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

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

It being 2:30 p.m., the House stands adjourned until Monday, October 19, at 11 a.m. pursuant to Standing Order 24(1).

Happy Thanksgiving, everyone.

(The House adjourned at 2:31 p.m.)

The House resumed from October 9 consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, allow me the opportunity to reflect on what has brought us to this point.

Shortly after the 2015 election, a number of pieces of legislation were brought before the House. One of those pieces was Bill C-14, a direct response to courts and the many concerns Canadians had with regard to the issue of dying with medical assistance. The issue was thoroughly discussed and debated. A lot of dialogue took place inside and outside the chamber, and, in fact, across the country. The number of Canadians who were engaged in the legislation was extraordinarily high. That was reinforced earlier this year, but I will get to that particular point later.

Back in January or February 2016, there was a great deal of dialogue taking place. Bill C-14 ultimately passed just prior to the summer break, in June 2016. At the time, parliamentarians recognized that there would be a need to make some modifications. In fact, within the legislation we passed, we created the opportunity for us to review it.

It should come as no surprise to anyone that the issue continues today. Even without legislation, dialogue has been taking place among members of Parliament and constituents. I have had ongoing feedback on the issue, in particular through emails, since 2016. People have expressed concerns and issues with the legislation.

The Superior Court of Quebec made a determination on the legislation, which ultimately dictated that we had to bring in Bill C-7. We had initially introduced the bill earlier this year, I think in February. Prior to its being introduced, Canadians were once again formally called upon to provide their thoughts on the issue. It was amazing that in a relatively short time span, we heard from in excess of 300,000 Canadians. People from all across the nation responded to provide their thoughts and ideas on what they would like to see the government and members of Parliament deal with on this very important issue.

We were very hopeful that a committee would have the opportunity to meet and review the legislation, with the idea of looking at ways it might be changed. Then came the pandemic. As we all know, the focus and attention of Canadians changed, just as the House's priorities had to change, in order to respond to the COVID-19 pandemic. As a direct result, we lost the opportunity for that parliamentary group or committee to get together to review the past legislation, and in fact even the legislation that was being proposed in January or February.

Fast-forward to where we are today. Bill C-7 responds to a decision of the Superior Court of Quebec. It is a reasonable and acceptable piece of legislation that, in this form, makes some changes. It deals with some very difficult issues. For example, it drops the number of days of waiting from 10, after a person is approved and in a near-death situation. I believe this will generally receive good support from all sides of the House. There is the reduction of witnesses from two to one. From what little debate there has been thus far, I believe this has the potential to receive good support. The criteria that a person's death must be reasonably foreseeable is an issue that no doubt will be talked about at great length, both in the chamber and at committee. There are other aspects of this legislation that I find very compelling, and I am very interested to hear what people have to say about them.

A big concern I have is the idea that someone is able to provide consent today but, as an illness or a disease continues, might be prevented from being able to give consent knowingly later, thereby disallowing them from having medical assistance in passing. I know many Canadians share that concern. I am expecting to see a good, healthy discussion on that, whether inside the chamber, in committees or in our constituencies, where we receive feedback.

There is the issue of mental illness and the severity of it. This area is worth ongoing exploration, in different ways. As a former member of the Manitoba legislative assembly, I remember that often when we talked about spending money in health care, mental illness was nowhere near being part of the discussion. In fact, it was a very dear friend of mine, Dr. Gulzar Cheema, who raised this issue at a time when very few people raised it. In general, it is something we need to debate more.

I suspect that as we continue the debate, whether in the chamber or at committee, we will see that it is very emotional for a number of people. I know first-hand how important palliative care is, through the experience of the passing of family, in particular my grandmother and my father. I am very grateful for the Riverview Health Centre in Winnipeg for the service in palliative care they provided. To be there at the passing of my father meant a great deal for me personally, as I knew that when he was there he had the love and care of professionals who deal with people who are passing on. A person has to have a very special heart to deal with that. I had a similar experience with my grandmother, at St. Boniface Hospital. They are two totally different institutions, but the thing they have in common is the supports that are there.

I believe we need to do more in the area of palliative care, and I would love to see more discussion, more debate and more action on the issue. I believe the federal government has a role to play in that area too.

To conclude, I will emphasize for members that here is an opportunity for us not only to look at the core of the issue and have discussions, but to look at some of the issues surrounding end of life and the circumstances that, either directly or indirectly, we are all somewhat familiar with.

[Eric Melillo, Conservative, Kenora, ON]

Madam Speaker, one of the things the member mentioned was improvements to palliative care. I think it is important to note that northern regions of the country and rural and remote regions, particularly indigenous communities in my riding, are chronically underserved in health care delivery.

What does the government plan to do to ensure that residents of indigenous communities, and northern and remote communities, have access to all health care options, including palliative care?

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, that is an excellent question, and that is why it is so important that Ottawa work with provincial jurisdictions. Health care, which incorporates palliative care, is administered by the provinces. The palliative care units that we often talk about are administered through our provinces. Ottawa has a role to play through standards and financial support.

