Debates of May 2nd, 2016

Criminal Code

[Pierre-Luc Dusseault, NDP, Sherbrooke, QC]

Mr. Speaker, I thank my colleague for his speech.

I would like to know what he thinks about the government's decision to use a different definition than the one set out in the Carter decision. The Supreme Court's decision used the term grievous and irremediable medical condition. Although the government was well aware of what was in the Supreme Court's decision, it decided to use a different definition.

What does my colleague think about the uncertainty this could create in the legal system and especially in our health care system?

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, I thank my colleague for his question.

I think the answer is politics. As we have seen characteristic of the Liberal government in recent weeks and months, it is reluctant to reach difficult decisions. There is an attempt to keep everyone happy on every file, with procrastination and avoidance of the tough decisions that need to be taken. I think this is another case, such as with pipelines, military missions abroad, the environment. However, in this case, risk aversion has basically brought the government to enter a piece of legislation which does not go, as I said, where the Supreme Court ordered us to go.

[Erin O'Toole, Conservative, Durham, ON]

Mr. Speaker, I would like to start by thanking my colleague, the member of Parliament for Thornhill, for a very thoughtful presentation in this House.

A debate on Bill C-14 is an example of this House of Commons at its best. Canadians do not send us here to have unanimous agreement on issues of the day. We are here to represent our ridings, the constituents who have sent us to Ottawa. We belong to political parties. We have different leaders' roles. However, we are Canadians who bring an experience and a point of view to this chamber.

Infrequently, we share that view in the personal stories that people bring to the House of Commons. Today, on the difficult subject of Bill C-14, I learned of my colleague's perspective and personal experience with a member of his family, his personal experience covering the Rodriguez case in the 1990s as a journalist, and how that has combined to formulate his position on assisted dying or euthanasia. Members should welcome that.

It is unfortunate that we do not have a full House for important debates like this. We get so busy, but it is important for us to learn the perspective that each of us brings as a member of this chamber. We are not sent here to be surrogates for other interests or to run polls. We are sent with the judgment to try to look at legislation from the lens of our own experience, education, and background. Many members have brought that to this floor today, and I applaud them for it.

I have looked at Bill C-14, and I have struggled with it. Certainly this is a place where there are two sides on this issue, maybe broken down even more than that. However, there is compassion at the heart of both sides, and that is what is often forgotten in this debate. Why I say this should be the House of Commons at its best is that the Supreme Court of Canada recognized the role of Parliament to clarify the law with respect to euthanasia in a way that is thoughtful and complies with its direction in Carter. This is indeed one of the important debates that we should not fear in our House of Commons. We should ensure that we take part vigorously and share perspectives, as my friend from Thornhill has.

I have looked at Bill C-14, not just as a member of this chamber but also as a lawyer. I have reviewed the case law going back on this some 20 years. I have also reviewed it as a father of two children, a husband—I know my wife is watching today—and the son of a strong woman who died from cancer when I was nine. My most formative memories of my mother Mollie are in her palliative stage of that disease. Of course, all of these things combine to formulate my position on Bill C-14 and what I feel is the government's position with respect to Carter.

However, I am using my speech today to talk about some of the concerns I have with the bill. I will start with a Supreme Court of Canada quote from Justice Sopinka:

Regardless of one's personal views as to whether the distinctions drawn between withdrawal of treatment and palliative care, on the one hand, and assisted suicide on the other are practically compelling, the fact remains that these distinctions are maintained and can be persuasively defended.

Within the Rodriguez decision in 1993, the Supreme Court struggled with the role of the state at end of life in euthanasia or assisted dying. It struggled with whether that role should be passive with respect to palliative care, treating and helping and comforting and limiting pain at end of life, or whether the role of the state should be an active role at end of life.

Justice Sopinka, in the majority court in 1993, said that the bright line of the active versus passive could be persuasively defended. That was the language of the court. Canadians remember, as my friend from Thornhill did, the tragic circumstance of Ms. Rodriguez and her compassionate arguments with respect to that. Bill C-14 is about the role of the state. It is not suicide alone, and that is why we have to have legislation that both accepts the Carter decision but brings us to a position that Canadians can be comfortable with, that persuasively defends it.

The second quote I will use is from Carter, paragraph 117, as to why the court found the position of the trial judge to be compelling. It states:

We agree with the trial judge that the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards.

At paragraph 120, it went on to state:

We should not lightly assume that the regulatory regime will function defectively....

What the Supreme Court did was to allow this Parliament to come up with a regulatory regime to function effectively. The importance of that function is to ensure that what both courts said, the court of the Sopinka decision and the unanimous court of today in Carter, is that the decisionally vulnerable should be safeguarded. That was clearly part of the direction of both courts. This key element, and the aspect of what I consider to be the challenge for an ironclad regulatory regime, the slippery slope argument, is where I find Bill C-14 to be failing. That is why I am not supportive of it.

