Debates of May 2nd, 2016

Criminal Code

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

Mr. Speaker, I want to thank my colleague for his work on the committee and also his continuing work on seniors care.

Just to follow up with my colleague across the way, in terms of the expert panel, there was a point where I had the report of the expert panel. The unfortunate part is that the Liberals refused any recommendations from the panel. They said it could give them the report but they did not want any recommendations. That was really a sad day, seeing the expert work that was done.

My question goes to the point of definition. Currently, Bill C-14 is called medical assistance in dying. I pointed out on a number of occasions that, many times when we see social engineering projects, they are preceded by verbal engineering, and I think this is another way that this is happening.

I would like my colleague to comment on the difference between physician-assisted suicide and voluntary euthanasia, because we know that the outcomes of those two different methods are vastly different. In fact there is a tenfold increase in people dying by voluntary euthanasia over physician-assisted suicide because of some of the ambivalence that occurs.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, there is a vast difference between the two definitions. In physician-assisted suicide, the physician would provide the lethal dose but the person must self-administer. With voluntary euthanasia, the physician or health care professional would administer it. The big question then is, when people use euthanasia, whether the person has been properly consulted. Do they really want this to happen, or are they closing their eyes? Are they able to self-administer, and should they? Therefore, they are two very different definitions.

It was the decision of the Supreme Court in the Carter ruling that it is a competent adult providing consent, proper competence being deemed by, if it is a psychiatric issue, a prior assessment to make sure the person is competent. Bill C-14, to give it credit, requires asking at the last minute to be sure people want to have their life ended. That is very important. The special joint committee did not want this prior asking of “are you sure you want this”. Death is permanent. Bill C-14 has that right, but we need to make sure that the person is competent and is giving consent right to the last moment.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, I appreciate the opportunity to add my voice to those who have expressed serious concerns about this legislation. Bill C-14 would, for the first time ever in Canada, establish a national right to die and the right to seek assistance in the act of committing suicide.

I acknowledge that the issue of assisted suicide is highly complex and of course deeply sensitive. Like it or not, the issue has been dropped in our laps by the Supreme Court of Canada and each one of us has been elected to wrestle with this very tough issue. I hope that, at the very least, we will have the courage to reject solutions that, on their face, may, by some, be characterized as progress, but in reality degrade rather than elevate the intrinsic value of each and every human life.

I believe that every human life is God given and is deserving of dignity, value, and protection. Indeed, from my earliest years as a public official in the community of Abbotsford, I have made it clear that my constituents can and should always expect me to defend human life against all threats. Today is no different. The legislation we are debating today represents a watershed moment in the life of this country, one in which our fundamental values are being re-examined and tested.

I believe Bruce Clemenger said it best when he stated:

With the introduction of Bill C-14, Canada has crossed a significant threshold.... The decriminalization of euthanasia and assisted suicide constitutes a fundamental shift in how we as a society value and understand life and the duty of care we owe one another. Never before have we as a nation said that intentional killing is an appropriate response to suffering, or that we should take the life of the one who suffers rather than finding ways to alleviate their suffering.

Let me begin by commenting on the role that the Supreme Court should or should not play in articulating a right to die. As a lawyer and lawmaker, I have the greatest of respect for the rule of law, for the courts which sustain it, and for the individuals who occupy the bench. It is the rule of law and our court system that are intended to act as a bulwark against oppression and discrimination and defend our prevailing national values, including our personal freedom and our democratic institutions.

That said, it is eminently within our prerogative as MPs to also respectfully question and challenge the very decisions that our courts make and to suggest what particular issues should more appropriately be left for Parliament to decide. It is my view that matters of protecting life and the taking of life should remain the sole domain and prerogative of the duly elected representatives of the people of Canada, namely, the members of the House.

More to the point, many Canadians are having great difficulty grasping how the court would presume to specifically direct Parliament to implement legislation that effectively creates a right to die and a state-sanctioned role in the taking of a life, all under the threat of the court doing so on its own. Therefore, let me be very clear. I am deeply sympathetic to the suffering of so many whose conditions are terminal, who have concluded that there is no medical hope for healing, who suffer from unbearable pain, whose quality of life has been eroded beyond measure, or who consider themselves an undue burden upon family, friends, and their caregivers. That is exactly why our first and primary focus should be to improve and extend 21st-century palliative care to all Canadians whose lives could be measurably improved by it.

Is it not ironic that at the same time that we are debating the state-sanctioned taking of a human life for compassionate reasons, the Liberal government has failed to follow through on its solemn promise to expand the availability of palliative care. The promised $3 billion would have gone a long way to ensuring that palliative care becomes an essential part of the end-of-life decision-making process.

Instead of barrelling ahead with active euthanasia legislation, is it not incumbent upon us as lawmakers to first explore every opportunity to provide compassionate and effective palliative care to those who are in the terminal stages of disease and health? We owe Canadians so much more than simply an ill-considered rush to implement a directive from Canada's Supreme Court.

