Justice Committee on Nov. 10th, 2020

[The Chair, Liberal, Iqra Khalid]

Welcome, committee members. I call this meeting to order. This is meeting number six of the House of Commons Standing Committee on Justice and Human Rights.

Today’s meeting is taking place in a hybrid format, pursuant to the House order of September 23, 2020. The webcast, just for members appearing virtually, will show only the person speaking, rather than the entirety of the committee.

There are a few rules to follow. Members and witnesses, you may speak in your official language. Please ensure that at the bottom of your screen, you select the interpretation for the language you would like to hear.

Before speaking, please wait until I recognize you by name. Please click on the microphone icon to unmute yourself. For those in the room, your microphone will be controlled as usual during the proceedings, as we've done in the past. When speaking, please speak slowly and clearly. When you are not speaking, please ensure that your microphone is on mute.

With regard to the speaking list, the committee clerk and I will do the best we can to maintain a consolidated order of speaking for all members, whether they are participating virtually or in person. You will see that I have a one-minute card and a 30-second card for members and witnesses to let you know how much time you have remaining when it comes to the rounds of questions.

At this time, and I know this issue has been raised at past meetings, I will remind members of routine motions that we've passed in our previous meetings. I will read this out.

With regard to timing for opening remarks and questioning of witnesses:

That witnesses be given five to seven and a half minutes, at the discretion of the Chair, to make their opening statement; and that, at the discretion of the Chair, during the questioning of witnesses in the first round there be allocated six minutes for the first questioner of each party as follows: Conservative Party, Liberal Party, Bloc Québécois, New Democratic Party; that for the second and subsequent rounds the order and time for questioning be as follows: Conservative Party, five minutes, Liberal Party, five minutes, Bloc Québécois, two and a half minutes, New Democratic Party, two and a half minutes, Conservative Party, five minutes, Liberal Party, five minutes.

I thank you for allowing me the discretion to Chair this meeting in an equitable fashion, and I hope we can continue that. I raise this because of the challenges we've had in the past with respect to rounds of questioning and timing, but more importantly, because one of the witnesses today has asked for accommodation to be allowed for extra time to speak where we normally give five minutes for witnesses. Using my discretion, I will be allowing Mr. Foley seven and a half minutes to be able to complete his remarks in the first round.

With that, I would like to welcome our witnesses. Appearing as an individual is Julie Campbell, who is a nurse practitioner for the provincial care coordination service. We have Mr. Roger Foley, who is accompanied by his lawyer, Ken Berger. We also have the Association for Reformed Political Action Canada. Appearing on their behalf is John Sikkema, who is legal counsel, and André Schutten, who is legal counsel and director of law and policy. We also have Inclusion Canada. Their representative is Krista Carr, who is the executive vice-president.

Thank you all for being here today. We'll go right into questioning. We will start with the first person on my list, Julie Campbell.

Ms. Campbell, you have five minutes for your remarks. Thank you very much. The floor is yours.

[Julie Campbell, Nurse Practitioner, Provincial Care Coordination Service, As an Individual]

Thank you, Madam Chair, and good morning, everyone.

I am Julie Campbell. I speak today as a MAID assessor and provider, and also from my experience coordinating, navigating and providing leadership in this area. I want to commend this government on the thoughtful investigation that's been undertaken to understand this work and, most importantly, our patients. I am also very pleased with how inclusive ministers have been in their language in recognizing the important work of both nurse practitioners and physicians.

Each month I speak to more than 140 new patients and families and present to community groups. By far the top concerns expressed to me are the lack of advance consent and the 10-day reflection period, so I am grateful to see these addressed. I am also grateful for the changes around witnessing requests. Patients requesting MAID should be afforded the same privacy rights as patients for any other medical procedure. Allowing care providers to sign is a positive step for this confidentiality. A specific statement allowing virtual witnessing would be beneficial.

I do this work, as do most of my colleagues, because we can make a difference in reducing suffering for patients who feel this is the right personal choice for them given their circumstances, their values and their experiences. I want to share with you a few key reflections that I feel are important for the implementation of this legislation at the front line.

