Madam Speaker, I would like to thank the Minister of Justice and Attorney General of Canada for her thoughtful presentation this morning.
The issue of physician-assisted dying is one of the most important social issues that Canada has faced in some time. There is no question that physician-assisted dying will be one of the most important issues this Parliament must address.
I had the unique opportunity to give special attention to the issue of physician-assisted dying as a vice-chair of the Special Joint Committee on Physician-Assisted Dying. The special joint committee had a very short time period to deal with a highly sensitive and complex issue. While I, along with my Conservative MP colleagues on the committee, the hon. member for Louis-Saint-Laurent, the member for Langley—Aldergrove and the member for Kitchener—Conestoga, were not able to agree with all the recommendations in the main committee report, all members from all parties and in both Houses worked respectfully and in good faith to do what they believed was best for Canada and respectful of the law arising from the Carter decision.
I would particularly like to a acknowledge the hon. member for Don Valley West, who served ably as chair of the special joint committee.
The issue of physician-assisted dying raises many deep legal, moral and ethical questions. It is an issue that Canadians get very emotional about, and that is understandable. When we are talking about physician-assisted dying, we are talking about something that is probably the most important thing to any human being, living and dying, the right to live and the right to die.
It is not a new issue to Parliament. Indeed, over the last 25 or so years, this issue has come before Parliament 14 or 15 times. Each time Parliament was asked the question whether to legalize physician-assisted dying or not, Parliament chose not to. However, the issue of whether we should legalize physician-assisted dying or not is over, because the Supreme Court of Canada in Carter determined that physician-assisted dying was a charter right for certain Canadians.
While the Supreme Court recognized that physician-assisted dying was a charter right for certain Canadians, it is important to emphasize that the Supreme Court said that it was a charter right for certain Canadians. The Supreme Court did not say that physician-assisted dying was a charter right to anyone, any time, anywhere, under any circumstances in Canada. Rather, the court set out a clear set of parameters. More specifically, what the court determined was that competent adult persons who were suffering intolerably from a grievous and irremediable condition and who gave their clear consent, had a right under section 7 of the charter to physician-assisted dying.
In so deciding, the Supreme Court sought to strike a balance between respecting individual autonomy with the need to protect vulnerable persons. The Supreme Court was satisfied that balance could be achieved with what the court characterized at paragraph 105 of its decision as a system of carefully designed and monitored safeguards.
The test before Parliament is to find that balance in the way of a legislative response. As a starting point for a legislative response, it is important to look to the Carter decision. Does the legislation satisfy the parameters of Carter?
I am satisfied that the legislation does satisfy the general parameters of Carter in limiting physician-assisted dying to competent adult persons who are suffering from an incurable disease or illness, in an irreversible state of decline, and whose death is foreseeable.
That being said, I believe the legislation falls short in at least two regards at this present time. First, I am not satisfied that the legislation sufficiently protects vulnerable persons, persons particularly with underlying mental health challenges. Second, I am disappointed that the legislation does not contain provisions to protect the conscience rights of physicians and allied health professionals.
With respect to safeguards, it is true that the legislation limits physician-assisted dying to persons who are suffering from a physical illness, and make no mistake, that is a very important safeguard. That safeguard, by the way, is consistent with what the Supreme Court pronounced in holding that one had a right to physician-assisted dying in the context of an irremediable condition.
However, where the legislation falls short is that it does not take into account persons who have a physical illness on the one hand, but on the other hand, suffer from an underlying mental health challenge. Make no mistake about it; if people have underlying mental health challenges, are suffering from physical illnesses, and they meet all the criteria of Carter, they have a right to physician-assisted dying as does every other Canadian who meets that criteria. The issue is ensuring their capacity to consent.
In that regard, it is important to remember that the Supreme Court, as one of the key criterion in the parameters that it set out, said that individuals must give their clear consent. Now the evidence before the special joint committee is that physicians generally have the training and skill to diagnose someone with an underlying mental health challenge, to identify the underlying mental health challenge. However, to take the next step, to undertake the kind of complex analysis of determining capacity and consent, a significant amount of evidence said that any physician was not able to do it. Rather, someone with more specialized training such as a psychiatrist would be able to undertake that type of assessment.
I would respectfully submit that it would be an important improvement in the legislation to contain a safeguard to require a psychiatrist to undertake an evaluation of the patient who is determined to have an underlying mental health challenge to determine capacity to consent on a decision that is ultimately irreversible.
With respect to conscience protections, I am disappointed that there is no provision for conscience protections in the legislation. Rather, this has been passed on to the provinces, to colleges, and to professional regulating bodies. The Government of Canada has a duty to protect the conscience rights of physicians and allied health professionals.
The conscience rights of physicians are charter rights and those charter rights are as important as the charter rights of patients to access physician-assisted dying. The charter rights of physicians with respect to the protection of their conscience and right to conscientious objection is not only any charter right, it is a charter right under section 2 of the charter. Section 2 charter rights are considered to be fundamental freedoms.
It is important that the legislation sufficiently respect everyone's charter rights, the charter rights of patients and the charter rights of physicians.
Last, I want to emphasize the importance for the government to respond quickly in the area of palliative care. This is very critical. It is something that Parliament has talked about for a long time. There have been somewhere in the neighbourhood of four or five Senate committee reports. There was at least one report out of the House of Commons. I know that the hon. member for Kitchener—Conestoga chaired a committee that looked at the issue of palliative care.
Now that physician-assisted dying has become a reality, it is time to end the discussion. It is time to act when it comes to providing access to palliative care. It is widely recognized that palliative care is an essential part of end-of-life decision-making. One thing that I heard over and over again as a member of the special joint committee was that a person cannot truly consent to physician-assisted dying unless the person has all options available to them. One of those options is palliative care, but the fact is that only 15% to 30% of Canadians have access to palliative care. Let me say that the option of palliative care without access to palliative care is no option at all.
I want to acknowledge that the Minister of Health did announce $3 billion in funding for palliative care. This is a very important step in the right direction, but it is also noteworthy that there is no mention of palliative care in the budget. There is not one new cent for funding towards palliative care. It begs the question, where is this funding going to come from and when, and where is it going to go? It is absolutely important that the government take decisive action on palliative care.
With that, I would say that this legislation is a significant step in the right direction, having regard for some of the recommendations in the special joint committee main report that I believe went beyond the scope of Carter. I want to thank the government for listening, for considering the dissenting report that was authored by me, as well as my three Conservative MP colleagues on the committee.
However, it is imperfect legislation. There are some of what I would consider to be significant flaws. I am hopeful that the government will be amenable as the legislation moves forward to accepting amendments so that everyone's charter rights can be respected, the charter rights of patients, the charter rights of physicians and allied health professionals, and the charter rights of vulnerable persons.