Justice Committee on Nov. 19th, 2020

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

I have a point of order, Madam Chair.

Unless this arises in response to something that was previously raised, perhaps it's not appropriate as an intervention.

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

I think it is appropriate.

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

Mr. Cooper had an opportunity to raise his commentary. This is now the second time he—

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Virani. I am going to allow Mr. Cooper to read this into the record, right before we go to the vote.

Go ahead.

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

Thank you, Madam Chair. I'll be very brief.

Cardinal Collins states:

In Ontario, we allow cooling-off periods for gym memberships and new condominium purchases but the federal government doesn't seem to believe a similar reflection period is necessary for euthanasia.

I think those are prescient words.

Thank you, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Cooper.

We'll go to a vote on CPC-4 at this time.

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

We'll go to CPC-5 now.

Mr. Moore, if you'd like to move that, go ahead.

[Rob Moore, Conservative, Fundy Royal, NB]

Sure, I move CPC-5.

It's ironic to see members just now voting against the very safeguards that some of them voted for a few years ago. I'm profoundly impacted by that.

Anyway, in light of that decision by the committee to not have the 10-day reflection period any further, CPC-5 would amend Bill C-7 to include a seven-day reflection period. Recognizing, as has been said by some members, that they feel the 10-day reflection period is perhaps too much, in spite of the fact that the 10-day reflection period could be waived, this would insert a seven-day reflection period under the same proviso that it could be waived.

Having a reflection period, as I mentioned previously, is supported by the Canadian Society of Palliative Care Physicians, and by other witnesses who appeared before this committee, including the Council of Canadians with Disabilities. They support having a reflection period. Other jurisdictions have a reflection period. Up until apparently just now, the Liberal government supported having a reflection period based on consultations they said they did on this legislation.

That there should be a reflection period in a life or death decision is abundantly clear to me. It's apparent from the vote we just had that the majority of members feel that a 10-day reflection period is too long. That's the 10-day reflection period that existed before, and that as I mentioned can be waived. In an effort to have some kind of reflection period, recognizing the fact that Mr. Cooper raised in his remarks that there are Canadians eligible for MAID who have said they wanted to receive assisted dying and then subsequent to that, during a period of reflection, decided not to proceed—literally a life or death decision—recognizing that fact, it's incumbent upon us to provide some measure of reflection. In cases where someone's death is imminent, this can be waived, but this says that due to the enormity of the decision being made, there be a period of reflection. If committee members feel that 10 days, as has existed for the last five years, is too long, then we are proposing that we have a reflection period of seven days. I think that's the least we can do.

I thank members for their consideration of amendment CPC-5, which would provide a seven-day reflection period before accessing MAID.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Moore.

Going down the speakers list at this time, Madam Findlay, you're up next. Go ahead.

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

Thank you, Madam Chair.

I'm speaking in support. Obviously, I was in support of a longer reflection period, but I am very much in support of a reflection period. That is what this is all about. This is what we had testimony about, about how important it is.

To me, it also underscores the problems with creating new legislation without having had the proper reviews of the operation of the first legislation that was passed just a few years ago. It is my understanding that to date, no provincial or territorial government has released into the public domain a comprehensive report on the performance of its MAID program that would include the perspective, other than what I've already cited in Quebec, of the number of people who changed their minds. It's good that at least Quebec and Ontario have released partial information.

So here we are, debating a huge change in legislation—the removal of a very essential reflection period, which is patient focused—when we haven't even had the benefit of reviews on how the MAID program that's already there has rolled out province to province. We are operating in the dark.

With all due respect to those practitioners practising MAID—the MAID suppliers or providers, if you will—they are a very, very small percentage of the medical profession. We had contrary views put before the committee in a letter from 800, I think up to 900, physicians. One of the witnesses, Dr. Naud, just said, oh, that's a minor percentage; it's no big deal. Well, the number of people who actually practise and supply MAID is a smaller number than that in Canada.

So we're listening here to a very small group of practitioners, when you look at the overall number of physicians and nurse practitioners and health care providers in Canada, and changing a system for all Canadians, once again, based on one province's court decision, which in itself did not go as far as we are going in these changes. If we truly care about what each patient is going though, if we truly care about what each patient is thinking within themselves as they make these decisions, and if we truly believe in their autonomy, we should give them the ability to change their mind. As I pointed out, at least 300 Quebecers that we know of did, over a few-years period, as reported by the health authorities in that province.

