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

[David Lametti, Liberal, Minister of Justice and Attorney General of Canada]

moved that Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Mr. Speaker, I rise today to speak to Bill C-39, an act to amend an act to amend the Criminal Code regarding medical assistance in dying. This bill would extend the exclusion of eligibility for receiving medical assistance in dying, or MAID, in circumstances where the sole underlying medical condition for MAID is a mental illness. The main objective of this bill is to ensure the safe assessment and provision of MAID in all circumstances where a mental illness forms the basis for a request for MAID.

An extension of the exclusion of MAID eligibility in these circumstances would help ensure health care system readiness by, among other things, allowing more time for the dissemination and uptake of key resources by the medical and nursing communities, including MAID assessors and providers. It would also give the federal government more time to meaningfully consider the report of the Special Joint Committee on Medical Assistance in Dying, or AMAD, which is expected this week.

My remarks today will focus on the legislative history of MAID in this country. I want to be clear that medical assistance in dying is a right, as affirmed by the Supreme Court.

In its 2015 Carter v. Canada decision, the Supreme Court of Canada ruled that the sections of the Criminal Code prohibiting physicians from assisting in the consensual death of another person were unconstitutional. In response, in 2016, our government tabled former Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.

The basic purpose of the bill was to give Canadians nearing the end of life who are experiencing intolerable and unbearable suffering the option to obtain medical assistance in dying. The bill was passed two months later, when medical assistance in dying, or MAID, became legal in Canada for people whose natural death was reasonably foreseeable. It included procedural safeguards in order to ensure that the person’s request for medical assistance in dying was free and informed, and to protect the most vulnerable.

In 2019, in Truchon v. the Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. One year later, in response, we introduced a second bill on medical assistance in dying, the former Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

Former Bill C-7 expanded eligibility to receive MAID to persons whose natural death was not reasonably foreseeable. It did so by creating a separate, more stringent set of procedural safeguards that must be satisfied before MAID can be provided. The government proposed, and Parliament supported, these stringent procedural safeguards in recognition of the increased complexities of making MAID available to people who are not otherwise in an end-of-life scenario.

Some of these additional safeguards include a minimum 90-day period for assessing eligibility, during which careful consideration is given to the nature of the person's suffering and whether there is treatment or alternative means available to relieve that suffering. This safeguard effectively prohibits a practitioner from determining that a person is eligible to receive MAID in fewer than 90 days.

Another additional safeguard is the requirement that one of the practitioners assessing eligibility for MAID has expertise in the underlying condition causing the person's suffering or that they must consult with a practitioner who does. The assessing practitioners must also ensure that the person be informed of the alternative means available to address their suffering, such as counselling services, mental health and disability support services, community services and palliative care. It is not enough just to discuss treatment alternatives. They must ensure the person has been offered consultations with relevant professionals who provide those services or care. In addition, both practitioners must agree that the person gave serious consideration to treatment options and alternatives.

The former Bill C-7 extended eligibility to medical assistance in dying to people whose death is not reasonably foreseeable. However, it temporarily excluded mental illness on its own as a ground for eligibility to MAID. In other words, the bill excluded from eligibility for medical assistance in dying cases where a person's sole underlying medical condition is a mental illness. That temporary exclusion from eligibility stems from the recognition that, in those cases, requests for medical assistance in dying were complex and required further review.

In the meantime, the Expert Panel on MAID and Mental Illness conducted an independent review of the protocols, guidance and safeguards recommended in cases where a mental illness is the ground for a request for medical assistance in dying. The expert panel’s final report was tabled in Parliament on May 13, 2022.

The Special Joint Committee on Medical Assistance in Dying also completed its parliamentary review of the provisions of the Criminal Code relating to medical assistance in dying and their application, as well as other related issues, including mental health. We eagerly look forward to the special joint committee’s final report, expected on Friday, February 17.

I would also like to highlight the excellent work of the expert panel, ably led by Dr. Mona Gupta.

This temporary period of ineligibility was set in law to last two years. It will expire on March 17 unless this legal requirement is amended by law. This bill would do just that, and proposes to extend this period of ineligibility for one year, until March 17, 2024.

As I stated at the outset of my remarks, this extension is needed to ensure the safe assessment and provision of MAID in circumstances where a mental illness forms the sole basis of a request for MAID. It is clear that the assessment and provision of MAID in circumstances where a mental illness is the sole ground for requesting MAID raises particular complexities, including difficulties with assessing whether the mental illness is in fact irremediable and the potential impact of suicidal ideation on such requests.

That is why, when some Canadians, experts and members of the medical community called on the federal government to extend the temporary period of ineligibility to make sure the system was ready, we listened. We listened, we examined the situation carefully and we determined that more time was needed to get this right.

As for the state of readiness of the health care system, I would like to take a moment to highlight the great progress that has been made toward the safe delivery of MAID in those circumstances. For example, standards of practice are being developed for the assessment of complex requests for medical assistance in dying, including requests where mental illness is the sole underlying medical condition. Those standards of practice will be adapted or adopted by clinical regulatory bodies and by clinicians in the provinces and territories. These standards are being developed and will be completed in March 2023.

In addition, since October 2021, the Canadian Association of MAiD Assessors and Providers, or CAMAP, has been developing an accredited study program for health professionals. Once completed, that program will include seven training modules on various topics related to the assessment and delivery of medical assistance in dying, including on how to assess requests for medical assistance in dying, assess capacity and vulnerability, and manage complex and chronic situations. That program should be finalized and ready to be implemented next fall.

This progress was achieved through our government's leadership and collaboration with the health system's partners, such as the provincial and territorial governments, professional health organizations, our government's regulatory agencies, clinicians and organizations such as CAMAP.

The Regulations for the Monitoring of Medical Assistance in Dying, which set out the requirements for the presentation of reports on MAID, came into force in November 2018.

These regulations were recently revised to significantly improve the collection of data and reporting on MAID. More specifically, the regulations now provide for the collection of data on race, indigenous identity and any disability of the person. The revised regulations came into force in January 2023, and the information about activities related to medical assistance in dying in 2023 will be published in 2024 in Health Canada's annual MAID report.

I think we can all agree that substantial progress has been made. However, in my opinion, a little more time is needed to ensure the safe assessment and provision of MAID in all cases where a mental illness is the sole basis for a request for MAID.

I want to be clear that mental illness can cause the same level of suffering that physical illness can cause. We are aware that there are persons who are suffering intolerably as a result of their mental illnesses who were waiting to become eligible to receive MAID in March 2023. We recognize that these persons will be disappointed by an extension of ineligibility, and we sympathize with them. I want to emphasize that I believe this extension is necessary to ensure the safe provision of MAID in all cases where a mental illness forms the basis of the request for MAID. We need this extension to ensure that any changes we make are done in a prudent and measured way.

I want to turn now to the more technical part of Bill C-39 and briefly explain how the bill proposes to extend the mental illness exclusion. As I stated earlier in my remarks, former Bill C-7 expanded MAID eligibility to persons whose natural death was not reasonably foreseeable. It also included a provision that temporarily excluded eligibility in circumstances where a mental illness formed the basis of the request for MAID. Bill C-39 would delay the repeal of the mental illness exclusion. This would mean that the period of ineligibility for receiving MAID, in circumstances where the only medical condition identified in support of the request for MAID is a mental illness, would remain in place for an extra year, until March 17, 2024.

I want to reiterate that we need more time before eligibility is expanded in this matter. We need more time to ensure the readiness of the health care system, and more time to consider meaningfully and to potentially act on AMAD's recommendations. This is why I urge members to swiftly support the passage of this bill. It is imperative that it be enacted before March 17. If it is not, MAID will become lawful automatically in these circumstances. It is essential that this bill receive royal assent so that this does not happen before we are confident that MAID can be provided safely in these circumstances. I trust that all colleagues in this place will want to make that happen.

The safety of Canadians must come first. That is why we are taking the additional time necessary to get this right. Protecting the safety and security of vulnerable people and supporting individual autonomy and freedom of choice are central to Canada's MAID regime. We all know that MAID is a very complex personal issue, so it is not surprising that there is a lot of debate. It should go without saying that seeking MAID is a decision that one does not make lightly. I know from speaking with members of the medical community that they take both their critical role in the process and their professional duties toward patients extremely seriously. I trust that medical professionals have their patients' interests at heart, and this sometimes involves supporting their patients' wishes for a planned, dignified ending that is free of suffering.

