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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.

Topics

Criminal CodeGovernment Orders

7:40 p.m.

Winnipeg North Manitoba

Liberal

Kevin Lamoureux LiberalParliamentary Secretary to the Leader of the Government in the House of Commons

Mr. Speaker, I appreciate the many fine words from my colleague, and I would like to ask him a question.

The government has brought this legislation forward because of the Supreme Court of Canada ultimately doing what Liberals believe is the responsible thing to do, with the strong leadership from the Prime Minister's Office to the ministers responsible for bringing forward the legislation itself; but one thing we are often being told about is the importance of not only the legislation but the whole issue of palliative care.

I am wondering if the member might want to take the opportunity to emphasize, from his perspective and his constituents' perspective, just how important palliative care is as part of this whole debate.

Criminal CodeGovernment Orders

7:40 p.m.

Liberal

Denis Lemieux Liberal Chicoutimi—Le Fjord, QC

Mr. Speaker, I thank my colleague for his question.

When I sat in the special joint committee, it really struck me how the issue raised by the Carter decision really forced us to reflect on the quality of palliative care in Canada.

That is why I was thrilled to hear that the Minister of Health had announced plans to invest an additional $3 billion over the next four years to improve palliative care. As we said in committee, medical assistance in dying must not replace palliative care. That care constitutes end-of-life care, and medical assistance in dying should be considered part of palliative care. I am therefore very proud of our government's decision and the decision taken by the Minister of Health.

Criminal CodeGovernment Orders

7:40 p.m.

Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

Mr. Speaker, I too would like to commend my colleague, with whom I served on the special committee struck by the government. The committee was made up of MPs and senators from all political parties.

I would like to know my colleague's thoughts on the text of the bill. It uses words that have raised many questions in Quebec and all across Canada regarding what is reasonably foreseeable: a reasonably foreseeable death. The Quebec legislation clearly states that care must be provided to people who are reaching their end of life.

Is the member comfortable with the term “reasonably foreseeable death”, or would he prefer a definition that is closer to the one used in Quebec, in other words, “end of life”?

Criminal CodeGovernment Orders

7:40 p.m.

Liberal

Denis Lemieux Liberal Chicoutimi—Le Fjord, QC

Mr. Speaker, I thank my colleague for his question.

I understand my colleague's points, and I have often heard him use those words in the media in the past few weeks. What Canadians need to know is that the point my colleague raised is one of the four criteria required for access to medical assistance in dying. It is important to explain to Canadians that there is not just one criterion for obtaining medical assistance in dying, but four.

I will take this opportunity to remind my colleague from Louis-Saint-Laurent about what he said this morning in response to a question from our colleague opposite. I was so sad to hear it. According to the member from Louis-Saint-Laurent, cases like Mr. Truchon's, which I talked about just now, are unintended consequences. That is what he said in response to my colleague.

I want the member to know that I really disagree with him. I invite him to talk to Mr. Truchon's parents. He will see that Mr. Truchon and his family are altogether remarkable and are not trying to abuse the system in the way that the member for Louis-Saint-Laurent suggested this morning.

Criminal CodeGovernment Orders

7:40 p.m.

NDP

Rachel Blaney NDP North Island—Powell River, BC

Mr. Speaker, I know from personal experience how hard it can be to be with people who are at the end of their life. I have actually been with people who have starved themselves to precipitate their end of life more quickly.

One of the concerns I have with this bill is that it would limit people who have health issues that are unbearably painful but whose end of life is far away in some cases. My question is this. How does the member think this would work with this bill, and how can we support people who have done the due diligence, have independent thought, and are ready to go when they are in unbearable pain?

Criminal CodeGovernment Orders

7:45 p.m.

Liberal

Denis Lemieux Liberal Chicoutimi—Le Fjord, QC

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

I look at the situation that Mr. Truchon and his family are in, and I see the law in Quebec. Mr. Ménard told us that he would certainly have drafted Quebec's law a little differently in light of the Carter decision.