In the Carter decision, the court said that it was not in a straitjacket because it rejected euthanasia in the Rodriguez decision, and it looked at it in light of recent charter decisions. However, it is looking to Parliament for a system that does not allow the decisionally vulnerable, those impacted by a terrible diagnosis, under the strain and stress of an illness, to at a moment want to take their life and have the state play a role in that. Both courts recognized that these are vulnerable Canadians who need to be safeguarded. My concern is that this would not take place within this legislation before this chamber.

If we look at the great work that members of the all-party committee did, from the aspects of the all-party committee recommendations to what is before us in Bill C-14, the bill actually reflects more of the work done by the Conservative opposition on that committee. However, it certainly shows an indication of where the regulatory regime regarding assisted death would go. At some point in the future, it will likely include mature minors, and it will likely include people afflicted with mental illness, because that was the recommendation of the all-party committee.

As a veterans advocate for years before I joined Parliament, and having the privilege of being the veterans minister, I have met dozens of veterans who would have been decisionally vulnerable when they were suffering from depression, post-traumatic stress disorder, or another operational stress injury, but who are now leading productive lives as mothers and fathers. Some have returned to their role in the military. Many are actually advocating and helping other veterans.

Therefore, I am concerned with a regime that indicates that is where it will go. I know that Bill C-14 does not contain those provisions. However, the slippery slope element, which both the Sopinka courts and the McLachlin courts considered, show that is what we should anticipate in a few years. Although this House of Commons is well intentioned, with an impossible regulatory regime, unable to look at every situation, I think the persuasively defended bright line has not been accomplished in Bill C-14.

Another example I will provide is that the Carter family themselves have expressed concern with Bill C-14. However, the Minister of Justice, in her thoughtful remarks in this chamber, which I appreciated, suggested that both appellants would have been provided for with respect to their assisted death under Bill C-14. That is not according to the family. The minister had to use language relating to a condition that can become “reasonably foreseeable” of death. Therefore, even the distinction between the named plaintiff in this case, the position of the family and the people who advocated for them, is at odds with Bill C-14 and the position of the justice minister.

If anything shows the fact that there is already a slippery slope and a very difficult framework to set, I am concerned that this has been rushed and it will not defend and safeguard against the decisionally vulnerable.

Could Bill C-14 be improved or, if Parliament could take more time, could it address this issue that confronts this place with Carter? In my weighing of all of the issues, as I said, as a parliamentarian who tries to draw upon my own experiences, as everyone does in this place, I do not think Bill C-14 can do that. I still feel that the persuasively defended bright line accomplished in the Sopinka decision has not been met by Bill C-14. In addition, many of the concerns providing the slippery slope that the Supreme Court in Carter raised have not been addressed by Bill C-14 either.

However, I have appreciated people sharing their points of view on this important issue. Parliament should not fear important debates. Members should come here in a respectful and thoughtful tone.

[Adam Vaughan, Liberal, Parliamentary Secretary to the Prime Minister (Intergovernmental Affairs)]

Madam Speaker, putting aside the fact that we are under a deadline because of inaction by the previous Parliament and that an extension has already been sought at the Supreme Court, the issue that concerns me is this notion that people with psychiatric conditions, post-traumatic stress disorder, I think, was the issue raised, would be able to avail themselves far too easily of physician-assisted dying.

Does the member not reflect upon the provisions around requiring attending doctors or medical personnel to assess the psychiatric condition of the individual seeking this? Are those not the safeguards that would prevent an unfortunate circumstance from being pursued based on psychiatric conditions which were present when the request was made?

Are those safeguards not significant enough to prevent a mistake from being made and could they not be strengthened with further conversation in committee?

[Erin O'Toole, Conservative, Durham, ON]

Madam Speaker, even his framing of this, that mistakes can be made, sort of shows that it is very difficult for Parliament or any sort of regulatory regime, or the professions themselves, to set certainty. In fact, one of my main concerns with Bill C-14 is that it essentially kicks the issue back to the courts by using a reasonable foreseeable standard, which is kind of the linchpin of our common law.

When it comes to the case of a veteran with PTSD, there is no reasonable foreseeable end to that person's life at all, provided there is proper intervention. I have talked to military members, lower ranks and higher ranks. When the black dog, as Winston Churchill described it, hits people, they do think their own only option is to end their lives. However, I have met veterans who are now helping dozens of other veterans because they have found a path to wellness through a whole variety of programs and have made the decision to err on the side of help and not on the side of tragedy.

