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 27 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

[The Speaker, Anthony Rota]

Before continuing, I wish to inform the House that because of the deferred recorded division, Government Orders will be extended by 43 minutes.

Resuming debate, the hon. member for Brampton Centre.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, our government acknowledges that medical assistance in dying is a complex and deeply personal issue. I would like to take this opportunity to thank the hon. Minister of Justice and Attorney General of Canada for his extremely hard work with respect to the bill. Our government has respected the court's decision and has made more than the necessary changes in the legislation.

The conversation around death can be an extremely difficult one in our society. We understand and acknowledge the deep feelings and emotions that arise when a loved one is suffering intolerably from an illness, disease or disability. To discuss a fundamentally moral issue such as this one, the need to consult with people was a necessary decision. Over 300,000 Canadians from all over this great nation and from different cultures, races, creeds and backgrounds were directly involved in the January 2020 public consultation process. Not only were these consultations vital, it was a strong call to Parliament as to how important this issue was for Canadians.

Initially, the minister, along with several other distinguished members, held round table discussions across Canada with over 125 experts and stakeholders. Furthermore, we have asked for a special extension to allow for a fruitful and powerful parliamentary debate on this topic. The debates that we as parliamentarians have had on medical assistance in dying since 2015 have been filled with emotion and passion, as a debate should be in the House. I am very pleased today to be part of this very important debate.

One of the great challenges of being a parliamentarian is not only having to reflect on our own moral considerations and carefully examining legislation such as the one before us today, but also to make decisions that fundamentally address Canadians and the changing moral landscape.

Today, I speak in support of the bill. I believe strongly in an individual's right to die with dignity and respect. The issue of moral integrity and an individual's right to autonomy must be protected at all costs. As many of my hon. parliamentary colleagues have noted in the debate, currently many Canadians are suffering intolerably. The tragedy is that death is the only way to ease such suffering in a number of these cases.

I would like to take this opportunity to acknowledge and quote the wise words of critical care and palliative staff physician James Downar, at the Toronto General Hospital, who stated:

I think it’s important to recognize that there are types of suffering that we do not have the ability to treat. There are dying patients who have a very low quality of life from their perspective, and sometimes only death would end their suffering.

In the bill, we also acknowledge the concerns about an increased risk where medical assistance in dying is provided to persons who are not dying in the short term. That is why we have proposed additional safeguards to ensure that sufficient time and expertise are devoted to exploring requests for persons whose natural death is not foreseeable.

As I mentioned earlier, medical assistance in dying is an extremely difficult topic. However, in consultation with our experts, the Canadian community and, more specifically, those individuals who are suffering from intolerable conditions, diseases and disabilities, the right to die with dignity and respect, as outlined in Bill C-7, must be protected at all costs.

I look forward to engaging with hon. members further on this very important topic.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Mr. Speaker, I would note that the government House leader was not in his seat. I was relying on him to maintain the comments and questions today.

I really appreciate the member's intervention. Is the member not concerned about conscience rights for individuals and organizations that provide end-of-life care?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, our law acknowledges the conscience right of health care providers and the role they may play in providing medical assistance in dying. The amendment proposed in Bill C-7 has many changes to this effect. Our government will remain committed to working with the provinces and territories to support access to medical assistance in dying, while respecting the personal conviction of health care providers.

[Denis Trudel, Bloc, Longueuil—Saint-Hubert, QC]

Mr. Speaker, I thank my colleague for his speech.

I have a simple question. Bill C-7 is very important, and all of the questions it raises are very delicate. However, right now, there are people who are expecting us and the federal government to pass legislation.

Does my colleague not agree that we could have used the five weeks during which the government prorogued the House to pass this bill and respond to the wishes of those who are waiting on the federal government so that they can take the next steps?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, I acknowledge what the member has said. This legislation is very urgent. Medical assistance in dying is a very complex and deeply personal issue, as the member has already stated. The sad reality is that death is the only way for many people who are suffering. We have tried our best by way of consultation all over Canada. People from different cultures, races and backgrounds were directly involved in the January 2020 public consultation process. The minister along with several other distinguished members held round table discussions across the country with 125 experts and stakeholders.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, I am pleased to see the member for Brampton Centre standing and speaking on this. I wonder if he would agree with me, though, that there is a task that we have left undone here. The original legislation required a review of the broader issues around medical assistance in dying and this review has yet to start.

