Debates of May 2nd, 2016

Criminal Code

[Rob Oliphant, Liberal, Don Valley West, ON]

Mr. Speaker, indeed, I think the member for Kitchener—Conestoga has it right. There are a variety of ways that people die and there are people who have been very clear about having a “do not resuscitate” order or that no heroic measures be taken.

However, there also comes a time when certain people have reached the end and physicians are working with them. There is a covenant. There is a sacred covenant, I believe, between our physicians and patients that allow them to understand that the role of the physician is to end suffering. It is not necessarily to prolong life. There are certain times when the natural course of life is taking too long for people who are suffering.

There was a case in Quebec recently where someone did not meet the bar because their death was not in the foreseeable future. They had to actually starve themselves, stop taking food, stop taking water, for 53 days, until they were finally allowed to pass away, as people say these days. I think that is unfair, and the Supreme Court has ruled that unfair.

The reality is that the Supreme Court has said it both allows for physicians to assist people in dying and for people to take that upon themselves with physicians helping them. I am proud to live in a country that is that compassionate.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, I want to thank my friend the member for Don Valley West and also my friend the member for Kitchener—Conestoga. I do not recall, in the five years that I have been in this place, a conversation or a debate that has taken place over an issue that is this difficult where there has been as much respect given one side to the other, one member to the other. We all recognize this is a deeply difficult issue. It is an ethical issue, it is an issue of rights, and it is also an issue of individual morality. It is a tough one, to put it mildly.

However, I am concerned about one part of this legislation that the hon. member for Don Valley West touched upon; that is, the notion of insisting that the person be capable of, once again, reasserting their decision to ask for physician-assisted death even after they have lost the capacity to have mental competence.

Again, on this question of an advance directive, this section of the legislation goes against the very essence of what the Supreme Court of Canada said we must do, which is to not put people in a position where they feel they must take their own life prematurely. They want to be able to trust the fact that they have made determinations for their end-of-life care.

I put that to my friend, the member for Don Valley West. Is that not, in a sense, asking the impossible, to ask someone who lacks mental competence to reaffirm a very clear decision that was made when they had mental competence?

[Rob Oliphant, Liberal, Don Valley West, ON]

Mr. Speaker, I want to thank the hon. member for her passion and compassion, as well.

This is the largest issue that has been raised in my riding in the last several weeks. Along with the member for Don Valley East, we held a town hall with about 200 people; 90% of whom asked for some capacity for an advance directive. They are very afraid that they are going to have to have a premature death because they are so worried that if dementia, Alzheimer's, or other diseases take place that would rob them of capacity, they are going to have to do that early. They are very concerned about that.

I had another meeting this week, in Leaside, and again, that issue came up.

I think the reality is that this will be unfolding over time. I think it is very important to review this legislation. We are going to take time as a society. I believe it has to happen.

One member I need to acknowledge is the late Francine Lalonde from the Bloc Québécois who brought this up and I also forgot to—

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

Resuming debate. The hon. member for Oakville North—Burlington.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Mr. Speaker, I am grateful for the opportunity to rise today to speak about Bill C-14, medical assistance in dying.

Death is a word that elicits strong emotions. We celebrate life. We embrace life. We talk about living. However, we avoid talking about death. We shy away from those conversations because they make us uncomfortable.

It is my sincere hope that this legislation will open the door to conversations about end of life and palliative care, about dying with dignity, and death.

I first want to thank all Canadians who participated in consultations with their provinces and the federal government on this issue. I want to acknowledge the work of all members of the Special Joint Committee on Physician-Assisted Death, who reported to Parliament at the end of February, and in particular my colleague, the member for Don Valley West, as well as the Minister of Justice and the Minister of Health. I personally appreciate their sensitivity and thoughtful dialogue.

I listened to the Minister of Justice and the Minister of Health when they spoke in the House on this bill. I have complete confidence in them to steward us as we begin the legislative process on Bill C-14, as well as in conversations about death and dying.

This is an issue that we have struggled with for many years. I recall in the early 1990s when former MP Svend Robinson compassionately took Sue Rodriguez's hand as she unsuccessfully sought permission from the Supreme Court to end her life as her ALS progressed.

The reasons for the need for this legislation are clear. The Supreme Court, in the Carter decision, unanimously decided that Canadians suffering intolerably have the right to request assistance to end their suffering.

With this legislation, the government has attempted to reach a balance, but, of course, in doing so will not please all people. Are there areas where the legislation does not go far enough? In my opinion, the answer is yes. Those with dementia will remain without an important option for end of life.

When on a journey with a terminal illness, there remains many questions pertaining to this legislation. I have no doubt that there will be fulsome discussion at committee on the legislation. I have received correspondence from residents concerned about implementation of this legislation by the territories and provinces. I am pleased that there will be additional study. This is just the beginning of the conversation, as it should be.

I know there are those who feel that this legislation goes too far. For the most part, I believe these people are fundamentally opposed to the Carter decision. However, regardless of where people fall on this legislation, I think we can all agree that the way we deal with death needs improvement.

