Debates of May 2nd, 2016

Criminal Code

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

Madam Speaker, a report in The Globe and Mail on April 24, 2016, says 13-year-old Sheridan Hookimaw killed herself on the banks of the river that winds through Attawapiskat. The sickly girl had been flown out for weekly medical appointments. She wanted to end her pain, and in the process, she set off a chain reaction not only in her community but in communities right across this country, which we are still dealing with today.

This debate strikes at the very heart of the meaning of life, it strikes at the heart of bureaucracy, and it strikes at the heart of how we care for the most vulnerable in our society. I have been told over and over again that this situation is different, that there is no connection.

In the indigenous world view, everything is interconnected. It is holistic, meaning that when a change is made in one place, the impact will be felt elsewhere, and the two cannot be separated. In the western world view, often we compartmentalize things. We believe that we can play, that we can control certain situations, that we can effect change here and not see change in other places. Above all, we have come to believe ourselves able to predict and control all, to control the future. This does not mean, though, that we should not take action.

The impact of this bill on people in Toronto may be very different than on the people in Nunavik or Attawapiskat. Our role as parliamentarians is to place ourselves in the moccasins of others, to place ourselves outside of our own experiences, to see the world through another cosmology and other world view, and to see the impact that our decisions may have on others.

We are making profound changes in concepts surrounding life, which cannot be undone in the future. In the indigenous tradition and philosophy, we are required to think seven generations into the future. If I am wrong and there is no connection between Attawapiskat and physician-assisted dying or suicide, if the average person does not see a connection and communities do not see a greater stress, then I will gladly say I was wrong; but if there is an impact, which is caused by the valorization of suicide, then what?

When the House passed amendments to the Criminal Code on other issues in our criminal justice system, who would have thought that indigenous peoples would now make up 23.2% of the prison population? It seems that madam justice is blind to the suffering of many of her fellow citizens. We have equal laws, and yet the treatment and effects are unequal across our country. We make laws often for the average person, but the impact is felt most by those who are on the margins of society.

Even though we have the Gladue rulings in our justice system and cases where we are supposed to take into consideration someone's upbringing, someone's past, unfortunately, those are not reflected in our justice system. Therefore, how can we be assured that the changes we are making today in the House will not have an equally detrimental impact on others?

My earliest memory, one of my strongest memories, is as a little six-year-old boy. My mother had just lost a house. We were in tough economic times in Calgary, Alberta, and she could no longer support us. She was a single mom, and she went off on the road looking for work. She decided at one point she could no longer raise me or my little brother by herself and she needed help, so she went to her ex-husband, my father. My father was a residential school survivor, an alcoholic, and a member of gangs. We knew all these things.

We knew he had a terrible temper. We were told this as young children, and we were very scared as children. We were dropped off at his place, with his parents, my grandmother and grandfather, and we were very upset. It is the only time that I remember my brother peeing his bed, because of the stress, because my mother had to find work because of economic stresses in her life.

I remember climbing a tree in the back yard and wrapping a rope around my neck at the age of six. This is a true story. People often think it cannot be true, but this happens in our country, like the case of the 13-year-old girl in Attawapiskat.

I wrapped that rope around my neck and thought, “Should I jump off into this universe, which is before me?” It was in that back yard that somehow I made the decision to climb down out of that tree and unwind that rope from around my neck.

If in my life I had seen, or I had known, that my grandmother had somehow used physician-assisted dying or physician-assisted suicide, or others in my family had completed the irreparable act, then it would have made it much more difficult for me to continue.

We might not think the impact will be there, but we do not know. We assume we know these things. We are deciding the future of a few for the end of a few.

In the case of Sheridan Hookimaw, as a society, we are unable to provide the necessary care, the love and the protection. We have failed our most vulnerable.

The Canadian Webbian bureaucracy was unable to respond to the needs of a 13-year-old girl. How can we be sure that it will now be able to respond to the needs of all in the future in our societies?

This debate is about life itself. Indigenous people never knew of suicide. It was unheard of in indigenous communities. Yet it now continues to plague our communities, and the spirit of suicide seems to always be there.

Life is not easy. It is about struggle, about fighting for another day. If indigenous peoples had committed suicide, then we would not be here today for all the trials and tribulations we have faced.

I participate in one of the high ceremonies of the indigenous custom and tradition of the Plains Cree. It is called the sundance. It is a four-day ceremony, and for three days and three nights, no food or water shall pass my lips. I pierce my body to sacrifice myself for others, in prayer for them. I do this not for myself, not to ask for something for myself, but for others.

In the sundance, in the sundance lodge, my Sundance Chief David Blacksmith talks about the spirit of suicide, how it is coming to take our young and is starting to take our old people, how it is affecting our society, how it is destroying our sense of community, and I have to listen to it. I have to be moved by the words he brings, because the people surrounding me in the sundance have all been affected by it.

We are placing ourselves now outside of nature. Nature itself is hard, to strive, to struggle, to see another day. It is a struggle that is noble. Now placing the tasks in the hands of the state removes us from nature, telling the state that it will now be the one who will be enabling us to do these things; someone else will be deciding, bureaucracy will now be deciding.

Others may feel that they are a burden. Others may say that they are a burden. I think there is something noble in sacrifice and in striving in the struggle for life itself, to hold someone's hands in the final moment, to have to grow up and not simply say, “I am going to hand it off to someone else to look after, but that I will stand there or I will sit there, holding your hand at that exact moment. Even in your final breaths, even though it may be difficult, we will continue on”.

Perhaps this is just another step on the road of moral relativism that we are in nowadays, but even our judiciary cannot serve as a balance between the different societies making up Canada. We are in a sorry state. We have truly entered a new age, one of the throwaway culture where all boundaries are starting to crumble.