Patients in rural areas may benefit most from the option of oral self-administered MAID. This is because patients can be assessed virtually, and our knowledge of this and its safety has been tested during this pandemic. For one particular patient who received oral self-administered MAID in a remote community, their prescriber was a significant distance away. They were monitored by local physicians and nurses who maintained communication with the prescriber. This supports the conscience rights of clinicians and supports patients to receive access in remote areas. I believe Bill C-7 should be amended to require the presence of a regulated health care professional authorized to pronounce death, rather than limiting the physical presence to the prescriber.

In the area of Ontario where I most frequently work, I calculated the number of unique providers of MAID in the past 12 months. I counted 49. However, 12 of the 49 assessors completed 84% of the 307 MAID provisions that year. The majority of MAID work is done by a small number of providers who have garnered expertise in this work through their experience. This highlights how we need to continue the current practice of careful, thoughtful patient-centred assessments, where an assessor reaches out to colleagues with various expertise when they feel that's needed. Should the wording require the same person to have expertise in the condition and have expertise in MAID eligibility assessment, some of our most complex patients will surely not have access due to the complexity of their condition or the number of qualified assessors in their area. This causes delays and enduring suffering where consultation, when needed, could maintain safeguards without compromising equity of access.

It is imperative that the wording defining “grievous and irremediable medical condition” be left without amendment, as these criteria are understood among MAID assessors. This would maintain that the suffering could be related to either the illness, disease or disability or the advanced state of decline and need not be related to both.

I would also like to ensure that Bill C-7 provides the same safeguards and supports for patients with respect to advance consent. This would allow an authorized alternative signer to make the written advance consent at the direction of the patient when the patient is unable to sign and date for themselves.

Lastly, I would be remiss if I did not mention that at the heart of implementing this federal legislation is collaboration with provincial governments. Inequities of access for patients exist regionally, provincially and nationally due to these differences. Examples include coverage for oral secobarbital, scope-of-practice limitations that are either provincially or employer-based, support for travel to remote areas, and remuneration for nurse practitioners. The law will only provide Canadian patients choice if it can be implemented.

I appreciate your time and I thank you for your hard work.

[The Chair, Liberal, Iqra Khalid]

Thank you very much, Ms. Campbell. That is much appreciated.

We'll now go to you, Mr. Foley. As per my discretion, you have seven and a half minutes to give us your remarks.

Go ahead, Mr. Foley.

[Roger Foley, As an Individual]

My name is Roger Foley. I'm 45 years old. I was born with spinocerebellar ataxia, which is a severe neurodegenerative disease.

Despite my disabilities, I achieved two degrees at Carleton University, in economics and history. I was a caregiver for my father, who had cancer, heart troubles and kidney problems. I helped him live eight years beyond his original diagnosis. He was a front-line Canadian World War II veteran. I worked at the Royal Bank of Canada as their e-business manager and was awarded several RBC top performer awards. I was independent and active in the community and in sports, and as a musician and a writer.

Unfortunately, my disabilities got worse over time and now I have become totally dependent. I can no longer walk, have very limited ability to move and great difficulty even swallowing. I need help with everything, including bowel movements, bathing and medications. I have invested a lot of time and money into making my apartment accessible, but the health care system denied direct funding home care to have the personal attendants I need to remain living in my own home.

With the assisted dying regime in Canada, I have experienced the lack of care and assistance I need to live. I have been denied food and water. I have not been assisted to transfer, take my medications and go to the bathroom. I have been abused and berated because I have disabilities and told my care needs are too much work. My life has been devalued.

I have been coerced into assisted death by abuse, neglect, lack of care and threats. For example, at a time when I was advocating for assistance to live and for self-directed home care, the hospital ethicist and nurses were trying to coerce me into an assisted death by threatening to charge me $1,800 per day or force-discharge me without the care I needed to live. I felt pressured by these staff raising assisted dying rather than relieving my suffering with dignified and compassionate care.

Hospital staff failed to provide me with the necessities of life. I was starved and denied water for up to 20 days. I became severely acidotic. An expert who reviewed the case concluded a failure to provide necessities of life and gross negligence.

