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

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I thank my hon. colleague from Rivière-du-Nord. He always provides an intelligent perspective to the debates.

To me, this is one of the three issues Parliament has to address. The first is the issue of mature minors, the second has to do with psychological illnesses only, and the third has to do with advance directives. I agree with the way in which the bill allows certain people to make an advance request.

The issue of advance directives is very complicated. If we allow people to give such a directive in advance, then we must put in place very clear and precise guidelines. This will certainly be part of our discussion during review of the legislation.

[Pam Damoff, Liberal, Parliamentary Secretary to the Minister of Indigenous Services]

Madam Speaker, it is a pleasure to follow the wise words of my colleague, the member for Mount Royal.

I am pleased to speak in favour of Bill C-7, an act to amend the Criminal Code, medical assistance in dying. As hon. members know, this bill responds to the Superior Court of Québec decision that struck down the eligibility criteria that naturally occurring death be reasonably foreseeable.

In the last Parliament, I spoke during debate on the original MAID legislation. At that time, I talked about the need for us to have conversations with loved ones about death and dying. “Death” is a word that elicits strong emotions. We celebrate life, we embrace life and we talk about living. However, we avoid talking about death. We shy away from those conversations because they make us uncomfortable. I know there are those who feel this legislation goes too far. However, regardless of where people fall on this legislation, I think we can all agree that the way we deal with and talk about death needs improvement.

Whether a grievously ill patient chooses to die at home or in a palliative care facility or chooses medical assistance in dying, we should be having these conversations sooner and lovingly assisting those who are ill in the end of their life. These decisions are often made during a health crisis. Ideally, each of us should be engaged in advanced care planning.

I would like to share the story of Bob Lush, an incredible man, respected lawyer and my friend. Bob and his wife Maureen shared a love and bond that was obvious to all who met them. Bob died on March 17. This summer I had lunch with Maureen and she shared with me the decision they took to use MAID. With Maureen's permission, I would like to share Bob's story.

Bob had been diagnosed with multiple system atrophy and pulmonary fibrosis. He also exhibited symptoms of Parkinson’s. While his body was failing him, his mind was as sharp as ever. Over time, these serious health issues would worsen, which led his doctors to tell him that he was palliative and that there was nothing more they could do. A palliative care nurse asked if they had thought about MAID and provided them with a brochure. It was not an option they had considered before, but Bob and Maureen together decided that this option would be the most loving way for Bob to leave this earth. I cannot possibly put into words the tremendous love these two shared.

Maureen described for me Bob's last days. They chose March 17. All medical equipment was removed from Bob's room and it was filled with flowers and candles. They loved listening to James Taylor's “American Standard” album, and it was playing. Maureen and Bob's son John were by his side. As Moon River played, the doctor administered the MAID drugs. Bob closed his eyes and peacefully, painlessly and humanely passed away. To hear Maureen describe it, I could hear both the love in her voice and the sadness of losing Bob, but she had no regrets and, in fact, wanted Bob's story to be shared so that other families could consider this option for their loved one, if it was the right decision for them.

The legislation before us here today would update our MAID laws in several ways. The bill would maintain existing safeguards and ease certain safeguards for eligible persons whose death is reasonably foreseeable. New and modified safeguards would be introduced for eligible persons whose death is not reasonably foreseeable. Persons whose natural death is reasonably foreseeable, who have been assessed as being eligible for MAID and who are at risk of losing capacity, can make an arrangement with their practitioners in which they provide their consent in advance, which allows the practitioner to administer MAID on a specified day, even if the person has lost their decision-making capacity.

For persons who choose MAID by self-administration, a person could waive in advance the requirement for final consent in case complications arise following self-administration, leading to loss of capacity but not death. These new safeguards would exclude eligibility for individuals suffering solely from mental illness. It would also allow the waiver of final consent for eligible persons whose natural death is reasonably foreseeable and who may lose capacity to consent before MAID can be provided.

This legislation would also expand data collection through the federal monitoring regime to provide a more complete picture of medical assistance in dying in Canada. These are important changes and ones that have been called for since 2016, when the government responded to the Carter decision with its original legislation.

