Justice Committee on Nov. 3rd, 2020

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

Ministers, respected colleagues, welcome.

I would like to begin by saying that, while we are asking questions to clarify this bill's intentions, people are suffering. People have been suffering since Bill C-14 was passed. We cannot ignore this.

In her ruling, judge Baudoin stated that this suffering was unreasonable under section 1 of the Canadian Charter of Rights and Freedoms. What is more, she said that Bill C-14 was a violation of a fundamental right set out in section 7 of the charter: the patient is entitled not only to safety, but to life. Owing to legislative provisions, the patient was being forced to shorten their life, out of fear of no longer being able to give their consent after losing their faculties. Minister Lametti talked about Ms. Parker's case. That is what we must take into account, and that is the perspective we should use in our work today.

Over the course of this debate and this study, two philosophical views will clash: on the one hand, paternalism of the state, which manifests in medical paternalism; on the other hand, a vision based on the legal principle whereby all individuals are entitled to self-determination.

The question we should ask ourselves is the following: what are the limits of the state intervention power at a patient's most intimate moment in life? Why would the state meddle in a patient's decision that concerns their own death, that has to do with their right to self-determination?

Contrary to my Conservative colleague, I would today like to congratulate Minister Lametti for putting forward this bill, which I feel has a broad consensus.

Mr. Lametti, do you have any figures showing the acceptability of Bill C-7 across Canada and Quebec? I know that Quebec has a broad consensus, but is that the case elsewhere in the country?

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

Thank you for your comment and your question, Mr. Thériault.

Consensus is similar across Canada. I have seen a number of figures concerning Quebec, but about 70% of Quebeckers are in favour of this. That's the case elsewhere in Canada, as well. So there is support.

I would like to add a remark to yours, Mr. Thériault. One of the biggest changes to occur since 2016 is what has happened in the medical community, which had concerns in 2016. As minister Hajdu mentioned in her answers, during our consultations held across Canada and online, it was practicians—for example, physicians and nurses—who made positive suggestions. They have accepted the fact that dying with dignity is a positive step in people's life. I must say that this paradigm shift shocked me.

[Luc Thériault, Bloc, Montcalm, QC]

What practicians need is clear legislation. Yet the criterion of reasonably predictable natural death was not a clear criterion. It lent itself to numerous interpretations and excluded people such as Ms. Gladu and Mr. Truchon, who then won the case. Mr. Truchon used medical assistance in dying. That criterion probably did not pass the test in Ms. Carter's case. Had there been certainty that Bill C-14 passed the test, the Supreme Court would have been asked for its opinion.

Let's now move forward. The patient is the standard, but they have to be heard.

Currently, palliative care is sometimes being pitted against medical assistance in dying. Because resources allocated to palliative care are lacking, proponents of that care are opposed to medical assistance in dying. To them, that's an escape route that lacks the necessary guidelines. There could be some division in that area.

Have you noted this opposition between palliative care and medical assistance in dying, in the sense that proponents of palliative care find that not enough is being done, while this was meant to be the solution for dying with dignity?

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

I will start the answer, but I think I will let Minister Hajdu finish it.

During the consultations we had, I noted that a number of practicians were doing both. They saw medical assistance in dying as an option that could be combined with palliative care. That was part of an array of responses to tragic circumstances, certainly, but responses that are not necessarily negative.

Of course, we must work with the provinces to ensure that palliative care is adequate. In addition, as Minister Qualtrough just said, options for living with dignity must be provided and the necessary support must be available. The options must be well supported, very clear....

[The Chair, Liberal, Iqra Khalid]

My sincerest apologies, Minister Lametti, but we are out of time.

I will go to Mr. Garrison for six minutes.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you very much, Madam Chair.

I would like to give the Minister of Health an opportunity to comment, since she wanted to answer that question.

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

Thank you very much, Mr. Garrison.

I am excited to talk about palliative care, because things are improving in that area. Budget 2017 committed $6 billion to the provinces and territories to ensure they could increase access to palliative care, something that is intertwined with this issue, as so many MPs have noted and as the minister himself has noted.

MAID does not exist in isolation outside of a palliative care framework. In fact, the majority of Canadians who have accessed MAID have utilized palliative care, some 82%. Even those who didn't access palliative care, the remaining 13% or so, had access to palliative care in most cases.

Is that to say we can't do more and we can't do better? To use an often repeated phrase, we can always do better. The provinces and territories, as you know, have largely the jurisdiction to improve health care services, but the federal government has been there all along to help improve access to palliative care, and will continue to do that.