The very fact that the special committee put mental injuries, many of which can be treated, in the framework for euthanasia shows how difficult it will be to find the right balance.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, I want to underline that there has been some discussion here about psychological suffering. The legislation very clearly includes psychological suffering as a criterion and subsection 241.2(2) talks about physical or psychological suffering being a criterion. The member, quite rightly, illustrates how having these provisions could create a more permissive environment for suicide more generally. We have heard his concerns about veterans. The member for Winnipeg Centre has spoken quite eloquently about the effect of some of this in the aboriginal community.

Would the member agree with me that we should simply remove the reference to psychological suffering from the legislation? It would be cleaner and clearer if we were to talk specifically about physical suffering and would not create some of these problems that he and others have raised.

[Erin O'Toole, Conservative, Durham, ON]

Madam Speaker, I would like to thank my friend and learned colleague who has provided a lot of perspective on this. That one issue needs to be addressed at committee or immediately with respect to Bill C-14, because it shows that already the legislation and the framework is flawed.

Going back to my earlier comments, this is a difficult circumstance, where, as parliamentarians, we are faced with compassion on both sides of the issue. Provided we have shared time between the member for Thornhill and myself, who may disagree on the final elements of what we see missing in Bill C-14, it shows the gravity of this decision, why we should have this debate, and why more members should be here to share their personal views with respect to concerns on either side.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

We are now at the five-hour mark for this part of the debate. Now we are going to the 10-minute debate and 5 minutes of questions and answers.

Resuming debate, the hon. parliamentary secretary to the Minister of National Defence.

[John McKay, Liberal, Parliamentary Secretary to the Minister of National Defence]

Madam Speaker, I was quite encouraged by the previous two speakers and their internal discussion on this issue. It does show that within parties, and I know within our party, there is considerable debate about this issue.

I found trying to assemble my thoughts to be quite difficult as it does go to the heart of our beliefs, our values, and our experiences. Sometimes, frankly, they are not reconcilable beliefs or values.

First, I take the opportunity to compliment the government on allowing a free vote. That is particularly important on this side of the chamber. In a debate such as this, it is very important that members feel complete freedom to speak freely, to vote freely, and to, as much as possible, minimize the partisan jabs that go on in this place. Because this is a free debate and a free vote, it actually strengthens this vote. It is, after all, important that we reflect the consensus of Canadians. They put us here, and they are the ones who we are to reflect.

In this perpetual dialogue between Parliament and the court, it is important that we establish a standard of deference for both institutions, both of which are critical to our freedoms and our democracy. Because this is a free vote, I believe it will therefore strengthen Parliament's expression on Bill C-14.

Some have said today that this decision flows from the Carter decision, and indeed Bill C-14 before us is a response to that decision. However, I would argue that the debate predates Carter by at least several decades as Canada unwinds itself from its Judeo-Christian heritage.

The sixth biblical commandment says simply “thou shalt not kill”. One way or another, it has formed the basis for our legislation and our jurisprudence for the last 4,000 years. In religious and secular terms, it is the doctrine of the sanctity of life.

The last time the Supreme Court dealt with this issue was, as has been mentioned many times, in the Rodriguez decision. At that time, Mr. Justice Sopinka spoke for the majority when he said, “This argument focuses on the generally held and deeply rooted belief in our society that human life is sacred or inviolable.”

He then goes on to reference section 7 of the charter and states that it is rooted in “the profound respect for the value of human life”, which is the right to life and the right not to be deprived therefore except in accordance with the principles of justice.

My own views, frankly, parallel Mr. Justice Sopinka, and in part explain why I do not support capital punishment. The reason I do not support capital punishment is that so often we get it wrong. Similarly, my views are pro-life, which I know is a minority view. I try to be, in my own philosophical way, as consistent as I can be.

What has happened for the justices to do what is an about-face, and disavow their own decision? I know that some will say that the charter is a living tree, but still this is a very significant change of position and even a disavowal of their previous decision in a space of less than 25 years.

In my view, it is the rapidity with which Canadians have disavowed their Judeo-Christian heritage on the sanctity of life and have substituted a test of the functionality of life. Life has to be functional in order to have meaning. Life for its own sake, let alone being created in the image of God, does not meet the test of functionality.

I appreciate that images of people in great suffering are felt deeply by us all and, as the previous speaker said, there is compassion on both sides of this argument.

I do hope the government means what it says in the preamble:

And whereas the Government of Canada has committed to develop non-legislative measures that would support the improvement of a full range of options for end-of-life care, respect the personal convictions of health care providers and explore other situations?—?each having unique implications...

I would be distressed if this were mere lip service, but I have some confidence that the money set aside will in fact start to address some of the situations where people find themselves in end-of-life situations with very few, if no, alternatives. I think as we as a society age, this is going to become more and more of a critical issue.

