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

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

Madam Speaker, it is a pleasure to speak today to the two amendments moved by the member for St. Albert—Edmonton and to the impacts of Bill C-7, an act to amend the Criminal Code respecting medical assistance in dying.

When I first rose to speak to the bill a month ago, I stressed the importance of a careful, diligent review of the legislation. The bill is crucial to Canadians, and what could be more important than matters that affect life and death?

Unfortunately, through my observations, research and participation as a member of the Standing Committee on Justice and Human Rights, what I have witnessed falls well short of the thorough appraisal for which I had hoped.

The committee heard approximately eight hours of testimony on this profound legislation, a bill that would make Canada's MAID regime among the most permissive in the world. On two occasions my Conservative colleagues moved for additional days of witness testimony. We asked first for two days. It was voted down. We then asked for one day. Again, it was voted down.

November is Indigenous Disability Awareness Month. I am sad to say that in studying Bill C-7, the committee did not take the time to hear from a single representative of the indigenous community. This is a travesty and we should all be ashamed. In the eight hours we had, we heard from both MAID practitioners and many doctors and advocates for persons with disabilities who passionately opposed Bill C-7.

Today, in the House, the Parliamentary Secretary to the Minister of Justice stated that Bill C-7 took into account the autonomy and dignity of the disability community. Persons with disabilities in Canada overwhelmingly disagree. Who are we to deny their lived reality and ignore their personal experiences?

Roger Foley, who suffers from a severe neurodegenerative illness, testified about the coercive pressures he had personally faced to choose MAID. He told the committee his health care needs were neglected and that he felt pressure by medical staff who specifically raised MAID as an option.

We heard from Dr. Ramona Coelho, who practises home care for many vulnerable patients. She explained that she had observed transient suicidal ideation in her patients, meaning while they sometimes have thoughts about suicide or wanting to die, with good supports, they often later choose to live. In highlighting the problem with the bill's 90-day period for individuals for whom death would not be imminent, Dr. Coelho explained that many treatments had waiting lists longer than 90 days. She also urged the committee to adopt a conscience amendment that would protect doctors and other health care professionals who did not want to participate in Canada's MAID regime.

Dr. Leonie Herx, Associate Professor and Head of Palliative Care at Queen's University, told the committee that the elimination of the 10-day waiting period would not allow time for a person who might have a transient death wish to change his or her mind, adding that patients often changed their minds when they were shown proper care. Dr. Herx also spoke to the witness requirement. She noted that having two witnesses helped ensure individuals were not coerced into choosing MAID. Specific examples of such coercion are known.

We heard there were not enough protections for persons with disabilities from Bonnie Brayton, national executive director of DisAbled Women's Network of Canada. Dr. Catherine Frazee, Professor Emerita, School of Disability Studies, Ryerson University, asked why persons with disabilities were being singled out by the legislation. It is a valid question.

Krista Carr, executive vice president of Inclusion Canada, told the committee, “The disability community is appalled that Bill C-7 would allow people with a disability to have their lives ended when they are suffering but not dying.” She added that every national disability organization disagreed with Bill C-7.

We heard from Dr. Heidi Janz, representing the Council of Canadians with Disabilities. She advocated for better monitoring of the MAID program, keeping the 10-day reflection period and two witness requirement and adding a condition that MAID must first be brought up by the patient, not the doctor. People do change their minds. Putting thoughts of death into a patient's mind can be very dangerous to his or her possible recovery.

David Roberge, representing the Canadian Bar Association, asked the committee to clarify what constitutes reasonably foreseeable death, noting the current law has caused significant uncertainty in practice. This is not defined in the legislation.

We also heard from Michel Racicot, a lawyer from Living with Dignity, who told us the Truchon decision should have been appealed to the Supreme Court of Canada, which I fundamentally agree with. We are making what some have called life-shattering changes to a MAID regime, which has not been properly studied since it was first introduced five years ago, based on a Quebec Superior Court decision that was not appealed to the Quebec Court of Appeal or the Supreme Court of Canada. The government has expanded its bill far past that original court decision.

Based on the text of the bill before us, apparently not all parties heard the same testimony. My Conservative colleagues and I proposed several common-sense amendments, as did the Green Party and the Bloc Québécois. These amendments sought to add safeguards to Canada's MAID regime to protect Canada's most vulnerable populations at moments of peak vulnerability, and would add reporting requirements to track MAID in Canada so we could properly review the program and better assess its flaws. This reporting was woefully unavailable as we studied this bill. At nearly every turn, the Liberals voted against these amendments.

The Conservatives proposed keeping safeguards from the 2016 legislation, passed by a Liberal majority government, such as requiring that MAID requests be signed and dated before two independent witnesses, and that Canadians choosing MAID receive a 10-day reflection period that would afford a final opportunity to deliberate the irreversible action of ending one's life. The Liberals voted against both.