A cursory study of assisted suicide regimes around the world quickly reveals that even the most stringent and well-meaning safeguards are never completely effective in ensuring that no wrongful deaths occur. Jurisdictions like Belgium have acknowledged that of the thousands of assisted suicides that have taken place, some have taken the lives of those who could not or did not provide an informed consent, or who otherwise should not have died.

In this country, here in Canada, we abolished capital punishment exactly because we could not guarantee that an innocent life would not be taken. Yet, today, we are being asked to take the morbidly contradictory position of saying that notwithstanding that some vulnerable or unwilling individuals would lose their lives, we are prepared to take that very risk. The hypocrisy is astounding.

I also note that Bill C-14 fails to properly address the right of physicians, nursing professionals, and health care institutions to refuse to participate in the taking of a human life. Leaving it to the provinces, territories, and professional associations to regulate is not the answer, and will simply result in a patchwork of directives that ultimately compromise the ability of doctors and nurses to refuse any direct or indirect participation in assisted suicide.

It is highly likely that a health care professional in one jurisdiction will find his or her right to conscientious objection protected, while a colleague in another province is left without such a fundamental right. That is unconscionable and a clear abdication of the government's obligation to protect the rights of all Canadians, irrespective of where they practice medicine.

The right of medical professionals to refuse direct or indirect participation in assisted suicide should never, ever, be subject to negotiation or compromise. On that measure alone, Bill C-14 fails the test.

Many Canadians have expressed a legitimate fear that Bill C-14 will become the precursor to much more radical right-to-die policies. They are right. I have no doubt that the legislation before us, if passed, will very quickly become the thin edge of the wedge to secure future liberalization of assisted suicide to include children, the mentally and physically disabled, the chronically ill, the elderly, and those no longer considered to be productive contributors to Canada. Is that really the Canada we were elected to build?

This debate exposes an astonishing irony. Today we are experiencing, to our national shame, an unprecedented epidemic of suicides of our youth on first nations reserves. In response, the federal government is undertaking extraordinary efforts to prevent such suicides from happening in the future.

Yet, at the same time, here we are, in this House, debating an assisted suicide bill that the special parliamentary committee recommended should in the future include extend the right to die to vulnerable children, the very group we are working so hard to save in first nations communities. Colleagues, what are we thinking?

Over the years, I have gotten to know many doctors and nurses, and have on numerous occasions dialogued with them on the issue of euthanasia. Our health care professionals are deeply compassionate, caring people who go to great lengths to ensure that patients who are terminal and suffering from great pain are made comfortable. They exercise a high level of discretion when they administer medications that alleviate pain, even where such medications may, on occasion, hasten the patient's death. The government's introduction of Bill C-14 failed to take that into account.

Let me close. More than a dozen times in the past this Parliament has considered and consistently rejected assisted suicide legislation. For whatever reason, our Supreme Court has now seen fit to insert itself into this debate by reversing itself on the Rodriguez decision. Its directive to the House to implement assisted suicide legislation calls upon us to act courageously and reject that directive.

Let us resist the urge to tread upon the steep and slippery slope of a policy whose implications are unclear, and whose trajectory represents a fundamental undermining of our foundational values.

We are faced with a monumental decision, one that challenges us to reaffirm the pre-eminence and inviolability of a human life. May we choose wisely and reject this deeply flawed bill.

[Celina Caesar-Chavannes, Liberal, Parliamentary Secretary to the Prime Minister]

Mr. Speaker, the Minister of Justice and the Minister of Health have really gone to lengths to ensure that this legislation strikes a balance between the complexities of medical assistance in dying. The Minister of Health has often stood in the House and talked about the fact that we need to improve our palliative care system as well as our home care system to ensure that people are having the best quality of life up until their time of death.

We now have a situation where we need to have this legislation go through, and I am wondering if my colleague could tell me why the previous government did not act and take charge on this particular issue when they were in power and are questioning our motives now.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, I can assure the member that we actually did take an active role in addressing the Carter decision. However, our government at the time was taking its time to get this right. Broad consultations across the country is the least that we could do with something this important, this critical to our foundational values.

Since when is the taking of a life defined as health care? That is my struggle. This country was founded upon values that respected the value of human life and protecting human lives. This is a huge step in the wrong direction, one that I am committed to resisting, as a parliamentarian and someone who deeply loves this country.

This legislation is a very dangerous step on a slippery slope of which we do not know where it will lead, but it is very clear it will lead to much greater liberalization and cast a much greater net in the future.

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

Mr. Speaker, I listened with great interest to my hon. colleague. I find it very unfortunate, though, to use the suffering of the children in Attawapiskat in this debate.

I have heard it used by some people in the faith community. I find that it is a real debasement of the issue because of what the children are suffering there, with the lack of basic mental health services from the federal government, the intergenerational trauma of the residential schools, and the churches just walking away from their legal obligations.

Edmund Metatawabin, a survivor of St. Anne's Residential School, who knows these families well says that there is a direct highway between the injustice committed by the federal government and the effect it is having on these children. I can tell my colleague, being in the community, I hear that. I respect his judgment on many things and I am just asking that we be careful when we bring in something tied to this.

My concern in listening to my hon. colleague is that I do believe it is the role of Parliament to offer legislation on what is the right of life and death in this country, but the Supreme Court decision is acted.