However, concerns have also been raised by those who represent vulnerable communities and their concerns are legitimate.

Jurisdictions that have gone down the route of assisted suicide have, frankly, a bit of a spotty record. Once institutionalized, there seems to be upward pressure on the numbers and expansion of categories and cases which seem to fall outside of even the most generous interpretation of the law. It is perfectly understandable that there will be expansionary pressure. Indeed, it is a certainty that those who want individual autonomy as the value that is above all other values will challenge this legislation. That is a guaranteed certainty.

However, for those who cannot speak for themselves or for whom consent is problematic at the best of times, there is a worry that the categories of “assistance” would be expanded. I know this sounds like a slippery slope argument, and that is only because it is.

There is an absolute certainty of judicial challenge, regardless what the Government of Canada puts forward, how this Parliament votes and possibly explains the reluctance of the previous government to engage.

While I support Bill C-14 as the best that could be offered up under these circumstances and therefore will vote for it, I would have liked to have seen a couple of other measures included.

First, I would have liked to have seen a panel approach, rather than the one that is offered up. In Ontario, we have declarations of medical competency. It is based upon a panel of one doctor, one lawyer, and one other.

It makes sense to me that leaving the process exclusively in the hands of health care professionals will inevitably create a bias to the questions doctors ask about health concerns rather than procedural concerns, consent concerns, and ethical concerns which lawyers, ethicists, and others focus upon.

It seems to me that if a panel of mixed professionals is required for mental health competency, which is after all a reversible decision, then a panel of three mixed professionals should be the norm in a decision that is not reversible. It also may go a long way to alleviate the concerns of “doctor shopping”. It would lead also to a consistency of approach across the country.

The second measure is conscientious objections. I have heard the argument that no health care professional can be compelled to participate, and it might even be true. I think we can solve that quite easily by simply stating that explicitly in the legislation.

Finally, there has been a lot of negative commentary about the right of religious groups to comment on this bill. It might be pointed out that rabbis, imams, pastors, priests, nuns, and so on, have literally sat at bedsides millions of times as people have passed. They have every right to give their opinion and they bring with them literally thousands of years of experience.

I would like to finish with a quote from Jean Vanier, which I obviously will not get to, but I know you will want to hear in the response to questions, Madam Speaker.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Madam Speaker, the member made some very insightful remarks. I certainly agree with him on many of the points he made in terms of how Bill C-14 needs to be improved, the panel oversight, some protections for conscience rights, and those kinds of things.

My question relates to the legal profession. I am not a lawyer, so I will ask my colleague who is a lawyer. He commented that in the Rodriguez decision in 1993, the Supreme Court decided that the social good was of higher importance than relieving the suffering of one individual. That ruling was affirmed again in the Latimer case in 1997.

I wonder if my colleague would comment on what he thinks changed in terms of the law that created a situation where the Supreme Court would reverse itself on a fundamental issue when from my perspective, I do not see that any laws have changed.

If he has time, I would love the hon. member to give the Vanier quote.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Madam Speaker, I am not sure the law has changed all that much. I do think societal conditions have changed, and I think there is a value shift that is going on from a communitarian view of life to a personal autonomy view of life. I think that actually is expressed by Jean Vanier, a philosopher, a theologian, a humanitarian, the founder of L'Arche, and a former Royal Canadian Navy officer, who said:

A society which discards those who are weak and non-productive risks exaggerating the development of reason, organisation, aggression and the desire to dominate. It becomes a society without a heart, without kindness—a rational and sad society, lacking celebration, divided within itself and given to competition, rivalry and, finally, violence.

I do not think we are there, but frankly, those are concerns that have been expressed and I think they are concerns that bear being listened to.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Madam Speaker, one of the concerns we have as New Democrats is the issue of finding a balance on this legislation.

It was put forward and put upon the House by the Supreme Court. It has laid down a set of rules that we have to respond to, but if we are to move in that direction, the obvious question is, where are the standards for palliative care across this country?

There are many areas under provincial jurisdiction, but the federal government plays an important role in the delivery of health care and the federal government also has a major responsibility in areas of its own jurisdiction, and we have seen a lack of action.

We moved through the last Parliament a national palliative care strategy, but we saw no movement from the government in the budget. We are now hearing on this day that we are discussing medically assisted death that they will come forward at some point with all kinds of money, but there is nothing there now.

We have Motion No. 46 that will be coming before the House about establishing a coherent national palliative care strategy, working also to improve the EI benefits for caregivers so that families are given support, and also calling on the federal government to establish standards under federal jurisdiction.

I ask my hon. colleague what he believes the role of this Parliament is on moving forward with palliative care at this important time.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Madam Speaker, I thank my hon. colleague for his work in the last few months with the people in Attawapiskat.

