Justice Committee on Nov. 3rd, 2020

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Thank you, Minister.

For my second question, we have heard from parents who have children with disabilities about their fears that their children, when they grow older, will pursue MAID because of their disabilities.

Minister, can you please help alleviate the anxiety of these parents and share how this legislation will prevent this from ever happening, and perhaps more importantly, can you please discuss the steps our government has made to create a more inclusive nation and treat persons with a disability with equity and equality?

[Carla Qualtrough, Liberal, Delta, BC]

Again, they're really important conversations. We're not shying away from these conversations. It worries me deeply that any child would be sent a message that their life isn't valuable or equal to another's, and we are, for lack of parliamentary words, hell-bent on making sure that's not the case.

We have moved a long way in this country on disability rights in the past five years, starting with the Accessible Canada Act and the consultations in that act, and committing to, in this legislation, a human rights-based approach to disability inclusion, which lets us get at the underlying systems.

A lot of it's provincial, and I'm not saying that as an excuse to suggest that we don't have an important role at the federal government. What it means is working collaboratively with provinces to make sure people have meaningful options. We have a commitment to work with the provinces and territories on this.

We have committed, as I said, to a very action-oriented disability inclusion plan. It includes the Canada disability benefits, which will give people income and maybe open up their choices, and it includes an employment strategy, again providing options and choices, and it includes an overhaul of federal government eligibility for disability programs and services, again giving people options.

I don't want anybody in Canada to think that their lives are less valuable than anyone else's, and we are very committed to making sure that message is not sent.

[The Chair, Liberal, Iqra Khalid]

Thank you very much, Minister Qualtrough.

I'm sorry, Mr. Sangha, your time is up.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Thank you.

[The Chair, Liberal, Iqra Khalid]

I'm moving on Monsieur Thériault. You have two and a half minutes, Monsieur Thériault.

Please go ahead. The floor is yours.

[Luc Thériault, Bloc, Montcalm, QC]

I will be brief.

Minister, Mr. Garrison raised an important issue: the bill is worthy of merit, but it leaves a number of delicate elements behind.

The legislative amendments enacted by Bill C-14 were supposed to be reviewed in the summer of 2020. Similarly, I imagine that you could commit to the consideration continuing, after Bill C-7 passes, to work on weak points, as a number of stakeholders from various backgrounds would like.

Wouldn't that be a positive compromise to reconcile Mr. Garrison's position with yours? Would you commit today to us looking into those delicate elements following the passage of Bill C-7?

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

You know my opinion on that, Mr. Thériault. I would also like to discuss these issues, as they are important. That is what I said to Mr. Garrison.

I can commit to doing my best to come to an agreement with Mr. Rodriguez, who is our party's leader in the House of Commons, and to work with you in the House to strike a committee as soon as possible. However, I cannot promise anything concrete in that respect, as, in the parliamentary context, there are other elements to consider as regards House leaders.

[Luc Thériault, Bloc, Montcalm, QC]

You agree that we shouldn't wait four years, or even one year, right?

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

I completely agree. You know that this is a priority for me, as demonstrated by my past actions.

[Luc Thériault, Bloc, Montcalm, QC]

It is important to note that there is a difference between mental health problems and cognitive degenerative diseases, and that implies the obligation to deal with this whole issue of advance requests.

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

Exactly. I am hearing from people from across Canada, and they are saying the same thing. This is important for many people.

[Luc Thériault, Bloc, Montcalm, QC]

My time is now up.

[The Chair, Liberal, Iqra Khalid]

Yes, your time is up. Thank you, Mr. Thériault, for recognizing that.

I recognize that it's now 12 o'clock. I would ask for the consent of the committee and the witnesses to be able to go through maybe two and a half minutes each for Mr. Garrison, Mr. Lewis and Mr. Zuberi.

If I have the consent of the committee, just give me a thumbs-up so that everybody has the option to be able to ask their last round.

Thank you very much.

Mr. Garrison, please go ahead for two and a half minutes, followed by Mr. Lewis and Mr. Zuberi.

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

Thank you very much, Madam Chair.

One of the reasons I'm very confident that there's public support for Bill C-7 is that it maintains a very high bar for accessing medical assistance in dying. A person seeking MAID must be suffering from an incurable condition, must be in an irreversible decline and must face intolerable suffering.

Some, however, who I think oppose the concept of medical assistance in dying, have been using some catchy phrases. I don't think they are designed to promote real debate about the issues, but I would like to give one of the ministers a chance to respond to those who are talking about Bill C-7 creating “death on demand” or creating “same-day dying”. I do not believe the bill does this, but I think we need to address the attempt to distort the bill.

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

Thank you, Mr. Garrison.

You're right. I think the phrases you've mentioned—I can't repeat them exactly—and also referring to this bill as “euthanasia” legislation, which I have heard in the House of Commons, are incredibly demeaning to the dignity of people who are attempting to access this service and incredibly demeaning to the professionalism of the incredible physicians and other MAID assessors whom I had the privilege of meeting while I did the consultation.