Finally I would like to say, in the words of Elder Winston Wuttunee, “If you cry, your children will die”. It is dangerous to abandon one's self to the luxury of grief. It deprives one of courage and even of the wish for recovery.

From an indigenous perspective, I look at this bill and I cannot support it, because it leads to a place where I do not believe we are looking out for the interests of all people within our society. It is not allowing us to fully comprehend the needs of everyone who makes up Canadian societies, but really, it is taking us down a path that is very dangerous, and we do not know where it ends.

Let us be very careful in this House, and take the time that is necessary as we make our decisions.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Speaker, I would like to thank my hon. colleague for sharing his views on this.

I know I will be reprimanded for this, but I am disappointed by the disrespect that one of his own colleagues made while he was speaking, by walking not once but twice directly in front and making noises, while he was trying to give that heartfelt presentation.

I have considerable concerns with the bill, and my comments are neither for nor against, but on the timing, the time we have to debate it and the rush to get the legislation through. Quebec took six years to, hopefully, get it right.

I have an adult child who is 28 years old. She presents herself as mature and is beautiful, but cognitively, she is developmentally challenged. My concern is that there are not enough measures in the bill as it exists today that would protect the cognitively challenged. It says a “competent” adult has the right to make this request. Who determines that adult is competent to make that decision, and are there enough safeguards in place for those who are cognitively challenged?

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

Madam Speaker, not being a lawyer, I am not sure. However, I know once we start doing a process, once we have gone down this path, we cannot go back. We need to take time to look at Quebec and see what happens there, how it plays out in that jurisdiction, before we start elaborating in other jurisdictions.

I understand that there are people who are suffering, but I do not think we have dealt properly with the suffering that goes on in many communities. We have not taken the time to really understand or to make sure that they feel protected.

I do not have a lot of comments to offer the member, but it is a concern as well.

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

Madam Speaker, it was very unfortunate that my colleague invoked the name of young Sheridan in the House in this debate. She did not die because she was suffering from an incurable illness like Lou Gehrig's disease. She died because of lazy indifference from federal and provincial officials, from poverty, and the fact that we do not have mental health workers. It took months to get her body home through the bureaucratic red tape, as the family could not deal with the trauma.

What we are dealing with here is our obligation before the Supreme Court. This is our job. However, it is extremely dangerous and unprofessional to invoke the suffering of those children as a way to say that we are not doing our job here.

We have a job to do before the Supreme Court, but we also have a job for those children, so a young child like Sheridan will never ever be denied mental health services because some official says we will not give it to them, or that they are going to have to live in a squalid shack because some official will not sign off on the housing agreements. Those are fundamentally different.

Knowing the family and what these children have gone through, it is very unfortunate that my colleague has used those stories to somehow conflate these two issues, which are fundamentally different.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

Madam Speaker, unfortunately, perhaps the member fails to understand indigenous philosophy, which is about the interconnectedness of everything. The member may believe that these are unconnected events, but in fact they are connected. We could debate about the definition of the bill. We could say “medically assisted dying” or “medically assisted suicide”. Our use of terminology is very important. If we use “medically assisted suicide”, it has connotations to it that people will understand. I am sure at some point that people will be banging on the doors at some emergency wards and saying they are suffering, they want to end it, and ask for help.

I apologize if I offended anyone in invoking the name of the young girl, but her name is in the newspapers and her case is well known. If we cannot speak truth in this place and use the truths that are out in society here in the House of Commons then where else will it happen?

[The Assistant Deputy Speaker, NDP, Carol Hughes]

Before we resume debate, I want to remind people that when others are speaking it would be good to allow that person to speak without going back and forth. I want to make sure we keep that level of respect here in the House.

Resuming debate, the hon. member for Calgary Shepard.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, as I rise today to speak about the grave implications of Bill C-14, I am reminded of the Yiddish proverb, which says: “From fortune to misfortune is a short step; from misfortune to fortune is a long way”. I am afraid that the legislation being brought forward by the current government is a short step to misfortune, and the path with proper safeguards would be a long one.

This is a difficult subject, but the floor of the House of Commons was made to debate weighty subjects, to define how we live in our Confederation, to seek out the objective truth, and to legislate wisely.

However, the House has addressed the issue several times over the last decades. In 1983, the Law Reform Commission of Canada recommended against legalizing or decriminalizing euthanasia or assisted suicide. In 1993, the Supreme Court dismissed the challenge by Sue Rodriguez on the Criminal Code prohibition of assisted dying. In 2006, Bill C-407, a bill that would have allowed physician-assisted suicide in certain circumstances, died on the Order Paper in that Parliament. We can see in the chronology the hesitancy to legalize assisted suicide, and for good reason.

Bill C-14 would impact how Canadians view the worth of their lives and the lives of their loved ones. The safeguards we put in place must protect Canadians from abuse when it comes to physician-assisted suicide, and that is something all Canadians can agree on. We must ensure that, as far as possible, the legislation we craft mitigates the harm inherent in legalizing the killing of human beings.

Additionally, I remind my fellow parliamentarians that the ruling of the Supreme Court in Carter v. Canada directly contradicts the Supreme Court's 1993 decision in Rodriguez v. British Columbia. In that ruling, the Supreme Court was clear when it stated that section 241(b) of the Criminal Code of Canada was in fact constitutional. It reads:

Every one who

aids or abets a person to commit suicide,

whether suicide ensues or not, is guilty of an indictable offence

At that time, it was ruled that the Canadian Charter of Rights and Freedoms confirmed its legality.