Today we are asking ourselves a big question in relation to the bill we are debating that was introduced by the Minister of Justice. Mr. Truchon's family is a real-life example. Will they have to watch their son suffer for five, seven, eight days, or will our bill enable them to witness a gentle death that lasts four or five minutes?

Criminal CodeGovernment Orders

7:45 p.m.

Conservative

Mark Strahl Conservative Chilliwack—Hope, BC

Mr. Speaker, it is always an honour to stand in this place and participate in the debate, no matter what the subject matter. There are some debates that are more important than others, and I would venture to say that parliamentary historians will not be poring over the Hansard of the latest budget implementation act in five, 10, or 50 years from now. However, the debate we are taking part in today is not just any debate. It matters. How we as a Parliament, as a group of elected representatives, respond to it will have a profound impact on our society and on the value we place on life in the months and years ahead.

We are here to debate Bill C-14. The short title of the bill is the medical assistance in dying act. I would suggest that this title downplays the decision that we as parliamentarians are being asked to make. Bill C-14 would remove the criminal prohibitions for killing a person, or helping that person kill himself or herself, in certain situations. That is the harsh, stark reality of what we are dealing with in this bill. It is not just another medical procedure that we can sterilize with antiseptic and non-offensive language. This is a serious matter. It will result in a fundamental shift in Canadian society, and making the language more palatable and less jarring does not change that.

We are here because of the Supreme Court of Canada's Carter decision. While the court had previously ruled that the Criminal Code provisions on euthanasia and assisted suicide were constitutional and did not violate the charter, last February it reversed itself and struck down sections of the Criminal Code. It gave Parliament until June to come up with a law that respects its ruling and places restrictions on when and where euthanasia and assisted suicide can take place without criminal penalty.

The Council of Canadians with Disabilities and the Canadian Association for Community Living have produced an excellent commentary on the court's decision, warning that persons with disabilities, including people with serious mental and emotional disabilities, have been put at serious risk. They have also provided these sobering statistics:

...in Belgium, the number of Assisted Suicide deaths has increased an average of 47.77% annually since 2003, and in the Netherlands it has increased 64.13% since 1995, with no end in sight to this increase.

They have called upon Parliament to “place crucial safeguards on the Court’s judgment to limit access to assisted suicide”.

Unfortunately, the joint parliamentary committee report on assisted suicide went the other way, suggesting that doctor-assisted suicide should even be made available to minor children and those struggling with mental illnesses. As a result, Conservative MPs on the committee filed a dissenting report recommending stronger protections for the vulnerable. Thankfully, most of their recommendations have made their way into Bill C-14.

I have heard from hundreds of my constituents who oppose assisted suicide and euthanasia. They fundamentally believe that the Supreme Court's ruling and this bill will lead us down a slippery slope. Some oppose it on religious grounds, believing in the sanctity of life at all stages. Others oppose it for a variety of logical or ethical reasons.

I have also been contacted by some constituents who support the concept of euthanasia in principle and in certain circumstances. Having myself watched a number of family members and friends ranging in age from 13 to 85 die from cancer over the last few years, I understand the desire to ease the suffering of those we love as much as possible at the end of their lives. I believe that, instead of considering euthanasia and assisted suicide as a desired way to provide relief to dying patients, the federal government should be doing more, in concert with the provinces, to promote and expand comprehensive palliative care services right across the country.

Indeed, we voted nearly unanimously for expanded palliative care services and a plan in the last Parliament. During the election campaign, the government promised to inject $3 billion into palliative care. However, its budget did not include a dollar of funding or a mention of it coming anytime soon. The Minister of Health referenced her commitment to palliative care again today in question period. However, words are not enough. We need action, and it should have been a companion to this legislation, not an afterthought.

I want to talk about my main concern with assisted suicide as it relates to this bill and the ruling by the Supreme Court.