Whether a grievously ill patient chooses to die at home, in a palliative care facility, or chooses medical assistance in dying, we should be having these conversations sooner, and lovingly assisting them in their end of life. These are not decisions that should be made during a health crisis, which is often the case. Rather, each of us should be engaged in advanced care planning.

I recall, shortly before my father passed away a few years ago, sitting in his hospital room as he battled pneumonia. My sister and I had to talk to him about his wishes should his heart stop. As members can tell, it was one of the most difficult conversations that we ever had. While it was painful and heartbreaking, it was also necessary.

While I recognize that this legislation is not the same as deciding on a do-not-resuscitate order, talking about death is difficult. Talking about the death of a loved one is incredibly difficult. However, because it is difficult does not mean we should not talk about it. In fact, I would say that because it is difficult is the very reason we should talk about it.

We do such a poor job of educating people about their choices for end of life. There are choices. We also do a really poor job of making available those choices for end of life. For those who wish to die at home, there are a lack of resources available to them. For those wishing palliative care, those options too are limited.

I believe the federal government needs to work with the provinces and territories to develop a better framework for end-of-life care. Our platform has included a much-needed $3 billion over four years for home care and palliative care.

Today marks the beginning of National Hospice Palliative Care Week. Shortly after I was elected, I had the opportunity to visit Carpenter Hospice in Burlington, one of the only palliative care options available in Oakville and Burlington for those in the last days and months of their lives. While I was there, we not only talked about the wonderful facility, but we talked about how we as a society need to have more open conversations about death.

I was deeply touched by Bonnie Tompkin's story. She is a community health coordinator at Carpenter Hospice, but her story is a very personal one. When her fiancé Ian was diagnosed with terminal cancer, he was adamant that he wanted medical assistance in dying. As is common, his biggest concern was the burden he would place on loved ones as his illness progressed. After he saw Carpenter Hospice and was educated on the options available to him, he made the choice to spend his last days at the hospice.

Carpenter Hospice is actively working with the City of Burlington on adopting a compassionate city charter. Widely implemented in the United Kingdom, citizens in compassionate communities are engaged, knowledgeable, and informed about death, dying, loss, and bereavement.

As our health and well-being extends beyond our health care system to our friends and loved ones, our connections to public spaces, and those in community, the thinking behind the compassionate city charter is that the community plays a similar role at the end of life. To quote from the compassionate city charter:

Compassionate Cities are communities that recognize that all natural cycles of sickness and health, birth and death, and love and loss occur everyday within the orbits of its institutions and regular activities. A compassionate city is a community that recognizes that care for one another at times of crisis and loss is not simply a task solely for health and social services, but is everyone's responsibility.

Compassionate cities are supportive of diverse religious and cultural beliefs. I met with a couple in my riding who were concerned that this legislation would normalize suicide, but if we are building compassionate communities and talking about both life and death, then we can give people the tools they need, and options for life.

The was a time when we did not talk about cancer. That changed when a one-legged young man embarked on the cross-country Marathon of Hope on April 12, 1980, forcing us to acknowledge not only his cancer, but the fact that people with disabilities need not be hidden from view.

We are only now starting to have a conversation about mental health, another subject that until recently was only spoken about in hushed tones. In fact, today on Parliament Hill, there was a walk for mental health awareness.

Death is another taboo subject, and one we do not want to talk about. However, because we do not talk about it, we do a disservice to our friends and loved ones when the time comes to face their own mortality.

I recently had a conversation with one of my best friends about death and dying, about this legislation, what end-of-life care should be, and what is lacking. Her husband, my good friend, is living with a terminal illness, ALS. Another of my good friends is currently navigating his father's end-of-life journey. These conversations are very hard, but perhaps in having these conversations we will make it easier for all of us to have choices, dignified choices about how our lives will end.

Death will never be easy to talk about, nor should it be, but death needs to be as much a part of our conversation as is life. We need to talk about life options and death with dignity. The time is long overdue.

We should perhaps take a page from the compassionate city charter and acknowledge that how we deal with death, dying, loss, and bereavement should be shared with the entire community, in every city from coast to coast to coast.

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

Mr. Speaker, I would like to thank the member for sharing her heartfelt feelings on this matter.

I am a new member of Parliament, and this is obviously a topic that is important to Canadians from coast to coast to coast. I wish we had more time to debate and discuss the topic.

The hon. member for Don Valley West referenced Quebec in his presentation. However, Quebec took six years to make its recommendations. Quebec took the time to meet with groups from all over, including families and those who were for and against. Again, I wish we had more time on this, but clearly we do not.

I met with a group of nursing students the other week. My son is going through sciences and wants to be a doctor. They all had the same question. This is something that through their chosen field they will ultimately be faced with, and it is a difficult decision. They go into this industry to help, protect, and make people better, yet at one point they are going to have to make the choice to administer this. The nursing students were flabbergasted that this responsibility could come down to them. The comments they had were, “I don't know if I can do that. I don't know if this is the right profession for me.”

What are we supposed to say to them? There should be more discussion about conscience protection in this. I understand all sides of the issue, and I have witnessed family members at end of life go through terrible areas. I have a special needs adult child, and I have concerns.

