Bill C-7

An Act to amend the Parliament of Canada Act and to make consequential and related amendments to other Acts

This enactment amends the Parliament of Canada Act and makes consequential and related amendments to other Acts to, among other things,
(a) change the additional annual allowances that are paid to senators who occupy certain positions so that the government’s representatives and the Opposition in the Senate are eligible for the allowances for five positions each and the three other recognized parties or parliamentary groups in the Senate with the greatest number of members are eligible for the allowances for four positions each;
(b) provide that the Leader of the Government in the Senate or Government Representative in the Senate, the Leader of the Opposition in the Senate and the Leader or Facilitator of every other recognized party or parliamentary group in the Senate are to be consulted on the appointment of certain officers and agents of Parliament; and
(c) provide that the Leader of the Government in the Senate or Government Representative in the Senate, the Leader of the Opposition in the Senate and the Leader or Facilitator of every other recognized party or parliamentary group in the Senate may change the membership of the Standing Senate Committee on Internal Economy, Budgets and Administration.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you Mr. Chair, and thank you, Minister, for being here today, as well as your officials.

I have a few questions.

We're seeing...kind of ripped from the headlines as of late. You were here before at this committee on Bill C-7, discussing medical assistance in dying. As you know, the bill that you had brought forward before was amended by the Senate to include those suffering with mental illness. As of March 17, 2023, those individuals will be eligible for MAID.

The amendment for that, quite frankly, surprised us at this committee—I think on all sides—because this was considered under Bill C-7. When you, yourself, spoke in the House in February 2021, you said that you “do not believe that we are fully prepared to safely proceed with the provision of MAID on the ground of mental illness alone”.

Now, we see in the headlines multiple instances—very disturbing ones—of individuals who have served our country, the Canadian Armed Forces veterans, being offered medical assistance in dying when they reach out for help, perhaps with post-traumatic stress disorder or some other challenge they're facing. Canadians are shocked and alarmed by this.

My question for you, Minister, is the following. We know that the RCMP is getting involved in this. Clearly, under our current system, vulnerable Canadians are not being sufficiently protected when it comes to medical assistance in dying. In light of this looming deadline of March 17, 2023, when MAID will be further expanded, are you willing to put the brakes on that expansion until we get some guidelines in place that clearly protect vulnerable Canadians—not only members of the Canadian Armed Forces and veterans, but all vulnerable Canadians suffering with mental illness?

[Professor Isabel Grant, Professor, Allard School of Law, University of British Columbia, As an Individual]

Thank you very much.

While I'm grateful for the opportunity to speak to you today, I do so with a profound sense of despair over what is happening with track two MAID. No matter how many people tell you that Bill C-7 is dangerous and no matter how many people die because they can't afford to live, it feels like a runaway train careening towards a human rights disaster. Ableism is so deeply embedded in our political and social structures that we don't see it as ableism but rather as a form of common sense.

The Supreme Court of Canada describes discrimination against people with disabilities as being premised on a distorted view that disability is a flaw that needs to be fixed or eradicated. It is precisely this ableist view of disability that fuelled Bill C-7 and is now killing disabled Canadians.

This ableism, sadly, has also permeated these hearings. Imagine that you are disabled. Perhaps you live in a one-room apartment. Perhaps you need diapers to deal with your incontinence. You've been listening to these hearings and heard your legislators talk about whether it would be better to be dead than to be like you. Far from feeling that your autonomy has been enhanced, you feel demoralized and depressed. You tell your doctor you are struggling, but she just reminds you that you are now eligible for MAID. Is it any wonder that so many disabled Canadians feel devalued and afraid?

If you take only one thing from my words today, it is this: There is only one safeguard that will protect people with disabilities from wrongful deaths, and that is reasonable foreseeability of natural death. That is the only safeguard that can prevent people from dying because they are too poor, too isolated or too exhausted from fighting for their survival to continue living. Death is the great equalizer. Everyone dies, and this is the only safeguard that removes making value judgments about the worth of disabled lives from the equation.