I think it is incumbent upon us to be truthful with the Canadian people that if Parliament does not respond to this legislation, it will create a legal vacuum, and in that legal vacuum, all manner of agents may step forward, may be heard, and may be recognized by the Supreme Court. It is not enough to say that we can push back against the Supreme Court. If we do not meet this deadline, then a legal vacuum will ensue and much broader interpretations may result.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, I want to be very sensitive to the hon. member's comments about not using the children of Attawapiskat as an unnecessary element in this debate, but I think it bears noting that this is a critical issue across Canada when our first nations are struggling with an epidemic of suicide. I look at this legislation in all earnestness and I see how it flies in the face of what we are trying to do, which is not only to protect and defend human life but to create an environment within Canada where life can be lived in a way that is not only happy but productive and contributes to building a better society.

With respect to his specific question, how do we approach this ruling from the Supreme Court of Canada? The government well knows it does have remedies available to address the ruling of the court. It has tools within the charter itself to respond to this decision.

When legislation is so fundamentally flawed, as is Bill C-14, as a person of conscience, as a person of faith, as a person who loves this country dearly, it is my duty to speak up against this kind of legislation and to say, no, there are better ways of addressing this.

I am so pleased with my colleague who has raised the issue of palliative care consistently in this House. That should be the first focus of the work we are doing to help people who find themselves in these circumstances.

[Joyce Murray, Liberal, Parliamentary Secretary to the President of the Treasury Board]

Mr. Speaker, I will be sharing my time with the member for Parkdale—High Park.

I am proud to stand in this House today in support of Bill C-14, introduced by the hon. Minister of Justice.

With this bill, our government recognizes the autonomy that Canadians hold over their own lives, the expertise of our medical professionals, and the decision of the Supreme Court of Canada. Through extensive consultation, we have introduced a balanced solution that will restore dignity, protect the vulnerable, and allow our nation's medical professionals to respect the wishes of their patients.

Until now, Canadians faced horribly debilitating end-of-life suffering and had no legal control over their own lives. In desperation, some have gone to court to regain this control. However, it is a difficult process, which has compounded the physical and emotional strain felt by the patients and their families.

Doctors, nurses, and family members alike have felt powerless to assist those they care for, with no legal means to honour the wishes of those who suffer. They face emotional strain and difficult moral dilemmas, as the law prohibits them from respecting the dignity of their patients and doing what they often know is compassionate medical assistance for a good death.

Many of us in this chamber and across the country have personal stories of the kind of suffering I have mentioned. I do as well. I have an indelible memory of visiting a dear friend of many decades in the hospitals, whose body was breaking down from a terminal illness. He was in excruciating pain for weeks. He eventually declared that he would not eat or take any water or liquids. He finally passed away after six days of even more miserable suffering.

We are here to talk about a bill that is setting out a new form of medical service in Canada, which is medical assistance in dying. With this bill, we recognize that the decisions over one's person, including the decision to end one's life with dignity, should ultimately rest with the individual and not with the government.

Through consultation and careful consideration, Bill C-14 includes the following safeguards: a requirement for a second independent medical opinion; a 15-day reflection period; the ability for a patient to withdraw consent at any time; and a rigorous requirement for documentation at every step, with new criminal offences to prevent any potential abuse.

This government recognizes the need to respect the moral conscience of individual medical professionals. While every patient who fits the medical criteria will have access to medically assisted dying, no individual doctor or nurse will be required to participate if it conflicts with his or her values and beliefs.

Some medical professionals have expressed reluctance to refer a patient seeking medically assisted death to a physician who can provide the service because they feel that the referral would make them complicit in the death of the patient.

However, while it is absolutely critical to reflect important safeguards, we must also respect that the people seeking this procedure should have reasonable access.

In Carter, the Supreme Court of Canada recognized that the conscience rights of physicians will need to be reconciled with the charter rights of patients seeking medical assistance in dying. Although much of the necessary balancing will be a matter for the provinces and territories, our government is committed to working collaboratively with provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

The federal government will offer support to help ensure that all Canadians have access to the medical aid they need. One approach is a pan-Canadian coordination system for access to medical aid in dying. We can start by reviewing the assisted dying regimes in other countries to see what they have done and assess their applicability to Canada.

Closer to home, in Quebec, the act respecting end-of-life care offers other examples. It includes a range of end-of-life care, including palliative care, palliative sedation, and medical assistance in dying. The legislation makes the service broadly available in institutions and at home.

Physicians in Quebec are not required to provide this option, but they are required to notify the institution or local authority of any request and to forward the patient's request form. The institution will then take the necessary steps to find another physician as soon as possible to address the request.

Many people in Vancouver Quadra who have contacted me about the bill have expressed their support for medical assistance in dying. As their representative, I am pleased to support the work of my colleagues, the Minister of Health and the Minister of Justice.

Under the proposed legislation, medical assistance in dying would be available only to mentally competent adults who are eligible for publicly funded health services in Canada, who have an incurable illness, disease, or disability, are suffering intolerably, are in an advanced state of irreversible decline in capability, and whose death is reasonably foreseeable.