We can learn a lot from the provinces. Some provinces deal with health care in different ways, such as urban versus rural. There are opportunities for us not to reinvent the wheel, but rather to look at who is doing it best: look for best practices and ensure that there is some sense of a national standard so that, when our loved ones need palliative care, their ending days are appropriately taken care of.

[Julie Vignola, Bloc, Beauport—Limoilou, QC]

Madam Speaker, this bill is one more step toward more equitable situation-dependent access to medical assistance in dying. This weekend, I had a conversation with my father. I believe there is an issue here with respect to foreseeability.

Take, for example, a person diagnosed with a very serious terminal illness who may nevertheless live for months or years. Can that person ask their doctor now to administer medical assistance in dying once the disease has progressed to a particular stage, even though that person may be incapable of requesting MAID once that time comes?

Will that be possible?

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I do not necessarily know all of the details. Within the legislation, from what I understand, the issue of second consent is important, as is the impact that it has on people who have a deteriorating illness. Today, they might be in a position to give consent, but in their dying days they might not be in that same position.

I believe there is an attempt to deal directly with that issue within the legislation. It is a good question, and I suspect it will be asked once it hits the committee stage.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Madam Speaker, this is a very important conversation to be having, and I appreciate all of the interventions that have been made by members of the House.

One of my questions is around that second track of accessing MAID, which requires that one of the two medical practitioners assessing the person has expertise in that condition. Considering that in Alberta, in particular, there are many communities where doctors have been leaving because of current fights with our provincial government, how will the government deal with the fact that some people will not be able to access doctors? Those doctors are not working in remote or rural communities right now, for that second track of the MAID.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, we need to go to my first answer, where I recognized that Ottawa needs to work with the provinces, particularly the different departments and ministries of health, to ensure that there is a sense of fairness and equity, no matter what region of the nation people are in.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, this is such an important debate that we are having here today, and I thank members for sharing their stories.

This is a very personal debate. I recall speaking on Bill C-14 when I first joined Parliament. I talked about my own experiences with death. I have watched other families go through these issues as well. We talked about how we could be part of making those last few days, months, and sometimes years work well and make sure of the necessary resources.

I am coming to this debate speaking from two sides, and am almost sitting on the fence on this. I am bringing forward a letter from Richard Sitzes, who is the chair of Our Choice Matters, part of Community Living Elgin. I would like to read this letter into Hansard, because I think it is very important to hear the voices and concerns of those who are disabled. I am also going to read some Twitter posts from the late Mike Sloan. Other people have covered this, and those in London would know that Mike Sloan passed away on January 20, 2020, with medical assistance in dying. He had a very difficult time, but he shared his experiences through his Twitter feed. Because of my work here in Parliament with those with disabilities, I had started a relationship with him and discussed what life looked like and how we were to move forward.

I will begin with the letter from Richard Sitzes, chair of Our Choice Matters, which is a self-advocate group. He writes:

I'm a constituent in your riding and live in St. Thomas, and am very concerned about Bill C-7 and the changes to Canada's law on medical assistance in dying (MAID). I'm worried about the negative impacts this bill will have for people who have a disability in our riding.

As chair of the Our Choice Matters self advocate group, supported by Community Living Elgin, I am speaking on behalf of our group. In Canada, many people think that their having a disability causes suffering, but people who have a disability say that it is the lack of supports, not disability, that causes them to suffer. We fear that Bill C-7 will make this situation even worse.

Right now, Canadians can only access MAID if they are suffering and close to death. Bill C-7 will make it possible for a person who has a disability to choose medical assistance to die, even if they are not close to death. We strongly believe that removing the end-of-life requirement will increase negative ideas and discrimination against people who have a disability. It will grow the idea that life with a disability is not worth living. We are afraid that people who have a disability will feel pressured to end their lives even if they are not close to death. This has already happened in Canada, and it will get worse because of Bill C-7.

We believe that the federal government should make it easier for people with disabilities to live good lives, not end them. For the safety of people who have a disability, MAID must be available only to people who are close to death. We strongly oppose Bill C-7 and ask that you oppose this legislation.

I was fortunate to follow up on this letter with Richard last week. He has been a volunteer, not only in my office but in our community, for decades. He is a person we see at every volunteer opportunity. He is there at community events to lend a hand. He looks at his life and recognizes that he has so much to give to our community. I have never met a kinder soul in my life. He just wants to help and at the same time wants to be heard. Having had the opportunity to sit down and talk to Richard, I know his concern is that he will not be the person making that choice, but that it will be made for him. He told me that he did not know who would have the final choice. This is something that Richard, who just celebrated his 60th birthday on August 15, is very concerned with. When I look at Richard, I do not see his life as being worth any less than mine. He has so much to offer to all Canadians. I hope we recognize it is imperative that we have appropriate safeguards for people like Richard who have so much to offer.

On the other side, there are some positives as well. This is where I want to talk about Mike Sloan. He was able to share with Canadians, especially in my region, his everyday struggles of living with cancer. As I indicated, I had created a bond with Mike over the last number of years. When he called to tell me he had cancer, the two of us talked about what he would be going through.

Mike had decided that he was going to die with medical assistance. Watching his death, I can understand why. I understand the struggles that he went through, and want to read some of the things that were put on his Twitter feed.

