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

[John Barlow, Conservative, Foothills, AB]

Mr. Speaker, I am really happy the parliamentary secretary brought up that issue. Unlike every other country in the world that has doctor-assisted dying legislation, the MAID legislation, as it currently stands in Bill C-7, does not explicitly ask that the person asking for doctor-assisted dying access those mental health and health support systems within that 90 days. They do not have to do anything within that 90 days.

How about having an amendment that explicitly requires them to access every available health resource to ensure this is exactly the path they want to go down? In many cases, people cannot access those services within that 90-day time period. That is why we ask for that to be extended to 120 days.

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

Mr. Speaker, there are two types of people.

There are people who, based on their values, decide to no longer endure severe suffering and choose medical assistance in dying. The bill proposes to eliminate the requirement to provide final consent in the case of death that is reasonably foreseeable, which responds to the wishes of those who do not want to use palliative care and do not want to lose the possibility of providing that final consent if they receive too many sedatives.

There are also people who, based on their values, sometimes religious, absolutely want to live until the bitter end. It seems to me that my colleague is trying to impose the choice that those people would make on everyone else.

The legislation excludes medical assistance in dying in cases of mental illness. In the absence of a mental illness, we want people who choose not to endure severe suffering to have the possibility of exercising that choice. I want to know what my colleague thinks of that.

[John Barlow, Conservative, Foothills, AB]

Mr. Speaker, I certainly understand my colleague's question, but my job here is to speak on behalf of my constituents. My constituents have been very clear that they do not support the direction that Bill C-7 is taking doctor-assisted dying in Canada. I know he brought up the fact that it is not accessible to people with mental health issues. We started, at the beginning of the last Parliament, with its not being accessible to the disabled and not being accessible for this and this. That has now changed. The Liberal justice minister has also hinted that it could be available to people with mental health issues.

Absolutely, I am doing everything I possibly can as a parliamentarian to speak to my constituents, strengthen the legislation and ensure there are safeguards in place to protect the most vulnerable in our society, disabled Canadians and those with mental health issues.

The House resumed consideration of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), as reported (with amendment) from the committee, and of the motions in Group No. 1.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, of all the pieces of legislation that I have debated in the House over the years, this one, Bill C-7, more than any other, deeply distresses me.

Four years ago when the Supreme Court created the right to assisted suicide in Carter, whether we liked it or not it became the law of the land. The court also set out the parameters of what that right entailed, and those parameters were addressed in Bill C-14 with the appropriate safeguards built in. Among those safeguards the most important was, arguably, that death had to be reasonably foreseeable in order to qualify for medical assistance in dying, or MAID.

Fast forward to 2019. In a puzzling decision from a Quebec court, a single judge ruled in Truchon that parts of the federal law on MAID were unconstitutional because, in her view, they were too restrictive. Among the safeguards deemed too restrictive was the requirement that death be reasonably foreseeable. One single judge of a lower court made a decision for all of Canada that was literally about life and death. What is worse, the Liberal government chose not to appeal this decision to the Supreme Court. Canadians have a right to ask the Prime Minister why not. Instead of appealing the case to determine whether the nine justices of the Supreme Court agreed with the lower court judge, this government immediately brought forward new legislation, presumably because Truchon reflected the Prime Minister's own ideology.

The new bill is a dramatic departure from the protections included in the original MAID legislation. It has confirmed the fears of many: that the initial legislation represented the crest of a steep, slippery slope towards a much more expansive and dangerous approach to euthanasia.

One of the primary functions of government is to protect the lives of its citizens. In fact, the right to life is expressly enshrined in our charter. Sadly, the bill before us fails to protect the lives of our most vulnerable. It would remove the critical safeguards contained in the original MAID legislation. Removing these safeguards would have irreversible consequences. What is deeply disturbing is that Liberal MPs steadfastly refused to allow additional hours of debate to ensure that the law would reflect the will of Canadians, and they obstinately refused to accept reasonable amendments to Bill C-7 that were brought forward by our Conservative MPs.