What are we supposed to say to the next generation of doctors and nurses, that we have not put safeguards in place through the bill before us?

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Mr. Speaker, to be honest, I know that people struggle with how to do many things when going into the medical profession. Doctors and nurses have to struggle with care throughout their careers. There are options for referrals if people feel strongly about this, but I think it is something that will be part of the discussions with the provinces and associations that govern nurses and doctors. It is a very important conversation to have, but certainly those professions already deal with very difficult decisions every day.

We trust them. I believe it was the member for Don Valley West who said that we trust the medical profession with our lives, and we need to trust them with our deaths.

As I said, it is the start of the conversation, not the end of the conversation. I think that is also the conversation we would have with new people going into nursing or medicine.

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

Mr. Speaker, I listened with great interest to my hon. colleague, and I am hearing the word “compassion” a great deal, and “options”. The problem is that most Canadians do not have those options because they do not have access to quality palliative care.

My colleague mentioned an election promise, but an election promise does not create it. This is done in the budget, and there were zero dollars for palliative care. This has to be spoken about in the House. Otherwise, everything else we are talking about is a fiction.

In areas of competence under federal jurisdiction, the word “compassion” strikes me because of section 12.1 of the non-insured health benefits for indigenous people. When they are being flown out to die, it says that under absolutely no circumstances will a loved one be allowed to travel with them. The federal government's rule for denying those from being with their loved ones who are dying is the word “compassion”. It is written into the federal guidelines that for these families, for compassionate reasons, their loved one has to die alone.

However, we can change this in the House. This is an area under federal jurisdiction. Will the Liberals look at dealing with this now so that we can be credible on this larger topic of compassionate choice at end of life?

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Mr. Speaker, I would like to thank the member for his passion on this issue. It is an important one. I know that he has done a lot of work with our Minister of Indigenous and Northern Affairs on this.

We do have to be more compassionate. Whether it is for our indigenous people or any people across the country, we need better options for palliative care.

To answer your question, that is why we need to start talking about it and to start investing and looking at how we can deliver.

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

I want to remind the hon. members that they do speak through the Speaker.

This a very difficult topic, and I just want to comment on the level of respect that is taking place in the House this morning. That is a tribute to all of the members who are here today.

Resuming debate, the hon. member for Louis-Saint-Laurent.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, as I rise today, I feel a sense of gravity and strong emotion. This is not the first time. Two years ago, when I was a member of the National Assembly of Quebec, I rose to debate the extremely sensitive subject of medical assistance in dying. At the provincial level, the debate was about end-of-life care.

This is therefore the second time that I have participated in the debate and the vote on this extremely delicate subject, and I intend to do so with diligence, careful consideration, and a great deal of compassion.

Usually when I rise I want to convince. That is the job of all politicians, to convince people. In this case, I do not want to convince; I just want to talk and to explain where I stand. Also, in political debate there is good and there is bad. In this case, no one is good and no one is bad; they are only honest Canadian citizens who want the best for the future of this country and the best for the future of our people, even if this debate is quite difficult and fragile.

Why are we here today?

We are here because a year ago, in February 2015, the Supreme Court made a ruling that had very serious and important consequences. It was the Carter decision that centred on medically assisted death.

The Supreme Court did not ask the House of Commons and Canada's Parliament to take a position for or against medically assisted death, but to develop a legal framework for it. That is the principle underlying this whole debate. We are not here to debate whether medically assisted death is good or bad. We are here to figure out how to give people access to it.

However, I have often said, and I want to repeat now from my seat in the House, that I find it very unfortunate that the Supreme Court gave the Parliament of Canada just under a year to take action. That is completely irresponsible. I know what I am talking about. I was a member of the Quebec National Assembly for almost seven years. I was there for the six years of detailed, painstaking work that led up to the passage of Bill 52. It took six years and three different governments with three different premiers: the hon. Jean Charest, the hon. Pauline Maurois, and the hon. Philippe Couillard. We worked on it for six years. There were two full years of direct consultation, and over 275 Quebeckers shared their opinions on the subject. However, the Supreme Court ordered the Parliament of Canada to take action within one year.

Why do I find that irresponsible? Because the Supreme Court knew that it was an election year and that this is not a subject for partisan political discussion. Despite all that, the Supreme Court ordered us to come up with legislation in under a year. The court knew that, as of February, the countdown was on to the month of June and that everything would then come to a grinding halt because the election was called for the fall and a new government would be taking office. In theory, parliamentarians could do nothing until December or January, and that proved to be true. In short, we lost six months in which we could have been debating this extremely important issue.

However, all was not lost. The previous government, led by the right hon. member for Calgary Heritage, set up a committee of three experts, including a former Quebec minister, whom I salute. This committee assessed all of the legal and parliamentary options regarding this sensitive issue and produced a document over 400 pages long. I am very proud to know that this work was done, despite the fact that it was an election year. I will come back to that a little later in my speech.

The report was written, but there was an election, and the new government created a parliamentary committee that could be described as bilateral, since it was made up of MPs and senators. The committee was co-chaired by a Liberal MP and a Conservative senator. Basically, the foundation for non-partisanship was laid, so that was good.

