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

[David Lametti, Liberal, Minister of Justice]

moved that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Madam Speaker, I am pleased to speak today about Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, MAID. The bill before the House today is identical to former Bill C-7, which I was proud to have introduced in February following significant consultation among Canadians and experts. I believe this bill reflects a consensus among Canadians and I call on all of my colleagues in this place to support its timely passage.

As members will recall, this bill proposes a legislative response to the Quebec Superior Court's ruling in Truchon and Gladu, in which the court ruled that it is unconstitutional to limit MAID to persons whose death is reasonably foreseeable. That declaration of invalidity, which applies only in Quebec, was initially suspended for six months and subsequently extended by four months, such that it would have come into effect on July 12.

We were all working toward that deadline when this bill was initially introduced. As with many other aspects of our lives, the COVID-19 pandemic disrupted our usual parliamentary activities and it became impossible to meet the July deadline. As Attorney General, I asked for a further extension, which the court granted, until December 18, 2020.

Even though the ruling in Truchon and Gladu was suspended, Quebeckers who are experiencing intolerable suffering and who meet all the eligibility criteria except that of reasonably foreseeable death can apply to the court for an exemption that would allow a practitioner to provide medical assistance in dying despite Parliament not yet having amended the legislation.

Six exemptions have been granted since Justice Baudouin handed down her ruling in September 2019, and others are under review. The availability of exemptions limits the impact of the suspension of the ruling in Quebec.

I would like to take a moment to note the passing of Mr. Truchon, one of the plaintiffs in the case that led to these important changes to our medical assistance in dying regime. Like many Canadians, Mr. Truchon was concerned about the impact of the pandemic on his quality of life in addition to the suffering caused by his medical condition. He want the option to obtain medical assistance in dying, which he did in April. I would like to express my deepest condolences to his loved ones.

The bill before members today, four years after the enactment of Canada's first medical assistance in dying provisions in 2016, proposes a significant change to Canada's MAID regime in broadening eligibility to persons whose natural death is not reasonably foreseeable.

The 2016 amendments were, themselves, a historic change in our criminal law. They created exemptions to some of the most serious criminal offences, which aim to protect one of our most fundamental values, that of human life. These exemptions sought to protect and promote another of our most cherished values, individual freedom, and more specifically, the freedom to decide when enough medical suffering is enough and to choose when and how one's life should end.

Health Canada's first annual report on medical assistance in dying in Canada released this past July indicates that since then nearly 14,000 Canadians have received MAID. In 2019, MAID accounted for 2% of deaths in Canada.

The requirement for reasonably foreseeable natural death was part of a MAID regime that was adopted in 2016. However, we decided not to appeal the Truchon and Gladu decision because we agreed that medical assistance in dying should be available as a means to address intolerable suffering outside of the end-of-life context. To ensure the consistency of criminal law across the country, we committed to amending the Criminal Code.

Before amending the Criminal Code, we conducted an extensive consultation with Canadians. We gathered responses from 300,000 people through an online questionnaire. My colleagues, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, our parliamentary secretaries and I also held round tables across Canada with over 125 experts and stakeholders. The summary of these activities can be viewed on the website of the Department of Justice.

Based on these consultations and other sources of information, the bill proposes adjusting both the eligibility criteria and the procedural safeguards to respond to the decision rendered in Truchon and Gladu. The bill also proposes allowing patients to waive the requirement to give final consent in specific circumstances so that they do not lose their access to medical assistance in dying.

We know that Canadians are also concerned about other issues that are not addressed in this bill. I am thinking, in particular, of access to medical assistance in dying on the basis of mental illness. I am also thinking about advance requests for medical assistance in dying for people who are not yet suffering but fear they will be after they have lost their ability to request this assistance and who want to make their wishes known before that happens.

The upcoming parliamentary review of the medical assistance in dying regime and of the state of palliative care in Canada will provide an opportunity to give these complex issues the time and attention they deserve. It is up to Parliament to determine the scope of this review and when to conduct it.

COVID-19 has delayed this important review, but I am confident that Parliament will undertake it as soon as possible. That being said, our government's top priority is to meet the deadline set by the Quebec Superior Court in the Truchon and Gladu case.

Before I discuss the contents of the bill in more detail, I would like to note the important concerns of many individuals in the disability community about changing Canada's MAID policy from a way to avoid a painful death to a means of relieving intolerable suffering. It is crucial that these concerns not be forgotten as we resume our debate. In the view of many disability groups, a MAID regime that does not limit eligibility to those whose death is already reasonably foreseeable enshrines in law the erroneous view that disability itself is a valid reason for ending life. We have also heard from individuals living with disabilities, like Mr. Truchon and Ms. Gladu, that autonomy in how they choose to live and die is paramount. These are complex and nuanced points of view.

Let me be absolutely clear. Our government supports the equality of all Canadians without exception and categorically rejects the notion that a life with a disability is one that is not worth living or worse than death itself. I believe the fundamental principle that all lives have equal and intrinsic value can be balanced with other important interests and societal values, in particular, the importance of individual choice for Canadians. This balance is at the heart of the bill's objectives, which are to recognize the autonomy of individuals to choose MAID as a means for relieving intolerable suffering, regardless of the foreseeability of their natural death, while at the same time protecting vulnerable persons, recognizing that suicide is an important public health issue and affirming the inherent and equal value of every person's life.

I will now go into the specifics of various elements of the bill.

The bill proposes to expand eligibility for medical assistance in dying by repealing the criteria for a reasonably foreseeable natural death. Medical assistance in dying would therefore be available to people suffering unbearable pain, who have a serious and incurable disease, infection or disability, and whose medical condition is characterized by an advanced and irreversible decline in their capacity.

This removal of “reasonable foreseeability of natural death” from the eligibility criteria would mean that some persons whose only condition is a mental illness could be eligible for MAID. However, the bill proposes to exclude mental illness on its own as a ground for MAID eligibility.

Our consultations and the report of the Council of Canadian Academies that studied this issue indicated that the trajectory of mental illness is more difficult to predict than that of most physical illnesses, that spontaneous improvement is possible, and that a desire to die and an impaired perception of one's circumstances are symptoms, themselves, of some mental illnesses.

This means that it would be very difficult to determine when, if ever, it is appropriate to grant someone's request that their life be ended solely on the basis of mental illness. In no way does this suggest that persons with a mental illness necessarily lack the decision-making capacity to consent to MAID, or that the suffering associated with a mental illness is of a lesser degree than the suffering associated with physical illness.

During second reading debate of former Bill C-7, some members noted their support for this exclusion while others raised concerns. This issue requires much more thought and debate. We feel the parliamentary review of the MAID legislation would be an appropriate forum for this.

The bill also proposes changes to the safeguards, since the existing safeguards were designed to protect persons whose death is reasonably foreseeable.

Expanding eligibility requires changes to the safeguards, since many experts believe there are greater risks in assessing applications for medical assistance in dying from individuals whose death is not reasonably foreseeable.

The bill therefore proposes two sets of safeguards. Each applies whether natural death is reasonably foreseeable or not. This is the only role that the concept of reasonably foreseeable death would play in the new regime. It would no longer constitute grounds for refusing a request for medical assistance in dying.

Reasonable foreseeability of natural death, or RFND, refers to a temporal but flexible connection between the person's overall medical circumstances and their anticipated death. It allows for clinical judgment, as it requires a comprehensive individual assessment that does not have a result in a specific prognosis and clearly does not require death to be imminent.

Individuals may decline towards death along trajectories of greater or lesser predictability. As such, RFND is not defined by a maximum or minimum prognosis, but it does require a temporal link to death in the sense that the person is approaching the end of their life in the near term.

We kept the RFND standard because it provides flexibility in relation to the difficult and imprecise exercise of anticipating when natural death might occur. A natural death that is expected within six to 12 months certainly meets the RFND standard. That was made clear when Parliament adopted Bill C-14 as an end-of-life regime. It did not impose a six- to 12-month prognosis requirement to preserve flexibility, but it still considered such timelines to be within the meaning of RFND.

A person's death may also be foreseeable in the temporal sense over longer periods, depending on the particular circumstances under consideration. However, having an illness that will cause death several years in the future would not normally meet the condition of RFND.

Safeguards for those whose deaths are reasonably foreseeable are based on safeguards that currently exist with two changes. First, the 10-day reflection period would be eliminated. Second, the request for medical assistance in dying will no longer require the signature of two independent witnesses, just one.

A person paid to provide health care services or personal care who is not involved in the assessment of the person's eligibility for medical assistance in dying can now act as an independent witness.

During second reading of former Bill C-7, some hon. members expressed concern about removing some of the safeguards.

Allow me to assure hon. members that these changes are based on the comments we received during our consultations and follow through on them.

For those whose natural death is foreseeable, many of whom spend a long time seriously thinking about what they want to do, the 10-day reflection period might unduly prolong their suffering.

We also learned that people who live in long-term care facilities or in remote regions may have difficulty finding two independent witnesses. These difficulties are exacerbated by the pandemic. The independent witness confirms the identity of the person, but does not participate in assessing their eligibility for medical assistance in dying. Only one person is required for meeting that safety objective.

Newly eligible persons whose death is not reasonably foreseeable would benefit from additional safeguards, the purpose of which is to ensure that sufficient time and expertise is devoted to the assessment of their MAID request. Where death is not reasonably foreseeable, the suffering motivating a MAID request may be due to a broader range of sources that warrant greater attention before someone's life is prematurely ended, to reduce the risk of providing MAID when there is a possibility of alleviating the person's suffering.

Specifically, the bill proposes a minimum 90-day assessment period, which would require that at least one of the practitioners assessing eligibility has expertise in the condition that is causing the person's intolerable suffering. A formal specialization or certification by a medical college would not be required. The bill would also require that a person whose death is not reasonably foreseeable be informed of and offered available means to relieve suffering, such as mental health and disability supports. In addition, the practitioner would have to be satisfied that those other means of relieving suffering have been seriously considered.

These are clarifications to the existing requirement of informed consent. It is our hope that these steps are already taken in all cases, but the Criminal Code would explicitly require them for those whose death is not reasonably foreseeable.

In addition to changes in response to the decision in Truchon and Gladu, the bill would let a person whose natural death is reasonably foreseeable and who has been deemed eligible to receive MAID to waive final consent if there is a risk they will lose the capacity to consent before the date on which they chose to receive MAID.

At present, the Criminal Code requires that, immediately before providing MAID, the practitioner must ensure that the person has given express consent to MAID and that they have the opportunity to withdraw their request. This safeguard, which attests to the irreversible nature of death and the importance of obtaining consent at the point of ending life, simply cannot be met if the person has lost the capacity to consent. This seems unfair when a person has been deemed eligible and was awaiting the procedure. In such cases, the rule could push some individuals to obtain medical assistance in dying earlier than they wanted to.

Under the amendments proposed in the bill, a person whose death is foreseeable, who has already been assessed and approved for MAID and has decided they want to receive it, could make an advance consent arrangement with their practitioner, setting out the date for the provision of MAID and their consent to MAID if they no longer have the capacity to consent at that later point.

According to round table participants and experts who looked at this question for the Council of Canadian Academies' 2018 reports, providing for advance consent in this way presents relatively little complexity or risk, and some practitioners have indicated they would be relatively comfortable providing MAID under such circumstances.

The bill does not propose to permit advance requests in contrast to what I have just described as advance consent. Advance requests are documents that may be provided at some future unknown date, if and when a set of expected circumstances materializes and when the person is no longer able to give consent. This issue is significantly more complex and challenging, and it will be examined during the parliamentary review.

Finally, the bill would enhance the monitoring regime, which is crucial for accountability and transparency. I have examined the bill for charter compliance and I am confident that it responds to the Truchon ruling in a way that respects the charter. I will soon table a charter statement that sets out key considerations about the bill's potential impacts on charter rights and freedoms.

In conclusion, these important amendments seek to guarantee that medical assistance in dying—

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

We must now proceed to questions and comments.

The hon. member for St. Albert—Edmonton.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, needless to say, this is an incredibly complex area. While Bill C-7 purports to respond to the Truchon decision, it goes considerably beyond the scope of Truchon, and in so doing, removes a number of safeguards that Parliament, in its wisdom, passed four short years ago. In so doing, it would pre-empt a legislative review, where there would have been an opportunity to thoroughly examine all of the issues before experts and to take into account the comprehensive reports of the Council of Canadian Academies.

Why would the government choose to pre-empt a legislative review and instead proceed in a rushed way, in the face of the expiration of a stay on the declaration of constitutional invalidity effective December—

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

The hon. minister.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank the hon. member for his participation and concern, over the last four years, with respect to this issue.

As the hon. member has pointed out, we are responding primarily to the Truchon decision, but we used the opportunity to make a certain number of other modifications where there was a clear consensus among Canadians. We consulted widely with MAID service providers and with families who had gone through the process. There was a universal conclusion that the 10-day waiting period was only a source of suffering, that people who decided to have MAID had made the decision and the 10 days only prolonged suffering. I continue to hear that. The witness requirement was actually becoming an impediment for people in regions and in long-term care facilities to access MAID, so we decided to change that now.

[Christine Normandin, Bloc, Saint-Jean, QC]

Madam Speaker, I thank my colleague for his exhaustive overview of the bill before us today. We are pleased to be able to work together on this bill, which speaks to the very needs of Quebeckers and Canadians.

I would like to hear the minister's thoughts on how he expects all members in committee to work together so that we can meet the December 18 deadline for the final legislation. I hope that our work will be constructive and that we will thoroughly examine the issues. We must not forget that the objective is for fewer people to suffer while awaiting a final piece of legislation.

Could the minister tell us how he hopes this will work and how he plans to make it happen? I believe we have chosen not to include mental illness for the time being. There is not necessarily a consensus on this issue. I would like to hear what he hopes to see from parliamentarians.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank my hon. colleague for her question.

Issues relating to minors, mental health and advance requests are complex ones. We will give these issues the consideration they deserve in a parliamentary review, which was already set out in the 2016 legislation.

I hope that we will have the co-operation of our colleagues in this chamber and in the other place. There is clearly a strong consensus across the country, including in Quebec, for measures like the ones we are proposing. We will ensure that parliamentarians work together to meet the deadlines.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I want to start by thanking the minister for the co-operative and open dialogue that he and I have maintained on the bill and many other matters in the justice area. I also want to thank him for bringing the bill back promptly, because the concern of the New Democrats has always been that we not inadvertently prolong suffering for those who are at the end of life and for their families.

I do have a concern that the minister seems to have dropped the review off the edge of the agenda here. We are talking about the bill, but the work we need to do also includes the broader review. I placed an order on the motion paper today suggesting that we establish a special committee to deal with these broader issues. The minister made many references to the review without talking about a schedule or how we would accomplish this review.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank the hon. member for his work and his collaboration. I think there is a question in there, which I am going to try to answer.

I will look at the motion. I am open to discussing the parameters of the review with my parliamentary colleagues from all sides of the House and, indeed, the other house. I am certainly open to discussing the parameters of the review as we move forward.

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

Madam Speaker, I wanted to touch on the consultations that took place around the country, some of which I was privileged to take part in, along with some of the other parliamentary secretaries assisting the ministers working on this file. I want to ask the minister if he could comment on the influence of the Audrey Parker case, and what that means in the context of persons who would have been approved of a proceeding but not had the time to wait until they can give that final consent. What does that do in terms of this issue of people availing themselves of MAID prematurely?

As a second point, I would ask the minister to clarify whether this new bill would affect at all the conscience rights of medical practitioners, in terms of their being compelled to provide medical assistance in dying.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank my hon. colleague for his work on this and various other aspects of our file.

I will answer the second question first. Conscience rights were protected in the bill. They were protected in 2016 in the original bill. They were reinforced by parliamentary committee, and they are maintained in the current bill.

With respect to Audrey Parker's amendment, colleagues will remember that this is the case of a woman in Halifax who had been evaluated and approved for MAID, but was at the end of her life and afraid of losing her capacity, so instead of being able to spend another Christmas with her family, she opted to take MAID earlier. We have incorporated what is, in effect, Audrey Parker's amendment into the legislation. There was widespread support for it across Canada, and I described it in my earlier remarks.

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

Madam Speaker, the minister's comments about conscience protection are totally false.

He knows, or should know, that the College of Physicians and Surgeons of Ontario policy, which pre-existed this, in combination with the law the government brought in, effectively requires physicians to either provide or refer for euthanasia in certain situations. He also should know that hospices, including one in B.C., are being forced to close, reducing the number of palliative care beds because of their lack of desire to provide euthanasia. So much for protecting patients' autonomy. If patients want to receive care in an environment that does not include euthanasia, they should have the freedom and autonomy to do so.

In addition to that, I want to ask the minister quickly about the 10-day reflection period. The member for Richmond Hill, from the minister's own caucus, said that the 10-day reflection period is necessary. The minister knows as well that this reflection period can be waived in certain extraordinary circumstances already.

Why not leave the reflection period in place, as members of his own caucus are calling on him to do, recognizing that it can already be waived in certain extreme situations?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, with respect to the 10-day period, once again, we heard in our consultations across Canada from families, from people who have experience with MAID and from MAID service providers that all the 10-day waiting period did was add to people's suffering. It was characterized as inhumane, and we are taking it out.

I would also properly characterize the issue, which I feel my hon. colleague has failed to do. This is a charter right. It was held in the Carter case that this was a charter right, and the 2016 legislation enforced the charter right. A medical service provider is never forced to participate in this himself or herself.

The member is correct. He underplayed the words “under certain circumstances”, but those are, in fact, crucial. Under certain circumstances, where the person's charter right to access the service would be endangered, a medical practitioner has to give a reference. However, that is the extent of it, and that is entirely in balance with our charter provision. I would humbly submit that the hon. member's mischaracterization is erroneous.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I am pleased to rise to speak on Bill C-7, an act to amend the Criminal Code respecting medical assistance in dying.

At the outset, I will say that the subject of medical assistance in dying is perhaps one of the most complex issues that could come before Parliament. Profound moral, legal and ethical questions are raised. Medical assistance in dying raises questions of individual autonomy, the need to respect the sanctity of life and the need to protect vulnerable persons, among other considerations.

It is no wonder that Canadians have such profound, deeply held and diverse views on this subject matter. After all, when we are talking about physician-assisted dying, we are talking about issues that literally concern life and death. When we, as parliamentarians, give consideration to an appropriate framework that provides safeguards, we must do so with regard to the fact that we are talking about a procedure that, when carried out, is irreversible. The patient dies. It is indeed a weighty subject of profound importance.

I am certainly informed of the complexity of the issue through my experience of having, in the last Parliament, served as the vice-chair of the Special Joint Committee on Physician-Assisted Dying. This committee was tasked with reviewing the Carter decision of the Supreme Court, which struck down the blanket Criminal Code prohibition and tasked Parliament and the committee with putting forward recommendations for a legislative response. I then sat on the justice committee, which studied Bill C-14, the government's legislative response. In that regard, I am in the unique position of having been through the process from start to finish, from the study of the Carter decision of the special joint committee through to the passage of Bill C-14 in June 2016.

The bill before us purportedly responds to the Truchon decision of the Superior Court of Quebec, which struck down an important component of Bill C-14, namely, that in order to qualify for medical assistance in dying, one's death must be reasonably foreseeable. When the Truchon decision was issued in September 2019, we on this side of the House in the official opposition called on the Attorney General to do the right thing and appeal the decision. We did this for a number of reasons.

To begin with, it is the responsibility of the Attorney General to uphold laws passed by Parliament. The law passed by Parliament was Bill C-14. I would note that the law had been passed a mere three years prior to the issuance of the Truchon decision. It was passed after a comprehensive review of the Carter decision and a comprehensive review of possibilities for a legislative framework. Therefore, in the end, Bill C-14 was a carefully thought-out and debated piece of legislation. One would think that in the face of that, the minister would have appealed the decision.

In addition to that, when one, having respect for this place and the laws passed by Parliament, actually looks at the Truchon decision and the reasoning of Madam Justice Baudouin, it should be all the more apparent the need to appeal the decision. Madam Justice Baudouin, in concluding that the reasonable foreseeability criterion contravened section 7 and section 15 of the charter, was driven, arguably, by a restrictive interpretation of the purpose of the law. Indeed, Madam Justice Baudouin reached her conclusion by singularly focusing on one objective of the law, namely, to protect vulnerable persons from being induced in a moment of weakness to ending their life.

However, that was not the only objective of the legislation. When one looks at the preamble of Bill C-7, it expressly provides for other objectives, including the sanctity of life, the dignity of the elderly and disabled, and suicide prevention, yet the judge in Truchon focused exclusively on only one of those objectives.

What Parliament sought to do in providing for a reasonably foreseeable criterion was to respond to what the Supreme Court called upon Parliament to do, namely, to strike a balance between individual autonomy and the need to respect vulnerable persons.

The Attorney General, moments ago, stood in this place and said that the government chose not to appeal the decision because it agreed with the substance of the decision. That is quite interesting because only four years ago, three years before the minister decided not to appeal the decision, ministers on that side of the House emphasized how critical the reasonably foreseeable criterion is to provide and ensure effective safeguards to protect the most vulnerable.

To that end I would quote the former health minister, Jane Philpott, who, on June 16, 2016 stated:

We are concerned with the Senate's recommendation for the removal of the clause that recommends that this be considered only in the face of natural death being reasonably foreseeable because of the fact that people with mental illness, among others, would not be adequately protected.

Then there are the comments of the then attorney general, the hon. member for Vancouver Granville, who introduced Bill C-14 and stated:

There are other compelling reasons for there to be a requirement that the person's natural death be reasonably foreseeable. First, it provides a fair way to restrict eligibility without making assisted dying available to almost everyone. Second, restricting eligibility in this way is necessary to protect the vulnerable.

In the face of those objectives, it is quite a departure and quite convenient for the minister to say that he was going to effectively abdicate his responsibility as attorney general to uphold the laws passed by Parliament by allowing a single decision of a single lower court judge in one province of this country to stand. The Attorney General acknowledged, and we should make no mistake about it, that the effect of Truchon and its codification, by way of this piece of legislation, significantly transforms the medical assistance in dying framework in Canada.

At the time of the Carter decision and when this House, four short years ago, debated Bill C-14, medical assistance in dying was thought to be an exception to the rule, not the rule. It was thought to be appropriate in certain circumstances in an end-of-life context, where one who was suffering intolerably could, upon providing clear consent, hasten their death.

With this legislation, it would now be appropriate to terminate human life even in the absence of a terminal illness and even in circumstances where the suffering is medically manageable. That is a radical transformation, and it creates a number of complexities around issues of suffering that might be psychological or existential and outside of an end-of-life context. When one removes the reasonably foreseeable criterion, all that is left is that one must have a serious disease, illness or disability, be in state of decline, and be suffering physically or psychologically as a result.

When one removes an end-of-life, or reasonably foreseeable, component, that already arguably subjective test becomes a whole lot more subjective, and that has the potential to put vulnerable persons' lives at risk. One can see that with those broad parameters, persons with degenerative disabilities could have their lives terminated, notwithstanding that they may have years, if not decades, to live. That has caused enormous concern in the disability community across Canada.

One month after the Truchon decision was issued, some 72 organizations from across Canada, representing a cross-section of the disability community, wrote to the Attorney General and pleaded with him to appeal the Truchon decision. They did so out of concern that persons with disabilities could be put at risk and have their lives prematurely ended.

The writers of the letter noted that the legislation could arguably contravene article 10 of the UN Convention on the Rights of Persons with Disabilities, which provides that persons with disabilities should be treated equally under the law. They note that persons with disabilities could be treated unequally because one could have medical assistance in dying made available to them for no other reason than they happen to be disabled.

It should be noted that the UN rapporteur on the rights of persons with disabilities sounded the alarm when she said she was, “extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective.” From a disability perspective, that plea fell on deaf ears on the part of the Attorney General in terms of his failure to appeal the Truchon decision.

In light of what a significant change this legislation means, it is unfortunate that it has come to this, because appealing the decision would have allowed for time. It would have allowed time for Parliament to take into consideration the significant complexities associated with this change, a mere four years after Parliament had legislated a comprehensive regime, and it would have provided clarity in terms of informing Parliament about the scope of the framework upon which Parliament can legislate.

However, instead of taking the appropriate time to ensure that any legislative change respects the charter, because respecting the charter, including life, means protecting vulnerable persons, we are here with a profoundly significant piece of legislation being rushed. It is being rushed in the face of the expiration of the stay on the declaration of constitutional invalidity, effective this December.

While the Attorney General and the government emphasized the Truchon decision, it must be noted that this legislation goes well beyond the scope of Truchon. It removes important safeguards, including the 10-day reflection period. It removes the requirement that there be two witnesses to confirm that a person made the request of their own free will and that the request reflected their true consent. It provides for a complex advanced consent regime, one of those complex areas when it comes to medical assistance in dying policy, and it does all of this pre-empting what Parliament had determined, called upon and legislated in Bill C-14; namely, a legislative review that was supposed to take place this spring, but is not going ahead.

Now we are in this rushed process, instead of having an opportunity for members of Parliament to come together to hear from expert witnesses, to review the state of the law, to give consideration to the comprehensive reports of the Council of Canadian Academies and to receive diverse feedback on all of these issues. It need not have been this way. It should not have been this way, and it is regrettable that the government has so recklessly put us in this position by rushing through legislation that, arguably, could put vulnerable Canadians at risk and remove critical safeguards.

[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 agree with the importance of the legislation and the issue at hand. The intent of the government back in February was to ensure there would be more debate and the opportunity for us to explore the matter at hand further. No one anticipated what was going to happen with the coronavirus, and that has changed all aspects of our society. The legislation is before us because a court is obligating us to move as quickly as we can on it.

Would the member not agree that in many ways, during the first debate we had years ago on the legislation, there was still opportunity for us to have critical input? Does he have amendments that he would like to bring forward on this legislation?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, to answer the question from the parliamentary secretary to the government House leader directly: The issue of amendments will be studied at the justice committee, and it is possible amendments could be brought forward.

With respect to the court decision, I will say this. Nothing in the Truchon decision necessitated this rushed legislation. The government could have appealed it and chose not to. What is more, the government has legislated on matters that the court in Truchon, and Madam Justice Beaudoin was very explicit, confined to the question of being reasonably foreseeable.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Speaker, I thank my colleague for his speech.

The Bloc Québécois is in favour of the bill, as are the NDP and the government, obviously. However, we still do not know whether the Conservatives will support this bill.

In Quebec City, we saw a good example of how all the parties decided to pass a bill without resorting to partisanship and attacking each other. Unfortunately, I get the feeling that this bill will not pass unanimously in the House.

Does my hon. colleague agree that the bill will not be passed unanimously because of the many religious lobbies that are putting pressure on some Conservative members?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, In response to the hon. member for Lac-Saint-Jean, I simply reject the premise of his question. I have to say I have never viewed this as a partisan issue. This is a complex legal, moral and ethical issue.

I had the privilege of serving on the special joint committee with my friend, the hon. member for Louis-Saint-Laurent, and the late hon. member for Langley. We had different philosophical views on a number of issues, but we came together to follow the law and put forward what we thought were the best possible recommendations for safeguards to do what the Supreme Court called on us to do, which was to protect vulnerable persons while at the same time respecting individual autonomy. That is exactly how I will approach Bill C-7.

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

[Chris Bittle, Liberal, Parliamentary Secretary to the Minister of Transport]

Madam Speaker, I know the member and I had a lot of debates four years ago when we discussed this on the justice committee.

Conscience rights for doctors have come up a bit in his remarks and in other members' remarks as well. I was hoping we could take it back to our profession. As a lawyer, and as a civil litigator, I have had a number of individuals whom I met with and, through my own conscience, I did not want to take on their cases, but I was required by the Law Society of Ontario to refer those individuals on, even though I may not have wanted them to succeed or have success in their cases.

I was wondering if that was the same case in Alberta, and why is it different in that particular case? Should doctors not be required to refer patients on?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, yes, it is correct that the member and I did serve on the justice committee together during the deliberation and study on Bill C-14.

When we speak about conscience protections, they are fundamentally important. It is important to remember that the Supreme Court of Canada, in the Carter decision, did recognize that Canadians have a right, in certain circumstances, to physician-assisted dying, but at the same time the court expressly stated that no physician should be compelled to provide the procedure. It is important that the Carter decision be respected.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I listened with interest to the hon. member's speech before question period, and I respect that his concerns about Bill C-7 are based on deeply held convictions. Therefore, I wonder whether he would support my attempt to get the government to start the broader review of the bill in parallel with Bill C-7, according to the motion I placed on the Order Paper earlier today.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, that is something I will give consideration to, but what is disappointing is that it has come to this. It need not have been so. The government could have very easily proceeded with a legislative review that would have been able to address all of the underlying issues associated with the bill, instead they have opted for a rushed process.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, when Bill C-14 was discussed, I did warn the House that if we look to other countries and how they enacted medical assistance in dying, we would see that they began with death rates in their countries of less than 1% and grew to 8%, through people not following the safeguards. It seems to me that the government, in the new version, has removed all of the safeguards: the reasonably foreseeable death provision, the independent two witness provision, the 10-day cooling-off period provision and asking for consent immediately prior.

Would the member agree that all the safeguards have been removed, or are there ones that still remain in place?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I can say that some of the key safeguards that were deemed to be essential in Bill C-14 have been removed. The member speaks about the 10-day reflection period. It is unclear why that was removed when the law, as it stands, currently provides an exception for cases where the lack of capacity to consent is imminent. That would provide for a shorter reflection period, so it is unclear why the government would choose to remove it altogether.

With respect to the removal of the need for providing two witnesses, the need is now to provide only one witness, which is in fact a lesser safeguard than what is required when a testator executes a will.

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

Madam Speaker, in respect of the most recent intervention by the member for Sarnia—Lambton, the provisions, in terms of complying with Truchon, have eased in terms of safeguards. Other safeguards have actually been enhanced. Therefore, when someone's death is not reasonably foreseeable, we now have a situation where one of the two practitioners assessing eligibility must have expertise in the specific condition that is causing the person's suffering.

As well, we have a minimum 90-day period of assessment from the date of the request to the date of the actual delivery of the service, which is not something that is contemplated by the Truchon decision. It is an additional safeguard that has been put in place.

I would ask the member to comment on those components, as well as the components that address palliative care and the need to understand that palliative care is provided as an option, and physicians are to deem that option has been entertained by the individual applicant, which is an additional feature of this bill.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, in the interest of time, I will address the issue of palliative care and simply state that it was recognized that the absence of palliative care denies a patient true autonomy to make an informed choice. The government has to do a better job when it comes to establishing comprehensive palliative care across the country.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I rise today in the House to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying. It is long overdue.

I want to start by saying that the Bloc Québécois is in favour of adopting the principle of this bill, because it clarifies two aspects of medical assistance in dying.

The first has to do with access to medical assistance in dying when death is imminent, meaning that the person is terminal and is receiving palliative care before receiving medical assistance in dying. At least, I hope that is the case, because people in palliative care are not always the ones to request medical assistance in dying. I will come back to this.

The second aspect has to do with people for whom death is not imminent, who were denied access to medical assistance in dying as a result of the “reasonably foreseeable natural death” clause in Bill C-14. The court struck down this criterion, which was the key safeguard. This is what Bill C-7 is designed to fix, and we are happy about that.

As we begin debating the underlying principles of Bill C-7, it will come as no surprise that I am discussing them. It is precisely because we, as lawmakers, did not do our job four years ago when we were studying Bill C-14, that we find ourselves debating Bill C-7 today.

This is a democracy, and parliamentarians, not judges, must make the laws. We, the representatives of the people, the lawmakers, must be the voice of Canadians, especially those who are suffering. Judges only interpret the grammar of justice. They examine the laws we make, as well as the rights and freedoms, and determine whether a potential infringement of rights and freedoms is reasonable or not.

In this case, the court has handed down its ruling: The provisions of the current law, the former Bill C-14, are an unreasonable infringement of rights and freedoms. Furthermore, before Bill C-7 was tabled, two courts had ruled that the Criminal Code, amended by Bill C-14, violated the right to life, liberty and security of the sick person suffering intolerably or with a terminal illness.

We have to be clear about the issue at the heart of this debate: before being legal, this is an ethical debate. On one side of this debate is the paternalistic vision of the state and medical practice, while on the other side is a vision based on the autonomy of the individual and its corollary, the principle of self-determination. I know that all my colleagues in the House have good intentions. They want to do good, they want the best for patients and they are caring. I am sure that during this entire debate they will reflect the very values they are advocating and they will be just as caring and compassionate about the interests of patients.

However, we cannot claim to be caring and compassionate, in other words wanting to do good and what is best for an individual who has reached their breaking point at the end-of-life stage, if we are interfering with that individual's autonomy and self-determination, and if we refuse to respect their wishes on something as personal as their own death. The literature is clear on this.

The basic question is this: What business does the state have interfering in a decision as personal as my own death? My life is my own, as is my death. No one else, and certainly not the state, is going to die in my place. The courts had to reframe the limits of the state's power to intervene because we did not do our job properly.

All I want is for us to understand what is at stake here. I am referring to the law, which my Conservative friends often put up on a pedestal. The value of autonomy is conferred by law through the principle of self-determination, especially with regard to medical care. That is what I want to discuss here today with my colleagues. Let's talk about the autonomy bestowed on a person by law through the principle of self-determination.

In the biomedical context, the principle of self-determination is associated with an inviolable rule, namely the rule of free, informed consent. The rule regarding free, informed consent to treatment has never been challenged in emergency situations. Patients always have the right to refuse treatment.

My question for my colleagues is this: Why would it be any different for human beings experiencing intolerable suffering due to an irreversible illness or condition? Why would it be any different for competent individuals who are neither depressed nor suicidal and who have expressed a desire to live fully until they reach the limit of what they can tolerate?

In the Carter decision, which led to Bill C-7, the Supreme Court ruled that the provisions prohibiting medical assistance in dying violated the right to life, liberty and security of the person. People like Ms. Gladu, Mr. Truchon, Ms. Carter and Ms. Taylor have not reached the end-of-life stage. They might not even be in the terminal phase of their illness. That does not mean they have not reached, or are not in the process of reaching, the limit of what they can tolerate.

The court stated that the restrictive provisions in Bill C-14 were effectively shortening the lives of such individuals, that they violated their right to life by inciting them to commit the act before they were ready. That is what needs to be fixed right here, right now. Bill C-14 did a fairly good job covering the end-of-life care for terminally ill patients whose death was reasonably foreseeable, with the exception of the requirement for a second consent, which is sometimes not necessary and means that people suffer even though they gave their informed consent.

There is no issue for people who are terminally ill. The dying process has already begun and is irreversible. Death is imminent and foreseeable. The issue we need to address as legislators has to do with people whose death is not reasonably foreseeable and imminent. Under Bill C-14, Ms. Carter, Ms. Taylor, Ms. Gladu and Mr. Truchon were ignored.

What we, the members of the Bloc Québécois, want is respect for the moral autonomy of the dying. We often hear the expression “dying with dignity”. I must point out that dying with dignity does not mean having a sanitized death. That is not what it means to die with dignity. The dignity of a person is derived from their freedom to choose and respect for their free will. That is what it means to be a human being. That is what it means to respect a human being. When that is violated, we violate the dignity of the human being.

Whether the death is unpleasant or not is not the issue. The crux of the matter is to allow the human being to make a decision about the end of their life. Unfortunately, in the past, we won the right to die rather than undergo aggressive therapies. At the time, this was called passive euthanasia. The person was left to die without much attention and without death being the intent. Palliative care was still in its infancy. There was a great fear of administering one last fatal dose of medication, but it always ends up causing death. Because palliative care is still care, it does not strictly count as passive euthanasia.

Patients won the right to die rather than undergo aggressive therapies, because people did not use to die from cancer; they died from the treatment. Medical paternalism has at times gone too far and has been less than helpful.

Today's patient-practitioner relationship prioritizes collaboration, negotiation and respect for the patient's choice. Patients alone can assess their quality of life, and that must be respected, which is why medical professionals must be transparent with their diagnoses.

Patients won the battle for the right to die rather than undergo aggressive treatment, and that evolved into palliative care as we know it. For a long time, palliative care was thought of as the only solution that would allow people to die with dignity, but if that is the case, why is it still so hard for people to get that care? If that is the solution, why is there still such a shortage of palliative care units?

Sometimes, even the best, most carefully managed palliative care in the world cannot alleviate people's suffering. Bioethics teaches practitioners to remember that patients come first, and that means listening to them.

That is true for Ms. Rodriguez, Ms. Carter, Ms. Taylor and Mr. Truchon, and it is true for Ms. Gladu and many others who have continued to suffer throughout this pandemic while they wait for us to do our job. Contrary to what some people think, these individuals are not suicidal. They want to live as long as possible.

I watched a very interesting interview with Ms. Gladu. What did she say to us? What did she want? She wanted the freedom to choose. Having this freedom greatly diminishes the suffering and anguish.

With Bill C-14, the government said its intention was to protect the most vulnerable. Is there anyone more vulnerable than a person who is suffering from intolerable pain, who is living with an incurable illness and who is being told to go to court for the right to choose and to die with dignity? Is there anything more important and more intimately personal for an individual than their own death?

I have a hard time understanding my Conservative colleagues' argument that the state must decide for an individual, when they are so economically libertarian. Several Conservatives felt that Bill C-14 went too far. The courts said that it did not go far enough and that it violated fundamental rights.

Elected members of the National Assembly of Quebec advanced the debate without pitting palliative care against medical assistance in dying. They chose to include requests for assistance in dying as part of a continuum of end-of-life care that is consistent with palliative care. Whether we are talking about a degenerative disease or an illness that causes extreme pain but is not terminal, let us not pit those two realities against each other. Respect for human dignity includes proper support when one is dying, which requires doctors to have the humility to recognize that they cannot always help people manage their pain adequately.

Our society recognizes people's right to self-determination throughout their lifetime but takes it away from them at the most intimate moment of their lives. In so doing, we think that we know what is best for people or that we are doing the right thing, when we are actually undermining human dignity, their freedom to choose.

There is no more important moment in a person's life than their death. Learning to live is learning to die. Learning to die is learning to live. I say that because the clock starts ticking the moment the doctor cuts the umbilical cord.

The Carter decision and the Baudouin ruling sent us back to the drawing board. We need to do our job as legislators and stop off-loading the problems and the ethical, social and political questions onto the courts. We have a job to do as legislators.

There is a sociology of law. In a society, the law evolves with people's consciences. I know I am straying from the technical details of the bill, but we will have plenty of time to discuss them in committee.

The bill proposes that a person who is not terminally ill must consent twice and be bound by a 90-day period. I really wanted to talk about advance consent, since that is about all that is missing from the bill.

Bill C-7 does not address degenerative cognitive diseases, which are predictable diseases. Doctors can tell patients how they will progress. People with these diseases often remain of sound mind for years and do not appear to be sick, but eventually, they become forgetful and then die. They can also experience complications from being bedridden or immobilized or conditions other than that disease. I think a person with Alzheimer's, for example, should have the opportunity to make an advance request. This bill does not take those people into account.

Still, I said at the outset that we agreed on the principle and the grounds for discussing this bill. We will have time to talk about these issues. I urge my colleagues to bring substantive arguments to the debate on the adoption in principle of medical assistance in dying.

I remember when the previous Parliament studied Bill C-14. I heard arguments about how we were putting ourselves on a slippery slope. Some people were practically saying that long-term care homes would turn into euthanasia factories. If evil people are working in our health system, they should be fired, no matter what job they do, because they have no business there. I am not buying the argument that this is a slippery slope because people are evil.

We must assume from the outset that everyone working in the health care system is caring and compassionate. Increased health transfers would enable these people to provide better care, and maybe there would be more palliative care units in hospitals. Even though people have been saying for 50 years that palliative care is the only solution, I do not believe it is. It makes no sense that people do not have better access to palliative care in this day and age.

I would like to end my speech, which I trust was a substantive one, with a wish for all of us, here in the House, concerning the delicate issue of the end-of-life. I sincerely hope—which is what the patients who turned to the courts were hoping for—to face death serenely, peacefully and without suffering. That is my wish for everyone, because that is the best wish we can make for a human being. We should imagine ourselves being at peace on our death bed and being able to let go because we have palliative care to support us in our journey towards death. That is the best wish we can make for a human being.

I am therefore calling for a debate on both the substance and the principles. I am also appealing to the humanity of all my colleagues so we can finally provide an adequate response to all those who are suffering and have been waiting for far too long.

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

Madam Speaker, I would like to congratulate my colleague, the member for Montcalm, for his very honest, very direct and very analytical speech.

I would simply like to highlight a theme he raised, the protection of individual autonomy and also of vulnerable persons. We are proposing to eliminate the 10-day waiting period because our consultations indicated that, in reality, this waiting period does not safeguard anyone; rather, it prolongs their suffering because vulnerable people want to act without delay, certainly faster than after 10 days. What does the member think of the idea of eliminating this 10-day period, and will this help better protect vulnerable persons?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, as I noted, this aspect of the bill seems perfectly adequate.

Far too often people who were dying, who were at the end-of-life stage, still had to wait another 10 days. Sometimes that second consent meant reducing sedation to be sure that the person understood exactly what was at stake. Sometimes the sedation is reduced so much that the person ends up suffering for no reason because everything that had already been done was clarified several times. Indeed, it was an unnecessary safeguard that made people suffer unnecessarily.

I think there are also contextual issues. If they have any doubts about doing what needs to be done, practitioners are also able to get that certainty in a clear and precise way. I think that is an important addition to Bill C-7.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I listened with great interest and care to the member's speech. It was an important contribution.

I know the member is aware that the original legislation, Bill C-14, required a broader legislative review of medical assistance in dying. That review was supposed to start in June.

Will the member and members of the Bloc be supporting efforts to get this broader review going in parallel with Bill C-7?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, absolutely, as critic on the matter, that is what I wanted in February. There are some issues that remain on hold and that should be discussed at greater length during the legislative review. I hope that review will start as soon as possible.

[Christine Normandin, Bloc, Saint-Jean, QC]

Madam Speaker, I thank my colleague for his speech, which was compassionate and inspiring, not to mention very well put together and documented. I am very proud that he is our colleague.

He spoke about the fact that, without the bill, some people would resort to the courts to finally win their case. Another option for some would be to go abroad to obtain MAID.

In this context, does he believe that the bill provides a better framework for MAID and ensures that everyone has equal access and that finances are not an impediment?

Those with the means to go abroad can do so even if they are far from their family and home, whereas others cannot. In a context of harm reduction, shaping the bill ourselves and offering it to everyone, rather than trying to make it impossible to do something, which is in any event somewhat inevitable—

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

The hon. member for Montcalm.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, that is a very good interpretation of the positive effects of the bill.

We must absolutely ensure that people are supported when they are about to die so they may have a better death. In addition to the issue of money, I find that going abroad is not an appealing or adequate solution. It is an interesting point.

However, I believe that we should further expand access to MAID with advance requests. I find that is an important element that is missing from the bill.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I want to ask the member a question respecting advance consent. In the bill, there is no time limit in which that consent would expire. If contemporaneous consent is no longer required, does the hon. member see the need for a time limit in terms of the validity of such a waiver to guard against someone who, hypothetically, could make a request well in advance and have the procedure carried out while very ill without their knowing?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the bill does not provide for advance requests. There is just a 90-day waiting period for people who are not terminally ill but who are in a situation like Ms. Gladu's or Mr. Truchon's. There is a 90-day waiting period after medical assistance in dying is requested. Bill C-7 does not cover the issue of advance requests.

We are going to amend the bill for people with degenerative diseases. At that point, I think we can talk about what kind of provisions would cover that aspect of dying with dignity.

[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 appreciate the member's comments about the importance of people to share their real thoughts on such an important issue. In the last go-around we had a great deal of discussion about palliative care, which I hope to address further at an opportune time. One of the benefits of having this debate is that we become a little more sensitized to some of the other things that we could be doing. Palliative care for me is really important.

Does my colleague have any further thoughts on the issue of palliative care? Communities do need to focus more resources in that area.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the funny thing is that people have been saying it is the only solution for 50 years now. Why is it that some hospitals still do not provide palliative care because there is a shortage of units?

Nowadays, in some hospitals, people who request medical assistance in dying cannot experience that end-of-life journey in a palliative care unit, even though palliative care is supposed to be end-of-life care and relief from pain and suffering in an environment that supports human dignity. How is that possible?

We must not think of palliative care and MAID as being mutually exclusive. It is a continuum of care that should be available to these patients. Those who are not terminally ill, for whom the dying process has not already begun and is not irreversible, are also entitled to a suitable environment. Bill C-7 makes that possible, and much more clearly than Bill C-14 did.

That was not possible under Bill C-14, with its unassailable reasonably foreseeable natural death criterion, which the court said undermined patients' right to life.

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

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, let me start by saying how much I would rather be in the House today than at home managing a small raise hand function on the screen and our own barking dogs. More seriously, let me say how much I would rather have completed this debate in March when it comes to avoiding or preventing unnecessary suffering.

COVID-19 has required us all to make adjustments. Obviously the adjustments we have to make as parliamentarians pale in comparison to the experience of most Canadians, especially those who have lost loved ones to COVID-19; those who have lost their livelihoods; those who are still struggling to make ends meet, to keep a roof over their head and to put food on the table; and those who are struggling with the pandemic while contending with life-threatening illnesses.

Let me also preface my remarks on Bill C-7 with a few words on why we find Bill C-7 before the House at all. There is a tendency by both the Liberals and Conservatives to emphasize that we are here because of a deadline imposed for changes in medical assistance in dying by the Quebec Superior Court decision in the Truchon case. That is true technically.

However, it obscures the role of the plaintiffs in that case, Jean Truchon and Nicole Gladu, who went to court to contest the provisions of Bill C-14, which they found violated their charter rights by causing or prolonging unnecessary suffering for those at the end of life and for denying individuals autonomy of decision-making over the end of their own lives.

I actually want to thank the plaintiffs today who brought us here, and also to stop for a moment to express my condolences to the family of Mr. Truchon, who left Canada a better place as a result of his attempt to improve the way we deal with medical assistance in dying, when he left us in April.

When it comes to medical assistance in dying, for New Democrats, our priority has always been, and remains, avoiding unnecessary suffering being inflicted on those who are already suffering from terminal illnesses and at the same time avoiding prolonging suffering for their families who have to bear witness to that suffering.

We were glad to see this legislation come forward in February, very promptly for a new government, but we are disappointed that we are here in October, starting over again. Some of this delay was due to COVID-19, but the blame for this delay lays equally at the feet of the Liberals for proroguing the House.

In February, there was recognition by all parties that there were two pieces of work outstanding on medical assistance in dying. First was the need to amend Bill C-7 to conform with the charter as demanded by the Quebec Superior Court ruling in the Truchon case, which found the current law too restrictive. This is the very reason New Democrats voted against Bill C-14 when it originally came before the House.

Even before the court ruling, there were many calling for changes. Those who listened carefully to the terminally ill, their families and practitioners providing the medical assistance knew well the unnecessary suffering that was being inflicted, and continues to be inflicted by our current law.

The second task with regard to medical assistance in dying was to conduct a legislative review of the broader issues around MAID after four years of our experience with it. This is not to be confused with a normal review of the specific legislative changes proposed in Bill C-7. This broader legislative review of the issues arising out of medical assistance in dying was mandated in the original legislation and was supposed to start this June.

Bill C-14 required that the review specifically look at the question of advance requests, requests from mature minors and requests where mental illness is the sole underlying condition, but it was not to be limited to those topics.

I am disappointed that the second task appears to have fallen off the agenda for the Minister of Justice. Early this morning I asked him to commit to starting this broader review in parallel with the examination of the changes in Bill C-7. As I told him then, I put Motion M-51 on the Order Paper today to create a special committee of the House that could conduct this broader review at the same time as the justice committee deals with the urgent changes needed and required because of the court decision and because of the unnecessary suffering inflicted by our current law.

I want to talk about each of these two tasks in more human and practical terms by starting with very personal stories, one for each of these. It is clear to me that the current legislation has some unintended and cruel consequences. These were clearly demonstrated by what happened to a very good friend of mine.

On January 1, 2019, I went to a traditional New Year's levee in one of the communities in my riding. When I arrived, I was not surprised to be greeted enthusiastically by someone I had become close friends with over 10 years involvement in public life together. I was surprised, however, to see her right arm was in a sling.

I am not going to name this friend today because I did not seek formal permission from her family to do so, but I am telling her story today as I trust she would want her unfortunate experience with medical assistance in dying to make a difference.

When I asked my friend what was happening, she recounted how, suddenly and inexplicably, she began having trouble using her arm over the holidays and that she was going to have it checked out as soon as possible. A month later, she began to see other symptoms and she found out that she had an inoperable brain tumour the size of a raisin but growing, growing slowly but growing nonetheless. This was a condition that would prove to be painful, debilitating and terminal.

As her condition rapidly deteriorated, she began to make plans for her end of life. Just four short months after a diagnosis, my partner and I received an invitation to what she was calling a masquerade ball in her honour. My friend was incredibly brave and never lost her sense of humour or her love of life right up to the end.

On that Saturday, she checked herself out of the hospital to celebrate her life with us that night. Rather than, as she joked, allowing us to get together after she was gone and talk about her then, she preferred to see us before and to hear what we had to say before she had to leave. Just days later, we found out she was gone. With her death, we were not only deprived of a larger-than-life member of the local arts community. We were also deprived of a friend whose enthusiasm for life had always been infectious.

Why such a sudden exit? The current law requires that those who have already been assessed and approved for medical assistance in dying be competent when the final moment to receive that assistance comes. Therefore, my friend was forced to depart weeks if not months early because she feared the loss of competence that might result from her brain tumour if she waited too long, and that this loss of competence would prevent her receiving medical assistance in dying and thus inflict weeks or months of suffering on her as the patient but also, more important to her, weeks of suffering on her family and friends who would be forced to witness a prolonged dying.

Bill C-7 would fix this by removing the requirement for final consent for those who are already assessed and approved for medical assistance in dying. This would take away the need to go early in order to avoid the loss of competence that now prevents receiving medical assistance in dying.

The bill would also make the process more straightforward in several other ways. It would do so by taking away the mandatory 10-day waiting period, reducing the number of witnesses required from two to one and expanding who could serve as a witness. These are all things practitioners have told us are unduly restrictive and only end up unnecessarily prolonging suffering.

Right now, I should take a moment to thank four doctors who have been kind enough to share with me their experiences in providing, or not providing in some cases, medical assistance in dying to hundreds of patients. Again, I will not name them today to respect their privacy, but my conversations with these four incredible people have helped me understand how medical assistance in dying operates in real life.

I should mention one other change in Bill C-7 that would have more substantial impacts. That is the removal of the requirement that death be imminent before one can receive medical assistance in dying. Bill C-7 then sets out a more restrictive process than that for those whose death is imminent and where there is more time for assessment and decision-making. However, I should emphasize, Bill C-7 still maintains the high standards set in the original legislation that in order to receive medical assistance in dying patients must have a condition that is incurable, must be in a state of irreversible decline and must face intolerable suffering. This means that Bill C-7 would not open the door for medical assistance in dying quite as wide as some have suggested.

My second story, also very personal, deals with one of the broader issues that the review of MAID was supposed to deal with. This story is my mother's story. My mum passed away just short of five years ago, during the debate on MAID. This is a story I have told before during the debate on the original bill, but one which still lacks resolution.

My mother had always been very clear with my sister and me about her wishes regarding the end of her life. For her, it was simple. She asked us that if she ended up bedridden, unable to shower or feed herself, and did not know who we were, then to please let her go. She suffered from dementia and other underlying conditions that were complicated by a serious fall and, fortunately for her, she was not forced to endure for long those conditions she had feared.

Unfortunately, the kind of advance directive or advance request that my mother had wanted to give is still not allowed under the existing legislation. I know many in my community, and more specifically, many in my own social circles, fear just such an outcome and feel that they should be able to make their own end-of-life wishes known and have them respected, just as they are now when it comes to questions of refusal of medical treatment. I tend to be of the same opinion. However, my discussions with practitioners providing medical assistance in dying have persuaded me that this question is not as simple as it appears on its face. This remains one of the important issues the legislative review of the current legislation can address and is mandated to address by Bill C-14.

As I mentioned earlier, there were other issues that were assigned to this broader review in the original Bill C-14, including requests from mature minors and requests for mental illness as the sole underlying condition, but one concern was missed. Let me take a moment now to address the concerns of disability advocates that, with the removal of the requirement that death be imminent, there will be pressure on the vulnerable in our society to choose medical assistance in dying.

First and foremost, as a society we can and must do better in offering support to people with disabilities. Failure to provide necessary resources to ensure that everyone can enjoy full and equal participation in life is a current and ongoing black mark on all of us. We have only to look at the failure to deliver additional assistance promptly to persons with disabilities during this pandemic to remind ourselves how often we forget about those living with disabilities. However, we should not dismiss the concerns of the disability community about medical assistance in dying out of hand. The legislative review is the place for us to consider seriously the question of whether the existing safeguards preventing pressure on the vulnerable to choose medical assistance in dying are, in fact, sufficient.

Before I conclude, I want to remind members that, as a society, we must do better in the job of end-of-life care. Again, COVID has demonstrated the tragic deficiencies in long-term care in ways I hope we will not ignore.

New Democrats will support the bill and help expedite its passage in order to bring an end to unnecessary suffering and to meet the deadline imposed by the Quebec court in the Truchon decision, but this support has always been predicated on going forward with a larger review without delay.

I have drafted a motion, Motion No. 151, which I have tabled today. I look forward to hearing a positive response from the government on this. We have just heard a positive response from the Bloc, and I am hoping for a positive response from the Conservatives.

Proceeding with Bill C-7 without proceeding with the broader review is only getting half the job done on medical assistance in dying. At the same time, failure to conduct the broader review potentially undermines public support for medical assistance in dying, which, so far, has only continued to grow. In fact, I believe this is one of the most important questions that could ever come before Parliament.

I look forward to the debate on the specific improvements that we can make to Bill C-7, but I urge all of us to consider undertaking the broader review of issues around medical assistance in dying without delay.

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

Madam Speaker, I thank the member for Esquimalt—Saanich—Sooke for his comments today, his work on the justice committee, his support for this legislation and also for underscoring the important role that the litigants have played in the evolution of this.

I would highlight the theme that the member raised when he talked about the sanctity of life. It is quite clear for those who have read the jurisprudence, and I know that he has, that in both the Carter and Truchon decisions the courts talked about the notion that the charter protection of the right to life under section 7 means that when people are prematurely considering availing themselves of medical assistance in dying because they worry about being able to give that final consent and having the capacity to give that final consent, when they take their lives prematurely, it actually violates their charter rights. This was outlined in both the Carter and Truchon cases.

I wonder if the member opposite could comment on that aspect of the decision, because it is very important in terms of the protection of the vulnerable, which is one of the things the legislation is attempting to address.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I believe Bill C-7 raises an important question around consent at the final moment. As I said from the very personal story of my friend, I got a picture of how this works in real life.

We can talk about the court decisions, but today I was hoping to introduce the reality of the family and friends of those who are facing unbearable suffering at the end of life and who are really looking to us to make the improvements they are calling for, to make sure we do not unnecessarily prolong suffering and that we do not unnecessarily inflict it on the families of those patients.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Madam Speaker, since the bill has come in a second time in two sessions of Parliament, I would like to ask how important is it for the government to listen a bit more this time and to take all the amendments from different parties into consideration to make sure that the bill would be the bill we are all looking for and Canadians are looking for.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, there are two tasks here. The first is to look at the amendments to medical assistance in dying legislation in Bill C-7 to make sure that they both conform to the requirements of the court decisions and the charter, but also to make sure they reflect the lived experience of people dealing with medical assistance in dying.

The second part is the broader review. I hope we get support from the Conservatives to start this parallel review that can look at the larger questions around medical assistance in dying and make recommendations to Parliament, if necessary, for further legislation.

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

Madam Speaker, Bill C-7 proposes removing the requirement for final consent for eligible individuals whose natural death is reasonably foreseeable.

This requirement could result in a person not receiving enough sedatives to relieve their pain because they need to be fully competent at the time of the second consent.

I would like to know my colleague's thoughts on whether we should also consider the possibility of granting the right to waive final consent in cases where natural death is not foreseeable.

Should we be considering the issue of advance consent, for example, to ensure that people suffering from degenerative or incurable diseases do not have to go before the courts to challenge the terms and conditions surrounding eligibility for medical assistance in dying?

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, the goal here is to avoid unnecessary suffering, so I am very supportive of providing for the waiver for final consent and eliminating the 10-day waiting period.

When it comes to advance directives, I tend to be in favour of people being able to make their instructions for end of life and have them respected. As I said, my talk with practitioners has convinced me that we need a broader debate about the issues around advance directives, and that is why I hope to see this parallel broader review start along with the consideration of Bill C-7.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Madam Speaker, I appreciate the honouring of the stories. I have had a dear loved one choose to use MAID for the next step in his journey. It was a very painful and beautiful day for the loved ones who were with him. One of the things I remember distinctly is that his doctor of over 30 years was a very strong Christian. He felt he could not take that step, but still showed up and held hands with him in his final moments. I remember feeling such respect and love in that room.

When we talk about the subject, the most important thing is the unnecessary suffering. We need to end that, not only for the person experiencing it but for the pressure of watching their loved ones go through that unnecessary suffering.

Could the member speak more about how important this broader review is? When we look at advance directives and vulnerable populations, all of us in the House, regardless of our point of view, want there to be a thoughtful discussion that provides this place with very thoughtful responses and actions we can take in the future.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I thank the member for North Island—Powell River for also sharing her personal experience with medical assistance in dying.

My background is as an academic and as a member of Parliament. I think we have the same tendency to get into the legal details and forget about the lived experiences that lie behind these kinds of cases and issues. By having a broader review of the issue around medical assistance in dying, we can help build a consensus about appropriate measures when it comes to advance directives and making sure that vulnerable populations are not under undue pressure. This review was mandated by the original legislation and was seen as an important part of the way we consider the experience we have actually had with medical assistance in dying. I am disappointed the government seems to have let this fall off its agenda and is leaving it to the rest of us in Parliament to push forward with this review.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, my question for the member has to do with the disabled. He made a comment about the disabled and in the legislation it looks like there is a different treatment of disabled people to other people. I am concerned about that. I wonder if the member is also concerned.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, the hon. member's question reflects something that I think is very important, which is that when concerns by a community are raised they be fully explored and fully considered, not just dismissed out of hand, regardless of what our own personal opinions are on those concerns. The place I believe we should do that is in the broader review conducted by the House that I suggested in the motion I tabled today. I want us to hear from the disabled community and its advocates and to think carefully about the issues they are raising. I want to make sure the safeguards we have in place to prevent vulnerable people from being pressured into selecting medical assistance in dying are actually adequate.

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

Madam Speaker, I will be splitting my time with the member for Glengarry—Prescott—Russell.

I am pleased today to speak on Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying.

As members know, clearly we are here because of the decision of the Quebec Superior Court in the Truchon case. That decision struck down a particular criterion under both the Quebec and Canadian regimes with respect to the end-of-life nature of medical assistance in dying, which is the reasonable foreseeability of natural death criterion, in particular, at the national level.

I will agree with some of the members we have heard from today that this is perhaps the most important issue we have faced in the last five years of this Parliament, both in the last Parliament and today. Fine-tuning the approach to medical assistance in dying is something that is intensely personal, but also intensely important to all of us in the chamber and to all Canadians.

What we should know at the outset is that the court's ruling in Truchon applies only in Quebec. We heard the minister speak about this. The court suspended its declaration of invalidity for a period of six months, until March 11.

It is important for this chamber to recall that on February 17 of this year, the Attorney General of Canada filed a motion to request an extension to give Parliament sufficient time to enact an appropriate response to ensure consistency in the criminal law. Given the circumstances of COVID and the pandemic, an extension was further sought and granted in June until December 18 of this year. Therefore, December 18 is the new deadline.

Before I go into some of the details in the bill, I want to start out with two important provisions that relate to conscience protection. This was raised in today's debate and was also raised in the context of an earlier debate on this bill in a previous parliamentary session. I think it is critical the record be crystal clear that conscience protections are robust in this country and are entrenched in law.

I am responding here to questions that were raised by the member for Sherwood Park—Fort Saskatchewan. The first location for conscience protections is in the preamble to the old bill, Bill C-14, which states, “Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms”.

