Madam Speaker, it has been quite the day on the procedural front, but I appreciate the opportunity to get back to a subject that is too important to be waylaid by these sorts of things. I mentioned four substantive amendments that I proposed. These are amendments that I think all members should be able to take a serious look at, and hopefully many on the government side will even agree with them.
I will say very clearly the purpose of these amendments. These amendments would not restrict access to something which the Supreme Court has deemed that we must give access to. Indeed, these amendments would provide greater shape and substance to the value of autonomy, which is supposed to be the basis of this legislation. They would give meaning and effect to that. I will mention that three out of four of these amendments would not even change the eligibility criteria.
What do I mean when I say that they would give added substance to autonomy? For an individual to have autonomy and effectively express that autonomy, the individual needs to have information about the choices he or she is making. How can people make autonomous choices if they do not have information about which they are supposed to be making the choice? That needs to include information about the impacts of a choice, as well as the alternatives that are available. Autonomy also requires some opportunity or space for meaningful deliberation based on that information.
What I am asking for in three out of the four amendments would not even require a change to the eligibility criteria. It is simply protection of the value of autonomy, assurance that individuals get the information they need, assurance that people who do not consent do not get pushed into this, and assurance that people who do not meet the criteria will not have their lives taken. The court asked us to develop a system of safeguards that would ensure that people who are vulnerable are not put at risk, that people who do not consent do not lose their lives in a medical environment, that people still feel safe in a medical environment, that they do not have to worry about going to a hospital and losing their lives without consenting to it.
We need these safeguards in place, and these amendments would do the job that the court asked us to do. They would provide the safeguards and protect the autonomy of individuals involved. I hope that members will take a serious look at all four of these amendments.
The first one, Motion No. 3 on the Order Paper, says that prior to making the request, someone must have consulted a medical practitioner specifically regarding palliative care options and be informed of a full range of options. Now, this can be part of the pre-existing consultation with a physician. There is no need for this to require additional time. This consultation, as I mentioned in committee, could happen with someone over the phone. There is not even a need for a requirement for an in-person consultation.
I see this amendment as the minimum of the minimum, but it would require that people get information about palliative care options before they take part in euthanasia or assisted suicide, and that people who express interest in euthanasia or assisted suicide at least first have someone say, “There is an alternative. This is what the alternative looks like. This is what is available in your area. Now you can choose between that robust, well-explained alternative of palliative care or the option of physician-assisted suicide or euthanasia.”
I do not see why members would have any objection to this amendment. It would not add any hoops to jump through. It is simply an assurance that patients would receive information about their alternatives. Indeed, it cuts to the core of what autonomy is supposed to be about: people having the information to make meaningful, understood choices between different alternatives.
It is interesting to hear members talk about their personal experiences on this issue. People talk about pain having been totally unmanageable in a particular case. In fact, the pain may have actually been manageable, but the person did not get good information and did not have access to the palliative care or pain management they needed. It is always unfortunate when I hear that said, because this speaks to people not getting the information they need about palliative care and pain management.
Let us do the minimum with that amendment. Let us make sure that people get information about palliative care options. I do not think that is too much to ask, and it would show the goodwill of the House to look at an amendment like that in a serious way.
My second amendment, Motion No. 7 on the Order Paper, would add a requirement of imminent natural death. This is the only one of my four amendments that would inform the eligibility criteria, but it is an important change. The phrase “reasonably foreseeable” is, of course, very ambiguous language. The use of the word “terminal” provides some greater degree of clarity.
This is very much constitutional. We have the right as Parliament to define the contours of an exception to the Criminal Code. As the justice minister herself has said, identifying the purpose of the law can alter the charter interpretation, and courts have said they would show deference. There is a need to proceed conservatively at the outset on an issue like this, and there is always the opportunity to study going further.
Most Canadians, when they think about this issue, are thinking in terms of terminal. This is consistent with the Quebec experience. There were seven years of study and a great deal of deliberation in the Quebec context. The conclusion, after much debate there, was that “terminal” was the best way to go. We would be unwise in a few months to rush to a very different conclusion than Quebec made after years and years of deliberation, or at least to go in a further direction than it did, because it had much more time to think about it.
Describing this legislation in a clearly terminal context provides greater protection from the concerns that the member for Winnipeg Centre and others have raised about this leading to some degree of suicide contagion. If we clearly define the legislation as applying to a limited population in a limited situation, we would have to worry relatively less so about how this may lead to some degree of suicide contagion in the rest of society.
I hope members will take a good look at that amendment as well.
The third amendment I am proposing is on the Order Paper as No. 12. It is a requirement for self-administration in cases where an individual is able to self-administer. This means that assisted suicide would be the default, as opposed to euthanasia, in the event that an individual is able.
This does not limit anyone's access to euthanasia or assisted suicide. Everyone who had access before the amendment would have access after it. However it ensures contemporaneous consent. It means that an individual who is seeking this service is consenting at the moment that they do it, and that there is no better way of doing it. This, again, adds substance to the idea of autonomy. It makes for good individual rationality in terms of the individual making the decision and doing it to themselves right at that moment.
This is a good safeguard in terms of ensuring contemporaneous consent, but it also has other benefits. It has the potential to help address the access issue. Doctors, in some cases, may be more comfortable assisting than they would be in actually providing. That is a safeguard that provides some additional benefits as well. There are no negative access implications. There is no harm in that provision.
The final amendment that I proposed is around advance review. The bottom line is that the so-called safeguards in the legislation are no good unless someone is checking. We have a requirement for two doctors and two witnesses, but a person could shop around. These four people could be anyone. They could be the same four people approving it for different Canadians across the country.
Therefore, I have put forward a proposal for a relatively minimal advance review process. It would be up to the provinces to designate that process. They could simply say that a lawyer has to sign off that the legal criteria were met, or they could have a judge do it. There are provisions for the provinces to have a choice within that context. However, there has to be an advance review. There has to be someone checking. If no one is checking, what good are the safeguards? What is the point of having any requirement at all if we do not have someone with the legal competency to understand what those safeguards are and to compare those safeguards to a situation? This is a complex legal situation. It requires some kind of competent legal authority.
The four amendments are modest amendments. They are surgical. They protect the value of autonomy. I hope all members, including members of the government, will take a serious look at them and give their support to them.