliative care, we could be in a different situation.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Mr. Speaker, I, too, have had several reflective conversations with constituents around the proposed legislation. I believe that we need to have thoughtful safeguards in place. I believe that the proposed legislation includes those.

My question is for the hon. member. I understand that a strong majority of Canadians support the direction this legislation takes us in. Notwithstanding the concerns the member has heard, I wonder how she understands that support among a majority of Canadians.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

Mr. Speaker, I believe that in order to have dignity in living, we need to be able to have the choice. If medical assistance in dying is going to be an option that is readily available, and doctors or counsellors are prompting patients or clients to receive that, we should have adequate funding in our hospices and for palliative care, so that people can have choices at the ends of their lives.

[The Deputy Speaker, Bruce Stanton]

It is my duty pursuant to Standing Order 38 to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Vancouver East, Housing; the hon. member for Battlefords—Lloydminster, Telecommunications; the hon. member for Courtenay—Alberni, Indigenous Affairs.

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

Mr. Speaker, I am pleased to join the debate today on Bill C-7, an act to amend the Criminal Code. Specifically Bill C-7 would amend section 241 of the Criminal Code, the provision that makes it illegal for a person to help someone else commit suicide. This section of the code was amended by the last Parliament in response to a Supreme Court of Canada decision in 2015, the Carter decision.

Bill C-14, a 2016 bill, stated that one of its objectives was, “permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance.” I would agree with that. The relevant operative provision in the act then sets out the criteria for determining whether a person qualifies for MAID, including that with respect to that person “their natural death has become reasonably foreseeable, taking into account all of their medical circumstances.” However, all of this is about to change if the government has its way with the current draft legislation, Bill C-7.

I am speaking to that bill because I have been encouraged by many of my constituents. Admittedly I have received some letters in support of the government's initiative to expand the reach of MAID, but the vast majority have encouraged me to speak in favour of leaving the law as it is or further restricting access to MAID.

The correspondence I have received in favour of keeping up the safeguards fall into two categories. First, the reasonably foreseeable death safeguard should stay in place. Second, more should be done to expand palliative care services. It was pointed out to me by many that many seniors and other people with serious diseases did not have good ready access to adequate palliative care.

I will quote Rebecca, one of the letter writers, “Let Canada be a society that is known for its modern and advanced palliative care services and not as a country that has ever-expanding use of MAID.” As a proud Canadian, I agree with that statement.

What is behind the current Bill C-7 is the 2019 Quebec Superior Court decision in Truchon. The plaintiffs in that case challenged the constitutionality of the then three-year-old law, arguing that their charter rights had been violated. The federal government, acting through the Attorney General's office at that time, did the right thing. It defended the law, which is what we would expect an Attorney General to do for Canada's laws.

The AG argued as follows, setting out the three main objectives of Bill C-14, which are still relevant today or at least they should be.

First, it is important to affirm the inherent and equal value of every person's life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled. Second, suicide is a significant health issue. Third, vulnerable people must be protected from being induced in moments of weakness to end their lives. I think we would all agree with that.

However, the Quebec court did not. It refused to accept the first two principles as representing the objectives of the law. It said, “the Court cannot accept the two first objectives advanced by the Attorney General regarding the affirmation of the inherent and equal value of every person’s life and the importance of preventing suicide.”

Having thrown aside those principles, it was easy for the court then to decide that the law needed to be changed. Remarkably, the current Attorney General did not appeal that decision. Instead the Liberals are now hastening to amend the legislation to eliminate the reasonable foreseeability of death safeguard.

With the reasonable foreseeability of death safeguard down, this is what we now have left. First, the applicant for MAID has a serious and incurable disease, illness or disability. Second, they are in an advanced state of decline. Third, their psychological or physical suffering is intolerable to them, which is completely a subjective test.

For example, people with Parkinson's, or MS or quadriplegic patients would check off all those boxes. If they had psychological suffering on top of that, they would be eligible for MAID.

Under this new regime, if it becomes law, people who are not dying but who meet all the other criteria will satisfy the requirements for state-sanctioned assisted dying.

I want to reiterate what Rebecca from my riding said. She said, “Let Canada be a society that is known for its modern and palliative care services and not as a country that has ever expanding use of MAID.”

I know the law will be amended. It must be to satisfy the Truchon decision. However, I will point out four things that I hope the committee will take into consideration in improving Bill C-7.