It is impossible to separate the suffering caused by disability from the suffering caused by the social, economic and political accompaniments of disability. If I cannot access smoke-free housing, is that my multiple chemical sensitivities or is that the inadequacy of social housing? If I can't afford an apartment with an elevator, is that my disability or my poverty? If I am facing institutionalization at 40 because the government won't provide me with home care to ensure I can get to the bathroom at night, is that my disability or is that the abject failure of the state to provide the basic necessities of life?

These situations have led to the deaths by MAID of real people who did not want to die. This is a system that would not provide Sathya Kovac with home care but gave her death by a house call. She wrote her own obituary before her death, saying, “It was not a genetic disease that took me out, it was a system.”

The Supreme Court of Canada has held in the death penalty context that one wrongful death is too many. I ask you how many wrongful deaths are too many for track two MAID? To those who say that MAID is just another form of health care, remember that it is legislated as an exemption to murder and aiding suicide, and that is the only reason Parliament has any jurisdiction. The Criminal Code makes explicit that ending a life is so serious that we don't allow people to consent to their own deaths. The MAID regime makes an exception to that, but only for disabled Canadians. Only their lives are not worth saving. How can you not see that this is discriminatory?

It is irresponsible to delegate the definition of murder and aiding suicide to doctors and ask us to trust a health care system that is strapped for resources and near the breaking point. When we look at Canada's record of eugenics, from residential schools to warehousing of the mentally ill and the sterilization of indigenous and disabled women and girls, we see that doctors were deeply implicated in all of these.

This government has focused not on eradicating the suffering of people with disabilities but rather on eradicating the sufferers. I urge this committee to take meaningful steps to prevent the impending human rights catastrophe that will be MAID for mental illness and to put an end to track two MAID.

Thank you.

[Marie-Françoise Mégie, senator, Quebec (Rougemont), ISG]

Thank you to all the witnesses for being with us today.

Ms. Carr, during the Senate review of Bill C‑7, we heard witnesses from the disability community. They said many among you think that they are vulnerable. From their point of view, putting this label on them means stigmatizing them. They have the right, like anyone else, to give their consent or to request medical assistance in dying.

What is the state's role in terms of drawing a line between protecting persons with a disability who may be vulnerable, and the necessity of respecting the individual choices they might make? How do we avoid infantilizing them? They were the ones to use that term. By saying that they are vulnerable, we are trying to infantilize them.

What do you think?

[Gabrielle Peters, Co-Founder, Disability Filibuster]

My name is Alex Cosh . I'm acting on behalf of Gabrielle Peters as her echo today.

Good morning, I'm joining you very early in the day from the unceded territories of the Squamish, Musqueam and Tsleil-Waututh nations.

Modern western ableism, and particularly scientific ableism, serve as historical and ongoing links between colonialism and MAID. Modern western ableism forms the basis and provides the rhetorical and pseudoscientific framework for constructing hierarchies, defining other and establishing lesser, as well as delineating arbitrary lines between “deserving” and “undeserving”. Within your ableist system, track two MAID extends the coercive but seemingly arm’s-length power of the state to provide a designated class of citizens with premature death at the hands of the state.

I'm speaking to you today as the co-founder of the Disability Filibuster, a national grassroots initiative started by Catherine Frazee and myself on the eve of the passing of Bill C-7 and the creation of its second track for MAID.

Disability Filibuster was in part a response to disabled people being marginalized from the discussion and decision-making around Bill C-7 and our frustration that our collective anger was cordoned off and isolated, much like our lives.

Disability Filibuster was the only space created for the only people targeted by the expansion of MAID to voice their views. The media locked down and was dominated by the endless public relations work of those lobbying for its expansion.

Concerns about the social contagion of covering the ending of one's life were tossed aside. The line between editorializing was blurred to the point of romanticizing and lionizing those who made the choice not to continue to be a “burden on those around them” and to “end things on their own terms”. You could hear Frank Sinatra singing between the lines.