Millions of Canadians believe that the Supreme Court erred in its interpretation of sections 1 and 7 of the charter. Despite this, I recognize that the court made a unanimous decision. Therefore, the question before us is no longer whether assisted suicide should be legalized or not, but rather to conform with the Carter decision in what the contents of the legislation should be, as well as the safeguards. That is the matter before us.

Many of my constituents have reached out to me with concerns about the direction that this legislation is taking. Bill C-14 would fail to provide stringent limits. It would fail to keep the deadly wolf of abuse and misapplication at bay.

Constituents like Alexia Blackwell wrote to me that, “Legislation must clearly spell out the protections provided by the Charter of Rights and Freedoms so that caregivers and their organizations will be protected from coercion or discrimination.”

Canadians must have access to palliative care before and alongside physician-assisted suicide so that their first end-of-life option can always be a peaceful, compassionate, and natural death.

Palliative care provides compassionate and ethical end-of-life care for those suffering intolerably as a result of a grievous and irremediable medical condition. It must always be presented as an alternative to physician-assisted suicide.

I would also like to note that in 2014, the House voted in favour of a motion brought forward by the hon. member for Timmins—James Bay, which read:

That, in the opinion of the House, the government should establish a Pan-Canadian Palliative and End-of-life Care Strategy...ensuring all Canadians have access to high quality home-based and hospice palliative end-of-life care...

That is the sort of care we should be working towards.

A very important safeguard, and one that I feel has only been partially addressed by the bill before us, is the conflict of interest that is bound to arise if we do not ensure that physicians are prohibited from benefiting directly or indirectly from recommending or performing physician-assisted suicide. I say this because, like millions of Canadians, I firmly believe that no person in Canada should profit from death. Since physicians in Canada are paid directly by their provincial health authorities, they cannot be placed in a situation where helping a patient choose physician-assisted suicide, or an extensive palliative care plan, or a chronic disease plan could be influenced by a consideration of monetary gain.

Similar prohibitions on physicians profiting for performing the physician-assisted suicide procedure exist in other jurisdictions that have now legalized the procedure, including Germany, Switzerland, and Oregon. These laws exist for good reason. As much as we may not like the idea, it is possible for unethical physicians to promote the idea of assisted dying over other health care alternatives if they stand to benefit from it.

The Dutch government, concerned over accusations that the practice of euthanasia was being abused, undertook studies in 1990, 1995, and 2001. Physicians were guaranteed anonymity and immunity from what they revealed in regard to violations of the guidelines. Therefore, the findings of these studies are indicative of what was going on in the practice of their profession.

It quickly became apparent that half of Dutch doctors had no hesitation in suggesting that their patients consider euthanasia, which compromised the necessary voluntary nature of the process. In addition, 50% of these cases were not reported, according to a study by researchers from the University of Ghent in Amsterdam.

Even more alarming was the fact that a quarter of the physicians said that they were terminating the lives of patients without an explicit request from the patient. Another third of the physicians said that they could conceive of doing so; they were not just thinking that they could do so.

We must not be naive about the possibility of coercion. That is why I am asking the government to amend paragraph 241.2(6)(b) and delete “other than standard compensation for their services relating to the request”, thus making the assisted-suicide decision and the provision free of any financial consideration.

Another issue I have heard brought up frequently is the lack of definition for the phrase “intolerable suffering”. I have heard a lot of talk about this particular issue. Should the definition of suffering include those struggling with mental illnesses, those struggling financially perhaps, or those who suffer from intense boredom? We should be protecting people from their suicidal desires rather than enabling them. After all, is that not the whole point of the excellent mental health initiative called Bell Let's Talk campaign, which we all support?

We cannot simultaneously work to end depression and suicide while also creating legislation that would allow people to request assisted dying simply because their situation has led them to consider their personal suffering intolerable or their death reasonably foreseeable. Realistically, this would fundamentally change the practice of psychiatry, the central focus of which is to develop good mental health that prevents suicide and shows persons the value of living and the inherent dignity of their condition.

Considering this incoherency, we must ensure that requests for physician-assisted suicide are considered objectively by a judicial review body that ensures the request is voluntary, well considered, informed, and consistent over time. This regulatory body must ensure that consent is actually being given by the patient requesting the physician-assisted suicide, and that all requests are reported to this body. The need for this sort of regulatory body is evident when we consider other jurisdictions where physician-assisted suicide is legal.

According to a study published in the Journal of Oncology Practice, over 500 people in the Netherlands are euthanized involuntarily every year. In 2005, a total of 2,400 deaths by euthanasia or physician-assisted suicide were reported, representing 1.7% of deaths in the Netherlands. There were 560 of these deaths that occurred without proper documentation of consent. In Belgium, the rate of euthanasia deaths that occur without explicit consent is three times higher than it is in the Netherlands.

Speaking of ambiguous requirements, it is the inevitability of life that it must end. From the moment we breathe our first breath outside our mother's womb, it is reasonably foreseeable that we will die. That is another vague, confusing term that at best fails to provide any meaningful guideline for physicians or their provincial colleges as they evaluate individual requests. Another vague term is the definition of medical practitioner as a person entitled to practise medicine under the laws of a province. This is problematic because that definition changes from province to province. In my home province of Alberta, it includes osteopaths, also known as chiropractors.

When deciding whether to provide assisted dying, physicians can follow their conscience without discrimination. No one should be compelled or coerced to provide assistance in suicide. I held a round table last week with participants who were for and against assisted suicide. I asked the question, regardless of whether people were for or against, what part of the bill they believed was most critical. They said it was protection for conscience. The people want an extension to protect the ability for people to say no based on moral and ethical grounds.

