Justice Committee on Nov. 3rd, 2020

[The Chair, Liberal, Iqra Khalid]

I call this meeting to order. Welcome to the fourth meeting of the House of Commons Standing Committee on Justice and Human Rights.

As you all know, today's meeting will be in hybrid format. The proceedings will be made available via the House of Commons website. Just so that all of you are aware, the webcast will show the person speaking rather than the whole committee.

To ensure an orderly meeting, I would like to outline a few rules to follow. Members and witnesses may speak in their official language. Just make sure that you're picking the correct interpretation at the bottom of your Zoom call, whether it's the floor, English or French. For members participating in person, please ensure that you're following health protocols on masking for the safety and security of you and staff.

Before speaking, please allow me to recognize you by name. For those participating virtually, please click on the microphone icon to unmute yourself. For those in the room, your microphone will be controlled by the proceedings and verification officer. Use the blue “raise hand” function if you would like to speak. That is the best way for us to know that want to speak.

I remind you that all comments by members and witnesses should be addressed through the chair. When speaking, please speak slowly and clearly, and when you're not speaking, please be on mute.

With regard to the speaking list, the clerk and I will do the best we can to maintain a list of the speaking order. With respect to timing for those who are speaking, I have two cards. I have a one-minute card and a 30-second card that I will show to ensure that we're keeping the whole meeting on track.

Before we proceed with hearing our phenomenal ministers today, I will allow a short five-minute presentation by the legislative counsel for Bill C-7, Alexandra Schorah, and Philippe Méla, the procedural clerk. They will tell you how things will operate with any amendments to the bill.

At this time, please go ahead, Alexandra and Philippe. You have five minutes. Any questions the members may have will be referred to you via email instead of in this forum.

[Rob Moore, Conservative, Fundy Royal, NB]

On a point of order, Madam Chair, we have the ministers with us for one hour. I'm very eager to hear from them and ask questions of them. Perhaps we can have the presentation from the legislative clerks at some other time, because right now we're talking about the bill. Amendments are going to come later, so I think we can have that type of discussion once the ministers have left in 59 minutes.

[The Chair, Liberal, Iqra Khalid]

Thank you for raising that.

Monsieur Thériault, is that on the same question? You had your hand raised, sir.

[Luc Thériault, Bloc, Montcalm, QC]

I had raised my hand well before, but you did not see it.

I just wanted to point something out. When witnesses, be they ministers or others, are reading or quoting from documents, they should speak more slowly, so that interpreters can properly render their statements in the other language. So I would like people to keep in mind the fact that someone is trying to simultaneously interpret what is being said.

Madam Chair, I would like you to be especially vigilant about this, since we are beginning the study of a delicate bill where every word counts.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you for your comment, Mr. Thériault.

I will try my best to speak as slowly as possible and to make sure that everybody in our committee does the same.

Going back to the question, Mr. Moore, it would take five minutes. I will ensure that it's equitable. I do feel it's necessary for everybody to hear from the legislative clerks. I will ask for a quick thumbs up or thumbs down from the committee for us to hear the legislative clerks at this time, or we can schedule them at a later time.

I see we don't have consensus.

Philippe and Alexandra, we will invite you in at a later time.

It gives me great pleasure to introduce and welcome the ministers. We have the Honourable David Lametti, Minister of Justice and the Attorney General of Canada; the Honourable Patty Hajdu, Minister of Health; and the Honourable Carla Qualtrough, Minister of Employment, Workforce Development and Disability Inclusion as witnesses before this panel.

You will have four minutes each for your opening remarks.

Minister Lametti, we'll start with you. The floor is yours. Please go ahead.

[David Lametti, Liberal, Minister of Justice and Attorney General of Canada]

Thank you, Madam Chair.

Thank you for the invitation to appear before this committee to discuss Bill C-7, An Act to amend the Criminal Code (medical assistance in dying).

I want to acknowledge my colleagues Ms. Hajdu and Ms. Qualtrough.

I want to specify that François Daigle, associate deputy minister, is here with me and is ready to assist me as needed.

Good morning, colleagues.

Bill C-7 proposes an important change to our medical assistance in dying, or MAID, regime. It would repeal the eligibility criterion requiring that natural death be reasonably foreseeable, and this is in direct response to the decision in the Truchon case. This legislation will prioritize the individual autonomy of Canadians who are suffering to choose a peaceful death if they determine that their situation is no longer tolerable to them, regardless of their proximity to death.

Other aspects of Bill C-7 are associated with this important change.

First, Bill C-7 proposes to exclude persons whose sole medical condition is a mental illness, who would otherwise become eligible through the removal of foreseeable death as a condition for eligibility.