No mention was made of the previously publicly articulated and enthusiastic supports for involuntary euthanasia of disabled people during the time of Tracy Latimer's murder in reshaping the narrative to make these same people the champions of autonomy. The political sphere was dominated by the disproportionate representation of politicians enthusiastic for expanding MAID and all for being seen in a favourable light by its well-connected and well-heeled proponents. A foundation sharing the same name and lineage as the Prime Minister played more than a minor role in propelling supports to the forefront.

Disabled people are a large minority, but we are still the minority, a minority that is disproportionately poor, racialized and not noted for its strong political value and influence, as is evidenced by our policy absence in political platforms and campaigns during elections. We didn't have a chance. There was no place for disabled people in the discourse around the policy that specifically and solely affects disabled people and no one else.

Even today, the only place for us in media coverage is as human interest stories about those among us who have resigned ourselves to applying for MAID after tiring of seeking non-existent supports and unable to gulp down the prospect of a future of subsistence-level poverty inflicted and normalized as a component of our broader dehumanization and oppression. In order to be allowed a presence, you have to agree to die.

So removed, uninterested and ill-informed are our politicians and media about our lives and the discussions that we have that we've found ourselves regularly characterized as right-wing religious fanatics. This characterization is so laughably incorrect that I struggle to express the absurdity of it.

Over the course of two years, Disability Filibuster has hosted approximately 80 hours of Zooms. These included panels, readings, arts, casual conversations and live processing of our grief and exhausted rage. A great deal of knowledge was shared.

However, the truth is that I didn't come here today under the illusion that I can alter minds or inform those who have consistently, persistently and wilfully chosen to do the least possible to inform themselves about the lives of disabled people, particularly those living in poverty and on the extreme margins of society—your society.

I came to put it in on the record: Canada's expansion of MAID to disabled people whose deaths are not reasonably foreseeable reifies and builds on the existing dehumanization of disabled people in Canada, breathes new life into the goals of never-dismantled eugenics and is based on the ableism that formed this country's foundation, and as such, represents a serious threat.

The material and social conditions and absence of positive liberty facing disabled people in Canada are fundamentally different from those of non-disabled people. The very different social contract offered to disabled people has yet to provide us with a guarantee of freedom to live in the community, to not be forced into institutions should our needs exceed those deemed appropriately human, the denial of our equal right to travel, and the provision of infrastructure that would make us intended participants—not unintended participants—in society.

I didn't come here with illusions. I came here to remind you that history changes and that one day our roles will be reversed and you will be the ones answering questions.

[Ellen Cohen, National Coordinator Advocate, National Mental Health Inclusion Network, As an Individual]

Thank you, Madam Chair.

Good morning. I hope everyone is well.

My name is Ellen Cohen, and I'm here today as an independent witness willing to share my expertise that is built from my professional and personal experiences.

For over 30 years, I have worked in the mental health consumer sector. I'm a person with mental health challenges and two chronic health conditions, and a family member. I need you to know that there is a lot on the line for me today, and I'm nervous. This is so much larger than all of us. The recommendations that you make to the government can make a big difference for people I support, persons with disabilities and people with mental health conditions living in Canada.

Who is not touched by mental illness? Mental illness affects everyone. People with disabilities make up 22% of the population, and that represents 6.2 million people living in Canada. Among youth aged 15-24 with disabilities, 60% claim to have mental health-related disabilities. All too often, some professionals do not understand that people with intellectual, physical and sensory disabilities can also have mental health conditions that are not related to any disability they may have.

I know that some of the problems where MAID is a major concern for our communities include poverty and lack of food security, safe housing, access to health care, mental health care and addiction services. There is also systemic discrimination—to mention a few.

I was invited onto the panel representing mental health from a disability perspective, which I did. The disability community is diverse, and I know that mental health consumer survivors are divided on the issue of MAID. Despite what was said by Dr. Gupta in her testimony to the members of this committee, I came onto the expert panel with an open mind. As a member of the panel, I was responsible to voice my opinion and to make recommendations for safeguards where mental illness was the sole underlying medical condition in applying for MAID.