Once again, I strongly believe that an extension of the exclusion of MAID eligibility in this circumstance is necessary to ensure the health care system's readiness and to give the government more time to meaningfully consider and to potentially implement the AMAD recommendations. I remind the House that those recommendations are expected just one month before the current mental illness exclusion is set to expire. Therefore, I implore all members to support this bill.

Persons with Disabilities

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, it is a pleasure to rise today. I have a number of petitions to present to the House.

The first petition comes from Canadians living with disabilities who have a number of asks regarding policies within the ambit of the federal government and Parliament that relate to Canadians with disabilities.

The petitioners note that inflation has increased the cost of living and is having the greatest impact on Canadians with fixed incomes, including Canadians living with disabilities. They note disturbing reports of people accessing euthanasia in Canada due to a lack of access to care and support. They also note that Canada's leading disability advocacy organizations had warned that Bill C-7 would threaten the lives and security of Canadians living with disabilities and that a choice to access euthanasia can never be truly free if those who suffer do not have access to the support they require.

The petitioners urge the House of Commons to pass Bill C-22, ensuring that the new Canada disability benefit is accessible to all Canadians who live with disabilities and does not take away existing benefits. They also ask for us to repeal Bill C-7 so that Canadians who live with disabilities are not coerced into accepting euthanasia because they do not have access to adequate support.

Mental Health

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

Madam Chair, I will be splitting my time with the member for Yorkton—Melville.

Millions of Canadians live with a mental illness. Tragically, each year more than 4,000 Canadians commit suicide, the vast majority of whom suffer from a mental illness. Concerningly, many more Canadians who suffer from mental illness will have their lives prematurely ended as a result of the Liberal government's ideologically driven, evidence-free expansion of MAID in cases where mental illness is the sole underlying condition.

It was not long ago that the Minister of Justice himself cautioned against expanding MAID in cases where mental illness is the sole underlying condition. In this very place, when Bill C-7 was debated, he said that there are “inherent complexities and risks with MAID on the basis of mental illness as the sole criterion, such as suicidality being a symptom of some mental illnesses”. What has changed? Those inherent complexities and risks remain. What has changed is purely political.

When Bill C-7 went over to the Senate, the Senate adopted a significant amendment to drastically expand MAID in cases of sole mental illness by way of a sunset clause that would come into effect in March 2023. Despite having spoken of “inherent complexities and risks”, the Minister of Justice, incredibly, did a 180° turnaround and accepted the Senate amendment, despite the absence of meaningful study and the absence of meaningful consultation. Then, the Liberal government shut down debate to ram through the bill and ram through this radical expansion of MAID.

By law, in order to qualify for MAID, it must be established that the patient suffers from a “grievous and irremediable” condition that is “incurable”, in which one is in an “irreversible” state of decline. In other words, in order to qualify for MAID, it must be established that one cannot get better.

The Special Joint Committee on Medical Assistance in Dying, of which I am a vice-chair, has heard testimony from medical experts, including psychiatrists, and the evidence is that it is not safe to move ahead. That is because it is not possible, or at the very least it is difficult, to predict irremediability.

Even the government's own expert panel concluded as much. On page 9 of the government's own expert panel report, the expert panel said, “it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient” in cases of sole mental illness. That means persons who are suffering from mental illness who could get better and go on to lead happy and productive lives will have their lives prematurely ended.

As such, I submit that it is reckless and irresponsible for the government to move ahead. What the government should do instead is take the evidence of the expert panel, listen to the experts who have come before the special joint committee and put a pause on this significant and, I would submit, dangerous expansion of MAID. Anything less would be a betrayal of some of the most vulnerable people in this country.

Medical Assistance in Dying

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, the next petition raises concerns with respect to Bill C-7 from the last Parliament and the fact that the bill would allow euthanasia for those with a mental illness as their sole medical condition.

This petition quotes the Canadian Mental Health Association in saying that CMHA does not believe that mental illnesses are irremediable and it supports recovery. Petitioners also note that suicide is the second leading cause of death for Canadians between the ages of 10 and 19. Petitioners call on the government to reject proposals to allow euthanasia in cases where mental health is the sole condition at play and further to protect Canadians struggling with mental health challenges and facilitate treatment and recovery for them as opposed to death.

I think I will leave it there for the present.

Canada Disability Benefit Act

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, I appreciate the opportunity to speak to Bill C-22 and, more broadly, to the situation confronting Canadians living with disabilities.

Bill C-22 proposes a new federal financial benefit for Canadians living with disabilities, however, it does not actually define many aspects of the structure of this benefit. I will be voting in favour of the legislation, because I agree with the principle of providing the support, but I am concerned about some of the lacking substance with respect to how this benefit would actually work.

Increasingly, we see from the government a desire to limit the actual work of Parliament in defining the nature and scope of programs. Instead, the government wants a blank cheque from Parliament, legislation that authorizes ministers to shape and define a program independently, according to their discretion.

In general, this is not a good way for governments to operate in a democracy and, in particular, I do not think the Liberal government has shown itself trustworthy when it comes to working out the details of critical programs.

When it comes to the structure of this benefit, the government's message is “just trust us.” From a government that cannot figure out how to deliver passports in a timely manner, cannot address the affordability crisis in Canada and cannot secure our borders, the message of “just trust us” seems rather hollow.

I have two specific concerns about the prospective structure of this program that I do want to highlight.

First, I share the concern of many about how this program would interact with other existing programs, including those provided at the provincial level. If a new federal benefit leads to a loss of eligibility for other existing benefits, then it would leave people worse off overall. It is not inevitable that this would be the case, but this is a matter that will require careful and respectful dialogue with other levels of government and hard work at every stage, hard work that the government has not always been prepared to do.

At this point, the government is passing broad framework legislation without ensuring that it will actually leave Canadians with disabilities better off in every case. The government does not have to wait for this legislation to pass to begin those discussions and I would encourage it to actually engage those discussions now about protecting existing benefits, because aspects of those dialogues may inform suggested amendments.

The second concern I have is that it is critically important that the structure of this benefit program protects access for Canadians with disabilities who are working or are trying to get into work. Even with existing benefit programs at other levels, certain Canadians with disabilities may find themselves in a position where entering the workforce actually leaves them worse off. It is critically important that work always leaves people better off financially.

Supporting Canadians, including Canadians living with disabilities, in being able to access meaningful work has long been a key priority for Conservatives.

Why is this important? Overwhelmingly, Canadians of all backgrounds and circumstances want to be able to work and are happier and more fulfilled if they are able to work. In this context, by work, I do not just mean commodified work, but work of any sort, where individuals exert themselves in order to contribute positively to the world around them.

The science of happiness and fulfillment measurement shows us that work generally makes people happier by providing them with meaning and with a workplace-based community, and with a greater level of power and agency. Quite apart from the notably important income-earning properties of work, work also provides meaning and happiness, totally independent of whether it generates income.

Think tank Cardus has done excellent work on this question of work and disability. It has found that most Canadians living with disabilities want to work or want to work more, but it has also found that the vast majority of public policy, focus and money has been toward income support as opposed to supports that help people get into work.

The critical point about work support and income support is that they are not mutually exclusive. In fact, often, they are necessarily complementary. Some people require income support in order to afford the resources and transportation required to find and get a job in the first place. If income supports are withdrawn immediately once people work or start work, they may not be able to afford vital necessities, as well as the things they need to sustain them in their new job.

Having both fulfilling work and steady income are vital for human happiness and fulfillment. Having income without work or work without income are both, in a sense, problematic.

Of course, having income is not just about fulfillment and happiness; it is about basic survival. Canadians with disabilities need income to take care of their own needs and the needs of those they love.

For most of us, work comes with earning income. However, when benefit programs are poorly structured, people may actually be forced to choose between work and income, because benefits are cut off or income is lost as a result of working. In such cases, given how essential income is for survival, people will understandably choose income over work if they are forced to choose between these things. It is cruel and pointless to force people to make this choice, to choose between the happiness associated with work and receiving the financial support that they need.

Income supports for Canadians with disabilities can and should go hand in hand with workplace support, only peeling those income supports back gradually when it is clear that income support is not required because of the level that an individual is able to work.

We saw an example of this terrible choice between work and income during the pandemic with the poorly constructed CERB program. Unemployed Canadians who were accessing CERB, and who were then offered part-time work, were in many cases actually worse off financially if they took that work because part-time work would push them over the threshold for CERB eligibility, even if they were not earning close to what they would have been entitled to receive under CERB. Thus people were forced to remain out of work in order to access the resources they needed to support their families.