These amendments were supported by a broad cross-section of stakeholders and included things such as leaving in place the 10-day reflection period before choosing death, ensuring the right to withdraw consent and protecting vulnerable patients by requiring the patient to be the one who first requested information on MAID. These were eminently sensible amendments that supported the autonomy of the individual while protecting the vulnerable, so it is fair to ask why the Liberal government did not support these amendments and why there is a rush to ram this legislation through the justice committee.

The Truchon case also highlights the role that judicial creep plays in the evolution of social policy in Canada. Four years ago, many of us expressed great apprehension that the original Bill C-14 would be expanded by future court decisions, and that these decisions would leave more vulnerable populations exposed to the reach of medically assisted suicide. Although our concerns were summarily dismissed at that time, Truchon and Bill C-7 have fully borne out our concerns, which is why more and more disability groups, I believe around 72, have set the alarm bells ringing and are vehemently opposing this legislation. They argue that this legislation amounts to “a deadly form of discrimination”, making it easier for disabled persons to die than to live. Again, piece by piece, the protections for the vulnerable that were promised in the original assisted suicide bill are being stripped away. In the future, things can only get worse unless we say a clear no to Bill C-7.

I have great sympathy for our fellow citizens who suffer from intolerable pain and are pleading for relief. Concern and compassion are hallmarks of life in Canada, and are qualities I hope we never discourage or disparage. However, I would also hope the primary focus of care for these individuals, at least in the first instance, would always be a higher level of palliative care.

What the government has done instead is focus on expanding the opportunities for Canadians to end their lives rather than improve them. This bill would allow Canadians with a mental illness or other disability to end their lives through assisted death even if they were nowhere near death. The government's own annual reporting revealed that, last year, 87 disabled Canadians who died with medical assistance had been denied access to critical disability support services. That is simply unacceptable. Canadians with disabilities deserve better.

To fully understand the slippery slope I referenced earlier, one need only look to the recent report from Dr. Ivan Zinger, Canada's chief correctional investigator, who exposed deep flaws in our current MAID regime as manifested in Canada's prisons. He cites the case of one terminally ill prisoner who was serving a two-year sentence. The inmate sought compassionate early parole to die a natural death in his community. Parole was denied. He then sought and received an assisted death. This is a gross misapplication of assisted suicide, and raises important questions about whether the government is adequately supporting Canadians who are facing difficult end-of-life decisions. Dr. Zinger has called for an absolute moratorium on all assisted suicide in Canada's prisons.

More broadly, I call into question whether the government is exercising the requisite caution and care to avoid unnecessary overreach and ensure that MAID is not abused or misapplied.

Equally disturbing is the concern that MAID would increasingly be used by the poor to escape their dire circumstances. A recent article in Maclean's, entitled “Dying for the Right to Live”, concluded that some disabled Canadians were considering MAID because they “simply cannot afford to keep on living.” The article referenced Susan, which is not her real name, who explained that because she had dietary restrictions food banks were not an option for her, and that a livable income was literally a matter of life and death. She said:

An increase [in income support] is the only thing that could save my life. I have no other reason to want to apply for assisted suicide, other than I simply cannot afford to keep on living.

How many other Susans are out there, for whom expanded availability of MAID represents a quick exit out of their circumstances? Who is next, children or perhaps Canadians struggling with mental illness who ask for assisted suicide because they fear being a burden to their family and friends? These are the vulnerable the Liberal government promised to protect. Members will recall that when the former minister of justice originally tabled MAID, she emphatically declared, “we need to be absolutely confident that we would not be putting vulnerable people at risk”, yet here we are today chipping away at the very protections that were so blithely guaranteed by our Liberal colleagues not so long ago.

I do not believe that Canadians expected that assisted suicide would be extended to those not terminally ill or near death, nor do I believe they would support MAID being used to displace a commitment to deliver a higher level of palliative care in our country. Similarly, I do not believe Canadians are in any way comfortable with the idea that our country would shirk its responsibility to the indigent by providing MAID as an escape from abject poverty.

For something as final as death and something as precious as life, should we not be taking a greater amount of time and care in debating and implementing the end-of-life options for Canadians? Instead of ushering in a new world of options for Canadians to seek death, should we not be doing our very best to incent Canadians to choose life?