Since the beginning of the process, there were challenges, including the composition of the expert panel. It was made up of seven doctors, five or six of whom provided assessments, one palliative care family doctor working with marginalized people, two doctors from the indigenous community, a psychiatric ethicist, two lawyers, two community members from the mental health community, and myself, a member of the disability/mental health community.

From the beginning of the panel, those who were assessors talked about the difficulties they were experiencing with [Technical difficulty—Editor] patients in general. They shared about the complications and difficulties of assessment. Those difficulties were not clear to me, nor were they transparent. The assessors also shared about the amount of time needed for each assessment and talked about the fair compensation for the work that is expected of MAID assessors. There was no space made for meaningful discussions on seriously complicated issues concerning decision-making, consent and capacity, accountability, monitoring, privilege, vulnerability. That just did not happen in the context of people suffering with mental health disorders.

When the discussion of mental illness came up, the discussion was shut down, or we moved on. When suggestions were brought forward, panel members were discouraged due to time constraints. When I did suggest something, I was shamed by the only other peer on the panel, stating that having specific safeguards for those suffering from mental disorders was discrimination.

Under Bill C-7, I believe there's a big difference between people requesting MAID for incurable and disabling conditions and those who are requesting MAID for mental illness as the sole medical condition. I ask you this: Is this a lack of resources or bureaucracy? I believe the outcome of the panel was a foregone conclusion. It became clear that some of the expert panellists had very little appetite to make any attempt at recommendations regarding the addition of legislative safeguards for any amendments to Bill C-7 with regard to mental health disability.

After reading the Quebec decision and giving it some thought, it became obvious to me that there were too many unanswered questions and issues in determining and assessing requests for track two patients without adding to it the request from people with mental illness, which will be available come March 2023, so I left the panel.

Through this whole process, there was limited discussion about mental illness as the sole mental condition for requiring MAID. The process was rushed. Seven months from our first meeting was not enough time to decide about life and death. It was not enough time to consult with the community that Bill C-7 is endangering. I would like to point out that this parliamentary process is also being rushed.

Thank you for allowing me to share my story.

Government Business No. 16—Proceedings on Bill C‑11

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Madam Speaker, the member has mixed in the Emergencies Act with this. The Emergencies Act did not suspend the Charter of Rights. This is another falsehood that is being peddled by the opposition.

I do not think one should take charter statements lightly. The member has essentially impugned the professional integrity of the lawyers at the Department of Justice, who are not just parroting government lines; they analyze a bill based on their own professional expertise and knowledge and they produce a charter statement that they feel is accurate. I do not think we should take charter statements lightly.

In terms of Bill C-7, the government was responding to court decisions. I think they are a very credible form of input.

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

Madam Speaker, I wanted to ask the hon. member a fairly specific question about the content of his speech. He spoke about charter statements and the importance the government attaches to charter statements. We have seen multiple cases in which the government has table-dropped amendments to its own legislation and it has not offered a revised charter statement to line up with that change in policy.

We saw that in another case with Bill C-7, where the government changed its policy in response to a Senate amendment but did not offer a revised charter statement. On the previous version of this bill, Bill C-10, we saw the government adopting changes from government members in committee without revised charter statements. This is a government that, through the Emergencies Act, has suspended the charter and then we have had contradictory stories told by the minister.

I am very suspicious of the stated commitment to the charter. It seems increasingly like these charter statements are then subsequently ignored through amendments and not updated. It suggests that this is just an effort by the government to whitewash an attack on human rights.

Most specifically, why does the government not have a practice of offering updated charter statements when bills are amended as a result of the amendments government members have put forward when they come out of committee?

[Luc Thériault, Bloc, Montcalm, QC]

I'm talking about the report the minister commissioned from the expert panel that was to look into whether or not to include in Bill C‑7 the sunset clause designating March 17, 2023, about when mental health disorders are the only medical conditions claimed.

That's okay, I will move on to another question.

