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

[Marc Dalton, Conservative, Pitt Meadows—Maple Ridge, BC]

Mr. Speaker, I would like to talk about a constituent of mine, whom I will call Linda to protect her identity. As members of Parliament, we are constantly dealing with people facing different situations. I have told my staff that the number one priority we have is to help our constituents with whatever they are facing.

Linda called my office and was in distress. She was dying of stage 4 cancer, and it had spread throughout her body. She was in a hospice. She was in distress because when trying to make her daughter, her sole beneficiary, a co-signer on one of her accounts, the bank manager told her that unless she came to the bank, this could not be done. She explained to him that she was unable to walk and unable to get out of bed, as she was in a hospice.

She called my office and was really shaken up. She talked to my staff. I phoned the bank manager and got the same response from him. I was quite surprised and looked for ways to push this forward. I talked to other banks, and they said they would find a way for her to sign. I had conversations with her bank and its head office, but that was not going anywhere fast. I then talked to the government ombudsperson, and finally, after many conversations with me, my staff and Linda, and after a lot of struggle, the bank found a way for her to sign the form.

This was a terrible way for Linda to finish her life, but she did it because she wanted to make a difference and help her family. She also did it for people who face a similar ordeal. She won before she succumbed to cancer.

I am mentioning this because I believe that in smaller and bigger ways, until our very last breath we can make a positive contribution. We can make a difference for our families and be an inspiration to others.

I think of my father, who died a few years ago. He was such an example for us as a family. We were with him before he passed into unconsciousness. In spite of his pain, he was thinking about us. He wanted to know how we were doing. He did not want to talk about himself; he wanted to talk about others. This surprised me, as did the fact that he was able to make a difference.

I do not want to come across as judgmental while talking about assisted suicide, or MAID, because people in my extended family have chosen assisted dying. Before COVID, many would have their families around to say their last goodbyes. However, 16,000 people have now made this decision. There are twice as many people dying through euthanasia than currently die in car accidents. This is skyrocketing.

I talked to a fellow a few days ago, a constituent of mine, who said that he was choosing MAID. That was his plan for down the road. He was very matter of fact and businesslike, and I do not think he was ill. This is becoming normalized in Canadian society, and that is concerning to me.

I know that words make a difference and we do not want to hear the word “suicide”, but this has been called “assisted suicide”. Suicide has always been seen as sad in our society, and as disturbing and tragic. We probably all know people who have committed suicide. I think of my own mother and think of others. It is about grieving.

I am concerned about the direction we are going, as this has increasingly become a benevolent action. It is seen that way. People do not want to be a burden on others. There are other reasons also.

In 1973, shortly after I became a teenager, a movie came out called Soylent Green. The main actors were Charlton Heston and Leigh Taylor-Young. It was a futuristic movie set 50 years later in New York City, or 2022, which is almost upon us.

In the movie, New York City was overpopulated, with 40 million people. They were going hungry. Aging people would come into a big room with beautiful images of the earth on screens, and there was lovely music. After about 20 minutes, they would be euthanized. I remember, as a teenager, being shocked. I felt that what was happening was deceptive. The way it dealt with overpopulation was glamourized, and it just goes to show how society has changed over the years.

Let us consider the term “MAID”. It is a personification of a female servant, someone there to help and assist who is harmless. I can think of other images for assistance in dying that are much darker.

I know the bill says it would not apply to people who are struggling with mental illness, but for how long? Euthanasia advocates keep pushing the courts further and further, which we are looking at right now, to undermine and change the criteria and expand it. The bill would repeal the provision that would require a person's natural death to be reasonably foreseeable in order for them to be eligible for medical assistance in dying. This opens the door wide for future challenges to any criteria. Furthermore, the bill would remove the 10-day waiting period.

I met with Angela, who is one of my constituents. She belongs to a group of about 300 families who support each other in British Columbia. They have children with disabilities. This group is upset about the bill and the assisted suicide door it would open for people with disabilities. They feel a statement is being made in this legislation: that disabled people do not have a life worth living like other normal people.

It is simply a matter of time before mental anguish becomes a sufficient reason. Why would the barriers and timelines be reduced and reduced and then removed? We are seeing that happening right now. How many people with a mental illness have gone through great mental anguish and depression that has led to them choosing suicide?

I think of a Filipino nanny who, years ago, was absolutely distraught because she had a fender-bender with her boss's vehicle. She was a wonderful person. What did she do? She committed suicide. While I am not concerned about things going in this direction, I am very concerned with the direction the bill is going.

