Justice Committee on Nov. 24th, 2020

[The Chair, Liberal, Iqra Khalid]

Welcome, everybody, to the 11th meeting and the clause-by-clause on Bill C-7.

Just as quick housekeeping for all members, when you are speaking, please speak slowly and clearly, and unmute yourself before you speak. To allow for interpretation, do speak slowly and clearly, and if you are not speaking, please keep your microphone on mute so that we are not disrupting other members.

We do have the department officials here with us today from the Department of Justice and the Department of Health. They are having some IT issues with their connectivity, which we're trying to resolve. I believe that as that's getting resolved we can continue.

We left off with amendment CPC-8 yesterday, That is where we will pick up again today. Just so members are aware, there was an amended notice of meeting that was sent out today with a clarified agenda of today's plan. Hopefully, we're okay with that.

I will start with resuming debate on CPC-8 at this time.

I see no members' hands raised, so I will call the question on CPC-8.

Mr. Clerk, can you please record the division?

(Amendment negatived: nays 7; yeas 5)

[The Clerk of the Committee, Mr. Marc-Olivier Girard]

Madam Chair, we have four yeas and seven nays.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Clerk.

CPC-8 is defeated. We're now moving on to CPC-9.

Mr. Moore, I do have concerns about the admissibility of CPC-9. As you are moving the amendment, can you please speak also to its admissibility as well as the reasons behind it? Thank you.

Go ahead, Mr. Moore.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

I would like to move CPC-9, which amends Bill C-7. It amends section 241 of the act, which Bill C-7 does touch on. I think this is fully within order. We heard testimony at committee, which I thought was very important testimony, from, for example, Roger Foley. For anyone who doesn't know, you can certainly find his story in the media. Various media outlets reported that Mr. Foley appeared to have been feeling some pressure to consider MAID. He, in fact, made recordings to this effect.

This is very important, because we're in a new stage now. Under Bill C-14, introduced by this government, an individual's death had to be reasonably foreseeable. That was never defined, and we chose not to define it as a committee, but reasonably foreseeable death is now no longer a requirement to provide for assisted death. In effect, someone does not have to be dying to be eligible for assisted dying.

I want to specifically mention, on this amendment, that the Canadian Society of Palliative Care Physicians spoke directly to this. They sent us a submission on Bill C-7, and their fourth recommendation is a recommendation on bringing up assisted dying:

To safeguard against any possibility of subtle or overt pressure on patients, health care professionals should not initiate a discussion about MAiD or suggest the option of MAiD unless brought up by a patient. If a patient raises questions or requests MAiD, health professionals should have the ability to explore these issues, including their underlying suffering, and provide information or direct them to someone who can provide information. In other jurisdictions—

And I draw the committee's attention to this:

—where assisted dying is legalized, such as in the recent legislation in Victoria, Australia, this risk of coercion due to the hierarchy and differential of expertise present in the physician-patient relationship is addressed directly in the law. Victorian Legislation states that a healthcare practitioner must not initiate a discussion or suggest Voluntary Assisted Dying (VAD) to a patient. We urge the Federal government to reduce harm of coercion to vulnerable patients by including this in the current revisions to the Canadian MAiD legislation.

We also received a submission from the persons with disabilities community. They make a number of recommendations. Their fourth recommendation states:

Investigate the “worrisome 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”, which were identified in the UN Special Rapporteur’s report, and establish an independent body, whose membership must include representatives of the disability community, to investigate such cases moving forward.

The Conservative Party members listened to the testimony of those witnesses. I paid particular attention to the testimony of Roger Foley. That is why we're moving CPC-9, which deals directly with the issue of when medical assistance in dying should be brought up. It makes it crystal clear that this should be a patient-initiated discussion, not a physician-initiated discussion.

Thank you, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Moore.

I will have to rule on CPC-9.

Bill C-7 amends the Criminal Code in relation to MAID. The amendment here, CPC-9, seeks to create a new Criminal Code infraction of coercing someone to request MAID, which would amount to counselling or aiding a person to commit suicide under section 241 of the Criminal Code.

Since Bill C-7 only provides for an easier access to MAID, the amendment goes beyond the scope of the bill. As the House of Commons Procedure and Practice, third edition, states at page 770:

An amendment to a bill that was referred to a committee after second reading is out of order if it is beyond the scope and principle of the bill.

Therefore, as stated before, I rule that this amendment is inadmissible, as it goes beyond the scope of this bill.

With that, I will now call the question on clause 1, as we have completed discussion and debate on all of the proposed amendments for clause 1.

[Rob Moore, Conservative, Fundy Royal, NB]

On a point of order, Madam Chair, while I respect your ruling, I do feel that CPC-9 is within the scope of this legislation. It deals directly with the provision of assisted dying; it deals with the very things this bill deals with, and it's an important safeguard.