Despite the fact that we had very little time to do our work, in fact barely five or six weeks, we had 13 meetings, we heard from 61 witnesses, and 132 briefs were submitted. That is great, considering the time we had. I want to commend all of my colleagues who are here. I see the House co-chair, as well as my colleague from Toronto. I apologize, but I do not know all the riding names by heart. The names are very long, and perhaps we should change that one day, but that is another matter altogether.

I want to commend all of my colleagues for working in such a positive, constructive, and non-partisan manner. It was an extremely delicate and difficult subject, but we took a serious and thorough look at it.

After all our work, two reports were produced: a main report and a dissenting report signed by the member for Langley—Aldergrove, the member for Kitchener—Conestoga, the member for St. Albert—Edmonton, and me.

Before I get into the substance of the dissenting report, which I signed, I want to point out that the Conservative MPs on the committee were the ones who signed it. However, it was not a Conservative dissenting report, since the Conservative senators did in fact sign the main report.

Let there be no mistake: in this case the dissenting report was not a Conservative dissenting report. It was a dissenting report from members of Parliament, because the Conservative senators signed the majority report.

It is very clear, and we have to be very careful with that. There was not a political agenda behind our dissenting report.

In the dissenting report, my three colleagues and I were driven by the need to protect the most vulnerable, but also by Carter and especially by what we referred to in our report as “the Quebec experience”.

I am proud to say that I witnessed the Quebec experience. Together, we applied that experience in the dissenting report and used it as a model in determining what should be done. We did that because in Quebec, we took our time to address this issue properly.

In Quebec, after six years of debate, work, intellectual rigour, and careful consideration, we came to certain conclusions. Bill 52 became law to ensure that everything is done properly with a certain social consensus.

It is very tough to have consensus on this difficult issue.

Our dissenting report outlined five concerns. I will read them, then go over them one by one.

First, we felt that end-of-life care should not be provided to minors. Second, we established that people suffering from mental illness should not have access to medical assistance in dying. Third, we raised the need to protect the conscience of doctors and health care professionals. Fourth, medical assistance in dying should be provided only to people at the end of their life. Lastly, we had some serious concern over palliative care. Those are the five concerns outlined in our dissenting report. Let us look at them one by one.

First, this should not apply to minors. This is a very sensitive topic. The Supreme Court was talking about adults, not minors. What is more, the Quebec experience applied only to adults. This otherwise creates almost insurmountable problems.

Imagine if the parents of a 16-year-old son or daughter refuse to allow their child to receive end-of-life care. What then? Who is right, the child or the parents?

In the worst case scenario, if a 17-year-old child asks for end of life care, which his father wants but not his mother, who is right? Do we try to convince the mother? That is so difficult, so touchy, so fragile.

That is why our dissenting report put aside minors, aided by the Quebec experience.

We do not want this bill on medical assistance in dying to apply to people with mental illness because it is almost impossible to determine at what point they are capable of giving informed consent. People with mental illness are unaware of what is happening. I know that it is terrible to say such things, but it is the truth.

This is the truth. For those who suffer from mental illness, it is very tough and difficult for them to be very clear on what they want to do. If we were to put them in that kind of situation, we would see the worst. Again, based on the Quebec experience, we put it aside.

Let us now discuss conscience protections for physicians and health care practitioners. This is a delicate but very important subject. Quebec came up with a rather unique solution, and one that the government should use as a model.

We must respect the patient who, in his heart and soul, wants to receive end-of-life care. However, we must also respect the physician who must provide this care. If the physician does not want to proceed, we must respect that. This is Quebec's solution: the physician who does not want to provide this care must refer his patient to a third party, namely, the administrator of the hospital or CLSC, and this third party will refer the patient to another physician. Thus, a physician does not refer his patient to another physician because a third party is involved. Consequently, a physician who is uncomfortable dealing with this situation does not find himself referring his patient to another physician. This decision must be respected. This is a detail, but it is all about the details in this bill and the entire medical assistance in dying situation. We must have conscience protections.

Once again, based on the Quebec experience, we believe that the same is true with respect to the end of life. At what point can patients give their consent to medical assistance in dying?

Quebec, after examining this issue for six years, concluded that patients were able to give consent at the end of their life and not before. It is quite easy for a guy like me, who is 51 years old, in good shape, and feeling well, to say that if I ever get sick, no problem, the doctors will come and that will be it. It is easy for me to say that at the age of 51, when I am in good health. However, will I feel the same way when I am at the very end of my life? Not necessarily, which is why we need protections in this area. Once again, there are five concerns based on the Quebec experience. The fourth one has to do with the fact that Quebec makes it clear that only patients who are receiving end-of-life care may receive this type of medical assistance.

The last concern is palliative care. My colleague from the second opposition party spoke about this earlier. We believe it is extremely important to have full, comprehensive palliative care for all Canadians, and not just for one-third of Canadians, as is the case now. We really need to focus on this.

There was the main report, the dissenting report, and the five concerns I mentioned, which were based on safeguards for the most vulnerable, the Carter decision, and the Quebec experience. After we presented our report, it was up to the government to proceed and introduce its bill.

