Debates of May 2nd, 2016

Criminal Code

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Mr. Speaker, the issue of access to medical assistance in dying is indeed crucial. Since it is a right, of course it must be accessible. That is why it is important to extend this capacity to other health care professionals.

When it comes to assessing eligibility for medical assistance in dying, physicians take care of that. The riding I represent is 50 kilometres from the nearest urban centre, and some of my constituents do not have access to a doctor. It is therefore important to allow other health care professionals to help people exercise their right.

[Wayne Stetski, NDP, Kootenay—Columbia, BC]

Mr. Speaker, I rise today to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts related to medical assistance in dying.

I support the bill at second reading. However, it does need to be amended.

I will start today with a story. Some years ago, my wife Audrey and I adopted a beautiful sable sheltie dog by the name of Princess Diana of Cornwall. She was named at a time when we lived on Cornwall Drive in Port Coquitlam, and the world was abuzz with a royal wedding involving two people named Charles and Diana.

Princess was a great dog. Unfortunately, when she was about 11 years old, she developed cancer. We were already living in our current home city of Cranbrook, located in the Rocky Mountains area of British Columbia. As the cancer progressed, Princess was living with more pain and discomfort. We consulted our local vet regularly. One day he told us that she was terminal and in a lot of pain and he thought the best thing we could do for her was to end her suffering. He asked us to bring her back the next day. We took her home to say our goodbyes, and the next day I brought Princess back to the veterinarian. He asked me if I would like to leave her with him or whether I would like to stay. I said I would stay. I held her in my arms and watched the needle go into her paw. She lay down and died in my arms. As I stood there with tears in my eyes, I thought that if I were ever in intolerable pain from an incurable disease, this is how I would want to leave this world, with a needle in my paw, lying in the arms of someone I love. I personally became a believer in physician-assisted suicide right there 20 years ago.

I am not suggesting that the death of a pet and that of a human are equivalent, though they certainly can feel much the same, as many who have loved a beloved pet will know. We need to take even more care that we have it right when we are talking about euthanasia through a human lens.

As members know, in February 2015, a unanimous Supreme Court ruling established the charter-protected right of competent adult Canadians who are experiencing enduring and intolerable suffering as a result of a grievous and irremediable medical condition, including a disease, disability, or illness, to access medical assistance in dying. We in the NDP are committed to implementing the Supreme Court order decision with balance and sensitivity, respecting the autonomy of patients, the rights of health care practitioners and vulnerable individuals, and the fundamentally personal nature of this issue to every Canadian; in other words, we need to get this legislation right.

Last week, when I was back in my riding of Kootenay—Columbia, I met with Bendina Miller, the past president of the Canadian Association for Community Living. The CACL was one of the main supporters of the vulnerable persons standard, the purpose of which is to protect the vulnerable in Canada, as Bill C-14, medical assistance in dying, moves forward. While the CACL believes that the bill in its current form takes appropriate steps toward addressing the vulnerability of people living with a disability, it believes some improvements are required to meet the Supreme Court's intent that the legislation must provide fair access to assisted death and also protect vulnerable persons who may be influenced or induced to use the system to die.

The Canadian Association for Community Living recommends five areas of substantive amendment to this draft bill. I will summarize them here.

First, Bill C-14 should be amended to extend the current requirement for judicial oversight until such time as a study of the merits and implications of the bill allows them to be clearly understood.

Second, included in the bill should be an explicit legal requirement to identify, explore, and record the sources of a person's suffering, and an attempt to address the motivations of his or her request for death.

Third, Bill C-14 should be amended to meet the requirements of the Carter decision and should specify that a voluntary request for medical assistance in dying cannot be made as a result of external pressure or any form of inducement.

Fourth, Bill C-14 should be amended to specify that the minister “will” make, not “may” make, regulations regarding the mandatory reporting of information about requests and the provision of assisted dying.

Fifth, it should mandate a palliative care or other professional evaluation to ensure patients' rights to informed consent by having information about the full range of available treatments and supports that could ease their suffering.

The bill should not proceed without an enhanced national palliative care strategy, which is clearly missing in the Liberal government's 2016-17 budget.

Back in November, I had the pleasure of meeting new members of Parliament from all of the parties represented here in the House, except the Green Party. I was struck by how consistent the words were from all of my colleagues. They said they were here to work collaboratively to build a better Canada. It was very encouraging for me as a new MP, because that is also why I am here.