We must be very careful that Bill C-14 will not force Canadian physicians with deeply held religious, moral, or ethical beliefs about the sanctity of human life to go against both their conscience and the Hippocratic oath. I believe that section 2 of the Charter of Rights and Freedoms that protects freedom of conscience and religion, as well as freedom of thought, belief, opinion, and expression applies here. Further, what is the point of any of these rights if we cannot express them through action or inaction without state coercion?

I could go on about the ways that Bill C-14 would go far beyond the recommendations of the Supreme Court, how it lacks the strict safeguards referred to in Carter, or the broadly worded definitions that are a problem. I could speak of the irresponsibility of poorly defining the person who is eligible to undertake or to perform assisted suicide.

This bill is based on badly reasoned and inadequately researched recommendations from a committee that failed to seek proper input from a broad diversity of Canadian beliefs and opinions. The National Assembly of Quebec got it right by allowing for six years of debate, through three different assemblies, to study and consider all of this.

To finish, I urge the government to move significant amendments to this legislation or drop this bill entirely and table a better one. The path back from the misfortunes of this bill are too significant to get it wrong.

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

Madam Speaker, I am sure the member is somewhat familiar that this decision was made by the Supreme Court well over a year ago. The previous government virtually did nothing to address the issue. It had a panel, and I recognize that, but it fell far short in trying to come up with any sort of legislation. We had opposition days to encourage the Conservative government to take action, but it chose to do nothing.

In hindsight, does the member believe there was an obligation on the former government to at least advance the issue in a more timely fashion? By doing that, who knows where we might be today. However, at the very least, we need to recognize the restraints we are currently under with the Supreme Court of Canada. We still have to go through the Senate. Does he believe there will be value in getting this to committee so we can talk about the many ideas we are hearing today and listen to what Canadians have to say in the hopes that—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

Order, please. We have to give time for the answer so other people can ask questions as well.

The hon. member for Calgary Shepard.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I was worried that the member had almost become mute after the Manitoba election results.

The previous government called national consultations and started the process of hearing from Canadians on what they wanted to see in the bill. It is an excuse to say that the timetable is so short. A few months have gone by since October 19. The current government could have tabled a bill and we could have considered it. We would have had much more time for a fulsome debate.

The answer is simple. The government should have simply tabled a bill back in December or January to get the process started. The Liberals knew the deadline and they knew when would be too late. Instead, they have chosen to table a bill so far along the process that requires us to have shortened debate and a shorter review time.

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

Mr. Speaker, I heard a lot of agreement, but I want to reflect on the correspondence I am getting from people in my riding of Nanaimo—Ladysmith.

One writer said, “I want to have the choice how and when I am ready to die. It is not simply a matter of providing palliative care facilities, but we should definitely have more and better hospice care in people's homes as well as residential hospice within the community. I consider it a basic human right and though it is of essential importance to me in my senior years, I believe that people of all ages should be supported in facing their own end.”

This is an issue that has gone on for a long time and my sense is this Parliament and people are ready to decide. However, following up on my colleague's comment across the aisle, the Conservatives had opportunities to consult, but slowed and slowed.

I think all parties recognize that the Quebec leadership on this issue, so far as thorough and complete consultation, is to be admired. After the Carter decision and while they were still in power, why did the Conservatives not take the initiative and do the consultation we needed?

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Mr. Speaker, obviously I was not a member of the government in the previous Parliament, but the Conservatives called for national consultations, appointed a panel and heard from Canadians on what they wanted to see in the bill. Again, the current government could have tabled a bill in December or January and kicked off the process in the House to ensure we would have enough time to get it to committee, have a fulsome consideration of section by section and leave enough time for the Senate to also contribute to the debate.

We can debate whether the timelines were good or not, but they are what they are. We have until June 6 to report back and have a bill that is passed by both Houses of Parliament. The most important thing is the content of the bill. That is what we are debating. We are not debating whether the timelines are appropriate. It is the content, the safeguards and conformity with the Carter decision that are important.

[Raj Grewal, Liberal, Brampton East, ON]

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 regarding medical assistance in dying.

I would like to start by saying that I value and recognize the deeply personal and difficult nature of this topic for many across our great nation. We all know at least one person who has passed, or may pass, in intolerable pain. It is difficult for families to witness their loved ones suffering, but more so for the patient who has no control over his or her situation and believe he or she should have a choice for a peaceful death. This, my friends, is the reason we need to have this discussion and pass this legislation.

Many of our colleagues on both sides of the House and in both chambers have worked diligently over the last few months on the Special Joint Committee on Physician-Assisted Dying in order to help create a comprehensive framework that upholds the essence of the Supreme Court's decision as a result of the Carter case. This decision balances different interests and protects vulnerable persons. I would like to thank all of our colleagues on the joint committee, their staff, library analysts, the clerk, and all of the witnesses who appeared and sent briefs to the committee.

This is not an easy topic on which to give, hear, or read testimony day in and day out, and for many it can take an emotional toll. At the same time, witnesses who contributed to the consultations should be commended for being a valuable part of Canada's history, as we shape this nation's law to allow our citizens to die with dignity.

Just last year, a provincial and territorial advisory group on medical assistance in dying was established, with most provinces and territories participating, led by Ontario. This shows the need for and interest in adapting our laws to allow for death with dignity.

Included in this report is the unequivocal call for amendments to the code to allow for assisted dying by regulated health professionals and to protect these professionals while they do it. We look forward to working with these territorial and provincial partners. It is also why, as part of our budget, we have put a multi-year health accord forward, with the federal government's commitment to providing $3 billion over the next four years to improve home care and palliative care.