I think of myself and challenges I had years ago, in my early twenties. I faced a very dark and painful period, with suicidal thoughts. Suicide almost seemed very appealing in some ways. I never attempted it, but I understood it. I came through that time with the help of doctors, my faith and the woman who later became my wife, Marlene.

I feel that as a society, we should come around and bring about those supports. It is essential. We need to look at this and other ways to support people who are going through these challenges and to give them strength.

I have not had the opportunity here to talk about palliative care. I will, maybe, in the questions.

I will allow the members here to ask a few questions.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Mr. Speaker, I appreciate the very personal comments of my friend across the way. Statistically, with roughly 7,000 Canadians having chosen assisted dying, I am wondering whether the member is completely against the notion.

Does he see some value in continuing to try to perfect the legislation?

[Marc Dalton, Conservative, Pitt Meadows—Maple Ridge, BC]

Mr. Speaker, the figures, I believe, up to the end of September are 16,000 having chosen assisted suicide. Right now it is legislation that has gone through the Supreme Court. I am disturbed that the Liberal government chose not to appeal the decision of the lower court to bring more amendments and changes. I think that is very important.

I mentioned the second part of the story about Linda that really spoke to me was her clarity of thought. I asked her very briefly what her level of pain was, and she said she had no pain. She had clear thinking and she had energy, but she was dying and could not move. She said that in palliative care one can deal with total pain and mental anguish. That is where our focus needs to be, and it is not available to most Canadians.

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

Mr. Speaker, I would like to thank my colleague for his very personal speech.

I think we agree that we need to improve the care and inclusion of people with disabilities. Personally, I think that this very important option has not been given enough consideration.

On the other hand, in the case of a person with a disability who has all his or her faculties, who suffers from intense pain and whose life expectancy has been shortened but whose date of death is unforeseeable, the bill provides for a 90-day period during which the person could receive the necessary care we are talking about, namely, mental health support. This period would allow us to make sure that the person's desire to die is not the result of suicidal ideation. What does my colleague think about this 90-day period?

[Marc Dalton, Conservative, Pitt Meadows—Maple Ridge, BC]

Mr. Speaker, I would like to thank the hon. member for her question.

I sincerely believe that a 90-day period is insufficient, because there is often a long wait time before a patient can see a counsellor and obtain the necessary support.

Also, I think that our society should send the message that we are there regardless of the situation. Whether or not a person has disabilities, that person can contribute significantly to our society and our country.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

Mr. Speaker, I want to thank my colleague for his passionate speech but also for sharing vulnerabilities of his past life experience. We cannot forget these are real people we are talking about.

In my past line of work I had the opportunity, and was blessed, to work with palliative care patients in a hospital setting. I realized and experienced how healing, with reconciliation among broken families, that process can be, even though it is very sad.

I am wondering if the member could elaborate a bit on palliative care, and the importance of that and hospice care.

[Marc Dalton, Conservative, Pitt Meadows—Maple Ridge, BC]

Mr. Speaker, I want to recognize those who are in the medical profession and volunteers in palliative care and in hospices. They make such a difference in the lives and the families of the others. That is something that I feel needs to be there. It concerns me that MAID is in the Canada Health Act, which guarantees public funding and access for all, yet palliative care is not available. It is only available to about a third of the population of Canada.

That is very disturbing. I talked with a doctor who said that they can control, totally, the level of pain and even the mental anguish. If patients are anxious, anxiety can be totally under control. I think people need to do that. I think a lot of people are afraid of the pain and the suffering that goes with that. It can be totally under control under palliative care.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Mr. Speaker, today I have the privilege of speaking to Bill C-7, An Act to amend the Criminal Code (medical assistance in dying).

This bill represents a substantial change. Given the limited time, the fact we are in a minority Parliament and the fact that we are going to have a fulsome review of this bill, I would have expected a more targeted approach that directly addressed the Truchon decision so that we could get this passed quickly and move forward with legislation reflecting the Truchon decision.

The government has taken a very different approach. For all MAID patients, the government's legislation has made two major changes. One is in accordance with the Truchon decision: The reasonable foreseeability of a natural death test has been removed. Because of that, there has also been a global inclusion of a protection for individuals with mental health issues. It is a very limited exclusion, I might add.

When we look at what changes have been made for where death is not reasonably foreseeable, we are on two tracks: one where death is reasonably foreseeable and another where it is not.

Where death is not reasonably foreseeable, a couple of additional precautions and safeguards have been put in. First, one of two practitioners must have knowledge of the underlying ailment. One might say that would be a good safeguard for all those who want MAID, or medical assistance in dying.