He puts the question in a very pointed way. We are in a bit of jam. We have a limited time frame in which to actually pass legislation which affects the Criminal Code.

When the Minister of Health answered a similar question in question period earlier today, she said that she is absolutely committed to putting forward a palliative care strategy. I am prepared to accept her at her word. Knowing her personally, knowing her personal background, knowing her integrity, I am perfectly at ease with accepting her word on this and her seeking out funds in order to put money behind that strategy.

I think the hon. member has raised a pretty legitimate issue, and we would all be a lot more comforted if we were doing this legislation in the context of a tabled palliative care strategy.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Madam Speaker, Canada is a secular state, but we are not, however, an amoral state. Our morality is defined in the shared set of values that sustain our pluralism, and our freedom of speech enables civil society to explore and frame what we define as right and what we define as wrong.

The law and policy that parliamentarians set also have the effect of shaping social norms. In this, I ask my colleagues in considering this bill to consider our responsibility as parliamentarians in defining the morality of our country. This is a sacred connection between us and the Canadians we represent.

The introduction of the Canadian Charter of Rights and Freedoms guarantees certain political rights to Canadian citizens and civil rights of everyone in Canada from the policies and actions of all areas and levels of government. It also greatly expands the scope of judicial review in Canada.

The Supreme Court of Canada ruling on physician-assisted dying, or the Carter ruling, touches the core of our nation's morality in that it discusses the sanctity of human life and how we should, as a nation, best respect it. It places the onus on Parliament to respond with a new legislative framework to address the issue of physician-assisted dying per the scope of the ruling. It also places an onus on Canadians to actively participate in one of the most transformative debates that Canada has had in a generation.

The Minister of Justice, in her speech on this bill, stated:

From the start, we have known from the Supreme Court of Canada's unanimous Carter decision, that it is not about whether or not to have medical assistance in dying; it is about how we will do it.

I disagree.

The debate in this place that the Carter ruling has spurred is about how we respond to the ruling, not simply how to allow physician-assisted dying to occur. This is material because the Carter ruling does not allow us to abdicate our responsibility to decide whether physician-assisted dying should occur or in what context it should be allowed.

To be clear, with this bill the government has chosen to respond to the Carter ruling by allowing physician-assisted dying to occur in the context defined therein. It could have responded to it in many ways, including the invocation of the notwithstanding clause of the charter.

My concern with the government's approach to the Carter ruling is multi-faceted, but particularly troubling to me is that much of its rationale for its response seems to be that the Supreme Court has forced Parliament to allow a framework for physician-assisted dying.

In this matter of deep concern and sensitivity to all Canadians with all viewpoints on this issue, this is not a sufficient enough explanation to show the government's intent over time as to how approaching broader questions related to physician-assisted dying should be addressed.

I say this not simply as an indictment of the government, but as a cause for reflection for us all. While the Carter ruling came out over a year ago, all of our political platforms and national debates were largely silent on approaches to this issue during the last federal election campaign.

While parliamentary panels and committees did a remarkable amount of work in a short period of time, similar legislation in Quebec took nearly six years of public engagement to draft and pass, and even then, Quebec's National Assembly was divided.

There are issues the government has touched upon in relation to the Carter ruling which I do not believe Canadians have given us a clear mandate to legislate upon.

I also believe that the bill in its current state would leave provincial legislatures and medical associations with unresolved legislative issues leading to a balkanized patchwork of legislation and processes related to this issue.

While I appreciate that the government must respond to the Carter ruling in a shortly defined period, I am concerned that the government has not clearly specified its preliminary positions on many issues raised in the joint committee report and in tone has resigned itself to the inevitability of future charter challenges on this legislation.

In this context, I respectfully urge my colleagues here and the government to deeply focus upon our responsibility as parliamentarians to respond to the Carter ruling with firmness and clarity and to do the following.

First, change the timing of the parliamentary review of this legislation to two years after coming into force as opposed to five years, and to develop a strategy to actively engage a wide range of Canadians in this discussion.

This would promote us as legislators and our electorate to embark upon a fully informed discussion on how to best provide end-of-life care and ease of suffering to Canadians, with the hope of engaging more Canadians on issues that arose in the joint committee report, which I do not believe we have a clear mandate to legislate upon and are beyond the scope of Carter. This early review would also allow Parliament to assess the efficacy of the government's proposed safeguards. The review of this legislation should also be held on a regular, as opposed to a one-time, basis. The requirement of an annual report to Parliament regarding the government's response to the Carter ruling would also be helpful.

Second, the government has signalled the need to study issues of use of advance directives in physician-assisted dying, availability of physician-assisted dying to mature minors, and the definition of conditions beyond the scope of the Carter ruling under which physician-assisted dying would be available in the future.