I have had further questions from members of the official opposition about why it is only in the preamble and not in the statute. That assertion is categorically incorrect, because conscience protections are in the statute itself. Section 9, page 8, of Bill C-14, which amended the Criminal Code, states, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

Lastly, the third point I will refer to is from the Carter decision of the Supreme Court, which has been the subject of extensive discussion in this chamber thus far. I am reading from paragraph 132 of the majority reasons in Carter. The court states, “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

Those are the three instances where the freedoms set out in section 2 of the charter are taken into account. One is jurisprudential and the other two are statutory. The fourth one is of course section 2 of the charter, which protects freedom of conscience for all Canadians, including those who practice medicine. Therefore, the assertion that somehow conscience rights are not protected or are somehow being eroded is categorically false.

Another point on what is being addressed in today's debate is the notion that a culture of overly facilitating medical assistance in dying is upon us. Here I am referencing some of the interventions made again by the official opposition, particularly the member for Sarnia—Lambton, that somehow this government bill is pushing us further toward predatory practices by health care practitioners or toward disavowing the right to life, liberty and the security of persons who are vulnerable, including persons with disabilities. That is categorically false and is not commensurate with what is in the evidence.

The evidence that we have is that, in total, nearly 14,000 medical assistance in dying deaths have happened in the country in the last four years. The average age of the people accessing MAID is 75 years old. It is being accessed equally by men and women, 51% of the time by men and 49% of the time by women. The most common medical condition is cancer, followed by neurological conditions. In that 67% of all people who access it have cancer; second, come neurological conditions; and third, come cardiovascular conditions.

Very important, in the most recent year of analysis, a grand total of 5,444 people accessed MAID in this country. That represents 1.89% of all deaths in the country. I am saying that specifically for the purposes of the debate, because it is important for Canadians to understand that there is not some sort of culture of medical assistance in dying that is being foisted upon unwitting individuals. I will elaborate upon this going forward.

I would like to address a few aspects of this bill. The eligibility criteria have changed, as the Minister of Justice mentioned this morning.

There are two sets of safeguards. One applies when the individual's death is reasonably foreseeable, while the other applies when it is not. The bill adds new safeguards for this second category.

The bill proposes allowing final consent to be waived on the day of the procedure in exceptional circumstances.

Earlier in the year, the minister, along with the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, as well as myself and other parliamentary secretaries, conducted a very vast consultation process. We heard from 125 individuals, who are experts in this field, whether they are delivering it or acting on behalf of disabled individuals, from nurses, doctors, etc. We also heard from 300,000 Canadians through their responses to a questionnaire that outlined various scenarios.

The views of those individuals were quite concrete in the direction they were seeking. They wanted to be empowered in terms of their autonomy, dignity and their choices. They were seeking fewer obstacles to what had evolved to become an overly restrictive regime, as identified by the court in Truchon. That important feature must be canvassed here. What is important to understand is that the input received was critical to the development of the bill.

As part of the proposed amendments to the Criminal Code, the reasonably foreseeable death provision will be removed from the eligibility criteria. This is in response to the Truchon decision.

In terms of legal impact, this amendment would mean that people whose death is not reasonably foreseeable would be eligible for medical assistance in dying if they meet all of the other eligibility criteria.

This point is very important. The bill proposes to exclude persons whose sole underlying condition is mental illness. This has been touched upon by different people who have already intervened in the context of today's debate and in previous debates in the previous session of Parliament. This is important, as was outlined by the minister this morning. It recognizes the increased complexities and risks associated with such cases, which were highlighted by many practitioners, stakeholders and experts at the main round tables.

What is also very important is that the Canadian Mental Health Association supports the position we are taking with respect to excluding mental illness as a sole underlying condition. This complex issue must be examined carefully as part of the parliamentary review of the legislation on medical assistance in dying.

Importantly, the Government of Québec has also announced the exact same study for the exact same provision in the context of mental illness. Issues of consent and capacity and properly being able to diagnose this and having a prognosis are critical.

I will move to some of the comments that have been made. It is important for people to understand the safeguards are under two tracks. Those safeguards respond to persons whose deaths are reasonably foreseeable and those whose death is not.

With respect to some of the aspects raised in the context of today's debate, please understand we have taken the 10-day period of reflection out of the legislation. The basis for this was that the safeguard was not doing the work it was meant to do. As opposed to protecting those who were vulnerable, it was increasing vulnerability insofar as it was prolonging suffering.

We have heard some people were so concerned about their inability to provide their final consent after 10 days that they would stop taking their pain medication, which was simply creating further suffering just to maintain the ability to provide final consent.

With respect to how we can ensure informed consent is applied when it has not been solicited actively, there are two responses. This is with regard to the advanced consent regime.

The government is conscious of the Audrey Parker situation and we are seized with it. When people have been assessed and approved for this procedure and when they make a determination they want to access it and provide consent in writing, that consent would be sufficient.

In direct response to whether it could be vitiated, yes it could. First, if the person has not lost capacity, consent could be vitiated. Second, it could be done by a physical gesture that could be interpreted to fully and finally eliminate that consent for the purposes of the practitioners. That is in response to a question posed by the member for St. Albert—Edmonton.

This bill strikes a balance and the balance is important, a compassionate response that protects vulnerable people, respects their dignity and autonomy and what is required by the Constitution. I am very hopeful we can achieve all-party consensus on this fundamental issue.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I would like to talk a bit more about the conscience protections. The hon. member mentioned it was in the preamble, in section 9 and in the charter. Why then does the government not immediately address the situation existing in Ontario, where physicians and nurses are being forced to participate in MAID even if it is against their religious beliefs?

[Arif Virani, Liberal, Parkdale—High Park, ON]

Madam Speaker, I will clarify that it is in a fourth place as well. It is in the penultimate paragraph of the Carter decision.

The reason the government is not intervening in respect to a jurisprudential decision in Ontario is because that jurisprudential decision complies with the charter. The regime in Ontario is that a person is not compelled to provide this service, as the court has indicated, but providing a referral is required, pursuant to the rules enacted by the College of Physicians and Surgeons of Ontario. That was deemed constitutionally compliant. That is sufficient for the purposes of protecting the Charter of Rights at issue.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Speaker, I want to thank my colleague for his speech. I appreciated his knowledge on the topic and his compassion in all this. It is very important.

The Bloc Québécois supports the bill in principle, as my colleague said earlier. I appreciate the fact that we can work together in a non-partisan way.

However, we believe that the bill may not go far enough in certain respects.

Does my colleague believe that the issue of advance consent should have been covered in this bill?

[Arif Virani, Liberal, Parkdale—High Park, ON]

Madam Speaker, I thank my colleague for this question and thank the Bloc Québécois for its support.

The notion of advance consent was put into this bill because it was necessary to accommodate Audrey Parker's request, which was covered extensively by Canadian media.

We must maintain an individual's autonomy and respect their choice, but also avoid prolonging their suffering or making a decision that would lead to premature death.

In English terms, it is the notion of not having someone accelerate and go to their death prematurely, simply because they had to wait for the ability to provide that final consent. That is the reason why we decided to insert it as consenting to the regime.

[Gord Johns, NDP, Courtenay—Alberni, BC]

Madam Speaker, first, we are pleased to see the reintroduction of Bill C-7 as part of the effort to end unnecessary suffering for those who are facing the end of life. I had a note from Jule Briese. She cited that her husband, Wayne, who is challenged with Alzheimer's, currently meets the criteria for medical assistance in dying as long as his window of capacity for informed consent does not narrow, preventing this. He has ongoing appointments at three-month intervals with his geriatric psychiatrist to assess his capacity for consent. She cites that this is extremely stressful, and could result in having to make this choice sooner rather than later. Legalizing advance requests for those with dementia to make the choice for MAID compassionately supports the individual's right to end-of-life choice guaranteed by the Canadian Charter of Rights and Freedoms.

Could the parliamentary secretary speak to Julie and Wayne, and talk about how this legislation is going to help them? We certainly do not want him to have to choose to end his life prematurely, and this is a directive he would like to have fixed in the bill.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Madam Speaker, I thank the member for this point and the case he is raising about Julie and her spouse. It underscores the very sensitive and delicate nature of what we are facing. What I can say in all candour is that we had a regime that had been deemed overly restrictive by courts. We have expanded the regime to allow for greater accessibility to medical assistance in dying. The notion of an advance consent is applicable here, but not yet an advance directive. That is something that was studied by the academic council when it looked at three separate areas. It would form part of the parliamentary review, and it is something that merits scrutiny. The safeguards that need to be put in place are that much more rigorous. That is why it is not inserted into this bill, but is something that obviously merits a lot of scrutiny and consideration going forward.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, before I begin, I want to wish you a happy Thanksgiving.

I appreciate this opportunity to discuss the Government of Canada's consultation process to inform amendments to the federal legislation on medical assistance in dying. My colleagues who hosted the round tables, the Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, had the privilege of hearing the perspectives of experts and other key stakeholders.

In September of last year, the Superior Court of Quebec handed down its decision in the Truchon and Gladu case.

The court found that the eligibility criteria of the federal and Quebec provincial legislation on medical assistance in dying that required a person to be at the point of reasonably foreseeable natural death, or at the end of life, were unconstitutional.

The federal government did not appeal the Truchon decision. Despite the short time frame, our government felt it was critical that any amendments to the law should be informed by evidence and feedback provided by Canadians, provincial and territorial governments, and key stakeholders.

That is why, during January and early February, our government launched an online public consultation and hosted round tables with stakeholders from across the country. During this process, participants shared their views on key aspects of the law governing MAID, including eligibility requirements, safeguards and advance requests. An online survey led by the Department of Justice ran for two weeks in January. The survey closed with over 300,000 responses: the largest number of responses the department has ever seen for any public consultation.

Our government also hosted a series of 10 roundtable meetings in eight cities across the country. More than one hundred participants representing nearly every province attended these national and regional meetings, including academic experts, health care providers, medical and nursing regulators and other stakeholders. While the meetings included some representation from indigenous communities, a specific roundtable was also held with indigenous stakeholders.

Our government’s ultimate objective is to have a law that facilitates access for those who are eligible for MAID and provides protections for vulnerable people.

Feedback from both the online survey and round table discussions indicated wide support for removing the eligibility requirement that an individual's natural death be reasonably foreseeable. There is general comfort among Canadians and stakeholders with the idea that MAID should be available to eligible individuals who are suffering intolerably, but not necessarily at the end of their life.

Many organizations representing persons with disabilities expressed concerns about the removal of the requirement for reasonably foreseeable natural death, pointing to the potential for societal harm if disability were to be seen as a reason to terminate life.

Concerns were raised about extending MAID to include specific medical conditions where individuals may be more vulnerable, in particular, to those with mental illness. Most felt it was too early to allow MAID for persons with mental illness as their sole underlying medical condition and advocated taking additional time to study this issue.

The concerns about access to medically assisted death for individuals whose sole underlying medical condition was a mental illness were consistent with the findings of the Council of Canadian Academies report on this topic. As mandated by the 2016 legislation, our government commissioned three independent reviews on topics that were not included in the law at the time: requests by mature minors, advance requests and requests where a mental illness is the sole underlying condition. Of the council's three reports, the one addressing mental illness was the source of the greatest divergence among the experts. Ultimately, they could not reach consensus on ways to address the complexities and mitigate the risk associated with mental illness and MAID.

Many round table participants expressed support for creating a two-track system of safeguards, depending on whether a person's death is reasonably foreseeable. Many respondents to the online survey were open to the idea of some stronger safeguards for people who are suffering but not dying.

The proposed legislative changes include new or modified safeguards for individuals when their death is not reasonably foreseeable. It is proposed that one of the physicians or nurse practitioners assessing an individual's eligibility for MAID would need to have expertise in the individual's medical condition. In addition, individuals would be subject to a 90-day assessment period to ensure enough time is devoted to exploring relevant aspects of the person’s situation and to discussing possible options to alleviate their suffering.

During the round tables, participants expressed overwhelming support for removing the current requirement for two persons to witness an individual's MAID request. They cited the difficulties in finding independent witnesses based on the current definition in the law, which excludes health care providers and personal support workers.

Many individuals living in nursing homes or other residential settings have limited family or social networks. The amended legislation would reduce the required number of witnesses to one, and would not permit individuals who are paid to provide personal care or health care to take on this role. Anyone in a position to benefit financially, or in any material way, from the person's death would not be allowed to act as a witness.

The witness's role is strictly to confirm that the person seeking MAID has actually signed the request themselves. Safeguards, such as ensuring that the person signed the request voluntarily, are the responsibility of the practitioner who provides MAID, not the witness. We also clearly heard that there is no obvious benefit to the 10-day reflection period. We are proposing to remove this requirement from the legislation.

The third area of consultation was on the issue of advance requests. This is also one of the topics studied by the Council of Canadian Academies as part of their independent reviews.

Although many people speak of advance requests in general terms, the issue can be very different depending on an individual's situation relative to a diagnosis and when they are eligible for MAID.

The CCA report pointed out that not all advance requests are created equal and outlined several scenarios. It noted the most straightforward scenario is where an individual is nearing death, and has been found eligible for MAID, but fears losing capacity to consent prior to the procedure.

This was the case, for example, in the widely publicized case of Audrey Parker: the Nova Scotia woman battling late-stage breast cancer. She feared that she would lose the ability to provide consent later on, before the date she ideally wished to have the medically assisted death she was authorized to receive.

A more complicated scenario arises when an individual has been diagnosed with a disease such as Alzheimer's but has not yet come to the point where their circumstances make them eligible for MAID. However, the person may wish to outline the conditions under which they would like MAID to be provided in the future, when they no longer have capacity to provide final consent.

Nearly 80% of respondents to the online survey agreed that the revised law should allow for advance requests in both scenarios. However, there were concerns about allowing advance requests post-diagnosis. There was near unanimous support to refer this more complex scenario to consideration during the parliamentary review process.

The amendments we are proposing reflect the overwhelming support for the first scenario by permitting individuals who have been assessed as eligible for MAID, and whose death is reasonably foreseeable, to provide consent in advance if they lose capacity before their preferred date.

Our government is committed to maintaining an ongoing dialogue with indigenous groups on the topic of MAID, to ensure their families and their many diverse voices continue to be heard.

Lastly, it is important to note that, across the board, participants in the round table consultations all agreed on the importance of having appropriate health and social supports in place, including palliative care, assistance for persons with disabilities and mental health services, to protect against individuals choosing assisted dying due to the lack of adequate supports to live a dignified life.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, my question for my friend from Glengarry—Prescott—Russell is with respect to advance consent. The legislation provides for advance consent in certain circumstances in which a patient might lose their capacity.

When we studied the issue of advance consent under Bill C-14, the Canadian Medical Association noted that it was an extremely complex area. The expert panel's final report from the Council of Canadian Academies noted that there are significant knowledge gaps and a lack of consensus with respect to administering euthanasia, or medical assistance in dying, when a patient has lost capacity.

Why would the government include that in this bill, rather than allow a more thorough legislative review to take place, which it has pre-empted?

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, I certainly was not a member of the justice committee, but I do believe the rationale for including the advance consent in this particular case was because of the Audrey Parker case in Nova Scotia.

I can also say that the Canadian Medical Association, I believe, is supporting this particular legislation in accordance with what we are presenting today.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, as I know from his frequent interventions at the agriculture committee, the member for Glengarry—Prescott—Russell proudly represents a rural riding. My question is centred on that very fact.

As the member knows, the new second track for accessing medical assistance in dying requires that one of the two medical practitioners assessing the person has expertise in the condition from which the person is suffering.

How is this going to play out for Canadians who live in rural or remote areas, and who may not have access to that kind of expertise? How can we ensure that the provisions of this bill make sure that Canadians, regardless of where they live, have access to that kind of expertise?

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, the previous bill required two witnesses and this bill only requires one witness. This was actually raised with the Minister of Justice. I believe this will correct the issues that arose from the previous bill, Bill C-14. The current bill strikes the right balance to make sure there is access to a doctor or nurse who has knowledge of the particular patients in question.

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

Madam Speaker, I would like my colleague to comment on the possibility of granting the right to waive final consent when natural death is not foreseeable.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, quite frankly, I have no opinion on the matter and will therefore rely on the experts.

I know the Bloc Québécois and the NDP support the bill. The Standing Committee on Justice and Human Rights will have an opportunity to examine this more thoroughly in the coming weeks.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, my question for the hon. member has to do with the cool-off period, the 10-day provision that was previously there. It was to address, as I recall, when people are seriously ill and suffering. They can be depressed. One day they feel great and the next day they do not. That is why the 10-day period was put in. I am not sure what the rationale was for taking this out. Perhaps the member could comment on that.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, I believe it was taken out because, in terms of practicality, it served no purpose. The Minister of Justice and many of our colleagues heard from families, now that we have been living with Bill C-14 for over three years, about the 10-day period. Patients who have already made the decision that they need medical assistance consulted with their doctors, nurses and families about that extra 10-day period. Why is not 15 days? Why is it not five days instead of 10? They said it served no purpose.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I will be splitting my time with the member for Sarnia—Lambton.

It is my pleasure as shadow minister for justice for the official opposition to use this opportunity to speak to the proposed legislation before us. It is important legislation. We have been hearing points from both sides of the House on Bill C-7, which impacts many Canadians. In fact, it impacts us all. This is a piece of legislation that deals with life and death, and there is probably nothing more important that we could be talking about today.

Any time we, as legislators, are asked to review and analyze legislation like this, it is critical that we take the time to get it right, and this is part of the problem. As we have heard many times over the course of the last year, we should not be dealing with this legislation today because the Minister of Justice and this government should have appealed that decision.

This is what was being called for by those in the medical community, those in the disability community and individuals across the country after that decision came out in Quebec. The right thing to do, which is what our party, the Conservative Party, called on the government to do, would have been to appeal that decision.

What we have been left with is a patchwork across our country. We have been left with confusion. We should have had the certainty of an appeal to the Supreme Court of Canada on something this important. Instead, the government took the Superior Court of Quebec decision, responded to it and, in my view, went far beyond what was required to respond to that decision. I will discuss some of those things.

The bill was introduced as a response to a Superior Court of Quebec decision made on September 11, 2019. That decision found that the law was too restrictive in the requirement for death to be reasonably foreseeable in order to access medical assistance in dying. At the time, we called upon the government to appeal this decision to the Supreme Court.

As we debate the bill before us, we still do not have the clarity that we could have had if the government had appealed that decision. Rather than defend its own legislation, this government has used this as an opportunity to broaden assistance in dying legislation in this country without doing the fundamental consultation and homework necessary to get an important decision like this right. Even in the previous legislation, Bill C-14, there was to be a mandatory review of assistance in dying legislation and what flowed from it, which was to take place this past summer. This government circumvented all of that with this new legislation.

When the government passed Bill C-14 in the 42nd Parliament, it required this review to be conducted this year. The review was to analyze the state of assistance in dying in Canada in a comprehensive way, and instead of waiting for that, we see with this legislation the government going far beyond what had to be done to respond to the Quebec court decision.

This topic is a very sensitive issue for many in the House who have personal experience with it and, indeed, it is a sensitive issue for many Canadians. We ask that all members on each side of the House be aware of this. While there may be disagreements, we are each here to represent our constituents and arrive at legislation that best protects Canadians.

I have heard directly from many Canadians who are concerned about the lack of protection for conscience rights for health care professionals in both the bill before us and the original MAID legislation. As the government looks to broaden the legislation further, it becomes even more important that the conscience rights of health care professionals are protected. By further expanding medical assistance in dying, the government risks reducing the number of medical professionals willing to take part in this process. It is also important to note that this expanded access could result in a heavy emotional burden on those health care providers, as we head into uncharted territory with the bill.

We, as members of Parliament, cannot appreciate the burden that this has put on health care providers who are working in this system and providing medical assistance in dying.

Further, there are very few protections in place for medical professionals who do not want to participate in the process and may be penalized, as a result, by an employer. This is a point that I raised when Bill C-7 was introduced earlier this year, and it is disappointing to see that it was not corrected in this version of the bill.

This brings me to my next point about standing up for Canadians with disabilities. The 10-day waiting period, which could already be waived in the legislation for extenuating circumstances, has been removed. I heard the chief justice say today that removing the 10-day waiting period was universally accepted in his consultations across the country. I wonder who he has been talking to.

Yesterday I spoke with a group that represents those with disabilities across the country at Inclusion Canada. Those in that group said that they are in favour of maintaining the 10-day waiting period, and their role is to stand up for individuals with disabilities. It is interesting to note that they called on the minister of justice at the time to appeal the decision of the Quebec court. They said that medical assistance in dying must have limits. Individual rights must be balanced with protections, not only for our most vulnerable citizens, but also for society as well.

One of the most important foundations of our Canadian society and identity is that we are a caring, compassionate country. For those with disabilities, their experience now is that they are told, often bluntly, that they would be better off dead. The Foley case in London, Ontario, is one example of this. This decision, if it remains unquestioned, will simply erode provincial health responsibilities for expert clinical care and social support for people who are fragile.

The Minister of Justice would also be familiar with a letter written to him on October 4, 2019, which was signed by over 70 organizations that stand up for Canadians with disabilities from coast to coast to coast. They wrote that they found the decision by the Superior Court of Quebec to be very concerning. One of the reasons for this concern was that the decision failed to respect Parliament's authority to balance the interests of the individuals with the interests of society, effectively limiting Parliament's capacity to pursue social targets, such as substantive equality and inclusion.

They describe the decision as a dangerous precedent, writing, “The Supreme Court must weigh in on this flawed analysis. The decision will entrench stereotypes and exacerbate stigma further for Canadians with disabilities.” The letter continues, and I agree, “[We] must avoid sending a message that having a disability is a fate worse than death.... Canada must appeal the decision to prevent additional stereotyping”. The letter concluded by urging the government to appeal the decision to the Supreme Court.

Again, the letter was signed by over 70 organizations, including the Council for Canadians with Disabilities, the Canadian Association for Community Living, Disability Law Centre, People First of Canada and the Canadian Mental Health Association. I mention this because it underscores how we need to get this legislation right.

Last November, the Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Care Physicians issued a call to action due to ongoing confusion in the general public regarding hospice, palliative care and MAID. Quite frankly, palliative care focuses on improving the quality of life and symptoms through a person-centred approach for those living with life-threatening conditions.

The federal government should be looking for ways to improve further palliative care across Canada, as was committed to many times by the government. In their call to action, the groups I mentioned state, “Less than 30% of Canadians have access to high quality hospice palliative care, yet more than 90% of all deaths in Canada would benefit from it.”

I want to stress my previous point that this is an important issue for many Canadians. On matters of literal life or death, we need to take our responsibilities as legislators—

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

Questions and comments, the hon. Parliamentary Secretary to the Minister of Justice and Attorney General of Canada.

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

Madam Speaker, I thank the hon. member opposite, the official opposition critic, for his work at the committee and his work today in the chamber.

As an observation, it seems some parties opposite feel we are either taking this too far, as expressed by the official opposition, or not taking it far enough, for example, by entertaining advance directives. Clearly the proposal before the House is one that is a middle approach, a prudent approach and one that is constitutionally compliant.

The points raised about the disability community are well taken. Those are important points, and the minister addressed these points about the importance of equality and supports for those with disabilities. That is exactly what the consultations revealed.

The member opposite used the phrase “without doing consultations”. The evidence shows, and this is available on the Department of Justice website, that we heard from 300,000 Canadians, had 125 experts and ten meetings around the country. Is that kind of consultative exercise exactly the type the member has asked us to undertake?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I thank hon. parliamentary secretary for his work on the justice committee and on this file.

It is one thing to consult, but it is another thing to listen and hear what people are saying. We are hearing, loud and clear, from those in the disabilities community that this legislation, and these are their words, not mine, leads us to a society that says their disabilities are a fate worse than death. They want to see more protections in the legislation.

The hon. parliamentary secretary or the minister could pick up the phone and speak with Inclusion Canada or any one of the 70 signatories to that letter to hear about what they would like to see included in legislation safeguards to protect the most vulnerable in our society.

[Christine Normandin, Bloc, Saint-Jean, QC]

Mr. Speaker, I thank my colleague for his speech. I heard him mention that the government should have appealed the ruling and that, practically speaking, parliamentarians are somewhat muzzled by the courts.

He makes it sound like medical assistance in dying is going to be imposed on people with disabilities, whereas, in my view, this is more about a patient-centred approach. This is about giving patients options, not imposing anything.

I would like to hear my colleague's thoughts on what I just said. Did I misunderstand him? Does he not think it is more coercive to deny patients this right? Does he really think anyone wants to impose medical assistance in dying on people who could ultimately have a choice?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, normally with a case like this, which comes from one province's courts, a case of national importance, the responsible thing to do for certainty, because we are a federation, would be to appeal the decision to a higher court and, indeed, on a decision this important that impacts our criminal law would be to appeal the decision to the Supreme Court of Canada.

We are listening to organizations that represent those with disabilities. They say that the failure to appeal the decision, the failure to pre-empt the study that was to take place this summer on assistance in dying legislation and the desire of the government to push something out right after there was one decision on it, pushing new legislation that goes beyond what the decision called for, is an affront to those persons with disabilities.

We are listening to them, and those are their words on this bill.

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

Madam Speaker, this being Mental Health Week, could the member comment on the challenges people are facing in our nation right now? This year one in five are suffering from mental health issues.

What are the implications of this new legislation for people with mental health issues?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I thank the hon. member for the reminder to all of us that it is Mental Health Week.

We are hearing from those who suffer from mental health issues, from those in the disability community and from a broad range of people. This legislation literally deals with life or death. As the member rightly pointed out, as we have seen over the last several months with the COVID-19 crisis, mental health issues have been brought to the forefront. We need to ensure that even—

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

Resuming debate, the hon. member for Sarnia—Lambton.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I am happy to have the opportunity to rise today to speak to Bill C-7. It is a very serious matter. As the member for Fundy Royal just mentioned, it is a matter of life and death. I was part of the debate on the original bill, Bill C-14, and I am familiar with a number of the issues with that bill.

It is very disturbing to me. I understand with the Quebec court decision the government had to make a response of some sort, but the previous bill required them to do a fulsome parliamentary review, which was supposed to take effect this past summer. The government refused to let Parliament sit this summer and do the kind of fulsome work that needed to be done.

It is actually quite irresponsible that when the government introduced Bill C-7, instead of just addressing what was time sensitive in responding to the Quebec decision, it went further and took actions without doing that fulsome review of how things have been going with Bill C-14 in the last number of years.

For those watching at home who are not familiar with Bill C-7, the bill would repeal the provision that requires a person's death to be reasonably foreseeable. In addition to that, it would specify that people whose sole underlying condition is mental illness are not eligible for medical assistance in dying. It would create two sets of safeguards that have to be respected before medical assistance in dying can be provided to a person, and it would permit medical assistance in dying to be provided to a person who has been found eligible to receive it and whose death is reasonably foreseeable but who has lost the capacity to consent before the medical assistance in dying is provided. That is sort of an advance consent, and we will talk a bit more about that.

Bill C-14 was not without some issues that were not addressed in the previous legislation and will probably be considered in the fulsome review. There was a question about whether minors should be able to receive medical assistance in dying. There was significant discussion about advance consent. A lot of Canadians were demanding it, and I will talk a bit about some of the considerations that may have kept the government from moving ahead at that time. There was discussion of those who are not mentally competent to give consent. There have been a number of speeches today mentioning people with dementia, for example. That is another area where there was work done by the Council of Canadian Academies, the CCA. It did fulsome reports on a number of these things, and I will talk a bit about what was found.

There was discussion today about the protection of conscience rights, and I do not agree necessarily with the Parliamentary Secretary to the Minister of Justice. I see the charter provisions that were put into Bill C-14, but forcing somebody to refer, when they do not want to have anything to do with the process at all, is actually violating their rights. I am not a fan of violating one person's rights to give another person their rights. That is not good, so we need to have more discussion about that.

In its report, the special committee that studied the Carter decision said that, without good-quality palliative care, people really cannot make a true decision. They really do not have a choice. Obviously I have been an advocate for palliative care. My private member's bill, Bill C-277, on palliative care, was unanimously passed in the House and in the Senate. The government did a good job of putting the framework in place to get consistent access for all Canadians to palliative care.

The problem is that, once the framework was in, the government has since really not pushed ahead. There are 70% of Canadians who have no access to good-quality palliative care. Especially in the time of COVID, where people are dying, it is becoming even more important. The government needs to take action to up its game on palliative care to make it more available to Canadians.

There is an opportunity and a responsibility for the government to show leadership in how palliative care is being implemented in Canada. Right now, for example, British Columbia is violating the World Health Organization's requirements for where MAID should be performed. It has specifically said that palliative care is a different thing from medical assistance in dying and that they should not be performed at the same location because of a tendency by people wanting palliative care to be afraid that they will accidentally receive medical assistance in dying against their wishes. There is an opportunity for the government to revisit that and I am hopeful that it will.

With respect to the Council of Canadian Academies, many issues were studied. On the advance directives and advance consent issue, we see in this legislation that the government is allowing people who believe their conditions are going to decline and are eligible to receive medical assistance in dying to have a 90-day advance consent. It is not clear to me in the legislation when the 90 days start. Is it when patients first have discussions with their physicians? When does the clock start? That is a clarification that is needed in the legislation.

When the council looked at advance directives, it said there were a few difficulties. The first one was how to prove people have informed consent, what the criteria are and what the definition is of that. Therefore, that would have to be addressed. Who decides what is intolerable suffering, especially if the person has lost capacity? That is another question that needs to be and should be considered in this fulsome review that is required and that I would have preferred to have had before this bill came forward.

As a point of information, Belgium and Luxembourg only allow an advance directive when a person is permanently unconscious. That is the only way they will allow a person to have an advance directive in place: If they become permanently unconscious, they will receive medical assistance in dying.

On the issue of minors, “mature minors” would have to be defined. In Quebec, that is defined as people aged 14 to 17. However, we have to make sure they have the capacity to make medical decisions and confirm they understand that it is voluntary and they are not under duress. There are not many jurisdictions that have extended this to mature minors. The Netherlands does allow people aged 12 to 16, with parental permission, to have medical assistance in dying, and those aged 16 to 18 with parental consultation. Belgium allows it if the person is terminal, but pediatric palliative care has to be provided as an option. Therefore, there needs to be further discussion on that one.

Then there are those who suffer from mental illness. I was very pleased to see that it is clear in this legislation that they would not be eligible. It was very controversial. The council that studied it could not agree. There was discussion about the capability for informed consent and the fact that people with depression could have good and bad days and may change their minds, which again points to the need for some kind of cooling-off period. The Netherlands allows this but for dementia only, and there is still a lot of controversy about that.

The safeguards that were in the bill originally seem to have been removed. I am not a fan of doing that because I would say that if we remove the conditions that have to be met in order to get something, more people will take advantage of it. I am concerned with a broader creep on this, but I am sure there will be fulsome discussion about this at committee.

In Canada, everyone has the freedom to express themselves, to believe what they want and to choose what they want, and we should treat everyone's individual choices with respect.

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

Madam Speaker, I know the member for Sarnia—Lambton as an advocate of science and palliative care, which she raised today and is an important point. The question I would put to her is an observation about the current state of palliative care in Canada.

The government has invested $11 billion in accommodation of home care and mental illness care, which includes targeted money directly for palliative care. It is not just supplying the programming but ensuring that palliative care is provided to those seeking MAID. That is in track two, where someone's death is not reasonably foreseeable. The new requirements are that a person must be informed of counselling, mental health supports, disability supports and palliative care. Further, the practitioner must agree with the person that they have discussed and appropriately considered receiving means of alleviating their suffering before anything can be acted upon.

I know the member has talked about safeguards throughout today's debate. Do those address some of her important concerns about palliative care?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, these are absolutely the kinds of supports that are needed, but the reality is that they are not actually in place everywhere. This makes a huge difference.

I will give an example from the first year after Bill C-14 came into law. Sarnia—Lambton has a huge capacity for palliative care. We have a hospice with 20 beds. There are also beds in the hospital, and we have home care. We have an integrated palliative care system. There were two requests for medical assistance in dying in the first year. London, just an hour away, has a population that is about three times larger than Sarnia's population. It had 300 requests for MAID because it does not have adequate palliative care services.

The government can help out with establishing hospice. The virtual palliative care work that has started is very helpful, especially in rural and remote areas, but it of course requires broadband Internet access. The government can also use some of the successful models, like using paramedics in their off hours, to deliver palliative care. These things could really boost the existence of the supports people are being counselled about, and then people could take advantage of them.

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

Madam Speaker, if I understand correctly, my colleague thinks the Truchon and Gladu decision should have been appealed. These two individuals were refused medical assistance in dying because their deaths were not reasonably foreseeable. They both have serious degenerative diseases. People in this situation are forced to either wait or go to court.

I would like my colleague's opinion on this.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I do not have an opinion one way or the other. Quebec has its jurisdiction and its courts make decisions, but when the government has to respond to a decision, that needs to be the focus. I do not disagree with the member for Fundy Royal, who said that the government should have taken this to the Supreme Court. This is a very serious issue, not something to be decided in a rush.

There will be continual petitioning by those who want everyone to have access to medical assistance in dying. I expect the people I talked about in my speech, including minors and those who are mentally ill, will be continually legally petitioning to expand the scope, which I do not personally support.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, today's debate is forcing all parliamentarians to step into another person's shoes and have empathy for the grievous conditions that they are suffering through. That is difficult, especially when we are lucky enough to have our health.

I understand the member's concerns with the bill, but that being said, there are a lot of people in Canada watching today's debate. Does my colleague see a value in the second reading vote on the bill to get it to committee so that we can further dissect the provisions she sees as problematic and maybe come up with some amendments?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, there are certainly amendments that must happen to fix the things that are wrong in the bill. I look forward to that discussion at committee.

[Chris Bittle, Liberal, Parliamentary Secretary to the Minister of Transport]

Madam Speaker, before I begin, I would like to state that I am splitting my time with the hon. member for Winnipeg North.

We have a serious issue before us, the issue of Bill C-7. It has been an excellent debate so far and an excellent opportunity for members on all sides to talk about this issue because it goes to our morality and to our own conscience, and we are hearing from all sides about this. I want to say that we got it wrong with the last piece of legislation; we got it wrong with Bill C-14. I want to commend the Attorney General for coming forward with Bill C-7.

I would also like to recognize a few members who were vocal advocates, working on the justice committee with Murray Rankin at the time; the hon. member for Saanich—Gulf Islands; my friend, the hon. member for Don Valley West and many other members of the Liberal caucus who tried to advance medical assistance in dying so that it would be constitutional.

I am here today to speak in support of Bill C-7, which proposes amendments to medical assistance in dying legislation. Members are aware that the Superior Court of Quebec found the eligibility criterion of reasonably foreseeable natural death from the Criminal Code made legislation to be unconstitutional. The court delayed the effect of the ruling to allow both the federal and Quebec legislatures to respond. The government has agreed with this basic principle of this decision and is now proposing to amend the Criminal Code.

Bill C-7 proposes to repeal the requirement that natural death be reasonably foreseeable. It would create two sets of safeguards: one for those whose death is reasonably foreseeable and another for everyone else. Some of the existing safeguards for those who are dying would be relaxed, and for everyone else there would be a different set of safeguards based on the current ones with some additions and clarifications.

Bill C-7 proposes to continue to use the expression, “reasonably foreseeable” natural death, but as an element that determines which set of safeguards to use and not to use it as an eligibility criterion, which was the issue in the Truchon case.

The proposal to distinguish MAID requests on the basis of whether a person's death is reasonably foreseeable is consistent with the view that MAID for people whose death is reasonably foreseeable presents less risk and complexity than other circumstances, and that the assessment of requests should be tailored to these different types of cases. Having a reasonably foreseeable natural death would also be a critical element for another proposed amendment in the bill. Currently, the MAID law requires the practitioner to give the patient the opportunity to withdraw consent or to affirm their consent just before MAID is provided.

This requirement for final consent is a safeguard; however, it has also caused some MAID patients to choose to end their lives earlier for fear of losing their capacity to provide final consent and, sadly, for some to be denied MAID entirely after losing capacity. I would also like to point out that others chose to decrease their intake of painkillers prior to MAID being provided, to ensure they retained capacity to consent, which leads to an increase in suffering.

BillC-7 would allow for a possible waiver of requirement for final consent for individuals whose death is reasonably foreseeable but where there are fewest risks and complexities in providing MAID to a person who is no longer able to consent. Permitting this proposed waiver of final consent would respond to scenarios like that of Audrey Parker of Nova Scotia, who was diagnosed with terminal cancer that had spread to her brain leaving her uncertain as to how long she would have the capacity to consent. Because she feared losing capacity before her preferred date to receive MAID, she scheduled MAID and ended her life earlier than she wanted. She openly expressed how she felt unfairly forced by the limitations of the MAID law to schedule MAID sooner than preferred and called for amendments to the Criminal Code so that others like her would not be denied the freedom to choose their preferred date to receive medical assistance in dying.

I would recommend that all members listen to the speech in the previous session from the hon. member for Dartmouth—Cole Harbour. I believe Audrey Parker was a constituent of his. He powerfully used her own words to show us where we went wrong, the impacts our failures in the previous legislation had led to, and the impacts on her life. We owe it to people like Audrey Parker, who have been assessed and approved for MAID, to respect their need for freedom in making end-of-life choices. As a compassionate society, we know we can do better to support these individuals. These amendments seek to do just that.

Waiving final consent is, however, an ethically complex question. This is because it involves MAID being administered to a person who is no longer able to consent, or to withdraw the consent they previously gave. Bill C-7 proposes a new approach for patients whose death is reasonably foreseeable, who are assessed and approved for MAID when they have the capacity, and who make very specific arrangements with their practitioner in which they give consent in advance to MAID being administered on a specific day, even if they have lost capacity by that day.

I fully support permitting advance consent for this group of individuals, but at the same time, I note that certain protections must be in place. Specifically, if on the specified day for MAID, the patient has lost their capacity and they nonetheless actively show signs of resistance to the MAID procedure, or behave in a way that indicates a refusal, the practitioner must not follow through on the procedure.

Medical practitioners at the round table expressed concerns in relation to the emotional burden that could arise from such situations, for them and for family members. They talked of possible disagreement with family members on whether to end the life of a person who appears to resist the procedure. A similar situation led to the prosecution of a MAID provider in the Netherlands and made headlines around the world. That situation is what we wish to avoid here in Canada.

That is why Bill C-7 proposes an additional provision that states that signs of resistance from the patient would make the advanced consent invalid on the specific day and going forward. While an incapable person could no longer withdraw their consent from a legal perspective, given their track record and decision-making capacity, it is proposed that MAID not be permitted under this circumstance. The approach provides much needed clarity for practitioners and family members that MAID be prohibited if the patient is resisting. The bill would also make it clear that an anticipated reflexive response, like flinching when the needle is inserted, does not count as resistance.

It is important to be clear, however, that this amendment is not about advance requests. Advance requests for MAID refer to a situation in which a person puts in writing they would want to receive MAID at some later date when they are not able to consent to it, if circumstances arise that they predict would cause them unbearable suffering.

In this situation, a person is not asking for MAID now. Instead, they are putting in writing that they want it at a later date on the basis of anticipated suffering that has not yet happened. The most likely scenario would involve people who are diagnosed with conditions that could lead to dementia, such as Alzheimer's. These people would want to have a plan in place if their worst fears should come to pass.

Bill C-7 does not propose to allow MAID on the basis of advance requests. MAID in these circumstances would be extremely complex, would avoid ethical challenges and would require more time to consider such measures. In speaking to the Attorney General, I voiced my concern that we need to spend more time considering these measures. I hope that the issue will be studied during further upcoming parliamentary review of the MAID legislation.

Taking more time to study advance requests is consistent with the approach of the Government of Quebec, which is also moving forward to hold public consultations on the issue so that all of its dimensions can be better understood.

MAID is one of the most sensitive and challenging social issues we are currently faced with. Recognizing how deeply personal this issue is to so many people, and to so many members of this place, the government has listened carefully to the diverse opinions of Canadians and has considered the expertise shared by experts, MAID providers and other experts in the development of this important piece of legislation. Bill C-7 responds to the Superior Court of Quebec ruling, but it also achieves balance that respects personal autonomy, while protecting the vulnerable as well as equity rights for all Canadians.

For these reasons, I call on all members to support the bill.

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, I want to confirm to the House that the parliamentary secretary, in his speech, spoke the truth when he said that the Liberals got it wrong, because the Liberals did get it wrong. I was on the justice committee with the hon. member when Bill C-14 was before it, and the Conservatives presented over 100 amendments that would have strengthened the bill and provided proper safeguards, all of which were rejected by the Liberal government of the day. One thing that did get passed was the requirement for a mandatory review after five years, but the government has circumvented the requirement with a few consultations, which is completely inappropriate and should be unacceptable to the House.

Health care professionals in my riding are continually asking for better health care conscience protection rights for health care professionals. They have looked at the legislation and do not feel it is there. We have heard the Liberals argue that it is there and that it is adequate, but the health care professionals in my riding, including doctors and nurses, say it is not adequate. I would like the member to respond to that.

[Chris Bittle, Liberal, St. Catharines, ON]

Madam Speaker, perhaps the hon. member forgets that we had witnesses come before the committee and I asked them about this time after time. Can the member name me one time in Canadian history when a doctor has been forced to do a medical procedure against their will? No one, in the history of this country, has been made to do that.

I appreciate the member's revisionist history that suggests the Conservative amendments would have made the bill constitutional. On the contrary, they would have made it worse.

This is a more progressive way to move forward to protect the constitutional rights of Canadians. We still need to do more, and I look forward to the parliamentary review in the near future.

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

Madam Speaker, I commend my colleague on his speech. I found it very interesting to hear him talk about consent and the requirement for final consent, which forced some people to apply for medical assistance in dying earlier than anticipated.

Perhaps my colleague agrees with the idea of expanding the concept of waiving final consent so that there is a type of advance consent, including in cases where natural death is not foreseeable. I would like his opinion on that.

Can he provide a concrete example of how we might proceed?

[Chris Bittle, Liberal, St. Catharines, ON]

Madam Speaker, I believe the parliamentary review that was enshrined in the legislation needs to move forward. We have to focus on this piece of legislation right now, but we need to do better. This legislation is a big step forward, but there is a lot more work that still needs to be done.

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

Madam Speaker, I remember in the first go around, back in 2016, the controversy and the various points of view that were brought forward, including by my colleague from St. Catharines. I remember speaking to people in my riding about how proud I was that we were able to come forward with the bill. We heard some positive statistics earlier about people whose suffering was ended through the bill we brought forward.

I would ask my friend from St. Catharines about the point of view that we need to be exactly perfect when we come forward with Canada's legislation on assisted dying. At least we are at a point now that we can consider some very good things that have happened and a way of improving them.

[Chris Bittle, Liberal, St. Catharines, ON]

Madam Speaker, I appreciate the hon. member's comments. However, I look at this in a different way, because many of these concerns were brought to the attention of the decision-makers previously. Those voices were ignored and people suffered unnecessarily. I take this as a personal loss and wish my voice could have been stronger to prevent that suffering. We took a step forward with the previous legislation, but we need to keep taking steps forward.

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

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

Happy Thanksgiving, everyone.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Eric Melillo, Conservative, Kenora, ON]

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

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

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

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

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

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

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

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

Will that be possible?

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

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

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

[Heather McPherson, NDP, Edmonton Strathcona, AB]

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

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

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[The Assistant Deputy Speaker, Mrs. Alexandra Mendès]

Five minutes.

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

Fantastic. Okay, that is great.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Andréanne Larouche, Bloc, Shefford, QC]

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

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

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

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

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

Madam Speaker, we know that the member for Sarnia—Lambton put forward a bill and worked with the late honourable Mark Warawa on palliative care. We can do both. We can walk and chew gum, and we should increase our efforts in palliative care.

My Aunt Catherine passed away in hospice. It was a very important time for her family to be there and celebrate her life, but we have to recognize that not everyone has these options. Palliative care is something we should be working on, and the member is right that we should be doing both.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Madam Speaker, it is so wonderful to hear the member for Elgin—Middlesex—London bring in the human element that is so critical to this debate.

One of the challenges created by the current medical assistance in dying legislation is the requirement for final consent at the time the assistance is rendered. This forces patients to make a cruel choice when faced with a possible loss of competence that would make them unable to give consent. They are forced to either go earlier or risk not being able to receive the assistance they need.

Audrey Parker campaigned to make Canadians aware of this problem, and Bill C-7 would fix it by creating a waiver of final consent. I would ask the member this: Do the Conservatives support Audrey's amendment, which would help those facing the end of life to avoid this cruel choice?

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

Madam Speaker, I am very fortunate to be in a caucus where these issues are discussed and where we all have different ideas. I know where I stand, but I may be different than my neighbours on both sides. One just does not know. However, everybody should have the opportunity to have those discussions.

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

Madam Speaker, I am pleased to rise today, but I find it difficult to be speaking to another attempt by the Liberal government to endanger the most vulnerable in our society.

After just four years, when the original euthanasia and assisted suicide legislation came in through Bill C-14, we find ourselves considering legislation that would further loosen restrictions, eliminate safeguards and confuse our country's understanding of the sanctity of life and the government's role in end-of-life decisions. Once again, we have been told that in order to uphold the charter rights of some we must endanger the rights and freedoms of others.

I did not support Bill C-14 for many reasons. The first is the fact that the Supreme Court of Canada invoked such controversial and flawed legislation, which has been proven to be poorly applied around the world. The Liberals also chose to broaden the scope of the legislation, going far beyond the Carter decision. Another reason is that it has been placed ahead of and continues to overshadow any significant palliative care initiative.

In 2019, the Prime Minister promised to expand eligibility criteria, and on September 11 of last year, the Superior Court of Quebec ruled that it is unconstitutional to limit assisted suicide or euthanasia only to those whose death is reasonably foreseeable. Without even appealing the ruling and seeking the advice of the Supreme Court, which has been long occupied with this matter, the Liberals accepted the ruling. They are now rushing to change the law for our entire country.

They gave Canadians a mere two weeks to have their views heard on this deeply personal and complicated issue through a flawed online consultation questionnaire. The use of convoluted and biased language left little to the imagination in terms of how the government planned to legislate assisted death. I too tried to fill it out, and I would argue that many opposed would have been discouraged in participating due solely to the language used.

With such a flawed method, and with no idea if the feedback even remotely reflects the actual views of Canadians, how can the government proceed with this legislation in good faith? This is a rhetorical question because it does not seem to matter to these Liberals. It is clear they used this brief window for feedback to satiate the need for a consultative process.

We also know the government ignored its own timeline for a review of the original assisted suicide legislation, Bill C-14. It was planned for this summer, and instead, we have been presented with this reckless legislation. In the midst of COVID, this was still something very important. Without a proper review and without input from the Supreme Court, this House has been asked to greatly broaden the scope of assisted suicide and euthanasia without a clear enough understanding of whether the current regime is being consistently interpreted or properly enforced.

Bill C-7 is being rushed through. This is concerning. When reading through this bill, I see elements that go beyond the scope of the Superior Court of Quebec's decision, namely, Bill C-7 would eliminate the 10-day waiting period between the date the request is signed and the day on which the procedure is carried out.

The application of the law pertaining to those whose death is reasonably foreseeable has been problematic from the very start of this debate. We know a person's reasonably foreseeable death is a flexible estimation, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time they have remaining. The elimination of the 10-day waiting period for persons whose death is reasonably foreseeable would create the conditions for someone with an indeterminate length of time remaining in their life, possibly years, to be rushed to the decision to receive assisted suicide and euthanasia.

Aside from simply eliminating what most Canadians would consider to be a reasonable period of reflection, this element of the bill also ignores the possibility of medical advances and improved treatment methods in an incredibly innovative medical science environment. As Cardinal Collins has said, Bill C-7 creates the conditions where an individual can seek a medically assisted death faster than the wait time for a gym membership or a condominium purchase.

I also see no logical reason why the government would reduce the number of independent witnesses required for when the request is signed. It is down from two to one. The government has even relaxed the definition of someone who may serve as a witness, including medical professionals or personal care workers, even those who are paid to provide euthanasia and assisted suicide on a daily basis. This is in clause 1(8).

Surely we can agree that, for the vast majority of those requesting euthanasia and assisted suicide, the requirement for two independent individuals to witness a request to end a life is a reasonable safeguard. How do the Liberals plan to properly protect patients from potential malpractice? How does the government plan on ensuring requesters are presented with a myriad of treatment options rather than just one opinion?

The legislation continues as a series of safeguards the medical practitioner must adhere to before providing assisted suicide to those whose death is not reasonably foreseeable. One of these safeguards would require a medical practitioner to discuss with the person the means available to relieve their suffering, including palliative care.

The safeguard is even weaker for those whose death is reasonably foreseeable, requiring the medical practitioner to merely inform the person of these vital options. The government failed to follow through on its promise to invest $3 billion in long-term care, which includes palliative care. There does not appear to be any political will whatsoever to improve palliative care.

Canadians have also been calling on the government for a long-awaited national strategy for palliative care. There is a thirst among Canadians for real solutions to end-of-life care. The government seems all too willing to ignore the 70% of Canadians without access to palliative care and, instead, attempts to impose on them a flawed, one-size-fits-all regime. We can already see the consequences of pushing forward an assisted dying agenda when there is little regard for palliative care.

In British Columbia, the Delta Hospice Society was stripped of 94% of its operating budget for refusing to provide euthanasia in a facility intended for the provision of palliative care. Despite repeated attempts to defend its Charter-protected, faith-based objection to being required to provide euthanasia and reach a compromise in good faith, 10 hospice care beds are now at risk and will be surely defunded.

Why do the Liberals continue to ignore the voices of those who have a different perspective on the issue of end-of-life care? People who seek hospice care are seeking it for a reason. They do not desire a medically assisted death. In effect, what has happened in B.C. is an attempt to redefine what constitutes palliative care.

In fact, the Fraser Health Authority's decision flies in the face of the Canadian Society of Palliative Care Physicians, which has clarified that euthanasia and assisted suicide are distinct from palliative care. I caution Canadians not to regard the Delta Hospice Society's situation as an isolated one. The government has shown little interest in supporting hospice care, and I would not be surprised by further attacks on the ability of Canadians to chose to end their lives naturally.

In The Globe and Mail, Sarah Gray put it well, stating, “The hospice isn’t a place where people come to die. It is where they come to live — to live well for the little time they have left. It is a place of celebration, connection, comfort and support. It is a place of safety for the dying and the grieving.” In Cardinal Collins' words, let us work to create a “culture of care”, rather than rush toward a culture of “death on demand”.

The government would also be wise to recall that much of the debate on Bill C-14 revolved around calls for a solid framework of conscience protection for medical practitioners involved throughout the end-of-life process. At committee, witnesses stated that the protection of conscience should be included in the government's legislative response to Carter v. Canada.

The Canadian Medical Association confirmed conscience protection for physicians would not affect access to physician-assisted suicide or euthanasia. Its statistics indicated that 30% of physicians across Canada, or 24,000, are willing to provide it. I live in a rural area of Canada, and I can assure members there are many provisions that are not available to me directly where I live.

Unfortunately, the Liberals failed to defend the conscience rights of Canadians in Bill C-14. I also found it disappointing that they failed to support, in the last Parliament, critical legislation put forward by David Anderson in Bill C-418, the protection of freedom of conscience act. It would have made it a criminal offence to intimidate or force a medical professional to be involved in the procedure. It would also have made it a criminal offence to fire or refuse to employ a medical professional who refuses to take part directly or indirectly in MAID.

Here we are four years later, and Bill C-7 is also void of any provisions that would protect the section 2 rights of Canadians. In Canada, everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms. No one has the right to demand all services from all providers in all circumstances. As David stated, protections are needed for doctors and health care providers who are not willing to leave their core ethics behind when they are at a patient's bedside. Access to euthanasia and conscientious objection are not mutually exclusive.

We, as legislators, must ask ourselves where the Liberals will draw the line. There will always be the voices of those in our society who feel that the limitations and safeguards are too stringent. When will it be enough for the Liberal government? How far are they willing to go? What message are we sending to the most vulnerable and fragile in our society?

Over the last five years I have advocated for our veterans. I know there are countless veterans who appear able to cope with debilitating physical injuries, but they are extremely vulnerable in their mental health. We are all concerned about the number of them choosing to end their lives by suicide because of complications after serving our country. It is antithetical to try to prevent them from taking their own lives, yet tell them that there are government-designed opportunities to do so.

Bill C-7 fails to provide conscience protection, fails to protect the vulnerable and fails to fulfill the need—

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

Questions and comments, the hon. member for Guelph.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, unfortunately I found a lot of partisan comments in the member's intervention in contrast to the comments from the member for Elgin—Middlesex—London. This as a non-partisan issue.

I was visiting businesses in downtown Guelph this morning and I spoke with one of the business owners. He talked about his parents in England, how they had gone through this choice and how other countries provided ways in which people who faced death could control their exit through proper legislation.

I wonder if the member could comment on getting the personal comments directly from people who face those choices, even posthumously, as the member for Elgin—Middlesex—London presented to us, and should we should be looking at including those comments in the committee's study should we be able to get the bill to committee?

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

Madam Speaker, I would disagree with the member's comments. I totally agree with the member for Elgin—Middlesex—London. We are on the same page on this.

That being said, we have approached it from two different perspectives. On the personal side, I hear those things all the time. The concern is that at what point do we come to a decision on what the responsibility of the government is. I understand we want choice, but the problem is that there are not enough safeguards for those individuals, where it is creeping into a sense that their rights and privileges under the charter are being challenged. That is what I expressed here. Right now we are at the place where we are the line between those who want a certain thing and those who do not. Someone's rights will be trampled if we do not deal with this very carefully.

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

Madam Speaker, as citizens, we should all agree that it is important to prevent needless suffering at end of life and that it should be up to individuals to decide how they want to end their lives with dignity. However, we also need a legal framework to ensure that doctors can act within the law without being faulted after the fact for having helped someone end their life.

Would my colleague not agree that doctors need a legal framework to be able to do this work?

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

Madam Speaker, a legal framework was presented in Bill C-14. However, the Canadian Society of Palliative Care Physicians has said that there is creep where palliative care facilities are being shut down because the physicians do not feel they should be providing assisted suicide or euthanasia, and their rights are being trampled upon. Many people in our country choose not to go that route. Their rights and their protections need to be in place as well.

That is why we need a better focus on palliative care. We cannot say that we are giving people an option when people do not have an option. The government committed to a national strategy on palliative care and it is our responsibility as national legislators to make it very clear that palliative care is distinct from euthanasia.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Madam Speaker, I definitely am in full support of my hon. colleague's very moving remarks. A disability advocate called my office this past week. She was very concerned about watering down protections for vulnerable people by removing the requirements on physicians and having a physician who specializes in the area being involved.

Is there any provision for social workers to be involved? Frankly, physicians are not always equipped to recognize when there might be undue family pressure or other intersectional pressures being put on the patient to make an assisted-death call. What are my hon. colleague's thoughts on that?

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

Madam Speaker, there needs to be clarity in that regard. We are hearing stories, but, as was mentioned, these things are not being brought forward and prosecuted or there are not enough safeguards in place to ensure people are not being coerced in that way. I have had individuals come to me in tears over that very issue. It is becoming commonplace that this is naturally something that is offered to a lot of individuals who are in end-of-life scenarios.

Palliative care is an opportunity for individuals to live their life thoroughly to the end, along with their family. When individuals make that choice, they should not be coerced. We really need to be careful of this.

[Anthony Housefather, Liberal, Parliamentary Secretary to the Minister of Labour]

Madam Speaker, I will be sharing my time with the hon. member for Oakville North—Burlington.

This is a very difficult bill and subject for us to deal with. In this case, the sanctity of life, something that all of us cherish, conflicts with the liberty interests protected under section 7 of the charter. This is one of those difficult times where we have to recognize that our own religious views, our own moral views are not the ones we can simply impose on Canadians. We have to recognize that charter rights are sacrosanct. Sometimes, as a member, those are difficult moments.

I personally have said before that I would not choose medically assisted dying for myself. Nor would I encourage family members to avail themselves of the opportunity for medically assisted dying. However, I also fully respect the right of every Canadian to choose for his or herself whether this right should be exercised personally.

In the Carter decision, the Supreme Court of Canada upheld that under section 7 of the charter, there was a certain subgroup of Canadians whose liberty interests were violated by the existing provisions in the Criminal Code on not assisting someone to commit suicide. The Supreme Court in Carter told us that there was a subsection of Canadians, those who were in constant enduring pain and suffering that could not be alleviated by medical treatment reasonably acceptable to them, who had the right to have their death hastened by having medical professionals assist them in doing so.

In the last Parliament, our government brought in Bill C-14. I had the privilege of being the chairman of the Standing Committee on Justice and Human Rights. We heard from a great cross-section of Canadians. We heard from those who represented the disabled community and those who believed in the right to die with dignity. We heard from members of the clergy from all faiths. We heard from university professors, lawyers and doctors. We heard from a great cross-section of Canadians who had very diverse and different opinions.

What we tried to do was craft a law that brought Canadian society together, that protected the vulnerable but yet still afforded everyone the right that the Supreme Court had recognized in Carter, which was the right to decide for one's self whether to terminate one's life in the event he or she was in enduring pain and suffering that could not be alleviated by medical treatment reasonably acceptable to that person.

As well, we had to recognize that when we dealt with the Carter decision in Bill C-14, Canada was at the beginning of a list of countries dealing with medically assisted dying. There were very few countries in the world that had gone where Canada was going. Belgium, Holland, Uruguay and a few American states were, but that was it. Canadian society needed to come to terms with medically assisted dying and learn more about the process before we went too far.

That is why, at the time, I supported a clause in the bill that said that medically assisted dying was limited to those whose end of their natural life was reasonably foreseeable. However, we knew that would change over time and that as Canadian society looked at the experience of medically assisted dying, the bill would come back for review before Parliament and would need to change.

At the justice committee, we proposed a number of important amendments to that bill. We inserted, by unanimous agreement at the committee, conscience rights to ensure that the doctors, nurses and pharmacists whose own beliefs would be offended by medically assisted dying were not compelled to participate in the process. We said that Parliament would need to review some subjects that we were not dealing with, such as the issue of mental illness on its own; the issue of mature minors; and, probably most important, the issue of advance directives for those suffering with dementia.

We also adopted a motion that palliative care had to be part of that review. People should have their death hastened because palliative care treatment is not available to them in Canada.

This bill takes the medically assisted dying regime, Bill C-14, a step further based on the Truchon decision. It held that the provisions we had put in the law about reasonably foreseeable death were not constitutional and that a subgroup of Canadians who may have many more years to live but were in constant pain, enduring interminable suffering, and could not have that alleviated by medical treatment reasonable acceptable to them also had the right to medically assisted dying.

This bill establishes that this group of people also have the right to medically assisted death in Canada, but also imposes additional safeguards on them, namely a 90-day waiting period. We understand that certain people, for example, may suffer a traumatic injury and need time to consider all their options and come to terms with their situation before finally going through with a medically assisted death.

Also, based on the Canadian experience, we are amending the bill to allow certain Canadians who are about to lose their ability to offer agreement to medically assisted dying, because they have lost their capacity to consent, to do an advance consent.

Some Canadians want to access medical assistance in dying knowing that they may still have a few more weeks to live. The only reason they want to access it sooner is that they do not want to lose their capacity to consent to medical assistance in dying.

Personally, I want these people to be able to continue to live and spend those last few weeks with their families. I do not want them to end their lives prematurely because they are worried about losing their capacity to consent to the procedure.

The amendment to the law, this bill that is before us, gives hope to this group. These people will have permission to sign a contract with their doctor indicating that they want to put an end to their life on a specific date, even if they lose the capacity to consent to medical assistance in dying in the meantime.

However, there is still a safeguard in the sense that if people who have lost their capacity to consent show through any action or words that they no longer wish to end their life, the doctor must then stop the procedure.

I strongly support the bill. I think Canadian society has evolved with respect to how we see medically assisted dying. As Canadians, we now have seen where the procedure works and where it does not work. We have seen which groups have been positively impacted and which groups have been left out and where we can improve on the procedure.

Following a great deal of consultation and national interest and seeing a change in how Canadian opinion sees medically assisted dying, this bill is the right one at the right time.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I had the privilege of serving with the hon. member for Mount Royal on the justice committee when we studied Bill C-14

The member rightfully talked about the process in which we heard from a diverse range of viewpoints. It is ironic that this legislation circumvents that opportunity to hear from a diverse range of viewpoints by pre-empting a legislative review, which should have started in June.

The hon. member will know that this decision goes well beyond the scope of the Truchon decision. One such area is with respect to advance consent, to which he alluded. Arguably this goes beyond the scope of the Carter decision inasmuch as Carter stated not once, not twice but on three occasions that a patient must clearly consent.

