Mr. Speaker, I am honoured today to speak following on the comments made by my colleague, the Minister of Justice and Attorney General of Canada, when she introduced Bill C-14, an act to amend the Criminal Code for medical assistance in dying.
This is a historic debate on a matter of tremendous significance for Canada and for all Canadians. Advancing this issue and getting a legislative framework in place to allow medical assistance in dying is a solemn responsibility. This a deeply personal issue for every Canadian.
When a dying person approaches the end of life, many more people other than just that individual are affected, including the person's family, community, and employer, as well as the people working in our network of social and health care services, those who provide support during our difficult times.
For many people, death is a difficult topic. Conversations about death are difficult to have, whether it is with a family member or, in particular, with a health care provider. This topic is difficult on both sides of the conversation.
Our government has given this matter careful consideration.
Over the past 30 years, I have experienced the reality of talking frankly and openly with, perhaps, hundreds of patients as they were facing death. Through every stage of the process, my patients have taught me valuable lessons, lessons about caring and compassion, about fear and anxiety, about the importance of support when recovery is no longer probable.
In working with patients in the final months and years of their lives, I have learned that every person, every story, is unique. However, much is shared in common: the hope to die in peace; the desire to be respected; and to have personal autonomy and dignity honoured by family and health care providers alike.
My experiences have also reinforced my sense that we must uphold the principles of palliative care, as well as respecting the rights of patients to make their own decisions about their care as they approach the end of life.
On February 6, 2015, the Supreme Court of Canada declared that the Criminal Code prohibitions on assisted dying were unconstitutional. The federal government was given one year to develop a federal framework to address this decision.
On January 15, the Supreme Court granted a four-month extension, to June 6 of this year, to give our government time to develop a legislative framework for Parliament to consider.
The Supreme Court's decision marked a watershed moment in an important and long-standing debate surrounding the right of Canadians to have the choice to a medically-assisted death. However, how it will be implemented, for whom and by whom, needs careful consideration.
As parliamentarians, we have heard from Canadians on this issue through so many conversations with our constituents and through the dedicated work of the joint parliamentary committee. Hundreds of experts and organizations, both in our country and abroad, have contributed volumes to our understanding of this very difficult subject. Many have spoken passionately about their work on the front lines of palliative care, hospice care, and end-of-life care. Others have talked about personal experiences with loved ones and about easing the physical and emotional pain that they experience.
Our government is grateful for the work of the federal external panel on Carter and for the work of the Special Joint Committee on Physician-Assisted Dying.
We have also benefited from the work undertaken in the provinces and territories on this issue, including the thoughtful recommendations of the expert advisory group on physician-assisted dying.
We are grateful to members of Parliament who have shared their own thoughtful, considered, and wide-ranging insights over the past few months and, indeed, years.
Our government has listened, and the legislation we are tabling is the product of their efforts and their collective wisdom and experience.
Today, we are taking decisive action. I think that it is good news for Canadians, including those who are facing this personal and very difficult choice, their families, and their care providers, who have all been carefully considering this legislation.
For people who wish to have the choice of seeking medical assistance in dying, Bill C-14 would allow that, in keeping with the Supreme Court of Canada's decision. This proposed bill is the product of careful consideration of several principles that guide our government, including the desire to support personal autonomy and access to health care services, while recognizing that it is imperative to protect vulnerable persons, individually and collectively, from coercion and disrespect.
With Bill C-14, certain health care providers would, under certain circumstances and conditions, be exempt from Criminal Code offences in order to allow them to provide or assist in providing medical assistance in dying.
The bill would clearly define the criteria that must be met for individuals to be eligible. We have set up safeguards to be followed to ensure that these criteria are met and that the request is truly voluntary. This is critically important to protect vulnerable populations and, frankly, to ensure that anyone who contemplates medical aid in dying has fully reflected on their choice.
We also create the foundation for a regime to monitor medical assistance in dying so we can see how it is working in Canada.