We need to continue the national conversation about improving our mental health system of care, which is currently failing too many Canadians. Mental Health Week starts today. The Canadian Mental Health Association is encouraging us to get loud on ending the stigma around mental illness.

Many of us have participated in, and will participate in, events this week to do just that. We put on green ribbons. We have attended champions of mental health dinners. We celebrate those who have spoken out and shared their stories of overcoming the darkness in which they have often lived for years. We beg people struggling with mental illness to reach out. We tell them that help is available, and it is. We grieve whenever individuals take their own life as a result of their mental illness.

Indeed, we have had many debates in the House, with heartfelt speeches by members on all sides, trying to figure out how we can best support those struggling with mental illness. Why did we do that? It is because we believe we must provide hope for those who are suffering. We believe that every life is worth saving and that those with mental illness can be treated, helped, and hopefully made well again.

We are told we should, as parliamentarians, separate assisted suicide from suicide brought on by mental illness. We should not be under the impression that we get to choose whether these two issues will be conflated or not. If assisted suicide becomes normalized, we should not be surprised if societal attitudes on other types of suicide change as well.

I recognize that mental illness is currently excluded from permissible cases for assisted suicide or euthanasia, but the government has said it will be embarking on further studies to look at the unique implications of situations where mental illness is the sole underlying medical condition. Indeed, Liberals mentioned their intention to move forward on this study at the technical briefing on Bill C-14.

Why would the government want to study this matter further if not to bring it forward as a future amendment to the bill? We cannot allow the door to be opened even a crack to allow for those suffering from mental illness to be able to access physician-assisted suicide.

I recently spoke to someone who was diagnosed with bipolar II disorder about the bill. This person attempted to be well with every tool available, and shared the following with me:

My disease is a challenge every single day of my life. Sometimes I work to keep the symptoms at bay from minute to minute. Suffering is a given. And yet, I have much joy and hope, so much to live for. But what if I get really sick, what if I can not manage for an extended period and fall into a deep unbearable depression? Do I need to write an advanced directive to my doctor, asking them explicitly not to allow me access to euthanasia? To ask them to help me fight for my life, even if I can't do that in my moment of total despair?

We need to say it loud and clear that suicide is not the answer for mental illness, whether it is medically assisted or not.

I know that my time is short, so I will move on to another concern I have, and that is the possibility of having two nurse practitioners to sign off on assisted suicide or euthanasia requests for a patient. Nurse practitioners play a vital role in many remote, rural, and northern communities, but when we are dealing with a matter this serious, this permanent, with these types of consequences, I believe that not only should two doctors be required to sign off but that there should be a requirement for a psychological examination or independent oversight from a social worker to be done on patients before they can access assisted suicide or euthanasia.

This would provide an additional level of protection to ensure that patients are truly capable of making decisions with respect to their health and that the request to end their life was not made as a result of external pressure as is mentioned in section 241.2 of the bill.

Finally, Bill C-14 does not enshrine the legal rights of medical professionals such as doctors, nurses, pharmacists, and caregivers to opt out of providing assisted suicide services or referrals if their personal conscience, beliefs, or ethics do not permit them to do so. This is a critical flaw.

As the bill does not adequately protect vulnerable people and does not adequately protect the conscience rights of medical professions, unfortunately, I cannot support it.

Criminal CodeGovernment Orders

7:55 p.m.

Spadina—Fort York Ontario

Liberal

Adam Vaughan LiberalParliamentary Secretary to the Prime Minister (Intergovernmental Affairs)

Mr. Speaker, I listened with interest to the presentation and appreciate that these issues bring back memories and experiences that are extraordinarily personal, and I do not mean to move into those areas unduly, so I hope the member can forgive the question.

In situations where, quite clearly, individuals are exerting an individual right and an individual choice, I wonder if the member could reflect upon what right we have to impose bureaucracy, layers of decision-making, additional voices, and additional concerns into people's lives when they are trying to make a choice for themselves about the most personal decision they may ever have to make.

Criminal CodeGovernment Orders

7:55 p.m.