That is where compassion should lie—with the patients, with the people struggling. I've heard a lot of opinions here around this table, such as, oh, by the time you get to that point, you're all decided; it's all done; just don't get in the way. That is not the true patient experience. We are hearing very much to the contrary. We have heard that testimony.

Again, once size does not fit all. We should not be that tied to a certain ideology here that we forget about each and every patient struggling with a life-and-death decision.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Madam Findlay.

I want to welcome MP Jansen, who is joining us to replace Mr. Lewis for a little while.

Thank you for being with us.

Mr. Maloney, go ahead, sir.

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

Thank you, Madam Chair. I will be very brief.

I have a great deal of respect for the opinions of Ms. Findlay, Mr. Moore and everybody on this committee, and everybody who feels as passionately about this topic as those of us who are part of this meeting do, but with respect, the discussion on this amendment is identical to the discussion we just had on the previous amendment.

For that reason, I won't reiterate my points that I made earlier. I'm hopeful that we can move forward and deal with this without rehashing all of the points put forward, as passionate as they may be.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Yes, Mr. Lewis.

[Chris Lewis, Conservative, Essex, ON]

Madam Chair, on a point of order, Ms. Jansen is not replacing me.

[The Chair, Liberal, Iqra Khalid]

My apologies, Mr. Lewis. I must have been misinformed. I'm glad you're staying with us, then. Thank you.

Mr. Thériault, you're next on my list. Go ahead.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair

I am not aware of what ideology Ms. Findlay is referring to. I would like her to put a name to my ideology, other than its respect for human dignity. I don't think it has anything to do with ideology, but rather the principles that underpin our lawful society. When one is in favour of respect for human dignity, it is essential for it to go beyond the merely theoretical. That is why the law enshrines the principle of human self-determination in its biomedical decisions. No one can cause harm to someone without their free—with an emphasis on the word “free”—and informed consent.

Once a person has come to a decision, why would you have to give them more time, you ask? If they have changed their mind, that's their decision. We should also avoid the other side of the coin, by which I mean people who don't want medical assistance in dying to be administered at all in their hospital or institution. There are not a lot of MAID practitioners.

Let's consider a terminally ill patient who has battled cancer for 20 years and has been in palliative care for a year. There is no cure. One day, the patient ends up in emergency because the body can no longer function. If for 20 years it had been clear in that patient's mind that this was what they wanted and preferred, perhaps there might be a change of heart once they find themselves in an optimal palliative care context. Nothing in Bill C-7 or Bill C-14 prevents anyone from changing their mind. But the courts told us otherwise when they ruled that Bill C-14 and the Criminal Code infringed the right to life of the person.

Things need to be put back into perspective. I have a lot of respect for religious authorities, but when I am quoted comments made by a cardinal in a clause-by-clause debate, and told these should be included in the minutes, I get the impression that we are swinging back to the other extreme.

Respect for human dignity implies that we treat other humans as an end, and never as a means of imposing an ideology on them, whether religious or otherwise, or an authority other than their own. No authority other than that of the person dying, or the person suffering from an incurable illness causing intolerable pain, should determine on their behalf what level of pain is tolerable to them.

That is what we are talking about today. Everything possible to alleviate pain during the transition to death; that is what we are pursuing. The fact that some people assume, in support of some ideology, that a person in the throes of death needs more time, leads me to believe that perhaps they would like that person to die before the medical assistance in dying begins.

I do not wish to continue to impugn their motives, but would like my Conservative colleagues to respond in kind. The only principle guiding our deliberations today is respect for human dignity, which requires total respect for people's right to self-determination. Throughout our lives, the law protects our self-determination. Why should the state withdraw this principle at the most private moment of a human being's life? That is the substantive issue here.

We are trying to make it easier for people not to suffer and to have their wishes respected. Some witnesses, practicians and doctors who proffer palliative care came to tell us that they knew better than the patients what was good for them. They tried to make patients change their mind because they felt that the patients were not assessing their own condition properly and that they should be allowed to die only at the end of their anguish.

That is not the kind of medical practice I want to promote. I can tell you that if a patient decides to die only at the end of the road, I will be there to help because that was their decision. The bill does not prevent anyone from dying a natural death.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Thériault.

I have Mr. Lewis next on the speaking list.

