House of Commons Hansard #46 of the 42nd Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was palliative.
Nathaniel Erskine-Smith Liberal Beaches—East York, ON
Mr. Speaker, we have had a parliamentary committee do incredible work getting a report out after holding hearings that would have taken months and months on end in a very short time span. We have legislation before us that requires fixes, yes, but in the main part addresses the Supreme Court's concerns.
I do not believe an extension is necessary. I do not believe it would be granted if sought. I believe it is incumbent upon this House to act expeditiously and get this legislation passed.
Sheila Malcolmson NDP Nanaimo—Ladysmith, BC
Mr. Speaker, I appreciate the member's particular focus on the absence of advance directives in the legislation. I share his concern. I would like to explore that a little more with the member. Perhaps he could shine a light on why this might have been missed and how we could fill the gap.
In paragraphs 13 and 14 of the Carter decision, the Supreme Court referred to the cruel choice that is posed to legally competent patients facing degenerative diagnoses, and those who have to choose between taking their lives prematurely or losing capacity later on. The member referred to that in his speech. The solution proposed by the all-party committee, which I salute, was to allow them to record their wishes while legally competent, and then through an advance directive, which would be subject to the same stringent medical and legal safeguards as the instantaneous request that is more identified in the legislation that is before us.
I am hoping the member can shine a light on why his government ignored that very specific and very constructive recommendation.
Nathaniel Erskine-Smith Liberal Beaches—East York, ON
Mr. Speaker, I do know that the Canadian Medical Association has raised concerns and red flags with respect to advance directives. I expect that that worry has led my government to proceed more cautiously.
We can note that the parliamentary report in and of itself provided for advance directives, but limited to where individuals had been diagnosed. Even among advance directive advocates, and in looking at that parliamentary report, we can in fact go further. I personally think we ought to go further.
While, unfortunately, those advance directives did not find their way into this legislation, my hope is that parliamentarians across the aisle and on this side of the floor can work together to ensure that we protect fully informed choice, whether one is terminally ill or not, whether one has been diagnosed or not, through advance directives.
Marilyn Gladu Conservative Sarnia—Lambton, ON
Mr. Speaker, I will preface my comments tonight by saying it is not my intent to offend anyone, but I do believe that this is the time for plain speaking.
This bill is about choices and it is about rights. Although I resent that the Supreme Court has ignored 15 rulings of Parliament that said we did not want to bring in any law on this subject, I respect that we have to bring one in by June 6. Of course, if we do not bring one in, I am not sure that the consequence is worse than this rushed Bill C-14. As I understand it, if we do not bring in legislation, we remain in the circumstance we are today, where there is the precedent of the Carter decision but no law in either direction for or against.
I said that the bill is about choices and rights. First, let us talk about choices. If I want to kill someone, myself, my baby, or someone else, this is a choice I can make today in Canada. Each one has consequences not just for me, but for many others. If I kill myself, my insurance will not pay out, and that will affect my family. They will also deal with, hopefully, the emotional trauma from the shock of missing me.
If I kill my baby pre-term, I have to live with that, and the father of the baby has to deal with it, but otherwise, there is currently no consequence.
If I kill someone else, I risk imprisonment. I understand that the Carter decision is trying to ensure that even people who cannot pick up a gun themselves can choose to get assistance in killing themselves.
However, their choice does have an impact on others. It has an impact on the health providers who are opposed to participating and whose rights of religious freedom and the right to refuse to participate are not adequately protected in this current version of Bill C-14.
It has an impact on the taxpayer, who will be paying for several doctor consults, and if some of the suggested amendments come into place, additional psychiatric reviews or judicial reviews, as well as the drugs to do the deed. When we kill ourselves, we pay for the bullets or the rope.
Let us look at how this legislation addresses the Carter decision. Keep in mind that the Carter decision limited the scope to those who are over 18, terminally ill, and can give consent. I do not see anywhere in the Charter of Rights and Freedoms that we have the right to die, only that we have the right to live, so certainly the Carter decision, in my view, is flawed.
However, the decision limited the scope to those over 18, terminally ill, and with the ability to give consent, so I find it incredible that this bill before us is looking to study extending this right to mature minors, to those with psychological only conditions of suffering, and those who do not qualify as mentally competent to give consent.
I was a youth leader for over 30 years, and I have known young people who broke up with their boyfriends and girlfriends and who took their own lives. These were tragedies that could have been avoided if hope and counsel had been provided. However, there will be many more lives taken before their time if we allow mature minors to ask for assisted death.
This is a dark path. We should not be studying it or even considering it.
With regard to the studies on whether people who are mentally ill should be able to request medical assistance in dying, I am asking that the bill be amended to ensure that it does not provide for that possibility at all.
Many people suffer from depression, but it is treatable. I know many people who take anti-depressants and medications that come with a warning that possible side effects may include suicidal thoughts. If we start killing people who are not actually dying, it is akin to murder.
