Debates of Oct. 2nd, 2009

Criminal Code

[Jacques Gourde, Conservative, Parliamentary Secretary to the Minister of Public Works and Government Services and to the Minister of National Revenue]

Mr. Speaker, I am pleased to rise today to speak to BillC-384 that was introduced on May 13, 2009, by the member from La Pointe-de-l'Île. Two previous bills on this subject were introduced by the same member in past sessions of Parliament. One of them was debated in 2005, but did not come to a vote.

Mr. Speaker, I would like to state at the outset that I do not support Bill C-384 which proposes the legalization of physician-assisted suicide and euthanasia under specified conditions. This bill raises a number of serious concerns and I propose to outline the ones I consider to be most important.

First, Bill C-384 is too broad in terms of its scope. Mr. Speaker, Bill C-384 proposes to amend the Criminal Code to provide an exemption not only to the offence of assisted suicide, but also to the offence of murder. These amendments would represent a substantial change to the current state of the law on a matter that touches on life and death.

The proposed legalization of medical euthanasia and assisted suicide would not only apply to terminally-ill patients, but also to persons who suffer from severe physical or mental pain without any prospect of relief. Therefore, under this bill, persons who suffer from depression could request that a doctor help them to commit suicide. They could also request that the doctor carry out the act itself that would cause their death.

[Diane Bourgeois, Bloc, Terrebonne—Blainville, QC]

That is false.

[Jacques Gourde, Conservative, Lotbinière—Chutes-de-la-Chaudière, QC]

Therefore, when I articulated earlier that Bill C-384 is too broad in its scope, this concern applies to both the fact that it would permit physician-assisted suicide and euthanasia, and to the fact that it would allow a vast array of persons to make a request to a doctor for assisted death.

The second important concern I wish to raise with respect to this bill is how it does not encompass sufficient safeguards.

The subject of safeguards, like the subject of the scope, also has two aspects in the context of this bill.

The first deals with ensuring that the eligibility requirements and the terms used are properly circumscribed. In this respect, Bill C-384 contains a number of vague and undefined terms that could lead to interpretation problems and, therefore, potentially to misunderstandings or abuses.

For example, terms such as “while appearing to be lucid”, “appropriate treatment”, “severe physical or mental pain”, “without any prospect of relief” have the potential to be interpreted very subjectively.

Also, the 10-day “cooling off” period, if you will, is too short to ensure that a person’s wish to die was settled.

The other element of ensuring appropriate safeguards deals with putting in place an effective oversight mechanism. In this respect, it is my view that Bill C-384 contains a woefully insufficient oversight mechanism.

Under Bill C-384, the doctor who would assist in a suicide or terminate someone’s life would only have to provide a copy of the diagnosis to the coroner after the fact. This bill would give a doctor the authority to terminate life on the apparent consent of the patient.

Under the terms of C-384, people as young as 18, diagnosed with depression and not wanting treatment, could ask to have their life terminated by a doctor.

Parliament should not consider such profound changes to the law without prior input from Canadians. Many different stakeholder groups should be consulted in advance of specific reforms being considered. These amendments would have serious implications for the medical profession in particular.

Surely, the medical profession should be consulted in advance of such significant changes being made to current medical ethics and practice.

I know that other countries have struggled with this difficult issue over the years, both in their legislatures and in the courts. While some countries have amended their laws to permit physician-assisted suicide and/or euthanasia, others have not supported such changes. In any event, regardless of what other countries have done, we have to consider what is right for our society. It is not clear to me that the legal regime proposed in this bill is right for Canada.

In closing, I would like to reiterate that I do not support this bill. Bill C-384 would represent a substantial change to the current policy on the criminalization of euthanasia and assisted suicide. It raises a number of significant legal and policy concerns and, in my view, would not adequately protect human life. Bill C-384 would also have a major impact on current medical ethics and practice. Such substantial changes to the law should not be considered without extensive advance consultations.

[Marlene Jennings, Liberal, Notre-Dame-de-Grâce—Lachine, QC]

Mr. Speaker, please remind me when I have two minutes left.