To date, the government has not described the framework, the timing, nor the scope under which these studies would occur. This needs to be rectified immediately, hopefully with the input of members from a broad range of the community. Further, the government should commit to taking policy responses to these issues to the electorate before allowing them to come to pass.

Third, the bill is silent on direction regarding conscience rights of medical practitioners and faith-based care facilities in being required to provide physician-assisted dying to patients. In this, we are forcing the issue to be decided by provincial legislatures and by medical associations. This silence is an abdication of our responsibility to the electorate, as the Carter ruling clearly outlines the need for Parliament to respect the charter rights of both patients seeking physician-assisted death and the conscience rights of health care providers. I also have concerns regarding the selection of a panel approach to approval, as opposed to the way the bill currently outlines the selection.

Fourth, I am concerned the government's response to the Carter ruling to date is simply this bill. This fails a significant component of the Carter ruling. The ruling in its conclusion relies upon the assumption that a legislative framework allowing physician-assisted death would ensure that physicians properly inform patients of their diagnosis and prognosis and the range of available options for medical care, including palliative care interventions aimed at reducing pain and avoiding the loss of personal dignity, prior to allowing physician-assisted death to occur. In this, I believe Canadians have the responsibility to ensure that the range of options available to patients in this situation is robust and in every situation enables people to lessen their suffering while living.

In saying this, I in no way diminish the legitimate right for patients to choose the path of their end-of-life care. However, our country will have failed them if our response to the Carter ruling simply focuses on legislative mechanisms to allow physician-assisted death to occur rather than also placing a significant new emphasis on increasing and improving the range of available options for patients facing grievous and irremediable medical conditions.

Our response should also be clear about the limitations we would place on further expansions to the scope of access to physician-assisted dying. This includes a formal response from all levels of government, civil society, non-governmental organizations, Canada's faith community, and individuals to talk about and address the following: the mental anguish those facing grievous and irremediable medical conditions experience; how to support those who provide care to those who are suffering; reducing barriers to access to end-of-life care, including isolation, availability, and cost; reducing the stigma of mental health issues in Canada, and providing care and compassion to those facing this issue; ensuring a culture in which suicide is normalized does not arise, and ensuring strategies for suicide prevention are prioritized; ensuring that medical professionals have robust and comprehensive training on end-of-life care; developing and funding a comprehensive palliative care strategy to be implemented at the same time the bill comes into force; ensuring that physician-assisted dying does not evolve in our society as a promoted response to a diagnosis of a grievous and irremediable medical condition; and engaging research institutions and granting councils in a discussion on how to fund and manage research related to end-of-life care, and ensuring that what we have learned is effectively translated into public policy and clinical practice.

This discussion should not be treated as static, and a mechanism to address the success of programs and initiatives, in coordination with provinces and territories, health care providers, civil society, and the public at large, to address these issues on a regular basis should be immediately implemented.

Our collective response must first and foremost come from a place of compassion for those who are suffering. Our response must recognize the spirit of the Carter ruling in that Canadians ultimately have the right to choose their path of care.

However, we cannot abdicate our responsibility to respond to these issues to the courts or to other levels of government, nor should we see a legal framework in which physician-assisted dying occurs as a comprehensive response to the Carter ruling. Instead, we should ensure that our response is comprehensive, is clear and thoughtful, and is backed by a mandate from Canadians. Our covenant with our electors and the respect for the sanctity of life demand nothing less

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, I listened attentively to many of the comments the member made. There were several ideas which ultimately have a lot of validity. I have listened to the debate today, and she and other members have been very willing to share their many opinions on the legislation and justifiably so.

We have been fairly clear about wanting to get the legislation to committee. We are all very much aware of the Supreme Court of Canada deadline which is looming.

I would ask if the member would at the very least recognize the importance of getting the legislation to committee, where members like herself and others could share their thoughts on how they might improve the legislation. At the same time, they could provide Canadians from different parts of our great nation the opportunity to provide direct input to our standing committee.

Would she not support getting the bill to committee as soon as possible so we could actually get that feedback, especially given the deadline from the Supreme Court of Canada and the fact that we also have to get the bill through the Senate of Canada?

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Madam Speaker, while I appreciate that the government does have a timeline in which to respond to the Carter ruling, I also find its response to be lacking for the reasons that I have outlined in my speech.

[Pierre-Luc Dusseault, NDP, Sherbrooke, QC]

Madam Speaker, I thank my colleague for her speech.

However, how can she tell the House that it is not our duty to abide by this ruling and to grant this right? The court stipulated that medical assistance in dying is now a right guaranteed by the Canadian Charter of Rights and Freedoms.