Experts disagree on whether medical assistance in dying can ever be safely made available in such cases. While those with mental illness can suffer unbearably, unpredictable illness trajectories mean there is always the possibility of improvement and recovery, and it can be especially difficult to tell whether a desire to die is a symptom of the illness, or a rational response to it.

The exclusion gives Parliament more time to reflect on this complex question, which is fraught with serious risks, to determine whether it is possible to craft a safe MAID regime for this category of persons. I fully expect this issue will be examined in the course of the parliamentary review of the MAID legislation.

Second, the bill proposes to tailor procedural safeguards to the risks associated with assistance in dying for persons who are not nearing death. Ending the life of a person whose suffering is based in the lived experience of their medical condition is different than alleviating the suffering associated with the dying process that is already under way. Bill C-7, therefore, proposes different safeguards based on whether natural death is reasonably foreseeable.

Reasonable foreseeability of natural death refers to a temporal but flexible connection to death. It does not require imminent death or a specific prognosis, but a practitioner must be able to anticipate the person's death, based on their individual medical circumstances, in the near term.

Safeguards for those whose deaths are not reasonably foreseeable are built around the existing safeguards with some important enhancement that seek to ensure that adequate time, expertise and exploration of alternatives are devoted to assessing MAID requests from this group.

The existing set of safeguards for those whose death is reasonably foreseeable would be maintained, with two modifications that my colleague will discuss, as they are tailored to this context.

We believe these changes to the safeguards strike the right balance between individual liberty and public safety, for both groups of eligible persons.

Bill C-7 also proposes to allow for the waiver of final consent in specific circumstances, so that people whose death is foreseeable don't choose to die earlier than they want, or refuse pain medication, because they fear not being able to consent on the day of the procedure. This targeted and prudent change would address unfairness in these situations.

I will turn it over, Madam Chair, to my colleagues for their remarks.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you very much, Minister Lametti.

We will now go to Minister Hajdu for her remarks, please, for four minutes.

[Patty Hajdu, Liberal, Minister of Health]

Thank you very much, Madam Chair, for inviting us today to speak about the proposed amendments in Bill C-7.

I believe the proposed changes to Bill C-7 will expand freedom of choice for people who are suffering intolerably, strengthen safeguards to protect vulnerable individuals and respect individual autonomy.

Over the past four years we've heard from Canadians, from families and health care professionals, who have told us that there are critical issues with medical assistance in dying that need to be addressed. With Bill C-7 we are doing that work.

Among the feedback that Canadians gave is the mandatory 10-day reflection period. I must note that a dying person's decision to pursue medical assistance in dying is a carefully considered one. We heard that story over and over. We heard that the 10-day reflection period prolonged suffering, so we removed this requirement for people whose natural death is reasonably foreseeable.

We also heard that the requirement for two witnesses creates a barrier to access. After careful consideration, we reduced this requirement to one witness.

There is a strong public desire for consideration of advance requests, but this is a complex issue, and we believe it ought to be pursued in the context of the parliamentary review. We also believe we should address those situations where an individual nearing the end of life has requested and has been declared eligible for MAID but finds themself worrying about the time of their medical assistance in dying procedure. They could be worried because they don't know whether they'll lose capacity before their procedure, if they choose a date that would extend their life.

The majority of practitioners consulted on this issue are in favour of permitting a waiver of final consent in these limited situations.

I know there is a concern that these changes go beyond what is required to respond to the Truchon ruling.

Let us remember that the Truchon decision in effect created the need for a two-stream system of access to MAID: one for individuals who are suffering grievously but whose death is not imminent; and the other for those whose death is reasonably foreseeable and who have been eligible since 2016. It is essential that we set a higher bar, in terms of safeguards, for the first group while providing some modest relief from barriers to access for the second. That is what we are doing in Bill C-7.

The proposed amendments in Bill C-7 are informed by our health care system's experience in delivering MAID and reflect the opinions and perspectives shared by Canadians and a wide range of stakeholders.

They represent a balanced and compassionate approach, with respect for personal autonomy while ensuring that adequate safeguards are in place to protect vulnerable individuals. They also reflect the many hundreds of thousands of voices that took the time to consult with the government.

Thank you very much, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Thank you, Minister Hajdu, for your remarks.

We'll go to Minister Qualtrough now for four minutes.

Please go ahead, Minister.

[Carla Qualtrough, Liberal, Minister of Employment]

Thank you and good morning, everyone.

I'm here today with my cabinet colleagues to share the perspectives of persons with disabilities on this important and personal issue. Medical assistance in dying is a human rights issue.