I would like to announce to my colleagues in the House of Commons that the Liberal critic will not be voting in favour of this private member's bill by the hon. member for La Pointe-de-l'Île. I would like to thank her for raising this important issue. I personally think it is such an important and complex matter that a private member's bill is not the right vehicle to engage the public debate that this issue deserves. I would like to read a letter that the Canadian Medical Association addressed to my colleague, the hon. member for La Pointe-de-l'Île. A copy of this letter was sent to all hon. members. It sums up my concerns about this issue. The letter reads,

Madame,

The Canadian Medical Association (CMA) has been very interested in and concerned about the progress of Bill C-384 in the House of Commons. The House is at third reading of a bill that would, in some circumstances, allow a physician to aid a person to die with dignity if that person has provided free and informed consent. The CMA's policy is clear. “Canadian physicians should not participate in euthanasia or assisted suicide.”

As the attached policy notes, euthanasia and assisted suicide must be distinguished from the withholding or withdrawal of inappropriate, futile or unwanted medical treatment or the provision of compassionate palliative care, even when these practices shorten life. The CMA does not support euthanasia or assisted suicide and urges its members to uphold the principles of palliative care. Euthanasia and assisted suicide are opposed by almost every national medical association and prohibited by the law codes of almost all countries.

Our policies also clearly state that “the CMA recognizes that it is the prerogative of society to decide whether the laws dealing with euthanasia and assisted suicide should be changed”, but that there are some concerns that must be addressed before any changes are made. These include:

1. Adequate palliative-care services must be made available to all Canadians. In 1994, our members approved a motion that Canadian physicians should uphold the principles of palliative care. The public has clearly demonstrated its concern with our care of the dying. The provision of palliative care for all who are in need is a mandatory precondition to the contemplation of permissive legislative change. Efforts to broaden the availability of palliative care in Canada should be intensified.

2. Suicide-prevention programs should be maintained and strengthened where necessary. Although attempted suicide is not illegal, it is often the result of temporary depression or unhappiness. Society rightly supports efforts to prevent suicide, and physicians are expected to provide life-support measures to people who have attempted suicide. In any debate about providing assistance in suicide to relieve the suffering of persons with incurable diseases, the interests of those at risk of attempting suicide for other reasons must be safeguarded.

3. A Canadian study of medical decision-making during dying should be undertaken. We know relatively little about the frequency of various medical decisions made near the end of life, how these decisions are made and the satisfaction of patients, families, physicians and other caregivers with the decision-making process and outcomes.

Hence, a study of medical decision making during dying is needed to evaluate the current state of Canadian practice. This evaluation would help determine the possible need for change and identify what those changes should be. If physicians participating in such a study were offered immunity from prosecution based on information collected, as was done during the Remmelink commission in the Netherlands, the study could substantiate or refute the repeated allegations that euthanasia and assisted suicide take place.

4. Consideration should be given to whether any proposed legislation can restrict euthanasia and assisted suicide to the indications intended. Research from the Netherlands and Oregon demonstrate that a large percentage of patients who request aid in dying do so in order to maintain their dignity and autonomy.

If euthanasia or assisted suicide or both are permitted for competent, suffering, terminally ill patients, there may be legal challenges, based on the Canadian Charter of Rights and Freedoms, to extend these practices to others who are not competent, suffering or terminally ill. Such extension is the “slippery slope” that many fear.

This statement has been developed to help physicians, the public and politicians participate in any re-examination of the current legal prohibition of euthanasia and assisted suicide and arrive at a solution in the best interests of Canadians. The CMA is in favour of improving access to palliative care and suicide prevention programs, undertaking a study on how medical decisions are made near the end of life and having a comprehensive public debate on the matter, but we cannot support Bill C-384.

Sincerely,

Anne Doig, MD, CCFP, FCFP,

President

As I indicated at the beginning of my speech, I understand and deeply respect the desire of the hon. member for La Pointe-de-l'Île to bring this matter forth in the House of Commons, and I sympathize with her. I think this is a debate that we should have, but it should be initiated by the government.