For those who want to give their advance consent to be killed later, I ask them: why wait? Why not let them choose suicide when they are still able to commit suicide, rather than letting someone do it for them? They are not choosing to commit suicide in the beginning because they want to live as well and for as long as they can. That is why Canada needs good palliative care.
In my riding of Sarnia—Lambton, we have excellent palliative care. St. Joseph's Hospice has a wonderful staff, and we have the co-operation of Bluewater Health, the VON, community care, and so many other organizations, along with palliative care specialists who give the end of life dignity and meaning.
However, because palliative care is not completely funded in Canada, the hospice has to undergo significant fundraising of some $1.4 million each year. Government funding covers only 43% of the costs. Food, building maintenance, program coordinators, day hospice, and crisis support are not covered.
The cost of palliative care at home or in hospice is one-quarter of the cost of palliative care in acute care facilities. However, Bill C-14 would not do what it so simply could: amend the Canada Health Act to make palliative care a covered service so that all Canadians would have the end-of-life care that would cause them to choose life. Yes, of those who have good palliative care, 95% of them choose to live as long as they can and as well as they can. That is something missing in this bill.
Now that we have talked about choices, let us talk about rights. Most people who want to kill themselves can pick up the gun, or take an overdose, or hang themselves, or whatever. We are not talking about a huge percentage of people who cannot pick up the needle or swallow the pill. We are talking about a very slight minority of people. On the other hand, we have millions of health care workers, doctors, and nurses who for reasons of religion or otherwise do not want to participate in the killing of people, yet this bill says nothing about that. The rhetoric when the bill was presented said that health care providers would be able to refuse to participate or refer. However, based on the history of broken promises, I would want to see that one in black and white in the bill to be sure that the intent to protect the rights of health care workers is captured.
Let us move on to the subject of taxpayers' rights. When an individual decides to kill himself, he pays for his own bullets or pills. Now, the bill seeks to transfer that burden to taxpayers, who will have to cover the cost of medical consults and associated administrative formalities. I am opposed to my tax dollars being used to kill people.
I believe that, if people want to kill themselves, they should have to pay for the entire process. Some may say that killing people costs less than taking care of them, but that is a slippery slope, is it not? It creates a situation where we may start calculating the price of keeping people alive. In time, death may become a way to save money.
That was the case in all of the other countries that have implemented similar legislative measures. Belgium, the Netherlands, and Denmark all started out with strict guarantees. However, these guarantees were hard to implement and were eventually set aside.
After that, it became easy and practical to get rid of vulnerable and undesirable members of society. The percentage of deaths rose from less than 1% to 6%. I do not believe that there is enough accountability in this bill and I would like to see improvements made in that regard.
As I said, this bill is about choices and rights. I believe the bill does not do enough to protect the rights of health care workers, the young, and the vulnerable. I believe the choice to kill oneself should come with consequences, which are not well laid out in this bill, such as forfeiting of insurance and the cost of the deed for starters.
I am recommending that the bill be amended in committee to document the protection of health care workers' right to refuse without retribution, to capture the duty of the requesting individual to cover the cost of the process, and to remove from the scope of this bill the studying of mature minors, advance consent, and those suffering psychologically.
Karina Gould LiberalParliamentary Secretary to the Minister of International Development
Mr. Speaker, I would like to begin my comment with something that the previous speaker mentioned. He said that he appreciated the tone and the level of respect that this debate has taken.
My hon. colleague began by saying that she was not going to offend anyone, or that she hoped not to. However, it is incredibly important to recognize that this issue is deeply personal. It is something that affects many different people. Therefore, to put medical assistance in dying in the way that it was painted, I think is deeply offensive to many of my constituents and people across this country. There is a certain level of respect that needs to be offered to those individuals who are seeking this assistance. They are at a point where they are suffering so immeasurably and so severely that we need to respect that decision and ensure their voices are being heard. That is what this bill addresses. It is important to remember that there are many safeguards within this bill that protect vulnerable individuals.
Because she talked about choices and rights, I am wondering what my colleague would say to someone who is suffering so immeasurably that this is the choice that he or she would make.
Marilyn Gladu Conservative Sarnia—Lambton, ON
Mr. Speaker, I would repeat that there are different opinions on this issue. While we want to protect the views of those who would choose this way, there are many who are offended by that choice. We need to recognize that. That was my intent in bringing the message.
Bev Shipley Conservative Lambton—Kent—Middlesex, ON
Mr. Speaker, one thing I can say about my colleague from Sarnia—Lambton is that we always know where she stands. Quite honestly, this debate is about just that. She certainly would not offend anyone, because we either live or we die. Let us be frank about it. The Supreme Court has given medical people the right to kill people. That is what has happened.
I did not see anything in this bill with respect to the following. Let us say that there are people who are terminally ill and are dying of severe cases of cancer. They might not die of the cancer; rather, they could die because of the poison that is given to them. I am wondering what the death certificates would say in terms of the cause of death. If we are to track any of the statistics, if we do not have some indication of what they actually died from, then we lose track of what this bill would accomplish.