When I am back home in my riding sharing with my constituents what we are doing here in the House, I tell them that we are working on three bills in particular that would fundamentally change Canada, going forward: first of all, proportional representation voting; second, legalizing marijuana; and third, physician-assisted suicide.

This is the first of those three bills to come to the House for debate and further study, and we need to work together collaboratively to build a better future for Canadians. The bill would do three things: maximize one's willingness to live through expanded palliative care, ensure that our vulnerable citizens are protected, and give our citizens the Supreme Court assured right to choose to die in the arms of someone who loves them, if they are experiencing enduring and intolerable suffering as a result of a grievous and irremediable medical condition.

Let us amend the bill collaboratively and give Canadians the best possible outcome on this very important and emotional issue.

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

Mr. Speaker, I thank the member for his considered remarks to the House, but I did not hear a reference to the notion or the concept of advance consent. I am curious as to whether he has thoughts on that issue and how those concerns may be addressed in the parliamentary process as this bill moves through committee.

Clearly, some of the other areas we understand as areas that need to be questioned and explored by committee. We accept that and think it is a good legislative process. However, I did not hear those remarks, and I am interested to hear the member's thoughts on that.

[Wayne Stetski, NDP, Kootenay—Columbia, BC]

Mr. Speaker, absolutely, I think that is missing from the current version of the bill. I think it is really important to give Canadians the opportunity for an advance declaration of what their wishes are, particularly if they know their disease is leading to a condition where they will not have the ability to make that decision themselves later on. Therefore, I do think that should be in the bill.

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

Mr. Speaker, I want to pick up on the question of advance consent, because it has come up a number of times today.

What we heard from the special committee, at least from those who are involved in health care or represent those who are involved in health care, is that it is very difficult to have an advance directive about a very hypothetical situation in which a people do not actually know how they will experience what they will be going through. With an advance consent provision, one may end up with a situation where someone, who at the present time does not want to die, still has their life taken because of something they wrote down earlier, and they may be experiencing those events differently from how they expected.

I want to ask the member specifically with regard to sexual consent. We have a very clear understanding that a person cannot consent in advance. There has to be contemporaneous consent in the context of sexual consent. Therefore, why would we have a different and lower standard for someone consenting to die than for someone consenting to engage in sexual relations?

[Wayne Stetski, NDP, Kootenay—Columbia, BC]

Mr. Speaker, I really do not think it is a lower standard. If we have the opportunity to declare our intent ahead of time and put it in writing, that at least gives us some opportunity to have some say over our future. If we reach the point where we cannot consent and we cannot not consent, and then we have no options at all. Therefore, at least having an opportunity to declare our wishes ahead of time is an improvement over not having any choice at all.

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

Mr. Speaker, I really hesitated getting up to ask this question, but my colleague, and I respect him and his work, inferred some similarity between the loss of a pet and the loss of a loved one, a human. I have lost lots of pets over the last 60 years, and yes, I have shed some tears, and I have had this kind of experience. However, to infer that there is even a 1% similarity between losing a pet and losing a family member I think misses the point.

I watched my mother and dad approach death. I watched a brother, who lay unconscious for a month in hospital on life support approach death and die. Five years ago today, my wife suffered an intracranial hemorrhage and two days later passed away. However, not in one of those situations, not in one of them, would I have wanted to end their lives one day earlier.

We need to realize what suffering can teach us as we walk alongside those who are suffering and enter into their suffering. That is what it means to be human. My concern is that if we lose the drive to walk with those who are suffering and lose the commitment to actually do something about palliative care and provide good care for those who are suffering, we are really missing the boat.

I would like my colleague to comment on the lack in the budget of actual hard commitment to really get on with palliative care.

[Wayne Stetski, NDP, Kootenay—Columbia, BC]

Mr. Speaker, let me repeat what I said during my speech. I am not suggesting that the death of a pet and the death of a human are equivalent.

We need to take even more care that we get it right when we are talking about euthanasia using a human lens. I absolutely agree that palliative care is critical. We need to make sure that we have a national palliative care strategy to go along with this, but they need to go hand in hand if they are to move forward at all.

The story I told was what convinced me that if I had a choice, I would choose to die with dignity.

[Sean Casey, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Mr. Speaker, it is my honour to stand to speak in support of Bill C-14, a significant piece of legislation that would allow for the first time in Canadian history the provision of medical assistance in dying across the country.