Not only does it make zero financial or economic sense to create a financial disincentive to work, but it also puts people in the painful position of needing to choose between the happiness and dignity that come from work on the one hand and from financial security on the other hand. That is why we feel it is very important that this new federal program be structured in such a way that Canadians with disabilities, many of whom can and do work, or want to work, are not rendered worse off by entering the work force.

There is nothing in the text of the bill that would suggest it could not be structured in a way to ensure that work always pays, but the past record of the government gives us significant cause for concern. In the 42nd Parliament, the member for Carleton, now the leader of the Conservative Party, proposed Bill C-395, a bill specifically designed to address this problem of work sometimes bringing about a loss in benefits for Canadians living with disabilities.

Bill C-395 would have amended the Federal-Provincial Fiscal Arrangements Act to ensure that, in negotiations around transfers and the construction of benefits for Canadians living with disabilities, people with disabilities would not lose more through taxation and the reduction of benefits than they gain as a result of working. It would have protected Canadians with disabilities from these kinds of perverse situations where they would have to choose between the happiness that comes from work or the financial security that comes from government benefits.

If Bill C-395 were the law of the land, we could then pass this bill, even as written, with the confidence that the benefits constructed would leave people better off, but when it came to a vote on Bill C-395, Liberals actually opposed it. Liberals opposed the common-sense proposal from our leader to ensure that Canadians who work are better off as a result of the money they earn.

Sadly, Liberals do not seem to appreciate the value, dignity and happiness that comes from hard work. I am not sure if it can be found in the scope of this legislation as written, but I would welcome amendments that would capture the spirit of our leader's past work to protect Canadians with disabilities from being punished for working.

Parenthetically, I want to say something directly to employers about hiring Canadians with disabilities. Research done by Cardus shows that many employers have an exaggerated perception of the cost associated with accommodation. Cardus' work shows that including and accommodating employees with disabilities is often much cheaper than employers initially expect and that funding may be available from different levels of government for businesses, including small businesses, seeking to accommodate customers and employees living with disabilities.

Further, as our leader has previously shared in the context of speaking to Bill C-395, there are many cases of Canadians with disabilities who make incredible, committed and loyal employees who bring unique competencies for the workplace. Governments have a responsibility to ensure that poorly structured benefit programs do not undermine the ability of Canadians to access work, but employers also need to lead in pushing aside stereotypes and recognizing the contributions that Canadians with disabilities can make to their workplace. Many employers are already doing this, and I congratulate those who are doing this already.

Those were the main points I wanted to make on Bill C-22, but it is also very important to speak to the context of the legislation, which is the significant negative impacts on the lives of Canadians living with disabilities that flow from the government's radical ableist approach to euthanasia, the so-called MAID regime. We simply cannot have a conversation about financial benefits separate from a recognition that the biggest threat to the lives of Canadians living with disabilities is that those without disabilities are much more likely to be offered suicide prevention and recovery support, while our brothers and sisters, cousins and friends who are living with disabilities are being denied those supports and actively pushed towards death, even if they are saying they do not want it.

Among those who support legal euthanasia around the world, Canada is still increasingly seen as a cautionary tale, a warning of what not to do. In this vein, I want to start with a bit of history. Euthanasia in Canada started with Bill C-14, which was passed in the 42nd Parliament. This legislation affixed the name “medical assistance in dying” to what had previously been called euthanasia, the process of doctors killing a consenting patient. That legislation sought to define a regime whereby people could choose hastened death if their death was deemed reasonably foreseeable.

I criticized the legislation at the time for, among other things, not being sufficiently clear about what was actually meant by “reasonably foreseeable”. Indeed, there were significant abuses, even in the immediate aftermath of the passage of the legislation, whereby doctors determined someone's death to be reasonably foreseeable based on a string of hypotheticals when a person had nothing approaching a terminal condition.

For example, back in 2016, I highlighted a case in Vancouver where a physician declared a depressed person eligible for euthanasia without examining the individual because that patient “could easily get bed sores and then die of infection”. A person's death was, prior to examination, declared reasonably foreseeable because the person could theoretically die from an as yet uncontracted bed sore infection if they were bed bound as a result of the depression. These were the kinds of perverse outcomes that were possible even in 2016 as a result of a lack of safeguards and the ambiguity around what was meant by “reasonably foreseeable”.

The current rules allow someone also to consult many different physicians before finding two who will approve. Therefore, if 20 or 200 doctors say no, the criteria are not met, but then two say yes, the criteria are met, then the killing of the patient can proceed. The ambiguity and the opportunity to consult multiple doctors before getting the desired result means that, indeed, the holes were, and still are, large enough to drive a truck through. These were the pre-existing problems that were already, in particular, raising concerns of the disability community. The lack of clarity around what were and were not circumstances where death was reasonably foreseeable opened the door for people who were living with disabilities to be encouraged to pursue MAID, even if they did not want to, and even if they were actually not eligible.

Members do not have to take my word for it because the minister responsible for this legislation, the Minister of Employment, Workforce Development and Disability Inclusion of Canada, during a subsequent discussion of Bill C-7, said, “I regularly hear from families who are appalled by the fact that they take their child, potentially their older child and are offered unprovoked MAID. I think that has to stop.” That is from a minister in the government. This was already the context following the passage of Bill C-14 and prior to the passage of Bill C-7.

The road to Bill C-7 was much more contrived than the road to bill C-14. The already nebulous reasonable foreseeability clause was challenged and a lower court in one province proposed to overturn this restriction. The federal government could have appealed that lower court decision and, indeed, had a strong basis for doing so. An appeal would, at the very least, have given parliamentarians more time to consider a broad range of legislative options. Instead, the government made a political choice to embrace the lower court ruling and the artificial timeline it created, pushing medical assistance in dying for Canadians with disabilities. This was not about following a court ruling. This was about something the government could have appealed, but wanted to use the court ruling to advocate for a long-standing objective.

Following this contrived process, the government put forward Bill C-7, which was rightly opposed by all of the leading organizations representing Canadians living with disabilities, as well as by domestic and international human rights authorities.

Krista Carr from Inclusion Canada said, “Inclusion Canada has advocated for safeguards in MAID since we intervened in the Carter case. Our biggest fear has always been that having a disability would become an acceptable reason for state-provided suicide. Bill C-7 is our worst nightmare.” She continued, “By having a disability itself under Bill C-7 as the justification for the termination of life, the very essence of the Charter of Rights and Freedoms would be shattered. Discrimination on the basis of disability would once again be entrenched in Canadian law.”

She said further that the “singling out of one particular...group” of people based on their personal characteristics, which happen to be protected under the Charter of Rights and Freedoms, and to use those as grounds to justify the termination of the lives of the people who have those characteristics is just wrong, and that we would never consider doing this for any other group of people, including those who are indigenous, racialized or LGBTQ.

Dr. Heidi Janz from the Council of Canadians with Disabilities said:

People with disabilities are at a higher risk of suicide due to systemic and internalized ableism, yet they face substantial barriers when trying to access suicide prevention services. Medical professionals overlook typical sources of stress. Problems arising from relationship breakdowns, depression and isolation are wrongly attributed to disability. The removal of “reasonably foreseeable” natural death as a limiting eligibility criterion for the provision of MAID will result in people with disabilities seeking MAID as an ultimate capitulation to a lifetime of ableist oppression.

Finally, Bonnie Brayton from the DisAbled Women's Network of Canada pointed out, “Bill C-7, is sadly lacking in any meaningful public consultation with any people with disabilities despite how much more profoundly it could affect anyone who lives with a disability.” The disability community overwhelmingly opposed Bill C-7 and has repeatedly raised concerns about negative pressure and coercion impacting Canadians living with disabilities.

What about autonomy? The government would argue that Bill C-7 provides people with disabilities the option of medically facilitated death, but they do not have to chose that option. It is just another option that people have. To this, I would note that autonomy is always expressed in a social, legal and economic context. The context is that many Canadians living with disabilities struggle to access the key supports and services they need.

We do not have sufficient workplace supports in place and there are gaps in terms of community and income supports. In that context, the law and the medical system say to a person living with a disability that they have a simple way out and they can choose to die. If someone is at a point of existential agony and they have a disability, then the system will offer them death as a supposed solution.

In effect, if a person like me, without a disability, is experiencing existential distress and suicidal ideation, and if I were to discuss that distress with a doctor, I would be offered suicide prevention. However, if a person with a disability, the same as me in every other respect, is experiencing the same existential distress and suicidal ideations, and they discuss their distress with a doctor, they will be offered suicide facilitation by that same medical system.

