Justice Committee on Nov. 23rd, 2020

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Kelloway.

Mr. Virani, I have you next.

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

I'm sorry, Madam Chair. I believe that was from the previous round. I tried to lower my hand. I apologize.

[The Chair, Liberal, Iqra Khalid]

Madam Findlay.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

I'm hearing what our colleague MP Manly has to say. We've certainly heard a lot of testimony in this committee from persons with disabilities or advocacy groups for those persons in Canada. They have a lot of concerns about the expansion of this legislation as proposed by the Liberals.

So far, every amendment we've tried to propose to either further protect persons with disabilities or give them some comfort level has been defeated, by the Liberal and NDP votes specifically.

It seems to me that this is a very reasonable addition. It's a clarifying addition. It's an amendment that I feel I could support. In light of Mr. Manly's comments about the timeliness that he has experienced in being able to connect people with further and other support services and consultations, this isn't a high onus. It doesn't change the effect of this legislation and what the Liberal government is proposing here, but it does give a comfort level. It is the reality on the ground.

In question period today Minister Lametti once again, in response to a question, said something to the effect that by the time people make this decision, there is no doubt in their minds, that they've gone through whatever it is they need to go through to process all of this and it's a done deal. However, we've heard testimony about transient suicidal ideation. We've heard testimony—actually, there are reports, which I've referenced before—about people in fact changing their minds.

Everyone is different. If we really believe in individual autonomy, then it seems to me we should make it very clear that people would have the opportunity and would be encouraged, to the extent it makes sense in their particular case, to consult with others and get all the support services they need.

The individuals are the ones driving this agenda. They would know whether they want to seek this. They would know whether they feel they would get comfort out of it. They may have already made up their minds but just have a little doubt and want to talk it out with someone else. There are so many different scenarios that could be played out.

It seems to me that there is a thoughtful suggestion in this amendment. When I hear that a group such as Inclusion Canada are good with this wording and perhaps even supported Mr. Manly in bringing the wording forward, that is very persuasive to me, given the testimony we've heard.

I don't frankly think it's a great idea for legislators to put forward legislation that virtually ignores a very important segment of Canadian society, which is persons with disabilities. They have made it very clear that they're reaching out to us and saying, please don't make us different from everyone else, but make amendments here and improve this legislation in a way that makes us at least more comfortable, so that we don't feel that we're being isolated or segmented out.

I don't see why we cannot answer that call, frankly.

With those comments, I'm supportive of this amendment. Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Madam Findlay.

I have Mr. Moore and then Mr. Cooper.

Go ahead, Mr. Moore.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

First of all, I think this is a very thoughtful amendment by Mr. Manly. We heard the testimony from witnesses, vulnerable witnesses, Canadians living with disabilities. This response to some of the concerns raised by some of our witnesses....

In this discussion, I often hear medical professionals or doctors cited, but often we're talking about MAID assessors or MAID providers, and I think, as a committee, we have a responsibility. I've listened to the MAID assessors and MAID providers, but the broader physician-doctor-health care community....

On the specific issue of this Green amendment, we received a submission as a committee—I know I did—from Physicians Together for Vulnerable Canadians. It was signed by more than 800 physicians. These are physicians—medical doctors—who say they feel compelled to voice their “dismay at how individuals who have little lived experience of the realities involved in the everyday practice of medicine suddenly and fundamentally changed the nature of medicine” by making changes to assisted suicide.

Specifically on this matter, and I want to home in on this, they say:

...the authors of Bill C-7 consider it sufficient to offer patients information about other possible means to alleviate their suffering, [but] there is no requirement that the service be available to the patient.

How many times did we hear that? In the limited testimony we had on the bill, I heard over and over, from persons with disabilities and from others who have concerns with this bill, that it's not a true choice between assisted death and other options if those other options aren't available.

They go on to say:

We live in a country where the wait time to see a psychiatrist in certain areas is 4-8 times longer than the 90-day waiting period proposed in the bill for those whose natural death is not considered “reasonably foreseeable”, and where 70% of citizens nearing the end of life still have no access to basic palliative care services. Yet MAiD has been deemed an essential service under the Canada Health Act and palliative care has not. This bill creates the conditions for cheap and easy death through euthanasia or assisted suicide.

This is not the medicine that we have devoted our lives to practicing. Our intent is to heal and to alleviate suffering....

These physicians sent our committee this information. They are saying that it's not a true choice, if a person has not fully been able to explore what services, including palliative care services, are available to them. They say that 70 per cent of Canadians nearing the end of life still have no access to basic palliative care services.

In Bill C-7 we have a significant expansion of Canada's assisted dying legislation. My goal in this is to listen to the testimony from witnesses and ensure that we as a committee do everything in our power to protect vulnerable Canadians, protect Canadians who are at a low point in their lives and protect Canadians' basic and fundamental rights, and to make sure that, when a decision is made that involves assisted dying, it is made with all the best available information.

If a person dealing with end-of-life issues has not been able to avail themselves of a consultation with a palliative care doctor, then how are they supposed to make that decision? This is the point that these physicians—more than 800 of them—have made to our committee.