I believe Bill C-14 directly and thoughtfully responds to the Supreme Court of Canada decision in Carter. This legislation would strike a careful balance between the autonomy of competent adults whose deaths are reasonably foreseeable to seek medical assistance in dying and the protection of vulnerable people through careful tailoring of the eligibility criteria and robust safeguards that are essential to prevent error and abuse.

As recognized by the Canadian Medical Association before the Special Joint Committee on Physician-Assisted Dying, one cannot underscore enough the significance of this sea change in Canadian medical practice and Canadian society as a whole.

At present, there are eight jurisdictions in the world, in addition to Quebec, that have adopted precise legal rules on medical assistance in dying: four U.S. states, Colombia, and the European countries of Belgium, the Netherlands, and Luxembourg.

The international community is is looking at Canada's leadership on this issue right now, and I commend all hon. members on both sides of this House for their invaluable contributions to this complex and sensitive debate.

Bill C-14 would establish the criminal law rules regarding medical assistance in dying that address issues including eligibility, procedural safeguards, and the framework for a pan-Canadian monitoring system. In addition to the comprehensive legislative response proposed in Bill C-14, the government would undertake independent studies into three key issues that the Supreme Court declined to address in Carter: eligibility for persons under 18, advance requests, and requests for medical assistance in dying solely on the basis of a mental illness.

Allow me today to provide all members with further clarifications on the eligibility criteria included in Bill C-14 and how they respond to the Carter ruling, a question that has been asked numerous times since the bill was introduced.

Under Bill C-14, medical assistance in dying would only be available to mentally competent adults: one, who have a serious and incurable illness, disease or disability; two, who are in an advanced state of irreversible decline in capability; three, who experience enduring and intolerable physical or psychological suffering as a result of their medical situation; and four, whose natural death has become reasonably foreseeable taking into account all of their medical circumstances and without requiring any specific prognosis as to the length of time that they have remaining.

I would emphasize that those are the exact words of the legislation, because there has been some incorrect reporting on what is actually required. It is also important to remember that the criteria must not be read in isolation. Each element mutually informs the meaning and scope of the others. They work together to create a clear picture.

Some people wonder what reasonable foreseeability of death means given that everyone's death is reasonably foreseeable in the sense that death, like taxes, is inevitable for all of us. Bill C-14 expressly states that the person's natural death has become reasonably foreseeable, which clearly indicates that a change in the patient's medical circumstances is required. The patient is now on a path toward death, but previously he or she was not. A healthy person's death is not reasonably foreseeable unless the person experiences a change in his or her medical circumstances.

Mr. Speaker, at the outset of my remarks, I neglected to inform you, but I do now, that I will be sharing my time with the esteemed member for Fredericton.

The concept of reasonable foreseeability is also well known in law, and assessment depends on the context. In the context of medical assistance in dying, it would require a real possibility of the patient's death within a period of time that is not too remote from circumstances that can be predicted within a range of reasonable possibilities. Again, the legislation expressly states that a specific prognosis as to the time the patient has remaining would not be required. Because everyone's trajectory toward the end of life would be unique, this criterion was carefully crafted to provide maximum flexibility to medical practitioners so that they may assess the overall medical circumstances of a patient on a case-by-case basis. The overall medical circumstances, as opposed to any particular type of condition, are what matters when the objective is to give Canadians the option of a peaceful medically assisted death instead of having to endure a prolonged or painful one.

As recognized by medical standards and guidelines on prognostic indicators, there are many factors that may contribute to a patient's being assessed as approaching the end of life, including the presence of an advanced, progressive, and incurable disease, but also completely different factors, such as age, the general frailty of the patient, and risks of death from complications of other conditions that may not be fatal on their own, but which can jeopardize the life of someone who is otherwise weakened.

As recently recognized by the Canadian Medical Association, the requirement that natural death has become reasonably foreseeable would provide clearer guidance than the court's use of “grievous and irremediable” in that it would indicate , and I quote the CMA representative, that the condition should be “towards the end of the spectrum”, but does not mean “terminal or that death is immediately on the horizon”.

If we consider the Carter ruling itself, the Supreme Court expressly stated that the scope of its declaration was intended to respond to the factual circumstances of the case, and that it made no pronouncement on other situations where physician-assisted dying may be sought. Bill C-14 would directly respond to the factual circumstances of both Kay Carter and Gloria Taylor, who were both in decline and suffering while on a trajectory toward the end of their lives without it being certain when exactly they would die.