How can the hon. member defend that with respect to legislation that arguably goes beyond the scope of Carter? How can consent be truly meaningful if it is not contemporaneous?

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I want to say how much I enjoyed serving with my hon. colleague from St. Albert—Edmonton. He always brings a great deal of intelligence and rational thought to these situations.

First, as the House knows, the government and Parliament are not limited to simply creating a law that repeats the Carter decision; Parliament is perfectly entitled to go forward further and protect liberty interests that were not recognized in Carter. Nobody excludes the right of Parliament to go further than Carter.

Second, I believe that the legislative review on the subjects that we were supposed to review will continue to proceed. This law is a separate piece of legislation dealing with other subjects.

Finally, I would say that, regarding the issue of capacity to consent in advance to medically assisted dying, this is simply for somebody whose death is already foreseeable, coming up in the very near term, to agree with their doctor to end their life if they have lost the capacity to consent to further prolong their life, because otherwise they would make that decision more prematurely. I support it for that reason.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Madam Speaker, the Bloc Québécois agrees with the proposed amendments and welcomes them.

The issue that has not been addressed and that I think is important is advance consent. I would like to know where my colleague stands on that issue.

Would it not be a good idea for people who meet the criteria set out in the act to be able to give their consent in advance, as we do with organ donation, in the event that they are diagnosed with a degenerative disease? Is that an issue that was examined? If so, what is my colleague's position on that?

[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.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Madam Speaker, it is an honour to participate in the debate on Bill C-7, which will amend the Criminal Code.

As someone who travels four or five hours to get to Ottawa on a regular basis, often I sit in Parliament and ask, “Do my constituents really care about what we are talking about?” I am pleased today to participate because I believe that this is a subject matter that every Canadian feels strongly about, one way or another, and that potentially could impact every Canadian. I feel very honoured to participate in this debate today.

We are doing so because the Supreme Court deemed certain provisions of the original medical assistance in dying legislation, MAID, to be unconstitutional. That provision, deeming death must be reasonably foreseeable, is being withdrawn in Bill C-7. The second important piece of this bill is the removal of the 10-day waiting period. In my remarks today, I want to address both of those changes.

First, I would like to state at the outset that I support the bill. In contrast to some others who have spoken, I do not believe the government should have appealed the Supreme Court decision. While I commend the government for finally bringing forward this legislation, it is unfortunate that the Liberals are only acting when being made to do so by the courts. This is somewhat of a repeat of four years ago when the government was forced by the courts to introduce the original MAID legislation.

Those suffering near the end of life should not have to resort to the courts before government acts. I guess one could say, however, that late is better than never, and it is certainly better than endless appeals of the decisions.

Four years ago when the original bill was introduced in the House, I made a special effort to obtain the collective views of my constituents. While I personally supported the original legislation, I also wanted my vote to reflect the feelings of my constituents. I reached out extensively to survey my constituents through phone calls, emails, Facebook and direct mail.

The responses at that time were from all age brackets and all demographics. The end result was 77% of several thousand respondents supported the legislation. Ironically, that number is awfully close to the percentage of support I received in the general election just one year ago. I am confident that a similar survey today would yield the same results, and the majority of my constituents would be supportive of the changes being proposed in the bill.

What I heard from constituents reflected my own personal views. While I respect some deeply held views from constituents who do not support MAID, I am of the belief that I, and only I, should determine how much pain and suffering is reasonable for me when end of life is near. I do not believe any institution or government should deny me my constitutional right.

Some medical professionals do not support MAID, and that is their constitutional prerogative. Those advocating against these changes feel those rights are not adequately protected in the legislation. That may be legally correct, but medical professionals not wanting to administer MAID clearly have a professional responsibility to refer patients. In Alberta, the website for Alberta Health Services has a listing of doctors who are willing to perform MAID. If it is the view of a medical professional that he or she is not prepared to perform MAID, they can make a referral.

The second important piece of this bill is removing the 10-day waiting period. I also support this. The contention that someone who is suffering to the extent that they ask for MAID one day will simply wake up a few days later and change their mind, I do not agree with. In my view all the 10-day period provided for was additional suffering and an opportunity, for those who oppose MAID on fundamental principles, to try to change the patient's mind. In my view, both are wrong.

I am sure most MPs are receiving the same emails I am getting, many from constituents asking that I support the legislation and others who are opposed. I have no issue with those opposed to MAID. Where I do take issue is with some of the rationales that are being used. Medical professionals' conscience rights is one, and I have spoken to that.

Others claim the legislation would take us down the slippery slope of other countries, where euthanasia is available to children and those with mental illness. Clearly those are red herrings because this legislation would do none of that. Others are asking for more study, another delay tactic, similar to appealing the court decisions. It is more work for lawyers, less satisfaction for those suffering.

Increased funding for palliative care has also been raised as an option by those opposing this legislation. Enhancing palliative care is always welcome, but in my view is not directly related to this issue. We are talking here about people wanting to end excruciating pain and suffering. These people are not asking for their pain and suffering to be made more comfortable.

Our health care system must do both things well. It must allow for people to live with dignity and receive excellent care as they reach the end of their lives. In addition, the provision of health care is a provincial responsibility, and I do not believe it should be part of this discussion.

Since the original MAID legislation was passed four years ago, I have taken a special interest in this issue. Unlike some other members who spoke earlier, I have not attended a death where someone has chosen MAID. However, I have had dozens of constituents make a real effort to tell me they experienced MAID with a loved one and that it was very special and appropriate. They personally thanked me, as someone charged with making laws in this country, for making this provision available at end of life for their loved one.

I have not had one constituent call me to say how bad this experience was. In almost all cases, these same constituents have said that society needs to go further. In fact, many constituents seem to believe advance consent already exists. They cannot believe they are not allowed to prepare a legal document, while of sound mind, that would provide their loved ones with guidance in the event they are nearing their end of life but are no longer of sound mind. For that reason, it is critical the minister get on with his public consultation on a broader review of MAID, which was promised some time ago.

The minister needs to find out what Canadians want and not make those suffering take years to go through the court system to get change. Like most things, the Liberals blame COVID. However, there are many ways of seeking input from the public regarding other changes to MAID, and the minister needs to get this discussion moving now.

In summary, I look forward to the bill being studied in committee. I know there will be those opposed to the bill and those in favour making presentations, and all need to be heard. For me personally, I have consulted and listened to my constituents and feel very comfortable voting in favour of the legislation.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, the member for Calgary Signal Hill is the member of Parliament for my brother, and I appreciate the effort he is putting forward in reaching out to his constituents to find out what they are thinking on the issue. Our role as members of Parliament is to put aside where we may want to head in favour of finding out from our constituents how we can best represent them.

My question is regarding the speed of reaction. The legislation we introduced last time was a result of a lot of discussion and consultation. The consultations reached 300,000 throughout January of this year. We are being very careful to go one step at a time to avoid slippery slopes.

Could the hon. member talk about the importance of avoiding those slippery slopes by taking the proper amount of time to do the consultations we need?

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Madam Speaker, I am suggesting we need to launch these consultations that have been promised because there are Canadians who believe this particular legislation could be even further enhanced. The Liberal government needs to get on with these consultations and listen to Canadians.

As mentioned, at the end of the day we are here to represent our constituents. When I did my survey, I did not know how my constituents were going to react. Even though I felt strongly about this particular issue, I wanted to make sure I was representing their views, and I believe in both cases that was the case.

[Rachel Bendayan, Liberal, Parliamentary Secretary to the Minister of Small Business]

Madam Speaker, I will be sharing my time with my esteemed colleague from Argenteuil—La Petite-Nation.

It is with great emotion that I rise in the House to speak to the bill on medical assistance in dying.

First, this bill is the result of a decision handed down by the Superior Court of Quebec. I am very familiar with that court. I had the great honour and responsibility of arguing cases before it in my previous life. Barreau du Québec lawyers have the privilege of working with one of the best courts in the world.

This court rendered a decision and rather than appealing it, the Liberal government said yes. Quebec will once again be leading the way for the rest of the country. Our progressive and forward-looking Quebec will guide Canada. That makes me proud both as a lawyer and a federal government MP from Quebec.

The purpose of Bill C-7 is to ensure that people like Ms. Gladu and Mr. Truchon have the same rights, opportunities and freedoms as those who are facing an imminent or reasonably foreseeable death.

The ruling in Truchon found the eligibility criteria of reasonably foreseeable natural death to be unconstitutional. Our government also agrees that MAID should be available to relieve suffering and pain from serious medical conditions and is now proposing through this legislation to amend the Criminal Code so that Canadians can end their lives with medical assistance if that is the right choice for them. To accomplish this, Bill C-7 proposes to repeal the requirement that natural death be reasonably foreseeable, opening up access to those who are suffering in a wider set of circumstances.

The changes to the legislation propose to create two pathways in terms of the procedures that must be followed to assess a request for medical assistance in dying. While I do not have time to get into the details of the two regimes in full, there are a number of points that I wish to highlight today.

For those people who are suffering intolerably from a serious medical condition, but whose death is not reasonably foreseeable, the safeguards put in place emphasize the importance of ensuring that sufficient time is taken to evaluate the request. A minimum of 90 days will be needed so that the person can be assessed by a doctor who has some experience with this condition, which will help to ensure that the person gets all of the information, services and tools that might help them improve their quality of life.

Bill C-7 also creates new safeguards with respect to consent. Individuals requesting an assessment for medical assistance in dying give their consent, of course. Clearly, they also give their consent to receive MAID when they officially sign their request. However, what matters most is consent when MAID is about to be administered. There must be no doubt as to the person's desire to receive MAID at the moment they receive it. Doctors will be more comfortable proceeding under those circumstances.

Depending on their illness, some individuals risk losing their capacity to give consent between the time they are approved for MAID and the day they would like to receive it. Although we expect that most people are ready for MAID rather quickly once their request is approved, some people may wish to wait for a specific event such as a child's wedding or the birth of a grandchild. Those who wish to wait before going ahead with MAID are caught in an impossible situation if there is the risk of losing capacity. Either they wait for their special family event and risk losing their ability to die as they wish, or they move up the date of the intervention and miss a very important moment with their family and friends.

Therefore, this bill will enable individuals in real danger of losing their capacity to consent prior to the day specified for administration of MAID to make special arrangements with their practitioner. Such arrangements must be made in writing. The doctor and the individual must work together to come to an agreement that works for both of them. This safeguard is important for individuals as well as for doctors because they are the ones who bear the tremendous burden of ending someone's life.

The bill addresses another difficult situation.

Let us suppose that, when the day comes, the person has lost their capacity to consent to MAID, but remains conscious and alert, although not competent. Let us also suppose that they act in such a way or make gestures clearly indicating that they do not want to receive MAID. The bill addresses this situation—which we obviously hope will be rare—by clearly stating that the physician must not proceed because, in this case, it is no longer what the person wants.

The concept of freedom of choice, for me, remains central to all of this. I watched my grandmother suffer from Alzheimer's. Not long after I was born she was diagnosed, and when I was very young she used to repeat the same stories over and over again to me, about her own life and the life lessons that she wanted to pass on. She would tell me about how she used to work two and then three jobs, taking shifts overnight in order to buy her family's first home and provide a better life for her children. What that repetition instilled in me was certainly an understanding that my grandmother was probably the strongest woman I knew, that she was a force of nature.

When I was about seven or eight she forgot who I was, she forgot who everybody was, and I had to very painfully remind her every time I saw her. By the time I was 10 she no longer remembered language at all, and it was just humming, which I still somehow found very soothing, comforting and somehow okay. The degradation from there continued; her eyes no longer opened at all, she was in a wheelchair, the humming had completely stopped and when I was 15 the only muscles that worked were reflexive ones. Even if nothing else in her body moved, she would chew food if it was put into her mouth. It took two people to move her from her wheelchair to her bed or to change her, and this situation went on like this for 10 years.

As a teenager I used to wonder constantly what it would feel like to be trapped in a body like that, wondering if that was really the same strong woman in there or not. It was 10 years of listening to hushed voices in the kitchen saying, “...but there's nothing we can do.”

I do not know for sure, of course, what my grandmother would have decided for herself, but I do know for sure what I would want. For those who would decide something different for themselves, or for whom their beliefs are contrary to assisted dying, this framework provides everyone with the freedom to decide for themselves.

It is not a crime under the Criminal Code to take one's own life. It is a crime to take someone else's. The changes proposed would ensure that those people who need and who would like doctors to help them in order to end their life with dignity, at the time that they choose, can do so.

MAID is certainly one of the most challenging social issues in our society, which is made up of people with very diverse viewpoints and needs. I believe that this bill would achieve the right balance between the freedoms and rights of those who are dying and who are seeking a peaceful medically assisted death and our medical practitioners who need a clear framework for timing and consent.

I call on all members of this House to support Bill C-7.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Madam Speaker, when I think about this, and about the importance of choice, I am thinking about the horrible situation that has been uncovered in long-term care homes across this country. I am thinking of a gentleman named Roger Foley from London, Ontario, who has a degrading neurological condition. He is not being adequately supported by our health care system. He is not getting assisted living, and so how can people be truly given a choice when their choice is between living horribly in a health care system that does not support people or having medical assistance in dying?

Would the member not agree that we need to invest more in our health care system and more in improving the lives of our seniors and those with diseases before pushing forward and liberalizing assisted dying?

[Rachel Bendayan, Liberal, Outremont, QC]

Madam Speaker, I do not disagree with him. I do believe that we need to ensure that the quality of life that is available to our elderly and the people who are living in assisted-living homes and centres across the country allows them to have the option of living with dignity, but I do not believe the two are mutually exclusive.

Our government has invested in health care recently. We have made numerous transfers to the provinces in order to make sure that our seniors are being cared for, and we will continue to do so, but that does not mean that medical assistance in dying should not move forward at the same time.

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

Madam Speaker, I want to thank my colleague for her speech, which was very personal and very moving. I just want to pick up on the idea of the foreseeability of death.

Alzheimer's follows a certain progression. My colleague's grandmother went through that progression, as have some other people I know. People can experience different forms of dementia with aging, and some are more difficult than others.

With that in mind, would it be good to include the possibility of advance requests for medical assistance in dying in Bill C-7, along with very specific criteria?

[Rachel Bendayan, Liberal, Outremont, QC]

Madam Speaker, I thank my colleague for her question.

We need to keep this conversation going. We need to ask Canadians what they think and what they would be comfortable with. That is certainly not out of the question, but at this point in time, I think we have presented something that not only responds to the Quebec Superior Court's ruling but also meets the demands of those seeking medical assistance in dying.

I certainly think more needs to be done. I know this is a very real concern in Quebec. My constituents also ask me about this. I think we need to keep the conversation going and see how we can move forward into the future.

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

Madam Speaker, I appreciated the words of my colleague across the floor. My father passed away in February just before COVID from Alzheimer's, after nine long years in care. However, I also do know what his desire was. The member spoke of choice. That, I think, is the issue here, right down to the choice for doctors.

The member talked about making sure safeguards are in place. What about doctors who do not feel they can go forward in participating in this? They are not being properly protected across our country. As well, the Canadian Society of Palliative Care Physicians has made it clear that euthanasia and palliative care are two very distinct things.

How does the member feel about her government's position on palliative care? Would she be willing to say that those two things are very distinct and should exist independently?

[Rachel Bendayan, Liberal, Outremont, QC]

Madam Speaker, I have spoken to a few doctors who have told me they themselves are uncomfortable with the procedure. They have a system in place that appears to be working in which they can refer to their colleagues, other practitioners, in order to perform medical assistance in dying. That appears to be working for some.

I am not aware, of course, of the situation of all medical practitioners across the country, but I certainly was comforted to hear from a number of doctors who, for different reasons, including religious beliefs, do not feel comfortable with this. There is a process in place for referrals.

I would also note that medical practitioners do have the moral obligation to—

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

Order. The parliamentary secretary.

[Stéphane Lauzon, Liberal, Parliamentary Secretary to the Minister of Seniors]

Madam Speaker, I am so pleased to be able to speak to Bill C-7, which seeks to amend Canada's medical assistance in dying legislation.

This is officially one of the hardest decisions I have had to make since entering politics, first at the municipal level in 2009 and then at the federal level. I never used to get my family involved in my decision-making. However, on this issue, I decided to get my wife and adult daughters to sit down with me at the kitchen table for a frank and serious family discussion.

Our government has been working on this bill since 2019. We have had discussions about the future and the choices that we need to make as parents. These discussions were extremely difficult. I know that this is an issue that hits very close to home for Canadians, but we do not talk about it in public very much. However, medical assistance in dying is a very complex and very serious issue for me.

Yesterday, when I came back from my run, a neighbour was waiting on my doorstep. We had an intense discussion, a very good discussion, on medical assistance in dying. He had just been diagnosed with ALS and was very emotional, which made me very emotional. He asked me if I had voted for or against the bill the last time. Because I understood that an individual's right to choose is very important, I voted in favour of the bill. This time too, I agree with the amendments proposed by the Quebec courts.

I have deviated somewhat from my speech, but events like these give us an opportunity to reflect on the reasons we are here. This subject has not been talked about very much in the House, and some opposition members have asked why it is up to all of us here to make these decisions. It just so happens that we chose to be decision-makers and that sometimes we have to make tough choices like this one.

We immediately embarked on an inclusive process with the provinces and territories in response to recent court rulings about MAID rules. We held extensive consultations. We talked to doctors, organizations, vulnerable people and eligible individuals. The consultations were part of our government's progressive approach to ensuring that the federal framework reflects evolving views and Canadians' needs. That is how we always make decisions here in the House. Our goal is always to improve Canadians' lives and be as fair as possible.

We were particularly focused on making sure that people with disabilities could express their views on the subject. People with disabilities are extremely important to me, given my past experience as parliamentary secretary to the minister responsible for persons with disabilities. That was an incredible experience, and we drafted the first accessibility act, which is near and dear to my heart.

Bill C-7 would amend the Criminal Code provisions respecting medical assistance in dying to provide greater autonomy and freedom of choice to eligible individuals seeking medical assistance in dying.

Protecting vulnerable individuals and respecting the right of people with disabilities to equality and dignity are essential considerations. More specifically, this bill would broaden medical assistance in dying to people with irremediable medical conditions who are in an irreversible decline but are not at the end of life.

The bill also proposes excluding persons whose sole underlying condition is a mental illness, introducing a host of safeguards for persons whose death is not reasonably foreseeable while maintaining and relaxing existing safeguards for persons whose death is reasonably foreseeable.

The bill also proposes permitting persons whose death is reasonably foreseeable and who were deemed eligible for medical assistance in dying to provide consent in advance of the time of the procedure even if they lose the capacity to consent prior to the day specified in the arrangement with the medical practitioner.

Supporting and advancing disability inclusion is not new for our government. From day one, we have been committed to achieving these objectives and have improved our programs to better respond to the needs of persons with disabilities. It should be noted that the Government of Canada fully respects the equality rights of Canadians with disabilities. That is why we have been working hard since 2015 to advance the accessibility and inclusion of persons with disabilities.

For example, in 2018, we acceded to the optional protocol to the Convention on the Rights of Persons with Disabilities. This means that Canadians have additional recourse for filing a complaint with the UN Committee on the Rights of Persons with Disabilities if they believe their rights under the convention have been violated.

In July 2019, we passed the Accessible Canada Act, which we are in the process of bringing into force. This legislation is considered one of the most important advances in federal legislation on human rights for persons with disabilities in more than 30 years.

In 2019, we also launched the accessibility strategy for the public service of Canada, in order to make the public service more accessible and inclusive. In addition, we improved data collection, in particular regarding indigenous people with disabilities. We recognize that integrating people with disabilities is about more than simply passing a law, and we are working with these people and other stakeholders to combat stigmas and prejudices. The culture needs to change so that the significant contributions made by Canadians with disabilities are recognized and valued as much as those of other Canadians.

Bill C-7 gives vulnerable people new, concrete safeguards against pressure and coercion, to ensure that MAID remains an informed, voluntary decision.

Today, as Parliamentary Secretary to the Minister of Seniors, I see that this has once again become a hot topic in my riding and in our discussions. I see how important it is to give people the right to make their own end-of-life choices. Fundamentally, we hope to strike a fair balance between respecting the individual autonomy of people who request MAID and protecting vulnerable people. We want this measure to be as compassionate as possible.

[Claude DeBellefeuille, Bloc, Salaberry—Suroît, QC]

I want my colleague to know that I really appreciated his speech.

In the bill and in practice, there has been a lot of talk about importance of the role doctors play when someone makes the final decision to request medical assistance in dying. However, we must not overlook the caring presence of the social workers who support these individuals throughout the process, allowing them, as my colleague said, to make an informed decision and fully and knowingly consent. The presence of a social worker is an important part of the support provided to individuals and families, as this decision is often made as a family.

I would like to hear my colleague's thoughts on the arguments raised since this morning in favour of an individual's right to express their wishes in advance when they are diagnosed, know that death is inevitable and want to plan how they will leave this world. Would my colleague support including a way to express one's wishes in advance in this legislation?

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Madam Speaker, I would like to thank my colleague for her question.

It is an excellent question. Any avenue for helping vulnerable people and helping those who want to support access to MAID is appropriate. All we want is to have federal legislation that provides a framework for all the regulations to ensure that there is a system in place in every province and territory of Canada so that people have the fairest opportunity to make a decision.

However, if the provinces want to implement any measures, given that health is a provincial jurisdiction and that Quebec asked for the legislation to be amended, we will always be there to support the best outcome for the vulnerable.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, I am concerned that this bill would create two classes of Canadians. In one case, able-bodied persons suffering from mental illness would be provided with suicide prevention; in the other case, persons who happen to be in wheelchairs would be eligible for MAID.

Is the member not concerned that this bill would create two classes of Canadians?

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Madam Speaker, what we are saying is that we want to make the fairest decisions for each group of people.

People dealing with mental health issues are just as important as people with disabilities and people who are terminally ill and highly vulnerable.

This is a very sensitive debate, and people with mental health problems who are not capable of making decisions are excluded from this law.

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

Madam Speaker, I want to begin by saying that I was very touched to join my colleague in attending the commemoration of the great sacrifice of Canadian soldiers during the Second World War, in Caen, France.

I will put that aside for a moment.

I listened with interest to my colleague talk about the rights of handicapped people and how much the government cares for them. However, we saw complete indifference toward the crisis faced by handicapped people during the pandemic. We had to work hard and push the government to give a measly $600 to the most impoverished people when it was not going to give it. Handicapped people suffer extraordinary levels of poverty because they are marginalized from the workforce.

Given the fact that the Human Rights Commission had to call out the government on its lack of action and interest in supporting handicapped people during the pandemic, I would expect my colleague to recognize that the government needs to do a better job in addressing the rights of handicapped people so they can get through this unprecedented economic and medical catastrophe.

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Madam Speaker, it is a pleasure to rise to respond to my colleague who was also a travel companion in Normandy.

My colleague may be referring to the Speech from the Throne in which the Prime Minister put forward some very important decisions for persons with disabilities. We provided $600, but that has nothing to do with medical assistance in dying. However, I am pleased to inform him that we were there for persons with disabilities—

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

Resuming debate.

The hon. member for Shefford.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I would first like to mention that I will be sharing my time with the hon. member for Beauport—Limoilou.

I am speaking here in the House of Commons today about Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying.

Many people here have had unique experiences involving the end of a loved one’s life. Personally, my most recent experience was last year, when I held my father-in-law’s hand until we were sure that he could die without suffering. I realized then that not everyone is that lucky. I thought about my grandmother, who fought a long and painful battle with cancer for many years.

Naturally, as the Bloc Québécois critic for the status of women and seniors, I was contacted by a number of groups about this bill. I will therefore recap all of the work my party did on this important issue, while emphasizing the great sensitivity of Quebeckers when it comes to medical assistance in dying. I will conclude with the position of some seniors’ and women’s groups who have made extremely useful recommendations.

First, let us talk about the reason for this debate. In September 2019, the Superior Court of Quebec ruled in favour of Nicole Gladu and Jean Truchon, both suffering from incurable degenerative diseases, stating that one of the eligibility criteria for medical assistance in dying was too restrictive, both in the federal legislation covering MAID and in Quebec’s act respecting end-of-life care.

Two brave individuals, and I know people who knew them personally, simply asked to be able to die with dignity, without uselessly prolonging their pain. Suffering from cerebral palsy, Mr. Truchon lost the use of all four limbs and had difficulty speaking. Pain killers are no longer working for Ms. Gladu, who suffers from post polio syndrome, and she cannot remain in one position very long because of the constant pain. She said that she loves life too much to settle for mere existence.

What we are talking about here is the “reasonable foreseeability of natural death” requirement. Justice Christine Baudouin said it well in her ruling when she wrote that “The court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Mrs. Gladu's rights to liberty and security, protected by section 7 of the Charter.” That is the crux of this debate.

The defendants were challenging the fact that they had been denied access to medical assistance in dying because their death was not reasonably foreseeable, even though they had legitimately demonstrated their desire to stop suffering. Jean Truchon had chosen to die in June 2020, but he moved up the date of his death as a result the pandemic. Nicole Gladu is still living, and I commend her courage and determination.

The Bloc Québécois' position on this ethical question is clear. I thank the member for Montcalm for his excellent work and co-operation on this matter. I remind members that, as many have already pointed out, legislators did not do their job properly with Bill C-14. As a result, issues of a social and political nature are being brought before the courts.

We need to make sure that people who have serious, irreversible illnesses are not forced to go to court to access MAID. Do we really want to inflict more suffering on people who are already suffering greatly by forcing them to go to court for the right to make the very personal decision about their end of life? This will inevitably happen if we cannot figure out a way to cover cognitive degenerative diseases.

Obviously, we agree that we need to proceed with caution before including mental health issues, but that is not the issue today. The exclusion from the bill of eligibility for medical assistance in dying for individuals suffering solely from a mental illness requires further reflection, study and consultation, which will be completed at the Standing Committee on Health as soon as the motion that has already been moved by my colleague from Montcalm is adopted.

I would like to remind members of the important role Quebec played on this issue. Quebec was the first jurisdiction in Canada to pass legislation on this issue.

Wanda Morris, a representative of a B.C. group that advocates for the right to die with dignity, pointed out that the committee studying the issue had the unanimous support of all the parties in the National Assembly. This should be a model for the rest of Canada. Ms. Morris said she felt confident after seeing how it would work in Quebec and seeing that people were pleased to have the option of dying with dignity. The Quebec legislation, which was spearheaded by Véronique Hivon, was the result of years of research and consultation with physicians, ethicists, patients and the public. It has been reported that 79% of Quebeckers support medical assistance in dying, compared to 68% in the rest of Canada. That is important to point out.

In 2015, when the political parties in the National Assembly unanimously applauded the Supreme Court ruling on MAID, Véronique Hivon stated:

Today is truly a great day for people who are ill, for people who are at the end of their lives, for Quebec and for all Quebeckers who participated in...this profoundly democratic debate that the National Assembly had the courage to initiate in 2009. I believe that, collectively, Quebec has really paved the way, and we have done so in the best possible way, in a non-partisan, totally democratic way.

In this time of crisis, we must work together constructively to put people's well-being first. This is not about which has greater merit: palliative care or medical assistance in dying. This is about being able to offer both, to offer a choice. That is why I would like to remind the House that health transfers must be increased to 35% because Quebec and the provinces are the ones who know their regions' needs best and are in the best position to minimize disparity among the regions.

I would now like to tell the House about a meeting I had with the Association féminine d'éducation et d'action sociale, or AFEAS, in my role as critic for seniors and status of women. During the meeting, the AFEAS shared its concerns about this issue with me. I will quote the AFEAS 2018-19 issue guide:

Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly....

As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope....

This procedure cannot be accessed by individuals who are not at the end of life....People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.

That meeting took place last January. Last week I received a call from the president, reminding me how important this bill is, not only to her members but to all Quebeckers and Canadians. Work on this bill must continue in committee so the necessary improvements can be made.

Before being elected, I was a project manager responsible for raising awareness about elder abuse and bullying. I used to teach that violating people's rights is a form of abuse, that any attack on rights and freedoms, including the failure to recognize an individual's capacity to consent and to accept or refuse medical treatment, is a form of abuse. In 2020, a focus on proper treatment is long overdue.

Let me conclude by saying that I hope all of these comments and all of Quebec's lived experiences, in terms of respecting people who request and choose to die with dignity, will encourage all members of the House of Commons to give their unanimous support to Bill C-7 and to medical assistance in dying. Let's show some empathy for everyone who is suffering. Let's give them the choice. It is said that we do not choose to be born, but once we are, the cycle of life begins. Let's ensure that we ourselves have the choice to die with dignity in accordance with our own final wishes. This bill is long overdue. We need to act.

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

Madam Speaker, I thank the hon. member for Shefford for her speech and her very analytical and honest comments.

I have two simple questions for her since she took part in today's debate. It was said that consultations on Bill C-7 were inadequate. In my opinion that is absolutely not true, given that we have already heard from 300,000 people. I would like her thoughts on that.

The other question I want to ask her has to do with the dignity and autonomy of the person who wants to receive medical assistance in dying. Will changing the number of witnesses from two to just one independent witness and eliminating the 10-day waiting period improve or diminish the dignity of a person who has opted for medical assistance in dying?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for the question.

Eliminating the 10 days is a matter of dignity. This will allow some people to avoid suffering for days unnecessarily. As far as the committee work is concerned, we are aware that there is a world of difference between Bill C-14 and Bill C-7.

It is already planned, but the committee will have to address the issues of advance requests, which is something many seniors' groups are calling for, particularly for some people with degenerative diseases. There is also the issue of mental health and that of minors.

There are more issues that need to be studied, and I know that the committee will do the most exceptional work possible with input from all parties.

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

Madam Speaker, the Canadian Society of Palliative Care Physicians has put out a statement, indicating that euthanasia-assisted suicide is distinct from palliative care. We talk about choice and opportunity here, knowing that 70% of Canadians have absolutely no access to palliative care, yet it is part of this conglomerate of other options that are presented within the bill on euthanasia.

What is the member's perspective on the need for palliative care in Canada and should it be considered distinct from euthanasia?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her question.

I already addressed this in my speech. We must remember that it is important that we not pit palliative care against medical assistance in dying. We must continue to ensure that Quebec and the provinces receive the money they need for their health care systems through health transfers. Palliative care just like medical assistance in dying are part of a continuum of care. It is truly important to provide choice. I have already mentioned that.

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

Madam Speaker, I thank my colleague for her speech.

We agree on the fact that people must be given the choice. They must be able to leave this life with dignity and avoid useless suffering. However, there is a provision in the bill that concerns us a little, and that is the fact that the physician must have expertise or specific knowledge of the person's illness.

In the case of people living in rural or remote areas, there may not be a physician with knowledge of a rare illness. Would that not be an obstacle to accessing this right?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, that is one more reason to ensure that health care systems across Quebec and Canada have adequate funding through health transfers, as we have pointed out. This would give people access to specialists who could weigh in. That is why the government must increase health transfers and ensure that people everywhere have better access to care.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Madam Speaker, I agree entirely with my hon. colleague from the Bloc Québécois.

I wonder if there could be a response to an earlier question posed in the debate, which suggested that this legislation would open the door to seeing the possibility of medical assistance in dying for those who were not facing death but who were facing mental illness. As I read the legislation, that is specifically not contemplated here.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her question.

I remind members that the notion of mental health is not addressed in this bill because my colleague, the member for Montcalm, pointed out the need to be careful when dealing with such a sensitive issue as mental health.

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

Madam Speaker, no one likes to talk about death. It reminds us that we are mortal, as are the people we love and the people we are emotionally attached to. We do not like to feel negative emotions. Our brain reacts negatively to these emotions by releasing hormones that make us panic.

Death is such a difficult subject that most people worry when a loved one starts talking about wills, last wishes or funeral plans. They worry about the person’s health, when that person is only trying to plan for the future. This may sound ghoulish, but life always ends in death. Our entire lives are planned, starting with our parents planning our education and then us planning our careers, moves, children, and so on. We can plan for death and funeral arrangements the same way, even if we do not have suicidal tendencies.

For there to be death, there has to have been life. We have a short time on this planet, so we need to act responsibly, not only for ourselves, but also for the generations to come. We are only borrowing this planet. The place where we live is temporary.

I listened to my colleagues’ arguments last week, and I also read a lot about medical assistance in dying. I even discussed it with my father. I love my father. I hope that he will be with us for a very long time. I am a daddy’s girl. Unfortunately, my father’s wishes are currently impossible. He told me that, if he were to be diagnosed with a degenerative disease and told what was going to happen, he would like to be able to tell his doctor, at a certain point in the progression of the disease, that he wanted medical assistance in dying and that he did not want to linger.

For now, that is impossible. It is something to think about.

Even if these discussions about our loved ones’ final moments are difficult, we need to have them. They are important. They ensure that we can respect the person’s wishes to the very end. It does not mean that the person will necessarily opt for medical assistance in dying. It means that we will know what the person really wants at the end. It can also prevent families from being torn apart.

One of the points raised by my colleagues was the fear expressed by several disability advocacy organizations that people with disabilities will be urged to get medical assistance in dying. I must admit that I, too, was concerned before I read the bill.

Once I read the bill, I saw that the request for medical assistance in dying must be made in writing by the person in question, and that it can be withdrawn at any time. When the substance is being administered, if the person gestures or speaks in a way that appears to be expressing a change of heart, everything stops there. That is the case not only for people with disabilities, but also for people whose death is foreseeable.

The Canadian Charter of Rights and Freedoms states that people with disabilities have the same rights as people without disabilities. This implies that they have the right to life, and that they are entitled to receive the treatments appropriate to their condition. Why would they not also have the right to medical assistance in dying if they meet the criteria clearly indicated in the bill? Do people with disabilities not have the right to decide for themselves simply because they have a disability? I find that unacceptable. I reject the idea. People with disabilities are capable of making their own decisions. They are rational beings. This has nothing to do with making decisions for other people.

It has to do with allowing people the right to make their own decisions concerning their own death.

I would add that other safeguards have been put in place, namely the three-month wait time with support services. My colleagues talked about that. It is not always easy to get in touch with a doctor or social worker, for example. I used to live in the regions. My doctor was a general practitioner. However, I do not think anyone ever had a better doctor because, when the time came to pick up the phone and call a specialist, he was the first to do so. Nothing could stop him. I wish everyone had that kind of doctor.

All of this makes me think that people with disabilities are not at risk. They will decide for themselves, they will have the same rights and responsibilities as people who do not have disabilities and for whom death is foreseeable.

I read that people are concerned that doctors will suggest medical assistance in dying based simply on a person’s disability. The very idea is repulsive, since doctors would not encourage patients to die. They would first try to relieve their pain and make suggestions for how to live with their condition. Beyond that, according to the bill, it is not up to the doctor to decide, but the patient. Doctors assess the situation and the request. Their role is not to suggest but to inform. It is the patient’s role to request and suggest.

I also read that some people believe that opening up medical assistance in dying to people with disabilities might suggest that their lives are not worth living. I have read and re-read the bill, and nowhere does it say that the life of a person with a disability is not worth living. Did anyone here tell Stephen Hawking that his life was not worth living? Did anyone tell any of our Paralympic athletes that their life was not worth living?

I am getting worked up because I have a little cousin who suffers from severe cerebral palsy. She barely speaks, but when she wants something, she knows how to make herself clear. She will never be able to request medical assistance in dying. Given her personality, I am convinced that, even if she could speak, she would not request it, because she is a ray of sunshine, because she is the person in our family who always believes that everything is good, everything is right and, at the end of the day, we can get through whatever life throws at us. I love her. She makes us see the beauty of laughter and closeness.

Although her life is complicated, it is certainly worth living. Therefore, saying that the bill is suggesting that the lives of people with disabilities are not worth living is yet another despicable point that was made.

The bill’s preamble states that life and the dignity of seniors and people with disabilities must be respected and that suicide must be prevented. I agree. To deny people with disabilities who are capable of making the choice the right to decide whether to receive medical assistance in dying is to deny them their dignity. Are we prepared to do that?

That amounts to treating these people as if they were less important, as if they were incapable of making decisions because of their disability. The very idea is repulsive to me.

Not everyone with a disability will request medical assistance in dying, just as not everyone without a disability will request it. Medical assistance in dying is an exceptional measure. It is not the rule. It is a choice that is fundamentally personal and that should not in any way be imposed by another person.

Some called in particular for the withdrawal of the 10-day wait period for people whose death is foreseeable.

Once again, I have very personal reasons for supporting that withdrawal.

I had an aunt who was quite the character. She spent five years fighting cancer and receiving treatments, some of them experimental. At some point, she could no longer stand it, and asked for medical assistance in dying. Because of the 10-day wait period, she died the day before she was to receive the drug to help her die—

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

I am sorry, but the time has expired.

The Parliamentary Secretary to the Minister of Justice.

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

Madam Speaker, I thank the member for Beauport—Limoilou for her speech, and I would like to congratulate her for highlighting the autonomy of people with disabilities.

I would just like to add that the two people at the centre of the Truchon and Gladu ruling that we are discussing today had disabilities themselves, and the judge recognized their autonomy in making choices.

We have heard several times that our government made a mistake by not appealing the Truchon and Gladu ruling to the Supreme Court. When a provincial superior court decision is well developed, carefully analyzed, rigorous and clearly articulated, should we appeal the ruling to the Supreme Court, or should we take action, as our government is doing, to protect the dignity and autonomy of vulnerable people?

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

Madam Speaker, I thank my colleague for his question.

I am not a lawyer. However, in this case, a superior court handed down a ruling to address an unfair and unjust situation, where a right was taken away from people who were supposed to be treated equally. In my humble opinion, continuing the legal proceedings would only have added to the impression that these people are separate and different. They are full citizens, and they are entitled to be given our consideration and included in our reflections.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, the member mentioned that, in her opinion, there does not seem to be two classes of Canadians coming out of this. In the previous bill, there were two requirements: grievous and irremediable suffering, and reasonably foreseeable death. This bill would remove the reasonably foreseeable death requirement, therefore creating two classes of citizens. An individual who is suicidal and has no grievous and irremediable suffering would be given the host of services Canada provides to prevent suicide. A person who has a grievous and irremediable issue would be eligible for MAID.

Does the member not see that this bill would create two classes of citizens?

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

Madam Speaker, I thank my colleague for his question.

Nowhere in the bill does it say that someone who is suicidal can access MAID. On the contrary, the bill states that someone with a degenerative disability would have 90 days to reflect on their decision and would have the necessary support to ensure that they are not in a state of distress. The necessary safeguards are there to ensure that someone in a state of distress would get the help they need. Furthermore, the request may be denied if the assessment indicates that the problem lies elsewhere.

These are the same reasons for which mental health is not covered. We must start by providing support for mental health problems without giving people with mental illness access to MAID. A good assessment and good support are the safeguards in this bill.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Madam Speaker, my hon. colleague said that there is no way that a handicapped or disabled person could be given medical assistance in dying without their consent because, of course, they would write it on a piece of paper. Would the member not agree that there could be a number of factors put in there, from being put under pressure to feeling like they are a burden on society? Would the member not agree that there need to be protections to ensure that people are not being affected by other factors to ask for medical assistance in dying?

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

Madam Speaker, I have said it once and I will say it again: Yes, it is important to ensure that individuals make a free, informed decision and that they not be coerced. That is why the bill calls for a 90-day waiting period and support from a social worker.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, before I get started, I will let you know I am splitting my time with the member for Markham—Stouffville.

Today, I have the opportunity to participate in this debate on Bill C-7 from my riding in Guelph. Before I get going on the debate, I would like to recognize that Guelph is situated on the ancestral homelands of the Anishinabe people, specifically the traditional territories of the Mississaugas of the Credit First Nation.

I am proud our government has brought forward a bill that proposes changes that respond to the Superior Court of Quebec's September 2019 Truchon ruling. The proposed changes were informed by concerns and issues raised during consultations earlier this year in discussions with provincial, territorial and indigenous partners. As a result, we have had careful consideration of past experience with MAID in Canada.

I recognize medical assistance in dying is a deeply personal and complex issue. I have heard extensive feedback from my constituents on this topic as recently as this morning. During today's debate, we are hearing very personal stories from MPs that are very similar to what we heard when we first brought forward the legislation in Bill C-14. There are arguments for and against, which we need to recognize and look at.

Some of my constituents who have shared their support for these amendments and the swift passage of this bill have noted to me the importance of dying with dignity, as well as consistent and equal accessibility for all Canadians, as part of what our legislation needs to provide.

Earlier this year, I had a constituent reach out to me and share her personal story regarding medical assistance in dying. She told me that she felt very strongly about this issue because her husband of 56 years, John, had passed last December after four years of battling an illness and how appreciative she was that we had taken some first steps toward addressing these issues. She told me about the vibrant man John was, with a big heart, a successful career and an impressive education. She told me they had conversations about getting old together and how they would deal with aging, but these discussions did not include suffering or what might happen if the pain became too great. As John's illness progressed, he was moved into a long-term care facility where he spent the rest of his life. It was there that she saw so many others who were unable to be independent. She was saddened to see there was no dignity for these people, or for her husband John, as they were no longer able to look after their own personal needs. I saw this myself with my mother as she went through care in her last 10 years of life. The story of my constituent was one that conveys the importance of providing a diverse end-of-life option for Canadians that will help them provide the right decisions to be able to end their days with dignity, comfort and peace of mind.

Of course, there are two sides to this debate. I have heard from other people and received a lot of feedback that they understand we are coming at this as a deeply personal and sensitive topic for everyone, but are concerned these new amendments may impact the disability community, something we have discussed in the debate today, and the conscience rights of medical practitioners or our work toward improving palliative care. They all really do stitch together. While I am sympathetic to these concerns, I am also pleased to see our new legislation strikes the right balance of autonomy and protection of vulnerable people. This is thanks to many disability advocates who have participated actively throughout the consultation process, including specific round tables that focused on issues faced by the disability community. As was mentioned earlier in the debate, 300,000 people had input throughout the month of January 2020 to help us get to where we are today.

Additionally, our law specifically acknowledges the conscience rights of health care providers and the role they play in providing medical assistance in dying. These new amendments do not make changes to these rights and I know we will continue to work with provinces and territories to support access to medical assistance in dying while also respecting the personal convictions of health care providers.

However, the most common concern I have heard from my constituents is the need to prioritize palliative care over medical assistance in dying.

It is really the end-of-life care that we are talking about in both cases. In palliative care, Canadians are approaching the end of their life, and they deserve to receive care in the setting of their choice and to live out their days in comfort and dignity. They also deserve the freedom to make this fundamental decision about life and death without fear of their personal choice being obstructed by politics or government.

In Guelph, we are very blessed to have a wonderful palliative care facility that has been growing over the years as people recognize this as an option towards the end-of-life care that they are looking for.

However, 70% of Canadians are left without access to adequate palliative care. We have the responsibility to act in the interests of patients and their families, which is why our government supports access to both palliative care and medical assistance in dying. End-of-life issues are as diverse as Canadians themselves, and these issues also change throughout the course of medical needs and procedures that are available.

It is our responsibility as a government to provide as many options as possible for Canadians, so that they can take these deeply personal choices and make them on their own. That is why our government has worked collaboratively with partners, such as the provinces and territories, to develop a framework on palliative care. To support this framework, our government is implementing a targeted action plan that will help to improve access to palliative care for underserved populations; support families, health care providers and communities; and look at the funding that is needed to be able to execute our plans.

I would like to take this opportunity to thank Hospice Wellington and its executive director, Pat Stuart for the amazing work they do to support our most vulnerable citizens, including through palliative care.

I would also like to thank the constituents of Guelph who have personally reached out to me over the last several months to share their feedback, suggestions and personal stories around medical assistance in dying. I look forward to continuing to engage with my colleagues on this important subject and with my constituents, so that we can work to create a system that is responsive to the needs of patients, and creates an environment that can create comfort and reassurance for patients and their families.

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

Madam Speaker, I wish to thank my hon. colleague for his perspective on this issue. Indeed, I want to thank all of the members from both sides of the aisle who have shared on this deeply important topic.

My concern, and the member raised it, as did several of the previous speakers, is about the concerns expressed by the most vulnerable in our society, the disabled. They wrote, one month after the Truchon decision, to the Attorney General, 72 groups of them, pleading that this case be appealed to the Supreme Court for several reasons, that would buy time for a proper consultation process as part of the review, and that their voices would be further heard.

Could my hon. colleague please comment on why this process has been chosen superior over the voices and wishes of 72 representatives of the disabled community?

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I thank the hon. member for Chatham-Kent—Leamington, where we also have family members. As we have these discussions, we do see the cross-ties across Canada as we look at these issues.

The disability community is involved with the consultation process and will continue to be involved. We are reacting to the Superior Court ruling from Quebec, where we do need to look at some amendments. When we can get those in place, we will do the further review of Bill C-14, which will include the broader issues the member has mentioned.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, I will continue on in this vein.

I am concerned that the bill creates two classes of Canadian citizens: one, where if they are attempting suicide, suicide prevention measures will be given to them; and, two, another class of citizens who have a grievous and irremediable condition and who will be offered MAID.

Is the member not concerned with the two classes of Canadian citizens?

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, similar to colleagues on both sides of the aisle, I do not see this as an issue of dividing Canadians, I see this as an issue to be able to reach all types of Canadians, coming from different experiences and different health needs. We will be addressing the needs of all Canadians through this bill, as well as through ongoing legislative review of this legislation.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Madam Speaker, I know that my hon. colleague is a sincere man. That is why I was very disturbed by something I thought I heard him say, about some people at the end stage of their lives, that their lives were simply not dignified. Who is he to say that their lives were not dignified?

Would the member state unequivocally that all human lives, regardless of what condition or how they are at the end of their lives, are always dignified?

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I apologize if I left that impression with the hon. member. All life is dignified in Canada.

When my mother was passing away in Winnipeg I spent her last few days with her. Family members were looking at the question of how long to keep the machine going. My mom, in a moment of lucidity, came back to me when my brothers and sisters were out of the room and she said to me, “It's part of my decision as well, dear.”

The people who make those decisions have to be dignified and respected, so that their decisions are included in the legislation. In fact, this legislation is central to their decisions and not the decisions of family members or others.

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

Madam Speaker, what concerns me is that I have been in the House for many years, and twice now we have had to respond to court decisions in regard to end-of-life legislation.

I brought forward, in the previous Parliament, a motion for a palliative care strategy that received support from every member of Parliament. I heard many of my Liberal colleagues get up to say great things about it and then we never saw any action on it. The concern I have is that, in all of the work I have done with palliative care groups across the country and with people I knew very closely who have died, the will to live is so incredibly strong.

What we do not have ever, it seems, at the federal level is the willingness to make sure that we have standards in place to ensure the dignity of people in their final days and months, to ensure there are proper pain medications, supports and strategies in place. Here we are once again talking about amending the right-to-die legislation, but we have never ever gotten serious about responding to Parliament's call for support for people who want to die with dignity at their own time through palliative care.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I do not mean to talk down to the hon. member across the way because I would not do that.

The courts make decisions that then come back to Parliament so that we can review the decisions we have made on legislation to see whether further amendments are needed. This is a case where a court is telling us that there are further amendments needed. We agree with the court and are going forward with Bill C-7, so that we can make the amendments to try to satisfy the needs of the—

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

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Mr. Speaker, I am pleased to rise today to discuss Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying, or MAID.

As a physician, I took a keen interest when Parliament passed federal legislation in June 2016 to allow eligible Canadian adults to request medical assistance in dying. This was subsequent to the February 2015 Supreme Court of Canada ruling that parts of the Criminal Code would need to change to satisfy the Canadian Charter of Rights and Freedoms.

At the time, I was also a member of the provincial parliament in Ontario and was involved in how that province would ensure people would have their personal choice of access to medical assistance in dying, while also ensuring the conscience rights of health care providers would be respected. The actual implementation of MAID was our responsibility and was very carefully considered.

Working with provincial organizations like the College of Physicians and Surgeons of Ontario, we established policies to ensure that, should physicians have conscientious objections to administering MAID, systems were in place to provide appropriate care options to the patient. Consistent with the expectations set out in the college's professional obligations and human rights policy, physicians who decline to provide MAID due to a conscientious objection must do so in a manner that respects patient dignity and must not impede access to MAID.

They must communicate their objection to the patient directly and with sensitivity, informing the patient that the objection is due to personal and not clinical reasons. They must not express personal moral judgments about the beliefs, lifestyle, identity or characteristics of the patient. They must provide the patient with information about all options for care that may be available or appropriate to meet their clinical needs, concerns and/or wishes, and they must not withhold information about the existence of any procedure or treatment because it conflicts with their conscience or religious beliefs. They must not abandon the patient and must provide the patient with an effective referral. Physicians must make the effective referral in a timely manner and must not expose patients to adverse clinical outcomes due to a delay in making the effective referral.

While there is importance in ensuring widespread access to MAID, the law specifically acknowledges the conscience rights of health care providers and the role they may play in providing medical assistance in dying. As a physician who spent all of my time in clinical practice doing my best to preserve life, I feel this balance is working well, and the amendments proposed in Bill C-7 do not make any changes to any of this.

As a government, we remain committed to working with provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

What are the amendments that Bill C-7 proposes?

In response to the Superior Court of Quebec's Truchon decision, it repeals the MAID eligibility criterion that applies when a person's natural death is reasonably foreseeable. The criterion is the 10-day reflection period. One concern at the forefront is to ensure that measures are in place that provide safeguards for the MAID process. I believe Bill C-7 does precisely this. It proposes to create two sets of safeguards that must be respected before MAID is provided. For persons whose natural death is reasonably foreseeable, the existing safeguards, as amended by Bill C-7, would continue to apply. For persons whose natural death is not reasonably foreseeable, the existing safeguards with additional safeguards would apply.

I think we are all aware of the concern about increased risks where MAID is provided to persons who are not dying in the short term. That is why additional safeguards would apply where a person's natural death is not reasonably foreseeable. With these new safeguards, specific attention with respect to both time and expertise would be devoted to assessing requests for MAID and to ensuring those making the request are made aware of and seriously consider all other available means of relieving their suffering, including palliative care. In nearly half of the reported MAID deaths in Canada to date, the practitioner providing MAID had in fact consulted with at least one other health care professional in addition to the required second opinion from another practitioner. There is no question these practitioners are taking their responsibilities very seriously.

For those whose death is reasonably foreseeable, Bill C-7 most importantly proposes to eliminate the 10-day reflection period, which many practitioners say can prolong unbearable suffering.

The proposed amendments of the bill will allow waiver of final consent for persons whose natural death is reasonably foreseeable, who have been assessed and approved to receive MAID and who have made an arrangement with their practitioners for waiver of final consent because they are at risk of losing decision-making capacity before their chosen date to receive MAID.

We have heard many touching stories during the course of debate on this bill and situations like that of Audrey Parker, who chose to access MAID on November 1, 2018, despite her desire to see Christmas with her family. She feared that she would lose her capacity to give full consent before Christmas and so she requested MAID before then. Considering her case, we see the need for this amendment in real human terms. Ms. Parker, herself, stated:

I would like nothing more than to make it to Christmas, but if I become incompetent along the way, I will lose out on my choice of a beautiful, peaceful and, best of all, pain-free death.

Since the Truchon decision, our government has engaged in extensive consultations. Beginning in January of this year, over 300,000 Canadians took the time to participate in an online questionnaire on the subject. It should be noted that as part of this questionnaire, direct questions were asked about final consent for MAID. The following question was asked:

Imagine that a person makes a request for MAID, is found to be eligible, and is awaiting the procedure. A few days before the procedure, the person loses the capacity to make health care decisions, and cannot provide final consent immediately before the procedure. In your opinion, should a physician or nurse practitioner be allowed to provide MAID to a person in these circumstances?

Over 78% of participants said yes, that a person in these circumstances should be allowed to receive medical assistance in dying.

In addition to the online questionnaire, the Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion hosted a series of 10 in-person round tables across the country, from January 13 to February 3 of this year. These round tables allowed the ministers to hear from over 125 experts and stakeholders, including doctors, nurse practitioners, health regulatory bodies, key health stakeholders, legal experts, civil organizations and, of course, the disability community.

The ministers also hosted a separate round table focused on receiving specific feedback from indigenous practitioners and community leaders.

The importance of palliative care continues to be raised in these discussions. Our government recognizes the need for quality and appropriate palliative care, which is why it has worked collaboratively with partners, such as the provinces and territories, to develop a framework on palliative care. To support this framework, our government is implementing a targeted action plan, which will help to improve access to palliative care for underserved populations and support families, health care providers and communities. In addition, our government is providing $6 billion in federal funding directly to provinces and territories to support better home and community care, including palliative care.

There is no question that MAID is a very important consideration for all of us. This is an issue about which all Canadians care. I know in my riding of Markham—Stouffville, it is a concern that a significant number of my constituents have shared with me. This matter is extremely complex and further discussion will be needed during a future parliamentary review of the previous Bill C-14.

There is a medical aphorism attributed to Sir William Osler, a Canadian who is considered the father of modern medicine and internationally recognized, that says that a physician's duty is to “cure sometimes, relieve often, comfort always.” Our MAID legislation provides comfort to those facing death. For now, let us move forward with Bill C-7 and provide compassionate care to those in need.

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

Madam Speaker, if I heard right, I heard the member say that she had practised previously as a physician. She also expressed the view that the requirement in Ontario for effective referral was consistent with conscience protection. That is the view she expressed.

If the member happened to be practising medicine in a jurisdiction that allowed female genital mutilation, would she be willing to provide an effective referral for someone seeking that service?

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Madam Speaker, I fail to see how the example given by the member opposite relates to Bill C-7.

What I am saying is that the relationship between patients and their practitioners is one that should be based on trust and clear communication and that health care providers should always do their very best to provide that type of compassionate care to their patients, and to discuss the matter as necessary and refer individuals to specialists in the particular area. This is the normal practice of medicine.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Speaker, the Bloc Québécois was the first to introduce a bill on this matter. I am thinking of two of our members, who have now passed on. One is Francine Lalonde, who introduced a bill on this topic, and the second is Father Gravel, who was bullied by certain religious lobbies, which even wrote to the Vatican to have him removed from his position and driven out of the Catholic Church. I will spare you the details, but that was not easy for him. I will think of these two, who are dear to my heart, when we vote on this bill.

I thank my colleague for her speech. Does she not think that we need to address the notion of advance consent, which is not in this bill, as quickly as possible?

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Madam Speaker, the whole issue around the advance directives, which I think my colleague opposite was referring to, is one that comes up in conversations with my constituents. A number of Canadians are very concerned about the possibility. In most of the conversations I have had people are in favour.

Bill C-7 at the moment is taking one step forward. This is a good improvement to the existing legislation. As I understand it, there may very well be a parliamentary review of the existing Bill C-14 and I have no doubt that these types of discussions will occur at that time.

[Darren Fisher, Liberal, Parliamentary Secretary to the Minister of Health]

Madam Speaker, I know the Audrey Parker situation so well and I want to thank the member for putting those words into Hansard one more time, because they are so important as it pertains to Bill C-7.

I wonder if the member could tell me her personal opinion on whether the bill provides the level of safeguards that the Canadian public will be comfortable with and need?

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Madam Speaker, I believe the required safeguards are there. Clearly there is a balance between individual choice and the fact that there could be perhaps some second thoughts in discussion with an individual, a change of heart in essence, as to what the individual might choose to do. There is the 90-day period of reflection. The assessment is very thorough. There is nothing in Bill C-7 that endangers those safeguards. We have them under the current legislation and they are preserved in this bill.

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

Madam Speaker, it really amazes me how quickly we have gotten here. The 2015 election was five years ago today. One of the first issues we dealt with in that Parliament was a new law that legalized euthanasia. The government came up with a new term for it, calling it medical assistance in dying. At that time, the then minister of health and the then minister of justice said that it was a finely tuned balance where there was the right mix of safeguards and opportunities. Of course, as a result of the SNC-Lavalin scandal, both of those ministers were kicked out of the Liberal cabinet and the Liberal Party, but they along with their colleagues said that this was a necessary balance that was struck.

What was built into the process as well was a legislative review five years later. However, the government jumped the gun on that legislative review. It said that before the legislative review, it would remove some of the safeguards that were thought to be vital less than four years ago and would do that ahead of any review. The fig leaf the government used to do that was the Truchon decision in Quebec. This decision dealt with a very specific issue, the question of reasonable foreseeability.

It was a political choice for the government not to appeal that decision because it did not want to. It wanted to be able to justify, ahead of the timeline set by the legislative review, moving forward with the removal of safeguards that it had said quite recently were vital. Then it packed into the legislation a number of critical changes that had absolutely nothing to do with the content of the Truchon decision.

My colleagues have spoken eloquently about the specific issues around removing reasonable foreseeability and the concerns raised by people in the disability community. I want to focus on the aspects of this legislation that have absolutely nothing to do with the court decision to which it is supposedly responding.

This legislation will bring us, for the first time, three things about which Canadians should be very concerned. First, it will bring us same-day death, the opportunity to receive death on the same day a person requests it. Second, it will bring us death without contemporaneous consent. It will bring us a situation where people will have their lives taken without being consulted in the moment. Third, it will bring death without the presence of independent witnesses.

I am opposed on all three counts. I do not think we should have same-day death. I do not think we should have death without contemporaneous consent or any kind of contemporaneous consultation. I do not think we should have death without independent witnesses present.

Let us talk about same-day death. Right now there is a 10-day reflection period. Let us be very clear that the law already allows that reflection period to be waived in certain circumstances. The waiving of that reflection period is not a long, arduous process. If the physicians involved say that because of the particular circumstances in this case that the 10-day reflection period should be waived, that 10-day reflection period can be waived, but it is a default. It says that on balance, except in exceptional circumstances, the 10-day reflection period between when a person requests death and receives it is a reasonable frame of time. I think we can all understand that people who are going through challenging circumstances and major changes in their lives will feel intense feelings of pain, suffering and angst in a moment. Those are real sincere feelings, but they might feel differently in a different space with a little time and opportunity for reflection.

I would like us to be the kind of country where if people say that they have had enough and that they want to die, instead of being told okay, let us do it right now, they are told that we have this mechanism of review of consideration, take that time and even that review process can be waived. That is eminently reasonable.

What we do not want in the country is a situation where I might go visit an elderly relative on Wednesday and seems totally fine. Then I come back on Friday and find that the person requested death yesterday and received death on the same day. We should leave in place a default of a 10-day reflection period. It is not only members on this side of the House who feel that way. I raised the question during questions and comments before prorogation. Even the member for Richmond Hill said that he supported leaving in place the 10-day reflection period.

I know other Liberals believe this as well, and I would challenge them to do the right thing and recognize the need for this amendment to remove same-day death. It just is not safe. It is dangerous. It is rife with abuse. It does not allow people the time and space to consider carefully in consultation with family members. The 10-day reflection period can be waived, but it is an important default to have in place.

Secondly, we have a proposal on this legislation, and it has nothing to do with the Truchon decision, for death without contemporaneous consent. What this means is that a person could say in advance, “I want you to take my life on December 31, and if I don't have capacity then go ahead and take my life anyway.” There is no requirement in this legislation, on that future date set, for there to be any kind of consultation with the patient. In other words, a person, in whatever state of mind, could not even be told. They could have something slipped in their coffee without being told in advance. They could have their life taken without being asked in the moment.

Members are giving me looks. They should look at the legislation. There is no requirement in the legislation for the patient to be told what is happening while it is happening. I would, at a minimum, propose we amend the legislation to say that if somebody has provided advance consent, that at least at the moment the action is happening the person administering it be required to tell them what is happening, and that the person is given the opportunity to, in that moment and regardless of their state of capacity, be able to offer some kind of objection if that is the way they feel. There is nothing in the legislation, as it is written right now, for a person to be told what is happening or asked their opinion in any way in the moment their life is being taken.

I do not believe that, as a matter of principle, it is consistent with the ethics of choice and autonomy for my past self to be able to bind my future self. Garnett Genuis on October 19, 2020 might want a future version of myself to behave in a certain fashion, but that future version of myself should still have autonomy to make choices that contradict something that my past self wished for, especially in cases where disease and disability are involved where people adapt to circumstances. They adapt in ways perhaps they do not expect.

The third point I want to talk about is that this legislation would bring us death without independent witnesses. It would remove a requirement for independent witnesses to be involved. I just do not see the purpose of that. Why not leave in place a requirement for independent witnesses? It ensures there are not abuses.

When I finish my remarks, I am going to be sharing my time today with the excellent member for Peace River—Westlock.