The second is a minimum 90-day waiting period. I have heard much discussion on, and have had my own experience with, this. I know many members across the way and on our side have experience with medical practitioners. These individuals are in demand. Often, these resources and supports are difficult to get. Getting this type of support to rally around people who may be contemplating MAID and who, in time, may decide not to opt for it, will be challenging, there is no doubt. In fact, I wonder aloud whether this might eventually be a reason the Supreme Court may strike this law down.

Where death is reasonably foreseeable, it is inexplicable why the government has included these various reductions in safeguards. They may very well be worthwhile amendments. They might be great ideas. However, now is not the time. We are due for a fulsome review of the complete legislation.

The Liberals have removed the two witnesses and made it one witness. They removed the 10-day period. Practitioners now can provide MAID on the basis of prior consent. No longer is final consent required. When someone is making the most important decision of their life, literally a life or death situation, that person's consent is no longer required. We may be able to debate this, and that is what the House is for. I would call upon all members to have a fulsome debate. Let us encourage these discussions and have a full parliamentary review.

Let us dig a bit deeper and go through what this legislation is for those who are contemplating MAID, but for whom death is not reasonably foreseeable. The legislation says eligible individuals must have a grievous and irremediable medical condition. That is defined as a serious, incurable disease or disability, in an advanced state of irreversible decline in capability, and having physical or physiological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.

To paraphrase, eligibility requires an individual to have a progressive ailment in which they are suffering pain, either mental or physical. Please remember, and this is absolutely critical, there are areas in this legislation where someone can access MAID based on mental suffering alone. I will elaborate on that.

Before I go any further, I want to remind all members about something. I know we have a sense of this with the many great women and men in this chamber. As Mahatma Gandhi said, “The true measure of any society,” and any legislation, I might add, “can be found in how it treats its most vulnerable members.”

As a parliamentarian and as a human being, I take these words very seriously. It is our shared and sacrosanct responsibility to the most vulnerable in our community to make sure that we are always there. To those who are struggling in our community, we have a commitment, above all else, to bring them back to the light.

Frank Stephens, author and disabilities advocate, said that people with disabilities' lives are worth living. I repeat: People with disabilities' lives are worth living.

Anything that takes us away from that, we should seriously consider and not ram through legislation. Bill C-7 purports to protect individuals with mental illness, as it does not include mental illness in the definition of serious, incurable disease or suffering. The effect of this provision is to prevent people who are battling mental illness, and who may be in a horrible yet temporary situation, from accessing MAID so that we bridge them to another day. I think most Canadians would agree with that.

The challenge with the legislation is that if an individual has a pre-existing condition or a disability, they are not afforded this same protection. To be clear, if someone has a disability and is suffering through mental illness, they will have access to MAID. If they do not have a disability, they will not have access. That, by its very definition, is discrimination.

This sends a dangerous signal to persons with disabilities that their lives are not worth as much as others. That is not something that I can stand by. I would like to say to all those persons with disabilities out there right now that their lives are worth living, and I will fight for them.

I will move to the next part of the legislation, regarding folks with a reasonable expectation of death. For those individuals, for whatever reason, even though not relevant to the Truchon decision, a series of safeguards was taken off the table, one of which is the 10-day waiting period. This 10-day waiting period gives people the ability to reflect, to make sure that MAID is the correct choice. I cannot say strongly enough that MAID is permanent. This is a life or death decision. I do not think waiting an additional 10 days is overly burdensome, especially when, in circumstances where a person is suffering, it can be waived. In many cases, in the application of MAID, it actually is.

Another significant application safeguard that has been removed is the requirement of final consent. The removal of final consent is in direct contravention to the Carter decision, which requires clear consent to MAID. Removing this consent creates uncertainty. Once again, a safeguard that has absolutely nothing to do with the Truchon decision has been removed. This is a significant change in the law that should have been included in a more fulsome review.

To be fair, the legislation does allow an individual to void MAID on the day of their procedure; however, their consent is not required, which changes the entire onus of the decision. Instead of the doctor having to approach the individual, the individual has to seek out and give consent. As many have had the experience, myself included, when someone is in a difficult situation, it can be difficult for them. For example, does this mean goodbye, everyone, or does this mean stop? The way this legislation is framed, we are putting people and physicians in very difficult situations.

There is also a legal issue. Not to get too far in the weeds here, but we are putting one of the most important decisions on people who are incapacitated. It is trite law that one has to have capacity in order to make decisions. In this law, we are actually giving people who are knowingly incapacitated the ability to make the most important decision of their life: literally life or death. This is against all law and does not really make a ton of sense.