When the physicians talked to us, they really felt this was not an either/or conversation. This was really about adding on, as Mr. Thériault pointed out, a certain degree of autonomy for people to decide at what point they wanted to die with circumstances they could control themselves, regardless of the situation of palliative care.

Palliative care, as we know, is a critically important component for people who are experiencing long-standing severe illness or approaching death, but in some cases people, even with palliative care, still want to end that suffering. That is the premise of this bill. It's based on dignity and choice, concerns we heard echoed by the practitioners who were so generous with their time to share their experiences with us.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thanks very much, Madam Minister.

I want to do something now that the Westminster parliaments don't often allow for, which is for opposition members to acknowledge the work of the government minister.

I first ran across requests for medical assistance in dying at the height of the AIDS crisis, when an HIV diagnosis was a death sentence because we didn't have treatment at the time. The minister knows I've been dogging her for a long time on getting better access to testing and treatment for HIV. I want to acknowledge the approval yesterday of the first HIV self-test kits, which will help us down the road toward eradicating HIV. I know that doesn't happen often, but I wanted to take a moment to do that.

When it comes to Bill C-7, I do want to say the same thing that many others have said. There is real suffering going on in the system for those who face terminal illness. It's suffering by the patient and also by their families. I'm very happy to see Bill C-7 come forward at this time to try to address especially the cases of those who have already been assessed and approved for medical assistance in dying and fear losing capacity. We've had famous cases and we've had, in my own riding, personal cases when I've had friends who have had to go early for fear of loss of capacity. I think this bill is important.

My question this morning to Minister Lametti is about the other issues and the statutory review. It's very important that we deal with the very complex question of advance directives. I believe it's also very important that we thoroughly the examine the question of mental illness and those who are suffering from mental illness, and the question of mature minors, which were all mandated in the statutory review.

As the minister knows, I would like to add to that statutory review the question of whether there are adequate safeguards when it comes to other vulnerable populations and people with disabilities.

My question is very simple. I've been after the minister for months on this. I would like to see us starting the larger statutory review at the same time that we're examining Bill C-7 so that we have a place for those concerns to be fully aired and fully studied in public.

Mr. Minister, when will we see a mandate for the statutory review and when will we see a proposal to get it under way?

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

Thank you, Mr. Garrison, for your question and your comments.

You know that I agree with you in principle that we're committed to that other review. I can't commit to the form yet. My priority is Bill C-7, but I'm going to work with you and other members around this table—all parties—to make sure that we fulfill our obligation.

I'm sorry that I can't say more than that right now.

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

Madam Chair, can I just jump in for one second? I want to clarify that the $6 billion we gave in budget 2017 included palliative care, but it was also for things like mental health and home care.

[The Chair, Liberal, Iqra Khalid]

Mr. Garrison, you have 30 seconds if you'd like to add anything.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

I want to say to the minister that I do fundamentally disagree with him when he says his priority is Bill C-7. Yes, Bill C-7 is important for those who are suffering, but the other issues on medical assistance in dying are equally important. I firmly believe that Parliament could walk on two legs here and that we have the capacity to deal with Bill C-7 at the same time as the statutory review.

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

I don't dispute at all the importance of the.... I know they're equally important. I agree with you on that. We'll have to disagree procedurally for, hopefully, a very short period of time.

[The Chair, Liberal, Iqra Khalid]

Thanks very much, Minister.

Keeping a close eye on the time, we're now moving into our second round of questions. We have five minutes for the Conservatives, five minutes for the Liberals and two and a half minutes each for the Bloc and the NDP. I'm hoping to get to the last 10 minutes between the CPC and the Liberals as well. Please try to be as concise as possible. I'd really appreciate it.

Mr. Cooper, you have five minutes. Please go ahead.

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

Thank you very much, Madam Chair, and thank you, honourable ministers, for being here and for your presentations.

Minister Lametti, you stated that the legislation excludes sole mental illness. It is true that the legislation does provide that mental illness is not considered an illness, disease or disability. However, I would note that with regard to the criteria, physical or psychological suffering is the test.

Could you address the concern about ambiguity, in that when you remove “reasonably foreseeable” and leave “psychological suffering”, arguably the legislation does in fact provide for, or could open the door to, mental illness?

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

Thank you, Mr. Cooper, for your question. It's a very good question and a very important question. The reconciliation of those two points is the following.