People advancing this legislation say it is about choice. I would say, in the context of choice, let us recognize the context and the architecture in which choice is made and let us protect people's ability to make a genuinely autonomous choice. Is that fair enough? Is same-day death consistent with giving people real choice, that the moment they ask for death they receive it right away, or is it more consistent with choice that they have the time and the space to reflect?

Is it consistent with choice to remove the requirement for contemporaneous consent? I do not think so. Is it consistent with choice to remove independent witnesses who can verify what is happening?

Same-day death, death without contemporaneous consent and death without independent witnesses are moving us in a dangerous direction that will leave people vulnerable. In the government's defence of this legislation, it says it held lots of consultations and that virtually everybody it talked to agreed with it. I doubt it. We have already had over 400 physicians sign a letter raising objections to this. We have had a joint letter sent by many faith leaders from different communities across the country. We had over 70 representatives from the disability community come out against this bill.

May I say that the government runs consultations that involve loaded questions: questions that presuppose a particular result. One of my colleagues once talked about another consultation the government did as being like a dating website designed by Fidel Castro. When one asks loaded questions, there will be no meaningful result to the consultation. We are going to have what we have right now, which is hundreds of physicians and dozens of leaders from the disability community speaking out.

Finally, is it not sad that the only time we talk about palliative care in the House is when we are bringing in more euthanasia and removing vital safeguards? That is the only time the government pays lip service to palliative care. It is so eager for assisted dying but it is taking no action on assisted living, and it does not appreciate that if people do not have proper assisted living and palliative care available, then they do not have a meaningful choice. People have read the reports about what is happening with seniors care in this country.

People do not have a meaningful choice when they do not have access to the care that they want and need. Let us do more for assisted living, instead of removing vital safeguards that protect people around the assisted dying regime.

[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 must say right at the beginning that numerous members of Parliament, at least on the Liberal benches, have talked about the importance of palliative care. It has been incorporated in many ways, whether in budget issues or the throne speech.

When we talk about this particular piece of legislation, the member is upset over two or three aspects of it. I can appreciate that. I suspect the bill will eventually get to committee and in a minority situation, the member will be afforded the opportunity to bring forward ideas and changes that he would like to see with the legislation.

Would the member not agree that having this discussion, and having it go to committee, is a good thing to do? In regard to input, at the beginning of the year over 300,000 Canadians provided input on this legislation.

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

Madam Speaker, I already spoke about the flaws in the government's consultation process. If this bill gets to committee, I certainly look forward to the opportunity to raise these amendments around removing the provisions dealing with same-day death, around removing the provisions that deal with death without contemporaneous consent, and around removing provisions that deal with death without independent witnesses. I hope government members and members of other parties will listen to those proposals, recognizing that those aspects of the bill have nothing to do with the court decision that this bill is supposedly responding to.

The member is right to say that Liberals often speak about palliative care during debates about expanding euthanasia. However, what I have failed to see is action. How about they bring forward legislation on palliative care? How about they bring forward legislation on improving access to assisted living, instead of paying lip service—

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

The hon. member for La Pointe-de-l'Île.

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

Madam Speaker, I listened carefully to my colleague's speech. He shared a number of concerns, but I have to wonder what is behind them.

All members know that this bill is based on principles, and I think principles are behind his concerns. My colleague should know that our own personal principles should not violate someone else's principles. This is even more important in the case of dying with dignity. We cannot force our religious beliefs on others who may not necessarily share those beliefs.

One part of my colleague's speech about choice stood out to me. He said that people should have autonomy to make choices. I would remind the member that the word “autonomy” derives from the two Greek words “auto” and “nomos”, meaning “to be ruled by one's own laws”. It is up to an individual to decide whether to end their own life. It seems to me that any attempt to impede that decision would be made under false pretences.

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

Madam Speaker, I would welcome the opportunity to speak with my colleague at great length, perhaps outside of the House, about our religious views and how all of our basic a priori assumptions about human dignity and human value may inform things we are talking about.

We might find ourselves agreeing on the importance of some application of autonomy. I do not think removing the requirement for contemporaneous consent is consistent with autonomy. I do not think that if a person, at a low moment, says they want to die today, removing any possibility of a reflection period is consistent with autonomy. The values of autonomy should engage people in expressing their considered judgment over time with all the information in a situation where they have alternatives.

If we tell someone their only choice is between living in a cockroach-infested facility and death, they are more likely to choose death than if they are given a real, humane, living with dignity alternative. Let us agree on the importance of autonomy, but let us recognize that the architecture of choice informs the choices that are and are not available to people. We can do better by giving them a context in which to make a life-affirming choice, if that is what they wish.

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

Madam Speaker, we are not leading the way with this bill. We are already lagging behind. Hundreds of people have been dying in needless pain for years. We have the opportunity to take a step forward and let people die with dignity. It is not about moving from a cockroach-infested room to a clean one. It is not the same thing. People are prisoners in their own bodies and suffering needlessly.

Why should they not be able to make that decision?

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

Madam Speaker, the member referred to court decisions. Again, the focus of my remarks was on aspects of this legislation that have nothing to do with court decisions. I want us to remove same-day death, to remove death without contemporaneous consent, and to remove death without independent witnesses. I think all three of those are reasonable changes, and none of them would interact with a court decision that was made.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, it is my honour and privilege to join this debate today, though it is a sad one for me. I remember coming to this place. We passed Bill C-14 right off the get-go. It is where I cut my teeth in politics, I would say. At the time, we mentioned that this was a slippery slope. We had seen it in the Netherlands. Currently the government there is passing legislation to allow children under the age of 12 to be euthanized. They are working with what's called the Groningen protocol, where it is not the individual but a group of doctors making the decision as to who gets to live and who gets to die. Here, we saw that this erosion of protection began virtually as the ink was drying on the original bill. We have seen the government not uphold the wishes of this Parliament. We have seen a junior court strike down the law, calling it unconstitutional.

This is where I have some frustration. The ink was not even dry on the bill when it was being challenged in the courts. It had just passed through the House of Commons. It is incumbent upon the executive branch of government to defend the decisions of this place, whether the government agrees with a court or not, and this was a brand new law that had just been thoroughly discussed in this place. We had worked hard for the amendments. For the government to abandon all the work we had done and decide that a junior court decision stood and that it was not going to appeal it to a higher court, like the Supreme Court, was an abdication of the executive branch's responsibility, and I definitely want to acknowledge my frustration that the government did not appeal this court decision.

That said, this bill is much broader than the court decision, and I would argue that we continue down the slippery slope. When Bill C-14 was introduced, I remember talking about the slippery slope and being assured it was not a thing. Yet here we are, removing safeguards from the bill.

This bill definitely makes two classes of Canadians. Across the country, we see a big emphasis on suicide prevention. Every level of government in this country has suicide prevention strategies. We see community groups getting together to run hotlines. Facebook has a warning system to help folks who are considering suicide. Facebook will even identify them and notify people who are close to them that their friend is not feeling well. The American military has worked with Facebook as well, to identify veterans who are considering suicide. We see throughout Canadian society that there is very much a focus on preventing suicide.

Where does that comes into play in this bill? It would create two levels of Canadians. In one case, there are able-bodied, otherwise healthy people suffering from mental illness who are considering suicide. All of those suicide-prevention apparatuses come to their aid. We even have bridges in this country that have nets to catch people in case they jump. All of that stuff comes to the aid of those particular people. However, for sick people who have a grievous and irremediable condition, that stuff is optional and they can request death. They can go to their doctor and say they are not feeling well and are suffering, and that their grievous and irremediable condition has affected their mental health and they are having suicidal thoughts. Then suddenly they are eligible for assisted suicide.

This creates two classes of people. If they are otherwise healthy, suicide prevention is granted to them; if they have an underlying grievous and irremediable condition, they are eligible for, as the government likes to call it, medical assistance in dying or assisted suicide. That is what this bill would do.

Prior to this bill, there was a requirement that a person's death be reasonably foreseeable. I remember that when we were discussing this, we found it to be kind of nebulous. What did that mean? There was no timeline on it. I remember we said that for a death to be reasonably foreseeable, it would have to be in six months or within a year. Those were amendments we brought forward. The government did not go for them back then. Now we see the courts are taking that off and the government is not even defending it. That is definitely one of the concerns we have. We are creating two classes of citizens: one for which suicide prevention is available and one for which it is optional.

The other thing I want to talk about is an amendment we brought to the original bill, one that I think would be an improvement on this bill. It is the need for video verification. In the current rendition of the bill, the timelines have been reduced or eliminated altogether, from the time of the request to the time when MAID is administered. There is a concern that family members may not be convinced that their loved one requested MAID and that they were giving consent at the moment thereof. There has been a suggestion by some groups that there be a video recording of the administration of MAID. That is an amendment I would seek at committee. We would definitely like to see something like this.

Lastly, we would like to see the government work to enhance assistance in living. With COVID, many of our old folks in seniors care facilities are not able to see their loved ones because of restrictions on movements and not being able to travel. The military had to be called in to deal with some of the situations. We talk a lot in this place about dying with dignity, but maybe it is time that we started focusing on living with dignity, having a dignified life, taking care of our elders and being part of a family.

I have talked to folks who have been working in the old folks homes lately and it has been a rough job. They say the loneliness is a major issue in old folks homes these days. The loneliness leads to mental health issues, and if those mental health issues are not addressed, people will become suicidal and will request MAID for loneliness. Is that what we really want in this country? Assistance in living is something we have to be concerned about.

This also deals with palliative care. Palliative care is something the government pays lip service to. We have called for national strategies on this. We have called for money to be put into it. In the absence of palliative care, there is no real choice. There is no ability for somebody to say that this is what they are choosing. Palliative care is an acknowledgement that while there is, humanly speaking, nothing more we can do, we can make a person comfortable and allow them to be surrounded by friends and family as they leave this earth. We would very much like to see the government pursue a significant improvement in palliative care, rather than allowing the elderly members of our families to vanish into an old folks home, where we are not allowed to visit them at this point, to die of loneliness and be offered MAID as the first available option.

This bill has many concerns. It is the first evidence of the slippery slope that is happening in the euthanasia debate, and I definitely wanted to raise that concern. I am also concerned that this bill creates two classes of citizens, as I clearly outlined. I am looking forward to the government making some amendments to the bill and look forward to being able to participate in those discussions at committee.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Madam Speaker, of course, no one is going to disagree with improving the lives of our seniors through better palliative care, but the soft paternalism that ran through those comments is completely fabricated, as though if we just focus on assisted living and just provide additional support, nobody in any position is going to want to end their life and exercise personal autonomy and individual rights. There are individuals who are suffering intolerably, people who are of sound capacity and mind to make decisions about their own lives. They are suffering from an effectively incurable illness and some members want to take those rights away.

My question is simple. Has the member read the Supreme Court's unanimous decision in Carter, and if he has, what about the criteria established for eligibility does he disagree with?

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, I was pointing out that with Bill C-14, we entered a slippery slope, as the safeguards had been removed. Bill C-14 is the law of the land. I am merely pointing out that we are now removing the reasonably foreseeable requirement. We are not improving the safeguards at all with the bill. In fact, we are removing safeguards. In the absence of palliative care, in the absence of a true choice, that leaves folks with no choice at all.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Speaker, I believe that two of my hon. Conservative colleagues in a row have spoken to us about palliative care and care in long-term care facilities, such as CHSLDs in Quebec. It seems to me that they are trying to sidetrack the debate. We are talking here about medical assistance in dying. The two are not related. They seem to be saying that, if we had better palliative care services, then there would be no need for this bill. That does not make any sense.

However, if they want to go there, then I would tell my hon. colleague that his party was in office from 2006 to 2015 and the provinces were not granted the increased health transfers that the Quebec and other provincial premiers are calling for. In fact, the Conservatives made cuts to those transfers. It seems to me that this party, which is lecturing us on palliative care, had a role to play in the fact that the provinces do not have enough money to manage their jurisdictions.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, I would say that is fake news. Under Stephen Harper, health transfers actually increased. Under Stephen Harper, the sovereignty of the provinces was improved. Under Stephen Harper, the separatist movements across this country were diminished, both in the member's province and in my province. Under the current government, divisions run deep across this country and separatist movements are growing not only in his province, but also in mine.

[Eric Melillo, Conservative, Kenora, ON]

Madam Speaker, as I mentioned earlier in this debate, unfortunately in a lot of the rural and remote communities and the many indigenous communities in my riding, and I imagine in the hon. member's riding as well, there is not an equitable access to health care services. That includes palliative care, unfortunately, in many circumstances.

I am wondering if the member could speak to how important palliative care and all these health services are for every single Canadian.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, across Canada palliative care is inconsistent. We are looking for some guidelines from the federal government on what palliative care should look like, with standardization across the country. We want funding to be dedicated to it. We also want the conscience rights of folks and organizations working in health care to be protected. In the Delta Hospice Society case, for example, the provincial health authority is forcing its ideology upon a hospice that is quite convinced that MAID has no place whatsoever in hospice care.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, I am delighted to speak today to Bill C-7, an act to amend the Criminal Code, medical assistance in dying. Its proposed Criminal Code amendments to the medical assistance in dying regime are a true reflection of the value we as Canadians ascribe to individual autonomy.

I wish today to address a specific aspect of Bill C-7, which is the exclusion from eligibility for medical assistance in dying, or MAID, of those whose sole underlying medical condition is a mental illness. This is an aspect of the bill that has already attracted some attention, and I am grateful for the opportunity to make these remarks to provide context around the government's choice to not extend medical assistance in dying in this area at this time.

The government has heard from various sources that there are unique risks and complexities associated with medical assistance in dying on the basis of mental illness alone. These include the report of the Council of Canadian Academies' expert panel on medical assistance in dying where a mental disorder is the sole underlying medical condition, as well as the experts the ministers consulted in recent round tables on medical assistance in dying.

In this Canadian-made context, very specific concerns have been raised in relation to mental illness, those illnesses that affect how a person perceives themselves, their environment, their place within it and sometimes their future. The first main concern is that the trajectory of mental illnesses is harder to predict than that of other illnesses. Unlike some dementia and intellectual disabilities, the underlying causes of mental illness remain largely unknown. Mental illnesses can spontaneously remit or can be difficult to treat for years until one treatment or one social intervention works and improves quality of life, reducing that person's suffering.

For example, we learned from the Council of Canadian Academies' report that an important percentage of persons living with borderline personality disorder will see their symptoms go away as they age, and some people with problematic substance use disorders also spontaneously remit. Experts disagreed on whether a mental illness can ever truly be considered incurable. Indeed, the Canadian Mental Health Association has indicated, “CMHA does not believe that mental illnesses are irremediable, though they may be grievous or unbearable [and] there is always the hope of recovery.”

A second main area of concern is that the desire to die can be a symptom of some mental illnesses. Here I address specifically the concerns just raised by the member for Peace River—Westlock around suicide. I acknowledge and recognize his sincere concern. Having a mental illness is, indeed, a significant risk factor for suicide.

This underscores the difficulty of assessing the voluntariness of a MAID request from a person who may be experiencing a desire to die as a symptom of mental illness. Some practitioners also raised the concern that an expanded MAID regime could negatively impact suicide prevention efforts if MAID were a legal option in response to suffering caused by mental illness alone, both at the level of public messaging and at the individual clinical level.

The Council of Canadian Academies' expert panel also noted the particularly troubling situation of suicide rates in indigenous populations. This is an issue that concerns us all deeply. It was the expert panel's view that the potential impact of MAID where a mental illness is a sole underlying condition, if any, on suicide prevention efforts must be explored more deeply with indigenous people.

By contrast, there are other conditions affecting the brain that do not raise these same concerns. For example, the trajectory of cognitive impairments such as Alzheimer's, Huntington's Disease or other neurodegenerative diseases is more easily predicted, in large part because the underlying pathology is better understood.

Intellectual disabilities are a permanent state and there are no concerns with an unpredictable illness trajectory or a person's perception of their place in the world being affected. Indeed, many do not consider such conditions to be a mental illness or mental disorder. While they may raise other concerns, these are likely more properly addressed by assessments of decision-making capacity.

On the other hand, those who live with mental illness can experience unimaginable suffering and even physical pain. There is no question that the suffering that some with mental illness endure can be intolerable. Some who suffer from both physical and mental illness have said that, if they were able to choose, they would easily choose to endure the physical pain if the mental anguish could end. It is understandable that there is no consensus on this issue.

The group of experts the Council of Canadian Academies recruited could not agree on several fundamental questions, including whether it is possible to have a valid and reliable method of distinguishing between suicide and an autonomous decision for medical assistance in dying where a mental illness is the sole underlying medical condition.

A subset of the Council of Canadian Academies' expert panel, the Halifax group, recently recommended that the MAID regime should not exclude persons whose sole underlying medical condition is a mental illness. Instead, there should be a legislative requirement that the decision to die be well considered to ensure that a MAID request is well thought out and not impulsive. Others say that to exclude those with mental illness only perpetuates stigma and discrimination.

On the other hand, another subset of the Council of Canadian Academies' experts, the expert advisory group on MAID, recommended that the MAID regime acknowledge that, at this time, it is not possible to determine that a mental illness is irremediable or that a state of decline due to a mental illness is irreversible. Therefore, persons whose sole underlying medical condition is a mental illness could not fulfill the current MAID eligibility requirements.

Given these diametrically opposed points of view from experts, it would not be prudent to permit eligibility for medical assistance in dying where a mental illness is the sole underlying medical condition at this time without more study and deliberation.

We, as legislators, are not experts in mental illness. Let us, instead, take the time to listen closely to what experts have to say on such an important topic, where the consequences of a decision are irreversible.

The parliamentary review will provide an opportunity to hear from experts and others, and allow parliamentarians to carefully consider, without the time pressure of responding to the Truchon decision, whether and how medical assistance in dying could safely be extended to persons whose sole underlying medical condition is a mental illness.

The government understands very well that mental illnesses can and does cause intolerable suffering. By excluding persons whose sole underlying medical condition is a mental illness, we are not seeking to send a message that this suffering is lesser, that persons struggling with a mental illness cannot make decisions for themselves, or that their autonomy to choose when and how to die matters less.

Instead, we are taking a pause and acknowledging that this very complicated question needs more time, careful consideration and requires us to proceed prudently. The Province of Quebec is adopting a similar approach, though not through legislative amendments. I think this is wise, and we will be paying close attention to the consultations taking place in that province as well.

[Eric Melillo, Conservative, Kenora, ON]

Madam Speaker, the member mentioned mental illness quite a bit, however, he did not go into a lot of detail.

Does the member believe that if someone's sole underlying condition is mental illness, they should be able to receive MAID?

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, I thank the member for the question, although I think that was the full focus of my speech, the contention that people whose sole medical condition is a mental illness should not be eligible for MAID at this time.

We absolutely need to consider this. It is a very complex issue. We need to consider it much more thoroughly than we have the ability or capacity to do at this time in response to the Truchon decision.

I would refer the member to my speech. We will happily consider the matter very rigorously as we go forward.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Madam Speaker, my Liberal colleague's position is quite fair. We in the Bloc Québécois also agree that those whose sole medical condition is a mental illness should not be included in this bill.

This is such a sensitive matter, I think it is important to send a clear message that we are capable of moving forward in our reflection.

We must not sweep this under the rug because that would be dangerous, as my colleague, the member for Montcalm, has already said. We need to be able to get ahead of this, rather than waiting for the courts to tell us what to do.

Aside from looking at what Quebec is doing, I would like to hear my colleague's thoughts on how we too can start proactively reflecting on this.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, we know that part of the original legislation for medical assistance in dying provided for a review at the five-year mark, and we are coming up to that time. It is very important we exercise that opportunity to look deeply into questions of this kind and canvass them very thoroughly, because it is, as the member noted, a very serious and delicate question. It is very complex.

We need to examine all aspects of it, as well as the other aspects of medical assistance in dying, to make sure that as we move forward we can adapt and move forward correctly on this very important bill.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Madam Speaker, I found this was a very challenging speech. I appreciate the member's thoughtfulness in approaching the issue, which this bill does not touch. It is important to confirm for Canadians that, in looking at the new version and the amendments, mental illness is not to be considered an illness within the context of medical assistance in dying.

Does the member think that we will evolve our understanding of certain kinds of mental illness? It seems to me that he is suggesting that we may in fact revisit this topic in the future.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, yes, I absolutely believe the proper place to deal with this question is during the more fulsome review that should be forthcoming. It is certainly my understanding that mental illness, as a sole underlying factor, would exclude a person from the regime of medical assistance in dying.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I was glad that the member brought up mental health conditions. He was very attentive to the language being proposed in this legislation and how we would deal with it going forward. This piece of legislation goes much further than Justice Baudouin mentioned in her judicial decision where she struck down section 241.2(2)(d) specifically on death being reasonably foreseeable. I do not have a question for the member. I just want to bring this up and hear his commentary on it.

“Reasonably foreseeable” was something I criticized in the last Parliament when this was being debated. I could foresee this exact situation in which different reasonable people could interpret it in very different ways. We already see this going on all over the country. Different provinces have interpreted it differently in their health systems. I want to hear the member's commentary on that.

In this debate so far, people have mentioned incurable diseases. The minister mentioned it as well. Three of my living kids have an incurable disease called Alport syndrome. It leads to a chronic kidney condition, and in the case of males, it will eventually require a kidney transplant. In most cases it is also associated with the underlying risk of depression and social isolation. It is incurable today. That does not mean it will be incurable tomorrow.

Diseases change and their statuses change. Things that were incurable 100 years ago and were considered lifelong conditions change over time as medical technology catches up. Our knowledge matches the necessity of the time we live in. That is my commentary on the member's speech.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, my understanding on this bill regarding a trajectory for an immediately foreseeable death is that, in some cases, the requirement has been reduced, but in other cases, it remains in place. It depends on the nature of the person's underlying condition.

I certainly look forward to what I am sure will be a robust debate on medical assistance in dying when the review happens. I had the honour to participate on the Standing Committee on Justice and Human Rights when the original bill was brought forward. I certainly recognize some of the questions we are dealing with now we also dealt with then, and we did the best we could. It is very helpful that in light of experience and court decisions, we can review those decisions. It is a great opportunity, as we move forward, to embrace fully the upcoming review.

[Martin Shields, Conservative, Bow River, AB]

Madam Speaker, I very much appreciate the commentary that I have heard from my colleagues about this very significant issue today.

One of the things I remember doing in a past life is working with doctors on “do not resuscitate” orders. It became very difficult for doctors, whose oath it is to save lives, to have this type of discussion. They would do anything to get out of a “do not resuscitate” order. They did not want to touch it or undo it, because they were ending up with all sorts of complications with family members and relatives. All sorts of different things would happen with this type of situation.

Does my hon. colleague feel the legislation would protect mental health with what is basically a “do not resuscitate” order in a different language?

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Madam Speaker, I would like to first note that medical assistance in dying and a “do not resuscitate” order are fundamentally vastly different concepts.

In any event, I believe the checks and balances that are currently in the legislation around mental illness will prevail as we go forward, because this bill would not extend medical assistance in dying to people whose sole underlying condition is mental illness. That is an important distinction and it is a very important one to consider fully and robustly as we go forward. I refer all members to the opportunity that will present itself as we review the totality of the medical assistance in dying regime at its legislated juncture.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, it is a real pleasure for me to be joining the debate today, from my riding, on Bill C-7. I find myself in a unique position because, having given a speech on this very same bill earlier this year, I see we now find ourselves still at second reading for what, I would argue, is absolutely the most important piece of legislation we have before us at this time.

I was also one of the members of Parliament who had the honour of participating in the previous debate on Bill C-14 during the 42nd Parliament. I can remember very much the debates that went on in 2016 and the amount of attention that was given to that piece of legislation. We had an expert committee. We had a special joint committee. There were many hours spent, both in the House of Commons and at the Standing Committee on Justice and Human Rights, on that important piece of legislation because it made a monumental amendment to the Criminal Code in recognition of a very important Supreme Court ruling that forced Parliament to finally take the necessary action.

I remember, during that time, we in the New Democratic caucus ultimately voted against Bill C-14, but we always took the time to explain to people that we were ultimately supportive of what the overall aims of the bill were. Our major problem of the time was that the bill was too restrictive. I remember very well in 2016 referencing a particular section of the bill that I knew would be challenged by the court. Lo and behold, here we are in the year 2020, and we are revisiting that problematic section and having to fix a mistake that was made very clearly four years ago.

It is good to see Bill C-7, and it is good to see that we are complying with challenges that were made before the courts, this time coming in response to the Truchon decision by the Superior Court of Quebec. I know that we are operating under quite a tight deadline. That being said, I still think Parliament has to do a full job on this bill. As parliamentarians, whether we support the legislation, have problems with it or are opposed to it, we owe it to the people of Canada to give this debate as full a discussion and time as Bill C-14 had.

At this time, in particular for the benefit of the people of Cowichan—Malahat—Langford, it is important to underline why we are here discussing this. It really centres on the Charter of Rights and Freedoms, notably sections 7 and 15.

I am increasingly seeing section 7 as probably the most important part of the charter or one of the most important parts, because so many cases seem to be coming forward that directly reference section 7. I know it is open to interpretation, but if we go along with successive court rulings, my own personal view on the subject is that it is a very important section because it is ultimately making the case that every person in Canada has the right to autonomy over their own body. That is why it is such an important section. If we truly believe in the rights of individuals to make decisions for themselves over what goes on with their own bodies, section 7 is incredibly important. It is really life, liberty and security of the person. That is the part that has to be underlined.

We also have to mention section 15 of the Charter of Rights and Freedoms, which guarantees quality before and under the law and makes sure people are free from discrimination. Why those two sections have such an important bearing in this case is that this bill is trying to make sure people have the right to say what goes on with their own bodies and that in making that decision they are not going to be discriminated against.

I have been listening to the debates on Bill C-7, both from the previous week and today. I acknowledge that many members are bringing forward some concerns with the bill, and I understand and want to validate those concerns. I do not believe we have to make the debate on Bill C-7 an overly partisan issue. That is why I made the comment at the beginning that it is important that all members of Parliament, no matter what party they belong to, be given the chance to fully air their views.

I believe the bill passes muster at second reading and deserves a vote of confidence at this stage of debate, because if there are particular sections of the bill that need further attention, that work is best done at the Standing Committee on Justice and Human Rights.

I fully understand that many members have raised concerns about the removal of safeguards. I have heard many members talk about the state of palliative care in Canada, whether there is enough being done with suicide prevention and so on, and I am very sympathetic to those. I think every member of Parliament, no matter what part of the country we are fortunate enough to represent, can relate to those concerns. We can relate to the concerns that we have received through email correspondence, letters, phone calls and speaking with our constituents face to face.

I am lucky enough to have a hospice undergoing major construction right now. There is a new hospice being built in the Cowichan Valley. I am really glad to see that the level of palliative care in my home riding is going to be significantly better than it was, but of course more can always be done.

Ultimately what is guiding me in this is that it is quite impossible for me, as a member of Parliament who is lucky enough to have his health and not have a grievous and irremediable medical condition, to really understand the level of suffering some individuals in Canada go through. When we are talking about the bill, the struggle we have before us is to not subject other people to our own values, whether those are guided by religious beliefs or the way we were raised and so on. It is quite impossible for people who are healthy and lucky enough to have all of their faculties to understand what the day-to-day life existence is of people who are suffering from one of these incurable and irremediable medical conditions.

Therefore, what is guiding me and members of the New Democratic caucus is an overall goal of trying to ease that suffering, to respect those people's section 7 rights and to understand that they should have the ability to live their lives in dignity and make a determination as to how they want to exit this world. I know it is an uncomfortable debate for many people to have, but that is what is going to be guiding me through these deliberations. I hope it is something all members can take note of.

Following on the speech my colleague, the member for Esquimalt—Saanich—Sooke, gave the other day concerning the legislative review that was part of the former Bill C-14, I want to draw the attention of members to the fact that this was a requirement of Bill C-14. The member for Esquimalt—Saanich—Sooke has put forward a proposal through his private member's motion, Motion No. 51, that will establish a special committee to look at how the legislation is doing. That is something Parliament can easily do while we are deliberating the provisions of Bill C-7. The creation of such a special committee to look at how Bill C-14 has been enacted over the last four years is really important.

This goes back to my first point that, yes we are operating under deadlines, yes we have had people waiting for some time, but, ultimately, it is critically important that we let Parliament deliberate this issue to the fullest extent possible.

With that, I conclude my remarks and look forward to any questions my colleagues may have.

[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 think it is important for us to recognize that, at times, inside the chamber some very difficult debates take place. However, the importance of this legislation cannot be underestimated. Over the last number of years, through consultation, through a court decision, we have come to this point, and I think we are on the right track.

The member made reference to palliative care, and a number of members have made reference to the importance of palliative care. I wonder if he could provide some further thoughts in terms of how the federal government's role in palliative care could make a difference in terms of quality of life for seniors across the country.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I will first acknowledge that the delivery of health care services does fall under provincial jurisdiction, but that being said, I have always been an advocate for a strong, federal leadership role in health. After all, we do have some control over health policy through the Canada Health Act.

The real opportunity for the federal government is to make sure that every part of Canada, no matter what province someone finds themselves residing in, has access to the same kinds of standards nationwide. I think that is the real strength of the federal government. It is to make sure that someone living in Prince Edward Island can access the same level of care as someone in my beautiful province of British Columbia.

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

Mr. Speaker, I certainly appreciated what the member had to say, and I am especially excited to hear that he has a new hospice being built in his riding. However, I am sure he is aware that 70% of Canadians have no access to palliative care right now. It is contravening in my mind to think that we are somehow saying to people that they have this choice and here is another choice, but, truthfully, one of them does not exist.

As well, I am sure the member is aware that the Delta Hospice has lost its funding and is losing the ability to run the hospice on the basis that the government has said that it must provide euthanasia along with palliative care, yet the Canadian Society for Palliative Care Physicians has indicated that these are antithetical and totally separate. I am wondering if he is aware of what is going to be happening with the hospice that he just mentioned being built in his own riding.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I have been very fortunate to have a good working relationship with the team that has been behind the Cowichan Hospice over the last number of years. Of course, our community is absolutely overjoyed to see the project moving ahead and seeing that it is going to be such an important part of going forward.

In the 42nd Parliament, the House passed a motion expressing that more palliative care was needed. However, when it comes to the difficult decisions that are made over where the funding goes, I would draw the member back to the importance of individual rights as outlined under section 7. Ultimately, our focus needs to be on patients and ending unnecessary suffering, which is why I drew such importance to section 7 when it comes to these important decisions.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Mr. Speaker, I want to thank my colleague for his speech. I listened closely and he was sensitive and respectful of all the ways to look at this bill and of all the MPs who might be opposed to it. I think that is the way to approach this type of issue.

We experienced that in Quebec City. The leadership of Véronique Hivon led to a multi-partisan consensus at the National Assembly, resulting in smooth passage of the bill for the good of our constituents.

We know that we are taking a step in the right direction with this bill. My hon. colleague and his party think that we should go further. How much further does he think we should go?

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I do not want to presuppose the work that is going to be done at committee and that is why I placed such important emphasis in my remarks about getting this bill to committee. The committee study of this bill has to be very detailed and there has to be a very broad cross-section of witnesses to inform our work as parliamentarians. I am sure there will be quite an extensive list of witnesses who wish to speak to this bill. I hope members of the committee will take note of what is heard at committee, deliberate in an appropriate manner and report the bill back, something that reflects the importance of all of the deliberations.

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

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, I apologize in advance if there is noise in the background; it is either traffic or my kids, so I have chosen traffic.

I want to start first by speaking to what is at stake with Bill C-7 and with the medical assistance in dying framework overall. What is at stake fundamentally is, first, alleviating intolerable, cruel suffering. The Supreme Court and other courts have spoken about the cruel choice that individuals face in the circumstance where they have a sound mind, they are of capacity and can make these decisions themselves, where they are suffering from an illness that is not going to go away and when they are suffering in an intolerable way. Forcing that suffering upon individuals is cruel and we have to be cognizant of the fact that this is first and foremost about alleviating suffering, but it is about alleviating suffering within the context of empowering and respecting one's personal autonomy.

This is fundamentally about individual rights, and our job fundamentally is to respect those individual rights, to protect those individual rights, to ensure that we end suffering in the course of protecting those individual rights and to make sure that we fulfill the promise of section 7 as it has been interpreted and upheld by our courts, not only in the unanimous Carter decision by the Supreme Court, but also by other courts, like the Alberta Court of Appeal and more.

Now, this bill is important, because it addresses a long-standing concern with Bill C-14. It addresses the concern that we had not answered the call from the Supreme Court adequately. We had added an additional criterion unnecessarily. We had basically said that if people are suffering intolerably and they can absolutely make this choice for themselves, they have capacity, and they have an irremediable condition, an effectively incurable illness, they cannot access this regime if they are not near the end of life or there is not path dependency, but they know the trajectory they are on, even if they are already intolerably suffering.

That, obviously, was unconstitutional. The courts determined that to be so. The government rightly opted not to appeal that decision, and here we are.

Importantly, we have actually gone beyond what the court has mandated in pursuit of individual rights and respect for our charter, as we have said in the case of Audrey Parker, a woman who chose to end her life earlier than she had wanted to. She wanted to get through the holiday season, but she also did not want to lose capacity and then lose the option. She did not want to lose ability to end her life and her suffering. She did not want to lose the possibility of death with dignity, so she chose to end her life before she wanted to. Thankfully, we have actually gone above and beyond what the court has mandated us to do, and we have provided one form of advance request to ensure that individuals, like in Audrey's case, do not end their life before they would like to.

This bill, on those two fronts, is positive. There are some challenges. That is not going to stop me from supporting this legislation at second reading, but it does give one pause. I think we, as parliamentarians, have to be very careful about adding additional exclusions to accessing the MAID regime. That is what this bill would do, unfortunately. I have heard others speak to the issue of mental illness, and there are reasons to proceed cautiously, but there are not good reasons for blanket exclusions. In fact, we potentially render the bill unconstitutional with blanket exclusions, just as we did with exclusions in Bill C-14.

I hope at committee there is expert testimony on this piece, and I hope we get this right. I will give an example specifically on mental illness. In 2016, there was a case at the Alberta Court of Appeal. A woman, identified as E.F., had capacity, she was suffering intolerably, it was irremediable, she had consulted with her family and she had made the decision to end her life. She was able to do so, thankfully, because of the Alberta Court of Appeal applying the Carter decision by the Supreme Court. If the federal justice department had gotten its way in that case, it would have read down Carter to mean only terminal illness. Of course, they said that is not the case. Then we saw, through Bill C-14, that our government tried to impose that kind of criteria, and the court subsequently struck it down. The justice department lost that leg of the argument.

Then, in E.F., they put forward the argument that it could not be an underlying psychiatric condition on its own, but that is exactly what E.F.'s was, an underlying psychiatric condition. The court said that this underlying psychiatric condition, which manifested itself in great significant pain in the documented evidence, did not affect her capacity to make a decision. She was of sound mind.

In E.F., the Alberta Court of Appeal went beyond that. As to the consideration whether MAID should be available to people with mental illness as their sole underlying condition, the Alberta Court of Appeal, in E.F., said that the Supreme Court, in Carter, had canvassed this conversation, this discussion and this concern. Unanimously, they had determined that it was not an additional exclusion. It was not a factor to exclude, and not an additional criterion for eligibility, for those with mental illnesses and those with physical illnesses, so long as they meet the specific criterion of an irremediable condition of intolerable suffering and that they have capacity. It may be that one is depressed, or it may be that one is suffering from a mental health issue such that it impinges upon one's capacity to consent, but in other cases it clearly does not. In E.F., it did not. The justice lawyers lost that case, yet here we are.

In Bill C-14, the government added an additional criterion of close-to-terminal illness and reasonably foreseeable death, and it was struck down. Here, the justice department is adding that second argument from E.F. that it already lost in the courts, and is adding a blanket exclusion for mental illness. As a matter of constitutionality, I would say that if this excludes the case of E.F., which it does, then it creates a ready constitutional challenge. I will be reading the Charter statement from the justice department very closely. I am not suggesting that we do not proceed cautiously, but a blanket exclusion on mental health, when there is a case like E.F. before the court, is likely to render this law unconstitutional, and that has to be addressed by the committee.

The second piece I want to flag is the two tracks. If one's death is reasonably foreseeable, then there is no additional track. There is not even a 10-day waiting period. That 10-day waiting period has been waived, although there was not great concern even with that 10-day waiting period. There is this dual track now, if one's death is not reasonably foreseeable, where one waits 90 days. This is what we are telling people in those circumstances. I have spoken to family members who are affected by this, and they are absolutely challenged by these circumstances when one is already intolerably suffering: They are suffering from a condition that is not going to go away, and they are making this decision themselves, having capacity. If we respect personal autonomy at all, surely a fundamental life decision like this is one that we have to respect, and we are telling these individuals that they have to wait another 90 days, and not just suffer but suffer intolerably for another 90 days. It is inexplicable that we are asking people to suffer intolerably for that length of time. Those are the two specific issues that need to be addressed at committee in a serious way in order to make this bill not only constitutional, but to make it the best bill that it can be.

I wish we had dealt with this last item, because the idea of constantly revisiting this conversation instead of just getting it right for Canadians in need is frustrating. I mentioned Audrey Parker, and we are addressing one type of advance request. However, I do wish that, in the course of this legislation, we had answered the second type of advance request, in which an individual has been diagnosed and is not yet suffering intolerably, but that future is not so far away. Those individuals should also be in a place where they can make an advance request, if we are to respect their autonomy and respect their wishes.

I just wish politics did not get in the way. That is what this is. This bill is a cautionary step. It does not go as far as it could because of politics. I know Conservative members will say it goes too far and others will say we have to be concerned about vulnerable Canadians. We know we can protect vulnerable Canadians and respect people's individual choices at the same time, and I wish politics did not get in the way of alleviating suffering. I wish politics did not get in the way of respecting and protecting individual rights. We like to say we are the party of the Charter. I wish we carried through that promise and demanded greater respect for individual rights in the course of Bill C-7.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Speaker, I have been getting phone calls basically on both sides of the issue. I am having some people, as our colleague said, saying it is not going far enough. Other people are saying that it is going way too far.

I would like to talk about one of my constituents, Carol, who had a very respectful conversation with me. She totally respects the rights of physicians who do not want to participate, and people who do not want assistance in death. However, she has some concerns about advance directives, and my colleague touched on this. His comment at the end was very important. He said it is important that we get it right.

As far as advance directives, does the member actually think that this piece of legislation in front of us today addresses those, and does he feel that it is still supportable?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, it is supportable, particularly at second reading. The Council of Canadian Academies identified three kinds of advance requests. One is as in the case of Audrey Parker, which I mentioned, where someone not only is diagnosed but is already suffering intolerably. This bill would address that issue, and I am glad that it would.

The second issue, which I think is easy to address and has been recommended up and down by every expert who has looked at this, is when one has already been diagnosed but is not yet subject to intolerable suffering. We ought to provide an advance request for that as well. We could address it with sunset clauses if folks are concerned.

The third issue is when someone has not yet been diagnosed. I would argue that we could probably get there, but I think, at a minimum, we should address the second advance request where someone has already been diagnosed, but is not yet suffering intolerably. That would have been a relatively straightforward one to address. Given the time period we have had, especially in the course of COVID, I wish this had been better addressed in this bill, as well.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Mr. Speaker, I want to begin by acknowledging my colleague's ability to focus and to find work-life balance in these difficult times. I would also like to commend the progressive values that he brings to many of his interventions, including at the Standing Committee on Industry, Science and Technology and in the current debate.

I wanted to address the end of his speech and give him a chance to elaborate.

Does my colleague agree with the possibility of granting the right to waive final consent in cases where natural death is unforeseeable? How might we further facilitate this step for the victims of this mechanism?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, the advantage of any view that respects personal autonomy is that one is not tied to a decision one has made: one can always revisit it. The importance of advance requests is that people might lose capacity. If one is suffering intolerably, as in the case of Audrey Parker, but is so worried that she is not going to be able to make a decision to end her life and access death with dignity because she might lose capacity, then we, of course, need an advance request and that is exactly what this bill would provide.

As for the second category, where an individual has been diagnosed and has not yet begun to suffer intolerably, when they have made it very clear that this is what they want as a matter of personal autonomy, we have to respect that as well. Of course, if we are to respect personal autonomy, one can always withdraw when one has the capacity to do so.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Mr. Speaker, my colleague's comments were very thoughtful and certainly resonated with me. My father-in-law is currently in a situation where he cannot give consent any longer. He is trapped in a situation that we know he would not want to be in, so a lot of the comments the member brought forward really resonate with me.

At the beginning of his comments, the member talked a lot about intolerable suffering and the need to alleviate that intolerable suffering. I am wondering if he could talk a bit about where we came up with the 90 days.

Where did the Liberal government come up with 90 days as the amount of time we should make people wait, in intolerable suffering, before they can get relief?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, I can honestly say I have no idea, and I do not think the 90 days are justified in the end. I think the committee should examine this timeline and correct it. I hope, when this bill comes back to the House for third reading, that we have avoided the blanket exclusion for mental illness. If need be, we can add a sunset clause to that provision to give the government more time, if necessary, but I hope we avoid the blanket exclusion indefinitely. Second, I hope that we cure that 90-day period and reduce it significantly. We cannot possibly want Canadians who are still of sound mind to suffer intolerably for such an extended period of time.

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, it is a privilege to have this opportunity to rise and speak on Bill C-7, an act to amend the Criminal Code (medical assistance in dying).

Not long ago, we in the House debated the merits of Bill C-14. I was a member of the justice committee when the committee was seized with doing that. That opened the door to physician-assisted death in Canada.

I want to begin my speech today with the same words that I used to open my speech on that bill:

I believe in the sanctity of life, and I believe that all life, from conception right through to natural death, has value, has worth, and has purpose.

A pastor friend of mine told me a story that had happened just prior to the passing of Bill C-14 in 2016. A woman the pastor knew who had battled stage four cancer for 10 years, savouring every moment of that time with her grandbabies and family, was told by one of her care workers, “I bet you cannot wait for the assisted-suicide bill to pass.” The pastor recalled the desperation in her tears when she called to recount her story, asking, “Has my life only become a burden to society?”

After the legislation was in effect, another woman was reunited with her childhood sweetheart and engaged to get married when her fiancé discovered that he had stage four cancer. Together they mustered up every possible hope for a future together, only to have their hopes dimmed by repeated offers for medical assistance in dying.

As the House now considers an expansion of MAID, I think it remains vitally important that the worth of every person is reaffirmed and underscored. It must be our priority in this place to remind every Canadian that they have value regardless of their age. They have value regardless of their ability. Their dignity is not determined by their suffering or their autonomy. It is intrinsic. It is inherent. Their lives are worth living.

I think these statements are important, because the reality is that every time we talk about expanding access to MAID, we send a troubling message to those who may be vulnerable: the idea that, if certain conditions or factors are present, somehow a person's life has less worth; the idea that ending a person's life is a mere medical decision among any number of medical decisions.

Expanding eligibility cannot be about removing safeguards and fundamentally redefining the nature and role of assisted death. This bill intends to offer assisted dying to individuals who are not dying, whose lives are still viable. This is a contentious issue that has been raised by multiple legal voices because assisted death was previously sold as an option only when death was imminent, or reasonably foreseeable.

In just four short years, we have embarked beyond that final stage of suffering. The whole health care system is feeling the pressure for acceptance of MAID, says Nicole Scheidl. Doctors and medical staff are feeling this pressure. Scheidl adds that the most terrifying thing about MAID is how it will impact the future of medicine, as only doctors comfortable with MAID will go into medicine, unless perhaps some provision is made for conscience rights.

Cardus executive vice-president Ray Pennings warns us that Bill C-7 does not take the protection of conscience rights seriously. He writes:

Conscience rights are Charter rights...including the rights of medical professionals not to participate in MAID in any way and the rights of hospices and other institutions not to cause the deaths of people in their care.

There are other valid concerns as well: psychological suffering in combination with other permanent injuries potentially justified under MAID, the elimination of the 10-day waiting period, the requirement for only one independent witness as opposed to two, the waiving of final consent, and also that a witness cannot be a primary caregiver.

Even in its current form internationally, MAID raises flags. When the United Nations Special Rapporteur on the rights of persons with disabilities visited Canada in 2019, she noted that she was extremely concerned about the implementation of MAID from a disability perspective. She flagged that:

there is no protocol in place to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assistive dying.

She highlighted:

...claims about persons with disabilities in institutions being pressured to seek medical assistance in dying, and practitioners not formally reporting cases involving persons with disabilities.

Her advice was to:

put into place adequate safeguards to ensure that persons with disabilities do not request assistive dying simply because of the absence of community-based alternatives and palliative care.

Instead, Bill C-7 goes the opposite direction in order to expand eligibility.

Let us not forget that every choice we make has a ripple effect of different magnitudes. Mother Teresa once said, “I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” The world can be changed for better or worse. When vulnerable people start feeling like they are only a burden to society because of our actions, we need to consider what kind of culture we are creating.

Kory Earle, the president of People First of Canada, a national organization representing people with intellectual disabilities, expresses his concern that everything is already more difficult for people with intellectual disabilities, including exclusion, isolation, housing, resources when abused, education, securing jobs, social lives and finding friends. He further adds that even their word in court is not considered credible. Mr. Earle explains, “everything, and I mean EVERYTHING, is more difficult for people with intellectual disabilities. Many, many other things should be made easier. This [assisted death] is not one of them.”

Passing Bill C-7 is sending a message that individuals with disabilities are no longer safe. This concern is echoed in a joint statement by over 140 lawyers who fear the perception this bill gives, if even unintentional, the perception that life with a disability is inferior and if ratified by law, we diminish the choice to live with dignity and exasperates systemic discrimination.

On top of this, Canada has tragic statistics around suicide. An average of 10 people die by suicide every day. Statistics reveal that nine of those 10 individuals faced a mental health problem or illness. I know and appreciate that those suffering solely from mental illnesses are not eligible for MAID under Bill C-7, but we are nonetheless sending a devastatingly mixed message.

The former Liberal member for Winnipeg Centre raised these concerns when we were first considering Bill C-14. As he observed the rash of suicides in several first nations communities at that time, he expressed concern that, “we haven't thought out the complete ramifications that a decision like this might have on indigenous communities that seem to be suffering greatly.”

In his speech, he shared one of his memories as a six-year-old child. His family was facing serious financial hardship, forcing his mother to go off in search of work. He and his younger brother were to stay with their father, who he described as “a residential school survivor, an alcoholic, and a member of gangs” with a “terrible temper”.

The rest I will quote directly from the former member. He said:

I remember climbing a tree in the back yard and wrapping a rope around my neck at the age of six... I wrapped that rope around my neck and thought, “Should I jump off into this universe, which is before me?” It was in that back yard that somehow I made the decision to climb down out of that tree and unwind that rope from around my neck.

If in my life I had seen, or I had known, that my grandmother had somehow used physician-assisted dying or physician-assisted suicide, or others in my family had completed the irreparable act, then it would have made it much more difficult for me to continue.

We must be mindful of the messages we send through this debate and always affirm life, but we must also do more than just offer words. We need to ensure that individuals facing end of life have access to the end-of-life care they deserve.

There are important questions we need to be asking to ensure those who are suffering truly have a choice between living well and pursuing MAID. For example, how do we better love those who live in unbearable pain, whatever form that pain takes? Feeling loved gives inherent strength to those losing hope. How do we show people how their lives teach us? How do their contributions strengthen us as individuals and a society? How do we instill in all people that they are not a bother, a financial burden or a disruption to deal with, but that their life is treasured? We must foster this type of society that affirms life and the pursuit of well-being.

As four physicians suggested in the National Post in response to the proposed legislation, increasing health care personnel, improving our quality of care, enhancing our palliative care options and ensure quicker access to psychiatric care would all be more advisable. Instead, we are “fast-tracking death on demand and dismantling the...[earlier] safeguards that were put in place to protect the vulnerable.”

We have all heard that only 30% of Canadians have access to palliative care and disability supports, which is possibly why there were 50 religious leaders who wrote an open letter urging us to consider that. It states:

Palliative care administered with unwavering compassion, generosity and skill expresses the best of who we are. Rather than withdrawing from those who are not far from leaving us, we must embrace them even more tightly, helping them to find meaning up to the last moments of life. This is how we build compassionate communities.

Furthermore, the joint statement by 140 lawyers explains that singling out non-life-threatening illness and disability as eligibility criteria for assisted death—

[The Deputy Speaker, Bruce Stanton]

I am sorry, we will have to finish there. The time has expired for the member's comments. He may be able to reflect on some of those ideas when he answers questions and comments.

Questions and comments, the hon. parliamentary secretary to the government House leader.

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

Mr. Speaker, I remember quite well the former member for Winnipeg Centre and his speech on Bill C-14. One of the things I can recall from the Bill C-14 debate was there were a lot of examples, real-life stories. I say that because it is important for us to recognize the seriousness of the legislation we are debating. Ultimately it will go to committee, where there will be opportunities to have that dialogue and who knows what it will eventually come back as.

Does the member believe the bill is moving us in the right direction?

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, I do not believe the bill is moving us in the right direction. We should be strengthening the bill by adding additional safeguards for vulnerable people. It has been clearly demonstrated that people with disabilities are very concerned the bill does not go far enough to provide them the protection they are looking for.

I have heard from many health care providers, physicians, nurses and those who assist those health care professionals, who themselves are also health care professionals, express concerns that adequate conscience rights protections have not been built into the bill. It is something I have heard over and over in my riding and it is very important to health professionals. They want clearly articulated conscience rights protection inside the bill.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Mr. Speaker, I have a related question.

It is my understanding that, essentially, the member will vote against the bill for considerations that have more to do with religion and faith than with the bill before us.

When we talk about the right to life, and tell people that we have values, that dignity is intrinsic and that life is precious, does Bill C-7 not align with all that even though it is not perfect? With respect to their right to life and dignity, does a person who is suffering and who has an incurable disease not have the right to choose this solution after we have had a wide-ranging debate? Is that not a response? How is that not a response?

[Ted Falk, Conservative, Provencher, MB]

Mr. Speaker, the member's question is one that many people ask. My response is that a lot of people would make different choices if they had access to better palliative care. We know 70% of people across Canada do not have access to the palliative care they deserve. Even people with very uncomfortable and some would say intolerable diseases and situations, with the proper amount of palliative care, would have a different opinion than when confronted with the option of medical assistance in dying.

In fact, I spoke to a doctor at a function not that long ago. He said that when it came to MAID, they already had the technology to make people comfortable so they would not experience pain. They also could give them drugs. They had access to drugs that would also take away any psychological anxiety people may experience with their intolerable diseases. He said that there was no need for MAID.

[Greg Fergus, Liberal, Parliamentary Secretary to the President of the Treasury Board and to the Minister of Digital Government]

Mr. Speaker, I am very pleased to speak today in support of Bill C-7, which proposes amendments to the Criminal Code's medical assistance in dying regime in response to the Superior Court of Quebec's Truchon decision.

As members know, prior to the prorogation of Parliament, we introduced former Bill C-7, which proposed amendments to the MAID legislation and made it to second reading in the House. With the opening of this new session, we are reintroducing the same proposed changes as Bill C-7.

In September 2019, the Superior Court of Quebec struck down the federal and Quebec criteria limiting MAID to end-of-life circumstances. The court suspended its declaration of invalidity for six months, until March 11, 2020. In February, the Attorney General of Canada obtained an extension to provide enough time for Parliament to respond to the Quebec court's ruling and create a consistent MAID regime across the country.

Unfortunately, the disruptions to the parliamentary process resulting from COVID-19 made it impossible to meet this deadline. On June 29, the Superior Court of Quebec granted the request of the Attorney General of Canada for a second extension, until December 18, 2020.

Before I turn to the content of the bill, this legislation was informed by the Truchon decision itself, available Canadian international reports, the experience of existing international regimes and the government's consultations on medical aid in dying held in January and February earlier this year.

With respect to the consultations, the Minister of Justice, Minister of Health and Minister of Employment, Workforce Development and Disability Inclusion as well as their parliamentary secretaries hosted medical aid in dying round tables across the country. There were more than 125 stakeholders in attendance, including health regulatory bodies, legal experts, doctors, nurse practitioners, representatives of the disability community and indigenous representatives. They all shared their experiences and insights into MAID and its implementation in Canada over the last four years.

In parallel to these efforts, the government hosted an online public survey in January and received over 300,000 responses from people all across the country, an unprecedented number of responses, that reflects the significance of this issue for Canadians. A summary of the consultations was released in March as a “What We Heard Report”.

I would like to speak to the two proposed Criminal Code amendments in relation to eligibility for MAID.

First, the bill would amend the list of eligibility criteria so that it would no longer be necessary for a person’s natural death to be reasonably foreseeable. This change would respond directly to the Quebec Superior Court’s ruling in Truchon and Gladu.

Second, the amendments proposed in this bill would make persons whose sole underlying medical condition is a mental illness ineligible for MAID. Members may recall that the Council of Canadian Academies’ expert group on this issue could not come to a consensus on this question. This lack of agreement was also evident among participants at the MAID roundtables.

This complicated issue should be studied as part of the five-year parliamentary review of the medical aid in dying legislation.

With respect to applicable safeguards, the proposed Criminal Code amendments will create two different sets of safeguards, depending on whether the person's natural death is reasonably foreseeable or not. The first set of safeguards will continue to be tailored to the persons whose natural death is reasonably foreseeable where risks are reduced.

The second set of safeguards would be tailored to persons whose natural death is not reasonably foreseeable or who are not dying at all and would address the elevated risks associated with the diverse sources of suffering and vulnerability that could lead to a person who is not nearing death to seek access to medical aid in dying.

Bill C-7 proposes to use the “reasonable foreseeability of natural death” standard to determine which set of safeguards apply to a particular case.

In terms of those whose death is reasonably foreseeable, the bill proposes to ease some of the existing safeguards. Specifically, it would require that a medical aid in dying request be witnessed by one independent witness instead of two, and it would allow individuals who are paid to provide either health or personal care to act as an independent witness. Bill C-7 also proposes to repeal the 10-day mandatory reflection period.

With respect to the second set of safeguards that would apply to those whose deaths are not reasonably foreseeable, in addition to the same witness requirement being eased, the following new and clarified safeguards would apply.

The first new safeguard would require a minimum period of 90 days for the assessment of a person’s eligibility. This safeguard reflects the need to ensure that the assessment takes the time needed to address the additional challenges and concerns that may arise in the context of assessing the MAID request of a person whose death is not foreseeable, and who may have many years or even decades left to live. These include, for example, considering whether the person’s suffering is caused by factors other than the medical condition and whether there are ways to address the suffering other than MAID.

The second new safeguard would require that one of the two mandatory eligibility assessments be conducted by a practitioner with expertise in the condition that is causing the person's suffering. This would require that all treatment options to be explored before medical aid in dying is provided, while avoiding the need for specialist involvement, which could pose a barrier in remote and rural areas.

The existing requirement for informed consent would be clarified in two ways. First, the person would have to receive information on available and appropriate services that could help address their situation. Second, the person and the practitioners would have to agree that reasonable means to alleviate the person's suffering had been seriously considered before medical aid in dying could be provided. These proposed safeguards reflect the seriousness of ending the life of someone who is not nearing death, the importance of protecting vulnerable individuals who may seek medical aid in dying and would support a fully informed decision in this regard.

The bill also proposes amendments that would allow people whose natural death is reasonably foreseeable and who have been assessed and approved for medical aid in dying to retain their ability to receive MAID if they lose the capacity to consent before the day of the procedure. Certain conditions would need to be met, including having a scheduled date for the procedure, that the person gives consent to receive MAID on that date even if they have lost capacity, and that the practitioner agrees to provide MAID on the patient's scheduled date or before if the capacity is lost before that time.

This bill, I believe, seeks to balance several interests and societal values, including the autonomy of persons who are eligible to receive medical aid in dying and the need to protect vulnerable persons from being induced to end their lives. It represents a significant paradigm shift, and I hope one that will meet the consensus of the members of this Parliament.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, I thank my colleague for his speech, but I am a little confused. He mentioned the different groups that were consulted and the 300,000 responses that were received, but it was my understanding that there was to be a legislative review of the MAID legislation this year in June, which did not happen and still has not happened. It almost seems like the government did not want to let the normal process happen and instead wanted to control it and provide the information it wanted, or perhaps the minister wanted to pursue his own agenda or his own vision.

Why did the government not deal with the Truchon issue that needed to be dealt with and leave the rest of the changes until after the proper legislative review had been completed as required by the legislation?

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Mr. Speaker, as the member will recall, back at the time the legislation was supposed to have been reviewed, Parliament had taken the extraordinary step of sitting in a reduced format in order to comply with the outbreak of COVID-19. As a result, any legislation, as had been agreed to by all House leaders, would deal uniquely with the issue of COVID-19.

That is also why the Minister of Justice sought to have an extension granted by the courts until the end of this year, knowing that when we got back in the fall we would be able to pick up where we left off in March and continue the evaluation going forward.

I would also like to reassure the member that the legislation provides an opportunity for us to review this in five years, so that we can once again take a look, take stock of the situation in terms of how it is being used or how it is not being used appropriately, and make changes accordingly.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, the Bloc Québécois shares our Liberal colleague's point of view.

I would like to ask him a question about something one of our Conservative colleagues said earlier. He tried to make a connection between suicide and medical assistance in dying. It seems to me that this kind of connection is more often made to align with a certain right-leaning and often religious way of thinking.

Knowing that Conservative Party members have already indicated they wanted a free vote on this issue, I would like to hear my colleague's thoughts on what might motivate a parliamentarian to vote against this kind of bill.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Mr. Speaker, I would like to thank my colleague from Jonquière for his question.

With all due respect, I have to say, this is a very difficult and very sensitive issue for many people.

This situation is intimately linked to one's personal values and religious values, which may be at odds with the values of freedom guaranteed in the Canadian charter and the Quebec charter. This is a very difficult debate for many people. I do not wish to trivialize the values he brings with him to Parliament.

I think there is a consensus. However, I want to respect all viewpoints. Our colleague from Manitoba shared his perspective and our colleague from Toronto shared a different one. We must try to balance the two and use common sense.

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

Mr. Speaker, I would like to bring my colleague back to the very beginning, when we began this discussion in the previous Parliament and, remarkably, got a bill through.

I know it is hard to achieve perfection, but I am encouraged by the fact that a five-year review is in place. Does the member realize that there are many opposing views on this? We have heard them all. We are not working with underlying motives. We are working toward a good result for Canadians. Would the member agree with that?

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Mr. Speaker, I would agree. I must say I have grown and evolved around this issue. That is why I feel I can understand both perspectives on this issue. I have been very pleased in hearing the debate so far.

We have struck the right balance, but I understand why those who would want us to go further certainly would want us to do so. I can also appreciate the perspective of people who would want us to hold back a little.

It is not perfect, as my hon. colleague from the Hamilton area has said. However, we will not let perfection become the enemy of the good. We have a fair compromise that strikes the right balance.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, I am pleased to join the debate. The last several speakers raised some excellent points. It is good to see members bring different perspectives to this debate, and I hope to achieve that as well tonight.

I would like to say broadly at the outset that, in a binary world where one must say they are either in favour or not in favour of the availability of medical assistance in dying for people who are adults, mentally competent, grievously and irremediably ill and suffering cruelly from intolerable pain and anguish, I support the availability of assistance in dying for those people.

However, this bill and few bills we would consider in the House are as simple as a binary choice between two poles. Although we have had all kinds of different perspectives on this, the nuances and the details of this bill, as well as the bill that preceded it, Bill C-14, are very important. I enjoy these types of debates where we hear these points of view and can hopefully improve a bill before it is passed, if it is indeed the will of this Parliament to pass the bill.

I have ordinarily been highly critical of the government on a host of issues. I will take advantage of this moment to say that although there was much consternation to get to the final vote that occurred on Bill C-14 in the previous Parliament, there was something in that process that brought out what is good in Parliament. At that time, we had a lot of different perspectives on that bill. We had a bill that was tabled and amended. It was amended in this chamber. It had committee amendments, many of them, that were brought back and voted on by different parties, and we saw members of the Liberals' side who did not agree with their government for a variety of reasons. There were members, including me, who ultimately at third reading did vote with the government to support it.

That is what Parliament should do. It should bring out vigorous debate that really gets to the heart of an issue in order to have good legislation. I thought Bill C-14, at the time, was a reasonable, limited change to criminal law in Canada to both comply with the Carter decision and establish the availability of medical assistance in dying. Credit also should go to members who are no longer a part of the government: the member for Vancouver Granville, who was the minister of justice at the time; and Jane Philpott, who was the minister of health and who showed leadership at that time in debating Bill C-14.