The Supreme Court did not define the term “grievous and irremediable medical condition”. It rather acknowledged that it was Parliament's task to weigh and balance the perspective of those who might be at risk in a permissive regime against those who seek assistance in dying. This is exactly what Bill C-14 does. It defines eligibility in a manner that is consistent with the Carter ruling read in its entirety, and provides necessary clarity on the assessment of eligibility.

Some have expressed concern over the lack of express protection for conscience rights of health care providers. The legislative objectives of Bill C-14, which are clearly stated in its preamble, include respecting the personal convictions of health care providers while also recognizing the provinces' jurisdiction over various matters related to medical assistance in dying. Balancing the interests of medical practitioners and those of patients is such a matter. Importantly, nothing in Bill C-14 would compel health care providers to provide any assistance that may be contrary to their conscience rights. More important than legal protections in a statute book are the concrete and practical actions that are directly aimed at supporting conscience rights of practitioners. In this regard, the Minister of Health has offered to work in collaboration with the provinces and territories on the development of an end-of-life care coordination system to help respect the providers' conscience rights while facilitating patients' access to care including assistance in dying.

Some have expressed concern that the safeguards in the bill are not sufficient. The proposed safeguards are generally consistent with and perhaps even a little stronger than the safeguards found in other medical assistance in dying regimes around the world.

The trial judge in Carter considered voluminous evidence on the efficacy of these regimes, and the evidence persuaded her that the risks to vulnerable people could be adequately managed under such systems. We are equally confident that these safeguards would guard against abuse and error.

I believe the proposed legislation is the right way forward on medical assistance in dying for Canada at this time and is a principled response to the Carter decision. I would urge all members to support second reading of Bill C-14.

[Martin Shields, Conservative, Bow River, AB]

Mr. Speaker, I appreciate the presentation on the debate today. One of the areas I am concerned about with the bill is that in rural Canada it can be a challenge to identify two physicians or two nurse practitioners. Outside the large urban areas there are a smaller number of doctors and often not even a nurse practitioner. Even if we had those four, it would quickly become identifiable who those people were, and that could be a severe challenge in rural communities. The only other alternative then is referrals. Again, those are the people who become the referral that people go to.

That is a question I have with this legislation. I am very concerned about the limited number of medical people who would have to be involved in this process outside the major urban centres.

[Sean Casey, Liberal, Charlottetown, PE]

Mr. Speaker, it is that very concern that was borne in mind when the decision was made to extend the exemption with respect to medical aid in dying to nurse practitioners. We see more and more in the country, with doctors being abundant in major centres and not so much outside of major centres, that much of the load has now fallen to nurse practitioners. That is the very reason why they are included.

Access is important with respect to any charter right. The member raises a very valid concern and the specific attempt to address it is with respect to the inclusion of nurse practitioners.

[Georgina Jolibois, NDP, Desnethé—Missinippi—Churchill River, SK]

Mr. Speaker, I have a question about access to adequate medical services and access to nurse practitioners or doctors. Where I come from, in my riding, most reserves and communities do not have that privilege when we talk about the national palliative care strategy. I am very concerned because where I come from we do not even have access to a nurse. How can the government ensure that we can have this meaningful discussion in a broader context to help people die with dignity?

[Sean Casey, Liberal, Charlottetown, PE]

Mr. Speaker, clearly, the last two questions point out the unevenness of access to medical services right across the country.

Today in Parliament we are debating an act to amend the Criminal Code. The government's response to the Carter decision was both legislative and non-legislative. The legislative measures are the ones we are debating now, but in terms of non-legislative measures, there is a commitment of $3 billion in home care, a significant part of which would be palliative care.

This legislation alone would not resolve the inequality in access to medical services across the country. We acknowledge that. It cannot do that. That is something the government has to continue to strive to accomplish through the negotiation of the health accord and through working with provinces for a palliative care strategy and for medical coverage in rural and remote areas.

[Nick Whalen, Liberal, St. John's East, NL]

Mr. Speaker, I would like to thank the member for his comments and reasoned commentary on this.

I had the good opportunity of having a round table last week with the Newfoundland and Labrador coalition of pensioners and seniors associations. To a person, they were favourable of the approach we have taken with this legislation. There was one issue that really hit to the crux of what they felt might be far enough or not far enough in the legislation. That was with respect to advance care directives. They also had a concern with respect to determining in advance whether or not one's condition would become intolerable. They were also concerned about the ability of provinces to have appropriate registries in place to handle that type of medical care.

