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

[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]

Madam Speaker, the member is very much a distinguished parliamentarian, both from the provincial legislature and national legislature here in Ottawa, and is very much aware of process. For example, Conservatives attempted to bring amendments in the hope that if they passed in committee then they would be in a position to support the legislation.

However, the member is also aware that we do not have a majority government. That means they could not get the support of opposition members for the Conservative amendments, just like today the Conservative leadership supports not passing the legislation. The Conservative leadership has made it very clear that it would have taken this to the Supreme Court of Canada, and that because it did not get its amendments, it does not support the legislation.

Would the member acknowledge, in the name of transparency, that it is the Conservative Party House leadership that does not want it to come to a vote? It is not the process, because even if we debated this for another month, the opposition has the mechanisms, tools and so forth to ensure it never comes to a vote.

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

Madam Speaker, I will remind my hon. colleague from Winnipeg North that I deeply appreciated, as I said earlier in my speech, that the Leader of the Opposition voted against and the House leader voted for the bill. This is the best demonstration of democracy. The Conservative Party respects everyone, as well as each of their opinions, even all my colleagues here who applaud me. Maybe they are disappointed to learn I will vote in favour, but this is what democracy is all about.

Yes, as I said earlier, we would have preferred to see the Supreme Court table a decision on this issue. Whatever happens, and the member knows this quite well, it will be challenged in court. As far as we are concerned, it would have been preferable to have a bill based on the toughest jurisdiction, which is a Supreme Court decision, so that we could build a bill, which we could oppose or support, that would at least have a foundation based on the greatest, toughest and highest court of this country, the Supreme Court of Canada.

[David Sweet, Conservative, Flamborough—Glanbrook, ON]

Madam Speaker, my colleague started out by saying that often the problem with this debate is that motives are being impugned. Unfortunately, I am going to have to come to his defence because the member for Winnipeg North impugned his motives.

My colleague from the NDP, the great musician, made an excellent point earlier. The government will take first nations to court and will take veterans to court, but with a life and death situation, it will not deal with that in the Supreme Court of Canada. How does my colleague feel about that?

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

Madam Speaker, I feel very uncomfortable.

My colleague raised first nations, saying the government is ready to take them to the Supreme Court. First nations leaders said that they are concerned about the bill, as did the Canadian Psychiatric Association. There is no link there with the Conservative Party of Canada. No, it is Canadian society who has these concerns.

More than that, as human beings, we can change our minds. A friend of mine, who was a strong supporter of the medical assistance in dying policy, changed his mind. Why? Because his father was suffering two years ago and he had to fight with him about it. He said that he was a strong supporter of assisted dying, but not anymore because he lived through it with his father. This is what he told me.

As I said, there is no right or wrong decision and no right or wrong vote. There are just votes and decisions based on what we feel comfortable with.

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, I am thankful for the opportunity to again speak to the bill. There were a lot of things that I wanted to say the first time around at report stage that I could not share because we ran out of time, but hopefully I will be able to conclude my remarks today.

I am splitting my time with the member for Northumberland—Peterborough South.

The Leader of the Opposition spoke in the House earlier today and talked about how Bill C-7 is moving our country from a regime of assisted death to a regime of assisted suicide. We presently have in place former Bill C-14, which was brought in as a response to the Carter decision. That bill recognized the fact that the Supreme Court said that medically assisted death was a right but needed to be surrounded by guardrails, by safeguards that would ensure that the most vulnerable in Canada do not end up dying when they have an opportunity to live a productive life.

The Carter decision resulted in legislation that imposed a requirement that death needed to be reasonably foreseeable. The legislation before us eliminates that and a whole bunch of other safeguards that the original legislation was intended to keep in place.

Why are we at this place in the first place? Members in the House know that a lower court from Quebec, one single judge, ruled in the Truchon case that the reasonable foreseeability aspect of Bill C-14 violated the Charter of Rights. It was unconstitutional. This is a lower court from Quebec, one single judge, making a life and death decision for Canadians across the country.

One would expect, from a Liberal government that takes veterans to court and takes first nations to the Supreme Court of Canada, that this life and death decision would be appealed. The Truchon case would be appealed through to the Supreme Court so that we could have the Supreme Court, which articulated the Carter decision, comment on whether reasonable foreseeability was in fact constitutional.

Instead the Liberal government said, no, it was not going to appeal and in fact it would simply respond to the Truchon case and do exactly as that single judge of a lower court asked it to do. The Liberals eliminated reasonable foreseeability from Canada's medical assistance in dying regime. That is why we are here.

Members may recall, when C-14 first came forward, when the Carter decision had to be responded to, that parliamentarians noted the fact that this represented the crest of a steep, slippery slope toward making assisted suicide available to a broader and broader group of vulnerable Canadians. That was the concern that we expressed at the time and, quite frankly, some people mocked us. They said we were fearmongering. They pooh-poohed our concerns. Today, here we are and our concerns have been borne out.