The bill before us today was introduced ostensibly to deal with the Truchon decision and the Quebec superior court's striking down of the reasonable foreseeability phrase from Bill C-14. In this bill, the government has chosen to address other issues at this time. As has been pointed out, there was to be a five-year review, per the previous bill, that should have occurred this summer. I understand the crisis we are in, but let us also not forget we have a government that prorogued the House and prevented the House from examining critical legislation and issues that face Canadians.

The timing of the bill puts us up against something of a deadline looming in December over the Truchon decision, and here we are. December is not very far away when we talk about all the different stages a bill must go through to do it right, to allow all voices to be heard and to allow all members of Parliament to represent their constituents on this.

The bill introduces a few changes beyond addressing the reasonable foreseeability. I am not going to get into the details of that, because time is pressing. However, like most MPs, I have received a lot of correspondence and phone calls from the disability community and concerned citizens who have real reservations about any expansion of medical assistance in dying.

Some have argued from the point of view of a slippery slope and are concerned: Once changes are adopted, what comes after them? I understand the sincerity of these concerns. However, we have to examine the bill for what it says and what it does rather than what people might project into it.

Prior to the adoption of Bill C-14, I had four major concerns regarding medical assistance in dying: first, the assurance that quality palliative care be available to persons considering medical assistance in dying; second, strong safeguards for vulnerable Canadians, such as minors, the mentally ill and the disabled; third, the conscience protection for medical practitioners; and fourth, any changes that would expand the availability of medical assistance in dying be well considered, well thought out, carefully drafted and not rushed.

I share many of the concerns raised by members of the disability community, but we have to deal with this issue and not forget the broader purpose of ensuring the availability of medical assistance in dying. It is not merely to comply with court rulings. We must do this out of a sense of compassion for adults who are grievously ill, intolerably suffering and are of sound mind, and who, of their own free will and volition, wish to obtain medical assistance in dying.

I would not support the bill if I thought it was a clear threat to disabled Canadians or if the bill would lead us into a path where medical assistance in dying is offered as an alternative to palliative care or an alternative to treatment. I do not see that in the bill as is. Recalling the experience of Bill C-14, I assume that the bill will be thoroughly studied and that the committee, after it hears testimony from experts and concerned Canadians, will bring amendments back to the House that may offer better assurance to the disabled community and others.

I am inclined to see the bill go forward as far as committee so that we can have a robust, thorough examination of the bill, and so that as parliamentarians, we can do our legislative jobs to ensure that the best bill possible is brought back to Parliament. I look forward to that and assume that we will have this debate.

I am still a little concerned, though. My colleague from Hull—Aylmer mentioned the five-year review and that a committee hearing would constitute that review. This is what it sounded like he was saying, and this does not seem to be in the spirit of what was passed by the House in Bill C-14. However, there is clearly much work to do in this area, and I hope we will have time for a robust, full and proper hearing of the bill at committee so that when the bill comes back to the chamber at third reading, it will give assurances to those who have raised concerns about medical assistance in dying, in particular to the disabled community.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Mr. Speaker, I thank my hon. colleague for participating in the debate and for his speech, which is very much appreciated.

I take it that he will vote in favour of the bill. I know that some of his colleagues may be opposed to the bill. However, I will not directly mention the Conservative members who will be voting against this bill.

I learned that 52 religious groups have launched a coordinated campaign against Bill C-7.

It is called “Religious Leaders in Canada oppose Bill C-7”.

Fifty-two religious groups are opposed to the bill.

They include Canadian Assemblies of God, Canadian Conference of Catholic Bishops, Evangelical Free Church of Canada and Canadian Baptists of Western Canada.

There are 48 other groups that are also against it.

I just want to ask my colleague if he believes that the religious principles of some people should be set aside when it is a matter of respecting the choice of all Canadians.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, one of the four major concerns I have about the notion of medical assistance in dying relates to the conscience protection for practitioners. I think what the member was drilling to in the question is making sure that the conscience of professionals in the medical field is protected. I support wholeheartedly groups that have this concern. That is one of the main areas of concern I have with the bill.

I certainly recognize that there are very strong feelings on the bill all around. The responsibility of this Parliament is to try to get it right, satisfy the judgments that have already been delivered and get a bill that, broadly speaking—

[The Deputy Speaker, Bruce Stanton]

The hon. member for Saanich—Gulf Islands.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, I want to commend my hon. colleague from Calgary Rocky Ridge for a thoughtful speech that did not fall into the trap of partisanship. This is a very difficult issue, and having been part of the debates in Parliament since the first version of medical assistance in dying came forward, I have been taken with how we as a chamber have approached the issue respectfully from all sides.

This is a comment; I am not putting a question to my hon. colleague, so he can amplify his points. I am deeply grateful that he is drawing a line where he does not see evidence of moving into an area that would put people with disabilities at risk or moving into an area that would make him uncomfortable. This does more than make sure we are within the law and respecting the rights of individuals who legitimately need medical assistance in dying.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, I thank the member for her comments, but I do have these concerns that members of the disability community have raised. It is critical to me, before I vote at third reading in support of the bill, that the protections for the disabled community remain, that we do not enter into scenarios where medical assistance in dying is foisted on somebody and that this will remain merely for those who seek it as a result of grievous cruelty and suffering from an irremediable condition.

[Martin Shields, Conservative, Bow River, AB]

Mr. Speaker, I think this has to do with the sense of a court deadline. Our Parliament is constructing legislation. We are working on it. I refuse to accept the idea of being blackmailed into not doing a full and thorough review. We did not do one with Bill C-14. I think the courts would fully understand.

Would my colleague respond to this deadline, which is really blackmailing us into a rush?

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Mr. Speaker, the hon. member for Bow River makes a great point, and I did touch on the review in my speech.

The committee hearing on the bill is not a substitute for the fulsome review that was promised in Bill C-14. I am concerned about the rushed timeline, and I identified in my remarks that for the bill to be fully supported at third reading, things must be done properly. It has to be drafted and worded carefully and thoughtfully, following a proper and robust consultation by the appropriate parliamentary committee.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, it is interesting that the last question has brought us to the issue of urgency and why this is pressing.

We had this bill before us in the spring, before we adjourned and before COVID-19 took over our parliamentary process. We now have the process, for which I am grateful to all parties, that allows us to debate controversial legislation, to have votes at a distance, to respect the threat of COVID-19 and to protect public health.

When debating this bill before we adjourned, I was getting emails in the House from one of my best friends, who was dying of ALS. She asked me if there was any chance we would make changes to the bill for advance directives in time to help her. I deeply regret that we were unable to get this bill passed last spring, when my friend, Angela Rickman, could have benefited from access to medical assistance in dying. She died in a situation of suffering that would have been her wish to avoid. Now, as we debate this, a member of my own family is wondering whether we can get this bill through quickly enough so that they are not put in the impossible situation that Audrey Parker found herself in. I will reflect further on Audrey Parker later.

There is urgency, whether driven by courts or by compassion. We know as legislators, as our friend from Beaches—East York just commented a few speeches ago, that we have, at this point, repeatedly passed legislation that did not meet the judicial thresholds and frameworks that have been set before us in order to ensure that the legislation we pass on medical assistance in dying meets previous court decisions. I know everybody is deeply affected by their own constituents, their own personal experiences and their frameworks of religious traditions or lack thereof, but I hope we all come to this with open hearts, recognizing that this is a crucially important issue, one that I hope our Parliament will handle better than we have in the past. Let us make sure we pass legislation that does meet the constitutional requirements that have been put before us, if for no other reason than making sure we do not have to continually return to improve our legislation. Ensuring it meets the bar that was set for us by our courts has to be paramount.

I happen to come from a constituency where, overwhelmingly, constituents have wanted to see medical assistance in dying legalized for many years. My colleagues in the chamber and watching remotely will remember the name Sue Rodriguez. Sue Rodriguez was a resident in my constituency, in North Saanich. Her first effort, which was, of course, the case she brought forward, was the first time the Supreme Court of Canada ruled, by a very narrow margin, that medical assistance in dying would not be allowed in Canada. That was back in 1993, and it was by a vote of five to four that the Supreme Court denied her final wish. She was able to access illegal assistance from a doctor who remains unknown, but God bless him, and she achieved medical assistance in her own death in February 1994. It was not a situation we would want any of our loved ones to find themselves in, unable to find the help legally and choosing to find someone willing to help otherwise.

The next set of cases, of course, bring us to more recent cases, the ones we talk about in Parliament today, and particularly the one that brought us to Bill C-14 in the previous Parliament, brought forward after the 2015 election. The names of the ministers who were involved have been referenced several times: the hon. member for Vancouver Granville and, of course, the former minister of health, Jane Philpott.

I lamented then, in this place, that the Carter decision of the Supreme Court of Canada was not being respected fully in the legislation that we were debating. I was able, in clause by clause consideration at committee, to bring forward amendments, which were rejected there, to do away with the requirement that someone be capable and competent on the day of the procedure to confirm their desire for medical assistance in dying.

It is that requirement that drove Audrey Parker to have to get medical assistance in dying before the moment she really wanted to, for fear that she would be unable to provide that consent through the vagaries of the disease or the pain-killing drugs. We know Audrey Parker's story. It was related to us today earlier by the current member for Markham—Stouffville and by the member for Dartmouth—Cole Harbour, who knows the Audrey Parker story well.

She died November 1, 2018, nearly two years ago, saying that this Parliament had let her down through the requirement that she be competent the day of the procedure to confirm that it was, indeed, her wish. This was impractical. Even as we worked in Parliament on Bill C-14, we knew from the language in the Carter decision of the Supreme Court of Canada that this was a violation of patients' constitutional rights.

When the bill got to the Senate, I was very pleased that the amendments I put forward in clause by clause, which had been rejected in the House, were taken up and approved by the Senate. However, as we will recall, when the bill came back from the Senate, the government rejected the amendments to deal with ensuring that people would have access to medical assistance in dying and to deny patients access to an advance directive. Predictably, here we are.

As many of us argued in Parliament in the first round of debates on Bill C-14 on medical assistance in dying, we were not, as a Parliament, passing legislation that was likely to survive a court challenge. There was not much prescience or crystal ball-gazing to know it. We knew it if we read our legislation and compared it to the reasoning in the Carter decision. Here we are now with a new decision, the Truchon decision from the Quebec Superior Court, and we are going back to amend the legislation.

What we are doing, of course, is making sure that people in a situation where they do face a terminal illness and their doctors know that they cannot survive this illness will be able to access an advance directive. Again this was the Carter decision. The Carter decision was full square about facing irremediable suffering and accessing medical assistance in dying. Clearly in this legislation, we have said mental illness is not going to be covered, that mental health issues will not be considered an illness that can be considered irremediable in the context of this legislation. We will very likely have to come back and revisit that.

Certainly, as this legislation goes forward from this vote at second reading to committee, I hope we will find a way to amend the legislation to remove the 90-day timeline around assessing someone's irremediable state of suffering. I support what the member for Beaches—East York has said on this. It does not appear at all to be a humane decision or within what the courts have already told us to insist on that 90-day period.

There are some things that have been argued today in this House that I want to draw attention to because I would hate for Canadians to think that this bill was as cavalier as some would have us believe. Some have said that this bill would allow for “death on demand”. That was one phrase used by one hon. colleague. It's important to know that the bill says quite the contrary.

One of my friends in the House said this bill does not make any effort to allow someone to change their mind the day of the procedure. I urge colleagues to look at subclause (3.1)(d). It is very clear. They should also look at subclauses (3.2), (3.4) and (3.5). Throughout the bill, there are many points at which it is very clear that people have the ability to say, and doctors have the requirement to verify that people have the ability, even on an advance directive, to subsequently change their minds. That is a very clear set of provisions in the legislation, as I said, particularly under subclause (3). To clarify again, in subclause (3.1)(d), it is very clear that one has to ensure that people have been informed that they may, at any time and in any manner, withdraw their request. That is the context throughout this bill.

I know my time is at an end. I just want to say that I support this bill and I hope we pass it as quickly as possible. People are suffering and they want us to act.

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

Mr. Speaker, it is important for us to recognize that back in 2015, shortly after the election, one of the challenges we had was to come up with new legislation dealing with medical assistance in dying. There was a general feeling that, yes, here we are at this particular point, but we will have to make some changes. Today, that is exactly what we are doing, but it is primarily being driven because of a court decision in the province of Quebec.

Could the member provide further thoughts in regard to the dropping of the 10-day waiting period for people who are near death?

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, the legislation is clear that nothing happens in the blink of an eye. A lot of consideration must be given to the situation of each individual patient. The medical experts engaged must have specific knowledge of whatever particular irremediable condition is being raised. The question of eliminating a 10-day waiting period is not to make it on demand. There are still very significant stipulations and requirements that must be assessed and considered in advance of accepting that it is a case for medical assistance in dying.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Mr. Speaker, like a lot of members of Parliament, I consulted my constituents extensively on Bill C-7. One area of commonality everyone seemed to share was that the Government of Canada, we collectively as legislators, can do more for people to have more options when they reach a period in their life when death is foreseeable.

What would the member say about providing more supports for palliative care to give people that option? In many communities across Canada, we know that option just is not there.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, it is not either-or, but it is absolutely the case that we need to do far more. The provision of health care is provincial, but the federal government has responsibilities under the Canada Health Act and there is, of course, federal-provincial cost-sharing around health care.

We should make it a priority that we improve access to palliative care across Canada. I completely agree. I resist when I hear some of my hon. colleagues suggesting that the government has a preference for pushing people toward medical assistance in dying. That is not the case. That needs to be understood. We need both.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I want to come back to what was just said.

I do not know if my colleague agrees with me that there is a fundamental difference between palliative care and medical assistance in dying. Palliative care is provided through the health care system. If we want better palliative care, I think that the best way to get there is to provide the health care funding that the provinces want. We know that in the past, both the Liberals and the Conservatives slashed health care funding.

Does my colleague agree that if we want better palliative care, then we need better health care funding?

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, I completely agree with my colleague from the Bloc Québécois. We must increase the level of service in the public health care system while also amending the Criminal Code to improve access to medical assistance in dying.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Mr. Speaker, I am glad my colleague brought up the history of Bill C-14 in the previous Parliament and the concerns that she and all of us in the NDP share. This bill did not match the findings of the court decision that brought us to deal with that.

The member did mention the 90-day period and I am wondering if she can expand on that. What does she think this is for? People are in intolerable suffering and asking them to wait another three months seems to be not right.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, in my analysis of Bill C-14, which may be right or wrong, it seemed to me the country's doctors were in a discussion and dispute with the country's lawyers. The lawyers were looking at it from the point of view of what the courts require of us and the doctors were saying they were not sure how they wanted to administer it. At that point, I think we let down individual human beings across Canada. I do not think we should do it again. I think the 90-day period is an arbitrary bureaucratic response to trying to find the balance points between those competing interests. What we should always be thinking about and what should be paramount is respecting the rights of individual Canadians at the point they are in irremediable suffering as confirmed by their physicians.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, this is the second time I have had the opportunity to speak to this legislation, Bill C-7, an act to amend the Criminal Code, medical assistance in dying, due to the Liberals proroguing Parliament. Unfortunately, my earlier concerns, such as the legislation going above and beyond the Superior Court of Quebec decision, have not been remedied. I was also on the justice committee when this was being dealt with before.

I have long believed the place for drafting legislation is in Parliament so I will not criticize the government for tabling this legislation. My critique of the government is it is using the Superior Court of Quebec decision to make other amendments to Bill C-14 instead of using the automatic five-year review to do so, which was spoken about here earlier.

No one better understands the reasons why this legislation is needed to respond to the Quebec Superior Court decision than the current Liberal Minister of Justice. In the previous Parliament, he voted against his own government's legislation because he foresaw that a court would strike down the previous provisions as he felt they were too rigid.

The member for Vancouver Granville, the then former minister of justice who drafted Bill C-14 at the time, was aware of this criticism and spoke directly to that issue in her opening remarks at the justice committee back in May 2016. She said, “In terms of eligibility, I am aware of the requirements that a person's natural death be 'reasonably foreseeable' has received some attention, including in terms of how it relates to the Carter decision. I would like to address these concerns.”

She went on to say that, “A person can be approaching a natural death based on medical circumstances that are not directly related to a serious, incurable illness. As well, eligibility does not depend on a person having a given amount of time remaining, such as a certain number of weeks or months to live, as in the United States.”

It was clear from her remarks she felt Bill C-14, the predecessor to this bill, struck the right balance.

As we are all too aware, there are always unique situations where the law cannot accurately predict every scenario. The former minister of justice understood the complexities and challenges the families, doctors and patients were going to face with this new MAID regime. She went to say at committee:

Reasonable foreseeability of death is ultimately a medical decision, and not a legal one, to be made by taking into account all of the person's medical circumstances, including the types and number of medical conditions, frailty, age, etc..... By defining the term “grievous and irremediable medical condition”, the bill would ensure that all competent adults who are in an irreversible decline while on a path toward their death would be able to choose a peaceful, medically assisted death, whether or not they suffer from a fatal or terminal condition.

The word that has caused considerable consternation with both individuals seeking MAID and their doctors is “competent”. As with many illnesses, the drugs needed to either treat or provide comfort can impede one's competencies. This will be an important issue as it relates to the legislation as the government is creating a process for advance requests for persons newly diagnosed with a condition that could affect their decision-making capacity in the future.

As Jane Philpott, the former health minister, said when drafting the original MAID legislation in 2016:

We faced similar challenges in considering the issue of advance directives. The Supreme Court did not deal with this issue in Carter, and the views of Canadians and stakeholders, as you know, are divided. I understand the hardship for those Canadians who fear that after being diagnosed with a disease such as dementia they may experience a decline that could compromise their dignity. This has led to pleas to allow people to make requests for medical assistance in dying well in advance of the time when the person is no longer competent to make or reaffirm a desire to accelerate their own death.

While I agree, I also agree that once this legislation is referred to the justice committee it would be prudent to revisit this issue with medical professionals who are experts on Alzheimer's and dementia-related illnesses.

We must bring in families and those who understand these types of illnesses so we can think through as many scenarios as possible. I would prefer Parliament get this right rather than a court striking down the legislation in the future as it could lead to the situation we find ourselves in today.

The other issue I want to touch on stems from the Truchon decision. The Superior Court of Quebec struck down Bill C-14's provision that death had to be reasonably foreseeable. One could argue the government should have appealed the superior court decision, as we have spoken about in other speeches and questions tonight. It would not be an unusual step as the Government of Canada appeals all sorts of lower court decisions.

While I was not expected to be consulted on the government's response to the Truchon case, there has been very little public discussion from the Liberals about the likelihood of prevailing at the Supreme Court. My only question would be this. If the government did appeal to the Supreme Court, could it have gotten a more limited and narrow ruling on the implications of deleting the reasonably foreseeable clause?

By completely removing this clause, even with a new set of safeguards, it will expand the list of people who might be eligible for MAID rather than just dealing with the specific concern raised in the Truchon case. The very reason the reasonably foreseeable clause was put in the original legislation was that the former ministers wanted a balance between personal autonomy and the protection of the vulnerable.

Obviously the Superior Court of Quebec did not approve of the balance the Liberals sought in Bill C-14. However, in response, we must be mindful of the unintended consequences of this legislation. I know every member of Parliament has been contacted by their constituents about the implications of removing reasonably foreseeable criteria.

There are varying degrees of concern, ranging from moral and ethical grounds to concerns about the role of the state in sanctioning MAID for individuals who are doing so out of the lack of proper palliative care services. The government has decided in this bill to continue to allow doctors and individuals to decide what constitutes a grievous and irremediable medical condition rather than provide a prescriptive list of eligibility criteria. As someone who believes in individual rights and in the judgment of medical experts, I agree with this approach. My only concern is that we have left it too vague.

The government could have eliminated the reasonably foreseeable clause and replaced the original criteria with something that would be deemed constitutional rather than what we have before us today. There are those with apprehensions that proceeding this way will lead to situations where individuals will seek MAID and even be able to proceed for reasons no one in Parliament intended it to. I, for one, would like to see the law as written and intended by the drafters be carried out accordingly.

That is one of my concerns that must be answered fully before we pass the legislation and send it to the Senate. While the legislation explicitly states that having a mental illness is not a serious and incurable illness, disease or disability, we must be prepared to withstand that court challenge.

To refer back to the 2016 debate on MAID, Jane Philpott, at the justice committee, said, “There is no denying that mental illness can cause profound suffering. However, illnesses such as chronic depression, cognitive disorders and schizophrenia raise particular concerns with respect to the matter of informed decision making.”

It goes without saying that there are deep divisions on the overall issue of MAID. What we find in this bill goes much further than deleting and replacing the phrase “reasonably foreseeable” in order to be compliant with the recent court decision. For example, the government is using safeguards which, I might add, is the actual language found within the presentation with which department officials briefed MPs. As it stands, patients must make a written request for MAID that is witnessed by two independent witnesses. In Bill C-7, this would be changed to one independent witness. I believe it is incumbent on the government to justify this change and outline the rationale why it needed to be amended.

Last, the government is also be removing the mandatory 10-day period after the written request is signed. Once again, this is a significant change that goes above and beyond what was required to be in compliance with the Superior Court of Quebec decision.

I have listened closely to the concerns of constituents about the bill, I support it going to committee for scrutiny and clarity. I want government to know I am committed to working with them constructively on the legislation.

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

Mr. Speaker, I appreciate the comments and concerns expressed by the member opposite. On the reasonably foreseeable clause, because of the decision of the Superior Court of Quebec, we find ourselves having to bring forward this legislation. However, when we brought in Bill C-14, there was this expectation from parliamentarians that changes would be on the horizon, that the debate did not stop when the bill passed in June 2016. Ongoing dialogue had taken place and some of that dialogue is reflected equally in the feedback we received in January from some 300,000 Canadians.

Would the member not agree that if we are opening the door at this point in time, it only makes sense to look at other things that could be done to improve the legislation overall.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, that is exactly what I was referring to when I said I would work collaboratively to try to improve this legislation. I know there were ongoing opportunities for change in Bill C-14 when it came up and went to committee.

My colleague has also forgotten that there was a five-year review which the government could have done a lot more with this past summer. We could have looked at a lot of the issues such as the 10-day issue versus the 90-day issue that my colleague from Saanich—Gulf Islands spoke of earlier. There is a real opportunity for improvements to be made in the bill and that review process, which was more or less forgotten, was one of those opportunities.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I thank my colleague for his speech.

I would also like to come back to the concept of reasonably foreseeable death. I think that this concept is problematic because, according to many health specialists, there is no foreseeable death for people who suffer from a degenerative disease. However, a person with a degenerative disease eventually loses the ability to provide informed consent. Consider, for example, people with Alzheimer's and related cognitive disorders.

Does my colleague not think that we should listen to the experts so we can improve the legislative process? The ones I heard from were of the opinion that this notion of reasonably foreseeable death is problematic. Does he agree with me?

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, I referred to that in my presentation. We need to get it to committee and bring experts forward, including doctors, people in the medical field and legal professions as well, so we get the legislation right and so it will withstand any kind of court challenges, as I referred to in my speech.

In answer to the member's question, I strongly believe we need to get it right this time, and we have the opportunity here to do that. It is a good opportunity for us to look at the types of circumstances around not just the 10-day area, but also on the other sections of foreseeable issues that were looked at in the bill.

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

Mr. Speaker, a wise person, John Wooden, once said, “If you don't have time to do it right, when will you have time to do it over?” The debate today is a perfect example of that.

Back in 2015, we were working against time to pass legislation, and now we have heard the hon. parliamentary secretary say this on a couple of occasions, and particularly this last time, that they found themselves having to bring forward this legislation because of a court judgment, because they did not get it right the first time. Here we are again, racing against time.

What the government could have done was challenge that ruling and heard from the Supreme Court in its wisdom. In parallel with that, we could have had a parliamentary committee study it, as mandated by the previous legislation, and we would have had a shot to get this right. Maybe the hon. member could speak to the importance of due process in getting legislation right.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, the member's question is so pertinent to the debate we are having on Bill C-7. It is an opportunity to get improvements to Bill C-14 and we need the opportunity to do that. Due process is what Parliament is all about and we need to have that opportunity in the House.

On the issues of grievous and irremediable medical conditions, as I said in my speech, we could have had an opportunity to put more definition into some of these issues. The foreseeable issues were just another one of those areas where we could have had more definition.

[Adam van Koeverden, Liberal, Parliamentary Secretary to the Minister of Diversity and Inclusion and Youth and to the Minister of Canadian Heritage (Sport)]

Mr. Speaker, it is an honour to stand in the House of Commons and participate in the second reading debate on Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

In developing these amendments, Canadians were widely consulted in January 2020. During these consultations, approximately 300,000 Canadians completed an online questionnaire. In addition, the Minister of Justice and Attorney General of Canada, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion met with experts and stakeholders in Halifax, Montreal, Toronto, Vancouver, Calgary, Winnipeg, Ottawa and Quebec City to discuss proposed revisions to Canada's medical assistance in dying framework. These experts and stakeholders included doctors, nurses, legal experts, national indigenous organizations and representatives from the disability community.

The high level of participation in both the questionnaire and the in-person sessions is a reflection of the importance of this issue to Canadians. Moreover, the results of consultations were critically important in shaping our government's approach to medically assisted dying as it evolves to reflect the needs of Canadians.

The bill would amend the Criminal Code to allow medical assistance in dying for people who wish to access a medically assisted death whether their natural death is reasonably foreseeable or not. The bill would remove the reasonable foreseeability of natural death from the list of eligibility criteria. It would also expressly exclude people seeking medical assistance in dying solely because of mental illness.

The bill proposes a two-track approach based on whether a person's natural death is reasonably foreseeable. Existing safeguards remain and are used for people whose death is reasonably foreseeable. In addition, new and modified safeguards would be applied to eligible persons whose death is not reasonably foreseeable.

In the spirit of “nothing without us”, I would like to mention that our government remains focused on addressing the concerns of the disability community around vulnerability and choice. The proposed changes to the legislation supports greater autonomy and freedom of choice for eligible persons who wish to pursue a medically assisted death. At the same time, full consideration has been given to the protection of vulnerable persons and to respecting the equality rights and dignity of persons with a disability.

In short, the bill maintains and strengthens safeguards to support fully informed decision-making while also respecting individual autonomy. The bill would allow people who risk losing decision-making capacity to make arrangements with their practitioners to receive medically assisted dying on their chosen date even if they lose the decision-making capacity before that date. The bill would also make advance consent invalid if the person demonstrates refusal or resistance to the administration of medically assisted dying.

In addition, the bill would allow eligible persons who choose to self-administer to provide advance consent or for a physician to administer if self-administration fails and causes them to lose capacity. This type of advance consent would be available for eligible persons regardless of their prognosis.

I would also like to take a moment to speak to the progress our government has made with respect to the rights of persons with disabilities in Canada.

Last year, we enacted the Accessible Canada Act, which aims to create a barrier-free Canada through the proactive identification, removal and prevention of barriers to accessibility wherever Canadians interact within areas under federal jurisdiction. The act is one of the most significant advancements in disability rights since the charter in 1982 and is designed to inspire a cultural transformation toward disability inclusion and accessibility in Canada.

Knowing that I do not have that much time left, I would say that members of my community as well as members of my family and members of the greater Parkinson's and Alzheimer's community have been very vociferous on this issue, and both of those diseases affect people in my family. I am strongly in favour of the bill passing as quickly as possible.

The House resumed from October 19 consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[The Speaker, Anthony Rota]

Before continuing, I wish to inform the House that because of the deferred recorded divisions, Government Orders will be extended by 81 minutes.

[Adam van Koeverden, Liberal, Parliamentary Secretary to the Minister of Diversity and Inclusion and Youth and to the Minister of Canadian Heritage (Sport)]

Mr. Speaker, it is an honour to virtually join the debate in the House of Commons and participate in the second reading debate on Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

I will take a moment to speak to the progress that our government has made with respect to the rights of persons with disabilities in Canada.

Last year, we enacted the Accessible Canada Act, which aims to create a barrier-free Canada through the proactive identification, removal and prevention of barriers to accessibility wherever Canadians interact with areas under federal jurisdiction.

The act is one of the most significant advancements in disability rights since the charter in 1982 and it is designed to inspire a cultural transformation toward disability inclusion and accessibility in Canada. The act created Accessibility Standards Canada, an organization that will create and revise accessibility standards and support and promote innovative accessibility research. The CEO and board of directors were appointed and the operations began last summer.

That act also established National AccessAbility Week, a week dedicated to accessibility in late May and early June each year. National AccessAbility Week is an opportunity to promote inclusion and accessibility in communities and workplaces and to celebrate the contributions of Canadians with disabilities. It is also a time to recognize the efforts of individuals, communities and workplaces that are actively removing barriers to give Canadians of all abilities a better chance to succeed.

Our government is taking real action to address the rights of persons with a disability. The careful writing of Bill C-7 is a testament to that. Representatives of disability organizations and leading disability scholars participated in consultations across the country and their input informed the reforms proposed in this bill.

We recognize that disability inclusion requires more than legislation and that is why we are continuing to work with the disability community and stakeholders to address stigma and bias. It is important to bring about cultural change to ensure that the important contributions made to Canada by persons with a disability are recognized and valued on the same basis as other Canadians.

Going forward, we will continue to focus on improving the social and economic inclusion of persons with a disability. This means moving forward with our commitment to build on the progress we have made over the past months and years with the development of a disability inclusion plan. This disability inclusion plan would include important initiatives like a new Canadian disability benefit modelled after the GIS for seniors, a robust employment strategy for Canadians with disabilities and a better process to determine eligibility for government programs and benefits. We all benefit when everyone can participate equally in our economy and society.

We will continue to work hard to ensure that every person in Canada is treated with the dignity and respect they deserve, especially when it comes to the deep and personal issue; that is ending one's life. It is imperative that the voices of all Canadians, including persons with a disability, continue to be heard on the issue of medical assistance in dying.

[Matthew Green, NDP, Hamilton Centre, ON]

Madam Speaker, I want to acknowledge the words of the hon. member. I have known him to be a compassionate man.

He talked about people with disabilities living with dignity, yet, as it relates to the COVID situation, with so many people living with disabilities being left out of recovery packages and support, we are hearing that they are considering accessing MAID simply because they do not have the money to survive.

What does the member have to say about programs that have excluded people living with disabilities to the point where they are actually considering accessing this end-of-life scenario?

[Adam van Koeverden, Liberal, Milton, ON]

Madam Speaker, I profoundly appreciate the work that my colleague across the floor has done for his community in Hamilton prior to his entering federal politics. I am well aware of his many contributions in areas of social justice and I am proud to call him a colleague. He is somebody who stands up for people and ensures their voices are amplified.

In areas of mental health concerns that our government has, we have taken many precautions to ensure that people are being heard and that the correct precautions are being made in order to ensure that mental health and people with disabilities do not fall victim to many of the inadequacies that are baked into the system. This is an effort to change the ways it has been dealt with in the past.

I fully recognize, from consultations with many constituents in my riding who live with disabilities, that the benefit we have promised is too little and too late and that we must continue to do more for Canadians with disabilities, in particular, with regard to mental health.

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

Madam Speaker, with this legislation, it is clear that the Liberals have snuck in a number of different provisions that have nothing to do with the Truchon decision. One of them is bringing in the possibility of same-day death.

The elimination of a 10-day reflection period means that somebody could request and receive euthanasia or medical assistance in dying on the same day, without any further requirements or checking back the following day to see if this was a consistently expressed desire or simply the response to an immediate low.

Does the member believe same-day death is reasonable or does he think there should be a default to a reflection period? Right now, the reflection period can be waived in certain circumstances by the physicians. Does he think the default should be to have some degree of a reflection period so we do not have same-day death?

[Adam van Koeverden, Liberal, Milton, ON]

Madam Speaker, while I appreciate the many contributions and reflections upon this and many other issues from my colleague opposite, I, unlike him, rely on experts and expert opinions, research and evidence from people who work in these fields.

As a politician, I do not feel prepared or adequately informed to make these decisions in the House. They are made through evidence finding exercises in consultations with experts, physicians and researchers. Because we are an evidence-based government and one that bases all our decisions on that evidence-based approach, I am very confident we are making the most compassionate, best decision possible.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, Inclusion BC is seeking additional safeguards for people with disabilities. Would the Liberal government consider providing each province and territory with additional health transfers to cover, under this legislation, supports for mental health and psychiatric care that are embedded into the legislation to give Canadians assurances, especially those with disabilities, that all options are on the table for them when they consider MAID?

[Adam van Koeverden, Liberal, Milton, ON]

Madam Speaker, I will take the question under advisement and ask the correct officials and the minister in charge if this is something that we might consider.

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

It is my duty pursuant to Standing Order 38 to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Mégantic—L'Érable, COVID-19 Emergency Response; the hon. member for Calgary Nose Hill, Health; the hon. member for Courtenay—Alberni, COVID-19 Emergency Response.

[Richard Bragdon, Conservative, Tobique—Mactaquac, NB]

Madam Speaker, it has been said the character of a nation is revealed in how it treats its most vulnerable citizens. It is my priority to ensure that this type of legislation has the proper safeguards to protect the most vulnerable in our society, like our seniors and those with disabilities. Throughout COVID-19 we are learning of more and more persons with disabilities who are considering MAID as an option due to the increased economic challenges they are facing, as well as the increased social isolation that has arisen, as a result of COVID.

There also must be proper safeguards for the conscience rights of physicians and allied health professionals. The key principle of any democracy is freedom of belief and conscience, the freedom to be able to hold those beliefs, practise those beliefs and carry out in one's life what one feels is a true reflection of those beliefs, without impediment.

We have a responsibility as parliamentarians to make sure we get this legislation right. From the beginning, the federal government should have appealed to the Supreme Court, so that there could be certainty on the framework within which Parliament can legislate. Sadly, it did not and as a result there are still many questions surrounding this legislation.

There are many things we can talk about when it comes to an issue as sensitive as this, a bill that affects the lives of many Canadians and people throughout our country, many of whom are in situations where they find themselves struggling to cope or to handle a circumstance that has put them in a very vulnerable state. I feel that we as parliamentarians need to measure all options on this and be extremely cautious because of the ramifications this type of legislation can have, and not just now but for many years to come.

This issue is near and dear to my heart because of my background. I worked for many years in the private sector and spent some time working with vulnerable populations, people who have faced the tremendous challenges that can arise when they are battling mental health related issues, such as depression and anxiety. I have seen people who have had battles with addictions and considered taking drastic measures to somehow end the suffering they were going through at that time. I recall one particular instance, which I would like to share with the House today, that had a huge impact on my life and really informs some of what I would like to talk about here this afternoon.

I will never forget the day. I was called by a local police force in our region to get to the bridge in our local community as quickly as I could. At that time, my wife was visiting a friend of hers who had just had a baby in the hospital, and I happened to be out in the vehicle with our youngest child who was sleeping in the car seat. I told the officer that my wife was at the hospital and that I did not know what room she was in. I said that I did not know how to get to her and that I had an infant child with me, and I asked if he could help me. He said he would be right there and stay with my child, and the other officer would take me to the bridge.

Of course, immediately my heart started to pump and I felt the emotion of it. With my background, I said a quick prayer, hoping things would turn out okay. We rushed down to the bridge in our community. The traffic was backed up on both sides. I got out of the police car and ran up onto the bridge. Search and rescue was there in the water, and a lot of police officers were on the scene. There was the young lady, standing on the outside of the railing and clinging to a lamppost.

She was waiting there, because she wanted to tell me the things she wanted me to say to her parents and to her infant child. Of course, I was scrambling, trying to come with anything to say to dissuade her. As she told her story, I was holding her hand and trying to dissuade her from making the decision to jump. She told me what she wanted me to tell her mom and dad and her little girl, and I told her that she did not have to do this and that she could talk with them. I told her that her little girl needed her and that her parents loved her. I was doing all the things I could think of.

I will never forget. She looked me straight in the eye. She let go of my hand and said, “Thanks for doing this, Richard. Goodbye.” Then she jumped.

Immediately, everything flashed in front of me. I wondered if I could have said something different. I was very emotional at the time.

Thankfully, when she hit the water, the search and rescue teams had enough time to be in place so that when she emerged from her plunge, they were able to pull her out of the water and get her to the hospital. I am glad to say that she is on the road to recovery. She came through it. Even though her journey from that point has not always been easy, I am glad to report that, several years later, she is still with us. Now she is impacting many people's lives for the better. She is helping other young women who have found themselves in desperate situations and struggling with addictions and health related issues. She is helping to provide an example of hope.

I share that story, because I believe it is so important that we do everything we can to make sure we build in all the safeguards possible and all the bridges possible to allow people to make the choice of life and to choose to keep going, even in the midst of adversity, even when things look hopeless and even when things look like they cannot turn around. Some of the best stories that have ever been written, some of the most inspiring songs that have ever been sung, some of the best writings that have inspired generations were written from very dark places, places where shadows run deep. They have come from people who have literally walked through the valley of the shadow of death and came out on the other side.

I would encourage the House to do everything possible to put those safeguards in place and to make sure we do everything we can to foster an atmosphere where people who are in vulnerable places can be inspired towards hope and realize that they are not alone. All the adequate supports should be there with a full range of options for those in desperate times.

I am thankful for the opportunity to share that story today. I hope it encourages all of us to reflect and take the time to seriously consider the bill before us and to ensure that we put every safeguard possible in the bill.

[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 thank the member for sharing his story with such sincerity. I am so glad that she is still with us today.

When I look at the legislation before us, one thing that provides me comfort is the understanding of health care professionals. I have had first-hand experience, through the passing of my father and my grandmother, with their depth of knowledge. I suspect that was not unique to those two or three health care workers. I have a great deal of faith, both in health care professionals and family and friends. I suspect that for those who go through that very difficult time in their lives, when they have to consider MAID, the supports will be there.

I wonder if the member could provide his thoughts in regard to the types of people I have referenced.

[Richard Bragdon, Conservative, Tobique—Mactaquac, NB]

Madam Speaker, I absolutely concur that we have incredible people working in the health professions who truly walk through the darkest of times with people, providing them care and hope, and providing help for families as well as those who are in that valley of decision.

I think the hon. member would concur with me that these types of care providers deserve a lot of credit. Also, I believe they need to be assured that they can practice their conscience and be able to carry out their personal beliefs in their profession, and not feel threatened or feel that they have to do something that would be opposed to their conscience.

I know many health care professionals who do such excellent work. I know that is a value that is so important to them, being able to exercise their conscience. I do agree with the hon. member about their important role.

[Martin Champoux, Bloc, Drummond, QC]

Madam Speaker, I join my colleague opposite in thanking and congratulating the member for sharing that touching story. It really makes us think.

I want to point out that there is a difference between suicide and suicidal tendencies and what someone suffering from a serious, irreversible illness has to deal with. As my colleague mentioned, we obviously need to create preventive safeguards and very clear regulations on these details. As everyone knows, the devil is in the details.

However, I did not hear my colleague's opinion on the question. I want to know whether he is satisfied with the measures in this bill that will be included in future MAID legislation.

Does he feel reassured that the framework for people with mental illness is sufficient? The bill must not include depression or a problem other than a terminal physical illness.

Would the member be okay with such legislation regulating MAID?

[Richard Bragdon, Conservative, Tobique—Mactaquac, NB]

Madam Speaker, again, understanding the sensitivities around this piece of legislation, what is important is that there are not enough adequate safeguards within the current bill. I believe there are inadequate supports as it relates to persons struggling with mental health related issues. That is an area where we need much more support and much more awareness. There needs to be great improvement in the area of palliative care and support for those who are aging, and those who are facing extremely difficult times and choices.

There is not adequate support in the bill to ensure that there are alternatives and options being clearly presented, as well as the proper time to reflect. The bill, in its current form, diminishes the safeguards that need to be in place for a decision of such finality. We need to do everything we can as parliamentarians to ensure the safeguards are augmented in this bill.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Madam Speaker, I am really pleased to speak to this bill, Bill C-7, in its current form, mostly because I did not support the original bill, Bill C-14, from four years ago. I did not support it because I felt that it did not reflect the intent of the Supreme Court of Canada's ruling in Carter. I also felt, as a family physician who practised medicine for 20 years, that it did not act in the best interest of my patients.

As a family physician, I walked with my patients through many things: through the joys of having a baby, of giving birth and of marriage, but also through the difficult, challenging and painful times when they struggled with excruciating incurable diseases and with knowing they were going to die because of a terminal illness. They had to work with their families, who may or may not have wanted them to go through with this. I held their hand and walked with them, so this bill has a very personal meaning. That is why I am pleased to speak to it now.

I like the bill in this form in many ways, though there are a couple of things that have not happened in it that I would like to see. The first thing I am pleased with is that it removes the clause saying natural death has to be reasonably foreseeable. It was very difficult for physicians to understand what exactly that meant. If the clause meant only people who were going to die soon, it did not reflect the Carter decision by the Supreme Court, because it did not look at issues of incurable disease or intractable pain and suffering. This bill addresses that, I think, in that it is distinguishing what we mean by natural death becoming reasonably foreseeable. In other words, I think it recognizes that if a natural death, because of a disease or a terminal illness, is going to be foreseeable within maybe a week or two, then a person does not need to go through the 10-day reflection period that was asked for earlier on. However, if it is a longer period of time, maybe four months or so, a person can continue to reflect on whether this is what they really need.

I also like that it has brought back something called advance directives. It is interesting to note that long before medical assistance in dying was considered, physicians had advance directives. This is at the heart of a doctor-patient relationship. They would sit down with patients and go through all of the things patients faced and their concerns, especially if they were diagnosed with a serious and terminal illness, and they would say what they would like to do if something happened. That would be in writing, between the doctor and the patient. I was present when families of patients who were dying, in great pain and suffering and under the deep stress of this, would debate the decisions they had made earlier with their physician. Putting this back in means that we are respecting patients' desires. Regardless of their mental capacity at the time of their dying, we are respecting what they originally wanted, if they still want it, not having other people rule on their decision.

Inherent in everything I dealt with regarding patients who were terminally ill or had an intractable and incurable disease is that they wanted to die with dignity. Dying with dignity cannot be understated. Dying with dignity means that people can choose how they die, where they die and the manner in which they live with the suffering of dying and the mental anguish of leaving their loved ones. This is a deeply personal thing that patients face. It is impacted by their religion, it is impacted by their ethics and it is impacted by their family situation. It therefore has to be done on a case-by-case basis, and having an advanced directive with a physician is always a really important thing in that regard. That had been removed in the last bill and I am glad to see it back. It took the decision away from the patient and gave it to the state, at the end of the day, and now it is back with the patient.

I want to applaud the inherent compassion I see in this bill. I think it is really important. The deeply held desire of every single patient I knew, regardless of whether they chose to have medical assistance in dying or not, was the ability to die with dignity. The patient's ability to choose where they die is really important. Do they want to die at home in bed? Do they want to die in a palliative care unit, where they have become accustomed to spending their last days? Do they want to die in a hospital? Most patients do not want to die in a hospital. They want to be surrounded by their loved ones.

The government is giving $6 billion to provide home and palliative care resources to the provinces, because it is the responsibility of provinces. They can facilitate this deeply held desire to die with dignity and help patients make this choice at a time when the ability to do so is often impacted by extreme pain and suffering and the extreme mental anguish of knowing they have to leave their loved ones. It simplifies this in a great way, and that is a compassionate thing.

There are some areas that can be improved, and one of them is the singling out of mental illness and disability as a sole diagnosis. I agree with everyone who has spoken in the House today, and with the desire of a lot people, to recognize that mentally ill people should not be put away and should not be allowed to simply decide they want to pass on because the people they live with think they are a burden. It is really important to also look at this from the perspective of the disabled.

I know the minister has taken a lot of time to speak with the disability community and physicians. This government is committed to dealing with mental health and illness. My colleague from the Conservative Party told a very moving story earlier about a particular woman who was contemplating suicide. Giving people options when they are depressed or disabled that let them know there are other options for them, that there is a better life available to them, is inherent to this bill.

The minister is going to look at this aspect and consult broadly with the disability community once again as he is looking at the legislative parts of the bill and the regulations. This is really important. Remember, if we single out mental illness and disability as a sole diagnosis, we may be contravening section 15 of the charter. It assumes that, because someone has a mental illness or is disabled, they do not have the right to make a decision regarding their own life and pain and suffering, whether it be mental or not. The idea that this issue will be addressed in work with the provinces, health care providers and the disability community is really important. The safeguards will be worked out. I will be really clearly involved in making sure they are worked out so they can be put into place to protect mentally ill people and people who are disabled.

I want to quote Justice Baudouin in the Truchon decision: “The vulnerability of a person requesting medical assistance in dying must be assessed exclusively on a case-by-case basis, according to the characteristics of the person and not based on a reference group of so-called ‘vulnerable persons’.” Justice Baudouin also added that the patient’s ability to understand and consent should ultimately be the deciding factor with a physician, along with looking at all of the legal criteria.

Those safeguards must be in place, but we should not assume we can make decisions for people who, because of mental illness and disability, may wish to get medical assistance in dying. Intractable pain and suffering is not merely physical; it can also be mental. With the help of good psychiatrists and good support systems, we will be able to put those safeguards in place.

This bill has come a long way in rectifying many concerns that some medical practitioners have raised. It is important that it respects the right of a medical practitioner or a health care provider to use their own ethics and religion to decide whether they wish to perform medical assistance in dying or not. I am—

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

Questions and comments, the hon. member for Oshawa.

[Colin Carrie, Conservative, Oshawa, ON]

Madam Speaker, I thank my colleague for sharing her experiences. I have a lot of respect for her and her experience as a physician. I have sat at committee with her over the years.

I remember that when we debated the original bill, I talked to a physician in Oshawa. Her name is Dr. Gillian Gilchrist. She is very well-known in the field of palliative care, and she opened the first palliative care clinic in Oshawa, in 1981. Originally, she said that she was very much against this bill because in her experience over the years, she had never had one patient ask her for an assisted death. Not one needed it if they were controlled properly with proper medication and palliative care.

Although we passed a private members' bill from the member for Sarnia—Lambton requesting that the government come up with a national strategy for palliative care, in Canada today, about 70% of people cannot get proper palliative care. I wonder if my colleague supports a more vigorous strategy for Canadians. As 70% of people are not getting proper palliative care, does the lack of care factor into their decision to choose an assisted death? Perhaps they would not choose it if they had proper palliative care.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Madam Speaker, that is a very thoughtful question. One thing we must understand is that palliative care is for people who are terminally ill and whose death is foreseeable. They know they are going to die from a terminal disease. However, this bill is also about the Carter decision by the Supreme Court. It is for people who are not in danger of dying but who are suffering intractable pain from an incurable disease. Let us not mix up those two things.

For people who are dying and are terminally ill, absolutely palliative care is at the heart of this. People need to know that they do not have to be in absolute pain and suffering and that they can die with dignity. I support palliative care completely and totally, and I think this bill speaks to the idea that people can die in palliative care in their home and in some of those areas—

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

Questions and comments, the hon. member for Skeena—Bulkley Valley.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Madam Speaker, my question concerns the second track: people whose natural death is not reasonably foreseeable. The bill, as it is presented, requires that one of the two medical professionals conducting the assessment have specific expertise in the condition that a person is suffering from. In rural areas, such as the region I represent, there are many rural communities that lack certain medical specialties.

Does the member feel that this particular safeguard creates an inequity between urban and rural parts of the country?

[Hedy Fry, Liberal, Vancouver Centre, BC]

Madam Speaker, many medical practitioners are concerned about the inequity of access in rural communities and isolated communities. However, we now have telemedicine and the ability to reach out to get an opinion from a person who has expertise in the condition. That can go on for a period of time so that a patient can have access to the kinds of decisions that can be made with telemedicine. People living in rural areas can have access to tertiary care in big cities, for instance, where they have university hospitals, etc.

I think the bill is saying that we must have that happen and that it can happen. I hope we continue to expand telemedicine and that kind of equitable access for people who live in parts of Canada where they cannot get access as readily as those of us who live in cities.

[Martin Shields, Conservative, Bow River, AB]

Madam Speaker, I appreciate the expertise that my hon. colleague brings to this issue as a doctor. When my elderly father was facing surgery, we had in place and discussed with a surgeon a do-not-resuscitate order. My father was very angry after the surgery because they resuscitated him, but as the doctor pointed out, he signed an oath and found it very difficult to deal with this issue.

In the member's opinion as a doctor, how are we going to deal with this? By the way, lack of rural broadband is a problem for telehealth.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Madam Speaker, that is a very important question. Here is why an advance directive is important. If the father would have had an advance directive written with his physician as a doctor-patient written directive, then no one would be able to overturn it. However, this physician obviously felt he knew better and overruled the patient's desire to die with dignity. He felt he knew better than what the patient wanted. I do not accept that as reasonable at all.

[Mario Simard, Bloc, Jonquière, QC]

Madam Speaker, medical assistance in dying is a sensitive issue that needs to be discussed calmly. It is a difficult subject, let's face it. It is especially difficult because, like all matters dealing with human dignity, any answers we might offer are a reflection of our own values, our beliefs, our way of defining what we see as right and wrong.

That is precisely where the potential pitfalls lie for us parliamentarians as we grapple with moral issues like medical assistance in dying, abortion and same-sex marriage. Relying solely on our own values in the legislative process is tantamount to subjecting the freedom of others to the dictates of our individual consciences. In this case, medical assistance in dying raises the kind of impossible questions that political thought has been considering since the dawn of the modern era. This issue compels us to seek a delicate balance between power, knowledge and freedom.

Everyone knows that, as parliamentarians, we have been given a certain power by our constituents. This legislative power means we have the ability to restrict the rights of our peers through legal prohibitions, directly affecting their freedom. However, it does not necessarily follow that we have all the knowledge to apply that power in a fair manner. To avoid any abuse, we must be humble enough to acknowledge that we are not experts in everything, even though we have to speak to everything.

Max Weber, the father of modern sociology, may provide valuable support to the legislator who is concerned about using their power properly. In his essay “Politics as a Vocation”, Weber says this about the career of politics:

Well, first of all the career of politics grants a feeling of power. The knowledge of influencing men, of participating in power over them, and above all, the feeling of holding in one's hands a nerve fiber of historically important events....

Weber then asks a very perceptive question that applies remarkably well to the debate on medical assistance in dying. He says, “What kind of man must one be if he is to be allowed to put his hand on the wheel of history?” Putting one's hand on the wheel of history evokes the idea that a legislator can change the course of society, as happened with same-sex marriage and abortion.

How does one go about changing the course of society? Weber says that, first, we must determine what qualities a legislator must have to enable them to do justice to the power they exercise and to the responsibility that power imposes upon them. Weber states that there are two pre-eminent qualities for a politician: passion and a feeling of responsibility.

He means passion in the sense of matter-of-factness, of passionate devotion to a cause. For me and my political party, that cause is Quebec's independence. For the Conservatives, who knows. Perhaps it is balancing the budget or some form of social conservativism. For the Liberals, it is multiculturalism and conflicts of interest. Just kidding.

Weber cautions us. “[M]ere passion, however genuinely felt, is not enough...passion as devotion to a 'cause' also makes responsibility to this cause the guiding star of action.” This passion must to some extent be controlled by a form of responsibility.

Weber warns us because he believes that the legislator must be a man of reason. According to Weber, the lack of distance from our passion is one of the deadly sins of legislators. In the context of the bill on medical assistance in dying, this distance means that we cannot let certain interest groups or certain religious groups guide our discussions because we feel that they may withdraw their support for us. In short, Weber tells us that political favouritism disregards distance and this leads us to political incapacity.

Therefore, on the issue of medical assistance in dying, we must adopt this attitude of “distance” in the strongest sense of the word. This distance implies that, on a matter of human dignity, partisan and ideological considerations must take a back seat.

The topic of medical assistance in dying forces us to deal with the complex relationship between ethics and politics. According to Weber, ethics must not be used as justification. He believes that contorting ethics in an attempt to justify one's behaviour is wrong, which brings us to the struggle between two well-known positions: the ethics of responsibility and the ethics of conviction.

The ethics of conviction often manifests in religious beliefs, in being dogmatic about ideologies. This type of ethics is meant to establish a definitive truth that must be protected at all costs in order to achieve one's objective.

Weber said, “If the consequences of an action that flow from pure conviction are evil, then for him the responsibility lies not with the actor but with the world, the stupidity of other people, or the will of God”. He continues, “He who seeks the salvation of the soul, of his own and of others, should not seek it along the avenue of politics”, which seeks to solve quite different tasks.

The ethics of responsibility has us look at the potential consequences of our actions. It forces us to use our legislative power responsibly and to look beyond our allegiances and personal beliefs. We are meant to be conscious of our collective duty and to accept that the greater good comes before personal interests.

I would like to comment briefly on the ethics of responsibility, which is something Quebec is familiar with, from the Select Committee on Dying with Dignity. The members of the commission were mandated by the Quebec National Assembly to hold a rather unique public consultation process, in which the members travelled across Quebec to meet with experts and Quebeckers.

The Parti Québécois's Véronique Hivon took the lead on this file. She handled the process transparently and tackled difficult issues in the realms of medicine, law, philosophy, ethics, sociology and psychology. The committee's work resulted in the passage of the Act Respecting End-of-Life Care, which came into force on December 10, 2015, in Quebec.

I see a striking contrast between Quebec's approach, characterized by the ethics of responsibility, and the federal government's approach. At the time it was passed, the Quebec law went as far as it could without running afoul of the federal legislative framework. Quebec was proactive in engaging in this social debate, whereas the federal government has, so far anyway, simply been reacting to court rulings. This is the old “government of judges”. Governments would rather refer thorny issues to the courts than take a stand. Maybe they are trying to protect their beliefs or avoid offending certain religious groups. Still, parliamentarians have a job to do.

I will now come back to Carter, in which the Supreme Court overturned the Rodriguez decision in order to give greater weight to respect for integrity of the person and the individual's decision-making authority. This opened the door to medical assistance in dying.

Previously, when religious values were more prominent, this situation would have been impossible. In this case, the Supreme Court served as a driver of social progress, but we cannot always turn to the Supreme Court. This raises the following question: Is it normal for elected officials to lag behind on social change and leave it up to the courts to bring legislation in line with the reality of citizens? This is not the first time that members of the House of Commons have turned to the judiciary to avoid making tough decisions so as not to offend anyone. Take, for example, same-sex marriage.

The truth is that these social issues must be discussed in the House with compassion. Bill C-7 responds to a decision of the Quebec Superior Court, which ruled in favour of Ms. Gladu and Mr. Truchon, both suffering from serious degenerative diseases. They claimed that the reasonably foreseeable natural death criterion was too restrictive in both legislative regimes, the federal and the provincial.

We are all driven by our personal convictions, but our thinking must transcend those beliefs. We have a duty to act with empathy. People suffering from incurable degenerative diseases should not have to go to court to fight the terms and conditions of the administration of medical assistance in dying.

In my view, Bill C-7 will undoubtedly make medical assistance in dying more accessible. We should be relieved that the bill specifically excludes individuals suffering solely from a mental illness from eligibility for medical assistance in dying. I think everyone agrees that this aspect requires further reflection, study and consultation. However, as legislators, we do need to address the issue of advance consent. Many people who reach end of life risk losing their capacity to consent. We therefore need to find a way to respect their choice, too.

At the end of the day, it is fair to say that our reflections on a framework for medical assistance in dying relate to the fundamental freedom of individuals to determine their own condition. Our reflections must be guided by compassion.

I know some people have expressed strong reservations about medical assistance in dying. I can only hope that such personal beliefs will not be imposed on those already suffering.

Lastly, I hope the House will follow Quebec's lead and approach this issue with openness and empathy, rising above partisan lines.

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

Mr. Speaker, I want to congratulate the member opposite on his speech and his one-year anniversary as a member of Parliament.

I want to address a point related to a question that the Conservative Party has asked several times. According to the Conservatives, we were negligent for not appealing the Truchon decision by the Superior Court of Quebec and seeking the opinion of the Supreme Court of Canada.

My question for the hon. member for Jonquière is the following. When we have a well articulated, well documented, carefully analyzed ruling, is it better to act immediately to protect the vulnerable and their dignity or is it better to carry on by appealing the ruling all the way to the Supreme Court, leaving these people to wait for their rights to be protected?

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, frankly, it seems to me that appeals brought before the Supreme Court are often used as an excuse to shirk our duty as legislators.

I know that when it comes to issues that touch on individuals' moral values, debate can be a bit trickier, but we must have the courage to take a stand. That is our role as legislators. We cannot just turn to the courts every time the going gets tough. Unfortunately, that often happens. I hope that will not be the case in the debate we are having right now.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, I am a little confused. The member spoke about Weber and being detached. He mentioned not allowing personal beliefs and things such as religion to influence decisions that we make here in this House.

On the one hand, I understand what the member is saying in the sense that we do need to keep the values and opinions of all of our constituents and all Canadians at the forefront. However, at the same time, each of us have our own beliefs and our own opinions.

I have a question for the member. Does he think it is possible that having 338 individuals, all with different beliefs and opinions, coming together to make decisions is a way to actually improve legislation, rather than being more robotic and not allowing personal beliefs into the process?

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I really do not think that Max Weber was implying that we are robots and that we must act like robots.

When Weber speaks of distance, he means that I cannot apply my values when dealing with an issue that affects the fundamental rights of others. If I were to do so, I would limit the freedoms of those individuals on the basis of my own values. That is what Weber meant.

In the context of the “dying with dignity” bill, I cannot use my religious beliefs to justify limiting the freedom of individuals who can access medical assistance in dying because they have a deteriorating health condition, because one day they will no longer be capable of giving their consent.

I cannot curtail their freedoms based on my moral principles. I believe that this should guide us in our debate. This does not mean that we leave our values behind, but that certain principles must lead us to greater fairness and greater equality.

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, this is absolutely a very important issue for many Canadians.

When the House of Commons debated Bill C-14, I, too, along with my NDP colleagues, voted against that bill because there were many flaws within it. From there, many constituents wrote to me with heartbreaking stories. In fact, one constituent talked about how his mother had to end her life early because she was very worried that if she waited she might lose the faculty to provide informed consent. Those are the kinds of stories that absolutely move us.

To that end, with respect to advance requests as stipulated in the bill before us today, I wonder what the member's thoughts are. Does the member support advance requests?

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I think that advance requests are essential for people with degenerative diseases. We need to balance our personal beliefs with scientific facts. The medical sector is providing guidance.

Numerous reports have been submitted to the Select Committee on Dying with Dignity at the Quebec National Assembly. There is a whole process to manage medical assistance in dying. The decision-making process is very complex, so this is not done in isolation. I think that a person must be able to give consent to an action when they are fully aware. Not allowing this would infringe of some individuals' freedoms.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Mr. Speaker, I appreciate the opportunity to speak to Bill C-7, a very important bill that proposes to amend the Criminal Code provisions on medical assistance in dying, MAID.

It took me a long while to decide that I was going to speak to this bill. In fact, when I first learned that we would be debating this legislation this month, I decided I was not going to speak to it at all because I do not do very well with these topics. I have a very difficult time accepting that life eventually comes to an end, especially the life of those closest to me. In fact, I can come to terms and accept that my own life will end at some point, but I cannot deal with the thought of losing those closest to me.

Some of my colleagues' speeches earlier this week brought me to tears. When someone has strong feelings about a given topic, it generally means that they have something to say about it and that the topic should be discussed.

Canadians must know that, if they are eligible, they have been able to access MAID since June 2016. To be eligible for MAID right now, the person must meet all of the following criteria: They must be at least 18 years of age, be mentally competent, have a grievous and irremediable medical condition, make a voluntary request for medical assistance in dying that is not the result of outside pressure or influence, and give informed consent to receive medical assistance in dying.

Furthermore, in order to be considered as having a grievous and irremediable medical condition, those seeking MAID must meet all of the following criteria: have a serious illness, disease or disability; be in an advanced state of decline that cannot be reversed; experience unbearable physical or mental suffering from the illness or state of decline that cannot be relieved under conditions that the person considers acceptable; and, lastly, be at a point where natural death has become reasonably foreseeable.

Bill C-7 proposes to repeal the MAID eligibility criteria by modifying the criteria that must be met to be considered to have a grievous and irremediable medical condition so that it includes persons whose natural death is not reasonably foreseeable.

Furthermore, the bill proposes to specify that those whose sole underlying medical condition is a mental illness are not eligible for MAID.

Last, it proposes to create two sets of safeguards that must be respected before MAID is provided. The first set of safeguards would apply to persons whose natural death is reasonably foreseeable and these would be the existing safeguards that have been in effect since 2016. The second set of safeguards would be for persons whose natural death is not reasonably foreseeable. These would include existing safeguards as well as additional ones that would apply.