Facing these ongoing attacks, I started researching how and why this was happening in Canada. I found out the entire assisted dying regime is all based on false propaganda, bias, conflicts of interest, blindness, a complete abdication of the health and legal systems and the law failing to protect me. Judges who were completely biased and had conflicts of interest decided the assisted dying cases. They were supposed to be fair and impartial, but instead let our country down and failed to protect our most vulnerable.

What is happening to vulnerable persons in Canada is so wrong. Assisted dying is easier to access than safe and appropriate disability supports to live. Committee members, you cannot let this happen to me and others. You have turned your backs on the disabled and elderly Canadians. You or your family and friends will all be in my shoes one day. You cannot let this sliding regime continue.

The Truchon decision is an illegitimate decision made by a biased and compromised judge. Christine Baudouin made her decision because her father's works were used as evidence by the plaintiff's lawyer. She should have recused herself and declared her conflicts of interest. The same issues of bias, conflict of interest and misleading Canadians about assisted dying happened in Carter, during the Lamb case and with the Audrey Parker situation.

The grave mistakes by our legal and health care systems and the failure to protect our most vulnerable need to end.

I read an email from Jean Truchon prior to his death revealing all he needed was 70 hours of home care per week to live. Instead, he was wrongfully assisted to die by your health and legal systems.

I made complaints to the United Nations. The special rapporteur completed a country visit. Her report is very critical. She is extremely concerned about people with disabilities being asked to consider assisted dying.

I made a complaint to the special rapporteur on the independence of judges about the lack of independence and impartiality of our courts as related to assisted dying. I also plan to assist with the motion to retract Truchon in Quebec, as I do not believe the judgment is legitimate, and it puts all persons with disabilities in grave danger.

You are all highly intelligent individuals dedicated to public service. You are not so gullible, are you? Are you persuaded by propaganda, misinformation and a lack of objectivity by decision-makers? Your constituents expect you to scrutinize what has actually happened with the sliding practices of assisted dying and what you need to do to protect all citizens. Please move away from the dogma and see things how they really are.

Do you want to help vulnerable people who want to give back to society and be a part of our community, like heroes such as Terry Fox, or do you just want to be misled and have blood on your hands? My blood will be on your hands if you allow the illegitimate Truchon decision to tear down our laws. I will not survive, and there will be thousands of wrongful deaths.

Help Canada to be the country it should be and not what it is currently sliding toward.

Thank you for your time.

[The Chair, Liberal, Iqra Khalid]

Thank you very much for that, Mr. Foley.

We will now move on to the Association for Reformed Political Action Canada.

You have five minutes. Please go ahead.

[John Sikkema, Legal Counsel, Association for Reformed Political Action Canada]

Thank you. I'm glad I could be here.

Just a few days ago, my wife gave birth to our daughter. During her pretty long labour, doctors presented her with different options that were new to me—misoprostol or oxytocin—to move things along. They needed to move things along faster: an epidural, forceps or vacuum. Also, a C-section was discussed at one point. In our vulnerable state, we trusted that the options the doctors presented were good options. We also wanted to know what the doctor thought was the best option and, frankly, we went with that every time.

Medical assistance in dying—or assisted suicide, or consensual homicide, or whatever you want to call it—is not health care. At least, it is fundamentally distinct from any other medical service. Advising somebody to have a C-section or chemotherapy or pain medication is not a crime, but encouraging or inducing someone to end their life is a crime.

If MAID were simply another health care service, we wouldn't be here today discussing substantial amendments to the Criminal Code. Medical services are not regulated by the Criminal Code. We are wrestling here with when we as a society will permit some people to kill others. That's why this is before Parliament.

The fundamental problem with this bill, as we see it, is that it fails to take this seriously enough. It's almost flippant in its treatment of the—

[Luc Thériault, Bloc, Montcalm, QC]

I'm sorry, Madam Chair, but the interpreters are unable to translate Mr. Sikkema's comments because he is speaking too quickly. You don't seem to have been informed of the problem.

I apologize to Mr. Sikkema, but I think we should be able to properly hear witnesses' statements for the sake of fairness.