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

Madam Speaker, by way of clarification, amendments were accepted at committee. One was by the NDP with respect to accessing expertise in rural and remote communities and one by the Green Party in respect to ensuring consultation happens between the Minister of Health and the Minister of Disability Inclusion.

Over the last couple of days we have heard a lot of debate on safeguards and why some safeguards are being eased while others are being increased. What I would put to the member is that we have the benefit now of four years of data after the advent of Bill C-14 in the last Parliament. What that data has shown us, and what the results have shown us, is that some of the safeguards were not doing the work they were intended to do.

The 10-day reflection period, for example, was prolonging suffering among those who were availing themselves of MAID because some were ensuring they would be able to provide final consent on that 10th day by depriving themselves of their own pain sedation medication.

Does the member agree that, in certain instances, safeguards like that need to be revisited and altered to address the need to be compassionate and alleviate suffering?

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, certainly, we should always be open to reviewing legislation, safeguards and some of the regulations attached. However, the amendments he suggested were accepted by the Liberals at committee are the least substantive of the amendments that were submitted.

With respect to prolonging suffering, the 10-day reflection period was intended to make sure that people had a proper opportunity to consider what it meant to receive medical assistance in dying. Prolonging suffering is never the intent of government, and it should not be of any member of this House.

The focus, however, should be on providing palliative care, alleviating that suffering and encouraging people to live fulsome and productive lives that are free from pain. That is where the focus on palliative care should come in. Sadly, the government has completely abandoned making palliative care the focus of end of life care.

[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, I have been listening throughout the day to many of the comments from the Conservative Party, and they always want to emphasize the role of the Liberal government. I think it is important for us to recognize a couple of things.

One is that all lives are of equal value. I genuinely believe that, as I know my caucus colleagues do. The second is that it is important to note, because this is a minority government, this could not be done without the support of other opposition parties. We have the support for the legislation from the Conservatives, the Greens and the New Democratic Party.

I am wondering if the member could provide his thoughts. Is it the Conservatives' intention to hold off on preventing the question to be called, or does the member see us continuing to debate this indefinitely?

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, I would remind the member that it was the current Liberal government that actually brought forward this MAID legislation, and, more critically, failed to appeal the Truchon case, which was a case that came up from a lower court from a single judge. To then make a life-and-death decision in a piece of legislation that affects life and death without consulting the nine justices of the highest court in the land is grossly irresponsible.

That is why I am asking this member and his party to reconsider. It is very clear this legislation was rushed through to try to comply with an arbitrary date that was set by that lower court judge. This deserves a full airing and review at the highest court of the land. Sadly, the Liberal government has refused to do that for Canadians.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I am very pleased to be joining the debate on this issue. It is an important one, and I want to make sure I reflect what my constituents have been telling me on Bill C-7. The vast majority of them want me to vote against this legislation because it would remove a great many safeguards. It would also, in my view, violate some of the intentions set out in the debate we undertook on Bill C-14.

I remember this was a deeply, deeply personal issue for many parliamentarians in the last Parliament, and it is a deeply personal issue to many of my constituents now. They have stories of loved ones who have grievous chronic conditions and were found to be ineligible because of the way Bill C-14 was structured, but they found solace in the fact Carter had paved the way at the Supreme Court to allow for this exemption to the assisted suicide provisions in the Criminal Code. While this is a debate that is deeply personal to parliamentarians and constituents, the law is not, and the law has to be as clear as possible.

In preparing for this debate, I went back and looked at Hansard to see what I had said previously on this. I had problems with the term “reasonably foreseeable”. I could foresee that a judge at some point would strike down this provision. That is exactly what I raised as an issue with Bill C-14 at the time, and it continues to be an issue in Bill C-7.

“Grievous and irremediable” is the term used in paragraph 127 of the Carter decision. I am always worried when I start quoting decisions of various judges, as I remember it was H. L. Mencken who said that judges are simply law students who grade their own exams.