My first point is that the 10-day reflection period for the track one patients, those whose death is reasonably foreseeable, should come back. It should be there. That was not a requirement of Truchon and I do not believe that Bill C-7 is improved by taking that10-day reflection period out. For track two applicants for MAID, people whose death is not reasonably foreseeable, there is a 90-day reflection period, and I agree with that.

The second point I want to make is about the 90-day reflection period. I agree with it, but the wording is inadequate. I would recommend to the committee that it amend the 90-day reflection period clause to be the same as the 10-day reflection period clause, but with the necessary change in wording.

My third point is that Bill C-7 would reduce the number of witnesses required for a patient's written directive for MAID. There is absolutely no requirement for that at all and it is certainly not an improvement. Many of the legal documents, including last wills and testaments, require two witnesses as a safeguard against coercion and that should be maintained.

The fourth improvement is that the provision in Bill C-7 saying that a patient's request for MAID must be voluntary without coercion should be expanded to prohibit the attending physician or other health care professional from being the first to raise the availability of MAID option. MAID should never be presented as just another option because in some circumstances, that in itself, would be coercive.

When Bill C-7 was first introduced into the House back in January, COVID-19 had not hit us yet. Since then, many seniors have died of this virus and many others are in isolation. I have seen first-hand the devastating effect isolation has on the mental and physical well-being of seniors, my father-in-law included, as it would for any person. We are created to be social creatures after all.

As my constituent Sarah told me in a very thoughtfully drafted, “[Bill C-7] will put many elderly Canadians, isolated and lonely in their long-term care homes, at greater risk of being considered eligible for MAiD. That is not how we should be caring for our seniors!”

Let us use our experience with COVID-19 as a lens to have a very careful review of this draft legislation to reconfirm our commitment to value life and to build as many safeguards as we can around our most vulnerable citizens.

[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, since November or December of 2015, there has been a great deal of debate on the important issue of medical assistance in dying. At the beginning of 2020, a massive input was solicited. We received input from Canadians in all regions of the country, over 300,000 Canadians. There has been ongoing consultations, discussions and debates over the last number of years.

The bill before us is because of a court ruling. After the legislation has passed, it does not prevent us from continuing discussions on this. I wonder if the member would recognize that this is something we are not only being compelled to do, but in fact it is the right thing to be doing at this time.

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

Mr. Speaker, I realize and confirm that we are being compelled to do this. Sadly, that is true. The Attorney General, in my opinion, should have appealed the Truchon decision. It should have gone to the Supreme Court of Canada. It would have been given a very fair hearing there and it also would have given Parliament the opportunity to review the legislation as we were scheduled to do.

As for consultations, I do not think any consultations would forestall us from putting in the safeguards that I am suggesting, the 10-day reflection period, keeping the two witnesses in place and clarifying some of the language around the—

[The Deputy Speaker, Bruce Stanton]

Questions and comments, the hon. member for Jonquière.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, in my opinion, in his presentation my colleague regrettably confused two concepts, and in doing so, has made it difficult for parliamentarians to have a clear picture of medical assistance in dying.

First, he confuses medical assistance in dying with suicide. In my opinion, suicide is a permanent solution to a temporary problem, which is a phrase we often hear. A person who commits suicide is someone who may have a future but who, unfortunately, commits a fatal act in a moment of despondency. That is not the case for those who resort to medical assistance in dying.

Even more significant is the troublesome confusion of medical assistance in dying with palliative care. Palliative care already exists in our health care system. If it were better funded, we might perhaps have access to better palliative care. However, I believe that medical assistance in dying has nothing to do with palliative care.

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

Mr. Speaker, I will start with the second question first. I agree that more money and resources should go to palliative care. People should be given a real choice. If the choice is between intolerable suffering or seeking medical assistance in dying, that is not a real choice.

As for conflating medical assistance in dying with suicide, the point that I was making was that Bill C-14 amended section 241 of the Criminal Code, which is the provision dealing with suicide.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, very few subjects in federal politics are more sensitive than the one before us today as parliamentarians. Of course, this all comes from the Carter decision by the Supreme Court of Canada that Canadians had a constitutional right to access physician-assisted death. Therefore, our job is to craft the best possible system to facilitate that right while we ensure there are the proper protections.

My question is about one of the challenges created by the current medical assistance in dying legislation, which is the requirement for final consent at the time assistance is rendered. This sometimes forces those already assessed and approved for medical assistance in dying to make a cruel choice when faced with the possible loss of competence that would then make them unable to give consent, with the result that they are forced to go earlier or risk not being able to receive the assistance they need to avoid continuing to live with intolerable pain.

I wonder if my hon. colleague has some comments on how the government ought to best deal with that situation.