[The Chair, Liberal, Iqra Khalid]

Thank you.

Mr. Sikkema, could you please slow down a bit in your remarks? I've stopped the time, so you won't get penalized on this.

Could you also move your microphone just a bit between your nose and your mouth so that we don't hear that popping sound? Do you want to give it a go? Thank you. Go ahead.

[John Sikkema]

My apologies to the translators.

Our current law, as amended by Bill C-14, is already interpreted to allow doctors to euthanize patients who have a decade or more of life ahead. Our current law already fails to prevent doctors from suggesting MAID without being asked, or at least listing it as an option, which can send a powerful message to the sick and disabled that someone thinks their life isn't worth living.

Bill C-7 not only fails to address those problems, as identified by the United Nations special rapporteur, among others, but it makes them worse. If Bill C-7 passes, it will be possible for a person with a serious illness to go to their doctor's office, have their doctor suggest MAID as an option for them, have the doctor's secretary pop in to witness a written request and then be killed as soon as the second opinion is acquired. Of course the doctor would have to mention other options, but that's just the basic rule of informed consent.

That's the fast and easy track. The slow track isn't much better. For those in the ambiguous category of not reasonably foreseeable death, Bill C-7 says that other options should be discussed and consultations offered, which isn't much, and one would think that such basic steps should already be there for the fast-track cases.

As for the 90-day waiting period, palliative care physicians have already pointed out that it's inadequate because it often takes longer to help people manage their symptoms and to find satisfactory treatments, and so on. We share that concern. We would also point out that the 90-day waiting period is itself ambiguous given that it begins, not on the day a written request is signed and dated, as with the 10-day waiting period that would be cut, but on the day the doctor begins to assess a patient's eligibility, which could be months earlier.

Many people seem to think further expansion of euthanasia is inevitable. This is not true. The Carter decision was very limited in scope, as the court stated at the beginning and end of its decision. This is about Ms. Taylor and persons in her position. She was near death with a known fatal illness and the court said, “We make no pronouncement on other situations where physician-assisted dying may be sought”, at the end of its judgment. It bookended its judgment with those things.

The lone judge who decided Truchon failed to appreciate this and failed to recognize Parliament's objectives in limiting MAID to the end-of-life context. It is the responsibility of Parliament and this committee to listen to the concerns of all parties, including disability rights advocates, palliative care physicians and others; to be clear about its objectives; to defend them against a particular judge; and to enact more responsible policies.

Thank you very much.

[The Chair, Liberal, Iqra Khalid]

Thank you very much, Mr. Sikkema. If you could please send us your written submissions or your speaking notes, it would be helpful for members. Thank you for that.

We'll now move on to Inclusion Canada, Ms. Carr, who is the executive vice-president.

Please go ahead, Ms. Carr. You have five minutes.

[Krista Carr, Executive Vice President, Inclusion Canada]

Good morning.

I'm Krista Carr, executive vice-president of Inclusion Canada, formerly the Canadian Association for Community Living, Canada's national organization for people with intellectual disabilities and their families.

Inclusion Canada has advocated for safeguards in MAID since we intervened in the Carter case. Our biggest fear has always been that having a disability would become an acceptable reason for state-provided suicide. Bill C-7 is our worst nightmare.

Inclusion Canada stands united with all national disabled persons organizations in calling for MAID to be restricted to the end of life. The disability community is appalled that Bill C-7 would allow people with a disability to have their lives ended when they are suffering but not dying. This is not how we respond to the suffering of any other group of Canadians, much less any other charter-protected group.

We're told that this abrupt pace of passage through Parliament has been set by the Superior Court of Québec, yet amending the Criminal Code to satisfy a superior court decision appears unprecedented. We're told Canadians want this, yet every national disability organization is opposed.

If Canadians supported assisted suicide for being indigenous or a member of the LGBTQ2S+ citizens, for example, who are suffering as a result of being indigenous or because of their gender identity, we would not be here today. Canadians recognize that suicide is more prevalent amongst those who experience systemic racism or societal devaluation. Thus, prevention is a necessity, and every life lost is a tragedy. Why is it not just as great a tragedy for an indigenous person with a disability or someone with any other identity who has a disability? I hope you will hear from indigenous organizations as part of this committee.