It's for those reasons and others that I think this particular amendment is bang on. I think it is a further safeguard. I don't think it's too onerous at all. Remember, these are cases where death is not reasonably foreseeable, so we want to make sure that Canadians have been able to avail themselves of all possible options.

It's for those reasons that I'm happy to support this Green amendment from Mr. Manly.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Moore.

Mr. Cooper, you're up next.

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

Thank you very much, Madam Chair. I too would like to express my support for Mr. Manly's amendment. I believe it is very reasonable and, in some respects, a modest amendment.

We heard over and over again from witnesses, particularly those representing persons with disabilities, of the inadequacy of the provision, in the context of where death is not reasonably foreseeable, to merely inform a patient of alternatives. To merely inform a patient without requiring them to seek any alternatives or without any guarantee of seeing that they have access to those alternatives puts vulnerable people at risk, vulnerable people who are often in their most vulnerable state upon making a request for medical assistance in dying.

I would note that the minister has often said, and others have said, that when someone makes a request for medical assistance in dying, they have long thought through the process and it's therefore somehow important that it be expedited, which I don't quite understand. When we're speaking about where death is not reasonably foreseeable, it opens the door to persons who might have had an accident or a traumatic event or a diagnosis that causes them to have their life literally turned upside down. We heard evidence of suicidal ideation, particularly in circumstances where people have bad news or where they are experiencing significant pain and suffering, without having an opportunity to identify or determine what possible treatments might be available to them.

I would note that Dr. Catherine Ferrier appeared before this committee. I'm going to read this into the record because I think it's important in the context of this motion. She is a physician who has worked since 1984 in the geriatric clinic at McGill University Health Centre. She noted in her testimony that:

The suicide rate after traumatic spinal cord injury is [five] times that of the general population for five years. Those who choose suicide may not [have a diagnosable depression] or [be] incapable of decision-making. Their options have been tragically narrowed, and it takes a long time to readjust, but people do. After five years, the rate is the same as that of the general population. They need protection from their despair. That's why our society responds to suicidal desires with prevention. That's why [it makes no sense to] allow MAID after 90 days [for people who are not near the end of life].

She objects to the 90-day period. One can debate that. I, too, don't agree with the 90-day period. With respect to Mr. Manly's amendment, I've cited one example, but there are many other examples of people who suffer from a disease or illness who have much higher suicide rates until after a period of time when they can adjust. It speaks, therefore, to the importance of the amendment, to not just provide information but to see that they can get appropriate consultations.

I would note that this amendment is consistent in some ways with what was said in the final report of the External Panel on Options for a Legislative Response to Carter v. Canada.

That report, which was very important when we were giving consideration to Bill C-14, said “a request for a physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available to alleviate a person's suffering.” Surely someone should, at the very least, be required to go through a consultation in circumstances where death is not reasonably foreseeable.

I would note that Canada, by going down this road, would be an outlier in the world. We would have, arguably, the most permissive regime in the world. I would note that in the Netherlands, for example, a physician must confirm that there are no other potential means to relieve suffering before administering medical assistance in dying to a patient. Here we would provide merely information but no obligation to ensure that the person could truly make an informed decision. You can't make a truly informed decision and you can't exercise your autonomy if the choice is simply intolerable suffering versus medical assistance in dying.

I believe that Mr. Manly's amendment, for all of those reasons, makes sense.

I will say I find it troubling that when we have heard from 72 national organizations representing persons with disabilities and the rights of persons with disabilities, when we have heard concerns expressed by the UN special rapporteur on the rights of persons with disabilities and when we have heard questions asked about Canada's compliance with its international obligations under the Convention on the Rights of Persons with Disabilities, including article 10, that the members on the government side have given short shrift to all of those concerns. I would just—

[The Chair, Liberal, Iqra Khalid]

Mr. Cooper, just talk about the amendment, please.

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

—hope, taking into account those concerns, that members on the government side would be open to supporting what I believe is a good but very modest amendment.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Cooper.

Mr. Manly, if you want to respond to some of the concerns or issues that have been raised, briefly, sir, please go ahead.

[Paul Manly, Green, Nanaimo—Ladysmith, BC]

I was just going to say that many of the things are listed here say “where appropriate”, so these aren't services that everybody will need to access. It has, “where appropriate, counselling services, mental health and disability support services, community services and palliative care”. I think that many people will have already sought out some of these things before they seek a medically assisted death.

I don't want to take away somebody's agency to say that they don't want to have to seek mental health services or disability support, but I think many people seek these things out already. We want to make sure that, for people in the disability community, they have actually had the opportunity to get those consultations and see what supports are available to them.

In my work I have had youth who were threatening suicide. They were at their wit's end because they weren't getting the services and the things they needed. It just took some patience and some time to work with them, and to work within the community, to ensure that they had access to the things they needed so that they could thrive in the community.

That's all I have to add. Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Manly.

I have Mr. Lewis next on the list.

Go ahead, Mr. Lewis.

[Chris Lewis, Conservative, Essex, ON]

Thank you, Madam Chair. I certainly appreciate the opportunity to speak to this tonight.