Some of my constituents have also expressed concerns about access.

Our criteria permit medical assistance in dying for some, but not all individuals who may seek it. We have heard concerns from some Canadians and experts about extending eligibility to mature minors, permitting requests made in advance, and including psychological illness as a sole underlying condition.

I want to let Canadians know that our government has heard their concerns.

At the present time, the limited information available on these issues warrants the cautious approach in the draft legislation before us.

However, the government is making a commitment to undertake independent studies on these issues to better understand the risks. The results of the reports will feed into the five-year legislative review set out in the bill.

There are other facets of the challenge of access. As we all know, our country has many remote and rural communities that face challenges in accessing health care services, including access to a physician or other health care provider. Although delivery of health care is a provincial and territorial responsibility, accessibility is one of the five main principles of the Canada Health Act.

I am pleased to report that, along with the protection of vulnerable populations, questions of access have been considered and addressed throughout the proposed legislation and in the complementary initiatives.

Let me provide an example. The umbrella term “medical assistance in dying” encompasses both the situation where a provider must be physically present to administer a substance that causes death, and the situation where the provider prescribes a medication that the person can take himself or herself. Having criminal exemptions for both procedures would help to increase access for eligible people and provide choices in the circumstances around which medical assistance in dying is provided.

Second, the draft legislation provides exemptions for both physicians and nurse practitioners to be able to provide this assistance. Nurse practitioners, or those with an equivalent designation, are authorized in many provinces to perform medical functions that are necessary for medical assistance in dying.

Exempting nurse practitioners from criminal liability provides the provinces and territories with an additional option to facilitate access to medical assistance in dying in underserved areas.

I will offer another example of how we are working to support access in our health care system. Canadians, experts, and stakeholders have focused on the need to improve access to quality palliative care in Canada, even as we consider how to implement medical assistance in dying. We have listened. Our government is making the commitment to develop, along with the provinces and territories, measures to support the improvement of a full range of end-of-life care, including palliative care.

In the context of a new health accord, our government has committed to providing $3 billion over the next four years to improve home care, including palliative care. Discussions with the provinces and territories are already under way.

In the meantime, it is essential that we end the suffering and restore the dignity of Canadians currently experiencing grievous and irremediable medical conditions as soon as possible.

The draft legislation before us acknowledges the need for access, alongside the need for safeguards and protections. With the bill, our government would achieve these objectives and meet the deadlines imposed by the Supreme Court of Canada.

I have confidence that we can put in place a system that meets the needs of Canadians for compassionate care and support at the end of life.

I invite my colleagues in this House, and all Canadians, to contribute their views to this discussion as we continue the process of updating our laws to reflect 21st-century realities. Our door is open, our government is listening, and we are committed to supporting our medical professionals, protecting our most vulnerable, and restoring the dignity of Canadians in their most trying moments.

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

Mr. Speaker, the member concluded by asking that we update the law to reflect 21st-century realities. By my count, this is the third issue on which the government is using an argument of dates to demonstrate a particular legislative opinion. We need more than just the dates.

With respect to the legislation before us, I have advocated for two changes.

One is that we have some kind of advance review by a competent legal authority to ensure that somebody receiving this service, or whatever we want to call it, did actually meet the criteria. Without advanced legal review, there is no way of actually ensuring that the criteria were met. A person could go from doctor to doctor, or someone else could go from doctor to doctor for them. I want to know what the member thinks about advanced review by a competent legal authority.

Also, what does the member think about removing the “reasonable but mistaken” clause, which would allow somebody who takes somebody else's life without consent to escape prosecution if they had a reasonable but mistaken belief that the person did consent?

Would the member accept those two changes? With those two changes, I think many of us would have a much easier time supporting the legislation so that we can meet the timeline.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Mr. Speaker, I want to thank the member for those thoughtful proposals.

There will be a committee process in which these kinds of ideas can be put forward and the committee can hear from expert witnesses. What we do not want to do is put unnecessary barriers in the way of people who are qualified to have this kind of end-of-life assistance.

I do want to say that it would have been helpful if the Conservative Party had done the work on how to follow through on the Supreme Court of Canada's requirement for medical assistance in dying when that Supreme Court ruling came out. There could have been much more discussion in Parliament a year ago, which is what our party called for and the Conservatives refused to do.

[Robert Aubin, NDP, Trois-Rivières, QC]

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

I want to begin by saying how much I appreciate the tone of our exchanges today. It is inspiring and a change from our debates.

My question is quite simple and is on the example my colleague gave in her speech about one of her friends who stopped eating and drinking for six days in order to end his life. Although the Supreme Court's criteria are relatively clear in the legislation, the fourth element is rather vague in my opinion.

We are talking about natural death becoming reasonably foreseeable. Could my colleague provide some clarification on this fourth criterion? If someone meets the first three criteria, would he not be forced, once again, to stop drinking and eating in order to meet the four criteria to get the service he is seeking?

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Mr. Speaker, I thank the member for the question.

I can guarantee that my friend's condition was consistent with the criteria of our bill.