Marilyn Gladu Conservative Sarnia—Lambton, ON
Mr. Speaker, my understanding of the way it is intended to work is that if someone does request assisted dying, the cause of death would be listed as the pre-existing condition as opposed to assisted suicide. Therefore, I agree that this will cover up the tracks of how often this is happening. All of the countries that have implemented legislation like this began with good intent and good process. However, people were not following the rigour, so the data tracking was difficult. Eventually, they opened it very wide, which is my concern with this legislation.
Kevin Lamoureux LiberalParliamentary Secretary to the Leader of the Government in the House of Commons
Mr. Speaker, I wonder if the member could provide some comment. She was a part of the government for a number of years. The Canada health care accord that was signed back in 2004 was allowed to expire. Year after year, we in the opposition argued that the Conservative government of the day should have done something with respect to the renewal of that health care accord. It is a bit much to listen to the Conservatives saying that we are not doing enough in terms of palliative care, because palliative care no doubt would have played a very important role in any future health care accord. If we think of the future of health care delivery, would she not agree that palliative care has to be a major component of that?
Marilyn Gladu Conservative Sarnia—Lambton, ON
Mr. Speaker, I absolutely do agree that palliative care has to be a fundamental part of health care as we go forward.
I heard questions earlier tonight that asked when end of life starts. Palliative care experts will tell us that even up to a year before death, in some cases two years, there is an advantage to good palliative care, the kind that does not just occur in the hospitals but in hospices and in home care. Therefore, I encourage the current government to do what it can to implement the promise it made in the budget.
Kevin Lamoureux LiberalParliamentary Secretary to the Leader of the Government in the House of Commons
Mr. Speaker, I can assure the member that the Liberal government will do what it can in terms of administering a palliative health care policy from coast to coast to coast. It is something we have believed in for many years and ultimately have been advocating for. Therefore, it is with pride when I look to the current Prime Minister and the Minister of Health when we talk about how we are going to see an investment in palliative care.
Before I talk more about palliative care, I want to talk about why we are here today.
It was a Supreme Court decision, a unanimous decision, which needs to be highlighted, where all of the judges came to the conclusion that Canadians suffering intolerably have the right to request assistance to end their suffering. We respect that decision. The issue before us today is, if Canada should have medical assistance in dying, how do we make it available? In essence, that is the issue before us today.
It is important that we recognize that this decision was made in February 2015. The government of the day sat back and did virtually nothing. It took a change in government, when Canadians spoke on October 19, and then a number of weeks that followed. We had the first Liberal-appointed cabinet in the last decade, and part of the mandate letter was to deal with this issue.
We do not have a choice. The Supreme Court has made this decision. We have a responsibility as parliamentarians to act on that court decision.
We have seen an incredible amount of effort put in by members of the Special Joint Committee on Physician-Assisted Dying, who worked virtually around the clock, seven days a week, with Senate colleagues. They did a phenomenal job in terms of getting us into the position of where we are today, which is debating the bill at second reading.
Hopefully, sometime this week, we will see the bill pass second reading. Parliamentarians, many of whom have talked about all sorts of ideas, will be able to make their presentation or express their thoughts at the committee stage, and at the same time allow stakeholders and individuals to share their incredible experience. At the end of the day, if we can improve this legislation, I can assure members that the Government of Canada is open to doing that. We are not fearful of accepting amendments, if in fact it can improve the quality of the legislation.
Within the legislation, members will find that there is an automatic review mechanism. After four years from this legislation becoming law, it will be reviewed by Parliament. I believe that is the responsible thing to do.
As parliamentarians, I would suggest we all have a role to play in terms of looking at how we are going to get this legislation through in a timely fashion. Not only does it have to pass the House and go to committee, it also has to get through the Senate, and it is important that it be done by June 6. We need to do this, because it is one of the ways we ensure that there are standards across the country so that void can be been filled.
We can look at what the legislation would actually do.
Access to medical assistance in dying would only be available to those who meet certain conditions. One, they must be mentally competent adults who are in an advance state of irreversible decline and capability. Two, they must have a serious and incurable illness, disease, or disability, and are experiencing enduring and intolerable suffering caused by their medical condition. Three, it must be those whose death has become reasonably foreseeable, taking into account their medical circumstances. We believe this meets what the Supreme Court of Canada has asked of us.
Obviously, it is a very emotional issue. We all have stories that we can reflect on. In 1999, I was at my father's deathbed. Thanks to good palliative care, I was able to be there at his time of passing. I appreciate the importance of pain management. He was in what I would classify as a fantastic facility. It allowed my father to end his life in a very positive fashion. Having a wonderful relationship with those he truly cared about and loved was very important, not only to me but to my family.
Prior to his going into Riverview Health Centre, I remember that we could barely communicate with him because of the intense pain that he endured. Once he was in the loving and caring hands of our health care professionals in a palliative care unit, with proper medications and painkillers, the difference was night and day. I remember saying to the doctor that we were going to have to look at having him come out, believing that he was getting so much better.