That difference in the way the law and the health system treat those living with and without disabilities obviously sends a message to everyone involved in those interactions about whose life the law and the health system deem to be more or less worth living. The Liberal government has built a staircase to suicide prevention and a ramp to suicide facilitation.

As much as members opposite would like to say that this is about autonomy, the social and legal context that the government has created is not neutral and it is, in fact, discriminatory. Disability rights groups overwhelmingly see this reality, which is why they have been diametrically opposed to the approach of the government, and so much for “nothing about us without us”.

Canadians with disabilities feel devalued by a system that offers them easy death and does not offer them critical supports to live. Sadly, the mentality of the medical system is changing as well in response to these legal changes. The House has heard from many witnesses at different times and in different communities where patients were repeatedly pushed toward death and even called selfish for rejecting that option.

I will quote the minister again who said herself, “I regularly hear from families who are appalled by the fact that they take their child, potentially their older child and are offered unprovoked MAID. I think that has to stop.”

In response to the testimony we heard, Conservatives sought to amend Bill C-7 to guarantee that a physician or other health care worker would not raise euthanasia or MAID with a patient, unless the patient raises it first. This amendment would have ensured that, for instance, a person with a disability who goes to the doctor for something unrelated would not be offered facilitated death out of the blue. This would have solved the problem the minister identified, but the government opposed this—

Protection of Freedom of Conscience Act

[Nathalie Sinclair-Desgagné, Bloc, Terrebonne, QC]

Thank you, Madam Speaker. Now I feel I can deliver a speech.

I want to make one thing clear to the House of Commons. I think this is the appropriate time to point it out, and I think everyone here will agree with me. No one is condoning bullying, be it of health care workers or here in the House. We all know people who have bullied others. Bullies are mean-spirited people whose actions betray their insecurity and fear. We all agree on that.

That being said, we are well aware that this bill has nothing to do with bullying or protecting health care workers from bullying. What this bill would actually do is interfere with people's ability to obtain medical assistance in dying. As I said this morning, the Conservative Party is once again exploiting a serious problem to put forward a misleading solution. The party claims this bill will protect health care workers from bullying, but it is hiding the real objective, which is to interfere with medical assistance in dying. As I said this morning, this is populism.

This morning, a member corrected me, saying that being populist was not necessarily a bad thing. Fine. I should have used the term “demagoguery”. It is demagoguery.

We know full well that this bill does not seek to eliminate the bullying of health care professionals. Its objective is simply once again to obstruct existing legislation in Quebec. What is more, it seeks to allow a medical practitioner or a health care professional to not refer a case to a colleague. That goes against what we have in Quebec.

Obviously, the Bloc opposes this bill, just as we opposed Bill C‑268 in the last Parliament, and just as we opposed the proposed amendment to Bill C-7 when it was studied in committee. We have always been opposed to this. I do not know why it has come up a third time. Apparently, they have run out of topics, when there are so many to work on. If the Conservatives are looking for topics, we can help them with that.

Again, the Conservative Party is presenting us with a bill that has a certain objective, but which is worded differently in order to hide its real objective.

We oppose this bill for two reasons.

First of all, it contravenes the Quebec charter of values, rights and freedoms. There are already laws in place to protect health care workers in such situations involving intimidation. Let me give some examples of legislation that allows health care workers to refuse to provide medical assistance in dying.

Quebec's Act respecting end-of-life care states the following:

A physician practising in a centre operated by an institution who refuses a request for medical aid in dying for a reason not based on section 29 must, as soon as possible, notify the executive director of the institution or any other person designated by the executive director and forward the request form given to the physician, if that is the case, to the executive director or designated person. The executive director of the institution or designated person must then take the necessary steps to find, as soon as possible, another physician willing to deal with the request in accordance with section 29.

Subsection 241.2(9) of the Criminal Code states:

For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.

Health care workers are already protected by the Criminal Code.

Finally, section 24 of the Code of ethics of physicians of Quebec recognizes conscientious objection for medical practitioners, which is the right not to resort to a medical act that goes against their values. It is also recognized in Quebec's Act respecting end-of-life care. The physician is nevertheless required to find another physician.

A physician must, where his personal convictions prevent him from prescribing or providing professional services that may be appropriate, acquaint his patient with such convictions; he must also advise him of the possible consequences of not receiving such professional services. The physician must then offer to help the patient find another physician.

Ontario has a similar provision. Therefore, physicians and health care workers in that province do not need this bill.

Second, we are opposed to this bill because it allows physicians not to refer a case. Let us recall certain statistics. It is all too clear: There is a growing demand for medical assistance in dying, in Quebec as well as in Canada, since these laws were passed.

End-of-life care meets a need and helps ease the suffering of patients who are dying. Since the act came into force, the number of cases of MAID in Quebec has increased year over year. In 2016-17 there were 599 cases and in 2020-21 there were 2,426, which represents a 405% increase.

According to the annual report of the commission on end-of-life care, three-quarters of patients who requested MAID had cancer.

We can all agree that individuals who request MAID do not do so lightly. These people have a right to dignity and that is what is most important in all of this.

A certain balance must be struck and a decision made. That is the issue: striking a balance between an individual's dignity and freedom of conscience and religion. This has already been studied. Quebec has been discussing these issues for 10 years. That was the objective of the bill sponsored by Ms. Hivon, who I would like to congratulate today, and which was adopted on June 5, 2014. A lot of work went into this. Years were spent studying and evaluating these issues. Why not trust the work that has already been done by Quebec in this area?

This seems to be a recurring theme in the House. The federal government starts from scratch without building on what has already been done. It does not have to look far; Quebec is just across the Ottawa River.

The Quebec National Assembly is working on the issue; among other things, the Select Committee on Dying with Dignity was created on December 4, 2009. There is a consensus in Quebec that access to medical assistance in dying should not be restricted. The Quebec National Assembly spent 10 years examining both sides of the issue I just spoke about.

I will conclude here. I repeat: Medical assistance in dying is not designed to go against the values, religions or religious practices of certain Conservative Party members. Medical assistance in dying is an essential measure that allows people to die with honour and dignity. That is in line with Quebec's charter of values and its charter of rights and freedoms.

Extension of Sitting Hours and Conduct of Extended Proceedings

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, as I was saying, I rise in the House feeling extremely disappointed. I am disappointed with the government's vision of parliamentary democracy. What a waste of time and energy.

Since securing the support of the NDP, the government has been acting with the arrogance of a majority government. Some will ask whether I am truly surprised. I will answer that I entered politics because, first and foremost, I refuse to be cynical.

Last Thursday, I heard the Parliamentary Secretary to the Leader of the Government brazenly state that this type of motion was nothing out of the ordinary. A brief review showed me that, indeed, this happens too often in the House.

The Liberals said that it was not uncommon and that it was not a big deal, because the Conservatives did it before. Just because the Conservatives did something once, that does not mean that another party is justified in doing the same thing once in power. There is no reason to normalize parliamentary mediocrity and an inability to manage the parliamentary agenda.

The government has been lax, not to say lackadaisical, in administering its legislative agenda, especially when it comes to medical assistance in dying. There was an election, there were three sessions before the election, and a committee was created, but the committee was not recalled until late March, and its first meeting was held on April 8. That is totally unacceptable.

In my view, this motion is unworthy of a democratic Parliament. It is despicable. Either this motion is malicious, deceptive and twisted, or it is astoundingly insensitive toward people who are suffering. Today, with this motion, not only is the government limiting the powers of the opposition parties, but it is doing so for partisan reasons. This is end-of-session quibbling over matters of life and death. The government is exploiting the issue of end-of-life care and capitalizing on the suffering of people who are dying, who are experiencing intolerable suffering, who would like to have access to support in dying with dignity and who would like the proper respect to be shown for their right to make a free, informed choice.

These people trusted us last year when we passed Bill C-7. They assumed we would spend the next year conducting a rigorous, thorough cross-party analysis and produce a credible report on the revision of the act.

In our opinion, the Liberals’ strategy is the epitome of cynicism. They are preparing to trample on the powers of the opposition parties with the NDP’s complicity, while in 2017, 2018 and 2019 the NDP voted against this type of motion. The Liberals are muzzling the opposition parties, something we have always voted against. They are imposing closure, but they are careful to add in the same motion what the Bloc Québécois wants, namely to extend the mandate of the joint committee until October 17. On the one hand, they are giving us less time. On the other hand, they are extending the deadline.