For that reason, I would like to challenge the ruling of the chair on the admissibility of CPC-9.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Moore.

I will call the question: Shall the chair's ruling be sustained?

(Ruling of the chair sustained: yeas 7; nays 4)

My ruling is sustained.

[Rob Moore, Conservative, Fundy Royal, NB]

On a point of order, Madam Chair, before we move to the vote on CPC-9, on CPC-8 it was brought to my attention—I thought I heard it as well—that four people had voted in favour, when I think it was five who voted in favour of CPC-8. I just want to make sure the record is accurate.

[The Clerk]

Yes, you are right. I will correct the record.

[The Chair, Liberal, Iqra Khalid]

You are right, Mr. Moore, so the record will be corrected. Thank you for pointing that out.

Also, to clarify, Mr. Moore, we're not voting on CPC-9. We are now voting on clause 1.

Should clause 1 as amended carry?

(Clause 1 as amended agreed to: yeas 7; nays 4)

Thank you, Mr. Clerk.

There were no amendments received for clause 2, so I will call the question on clause 2.

Mr. Clerk, could you please—

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

Point of order, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Yes, Madame Findlay.

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

I cannot hear what the chair is saying because I think Mr. Thériault's mute is not on. There, it's on now.

I didn't hear anything you just said. Sorry.

[The Chair, Liberal, Iqra Khalid]

That's absolutely fine, Madame Findlay. I'm happy to repeat myself.

Clause 1 as amended carries. Because there were no amendments submitted for clause 2, I'll call the question on clause 2.

(Clause 2 agreed to: yeas 7; nays 4)

(On clause 3)

We're now moving on to the proposed amendments before us for clause 3.

We have PV-3. We'll just give a couple of seconds to Mr. Manly. I see that he's joined us now by video conference.

Mr. Manly, if you'd like to briefly speak to PV-3, please go ahead.

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

Thank you, Madam Chair.

This amendment is another amendment that was adapted from a request by Inclusion Canada and supported by the Nanaimo Association for Community Living.

This is about collecting relevant data on the people who receive MAID. It will help with research so we have a better understanding of the circumstances of the people who have accessed MAID. This includes “information regarding the factors in the living conditions or life circumstances of a person who has requested medical assistance in dying that may be causing or increasing their suffering and any services or care that have been offered or made available to them, including palliative care, disability supports, assistive technology, income assistance, counselling services, communication supports and environmental accommodations.” Any regulations “must provide for the establishment of a data collection system designed to facilitate the analysis and interpretation of the information provided, particularly as it relates to the protection of vulnerable persons from being induced to end their lives.”

This is not about putting barriers in the way of MAID, but about understanding what factors are involved in people accessing MAID and ensuring that we have proper data collection for researchers and people interested in following up on why people have accessed MAID.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Manly.

Mr. Virani, I have you next. Go ahead, sir.

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

Thank you very much, Madam Chair.

I thank Mr. Manly for his continued participation in these committee hearings and this clause-by-clause analysis.

I'm going to be opposing this amendment. There are no objections to the objective that's being pursued. Presenting a comprehensive picture of how medical assistance in dying is being delivered in Canada is important. It's important for monitoring to occur, to collect a range of information, but I believe that the amendments being proposed are actually not needed.

The first part of the amendment is not needed insofar as, if Bill C-7 is enacted, the regulations will be amended to align with the legislation, resulting in the collection and analysis of additional data. In developing those regulations, government is going to consult with a broad range of stakeholders, including the groups representing persons who may be vulnerable.

The second part of the amendment, in my respectful view, is also not necessary, as a federal monitoring system is already designed to analyze and report on available data regarding the protection of persons. I can give you an example of this, Madam Chair, for the benefit of the committee. The practitioner reports on how they determined that the request for medical assistance in dying was voluntary. This data is reported in an annual report.

On that basis, although I agree with the spirit of what the amendment is driving at, I do not think it is necessary and will be voting against it.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Virani.

I have Madame Findlay next on the list. Go ahead.

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

Thank you, Madam Chair.

I would like to speak in support of this amendment, and I thank Mr. Manly for bringing it forward.

To me, it simply isn't the same. In practice, if one reflects—others may agree with me—it's not the same to have implementation in regulations as having it as a requirement in legislation. The whole point of this amendment, as I read it, is to make sure this is being done.

Right now we're going through this bill, but we already know that we will be going through a study, which should have been commenced in June and wasn't because of prorogation.

We're here dealing with a bill when, in many ways, we don't have sufficient data: data is inconsistent between provinces; certain data is coming from some provinces and no data from others. To my mind, that's partly because there is no requirement within the legislation that this data be collected. This would be very informative.

Here we're dealing with a bill that four years ago looked very different, when it was first passed. This is a revision of an earlier piece of legislation, and we're doing it without sufficient data, in my view.