I would ask the member if he agrees that this integrative approach of going incrementally toward medical assistance in dying is the proper way to go, or if he feels we should go even further at this stage.

[Sean Casey, Liberal, Charlottetown, PE]

Mr. Speaker, I thank the member for St. John's East for the question and also that he used part of his constituency week to consult with his constituents. That is extremely important. It is something that I did as well.

The government has clearly proceeded carefully. Given the compressed time frame that we were given by virtue of the inaction prior to the election and the deadline imposed by the Supreme Court, I believe that this is the prudent course. The preamble of the bill and the non-legislative measures indicate that there will be a further, more detailed, thorough, and more drawn-out examination of the more sensitive questions, and I think that is the best solution for Canada at this time.

[Matt DeCourcey, Liberal, Fredericton, NB]

Mr. Speaker, with the Supreme Court's decision in Carter, Canadians were given notice that medical assistance in dying would effectively become legal in Canada. It was, hence, the responsibility of the government to put forward clear rules around who is eligible to obtain medical assistance in dying, what safeguards must be followed to protect vulnerable individuals, and to create a monitoring regime to ensure accountability, transparency, and public trust in the system. Federal legislation was also important to ensure that a consistent approach to medical assistance in dying would be available across Canada.

Bill C-14 is the result of extensive consultation over the past year with individuals, groups, and experts at home and abroad. It takes into account a range of interests, including personal autonomy and safeguards to protect the vulnerable. It also recognizes the diverse and personal ways in which individual Canadians arrive at the question of medical assistance in dying. It balances individual rights and informed conscience, and respects the professional ethics and conscience of physicians and medical practitioners.

This legislation also addresses and proposes broad action on an aspect of end-of-life care where Canadians, regardless of their views of medical assistance in dying, have clearly indicated that they want action, chiefly, palliative and hospice care. I had the pleasure yesterday to take part in Hike for Hospice in sunny Fredericton and I am proud of the overwhelming support demonstrated by community members for such a worthy and important cause.

As we address an issue as delicate as medical assistance in dying, we cannot act without a full and intentional movement toward expanding all options of end-of-life care. The government has made clear that as part of a multi-year health accord, financial resources to improve home care, including palliative care, will be of primary importance. Also, as we launch Mental Health Week today in Canada, we must recommit our efforts to providing greater care and support for those suffering from mental illness and deliver on clinical and community-based approaches that will allow greater access to mental well-being for Canadians who suffer from mental afflictions.

On December 11, a Special Joint Committee on Physician-Assisted Dying was tasked with reviewing recent consultation activities. The committee also consulted with Canadians and stakeholders and made recommendations on the framework of a federal response to the Carter decision. The committee met 16 times, heard from 61 witnesses, received more than 100 briefs, and tabled its final report to Parliament on February 25.

I would like to extend my thanks for the work of the committee, as well as for the individual commitment demonstrated toward this issue from each and every committee member.

I, too, have heard from hundreds of people in the riding I represent, and have sought out wisdom and advice from leaders within the disability community who are calling for assurances that those with vulnerabilities will be safeguarded from outside influence in their personal decision-making; from the faith community, including trusted mentors and friends, who have encouraged me to reflect upon my own informed conscience in rendering a decision on this important matter; from the medical community, including leading voices, who have called for a sage and measured approach to the development of a framework around medical assistance in dying; and from those seeking a more liberalized approach, who may be dissatisfied with the framework that is proposed in front of us.

I have listened, I am listening, and I will continue to listen to people in the riding I represent. I have reflected, I am reflecting, and I will continue to reflect upon this important decision that will change the way Canadians consider end of life.

I approached this question like many others, with great humility, understanding that in a pluralistic society as rich and diverse as Canada's there will undoubtedly be those who feel that this legislation does not meet their world view. I wish to extend my empathy and understanding to them, and let them know that I, like all my colleagues, will continue to do my best for them.

I believe the ministers charged with crafting this legislation and the government as a whole have also approached this question with great sensitivity. The approach being taken is emblematic of a government that has listened to citizens, and will continue to listen to the wide diversity of opinion on this personal and challenging decision.

With this in mind, I wish to express my general comfort with the legislation before us. I would like to take the time to explain in greater depth the elements of the legislation and what it means for Canadians.

First, to allow access to medical assistance in dying in Canada, the Criminal Code would need to be amended so that doctors, nurse practitioners, and those who assist them can help eligible patients die without the risk of being charged with assisting a suicide or committing a homicide. There will also be safeguards to ensure that those who receive medical assistance in dying are eligible for it, can give their informed consent, and voluntarily requested assistance in dying.