Fortunately, knowing that we could not divide the motion, the Speaker allowed us to divide the vote.

By tabling the motion last Thursday, however, the government placed the Bloc Québécois in a position where it had to vote against its desire to implement a rigorous and credible process to review the act respecting medical assistance in dying in order to allow the joint committee to submit a report worthy of expectations or alternatively compromise its principles of parliamentary democracy. This is the Liberals’ twisted way of governing.

Since the last election, the government has dragged its feet when it came to reconstituting the special joint committee. It did so not in a separate motion, but—nice going—in a motion adopted under a gag order, which muzzled the opposition.

Since the beginning of the 44th Parliament, the Bloc, represented by myself and my excellent House leader, has told the government that we were short on time and that we should proceed by consensus to extend the deadline for the joint committee’s report. A first compromise was made, and the deadline was extended until June 23. Unfortunately, to succeed, we would have had to sit continuously, and intensively, more than once a week, starting with the first meeting.

The way we conduct this process is important for ensuring the credibility of the findings. This part of Motion No. 11 should at least have been moved separately. Discussions could have continued with the Conservative party; so far, the Conservatives are claiming that the June 23 deadline is reasonable and sufficient.

Obviously, the schedule can be reorganized at the end of the session. Obviously, with this hybrid parliament, resources cannot be optimized to accommodate more work, even until midnight. Obviously, this limits the organization of business. Claiming that we can call witnesses and ensure—

Protection of Freedom of Conscience Act

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

Madam Speaker, I rise in strong support of Bill C-230, the protection of freedom of conscience act, introduced by my friend, the member for Carlton Trail—Eagle Creek.

The bill before us is much-needed legislation to protect the charter rights of medical professionals who conscientiously object to providing or otherwise participating in medical assistance in dying. I want to commend the member for her steadfast leadership in championing conscience rights and for bringing this bill back to the House, as she introduced a similar bill that died on the Order Paper in the last Parliament.

Medical assistance in dying raises profound legal, moral and ethical questions. The trial judge in the Carter decision, which struck down the Criminal Code prohibition against physician-assisted death, stated, “The evidence shows that thoughtful and well-motivated people can and have come to different conclusions about whether physician-assisted death can be ethically justifiable.” This is true of patients, and it is true of medical professionals.

Medical professionals have a duty to do what is in the best interest of their patients and to provide the best possible advice based upon their judgment and experience, all of which are grounded on moral and professional convictions. In the case of medical assistance in dying, there are professional, moral and ethical considerations of the highest weight.

In the Carter decision, the Supreme Court predicated its decision on two things: a willing patient and, as importantly, a willing physician. At paragraph 132 of the Carter decision, the court said that nothing in its pronouncement would compel medical professionals to participate in MAID. The court went further in stating that, “However, we note...in addressing the topic of physician participation...that a physician’s decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief.” In other words, again, it requires a willing patient and a willing physician.

Now, there are those who would say that this legislation is redundant, that it is not needed, and that in terms of medical assistance in dying, conscience rights of medical professionals are already protected. They would point to the pronouncement in Carter. They might also cite Bill C-14, which includes a preamble that expressly recognizes conscience rights as well as a “for greater certainty” clause in the Criminal Code, which simply provides that “for greater certainty, nothing in this section compels an individual” to provide MAID.

While the intention of Parliament was to protect the conscience rights of medical professionals when Bill C-14 was debated and passed—and I was there for, and actively participated in, that debate and the study of that bill at committee—in practice, conscience protections and the rights of medical professionals are not being respected across Canada. There is a gap, and that is why, when Bill C-7 was studied at the justice committee, we heard from medical professionals who expressed serious concerns about pressure and coercion in providing MAID.

Indeed, the Ontario Medical Association wrote to our committee and specifically called on the committee to amend Bill C-7 to provide greater conscience protections for medical professionals, given that the “for greater certainty” clause, although better than nothing, simply does not have teeth. It is not enforceable. In that context, while the Criminal Code does not compel a medical professional to provide MAID, there is nothing in the Criminal Code that specifically protects medical professionals when they are pressured or coerced to provide MAID. This bill addresses that gap and would close it by establishing two targeted offences; namely, it would make it an offence to intimidate or coerce a medical professional with regard to providing or participating in MAID, and secondly, it would make it an offence to dismiss or refuse to hire a medical professional solely on the grounds that they object to participating in MAID.

While this legislation would protect the rights of medical professionals, it must also be emphasized that this bill would just as much protect the rights of patients. The bill would protect the rights of patients by protecting the physician-patient relationship. It would do so by safeguarding the ability of medical professionals to provide their best advice and judgment, free of pressure and free of coercion, to a patient who is considering medical assistance in dying. It would protect patients by protecting their right to a second opinion. There can be no second opinion, or at least a guarantee of a second opinion, in the face of coercion or pressure to provide medical assistance in dying. There can be no second opinion when the only choice offered to a patient is medical assistance in dying as a result of pressure and coercion.

The need to safeguard the patient-physician relationship, which this bill works toward achieving, is all the more needed in the face of the radical expansion of medical assistance in dying in Canada with the passage of Bill C-7, which removes critical safeguards, including the criterion that death be reasonably foreseeable and opens the door to medical assistance in dying for persons who are suffering solely from a mental illness, even though it is never possible to predict when someone who is suffering from mental illness can get better. It is never possible to predict irremediability in the case of a solely mental illness. As a result of the removal of those critical safeguards, vulnerable patients are put at greater risk.

When the conscience rights of medical professionals to exercise their best judgment are protected free of intimidation and coercion, the rights of patients are equally protected. This is a timely, targeted and necessary piece of legislation that would protect the rights of medical professionals and their charter rights and the rights of patients. I urge its passage.

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

Madam Speaker, I am pleased though a bit surprised to be speaking on Bill C-230. Less than a year ago, on May 27, 2021, we were in the House debating Bill C-268, the very same bill from the very same member for Carlton Trail—Eagle Creek. While I am a bit in awe of the member's ability to place so highly in the random draw for Private Members' Business in two successive Parliaments, I am also at a bit of a loss to explain why the member would squander her luck on this bill.

There are two reasons I say this. As MPs we get limited opportunities to place bills directly before the House. I had that opportunity in 2013, and I used it to put forward Bill C-279, which sought to add gender identity and gender expression to the list of prohibited grounds for discrimination in the Canadian human rights code and in the hate crime section of the Criminal Code. Though many thought it unlikely, the bill did pass the House with support from MPs from all parties. It took a lot of work to put together that coalition of MPs. While my bill followed a somewhat torturous path, there was always a path forward and it became law.

I wonder why it is that having heard so clearly, in speeches less than a year ago, that there was limited, if any, support for this bill outside her own party, the member for Carlton Trail—Eagle Creek has brought it back again. Since there is nothing to indicate any change of circumstances or any change of heart, this bill will go nowhere this time as well. Failing to bring forth a bill that might have some prospect for passing or reintroducing this bill instead of bringing forward a new bill presenting ideas not already debated here in the House leads me to call reintroducing this bill, at best, a missed opportunity.

The second reason I have for declaring the reintroduction of this bill a lost opportunity has to do with the bill itself. This bill picks up a tiny portion of the extensive and important debates on medical assistance in dying that took place on Bill C-14 in Parliament in 2016 and again on C-7 in the last Parliament. It seeks to take one small and very debatable point and turn it into a wedge issue in the House.

We are waiting for the Special Joint Committee on Medical Assistance in Dying to get down to work on outstanding important and critical issues around medical assistance in dying, but as that committee has yet to get under way, I want to take this opportunity today to restate the principle that has guided New Democrats through these debates.

We believe that medical assistance in dying is an important tool for helping to end unnecessary suffering for patients facing end-of-life issues and for avoiding the unnecessary suffering of their families, who have to accompany them on this journey. This is the reason New Democrats will always defend the right of access to information about MAID and access to the service for all those who qualify for assistance in dying and choose to proceed.

In the debate on Bill C-7, many issues arose concerning the challenges Canadians face at the end of life, some of which Bill C-7 addressed directly and some which have not yet been addressed. Two important concerns were front and centre, and these, for me, were the most important. The first was to help alleviate unnecessary suffering by eliminating the waiting period, which was a cause of great concern for patients who feared loss of capacity before they could complete the waiting period and thus make them ineligible for medical assistance in dying and forced to consider suffering.