On February 6, 2015, the Supreme Court of Canada unanimously declared that the Criminal Code prohibitions against physician-assisted dying were unconstitutional when considering competent adults who clearly consented to die, who were suffering, and where death was reasonably foreseeable. I would like to quote a vital part of that SCC ruling. It states:

It is a crime in Canada to assist another person in ending her own life. As a result, people who are grievously and irremediably ill cannot seek a physician’s assistance in dying and may be condemned to a life of severe and intolerable suffering. A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.

This highlights the core of this issue, and the special joint committee showed it understood the Supreme Court's points. The report of the committee illustrates this, and I will quote from it. It states, "Our response to the Carter ruling must be focused on the needs and wishes of patients. The Committee was unanimous in recognizing the overarching need to have safeguards to protect the vulnerable.”

Therefore, the objectives of this legislation are comprehensive and adequately balance all the core elements of the discussion on this topic, some of which are: recognizing personal autonomy and dignity; recognizing inherent and equal value of every life; setting out eligibility for competent adults where death is reasonably foreseeable and who are suffering intolerably; balancing different interests, including personal autonomy toward the end of life and the protection of vulnerable persons; and encouraging a consistent approach across Canada.

Bill C-14 incorporates the points made by various stakeholders, including doctors and nurse practitioners, patients and families, civil rights groups, leading experts, faith-based groups, provincial and territorial governments, and more.

To enable access to medical assistance in dying, the Criminal Code will be changed so physicians, nurse practitioners, and those who help them can provide eligible patients assistance in dying without the risk of being charged with assisted suicide or homicide. There will be safeguards to ensure those who receive medical assistance in dying are eligible, can give informed consent and can voluntarily request it. The foundation will be laid for the Minister of Health to make regulations to establish a process for monitoring and reporting on the use of medical assistance in dying. It is crucial that the ability to provide assistance in dying is not limited to physicians.

Nurse practitioners are an important part of this framework if we are to provide all Canadians with equitable access to a peaceful death. Nurse practitioners have the authority to deliver many of the same medical services as family physicians. They can assess, diagnose, prescribe and treat patients. They can act independently in every jurisdiction, except Quebec, where they practice under the authority of a physician. That is why they are covered under Bill C-14.

In order to ensure the safety of all vulnerable persons, we have included the following safeguards that must be respected: a medical opinion to ensure the patient meets all of the established criteria; a second independent medical opinion; a request in writing or by proxy before two independent witnesses; the right to withdraw the request at any time; a 15-day waiting period, unless death or loss of capacity is imminent; and, consent must be confirmed immediately before medical assistance in dying is provided.

As a government that values the power of evidence-based decision making, the provisions regarding monitoring will be critical for transparency and public accountability of medical assistance in dying, as well as to evaluate whether the law is achieving its goals of respecting the autonomy of eligible persons to choose medical assistance in dying while protecting vulnerable persons and the conscience rights of health care professionals.

Nearly all jurisdictions that permit a form of medical assistance in dying have established monitoring systems for these purposes. The government would work with the provinces and territories in developing these regulations and in establishing an interim system until a permanent process is in place. As the legislation stipulates that there must be a parliamentary review in five years, the data collected from monitoring will be essential to improving the law.

There are those who say this legislation does not go far enough. We have listened carefully and appreciate their input and passion for a thorough framework for medical assistance in dying. It is their tireless advocacy which will ensure that we have the best possible legislation regarding this very sensitive issue.

With that being said, at this time not enough is known about the risks or benefits of medical assistance in dying for minors. We could certainly use more time to study this, as well as advance requests when mental illness is the sole underlying medical condition for requests.

These are important parts of the issue that cannot be written in hastily. They will be studied independently once this bill is passed so we meet our responsibility as a government to protect all vulnerable persons from any potential abuses or error.

To conclude, we do not have an easy task ahead of us. However, most things worth doing are not easy. We each have been elected to make difficult decisions and work hard to do what is best for our constituents and all Canadians. Canadians have spoken loudly on this issue, and we know that a majority of them support medical assistance in dying. We owe it to them to vibrantly debate and pass this legislation in order to allow Canadians a choice in how they end their lives.

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

Mr. Speaker, the member wrapped up by referencing opinion polls. Of course, we know Canadians support strong safeguards, including conscience protection. There will be some form of assisted suicide in this country going forward, but Canadians want to see us do the hard work of putting in safeguards.

The member talked specifically about the court decision. He would know that when the court granted the four-month extension, it put in place a system by which people could still, in the interim, seek euthanasia or assisted suicide, but they needed to go before a judge to do that. The court in its wisdom understood the need for some kind of system of legal review.

With ambiguous criteria, the absence of advanced legal review, and allowances for people to go from doctor to doctor until they get the right outcome or the outcome they want, this is not a system for ensuring that any kind of meaningful check occurs at all.

Would the member agree with me, and agree, frankly, with the direction the court seems to have given us when they granted the extension, that we should have some kind of system of advanced legal review by competent authority, and it would not have to be onerous, to ensure that whatever criteria are in this legislation are actually met in every case?

[Raj Grewal, Liberal, Brampton East, ON]

Mr. Speaker, the government has laid out a clear framework to ensure that the most vulnerable people in our society are protected. For mentally competent adults who are in an advanced state of irreversible decline and capability, have a serious and incurable disease, and for whom death is reasonably foreseeable, there will be not one but two medical opinions by independent witnesses.

We have also stipulated that we will be working with the provinces and territories to ensure that we have regulations that are in the best interests of all Canadians.

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

Mr. Speaker, we want the bill to move forward. We want this medical service to be accessible to all. We also want to get the details right.

During the election campaign, the leader of the Liberal Party issued a statement that told us that he believed the Supreme Court made the right decision and that Canada's laws must be consistent with the court's ruling, because that is the right thing to do.