Since MAID became legal in June 2016, there have been more than 13,000 reported medically assisted deaths in Canada. This figure is based on voluntarily reported data from the provinces and territories prior to November 1, 2018; and the data collected under the new monitoring regime after that date. MAID deaths as a percentage of all deaths in Canada remains consistent with other international assisted-dying regimes.

The government undertook extensive consultation in order to update the MAID legislation. In January and February 2020, the Government of Canada engaged with provinces, territories, Canadians, indigenous groups, key stakeholders, experts and practitioners to receive their feedback on expanding Canada's MAID framework. Over 300,000 Canadians participated in online public consultations between January 13 and January 27 of this year.

It is important to recognize that MAID is not the right option for everyone. We still have work to do to educate Canadians about end-of-life options. When the former Bill C-14 was debated in the House, I spoke about palliative care and the need to educate Canadians about it as an end-of-life option. I was pleased the Senate amended our original bill to include palliative care in the legislation. Our government has worked collaboratively with partners, including the provinces and territories, to develop a framework on palliative care. We are implementing a targeted action plan of providing $6 billion directly to provinces and territories to better support home and community care, including palliative care.

I would like to share once again Bonnie Tompkins' story, a story I shared in 2016 during debate on the original MAID legislation. She is currently compassionate communities national lead for Pallium Canada, a national non-profit organization focused on building professional and community capacity to help improve the quality and accessibility of palliative care in Canada.

When her fiancé, Ian, was diagnosed with terminal cancer, he was adamant that he wanted medical assistance in dying. As is common, his biggest concern was the burden he would place on loved ones as his illness progressed. After he saw Carpenter Hospice in Burlington and was educated on the options available—

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

We seem to have lost the connection with the hon. parliamentary secretary.

The hon. parliamentary secretary has about two minutes left.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Palliative care is something that too few people consider, let alone discuss with their loved ones. Just as Bob Lush's decision was the right one for him, so too was Ian's. These are deeply personal and extremely hard decisions that people make as they near the end of their lives.

This legislation today would address concerns about eligibility for MAID and allow more people who wish to use MAID to do so. I want to applaud the Minister of Justice for his leadership on this bill; as well as the Minister of Health; and the Minister of Employment, Workforce Development and Disability Inclusion. I would also like to give a shout-out to the member for Don Valley West, who chaired the committee in 2016 that reviewed options for MAID legislation and that laid the groundwork for where we are today.

It is my hope that all members of the House will support this important legislation.

[Colin Carrie, Conservative, Oshawa, ON]

Madam Speaker, I want to thank my colleague, especially for sharing those personal thoughts with us because this issue we are debating today is a very personal matter.

I wanted my colleague to comment on a statement by her colleague, the member for Mount Royal, who said in his speech that nobody should have their death accelerated due to lack of palliative care.

We know that my colleague from Sarnia—Lambton brought forward a private member's bill that was in response to this decision, that was basically to allow Canadians to live as well as they can, for as long as they can. This private member's bill was dedicated to providing a national palliative care action plan.

I wonder if my colleague could comment on the government's response to providing appropriate palliative care so people do not have to choose medical assistance in dying, considering that approximately 70% of Canadians do not have access to appropriate palliative care.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Madam Speaker, I thank the member for his question, and I also applaud my colleague, the member for Sarnia—Lambton,, for her advocacy on this issue.

One of the problems is that people do not know what palliative care is and what is available, as the story I told about Bonnie Tompkins's fiancé demonstrates. People need to be educated on it, but not going into palliative care does not automatically mean they are choosing medical assistance in dying. That logic is flawed, in my opinion.

There is a need for more education on all aspects of people ending their lives. I think there are conversations that need to be had between families and loved ones so that when or if they become ill, families will know what options are available. As I described in Bob Lush's story, had a nurse not provided information on MAID, the family could never have chosen that option.

Our government is committed to palliative care.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, the bill proposes removing the requirement of final consent for eligible people whose natural death is reasonably foreseeable.

Would it not be appropriate to allow for advance consent and waive final consent for people with degenerative, incurable diseases? What are my colleague's thoughts on that?