The second was a change allowing a waiver of final consent. This is a provision I know quite well, personally, as a friend of mine chose to go earlier than she would have liked because of a brain tumour and her fear that she would lose capacity to consent at the last moment and, in doing so, have to continue making her family suffer.

A second challenge was also debated in Bill C-7. How do we preserve as much autonomy as possible for Canadians who are dying? Most of the issues related to this still have to be dealt with at the special joint committee. This includes questions of advance directives, the question of access to MAID for those with mental illness and for mature minors, and whether protections for people with disabilities from being pressured to seek MAID are adequate. I remain frustrated with the delays in dealing with these very important issues. The bill before us is not one of those.

A third challenge that came up in the debate on Bill C-7 was access to services at the end of life. We learned there are a great many gaps in services in our Canadian health care system for those who are facing death. There are gaps in diagnostic and treatment services depending on where one lives, whether it is a major city with excellent facilities or a rural and remote area. We learned of important gaps in palliative care.

However, instead of addressing these challenges, the challenges of autonomy and the challenges of access to services, Bill C-230 is about something else altogether. What this bill would do is override a patient's right to access information about and to have access to legally provided medical services, based on the personal beliefs of a service provider.

Let me put that in plain language. Let us suppose there are a variety of treatments available to a patient. It does not really matter in this case what they are. If a medical professional believes that one of them should not be available, this bill says there is no obligation on that professional to make sure patients find out all the options available to them. Professional organizations, like colleges of physicians and surgeons, and colleges of nurses, have found this to be unethical behaviour, so they require doctors, to varying degrees, to refer patients to someone who is supportive of those services and who is available to provide those services.

This requirement to refer exists in its strictest form in Ontario as the right of patients to an effective referral, meaning a referral to a health care professional who is available, capable and willing to provide that service. This has been upheld by the courts as a reasonable compromise between the rights of patients' access to medical issues and the conscience rights of service providers. That is the main reason I cannot support this bill. If passed, it would result, on a very real and practical basis, in the denial of access to necessary health services for many Canadians.

Many communities have a very limited number of doctors and if one of those doctors, or even more than one of those doctors, is unwilling to let their patients find out about medical assistance in dying, then we are condemning those Canadians to suffer at the end of life in ways that other Canadians would not have to suffer. No health care professionals are in fact required by law to participate, and that is why I find titling this bill “intimidation of health care professionals” disingenuous at best. Is requiring a referral actually participation in medical assistance in dying? Clearly it is not, and trying to torque a requirement to provide information into participation helps no one understand the real issues of conscience involved in medical assistance in dying.

An equally important reason for opposing this bill is the dangerous precedent that this bill would set. Its role as a potentially precedent-setting bill has already been noted by anti-choice advocates who have been vocal in their support for this bill. They recognize that it would provide a precedent for denying referrals for access to contraception and abortion services, and I want to point out that denials of service and denials of information are very real in our existing Canadian medical care system.

This bill would also be a very bad precedent for current attempts to deny transgender minors the counselling and medical services they need to affirm who they are. Without access to services that others may think are inappropriate, this will leave families with trans minors struggling to find the information and support that their kids really need. If this kind of precedent is allowed, medical professionals would not have to provide a referral to someone who would be providing a medically necessary service.

As I approach the end of my comments today, I cannot end without mentioning yet another unfortunate precedent set in this bill, and that is its use of inflammatory language. I have no doubt, as I said in my question to the sponsor of this bill, of her personal convictions and their strength. However, as sincere as they may be, the language used in this bill conjures up a spectre of the use of violence to intimidate medical professionals, something of which there is absolutely no evidence of happening in Canada. Invoking the spectre of violent intimidation is certainly not conducive to an informed debate on the real issues that are in question here.

I will close my comments today by restating that, on principle, New Democrats are opposed to any legislation that would limit access to Canadians seeking information about or the service of medical assistance in dying. No matter how strong the beliefs others may hold, this right exists to access medically necessary services. There is no doubt that the end of life is a difficult moment for all families, and medical assistance in dying, I still believe, is an important way of ending unnecessary suffering both for patients and families at the end of life. I would not like to see anyone denied access to information they need to make a choice that protects their own autonomy of how their lives end. At this point, let me salute the health care professionals who assist patients and their families through this very difficult process.

Once again, I lament the tendency of not just this member but, indeed, many Conservative members of the House to use private member's bills for scoring political points and sharpening divisions in the House—

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the bill we are debating today has to do with protecting the freedom of conscience of health care professionals and practitioners when it comes to medical assistance in dying.

I think we should base our debate on the approach that Quebec took on this matter back in 2010. Quebec studied this issue from 2010 to 2014. The debates were non-partisan. The process allowed for all points of view to be heard and compiled. The focus of the debate was human dignity.

When talking about end-of-life care, we must not forget that the way to protect human dignity lies in freedom of choice. No one can claim to be acting in a patient's best interests if that patient is not allowed to make their own decisions. What is interesting about the Conservatives' bill is that they want the state to be less involved in the economy but more involved in our lives, especially when it comes to death, which is one of the intimate decisions a human being will make.

It is not the state or Conservative members who are going to die in place of the individual, the person who is dying, the patient, so why are they trying to interfere in this decision?

This bill is pointless, and I say this because subsection 241.2(9) already stipulates that no one can be compelled or forced to provide medical assistance in dying against their will.

As I just mentioned, the Quebec legislation should guide us in our debate here today. Section 31 of the Quebec legislation stipulates that medical practitioners cannot be forced to participate directly or indirectly in MAID, and I quote:

A physician practising in a centre operated by an institution who refuses a request for medical aid in dying for a reason not based on section 29 [which sets out all the conditions that a doctor must meet before deciding whether to provide medical assistance in dying] must, as soon as possible, notify the executive director of the institution or any other person designated by the executive director and forward the request form given to the physician, if that is the case, to the executive director or designated person. The executive director of the institution or designated person must then take the necessary steps to find, as soon as possible, another physician willing to deal with the request in accordance with section 29.

This means that a patient who is dying and highly vulnerable should not be burdened with having to take the steps I just mentioned. The bill the Conservatives are introducing today would do just that. It would force these individuals to take those steps at the most vulnerable time of their lives, when they are dying or about to die. However, medical practitioners can refuse to participate directly or indirectly in MAID.

As we heard during the Standing Committee on Justice and Human Rights' study of Bill C-7, some practitioners, citing freedom of conscience, are currently refusing to abide by the Collège des médecins du Québec's code of ethics and forward the request. In other words, they are ignoring the request, which they are not allowed to do.

In Quebec, conscientious objection is defined as follows: “Health professionals must not ignore a request for medical aid in dying. However, a doctor may refuse to administer medical aid in dying because of his or her personal values. The doctor must notify, as soon as possible, the executive director of the institution”.

That is the issue. The Conservatives have introduced a bill to add a provision to the Criminal Code that would make what they call intimidation in health care facilities an offence.

This would be a situation where a health care professional dealing with a family supporting a dying patient—a father, a mother, a brother, a sister—offers end-of-life options without ever mentioning medical assistance in dying. That is the kind of scenario we are talking about.

Quebec was a leader in this area and contributed to advancing the legislation, but there is still a lot of resistance on the ground when a patient requests medical assistance in dying. That can manifest in various ways. The surprising thing is that this resistance stands in stark contrast to what I consider the essence of Quebec's legislation, which was to integrate end-of-life care into the palliative care continuum.

In the current debate, there is one side advocating for palliative care and another advocating for medical assistance in dying. Quebec's legislation did not fall into the trap of such unnecessary division. Palliative care should be accessible, and the continuum of palliative care can give rise to a request for medical assistance in dying. A request for MAID emerges when a patient is given the opportunity to make a free and informed choice.

A person's dignity must not be defined by how they die, and it cannot be compromised because death is considered to be distasteful. To respect a human being is to respect their dignity, and that means respecting their independence and capacity for self-determination until their last breath.

The law enshrines the principle of self-determination throughout our lives, especially when it comes to medical decisions. No one can interfere with my person without my free and informed consent. Why then, at the most intimate moment in my life, would the state interfere in my life and take away my right to self-determination? I can only make a free choice if the practitioner is able to offer me all the choices, including access to palliative care, palliative sedation, and medical assistance in dying. This is a decision that only a dying person can make.

These types of bills and debates take us away from far nobler objectives. There is nothing new here to crow about; it was already set out in the legislation.

I would like members to understand why the Bloc Québécois will oppose this bill. We oppose this bill because at present, in Quebec, some people requesting MAID in a hospital are not being admitted to a palliative care unit. It is shameful that people at the end of their lives must live their last moments in a place that is far from peaceful and far from what is recommended as appropriate for dying with dignity. Why oppose that?