I put a motion on the Order Paper suggesting that committee be established without delay. Would the member support setting up such a broad review?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, the issue at hand today is very delicate. Everybody knows that. This needs to be discussed at length. For everyone listening to this debate, those who are in Parliament deliberating this issue are taking deep steps to resolve all the issues so we can bring back legislation, and in front of the public.

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, I appreciate this opportunity to outline the proposed amendments to the federal legislation on assisted dying. This bill responds to the Superior Court of Québec's ruling last year in Truchon by removing the requirement that a person's natural death be reasonably foreseeable in order to be eligible for medical assistance in dying. The proposed amendments were developed with the goal of supporting autonomy and choice for those Canadians with non-terminal conditions who are suffering intolerably, while addressing the potential risks of expanded eligibility for medically assisted death.

Our government consulted widely on this issue. We examined the evidence submitted before the court. We looked at domestic and international research. We compared our experience to other assisted dying regimes from around the world. We consulted with constituents, including 300,000 individuals who took part in our online public consultation, and we asked health care professionals about their practical experience with MAID over the past few years.

The bill reflects some important changes based on what we heard. In light of the need to respect the autonomy of Canadians seeking MAID, while providing protections for vulnerable people, the bill proposes the application of a two-track system of safeguards. While the bill no longer uses a reasonably foreseeable natural death as a basis for determining eligibility, it does use it as a basis for determining whether to apply a more rigorous set of safeguards. If a person's death is reasonably foreseeable, a set of safeguards akin to the existing regime would apply. However, some of the original safeguards have been eased in light of the feedback we received.

For example, there was overwhelming support for changing the witness requirement from two witnesses to one. Providers consistently reported that finding two independent witnesses posed a barrier to those seeking MAID, especially for anyone living in a care home with a limited social network. The sole purpose of the witness is to confirm that a person seeking MAID has signed the request themselves. To be clear, the witness has no role in confirming whether the request was made voluntarily, nor does the witness have any role in assessing whether the person's condition makes them eligible for MAID. Rather, it is the MAID provider who undertakes the eligibility assessment and ensures that the person requesting MAID is making the request freely and not in response to external pressures.

The proposed bill responds to these concerns and eases this requirement to one witness. It also allows for a witness to be someone who is paid to provide personal support or health care services. Anyone who is in a position to benefit in any way from the person's death, as a beneficiary to a will or in any other material way, would not qualify as an independent witness.

Health care providers and the families of people who receive MAID also told us that the mandatory 10-day wait period often results in prolonged suffering for individuals who had already put careful and extensive thought into their decision. As a result, the proposed bill would remove this requirement.

I would like to address how the bill would protect Canadians, while satisfying the requirement from the Truchon ruling to eliminate the reasonable foreseeability of natural death clause. On this issue, we received feedback from practitioners and stakeholders who expressed concerns that people who are suffering but not at the end of life could make decisions about MAID that are not fully informed with respect to all available treatments and supports.

On this very sensitive subject, I consulted with my own constituents in Mississauga—Streetsville. I found one of the strongest proponents of these MAID reforms in Mr. Paul Irwin, who suffers from Parkinson's disease. Although this horrible affliction is slowly robbing Mr. Irwin of his neurological functions, I can assure the House that his mind remains razor sharp. Mr. Irwin has explored all available treatments and supports, and he has consulted a wide range of medical professionals. There is no doubt in Mr. Irwin's mind that he would like to control when and how he passes as a recipient of MAID. It is not a decision that individuals in Mr. Irwin's circumstances take lightly or without having weighed all alternatives. I applaud Mr. Irwin's courage.

In order to afford individuals like Mr. Irwin the dignity they deserve, we have added safeguards in lieu of foreseeable natural death that would apply only to requests where a person's death is not reasonably foreseeable. These strengthened safeguards are designed to support informed decision-making and the consistent application of good medical practice. For example, the bill proposes a 90-day minimum assessment period to offer an exploration of all relevant aspects of the person's situation.

We heard very clearly through the consultation process that Canadians are concerned about implementing a requirement for specialist consultations in assessments of MAID. We know that in some parts of the country, such as rural and remote communities, a consultation with a specialist can be harder to arrange. We do not want to create unnecessary barriers. This is why the bill proposes that, for people whose death is not reasonably foreseeable, one of the assessments will be done by a provider with expertise in the person's medical condition but not necessarily a specialist. We recognize that many health care providers have special training and certifications that qualify them to assess a person's particular medical circumstances, even if they are not specialists.

The bill also proposes that the practitioners and the patient would need to agree that reasonable options to relieve the patient's suffering had been seriously considered. This safeguard respects an individual's autonomy, while at the same time underscoring the importance of a fully informed, decision-making process.