As I said in my remarks, with such a short time to deliver on the Supreme Court's mandate in the timeframe available, it is important to be cautious on how this is framed. That is what the proposed law would do. It finds the correct balance between safeguards for the vulnerable, the rights of physicians and nurses, and the personal rights of those who wish to have assistance in dying.

We have time moving forward to continue considering situations such as the member has brought forward to confirm that we have the balance right, or make adjustments in the future when the bill is reviewed in five years.

[Arif Virani, Liberal, Parliamentary Secretary to the Minister of Immigration]

Mr. Speaker, I rise today to speak to Bill C-14. I start with reference to the Supreme Court of Canada's Carter decision, about which we have heard much.

In the opening paragraph of that ruling, the unanimous court said:

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.

I agree with the Supreme Court. The choice is cruel.

The Supreme Court concluded that the criminal law as it currently stands was not only cruel, it was also unconstitutional. The court found that section 7 of the charter required access to medical assistance in dying, subject to certain safeguards. That is where the House finds itself today.

Let us be clear. The question facing parliamentarians is not whether we can permit Canadians access to medical assistance in dying. That access must be permitted to comply with the charter. The actual question facing us is how to design the access. In terms of design, I believe Bill C-14 strikes the right balance. The balance is between the right, on the one hand, of a competent person who seeks an assisted death in response to a grievous and irremediable condition, as compared to the need to protect the vulnerable from being induced to commit suicide at a time of weakness.

Striking this balance is not simple. Nor is it permanent, and this is an important point. The balance must be calibrated and re-calibrated according to changing evidence and the evolution of societal values. Indeed, the Supreme Court's 2015 decision, which reversed the court's earlier ruling in 1993 in Rodriguez, is evidence of this very evolution. However, for now, in terms of where we are in 2016, I am firmly of the view that the bill would strike the right balance.

There is another reason why I rise before members today to speak in favour of the bill. That is because I have spent my career as a constitutional litigator fighting for people's rights, their human rights, their charter rights, their right to equality. Treating people equally means treating people with respect, according them dignity and according them autonomy. The bill would do that. It would give people control over their own lives, including the conclusion of their lives. It would allow those nearing death to pass in a manner of their choosing with less suffering.

In empowering choice, the bill would empower Canadians. It would strengthen us as a people because it is informed by a desire to give Canadians more autonomy and, as a result, greater dignity.

For the rest of my speaking time I would like to address two major categories of concern that this bill raises: the criticism that Bill C-14 does not go far enough to make medical assistance in dying available; and the opposite criticism that the bill goes too far and makes medical assistance in dying too accessible.

In this first category, the concerns are that Bill C-14 is not broad enough. They centre on three main components, and we have heard some of them this afternoon and in previous days of debate. For now, it is proposed that medical assistance in dying only be permitted for adults and for those who suffer from more than a mental illness alone. In addition, for now Bill C-14 would not provide for advanced directives regarding medical assistance in dying.

The words “for now” are important. The government has committed to an independent study of legal, ethical, and medical issues that are raised by each of these three different categories. This is important. If medical assistance in dying is to be expanded into any of these three areas, it must be done only after a comprehensive study of the benefits and the risks associated with permitting medical assistance in dying in such circumstances.

I was determined to hear from my constituents directly on this important legislation. Therefore, in early April I hosted a town hall in my riding of Parkdale—High Park on the issue of medical assistance in dying. The engaged constituents of my community came prepared with thoughtful and personal reflections, with concerns, and with questions, many of which related to these very three items I just raised.

While the residents and community, like me, are keen to protect and promote the autonomy and dignity of all Canadians, including youth and the mentally ill, the residents of my community also cautioned about moving too quickly in an area where the consequences of a decision were final and irreversible. They noted, for example, that in Belgium medical assistance in dying had been legalized and studied for a period of 12 years prior to medical assistance in dying being made available to minors. The mentally ill, it was noted, would be able to avail themselves of medical assistance in dying under this legislation provided the mental illness was part of the patient's overall medical circumstances and that the applicant was still able to meet all of the general eligibility criteria.

As one who has championed the rights of mental health consumer/survivors in my community, I know it is critical that before embarking on the path of increased access to medical assistance in dying for those whose condition is mental illness alone, we get this right.

As we have said repeatedly, our government believes in enacting legislation that is well reasoned, carefully analyzed, and based, above all, on sound evidence. The proposed independent studies into things like access for minors will help inform this analysis and critical evidence-building process. Importantly, Bill C-14 also contains a provision which calls for a mandatory review of the entire legislation every five years.

As I said at the outset, finding the right balance in legislation of this nature is not permanent; it is fluid. It is a dynamic process which can and must adapt to changing evidence and societal norms.

Bill C-14 is not an extensive enough category. We also find an argument relating to reasonable foreseeability. We heard questions about it this afternoon. Some assert that the requirement to Bill C-14 that a person's death must be reasonably foreseeable is an unnecessary barrier. Such concerns are unfounded. Bill C-14 is actually more permissive than any assisted-dying legislation in North America. In Quebec, an applicant must have a terminal disease. Bill C-14 is more accessible. It would allow medical assistance in dying where death is reasonably foreseeable, looking at the totality of the medical circumstances.