Our health care workers do an incredible service to Canadians. We need to recognize that. We should not be fearful that the legislation is going to obligate a doctor, a nurse, or a nurse practitioner to do something that goes against who they are, or that they are going to be penalized for that.
We have had those assurances, whether it is a charter of rights assurance or assurances from the ministers directly when they brought this bill forward and addressed it. The assurances are there. We are going to provide a service that is necessary. It is the right thing to do.
This is not something that is coming from one political party or one faction of society. It has gone through the court process. Nine Supreme Court judges ruled unanimously. We believe in Canada, and we believe in the rule of law. We recognize that this legislation is necessary.
As I indicated, there is always the opportunity to look for ways to improve the legislation. I am anxious to see it get to the committee stage, and to see if there is anything that could come out of the committee that would make it a better piece of legislation.
I have had the opportunity to listen to a good portion of this debate. I want to emphasize how important it is that we continue to look at palliative care and the potential that the Government of Canada has to show leadership on this issue, much like the current Prime Minister demonstrated leadership by getting in this legislation in its current format and getting the Special Joint Committee on Physician-Assisted Dying working together to bring us to where we are today.
We want to see the same sort of leadership, and I believe it is there, on the issue of palliative care. We do need to see strong national leadership on that issue. That is why I was very glad when the Minister of Health made a $3-billion commitment to palliative care.
Let us not kid ourselves; it will not be easy. I was a health care critic at the provincial level. If we are going to try to implement a program that is going to be universal so that it does not matter what region of the country people are living in, it will require a great deal of sitting down with our provincial counterparts and other stakeholders, in particular our first nations, aboriginal communities, to come up with how we can shape a world-class palliative care system.
Let us not kid ourselves; it is not going to be an easy challenge. That is why I am very grateful for the sense of commitment, whether it is coming from the PMO's office or from the Minister of Health in regard to making sure that, number one, there are financial resources to follow the commitment; and number two, that there is a feeling that in order to achieve it, we have to get people sitting around the table. That is something that is truly different this time around from what it was under the previous administration.
This government believes in working with other levels of government and believes in working with people. I believe that ultimately that is going to make the difference.
Today we debate this very important issue that all Canadians are very much concerned about. All Canadians have an opinion on it. It is such a privilege to express what I believe is what a majority of my constituents would want me to do on this issue and I feel very proud in terms of what this government has been able to accomplish in a relatively short period of time.
Martin Shields Conservative Bow River, AB
Mr. Speaker, I appreciate the member and the speaker before him for thanking us for the tone of this debate and the non-partisan and impersonal debate it was, although it got a little more personal with our colleague there.
A question I asked earlier was answered in a different way and I will try again. One of the things I see in the document deals with two doctors and two nurse practitioners that will be put in the role of signing or agreeing with the documents. In the rural areas I am familiar with having that many doctors and nurse practitioners can be a challenge. The answer I got was, “That is why there are a lot of nurse practitioners.” In the rural areas I am familiar with there are more doctors than nurse practitioners. There are not many nurse practitioners.
We come down to the challenge in rural areas of those people being known. It is very tough in a smaller community for medical staff to be labelled with that kind of a role. How would my colleague deal with this in rural areas, realizing that nurse practitioners in some areas are not as plentiful as they are in other areas?
Kevin Lamoureux Liberal Winnipeg North, MB
Mr. Speaker, I note that nurse practitioners for all intents and purposes, even though they have been around for many years, it is only in the recent decade or so that we have seen provinces looking at how we could potentially expand the roles of nurse practitioners.
I realize there are a lot of sensitive issues in regard to health care and the delivery of health care services, which include doctors in many rural communities. The more remote, the more difficult it can be, but there are also many rural communities that have a fairly healthy situation with doctors.
The answer to the question likely lies in working with our health care professionals and different stakeholders like our provinces to see if the concerns the member has raised could possibly be dealt with. I do not have the short answer, but hopefully that will assist him in getting a better understanding of where I am coming from on that issue.
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Mr. Speaker, I appreciated the parliamentary secretary's speech. In the Carter ruling of the Supreme Court of Canada when it held up the appeal, it defined a competent adult person as one who clearly consents to the termination of life and has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.
In Bill C-14 under proposed paragraph 241.2(2)(d), the legislation specifically mentions that a natural death has to be reasonably foreseeable. I want to know the member's opinion on that specific section of the bill. Does he believe that complies with the Carter ruling and is the government prepared to refer this legislation at some point down the road to the Supreme Court to make sure that we do not have future charter challenges?
Kevin Lamoureux Liberal Winnipeg North, MB
Mr. Speaker, as the legislation stands currently, I am fairly confident that it meets the requirements of the Supreme Court of Canada's decision. Having said that, I would remind the member, as I indicated during my remarks, that once we get to the committee stage there will be the opportunity to hear expert witnesses and the individuals who have written the legislation. Many of these questions could be put right to the table.