As legislators, how can we refuse to grant a right that was confirmed in the Supreme Court decision?

What does she want us to do if she does not want us to abide by the court's decision and understand that this is now a charter right that must be granted to all Canadians?

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Madam Speaker, as I outlined in my speech, the options afforded to us as parliamentarians with regard to a Supreme Court ruling are many. The government has chosen to respond with this bill and I do not feel that the government has responded adequately in terms of providing a concurrent framework on palliative care outlining how. For example, the Liberals talked about studying an expansion of the Carter ruling in terms of situations in which physician-assisted dying would occur.

I believe it is incumbent upon the government to clearly communicate this prior to a vote happening in the House of Commons. I do not think it has done that to date. I certainly think there is a little more work to do on this before it is an adequate response to the Carter ruling.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Madam Speaker, my colleague has outlined many of the concerns that many of us in the House have. Throughout debate today we have heard government members assure us that conscience protection is included in Bill C-14. I do not share that optimism because it do not see it here, other than in the preamble, and it is actually along with the intention to expand physician-assisted dying to minors and people with psychological issues. That is a pretty weak commitment.

My bigger concern is that the bill is totally silent on protection for health institutions. We know that many hospices in Canada have been started with the express purpose of improving the quality of life for those approaching end of life and many of them are supported by very generous donors. If we are to insist that those institutions now need to participate in physician-assisted dying, I have concerns that we will end up losing a lot of health care facilities in our country. I am wondering if my colleague would share any comments on her views on protection for institutions.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Madam Speaker, the Carter ruling is quite clear in the need to acknowledge both the charter rights of patients in choosing their end-of-life care and the charter rights of medical practitioners. I do not believe that the bill has adequately done that. It will leave it to the provinces and medical associations, and I feel this is an abdication of our responsibility as parliamentarians.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Madam Speaker, I appreciate this opportunity to discuss the Government of Canada's commitment to establish a framework for medical assistance in dying.

On April 16, I hosted a town hall meeting for the residents of Don Valley East on this matter. As we know, this is a very emotional and personal matter. It was important for me to listen to my constituents' concerns and to ensure that their concerns were heard. Some of my constituents wanted dementia and Alzheimer's to be included, others wanted advance directives, and some wanted protection for the vulnerable.

In order to ensure that there is no confusion on what this bill is all about, I am taking this opportunity to speak on the matter.

Being part of the Abrahamic tradition, I had to park my own beliefs and listen to my constituents and ensure, as a parliamentarian, a balanced approach. Some of my constituents thought that this bill does not go far enough. Others felt that we should not allow it. To help my constituents have a say in this matter, I have asked them that when this bill goes to committee to make a submission to the justice committee.

The Supreme Court of Canada's decision in Carter has significant implications for provincial and territorial governments, and touches many Canadians in a very personal way. A number of individuals have already been granted exemptions by provincial superior courts to access medical assistance in dying. This is in keeping with the conditions set out by the Supreme Court's decision to extend the timeline for its ruling to come into effect to June 6, 2016. It is now time for us to establish a legislative framework for medical assistance in dying to legally become part of the options available to Canadians at their end of life.

Bill C-14 would provide Canadians with greater autonomy over their health care at the end of life, while also providing protection to health care providers and to individuals who may be vulnerable. It would provide provinces and territories with a strong foundation for implementation.

Canada is not the first to implement medical assistance in dying. In Europe, for example, three countries have legislated access to medical assistance in dying: Belgium, the Netherlands, and Luxembourg. In the United States, four states have legislated access.

Where Canada is unique is in the jurisdictional complexities we face. In Canada, the federal government has exclusive jurisdiction over criminal law. However, health care is a shared jurisdiction between the federal, provincial, and territorial governments. Primary responsibility for the provision and delivery of health care services rests with individual jurisdictions. The provinces are responsible for hospitals, the delivery of health care, and regulation of the medical profession, among other things.

As provinces and territories bear ultimate responsibility for the implementation of medical assistance in dying, the scope of the federal legislation has a significant impact on them.

That is why our government has been working collaboratively across governments, while at the same time respecting jurisdictional roles and responsibilities.

When health ministers met in January, they came to an agreement that a robust and consistent regime across the country is in the best interests of Canadians. Health Canada has also engaged in ongoing discussions with health officials in the provinces and territories to hear their views on many aspects of this important issue.

By establishing national eligibility criteria and safeguards, this bill will help ensure consistency across the country as well as respect the underlying criteria of the Canada Health Act.

The proposed legislation will set out who is eligible to receive medical assistance in dying and the safeguards that must be adhered to for medical practitioners to be protected from criminal responsibility.

Provinces and territories cannot modify these Criminal Code exemptions through their own legislation or regulations.