Madam Speaker, how much time do I have, given that I talk so much?

[The Assistant Deputy Speaker, Mrs. Alexandra Mendès]

Five minutes.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Fantastic. Okay, that is great.

I want to talk about Mike. There was a CTV interview done with Mike back in early January. Mike had already pinned to his desk area his plans for his own funeral, with the date to be determined. He knew what he wanted in life. He was also a very strong advocate for those with disabilities, but when he got cancer he knew that there were going to be struggles. It was not just his mental capacity he was concerned with, but the physical pain he was going through.

I want to start off with the day of Mike's death: January 20. Bob Smith, a Rogers TV host in the London area, wrote:

Mike Sloan passed peacefully at 1:25 pm EST via MAID. He asked me...to let you know. I was with him at the end, holding his hand. He thanks you all for your support on this journey. His last words were, “Tell Chub I love him.”

Chub was Mike's cat. If anyone knew Mike, Chub got him through each and every day. Chub could always be relied on because some days were a little harder than others.

Going back to January 18, Mike wrote, “When it's getting too frightening to drink liquids because they may simply spit back up or choke me, you know, let's be honest about choices here.” To me that statement by him is extremely impactful. Another day he talked about being afraid to get in the shower. He was afraid of falling in the shower. He would get in and fall and started thinking that even though he was a young guy he might need a bench. He was going through all of those different issues each and every day.

Mike was diagnosed with stage four thyroid cancer in February of 2019. He tweeted about his experiences with palliative care and the care he received. It was interesting for anyone to watch this as he would show his belly, which had different things attached for his pain medication. The thing that was so incredible about this man, for any of the other members from the London area, is that he had an incredible sense of humour. He would post a picture of his belly tied to a medical bag that he called his “little purse,” which contained his pain medication. He would also show the different tubes that he would inject the medication in to make the pain go away. He was in absolute pain.

He wrote on January 7, “I've never died before, so I don't know what it feels like, but if agonizing pain, difficulty breathing, a fever and inability to sleep are symptoms, I'm getting there.” This was a man who did not fear death, but recognized that it was going to happen. He was also a man who would go into the hospital and just be released. What was actually really comical was when he went in with shortness of breath and walked out saying he was being released with pneumonia, but was walking and doing well.

Thinking of Mike, we have to find the right balance. We have to find the balance so that the Mike Sloans and the Richard Sitzes of this world have their wishes honoured. I recognize that this is a very difficult decision for many members of Parliament.

I can tell my colleagues that my vote on Bill C-14 was the most difficult vote I ever made. One of the most important things was that there were safeguards to make sure that the family, individual and entire team involved in medical assistance in dying all knew what they were getting into. It is really important that we make sure that those safeguards are in place and use strong caution with Bill C-7 as to whether this may open a new can of worms.

I am very proud to talk about this because it needs to be debated. There is no wrong or right answer. It is about finding a balance for all Canadians.

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

Madam Speaker, my thanks to the hon. member for Elgin—Middlesex—London for her contributions to this debate and in the past years. She raised a very important point when she related the story about Richard. I want to state at the outset that obviously our government values all lives, including the lives of persons with disabilities. We have reflected that in the supports we have put in place. Those lives are also protected by the Constitution.

I put this to the member for Elgin—Middlesex—London, because she ended by talking about safeguards. I actually raised the issue about pressure being put on individuals during my consultations with various members of the medical establishment. They indicated to me that in the province of Ontario, for example, not a single prosecution had happened in the case of a doctor alleged to have pressured an individual. I put that out there for context.

How does the member feel about the safeguards put in place where the decision has to be the decision of the individual? It has to be in writing and it has to be witnessed. Counselling and supports must be provided to such an individual, including disability supports.

Do those address at least some of Richard's concerns?

I appreciate it is a difficult situation and I can see the member struggling with it, but I just put that out there as part of the conversation about this important bill.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Madam Speaker, the safeguards are something I am concerned about. Last night, while driving to Ottawa, I listened to a podcast from The Ottawa Hospital and the doctor on it talked about the first time—I'm sorry, that was probably another interview I listened to. Yesterday I listened to six hours of interviews on this.

Not a single person has gone to court, nor have any physicians received judgments or charges based on whether persons were fragile enough to die. There is a whole variety there. One of my concerns is, as we know and as the member from Edmonton indicated, that there are not enough resources.

I am in a smaller community as well. For people to get an appointment with a psychiatrist in my area usually takes nine to 12 months. When people are going through this, they have a really short window in which to receive this type of support. By reducing some of the time frames, we will not be able to provide the services that are really important for the patients, the Canadians, who are making this difficult decision.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her presentation. I appreciate her sensitivity on this matter and would like to hear her thoughts on the following.

My colleague just mentioned the importance of making sure everyone has access to health care. I would like to go back to an important aspect of this bill.

Would she agree that we need to stop putting palliative care and medical assistance in dying at odds with one another?

The two are not mutually exclusive. In other words, people should be allowed to choose medical assistance in dying if they so wish, just as people who want palliative care should be able to receive it for as long as possible. This might require an increase in health transfers.