Overall, we need to look at the framework. My learned colleague talked about this as well. When we look at making decisions, these are not made in a vacuum. These are made with respect to the entire approach. We need to look at the medical system: a medical system that now, because of COVID-19, is even more strained. How are we going to get these resources?

In my riding of Northumberland—Peterborough South, I know the resources are strained when it comes to palliative care. We are not giving people the full right to decide if we are not giving them access to palliative care. We need to make sure that people do not just have the right to die with dignity, but the ability to live with dignity.

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

Mr. Speaker, I want to thank the hon. member for Northumberland—Peterborough South for his past contributions at the justice committee.

By way of clarification, I would offer that some of the safeguards have been improved in the legislation with respect to track two, in particular, for those whose death is not reasonably foreseeable.

The necessity of moving forward quickly now is prompted solely by the need to respond to the Truchon decision and the court-imposed deadline.

A lot of discussion has taken place today, at committee and on Friday with respect to persons with disabilities and how we would ensure their rights are protected. I want to remind members of the House that in the Truchon decision, Mr. Truchon and Madam Gladu were persons with disabilities. When dealing with this issue of discrimination, the court said that if it denied the ability to make decisions about one's body, including the timing of one's passing, then it was actually denying the autonomy and competence of those persons who were disabled. Therefore, the old status quo was violating the charter rights of those individuals.

I wonder if the member opposite would want to comment on that finding in the Truchon case.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Mr. Speaker, the member's arguments are always extremely well thought out and all of his debates are extremely respectful.

Right now the bill discriminates. If people with disabilities are dealing with mental health issues, such as depression, they will have access to MAID whereas people without disabilities will not have access. That is discrimination and it is wrong. I will always stand up to fight for the most vulnerable, including persons with disabilities.

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

Mr. Speaker, I would like to invite a further response to some of the comments made by the parliamentary secretary.

We know that a small part of this bill responds to the lower court Truchon decision, but many parts do not in any way respond to that. The government has created an artificial time crunch by proposing to lump together all sorts of other complex aspects of this legal regime into a bill that is also responding to the Truchon decision. If the government were serious about meeting these timelines, first, it would not have prorogued Parliament; and, second, it would have separated out the parts of the bill that deal with the Truchon decision and then all of these other issues.

We are debating report stage amendments, all of which are totally compatible with the past findings of all levels of courts. No court has raised issues with the 10-day reflection period, which can already be waived. No court has raised concerns about the possibility of the 120-day period proposed in this amendment.

I think the member might agree that it is a bit sleight of hand for the government to use a court decision on the one hand, but then go in a completely different direction from that decision with many other aspects of the legislation.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Mr. Speaker, Parliament's very existence is to have important discussions and respectful debates like this. Therefore, we should be looking to get the expertise of a full review instead of trying to ram through things that were not part of the Truchon decision. Members of Parliament who are doctors and members of Parliament who are married to doctors have a lot of great connections with physicians across the country. We should be bringing that in for a fulsome discussion. We cannot talk about this too much.

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, in my province we would see road signs saying “Speed kills”. This bill picks up the speed on this thing, and that kills. We need proper restrictions, restraints and controls. In the absence of a review, the bill goes too far.

Would the member like to comment a little further on that?

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Mr. Speaker, as I said, this is a life-or-death measure. We are making important decisions, so a little more discussion to ensure we get this right is well merited. If the government wants to focus on speed, let us get the vaccines out today.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Mr. Speaker, it is a pleasure to take part in this debate. I listened carefully to the speeches and I am very thankful for my colleagues who have had a lot to say on the necessary protections for people with disabilities. I will follow suit.

Before I do that, I want to take the opportunity to wish my mother a happy 74th birthday. I can think of no person more worthy of recognition for her love and concern for the most vulnerable in our country. She has dedicated her life to making people's lives better at times when they need it. Therefore, I wish my mom a happy birthday, and I love her.

I will start with a quote from the executive vice-president of Inclusion Canada, Krista Carr. It captures the conversation around disabilities perfectly. At committee, she said:

The lives of people with disabilities are as necessary to the integrity of the human family as any other dimension of humanity, and this threat to the lives of people with disabilities is a threat to us all.

I am very concerned. When I think back to times I have heard Liberal ministers speak, particularly the Minister of Employment, Workforce Development and Disability Inclusion, who I have a lot of time for, we have heard a lot of talk about a disability lens. In fact, during the election campaign back in October of 2019, an article ran on CTV under the headline, “Liberals vow to implement disability lens for all government policies if re-elected.” The minister was quoted as saying that this was the next step to systemically entrench disability inclusion into the way the government did business and into the way the government made decisions.