The human rights of a charter-protected group must never be a matter of public opinion. Equating assisted suicide to an equality right is a moral affront.

There are three points I'd like to cover.

First, why us? As no other charter-protected Canadian life is being put at risk by this bill, there is only one answer to this question: that the lives of Canadians with disabilities are not of equal value. Language and perceptions are powerful. Including disability as a condition warranting assisted suicide equates to declaring some lives as not worth living, a historically horrific premise with consequences that should terrify us all, and that clearly terrify the disability community and their families.

Second, people with an intellectual disability and their families are in a constant struggle for inclusion, a universal human right not yet realized in Canada. When people with intellectual disabilities suffer because of their pervasive exclusion and marginalization, families now fear that their family members will be encouraged to end their lives. Rather than addressing their suffering, as we do for every other Canadian who tries to end their suffering through suicide, their lives are now judged as not worth saving.

To be clear, inclusive life remains elusive for the majority of adults with intellectual disabilities. There is no right to adequate supports in Canada. Seventy-five per cent of adults with an intellectual disability are unemployed. They are four times more likely to be living in poverty, and four times more likely to experience violence. Also, a staggering amount of people with an intellectual disability remain housed in institutions and long-term care facilities.

Canada is failing its commitments under the UNCRPD to uphold the rights and inherent dignity of all people with disabilities. Persons with disabilities in Canada suffer an inadequate patchwork of supports, with extensive wait-lists for services. A state-sanctioned death is not the solution.

Third, and lastly, until now, MAID has been restricted to end of life. The end-of-life requirement was the only safeguard whereby disability was not the sole criterion. By having a disability itself under Bill C-7 as the justification for the termination of life, the very essence of the Charter of Rights and Freedoms would be shattered. Discrimination on the basis of disability would once again be entrenched in Canadian law.

People with disabilities have been historically devalued and marginalized in Canada, and that remains to be sufficiently remedied. Bill C-7 further devalues the lives of people with disabilities and fundamentally changes MAID from physician-assisted dying near the end of life to physician-assisted suicide on the basis of disability. The lives of people with disabilities are as necessary to the integrity of the human family as any other dimension of humanity, and this threat to the lives of people with disabilities is a threat to us all.

We urge the committee to seek an amendment to MAID to sustain MAID as available only to those who are dying and unequivocally restrict anyone with a disability from having their life ended unless their natural death is imminent.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thanks very much for that, Ms. Carr.

Thank you to the witnesses.

We'll now move on to our first round of questions. The first round of questions will be six minutes each.

Mr. Moore, please go ahead. You have six minutes, and your time is starting now.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

Thank you to all of our witnesses. You all bring something different to this discussion, and I really appreciate your very informed presentations.

It concerns me, when we're dealing with something that's literally life-or-death, the dramatically reduced time in which we're dealing with this important issue. We're only taking four days of meetings to discuss this. Parties are only going to have about one round of questions to ask you important questions. When I hear Inclusion Canada, an organization that works with those in the persons with disabilities community from coast to coast, describe this as a “worst nightmare”, I really, truly believe that we need to have more discussion on this. The government would have us believe that this is an open-and-shut case and that there is a great deal of unanimity among doctors.

I am going to ask my first question of Krista Carr, with Inclusion Canada.

There is a group called “Physicians Together for Vulnerable Canadians”. We received a letter from them, and I know your organization works deeply with vulnerable persons. It was signed by 800 medical doctors throughout our country, from every province. These are people who are working with people who are vulnerable.

I know the position of Inclusion Canada was that the court of appeal decision should have been appealed even to the Supreme Court. That happens to be the position as well of the Conservative Party, that this decision should have been appealed. However, this bill goes far beyond even responding to the Quebec decision.

My question for you, if you could answer it quickly, is this: Is Inclusion Canada of the opinion that this bill needs more review to analyze the impacts, even those we heard about today, on safeguards for the persons with disabilities community?

[Krista Carr]

Thanks, MP Moore.