With this bill, we are demonstrating our government’s commitment to supporting the autonomy of patients who are approaching the end of their lives, while protecting the most vulnerable in our society.
There has been considerable focus on whether providers should be free to exercise their conscience rights. I want to underscore that this proposed legislation does not compel any health care practitioner to provide medical assistance in dying. Practitioners will have the right to choose as their conscience dictates.
However, we must also respect the rights of people seeking this procedure by ensuring that those providers who have expressed a preparedness to help patients can do so without fear of criminal prosecution. Under Bill C-14, certain health care providers, such as physicians and authorized nurse practitioners who administer medical assistance in dying would be exempt from criminal prosecution.
Since nurses and nurse practitioners have the authority to deliver many of the same medical services as family physicians, in that they can assess, diagnose, and treat patients, they, too, would be exempt from criminal prosecution.
This is critical, as nurse practitioners often work alone providing vital health care services in underserved areas, such as the most remote and rural parts of Canada. Other providers, such as pharmacists, registered nurses, and physicians who may provide assistance would also be exempt from criminal prosecution.
Therefore, rest assured that health care workers who provide and assist in providing medical assistance in dying will have no reason to fear criminal prosecution as long as they follow the appropriate safeguards.
In consultations leading up to this bill, there was strong consensus among Canadians that standardized data needs to be collected on the practice of medical assistance in dying.
In addition to Criminal Code amendments, this bill creates the power necessary for the Minister of Health to make regulations about the information to be collected, the use and protection of that information, and the processes for collecting and reporting that information.
We agree that a robust, transparent monitoring system on the practice of medical assistance in dying is essential, and analysis and trends need to be reported to the public on a regular basis. We, as the Government of Canada and Canadians, need to understand as much as possible about how the system is operating in practice so we can address any potential concerns.
To that end, this proposed bill commits the federal government to working with the provinces and territories to develop a pan-Canadian monitoring system. The system will allow us to collect and analyze data, monitor trends, and make recommendations for potential legislation and policy reforms.
We are not starting from scratch. Around the world in other places that have legalized medical assistance in dying, mandatory oversight systems are in place to carry out monitoring and public reporting each year.
We can look to these examples to help us decide what is right for Canada. We can also look closer to home, in Quebec, where a monitoring system was recently established.
Developing a robust pan-Canadian system with provinces, territories, and stakeholders will take time, and we know we need to be tracking this information as soon as possible.
From a health perspective, I feel strongly that it is important for us work toward consistency in the provision of health care services for all Canadians, regardless of where they live. Canadians and stakeholders are expecting and hoping for a pan-Canadian approach. They do not want a patchwork where they observe significant differences in quality and availability of services in their own community, province, or territory relative to other parts of the country.
A fundamental value in Canada is our commitment that Canadians across the country will have access to medically necessary health care services when they need them. This view reflects the underlying principles of universality, accessibility, and comprehensiveness so vital to our health care system.
Bill C-14 contains well-defined eligibility criteria and safeguards, which go a very long way to achieving our government's objective of a consistent framework for medical assistance in dying. While certain implementation details will be left to provinces, territories, and medical regulatory bodies, we will all operate under the same legal and access framework.
My health minister colleagues across the country have looked to us for leadership on a consistent approach for all Canadians. I am pleased that our proposed bill fulfills that expectation.
No aspect of what we do on the question of complementary measures should be done precipitously. There are several particularly challenging issues. On these, our proposed bill suggests a cautious approach that will seek further advice, as suggested by the special joint committee.
However, we also recognize that there is a difference between the decision to accept or forgo treatment and the decision to hasten one's own death. Accordingly, a higher standard of decision-making capacity should be required in the latter case.
As part of the eligibility criteria, the bill specifies that individuals must have reached the age of 18 to seek medical assistance in dying.
There is the equally if not more contentious matter of advanced directives. Advanced directives are used to indicate wishes for treatment if a person can no longer communicate.