In addition, in each of the four American states that have legislated medical assistance in dying, one is required to have a specific prognosis that an individual has less than six months to live. There is no such temporal restriction in Bill C-14.

Finally, in the category of Bill C-14 not being quite broad enough, some contend that the bill should stipulate, and again we heard it this afternoon, that medical practitioners are professionally bound to provide such service. This criticism misunderstands the nature of Bill C-14. It is an amendment to the federal Criminal Code. It is also misguided jurisdictionally.

Wearing my constitutional hat, it is clear that the federal government has an important role to play in maintaining universal access to insured health services, but the ultimate delivery of medical services is primarily a matter of provincial jurisdiction. Our government, as was mentioned by my colleague, has committed to work going forward with provinces and territories to support access for medical assistance in dying, while simultaneously respecting the personal convictions of health care providers. This approach reflects the balancing that must occur when addressing competing charter claims.

On the one hand, the section 7 claims of those who seek access to medical assistance in dying must be balanced with the freedom of conscience rights that are entrenched in subsection 2(a) of the charter. Those are the freedom of conscience rights of health care providers. The Supreme Court recognized this in the Carter decision, in paragraph 132, and this bill recognizes it in the preamble.

The second broad category is that the bill is too permissive.

In fact, those who maintain that Bill C-14 is too permissive are the ones who are failing in the fundamental responsibility to protect people who might commit suicide in a moment of weakness.

Requesting medical assistance in dying is not simple. Nor should it be. Requests must be made in writing. This has a meaningful impact. All such requests must be witnessed by two independent individuals. They cannot be a beneficiary in a will or a person charged with the care of the ill individual. A request must then be approved in writing by not one, but two different medical practitioners. Finally, the bill calls for a mandatory waiting period of 15 days in order to allow individuals to reflect on the seriousness of this choice.

The bill goes further. It requires an extensive regime of monitoring, so data and trends respecting medical assistance in dying can be obtained and analyzed by government. This kind of monitoring will ensure transparency, but more important, it will facilitate strengthening safeguards where required.

Finally, I am encouraged by the fact that Bill C-14 not only reflects the significance of choosing medical assistance in dying, but that every choice ought to be an informed one. By this, I am referring to the pressing need to enhance palliative care in Canada, a need expressed to me time and again by residents in my riding of Parkdale—High Park. If we are to ensure that the significant choice of requesting medical assistance in dying is fully informed, it is critical that we work collectively, in a non-partisan manner, to ensure that improved palliative care is readily available.

In conclusion, I reiterate that this proposed legislation is neither too restrictive nor too permissive. It strikes the correct balance, while simultaneously recognizing that with further study and mandatory review, the balance will continue to be re-calibrated to reflect new evidence and evolving societal values respecting medical assistance in dying.

Most important, the bill would eliminate the cruel choice that the Supreme Court described in the opening paragraph of the Carter decision. No longer will grievously ill Canadians be faced with either taking their own life prematurely or prolonged suffering until they die. Bill C-14 would give such Canadians what the charter requires, autonomy. It would give them control over their passing in a manner that ensures their dignity. For this reason, I will be supporting this legislation.

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

Mr. Speaker, there is a couple of things I would like to clarify. The member and his colleague who spoke earlier said, pretty unequivocally, that no doctor would be required to participate in this regime. I do not see any protection in Bill C-14 that would assure doctors they would not be required to participate, other than a very vague comment in the preamble talking about that possibility. It certainly does not put iron-clad protection in the bill.

The other issue I would like to raise with all my colleagues on the other side is palliative care. We continue to hear their commitment to palliative care. I applaud that. We need better palliative care. I have been working on that years. We can talk about it, but I do not see any evidence in the budget of the $3 billion that was promised to be immediately invested. I am very concerned. We need to get working on this. I want to see an actual firm commitment within the budget so we have something we can take to Canadians that says help is on the way.

Barring that, to offer physician-assisted death without—

[The Deputy Speaker, Conservative, Bruce Stanton]

The hon. parliamentary secretary to the Minister of Immigration, Refugees and Citizenship.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Mr. Speaker, my hon. colleague has raised two points. One is the issue of doctor participation, and it is broader than just doctors; it is also nurse practitioners. Clearly, in the Carter decision, paragraph 132, the court went beyond the call to specify that nothing in its decision would compel a health care practitioner from being required or compelled to provide medical assistance in dying.

The preamble, as my colleague noted, reflects that same sort of rhetoric. I would put it to him that our party and this government firmly believe in complying with the charter, including all aspects of the charter, including section 2(a), which protects those conscience rights.

On the issue of palliative care, the member is correct. It would be inappropriate for palliative care to be entered into this bill, which deals with a discreet amendment to the Criminal Code. An announcement was made today in question period, and my friend was here to hear it. The minister indicated the amount of monies being allocated for palliative care. I would ask him to put faith in the minister. She is a family physician and has been on the ground providing these services. She recognizes the important need for palliative care to be provided in a robust way so people have an informed choice when they make this significant decision.

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

Mr. Speaker, I listened with great interest to my hon. colleague.