Yes, we are of course of that opinion, and we feel very strongly that the only way to make this bill not discriminatory is to keep it to end of life. Anybody who is at end of life and is suffering intolerably has access.

When you open it up and make it based on the grounds of things like disability—this is already a very vulnerable population in our society today that experiences a tremendous amount of systemic ableism in the health care system already, and we've seen that pervasively throughout the COVID-19 pandemic in everything from triage protocols to deprioritizing their lives, and the list goes on—we're on a very dangerous slippery slope.

I think we have to stop, hit the pause button and really focus, particularly on a consultation with the disability community. We are speaking. We are trying to speak. We are united, but our voices are getting drowned out by people who do not experience the systemic marginalization, the poverty and the very difficult lack of support in life circumstances that people with disabilities experience, which leads them into situations where either MAID is promoted to them or they feel it is their only option.

Yet—

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you for that.

That brings me to my next question, on the promotion or the choice that people are being dealt.

Mr. Foley, thank you so much for your testimony today. You certainly bring a perspective that we have not heard at this committee. I think we should hear more of your perspective, with the government expanding access to assisted dying in Canada. I heard the recordings you had, where a doctor was pressuring you into MAID and was saying that the per diem rate to stay at the hospital was $1,500 or so. You mentioned the contributions of persons with disabilities, including Terry Fox, and how much...even what you're doing today by bringing this, standing up for vulnerable people at this committee for this meeting.

Do you feel there should be greater protections in this legislation that we have before us for vulnerable Canadians so they're not pushed as you were towards medically assisted death?

[Ken Berger, Lawyer, As an Individual]

Mr. Moore, I'm going to answer that on behalf of Mr. Foley.

Absolutely, there need to be very robust protections here because people with disabilities can be easily exploited. They're subject to abuse and could be at high risk of being wrongfully assisted to die. The other issue is that with such individuals, the disabled, all they really need is good care and support, and 99.9% of the time their grievous and irremediable suffering will be gone. If you do that, you solve the problem. Then for the remaining 0.1%, where you can't relieve the suffering, let's take a look at this. This is a subjective conclusion based on the individual.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Berger. My apologies, but we're out of time for Mr. Moore. We're going to move on to Mr. Virani for six minutes.

Go ahead, Mr. Virani, your time starts now.

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

Thank you very much, and thank you to all of the witnesses for their important testimony today. I want to start with Ms. Campbell.

Ms. Campbell, we've heard today and at previous testimony about instances of influence or potential coercion. You are a nurse in the middle of the milieu. Can you tell me whether the appropriate step when such instances are raised is to raise a complaint with both the professional regulatory bodies and/or the police if such influence is being asserted so that it can be investigated? If that is the proper course, what is your knowledge of any complaints resulting in actual prosecutions against nurses or physicians?

If you're able to answer that, thank you.

[Julie Campbell]

The answer is no, there haven't been any such instances that I'm aware of move forward, and certainly there are those safeguards and steps in place for patients or families to raise those concerns. Those exist. I believe there's a very big difference in our language between saying that something is available and saying that someone then warrants or needs or should have a certain procedure just because it's available. That's very individual. The same goes for advising about alternatives, which is not the same as encouraging. I think they're very different in how we word those.

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

In your experience, Ms. Campbell, is active encouragement and pressure being put upon individuals to pursue medical assistance in dying?

[Julie Campbell]

No, in fact what I find is that more people come and say, “I wish I knew that those were my options earlier. Nobody mentioned them it to me”. I think it's very important not to encourage anyone to pursue a particular option, but it's equally important that all patients know all of their options and get to decide for themselves which option is right for them.

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

Turning to Ms. Carr, I respect the work that you do and all of the groups you represent in your interventions in previous court cases, etc. I'm just struck by the fact that when I look back at the Truchon decision, the two individuals in that case, Mr. Truchon and Madam Gladu, were themselves persons with disabilities. They themselves brought forward their claims to that judge in the Superior Court of Québec. I looked back at paragraph 681 to paragraph 690—it's a long decision—while you were testifying and found that the judge addressed head on the issue that you're raising, the equality rights of these individuals. You compared the rights of persons with disabilities with indigeneity or people who experience racism, etc. Those are important rights. This is an area I practised in prior to coming to Parliament.