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Madam Speaker, these are indeed very difficult conversation to be having, and that was certainly discussed in 2016. My understanding is that part of the parliamentary review that is to take place on this legislation is about the issue the member has described regarding the people who have a terminal illness and want to provide direction and demands. It is something Parliament needs to look at, and we need to have a fulsome discussion on how we proceed if we choose to proceed on that.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Madam Speaker, I thank my colleague for her very compassionate and heartfelt speech. It was very moving.

I have a question about requiring a person with an incurable disease to obtain permission from a medical practitioner specializing in the disease in order to get access to medical assistance in dying. In the case of people living in rural or remote regions that do not always have the appropriate medical specialists, does this requirement not constitute an impediment?

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Madam Speaker, the question from the member is an important one. One does not have to be in a rural area to not have access to medical practitioners who may have expertise. In speaking with Maureen Lush, I know there is only one doctor in Oakville who is available to perform MAID, and there is no one at all in Burlington.

I think it is very important that people have options and that we remove the stigma of MAID. Hopefully telling these stories will help to educate people on the right option for them and if this is the way they should proceed.

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I am very pleased to speak to the important Bill C-7. We need to know its origins to understand why we are at this point today.

In 2016, working on Bill C-14 was a rather difficult exercise given that the Liberal government was intent on bulldozing it through. I believe that is the right expression, because the government refused all amendments proposed by the different opposition parties, including the Conservative Party, the NDP and the Bloc Québécois.

The government put pressure on the Senate by giving it a deadline. The Senate wanted to improve the bill before the House voted on it. What was the end result? In September 2019, the Superior Court pointed out that the bill passed by the House was not adequate, especially with respect to the issue of the foreseeability of the date of the person's death.

That is where we find ourselves today. We are in the House debating an extremely sensitive subject, but we have not had much time to consult the experts.

Everyone has a different perspective on the issue, whether they are members of the House or members of the public in Quebec or elsewhere in Canada.

I wrote a speech, but I have decided not to read it. Instead, I would like to share my own experience with my colleagues.

The vote on Bill C-14 was the hardest vote I cast in my first four years in Ottawa.

On the one hand, I had some constituents asking me to vote in favour of the bill, while others wanted me to make sure that the legislation would protect the most vulnerable and honour the conscientious objection rights of medical practitioners. On the other hand, I had constituents going through a very difficult time with a loved one who was suffering and could not access MAID.

I did not sleep well the night before the vote. I knew that no matter which position I took, whatever I said in the House could be interpreted by the media and by Canadians. Allow me to explain. Some members voted against Bill C-14, and I would imagine that others will vote against Bill C-7. Members voting against the bill are doing so not because they are against it, but because they do not think it goes far enough.

The opposite is also true. Some members voted in favour of Bill C-14 in 2016 because they wanted to make sure people got the bare minimum. No matter which side we took, we had to explain something extremely sensitive, and I do not think a simple yes or no could accomplish that.

I often ask myself, who am I to decide for someone else? As lawmakers, it is our duty to protect the most vulnerable, especially if we remove the criterion of reasonably foreseeable natural death for access to MAID. This is reflected in the questions that some members have been asking in the House. I am sure it reflects the opinion of many Canadians who wonder what would happen if a person wanted to give advance written consent in case their situation changed over time. There is much more to this debate, and I do not think we are done talking about it.

Madam Speaker, I forgot to tell you that I will be sharing my time with the member for Calgary Signal Hill.

I am very concerned about ensuring that this bill enables all Canadians, wherever they may live in this country, to have access to the appropriate resources to make the right decision for their situation. The current pandemic has exposed the weaknesses in our health care systems. I doubt all Canadians in rural areas have access to specialists who can guide them and give them the right information so that they can make a decision based on their circumstances.

I am also very concerned about minors and vulnerable people. During the study of Bill C-14 in 2016, I had the opportunity to hear the testimony of two witnesses who had suffered accidents and endured the most traumatic ordeals a human being can experience. They told me that, had they had access to MAID back then, they probably would not have been talking to me that day because they had been in such a dark place at the time.

I know people who were there for the final moments when someone who was suffering asked for MAID. I am certainly concerned about all that, and it makes me wonder what the best solution is. Is it because we do not have the necessary palliative care resources? Is it because both the federal and provincial governments and health care facilities are making poor decisions? I am wondering about that.