The prospect of permitting requests for assistance in dying through advance directives is concerning to many Canadians. At the same time, others feel strongly that they should be able to convey their wishes for a medically-assisted death in advance of a future point time when, as in the case of a progressively debilitating condition such as dementia, they are no longer competent to make a request.
Advance directives are a difficult issue for many individuals, family members and health care providers. As difficult as it is to discuss the end of life ln the final days, it can be even more difficult to predict one's wishes and circumstances in the case where it is further off, especially in the distant future.
Many people are also troubled by the prospect of patients with a psychiatric disorder being eligible for assistance in dying on the basis of psychological suffering alone. There are strongly held views on both sides of this issue. That is why legislating medical assistance in dying has required a cautious approach, and that is why we have committed to independent studies to explore the challenging issues of mature minors, advanced directives, and mental illness further.
Following a period of study and further reflection, we will be better positioned to determine how these issues best fit into a Canadian framework for medical assistance in dying.
I believe that this is an approach that most Canadians would favour.
I said earlier in my remarks that this bill did not compel participation by health care providers to do anything which would run counter to their convictions. At the same time, we are also mindful that the exercise of conscience rights by providers may constitute a barrier to access for those who are seeking medical aid in dying. There is therefore a federal interest on behalf of Canadians in working with our provinces and territories to support access.
Collaborative work with provinces and territories could build on important international examples, such as the well-established networks we see in the Netherlands and Belgium. These provide insight as to how an end-of-life care coordination system could help facilitate access to a consulting physician or nurse practitioner. This is particularly important in rural and remote areas, or in situations where identifying a second provider to assess eligibility may be problematic.
One of the things I have heard is that better palliative care would assist in the end-of-life care options that have now been prescribed by the Supreme Court. I know first hand that there is a place and a need for both.
Palliative care focuses on relieving suffering and improving the quality of life for the living and dying. It provides relief to people dealing with a range of life-threatening conditions such as cancer, cardiovascular disease and amyotrophic lateral sclerosis, or ALS.
Today, Canadians are aware, and have a general understanding, of palliative care. However, some studies have found that the overwhelming majority, perhaps 70% or more of us, do not have access to it, particularly in rural and remote areas. Many providers are not well trained to provide palliative care services. Reinforcing this government's commitment to quality palliative care, this proposed bill signals our intent to support improvements to a range of end-of-life care services.
Like other health care services, the delivery of palliative care is mainly the responsibility of provinces and territories. However, the federal government can make significant contributions in this area. We are already supporting a number of initiatives aimed at improving capacity in our health care system to provide palliative care.
In partnership with the provinces and territories, health care providers, and non-governmental health organizations, the federal government has funded initiatives designed to advance palliative care awareness, education, national standards, and research. For real improvements to be made, we need to work closely with provinces and territories.
Since my appointment as the Minister of Health, it has been my immediate priority to reach out to provinces and territories to discuss needed transformation in our health care system, including care at the end of life, particularly in the setting where Canadians say they most wish to die; that is usually in their own home and community.
In that spirit, early this year I met with provincial and territorial health ministers in Vancouver to launch discussions on a new multi-year health accord. Through the health accord process, our government will be making significant investments totalling $3 billion to help deliver more and better quality home care services for Canadians.
We expect that support for palliative care in a variety of settings, where patients can receive the ongoing care they need and deserve at the end of life, will be one of the priorities going forward.
I believe that by working together, we can bring real change to the health care system so that Canadians can continue to have access to high-quality, sustainable care.
There is no doubt that care at the end of life should be there when people need it. We want all Canadians to have access to the best care possible. We want them to have autonomy in making decisions as they approach the end of their lives.
We are facing a challenging time frame to put this legislation in place, with a June 6 deadline. However, I believe that with this proposed bill, we have found a balanced approach that reflects the best interests of Canadians. That is why I urge all members of this House to support Bill C-14.