Madam Speaker, I am thankful for the opportunity to join the debate today on Bill C-14, which addresses medical assistance in dying. I would like to acknowledge the incredible respect and thoughtfulness expressed by members in this very delicate debate.
Before I begin, I would like to acknowledge the advice and insights I received from a former colleague, Dr. Lorne Martin, chief of staff at Halton Healthcare, on the medical ethics and physician perspectives that would be created by the legislation.
The bill has generated significant debate and feedback from my riding of Oakville, both from people who wrote or contacted me on their own initiative, as well as those who responded to the forums that were created to solicit feedback through local media and my interactive website, johnoliver.mp. I have read and carefully considered the many views and concerns that came from residents of Oakville and I would like to address those that are relevant to the act and the amendments proposed.
The community responses can be grouped into five categories. The first is from those who are opposed to any form of medically assisted death and want the law to respect and protect every human life from conception to natural death. These are individuals who put forward the principle that we must not take another's life. There were many submissions of this nature.
For people who hold these values, I believe it is important, once again, at this stage, to understand that the Supreme Court of Canada's unanimous decision in the Carter case was a declaration that the Criminal Code prohibitions on assisted dying were not in accordance with the Charter of Rights and Freedoms. Effective June 6, 2016, medically assisted death is legal in Canada whether the bill is passed or not.
Therefore, the issue before this legislature is not whether medically assisted death will be allowed. Rather, the issue is whether medically assisted death will be permitted in accordance with the parameters set out by the Carter ruling or under a legislative framework established by elected representatives. Accordingly, our decisions are how to safely implement this new practice, who should be eligible, what safeguards are needed to protect vulnerable individuals, what are the roles and responsibilities of medical professionals, and how do we create a monitoring regime to ensure accountability, transparency, and improvement in this area as we go forward.
The second category of responses from my community were in reaction to the special joint committee recommendations. Many Oakville residents wrote to me expressing their concern that the rights of vulnerable Canadians may be infringed upon as we protect the rights of those seeking autonomy in their end-of-life decisions. Specific concerns were raised in relation to including Canadians with psychiatric conditions, psychological suffering, and minors.
Bill C-14 and the proposed amendments are more restrictive than both the Carter decision and the committee recommendations, in part, for the reasons raised by these constituents. To protect the rights of the more vulnerable, the bill has not included these broader situations or circumstances in the eligibility criteria, thereby addressing the concerns raised by these residents.
The third category of responses were diametrically opposed to those previously stated. These residents spoke in favour of the Supreme Court decision and about their belief that the Charter of Rights and Freedoms should allow autonomy to the individual in end-of-life decisions. Several accompanied their statements with personal stories of difficult end-of-life experiences for loved ones or worries about their own unique circumstances.
They also expressed concerns that Bill C-14 is too restrictive and does not address all the circumstances that should be considered eligible under the act. In particular, the clause requiring that natural death be reasonably foreseeable was felt to exclude many Canadians that they felt should be allowed.
In addition, there were concerns raised about denying advance directives. Denying advance directives puts people who suffer from degenerative illnesses that will eventually affect their competency in the position of having to exercise their right to an end-of-life decision in advance of losing competency.
The fourth category of concerns surrounded the rights of medical practitioners and institutions to ensure that they would be able to have freedom of conscience and religion to decide whether to participate in a medically assisted death. Bill C-14 would not compel participation by health care providers and I feel it is sufficient.
The final category of responses were fewer in number, but supported the position put forward by Bill C-14 as a reasonable starting point to address the complex and competing values and rights created by the Carter decision.
Having now spent considerable time in understanding and researching the issues raised by my constituents, and after careful consideration and personal reflection, I will be supporting Bill C-14 as reported by the committee for the following reasons.
I committed upon entering the past election and during my campaign to uphold the Canadian Charter of Rights and Freedoms. The Supreme Court ruling clearly found that the existing laws were not compliant with charter rights and freedoms and denied autonomy to a person seeking to end his or her life who clearly consents to the termination of life, and has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual. It is therefore morally incumbent, I believe, on this legislature to put legislation in place to protect this right and freedom, and I support that direction as carried out in the act.
We face, as a legislative body, the difficult task of balancing the competing social and moral values and interests surrounding this direction. For me, the protection of the vulnerable who may be individually or collectively disrespected or coerced to choose a premature death in the face of a too-permissive regime of assistance in dying must be balanced against those suffering from grievous and irremediable conditions.
As a first step in understanding the competing social and moral issues and the charter rights and freedoms of different groups, I believe Bill C-14, while not perfect, is an acceptable starting position for Canadians.
I would have preferred that Bill C-14 was more permissive for those where death is not reasonably foreseeable, and instead, built in protections for those who are vulnerable to the too-permissive language. While the bill's language is open to reasonable interpretation of foreseeable death, it does leave complex legal and ethical decisions with families and medical practitioners that will be open to court challenges and future charter appeals. This will add further stress and suffering to already untenable situations for many.
I do take some comfort from provisions within Bill C-14 to conduct further reviews after five years of eligibility criteria, and from the amendments coming back from the committee to review, after 180 days, other initiatives such as advance directives.
Another factor in my decision to support Bill C-14 is my belief that with properly offered health services, such as palliative care, most Canadians will not opt to use its provisions. Research from other countries suggests that most people prefer to enter into a palliative care program and experience natural death. While palliative care is not always a substitute for medically assisted death, it would be unacceptable to have people choosing medically assisted death as a result of inadequate palliative care services. I believe we can do more to ensure that palliative care programs are available and accessible across Canada, as proposed in some of the amendments.
The work of the Minister of Health in negotiating a new health accord agreement with the provinces and territories is fundamental to achieving these services, and I fully support her diligent efforts to achieve a new accord and ensure that all Canadians have access to high-quality sustainable care.
In discussion with doctors and other health care workers, there is general support and agreement with the bill, particularly the freedom given to caregivers to choose to participate in assisted death based on their own conscience and religious beliefs. I support the freedom that is put forward in the bill and do not feel an amendment is required.
Physicians today are already involved in substantive decisions regarding end of life, working with families or in accordance with advance directives. They often provide key clinical advice in the decision to end life support or to apply do not resuscitate orders. However, asking physicians to interpret and execute advance directives to end a life is ethically more challenging and places significant onus on them as individuals, particularly in hospital environments where they do not know the person or where there is not a family to consult.
Finally, my decision to support the bill arises from personal experiences and the loss of a loved family member who, as she requested, passed away at home in the presence of family. The final days of her life were marked with pain and suffering, which we were able to somewhat alleviate through oral morphine.
However it is allowed, appropriate care at the end of life needs to be available to people when required. I want my family members, fellow Oakvillians, and fellow Canadians to have autonomy in making end-of-life decisions as they have enjoyed autonomy in all of the major decisions in their lives.
I will be supporting Bill C-14 , and I urge all members of the House to support this important bill.