Justice Committee on Nov. 19th, 2020

[Luc Thériault, Bloc, Montcalm, QC]

I can't hear what you're saying, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Can you hear me now?

[Luc Thériault, Bloc, Montcalm, QC]

Yes.

[The Chair, Liberal, Iqra Khalid]

Thank you.

We're just going to continue with the vote, which was already started before you started speaking, sir.

[Luc Thériault, Bloc, Montcalm, QC]

Okay.

[The Chair, Liberal, Iqra Khalid]

Please continue, Mr. Clerk.

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

Thank you, Mr. Clerk.

Now going on to CPC-4, I want to note that if CPC-4 is adopted, it makes CPC-5 unmovable because of a conflict of lines.

Mr. Moore, if you would like to move CPC-4 or CPC-5, go ahead.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

I'd like to first move CPC-4.

I'll reflect back on Bill C-14, which was adopted five years ago. It required that individuals be given the opportunity to change their mind after a request was made. This is where death is reasonably foreseeable, but it doesn't mean it's imminent. It doesn't mean it's within weeks. In fact, as we've seen from some cases, it could be years.

In the limited testimony we've had, it became a theme that people can change their mind. We tossed around this idea of life or death. People have said, “This is a life-or-death situation” when often it isn't, but in this case we are literally dealing with life or death.

The majority Liberal government that introduced Bill C-14 put in place a requirement that there be:

...10 clear days between the day on which the request was signed by or on behalf of the person and the day on which the medical assistance in dying is provided or—

It means that if you've signed and said, “I would like to have medical assistance in death”, there would be 10 clear days. There was a reason why that was put in place by the Liberal government.

—if they and the other medical practitioner or nurse practitioner referred to in paragraph (e) are both of the opinion that the person’s death, or the loss of their capacity to provide informed consent, is imminent—any shorter period that the first medical practitioner or nurse practitioner considers appropriate in the circumstances....

When we've discussed this, I've heard other colleagues say, “Sometimes this was just making people wait for no reason.” Well, Bill C-14 provided for that scenario. The 10 days could be waived in circumstances where death is imminent. If someone is going to pass away in two days or a day, no, there does not have to be a 10-day reflection period. Remember we're dealing with cases where an individual may have years to live, and what we're saying is to take that 10-day reflection period. There's a reason it was put in place.

Now we have two tracks—death reasonably foreseeable and death not reasonably foreseeable—without a definition of “reasonably foreseeable”. If someone falls into the other track, there is a 90-day reflection period. If someone falls into death being reasonably foreseeable, under Bill C-14, there was a 10-day reflection period that could be waived. Bill C-7 strips that out. Some may say that it's unnecessary suffering and so on, but what they don't say is that the 10-day period could be waived.

I want to list a few organizations, and every one of us is familiar with these organizations: the Canadian Society of Palliative Care Physicians, the Council of Canadians with Disabilities, and Inclusion Canada. We heard testimony from Inclusion Canada's executive vice-president. The persons with disabilities communities are in favour of this being reinstated. Palliative care physicians, who are end-of-life physicians, are in favour of this being reinstated.

We're not asking for anything earth-shattering here. Some of the safeguards that were put in place by the previous government were just that. They were safeguards to protect the vulnerable. One of them was this 10-day reflection period. Bill C-7 takes it out. This amendment simply keeps it in, and it keeps in the possibility that the 10 days can be waived when death is imminent.

I thank you for your consideration of this amendment.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Moore.

Monsieur Thériault, I have you next on the list.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Chair, I just wanted to point out that one of the important impacts of Bill C-7 with respect to terminally ill patients whose death is inevitable and imminent is to prevent people from suffering for 10 days simply because there is uncertainty about what they want. Once their intentions are clear, they ought not to be left to suffer.

People in the field might sometimes believe that the person could live for another 10 days, but that it would be 10 days of delirium, agony and extreme suffering of the kind no one would want for their loved ones. Allowing this to happen is not a matter for reflection. It removes the burden of suffering from the patient.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Thériault.

Mr. Maloney is next on the list.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

I'm going to be brief, and right to the point. Mr. Moore anticipated some of what I was going to say.

The preponderance of evidence that was heard during the course of the consultation makes it very clear that eliminating the 10-day reflection period is a critical thing to do. We need to listen to those people.