I am critical, however, of this government and previous governments of my political stripe for not having had the moral fortitude to take the necessary steps to allow such a debate to take place and not undertaking such a study, as suggested and recommended by the Canadian Medical Association.

I truly believe that it is an issue that many Canadians, many families are grappling with and an idea that they are finding very painful to think about. Government has a responsibility to help Canadians deal with this issue, to see what the actual state is and whether or not this issue can be dealt with in a way that provides dignity and serenity, and also to provide a sense of security that there will not be mistakes made if legislative measures are in fact taken.

As I have said, I blame the government but I also blame my own political party, which formed government for several terms, for not having had the moral courage to deal with this.

[Joe Comartin, NDP, Windsor—Tecumseh, ON]

Mr. Speaker, like other members who have risen to address this issue, I think it is a very painful one for all of us. It is certainly a very emotional one, and it is one to which there is no clear solution.

I will start off by saying, as I have regarding the previous incarnations of the bill, that I am opposed to the bill, and I am opposed to introducing into Canada assisted suicide at this time. I want to say that philosophically I understand the arguments. I have to say I may even be inclined in extreme cases to agree that we need, in those rare cases, an assisted-suicide system. However, that is not where we are at as a society now. I believe it would be a tragedy and a major mistake if we moved to assisted suicide in this country at this time.

I must admit I deliberated quite extensively over whether I should support the bill to get it through second reading and to committee, and ultimately I decided that I was philosophically opposed to it at this time, but more important, I decided that the debate we would have around the bill is not the debate that we need in the country.

The misinformation that we have around assisted suicides and around end-of-life decisions is quite grotesque. We heard from my colleague the member for La Pointe-de-l'Île.

Surveys showed that 70% to 80% of Canadians support euthanasia, but when people are provided with an informed amount of information, that changes dramatically.

I am going to make these two points with regard to the information that is needed. One, the reality is that we do not train our doctors. I have been told to be careful about being overly critical of them, but it is the reality of our medical training. We do not train our doctors anywhere near sufficiently in pain control: pain control techniques and mechanisms and pharmacology.

I come from a community that has a hospice, which I believe is the best in the country. It has been in place for almost 25 years. It has gone out of its way to train local doctors by mentoring. Unfortunately, there was a pain specialist who recently retired. It has been training its doctors in this area, but it is an exception to the rest of the country.

There are all sorts of doctors, including some specialists I think should know better, who believe sincerely that there are a large number of cases in which they cannot control the pain and provide people with dignity at the end of their lives.

I want to quote from a statement made by Dr. Balfour Mount, whose name I think everybody in the country would recognize as being the leading doctor in palliative care. He started palliative care. He teaches at McGill University in Montreal.

We know from what has gone on this past summer in Quebec that physicians' associations there are looking at whether they are going to come onside the euthanasia position. This is what Dr. Mount said:

--the debate should be about the doctor's role in accompanying a terminally ill patient towards the inevitability of death, offering as much dignity and medical assistance as possible.

That is not the same as saying that we should kill people.

Mount said he is profoundly against euthanasia because it is simply not needed...

What he was saying is that it is not needed in the kind of care he is able to provide and that he has provided for the better part of 30 years, as is the case in my community.

I have spoken to Carol Derbyshire, who is the head of the hospice. She said the hospice does not get requests for assisted suicide. They provide the care, not just to the patient but to the family. She was very clear on that. She has seen any number of surveys that say one of the major reasons, aside from pain, that people want assisted suicide in their regime is that they do not want to be a burden on their family, their society, their community. If we can build that system to make sure they do not have to be concerned about that, we take away any desire to terminate their lives arbitrarily and at an earlier date than would be natural.

We need to look at our system right now. Like the previous speaker, I want to be somewhat critical of prior governments. At this point, approximately 20% of our population is covered by meaningful palliative care, hospice and a home care system. That is all we have in the country. Then there is another 15% or maybe 17% who are covered by partial assistance at the end of life.