However, I went through the Carter and Truchon decisions again in preparation for this after hearing the excellent contributions at second reading debate by my colleague, the member for St. Albert—Edmonton. He rightly pointed out that this should have been appealed to the Supreme Court, the original judicial body that decides the laws of the land and if they conform with our Constitution.

Paragraph 682 of the Truchon decision reads:

Individuals in the same position as Mr. Truchon must be allowed to exercise full autonomy not only at the end of life, but also at any moment during their life, even if this means death, where the other eligibility conditions for medical assistance in dying are met.

Looking at the Carter decision, it does not conform to Truchon. Again, this should have been appealed to a higher court. Bill C-7 goes far beyond what was in the Truchon decision and what that single Justice Baudouin said. I really think the government did a great disservice to Canadians by not appealing the decision in order to get a final verdict for parliamentarians to be able to legislate on this question. At the end of the day, we are supposed to be the ones who legislate on behalf of our constituents.

I have concerns many of the safeguards we have talked about are being eliminated. There is a doctor in Calgary, Dr. Thomas Bouchard, who said that the way the government is legislating on this question is reckless. As well, the timeline is incredibly rushed. I would much rather hear from more parliamentarians in the chamber reflecting on the views they are hearing from their constituents, so we can get this right the second time around, now that we are relying on the Truchon decision in the matter.

The UN rapporteur on the rights of persons with disabilities said that MAID violates the right to life of persons with disabilities. I had a disabled daughter who passed away in the last Parliament, and I cannot but think that had she been able to grow up to be an adult that she would have been placed in an awful situation. I likely would have been her guardian in her later years, and I would have been placed in a situation looking after a loved one who would be rendered eligible for MAID. I cannot be there all the time.

I have had many constituents tell me they are concerned about their minor children and whether, once they have grown up and become adults, they will be able to be with them all the time to ensure that, when they go to the hospital with a medical condition, MAID is not pushed onto them. My constituents are concerned that MAID may be pushed on them because palliative care options may not be there. They are concerned the chronic conditions that are found to be grievous, irremediable and cannot be cured with current medical technology would lead to them being pushed into MAID by physicians, whether rightly or wrongly.

My colleague from Foothills and my colleague from Abbotsford raised excellent points, and I do not want to retread on the same matters they spoke about.

Constituents in my riding have constantly told me that they understand the debate on whether medical assistance in dying should exist in Canada. It was settled in the previous Parliament in Bill C-14. The question before us is what types of safeguards need to be in place.

In the Truchon decision rendered by Justice Beaudoin, it says that it should be open to people beyond what the Carter decision of the Supreme Court said. This is the box that Parliament should legislate within. We have to be conscious of that. Just as I have issues with death needing to be reasonably foreseeable, there were ways that we could have fixed those issues, but not with what is in Bill C-7. It goes far beyond what Truchon called for in any of the sections. In reading the decision, I do not see Bill C-7 meeting those goals.

Every single step in the process is a safeguard for that a person. They may change their mind, reflect on the questions, or obtain access to better palliative care or new technologies that render care for them better and simpler, or perhaps relieve them of a chronic condition.

I am thinking of my other three live-in kids, who have a chronic kidney condition called Alport Syndrome. It is incurable right now, and it leads to kidney failure eventually. I do not know if many members have spoken to those who are on dialysis, but it is deeply unpleasant.

I know one person on dialysis who does half marathons. I have walked 100 kilometres in the Kidney March right next to Said, who lives in my riding. He is a two-time kidney transplant recipient. He told me how difficult dialysis is and how one's mental health suffers from it.

He explained the difficulties around it, but he persevered and went through it. I think of my children in the future. If a cure is never found for their Alport Syndrome, and they are on dialysis or waiting for a kidney transplant, what will the options set before them be? What will be the safeguards available for them when the time comes and perhaps they want to make decisions and a choice like that.

I have had constituents who are surprised by their family members having made a request for medical assistance in dying at the hospital. They were completely unaware of. That should be taken into account. That is why the 10-day cool down period allows family members to be in the know.