Conservative

Mark Strahl Conservative Chilliwack—Hope, BC

Mr. Speaker, I accept the question in the spirit in which it was given.

I think what the court has called on us to do is to set limits. It has not thrown the door completely open. It put its own conditions on grievous and irremediable conditions, and when and where this can be accessed. The court in its ruling has asked Parliament to specifically consider when and where assisted suicide, euthanasia, can be accessed. I think that is what we are doing here today.

There has been debate throughout the day. Some believe the bill does not go far enough in terms of its permissiveness, and others, like myself, believe that it is not tight enough around the court ruling. We are going to have a variety of opinions here, but that is exactly what we are doing. We are talking about what limits we believe should be placed on assisted suicide and euthanasia, because that is what the court has asked us to do.

Criminal CodeGovernment Orders

7:55 p.m.

Conservative

Bev Shipley Conservative Lambton—Kent—Middlesex, ON

Mr. Speaker, we have moved 180 degrees, from a criminal activity which was under the Criminal Code to now, where actually we can kill somebody and call it assisted suicide, and at the same time get the health care to pay for it.

I wonder if the member would comment about doctors and nurses who have an ethical or moral gauge within their own soul that will not allow them to do this. Would the bill protect them?

Criminal CodeGovernment Orders

7:55 p.m.

Conservative

Mark Strahl Conservative Chilliwack—Hope, BC

Mr. Speaker, I would certainly argue that it would not. There is mention of conscience rights in the preamble, but we have seen before that the preamble is not the meat of the bill. It does not have the same effect that it would if it were in among the provisions of the bill.

I have spoken with many medical professionals since the bill came out, since the Supreme Court ruling came out, and there is grave concern about participating in this sort of scheme. I want to be clear that sometimes there is a religious bent, but often it is an ethical bent. It is people who have spent their entire lives, gone to school, sometimes for over a decade, to help save lives, who are now being told that part of the medical system is to provide assisted suicide or euthanasia services, and they are morally or ethically opposed to doing so.

I do not think the bill goes far enough in protecting those people from opting out of the system, and it is one of the reasons I will not be supporting it.

Criminal CodeGovernment Orders

7:55 p.m.

Conservative

Todd Doherty Conservative Cariboo—Prince George, BC

Mr. Speaker, I really appreciate the debate. Again, I will go on record as saying that I fear we do not have enough time to have a lengthy debate, but I do appreciate the comments from both sides.

My comments are neither for nor against at this point. However, it says informed consent being given, but in the bill itself there is no advance directive. The very people whom the bill could help, such as someone suffering from advanced stages of ALS, Lou Gehrig's disease, may not be able to give that consent at the time. Is there not a concern, and how can we rectify this as we move forward?

The deadline is speedily approaching. Does my colleague share the same concerns?

Criminal CodeGovernment Orders

8 p.m.

Conservative

Mark Strahl Conservative Chilliwack—Hope, BC

Mr. Speaker, quite frankly, I think that is one of the unfortunate things that has happened in this debate. Due to the timing of the dissolution of Parliament for the election, there were several months lost when we were not debating this in the chamber. There were many months lost when this was not on the national agenda.

To now rush the bill forward, as we are compelled to do, I cannot think of a bill that deserves more time, more thought, and more debate than the bill before us, yet we have an arbitrary deadline that has been set by the court. That is truly the most unfortunate part of this debate, and one which I hope we do not live to regret.

Criminal CodeGovernment Orders

8 p.m.

Liberal

René Arseneault Liberal Madawaska—Restigouche, NB

Mr. Speaker, I thank you for giving me the opportunity to share my thoughts on Bill C-14.

I had the privilege of sitting on the Special Joint Committee on Physician-Assisted Dying. Along with the members of the committee, made up of 11 of our colleagues and five senators, I believe I can say that I was right in the thick of things, when it came to testimonies and opinions from the various stakeholder groups, experts, and everyday citizens.