Mr. Carnevale, you talked about additional safeguards for mature minors. You also stated that mature minors should not be granted medical assistance in dying if they are suffering from mental health disorders. I did understand what you said.

In your opinion, what should the additional safeguards be?

[Dr. Derryck Smith]

That's a very interesting question as well. I have to tell you that, when people ask me what I do for a living, I tell them I'm a medical doctor first and a psychiatrist second. The seat of all psychiatric illness is the human brain, which the last time I looked was part of the body and part of the human experience. Our personality, as we describe it, lies in the frontal lobes of our brain, so I'm very much opposed to this dichotomy between physical illness and mental illness. These are all disorders of the human body—and, in this case, mostly the human brain.

I don't have a problem sorting out whether people should or shouldn't. We have pretty clear criteria that are put down in the legislation. We have new criteria in Bill C-7. Assessment could involve a skilled clinician who knows what they're up to in psychiatry and a second assessor, and maybe even talking to the family doctor and to the patient's family. These assessments take literally hours and involve a wide variety of people—the patient, the doctor, a couple of assessors and the patient's family.

I can remember one assessment I did, in which I spent three hours talking to each of the children of a man who was seeking MAID. I want to make sure of what everybody's opinion is. In the end it's up to the individual person, but we want to listen to what other people have to say when approaching that decision.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

I would like to take the opportunity to ask a legal specialist who is here today something that I was asked in the past 24 hours and that I could not answer on the spot.

Mr. Roberge, in its report, Quebec and its special commission on the evolution of the end-of-life care act chose not to proceed and not recommend that the bill tabled this morning open the door to mental illness as the sole medical issue.

If we were to follow this recommendation and bill C‑7 and its sunset clause were indeed adopted, what effect would that have on coordination or consistency?

Do you think Quebec would then have to abide by that decision? Would it have some autonomy, leeway? We are well aware that the regulatory frameworks are not necessarily in the Criminal Code.

In your opinion, what would happen from a legal point of view?

[Pierre Deschamps, Lawyer and Ethicist, As an Individual]

Good evening, everyone.

Thank you for inviting me to testify.

This evening I will be discussing advance requests for medical assistance in dying.

Advance requests for medical assistance in dying make it possible for capable persons to consent in advance to the provision of medical assistance in dying where they are in a state of life or health incompatible with their values, such as a state of advanced dementia preventing them from recognizing family members or from performing their activities of everyday life. Such requests are now made as part of a relaxing of the rules governing access to medical assistance in dying, as may be seen in the way Canadian legislation has evolved on the matter.

I would like to draw your attention to a few historical facts.

Bill C‑14 made it possible for persons to agree to have a physician or nurse practitioner inflict death on them with their consent, provided they gave their consent at the time the medical assistance in dying was administered. This constituted an exception to, or a derogation from, the rule stated in section 14 of the Criminal Code that prohibits a third party from inflicting death on a person even where that person has given consent. This development was accompanied by the legislator's introduction of safeguards that restricted or limited the circumstances in which medical assistance in dying may be provided based on the eligibility criteria developed at that time.

Bill C‑7 added an exception to that rule by permitting persons to receive medical assistance in dying even if, at the time it is administered, those persons are unable to consent to it, provided they have signed a prior written agreement with a physician waiving the requirement to consent to medical assistance in dying at the time it is provided. Here again, the legislator established safeguards to protect the person who is to receive medical assistance in dying.

It is now being proposed that persons who do not yet have a grievous and irremediable medical condition, but who anticipate having such a condition, should, if in a given situation such as a state of advanced dementia preventing them from recognizing family members or performing their activities of everyday life, be allowed to receive medical assistance in dying in circumstances in which — and I want to emphasize this — they, although conscious, are unable to consent to the provision of medical assistance in dying.

By legislating on this matter, Canada would be joining a very small number of countries that have accepted that a person may receive medical assistance in dying by means of an advance request. I am referring to the Netherlands and Belgium, which have very different statutes on this issue.