What the court found is that, when you look at it from an equality rights analysis perspective, the section 7 and the section 15 rights of Mr. Truchon and Madam Gladu were in fact being violated by virtue of their inability to pursue MAID because it was restricted to the end of life. Therefore, they did do that analysis, but the conclusions are vastly different from what you indicated in your testimony. I'm just wondering if you could comment to us on that portion of her decision, because in paragraph 681 she clearly said:

By seeking to counter only one of the stereotypes that the disabled face—vulnerability—the challenged provision perhaps perpetuates another probably more pernicious stereotype: the inability to consent fully to medical assistance in dying.

What she explained is that we need to empower and give autonomy to persons with disabilities, the same autonomy that is granted to people without a disability. Could you perhaps comment on that point, Ms. Carr?

[Krista Carr]

First of all, I want to point out that Jean Truchon was presenting himself for a medically assisted death because he couldn't get a good life, and that was very clear in the proceedings. He was forced to live in an institution. He didn't want to live there. His life was not good. There were multiple attempts for him to live in other places and have a better life, and nobody seemed to be able to get him out of that place. That's how he ended up there in the first place, and that's the thing we lose quite a bit when we talk about the Truchon decision.

The second thing is about the rights piece. We talk about this being all about autonomy, all about individual choice and decision, but it is a balance of autonomy rights and equality rights. That's what section 1 of the charter is for. We say that we can violate autonomy rights if it's for the public good.

We have to keep in mind that for people with a disability, this is not a choice. Every day of their lives, the lives that they are forced to live because of inadequate supports, poverty and society depriving them of inclusion, causes their suffering. That suffering could be remedied through many, many other means, but because we don't respond and governments don't provide the supports, and communities and society don't include people, they're forced into situations in which they feel they have no choice.

Sure, they're presented with options. For example, the bill says we need to let people know what services are available, but letting people know what's available doesn't get them services and supports; it doesn't get them off wait-lists; it doesn't get them out of institutions; it doesn't make their lives better. Until we're committed to making sure that everybody has the opportunity, an equal opportunity, to live a good life, medically assisted death on the basis of disability is not the solution.

[The Chair, Liberal, Iqra Khalid]

Thank you very much.

Thank you, Mr. Virani.

Mr. Thériault, go ahead for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

I thank all the witnesses for their testimony this morning.

Mr. Foley, your testimony is pretty moving and troubling.

In a debate like this one, there must absolutely be no confusion in the concepts. Yet the criterion of reasonably predictable natural death has been problematic for practitioners.

As of 2015, a terminally ill patient in Quebec receiving palliative care could decide to request medical assistance in dying. Improvements still must be made to palliative care. It is one thing to call for better conditions for patients, but it is another to encroach on their free will and take away their freedom to choose. Paternalism must be avoided.

An individual's dignity is not based on their physical or psychological autonomy—in other words, their cognitive abilities. Those factors contribute to autonomy. Dignity is based on the respect of an individual's moral autonomy, and the respect of an individual's moral autonomy is rooted in the respect of their freedom of choice and their ability to exercise their self-determination. In biomedical terms, this is called free and enlightened consent.

Mr. Foley did not end up in a situation of free and enlightened consent, and he is before the courts. I will stop here because I don't want to comment on that specific situation. That is not what we are discussing this morning. This is rather about providing a choice to individuals already in an irreversible process or terminally ill. I'm thinking of people like Ms. Gladu, who has not yet exercised her right to die with dignity. However, she said she at a meeting that she was already relieved and was suffering a bit less because she now had that choice, which was previously taken away from her.

However, things should not be confused. On the one hand, there are suicidal patients. We are talking about a reversible state, and society should in fact fight against suicide. On the other hand, there are requests for medical assistance in dying from humans who have led a full and complete life. Mr. Foley told us he was living a full and complete life, even though he is now somewhat more limited. Since the patient comes first, it is up to them to make the decision.

Ms. Carr, are you against that principle?