When our 10-day reflection period was voted down, we proposed a period of seven days. Again, the Liberals voted against it. Unlike the previous MAID regime enacted in 2016, this bill extends the availability of MAID to those whose death is not reasonably foreseeable and introduces a 90-day waiting period before the end-of-life procedure may be carried out.

We proposed extending the period to 120 days to allow patients more time to see doctors, consider available treatments and see what their lives could be like with the proper supports in place. The Liberals voted against that.

We then tried to at least clarify the specific event that would trigger the beginning of the 90-day period. The Liberals voted against that, too.

The Conservatives were not the only party to listen to the testimony of doctors and people with disabilities advocating for safeguards. I applaud the member for Nanaimo—Ladysmith for proposing an amendment that would require individuals considering MAID, when death is not imminent, to receive a consultation with a palliative care professional. The member also proposed that the living conditions of persons requesting MAID, and the care made available to them, be recorded for program assessment purposes. The Liberals voted against that.

I also thank the member for Montcalm for two thoughtful amendments. One sought to provide clarity around the ambiguous phrase “reasonably foreseeable death” by drawing the line at having one year to live. The second asked for a review of Canada's MAID regime within 12 months of royal assent. As members can guess, the Liberals voted against both.

A system that does not seriously consider safeguards and reporting requirements, and that does not protect health care professionals, is broken before it begins. We heard time and again that these changes are essential. The Liberal government simply will not listen.

We are left with only one independent witness, and no reflection period for those facing imminent death; a 90-day waiting period, with no clear start date; a bill that does not require a consultation with a palliative care professional, and does not clearly outline what constitutes reasonably foreseeable death; and a bill that does not necessitate the tracking of living conditions and available treatment for those who choose MAID, nor a mandated review of the program within a year. Quite frankly, Canadians should be outraged.

I am disappointed this bill is being rushed through amid a pandemic because the Liberals chose to prorogue Parliament last summer and chose not to appeal the ruling to the Supreme Court of Canada. I am appalled this bill requires fewer witnesses to end life than are required to execute a will. I am distressed that this bill does not address the medical professionals—

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

Questions and comments, the hon. Parliamentary Secretary to the Minister of Justice.

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

Madam Speaker, as a point of clarification, there are four protections for conscience rights in this regime: the preamble, section 9 of the former Bill C-14, section 2 of the Charter and paragraph 132 of the Carter decision.

In terms of persons with disabilities and respecting their autonomy, I refer the member opposite to the comments of Senator Petitclerc, former Conservative minister Steven Fletcher, and many others who have indicated that there is a heterogeneity of views among the disability community.

Last, the question I would put to the member opposite comes from the Truchon decision at paragraph 678. The court addressed the issue of the competence and dignity of persons with disabilities and said:

Where natural death is not reasonably foreseeable, the consent and suffering of the disabled are worthy only of the sympathy of Parliament, which has adopted a protectionist policy towards every such person, regardless of his or her personal situation. As soon as death approaches, however, the state is prepared to recognize the right to autonomy. This is a flagrant contradiction of the fundamental principles concerning respect for the autonomy of competent people, and it is this unequal recognition of the right to autonomy and dignity that is discriminatory in this case.

That is the court in Truchon disavowing the previous regime and requiring this Parliament to extend the regime to ensure the competence, dignity and autonomy of persons with disabilities.

I was wondering if the member opposite would care to comment on that paragraph.

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

Madam Speaker, I would love to comment on it. That is a Quebec Superior Court decision. It was not appealed to the Quebec Court of Appeal. It was not appealed to the Supreme Court of Canada. That is the court we should have listened to on something that so significantly changes a regime in Canada.

We already have MAID. We have accessibility for people who choose it. However, the safeguards are very important. Regardless of what the court may have said, we heard from persons with disabilities at committee who were very clear in their opposition to the changes in this bill, which go far beyond the Truchon decision without a review.

Why did we not do the mandated review? Why has that not happened? Why is the Liberal government choosing to expand into territory that the Truchon decision did not even address?

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

Madam Speaker, I thank my colleague for her speech.

An article in yesterday's edition of La Presse stated the following:

The disability inclusion minister says health practitioners should not be allowed to discuss the issue of medical assistance in dying until a patient asks about it, and she is open to amending the law to make that clear.

However, some health care practitioners disagree with her and believe that talking about all options available to patients is part of their duty to ensure informed consent. The Canadian Nurses Association has urged the government to specifically clarify in the law that medical professionals can initiate discussions on medical assistance in dying.

What does the Conservative member think about that?

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

Madam Speaker, there should be an ability for health care professionals to explore all options. However, what we are talking about is who initiates that conversation. It is not a conversation, with respect to this particular regime, that should be forced on a patient, as we heard in testimony from Mr. Foley and another witness: a young woman in a wheelchair who was suffering from pneumonia. She survived, but instead of being immediately provided with the oxygen she needed, she was talked to about MAID.