Therefore, what we have now is Bill C-14. What we like in the bill is what it does not have. That is funny to say, but it is true, because the bill put aside some of the most touchy subjects that we put in our dissenting report.

In our dissenting report, we did not want medical assistance in dying to be available to minors or people suffering from mental illness. The government embraced our position, which is good. We thank it for that. Congratulations.

However, we still have some other concerns regarding this bill, particularly when it comes to conscience protection. This bill contains no provisions regarding the protection of conscience for doctors and other medical practitioners, including nurses and pharmacists, in the context of medical assistance in dying.

I asked the Minister of Health about this during the debate two weeks ago. She said that it was not mentioned because it falls within provincial jurisdiction. Technically, that is true, but we are in a federal Parliament. The bill's own preamble clearly states that the law must adapt and apply consistently all across Canada. We need to have a national policy in order to avoid fluctuations from province to province. Once again, I urge the government to learn from the Quebec experience, which allows for the protection of conscience for doctors.

What will happen if that protection is not ensured? It will be left up to the provinces to decide whether they want to provide, or not, a framework for this in a particular way. I understand the goodwill of the Minister of Health, but there is such a thing as too much vagueness. In this situation, we are not talking about deciding between an apple and an orange; we are talking about deciding whether to live or die. Vagueness is unacceptable in this situation. We need to provide clear guidelines, particularly regarding conscience protection, because there is nothing that is more fragile and more precious than the conscience of someone who is there to save lives or end lives, depending on the patient's wishes.

I invite the government to take a closer look at the Quebec experience and really take note of that experience, as well as what we have said.

As I mentioned earlier, in Quebec it is clear that this type of care is provided at the end of life. In the legislation we find the concept of “reasonably foreseeable”. I have to read that because I have been asked about this a number of times and I always have a hard time because it is a bit vague.

I can assure the House of one thing: I am going to die. That is foreseeable. There is no doubt. I am 51 and I think I have done more than I have left to do. Reasonably, I could die in a few decades. I am in no hurry, by the way.

What I am trying to say is that “reasonably foreseeable” is not clear. The first question I was asked in an interview on RDI by Julie Drolet, a former colleague whom I salute, was whether I really understand this “reasonably foreseeable”. Well, the answer is no, not really. That being said, I am not the one who drafted the legislation. Perhaps we need to ask the minister that question.

All that to say that this needs to be clear, as does “conscience protection”. The same goes for end-of-life and what is reasonably foreseeable. It is much too vague.

During an interview last weekend on Radio-Canada's political television show, Les coulisses du pouvoir, Quebec's health minister, Dr. Gaétan Barrette, said there could certainly be a debate about the legality of this bill with respect to the notion of reasonably foreseeable death. He added that it should be reasonably foreseeable regardless of the prognosis on the progression of the disease. After all, if death is reasonably foreseeable, that means a prognosis has been reasonably established.

In situations like that, there is no clear answer. I would ask the government reasonably, no pun intended, to clarify its thinking on this.

There is a similar issue with regard to nurses and doctors. They say that nurses can provide the care. I want to be very clear. I have tremendous respect for nurses. Based on my experience in Quebec, they are the ones who keep the health system going, and I thank them for that. However, we think that a diagnosis of this importance needs to come from a doctor. People might think I am saying the same thing over and over again, but that is the conclusion drawn from the Quebec experience after six years of thorough, serious work.

With respect to palliative care, we all agree that more money should go to that. I would like to point out that the latest budget allocated no money to palliative care, even though that is an extremely important and sensitive subject. In a press conference, the Leader of the Government in the House of Commons talked about allocating $3 billion. That is very nice, but we would like to see that in the budget. The government can be sure we would support that enthusiastically.

Nothing is perfect, especially this bill, but we should be very concerned about that. We should be very concerned, because if we do not adopt a law, good or bad, we will have to deal with the Carter decision. For some people, it will be the worst-case scenario, because in that case, the medical professional associations in some provinces will say one thing and the associations in other provinces will say another thing; some provincial legislatures will adopt certain bills and other legislatures will adopt other bills. There will be a lot of movement in Canada in that case and the last thing we want is movement. We need a clear bill on those issues.

I want to say that this is obviously a very emotional debate. Everyone who speaks to this issue will be right. They have the right to do so and we hope they will. No one here is wrong, no one here is right. We are all honest Canadians and we want to do what is best for the future of this country and for the future of Canadians.

[Anthony Housefather, Liberal, Mount Royal, QC]

Mr. Speaker, I would like to thank my hon. colleague for his very wise words.

I imagine that as one of the MPs who wrote the dissenting report, he must be generally pleased. In drafting the bill, the government really took a look at the dissenting report.

I would like to ask a questions about conscience. We all agree that we must protect the freedom of conscience of medical practitioners and nurse practitioners, but this has to do with criminal law. There is a criminal prohibition, and now there is an exemption from the criminal prohibition.

Where in the bill will we include protection for a nurse's or medical practitioner's freedom of conscience? I understand that it is a good thing to have a bill that will cover all Canadians and that there will be consistency across Canada. However, as you know and as you said in your speech, this comes under provincial jurisdiction.