All of our deaths are reasonably foreseeable. That was my complaint on Bill C-14 in the last Parliament. However, we do not have to die alone, and family is there for those types of difficult places. I was there for my daughter when she passed away. Even though we may consider this debate difficult, after a judicial decision, we have to get it right. Our personal views should be set aside. What our constituents believe to be the right thing to do in this matter matters the most.

I am trying to reflect what I have heard from my constituents who have express deep concerns over the lack of safeguards. Too many of them are being eliminated merely four years after the previous legislation was passed in Parliament. This is probably going to be the most important debate that many of us have in the scope of our parliamentary careers. I know that is what I will think after my time in Parliament is done. This will have been the capstone, the greatest, most important debate.

I want to reflect what my constituents have said. While dying with dignity is a slogan I have often heard, so is living with dignity. We have to ensure we put the resources and the time. We have to ensure the ability to protect our physicians and nurse practitioners, who are providing this service in the different provinces and territories, and that proper safeguards are in place, so that those who are vulnerable, those who are disabled, are not looked upon as the next person for whom MAID should be offered.

Safeguards are important. This legislation does not meet the expectations of my constituents. I will have to vote against it.

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

Madam Speaker, I offer the sympathies on behalf of everyone in the House with respect to the personal loss the member has had within his family.

I would point out a couple of clarifications. In terms of the consultations that went into the preparation of the bill, 300,000 people did fill out a questionnaire and about 125 experts were consulted. There was a lot of due diligence done in that regard. I asked these very questions about the prosecution or discipline of any medical or nursing professionals in the course of delivering MAID in the last four years, and there has been no evidence of that.

The member has read the case law and I appreciate that. I want to take him to one part of the Truchon decision because it goes to the heart of what is alleged to be discriminatory here. Paragraph 678 of the Truchon decision says that, when you deny the ability for people like Mr. Truchon and Madame Gladu to make this kind of choice, you are actually discriminating against them in failing to appreciate their competence and their autonomy. I wonder if the member opposite could comment on that paragraph of the decision.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I have paragraph 678 right here and I am looking at it. I have read it. In Truchon, they found that paragraph 241.2(2)(d) was unconstitutional.

Again, this a lower court decision. The right thing to do here would have been for the government to appeal this to the Supreme Court of Canada and have it confirmed there by whatever decision the Supreme Court's nine justices, supposed to be the best legal minds of Canada, made as to whether Justice Beaudoin was correct in her determination of paragraph 678 in her decision. That would have been the right thing to do.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Madam Speaker, I as well would like to offer my condolences to the hon. member and thank him for sharing that story so that we can learn.

I actually have a question. I am aware of some of the concerns that have been raised by the disability community, particularly in regard to the failure of mentioning the United Nations Convention on the Rights of Persons with Disabilities, specifically related to article 19, which refers to the rights of persons with disabilities “to live in the community, with choices equal to others, and shall take effective and appropriate measures to facilitate full enjoyment of persons with disabilities of this right and their full inclusion and participation in the community, including”, and then it goes into that.

I know the member said he would vote against this. If the government was open to making some of these amendments to reflect the concerns coming from the disability community, would he then be open to supporting this particular bill?

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, it is actually a very good question. I was hoping, through the committee process of the House of Commons, at the justice committee, which I participated in for some of the meetings as a substitute for some members, that we could reintroduce the safeguards that are being eliminated beyond the Truchon decision, ensure that we protect the conscience rights of physicians who are also a party to this decision-making process, include better safeguards for persons with disabilities, and find wording somewhere between “reasonably foreseeable” and what the government is doing in Bill C-7 to put a better scope in for end-of-life care and determine it that way. In that case, I would absolutely reconsider how I would vote on this.

However, because of the way it is structured in Bill C-7, I would rather get it right on a matter as important as life and death.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Madam Speaker, I thank my colleague for that common-sense and well-thought-out speech. My question again has to do with COVID-19. We see right now that there is a pandemic of mental health challenges within this pandemic. Loosening the safeguards in a bill like MAID makes me wonder if the member thinks it might have a very detrimental impact on Canadians who are struggling with mental health and that it might potentially create a climate for a suicide pandemic, looking to MAID as an option rather than the last resort. As we know, death is final and irreversible.