Foreign Affairs Committee on Feb. 27th, 2019

[The Chair]

Thank you very much.

MP Genuis, please.

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

Thank you, Mr. Chair, and thank you, Mr. Saini, for proposing an amendment and for your active engagement within the discussion. I do respectfully disagree with what you've proposed. I'll just make two points in response.

The first is on the exceptions in terms of confidentiality in a medical context. There are already exceptions in law for things around child abuse and around the reporting associated with gunshot wounds. These are things that doctors do. Hopefully they're not necessary to do very often, but they're things that are established in law because we recognize that the protection of vulnerable people at certain points in time exceeds that bond of confidentiality. I think that's right and appropriate.

In terms of the issue of the Governor in Council designation, there is nothing in this provision that precludes a designation of provincial bodies for the purposes of that designation. Arriving at those designations, when and where possible, in collaboration with the provinces and territories would be a very reasonable thing to do. At the same time, this is a question of tracking information for the purposes of criminal law, recognizing that there's health and there's criminal law and there's a point where there needs to be a dialogue between the two, and that obviously involves the engagement of different levels of government.

We're amending the Criminal Code here. To do that effectively, we need to establish the provisions for that designation. However, again, this should be implemented with a good level of provincial and territorial co-operation, including potentially in the process of that designation.

[The Chair]

Parliamentary Secretary Virani, please.

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

Thank you very much, Chair.

In response to this discussion, I just want to contribute a few points.

The issue of, clearly, doctor-patient confidentiality is quite sacrosanct. It is purist on occasion. What is entered into the debate in the context of this bill has been the examples of the duty to report gunshot wounds and the duty to report child abuse. Those examples raised just now by Mr. Genuis were raised yesterday in the testimony with Mr. Matas. In both of those contexts, it is the provincial legislative mechanism that has been invoked and is used to compel that breach of the doctor-patient confidentiality.

Doctors are regulated largely, almost exclusively, by the provinces themselves in terms of the College of Physicians and Surgeons of Ontario, for example, in setting standards of practice, the oaths that are taken, the licensing requirements, and so on.

In respect of federal-provincial-territorial suppleness, for want of a better phrase, in terms of being able to adapt to amendments that might happen here, the FPTs have actually not been engaged on this bill to date. I think that's important to inject into the context of this committee's deliberations.

[The Chair]

MP Genuis, go ahead, please.

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

Thank you, Mr. Virani, as well, for your comments and your engagement on this.

I would just say that of course there are many examples of federal statutes, probably the most famous being the Canada Health Act, that do touch on matters to do with health, and so I think the fact that the federal Parliament and members of Parliament are engaged with these issues to some extent already is reasonable and reflects the kinds of conversations we have with our constituents in terms of being engaged with health matters. But again, the reporting mechanism is left to the Governor in Council, so this is something that can be arrived at.

Obviously, on private members' legislation, there's no mechanism for us to be actively engaged in negotiations with provincial counterparts at this stage, but this is the sort of thing that is pretty common sense, and I think something significant is lost by removing this section. What is lost is a clear certainty that we will have an effective mechanism for identifying and prosecuting effectively those who are involved in this. So I think, with respect, that it is a workable mechanism and it is very much worth leaving in.

[The Chair]

MP Saini.

[Raj Saini, Liberal, Kitchener Centre, ON]

I respectfully disagree with Mr. Genuis.

I can give you a personal example. In the House of Commons, there are people who have asked me for medical advice, from the opposition, from my own benches, serving staff, police officers, sometimes administration staff and sometimes the bureaucracy.

So I have a wide range of people in Parliament itself, and I say that because nobody will ever know who those people are. There is something sacrosanct in medicine that no law will change. To suggest that a law is going to compel someone to do something.... Especially in the medical profession, that is the one thing that we keep very, very close to us, that medical professional relationship.

So putting it in or not putting it in, I can tell you, practically, is not going to work. It's better just to remove it and not cause any further complications to the passage of this bill.