This is incredibly personal, detailed work, which a physician and practitioner does sometimes within a team and sometimes on their own within a hospital setting or clinical setting, with people who are in what might arguably be some of the worst conditions of their lives, who are struggling and suffering, and who want, above all, compassion and empathy.

I think we all need to understand that no one, especially in the medical profession, takes life frivolously. As a practitioner, no one considers this lightly. As a matter of fact, one of the challenges we've had in people accessing medical assistance in dying is that we don't yet have enough practitioners who feel that they have the skills and the ability to do this work.

I think we need to respect that the professionals who are providing this support for Canadians in some of the darkest times of their lives are doing so with a high degree of respect for life and a high degree of respect for individuals who, as the practitioners themselves have pointed out, have deliberated on this decision for way longer than they've even told their practitioners. I don't think it does any of us a service in Canada when we demean the individuals who desperately want this help and demean the people who are doing the work.

[The Chair, Liberal, Iqra Khalid]

Thank you very much for that, Minister Hajdu, and thank you, Mr. Garrison.

We're going to move on to Mr. Lewis for two and a half minutes.

Mr. Lewis, the floor is yours. Please go ahead.

[Chris Lewis, Conservative, Essex, ON]

Thank you, Madam Chair.

Thank you to all the ministers for appearing today at committee. We certainly appreciate that, and it's an honour to be here.

I have just a few statements, and I know that two and a half minutes go by very quickly, so I'm going to make the statements and then allow Minister Lametti, hopefully, to answer my question.

First and foremost, on the 10-day reflection period, I realize that the way the bill is written now, it would go down to zero. I guess I really question why we wouldn't at least start with the number five and give people some time to get together with family to really reflect on the decision that's being made.

With regard to witnesses—down from two to one—that's incredibly concerning as well, because we'd all love to believe that all families get along very well, but unfortunately there's a lot of back-and-forth in families. I have a real issue with that.

Would it not be a fair statement that doctors being forced to refer patients to another doctor to administer MAID directly contradicts the very constitutional right that they are entitled to? Further, would it not be a fair statement to suggest that forcing physicians to refer MAID to another physician to administer MAID is no different from someone saying, “I don't believe in robbing banks, but here are the keys.”

Minister Lametti, you spoke of suffering in your opening remarks. Would you not agree that while the physical state of suffering of those requiring MAID is indeed met, for these physicians who have to refer patients to another against their will, it will indeed inadvertently create emotional and mental stress, which they will need to live with?

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

Thanks, Mr. Lewis, for your questions; they're important questions.

First, let me start with the 10-day reflection period. All the work, all the family consultations, all the consultations, the assessments and the medicals have already been done. All the 10-day period was, was effectively that you've made your decision, and now you have to wait 10 days just in case you change your mind.

Universally in our consultations, medical practitioners and families told us that all this did was force people to suffer. It was a form of torture, a period in which people didn't take their medication in order to be able to make a decision after 10 days. The kinds of reflections you're referring to had already been done, so it was seen to not be necessary.

The two witnesses are just witnesses who are effectively doing a pro forma witnessing of identity. This isn't in any way medical or in any way part of the medical assessment. Again, that's already been done. All the witness is doing is saying that Mr. X is Mr. X , and that can be anybody. Again, we're told by practitioners and by families that sometimes it was an impediment. You don't need two people.

With respect to freedom of conscience, the bill enshrines freedom of conscience. No medical practitioner is forced to give the procedure in any way, shape or form, and we've protected that. It already was protected, and we further protected it back in 2016 in the legislation.

The requirement to give a referral comes from a decision of the Court of Appeal for Ontario, so the courts have told us that. That's true in any medical setting in a variety of different areas, not just MAID, where there is a health care obligation to refer someone to a service so that people who have a right to a service can get it, even though the person who is referring has a freedom of conscience objection to providing that service himself or herself. There is a right to get the service, and health care services across Canada, which are provincial, have an obligation to provide that.

[The Chair, Liberal, Iqra Khalid]

Thank you very much for that, Minister Lametti.

Finally, Mr. Zuberi, if you can keep your question pretty tight, that would be great. Go ahead. The floor is yours for two and a half minutes.

[Sameer Zuberi, Liberal, Pierrefonds—Dollard, QC]

I want to thank the ministers for being with us today on this very sensitive and important matter.

My question relates to safeguards. We know that the legislation, as it's being put forth, has safeguards when death is not reasonably foreseeable. Those safeguards include that physicians have expertise, that one is informed about how to alleviate one's suffering, and that there is serious consideration given to the person in question, who is considering ending their life, in terms of those means to alleviate their suffering.

Can you touch upon why those safeguards are not included when it comes to the question of the death not being reasonably foreseeable?