How does that relate to a diagnosis of pneumonia?

[Gord Johns, NDP, Courtenay—Alberni, BC]

Madam Speaker, as we know, one of the challenges created by the current medical assistance in dying legislation is the requirement for final consent at the time the assistance is rendered. This 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 make them unable to give consent. They are forced to either go earlier, which a constituent of mine is thinking about, or risk not being able to receive the assistance they need to avoid continuing to live with intolerable suffering.

Audrey Parker campaigned to make Canadians aware of this problem, and Bill C-7 would fix it by creating a waiver of final consent. Do my colleague and the Conservatives support Audrey's amendment to help those facing the end of their lives avoid this cruel choice?

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

Madam Speaker, I understand it is a cruel choice and that someone in Audrey's situation wants to be able to make those arrangements. I think they should be able to make those arrangements, but I also think we cannot deny those who are in a position to change their minds the reflection period to do so. It is cruel—

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

Resuming debate, the hon. member for Battle River—Crowfoot.

Before he starts, I would ask him to please use his headset with the proper mike.

[Damien Kurek, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, I do not have a headset.

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

I do not think we can proceed with the hon. member's speech because there will not be interpretation.

The hon. member for Cloverdale—Langley City.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, what is before us now is perhaps among the greatest human rights abuses in Canadian history, legislating what amounts to a eugenics movement in Canada.

As that quote hits members and sinks in, they might imagine the horrors she is speaking about. Is it an effort by the Canadian government to perfect the gene pool? Is it a plan to eliminate those in society deemed burdensome or unwanted? What could the plan possibly be? She is speaking about Bill C-7.

Catherine Frazee, a professor at Ryerson University and disabled persons advocate, who lives with a disability herself, stated that Canada's disability community stands firmly against Bill C-7 because it communicates to us that our lives are not worth living.

Bill C-7, which seeks to remove necessary safeguards to protect the vulnerable from euthanasia, and to expand access to euthanasia for those for whom death is not reasonably foreseeable, is dangerous and will lead to countless early and tragic deaths.

Since it was tabled in the previous session, Canada's Conservatives have listened to the pleas of Canada's disability community, who are begging the government to change the bill to protect them from the harm it will cause.

We have listened to people like Roger Foley, who told the justice committee from his hospital bed that he would not survive if this legislation passed, and that the Parliament of Canada would have his blood on its hands.

We listened to Dr. Heidi Janz, who told the committee that the removal of “reasonably foreseeable natural death” as a limiting eligibility criterion for the provision of MAID would result in people with disabilities seeking MAID as an ultimate capitulation to a lifetime of ableist oppression. We listened to countless others from Canada's disability community and indigenous community, whose voices the Liberals decided were not even worth hearing.

Why will the Liberals not listen? Why are they in such a rush to pass some of the most complicated legislation to ever come before Parliament? Why did they vote down all our amendments, which Canada's disability community had a hand in drafting?

To Canada's disability community, their doctors and their advocates, I say this. I am listening. We are listening, and we will not stop until their voices are heard.

I would like to speak now about Dr. Ramona Coelho, a doctor practising in London, Ontario, whose current practice is largely composed of people living with disabilities, as well as refugees, men out of prison or on bail, and other marginalized persons.

She made it clear to the committee that if this bill passes, she may be forced to leave the medical profession. She stated, “I find it appalling that there is a suicide completion track just for my type of patients. Everyone else's suicidal thoughts are irrational and those people deserve saving, but in this bill, my patients do not. If a young man tried to shoot himself, we would hide his guns and offer him suicide prevention. What is it about persons who are disabled and sick that makes it okay to do otherwise? There is no medical evidence that their suicidality is different from that of able-bodied persons.”

This is the ultimate form of ableism with stakes as high as life and death. We offer suicide prevention to able-bodied people who experience suicidal ideation, but if someone is disabled, their life has no value and is not worth living. Their suffering and the burden they place on the health care system qualifies someone for suicide assistance, not suicide prevention.

If Bill C-7 passes unamended, presenting MAID to patients who live with disabilities will become a standard of care. Doctors will be forced to offer the termination of a patient's life, which could be long ahead of them, as a standard of care. Imagine the weight placed on that doctor's conscience. Doctors work with patients to help them find value, joy and hope for a future in their lives. When death is not reasonably foreseeable we are no longer dealing with medical assistance in dying, but medically administered death. We have gone from MAID to mad.

A letter penned by Physicians Together with Vulnerable Canadians explained the challenges medically administered death as a standard of care would pose to their ability to do their jobs. This petition received a thousand signatures from physicians across the country. Normally to table a petition in the House, it only takes 25 names. Therefore, when a thousand experts in a field vehemently oppose what the government is doing to their work and to their patients, the government needs to listen to what they are saying.

