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

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

Madam Speaker, I listened with great interest and care to the member's speech. It was an important contribution.

I know the member is aware that the original legislation, Bill C-14, required a broader legislative review of medical assistance in dying. That review was supposed to start in June.

Will the member and members of the Bloc be supporting efforts to get this broader review going in parallel with Bill C-7?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, absolutely, as critic on the matter, that is what I wanted in February. There are some issues that remain on hold and that should be discussed at greater length during the legislative review. I hope that review will start as soon as possible.

[Christine Normandin, Bloc, Saint-Jean, QC]

Madam Speaker, I thank my colleague for his speech, which was compassionate and inspiring, not to mention very well put together and documented. I am very proud that he is our colleague.

He spoke about the fact that, without the bill, some people would resort to the courts to finally win their case. Another option for some would be to go abroad to obtain MAID.

In this context, does he believe that the bill provides a better framework for MAID and ensures that everyone has equal access and that finances are not an impediment?

Those with the means to go abroad can do so even if they are far from their family and home, whereas others cannot. In a context of harm reduction, shaping the bill ourselves and offering it to everyone, rather than trying to make it impossible to do something, which is in any event somewhat inevitable—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Alexandra Mendes]

The hon. member for Montcalm.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, that is a very good interpretation of the positive effects of the bill.

We must absolutely ensure that people are supported when they are about to die so they may have a better death. In addition to the issue of money, I find that going abroad is not an appealing or adequate solution. It is an interesting point.

However, I believe that we should further expand access to MAID with advance requests. I find that is an important element that is missing from the bill.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I want to ask the member a question respecting advance consent. In the bill, there is no time limit in which that consent would expire. If contemporaneous consent is no longer required, does the hon. member see the need for a time limit in terms of the validity of such a waiver to guard against someone who, hypothetically, could make a request well in advance and have the procedure carried out while very ill without their knowing?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the bill does not provide for advance requests. There is just a 90-day waiting period for people who are not terminally ill but who are in a situation like Ms. Gladu's or Mr. Truchon's. There is a 90-day waiting period after medical assistance in dying is requested. Bill C-7 does not cover the issue of advance requests.

We are going to amend the bill for people with degenerative diseases. At that point, I think we can talk about what kind of provisions would cover that aspect of dying with dignity.

[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]

Madam Speaker, I appreciate the member's comments about the importance of people to share their real thoughts on such an important issue. In the last go-around we had a great deal of discussion about palliative care, which I hope to address further at an opportune time. One of the benefits of having this debate is that we become a little more sensitized to some of the other things that we could be doing. Palliative care for me is really important.

Does my colleague have any further thoughts on the issue of palliative care? Communities do need to focus more resources in that area.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the funny thing is that people have been saying it is the only solution for 50 years now. Why is it that some hospitals still do not provide palliative care because there is a shortage of units?

Nowadays, in some hospitals, people who request medical assistance in dying cannot experience that end-of-life journey in a palliative care unit, even though palliative care is supposed to be end-of-life care and relief from pain and suffering in an environment that supports human dignity. How is that possible?

We must not think of palliative care and MAID as being mutually exclusive. It is a continuum of care that should be available to these patients. Those who are not terminally ill, for whom the dying process has not already begun and is not irreversible, are also entitled to a suitable environment. Bill C-7 makes that possible, and much more clearly than Bill C-14 did.

That was not possible under Bill C-14, with its unassailable reasonably foreseeable natural death criterion, which the court said undermined patients' right to life.

The House resumed 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.

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

Madam Speaker, let me start by saying how much I would rather be in the House today than at home managing a small raise hand function on the screen and our own barking dogs. More seriously, let me say how much I would rather have completed this debate in March when it comes to avoiding or preventing unnecessary suffering.

COVID-19 has required us all to make adjustments. Obviously the adjustments we have to make as parliamentarians pale in comparison to the experience of most Canadians, especially those who have lost loved ones to COVID-19; those who have lost their livelihoods; those who are still struggling to make ends meet, to keep a roof over their head and to put food on the table; and those who are struggling with the pandemic while contending with life-threatening illnesses.

Let me also preface my remarks on Bill C-7 with a few words on why we find Bill C-7 before the House at all. There is a tendency by both the Liberals and Conservatives to emphasize that we are here because of a deadline imposed for changes in medical assistance in dying by the Quebec Superior Court decision in the Truchon case. That is true technically.

However, it obscures the role of the plaintiffs in that case, Jean Truchon and Nicole Gladu, who went to court to contest the provisions of Bill C-14, which they found violated their charter rights by causing or prolonging unnecessary suffering for those at the end of life and for denying individuals autonomy of decision-making over the end of their own lives.

I actually want to thank the plaintiffs today who brought us here, and also to stop for a moment to express my condolences to the family of Mr. Truchon, who left Canada a better place as a result of his attempt to improve the way we deal with medical assistance in dying, when he left us in April.

When it comes to medical assistance in dying, for New Democrats, our priority has always been, and remains, avoiding unnecessary suffering being inflicted on those who are already suffering from terminal illnesses and at the same time avoiding prolonging suffering for their families who have to bear witness to that suffering.