The debate on medical assistance in dying is an emotional one. That is because it deals with the last of the taboos of any society, namely to plan one's own death and, in a way, to get help organizing it.

Whether you are religious, secular, atheist, philosophically liberal, or ideologically conservative, every opinion on medical assistance in dying matters. In the wake of the Carter decision, the diverging opinions and our deepest moral values now seem to torment us. Either side of the argument on medical assistance in dying is a source both for concern and for hope. This issue leaves no one indifferent, but above all stirs the most sincere and honest emotions.

That is where we run the risk of losing sight of the purpose of the debate. In fact, medical assistance in dying, regardless of our personal values, is not something that any of us must impose on or deny anyone else. I urge all my colleagues to keep in mind that medical assistance in dying is now an individual right recognized by the Supreme Court of Canada, a right that is no one's business but the individual's and, at the same time, a right that does not force anyone to compromise their deepest individual moral convictions.

Morality, taboos, planned death and the emotions this stirs must not cloud the rationale of the Carter decision. If we eliminate our individual morality from the analysis of the Carter decision, then it is rather simple.

First of all, two sections of the Criminal Code are affected, namely section 14 and paragraph 241(b). These provisions prohibit a person from counselling or aiding another person to commit suicide.

Second, as a result of these Criminal Code provisions, a person suffering from a grievous and irremediable illness could prematurely end their life, knowing that no one could help them die when they are no longer able to commit suicide because of the progression of the illness. In short, the prohibition in the Criminal Code provisions I mentioned could lead a person with an irremediable illness to take their own life early, even though they are still enjoying a certain quality of life, because they foresee that they will no longer be able to do so themselves at a later date.

Third, section 7 of the Canadian Charter of Rights and Freedoms states that everyone has the right to life. In Carter, the Supreme Court cited this principle in stating that a person suffering from a terminal illness cannot be deprived of this right. In other words, medical assistance in dying will maximize the time the person has left to live. That is the objective of Bill C-14, which amends the Criminal Code of Canada in order to allow medical assistance in dying.

In its wisdom and with a unanimous decision, the Supreme Court of Canada is showing us the way so that we can amend section 14 and paragraph 241(b) of the Criminal Code, which currently violate the right to life, liberty and security of the person guaranteed by section 7 of our charter.

The principles in Carter that must guide us in developing Bill C-14 are found in paragraph 127 of the decision, a paragraph that I invite my colleagues to read carefully because it will require our attention when we debate this matter.

The Supreme Court of Canada stated:

[These sections] are void insofar as they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life; and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

Also in paragraph 127, the Supreme Court of Canada stated:

The scope of this declaration is intended to respond to the factual circumstances in this case. We make no pronouncement on other situations where physician-assisted dying may be sought.

I will support this bill at second reading, but I must confess that I hope the committee can re-examine the bill and try to fine-tune it, because I have some concerns.

For example, this bill may suggest a rather restrictive approach with respect to Carter, especially since the bill contains words that are not in this decision. For example, subsection 241.2(2) states: “A person...[has] a serious and incurable illness, disease or disability”. The word “incurable” never appears in the Carter decision, and that may seem a bit too restrictive.

The bill also refers to an “advanced state of irreversible decline in capability”. The words “advanced” and “decline” do not appear in the Carter decision and could be interpreted as rather restrictive language.

Another one of my concerns has to do with the fact that, right now, this bill seems to disregard any advance requests for medical assistance in dying. Since the Carter decision suggests that there may be other requests in other exceptional circumstances, I believe that it is quite likely that people with a grievous and irremediable medical condition may also experience a deterioration of their cognitive and intellectual faculties.

I think that perhaps the committee should re-examine the possibility of an advance request so that someone with Alzheimer's or brain cancer, for example, is not prevented from giving informed consent to medical assistance in dying the second time because of the deterioration of his or her mental and cognitive abilities.

On page 6 of the bill, in paragraph 241.2(3)(h), it reads:

immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request and ensure that the person gives express consent to receive medical assistance in dying.