In the interest of time, I will not address all of the safeguards that have been put in place. Rather, I will just focus on those that have been added recently.

A person whose death is not reasonably foreseeable must talk to a doctor about the options available to them to ease their suffering. The two parties must agree that they seriously examined all the possible options, including palliative care and mental health support, before making a decision to apply for medical assistance in dying.

Two independent doctors or nurse practitioners must provide an assessment and confirm that all the eligibility criteria have been met. This eligibility assessment period must take at least 90 days, unless the person is at risk of losing their mental capacity before that time is up. In such cases, the assessment must be a priority and completed before that deadline.

Bill C-7 seeks to respect the personal autonomy and freedom of choice for those seeking access to MAID while, at the same time, protecting vulnerable people and the equality rights of all Canadians. It aims to reduce unnecessary suffering. This issue is a deeply personal one. In fact, we saw from consultations held earlier this year that there was a wide array of opinions and feedback received. Many people were opposed to the idea of MAID altogether, while many others believed the safeguards were too restrictive and made it difficult for some people to receive MAID.

This is a profoundly personal matter for all those involved. I do not think that it is for anyone who has never faced death or end-of-life suffering to judge or determine whether this should be a right and for whom it should be a right. We all have a certain pain threshold, but it is not the same for everyone. We are talking about excruciating physical pain. Who then is in a position to say to what extent such pain can be tolerated?

MAID legislation was passed in 2016 with the intention of ending suffering for those facing death, those who do not have a chance to improve their medical condition. It was passed because the MPs in this chamber thought it would be the right thing to do: to give people the choice to receive MAID if they felt they needed it. Nobody is forced to go down that path, it is a choice, but legislators basically deemed it the right thing to do and the humanitarian thing to do to allow someone in that situation to receive medical assistance in dying.

If this was the humanitarian thing to do for people whose death is reasonably foreseeable, then it only makes sense that those suffering from an illness and experiencing unbearable pain whose death is not reasonably foreseeable and may be five or 10 years away should also be granted those rights. They should also have access to MAID if they have exhausted all other options and have decided with their medical practitioner that this is the way to go.

Again, it is extremely important that we remember this is a choice of the person who is suffering. However, it is also critical to give those in a position to provide medical assistance in dying, such as physicians and nurse practitioners, the choice to refer their patients to someone who is willing to administer MAID if they themselves are not. If administering MAID does not coincide with their values or religious beliefs, it must not be expected of them.

With that being said, it is important for everyone to respect the religious beliefs and values of all Canadians. As such, I completely understand that some may perceive the act of receiving medical assistance in dying as committing a sin. They have the right to die of natural causes if that is their will. In my own religion, this would technically be problematic for me. However, I feel comfortable knowing that if it ever comes to a point where I am in a situation where I am suffering, I have no chance of recovery and I am only going to get worse with time, I will at least have the choice.

One of my colleagues across the aisle in his speech earlier today spoke about an amazing comeback story of someone who was in a terrible situation, but who was on the road to recovery. My colleague was grateful that this person stuck it through and fought to survive. It is important to remember that those who will be eligible to receive MAID will have been assessed by two medical practitioners and both will have determined that the person's medical condition would never improve. If there is a chance for recovery, the person would not be eligible for MAID in the first place.

I understand that not everybody in the House will vote on this bill in the same way and I fully respect everyone's personal choice on this matter, because, once again, it is an extremely personal issue. All members are trying their best to represent their ridings and constituents in the best way they know how. I will be voting in favour of this bill because I do not believe it is my place to get in the way of someone receiving the kind of relief that MAID offers.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Mr. Speaker, this bill goes well beyond the scope of Truchon and in so doing, it removes a number of safeguards, including safeguards in which there was a fair bit of consensus some four years ago. I say that having served as the vice-chair of the Special Committee Joint Committee on Physician-Assisted Dying.

One of those safeguards is the requirement that there be two witnesses. That was not controversial four years ago and yet, in this bill, it is removed. In that regard, it provides a lesser safeguard for medical assistance in dying than validating that of a will, which requires two witnesses. Can my colleague explain the removal of the safeguard?

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Mr. Speaker, as we saw in a lot of the feedback received during consultations, many people did think that a lot of the safeguards were preventing many people from receiving the right to receive MAID in their final moments or in times when they did not see a recovery and they saw their condition getting worse with time. Not everybody has a family, not everybody has a lot of people in their close circle. Obviously, I believe in protecting Canadians, but at the same time in making sure that everybody has equal access to rights. This obviously gives more accessibility to more people.

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, Bill C-7 sets the assessment period at 90 days for those whose natural death is not reasonably foreseeable, but are facing intolerable suffering. Does the member agree with the 90-day assessment and does she know how the government came up with the 90-day period?

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Mr. Speaker, I personally do not know how that number came up, however, I know that if someone's mental capacity is at the risk of being lost in that 90-day period, it will not take 90 days. However, I would imagine that, for somebody who does have many more years ahead of them and does not have a reasonably foreseeable death, perhaps more reflection needs to be done before actually going through with this kind of thing. I do agree with the 90 days. I think that people need to have enough time to really think about this issue and whether this is the route they want to take and to really consider all other options available before finally going with this one.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, when the government is talking about things like intolerable pain or unbearable pain, I think we can all agree that for some people it is a very fluid, subjective statement. Therefore, if we are basing it on subjectivity, what can be intolerable pain for one person could be a case of depression for someone else. Is the government not really admitting that it is opening the door in the future for people to get an assisted death for any and every reason because the criteria it is setting are just so subjective for people?

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Mr. Speaker, the bill also proposes to ensure that mental illness is not a reason to go ahead with MAID and that people who suffer solely from a mental illness will not be eligible for MAID. That has been taken into account. I still agree that this is something that people should have the choice to decide for themselves.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Mr. Speaker, today I am pleased to speak to Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying, which I will refer to as MAID throughout the course of my speech.

This can be a difficult issue for many to address because it intersects several issues in society. First of all, there are taboos, and societal norms associated with those taboos, around discussing dying, religious beliefs, social supports, or the lack thereof, related to people who are in difficult or life-threatening situations, love and compassion for one another, and the agency that each of us has to direct our future.

I would like to explain what this bill would do, what I am hearing from my constituents on this issue, my approach to addressing this legislation and my decision on how I will be proceeding on their behalf.

As has been mentioned in many speeches, this bill builds on previous legislation that allowed for legal, medically assisted dying in Canada. This bill would amend legislation to remove the “natural death has become foreseeable” clause, meaning that reasonably foreseeable death would not be a criterion for accessing MAID. Of course, this comes after a decision in the Quebec Superior Court ruled that reasonably foreseeable provisions violated section 7 of Charter rights to life, liberty and security of the person. It eliminates MAID access to those who only have mental illness as an underlying condition. My understanding is that the Minister of Justice said this would be addressed in the parliamentary review of this legislation.

It would also create a second set of safeguards for people accessing MAID without a reasonably foreseeable death clause including that, for both those whose deaths are foreseeable and those whose are not, this bill would change the Criminal Code so that only one witness is needed to sign the MAID request, rather than the two currently needed. It would eliminate the 10-day waiting period for MAID and its administration for those with foreseeable deaths. For those without foreseeable deaths, Bill C-7 would create a 90-day waiting period request. There is a bit more technicality. It builds on legislation that has already been passed in this place.

I want to outline some of the things I have been hearing from my constituents on both sides of this issue. The response in my office has been pretty evenly split between people advocating for these changes and against them.

Those in support of this bill have been writing to my office on the need to exercise personal autonomy, which would be the agency issue that I mentioned. The constitutional right to make choices about end-of-life access to medicine and health care should be part of a health care option that is available to Canadians. There is a need to ensure that, in our country, we have the ability to die with dignity: to look at death as part of the life process, and to ensure that the continuum of care involves a death with dignity. Also, there is a need to normalize and end the stigma surrounding death, and to respect individuals' and families' desire to end unbearable suffering.

Those who have issues with this bill have mentioned consent by minors and those who have mental illnesses, and what the nature of consent is in those situations. There are concerns that it is not clearly defined. There are concerns about how this legislation would impact the nature of consent in jurisprudence, as well as religious concerns around life, and doctors' conscience rights. There are concerns around repealing the 10-day waiting period and also allowing medical professionals to shorten the 90-day waiting period if the capacity to consent would be lost. I have heard those concerns.

This is my approach to addressing this legislation. As a legislator, it is my duty to ensure that individuals have the ability to use their agency in their choice on medical decisions, regardless of my personal proclivities. I will be supporting this bill through to the committee stage. I understand that there may be amendments proposed.

At the same time, some of the concerns that constituents have raised in my community against this bill are valid. From my perspective, some concerns that I have are whether we have proper supports in place for people who might be considering MAID in a not-foreseeable-death situation. I am talking about social supports for those who are in situations of great disability: Do we have social supports for day-to-day living? What about poverty? Is it a determinant of mental health?

With respect to palliative care, I do not think our country has yet addressed that issue adequately. I would like to see complementary legislation on that issue so we can be assured as a society that, in proceeding with this legislation, people are in the position of exercising their agency: They are not making a decision based on desperation or on our failure as a society to provide them with adequate social supports.

Another question I would like to see the committee address is this. When a person has lost the capacity to give consent, who will decide what is intolerable suffering? We need to suss that out. There needs to be some path to that. Parliament needs to give some direction to that so it is not simply left to the courts in the future. I think Parliament has a role in this because, as I am bringing the concerns of my constituents, both for and against, this is the place to give direction to the courts on any future decisions, and I would like to see the committee address some of those issues.

Another concern is for those struggling with mental health issues, such as depression, when death is not reasonably foreseeable. How will this legislation impact them?

With respect to mature minors, determining their capacity to decide and voluntary choice, free from duress, are concerns that have been raised. I also have those concerns.

I want to re-emphasize that I do not feel many Canadians have appropriate access to palliative care across the country. This is not the fault of any medical association, but I feel as a society we often spend a lot of time focusing on getting to a diagnosis. We have spent a lot of time in this place talking about dying with dignity, but we do not talk about how to live with dignity, and the choice of a person to see their life through to its natural end. If we are talking about choice and agency, somebody who makes the choice to see their life through without medically assisted dying should have the right and capacity to make that choice knowing that we, as a society, are caring for them. We are not just offering this as an alternative: that the only way to end suffering is to provide this as an option.

I give this nuanced answer because my own views on this have changed over the course of my term as a legislator with two very personal experiences. One experience was with both of my grandmothers, whose lives ended naturally. They both suffered from severe dementia. I do not think either of them would have chosen to have medically assisted dying because of their religious beliefs, but that option was not available to them, so I take that into consideration.

I am also living a situation right now, and she allowed me to share this, where earlier this year my mother-in-law, Debbie Garner, was diagnosed with a severe form of aggressive breast cancer. She has been fighting so hard and I feel so robbed because I just met this incredible woman a few years ago. She is fighting and giving it her all, but she lives in a jurisdiction where she does not have this option available to her. As part of her fight, she does not have the ability to exercise her agency in the way we are talking about, so this is now adding stress on her. She is doing everything she can to try and beat this disease, but the reality is there is a 50% chance, and probably greater with the form of cancer she has, that this will spread to her brain and leave her in a state I know she does not want to be in as a person. As a family member, I want to ensure that people in the position of my grandmother, who I know would have chosen to see her life through her way, have their wishes respected as do people in my mother-in-law's situation, who is saying she does not have the ability to exercise that choice, so she could use that agency as appropriately as possible.

That is my approach to this legislation. I would like to see this go forward to committee. I would like to see our society ensure that people have agency in both situations: that they are fully supported through the choice to see their life to its natural end, or are fully supported in a choice to end it with dignity and in a way that recognizes their own beliefs, their own agency and their own right to determination in these matters.

I thank the House for its time and I am happy to answer questions.

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

Mr. Speaker, I thank the member for Calgary Nose Hill for her analysis and for her very pointed and personal remarks today.

I am going to put a question to her that has been raised by some of her Conservative colleagues and was, in fact, raised in her speech.

When the member canvassed some of the pros and cons and related what she was hearing from constituents, she mentioned conscience rights. I find that criticism a little confusing, and am trying to understand it, because conscience rights are protected in the preamble of the old Bill C-14, in the text of Bill C-14, in section 2 of the Canadian Charter and even in the Carter decision, which is what got us all here. The Carter decision states, in paragraph 132, that, “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

I am wondering if the member for Calgary Nose Hill could flesh out what she understands to be the conscience rights concerns, because I believe that they are fully protected in the jurisprudence and in the statute.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Mr. Speaker, the member is correct in acknowledging that I raised that concern as something that is coming up in my constituency. I would argue that, because this is a common concern coming up in constituency offices across the country, the government has probably not explained this well enough to Canadians. I think that could be done with the parliamentary review on the previous bill in the previous Parliament, which should be happening. I find it unfortunate that the review could not have happened before this particular bill came forward.

With regard to my personal opinion on the issue of conscience, I do not believe that any Canadian should be denied the right to care at any point in time based on gender, sexuality, gender identity or in choice of agency in this situation.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I thank my colleague for her nuanced speech. I would also like to say how sorry I am about her mother-in-law's painful situation.

My colleague gave two examples. She spoke about her grandmother and her mother-in-law, and she mentioned the choice to see life through. I feel that goes without saying. I would like some clarification from her, because medical assistance in dying only occurs upon request. If the request is not made, it is understood that the right to live prevails.

I would like some clarification about what she presented as the right to live.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Mr. Speaker, there are stakeholder groups that represent Canadians with disabilities who are concerned that this legislation could diminish the value of the lives of people who live with severe disabilities. I believe that, in certain situations, social supports should be available to people living in those situations so that there is never any question that somebody is making a choice to end their life because of a lack of resources to live with dignity.

We spend a lot of time here talking about dying with dignity, but we also have to talk about living with dignity in a complementary way. I am talking about access to affordable housing for those living in poverty, especially for those who have disabilities who may not have the same access to opportunities for employment or success, and access to home care. These are all things that I believe people need to have in place in order to be in a position of empowerment when making the choice of how to proceed with either end of life or living with a severe disability.

I also think that in this place, as we are debating this issue, we need to reaffirm over and over again that those who have disabilities in Canada are equal in every way, and that we have a dual responsibility to ensure that they are supported and—

[The Deputy Speaker, Bruce Stanton]

We have time for one more question.

The hon. member for Windsor West.

[Brian Masse, NDP, Windsor West, ON]

Mr. Speaker, I thank the member for Calgary Nose Hill for her intervention.

I am pleased that the member is supporting the bill to get to committee. Where does she think that could be an advantage to resolve some of these complex problems?

As a PSW, I can tell the member that a person's quality of care can often be affected by their income. What does the member think about that?

What should the Canada Health Act do regarding that? A person's income can affect how many service hours they get as an individual, which affects quality of life and the decisions they make beyond that.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Mr. Speaker, my colleague, as always, makes an excellent point. This is exactly what I am getting at.

As we are considering this bill, we should also be considering reviewing situations such as the member just raised: national legislation and a framework around palliative care, home care, etc. I believe that all these issues influence someone's decision on how to proceed. For people who are living in poverty, with no hope of employment, in isolation and without access to home care, their sense of suffering might be different than if those supports were in place.

The bottom line is that we have to act to give people agency to end their lives with dignity, but we also have to act to give people agency to live their lives with dignity. I hope the committee study, as well as the parliamentary review of the previous legislation, would aim to resolve that.

[Élisabeth Brière, Liberal, Parliamentary Secretary to the Minister of Economic Development and Official Languages (Economic Development Agency of Canada for the Regions of Quebec)]

Mr. Speaker, I am very happy to have an opportunity this evening to share my thoughts on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

This bill has generated a lot of debate. It is good to talk about this because it is extremely important. It is important because too many sick people are suffering, knowing they will never get well.

I worked with such people for a long time, and I can say that knowing them, learning about their struggles, and helping them through their ordeal fosters a much better understanding. It goes without saying that medical assistance in dying is a matter of societal choices, choices that must be carefully considered from all angles.

I strongly believe that the government did its homework before introducing Bill C-7, which is the outcome of a series of round tables with experts and stakeholders, as well as a number of public consultations. We had to go through this process after the Quebec Superior Court's decision in Truchon and Gladu, which found that limiting medical assistance in dying to persons whose death was reasonably foreseeable was unconstitutional.

Ms. Gladu and the late Mr. Truchon both suffered from incurable degenerative diseases but were not eligible for medical assistance in dying because their deaths were neither imminent nor reasonably foreseeable.

The government's Bill C-7 proposes significant changes. It broadens the eligibility criteria to include people whose natural death is not reasonably foreseeable, as was the case for Mr. Truchon and Ms. Gladu. It also adjusts certain safeguards, allowing patients to waive final consent, for example. These are significant changes.

Let us first consider the reasonably foreseeable death criterion. A number of MPs are concerned about removing this criterion because they believe it would make it too easy to access medical assistance in dying. There is also some concern that people with disabilities or mental illness will not be properly protected. Life is precious and has so much to offer. I believe in that, and the government believes in it, too.

Under the provisions of this bill, mental illness is not considered to be an illness, disease or disability. The bill also expressly excludes people seeking medical assistance in dying solely because of mental illness. The government knows that the best treatment for mental illness is effective therapy, so greater emphasis needs to be placed on enhancing preventive measures and support resources.

What exactly is a reasonably foreseeable death, anyway? It is an assessment of the amount of time between a person's current state of health and their death. It is not something that can be measured with a blood test or a thermometer. It requires a clinical judgment based on an exhaustive medical evaluation of the patient. The fact remains that it is a difficult and sometimes imprecise exercise, and that is why the amendment is necessary.

Expanding patients' right to request medical assistance in dying does not necessarily mean it will be administered. Requesting medical assistance in dying does not automatically mean it will be administered. Even if the legislation is changed by removing a criterion, the spirit in which it will be applied does not change.

Requests will be evaluated based on the other criteria in the legislation and the new safeguards that I will get to shortly.

The government's priority is to strike a balance between the autonomy of eligible persons, the protection of vulnerable persons from being induced to end their life, and the important public health issue of suicide.

We care about compassion and dignity for both the patients and the process. In fact, that is why, in the first version of the legislation, the government included safeguards that would support decision-making, reflect the finality of the act, provide robust procedural guarantees to prevent errors and abuse, and protect vulnerable people.

Nevertheless, experience has exposed some gaps, and that is why we are proposing that two of these measures be amended.

The first change is to eliminate the 10-day waiting period between the date the request is signed and the date on which medical assistance in dying is provided, for individuals whose death is reasonably foreseeable. This 10-day waiting period needlessly prolongs suffering. Patients who are worried about losing their cognitive abilities and no longer being able to provide final consent live in fear. They may even refuse to take their medication and sometimes choose to request medical assistance in dying earlier.

The patient's stress also extends to their loved ones, making those last moments more painful than they need to be. Being able to choose when to die allows patients to go with their head held high, bolstered by the presence of their loved ones. These patients show noticeable relief when they realize that no matter what happens, they will get medical assistance in dying, as requested.

Although reasonably foreseeable natural death is no longer an eligibility criterion, it will be used to help determine which safeguards will be applied to requests for medical assistance in dying.

For people whose death is not reasonably foreseeable, a period of at least 90 days will ensure that there is informed consent. The sources of suffering causing the patient to request medical assistance in dying must be verified. Furthermore, it must be verified that the decision is being made without any outside pressure or influence.

The assessment of the person's overall medical condition is even more rigorous. We may be withdrawing the criterion of reasonably foreseeable death, but that does not mean greater access to medical assistance in dying. The bill continues to ensure that there is proper protection for the process, our medical practitioners and, above all, our patients.

Having recently discussed the bill with palliative care specialists, I can confirm that the 10-day waiting period often negatively influences a patient's decision and that removing this provision will make their last moments more peaceful.

The second safeguard I want to discuss today is the waiver of final consent.

Under the current legislation, immediately before providing medical assistance in dying, the medical practitioner or nurse practitioner must ensure that the person gives express consent to receive medical assistance in dying and give the person an opportunity to withdraw their request. The government's amendment means that final consent can be waived if certain conditions are met, such as the loss of cognitive ability and the signature of a written agreement stating that medical assistance in dying will be administered on a specified date. This measure helps to ease patients' anxiety so they can take their medication, suffer less and set a later date.

It is important to note that this is not the same thing as an advance request, meaning a request for medical assistance in dying on an unspecified future date under particular circumstances. That type of request could be included in a notarized health care directive. Currently, a person can state in their health care directive whether they would want to undergo aggressive treatment and what that term means to them, but they cannot request medical assistance in dying in advance.

That is a more complex subject because, in such cases, a legal representative is being asked to make a decision on behalf of someone else. This issue will be examined by a parliamentary committee. The committee will also discuss other issues, such as medical assistance in dying for minors.

All these changes to the reasonably foreseeable death criterion and adjustments to the safeguards reflect the government's desire to keep doing better, to create a more dignified, freer and more progressive society. I therefore encourage all members to vote in favour of this bill.

I would like to conclude with a quote from the late Jean Truchon: “I ask you to try to understand me and not to judge me”.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Speaker, I would like to thank the parliamentary secretary for her speech.

She talks about proper choice, but also safeguards. I would suggest that having available palliative care as a safeguard does reflect a person's ability to make a choice.

During the original bill, I had the opportunity as well to consult with some of the top palliative care experts in Canada, some would say in the world. One is in my own riding. Her name is Dr. Gillian Gilchrist. She has been a palliative care expert since 1981. One of the things she mentioned to me was that, in all her years of practice, she had never had one patient ask for medical assistance in dying. She said that if people are given proper medication, especially with the newer medications today, they can be kept very comfortable until the very end of their lives.

We have heard a lot of arguments that we should be making this more available because of the pain involved. Does the member agree that proper palliative care being available is important for choice? With 70% of Canadians not having palliative care available, is it something the government should make a priority?

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Mr. Speaker, I thank the member for his comment. He makes a good point.

Palliative care is one aspect of end-of-life care. I would like to take a moment to acknowledge the vast expertise and excellent work of staff at palliative care homes, including homes in my riding, Sherbrooke.

It is true that palliative care is a good way for a person at the end of life to receive adequate care. Palliative care reduces suffering and guides people toward a natural death.

All lives have the same intrinsic value. That is a fundamental principle that we have to square with our societal values, including individual freedom of choice. Medical assistance in dying is part of a range of end-of-life care options that includes palliative care, and now medical assistance in dying.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I thank my colleague for her speech. I would like her to clarify something for me.

I do not know whether, like me, she noticed that since the beginning of the week some members have been making an unfortunate connection between palliative care and medical assistance in dying, conflating two completely different realities. Just because a person has access to medical assistance in dying does not mean that they do not have access to palliative care.

What is more, on many occasions, I also heard our Conservative colleagues establishing a connection between suicide and medical assistance in dying.

Does my colleague agree with me that these two very unfortunate connections are undermining the debate?

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Mr. Speaker, I agree with my colleague from Jonquière, and I want to congratulate him on his speech earlier this evening.

Indeed, that is a very important distinction, as I said in my previous answer. End-of-life care includes palliative care, and now we are adding medical assistance in dying.

As I said in my speech, I was close to the palliative care home in my riding. People do not go into a palliative care home seeking medical assistance in dying. When the palliative care facility in my riding was authorized to offer medical assistance in dying, it was clear that that was not intended to become the standard. So far, statistics show that this will is being respected.

People go into a palliative care home to receive palliative care. However, once suffering becomes intolerable and the normal protocols are no longer easing that suffering, medical assistance in dying is an option, an individual choice offered out of respect for freedom of choice.

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

Mr. Speaker, I am very honoured, as always, to rise in the House, particularly on such a profoundly important issue.

I am going to ask the Speaker's indulgence for a few minutes to speak about an issue that is occurring right now. I have learned that in Treaty No. 9 tonight families in Neskantaga First Nation are being evacuated because they have no access to water. For an Oji-Cree community in the middle of a pandemic to be willing to be flown out to an urban centre shows how severe the situation in Neskantaga is. I think every member in every party will understand the importance of bringing this forward.

One of the beautiful things we have said during the pandemic in Canada is that we are all in this together, but we are not, not in Canada. We have never all been together, not when it comes to the poverty, the casual degradation that indigenous people suffer and the systemic negligence of the most basic rights to life and dignity that Canadians take for granted as part of how this country is run. We cannot find a community that has suffered more than Neskantaga. For 25-plus years they have lived with unsafe water. That is a second generation growing up with improper water.

What does that mean? I remember meeting a beautiful young girl from Treaty No. 9. She had this incredible long, thick hair and she said she did not like to take a shower because it gave her blisters. That is what we put young people through in communities like Neskantaga. At age 13 or 14, they have to leave home because the federal government will not bother to give them a school. They have to go to a foreign culture in Thunder Bay. We know of the horrific treatment and abuse that indigenous children have suffered in Thunder Bay, the deaths of children in the rivers and the racist attacks, yet they have to leave their homes.

We are talking about something as profound as medical assistance in dying. However, when one has had to go to a hotel room in Thunder Bay to say sorry because a beautiful young girl from Neskantaga gave up hope at age 14, we could say this nation does a lot of work to assist in the dying and hopelessness. Tonight, in Neskantaga, after 25 years of not having water, where the schools cannot be opened because they cannot get water to the schools. They have had to shut the water system down. It is winter there and elders are going to the river and getting water in buckets.

Yes, this is Canada in 2020. Therefore, when I hear people say that we are all in this together, we could say it more clearly by saying we are all in this together, except when it comes to indigenous people, because they are at the back of the line again and again. I am not saying this from a partisan point of view. This was the primary program. Neskantaga was going to be fixed. We were told that by the Prime Minister. The previous prime minister put enormous amounts of money into water, yet the government continues to refuse to put in place the basic infrastructure that will support safe communities: the sewage lifts, the water pipes, the proper water treatment centres.

I am asking my colleagues tonight, in light of the crisis in Neskantaga and the risks people are taking by being flown out in the middle of a pandemic, to say we have to make the guarantee of access to clean water a fundamental human right. It has to be done, and it has to be done now. We cannot have any more nice words. We have all the beautiful words that come from the government, yet there are people who cannot even live in their own community because they do not have water. I am asking my colleagues to work with us to guarantee that the people in Neskantaga will be able to go home to safety, decency and water.

The issue of medical assistance in dying is an important conversation for us to have in the House. The last time we had this conversation, we were under the gun because it was a court decision that pushed the federal government to act. I had a number of concerns about the previous legislation. We knew it was not going to withstand a court challenge, yet the government went ahead with it. Now we have to come back and do it again. We need to work together because we have some fundamental principles that we have to protect in terms of how this moves forward.

I worked on a national palliative care strategy across the country before the last election. The one thing I have learned, and I saw this with my beautiful sister who died so young, is that the will to live is incredibly strong. People deal with an incredible amount of suffering, and they have the will to have family and have support. The right to die in dignity is a fundamental human right. Part of that is making sure we have a proper medical system in place to give people this support, so we have to have the provisions in place with this legislation.

Nobody's claim of dealing with someone who is dying is more precious than anyone else's. In our lives, it is the most intimate thing we can be involved in, and those deaths can actually be good deaths, deaths of dignity and of hope, where families are together. The day my sister died, as my mom said the rosary I sang Danny Boy for her because that is how we go out in our culture. It was terrible to see my sister go, but we came together and it was beautiful.

There are deaths that do not have dignity, and deaths of suffering. It is incumbent upon the House to make sure that the legislation in place meets a number of steps in the right to dignity, but also that it makes sure that people who are making this choice are not doing it because they feel they have been neglected or they are in a substandard seniors home, as we have seen with so many of our seniors in Quebec and Ontario who died in the pandemic. People must actually have dignity, and if they are in a home, there must be support for them so that they do not have to make that choice.

I will agree with my Conservative colleagues and all the people I have talked to in all the work I have done with palliative care, that if that choice has to be made, it is one that people do not want to make. People want to go out in a way that allows them as much time as possible. However, when that decision is made, as it is a right upheld in the courts, we have to make sure that the provisions are there to allow it to be done properly, to allow it to be done so that people are of a mind that they understand what they are doing and that they can do this in a way that meets the test of a caring society.

To that end, we have seen a staggering number of our elders die without dignity in this pandemic. It has exposed the fact that we do not put investments into care for our elders and they have suffered needlessly. That we had to send in the army to keep people from dying is a fundamental failing of our system for seniors and their health.

Of course, it is not just seniors who have to make this decision. My sister died much too young. Her husband died at 42, and he was one of the greatest people I have ever met. People die at different ages, and some of those deaths are very difficult.

I am very pleased to say that we will support the bill being sent to committee because it is at committee where we will hear witness testimony. We need to hear from the experts. We need to have a conversation and start to make sure that in the legislation, which we are compelled to bring forward because of the Quebec superior court decision, we meet the tests of the court and we meet the tests of dignity.

Again, I do not believe this needs to be a partisan issue, where a party is going to be on one side or the other. We have to put first the rights of the individual and their dignity, and the support for their family, because death should never be a lonely act. Death has to be part of family and community, and when it is, it can actually be a moment of real grace and learning.

The New Democrats are supporting the motion to send the bill to committee to be studied. We want to make sure that we get it right this time so that we do not have to change it for the next court decision.

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

Mr. Speaker, first, I appreciate the member's bringing to the attention of the House the situation in regard to the evacuation. I very much appreciate the sensitivity of the issue, as we move on to yet another very sensitive issue that has been debated for a number of days now. It is very much an emotional time when we have these types of debates.

When we first brought in legislation, and I am referring to the House in its entirety when I say that because the legislation came as a result of a Supreme Court decision, the general feeling back then was that there would be a need for us to come back and look at the legislation. What we are doing today is making changes to the original piece and there are a few changes. I wonder if the member would want to provide his thoughts on any of the specific changes, or any thoughts in regard to specific amendments that he would like to see.

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

Mr. Speaker, even though we are being ordered to because of the Superior Court of Quebec decision, it is important that we do revisit legislation. What we anticipated may not be the case out in the field.

In terms of the request for medical assistance in dying be done in writing and signed by an independent witness, the request can be made after the person is informed they have a grievous and irremediable medical condition, and a professional or health care worker can serve as that witness. That is interesting. I would like to have that tested with people in the field who can let us know whether that will meet the need of ensuring we have adequate safeguards.

The fact that the person must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health services and palliative care, is important. However, we have to be able to test that at committee. Is that a reality that people are going to have in rural areas? What about for people who do not have a larger family unit to support them? I am looking forward to seeing how these will be tested at committee.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, I thank the member for his commitment to standing up for his constituents, particularly his indigenous constituents.

When the government is reducing some of the safeguards regarding the number of witnesses needed and the kinds of witnesses needed, I become very concerned. If we are not including social workers in the decision-making process, how are we ensuring that those who are going through the process of requesting MAID are truly doing it in a way that is of their own volition? Physicians are not always equipped to recognize these situations.

What about increasing safeguards by bringing in social workers so we can ensure it is truly a free choice that people are making?

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

Mr. Speaker, one of the things that frustrated me with the Supreme Court decision was that I felt it put an unfair restriction on the review of Parliament. Because this was a profound piece of legislation, we needed the opportunity to have enough witnesses.

I do not believe this is something that should be dragged out, but as parliamentarians, we need to ensure we have an adequate number of witnesses to bring forward enough points of view that we can ensure the proper details are in this legislation. I do not know the details of what goes on in a medical relationship. I am not that person, but I have sat at the deathbed of many people. I want to make sure it is done right.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I commend my colleague on his speech. Since he went off topic to talk about access to drinking water in indigenous communities, I will do the same and ask him a question about that. I share his outrage. It is absolutely unacceptable that indigenous communities do not have access to drinking water.

That said, being outraged is good, but taking action is always better. In that sense, I wonder why my colleague, who criticizes the Liberal government's decisions, earlier today supported that same government that has done nothing about drinking water access in indigenous communities.

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

Mr. Speaker, the member went from profound to as cheap as one can get. We are talking about the dignity of people. I bet the member has never seen the kind of poverty we see. Am I going to plunge the nation into an election because the little guy in the front from the Bloc said he wanted an election last spring? No, I have better issues to deal with.

If that member cannot understand the profound issues facing people in Neskantaga, I would say that we can see what happened. I have not heard anything from that member in terms of the horrific death of a woman in a hospital in Quebec.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, I want to thank the hon. member for a very moving statement. I know it is difficult, and I am usually persnickety about saying that any member speaking should speak to the topic before us. The Neskantaga First Nation situation, in that they may be facing an evacuation because of a lack of clean drinking water, draws into sharp focus why we need Parliament to continue to work in this place.

I specifically want to thank the member for his shared concern for a dear mutual friend of ours. When we started debating Bill C-7 last spring during the last Parliament, Angela Rickman sent me texts and emails asking us to bring her relief. She was suffering from ALS and wanted to be able to use medical assistance in dying, and we failed her. I would like my hon. colleague to add whatever he chooses on the desperate need for us to continue to act in Parliament.

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

Mr. Speaker, my hon. colleague and I shared a friend in Angela Rickman. She was a very powerful and profound woman who worked on the Hill and died much too young. I am glad the hon. member thought of her tonight.

We have to think of the people we know who are suffering and make sure we do this in a manner that respects them and respects our obligations under the law.

[Carla Qualtrough, Liberal, Minister of Employment]

Mr. Speaker, it is really an honour to participate in this important debate on Bill C-7, alongside my colleagues, the Minister of Justice and Attorney General of Canada, and the Minister of Health.

By way of background, in 2015, the Supreme Court of Canada struck down the sections of the Criminal Code that made assisted suicide illegal. In 2016, the federal law in medical assistance in dying came into effect. This law created an end-of-life regime, which limited access to medical assistance in dying to individuals whose deaths were reasonably foreseeable. A number of specific eligibility criteria were put into place, along with procedural safeguards.

As we all know, in September of 2019, the Superior Court of Quebec found it unconstitutional to limit the availability of medical assistance in dying to people whose deaths are reasonably foreseeable. The federal government has once again been tasked with changing the law.

In early 2020, the Government of Canada held consultations across the country. There was also an online survey that received almost 300,000 responses. The feedback was thoughtful, compassionate and candid. From my perspective as the minister responsible for disability inclusion, I am working to ensure that the voices of persons with disabilities are heard on this important issue.

Medical assistance in dying is a human rights issue. The proposed legislation recognizes the equality rights of personal autonomy, and the inherent and equal value of every life. Disability rights advocates have long fought for these rights. Being able to make decisions about one's own life is fundamental. There are many examples in our history of where the personal autonomy and equality of our citizens with disabilities has been threatened, denied or taken away. I can assure my colleagues that these concerns are top of mind as we undertake this important legislative work.

The proposed legislation before us explicitly recognizes equality rights. The preamble refers to the Charter of Rights and Freedoms, as well as Canada's obligations as a signatory to the United Nations Convention on the Rights of Persons with Disabilities. The preamble also expressly differentiates between these fundamental equality rights and the various societal interests and values we need to balance with this legislation, such as the important public health issue of suicide. To put it another way, we wanted to be clear that ensuring equality rights underpins this legislation.

I will mention one more important aspect of the preamble that frames this proposed legislation, which is the importance of taking an approach to disability inclusion based in human rights. With these words, we are committing to using human rights principles to guide the development and implementation of our systems, programs and processes. This is important because the full realization of the rights we enshrine in law is predicated on having systems and structures in place that do not themselves create barriers, discriminate or infringe upon these rights.

I will digress here for a moment to take us back to June of 2019. That month, this House unanimously passed the Accessible Canada Act, which I believe to be the most significant advancement in disability rights since the Charter. Section 6 of the Accessible Canada Act sets out guiding principles, which include that everyone “must be treated with dignity”, everyone “must have meaningful options and be free to make their own choices,” and everyone “must have the same opportunity to make for themselves the lives that they are able and wish to have regardless of their disabilities”.

Another guiding principle states, “laws, policies, programs, services and structures must take into account the disabilities of persons, the different ways that persons interact with their environment and the multiple and intersecting forms of marginalization and discrimination faced by [individuals]”.

These principles must also guide us as we tackle the important task of responding to the 2019 Superior Court of Quebec decision. As this House has heard, Bill C-7 proposes a two-track approach to medical assistance in dying, with less or more stringent safeguards depending on whether a person's death is reasonably foreseeable.

The House has heard about the safeguards when death is reasonably foreseeable, and it is our hope that these will allow for dignified end-of-life decision-making. I will focus my attention on the new track where MAID is permitted even though the individual's death is not reasonably foreseeable. As I mentioned, in these situations there are heightened safeguards. These include the requirement that two independent doctors or nurse practitioners assess and confirm eligibility, with one of these having expertise in the individual's medical condition.

It is also required that the individual be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability services, community services and palliative care, and that the individual be offered consultations with professionals who provide these services. The individual and their medical practitioner must have discussed these measures and agree the individual has seriously considered them.

Finally, the eligibility assessment must take a minimum of 90 days, unless loss of capacity is imminent.

As we look to broaden access to MAID as directed by the court, we are very aware of the need for Canadians to know their options, to ensure their consent was informed and to have a real choice. I spoke earlier about equality rights and personal autonomy. I also spoke about taking a human rights-based approach to disability inclusion, having meaningful options and having the opportunity to make a good life for oneself. If our systems, processes, programs and services do not offer these options, and if our citizens do not see these options are available to them, then their equality rights are not being fully realized.

This proposed legislation recognizes the significant role that social, mental health, disability and community support services play in the full realization of equality rights. Accessing MAID should not be easier than accessing disability supports. The new legislation makes it the responsibility of the medical practitioner to ensure that the individual is made aware of the supports available to them because the harsh reality is that many Canadians with disabilities are not living with dignity. They are not properly supported. They face barriers to inclusion and regularly experience discrimination.

We have seen during this pandemic how many of our systems fall far short of truly supporting and including all Canadians. Canadians with disabilities are rightfully calling for governments to address these inequities, and we must.

In the recent Speech from the Throne, our government committed to a disability inclusion plan. This will include a Canada disability benefit modelled after the GIS, an employment strategy, and a modernized approach to eligibility for Government of Canada disability programs and services. The disability inclusion plan is an important next step in advancing the rights and inclusion of person with disabilities. I look forward to sharing more on this with the House and all Canadians in the coming months.

Before concluding, I will mention the need for robust federal monitoring and data collection on MAID. We need a reliable national dataset that promotes accountability and improves the transparency of implementation. Quite frankly, we also need to better understand who is accessing MAID and why. This is of the utmost importance to the disability community. It is incumbent upon all of us to ensure the regulations that flow from this legislation allow for fulsome data analysis.

We have before us legislation that seeks to balance making medical assistance in dying available, without undue obstacles to those who choose it, and having safeguards to ensure this decision is truly informed and voluntary. A truly progressive medical assistance in dying law is one that recognizes, without compromise, the equality rights of everyone.

I am thankful for the opportunity to contribute to this debate.

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

Mr. Speaker, I listened intently to the hon. member's speech, as I always do when my friend speaks. I wish we had the time for the committee do its study. I wish that the government had taken the time to challenge the decision of the court in the Supreme Court if only to get the best advice we could before we moved forward with legislation like this.

I think about the disability community. Both of us know the disability community very well, and we have heard significant concerns from that community. This is a complex issue, and issues related to communications for those with disabilities are also complex. There are many in the disability community who would say that their voices are not being heard right now and they do not feel they have agency right now because of the way society views them. They feel this legislation is coming too fast, too quickly, too soon. I wonder what kind of commitment the hon. member will make to those in the disability community to make sure their voices are heard.

[Carla Qualtrough, Liberal, Delta, BC]

Mr. Speaker, I thank the hon. member for his collaboration and partnership in advancing issues related to disability.

This is a very complicated, complex and deeply personal issue. I have been committed since the beginning to living by our commitment to a “nothing about us without us” perspective by ensuring members of the disability community have voices at every table around decisions like this.

My COVID disability advisory group has been digging in on this. I know we will have robust presentations at committee from members of the disability community. My bottom line is that I will do whatever it takes to ensure these voices are heard.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, I am wondering about the question that was just asked.

I would like my colleague to clarify. When I am told about the vulnerability of persons living with disabilities I completely agree. However, the process that leads to medical assistance in dying requires clear consent. There are physician groups that are already working on this issue trying to determine the terms and conditions for such consent.

Does my colleague agree that some parliamentarians seem to want to drag out the debate to throw the baby out with the bath water?

[Carla Qualtrough, Liberal, Delta, BC]

Mr. Speaker, we are talking not only about changing the Criminal Code, but being very careful not to send a message to a very important group of our citizens that their lives are not as valuable as those of the rest of us. I want to ensure that, as we have this conversation, nothing we do sends that message. Everybody's life is of equal and inherent similar value.

Perhaps I misunderstood the question, but if people do not have a real choice at their disposal, as I suggested in my speaking notes, then we are not really giving them their full rights of equality.

[Matthew Green, NDP, Hamilton Centre, ON]

Mr. Speaker, the minister has just reminded us that everyone ought to have equal and inherent rights, but we know that throughout this pandemic the government has refused to prioritize the pursuit of a very equal life for people with disabilities.

I want to bring the voice of one of my constituents, Sarah Jama, who is part of a disability justice network, to ensure that her and their voices are heard. She states, “It is evident through our history of forced sterilization and institutionalization that the current crisis of deaths in long-term care homes and continued legislated poverty across this country that with the changes in the requirement for foreseeable death to MAID, what measures will our government put in place to adequately ensure that people with disabilities will not experience systemic or implicit coercion regarding their access to MAID and will this government finally prioritize the life of people with disabilities in this country as much as it has thoughtfully prioritized their access to death?”

[Carla Qualtrough, Liberal, Delta, BC]

Mr. Speaker, I thank Sarah for fighting the fight. I hear many of her views about how, historically, we have done wrong by this really marginalized group of citizens. We are taking every effort to do right by our citizens with disabilities. It started with the Accessible Canada Act, which put a disability lens on our pandemic response, resulting in a COVID disability advisory group, resulting in recommendations from that group as to how we could ensure that sufficient safeguards were put in place, resulting in a commitment in the Speech from the Throne to a direct payment to citizens with disabilities, the Canada disability benefit modelled after the GIS, so they can have the choice to not live in poverty, access to the services and supports they need to live with dignity. I promise Sarah that we are not giving up this fight.

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, today we are talking about Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying. While I realize this is a very sensitive and difficult issue, I want to be very clear that I will not be supporting the bill. I would like to take a few minutes to talk about why that is and to provide some context to all Canadians, specifically from my constituents in Niagara West.

On February 6, 2015, the Supreme Court of Canada ruled that grievously suffering patients had the right to ask for help in ending their lives. This was the Carter v. Canada decision. The court declared that paragraph 241(b) and section 14 of the Criminal Code, which prohibited assistance in terminating life, infringed upon the charter right to life, liberty and security of the person for individuals who want to access an assisted death.

The Supreme Court decision was suspended for a year to give the government time to enact legislation that reconciled the charter rights of individuals, doctors and patients. As a result, the government introduced Bill C-14 on April 14, 2016, which received royal assent on June 17, 2016. Medical assistance in dying has been legal since then.

On September 11 of last year, the Superior Court of Québec found that it was unconstitutional to limit access to medical assistance in dying to people nearing their end of life. Basically, the court said that the Criminal Code requirement that natural death should be reasonably foreseeable to get medical assistance in dying is against the rights and freedoms of Canadians as they are written in the charter. It is important to note this ruling will come into effect on December 18, 2020, unless a third extension is granted by the court.

The focus and priority of all of us in the chamber should be to ensure safeguards are always in place for the most vulnerable in our society. We also have to keep in mind that we need to be respectful and accepting of the conscience rights of physicians and health professionals. Doctors are trained to save lives, not to end them. I actually believe we should go a step further and protect the conscience rights of all health care professionals.

I am supportive of doctors and health care providers who are not willing to leave their core ethics behind when they are at their patient's bedside. I do not believe it is appropriate to force a doctor or other health care provider to participate in assisted suicide. I also do not believe it is appropriate to hire or fire an employee based on their willingness to be involved in assisted suicide. Physicians who wish to follow their conscience on serious moral issues should be free to do so. Again, we need to be respectful and accepting of the conscience rights of physicians and health professionals.

The last time I voted on this issue, I went through the legislation, which at the time was Bill C-14, and I made a determination that it did not include sufficient safeguards for those most vulnerable, so I opposed it. I had the chance to examine the current bill before us today and I still do not think it has sufficient safeguards, so I will oppose it again.

Let us be clear about something. Medical assistance in dying is a tremendously difficult issue to debate. It absolutely is. It is a highly emotional topic for all sides, and there are many factors and personal convictions that come into play. In the House we agree on many things, but we also disagree strongly on others. The key is to respect one another in the process as we discuss sensitive issues, especially issues relating to human life. Medical assistance in dying has to do with some of the most vulnerable people in our society. That is why it is important we, as representatives of the people who voted for us, have utmost respect for all who have an opinion on this topic. This includes many folks in my riding of Niagara West who are people of faith and disagree with what this bill would do.

I would like to highlight some critical evidence from an expert who appeared before the Quebec superior court on this issue. Dr. Mark Sinyor is a Canadian psychiatrist widely recognized for his clinical expertise and research on suicide prevention. He was an expert witness in the case, who provided important testimony before the Quebec superior court.

In his 50-page affidavit, Dr. Sinyor detailed for the court the likely impact of expanding medical assistance in dying to those who are not at the end of their lives. He notes that under an expanded law, which is what we have in front of us here today, physicians would bring about a death that is not otherwise foreseeable. This is something that is exceptionally difficult to accept for many Canadians across the country and for many in my riding of Niagara West. Issues like the planned legal death of someone who is terminally ill is a very delicate matter to begin with, but to open up the door for more people to qualify for a planned death, a legal death, to me and to many of my constituents, is very troubling.

I would like to return to Dr. Sinyor again.

He talks about a well-established phenomenon referred to as suicide contagion. Dr. Sinyor explains that suicide contagion occurs “through a process called social learning in which vulnerable people identify with others who have had suicidal thoughts and/or behaviour.” He goes on to say, “Expansion of MAID to include suffering, not at the end of life is likely to lead to suicide contagion and higher suicide rates, and to have a negative impact on suicide prevention.”

Dr. Sinyor also talks about the extent to which many elderly people with chronic conditions and younger people with severe disabilities are impacted. He says that they “feel like a burden to their loved ones and that their families would be better off if they were dead.”

When one of our friends, of family members or loved ones is in a similar circumstance and they begin to think that they will be solving this problem of being a burden, knowing that this law will allow it, would it be more comfortable for us? My answer is no, I do not think it would be.

To quote Dr. Sinyor again, “Normalizing suicide death via MAID as a remedy for suffering not at the end of life is likely to increase suicide rates in Canada at a time where there is a universal consensus among public and mental health experts of the imperative to decrease suicide rates.”

In short, the bill would simply make it possible for a person to choose to access medical assistance to end their life, even if their death is not reasonably foreseeable. I am concerned for people with disabilities. I am concerned that, if passed, the legislation will allow people with disabilities to die with medical assistance because they have a disability.

Michael Bach, managing director for the Institute for Research and Development on Inclusion and Society confirms this, saying “people who are not at the end of life will nevertheless be able to access assisted death on the basis that their disability is grievous and irremediable and they experience suffering they find intolerable.” I am concerned that people with disabilities may be coerced into ending their life while they are in a state of personal suffering.

Michael Bach also said, “Negative stereotypes are an undeniable cause of disability-related disadvantage and suffering. The Quebec Superior Court struck a blow to social rights in Canada when it rejected the end of life requirement.”

One of Bach's most striking statements on this issue is that the court's decision “institutionalizes the idea that disability can justify terminating a life. Stereotypes don’t get much worse than that.”

I am afraid that the bill may reinforce horrible stereotypes that a life with a disability is a life not worth living or that living with a disability is a fate worse than death. This cannot happen. I am also concerned that the suffering may not be caused by the disability but because of a lack of services and supports needed by many people with disabilities to lead a full life.

As an example, we have the story of Sean Tagert, a B.C. man who was living with ALS. Sean chose to access medical assistance in dying because he was unable to secure funding for the 24-hour care he needed to live in his home, in his community and raise his young son. The story is heartbreaking. This young man chose death because he was unable to get the proper care for his disability, and he left a young child behind.

It is so sad to hear stories like this. That is why I believe that providing high-quality palliative care is critical. Palliative care is so important because it puts patient care at the forefront of this discussion and not the patient's death. Palliative care helps improve the quality of life, reduces or relieves physical and psychological symptoms and supports the families and loved ones of those struggling with the condition. It could be provided in a variety of settings, including hospitals, at home, long-term care facilities and hospices.

The focus of palliative care is on respecting dignity and having compassion for human life. That in my view is the right approach. I do not think any of us in the chamber should ever underestimate the importance of this issue and its complexity. We all understand the delicate and sensitive nature of it. We all have views and we all know the views of our constituents. They sent us here to represent them, and that is what we are doing.

My hope is that we will all uphold the original objective of this legislation, and that is to affirm the inherent equal value of every person's life to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled. This bill does not do that, and for that reason I will be voting against it.

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

Mr. Speaker, I share the member's concern with respect to palliative care and how critically important it is that Ottawa continues to work with provinces to look at ways we can deliver a better service, particularly for some communities that have been neglected on this issue.

My question relates to the concerns of the member. We have health care professionals, families, friends and for some of the larger groups, such as the disabled, advocacy groups. I am wondering if the member might be underestimating the value they have to this debate. Once the bill gets to committee, we will hear a lot more on those issues.

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, as I have said before, I have talked to numerous people who have come to my office and whose homes I have gone to. When it comes to the disability community in particular, they are certainly very concerned about some of the things that underlie this, whether it is removing the 10-day waiting period or encouraging doctors to move forward proactively. There are a number of things and that is why a letter, signed by over 77 organizations, was sent to legislators that talks about the concerns that they have. We need to be very mindful of them.

[Matthew Green, NDP, Hamilton Centre, ON]

Mr. Speaker, we have heard today from our Conservative friends down the way stories of anguish, conversations and statements around the sanctity of life and safeguards. It is clear to me that this is not a critique particularly of MAID, but, rather, the condemnation of capitalism.

What does the member have to say about the privatization of mental health, the criminalization of addictions and the commodification of every basic necessity of life, to the point where almost complete and utter despair has caused people to be sentenced to live in deep poverty and have to, at the end of life, under coercion perhaps, contemplate this last and drastic step?

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, we realize this is a delicate issue. As I have said before, this is complicated and not easy. One of the things I wish the government had done more of, which we have talked about, and has been mentioned in other speeches and my speech, is the whole issue around palliative care.

We need to provide people options at the end of life. They may believe that is the only option they have. They may be in pain that is unbelievably difficult and believe that there is no way around it if they do not have proper pain medication, all these kinds of things. There are all kinds of communities that do not have access to these services. The first thing we should look at is how we should deal with this and how to provide those communities with these types of services.

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

Mr. Speaker, I was encouraged when I heard the Minister of Employment, Workforce Development and Disability Inclusion state that she felt it was not advisable for Canadians to have access to MAID more easily than supports for our disabled community. Could my hon. colleague comment on whether what is proposed in Bill C-7 makes that situation worse or better?

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, it goes back to what the member for Hamilton Centre said as well. What kinds of supports do we have for these individuals, people who are disabled and people who have addiction issues? The member for Hamilton Centre asked how to deal with people with addictions. We should be looking at helping these individuals as well. I do not believe it is one thing or the other. If we are going to be looking at things like this, at the very least we should have better supports for our disabled and for palliative care and that is where the focus should be in the short term, in my belief.

[Caroline Desbiens, Bloc, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, I commend my colleague on his speech, but I am very concerned about the position he is taking.

As I was listening to him speak, I was imagining all the people who are waiting for relief and thinking about how upset they must be to see that this bill is still not making any progress.

I would like to ask my colleague whether he has ever met someone who had no choice but to obtain medical assistance in dying to put an end to their suffering. In his life, has he ever met anyone who had no other option?

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, it has been my experience in talking to constituents over the years that there are a lot of people who do not understand what is available out there. It has also been my experience in my time of being elected to the House of Commons and talking to my other colleagues from across the country that there are still a lot of programs that are not available to people across the country.

We are in great shape in Niagara. I am very grateful that we have a hospice, and very grateful that we have organized agencies that administer palliative care. I really believe that we should be looking at these options. These are things that we should be focusing on at this point in time, and I believe that we should be finding supports for these individuals.

[The Deputy Speaker, Bruce Stanton]

Now we will go to the hon. Minister of Health. My apologies, I think the change was at our end, but we have it right this time.

Resuming debate, the hon. Minister of Health.

[Patty Hajdu, Liberal, Minister of Health]

No worries, Mr. Speaker. With virtual Parliament, all members of the House of Commons and, of course, you, Mr. Speaker, and your team, should be really proud of the work that we have done to keep Parliament functioning.

I am so happy to speak to the House today to address Bill C-7. I have been listening to the debate quite closely. I have to say that I am so impressed by the passion and compassion that I have heard in all of my colleagues' voices in talking about this very personal and very emotional topic.

In responding to the ruling of the Superior Court of Quebec on Truchon, we have had the opportunity to consider measures for which there is strong public support, and that is why we are proposing changes that will help clarify and strengthen Canada's medical assistance in dying legislation that is in place today.

Canadians have shared their views since we had passed the original legislation in 2016. Earlier this year, I had the opportunity to listen to their opinions and ideas. I also listened to the practitioners who have been providing these services over the past four years. I have to say, on a personal note, that the stories of both groups really were very moving, but particularly from the practitioners who have been using the legislation to provide choice to patients who oftentimes had been suffering terminally for a very long time. It is very clear that their compassion and expertise is something we should all be very proud of and grateful for as Canadians. However, it is also clear, through those conversations, that certain aspects of the current legislation could be altered to improve access, protect the vulnerable and respect this personal choice that is at the foundation of the legislation. With this bill, I think that we achieve a balanced approach that reflects the best interest of all Canadians.

The proposed changes to this bill have been informed by years of study and consultation. In December 2016, we asked the Council of Canadian Academies to review three types of requests for medical assistance in dying that are currently outside the scope of the law: requests by mature minors, advance requests and requests where a mental disorder is the sole underlying condition. As part of our analysis, we also consulted a number of other sources, including evidence submitted before the court in Truchon, as well as domestic and international research.

Medical assistance in dying is a complex and deeply personal issue, as so many of my colleagues have illustrated in their remarks. We knew that before going forward with changes to the current law, we needed to hear from Canadians. We held public and online consultations for Canadians to participate to complement our discussions among cabinet ministers, medical experts and other stakeholders in the country.

Protecting the safety of vulnerable people, a focus of many of the comments today, while respecting the autonomy of Canadians, another key aspect that was so important in our consultations, remain our central objectives. That is why the bill proposes a two-track approach to safeguards based on whether or not a person's death is reasonably foreseeable. The bill would no longer make reasonably foreseeable natural death the basis for determining eligibility, but it would use it to establish whether a more rigorous set of safeguards should be applied.

If a person's death is reasonably foreseeable, a set of safeguards similar to the existing regime would apply, but after hearing Canadians' feedback on the barriers that some of those original safeguards pose to those seeking medical assistance in dying, some of the conditions have been changed. I will expand on the specifics of the bill's proposed changes to these safeguards in this case.

For those whose death is reasonably foreseeable, we would ease some of the pre-existing safeguards that we know have not served their purpose of protection. For example, under the current system, there is a requirement for a 10-day reflection period. Health care providers and family members, those who have been through this and have shared their loved ones' stories, have told us that the safeguard often prolongs the suffering of individuals who have already given extensive consideration to their decision to request medical assistance in dying. As a result, the proposed bill would remove this requirement.

During the round table discussions, we also heard that the existing requirement for two independent witnesses posed a barrier to those seeking medical assistance in dying, especially for those living in a care home or institution. We proposed only requiring one witness and allowing this witness to be a care provider. Those involved in assessing or providing medical assistance in dying would still not be eligible as witnesses.

Last, we heard from Canadians about the waiver of final consent.

Under the current legislation, a practitioner must ensure the person seeking and deemed eligible for MAID gives their express consent immediately before providing MAID. This is often referred to as the final consent and provides final confirmation of the person's desire to proceed with MAID.

This safeguard also prohibits MAID for individuals who have lost the capacity to provide final consent, regardless of how sure and definitive they were about their intention when they had capacity. This safeguard unintentionally created situations for individuals who had chosen to end their lives earlier than they wanted out of fear of losing the opportunity to receive MAID because of an impending loss of capacity.

I know many of members are aware and have spoken about Audrey Parker, who last year died and used her final days to advocate for changes to this very part of the legislation. In one of her last posts, she said, “the law has forced me to play a cruel game of chicken... I would like nothing more than to make it to Christmas, but if I become incompetent along the way, I will lose out on my choice of a beautiful, peaceful and, best of all, pain-free.”

Inspired by Audrey's memory, we are proposing to include a waiver of final consent for persons whose death is reasonably foreseeable, but who are at risk of losing decision-making capacity. As proposed in the bill, the individual would be able to provide written consent for their practitioner to administer MAID on a specified date.

In addition to easing certain safeguards, the bill also proposes strengthening others for those whose death is not reasonably foreseeable. We heard concerns from stakeholders and Canadians alike that eliminating the reasonable foreseeability of natural death requirement could result in increased risk for some people. Their concern is for people who are suffering, but not at the end of their life, who might make a choice that is not fully informed, with respect to treatments and supports. We think it is important while improving access to ensure vulnerable individuals are protected.

For example, the bill proposes a minimum period of 90 days for assessing the MAID requests in these circumstances. This period would allow for exploration, discussion and consideration of options by the person seeking MAID in collaboration with his or her practitioner. The bill would also require that the people requesting MAID in this circumstance be provided with information about the available counselling, mental health supports, disability supports and palliative care to ensure he or she were making an informed consent.

Following the Truchon decision, some have expressed concerns about individuals suffering solely from mental illness receiving MAID. Many clinicians argue that the trajectory of mental illnesses is harder to predict than that of physical disease. In light of this consideration, the wording of the bill precludes individuals suffering solely from a mental illness from accessing MAID. This proposed change does not mean that people will be excluded if they have a mental illness; it means that mental illness cannot be the only underlying medical condition. We anticipate that the issue of mental illness and medical assistance in dying will be further explored as part of the parliamentary review process.

There is also an agreement among experts that allowing advance requests for people with illnesses like Alzheimer's disease is very complex and would require careful consideration and consultation before it could be implemented.

During round table consultations, I heard from health care providers who were worried that because they had seen patients who, as their condition progressed, might not have had the same desire for MAID as when they were first diagnosed, it would be very difficult to assess these types of requests. The Council of Canadian Academies expert panel report on advance requests came to the same conclusion. For this reason we believe this topic is deserving of deeper examination through a parliamentary review. We need to approach this area with the careful consideration that it warrants.

Since MAID legislation was first enacted in 2016, nearly 14,000 Canadians have chosen the option of a medically assisted death, and this is not unexpected. We have seen a gradual increase in the numbers over the last three years, and Canada's experience is in line with other similar regimes around the world.

This is why we are also proposing changes to expand data collection to help provide a more complete picture of MAID in Canada. Today we are taking steps to clarify and add precision to Canada's medical assistance in dying legislation to respect the issues and the concerns raised by participants and numerous consultations about the need to place the personal autonomy and protection of vulnerable persons at the centre and the heart of this legislation.

I believe this legislation would improve the existing legislation, especially for those people whose health conditions lead them to consider this difficult decision. I urge all members of the House to support Bill C-7.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Mr. Speaker, my question this evening is about options and appropriate and available supports. Earlier this evening, the hon. minister and member for Delta stated that accessing MAID should not be easier than accessing supports, in reference to people with disabilities. Is the government committed to increasing on a permanent basis, to provinces and territories, transfers for palliative care and mental health in conjunction with Bill C-7?

I ask this question because in my rural riding services are not equally distributed. Rural Canadians do not have access to palliative care, let alone mental health supports. What options will they have, especially in remote indigenous communities?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, I want to thank the member for his compassionate question but also my colleague, the Minister of Employment, for her work with Canadians with disabilities, to understand and to be able to advocate for the need for better services for all people who are living with disabilities. The member referenced supports for mental health and I will remind the member that in fact we have been supporting provinces and territories with billions of dollars in transfers specifically for mental health support. We have worked with provinces and territories all through COVID-19 in a way that demonstrates there is a lot more we could all do collectively to make access to services and supports available no matter where people live. I am extremely excited about, for example, the potential of virtual care in a way that can assist in those situations.

[Martin Champoux, Bloc, Drummond, QC]

Mr. Speaker, I thank the minister for her speech.