My concern with the lack of action on palliative care is that there was zero dollars in the budget. We have a promise now, but that is another year lost. I find it extraordinary to be talking about the right to die, but not the right to quality palliative care and the role the federal government has to play.

The other area that concerns me is the federal government has major health responsibilities in the delivery of health services to the military, the federal penitentiaries, and indigenous people. Yet, under section 12.1 of the first nations non-insured health benefits, when people are dying and have to be taken out of a reserve for palliative treatment, their loved ones are not allowed to go with them.

It says in federal regulations that the first reason to deny loved ones to be with their spouse at the end of life is compassion. Compassion is the number one rule for denying loved ones a chance to have palliative care. If the Liberals are serious about ending these cruel choices, they will tell that health minister to change the wording in the health guidelines now, so loved ones are never separated at the time of death.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Mr. Speaker, as we have indicated, the palliative care financial allotments do not appear in this discreet legislation. The member has raised an issue about whether they should have appeared in the budget. I can assure the member that we are working to renew a lapsed agreement called the Canada health accord, with which the member for Timmins—James Bay will be very familiar.

The previous government simply allowed that to lapse. We do not believe in governing in that manner. We believe in engaging with provinces and meeting with them to understand their needs, and to address them going forward in a robust manner that is consensual, two-way, and that provides the financial supports that are needed by the provinces and territories.

With respect to first nations palliative care in particular, and the very particular issue that the member for Timmins—James Bay has raised, I think it is an important issue. Obviously more important than the issue we are dealing with discreetly here is repairing a woeful and shameful record in respect of first nations peoples, which has existed for generations.

We see that reflected in every mandate letter provided to every cabinet minister by the Prime Minister. That is something on which we are actively working. We have had robust debates about mental health in particular communities, including the community the member represents. However, that is only one part of a broader piece that needs to be addressed.

I look forward to working closely with the member going forward about how to address compassionate care and palliative care, in particular for first nations people, as part of our duty of care to first nations.

[The Deputy Speaker, Conservative, Bruce Stanton]

Before we resume debate, I get the sense, especially given the nature of the debate today, of the need for time for members to explain points in questions that they might pose to a speaker who has just presented. We are doing our best. In the five-minute period, it is very difficult to pose much more than two questions and receive their responses. If members make their interventions more concise, obviously more members can participate, but in all honesty and as the presiding officer, the last thing we want to do is cut people off.

We will be as judicious as we possibly can, but if members are able to be concise in their interventions, it would help their colleagues to have more opportunities to pose questions in the five-minute period.

Resuming debate, the hon. member for Saint-Hyacinthe—Bagot.

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

Mr. Speaker, first of all I would like to say that I will be sharing my time with my colleague from Kootenay—Columbia.

Medical assistance in dying is definitely one of the most important social issues our country and our Parliament will face and have faced in a long time. There is no doubt in my mind that this is the most delicate issue that our Parliament will have to deal with.

I would like to say that I will be supporting this bill at second reading stage even though I feel that we need to amend it.

We have known from the beginning that the NDP will have a free vote on this personal and delicate issue. Therefore, we are not seeking a consensus, but rather we want to continue consulting our constituents and the many experts studying this issue in order to determine what would be the best bill to reflect Canadians' rights.

It is important that we clarify the bill we are studying because it leaves room for interpretation and, above all, it contradicts the Supreme Court's ruling in the Carter case.

We will debate the necessary amendments in a non-partisan manner, but it is important for everyone here in the House to remember why we are voting on this issue. The issue at hand is not whether we are for or against medical assistance in dying. The Supreme Court of Canada was very clear that medical assistance in dying is a charter right. We are here to debate the bill and ensure that it reflects the Carter decision and does not leave anything open to interpretation.

As I just said, the Supreme Court unanimously ruled that competent Canadian adults who are suffering intolerably as a result of a grievous and irremediable medical condition have the right, under the charter, to medical assistance in dying.

The Supreme Court mandated our Parliament, and also the provincial legislatures, to pass legislation that is compatible with the Supreme Court's decision. This decision sent a strong message to update our laws, which are meant to protect vulnerable people and also the health care professionals who help them.

It is important not to politicize this issue or deal with it in a partisan manner. It is also important not to reduce this major issue to a pro-life and pro-choice debate since we know that debates like that can be never-ending.

I am very proud to have been a member of the Special Joint Committee on Physician-Assisted Dying. I worked on that committee with my colleague from Victoria, and I would like to sincerely thank him for his expertise, experience, and wealth of knowledge on this issue. This was my first experience with committee work. I would therefore like to thank him again, along with all of the committee members and the staff who assisted us. It was a privilege for me to be part of that committee because it gave me the opportunity to carefully study the Supreme Court's decision in this regard, and the provincial court decision that preceded it. We also carefully considered the laws in Quebec. I am very proud of the role that Quebec has played in leading the way on this sensitive issue. We also considered legislation from countries around the world.

Our committee reviewed two major studies, which together heard from over 13,000 people and more than 100 organizations. We held 11 hearings.