As an aside, one of the other things Carol said to me is that we have to shift the debate from dying to living out our lives. She is trying to come up with a phraseology that I may be able to use.

However, that is what it is about. It is about providing that system, and we are not doing it. In the last few months the government has cut more funding, the last of the funding it was providing for palliative care. It was mostly for research and helping the provinces set up standards. That is the second cut. Now all funds at the federal level have been eliminated to aid the provinces in establishing educational standards and training standards for palliative care in hospices. The government has cut it all.

The other thing the government has not done, which is another area we need to be working on, is expanding EI benefits for family members who are caring for their parents or a sibling or spouse in need of that kind of assistance.

We have so severely restricted those funds as to make them almost meaningless. That is another area where we could be doing something that would take away the need for this kind of legislation.

We need to train our doctors much better, and we need to build the system. Until we do that, we should not be looking at this kind of legislation. I say that because I have also studied the situation in the Netherlands, Belgium and Oregon fairly extensively. Although they all have different systems of determining when doctors can assist suicide or an individual can get assistance for suicide, the same result is true in all those communities.

I know there are disputes over this, but it is the analysis that I have brought to bear, and I think it is an accurate one. In spite of how we build that system, and I say that about the legislation my colleague has brought here, that is not what actually happens. Should we make the mistake of passing this kind of legislation, we are in effect giving our approval to doctors who are willing to do this, to family members who want it and to those individuals who are still capable of making a decision. They will simply figure out ways of working around the legislation.

I respect my colleague from the Bloc extensively. The work she has done on foreign affairs and human rights in this country is almost beyond compare. I do not know if anybody's work is superior to the work she has done. However, I think she is wrong on this one.

I say this as a practising lawyer. I look at the terminology that she used, in particular where we are assessing the patient. She has set out a standard in this legislation about apparent lucidity. That is the terminology. That does not exist anywhere else in the law that I am aware of. If this test were to be applied, it would be easier for a person to commit suicide than it would be for somebody to take over control of their finances. That is simply wrong.

I am running out of time. I think we do need a fuller debate on this, but not in this context. It has to be in the context of people living out their natural lives, and what we, as a society and legislators, have to do to ensure that can happen.

[Serge Cardin, Bloc, Sherbrooke, QC]

Mr. Speaker, first of all, I would like to congratulate and thank my colleague, the hon. member for La Pointe-de-l'Île, who, for a third time, is introducing this bill concerning the right to die with dignity. We could call it the freedom to die with dignity. Clearly, for many people, when they hear that, they hear “suicide”, “assisted suicide” or “euthanasia”, and yes, it makes us shiver, because we have probably all known, every one of the 308 members have probably known someone directly or indirectly who has committed suicide, although no one expected it. We are always surprised. That person was probably suffering, suffering more than anyone can imagine.

We now have resources to help these people, but we have to find them and help them, for they will continue to suffer until we help them. Getting to the point of assisted suicide, this means that the someone is suffering, and there are situations in which there is nothing we can do. That person is suffering, and is becoming something that he or she never thought possible, bent over in pain, or often not bent over, but bedridden and suffering for weeks and months on end, which to that person seems like an eternity. This bill does not seek to eliminate people who are suffering. That is not what we are asking for; rather, we are seeking a right for these people, people who have all their faculties about them, who are suffering, who are aware of their suffering and who want to escape it. These people could commit suicide on their own and no one could stop them. However, some people have philosophical or religious considerations. Philosophy and religion eventually cross paths.

I can say that in ancient times, the Greeks and the Romans were able to bring the issue of suicide out into the open and ensure that it was part of public discourse and debate. That was in ancient times. They decided to discuss it honestly and openly, to debate the matter. Intolerance of suicide began to take root in the 2nd and 3rd centuries and was heightened under the influence of Christianity. Naturally we do not wish to go against people's beliefs. However, we are talking about the right to die with dignity. Some people fear that we are confusing palliative care with assisted suicide, that we are taking sides.