Therefore, I am not going to support the amendment.

[The Chair, Liberal, Iqra Khalid]

Mr. Garrison, you are next.

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

I think this amendment ignores an important fact. Those who have reached this point in their lives where their medical condition has dealt them a bad hand, we might say, and who are suffering intolerably, have been consulting with their doctors, some for many months. This is not something that happens in any rapid fashion.

We heard from the assessors and providers who carefully monitored what was happening under Bill C-14. They told us very clearly that this does inflict unnecessary suffering. In fact, when you look at statistics about the 10-day waiting period, a very large proportion, over half, of the medically assisted dying occurs on the 11th day. That tells me we are forcing people to wait, and forcing them to suffer in a way that's not necessary if we are truly compassionate.

I will be opposing this amendment.

[The Chair, Liberal, Iqra Khalid]

Mr. Cooper is next.

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

I support this amendment.

The Supreme Court of Canada in the Carter decision contemplated a carefully designed and monitored system of safeguards. Bill C-7 removes one of the key safeguards provided for in Bill C-14, Parliament's response to the Carter decision, and that is a reflection period.

If you look at the legislation as it is currently drafted, it could provide a scenario where there is same-day death and there is virtually no reflection. It is important to note that people do change their minds. Indeed, in the Truchon decision, evidence before the Quebec Superior Court indicated that in the province of Quebec, between December 2015 and March 2018, some 167 written requests were made and subsequently withdrawn by patients, because they had changed their minds. That equals approximately 7% of all MAID requests in the province of Quebec.

I believe this data underscores the need for a reflection period.

With the issue surrounding the loss of capacity, this is already addressed in the existing legislation, in Bill C-14, whereby that period can be shortened where necessary, but that should be limited. It should be the exception; it should not be the rule.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Cooper.

I have Mr. Lewis next on the list.

Go ahead, sir.

[Chris Lewis, Conservative, Essex, ON]

Thank you, Madam Chair.

I have just a couple of very brief comments. The first one is that I was a firefighter, a first responder, for seven and a half years, so of course I went to a lot of car accidents and I went to a lot of fires, but I was equally a paramedic as well and responded to a lot of folks who had DNR orders. At the time, the fire department I was part of didn't recognize DNR orders, so we would send them to the hospital.

I will tell you that, in my seven and a half years in the small town in which I was a firefighter, on more than one occasion I did meet somebody on the street, a cancer survivor, who upon going to the hospital actually found a new specialist, a new treatment and indeed survived.

My point is this. I think we'd all agree that at the very least we'd have what I call the 24-hour rule. This is now somebody's life, and life deserves, at the very least, a 10-day reflection period.

Again, I go back to my time served in the fire department. I've seen this. I've been part of it. I've seen people who have been in a coma with the doctors saying to pull the plug, and 18 days later they have woken up with thumbs-up and are living a normal life today.

Because I have seen it, because it's first-hand for me, I really don't understand why we would not have that 10-day reflection period at the very least to talk it through. It is absolutely vital.

The last point I would make is that this was the Liberals' legislation through Bill C-14 and if they don't believe now that we need a 10-day reflection period, are they suggesting they were wrong when they put this legislation forward in the first place?

Thank you, Chair.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Lewis.

Madame Findlay, you are next. Please, go ahead.

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

Thank you, Madam Chair.

I am speaking in support of this motion.

In the discussions we've had to date, obviously we've had a breadth of witnesses and it seems very clear at this point that certain members of the committee are listening to certain witnesses and others are listening to other witnesses. I guess it depends on where you are coming from who you want to give emphasis to, but the whole point of having a variety of witnesses is that you hear more than one point of view.

We have heard more than one point of view from persons with disabilities, who, I felt, spoke in a very heartfelt and personal way about their personal experiences, and also from physicians, family practitioners and even academics who have a variety of opinions.

The whole point of having a reflection period, as was in the original legislation, is for it to be patient-centred. I'm hearing comments here that everyone at that point is sure of what they are doing. With respect, I don't see how that's necessarily possible when we've also heard testimony about transient suicidal ideation and about people who do change their minds.

My colleague MP Cooper spoke about the Quebec example, but the number he had went only to March 2018. The further report we have that comes right up to date from Quebec's annual end-of-life care report said that, since 2015, over 300 patients in Quebec alone changed their mind after requesting medical assistance in dying.