We all know that this is a sensitive topic. Some believe it should be debated longer so that we have the time to discuss it more thoroughly. Others believe that we need to move more quickly because people are waiting for us to legislate on the issue.

As I was saying, people know that this is a sensitive topic, but I also think that many people do not understand it properly or are intentionally conflating the issues. I am thinking, for example, about suicide, which is often associated with medical assistance in dying. We have also heard about the option of palliative care, which may be inadequate in some regions. That also needs to be looked at.

The minister spoke about the consultations she held with the health care community. What concerns did health care professionals raise regarding the implementation of legislation on medical assistance in dying?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, I thank my colleague from Drummond for such an insightful question. In fact, I found the consultations with the physicians extremely important in understanding both the value of providing MAID in their practices, giving people options for dignity at the end of their lives when it was very clear this was the choice they had made, but also the complications in trying to assess a person's condition and whether or not, for example, death was imminent. There was a number of issues that physicians raised specifically around some of the amendments that we are making.

One that was really poignant was the need for additional witnesses in a case where someone could be extremely elderly or isolated and had no one to vouch for them. They said that they did a very thorough job assessing these situations and they needed government to acknowledge the expertise they have.

[Paul Manly, Green, Nanaimo—Ladysmith, BC]

Mr. Speaker, I have a quick personal story. I witnessed the medically assisted death of my 90-year-old aunt a few months ago. I witnessed the process, the consultation and everything else, and it was a very caring, loving ceremony. What I have been hearing from constituents is that people with disabilities want to live with dignity, so they are feeling left out in a lot of ways. They are concerned about MAID but want to see better supports for people with disabilities, better supports for palliative care and better supports for people who are struggling in life.

I would like to ask the minister: what kind of measures is she putting in place? We have people with disabilities—

[The Deputy Speaker, Bruce Stanton]

The hon. Minister of Health, a short response if possible.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, I think the member for Nanaimo—Ladysmith really illustrates how this bill attempts to ensure that people have choice, autonomy and dignity at the ends of their lives, while also ensuring people must know of the supports that are available and have a reasonable expectation they will be advised of all of their options so they truly do have a choice. The work with the disability advisory group that the Minister of Disability Inclusion and I have had the privilege to do has highlighted for us that there is not a one-size-fits-all answer for the disability community, but that working together with them, we can enhance supports that will be meaningful and give people that true choice.

[Caroline Desbiens, Bloc, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, Bill C-7 on medical assistance in dying is an important, sensitive and justifiable bill on a very difficult subject.

I am quite happy to be speaking at the end of the day, at the end of the debate. Before getting into my speech, I would like to lighten the mood for a moment and wish my young, beautiful daughter a happy 19th birthday. Last year she had to celebrate her 18th birthday on her own because her mother was on the campaign trail. This year she has to celebrate her 19th birthday on her own because her mother is in the House of Commons. I want to tell her that I love her and wish her a very happy 19th birthday. This will give us some energy to continue with the debate. It feels good to lighten the mood a bit and talk about our lives.

A year ago, I was elected in the riding of Beauport—Côte-de-Beaupré—Île d'Orléans—Charlevoix, and I was given a very important mandate: to represent, here in the House, Quebec's values in matters of culture, languages, the environment, the green economy and health. A year ago, I had no idea that I would be rising in the House and speaking to my distinguished colleagues in favour of Bill C-7 on medical assistance in dying. To be perfectly frank, this is not usually a topic we find easy to talk about.

However, something happened that gave me the courage to get more involved in this issue of late, and so, despite everything, I am pleased to do so. This is not an easy debate because what we are doing will have a major influence on the fate of courageous individuals with conditions that cause them extreme and irremediable pain and suffering that will never end.

To help us do this work, we must turn to our own experience. I will share some of my own experiences that, sad as they are, will put a human face on this afternoon's debate.

As an only child, I accompanied my parents on the sad and often difficult path leading to the end of life. My father was the captain of a schooner, a small wooden boat, that he sailed on the St. Lawrence. His entire life he claimed that his schooner was a leaky boat and that he had to learn to sail in order not to drown.

His lung specialist told him that he was going to drown, that the cancer would drown his lungs and that he would suffocate to death. My father had a great deal of character and thought that he had not worked all his life without drowning to then die by drowning. That was out of the question. He wanted the doctors to find a solution. Surprisingly, he was told that, in his particular case, he had to right to a medical protocol involving sedation to avoid a situation of imminent death, respiratory distress. On the morning of August 12, 2010, he decided that he could not go on, that his condition was deteriorating, that he wanted relief. He was relieved to learn that he would not die by drowning, because he could avail himself of the protocol on the day that he decided that he could take no more. He passed away peacefully and serenely.

My mother was not as lucky. She had pancreatic cancer and died in excruciating pain. She was dehydrated and her stomach was perforated by the disease. She was in palliative care for 17 days. In her case, palliative care could not ease her suffering. Use of the respiratory distress protocol was not an option, even though there was plenty of distress for her, me and all her health care providers. In short, there are many ways to die, but in her case, morphine never did any good. Her heart was too good, too strong and it resisted. It resisted for far too long, much longer than the specialists could have predicted.

My experience with my parents is certainly just as valid as those of my dear colleagues. It allowed me to compare what it means to die when you can control how things happen and the consequences, and what it means to die in desperation without any way to ease the pain.

I now want to talk about my friend Sophie, who died on Saturday. Sophie was 39 years old and had two young children aged 11 and 13. Sophie had cystinosis, a nasty disease that took her sight, then her ability to swallow, and finally her kidney function. She had had a kidney transplant, was part of an American research program and had access to some new potential medications developed in the United States, which were able to help some people with the same disease. Unfortunately for her, the disease had progressed too far. The experimental treatments did not work, in spite of the 100 pills a day she had to swallow, at a cost of $300,000 a year.

I share my friend Sophie's story because it needs to be heard here today. When her condition started to get worse, she wanted to request medical assistance in dying. She had already started the process and started filling out the mountain of paperwork, as she called it. Unfortunately, even with the help of her loved ones and her doctor, she did not have the time to go through with it, because she suffocated and collapsed, dying in front of her powerless, terrorized and unprepared young children, who will forever be traumatized by these memories. This happened on Saturday at 6 p.m. in Quebec City.

Things could have been very different for our dear Sophie and her two children. Simplified access to medical assistance in dying based on criteria that suited her situation could have given her children a chance to say goodbye to their mother, to hold her in their arms and to be with her as she passed away quietly and serenely. Their experience of death, while deeply sorrowful, could have been tempered by the dignity and peace that only medical assistance in dying can provide in some cases clearly defined by law and the experts when given the chance.

Bill C-7 is a step in the right direction. We must make it so that other people suffering from degenerative or incurable diseases need not go to court to challenge the eligibility criteria for medical assistance in dying. This bill is a step in the right direction because a person's eligibility for medical assistance in dying no longer hinges on their death being reasonably foreseeable.

The complexity and diversity of Sophie's symptoms made it impossible for her death to be reasonably foreseeable and to know what would ultimately be her cause of death. Everyone around her knew that her only hope of dying with dignity and without suffering was quick and easy access to medical assistance in dying after obtaining the appropriate medical opinion.

Sophie's story will not be reported in the papers or on television. Maybe it will be shared a bit on the family's social media, but Sophie is the perfect example of what we have failed to do so far.

On behalf of all those who are sick and waiting for medical assistance to die in peace and with dignity, I call on all hon. members to stop playing games and acting superior to those around you, and drop all the political strategies that often animate and sometimes drag out our debates. I ask each one of these people to take a deep breath on behalf of all those we have yet to help who are anxiously waiting and hoping that our good collective judgment will help us reach a consensus. Let us set aside all the parliamentary back and forth and let us be guided instead by our humanity and compassion.

[Brenda Shanahan, Liberal, Châteauguay—Lacolle, QC]

Mr. Speaker, I thank my colleague for her very moving speech. I really got a sense of her friend's sadness, but also her courage, and that of her friend's family, as she shared their story.

Five years ago, I served on the Special Joint Committee on Physician-Assisted Dying. We were inspired by how this issue evolved in Quebec, and I even remember attending a meeting with Véronique Hivon and Pierre Moreau. It was quite controversial, but it was very important to have that discussion. Quebec has really been a leader on this issue.

Is there anything else my colleague would like to see addressed in this process regarding medical assistance in dying, this very important choice?

[Caroline Desbiens, Bloc, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, in response, I will say what I hope not to see. I do not want to see any wandering discourse meant to sweep this under the rug.

I also want everyone here to acknowledge that we are but humble humans, not experts. We will hear from the experts in committee, experts who will guide us on what useful, appropriate tools should be included in the bill.

We must not use urgency as an excuse to rush this. Once again, I am thinking of those who must have nothing better to do at the moment and are listening to us on ParlVU. They are probably thinking that we should stop talking and get on with it already.

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

Mr. Speaker, I want to add to the member's comments, which are very much appreciated. She puts faces and reality to the legislation we are debating today.

It was not that long ago, back in 2015, that we had to bring in legislation. We have been seeing it evolve, and in many ways it cannot evolve fast enough. We could take a look at the province of Quebec, for example. In certain areas, they are further advanced than other parts of Canada. That is one of the benefits of the federation. I agree with the member: I would ultimately like to see the bill go to committee, because I think a lot of stakeholders are interested in contributing to the discussion.

This is more of a comment than a question.

[Caroline Desbiens, Bloc, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, since I am probably coming to the end of my time, I would like to commend my esteemed colleague, Véronique Hivon, who worked very hard to ensure that Quebec led the way in medical assistance in dying. It now sets the standard. I take this opportunity to acknowledge her.

I will also take this opportunity to say that Quebec is often a source of inspiration. In this case, that is probably even more true. I hope that everyone will look to Quebec's example in passing this legislation.

[Martin Champoux, Bloc, Drummond, QC]

Mr. Speaker, like my colleague opposite, the member for Winnipeg North, I want to add to my colleague's speech.

I, too, have some touching stories that are often hard to talk about because it is such an emotional subject. I want to congratulate my colleague for her very poignant speech. These stories humanize the debate and show us the situations that we are making decisions about.

In my riding, a woman who had fought to obtain MAID passed away last year. She did not have time to complete the process. As my colleague said, we must stand together to ensure that people who are dying have the right to die with dignity.

[Caroline Desbiens, Bloc, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, once the bill is passed, we will put our faith in eminent experts who are much more knowledgeable than we are, thanks to a university system that is supported by our tax dollars. They will testify in committee, and we will listen to them. We will improve the bill, to make sure that the act is fair and easy to implement.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

Mr. Speaker, I appreciate the opportunity to rise and speak this evening on Bill C-7, an act to amend the Criminal Code with respect to medical assistance in dying, or MAID.

The meaning and consequence of this bill should weigh heavily on all Canadian parliamentarians. Today we are debating the competing interests of individual autonomy and the sanctity of human life. We are addressing the suffering of our loved ones, the dignity of the elderly and disabled and the moral, legal and ethical concerns that are inextricably tied to medically assisted death. We are setting out the rules, standards and boundaries by which Canadian doctors and nurses can, at a patient's request, terminate life. This cannot be taken lightly and it is not legislation that should be rushed, but that is the predicament that this Parliament finds itself in.

In 2016, the Liberal government passed Bill C-14, legalizing MAID. Last year, in the case of Truchon v. Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. Contrary to the requests of my Conservative colleagues and many advocacy groups, the Attorney General, who bears the responsibility of upholding laws passed in Parliament, chose not to appeal the ruling in Truchon. It is difficult for me to understand how something as essential to life as one's departure from it is not important enough for the Liberal government to appeal. This is something that should have had both comment and decision from the Supreme Court of Canada.

Because of the Liberal government's inaction, we are now working up against a December 18 Quebec-court-imposed deadline to enact a legislative response for the whole country. Its declaration of constitutional invalidity expires on that date. I want to assure my constituents in South Surrey—White Rock and all Canadians that, as a member of Parliament and a member of the Standing Committee on Justice and Human Rights, I will stand up for their shared values and beliefs and work tirelessly to ensure the amendments proposed in Bill C-7, and their consequences, are carefully studied and considered despite the impending December deadline.

Turning now to the substance of Bill C-7, I am concerned that the bill, as written, is too broad and lacks the safeguards necessary to protect Canada's most vulnerable populations. Let me be clear. The removal of the “reasonably foreseeable” standard will significantly increase the number of Canadians eligible for MAID. The breadth of qualifying conditions widens considerably under Bill C-7. For anyone who initially opposed MAID on slippery slope concerns, it appears we are now sliding down that proverbial hill. Will we eventually follow the Netherlands' lead, which recently ended up in its announced plans to offer MAID to children under 12?

As a group of physicians recently put in a letter to the Minister of Justice and Attorney General of Canada, urging an appeal of the Truchon decision, “Canada will have moved well beyond allowing an autonomous life-ending decision at the end of life into the realm of death on demand for almost any reason at any time.”

We know, from Health Canada's annual report published in July, that 2% of deaths in Canada in 2019 were medically assisted.

How much higher would that number be under Bill C-7, and how many Canadians would be eligible for MAID without the “reasonably foreseeable” requirement? Both questions must be answered.

If this is in fact the direction in which Parliament decides to take this legislation, we need more safeguards to protect the more vulnerable, not fewer. As written, Bill C-7 redefines who qualifies for the end-of-life procedure and strips away some of the protections put in place a mere four years ago.

One such amendment is the elimination of the mandatory 10-day reflection period. Under the original legislation, unless an exception applied, individuals wishing to receive MAID had to wait a period of 10 days after submitting their signed requests. In most instances, the waiting period makes sense. It ensures time for reflection before taking the irreversible action of ending one's life.

We know from Quebec's annual end-of-life care reports that since 2015, over 300 patients in Quebec alone changed their mind after requesting medical assistance in dying. In any event, exceptions already exist under the original law for those whose death is fast approaching and for people who will soon lose the capacity required to provide the necessary informed consent. Why then remove this 10-day reflection period?

Bill C-7 also takes aim at another safeguard included in the previous laws, reducing the number of independent witnesses needed to sign and date the candidate's application for MAID, from two to one.

This amendment would now apply to the newly eligible class of persons who are not faced with reasonably foreseeable or imminent death. Contrary to statements made in the House by the member for Winnipeg North, this is a real concern for many.

As a civil litigation lawyer, I have had my fair share of exposure to all sorts of legal documents requiring the signatures of independent witnesses to ensure both authenticity and true intent: wills, divorces, financial disclosures, affidavits and mortgages, to name a few. To express one's intentions in a will in B.C., a person must have two independent witnesses not named in the will to witness the authenticity of their signature and their intention at the time of signing. If these requirements are there to safeguard intentions regarding possessions, should they not also be there to safeguard a person's intentions regarding the method and timing of their death?

It should be noted that Bill C-7 does include a 90-day assessment period and directive that applicants be informed of available alternative treatments, but will these safeguards sufficiently protect our most vulnerable populations? When does the 90-day period begin? Is it recorded?

Another piece of the bill that I have difficulty with is that it allows patients who may lose capacity before the end-of-life procedure is performed to give their final consent in advance. This troubles me for the same reasons discussed before with respect to the 10-day waiting period. As we have seen, people do change their minds.

In recent weeks, we have heard from many representative groups that have expressed concern about the decision in Truchon. The Council of Canadians with Disabilities, the Canadian Mental Health Association, the ARCH Disability Law Centre and others have articulated the concern that making individuals with disabilities who are not facing imminent death eligible for MAID would be harmful to the disabled community at large, affirming the untrue stereotype that a life with disabilities is not worth living.

We must pause to reflect on that. Those who are passionate advocates for Canadians with disabilities are very concerned about the direction these court and policy decisions are taking us, yet the Liberal government moves forward.

There still exists the legal concept of undue influence. Who are most susceptible to undue influence and coercion? It is the vulnerable. We have also heard from hundreds of physicians who share a concern that some patients have chosen the path of MAID due to the suffering caused by a lack of proper supports. A tragic example is from B.C., where a father suffering from Lou Gehrig's disease chose to undergo the end-of-life procedure because he did not receive the support and resources he so desperately needed.

The government is not listening to the heartbreaking stories of these ALS sufferers and their cries for the fast-tracking of life-lengthening and life-sustaining hopeful therapies that we cannot get in Canada. Is the government giving those sufferers and Canadians true options? We need compassion, yes, but compassion takes many forms.

Hospices are not readily available to all Canadians as an alternative. A good friend of mine died a couple of years ago of inoperable brain cancer. He was a doctor. In his case, he very carefully weighed MAID as opposed to living in hospice. He chose hospice because it extended his life for five months, which he could spend with his family. They were okay with his deterioration because they loved him, and they wanted to support him and be with him. However, he had that true option.

If we are going to expand the legislation, the government should equally ensure robust support for the vulnerable, hospice care and hopeful therapies are available. Everyone matters.

Finally, I would like to reflect on the health care professionals who are asked to implement this proposed law. We are now celebrating our doctors and nurses for their tireless efforts to keep our country healthy and safe. We should also ensure that they have the ability to decide whether this is compatible with their will or beliefs, and not be mistreated for any refusal to administer it.

To conclude, I have heard from constituents in my riding who are on both sides of this argument. I ask my colleagues to really take the necessary time to study the bill and reflect on these proposed amendments, especially as they affect the most vulnerable. We must be compassionate but we must also respect human life.

The House resumed from October 21 consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[Jenica Atwin, Green, Fredericton, NB]

Mr. Speaker, I recently celebrated one year since I became an MP. In my role, I have had the incredible opportunity to learn every day. I listen to people, organizations and advocates, and the discussion around medical assistance in dying is truly about listening. Today I will add my voice to an issue that affects us all.

Talking about death and dying is still taboo in our society, yet each of us must face it, not only for ourselves, but also for the ones we love. This conversation does not come easily, but for those whose time is closer than others, we owe it to them to listen and to act in passing this bill.

The debate on Bill C-7 has been passionate, emotional and raw, and rightly so. I wish to congratulate and offer my gratitude to each member of the House for their efforts on behalf of their constituents, family members and friends. Each of us has been speaking with our community members to learn their thoughts and hear their stories. Human agency has been on display, and the speeches before the House have shown professionalism and integrity, with a deep commitment to the fundamental rights of Canadians.

Sometimes we need a reminder that our constitution is a beautiful thing. It is the crux of why I am so proud to be Canadian, and why I feel so honoured to have the privilege to defend and uphold the Charter of Rights and Freedoms.

I remember first learning in depth about the charter as a grade 11 student. I remember the way it made me feel, the way it made me think about our lives and our interactions with one another, and the empowerment that it brought into focus. It was right around this time that I knew I wanted to some day to be involved in politics. While that seems like ages ago, it was only recently I learned about the urgency in amending our laws specifically concerning the issues within the legislation on medical assistance in dying and how it interacts with the charter.

I sat with it, without lived experience, and I thought of many what-if situations. I thought of the various scenarios and scary predicaments I would not want to face out of the risk of overstepping constitutional rights, if mistakes were made. I heard some of these same concerns from many stakeholders, from those who are concerned about how this would impact people living with disabilities or with suicidal ideation. I have listened to those concerns, and filtered this legislation through those important lenses. While I know some of these people may still disagree with me, I want them to know that I am confident this legislation strikes a balance and it will not have the impact they fear.

I also sought out opportunities to speak to individuals who had a personal connection to this legislation, and as it turns out, many people are willing to discuss their wish for dignity in dying, as well as their concerns about the current process and these proposed amendments. These individuals shared with me their efforts to pursue their right to bodily autonomy in their final moments on earth. In the powerful conversations I have had, the specific issues of advance requests and mental competency, as well as the discretionary role of a foreseeable death, were the exact hurdles to the peace of mind that would come from having control over their own death and final control over the pain.

There are Canadians right now who are suffering intolerably and enduringly. They already have do-not-resuscitate orders. They have made final wills and testaments, and have pre-paid for funeral arrangements. They have demonstrated their competence in preparing for death. They should be trusted to make a decision about the nature of their own death as well. If we rob them of this opportunity, then we have failed them. We have allowed our laws to overstep into bodily integrity and autonomy, an infringement of our protected right to security of the person.

I also want to address the language of “assisted suicide” and “euthanasia”. Our words are important, and it is important to remember that this bill is to amend a bill on medical assistance in dying. We know that a medical prognosis is the safeguard. It is the authoritative layer that protects individuals who are vulnerable.

The reality of the situation facing real Canadians is that co-occurring mental and physical illness is extremely common and should not be a barrier to anyone's right to bodily autonomy at the end of their life. Severe depression often accompanies other medical illnesses, and has a high rate of occurrence among persons with disabilities. As a further example, an individual may be bipolar and later develop terminal cancer. This pre-existing condition, likely to flare up in such a stressful time, cannot be the reason to deny the will of an individual to determine their final moments.

In conclusion, I remain firm that mental illness in Canada requires rapid access to effective mental health services, including in-person counselling and access to psychiatrists where necessary, as well as wraparound community supports. We also need to set national standards for long-term care to ensure that the facilities intended to house older adults are providing a quality of life that keeps them healthy and active throughout their later years, and we need to invest in robust palliative care to ensure there is dignity in living, even through those final difficult days.

I think of Hospice Fredericton and the peaceful, beautiful experience people and their families have in that environment. The option to welcome death peacefully should be an option for those who want it. We must also value and listen to Canadians with disabilities and their advocates. We can do all of these things and still pass this bill.

I do not believe that MAID introduces the risk that some patients will be forced to receive this procedure against their wishes. There are preventive measures capable of eliminating this risk. I do believe that my duty to uphold the Charter of Rights and Freedoms means passing legislation like this to uphold security of the person for all Canadians at all moments during their lives.

I will be proudly voting for this legislation. This is about justice. It is about empathy. It is about choosing to respect one's wishes and not interfering in that decision. It is about giving peace of mind to people, so the final chapter in their lives can be written in confidence, and their story can be concluded according to their own volition.

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

Mr. Speaker, this is very important legislation, which, in essence, comes out of a court ruling. The debate in the House really began on this issue after the last federal election, again due to a Supreme Court ruling. Listening to the many speeches on this has been very touching. I suspect it will receive unanimous support, at least I am hopeful it will.

In debate, a lot of members have been talking about related issues, such as the importance of palliative care and the need to do more in that area. To that extent, I would ask my colleague what her thoughts are on how important it is for the federal government to be working with provincial governments in dealing with some of the issues we have before us, including palliative care.

[Jenica Atwin, Green, Fredericton, NB]

Mr. Speaker, it makes me think about where I am in my life and what the future could possibly hold. I know it really comes down to that choice. I hope that at that point in my life, there is effective palliative care to ensure that I have the choice to live with dignity until the end, if that is what is best for me as an individual.

Absolutely, we need to do far more, and we need to collaborate with our provincial counterparts. This is a huge piece of why I also advocate for an increased health transfer for Atlantic provinces. We know we have an aging population. This is an issue we must confront, but the other piece is to ensure dignity in dying as well.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Speaker, my colleague across the way gave a great speech. I want to talk a little more about palliative care, as I am obviously a passionate advocate.

My mother passed away this past week, and she was fortunate enough to have excellent palliative care, as we do in Sarnia—Lambton. The government made a good beginning on the palliative care framework and starting down that path, but it has really not put a lot of muscle in it since then, especially during the COVID pandemic with so many people needing palliative care at the end. We need to have that to ensure people can make that choice.

I wonder if the member could share her thoughts on what the government ought to do to boost its efforts in this area.

[Jenica Atwin, Green, Fredericton, NB]

Mr. Speaker, my condolences to the member and her family on their loss.

This continues from what I have been saying, but I think it is important for us as opposition members to continue to hold the government accountable on some of these promises and initiatives. We hear great things in some of the speeches of members opposite, and in the throne speech, but we need to see the action in the legislation that correlates. I will certainly do all I can to push for better palliative care across this country.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Mr. Speaker, I thank my colleague from Fredericton for her comments.

My question is very simple. What would she like to see added to this bill? Does she think the bill goes far enough? How could we improve it to enhance the quality of end-of-life care for people who need it?

[Jenica Atwin, Green, Fredericton, NB]

Mr. Speaker, for me, one of the key issues that has been brought forward by constituents is the concept of irremedial mental illness and how this might impact people's ability to follow through with their wishes.

As an advocate for mental health supports, it is such an important question and I want to be really careful and clear. As I mentioned, co-occurring disorders often exist, and that should not be a reason for someone to not be able to pursue dignity in death when experiencing another physical illness. It is a very specific issue, and I hope to see that addressed and the legislation changed.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, it is my privilege to speak in the House today on Bill C-7, the medical assistance in dying act. This legislation was previously introduced in Parliament back in January, and I had the privilege of speaking to it in February. The bill died with prorogation, which occurred so that the Liberal government could avoid questions about the WE scandal. This bill would amend the original MAID legislation from 2016.

MAID is a very touchy, personal and non-partisan issue, and everybody has different views on it. I have asked my constituents and most of them are opposed to this legislation. I am opposed to it and, therefore, will not be supporting it.

The question arises as to why we are here today. I believe there are two examples of Liberal inaction that have brought us to this point. The first is that a judge in Quebec struck down the reasonably foreseeable portion of the bill, which is commonly known as the Truchon case. Typically, in a case with such profound and life-altering consequences for Canadians, the federal government would appeal such a decision from a lower court, but in this case it chose not to do that. It is an example of the inaction that has led us to this place. The government should have appealed it to get a ruling from the Supreme Court.

A second example of inaction is the legislative parliamentary review that was scheduled for this past summer. Obviously, COVID threw a monkey wrench into that, but we have more or less figured out how to live with COVID and get things done, so there is really no reason why that parliamentary review could not be ongoing. However, because of the Liberal inaction on that, the review has not happened.

What is the real reason for this inaction? I believe the current justice minister voted against the legislation originally, back in 2016, not because he did not agree with the legislation but because it did not go far enough in his view.

The Liberal government talks about consulting with and listening to Canadians, but the truth is that it has its own agenda and wants to push that. The truth is that it did not want the parliamentary review. It wanted something that was less. The truth is that it had its own agenda and simply wanted to implement it. The Liberals will talk about the consultations they had with different groups and the fact they had over 300,000 responses to their website and polls, but a consultation is a very different thing from a parliamentary review. Consultations are easy to manipulate. They can be ignored. They provide cover for answering the question, “Did you consult with people?”, as the government can say that it did. However, that is very different from a parliamentary review.

That is why we are here. It is the Liberal government's agenda. It is not about listening to Canadians so much.

What do I think about this legislation? Let us start with my constituents. In January, I sent out a mailer and since then my office has received over 400 contacts on this issue through phone calls, emails and letters. Two-thirds of those contacts are opposed to the legislation. I also received a lot of feedback on the rights of health care workers, asking if they have the right to say no to euthanizing someone. As this is an issue of conscience protection, are they free to not participate? Are they free of penalty or harassment?

Also, the conscience objection of institutions is another thing that must be protected, because an institution is far more than bricks and mortar. An institution is made up of the people and the values of those people who are invested in that institution.

Right here in Saskatoon we have St. Paul's Hospital. It is a Catholic hospital managed by the Catholic bishops of Saskatchewan. In our province, hospitals are allowed to choose which services they wish to perform. This hospital operates on the basis of the Catholic faith and has chosen to not perform MAID. The hospital respects a patient's right to choose, however, so if a patient wishes to have MAID, it will help transfer that patient to another hospital.

Instead of MAID, St. Paul's is very well known for its amazing palliative care. In fact, it is the only location in the city. My own mother-in-law was a patient there. In her case, MAID was not requested nor desired and she was fortunate enough to get one of only 12 palliative care beds in the city. She received amazing care as she came to the end of her life. Notice I said 12 beds. Since she has been in there it has added 13 more, so there are 25 palliative care beds for all of northern Saskatchewan, which just is not enough. In fact, 70% of Canadians do not have access to palliative care. I would hope that lack of palliative care would not force people into MAID as their only option.

I would also note that St. Paul's Hospital built its existing and new palliative care facilities all on its own and raised all the money to build the units. Is this not exactly the behaviour that we want to encourage? However, now, because of the lack of conscience protection, the hospital is being sued by activists to provide MAID. A hospital well known for amazing palliative care is forced to defend itself in court because it will not provide euthanasia.

I think that several Supreme Court cases are instructive here. In 2015, in the Loyola case, the court said, “Religious freedom under the Charter must therefore account for the socially embedded nature of religious belief, and the deep linkages between this belief and its manifestation through communal institutions and traditions.” In another 2015 decision, the Supreme Court said, “A neutral public space free from coercion, pressure and judgment on the part of public authorities in matters of spirituality is intended to protect every person’s freedom and dignity, and it helps preserve and promote the multicultural nature of Canadian society.”

We must respect the multicultural nature of Canadian society. We must respect both medical professionals and institutions, and allow them to have full conscience protection free from harassment and consequences.

As I said, MAID is a very touchy, personal and non-partisan issue. One can always find examples of people for whom MAID is a difficult but welcomed option. Unfortunately, those simple examples are the minority. Most often, it is far more complicated than that. The stories I have heard reflect these complications. I have heard of cases where families are caught by surprise and forced to deal with the aftermath, cases where a person is at a particularly low point in their health but under the legislation before us would be able to request and receive MAID with no waiting period, and other cases where physicians or hospital officials apply pressure on individuals to consider MAID.

I am concerned about the removal of the waiting period. Canadians with serious illness could receive a lethal injection on the same day they receive their diagnosis. I am concerned that people, in a time of very high stress, will make a life-ending choice. Many provinces have a cooling-off period for the purchase of something major, whether it is a car, appliance or something like that. A cooling-off period is there to prevent one from making a terrible decision. Does it not make sense to provide a cooling-off period before MAID? I mean, this is the most significant decision that a person could make.

Of course, there are specific cases where a waiting period is not required, but the current legislation already allows doctors to waive this waiting period. During COVID, we shut down our economy on the advice of doctors. Surely we can trust doctors to waive cooling-off periods if it is required.

I am very proud of our Conservative Party. The vote on Bill C-7 will be a free vote and not a whipped vote. Each of us Conservative MPs will be able to vote our conscience and, once again, I am going to be sending out a mailer at the end of this month to ask the people of Saskatoon West for their opinions. I will make sure that the House knows those results at third reading.

I am reminded of something that a constituent told me back in February. He said that we needed to slow this down, not speed it up. I agree with him. Yes, we need to deal with the Quebec court decision, but that only requires one change. Let us wait for a proper, legislated parliamentary review. Let us have a pan-Canadian strategy for palliative care. Let us put full conscience protection in place for physicians and health care professionals. Let us put conscience protection in place for institutions, and let us leave the 10-day waiting period and the ability to create exceptions the way it is right now.

I would like to slow this down.

[Ken McDonald, Liberal, Avalon, NL]

Mr. Speaker, the member mentioned palliative care in his speech and how the majority of his constituents are not in favour of MAID per se. Does the member believe that palliative care in itself is a form of MAID?

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, MAID is a very specific thing. Palliative care is a very different thing. Palliative care is natural. Palliative care is something that enhances the end-of-life position for a person.

The real issue with palliative care in Canada is the fact that 70% of Canadians do not have access to it. I believe there is a place for MAID in Canada, for sure, but I also believe that, as much time as we spend on that, we should spend even more on helping Canadians have access to good palliative care so that they have good options and a good way to live out the last days of their lives.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, my colleague's speech raised some concerns for me, particularly regarding terminology. When the term “euthanasia” is used, some specialists mean physician-assisted suicide. It is important to distinguish between suicide and medical assistance in dying. It seems to me that certain moral considerations are polluting the debate. As legislators, we have to put our obligation to respect individuals' choices ahead of these moral considerations.

Does my colleague not think we are limiting people's choices when we bring these moral considerations into play?

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, that is a very important point and I think it is at the heart of my concern about conscience protection. I believe different medical professionals and different individuals all have different opinions based on their backgrounds, faith and beliefs. We need the ability to provide the services Canadians want and need, but we also need protections for people for whom issues like this go against their conscience so that they have full protection in law not to be forced to do something that would go against their rights. It is very important that we allow for people for whom this is a conscience problem to have protection in law.

[Laurel Collins, NDP, Victoria, BC]

Mr. Speaker, the member called this a touchy issue and gave examples of people he had spoken to who oppose it. However, 300,000 people responded to the survey about this issue and a large majority, 86% of Canadians, support the Supreme Court of Canada's decision in Carter v. Canada, which recognizes medical assistance in dying as a right. Seven in 10 Canadians, 71%, support in some way the removing of the reasonably foreseeable requirement from the assisted dying legislation. Most Canadians know someone who has been affected by intolerable suffering at the end of their life. This bill would provide dignity to those who would not otherwise have it.

When the member talks about slowing down the legislation, how does he respond to people who do not have the time or who would live out their last days in intolerable pain?

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, this legislation does not provide that. The current legislation provides that. This legislation is simply changing and modifying the existing legislation. All of the things the member mentioned are in existence with the current legislation, with the exception of the reasonably foreseeable part. I do not have any disagreement with that. My disagreement is with the 10-day waiting period. I would like to see stronger protections of conscience, and I would like to see more focus put into palliative care.

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

Mr. Speaker, it is a privilege for me to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying. As parliamentarians, it is so important that we are mindful that the decisions that are made in this place have a real-life impact on Canadians, and the life-and-death implications of this particular legislation only make it more important that we approach it with great seriousness and sensitivity.

I approach this subject through the lens of placing tremendous value on every single person's life, and through my own deeply held conviction that every life is valuable and worthy of protection until the point of natural death. As demonstrated throughout this debate, we, as members of Parliament, hold diverse opinions on this subject and many of us approach it with deeply held convictions. The diversity of viewpoints is undoubtedly a reflection of the diverse views among Canadians.

Where I hope we can at a minimum find common ground, is on the importance of protecting vulnerable Canadians. That is why, to me, it is so important to have the opportunity to speak to this legislation: If that is our shared goal, there are significant areas where this legislation misses the mark.

This legislation takes many steps to broaden the eligibility for medical assistance in dying and removes safeguards that were previously put in place. While I recognize that this legislation is in response to the Quebec Superior Court decision in the Truchon case, the legislation introduced by the current Liberal government goes much further than the court decision required. We know that many Canadians were disappointed that the Liberals chose not to appeal the Quebec Superior Court decision to the Supreme Court of Canada. Among those who were vocal in their plea to the justice minister to appeal it were physicians from across Canada and many advocacy groups for Canadians with disabilities.

It is disappointing that the decision was not appealed, but perhaps it is even worse that the Liberals took this opportunity to make significant changes to the legislative framework of MAID prior to the mandated parliamentary review. The medical assistance in dying law that came into effect in 2016 required a parliamentary review of its provisions and of the state of palliative care in Canada. As you know, Mr. Speaker, this review was scheduled to start this summer. The significant changes proposed in Bill C-7 undermine the parliamentary review that has yet to commence. They also undermine our ability as parliamentarians to review changes to MAID with the full knowledge of a comprehensive review.

The Truchon decision struck down the “reasonably foreseeable natural death” criterion, but in considering the proposed legislation we are also considering many legislative changes outside the scope of that decision. We are putting the cart before the horse by forging ahead with fewer safeguards when the personal experiences shared, and the concerns raised by Canadians and relevant stakeholders, should give us all reason to pause in loosening safeguards.

We, as parliamentarians, have a responsibility and a duty to ensure that medically assisted deaths are not driven by lack of access to palliative care or by economic or social vulnerability. Ensuring adequate access to health care services and supports should be our number one priority. Palliative care is a main component of that. Through pain management and psychological, emotional and practical support, palliative care helps to reduce suffering and improves the quality of life for a person with a life-limiting illness. Ongoing gaps in access to, and quality of, palliative care in Canada need to be addressed. With an aging population, the demand for palliative care is increasing. As it is, there are not nearly enough health care providers who specialize in palliative care. If the existing gaps are not addressed, they will only grow.

A 2018 report by the Canadian Institute for Health Information found that while 75% of Canadians would prefer to die at home, only 15% of Canadians had access to palliative care or home-care services. Quality palliative care offers an individual facing a life-limiting illness dignity in living.

In addition to palliative care, we should also be looking at access to, and the quality of, other supports like long-term care, disability support and counselling. If we cannot first ensure dignity in living, there cannot be dignity in dying.

We know that medically assisted deaths are most common among seniors. While that might be expected, given the realities of aging, we must also acknowledge the potential for vulnerabilities. We owe it to Canada's seniors, who have helped build and shape this country, to ensure that they are cared for in their older years. We know that it is families and friends who most often take on the caregiving role. In fact, when options like palliative care are unavailable, caregivers step up to support them.

We need safeguards in place to ensure that seniors are not choosing medically assisted death because they feel like they are a burden on the health care system or a burden to their friends or their families. Ultimately, the best safeguard we can put in place to protect vulnerable seniors is to ensure that they have adequate and appropriate supports for a good quality of life. Without these, there is no real choice.

To help ensure that seniors, and any individuals for that matter, are not led to choose MAID out of concern that they are a burden, it is important that they do not feel pressured to do so. First-hand accounts from Canadians who have had medically assisted death suggested, without them seeking it, are extremely troubling. Offering MAID to someone who has not sought it sends a message. When a person is at a low point or in a fragile state of mind, prompting them to pursue MAID may suggest to them that their life is less valuable or has lost value. It might also suggest that they are a burden to society or to their family.

As legislators, we should be looking to ensure that no person is counselled or pressured into MAID. Unfortunately, the legislation before us takes a step further away from ensuring that, perhaps unintentionally. It does this by no longer requiring that there be two independent unpaid witnesses. If passed, it would require one single witness. This independent witness could also be a paid personal or health care worker. This leaves the door open for individuals to be presented with the option of MAID unprompted, in the presence of no other witnesses.

The same individual who counsels a vulnerable person to consider MAID could also serve as one of their independent witnesses. In a vulnerable state, a person could easily be made to feel that they are a burden, and that prompting could lead them to feel pressured to end their life. With the absence of a second witness, this decision could be made without the knowledge of the individual's family.

The proposed legislation also significantly broadens eligibility by allowing for advance consent. Advance consent would allow a medical practitioner to proceed with MAID without a person's consent immediately before administering it. While consent is deemed invalidated if a person demonstrates, by words or gestures, refusal or resistance to a procedure, this assessment is solely up to the practitioner administering it. This leaves space for errors. By solely placing that responsibility on practitioners, it does them a disservice, just as the absence of conscience rights for health care workers in the existing or proposed legislation does them a disservice as well.

There is a finality to death. We cannot afford to leave room for error. As legislators, we have the responsibility to think about how every individual will be impacted by this legislation, because every life is valuable. We have to be mindful of not reinforcing negative stereotypes about illness, age or ability. We cannot undermine suicide prevention efforts or devalue human life. We have to ensure that meaningful alternatives to MAID not only exist, but that they are readily available. Above all, we have to first ensure the protection of vulnerable Canadians. We cannot allow individual autonomy to outweigh their protection.

[Lloyd Longfield, Liberal, Guelph, ON]

Mr. Speaker, I thank the hon. member for her contribution this afternoon.

Earlier in her speech, she talked about our role as members of Parliament. I wonder if she could comment on the role of the court systems that are also looking at legislation we put forward, and then ruling on it when it comes back to us for review, and looking at how we could make our legislation align with the court systems that we have in Canada.

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

Mr. Speaker, this goes back to a speech I gave in this place earlier today, about not rushing things and making sure we take the time to listen to Canadians, stakeholders and experts.

Another good point that I mentioned in my speech is that there was supposed to be a review. The review has not happened. The Liberal government is bypassing that altogether.

Absolutely, COVID-19 has happened and things have changed a bit, but the review could have at least been started so that this legislation could then be tabled.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Mr. Speaker, I thank my colleague for his speech. I wonder if we are wasting our time today.

Yesterday, we were talking about conversion therapy, a file Quebec has been a leader on, but still has to wait for Ottawa. We are always trailing behind Ottawa because we are always waiting for Ottawa to get moving and get on board. Today we are talking about medical assistance in dying because a decision was made in Quebec, which is ahead of the curve there too. We have come back to Ottawa to work on this file again. If Quebec were independent we would not be wasting our time duplicating our work on these types of files.

I want to come back to my colleague's speech. Legislators did not do their job when it comes to former Bill C-14 on medical assistance in dying. That is why we are here today. We have to come back to this file because the Bloc Québécois's proposed amendments in 2016 to avoid bringing the courts into social and political issues were rejected. We are coming back to it today because a decision was made by the Quebec Superior Court.

I would like to hear what my colleague has to say about people who have a serious irreversible illness and are essentially forced to go to court. These people are already sick and have to fight the system to be able to access medical assistance in dying. Sometimes they even have to go on a hunger strike to be heard.

My colleague talked about dignity earlier. Does she see any dignity or humanity in putting people in this position?

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

Mr. Speaker, this goes back, again, to the fact that these matters cannot be partisan. These are matters of conscience. We need to be hearing from our constituents and making sure that our conscience is also reflected.

We cannot be bringing forward amendments and having them just be shut down because we are not from the governing party. We need to work together.

I believe every life has immense value. If we put funds and resources into palliative care, we could be in a different situation.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Mr. Speaker, I, too, have had several reflective conversations with constituents around the proposed legislation. I believe that we need to have thoughtful safeguards in place. I believe that the proposed legislation includes those.

My question is for the hon. member. I understand that a strong majority of Canadians support the direction this legislation takes us in. Notwithstanding the concerns the member has heard, I wonder how she understands that support among a majority of Canadians.

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

Mr. Speaker, I believe that in order to have dignity in living, we need to be able to have the choice. If medical assistance in dying is going to be an option that is readily available, and doctors or counsellors are prompting patients or clients to receive that, we should have adequate funding in our hospices and for palliative care, so that people can have choices at the ends of their lives.

[The Deputy Speaker, Bruce Stanton]

It is my duty pursuant to Standing Order 38 to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Vancouver East, Housing; the hon. member for Battlefords—Lloydminster, Telecommunications; the hon. member for Courtenay—Alberni, Indigenous Affairs.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I am pleased to join the debate today on Bill C-7, an act to amend the Criminal Code. Specifically Bill C-7 would amend section 241 of the Criminal Code, the provision that makes it illegal for a person to help someone else commit suicide. This section of the code was amended by the last Parliament in response to a Supreme Court of Canada decision in 2015, the Carter decision.

Bill C-14, a 2016 bill, stated that one of its objectives was, “permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance.” I would agree with that. The relevant operative provision in the act then sets out the criteria for determining whether a person qualifies for MAID, including that with respect to that person “their natural death has become reasonably foreseeable, taking into account all of their medical circumstances.” However, all of this is about to change if the government has its way with the current draft legislation, Bill C-7.

I am speaking to that bill because I have been encouraged by many of my constituents. Admittedly I have received some letters in support of the government's initiative to expand the reach of MAID, but the vast majority have encouraged me to speak in favour of leaving the law as it is or further restricting access to MAID.

The correspondence I have received in favour of keeping up the safeguards fall into two categories. First, the reasonably foreseeable death safeguard should stay in place. Second, more should be done to expand palliative care services. It was pointed out to me by many that many seniors and other people with serious diseases did not have good ready access to adequate palliative care.

I will quote Rebecca, one of the letter writers, “Let Canada be a society that is known for its modern and advanced palliative care services and not as a country that has ever-expanding use of MAID.” As a proud Canadian, I agree with that statement.

What is behind the current Bill C-7 is the 2019 Quebec Superior Court decision in Truchon. The plaintiffs in that case challenged the constitutionality of the then three-year-old law, arguing that their charter rights had been violated. The federal government, acting through the Attorney General's office at that time, did the right thing. It defended the law, which is what we would expect an Attorney General to do for Canada's laws.

The AG argued as follows, setting out the three main objectives of Bill C-14, which are still relevant today or at least they should be.

First, it is important to affirm the inherent and equal value of every person's life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled. Second, suicide is a significant health issue. Third, vulnerable people must be protected from being induced in moments of weakness to end their lives. I think we would all agree with that.

However, the Quebec court did not. It refused to accept the first two principles as representing the objectives of the law. It said, “the Court cannot accept the two first objectives advanced by the Attorney General regarding the affirmation of the inherent and equal value of every person’s life and the importance of preventing suicide.”

Having thrown aside those principles, it was easy for the court then to decide that the law needed to be changed. Remarkably, the current Attorney General did not appeal that decision. Instead the Liberals are now hastening to amend the legislation to eliminate the reasonable foreseeability of death safeguard.

With the reasonable foreseeability of death safeguard down, this is what we now have left. First, the applicant for MAID has a serious and incurable disease, illness or disability. Second, they are in an advanced state of decline. Third, their psychological or physical suffering is intolerable to them, which is completely a subjective test.

For example, people with Parkinson's, or MS or quadriplegic patients would check off all those boxes. If they had psychological suffering on top of that, they would be eligible for MAID.

Under this new regime, if it becomes law, people who are not dying but who meet all the other criteria will satisfy the requirements for state-sanctioned assisted dying.

I want to reiterate what Rebecca from my riding said. She said, “Let Canada be a society that is known for its modern and palliative care services and not as a country that has ever expanding use of MAID.”

I know the law will be amended. It must be to satisfy the Truchon decision. However, I will point out four things that I hope the committee will take into consideration in improving Bill C-7.

My first point is that the 10-day reflection period for the track one patients, those whose death is reasonably foreseeable, should come back. It should be there. That was not a requirement of Truchon and I do not believe that Bill C-7 is improved by taking that10-day reflection period out. For track two applicants for MAID, people whose death is not reasonably foreseeable, there is a 90-day reflection period, and I agree with that.

The second point I want to make is about the 90-day reflection period. I agree with it, but the wording is inadequate. I would recommend to the committee that it amend the 90-day reflection period clause to be the same as the 10-day reflection period clause, but with the necessary change in wording.

My third point is that Bill C-7 would reduce the number of witnesses required for a patient's written directive for MAID. There is absolutely no requirement for that at all and it is certainly not an improvement. Many of the legal documents, including last wills and testaments, require two witnesses as a safeguard against coercion and that should be maintained.

The fourth improvement is that the provision in Bill C-7 saying that a patient's request for MAID must be voluntary without coercion should be expanded to prohibit the attending physician or other health care professional from being the first to raise the availability of MAID option. MAID should never be presented as just another option because in some circumstances, that in itself, would be coercive.

When Bill C-7 was first introduced into the House back in January, COVID-19 had not hit us yet. Since then, many seniors have died of this virus and many others are in isolation. I have seen first-hand the devastating effect isolation has on the mental and physical well-being of seniors, my father-in-law included, as it would for any person. We are created to be social creatures after all.

As my constituent Sarah told me in a very thoughtfully drafted, “[Bill C-7] will put many elderly Canadians, isolated and lonely in their long-term care homes, at greater risk of being considered eligible for MAiD. That is not how we should be caring for our seniors!”

Let us use our experience with COVID-19 as a lens to have a very careful review of this draft legislation to reconfirm our commitment to value life and to build as many safeguards as we can around our most vulnerable citizens.

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

Mr. Speaker, since November or December of 2015, there has been a great deal of debate on the important issue of medical assistance in dying. At the beginning of 2020, a massive input was solicited. We received input from Canadians in all regions of the country, over 300,000 Canadians. There has been ongoing consultations, discussions and debates over the last number of years.

The bill before us is because of a court ruling. After the legislation has passed, it does not prevent us from continuing discussions on this. I wonder if the member would recognize that this is something we are not only being compelled to do, but in fact it is the right thing to be doing at this time.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I realize and confirm that we are being compelled to do this. Sadly, that is true. The Attorney General, in my opinion, should have appealed the Truchon decision. It should have gone to the Supreme Court of Canada. It would have been given a very fair hearing there and it also would have given Parliament the opportunity to review the legislation as we were scheduled to do.

As for consultations, I do not think any consultations would forestall us from putting in the safeguards that I am suggesting, the 10-day reflection period, keeping the two witnesses in place and clarifying some of the language around the—

[The Deputy Speaker, Bruce Stanton]

Questions and comments, the hon. member for Jonquière.

[Mario Simard, Bloc, Jonquière, QC]

Mr. Speaker, in my opinion, in his presentation my colleague regrettably confused two concepts, and in doing so, has made it difficult for parliamentarians to have a clear picture of medical assistance in dying.

First, he confuses medical assistance in dying with suicide. In my opinion, suicide is a permanent solution to a temporary problem, which is a phrase we often hear. A person who commits suicide is someone who may have a future but who, unfortunately, commits a fatal act in a moment of despondency. That is not the case for those who resort to medical assistance in dying.

Even more significant is the troublesome confusion of medical assistance in dying with palliative care. Palliative care already exists in our health care system. If it were better funded, we might perhaps have access to better palliative care. However, I believe that medical assistance in dying has nothing to do with palliative care.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I will start with the second question first. I agree that more money and resources should go to palliative care. People should be given a real choice. If the choice is between intolerable suffering or seeking medical assistance in dying, that is not a real choice.

As for conflating medical assistance in dying with suicide, the point that I was making was that Bill C-14 amended section 241 of the Criminal Code, which is the provision dealing with suicide.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, very few subjects in federal politics are more sensitive than the one before us today as parliamentarians. Of course, this all comes from the Carter decision by the Supreme Court of Canada that Canadians had a constitutional right to access physician-assisted death. Therefore, our job is to craft the best possible system to facilitate that right while we ensure there are the proper protections.

My question is about one of the challenges created by the current medical assistance in dying legislation, which is the requirement for final consent at the time assistance is rendered. This sometimes forces those already assessed and approved for medical assistance in dying to make a cruel choice when faced with the possible loss of competence that would then make them unable to give consent, with the result that they are forced to go earlier or risk not being able to receive the assistance they need to avoid continuing to live with intolerable pain.

I wonder if my hon. colleague has some comments on how the government ought to best deal with that situation.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I agree with the hon. member that this is probably one of the most difficult and sensitive questions in this whole legislative framework.

Whose decision is it when it is the right time to inject a lethal substance? If it is not the person receiving it making that final call, whose call is it to decide when the right time is to do it? It is equally difficult the other way.

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

Mr. Speaker, I will read a post by a well-known physician in Ridge Meadows Hospital in Pitt Meadows—Maple Ridge. It states, “I personally have had a patient undergo MAID who would have had a very good chance of living for 5 or more years. The quality of care and the decision to administer MAID was very questionable in my view and when I contacted the coroner to request a review was told that these cases are not reviewable by the coroner's service. Where is the oversight?”

Would the member comment on oversight? A lot of these have been taken off.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, that is a very good and important question, but there is no easy answer to it. Of course, there is patient confidentiality, so that information would not be readily available to the public because it was a decision that a patient made in consultation with their doctor.

I would say to keep the 90-day reflection period in and clean up the language to make it much clearer so that doctors and other health care providers understand what the guidelines are. Right now it is too confusing.

[Stéphane Bergeron, Bloc, Montarville, QC]

Mr. Speaker, I have to say that I am very happy to be participating in this debate, not because it is an exciting or joyful topic, but because it is nevertheless a crucially important social debate.

The constitutional distribution of power means that we can talk about one issue in both legislatures. I had the immense privilege of sitting here for 12 years, then sitting in the National Assembly for 13 years, and then coming back here on October 21 of last year. I have had the opportunity to discuss issues relating to same-sex marriage, the subject of a civil union bill in Quebec. When I was an MP, I had an opportunity to talk about gun control. As minister of and official opposition critic for public safety, I debated a gun registry bill in Quebec. When I was an MNA, we talked about end-of-life care and medical assistance in dying. Now I am back in Ottawa, where we are discussing medical assistance in dying once again.

We have heard plenty of relevant arguments on both sides, extremely well-thought-out legal arguments as well as moral arguments.

I do not normally do this in the House, but my speech will be far more personal than usual, because this moral issue is close to my heart.

First, I would like to point out that I am a man of faith. I am Catholic; I was baptized and raised Catholic, but my convictions go much further than that. I do believe that a higher power created the universe, because there is no other way to explain creation other than by that sort of demiurgic form that created the universe. Some have a name for this higher power; others have several names. I think we are all talking about essentially the same thing.

Some people invoke their beliefs, their faith, to say that it is wrong to end a life. I have something to say about that, since it is part of my Catholic upbringing: we should live our lives to the very end, no matter how much we suffer. However, I refuse to believe that the Creator wants his creatures to suffer. I simply cannot bring myself to believe that, first of all.

Secondly, I like to think that if there really is a Creator and he expects certain things of us, then is it not up to each and every one of us to stand before our Creator when we leave this earth and not interfere in other people's lives and the choices they have to make?

It is not for us to determine the choices individuals make. Life is fair in that the same outcome awaits us all, but it is unfair in that the outcome does not await us all in the same way. In some cases, the outcome is gentler, in other cases it is marked by incredible suffering. In some cases, the outcome arrives more quickly and in other cases, much later. The outcome might be the same for everyone, but it is not equitable for everyone and each and every one of us will have to endure suffering to varying degrees.

I can understand some people saying enough is enough, they have had it. Since the outcome is inevitable, if the person no longer wants to suffer, why would we allow them to continue to suffer and even force them to continue to suffer?

I believe that if our faith means something, it must let us be compassionate. To be compassionate is not to watch someone suffer and relish their suffering because we want them to live it to the end, but, on the contrary, to support them in whatever choice they make. If they choose to leave this earth earlier to put an end to their suffering, which will lead them to this inevitable outcome anyway, I think that our duty as believers, human beings and political decision-makers is to support this person's choice and decision.

That is why, as a believer, as someone born and educated as a Catholic, I call on this faith and education not to oppose end-of-life care and medical assistance in dying, but to encourage it, to ensure that it is made possible. In fact, I believe that our role is not to judge what someone else wants to make of their end of life, but to support them in the decision they make for themselves for their end of life.

I said somewhat the same thing as what I just said before the Quebec National Assembly when I was a member there. When I expressed this opinion at the time, it generated a lot of interest from the bishop of the diocese in Saint-Jean-Longueuil, where I live. Bishop Gendron invited me to dinner at his home, where we ate spaghetti and talked a little bit about all of this. He wanted to understand where I was coming from as a Catholic to say that I was in favour of medical assistance in dying. I told him that I was in favour of abortion for the same reasons. My Catholic beliefs are what led me to be in favour of abortion because, if it is true that the Creator is opposed to abortion, then it will be up to the individual to stand before our Creator and give account when she leaves this world. It is not up to us to judge that woman or to impute motives that will make the already difficult decision of having an abortion even harder for her.

Similarly, I was proud to vote in favour of same-sex marriage in the House. I told my bishop that I could not believe a religion that emphasizes love so much would refuse to accept that people love each other.

Because of my Catholic convictions and my faith in our shared humanity, I believe that we must not judge others' choices, whether we are talking about love lives, terminating an unwanted pregnancy or unbearable suffering. It is not up to us to judge these choices. Our role, as human beings, as decision-makers, is to support these people's choices.

I touched on this at the beginning of my speech and I want to close in the same vein: The people of Verchères, and now Montarville, have entrusted me to represent them, and I have had the immense privilege, during my wonderful career, to be able to speak to certain social issues that are at the very core of what I just mentioned, specifically that we all have an obligation to support others and refrain from judging them.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Mr. Speaker, I enjoyed listening to the presentation by my colleague from the Bloc Québécois. It is not very often that I find myself agreeing with just about everything he said.

I ask the member for his thoughts on what I am hearing from the majority of my constituents. They support medical assistance in dying but are asking that we look at going somewhat further, with things like advance consent for when people are no longer of sound mind and cannot make a medical decision. I would like the member's impression on whether or not that is something we should be allowing sooner rather than later. Also, how can we get the government to undertake this study immediately?

[Stéphane Bergeron, Bloc, Montarville, QC]

Mr. Speaker, I thank the hon. member for his question, because it allows me to address another issue, one that is just as important as what I talked about in my speech.

If one detects early signs of a degenerative disease, such as Alzheimer's or Parkinson's disease, for example, should that person not be given the opportunity to indicate in advance, like a kind of living will, what their intentions are regarding how to move forward when they might no longer be able to make an informed choice?

I must say, I am pleased that the government decided to introduce this legislation, because, let's admit it, the previous one was too restrictive and some people think that even this one is too restrictive. Perhaps we should start thinking about expanding it even further, as the Government of Quebec is doing with its legislation.

[Lenore Zann, Liberal, Cumberland—Colchester, NS]

Mr. Speaker, I want to thank our hon. colleague for his passionate speech. I found it informative and extremely emotional. As somebody who was brought up as a Catholic as a young girl, I too feel people should have their own choice as to how they end their life if they are in great pain and suffering.

What would my hon. colleague say to our colleagues on the floor who are having trouble with this bill because their constituents have said it could be used the wrong way to perhaps put people to death who are having some kind of problem? What would he say to those people so they see his perspective?

[Stéphane Bergeron, Bloc, Montarville, QC]

Mr. Speaker, again, I think that is an extremely legitimate concern.

We cannot allow people to be euthanized based on a consent that might not reflect their true intentions. That is why it is so important to bring in parameters and safeguards that allow us to be sure of the person's consent.

Once informed consent is clearly expressed, whether in advance, as I mentioned a few moments ago, or in the present-time situation, I believe we must respect it. I believe this is a legitimate concern and we need these parameters to help us be certain of the informed consent of the person choosing to end their life.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Mr. Speaker, I would like to thank my hon. colleague for his articulate and passionate speech. I only wish that my French was better so I could hear its full impact. His words about the duty not to judge but to support and honour people's choices had a particular impact.

I had the honour recently to sit with some constituents, and I heard their deeply held concerns about medical assistance in dying. While my party and I support the bill, I wonder sometimes when speaking with these individuals whether at the heart of this is an unreconcilable conflict between beliefs and perspectives when it comes to the end of life.

[Stéphane Bergeron, Bloc, Montarville, QC]

Mr. Speaker, I sincerely believe that, in most cases, apart from the legal arguments, people's reservations about this issue and their resistance to the idea stem from moral arguments. That is why it was so important to me to express my point of view, however humbly among my fellow MPs, which is that I support MAID for moral and even religious reasons, just as I support abortion and same-sex marriage.

I understand why people who oppose MAID for moral reasons have those reservations. They truly believe it is a sin, but that sin, if it really is a sin, is on the part of the individual, who must bear responsibility for it when brought before their Creator. It is not society's or the community's sin; we are not responsible for the choices of others. Each person must take responsibility for their own choices.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Mr. Speaker, today I am pleased to present my maiden speech to advocate on behalf of those who cannot advocate for themselves. It is truly a privilege to be a voice for them. Some of them will even be voices from beyond the grave.

I call on my colleagues today to truly stop a moment and hear the cri de coeur from those who are still among us and from those calling to use from the next life. They should take a moment to listen to what we here in the House have done to destroy the value of their lives, to exclude them from society and to encourage them to exit the stage rather than wait for the curtain to fall once the final act is finished.

I will begin by introducing members to Roger Foley. As a young man, Roger was a musician and creator. He loved life, and it showed. However, in his early thirties, Roger was diagnosed with cerebellar ataxia, a debilitating disease that has stolen away his physical abilities one function at a time. Roger is now completely reliant on care providers for every necessity of life.

In the summer of 2018, after almost dying from a life-threatening case of food poisoning he contracted in long-term care, Roger was trying desperately to access funding for patient-directed care to hire and train his own consistent caregiver in his own home, as opposed to living in a hospital or in long-term care with rotating staff who do not understand his specific care needs. Members may remember Roger as the man who recorded his caregivers offering him euthanasia as an easy way out of his suffering. As we heard in the recording, the nurse says, “You don’t have to do it in some dramatic manner. You can apply for assisted—you know.” The nurse could not even bring himself to utter the word “euthanasia”, yet there he was, against Canadian law and all moral and ethical standards, offering a desperate man an easy way out. It was problem solved. However, Roger is a fighter, and even though he was overwhelmingly desperate, Roger decided he wanted to fight this injustice on behalf of himself and all our vulnerable brothers and sisters.

Roger's path intersected with mine early this year at the beginning of my time on the health committee. In preparation for a study on palliative care in Canada and a review of the euthanasia regime, issues that I thought would soon be on the table for discussion, I reached out to him and his lawyer for his perspective as someone within the system. I finally had a chance to speak via telephone with Roger while he was in Victoria Hospital in a private ward getting good care. While not in his preferred setting of his own home, I found him to be very open and engaging. His knowledge of the issue of euthanasia and the danger it posed for the vulnerable was enlightening. Just before we hung up that night, I said to Roger, “I wish you were on the committee because you are so much more equipped to speak to this issue than I am”, and we agreed to speak again soon.