It seems that this paragraph is rather strict, given that people who are terminally ill could lose consciousness or that their intellectual faculties could be impaired because they are being heavily medicated. They therefore might not be able to consent to the medical assistance in dying the second time.

Those are some of my thoughts on the bill. I hope that the committee responsible for studying it will reflect on these comments.

Criminal CodeGovernment Orders

8:10 p.m.

Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

Mr. Speaker, it is once again my turn to commend my colleague from New Brunswick, whom I respect and hold in high esteem. In committee, we worked together a great deal and did so positively and constructively. I got to know him, and I believe the feeling is mutual.

Earlier, our colleague mentioned that there are words in the bill, such as “incurable" and “advanced state of decline”, that were not in the Carter decision. There are also words such as “minors” and “reasonably foreseeable” that were not in the Carter decision. Why am I raising the subject of “minors”? Because that was touched on in the majority report. As for “reasonably foreseeable”, that is not clear enough to us.

I would like to hear my colleague's thoughts on the debate that has been going on across Canada for a few weeks now about how to define “reasonably foreseeable”.

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8:10 p.m.

Liberal

René Arseneault Liberal Madawaska—Restigouche, NB

Mr. Speaker, my colleague from Louis-Saint-Laurent's question is an excellent one.

The words “reasonably foreseeable” can cause some confusion from a legal point of view. What is reasonably foreseeable? There are many ways to interpret those words. It is true that those words do not appear in the Carter decision and that removing them from the bill would be a good thing.

My colleague often referred to the Quebec version of the law, which is about the moment when a person is at the end of his or her life. The words “end of life”, however, can also cause confusion from a strictly legal point of view. When does end of life begin? Is it 24 hours before a person dies, a week before death, a month before death, or is it the moment when a doctor confirms that no treatment can save that person's life?

The committee needs to take a close look at those words to ensure there is no ambiguity that could open the door to a legal challenge.

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8:10 p.m.

NDP

Rachel Blaney NDP North Island—Powell River, BC

Mr. Speaker, in the backgrounder, the government refers to having equal access. I am curious as to why the provisions to protect the personal convictions of health care practitioners are not included directly in the text of this bill.

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8:10 p.m.

Liberal

René Arseneault Liberal Madawaska—Restigouche, NB

Mr. Speaker, I am not sure I understood my colleague's question correctly.

The independence of doctors is not included anywhere in the bill. Doctors can in fact be independent, because two doctors are needed to approve the consent when a competent adult is seeking medical assistance in dying. This is actually referring to two doctors who are independent in relation to the person seeking medical assistance in dying. If I understood the question correctly, that is what I think.

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8:15 p.m.

Winnipeg North Manitoba

Liberal

Kevin Lamoureux LiberalParliamentary Secretary to the Leader of the Government in the House of Commons

Mr. Speaker, I appreciate the fine comments made by my colleague.

I have raised the issue of palliative care a great deal today. As we go through the debate on this legislation, a lot of members have been talking about the importance of palliative care. Could the member provide some thoughts from his constituency on the whole issue of palliative care? This has been thoroughly discussed as we have debated this bill. Does the member have any thoughts he would like to share with regard to this issue?

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8:15 p.m.

Liberal

René Arseneault Liberal Madawaska—Restigouche, NB

Mr. Speaker, I thank my colleague for his excellent question.

He definitely must have read the report produced by the Special Joint Committee on Physician-Assisted Dying, which recommends taking a long, hard look at palliative care and developing a policy on the issue.

Because of the Carter decision, time is of the essence. To respond to the Carter case meant responding to medical assistance in dying based on the charter and the Criminal Code, which prohibited medical assistance in dying. Palliative care was not the crux of the debate in Carter, although everyone seems to agree that we need to think carefully about this service and provide it for Canadians.

Criminal CodeGovernment Orders

May 2nd, 2016 / 8:15 p.m.