Just as a point of clarification with regard to Mr. Cooper, I thought Mr. Cooper actually was very much speaking to the amendment. I'm just wondering what the rules of engagement are. I have quite a bit to say on this as well. I guess I'm asking you, Madam Chair, whether as long as I'm speaking to the amendment I'm fine to continue on. Is that correct?

[The Chair, Liberal, Iqra Khalid]

Absolutely. We're talking about relevance and specifically what the amendment does and how it would impact Bill C-7, as with all clause-by-clause.

[Chris Lewis, Conservative, Essex, ON]

Excellent. Thank you very much, Madam Chair. I appreciate that information.

As I noted earlier, the speed at which Bill C-7 is being pushed through has been quite distressing, to say the least. It has left very little time for consultation with the proper groups. Medical professionals and groups advocating for vulnerable Canadians have been excluded from the consultation process, but thankfully tonight we did allow briefs to come forward. I think that's a fantastic step forward for this committee.

It has always been common practice in other nations with laws that allow euthanasia that it is treated as a last resort, not as an initial treatment option. The typical requirement in these nations is that the standard of care must be applied before it is offered. This has been a point raised by many doctors and other health care professionals across the country as they voice their concerns over how this bill puts vulnerable groups in our country at risk.

I am grateful that our colleagues in the Green Party put forward this valuable amendment that could very well save lives. The amendment proposes to change the wording of proposed paragraph 241.2(3.1)(g). This would require that those whose death is not reasonably foreseeable go through consultations with professionals who have relevant experience in the care of and services for those with a similar diagnosis or condition.

It is of the utmost importance that patients are also given this consultation by the proper professionals. These professionals must be individuals who currently provide the service or care that is applicable to what the patient's diagnosis or injury would require. The responsibility to ensure that individuals considering MAID are fully informed prior to making such an important decision ought to be paramount. When a person is in such a desperate position that they are driven to consider ending their own life, they should be afforded every available support, and this necessarily includes being informed of alternatives to MAID.

I'm sure that often when someone receives a diagnosis of a chronic issue or disability, they can feel like the world is falling—

[The Chair, Liberal, Iqra Khalid]

Mr. Lewis, your audio and your video aren't of good quality.

Are members able to hear and understand Mr. Lewis?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

No, not clearly.

[Chris Lewis, Conservative, Essex, ON]

Is that any better?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

It's not very clear, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Mr. Lewis, could you check your connection? Maybe you can connect with IT and we'll come back to you, if that's okay.

[Chris Lewis, Conservative, Essex, ON]

Absolutely. Thank you, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Lewis.

Monsieur Thériault, it's good to see you in good health in our committee. Please go ahead, sir.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair. That's kind of you.

I'm sorry, but I do not agree with my colleagues' comments, relevant though they are, because they are based on assumptions like the following. Paragraph (g) is located at the end of the safeguards in subclause 241.2(3.1), which states that: Before ... provides medical assistance in dying to a person whose natural death is not reasonably foreseeable...

When a person makes a request of that nature, we cannot assume that they are doing so on an uninformed basis. There is a whole process for requests made by people with degenerative illnesses or conditions, impairments that lead to intolerable disability and suffering, or grievous or irremediable conditions or states.

Bill C-7 says that, when such a request is made, a certain number of things must be done. I do not think we should assume that, just because somebody has a physical or cognitive disability, they do not have as much moral autonomy than any of us here. That assumption is forgotten at the outset. Another forgotten assumption is the following: when legislation or the Criminal Code includes an exculpatory measure, it cannot be misleading or unevenly accessible across the country.

After all the other safeguards in Bill C-7, paragraph (g) states the following: ensure that the person has been informed of the means available to relieve their suffering...

I would like to emphasize that an assessment of the irreversibility of a person's state has been conducted beforehand. We talked about this, because the core issue is the irreversibility of a person's state of suffering. That is what medical professionals must assess. The full wording of paragraph 241.2(3.1)(g) is as follows: ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care and has been offered consultations with relevant professionals who provide those services or that care;

After that entire list of the services available, Mr. Manly would like us to say “and has had consultations with the relevant professionals who provide those services or that care”. If that is not a requirement, I wonder what is. Does the requirement for consultation apply to only one of these services? Does it apply to all of them? Mr. Manly mentioned palliative care, but that is not the only service listed here.

In this context, I would hope that, by the end of the process, people have made a completely free and informed decision, with no one pressuring them into doing so. However, they are being told that a certain number of parameters still have to be checked and that professionals can be consulted. When someone is suicidal due to an accident, the suicidal state is reversible. We cannot be comparing apples to oranges. When someone requests medical assistance in dying, their state, condition, problem, disability... Disabilities are always social. I always have a difficult time referring to people with disabilities as “disabled”. It's we, as a society, who disable them.

They have the same moral autonomy as you and I, yet the Criminal Code would require them to undergo additional consultations, as if their decision was not informed by a consultation process already. State paternalism can only go so far, and this amendment runs contrary to the principles set out in the Carter decision and in the one rendered by Justice Baudouin. That is why I am opposed to it.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Thériault.

Mr. Moore, I have your hand raised for a response to any of the comments you've heard since your last intervention.