In addition, following the Truchon decision, some have expressed concerns that individuals suffering solely from a mental illness could receive MAID. For example, many clinicians argue that the trajectory of mental illness is harder to predict than that of physical diseases, rendering it impossible to determine when or if a mental illness can be considered irremediable as required by MAID legislation. Another concern is the challenge of conducting capacity assessments, given that the symptoms of mental illnesses can affect a person's ability to understand and appreciate the nature and consequences of treatment decisions.

In light of these important concerns, the wording of the bill would preclude individuals suffering solely from a mental illness from accessing MAID. The decision to include this wording reflects the complexity of this problem and the need to fully consider the potential consequences of permitting MAID for individuals with a mental illness to make sure that vulnerable persons are not put at risk. We anticipate that this issue will be further explored as part of the parliamentary review.

I would now like to turn my attention to the waiver of final consent.

The current law includes a procedural safeguard that requires the practitioner to ensure that the person gives their express consent immediately before providing MAID. This is often referred to as “final consent” and is significant for health care providers as it provides a 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 definitive they were about their intention when they had capacity, made the request and were deemed eligible.

Unfortunately, the requirement for final consent had the unintended consequence of encouraging some individuals to receive MAID earlier than they would have liked out of fear of losing capacity to consent prior to their preferred date. This was the situation faced by Audrey Parker. Ms. Parker was very clear about her desire to share one last Christmas with her family, but felt compelled to receive MAID almost two months earlier than anticipated in order to ensure that she was still capable of providing final consent for the procedure.

In a similar example that is a bit closer to home, my friend and legislative assistant recently lost his father. A MAID recipient, Wah-Lit “Edward” Lui passed away peacefully at home on September 23, 2020. Once doctors had diagnosed Edward with a rare complication of terminal cancer, he had little choice but to immediately initiate the MAID process, which had long been his expressed desire, for fear of losing the ability to final consent over the next few days. Thus, Andrew and his family had a mere 24 hours to say their final goodbyes.

Under the proposed amendments, individuals who have been found eligible to receive MAID and whose death is reasonably foreseeable, but who may be at risk of losing decision-making capacity, could waive the requirement to provide final consent before the procedure. For families like the Parkers and the Luis all across Canada, allowing MAID to proceed in the absence of the ability to provide final consent is simply the right thing to do.

As a further safeguard, in order to waive this requirement, an individual would need to have been assessed and approved for MAID, and be at or very close to the end of life. As proposed in the bill, the individual would provide written consent for the practitioner to administer MAID on a specified date.

In conclusion, the proposed amendments in the bill take into account the lessons we have learned through consultations and respond to the immediate task of following up on the Truchon decision. With this revised legislative package, our government has gone a very long way to respect and support the autonomy of Canadians who wish to consider a medically assisted death, while taking seriously our responsibility to protect vulnerable people.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Mr. Speaker, I have a question for my colleague in regard to respecting the conscience rights of physicians across our nation. I understand this is provincial jurisdiction, yet the government does tend to express its views when it sees value in that and it has committed to a national palliative care strategy.

For physicians, does he not see the need to allow them to have the right to make the determination of whether they want to participate either directly or indirectly in MAID?

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, physicians do have the ability to opt out. I believe that in a country like Canada, which is among the best in the world, it is imperative we provide individuals with the best health care Canadians deserve. I do not think we can provide that in good conscience without providing a system like MAID. I would even go as far as to say it is a moral imperative that Canadians have this kind of health care available to them.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Mr. Speaker, I would like to ask the member about same-day death, which the bill would allow for. There was a definite waiting period, which could have been waived in special circumstances, but now the bill would allow for same-day death.

I am wondering if the member is okay with the fact that in most cases it would allow for somebody to request being euthanized and have it happen on the same day.

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, depending on the track provided, there have been safeguards put in place so that the proper assessment can be done. Based on our consultations and experts' advice, I do not think a same-day assessment would be adequate, but again, I leave that to those individuals best suited to provide that advice. I leave it with the medical practitioners to make that assessment.

[Dan Mazier, Conservative, Dauphin—Swan River—Neepawa, MB]

Mr. Speaker, the member across the way mentioned rural Canada and access to doctors, and that certain doctors would review the 90-day circumstances for preconsent. What happens if someone cannot get access to that kind of doctor to prescribe on a particular disease on preconsent?

Is there any kind of leeway or language in the bill about that?