There are already exceptions existing under the original law for those whose death is fast approaching and for people who will soon lose the capacity required to provide the necessary informed consent, so they're already contemplative. This 10-day reflection period gives the patient—not the doctors, not the nurse practitioners, not the people around them, not their families—the opportunity and the ability to change their mind, and we should give them that autonomy.

We have talked a lot here about autonomy. We've talked a lot here about a patient focus. This is what this is meant to do.

If there are 300 people in Quebec alone who have changed their minds—I wish I had national statistics but they are hard to find—and there are 10 provinces in Canada, that means there are probably thousands of Canadians who have changed their minds. They should have the ability to do that, and that's what this is speaking to.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Madame Findlay.

Mr. Cooper, I have you next.

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

Thank you, Madam Chair.

I would just like to add that providing for same-day death or entertaining that possibility, as Bill C-7 would allow for, I believe is virtually unprecedented in any other jurisdiction.

I recall that when we considered the reflection period during the debate around Bill C-14 at the time, we were looking at a 14- or 15-day reflection period, and the government brought forward an amendment to reduce that to 10 days. Even a 14- or 15-day period, as I recall, was significantly less than that which was provided for in the Benelux countries, where the waiting period, at least as of 2016, was in the range of 30 days.

We really are heading down uncharted waters. I think any time we legislate on this issue, in which there are so many complexities and we're dealing with vulnerable persons who are at their most vulnerable state in life in many instances, we need to proceed with care and caution, having regard for the evidence before our committee and having regard for the data coming out of the province of Quebec.

I believe it is imperative that we maintain a reflection period and not go down an uncharted path.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thanks, Mr. Cooper.

I have Mr. Moore next, for anything to add to what you've already spoken about.

Thank you, sir.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

A couple of my points were made by others and I promise I won't remake them. I do want to respond to MP Garrison, who mentioned that assessors and providers of MAID are in favour of waiving the 10-day reflection period.

Consultation went into Bill C-14. We were supposed to have a parliamentary legislative review this past summer that would look back on what the Canadian experience has been in dealing with assisted dying. Based on consultation on Bill C-14 and based on international norms, Parliament put in a 10-day reflection period that could be waived when appropriate.

Now the Liberal government has put in a 90-day reflection period when death is not reasonably foreseeable, but we'll get to that later. This 10-day reflection period is important. Mr. Garrison mentioned individuals who, on the 11th day, received MAID. That's not taking into account the people who, within that reflection period, decide not to go through with MAID.

As Mr. Cooper pointed out, this happens, and we have to give people that opportunity if we believe that life is important and every life is important, as we heard from individuals in the persons with disabilities community. I felt the value of their lives as they presented at our committee. Their perspective is important. Their lives are important.

We know overwhelmingly that people can and do change their mind about assisted death. It happens. This has been characterized as people who have days or weeks or hours to live. That is not what this is about. This is about, in some cases, people who could have years to live.

The least we can do as a safeguard.... We're putting in place this regime. Everywhere else has safeguards. We need to have safeguards. This was a safeguard that was seen as appropriate just a few years ago. This is not something new. This is something that existed in the previous legislation and we want to make sure we maintain that.

We can talk about assessors and providers of MAID. Well, I'm also talking about the Council of Canadians with Disabilities. I'm talking about the Canadian Society of Palliative Care Physicians. These are physicians who deal, day in and day out, with end-of-life issues. Those physicians are saying to maintain this 10-day reflection period. I don't know how we as a committee can just ignore that and cherry-pick the odd thing that we agree with from people who have a completely different perspective, being the assessors and providers of MAID. Maybe the assessors and providers of MAID should not be the ultimate authority on all things dealing with MAID, including the safeguards and the 10-day reflection period.

We need to have a balanced approach. We've listened to the assessors and providers. I also want to listen to people with disabilities, other specialists and palliative care physicians. We cannot make this a closed club where the only people we listen to are the ones who provide MAID. That is not how this does work and it's not how it should work.

I'll leave it at that, Madam Chair. I thank everyone for their contribution to the discussion on this amendment.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Moore.

Mr. Cooper.

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

Madam Chair, I wish to read into the record the words of Cardinal Thomas Collins in the Toronto Star on March 2, 2020, in regard to the reflection period. He stated—