Then COVID-19 hit, and Roger Foley's world changed completely. Roger was repeatedly transferred between units where there was little room for lift equipment and insufficient staffing for his specialized care. Living at the mercy of care attendants who are pressed for time was agonizingly difficult. Roger has very little in his life that is in his own control, but one thing he can do is swallow when offered food, with a certain technique. His head needs to be tipped at just the right angle, and the spoon needs to be offered in just the right way. For Roger, the ability to swallow affords him a feeling of independence. It may seem like a little thing to us, but to Roger it means a whole lot.

When the hospital wanted to feed him with a feeding tube to minimize the care hours required, his mental health took a turn for the worse. On May 15, Roger's brother filed a complaint with the ombudsman on Roger's behalf, yet things just got worse. Roger was suddenly informed that he would be transferred to the long-term care facility that had led to his original food poisoning and hospitalization. Understandably, Roger refused the transfer, begging instead, if not allowed self-directed care, to go back to his original unit, where staff knew him and his needs well. The hospital ignored his request, insisting that it was not safe for him because of COVID and that he needed to transfer.

The night before the transfer was to take place, Roger became completely desperate. He had not been sleeping, due to his fear and anxiety of being transferred. He became so distressed that he told his caregivers that he would throw himself off the gurney if they tried to transfer him the following morning. With no hope of help in sight, Roger reached out to his brother. His brother reached out to his lawyer. His lawyer reached out to me.

That evening we spent three hours on a conference call with Roger, encouraging him to be positive, to keep up the faith and to stay the course on behalf of those in the disabled community who would not have his strength and courage. All the while, I was attempting to contact the hospital administrators on another phone to beg them to back down and to warn them that Roger was possibly suicidal and needed them to reconsider for his mental health's sake.

Suddenly, I could hear on the phone in the room with Roger a new voice. The voice introduced herself as the hospital's mental health personnel, there to administer the 10-question suicide checklist on Roger. She began with her first question, attempting to gauge his distress level. Roger told her that he had no intention of answering her questions, since it was her and her bosses' fault he was in so much distress. She tried over and over, and he refused until she finally left the room in a huff.

The House heard me right; the mental health professional was so annoyed that Roger refused to answer her suicide checklist, she left the room and never returned. I was absolutely dumbfounded on the other side of the line, sitting helpless in my office in Langley. All these able-bodied health care professionals were able to leave the room freely. Everyone could leave as they pleased, except Roger. Roger was trapped.

When we finally got some assurances that a trusted doctor would come and talk to Roger, and it encouraged him to try to rest, I hung up the phone, I had no idea what was going to happen in the morning. I was helpless, but not nearly as helpless as Roger. I can tell members that it was with great relief in the morning that Roger had indeed received an intervention through a trusted doctor and was getting proper care and nutrition. However, this event was a life changer for me. It dawned on me that without the help of his lawyer, who stayed on the phone with us the entire time, Roger's story may have ended quite differently. I wondered how many others in the country are at risk under this new MAID regime. How many vulnerable disabled are offered euthanasia when they are at their weakest? I made it my mission to find out.

What did I find out? I found out that Roger's case is by no means an isolated case. We can see this sort of abuse happening across the country. Take, for example, Jonathan Marchand: 43 years old, suffering from muscular dystrophy and living confined to bed in a nursing home in Quebec. He produced a video from his hospital room which he released on YouTube in response to living in long-term care during the pandemic. Jonathan states, “Increasingly, euthanasia is offered as a solution to institutionalization. The idea is if you don't want to go into a long-term facility and die a slow death, then we are going to help you kill yourself. And those ideas are based on false assumptions about people with disabilities - like our lives are not worth living, that it's better to be dead than to have a disability - but it's not true!” He says that he decided that he would not go ahead with euthanasia, but would fight to get out of that place. Jonathan said, “In a world where there will be no empathy for people who need more help, it would be terrible. It would be something out of the nightmare of the Third Reich.”

Bill C-7 is an absolute nightmare that is facing disabled Canadians. Many are already afraid to go to hospital for fear they will be treated differently from the able-bodied. With the implementation of MAID in 2015, the community braced itself for the slippery slope ahead. Everyone said they were just overreacting. They said that safeguards were in place and euthanasia was meant to be safe and rare. We jump to 2020, and here we are racing down the hill at breakneck speed. In consultation with the disabled community, they have expressed firm opposition to this bill.

They explain that with the wording of Bill C-7, the Liberal government is proposing to set up two lines. Line one is for the able-bodied, who, in times of extreme distress, will be offered suicide prevention. Line two is for the disabled, who, in moments of weakness that they all endure as life ebbs and flows, will be offered assisted suicide, because their lives are not worth living, they are told. Add to all that the fact that current safeguards have already been proven completely ineffective. There is a complete lack of accountability structures to ensure abuses do not occur, and yet we are being asked to loosen restrictions even more. Where is the palliative care that was promised? Where is the review that was supposed to have happened? What are the Liberals afraid of finding out? Is it that in actual fact MAID has led to coercive deaths across our country, which go on undetected daily?

I stand here on behalf of all those who cry out for compassion and dignity as they travel a very tough road filled with complex care needs and physical ailments that require far more from us as a society. I stand here as the voice of Roger in Toronto, Jonathan in Quebec, Raymond Bourbonnais, Candice Lewis, Sean Tagert, Archie Rolland and so many more who we may never know.

“Lean on me.” That is what I want all of us to say here in this House—

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

We are unfortunately out of time.

Questions and comments, the hon. parliamentary secretary.

[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 appreciate the member sharing her thoughts and in particular highlighting some individuals. Part of this debate, from its origins five or six years ago, was the citations from real people about what is happening in their lives. We have looked at those as well as the court decisions that have taken place, and listened to the literally thousands of Canadians throughout the country who have had the opportunity to participate and provide information. We are talking about hundreds of thousands of Canadians who have provided input.

I believe the legislation before us is fairly good, in that it puts us in a place where the bill can be sent to committee and the member can hopefully get some of her concerns addressed. I am wondering if the member supports the bill being sent to committee, at the very least, to hear some others' thoughts and maybe get some of her questions answered.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, a recent statement was penned and signed by over 800 physicians in Canada in response to Bill C-7. Only 25 people are required to sign a petition for it to be recognized, so when a document is presented with 800 signatures from experts in a relevant field, the House should pay close attention to what that document says. Let me read—

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

My apologies to the hon. member, but the time is up.

It being 5:30 p.m., the House will now proceed to the consideration of Private Members' Business as listed on today's Order Paper.

The House resumed from October 27 consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[The Speaker, Anthony Rota]

Before continuing, I wish to inform the House that because of the deferred recorded division, Government Orders will be extended by 43 minutes.

Resuming debate, the hon. member for Brampton Centre.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, our government acknowledges that medical assistance in dying is a complex and deeply personal issue. I would like to take this opportunity to thank the hon. Minister of Justice and Attorney General of Canada for his extremely hard work with respect to the bill. Our government has respected the court's decision and has made more than the necessary changes in the legislation.

The conversation around death can be an extremely difficult one in our society. We understand and acknowledge the deep feelings and emotions that arise when a loved one is suffering intolerably from an illness, disease or disability. To discuss a fundamentally moral issue such as this one, the need to consult with people was a necessary decision. Over 300,000 Canadians from all over this great nation and from different cultures, races, creeds and backgrounds were directly involved in the January 2020 public consultation process. Not only were these consultations vital, it was a strong call to Parliament as to how important this issue was for Canadians.

Initially, the minister, along with several other distinguished members, held round table discussions across Canada with over 125 experts and stakeholders. Furthermore, we have asked for a special extension to allow for a fruitful and powerful parliamentary debate on this topic. The debates that we as parliamentarians have had on medical assistance in dying since 2015 have been filled with emotion and passion, as a debate should be in the House. I am very pleased today to be part of this very important debate.

One of the great challenges of being a parliamentarian is not only having to reflect on our own moral considerations and carefully examining legislation such as the one before us today, but also to make decisions that fundamentally address Canadians and the changing moral landscape.

Today, I speak in support of the bill. I believe strongly in an individual's right to die with dignity and respect. The issue of moral integrity and an individual's right to autonomy must be protected at all costs. As many of my hon. parliamentary colleagues have noted in the debate, currently many Canadians are suffering intolerably. The tragedy is that death is the only way to ease such suffering in a number of these cases.

I would like to take this opportunity to acknowledge and quote the wise words of critical care and palliative staff physician James Downar, at the Toronto General Hospital, who stated:

I think it’s important to recognize that there are types of suffering that we do not have the ability to treat. There are dying patients who have a very low quality of life from their perspective, and sometimes only death would end their suffering.

In the bill, we also acknowledge the concerns about an increased risk where medical assistance in dying is provided to persons who are not dying in the short term. That is why we have proposed additional safeguards to ensure that sufficient time and expertise are devoted to exploring requests for persons whose natural death is not foreseeable.

As I mentioned earlier, medical assistance in dying is an extremely difficult topic. However, in consultation with our experts, the Canadian community and, more specifically, those individuals who are suffering from intolerable conditions, diseases and disabilities, the right to die with dignity and respect, as outlined in Bill C-7, must be protected at all costs.

I look forward to engaging with hon. members further on this very important topic.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Mr. Speaker, I would note that the government House leader was not in his seat. I was relying on him to maintain the comments and questions today.

I really appreciate the member's intervention. Is the member not concerned about conscience rights for individuals and organizations that provide end-of-life care?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, our law acknowledges the conscience right of health care providers and the role they may play in providing medical assistance in dying. The amendment proposed in Bill C-7 has many changes to this effect. Our government will remain committed to working with the provinces and territories to support access to medical assistance in dying, while respecting the personal conviction of health care providers.

[Denis Trudel, Bloc, Longueuil—Saint-Hubert, QC]

Mr. Speaker, I thank my colleague for his speech.

I have a simple question. Bill C-7 is very important, and all of the questions it raises are very delicate. However, right now, there are people who are expecting us and the federal government to pass legislation.

Does my colleague not agree that we could have used the five weeks during which the government prorogued the House to pass this bill and respond to the wishes of those who are waiting on the federal government so that they can take the next steps?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, I acknowledge what the member has said. This legislation is very urgent. Medical assistance in dying is a very complex and deeply personal issue, as the member has already stated. The sad reality is that death is the only way for many people who are suffering. We have tried our best by way of consultation all over Canada. People from different cultures, races and backgrounds were directly involved in the January 2020 public consultation process. The minister along with several other distinguished members held round table discussions across the country with 125 experts and stakeholders.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, I am pleased to see the member for Brampton Centre standing and speaking on this. I wonder if he would agree with me, though, that there is a task that we have left undone here. The original legislation required a review of the broader issues around medical assistance in dying and this review has yet to start.

I put a motion on the Order Paper suggesting that committee be established without delay. Would the member support setting up such a broad review?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, the issue at hand today is very delicate. Everybody knows that. This needs to be discussed at length. For everyone listening to this debate, those who are in Parliament deliberating this issue are taking deep steps to resolve all the issues so we can bring back legislation, and in front of the public.

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, I appreciate this opportunity to outline the proposed amendments to the federal legislation on assisted dying. This bill responds to the Superior Court of Québec's ruling last year in Truchon by removing the requirement that a person's natural death be reasonably foreseeable in order to be eligible for medical assistance in dying. The proposed amendments were developed with the goal of supporting autonomy and choice for those Canadians with non-terminal conditions who are suffering intolerably, while addressing the potential risks of expanded eligibility for medically assisted death.

Our government consulted widely on this issue. We examined the evidence submitted before the court. We looked at domestic and international research. We compared our experience to other assisted dying regimes from around the world. We consulted with constituents, including 300,000 individuals who took part in our online public consultation, and we asked health care professionals about their practical experience with MAID over the past few years.

The bill reflects some important changes based on what we heard. In light of the need to respect the autonomy of Canadians seeking MAID, while providing protections for vulnerable people, the bill proposes the application of a two-track system of safeguards. While the bill no longer uses a reasonably foreseeable natural death as a basis for determining eligibility, it does use it as a basis for determining whether to apply a more rigorous set of safeguards. If a person's death is reasonably foreseeable, a set of safeguards akin to the existing regime would apply. However, some of the original safeguards have been eased in light of the feedback we received.

For example, there was overwhelming support for changing the witness requirement from two witnesses to one. Providers consistently reported that finding two independent witnesses posed a barrier to those seeking MAID, especially for anyone living in a care home with a limited social network. The sole purpose of the witness is to confirm that a person seeking MAID has signed the request themselves. To be clear, the witness has no role in confirming whether the request was made voluntarily, nor does the witness have any role in assessing whether the person's condition makes them eligible for MAID. Rather, it is the MAID provider who undertakes the eligibility assessment and ensures that the person requesting MAID is making the request freely and not in response to external pressures.

The proposed bill responds to these concerns and eases this requirement to one witness. It also allows for a witness to be someone who is paid to provide personal support or health care services. Anyone who is in a position to benefit in any way from the person's death, as a beneficiary to a will or in any other material way, would not qualify as an independent witness.

Health care providers and the families of people who receive MAID also told us that the mandatory 10-day wait period often results in prolonged suffering for individuals who had already put careful and extensive thought into their decision. As a result, the proposed bill would remove this requirement.

I would like to address how the bill would protect Canadians, while satisfying the requirement from the Truchon ruling to eliminate the reasonable foreseeability of natural death clause. On this issue, we received feedback from practitioners and stakeholders who expressed concerns that people who are suffering but not at the end of life could make decisions about MAID that are not fully informed with respect to all available treatments and supports.

On this very sensitive subject, I consulted with my own constituents in Mississauga—Streetsville. I found one of the strongest proponents of these MAID reforms in Mr. Paul Irwin, who suffers from Parkinson's disease. Although this horrible affliction is slowly robbing Mr. Irwin of his neurological functions, I can assure the House that his mind remains razor sharp. Mr. Irwin has explored all available treatments and supports, and he has consulted a wide range of medical professionals. There is no doubt in Mr. Irwin's mind that he would like to control when and how he passes as a recipient of MAID. It is not a decision that individuals in Mr. Irwin's circumstances take lightly or without having weighed all alternatives. I applaud Mr. Irwin's courage.

In order to afford individuals like Mr. Irwin the dignity they deserve, we have added safeguards in lieu of foreseeable natural death that would apply only to requests where a person's death is not reasonably foreseeable. These strengthened safeguards are designed to support informed decision-making and the consistent application of good medical practice. For example, the bill proposes a 90-day minimum assessment period to offer an exploration of all relevant aspects of the person's situation.

We heard very clearly through the consultation process that Canadians are concerned about implementing a requirement for specialist consultations in assessments of MAID. We know that in some parts of the country, such as rural and remote communities, a consultation with a specialist can be harder to arrange. We do not want to create unnecessary barriers. This is why the bill proposes that, for people whose death is not reasonably foreseeable, one of the assessments will be done by a provider with expertise in the person's medical condition but not necessarily a specialist. We recognize that many health care providers have special training and certifications that qualify them to assess a person's particular medical circumstances, even if they are not specialists.

The bill also proposes that the practitioners and the patient would need to agree that reasonable options to relieve the patient's suffering had been seriously considered. This safeguard respects an individual's autonomy, while at the same time underscoring the importance of a fully informed, decision-making process.

In addition, following the Truchon decision, some have expressed concerns that individuals suffering solely from a mental illness could receive MAID. For example, many clinicians argue that the trajectory of mental illness is harder to predict than that of physical diseases, rendering it impossible to determine when or if a mental illness can be considered irremediable as required by MAID legislation. Another concern is the challenge of conducting capacity assessments, given that the symptoms of mental illnesses can affect a person's ability to understand and appreciate the nature and consequences of treatment decisions.

In light of these important concerns, the wording of the bill would preclude individuals suffering solely from a mental illness from accessing MAID. The decision to include this wording reflects the complexity of this problem and the need to fully consider the potential consequences of permitting MAID for individuals with a mental illness to make sure that vulnerable persons are not put at risk. We anticipate that this issue will be further explored as part of the parliamentary review.

I would now like to turn my attention to the waiver of final consent.

The current law includes a procedural safeguard that requires the practitioner to ensure that the person gives their express consent immediately before providing MAID. This is often referred to as “final consent” and is significant for health care providers as it provides a final confirmation of the person's desire to proceed with MAID. This safeguard also prohibits MAID for individuals who have lost the capacity to provide final consent, regardless of how definitive they were about their intention when they had capacity, made the request and were deemed eligible.

Unfortunately, the requirement for final consent had the unintended consequence of encouraging some individuals to receive MAID earlier than they would have liked out of fear of losing capacity to consent prior to their preferred date. This was the situation faced by Audrey Parker. Ms. Parker was very clear about her desire to share one last Christmas with her family, but felt compelled to receive MAID almost two months earlier than anticipated in order to ensure that she was still capable of providing final consent for the procedure.

In a similar example that is a bit closer to home, my friend and legislative assistant recently lost his father. A MAID recipient, Wah-Lit “Edward” Lui passed away peacefully at home on September 23, 2020. Once doctors had diagnosed Edward with a rare complication of terminal cancer, he had little choice but to immediately initiate the MAID process, which had long been his expressed desire, for fear of losing the ability to final consent over the next few days. Thus, Andrew and his family had a mere 24 hours to say their final goodbyes.

Under the proposed amendments, individuals who have been found eligible to receive MAID and whose death is reasonably foreseeable, but who may be at risk of losing decision-making capacity, could waive the requirement to provide final consent before the procedure. For families like the Parkers and the Luis all across Canada, allowing MAID to proceed in the absence of the ability to provide final consent is simply the right thing to do.

As a further safeguard, in order to waive this requirement, an individual would need to have been assessed and approved for MAID, and be at or very close to the end of life. As proposed in the bill, the individual would provide written consent for the practitioner to administer MAID on a specified date.

In conclusion, the proposed amendments in the bill take into account the lessons we have learned through consultations and respond to the immediate task of following up on the Truchon decision. With this revised legislative package, our government has gone a very long way to respect and support the autonomy of Canadians who wish to consider a medically assisted death, while taking seriously our responsibility to protect vulnerable people.

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

Mr. Speaker, I have a question for my colleague in regard to respecting the conscience rights of physicians across our nation. I understand this is provincial jurisdiction, yet the government does tend to express its views when it sees value in that and it has committed to a national palliative care strategy.

For physicians, does he not see the need to allow them to have the right to make the determination of whether they want to participate either directly or indirectly in MAID?

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, physicians do have the ability to opt out. I believe that in a country like Canada, which is among the best in the world, it is imperative we provide individuals with the best health care Canadians deserve. I do not think we can provide that in good conscience without providing a system like MAID. I would even go as far as to say it is a moral imperative that Canadians have this kind of health care available to them.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Mr. Speaker, I would like to ask the member about same-day death, which the bill would allow for. There was a definite waiting period, which could have been waived in special circumstances, but now the bill would allow for same-day death.

I am wondering if the member is okay with the fact that in most cases it would allow for somebody to request being euthanized and have it happen on the same day.

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, depending on the track provided, there have been safeguards put in place so that the proper assessment can be done. Based on our consultations and experts' advice, I do not think a same-day assessment would be adequate, but again, I leave that to those individuals best suited to provide that advice. I leave it with the medical practitioners to make that assessment.

[Dan Mazier, Conservative, Dauphin—Swan River—Neepawa, MB]

Mr. Speaker, the member across the way mentioned rural Canada and access to doctors, and that certain doctors would review the 90-day circumstances for preconsent. What happens if someone cannot get access to that kind of doctor to prescribe on a particular disease on preconsent?

Is there any kind of leeway or language in the bill about that?

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, that is certainly something that could also be brought up during the parliamentary review. What I was really referring to for individuals who live in remote areas was the number of witnesses required before their consent, which would be reduced to one, because of perhaps a smaller social circle or just not having as many individuals there. What you brought up could certainly be reviewed, and it should be.

[The Speaker, Anthony Rota]

I want to remind hon. members to speak through the Chair and not directly to each other.

Questions and comments, the hon. member for Peace River—Westlock.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Mr. Speaker, is the hon. member not concerned about the two classes of Canadians we could be building with this bill? Those who do not have an underlying condition and are suffering from mental illness are then eligible for all the suicide prevention tools of this country, but those with an underlying illness are not.

Is he not concerned this bill would be creating two classes of citizens?

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, I do not think this bill would create two classes of citizens. It would create two streams to make MAID available to them, as it should, because the circumstances are very different. I do not think it would create two classes of citizens, but would rightly create two different streams to make MAID available.

[Chris Lewis, Conservative, Essex, ON]

Mr. Speaker, I rise today to speak to Bill C-7, which proposes to remove safeguards contained in the existing Criminal Code provisions for medical assistance in dying, as well as to expand eligibility. This is a grave matter and one that should not be treated lightly. Its impacts will be significant, especially for vulnerable Canadians. It is important that we get this right.

Before I get into the substantive issues contained in this bill, I would like to add my voice to those of the people who previously urged the Minister of Justice to appeal the Quebec Superior Court's ruling to the Supreme Court. One month after the Quebec Superior Court decision, 72 organizations that help Canadians with disabilities wrote to the minister, calling on him to appeal the decision. Less than a week later, 300 physicians signed a similar letter and since then, many others have voiced their concerns as well.

Referring it to the Supreme Court would have been the more prudent course of action, as it would have provided Parliament with a framework within which it could legislate. Alas, those many voices, as well as those of my Conservative colleagues in the House, went unheeded.

Further, when Parliament passed Bill C-14 in 2016, the legislation required a parliamentary review of its provisions to commence at the start of the fifth year following royal assent. That review, which was also to include a study of the state of palliative care in Canada, could have taken place this past summer but, instead, the government opted to shut down Parliament. That was time squandered.

There was much wisdom in including a mandatory review when Bill C-14 was adopted. Now, instead of giving this matter the thorough attention benefiting its gravity, parliamentarians are being asked to rush legislation through to meet the judicial deadline of December 18, unless, of course, a third extension is sought and granted. We call that putting the cart before the horse. It is therefore vital, in the short time we have to review these changes to the MAID clauses in the Criminal Code, that we hear from as many Canadians as possible from all walks of life, and especially those likely to be most impacted by any expansion of the current laws.

There are two changes to the existing law that are most troubling. The first is the repeal of the provision that requires that a person's natural death be reasonably foreseeable and its replacement with the words “grievous” and “irremediable”. The other is the elimination of the clause requiring a 10-day waiting period between when MAID is requested and when it can be administered. These changes need careful study. What will the unintended consequences be?

Moving forward, the priority of the Conservative Party is ensuring this type of legislation includes safeguards for the most vulnerable in our society, as well as for the conscience rights of physicians and all other health care professionals. One concern in that regard is ensuring adequate safeguards to protect those who may not have the ability to consent. Many of those involved in the care and advocacy for citizens with disabilities are sounding the alarm. We would be well advised to heed them.

I would like to quote from the letter from 72 advocacy groups written to the Minister of Justice just last fall. They were among those who urged the minister to appeal the Quebec Superior Court's decision in Truchon and Gladu. These are their words:

When the original medical assistance in dying legislation was debated in Parliament, there was a clear understanding that MAiD must have limits; that individual rights must be balanced with protections not only for our most vulnerable citizens, but for our society as well. One of the most important foundations of our Canadian identity is that we are a caring, compassionate country. We...place a high premium on being inclusive and tolerant while working hard toward the accommodation and integration of minority members of our communities. And yet, if the Quebec decision is allowed to stand [or as it stands now codified in the law], we will be in serious danger of losing this fundamental element of our Canadian identity. Our neighbours and our loved ones living with disabilities already continually experience the devaluation of their lives. They are frequently told—often bluntly—that they would be “better off dead.”

The letter makes the point that the unintended consequences would be to “...erode provincial health responsibilities for expert clinical care and social support of citizens who are fragile.”

It is crucial that adequate safeguards are included in Bill C-7, and that will be one of my highest priorities. Another concern worth repeating is removal of the end-of-life criterion. As the Council of Canadians with Disabilities stated in its October 2000 letter to the Minister of Justice, “Without the equalizing effect of the end-of-life criterion, which guarantees that the common thread between all persons who access an assisted death in Canada is that they are all dying,” with the proposed changes, “...persons with disabilities will be able to gain access ultimately because they have a disability.”

A worse stereotype could not be institutionalized in law: that disability-related suffering, largely caused by a lack of support and equality, justifies the termination of a person's life.

I now want to take some time to address the need for palliative care in Canada and the importance of such end-of-life care. As mentioned previously, a study of palliative care was to be included in a mandated parliamentary review. This should have happened before Parliament took action to expand the current Criminal Code provisions. Again, I would like to turn to the experts on this: the doctors and other health care professionals who provide end-of-life care and face these life-and-death decisions every day.

The Canadian Society of Palliative Care Physicians strongly advocates for the prioritization of adequate investment in, and enhancement of, palliative care services. Without access to high quality palliative care, some patients who are suffering may feel that MAID is their only option because their suffering has been inadequately addressed, or they perceive that their families or social supports must carry an excessive burden. Data regarding availability, access, quality and types of special palliative care, for example, are essential not only for those requesting or receiving MAID, but in general in order to better inform areas for improvement. Palliative care should remain distinct from MAID to ensure clarity, and to avoid risk of confusion and the potential for people to refuse palliative care services because they may confuse them with MAID.

During my consultations on Bill C-7, the doctors I have spoken with have stressed that palliative care is more than providing access to morphine, and that the public needs to be educated on this. As well, concern was expressed that elder abuse and financial motives, such as inheritance, could contribute to an abuse of MAID. Another concern is the temptation to save health care dollars with MAID. It is easy to conclude that MAID is more cost effective than continuing care. This raises ethical questions about its potential overuse, particularly as the previous safeguards are being lifted.

These are all serious concerns. I look forward to hearing what the doctors and health professionals on the front lines recommend as we move forward. I would also like to make a brief comment about the need for conscience protection for physicians. Doctors are concerned that they will be forced to administer MAID. I have been advised that the Ontario College of Physicians has created a policy that doctors have to arrange a referral. Some doctors have confided to me that they are considering leaving their profession over this. Suffice to say that physicians should have their freedom of conscience protected, and that this fundamental freedom needs to be codified in law as has been done in Australia.

In closing, I urge the House to take our responsibility to review this legislation seriously and to do as thorough a job as possible, keeping uppermost in mind those most affected by the decisions that we make. As those 300 physicians said in their letter to the Minister of Justice, “For all patients who seek an assisted death, we must ask first if they have had access to adequate and funded social and living supports, as well as exemplary health care and symptom management, in order to assure that they are not seeking an assisted death.” I think we can and must 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]

Mr. Speaker, in good part, I disagree with the member's assessment that we need to appeal to the Supreme Court of Canada or that somehow a lot of the discussion around the bill has not occurred. We have been discussing this virtually since the 2015 federal election. It has had all sorts of committees' direct and indirect input. Even this year, over 300,000 people participated through providing input. There has been an enormous amount of consultation. A lot of that never ended after we first passed the legislation.

What we see before us are some changes that we learned from, whether it was a court order or from what Canadians have been saying for the last while.

Does the member not agree that it is time, at the very least, to allow it to go to committee where we can get additional feedback on some of the specifics that have been raised here in second reading?

[Chris Lewis, Conservative, Essex, ON]

Mr. Speaker, I guess I would say two things.

First, if the government had not prorogued Parliament, we would have had a whole summer to have more of these discussions.

Second, much more discussion needs to happen. I will tell colleagues exactly why.

This past Friday, I spoke to two doctors via Zoom. They are the ones who specifically told me four points: They are considering leaving the profession. We cannot afford to lose any more physicians. They were taught to save lives, not to take them away. What a powerful statement. The doctors told me that 800 physicians have signed a new letter denouncing them from being forced to refer a patient to another doctor to get MAID, and that more would sign that letter, but they were afraid that the hospitals would blackball them and they were in fear of losing hospital privileges.

Much more discussion has to happen over this and it will definitely be going to committee. I look forward to it.

[Kristina Michaud, Bloc, Avignon—La Mitis—Matane—Matapédia, QC]

Mr. Speaker, I thank my colleague for his speech.

He mentioned the December 18 deadline and seemed worried that we are moving too fast with this bill, but in my opinion, the government has already asked the courts for enough extensions.

Does my colleague agree that the reasonably foreseeable death criterion was too restrictive and that we have to stop postponing the dignity of seniors and seriously ill individuals? Does he agree that we need to send this bill to committee quickly so that it can be studied and passed in response to the Quebec Superior Court's decision?

[Chris Lewis, Conservative, Essex, ON]

Mr. Speaker, definitely more discussion needs to happen at committee. There is no doubt. I will continue going back to our parents, doctors and clergy as more discussion has to happen around them as well. I am really concerned about them being victimized. For them to not be able to speak with their conscience and to be forced to not discuss life and death is a real issue.

As I mentioned before, doctors do not lie. Doctors told me on Friday about the shortcomings in this bill, and that is why I am looking forward to getting Bill C-7 to committee, fixing it and amending it as required.

[Tracy Gray, Conservative, Kelowna—Lake Country, BC]

Mr. Speaker, I would like to thank my colleague from Essex. You had mentioned palliative care. I wanted to ask you this, especially at a time when families are separated due to COVID-19 and people are feeling isolated. We see palliative care as an important part of the health care service, and it is not readily available to everyone.

I am wondering if you could maybe expand on that.

[The Speaker, Anthony Rota]

The hon. member for Essex, in 25 seconds or less.

I just want to remind the hon. members that even though we are close and it is very intimate, to please place your questions through the Chair. Thank you.

The hon. member for Essex.

[Chris Lewis, Conservative, Essex, ON]

Mr. Speaker, palliative care is very near and dear to my heart. Caregivers did a wonderful job when my mémé had brain cancer and kept her incredibly comfortable. The discussion within our family was not about how to end her life; it was about how to make it more comfortable and last a little longer, so palliative care is vital.

[The Speaker, Anthony Rota]

It is my duty pursuant to Standing Order 38 to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Kelowna—Lake Country, Indigenous Affairs; the hon. member for Mission—Matsqui—Fraser Canyon, Health.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, before getting into the details of the proposed legislation in front of us, I first want to make sure that in the House we avoid a common misunderstanding that seems to come up whenever people strongly disagree with assisted suicide or related issues. Quite often, someone in favour of allowing assisted suicide or removing safeguards will express compassion and empathy for those who are suffering. In saying this, I am not questioning their feelings or their sincerity; nobody wants to suffer or watch their loved ones go through terrible pain. What I am saying here, for everyone's benefit, is that those who are opposed to it or who want to support safeguards have a deep sense of compassion and empathy for those who are suffering. In other words, our human feelings of compassion by themselves do not automatically lead to one position or another.

Along with my wife, I have watched four grandparents pass away, and at present we have another one who is living in palliative care. Each time I have witnessed and cared for family members as they go through difficult health problems, I am reminded of the importance of always affirming a dying person's dignity while they live out the last part of their life.

For the past year, we have had widespread awareness of and concern for how the spread of COVID-19 could devastate seniors and others who are more vulnerable because of medical conditions. For the most part, these are the same people who are at risk and would be even more so under this new law. Along with everything else we could learn from 2020, I hope we can improve our medical practices and strengthen safeguards for the most vulnerable in every area, including this one.

As we continue to debate Bill C-7, it is important for all of us to take a moment to carefully consider its wider impact and unintended consequences. If passed, the new law will significantly expand the number of Canadians who will be eligible for assisted suicide. Whether we agree with these changes or not, it is clear that they are major and fundamental.

It was only a few years ago that Parliament passed Bill C-14, which created the legal framework for what it called “medical assistance in dying”. Previously, the Criminal Code had considered it a serious crime to either kill a patient or participate in a patient's suicide. While amending the section on culpable homicide and defining eligibility, it presented MAID as the narrow exception.

At the time, the former justice minister, with the same sense of transparency for which she later fell out of favour with the Liberal government, publicly stated, “We recognize that medical assistance in dying will in many respects fundamentally change our medical culture and our society.” It was true for what happened back then, and now we are adding some more major changes before the last ones were ever properly reviewed. There was supposed to be an official review of the MAID system, but that has not happened.

Without having a thorough and careful review, we are supposed to proceed with Bill C-7 anyway. So far, in the current session, we have started debating this bill for part of only four days. I hope there will be much more time than this for considering this bill at every stage, especially when it is studied by the justice committee. There is so much that should be said, and the amount of time we all have to work with is too limited.

I share the deep concern of many Canadians who recognize that this bill undermines our country's commitment to upholding and protecting the equal value of each human life. More particularly, there needs to be even more attention given to how assisted suicide, especially in the way this bill handles it, affects the lives and social well-being of people with disabilities.

Over the past year, the idea of systemic discrimination has come to the forefront of our public discourse in Canada, in the U.S. and around the world. To help us better reflect on how it can relate to this discussion, we can look to the work of Dr. Laverne Jacobs. Dr. Jacobs is a law professor at the University of Windsor. She has approached the issue with her legal expertise and speaks from her experience as a Black woman living with disabilities in Canada.

As part of a longer presentation about MAID back in January, she compared and related the experiences of minority communities. She said, “What's particularly troubling about any system or any structure of systemic discrimination is that once ideas that are harmful to a minority group have been legislated into law, it is very difficult to convince the general public that they are not stigma-inducing or ultimately discriminatory. So in both cases, in both the case of racial inequality in the U.S. and the case of MAID here in Canada, we're dealing with the stigmatization of a historically disadvantaged group.”

In an article on the subject of MAID, Dr. Jacobs wrote:

More explicitly, while the MAID law indeed requires consent, these irreversible choices about ending a life are made in a complex social, cultural and health-care context, where lack of access to adequate care, lack of social support and overall ableist stigma have an impact on the choices people with disabilities may have.

In the same article, she also said:

There are also concerns, fuelled by developments in the few countries that provide access to MAID outside the end-of-life context, that being elderly and fragile is increasingly accepted as a reason for a physician-assisted death and that this may create subtle pressure.

This is a small sample of her work, and Parliament would do well to take a closer look at the rest of her comments.

Loss, especially one of this nature, directs and shapes people's actions and attitudes. We cannot say that people with disabilities and other vulnerable populations have not told us this and explained how this bill will inevitably hurt them. Many other advocates and members of the disability community have been speaking out with similar fears, but they were not heard when they called for the government to appeal the Quebec Superior Court ruling. They have also been ignored when it comes to the problems in Bill C-7.

Bill C-7 has to do with life and death, which are ultimate realities. It is reasonable to expect that altering the way our institutions and culture approach the most consequential matters will have wide-ranging effects across all of society. It is hard, if not impossible, to imagine where we will end up if we follow this path.

In my remaining time, I want to highlight some of these problems.

Most notably, Bill C-7 removes the reasonably foreseeable natural death criterion, which is very concerning to me. I am concerned that removing it will normalize suicide over time. Without appealing the decision, the government is going beyond what the Quebec Superior Court ruled.

As one example, the government wants to allow for advance directives. As I have said before, there has been no thorough review of MAID as it currently operates. I am also not aware of any specific study about the risks and problems associated with a process for advance directives. That should happen well before we ever consider enacting it.

Advance requests raise difficult questions. For example, I have to wonder: Could someone consent in advance to be killed once they reach a state they fear but have never experienced, like living with advanced dementia? Further, once someone has signed an advance request and lost the capacity to consent to medical treatment, at what point exactly would their life be terminated? More alarming to me is this: If a non-capable person seems to resist a lethal injection, can the physician still proceed with the injection if the physician believes that the resistance is not due to any understanding on the patients' part that the injection will kill them? Bill C-7 states that apparent resistance means a doctor must not proceed but clarifies that involuntary responses to contact is not resistance. This raises another question. How does a doctor determine if the response to contact is involuntary?

Given that advance requests raise serious ethical issues, oversight challenges and safety risks, legalizing advance directives in the way that Bill C-7 would is irresponsible. This is the position we are left with when we are not trying to create effective accountability mechanisms and when we have insufficient data.

I am also troubled that Bill C-7 would remove the 10-day waiting period. Frankly, I find this disturbing. The 10-day waiting period in Bill C-14 already had a built-in exemption for those whose death or loss of capacity to consent was imminent, and as such, I cannot understand why the removal of this waiting period is necessary or prudent. On the contrary, I find it negligent.

It is well established that the desire to die is often transient. Suffering individuals have ups and downs throughout the day, throughout the week and throughout the year. No one should be able to make a death or life decision when at their most vulnerable point. The 10-day waiting period effectively allows a patient to reconsider their decision and take the time to speak with loved ones. This is critical.

Finally, I want to add that I believe the bill should add a provision that prohibits medical practitioners from discussing MAID unless the patient explicitly asks. We must not underestimate the power of pressure and suggestion, no matter how subtle, especially when it is combined with social stigma, as I mentioned before.

Journalist Ben Mattlin, who suffers from spinal muscular atrophy, wrote this in the New York Times:

I’ve lived so close to death for so long that I know how thin and porous the border between coercion and free choice is, how easy it is for someone to inadvertently influence you to feel devalued and hopeless—to pressure you ever so slightly but decidedly into being “reasonable,” to unburdening others, to “letting go.”

Perhaps, as advocates contend, you can’t understand why anyone would push for assisted-suicide legislation until you’ve seen a loved one suffer. But you also can’t truly conceive of the many subtle forces—invariably well meaning, kindhearted, even gentle, yet as persuasive as a tsunami—that emerge when your physical autonomy is hopelessly compromised.

Despite Mattlin's significant physical disability, he is a father, husband, author and journalist. He has a successful life and knows what he wants. He is less vulnerable than others who might be more easily persuaded that MAID is their best option. In this way, voluntary MAID is the start of a slippery slope that leads to involuntary MAID.

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

Mr. Speaker, all lives are of equal importance. I listened to the member across the way, and I think he is ruling out what, I believe, a vast majority of Canadians want.

I recall the debates we had in 2016 when, in essence, we were talking about this issue in a tangible way for the first time on the floor of the House of Commons. Through that debate, we ultimately saw good legislation, but I believe everyone back then realized there would be a necessity for change.

There have been ongoing discussions. All sorts of consultations have taken place at a multitude of levels. I think we have something before us today that will make the legislation better overall, and the member will be afforded an opportunity to hear and provide more feedback.

Does the member have any specific amendments he would like to see in the legislation before us today?

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, while we are debating this, one thing we need to remember is that people want to see stronger mental health and palliative care supports. It is incumbent upon us to take those requests seriously. Ultimately, if we were to more seriously address mental health, social issues and palliative care, fewer people would feel this is their last resort.

As far as specific amendments go, we need to look at the provisions, such as the 10-day wait, which need to stay in the legislation.

[Matthew Green, NDP, Hamilton Centre, ON]

Mr. Speaker, I appreciated the hon. member bringing up the nuances, and I particularly appreciated his calling out the potentials for ableism in the agency of patients.

One of the challenges created by the current medical assistance in dying legislation is a requirement for final consent at the time the assistance is rendered. This forces those who have already been assessed and approved for medical assistance in dying to make a cruel choice. When faced with a possible loss of competence that would make them unable to give consent, they are forced to either go earlier, or risk not being able to receive the assistance they need to avoid living with intolerable suffering.

Audrey Parker campaigned to make Canadians aware of this, and Bill C-7 would fix this by creating a waiver of final consent. Does the hon. Conservative member support Audrey's amendment to help those facing the end of life avoid this cruel choice?

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, I will reiterate that, ultimately, the review period was more or less was skipped, which has prevented everybody from having the opportunity to hear more and learn more about the different issues and perspectives people like Audrey have with the bill. The more we can learn before we are forced into legislating this, the better.

Unfortunately, whether it was through prorogation or other means, we have been asked to skip these very important aspects, such as consultations and review processes, which are so vitally important when we are dealing with issues such as medical assistance in dying.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Mr. Speaker, I am the son of two elderly Canadians. My dad is 86 and my mom is 76. I am very concerned about our seniors' access to health care and that they will be put in a position where they have to make a decision between care and maybe ending their lives as a result of this pressure. This concerns me deeply, as it concerns many Canadians across the country.

Would this proposed legislation adequately protect those individuals in Canada?

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, the way I see it, no, I do not think it does. It is opening the door for those subtle suggestions that, quite honestly, for a person in a tough state, might be seen as a lot of overt pressure. They may be willing to take on advice like that, even though they maybe do not want to, because of the pressure on them. I think it is important that we consider those protections in this piece of legislation.

Again, we need to ensure that we are focusing on high-quality palliative care going forward.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, today I am speaking in opposition to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying. I am also rising to raise the alarm and call on the government to put an immediate halt to medical assistance in dying in Canada's prisons until a full investigation can take place and legislative amendments can be made.

I believe, as a Conservative, my role is to be someone who stands athwart history yelling “stop” at a time when no one else is inclined to do so. History has shown us the consequences of people not speaking up in opposition to issues that may even have seemed overwhelmingly popular at the time.

Today is one such case, where years from now we may look back at these debates and wonder how we could push forward with such radical legislation and changes to our societal values. That is why I am speaking out today, despite the consensus, which appears to reign in this House, that medical assistance in dying on demand is the way to go.

Dr. Ivan Zinger, the head of the Office of the Correctional Investigator of Canada, released a deeply disturbing report this past June. I presume the government has had access to this report for months, but it was just tabled yesterday in the House of Commons. The correctional investigator raises some serious allegations, citing three cases of prisoners undergoing medical assistance in dying that raise, as the report states, “fundamental questions around consent, choice and dignity.” His office also found serious omissions, inaccuracies and misapplications of the law and the policies surrounding medical assistance in dying.

In one case, a prisoner who was terminally ill and serving a non-violent two-year sentence was denied parole and any opportunity to serve out his remaining days in the community. The inmate wished to explore the possibility of a compassionate parole, but after being denied the opportunity to do so, he sought an assisted death. Before receiving his assisted death, the prisoner repeatedly sought an opportunity to seek out an alternative to MAID in prison. He was repeatedly denied the opportunity to do so. Therefore, he was left with what he felt was no choice but to seek out medical assistance in dying. He was later granted that.

This raises important questions on whether the government is adequately supporting Canadians, including Canadian prisoners, who are facing difficult end-of-life decisions, especially decisions where the power imbalance is so huge.

In another case, a prisoner, a dangerous offender with a terminal illness who was suicidal and suffering from mental illness, also received an assisted death. When prisoners are in a hopeless situation and disempowered, it is no surprise they would seek an assisted death.

In response to these cases, Dr. Zinger points out, “the decision to extend [medical assistance in dying] to federally sentenced individuals was made without adequate deliberation by the legislature.” He is talking about us. He also claims there is no oversight mechanism in the Canadian correctional services to ensure accountability or transparency for medical assistance in dying deaths in correctional institutions.

Given that the above cases were restricted to those with terminal illnesses who qualified under the previous requirement of death being reasonably foreseeable, I find it very concerning the government would be removing this requirement without first acknowledging and investigating the serious concerns and allegations of the corrections investigator.

The corrections investigator is actually calling for an absolute moratorium on all medical assistance in dying procedures in Canada's correctional institutions. Until such a time as we can craft legislation that protects the lives of vulnerable prisoners, who are clearly making a choice in a situation of severe duress, we should clearly consider holding off, or at least placing a moratorium, on medical assistance in dying in Canada's prisons.

This brings me to my next concern with this legislation, which is the need to protect the lives of vulnerable people like the disabled, the elderly and the mentally ill. When this legislation was originally considered a few years ago, Canadians were assured by the government that the legislation would protect the vulnerable. Restrictions that were put in were meant to protect people from being unduly coerced into making a decision to seek MAID. They also exist to encourage people to seek out alternatives before seeking an assisted death.

Everyone can sympathize with somebody nearing the end of their life who is in intolerable pain and seeking out an assisted death, but what Canadians did not expect four years ago was that today the government would be expanding this legislation to allow those who are not terminally ill or near death to qualify.

This raises important concerns for disabled people and those with mental illnesses. Many of them are not close to death and will now be eligible to seek an assisted death. The government has washed its hands of responsibility for restrictions and has left it up to individuals to make this choice for themselves. Choice has been enshrined as the overriding principle of medical assistance in dying legislation, while little or no concern is being given to the factors that can go into those choices.

Similar to the cases that I cited in our prisons, many elderly, disabled or mentally ill Canadians have been isolated for many months from loved ones in Canada's troubled long-term care centres. I wonder how many decisions to access MAID would not have otherwise been made had the situation in long-term care been addressed or how many decisions to access MAID would have been made if Canada had an effective system of palliative care centres for people to live out the remaining days of their life in comfort and peace.

We know from the government's own annual reporting that there is a significant number, and even one is too many, of Canadians, who did not have access to palliative care, who received an assisted death. No Canadian should be forced to choose an assisted death without the opportunity to access palliative care.

The government's annual reporting also revealed that in 2019 alone, 87 Canadians with disabilities received medical assistance in dying but were denied access to critical disability support services. That is simply unacceptable. Canadians with disabilities deserve better.

I am concerned that every time we remove a protection on medical assistance in dying, we are blurring the lines between an assisted death that is acceptable and constitutional and an assisted death that is not. I do not believe, for many in the House, that there is a single assisted death case that would be unacceptable. I challenge members to tell me what they think is unacceptable.

The consensus among most parties in the House, and most members, seems to be that we need to affirm individual choices. I think we can all recognize that no choice is made in a vacuum. Choices are made with a variety of factors, such as people's socio-economic status, the quality of their life, their relations with family and friends, their mental state and their physical state, and the list goes on. Simply boiling down this argument to a matter of individual choice ignores the very real factors that can go into making someone make the decision to seek out medical assistance in dying.

For example, do people feel they are a burden on their family or society? Do they feel there is no alternative to the pain they are feeling? Are there monetary reasons at play? A recent article in MoneySense magazine was advising readers on how to maximize their pension and life insurance benefits if they chose to undergo medical assistance in dying. Where we have come in our public discourse in four short years is shocking to me.

Given that I have outlined a number of factors in determining what factors could be behind someone's decision to seek out MAID, I would ask this. What provisions is the government putting in place to ensure that people's lives are being affirmed and that they are receiving the support they deserve? The fact is that I believe the government is ignoring the very important role that social workers can play in these decisions. By limiting the decision for medical assistance in dying between a doctor and a patient, the government is ignoring the fact that doctors are not always equipped to recognize situations where socio-economic factors or other factors could be at play in the decision. When the government takes away the requirement for two witnesses, it also creates a huge power imbalance, where essentially only one person, the doctor and the patient, is making the decision. There is very little accountability.

Finally, I want to raise the concerns of Dr. Leonie Herx, who is a chair at Queen's University and one of 750 doctors from across Canada who have urged the government to stop this legislation. In her words:

(MAiD) was intended to be a last resort when all other measures had failed and someone had irremediable suffering close to the end of life. (Bill C-7) makes death on demand available to anyone who wants it. It’s a radical shift for medicine.

I call on the government to heed the concerns of the 750 doctors as well as the report from the corrections investigator and immediately move to place new restrictions and protections on medical assistance in dying to ensure that vulnerable people are protected. We have a responsibility. Every Canadian life matters. We cannot get this wrong.

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

Mr. Speaker, the member referenced dying on demand. I know a couple of Conservative members of Parliament have used that sort of terminology. That undervalues the immense contributions, at a very difficult time in a person's life, of the people around them. I am talking about medical doctors, social workers, most importantly, family members and others. The infrastructure is there. There is no doubt, as some people have talked about, including myself, that we need to look at palliative and hospice care and other ways to ensure a quality of life when the end approaches.

When members talk about dying on demand through this legislation, they do a disservice to those who are there in those very precious moments at the end of a person's life. I wonder if the member could provide his thoughts about the advisers, in particular, health care professionals and social workers. I have had that experience on two occasions, for both my father and grandmother. I valued and appreciated the feedback that I got from health care professionals back then.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, these are not necessarily just the words of Conservative members in the House. These are the words of Dr. Leonie Herx and 750 doctors who have raised the alarm with the government. This is a term they are using. The fact is that the government is removing restrictions on the number of witnesses that need to be involved. In some cases, people who have a reasonably foreseeable death can request assistance in dying and receive it on the same day.

When we get rid of these reflection periods, it seems that the goal of this policy is to ensure that as many people can access an assisted death as possible. We need to look at this from the other perspective and ask how many people we can divert away from an assisted death through better palliative care, better pain management and better mental health supports. That is what we should be looking at, not trying to speed up and increase the number of people accessing medical assistance in dying.

[Kristina Michaud, Bloc, Avignon—La Mitis—Matane—Matapédia, QC]

Mr. Speaker, I thank my colleague for his speech. I appreciate the approach he took in talking about the situation in correctional institutions.

Then again, I heard him refer to this bill as radical. Personally, when I think of this bill, I think of compassion. I cannot help but think of Nicole Gladu and Jean Truchon, who honourably fought for their cause before the courts.

Would my colleague agree that, as legislators, we need to do everything we can to ensure that other people suffering from degenerative, incurable diseases are not forced to go to court to challenge the terms and conditions of medical assistance in dying?

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, I apologize to the member for not answering in French, but I am working on it.

We are all here because we care about vulnerable people and people who are sick and suffering, but it is important that we do not all buy into this consensus. When we all get on the train and buy into the same consensus, we lose the opportunity to raise very important points. That is what I and a number of my colleagues are trying to do. We are trying to point out the flaws in this legislation, which I would say is radical because just five or six short years ago, we did not have legalized assisted dying in Canada and here we are today, already passing the second piece of legislation.

Nobody could have imagined six years ago that we would be allowing people without a terminal illness to receive an assisted death. That is what we are debating today, that basically anyone who has a grievous or irremediable condition, even if it is not terminal, should be allowed to receive assistance in dying, and I do think that is quite radical.

[Mel Arnold, Conservative, North Okanagan—Shuswap, BC]

Mr. Speaker, it is an honour to rise and speak in this House on Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

Each and every time that I speak in this House, I am reminded that the opportunity has been entrusted to me by the citizens of North Okanagan—Shuswap, first in 2015, and again in 2019. It is roughly five years now since I arrived in this place for the first time and I still remember the anticipation I experienced as I approached my work as a member of Parliament. I still carry great appreciation for the opportunity to serve the people of North Okanagan—Shuswap and, indeed, all Canadians.

Each and every member of this House has been entrusted by their constituents to represent all constituents, and this is a responsibility that I hope all members keep as a guiding principle as we undertake our work. I do not think anyone could be fully prepared for what the role of being an MP entails and the unexpected situations that arise, but I will say that I came here with an open mind, eager to listen and committed to doing my very best to represent the constituents of North Okanagan—Shuswap.

Shortly after the 2015 federal election, Bill C-14 on medical assistance in dying was introduced to the 42nd Parliament. In fairly short order, Bill C-14 was debated and passed. As members will recall, Bill C-14 was passed in response to the Supreme Court decision that ruled that adults with grievous and irremediable medical conditions are entitled to physician-assisted suicide, as it was termed at the time.

Over the time that was allotted for debate and committee study of the original Bill C-14 legislation, I took the opportunity to hear from constituents and took what I heard at that time to form my position on the legislation at hand. Since then, I have continued to listen to constituents on all sides of this debate in an effort to ensure that I am aware of their many differing viewpoints. I have heard from many who believe in the sanctity of all human life and believe the time of life and death is to be decided by a greater power than any of us possess. I have also heard from others with various incurable health conditions who want the ability to choose an appropriate time so that they are able to pass with dignity, and the ability to choose when to say a final goodbye.

While listening to and pondering the various personal beliefs and scenarios shared by constituents, I have also reflected on my own personal experience and how fortunate many of us are that we have not had to make the very difficult, personal decision that many Canadians face every day.

I would like to share what weighed heavily on my mind during the debate and considerations, back in 2016, and remains with me today as we revisit this topic in the legislature. My mother had developed dementia over a period of years before her passing. At first, we did not recognize the symptoms or maybe we did not want to actually acknowledge that they were there, but as time went on Mom became more forgetful. At first it was just that she would end up with multiple jugs of milk in the fridge because each time she went to the grocery store she simply remembered that she needed milk and not the fact that she had just bought some the day before.

As time progressed, her memory got worse and eventually she moved into a full-care home where she was safe and cared for. Initially it was only her short-term memory that faded away and she could still remember many things from earlier in her life and about her family, but that gradually changed. One thing we did notice in the last few months of her life was that she no longer used the telephone. It would ring but she was not able to put the pieces together to pick it up and talk to whoever was calling. The phone had been a big part of her life as she would always call all of her children, grandchildren and great-grandchildren on our birthdays, but for a number of months she was no longer able to remember phone numbers, what the telephone was for, or how to start a conversation.

At the time of what turned out to be her last Christmas, we made plans to have her home for Christmas dinner and we all looked forward to the day. Then on Christmas morning, we got a call from the care home. They said she had come down with the flu and would not be able to go out. We managed to get through Christmas Day but were concerned the illness was more than she could take in her frail condition.

The next day we were surprised when the care home called and said my mom was doing much better that day and asked if we wanted to come for a visit. We headed out, knowing that mom might not be looking or feeling her best because she had been ill.

We walked into the room that day and were totally taken aback. She was sitting up, fully articulate and waiting for us. We were shocked when she started conversations like someone had turned back the clock two years on her dementia. She told us how she felt bad she had not been able to go out and do any Christmas shopping for the grandchildren and many other things she had not been able to communicate for months.

When we returned home later that day, our answering machine was full of messages from my five siblings all wondering what was going on with mom. She had picked up the phone and called each of them from the numbers in her head and had extensive conversations with each of them.

We were all in shock from this remarkable recovery of her memory and the restoration of her mental function from what had been considered incurable. Unfortunately, the recovery was temporary and only lasted about 24 hours, but nonetheless it was a complete reversal of her dementia for that period of time. To this day, no one has been able to explain how or why this happened. We wondered, at the time, and still wonder today if there may be a cure just around the corner.

This is only one scenario, and in the time since medical assistance in dying became legal, I have heard from constituents and observed cases where family members have been quite open about their aging parent or terminally ill family member. They have been open about how, at some point, the parent or family member is no longer the person they once were and no longer wants to carry on. I have heard how they want to be able to make the choice and should not be denied that choice.

In considering the legislation before us today, we must consider all of the people and lives that will be affected by our decision. It is a very difficult task when we are not able to hear all of the different scenarios, learn the details about symptoms and reasons for personal choices.

That is why I urge all members to consider what safeguards should be in place and if safeguards are not in the current text of the bill, can it be amended so that our decision respects the needs and rights of our constituents and Canadians.

I will continue to open my mind and listen to what I hear from my constituents. I expect I might hear cases like mine where we were fortunate that when mom passed peacefully in her sleep a few months later, we did not have to make those difficult decisions. There are cases where a cure might be found soon for someone who is incurable today. There are cases where there is no hope for recovery and someone wants to ensure dignity is retained.

There are many other personal situations out there and as legislators, we must remember that. We have a duty to consider more than just our own personal opinions or those of the people close to us. We must be considerate of those who will be tasked with carrying out what we legislate. We must guard against any loophole or opportunity for this legislation to be exploited or abused, because we are literally legislating on matters of life and death here. Let us consider all of that in our deliberations.

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

Mr. Speaker, I appreciate the member sharing his personal story about his mom. It is quite compelling to hear personal stories or to hear from individuals on all points on the spectrum as to why there is such a desperate need for the legislation and why it is very important we be so careful as we enter into this area, putting the checks and balances in place.

I had the opportunity to listen to all sides, as the member recommends we do, and put aside our personal thoughts, feelings, and maybe even situations, to get a fair assessment of the bigger picture. We have before us legislation that will move us forward. I suspect it will go to committee. Does the member have some very specific amendments he would like to see made to the legislation or is he more content to see it go to committee?

[Mel Arnold, Conservative, North Okanagan—Shuswap, BC]

Mr. Speaker, I appreciate the member is willing to listen to all of the personal scenarios that are out there. We certainly cannot hear them all. As he mentioned, there may be amendments moving forward. I do not think this is the correct place to get into exactly what specific amendments should be there. I would expect there would be amendments being moved if this bill gets to committee, and hopefully what comes out of that committee will be a bill that is respectful of the wishes of every Canadian.

[Kristina Michaud, Bloc, Avignon—La Mitis—Matane—Matapédia, QC]

Mr. Speaker, I thank my colleague for his very poignant remarks.

I agree with him that we need to take the time to study the bill carefully. The Bloc Québécois was actually relieved that the bill excludes individuals suffering solely from a mental illness from eligibility for medical assistance in dying, since that aspect requires further reflection, study and consultation. We hope this will be completed at the Standing Committee on Health as soon as the motion moved by my colleague from Montcalm is adopted.

I would like to hear more from my colleague on that aspect.

[Mel Arnold, Conservative, North Okanagan—Shuswap, BC]

Mr. Speaker, I appreciate the comments regarding the mental health portion being left out of this bill. Certainly, mental health has become a much more talked about issue over recent years. That is a good thing. The mental health aspect, especially now during the COVID situation with people suffering from isolation more than any other time I have ever known and probably any of us have ever known, of medical assistance in dying certainly needs further discussion and may be addressed in further legislation in years to come.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, I also want to thank the member for North Okanagan—Shuswap for his moving commentary on this bill. I want to reflect on what the member for Cypress Hills—Grasslands said, which is that all members of Parliament have sincerely held beliefs on the issues before us in this bill. What I would urge here is for us to make the distinction between the need for the larger review of medical assistance in dying, which was provided for in the original legislation, and that review unfortunately has not started, and what is actually in Bill C-7. While the member for North Okanagan—Shuswap was not really as guilty as some of his colleagues have been of doing this, I think there are some people who by using “death on demand” and “same-day dying” are distorting what is actually in Bill C-7. I think it behooves all of us, in order to have a respectful debate, that we talk about what is actually there. The bill still requires that someone be suffering from an incurable illness, intolerable suffering and irreversible decline, so I would urge all members, including this member, to keep in mind what is actually in the bill.

[Mel Arnold, Conservative, North Okanagan—Shuswap, BC]

Mr. Speaker, I certainly agree with the member that the review of the original Bill C-14, medical assistance in dying, needs to take place so there is a proper review of what has been happening since 2016 when it passed. As we move forward with this bill, we certainly need to be cautious and review it, because what we are dealing with here as legislators is the life and death of other people.

[The Deputy Speaker, Bruce Stanton]

That is all the time that we have for questions and comments.

Is the House ready for the question?

[Some hon. members]

Question.

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

On a point of order, Mr. Speaker, I am just a bit confused about the process here. Are we proceeding with the question now or is there somebody else who is up to speak?

[The Deputy Speaker, Bruce Stanton]

I thank the hon. member for Sherwood Park—Fort Saskatchewan. There was no time left in the five minutes for questions and comments. I then went to resuming debate and no person rose. Nor did I see any hands raised on the Zoom participants. Therefore, I proceeded to the question on the bill.

Does the member wish to make a speech on the matter?

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

Sorry, Mr. Speaker, I do not. I was trying to get a bit of clarification on the process.

[The Deputy Speaker, Bruce Stanton]

I thank the member for that. That is perfectly fine to do if members are unsure. It is good to check in and we are happy to get it clarified.

The question is on the motion.

As members will know, if a member present wishes to request a recorded division or request that the motion be adopted on division, I invite the member to rise in his or her place and that would signify a recorded division.

And one or more members having risen:

Accordingly, pursuant to order made on September 23, the division stands deferred until Thursday, October 29, at the expiry of the time provided for Oral Questions.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, I suspect if you were to canvass the House, you might find unanimous consent to call it 6:13 p.m. at this time in order to facilitate private members' hour beginning.

[The Deputy Speaker, Bruce Stanton]

Are there any objections to the House seeing the clock at 6:13 p.m.?

Seeing none, the House will now proceed to the consideration of Private Members' Business as listed on today's Order Paper.

[Damien Kurek, Conservative, Battle River—Crowfoot, AB]

Mr. Speaker, on a point of order, just as clarification, I was attempting to connect prior to the question being read. I am making the assumption from the last few moments, because I was not connected before that point, that the debate is now collapsed.

[The Deputy Speaker, Bruce Stanton]

That is in fact correct. No other member stood and so the question was put and a recorded division requested and deferred until tomorrow after the time for Oral Questions.

The House resumed from October 28 consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[The Speaker, Anthony Rota]

It being 3:10 p.m., pursuant to an order made on Wednesday, September 23, the House will now proceed to the deferred recorded division on Bill C-7 at second reading stage.

Call in the members.

(The House divided on the motion, which was agreed to on the following division:)

Vote #15

[The Speaker, Anthony Rota]

I declare the motion carried. Accordingly, the bill stands referred to the Standing Committee on Justice and Human Rights.

(Bill read the second time and referred to a committee)

[The Speaker, Anthony Rota]

I wish to inform the House that because of the deferred recorded division, Government Orders will be extended by 39 minutes.