The bill would allow a person who has just suffered a life-changing spinal cord injury to end his or her life just 90 days after the catastrophic event that caused the injury. When people are most vulnerable, experiencing unimaginable stress about their new reality, a doctor would be forced to suggest ending their lives as an option.

From my conversations with doctors and some testimony on the record at justice committee, suicidal ideation after a catastrophic injury is very common but almost always goes away with good care and when a patient eventually finds a way to cope with what he or she is dealing with. By offering death when people are most vulnerable, we are robbing them of their futures.

It takes much longer than 90 days for suicidal ideations to go away, but they do and people find joy, support and a life that is absolutely worth living. In fact, because of chronic underfunding of our health care system in Canada, it usually takes more than 90 days for a patient to even see a specialist. Do we really want to offer death before we offer care? Is that what we want our legacy as members of this Parliament to be?

The Minister of Employment, Workforce Development and Disability Inclusion told the justice committee that it was easier to receive MAID than it was to get a wheelchair. It is far easier to receive MAID than it is to receive quality specialized care. A request for MAID cannot be truly voluntary, free from coercion, without first access to quality care that meets the needs of a patient.

The opposition put forward an amendment to require patients be offered meaningful access to care before MAID could be carried out, and Liberal members voted it down. This is what systemic discrimination looks like. On the street, people look away from persons with disabilities and many Canadians think they would rather be dead than left disabled. This type of discrimination is 100% unacceptable in 2020.

Let me share the story of Spring Hawes, a lady who has lived with a spinal cord injury for 15 years now. She said, “As disabled people, we are conditioned to view ourselves as burdensome. We're taught to apologize for our existence and to be grateful for the tolerance of those around us. We're often shown that our lives are worth less than non-disabled lives. Our lives and our survival depends on our agreeableness.”

Let us face it. A choice to die is not a free choice when their lives depend on their compliance. What does it tell disabled Canadians when we are willing to offer them death before we are willing to offer them care?

Kristine Cowley, a person who had a spinal cord injury 33 years ago, now has a doctorate and is a professor at a university. She was a wheelchair track Paralympian. She is married, has three children and has travelled extensively, all done after her accident.

Kris shared that it took her five years after her spinal cord injury to feel great again. She said, “To all outward appearances, I'm a successful person living and contributing to our community, but I'd be lying if I told you that I was good to go within three months of my injury when I was discharged from hospital. In fact, it was a few years before I was able to open my eyes in the morning and feel good.”

How many stories like Kristine's will never be told if Bill C-7 passes? That is what we need to ask ourselves.

My colleagues and the disability community are begging the government to stop this mad train. We do not want to be responsible for one of the greatest human rights abuses in Canadian history.

I am here on behalf of disabled Canadians, their doctors and their advocates. The government did not listen to them, but it has to listen to me: Stop the ableism, stop treating them like their lives are not worth living.

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

Madam Speaker, I think it is unfortunate and inaccurate to conflate the idea of discrimination in this context.

First, the charter of rights requires that persons with disabilities be able to make the exact same decisions about their body and their passing as persons with ability, which is what the Truchon decision references.

Second, there is reference to conscience protection rights in the Carter decision, and I have already referenced that. Also, there is a reference to it in the preamble of the previous bill, Bill C-14, and I referenced that. Out of an abundance of caution after amendments that, I believe, were moved by the member for St. Albert—Edmonton in the last Parliament for further clarity, a further amendment was made with respect to conscience rights in Bill C-14. To purport that conscience rights are not protected in this legislative scheme is categorically false.

There have been assertions of a culture of coercion or encouragement towards accessing MAID on the part of practitioners. Is the member aware of any instances, not just in her province but anywhere in this country, where such instances of coercive behaviour of medical practitioners have resulted in a prosecution under the Criminal Code?

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, I would really like to assure the hon. member that the words about discrimination are not my words. Those are words from the disabled community. It is very important that he also listen to the disabled community. They are not able to be here today, because they are not elite politicians. I am here, and I am telling the member that they call what the government is doing in the bill discrimination.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my hon. colleague for his speech. Once again, this is a very emotional debate.

I would like to hear what my colleague has to say about the fact that many people believe it is important that services for people with disabilities be improved so that these individuals are not choosing to access medical assistance in dying because of the poor quality of care available to them.

I have spoken with many organizations that help people with disabilities, and there might be a deeper problem here. Some requests for medical assistance in dying may be attributable to the poor quality of care that is sometimes given to people with disabilities.

Perhaps that is because, in recent years, the federal government has not transferred enough money to Quebec and the provinces for health care. Increased health transfers could help people with disabilities and give those who want to live the option of receiving proper palliative care. In short, it would give them options.

What does my colleague think about the importance of reinvesting in health care?