Liberal

Nathaniel Erskine-Smith Liberal Beaches—East York, ON

Mr. Speaker, “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice”, so says section 7 of the Canadian Charter of Rights and Freedoms.

In February of last year, the Supreme Court applied those words to strike down the criminal prohibition against assisted dying.

As a matter of policy, this was a welcome decision. Blanket bans are an ill-advised form of regulating conduct that is not inherently wrongful. The criminal law is a blunt instrument, often imposing costs beyond the benefits it seeks to achieve and it should be resorted to sparingly.

An optimal policy involves nuance legislation that protects those at risk without preventing others from making their own choices and directing their own lives as they see fit.

In response to the Supreme Court's decision in Carter, the government has drafted Bill C-14. The government states correctly that it is no longer a question of whether to legalize assisted dying but how we should do so. In other words, relitigating Carter is a futile exercise when the Supreme Court has already spoken, unanimously no less.

Still, it remains useful to understand how we got to where we are. If we are to adequately address the court's concerns, we should have a complete understanding of those concerns. Having studied section 7 of the charter in depth, I would like to first briefly explain what the Supreme Court requires of us on this issue.

Section 7 of the charter provides the right to life, liberty, and security of the person qualified by the principles of fundamental justice. A violation of life, liberty, and security of the person is only unconstitutional if there is also an infringement of a principle of fundamental justice.

The court has stated that those principles are to be found in the basic tenets and principles of the legal system. The key principle to understand on this issue is over-breadth, or what we refer to as “minimal impairment” under the classic Oakes test under section 1. If a law infringes life, liberty, and security of the person, over-breadth requires the law to be reasonably necessary to achieve an important government objective.

In Carter, the court first determined that the blanket criminal prohibition against assisted dying engages life, liberty, and security of the person. In the court's words:

Liberty protects “the right to make fundamental personal choices free from state interference”.... Security of the person encompasses “a notion of personal autonomy involving control ...over one's bodily integrity...”...

Second, the court determined that the blanket prohibition was over broad. The purpose of the legislation, as defined by former Justice Sopinka in the earlier Rodriguez decision, was “...the protection of the vulnerable who might be induced in moments of weakness to commit suicide ...”. In the court's view, the absolute prohibition on assisted dying went too far. While protecting vulnerable people is the law's object, it caught people outside of this class: those who are competent, fully informed, free from coercion or duress, yet choosing to end their lives.

We are now faced with new legislation, Bill C-14.

Our first job is to assess whether this legislation meets the criteria set by the Supreme Court. To answer this, we must first assess the government's objective, now a dual objective: one, to provide a means by which those subject to grievous and irremediable suffering can die with dignity; and, two, to protect those who wish to continue to live from coercion or undue influence.

Is this legislation reasonably necessary to effect these twin purposes? The answer is, unfortunately, not a resounding yes. It is a resounding almost.

I have real concerns, for example, that limiting access to those for whom death is “reasonably foreseeable”, however one seeks to define that term, would have precluded one of the applicants in the very Carter decision from accessing the new regime.

There is no evidence presented by the government that limiting access to terminal illness is necessary to protect the vulnerable, provided other safeguards are put in place, and it is an open question whether this provision is constitutional.

As one constituent aptly put it, “What Bill C-14 says is: I can express a desire to die when I'm terminally ill, but if I'm not considered competent, it won't count; I can express a desire to die when I'm competent, but if I'm not considered terminally ill, it won't count.” This should be remedied before we pass this legislation.

The remainder of the law may well fall within a range of reasonable options and therefore be charter-compliant. but that cannot possibly be what we aspire to in the House. We may have been tasked by the court to address the constitutionality of the current laws, but we are tasked by Canadians to go beyond that. The law we put forward should not simply fall within a range of reasonable options. It should be the best possible law we are capable of drafting.

I have met with many constituents over the last number of weeks and months to discuss this issue. In early April, for example, we hosted a town hall on the topic. It is, rightly, a sensitive topic for many.