It is intensely surprising and frustrating in the face of virtual unanimity from the disability community that the legislation gets it wrong, with 72 disability organizations, including every one of the national disability organizations, writing a letter to the government and saying as much, that the legislation needed to be rethought. It is particularly troubling because there was no need to get here. This was a driven by decision by the court of one province. It could have been appealed to the Supreme Court to get further guidance and clarity. Of course, there was a five-year review plan in the previous MAID legislation that would have been a practical and thoughtful way to move forward.

We have had the opportunity over the last several months to strike that committee. It could have been doing its work over time. Unfortunately, Parliament was shuttered for the better part of six months, with the odd sitting to pass extensions and other things that needed to keep going. For the most part, we were not sitting as a Parliament. For six weeks everything was shut down because the government wanted to avoid scrutiny on the WE scandal. We did not have to be here. That time would have been valuable to call experts in a meaningful way and have them weigh on this.

I had the opportunity to fill in at one of the committee meetings. It was, quite frankly, a complete gong show as we raced to hear hurried testimony from people who were experts in the field, weighing in on both sides of the equation. In the end, what was supposed to be a five-minute spot to ask meaningful questions to witnesses was shrunk down to two minutes. Then debate happened to try to get some of that time back. Quite honestly, it was hurried and rushed.

I think back in history to a quote by someone who I have a lot of time for, someone who has a lot of wise quotes, John Wooden, one of the most successful coaches in sports history. He once said, “If you don’t have time to do it right, when will you have time to do it over?”

We find ourselves in this situation right now. We certainly have not taken the time to do this right and we will have to do some of this over at some point in time. In the meantime, there are likely to be very troubling ramifications for those Canadians living with disabilities.

I talked about the community and all the different things the communities had to say.

I looked at recent headlines: iPolitics, “Equating assisted suicide with an equality right is a moral affront”, by Krista Carr; Michael Bach, Neil Belanger and Catherine Frazee, on November 23, in a Hill Times article titled, “Canada doesn’t need a shortcut to medically assisted dying for people with disabling conditions”; Gabrielle Peters wrote in Macleans, “Dying for the right to live”; and Trudo Lemmens and Leah Krakowitz-Broker, wrote in CBC under the headline, “Why the federal government should rethink its new medical assistance in dying law”.

I will focus particularly on the last one because from start to end, this piece gets it right. The authors start in the first paragraph, saying:

To meet the twice-renewed deadline imposed by the Quebec Superior Court in the Truchon case, the federal government is trying to push its new medical assistance in dying...bill through Parliament before year's end. Parliament should reject the key premise of this new legislation, and ask government to go back to the drawing board and start again.

It is not too late for that. Hopefully, if members of the government do not get this right in our vote coming up, hopefully, at least the Senate gets it right in its review.

Talking about people with disabilities, the authors go on to say:

[T]he bill makes their dying easier than living. Rather than instilling hope and helping to build resilience by focusing on options for living, health care providers will now be asked to discuss an early death....

[I]t seems unconscionable for governments to prioritize state-financed MAID, rather than putting resources into ensuring access to proper care and offering people a reasonable quality of life. In fact, expanding MAID is giving our health care system an all-too-easy way out.

These are very troubling words from the disability community, from experts across the country and across the range of disabilities, yet, being completely ignored by a government whose members have previously said that they would view everything through a disability lens.

I spend good part of my life, as many people know, speaking to university classes and folks around the world, at teachers conventions or whatever it might be, telling the story of my son Jaden who is 25 years old. He has autism; he is non-verbal. One of the things that we talk about all the time is the need to unlock potential, the skills and abilities that come with autism as opposed to just the challenges.

I would note that one of the most commonly used words at committee by the ministers was the word “suffering”. They talked about suffering, ending suffering, having a mechanism and the number of people suffering. Sometimes when people are talking about people with disabilities, especially people who do not have a disability themselves and maybe do not have the life experience of living with somebody who has disability, the tendency is to think of them suffering.

In fact, when we were debating the Canadian autism partnership project or the idea of a national autism strategy, in response to a question in question period, the Prime Minister referenced new tools and treatments for those suffering from autism. This mindset is problematic. When one equates a mindset that thinks of people with disabilities automatically as suffering as opposed to people who have skills and abilities that we need to invest in, that they can contribute to making life better for all of us, we are on a dangerous path when we combine it with the legislation we are dealing with now and that thinking of people with disabilities.