Last time I did not get a chance to read into the record a letter from a doctor in my community of Abbotsford, Dr. James Warkentin, who expressed his concerns about the legislation. He says, “I appreciate your invitation to write to you regarding C-7. As a family physician, the decriminalization of medical assistance in dying in 2016 struck me at my core. How could killing someone one day cost me my licence and send me to jail, and the next day be expected of me to provide? Furthermore, how could our most vulnerable be protected from the pressure to end their life one day and then have state-sanctioned avenues the next?” He went on to reference the six reasons why over 1,000 Canadian physicians have signed a letter opposing Bill C-7.

In a moment I am going to read that letter into the record, because I believe those judges would appreciate having that letter on the record so it is very clear that many medical professionals across the country oppose Bill C-7, which would remove many of the safeguards, the guardrails, the protections for the vulnerable which were originally intended under the Carter decision.

The letter begins like this:

This bill, expanding “medical assistance in dying” (MAiD) to virtually everyone who is sick and suffering in Canada, will, if passed in its current form, make our country the world leader in administering death.

As medical doctors, we feel compelled to voice our dismay at how individuals who have little lived experience of the realities involved in the everyday practice of medicine suddenly and fundamentally changed the nature of medicine by decriminalizing euthanasia and assisted suicide.

As a side note, when they refer to “individuals who have little lived experience of the realities involved in the everyday practice of medicine”, they are referring to us, the parliamentarians in the House. It goes on:

Unfortunately, our patients are the ones who suffer the most from the consequences of this ill-devised scheme. The shock of a sudden illness, or an accident resulting in disability, can lead patients into feelings of anger, depression, and guilt for requiring care - emotions that, with proper support and attention, can resolve over time. The care and encouragement shown by physicians may be the most powerful force in overcoming despair and providing hope. Unfortunately, patients can no longer unconditionally trust their medical professional to advocate for their life when they are at their weakest and most vulnerable. Suddenly, a lethal injection becomes part of a repertoire of interventions offered to end their pain and suffering.

Bill C-7 would allow those who are not dying to end their lives by a lethal injection at the hands of a doctor or nurse practitioner. Shockingly, most of the safeguards that Parliament deemed necessary in 2016 to protect the lives of vulnerable individuals from a wrongful death are being removed. Under the new bill, an individual whose natural death is considered to be “reasonably foreseeable” could be diagnosed, assessed and euthanized all in one day. We are very concerned that removing the 10- day reflection period and other safeguards will lead to an increase in coerced or tragically unconsidered deaths.

The reckless removal of safeguards previously deemed essential will place desperately vulnerable patients directly in harm’s way and may cost them their very lives....

Our profession has been coerced into facilitating suicide rather than preventing it, for ever-increasing numbers of citizens. We watch in utter dismay and horror at how the nature of our medical profession has been so quickly destroyed by the creation of misguided laws.

That is an excerpt from a letter from over 1,000 physicians in Canada. It does go on, but I do not have time to complete it.

That is the perspective coming from our medical profession across the country and it is the disability groups, medical professionals, faith groups, palliative care advocates and first nations that are all calling for more caution before expanding assisted suicide, yet the government has refused to listen to those concerns.

At the committee, our Conservative opposition members brought forward numerous amendments that would have addressed some of the failings of the legislation, that would have reinstated the protections for which the vulnerable within our country have called. Seventy-two disability groups oppose this legislation. They want more protections, yet they are not there.

I encourage my colleagues across the way to please give this legislation more time. Give us an opportunity to get this right.

[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]

Madam Speaker, whether it was the Supreme Court of Canada five years ago in the Carter decision, or the Superior Court decision in the province of Quebec or parliamentarians in this or previous sessions debating this for hundreds, if not thousands, of hours via committees or the chamber at second or third reading stages and so much more, this issue has been debated in a very passionate way for many years. Let there be no doubt that every life is of equal value. I believe that Canadian society wants this legislation passed.

When the Conservatives were in committee, they proposed amendments and had those amendments passed. I assumed they would agree to pass this legislation. It was not just the Liberal Party agreeing, other political parties in the House also agreed.

Could the member provide his thoughts on that issue?

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, the member has suggested that the contents of Bill C-7 have been debated for years and years. The legislation was just brought forward by the Liberal government. The issues of expanding medical assistance in dying to effectively become assisted suicide need fulsome debate, because it is an issue of life and death.

Unfortunately, the member does not realize that. He does not understand how critical it is that the 72 disability groups across Canada fear the legislation will put their members at risk. The most vulnerable in our society, whether it is the poor, children or those with mental health issues, all feel vulnerable under the legislation. Why is that and why is the Liberal government not listening to those concerns?