A voluntary and informed request must be submitted in writing by the person in the presence of two independent witnesses, and a second medical opinion is required. No one aside from the person wishing to receive medical assistance in dying can make that voluntary request. This approach holds that the right to choose medical assistance in dying belongs only to the competent adult who would receive it. This is also necessary to protect vulnerable people.

A person who wants to access medical assistance in dying would have to meet the following criteria. They would have to be a mentally competent adult of 18 years or older. They would have to have a serious and incurable illness, disease or disability, be in an advanced state of irreversible decline of capability, and experience enduring and intolerable suffering as a result of their medical condition. They would, in effect, have to be on a course toward end of life. Death would have to be reasonably foreseeable.

The proposed legislation holds that mature minors would not be eligible nor would people suffering solely from a mental illness. The government is, however, proposing an independent study of the legal, medical, and ethical issues related to medical assistance in dying for mature minors, for those suffering from a mental illness, and around advance directives.

Again, the bill includes protections to ensure that patients are eligible and have given their informed consent. There would be a mandatory waiting period of at least 15 days, and patients could withdraw their consent at any time.

Also, there is nothing in the proposed legislation that would compel a health care provider to provide medical assistance in dying or to refer a patient to another practitioner.

The proposed approach to this most difficult of questions does its best to recognize individual choice for adults who are suffering intolerably and for whom death is reasonably foreseeable. It seeks to affirm the inherent and equal value of every person's life. It has the goal of protecting vulnerable people and reaffirms society's goal with regard to preventing suicide. It is an approach that recognizes where we are as a society and as a people advancing in the world. It is respectful of the divergent voices of Canadians and it demonstrates flexibility in its ability to reassess and examine the issue of medical assistance in dying in the weeks, months, and years to come.

I wish to thank my constituents who have reached out to me on this important matter and the many more who, I know, have wrestled with this question internally.

Know that this Parliament and I will do our collective best to serve each one's interests and those of their neighbours on this and on all important matters.

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

Mr. Speaker, this member and the previous member referred to the “flexibility” of this legislation. Flexibility may be a good quality to have at a dinner party, but it is not much of a virtue in the context of legislation. Flexibility does not help physicians who are going to have to look at this legislation and decide if something is legal or not. Let us not call it “flexibility”; let us be clear and call it “ambiguity”.

I wonder if the member would support at least clarifying the ambiguous criteria, because the more he talked, the less I understood.

He talked about death being “reasonably foreseeable” and said that one has to be on a course toward end of life. Again, we are all on a course toward the end of life.

What prevents the government from amending the legislation to actually, in a very basic and sensible way, define what we are talking about? Ideally it would put in the word “terminal”, because that is what is implied but not said—and if it is not said, then it is not in the legislation.

Could we get some clarity around what these things actually mean?

[Matt DeCourcey, Liberal, Fredericton, NB]

Mr. Speaker, I thank my colleague across the aisle for his question, although I would caution him to advance with some modesty in the commentary he uses to talk about this sensitive issue.

As I explained, I did have the opportunity to consult with medical practitioners, with leading voices, about where they saw this legislation fitting into what we needed to accomplish as a government in response to Carter.

My general reflection of these conversations has been that the medical field is, by and large, comfortable. Of course there will be those who will not see this within their own world view, and that is where the flexibility in this legislation exists: to ensure we meet the rights of those adults who are suffering intolerably to access medical assistance in dying while also recognizing the conscience of practitioners who will be providing the service.

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

Mr. Speaker, I listened with great interest to my hon. colleague. I think what is disturbing me in the tone of the debate today is that there is an impression being created by the Conservatives that somehow the great moral crusade here is to actually defy the Supreme Court ruling. The Supreme Court ruling made a decision that has really tied the hands of Parliament. I may not agree with how it arrived at it or I may not agree with the fact that it has limited our ability to consult with Canadians, but one thing I am very aware of is that this right already exists now. It is already being practised by the courts, and if Parliament does not frame clear legislation with clear limits, there will be a legal vacuum come this summer in which the fears that my Conservative colleagues are raising may well be much more realized by other parties who step forward and go to the Supreme Court to say Parliament has failed in its fundamental duty to act.

Given the constraints put upon us by the Supreme Court, I would like to ask my hon. colleague what he feels will happen if Parliament does not come up with this bill to meet the timeline of the Supreme Court and leaves that legal vacuum that would exist across this country?