Go ahead, sir.

[Chris Lewis, Conservative, Essex, ON]

Thank you, Madam Chair.

Sometimes less is more. I'm going to be brief here. I just want to make one comment about MP Findlay.

She was speaking about the 300 people from Quebec, and I very much appreciate that and respect it. I think that at the end of the day, if we can talk about just one life, if one person had a reflection period and they went on to live, I think that can be the real narrative. So although I appreciate Mr. Thériault's opinion on this, I think we're being incredibly fair. I think we're being incredibly just.

I'll just leave it with this, which kind of puts it all into perspective, and I hope it resonates with the committee.

Mark Warawa didn't see a palliative care physician for nine days. We just lost the last amendment, which called for 10 days. He was in the hospital for nine days before he saw a palliative care physician. That would be two days later than the seven days. So again, we have to look at both sides of the issue here. But I think this reflection period is absolutely necessary and vital because there are still people falling through the cracks. Mr. Warawa is exactly a perfect case of this, and I think that's the real importance of why we have to ensure we have a reflection period.

Thank you, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Thanks for that, Mr. Lewis.

Madam Findlay, did you want to add to your earlier remarks as well?

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

Yes, I do because I think that Deputy Thériault and I actually totally agree with each other, but we've come to different conclusions.

This amendment speaks to the free and informed consent of the patient. Even if someone is clear in their mind for 20 years, it gives them the opportunity at the very end of the day to just think again. This amendment is fundamentally in support of the authority of the dying person and their autonomy. This is totally patient focused.

If the person wants to have a change of mind, a change of heart, and we now have statistics that bear out that this happens, it's up to them. If they have intolerable suffering, they wouldn't change their mind. If they have lost capacity and already made their intentions known, this wouldn't change anything. We're talking about giving people a few days so that if they wish to change their mind they have that ability to do so. I really urge people to consider this.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Madam Findlay.

We'll go to Mr. Garrison next.

Go ahead, sir.

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

Thank you very much, Madam Chair.

This is essentially the same debate as on the last amendment, but I do want to note that it was not just one witness we heard from who favoured removing the waiting period. There were a number of witnesses, including the Quebec Association for the Right to Die with Dignity, who read the same report cited by the Conservatives. I would urge us to be careful about interpretations of that report because I believe the report says what is certainly the case from those I consulted, namely, that changing of the mind does often occur, but almost always during their assessment period, not during their reflection period.

Because someone has requested medical assistance with dying, they do not always go forward with that, nor are they always approved for that. And of course the main protection that we have here, and I do have to make reference to this, is the professionalism of physicians. It does concern me when we hear members of Parliament talking about same-day dying, because that is not something that is in any way permitted or allowed under the law or professional standards in Canada. It's simply an exaggeration used for political effect.

Again, it's the same debate. I believe the effect of inserting this waiting period would be to unnecessarily prolong suffering of those who have already gone through a long process of reflection and consideration.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thanks, Mr. Garrison.

I have Monsieur Thériault next on the speaking list.

Go ahead, sir.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

I would like to address the point raised by Mr. Garrison.

I often detect bias in our discussions. It's not a matter of life or death. Once terminally ill, there is support as death approaches, in the form of palliative care, but this care also slows the process of dying. In palliative care, the end does come. The idea is to control pain until eventually the heart stops beating. If terminally ill patients do not ask to be resuscitated, they won't be.

There is no point in pretending that palliative care is not an intervention; it is anything but natural death. It is not a matter of life or death. It is more someone's decision to shorten the inevitable process of dying. That is what we are talking about.

[The Chair, Liberal, Iqra Khalid]

Thank you, Monsieur Thériault.

I have Mr. Cooper for any concluding remarks.

Go ahead, sir.

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

I'll be brief, Madam Chair.

With respect to the comments that Mr. Garrison made, I would simply note that those concerns are being raised by medical professionals, by physicians, with respect to the possibility of same-day death. Those aren't my words; those are the words of esteemed physicians.

With respect to the need for some kind of reflection period, I would note that Dr. Harvey Chochinov of the University of Manitoba pointed out in his evidence that death wishes can be transient even over a period of “12 to 24 hours.” Again, it's underscoring the need for some kind of reflection period. I would like to have seen a 10-day reflection period, but seeing that this was rejected, at the very least we should provide for a seven-day period.

Thank you.