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I am thrilled to be part of a party that allows its members to vote with their conscience when it comes to bills like this. We have stressed that this is not a partisan issue. From what we heard from Canadians across the country, this impacts them at their core. I would like some feedback from the member on the concept of being able to vote our conscience.

I grieve for people across the floor and around me who I do not think have that freedom. That is something Canadians absolutely look for in their Parliament, the realization of our responsibility in these circumstances to vote our conscience.

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, I am safe in saying that the Conservative Party is the only party in the House that takes free votes seriously, that regularly provides its MPs the avenue of saying yes or no to legislation, especially on issues of conscience.

I would extend that to protections that should be available to physicians and medical practitioners across Canada to not to be involved in any way in facilitating assisted death or assisted suicide. Across our country physicians are being told it is part of their obligations as physicians to refer people to another physician if they themselves will not counsel on the issue of medical assistance in dying. This is not about a country that respects freedoms and conscience rights.

We need to step into that gap, protect physicians from having to do something against their conscience in the same way the Conservative leader provides us as parliamentarians a free vote on any matters of conscience.

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

Madam Speaker, I have been a little disappointed at the tenor of the debate recently regarding MAID. I am hopeful we can carry this back to the passionate, but compassionate, debate we had earlier.

This is a matter of conscience and I am certainly very proud to be part of a party that has given me, as the member for Northumberland—Peterborough South, the freedom to decide how I would like to vote on this bill.

When we look at the legislation, after extensive consultation with folks inside and outside of my riding, a number of issues have occurred. The challenging part for me is that despite many advocates for persons with disabilities raising the alarm bells, much media attention on this and how they might feel, we really have not seen any amendments or changes to this legislation.

I would say this earnestly and with openness for my friends across the aisle. Are we so arrogant that we believe this language is absolutely perfect and completely beyond improvement? The member for Papineau used to say a number of times that there was always room to be better and there was always the opportunity to be better. In response to that, with all kindness and respect, this bill can be better and there are opportunities to do that.

Some legislation the government has put in during this last year alone has failed. The rent subsidy program did not go off as well as the government had hoped. All reasonable observers, and even members on the other side, would acknowledge that. That is why they had to relaunch the program. The LEEFF program is also not working up to capacity and no doubt will have to be redone. We have seen those challenges.

The difficulty with this legislation is that there is no ability to redo it. This is a life or death matter. If we lose members of our most vulnerable communities due to the legislation, we cannot come back. There is no redo of this. I am perfectly aware, as a lawyer, of the obligation the court has put in front of us from the Truchon decision to get this legislation revised. However, there are multiple devices, as our leader spoke about, to get that time extended.

In all respect and fairness, any reasonable, objective observer would say that it was the government that prorogued Parliament for an additional six weeks. We would have had the time to pass this on time.

I will get into my remarks, but let us keep the tenor of this debate how it is meant to be and how our constituents want it to be. They want a deep discussion of the important issues of passion, the very reason our Parliament exists and the very reason this reasonable debate is what makes Canada, in my opinion, such a great country.

To get into the substance of my speech, those who support Bill C-7 do not want anyone to suffer. Those who do not support it do not want anyone to suffer either. It is important to begin this controversial debate by recognizing that both sides, regardless of how different their beliefs are, are passionate for the right reasons. As with any legislation that will have a dramatic impact on people's lives, the discussion is very important.

Medical assistance in dying is a relatively new topic. Canada is one of the few countries that has legalized it so far, and as such, we much proceed in this new territory with the utmost caution. As our members have spoken about, we need the safeguards. This is not just the members of the Conservative Party mentioning this. Some of our most noted jurists in Canadian history have brought this up, jurists from all sides of the political spectrum who have called for and demanded that there be safeguards. As we say, and it is only common sense, this is a matter of life and death. While we should be guaranteeing a death with dignity, I strongly believe we should first guarantee a dignified end of life.

In order to do this, in order to make sure that people are choosing medical assistance in dying for the right reason, I believe that we need to have a conversation around the state of palliative care in our country. Unfortunately, the state of palliative care in our country is less than favourable. While medical assistance in dying is currently considered an essential service, palliative care is not. This is an issue that should be gravely concerning to everyone in this House and across our country.

Palliative care is a type of health care for patients and families facing life-limiting illnesses. It helps patients to achieve the best possible quality of life right up to the end of one's life. I know, and I am sure that many members share this, I have had some of the most important conversations of my life with loved ones and friends at or near the end of their life. These moments provide so much quality to those who carry forward and provide so much advice that I carry forward with me to this very day.

Where it is possible to retain a reasonable quality of life, we as a society have a sacrosanct obligation to make sure that people are taken care of, so that, if they do decide on medical assistance in dying, they have done so of their own free will and not because of a poor quality of life that could have been avoided.