Do you have other examples? As committee chair, I am interested in this because I want to determine whether we can accept an amendment on this issue or whether such protections already exist in the Criminal Code.

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

Before the member answers the question, I would like to remind members that it is important that they address their comments to the Chair and not directly to other members.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

I will answer my distinguished colleague's question through you, Mr. Speaker. He is a lawyer so he knows what he is talking about when he says that this is a legal issue.

This issue falls under provincial jurisdiction. However, it is such an important one that we need to ensure that we have a consistent approach across the provinces.

If doctors' conscience is not protected in the legislation, some medical associations might challenge it, which will lead to variations from province to province. That will result in delays and the rise of health tourism, a term that horrifies me. For example, dissatisfied people in Alberta may go to Quebec, and dissatisfied people in Quebec may go to Newfoundland.

That could very well happen in this case. As the member so clearly stated, we are all gathered here because this issue relates to the Criminal Code. This issue sits at the very precarious junction where the Criminal Code meets health care delivery, an area of provincial jurisdiction.

I find it hard to imagine that one of the provinces would challenge this sort of law because this issue falls under its own jurisdiction. In the unlikely event that one of the provincial health ministers dared to do so, he would have to face the wrath of the people he represents.

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

Mr. Speaker, I thank my colleague from Louis-Saint-Laurent for his wonderful speech. I was listening carefully. He rightly brought up his own experience with the debate held in Quebec, and I think this experience is very important.

In Quebec, legislators realized that this law had to respect Quebec's own areas of jurisdiction, so they quickly started talking about end-of-life care, to ensure that the debate remained focused on health care.

Will the decision that we are making in Ottawa prevent unintended consequences that may not even have been considered in Quebec? For example, people are starving themselves to get access to end-of-life care.

By getting the legislation right in Ottawa, we can ensure that this legislation enables people who have serious medical concerns to make this decision. It always comes back to the issue of a reasonably foreseeable natural death. I agree with my colleague that this concept is rather vague. However, we do not want to have people starve themselves to access a service to which they are entitled.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, unfortunately, no legislation could have prevented that type of situation. We have to realize that.

There is not much we can do about people who are in utter despair. It would be nice to pass legislation asking them not to starve themselves in order to access this care. That goes without saying, but it will not stop those who are in the darkest days of their lives and feeling so vulnerable that they would go to such lengths. Should we pass such legislation? It is too hard.

It is on all of us as parliamentarians. We have certain responsibilities, but we must also work within certain boundaries, including our conscience, which is part of being human. That is why we must protect the most vulnerable among us. That is why this will not apply to minors and especially not to those suffering from mental illness. Those people are far too fragile.

If I said that this could prevent unintended consequences, I would be lying, unfortunately, because we cannot control human nature. We can try to limit them, but preventing them completely is wishful thinking.

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

Mr. Speaker, I want to follow up on the question from the member for Mount Royal about jurisdiction and conscience, because it is a very important question. In fact, the Carter decision recognizes health care as a joint area of jurisdiction, so it is very clear that there is involvement of the federal jurisdiction. Also, it is important to acknowledge the parallels to the same-sex marriage debate and what the then Liberal government did in the Civil Marriage Act with respect to protecting the conscience of religious officials who did not want to perform same-sex marriages. It was important at the time, as part of that debate, to ensure that nobody would be forced to perform that union, a religious official who did not want to. It was put in that legislation, even though the solemnization of marriage is done at the provincial level.

We see a clear parallel, and if it was doable then by a Liberal government, there is no reason not to include conscience protection in this legislation as well. Very similar language could in fact be used in the development of the amendment. That is important. It is something worth considering when we have a major social change like this. Some people will want to be part of that change, but others will not want to be part of that change, and we should respect those who do not want to be part of that change.

I wonder if the member sees a parallel between these two debates and would support including a similar provision in this law, as the previous Liberal government did in the Civil Marriage Act.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, I will speak to what I know. I am very familiar with the issue of medial assistance in dying and end-of-life care, as I took part in drafting the two applicable statutes. I can say that in extremely sensitive and fragile cases, we have to respect the doctor. I personally received calls from Quebec doctors about this. They told me that they were there to save lives and what they were being asked to do goes against their long-held beliefs. They agreed to do it, but we have to realize that doctors are ultimately there to save lives.

[Lloyd Longfield, Liberal, Guelph, ON]

Mr. Speaker, the hon. member has an excellent approach to the subject. It is definitely something very personal for each of us. I know myself, with my mother's passing, we had some very difficult conversations at that time.

This goes beyond what we do in the House here. However, one of our responsibilities is to provide guidelines for the conversations.

Let us look at the role the provinces play in this conversation. I was personally struggling with recommendation 11 from the committee, as a member of a Catholic community within my riding and having a lot of Catholics reporting to me that they were very concerned about Catholic institutions being mandated to perform services against their conscience.

The current legislation is leaving some very important details up to regulations with the provinces and those who are reporting to the provinces. We have a tight timeline. We have to provide some guidelines that may be seen by some as not restrictive enough and by others as too restrictive.

Could the hon. member comment on the need to have some flexibility in terms of getting this to the provinces for further discussion?