A lot will depend on how the ebb and flow of the committee goes. It is not to say that I do not know the specific answer, but I would feel far more comfortable given the makeup of the committee and I know the types of effort that people have gone to in looking at the actual wording. A little change in a word could have a fairly profound impact in terms of how the legislation is actually interpreted.
It is best that we understand what is being said in our intent and then we have to rely on the professionals and the individuals who are drafting the legislation and working with the different stakeholders to make sure that we get it right. I am confident that at the end of the day we will get it right.
Adam Vaughan LiberalParliamentary Secretary to the Prime Minister (Intergovernmental Affairs)
Mr. Speaker, I thank members for pursuing this issue not just from some excellent legal scholarship, and we heard that tonight with presentations from my colleagues, but also talking about the impact their lives have had on how they assess the legislation before us.
I too will reflect on my time on this planet, dealing with the challenges of watching a loved one pass away. In this case it was my mother. It was 20 years ago this past January. After a very determined 15-year battle with cancer, she succumbed. Part of the process involved palliative care at the end, which was excellent. However, it was too much for her at one point and she called her three children around, my two sisters and myself. She said, “Kids, I've had enough.” She pulled her oxygen mask off and said, “Don't revive me. I love you. Goodbye.”
We had been dealing with three or four months, it is almost impossible to measure the time, of watching my mother struggle on to make sure that all the kids were there to say goodbye, and saying goodbye to loved friends and family. Clearly, after 15 years, she had had enough.
We sat there by the bedside and watched as life started to leave my mother's body. For myself, who had been in the city and was taking care of her at the end, most persistently on a daily basis, it was too much for me. I could not take it anymore. I left the hospital room knowing that I had said my goodbyes and this was the end. When I came in the next morning, there was my mother sitting up in bed saying, “Well, that didn't work.” Palliative care continued for weeks afterward. It was a palliative care that got more fragile, more painful, and a greater hardship for her and for us to deal with, but in the end she passed away.
She had a do not revive order. As we talk about this issue, we have found ways in the country before to assist people in making decisions, even when they are not in a place to make those decisions.
That is what we are struggling with today. How do we find a more proactive and more informed way of doing this when different dimensions and different diagnostic tools come into play, and different eventualities are being considered?
What we are trying to figure out here is how to extend the do not resuscitate orders into a new sphere of medical assistance. That is the essence of what we are trying to do. It strays into other areas. I have heard it in these debates that the legislation is fine but it does not do X or it does not do Y, which are really topics for other pieces of legislation. We are not focusing on what we are trying to get done right here.
The bill responds to the Supreme Court, as we are compelled to do constitutionally. I do not resent it. It is an extraordinary responsibility to respond to the Supreme Court when it assesses our laws to be lacking or the needs of our population not being met. What we are trying to do is to get a perfect letter through a defined letter box and making sure it clears that letter box.
People in our country are suffering and families are suffering as we debate this. I appreciate the sentiment from many people in the debate to try to get the legislation perfect. It deserves to be perfect. We all strive to make it perfect. However, we cannot let perfection get in the way of what is needed and what is good. There is goodness in the bill, because it does limit people's suffering. Have we done enough on palliative care? Of course not. Have we done enough on the quality of life? Of course not. Have we done enough on medical research? Of course not.
Death is still a very difficult subject for far too many of us. However, Bill C-14 responds to the court's challenge in a very particular way, and the committee will try to make it better. I trust it will come back to the House with a better bill. I hope we can get the bill to committee as soon as possible so it has the space to work on that perfection, rather than us pursuing our task of trying to perfect the criticism of the bill. We need to get the bill to committee so it can be studied, some of the language refined, some of the opportunities better understood, and some of the restrictions better defined. We need to get it to committee quickly.
However, we have to resist being afraid of this bill because it would start to do things that we have not contemplated, such as the slippery-slope comments we had, where we are worried about what happens with person X and person Y in five and ten years' time if these conditions change. We have to look at the legislation that is in front of us, we have to deliver it to committee with criticisms attached, and then we have to trust ourselves as colleagues, as parliamentarians engaged in this issue, to try to and hope to deliver a better bill for the next reading and then on to the Senate for its work and for its resolution.
Let us not kid ourselves. There will be no bill passed in this Parliament that will not be challenged at some future date at the Supreme Court. There will be no new thinking or new idea or new circumstance that does not demand of us to revisit this bill in one, two, three, five, or ten years from now. We have lived on this planet for thousands of years and never perfected the art of dying. It is a tough issue. It is a hard issue. If we lose sight of the fact that our inability to come to terms with that promotes and prolongs the suffering of individuals, we will have truly failed as parliamentarians. We are being asked to make a tough call. This legislation would define what we think is a good judgment and would define what we think is a good approach to this.