We were glad to see this legislation come forward in February, very promptly for a new government, but we are disappointed that we are here in October, starting over again. Some of this delay was due to COVID-19, but the blame for this delay lays equally at the feet of the Liberals for proroguing the House.

In February, there was recognition by all parties that there were two pieces of work outstanding on medical assistance in dying. First was the need to amend Bill C-7 to conform with the charter as demanded by the Quebec Superior Court ruling in the Truchon case, which found the current law too restrictive. This is the very reason New Democrats voted against Bill C-14 when it originally came before the House.

Even before the court ruling, there were many calling for changes. Those who listened carefully to the terminally ill, their families and practitioners providing the medical assistance knew well the unnecessary suffering that was being inflicted, and continues to be inflicted by our current law.

The second task with regard to medical assistance in dying was to conduct a legislative review of the broader issues around MAID after four years of our experience with it. This is not to be confused with a normal review of the specific legislative changes proposed in Bill C-7. This broader legislative review of the issues arising out of medical assistance in dying was mandated in the original legislation and was supposed to start this June.

Bill C-14 required that the review specifically look at the question of advance requests, requests from mature minors and requests where mental illness is the sole underlying condition, but it was not to be limited to those topics.

I am disappointed that the second task appears to have fallen off the agenda for the Minister of Justice. Early this morning I asked him to commit to starting this broader review in parallel with the examination of the changes in Bill C-7. As I told him then, I put Motion M-51 on the Order Paper today to create a special committee of the House that could conduct this broader review at the same time as the justice committee deals with the urgent changes needed and required because of the court decision and because of the unnecessary suffering inflicted by our current law.

I want to talk about each of these two tasks in more human and practical terms by starting with very personal stories, one for each of these. It is clear to me that the current legislation has some unintended and cruel consequences. These were clearly demonstrated by what happened to a very good friend of mine.

On January 1, 2019, I went to a traditional New Year's levee in one of the communities in my riding. When I arrived, I was not surprised to be greeted enthusiastically by someone I had become close friends with over 10 years involvement in public life together. I was surprised, however, to see her right arm was in a sling.

I am not going to name this friend today because I did not seek formal permission from her family to do so, but I am telling her story today as I trust she would want her unfortunate experience with medical assistance in dying to make a difference.

When I asked my friend what was happening, she recounted how, suddenly and inexplicably, she began having trouble using her arm over the holidays and that she was going to have it checked out as soon as possible. A month later, she began to see other symptoms and she found out that she had an inoperable brain tumour the size of a raisin but growing, growing slowly but growing nonetheless. This was a condition that would prove to be painful, debilitating and terminal.

As her condition rapidly deteriorated, she began to make plans for her end of life. Just four short months after a diagnosis, my partner and I received an invitation to what she was calling a masquerade ball in her honour. My friend was incredibly brave and never lost her sense of humour or her love of life right up to the end.

On that Saturday, she checked herself out of the hospital to celebrate her life with us that night. Rather than, as she joked, allowing us to get together after she was gone and talk about her then, she preferred to see us before and to hear what we had to say before she had to leave. Just days later, we found out she was gone. With her death, we were not only deprived of a larger-than-life member of the local arts community. We were also deprived of a friend whose enthusiasm for life had always been infectious.

Why such a sudden exit? The current law requires that those who have already been assessed and approved for medical assistance in dying be competent when the final moment to receive that assistance comes. Therefore, my friend was forced to depart weeks if not months early because she feared the loss of competence that might result from her brain tumour if she waited too long, and that this loss of competence would prevent her receiving medical assistance in dying and thus inflict weeks or months of suffering on her as the patient but also, more important to her, weeks of suffering on her family and friends who would be forced to witness a prolonged dying.

Bill C-7 would fix this by removing the requirement for final consent for those who are already assessed and approved for medical assistance in dying. This would take away the need to go early in order to avoid the loss of competence that now prevents receiving medical assistance in dying.

The bill would also make the process more straightforward in several other ways. It would do so by taking away the mandatory 10-day waiting period, reducing the number of witnesses required from two to one and expanding who could serve as a witness. These are all things practitioners have told us are unduly restrictive and only end up unnecessarily prolonging suffering.

Right now, I should take a moment to thank four doctors who have been kind enough to share with me their experiences in providing, or not providing in some cases, medical assistance in dying to hundreds of patients. Again, I will not name them today to respect their privacy, but my conversations with these four incredible people have helped me understand how medical assistance in dying operates in real life.

I should mention one other change in Bill C-7 that would have more substantial impacts. That is the removal of the requirement that death be imminent before one can receive medical assistance in dying. Bill C-7 then sets out a more restrictive process than that for those whose death is imminent and where there is more time for assessment and decision-making. However, I should emphasize, Bill C-7 still maintains the high standards set in the original legislation that in order to receive medical assistance in dying patients must have a condition that is incurable, must be in a state of irreversible decline and must face intolerable suffering. This means that Bill C-7 would not open the door for medical assistance in dying quite as wide as some have suggested.