Sixty-one expert witnesses shared their work with us. Since February 6, 2015, the day of the Supreme Court ruling, every medical organization in the country and every organization that represents people with illnesses or health care professionals has given this sensitive issue very careful consideration. Those speaking on behalf of doctors told us how they were trained up until February 6, 2015. Their careers were based on the duty to heal. Since February 6, 2015, they have become aware that their role is now also to help people avail themselves of their right to seek medical assistance in dying.

During the committee's work, I made a point of meeting with all of the organizations in Saint-Hyacinthe—Bagot with an interest in this issue. I met with representatives of organizations for people with disabilities, user committees, institutions, medical institution representatives, and an organization that works with bereaved families and supports people at the end of their lives. I shared the committee's thoughts with them. I also had a meeting with all of these stakeholders to discuss our committee's report. Everyone who is directly involved in this issue and deals with it on a daily basis was very comfortable with our recommendations.

The role of the committee was to take advantage of this unique opportunity to reflect on all of the aspects of physician-assisted dying. Of course, we know that the government will not take all of our 21 recommendations into account in its bill. As the parliamentary secretary was saying, we do not have a lot of time. However, we should be considering all aspects of this issue. We made one recommendation that generated a lot of questions, our recommendation on mature minors.

Some witnesses told us that, for years, they have been helping young people around 16 or 17 years of age who have lived with incurable diseases for a long time and that those young people achieved a degree of maturity that very few adults achieve over the course of their lives.

Of course, after hearing this sort of testimony, we cannot close the door on that aspect of the issue. We cannot move forward with it now, because studies need to be done. One of our recommendations was that the necessary studies be conducted according to a certain timeline. We should not wait for these young people to end up before the Supreme Court.

As I said, the legislation leaves too much room for interpretation. I believe that, as parliamentarians, we have the duty to ensure that people who are sick do not have to continue to go before the courts to defend their right to physician-assisted dying.

Lawyers told us that we could consider the Carter ruling as a floor. That is what we, as MPs, chose to do. The Conservatives are saying that the Carter ruling should be considered a ceiling. The Liberals decided to go below the Carter ruling and down into the basement with their provision on reasonably foreseeable natural death, and that needs to change.

The Liberals keep telling us that $3 billion has been promised for palliative care. That is only a promise. There was nothing about it in the budget. However, all of the witnesses spoke about palliative care. Everyone in my riding has talked to me about it too. The important thing is to work for the best interests of all Canadians and to allow them to die with dignity.

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

Mr. Speaker, with respect to the importance of palliative care, the member referenced that we heard from the government, not only in recent weeks, but for a number of months, in terms of its commitment to palliative care. It is a very important part of the debate, no doubt, and as we continue to debate, a very emotional piece of legislation about which we are all very opinionated. However, one of the things that is very important for us to recognize, when we talk about palliative care, is that there are many different stakeholders—in particular, provinces, first nations, and so forth—that need to play a critical role in the development of palliative care policy.

I wonder if the member might want to provide some comment, from her perspective, as to how important it is that Ottawa work with the different stakeholders to ensure that we do provide the type of palliative care that Canadians from coast to coast want to see?

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

Mr. Speaker, we must go much further. The federal government must provide leadership on palliative care. It is all very well to promise $3 billion and to promise to talk about it, but there was no money in the last budget to initiate discussions with the provinces and carry out the necessary studies.

I held consultations in my riding, which has one of the largest long-term care facilities in Quebec. For hundreds of seniors, there are only 12 palliative care beds in that institution. That is clearly inadequate. It is not enough to promise $3 billion. There has to be money in the budget, and the government has to get to work on this right now.

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

Mr. Speaker, I thank the member for her remarks.

The member for Parkdale—High Park, I believe it was, is quite correct to say that this legislation would create one of the most permissive euthanasia regimes in the world. That is certainly what I understood him to say, and I think that would be quite correct.

We are limited to some extent, obviously, by the legal environment we are in. However, my concern is that this does not contain the safeguards we need to ensure that there are precautions in place so that someone who took someone's life without consent would be effectively prosecuted.

I want to ask the member if she would support my proposal to remove the reasonable, but mistaken, provision within this bill. I think that would be a substantial improvement.

The bill right now says that people could avoid prosecution if they have a reasonable, but mistaken, belief that someone consented. This would allow people to take the life of a person who did not consent and, yet, escape prosecution if they could at least show, beyond a reasonable doubt, that they had a reasonable, but mistaken, belief.

Would the member support removing that very concerning section, in order to ensure that vulnerable people are protected?

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

Mr. Speaker, the clause on natural death that is reasonably foreseeable is the most contentious clause in this bill.

Yesterday, Quebec's health minister, Gaétan Barrette, said that the courts would quickly strike down this clause. He even called on doctors to rely on Quebec's law rather than the federal law as drafted. We have a duty to ensure that the law is clear.

In recent weeks, some Quebeckers have starved themselves to death while trying to become eligible for medical assistance in dying. That has to stop. People have to be able to decide to die with dignity. Our law must allow it.

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

Mr. Speaker, I would like to thank my colleague for her work on this issue.

Could she talk about access to medical assistance in dying for all Canadians, no matter where they live in Canada, as it is now a right protected by the charter as a result of the ruling?