I can hear good ideas emerging. However, the debate being called for by many quarters about improving palliative care did not need this bill for that call to be made. We should have been perfecting palliative care years ago. The call to ensure that vulnerable people are better protected and their quality of life is better protected did not need this bill for that debate to happen. Vulnerable people should have been spoken to and their needs addressed long before this bill was ever presented.
However, to use those as roadblocks to end suffering is unconscionable in my perspective, and we have to respond to the deadline that has been imposed upon us by a court that has already been asked to extend that deadline once and already has referenced the suffering as a reason not to extend it again. We have a duty, and we have a duty tonight and over the next few days to get this bill to committee as quickly as possible, and then to listen to what we have said to one another in these last few hours. I do not think anybody has presented a concern that is not of value and does not inform our ability to talk about this bill in more pronounced ways and more reflective ways, and that is good.
Let us amend. Let us lean into the parliamentary committees that we have here. Let us trust one another to fix good ideas and make them better ideas. That is what the committee process is supposed to be about, and that is something that I trust will happen. Let us measure the impact of this debate through that process and ensure that our voices and the voices of our constituents are heard in this debate and also heard in the legislation as it moves forward. At the end of the day, let us be honest with ourselves. We will be revisiting this issue the minute it gets royal assent. We will revisit it because life brings us these challenges as surely as it brings us death. We have to be, on these sorts of issues, smart enough to trust one another, compassionate enough to learn from one another, and at the end of the day, disciplined enough to ensure that this Parliament works for those who are suffering, those who are vulnerable, and those who want to live out their last few days with dignity.
My mum taught me a lot about life by the way she died, and I am sure it is a story that all of us have learned from loved ones as we have watched them move through very difficult times. However, I also remember my mum saying, as she was sitting there, that she loved us and it was not just her suffering she was trying to manage, it was ours. Therefore, it is not just our difficult decision we are trying to manage here today; it is the country's difficult decision.
I trust all members to take that seriously, but I also trust them to support us as we pursue palliative-care improvement, as we pursue the opportunity to improve the lives of vulnerable people in this country, and as we seek to deliver choice to people about how they move forward, with support when they make mistakes but understanding when they get it right.
I hope we can get it right with this legislation. I hope the committee gets it right, and I hope the next debate about this finds even more consensus.
Todd Doherty Conservative Cariboo—Prince George, BC
Mr. Speaker, I want to thank the hon. member for Spadina—Fort York for his comments and for sharing his experiences with the House.
The hon. member mentioned trust a number of times, about getting it right. With a decision and legislation that bears the gravity that this does, I again go back to the time that we are spending discussing this—this is not a debate; it is a discussion—trying to make sure we get it as close to right as possible. The balance of power rests on that side of the House, and I would think that the public and perhaps those down the street in the Supreme Court can see that we are having those discussions and that, at this point, if the government went across the street and said it needs more time, I would hazard a guess that it would allow that.
Whether it is a notwithstanding clause or just asking for another extension, would my hon. colleague across the way at least say that true leadership would be asking for a bit more time for us to have this great discussion?
Adam Vaughan Liberal Spadina—Fort York, ON
Mr. Speaker, I was in the House last session when Liberals were in opposition and we moved a motion to speed this debate up to give us that time, and it was defeated. I do not think it is our privilege now, having already gone to the Supreme Court and asked for an extension, to prolong other people's suffering. We have a responsibility to act.
This issue has been in front of us for a lot longer than the bill has been in front of us; the committee spent time on it and did extraordinary work exploring this issue and laying the groundwork for the legislation; and there was work done in the previous Parliament, although not nearly fast enough.
The issue is that we have to accept, as parliamentarians, that we do not produce perfect legislation. We never will. We are just people giving it our best effort. On this bill, where a free vote has been offered to all parliamentarians on this side of the House, and I assume on the other side, we are in the position of trying to make this work. The deadline we have been given by the Supreme Court is the right decision.
It is time to act. It is time to end the suffering for some and provide clarity for others, so I do not think the responsible thing to do is to ask for a delay. We must make a decision, and then we must revisit this issue when problems arise again, because, as surely as we stand here today, they will.
Daniel Blaikie NDP Elmwood—Transcona, MB
Mr. Speaker, I want to thank the hon. member for his compelling speech. The one piece that stood out to me is more of a process issue.
He talked about the need to get this bill to committee so that it can be improved. That is something I would like to see. I could go on about some of the things that I do not think the government got right in this bill, but given that a special committee did a lot of great work on this and issued a report, and the government legislation does not really reflect much of anything that came out of that report, why should we have confidence that the government is going to respond appropriately to the next committee that looks at this bill?
Adam Vaughan Liberal Spadina—Fort York, ON
Mr. Speaker, I am tempted to quote one of my favourite movies and say, “You have to have a little faith”.
The committee that laid the groundwork for this legislation, the bill that is in front of us, explored a lot of issues; and at the end of the day, the justice minister presented a bill, which in the opinion of the government, gets the issue fundamentally right as it relates to the Supreme Court. It takes away some of the other issues, says that this is core of what we need to do, and leaves it to Parliament to improve upon it. We need to seize that, as parliamentarians, as an opportunity to show how Parliament can work collaboratively around, in particular, difficult issues.