However, the provinces and territories can legislate or introduce policy measures with respect to aspects of medical assistance in dying under their jurisdiction. This could include identifying any special training for offering medical assistance in dying, specific forms to be filled out, or how the cause of death should be recorded.

However, in order to respect the principle of accessibility upheld in the Canada Health Act, provinces, territories, and regulatory bodies would need to consider the implications that any additional guidelines or regulations would have for patient access.

The bill gives the Minister of Health the authority to make regulations about the information to be collected and the processes for collecting it. Working with provinces and territories will be critical to determining how a pan-Canadian monitoring mechanism can be put in place, the types of information to be collected, and the reporting requirements among other elements.

In reviewing the bill, I see that the government has taken into account the concerns of some health care providers; that is, the protection of their conscience rights. The Supreme Court was clear that providers should not be compelled to provide medical assistance in dying. However, the government is also aware that the exercise of such rights may constitute a barrier to access for those who are seeking it.

To address these issues, the government will work with provinces and territories to support access to medical assistance in dying, while respecting the personal convictions of health care providers. This could include, for example, a pan-Canadian system that would facilitate access for patients to willing providers of medical aid in dying.

Throughout the consultations on medical assistance in dying, we heard loud and clear from Canadians calling for more resources for quality palliative and end-of-life care.

With Canada's aging population as well as growing rates of chronic disease, we must consider ways to support the improvement of a full range of options for end-of-life care. This includes better integration and expansion of access to services at home, including palliative care.

Medically assisted dying is a complex and important issue for Canadians and requires collaboration across jurisdictions to ensure that we have a framework that fits within our uniquely Canadian context.

I would therefore like the bill to go before committee where our collective thinking and robust consultation will hopefully result in a better bill, which is satisfactory to all. I think the bill at least provides a foundation for our continued collaboration.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, I enjoyed listening to the member's speech. She did something interesting at the beginning where she referenced her personal religious beliefs coming from the Abrahamic tradition. We have heard a number of Liberal members reference their personal religious beliefs, but then also say that they are going to have to in some way park those beliefs.

When I think about the relationship between faith and reason, I am often drawn to think of one of Plato's dialogues called Euthyphro and I would commend it to the reading of hon. members. It discusses the question of the origin of goodness; in particular, is a thing good because it is declared so by religion, or is a thing declared good by a religion because it is intrinsically so? I think most of us would agree that religions declare things good or bad because they are so intrinsically. They do not render a thing good or bad by declaring them so.

It is one thing for the member to ignore religious convictions, but it is another to ignore the underlying realities and truths that those things express.

I want to ask the member to further comment on that dynamic. I want to ask her if she believes in the universal immutable human dignity as a reality, not just as an arbitrary confession. Does the member believe that to be a reality and will that be expressed in the vote she makes on the bill?

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Madam Speaker, for me and for the religious beliefs of all of the Abrahamic tradition, life is sacred. However, what we are talking about here is people who have unbearable diseases, and the Carter case is very clear. As people with religious convictions, we have to ensure that Parliament observes the laws of the land and observes the Charter of Rights and Freedoms. My assessment is that, if we are to move forward with this bill and help our constituents and Canadians live with dignity, we should let this bill go before committee and listen to other concerns and then come up with a robust bill.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Madam Speaker, I have been listening with great interest, and this is a profound discussion that we are having tonight. The issue in terms of what people are able to access at end of life has been put before this House, not simply because of the Carter decision and not because of, as some colleagues have said, a narrow rewriting of the legislation. However, if we are going to rewrite this legislation, we have to deal with the huge shortfalls in end-of-life care for those who are wanting to live—the palliative-care needs of the sick and their families. Yet only 16% to 30% of Canadians are able to access quality palliative care. Only four provinces even have a palliative-care framework. It is the responsibility of the federal government to work with the provinces, and also to put the money on the table to say that palliative end-of-life choices are going to be available. However, we saw zero money in the budget from the current government.

If this bill is going to be in place in June, we are going to be in a situation in Canada where people will have technically the right to end their life if they are facing intolerable suffering, but they will not also share the same right to access quality health care for their family if they are living in under-serviced areas and patchwork areas. I am asking why the current government has not stepped forward in advance of this legislation to start dealing with the huge shortfalls we are facing in palliative care.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Madam Speaker, palliative care is an important aspect. I believe, when I was doing my presentation, I made palliative care part of the comprehensive framework that we have to work with. There are cases in one of the states where it is the Cadillac version of palliative care. Those people who have the Cadillac version of palliative care are the first ones to want assisted dying. I do not mean to say that we should not have palliative care. It is extremely important, and choices are important. However, to have a robust and very strong bill, we need to send this bill to committee and work around it.