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, based on the Quebec experience, we have to have conversations with each other. We need to have good conversations with the provinces. We had that in Quebec.

The member talked about his personal experience, as did his colleague a few minutes ago. I want to say that everyone has the right to act on behalf of their own conscience.

In Quebec, I voted for the law. I voted for the bill. However, 22 members of the National Assembly voted against it, all members of the Liberal Party, the governing party. Among them, 11 cabinet ministers, nearly half of the cabinet ministers, voted against that bill.

I do not want to interfere with everyone.

However, every member has to know that he or she is entitled to vote their conscience and that every vote is important, every vote is good because it is the vote of each individual member.

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

Mr. Speaker, I rise today to speak to Bill C-14 regarding medical assistance in dying. This is not the first time I have had the honour to participate in the discussion of this matter as a member of Parliament. I also was a member of the Special Joint Committee on Physician Assisted Dying. As a member of that committee, I was able to hear the thoughts of many people, both in my riding of Toronto-Danforth and across the country, on this very important issue that affects us all, and that is our end-of-life care.

My preference would have been for a bill that would have allowed for a broader scope of application. However, I support this legislation because it is a first step in the right direction, and it was a commitment to study the important issues of age, mental health, and advance directives, as will become apparent as I speak further. We need to take this first step, because this file has been left to languish for too long. My step would have been a bit bigger, but I am ready to start here on this path of incremental change.

Mr. Speaker, I intend to share my time with the member for Hamilton West—Ancaster—Dundas.

To date, we have struggled with the question of whether to allow, or not, medical assistance in dying. However, now we are faced with a different question, specifically, how we are going to legislate that assistance. This is an important change for us to consider, because following the Supreme Court of Canada decision in Carter, medical assistance in dying will be legal as of June 6. This bill is important because it gives us the opportunity to create a federal framework to govern medical assistance in dying.

In 1983, the Law Reform Commission of Canada reported on “Euthanasia, Aiding Suicide and Cessation of Treatment”. It found three basic principles reflected in our law, and I find that these principles set a good basis for our debate. The first is that the protection of human life is a fundamental value. The second is that patients have the right to autonomy and self-determination in making decisions about their medical care. The third is that human life needs to be considered from a quantitative and qualitative perspective.

I find it particularly instructive that the second principle creates a basis for a patient-centred approach to medical assistance in dying. This was the approach adopted by the Special Joint Committee on Physician-Assisted Dying on which I served.

Looking at the history of this issue, I have traced a long path of private members' bills, Senate bills, and private motions in the House. The issue has been before us approximately 11 times since 1991. The list of past attempts on this issue is incredible and demonstrates that efforts that have been made to grapple, unsuccessfully, with this issue have continued for too long. It is why I find it so important for the House to cross over this impasse and to take the first step toward legislating a framework.

The issue has not only been before us here. The other place has also considered the matter in committees, subcommittees, and bills. Just over 20 years ago, the Special Senate Committee on Euthanasia and Assisted Suicide released its report “Of Life and Death”.

The goal of that committee was to set the stage for the national debate that would take place in the years to come. The majority of senators on the committee were not ready to support medical assistance in dying. The minority on that committee made some recommendations to support medical assistance in dying for an individual who was competent and suffering from an irreversible illness that had reached an intolerable stage, as certified by medical practitioners.

Over the weekend, I finished reading the Hon. Steven Fletcher's book, Master of My Fate, which outlines his experience as a parliamentarian, generally, but focuses upon private members' bills that he brought on the issue of medical assistance in dying. The book brought special insight into his journey on this question. He shared his story of the massive accident that rendered him quadriplegic and his election to the House, including the time he served as a cabinet minister.

Our most recent initiative in the House on the issue of medical assistance in dying was two connected private members' bills put forth by the Hon. Mr. Fletcher. The first, Bill C-581, proposed to amend the Criminal Code to permit a doctor to assist a person in taking his or her own life. The eligibility criteria proposed in the bill would track the language in Carter very closely. I will read the most salient eligibility criterion for the sake of the House:

...a person must...have been diagnosed by a physician as having an illness, a disease or a disability (including disability arising from traumatic injury) that causes physical or psychological suffering that is intolerable to that person and that cannot be alleviated by any medical treatment acceptable to that person, or the person must be in a state of weakening capacities with no chance of improvement...

His other initiative, Bill C-582, proposed to establish a Canadian commission on physician-assisted death, which would have collected data from physicians who performed physician-assisted death. It recognized the possibility for incremental steps.

The bills were read a first time and left to languish on the Order Paper. However, on December 2, 2014, similar legislation was introduced in the other place and was debated on seven occasions, as late as June 2, 2015.

As we all know, during that time frame of December 2, 2014, to June 2, 2015, the Carter decision was released.

It is also worth noting that there have been active discussions in our provinces and territories about a framework for medical assistance in dying. The most notable example is Quebec, which struck a committee in 2009 to develop legislation on medical assistance in dying. The legislation came into effect in December of 2015. Much has been said regarding that law, and I will not repeat it, but it is notable that they too have a terminality provision.