The proposed legislation recognizes the equality rights of personal autonomy as well as the inherent and equal value of every life, something that disability advocates have fought tirelessly for for decades. In doing so, it remains true to the Charter of Rights and Freedoms, the United Nations Convention on the Rights of Persons with Disabilities, and the principles of the Accessible Canada Act that everyone must be treated with dignity, that everyone must have meaningful options and be free to make their own choices, and that everyone must have the same opportunity to make for themselves the life that they are able and wish to have, regardless of their disabilities.

As we looked to broaden access to MAID as directed by the court, we were very aware of the need for Canadians to know their options, to ensure that their consent was informed, and to have a real choice. Equality rights, personal autonomy, human rights, meaningful options and the opportunity to make a good life for oneself are top of mind. If our systems, processes, programs and services don't offer these options and if our citizens don't see that 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 individuals are made aware of the supports that are available to them and that those have been seriously considered. The harsh reality is that many Canadians with disabilities are not living with dignity, in the sense that they are not properly supported, they face barriers to inclusion and they regularly experience discrimination.

The pandemic has shown us that many of our systems are not able to truly support and include all Canadians. Canadians with disabilities as well as many other marginalized communities rightly demand that governments address these inequities.

Moving forward, we'll continue to work with the disability community. We'll not shy away from the long-overdue conversations that we need to have in our country with respect to disability inclusion and the system of barriers to inclusion that continue to persist. We'll also take action, as laid out in the throne speech, by bringing forward the first ever national disability inclusion plan, one that provides systemic changes to how the federal government interacts with and supports its citizens with disabilities.

We have before us legislation that seeks to balance making medical assistance in dying available without undue obstacles to those who choose it with safeguards to ensure that 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.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you very much for that, Minister Qualtrough. I really appreciate the succinct and quite informative remarks by all three ministers.

We'll go right into our rounds of questioning, starting with the Honourable Rob Moore for six minutes.

Go ahead, please, sir. Your time starts now.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair, and to our three ministers for being here today on this important piece of legislation.

Minister Hajdu mentioned that the Truchon decision created the need for a two-track system with regard to assisted dying. In fact, nothing could be further from the truth, which leads me to my question.

It was the failure of this government to defend its own legislation, legislation that it passed as a majority Liberal parliament in June 2016. Just three short years later, when this legislation was challenged in a lower court, instead of appealing as we called on them to do, instead of appealing as the disability community called on them to do, this government chose at the first possible opportunity to in fact not defend its own legislation. There were numerous organizations that raised alarm bells over the expansion of MAID last year in response to this Quebec Superior Court decision,

We've all had the opportunity to hear from many in the disability community—those who are most vulnerable in our society—and the message that this legislation sends, that you no longer need to be dying to access assisted dying, is a fundamental change in our country.

A letter was sent to the offices of Minister Lametti and Minister Qualtrough. It was signed by 72 organizations across our country that assist Canadians with disabilities. They do honourable work helping those who are most vulnerable. They wrote that a failure to appeal the decision would be a failure “on the part of your government to defend persons with disabilities from significant and tangible harm.”

We know that the bill before us strips away many safeguards that it's not even required to do under the Truchon decision. So my first question to Minister Lametti is why didn't your government take the concerns raised by these organizations that help Canadians with disabilities when deciding not to appeal this lower court decision? It is the job of the Attorney General and it's the job of a government to defend its own legislation.

Thank you.

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

Thanks very much, Mr. Moore, for that question. It's an important one.

It was a difficult decision. We did hear various voices, including voices from the disability community.

We took the decision, put quite simply, to reduce suffering. It was hard to see cases like those of Nicole Gladu and Jean Truchon, and Julia Lamb out west, and not see the suffering they were going through, with no recourse to medical assistance in dying that other Canadians had.

When the legislation was passed, there were concerns raised about whether the proposed regime was in conformity with the charter, and in particular the Carter decision.

Given the very positive experience with MAID that Canadians have had since 2016 and the real moving of the goal posts that had occurred from 2016 to 2019, we felt that we could reduce the suffering of Canadians by moving simply to implement the Superior Court decision, without waiting for further suffering, appeals and that sort of thing, and also to meet the very legitimate concerns raised by the disability community about valuing the dignity of life. We think we've done that in this bill.

[Rob Moore, Conservative, Fundy Royal, NB]

Thanks, Minister.

Madam Chair, this government decided not to defend its own legislation at the first instance, which is incredibly unusual and, in fact, offensive to Parliament, which passed the legislation.

Minister, we know that rather than appealing the Superior Court decision, you chose, instead, to introduce this bill, which in fact goes far beyond simply responding to the decision. This was all done before a parliamentary review that was supposed to take place under your government's own legislation.