If experts who testified in the Carter case find that in fact the outline of the bill is not consistent with the court's direction and ruling, will the Prime Minister and his party still support the direction of this legislation, or will they bring forward amendments at committee in order to bring it in line with the Supreme Court ruling? Will they seek a reference to the Supreme Court to ensure that their proposal is completely charter compliant?

[Raj Grewal, Liberal, Brampton East, ON]

Mr. Speaker, Bill C-14 represents a direct response to the Carter ruling. It sets out a framework to ensure that we have assisted dying in this country within a framework that ensures we protect the most vulnerable people from abuse.

On second reading, the Attorney General said the government will be putting forward, publicly, the documents that examine the charter impact of the bill for all Canadians and this House to look at as well.

We will be working with the provinces and territories to ensure that we have regulations to protect this framework, because this is a very sensitive issue for all Canadians. This bill is a great response to the Carter ruling, and the parliamentary review after five years will ensure that this issue keeps building forward.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Mr. Speaker, I heard the member talk about the details for the physicians and nurse practitioners making decisions.

I am wondering if the member would agree that the legislation puts the onus on the provinces, and in particular, the regulatory bodies. By doing so, it opens the doors for different regulatory decisions across Canada and these will not be uniform and consistent across the country.

[Raj Grewal, Liberal, Brampton East, ON]

Mr. Speaker, my hon. colleague is well aware that health care is a joint federal and provincial jurisdiction, and as a federal government, we have to work with our partners, the provinces and territories, to pass this legislation and set a framework.

We clearly stated that we are willing to work with our partners to ensure that in Canada our confederation works best for all Canadians, especially on issues such as physician-assisted dying, and that we have the best interests of Canadians at heart.

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

Mr. Speaker, I am very proud to take part in this debate as the representative for the people of Timmins—James Bay.

This is a historic debate for our country. The issue of medical assistance in dying is very complex and very personal. As parliamentarians, we have a duty to work together, strike a balance, respect the Supreme Court ruling in Carter, put in place the necessary protections for vulnerable individuals and seniors, and, lastly, introduce a national plan in order to guarantee access to palliative care.

At the beginning of this discussion, I think it is very important to put on the record that none of us come into this discussion with any level of moral superiority. This issue affects every single one of us. It affects our families. We cannot discuss this issue without putting it through the prism of our own personal lives and the lives of the people we know.

During this very time that the discussion has been going on, I was in the hospital with someone very close to me. The doctors said that there was nothing more to be done, they would have to go to hospice, and there were only days left. This person who is very close to me said that if they only had days, they were getting their hair done and were going to buy some nice shoes, $600 shoes. Being from a Scottish family, that was quite shocking. They said if they only had days, they were going to go out and have a nice dinner. Those days have turned into weeks.

Every day is a miracle. That is something we need to recognize. The power and the will to live is so incredible. We have to support it. We also have to recognize those who are living with intolerable pain, and be respectful of those whose hopes for the future are so crushed by debilitating illness. It puts us in a very special position, to be careful.

I want to say at the outset that I respect the importance and supremacy of the Supreme Court in our country, but I think it made a fundamental error and mistake in its treatment of the Canadian people. I think it was responding to what it felt was the last government's refusal to respond on a number of court decisions, so it put a firm timeline on Parliament to act.

It would have been fair for the Supreme Court to recognize that in October there was an election, a new mandate, and a new government. That government should have been given the opportunity to take this discussion across the country. This discussion should not be dealt with simply within this Parliament. This discussion should be a mandate that every Canadian is able to participate in. It is very unfortunate, and nobody will ever accuse me of giving the government a free pass, but the government's hands have been tied in a very unfortunate manner, in that we have to have this legislation passed by June.

For those who are very concerned about this legislation and in listening to some of my Conservative colleagues, I would warn that if Parliament does not act and if Parliament does not set the parameters for this legislation, we will then see a legal vacuum. The decisions on medically assisted death are already being made by the courts across this country. They are stepping into the vacuum that exists now.

It is incumbent upon us to respond. It is not good enough to say that we will fight this, that it is not the Supreme Court's job, and that Parliament should take back control. People can say whatever they want, but at the end of the day if we do not act by June, there will be a legal vacuum in this country. I would tell any of my colleagues who are very concerned about this legislation to just watch what happens in a legal vacuum, where others go back to the Supreme Court saying that they want to expand the rules much further.

Where does that bring us? One of my concerns is that if we are going to talk about the right that people have, the constitutional right, wherever they are in this country, to end their life if they are in medically difficult circumstances, how can we have that discussion without saying that people also have the right to quality palliative end-of-life care?

Across this country, only 16% to 30% of Canadians are able to access quality palliative care. Only six provinces have palliative care definitions under their framework. In fact, only four provinces actually even have a palliative care framework. There is a patchwork across this country.

We respect, within the House, that much of the health care services are delivered through the provinces, but the federal government has a fundamental role to play in working with the provinces. This is why the New Democratic Party pushed in the last Parliament for a national palliative care strategy, respecting the provincial and territorial jurisdictions but working to find ways of establishing proper palliative services. Pretty much every parliamentarian voted for that, yet we have seen no action. We have seen no action from the present government, which is a fundamental mistake if we are talking about having this legislation in by June.

Today is the first day I have ever heard someone from the government talk about their election promise that was supposed to be $3 billion. Well, that $3 billion is not happening now. Again, we are putting that to some time in the future. That is not acceptable. I have heard people talk about cruel limited choices and compassion, but it happens all the time. If someone is living in a rural area in Northern Ontario and are sick, and their children are living in Alberta or B.C., they are having to make some pretty tough decisions on their own. I have dealt with them in my office, and that lack of access to quality palliative care is heartbreaking.