I found it interesting that in testimony before our committee, Jean-Pierre Ménard of the Barreau du Québec stated that he believed the terminality clause of the Quebec legislation would have to be removed in light of the Carter decision. It underscores the point that such legislation will develop through incremental changes.

Working on the joint committee was an amazing experience. It was the first special joint committee in 20 years, and I see a strong value to this form of collaboration on major issues. The witness testimony and the thoughtful written submissions gave us a strong base upon which to form our recommendations. I stand behind the recommendations that we made. We did not come to our decisions easily. We lost sleep, debated a lot, and worked together to formulate our recommendations.

How then does my background on this file inform my views of the legislation we are debating today. I would have preferred that it would be broader. Most of what I have heard from my own constituents favours a broader approach. However, the bill is the first step into a complicated matter.

We need to empower individuals to choose how to manage the end of their lives and give value to the law reform commission's idea of a patient centred approach. Also, we need to consider not only the quantity of life but the quality. We need to respect people's autonomy and their right to be free from suffering, without putting vulnerable Canadians at risk. Bill C-14 gets us much closer to that goal than we currently find ourselves.

I would have preferred that we remove the clause of a reasonable and natural death, which refers to the foreseeability of a natural death. It is a terminality clause of sorts. The clause is vague and could place an overly broad restriction on a sick person's right to be free from pain and suffering. The concern about this terminology is that it tends to devalue the lives of the oldest among us. They are the most likely to be given permission to seek medical assistance in death with the legislation.

The young and sick suffer as much as the elderly. To quote Steven Fletcher “If the person is a cognitive adult, why on earth would we impose our views on what their quality of life is on them?”

The lack of advanced directives in the legislation is also too restrictive. A fundamental point of the Carter decision was that the Supreme Court of Canada had found a violation of “Life, Liberty, and Security of the Person” if individuals would feel they would have to cut their lives short because they did not have an expectation that they could end it later when the time would come. It is a tricky issue, but I am happy to see a commitment to study the issue further.

In my opinion, the positives of the bill outnumber the negatives, so I will be supporting the bill. However, I do see it as a first step on the journey.

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

Mr. Speaker, I want to thank my colleague for her service on the joint parliamentary committee that studied physician-assisted dying.

My colleague referred many times to my former colleague, Steven Fletcher, who appeared before the committee. I have had many conversations with him, and I understand his position. However, my concern is that had Mr. Fletcher had access to physician assisted suicide years ago when his accident first occurred, he very well may have followed through. That would have been a huge loss for Canada and for his family.

My concern is that when we implement these kinds of decisions, there is always the risk of one person inadvertently terminating his or her life, which would be a huge loss. We no longer practice capital punishment in Canada. One of the reasons is that it is too great a risk that one innocent person might die.

How would my colleague ensure that someone like Mr. Fletcher, who in a time of deep depression and deep physical suffering, may have taken the choice that would have hurt him and all of Canada because of the loss of his life and his contribution to our country?

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

Mr. Speaker, I would rather not speak about an individual specifically when I respond to my friend, because I cannot predict what his decisions may or may not have been if this legislation had been in place.

To speak more generally, I understand the point the member is raising. It was a question that was a concern to me and the committee as well when we examined the issue of a person who suffered a traumatic injury and was faced with a change of circumstances. How would that person handle these types of decisions? We did hear evidence before the committee on this issue, especially from Professor Jocelyn Downie, which stands out in my mind.

When we talk about irremediable as part of the determination and the assessment of competence, a person right after a traumatic injury may not, in a medical opinion, be found to be in an irremediable state and able to make the competence test because he or she would be in a state of flux at that moment.

We need to look at that further. That is just something we heard in our evidence. It was one position. That is why I am so happy we are committed to looking at the issues and discussing them further, because it is an important question.

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

Mr. Speaker, this issue affects all of us and we respect the very personal views that are brought forward.

What concerns me in the legislation that has been put before us is that we are not talking about an overall balance in end-of-life choices. We are talking about the very specific responses to the Carter decision. Eighty per cent of Canadians do not have access to quality palliative care. Therefore, 80% of Canadians facing end of life and their families do not have choices about good quality end-of-life care. In this vacuum, there must be a commitment by the federal government, but we have not seen that. We saw zero dollars in the budget for palliative care.

The New Democrats have Motion No. 46 before the House about moving forward not only on a palliative care strategy, but also taking responsibility for areas under federal jurisdiction. The federal government plays a huge role in the delivery of health services and it denies palliative care services often. There are also issues of changing EI provisions to help families.

Where is the government's commitment to the larger discussion on end of life in which Canadians need to be engaged?

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

Mr. Speaker, palliative care is an important part of the discussion about end-of-life care. There is no question that it has come up several times in this place and it is important.

I am a little wary of throwing around percentages and numbers. At committee, we heard a lot of different percentages. Perhaps it is that we do not have a fulsome understanding at this moment about what access to palliative care truly is. This needs further examination as well. On the numbers, I am a little concerned about percentages.

From what we heard and read at committee, the jurisdictions that have introduced medical assistance in dying have increased their access to palliative care at the same time as quality of that care.