I have experienced this suffering. Who among us has not gone through the experience of watching a loved one die of cancer? Who has not experienced that? If I look at some of the reactions, what is happening now is not any better than what we are asking for. What we are asking for is to allow people to make a free and informed choice. You have probably all seen a loved one go through cancer. At a certain point, the suffering is intolerable. Of course the person is given morphine. At first things are better, but in the long run it is not enough. What to do? How long do we let them lie there unconscious? Are the doctors not somehow assisting them? Some people have a strong heart and their life, which they are no longer conscious of, will continue for as long as their heart beats.

My father, who died at age 68, started having strokes at age 63, shortly after he retired.

He had various handicaps in addition to Alzheimer's disease. Of course there came a time when he had to be hospitalized. He was bedridden and unconscious for weeks, months. My father was strong and he had a healthy heart despite the fact that he was unconscious. It is normal for a human body to want to continue living.

We say that we want what is best for society, yet the fact that we refuse to speak openly and honestly about this issue raises a question. How can we be thinking of what is best for society when confronted with an individual in the final stages of a terminal illness who knows that they will die sooner or later and asks to die with dignity, thereby minimizing their own suffering and that of the people close to them?

I went through a second experience because I was also there when my father-in-law died in my home. He had been receiving palliative care. CLSC staff came to take care of him regularly. The same thing happened: doctors said that they might be able to help the end come sooner. In that case, the patient did not make a request.

This bill covers requests by lucid individuals. If a sick but lucid person decides to end their life with dignity—and everyone knows that they are going to die anyway—who am I to refuse?

We know that such pacts are becoming more and more common. When people know that they cannot end their own lives, they ask another person to help them in the event it becomes necessary. It is not very nice to be asked to do this kind of thing. How heartbreaking. But if there is a legal framework and people can make an informed choice, what right do we have to refuse them? Who am I to decide whether a human being should live or die? I believe that only the dying person has the right to decide whether they want to live or die.

I am certain that if we do not have this debate, more and more cases will come before the courts. People will be faced with such situations and, out of compassion, will decide that they cannot continue to watch loved ones suffer and that they must help them because their loved ones have asked for their help. Who am I to decide that someone will continue to suffer, continue to be bedridden, continue to decline, continue to no longer be the person they once were and no longer know where they are, even though that person asked me to do something for them if this sort of situation should occur?

In my opinion, we, the 308 members of this House, have a duty to consider this issue. I am not trying to convince the members to say yes so that this bill becomes law tomorrow morning. What I am trying to do is convince them to consider, discuss, debate and improve this bill. In the end, it is not up to us to choose. It is up to the person to say lucidly that, in the event something should happen, they want to have control over their life and, ideally, their death as well.

[Paul Szabo, Liberal, Mississauga South, ON]

Mr. Speaker, I thought I would outline some of the subjects that I will deal with in my closing statements in the remainder of my speech.

I spent nine years on the board of the Mississauga Hospital, five years of which were on the ethics committee of the board of directors. During that period of time, I headed up a group that looked at the subject matter of no CPR orders, non-resuscitation policies.

The issues of informed consent and mental competency, whether the person had all the medical information, or were aware of all the options or there was coercion by family members or friends, are important issues to take into consideration.

The bill goes under the moniker of right to die with dignity, but the amendment to the Criminal Code would give a person the right to terminate a life before natural death. It would not give the right to die with dignity to someone. It would give the right of someone to take a life. That is a subtle difference.

I hope as many members as possible will get an opportunity to address this. Palliative care workers are concerned about this. Organizations and hospices are doing their very best to give the best possible care in terrible situations. Disabled in our society are obviously concerned about whether their lives are at risk because someone decides they do not live in dignity.

All human life is dignified life.

[The Deputy Speaker, Conservative, Andrew Scheer]

The hon. member will have eight minutes to conclude his remarks the next time the bill is before the House.

The time provided for the consideration of private members' business has now expired and the order is dropped to the bottom of the order of precedence on the order paper.

It being 2:30 p.m., the House stands adjourned until Monday at 11 a.m. pursuant to Standing Order 24(1).

(The House adjourned at 2:30 p.m.)