The New Democratic Party has pushed Motion No. 46 in this new Parliament, which calls for the establishment of a pan-Canadian palliative end-of-life strategy. It has already been supported by Parliament, but we have not seen any action on it. We are asking for that to be moved now, to re-establish the secretariat on palliative and end-of-life care, with dedicated funding. That could have been done in this budget and it could still be done now to implement a national awareness campaign on end-of-life care so that people can have this discussion. I have been hearing lots of talk about how important it is to have this discussion in the House, but the federal government can play a role in furthering the discussion.

The other area is EI benefits for compassionate care so that people are able to look after their loved ones. Finally, there is a huge area of jurisdiction under the federal government, where it delivers health services to indigenous people, people in the military, and people in prisons.

Section 12.1 under the federal health act says that under no circumstances whatsoever, when someone is dying on a reserve and is being flown out for their final hours, will their spouse be allowed on the plane with them. They are to die alone. Under section 12.1 of these standards, it says it cannot be appealed. The first rule in the health standards says under no circumstances will compassion be accepted. That could be changed tomorrow. The health minister could stand up and say it is an unacceptable, cruel standard that the federal government would allow an elderly person to die alone without their life partner there, and that they would have written into the legislation that under no circumstances would compassion be considered a reason for letting someone be with them when they die. What kind of nation are we, if we think that is a perfect bureaucratic standard? It is not.

Therefore, if we are going to have this discussion about allowing people with incurable suffering to make that choice, and if we are going to make it available nationally, then it is incumbent upon the House to say that every family that has a loved one who is suffering will have the support they need, because how we come through death as a family is how we find ourselves. We either come out through these deaths stronger and closer together, or sometimes we see families breaking apart because of the strain that is put on them by a system that has failed them again and again, and when they needed it in the most vulnerable moment in their lives.

I am asking my colleagues. We could rise to a higher level in the House. We could rise to what we are called to do, which is to establish a vision for our nation. This is an opportunity, but it is going to have to move beyond simply this legislation. It is going to have to be done in conjunction with a plan for palliative care across the country.

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

Mr. Speaker, I appreciate many of the comments on the issue of palliative care. As a former health critic in the Province of Manitoba, I spent a good number of hours meeting and talking with individuals who were very much concerned about the need for expanding palliative care. This is an issue that all provinces, as they try to deal with their provincial budgets, have to come to grips with. It is not an easy issue.

The Minister of Health and the Prime Minister have made the commitment, and we want to demonstrate strong leadership on this file. We are talking about $3 billion. We are talking about the issue of a health care accord renewal. The last time that took place was back in 2004.

There is an opportunity for us as parliamentarians to recognize that we need to invest in palliative care, but at the same time would the member not agree that it is absolutely critical that in demonstrating this leadership we also need to work with our provincial stakeholders and others to ensure that we are providing a service, so that it does not matter what region in the country, there is some level of basic palliative care for all Canadians?

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

Mr. Speaker, certainly the reason we passed the palliative care strategy in the last Parliament was that one of the key first lines was to work in conjunction with the provinces and territories, but we have not seen that action. There was no action on the call for establishing the palliative care strategy. We can talk about it, but unless we establish a palliative care strategy or unless we put in the secretariat, this is just talk.

Yes, it is $3 billion, but there was nothing in the budget. There were zero dollars in the budget to deal with the shortfalls in health care.

My colleague can shake his head all he wants, but an election promise does not make palliative care. Palliative care is made by political will, and political will needs someone to stand up and say in a budget or a throne speech that we will establish that secretariat and we will make this happen.

So far, today has been the first time the Liberals have announced it. Lo and behold, guess what we are discussing. We are talking about medically assisted death and suddenly there is all this will on the other side. However, that will is the power of the government.

I would ask the Liberals, where were the dollars for health care for first nations under their jurisdiction when we got zero dollars to augment the huge shortfall? On palliative care, the Liberals can talk all they want, but they are going to have to put the structures in place and they have not done it yet.

[Jim Eglinski, Conservative, Yellowhead, AB]

Mr. Speaker, the hon. member mentioned quite a bit about the vacuum that may come about if this does not happen. I would like his opinion on what would happen if this House votes the bill down.

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

Mr. Speaker, I think it would be incredibly irresponsible if we told the Supreme Court that we have taken our opportunity to respond to it and we are not going to do it. Is the Supreme Court going to sit around and say that is perfectly reasonable? The Supreme Court will say that we had an opportunity to draft legislation with clear rules and clear limits, and in that vacuum other decisions will be made.

There will be groups that will come forward and will challenge the Supreme Court and say that they saw the Carter decision and they do not think it goes far enough and they want to establish further rights. Those rights would be established because Parliament has made it known under the mandate. I believe that we should have had more time, but we do not have more time. If we are telling the Supreme Court that we are not going to take our responsibility here in the House to draft legislation, in that vacuum, a lot of steps are going to be taken and members of Parliament are not going to be able to do anything except get up and make their Standing Order 31 statements to rail at the Supreme Court once again.

It is our responsibility; we have that duty, and we can do it now. I would say we all work together, because we are all in this together. We have to come out with legislation. Otherwise, that vacuum is going to be, potentially, very socially difficult and maybe destructive.

[Denis Lemieux, Liberal, Chicoutimi—Le Fjord, QC]

Mr. Speaker, it is a great pleasure to take part in this second reading debate of Bill C-14 on medical assistance in dying in Canada.

I had the privilege of being a member of the Special Joint Committee on Physician-Assisted Dying, and I supported all of the report's recommendations.

However, as many members have acknowledged today, medical assistance in dying is a complex, sensitive, and extremely personal issue.