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

The first set of safeguards, in the end-of-life regime, where we've used the reasonable foreseeability of a natural death to be a channelling criterion and not an eligibility criterion, were well known by medical practitioners and by families. For the most part, we have kept them. We have taken out the things they have told us were prolonging suffering unnecessarily. Those are the vast majority of cases: terminal cancer, people near the end, everyone preparing for the inevitable. We feel we have made that part of this more compassionate for the vast majority of people.

In the non-end-of-life regime, as Minister Qualtrough pointed out, we wanted to make sure that people had adequate support and information to make a decision, either about how they wanted to live or about how they wanted to die. We were told again by experts, families and practitioners.... In the case of catastrophic accidents, for example, your first reaction is often that you'd rather die. It's only after a few weeks and seeing what the alternatives are that you come to the conclusion that you have a lot of things to live for, and you could live this way or that way, given the right information and the right support.

We wanted to make sure those safeguards were embedded in our regime. Some countries require six months. We have required 90 days for the assessment period. It's not a waiting period, but it's the assessment period when the person is consulting with their family, their doctors, their nurses and getting the appropriate options, getting consultations on supports that will be available should they choose to live, and how they might live.

We're trying to balance two different types of scenarios. The non-end-of-life scenario is the less frequent number of cases. As I said, the vast majority of cases are the end-of-life scenario. It is what medical practitioners and MAID service providers are used to working with, and we think we've made that better.

[The Chair, Liberal, Iqra Khalid]

Thank you very much, Minister Lametti.

As we have concluded our two rounds of questions, I will take this opportunity to thank Minister Lametti, Minister Hajdu and Minister Qualtrough for taking the time to answer these very important questions about Bill C-7 and medical assistance in dying. Thank you for your efforts and your hard work.

We will suspend the meeting for a minute while we switch in our witnesses for our second round.

Thank you, everyone. Thank you for joining us, Ministers.

[The Chair, Liberal, Iqra Khalid]

We will get started. I take note of the time; it is almost 12:20. The meeting concludes at one o'clock. I will do my best to have an equitable distribution of time for questions from all the members.

If I can ask the witnesses, I know we had initially said five minutes for your opening remarks. Can you please aim for three minutes? I will make sure you finish your thought before I ask you to move on.

I will introduce our witnesses: Dr. Ramona Coelho, physician; Dr. Tanja Daws, family physician. From Dying with Dignity Canada, we have Senator James Cowan, chair of the board of directors, and Helen Long, chief executive officer. Then we have Dr. Georges L'Espérance from the Quebec Association for the Right to Die with Dignity.

We'll start with Dr. Ramona Coelho. Please, the floor is yours.

[Dr. Ramona Coelho, Physician, As an Individual]

My name is Dr. Ramona Coelho. I practised home care in Montreal and now practise in London, Ontario.

My home care patients were ill or disabled and homebound. In London, I care for many Syrian refugees and other people. I would say that half of my practice comprises people with disabilities.

I am here today to say that suicide prevention must remain a priority and that standard medical care must be given to Canadians. I work with vulnerable patients and I am concerned that I won't be able to protect them from transient suicidal ideations if this bill goes forward without some amendments. Also, an amendment protecting conscience is equally necessary, to respect diversity and autonomy on this controversial issue.

Many of us who work with the ill and disabled, regardless of religion, could not facilitate a lethal injection by request solely on our medical judgment. I had a lovely 70-year-old lady losing weight and requesting death for months. Looking into her condition for cancer and other issues didn't give me clarity; it turned out that her son, who had moved in some months before, was stealing her money and not feeding her. Following my clinical workup benefited this lady, but I know that if I had a 90-day framework to try to outrun her death wishes, I would have facilitated a death driven by elder abuse and financial abuse.

As I shared, many of my other patients have disabilities, rheumatism, fibromyalgia, multiple sclerosis, organ failure and many others. The existential crises and hardships of these people are real, but their death wishes are often transient and we need time to apply good medicine.

We will become a place in Canada where you can receive a lethal injection before the standard of good care is actually applied, if this bill passes without amendment. Pain clinics, psychiatry, rheumatology, neurology, they all take more than 90 days to initiate contact and meeting, and then education and treatment plans. Bill C-7 is currently constructed so that vulnerable patients can choose the 90 days to have a lethal injection and only know that services exist, without actually having gone through the standard of good care to see if that resolves their suicidal ideations.

There should be some amendment that lethal injection for those who are not dying should be only for people who have gone through psychosocial education, who have had actual good medical care, not just been offered it. To know that an injection for pain relief exists and be offered it is very different from actually experiencing that pain relief—and wait times, at least where I am in London, Ontario, are very long.

I also urge a conscience amendment. In Ontario, many doctors have retired or left palliative care and other things, and none of these outcomes increase patient services anyway.

With this bill, many physicians across all specialties will find themselves under duress. We have a MAID to MAD statement, with 945 doctors across all specialties, across Canada, who are saying that this bill needs amendments.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you very much, Dr. Coelho. We really appreciate your concise remarks.

We will move on now to Dr. Tanja Daws, for three minutes as a minimum.