[Matt DeCourcey, Liberal, Fredericton, NB]

Mr. Speaker, I think the best way I could reply is by explaining to my hon. colleague the advice that I have been given, again, from people in the medical community, people in the vulnerability community, and all those who have first-hand experience in trying to deal with end-of-life situations.

They have all impressed upon me the need for this Parliament to move with legislation that is caring, that is compassionate, that is smart, that recognizes in fact that the Supreme Court has already decided upon this issue, and that it is up to us as legislators, as parliamentarians, as leaders in our community, to come up with appropriate legislation that would best meet the collective interests of Canadians.

I cannot speak in specifics of what might happen, but I do know, in consultation with those who do have insight into vacuums in the legal and medical system, that it is not something we want to see here in Canada.

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, I will be splitting my time with the member for Durham.

I think it is important for Canadians to realize that the legislation before us is neither the alpha nor the omega in the continuing conversations Canadians are having about physician-assisted death. The Supreme Court forced this legislative moment on reluctant politicians with the Carter decision, but the conversation has been simmering, occasionally percolating, for decades in hospital intensive care wards, doctors' offices, around family dinner tables and at the bedsides of loved ones, from holy pulpits and at congressional retreats, medical schools and law schools, from theist philosophers and from the atheist sort. Most personally, the conversation has been conducted within ourselves, in our own minds, in both sickness and in health.

If the proposed legislation before us is neither the beginning nor the end of our ongoing conversation about physician-assisted death, what is it? Where exactly are we?

First of all, I think it is abundantly clear that we are definitely not where the Supreme Court told us to go. The legislation before us, which I believe will easily pass the House, and should as well the Senate, is only an interim step that will almost certainly very quickly lead us again to the Supreme Court.

The official opposition has set as its highest priority safeguards to protect the most vulnerable in society as well as the conscience rights of physicians and other health care professionals. We are pleased that the government accepted recommendations from the Conservative dissenting report from the special joint committee to exclude minors, to include stringent safeguards to protect those with underlying mental health challenges, and to recognize the risks involved with advance directives, which I will come back to in a moment. However, there are still concerns with the proposed legislation before us.

First, a point that has been and will be raised by colleagues many times, and I believe on both sides of the House, is the lack of specified conscience protection, an assurance that medical practitioners and institutions may decline participation in physician-assisted death. However, I do not believe that should be a problem, because I do not believe there will be a shortage of physicians willing to assist those patients who meet the criteria for assistance.

Also, there are the concerns, again raised by many of my colleagues, on the need for greater provisions for prior review, for consideration of underlying health issues, and for the effect of possible psychological disorders on patient decision-making. I believe those matters should be thoroughly reviewed again in committee.

As well, many of my colleagues have expressed concern with the extension of the Supreme Court's specific direction that physician-assisted death be performed by medical doctors to also include nurse practitioners. We know the government's logic in broadening the responsibility is to provide for remote areas where qualified nurse practitioners now carry out many of the services traditionally provided by MDs. Again, I believe the legislation needs more specificity in this area. I firmly believe that many nurse practitioners are qualified, capable, and willing, but perhaps the legislation should explicitly state that nurse practitioners be engaged only as physicians of last resort in circumstances where no medical doctor is available.

I also recognize the widespread concern and resistance to the vague nature of such phrases within Bill C-14 as “reasonably foreseeable”. I personally accept such imprecise conditions because I realize that as magnificent as modern medicine is today, prognoses regarding the time of a final breath or a final heartbeat are still often only educated guesses. This is certainly worthy of further examination at committee.

Finally, one of the most important shortcomings in convincing Canadians to accept Bill C-14 is in the government's unkept and—I will be perfectly frank—broken promise on palliative care.

The Liberals made a campaign commitment to invest $3 billion in long-term care, including palliative care. The importance of access to palliative care in end-of-life decision-making was one of the few unanimous points of agreement in the special joint committee's report.

We as parliamentarians can rush to meet the Supreme Court deadline of June 6, but at the same time, the government has a clear duty, a moral obligation, to put in extra effort to expedite fulfillment of that promise to expand the availability of accessible, affordable, acceptable palliative care for all of those who, for reason of conscience, faith, or choice decide not to avail themselves of physician-assisted death.