I must say, I feel like we are rushing the process today, because has been quite a while since the courts asked Parliament to modernize this legislation after what happened in Quebec. This is a government that shut down Parliament under the pretext of being in a pandemic, as though we could not do more than one thing at a time. There are 338 MPs. Committees could have continued to sit. We could have heard from experts who could have explained this issue to us properly so we could make the right decision, the best decision.

Again, this is something that will not be easy for many of us. We have differing opinions within our party and elsewhere. However, I would like to note that I am proud of my party for letting me vote freely. I want to thank my leader for allowing this, without any pressure from my organization. I hope that all political parties will offer this choice, because this is a vote of conscience, and it is challenging for us to represent our constituents, who do not all share the same opinion. We also have our own conscience. For some, this is a matter of religion or beliefs, which means we may not all see eye to eye on this file.

Personally, the thing I wrestle with the most is wondering who I am to decide what is best for someone who is suffering. I believe that is what will guide my decision on the day of the vote. I hope that I will be able to make the right decision and that all of us can then work with the government to put all the necessary resources in place to properly inform and educate the public, and provide everything we can to vulnerable people who are going through tough times with loved ones, so that they are adequately supported in making the best decision.

In closing, I hope that next time, we will have more time to talk about people who are not vulnerable, sick or about to die, but still want to express advance consent.

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

Madam Speaker, I thank the member for Richmond—Arthabaska for his very frank and candid comments.

I would just like to clarify something. He mentioned that the Liberal Party did not accept the other parties' amendments. That is not quite accurate, because during the debate on Bill C-14, we accepted an amendment endorsed by all parties concerning medical practitioners' freedom of conscience and religion.

I would also like to point out that Bill C-7 does allow for advance consent, but not advance directives. The issue of advance directives will be dealt with in the comprehensive review, which will take place every five years.

I would also like to point out that there is a 90-day waiting period to eliminate the impulsiveness my colleague pointed out in his speech. For example, when a minor has an accident, we do not want them to make an impulsive decision on this matter.

Does the member opposite believe that having a specialist is necessary? For example, Mr. Truchon, who was from Quebec just like the member opposite, had cerebral palsy. Our party believes that a physician must have the requisite expertise to treat and advise patients before they make their decision.

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I thank my colleague for his question and for the clarifications he provided.

I do think that some expertise will be required. This is a very big decision for patients and their loved ones. There is the whole issue of grieving, a whole process. Yes, it makes sense that the doctor would be a specialist in the individual's illness or disability. However, I wonder if everyone will have access to those resources during the decision-making process. The devil is in the details, as they say. This shows just how urgent it is to deal with the matter of medical assistance in dying and, in particular, Bill C-7.

[Martin Champoux, Bloc, Drummond, QC]

Madam Speaker, this is a particularly meaningful day to talk about this sensitive issue. Yesterday, October 18, marked the first anniversary of the passing of my aunt Claire, who chose to access medical assistance in dying. She was not looking to end her life, but she simply wanted to choose how she would put an end to her suffering and to do so with dignity. I think that the word “dignity” is important, because that is what we are talking about here.

I heard the speech by my colleague from Richmond—Arthabaska, and I appreciated the considerable sensitivity he showed in expressing his concerns. The topic of palliative care is a very important one.

If every patient across the country had fair and equal access to palliative care, would my colleague agree to remove the element of final consent, so that people with degenerative diseases could make a decision several weeks or months in advance, or even years, before their unforeseeable, yet inevitable, death?

Could my colleague speak to that?

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I thank my colleague for his question.

At the end of my speech, I talked about reflecting on the notion of who am I to decide on behalf of someone else going through such a terrible ordeal. I had those discussions, that very debate, more than once with friends over dinner. Some of those friends were going through this situation with their mother or father, or a brother or sister. This is what is really giving me pause right now.

Ultimately, I should allow these individuals to have access to this resource. I am not sure “resource” is the right word; I should say, people should have this as one of their options.

I do want to ensure, however, that the government does everything it can to protect vulnerable people if the time ever comes in their life that they want to end it. It should not have to come to that, and that is what I am wrestling with at the moment.

Ultimately, I hope to be able to let go and vote in favour of this bill, as my colleague mentioned earlier, to let everyone decide for themselves.