We must focus our efforts on having a continuum of care, working to ensure that palliative care is as available and accessible as possible in all forms, whether at home, in hospices, or elsewhere. A request for assisted death must be viewed not as a failure, but as a success in accompanying an individual towards death.

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

moved that Bill C-230, An Act to amend the Criminal Code (intimidation of health care professionals), be read the second time and referred to a committee.

Mr. Speaker, it is a privilege to rise today to begin the debate on my private member's bill, Bill C-230, the protection of freedom of conscience act. This bill revives my private member's bill, which died on the Order Paper, from the last Parliament, with some slight modifications.

I would be remiss if I did not once again acknowledge that this bill is built on the hard work and determination of former members of Parliament. The first bill proposed to address this issue was introduced by the late Mark Warawa in 2016. His bill did not proceed because of the government's introduction of Bill C-14. After Bill C-14 was passed into law, my former colleague David Anderson introduced his private member's bill, Bill C-418, during the 42nd Parliament. However, that bill also died on the Order Paper when the general election was called in 2019.

I would like to thank all those who have been championing this issue for many years and their willingness to work with me. Experts throughout Canada have provided information and advice, while thousands of grassroots Canadians voiced their support for protecting our fundamental freedoms. I would also like to thank the Library of Parliament for its timely, diligent and expert research, which helped inform this proposed legislation.

For the purposes of this debate, I think it is important to understand conscience. There are numerous definitions of conscience, but they are consistent in defining it as an individual’s inner sense of knowing the difference between what is right and wrong and allowing that knowledge to guide their behaviour. The Canadian Charter of Rights and Freedoms, under the heading of “Fundamental Freedoms”, in subsection 2(a) states that everyone has the fundamental freedom of conscience. In this way, Bill C-230 is straightforward. It seeks to add two new offences to the Criminal Code of Canada. I will read the summary so members will know what they are:

This enactment amends the Criminal Code to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of medical assistance in dying.

It also makes it an offence to dismiss from employment or to refuse to employ a medical practitioner, nurse practitioner, pharmacist or other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of medical assistance in dying.

This bill is a response to calls from disability rights groups, first nations, the Ontario Medical Association, legal experts and many medical and mental health professionals to protect conscience rights. It ensures that medical professionals who choose not to take part in or refer a patient for assisted suicide or medical assistance in dying will never be forced or coerced to violate their freedoms as stated in the charter.

Previous Parliaments have passed laws that created the unintended consequence of doctors and medical professionals being forced to participate in providing a patient's death, regardless of whether they believe it is in their best interest. Bill C-14 and Bill C-7 created a federal standard for medical assistance in dying and assisted suicide but not for conscience protections.

By way of background, sections 241.1 to 241.4 of the Criminal Code of Canada deal with the provision of medical assistance in dying. These sections are in part VIII of the code. It deals with offences against the person and reputation, which include offences such as homicide, kidnapping, assault and many more. Subsection 241(1) of the Criminal Code still makes it a criminal offence to counsel or aid in a suicide. It reads:

Everyone is guilty of an indictable offence and liable to imprisonment for a term of not more than 14 years who, whether suicide ensues or not,

(a) counsels a person to die by suicide or abets a person in dying by suicide; or

(b) aids a person to die by suicide.

When creating the exemption allowing for MAID, the government had to create an exemption to this prohibition on counselling or aiding in suicide. This then leads to the untenable claim that the Criminal Code already protects the conscience rights of medical professionals.

Some claim that the clarification clause, section 241.2 (9) of the Criminal Code, somehow protects conscience rights. It states:

For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.

While I understand why some would want to think it protects conscience rights, I believe they are sadly mistaken. While I appreciate and support this inclusion in the Criminal Code, it only addresses one side of the coin. This clause only confirms that the Criminal Code is not the source of compulsion to participate in medical assistance in dying.

For the Criminal Code to have any teeth on this issue, it should articulate that it is an offence to compel someone to provide, or assist in providing, medical assistance in dying against their will. Compelling someone to participate in MAID can and does happen, which is why I have brought forward this legislation and why it needs to pass.

Regarding jurisdictional questions about this bill, as I mentioned earlier, this bill proposes that two new offences be added to the Criminal Code of Canada to address intimidation, dismissal from employment or refusal to employ a medical professional. This is similar to section 425 of the Criminal Code, which addresses the same actions taken by an employer to compel employees with respect to belonging to or organizing a union. I would suggest that if it is appropriate to have section 425 in the Criminal Code, it is reasonable to include the amendments I am proposing.

I would also submit that it is inaccurate to argue that conscience rights legislation somehow interferes with the role of the provinces while, at the same time, believing that the legalization of medical assistance in dying does not. Ensuring that conscience rights are protected is the responsibility of Parliament and of the Government of Canada, which is why I introduced this bill and why it should be passed.

Additionally, provinces can introduce their own conscience rights legislation for medical professionals. For example, Manitoba has passed simple and clear legislation in this regard, and I would encourage all provincial legislatures and parliaments to follow Manitoba’s example.

While the text of this bill focuses on the conscience rights of medical professionals, this legislation also serves to protect the right of patients to receive a second opinion. What do I mean by this? If all doctors are forced to propose MAID as a treatment option to their patients, this one-size-fits-all approach would give Canadian patients less choice, not more.

Additionally, individuals who object to MAID would be deterred from entering the medical profession altogether. Patients would no longer be able to seek a second opinion for their end-of-life care. In this way, conscience rights for medical professionals not only protect medical professionals and their patients, but they also protect our health care system.

Without conscience rights, doctors are constrained to provide, or refer their patients to receive, medical assistance in dying, regardless of whether it is their professional opinion that it is in the best interest of the patient. This concern for the patient’s best interest does not mean that a medical professional objects to medical assistance in dying in all cases, just that in his or her opinion it is not an option that should have to be offered in every case. This became especially pertinent to the medical community with the passage of Bill C-7.

To highlight the impact of the removal of the safeguard that death be reasonably foreseeable, I would like to quote from a recent column published online in Policy Options magazine which states the following:

Many injuries and physical illnesses are indeed accompanied by temporary depression and suicidal thinking. For example, research demonstrates increased risk of suicide for two years after a spinal cord injury. This suicidality overwhelmingly ends with adaptation and recovery support. Offering death to anyone during a period of transient increased suicidality is, in our view, unethical and violates the standard of medical care by which physicians must abide.

The fact that the newly expanded law may facilitate death in those circumstances of increased suicidal thinking is, in and of itself, problematic.

Some have tried to frame conscience rights as the rights of the patient versus the rights of the doctor. Nothing could be further from the truth.

Health care is fundamentally about the doctor-patient relationship. For example, take the psychiatrist who supports MAID in certain circumstances, but in a certain case has spent 15 years counselling a patient who suffers from bouts of depression and suicidality. For 15 years, they have built understanding and trust. What would happen if that patient, suffering from a bout of suicidality, should demand assisted suicide? Under current law, that psychiatrist would be forced to refer that patient to someone else so he or she could die. They must do this, despite knowing that the suicidal thoughts are temporary and that otherwise the patient is joyful and loves his or her life. Ending that patient's life would be wrong, but the psychiatrist’s hands are tied. This should not be what passes for medical care in Canada.

Some might claim that there are safeguards in place to prevent such tragedies, but I would ask them if they are absolutely sure. With the passage of Bill C-7, many safeguards for medical professionals were removed. We are talking about ending a human life. There is no room for uncertainty when a life hangs in the balance.

Additionally, should the first line of safeguards not be the expertise of the medical professionals who know their patients best? If those medical professionals do not believe death is the answer, should we not at least consider if they are right? However, this then leads to the concern some raise that protecting the conscience rights of medical professionals will block access to those who truly want it. I would suggest this is both misleading and nothing but baseless fearmongering. Medical assistance in dying and assisted suicide are readily available throughout all of Canada. There are information phone lines, hospitals staffed with willing medical professionals, even email addresses to help set up appointments. In a word, MAID has become the status quo. It is available.

The Canadian Medical Association also stated clearly that conscience protections would not affect access because there were more than enough physicians willing to offer MAID. Therefore, common sense should tell us that the charter rights of medical professionals are breached when they are forced to either offer or refer assisted suicide or medical assistance in dying. Surely, we have the capacity to both ensure access to MAID while still protecting the fundamental charter right to freedom of conscience.