My constituents' views and opinions have informed the following thoughts, all of which revolve around the importance of choice.

First, my constituents overwhelming favour advance directives. I appreciate that this is a complex area. It is one thing to assess an advance directive regarding a permanent coma and another thing to assess an advance directive regarding differing degrees of dementia. However, simply because a matter is complex or difficult does not mean we should not attempt to address it. I believe we need to look at advance directives more seriously and that many of the worries regarding stale decision making can be resolved by sunset clause provisions.

As former Chief Justice Lamer said in Rodriguez, the legal system should not deny consent but should seek to ensure that such consent “is as independent and informed as is reasonably possible”. With appropriate safeguards in place, witness requirements, competency assessments, informed consent through advance directives should be respected.

Second, my constituents overwhelmingly favour placing assisted dying within the context of end-of-life health care overall. Under our charter, access to assisted dying cannot depend upon the availability of palliative care, but, as a matter of policy, for there to be a real choice, we should invest significantly in palliative care options. The $3 billion promise for home care investments is a good start, but it is only a start.

Third, choice depends upon competency and capacity. A competent adult should not be defined by age, but by capacity to understand and to choose.

Fourth, a small but vocal group of constituents have asked for choice for doctors, the right to conscientiously object. It is important for the government to acknowledge the deeply held beliefs of some doctors and we must do our best to reconcile those beliefs with the importance of providing access to assisted dying across our country. It is reasonable to respect doctors' choices, at the outset a cautious approach, providing patients with a public list of participating health professionals across the country.

Fifth, and finally, a similarly cautious approach regarding mental health is also warranted. The foundation of the court's decision was autonomy and dignity, and mental illness, including depression, can impinge upon fully informed and free choice. The law does not require anyone to choose life or death, but allows Canadians to make that deeply personal choice for themselves. For some, the right to life precludes assisted dying, but for others, including former Justice Cory, the right to life includes the right to death.

I will support this legislation at second reading and I hope it will be improved at committee.

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8:20 p.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Mr. Speaker, I fully agree with what the member opposite said about the need for palliative care as an option. Therefore, could he comment on why it is not part of Bill C-14 and why the word does not even appear in budget 2016?

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8:25 p.m.

Liberal

Nathaniel Erskine-Smith Liberal Beaches—East York, ON

Mr. Speaker, I was also perplexed that we did not see palliative care options in budget 2016. We have made a commitment to spend $3 billion on home care, as I understand it, although I am not spending the money personally or individually, so I cannot make that choice on my own.

However, I do know that we are committed to working with the provinces, first and foremost, to establish a new health framework. I am convinced by this government that we are committed to investing in home care through that framework.

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8:25 p.m.

Conservative

David Tilson Conservative Dufferin—Caledon, ON

Mr. Speaker, the member gave an excellent presentation. In fact, I have listened to all the speeches that have been given so far and they are all excellent. Some are for the legislation and some are against. Almost all members speaking for or against the legislation have said that they have some serious concerns about the legislation. The problem is that the Supreme Court of Canada has already extended the time once and the next date is June 6.

The fact is that we are all admitting that there are serious concerns with this bill. It has been studied by a committee of members of Parliament, a committee of the Senate, and the justice committee is reviewing it now as we speak. Should we be rushing through with this? This is a very serious issue. We all agree that this bill is not perfect and we can do better. Therefore, the question is whether we should be asking for yet another extension so members of Parliament and the Senate can spend more time on this subject.

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8:25 p.m.

Liberal

The Speaker Liberal Geoff Regan

Before I turn to the hon. member for Beaches—East York for his reply, I want to take this opportunity, since the hon. member for Dufferin—Caledon has made mention of the excellent speeches we have heard this evening on this topic from both sides, and I appreciate his comments in that regard, to say that I appreciate the tone of this debate and the desire of all members to take part in it in a very serious and respectful way.

The hon. member for Beaches—East York.