Certainly psychological suffering is a factor that can be part of a larger set of factors that would potentially qualify a person for medical assistance in dying. What we have done is to say that mental illness can't be the sole criterion at this stage. We need to study that further. As I mentioned in my opening remarks, there isn't consensus, and it's a very deeply felt fear in the experts to whom we have spoken in the medical community and in the CCA report as well. We still need to know more.

In terms of being a sole criterion, it can be a factor with other criteria present. That's the specific reconciliation of the point you bring up.

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

But it would not have to necessarily involve a physical illness. You would concede that.

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

If it is the sole criterion, then that person at this stage will not be eligible for MAID. That will wait, and sadly, because these are tragic situations and people are suffering. There is certainly no view on our part that psychological suffering is any less serious than physical suffering, but it can't be the only criterion, as we have outlined.

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

I guess the upper concern, just to follow up on that, is that the legislation provides for mental illness being excluded, but there is no definition of mental illness. There is no definition of mental illness anywhere, in fact, in the Criminal Code. It leaves practitioners in an arguably difficult position to understand and interpret the legislation correctly when you strike down the “reasonably foreseeable” criterion, which did make it very clear that psychological suffering or some form of mental illness could never, or should never, constitute a basis on which the procedure could be carried out.

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

Look, we were listening to the medical community, we were listening to experts and we were listening to families and others. They were suggesting this particular wording. We can look at the wording to see if there's a way to make it clearer, but as I certainly made clear in my response to Mr. Garrison, this is an important issue that needs to be studied. It needs to be studied quickly and it needs to be addressed quickly, because people are suffering out there. We want to help reduce their suffering and give them the full set of options that every other Canadian has.

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

Lastly, I will ask you, Minister, if you can address expanding the criteria to provide for an advance consent, in albeit limited circumstances, despite the fact that the expert panel working group provided that there were significant knowledge gaps and a lack of consensus. Why is the government proceeding with that in the face of those concerns, all the while pre-emptively moving ahead of the legislative review?

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

Those CCA studies in this particular regard don't represent Canada in 2019. In Audrey Parker's case and other cases, it became clear that a very limited kind of consent, as we are proposing in this legislation, was in fact widely reflective of a consensus across Canada. The outpouring of support for Audrey Parker and an Audrey Parker-type amendment was clear across the country.

Therefore I would disagree with you, Mr. Cooper, that there was no consensus on this particular point. I would say that the Council of Canadian Academies' report on this particular point would actually be outdated. There is a clear consensus on this, and that's why we're doing it.

[The Chair, Liberal, Iqra Khalid]

Thank you very much, Minister Lametti.

Thank you, Mr. Cooper.

Mr. Sangha, the floor is yours for five minutes.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Thank you, Madam Chair.

Thank you very much, Minister Qualtrough. I have two questions for you.

Number one, Minister, in your remarks in the House on October 21, you discussed the government's effort to engage in extensive consultation with the disability community to hear their concerns about medical assistance in dying. Can you share how the concerns of the disability community are reflected in the legislation?

[Carla Qualtrough, Liberal, Delta, BC]

Thank you for your really important question.

There has been extensive consultation, as my colleagues have said, and we all have spoken directly with disability advocates, disability rights groups, and individuals.

As I said in my remarks, we heard about the long-fought battle for personal autonomy and choice and also about the concern that nothing we do in any way should devalue an individual's life by saying that some lives are more valuable than others. That's a really important distinction to be made, because in my mind and our mind, they are not opposing views. It's not as divisive as sometimes it has been portrayed.

Listen, we have been very clear that this law is based on equality rights, both the personal autonomy rights and the equal value of each right, but what we heard was that we had to make sure that people had a choice in front of them, that they knew what options were available to them, that they weren't going to choose to end their life because they didn't have the proper disability supports around them to make their lives meaningful and valuable and productive and healthy.

That's why we went so far in the non end-of-life track to make sure that people knew, and that there was an obligation on medical practitioners to discuss counselling, mental health supports, disability supports, community services, and palliative care and make the assessment a minimum of 90 days.

As I said, we know that in some places in our country, it's easier to access MAID than it is to get a wheelchair. That shouldn't be the case. That isn't what this law is about, but we wanted to make sure we spoke about the charter and the UN convention. I am committed to working with my provincial colleagues to make sure people are making the choice for reasons related to their circumstances, but not their social circumstances, not their lack of housing, not their lack of equipment, not their lack of employment.

It's really hard to talk about this in the context of amending the Criminal Code, but it still needs to be talked about. That's why we put such effort in the second track to provide access to alternatives for people who might not think they have any.