Ever since the Supreme Court handed down its ruling in Carter last year, Canadians all across the country have been contributing to the discussion. The issue continues to be the subject of serious debate and deliberations all around the world, everywhere from the United States to Europe, Australia, and New Zealand.

In virtually all parts of the world, deliberately ending someone's life and helping someone end his or her own life are serious crimes that carry harsh penalties.

However, as many people know, Canada is not the only jurisdiction to legislate and authorize medical assistance in dying. Four U.S. states, specifically Oregon, Washington, Vermont, and California, along with Colombia, and three European countries, specifically Belgium, the Netherlands, and Luxembourg, have a legislative framework that allows some form of medical assistance in dying.

I listened to more than 60 expert witnesses during the meetings of the Special Joint Committee on Physician-Assisted Dying, and I was deeply moved by the testimony of the hon. Steven Fletcher; Benoît Pelletier; Jean-Pierre Ménard from Quebec; Dr. Cindy Forbes, president of the Canadian Medical Association; and Dr. Monica Branigan of the Canadian Society of Palliative Care Physicians.

Last week, though, I got a call at my constituency office from Bibianne Gauthier, the mother of Jean Truchon. After our conversation, I was able to put a face to a real request for medical assistance in dying.

After meeting Ms. Gauthier and her son Jean, I decided to share this real case with my colleagues in the House and read the letter that Jean Truchon wrote to his health care team on January 20.

I would like the House to know that I personally got permission from Jean Truchon to read this letter in Canada's Parliament. I am also doing this at the request of Mr. Truchon's parents:

“I am 48 years old and I have had cerebral palsy since birth. I spent 22 wonderful years living in an apartment.

On March 11, 2012, my life was turned completely upside down when the medical team at the Centre hospitalier universitaire de Montréal diagnosed me with inoperable degenerative cervical disc disease. That day, I reluctantly put one foot in the grave and I have every intention of putting the rest of my body there on September 1, 2016. I had to resign myself to living in a home and despite the good care I am receiving and my efforts to adjust to the situation, I simply cannot imagine living much longer under these conditions.

My question is this. Since I believe that I do not meet the eligibility criteria for medical assistance in dying [in January of this year], I intend to refuse to allow the staff to feed me or give me water, as I am unable to feed myself. I am asking that my doctor at the centre be authorized to administer a drug to at least relieve the pain.

I look in the mirror and I no longer recognize the man I once was. That is when I say, ‘What is the use in living like this’. Sometimes I think you do not have be at the end of your life to experience the intolerable suffering that I am currently experiencing. Doctors have told me that eventually I will become incontinent. The thought of it is too much to bear. I still have too much dignity to live like that.

At one point, I was in bed and no one responded when I pressed the call bell. I had to relieve myself in bed. It was then that I understood that life in an institution was not for me. I know that other people living a similar life in similar circumstances make different choices. However, in my case, I made the carefully considered decision that 2016 would be my last year.

I realize that dying before my parents is not the best way to go because it defies logic. However, I cannot take it anymore. My family and my friends are aware of and respect my decision even though they do not agree with it, because they are going to lose me. They understand all my struggles, and I thank them for their understanding.

I have considered a more dramatic form of suicide, but the fear of surviving and being in an even worse condition prevents me from doing it. Furthermore, to ease my family's pain, I am choosing to leave in a more honest manner by having them at my side. The antidepressants I have been offered, together with an explanation of their potential benefits, will never give me back the use of my arms or change the prognosis of physical decline. In good conscience and of my own free will, I have refused the medication, which will not give me back the will to live what would seem like an artificial life.

If this letter results in a more objective awareness of those who are suffering and are not at the end of their lives, I will have achieved one of my objectives.

Since I have no expectations that my case will be eligible for medical assistance in dying, I am also appealing to the CIUSSS bioethics committee to allow my treatment team to respect my choice and to allow me to receive the comfort care and the medication required to alleviate my suffering when I stop my feeding.

Thank you for taking the time to read this letter.”

The letter was signed by Jean Truchon.

This extraordinary 48-year-old man is just one of the faces of medical assistance in dying in Canada, but as I read about Jean's courageous decision, I felt that the committee had made good recommendations in its report.

The Minister of Justice consulted all of the existing legislation around the world to draft the government's legislative response to the Carter decision.

The bill sets three eligibility criteria: individuals must be competent adults who are in an advanced state of irreversible decline; they must have a grievous and irremediable illness or disability, and their medical condition must cause them enduring and intolerable suffering; and their deaths must have become reasonably foreseeable, taking into account all of their medical circumstances.

The bill also has a non-legislative component. It provides for further study of three specific topics: mature minors, advance requests, and mental illness.

I am also pleased to see that Bill C-14 includes solid safeguards to prevent mistakes and abuses. I would like to reiterate them: the patient must get an opinion from two independent doctors and the request must be made in writing; the patient has the right to withdraw the request; there is a 15-day waiting period; and consent must be confirmed immediately prior to the administration of the medical assistance in dying.

In closing, I would like to encourage all members to read the document entitled “Legislative Summary of Bill C-14: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)”, which was tabled in the House by the Minister of Justice. It contains important information on the international laws and regimes that influenced the government's approach to medical assistance in dying in Canada.

The government wanted to learn from the experiences of other jurisdictions. The approach it plans to take is broader in scope than that of the United States, which gives access to medical assistance in dying only to people with an incurable disease. The approach the government is considering gives the option of a peaceful death to everyone approaching the end of his or her life, not just those suffering from incurable diseases. At the same time, it eliminates some of the risks that may be associated with a broader regime. The government has also committed to continue examining these more general issues and will continue to observe what is being done elsewhere in the world in terms of medical assistance in dying.

I urge all members to support this bill and send it to committee, thereby responding to our Supreme Court's request to legislate in this area.