[The Chair]

Parliamentary Secretary Virani, go ahead, please.

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

I think it's entirely appropriate that this committee, among others today in Ottawa, is talking about confidentiality, but when you underpin, you explore what confidentiality is meant to promote, it's so clear that sometimes we don't think about it, but it's there to promote people coming forward.

We keep these things confidential so that someone feels that it's not going to be shared with another person, so they can talk about their depression; they can talk about their anxiety; they can talk about whatever health issues are plaguing them to their pharmacist, to their doctor, or whatever the case may be. That's because we want people to get better. We want them to safeguard their own health. That is a fundamental imperative, which I think supersedes any objectives that have been articulated otherwise and which is why that doctor-patient relationship is so sacrosanct. I think that's important for this committee to underscore.

[The Chair]

Thank you.

MP Genuis, go ahead, please.

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

Mr. Chair, with great respect, I don't think anybody here is debating the importance of confidentiality in a medical context. My wife's a physician. There are many physicians in my family. I know it well. I know the importance of it well. I think all members do, and all members understand the critical importance and exactly what Mr. Virani said about why.

There are also exceptions in law which are designed to protect the most vulnerable, so that if a child is being abused, that child can be protected. The fundamental concern for justice for the innocent supersedes that principle of confidentiality. It's not to deny its importance; it's to recognize the need for those exceptions that already exist in law.

It's hard for me to understand why it would be suggested in this case—where we have instances of people's vital organs being taken from them while they're alive, simply because of their political convictions, or in other cases being exploited because of their poverty—that we would somehow not automatically equate that with the other forms of abuse where we already have these exceptions in law. It's not something new. It's simply an extension, from my perspective, of a very clear-cut moral principle.

I have a few other points. One is that adding this section was an amendment that was specifically requested by the Senate and supported by the Senate. I think it was very important. All of the previous versions of the bill—from Irwin Cotler and, I believe, from Mr. Wrzesnewskyj as well—had a reporting mechanism in them. If you want to get this done, if you want to protect people, then there has to be an effective reporting mechanism that creates a possibility of prosecution. There is no sense in which facilitating the prosecution of heinous criminals like child abusers undermines the wider principle of physician-patient confidentiality.

I really hope we don't pass this amendment because—well, I won't repeat myself. That's enough. Thank you.

[The Chair]

Thank you very much, MP Genuis.

Seeing no further debate on this point, I will bring it to a vote.

(Amendment agreed to)

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

Mr. Chair, I'd like a recorded vote on this, then.

[The Chair]

Sure.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

I have a point of order, Mr. Chair.

[The Chair]

Yes, MP Fergus.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

I'm not a member of this committee, and I would hate to break the normal relations that happen on this committee, but it's my understanding that once a vote has been taken, if it hadn't been called as a recorded vote, then the vote's actually done.

[The Chair]

I will ask the clerk.

Yes, I'm told it can be either before or after the vote, but as long as it's asked for, we will allow it.

(Amendment agreed to: yeas 5; nays 4)

We will now go to the vote on clause 2 as amended.

Sorry, Ms. Levman.

[Nathalie Levman]

I don't want to hold you up, but I just wanted to point out that because you removed the definition of informed consent and retained the financial transaction offence, you do have a numbering problem. It's very minor, but it goes—

[The Chair]

Thank you for pointing that out. We will address that right now.

[Nathalie Levman]

In subclause 2(4), it should say “(1) or (2)”. It's just a tiny technical thing.

[The Chair]

Thank you.

The renumbering will be reflected when they reprint the bill.

We will now vote on clause 2 as amended.

(Clause 2 as amended agreed to)

(On clause 3)

I don't believe there are any changes that have been put forward. Is there any debate on clause 3?

Ms. Vandenbeld, please.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

I have a question for Ms. Levman.

It refers to the minister. I'm wondering if it needs to specify which minister.

[Nathalie Levman]

I believe that's an excellent question. I am not an expert on the Immigration and Refugee Protection Act. There are experts on the IRPA in the room. Would you like to hear from them?