I firmly believe that choice must be extended, as I believe the Supreme Court clearly meant it to be in the Carter decision, to patients suffering from the specific diseases and conditions that formed the basis of the Carter decision: the brutally imprisoning final stages of spinal stenosis; the choking, smothering final stages of ALS; and the unrelieved pain of irreversible but interminably long final stages of progressive multiple sclerosis.

While I am on this point, I remarked earlier on the need to recognize the risks involved in advance directives for diseases such as Alzheimer's, dementia, and the like. That said, I believe advance directives must eventually be allowed in physician-assisted death.

I consulted with many individuals and groups in my riding of Thornhill in recent months and beyond. I greatly respect—profoundly respect—the advice and interventions of various faith communities, social agencies, and medical institutions and their concern over the need for greater protection of the most vulnerable.

My personal decision, which will determine my vote on this legislation, is a product of three individuals and their experiences. In my previous life as a journalist, I followed closely the unsuccessful legal crusade of Sue Rodriguez as ALS steadily increased its deadly grip and her rhetorical question posed to Canadians: “If I cannot give consent to my own death, whose body is this? Who owns my life?”

In the previous couple of Parliaments I became close with another thoughtful, courageous Canadian, a fellow member of Parliament, the Hon. Steven Fletcher, Canada's first quadriplegic MP, re-elected three times and just last month elected to the Manitoba legislature, who did not give up after his life-changing accident 20 years ago. He met immense challenges and he overcame them.

However, in two private members' bills tabled two years ago, which I seconded, and in testimony before the parliamentary committee this January, Steven made a powerfully convincing argument for self-determination to one day make a final decision. He said such a law would be based on an individual's own morals and ethics while stressing that there should be no pressure on that person from society, family, friends, or the institution they may be in.

I was also powerfully informed and persuaded by the tragically tortuous passing of my brother-in-law, Rik Davidson, a brilliant academic, through Alzheimer's. Should such an ending be diagnosed for me, I assure the House that an advance directive would be composed, and either under law or not, it would be fulfilled.

Finally, as a cancer survivor, I have had many hours of reflection, during treatment and since, to ponder the issues involved in this debate on a personal level. I am fortunate that modern medicine, faith, and an incredibly supportive wife and family have left me—for now—clear and happily continuing my late-life adventure as a politician.

I am honoured that I can participate in this debate to argue for the passage of Bill C-14, eventual broadening of this legislation's provisions, and immediate government action to expand palliative care facilities and services, because I passionately believe that the issue before us ultimately comes down to choice: the free choice of a competent adult individual to choose between accessible, affordable palliative health care and the constitutional right to physician-assisted death.

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

Mr. Speaker, the issue of advance consent or advance care directives was spoken to in the presentation to the House of the hon. member. My question is about how the timing in that regard could be spoken to in amendments to this legislation.

How would the hon. member see advance care directives provided at the age of 20 when the person will encounter difficulties maybe 30, 40, 50 years later? Alternatively, upon diagnosis of a situation and immediately entering into advance care directives, how would the hon. member model timetabling around that so as to review the person's decision before the ultimate act is pursued?

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, I thank my colleague for a very thoughtful question, one that has been asked many times in recent months as the Supreme Court deadline has loomed. There are a great many accounts written by Alzheimer's patients with significant medical and academic ability, who compose diaries from the time of diagnosis and their observations of steadily diminishing capacity.

There is a point, supported by an Alzheimer's patient in the final stages, and I would be surprised if they would allow that they themselves, even though they might be unaware, continue to that final stage. The burden on family, friends, and the medical institutions is overwhelming. The period of 15 days obviously does not work, but there are some worthy accounts which can be referred to. There was a great personal diary in The New York Times Sunday magazine a few months ago about an academic who was provided with mail order barbiturates from Mexico to be prepared when she realized she was in the last stages of fully controlling her life and her situation.

I think physicians and experts in this area could provide us with answers to the member's question.

[Michael Chong, Conservative, Wellington—Halton Hills, ON]

Mr. Speaker, I want to thank the member for Thornhill for his thoughtful views on the bill and for his personal stories relating to the bill.

In his speech, he mentioned that he did not believe the bill was compliant with the Supreme Court. Could he tell the House in what ways he believes the bill is not compliant with the Carter decision?

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, the reality is that the three parties to the Carter decision would not be assisted by Bill C-14. I listed the three conditions: spinal stenosis, ALS, and multiple sclerosis. All three of these particular afflictions would require additional legislative provision. I believe that is why the legislation will be back before the Supreme Court to order an extension of its provisions.