The challenge we have is to find ways to address some of the ideas we want pursued, not just through this specific piece of legislation. Advance consent is an issue for me, or the different names that it is given, like advance care directives. It is a fundamental part of what is missing in this bill, and I want to see that really seized upon by the committee. The palliative care component, the duty of care to people with vulnerabilities, all of those issues are other issues we need to bring to the House, and we need to bring the same level of creativity and compassion to those issues.
We get locked into this notion that governments must present perfect legislation or, otherwise, it is thumbs up or thumbs down. Parliament is not supposed to work that way. We come here representing parties and our constituents, and we have to bring all of that to bear on legislation each and every day, not just simply vote party colours all the time. That is part of the freedom we need to explore in Parliament and one that our leader has put on the table and is trying pursue, and we need members' support to make it happen.
The Deputy Speaker Conservative Bruce Stanton
Before we resume debate, I want to make a brief comment to all hon. members. First, I want to compliment members, as we have heard earlier today, on some very heartfelt interventions from all sides of the House on this particular issue, a very human and emotional issue that is before the House.
The chair occupants are doing their best to accommodate members and are trying not to cut them off. We are down to 10-minute speeches and five-minute periods for questions and comments, which generally only leaves us enough time for two interventions during that five minute period.
We will do our best, but if members happen to notice that there are a good number of members rising on questions and comments and wish to keep their interventions concise, that would allow more members to participate in that five-minute question and comment period.
We will be as judicious and fair as we can in making sure that all members have the opportunity to finish their points, and so on.
Resuming debate, the hon. member for North Island—Powell River.
Rachel Blaney NDP North Island—Powell River, BC
Mr. Speaker, today this House stands to discuss Bill C-14. As we do so, we must seriously consider this important responsibility. The Supreme Court decision has been made. The job in this House is to create legislation that would provide clear boundaries moving forward.
In February 2015, the Supreme Court of Canada concluded that the absolute prohibition on assisted suicide violated the charter rights of Canadians suffering intolerably with grievous and irremediable medical conditions who, being adults and assessed as competent decision-makers, would otherwise seek medical assistance in dying on their own terms.
In response, the joint special committee of Parliament was tasked to consult with experts and Canadians who reflect the diverse perspectives on this issue. It reviewed the Supreme Court's decision in the Carter case and the 400-page judgment of the B.C. Supreme Court that preceded it. It studied Quebec's new assisted dying law, as well as the reports of two major panels on medical aid in dying, which together heard from 13,000 Canadians and more than 100 organizations. The committee then held 11 hearings, called 61 expert witnesses, and received more than 100 written briefs from groups across Canada.
I have read the report and want to thank the committee for the great work it has done, resulting in 21 recommendations on a legislative response. These recommendations demonstrate balance and sensitivity, respecting the autonomy of patients, the rights of health care practitioners and vulnerable individuals, and the fundamentally personal nature of this issue to every Canadian.
I have also been listening to the constituents in my riding of North Island—Powell River, where people are very concerned. Many from my riding are worried that there is not enough support for palliative and end-of-life care. They want to know that the vulnerable will be protected and they want to know that those who suffer greatly can decide to die with dignity. I have had many letters from my constituents, and I know there will be many more. This is a subject that deserves much discussion in each riding across Canada.
Bill C-14 is also a very personal one for me. Years ago, I was a volunteer for a hospice and watched many people die. I remember being present for people who were in so much pain and who wanted the release of death so badly that starving themselves became their only solution. I remember the agony of the people and their families who just wanted a safe release from this pain.
I also sat with people who fought every day for one more. Their desire to continue in the face of such pain was tremendous.
After volunteering there for years, I left knowing that death is an intensely personal process and that honouring people and their families through it is so important.
Today, I want to talk to Bill C-14, the Liberal government's legislative response to the Carter case.
The Liberal bill has raised new concerns and leaves many questions, for me, unanswered.
There is consensus among academics, health professionals, faith communities, and the public that Canadians deserve better end-of-life and palliative care treatment.
The federal government has a role to play in working with the provinces and the territories, as well as first nations, Inuit, and Métis communities, on finding strategies that work.
We have a critically important opportunity to enhance the services across the country, yet the government was missing in action in the budget on palliative care—even after promising $3 million for home care during the campaign. Holding the government to account on the promise of that motion remains one of our top priorities as we assist in the legislative response to the Carter decision.
This bill refers to palliative care in its preamble; yet while introducing this bill, the government made no new commitments to palliative care. The people of my riding want to see this investment happen.
The NDP took a significant step forward in the last Parliament when a motion brought by the member for Timmins—James Bay to establish a pan-Canadian palliative and end-of-life care strategy earned nearly unanimous support of the House of Commons.
Palliative care is about patient- and family-centred physical, psychological, and spiritual care.