My second story, also very personal, deals with one of the broader issues that the review of MAID was supposed to deal with. This story is my mother's story. My mum passed away just short of five years ago, during the debate on MAID. This is a story I have told before during the debate on the original bill, but one which still lacks resolution.

My mother had always been very clear with my sister and me about her wishes regarding the end of her life. For her, it was simple. She asked us that if she ended up bedridden, unable to shower or feed herself, and did not know who we were, then to please let her go. She suffered from dementia and other underlying conditions that were complicated by a serious fall and, fortunately for her, she was not forced to endure for long those conditions she had feared.

Unfortunately, the kind of advance directive or advance request that my mother had wanted to give is still not allowed under the existing legislation. I know many in my community, and more specifically, many in my own social circles, fear just such an outcome and feel that they should be able to make their own end-of-life wishes known and have them respected, just as they are now when it comes to questions of refusal of medical treatment. I tend to be of the same opinion. However, my discussions with practitioners providing medical assistance in dying have persuaded me that this question is not as simple as it appears on its face. This remains one of the important issues the legislative review of the current legislation can address and is mandated to address by Bill C-14.

As I mentioned earlier, there were other issues that were assigned to this broader review in the original Bill C-14, including requests from mature minors and requests for mental illness as the sole underlying condition, but one concern was missed. Let me take a moment now to address the concerns of disability advocates that, with the removal of the requirement that death be imminent, there will be pressure on the vulnerable in our society to choose medical assistance in dying.

First and foremost, as a society we can and must do better in offering support to people with disabilities. Failure to provide necessary resources to ensure that everyone can enjoy full and equal participation in life is a current and ongoing black mark on all of us. We have only to look at the failure to deliver additional assistance promptly to persons with disabilities during this pandemic to remind ourselves how often we forget about those living with disabilities. However, we should not dismiss the concerns of the disability community about medical assistance in dying out of hand. The legislative review is the place for us to consider seriously the question of whether the existing safeguards preventing pressure on the vulnerable to choose medical assistance in dying are, in fact, sufficient.

Before I conclude, I want to remind members that, as a society, we must do better in the job of end-of-life care. Again, COVID has demonstrated the tragic deficiencies in long-term care in ways I hope we will not ignore.

New Democrats will support the bill and help expedite its passage in order to bring an end to unnecessary suffering and to meet the deadline imposed by the Quebec court in the Truchon decision, but this support has always been predicated on going forward with a larger review without delay.

I have drafted a motion, Motion No. 151, which I have tabled today. I look forward to hearing a positive response from the government on this. We have just heard a positive response from the Bloc, and I am hoping for a positive response from the Conservatives.

Proceeding with Bill C-7 without proceeding with the broader review is only getting half the job done on medical assistance in dying. At the same time, failure to conduct the broader review potentially undermines public support for medical assistance in dying, which, so far, has only continued to grow. In fact, I believe this is one of the most important questions that could ever come before Parliament.

I look forward to the debate on the specific improvements that we can make to Bill C-7, but I urge all of us to consider undertaking the broader review of issues around medical assistance in dying without delay.

[Arif Virani, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I thank the member for Esquimalt—Saanich—Sooke for his comments today, his work on the justice committee, his support for this legislation and also for underscoring the important role that the litigants have played in the evolution of this.

I would highlight the theme that the member raised when he talked about the sanctity of life. It is quite clear for those who have read the jurisprudence, and I know that he has, that in both the Carter and Truchon decisions the courts talked about the notion that the charter protection of the right to life under section 7 means that when people are prematurely considering availing themselves of medical assistance in dying because they worry about being able to give that final consent and having the capacity to give that final consent, when they take their lives prematurely, it actually violates their charter rights. This was outlined in both the Carter and Truchon cases.

I wonder if the member opposite could comment on that aspect of the decision, because it is very important in terms of the protection of the vulnerable, which is one of the things the legislation is attempting to address.

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

Madam Speaker, I believe Bill C-7 raises an important question around consent at the final moment. As I said from the very personal story of my friend, I got a picture of how this works in real life.

We can talk about the court decisions, but today I was hoping to introduce the reality of the family and friends of those who are facing unbearable suffering at the end of life and who are really looking to us to make the improvements they are calling for, to make sure we do not unnecessarily prolong suffering and that we do not unnecessarily inflict it on the families of those patients.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Madam Speaker, since the bill has come in a second time in two sessions of Parliament, I would like to ask how important is it for the government to listen a bit more this time and to take all the amendments from different parties into consideration to make sure that the bill would be the bill we are all looking for and Canadians are looking for.

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

Madam Speaker, there are two tasks here. The first is to look at the amendments to medical assistance in dying legislation in Bill C-7 to make sure that they both conform to the requirements of the court decisions and the charter, but also to make sure they reflect the lived experience of people dealing with medical assistance in dying.

The second part is the broader review. I hope we get support from the Conservatives to start this parallel review that can look at the larger questions around medical assistance in dying and make recommendations to Parliament, if necessary, for further legislation.