In the Netherlands, advance requests for medical assistance in dying are authorized, but, between 2017 and 2019, there were only two or three cases per year of persons suffering from advanced dementia who received euthanasia in accordance with their advance medical directives.

In Belgium, an advance euthanasia directive takes effect only if a person is irreversibly unconscious at the time of euthanasia. In other words, that person must be in an irreversible coma. From 2016 to 2020, between 22 and 33 persons per year received euthanasia in accordance with their advance medical directives.

Unlike Belgium, Canada is currently considering the possibility of providing medical assistance in dying to a person who has made an advance request, not where that individual is in an irreversible coma, which presupposes a total loss of consciousness, but where a person with a grievous and irremediable medical condition such as advanced dementia is still conscious, even if only minimally so, but incapable of giving free and informed consent to the provision of medical assistance in dying.

In such circumstances, Parliament would be asked to validate or sanction under criminal law the possibility for a person who makes an advance request for medical assistance in dying to receive such assistance if the conditions that individual has established as activation triggers of his declaration are met.

While the drafting of an advance request for medical assistance in dying entails its own difficulties, particularly with regard to the identification of factors that may determine when it should take effect, activation of the declaration presents challenges in many areas: the medical condition required for consideration to be given to providing such assistance; the provision of medical assistance in dying to an incapable or more or less unconscious person; the severity of the person's cognitive losses; the family members who would be called upon to commence the assessment process leading to the provision of medical assistance in dying; and the medical and other assessments required to determine whether the person has reached a point where his or her previously expressed wishes must be considered.

Here the challenge for legislators is to design robust safeguards that will protect persons who have made advance requests for medical assistance in dying — such requests are generally made many years before the condition that may potentially give rise to their activation appears — from abuses such as medical assistance in dying that is provided too early or in haste under pressure from family members or medical staff who sympathize with the state of mental deterioration of the person, who will thus be put in a highly vulnerable position.

In addition to Parliament's intervention in criminal law, there can be no doubt that provincial statutes, as in Quebec's case, will be required to determine the circumstances in which an advance request for medical assistance in dying may be activated when a person is considered incapable of giving consent yet is still conscious, even if minimally so.

Motion That Debate Be Not Further Adjourned

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

Madam Speaker, the hon. member indeed reminds me that Conservatives, whether inside or outside the House, seem to have fallen in love with blocking and blockades.

We are here because we have many other pieces of legislation, including a budget. There is not just Bill C-8, which, as we have mentioned, has had 12 days of debate and obstruction and concurrence motions and everything else that the Conservatives can throw up in order to delay it, but also Bill C-7, which we have not debated yet, and Bill C-9, which we have not debated yet. There is Bill C-18 and there is Bill C-19.

There are all kinds of things that we have yet to debate, as well as the budget, and that is because the official opposition simply wants to run out the clock; delay, delay, delay; and use every tactic at its disposal to throw this government off its agenda. Canadians do not want that. They want us to work together.

[Jay Potter]

When Bill C-7 was passed, the safeguards related to a death that was not reasonably foreseeable included a safeguard that required the person to be offered consultations with various professionals, including disability support services. That was part of, as I understand it, responding to concerns that were expressed by the disability community. There is obviously much more that can be said on this issue.

The committee could look to members of that community and to disability rights organizations to provide evidence to inform its considerations.

[Abby Hoffman]

That is correct at the present time, and that is absolutely something we need to fix. Bill C-7 directed the Minister of Health to develop regulations that would ensure that we would collect that kind of data. That is what we are doing.

Protection of Freedom of Conscience Act

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, one of the most common threads we heard throughout the testimony from experts on Bill C-7 was that there was a need for national conscience rights.

The committee heard from patients rights groups, lawyers, disabilities rights experts, medical ethicists, indigenous leaders, imams, rabbis and priests, as well as individuals who provided testimony of their own personal experiences, which are very different than the one that the member spoke to.

I have also received emails from physicians from across the country who are deeply concerned about their ability to continue practising as a result of, and from those who have experienced, intimidation and coercion to participate in the provision of MAID.