Everyone dies, every family has to deal with the loss of a loved one, and these traumatic moments are made more difficult and more expensive when there is no access to quality palliative care. With an aging population, it is crucial that the federal government provide leadership now.
The government backgrounder refers to the following system to ensure equal access:
The government is proposing to work with provinces and territories on the development of mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying. This system would help connect patients with a physician or nurse practitioner willing to provide medical assistance in dying, and support the personal convictions of health care providers who choose not to participate. It would also respect the privacy of those who are willing to provide this assistance. This system could also offer other end-of-life care options to both patients and providers.
However, this is not mentioned at all in the bill. This leaves a lack of clarity and room for poor decisions. It is important to respect the health care practitioners' freedom of conscience while at the same time respecting the needs of the patient.
Having seen the previous government's agenda being held up in the courts time and time again, Canadians expect a government to be thorough. Now is the time to strengthen the bill against charter challenges by resolving contradictions with the Supreme Court ruling in Carter. Canadians have waited long enough. Let us get it right the first time.
It is not a partisan criticism either. The co-chair, Conservative Senator Ogilvie, told the Hill Times that the law as it has been introduced will be challenged in courts, and he is disappointed that the government did not take more of the committee's recommendations.
This is not a case where good enough legislation is good enough. This is a life and death issue, so let us get the right legislation.
The people in my riding are concerned about safeguards. They know the value of life and want to make sure that some lives are not considered less valued than others. I could not agree more. I have members of my family who have severe mental illness and who are differently abled. They are precious to me, and I would not wish them gone from my life.
Right now, Bill C-14 would legalize medical assistance in dying for competent adults 18 years of age or older who meet the following criteria: serious and incurable illness, disease or disability; in an advanced state of irreversible decline in capability; experiencing enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.
There are also requirements for two independent medical practitioners or nurse practitioners to confirm each criterion. The request must be in writing where possible and witnessed by an independent adult, and a 15-day reflection period must be observed. To help protect people in vulnerable situations, the witness to the request cannot be a beneficiary under the will of the patient, someone who may benefit from the patient's death, or directly involved in providing care to the patient. The two physicians or nurse practitioners must also be independent from one another. Safeguards must be there to provide the support that patients and their families need during this painful time.
We know that this is a difficult issue that touches many in a personal way. There are many issues to discuss, and we hope to see them discussed. Therefore, I will be voting in support of the bill, but I know that it is going to a special committee, and when it returns to the House I hope to see many more changes made.
Many speakers today are expressing their profound disbelief that Bill C-14 would deny Kay Carter, one of the two women on whose behalf this case was brought to the Supreme Court, suffering from serious and incurable but non-fatal conditions, the right to choose medical assistance in dying.
According to many experts, their only remaining recourse to meet the bill's final criterion would be to starve themselves to near death, as we have seen people do in Quebec, in order to meet the province's eligibility criteria. I have seen this in action, and it is a dreadful way to die.
Going forward, New Democrats will consult with experts and people affected as we study this legislation very carefully. As Amy Engel wrote, “I want to be someone strong and brave enough to make hard choices. But I want to be fair and loving enough to make the right ones”.
Harold Albrecht Conservative Kitchener—Conestoga, ON
Mr. Speaker, the member referred to page 7, numbers (5) and (6), which talk about independent witnesses, and the independence of medical and nurse practitioners, ensuring that there is no business relationship, and there is no potential financial benefit from having someone have their death hastened.
Certainly, I agree with these principles that are here, but my concern is that, while they are here, a person could say that, yes, they are independent and all of those things, but there is no method of verifying whether or not that is in fact the case.
I wonder if my colleague would support the idea of a prior review, either a tribunal or judicial review, or some panel which would oversee and verify the facts that are stated.
Rachel Blaney NDP North Island—Powell River, BC
Mr. Speaker, this is part of the realities we are facing.
We know that some of these decisions have to be done in partnership with the provinces which will have certain authority and responsibility in this process.
I think it goes back to that bigger question of making sure there is the support, so that we do not have a patchwork framework across the country. We want to make sure that the services make sense, and we want to make sure that we ask these hard questions.
I am hopeful that the work done in committee will answer some of these questions for us in a good way, and that we will see that process unfold in our relationship with the provincial and territorial governments.
David Graham Liberal Laurentides—Labelle, QC
Mr. Speaker, palliative care is, indeed, a very important issue.
There are many people here who believe the bill goes too far. There are many others who do not believe it goes far enough, and I fall generally in that camp. I think we could do a lot more, but I appreciate the compromise presented in this bill.
The member for Spadina—Fort York who spoke earlier is correct in that anything we do will face further challenges. For better or for worse, I do not believe this file is ever going to be completely closed. It is too close to the hearts of too many people. I think all members can agree with that.
The member wants to resolve a number of conflicts she sees between the bill and the Supreme Court ruling. I am wondering if the member plans to submit amendments to achieve that very thing at committee, and if she agrees that the committee process is the best way to address these issues within the tight timelines we face.