This would be very helpful. If you look at the specifics of this amendment, you see that it speaks exactly to who is choosing this, why they may be choosing this, what resources were available to them and how this came about. It's exactly the sort of thing we should be looking at in a review now, and any review in the future.

That next review is going to be very important. There is already signalling by the Liberal government that, in that review, they intend to pursue an expansion from where we are now. It seems pretty basic to me that we should have the kind of data spoken to in this amendment, so as to have a fulsome discussion and really understand what we're talking about and what the real, lived experience is of those who have decided to access this, as well as those who decided to access it and then perhaps changed their mind at some point, because we've heard that this happens as well.

I'm in support of this amendment, and I thank Mr. Manly for bringing it forward.

[The Chair, Liberal, Iqra Khalid]

Thank you, Madame Findlay.

I have Mr. Lewis next on the list.

Go ahead, sir.

[Chris Lewis, Conservative, Essex, ON]

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

I echo the comments of Ms. Findlay. I want to thank Mr. Manly for his foresight in bringing this forward. I think it's a fantastic amendment.

I would suggest, Madam Chair, that this should not be partisan in nature at all. I hope we can count on our colleagues across the floor, so to speak, to support this. I believe it's an amendment that is about human dignity and compassion. It is about ensuring that we can figure out where supports are lacking for disabled people and why they chose to end their lives prematurely, so that we can do everything in our power to help them live a dignified and full life, having received the support they require.

Madam Chair, this morning there was a press conference, and I jumped in to watch it. There was some.... I'm not going to call it “testimony”, because it didn't come to this committee specifically, but there were some very powerful speakers this morning from the disability community, for a lack of better words—I apologize. There was some fantastic testimony. There were so many things that really hit home for me.

I believe that this amendment—clause 3, I guess, if we were to agree to the amendment—really brings home what they're asking for and protects their rights specifically. Again, to Mr. Manly, I want to say thank you very much for bringing this amendment forward. I'll be voting in favour of it.

Thank you, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Lewis, for that.

Mr. Moore, go ahead, sir.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

I think some of the most important testimony we heard, in the very limited testimony time that was allotted at this committee.... We had only four days. One of those days was the ministers responsible, so really we had only three days of testimony. One of the most important takeaways from the testimony I heard, among the physicians, psychiatrists and MAID practitioners we heard from, came from those representing the persons with disability community.

Mr. Manly mentioned that this particular amendment is supported by Inclusion Canada. Inclusion Canada is an organization that represents the interest of persons living with disabilities, but the persons living with disabilities community—provincial organizations, local organizations and national organizations—are virtually universally opposed to Bill C-7. Realizing that the numbers are against them, they want to at least make the appeal for safeguards.

There was a report prepared by advisers to the vulnerable persons standard. These are doctors and physicians working in the Canadian health care system. It's titled “Failing People with Disabilities who Experience Systemic Suffering: Gaps in the Monitoring System for Medical Assistance in Dying”. I would certainly recommend it to all committee members.

They make the following case:

The existing monitoring reporting system is the result of a federal-provincial negotiation. At the time it was first...developed in 2018, comprehensive proposals for a more robust system were put on the table by a broad cross-section of experts and disability organizations. However, these were rejected by the federal government....

They go on to list a number of cases where they've identified gaps in the monitoring and reporting system:

Several cases of people with disabilities who requested and received MAiD raise very serious concerns that the eligibility criteria for access are not being adhered to in all cases. Nor is the process for obtaining informed consent and guarding against “external pressure,” as the legislation requires, always being managed in a way to fully explore alternative courses of action. In some cases, it appears that multiple pleas for access to needed supports have gone unaddressed, eventually leading the person to give up and apply for and accept MAiD in apparent defeat.

They mention the case of Archie Rolland, who was transferred against his will from a residence that provided highly specialized care to a geriatric long-term care facility in Lachine, Quebec: “Without staff adequately trained to communicate with him and provide essential care, he spent the remaining days of his life documenting the suffering that this caused and advocating for humane and capable care.”

How inspiring it is that some individuals who are dealing with a really low point in their life—we all saw the testimony of Roger Foley—who, in spite of the challenges they're facing, take the opportunity to try to advocate on behalf of people who may walk down the road that they're travelling. I find it inspiring that they do that.

One of the things being said by these groups, these persons with disabilities organizations and Inclusion Canada, is that there need to be more robust safeguards. They support this amendment.

With that, Madam Chair, I'd like to indicate my support as well for this amendment, PV-3.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Moore.

I don't see any more hands raised.

I'll call the question on PV-3.

(Amendment negatived: nays 7; yeas 4 [See Minutes of Proceedings])

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Clerk.

We'll now move on to PV-4. Before I ask Mr. Manly to comment briefly on PV-4, I will refer members to an email received yesterday on some friendly amendments that were circulated.

Mr. Manly, could you also speak to those as we initiate debate on PV-4?

Go ahead, sir.