Why did your government choose to skip an important parliamentary review that was supposed to look at MAID in the Canadian context after Bill C-14 was passed? Why did you skip that review and, instead, go beyond what was required in the Truchon decision?

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

We're not skipping anything. We're still going to go ahead with the parliamentary review. That review is going to look at very important issues that were identified and that were further studied by the Council of Canadian Academies, among others. These issues are the question of advance requests, the question of mental illness as the sole criterion for MAID, the question of mature minors, as well as many other things that came up.

Again, from the experience since 2016, we were going to reduce the suffering and respond to the Truchon decision, and we saw that there were other cases, such as Audrey Parker's, where Canadian society had moved. We had the lived experience from the medical profession and from families to say, here are some changes that can be made right now to reduce people's suffering. We've chosen to do that.

This is a very responsible thing to do, but by no means are we skipping the larger parliamentary review. That's critically important to moving forward as Canadian society moves forward.

[The Chair, Liberal, Iqra Khalid]

Thank you very much for that, Minister Lametti and Mr. Moore.

We have Mr. Kelloway next, for six minutes.

Mr. Kelloway, the floor is yours.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you, Madam Chair.

Hello, colleagues, staff, and ministers.

Thank you, ministers, for coming today.

My question is for Minister Lametti.

Audrey Parker was a strong woman who lived in my home province of Nova Scotia. In Audrey's case, the issue around advance consent or waiving final consent was very heart-wrenching.

Can the minister please explain how that case informed his decision to propose the final consent waiver outlined in Bill C-7?

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

Thanks very much, Mr. Kelloway, for reminding us of Audrey Parker's courage.

As you know, she was in the final stages of terminal cancer. She wanted to spend one last Christmas with her family, but because of the regime currently in place, she was very fearful that she would lose the ability to finally consent to the procedure and didn't want to continue to live in her situation after that, so she took MAID before being able to spend that final time with her family. It was a gut-wrenching set of facts and it resonated across the country. In English and in French there was an outpouring of support for Audrey Parker and for someone's ability to give advance consent, or waiving final consent, as we have framed it in this legislation.

To meet the Audrey Parker example where a death is reasonably foreseeable, when someone has been assessed and approved and they've made an arrangement with their MAID practitioner to waive final consent if they do lose capacity at the end, then the MAID practitioner can go through with it.

The other thing that was happening was that people weren't taking their pain medication at the end, for fear of losing that final capacity.

Again, all we're doing here is alleviating suffering. There is wide consensus and widespread support across Canada for this particular amendment to be added now.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you, Minister, for that very thoughtful answer.

Minister Lametti, you stated that during consultations you heard that the 10-day waiting period between signing a request for MAID and receiving MAID is an unnecessary prolonging of suffering. I can only imagine how trying these 10 days must be.

Can you please elaborate on these findings in the consultation process?

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

Again, as Minister Hajdu pointed out in her remarks, what we heard almost universally, from coast to coast to coast in Canada, from people who were helping to provide MAID as a service—doctors and nurses and people in the health profession—as well as families who had gone through MAID, is that the decision was already made. They had gone through the evaluation; they had taken it seriously; they had to wait another 10 days, suffer another 10 days, to get to the end of that 10-day period.

Again, even after we proposed this bill, I've had friends who have lost family and had access to MAID who said to me that we've got to get rid of the 10 days. All it does is to increase people's suffering. The decision was made; it was serious, and they said that we should let people and their families get on with it.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Madam Chair, can I add to that response? I'm sorry to jump in.

[The Chair, Liberal, Iqra Khalid]

Please go ahead.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Thank you so much.

I want to point out that this reflection was also on behalf of the practitioners who were providing medical assistance in dying. I've never met a more thoughtful group of people. They're helping people make very profound decisions and all the practitioners noted to us that they felt that the additional 10-day waiting period was, in many cases, undue cruelty. They felt that by the time a person got to a place where they had thoroughly searched their soul, thoroughly explored their options with their family members, etc, and knew that their days were final, this reflection was deep, considered and profound, and the additional 10 days did nothing to help that person reflect. In fact, all of that reflection, the assessment period and the offering of additional services had already happened prior to the request for MAID.

I want to reiterate that this was not just from the perspective of the families and, obviously, the patients whom we have some very famous examples of, but also from the perspective of the practitioners, to whom we owe a debt of gratitude because they are truly some of the most thoughtful practitioners we have, doing immensely, deeply important work in our society.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

They are incredible people.

Thank you, ministers.

[The Chair, Liberal, Iqra Khalid]

We are moving on to the next speaker.

Mr. Thériault, go ahead for six minutes.