Quality palliative care focuses on the concerns of patients and families, and works to support patients through both physical and mental symptoms of serious illness. This may include everything from helping to manage a patient's pain and symptoms to keeping them comfortable in their home for as long as possible.

Unfortunately, while 75% of Canadians would prefer to have their last moments at home, only about 15% have access to palliative home care and 60% die, instead of being surrounded in the homes that some of them have grown up in, in cold, stark hospitals.

Many physicians have raised the concern, because the majority of Canadians do not have access to high-quality palliative care. It is possible that many people, or at least some people, may be choosing MAID because they do not feel there are other options. Amongst the concerns are those laid out by Dr. Stephanie Kafie, a family physician in Niagara Falls with a focus on caring for the elderly.

She has said that something that has not been considered in the rush of passing this bill is the state of palliative care. It is not considered an essential service, however, MAID is. In her experience, many requests for MAID reflected a need for palliative care. Rushing misguided laws regarding the medical profession has led to an erosion of their profession and started significant damage to doctor-patient relations. Their hands are tied. They are not consulted on the drastic changes that are being made.

As Dr. Kafie notes, the importance of consulting with doctors in the creation of legislation is so crucial. As is so often is the case with parliamentarians, not enough people working on the legislation have any experience in the field itself.

Dr. Drijber, a palliative care physician, has spoken out on this issue, stating that this legislation seems to ignore the importance of the dignity that comes with palliative care, the importance of those final moments for both the living and those who will pass on. He has gone so far as to say that it seems the government has not fully consulted with experts or people who work in the field to help guide them through their decision-making process.

When we come to a conclusion here, in all earnesty and openness, I am reaching out to the other side. They know that there are people in their constituencies who will have differing opinions from them, as do I. We need to make sure that all voices are heard. Are we so arrogant as parliamentarians to think we should not change the legislation, that we cannot, as the member for Papineau has said, always do better?

[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]

Madam Speaker, where I agree wholeheartedly with the member is in regard to the issue of palliative care, home care services or long-term care services.

Even though these are provincially administered, the national government does have a role to play. I have always believed that. It goes beyond just transferring cash. We have to ensure there are some standards, that there are opportunities for individuals to be able to have those types of services, in particular, palliative care. We have too many palliative care patients passing in hospital hallways and rooms versus in a proper palliative care facility or in a home.

Could my friend provide his thoughts in terms of to what degree he would like to see the national government take a more proactive approach in working with other governments, and possibly what role he believes Ottawa should be playing in ensuring that there is more consistency across Canada when it comes to these types of services, in particular, palliative care?

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

Madam Speaker, I appreciate that well-thought-out and reasonable question. I understand completely that the member's intentions are nothing but the best to make sure that our seniors and those who are at the end of their life have the best possible care.

It is also important to enable innovation and provincial innovation, so that we can see that for Quebec or Ontario, and we are able to get those best practices across the various provinces. It is also critical that we manage our finances well, so that the federal government is in a position to enable proper funding of health care transfers, not as the transfers were slashed under the Chrétien government.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Madam Speaker, my hon. colleague's background is not a lie. He is a lawyer.

There were concerns expressed in 2016 with the legislation then, about the potential for judicial creep and now we are experiencing some of that. Why would the decision, then, not be appealed to the Supreme Court where the court could actually uphold some of the guardrails and safeguards that it put in place? I am wondering if my hon. colleague would have a comment on that.

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

Madam Speaker, truly, we have some of the most brilliant jurists in all the world in Canada, in our upper courts, in the Supreme Court, and in our lower courts as well, so why we would not give them the opportunity to put their learned intelligence and wisdom to this legislation I just do not understand.

As we have seen, our justices have much to contribute to this debate. Whether it be Justice McLachlin or Justice Cory or Justice Sopinka, they have all offered so much to this debate and to the discussion and, in many ways, they define the very terms of this conversation.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Madam Speaker, I always like listening to my colleagues and I especially like listening to my friend from Winnipeg North because he really focuses the discussion so clearly. He said that he thinks it is really important to learn lessons about palliative care and how the federal government could play a role. Well, he stood in the House with his Prime Minister when we brought forward a national palliative care strategy and the Liberals voted for it.

I raised it during the first round of discussions on the end-of-life bill and asked why we do not have a palliative care strategy.

The Liberals said, “Oh well, we will but we have to respond to the Supreme Court, we have to do this first”.

Therefore, here we are. We have another end-of-life bill and we have the Liberals saying, “Can anyone can tell us how we could do a palliative care strategy? It is such a good idea, maybe we could start some kind of conversation.” We have been through this. We voted on it. We told the Canadian people it would happen and the Liberals did nothing. How long is it going to take?