Finally, some have suggested that medical professionals should leave their morality at the door. I do not believe we want this to happen. For example, we would all want and expect doctors to be bound by their morals if they were offered a bribe to move someone up on a waiting list. If we hold our medical professionals to a higher standard, we cannot then tell them to ignore their personal moral standards. Further, while discussing the issue of conscience rights with a doctor, she told me that, in the absence of conscience protection, the group with the most to lose are the patients, and they are the ones we are trying to help. This bill protects the doctor-patient relationship by ensuring that doctors and other medical professionals are always able to recommend and provide the care they believe is best for their patients. Patients need this bill to pass. Canada’s medical professionals need this bill to pass.

Over the past two years, we have seen just how important our health care system is and how critical the medical professionals who work in that system are to Canadians and our way of life. We need to create a work environment for medical professionals that protects them, supports them, and encourages them to continue in the critical work they do.

In closing, I encourage all members to support passage of the protection of freedom of conscience act.

Alleged Premature Disclosure of Bill C-10

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, I am very pleased to participate in today's debate.

However, I want to raise a very serious concern about what we call a question of privilege.

I am rising on a question of privilege regarding the premature disclosure of the content of Bill C-10, an act respecting certain measures related to COVID-19, by the Prime Minister himself while it was on notice and before it was introduced and tabled in the House of Commons. On Saturday, a special Order Paper was published that contained the notice for Bill C-10.

As members know, according to our Standing Orders, notices of bills must be very succinct. In this case, the notice was. It gave the title of the bill and the number, Bill C-10.

Yesterday at noon, the Prime Minister held a press conference in front of his house. Incidentally, we were able to see that, despite the fact that he and his two children have COVID-19, he is doing well. That is good.

However, he said a lot more about Bill C-10 than what was written in the notice.

In fact, CTV, in a publication following the press conference, noted that the Prime Minister provided a bit more detail about the bill's contents beyond its title. Those details provided by the Prime Minister were as follows: “We'll be introducing legislation to ensure we continue providing as many rapid tests as possible to the provinces and territories.”

Yesterday, after question period and the Prime Minister's press conference, Bill C‑10 was introduced during Routine Proceedings. At that very moment, it became clear to us and to all Canadians that what the Prime Minister had said was exactly what was in the bill.

The bill authorizes the Minister of Health to make payments of up to $2.5 billion out of the consolidated revenue fund in relation to the coronavirus disease 2019, well known as COVID-19, tests. It also authorizes the Minister of Health to transfer COVID-19 tests and instruments used in relation to those tests to the provinces and territories and to the bodies and persons in Canada.

The Prime Minister talked about Bill C‑10 in detail at the press conference before the bill was introduced. In our view, that is a breach of trust under the rules that govern us.

The Prime Minister's disrespect for Parliament goes beyond just the premature disclosure of a bill. The Prime Minister, having wasted so much time with a prorogation, followed by an expensive and unnecessary election, is trying to play catch-up by leaning on the opposition to co-operate and fast-track his bill.

In an attempt to show some goodwill, his House leader provided embargoed copies to the House leaders of the opposition. For our part, and for the part of all opposition parties, we did respect the fact that we cannot make any comment publicly about the bill. That is the way to do it. Unfortunately, yesterday the Prime Minister did not respect that situation.

On March 10, 2020, you commented on the premature disclosure of Bill C‑7 on medical assistance in dying. You said the following:

...based on a reading of the Canadian Press article on Bill C‑7 on medical assistance in dying, and in the absence of any explanation to the contrary, I must conclude that the anonymous sources mentioned were well aware of our customs and practices and chose to ignore them. It seems clear to me that the content of the bill was disclosed prematurely while it was on notice and before it was introduced in the House.

...

The rule on the confidentiality of bills on notice exists to ensure that members, in their role as legislators, are the first to know their content when they are introduced. Although it is completely legitimate to carry out consultations when developing a bill or to announce one's intention to introduce a bill by referring to its public title available on the Notice Paper and Order Paper, it is forbidden to reveal specific measures contained in a bill at the time it is put on notice.

On April 19, 2016, the Speaker found there was a prima facie question of privilege regarding a similar bill, namely Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, respecting medical assistance in dying. He said the following:

As honourable members know, one of my most important responsibilities as Speaker is to safeguard the rights and privileges of members, individually and collectively. Central to the matter before us today is the fact that, due to its pre-eminent role in the legislative process, the House cannot allow precise legislative information to be distributed to others before it has been made accessible to all members. Previous Speakers have regularly upheld not only this fundamental right, but also expectation, of the House.

Another question of privilege was raised on March 19, 2001, regarding the media being briefed on a bill before members of Parliament. In that ruling, Speaker Milliken said, at page 1840 of the House of Commons Debates:

In preparing legislation, the government may wish to hold extensive consultations and such consultations may be held entirely at the government's discretion. However, with respect to material to be placed before parliament, the House must take precedence. Once a bill has been placed on notice, whether it has been presented in a different form to a different session of parliament has no bearing and the bill is considered a new matter. The convention of the confidentiality of bills on notice is necessary, not only so that members themselves may be well informed, but also because of the pre-eminent rule which the House plays and must play in the legislative affairs of the nation.

The Speaker at that time found another case of contempt on October 15, 2001, again involving the media being briefed on the contents of a bill prior to the legislation being introduced in the House. The precedents are very clear in these matters. The Prime Minister is in contempt of the House for disclosing the content of Bill C-10 while it was on notice and prior to being introduced in the House.

In conclusion, I would like to point out that this issue of COVID tests was part of the opening round of questions during the first question period my leader attended in September 2020 after becoming the leader of the official opposition. This issue is a really serious one and we care about this situation. It may have taken the Prime Minister a while to get it and I understand he now needs help to hurry things along, but he does himself no favours by thumbing his nose at the privileges of this House and the goodwill of the opposition parties by playing by his own rules.

This practice has gotten him into trouble before. On more than one occasion, he ran into difficulty with the Ethics Commissioner. The commissioner found in 2019 that he breached ethics rules. The Prime Minister had tried in 2018 to undermine a decision by federal prosecutors allowing a construction company, the SNC-Lavalin Group, to face a corrupt trial. The Ethics Commissioner also sanctioned him in December 2017, ruling that he broke conflict of interest rules when he accepted a vacation on the Aga Khan's private island in 2016.

I could go on and on, but to quickly get to the point and pursue a resolution to this matter, I ask, Madam Speaker, that you find a prima facie case of privilege. I am prepared to move the appropriate motion.

Medical Assistance in Dying

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, I thank you for your wise exercise of discretion on that point.

The petition I was tabling when I was interrupted by my good colleague was on Bill C-7, a bill that came forward in the last Parliament. At the time, the government chose to support an amendment that came from the Senate, an amendment that allowed individuals who are suffering from mental health challenges to receive facilitated suicide within the medical system.

Petitioners highlight the fact that mental health challenges are not irremediable. The Canadian Mental Health Association states, “As a recovery-oriented organization, CMHA does not believe that mental illnesses are irremediable".

Petitioners are very concerned this policy change completely changes the message to those who are struggling with mental health challenges, effectively offering them suicide instead of recovery as a path forward. They call on the government to reject this policy of facilitated suicide for those suffering from mental health challenges and to protect Canadians struggling with these challenges by facilitating treatment and recovery.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, the next petition highlights concerns about Bill C-7 from the last Parliament.

The petitioners note this bill raised significant concerns from the disability community about how this would really push people toward death instead of giving them options for life. They called on the House to reject this approach of allowing mental illness to be an adoption for assisted death and to protect Canadians struggling with mental health challenges by facilitating treatment and recovery, not death.

Resumption of Debate on Address in Reply

[Alain Therrien, Bloc, La Prairie, QC]

Mr. Speaker, we can look at all the bills and go over their history. I have no problem with that.

We could talk about Bill C-7 on medical assistance in dying. The Conservative Party blocked that bill, as my colleague said. The Bloc Québécois, meanwhile, decided to support the bill and move it forward.

No, the Conservatives' approach to Bill C-6 was not exemplary. However, an election should not be called simply because one or two bills get stuck, when many bills are going through without a hitch. I know; I was there.

Yes, the Conservatives could take a good hard look at themselves when it comes to this bill. They have not been effective, one could say, but the fact remains that this is a democracy. The Conservatives were against the bill and they showed it.

What I am trying to say is that when there is a strong, robust, intelligent and effective legislative agenda, things go well. That was the problem in the last Parliament. The government did not get the job done.